Header image  
   
line decor
 

  

    HOME   ::   ACTIVITIES   ::   MEDICAL ELIGIBILITY   ::   CLAIMS    ::   MTP   ::   MATERIALS   ::   TOOLS   ::   LINKS   ::  CONTACT US  ::
line decor
   
 

 

Breaking News

 

CCS PILOT PROJECT: State Approves Five CCS Pilot Projects

On October 12, 2011 the State issued the list of approved CCS pilot projects.  The five awardees are:
  • Alameda County Health Care Services Agency: Enhanced Primary Care Case Management Model
  • Rady Children's Hospital, San Diego: Accountable Care Organization
  • Children's Hospital of Orange County: Accountable Care Organization
  • Los Angeles Care Health Plan (aka LA Care): Specialty Health Plan
  • Health Plan of San Mateo: Medi-Cal Managed Care Plan
Visit here for more information.  We will post details on the pilot implementation timeline, evaluation, and other components when we have them.

 

PROVIDER RATE CUTS: Federal Government Approves CA Medi-Cal Provider Rate Reductions

On October 27, 2011, California received approval from the federal Centers for Medicare and Medicaid Services (CMS) to implement some, but not all, of its requested 10% Medi-Cal provider rate reductions.  Rate reductions were approved for most adult services, but rates for some critically important pediatric services were protected from the reductions.  At the same time, it is important to note that some services used by children are subject to the requested rate cuts.

Below is a summary of pediatric services and the decision on the requested rate reduction:

  •  Physicians serving children (including CCS):                    No rate reduction
  • Clinics serving children (including CCS):                           No rate reduction
  • Home health services:                                                    No rate reduction
  • Pediatric sub-acute facilities:                                           No rate reduction (but could be reduction in future)
  • Dental services:                                                            10% rate reduction as of 6/1/11
  • DME:                                                                           10% rate reduction as of 6/1/11
  • Clinical lab services:                                                       10% rate reduction as of 6/1/11
  • Pharmacy services:                                                        10% rate reduction as of 6/1/11
See the Department of Health Care Services website at www.dhcs.ca.gov for all the details, including the federal approval letters and the analysis the state prepared on each proposed reduction.  See the Department's rate reduction chart and the Frequently Asked Questions document here for more information.
 
NOTE:  We still do not have a decision from the federal government regarding California's request to implement Medi-Cal co-pays and to increase Healthy Families premiums and co-pays.  We will post this information as soon as we have it.

 

FINAL CALIFORNIA STATE BUDGET FOR FISCAL YEAR 2011-2012

For the first time in years California has a balanced budget on time:  Governor Brown signed the new state budget on June 30, 2011 just in time for the start of the state’s new fiscal year on July 1, 2011.  This final budget closes the last of the deficit remaining from the state’s original $26 billion deficit inherited from the Schwarzenegger Administration.  An additional $6.6 billion in additional tax revenue collected by May this year helped to reduce the remaining deficit, but not enough to remove the need for further cuts.  The final budget does not include the extension of taxes that the Governor sought, doesn't solve the state’s structural deficit problem, and makes deep cuts to health, human services, and education.  If the Administration’s revenue projections aren’t met, we also could see more rounds of painful cuts during the current fiscal year. See here for a brief summary of the final budget, including the cuts made to children’s health and developmental services. 

New state appointments include:

  • Diana Dooley as secretary of the  Health and Human Services Agency
  • David Maxwell-Jolly (former director of the Department of Health Care Services) as Undersecretary
  • Toby Douglas (former deputy director of DHCS) as DHCS director.

New Requirements for IHSS Recipients

As of June 1, 2011 all new applicants for In-Home Supportive Services (IHSS) and all current recipients of IHSS services must obtain certification from their physician or other licensed health care professional that these services are required in order to prevent out-of-home placement or institutionalization.  This requirement applies to children and youth as well as to adults.  See here for materials for families and health care providers that explain the new requirement and include a template to assist providers in writing the letter of certification.

Mandatory Enrollment of Seniors and Persons with Disabilities

As of June 1, 2011, many adults and children with disabilities who have fee-for-service Medi-Cal are required to join a Medi-Cal managed care plan if they live in one of 16 counties:  Alameda, Contra Costa, Fresno, Kern, Kings, Los Angeles, Madera, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, Santa Clara, Stanislaus, and Tulare.

Not everyone on Medi-Cal in these counties is affected:  Children do not have to enroll in a managed care plan if they:

  • receive services from the California Children’s Services (CCS) program*;
  • receive foster care or adoption assistance benefits;
  • are enrolled in a private health care plan (e.g. Kaiser);
  • are in a long-term care facility such as a nursing home or intermediate care facility;
  • have Medicare as well as Medi-Cal (e.g. has End-Stage Renal Disease); or
  • have a share-of-cost for Medi-Cal (i.e. must spend a certain amount of money on health care each month before Medi-Cal can be used).

Please click here for more details.

 

NATIONAL HEALTH CARE REFORM

On March 23, 2010 President Obama signed historic national health care reform legislation (HR 3590, the patient Protection and Affordable Care Act) that may have a profound effect on health care delivery in California.

In short, the health reform package will:

  • require most U.S. citizens and legal residents to have health insurance;
  • create state-based American Health Benefit Exchanges through which individuals can purchase coverage, with premium and cost-sharing credits available to individuals and families with income between 133-400% of the Federal Poverty Level (the 2009 FPL is $18,310 for a family of three);
  • create separate Exchanges through which small businesses can purchase coverage;
  • require employers to pay penalties for employees who receive tax credits for health insurance through an Exchange, with exceptions for small employers;
  • impose new regulations on health plans in the Exchanges and in the individual and small group markets; and
  • expand Medicaid income eligibility to 133% of the FPL.

Click here for a detailed summary on national health care reform. If you would like more information, please visit Center for Children and Families, Georgetown University Health Policy Institute and Kaiser Family Foundation.

  • Child-Focused Provisions Implemented in September, 2010: On March 23, 2010 President Obama signed historic national health care reform legislation (HR 3590, the Patient Protection and Affordable Care Act) that will have a profound effect on health care delivery in California.  Most provisions in the reform package will take effect in 2014, but some very important provisions for children and youth are required to begin implementation within six months of the date of enactment, in September, 2010. See the summary here of these child-friendly provisions.

 

FAMILY HEALTH OUTCOMES PROJECT: TITLE V REPORT

The Family Health Outcomes Project (FHOP) has submitted the final Title V CSHCN Assessment report to the state. The report is available on the state CCS website. You can also download the report directly here.

 

CCS REDESIGN AND FEDERAL WAIVER RENEWAL PLANNING

Reports and CRISS Comments on the CCS Program

  • Health Management Associates (HMA) report on CCS, “Considerations for Redesign of the California Children’s Services (CCS) Program”, September, 2009, available here.  CRISS comments on the first draft of the HMA report are available here.
  • State concept paper for the new 1115 waiver in October, 2009, A Bridge to Reform”, available here.   CRISS submitted comments on the draft version of the concept paper, available here.
  • State CCS Technical Workgroup

The state created a CCS Technical Workgroup under its Federal 1115 Waiver planning process.  CRISS project director Laurie Soman was named to the group as the official representative of CRISS, and several other CRISS members also served on the group representing other organizations and county CCS programs.  The CCS Workgroup met four times from February to April. All materials for the Workgroup are posted on a special tab on the state federal waiver site at the DHCS website. Links to the minutes of the CCS Technical Workgroups meetings are below:

 

SENATE BUDGET COMMITTEE HEARING ON CCS EFFICIENCIES AND PROGRAM IMPROVEMENTS

CRISS submitted a letter to the Senate Budget Subcommittee #3 for its hearing on May 13, 2010 concerning potential CCS efficiencies. The letter is available for download here.

Future CRISS comments and news will be posted here.