CDCAN: US 9th CIRCUIT COURT OF APPEALS SIDES WITH STATE ON 10% MEDI-CAL PROVIDER CUTS

laaac — Fri, 24 May 2013 19:05:35 +0000

BREAKING NEWS:

US 9^TH CIRCUIT COURT OF APPEALS SIDES WITH BROWN ADMINISTRATION ON 2011 MEDI-CAL PROVIDER 10% RATE CUT

· In Other Budget News: Assembly Budget Subcommittee #1 on Health and Human Services Will Now Meet At 12 Noon – Met Briefly But Decided to Delay Hearing At Request of A Subcommittee Member – Senate Budget and Fiscal Review Committee Will Meet Shortly

SACRAMENTO, CA (CDCAN) [Last updated 05/24/2013 11:01 AM] – The full US 9^th Circuit Court of Appeals issued an order this morning that sides with the State’s 10% rate reduction for nearly all Medi-Cal providers that was enacted in 2011 (AB 97) but blocked since then by a federal district court order.

The full appeals court denied a petition for a rehearing on a ruling issued last December by a 3 judge panel of the appeals court that reversed that lower federal district court order that blocked the State from implementing the 10% reduction.

The Brown Administration, as part of the 2013-2014 State Budget, intends to implement the 10% reduction retroactive to June 1, 2011.

A copy of the 42 page order denying the rehearing by the US 9^th Circuit Court of Appeals and a new order replacing the previous December 2012 ruling that sided with the Brown Administration’s position on the Medi-Cal provider cuts is attached to this CDCAN Report.

· “20130524 – US 9thj Circuit Court of Appeals Denial of Rehearing on Medi-Cal Provider 10% Reduction (42 Pages). This is a pdf document file that can be read by people who are blind or sight impaired using a screen reading device.
· “20130524 – US 9^th Circuit Court of Appeal Order on Medi-Cal Provider 10% Cut (3 Pages).pdf” This is a pdf image file – the only copy currently available – that cannot be read by people who are blind or sight impaired using a screen reading device. CDCAN will obtain a readable version and send out later today.

CDCAN will issue more details in a CDCAN Report later today.

The attorney representing a group of Medi-Cal pharmacy providers and Medi-Cal recipients said they would consider filing another appeal to the US 9^th Circuit Court of Appeals or file an appeal to the US Supreme Court.

Lynn S. Carman, counsel for Medicaid Defense Fund which brought the lead lawsuit on behalf of a group of pharmacies (Managed Pharmacy Care), and Medi-Cal recipients , said that that the new decision “…will destroy both the Medicaid program both for existing beneficiaries and for millions of working poor who are being forced into the Medicaid program in California by Obamacare and Governor Brown in 2014”.

Carman said that Medicaid Defense Fund will go back to the US 9^th Circuit Court of Appeals or file an appeal with the Supreme Court, to set aside this newest 9th Circuit decision.

ASSEMBLY BUDGET SUBCOMMITTEE WILL MEET AT 12 NOON – SENATE BUDGET COMMITTEE WILL MEET VERY SHORTLY

Meanwhile in other budget news, the Assembly Budget Subcommittee #1 on Health and Human Services will now meet at 12 noon. The panel met briefly but decided to delay hearing at request of a subcommittee member.

The Senate Budget and Fiscal Review Committee will meet shortly.

Read articles like this here: www.cdcan.us

TAC: People with Disabilities Priced Out of Nation’s Housing Market

laaac — Fri, 24 May 2013 18:55:02 +0000

TAC Releases Priced Out 2012

Wednesday, May 22, 2013

The Technical Assistance Collaborative (TAC) and the Consortium for Citizens with Disabilities (CCD) Housing Task Force have released a study, Priced Out in 2012, which demonstrates that the national average rent for a modestly priced one-bedroom apartment is greater than the entire Supplemental Security Income (SSI) of a person with a disability. The study sheds light on the serious problems experienced by our nation’s most vulnerable citizens – extremely low-income people with significant and long-term disabilities.

Priced Out in 2012 compares the monthly SSI payments received by more than 4.8 million non-elderly Americans with disabilities to the Fair Market Rents for modest efficiency and one-bedroom apartments in housing markets across the country. The Fair Market Rent for rental housing is determined by the U.S. Department of Housing and Urban Development (HUD). According to HUD, rent is affordable when it is no more than 30 percent of income. SSI is a federal program that provides income to people with significant and long-term disabilities who are unable to work and have no other source of income and virtually no assets. Priced Out in 2012 reveals that as a national average, people with disabilities receiving SSI needed to pay 104 percent of their income to rent a one-bedroom unit priced at the Fair Market Rent.

Access articles here: http://bit.ly/12BUMtB

California Healthline: Exchange Rates Make ‘Great Day For California’

laaac — Fri, 24 May 2013 18:51:09 +0000

by David Gorn

Covered California, the state’s health benefit exchange, yesterday announced a rate structure for its health insurance plans that came in at a much more affordable price than first projected.

That was great news for exchange officials and it accounted for much of the pomp around that rare circumstance during yesterday’s announcement.

“This is really a great day for California,” said Diana Dooley, secretary of the state’s Health and Human Services agency and chair of the Covered California board. “We have come a long way and we have a long way to go,” she said. “We are moving to make Californians healthier and give them the financial security they need.”

At the same time, the exchange also needed to announce that premiums would increase for many people who don’t qualify for federal subsidies. In the case of Blue Shield of California, the average base rate will increase 8% and the overall rate increase will total 13%, according to Blue Shield’s president and COO, Paul Markovich.

“People are going to have a change in rates,” Markovich said. “On average, our members will experience an 8% increase. That’s an 8% core cost. Including fees and taxes and higher benefits, that becomes 13%. That’s a Blue Shield-specific number.”

That left exchange officials in a somewhat awkward spot, needing to announce that premiums would rise but as much as expected.

“We looked a lot at the rates. And all the predictions have been that rates are going to skyrocket,” said Peter Lee, executive director of Covered California. Rates are going up at a far lower rate than the Milliman study predicted they would, Lee said, referring to a study commissioned by the exchange board, in part, to estimate premium cost.

LA Times: California picks 13 health plans for state-run insurance market

laaac — Fri, 24 May 2013 18:47:51 +0000

By Chad TerhuneMay 23, 2013, 9:36 a.m.

After weeks of negotiations, California said it has selected 13 health plans for a new state-run insurance marketplace where as many as 5 million people will shop for coverage next year.

Officials at Covered California, the state agency implementing the federal Affordable Care Act, said Thursday that the winning bidders reflected a mix of large commercial insurers and smaller regional plans.

The state also released some sample rates, illustrating how premiums will vary across health plans in this new market.

In a southern Los Angeles County region, for instance, rates for a 40-year-old person purchasing a “Silver” plan ranged from $242 a month for Health Net Inc. to $325 per month for Kaiser Permanente. Blue Shield would charge $287 a month.

Each company must now file detailed rate filings with state regulators, and these proposed premiums are still subject to that review in the coming weeks.

Overall, Covered California said the rates submitted for next year’s individual market ranged from 2% higher to 29% below the average premium now for small-employer plans in the state’s biggest metro areas.

The agency said the winning health plans whittled their profit margins down to 2% to 3% and negotiated lower reimbursements for hospitals and doctors to help hold down premiums.

Continue reading here: http://lat.ms/10VShkm

NY Times: California Puts Tentative Price on Health Policies Under New Law

laaac — Fri, 24 May 2013 16:18:47 +0000

By REED ABELSON

Published: May 23, 2013

California, widely seen as a model for how individuals will buy health insurance under the new health care law, announced Thursday that 13 insurers had been chosen to sell policies through the insurance marketplace — or exchange — being created under the law.

Rich Pedroncelli/Associated Press

Peter V. Lee, executive director of Covered California, the state agency running the exchange, said it negotiated aggressively.

State officials said that rate increases for individuals who already had insurance would not be as high as some had feared. Blue Shield of California, for example, estimated its current customers would see rate increases of about 13 percent. Some estimates had suggested rate increases could be 30 percent. The increases are largely the result of higher prices and the need to cover people who now have no insurance and are likely to have expensive medical problems.

The new rates for individuals will be about the same — or lower — than the current rates for small businesses, according to officials from Covered California, the group operating the exchange.

“The changes in the market are really making individuals much more like employer groups,” Paul Markovich, the chief executive of Blue Shield, said. Like people who now receive health insurance through their employers, individuals buying policies on their own will be able to enroll next year even if they have a potentially expensive medical condition, and the policies’ benefits and premiums will be more standardized.

Continue reading here: http://nyti.ms/13QfN6B

LA Times: UnitedHealth, Aetna and Cigna opt out of California insurance exchange

laaac — Thu, 23 May 2013 21:01:11 +0000

Kaiser Permanente, Anthem Blue Cross and Blue Shield of California are all expected to participate in the state-run market for individual health coverage.

By Chad Terhune, Los Angeles Times

May 22, 2013, 5:59 p.m.

Some prominent health insurers, including industry giant UnitedHealth Group Inc., are not participating in California’s new state-run health insurance market, possibly limiting the number of choices for millions of consumers.

UnitedHealth, the nation’s largest private insurer, Aetna Inc.and Cigna Corp. are sitting out the first year of Covered California, the state’s insurance exchange and a key testing ground nationally for a massive coverage expansion under the federal healthcare law.

Meanwhile, the biggest insurers in the state — Kaiser Permanente, Anthem Blue Cross and Blue Shield of California — are all expected to participate in the state-run market for individual health coverage.

Quiz: Test your healthcare knowledge

Covered California, the state agency implementing the federal Affordable Care Act, is announcing the winning bidders and proposed rates Thursday for its insurance exchange, where as many as 5 million residents are expected to shop for coverage next year.

The state has picked a group of health plans for each of 19 regions across California. The insurers will be selling policies with uniform benefits packaged in four broad categories of coverage. For the first time in the individual market, consumers will be able to make easier price comparisons among companies.

Continue reading here: http://lat.ms/16ReLdV

LA Times: Garcetti wins race for L.A. mayor; Greuel concedes

laaac — Wed, 22 May 2013 19:04:53 +0000

By Seema Mehta and Laura J. NelsonMay 22, 2013, 3:27 a.m.

Wendy Greuel called Eric Garcetti early Wednesday morning to concede the mayoral election, a Greuel campaign source told The Times, ending a two-year campaign to determine Mayor Antonio Villaraigosa‘s successor and the new political leader of Los Angeles.

Garcetti will be the first elected Jewish mayor of the city. At 42, he will also be the youngest in more than a century. He is scheduled to take office July 1.

“Thank you, Los Angeles,” Garcetti wrote in a tweet posted at 2:52 a.m. PDT. “The hard work begins but I am honored to lead this city for the next four years. Let’s make this a great city again.”

During early returns Tuesday, Greuel led the race by a slight margin. But as the night wore on, Garcetti’s lead grew. Election tallies from the city clerk’s office posted at 1:38 a.m., with nearly 73% of precincts reporting, showed Greuel had fallen 8 points behind Garcetti.

Live video analysis: Wednesday, noon to 2 p.m.

After seeing those numbers — Greuel 46%, Garcetti 54% — she called Garcetti at 1:42 a.m. to concede the race.

“It was positive,” the source, who would only speak on the condition of anonymity, told The Times. Greuel told Garcetti, “Congratulations. You did a great job. I’ll officially concede tomorrow, but it looks like the results are in.”

Greuel is expected to officially concede the election in Van Nuys on Wednesday morning.

She had hoped that absentee ballots, which are sometimes counted later than ballots cast at polling places, could make a difference, the source said.

Continue reading here: http://lat.ms/1a7wGdg

Sac Bee: Loophole in health care law could stick doctors with tab

laaac — Wed, 22 May 2013 18:31:23 +0000

By Jim Sanders
jsanders@sacbee.com

Published: Wednesday, May. 22, 2013 – 12:00 am

Last Modified: Wednesday, May. 22, 2013 – 7:59 am

A loophole in California’s upcoming health care overhaul could be exploited by families gaming the system or responding to hardship in a way that doctors say could leave a pile of unpaid bills.

A chain of events would create a two-month period during which a family has medical coverage but no insurer must pay its claims.

Nonpayment of premiums for subsidized policies would trigger the oddity: Federal law provides a three-month grace period before cancellation – but insurers are responsible only for the first month.

Doctors say the liability might keep many physicians from participating in next year’s program. A single prostate cancer patient’s course of treatment can cost $93,000, they say.

“I do think there’s legitimacy to their concerns,” said Diana Dooley, head of the state Health and Human Services Agency and a trustee of Covered California, which is implementing the state’s health care overhaul.

Capital Public Radio: Legislative Dems Want to Restore Budget Cuts, but Priorities Differ

laaac — Wed, 22 May 2013 18:15:33 +0000

By Ben Adler

CPR photo/Ben Adler

As budget talks head into their final weeks, supporters of programs suffering from years of cuts are asking for help. Gov. Jerry Brown opposes any new spending. But Assembly and Senate Democrats have different programs in which they’d like to invest.

(Sacramento, CA)
Tuesday, May 21, 2013

The steps of the State Capitol have hosted rally after rally in recent weeks, including one Tuesday that drew a high school marching band and flag squad. Each group wants to draw attention to a program that’s taken deep budget cuts in recent years: child care, health care, and in this case, after school programs.

Many Democrats have been hoping state revenues would improve enough to restore at least some of those cuts, such as Sen. Mark Leno (D-San Francisco), who spoke at the rally for after school programs. “To the degree that we have a little bit of additional money – yes, we want to pay down debt and yes, we want to put some money away, appropriately, for a Rainy Day, but then we need to reinvest where we can,” Leno said.

But Democrats in the Senate and Assembly have different priorities. The Senate hopes to increase money for mental health programs, adult dental coverage and career technical education. The Assembly is focused on child care programs, courts and child poverty grant increases for the state’s welfare-to-work program.

Continue Reading here: http://bit.ly/10mOsoA

National Skills Coalition: Appropriations Dems release sequester report

laaac — Wed, 22 May 2013 17:59:30 +0000

May 20, 2013

Democratic Members of the House Appropriations Committee, led by Ranking Member Nita Lowey (D-NY) recently released a report detailing the impact sequestration is having on public safety, health, education, national security, judiciary and legal representation, housing, commerce, seniors, and foreign assistance.

While the committee Democrats did not specify what sequestration will mean for workforce development programs, their report does make important points about how sequestration – no matter how Congress and federal agencies attempt to mitigate the impact – will result in long-term disinvestments that will impact the core functions of government.

The report notes that mitigating actions Congress might take, such as making changes in law, will draw funding away from other important purposes. For instance, the recently-enacted legislation to end Federal Aviation Administration (FAA) furloughs will be financed by funds previously set aside to improve the infrastructure of our nation’s airports, an important long-term goal. The report also warns that agency attempts to reprogram funds and prevent furloughs by eliminating employee training and other operating expenses, while seemingly helpful in the near term, will ultimately have a long-term negative impact on government functionality.

National Skills Coalition has repeatedly called on Congress to unwind the damaging sequesters, and instead adopt a balanced approach to deficit reduction that does not include further funding cuts to non-defense discretionary programs, which have already contributed $1.5 trillion to deficit reduction since 2011.

The section on seniors may be found on page 22-23

Continue reading here: http://bit.ly/12WlYnA