THIS WILL BEGIN TODAY'S SUB.
COMMITTEE NUMBER ONE. HEARING
IT'S OUR SECOND HEARING OF THE
YEAR. WE'RE GOING TO START WITH
ISSUE ONE AND LOOK FORWARD TO
TODAY
.
SURE.
YEAH SO GOOD AFTERNOON JENNIFER
CAN'T WITH THE DEPARTMENT OF
HEALTH CARE SERVICES.
.
I WILL CERTAINLY.
DEFER TO MY COLLEAGUES THAT
FINANCE THE FI.
MISS SOMETHING OR FEEL FREE TO
ASK QUESTIONS.
I WOULD LIKE TO FIRST START OUT
BY SAYING I'M GOVRNOR'S BUDGET
AS IT WAS RELEASED IN JANUARY.
IS ESTIMATING THAT WILL BE
SEEKING APPROXIMATELY A HUNDRED
AND FOUR AND A HALF BILLION
DOLLARS FOR THE NEXT FISCAL
YEAR.
THERE'S A CHANGE OF
APPROXIMATELY FOUR HUNDRED AND
FIFTY MILLION DOLLARS FROM THE
CURRENT FISCAL YEAR TO THE END.
ON THERE'S A LOT OF.
.
DIFFERENT REASONS FOR WHY
THERE'S SOME COSTS THAT HAVE
COME AND HIGHER THERE SOME
REBATES THAT HAVE BEEN ACCOUNTED
FOR AND SO WE'RE HAPPY TO. TALK
THROUGH THAT BUT I THINK I'M
OVERALL I'M SIPPING THROUGH THE
ESTIMATE AND THE OVERALL BUDGET
I'M WHEN YOU BREAK IT BETWEEN
STATE OPERATIONS AND LOCAL
ASSISTANCE WERE SPEAKING ABOUT
SIX HUNDRED EIGHTY FIVE MILLION
DOLLARS FOR STATE OPERATIONS AND
ABOUT A HUNDRED AND THREE. POINT
NINE BILLION AND LOCAL
ASSISTANCE.
FOR.
WHEN YOU BREAK THAT DOWN
BETWEEN GENERAL FUND FEDERAL
FUNDS AND SPECIAL FUNDS IT'S
ABOUT TWENTY ONE POINT NINE
BILLION. IN GENERAL FUND SIXTY
SEVEN POINT NINE AND FEDERAL
FUNDS AND FOURTEEN POINT EIGHT
ISN'T SPECIAL FUNDS SPECIAL
FUNDS CAN BE. PROVIDER TAXES
THEY CAN BE.
LOCAL FUNDS FROM COUNTIES
PUBLIC CONSTABLES OTHER TYPES OF
FUNDING SOURCES.
IN ADDITION OUR BUDGET IS ALSO
SEEKING.
TO ESTABLISH FORTY ONE NEW
POSITIONS INCLUDING CONVERTING
EIGHTEEN POSITIONS FROM LIMITED
TERM AND TO PERMANENT.
SOME OF THE MAIN.
POLICY CHANGES IN OUR
ESTIMATION.
AND I WILL DISCOVER THESE
REALLY QUICKLY BECAUSE I THINK
IN SOME CASES THE HEARING WILL
EITHER TALK ABOUT THEM TODAY IN
MORE DETAIL OR WE WILL BE
SPEAKING AT THEM AND A
SUBSEQUENT HEARING.
WE'RE.
LOOKING FOR APPROVAL FROM THE
LEGISLATURE FOR A HOME HEALTH
RATE INCREASE USING PROPOSITION
FIFTY SIX FUNDING.
THIS WOULD BE SIXTY FOUR AND A
HALF MILLION DOLLARS IN TOTAL
FUNDS THIRTY ONE POINT SIX
MILLION AND PROP FIFTY SIX.
THE THING TO NOTE ON THIS.
HOME HEALTH INCREASE AS IT IS
ONLY FOR THE FEE FOR SERVICE AND
THE WAIVER POPULATION SO WE'RE
NOT SEEKING A HOME HEALTH RATE
INCREASE IN MANAGED CARE SO. WE
ONLY IDENTIFIED TWO POTENTIAL
BOTH PROVIDERS AND DELIVERY
SYSTEMS TO GET THAT RATE
INCREASE.
OVERALL.
WHEN WE TALK ABOUT PROPOSITION
FIFTY SIX THERE'S AN ADDITIONAL
TWO HUNDRED AND THIRTY TWO
MILLION DOLLARS IN FUNDING THAT
HAS BEEN.
PROPOSED IT MAINTAINS THE
SUPPLEMENTAL AND PAYMENTS THAT
WERE NEGOTIATED BETWEEN THE.
ADMINISTRATION IN THE
LEGISLATURE LAST YEAR AND THEN
THE ADDITIONAL.
FUNDING WOULD BE BROKEN BETWEEN
THE PHYSICIAN AND DENTAL
PROVIDER GROUPS AND THEN WHAT I
JUST SPOKE TO.
AS WELL AS TO THAT ADDITIONAL
FUNDING FOR THE HOME HEALTH RATE
INCREASE.
THERE IS AN ADDITIONAL HUNDRED
AND SIXTY NINE POINT FOUR
MILLION TO SUPPORT NEW GROWTH
AND MEDI CAL.
EXPENDITURES OVER AND THE
PREVIOUS BUDGET ACT AND SO ALL
TOLD AND.
THE.
TOTAL FUNDS WHEN YOU.
COUNT THE FEDERAL FUNDS THAT ARE
MATCH ITS ABOUT TWO BILLION
DOLLARS USING THE PROPOSITION
FIFTY SIX OF THE NON FEDERAL
SHARE.
ANOTHER SIGNIFICANT NOTE IS AN
MEDI CAL COUNTY ADMIN.
WE HAVE BEEN WORKING CLOSELY
WITH THE COUNTY'S OVER THE PAST.
SEVERAL YEARS TO I'M TRYING TO
FIND OUT TRY TO FIND OUT TRY TO
FIGURE OUT HOW BEST TO PAY FOR
THE ADMINISTRATIVE ACTIVITIES
THE COUNTY'S CONDUCT ON OUR.
PART FOR PURPOSES OF
ELIGIBILITY DETERMINATIONS I'M
WE ARE SEEKING TO INCREASE THIS
ALLOCATION UP TO TWO BILLION
DOLLARS.
WHAT WE DID WAS WE HAD A BASE
ALLOCATION OF ABOUT ONE POINT
THREE BILLION DOLLARS AND THEN
WHEN THE AFFORDABLE CARE ACT HAD
COME IN?
IN TWENTY THIRTEEN TWENTY
FOURTEEN WE KNEW THAT THE
COUNTIES WERE GONNA HAVE AN
INCREASED CASELOAD ESPECIALLY
BECAUSE.
AS WILL SPEAK TO CASELOAD IN
JUST A MINUTE THE NUMBER OF
PEOPLE THAT WEREN'T.
NOW ELIGIBLE TO SEE COVERAGE
WAS CERTAINLY GOING TO BE A
WORKLOAD IMPACT AND SO THERE HAD
BEEN ABOUT SIX HUNDRED AND FIFTY
FIVE MILLION DOLLARS
APPROPRIATED TO THE COUNTIES TO
HELP.
ADDRESS THAT ADDITIONAL
WORKLOAD FOR ON THIS BUDGET
WE'RE I'M PROPOSING TO
BASICALLY.
MAKE THAT INTO ONE BASS
ADJUSTMENTS THAT WE WOULD BE
TAKING THAT SUPPLEMENTAL PAYMENT
WE WOULD BE PUTTING AN END TO
THEIR BASE PAYMENT. AND THEN
WE'RE PROPOSING THAT.
COST OF DOING BUSINESS
ADJUSTMENT WHICH IS ABOUT FIFTY
FOUR POINT EIGHT MILLION DOLLARS
WHICH GETS UP TO THE TWO BILLION
THAT I JUST MENTIONED.
WE'LL BE WORKING WITH THE
COUNTIES.
ON AN ONGOING BASIS TO.
FURTHER ENHANCE SOME OF THE
DATA THAT WE GET FROM THE
COUNTIES AROUND ELIGIBILITY
DETERMINATIONS ISN'T AND
RENEWALS AS WELL AS WORKING WITH
THEM ON SOME DATA METRICS
BECAUSE. BOTH ON THE STATE AND
THE FEDERAL GOVERNMENT
PARTICULAR HAVE BEEN INTERESTED
IN HOW COUNTIES HAVE CHANGED THE
ELIGIBILITY SYSTEMS WITH THE.
AFFORDABLE CARE ACT.
WE DON'T HAVE NUMBERS AND WE
WILL BE PROPOSING THEM.
FOR MAY WHEN WE PUT THAT.
BUDGET TOGETHER IN THE FALL AND
IN THE WINTER THE CHILDREN'S
HEALTH INSURANCE PROGRAM HAD NOT
BEEN REAUTHORIZED BY CONGRESS AT
THE TIME. THE CURRENT BUDGET
HAD.
CHOSEN A MIDDLE ROAD APPROACH
WHICH WAS WE ASSUME THAT THE.
PROGRAM WOULD BE REAUTHORIZED
WE WERE NOT I'M THINKING THAT
pEIGHTY EIGHT PERCENT MATCHING
LEVEL AND SO WE WENT BACK DOWN
TO THE SIXTY THE MORE
TRADITIONAL SIXTY FIVE PERCENT
MATCHING LEVEL AND THEN.
CONGRESS DID FINALLY
REAUTHORIZE THE PROGRAM BUT
THEY.
DID IT AT THE EIGHTY EIGHT SO
THERE WILL BE AN ADJUSTMENT IN
THE MAY REVISION I'M TO
ACCOMMODATE FOR THAT THAT CHANGE
WHICH WAS MADE TOO LATE FOR US
TO. TAKE INTO ACCOUNT WHEN WE
WERE DOING THE BUDGET.
ANOTHER ITEM THAT I'M SURE WE
WILL SPEAK OUT AT A FURTHER
HEARING IS WE'RE PROPOSING TO
MAKE SOME CHANGES IN THE THREE
FORTY.
BE DRUG.
PROGRAM.
THERE ARE SOME INCREASING
CONCERNS BOTH AT A STAY AT A
NATIONAL LEVEL AS TO HOW THIS
PROGRAM IS.
ADMINISTERED.
BECAUSE THAT NATURE OF THE
REBATES AND THOUGH WAY THAT
THOSE DRUGS ARE PRICED AND
DISCOUNTED IS THAT.
WE HAVE.
SOME CONCERNS ABOUT HOW THOSE
REBATES ARE EITHER ACCOUNTED FOR
NOT IN BOTH FEE FOR SERVICE AND
IN MANAGED CARE AND SO WE HAVE A
PROPOSAL IN THIS YEAR'S BUDGET
TO ELIMINATE THE USE OF THOSE
DRUGS FOR PURPOSES OF THE
MEDICAID PROGRAM. THEY WOULD
OBVIOUSLY STILL BE ABLE TO BE
USED IN DISPENSED FOR OTHER
POPULATIONS BUT JUST NOT FOR
MEDICAID.
THERE ARE AND SMALLER CHANGES
THAT WE'RE SEEKING TO INCREASE
OUR ADMINISTRATIVE CAP.
WITH THE AND AS WE HELP SUPPORT
AT THE HOSPITAL COMMUNITY AROUND
THE WHOLE HOSPITAL QUALITY
ASSURANCE FEE. IN WHICH WE WOULD
BE SEEKING TO.
FUND ADDITIONAL ADMINISTRATIVE
ACTIVITIES AND THEN WE ARE ALSO
PROPOSING TO ELIMINATE.
A PROGRAM THAT WAS ENACTED
SEVERAL YEARS AGO BACK IN TWO
THOUSAND AND SIX AND.
BOTH FROM A LENGTH OF TIME IN
WHICH IT TOOK US TO GET IT
APPROVED BY THE FEDERAL
GOVERNMENT AND IN WORKING WITH
THE PUBLIC FREE SPENDING.
NON HOSPITAL BASED CLINICS
THERE WAS.
ESSENTIALLY NO TAKERS FOR THIS
PROGRAM AND SO WE'RE PROPOSING
TO REPEAL THAT.
.
FOR PURPOSES OF THE MEDI CAL
ESTA MEANT.
AS YOU HAVE NOTED IN YOUR
AGENDA CASELOAD HAS REMAINED
RELATIVELY FLAT.
FOR A VARIETY OF.
REASONS FOR WHICH WE WERE NOT
QUITE I'M SURE BUT WE THINK THAT
THE.
VERY LOW UNEMPLOYMENT RATE THAT
INCREASING ECONOMY IN CALIFORNIA
HAS CERTAINLY LED TO A
SIGNIFICANT.
TAPER IN FAMILY AND CHILDREN
PARTICIPATION IN THE PROGRAM IN
TERMS OF THOSE ELIGIBILITY
CATEGORIES BUT WE'RE STILL SEEN
INCREASES IN THE OPTIONAL
EXPANSION. AS WELL AS IN THE
SENIORS AND PERSONS WITH
DISABILITIES CATEGORY.
AND.
THE LAST THING I WOULD SAY IN
TERMS OF MAJOR POLICY CHANGES.
WITHIN THE ESTIMATE.
RELATES TOWARD DRUG MEDI CAL
ORGANIZED DELIVERY SYSTEM WAIVER
SO JUST A QUICK REMINDER THIS IS
A VOLUNTARY WAIVER THAT ARE
COUNTIES ARE WORKING ON WITH US.
TO IMPLEMENT A.
CONTINUUM OF SUBSTANCE ABUSE
TREATMENT IN THEIR COUNTIES FOR
THEIR MEDICAL POPULATION AND.
WE HAVE.
TEN COUNTIES THAT ARE CURRENTLY
PARTICIPATING WE ANTICIPATE
ADDING AN ADDITIONAL TEN WITHIN
THE FISCAL YEAR AND WERE
ESTIMATING THAT THERE WILL BE
APPROXIMATELY.
THREE HUNDRED AND SEVENTY FIVE
MILLION DOLLARS TOTAL FUNDS THAT
WILL BE.
DRAWN DOWN AND USE TO PROVIDE
SUBSTANCE USE TREATMENT SERVICES
IN THESE COUNTIES.
AND WITH FATS I WILL I STOP AND
ASK IF THERE'S ANY QUESTIONS.
TURN IT OVER TO MISTER CHAIR.
WE HAVE SOME QUESTIONS REGARDING
PROPOSITION FIFTY FIVE IN THE
STAFF COMMENTS AND QUESTIONS AND
WAS WONDERING IF YOU WANTED TO
ADDRESS THAT BEFORE WE HAD.
DEPARTMENT FINANCE IN LA
ILLITERACY I'M GONNA DEFER TO MY
COLLEAGUE THE DEPARTMENT OF
FINANCE.
THANK YOU KARLUK ASSAIL THE
DEPARTMENT OF FINANCE. ON YOUR
AGENDA PROVIDES A NICE HIGH
LEVEL SUMMARY STYLE FIGHT A FEW
MORE POINTS TO PUT IT IN
CONTEXT.
AND THEN WALK YOU THROUGH THE
CALCULATION ASSUMPTIONS.
AS DETAILED ON PAGE FIFTEEN OF
YOUR AGENDA.
SO PROPOSITION FIFTY FIVE
EXTENDED THE HIGHER.
TAX RATES FOR PERSONAL INCOME
TAX.
OF THOSE WERE ORIGINALLY
AUTHORIZED IN PROPOSITION
THIRTY.
THESE REVENUES ARE DEPOSITED
INTO THE EDUCATION PROTECTION
ACCOUNT.
THE EDUCATION PROTECTION
ACCOUNT OFFSETS EXPENDITURES FOR
EDUCATION AS WELL AS HEALTH
HEALTH CARE SERVICES.
AND.
.
PROPOSITION FIFTY FIVE LIMITED
THAT CALCULATION TO
APPROXIMATELY TWO BILLION OF THE
EPA DOLLARS.
.
SO TO LOOK AT THE REPORT
CALCULATION ON PAGE FIFTEEN OF
YOUR GENDER.
THE FIRST LINE SHOWS YOU ARE
REVENUES WITHOUT PROPOSITION
FIFTY FIVE.
SO IF YOU WERE CURIOUS BUT THE
AMOUNT OF THE PROPOSITION FIVE
ADDITIONAL REVENUES ARE THAT IS
ON YOUR.
ON THE WORKSHEET ONLINE FOR.
AND THE REASON YOU HAVE A LOWER
AMOUNT EIGHTEEN NINETEEN IS
BECAUSE PROPOSITION THIRTY WENT
THROUGH DECEMBER OF TWENTY
EIGHTEEN SO THAT FISCAL YEAR.
HAS THE ADDITIONAL SIX MONTHS.
.
THE REVENUES TOGETHER ARE
CONSISTENT WITH THE WAY WE DO
OUR PROJECT ESTIMATES.
SO FOR EXAMPLE ARE MULTI YOUR
REVIEW.
THOSE REVENUE DOLLARS ALSO TAKE
INTO ACCOUNT TRANSFERS AND SO.
THE BUDGET STABILIZATION
ACCOUNT TRANSFERS THE REQUIRED
AS WELL AS ANY SUBLIMINAL
DEPOSITS WOULD BE PART OF THAT
CALCULATION.
SO THAT WILL BE A POINT OF
CONTENTION LATER AND SO I'M
GONNA HOLD THE COMMENT BUT PUT A
MARKER THERE IF YOU CAN ABOUT.
WHAT WE ARE FORCED AND OBLIGATED
TO DO AND WHAT WE CHOOSE TO DO
VOLUNTARILY? IN ADDITION TO
THAT.
THE NEXT LINE IS A LITTLE MORE
STRAIGHTFORWARD PROPOSITION
NINETY EIGHT DOLLARS THAT IS
THEM THEIR CONSTITUTIONAL
CALCULATION SO.
I THINK LEGISLATIVE ANALYST'S
OFFICE WILL ALSO CLARIFY WHETHER
IT THE LEGISLATURE APPROPRIATES
A DIFFERENT AMOUNT THAN THE
CONSTITUTIONAL MINIMUM THIS
CALCULATION LOOKS AT WHAT THAT
FORMULA WOULD BE.
FOR THE NINE NINETY WORKLOAD OF.
A LOT OF PROGRAMS ARE LOOKED AT
ON A CASE BY CASE BASIS SO MOST
OF THE BUDGET IS DEVELOPED.
.
HELLO A CASELOAD ESTIMATES
REQUIRED ESTIMATES.
THE VAST MAJORITY OF THE
ESTIMATE FOR THE EIGHTEEN
NINETEEN GOVERNOR'S BUDGET IS
CONSIDER CURRENT CURRENTLY
AUTHORIZED SERVICES.
.
AND THEN AS YOU SEE THE
COMPARISON OF LINE FOR WITH
FLYING.
.
I ONLINE FIVE WE SHOW THAT THE
REVENUES ABSENT PROP FIFTY FIVE
WOULD NOT BE SUFFICIENT TO COVER
THE WORKLOAD ESTIMATE. SO.
ASSUMING ALL OF THE PROPOSITION
FIFTY FIVE DOLLARS THERE WOULD
STILL BE ABOUT ONE POINT NINE
BILLION IN NEED.
AND SO FOR EIGHTEEN NINETEEN THE
GOVERNOR'S BUDGET DOES NOT
ASSUME. ANY P. DOLLARS GOING TO
MEDI CAL FUNDING.
OF ONE CAVEAT I WANTED TO KNOW
WHAT IS THE MULTI YEAR LOOK HERE
IS ASSUMING THAT. BUDGET AS
PROPOSED
SO ANY CHANGES IN EIGHTEEN
NINETEEN WOULD AFFECT THOSE ARE
YOURS.
SO I'M GONNA ONE HERE FROM LA
JOH BUT WANTED TO ALSO
UNDERSTAND IS THIS FOR THE
JANUARY BUDGET PRETTY MAY REVISE
AND IS THERE OPPORTUNITIES THAT
MAY REVISED. RE EVALUATE SOME OF
THE CALCULATION.
THIS WILL BE UPDATED AGAIN
AMERICA SHOULD AND WILL BE
UPDATED AGAIN OUT BUDGET ACT AND
SO ON IF YOU'D LIKE I CAN
ADDRESS YOUR QUESTION ON THE
BUDGET TAPE THING I CANNOT POINT
TO HEAR FROM AYE LEO AYE
THROUGH.
YOU HAD A VERY GOOD.
.
PRESENTATION AND WOULD LIKE TO
SEE IF THAT STEMS FURTHER
CONVERSATION.
THANK YOU TERRY MEMBERS AND
HOLLINGS HAD FINALLY JUST LET OF
ANALYST'S OFFICE SO I JUST BE
SPEAKING.
BRIEFLY FROM A REPORT THAT OUR
OFFICE ISSUED A FEW DAYS AGO ON
THE PROPOSITION FIFTY FIVE
ESTIMATES BY THE ADMINISTRATION.
LET ME JUST.
US TO GIVE YOU A HIGH LEVEL.
CONTEXT FOR MY REMARKS A MINUTE.
HOPEFULLY PUT A LITTLE CONTEXT
AROUND THE NUMBERS THE
DEPARTMENT OF FINANCE JUST GAVE
YOU WALK THROUGH HALL THE
CALCULATION WORKS UP FROM THE
MEASURES PERSPECTIVE. AND NOT
GIVE YOUR OFFICES TWO COMMENTS.
ON THE ADMINISTRATION'S
IMPLEMENTATION SO JUST TURNING
TO FIGURE ONE ON THE FIRST PAGE
THIS OUTLINES I IN GENERAL HOW
THE MEASURE SAYS THAT THE
PROPOSITION FIFTY FIVE
POPULATION SHOULD WORK.
SO IT DIRECTS THE DEPARTMENT OF
FINANCE TO BEGIN WITH AN
ESTIMATE OF AVAILABLE GENERAL
FUND REVENUES AS HAS JUST BEEN
NOTED.
THAT IS INCLUSIVE OF BOTH THE
OPTIONAL AND CONSTITUTIONAL BSA
DEPOSITS UNDER THE
ADMINISTRATION'S LA
CALCULATIONS.
THEN.
WE SUBTRACT FROM THAT AS IT
ADMINISTRATION NOTED THE MINIMUM
FUNDING GUARANTEE AND THEN WE
SUBTRACT FROM THAT THE WORKLOAD
BUDGET. NOW THERE'S NOT
NECESSARILY A STRAIGHTFORWARD
EXPLANATION HERE FOR WHAT THE
WORKLOAD BUDGET IS BUT AS IT IS
DESCRIBED IN THE MEASURE. IT IS
THE BUDGET YOUR COST IN TWENTY
EIGHTEEN NINETEEN OF PROVIDING
SERVICES THAT WERE AUTHORIZED ON
JANUARY FIRST TWENTY SIXTEEN. SO
IN THE MEASURE SPECIFICALLY
OTHER DEPARTMENT FINANCES TO
TAKE THE TWENTY FIFTEEN SIXTEEN
BUDGET AND THEN UPDATED FOR A
VARIETY OF CHANGES INCLUDING
CASELOAD PRICE INCREASES.
AS WELL AS CHANGES THAT WOULD
BE OUTSIDE OF THE LEGISLATURE'S
CONTROL LIKE FEDERAL IN COURT
MANDATES.
SO.
AS A DEPARTMENT FINANCES NOTED.
THERE'S A DEFICIT IN THEIR
WORKLOAD BUDGET CALCULATION WE
JUST SHOW A SIMPLE SIMPLIFIED
VERSION OF FAT I'M AT THE TOP OF
PAGE TWO.
THERE ARE.
IN OUR ESTIMATE TWO REASONS.
THAT THE DEPARTMENT OF FINANCE
IDENTIFIES A DEFICIT IN ITS
WORKLOAD BUDGET CALCULATION THE
FIRST IS RELATED TO THAT
AVAILABLE REVENUES PIECE. AND
THE SECOND IS RELATED TO THE
WORKLOAD BUDGET CALCULATION.
AS WAS NOTED ON AVAILABLE
REVENUES. THERE'S AN ARGUMENT
THAT WHILE CONSTITUTIONAL
DEPOSITS SHOULD BE COUNTED SORT
OF IN THE NORMAL BUDGETARY SONS
AS A NEGATIVE A NEGATIVE
TRANSFER FROM AVAILABLE
REVENUES.
THERE'S AN ARGUMENT THAT THE
OPTIONAL DEPOSIT INTO THE BSA
SHOULD NOT BE COUNTED THIS WAY.
THE DEPARTMENT OF FINANCES I'M
INTERPRETATION ABOUT ESTIMATE AS
A RESULT WOULD SLIGHTLY INCREASE
ARTS I WOULD SLIGHTLY DECREASE
THE AMOUNT OF AVAILABLE REVENUES
AND THEREFOREI REDUCE THE
AMOUNT OF POTENTIAL SURPLUS
AVAILABLE FOR MEDI CAL.
SO.
OUR SECOND COMMENT IS REGARDING
THE WORKLOAD BUDGET CALCULATION.
BICU.
THE REPORT OF FINANCE TAKES A
VERY BROAD INTERPRETATION OF THE
PHRASE CURRENTLY AUTHORIZED
SERVICES.
AND SPECIFICALLY WHAT I MEAN BY
THAT THE INTER.
IS THAT THE DEPARTMENT FINANCE
COUNTS ANY SERVICE THAT WAS IN
PLACE ON JANUARY FIRST TWENTY
SIXTEEN. OF ANY GENERAL TYPE AS
CURRENTLY AUTHORIZE EVEN IF A
SPECIFIC BENEFIT OR PROGRAMMER
SERVICE WAS NOT AVAILABLE AT
THAT TIME.
SO LET ME GIVE AN EXAMPLE IN THE
TWENTY SEVENTEEN EIGHTEEN BUDGET
THE LEGISLATURE PASSED THE
EMERGENCY CHILDCARE BRIDGE
PROGRAM OF THIS PROVIDED A MEDIA
CHILDCARE ACCESS TO FOSTER
FAMILIES ON FOSTER PARENTS. NOW
THE ADMINISTRATION COUNTS THAT
AS PART OF THE WORKLOAD BUDGET
UNDER THE RATIONALE THAT THE
STATE HAS LONG PROVIDED FOSTER
CARE SERVICES AND ASSOCIATED
SUPPORT FOR FOSTER FAMILIES.
.
THAT SAID THE THAT PARTICULAR
SERVICE IMMEDIATE ACCESS TO
CHILDCARE WAS NOT AVAILABLE ON
JANUARY FIRST TWENTY SIXTEEN. SO
AS YOU CAN SEE ON BOTH OF THESE
DECISIONS WOULD TEND TO REDUCE
THE AMOUNT OF MEDI CAL.
SURPLUS AVAILABLE UNDER THE
MEASURE UP PERHAPS BY HUNDREDS
OF MILLIONS OR EVEN BILLIONS OF
DOLLARS A YEAR IN THE FUTURE.
THANK YOU.
.
WITH THAT IT SEEMS TO GIVE A
COMMENT WOULD YOU LIKE TO
RESPOND TO WHAT I WAS JUST WILL
INTO A FOR THE ADDITIONAL
INFORMATION.
FOR THE BSA DEPOSIT AT THE
DIFFERENCE BETWEEN THEIR PART IN
THE ADDITIONAL.
WE WANTED TO NOTE THAT IN
TWENTY SIXTEEN WHEN THERE WAS
THAT ADDITIONAL SUPPLEMENTAL
DEPOSIT.
GOT WAS ALSO TREATED THE SAME
WAY IN THE CONTEXT OF THEIR
REVENUES FOR THAT FISCAL YEAR.
ON AND THEN ANOTHER IT
CLARIFICATION OF THE METHODOLOGY
THAT WE IS OF THE ASSUMPTIONS.
THERE'S NO TRUE UP FOR THIS
DETERMINATION SO THAT THE
TERMINATION OF BUDGET ACT WILL
BE THE FINAL EVEN THOUGH I A
NUMBER OF FACTORS WILL STILL BE
CHANGING AFTER THAT. AND IT IN
THAT VEIN THAT OUR CONCERN AS
THE LEGISLATURE IS COMING
FORWARD TODAY WHICH IS TO MAKE
SURE THAT WE'VE SET A PROCESS
THAT WILL BECOME PRESIDENT.
GOING FORWARD AND SO LOOKS TO
MAKE SURE THAT WERE CREATING IT
TOGETHER. MIRRORING WHAT VOTER
INTENT WAS IN PASSING THIS
LEGISLATION.
AND I HAVE CONCERNS GLOBALLY IF
I MAY JUST SPEAK PLAINLY THAT
WHEN WE HAVE SEVEN POINT FIVE
BILLION DOLLARS WORTH OF.
SURPLUS
THAT WE FIND OURSELVES IN A
BUDGETARY DEFICIT AND UNABLE TO
PROVIDE ANY INCREASE OF FUNDS TO
MEDI CAL DOES NOT SEEM TO BE.
AT ITS FACE VALUE. WHAT THE
VOTERS HAD INTENDED TO DO?
SO I WOULD LIKE TO BRING IT UP
TO THE DYESS FOR QUESTIONS BUT
FIRST WE'RE GONNA GET PUBLIC
COMMENT TO. ON ISSUE ONE
.
GOOD AFTERNOON MISTER CHAIRMAN
BEARS I MEAN THOUSANDS OF HEALTH
ACCESS WE ARE THE STATEWIDE
CONSUMER HEALTH ADVOCACY
COALITION. ADVOCATING FOR
QUALITY AFFORDABLE HEALTHCARE
FOR ALL CALIFORNIANS.
WE AND SHARE THE LA LA WAS
CONCERNED THAT THE
ADMINISTRATION'S PROP FIFTY FIVE
CALCULATIONS. WILL RESULT IN
MEDI CAL RECEIVING NO ADDITIONAL
FUNDING BECAUSE THIS YEAR'S
CALCULATION WILL SET A PRECEDENT
FOR FUTURE YEARS AS I'M THE
CHAIR MENTIONED THE LEGISLATURE
MUST LOOK CAREFULLY. AT THE
CALCULATIONS BECAUSE HUNDREDS OF
MILLIONS OR EVEN BILLIONS OF
DOLLARS FROM MEDICAID I'LL ARE
AT STAKE.
HEALTH ACCESS REQUESTS THAT THE
ADMINISTRATION AND THE AND THE
LEGISLATURE ACT CONSISTENTLY
WITH THE WILL OF THE VOTERS TO
YOU STATE REVENUES TO
APPROPRIATELY FULFILL PROP FIFTY
FIVE MEDI CAL FUNDING.
ON CHIP YOU KNOW WE ARE GLAD
CONGRESS REAUTHORIZED CHIP AT A
HIGHER RATE OF OF THE EIGHTY
EIGHT PERCENT FEDERAL MATCH AND
WE REQUESTED THAT THE
LEGISLATURE USE.
THOSE NINE HUNDRED MILLION IN
SAVINGS IN THE CHIP PROGRAM AT
THREE TWENTY EIGHTEEN TWENTY
NINETEEN TO IMPROVE THE MEDICAL
PROGRAM. BY RESTORING BENEFITS
OR PROVIDING MORE PEOPLE WITH
HEALTH COVERAGE THANK YOU.
THANK YOU.
JANICE CAN DOWN CHILDREN'S
DEFENSE FUND REPRESENTING THE
CHILDREN'S HEALTH COVERAGE
COALITION.
I WOULD LIKE TO EMPHASIZE THE
POSITIVE IMPACT THAT THE RECENT
FEDERAL ACTION TO EXTEND
CHILDREN'S OF THE CHILDREN'S
HEALTH INSURANCE PROGRAM FUNDING
FOR TEN YEARS WILL HAVE ON THAT.
CALIFORNIA'S.
MEDICARE BUDGET AS PREVIOUSLY
MENTIONED THE NINE HUNDRED
MILLION WAS NOT ASSUMED IN THE
GOVERNOR'S JANUARY BUDGET.
AND IT'S OUR HOPE THAT THE.
THAT.
THOSE SAY OF CHIP FUNDS WILL BE
DEDICATED TO ADDITIONAL
INVESTMENTS IN IMPROVING THE
HEALTH OF CHILDREN AND FAMILIES
THANK YOU. THANK YOU.
ON A HOUSE ABOUT WITH UNITED
RAISE THE CALIFORNIA I WOULD
LIKE TO ECHO THE COMMENTS OF MY
COLLEAGUE WITH THE CHILDREN'S
DEFENSE FUND.
AND JUST.
RESPECTFULLY REQUEST OF THE
ADDITIONAL NINE HUNDRED MILLION
IN CHIPS SAVED DOLLARS.
IS SOMETHING THAT.
IS FOCUSED ON.
CHILDREN'S HEALTH AND WELLNESS.
AND ENSURING THAT THOSE DOLLARS
GO TO OF THOSE THAT NEED THEM
THE MOST.
THANK YOU.
THANK YOU MARY MARTIN HERE ON
BEHALF OF THE CALIFORNIA
CHILDREN'S HOSPITAL ASSOCIATION
AND JUST WANT TO THANK THE
DEPARTMENT AND SUPPORT ITS
PROPOSAL TO INCREASE HOME
NURSING RATES. A WE HAD A LOT OF
COUNTIES IN THE STATE WHERE
THERE WERE NO PEDIATRIC HOME
NURSES AVAILABLE FOR CHILDREN. A
BECAUSE THE REACHES COULD NOT
SUPPORT THE SUPPORT THE LEVEL OF
NURSING THAT THOSE KIDS ON
VENTILATORS AND I MEAN I.
INFUSION SYSTEMS NEEDED AND SO
WE'RE PLEASED TO SEE THAT ON THE
WORK ON THIS ISSUE OVER THE LAST
SEVERAL YEARS HAS PAID OFF AND
WE'RE IN STRONG SUPPORT
THINKING.
THANK YOU.
ANY FURTHER PUBLIC COMMENT ON
THE ISSUE ONE.
SEEING NONE A BRING IT TO THE
DYESS FOR ANY QUESTIONS THAT YOU
MAY HAVE.
WHEN I HAVE SOME.
I WANTED TO HEAR AGAIN HOW THE
OPTIONAL THREE POINT FIVE
BILLION. THAT WE'RE PLACING.
INTO THE BSA. IS NOT A DECISION.
THAT WE ARE MAKING TO THEN
CREATE THE APPEARANCE THAT WERE
IN A BUDGET DEFICIT.
I'D WANT TO GET INTO THE
SPECIFICS TO MAKE SURE WE
UNDERSTAND THAT PRESIDENT'S.
THE ADMINISTRATION'S PROPOSAL
IS.
ASSUMING THAT THAT'S THE ACTION
TAKEN BY THE LEGISLATURE SO OF
THAT AS WE TO SOME XIN JUST OFF.
THE BAT HOW CAN WE BUDGET FOR
THAT. IF THE LEGISLATURE CHOSE A
DIFFERENT AMOUNT TO BE ADDED TO
THE REQUIRED DEPOSIT. THAT WOULD
BE PART OF THE CALCULATION AND
AGAIN THIS WAS MORE OF A
CONSISTENCY OF HOW THE REVENUES
ARE DETERMINED AND TREATED IN
VARIOUS CALCULATIONS FOR THE
BUDGET.
TYPE I'M NOT UNDERSTANDING THAT
PORTION OF IT THEN HOUSE JUST
MAKING IT CONSISTENT WITH THE
REMAIN. AND THE REVENUES THE
DETERMINATION OF THE AMOUNT OF
AVAILABLE REVENUES.
INCLUDES THE REVENUES IN
TRANSFERS SO AT WHATEVER LEVEL
THE LEGISLATURE CHOSE TO DO
ABOVE THE REQUIRED THAT WOULD BE
PART OF THIS CALCULATION AND YET
YOU HAVE. PUT UP PLACE MARKER IN
THERE THAT THEN PROHIBITS
FUND'S THAT SHOULD BE GOING IN.
THE VOTERS MIND TOWARDS MEDI
CAL.
HOW HAVE YOU MADE THAT
DETERMINATION AND WHY ARE WE
THEN IN A SITUATION WHERE WE ARE
NOT GOING TO HAVE THOSE FUNDS?
TO HELP.
THE PROGRAMS THAT NEED. THE
MOST IT IN THE CONTEXT OF THE
OVERALL GOVERNOR'S BUDGET WE
WERE LOOKING TO SET ASIDE
ADDITIONAL FUNDS FOR. THAT THE
POTENTIAL DOWNTURN WHERE WE
NOTED THAT THE.
AS AT THE END OF EIGHTEEN
NINETEEN WE WOULD BE.
AT THE SAME.
EXTENDED THE ORB THE LENGTHIEST.
OF RECOVERY PERIOD IN THE ITS
POST WORLD WAR HISTORY SO PART
OF THE PROPOSAL WAS MAKING SURE
THAT THERE WAS ENOUGH CERTIFIED
IN RESERVES NO I'M NOT A.
I THINK OUR STRUGGLE IS YOUR
BUDGET CALCULATION.
IT IS THAT BY TAKING IT AS A
TRANSFER BY CREATING A NEGATIVE
BALANCE.
YOUR CREATING A GIMMICK. IN
BUDGET PARLANCE THAT ACTUALLY.
IS TAKING AWAY THE ABILITY FOR
US TO HAVE A REAL SURPLUS AND TO
REPRESENT THE VOTER'S INTENT
TIGHT STRUGGLE. TO UNDERSTAND
HOW. THIS WAS WHAT THE VOTERS
VOTED ON.
LAST FOR US. CREATE SPREADSHEETS
THAT TOOK AWAY THEIR INTENT.
I'LL TRADE AND OF A DIFFERENT
WAY OF IT BUT WHAT I'M TRYING TO
SAY.
THE CLARIFICATION IS MORE OF
WHAT THE INTENT DOES AS OF JUNE
THIRTIETH AND SO AS OF JUNE.
BY JUNE THIRTIETH IF THE
LEGISLATURE HAS CHOSEN TO DO A
SUPPLEMENTAL SO OUR PROPOSAL
INCLUDED THAT ASSUMPTION.
WHATEVER THE LEGISLATURE DOES IT
WOULD BE AS OF THE JUNE
THIRTIETH SO IT'S MORE OF A.
THE PROPOSAL IS TO INCLUDE THAT
WHETHER THE LEGISLATURE TO
SOMETHING DIFFERENT BEFORE JUNE
THIRTIETH THAT WOULD BE THAT
ESTIMATE.
YEAH I'M.
.
WOULD IT NOT HAVE BEEN.
EQUIVOCAL TO.
.
NOT HAVE SUBTRACTED IT IN THE
NEGATIVE WAY THAT THE LA O. HAS
RECOMMENDED.
AS A FASHION FOR US TO GET AN
ACCURATE REPRESENTATION OF WHAT.
SHOULD HAVE BEEN IN.
CLUE DID TO REPRESENT THE
VOTER'S INTENT AGAIN I'M
STRUGGLING TO.
FEEL AS IF THIS IS A ONE SIDED
CONVERSATION AND I UNDERSTAND
THAT THE DEPARTMENT OF FINANCE
ULTIMATELY HAS.
QUITE AN ABILITY TO DETERMINE
WHAT IS WITHIN OUR WORKLOAD
BUDGET. BUT I'M CONCERNED ABOUT
THE PRECEDENT THAT'S BEING SET
ABOUT OPTIONAL PAYMENTS OUTSIDE
OF WHAT WAS MANDATED BY
PROPOSITION TWO. AND I'M
WONDERING HOW WE DECIDED UPON
THE THREE AND A HALF BILLION HOW
WE.
YOU KNOW IT SEEMS TO BE FAIR IS
IF WE WANTED TO FILL UP THE
PIGGY BANK AND CREATES THE
OPTIC.
AND YET IS THAT WHAT VOTERS
INTENDED FOR US TO DO. OR WHEN
WE HAVE SEVEN POINT FIVE BILLION
DOLLARS WORTH OF SURPLUS THAT
WILL ACTUALLY INVESTED INTO MEDI
CAL AS INTENDED BY THE VOTERS.
IT SEEMS AS IF WE ARE.
CREATING.
THIS BUDGET.
DEFICIT ON PAPER.
SO AS TO NOT FUND MEDI CAL CAN
WOULD LIKE TO UNDERSTAND
DEPARTMENT OF FINANCES. READING
OF
THIS PROPOSITION AND AS IT
SETTING PRECEDENTS GOING
FORWARD.
AND WE WERE LOOKING AT MORE OF
THE CONSISTENCY ACROSS THE
DOCUMENT SO ACROSS MULTIPLE
CALCULATIONS.
SO. IF MULTI YEAR PROJECTIONS
ASSUME TRANSFERS IN THE REVENUE
NUMBER IT'S THE SAME FORECAST
HERE THE REVENUE NUMBERS ASSUME
THAT TRANSFER.
.
BUT PROPOSITION NINETY EIGHT WAS
MANDATED AT THE MINIMUM AMOUNT.
TO GO AND. WHY ARE WE NOT DOING
AND BEING CONSISTENT WITH
PROPOSITION TWO TO PLACE THE
MINIMUM TRANSFER AMOUNT TEN WHY
DO WE INCLUDE SUPPLEMENTAL?
OPTIONAL INCREASES ABOVE.
WHAT? IS HAPPENING IN PROP
NINETY EIGHT FOR US TO BE
CONSISTANT SHOULDN'T WE MIRROR
WHAT WE'RE DOING AND PROP NINETY
EIGHT AS WE SHOULD DO AND PROP
TWO.
I I THINK IT'S AN ORDER OF
EVENTS THAT MIGHT BE A LITTLE
CONFUSING BUT.
WHEN WE'RE DOING THE
PROPOSITION NINETY A GUARANTEE
THAT DODD GENERAL FUND REVENUE
NUMBER ALSO TAKES INTO ACCOUNT
TRANSFERS OVERALL.
THESE TO BE INCLUDED IN THEIR
EYES AS THE THE EPA DOLLARS.
IN GENERAL BUT THEIR PROPERTY
FIVE IS THE LAST CALCULATION AND
IT LOOKS AT WHAT THAT FINAL.
PACKAGES.
I AM STILL.
I'M NOT FEELING LIKE.
.
I'M UNDERSTANDING HOW WE WERE
ABLE TO INCLUDE THE THREE AND A
HALF BILLION.
DAHLE ARE OPTIONAL PAYMENT
TO TAKE IT OFF THE TOP AND NOT
INCLUDE IT INTO THIS PROPOSITION
FIFTY FIVE ESTIMATES AND REALLY
WOULD LIKE A BETTER
UNDERSTANDING OF. WHERE THAT
STATUTORY AUTHORITY CAME FROM?
AND HOW. WE WERE ABLE TO MAKE
THOSE ASSUMPTIONS.
SO THEY AUTHORITY WILL COME WHEN
THE LEGISLATURE APPROVES A
SUPPLEMENTAL DEPOSIT SO THE
REQUIRED AMOUNT YOU CRACKED IS.
HOWEVER THE CONSTITUTION
CURRENTLY PROVIDES THAT.
.
WHEN OUR SUCTION WAS THAT THIS
WOULD BE THE LEGISLATURE'S UP
OF.
RECOMMENDATION AND THE AMOUNT
YOU'RE CORRECT WAS DETERMINED AS
THE AMOUNT THAT WOULD GET US TO
THE TEN PERCENT CONSTITUTIONAL
TARGET AND I SEE THE REAL
BENEFIT OF DOING WHAT YOU'RE
RECOMMENDING. BUT IN TERMS OF US
MAKING SURE THAT WE ARE SETTING
INAPPROPRIATE PRECEDENT I WANT
THE CALCULATION THE PROCESS
CORRECT.
AND I'M STRUGGLING TO FEEL LIKE
THIS IS THE RIGHT PROCESS.
WHEN IT FEELS LIKE WE'RE GETTING
AHEAD OF OURSELVES BEFORE THE
JUNE BUDGET IN SO. I'M ACTUALLY
WONDERING IF THE APPROPRIATE
PROCESS IS TO SET WHAT WE HAVE
IN FRONT OF US TODAY TO DO WHAT
THE MINIMUM IS WITH AND
PROPOSITION TWO IN TERMS OF
CREATING OUR BUDGET. AND THEN TO
DO WHAT WE NEED TO COME JUNE
THIRTIETH TO ENSURE THAT WERE
PREPARING FOR TOMORROW. I'M JUST
FEELING AS IF.
WHAT DEPARTMENT OF FINANCE IS
PRESENTING IS A WAY FOR US NOT
THAT?
TRULY REFLECT VOTER INTENT AND
I'M TRYING TO REALLY UNDERSTAND
FROM YOU WHY WE. ARE IN THIS
POSITION TODAY WHO AM I I THINK
THAT WE ARE SAYING THE SAME
THING THAT WE WILL END UP WE
WILL UPDATE THIS AT BUDGET ACT
WITH WHATEVER THE LEGISLATURE'S.
APPROVED AMOUNTS ARE SO THIS
WAS JUST THE GOVERNOR'S PROPOSAL
ASSUMING THAT THAT ADDITIONAL.
REVENUE TO ADDITIONAL DEPOSIT
WAS MADE IT TO BE A THING WHICH
CONSISTENT WITH OTHER.
TRACKING OF REVENUES AND
TRANSFERS
WOULD BE REDUCED FROM THAT
AMOUNT.
THE PROBLEM I'M HAVING IS WHY
WOULD WE APPROVE IT IF YOU'RE
NOT EXPLAINING IT. TO LOOK WHY
WOULD BE AND WE BE ENCOURAGED TO
VOTE FOR THAT YOU'RE ASSUMING
THAT WE'RE GOING TO VOTE ON IT
BUT IF IT'S NOT CLEAR NOW. THEN
I WOULDN'T RECOMMEND IT I THINK
THAT'S WHERE I THINK THE
DISCONNECT IS IS YOU'RE SAYING
ASSUMING THAT THE LEGISLATURE
PROVES THAT BY. YOU NOT GIVING
ME INFORMATION IN ORDER TO
APPROVE IT AND SO.
I'M UNDERSTANDING EITHER.
THEY ARE SEPARATE DETERMINATION
SOAP THE WHATEVER THE
LEGISLATURE DETERMINES AS A
SUPPLEMENTAL DEPOSIT IF THEY
CHOOSE TO DO ONE.
THAT WOULD BE IT.
.
BUILT INTO THE REVENUES FOR
VARIOUS PRODUCTS BUT THEN FOR
THIS CALCULATION WOULD BE AT THE
FINAL WHATEVER THAT AMOUNTS
IT'S.
IT COULD BE IT GOING PLEASE.
I THINK NOT ONLY SUPPOSE A VERY
CLEARLY.
YOU'RE PRESENTING AN ASSUMED.
AMOUNT WITHOUT PRESENTING THE
FULL AMOUNT
SO ALL OF YOUR CALCULATIONS THE
YOU'RE PRESENTING TO US TODAY.
IT USING A ENDING THIS IS THE
BEST DOUBLE SPEAK OF EVER HEARD
IN MY LIFE.
IT YOU'RE SHOWING US BASED UPON
AN ASSUMPTION.
THAT IT SHORT CHANGED
INSTEAD OF THE FULL AMOUNTS.
THE IS IS WHAT IT WHAT I'M TAKEN
FROM AND I THINK WHAT EVERYBODY
ELSE APPEAR ON THE DICE IS TAKEN
FROM A MAN.
SO IT'S VERY DIFFICULT FOR US.
TO TAKE YOUR ASSUMPTION THAT
WILL DECIDE SOMETHING THAT YOU
HAVEN'T PRESENTED WITH THE FULL
AMOUNTS.
AND AND FROM THE
ADMINISTRATION'S PROPOSAL THE
PROPOSAL BEFORE THE LEGISLATURE
WAS TO MAKE THAT SUPPLEMENTAL
DEPOSIT AND THEN ALL THE
CALCULATIONS WOULD CONSISTENTLY
REPRESENT THAT TRANSFER IN THAT
ADDITIONAL AMOUNT SO I THINK.
THAT THERE'S A CHOICE YOU COULD
MAKE AS WELL TO NOT CREATE A NET
NEGATIVE TRANSFER.
YOU COULD CHOOSE TO MAKE THIS AS
AN OPTIONAL PAYMENT.
ON PAPER. AS THE LA OBRA FLEX
THAT WOULD RESULT IN EIGHT
HUNDRED MILLION DOLLARS INCREASE
IN TO MEDI CAL REIMBURSEMENT AND
SO I QUESTION YOU AGAIN.
WHY DID WE DECIDE TO DO THIS AS
A NET NEGATIVE TRANSFER AND IS
THERE ANOTHER OPPORTUNITY FOR US
TO REEVALUATE THAT PRECEDENT
SETTING DECISION?
HOW DID WE COME TO THAT DECISION
AND?
HOW DO WE MOVE FORWARD TO
ENSURE THAT THIS IS THE BEST
PROCESS WE HAVE?
IT. THE DETERMINATION TO FILL
THE THE RAINY DAY FUND.
TO THE CONSTITUTIONAL MINIMUM
WAS SEPARATE AND ASSUMING THAT
THAT WAS THE ADOPTION IT THEN BY
JUNE THIRTIETH THAT WOULD BE
LESS REVENUE AVAILABLE WHICH WAS
HOW WE CAME UP WITH. THE
CALCULATION FOR WHEN YOU'RE
DETERMINING HOW MUCH REVENUE IS
AVAILABLE FOR PROP FIFTY FIVE
PURPOSES.
AND FOR TAKING MONEY FROM THE
EDUCATION PROTECTION ACCOUNT. IT
WAS MORE OF A COMPARISON OF WHAT
IS AVAILABLE AS OF JUNE
THIRTIETH AND SO.
CONSISTENT REPRESENTATION OF
THAT REVENUE WAS AS OF THAT
POINT OF TIME IS WHY WE
SUBTRACTED IT HERE.
LET ME SWITCH TO THE WORKLOAD
BUDGET JUST SO THAT WE MAY HAVE
AN OPPORTUNITY TO. CONTINUE TO
PONDER WHAT HE JUST SAID.
THE ONE POINT TWO BILLION THAT
THE GOVERNOR HAS PUT AN OPTIONAL
SPENDING HAVE ALL BEEN. INCLUDED
INTO THE WORKLOAD BUDGET.
AND. I AM WANTING TO UNDERSTAND
HOW EVERYTHING THAT THE GOVERNOR
PUT IN WAS ALREADY INCLUDED AS
OF JANUARY FIRST OF TWENTY
SIXTEEN.
BECAUSE IT SEEMS AS IF.
AGAIN WORK CREATING ON PAPER A
SITUATION WHERE WE WILL HAVE
ZERO DOLLARS TO SPEND ON MEDICAL
WHEN WE HAVE SEVEN POINT FIVE
BILLION IN SURPLUS.
AND I'M QUESTIONING IF FOR OF
RESPECTING VOTERS CONTENT.
BY CREATING A SITUATION WHERE WE
HAVE NOT.
.
IT IT SEEMS AS IF IT BOTH DOUBLE
SPEAK AND AND FRANKLY IT'S
COOKING THE BOOKS A BIT.
AND I'M TRYING TO UNDERSTAND
WHY.
WE'VE MADE THESE ASSUMPTIONS IS
THERE A WAY TO WHAT EXTENT AND
WHY WE HAVE DONE.
UP I I THINK VILLAGE CIVILES DID
A GREAT JOB OF KIND OF
DESCRIBING WHAT WAS THE
DIFFICULTY IN DOING SOMETHING
DIFFERENT.
WE WERE TAKING A BROAD APPROACH
TO THE DEFINITION AND IT IS THE
MAJORITY OF THE PROPOSED
GOVERNOR'S BUDGET THAT'S
CONSIDERED WORKLOAD. THERE WAS A
SMALL PORTION THAT WE LOOKED AT
THE END AT GOVERNOR'S BUDGET WAS
THE PROXIMATE THIRTY SEVEN
MILLION. THAT WE DIDN'T CONSIDER
PART OF CURRENTLY AUTHOR I
SERVICES.
BUT FOR THE REASONS DESCRIBED
IN THE REPORT IT THEY'RE TRYING
TO PROJECT OR TRACK THOSE
ONGOING. A WE WERE LOOKING FOR
PRACTICAL APPROACHES TO THIS
DETERMINATION.
AND I CAN APPRECIATE I DID LIKE
THE LA DOES. WRITING UP OF IT IN
TERMS OF OUR ABILITY TO.
WORK FORWARD IT WOULD BE
DIFFICULT TO CONSTANTLY COME
BACK TO JANUARY FIRST BUT.
WOULD HAVE.
.
AND AM LOOKING TO THE DEPARTMENT
OF FINANCE TO WORK WITH THIS
LEGISLATURE TO ENSURE THAT WE'RE
MEETING. OUR.
STATUTORY OBLIGATIONS WITH
PROPOSITION FIFTY FIVE.
AND FRANKLY DON'T FEEL THAT
WE'VE DONE TO THAT POINT YET I
THINK MANY OF THE ASSUMPTIONS
THAT HAVE BEEN MADE.
.
I FIND A TROUBLING AT BEST.
I I FIND THAT THE DECISION TO
EXCLUDE THAT OPTIONAL THREE AND
A HALF BILLION WILL TAKE
HUNDREDS OF MILLIONS OF DOLLARS
AWAY.
FROM NETWORKS THAT WE WILL HEAR
LATER TODAY THAT NEED HELP.
AND I WONDER WHY WE HAVE MADE
THAT DECISION.
TO.
.
BUT IT DOES NOT HERE THAT I DO
NOT HEAR.
BETTER ANSWERS FROM THE
DEPARTMENT THAT WILL HELP US TO
DRIVE FOR THAT.
SO AT THIS POINT WILL LOOK TO
OUR COLLEAGUES TO SEE IF YOU
HAVE ANYTHING ELSE TO ADD TO IT.
WHAT FOR ME I'M REALLY NOT
UNDERSTANDING ANYTHING I I DON'T
KNOW IF IT'S JUST ME
MISUNDERSTANDING BUT IT JUST
DOESN'T SEEM LIKE IT'S MATCHING
WITH?
AND WHAT WE'RE NOT GIVING CLEAR
ANSWERS I GUESS THAT'S WHERE THE
FRUSTRATION IS THAT I KNOW MAYBE
I NEED A CHART OR SOMETHING TO
SHOW ME SPECIFICALLY WHAT WHAT
YOU'RE DOING WITH THE MONEY IT'S
JUST.
WE'RE GOING I FEEL LIKE I'M
GOING ROUND AND ROUND AND WE'RE
NOT GETTING THE ANSWER AND
THAT'S WHERE THE FRUSTRATION
COMES ANDERSON AS WE GET
FRUSTRATED YOU GONNA START
HEARING CURING MORE.
.
IT'S SO IF YOU CAN SPEAK AND.
NON. NON ACCOUNTING LANGUAGE
WOULD BE MUCH BETTER BECAUSE I'M
STILL COMPLETELY LOST AS TO WHY
WE HAVE A DEFICIT I MEAN THAT'S
JUST THE BOTTOM LINE I DON'T
UNDERSTAND. AND SO I APPRECIATE
EVERYTHING ELSE BUT WHY DO WE
HAVE A DIFFERENCE.
I THINK SAID THE GENERAL
DESCRIPTION THERE IS THERE'S A
COUPLE OF THINGS AND IT'S
PROBABLY BECAUSE THERE ARE
MULTIPLE DISPLAYS IN THE
GOVERNOR'S BUDGET THAT THE
CUSTOMER THAT CONFUSION. OF.
FOR EXAMPLE IN THE MULTI YEAR
DISPLAY YOU'LL SEE.
THIS HUGE CARRYING BALANCE AND
THAT MAKES IT LOOK LIKE THERE'S
A.
ALONG A HUGE RESOURCE BUT
THAT'S NOT PART OF THE
CALCULATION FOR. PROP FIFTY FIVE
SO I THINK PART OF THAT IS
BECAUSE OF THE MULTIPLE
DISPLAYS.
BUT THEY ARE REPRESENTING
DIFFERENT THINGS.
AND I'D BE HAPPY TO UP TO
PROVIDE MORE INFORMATION TO YOUR
STAFF AT THAT WOULD.
WHAT WOULD HELP TO?
?
UNDERSTAND THE CHART WELL IT'S
YES BUT THE WHOLE PURPOSE OF
THIS THIS HEARING IS FOR
EVERYBODY ELSE TO UNDERSTAND I
JUST ME GET MY PRIVATE. YOU KNOW
EXPLANATION SO I APPRECIATE AND
I'LL TAKE YOU UP ON IT BUT IS
THERE A MORE CONCISE WAY SO WE
CAN SAID SO THAT EVERYBODY ELSE
HUNDRED THAT'S THE WHOLE POINT
OF THESE HEARINGS THAT THAT
WERE.
YOU KNOW MAKING THE PUBLIC
UNDERSTAND WHY WE'RE DOING ALL
OF THESE AND IF I DON'T
UNDERSTAND AND I'M NOT YOU KNOW.
IN THE BUSINESS BUT I'D I FOR
CONFUSED I THINK MOST OF OUR
AUDIENCE IS CONFUSED AS WELL AND
SO. I APPRECIATE OUT TAKE YOU UP
ON IT BUT IF THERE ARE A OF MORE
CONCISE WAY OR MORE CLEAR WAY OF
EXPLAINING IT SO THAT EVERYBODY
UNDERSTANDS AND NOT JUST ME AND
MY STAFF.
I DON'T THINK THERE'S AN EASIER
WAY I'M THINK I'M I'M PICTURING
ARE ARE MULTI YOUR DISPLAY THAT
HAS THE SAME REVENUES BUT IT
DISPLAYS THEM DIFFERENTLY AND
THE DEFICIT THAT YOU SEE. OR THE
SURPLUS THAT YOU SEE WOULD BE
DIFFERENT AND.
THE PROPERTY FIVE CHART WILL
SHOW PIECES OF THE SAME
INFORMATION AND SO YOU YOU DON'T
SEE THE SAME THING ACROSS.
WELL WHY WOULD THIS NOT SET A
PRECEDENT THOUGH BEYOND THIS
ADMINISTRATION THAT FUTURE
ADMINISTRATIONS COULD MAKE.
SIMILAR OPTIONAL DEPOSITS
INTO FUNDS WHY IS THIS NOT
PRECEDENT SETTING.
FOR EVERY. ADMINISTRATION TO
WANT TO.
SEEMINGLY TAKE FUNDS AWAY FROM
MEDI CAL.
THIS SEEMS AS IF IT'S A
INDEPENDENT DECISION MADE FROM
ONE BRANCH OF THE LEGISLATURE
CONTRARY TO WHAT VOTERS INTENDED
TO BY SENDING US THIS MONEY. AND
I'D LIKE TO REALLY UNDERSTAND
AGAIN. WHAT WHY IS IT THAT WERE
HERE TODAY AND?
IS THEIR OPPORTUNITY FOR US TO
WORK FORWARD COLLABORATIVELY TO
ENSURE THAT.
WE ARE.
LISTENING TO VOTERS WHO SENT US.
THEY ARE FUNDS IN THE FIRST
PLACE.
I I WILL TAKE BACK THESE
CONCERNS ALUM. A I EIGHT THINK
AGAIN TO THE ADMINISTRATION'S
PROPOSAL WAS TO IF A SEPARATE
DECISION TO HAVE THAT ADDITIONAL
DEPOSIT BUT THEN. THE REVENUE
DISPLAY IS CONSISTENT ACROSS.
THE MULTIPLE PRODUCTS.
BUT WE WILL CONTINUE TO HAVE
CONVERSATIONS I WILL TAKE BACK
YOUR CONCERNS.
.
SEEING.
ANY FURTHER QUESTIONS FROM OUR
COLLEAGUES I THINK AT THIS TIME
WE WILL HOLD THIS ITEM OPEN AND
LOOK FORWARD TO PURSUING THOSE
CONVERSATIONS AS WE GO FORWARD.
WITH THAT WE WILL MOVE ON TO
ISSUE TO
.
LARA I LA DEPARTMENT OF FINANCE.
THE COUNTY ADMINISTRATION
FUNDING AS DOCTOR CAN'T EXPLAIN
EARLIER THE GOVERNOR'S BUDGET
PROPOSES AN INCREASE OF FIFTY
FOUR POINT EIGHT MILLION TOTAL
FUNDS EIGHTEEN POINT FIVE
MILLION GENERAL FUND.
IN TWENTY EIGHTEEN NINETEEN
BASED ON THE CALIFORNIA CONSUMER
PRICE INDEX PROJECTION AT THE
TIME OF THE TWENTY EIGHTEEN
NINETEEN GOVERNOR'S BUDGET
DEVELOPMENT. THE NEW ALLOCATION
COMBINES THE PREVIOUS ONE POINT
THREE. AT BILLION DOLLAR BASS
AND SIX HUNDRED FIFTY FIVE
MILLION A CA AUGMENTATION AND
THEN APPLY INCREASES IT
ACCORDING TO THE TWENTY EIGHTEEN
NINETEEN CPI PROJECTION.
WITH THIS INCREASE COUNTIES WILL
WORK TO PLACE BENEFICIARIES IN
THE CORRECT EIGHT CODES INCREASE
THE PERCENTAGE OF COMPLETED AND
ACCURATE ELIGIBILITY
DETERMINATIONS AND ANNUAL RE
DETERMINATIONS.
AND PROVIDE TIMELY ALLEGE
BILLION ENROLLMENT DATA AND
REPORTS TO THE DEPARTMENT AND
SIMILAR INCREASE WILL BE APPLIED
FOR AN ADDITIONAL TWO YEARS.
THANK YOU.
MISTER CHAIR AND MEMBERS KATHY
SAID NEARLY MADONNA WITH THE
COUNTY WELFARE DIRECTORS
ASSOCIATION WE DO SUPPORT THE
INCREASE THAT'S PROPOSE TODAY.
IT'S OUR UNDERSTANDING.
AND WERE IN SOME CONTINUING
DISCUSSIONS THAT IT'S INTENDED
TO BE AN ON GOING BASIS ON NOT
JUST THE TWO YEARS THAT WAS
NOTED IN THE.
IN THE AGENDA.
AND WILL LOOK TO CLARIFY THAT
HOPEFULLY AT THE MAY REVISE WE
DO THINK THE STATE MADE A REALLY
GOOD EFFORT TO TRY TO SEEK A
CONTRACTOR WE. ARE MORE ENGAGED
UNDER CONFIDENTIALITY TO HELP
WITH THINKING THROUGH WHAT WE
WOULD WANT A CONTRACTOR TO DO.
THEY MADE A GOOD EFFORT THE
PERSON THAT THEY WOULD WANT TO
HIRE WOULD NEED TO HAVE VERY
SPECIFIC KNOWLEDGE AND
UNDERSTANDING OF ELIGIBILITY
SYSTEMS OUR COMPUTER SYSTEMS.
HOW WE HOW WE DO THAT WORK AND
THE PERSON JUST WAS NOT
FORTHCOMING THEY TRIED AND THEY
YOU KNOW DID NOT FIND A
CONTRACTOR WHO CAN HELP DEVELOP
IN THE BUDGET METHODOLOGY? GIVEN
THE LATE NATURE OF IT AND THE
WE'VE BEEN PUTTING THAT OFF FOR
A NUMBER OF YEARS THEY PROPOSE
THIS APPROACH TO REINSTITUTE A
COST OF OF.
DOING BUSINESS ADJUSTMENT
ESSENTIALLY AND WE THINK THAT'S
AN APPROPRIATE APPROACH.
IT MAYBE IN THE FUTURE AS
THINGS SETTLE DOWN AT THE
FEDERAL LEVEL THAT WERE ABLE TO
KIND OF COME BACK TO THIS
CONVERSATION ABOUT WHETHER WE DO
NEED TO REDO FROM SCRATCH THAT
BUDGET METHODOLOGY BUT FOR NOW.
IT FEELS LIKE WE'RE DOING GOOD
WORK WERE VERY PROUD OF THE WORK
WE DO IN THE TWENTY THOUSAND
PLUS ELIGIBILITY STAFF THAT WE
HAVE THROUGHOUT THE COUNTIES. ON
BEHALF OF THE STATE I JUST WANNA
KNOW ONE THING THAT WERE STILL
ALSO INTO SOME DISCUSSIONS WITH
THE ADMINISTRATION ON.
IS A PART OF THE PROPOSAL IS
RELATED TO THE ANNUAL
REALLOCATION OF FUNDS FROM UNDER
SPENDING COUNTIES TO
OVERSPENDING COUNTIES.
WE'RE TALKING A FEW PERCENTAGE
POINTS ON THE MARGIN HERE THIS
HAPPENS AT THE CLOSE OUT IT'S A
COUPLE OF YEARS AT THE END OF
EACH FISCAL YEAR IT'S PRETTY
TECHNICAL IN NATURE. ON THE
PROPOSAL DOES INCLUDE
ELIMINATING THAT WE THINK YOU
CAN'T EVER QUITE GET A HUNDRED
PERCENT ON THE NOSE WHICH
COUNTIES TO ALLOCATE THE FUNDING
TO THERE'S ALWAYS GOING TO BE
SOME ADJUSTING THAT NEEDS TO BE
DONE. SO WE'VE BEEN IN SOME GOOD
CONVERSATIONS WITH THE
ADMINISTRATION ON THAT WE HOPE
TO GET RESOLVED BEFORE THE MAY
REVISE. JUST WANTED TO PUT A
NOTE IN IN CASE WE DO NEED TO
COME BACK FOR FOR SOME REASON
NOT ABLE TO FIT
GET THAT OUT BUT WE'RE CONFIDENT
THAT WE'LL BE ABLE TO WORK
TOGETHER TO TO WORK THROUGH
THAT.
OTHERWISE WE URGE YOUR SUPPORT
THANK YOU.
BELOW IN THE COMMENTS ON
INITIATIVE.
THANK YOU MISTER CHAIR I WILL
SEE WHAT THE LA SO WE DON'T HAVE
ANY SPECIFIC CONCERNS WITH THE
PROPOSAL AT THIS TIME BUT ACTIVE
DATA REPORTING AND.
COMPLETION UMKHONTO TIMELY
BASIS THE ADMINISTRATIVE
PROCESSES
AND AND AND IN CONNECTION WITH
THE FUNDING. GRIP.
BOB WILL TAKE PUBLIC COMMENT ON
ISSUE TO AT THIS TIME.
THANK YOU MISTER CHAIRMAN
MEMBERS MARK WINDOWS ON BEHALF
OF SEIU CALIFORNIA.
WE AS WELL ARE IN FAVOR OF THE
ADDITIONAL FUNDS THAT ARE BEING
ALLOCATED AND TO THE COUNTIES
FOR MEDI CAL ADMINISTRATION.
I JUST WANNA ECHO WHAT THAT THE
POINTS MADE BY MY COLLEAGUE FROM
C. WTA AND ALSO BELIEVE THAT
BECAUSE OF THE LACK OF SPECIAL
OF A SPECIALIZED CONTRACTOR. WE
TO AGREE THAT.
WITH THE ADMINISTRATION'S
APPROACH I'M RECOGNIZING COST
ISSUES AND WE ALSO APPRECIATE
THE ONGOING DISCUSSIONS ABOUT
THE REALLOCATION OF FUNDS.
AND THE ADMINISTRATION'S
OPENNESS TO FIGURING OUT THE
SOLUTION WITH US THANK YOU.
YOU.
MARY VALDEZ WHAT HEALTH ACCESS
WE SUPPORT THE COUNTIES HAVING
ENOUGH RESOURCES TO DO THE
IMPORTANT WORK OF DETERMINING
ELIGIBILITY AND ENROLLING PEOPLE
INTO MEDI CAL. WE ARE AWARE OF
THE DISCUSSIONS THAT ARE TAKING
PLACE AND WE ALSO HOPE.
THAT THIS AND I GUESS RESULT
THANK YOU.
IF YOU.
WITH THAT I'LL BRING IT TO THE
DIVESTMENT QUESTIONS WE HAVE.
SO DO AND I'VE HAD SEVERAL
CONVERSATIONS ABOUT THESE ISSUES
WITH COUNTIES AND IMPROVING THE
SYSTEMS AND IN THIS KIND OF GOES
TO THE LA US QUESTION.
ARE WE GONNA BE USING SOME OF
THE SPENDING.
TO ACTUALLY UPDATE THOSE SYSTEMS
TO HELP THOSE CASELOADS AND WITH
THE MANAGEMENT AND AND FINALLY
GET WITH THE TWENTY FIRST
CENTURY LIKE WE'VE DISCUSSED.
I DO HOPE SO I THINK AS YOU NOTE
IN THE.
IN THE ANALYSIS THAT THE
THINKING AS WE'RE MOVING TOWARD
A SINGLE STATEWIDE SYSTEM THAT'S
GONNA TAKE A FEW YEARS AGO TO
TAKE MORE THAN JUST TWO YEARS
WHICH HENCE MY COMMENT ABOUT I
THINK THIS IS KIND OF AN ONGOING
CONVERSATION AROUND.
ENSURING THAT WE GET THE COST
INCREASES THAT WE NEED THE
FUNDING FOR THE ACTUAL NEW
SYSTEMS OF THE IN A SEPARATE
BUDGET ITEM IT WOULDN'T BE HERE
EMBEDDED IN THIS BUDGET ITEM.
BUT WE ARE IN VERY CLOSE
CONVERSATIONAL WORKING A GOOD
PARTNERSHIP WITH THE
ADMINISTRATION TO GET THAT DONE.
AND WE'VE ALSO BEEN WORKING FOR
A FEW MONTHS.
ACTUALLY A NUMBER OF MONTHS TO
IDENTIFY AREAS WHERE WE CAN
IMPROVE.
ON OUR PROCESSING OF CASES THAT
WERE PRE AFFORDABLE CARE ACT
WE'VE HAD CASES THAT WERE UNDER
THE OLD RULES AND MAKING SURE
THAT WE BROUGHT THE MEN UNDER
THE NEW RULES WHICH IS A MORE
EFFICIENT AND GENERAL. AND SO ON
THAT SOME OF THE WORK THAT IS ON
BEING DONE WITH THE STATE RIGHT
NOW TO GENERATE LISTS FOR THE
COUNTY SO WE CAN. WORK THROUGH
THOSE AND GET THOSE OUT OF THE
ONE EIGHT CODE IN INTO THE
PROPER LONG GOING EIGHT CODE AND
TRY TO GET THAT CLEARED OFF THE
BOOKS SO I THINK BOTH FROM AN IT
PERSPECTIVE. AND ALSO FROM SORT
OF A MANAGING THE CASELOAD
PERSPECTIVE WE'VE GOT.
IRONS AND BOTH FIRES THERE.
IT SOUNDS LIKE YOU'RE ON THE
RIGHT TRACK FINALLY.
ANY FURTHER QUESTIONS.
SEEING NONE SUBCOMMITTEE STAFF
HAS RECOMMENDED HOLDING THIS
ITEM OPEN AND WE WILL TAKE NO
ACTION AT THIS TIME MOVE ON TO
ISSUE THREE
.
SO.
FOR PROPOSITION FIFTY SPECS.
AS YOU KNOW.
THERE WAS A NEGOTIATION.
LAST YEAR BETWEEN THE
ADMINISTRATION AND THE
LEGISLATURE AND HOW TO USE THOSE
FUNDS ON THEY ARE STRUCTURED AS
ONE YEAR SUPPLEMENTAL PAYMENTS.
THERE WAS MONEY THAT WAS.
DEDICATED FOR OUR HIV WAIVER
AGENCIES THERE WAS.
FUNDING FOR ICF DD'S THERE WAS
A I'M SIGNIFICANT RATE INCREASES
FOR.
.
WOMEN'S HEALTH
AND THEN THERE WAS PHYSICIAN AND
A PENCIL RATE INCREASE THE ODDS
I THINK YOU KNOW WE'RE STILL
GOING THROUGH THE PROCESS AND.
CERTAINLY WOULD ACKNOWLEDGE
THAT IN ORDER TO ACHIEVE THE
SUPPLEMENTAL PAYMENTS THEY
REQUIRE BOTH ADMINISTRATIVE
INTERNAL SYSTEMS CHANGES TO OUR.
COMPUTER SYSTEMS BUT THEY ALSO
REQUIRE.
APPROVALS AT THE FEDERAL LEVEL
AND SO YOU KNOW WE HAVE BEEN
MOVING ALL OF THOSE DIFFERENT
PIECES ALONG THE FIRST ONE THAT
WAS THE EASIEST TO DO WITH HIV.
WAIVER AGENCY INCREASE THAT WAS
A WAIVER AMENDMENT AND THAT WAS
VERY QUICKLY DONE.
THE ONES THAT HAVE TAKEN A LOT
LONGER WORD THE DIRECTED
PAYMENTS.
FOR PHYSICIANS SERVICES AND
DENTAL SERVICES BECAUSE WE ARE
HAVING TO FLOW THOSE
SUPPLEMENTAL PAYMENTS THROUGH
OUR MANAGED CARE PLANS AND THAT
ALSO COINCIDED AT THE TIME THAT
WE WERE SEEKING NOT APPROVAL. IT
COINCIDED WITH THE
IMPLEMENTATION OF THE FEDERAL
MANAGED CARE ROLE IN WHICH WAS A
NEW STRUCTURE ALTOGETHER AND SO
WE JUST RECENTLY RECEIVED
APPROVAL FROM THE FEDERAL
GOVERNMENT ON THE DIRECTED
PAYMENTS FOR THE PHYSICIAN
RATES.
THROUGH THE MANAGED CARE PLANS
ALL THAT BEING SAID IS THAT.
EVERYTHING ALWAYS TAKES LONGER.
EVEN WHEN WE'RE MOVING AS FAST
AS POSSIBLE.
WE CERTAINLY.
WILL BE FLOWING THOSE FUNDS
BACK
TO JULY FIRST AND SO EVEN
THOUGH.
DEPENDING ON WHO THE PHYSICIAN
IS AND WHAT THOSE SERVICES WERE.
ANYTHING THAT THEY PROVIDED
AFTER JULY FIRST WILL HAVE THAT
SUPPLEMENTAL PAYMENT.
PROVIDED TO THEM AND SO I THINK
ON AN ONGOING BASIS WERE
CERTAINLY.
TRYING TO SMOOTH THE PATH
ON IT.
BECAUSE WE WILL HAVE TO SEEK
NEW ANNUAL APPROVALS ON A YEAR
BY YEAR BASIS EVEN IF NOTHING IS
CHANGED WE WOULD HAVE TO GO AND
GET THAT APPROVAL AND SO I
THINK.
.
ONE OF THE WAYS THAT WE'LL TRY
TO DO THAT IS TO ANTICIPATE AND
OR BE TALKING TO OUR FEDERAL
COLLEAGUES.
I'M IN ADVANCE AND CERTAINLY THE
MORE COMFORTABLE THEY ARE WITH
DOING THESE PAYMENTS THAT WILL
HOPEFULLY GET EASIER. THAT
NEWEST ON PROPOSAL THAT WAS
INCLUDED IN THE GOVERNOR'S
BUDGET I'M USING PROPOSITION
FIFTY SIX WHICH I SPOKE TO
EARLIER. IS THAT FIFTY PERCENT.
RATE INCREASE FOR THE HOME
HEALTH AGENCIES IN OUR FEE FOR
SERVICE POPULATION AS WELL AS IN
OUR WAIVER PROGRAMS.
AND SO OVERALL GIVEN ALL OF
THOSE DIFFERENT FUNDING AS I
NOTED IT WOULD BE ABOUT TWO
BILLION DOLLARS TOTAL FUNDS THAT
WE WOULD BE PROVIDED IN THESE.
PARTICULAR CATEGORIES.
WE ARE HOPING THAT WE CAN
PROVIDE MORE DETAILED DATA.
WITH THE GOVERNOR'S NAY
REVISION AROUND SOME OF THE
UTILIZATION AND EARLY.
ENCOUNTER DATA THAT WE ARE SEEN
WITH THESE PROVIDERS IN THESE
VARIOUS CATEGORIES OBVIOUSLY DUE
TO THE NATURE OF THE CHANGES
THAT WE HAVE TO MAKE AND THEY'LL
AND APPROVAL DELAY.
WE ARE HOPING THAT THAT DATA
WILL BE ENOUGH TO DEMONSTRATE.
HOPEFULLY PROGRESS THAT AND TO
ACHIEVE AS YOU ARE SO.
GET IT SAYING YOU KNOW DID WE
ACCOMPLISH WHAT THE VOTER SET
OUT TO DO WITH THESE PROPOSITION
FIFTY SIX PAYMENT SO WE'LL BE
LOOKING AT A COUPLE OF KEY. DATA
INDICATORS WILL BE LOOKING AT
ENCOUNTER DATA WHICH IS YOU KNOW
DID ADDITIONAL SERVICES GET
PROVIDED UNDER THE SPECIFIC
SERVICES.
WE WILL CERTAINLY BE LOOKING TO
SAY DID ADDITIONAL PROVIDERS
JOIN THE PROGRAM TO PARTICIPATE
IN A MEDICAL PROGRAM BECAUSE OF
THE SUPPLEMENTAL PAYMENTS. SO
THERE'S GOING TO BE SOME KIND OF
NOTABLE.
BENCHMARK PIECES OF DATA THAT
WE HOPE TO BE ABLE TO PROVIDE
YOU ON IN THE NAY REVISION.
TO HEAR FROM THE REST OF THE
PATH WE CAN DEPARTMENT OF
FINANCE LA JOH WESTERN CENTER
MISTER CHAIR WITH AN OPEN MIND
BECAUSE WITH THE DEPARTMENT OF
FINANCE WOULD LIKE TO KNOW
CONSISTENT WITH THE AGREEMENT
LIKE I'M DIRECTOR CAN'T MENTION.
IN BUT YOU WE ARE INCREASING
PROVIDER PAYMENTS UP TO EIGHT
HUNDRED.
MILLION DOLLARS IN PROPOSITION
FIFTY SIX.
OF FUNDS.
TOTAL FUNDS IS ABOUT TWO POINT
TWO BILLION DOLLARS SO.
AT.
INCLUDING THE FEDERAL PIECE.
ARI GOVERNOR'S BUDGET HAS UP
EXPENDITURE PROJECTIONS BASED ON
THE PAYMENTS WILL GO OUT.
INTO WANTED TO CLARIFY THAT
BEFORE WE GOT DEEPER INTO THE
CONVERSATION THANK YOU.
I'VE BEEN JOHNSON WITH THE
LEGISLATIVE ANALYST'S OFFICE BUT
WE CONDUCTED A REVIEW OF THE
GOVERNOR'S PROPOSITION FIFTY SIX
PROPOSAL AND FOUND THAT IT IS
ESSENTIALLY CONSISTENT WITH THE
TWENTY SEVENTEEN EIGHTEEN BUDGET
AGREEMENT ON THE USE OF
PROPOSITION FIFTY SIX FUNDING.
US DEPARTMENT OF FINANCE AND I'M
THE DIRECTOR OF SAID THE
PROPOSAL IS TO SPEND THE FULL
ONE POINT THREE FOUR SIX BILLION
DOLLARS ON PROVIDER PAYMENT
INCREASES. AS.
IN THE SERVICE IN PROVIDER
CATEGORIES THAT WERE INCLUDED IN
THE DEAL I THINK THERE COULD BE
SOME FLEXIBILITY AROUND THAT.
GOING FORWARD BUT.
DE THEIR PROPOSAL IS
ESSENTIALLY CONSISTENT.
WE ESTIMATE THAT ABOUT FIVE
HUNDRED AND TWENTY THREE MILLION
DOLLARS AYE IS AVAILABLE TO FUND
NEW PROVIDER PAID.
PAYMENT INCREASES UNDER THE
GOVERNOR'S PROPOSAL AND THAT IS
ATER THE PROVIDER PAYMENT
INCREASES THAT WERE STRUCTURED
IN THE TWENTY SEVENTEEN EIGHTEEN
AGREEMENT ARE FULLY PAID FOR.
A AND THIS FIVE HUNDRED TWENTY
THREE MILLION DOLLARS REFLECTS A
COUPLE OF DIFFERENT THINGS ONE
THAT REFLECTS THE PROPOSED
INCREASE BETWEEN TWENTY
SEVENTEEN EIGHTEEN AND TWENTY
EIGHTEEN NINETEEN.
IN TERMS OF HOW MUCH UP
PROPOSITION FIFTY SIX FUNDING
GOES TO PROVIDER PAYMENT
INCREASES AND SECOND IT RECALL
IT REFLECTS SOME ARE FREED UP
FUNDING BECAUSE.
THE GOVERNOR'S BUDGET HAS
LOWERED THE ESTIMATED COSTS AT
LEAST TO THE STATE OF THE
PROVIDER PAYMENT INCREASES THAT
WERE STRUCTURED IN THE TWENTY
SEVENTEEN AGREEMENT.
THE GOVERNOR'S PROPOSAL WHILE
IT DOES DEDICATE THIS FUNDING TO
PROVIDE A PAYMENT INCREASES AYE
IT DOESN'T HAVE A DETAILED. A
SPENDING PLAN FOR WHERE TO
ALLOCATE THIS FUNDING TOWARDS A
SET OF SERVICES OR OR OR OR
PROVIDERS IT GENERALLY WOULD
ALLOCATE THEM AMONG THE. DENTIST
IN PHYSICIAN CATEGORIES BUT BUT
THERE ARE NO SPECIFIC SAY
PROCEDURE CODES FOR WHICH THIS
WOULD FUND AND OUR UNDERSTANDING
IS THAT.
DID ADMINISTRATION BUT
INTENTIONALLY LEFT THE DETAILS
OUT UP TO BE WORKED OUT WITH THE
LEGISLATURE.
IN TERMS OF HOW THIS FUNDING
WOULD ULTIMATELY BE ALLOCATED
AND THIS REALLY PROVIDES AN
OPPORTUNITY FOR THE LEGISLATURE
A TO PROVIDE INPUT AND HOW TO
TARGET THE THESE RESOURCES.
TO AND IMPROVE SERVICES AND AND
ACCESS WITHIN THE MEDICARE
PROGRAM.
THANK YOU.
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY AYE IN LIGHT OF
THE DOCUMENT AND ACCESS ISSUES
WITH THE DAN ECHO PROGRAM WE DO
SUPPORT THAT SUPPLEMENTAL
PAYMENTS TO DANTICAT. PROVIDERS
I IN PARTICULAR WE REQUEST THAT
BASIC PREVENTIVE SERVICES BE
ELIGIBLE FOR SUPPLEMENTAL
PAYMENTS AT MAINTENANCE IS
ALWAYS PREFERABLE TO HAVING TO
RESTORE TEETH. AND IN ADDITION
THEY MAKE THIS MAY SAVE THE MEDI
CAL PROGRAM IN THE LONG RUN. UP
IN ADDITION TO ENSURE THAT COME
TREATMENT THE RESTORATION OF GUM
TREATMENT THAT.
THAT I WAS RECENTLY AND INCLUDED
IN THE BUDGET. ARE.
ACTUALLY UTILIZED WE REQUEST
THAT BUT GUM TREATMENT BE
ELIGIBLE FOR SUPPLEMENTAL
PAYMENTS A THERE'S A STRONG AND
GROWING EVIDENCE THAT. THAT THE
RELATIONSHIP BETWEEN COURT GUM
HEALTH AND MEDICAL PROBLEMS
INCLUDING HIGH DIABETES AND
HEART DISEASE I'M THERE'S A
STRONG CORRELATION THERE.
I IN ADDITION A WEEK WE DO
SUPPORT THAT THE
ADMINISTRATION'S PROPOSAL TO
INCREASE THAT THE HOME HEALTH
UP.
RATE AND AS I'M SURE OTHERS WILL
BE SPEAKING ABOUT SHORTLY
THINKING.
THANK YOU.
HI AM JANICE CANAL AND I'M WITH
THE CHILDREN'S DEFENSE FUND
CALIFORNIA AND I'M REPRESENTING
THE CALIFORNIA CHILDREN'S HEALTH
COVERAGE COALITION. WHICH ALSO
INCLUDES CHILDREN NOW THE
CHILDREN'S PARTNERSHIP UNITED
WAYS OF CALIFORNIA AND THE
CALIFORNIA COVERAGE AND HEALTH
INITIATIVES.
I'M HERE TO SPEAK ON BEHALF OF
THE FIVE POINT SEVEN MILLION
CHILDREN AND MEDI CAL WHO NEED
ACCESS TO THE FULL RANGE OF
PREVENTIVE AND SPECIALTY
SERVICES.
LIKE THE VOTERS TO PASS
PROPOSITION FIFTY SIX AND TWENTY
SIXTEEN WE SUPPORT THE GOALS OF
THETARGETED SUPPLEMENTAL
PAYMENTS FOR MEDI CAL POSITION
AND DENTAL SERVICES IN ORDER TO
INCREASE PROVIDER PARTICIPATION.
IN THE MEDI CAL AND TEND TO CALL
PROGRAM AND INCREASE ACCESS TO
SERVICES FOR BENEFICIARIES.
CHILDREN MAKE UP A SIGNIFICANT
SHARE OF ALL MEDI CAL ENROLLEES
AND THEY HAVE UNIQUE HEALTH CARE
NEEDS THAT ARE NOT REFLECTED IN
AN ADULT MODEL OF CARE.
AND THAT'S EFFORTS TO INCREASE
ACCESS TO SERVICES FOR MEDI CAL
BENEFICIARIES LIKE PROP FIFTY
SIX
SUPPLEMENTAL PAYMENTS SHOULD BE
DIRECTED TOWARDS CHILDREN'S
UNIQUE HEALTH CARE NEEDS.
RATHER THAN ASSUMING THERE
ACCESS AND CARE IS CONGRESS.
WITH ADULT MEDI CAL POPULATIONS.
WE'RE CONCERNED THAT THE CURRENT
LIST OF PHYSICIAN SERVICES
ELIGIBLE FOR THE PAYMENTS MISSED
AN OPPORTUNITY.
TO REALIZE THE PROPERTIES
SCHOOLS.
FOR MOST CHILDREN AS MANY OF THE
COATS ARE SKEWED TOWARDS
EPISODIC CARE FOCUSED ON PROBLEM
ORIENTED EVALUATION AND
MANAGEMENT SERVICES.
BUT CHILDREN SOMETIMES RECEIVE
THIS TYPE OF EPISODIC CARE THE
PREDOMINANT CARE FOR CHILDREN IS
MORE ROUTINE DEVELOPMENTAL AND
PREVENTION FOCUSED.
IMPORTANT PEDIATRIC PREVENTIVE
SERVICE UNDER THE EARLY PERIODIC
SCREENING DIAGNOSTIC AND
TREATMENT BENEFIT WERE LEFT OUT
OF THE POTENTIAL ACCESS AND
UTILIZATION ENHANCEMENTS. UNDER
THE PROP FIFTY SIX SUPPLEMENTAL
PAYMENTS.
THESE PREVENTIVE SERVICES
INCLUDE WELL CHILD VISITS HEALTH
SCREENINGS.
IMMUNIZATION ADMINISTRATION.
AND FLUORIDE VARNISH APPLICATION
BY PHYSICIANS.
ACCORDING TO AVAILABLE DATA
MEDICAL PERFORMS BELOW THE
NATION'S AVERAGE IN PROVIDING
EPS DE T. SCREENINGS FOR
CHILDREN.
ONLY FORTY TWO PERCENT OF KIDS
AND MEDI CAL WHO RECEIVE AT
LEAST ONE INITIAL.
OR PERIODIC SCREENING THAT THERE
WERE THAT THEY WERE SUPPOSED TO
COMPARED TO FIFTY PERCENT
NATIONALLY ACCORDING TO TWENTY
SIXTEEN DATA.
SUGGESTING THAT THERE IS AN
IMPERATIVE FOR THE STATE TO
DIRECTLY INVESTING AUGMENTATIONS
TO CHILDREN'S PREVENTATIVE
HEALTH.
WELL PROP FIFTY SIX SUPPLEMENTAL
PAYMENTS ALONE OF COURSE ARE NOT
A PANACEA TO IMPROVING ACCESS
AND UTILIZATION FOR CHILDREN.
LEAVING THEM OUT COULD CAUSE
MORE DISRUPTIONS AND EXACERBATE
DISPARITIES.
TO THAT END WE STRONGLY URGE THE
LEGISLATURE AND D. H. YES TO
CLOSELY CONSIDER HOW A PORTION
OF THE ESTIMATED FIVE HUNDRED
AND TWENTY THREE MILLION IN
TOTAL NEW PROPOSITION FIFTY SIX
FUNDING.
AVAILABLE FOR ADDITIONAL
PROVIDER PAYMENTS CAN BE USED
FOR TARGETED INCREASES.
IN PEDIATRIC PREVENTIVE SERVICES
SO THAT CHILDREN AND MEDICARE
CAN REALIZE THE PROPOSITION
FIFTY SO
SCHOOLS TO IMPROVE ACCESS FOR
THEIR CARE.
WE ALSO SUPPORT A STRINGENT
EVALUATION METHODOLOGY THAT
LOOKS AT HOW WELL THE PAYMENTS
ARMENIAN PROP FIFTY SIX GOALS
FOR CHILDREN AS WELL AS ADULTS
THANK YOU. THANK YOU.
WILL NOT TAKE PUBLIC COMMENT ON
ISSUE THREE AT THIS TIME.
CAN REALLY CHECK OUT THE
NETWORK WE WOULD WANT OURSELVES
OF THE COMMENTS ARE. A
COLLEAGUES AT THE WESTERN CENTER
ON LAW AND POVERTY INSURE THAT
PREVENTIVE SERVICES ARE ALSO
ELIGIBLE FOR SUPPLEMENTAL
PAYMENTS AS LONG WITH ALONG WITH
COMPARTMENTS THANK YOU.
THANK YOU.
HELLO ON A HOUSE ABOUT WITH YOU
IN THE UNITED REYES A CALIFORNIA
ECHOING THE COMMENTS OF OUR
COLLEAGUE AT CDF I'M ALSO ON
BEHALF OF THE CALIFORNIA
CHILDREN'S. HEALTH COVERAGE
COALITION WE SUPPORT THE GOALS
OF THE TARGETED SUPPLEMENT
PAYMENTS FOR MEDICAL PHYSICIANS
AND DENTAL SERVICES HOWEVER THE
CURRENT LIST OF PHYSICIANS
SERVICES ELIGIBLE FOR THESE
PAYMENTS ARE CENTERED ON THE
EPISODIC CARE PRIMARILY AROUND.
PROBLEM ORIENTED EVALUATION AND
SERVICES THIS FOCUS.
IS POTENTIALLY MISSING THE MORE
ROUTINE DEVELOPMENTAL AND
PREVENTION FOCUSED CARE WHICH IS
THE PREDOMINANT FORM OF CARE FOR
CHILDREN. CONSIDERING THE
CHILDREN MAKE UP A SIGNIFICANT
SHARE OF MEDI CAL WITH FIVE
POINT SEVEN MILLION ENROLLEES
IT'S IMPORTANT TO REFLECT THEIR
UNIQUE HEALTH CARE NEEDS. AS WE
INVEST IN SMART PROVIDER
PAYMENTS THANK YOU THANK YOU.
MARY VALDEZ OF HEALTH ACCESS ON
DENTAL.
WE ECHO THE COMMENTS FROM OUR
COLLEAGUES AT WESTERN CENTER AND
URGE THE LEGISLATURE TO MAKE
BASIC PREVENTIVE AND GUN
TREATMENT DENTAL SERVICES
ELIGIBLE FOR SUPPLEMENTAL
PAYMENTS.
ON HOME HEALTH WE ARE PLEASED
TO SEE THE ADMINISTRATION
ACKNOWLEDGE THAT ACCESS IS A
CHALLENGE.
FOR SOME MEDICARE BENEFICIARIES
WHO RELY ON HOME HEALTH AND
ENCOURAGE THE LEGISLATURE TO
EVALUATE UTILIZATION OF THE
PROGRAM TO SEE HOW THESE
PAYMENTS CAN BE BEST TARGETED.
TO IMPROVE ACCESS FOR THESE
BENEFICIARIES.
ON PROP FIFTY SIX.
YOU KNOW HEALTH ACCESS WAS ONE
OF THE ORGANIZATIONAL SPONSORS
OF THE MEASURE HELPED DRAFT THE
INITIATIVE AND ACTIVELY
CAMPAIGNED FOR THE MEASURE. THE
ELLIOT ESTIMATES THAT THE
GOVERNOR'S BUDGET MAKES FIVE
HUNDRED TWENTY THREE MILLION
MORE AVAILABLE FOR RATE
INCREASES THAN LAST YEAR'S
BUDGET. AND GOING FORWARD THESE
INVESTMENTS IN ANY ADDITIONAL
INCREASES IN PROVIDER RATES
SHOULD BE DIRECTED TOWARD
SPECIFIC PROVIDERS SERVICES
GEOGRAPHIC REGIONS THAT WILL
RESULT IN SUBSTANTIVE MEASURE
MEASURABLE GAINS. IN PATIENTS
ACCESS TO CARE AND IMPROVE THE
QUALITY OF CARE PROVIDED TO
MEDICARE BENEFICIARIES SO WE
REQUEST THAT THE LEGISLATURE.
REQUIRE THE ADMINISTRATION TO
EVALUATE WHETHER LAST YEAR'S
RATE INCREASES A WERE THE BEST
WAY TO IMPROVE ACCESS TO CARE.
AND LASTLY YOU KNOW IN ADDITION
TO MAKING TARGETED PROVIDER RATE
INCREASES WE REQUESTED THAT THE
LEGISLATURE CONSIDER USING
THESE.
ADDITIONAL FUNDS TO AUGMENT AND
IMPROVE THE MEDICAL PROGRAM IN
OTHER WAYS SUCH AS EXPANDING
COVERAGE TO UNDOCUMENTED ADULTS
OR RESTORING THE REMAINING
OPTIONAL MEDICAID BENEFITS THAT
WERE CUT. DURING THE RECESSION
THANK YOU.
KATIE LADEN ON BEHALF OF THE
CHILDREN SPECIALTY CARE
COALITION IN SUPPORT OF THE
ADDITIONAL TWO HUNDRED AND
THIRTY TWO MILLION DOLLARS THEN
PROP FIFTY SIX REVENUE. TOWARD
SUPPLEMENTAL PAYMENTS FOR
PHYSICIAN AND DENTAL SERVICES
AYE WE FEEL THESE PAYMENTS WILL
HAVE A POSITIVE IMPACT ON ACCESS
TO PEDIATRIC CARE AND WOULD
ENCOURAGE THE DEPARTMENT TO
ALLOW AMPLE TIME FOR THE RATES
TO TAKE EFFECT BEFORE CONDUCTING
THEIR ANALYSIS. AND WERE ALSO
HERE IN A VERY STRONG SUPPORT OF
THE FIFTY PERCENT RATE INCREASE
FOR HOME HEALTH SERVICES.
THANK YOU.
HUG THAT AFTERNOON BRING ACROSS
HIM BEHALF THE CALIFORNIA
ASSOCIATION FELL SERVICES AT
HOME.
WE'RE REALLY STRONG SUPPORT OF
THE PA HOME HEALTH FIFTY PERCENT
RATE INCREASE.
AMONG BE BRIEF RUNNING ALONG
COMMITTEE BY REALLY JUST WANT TO
SAY THAT WE DO BELIEVE THAT
THERE IS A BIG GAP BETWEEN OUR
HOURS AUTHORIZES AN HOUR'S
RENDERED. WITHIN THIS TO REALLY
HELP THAT MP MORE PROVIDERS
INSTANTLY THINK VERY MUCH THANK
YOU.
HI SIMONE SHEKINAH WITH ALWAYS
HOMEOWNERS SCENE AND WE PROVIDE.
MEDI CAL HOME HEALTH SERVICES
THROUGHOUT.
NORTHERN CALIFORNIA.
ON BEHALF OF ALL OUR PATIENTS
THAT MEDI CAL PATIENTS
SPECIFICALLY THAT AREN'T
RECEIVING SERVICES.
AS WELL AS THE NINETY CLIENTS WE
HAVE ON OUR WAITING LISTS WE
STRONGLY SUPPORT THE RATE
INCREASE THANKS. THANK YOU AND
THANK YOU FOR WHAT YOU DO.
MISTER CHAIRMAN MEMBERS TERRY
CALLIER HILL ON BEHALF OF ANY OP
CHILDREN'S HOSPITAL OAKLAND WE
ARE IN STRONG SUPPORT OF THE
GOVERNOR'S PROPOSAL TO. RAISE
THE HOME HEALTH NURSING RATES BY
FIFTY PERCENT WE HAVE A LOT OF
PATIENTS THAT ARE IN OUR
HOSPITAL I'D THAT HAVE BONE
MARROW TRANSPLANTS IN THEIR VERY
COMPLEX OUGHT TO CARE FOR
PATIENTS AS YOU KNOW WHEN
THEY'RE IN THE HOSPITAL FOR
SEVERAL MONTHS. AND WE WERE
HAVING DIFFICULTY FINDING A
PLACEMENT FOR THEM TO TO THE
LOWER RATES SO THIS GOES A LONG
WAY IN ENSURING THAT THOSE
PATIENTS CAN BE SENT HOME WITH
THEIR FAMILIES WHERE THEY NEED
TO BE WHEN THEY'RE WELL. THANK
YOU SO MUCH THANK YOU.
I GOOD AFTERNOON BRANAGH PITTMAN
SPONSOR WITH THE CALIFORNIA
DENTAL ASSOCIATION JUST WANNA
SAY THAT WE ARE VERY PLEASED AT
THE GOVERNOR'S PROPOSED BUDGET
DOES INCLUDE ON THE FUNDING FOR
THE SUPPLEMENTAL RATES AND TEN
AND FOR DENNIS AND POSITIONS.
AGREED TO IN LAST YEAR'S BUDGET.
AND MORE.
SO OUR MAIN ASK FOR YOU TODAY
WOULD JUST BE STABILITY ADD THE
WAY I THINK WAS DISCUSSED
EARLIER THAT THERE'S A SPA AND
THAT WILL AND ON THE END OF
JUNE.
AND SO I THINK THE BEST WAY TO
AND BE VERY COUNTERPRODUCTIVE
AND MAKE SURE THESE RATES DON'T
WORK IS TO HAVE THEM START AND
STOP AND START AGAIN. EYES WE
JUST REALLY WANNA MAKE SURE THAT
THERE'S A WAY TO CONTINUE THESE
SO WE DON'T HAVE DENNIS WHO ARE
DOING WHAT WE WANT THEM TO DO
WHICH IS YOU KNOW TAKING MORE
DENTICLE PATIENTS GETTING BACK
INTO THE PROGRAM. WHO THEN ALL
OF A SUDDEN CD'S RATES ARE OF
STOP INCOME WONDER WHAT WHAT THE
HECK IS GOING ON HERE?
WE DO AGREE THAT PREVENTION AND
PERRY O. OUT DUMB DISEASE
TREATMENT HOULD BE PRIORITIZE
AS THE DEPARTMENT IS I'M.
LOOKING AT WHERE TO SPENDTHESE
DOLLARS NEXT AND WANT TO BE A
PART OF THOSE CONVERSATIONS.
AND THEN I THINK WE ALSO WANNA
MAKE SURE WE'RE NOT UNDER
SPENDING ON THE WE ARE AIMING TO
HIT THOSE NUMBERS THAT WE PUT
OUT THERE BOTH IN THE CURRENT
YEAR AND NEXT YEAR. AND WE'RE
VERY MUCH LOOKING FORWARD TO THE
EVALUATION I THINK WE WOULD NOTE
THAT.
THE RATES DIDN'T START AND YOU
KNOW GETTING TO DENNIS AND
TALKING ABOUT DECEMBER.
AND AGAIN I THINK WITH THIS
CONCERN ABOUT IF THEY'RE
STARTING AND STOPPING AND HOW
YOU KNOW HOW LONG IT'S REALLY
GONNA TAKE TO MAKE. I'M A BIG
INCREASE BECAUSE WE ARE ON VERY
OPTIMISTIC
THANK YOU THANK YOU.
TURN MEMBERS KATHY MUST WORK ON
BEHALF OF SIMPLY DISGRACEFUL
NATION AS WILL THE DEVELOPMENTAL
SERVICES NETWORK WANT TO THANK
THE DEPARTMENT AS WELL AS THE
LEGISLATURE. FOR INCLUDING IN
CONTINUING TO INCLUDE THE RATES
FOR ICF TO DIS AGES AND ENDS AS
WELL AS THE HIV WAY FOR.
AS AS ON THE DIRECTOR SAID EACH
OF YOU WAVER HAS GONE INTO
EFFECT WE ARE NOW JUST RECENTLY
GETTING SUPPLEMENTAL RATES FOR
THE ICF DD'S AND WE WOULD SAY
BEFORE DOING ACCESS STUDY WOULD
LIKE TO HAVE SOME TIME. BUT
OBVIOUSLY BEFORE THIS WE WERE
SEEING A NUMBER OF FACILITIES
LOOKING AT CLOSURE. AND ONCE WE
WERE ABLE TO SECURE THE US THERE
NOW BE ABLE TO STAY OPEN SO
THINKING.
THANK YOU.
SEEING NO FUTHER PUBLIC COMMENT
ON BRING IT UP TO THE GUYS FOR
ANY QUESTIONS REMAIN. GETS JUST
SOME CLARIFICATION PLEASE.
ON HERE.
.
IS THE UNDER SPENDING BECAUSE
THE THE REIMBURSEMENTS DIDN'T
START UNTIL DECEMBER. OF I HAVE
YOUR THAT.
THE ACCORDING TO THE BUDGET WE
HAD A HUNDRED AND FORTY MILLION
DOLLARS HEALTHCARE TREATMENT
FUND. AND AND RIGHT NOW THE
ESTIMATE IS THAT WOULD ONLY
SPEND SEVENTY EIGHT POINT EIGHT
MILLION IS THAT BECAUSE WE
STARTLED DECEMBER.
JUST I THINK IT'S DEPARTMENT
FINANCE THERE ARE A NUMBER OF
REASONS FOR THE DELAY IN THE
TIMING.
SOMEONE OF WHICH BEING THAT THE
DEPARTMENT HEALTHCARE SERVICES
ON A CASH BUDGET.
THERE WERE SEVERAL A TECHNICAL
AYE DELAYS AND BECAUSE IT IS
BECAUSE THERE'S A BRAND NEW
PROGRAM THE ARE CLAIMING PROCEED
OUR PROCEDURES THE TECHNICAL
UPGRADES HAVE YOU MADE ORDER TO
PROCESS THE PAYMENTS. AS WELL AS
WAITING FOR APPROVAL FROM THE
FEDERAL GOVERNMENT FOR THE
PAYMENTS TO GO OUT BUT AS
DIRECTOR KENT MENTIONED.
.
THESE PAYMENTS WILL BE
RETROACTIVE TO JULY FIRST SO TO
THE EXTENT THAT WE ARE ABLE TO
OF THE DEPARTMENT IS ABLE TO
GET.
UP AND GOING IN PROCESSING THESE
PAYMENTS I'M WE AND DO
ANTICIPATE THAT ALL OF THE AYE
PAYMENTS THAT HAVE COME IN SO
FAR WILL BE RETROACTIVELY
PROCESSED BEFORE JUNE THIRTIETH
OF TWO THOUSAND EIGHTEEN. FOR
FISCAL YEAR TWO THOUSAND
SEVENTEEN EIGHTEEN SO AND THAT
THE NUMBER THAT YOU CITED BY
THOSE IN THE AGENDA THAT IS OUR
BEST.
ESTIMATE FOR THE BEST FORECAST
THAT WE HAVE AT THIS TIME WE
WILL BE UPDATING THESE THAT MAY
REVISION DEPENDING ON WHAT THE
ACTUAL DATA THAT WE'RE SEEING.
AND I IN ENGAGING WITH
STAKEHOLDERS ABOUT HOW THIS
PROCESS IS GONE SO FAR AS WE
WILL HAVE UPDATED INFORMATION AS
SOON AS THAT DATA IS AVAILABLE.
.
SO THOSE ARE SOME OF THE. ISSUES
THAT THE DEPARTMENT AND THE
ADMINISTRATION HAVE BEEN WORKING
THROUGH TO GET THIS BRAND NEW
PROGRAM UP AND RUNNING.
WE JUST SAW THAT WE CAN GET SOME
CLARIFICATION THE PROGRAM IS UP
AND RUNNING AND IS WORKING FINE
SO WE'RE NOT DAM NEXT YEAR SAY
THAT IT. YOU KNOW WE DIDN'T DO
THIS BECAUSE THE PROGRAM WAS A
MARKET.
I'M NOT TO MY KNOWLEDGE.
I THINK.
ANY FURTHER QUESTIONS ON THE
SIDE.
JUST LIKE THAT I WANT TO SEE
WHAT THIS LOOKS LIKE IN THE MAY
REVISE WITH THAT FULL FUNDING
EXPENDITURE FOR THE.
PREVENTIVE WITH THAT GALLON ALL
THE DENTAL AND EVERYTHING
BECAUSE IT'S IMPORTANT THAT WE
GET THAT FOR THE KIDS.
SOMEONE TO SEE WITHOUT ACTUALLY
LOOKS LIKE IN WITH THE
PROJECTIONS.
AND MAKE SURE THOSE MONIES GO
THERE WHERE THEY NEEDED ME.
CAN WE DESCRIBE THE PROCESS A
LITTLE BIT OF WORKING THROUGH
HOW WE CAN COLLABORATE TOGETHER
TO INSURE THAT THE SPENDING IS
MATCHING. OUR MUTUAL PRIORITIES
AND IF I CAN ECHO THE COMMENTS
OF WANTING TO ENSURE PREVENTIVE.
SPENDING. IN ADDITION TO OUR
PROVIDER RATE INCREASES AS A
MECHANISM FOR US TO SAVE MONEY
TO THE SYSTEM OVERALL.
SURE MAYBE I'LL I'LL START NOW
LOOK TO FINANCE IN THE EARLIER
TO. CHINA AND.
SO EACH OF THE DIFFERENT
PROVIDER CATEGORIES THAT ARE
RECEIVING PROPOSITION FIFTY SIX
FUNDING I'M WE DID IT IN A
SLIGHTLY DIFFERENT WAY CORRECT
SO HIV WAIVER AGENCIES GOT.
A DIFFERENTIAL WHERE WE
INCREASE THEM TO A CERTAIN LEVEL
ICF DD'S WE DID A CERTAIN
DIFFERENTIAL THAT GOT THEM UP TO
THEIR YOU KNOW UPPER PAYMENT
LIMIT WOMEN'S HEALTH FOR
SPECIFIC SET OF CODES THEY
RECEIVED A HUNDRED AND FIFTY
PERCENT RATE INCREASE IN THOSE
CODES. YOU KNOW RECEIVED A VERY
SPECIFIC DOLLAR AMOUNT FOR THE
PHYSICIAN CODES WE IDENTIFIED
THIRTEEN IAN THEM CODES SO YOU
WOULD BE FAMILIAR WITH BILL IN
ANY AND THEM CODE.
AND WE ATTACHED
IF IT DOLLAR AMOUNTS TO THOSE IN
M. VISITS AND THERE WERE THREE
PSYCHIATRIC VISITS
ARE PSYCHIATRIC CODES THAT WE
SPECIFICALLY TARGETED BECAUSE.
PSYCHIATRY IN CHILD PSYCHIATRY
ARE VERY MUCH.
IN BOTH.
SHORTAGE AND WE WANTED TO
INCREASE THE NUMBER OF
PSYCHIATRISTS PARTICIPATING IN
THE PROGRAM. THE OTHER CODES
WERE CHOSEN TO BE BROAD BASED
AND TO ATTRACT POSITIONS OF ALL
CAPACITY.
WHEN WE TRIED VERY HARD BECAUSE
AGAIN AS YOU HEAR SOME OF THE
DELAYS IN IMPLEMENTATION IF WE
GET TOO FANCY IT JUST MAKES IT
MORE COMPLICATED WHICH TAKES
LONGER AND SO WHEN WE CHOSE
THOSE POSITION CODES WE WERE
TRYING TO DO IT. SO THAT WE HIT
THE BROADER SWATH OF PHYSICIANS
POSSIBLE.
USING A STANDARD IN M. CODE AS
OPPOSED TO TRYING TO GET. IN A
VERY VERY SMALL CODES THAT ARE
VERY IMPORTANT TO KEEP YOU KNOW
CONSTITUENCIES BUT MAY NOT BE
BROADER OR MAY NOT AND BE ABLE
TO KIND OF. AND BE ESTIMATED SO
I THINK THAT WAS OUR BEST
SHOT AT THE TIME. WHEN WE WENT
TO THE DENTAL CODES THERE ARE
THOUSANDS OF DENTAL CODES AND IT
WAS IMPOSSIBLE TO TRY TO ATTACH
A SPECIFIC DOLLAR AMOUNT TO A
SPECIFIC DENTAL CODE SO WE DID A
FORTY PERCENT INCREASE. OVER
CERTAIN CATEGORIES OF DENTAL
PROCEDURES SO.
ENDODONTIC AND RESTORE IT IS
AND WE DELIBERATELY DID NOT DO
THE PREVENTIVE CATEGORY WITHIN
THE DENTAL PROGRAM AND THERE WAS
A REASON WHY. IS THAT WE HAVE A
DIFFERENTIAL.
FUNDING PROGRAM THAT IS
CURRENTLY UNDERWAY CALLED THE
DENTAL TRANSFORMATION INITIATIVE
WHICH IS UNDER OUR MEDI CAL
WAIVER. WHICH IS A FIVE YEAR
DEMONSTRATION.
SEVEN HUNDRED AND FIFTY MILLION
DOLLARS SPECIFICALLY GEARED ONLY
TOWARDS CHILDREN AND
SPECIFICALLY GEARED TOWARDS
PREVENTIVE SERVICES.
.
PURSUANT TO A LOT OF FEDERAL
RULES WE CANNOT PAY.
THIS FOR THE SAME THING TWICE
AND SO WE WERE REALLY CONCERNED
AGAIN ABOUT NOT WANTING TO MAKE
IT SO COMPLICATED THAT WE WOULD
TRIP OVER OURSELVES THAT IF WE
DID A PREVENTIVE RATE INCREASE.
AT THE SAME TIME THAT WE HAD D.
T. I WOULD ACTUALLY NOT GET
FEDERAL APPROVAL BECAUSE OF THE
FEAR OF DUPLICATING. A PAYMENT
AND SO THAT WAS WHY WE DID IT
THAT WAY.
.
I THINK THAT WE ARE ABSOLUTELY
WANTING TO WORK WITH THE
LEGISLATURE ON AS THE DATA FOR
EACH OF THESE DIFFERENT PROVIDER
CATEGORIES COMES AND SO THAT WE
CAN.
BOTH TARGET THE RIGHT CODES I
DON'T THINK THAT WE SIT HERE
TODAY AND SAY THAT THE CODES
THAT WE SAW.
CHOSE WITH THOSE POSITION CODES
WHERE THE ONLY BECAUSE WE COULD
HAVE CHOSEN THEIR NOT THE.
THE SUM TOTAL OF ALL THE THINGS
THAT WE WANTED TO ACCOMPLISH BUT
THEY MET OUR NEEDS I'M GIVEN THE
SHORT TIMEFRAME GIVEN THE ONE
YOUR SUPPLEMENTAL PAYMENT AND
GIVEN OUR INTEREST IN.
MAKING IT IS APPLICABLE TO AS
MANY PHYSICIANS AS POSSIBLE SO I
THINK.
ON A GOING FORWARD BASIS AS
SOON AS WE CAN PROVIDE THE DATA
WITH SOME KIND OF OUR INITIAL
ANALYSIS. WE WILL BE WORKING
WITH THE LEGISLATURE AND THE
STAKEHOLDERS TO SAY HERE'S WHAT
WE'RE SEEN.
HERE'S MAYBE WHAT WE CAN'T SAY
YET WITH ANY KIND OF CERTAINTY
ABOUT WHAT THIS.
SUPPLEMENTAL PAYMENT WILL OR
WON'T DO FOR PARTICIPATION.
THERE MAY VERY WELL BE AN
AGREEMENT.
BETWEEN THE ADMINISTRATION AND
THE LEGISLATURE TO SAY LET'S
JUST.
STAY THE COURSE FOR ANOTHER
YEAR AND SEE IF ANOTHER YEAR OF
DATA MAKES ANY DIFFERENCE OR
THERE COULD BE A DECISION BASED
ON THE DATA THAT THE LEGISLATURE
IN THE ADMINISTRATION SAY. YOU
KNOW.
THERE ISN'T NEW SET OF CODES
THAT WE WANT YOU TO GO AND
ATTACHED CERTAIN SUPPLEMENTAL
PAYMENTS TO AND WE WOULD WORK
WITH AND. YOU KNOW OUR INTERNAL
STAFF TO DEVELOP ESTIMATES OF
WHAT WE THINK THAT COSTS AND
THEN WE WOULD JUST KIND OF
NEGOTIATED OUT BUT I THINK WHEN
WE PUT THE. GOVERNOR'S BUDGET
TOGETHER IN JANUARY WE HAD AN
ABSENCE OF DATA.
AND DIDN'T FEEL THAT WE WERE IN
ANY BETTER POSITION TO MAKE A
RECOMMENDATION THAN THAN ANYBODY
ELSE AND SO WE WE DO WANT TO
HAVE THAT CONVERSATION WHEN WHEN
DO YOU THINK YOU WILL HAVE
SUFFICIENT DATA TO MAKE THOSE.
APPROXIMATIONS.
WE'VE ASKED BECAUSE WE'RE IN
THE PROCESS OF DEVELOPING THE
MAY REVISION AS WE SPEAK AND SO
WE'RE LOOKING FOR EARLY DATA AND
I THINK IT'S IT'S PRETTY EARLY
AND TO THE.
POINT MADE BY FINANCE THE LAGS
IN OUR CLAIM SYSTEM.
SO WE CAN CATCH UP WITH WHAT
WAS BILLED IN JULY RIGHT AND SO
WE KNOW WHAT WAS BILLED IN WHAT
RECEIVED A SUPPLEMENTAL PAYMENT.
ON THE PHYSICIAN AND THE DENTAL
MANAGED CARE DIRECTED PAYMENTS
THOSE ARE SO NEW THAT I'M NOT
SURE THAT WE HAVE. GREAT DATA
BUT WILL BE CERTAINLY POLLING
THAT FROM THE HEALTH PLANS.
AND THEN.
.
BECAUSE PHYSICIANS AND OTHER
PROVIDERS HAVE A YEAR TO SUBMIT
CLAIMS THERE'S ALWAYS A CLAIMS
LAG AND SO I WOULD SAY. ANYTHING
THAT IS IT'S QUOTE GOOD DATA YOU
USUALLY NEED SIX MONTHS AT LEAST
IF NOT A YEAR TO TRY TO MAKE
SURE THAT YOU'VE GOT LIKE A
GOOD.
CAPTURE BUT I THINK WE YOU KNOW
WE'RE COMMITTED TO DOING. AND
GIVING AS MUCH AS WE CAN AND
THAT MAY REVISION.
HOME. WILL LOOK FOR THOSE DATA
POINTS AS THEY COME BACK AND
THAT WILL HELP US TO INFORM OUR
DECISIONS I SEE WESTERN CENTER
HAS A COMMENT THAT LIKE TO MAKE.
IN IN REGARDS TO DUPLICATING
PREVENTIVE SERVICES OUT WE
RECOGNIZE THE CONCERNED THERE
WOULD NOTE THAT THAT DENTAL
TRANSFORMATION INITIATIVE IS
SPECIFIC TO CHILDREN OF MISS
CAN'T SAID. AS WELL AS THERE IS
AT LEAST ONE ICD TEACH CODE THAT
IS A PREVENTATIVE THAT SPECIFIC
TO ADULTS AND SO THAT. I THAT CO
DOES EXIST AND THAT IS NOT
CURRENTLY INCLUDED IN THE
SUPPLEMENTAL PAYMENT.
QUICK.
BUT I JUST TO CLARIFY SO SO THAT
CAN BE INCLUDED. THAT THAT.
CODE BECAUSE I'M.
I GOT LOST IN THE CLOUDS PARTY
SAID THAT THERE WAS THOUSANDS OF
CODES ARE IN THE DENTAL IS THAT
WHEN SEPARATE FROM THE QUOTES
THAT YOU'RE TALKING ABOUT.
SO IS THAT INCLUDED IN THIS IT'S
NOT CURRENTLY BUT THAT HER POINT
IS IS THAT. WE DID NOT INCLUDE
ANY SUPPLEMENTAL PAYMENTS FOR
THE PREVENTIVE CATEGORY WITHIN
THE DENTAL THERE SEVERAL
DIFFERENT CATEGORIES OF CODES
AND WE DIDN'T INCLUDE ANY AND
HER POINT WAS IS THAT. THERE IS
A SPECIFIC DENTAL CODE FOR
ADULTS FOR PREVENTION THAT COULD
BE INCLUDED SHOULD WE
COLLECTIVELY DECIDE TO AND CRY
AND WANT THAT THEN THAT'S MY
QUESTION THOUGH BUT WHY WASN'T
THAT INCLUDED IN THE FIRST
PLACE.
I THINK WE JUST EXCLUDED THE I
MEAN FIRST OFF WE PROBABLY
DIDN'T HAVE THE TIME WHEN THE
BUDGET WAS NEGOTIATED THEM PROP
FIFTY SIX WAS DEVELOPED TO HAVE
A. AN ITERATIVE UNDERSTANDING OF
GOING OVER THOUSANDS AND
THOUSANDS OF DENTAL CODE SO WE
JUST EXCLUDED THAT CATEGORY BUT
IF THERE IS A SINGLE CODE WE
WOULD TAKE A LOOK AT IT.
NUMBER AND I WILL END BY ECHOING
THE COMMENTS TO MAKE SURE WE
HAVE SOME CONSISTENCY.
TO MAKE SURE THAT THE DATA
COLLECTION I APPRECIATE THAT
WHILE WE'VE HAD A LAG WE'RE
GOING TO RETROACTIVELY PAY IT.
BUT WANTS TO MAKE SURE THAT HAS
WORK CONTINUING THIS PROGRAM
THAT WE REALLY DO GIVE PROVIDERS
AN OPPORTUNITY TO REALIZE THE
BENEFIT OF TAKING CARE OF
MEDICAL AND DENTAL PATIENTS.
WITH THAT.
STAFF HAS RECOMMENDED NO ACTION
ON ISSUE THREE WILL HOLD IT OPEN
AND MOVE ON TO ISSUE FOR.
SIMILAR PATTERSON WELCOME
.
MISTER CHAIR AND. MEMBERS.
WE ARE REQUESTING FOUR MILLION
DOLLARS.
TO INCREASE REIMBURSEMENT RATES
FOR PEDIATRIC DAY HEALTH CARE
FACILITIES.
WHICH WITH A FEDERAL MATCH WILL
BE A TOTAL OF EIGHT MILLION
DOLLARS.
IT APPEARS TO US THAT.
.
THEY MAY HAVE BEEN LEFT OUT OR
PERHAPS UNINTENTIONALLY.
ARE AND WE ARE ASKING FOR
PARITY.
AND INCLUSION WITH OTHER SIMILAR
PROVIDERS.
THE CENTERS PROVIDE CRITICAL
SERVICES TO CHILDREN WITH SEVERE
MEDICAL CONDITIONS.
BUT ALLOWED CHILDREN TO INTERACT
WITH EACH OTHER DEVELOP
FRIENDSHIPS BE KIDS
THE PART OF THE COMMUNITY WHILE
RECEIVING. THE CARE THEY NEED.
PT EIGHT SEIZE REIMBURSEMENT
RATES HAVE BEEN STAGNANT FOR
FOURTEEN YEARS MAKING IT
INCREASINGLY DIFFICULT TO
RETAIN.
THE BEST QUALITY NURSES AND
PROVIDERS OF CARE FOR CHILDREN.
TO CLOSE OR LIMIT HOURS.
OR TO NOT EXPAND OR OPEN NEW
FACILITIES BECAUSE OF LOW
REIMBURSEMENT RATES.
THIS FOUR MILLION DOLLAR BUDGET
REQUEST WILL BRING PARITY FOR
PDA AGENCIES WITH THE GOVERNOR'S
BUDGET REQUEST TO INCREASE
REIMBURSEMENT RATES. FOR HOME
HEALTH AGENCIES WHO PROVIDE AN
EQUALLY IMPORTANT SERVICE FOR
CHILDREN IN THEIR HOMES.
HOME HEALTH AGENCIES AND
PEDIATRIC DAY HEALTH CENTERS.
HAVE HISTORICALLY RECEIVE THE
SAME REIMBURSEMENT RATES.
HERE TODAY IS TERRY RICARDO
CHAIR OF THE PEDIATRIC DE HEALTH
CARE COALITION. TO ALSO PROVIDE
TESTIMONY THERE ARE ALSO A
NUMBER OF FAMILIES AND CHILDREN
IN THE AUDIENCE WHO HAVE
TRAVELLED HERE. TODAY TO SHOW
HOW IMPORTANT IT IS TO THEM THAT
THE CENTERS KEEP THEIR DOORS
OPEN APPRECIATE YOUR
CONSIDERATION OF THE REQUEST
THANK YOU.
GOOD AFTERNOON MISTER CHAIR
MEMBERS OF THE COMMITTEE. WE
APPRECIATE THE OPPORTUNITY TO
COME BEFORE YOU TODAY TO FURTHER
EXPLAIN A REQUEST AND BE
AVAILABLE FOR ANY QUESTIONS YOU
MIGHT HAVE.
MY NAME IS TERRY ROCH YADDO I AM
A REGISTERED NURSE FORMERLY
OPERATED A HOME HEALTH AGENCY.
AND SINCE NINETEEN NINETY TWO
HAVE OPERATED PEDIATRIC DAY
HEALTH CARE CENTERS.
CURRENTLY I HAVE TO CENTERS ONE
IN SAN DIEGO AND ONE IN VISTA.
I WOULD LIKE TO ASK THE CHAIRS
PERMISSION TO ACKNOWLEDGE THE
PARENTS THE CHILDREN WHO HAVE
TRAVELED TO BE HERE TODAY TO BE
PART OF THIS HEARING.
YOU HAVE WHAT KIND OF THE ROWDY
BUNCH IN THE BACK.
NO ONE TOLD CHILDREN TO BE
QUIET.
THERE ARE EIGHTEEN P. H. SEES IN
CALIFORNIA WHO PROVIDE SKILLED
NURSING CARE FOR APPROXIMATELY
FIVE HUNDRED AND FORTY FOUR
CHILDREN AND THEIR FAMILIES.
PEDIATRIC TO HEALTH CARE CENTERS
PROVIDE SKILLED NURSING CARE TO
CHILDREN UP TO THE AGE OF TWENTY
ONE WHO ARE MEDICALLY FRAGILE OR
TECHNOLOGY DEPENDENT.
WE CAN ALSO CONTINUE TO CARE FOR
THESE CHILDREN WHEN THEY TURN
TWENTY ONE IF WE ARE LICENSED
FOR TRANSITIONAL CARE UNIT.
PD AGENCIES MAKE IT POSSIBLE FOR
CHILDREN TO SOME REMAIN AT HOME.
WITH THEIR FAMILIES AT THE SAME
TIME THEY RECEIVE SKILLED
NURSING CARE.
THEY ALSO RECEIVE
DEVELOPMENTALLY APPROPRIATE
PROGRAMS HAVE THE CHANCE TO MAKE
FRIENDS AND BE A CHILD.
NOT SOMEONE WHO IS DIM DEFINED
BY THEIR HEALTH CONDITION OR
THEIR WAY OF COMMUNICATING.
WE HAVE SENSORY ROOMS BALL PITS
ACCESSIBLE SWINGS PARTIES AND
FIELD TRIPS.
PDH SEES MAKE IT POSSIBLE FOR
PARENTS TO CONTINUE WORKING.
MANY OF OUR PARENTS ARE SINGLE
PARENTS.
MANY OF OUR CHILDREN REQUIRE
ROUND THE CLOCK CARE.
MANY OF OUR CHILDREN ATTEND OUR
CENTER FOR THE TWO HOURS AFTER
SCHOOL SO THAT THEIR PARENTS CAN
CONTINUE TO WORK A FULL WORK
DAY.
EACH CHILD IS UNIQUE IMPORTANT
AND WELL LOVED AT OUR CENTERS.
FOR APPROXIMATELY THIRTEEN YEARS
PDA IT SEES BEEN PAID TWENTY
NINE DOLLARS AND FORTY ONE CENTS
PER HOUR.
THIS SET RATE HAS STAYED THE
SAME REGARDLESS OF THE FACT THAT
WE HAVE BUILDINGS TO MAINTAIN.
INCREASE RENTS FOR CENTERS AND
THE EVER INCREASING COST OF
SERVICES AND SUPPLIES.
ADDITIONALLY. ALL ACCREDITED
NURSING SCHOOLS MUST HAVE A
PEDIATRIC ROTATION AS PART OF
THEIR CURRICULUM.
PDH SEES OF THE ONLY PEDIATRIC
ROTATION AVAILABLE FOR HUNDREDS
OF FUTURE NURSES. WITHOUT PT
AGENCIES AS THEIR PEDIATRIC
ROTATION MANY FUTURE NURSES
WON'T BE ABLE TO CHOOSE AND
TRAIN IN THE NURSING CAREER. FOR
THEIR FUTURES.
WE HAVE A GREAT DIFFICULT.
WE HAVE HAD GREAT DIFFICULTY.
RECRUITING AND RETAINING LV ENDS
DUE TO COMPETITION WITH
HOSPITALS AND OTHER HEALTHCARE
PROVIDERS.
WE'VE HAD TO CANCEL PROGRAMS
REDUCE HOURS OF OPERATION AND
LIMIT ENROLLMENT BECAUSE OF THE
SCARCITY OF STAFF WILLING TO
PROVIDE NURSING CARE FOR THE
RATES THAT WE RECEIVE.
FOR EXAMPLE.
IN THE YEAR TWO THOUSAND
SEVENTEEN WE WERE ONLY ABLE TO
FILL SIXTY FIVE PERCENT OF THE
APPROVED HOURS THE OTHER THIRTY
FIVE PERCENT WE WERE NOT ABLE TO
DO. BECAUSE WE DID NOT HAVE
ADEQUATE STAFF.
TO BE ABLE TO SERVE THOSE KIDS
DURING THAT TIME PERIOD.
WHAT MANY PEOPLE DON'T REALIZE
IS THAT HOME HEALTH AGENCIES IN
PAC'S CARE FOR THE SAME CHILD?
UNDER EPS TO T. BOTH PDA IT SEES
AN IN HOME CARE OUR SUPPLEMENTAL
SERVICES.
A CHILD IS AUTHORIZED A SPECIFIC
NUMBER OF HOURS TO USE EACH
MONTH BASED ON MEDICAL
NECESSITY.
THEIR LEVEL OF CARE NEEDS AN
INDIVIDUAL PREFERENCE.
IF ONE OF OUR CHILDREN IS SICK
AND NEEDS TO STAY HOME THEY CAN
USE THEIR HOURS FOR IN HOME
CARE.
IF A FAMILY PER FAIRS PREFERS
THEIR CHILD CARE FOR AT HOME
THEY CAN ALSO USE THE SERVICES
OF OUR CENTER FOR A CHANGE OF
PACE OR FOR WHATEVER REASON.
THEY CHOOSE.
IT'S A LOT ABOUT CHOICE.
WHILE THE CURRENT RATES
EXCEPTIONALLY LOW IT IS
EQUITABLE IF THE HOME HEALTH
AGENCIES RECEIVE A RATE INCREASE
AND PDAS SEES DO NOT. PAC'S WILL
BE UNABLE TO RECRUIT STAFF LOSE
EVEN MORE STAFF AND WILL BE IN
JEOPARDY OF CLOSING.
WE FULLY SUPPORT THE INCREASED
RATE FOR HOME HEALTH AGENCIES.
BUT ANY RATE INCREASE MUST BE
EQUITABLE AND BALANCE AND
PRESERVE CHOICE FOR PARENTS AND
CHILDREN.
WE ASK OF THE PD EIGHT SEASON
HOME HEALTH AGENCIES BE VIEWED
IS INTERCHANGEABLE CHOICES THAT
CAN BE MADE BY THEIR PARENTS.
WE RESPECTFULLY REQUEST THAT
PARENTS AND CHILDREN CAN
CONTINUE.
TO EXERCISE THOSE CHOICES.
IT PDAS SEES CLOSE.
THESE FIVE HUNDRED FORTY FOUR
CHILDREN WILL HAVE LIMITED OTHER
CHOICES AVAILABLE.
THEY CAN ATTEMPT TO USE AND HOME
NURSING.
OR THEY CAN BE ADMITTED TO A
CONGREGATE LIVING FACILITY.
THE SECOND OPTION WOULD COST AN
ADDITIONAL TWENTY SEVEN MILLION
DOLLARS FOR THE HOURS FIVE
HUNDRED AND FORTY FOUR KIDS.
PLACING THESE CHILDREN IS
COMPLETELY UNACCEPTABLE.
THESE CHILDREN ARE THE LUCKY
ONES AND THEY REALLY ARE.
THEY HAVE FAMILIES WHO LOVE
THEM.
THEY SLEEP IN THEIR OWN BEDS IN
THEIR OWN HOMES WITH THEIR OWN
PARENTS.
AND THE BROTHERS AND SISTERS AT
NIGHT.
WE THANK YOU SO MUCH FOR YOUR
TIME TO LISTEN TO OUR CONCERNS I
WOULD BE GLAD TO ANSWER ANY
QUESTIONS YOU MIGHT HAVE.
THANK YOU TERRY.
WITH THAT WE WILL NOW HAVE
PUBLIC COMMENT ON ISSUE FOR IF
WE CAN MOVE THE MIKE MORE
TOWARDS THE CENTER. DEEPLY
SHOULDN'T THINK.
EVERYBODY BUT A PUBLIC SPEAKING
SO I MARRIED FROM THIS.
YOUR BABY DIDN'T DEVELOPER
BRING. THOSE WORDS SPOKEN TO ME
IN A ROUTINE ULTRASOUND WERE THE
BEGINNING OF A JOURNEY THAT IS
ULTIMATELY LED ME HERE TODAY. MY
NAME IS RACHEL LUCAS MY HUSBAND
DEAN. THIS IS OUR MIRACLE GIRLY
MARIN SCHUH BEFORE ON WEDNESDAY.
SEVEN MONTHS AFTER LILY WAS BORN
AFTER COUNTLESS HOURS SPENT AT
SPECIALIST EARLY INTERVENTION
MEETINGS AND APPLYING FOR
PROGRAMS I AM EXHAUSTED MY LEAVE
OF ABSENCE FROM MY JOB.
I HAD TO GO BACK TO WORK TO HELP
PROVIDE FOR OUR FAMILY.
I HAD TO LEAVE MY BABY.
WHO'S ON HOSPICE CARE IN THE
HANDS OF OTHER PEOPLE.
A SOCIAL WORKER TOLD US ABOUT
TOGETHER WE GROW A PLACE WERE
UNWILLING WOULD BE CARED FOR AND
LOVED.
LILY IS A VERY SOCIAL GIRL WHO
LOVES LAUGHING CIRCLE TIME DANCE
PARTIES AND DISNEY SONGS.
SHE IS LOTS OF FRIENDS BOTH
MEDICAL AND TYPICAL THIS IS
BECAUSE OF THE CARE THAT SHE HAS
RECEIVED A TOGETHER WE GROW.
WILLOWS BABY BROTHER CAME ALONG
WHOSE MEDICALLY TYPICAL WE
STRESSED ABOUT HOW WE WOULD CARE
FOR A NEW BABY BOTH WORK FULL
TIME AND MANAGE LILIES
APPOINTMENTS SOMETIMES UP TO SIX
PER WEEK.
TOGETHER WE GROW ALLOWS FOR BOTH
OF OUR CHILDREN DESPITE THEIR
VAST DIFFERENCES TO RECEIVE
EXCELLENT CARE IN A SINGLE
PLACE.
THIS ALLOWS DENYING TO CONTINUE
WORKING FULL TIME STAYING OFF
PUBLIC ASSISTANCE.
OUR SON ACE OUT ROSEN THRIVES IN
AN ENVIRONMENT WHERE CHILDREN
LIKE HIS SISTER ARE LOVED
ACCEPTED RESPECTED AND INCLUDED.
I KNOW BECAUSE OF HIS TIME
TOGETHER WE GROW HE WILL GROW
INTO A MAN WILL VALUE AND
RESPECT CHILDREN AND ADULTS OF
ALL ABILITIES.
IT'S INCREDIBLY IMPORTANT THAT
THE RATE INCREASE ALSO APPLIED
OF PD AGENCIES SO FAMILIES LIKE
OURS CAN HAVE PEACE OF MIND
KNOWING OUR CHILDREN BOTH
MEDICAL AND TYPICAL ARE CARED
FOR IN CAN GROW TOGETHER.
THANK YOU.
THANK YOU AND THANK YOU LITTLE.
TOUGH ACT FALL ON.
HELLO MY NAME IS DEAN LUCAS AND
THIS IS ALSO MY DAUGHTER LILY.
I DON'T HAVE MUCH TIME WITH YOU
GUYS TODAY BUT THAT'S KIND OF
THE POINT OF.
MY DAUGHTER LILY SHE CANNOT
SPEAK BUT SHE'S NOT ON MOBILE.
IS NOT CAPABLE INDEPENDENT
SOONER FEEDING YET SHE IS ONE OF
THE MOST AMAZING POSITIVE STRONG
FUNNY AND LOVING HUMAN BEINGS
YOU'LL EVER MEET.
IT TAKES A LOT OF TIMETO GET TO
KNOW WHAT WEEK HER VERBAL CUES
HER MANNERISMS HOTEL HER LIKES
FOR WANTS OR NEEDS.
AS WELL AS HER INTENSE
MEDICATION PHYSICAL THERAPY
REGIMENT.
AND HOW TO HELP BEST CHEAPER
GOAL WAS TO BE THE BEST HUMAN
BEING THAT SHE CAN BE.
BECAUSE OF A LACK OF CRITICALLY
NEEDED FUNDING FOR PEDIATRIC DAY
HEALTH CARE CENTERS TIME IS NOT
A LUXURY THAT THEY CAN AFFORD.
MANY TIMES IN LILY'S LIFE SHE'S
LOST MAZING CAREGIVERS THAT
DIDN'T WANNA LEAVE THE CHILDREN
THEY KNOW WHEN LEFT OVER FORCED
TO IN ORDER TO ACHIEVE A WAGE
THAT WOULD ALLOW THEM TO TAKE
CARE OF THEIR OWN FAMILIES.
THIS LACK OF FUNDING FOR
FACILITIES LIKE TOGETHER WE GROW
CREATES A SITUATION WHERE HIGH
AMPLY TURNOVER RATE DIRECTLY
IMPACTS NOT ONLY LILY AND
CHILDREN BEFORE YOU BUT
COUNTLESS OTHERS THROUGHOUT THE
STATE.
EVERYTHING IN NEW CARE GIVER
EVERYTIME AT NEW CARE GIVER AND
HERS LOUISE LIFE THEY HAVE TO
LEARN HER AND BY THE TIME THEY
GET TO THE POINT WHERE THEY CAN
TRULY HELPER THRIVE. FAR OFTEN
THAN NOT A RESET BUTTON IS HIT.
MANDATE LEAVE AND IN NEW CARE
GIVERS FORCE TO COME IN AND
RELEARN LILY ALL OVER AGAIN.
HI AT ANY PARENT KNOWS THAT THE
CONTINUITY OF CARE IS CRUCIAL TO
ANY CHILD'S DEVELOPMENT. AND
THAT'S EVEN MORE TRUE FOR THE
CHILDREN LIKE OURS WHO CAN'T
ADVOCATE FOR THEMSELVES.
IF ANY OF YOUR INTEREST IN
LEARNING MORE ABOUT WILLIAM HER
STORY HIGH COURAGE YOU TO REACH
OUT TO WATCH.
SORRY I APOLOGIZE BUT TO MEET
HER AS I WOULD LOVE EXPRESSED
YOU IN A LONGER FORMAT HOW
IMPORTANT IS FUNDING IS FOR HER
AND HOW MUCH OF AN IMPACT
TOGETHER WE GROW IS PLAYED IN
OUR FAMILY'S LIFE AS WELL AS OUR
CHILD'S DEVELOPMENT.
INCREASE FUNDING IS GREATLY
NEEDED AND I'M POOR YOU TO MAKE
THE RIGHT DECISION BY INCREASING
THANK YOU FOR YOUR TIME AND
GETTING TO OUR FAMILY PLEASE
SIR.
HELLO THIS IS KING STAN AND I AM
AMANDA FRY. ó WE GO TO
LORETTA'S LITTLE MIRACLES.
HE HAS A RARE GENETIC DISORDER
ARE SYNDROME AND I ALSO HAVE IT
TOO.
CALLED ALAN HERNDON DUDLEY
SYNDROME.
HERE'S A FEW REASONS I WOULD
LIKE TO EXPLAIN OF WHY I.
LOVE LORETTA SO MUCH AND HOW WE
NEED TO AND OUR LIVES.
SO HERE'S A FEW THINGS I DO
WHILE KINGSTON OUT LORETTA'S
INSTEAD OF THE HOME SO BECAUSE I
HAVE THE SAME DISORDER SYNDROME
THAT HE DOES I GET SICK I WAKE
UP ALMOST EVERY MORNING PUKING
THROWING UP. AND IT'S IT BUILDS
GOOD NOT TO WATCH MY SON WATCHED
ME SICK AND YOU KNOW HE'S OUT
LORETTA'S GETTING TAKING CARA Y.
CAN TAKE CARE OF MYSELF.
I USED TO WORK OUT OF TOWN SO I
COULD GO TO WORK NOT HAVE TO
WORRY ABOUT HIM.
I HAD COME FROM A BAD FAMILY
OUT I DON'T HAVE A MOM AND A DAD
THAT CAN WATCH HIM I DON'T HAVE
ANYBODY THAT CAN WATCH HIM. SO
IF THIS IS TAKEN AWAY FROM US
AND WE GET TO GO TO SCHOOL AYE
THIS FINISHED MY HIGH SCHOOL
DIPLOMA. I AM A STUDENT AT
FRESNO CITY AND LORETTA'S FAMILY
TO US WE DON'T WE DON'T HAVE
ANYBODY. AND PERSONALLY I
WOULDN'T TRUST MY OWN FAMILY
WITH MY SON.
I TRUST HER AND ALL THE
EMPLOYEES THAT SHE ACCEPTS.
ANOTHER THING IS.
.
WELL I'M OUT SCHOOL AND WORKING
I DON'T HAVE SOMEBODY CALLING ME
HOW DO YOU HOW DO YOU WORK WITH
THEM WHAT DO WE DO.
HOW DO YOU PUT HIS SHOES ON HIS
YES SPECIAL BRACES ON?
THE LITTLEST THINGS
I NEVER GET A CALL FROM THE
READINESS IT IS SUCH.
WEIGHT OFF MY SHOULDERS AND I
CAN LIVE LIFE AND GO TO SCHOOL
AND GO GET THINGS DONE.
.
PERSONALLY I LIKE I SAID I DON'T
HAVE FAMILIES SO IF I WERE TO
HAVE SOMEBODY COME INTO MY HOME
IT'S A STRANGER.
I'VE HAD PEOPLE COME INTO MY
HOME AND THEY'VE STOLE STUFF I'D
CALL.
PEOPLE SLEEPING ON THE JOB
INSTEAD OF TAKING CARE KING
STAND.
DRINKING SMOKING CIGARETTES
IT'S UNACCEPTABLE.
END IT IF YOU TAKE THAT AWAY IF
YOU TAKE A LOOK AROUND AS A WAY
THAT'S WHAT I'M GONNA HAVE.
TO HELP ME AND I DON'T I DON'T
WANT THAT.
ON TOP OF WE IT'S JUST ME SO I
WOULD HAVE TO SHARE KEYS WITH
THIS PERSON.
HAVE I WOULD REALLY HAVE TO
TRUST THIS PERSON AND WHILE HE'S
OUT LORETTA'S AND WE DON'T HAVE
TO WORRY ABOUT THAT.
ON.
AND.
OUT LORETTA'S HE EVERYONE HE
GOES TO SCHOOL WITH GOES THERE
SO HE SEES THE SAME KIDS HE'S
AROUND THE SAME.
SPECIAL NEEDS CHILDREN THAT HE
SEES SENSE HE WAS LIKE TWO YEARS
OLD. AND HE'S A HE'S GROWN WHEN.
BEFORE HE WENT TO LORETTA'S.
HE WAS VERY SICK HIS HANDS WERE
STOCK LIKE THIS HIS TONGUE WAS
HANGING OUT OF HIS MOUTH. AND HE
WAS.
NOT MOVING AT ALL AND BECAUSE OF
LOW RED AS HE IS.
SO BRIGHT BIGGER STRONGER.
SUCH A GREAT CHILD BECAUSE OF
LORETTA'S.
IT'S LIKE A CLASSROOM
ENVIRONMENT WHY TAKE A CHILD
ADDED THAT AND STICK HIM IN A IN
A ROOM WITH AN ADULT THAT
DOESN'T REALLY CARE WHAT THEY'RE
JUST NEED A PAYCHECK.
I AM SO BECAUSE IN EFFECT IF WE
LOSE THIS I WILL LOSE MY JOB I
WILL LOSE MY SCHOOLING I WILL
LOSE ARE. ONLY FAMILY THAT WE
HAVE.
AND YOU'LL ALL LOSE HOPE I WON'T
HAVE ANYTHING.
AND SO I JUST HOPE THAT YOU GUYS
UNDERSTAND HOW IMPORTANT THIS
THIS IS IT NODDED DE CARE IT'S A
SPECIAL FACILITY THAT TAKES CARE
PART CHILDREN WHEN WE HAVE
NOBODY ELSE TO COUNT ON.
THAT THAT THANK YOU SO MUCH.
THANK YOU MEMBERS THANK YOU
KINGS AND.
THAT AFTERNOON.
MY NAME IS CINDY JACKSON FROM
THE ASSOCIATION OF REGIONAL
CENTER AGENCIES ARCA AN ARCA.
IS SUPPORT IN SUPPORT OF THE
PROPOSED RATE INCREASE FOR THE
PEDIATRIC DAY HEALTHCARE
PROVIDERS AS THESE PROVIDERS.
OFTEN WILL SURE THAT CHILDREN
WITH COMPLEX HEALTH NEEDS.
CONTINUE TO RESIDE IN THEIR
NATURAL LIVING SITUATION WITH
THEIR FAMILIES.
THANK YOU SIR.
TRYING NOT TO CRY YOU KNOW WE
ALL COME.
AND HAVE A CHILD AND YOU CAN
DON'T EVER ASK FOR CHILD TO BE
BORN WITH A DISABILITY. AND I
CAN SAY IT WAS QUITE A SHOCK FOR
MY FAMILY. I WHEN I HAD CHARLIE.
HE WAS DIAGNOSED AS THE FIRST
US CASE WITH HIS MEDICAL
CONDITION. AND ONLY ONE OF
TWENTY SIX IN THE ENTIRE WORLD.
SO THIS IS MY LITTLE GENETIC
JACKPOT IF I CALLED. AND.
YOU KNOW WHEN I WAS I WAS
WORKING FULL TIME STILL M..
AND THANK GOODNESS TO THE PIT
AT PEDIATRIC DAY HEALTH CARE
CENTER TOGETHER WE GROW THAT THE
CHARLIE GOES TO. BECAUSE I
THOUGHT I HAVE ANOTHER CHILD
SHE'S OLDER SHE'S TYPICAL I
THOUGHT I CAN GO BACK TO WORK
ALL. BE ABLE TO DO THE DAYCARE
THING LIKE I DID WITH HER NO
PROBLEM.
I WENT TO THESE DAY CARES IN THE
LIKE YOU KNOW IF YOUR CHILD AS
DIAPERS AND ISN'T POTTY TRAINED
AND YOUR CHILD CAN'T FEED
THEMSELVES.
WE CAN HELP YOU AND I WENT HOME
FEELING LIKE I HAD AN ALIEN.
AND IT WAS VERY DISHEARTENING I
GO WHAT DO I DO.
AND I HAVE A PHYSICAL THERAPIST
THAT WAS WORKING WITH HIM THAT
SAID THERE'S A CENTER I WANT YOU
TO GO SEE IT WAS JUST OPENING.
THAT'S CENTER WAS MY MIRACLE SO
THAT I COULD STAY WORKING WITH
MY HUSBAND BOTH OF US COULD WORK
PROVIDE HEALTH CARE AND USE MEDI
CAL AS A SECONDARY FOR
INSURANCE.
I'M NOT TRYING TO BE A BURDEN ON
THE STATE OF CALIFORNIA. I'M
TRYING TO BE A WORKING
INDIVIDUAL THAT JUST HAPPENS OF
A CHILD THAT DOESN'T FIT INTO
THE MOLD.
AND THIS THIS FUNDING IS SO
IMPORTANT BECAUSE IT ALLOWS ME
TO GO TO WORK AND HAVE THAT
CONTINUITY OF CARE AND AS YOU
FOR THE OTHER FAMILY SAY SO FAR.
THERE'S DIFFERENT UNIQUE THINGS
WITH WITH EACH CHILD CHARLIE
TALKS IN CHARLIE'S WAY.
CHARLIE HAS VERY SMALL
IDIOSYNCRASIES I CAN'T JUST HAVE
IF ONE PERSON BECAUSE OF SICK
ANOTHER PERSON COME IN. AND BE
ABLE TO HAVE THAT QUALITY OF
CARE WHAT I GET IN THE PEDIATRIC
TAKE HEALTH HEALTH CARE SYSTEM
IS. IS A GROUP
STAFF OF NURSING STAFF BUT NO
CHARLIE SO THAT ONE CAN FILL IN
WITH THE OTHER ISN'T THERE IT'S
A GROUP APPROACH. PLUS GREAT
SOCIALIZATION FOR HIM WHY SHOULD
MY CHILD HAVE TO BE.
NINETEEN FIFTY SET THE CORNER.
PUTTING BACK AT HOME AND NOT BE
SEEN BY THE WORLD WHEN HE CAN
ACTUALLY INTEGRATE WITH TYPICAL
KIDS.
AND HE CAN INTEGRATE WITH KIDS
LIKE HIMSELF AND HAVE A SENSE
ROOM WHICH IS WHICH IS
FANTASTIC.
HE.
IS A HAPPY KID AND MY MY PURPOSE
IN LIFE IS TO GIVE HIM THE BEST
LIFE THAT HE CAN HAVE AS LONG AS
I HAVE HIM HERE.
AND SO IT'S REALLY IMPORTANT FOR
ME TO GET THAT SOCIALIZATION
PIECE AND THAT CARE PIECE TO
HIM.
SO THANK YOU
THANK YOU MA'AM THANK YOU
CHARLIE.
RIGHT TURN CHARLIE.
GOOD AFTERNOON CHAIRMAN. OF. MY
NAME IS BRUCE BOWMAN THIS MY
HUSBAND MICHAEL AND THIS IS OUR
DAUGHTER PRISCILLA.
.
I DON'T WANT TO REITERATE ALL
THE THINGS IT OF MY FELLOW
FAMILY MEMBERS HAVE SAID. IN
TERMS OF.
INTEGRATION OF OUR CHILDREN
INTO SOCIETY.
.
WHAT I DO WANT TO EMPHASIZE IS
THAT?
BY.
NOT BUT ALLOWING THIS OVERSIGHT
TO A CLOSEDOWN.
PEDIATRIC DAY HEALTH CENTERS.
.
THAT WOULD IMPOSE A LARGER
BURDEN ON.
ON CALIFORNIA AND AS A TAXPAYER
I WANT TO.
ASK YOU TO DO THE RIVER THE
FISCAL FISCALLY RESPONSIBLE
THING. AND ADD THIS FUNDING THIS
AND OMIT THIS OVERSIGHT SO THAT
FACILITIES LIKE TOGETHER WE GROW
AND.
AND OTHERS AROUND THE STATE HOW
THE FUNDS TO RETAIN STAFF.
TO CARE FOR OUR CHILDREN.
AND NOT BECOME A LARGER DROP BY.
RELEGATING R. CHILDREN TO ONE ON
ONE IN HOME HEALTH CARE
SO THIS.
OVERSIGHT OR.
BY REMOVING THIS OVERSIGHT I
THINK WE COULD PROVIDE A BETTER
FISCAL. OUR RESPONSIBILITY TO
THE TAXPAYERS OF CALIFORNIA.
THANK YOU THANK YOU SIR.
THANK YOU PRISCILLA.
GOOD AFTERNOON THINK YOU ARE
MONEYNESS JONI IN THIS IS MY SON
LIAM AND MY HUSBAND FABIAN. UMP
LIAM IS NINETEEN YEARS OLD AND
HE IS PAN A LOVING PARTICIPANT
AT OUR LOCAL PDH SEE TOGETHER WE
GROW. FOR EIGHTEEN YEARS ON IT
WE STARTED AT THAT PP AGE SEE MY
HUSBAND I WERE BOTH SERVING
ACTIVE DUTY MILITARY MEMBERS.
WE HAD ABOUT SEVENTEEN EIGHTEEN
YEARS THEN AND I WAS WILLING TO
ACTUALLY GET OUT OF THE MILITARY
BECAUSE MY SON AT THE TIME. PRE
MUCH LIVED IN AYE CEO HE'S HAD
OVER HUNDRED AND FIFTY BRAIN
SURGERIES IF YOU CAN ONLY
IMAGINE.
I HAD GREAT CEO WHO SAID WE'RE
GONNA FLOAT YOUR BOAT YOU'VE
GIVEN YOU POUND A FLASH.
ON.
SO WHY IS THAT MAN ON BUT I
STAND HERE TODAY BECAUSE PART OF
THAT PROCESS WAS WE WERE
REFERRED TO PD AGE SEE IT WAS
ALLOWING US.
TO FINISH OUR COMMITMENT TO
SERVING OUR COUNTRY.
ON IT IS ALSO.
CHANGED OUR QUALITY OF LIFE.
YOU CAN ONLY IMAGINE.
MY SON IS A TWO PERSON LEFT
I CAN'T FIND A HOME HEALTH NURSE
THAT CAN COME IN.
WHO'S VERY KNOWLEDGEABLE YOUNG
IN HER TWENTIES AND PROBABLY
HALF MY SIZE WANTING TO LIFT HIM
WHO'S PROBABLY TWENTY FIVE
POUNDS HEAVIER THAN HER. HE ALSO
HAS A SPINAL RON IT'S A
CHALLENGE FOR ME TO LIFT HIM. SO
I WOULD NEED TO HOME NURSES.
ONE IS HARD TO COME BY.
I WOULD LOVE IT BUT TO IS
IMPOSSIBLE.
THE OTHER THING THAT'S REALLY
INTERESTING ABOUT HIS TIME THERE
FIELD ACTUALLY SAVED HIS LIFE
ONTO VERY SPECIFIC CATIONS.
HE WENT SEPTIC
AND IT WAS A QUIVER OF HIS LIT.
THAT GAVE IT AWAY AS WE WERE
EXITING FACILITY THEY SAID.
HEAPED HIS LITTLE QUIET TODAY
IS WE WALKED OUT THE DOOR WHEN
THE NURSES TURNED AND SAID HEY
BECAUSE YOU KNOW THEY ALL KNOW
HIM.
ARM AND TURNED HIM SAID LIAM YOU
DON'T LOOK QUITE LET'S GO BACK
IN AND TAKE A LOOK AT HIM.
AND SURE ENOUGH WE ENDED UP IN
CHILDREN'S HOSPITAL ICE YOU AND
HE SURVIVED OUT BECAUSE OF EARLY
INTERVENTION.
THERE'S BEEN AT LEAST ONE OTHER
OCCASION THAT THAT HAS OCCURRED
WITH SEPSIS FOR HIM.
AND ALSO TALK ABOUT JUST A
MOMENT.
IT'S A SAFETY ISSUE MY SON IS
COMPLETELY NONVERBAL AND I KNOW
THE OTHER PARENTS TALKED ABOUT
THAT. IT IS TERRIFYING AS A
PARENTS TO THINK NAMELY CAM
EVERY SQUARE INCH.
TOM I JUST CAN'T IMAGINE LIVING
WITH THE NANNY CAMS WHEN THEY'RE
NOT IN MY HOME IT'S KIND OF
INVASIVE.
TOM YOU KNOW THE FREEDOM THE
CHOICE THE QUALITY OF LIFE THAT
WE HAVE BY HAVING THEM FACILITY
AVAILABLE. THE RELIABILITY WE
BOTH CONTINUE TO WORK WERE BOTH
TAX PAYING CITIZENS.
ON IF WE SHOULD GO OUR SONS CAN
STEP IN THE FACILITY IS THERE
THEY CAN PICK UP AND TAKE OVER
THINGS ARE IN PLACE.
MY SON.
WANTS TO BE HOME IN PART IS
COMMUNITY HE WANTS TO SPEND HIS
TIME IN HIS OWN BED TO SLEEP NOT
TO LIVE.
SO WE APPRECIATE THAT YOU
CONSIDER ADDING THIS.
PAY RAISE POOR THEM THEY DESERVE
IT IT'S BEEN FOURTEEN YEARS OF
WONDERFUL CARE FOR HIM WE HOPE
THAT YOU CONSIDER ADDING THAT
BACK INTO THE BUDGET THINK YOU.
THINK YOU FOR YOUR SERVICE AND
THANK YOU LIAM.
GOOD AFTERNOON THANK YOU FOR
HEARING US.
MY NAME IS HEATHER AREAS AND
THIS IS MY SON ZACHARY.
I'M.
I JUST LIKE TO ECHO EVERYTHING
THAT ONLY.
MAY FELLOW AND FRIENDS AND.
HAVE COME TO THE.
AND BECAUSE I'M JUST SO NERVOUS.
YOUR TIME IS GOING TO BE OKAY
AND. I WON I WON EXPAND WHAT
THEY SAY EVERYTHING THAT HOLDS
CHEER FOR THEM HOLDS TRUE FOR ME
TOO. I'M A SINGLE MOM A SINGLE
MOM OF TWO BOYS DUCK CREEK
CLEARLY. IS DISABLED AND MY
OTHER SON IS TYPICAL AND I THINK
A REALLY IMPORTANT POINT THAT
NEEDS TO BE BROUGHT UP.
ABOUT THE VALUE OF THE THE PTH
THESE IS THAT THEY SOCIALIZE OUR
COMMUNITIES NOT JUST OUR
CHILDREN WHO ARE DISABLED AND IT
IS.
SUPREMELY IMPORTANT THAT THEY
ARE SOCIALIZED.
IT.
ALLOWS FOR OUR TYPICAL SOCIETY
TO BE SOCIALIZED TO PEOPL WHO
ARE DIFFERENT.
RIGHT OUR CHILDREN WHERE THEIR
DIFFERENCES ON THE OUTSIDE.
WE OFTEN HIRE THEM ON THE INSIDE
AND TRY TO FIT IN.
AND SAN DIEGO HAS REALLY I MEAN
WE LIVE IN SAN DIEGO SO. IT'S
BEEN OUR COMMUNITY HAS REALLY
RALLIED TO OUR CHILDREN. AND
HAVING PDH SEE I TOOK GALLERY
GRASS RPD AGENCY HAS THERE'S A
STABILIZING FORCE. AND MY FAMILY
ALLOWED ME TO RAISE BOTH OF MY
CHILDREN TOGETHER.
GREAT HE IS ONE YEARS OLDER THAN
HIS BROTHER UNDER THE PAST
DIFFERENCE.
HEY.
HE IS THRIVING THE BEST THAT HE
ABSOLUTELY CANNOT EVERYBODY'S ON
PASSED
NOBODY THOUGHT HE LIVE.
EVERYBODY BUT.
PERIOD.
THAT'S THE WONDER OF IT. BUT
FURTHER HIS BROTHER.
I GREW UP WITH A BROTHER WHO'S
VERY DISABLED AND REQUIRES ALL
OF MY TIME.
ALL OF MY ENERGY.
ALL OF MY FOCUS
I CAN'T TAKE MY EYES OFF OF HIM
FOR A MINUTE.
IT WHEN I GO TO SLEEP. I'M
LISTENING.
I.
IT'S NONSTOP IT'S TWENTY FOUR
HOURS A DAY.
HOW THE P. H. CDS?
THAT PROVIDE QUALITY CARE. AND
YOU KNOW I CAN ONLY SPEAK TO
TOGETHER WE GROW AND I. AM SURE
SHE SETTING THE STANDARD SET A
HIGH STANDARD WE'VE QUALITY
NURSES WHO KNOW OUR CHILDREN'S
CITED OUT.
WHEN HE'S WITH BY MY CAN REST
I CAN WORK. IT ALSO GAVE ME THE
OPPORTUNITY TO SPEND TIME
INDIVIDUALLY WHAT MIGHT. TYPICAL
CHILD AND WE TELL YOU WHY THAT'S
IMPORTANT.
HE JUST HE HE GREW UP TO BE A
PHENOMENAL YOUNG MAN.
HE APPLIED FOR A SCHOLARSHIP
MATE HE HE PURSUED HIS FOR HIS A
SWIMMER.
AND HE HE JUST DREAM DEBATE
AGAIN HE PROCEEDED SCHOLARSHIP
THEIR BRANDEIS SIC A FULL
RAGGED.
AND PART OF THAT WAS HIS
SWIMMING. AND PART OF THAT WAS
HIS ESSAY. WHERE HE WROTE ABOUT
THE VALUE?
HAVE HAVING A BROTHER LIKES
HUNGARY.
AND HOW HE SEES THE WORLD
DIFFERENTLY.
AND THAT IS A KEY TO BE
DIFFERENT BECAUSE OUR
DIFFERENCES SPEAK.
IT'S MAKING US STRONGER AND
BETTER AND MORE UNIQUE. AND I
THINK.
I HAVE ALWAYS THOUGHT THAT'S
IMPORTANT.
AND I THINK YOU TERRY FOR
REALLY.
EVEN THE WAY.
FOR INCLUSION.
BUT I THINK IN THIS MOMENT RIGHT
NOW.
IN OUR COUNTRY AND OUR SOCIETY
WE VIEW THE ME. TO SPEAK TO.
HOW IMPORTANT ACCEPTANCE AND
INCLUSION ES?
THEM SOLICIT THINK YOU FOR
GIVING ME A COUPLE MINUTES.
SOLICITING BICU FOR GIVING US
A COUPLE MINUTES AND HEARING
HOUSE
IT REALLY MEANS A LOT ANTIOCHUS
OCCURRED.
THE STATEMENTS OF THESE FAMILIES
DIMINISH WHAT I'M GOING TO ADD
TO THIS MONEY RESPONSIBILITY AND
I REPRESENT SHOULD SHIP WE ARE A
PEDIATRIC DAY HELP.
.
AND PRESCHOOL AND LOCAL INTO
CALIFORNIA.
AND.
WE'VE BEEN OPEN SINCE TWO
THOUSAND ONE SHIFT OVER A
THOUSAND CHILDREN.
WHERE A PRESCHOOL THAT ALLOWS
CHILDREN THAT NEED NURSING CARE
THROUGHOUT THE DAY TO RETURN TO
SCHOOL WITH THEIR PEERS?
THE FAMILIES OF MEDICALLY
FRAGILE CHILDREN BENEFIT GREATLY
FROM THE SERVICES OFFERED BY
BOTH HOME BASED CARE AND CENTER
BASED CARE. CATCHER PROVIDES THE
CENTER BASED CARE.
WE NEED THE SAME RATE INCREASE
TO APPLY SO WE CAN PAY OUR
NURSES AND STOP THE FINANCIAL
LOSSES THAT PLAGUE US.
ZERO RATE INCREASE SINCE TWO
THOUSAND HREE HAS BEEN A GREAT
OVERSIGHT.
WE'RE SEEING HIGHER ACUITY AMONG
THE POPULATION WE SERVE WE HAVE.
A DIABETIC CHILD WHO'S GLUCOSE
LEVELS HAVE TO BE CHECKED EVERY
TWO HOURS.
AND WHOSE LEVELS WILL SPIKE CAN
DROP AT ANY GIVEN MOMENT.
WE HAVE CHILDREN THEY HAVE TO BE
CATHARINE EYES FOR BLADDER
RELIEF EVERY THREE HOURS.
WE HAVE A FEW CHILDREN THAT
REQUIRE MULTIPLE CARES WITH
SEIZURES CHIU TUBE FEEDINGS
OSTOMY BAGS.
ALL WHILE TRYING TO PLAY.
AND DOWN. THERE PLAYING WITH THE
CHURCH IS WHAT. ALL OF OUR
CENTERS DO.
AND THE PARENTS COME TO RUSSIAN
TEARS THANKING US FOR BEING
THERE.
PLEASE GRANT US RATE INCREASE
FOR THE KIDS THAT BENEFIT SO
MUCH FROM THE CENTER BASED CARE
EVERYDAY.
THANK YOU SIR.
AFTERNOON MY NAME IS JOANNE MORE
MY SON HE IS NOT HERE BUT IF A
SIXTEEN YEAR OLD. WITH CEREBRAL
PALSY DEVELOP EXTREME
DEVELOPMENTAL DELAY. AND HIS
ALSO EPILEPTIC AYE MY SON
ATTENDS RICH LINE PEDIATRIC IN
YUBA CITY WHICH JUST OPENED A
FEW SHORT FEW YEARS AGO.
THREE YEARS AGO MY SON AGE OUT
OF. DAYCARE NOR NORMAL DAYCARE.
I PANICKED I DIDN'T KNOW WHAT
TO DO I'VE.
AGAIN SINGLE MOMS APPROACH I CAN
RELATE TO EVERY SINGLE ONE OF
THESE FAMILIES BACK THERE. WITH
ALL THE STRUGGLES AND EVERYTHING
ELSE THAT I HAVE WE HAVE TO DEAL
WITH WE HAVE SPECIAL NEEDS
CHILDREN.
SO I HAVE A CAREER AND WORK AYE
AYE ONE TO DO ALL THESE THINGS
AND THEY CAME TO A POINT WHERE
I.
I HAD NO ABSOLUTELY NO DAYCARE
FOR MY CHILD SO MY BROTHER
FOUND.
RIDGE LINE AND WE GOT HIM SET UP
THERE AND IT'S BEEN A GODSEND.
I'M ABLE TO EVERYDAY WORK.
AND PROVIDE FOR ALL THREE OF MY
CHILDREN TO WHICH YOU ARE
PURSUING THEIR DEGREES IN
COLLEGE.
AS WELL AS AS MY SON KYLE WHO.
I AM IS HAPPY AND IS JUST HE IS
JUST SO OBSOLETE ELATED TO GO TO
HAVEN'T RICH LINE EVERYDAY. SO I
A REALLY STRONG WE URGE YOU GUYS
TO PLEASE ON BEHALF OF ALL OF
OUR CHILDREN AND OUR FAMILIES
AND AND EVERYBODY THAT IT
AFFECTS WHEN YOU HAVE A SPECIAL
NEEDS CHILD. TO PLEASE TAKE THIS
INTO CONSIDERATION SO THAT WE
CAN KEEP THESE NURSES WHO ARE
CHILDREN FALL IN LOVE WITH AND.
AND THAT WE FOLLOWING UP WITH
THIS WELL BECAUSE I MEAN THESE
ARE TAKEN CARE OUR BABIES.
WHO OBVIOUSLY HAVE A LOT MORE?
NEEDS THEN YOU KNOW AT A NORMAL
CHILDHOOD SO AGAIN I THINK YOU
FOR LISTENING TO ME AND AND US.
BUT I APPRECIATE IT THANK YOU
THANK YOU TO HIM.
HELLO I'M MICHAEL VOTING DOWN
AND I WAS UP WITH MY HUSBAND OUR
DAUGHTER PRISCILLA.
I HAD TO WALK AWAY WITHOUT
SAYING ANYTHING BEFORE BUT I
REALIZE THAT I HAVE VOICE TO
PRISCILLA NINETY TO USE IT.
I'LL BE VERY BRIEF I JUST WANT
TO THANK YOU ALL I'VE BEEN
WATCHING YOU YOU'RE ALL LOOKING
AT US AND LISTEN TO LISTENING TO
US. I ASK YOU TO JUST KEEP YOUR
OPEN MINDED OPEN EYES OPEN HEART
WHEN YOU MAKE THIS DECISION.
IT'S ALL THESE BEAUTIFUL LITTLE
CHILDREN. AND.
I JUST WANNA THANK YOU VERY MUCH
FOR LISTENING. THANK YOU MICHAEL
I KNOW YOU MAKE THE RIGHT
DECISION THINKING.
GOOD AFTERNOON RADIO PRESS HIM
HALF OF THE CALIFORNIA
ASSOCIATION HEALTH SERVICES AT
HOME FULLY SUPPORT THE PUZZLE
FOR ALL THE REASONS OUR
DIMENSION THINK.
THANK YOU.
SEEING NO FURTHER PUBLIC COMMENT
ON BRING IT BACK UP TO THE DYESS
AND SEE IF WE HAVE ANY QUESTIONS
OR COMMENTS.
FIRST I WANNA THANK THE
FAMILIES.
ALL OF YOU FOR SHOWING UP.
I'M THE PARENT OF NOT.
JUST ONE BUT TWO SPECIAL NEEDS
CHILDREN.
I HEAR YOU.
PHIL YOU.
PATTERSON PLEASE ADD ME ON AS A
CO.
TO THIS MEASURED TERRY YOU'RE
DOING GOD'S WORK.
THANK YOU THERE'S ANYTHING I CAN
DO.
LET ME KNOW I WILL USE THE FULL
FORCE OF MY POWERS AND ASSEMBLY
MEMBER TO HELP YOU ON THIS THANK
YOU.
THANK YOU YES AND AND.
I WAS A FORMER TEACHER I TAUGHT
FOR SIXTEEN YEARS AND JUST
THAT'S JUST REGULAR CHILDREN.
ARE THAT DON'T HAVE THE SPECIAL
NEEDS NEED THE CONTINUITY THAT
YOU'RE TALKING ABOUT SO PLEASE
AND KNOW THAT WE ARE LISTENING
AND WE WILL DO WHAT WE CAN TO
PUSH FOR THIS INCREASE. I KNOW I
MET SOME OF YOU ALREADY BUT I
JUST WANTED TO MAKE SURE THAT
YOU KNEW THAT WE ARE WITH YOU.
AND I WE APPRECIATE YOU TAKING
THE TRIP IT MUST'VE BEEN VERY
DIFFICULT FOR YOU TO COME HERE
BUT WE REALLY DO APPRECIATE YOUR
AT YOUR PRESENCE HERE.
I JUST WANTED TO SHARE HOW
IMPORTANT IT IS FOR US TO HEAR
FROM THE MOUTH OF THE PARENTS
YOUR ADVOCACY REALLY DOES WORK
WONDERS ON THIS DYESS AND.
APPRECIATE ALL THE TIME THAT IT
TOOK IN EFFORTS TO COME UP HERE
AND SHARE YOUR STORIES.
WITH THAT WE WILL HOLD THIS ITEM
OPEN AT THIS TIME AND MOVE ON TO
ISSUE FIVE BUT AGAIN WANT TO
THANK ALL THE MISTER CHAIRMAN
AND MEMBERS I DO APPRECIATE THE
OPPORTUNITY AND FOR YOUR
PATIENCE AND FOR HEARING. AND
THAT WHEN THE TIME IS RIGHT THAT
WE HOPE THAT. WE CAN HAVE AN
THAT. THIS DECISION.
MADE IN THEIR FAVOR
APPRECIATE IT VERY MUCH THANK
YOU
.
PARDON.
GREAT OTHER MISTER CHAIR AND
MEMBERS TERRY CALGARY HILL ON
BEHALF OF THE CALIFORNIA WEAK
ASSOCIATION WE ARE THE CO
SPONSORS OF THIS NEXT ITEM WITH
OUR PARTNERS AT THE CALIFORNIA
BREASTFEEDING COALITION. SO I I
JUST LIKE TO SAY THAT THERE IS
NOT BEEN A RATE INCREASE IN
MEDICARE FOR QUALITY BREAST
PUMPS FOR WOMEN IN THE LAST
THIRTY YEARS. SO WE HAD MET WITH
THE STAFF UM DOS FALL AND RASTA
BRING UP ALL OF INFORMATION SO
I'D LIKE TO INTRODUCE ROBBIE
GONZALEZ DOW WITH CALIFORNIA
BREASTFEEDING COALITION TO MAKE
OUR KEY POINTS.
THANK YOU TERRY CHAIR AND
MEMBERS SAYS TERRY MENTIONED
THAT THE. CALIFORNIA
BREASTFEEDING COALITION IS A CO
SPONSOR OF THE BUDGET PROPOSAL
TO INCREASE THE PRESS THE
REIMBURSEMENT RATES.
FOR PRESS PUMPS AND KITS.
AND THE REIMBURSEMENT RATE HAS
NOT BEEN INCREASED IN THIRTY
YEARS MOST LIKELY SINCE IT WAS
FIRST DETERMINED.
AS A RESULT ACCESS TO QUALITY
BREAST PUMPS ARE UNATTAINABLE
FOR MEDI CAL RECIPIENTS THE
CURRENT RATES ARE AN ADEQUATE
FOR DURABLE MEDICAL. EQUIPMENT
PROVIDERS AND HEALTH PLANS TO
PROVIDE QUALITY BREAST PUMPS
TO ADDRESS THE VERY NEEDS OF
MOTHERS AND CHILDREN.
IMPRESS PUMPS ARE USED FOR MANY.
A DURING MANY TIMES OF OF THE
SPAN OF BREASTFEEDING AND ONE IS
TO INITIATE BREAST FEEDING. AS
MORE AND MORE MOTHERS ARE BREAST
FEEDING THEIR EXPERIENCING
COMMON PROBLEMS EARLY ON. AND
IT'S REALLY NECESSARY TO HAVE A
GOOD QUALITY PUMP TO HELP WITH
THE INITIATION OF BREASTFEEDING.
I'M OUT THERE ALSO USED FOR MORE
CHALLENGING CASES SUCH AS FOR
PRETERM INFANTS.
AND.
FOR INFANTS THAT START THEIR
LIVES OUT HOSPITALIZED OR SICK
WHEN IT'S MEDICALLY NECESSARY TO
HAVE ACCESS TO FIRST FOOD TO
BREAST MILK. AND WHEN MOTHERS
ARE HAVING MEDICAL CONDITIONS.
MOTHERS WHO WORK OR GO TO SCHOOL
ALSO DEPEND ON GOOD QUALITY
BREAST PUMPS TO EXPRESS MILK
WILL THEY'RE SEPARATED FROM
THEIR CHILD.
AND.
SO IT'S NECESSARY FOR THOSE
PARENTS TO HAVE GOOD SUPPLIES
GOOD BREAST PUMPS AND SUPPLIES
BECAUSE THEY'RE PUMPING MULTIPLE
TIMES PER DAY. AND IN SHORT.
BREAK PERIODS.
AND THE.
TO LEAVE THAT MILK FOR THEIR
CARE PROVIDER.
TO BE EFFECTIVE BREAST PUMPS
MUST BE ENGINEERED TO PROVIDE A
RANGE OF PRESSURES AND PUMPING
SPEEDS AND PROVIDE SOME
ADAPTABILITY OF DIFFERENT FOR
DIFFERENCES IN MOTHER'S ANATOMY.
NOT ALL BREAST PUMPS ARE
DESIGNED FOR EFFECTIVENESS OR
DURABILITY. THE MET THE RATE SET
BY MEDI CAL USED FOR BREAST
PUMPS PROVIDED TO RECIPIENTS IS.
FOR FEE FOR SERVICE HEALTH
BENEFITS BUT ALSO FOR THE
MAJORITY OF MOTHERS IN MANAGED
CARE TO DETERMINE THE
REIMBURSEMENT RATES AND THE
PRESS PUMP SELECTION.
MEDI CAL IS ALWAYS SUPPOSED TO
BE THE FIRST LEVEL OF SUPPORT
FOR BREASTFEEDING NEEDS.
INCLUDING THE PROVISION OF
BREAST PUMPS BUT IN REALITY.
.
LOW INCOME PARENTS HAVE NOT
GOTTEN THE SUPPORT THAT THEY
NEED. FROM THEIR HEALTH PLAN OR
THE MEDICAL PROVIDER ESPECIALLY
IN THIS REALLY SENSITIVE TIME
THIS.
WHEN THEY NEED OF SUPPORT FOR
BREASTFEEDING SO WHAT'S HAPPENED
IS THEY'VE TURNED TO THE WOMEN
INFANTS AND CHILDREN
SUPPLEMENTAL NUTRITION PROGRAM
FOR THAT SUPPORT.
AND IT WEEK DOES HAVE A GOOD
QUALITY PUMPS IN THE HAVE
SPECIFICATIONS.
THE PROBLEM IS THEY'RE JUST NOT
ABLE TO PROVIDE PUMPS FOR EVERY
MOM THAT NEEDS THEM.
WHO IS IN NEED OF THEM?
SO WE'D REALLY LIKE TO HAVE SOME
SH CHAIR RESPONSE ABILITY WITH
WICK MEDICAL HEALTH PLANS FOR
THE PROVISION OF EFFECTIVE
PUMPS.
AND WE'RE ASKING THAT THE MEDI
CAL RATES BE INCREASED
FOR PRESS PALM SO THAT THE
DURABLE MEDICAL EQUIPMENT
PROVIDERS CAN HAVE GOOD QUALITY
PUMPS AND THE HEALTH PLANS.
THANK YOU.
THANK YOU VERY MUCH ANY PUBLIC
COMMENT ON ISSUE FIVE AT THIS
TIME.
THANK YOU MISTER CHAIRMAN BIRDS
MAY CONSUMERS ON BEHALF OF
CALIFORNIA HEALTH PLUS ADVOCATES
IN THE THIRTEEN HUNDRED
COMMUNITY HEALTH CENTERS AND
CLINICS. IN CALIFORNIA PROVIDING
A COMPREHENSIVE CARED ABOUT SIX
AND A HALF MILLION PATIENTS
WE'VE I'M FOR A THE LAST FEW
YEARS WORKED CLOSELY WITH OUR
PARTNERS AT THE WITH
ASSOCIATION.
ON THIS ISSUE AND MORE BROADLY
ON PROVIDING.
BREAST PUMPS TO LOW INCOME
WOMEN AND FAMILIES ACROSS
CALIFORNIA SO WE ARE IN STRONG
SUPPORT OF THIS PROPOSAL.
WE THINK IT'S IMPERATIVE THAT
THESE LOW INCOME FAMILIES HAVE
ACCESS
TO THESE THIS THESE PRESS OF
DISNEY BREAST PUMPS AND OTHER
SUPPLIES NEEDED.
AND SO WE WOULD ASK YOUR
SUPPORT THIS AT THE TIME THAT
IT'S I'M ASKING. THANK YOU.
JANICE COUNT CHILDREN'S DEFENSE
FUND CALIFORNIA I'D JUST LIKE TO
ALIGN OUR COMMENTS.
WITH MY CHILD HEALTH COLLEAGUES
ON THE PANEL AND.
JUST REITERATE THAT IT'S AN
IMPORTANT STEP IN OUR REDUCING
HEALTH DISPARITIES THANK YOU.
THINK.
TURN MEMBERS BOB ACKERMAN WITH
THE CALIFORNIA ASSOCIATION
MEDICAL PRODUCT SUPPLIERS THESE
ARE PROVIDERS OF DIEM ME.
WHEN IT AND MEDICAL SUPPLIES.
A VERY MUCH SUPPORT THIS REQUEST
OF THE CHAIR IS WELL AWARE LAST
YEAR THIS COMMITTEE PASSED ON
THE COMP COMMITTEE. A
REQUIREMENT THAT THEY MEDICARE
RATES GO TO ON A PERCENT OF
MEDICARE IS WE'RE DUMBING DOWN
THESE RATES LOWER AND LOWER THE
EQUIPMENT'S GETTING MORE
SOPHISTICATED. PROVIDERS IN
EVERY DIFFICULT POSITION PART OF
WRITER LAST WEEK WHO DISPENSES
BREAST PUMPS. WHO'S LOSING AN
AVERAGE FIFTEEN DOLLARS EVERY
PUMP. THAT THEY DISPENSED
BECAUSE OF THE COST TO SHIP THE.
PUMP TO THE PATIENT'S HOME IT'S
ATRASO FROM WHICH LIKE TO SEE
THESE RATES ADJUSTED THANK YOU.
THANK YOU SIR.
SEEING NO FURTHER PUBLIC COMMENT
ON BRING IT BACK UP TO THE DYESS
FOR ANY QUESTIONS WITH. JUST A
COMMENT I KNOW THAT WE TALK
ABOUT.
THE EARLY YEARS OF A CHILD AND
HOW IMPORTANT IT IS AND I KNOW
THAT PART OF THAT IS.
BREASTFEEDING IS A CRITICAL
COMPONENT TO TO THE THE HEALTH
OF A BABY SO I AM IN PAIN
SUPPORT OF. THE REQUEST AND HOPE
THAT WE CAN CONSIDER IT.
IT IS IMPORTANT NOT JUST FOR
THE DEVELOPMENT OF THE BABIES
BUT ALSO WHEN WHEN THE THE MOMS
GO TO WORK.
YOU KNOW THEY NEED SOME SUPPORT
AS WELL AND I THINK THAT IF WE
WANT TO HAVE FULLY FUNCTIONING
FAMILIES THAT WE HAVE TO SUPPORT
ALL ASPECTS OF THAT A. OF THAT
CHILD SO I SO I'M IN SUPPORT OF
YOUR REQUEST.
THANK YOU.
FROM ANY OPPORTUNITY FOR
JENNIFER CAN'T TO ADDRESS ANY
PROBLEMS WE MAY HAVE WITH
INCREASING THESE RATES IS.
THERE'S SOMETHING ABOUT BEING
TIED TO MEDICARE RATES WHICH
MAY.
PROHIBIT IT AND CAN YOU HELP
ELUCIDATE WHAT THAT DIFFICULT
TIAS.
SURE I THINK AND IT WE WILL
CERTAINLY COME BACK TO THE
COMMITTEE.
WITH MORE TECHNICAL FEEDBACK ON
THE COST SEEN OF EACH OF THESE
PROPOSALS THAT YOU'RE HEARING
TODAY. BUT I DO KNOW THAT THERE
HAVE BEEN.
CHANGES AND HOW STATE MEDICAID
PROGRAMS PAY FOR DURABLE MEDICAL
EQUIPMENT AND THAT WE ARE I
BELIEVE NOT SUPPOSED TO PAY MORE
THAN EIGHTY PERCENT OF ESTABLISH
MEDICARE RATES ON.
HOW MANY?
OF THE GATHERS A.
THERE THE FEDERAL RULE OF THAT
KIND OF SETS HOW.
WE CAN PRICE CERTAIN PIECES OF
DURABLE MEDICAL EQUIPMENT SO WE
WOULD NEED TO COME BACK AND
PROBABLY PROVIDE YOU WITH SOME
TECHNICAL ASSISTANCE TO
UNDERSTAND. WHAT YOU COULD OR
COULDN'T DO AND IF YOU?
IF YOU SO CHOSE BASED ON THAT
DECISION.
IN SOME CASES YOU WOULD BE
DOING IT WITH A HUNDRED PERCENT
GENERAL FUND AND WITHOUT FEDERAL
MATCHING FUNDS BUT THOSE ARE
CERTAINLY. OPTIONS THAT WE CAN
WORK WITH YOU ON A TECHNICAL
BASIS TO HELP YOU WORK THROUGH
CURRENTLY TODAY THERE.
PROVIDED ON A BY REPORT BASIS
WHICH IS THERE'S NO ESTABLISH
MEDICARE RATE FOR A LOT OF
THESE.
PUMP SO THEY'RE BUILT EITHER AT
THE LESSER OF THE BUILD RATE OR.
.
A CERTAIN YOU NOTICE FLOOR THAT
WE HAVE SET WITH A TWENTY THREE
PERCENT MARKET BASED ON YOUR
INVOICE COST AND SO.
IT'S BOTH COMPLICATED AND
PROBABLY ADMINISTRATIVE CHAO
ADMINISTRATIVELY CHALLENGING FOR
PROVIDERS AND SO.
THEIR SON.
COMPLEXITY AND HOW YOU CHANGE
THE RATES.
I'M JUST CURIOUS WHY THE SAID ON
MEDICARE THESE ARE YOUNG
MOTHERS.
WHAT WHERE WE WHERE WE RELY ON
MEDICARE RATES HELP ME
UNDERSTAND IT FALLS UNDER
DURABLE MEDICAL EQUIPMENT WHICH
IS A MUCH BROADER CATEGORY OF
CARE SO THING IS NOT SPECIFIC TO
THIS RIGHT IT'S NOT SPUR?
TO THIS PART
A KILLER.
DEVICE BUT IT IS BROAD MEDICAL
EQUIPMENT SO THINK WHEELCHAIRS.
YOU KNOW WALKERS AND DIAPERS ALL
OF THOSE THINGS ARE DURABLE
MEDICAL EQUIPMENT.
THANK YOU.
WAS HOPING TO HEAR A LITTLE BIT
MORE AS WELL ABOUT THE AND.
ACTUAL WHERE ILL ANALYSIS THAT
SHOWED A GOOD RETURN ON
INVESTMENT CAN YOU HELP.
SPEAKER THAT.
SO ARE YOU WANTING TO KNOW. WHY
THE RATE WAS?
AS WHAT IT WAS OR WHAT WE CAME
OUT OF THE.
I'M WHO I KNOW YOU ANNOUNCES
RETAILERS SHOW WHY IT WOULD BE A
GOOD RETURN ON INVESTMENT FOR
THE STATE'S TO WANTS TO INVEST
IN THESE BREAST PUMPS.
WELL ITS A REASONABLE RATE
INCREASE.
.
IT WAS DONE WITH SOME COMPLEXITY
OF LOOKING AT MEDI CAL A THEM
THE MOUND OF WOMEN IN MEDI CAL
LOOKING OUT EXCLUSIVE
BREASTFEEDING. THREE MONTHS OUT.
I AM ASSUMING THAT NOT EVERY MOM
IS GOING TO NEED A PUMP IT
LOOKED ABOUT HALF OF THE WOMEN
NEEDING A PUMP.
WHO ARE BREASTFEEDING FOR A
LONGER TERM BECAUSE THEY PUBLIC
PROBABLY RELYING ON THE PUMP
THAT GOING BACK TO WORK?
AND. ALSO LOOKING AT A A A
PERCENT SOMEONE ELSE. COULD DID
THIS ANALYSIS FOR US ARE TRYING
TO EXPLAIN IN THAT WAY. IT DOES
PRO IT'S.
ESTIMATED AT.
A PROVIA BUZZ THE NUMBER OF
WOMEN WHO ARE GOING TO NEED A
PUMP AT A HIGHER RATE THEM.
PROBABLY WHO ACTUALLY WILL NEED
A PUMP BUT THE WAIT WAS
ESTIMATED WAS USING.
TOM THEN AMOUNT OF WOMEN ON
MEDICARE ALL IN THE LOOKING AT
FIFTY PERCENT MEDIAN THAT THAT
PUMP. AND THEN THE THREE MONTH
EXCLUSIVE BREASTFEEDING GREAT SO
THAT'S HOW IT WAS DETERMINED.
WE ALSO LOOKED AT WHAT THE
REIMBURSEMENT RATE OF PUMPS.
ARE OF IN OTHER STATES IN SO
THIS WHAT WE'RE ASKING FOR THE
INCREASE IS BASED ON AN AVERAGE
OF FIVE OTHER STATES WHO HAVE
MUCH HIGHER REIMBURSEMENT RATES.
THAN CALIFORNIA DOES IN SO WE
THINK IT'S QUITE REASONABLE.
.
THE. THE ANALYSIS THAT WE DID
ALSO IN YOUR REPORT. THAT WE
PROVIDED.
LOOK IF YOU.
SUPPORTED MOMS WITH COUNSELING
AND BREASTFEEDING SUPPORT IN
AND.
ALSO EQUIPMENT.
THAT IT WOULD ONLY COST.
NOW LISTEN TO DOLLARS LIKE A
DOLLAR NINETEEN PER PER.
THE PIT AND MEDI CAL TO PROVIDE
THOSE SERVICES.
GREAT AND. HAVING THREE DOLLARS
AT HOME WHO HAVE BENEFITTED. I'M
LOOKING TO MAKE SURE THAT THE
REST OF THE KIDS FOR CALIFORNIA
CAN.
REALIZE THE TRUE OPPORTUNITIES
THAT BREASTFEEDING HOUSE AND THE
BENEFITS
TO HELP TO. IMPROVE THE IMMUNE
SYSTEM METAGENOMICS AND FRANKLY
PROVIDE ANTIBODIES FROM THE
PROTECTION THAT OUR KIDS. SO IT
LOOKS AT WITH THAT.
WILL HOLD THIS ITEM OPEN AT
THIS TIME AND MOVE ON TO ISSUE
SIX
I THINK IF
.
THE BRICK THINK. THINK WANTED
TALK TO YOUR BACK ASSURE HER BY
CATHERINE COVERS IN THE
CALIFORNIA AREA MELONES
PROVIDERS TRUCK CALIFORNIA.
AS THIS I THINK BOTH YOU MEMBER
BOTH OF YOU KNOW THE AREA MIL
PROVIDERS HAVE BEEN FUNDED.
USING THE.
EMERGENCY MEDICAL AIR
TRANSPORTATION.
AUTHORITY A RATE DEVELOPED
ARCHES ME AN ADDITIONAL FOUR
DOLLARS.
THAT IS PAID THROUGH AT THE USE
OF A VEHICLE OF. FEES SO
VEHICLE.
MODE MOVING VIOLATIONS EXCUSE
ME I'M AND THAT'S COLLECTED FOR
THE LAST SEVEN YEARS ANYWHERE
BETWEEN EIGHTEEN MILLION AND
TWELVE MILLION I THINK FOR IT
TEN MILLION THIS YEAR. THAT THEN
IS MATCHED
AND.
PROVIDED A SUPPLEMENTAL PAYMENT
UNFORTUNATELY THAT HAS A SHELF
LIFE.
IT EXPIRES IN EIGHTEEN MONTHS
I'M SO WE ARE ASKING THIS
COMMITTEE TO CONSIDER A RATE
THAT IS.
SIMILAR TO.
AND MATCHES A SUSTAINABLE RATE
FOR AREA MELONES PROVIDERS THE
RASON THEY DID THE FOUR DOLLAR
FEES SEVEN OR TEN YEARS AGO NOW.
IS BECAUSE AT THE TIME.
WE CAME TO THE CAPITOL AND THEY
WERE ABOUT TWENTY YEARS BEHIND A
RATE INCREASE SO.
ON AVERAGE ARE VERY MOST
WRITERS ARE PAID ABOUT THREE
THOUSAND DOLLARS PER FLIGHT BUT
I'M THEIR COSTS ARE BETWEEN TEN
AND FOURTEEN THOUSAND DOLLARS
DEPENDING ON.
WHERE THEY ARE IN THE STATE AND
THE LEVEL OF ACUITY AND THAT'S A
ROTH CAR SO THAT'S NOT? I'M
INCLUDING ADDITIONAL FEES THAT
WE OFTEN.
ARE LAYERED INTO.
SORT OF THE OVERALL COST SO
UNFORTUNATELY.
WHEN WE UNDERSTOOD THAT.
WE CAME THE LEGISLATURE IN AND
WERE HOPING FOR A RATE INCREASE
BUT.
HOUSE BUT DEFICIT TIME SO WHO.
WHILE THE DEPARTMENT WAS VERY
THOUGHTFUL AND APPRECIATIVE OF
OUR SERVICES.
WE NEEDED TO FIND ANOTHER
REVENUE SOURCE ABOUT SO WE CAME
TO THE LEGISLATURE FOR THE FOUR
DOLLARS IT WAS APPROVED BUT AS A
SIDE THAT HAS A SHELF LIFE AND
IT EXPIRES AT THE END OF NEXT
YEAR. SO WE ARE RE ENGAGING AND
DISCUSSIONS RELATED TO A RATE
INCREASE I'M AND THAT INCREASE
BY TARGET AT CITING IT OUT THE
RULE MEDICARE RATE INCREASE CAN
SET IT. AT A LEVEL THAT SORT OF
BRINGS THEM UP.
TWENTY FIVE PLUS YEARS OF NO
RATE INCREASES NOT EVEN THAT TEN
PERCENT ARE A COUPLE OF RATE
INCREASES THE HAPPEN AYE
MEMBRANES INTO A SUSTAINABLE
RATE SO THAT'S WHY WE. WE SET IT
UP THAT RATE.
.
HI DENISE WILL TALK A LITTLE
ABOUT THE SERVICE I'M TALKING
ABOUT THE MECHANICS BUT. UNLIKE
HER TO JUST GIVE A SECOND OR TWO
ON THE ON THE SERVICE SO I
SUNDANESE CELESTE I'M A FLIGHT
NURSE AT WITH CAPS ARE TWELVE
AND I SUPPORT THIS PROPOSAL.
I CURRENTLY WORK AT THE MODESTO
CENTRAL VALLEY AREA SO I SERVICE
THE VERY RURAL COMMUNITY.
WE HAVE NO PEDIATRIC RECEIVING
FACILITIES IN OUR AREA SO I
SERVICE QUITE A FEW PEDIATRIC.
PATIENTS WHETHER THEY BE TO
TRAUMA OR.
IT DEPENDENT CHILDREN THAT HAVE
A LOT OF SPECIALTY NEEDS WORD
DAHLE PROVIDER CRITICAL CARE
SERVICE SO I FLY TYPICALLY
WITHIN OUR SCHOOL WERE ADDED
HIGHLY TRAINED PARAMEDIC WHICH
IS A SERVICE THAT ISN'T PROVIDED
BY GROUND PARAMEDICS. I SERVICE
THE FOOTHILL AREA CALAVERAS
MARIPOSA SMALL RURAL FACILITIES
THERE.
I JUST RISLEY TRANSPORTED A
LADY INVOLVED IN A HIGH SPEED
MOTOR VEHICLE ACCIDENT OUT OF
AMADOR COUNTY. AND HAD SHE NOT
FLOWN SHE WOULD HAVE DIED SHE
ALMOST UNDER MY AIRCRAFT FIVE
MINUTES BEFORE LEANING TOWARD
TRAUMA CENTER IN MODESTO.
THAT WAS A TWO HOUR DRIVE DOWN
THE MOUNTAIN AND SHE. WAS ABLE
TO MAKE THE SURGERY AND GO HOME.
WE ALSO PROVIDE SERVICE TO
CARDIAC PATIENTS ALSO GET IN THE
RURAL AREAS I HAD A AND.
TO YOUR I'VE PATIENT WHO COATED
WE LOST OUR PULSES WERE ABLE TO
GET PULSES BACK.
FLEW HER TO A CARDIAC RECEIVING
CENTER SHE ALSO OUT WALKED OUT
THE HOSPITAL SEVEN DAYS LATER
AGAIN I DON'T THINK SHE WOULD
HAVE THAT SAME OUTCOME.
SO I APPRECIATE CONSIDERATION
THIS PROPOSAL.
THANK YOU VERY MUCH.
WITH THAT WILL TAKE PUBLIC
COMMENT ON ISSUE SIX AT THIS
TIME.
HI MARY MARTIN HERE ON BEHALF
THE CALIFORNIA CHILDREN'S
HOSPITAL ASSOCIATION PLEASE TO
SUPPORT THIS PROPOSAL. AND MANY
OF OUR HOSPITALS ACTUALLY
PROVIDE THEIR OWN AIR AMBULANCE
SERVICES BUT THEY ALL ALSO
RECEIVE PATIENTS USING. THIRD
PARTY AIR TRANSPORTATION
SERVICES TO MAKE SURE THOSE KIDS
GET THE CARE THE MOST
APPROPRIATE SETTING AND REPLACE
TO SUPPORT THIS INCREASE THANK
YOU. THANK YOU.
MISTER CHAIR MEMBERS TERRY
CALLIER HILL AGAIN ON BEHALF OF
BENIOFF CHILDREN'S HOSPITAL
OAKLAND WE RELY ON THESE
TRANSPORT SERVICES WERE A LEVEL
ONE PEDIATRIC TRAUMA CENTER AND
WE APPRECIATE ANY CONSIDERATION
OF A RATE INCREASE THANK YOU.
THANK YOU.
SEEING NO FURTHER PUBLIC COMMENT
OF BRING IT UP TO THE DYESS FOR
ANY QUESTIONS WE MAY HAVE.
NO QUESTION JUST COMMENT TO.
THIS YEAR YOUR SERVICES ARE
CRITICALLY ABOUT CRITICALLY
IMPORTANT IN RURAL AREAS AND
WHERE OFTENTIMES WE HAVE
HIGHWAYS CLOSED.
THIS TIME OF YEAR FOR EXAMPLE.
SO I I I I LIKE TO SPEAK IN
SUPPORT OF THE THE INCREASE I
THINK IT'S ABOUT TIME AND.
RECOGNIZING THAT.
CERTAINLY WITH THE MEDICARE
POPULATION.
IT'S A IT'S A HUGE LOSS FOR
EACH TIME YOU YOU GUYS TAKE A
FLIGHT SO. SIDE LIKE THIS IT
WEAKENED A CHIP IN AND DO OUR
PART. AS MUCH AS WE CAN THINKING
HE.
THANK YOU AND I JUST WANTED TO
ADD AS BEING AN EMERGENCY ROOM
DOCTOR WHENEVER I SAW THE FLIGHT
NURSE I FELT LIKE AND KNEW THAT
YOU WERE SAVING OUR BACON.
YOU KNOW THAT TIME IS TISSUE AT
SOME POINT.
AND AS YOU ARE TALKING ABOUT
HEART ATTACKS AND SOME OF THESE
MAJOR TRAUMAS OUR ABILITY TO
MOVE THEM QUICKLY AS. IN YOUR
HANDS AND JUST WANTED TO THANK
YOU FOR EVERYTHING THAT YOU DO
AND THE HARD WORK THAT PEOPLE
LIKE YOU DO EVERY DAY. THINKING.
DITTO. YOU GUYS ARE AMAZING AND.
I I COVER.
ALL OF INYO COUNTY OUT IN THE
EASTERN SIERRA.
AND.
TULARE COUNTING KERN COUNTY AND
I MEAN THERE'S.
THERE'S NO WAY TO GET SOME THE
SPOTS WITHOUT YOU FOLKS SO WHAT
YOU DO IS TRULY AMAZING.
THINKING.
GOOD LUCK WITH THAT WE WILL HOLD
THIS ITEM OPEN AT THIS TIME AND
MOVE ON TO ISSUE SEVEN.
GOOD AFTERNOON LINDA WAY WITH
WESTERN CENTER ON LAW AND
POVERTY WE APPRECIATE THE
ADMINISTRATION AND THE
LEGISLATURE'S ACTION TO. UP RISK
I FULLY RESTORED ALL DEMO
EARLIER THIS YEAR AS WELL AS
I'VE RESTORING EYEGLASSES AND
TWENTY TWENTY AYE WE REQUEST THE
RESTORATION OF. OTHER MEDI CAL
BENEFITS THAT WERE CUT IN TWO
THOUSAND NINE DUE TO A TRIGGER
MECHANISM. UP FROM THE STATE'S
BUDGET CRISIS
I REFERRED AS OPTIONAL BENEFITS
BECAUSE THE STATE CAN ELECT TO
PROVIDE THE SERVICES THE
SERVICES ARE NOT OPTIONAL FOR
THAT MEDI CAL MEMBERS WHO
DESPERATELY NEED THEM. RESTORING
AUDIOLOGY PODIATRY SPEECH
THERAPY INCONTINENCE CRIMINAL
WASHES WOULD ONLY COST THE STATE
ABOUT FIFTEEN MILLION IN GENERAL
FUND DOLLARS BUT WOULD GREATLY
IMPROVE THE HEALTH OUTCOMES. OF
UP SOME LOW INCOME CALIFORNIANS
IN THE TIME OF RECOVERY IT'S
PARAMOUNT THAT THE STATE'S MOST
VULNERABLE RESIDENTS HAVE ACCESS
TO THESE CRITICAL SERVICES AND
SO I. REQUEST THE RESTORATION OF
THESE BENEFITS.
YES.
.
I'M THE OF MY NAME IS JOHN
ABOARD I DON'T WITH THAT IS THE
CALIFORNIA WHAT DO YOU HAVE WITH
MEDICAL ASSOCIATION.
AND THAT BY TO THANK YOU ALL FOR
DOING THIS TEST ADVOCATE FOR MY
BASIS OF MY COLLEAGUES. I'M HERE
TODAY TO ASK YOU TO PLEASE
CONSIDER FULL RESTORATION OFF
WITH DIET THREE AS A BENEFIT IN
THE MEDICAL PROGRAM.
US WITH ACTRESS WORKING IN THE
CENTER WHILE LEAN WITH THAT'S
THE ONE MERCED WE HAVE A LOT OF.
MEDICAL PATIENTS I HAVE US IN
THE IMPACT OF NOT HAVING GOOD
PREVENT AT THE FOOT CARE FOR
DIABETIC PATIENTS WHEN I SEE
THEM WITH THE EMERGENCY ROOM
WHAT HOSPITALS. FOR SERIOUS FOOT
INFECTIONS THAT UP AND LEAD TO
AYE PATIENTS.
OUT I'M ALSO AN ARMY US ARMY
VETERAN AND A GOOD FIVE PERCENT
OF THE US VETERANS ALSO SUFFER
I ACCESS TO PROVIDE IT TO PUT A
HAPPY CAREFUL OUT OF OUR
DIABETIC PATIENTS HAVE BEEN
SEVERELY CURTAILED SINCE WHAT I
DID WAS REMOVED FROM MEDI CAL
TWO THOUSAND NINE. BUT ALL DOPE
WHAT I ACTUALLY HAVE BEEN
RESTORED FOR EMERGENCY ROOM
VISITS AND HOSPITALIZATIONS.
BASIS STILL HAVE LIMITED ACCESS
TO OUT PATIENT UP WOULD BE ACTED
CARE WHERE MOST OF THE FOOT
SCREENINGS AND MOST OF THAT
TREATMENT FOR WOUNDS OCCUR.
SO WITHOUT THIS IMPORTANT
SCREENINGS NEGATIVE OUTCOMES MAY
RESULT AND AYE PETITIONS WHO
WRITES THIS AMOUNT OF PLAQUE. A
RECENT STUDY SHOWED THAT THERE
WAS THAT THIRTY ONE PERCENT
INCREASE IN LOWER EXTREMITY
APPLICATIONS.
WITHIN TWO THOUSAND TEN AT THE
THOUGHTS AND SIXTEEN STATE OF
CALIFORNIA.
UP TO THAT WAS CONTINUE TO BE
THE PRIMARY PROVIDER FOOT AND
ANKLE CARE TO THE SPACIOUS AND
YET WHEN WE ARE CALLED TO SEE A
PATIENT. AT THE E. R..
EITHER WE ARE NOT REIMBURSED FOR
SERVICES.
OR WE HAVE TO OVERCOME
UNNECESSARY HURDLES JUST TO GET
REIMBURSED.
A MEDICAL DOCTOR WHO PROVIDE
SUPPORT BE HAPPY SERVICES. TO A
MEDICAL BASIS IS REIMBURSED FOR
TREATMENT.
WHILE A PODIATRIST PERFORMS THE
SAME SERVICES.
IT'S OFTEN NOT.
THE WAY WE SEE IT FOOT SCREENING
REGARDLESS OF PROVIDER SHOULD
NOT BE OPTIONAL. UNLESS OF
COURSE WE CONSIDERED LOWER
EXTREMITY ES OPTION.
WHEN A PATIENT GHOST OF THE
EMERGENCY ROOM BECAUSE OF A FOOT
INFECTION THAT YOUR DOCTOR
TYPICALLY AT THIS THAT THE
ASSAULT WITH A GENERAL SURGEON
OR THE. THE VASCULAR OR
ORTHOPEDIC SURGEONS
THAT YOUR DOCTOR WOULD CALL THE
PODIATRIST AND CALLED WOULD THEN
COME AND SEE THE PATIENT AND
PROVIDE THE CARE THAT IS NEEDED.
IN A LOT OF THESE CASES WHEN THE
PATIENT ARE CUMPLIR EMERGENCY
ROOM IT'S BECAUSE THE ONE UNDER
FOOT. HAVE WORSENED AND STARTED
TO INFECT THE BONE.
AND SO THE ONLY THING THAT CAN
BE DONE IS TO ACTIVATE THE FOOT
OR TO TOAST.
AND SUCH WOULD INFECTIONS A
LOWER EXTREMITY AMPUTATIONS
COULD HAVE BEEN PREVENTED IF THE
PATIENTS BEEN ABLE TO GET THAT
THE VERY PORTANT OUT PATIENT
FOOT SWING IN HERE.
I LESS PODIATRISTS RESTORED AS A
BENEFIT ACCESS TO CARE FOR
PATIENTS OF THE NEED TO BE
LIMITED.
AND LOWER EXTREMITY AMPUTATION
RATE WILL CONTINUE TO INCREASE
LIVING OF COURSE THE LOSS OF
PRODUCTIVITY ON THE PART OF THE
PATIENTS.
THAT'S MAKING IT MORE COSTLY FOR
THE STATE.
IT COSTS BETWEEN SEVEN THOUSAND
FIVE HUNDRED DOLLARS TO ABOUT
TWENTY THOUSAND SIX HUNDRED
DOLLARS EACH TIME A DIABETIC
WITH ALL SERIES THREE ADDED.
BUT A LIMB AMPUTATION RESULTING
FROM FOOT ULCER.
IT COSTS ABOUT SEVENTY THOUSAND
FOUR HUNDRED DOLLARS.
AND AS MUCH AS HALF A MILLION
DOLLARS OVER A PATIENT'S
LIFETIME.
IT IS ESTIMATED THAT CALIFORNIA
WOULD SAY BETWEEN SEVEN POINT
FIVE AND SIXTEEN POINT NINE
MILLION DOLLARS FOR MEDI CAL
PATIENTS ALONE. BY PROVIDING
FOOT SCREENING AND PREVENTING
APPLICATIONS.
SO I ALLOWING PODIATRIST TO
GIVE.
DIABETIC PATIENTS REGULAR FOOD
HEALTH SCREENINGS.
SAVE LIVES LIMBS AND SAVE MONEY.
SO ON BEHALF OF MY PAGES OF MY
COLLEAGUES I AM APPEALING TO ALL
OF YOU TO HELP US CONTINUE
PROVIDING QUALITY CARE TO OUR
PATIENTS.
BY FULLY RESTORING PODIATRY
UNDER MEDICOS OPTIONAL BENEFIT
PROGRAM IT IS THE RIGHT TIME.
AND THE CALIFORNIA PUTTING OUT
OF MEDICAL ASSOCIATION STANCE
WITH YOU IT IS ALWAYS READY TO
HELP. IN ANYWAY.
THANK YOU FOR YOUR TIME THANK
YOU SIR. WITH THAT WE WILL TAKE
PUBLIC COMMENT ON ISSUE SEVEN.
ONLY ONE.
RIGHT MEMBERS FIVE ACT BUT WITH
THE CALIFORNIA.
PRODUCT SUPPLIERS WITH THE ON
THE ISSUE
COMEY CREAMS WASHES.
WAS A BENEFIT THAT WAS CUT BY IN
TWO THOUSAND NINE WHEN WE HAVE
FINANCIAL PROBLEMS THANK YOU
SIR.
.
WHEN IS A BENEFIT THEIR SEPARATE
UTILIZATION CONTROLS IN TERMS OF
QUANTITY PER MONTH PER PATIENT
DEPARTMENT CONTRACT DIRECTLY
WITH MANUFACTURES TO GET THE
BEST PRICE PROVIDER IS PAID A
SMALL MARK UP TO DISPENSE. THESE
ARE ADULTS WERE BEING CHANGE
SOMETIMES FIVE SIX TIMES A DAY
SIMPLE SOAP AND WATER IS NOT
SUFFICIENT PREVENT COMPLICATIONS
SO WE ASK FOR CONSIDERATION.
ONE.
MARY DOLLARS OF HEALTH ACCESS
AND WE ALSO SUPPORTS AND I'M THE
RESTORATION OF THE REMAINING
OPTIONAL BENEFITS AND AT THE
TIME REDUCE COST THE STATE A
LONG RUN AND. IT'S JUST THE
RIGHT THING TO DO BEGIN.
THINKING OF.
WITH THAT WILL BRING IT UP TO
THE DYESS ANY QUESTIONS OR
COMMENTS WE HAVE.
SEEING NONE WE WILL HOLD THIS
ITEM OPEN AND. MOVE ON TO ISSUE
EIGHT.
SO AGAIN JENNIFER CAN'T
DEPARTMENT OF HEALTH CARE
SERVICES.
I WILL BE PRESENTING ON THIS
PARTICULAR BE CP AND THEN I'LL
BE JOINED BY ERICA SPUR BACK FOR
THE REMAINING ITEMS.
AS YOU KNOW WE'RE IN THE MIDDLE
AS OUR.
SECTION ELEVEN FIFTEEN MEDICAID
DEMONSTRATION WAIVER WITH THE
FEDERAL GOVERNMENT IT EXPIRES IN
TWENTY TWENTY AND THIS VCP IS
SEEKING TO.
.
PROVIDE FOR RESOURCES FOR TO A
LIMITED TERM POSITIONS AS WELL
AS CONTRACT FUNDING FOR CERTAIN
EVALUATIONS THAT ARE REQUIRED AS
PART OF THE WEAVER TERMS AND
CONDITIONS. I'M SPECIFICALLY
THERE ARE EXTERNAL EVALUATIONS
REQUIRED FOR A WHOLE PERSON
CARE.
WHICH IS OUR.
.
INITIATIVE THAT WE ARE WORKING
ON WITH CERTAIN COUNTIES WHERE
THEY ARE AND.
THEY HAVE TARGETED THEIR HIGH
COST POPULATIONS ON OUT
DETERMINES BY LOCAL NEED AND
THEY'RE OFFERING SERVICES SUCH
AS SUPPORTIVE HOUSING SOBERING
CENTERS A LOT OF DIFFERENT
WRAPAROUND SERVICES THAT
OTHERWISE WOULD NOT BE PROVIDED
UNDER A STRAIGHT MEDICAID.
TYPE OF BENEFIT SO WE ARE
REQUIRED AS PART OF THE WEAVER
TERMS AND CONDITIONS TO DO AN
EVALUATION OF THAT. THERE'S ALSO
ON AN EVALUATION REQUIRED.
AS PART OF OUR SENIORS AND
PERSONS WITH DISABILITIES
PROGRAM AS WELL AS OUR WHOLE
CHILD MODEL THE WHOLE CHILD
MODEL IS A NEW INITIATIVE THAT
WE WILL BE. I'M STARTING THIS
COMING.
AYE YEAR THAT WILL ENROLL
CHILDREN WITH CCS.
WITH COMPLEX MEDICAL CONDITIONS
INDICATING ORGANIZED HEALTH
SYSTEMS AND THE CAN ORGANIZE
HEALTH SYSTEM WILL BE
RESPONSIBLE FOR PRAYER PROVIDING
BOTH THE CCS AS WELL AS THE NON
CCS SERVICES.
SO THIS B. C. P. MERRILY I'M
AUTHORIZES THE TWO POSITIONS AS
WELL AS THE CONTRACT DOLLARS AND
I'M HAPPY TO ANSWER ANY
QUESTIONS.
DEPARTMENT OF FINANCE LA WHEN IT
COMES.
SEEING NONE WILL MOVE TO PUBLIC
COMMENT FOR ISSUE EIGHT AT THIS
TIME.
SEEING NONE WILL BRING IT BACK
TO THE DYESS FOR ANY QUESTIONS.
WITH THAT WE WILL HOLD ISSUE
EIGHT OPEN AND MOVE ON TO ISSUE
NINE.
GOOD AFTERNOON MISTER CHAIRMAN
BURRS MA'AM CIRCUS PERFECT THE
DEPARTMENT HEALTH CARE SERVICES
SUMMIT A PRESENT THE NEXT FOUR
ISSUES BUT TO CHANGE PROPOSALS.
FOR THE DEPARTMENT THE FIRST IS
FOR HEALTHCARE REFORM FINANCIAL
REPORTING AND THIS IS A REQUEST
TO EXTEND. BUT EIGHTEEN EXISTING
THREE YEAR LIMITED TERM
POSITIONS FOR AN ADDITIONAL
THREE YEARS. AYE WE'RE
REQUESTING ONE POINT NINE
MILLION HALF OF THAT IS GENERAL
FUND HOW OFFICE FEDERAL FUNDS.
IN THIS IS ESSENTIALLY TO
PERFORM OF THE CONTINUED
INCREASED SIGNIFICANTLY
INCREASED WORKLOAD RELATED TO
THE ACA FEDERAL REPORTING THAT'S
REQUIRED.
IN SOME CASES.
THAT WORKLOAD HAS GONE UP IN
TERMS OF THE FORMS THAT WERE
REQUIRED TO REPORT TO THE FADS
OF BY TWENTY THREE PERCENT.
AN INSUFFICIENT STOPPING HERE
WOULD PUT THOSE FEDERAL FUNDS IN
JEOPARDY IF.
DEPARTMENT OF FINANCE LA ONLY
COMMENT.
MISTER CHAIR ON WHEELS WITH THE
I'LL JUST NOTE THAT THESE
POSITIONS ARE LIMITED TERM.
AND JUST SOMETHING TO KEEP ON
YOUR.
RADARS THAT THE DEPARTMENT IS
IN THE PROCESS OF
AND IMPROVING SYSTEMS THAT ARE
RELATED TO THESE CLAIMS. AND THE
THOUGHT IS THAT AND IN A PERIOD
OF A FEW YEARS THESE SYSTEMS
WILL APPROVED.
TO PERHAPS ALLOW FOR REDUCTION
WORKLOAD THEREFORE WE THINK IT
DOES MAKE SENSE FOR THESE TO BE
LIMITED TERM AT THIS TIME.
THANK YOU.
PUBLIC COMMENT ON ISSUES NINE AT
THIS TIME.
SEEING NONE OF BRING IT UP TO
THE DIVESTMENT QUESTIONS YOU
KNOW HOW.
SEEING NONE WILL HOLD THIS ITEM
OPEN AND MOVE ON TO ISSUE TEN.
SO ISSUE TEN IS.
.
A WORKLOAD REQUEST FOR
REQUESTING OF FOR PERMANENT
POSITIONS FOR OFFICE A HIPAA
COMPLIANCE.
IN THIS IS THESE ARE RESOURCES
TO ADDRESS THE CONTINUANCE
INCREASE AND PRIVACY AND
SECURITY. A WORKLOAD FOR THE
DEPARTMENT IN TERMS THE HIP BUT
INCIDENT WORKLOAD WE'VE SEEN UP
TO A NINE HUNDRED PERCENT
INCREASE FROM TWO THOUSAND TEN
TO TWO THOUSAND SIXTEEN.
IN HIP A COMPLAINT WORKLOAD
WE'VE SEEN A FOUR HUNDRED FIFTY
PERCENT INCREASE IN THAT
WORKLOAD SO THIS IS.
PERMANENT RESOURCES TO ADDRESS
THAT WORKLOAD WHICH WE THINK HAS
GONE UP DUE TO. INCREASED NUMBER
BENEFICIARIES AS WELL AS
INCREASED AWARENESS IN THIS
AREA.
DEPARTMENT OF FINANCE LA ONLY
COMMENTS ON ISSUE TENTH.
PUBLIC COMMENT ON ISSUE TEN AT
THIS TIME.
SEEING NANA BRING IT BACK UP TO
THE DIET.
TING NO QUESTIONS WE WILL HOLD
ISSUE TEN OPEN AND MOVE ON TO
ISSUE ELEVEN.
SO ISSUE NUMBER ELEVEN.
IS BOTH ONE TIME AN ON GOING
RESOURCES FOR AN ORANGE COUNTY.
OFFICE RELOCATION PROJECT A
REQUESTING FIVE HUNDRED SIXTY
TWO THOUSAND AND.
GOING TO RELOCATE SIXTY SEVEN
OF OUR STAFF I'M OUT OF THE
SANTA ANA STATE OFFICE BUILDING.
AND CONSOLIDATE THEM WITH
TWENTY TWO OF OUR STAFF.
IN ORANGE COUNTY AREA ORANGE
CALIFORNIA WE WANT TO PUT THEM
IN ONE LOCATION. AND THIS IS
PRIMARILY DRIVEN BY THE.
INADEQUACY OF THE SANTA ANA
STATE OFFICE BUILDING.
BERMAN FINANCE IN THE COMMENTS.
SEEING THE LA A HAVING A
RECOMMENDATION I'M HOPING YOU'RE
WILLING TO SUPPORT ABLE TO SPEAK
TO THAT'S. GREAT THANK YOU UP
BRYAN METZGER LA.
WE RECOMMEND REJECTION OF THIS
PROPOSAL AS THE RESOURCE
REQUESTED IN THE PROPOSAL ARE
NOT NEEDED AT THIS TIME.
THE JOINT LEGISLATIVE BUDGET
COMMITTEE SUBMITTED A LETTER.
TO.
THE DIRECTOR OF THE DEPARTMENT
OF GENERAL SERVICES.
EXPRESSING CONCERNS ABOUT THE
PROPOSED LEASE OUT FOR SIX STATE
DEPARTMENTS INCLUDING D. H. CS.
TO MOVE FOLKS OUT OF THEIR
CURRENT OCCUPANCY IN THE SANTA
ANA STATE BUILDING.
AMONG ITS CONCERNS THE GOP SEE.
FELT THE THIRTY DAY
NOTIFICATION PROCESS.
WASN'T NOT ADEQUATE.
TO PROVIDE THE LEGISLATURE AN
OPPORTUNITY.
TO EVALUATE A PROPOSAL
INVOLVING A METER STATE ASSET.
THE GOP SEE ARE ALSO.
NOTED.
CONCERNS ABOUT THE COSTS
ASSOCIATED WITH THE NEW LEASE.
AND THAT IT MIGHT NOT BE THE
MOST OUT FINANCIALLY PRUDENT
DECISION NUTS MOVE FORWARD WITH
THIS PROPOSAL AT THIS TIME. AND
SO GIVEN THESE CONCERNS THE JAIL
BE SEATED NOT CONCUR WITH THE
ADMINISTRATION'S PROPOSAL.
AND.
SUGGESTED THAT THE DA TGS I'M
SUBMIT.
A REVISED LEASE AGREEMENT.
FOR CONSIDERATION THROUGH THE
ANNUAL BUDGET PROCESS TOM IF THE
ADMINISTRATION TAKES THIS
APPROACH THE LEGISLATURE COULD.
CONDUCT AN ASSESSMENT OF THE
NEW.
LEASE PROPOSAL AND DETERMINE IF
IT MEETS.
SOME OF THE CONCERNS THAT WERE
EXPRESSED BY THE JAIL BC. TOM
AND SUBSEQUENTLY.
CONSIDER ADDITIONAL RESOURCES
FOR THE AFFECTED APARTMENTS
INCLUDING PHD.
DOES THE ADMINISTRATION CARE TO
RESPOND TO THOSE CONCERNS.
HARD YES NO JOHNSON DEPARTMENT
OF FINANCE SO DEPARTMENT GENERAL
SERVICES AND FINANCE ARE
CONTINUING TO WORK CLOSELY WITH
DELEO. AND OTHER LEGISLATIVE
STAFF TO ADDRESS VARIOUS
QUESTIONS CONCERNS RELATE TO THE
PROPOSAL AND THE LOCATION OF THE
SAN AN OFFICE BUILDING. AYE
INCLUDING DHS STAFF INTO
NEIGHBORING THE SPACE ORANGE
COUNTY. ARE CURRENTLY THESE
DISCUSSIONS ARE ONGOING AND WE
EXPECT RESOLUTION OF THE ISSUE
SOMETIME EARLY THIS SPRING.
IF WE'RE GOING TO GET A
RESOLUTION EARLY THIS SPRING AND
OUR.
AND BUDGET PROPOSAL WON'T GO IN
THROUGH JUNE FIFTEENTH IS THERE
A REASON CAN I UNDERSTAND THE
TIMING A LITTLE BIT BETTER FOR
WHY THIS PROPOSAL IS BEFORE US
RIGHT NOW.
SHOULD WE WAIT UNTIL AFTER THE
RESULTS OF. THAT.
WHICH YOU JUST SPOKE OF.
I DO KNOW THAT THE
THE PARTIES ARE STILL SPEAKING
SO.
.
APPROPRIATELY AT THIS TIME.
YEAH I I WOULD JUST ADD MY
SENSES HAT THE ADMINISTRATION
IS REGROUPING GIVEN OF THE LA AS
PERSPECTIVE I CAN TELL YOU FROM
OUR PERSPECTIVE AS A DEPARTMENT
WE ARE COMMITTED TO ENSURING.
ADEQUATE AND SAFE SPACE FOR WORK
FORCE THE TO THE EXTENT THAT
THERE'S.
ANOTHER PROPOSAL AND WERE
ACTIVELY ENGAGED IN THOSE
CONVERSATIONS AS WELL.
I THINK WE'LL CONTINUE TO
MONITOR AND TRACK THIS AS THIS
GOES AND LOOK FORWARD TO SEEING
SOME OF THAT RESOLUTION AND
WOULD LIKE TO MAKE SURE MY
OFFICE IS INVOLVED WHEN MATT.
COMES BACK.
WITH THAT WE WILL HOLD ISSUE
ELEVEN OPEN AT THIS TIME AND
MOVE ON TUITION TWELVE.
ISSUE NUMBER TWELVE IS RELATED
TO OUR CALIFORNIA TECHNOL
TECHNICAL ASSISTANCE PROGRAM.
AND WE'RE REQUESTING A TWO YEAR
NO COST EXTENSION AS WELL AS
REAPPROPRIATION LANGUAGE IN THE
BUDGET.
THIS IS TO CONTINUE EXISTING
CONTRACTORS.
TO PROVIDE ELECTRONIC HEALTH
RECORD TECHNICAL ASSISTANCE TO
MEDI CAL PROVIDERS. AND THERE
WAS A DELAY RELATED TO THE
PROCUREMENT CONTRACT ACTIVITIES
HERE SO THIS WOULD PUSH THE DATE
OUT. OF FROM SIX THIRTY TWO
THOUSAND EIGHTEEN TO SIX THIRTY
TWO THOUSAND TWENTY.
BERMAN FINANCE ILIO ANY COMMENTS
ON THIS.
ANY PUBLIC COMMENT ON ISSUE
TWELVE AT THIS TIME.
MISTER CHAIRMAN MEMBERS DAVID
FOR EXECUTIVE DIRECTOR OF THE
CALIFORNIA HEALTH INFORMATION
PARTNERSHIP AND SERVICES
ORGANIZATION. WHERE THE LARGEST
OF THE FOUR CONTRACTORS
REFERENCED IN THE PROGRAM?
JUST TO UNDERSCORE THE
IMPORTANCE OF MOVING THIS OUT
THIS THAT DELAYS IN GETTING THE
MONEY OUT THE DOOR IN THIS
PROGRAM ARE REALLY NOBODY'S
FAULT EXCEPT. SEEM AS TO KEEP
CHANGING THE RULES ON US.
BUT GIVEN ENOUGH TIME WE CAN
ACTUALLY REALIZE THE BENEFITS OF
THE PROGRAM THINK IF. THANK YOU
SIR.
THANK YOU MISTER CHAIRMAN FIRST
MAKE IT SUPER SOME BEHALF OF
CALIFORNIA HEALTH PLUS ADVOCATES
IN THE THIRTEEN HUNDRED AND
GREENHOUSE CENTERS AND CLINICS
IN SUPPORT.
THANK YOU MA'AM.
SEEING NO FURTHER PUBLIC COMMENT
ON BRING IT UP TO THE DYESS FOR
ANY QUESTIONS WE HAVE.
SEEING NONE WE WILL HOLD ISSUE
TWELVE OPEN AND MOVE ON TO ISSUE
THIRTEEN
.
GOOD AFTERNOON MISTER CHAIRMAN
MEMBERS MICHELLE POCKET WITH THE
CALIFORNIA MEDICAL ASSOCIATION
THANK YOU FOR THE OPPORTUNITY TO
PRESENT OUR PROPOSALS HE TODAY.
FONG THE PASSAGE OF THE
AMERICAN RECOVERY AND
REINVESTMENT ACT TWO THOUSAND
NINE STATES WERE ABLE TO APPLY
FOR AND RECEIVE ENHANCED NINETY
TEN FEDERAL MATCH FOR INCENTIVE
PAYMENTS TO ELIGIBLE MEDICAID
PROVIDERS. CONCURRENCY ADOPTION
OF ELECTRONIC HEALTH RECORDS
TECHNOLOGY.
IN TWENTY SIXTEEN THE FEDERAL
GOVERNMENT EXPANDED ITS PREVIOUS
GUIDANCE ON THE USE OF THESE
FUNDS ALLOWING STATES TO APPLY
FOR THE ENHANCE FEDERAL MATCH
FOR A WIDER ARRAY OF PROVIDERS
AND SERVICES.
INCLUDED IN THE ALLOWABLE
ACTIVITIES THAT STATES CAN CLAIM
FOR IS THE ONBOARDING OF
MEDICAID PROVIDERS TO HEALTH
INFORMATION EXCHANGES. AND
ASSISTING PROVIDERS WITH THE
ESTABLISHING OF A DIRECT
CONNECTION TO STATE PRESCRIPTION
DRUG MONITORING PROGRAMS WHICH
IS TIMELY GIVEN THAT STATE LAW
NOW AUTHORIZES HEALTHCARE
PROVIDERS TO ESTABLISH HIS
CONNECTION. TO THEIR CURIOUS
DATABASE.
IN ADDITION TO ADVANCING HEALTH
INFORMATION TECHNOLOGY
CAPABILITIES THE ABILITY TO
CONNECT DIRECTLY TO CARRIERS
WILL ALLEVIATE ONE OF THE MOST
COMMON COMPLAINTS BY PROVIDERS.
USING THE DATABASES THAT WILL
ELIMINATE THE NEED FOR THEM TO
LOG OFF AND LOG BACK ON TO THE
SYSTEM.
AND TO ACCESS THE INFORMATION.
WE BELIEVE THAT MAKING A MODEST
ONE TIME INVESTMENT OF FIVE
MILLION DOLLARS WOULD ALLOW THE
STATE TO TAKE ADVANTAGE OF THE
ENHANCED FEDERAL MATCHING
RECEIVE AND NINE TWO ONE RETURN
ON THAT INVESTMENT.
ADDITIONALLY THROUGH THE SEA TAP
CALIFORNIA ALREADY HAS THE
INFRASTRUCTURE IN PLACE TO
SUPPORT THE DISSEMINATION OF
FIFTY MILLION ADDITIONAL. A
DOLLARS IN THIS AREA.
AS DHS IS ALREADY SUPPORTING
THOUSANDS OF PROVIDERS CURRENTLY
THROUGH THE C. TOP PROGRAMS.
LASTLY THIS FUNDING WOULD
PROVIDE A TECHNOLOGICAL SOLUTION
TO HELP ALLEVIATE THE OPIOID
CRISIS BY MAKING IT EASIER FOR
PROVIDERS TO USE SECURE SYSTEM.
POSITIONS HAVE BEEN AND CONTINUE
TO BE STRONG SUPPORTERS OF THE
CURIOUS DATABASE AS IT IS AN
IMPORTANT TOOL TO HELP. MAKE
APPROPRIATE PRESCRIBING
DECISIONS AND FOR ADDRESSING THE
ABUSE AND DIVERSION OF
PRESCRIPTION DRUGS.
WITH THAT I'D LIKE TO INTRODUCE
DAVID FORD WHO'S WITH ME ODAY.
AND WE'RE HAPPY TO ANSWER ANY
QUESTIONS YOU MAY HAVE.
THANK YOU.
MISTER CHAIRMAN AND MEMBERS
DAVID PART OF CAL HIMSELF AGAIN.
I THINK SEEING THE ADVANCING
OUR I WILL SIMPLY UNDERSCORE
EVERYTHING THAT. BY OUT CALLING
PARTNER SAID ON THIS ISSUE WE
WON'T GET THIS OPPORTUNITY VERY
OFTEN TO PUT UP A ONE TIME.
ALLOCATION AND HOW THE FEDERAL
GOVERNMENT RETURN US NINE TO
ONE.
SO I THINK THAT'S AN IMPORTANT
MOMENT TO STRIKE THINKING. THANK
YOU SIR.
WITH THAT WE'LL TAKE PUBLIC
COMMENT ON ISSUE THIRTEEN.
THANK YOU MISTER CHAIRMAN
CONSUMERS ABOUT THE CALIFORNIA
HEALTH PLUS ADVOCATES WE THINK
IT MAKES SENSE TO PUT UP THE
FIVE MILLION DOLLARS TO TAKE
ADVANTA THE NINETY PERCENT.
FEDERAL MATCH AND WE ARE IN
SUPPORT.
THANK YOU.
KELLY BEAM ON BEHALF OF THE
CALIFORNIA DALLAS CESSATION IN
SUPPORT THANK YOU.
RIGHT SPEND SOME HALF THE
CALIFORNIA ACADEMY OF FAMILY
PHYSICIANS IN SUPPORT THIS
PROPOSAL. HOW I MUST LEARN ON
BEHALF OF?
CHAN WHICH IS THE NATIONAL FIVE
ONE C. THREE NONPROFIT COMMUNITY
BASED HEALTH INFORMATION
TECHNOLOGY COLLABORATIVE WHOSE
MISSION IS TO PIONEER THE USE OF
SUCH ACKNOWLEDGING CARING FOR
THE MEDICALLY UNDERSERVED.
OCEANS ALSO SUPPORT THIS
PROPOSAL BUT HAS IDENTIFIED SOME
IMPLEMENTATION ISSUES BUT IS
COMMITTED TO WORKING CA MAY AS
WELL AS THIS COMMITTEE IN
ADDRESSING THEM THANK YOU. THANK
YOU SIR.
SEEING NO FURTHER PUBLIC COMMENT
OF BRING IT UP TO THE DICE FOR
ANY QUESTIONS.
SEEING NONE ALL MAKE A COMMENT
IF I CAN HAVING UTILIZED THE
CURE'S DATABASE I'M. I'M EXCITED
ABOUT THE OPPORTUNITIES THAT
THIS PROPOSAL BRINGS FORTH
PARTICULARLY WITH THE NINE TO
ONE MATCH IT DOES SEEM LIKE THAT
INVESTMENT FROM THE STATE WILL
HELP BRING. MAJOR FEDERAL
DOLLARS DOWN AND IS A STRONG
PROPOSAL SO.
WITH THAT WE WILL HOLD THIS ITEM
OPEN AND MOVE ON TO ISSUE
FOURTEEN.
THANK YOU MISTER CHAIR.
THE NEXT ISSUE I'D LIKE TO
PRESENT YOU TODAY AS A PROPOSAL
TO PLACE SOME REASONABLE
LIMITATIONS ON THE STATE ONE
RECOUPING PROVIDER PAYMENTS IN
THE MEDICAL PROGRAM.
WE HAVE SIGNIFICANT CONCERNS BUT
THE PROCESS OF THE STATE
CURRENTLY HAS IN PLACE TO RECOUP
PROVIDER OVERPAYMENTS HAPPEN AS
A RESULT OF AN AIR THE STATE HAS
MADE.
CURRENTLY DE IT'S YES HAS THE
AUTHORITY TO RECOVER THESE
OVERPAYMENTS BY WITHHOLDING
PAYMENT FOR CURRENT AND FUTURE
SERVICES WITH NO LIMIT ON THE
RIGHT TRACK OF TIME FRAME. OR
THE AMOUNT OF THE PROVIDERS
CURRENT PAYMENT THAT CAN BE
WITHHELD.
ADDITIONALLY THE NOTIFICATION
THAT PROVIDERS ARE GIVEN THAT
THE AIR HAS HAPPENED HAS NO
INFORMATION REGARDING THE AMOUNT
OF THE OVERPAYMENT WHAT THE
SPECIFIC SERVICE PROVIDED.
THE LACK OF INFORMATION FOR
THAT'S A CHALLENGE FOR PROVIDERS
AS THEY TRY TO FIGURE OUT HOW
MUCH THE OVERPAYMENT MIGHT BE ON
THEIR OWN AND THEN SUBSEQUENTLY
PLANNED FOR CURRENT PAYMENTS
BEING WITHHELD.
AS A RESULT WE WOULD LIKE TO
PROPOSE TRAILER BILL LANGUAGE
THAT PLACES WE A REASONABLE
LIMIT OF ONE YEAR TO RECOUP
OVERPAYMENTS.
AND LIMITS THE PERCENTAGE OF A
CURRENT PAYMENT THAT CAN BE WHAT
HELL TO TWENTY PERCENT. WHEN THE
OVERPAYMENT AS A RESULT OF STATE
AIR.
WE BELIEVE THIS WILL CREATE A
MORE EQUITABLE PROCESS AND WILL
HELP TO REDUCE ANOTHER BARRIER
THAT PHYSICIANS FACE. WHEN
DECIDING TO BECOME MEDICAL
PROVIDERS.
WITHOUT THANK YOU AGAIN FOR THE
OPPORTUNITY TO PRESENT YOU TODAY
I'M HAPPY TO TAKE ANY QUESTIONS.
THANK YOU WITH THAT WILL TAKE
PUBLIC COMMENT ON ISSUE FOURTEEN
AT THIS TIME.
CHURCH MEMBERS BOB BACKGROUND TO
HAVE THE CALIFORNIA RADIOLOGICAL
SOCIETY COULD SPEAK ON BEHALF
ANY NUMBER PROVIDER GROUPS THE
EPC PROCESS IS A CHALLENGE FOR
PROVIDERS.
AS MICHELLE SO THERE'S NO NO
TIME LIMIT ON TIME ON WHEN THEY
CAN TAKE THOSE FUNDS BACK. THEN
INFORMATION PROVIDED IS IS VERY
LIMITED OUT ONE CONCRETE
EXAMPLE.
IN TWO THOUSAND TEN LEGISLATURE
ADOPTED THE PROVISION THAT
LIMITS RADIOLOGY REIMBURSEMENT
AND TO NO MORE THAN EIGHTY
PERCENT OF THE MEDICARE
ALLOWABLE.
THAT PROVISION WAS NOT
IMPLEMENTED UNTIL TWO THOUSAND
FOURTEEN IN TERMS THE ACTUAL
RATE CHANGES THEN IN TWO
THOUSAND SIXTEEN THEY WENT BACK
IN TIME FOR THE TWO YEAR PERIOD.
AND RECOUP THE OVERPAYMENTS IN
THE TWO YEAR PERIOD. VERY
CONFUSING FOR THE REALITY
COMMITTEE I AM VERY DIFFICULT TO
ENFORCE.
RIGHT SPENCER WITH THE COMPANY
CAN MEET HOW MY POSITIONS IN
SUPPORT. THANK YOU.
SEEING NO FURTHER COMMENT PUBLIC
COMMENT ON BRING IT BACK UP TO
THE DYESS.
SEEING NO QUESTIONS WE WILL HOLD
THIS ISSUE OPEN AND MOVE ON TO
ISSUE FIFTEEN
.
I GOOD EVENING MISTER CHAIR AND
MEMBERS MY NAME IS TAMLA AND THE
LEGAL AND POLICY DIRECTOR AT
HEALTH ACCESS CALIFORNIA. AND
WHERE THE HITS IT WIDE
HEALTHCARE CONSUMER APATHY
COALITION WORKING TO ENSURE THAT
ALL CONSUMERS HAVE ACCESS
IT'S THE CLEARLY TO QUALITY
AFFORDABLE HEALTH CARE. SO HELP
ACCESS HAD A LONG HISTORY
WORKING ON NETWORK AGASSI ISSUES
AND WITH SPONSORED MUCH OF THE.
NETWORK ASK THE LEGISLATION
THAT I AM THAT.
.
NO THAT'S IT THAT OF HEALTH
PLANS REQUIRED TO COMPLY WITH
SO KEEP WATCHING THAT YOU KNOW
YOU HAVE IN THAT WE HAVE IS HOW
LONG THE CONSUMER HAVE TO WAIT
TO SEE A DOCTOR. AND THIS IS IN
PART QUESTION FOR ALL CONSUMERS
AND MANAGE CARE WHETHER THEY
HAVE PRIVATE INSURANCE OR MEDI
CAL. AND THE SHORT ANSWER IS
IT'S REALLY COMPLICATED AND I
WILL.
IN MY COMMENTS TODAY CAN OF
DISC BROUGHT DESCRIBE THAT
TIMELY ACCESS STANDARDS THAT WE
HAVE NOW A BACKGROUND OF HOW WE
GOT THIS STANDARDS THAT WE HAVE
TODAY. AND YOU'LL SEE THAT IT'S
BEEN A VERY LONG STRUGGLE BUT
IT'S VERY POINT FOR THIS
COMMITTEE THREE BUT BE REMINDED
OF THIS HISTORY AS IT CONSIDERS
HOW TO BEST MOVE FOR TO ENSURE
THAT CONSUMERS GET THE CARE THAT
THEY NEED. WHEN THEY NEED IT.
SO IF CONSUMERS DON'T GET TIMELY
ACCESS TO CARE IT CAN AND DOES
HAVE SERIOUS IMPLICATIONS FOR
THE CONSUMER.
THE CARE THAT THEY NEED IS
DELAYED THE TREATMENT OPTIONS
THEY HAVE CAN BE LIMITED. WHAT
DICK THE COST OF CARE GOES UP
ESPECIALLY WHEN ONLY EXPENSIVE
ALTERNATIVES REMAIN?
AND WHAT CONSUMERS CAN GET
TIMELY ACCESS TO CARE THEY OFTEN
END UP GETTING CARE THE MOST
EXPENSIVE AND INEFFICIENT STUDY
THE EMERGENCY ROOM AND NO DOCTOR
REVEAL YOU KNOW THAT VERY WELL.
AND IN WORST CASE SCENARIO
CONSUMERS DIE WAIT TO SEE A
DOCTOR.
CALIFORNIA HAS THE NATION'S
STRONGEST TIMELY ACCESS TO CARE
STANDARDS AND WE WERE THE FIRST
STATE TO MANDATE HOW QUICKLY
HEALTH PLAN MEMBERS SEE A
DOCTOR.
FOR URGENT CARE OF ITS FORTY
EIGHT HOURS.
IT'S A FOR PRIMARY CARE AND
MENTAL HEALTH APPOINTMENTS IT'S
TEN BUSINESS DAYS AT FOR
SPECIALISTS FIFTEEN DAYS.
HEALTH PLANS ARE SUPPOSED TO
HAVE ENOUGH DOCTORS AND THEIR
NETWORK TO PROVIDE CONSUMERS
WITH AN APPOINTMENT WITHIN THE
SPECIFIC TIME FRAMES.
MOST IMPORTANTLY TIGHTLY AFTER
STANDARDS ALSO REQUIRE HEALTH
PLANS TO MAKE INTERPRETER
SERVICES AVAILABLE AT THE TIME
OF APPOINTMENT.
CARE CANNOT BE DELAYED FOR THOSE
WHO SPEAK ENGLISH LANGUAGES
OTHER THAN ENGLISH.
SO WHAT IF THE STANDARDS COME
FROM.
THE STRUGGLE TO CHECK CONSUMERS
GET TIMELY ACCESS TO CARE HAS
GONE ON FOR OVER FOUR DECADES.
THE CONCEPT OF TIMELY ACCESS WAS
ONE OF THE CORNERSTONES OF THE
ORIGINAL KNOCKS CAN ACT WHICH
WAS SIGNED INTO LAW IN NINETEEN
SEVENTY FIVE BY WHAT WE.
NOW FONDLY REFER TO AS GOVERNOR
JERRY BROWN ONE POINT NO.
KNOCKING PLAN THE KNOCKING ACT
REGULATES HEALTH PLANS WHICH
REQUIRES.
WHICH INCLUDES BOTH PRIVATE AND
MEDI CAL MANAGED CARE PLANS.
AND SINCE NINETEEN SEVENTY FIVE
THE KNOCKS CAN ACT AS REQUIRED
PLANS TO QUOTE. MAKE ALL
SERVICES READILY AVAILABLE AT
REASONABLE TIMES CONSISTENT WITH
GOOD PROFESSIONAL PRACTICE.
FOR MANY YEARS EACH HEALTH PLAN
DEVELOPED ITS OWN INTERNAL
GUIDELINES FOR WHAT TIMELY
ACCESS MONTH AND FEW OF THEM BUT
THEIR OWN RULES.
IN THE NINETEEN NINETIES YOUR
PASSWORD FROM NINETEEN THIRTY
FIVE TO THE NINETEEN NINETIES
THERE'S A LOT OF ATTENTION TO
FOCUS ON HEALTH PLANS IMPROPERLY
DENYING CARE OR DELAYED CARE.
THE SUSPICION WITH THE HEALTH
PLANS WERE NOT SPENDING ENOUGH
MONEY ON CARE AND WERE
CONTRACTING WITH FEW DOCTORS.
STUDIES AT THE TIME SHOWED THAT
CONSUMERS HAVE TO WAIT MONTHS TO
GET A DOCTOR'S APPOINTMENTS.
HEALTHAXIS ALONG WITH OTHER
CONSUMER GROUPS LED EFFORTS TO
STRENGTHEN CONSUMER PROTECTIONS
THROUGH THE AGE OF A PATIENT
BILL OF RIGHTS WHICH IS THE BILL
PACKAGE THAT HAD DOZENS OF
BILLS.
THE FIGHT FOR THESE PROTECTION
STARTED DURING THE WILSON
ADMINISTRATION AND A PACKAGE OF
BILLS WHAT'S SIDE BY GOVERNOR
GRAY DAVIS IN NINETEEN NINETY
NINE.
THESE BILLS CREATED THE
DEPARTMENT MATCH HEALTH CARE TO
REGULATE HEALTH PLANS A
PREVIOUSLY WITH THE DEPARTED
CORRUPTS CORPORATIONS THAT WAS
DOING IT.
THE A TO APPEASE A BILL OF
RIGHTS GIVE CONSUMERS THE RIGHT
TO HAVE OUTSIDE REVIEW OF.
DECISIONS HEALTH PLAN DECISIONS
AT THE NIGHT COVERAGE THAT WE
NOW KNOW THAT IS INDEPENDENT
MEDICAL REVIEW.
AND THE.
.
PAGE OF BILL OF RIGHTS ALSO
STEPS CLEAR PROCEDURES FOR
GRIEVANCES AND APPEALS.
WE HAVE HOPE THAT AT THE TIME
THAT THEY WOULD BE SPECIFIC
STANDARDS FOR TIMELY ACCESS.
YOU KNOW THAT WAS PART THE
CONCERT. WITH RUSSIA BUT NO
BILLS WERE ENACTED AS PART OF
THAT PROCESS SO AGAIN HEALTH
PLANS WERE SETTING THEIR OWN
INTERNAL STANDARDS WHAT
TIMELYACCESS MATT. AND THERE
WASN'T A
WHOLE LOT OF ENFORCEMENT GOING
ON.
SO WE KEPT TRYING AND IF YOU
THOUSAND TO A WE TOOK A
DIFFERENT APPROACH. AND THE
LEGISLATURE PASSED THE BILL THAT
DIRECTED THE INMATES SEE TO SET
STANDARDS TO GUARANTEE TIMELY
ACCESS TO CARE.
WE WANTED SPECIFIC STANDARDS
THAT WERE CLEAR MEASURABLE AND
ENFORCEABLE AND WE WANT THE
ENTIRE INDUSTRY TO OPERATE BY
WHAT SCATTERED RATHER THAN
HAVING EACH HEALTH PLAN DECIDE
FOR ITSELF WHAT TIMELY ACCESS
MET.
IT TOOK EIGHT YEARS TO GET THE
REGULATIONS THAT.
THE EFFORT STARTED IN THE DAVIS
ADMINISTRATION AND IT WAS A
FINALIZING FOR THE END OF THE
SORTS NAY GOOD MINISTRATION.
THERE THE COUPLE RESISTANCE ON
THE HEALTH PLANS UP ROUND THE
STANDARDS.
IN THE END THE IMAGE SEIZE
REGULATIONS DID WHAT CONSUMER
ADVOCATES HAVE BEEN ASKING FOR
OVER A DECADE THAT THERE BE
CLEAR MEASURABLE ENFORCEABLE
STANDARDS.
AND THOSE STANDARDS ARE WHAT WE
HAVE A LOT TODAY.
IT FORTY EIGHT HOURS TO GET AN
URGENT CARE APPOINTMENT TEN
BUSINESS DAYS FOR PRIMARY CARE
ABOUT THE HEALTH APPOINTMENT AND
A SPECIAL VISIT AND FIFTEEN.
DAYS.
THESE THE LOS IT'S TIME LIMIT ON
HOW LONG PATIENTS HAVE TO WAIT
AND THE STANDARDS HAVE BEEN IN
EFFECT SINCE JANUARY TWENTY
TOUCH.
SO GOING BACK
TO THE ORIGINAL QUESTION HOW
LONG OF THE CONSUMER HAVE TO
WAIT FOR A DOCTOR'S APPOINTMENT.
NO NOW THAT WE HAVE CLEAR
STANDARDS IN PLACE HOW DO WE
KNOW IF THE HEALTH PLANS ARE
MEETING THEM.
THE TWO THOUSAND THREE BILL THAT
REQUIRED YOU MAY SEE TO SET THE
STEP CREATE THE STANDARDS ALSO
REQUIRE THEM TO REVIEW HEALTH
PLAN THAT WORKS EVERY YEAR.
UNFORTUNATE DURING THE AND THE
IMPLEMENTATION ON HEALTH PLANS
WORK AGAIN ALLOWED TO USE
DIFFERENT METRICS AND APPROACHES
FOR DETERMINE COMPLIANCE WHICH
MADE ENFORCEMENT QUITE
DIFFICULT.
SO TWENTY FOURTEEN HEALTH ACT
THE SPONSOR S. B. NINE SIXTY
FOUR WHICH STANDARDIZES THE DATA
THE HEALTH PLANS HAVE TO REPORT
EVERY YEAR REGARDING NETWORK
ADEQUACY. AND REQUIRED YOU WOULD
SEE TO DOUBLE THE PROCESS TO
MEASURE WHETHER HEALTH PLANS IN
MEETING THESE.
TIMELY ACCESS INTO THAT WE HAVE
A LOT.
WE SPONSORED THE SPELL FOR TWO
REASONS.
FIRST WE NEEDED TO SEE PROOF
THAT HEALTH PLANS ROUGHLY
PROVIDING TIMELY ACCESS.
AND SECOND MILLION MORE MILLIONS
MORE CALIFORNIA'S REGAINING
COVERAGE THANKS TO THE
AFFORDABLE CARE ACT AND THEY
WERE AND ROLLING EITHER
UNCOVERED CALIFORNIA PLANTS ARE
MEDI CAL MANAGED CARE PLANS. AND
AS MORE PEOPLE ENROLL THERE WERE
PERSISTENT CONCERNS ABOUT
WHETHER NETWORKS WERE ADEQUATE.
AT THE SAME TIME MILLIONS OF
PEOPLE AND MEDI CAL HAD BEEN
TRANSITIONED INTO MANAGED CARE
FROM FEE FOR SERVICE WE WANT TO
MAKE SURE THAT CONSUMERS A MEDI
CAL MANAGE CARE. WE'RE GETTING
THE SAME PROTECTIONS THAT OTHER
CALIFORNIANS WERE GETTING.
SO UNDER S. B. NINE SIXTY FOUR
AT THE HEALTH PLAN USES A
DIFFERENT NETWORK FOR MEDI CAL
MANAGED CARE THAT FOR OTHERWISE
BUSINESS THEY HAVE TO SEPARATE
ANNUAL REVIEW. FOR TIMELY ACCESS
ACCESS THE NETWORK AT SEA FOR
THE MEDI CAL NETWORK.
HEALTH PLANS ARE REQUIRED TO
SUBMIT THE SAME INFORMATION ON
THAT WORKS TO BOTH THE IMAGE THE
NTSC US OF THE DEPARTMENT THAT
CHECK.
AND CHECK FOR INCONSISTENCIES.
SO HOW LONG THE CONSUMER HAVE TO
WAIT FOR DOCTORS APPOINTMENTS.
SO FAR HEALTH PLANS HAVE FILED
TIMELY ACTS OF PORTS FOR TWO
YEARS WITH A STANDARDIZED DATA
THAT WAS REQUIRED BY SB NINE
SIXTY FOUR.
THE FIRST YEAR OF DATA BASED ON
TWENTY FIFTEEN WITH RENTAL WITH
SO MANY ERRORS THAT THE IN WHICH
HE WAS UNABLE TO DETERMINE
WHETHER HEALTH PLANS WERE
ACTUALLY MEETING THE STANDARDS.
DO YOU WHICH YOU JUST RELEASED
THE TWENTY SIXTEEN TIMELY ACCESS
REPORT LAST WEEK AND YOU'LL BE
HEARING FROM THEM. ABOUT THE
FINDINGS AND IN THE NEXT PANEL.
BUT IT'S SOMETHING ILL
CALIFORNIA'S TIGHTLY AFTER
STANDARDS ARE THE STRONGEST
NATION.
THEY APPLY TO BOTH THE MAKES
THE PLANS OUT AND MEDI CAL
MANAGED CARE PLANS. AND THE A TF
CORPORATE THESE REQUIREMENTS
INTO THE CONTRACT WITH MEDI CAL
PLANS.
D. H. YES ALSO DOES ITS OWN
MONITORING OF TIMELY ACCESS AND
PER THE FEDERAL MANAGE CARE
FINAL RULE.
ITSELF A FOR DOING ANNUAL
CERTIFICATIONS OF HEALTH PLAN
THAT WORKS WITH WELL.
WE DO CONSISTENT YOU TO STRUGGLE
OF KNOWING WHETHER HEALTH PLANS
ARE MEETING THE STANDARDS.
THE STANDARDIZED DATA AND
REPORTING OF S. B. NIGHT SIXTY
FOUR IS STILL RELATIVELY NEW
HOWEVER AS I SHOULD HAVE SHARED
WITH YOU. HEALTH PLANS HAVE BEEN
REQUIRED TO PROVIDE TIMELY
ACCESS TO CARE SINCE NINETEEN
SEVENTY FIVE AND WE'RE STILL
WAITING FOR THEM TO SHOW THAT
THEY'RE NOT MAKING CONSUMERS
WAIT TOO LONG FOR DOCTORS
APPOINTMENTS.
AND WHAT PLAN PROVIDERS.
DID UPRIGHT BY TIMELY ACCESS TO
CARE IT OUGHT TO MATH OTHER
PROBLEMS SUCH AS INADEQUATE
PROVIDER NETWORKS OR FINANCIAL
INSOLVENCY.
SO GOING BACK TO THE ORIGINAL
QUESTION.
HOW LONG DOES THE CONSUMER HAVE
TO WAIT FOR A DOCTOR'S
APPOINTMENT THE STANDARD SAY
FORTY HOURS FOR URGENT CARE TEN
BUSINESS DAYS FOR PRIMARY CARE
OR MENTAL HEALTH? FIFTEEN DAYS
FOR SPECIALIST BUT WE'RE STILL
WAITING FOR PROOF THAT THIS IS
ACTUALLY HAPPENING AND WILL LIFE
THANK YOU.
MISTER CHAIRMAN FIRST KIMBERLY
CHEN OF THE CALIFORNIA PAN
ETHNIC HELP WORK HEALTH NETWORK
WAS STATE WHAT HEALTH ADVOCACY
ORGANIZATION DEDICATED TO
ADVANCING HEALTH EQUITY IN
REDUCING HEALTH DISPARITIES NO
WANNA. BUILD ON THE BACKGROUND
AND FOUNDATION LAID BY MY
COLLEAGUE HERE AND SPEAK TO THE
IMPACTS THAT CULTURAL AND
LINGUISTIC ACCESS HAVE.
TICKET ACCESS TO CARE
SPECIFICALLY I'LL BE TOUCHING ON
TWO POINTS LANGUAGE ACCESS AND
TIMELY UP TIMELY ACCESS
STANDARDS AND WHAT GOES INTO
ENSURING A NETWORK ACTUALLY
MEETS THE NEEDS A BENEFICIARY.
I THINK IT'S USEFUL TO START
WITH SOME FACTS WE KNOW THAT
APPROXIMATELY TWO THIRDS OF MEDI
CAL AND RELEASE ARE PEOPLE OF
COLOR AND ONE THIRD ARE LIMITED
ENGLISH PROFICIENT.
WHICH MEANS TO SAY THAT CULTURAL
LINGUISTIC ACCESS IS NOT JUST
ANOTHER ISSUE THAT IS LAID ON
TOP IT IS A CENTRAL FACT WHETHER
COVERAGE.
ACTUALLY MEANS BEING ABLE TO SEE
YOUR DOCTOR AT YOUR TREATMENT
REGIMENS AND ULTIMATELY
EXPERIENCE OPTIMAL HEALTH
OUTCOMES.
THEREFORE AN ADEQUATE NETWORK
MUST BE ONE THAT SERVES THE
CULTURAL AND LINGUISTIC NEEDS OF
THE BENEFICIARIES.
SO LET'S TALK ABOUT LANGUAGE
ACCESS IN TIMELY ACCESS
STANDARDS WHAT IS A LOSSY.
MEDICAL MANAGED CARE PLANS ARE
REQUIRED TO PROVIDE ORAL
INTERPRETATION AT ALL POINTS
SERVICE.
REQUEST FOR INTERPRETATION WAS
NOT DELAY CARE RESULT IN REFUSAL
CARE.
IN SHORT IF YOUR BENEFICIARY.
TIMELY ACCESS TO CARE SHOULD
NOT BE COMPROMISED BY YOUR NEED
TO HAVE AN INTERPRETER OR HAVE
ANY OTHER ORAL INTERPRETATION.
UNFORTUNATELY WE DON'T HAVE VERY
STRONG MECHANISMS TO MAKE SURE
THAT THIS LAW HAS ACTUALLY BEEN
FOLLOWED OR UNDERSTAND WHERE THE
GAPS IT MAY BE. WE'D SEE PENS
WARTS.
WITH THE DEPARTMENT OF MANAGED
HEALTHCARE ON HOW TO INCLUDE
THIS IN THEIR TIMELY ACCESS
SUPPORT AND CERTAINLY
ACKNOWLEDGE THE CHALLENGE
CHALLENGES THAT THEY HAVE BEFORE
THAT WE'VE GONE THROUGH MULTIPLE
ITERATIONS OF. HOW WOULD YOU
ASKED THE QUESTION WHAT WOULD
YOU DO IF THE SCHEDULE THE
SCHEDULE DOESN'T KNOW THE RIGHT
ANSWER HOW TO EVEN DO THAT
WITHOUT COMPROMISING THE DATA
THAT THE PARTY HAD CHALLENGES
COLLECTING WE UNDERSTAND THAT?
THAT SAID A GAP STILL EXISTS
BETWEEN WHAT THE LAW SAYS AND
HOW WE MAKE SURE IT'S ACTUALLY
HAPPENING.
WHAT HAPPENS WHEN A PATIENT
ARRIVES IN THE OFFICE WITH THE
CLEAR LANGUAGE NEED THAT WASN'T
FLAG?
WHEN THEY MADE THAT APPOINTMENT
AT THE TIME DID THEY GET TO GO
TO THE OR SOMETHING GO HOME.
WHAT HAPPENS THEN CAN CAN THE
PROVIDER CALLED LANGUAGE LINE AT
THE TIME WITH THE PROOF WHEN THE
A MANAGED CARE PLAN HASN'T RANGE
THAT PREVIOUSLY?
WHAT HAPPENS WHEN?
UP PERSONAL QUESTION THE THE
APPOINTMENT.
.
I AND THE STAFF AT THE DESK
DOESN'T SPEAK ANOTHER LANGUAGE
AND THE PERSON WHOSE INTERPRETER
ON STAFF THAT DAY ISN'T THERE.
THAT STUFF NEVER GETS RECORDED
THOSE ARE THE THINGS THAT WE
DON'T KNOW.
AND WE KNOW THAT THE DEPARTMENT
HEALTHCARE SERVICES OMBUDSMAN
OFFICE IS NOW COLLECTING MORE
INFORMATION ON COMPLAIN DATA BUT
THERE IS STILL LIMITATION SAID
THAT.
ESPECIALLY ON FINDING THINGS
THAT WE DON'T KNOW.
.
NEXT LET'S TALK ABOUT WHETHER
NETWORKS ARE SERVING.
TO DELIVER THE CARE AND
CULTURALLY APPROPRIATE WAY.
FEDERAL REGULATIONS REQUIRE THAT
SERVICES BE DELIVERED IN
CULTURALLY COMPETENT MANNER TO
ALL ENROLLEES AND THAT INCLUDES
LANGUAGE DIVERSE ETHNIC AND
RACIAL BACKGROUNDS GENDER SEXUAL
ORIENTATION AND GENDER IDENTITY.
ONE TOOL PLANS AND DH YES USED
TO ASSESS THE NEEDS OF CONSUMERS
TO MAKE ADJUSTMENTS TO MEET
CULTURAL LINGUISTIC NEEDS IS A
GROUP NEEDS ASSESSMENT ALSO
KNOWN AS THE G. IN A SURVEY.
PLANS ARE REQUIRED TO PROVIDE
AGING A GENIE SURVEY EVERY FIVE
YEARS.
AND WHILE THE GENIE SURVEY IS
NOT NECESSARILY A TOOL FOR
ENFORCING NETWORK ADEQUACY DOES
IDENTIFY CNL NEEDS OTHER GAPS IN
SERVICE AND OTHER NEEDS UP OF
THE AND WILL LEASE AND
BENEFICIARIES.
BUT IF IT'S NOT THE GM A SURVEY.
HOW WE ENSURING THAT EACH SI
ESTAS MONITORING NETWORKS I'M
SURE THAT MEET THE NEEDS OF
HISTORICALLY UNDERSERVED
POPULATIONS AND MEETING THE
REQUIREMENTS OF THE FEDERAL
REGULATIONS?
IN SUMMARY AS MY COLLEAGUES HAVE
CALIFORNIA DOES HAVE STRONG
CONSUMER PROTECTIONS IN PLACE.
AND IT INCLUDES ACCESS TO
CULTURAL LINGUISTICALLY
APPROPRIATE SERVICES PROVIDERS
IN A TIMELY MANNER.
BUT HOW WILL WE KNOW THAT THE
APPROPRIATE OVERSIGHT IS THERE
TO ENSURE THAT THEY'RE BEING
FORCED.
THANK YOU.
GOOD AFTERNOON THE NO WAY WITH
WESTERN CENTER ON LAW AND
POVERTY WE WORK CLOSELY WITH
LOCAL LEGAL AID ORGANIZATIONS I
DO APPRECIATE THE OPPORTUNITY TO
PROVIDE A CONSUMER PERSPECTIVE.
ON NETWORK ADEQUACY AS I
PREVIOUSLY STATED CALIFORNIA HAS
SOME OF THE NATION'S STRONGEST
CONSUMER PROTECTIONS IN PLACE.
THANKS TO THE KNOX KING ACT
WHICH PROVIDE TIMELY ACCESS
STANDARDS THAT YOUR STAFF TO DO
NEXT WHEN JOB SUMMARIZING.
DESPITE THESE CLEAR ACCESS
STANDARDS.
OF TEN BUSINESS DAYS FOR PRIMARY
CARE PROVIDER AND.
MENTAL HEALTH PROVIDER FIFTEEN
BUSINESS DAYS FOR SPECIALIST
MEDI CAL MEMBERS THROUGHOUT THE
STATE.
I HAVE REPORTED WAITING OVER
THIRTY DAYS TO SEE A SPECIALIST
AND EVEN A PRIMARY CARE PROVIDER
AS SEEN IN THE EXAMPLE OF A
SACRAMENTO WOMAN GIVEN A PRIMARY
CARE PROVIDER APPOINTMENT A
MONTH AWAY AND I KIND ECOLOGIST.
APPOINTMENTS OVER A MONTH AND A
HALF AWAY.
MEMBERS OFTEN DO NOT BOTHER
REPORTING THIS TO THE STATE
FINDING THE GRIEVANCE PROCESS
CAN TAKE AS LONG AS THE
APPOINTMENT WAIT TIME AS THEY
MUST FIRST.
EXHAUST THE INTERNAL PLAN
GRIEVANCE OF THIRTY DAYS BEFORE
THEY CAN EVEN FILE A GRIEVANCE
WITH THE STATE.
THE MEMBER MAY ALSO NOT WANT IN
DANGER HER RELATIONSHIP WITH THE
ONLY PROVIDER OR CLINIC IN TOWN
WHO IS ACCEPTING NEW PATIENTS BY
FILING A GRIEVANCE.
AND MANY MANY MEMBERS ARE NOT
EVEN AWARE OF THE TIMELY ACCESS
STANDARDS SO THAT WHEN THEY ARE
TOLD TO WAIT TWO MONTHS THE
FADING THAT'S JUST HOW MEDI CAL
WORKS.
DEBATES THESE TIMELY ACCESS
REPORT WAS TO PROVIDE DATA ON
APPOINTMENT WAIT TIMES BY LINES
OF BUSINESS WHICH WOULD HAVE
ALLOWED COMPARISONS BETWEEN MEDI
CAL INDIVIDUAL AND LARGE GROUP
MARKETS.
HOWEVER DUE TO SIGNIFICANT DATA
ERRORS FROM HEALTH PLANS THAT
INFORMATION WILL NOT BE
AVAILABLE UNTIL THE END OF NEXT
YEAR ASSUMING THAT THE DATA IS
CORRECT.
EVEN ONCE THAT THAT REPORT IS
RELEASED IT WILL NOT CONTAIN
INFORMATION ON WAIT TIMES FOR
THE TWO MILLION MEMBERS WHO GET
SERVICES FROM THE COUNTY
ORGANIZED HEALTH SYSTEM CODES.
THAT ARE NOT KNOCK SCHEME
LICENSE.
IN TERMS OF ACT THIS TO SPECIFIC
PROVIDERS WE'VE HEARD OF LACK OF
ACCESS TO MENTAL HEALTH
PROVIDERS ENDOCRINOLOGIST.
GEN UROLOGIST AND YOU SEE
HOSPITAL BASED PROVIDERS.
CENTRAL VALLEY. ADVOCATES REPORT
AND MINIMUMWEIGHT TIME OF THREE
MONTHS FOR AN INITIAL
APPOINTMENT WITH A NEUROLOGIST
OR METALLIC JUST FOR SERGEANT
AND EIGHTEEN MONTHS TO SEE A
SPECIALIST WITHIN A HOSPITAL.
SPECIFICALLY A WOMAN IN FRESNO
HAD TO WAIT NEARLY THREE YEARS
FOR SURGERY TO TREAT HER
RUPTURED BREAST IMPLANT.
IN DECEMBER OF TWO THOUSAND
FOURTEEN SHE WAS ADMITTED TO THE
EMERGENCY ROOM AND DIAGNOSED
WITH A RUPTURED BREAST IMPLANT.
AFTER OVER TWO YEARS OF RETURN
HOSPITAL VISITS SPECIALIST
APPOINTMENTS AND SEVERE PAIN
FROM THE LEAK SILICONE. THAT
CAUSED
THAT THE HER RIGHT BREAST TOO
LARGE TO TWICE THE SIZE SURGERY
WAS SCHEDULED IN JUNE TWENTY
SEVENTEEN HOWEVER THIS WAS
CANCELLED BY CALVI OF US MEDICAL
GROUP EACH ASKS. DUE TO CONTRACT
ISSUES WHICH WERE SUDDENLY
RESOLVED WHEN AN INDEPENDENT
MEDICAL REVIEW WAS CLOUT WITH
THE MHC.
SHE FINALLY HAD HER SURGERY IN
OCTOBER ALMOST THREE YEARS
LATER.
UNFORTUNATELY THESE DELAYS ARE
NOT UNCOMMON AS SEEN BY A MORE
RECENT CASE OF AN ELDERLY WOMAN
IN FRESNO WHO HAD TO WAIT OVER
ONE YEAR FOR AN ORTHOPEDIC
REFERRAL.
WHICH ULTIMATELY RESULTED IN
TOTAL KNEE REPLACEMENT.
WHEN PLANS TALK ABOUT
CONTRACTING WITH THE MAJORITY OF
PROVIDERS IN THE AREA THIS
DOESN'T DESCRIBE ACTUAL CAPACITY
AS MANY OF THE SPECIALISTS ONLY
CONTRACT TWICE A MONTH. FOUR
HOURS EACH TIME.
A BETTER INDICATOR OF ACCESS IS
THE AVAILABILITY OF FULL TIME
EQUIVALENT.
POSITION SEEING MEDI CAL MEMBERS
BROKEN DOWN BY SOCIALIST TYPE.
MOST PROVIDERS PRACTICED IN
MULTIPLE LINES OF BUSINESS SO
IT'S MORE ACCURATE TO GET
ACCOUNT OF F. T. E. PROVIDERS
SEEING.
MEDI CAL PATIENTS DH DS COULD
COLLECT THIS FROM PLANNING
COUNTER DATA AND WOULD FURTHER
RECOMMEND THIS BE BROKEN DOWN BY
DELEGATED MOTTO. AS THE
DELEGATED MODEL DOES SEEM TO
FURTHER NARROW NETWORKS.
WE'VE REQUESTED EACH DEE YES
CERTIFY NETWORKS AT THE
DELEGATED AND LEVEL AND
RECOGNIZED ARE CONCERNED THAT
THEY DON'T HAVE THE CAPACITY TO
DO THIS BY JULY. THEREFORE WE
ASK THE LEGISLATURE TO WORK WITH
DTS TO BUILD THAT CAPACITY TO
CERTIFY DELEGATED ENTITIES BY
JULY TWENTY NINETEEN CONTRACT
YEAR.
IN ADDITION WE ALSO RECOMMEND
USING ENCOUNTER DATA TO
DETERMINE WHETHER PROVIDER IS
ACCEPTING NEW PATIENTS. AND HAVE
THAT THE PROVIDER DIRECTORIES
REFLECT VESTS.
WE LOOK FORWARD TO THE MEDICAID
MANAGED CARE RULE IMPLEMENTATION
BUT THEIR CURREN ACCESS
CHOOSE THE CAN BE ADDRESSED NOW
AND WE'VE OFFERED SOME
RECOMMENDATIONS INCLUDING.
BUILDING DCS CAPACITY TO CERTIFY
THE NETWORKS OF DELEGATED
ENTITIES BY JULY TWENTY
NINETEEN.
GREATER ANALYSIS OF SPECIALIST
ON.
BY FULL TIME EQUIVALENT.
TEAMMATES THE TIMELY ACCESS
REPORTING BY LINES OF BUSINESS
AND KNOCKS KING LICENSURE CODES
SO THAT THE TWO MILLION MEDIC
CAO LIVES HAVE ACCESS TO AN
INDEPENDENT MEDICAL REVIEW. AND
THE HELP LINE TIMELY ACCESS
REPORTING REQUIREMENTS AND THE
SAME REGULATORY OVERSIGHT THAT
ALL OTHER. CALIFORNIA HEALTH
CONSUMERS HALF THINKING.
IF YOU.
MISTER CHAIR MEMBERS THANK YOU
FOR THE OPPORTUNITY TO SHARE THE
HEALTH CENTER PERSPECTIVE ON
MEDICARE MANAGED CARE NETWORK
PACKED WITH AGASSI AND ITS
EMPIRE ACT ON ACCESS TO CARE. MY
NAME IS ROBIN AFRO I'M IN I'M C.
E. O. OF COMMUNICATOR HOW
CENTERS AND NONPROFIT FEDERALLY
QUALIFIED HEALTH CENTER
PROVIDING CARE TO OVER TWENTY
FIVE THOUSAND PATIENTS
THROUGHOUT YOLO COUNTY.
I'M ALSO A BOARD MEMBER OF THE
CALIFORNIA PRIMARY CARE
ASSOCIATION.
TODAY I'LL START BY SHARING MY
HEALTH CENTERS NETWORK ADEQUACY
STORY AND THEN PROVIDE SOME
STATE WHY PERSPECTIVE BASED ON
THE EXPERIENCES OF THE OVER
THIRTEEN HUNDRED COMMUNITY
HEALTH CENTER SITES THAT SERVE
THE STATE OF CALIFORNIA. AND
PROVIDE COMPREHENSIVE HIGH
QUALITY CARE TO SIX POINT FIVE
MILLION PEOPLE OR ONE IN SIX IN
CALIFORNIA.
COMMUNICATOR IS UNIQUE THAT OUR
PATIENT POPULATION TOUCHES THREE
MEDI CAL MANAGED CARE MODELS.
WHILE THE VAST MAJORITY OF OUR
MEDI CAL PATIENTS RECEIVE
COVERAGE THROUGH A COUNTY ORGAN
I'D HELP OUT COUNTY ORGANIZED
HEALTH SYSTEM PARTNERSHIP HEALTH
PLAN.
SOME OF OUR PATIENTS MOSTLY PERI
NATAL PATIENTS ARE COVERED
THROUGH THE GEOGRAPHIC MANAGED
CARE MODEL IN SACRAMENTO COUNTY.
AND REGIONAL EXPANSION MODEL A
COLUSA COUNTY.
IT IS THROUGH OUR EXPERIENCE
ACROSS THESE DIFFERENT MODELS
AND PLANS THAT WE'VE LEARNED TO
APPRECIATE THAT NOT ALL PLANTS
APPROACH ACCESS AND NETWORK
ADEQUACY IN THE SAME WAY IN
PARTICULAR WE SEE A REAL MODEL.
IN PARTNERSHIP HEALTH PLAN OF
CALIFORNIA P. H. SEE A MULTI
COUNTY KOS SERVING FOURTEEN
NORTHERN CALIFORNIA COUNTIES.
COMMUNICATOR HEALTH CENTERS
JOINT PARTNERSHIP HEALTH PLAN IN
ON TWO THOUSAND AND ONE AT THAT
TIME WAS ONLY SOLANO NAPA AND
YOLO COUNTIES.
WE CURRENTLY HAVE A LITTLE OVER
TWELVE THOUSAND PEACH THE LIVES
ASSIGNED TO US.
AS P. H. C. IS GROWN THEIR
COMMITMENT TO NETWORK ACT
ADEQUACY HAS ONLY GROWN
STRONGER.
WE HAVE FOUND P. H. C. IS
COMMITTED TO TRANSPARENCY AND
ACCESSIBILITY THIS CAN BE SEEN
IN THE OPEN LINE OF
COMMUNICATION BETWEEN THE PLAN
AND IT'S PROVIDERS AND THE PLAN
IN ITS CONSUMERS.
THIS HAS INFORMED AN ENVIRONMENT
THAT ALLOWS CONSTRUCTIVIST
CONCERNS TO BE ADDRESSED IN A
TIMELY MANNER.
THIS CAN ALSO BE SEEN IN THEIR
UP TO DATE WEBSITE THE PROVIDES
AN ACCURATE REFLECTION OF
ELIGIBILITY VERIFICATION THE
PROVIDER DIRECTORY. RECOGNIZING
THAT HAVING A ROBUST NETWORK
MIGHT REQUIRE THE PLAN TO
CONTRACT WITH SPECIALIST THAT
ARE NOT AROUND THE CORNER. PHP
H. C. HAS IMPLEMENTED AN
EXPANDED TRANSPORTATION BENEFIT.
S. BENEFIT HAS BEEN TRUMP
TREMENDOUSLY WELL RECEIVED BY
OUR PATIENTS AND PROVIDERS WE NO
LONGER HAVE TO WORRY IF A
PATIENT HAS THE GAS MONEY TO GET
TO THEIR NEXT APPOINTMENT.
AS A RESULT THERE IS HARDLY ANY
DIFFICULTY IN DOING SPECIAL
REFERRALS FOR A PEACH THE
PATIENTS THEIR* CERTAIN
SPECIALTIES THAT ARE DIFFICULT
TAKE LONGER LIKE UROLOGY IN
ROLLA G. BUT THEY'RE DIFFICULT
FOR THOSE OF US WITH PRIVATE
INSURANCE AS WELL.
THEY LIVE UP TO THEIR NAME IT
DOES FEEL LIKE A PARTNERSHIP
BETWEEN PLAN PROVIDERS AND
CONSUMERS.
NOW I WOULD LIKE TO TURN TO THE
STATEWIDE NETWORK ATTICUS
ADEQUACY CONCERNS REGARDING D.
H. CS AND D. M. H. C. NETWORK
ADEQUACY MONITORING I WANT TO
START. OFF BY SAYING THAT SI PC
A AND HEALTH CENTERS ENCOURAGE
AND SUPPORT STRONG STANDARDS AND
VIGOROUS MONITORING AND
OVERSIGHT. OVER THE PAST FEW
YEARS D. H. CS AND DE EIGHT NDM
H. C. HAVE BOTH BEGUN TO RAMP UP
THEIR NETWORK ADEQUACY
MONITORING BUT FROM THE
STAKEHOLDER PERSPECTIVE THE
PROCESSES APPEAR TO BE
DUPLICATIVE AND UNCOORDINATED.
FOR EXAMPLE D. EIGHT D. H. CS
PROPOSES TO LOOK AT THIRD NEXT
AVAILABLE APPOINTMENT TO ENSURE
TIMELY ACCESS TO CARE WELL D. M.
H. C. LOOKS AT NEXT AVAILABLE
APPOINTMENT AND WE ACTUALLY AS A
MEASURE. WE USE THIRD NEXT
AVAILABLE JUST
AS INFORMATION ANOTHER EXAMPLE
IS AROUND HOW FQHCS ARE CAPTURED
IN THE MONITORING STANDARDS.
UNDER THE WELFARE INSTITUTIONS
CODE MEDI CAL ENROLLEES ARE
SUPPOSED TO BE ASSIGNED TO AN
FQHC RHC AS THE PRIMARY CARE
PROVIDER TO THE ACTUAL
ORGANIZATION. RATHER THAN TO A
CLINICIAN WORKING AT THE FQHC
ART ART IN OUR AGE SEE. THE D.
MHC HAS BEEN VERY RESPONSIBLE
WHAT'S OF TO CBC IN ENSURING
THAT FQHC SPECIFIC ASSIGNMENTS
REFLECTED IN OUR AGASSI. AND
TIMELY ACCESS MONITORING.
D. H. CS HASN'T REALLY MEANT
THAT EFFORT
WHY WAS SUPPORT ROBUST NETWORK
MONITORING STANDARDS WE STRONGLY
URGE THE STATE DEPARTMENT'S TO
WORK MORE CLOSELY TOGETHER.
THE LESSONS LEARNED FROM D. M.
H. C. MAY BE USEFUL TO D. H. CS
IN THE DEVELOPMENT OF THEIR
STANDARDS THEIR OTHER TWO QUICK
POINTS REGARDING TELEHEALTH AND
CARE COORDINATION THAT I'D LIKE
TO HIT UPON.
TELEHEALTH IS PLAYING A BIGGER
AND BIGGER PART IN OUR DELIVERY
SYSTEM AND I ONLY SEE THAT ROLE
GROWING IN THE FUTURE. TELL
HEALTH IS A WONDERFUL OPTION FOR
EXPANDING ACCESS TO CARE BUT
FQHCS EXPERIENCE FINANCIAL
BARRIERS TO PARTICIPATION IF IT
FQHC PRIMARY CARE PROVIDER WANTS
TO USE TELEHEALTH TO OFFER A
SPECIAL THE ACCESS TO PATIENT.
THE FQHC MUST GIVE UP AN EXAM
ROOM PURCHASE A MAINTAIN
EQUIPMENT BUT IS NOT REIMBURSED
AS AN ORIGINATING SITE OF THE
TELEHEALTH VISIT.
D. H. CS REIMBURSES THE
SPECIALISTS AT THE OTHER END OF
THE TELL HER HEALTH EQUIPMENT
BUT WILL NOT REIMBURSE CLINICS
IF THEY ARE THE ORIGINATING
SITE.
WE NEED TO CHANGE THAT.
WE NEED TO CHANGE THIS IF WE ARE
TO OFFER MORE SERVICES THROUGH
TELEHEALTH A CONVENIENT PHC BASE
LOCATION FOR PICK.
AND I THINK THIS IS PARTICULARLY
IMPORTANT AND RURAL AREAS.
THE LAST POINT I WANT TO MAKE IS
AROUND THE IMPORTANCE OF
BUILDING A ROBUST ON THE GROUND
INFRASTRUCTURE OF CARE
COORDINATORS ESPECIALLY FOR THE
MEDICARE POPULATION. THERE IS A
BILL ON THE SET.
PAN WHICH IS MEANT TO EASE UP
SOME FINANCIAL BARRIERS THAT
FQHCS EXPERIENCE THAT MAKE IT
DIFFICULT TO PROVIDE THE KIND OF
CARE COORDINATION SERVICES THAT
MEDI CAL MANAGED CARE PATIENTS
NEED.
THIS BILL ALLOW FQHCS TO PARTNER
WITH MEDI CAL MANAGED CARE PLANS
HOSPITALS AND OTHERS IN THE
DELIVERY SYSTEM TO BUILD UP CARE
COORDINATION INFRASTRUCTURE.
THE FQHC AS THE PRIMARY CARE
PROVIDER WILL ENSURING THERE IS
A DEEP LOOK THERE IS NO
DUPLICATION OF PAYMENT.
AS YOU CONTINUE YOUR
DELIBERATIONS ON NETWORK
ADEQUACY THE HEALTH CENTER
COMMUNITY LOOKS FORWARD TO BEING
A RESOURCE.
IN CLOSING THANK YOU FOR
CREATING THE SPACE FOR THIS
IMPORTANT CONVERSATION.
YOU.
MITCHELL BACO WITH THE
CALIFORNIA MEDICAL ASSOCIATION.
CMA HAS LONG ADVOCATED FOR
ROBUST NETWORK ADEQUACY
STANDARDS IN CALIFORNIA BOTH AND
MEDI CAL AND COMMERCIAL MANAGED
CARE DELIVERY SYSTEMS.
IN RECENT YEARS WE HAVE BEEN
ACTIVE IN THE STATE CLIP PROCESS
HOPING TO INFORM THE STATE'S
POLICY ON NETWORK ADEQUACY AND
ACCESS TO CARE. INCLUDING A
POSITION PARTICIPANT WHO IS A
MEMBER OF DATES YES OF ACCESS
AND ASSESSMENT BY THREE
COMMITTEE. AS REQUIRED BY THE
SPECIAL TERMS OF THE STATE'S
OLYMPIC TEAM WAVERING ALL.
MORE RECENTLY CMA HAS BEEN
ACTIVELY ENGAGED IN VOICING
CONCERNS TO THE STATE ON THE
MEDICAID MANAGED CARE FINAL
RULE.
NETWORK ADEQUACY POLICY
PROPOSAL. THAT WAS RELEASED LAST
YEAR AS WELL AS WELL AS THE
DRAFT ALL PLANNED LETTER AND
THAT CAME OUT THIS PAST JAN
JANUARY.
OUR GREATEST CONCERN WITH THE
ALL PLAN LETTER IS THAT IT DID
NOT ADDRESS DOUBLE COUNTING OF
PROVIDERS PARTICIPATING IN MORE
THAN ONE PLAN. AND THE
DEPARTMENTS OVERSIGHT STILL
RELIES HEAVILY ON THE SELF
REPORTING OF HEALTH PLANS.
WE BELIEVE LACK OF PATIENT
ACCESS TO KAREN MEDI CAL MANAGED
CARE CONTINUES TO BE AN ISSUE
DUE TO INADEQUATE NETWORKS.
THE A NUMBER OF FACTORS
IMPACTING PROVIDED PARTICIPATION
AND FOR MEDI CAL MANAGED CARE.
INCLUDING A LACK OF TRANSPARENCY
REGARDING PROVIDER PAYMENT RATES
NEGOTIATED BETWEEN THE STATE AND
MEDICARE MANAGED CARE PLANS.
ALONG WITH EROTIC ADEQUATE
CAPITATED RATES PAID BY PLANS TO
DELEGATED GROUPS AND INADEQUATE
CONTRACTED PROVIDER PAYMENTS.
THERE'S LITTLE TRANSPARENCY AND
OVERSIGHT OF THE RATE SETTING
PROCESS BETWEEN PLANS AND STATE
REGULATORS.
TO DETERMINE IF THEIR AGREEMENTS
BEING ENTERED INTO ARE LIKELY TO
RESULT IN ADEQUATE PATIENT
ACCESS.
AND MEDICARE MANAGED CARE
PROVIDER PAYMENT RATES ARE A
CONTRACTUAL MATTER BETWEEN PLAN
THE PROVIDERS HOWEVER THE RATES
PAID TO THE PLANS IMPACT THE
CONTRACTED PROVIDER PAYMENT
RATES.
UNFORTUNATELY PHYSICIANS HAVE
HISTORICALLY HAD AN ADEQUATE FEE
LEVELS WHILE THE PROFITS FOR.
FOR PROFIT PUBLICLY TRADED
HEALTH INSURANCE COMPANIES.
SORE.
THERE'S ALSO INADEQUATE
OVERSIGHT OF PLANS BY STATE
REGULATORS.
THE SITUATION WITH CENTER MATT
WAS A CLEAR EXAMPLE THE STATE'S
LACK OF OVERSIGHT IN THIS AREA.
TMA HAS A LONGSTANDING POSITION
OPPOSING THE USE OF THESE TYPES
OF NARAL NETWORKS AND OPPOSES
THESE TYPES OF ACTIONS BY PLANS
AND DELEGATED GROUPS TO LIMIT
PATIENT ACCESS TO CARE.
IT IS CRITICAL THAT THE STATE
ACT TO REFORM THE CURRENT SYSTEM
OF MONITORING CONTRACTED PLANS.
ADDITIONALLY DATA SHOULD BE
REVIEWED AND VERIFIED ACROSS
MULTIPLE STATE AGENCIES AND
SOURCES.
JCS HAVE RELIED HEAVILY ON PLAN
SELF REPORTING TO MONITOR
ACCESS.
STAKEHOLDERS HAVE LONG CONTENDED
THIS METHOD WITH INADEQUATE. AND
IT DATES YES FOR TIGHTENING
MONITORING OF MANAGED CARE PLANS
AND NOT RELY EXCLUSIVELY ON DATA
PROVIDED DIRECTLY BY HEALTH
PLANS.
A CALIFORNIA STATE AUDITOR'S
REPORT CONCLUDED THAT THE ACS
DID NOT VERIFY THAT THE PROVIDER
NETWORK DATA RECEIVED WHO HEALTH
PLANS WITH ACCURATE.
THERE BY FAILING TO ENSURE THAT
THE MANAGED CARE PLANS HAD
ADEQUATE NETWORKS OF PROVIDERS
TO SERVE MEDI CAL BENEFICIARIES.
WE BELIEVE PLANS MUST BE HELD
ACCOUNTABLE FOR MAINTAINING
ADEQUATE NETWORKS AND ENSURING
THAT MEDI CAL BENEFICIARIES
RECEIVE. THE SAME QUALITY
HEALTHCARE THAT NON MEDICAL
BENEFICIARIES RECEIVE.
WITH THE PASSAGE OF AB TWO OH
FIVE LAST YEAR WITH CMA
SUPPORTED THE GROUNDWORK WITH
WAS LATE FOR THIS TO HAPPEN.
HOWEVER TO MAKE CERTAIN THAT
THIS PROCESS IS SUCCESSFUL THE
STATE MUST BE WILLING TO MAKE
LONG TERM INVESTMENTS IN THE
PROVIDER NETWORK. ENGAGE IN
MEANINGFUL OVERSIGHT OF MANAGED
CARE PLANS.
AND ESTABLISH A HIGHER DEGREE OF
TRANSPARENCY BY ENSURING THAT
DATA ON PLAN COMPLIANCE AND
ALTERNATIVE ACCESS STANDARDS ARE
PUBLICLY AVAILABLE IN A TIMELY
MANNER.
AND I JUST FIND OUTSIDE AND
OTHER SORT OF REAL WORLD
ANECDOTE.
TO WHAT LINDA WAS SAYING.
WE HAVE A MEMBER IN SAN DIEGO
THAT IS IN YOUR NOSE AND THROAT
SPECIALIST.
AND.
HE'S HAD.
SIGNIFICANT ISSUES.
FINDING AN ONCOLOGIST TO REFER
TO WHEN HE HAS PATIENTS THAT ARE
DIAGNOSED WITH.
WITH CANCER AND.
HE'S IN THE SAN DIEGO AREA SO
NOT A RURAL AREA BUT STILL.
DIFFICULTY FINDINGS.
SPECIALTY CARE.
AND WHEN YOU'RE DEALING WITHIN.
A DIAGNOSIS LIKE CANCER IT'S I
MEAN TIME IS OF THE ESSENCE AND.
THAT'S SORT OF AN ADEQUATE
NETWORK NOW NETWORK IS TO SIMPLY
UNACCEPTABLE.
SO WITH THAT I'M. HAPPY TO
ANSWER.
THANK YOU.
OUR PLAN IF I MAY IS TO HAVE
PANEL TWO PRESENTS NEXT BUT STAY
CLOSE WE MAY CALL YOU BACK FOR
QUESTIONS AS WORK GOING FROM
THERE
.
HI GOOD AFTERNOON MY NAME IS
MARTA GREEN AND I'M THE CHIEF
DEPUTY DIRECTOR AT THE
CALIFORNIA DEPARTMENT OF MANAGED
HEALTHCARE.
THE MISSION OF THE CALIFORNIA
DEPARTMENT MANAGE HEALTH CARE IS
TO PROTECT CONSUMERS HEALTHCARE
RIGHTS AND ENSURE A STABLE HAVE
CARE DELIVERY SYSTEM. BEFORE I
JUMP INTO THE SPECIFIC QUESTIONS
THAT THE.
AGENDA SET FORTH FOR US I
WANTED A GIVE A LITTLE BIT MORE
CONTEXT BUT ONE OF THE OTHER
WAYS IN WHICH WE MONITOR. ACCESS
AND AND REPORTS OF INADEQUATE
ACCESS IN THAT STORE THE DAMAGE
HE'S HELP CENTER.
SO WHAT THE HELP CENTER DOES IS
IT PROVIDES DIRECT HEALTHCARE
CONSUMER ASSISTANCE THROUGH A
CALL CENTER. AND ONLINE PORTALS
YOU CAN DO PHONE CALLS ONLINE
WHATEVER YOU PLEASE AND WE USE
IN HOUSE IT ANALYSTS ATTORNEYS.
AND WE ALSO HAVE CONTRACTED
INDEPENDENT MEDICAL REVIEW
ORGANIZATIONS TO RESOLVE
CONSUMER COMPLAINTS. BUT AS AN
EXAMPLE LAST YEAR WE RESOLVED
ABOUT A HUNDRED AND SIXTY FIVE
THOUSAND A DIFFERENT COMPLAINTS
THAT CAME AND.
SO MOST OF THE CONSUMER
COMPLAINTS ARE RESOLVED OR
STANDARD COMPLAINT PROCESS A
COMMON ISSUES INCLUDE
CANCELLATION OF COVERAGE BILLING
ISSUES QUALITY OF SERVICE AND
THE LIKE.
BUT WE TREAT ACCESS COMPLAINTS A
LITTLE BIT DIFFERENTLY AND WE
HAVE SOME SPECIAL PROCESSES IN
PLACE FOR ACCESS COMPLAINTS.
SELECT SAY FOR EXAMPLE CONSUMER
CALLS WITH ONE OF THE REAL WORLD
EXAMPLES THAT WAS PRESENTED BY
THE FIRST PANEL I CAN'T GET
ACCESS WITHIN THE REGULATORY
TIME FRAMES OR. I HAVE AN URGENT
MEDICAL CONDITION AND I NEED
SOMETHING QUICKER THAN THE
STANDARD REGULATORY TIME FRAMES
WE ACTUALLY PERFORM A THREE OR A
PHONE CALL WHERE WE GET THE
CONSUMER. THE HEALTH PLAN AND US
ON THE PHONE AND HELP THE IT
REALLY THROUGH THE HEALTH PLAN
GET ACCESS TO THAT MEDICAL
PROFESSIONAL IN A AN
APPROPRIATE.
LENGTH OF TIME FOR WHATEVER
THEIR MEDICAL CONDITION MAYBE.
AND SOMETIMES AN ACCESS
COMPLAINT COULD COME IN AS A
CONSUMER WENT TO AN OUT OF
NETWORK PROVIDER BECAUSE HERE
SHE COULD NOT GET ACCESS. IN A
TIMELY WAY WITHIN AND NETWORK
PROVIDER IN SEEKING
REIMBURSEMENT FOR THAT AT A
NETWORK CARE.
AND WE ALSO GET COMPLAINTS FROM
CONSUMERS THAT MAYBE HAVE TOLD
THEY NEED TO GO TOO FAR AND IT'S
BEYOND A REASONABLE DISTANCE TO
TRAVEL FOR WHATEVER THAT THAT
PROVIDER TYPE MAYBE.
SO WITH ANY OF THE SCENARIOS ARE
HELP CENTER STAFF WOULD ASK THE
HEALTH PLAN FOR A LIST OF
CONTRACTED PROVIDERS AND WORK
WITH BOTH THE HEALTH PLAN IN THE
IN RELIEF TO FIND SOMETHING
THAT'S WITHIN A REASONABLE DEAF
DISTANCE AND WITHIN A REASONABLE
TIME FRAME. AND IF THE END OF
THE DAY THE HEALTH PLAN IS NOT
ABLE TO MEET THE STANDARDS WOULD
OFFER FOR THAT CASE TO OUR
OFFICE OF ENFORCEMENT.
ANOTHER KIND OF ACCESS TYPE
ISSUE THAT WE SOMETIMES SEE IS
RELATES TO CONTINUITY OF CARE
SO.
YEAH WITH THE RECENT OF.
WITHDRAWAL OF ANTHEM BLUE CROSS
FROM THE MAJORITY OF THE
INDIVIDUAL MARKET.
A LOT OF THOSE IN RELEASE
TRANSITION TO WHATEVER HEALTH
PLAN FOR HEALTH PLANS WERE
AVAILABLE AND THAT SPECIFIC
REGION. AND SO THEY MAY HAVE
BEEN MID COURSE OF TREATMENT AND
SO UNDER CALIFORNIA LAW THEY'RE
ENTITLED TO CONTINUITY OF CARE
SO SING THE SAME PROVIDER.
THAT MAYBE NOW OUT OF NETWORK
BUT IT IN AND NETWORK COST
SHARING SO WE'VE HAD A NUMBER OF
CASES INCLUDING SOME IN THE
CENTRAL VALLEY WHERE THE
ENROLLEE REQUEST DIDN'T KNOW HOW
TO REQUEST COGNITIVE CARE AND SO
WE WILL WALK THE ENROLLEES
THROUGH THE PROCESS OF WORKING
WITH THE. HEALTH PLAN TO REQUEST
AND RECEIVE CONTINUITY OF CARE.
LASTLY I WANNA POINT OUT THAT WE
DO HAVE A CONSUMER ASSISTANCE
PROGRAM THAT WE ALSO MAINTAIN
WHICH IS A NETWORK OF LOCALLY
BASED ON MOSTLY LEGAL AID
SOCIETIES WITH THE CURRENT
CONTRACT BUT. IT'S OPEN TO.
COMPETITION EVERY THREE YEARS
AND IN ADDITION TO WHAT WE DO AT
OUR HELP CENTER THEY PROVIDE
BOOTS ON THE GROUND ASSISTANCE
TO PEOPLE IN THE COMMUNITY.
THAT HAVE MORE LANGUAGES THAN
WE HAVE A CAPABILITY OF PROVIDE
IN HOUSE AND THEY CAN ALSO HELP
WITH.
ISSUES OUTSIDE OF OUR
JURISDICTION SO MAYBE THE
CONSUMERS AND A HEALTH PLAN THAT
IS NOT REGULATED BY THE STATE
BECAUSE IT'S A PREEMPTIVE FROM
STATE REGULATION OR THEY'RE
HAVING DIFFICULTY WITH MEDICARE
AND THE LIKE. SO OUR CONSUMER
ASSISTANCE PARTNERS CAN ALSO
ASSIST OF THOSE ENROLLEES.
SO WITH THAT I'M HAPPY TO JUMP
INTO THE SPECIFIC QUESTIONS THAT
YOU HAVE.
LIKE IT'S A THE FIRST ONE
RELATED TO THE TIMELY ACCESS
REPORT FOR MEASUREMENT YEAR
SIXTEEN. MY COLLEAGUE AT.
HEALTHAXIS DID A GREAT JOB
TALKING OF THE HISTORY SO WON'T
RIP PETE ANY OF THAT BUT IT WILL
TALK A LITTLE BIT MORE IN DEPTH
ABOUT WHAT HAPPENED LAST YEAR
AND THEN WHAT HAPPENED WITH THIS
YEAR'S REPORT.
SO IN MEASURE YOUR TWENTY
FIFTEEN THE DAMAGE HE WAS UNABLE
TO COMPARE HEALTH PLAN DATA
BECAUSE OF THE DATA ELEVATOR.
DATA ERRORS THAT WERE DISCUSSED.
FOLLOWING THE RELEASE OF THE
TWENTY FIFTEEN REPORT WHICH
BASICALLY SAID WE HAVE NOTHING
TO REPORT BECAUSE WE CAN'T
REPORT. THE DAMAGE SEE REQUIRED
TO TAKE UP OF THE PLANTS TAKE A
NUMBE OF STEPS TO IMPROVE THE
THOUGH CHANCES OF A. DEAL THAT
WE CAN REPORT THE SHARE.
NATE THESE STEPS INCLUDED
RETAINING DATA VALIDATORS TO
REVIEW AND AUTHENTICATE THE
TIMELY ACCESS DATA BEFORE THEY
SUBMIT THEIR TWENTY SIXTEEN AND
TWENTY SEVENTEEN COMPLAINTS
REPORTS. SO THE INFORMATION WE
GOT FOR THE TWENTY SIX
STEEN MEASUREMENT HERE WHICH WAS
SUBMITTED IN MARCH OF TWENTY
SEVENTEEN HAD FAR FEWER ERRORS
THAT WE WE MADE A LOT OF
PROGRESS FROM WHAT WE SAW THE
YEAR BEFORE. UNFORTUNATELY WE'RE
NOT ALL THE WAY TO THE FINISH
LINE AND PART OF THAT REASON IS
BY THE TIME WE REALIZED WE HAD
SO MANY ERRORS IN THE TWENTY
FIFTEEN.
MEASUREMENT YEAR A LOT OF THE
SURVEYS FOR TWENTY SIXTEEN HAD
ALREADY BEEN CONDUCTED SO TO THE
EXTENT THAT THOSE SURVEYS WORDY
DON THAT COULDN'T BE REDONE. AND
BECAUSE WE WERE NOW IN TWENTY
SEVENTEEN BY THE TIME THAT WAS
THAT WAS DISCOVERED AND SO WE
HAD TO WORK WITH THE SURVEYS.
THAT WERE DONE AND WE CAN ONLY
WE CAN ONLY ADDRESS THE DATA
ISSUES THAT WE COULD ADDRESS
AFTER THE FACT.
SO WHILE THE DATA FOR TWENTY
SIXTEEN HAD FAR FEWER ERRORS IN
THE PREVIOUS YEAR SOME REMAINED.
AND IN WE WORK WE MADE THE
DECISION TO ONLY PUBLISHED
CHARTS AND SUMMARY DATA WHERE WE
HAD A MARGIN OF ERROR OF LESS
THAN FIVE PERCENT.
BECAUSE WE FELT STRONGLY THAT IF
WE PUBLISH DATA WITH A MARGIN OF
ERROR OF GREATER FIVE PERCENT
COULD BE WILDLY MISLEADING SO
WERE UNWILLING TO DO THAT. AND
FOR THAT REASON THAT WE DO NOT
HAVE BY ONE OF BUSINESS AS A ONE
OF THE PREVIOUS PANEL MEMBERS
TALKED ABOUT WE DON'T HAVE
TOWARDS RELATED TO LINE OF
BUSINESS BECAUSE ONCE. WE CARVE
TO THE INFORMATION INTO THAT
SMALL OF A BUCKET ARE DID IT
ARE.
ARE SIMPLY AREAS WERE GREATER
THAN FIVE PERCENT AND ALSO WHEN
WE WENT DOWN TO THE COUNTY LEVEL
OR SAMPLING ERRORS WERE GREATER
THAN FIVE PERCENT.
SO THE RATES OF COMPLAINTS FOR
APPOINTMENTS WITHIN THE TIME
LAPSED STANDARDS VERY PRETTY
SIGNIFICANTLY BY PLAN PROVIDER
TYPE AND THE STANDARD. BUT THE
TOTAL RANGE FOR FULL SERVICE
HEALTH PLANS ARE NOT TAKE INTO
ACCOUNT SPECIALIZED PLANS. OF A
PROVIDERS IN THE SAMPLE SIZE
MEETING THE APPOINTMENT RETAIN
STANDARD VARIED FROM A HIGH OF
NINETY FIVE PERCENT TO A LOW OF
THIRTY TWO PERCENT. SO WHAT THAT
MEANS IS FOR WHATEVER SAMPLE WAS
CALLED FOR THAT APPOINTMENT WAIT
TIME STANDARD. AND ANYWHERE FROM
THIRTY TWO PERCENT OF THE
PROVIDERS THAT ANSWERED THE
PHONE AND ANSWERED THE SURVEY OR
THEIR STAFF THAT ANSWERED THE
PHONE AND ANSWERED THE SURVEY.
SAID YES I HAVE AN APPOINTMENT
WITH IN THE TIME LAPSE STANDARD
TO UP TO A HIGH OF NINETY FIVE
PERCENT.
AND SO WE SINCE I ALREADY
MENTION WE DON'T HAVE COUNTY
LEVEL DATA IN THE REPORT I CAN
TALK GENERALLY ABOUT SOME OF THE
COMPLAINTS RATES FOR PLANTS THAT
OPERATE EXCLUSIVELY IN THE
CENTRAL VALLEY. SO WON'T BE
FRESNO ALONE BUT IT WILL BE
AREAS. IN THE GREATER CENTRAL
VALLEY AREA SO FIRST EXAMPLES
CAL VIVA AND THEY OPERATE FRESNO
KINGS AND MADERA. SO FIFTY SIX
PERCENT OF THE SURVEYED
PROVIDERS MET THE APPOINTMENT
WAIT TIME STANDARD SO FIFTY SIX
SIX PERCENT OF THE PROVIDERS
CALLED SAID YES.
MY NEXT AVAILABLE APPOINTMENT
WAS WITHIN THE STANDARD THAT A
PASSING SCHOOL WORST IS THAT AN
ACCEPTABLE PERCENTAGE.
IT'S AN EXCELLENT QUESTION AND
ONE THAT WE CAN'T ANSWER YET
BECAUSE WE DO NOT HAVE WE DO NOT
HAVE THE METRIC SET YET PUMP FOR
WHAT IS.
WE HAVE COMPLETE THE RATE OF
COMPLAINTS THE CARE.
WE DON'T HAVE A READ A
COMPLAINT SET FIRST WE NEED TO
SEE WHAT THE DATA TOLD US AND
THEN WE ARE GOING TO WORK A
STAKEHOLDER PROCESS WITH PLANS
PROVIDERS ARE SISTER STATE
AGENCIES TO ESTABLISH A READ A
COMPLAINT STANDARD THAT'S
REASONABLE. ISN'T THE RATE OF
COMPLIANCE TO MEET THE STANDARDS
BY THE KNOX KEEN ACT AND HENCE
THEIR FOURTH SHOULDN'T BE A
HUNDRED PERCENT. WELL A HUNDRED
PERCENT WOULD MEAN THAT EVERY
PROVIDER YOU CALLED IN THE
NETWORK HAD AN APPOINTMENT
AVAILABLE WITHIN THE TIME LEFT
STANDARDS AND FOR CERTAIN
PROVIDER TYPES THAT'S JUST NOT
REALISTIC RIGHT IF YOU'RE A
PROVIDER TYPE WHOSE.
IF YOU'RE JUST REALLY POPULAR
RIGHT YOU'VE GOT YOU'VE GOT
PEOPLE THAT REALLY WANT TO SEE
YOU BECAUSE YOU YOU ARE
PERCEIVED TO BE THE BEST
PROVIDER IN WHATEVER FIELD YOU
MAY BE AND. YOU'RE PROBABLY
GOING TO BOOK UP AND SO I I I
DON'T THINK WE'RE GOING TO FIND
ITS WAY I RATED COMPLAINTS A
HUNDRED PERCENT BEING SOMETHING
THAT'S ACHIEVABLE A GIVEN THAT
WE. HAVE A DOCUMENT A PROVIDER
SHORTAGE IN CALIFORNIA BUT WE
DON'T KNOW EXACTLY WHERE THAT
PERCENTAGE SHOULD BE BECAUSE NOT
ALL PROVIDERS ARE GOING TO HAVE.
AND EQUIPMENT AVAILABLE WITHIN
THE TIME LEX STANDARD BUT HOME
HOW MANY IN THE NETWORK. HAVE
THAT APPOINTMENT AVAILABLE.
HOW THE PHONE CALLS DO NEED TO
MAKE IS AN EXAMPLE IS THREE
PHONE CALLS IS THAT REASONABLE
THOSE OF THE TYPES OF QUESTIONS
WILL BE ASKING IN THE STICKLER
PROCESS?
SO THE THREE OTHER PLANS THAT
OPERATE PRETTY MUCH EXCLUSIVELY
IN THE CENTRAL VALLEY COMMUNITY
CARE HEALTH PLAN THERE IN BOTH
FRESNO MADERA. THEY WERE FIFTY
NINE PERCENT OF SURVEYED
PROVIDERS CURRENT HEALTH SYSTEMS
THERE IN KERN COUNTY WAS FIFTY
NINE PERCENT AND HEALTH PLAN OF
SAN JOAQUIN WHICH ISN'T S. PARTS
OF SACRAMENTO SAN JOAQUIN
STANISLAUS COUNTIES.
IS EIGHTY FIVE PERCENT.
SO THAT WAS THE FIRST TIME WITH.
THANK YOU AND GOOD AFTERNOON
CEREBRAL IT'S WITH THE
DEPARTMENT HEALTH CARE SERVICES
I'M THE DEPUTY DIRECTOR OF THE
HEALTHCARE DELIVERY SYSTEMS.
I'M SO WITH RESPECT TO ITEM
EIGHTY TO A FIVE IN PROVIDING AN
UPDATE TO YOU TODAY. THE MANAGE
CARE FINAL RULE WAS ISSUED IN
MAY OF TWO THOUSAND SIXTEEN BY
CMS.
AND THE RULE ITSELF DID REQUIRE
STATES TO ESTABLISH NETWORK
ADEQUACY STANDARDS BUT STILL
PROVIDE FLEXIBILITY TO THEM TO
DESIGN.
THEIR OWN CREATION IN TERMS OF
IMPLEMENTING THEM.
THE RULE THOUGH DOES REQUIRE
THAT STATES ARE ESTABLISH
STANDARDS FOR A DIFFERENT
PROVIDER TYPES INCLUDING PRIMARY
CARE SPECIALTY CARE HOSPITALS
AND PHARMACIES AMONG OTHERS.
I'M IN CALIFORNIA THE FINAL RULE
APPLIES TO FOUR DIFFERENT TYPES
OF HEALTH PLANS MEDI CAL MANAGED
CARE HEALTH PLANS COUNTY MENTAL
HEALTH PLANS. DRUG MEDI CAL
ORGANIZED DELIVERY STILL SYSTEM
HEALTH PLANS AND DENTAL MANAGED
CARE PLANS ARE AT THE MOUTH.
BUT THE RULE ITSELF DOES
REQUIRES THE C. ANNUALLY CERTIFY
FOR ALL OF THOSE HEALTH PLANS
THAT EACH HEALTH PLAN'S NETWORK
AWESOME.
IS IN COMPLIANCE WITH THE
REQUIREMENTS THAT THE STATE HAS
PUT INTO PLACE.
EIGHTY TWO OH FIVE ITSELF WAS
SIGNED BY THE GOVERNOR LAST YEAR
IN THIS PAST SESSION IMPLEMENTED
SPECIFIC PROVISIONS OF THE FINAL
RULE INCLUDING NETWORK ADEQUACY
STANDARDS.
IT DOES REQUIRE HEALTH PLANS TO
MEET TIME OR DISTANCE AND OR
TIMELY ACCESS STANDARDS FOR THE
E. PROVIDER TYPES THAT THE FINAL
RULE DOES SET FORTH.
OVER THE PAST FIVE YEARS DTS HAS
WORKED TO SIGNIFICANTLY
STRENGTHEN MONITORING AND
OVERSIGHT OF OUR HEALTH PLANS.
THROUGH THE CREATION AND
IMPLEMENTATION OF NEW DATA
SYSTEMS THE DEPARTMENT HAS
BETTERED ITS ABILITY TO COLLECT
VALITY AND ANALYZE DATA THAT ARE
SUBMITTED TO US BY OUR HEALTH
PLANS.
ONE EXAMPLE OF THIS IS THAT
HEALTH PLANS NOW SUBMIT A
MONTHLY PROVIDER FILE TO S..
THIS PROVIDER FILE INCLUDES ALL
INFORMATION ABOUT THE HEALTH
PLAN'S NETWORK FROM THE PLAN
LEVEL DOWN TO THE INDIVIDUAL
PROVIDER.
AND THE DATA SYSTEM THAT DOES
COLLECT THIS INFORMATION IS
CALLED PIECES AND IT DOES
COLLECT THESE DATA.
WITH UP FRONT EDITS WHICH ALLOW
US TO VALIDATE THE INFORMATION
THAT IS BEING SIMILAR TO US AND
SO FOR EXAMPLE IF AN NPI WORK
SUBMITTED TO US INCORRECTLY
THROUGH THE SYSTEM. IT WOULD BE
REJECTED IN THE HEALTH PLAN
WOULD NEED TO THEN SUBMITTED TO
US AS CORRECTED WITH UPDATED
INFORMATION.
THIS DATA SYSTEM PROVIDES DH YES
WITH NEW ABILITIES TO OVERSEE
HEALTH PLANS.
ALLOWING THE H. YES IT ENGAGE IN
MORE TIMELY RESPONSES TO DATA
QUALITY ISSUES AND MAKING OF
DATA AVAILABLE WHICH PREVIOUSLY
WERE NOT.
WE NOW KNOW THE NUMBER AND TYPE
OF THE FIGHTERS AVAILABLE
THROUGH EACH HEALTH PLANS NOW
WORKING WHERE THEY OPERATE.
SO EXAMPLES OF THIS INCLUDE
HEALTH PLANS HAVE APPROXIMATELY
SEVENTY ONE THOUSAND PHYSICIANS
ARE PROVIDER STATEWIDE NOW FOR
MEDI CAL MANAGE CARE HEALTH
PLANS.
BUT WE ALSO CAN COLLECT DATA AT
A MORE GRANULAR LEVEL SO FOR
EXAMPLE FOR DISTRICT THIRTY ONE
WE KNOW THAT THERE ARE A TOTAL
OF NINE HUNDRED NINETY THREE
TOTAL MEDI CAL PHYSICIANS WITH
THREE POINT FOUR PHYSICIANS PER
TWELVE HUNDRED. MEMBERS WHICH
EXCEEDS THE STATE PASSED
STANDARD OF ONE POSITION PER
TWELVE HUNDRED MEMBERS.
AND WERE ALSO ABLE TO UTILIZE
THESE DATA TO MONITOR OTHER
HEALTH PLAN NETWORK ADEQUACY
REQUIREMENTS INCLUDING TIME AND
DISTANCE.
WERE ABLE TO COMBINE OUR MONTHLY
PROVIDER FILE WITH ARCGIS
SOFTWARE AND THAT ALLOWS US TO
MAP OUT THE GEOGRAPHIC AREAS OF
WHERE.
.
TO MAP OUT HELP MY NETWORKS
ENSURE FULL COVERAGE OF THE
GEOGRAPHIC AREA THAT A PLAN
OPERATE THEM. THOUGH DATA WERE
AVAILABLE TO THE DEPARTMENT
BEFORE WE NOW KNOW THAT THEIR WE
CAN HAVE MORE CONFIDENCE IN THE
DATA THAT ARE REPORTED TO US DUE
TO OUR INCREASE VALIDATION
PROCESS IS THAT WE HAVE PUT IN
PLACE.
JH YES IS ALSO ENGAGED IN NEW
ACTIVITIES PERTAINING TO
MONITORING AND OVERSIGHT OF
TIMELY ACCESS.
SO AS NOT TO SOLELY RELY ON
HEALTH PLAN DATA THAT ARE
REPORTED TO US WE'VE ENGAGED OUR
EXTERNAL QUALITY REVIEW
ORGANIZATION OR ARE EQUAL AS WE
CALL IT. I'M WHICH IS AN
INDEPENDENT ENTITY TO CONDUCT
QUARTERLY TIMELY ACCESS SURVEYS
ON OUR BEHALF.
THE EGO WILL CONDUCT A
STATISTICALLY SIGNIFICANT
TELEPHONE SURVEY AND COLLECT THE
FIRST THREE AVAILABLE
APPOINTMENT TIMES FOR EACH
HEALTH PLAN IN EACH GEOGRAPHIC
AREA THAT THEY OPERATE AND.
SO WILL BE COLLECTING TIMELY
ACCESS DATA FOR PC PEAS ALL
COURSE SPECIALISTS NON PHYSICIAN
MENTAL HEALTH PROVIDERS OBGYN
AND SOME ANSEL AREAS PROVIDERS
WILL BE COLLECTING TIMELY ACCESS
QUARTERLY. I'VE GONE AYE IT WITH
RESPECT TO HOW QUICKLY
BENEFICIARIES CAN GET IN TO SEE
THESE TYPES OF PROVIDERS.
DECIMATED SAMPLE SIZE STATEWIDE
FOR TWO THOUSAND EIGHTEEN IS
TWENTY EIGHT THOUSAND THREE
HUNDRED AND FIFTY FIVE PROVIDERS
AND AS I MENTIONED THIS WILL BE
CONDUCTED QUARTERLY THROUGHOUT
THE YEAR. I'M SHOULD WE IDENTIFY
THAT THERE IS AN AREA OF CONCERN
WITH RESPECT A TIMELY ACCESS
THROUGH THE SURVEYS THAT WE
WOULD PROVIDE TECHNICAL
ASSISTANCE AND OR IMPOSE A
CORRECTIVE ACTION PLAN ON THE
HEALTH PLAN ITSELF.
I'M AND IT'S IMPORTANT I THINK
TO NOTE THAT WE WILL BE
INCLUDING THIS INFORMATION AND
OUR QUARTERLY MANAGED HER
DASHBOARD AS WELL BECAUSE WE
WANNA BE TRANSPARENT MAKE SURE
WE'RE SHARING THIS INFORMATION
OUT PUBLICLY AS WELL.
FINALLY PER THE MANAGED CARE
FINAL RULE IN STATE STATUTE DHS
AS WAS NOTED EARLIER MUST
ANNUALLY CERTIFY EACH HEALTH
PLAN'S NETWORK TO THE STANDARDS
AS SET FORTH IN STATE LAW. THIS
IS A GREAT UNDERTAKING ITEM. DHS
WILL COMPLETE OVER SIXTY NOTICED
NETWORK CERTIFICATIONS PARTS
MEDICAL MANAGE CARE HEALTH PLANS
ALONE IN TWO THOUSAND EIGHTEEN.
ALL OF WHICH ARE DUE TO CMS
PRIOR TO JULY ONE OF THIS YEAR.
WE DID ISSUE ALL PLAN LETTER
EIGHTEEN VAST ZERO ZERO FIVE
NETWORK CERTIFICATION
REQUIREMENTS TO SET FORTH
REQUIREMENTS THE HEALTH PLANS
PERTAINING TO DEMONSTRATING
COMPLIANCE.
THIS APL WAS REVIEWED PUBLICLY.
AND ISSUED FOR COMMENT AND WE
ALSO HELPS A SEVERAL WEBINARS AS
WELL ALONG THE WAY TO REVIEW THE
CONTENTS OF IT TO MAKE SURE THAT
THE PUBLIC WAS WELL AWARE OF
WHAT WAS INCLUDED IN THE
DOCUMENT.
THE CERTIFICATION ITSELF FOR THE
NETWORK CERTIFICATION WILL
INCLUDE AN ASSESSMENT OF
PROVIDER RATIOS.
COMPLIANCE WITH THE COURT'S
SPECIALIST MANDATORY PROVIDER
TYPES BEHAVIORAL HEALTH
TREATMENT PROVIDERS WILL LOOK AT
TIME AND DISTANCE AND ALSO
ANNUAL AUDIT FINDINGS SO IT'S A
SIGNIFICANT UNDERTAKING.
WITH RESPECT TO YOUR QUESTION ON
A PHYSICIAN RATIOS OF THE
DEPARTMENT'S RATIO IS ONE
POSITION PER EVERY TWELVE
HUNDRED BENEFICIARIES THAT WE DO
ALSO HAVE A ONE PRIMARY CARE
PHYSICIAN PER TWO THOUSAND
BENEFICIARIES REQUIREMENT AS
WELL. THAT SET FORTH IN STATE
LAW BOTH OF THOSE REQUIREMENTS
AND OUR COMPARATIVE THEIR STATES
AS WELL.
I'M FINALLY REGARDING THE DATA
VALIDATION AND YOUR THIRD
QUESTION AS WAS MENTIONED
EARLIER DHS HAS IMPLEMENTED A
NEW ROBUST MONTHLY PROVIDER FILE
SYSTEM WHICH IS AUTOMATED AND
RUNS DATA AGAINST BUSINESS
REQUIREMENTS UPON DATA EACH
STATUS THE MISSION.
THIS SYSTEM IS FURTHER VALIDATED
THROUGH CROSS CHECK IN THE DATA
WITH PLAN PROVIDER DIRECTORIES
AND THE QUARTERLY TIMELY ACCESS
SURVEYS.
IN ADDITION DHS HAS ENGAGE ARE
EQUAL TO VALIDATE ON THE STATE'S
BEHALF DATA ON THE STATE'S
BEHALF SO WILL ACTUALLY BE
SENDING ARE EQUAL ON SITES
PROVIDER OFFICES SO THAT THEY
CAN CHECK THE DATA THAT ARE.
THERE AT THE PROVIDER SITE AND
THEN CHECK TO SEE WHAT'S
ACTUALLY BEEN SUBMITTED TO THE
DEPARTMENT SO WE CAN BALLOT IT
WHAT'S COMING TO THE DEPARTMENT
FROM THE PROVIDERS THEMSELVES TO
MAKE SURE THAT THE PLANTS ARE
SUBMITTING ALL DATA TO US.
DCS WILL ALSO UTILIZE THE
QUARTERLY TIMELY ACCESS SURVEYS
COMPLETED BY OUR EQUAL TO
DETERMINE IF THERE ARE SPECIFIC
HEALTH PLANS OR HEALTH PLAN
GEOGRAPHIC AREAS THAT INDICATE
AN AREA OF CONCERN. AND SO AS I
INDICATED EARLIER IF WE DO
IDENTIFY AN AREA OF CONCERN THAT
WE WOULD IMPOSE A CORRECTIVE
ACTION PLAN ON THE HEALTH PLAN
AND WORK WITH THEM TO BRING THEM
INTO COMPLIANCE WITH THE
REQUIREMENTS.
AND FINALLY WE ARE WORKING TO
UPDATE OUR ANNUAL AUDIT TOOL WE
DO I WE AUDIT OUR HEALTH PLANS
ANNUALLY.
AND WE ARE WORKING TO
STRENGTHEN THE SECTIONS WHICH
ADDRESSING REVIEW OVERSIGHT OF
DELEGATED ENTITIES AND
SUBCONTRACTORS AT THIS TIME.
AND THANK YOU FOR THE
OPPORTUNITY WE ARE HAPPY TO
ANSWER ANY QUESTIONS THANK YOU.
FOR THIS TIME WILL TAKE PUBLIC
COMMENT ON ISSUE FIFTEEN.
THANK YOU TEMAS COUNT AGAIN WITH
CHILDREN'S DEFENSE FUND ON
BEHALF OF THE CHILDREN'S HEALTH
COVERAGE COALITION. I AM I THINK
WE JUST WANT TO REITERATE THE
IMPORTANCE OF.
PEDIATRIC SPECIFIC DATA AND
PIAT PEDIATRICS JUST
NETWORKS
GIVEN THAT MORE THAN HALF OF
CALIFORNIA'S CHILDREN ARE IN
MEDI CAL.
I'M AND THEN I THINK. WE JUST
WANNA SAID WERE REALLY DEEPLY
CONCERNED THAT D. H. YESUS
MONITORING ENFORCEMENT AND
REPORTING IS AN ADEQUATE.
EVEN THE PROPOSED INCOMPLETE
IMPLEMENTATION PLAN TO COMPLY
WITH THE UPCOMING.
A FEDERAL RIGHT I REGULATIONS ON
MONITORING. AND MOSTLY JUST
BECAUSE IT'S NOT PEDIATRIC
SPECIFIC AND IT'S IN THE
AGGREGATE.
SO.
IT'S REALLY HARD TO FIND OUT
HOW CHILDREN ARE FARING IF WE
DON'T HAVE PEDIATRIC SPECIFIC
DATA.
SO.
AND ACTUALLY AN ADORABLY WE.
WE DID OUR OWN SMALL SAMPLE
SURVEY OF.
OF
A JUST TESTING THE TIMELY ACCESS
TO CARE STANDARDS FOR
PEDIATRICIANS.
AND.
WE FOUND OUT ABOUT.
IT TOOK ABOUT SIX.
PHONE CALLS TO GET A WELL CHILD
CHECK IN SOME COUNTIES.
AND THEN ALSO AND WE WERE TOLD
AND REPEATEDLY ARM AT THE TIME.
WHEAT TO THE SURVEY AT THE
BEGINNING OF.
SEPTEMBER AND AUGUST
THAT.
BECAUSE AT THE TIME OF THE YEAR
THERE THEY COULDN'T COMPLY WITH
THE STANDARDS BECAUSE AND THERE
WERE TOO MANY APPOINTMENTS FOR
BACK TO SCHOOL. WHICH
AND WE DON'T THINK IT'S AN
ADEQUATEI'M ANSWER FOR PARENTS
I AM SO THANK YOU FOR THIS
PROPOSAL.
THANK YOU.
SEE NO FURTHER PUBLIC COMMENT ON
BRING IT BACK TO THE DYESS.
ALL START WITH A FEW QUESTIONS
IF I CAN.
FIRST I WANT TO UNDERSTAND FROM
THE STATE'S PERSPECTIVE DO WE
CURRENTLY BELIEVE THAT THEY'RE
SUFFICIENT NETWORK ADEQUACY.
.
SO I'D THIS IS JENNIFER CAN'T.
DIRECTOR FOR THE DEPARTMENT.
I WOULD SAY THAT THERE ARE
CERTAIN AREAS OF THE STATE OR
CERTAIN PROVIDER TYPES THAT WE
WILL STIPULATE THAT WE HAVE
DIFFICULTY.
THERE ARE CERTAIN ZIP CODES
WHERE WE HAVE EXEMPTED MANAGED
CARE ALTOGETHER AND MEDICAL
BECAUSE THEY'RE SIMPLY. NOT
ENOUGH.
PROVIDERS WITHIN REASONABLE
DISTANCE SINCE A MANAGE CARE IS
NOT IN THOSE AREAS. I'M I THINK
THERE ARE A LOT OF PLANS AND I
THAT WE THAT WE WOULD SAY THIS
CHILD PSYCHIATRISTS ARE. I'M
ALMOST IMPOSSIBLE TO FIND IN
FACT I WAS IN A MEETING WITH ONE
THE OTHER DAY AND I WANTED TO
RUN UP TO HIM AND SAY. YOU KNOW
CURRY CONTRACTING WITH AND HOW
CAN WE GET YOU TO CONTRACT THERE
ARE CERTAIN.
SPECIALTIES THAT ARE JUST
EXTREMELY DIFFICULT DEPENDING ON
THE GEOGRAPHIC AREA THAT YOU'RE
IN IN THE STATE BECAUSE.
THEY REQUIRE A CERTAIN AMOUNT
OF VOLUME IN ORDER TO SURVIVE
AND IF YOU'RE IN A CERTAIN RURAL
AREA IF YOU'RE NEUROLOGISTS.
AND YOUR YOU KNOW I COME FROM
MARIPOSA COUNTY SO.
THERE'S ONLY ONE THOUSAND SEVEN
HUNDRED SIXTY THREE PEOPLE IN
THE ENTIRE COUNTY THERE'S NOT A
NEUROLOGISTS THAT'S GOING TO BE
ABLE TO SURVIVE IN THAT COUNTY
BECAUSE OF THE LOW.
POPULATION ALTOGETHER AND SO I
WOULD SAY THAT WE BELIEVE THAT
WE HAVE COME A GREAT DEAL IN
TERMS OF OUR TOOLS.
AND OUR DATA IN ORDER TO
MONITOR NETWORK ADEQUACY BUT I
WOULD NEVER SAY THAT YOU KNOW
THERE IS A HUNDRED PERCENT
COVERAGE FOR A HUNDRED YOU KNOW
PERCENT OF THE TIME MEETING ALL
OF THE DIFFERENT REGULATORY
REQUIREMENTS BUT I BELIEVE THAT
WE ARE SO MUCH FARTHER ALONG
THAN WE. USED TO BE AND THAT YOU
KNOW SERIOUS VERY.
KIND OF TOPICAL IN TERMS OF
TALKING ABOUT THE SOPHISTICATION
THAT WE HAVE REALLY GROWN UP AS
A STATE AND AS A DEPARTMENT. BUT
WE HAVE REALLY MATURED OUR
SYSTEMS AND SO I'M.
.
I BELIEVE WE'RE ON THE RIGHT
TRACK BUT I KNOW THAT THERE WILL
ALWAYS BE CERTAIN AREAS OR
SPECIALTIES THAT WE WILL ALWAYS
AND STRUGGLE WITH NOT JUST FOR
MEDI CAL BUT FOR BOTH. MEDI CAL
AND COMMERCIAL AND OTHER TYPES
OF OF POPULATIONS
WHAT I.
ON.
HOPE YOU HEAR FROM US IS IT
SEEMS AS IF THIS IS AN ONGOING.
PROBLEM AND EVEN IF WE HAVE MADE
GREAT STRIDES.
WE BEAR THE FIDUCIARY
RESPONSIBILITY.
TO ARE TAXPAYERS TO MAKE SURE
THAT WE'RE PROVIDING. THE
SERVICES AS DESIGNATED BY THE
KNOX KEEN ACT AND SO. I'M TRYING
TO UNDERSTAND WHO IS IT
SPECIFICALLY THAT DETERMINES
NETWORK ADEQUACY AND AUTHORIZES.
SO FROM OUR PERSPECTIVE FROM OUR
DEPARTMENT.
WE AND CERTAINLY AND MARY
CAMPBELL WHO'S THE STATE
MEDICAID DIRECTOR SHE HAS TO
PERSONALLY CERTIFY EVERY SINGLE
PLANNED NETWORK BY JULY FIRST
AND AGAIN SARAH SPEAKING ONLY TO
MEDICAL MANAGED CARE WHICH IS
WITHIN HER PURVIEW. THESE ARE
ALSO NETWORK CERTIFICATIONS
REQUIRED OF OUR COUNTY MENTAL
HEALTH PLANS THERE'S FIFTY SIX
OF THEM.
TEN COUNTIES SUBSTANCE USE
DISORDER NETWORKS AND ALL OF THE
DELL MANAGED CARE PLANS IN BOTH
SACRAMENTO AND LOS ANGELES
COUNTY SO PROBABLY WELL OVER.
OF HUNDRED AND.
TWENTY NETWORK CERTIFICATIONS
THAT SHE WILL HAVE TO SIGN OFF
ON AND CERTIFY TO THE FEDERAL
GOVERNMENT. AND SHE WILL NOT DO
THAT UNTIL WE HAVE.
MADE SURE THAT THE DATA PROVIDED
BY THE PLANS HAS BEEN BOTH
VALIDATED AND THAT WE FEEL IT'S
ADEQUATE FOR THE POPULATION. IN
THAT COUNTY OR IN THAT SERVICE
AREA. UNDER THE CERTAIN
REQUIREMENTS THAT WERE OUTLINED
IN THE BILL.
TO THE EXTENT THAT PLANTS DO
NOT HAVE AN ADEQUATE NETWORK
MEANING THEY HAVE A SHORTAGE OF.
A CERTAIN TYPE OF SPECIALIST OR
ON THE COUNTY MENTAL HEALTH SIDE
IF THEY DON'T HAVE ENOUGH
PSYCHIATRISTS.
TO HANDLE THE POPULATIONTHAT
WE ESTIMATE THAT THEY NEED.
THEY HAVE BEEN TOLD THAT OUR
CERTIFICATION TO THE FEDERAL
GOVERNMENT WILL INVOLVE THEM
PAIN OUT OF NETWORK FOR
PROVIDERS UNTIL SUCH TIME AS
THEY CAN HAVE A CONTRACT GOOD
NETWORK IN PLACE THAT MEETS
NETWORK ADEQUACY STANDARDS. SO I
THINK THAT WE ARE TRYING BOTH TO
IMPART.
THE SERIOUSNESS OF THE.
PROCESS AND THE CERTIFICATION
ON OUR BEHALF AND I'M NOT
SPEAKING TO THE D. IMAGE SEE
ISSUES AROUND WHAT THEY DO TO
VALIDATE NETWORK ADEQUACY BUT I
THINK. THE PLANS.
KNOW OUR INTENT OF HOW WE
INTEND TO CERTIFY BECAUSE WE
TAKE IT SERIOUSLY AND THEN AGAIN
IT'S A MATURITY OF BOTH DATA AND
PROCESS.
I MEAN WE HOPE THAT.
THERE'S OTHER PARTS OF THE
WORLD'S THAT.
OUR DEPARTMENT DOESN'T TOUCH
RAY I CAN'T GROW PHYSICIANS ON
AS MUCH AS I WOULD LIKE TO GROW
SOME CHILD PSYCHIATRIST ON THOSE
ARE ISSUES BIGGER AND BROADER
BINDER BEYOND OUR DEPARTMENT BUT
I KNOW THAT WE WORK WITH THE
PLAN'S PRETTY CLOSELY TO BOTH
IDENTIFY THOSE. AND THEY ARE
PUSH TO PAY AT CERTAIN POINTS
WHATEVER IT TAKES TO GET A
PATIENT TO THE PLACE THAT THEY
NEED TO BE IF THEY DON'T HAVE
SOMETHING WITHIN THEIR
CONTRACTING NETWORK.
ARE THERE ANY OTHER MEDICAL
PATIENTS BEING IMPROPERLY DENIED
ACCESS TO CARE IN ORDER TO
REDUCE COSTS.
FOR MORE EXPLICITLY IF I CAN
SYSTEMATICALLY BLOCKING PATIENTS
AND PROVIDERS FROM ACCESSING IN
NETWORK.
SPECIALISTS WHO ARE DEEMED TOO
COSTLY.
SO I THINK YOU'RE REFERRING TO.
AN ISSUE THAT HAPPENED IN THE
FALL.
IN WHICH
ARE THERE WERE WHISTLEBLOWER
ACCOUNTS OF IMPROPER ON
ACTIVITIES BY A NON.
IT WASN'T A MEDICAL GROUP IT
WASN'T HEALTH PLAN IT WAS A.
ENTITY OUTSIDE OF THAT AND SO
WE WORKED VERY CLOSELY WITH THE
DEPARTMENT OF MANAGED HEALTHCARE
AND THE PLANS TO BOTH.
QUICKLY ADDRESS THAT PARTICULAR
SITUATION AS WELL AS PUT ALL OF
OUR PLANS ON A CORRECTIVE
ACTION.
I PLAN THAT SARAH AND HER TEAM
HAVE BEEN LEADING TO MAKE SURE
THAT.
PATIENTS WERE NOT IMPROPERLY
EITHER DENIED OR THAT REFERRAL
FORM.
.
REFERRALS NEEDED TO BE MADE TO
THE RIGHT PROVIDER FOR THE RIGHT
ITEM BUT PLANS WENT BACK.
GOING BACK TWO YEARS TO MAKE
SURE THAT THEY REACHED OUT TO
PATIENTS TO MAKE SURE THAT HAD
THERE BEEN A REFERRAL OR HAD
THERE BEEN AN AUTHORIZATION FOR
SERVICES THAT WERE NOT PROVIDED
THAT WE MADE. UP FOR THAT AND SO
I WOULD AND SAY THAT THAT
PARTICULAR INSTANCE AN EXAMPLE
HAS BEEN ADDRESSED AND WE'RE
CURRENTLY STILL I'M WORKING WITH
THE PLANTS UNDER THEIR
CORRECTIVE ACTION PLANS FOR THE.
DOES IT SHOW THOUGH IT LACKED
GOAL LACK OF ACCOUNTABILITY OF
AMONG THE COMPANIES INVOLVED IN
MEDICAID MANAGED CARE.
YOU KNOW NOT TO USE A EUPHEMISM
BUT AS THE FOX GUARDING THE HEN
HOUSE.
WELL I WOULD SAY FOR THAT
PARTICULAR.
CASE THOUGH THE WAY THAT IT WAS.
FOUND WAS A PLAN WAS IN DOING
AN AUDIT AND COMPLIANCE CHECK.
AND THERE WAS A STAFF MEMBER.
THIS IS ACCORDING TO THE
WHISTLEBLOWER COMPLAINT THAT
ACCIDENTALLY GAVE THEM DATA THAT
THEY SAID THIS DOESN'T. LOOK
RIGHT AND THEN THE WHOLE AYE
THING. KIND OF OPENED UP.
WHEN ALL OF OUR PLANS WENT IN
TO DO THEIR OWN CHECK
SEE.
WHAT WERE THE CIRCUMSTANCES AND
THEN AND TO VALIDATE THE NATURE
OF THE WHISTLEBLOWER COMPLAINT?
?
INDIVIDUALS EMPLOYED IN THAT
ORGANIZATION ADMITTED TO
FALSIFYING DOCUMENTS
SO I THINK THAT IT'S PROBABLY.
A LITTLE BIT OF A UNFAIR
STATEMENT TO SAY THAT THE PLANS
WERE NOT CONDUCTING OVERSIGHT
WHEN THEY ACTUALLY WERE BUT THAT
YOU HAD AN ENTITY THAT WAS
DELIBERATELY AND THEY HAVE NOW
CSUS.
ADMITTED AS MUCH THAT THEY WERE
FALSIFYING DOCUMENTS AT THE
PLANS WERE VALIDATING AND SO I
THINK IT OPENED FOR US OBVIOUSLY
WE TOOK IT VERY SERIOUSLY I
THINK FOR THE PLANS THEY TOOK IT
VERY SERIOUSLY AND. WERE STILL
INVOLVED IN.
SOME INTERNAL THINKING ABOUT.
WHAT CAN WE DO?
AS A STATE TO MAKE SURE THAT WE
ARE ON PUTTING INTO THIS.
PLACE OTHER WAYS TO DOUBLE
CHECK INFORMATION I THINK THE
PLANS CERTAINLY WANT TO DO THAT
AS WELL BUT.
THE FALSE THE DIRECT
FALSIFICATION OF DOCUMENTS
SOMETIMES IS I'M CERTAINLY WE
WOULD NOT HAVE KNOWN HAD
WHISTLEBLOWERS NOT NOT MADE THAT
AVAILABLE TO US. AND I'M GONNA.
ALLOW ASSEMBLYMEMBER RUBIO TO
JUMP IN HERE BUT IT DOES SEEM
THAT THIS IS SUBSIDIARITY AT ITS
WORST.
THAT BY PUSHING THIS
ACCOUNTABILITY FURTHER DOWN IT'S
REMOVING THE STATE FROM OUR
OBLIGATION TO ENSURE THAT WE
ARE.
MEETING OUR KNOCKS KEEN ACT.
REGULATIONS. QUITE A SECOND
QUESTION DO YOU HAVE ANY IDEA
HOW MANY PATIENTS WERE AFFECTED
MOM BY THAT.
I'M I DON'T THINK THAT WE KNOW
AND IF THEY WERE IMPACTED OR WE
KNOW THE GENERAL POPULATION FOR
WHICH THIS ENTITY WAS MANAGING.
APPEALS GRIEVANCES REFERRALS
ALL OF THE BACK AND
ADMINISTRATIVE FUNCTIONS BUT
WHEN THE PLANS WENT AND EACH OF
THE PLANS.
TRIED TO FIND MEMBERS THAT HAD
BEEN NEGATIVELY IMPACTED OUR OF
MAYBE HADN'T HAD THE RIGHT
REFERRAL. THOSE ARE MUCH HARDER
NUMBERS TO.
.
TO KNOW JUST BECAUSE SOME
PATIENTS YOU COULDN'T FIND AND
IF POPULATION THAT WAS
BEING MANAGED BY THAT ENTITY WAS
SIX OR SEVEN HUNDRED THOUSAND.
LIVES BUT THEY WERE.
THEY WEREN'T NECESSARILY ALL
IMPACTED.
AND THAT'S JUST SOMETHING THAT
WE DON'T NECESSARILY.
HAVE ANYWAY TO VALIDATE BUT
THAT'S WHY WE SENT SENT THE
PLANS BACKED
TWO YEARS TO REACH OUT TO THE
BENEFICIARIES THAT THEY HAD
UNDER THEIR CARE. TO MAKE SURE
THAT THEY WERE.
BOTH CONTACTED IF THEY.
WERE ABLE TO BE CONTACTED AND
THEN IF THERE WAS SOMETHING THAT
HAD BEEN AUTHORIZED TO AUTHORIZE
IT. SO.
I GUESS IF EVEN IF IT WAS TEN
PERCENT WERE LOOKING AT SIXTY
THOUSAND.
PEOPLE AFFECTED. PLANE WHEN YOU
TALK ABOUT THOSE NUMBERS LIKE
THAT.
IT'S.
IT'S DIFFICULT TO COMPREHEND FOR
ME I AND I'M SURE THAT MY
COLLEAGUES FEEL THE SAME WAY BUT
EVEN TEN PERCENT OF SIXTY
THOUSAND PEOPLE THAT WERE
AFFECTED AND SO. SO.
E..
WE ARE DISCUSSING YOU KNOW WHAT
YOU ARE TRYING TO DO. THAT YOU
JUST SAID THAT YOU'RE IN.
CONVERSATIONS ABOUT HOW TO
PREVENT IT BUT.
IT GOES BACK TO ON THE
ACCOUNTABILITY.
OFFICE SO WE CLEARLY DIDN'T HAVE
ENOUGH ACCOUNTABILITY SYSTEM.
AND THAT'S.
THIS IS THE SECOND TIME OR
THERE'S MORE THEN THAN.
ONES THAT. ARE ACCOUNTABILITY
IS NOT WORKING AND SOUL.
WHAT I'M THINKING IS HOW MANY
OTHER? ISSUES ARE WE GONNA FIND
THAT THERE IS LACK OF
ACCOUNTABILITY. SO I THINK FOR
ME THE OVERALL.
.
CONVERSATION SHOULD BE ABOUT NOT
JUST ONE DEPARTMENT OR ONE
PARTICULAR AREA BECAUSE IF I'M
THINKING THAT THERE'S MORE.
AREAS THAT THERE IS NO
ACCOUNTABILITY I THINK THE
BIGGER QUESTION IS WHAT ARE WE
DOING TO MAKE SURE THAT
EVERYTHING IS ACCOUNTED FOR
EVERYONE IS ACCOUNTABLE AND I.
AND THAT'S. THE QUESTION THAT
YOU KNOW I WOULD FRANKLY LIKE AT
LEAST SOME CONVERSATION ON. AND
ALONG THOSE LINES THE STATE HAS
ORDERED INSURERS ON NOVEMBER
SEVENTEENTH TO DETERMINE HOW
MANY ENROLLEES EXPERIENCED THE
LATER UNFILLED SERVICES. DO WE
HAVE ANY RESULTS FROM THAT
QUARTER SO WE DO COLLECT WEEKLY
REPORTS FROM OUR HEALTH PLANS
AND THEY HAVE BEEN ONGOING IT'S
ADMITTING THEM TO US THE. HEALTH
PLANS THEMSELVES ARE STILL IN
THE PROCESS OF REACHING OUT TO
BENEFICIARIES CONTACTING THEM
AND SO WE DON'T HAVE FINAL
NUMBERS AT THIS TIME BUT I
EXPECT WE'LL HAVE AN UPDATE IN
THE FUTURE.
WHAT CAN THE MHC DO TO IMPROVE
THE ACCURACY AND COMPLETENESS OF
THEIR TIMELY ACCESS COMPLIANCE
DATA AND HOW DO WE DISAGGREGATED
THIS DATA TO ENSURE THAT SUB
SPECIALTY CARE? IS BEING MET.
SO ANOTHER THE STEPS THAT I
DISCUSSED EARLIER ABOUT.
REQUIRING THE INDEPENDENT IT A
VALIDATOR.
TO VALIDATE THE DATA BEFORE IT
SUBMITTED TO THE DAMAGE SEE.
HAS ALREADY APPROVED THE.
DATA QUALITY THAT WILL ALLOW US
TO DISAGGREGATED AS YOU
MENTIONED.
WE EXPECTED THE INFORMATION
THAT'S GONNA COME IN ON MARCH
THIRTY FIRST OF THIS YEAR WHICH
WILL BE FOR THE TWENTY
SEVENTEEN.
ARE REPORTING YEAR WILL BE MUCH
BETTER BECAUSE THEY WILL HAVE
CONDUCTED THOSE SURVEYS AFTER WE
IDENTIFIED THE ERRORS IN THE
TWENTY FIFTEEN CLICK HERE. AND
SO WERE WERE VERY MUCH LOOKING
FORWARD TO THAT REPORT AND
EXPECT THAT WE ARE GOING TO BE
ABLE TO REPORT ON GRANT. OF MUCH
MORE GRANULARITY INCLUDING MORE
LOCAL LEVEL AND I DON'T KNOW IF
I'LL BE ABLE TO DO EVERY COUNTY
BECAUSE. AT THE AN AMAZING
EXAMPLE THAT JENNIFER GAVE AND I
MARIPOSA COUNTY SOMETIMES YOU
CAN'T GET TO ANYTHING CLOSE TO A
FIVE PERCENT.
.
STANDARD AND SO.
I EXPECTED ARE TWENTY SEVENTEEN
REPORTING YEAR WILL GET MUCH
CLOSER TO WHAT YOU'RE EXPECTING
A WHAT FRANKLY WE'RE EXPECTING
CAN WE TALK ABOUT THE CONTRACT
VERSES THE FULL TIME.
EQUIVALENT TO ENSURE THAT WE
ARE.
MAKING AND. BEST USE. YOU KNOW
IT DOCTORS WHO I USED TO WORK
WITH WORK CONTRACTED FOR AFTER
DAY A MONTH. AND FRANKLY IS THAT
A FULL TIME EQUIVALENTS WORTH OF
THE PHYSICIAN.
OR IS THAT CHECKING A BOX AND SO
HOW DO WE ENSURE THAT OUR
NETWORKS ARE ADEQUATE.
SO I CAN TO THAT TO TALK ABOUT
OUR PROCESS BUT I WILL DEFER TO
DH CS TO DISCUSS THEIR PROCESS
AND WE DON'T HAVE A LEVEL OF
DETAIL THAT INDICATES THAT IT'S
TO TWO DAYS A MONTH THAT THE
SITUATION THAT YOU DESCRIBED.
BUT WHAT WE DO DO IS WE LOOK AT
EVERY SINGLE A PROVIDER HOWEVER
HOW MANY NETWORKS HERE SHE MAY
BE CONTRACTED AND SO LET'S SAY.
ANYONE PROVIDER IS CONTRACTED
INTO NETWORKS WE ASSIGN A TEN
PERCENT FD TO THAT PROVIDER
BECAUSE WE HAVE NO OTHER DATA TO
INDICATE WHAT ACTUAL PERCENTAGE
IN IT MAY BE UNFAIR TO CERTAIN
PLANTS THEY MAY BE GETTING SHORT
SHRIFT THAT. THEY MAY HAVE FORTY
PERCENT OF THAT ONE PROVIDERS
TIME BUT WERE ONLY GIVING THEM
CREDIT FOR TEN BECAUSE THEIR
INTENT NETWORKS THAT'S THE BEST
DATA LEVEL THAT WE HAVE SO.
DETECTING THE BOXES YOU
DESCRIBED THE ONE FTE FOR EVERY
SINGLE.
NETWORK THAT INDIVIDUAL SHOWS
UP AND IS NOT THE WAY WE PERFORM
NETWORK ADEQUACY BUT THERE'S NO
WAY WE CAN GET BECAUSE WE DON'T
HAVE THAT LEVEL OF DATA THAT
IT'S TWO DAYS A MONTH SO WE DO A
PROPORTIONALITY ASSESSMENT BASED
ON THE NUMBER OF MANAGED CARE
NETWORKS THAT INDIVIDUAL. ISN'T
SO IF THERE AND ONE YOU COUNT
THEM AS A FIDDLE IF THERE AND
ONE EVEN.
BUT SINCE ALL MANAGED CARE
PLANS.
UNDER OUR JURISDICTION REPORT
WHICH IS SEVENTY FIVE PLANS WE
HAVE A GOOD UNDERSTANDING OF THE
PENETRATION OF MANAGED CARE
CONTRACTS THAT EACH PROVIDER
HOUSE THAT'S NOT GONNA TELL US
HOW MANY FEE FOR SERVICE
PATIENTS. THEY MAY SEE OUTSIDE
OF A MANAGED CARE NETWORK THAT'S
NOT GONNA TELL US MEDICARE
BECAUSE MEDICARE.
FOR NETWORK ADEQUACY IS NOT
UNDER OUR JURISDICTION BUT IT
WILL TELL US BY KNOX CONNECT
LICENSE MEDICARE MANAGED CARE
IT'LL TELL US THE COMMERCIAL
LINES OF BUSINESS.
HOW MANY PLANS ARE CURRENTLY
UNDER CORRECTIVE ACTIONS?
I THINK WE'LL HAVE TO FALL BACK
UP WITH YOU PUT THAT INFORMATION
WE DO HAVE THAT INFORMATION AND
CREEK WE KEEP THAT REGULARLY BUT
I WANT TO PROVIDE YOU WITH THE
CORRECT INFORMATION.
IT'S IMPORTANT TO NOTE ALSO
THAT WE DO DO ANY AUDITS AS I
MENTIONED AND IF THERE'S ONE
FINDING IT AND NOT IT THEN THERE
WOULD BE A CORRECTIVE ACTION
PLAN FOR THAT HEALTH PLAN AND SO
WILL WILL FOLLOW BACK UP WITH
YOU FOR THAT INFORMATION. WHAT?
CAN YOU GIVE ME AN IDEA GIVES AN
IDEA OF HOW MANY.
I WOULD SAY.
WE HAVE LESS THAN TWENTY
CORRECTIVE ACTION PLANS AT THIS
TIME AND WE HAVE TWENTY FOUR
HEALTH PLANS AND SO AS I
INDICATED WE ANNUALLY AUDIT EACH
HEALTH PLAN AND SO.
THE LIKELIHOOD OF HAVING AT
LEAST TEN HEALTH PLANS UNDER
CORRECTIVE ACTION PLAN BECAUSE
OF THAT AT ANY TIME IS LIKELY.
AND IN DUE TO THE EVENT THAT WE
JUST DISCUSSED THAT WITH SEVEN
YOU
PLANS THAT ARE NOW UNDER
CORRECTIVE ACTION PLAN JUST ON
THAT ISSUE SO THAT'S AN EXAMPLE.
SO HALF.
ON CORRECTIVE ACTION PLANS NOW
ARE MORE IS THE ESTIMATE THAT
I'M HEARING WELL WE HAVE TWENTY
FORTY FOUR FOUR CONTRACTING
PLANS.
IF A PLAN IS ON A CORRECTIVE
ACTION PLAN IT DEPENDS ON WHAT
IT'S UNDER FOR RIGHT SO
CORRECTIVE ACTION PLANS ARE USED
FOR ENCOUNTER DATA.
WE HAVE. WE HAVE SEVERAL PLANTS
UNDER CORRECTIVE ACTION.
I PLANS FOR ENCOUNTER DATA THE
EVENT THAT I JUST TALKED ABOUT
INVOLVING EHS AND CENTER MAD.
WE PUT ALL OF THAT MANAGED CARE
PLANS THAT HAD ANY CONTRACTS
WITH ANY OF THOSE MEDICAL GROUPS
OR THAT MSO UNDER A GLOBAL
CORRECTIVE ACTION PLAN SO. IT
DEPENDS I'M NOT SAYING THAT ALL
OF THEM HAVE A CORRECTIVE ACTION
PLAN SOME OF THEM MAY HAVE TWO
OR MORE ONE MIGHT BE ENCOUNTERED
DATA IN COUNTER. THAT ENCOUNTER
DATA CORRECTIVE ACTION PLAN AND
ONE MAY ALSO BE AN OVERLAPPING
ONE WITH THE SENTIMENT ISSUE
JUST KIND OF DEPEND SO WE CAN
CERTAINLY FIND YATTON GIVE YOU
A.
BETTER DETAIL WITH THAT.
VOTERS A CORRECTION. CORRECTIVE
ACTION PLAN ACTUALLY LOOK LIKE.
WELL IN A IN IT'S GONNA IT'S
GONNA VERY BE BASED ON WHAT'S
GOING ON BUT I MEAN CAN YOU
SPELL THAT OUT FOR US.
SURE SO CORRECTIVE ACTION PLAN
ESSENTIALLY INCLUDES.
A PLAN OF ACTION AND THAT THE
HEALTH PLAN HAS SUBMITTED TO US
AND THAT WE HAVE APPROVED IT
INCLUDES SPECIFIC MILESTONES IN
TIME LINES THAT THE HEALTH PLAN
MUST COME INTO COMPLIANCE WITH
THE REQUIREMENTS WITH. AND IF
THEY DO NOT COME INTO COMPLIANCE
THEM WE CAN TAKE ADDITIONAL
STEPS SUCH AS WE COULD STOP.
ASSIGNMENT TO THEM OR WE COULD
IMPOSE FINANCIAL SANCTION.
THE THE CORRECTIVE ACTION PLAN
THAT WE MADE.
PUBLIC AND WE SHARED WITH THE
LEGISLATURE IN THE FALL RELATING
TO THE CENTER MADDEN EHS
ISSUE IS A IS A GREAT EXAMPLE OF
WHAT A CORRECTIVE ACTION PLAN
LOOKS LIKE THERE'S A FINDING.
THAT SAYS THIS HAS HAPPENED AND
THEN BEEN OUR RECOMMENDATION OR
YOU KNOW WHAT WE'RE REQUIRING
THE PLANTS YOU WHICH IS YOU HAVE
TO DO THIS BY A CERTAIN TIME YOU
HAVE TO FILE. THIS KIND OF
REPORT YOU HAVE TO INCLUDE THIS
KIND OF A TRANSITION PLAN AND
THE CASE THAT WE WERE MOVING
MEMBERS FROM ONE MEDICAL GROUP
TO ANOTHER. ON YOU HAVE TO MEET
THE CERTAIN KINDS OF METRICS OR
WE REQUIRE THEM TO COME BACK
WITH. DOCUMENTATION JUST DEPENDS
ON WHAT THEY'RE BEING PUT UNDER
A PLAN FOR ENCOUNTER DATA THAT
WE HAVE A PLAN THAT WE.
PENALIZED FOR FIVE MILLION
DOLLARS FOR REPEATED.
VIOLATIONS AND THEIR INABILITY
TO PROVIDE US ENCOUNTER DATA AND
I BELIEVE THAT THAT.
PENALTY FINALLY.
CORRECTED THE.
PROBLEM.
WHAT HAPPENS TO THE PLANS THAT
ARE FOUND TO BE OUT OF
COMPLIANCE?
SO WE CAN TAKE ADDITIONAL STEPS
AND WE DO HAVE A DEFAULT
ASSIGNMENT PROCESS WHERE A
CERTAIN NUMBER OF BENEFICIARIES
ARE ASSIGNED TO A HEALTH PLAN
AND EACH MONTH IF.
IN SO WE CAN TAKE STEPS TO SAY
THAT ASSIGNMENT CAN'T HAPPEN
ANYMORE AND SO WE ARE GOING TO
PROVIDE ANY NEW BENEFICIARIES TO
ON AN ONGOING BASIS WE ALSO CAN
IMPOSE.
SANCTIONS AS JENNIFER CAN'T
JUST MENTIONED.
WE DID SANCTION ONE HEALTH PLAN
FOR UP TO FIVE MILLION DOLLARS
THIS PAST YEAR AND SO WE CAN
TAKE FINANCIAL SANCTIONS AS WELL
HOW LONG THE STORK LEE HAS THE
STATE.
TAKEN BEFORE SERIOUS
CONSEQUENCES OF.
THE FAILURE TO MEET THE
STATUTORY WOULDN'T REQUIREMENTS
OF THE KNOX KEEN HOW LONG
HISTORICALLY HASN'T TAKEN FOR US
TO GET INTO IT DEPENDS ON THE
SEVERITY OF THAT ACTION I KNOW
THAT WE AS TO DEPARTMENTS WORKED
ON. A FEW YEARS AGO WHEN WE HAD
A PLAN REACHED
SIGNIFICANT CONCERNING LEVELS OF
FISCAL AND AND INTEGRITY THEY
HAVE LEFT THEIR RESERVES DROPPED
TO. DANGEROUSLY LOW LEVELS AND
THE DEPARTMENT OF MANAGED HEALTH
CARE PUT A TEMPORARY MONITOR
AND.
THAT'S ONE OF THE MOST SERIOUS.
WAYS THAT WE AS A STATE CAN
TAKE.
ACTION ON THE PLAN AND THEN THE
OTHER CORRECTIVE ACTION PLANS
ARE CERTAINLY FAR MORE.
YOU KNOW IT'S YOUR ENCOUNTER
DATA OR WE WENT IN AND LOOKED AT
YOUR POLICIES AND PROCEDURES
WHEN WE AUDITED YOU AND YOU HAD
UPDATED YOUR POLICIES AND
PROCEDURES AND SO. DEPENDING ON
THE SEVERITY AND THAT.
EITHER THE COMPLETE THE QUICK
COMPLIANCE BY THE PLAN OR THE
LACK OF COMPLIANCE KIND OF
DETERMINES WHAT ARE ACTION IS
DEPENDING ON THE PLANS REACTION
AND SO.
WE CAN MOVE ON QUICKLY OR WE CAN
TAKE LONGER DEPENDING BUT I
WOULD SAY USUALLY WHEN A
CORRECTIVE ACTION PLAN IS
IMPOSED WE CERTAINLY WANT TO SEE
SOMETHING.
BACK USUALLY WITHIN THIRTY
THIRTY DAYS IF IT SEE AND NON
URGENT ISSUE ON MORE URGENT
ISSUES WE REQUIRE AND SOMETIMES.
GIVE US SOMETHING IN A WEEK.
YOU KNOW SOMETHING MORE. MORE
TIMELY.
IN LIGHT OF WHAT WE'VE HEARD
FROM THE ADVOCATES IN THE FIRST
PANEL AND I DON'T WANNA ADD MY
ANECDOTAL EXPERIENCE OF FIFTY
THOUSAND PATIENTS AS WELL BUT.
SOME OF US WHO HAVE BEEN ON THE
FRONT LINES FEEL FIRST HAND WHAT
INADEQUATE NETWORKS LOOK LIKE.
AND I'M TRYING TO GET A SENSE
FROM YOU DO YOU HAVE ALL THE
TOOLS THAT YOU FEEL YOU NEED AS
A DEPARTMENT.
OR WHAT COULD WE AS A
LEGISLATURE DUE TO HELP WORK
WITH YOU.
TO ENSURE THAT HEALTH PLANS
CONSUMERS AND PROVIDERS.
CAN DEVELOP AN ACCEPTABLE RATE
OF COMPLIANCE.
I THINK IT JENNIFER ALLUDED TO
ONE THING THAT WE HAVE SUPPORT
BROADLY WHICH IS INVESTMENTS IN.
AREAS WHERE WE KNOW WE HAVE
PROVIDER SHORTAGES
SO THAT'S OUTSIDE OF BOTH OF OUR
JURISDICTIONS BUT WE ASK OF THE
COMETS AND JENNIFER MADE THAT
WE.
AS A STATE AS A A LARGER GROUP
OF PEOPLE NEED TO WORK TOGETHER
TO ADDRESS THOSE ISSUES BECAUSE
WE HAVE BOTH DOCUMENTED AREAS
AND IN THE VERY RURAL AREAS THAT
JENNIFER MENTIONED BUT ALSO. IN
SOME URBAN AREAS WHERE
PENETRATION OF CERTAIN PROVIDER
TYPES IS NOT AVAILABLE EVEN
CERTAIN SEGMENTS OF IT OF AN
URBAN POPULATION AND BECAUSE
TRANSPORTATION CAN BE AN ISSUE
THAT CONCRETE BARRIERS TO CARE
WHICH. AREN'T REALLY OBVIOUS YOU
KNOW IT'S REALLY OBVIOUS WHEN
YOU HAVE A COUNTY OF SEVENTEEN
HUNDRED IS AN OBVIOUS WHEN
YOU'RE IN CERTAIN PARTS OF LOS
ANGELES AS AN EXAMPLE. SO I I
DEFINITELY THINK WORKING
TOGETHER ON PROVIDERS SHORTAGE
ISSUES IS AN AREA THAT WE CAN
ALL GET BEHIND AND I WOULD BE
REMISS IF I DID NOT TAKE THIS
OPPORTUNITY TO MENTION THAT WITH
PROP FIFTY SIX WE HAD PLACED
MONEY AND FOR GRADUATE MEDICAL
EDUCATION.
AND THAT MONEY COULD GREATLY
HELP US MEET SOME OF THE NETWORK
ADEQUACY ISSUES THAT WE ARE
FACING AS A STATE. AND WOULD
IMPLORE YOU TO HELP US TO.
WORK FOR THOSE FUNDS TO SEE HOW
WE CAN. HELP TO INCREASE OUR
NETWORK ADEQUACY.
I JUST WANNA MAKE AN ADDITIONAL
COMMENT.
IT'S IT'S
IT'S DIFFICULT FOR ME TO SIT UP
HERE.
AND AND JUST LISTEN TO YOU KNOW
THE LACK OF ACCOUNTABILITY. AYE
WE'RE NOT BUILDING CARS
AND THESE ARE PEOPLE'S LIVES ARE
BEING AFFECTED AND THAT'S WHAT'S
SO DISTRESSING TO ME AND TO ALL
OF US I CAN SENSE. THAT IT FEELS
LIKE.
SOME OF THESE ISSUES ARE NOT
TAKING SERIOUSLY THE ACCOUNT
ACCOUNTABILITY PART.
ESPECIALLY BECAUSE IT'S NOT JUST
IN ONE AREAS IN MULTIPLE AREAS
AND IT'S.
HARD FOR ME TO GO BACK.
AND SPEAK TO MY CONSTITUENCY
ABOUT WELL THIS.
THERE IS NO ACCOUNTABILITY HERE.
AND THEN A COUPLE MONTHS LATER
THERE'S NO ACCOUNTABILITY HERE.
I DON'T KNOW HOW TO HELP.
ON THAT ISSUE BECAUSE IT SEEMS
LIKE.
QUITE FRANKLY A CHRONIC PROBLEM.
IN THIS AREA.
DIET WE HAVE NO ACCOUNTABILITY.
BUT YET.
THE ANSWERS ARE THOSE THAT GET
THE REQUEST THAT WE GET IS
ADDITIONAL FUNDS IN NORMANDY WE
CAN'T KEEP THROWING MONEY AT THE
PROBLEM. IF THE ACCOUNTABILITY
ISSUES ARE NOT BEING ADDRESSED
BECAUSE IF THERE'S NO
ACCOUNTABILITY THEY WERE WASTING
OUR MONEY AND AGAIN. THAT'S UP
HERE BUT ON THE ON THE GROUND
THESE ARE PEOPLE'S LIVES.
THAT ARE BEING AFFECTED IN IT
JUST SOMETIMES FEELS LIKE.
THIS PLACE DOESN'T GET THAT.
AND IN I DON'T WANT TO POINT
FINGERS BY.
QUITE FRANKLY THE DEPARTMENTS
DON'T GET PACKED
THAT WE'RE TALKING ABOUT REAL
PEOPLE REAL ISSUES BUT THE. YOU
KNOW YOU YOU STATED THAT TWENTY
OUT OF THE TWENTY THREE. OUR
MEDICAL PLANS ARE ARE UNDER
REVIEW THAT EIGHTY THREE
PERCENT.
OF.
I MEAN THAT'S CRAZY.
YES THERE'S. DIFFERENT DEGREES
OF YOU KNOW WHAT THEY'RE THEY'RE
BEING UNDER REVIEW FROM BUT THE
FACT IS THAT THAT'S WAY TOO
MANY.
THAT'S EIGHTY THREE PERCENT NOT
FIFTY PERCENT AND.
IT'S AGAIN IT'S DIFFICULT
BECAUSE HE'S A REAL PEOPLE.
THESE ARE NOT JUST NUMBERS AND
IT'S SENT AND I.
WISH THAT THERE WAS AWAY IN THAT
WE CAN KIND OF GET THAT MESSAGE
TO THE DEPARTMENTS THAT THESE
ARE REAL PEOPLE WERE AFFECTING.
AND I'M NOT SAYING THAT YOU
DON'T.
IN A CERTAIN UNDERSTAND BUT WHAT
I'M NOT GETTING IS WHAT WE DOING
ABOUT IT AND EVERY TIME THERE'S
SOMETHING THAT WE BRING UP.
THERE'S ALWAYS WERE DOING THIS
WOULDN'T SO WERE PLAYING CATCH
UP ALL THE TIME WHAT IS IT. AND
THIS IS
JUST FOR LATER WHAT IS IT THAT
YOU GUYS CAN DO TWO CATS THIS
INSTEAD OF A WHISTLEBLOWER.
INSTEAD OF YOU KNOW.
COMING UP HERE AND ASKING US TO
HELP CORRECT THESE PROBLEMS WHAT
ARE YOU DOING TO MAKE TO PREVENT
A LOT OF THESE PROBLEMS FROM
FROM APPEARING.
IT'S IT'S AGAIN IT'S VERY.
DIFFICULT WHEN WERE ASKED FOR
MORE BUDGET FOR MORE MONEY FOR
THIS OR FOR THAT.
WHEN THE MONEY THAT YOU HAVE IS
NOT BEING USED PROPERLY AND IT'S
NOT YOU BY THE ACCOUNTABILITY
PIECE IS NOT THERE SO THAT MEANS
THAT WE'RE WASTING A LOT OF
MONEY. THAT.
WHEN WE NEED FOR DIFFERENT
PROGRAMS.
I.
I'M I'M A JUMP IN HERE.
IT IS A THINK IT'S GOOD GOES
MARK TO.
THAT THE SYSTEM IS FAILING.
I NAY IN IN JANUARY AT TALKING A
LITTLE GIRL IN MY DISTRICT DIED.
BECAUSE THEY THOUGHT SHE HAD A
FLUAND YET ANOTHER INFECTION.
AND THE CENTRAL VALLEY.
IT HURT SOUTHERN SAN JOAQUIN
VALLEY.
IT TAKES OVER A WEEK.
TO GET IN TO SEE A DOC.
AND THERE'S SEVERAL ISSUES GOING
ON.
AND WHAT CONCERNS ME IS ON ONE
SIDE WE HAVE. A LACK OF
PROVIDERS.
SELECT YOUR SPEAK PLAIN ENGLISH
THAT'S ALL LACK OF DOCTORS.
THERE'S BEEN SEVERAL PIECES OF
LEGISLATION THAT OF MOVE
THROUGH.
THESE HOUSES
THE THROUGH THE LEGISLATURE
SINCE I'VE BEEN IN OFFICE OVER
THE LAST FOUR YEARS. TO ADDRESS
THAT PROBLEM AND NOT ONE OF THEM
IS MANAGED TO GET TO THE
GOVERNOR'S DESK TO GET SIGNED.
THAT'S A PROBLEM.
THE FACT THAT.
BUT YOU KNOW IT WHEN YOU LOOK AT
THE SYSTEM.
SO. WE WE HAVE THE PLANS
SO ONE PROVIDER COULD BE TAKE
ALL THE PLANS COULD TAKE ONE.
HOUSE THAT BEAM CANNON HOUSE
THAT BEING ADJUSTED FOR.
BECAUSE IF ALL THE PLANS ARE
USING THREE DIFFERENT DOCTORS
THAT ONE DOCTOR'S I CAN BE ABLE
SEE EVERYBODY THIS IS NOT
DOESN'T ADD UP.
A AND I HOPE THAT GOD THERE'S
SOME BETTER MATH OUT THERE TO
DRESS THIS BECAUSE THE SYSTEM
IS.
FUNDAMENTALLY FELLING. OR PEOPLE
AND THEY'RE DYING ON THE COLD
STREETS.
BECAUSE THERE'S NOT ENOUGH
PROVIDERS.
THE NETWORKS ARE WORKING IN THE
THAT THE WHOLE SYSTEM.
FILLING THESE PEOPLE.
IN AND WE'RE RESPONSIBILITY
THAT.
IN THIS HALF TO GET ADDRESSED.
WITH.
I LIKE MY COLLEAGUES SAY YOU CAN
JUST THROW MONEY AT THE PROBLEM
EVERY YEAR WE COME BACK IN ITS.
WE NEED MORE MONEY TO DO THIS SO
WE CAN MONITOR THIS AND WE CAN.
THAT'S FANTASTIC BUT INTEL THE
SYSTEM ITSELF MECHANICS WITHIN
THAT SYSTEM GET FIXED.
WE'RE GONNA BE RIGHT BACK HERE
BEING IN OUR HEADS AGAINST THE
WALL.
WITH LITTLE GIRLS DYING ON THE
STREET IN I'M NOT OKAY WITH
THAT.
SO WHEN WE COME BACK IN MAY.
POLL LEASE AYE I KNOW EVERYBODY
EFFORT WOULD LOVE TO SIT DOWN
WITH YOU ON ACTUALLY FIGURE OUT
A WAY TO MAKE THIS SYSTEM.
FUNCTION THE WAY IT OUGHT TO BE
DOING TO TAKE OUR PEOPLE.
I'LL HAVE TO LAST QUESTIONS AND
THEN WE'LL BE FINISHED WITH THIS
ISSUE.
WE HEARD ABOUT THE.
A NECESSITY TO HAVE PLANS
EXHAUST THEIR APPEAL PROCESS.
SURE.
BENEFICIARIES SORRY TO EXHAUST
THE APPEALS PROCESS AND WANTED
TO. UNDERSTAND IF THAT'S IN THE
BESTEST INTEREST OF THE
BENEFICIARIES OR WHAT FURTHER WE
CAN DO TO FIGURE OUT AN APPEALS
PROCESS THAT INSURED WE. WERE
HEARING FROM PEOPLE AND WHY I'M
ASKING ABOUT THAT.
AGAIN COMING FROM THE CENTRAL
VALLEY OFTENTIMES OUR. THAT
CERTAIN PARTS OF OUR COMMUNITY
THAT HIDE IN THE SHADOWS HAVE
DIFFICULTIES TO COME OUT. AND
WANTS TO ENSURE THAT WHATEVER
OUR APPEALS PROCESS IS WORKS FOR
COMMUNITIES LIKE MINE.
I THINK THAT'S A GREAT QUESTION
I'M ON THE MEDI CAL SIDE IT'S
ACTUALLY A FEDERAL REQUIREMENT.
AS PART OF THE MANAGE CARE
FINAL RULE THAT WAS IMPLEMENTED
IN MAY OF TWENTY SIXTEEN IT DID
BECOME A REQUIREMENT THAT WE
EXHAUSTED THE HEALTH PLAN LEVEL
PRIOR TO A BENEFICIARY BEING
ABLE TO GO TO A STATE FAIR
HEARING. BUT I'M AND YOU CAN
SPEAK TO SO THAT OUR HELP CENTER
GENERALLY SPEAKING TO DO A
FORMAL COMPLAINT THAT IS AN
ACCURATE ASSESSMENT BUT WHEN YOU
HAVE AN EARLY ISSUE WHERE YOU
NEED ACCESS TO MEDICALLY
NECESSARY CARE. WE RESOLVE IT WE
DON'T WE DON'T FORCE GENERALLY
TO GO BACK INTO A THIRTY DAY
GRIEVANCE PROCESS WILL DO
EXACTLY WHAT I DESCRIBED EARLIER
THAT THREE WAY PHONE CALL. WHERE
ONE OF OUR REPRESENTATIVES WILL
GET THE PLAN ON THE PHONE
BECAUSE THEY'RE REQUIRED TO BE
AVAILABLE TO US TWENTY FOUR
HOURS A DAY? AND WE WILL HAVE
THE EARLY ON THE PHONE CALL WE
WILL RESOLVE IT IN IN THAT PHONE
CALL OR IF WE HAVE TO MAKE TO
FOLLOW UP WHATEVER THE CASE MAY
BE BUT RESOLVE IT QUICKLY. AND
GET IN ROLE THAT WE WILL EITHER
OFFERS TO GO TO ANOTHER NETWORK
PROVIDER IF THAT'S WHAT WE NEED
TO DO OR.
GET THAT AND REALLY IN TWO AND
A REASONABLE APPOINTMENT FOR AN
IN NETWORK PROVIDER SO. IF IT'S
A FORMAL COMPLAINT LIKE I DON'T
BELIEVE THAT.
MY COST SHARING WAS APPROPRIATE.
APPLIED AND I WANT THAT TO BE
REVIEWED BY THE PLANT YES
SOMETHING LIKE THAT JUST JUST AS
SARAH DESCRIBED IN THE
COMMERCIAL SIDE IT'S THE SAME
PROCESS YOU GO THROUGH THE
THIRTY DAY. BUT IF IT'S
URGENT. IF IT'S ACCESS DOZER
TYPICALLY HANDLED IN AND THE
QUICK RESOLUTION FASHION THAT I
DESCRIBED EARLIER.
I'M ONE OF THE THINGS. THAT
DIRECTOR CAN'T HAS SAID THERE'S
THREE WAYS WE CAN AFFECT A COST
AND HEALTH CARE IT'S IT'S
PEOPLE.
UP PROGRAMS AND RATES PEOPLE
BENEFITS
AND RATE.
ONE OF THE.
STRUGGLES I HAVE IS GETTING TO
UNDERSTAND WHAT THE ACTUAL RATES
ARE.
THAT WE ARE PROVIDING TO OUR
PROVIDERS.
AND AM WONDERING HOW WE CAN MAKE
SURE THAT WE'RE GAINING THAT
INFORMATION TO BETTER UNDERSTAND
IF THE LACK OF NETWORK ADEQUACY.
HIS COMING FROM THE PROVIDER
RATES.
OR. WHERE WE ARE STRUGGLING TO
ATTAIN?
THE NETWORK ADEQUACY IS THAT ARE
NEEDED AND HOW CAN WE ATTAIN
THAT LEVEL OF INFORMATION.
BECAUSE IT MAY MEAN THAT WE TAKE
A LOOK AT PROP FIFTY SIX AND
FIGURE OUT IF WE NEED TO HAVE.
POLAND SOME FUNDS TO ACTUALLY.
DIRECT THE MONEY TO ENSURE
NETWORK ADEQUACY IF THE RATES
ARE INSUFFICIENT BUT I DON'T
HAVE THAT LEVEL OF GRANULARITY
IN DETAIL. AND I'M ASKING YOU
HOW CAN WE GET THAT LEVEL OF
DETAIL SO THAT WE CAN. HELP TO
ASSIST.
YEAH I WOULD SAY THAT.
.
THE. THE CONTRACTING SO THERE'S
A COUPLE DIFFERENT THINGS AND
PLAY.
WE HAVE MEDICAL PROVIDERS THAT
CAN BE CONTRACTING WITH HEALTH
PLANS THEY CAN ALSO BE.
SEEN FEE FOR SERVICE PATIENTS
FEE FOR SERVICES A SET RATE
RIGHT IT'S A CLAIM SYSTEM WE PUT
IN A CLAIM WE. PAY OUT THE RATE
THAT'S BEEN ESTABLISHED SO
THAT'S PRETTY STRAIGHTFORWARD.
PLANS HAVE A VARIETY OF
DIFFERENT FINANCIAL ARRANGEMENTS
SOME OF WHICH WE HAVE A SENSE OF
BUT SOME OF WHICH WE DON'T.
SOME.
CONTRACTS WITH HEALTH PLANS
WILL PAVE PHYSICIANS ON A FEE
FOR SERVICE BASIS.
SOME.
PLANS WILL PAY PHYSICIANS ON A
CAPITATED BASIS SOME PHYSICIANS
WILL GET PAID WITH A MIX MEANING
WILL. YOU KNOW WILL CAPITA YOU
FOR PRIME MAKE PRIMARY CARE AND
WE'LL PAY YOU SUPPLEMENTAL
PAYMENTS FOR OTHER THINGS.
THERE'S A LOT OF.
PAY FOR PERFORMANCE AND AS YOU
WOULD KNOW THAT HELPS KIND OF.
CHANGE SOME OF THE FINANCIAL
ARRANGEMENTS BETWEEN PROVIDERS
YOU HAVE MEDICAL GROUPS THAT YOU
KNOW NEGOTIATE RATES ON BEHALF
OF ALL OF THEIR PROVIDERS WITHIN
THEIR NETWORK. I DON'T THINK
THAT ANY ONE SITTING IN ANY ONE
OF OUR CHAIRS EITHER AT THE
DEPARTMENT AT.
ARE YOU KNOW DEPARTMENT MINUTES
HEALTH CARE US HAVE ANY KIND OF
COMPLETE AND TOTAL TRANSPARENCY
AND HOW THOSE FINANCIAL
ARRANGEMENTS ARE MADE. I WOULD
ONLY KNOW ABOUT MEDI CAL I WOULD
NOT HAVE ANY SENSE OF WHAT IS ON
THE COMMERCIAL SIDE AND SO
THERE'S A VARIETY OF KIND OF
LAYERS OF TRANSPARENCY THAT I
KNOW. THERE HAVE BEEN BILLS IN
THE LEGISLATURE TO TRY TO GET AT
YOU KNOW GREATER TRANSPARENCY IN
THOSE HAVE.
ALSO BEEN.
NOT SUCCESSFUL AND SO. YOU KNOW
WE HAVE WORKED WITH THE PLANS TO
SET YOU KNOW WE NEGOTIATE RATES
WITH THE PLANS AND WHEN I SAY
NEGOTIATE WE DON'T REALLY.
NEGOTIATE AS WE TAKE THEIR
ENCOUNTER DATA AND THEIR COSTS
IN THEIR UTILIZATION OUR
ACTUARIES TREND THAT.
AND THEN WE GIVE THE PLANS RATE
AND SAY THIS IS WHAT YOUR RATE'S
GOING TO BE FOR THIS ELIGIBILITY
CATEGORY IN THE GIVEN YEAR. AND
THEY CAN DISPUTE WHETHER WE HAVE
A.
AND I MATH ERROR YOU KNOW LIKE
WE DON'T THINK YOU CALCULATED
THIS TREND OR WE DON'T LIKE THE
WAY YOU TRENDED IT. BUT.
OUR ENTIRE RATES PROCESS IS
BASED ON A PLANS ACTUAL ON
ENCOUNTER COSTS UTILIZATION
DATA.
SO IT'S IT'S A LITTLE BIT AND
IT'S HARD TO KIND OF TELL IT
THAT MUCH MORE KIND OF. LARGER
LEVEL AND I DON'T KNOW WHAT
DAMAGE SEE DOES IN THEIR
FINANCIAL AUDITS BUT IF THE
COMMERCIAL RATES ARE EVEN HARDER
TO ASSESS.
I WOULD AGREE WITH JENNIFER WE
DO NOT HAVE ACCESS TO INDIVIDUAL
PROVIDER RATES PAID OR
INDIVIDUAL CAPITATED OVER A
RATES PAID WE DO HAVE ACCESS TO
IS THE OVERALL FINANCIAL HEALTH
OF ABOUT THE PLANTS AND THE
MEDICAL GROUPS FOR ABOUT WITH.
WITH TO WHOM THEY DELEGATE RISK
SO WE HAVE A GOOD PICTURE OF HOW
THEY'RE DOING FINANCIALLY WHICH
IS HOW WE WERE ABLE TO CATCH THE
ISSUE. THAT THE DIRECTOR
MENTIONED EARLIER WITH ONE OF
THE PLANTS THAT WE BOTH HAVE A
RELATIONSHIP WITH BUT WE ALSO.
RECEIVE MEDICAL US RADIO RATIO
IT.
INFORMATION FROM THE PLAN SO
THEY HAVE TO DOCUMENT FOR THE
PREMIUM THAT THEY'RE RECEIVING
WHAT HOW MUCH OF IT IS GOING TO
MEDICAL CARE.
AND HOW MUCH OF IT IS GOING TO
ADMINISTRATION PROFIT AND
THERE'S DIFFERENT STANDARDS SET
FOR MARKET TYPE SO ON THE
COMMERCIAL SIDE IT'S EIGHTY FIVE
PERCENT OF YOUR PREMIUM. MUST GO
TO MEDICAL CARE QUALITY
IMPROVEMENT AND RELATED
INITIATIVES.
ON THE INDIVIDUAL AND SMALL
GROUP SIDE IT'S EIGHTY PERCENT
AND SO WE PERIODICALLY CONDUCT
EXAMS WE GO ONSITE WE LOOK AT
THE MEDICAL RECORDS.
AND THE DE DIFFERENT.
OR READ NOT MEDICAL RECORDS BUT
WE LOOK AT THE FINANCIAL RECORDS
OF THE PLAN IN ORDER TO VALIDATE
THAT THEY YES HAVE CATEGORIZED
ALL THE EXPENSES CORRECTLY TO TO
ENSURE THAT THEY ARE SPENDING.
THE EIGHTY TO EIGHTY FIVE
PERCENT THAT THE REQUIRED TO
SPEND BUT WE DO WE DO NOT GET IN
ANY CAPACITY THE GRANULARITY OF
FOR AN INDIVIDUAL. CLAIM OR AN
INDIVIDUAL PROVIDER THAT THIS IS
HOW MUCH THAT PERSONS BEING PAID
WE SEE THEIR CONTRACT. IN KIND
OF AN AGGREGATE WITHOUT NUMBERS
IN IT SO WE ENSURE THAT THE
DIFFERENT PROVIDER PROTECTIONS
THAT ARE ENSHRINED IN THE KNOX
KY DOCTORED HERE TOO SO THAT HAS
TO DO WITH. HOW THEY RECOUP
PAYMENTS THE TIMELINESS OF
MAKING PAYMENTS WHETHER NOT
ENTRANCED INTEREST IS PAID ON
LATE PAYMENTS THAT SORT OF THING
BUT NOT THE ACTUAL AMOUNT WE
DON'T RECEIVE ANYTHING OF THAT
NATURE?
AND I PROMISED THAT WAS THE LAST
QUESTION SO I WILL LEAVE IT AT
THAT.
BUT DO WANT TO.
.
WORK WITH BOTH OF YOUR
DEPARTMENTS TO FIGURE OUT HOW
THE NEW DATA COLLECTION AND IF
IT PROVIDES US SOME OF THE
INFORMATION THAT WE'RE SEEKING.
BUT MORE IMPORTANTLY IF THERE'S
WAYS THAT WE CAN IMPROVE UPON IT
AND INSIST THAT WE ARE
COLLECTING TIMELY DATA. AND
ENSURING THAT WE'RE MEETING OUR
STATUTORY REQUIREMENTS
SO WITH THAT WE WILL HOLD ISSUE
FIFTEEN OPEN AND MOVE ON TO
ISSUE SIXTY
.
IT'S MUCH EASIER TO SEE EVERYONE
FROM THE SEATS ARE THANK YOU FOR
THE OPPORTUNITY TO MOVE SO. I
GET A MARK TO GREEN.
THE CHIEF DEPUTY DIRECTOR OF
THE DEPARTMENT OF MANAGED
HEALTHCARE. THIRTY TALKED A
LITTLE BIT ABOUT OUR MISSION
EARLIER NOW TALK A LITTLE BIT
ABOUT OUR ORGANIZATION HOW WE'RE
STRUCTURED. OUT SO WE LICENSE
AND REGULATE.
APPROXIMATELY TWENTY FOUR
HUNDRED TWENTY FOUR HEALTH PLANS
THAT PROVIDE COVERAGE TO MORE
THAN TWENTY SIX MILLION
CALIFORNIANS THAT'S BROKEN DOWN
BETWEEN THE FULL SERVICE HEALTH
PLANS THAT WERE OVERLY FAMILIAR
WITH AS WELL AS DENTAL VISION
AND OTHER SPECIALIZED PLANS.
AND WE REGULATE APPROXIMATELY
NINETY TO NINETY FIVE PERCENT OF
THE COMMERCIAL MARKET IN
CALIFORNIA. ARE PROPOSED TWENTY
EIGHTEEN NINETEEN BUDGET IS
SEVENTY NINE POINT TWO MILLION
WHICH IS A DECREASE WHICH YOU
PROBABLY DON'T HEAR THAT VERY
OFTEN THAT IT IS IN FACT A
DECREASE. OF APPROXIMATELY ONE
MILLION OR ONE POINT TWO PERCENT
FROM THE CURRENT YEAR SPENDING
AUTHORITY AND FOUR HUNDRED AND
FIFTY ONE AUTHORIZED POSITIONS.
I WE ARE SPECIALLY FUNDED WE
RECEIVE NO GENERAL FUND AND WE
ARE SPECIFICALLY FUNDED BY
ASSESSMENTS PAID BY HEALTH
PLANS.
SO WE HAVE A NUMBER OF MAJOR%
PROGRAMS ARE COVER THE FIRST IS
THE HELP CENTER I TALKED ABOUT
IT A LITTLE BIT EARLIER. BUT IT
WORKS TO EDUCATE ASSIST
CONSUMERS ABOUT THEIR HEALTH
CARE RIGHTS PROBLEMS THEY'RE
HAVING WITH THEIR HEALTH PLANS
HELP CONSUMERS NAVIGATING
UNDERSTAND THE COVERAGE. AND
ENSURES ACCESS TO APPROPRIATE
HEALTH CARE SERVICES SINCE TWO
THOUSAND OUR HELP CENTER HAS
ASSISTED MORE THAN TWO MILLION
CALIFORNIANS RESOLVE COMPLAINTS
AND ISSUES WITH THEIR HEALTH
PLANS. SUCH AS THE TYPES WE
TALKED ABOUT EARLIER COVERAGE
DISPUTES ACCESS TO PROVIDERS AND
BILLING ISSUES.
OUR OFFICE A PLAN LICENSING.
ALL HEALTH PLANS IN CALIFORNIA
ARE REQUIRED TO APPLY FOR AND
MAINTAIN A LICENSE TO OPERATE.
THE DAMAGE SEE REVIEWS ALL
ASPECTS THE PLANT'S OPERATIONS
INCLUDING BENEFITS AND COVERAGE
THE CONTRACTS WITH DOCTORS AND
HOSPITALS IN THAT TEMPLATE FORM
THAT I DESCRIBED EARLIER.
PROVIDER NETWORKS AND
COMPLAINING GRIEVANCE SYSTEMS TO
ENSURE COMPLIANCE WITH
CALIFORNIA LOCKED.
OUR OFFICE OF PLAN MONITORING
ASSESSES AND MONITORS HEALTH
KICK UP HEALTH PLAN CARE AND
DELIVERY SYSTEMS FOR COMPLIANCE
WITH OUR LAW.
WITHIN THAT OFFICER DIVISION A
PLAN SURVEYS PERFORMS ROUTINE
AND NON ROUTINE SURVEYS WHICH
ARE KIND OF LIKE FUNCTIONAL
AUDITS.
OF OUR LICENSE HOPE PLANS TO
ENSURE THEY MEET THEIR
OBLIGATIONS AND CONSUMER IT'S
GET ACCESS TO THE CARE THAT
THEY'RE ENTITLED.
OUR DIVISION OF PROVIDER
NETWORKS MONITORS THE PROVIDER
NETWORKS AND ACCESSIBILITY OF
SERVICES REVIEWS ANNUAL HEALTH
PLAN TIMELY ACCESS COMPLIANCE
REPORTS THAT REVERTED TALKED
ABOUT TODAY. AND CONDUCTS ANNUAL
COMPLIANCE REVIEW REVIEWS OF ALL
FULL SERVICE AND BEHAVIORAL
HEALTH NETWORKS.
OUR OFFICE OF FINANCIAL REVIEW
I'M WE ACTIVELY MONITOR THE
FINANCIAL STABILITY OF HEALTH
PLANS MEDICAL GROUPS THROUGH
REGULAR REPORTING FINANCIAL
AUDITS AND OTHER MONITORING
TOOLS. AYE WE ALSO RECEIVE THE
ANNUAL MEDICAL US RATIO FILINGS
THAT I DISCUSSED EARLIER IS TO
ENSURE THAT PLANTS ARE
APPROPRIATELY INVESTING IN
HEALTH CARE SERVICES.
AND.
WE ALSO HAVE A RATE REVIEW
PROGRAM FOR THE INDIVIDUAL AND
SMALL GROUP MARKET.
WE DON'T APPROVE RATES BUT WE
HAVE THE OPPORTUNITY TO REVIEW
THEM FOR JUSTIFICATION AND
REASONABLENESS AND THROUGH
NEGOTIATIONS WITH HEALTH PLANS
WHEN RATE FILINGS HAVE COME IN
THAT HAVEN'T MET THAT STANDARD.
WE'VE BEEN ABLE TO SAVE
CALIFORNIANS SINCE TWO THOUSAND
AND ELEVEN APPROXIMATELY TWO
HUNDRED TWENTY SIX MILLION
DOLLARS.
LASTLY OUR OFFICE OF ENFORCEMENT
WE OBSERVE A WIDE VARIETY OF
TOOLS TO ENFORCE THE LAW WOULD
VIOLATIONS ARE UNCOVERED
CORRECTION WE ALSO USE
CORRECTIVE ACTION PLANS AS TO
THE DEPARTMENT OF HEALTH CARE
SERVICES ARE IS A LITTLE BIT
DIFFERENT. SETTLEMENT AGREEMENTS
WHEN WE TAKE IT ADMINISTRATIVE
OR CIVIL MATTER AGAINST A PLAN
FINANCIAL PENALTIES CEASE AND
DESIST ORDERS ARE FREEZING
ROMANCE AND INSTALLATION OF
MONITORS AND AS. THE DH CEASED
DE HTS DIRECTOR DESCRIBED THE
CONSERVATORSHIP OF A PLAN THAT'S
ONE OF OUR MOST AGGRESSIVE.
SO THAT'S THE OVER GET THE
DEPARTMENT.
DEPARTMENT OF FINANCE LA ONLY
COMES.
ANY PUBLIC COMMENT ON ISSUE
SIXTEEN.
XENON OUT A BRING IT UP HERE
JUST FOR A QUICK COMMENT IT
SEEMS STRANGE TO BE DECREASING
THE BUDGET THAT'S PROVIDING THE
OVERSIGHT IN LIGHT OF. SOME OF
THE TESTIMONY WE HEARD IN THE
LAST ISSUE.
AND SO I'M.
WONDERING IF LESS OVERSIGHT AND
LAST FINANCES ARE NEEDED AT THIS
TIME AND WAS HOPING THAT PARK
COMMENT ON CERTAINLY SO IT
ACTUALLY JUST A FUNCTION OF
TIMING WE HAD A NUMBER OF PRAYER
YOUR BCP'S OR PROVE THAT HAD
LIMITED TERM RESOURCES TO ALLOW
US TO STAND UP NEW PROGRAMS.
THAT WERE REQUIRED UNDER PRIOR
LEGISLATION AND SO IT'S THOSE IF
THE EXPIRATION OF A WIDE VARIETY
OF LIMITED TERM RESOURCES
BECAUSE WE'VE STOOD UP THOSE
PROGRAMS AND THEY WERE INTENDED
TO BE SHORT TERM SO. IT'S JUST A
FUNCTION OF TIME A GREAT.
WITH THAT.
.
STAFF HAS RECOMMENDED NO ACTION
AT THIS TIME WE WILL HOLD ISSUE
SIXTEEN OPEN AND MOVE ON TO
ISSUE SEVEN.
OKAY SHOULD SEVENTEEN AS OUR
BUDGET CHANGE PROPOSAL RELATED
TO THE CONVERSION OF LIMITED
FEDERAL MENTAL HEALTH PARITY
COMPLIANCE REVIEW RESOURCES INTO
PERMANENT.
SO THE PAUL WELLSTONE TO PETE
DOMINICI MENTAL HEALTH PARITY
AND ADDICTION ACT OF TWO
THOUSAND EIGHT AND THAT IS ALSO
A MOUTHFUL. REQUIRES HEALTH
PLANS TO CLASSIFY BENEFITS IN
THE FEDERALLY MANDATED
CLASSIFICATIONS SUCH AS
INPATIENT AND NETWORK INPATIENT
OUT OF NETWORK EMERGENCY
SERVICES AND PRESCRIPTION DRUGS
WANTS ALL THE BENEFITS ARE
CLASSIFIED PLANS ARE REQUIRED TO
ENSURE THAT THE FINANCIAL
REQUIREMENTS I ELECT COST
SHARING IN COPAYS. AND
QUANTITATIVE TREATMENT
LIMITATIONS.
FOR.
ON THE MENTAL HEALTH SIDE OR
NOT MORE RESTRICTIVE THAN THOSE
ON THE PHYSICAL HEALTH SIDE.
AND IT ALSO REQUIRES PLANS TO
ENSURE THAT ANY NON QUANTITATIVE
TREATMENT LIMITATIONS APPLY
COMPATIBLE PROCESSES STRATEGIES
AND STANDARDS ON BOTH SIDES
SO IT'S IT'S AT THE ENTIRE.
RULE%
IS IT IS DESIGNED TO HELP.
LEVEL THE PLAYING FIELD BETWEEN
MEDICAL SURGICAL BENEFITS AND
MENTAL HEALTH AND SUBSTANCE
ABUSE BENEFITS.
LIMITED TERM FUNDING IN THE
AMOUNT OF FIVE HUNDRED TWENTY
NINE THOUSAND WAS INITIALLY
GRANTED FOR TWO YEARS IN A
FISCAL YEAR SIXTEEN SEVENTEEN
BC.
THAT IS SPECIFIC TO THIS BODY
OF WORK THAT I'M TALKING ABOUT
IN THIS.
BCP AND THAT FUNDING IS SET TO
EXPIRE IN JUNE SO THIS REQUEST
IS TO TAKE THAT EXISTING LIMITED
CONVERT IT INTO PERMANENT
ONGOING FUNDING. WHICH WILL
ALLOW OUR CLINICAL CONSULTANTS
TO CONTINUE TO ASSIST OUR OUR
OFFICE A PLAN LICENSING IN
COMPLAINTS REVIEWS WHEN A NEW
PLAN COMES INTO THE MARKET SO.
THAT WE IN CALIFORNIA ACTUALLY
HAD SOME NEW MARKET ENTRANTS
WHICH IS A GOOD THING AS A MORE
PLANS IS A GOOD THING.
AND THEN ALSO WE'VE HAD PLANS
THAT ADD NEW MARKET SEGMENT SO
MAYBE THERE ARE IN THE
INDIVIDUAL MARKET BUT THEY'RE
EXPANDING INTO THE SMALL GROUP
MARKET. THEY'VE BEEN IN THE
LARGE GROUP MARKET BUT THEY'RE
GETTING INTO THE INDIVIDUAL
MARKET SO WHEN THEY MAKE THAT
MARKET ADJUSTMENT THOSE PRODUCT
DESIGNS LOOK VERY VERY
DIFFERENTLY. AND SO THEY NEED TO
GO THROUGH A NEW REVIEW TO
ENSURE THAT FOR THAT MARKET
SEGMENT WITH THAT BENEFIT DESIGN
THAT THEY'VE GOT.
EQUITY BETWEEN THE DIFFERENT.
COST SHARING AND A NON
QUANTITATIVE TREATMENT
LIMITATIONS.
SO WE ANTICIPATE THAT WE WILL
REVIEW TWENTY EIGHT COMPLEX AND
EIGHTY FOCUS MENTAL HEALTH
PARITY FILINGS ON AN ANNUAL
BASIS
AND THERE ARE NO POSITIONS
ASSOCIATED WITH THIS RECALL.
DEPARTMENT OF FINANCE LA OPENING
COMMENTS.
SEEING NONE WILL TAKE PUBLIC
COMMENT ON ISSUE SEVENTEEN.
CAN REALLY TELL THE CALIFORNIA
PAN ETHNIC HEALTH NETWORK WE
SUPPORT THE DEMAND TO USE WORK
IN IMPLEMENTING FEDERAL MENTAL
HEALTH PARITY AND SUPPORT THIS
PETITION PROPOSAL.
THANK YOU.
SEEING NO FURTHER PUBLIC COMMENT
WILL BRING IT UP TO THE DYESS
FOR ANY QUESTIONS.
SEEING NONE WILL HOLD ISSUE
SEVENTEEN OPEN AT THIS TIME IN
THE BOND ISSUE EIGHTEEN.
ISSUE EIGHTEEN RELATES TO THE
IMPLEMENTATION OF SENATE BILL
SEVENTEEN WHICH IS A
PRESCRIPTION DRUG COSTS
TRANSPARENCY.
SO UPSET ABOUT SEVENTEEN
ATTEMPTS TO ADDRESS THE HIGH
PRICES FOR PER
CAPTION DROPS BY CREATING
GREATER TRANSPARENCY IN DRUG
PRICING.
THERE'S A WHOLE LOT OF
REQUIREMENTS IN S. B. SEVENTEEN
RELATED TO THE OFFICE OF
STATEWIDE HEALTH PLANNING AND
DEVELOPMENT WHICH I WON'T BE
DISCUSSING TODAY BUT I'M GONNA
TALK ABOUT THE REQUIREMENTS THAT
ARE SPECIFIC TO OUR DEPARTMENT.
WHAT WE WILL BE IMPLEMENTING
WITH HEALTH PLANS
SO WHAT THE?
IT WHAT IS REQUIRED SB
SEVENTEEN RELATED TO HEALTH PLAN
REPORTING IS THAT.
PLANTS REPORTS THAT IMAGE SEAT
THE TWENTY FIVE MOST FREQUENTLY
PRESCRIBED DRUGS.
THE TWENTY FIVE MOST COSTLY
DRUGS AS CATEGORIZED BY TOTAL
ANNUAL PLAN SPEND AND THEN
TWENTY FIVE DRUGS WITH THE
HIGHEST YEAR OVER YEAR INCREASE
IN TOTAL ANNUAL SPENDING. HEALTH
PLANS MUST REPORT THIS DATA TO
THE DEPARTMENT BY OCTOBER FIRST
OF TWENTY EIGHTEEN AND THEN
ANNUALLY THEREAFTER. WE WILL
ISSUE A REPORT TO THE
LEGISLATURE WITH AGGREGATE DATA
BEGINNING ON JANUARY FIRST OF
TWENTY NINETEEN AND ANNUALLY
THEREAFTER.
S. B. SEVENTEEN ALSO REQUIRES
ADDITIONAL REPORTING
REQUIREMENTS FOR THE LARGE GROUP
MARKET SAID THIS IS FOR PEOPLE
WHO SELL COVERAGE TO EMPLOYERS
OF MORE THAN A HUNDRED PEOPLE.
SUCH AS THE PREMIUM THE PERCENT
OF PREMIUM ATTRIBUTABLE TO DRUG
COSTS FOR EACH CATEGORY OF
PRESCRIPTION DRUGS. FOR EXAMPLE
GENERIC BRAND NAME. BY BRAND
NAME SPECIALTY GENERICS
SPECIALTY. AND YET THEY YEAR
OVER YEAR INCREASE AS A
PERCENTAGE AND A PER MEMBER PER
MONTH COST FOR EACH OF THOSE
FOUR CATEGORIES ALREADY
DESCRIBED.
THE YEAR OVER YEAR INCREASE IN
PER MEMBER PER MONTH COSTS FOR
DRUG PRICES COMPARED TO OTHER
COMPONENTS OF THE HEALTHCARE
PREMIUMS SO AS IT COMPARES TO
LIKE.
DOCTORS RIGHT SO HOW MUCH HOW
MUCH IS IN PROVIDER PAYMENTS HOW
MUCH IS ON DRUGS.
A SPECIALTY TEAR FORMULARY LIST.
THE PERCENTAGE OF PREMIUM
ATTRIBUTED TO PRESCRIPTION DRUGS
ADMINISTERED INSIDE A DOCTOR'S
OFFICE OF THIS IS WHEN YOU GET
AN INJECTION INSIDER DOCTOR'S
THAT'S ADMINISTERED INSIDE THE
DOCTOR'S OFFICE THAT'S
PRESCRIBED THAT'S PART OF THE
MEDICAL BENEFIT SINCE IT'S AN.
AN OUT PATIENT CITING AS
SEPARATE FROM THE FAR PHARMACY
BENEFIT IF AVAILABLE SO WE
UNDERSTAND WHERE SOME OF THE
COST PRESSURES ARE.
AND INFORMATION ON THE USE OF A
PHARMACY BENEFIT MANAGER IN IF
ANY INCLUDING WHICH COMPONENTS
OF THE PRESCRIPTION DRUG
COVERAGE ARE MANAGED BY THE
PHARMACY BENEFIT MANAGER VERSUS
THE PLAN.
SO I WON'T GET INTO THE GREAT
DETAILS ABOUT ABOUT BECAUSE IT'S
MUCH MORE EXTENSIVE WITH THE
OFFICES THAT WOULD HEALTH
PLANNING AND DEVELOPMENT SO FOR
OUR PIECE.
WE ARE REQUESTING ONE PERMANENT
POSITION AND EXPENDITURE
AUTHORITY IN THE AMOUNT OF THREE
HUNDRED AND SEVEN THOUSAND FOR
FISCAL YEAR EIGHTEEN NINETEEN.
TWO HUNDRED EIGHTY ONE THOUSAND
FOR FISCAL YEAR NINETEEN TWENTY
AND THE SAME AMOUNT ANNUALLY
THEREAFTER TO ADDRESS THE
INCREASEDWORKLOAD RELATED TO
THE SPELL.
DO YOU WANT ME TO GIVE ANY MORE
DETAILS ABOUT HOW THE SKIN
BREAKDOWN BY OFFICER WAS THAT
AND I THINK THAT'S WHAT I'M A.
DEPARTMENT OF FINANCE LA ANY
COMMENTS.
PUBLIC COMMENTS ON THE ISSUE
EIGHTEEN AT THIS TIME.
WE OF OUT OF THE OF HEALTH
ACCESS CALIFORNIA AND HEALTHAXIS
PROUDLY CO SPONSORED S. B.
SEVENTEEN A TRANSPARENCY MEASURE
THAT HELPS ENSURE UP
PHARMACEUTICAL COMPANIES CAN'T
JUST. JACK UP THE PRICES OF
PRESCRIPTION DRUGS WITHOUT
JUSTIFICATION AND.
YOU KNOW WE SUPPORT DAMAGE
THESE BCP TO IMPLEMENT THE
MEASURE WHICH WILL HELP THE
PUBLIC UNDERSTAND HOW DRUG COSTS
AFFECT HEALTHCARE PREMIUMS THANK
YOU. THANK YOU.
CAN REALLY TELL THE CALIFORNIA
PAN ETHNIC HEALTH NETWORK WE
SUPPORT THIS BCP.
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY WE SUPPORTED THE
LEGISLATION AND SUPPORT THIS
BEAST.
WITHOUT A BRING IT UP TO THE
DYESS FRIEND QUESTIONS WE MAY
HAVE.
AN ISLAMIC CHARITY RIGHT HE SAID
THREE HUNDRED AND SEVENTY
THOUSAND FOR ONE PERSON.
NO THAT'S THE ADDITIONAL CONSULT
OUR ADDITIONAL COSTS AND SO AT
THAT SPECIFICALLY WE GOT A FEW
THINGS.
OR LOOKING FOR SO.
OUR OFFICE OF FINANCIAL REVIEW
WAS LOOKING FOR FIFTY THOUSAND
FOR CONSULTANT FUNDING TO ASSIST
WITH THE PREPARATION FOR THE
ANNUAL REPORT SO SENSIBLE
RESOURCES THERE. WE ALSO HAVE TO
HOLD A PUBLIC MEETING AS A
RESULT OF THIS BILL AND. AND
IT'S ADDING ON TO AN EXISTING
PUBLIC MEETING THAT IS ALREADY
AT CAPACITY IN REQUIRED TO BE
HELD IN EITHER SAN FRANCISCO OR
LOS ANGELES SEWER RUNNING INTO
VERY HIGH VENUE COSTS. FOR THE
QUANTITY OF PEOPLE THAT ARE
ANTICIPATED SHOW UP SO WE
ESTIMATED THAT A THOUSAND PEOPLE
WILL PARTICIPATE IN THIS MEETING
AND BASED ON A REVIEW OF
AVAILABLE SPACES ABOUT SAN
FRANCISCO AND LOS ANGELES. WERE
ESTIMATING AN ANNUAL COST OF
TWENTY FIVE THOUSAND DOLLARS SO
THE THREE HUNDRED SEVEN THOUSAND
ISN'T.
IT IS THE EXPENDITURE OF THIRTY
PIECE NOT THAT ONE PERSON PIECE.
NO. WAS GOING TO SAY I THINK
WE'RE ALL GONNA THE PLAYER FOR
DIFFERENT JOBS.
ME TOO.
WITH THAT STEP WAS RECOMMENDED
KEEPING THIS ITEM OPEN AND WE
WILL MOVE ON TO ISSUE NINETEEN.
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY A MEMBER OF THE
HEALTH CONSUMER ALLIANCE ALONG
WITH NINE COMMUNITY BASED LEGAL
AID ORGANIZATIONS. IS REQUESTING
ADDITIONAL FUNDING FOR THE
CONSUMER OUTREACH AND ASSISTANCE
PROGRAM. THE HEALTH CONSUMER
ALLIANCE IS THE ONLY STATEWIDE
RESOURCE IN CALIFORNIA FOR ALL
HEALTH CARE CONSUMERS TO OBTAIN
APATHY. WHEN CONFRONTING
BARRIERS TO ELIGIBILITY COVERAGE
OBTAINING SERVICES THROUGH FREE
LEGAL ASSISTANCE IN TWO THOUSAND
SEVENTEEN. WE SERVED OVER
SEVENTEEN THOUSAND INDIVIDUALS
AND SUCCESSFULLY CLOSE NEARLY
FIFTEEN THOUSAND THOUSAND CASES
WHICH ALLOW CLIENTS TO KEEP
MAINTAINED AND MORE IMPORTANTLY
USED HEALTH COVERAGE. THEREFORE
WE RESPECTFULLY REQUEST THE TWO
MILLION AUGMENTATION OF THE
PROGRAM AND FOR FUNDING TO BE
ADJUSTED ANNUALLY FOR INFLATION
THIS FUNDING WOULD REPLACE THE
DEBATES THE SALARY SAVINGS THAT
ARE CURRENTLY.
FUNDING THE PROGRAM THEREBY
INCREASING THE TOTAL PROGRAM
FUNDING FROM TWO POINT FIVE
MILLION TO TWO POINT SIX
MILLION.
THANK YOU.
WE'LL TAKE PUBLIC COMMENT ON
ISSUE NINETEEN.
I'LL BE BRIEF CAN REALLY COUNT
THE CALIFORNIA PAN ETHNIC HEALTH
NUMBER WE SUPPORT THE STATE WILL
PROPOSE.
THANK YOU.
MARY ABOUT OF HEALTH ACCESS AND
SUPPORT THANK YOU.
BRING IT UP TO THE DYESS FOR ANY
COMMENTS.
THEN I'LL PROVIDE ONE IF I CAN.
EMINEM HUMBLE BRAG ABOUT MY
MOTHER WHO IS A LEGAL AID LAWYER
AS WELL AND FREQUENTLY USES THIS
SERVICE THIS IS A GREAT PROGRAM
AND ONE THAT.
I LOOK FORWARD TO ADVOCATE LATER
ON.
WITH THAT.
WE WILL HOLD THAT ITEM OPEN AND
THAT WILL CONCLUDE TODAY'S
HEARING. THANK YOU ALL FOR
COMING