THIS WILL BEGIN TODAY'S AND THIS
YEAR'S FIRST SUB ONE HEARING.
I'D LIKE TO INFORM THE GENERAL
PUBLIC THAT WE ARE GOING TO DO
THINGS A LITTLE BIT DIFFERENTLY
THIS YEAR.
WE'RE GOING TO HAVE ITEMS THAT
WILL BE HEARD AND THEN ON
DISCUSSION ITEMS AS SHOWN IN THE
AGENDA TODAY THAT WILL BE BOTH
FOR HEALTH AND HUMAN SERVICES.
WITH THAT WE WILL BEGIN ISSUE
ONE THE STATE OF THE STATE
PUBLIC HEALTH.
IF WE CAN BEGIN BY TAKING ROLE
[inaudible]
THE ARAMBULA HERE FRAZIER HERE
MATHIS PATTERSON.
RAMOS [inaudible]
RUBIO [inaudible]
WHAT?
GOOD AFTERNOON MISTER CHAIR
MEMBERS OF THE COMMITTEE I'M
DOCTOR KAREN SMITH I AM THE
STATE PUBLIC HEALTH OFFICER IN
THE TRUCK FOR THE CALIFORNIA
DEPARTMENT OF PUBLIC HEALTH.
AND WITH ME I HAVE BRENDA NUNEZ
WHO IS OUR CHIEF DEPUTY OF
OPERATIONS.
SO.
FIRST I WANT TO SAY THANK YOU
VERY MUCH TO THE COMMITTEE FOR
REQUESTING THAT CITY PH PROVIDE
YOU WITH A REPORT ON THE STATE
OF PUBLIC HEALTH.
IN --
THINKING ABOUT WHAT I WAS GOING
TO SAY IN THIS HEARING I THOUGHT
A LOT ABOUT ALL THE DIFFERENT
WAYS THAT WE ACTUALLY MEASURE.
HEALTH WHAT'S IMPORTANT WHAT'S
OUR PRIORITY IN PUBLIC HEALTH
AND SO I ASKED A NUMBER OF STAFF
FROM ACROSS THE DEPARTMENT TO
STOP DOING WHAT THEY WERE DOING.
AND TRY TO CREATE FOR YOU A HAND
OUT THAT SUMMARIZES SOME OF THE
KEY WAYS THAT WE LOOK AT HEALTH
AND SO THAT'S WHAT YOU HAVE.
BEFORE YOU YOU'LL SEE THAT THERE
ARE GRAPHS THINGS LIKE THE
NUMBER OF DEATHS RESULTING FROM
OF A PARTICULAR CONDITION OR
DISEASE.
THE NUMBER OF PREMATURE DEATHS
WHERE EARLY DEATHS --
SO DUST OF YOUNG PEOPLE WOULD
COUNT AS A HIGHER PRIORITY IF
YOU'RE LOOKING AT IT THAT WAY.
UNDER --
MORBIDITY OR HOW MUCH OF A THAT
A DISEASE THERE IS A SUPPOSED TO
DOCK WE LOOK AT THINGS LIKE.
HOW MANY CASES THERE ARE --
FOR HOW MUCH DISABILITY DO THEY
COSTS AND OVER WHAT PERIOD OF
TIME IS IT LIFETIME IS A CHORE
TO SUPPORT AND THEN.
ALSO.
WHICH DISEASES COST MOST BECAUSE
ULTIMATELY WE ARE TRYING TO
BALANCE IN A VERY EXPENSIVE
HEALTHCARE SYSTEM.
SO -- AND
THEN FINALLY IN ONE OF THE
THINGS THAT THAT YOU'LL SEE IN
THERE THAT YOU MAY NOT HAVE SEEN
VERY OFTEN IS A A DISPARITIES
INDEX.
THIS IS LOOKING AT DISEASES BY
WHICH OF THEM HAVE THE GREATEST
DISPARITIES IN HEALTH OUTCOMES
BASED ON THE SUB POPULATION THAT
YOU'RE LOOKING AT THE NEEDS IN
PARTICULAR ARE DISEASES AND
CONDITIONS.
THAT DISPROPORTIONATELY AFFECT
OUR MOST VULNERABLE OR
CHRONICALLY DISADVANTAGED PEOPLE
AND COMMUNITIES.
AND THEN FINALLY THERE ARE THE
REEMERGING OR EMERGING DISEASES.
AND THEN THOSE THAT ARE
INCREASING RAPIDLY ENOUGH TO
PRESENT A CONCERN THAT IF
THEY'RE NOT A DRASTIC ACTUALLY
POSE A THREAT EITHER TO THE
HEALTHCARE SYSTEM OR TO THE
POPULATIONS HEALTH.
SO COLLECTING AND ANALYZING DATA
AND THEN TURNING IT INTO
INFORMATION THAT INFORMS POLICY
IN ACTION IS A FOUNDATIONAL
PUBLIC HEALTH FUNCTION
PARTICULARLY AT THE STATE LEVEL.
AT CITY PAGE WE COLLECT.
INFORMATION AND DATA ON MANY IN
CONDITIONS WE MONITOR OVER TIME
AND WE CREATE MANY REPORTS SOME
OF WHICH I'M SURE YOU'VE SEEN.
INCLUDING LEGISLATIVE REPORTS
AND OTHER KINDS OF REPORTS I
JUST WANTED TO MENTION THREE OF
THEM ONE IS --
THE COUNTY HEALTH STATUS
PROFILES WHICH YOU MAY HAVE SEEN
WE PUT THESE OUT ANNUALLY THIS
CONTAINS STATE AND COUNTY DATA
FOR A NUMBER OF INDICATORS THAT
ARE RECOMMENDED BY THE CDC AND
THE NATIONAL CENTER.
FOR HEALTH STATISTICS AND THEN
IT PROVIDES PERCENTAGES FOR THE
COUNTIES AND RANKING HOW THEY
RANK IN THE STATE BUT THEN
COMPARES THEM TO THE HEALTHY
PEOPLE TWENTY TWENTY NATIONAL.
GOALS FOR THESE --
INDICATORS.
WE ALSO PUT OUT WE DIRECT AND
MANAGE THE LET'S GET HEALTHY
CALIFORNIA.
SAYS WHICH IS OUR STATE HEALTH
IMPROVEMENT PLAN.
AND THEN LET'S GET HEALTHY WE
HAVE SPECIFIC INDICATORS THAT WE
FOLLOW OVER TIME THAT ARE
DESIGNED TO REFLECT PROGRESS IN
SIX DIFFERENT GOAL AREAS --
THAT ARE OF WITH WHICH WE ARE
ALIGNING WITH OUR LOCAL
JURISDICTIONS AND OTHER PARTNERS
TO TRY TO ADVANCE HEALTH IN
CALIFORNIA.
AND FINALLY THE SECOND EDITION
OF OUR BURDEN OF CHRONIC DISEASE
REPORT SHOULD BE COMING OUT
FAIRLY SHORTLY AS WELL.
BUT WE DON'T JUST GATHER DATA
FOR DATA SAKE IT'S REALLY
IMPORTANT TO US THAT WE USE THAT
INFORMATION TO HELP SET
PRIORITIES AND MOST IMPORTANTLY
TO DRIVE EFFECTIVE ACTION.
AND IN PARTICULAR WE HAVE A
FOCUS ON PREVENTION.
AND THAT MEANS THAT WE DON'T
JUST COUNT HOW MANY CASES OF A
PARTICULAR THING THERE ARE BUT
TO THE DEGREE POSSIBLE WE TRY TO
SEE WHO IS IT IS BEING AFFECTED
WHAT ARE THE INDIVIDUAL SOCIAL
AND COMMUNITY FACTORS THAT
EITHER PUT PEOPLE AT RISK.
OR PROTECTION AND THEN THE SAME
DATA CAN ALSO BE USED TO
EVALUATE INTERVENTIONS THAT WE
PUT IN PLACE TO TRY.
TO EAT DECREASE THOSE DISEASES
AND CONDITIONS OVERALL. FOR THE
PURPOSES OF THIS HEARING I'M
GOING TO TALK ABOUT THE STATE OF
HEALTH IN CALIFORNIA BY
DISCUSSING SOME EXAMPLES WHERE
WE'VE HAD SOME SIGNIFICANT
SUCCESSES.
BUT THEN I ALSO WANT TO MENTION
SEVERAL SIGNIFICANT THREATS THAT
I SEE TO THE STATE OF OUT TO THE
HEALTH IN CALIFORNIA.
AND WHAT I THINK IT'LL TAKE TO
ADDRESS THEM.
SO FIRST I'M GONNA START AT THE
AT THE BROADEST POSSIBLE LEVEL.
CALIFORNIA'S SEEN SIGNIFICANT
IMPROVEMENT IN LIFE EXPECTANCY --
IN NINETEEN NINETY CALIFORNIA
RANK TWENTY FOURTH AMONG STATES
WITH A LIFE EXPECTANCY AVERAGE
OF SEVENTY SIX YEARS BUT
ACCORDING TO MOST MORE RECENT
REPORTS --
IN TWENTY SIXTEEN CALIFORNIA
RANK SECOND ONLY TO WHITE WITH
AN AVERAGE LIFE EXPECTANCY OF
EIGHTY ONE YEARS THAT'S A PRETTY
SUBSTANTIAL INCREASE IN LIFE
EXPECTANCY OVER ALL.
AND THIS WAS THE GREATEST GAME
OF ANY STATE OVER THAT SAME TIME
PERIOD -- IN
CHRONIC DISEASES ALL THE RATES
OF DEATH FROM CHRONIC DISEASE
HAVE STEADILY IMPROVED OVER TIME
THEY DO REMAIN SOME OF THE MOST
COMMON AND COSTLY EXPENSE M.
CONDITIONS.
THAT WE HAVE IN 75% OF ALL
DEATHS ARE ULTIMATELY DUE TO
CHRONIC DISEASES.
DISEASE AND CANCER --
BECAUSE NEARLY HALF OF ALL
DEATHS -- AT
APPROXIMATELY 25% EACH.
WORRISOME FOR THE FUTURE IS THE
FACT THAT ONE OUT OF EVERY SIX
CALIFORNIA CHILDREN AND ONE OUT
OF EVERY THREE TEENS ARE ALREADY
OVERWEIGHT AND OBESE.
A RISK FACTOR FOR CORONARY
ARTERIES --
AND OTHER CHRONIC DISEASES
INCLUDING DIABETES.
AND THE PREVALENCE OF DIABETES
AND CALIFORNIA'S INCREASED 34%
BETWEEN TWO THOUSAND THREE IN.
TWENTY SIXTEEN AS OF 20169% OF
ALL ADULTS OR TWO POINT SIX
MILLION PEOPLE IN CALIFORNIA.
HAD BEEN DIAGNOSED WITH DIABETES.
AND EVEN MORE CONCERNING --
46% OF ALL ADULTS WERE THIRTEEN
MILLION PEOPLE HAVE BEEN
DIAGNOSED WITH PRE DIABETES.
AND THAT END WITHOUT
INTERVENTION ON AVERAGE ONE OUT
OF EVERY FOUR OF THOSE PEOPLE
WILL GO ON TO DEVELOP DIABETES.
THIS HAS HUGE RAMIFICATIONS BOTH
FOR THOSE INDIVIDUALS AND HEALTH
OVERALL BUT ALSO FOR THE COST OF
HEALTHCARE SYSTEM.
AND RATES OF DIABETES ALL OF OUR
DIFFER SIGNIFICANTLY BY
GEOGRAPHIC REGION.
THE RATE IN IMPERIAL COUNTY IS
THE HIGHEST AT FOURTEEN POINT 8%.
AND IN MARIN COUNTY WITH THE
LOWEST AT TWO POINT 6%.
NOT ONLY DO WE HAVE GEOGRAPHIC
VARIATION BUT WE ALSO DIABETES
IS A DISEASE WHERE WE CAN REALLY
SEE.
THE IMPACT OF SOCIAL
DETERMINANTS OF HEALTH.
DIABETES RATES AMONG WHITES 27%
WHILE IT IS AMONG AFRICAN
AMERICANS 9% AND AMONG LATINOS
11%.
AND RATES ARE THREE TIMES HIGHER
IN PEOPLE WHO DID NOT COMPLETE
HIGH SCHOOL THEN THEY AREN'T WHO
COMPLETED COLLEGE.
AND THEY ARE TWICE AS HIGH IN
FAMILIES LIVING UNDER THE
FEDERAL POVERTY LEVEL TO EACH OF
THESE.
CHRONIC DISEASES HAS IT'S ROOTS
IN SOCIAL AND COMMUNITY FACTORS
AS WELL.
BUT WE HAVE SEEN SIGNIFICANT
IMPROVEMENTS IN MANY CHRONIC
DISEASES INCLUDING CANCER HEART
DISEASE HIGH BLOOD PRESSURE AND
STROKES.
OVERALL THE RATES IN ALL OF
THESE HAVE DECREASED.
MANY FACTORS CONTRIBUTED TO THAT
DECREASE INCLUDING --
X. TERRIFIC EXTENSION EXPANSION
OF AFFORDABLE HIGH QUALITY
HEALTH CARE AND PREVENTIVE
SERVICES BUT CALIFORNIA'S ALSO
MADE SOME IMPORTANT POLICY
CHOICES.
A GOOD EXAMPLE IS AROUND SMOKING
REMAINS THE LEADING CAUSE OF
PREMATURE DEATH TO DISEASE AND
DISABILITY EVEN THOUGH RATES OF
DEATH FROM LUNG CANCER
RESPIRATORY ILLNESS AND
CARDIOVASCULAR DISEASE HAVE BEEN
DECREASING.
IT'S STILL THE NUMBER ONE CAUSE
OF PREMATURE DEATH.
BUT CHANGES IN POLICY ENACTED
BOTH AT THE STATE AND THE LOCAL
LEVEL HAVE HAD A MAJOR IMPACT.
CALIFORNIA SMOKING RATES HAVE
DROPPED 54% AMONG ADULTS DOWN TO
TEN POINT 1%. ONE OF THE LOWEST
IN THE COUNTRY.
AND DOWN TO FOUR POINT 3% FOR
YOUTH IN HIGH SCHOOL.
AND BY TWENTY FOURTEEN LUNG
CANCER MORTALITY IN CALIFORNIA
DROPPED 43% AND WAS 30% LOWER
THAN THE REST OF THE NATION AND
THIS IS GOING TO WE'RE GOING TO
CONTINUE TO SEE IMPROVEMENTS
OVER TIME AS WE HAVE MORE AND
MORE ADULTS WHO NEVER HAD.
EXPOSURE TO TOBACCO EITHER
DIRECTLY OR SECOND HAND.
SO THEN I WANT TO TALK ABOUT
SOME ISSUES THAT I SEE IS REALLY
SIGNIFICANT THREATS TO PUBLIC
HEALTH OVERALL THAT ARE OR
MERGING.
OPIATES AS YOU ALL KNOW ARE
DRUGS THAT ARE TYPICALLY USED
FOR PAIN RELIEF.
THINGS LIKE CODEINE HYDROCODONE
IN FENTON ALL ARE THE WORDS THAT
YOU'LL HEAR MOST FREQUENTLY IN
THIS CONVERSATION.
AND DESPITE THE FACT THAT
CALIFORNIA'S OVERALL RATE OF
OPIOID ASSOCIATED OVERDOSES AND
DEATHS IS MUCH LOWER THAN THE
NATIOAL AVERAGE.
WITH NEARLY TWO THOUSAND OPIOID
ASSOCIATED DEATHS AND OVER EIGHT
THOUSAND HOSPITAL EMERGENCY
DEPARTMENT.
ADMISSIONS AND TWENTY FOUR
MILLION PRESCRIPTIONS WRITTEN
EVERY YEAR FOR OPIATES WE STILL
HAVE A SIGNIFICANT PUBLIC HEALTH
PROBLEM.
LIKE THE REST OF THE NATION
CALIFORNIA'S BEEN STRUGGLING
WITH THIS ISSUE FOR OVER A
DECADE.
THE RECENT SHARP INCREASE IN IN
OVERDOSES AND DEATHS THAT HAS
GARNERED SO MUCH ATTENTION IS
LARGELY DUE.
TO THE I A POORLY UNDERSTOOD --
BASICALLY MALFUNCTIONING --
PRESCRIPTION PAIN MANAGEMENT
ISSUE BUT IN RECENT RECENT THE
LAST TWO YEARS DESPITE EFFECTIVE
INTERVENTIONS THAT HAD INITIALLY
DECREASED PRESCRIPTION RELATED
OPIOID OVERDOSES AND US.
THE EPIDEMIC HAS INCREASINGLY
SHIFTED NOW TO ILLICIT DRUG USE.
WE'VE WE HAVE HAD SOME SUCCESS.
OPIOID PRESCRIBING RATES HAVE
DECREASED SHARPLY SINCE TWENTY
FIFTEEN I'M PRESCRIPTION OPIOID
ASSOCIATED DUST REACHED THEIR
LOWEST LEVEL IN.
TWENTY SEVENTEEN THIS IS ALL
GOOD NEWS.
THE BAD NEWS IS THAT HEROIN
ASSOCIATED OVERDOSE DEATHS HAVE
INCREASED 97% SINCE.
TWENTY TWELVE AND FENNEL
ASSOCIATED US HAVE INCREASED
FOUR HUNDRED AND 23%.
THIS IS A SIGNIFICANT PROBLEM
THAT WILL REQUIRE ENTIRELY
DIFFERENT TYPES OF INTERVENTIONS
AND THOSE THAT WE WERE ABLE TO
USE TO BRING DOWN PRESCRIBING
RATES.
THERE IS WHY GEOGRAPHIC
VARIATION IN THE OPIOID CRISIS
ALSO WITHIN THE OUR NORTHERN
RURAL COUNTIES HAVING THE
GREATEST BURDEN OF DISEASE AND
THE MOST ADVERSE OUTCOMES.
ANOTHER MAJOR ISSUE THAT IS
GETTING LESS ATTENTION IS
SUICIDE.
SUICIDE RATES HAVE DECLINED
SUBSTANTIALLY IN THE NINETEEN
NINETIES BUT THEY'VE INCREASED
IN THE MOST RECENT DECADE AND
ARE NOW DOUBLE THE HOMICIDE
RATES.
IN FACT SUICIDE ACCOUNTS FOR
NEARLY TWICE THE NUMBER OF DATE
DEATH STATE WIDE AS OPIOIDS OR
HOMICIDE.
AND IT'S ONE OF THE TOP TEN
CAUSES OF PREMATURE DEATH IN
CALIFORNIA.
AND WE KNOW THAT SUICIDE IS
ACTUALLY UNDER REPORTED ON DEATH
CERTIFICATES TO THE THE PROBLEM
IS EVEN BIGGER THAN THAT.
MEN COMMIT SUICIDE AT THREE
TIMES THE RATE OF WOMEN.
THAT ARE TEN TIMES MORE LIKELY
TO USE A FIREARM.
AND WHILE THE HIGHEST RATES
AMONG MALES ARE IN THOSE OVER
EIGHTY YEARS OF AGE SUICIDE IS
THE SECOND LEADING CAUSE OF
DEATH AMONG ADOLESCENTS AND
YOUTH AGES.
FIFTEEN TO TWENTY FOUR AND THAT
SHOULD CONCERN US ALL
TREMENDOUSLY.
MANY OF THE SAME COMMUNITIES
THAT SEE HIGH RATES OF OPIOID
OVERDOSES PARTICULARLY NOR THE
NORTHERN RURAL COUNTIES ALSO
EXPERIENCE ASIDE RATES HIGHER
THAN THE STATE AVERAGE.
AND THEN FINALLY I WANT TO TALK
A LITTLE BIT ABOUT SEXUALLY
TRANSMITTED DISEASES IN THE
SHARP INCREASE THAT WE'RE SEEING
ACROSS THE STATE.
THERE WERE OVER THREE HUNDRED
THOUSAND CASES OF STDS REPORTED
IN TWENTY SEVENTEEN WHICH IS UP
45% FROM JUST FIVE YEARS AGO.
AND PERHAPS THE GREATEST CONCERN
IS THE RESEARCH TIRE LEAP
PREVENTABLE CONDITION OF
CONGENITAL SYPHILIS.
DESPITE THE FACT THAT WE WERE
SUCCESSFUL IN PREVENTING AT
LEAST 70% OF POTENTIAL
CONGENITAL SYPHILIS CASES BY
DETECTING IT EARLY IN TREATING.
THE MOTHER THERE WERE STILL TWO
HUNDRED AND EIGHTY THREE CASES
OF CONGENITAL SYPHILIS AND
TWENTY SEVENTEEN AND THIRTY
SURPLUS ASSOCIATED STILLBIRTHS.
THAT'S THE HIGHEST IN TWENTY
YEARS.
MOST OF THE WOMEN WHO GAVE BIRTH
TO BABIES WITH CONGENITAL
SYPHILIS.
HAD DID NOT RECEIVE ADEQUATE OR
TIMELY PRENATAL CARE.
WHICH COULD HAVE PREVENTED
TRANSMISSION.
THE MOST COMMON MATERNAL RISK
FACTORS FOR CONGENITAL SYPHILIS
WERE SUBSTANCE USE HOMELESSNESS
THE EXCHANGE OF SEX FOR MONEY OR
DRUGS AND CONTACT WITH THE SALE
WITH THE JAIL SYSTEM.
SO STRANGE AS IT MAY HAVE SEEMED
FROM THE OUTSIDE AS WE TALK
ABOUT THE RISK FACTORS FOR THESE
THREE EMERGING CONDITIONS.
FATAL AND NO FATAL OVERDOSES
SUICIDE SEXUALLY TRANSMITTED
DISEASES SURE MANY OF THE SAME
UNDERLYING CAUSES.
AND THEY ARE INCREASING DESPITE
THE TREMENDOUS PROGRESS WE'VE
MADE EXPANDING ACCESS TO
AFFORDABLE HER HEALTH CARE
ACROSS CALIFORNIA.
IN LARGE PART THIS IS BECAUSE
THESE DISEASES ARE NOT JUST
DISEASES OF PEOPLE BUT OF
COMMUNITIES AND OF SOCIETY
OVERALL.
AND THERE ARE RISING AT A TIME
WHEN INCREASING NUMBERS OF
CALIFORNIANS SIMPLY CANNOT
AFFORD THE BASIC COSTS OF LIVING
THINGS LIKE HEALTHY FOOD.
AND STABLE HOUSING.
HOPELESSNESS AND DESPAIR ARE
COMMON SYMPTOMS REPORTED IN ALL
OF THESE CONDITIONS [inaudible]
THESE.
ALSO HAVE THEIR ROOTS IN ADVERSE
EXPERIENCES IN CHILDHOOD THINGS
LIKE POVERTY.
VIOLENCE AND OTHER FORMS OF
TRAUMA.
AND STICK MY REMAINS A POWERFUL
BARRIER TO SEEKING HELP.
IN ADDITION TO THAT EACH OF
THESE REFLECTS --
AN INCREASING RELIANCE ON A
HEALTHCARE SYSTEM THAT ALONE
SIMPLY DOESN'T HAVE THE TOOLS TO
ADD TO FIX THEM BECAUSE IT CAN
REALLY ONLY TREAT THE SYMPTOMS
AND NOT THE ROOT CAUSES.
ULTIMATELY ADDRESSING THESE AND
OTHER DISEASES OF DESPAIR.
AS I LIKE TO REFER TO THEM WILL
REQUIRE A SYSTEM OF PREVENTION
THAT ADDRESSES ROOT CAUSES LIKE
POVERTY AND HOMELESSNESS.
AND VIOLENCE IN ADDITION TO A
HEALTHCARE SYSTEM THAT.
CAN PROVIDE TREATMENT FREE FROM
BIAS AND STIGMA AND THAT
RECOGNIZES THAT MENTAL AND
EMOTIONAL HEALTH IS AS IN FOR
GOAL AS PHYSICAL HEALTH TO THE
WELL BEING OF PEOPLE.
MAKING SIGNIFICANT AND
SUSTAINABLE CHANGES IN THE
PUBLIC'S HEALTH IN CALIFORNIA IS
GOING TO REQUIRE THAT WE HAVE A
GREATER UNDERSTANDING OF HOW
THESE SOCIAL PHYSICAL AND
BEHAVIORAL.
FACTORS.
THAT AFFECT HEALTH AND FIGURING
OUT WHAT LEVERS WE CAN USE TO
MOST EFFECTIVELY ACHIEVE AND
MAINTAIN A HEALTHY AND RESILIENT
CALIFORNIA.
THANK YOU I'M HAPPY TO TAKE ANY
QUESTIONS YOU MIGHT HAVE.
THANK YOU DOCTOR SMITH AND
BEFORE WE BEGIN I JUST WANT TO
SEE IF ANYONE HAD ANY SPECIFIC
QUESTIONS.
IF NOT THEN I WILL --
ASSEMBLYMEMBER MATHIS THANK YOU
MISTER CHAIR --
JUST AS WE TALK ABOUT THE
INCREASED RATES OF SUICIDE
WITHIN OUR YOUTH IS THERE
ANYTHING.
LOOKING AT TIME LINES FROM WHEN
WE STARTED IN OR DO YOU SEEN --
CONVERSATIONS OF ASSISTED
SUICIDE WITHIN THE ELEMENTARY
SCHOOL CURRICULUM. TO I MEAN
JUST.
THE FACT THAT IT'S GOING INTO
THESE KIDS' HEADS MUCH YOUNGER.
JUST MAKES ME WONDER --
THIS IS THE THE INCREASE STARTED
WELL BEFORE THOSE CONVERSATIONS
WERE HAPPENING AND SEEMS TO BE
MUCH MORE RELATED --
TO PARTICULARLY IN ADOLESCENCE A
FEELING OF HOPELESSNESS AND THEY
KNOW THEIR FAMILIES ARE
STRUGGLING AND THEY'RE
STRUGGLING AND A FEELING OF
ISOLATION SOCIAL ISOLATION IN
PARTICULAR.
IS ONE OF THE MAJOR CAUSES AND
THEN IN SOME CASES --
SUBSTANCE USE OKAY USE I I'M
JUST WONDERING BECAUSE I YEAH I
HAVE YOUNG CHILDREN I GOT US THE
QUESTION THE OTHER DAY HE'D HAVE
WHAT'S THE SYSTEM SUICIDE. OH
BOY HERE WE GO.
SELL.
ART THANK YOU.
ASSEMBLYMEMBER RAMOS FOLLOWED BY
ASSEMBLYMEMBER WOULD.
THANK YOU MISTER CHAIRMAN THIS
WATER -- TO
BRING TO LIGHT OF THE NATIVE
AMERICAN POPULATION THE STATE OF
CALIFORNIA I SEE THE DIFFERENT --
RATIO HIGHEST POPULATION OF
NATIVE AMERICANS --
IN THE STATE OF CALIFORNIA WHEN
IT'S PUT TO AGAINST THE
DIFFERENT STATES IN THE UNITED
STATES SO HOW ARE WE GETTING
THAT MESSAGE OUT AND TO THOSE
COMMUNITIES ALSO IN A WEEK
COLLECTING DATA. TO MAKE SURE
THAT.
WERE ALSO TRACKING WHAT'S GOING
ON THERE.
YES WE DO WE DO ROUTINELY
COLLECT DATA ON AFFECT ON NATIVE
AMERICAN AND PACIFIC ISLANDER
POPULATIONS AS WELL --
MANY TIMES IN OUR REPORTS WHAT
YOU'LL SEE IS THEY WON'T BE
REPORTED AND IT'S BECAUSE THE
NUMBERS ARE SO SMALL THAT THERE
IS PARTICULARLY WHEN WE'RE
LOOKING OVER TIME.
THEY'RE NOT STABLE ENOUGH TO
REPORT BUT WE DO COLLECT THAT
DATA AND ACTUALLY IN OUR OUR
OFFICE OF HEALTH EQUITIES --
STRATEGIC PLAN. FOR A REDUCING
HEALTH AND MENTAL HEALTH
INEQUITIES THERE'S A LOT OF
INFORMATION ON NATIVE AMERICANS.
SPECIFICALLY BOUTS FOR EXAMPLE
POPULATION THAT HAS A HIGHER
RATES OF OF DIABETES AS WELL RAY
THEY DON'T SHOW UP HERE BECAUSE
WE DIDN'T HAVE STABLE RATES TO
REPORT.
BUT THERE'S A LOT OF DATE ON THE
PRIORITY POPULATIONS WORKING IN
THE OFFICE OF HEALTH EQUITY TO
TRY VERY HARD TO GET OUT THE
OTHER AREA WHERE WE'RE DOING
THAT IS WE HAVE A SPECIAL FOCUS
IN OUR OPIOID.
ESPECIALLY THIS COMING YEAR.
THANK YOU MISTER CHAIR FOR A
ALLOW ME TO ASK THOSE QUESTIONS
BECAUSE I KNOW THAT --
THE RATIOS --
WITHIN THE NATIVE AMERICAN
COMMUNITY OUTPACE SOME OF THE
OTHERS --
THAT ARE OUT IN OUR COMMUNITY SO
CONTINUE TO FOCUS ON THAT AND
THANK YOU --
FOR FOCUSING ON THOSE AREAS WILL
BE LOOKING FORWARD TO SEEING A
LOT MORE DOUBT ON THAT.
THANK YOU THANK YOU.
YES HI DOCTORS JUST TOOK JUST A
QUICK QUESTION AS AS WE TALK
ABOUT OPIOIDS GASES.
ARE YOU ARE YOU COMFORTABLE IN A
AND A AND M. AND THIS IS HONEST
QUESTIONS I REALLY DON'T KNOW
THE ANSWER --
WITH THE WAY --
DEATHS THAT MIGHT BE LINKED TO
OPIOIDS ARE ACTUALLY --
CALCULATED --
I'D I DO WONDER WITH ESPECIALLY
WITH --
OLDER AMERICANS --
OLDER OLDER CALIFORNIANS WHO MAY
BE ON HIGH DOSES OF OPIOIDS --
IS YOU KNOW THIS THAT IN THAT
BEING A THERE IN IN IN IN AN
EARLIER TASK.
SO I WONDER IF IS THAT.
BEING TAKEN INTO CONSIDERATION
IS THAT A POSSIBILITY OR THE
NUMBERS POTENTIALLY UNDER
REPORTED --
A COUPLE OF THINGS ONE IS
SENIORS DON'T ACTUALLY HAVE TO
BE ON HIGH DOSES OF OPIATES IF
THEY'RE ALSO THEIR NUMEROUS
OTHER MEDICATIONS PARTICULAR
BENZODIAZEPINES AS WELL.
IN FACT WE'RE GOING TO BE
LAUNCHING --
LATER THIS YEAR A AN EDUCATIONAL
CAMPAIGN SPECIFICALLY ADDRESSED
AT OLDER AMERICANS HELPING THEM
UNDERSTAND.
MY MOTHER FOR EXAMPLE DOESN'T
EVEN KNOW WHAT YOU'RE FOR
MEDICATIONS IS AN OPEN RIGHT AND
SO -- THAT
SOMETHING THAT WE THINK NEEDS
ATTENTION THERE'S NO QUESTION IN
MY MIND THAT THEY'RE UNDER
REPORTED PARTICULARLY ACCIDENTAL
OVERDOSES THAT --
MAY CONTRIBUTE TO AN EARLIER
DEATH THAT WOULD OTHERWISE HAVE
BEEN THE CASE OR A COMBINATION
OF POLY PHARMACY MULTIPLE DRUGS
AT THE SAME TIME SUPPRESSING
RESTORATION.
HOW WE GET A HANDLE ON THAT IS
REALLY DIFFICULT MOST PEOPLE
DON'T WANT TO HAVE AUTOPSIES?
CORNERS ARE OVERWHELMED DEALING
JUST WITH THE THE CASES THAT
THEY DO HAVE WE DO HAVE A
PROJECT ON GOING WITH CORNERS
RIGHT NOW WERE --
ENGAGED WITH AYE WE BURKE FROM
PROVIDING FUNDING. FOR THEM TO
TRANSFER TO A THEY HAVE A VERY
RICH DATA ABOUT THE THE CASES
THAT GET REFERRED TO CORNERS
THAT INCLUDE A LOT OF THE SOCIAL
SITUATIONS IN THE CIRCUMSTANCES
OF DEATH.
AND WE THINK BY LOOKING AT THAT
INFORMATION WILL THINK WE WILL
SEE SOME SENIORS IN THAT
POPULATION AS WELL.
SO FAR.
SO CORNERS ROUTINELY DO
TOXICOLOGY SKI --
PANELS ON ON PEOPLE DIE UNDER WE
HAVE RISE SO OR OPIOIDS NOT
TRADITIONALLY A PART OF THAT
PANEL.
THEY ARE THE THE DIFFERENCES
THAT.
SENIORS ARE MUCH LESS LIKELY TO
ACTUALLY --
BE TAKEN UP AS A CORONER'S CASE
SO WHEN SO WHEN SOMEONE'S DIED
UNEXPECTEDLY WERE IN THE
HOSPITAL THE ATTENDING PHYSICIAN
WILL CALL THE CORONER'S OFFICE
WITH THE CORONER'S OFFICE
DOESN'T HAVE AN OBLIGATION TO
TAKE THAT PERSON IF THERE'S A
REASON TO BELIEVE THAT THEY MAY
HAVE DIED THAT'S PARTICULARLY.
TRUE IN PEOPLE OVER EIGHTY FOR
EXAMPLE TO THEY RARELY END UP
GOING TO A CORNER [inaudible]
THANK YOU.
ASSEMBLYMEMBER FRAZIER.
THANK YOU OF DOCTOR WHEN YOU
TALK ABOUT THE WELL BEING OR THE
MENTAL HEALTH OF THE CHILDREN.
AND YOU LOOK AT THE SILOS THAT
HAVE BEEN CREATED ABOUT THE WELL
BEING THE SCHOOL SYSTEM AND THE
HEALTH SYSTEM.
WE LOOK IN THE OLD DAYS WHEN THE
SCHOOLS HAD PSYCHOLOGIST IN
ATTENDED TO THE CHILDREN AND
GUIDANCE.
COUNSELORS.
WHEN THERE BE A BETTER
[inaudible]
OPPORTUNITY TO CO MINGLE.
WITH SCHOOL THE SCHOOLS AND ALSO
HEALTH CARE --
INDUSTRY.
BECAUSE I AM ITALIAN SOLANO
COUNTY WHERE I REPRESENT.
WE HAVE ZERO PEDIATRIC CRISIS
BEDS [inaudible] ZERO WHEN YOU
LOOK AT THAT THEN THEY
AUTOMATICALLY GO TO THE HOSPITAL.
INTO THE EMERGENCY ROOM AFTER
NOT SEVENTY OF FIFTY ONE FIFTY
THAT SEVEN TWO HOURS THE
RELEASED AFTER A PERIOD OF TIME
WITH NO REAL CARE.
SO WHEN WE LOOK AT THE WELL
BEING.
SHOULD WE BE LOOKING AT A
HOLISTIC APPROACH.
AND THE WHOLE OVERALL --
A DEPUTATION OF MENTAL HEALTH
STABILITY FOR THE CHILDREN.
I COULDN'T AGREE MORE I THINK
THAT IT'S NOT JUST SCHOOLS
SCHOOLS ARE VITAL IS
PARTICULARLY FOR YOUNGER KIDS
ONE OF THE THINGS THAT WE'RE NOT
DOING THAT WE SHOULD BE DOING IS
IDENTIFYING CHILDREN.
EARLY WHO HAVE RISK FACTORS FROM
GOING ON TO HAVING SUBSTANTIAL
BEHAVIORAL PROBLEMS AND WE KNOW
WHAT MANY OF THOSE ARE BUT AS
YOU PUT IT AS YOU'VE MENTIONED.
OUR SCHOOL SYSTEM HAVE WE'VE
LOST A LOT OF THE KINDS OF
ANCILLARY STAFF THAT WE USED TO
HELP SCHOOL COUNSELORS NURSES AT
CETERA -- WE
ARE SEEING AN INCREASING NUMBER
SCHOOL BASED HEALTH CLINICS AND
I KNEW THAT THAT WILL HELP BUT
IT'S NOT NEARLY ENOUGH WE WE
WAIT TOO LONG PARTICULARLY IN
THE IN BEHAVIORAL HEALTH AND
TELL SOMEONE IS IN CRISIS.
WHEN THE BETTER TIME TO
INTERVENE REALLY IS FURTHER?
UP WHEN YOU FIRST START SEEING
BEHAVIORAL ISSUES AND CAN I YOU
KNOW IF IF YOU HAVE THE
OPPORTUNITY TO WORK WITH
CHILDREN.
AND DISCOVER WHAT THEIR SOCIAL
CIRCUMSTANCES YOU TRIGGERS ARE
FOR THE BEHAVIORS THAT
ULTIMATELY BECOME UNMANAGEABLE.
IT IS JUST ANOTHER PART OF
ANOTHER QUESTION I APPRECIATE
THAT ANSWER BECAUSE IT DOES MEAN
THAT EVERYBODY NEEDS.
TO ABSOLUTELY 1100% NOTHING IT
IS FAR AS PART OF THE OF THIS
WHOLE.
SURVEY THAT IS PUT TOGETHER IT'S
VERY EXTENSIVE.
CAN YOU SHARE WITH ME WHAT
PERCENTAGE OF THE POPULATION OF
THE THE DEVELOPMENTALLY DISABLED
OR PART OF THIS ALSO BECAUSE
THERE.
THERE HAVE THEIR PART OF THE
THREE HUNDRED AND SOMETHING
THOUSAND INDIVIDUALS IN
CALIFORNIA.
THAT HAVE ALL OF THESE HEALTH
ISSUES BUT THEY'RE HARD --
TO SCREEN EVEN EVEN IN SPECIAL
OF HIS WIT INSTITUTE OF HEALTHY
ATHLETES PROGRAM BECAUSE IT WORK
GETTING ADEQUATE CARE.
SO HOW DO WE HOW DO WE KNOW THAT
WE'RE TOUCHING HIS POPULATION
ALSO LIKE WE TALKED ABOUT THE
NATIVE AMERICANS --
SO IN TERMS OF OF THE DATA THAT
WE ACQUIRE SOME OF THE DATA
SOURCES THAT WE HAVE ARE VERY
SPECIFIC AND ASKING ABOUT
DISABILITYTHAT'S WHY YOU SEE
SORT OF DISABILITY ADJUSTED LIFE
YEARS THAT WE THAT.
BUT THERE ARE OTHER DATA SOURCES
THAT JUST DON'T TAKE THAT INTO
CONSIDERATION AND SO IT REALLY
IS GETTING A COMPREHENSIVE
UNDERSTANDING OF WHAT THE THE
POPULATION LOOKS LIKE AS A WHOLE
REQUIRES WE HAVE WELL OVER TWO
HUNDRED DIFFERENT DATA STREAMS
AND THEY'RE ALL.
THE DIFFERENT WHAT THEY
COLLECTED ABOUT RAM AND WHETHER
IT'S SURVEY AND SO IT'S A IT'S A
HUGE LEFT TO KIND OF TAKE ALL OF
THAT DATA.
DO AN ANALYSIS IT KIND OF PUTS
IT TOGETHER WE TAKE WE GO TO
SPECIAL LANCS TO LOOK FOR
DISABILITY BECAUSE IT'S ACTUALLY
ONE OF THE MOST IMPORTANT
OUTCOMES.
IF YOU CAN DECREASE MORTALITY
THAT'S GREAT BUT IF PEOPLE ARE
LIVING FOR YEARS IN DISABILITY
THAT THEY DIDN'T HAVE TO HAVE
BECAUSE YOU COULD HAVE PREVENTED
SOMETHING IN THE FIRST PLACE.
THEN THAT'S WHAT WE SHOULD BE
WORKING ON AS WELL AND SO I
SHARE YOUR PRIORITY AS FAR AS
WHETHER OR NOT.
WE'RE PROVIDING THEM WITH
ADEQUATE HEALTH CARE SERVICES
THAT'S REALLY.
I THINK PROBABLY NOT BUT I DON'T
IT'S NOT AN AREA WHERE I HAVE
MUCH EXPERTISE I HAVE TO SAY.
APPRECIATE THANK YOU.
DOCTOR WOULDN'T FOLLOW AT YES
AND I'LL BE BRIEF I APOLOGIZE I
SHOULD HAVE DONE THIS FIRST BUT
THE NUMBER OF SUICIDE --
DOES -- ONE
OF THE I JUST AND JUST MARON
MENTAL MENTAL HEALTH ISSUES.
AND BUT BUT ONE OF THE THE IN
SOME OF THE BACKUP MATERIAL WHAT
WE WILL BE SEEN AS SAID IN
NORTHERN CALIFORNIA ESPECIALLY
RURAL NORTHERN CALIFORNIA THE
SUICIDE RATE IS.
TWICE THE STATE AVERAGE THIS IS
ON IS IS THERE ON DOING STUDIES
TO DETERMINE.
THE OTHER STUDIES OUT THERE IS
WHAT WHAT'S HAPPENING.
THAT THAT SO MANY PEOPLE IN
RURAL NORTHERN CALIFORNIA.
AS A PERCENTAGE OF THE
POPULATION.
I THINK IT'SIT'S ESSENTIALLY
THE SAME CONSTELLATION OF
FACTORS THAT ARE DRIVING OPIOID
USE AND AND OTHER ILLICIT DRUG
USE -- IT IS
A COMBINATION OF HAVING.
A SICKLY SEEING NO WAY TO A
FUTURE WHERE YOU THRIVE TWO
PEOPLE ARE LIVING.
BARELY MAKING.
ENDS MEET.
NOT ABLE TO PROVIDE FOR THEIR
CHILDREN WHAT THEY'D LIKE TO
PROVIDE.
NOT HADN'T NOT BEING WHERE THEY
THINK THEY SHOULD BE AT THAT
TIME OF LIFE AND SEEING NO WAY
OF GETTING BETTER.
PEOPLE WHO HAVE CHRONIC DISEASES
IN PARTICULAR ALSO --
IF THEY LOSE IF IF YOU IF YOU
DEVELOP A CHRONIC DISEASE THAT
CAUSES DISABILITY AS YOU WERE
MENTIONING EVEN TEMPORARY
DISABILITY YOU CAN END UP LOSING
A JOB THAT WAS ALREADY TENUOUS
TO BEGIN WITH AND NOW SUDDENLY
YOU AND YOUR FAMILY ARE HOMELESS
OR CLOSE TO HOMELESS UNSTABLE
HOUSE.
ALL OF THOSE THINGS CONTRIBUTE
TO FAIR AND WE THINK THAT THAT.
IS NO ONE SINGLE FACTOR THERE
ARE A LOT OF THINGS CONTRIBUTING
TO IT --
WHAT WE DON'T THINK IS HAPPENING
IS INCREASE IN SORT OF ORGANIC
BRAIN DISEASE THAT'S LEADING TO
IS THERE FUNDAMENTALLY?
ISSUES WITH POVERTY AND A LACK
OF JOBS IN A WAY TO WAY OUT OF
WHERE THEY CURRENTLY ON
BASICALLY I GUESS WHAT AT POINT
A LACK OF SERVICES YES I HAVE.
SERVICES IN MANY OF OUR COMMUTER
THIS IS THAT RECOGNIZE WHERE
PEOPLE ARE AT THAT TIME AND AND
PARTICULARLY WITH SPECIAL
POPULATIONS LIKE THE HOMELESS
POPULATION.
WILL HAVE TO MEET THEM WHERE
THEY'RE OUT AND TAKE AND DRUG
USERS AS WELL.
TAKES TIME TO GET THEM ONTO A
PATH THAT SUSTAINABLE --
AND THAT'S A DIFFERENT KIND OF
SERVICE THAN SAY THE HEALTH CARE
SYSTEM IS ABLE TO PROVIDE.
THANK YOU DOCTOR WOULDN'T --
DOCTOR SMITH I FORGOT HOW MUCH I
LIKE SOMEONE HEARINGS SO SORRY
IF I ACTUALLY.
ENJOY WALKING OUT WITH YOU
REGARDING MANY OF THIS MY
PLEASURE.
BUT BUT I WAS INTERESTED IN YOUR
TERMINOLOGY USED HE SAID MUCH OF
WHAT YOU REPORT ON OUR SYMPTOMS
AND NOT THE ROOT CAUSES --
BASICALLY WHAT I'M TRYING TO SAY
IS THAT.
THE DISEASE DISEASES LIKE
CHRONIC DISEASES AND BEHAVIORAL
HEALTH ISSUES.
ARE SYMPTOMS OF THE ROOT CAUSES
OF ADVERSE CHILDHOOD AND
COMMUNITY EXPERIENCES AND THE
INCREASING DIFFICULTY THAT
PEOPLE HAVE IT BAD FEELING LIKE
THEY'RE SUCCESSFUL IN THEIR
LIVES.
IN.
IN I. E. AGREE WITH YOU THAT
MOST OF OUR UNMET NEED IS IN FOR
CHILDREN AS WELL AS COMMUNITIES.
AND YET WE NEED SOME DATA POINTS
THAT WE CAN TRACK AND FOLLOW SO
THAT WE CAN MAKE INFORMED
DECISIONS.
SO WHEN YOU SAID THAT WE USE
INFORMATION TO SET PRIORITIES
AND TO DRIVE FOR ACTION.
I BELIEVE THAT'S WHAT OUR
COMMITTEE IS ALSO TRYING TO DO.
AND THE ROLE OF THE STATE OF THE
STATE PUBLIC HEALTH WILL BE TO
HELP DRIVE US TOWARDS ACTION.
WHERE IT'S NEEDED THE MOST BASED
ON THE SYMPTOMS THAT YOU PRESENT
IN SO WE'RE WANTING TO PROVIDE
SOME QUESTIONS SO THAT WE CAN
HAVE RECURRING?
DATA STREAMS COME BACK TO US I
WELCOME THEM. FOR EXAMPLE THE
CONGENITAL SYPHILIS THAT YOU
BROUGHT UP.
NEARLY A QUARTER OF ALL OF THOSE
COULD GENERAL SYPHILIS OCCURRED
IN FRESNO COUNTY IN THAT
BACKYARD EXACT AND SO I'M QUITE
AWARE OF SOME OF THESE DATA
STREAMS BUT I UNDERSTAND THAT WE
HAVE TO DO A LARGER ROLE TO HELP
US TO DRIVE.
PUBLIC POLICY AND HOPE THAT THIS
CAN DO IT.
MY QUESTION REALLY IS WHAT CAN
WE DO FOR YOU FOR RESOURCES.
HOW DO WE ENSURE THAT YOU HAVE
WHAT YOU NEED? TO DO THE
DIFFICULT TASK OF PROVIDING DATA
TO THIS BODY SO THAT WE CAN
ENSURE THAT --
WE CAN ACT UPON THAT INFORMATION
APPROPRIATELY.
I'M NOT SURE I KNOW HOW TO
ANSWER THAT QUESTION --
I THINK IT IS YOU KNOW HONESTLY
IN TERMS OF SOMETHING LIKE A
STATE OF THE STATE.
ADDRESS IT IT'S NOT SOMETHING
WE'VE EVER DONE.
WE HAVE AN IDEA OF HOW TO GO
ABOUT IT --
AND WE HAVE DONE SOME WORK AT
THE REQUEST OF THE COMMITTEE AND
THE LA -- ON
WHAT IT WOULD TAKE AND JUST IN
TERMS OF OF OF HUMAN RESOURCES
TO ACTUALLY --
DO THAT THE CHALLENGE BEING THE
VARIETY OF DATA THERE'S SO MUCH
DATA THAT WE CAN'T PRESENT TO IN
A SETTING LIKE THIS SO WE KNOW A
LOT ABOUT THOSE WOMEN WITH
CONGENITAL SYPHILIS THAT COULD
TELL US A LOT ABOUT WHAT THINGS
WE COULD PUT IN PLACE TO
ACTUALLY ADDRESS.
IT -- BUT
RENDON DO YOU HAVE ANYTHING YOU
WANT TO ADD ON THAT.
MISTER CHAIR READINESS FOR THE
DEPARTMENT SO. ONE OF THE THINGS
YOU CAN IMAGINE OUR DEPARTMENT
PRODUCES QUITE A FEW REPORTS ONE
OF THE THINGS AND IF YOU LOOK AT
THE BACK YOUR HAND OUT LISTED
ACROSS THE TOP OR A NUMBER OF
THOSE TYPES OF REPORTS THAT WE
DO PRODUCE. ONE OF THEM DOCTOR
SMITH MENTION WAS THE COUNTY
HEALTH STATUS PROFILES REPORT
WHEN WE WENT BACK AND JUST KIND
OF TO TRY TO ADDRESS THE
QUESTION THOSE IN IN THE AGENDA
AS FAR AS WHAT WE WOULD NEED AN
RESOURCES WE LOOK AT WHAT SOME
OF THESE REPORTS CLASSES AND I'M.
NOT ON A BI ANNUAL BASIS WE'RE
TO DO.
PROBABLY AROUND FIVE HUNDRED
THOUSAND GENERAL FUND AND THREE
POSITIONS WITHIN OUR DEPARTMENT
TO PULL IN THE RESOURCES OF THE
NEEDED TO DEVELOP. ONE OF THE
REASONS WE WERE LOOKING AT A BI
ANNUAL REPORT RATHER THAN AN
ANNUAL REPORT WAS BECAUSE IT
MIGHT PRODUCE YOU --
MORE COMPREHENSIVE INVALUABLE
REPORT ONE OF THE THINGS THAT WE
HAVE TO DO WE HAVE AN ANNUAL CUT
OFF AS WE HAVE A REVIEW PROCESS
AND IT CUTS OFF THE ANALYSIS
TIME FRAME AND THINGS LIKE THAT.
PRESIDENT EXTENDED OUT THERE --
TO IT EVERY TWO YEAR REPORT
WOULD PRODUCE YOU OKAY SOMETHING
ALSO THAT YOU'D BE ABLE TO
COMPARE ACROSS REPORT TIME
PERIODS AS WELL SO THAT'S WHY WE
CAME UP WITH THE COSTS ON A TWO
YEAR BASIS THE OTHER THING ABOUT --
TWO YEARS IS THAT.
WHAT MOST OF THE DATA SOURCES
THAT WE HAVE ARE NOT ANNUAL TWO
YEARS IS MORE COMMON --
THE OTHER THING IS THOUGH THAT
IT WOULDN'T PROVIDED A PREVENT
US FROM PROVIDING UPDATES ON THE
OFF YEARS ON SPECIFIC TOPICS
WHICH ACTUALLY MIGHT ALLOW US TO
DELVE MORE DEEPLY.
THE CHALLENGE WITH THINGS LIKE
THE COUNTY HEALTH STATUS FOR
THEIR WONDERFUL IF YOU KNOW WHAT
YOU'RE LOOKING.
FOR BUT THERE ISN'T A LOT OF
WHAT I THINK OF AS INFORMATION
THERE'S A LOT OF DATA AND BUT
IT'S TURNING THAT INTO A STORY.
AND THAT'S WHAT WE WOULD DO --
ENDEAVOR TO DO WITH REALLY IF
YOU LOOK AT LET'S GET HEALTHY
CALIFORNIA IT DOES NOT TO SOME
DEGREE BUT ONLY FOR SELECTED
INDICATORS WE WOULD BE DOING IT
ON A BROADER SCALE.
WELL I AM WON'T BELABOR THIS
COMMITTEE ANYMORE BUT WOULD LIKE
TO MEET WITH YOU OFF LINE IF WE
COULD --
TALK MORE SPECIFICS ABOUT ANNUAL
PURSES BIANNUAL --
BUT IT'S THE AND TENT OF THIS
COMMITTEE TO GET UPDATED
INFORMATION SO THAT WE CAN MAKE
INFORMED DECISIONS AND ACT UPON
THEM AS WELL.
WITH THAT WE WILL HOLD ISSUE ONE
OPEN AND MOVE ON TO ISSUE TO
THANK YOU
.
WHEN YOU'RE READY?
GREAT SO GOOD AFTERNOON --
JUST WANTED --
TO INTRODUCE --
FOR THE MEMBERS OF THE COMMITTEE --
JENNIFER CAN'T DIRECTOR FOR THE
DEPARTMENT OF HEALTH CARE
SERVICES AND THEN I'M JOINED
TODAY -- ON
VARIOUS OF THE PANELS FI AND
BOTH OF MY CHIEF DEPUTIES AND I
REFER TO THEM AS RIGHT HAND AND
LEFT HAND.
AMERICAN WELL AN ERROR BECAUSE
FOR BACK AND THEN THEY WILL EACH
HAVE CERTAIN PARTS OF THE AGENDA
BUT THANK YOU VERY MUCH FOR
LETTING US --
BE HERE TODAY.
HI MERRY CAM --
DH CS SO JUST WANTED TO PROVIDE
A BRIEF OVERVIEW THAT WAS
REQUESTED OF THE DTS BUDGET.
SO AS AS YOU WELL KNOW WE ARE
RESPONSIBLE FOR PROVIDING
CALIFORNIANS WITH ACCESS TO
INTEGRATED CARE AND HIGH QUALITY
CARE --
INCLUDING PHYSICAL DENTAL AND
BEHAVIORAL HEALTH OUR LARGEST
PROGRAM OF COURSE IS THE MEDI
CAL PROGRAM WHICH DOES PROVIDE A
HEALTH CARE SERVICES TO ABOUT
THIRTEEN POINT TWO MILLION
PEOPLE IS WHAT WE ARE CURRENTLY
ESTIMATING FOR THE BUDGET YEAR.
THAT DOES CONTINUE A SLIGHT
DECLINE THAT WE'VE BEEN SEEING
OVER THE PAST FEW BUDGET CYCLES.
IN ADDITION TO MEDI CAL WE DO
OPERATE INCLUDING THOSE FOR
THOSE WITH SPECIFIC CONDITIONS
WHETHER THEIR GENETIC DISORDERS
CANCER TREATMENT PROGRAMS.
AS WELL AS OVERSEEING THE
COMMUNITY MENTAL HEALTH AND
SUBSTANCE USE SERVICES THAT
COUNTIES.
OPERATES.
IN TERMS OF THE OVERALL DH CS
BUDGET WE ARE PROJECTING FOR THE
BUDGET YEAR A BUDGET OF A
HUNDRED FOUR POINT TWO BILLION
DOLLAR TOTAL FIND. TWENTY THREE
POINT FOUR BILLION OF THAT IS
GENERAL FUND AND THE REST BEING
FEDERAL FUNDS AND SPECIAL FUNDS.
WE DO HAVE ABOUT THREE ABOUT A
LITTLE UNDER FOUR THOUSAND
EMPLOYEES AT EACH YES AND IN THE
JANUARY THE BUDGET WE ARE
PROPOSING THE ESTABLISHMENT OF A
HUNDRED AND THIRTEEN NEW
POSITIONS WHICH INCLUDES.
EIGHT EXISTING LIMITED TERM THAT
WOULD BE CONVERTED TO PERMANENT.
THE MEDICAL ESTIMATE IS THE
LARGEST PART OF THE G. H. YES
BUDGET SO AS I MENTIONED OUR
OVERALL BUDGET IS ABOUT HUNDRED
FOUR BILLION THE MEDI CAL
ESTIMATE. FOR THE BUDGET YEARS
ABOUT A HUNDRED BILLION --
AT THE NOVEMBER ESTIMATE DID AS
I'M SURE YOU'VE NOTED IN THE
AGENDA PROJECT A REDUCED NEED
FOR GENERAL FUND IN THE CURRENT
YEAR.
ABOUT TWO POINT THREE BILLION
DOLLARS THAT WAS REALLY RELATED
TO A HANDFUL OF OF THINGS ONE
BEING --
SOME SUCCESSFUL RESOLUTIONS WITH
THE FEDERAL GOVERNMENT OF
DEFERRALS THAT THEY ISSUE TO US
WHERE WE WERE ABLE TO GET THE
MONEY BACK.
AS WELL AS THEY DID NOT ISSUE
DEFERRALS IN THE AMOUNTS THAT WE
WERE ANTICIPATING.
SO THAT'S ABOUT FOUR HUNDRED
MILLION DOLLARS WE DO HAVE SOME
INCREASED TRANSFERS TO THE
GENERAL FUND FROM OUR PROVIDER
TAXES BOTH THE SKILLED NURSING
FACILITY AND THE HOSPITAL
PROVIDER TAX.
WE WE SAW INCREASED DRUG REBATES
WITH I'M TALKING ABOUT THE
PROPOSED DRUG REBATE FUND AND A
BETTER MANAGEMENT OF THAT FOR
MORE TRANSPARENCY.
AND THEN WE DID SEE SOME LOWER
MANAGED CARE COSTAGAIN RELATED
TO THE DECREASE IN CASE LOAN --
GIVEN THE ONE TIME NATURE OF
ESSENTIALLY ALL OF THOSE --
POTENTIALLY EXCEPT THE CASE LOAD
YOU DO SEE A A NEARLY EQUIVALENT
INCREASE IN BUDGET YOUR OF TWO
POINT TWO BILLION DOLLARS --
BUT SINCE I I PRESUME WILL HAVE
EITHER TO LATER TODAY OR IN
FUTURE HEARINGS MORE DISCUSSION
OF THE MAJOR PROPOSALS I'LL JUST
QUICKLY MENTION WHAT THEY ARE --
THE FIRST BEING THE EXPANSION OF
FULL SCOPE MEDI CAL NOW TO THOSE
UP TO THE AGE OF TWENTY SIX THIS
IS EXPANDING ON THE SB SEVENTY
FIVE EXPANSION THAT WAS FOR KIDS.
ZERO TO EIGHTEEN WE ARE
CONTINUING THE MOST OF THE PROP
FIFTY SIX PAYMENTS THAT WE'VE
BEEN SEEING FOR THE LAST BUDGET
YEARS.
AND WE HAVE SOME NEW INVESTMENTS
AS WELL BUT I KNOW WE'LL BE
TALKING ABOUT LATER.
THERE'S ALSO FUNDING FOR HOUSING
AND HOUSING RELATED SERVICES FOR
OUR WHOLE PERSON CARE PILOT
COUNTIES --
TO HELP SUPPORT THE PROVISION OF
ACTUAL HOUSING SERVICES IN IN
THOSE COUNTIES THAT WOULD BE
AVAILABLE --
FOR THE NEXT SEVERAL YEARS
THERE'S ALSO FIFTY MILLION
DOLLARS FOR EARLY PSYCHOSIS OUT
REACH DETECTION AND TREATMENT.
AND THEN US FOLKS AS FOLKS ARE
WHERE WE DO HAVE THE GOVERNOR'S
EXECUTIVE ORDER RELATED TO
PHARMACY BOTH --
THE CAR ABOUT IT MEDI CAL BUT
THE LOWER BOOK PURCHASING SO
WITH THAT I WILL STOP THERE IS
IF THERE ANY QUESTIONS.
THANK YOU AMERICAN WILL --
ANY QUESTIONS FROM THE COMMITTEE.
SEEING NONE ALL START FROM.
YOU KNOW I HAD I HAD ASKED
EARLIER REGARDING THE MCO TAX
AND REALLY JUST WANT TO PUT
ANOTHER MARKER AND IT AGAIN IF I
COULD ABOUT THE IMPORTANCE OF
THAT SOURCE OF REVENUE AND A
WILLINGNESS ON BOTH --
THIS COMMITTEE IN MY OFFICE
SPECIFICALLY. TO WANT TO REACH
OUT TO THE ADMINISTRATION TO TRY
TO WORK ON ITS TO ENSURE THAT WE
COULD --
CONTINUE THE MCO AND JUST WOULD
WANT TO MAKE SURE THAT WE'RE
WORKING ON THAT AS WE GO FORWARD.
SO.
THE FEEL RHETORICAL FOR ASKING
BUT ARE THERE ANY REASONS WE
SHOULDN'T BE WORKING ON IT OR
ANYTHING THAT'S PROHIBITING US
FROM --
MAKING SURE THAT WE CONTINUE IT
PASSED TOJUNE.
YEAH AND THIS IS --
JENNIFER CAN --
I THINK THAT WE ARE WILLING TO
HAVE THE CONVERSATION I THINK
OBVIOUSLY WITH THE NEW
ADMINISTRATION YOU KNOW SOME OF
IT WAS OBVIOUSLY RELATED TO THE
THE TRANSITION IT'S A
COMPLICATED TAX --
I DON'T KNOW IF YOU WERE IN THE
LEGISLATURE THE LAST TIME THAT
THAT WE DID THIS BUT IT IS IT IS
SOMETHING THAT IS --
IT CAME FROM MERRY SPRAIN AN
EXCEL SPREADSHEET --
IT REQUIRES A LOT OF
CONVERSATIONS WITH BOTH THE
INDUSTRY ITSELF AS WELL AS THE
LEGISLATURE AS AND THEN THE
FINAL CONVERSATIONS WITH THE
FEDERAL GOVERNMENT I THINK THAT
WE ARE HAPPY TO HAVE THAT
CONVERSATION --
AND THEY'RE CERTAINLY MORE THAN
HAPPY TO ENGAGEWITH YOUAND
OTHERS AS THE AS THE BUDGET YEAR
GOES ON I DIDN'T FEEL THE NEED
TO EXTRAPOLATE ANY FURTHER THAN
THE STAFF COMMENT OR QUESTION
THAT WE HAD REGARDING THE PUBLIC
CHARGING THE EFFECT THAT THIS IS.
HAPPENING BUT JUST THAT WE WILL
CONTINUE TO TRACKING TREND THAT
AND MONITORING.
I WANTED TO FOCUS A LITTLE BIT
IF I COULD ON MENTAL HEALTH THIS
YEAR AND JUST WANTED.
TO PUT THIS IN AS A PRIMER FOR
CONVERSATIONS THAT WILL HAVE
LATER ON IN THE YEAR.
BUT I'VE FOUND IT EASIER WHEN
YOU LISTEN MORE THAN YOU TALK
AND SO SOMEONE SAID SOMETHING.
TO ME THE OTHER DAY DURING A
MENTAL HEALTH CAUCUS THE AUTHOR
OF PROP SIXTY THREE DARRELL
STEINBERG SAID THAT THERE WERE
SOME THINGS HE THINKS.
HE COULD HAVE DONE A LITTLE BIT
BETTER.
AND SO I'M INTERESTED IN WORKING
WITH THIS ADMINISTRATION TO
FIGURE OUT.
WHAT POSSIBILITIES WE HAVE THIS
YEAR?
AND SO I HAVE BOTH SOME IDEAS
AND SOME QUESTIONS ACTUALLY FOR
THE LA --
BECAUSE I NEVER KNOW WHAT'S
QUITE POSSIBLE AND HOW FAR WE
CAN PUSH.
BUT LET ME START WITH THE IDEA
WHICH IS THAT EARLY INTERVENTION
AND PREVENTION SERVICES
CURRENTLY WE HAVE FIFTY EIGHT
DIFFERENT MODELS WE HAVE.
FIFTY EIGHT COUNTIES THAT ARE
ALL DOING IT INDEPENDENTLY AND
DIFFERENTLY.
ARE THERE THAT MANY BEST
PRACTICES.
OR COULD WE COME UP WITH THE
HANDFUL OF SUGGESTIONS.
THAT WE PROMOTE TO THE COUNTIES
THAT HAVE.
DELIVERABLE METRICS AND OUTCOMES
THAT WE CAN FOLLOW.
THAT WE CAN BRING BACK AND ALLOW
THE REGIONS ARE COUNTIES TO
SELECT THEMSELVES WHAT THEY
THINK IS BEST FOR THEIR OWN
COMMUNITIES.
BUT BY DOING SUCH WERE ABLE TO
REALLY DRIVE TOWARDS EVIDENCE
BASED PRACTICES TOWARDS MODELS
THAT ARE EFFECTIVE AND COULD BE
IMPLEMENTABLE.
IN SEOUL WANTS --
TO WORK WITH THE ADMIN THE TERM
STEINBERG CAME UP TO US.
BUT ALSO TO SEE IF THE COUNTIES
THEMSELVES HAVE ANY SPECIFIC
IDEAS THAT ARE SEPARATE AND
APART THAN WHAT HE CAME UP WITH.
TO MAKE SURE THAT WE'RE MEETING
THE NEEDS OF ALL OF OUR
COMMUNITIES.
BUT BY DOING THAT I THINK WERE
BETTER ABLE TO ACTUALLY
INTERVENE EARLIER.
WITH MENTAL HEALTH AND THAT GETS
US TO THE SECOND PART THAT HE
WE CAN CHANGE IT
BUT HE SAID 80% OF THE DOLLARS
WE SPEND IN PROP SIXTY THREE
GOES TOWARDS TREATMENT.
ONLY 20% TOWARDS EARLY
INTERVENTION AND PREVENTION.
IS THAT THE RIGHT RATIO.
IS THAT THE RIGHT AMOUNT.
COULD THERE BE A TRANSITION.
AND THAT'S WHERE I BELIEVE I
NEED THE LA YELLOWS AND PUT.
IN WILL WANT TO MEET WITH THEM
OVER THE NEXT WEEK OR TWO
HOPEFULLY TO TALK ABOUT WHAT
OPTIONS ARE AVAILABLE.
HOW WE COULD THINK ABOUT THAT
TYPE OF TRANSITION AND WHAT TYPE
OF CHANGES WOULD BE NEEDED?
IS IT SOMETHING THAT WILL NEED
TO GO BACK TO THE PUBLIC.
FOR SINCE PROP SIXTY THREE WAS
INITIALLY PASSED.
IS THAT A TWO THIRDS VOTE IS
THAT A MAJORITY VOTE THESE TYPES
OF QUESTIONS MATTER.
BUT AS WE START THINKING AND ARE
CONTEMPLATING WHAT WE'RE DOING
BOTH AND SUB.
ONE I WANTED TO TAKE THIS MOMENT
TO TALK ABOUT MENTAL HEALTH AND
I BELIEVE THE NEEDS TO CHANGE
THE WAY WERE FUNDING IT. TO MAKE
SURE THAT WE CAN HELP TO PREVENT
DISEASE AND GET AHEAD OF THE
CURVE.
SO WITH THAT I JUST WANTED TO
HOLD ISSUE TO OPEN.
BUT WANTS TO WORK WITH BOTH THE
ADMINISTRATION AND LA --
AFTER THIS TO CONTINUE THE
SESSIONS.
WITH THAT WE WILL MOVE ON TO
ISSUE.
THREE THANK YOU MISTER CHAIR
BECAUSE FOR BACK HEALTH CARE
SERVICES SO JUST AS A BIT OF
BACKGROUND AND GIVEN THE
SIGNIFICANT VARIANCES THAT WE'VE
SEEN IN THE MEDI CAL ESTIMATE --
WE INITIATED A DEPARTMENT WIDE
EFFORT. TO EVALUATE OUR
RESOURCES ARE PROCESS SEASON ARE
SYSTEMS FOR FISCAL MANAGEMENT --
I THINK IT'S IMPORTANT JUST
WRITE A LITTLE CONTEXT AS IS
MERRY MENTION MEDI CAL IS IN
OVER A HUNDRED BILLION DOLLAR
PROGRAM.
WHICH OVER THE YEARS HAS GROWN
BOTH IN SIZE AS WELL AS
COMPLEXITY WITHOUT COMMENSURATE
ADMINISTRATIVE RESOURCES OR
SYSTEM ENHANCEMENTS TO KEEP UP
WITH THE PROGRAM.
ADDITIONALLY IT'S ON A CASH
BASIS OF ACCOUNTING SO TIMING OF
PAYMENTS AND RECEIPTS ARE
CRITICAL AND SOMETIMES DIFFICULT
TO MANAGE --
IT'S WORTH NOTING A 1% --
VARIANCE IN OUR ESTIMATE IS A
BILLION DOLLARS OR TWO HUNDRED
MILLION DOLLARS GENERAL FUND SO
JUST JUST FOR CONTEXT --
SOME OF THE COMPLEXITIES IN THE
ESTIMATE --
GROWTH IN OUR MANAGED CARE
PAYMENTS --
WE'VE GROWN TO APPROXIMATELY 80%
OF BENEFICIARIES ABOUT 50% OF
OUR PAYMENTS ARE TO MANAGE CARE
WHICH PUTS A LOT OF MONEY AND
RELATIVELY FEW PAYMENTS --
AND THERE ARE OPERATIONAL ISSUES
ASSOCIATED WITH THOSE PAYMENTS
THERE ARE FEDERAL APPROVALS
ASSISTED WITH THOSE PAYMENTS SO
WE PUT A LOT OF MONEY.
IN ONE AREA AND ADDITIONALLY WE
HAVE INCREASED THE NUMBER OF
SUPPLEMENTAL PAYMENT SO THINGS
LIKE QUALITY ASSURANCE FEES EVEN
THEM CO TAXES AS YOU TOUCHED ON
ON THE SUPPLEMENTAL PAYMENTS ARE
MORE THAN --
FORTY THEY CREATE COMPLEX
ACCOUNTING ISSUES AND TIMING
ISSUES THAT THAT CAN BE
DIFFICULT TO MANAGE.
I'M AS WELL AS ARE DRUG FREE BAY
AREA WHICH MERRY ALSO TOUCHED ON
AND WE HAVE SOME --
TRAILER BILL LANGUAGE THAT WE'RE
PROPOSING CARE THIS DRUG REBATES --
TOTAL ABOUT A BILLION AND A HALF
GENERAL FUND A YEAR.
AND THEY'RE REALLY DIFFICULT IN
TERMS OF THE TIMING --
WHEN THEY COME IN AND SOMETIMES
THEY JUST COME IN?
AND IT'S DIFFICULT TO TO ACCOUNT
FOR THEM.
SO IN TERMS OF OUR BUDGET CHANGE
PROPOSAL WERE REQUESTING A TOTAL
OF TWENTY FIVE POSITIONS --
TO STRENGTHEN OUR FISCAL
MANAGEMENT AND CASH FLOW
MONITORING AND THESE RESOURCES
INCLUDING --
AN EXECUTIVE LEVEL POSITION TO
SERVE AS THE CHIEF FINANCIAL
OFFICER A SINGLE POINT WITHIN
THE DEPARTMENT.
AND TO BE RESPONSIBLE FOR A
COMPLEX --
BUDGETING ACCOUNTING AND AND
ESTIMATING PROCESSES MONITORING.
AND WE'RE ALSO ASKING FOR
ADDITIONAL RESOURCES WITHIN OUR
CENTRAL --
ESTIMATING BUDGETING AND
ACCOUNTING SHOPS AND THOSE ARE
THE PEOPLE WHO PREPARE THE
ESTIMATE DO THE ACCOUNTING DO
THE BUDGETING FOR THE DEPARTMENT.
EQUALLY AS IMPORTANT WERE
REQUESTING A NUMBER OF POSITIONS --
TO SPREAD THROUGHOUT OUR
PROGRAMS AND ONE OF THE THINGS
THAT WE'VE DONE AS PART OF OUR
OVERALL EFFORTS.
IS TO ESTABLISH AND REINFORCE
THE THE CONCEPT THAT FISCAL
MANAGEMENT IS EVERYONE'S
RESPONSIBILITY --
YOU KNOW UNFORTUNATELY THE THE
CENTRAL SERVICE FOLKS ONLY KNOW
WHAT THEY KNOW SO YOU KNOW WE'RE
PAYMENTS ARE MADE WERE DRUG
REBATES ARE COMING IN THAT KIND
OF THING IS HAPPENING ON THE
PROGRAM SO WE'RE ASKING TO
RESOURCE.
THOSE AREAS AND WE THINK THESE
RESOURCES ARE NECESSARY FOR THE
IMMEDIATE WORKLOAD --
DEMANDS THAT WE HAVE WE ARE ALSO
CONTINUING TO LOOK AT LONGER
TERM SOLUTIONS IN TERMS OF
SYSTEM ENHANCEMENTS AND CHANGES.
AND ENVISIONED WORKING WITH
STAKEHOLDERS ON THAT PROCESS --
IN ADDITION I MENTIONED WERE
PROPOSING TRAILER BILL LANGUAGE
TO ESTABLISH A MEDI CAL DRUG
REBATE FUN AND IT REALLY WOULD
SERVE AS A FISCAL MANAGEMENT
TOOLS SO THAT WHEN WE GET THOSE --
REBATES INTO THE DEPARTMENT WERE
BETTER ABLE TO MANAGE THE TIMING --
TO WHEN THEY OFFSET GENERAL FUND
EXPENDITURES.
SO -- YOU
HAD A COUPLE QUESTIONS --
THAT ALL SPEAK --
TO JUST UNDERSCORE THAT THE SIZE
AND COMPLEXITY OF THE PROGRAM
COUPLED WITH EITHER --
INSUFFICIENT INADEQUATE OUTDATED
SYSTEMS --
CREATE SIGNIFICANT SWINGS IN AND
OR CANS CREATE SIGNIFICANT
SWINGS IN IN THE ESTIMATE --
WE BELIEVE THAT THE REQUESTED
RESOURCE IS REDUCE THE RISK OF
SIGNIFICANT AVOIDABLE ERRORS IN
THE ESTIMATE --
BUT WE ARE WORKING TO ENHANCE
PROCESS SEES AN ON A LONGER TERM
BASIS THE SYSTEMS THAT WE USE TO
ACCOUNT FOR THOSE A HUNDRED
BILLION DOLLARS.
DEPARTMENT OF FINANCE OLEO.
THANK YOU MISTER CHAIR RHYME
WILL SEE WITH LEGISLATIVE
ANALYST'S OFFICE --
IN OUR VIEW THE THE SWINGS IN
THE MEDICARE BUDGET THAT HAVE
BEEN REFERENCED ARE SERIOUS
CONCERN THAT --
MERIT SOME SOME ATTENTION FOR
TWO REASONS NUMBER.
ONE THE SWINGS ARE VERY LARGE
AND THEY'VE BEEN IN BOTH
DIRECTIONS IT WASN'T VERY MANY
YEARS.
BACK THAT THERE WAS A
SIGNIFICANT UPWARD SWING IN --
ESTIMATED --
TO MEDI CAL SPENDING AND THIS
MAKES IT DIFFICULT FOR THE
LEGISLATURE TO HAVE LONG TERM
PLANNING.
AND SITS PRIORITIES CAN BE UPSET
BY CHANGING BASELINE NEEDS IN
THE MEDICARE PROGRAM --
BUT BEYOND THAT AND AND WARRANTS --
CLOSE LEGISLATIVE OVERSIGHT BUT
THAT OVERSIGHT.
IS MADE DIFFICULT BECAUSE OF THE
COMPLEXITY OF THE PROGRAM --
OFTEN THE INFORMATION THAT WOULD
BE NEEDED TO ADEQUATELY --
TRACKING INDEPENDENTLY OVERSEE
THE PROGRAM IS NOT PUBLICLY
AVAILABLE --
AND IN SOME CASES IT FOR THE
DEPARTMENT TO PROVIDE --
IN LIGHT OF ALL OF THIS WE THINK
THE GOVERNOR'S PROPOSAL FOR
STAFFING HAS MERIT AND WE RECKON
RECOMMEND THAT IT BE APPROVED --
HOWEVER WE SUGGEST THAT
INCREASED TRANSPARENCY FOR THE
LEGISLATURE AND OTHER EXTERNAL
STAKEHOLDERS SHOULD BE AN
ADDITIONAL PRIORITY --
AS THIS PROPOSAL IS CONSIDERED --
IN THE SHORT TERM WE WOULD
RECOMMEND THAT THE LEGISLATURE
DIRECT THE DEPARTMENT OF HEALTH
CARE SERVICES.
TO SHARE KEY INFORMATION THAT
WOULD BE GAINED.
FROM THE APPROVAL OF THESE
POSITIONS WITH THE LEGISLATURE --
FOR EXAMPLE REGULAR UP UPDATES
ON CASH FLOWS --
AND HOW THOSE COMPARE WITH --
BUDGET ESTIMATES SEEMS LIKE A
REASONABLE FIRST STEP THAT WE
THINK SHOULD BE EXPLORED --
SECOND THE ADMINISTRATION HAS --
MENTIONED THAT THIS IS JUST THE
FIRST STEP IN THAT THERE'S AN
ADDITIONAL PLANNING ON ON LARGER
MORE STRUCTURAL CHANGES OCCUR WE
COULD BE MADE AND WE WE AGREE
WITH THAT ASSESSMENT.
WE WOULD SUGGEST AND RECOMMEND
THE WHERE THE DEPARTMENT TO COME
FORWARD WITH A SPECIFIC PLAN.
OF STEPS THAT COULD BE TAKEN IN
THE FUTURE THIS WHAT ALLOWED
LET'S LET LEGISLATURE TO BE
INVOLVED --
INTO TO MAKE ITS PRIORITIES --
REFLECTED IN IN FUTURE CHANGES.
ON THE PROPOSED DRUG REBATES
SPECIAL FRONT FUND WE THINK THIS
IS ALSO PROMISING CONCEPT --
THAT COULD POTENTIALLY HAVE
BROADER APPLICATION ANOTHER
PORTIONS OF MEDI CAL BUDGET.
AND RECOMMEND THAT THIS ALSO BE
APPROVED [inaudible]
THANK YOU.
WITH THAT'LL BRING IT UP TO THE
DíAS FOR ANY QUESTIONS WE MAY
HAVE.
SEEING NONE I DO WANT TO SAY
THAT SINCE IT'S OUR FIRST
HEARING I THINK I FORGOT PUBLIC
COMMENT THE LAST ISSUE.
SO IF THERE ARE ANY PUBLIC
COMMENTS ON ISSUES TWO OR THREE
NOW WOULD BE THE TIME.
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY --
WE'RE WE'RE VERY PLEASED THAT
THAT GOVERNOR'S.
PROPOSAL INCLUDES US SUPPORT FOR
HEALTH FOR ALL YOUNG ADULTS AND
ALTHOUGH WE WOULD LIKE TO SEE
COVERAGE FOR ALL --
ALL REGARDLESS OF IMMIGRATION
STATUS A WELL AS FUNDING FOR
THAT THE WHOLE PERSON HERE WE WE
SUPPORT --
WE ALSO AGREE THE LA --
AND THE CHAIRS COMMENT REGARDING
REVISITING LOOKING AT THE A
MANAGED CARE ORGANIZATION TAXES
THAT BRINGS IN OVER A BILLION
DOLLARS.
US -- SOME
OF WHICH COULD BE USED --
TO TO TO TO IMPROVE THE MEDI CAL
PROGRAM INCLUDING HEALTH FOR ALL.
EXPANDING --
ELIGIBILITY FOR THAT MEDI CAL
AGING DISABLED PROGRAM AS WELL
AS RESTORING CUTS.
ON THAT HAVE.
BEEN IN PLACE SINCE TWO THOUSAND
AND NINE IN ADDITION --
IN REGARDS TO THE CHILLING
EFFECT OF A PUBLIC CHARGE --
WE WOULD NOTE THAT --
A LONG TIME --
ENROLLMENT NUMBERS HAVE DIPPED
BELOW THIRTEEN MILLION SOME OF
THAT CAN BE ATTRIBUTED TO AN
IMPROVING CON ECONOMY --
BUT CERTAINLY WE THINK SOME OF
THAT CAN BE ATTRIBUTED TO THE
CHILLING EFFECT OF OF PUBLIC
CHARGES WE HAVE HEARD --
OF INDIVIDUALS DISTANT ROLLING --
TO TO ISSUE THREE WE WE DO
SUPPORT --
DCS GETTING THE ADDITIONAL
RESOURCES AND IN TERMS OF THE
FISCAL FORECASTING --
BUT SIMILAR TO THE LA --
I WOULD HAVE REQUEST ADDITIONAL
TRANSPARENCY IN REPORTING
REQUIREMENTS THINKING BE GIVEN.
THANK YOU TURN MEMBERS LINDA TO
NARROW ITS ON BEHALF OF THE
CALIFORNIA PAN ETHNIC HEALTH
NETWORK IN RESPONSE TO ISSUE --
TO ALTHOUGH WE KNOW THERE WASN'T.
A MEDI CAL DENTAL SPECIFIC
AGENDA ITEM --
WE JUST WANTED TO RAISE THE
IMPORTANCE OF LANGUAGE ACCESS IN
THE DENTAL PROGRAM --
FOR EXAMPLE YOU WE ARE VERY
HAPPY TO SEE THE INVESTMENT IN
ORAL HEALTH --
FOR EXAMPLE THE PROP FIFTY SIX
FUNDS -- TO
IN ADDITION --
TO THE RESTORATION OF THE DENTAL
BENEFITS HOWEVER WE CONTINUE TO
ASSERT THE IMPORTANCE OF ACCESS
TO THE SERVICES THAT PEOPLE ARE
NOW ELIGIBLE --
FOR IN PARTICULAR WERE SEEN
CONSUMERS REPORT DIFFICULTY ARE
CONNECTING WITH PROVIDERS
BECAUSE ARE UNWILLING OR ON ABLE
TO PROVIDE LANGUAGE ACCESS
SERVICES --
THERE BEEN ISSUES AROUND THE
LANGUAGE ACCESS HOTLINE AS WELL --
WE'VE ALSO HEARD REPORTS OF
CONSUMER IS SAYING THAT THERE
ARE DOCUMENTS OF ONLY BEEN
PRESENTED TO THEM IN ENGLISH --
SO WE'RE COMMITTED TO CONTINUING
TO WORK WITH DH CS ON MAKING
SURE THAT WE CAN ALLEVIATE THESE
BARRIERS TO MAKE SURE PEOPLE CAN
FULLY ENJOY --
THE TOTAL BENEFITS OF OF THEIR
DENTAL CARE --
AND ALSO JUST TO REITERATE --
THE COMMENTS OF OUR COLLEAGUES
AT WESTERN CENTER WE ARE VERY
SUPPORTIVE OF HEALTH FOR ALL IN
THE EXPANSION FOR THE ENTIRE
ADULT POPULATION THINKING.
THANK YOU.
GOOD AFTERNOON MISTER CHAIRMAN
MEMBERS I'M FAIRLY DAY TING
SPEAKING ON BEHALF OF THE
CALIFORNIA STATE ASSOCIATION OF
COUNTIES REPRESENTING ALL FIFTY
EIGHT COUNTIES I JUST WANTED TO
SAY WE WELCOME THIS COMMITTEE'S
INTEREST IN THE MCO TAX RENEWAL.
AS WELL AS THE MENTAL HEALTH
POLICY CONVERSATION THANK YOU SO
MUCH.
WITH THE WE WILL HOLD ISSUE
THREE OPEN BUT I WANTED TO ECHO
THE COMMENTS OF THE LA --
IF I CAN FOR THE LEGISLATURE'S --
WANTING AND HOPING FOR MORE
TRANSPARENCY DURING THIS
DISCUSSION AS WE GO FORWARD WITH
THAT WILL MOVE TO ISSUE.
FOR IF WE CAN MAKE A LITTLE BIT
OF SPACE FOR JOHN BATTERS PLEASE
.
A MISTER CHAIR AND MEMBERS OF
THE COMMITTEE MY NAME IS JOHN
VOTERS --
DIRECTOR OF GOVERNMENT RELATIONS
AT CALIFORNIANS PERCEIVED
INJUSTICE WAS ALSO SELECTED AS
THE CHAIR TO REPORT OUT ON THE
AB THREE FORTY WORKGROUP WHICH
WE'RE HERE TO PRESENT TODAY WE
WANT TO BEGIN BY.
THANKING ASSEMBLY MEMBER
ARAMBULA --
FOR OFFERING THE LEGISLATION AB
THREE FORTY A GROUP OF MEMBERS --
FROM AROUND CALIFORNIA WHO
REPRESENTED COUNTY WELFARE
AGENCIES COUNTY MENTAL HEALTH
AGENCIES --
HEALTH CARE PROVIDERS CHILDREN'S
ADVOCATES WELLNESS ADVOCATES AND
MEMBERS OF THE PUBLIC SAFETY
REFORM SYSTEM.
WHEN I ALSO THINK THE DEPARTMENT
HEALTHCARE SERVICES FOR
CONVENING THIS GROUP AND
DIRECTOR CAN FOR HER WORK IN
PARTNERSHIP IN HELPING US
PREPARE --
TODAY'S REPORT.
WHEN I WANT TO DO BASICALLY JUST
COVER TWO THINGS ONE WAS THERE
REPORTS HIGH FINDINGS --
HIGH LEVEL FINDINGS AT ONE END
AND THAT THE OTHER END IS --
JUST A FOLLOW UP TO THOSE
FINDINGS ON NEXT STEPS AND
THINGS THAT THE COMMITTEE COULD
CONSIDER GOING FORWARD.
SO THE STATE WORK GROUP --
EXPLORED THE FOLLOWING TOPICS
THE KEY DIFFERENCES BETWEEN THE
SCREENINGS AND ASSESSMENTS THAT
ARE USED IN TRAUMA SERVICES THE
VARIOUS TYPES OF EXPOSURES THAT --
TOOLS THEY'RE USED TO SCREEN
KIDS AS WELL AS REVIEWING THE
CURRENT TOOLS AT THE STATE
PROGRAM UTILIZES.
OUR VALUATION AND
RECOMMENDATIONS WERE GUIDED BY
COMMON WORKPLACE --
WORKGROUP GOALS IN THE CRITERIA
THAT WAS DEVELOPED BY THE WORK
GROUP.
WE BASICALLY WERE LOOKING FIRST
DRAMA SCREENINGS THAT.
COMPASS THE FOLLOWING THINGS
VISIBILITY IN THE USE IN A
PEDIATRIC PRIMARY CARE FOR US
SETTING.
ACCEPTANCE BY PARENTS AND
CAREGIVERS FOR ITS UTILITY
MEANING SCREENING COMPLETION SO
IS THE CODE --
WITHIN THE DEPARTMENT --
INCLUSIVE AT A MINIMUM OF
CATEGORIES OF TRAUMA AND
EXPERIENCE THE INCLUDE THINGS
LIKE CHILD ABUSE CHILD NEGLECT
HOUSEHOLD DYSFUNCTION ANOTHER
POTENTIALLY DRAMATIC EVENTS.
THAT ARE DETRIMENTAL TO SOCIAL
HEALTH INCLUDING MAJOR STRESSFUL
EVENTS COMMUNITY VIOLENCE
DISCRIMINATION AND POVERTY.
THE GROUP RECOMMENDS THREE
THINGS IN PARTICULAR FOR THE
DEPARTMENT TO WORK ON THAT WOULD
ALLOW MEDICAL PROVIDERS TO BE
GIVEN OPTIONS AND INSURING THAT
TRAUMA SCREENINGS ARE IMPROVING
CALIFORNIA.
THE FIRST IS THAT WE ASK AND
RECOMMEND THAT THE BAY AREA
RESEARCH CONSORTIUM AND TOXIC
STRESS AND HEALTH SCREENING TOOL
NOTICE PEARLS.
IS USE ALONGSIDE THE STATE
REQUIRED --
STAYING HEALTHY ASSESSMENT WHICH
WE CALL THE SHOTS.
BRIGHT FUTURES OR ANY OTHER
APPROVED BY CUBA FOR THE
PURPOSES OF IMPROVING SCREENING
TOOLS FOR TRAUMA IN CHILDREN IN
EXAMINING THE FORMAL INTEGRATION
OF THAT TOOL WITH THE SHOW ON
THE FUTURE.
SECOND RECOMMEND THAT THE USE OF
THE WHOLE CHILD ASSESSMENT TOOL
WHICH IS AN EXISTING STATE HE
WOULD CONTINUE TO BE AVAILABLE
BECAUSE INCORPORATES --
SCREENING FOR EXPOSURE TRUMP
ALONGSIDE OTHER IMPORTANT
VARIABLES IN FACTORS IN
DETERMINING THE SOCIAL HEALTH
AND WELL BEING OF CHILDREN.
FINALLY WE CONTINUE --
TO RECOMMEND THAT THE REQUEST
FOR APPROVAL FROM DH CS FOR THE
USE OF ALTERNATIVE TOOLS THAT
ARE CONSISTENT AT A MINIMUM WITH
THE GUIDELINES AND QUESTIONS --
UTILIZED BY THE PROS TO WILL BE
AVAILABLE --
TO PROVIDERS IN THE FUTURE --
WE RECOMMEND FOR THE
IMPLEMENTATION OF THE PEARLS TO
IN PARTICULAR THAT THERE BE A TO
PART ASSESSMENT FIRST IS THE
IMMEDIATE --
IMPLEMENTATION OF PEARLS
ALONGSIDE THE THE SHOT AS I
MENTIONED --
THE THE PROS TOOL --
FOCUSES SPECIFICALLY ON ASK
QUESTIONS OF PARENTS OR CHILDREN
AS AGE APPROPRIATE. TO IDENTIFY
BARRIERS ARE ACES THE KIDS SPACE
THAT COULD BECOME PHYSICAL OR
MENTAL HEALTH --
IMPEDIMENTS TO THE DEVELOPMENT
EDUCATIONAL ATTAINMENT OF A
CHILD --
SECOND WE ALSO RECOMMEND THAT
THE DEPARTMENT EXPLORE --
THE POTENTIAL OF INTEGRATING THE
THE PEARLS TO OR QUESTIONS THAT
OUR CORPORATE IN THE POOR PEARL
STILL INTO THE SHOP.
SO WE HAVE AN INTEGRATED
FOOTBALL UNIFORMS TO ON THE
STATE --
THIS WOULD REQUIRE THIS
COMMITTEE IN THE STATE --
DEPARTMENT TO REVIEW THE COST
AND VALIDATION PROCESS FOR
MAKING THAT POSSIBLE AND WE
THINK THAT'S A WORTHWHILE --
ENDEAVOR FOR THE DEPARTMENT
ENGAGING --
THE COINCIDING WITH THE
IMPLEMENTATION OF THE PROS TO WE
ALSO RECOMMEND THAT THE
DEPARTMENT OF HEALTH CARE
SERVICES CONSIDER COMPLIANCE
MONITORING --
SPECIFICALLY THE USE OF A
DESIGNATED CPT CODE --
COUPLED WITH SOME PROVIDER
TRAINING TO ENSURE THAT THE
SUCCESS AND SUSTAINABILITY OF
TRAUMA SCREENING IS UNIVERSAL
ACROSS CALIFORNIA AS THERE ARE
SOME DISCREPANCIES AT COUNTY
ADMINISTRATION LEVEL TODAY.
FINALLY WE HAD MULTIPLE
DISCUSSIONS ABOUT THE IMPORTANCE
OF SCREENING --
FOR ACES IN ADULTS --
AND THE INTER GENERATIONAL
IMPACT ON THE TRUMP HAS AYE KIDS
IN THE CYCLICAL NATURE OF THAT
SO WE THINK THAT THE NEXT STEP
THAT THE LEGISLATIVE COMMITTEE
COULD UNDERTAKE.
IS TO ALSO EXAMINE BEYOND THE
SCOPE OF CHILDREN.
AB THREE FORTY THE POTENTIAL FOR
DOING TRAUMA SCREENINGS IN
ADULTS.
FOLLOWING UP TO THOSE
RECOMMENDATIONS WE HAVE --
WE HAVE A FEW OTHER IDEAS FOR
YOU -- BASED
ON OUR CONVERSATIONS ON THE EP
STT BENEFIT --
WE COULDN'T AGREE MORE WITH
DOCTORS MISS OPENING COMMENTS ON
THE STATE OF THE STATE OF PUBLIC
HEALTH.
SO EXTREMELY BROAD BENEFIT I'M
WORKING ON INTERVENTIONS FOR
TRAUMA FORCES THE OPPORTUNITY IN
GREAT PHYSICAL HEALTH AND MENTAL
HEALTH COMPONENTS OF HEALTH CARE
TO PROVIDE BETTER PUBLIC HEALTH
REALISTICALLY IN CALIFORNIA.
IF WE IMPROVE DRAMA SCREENINGS
ESPECIALLY IN CHILDREN ARE
PROVIDERS WILL BE ABLE TO BETTER
PREDICT MONITOR AND THEN PROVIDE
TREATMENT FOR THE MANIFESTATIONS
OF TRAUMA DIFFERENT LEVELS IN
PLACES ACROSS THE HEALTHCARE
SYSTEM. ONE OF THE KEY NEXT
STEPS THAT WE BELIEVE IS
IMPRISONMENT IMPROVING THIS
PROCESS IS TO MAKE SURE THE
PROVIDERS ARE WELL TRAINED ON
FROM THE SCREENINGS.
THIS CAN INCLUDE HOW TO PROVIDE
FROM IN FRONT CARE WHEN THEY'RE
ADMINISTERING SCREENINGS HOW TO
ENGAGE WITH PATIENCE WITH
EXPERIENCE ADVERSE CHILDHOOD
EXPERIENCES.
AND WHAT THE WHAT THE
APPROPRIATE REFERRALS OR
INTERVENTIONS MIGHT BE TO HELP
ADDRESS CHILDHOOD TRAUMA.
ADDITIONALLY ADVOCATES RECOMMEND
THAT THE LEGISLATURE EXPOSED THE
POTENTIAL OR EXPLORE THE
POTENTIAL NEXT STEPS WHEN IT
COMES TO EXPANDING THE ACTUAL
SERVICES THE TRAUMA VICTIMS
RECEIVE.
THIS WOULD REQUIRE --
DIFFERENT BY ARE THE VARIABLES
THAT IMPACT --
PEOPLE HOW THEY OVERCOME THOSE
TYPES OF EVENTS IN THEIR LIFE
COMMON CATEGORIES THAT INCLUDE
EXERCISE NUTRITION SLEEP
MINDFULNESS MENTAL HEALTH CARE --
INTERVENTIONS THE FOCUS ON
ADDRESSING THESE ISSUES WILL
HAVE A NET POSITIVE IMPACT ON
THE TYPES OF STRESS THAT AFFECT
CHILDREN AND YOUNG ADULTS AND
IMPROVE OUR OVERALL MENTAL
HEALTH AND RESULTING --
RESULTING CARE COUPLE OF FINAL
EXAMPLES OF WAYS THIS COULD BE
DONE WE ACTUALLY SPECIFICALLY --
WOULD LIKE TO SUGGEST THAT YOU
YOU COULD CONSIDER WAYS TO PILOT
THINGS LIKE TRAUMA INFORMED
ABOUT PARENTING SUPPORT MODELS.
BEHAVIORAL HEALTH --
SERVICES SPECIFICALLY FOR
CHILDREN PARENTS INCLUDING
INFANT EARLY CHILD MENTAL HEALTH
AND DYADIC MODELS --
WHERE THERE'S INTEGRATED PRIMARY
CARE CO LOCATED OR COMMUNITY
BASED --
CARE COORDINATION SYSTEM
NAVIGATION AND THEIR SEVERAL
STUDIES THAT THE NEW SURGEON
GENERAL OF CALIFORNIA
PARTICIPATED IN AS A MEMBER OF
THE CENTER AND USE WHILE THIS
BACK IN THE DAY --
THIS EXAMINE THE FEASIBILITY OF
IMPROVING SOCIAL HEALTH FOR
CHILDREN WITH DIFFERENT TYPES OF
INTERVENTIONS INCLUDING
INCLUDING HOME VISITATION
PROGRAMS --
YOUR LEADERSHIP ON THIS --
MISTER CHAIR AND THE COMMITTEE'S
INTEREST IN THIS ISSUE IN YOUR
PRIORITIZATION MENTAL HEALTH IN
HERE TO ANSWER ANY QUESTIONS.
DIRECTOR CAN SURE THANK YOU --
SO I WOULD SAY THAT THE WORK
GROUP THAT --
WE CONVENE SO --
TOGETHER WAS ACTUALLY REALLY IN
THE CONVERSATION AND QUITE
HELPFUL IN HELPING THINK THROUGH --
SOME OF THE ISSUES SURROUNDING --
TRAUMA SCREENS IN THE IN THE
POPULATION YOU KNOW I THINK --
I HAVE I HAVE TOLD PEOPLE THAT
ONE OF THE MORE NOTABLE --
COMMENTS FROM ONE OF THE PUBLIC
HEALTH --
DIRECTORS --
FROM SHASTA COUNTY WAS THE
RECOGNITION THAT --
A LOT OF THE ADULT POPULATION OF
THEIR THAT THEY HAVE FOUND --
IT'S AN ENERGY IT'S A IT'S A
GENERATIONAL THING AND YOU CAN'T
ADDRESS THE ROOT CAUSE OF
CHILDREN BEING IMPACTED UNLESS
YOU'RE ALSO LOOKING AT THE
ADULTS I THINK THAT.
SOME OF THE NATURE OF THAT --
IMPORTANCE WAS --
CARRIED FORWARD IN THE
GOVERNOR'S BUDGET PROPOSAL SO
WE'RE GONNA TALK ABOUT IT BOTH
TODAY AS WELL AS IN MENTAL
HEALTH --
DISCUSSIONS THAT ARE BEING --
HEARD -- TO
MISSION AND THE PROPOSAL BEFORE
THE LEGISLATURE TO DO TRAUMA
SCREENINGS FOR BOTH CHILDREN AND
ADULTS POPULATIONS --
I THINK IS INDICATIVE OF THE
ADMINISTRATION'S INTEREST IN
GETTING --
TO NOT ONLY DOING THE SCREEN BUT
THE BROADER CONVERSATION IS IS
ONCE YOU HAVE DONE THE SCREENING --
WHAT ARE THE SERVICES AND OTHER
OPTIONS THAT WE CAN MAKE SURE
THAT WE'RE KIND OF --
DOING A LOT MORE EARLY
INTERVENTION AND PREVENTION
ACTIVITIES AS YOU NOTED EARLIER --
I WOULD ALSO SAY THAT --
AGAIN I'M KIND OF GETTING INTO
THE PROP FIFTY SIX AGENDA ITEM
BEFORE WE GET THEIR OFFICIALLY
IS THAT THE VALUE BASED
PURCHASING PROPOSAL THAT IS IN
THE GOVERNOR'S --
BUDGET ALSO CONTAINS --
IDEAS AND INCENTIVES AROUND
BEHAVIORAL HEALTH INTEGRATION AS
WELL AS OTHER ITEMS AND SO I
THINK WE ARE SAYING THAT --
THE TRAUMA SCREENS ARE AN
IMPORTANT FIRST COMPONENT BUT I
THINK AS MR BATRES IS CERTAINLY
INDICATED IS THAT ONCE A PERSON
ADMITS.
ON A SCREENING TOOL THAT THEY
HAVE BEEN EXPOSED TO QUESTION IS
AS WELL WHAT DO I DO WITH THAT
PERSON AND I DON'T KNOW WHAT TO
DO AND SO I THINK THAT IS OF A
POLICY DISCUSSION THAT WE AS A
STATE HAVE TO HAVE IN TERMS OF
SERVICES AND SUPPORTS.
AND THINGS LIKE THAT AND SO
CERTAINLY HAPPY TO BE A PART OF
THAT BUT REALLY WANTED TO SAY
THAT THE WORKGROUP WAS DOES --
ILLUSTRATIVE AND VERY POSITIVE
IN COLLABORATIVE AND I THINK
THAT WE WERE --
WITH PLEASE WITH THE OUTCOME OF
THAT [inaudible]
LET'S SEE.
I'M.
WITH THAT WILL BRING IT UP TO
THE DIES FOR ANY COMMENTS OR
QUESTIONS THAT WE MAY HAVE.
XENON I'LL JUST SAY IT'S NICE TO
ACTUALLY HAVE YOU WELCOME AND
BECOME A BELIEVER IN A SAYS I
THINK.
SOMETIMES A NEVER MY YEAH.
I DON'T THINK YOU WERE --
NOT THERE BUT NOW THAT WE ARE
ALL ROWING IN THE SAME DIRECTION
IS QUITE NICE.
WANTED TO REALLY TALK IF I COULD
ABOUT THE IMPORTANCE AND
CRITICAL NATURE OF THE C. P. T.
CODE THE FIGHT COULD FOR
COMPLIANCE AND MONITORING.
IT'S REALLY DIFFICULT FOR US TO
TRACKING TREND UNLESS WE HAVE
THAT CPT CODE AND WOULD JUST
ENCOURAGE THIS ADMINISTRATION TO
WORK ON THAT WHEN.
I MET WITH THE SURGEON GENERAL --
EARLIER THIS MONTH THAT WAS THE
THING SHE BROUGHT UP TO ME.
ABOUT HOW IMPORTANT IT WAS AND
JUST WOULD HOPE THAT WE COULD
ACCOMPLISH THAT WORKING TOGETHER --
WITH THAT I'M EXCITED ABOUT
BEFORE US AND WE WILL NOW HAVE A
PUBLIC COMMENT ON THE ISSUE.
FOR THANK YOU MISTER CHAIRMAN
RIGHT MAKE EXECUTIVE DIRECTOR
THE COUNTY WELFARE DIRECTORS
ASSOCIATION AS A MEMBER OF THE
WORKING GROUP --
I CONCUR WITH WHAT MR BATTER
SAID RUEFULLY IN SUPPORT OF THE
RECOMMENDATIONS --
AND ALSO FULLY IN SUPPORT OF THE
GOVERNOR'S BUDGETS --
INCLUSION OF FUNDING FOR TRAUMA
SCREENINGS FOR CHILDREN AND
ADULTS LIKE TO THANK YOU AND
DIRECTOR CAN'T --
FOR ALL THE WORK YOU'VE DONE A
REALLY EXCITED ABOUT IT AND
LOOKING FORWARD TO THE NEXT
STEPS.
MICHELLE GIVENS OF THE COUNTY
HEALTH EXECUTIVES ASSOCIATION OF
CALIFORNIA AND WE'RE REALLY
PLEASED WITH THE RECOMMENDATIONS
THAT ARE GOING FOR IT BUT EVEN
FURTHER WE WERE HAPPY.
AND TO HAVE THE PUBLIC HEALTH
PERSPECTIVE AND NOT LANDS --
INCLUDED IN THE WORK GROUP
ACTIVITIES AND SHOULD THIS
CONVERSATION SHIFT TO WHAT COMES
NEXT -- OUR
PUBLIC HEALTH DEPARTMENT STAND
READY TO BE A PART OF THAT
CONVERSATION THINK YOU.
HI SERRA MARKS WITH THE CENTER
FOR YOUTH WELLNESS AND A MEMBER
OF THE AB THREE FORTY WORK GROUP --
I ALSO WORK WITH THE NATIONAL
NETWORK OF PEDIATRIC MEDICAL
PROVIDERS WORKING ON THIS ISSUE
SO WE'RE VERY EXCITED.
WE THANK YOU FOR YOUR LEADERSHIP
ON THIS I FULLY SUPPORT --
HOW MISTER OUT OF PRISON AND THE
RECOMMENDATIONS --
AND LOOK FORWARD TO SEEING PUT
TOWARDS TRAINING AND THE
ALIGNMENT OF SERVICES BASED ON
THE SCREENING WHICH ARE GONNA BE
IN CENTRAL --
FOR US USING THIS MONEY WISELY
AS WE MOVE FORWARD INSURING THAT
THESE PROVIDERS CAN DO WHAT WHAT
WE WANT THEM TO DO THANK YOU SO
MUCH.
THANK YOU.
HI THERE --
OF FROM A TEST FIVE WITH CENTER
FOR YOUTH WELLNESS AS WELL US ON
BEHALF OF THE CALIFORNIA
CAMPAIGN COUNTER TOLD TO DOT FOR
CITY FOR CA.
AND TODAY WE'RE HERE TO SAY WE
FIRMLY BELIEVE THE
RECOMMENDATIONS THAT YOU'VE PUT
FORTH -- AND
ALSO CONTINUE TO THINK ABOUT THE
PROPER WAYS WE CAN PROVIDE
PROVIDER TRAINING AS WELL NOT
SURE THAT THERE ARE PROGRAMS
THAT ARE --
CAN BE AVAILABLE TO PROVIDE
CHILDREN FAMILIES WITH THE
SERVICES THAT THEY NEED SO THANK
YOU.
THANK YOU MA'AM.
SEEING NO FURTHER PUBLIC COMMENT
ON BRING IT BACK UP TO THE DíAS
I I HAVE A FEELING YOU MIGHT
HEAR SOMETHING ABOUT PROVIDER
TRAINING LATER ON IN THIS YEAR
BUT WE WANT TO TRUST THAT IN
THIS FORM.
WITH THAT WE WILL HOLD ISSUE FOR
OPEN IN THE BOND ISSUE
.
FIVE GREAT SO ON ISSUE FIVE AS
IT PERTAINS TO PROPOSITION --
FIFTY SIX JUST --
TO NOTE THAT WE'RE HEADING INTO
THE THIRD FISCAL YEAR IN WHICH
PROPOSITION FIFTY SIX FUNDING
HAS BEEN MADE AVAILABLE --
AS PART OF THE GOVERNOR'S
PROPOSAL IN JANUARY WE ARE
PROPOSING TO CONTINUE THE
SUPPLEMENTAL PAYMENTS AND THE
PHYSICIAN --
AREA FOR BOTH MANAGED CARE AND
FEE FOR CONSISTENT WITH WHAT WAS
APPROVED BY THE LEGISLATURE IN
FISCAL YEAR --
EIGHTEEN NINETEEN WERE
PROJECTING THAT THIS WILL EQUAL
APPROXIMATELY --
ONE POINT TWO BILLION DOLLARS IN
TOTAL SUPPLEMENTAL PAYMENTS TO
PHYSICIANS UNDER THIS PROPOSAL --
THE DENTAL SUPPLEMENTAL PAYMENTS
ALSO REMAIN THE SAME WE PROJECT
THIS TO BE FIVE HUNDRED AND
FORTY SIX MILLION DOLLARS IN
ADDITIONAL SUPPLEMENTAL PAYMENTS
FOR DENTAL --
THE ADDITIONAL --
PAYMENTS THAT WERE MADE IN TERMS
OF WOMEN'S HEALTH --
FOR BOTH F. PACKED AS WELL AS AN
MEDI CAL --
THERE -- TO
FIFTY MILLION DOLLAR
APPROPRIATIONS ONE IS BEING
CONTINUED IN THE F. PACKED
PROGRAM THE GOVERNOR'S BUDGET
CALLS FOR AN ADDITIONAL FIFTY
MILLION FOR THE SAME FAMILY
PLANNING SERVICES.
BUT IN THE MEDICAL PROGRAM F.
PASSED AS A SEPARATE PROGRAM
THAT IS NOT MEDI CAL --
ALL OF THE PAYMENTS THAT HAVE
BEEN APPROVED BY THE LEGISLATURE
FOR HOME HEALTH PEDIATRIC DAY
HEALTH SERVICES AIDS WAIVER
SERVICES AND I SEE FTD PROVIDERS
ALSO CONTINUE --
WHAT'S NOTABLE IN THE GOVERNOR'S
BUDGET THAT ARE NEW ITEMS --
REFLECT THE TRAUMA SCREENS THAT
WE JUST --
DISCUSS FOR BOTH ADULTS AND FOR
SUPPLEMENTAL PAYMENTS AS IT
PERTAINS TO DEVELOPMENTAL
SCREENINGS --
THESE ARE FOR BOTH MANAGE CARE
AND FEE FOR SERVICE AND THEN --
AS I ALSO REFERENCE THERE'S A
HUNDRED AND EIGHTY MILLION
DOLLARS IDENTIFIED FOR VALUE
BASED PURCHASING --
INCENTIVES --
IN KEY AREAS THAT WE'VE
IDENTIFIED --
IN WHICH WE WOULD LIKE TO SEE
PROVIDERS --
EARN INCENTIVES THROUGH
INCREASED QUALITY SCORES AROUND
BEHAVIORAL HEALTH INTEGRATION
CHRONIC DISEASE MANAGEMENT PRE
AND POSTNATAL CARE AND WE WILL
BE --
WORKING ON ONE'S ON KIND OF
VACCINATION EARLY CHILDHOOD
DEVELOPMENT CONSISTENT WITH THE
GOALS OF THE ADMINISTRATION FOR
EARLY CHILDHOOD.
MORE BROADLY AND THEN --
NOTABLE AND WE WERE HAPPY TO
HAVE A CONVERSATION ABOUT THIS
AS WELL BUT WE STILL CONTINUE TO
BE REALLY EXCITED ABOUT THE
FUNDING THAT WAS PROVIDED IN
LAST YEAR'S BUDGET.
AS IT PERTAINS TO LOAN REPAYMENT
FOR BOTH PHYSICIAN AND DENTAL
PROVIDERS --
WE HAVE ENGAGE WITH PHYSICIANS
FOR A HEALTHY CALIFORNIA TO
ADMINISTER THAT APPLICATION
PROCESS AND OVERSIGHT OF THE OF
THE LOAN REPAYMENT PROGRAM FOR
THOSE PROVIDERS --
SO HAPPY TO PROVIDE MORE --
A NOTE OF KIND OF PIPELINE OR
MEDI CAL PROVIDERS EARLY AS THEY
GRADUATE OR FINISH THEIR
RESIDENT SEES --
PUT THEM INTO THE MEDICAL
PROGRAM AND THEN DO LOAN
FORGIVENESS AS A WAY OF MAKING
SURE THAT THEY ARE.
COMMITTED TO THE PROGRAM BUT
ALSO --
TAKING ONE OF THOSE
CONSIDERATIONS THAT A PROVIDER
FACES AS SOON AS THEY GRADUATE
IN TERMS OF WHERE DO THEY
PRACTICE AND AND WHAT WHAT KIND
OF CARE DO THEY PROVIDE IN TERMS
OF CARE SOURCE.
AND WE'RE TRYING TO KIND OF
GUARANTEE THAT THEY ARE --
EMBEDDED IN THE MEDICAL PROGRAM
AND AND CERTAINLY ABLE TO STAY
WITH US --
FOR THE LONG HAUL SO --
THERE IS A B. C. P. THAT I WILL
JUST QUICKLY REFERENCE WHERE WE
ARE SEEKING EIGHTEEN POSITIONS.
AND APART AND THREE MILLION
DOLLARS --
ONE POINT FIVE MILLION IN PROP
FIFTY SIX FUNDS AND ONE POINT
FIVE MILLION IN FEDERAL FUNDS.
TO ACTUALLY IMPLEMENT THE NEW --
VALUE BASED PURCHASING --
INITIATIVE THIS IS A LOT MORE --
INTENSIVE A FEW TEENS TO SETTING
UP THE METRICS --
THAT THE PLANS WILL BE WORKING
WITH PROVIDERS ON AN
INDIVIDUALIZED BASIS AS WELL AS
DOING THE OVERSIGHT AND THE
ACTUAL IN SOME OF THESE ARE NOT
ONE YEAR.
KIND OF SUPPLEMENTAL PAYMENTS
WHERE WE HAVE JUST --
TRADITIONALLY ATTACHED A DOLLAR
AMOUNT TO A CODE SUCH THAT IF A
PROVIDER BILL TO CERTAIN CPT
CODE IT THE SYSTEM AUTOMATICALLY
GENERATED AN ADDITIONAL DOLLAR
AMOUNT --
VALUE BASED PURCHASING IS A LOT
MORE TIME INTENSIVE BECAUSE
YOU'RE ACTUALLY LOOKING AT THE
MUCH MORE GRANULAR LEVEL IN
TERMS OF WHAT ARE THE QUALITY.
SCORES AND WHAT'S THE
IMPROVEMENT OVER TIME IN THOSE
PROVIDERS AND HOW DO WE PROVIDE
THOSE INCENTIVES AND SO.
CERTAINLY WE NEED THE ADDITIONAL
RESOURCES INTERNALLY IN ORDER TO
KIND OF DO THAT IN A LONG TERM
BASIS AND COMMITTED TO WORKING
WITH.
THE LEGISLATURE AND STAKEHOLDERS
ON HOW THOSE ARE GOING TO BE
DESIGNED IN THE METHODOLOGY IN
THE FUNDING AND DOLLAR AMOUNTS
ARE CERTAINLY --
DETAILS THAT WERE GOING TO BE
WORKING ON THROUGH THIS BUDGET
PROCESS SO HAPPY TO ANSWER
QUESTIONS.
ANY COMMENTS BERMAN FINANCE
EARLIER.
I JUST THINK IT'S DEPARTMENT OF
FINANCE WILL ALLOW THE LA A
COMMENT AND WE MAY I RESPOND
SHOULD THAT BE NECESSARY THANK
YOU.
HI BEN JOHNSON WITH THE
LEGISLATIVE ANALYST'S OFFICE --
ON FRIDAY WE RELEASED AN
ANALYSIS OF THE USE OF
PROPOSITION --
FIFTY SIX FUNDING IN MEDI CAL TO
IMPROVE ACCESS TO QUALITY CARE --
THE REPORT REALLY FOCUSES I
THINK ON BOTH THE NEW PER --
BY THE ADMINISTRATION AS WELL AS
ON THE PHYSICIAN SERVICES UP OF
NO PAYMENTS AS THEY SORT OF
INTERACT WITH MANAGED CARE WE
FOCUS ON ON THOSE PAYMENTS
BECAUSE THE MAJORITY OF
BENEFICIARIES GATE GET THEIR
CARE THROUGH.
MANAGED CARE AND IT HAS THE THE
CLOSEST NEXUS OF SORT OF A SORT
OF A INTERACTION.
WHAT WE DO WHAT WE FELT WE WE
BREAK OUR REPORT DOWN INTO KIND
OF TWO DIFFERENT PARTS ONE IS
ASSESSING HOW PROVIDER
REIMBURSEMENT WORKS WITHIN
MANAGE CARE AND SORT OF HOW?
PROPOSITION FIFTY SIX PAYMENTS
LATER ON TO THAT.
AND WE ALSO PROVIDE AN OVERVIEW
OF HOW ACCESS AND QUALITY --
ARE MEASURED WITHIN MEDI CAL
MANAGED CARE AND THEN FINALLY WE
TRY TO BRING THOSE TWO TOGETHER
TO ASSESS --
THE APPROPRIATENESS OR THAT THE
SORT OF THE THE PROMISE OF
PROPOSITION FIFTY SIX FUNDING
SPECIFICALLY FOR PHYSICIAN
PAYMENTS --
IN IMPROVING THAT QUALITY SO.
FIRST WE FIND THAT MANAGED CARE
PLANS DO HAVE FLEXIBILITY.
TO SET PROVIDER PAYMENTS --
ACCORDING TO THEIR OWN LOCAL
HEALTH CONDITIONS AND NEEDS --
THEY GET FUNDING THROUGH
CAPITATED AND THEN THEY CAN SET
THEIR PROVIDER REIMBURSEMENT
LEVELS --
ACCORDINGLY --
ON THE ACCESS AND QUALITY.
SIDE WE FIND THAT OVERALL THERE
AND THERE'S NO --
SORT OF WIDESPREAD EVIDENCE OF
NON COMPLIANCE WITH THE STATE'S
ACCESSING QUALITY STANDARDS --
GENERALLY THE MANAGED CARE PLANS
DO MEET THE TIME AND DISTANCE
STANDARDS THAT THE STATE HAS --
BEEN IMPOSING IN RECENT YEARS --
BUT WE DO FIND THAT THERE IS
ROOM FOR IMPROVEMENT. FOR
EXAMPLE WHILE MANAGED CARE PLANS
SEEM TO PHASE RELATIVELY --
A LESSER AMOUNT OF DIFFICULTY
FOR EXAMPLE RECRUITING PRIMARY
CARE PHYSICIANS THEY DO FACE
GREATER CHALLENGES IN RECRUITING --
SPECIALIST PRIMARILY --
PEDIATRIC SPECIALIST IN
LOCATIONS THAT ARE CLOSE TO
WHERE THEIR MEMBERS ULTIMATELY
LEFT.
WE ALSO FIND THAT THERE'S A
LARGE VERY BILL COMMENTS ON THE
QUALITY METRICS THAT THE STATE --
THAT THE STATE IMPOSES AS WELL
AS GENERAL ROOM FOR IMPROVEMENT
ON IN TERMS OF MEMBER
SATISFACTION WITH THE CARE THAT
THEY RECEIVE THROUGH --
THROUGH THEIR MANAGED CARE PLANS.
TURNING TO THE PROPOSITION FIFTY
SIX SIDE WE FIND THAT THE
PHYSICIAN SERVICES PROVIDER
PAYMENT INCREASES REALLY APPLY A
UNIFORM AND STATEWIDE --
SOLUTION TO POTENTIAL
DEFICIENCIES IN ACCESSING
QUALITY THAT REALLY VERY --
BY MANAGED CARE PLAN AND IN
VARIOUS DIFFERENT REGIONS OF THE
STATE.
SO WE DON'T NECESSARILY THINK
THAT THE EXISTING APPROACH IS
SUFFICIENTLY FLEXIBLE TO MEET
THOSE VERY ABLE --
HEALTH CARE NEEDS --
MOREOVER WE FIND THAT THE
EXISTING SO --
SUPPLEMENTAL PAYMENTS.
GENERALLY TARGET NON SPECIALTY
SERVICES WHEREAS IN OUR
PRELIMINARY ASSESSMENT OF WHERE
THERE IS --
SAY WHERE BENEFICIARIES I'M TO
SEE A THAT THAT HE CONCENTRATED
IN VERY SPECIALTIES.
ULTIMATELY WE WE RAISE CONCERNS
THAT THE GOVERNOR STATES AND
INTEND TO MAKE THE EXISTING
PROVIDER PAYMENT INCREASES --
PERMANENT DESPITE NOT HAVING
RELEASED AN EVALUATION SHOWING
THEIR IMPACT ON ACCESS AND
QUALITY IN INITIAL CONVERSATIONS
AND AND DEBATE OVER --
OVER HOW TO USE PROPOSITION
FIFTY SIX FUNDING --
WE WE BELIEVE THAT THERE WAS A
THERE WAS A COMMITMENT TO
PERFORMING THAT ANALYSIS AND
WE'D WANT TO SEE THAT --
SEE THAT ANALYSIS BEFORE THEY
ARE MADE PERMANENT.
FINALLY NOTE THAT GIVEN
PROJECTED REVENUES AND THE
PROPOSED LEVEL OF SPENDING UNDER
THE GOVERNOR'S PROPOSAL --
WE WE DO RAISE QUESTIONS ABOUT
THE SUSTAINABILITY OF PROVIDER
PAYMENT INCREASES UNDER
PROPOSITION FIFTY SIX USING ONLY
PROPOSITION FIFTY SIX FUNDING --
THE LEVEL PROPOSED IN --
TWENTY NINETEEN TWENTY IT BY A
SMALL AMOUNT EXCEEDS THE LEVEL
OF FUNDING FOR PROPOSITION FIFTY
SIX THAT'S DEDICATED. TO MEDI
CAL AND WE WOULD EXPECT THIS TO
BE A DECLINING REVENUE SOURCE
GOING FORWARD SO THERE COULD BE --
THERE COULD BE NEED IF WE KEPT
IF THINGS WERE --
IF IT WERE JUST HELD FORWARD AND
AND SUSTAINED IN TERMS OF THE
PROVIDER PAYMENT INCREASES THERE
COULD BE NEED FOR SOME GENERAL
FUND.
OVERALL WE JUST WE PROVIDE
SEVERAL ISSUES FOR CONSIDERATION
AND SOME RECOMMENDATIONS --
WHAT WE DO BELIEVE THAT THE
EXISTING PROVIDER PAYMENT
INCREASES SHOULD BE FURTHER
ASSESSED BEFORE THEY ARE MADE
PERMANENT AND RECOMMEND THAT THE
LEGISLATURE DIRECT H. YES TO
REPRODUCE SO PRO REPORT ON THEIR
IMPACTS AND --
IMPACT ON ACCESS TO QUALITY CARE
FIND THAT THE LEGISLATURE SHOULD
SERIOUSLY CONSIDER --
THE GOVERNOR'S VALUE BASED
PAYMENT PROPOSAL AS WE DO
BELIEVE THAT IT DOES TARGET
AREAS WITH SOME DEFICIENCIES IN
MEDI CAL AND WE FIND THAT PAYING
FOR OUTCOMES AS OPPOSED --
TO SERVICE UTILIZATION --
IS A PROMISING APPROACH --
TO IMPROVING CARE WITHIN MEDI
CAL IN SO FAR AS THE GOVERNOR'S
PROPOSAL IS --
APPROVED WE DO THINK THAT THE
STATE OPERATIONS RESOURCES WOULD
BE -- WOULD
BE APPROPRIATE --
THAT SAID WE WE DON'T HAVE A LOT
OF DETAIL ON THE NEW PROPOSED
PAYMENTS AND SO WE'D BE LOOKING
FORWARD --
TO SOME OF THAT ADDITIONAL
DETAIL AS THE BUDGET PROCESS
CONTINUES.
FINALLY WE WE DO RECOMMEND
REJECTION OF THE GOVERNOR'S
PROPOSED SUPPLEMENTAL PAYMENTS
FOR DEVELOPMENTAL SCREENINGS
WHILE WE ACKNOWLEDGE THAT THIS
IS -- THAT
THE IDENTIFICATION TREATMENT OF
INDIVIDUAL OF CHILDREN WITH
DEVELOPMENTAL DELAYS IS A WORTHY
GOAL WE DO NT BELIEVE THAT THE
GOVERNOR'S PROPOSAL REPRESENTS A
COST EFFECTIVE.
APPROACH TO SOLVING THIS ISSUE --
DEVELOPMENTAL SCREENINGS ARE
CURRENTLY REQUIRED WITHIN MEDI
CAL AND FUNDED THROUGH MANAGED
CARE AS WELL AS FEE FOR SERVICE
AND WE DO THINK THAT OTHER COST
EFFECTIVE APPROACHES SUCH AS
IMPROVING THE STATE'S
ENFORCEMENT OF EXISTING
REQUIREMENTS.
AS WELL AS OTHER POTENTIAL
SOLUTIONS SHOULD BE TRIED BEFORE
PROVIDING THE ADDITIONAL FUNDING
SO -- THAT
CONCLUDES MY REMARKS BY ANY
QUESTIONS FROM THE COMMITTEE.
WITHOUT A BRING IT UP TO THE
DíAS TO SEE IF WE HAVE ANY
QUESTIONS ASSEMBLYMEMBER FRAZIER.
THANK YOU WHEN YOU TALK ABOUT
THE AGENCY'S RESPONSIBILITY FOR
THE ID POPULATION.
WITH THE MANAGED CARE.
WHEN YOU LOOK AT THE PROVIDERS
THAT ARE OF?
SUPPLY TO SAY A FAMILY.
AND NOW THERE'S OVER YEAR
WAITING PERIOD FOR PROVIDERS
WHAT CAN THE AGENCY DO.
IS A RESPONSIBLE.
STEWARD OF THE GOVERNMENT TO
MAKE SURE THESE FAMILIES ARE
GETTING.
NOT DELAYED CARE. FOR THEIR
CHILD WHO LOSES THAT YEAR OR OR
LONGER.
WHEN YOU TALK ABOUT BEST VALUE?
I MEAN WE DON'T HAVE ENOUGH
PROVIDERS AS IT IS AND THAT'S
THE FOR THE FALL BACK ON SOME OF
THE MANAGED CARE SYSTEMS OR SAY.
WE CAN GET YOU THE SERVICES THAT
YOU DESERVE OUR NY.
WHAT CAN YOU DO IS AN AGENCY? TO
MAKE THAT AN EFFECTIVE.
VALUE FOR THAT FAMILY.
SURE I THINK --
AS AS I REFERENCED EARLIER ON
THE DEVELOPMENTAL SCREENINGS
THIS IS A REQUIREMENT THAT --
PROVIDERS ARE SCREEN ALL KIDS AT
CERTAIN --
PERIODICITY SCHEDULES WITH AND
YOU KNOW WHEN A PARENT BRINGS A
CHILD AND THERE'S CERTAIN TIMES
IN WHICH THEY ARE SCREENING FOR
CERTAIN ITEMS --
IT IS OUR THAT DOING
DEVELOPMENTAL SCREENINGS IS AN
IMPORTANT FIRST STEP TO
IDENTIFYING AND DOING AS MUCH
PREVENTION --
AS SOON AS POSSIBLE AND THEN
OBVIOUSLY IF THE SCREENS AREN'T
DONE THEN THE CHILD MAY LOSE A
YEAR OR ARE LONGER IF THEY'RE
NOT APPROPRIATE IDENTIFIED.
ON THAT.
THE INTERSECTION BETWEEN OUR
PROGRAM --
AND WHAT WE PROVIDE FROM A
MEDICAL --
HEALTH CARE STANDPOINT AND THEN
THE INTERACTION BETWEEN US AND
THEM THAT --
DEVELOPMENTAL SERVICES --
DEPARTMENT --
AND THE REGIONAL CENTER SERVICES
OUR PLANS ARE REQUIRED TO HAVE
MEMORANDUMS OF UNDERSTANDING
WITH THE REGIONAL CENTER SUCH
THAT IF A CHILD IS IDENTIFIED BY
A PEDIATRICIAN OR CLINIC THAT
THEY MAY HAVE DEVELOPMENTAL
DELAYS.
THERE'S FURTHER DIAGNOSTIC
TESTING THAT OCCURS AND THEN IF
THE CHILD IS FOUND TO HAVE A
NEED FOR SERVICES --
THEY ARE REFERRED OVER TO THE
DEVELOPMENTAL SERVICES
DEPARTMENT --
AND SERVICES ARE PROVIDED
THROUGH THE REGIONAL SOME I AM
TO WORK AS CLOSELY AS POSSIBLE
WITH OUR SISTER DEPARTMENT --
AND THEN OBVIOUSLY WE REQUIRE
OUR PLANS TO WORK WITH THE
REGIONAL CENTERS IN TERMS OF HOW
THAT RELATIONSHIP IN THOSE
REFERRAL PATTERNS GO. TO FULLY
BELIEVE THERE'S THERE'S PLENTY
OF PROFESSIONALS.
THAT ARE ABLE TO ASSASSIN AND
PROVIDE RECOMMENDATIONS FOR
CHILD.
THERE'S NOT ENOUGH PEOPLE IN THE
FIELD TO IMPLEMENT THE
RECOMMENDATIONS SO WE'VE GOT.
BUKU.
OF PSYCHOLOGISTS AND SPEECH
PATHOLOGISTS AND WE CAN ASSESS
THIS CHILD TILL THE DAY IS LONG.
BUT WE DON'T PROVIDE THEM THE
FIXTURES NO DIRECT SERVICES THAT
ARE PROVIDED TO THAT CHILD ONCE
THE ASSESSMENTS BEEN MADE WE
DON'T HAVE.
AND SO WE NEED TO BE ABLE TO
EITHER CREATE CREATE CREATE OF
CAREER PASS FOR THESE
INDIVIDUALS FOR THE PROVIDERS OR
AN INCENTIVE TO BE A PROVIDER.
BECAUSE AND NOW THE MEMBERS OF
THE FREE STUDY SUPPOSED TO BE
ROLLED OUT TODAY.
BUT YOU LOOK AT IN HISTORICALLY.
WE HAVE NOT ACCOMPLISHED.
ANYTHING THE LETTERMAN ACTUALLY
TALK ABOUT PROVIDING A DIRECT
SERVICE WHEN PEOPLE ARE WAITING
A YEAR. FOR BEHAVIORAL OR OR ONE
ONE CARE OR ANY THINGS THAT THEY
SHOULD BE AFFORDED.
OF GOING FORWARD AND THAT'S
CRIMINAL WE NEED TO LOOK AT YOUR
AGENCY TO BE ABLE TO STEP ON
MAKE MENTION HEALTH CARE OR A
RECOMMENDATION TO THE
LEGISLATURE. TO CREATE MORE
OPPORTUNITIES FOR PROVIDERS AND
THE CAREER PROFESSIONALS IN
BECAUSE THAT THERE'S A
DEFICIENCY WE HAVE ENOUGH
PROFESSIONALS WE DON'T HAVE THE
DOERS.
ASSEMBLYMEMBER FRAZIER --
WE HAVE --
REPORT ALSO COMING OUT LATER
THIS WEEK THAT IS GONNA IDENTIFY
SOME OF THE BROADER CHALLENGES
IN SURVEYING --
CHILDREN WITH DEVELOPMENTAL
DELAYS --
THE THE GOVERNOR'S PROPOSAL ON
ONE APPROACH BUT WE WE SORT OF
VALUE EIGHT AND SIX AND STATE
THAT BROADER --
REFORM IS POTENTIALLY NECESSARY
TO BE CHANGED TO ENSURE THAT
WE'RE SERVING --
ALL CHILDREN WITH DEVELOPMENTAL
DELAYS SO I JUST WANTED TO SHARE
THAT.
AND NOT TO MIX ISSUES BUT I
BELIEVE FULL ADDRESS MOST OF
THESE ON THE MARCH SIXTH HEARING
NEXT WEDNESDAY WHEN WE CAN.
TALK ABOUT THE RATE STUDY IN THE
FOLLOW UP THE YOU ARE.
MENTIONING TODAY BUT REALLY
TODAY'S ABOUT PROP FIFTY SIX AND
JUST WANTED TO SEE IF ANYONE
ELSE ON THE DIES AT OTHER
COMMENTS OR IF YOU WANT TO
FINISH YOUR THOUGHT OF SOMETHING
FRAZIER.
JUST PRELUDE TO THE NEXT.
I I LOOK FORWARD TO THE
DEPARTMENT OF DEVELOPMENTAL
SERVICES TESTIFYING [inaudible]
NO ACTUALLY.
ANY OTHER COMMENTS ON PANEL.
ONE I JUST THINK AS DEPARTMENT
OF FINANCE --
I'LL JUST BRIEFLY SAID THINK
THESE ELLIE --
FOR THEIR COMMENTS BUT I WOULD
LIKE.
TO BRIEFLY MENTION ABOUT THE
DEVELOPMENTAL SCREENINGS OF
COURSE WE SUPPORT THE GOVERNOR'S
BUDGET AND WE DO BELIEVE THAT.
THE FUNDING FOR THE
DEVELOPMENTAL SCREENING IS
CONSISTENT WITH THE SUPPLEMENTAL
PAYMENTS FOR PROVIDERS FOR
PHYSICIANS AND DENTISTS IN THE
TERMS THAT IT JUST FOR THE
INTENT ALSO EXPANDING QUALITY --
WE BELIEVE IT IS CONSISTENT WITH
THOSE SUPPLEMENTS PAYMENTS AS
WELL WE WOULD ALSO LIKE TO
MENTION --
TO COMMENT ON THE SUSTAINABILITY
OF THE FUND --
THE GOVERNOR'S BUDGET INCLUDES A
BALANCED --
BUDGET WE INCLUDE A BALANCED I
WITHIN THE REVENUE FORECASTS
THAT WE HAVE FOR PROPOSITION
FIFTY SIX FUNDS.
COURSE ON A YEAR BY YEAR BASIS
AS WE DO I KNOW ELLIE IS
CONCERNED THAT IT IS A DECLINING
REVENUE SOURCE WE WILL BE
EVALUATING ON A YEAR BY YEAR IN
CASE BY CASE BASIS TO MAKE SURE
THAT WE PRESENT A BALANCED
BUDGET.
THANK YOU.
THANK YOU AND I SHARE THEIR
CONCERNS ABOUT A DECLINING
REVENUE SOURCE IF WE'RE GOING TO
MAKE THEM PERMANENT AND YET I'LL
PROBABLY JUST AGREE WITH YOU
THAT I THINK MAKING THEM
PERMANENT.
ALLOWS FOR THE STABILITY AND FOR
THE PROVIDERS TO MAKE THE
CHANGES TO THEIR PRACTICE --
IN SO I SEE THE BENEFIT ON BOTH
SIDES BUT DO APPRECIATE YOU FOR
BRINGING THAT UP WITH THAT WE
WILL HOLD PANEL ONE OPEN AND
MOVE ON THE PANEL
.
TO WHEN HE SAID TOSS THE STEVE
HORN AND MICHELLE NIGHT OF OKAY.
GOOD AFTERNOON MISTER CHAIR AND
MEMBERS OF THE COMMITTEE I WANNA
THANK YOU AND YOUR STAFF --
FOR ALLOWING US --
TO COMING PRESENT OUR CASE AT
THIS POINT --
ON THE MEDI CAL RATES --
MY NAME IS DEBBIE TOTH AND I AM
THE PRESIDENT AND CEO OF CHOICE
AN AGING --
WE ARE A NONPROFIT ORGANIZATION
IT'S BASED IN CONTRA COSTA BUT
WE SERVE CONTRA COSTA SOLANO
NAPA AND SACRAMENTO COUNTIES --
I'M HERE ACTUALLY TESTIFYING ON
BEHALF OF THE CALIFORNIA FOR
ASSOCIATE ASSOCIATION FOR ADULT
DAY SERVICES ALSO KNOWN AS CABS
IT IS ALSO NONPROFIT
ORGANIZATION.
AND IT'S BEEN --
SUPPORTING ADVANCING IN LEADING
ADULT DAY SERVICES SINCE.
NINETEEN SEVENTY SEVEN SO FOR
THOSE OF YOU WHO DON'T KNOW I'M
GONNA FIRST PAINT A PICTURE SORT
OF OF WHO WE ARE WHAT ADULT DAY
HEALTH CARE IS.
I'M GONNA TALK TO ABOUT THE
PROBLEM AND THEN I'M GONNA MAKE
AN ASK THAT I KNOW YOU'RE GONNA
WANT TO MAKE SURE THAT WE GET --
SO ADULT DAY HEALTH CENTERS ARE
THINK ABOUT FOLKS WHO CAN NO
LONGER ATTEND A SENIOR CENTER
INDEPENDENTLY.
AND THE BABY SOME ASSISTANCE
GOING TO THE REST DISSIPATING
ACTIVITIES --
AND MATCH THAT WITH THE STAFFING
IN A SKILLED NURSING FACILITY.
SO MEDICAL DIRECTOR PHARMACY
CONSUL THANK CONSOLE NURSES
SOCIAL WORKERS PHYSICAL THERAPY
SPEECH THERAPY OCCUPATIONAL
THERAPY BLAH BLAH BLAH I COULD
GO ON RIGHT SO ALL OF THAT
STAFFING AND THE WHOLE IDEA IS
WE KEEP THESE FOLKS WHO WOULD
OTHERWISE BE.
IN SKILLED NURSING FACILITIES
LIVING INDEPENDENTLY IN THE
COMMUNITY WITH DIGNITY --
SO WE'VE BEEN DOING THIS FOR A
LONG TIME OUR ORGANIZATION HAD
THE SIXTEENTH LICENSED ADULT DAY
HEALTH CARE FACILITY IN THE
STATE OF CALIFORNIA.
I'VE BEEN THERE SEVENTEEN YEARS
PROVIDING THOSE SERVICES --
AND WE SUPPORT THAT POPULATION
WHICH YOU HEAR ABOUT CMS CENTERS
FOR MEDICAID AND MEDICARE AND
MEDICAID SERVICES TALK ABOUT
THAT THERE IS 5% OF THE MEDICAID
SPEND. 5% OF THE POPULATION THAT
IS 50% OF THE MEDICAID SPEND WE
HEAR ABOUT THAT THOSE ARE THE
PEOPLE WE SERVE AN ADULT DAY
HEALTH CENTERS --
WE ARE RECOGNIZED AS BEING ONE
OF CALIFORNIA'S MOST VALUABLE
AND COST EFFECTIVE LONG TERM
SERVICES AND SUPPORTS AND YET.
WE HAVE NOT HAD A RATE INCREASE
IN ELEVEN YEARS.
I'M GONNA TALK TO YOU ABOUT
THINKING THROUGH THAT IN JUST A
MOMENT.
FIRST THE REQUEST WE WOULD LIKE
TO REQUEST A RESTORATION OF AB
9710% CUT.
I'M THAT WOULD PUT US UP TO
CURRENT RATES.
WHICH HER WOEFULLY INADEQUATE
AND WE'LL GET INTO THAT FIFTY
SEVEN CENTERS HAS HAVE CLOSED
SINCE.
TWO THOUSAND ELEVEN AND SOME OF
THEM IN FRESNO IN SOME OF THEM
IN MENDOCINO AND SOME OF THEM IN.
MEMBER AREAS HERE --
AND YOU'VE LOST THAT FOREVER
BECAUSE THE INFRASTRUCTURE TO
REBUILD IS HUGELY EXPENSIVE AND
COST PROHIBITIVE.
TODAY WE HAVE TWO HUNDRED FORTY
EIGHT CENTERS COME WHEN WE HAD
THREE HUNDRED AND SIXTY SIX
CENTERS --
JUST TO GIVE YOU A PERSPECTIVE
I'M SURE YOU'RE FAMILIAR WITH IN
HOME CARE YOU CAN PAY FOR A
PRIVATE CARE NON SKILLED PERSON
TO COME IN AND HELP SOMEBODY IN
THE HOME. FOR TWENTY FIVE THIRTY
DOLLARS AN HOUR.
WITH THE CURRENT MEDI CAL RATE
FOR ADULT DAY HEALTH CARE.
IT'S THE REIMBURSEMENT IS LESS
THAN SEVENTEEN DOLLARS
[inaudible]
PER HOUR.
WITH THAT SKILLED STAFFING I
TALK TO YOU ABOUT.
NOW PAINTING THE PICTURE IMAGINE
THAT WE HAVE TO HIRE NURSES AND
PHYSICAL THERAPISTS AND
OCCUPATIONAL THERAPISTS.
ARE REGULATIONS GET.
MORE HEAVY THE ACUITY OF THE
PEOPLE THAT WERE SERVING GOES UP
WHEN I STARTED WE HAD A THREE
PAGE.
INDIVIDUAL PLAN OF CARE WE NOW
HAVE AN EIGHTEEN PAGE INDIVIDUAL
PLAN OF CARE.
SO ARE BURDEN INCREASES.
THE COST OF TRANSPORTATION HAS
DOUBLED SINCE I STARTED THE COST
OF A MEAL ALL OF THOSE THINGS WE
HAVE TO PAY FOR WE DON'T HAVE A
CHOICE IT'S REGULATORY --
REQUIREMENT.
SO WHAT WE'RE ASKING FOR IN
ADDITION TO RESTORING THAT RATE
IS A 15% COST OF LIVING INCREASE
TO THE PUBLISHED MEDI CAL RATE.
TO TAKE INTO.
ACCOUNT MORE THAN A DECADE WORST
OF THOSE COSTS AM FOR
PERSPECTIVE ACCESS IS NOT WHAT
IT SHOULD BE STATEWIDE WE HAVE
THIRTY TWO COUNTIES WITH NO
CENTERS AT A FIFTY EIGHT
COUNTIES IN CALIFORNIA WE HAVE
THIRTY TWO WITH NO.
CENTERS --
WE HAVE --
EIGHT AND EIGHTEEN COUNTIES WITH
SIX OR FEWER CENTERS.
I'M I DON'T KNOW ABOUT YOU BUT I
KNOW THAT MY ASSEMBLYMEMBER
FRAZIER RECOGNIZED AS WE HAVE
THIS MASSIVE GROWING AGING
DEMOGRAPHIC IN IN CONTRA COSTA
COUNTY THE EIGHTY FIVE AN OLDER
POPULATION BY TWENTY SIXTY
ACCORDING TO YOUR DEPARTMENT OF
FINANCE IS GOING TO GROW.
BY TWO HUNDRED AND 99%.
THE STATE WIDE NUMBER IS LARGER
THAN 3100%.
AND WE ARE THE OPTION TO KEEP
PEOPLE LIVING INDEPENDENTLY IN
THE COMMUNITY BUT NOT FOR NOT
GIVEN A REASONABLE AMOUNT OF
MONEY TO ME ARE REGULATORY
REQUIREMENTS.
SO THE RESTORATION OF THE 10%
CUT TO THE CURRENT PUBLISHED
RATE FOR THOSE CENTER SUBJECT TO
THE CUT WITH THE ADDITION OF A
15%.
MODEST COLA INCREASE WILL ENSURE
NECESSARY CONTINUITY OF CARE TO
SOME OF THE STATE'S MOST
VULNERABLE ELDERS AND PERSONS
WITH DISABILITIES BY AVOIDING
NEW CLOSURES.
IMPROVING STAFFING LEVELS AND
SUPPORTING COMPLIANCE WITH NEW --
FEDERAL AND STREET RIGHT STATE
REGULATIONS --
WE WANTED TO ENSURE THAT THOSE
WERE SERVE TODAY CAN CONTINUE TO
LIVE IN THEIR HOMES WITH
INDEPENDENCE AND WE NEED TO
EXPAND ACCESS NOT BE CUTTING IT
A TIME WHERE ARE AGING
DEMOGRAPHIC IS HUGE.
AND SPEAKING OF THE I. D. D.
POPULATION WE ALSO SERVE PEOPLE
WITH DEVELOPMENTAL DISABILITIES
WE SERVE PEOPLE WITH ALZHEIMER'S
DISEASE WE SERVE PEOPLE WHO HAVE
CHRONIC DIABETES ALL OF THE
SOCIAL DETERMINANTS OF HEALTH.
THAT YOU HEARD ABOUT AT THE VERY
BEGINNING FROM DOCTOR SMITH.
WE'RE THEIR HOME.
WHERE THE PLACE THEY COME DURING
THE DAY SO THAT THEY AND IT
COSTS ONE FIFTH OF THE COST OF A
SKILLED NURSING FACILITY TO HAVE
THEM COME TO ADULT DAY HEALTH
CARE TO ME IT'S A NO BRAINER
[inaudible]
THANK YOU.
THANK YOU MA'AM [inaudible]
STE [inaudible]
RESTORED.
GOOD AFTERNOON THANK YOU MISTER
CHAIR THANK YOU COMMITTEE
MEMBERS STAFF.
I'M STEVE HORN PRESIDENT A
CALIFORNIA MEDICAL
TRANSPORTATION SOCIAIS ASIAN WE
REPRESENT NON EMERGENCY MEDICAL
TRANSPORTATION THROUGHOUT THE
STATE OF CALIFORNIA. FOR THOSE
OF YOU THAT ARE AWARE NON
EMERGENCY MEDICAL TRANSPORTATION --
IS A BENEFIT FOR PEOPLE THAT --
HAVE PHYSICAL LIMITATIONS MENTAL
LIMITATIONS MANY THE CLIENTS AS
SHE TALKS ABOUT WE TAKE TO THEIR
MEDICAL APPOINTMENTS.
THEY REQUIRE ASSISTANCE THEY'RE
UNABLE TO RIDE IN A PRIVATE
AUTOMOBILE --
TAXI THEY NEED --
TO BE ESCORTED WHEELED --
FROM HOME TO THE DOCTORS WORTH --
SO THEY REQUIRE PHYSICAL
ASSISTANCE THE MAJORITY OF THEM
ARE WHEELCHAIR BOUND.
WE HAVE NOT RECEIVED A RATE
INCREASE FOR NINETEEN YEARS --
AND SO --
THEN WITH THE AB NINETY SEVEN
CUTS IT HAPPENED WORK 10% LESS
THAN WHAT THE RATE WAS NINETEEN
YEARS AGO.
HISTORICALLY WE'VE HAD MORE
PROBLEMS IN URBAN --
IN EXCUSE ME IN RURAL AREAS THEN
URBAN AREAS IN GETTING ACCESS --
TO TRANSPORTATION.
YET OVER THE LAST TWO YEARS --
WITH THE MINIMUM WAGE INCREASES
IN THE COST OF FUEL IN THE COST
OF INSURANCE WE ARE NOW SEEING
THE SAME PROBLEMS IN URBAN AREAS
AS WE ARE SEEING IN RURAL AREAS
ABOUT NUMBER ONE FINDING ENOUGH
PROVIDERS NUMBER --
TWO BEING ABLE TO FIND THE
SPECIALIST FOR EXAMPLE --
MANY PEOPLE TALKED ABOUT THE
CHILDREN SPECIALIST --
I OVERSEE FOR COMPANIES THAT
WORK HERE NORTHERN CALIFORNIA
AND WE DO ABOUT TWENTY THOUSAND
TRIPS A MONTH I COVER SALAAM
CINEMA SOLANO MARIN.
SACRAMENTO SAN JOAQUIN COUNTY I
WORK WITH FEE FOR SERVICE AND
WITH --
MANAGED CARE PLANS.
WITH MANAGED CARE PLANS WILL
STEP UP TO THE PLATE THEY WILL
PAY A MUCH HIGHER THAN MEDI CAL
RATE TO MAKE SURE THAT THESE
PEOPLE SEE THEIR SPECIALIST WERE
IN AND OUT OF A SPECIALIST IN
SAN FRANCISCO STANFORD --
ALL DIFFERENT ERRORS AT THESE
FAMILIES IN THESE CHILDREN GO IN
EXCESS OF DISTANCE TO RECEIVE
THESE MEDI CAL FEE FOR SERVICE
FORGET IT CAN'T DO IT.
I CANNOT TRANSPORT A MEDI CAL
FEE FOR SERVICE PATIENTS LONGER
THAN TEN MILES IN THE VEHICLE
WITHOUT PAYING MONEY OUT OF MY
POCKET.
IN WITH THE COMPANIES THAT I
WORK WITH THROUGHOUT THE STATE
[inaudible]
V..
THE ABILITY OF THESE COMPANIES
TO OFFSET TO OTHER PAY SOURCES.
THE LOSSES SO LARGE NOW WITH
MEDI CAL IT'S NO LONGER AN
OPTION SO MANY COMPANIES
THROUGHOUT THE STATE A REFUSING
TO TRANSPORT INDIVIDUALS ANY
FARTHER THAN TEN MILES --
ONE SIR --
ONCE YOU'RE IN THE VEHICLE SO IT
USED TO BE WHERE WE WOULDN'T
WANT TO DRIVE ANTI OUT TOO FAR
TO GET SOMEBODY WOULD BE WILLING
TO TRANSPORT THEM FIFTEEN OR
TWENTY MILES TO THEIR DOCTORS
APPOINTMENT.
IT DOESN'T MATTER NOW HERE IN
SACRAMENTO I WILL NOT TRANSPORT
A PATIENT FROM ROOSEVELT ELK
GROVE TO SEE A SPECIALIST.
BECAUSE OF THE DISTANCE THAT IT
COSTS AND I HAVE TO PAY MONEY TO
SUBSIDIZE.
THE STATE'S INADEQUACIES AND SO
COMPANIES CAN NO LONGER SURVIVE --
LIKE THAT CURRENTLY SUTTER
HOSPITALS PAYING US TO GO TO
AUBURN EVERY TUESDAY THURSDAY
SATURDAY --
TO TRANSPORT AND MEDI CAL
BENEFICIARY --
TWO DIALYSIS BECAUSE THEY CANNOT
GET ANY MEDICAL PROVIDERS AND I
CANNOT DO IT.
WITHOUT IT COST ME A SIGNIFICANT
AMOUNT OF MONEY YET CENTER
HOSPITALS ONE THE STEP INTO THE
PLATE TO SUBSIDIZE THE STATE'S
INADEQUATE ON THAT PATIENT.
SO WHAT WE'RE LOOKING AT IS.
MORE THAN JUST THE AB --
NINETY SEVEN CUT IT WE'RE
LOOKING AT AN ADDITIONAL 25% --
ABOVE CURRENT MEDI CAL RATES.
IN ORDER TO MAKE IT SUSTAINABLE
AND AT LEAST LOOK AT THE NEXT
THREE TO FOUR YEARS THAT
COMPANIES CAN.
STAY IN BUSINESS I REPRESENT A
COMPANY THAT WORKS IN ALAMEDA
COUNTY THEM BEEN IN BUSINESS FOR
FORTY YEARS.
THEY TRANSPORT.
BETWEEN THREE HUNDRED FIFTY TO
FOUR HUNDRED MEDI CAL
BENEFICIARIES IN ALAMEDA COUNTY
CURRENTLY THEY'RE LOSING TEN
THOUSAND DOLLARS A MONTH.
AND BASED ON THE LONGEVITY THAT
THEY'VE BEEN THERE IN THE
OBLIGATIONS THAT THEY FEEL TO
THE NURSING HOMES TO THE
DIALYSIS CLINICS TO THESE
MEMBERS TO THE MEMBERS FAMILIES
TO THEIR EMPLOYEES.
THEY'RE TRYING TO FIND A
SUSTAINABLE WAY THAT THEY CAN --
SERVICES AND NOT HAVE TO STOP
THE SERVICES TO THOSE BEEN
OFFICIERS BUT WITHOUT A RATE
INCREASE WE DON'T SEE IT.
AND CURRENTLY MINIMUM WAGE AND
ALAMEDA IS WHAT THIRTEEN EIGHTY
AND YOU KNOW IT'LL BE FIFTEEN IN
NO TIME AT ALL AND ITS CURRENT --
EXPENSES OF THANKS FOR LOSING
TEN THOUSAND DOLLARS A MONTH.
SO.
ALL OF OUR VEHICLES ARE
SPECIALLY EQUIPPED TO REQUIRE
DRIVER TRAINING DRIVERS ARE
CERTIFIED --
COMPANIES ARE CERTIFIED THROUGH
THE STATE.
AND AT THIS POINT WE'VE BEEN
ABLE TO SURVIVE --
BUT I DON'T SEE THAT IT'S GOING
TO HAPPEN --
MUCH LONGER.
THANK YOU MISTER HORN FOR YOUR
TESTIMONY MISMANAGED.
HI I'M SHAUN ITEM I AM --
REPRESENTING THE FOR A FREE
STANDING PEDIATRIC SUB ACUTE SO
IS HER LAST YEAR AND I WANT TO I
WANT TO THANK YOU AND THE
COMMITTEE FOR GIVING US ANOTHER
YEAR OF LIFE --
WE GOT PROP TWO TO SIX MONEY
LAST YEAR LET ME TELL YOU A
LITTLE BIT ABOUT WHAT WE DO.
SO WE'RE OTHERS ONLY FOR FREE
STANDING PEDIATRIC SUB ACUTE IN
ALL OF CALIFORNIA --
WE'VE COME TOGETHER --
AND I'M SPEAKING ON BEHALF OF
ALL OF THIS RIGHT NOW.
OF WHAT WE DO IS WE TAKE KIDS
WHO ARE --
RIGHT FROM THEN NICK YOU I SEE
YOU BRING TO OUR FACILITIES.
ARE FACILITIES --
ARE -- WITH
ALL GOT THEM.
DOCTORS INTENSIVE THIS ARE THE
HOSPITALS WE HAVE THE SAME STAFF
AS THE HOSPITAL'S WITH ARCHIE'S
NURSES --
SEEN AZL BIAN'S BUT WHAT HAPPENS
WHEN YOU COME TO OUR PLACE IS.
LET ME UP LONER SOME BACK UP --
FIRST OF ALL WE PROVIDE A
SERVICE THAT YOU REALLY NEVER
WANT TO USE BUT IF YOU NEED IT
WE'RE HERE.
AND SO WE TAKE KIDS WHO ARE
MEDICALLY FRAGILE --
MY LAST ADMIT WAS THREE IS A
THREE MONTH OLD WHO HAS THREE
SEIZURES A DAY --
AND WE TAKE KIDS WHO HAS
UNFORTUNATELY TRIED TO COMMIT
SUICIDE AND FAILED KIDS WHO ARE
IN CAR ACCIDENTS.
SO WE SEE NOT ONLY A CHILD WHO
IS POTENTIALLY DEVASTATED BUT A
FAMILY THAT'S POTENTIALLY
DEVASTATED.
IN SO WHAT WOULD BY WE WERE
CREATED WAS TO BRING THESE
PEOPLE THESE BABIES KIDS INTO
ENVIRONMENT THAT WE CAN
HOLISTICALLY TREAT.
SO WE CAN TREAT THE FAMILY'S
COMFORT THEN WE CAN TREAT THE
KIDS OUR GOAL IS TO GET THESE
KIDS HOME.
OR TO A HOME.
OFF GROUNDS TO SCHOOL WE HAVE
ACTIVITIES I HAVE ONE KID THAT --
WE HAD FOR A COUPLE YEARS AND
SHE WANTED TO GO SWIMMING SHOULD
NEVER TELL US WIMPLE SO OUR
ACTIVITIES DEPARTMENT WENT OUT
AND GOT. FIVE PLASTICS NGUYEN
POOLS OF THESE KIDS WITH TRADES
AND G. TUBES COULD EXPERIENCE
SWIMMING SO I COULD SIT THERE
AND SO THIS IS THE KIND OF
DIFFERENT THINGS THAT WE CAN DO
THAT -- THAT
THE NICK YOU AND YOU YOU AT THE
NICK USE KICK CAN'T GO --
BUT IF WE HAVE THE SAME STAFF --
IN SO BUT WHAT'S CRITICAL WE
HOPE THEY CAN TALK WE FEED THEM
IN SO IT'S IMPERATIVE THAT OUR
STAFF KNOW THE KIDS.
THEY KNOW THE KID THE BABY THAT
COMES IN IT HAS THREE SEIZURES
AS A SEIZURE IS THIS NORMAL IS
IS NOT NORMAL.
IN SO WE NEED TO KEEP STUFF --
THE SAME STAFF.
AND WE ARE RATES HAVE BEEN
FROZEN AS AS YOU KNOW FOR TEN
YEARS --
AREN'T IT COSTS OF GONE UP
BECAUSE WE HAVE TO DO ALL OF OUR
OWN TRANSPORTATION NOW SO WE'RE
DOING THREE TRANSPORTATION TODAY
WITH THE DRIVER CNN OR CNA.
ARCHIE LV AND IN SO DOING THINGS
GONE UP AS OUR EXPENSES --
AND WE'RE HAVING A HARD TIME
KEEPING THE DOORS OPEN AND
KEEPING THE STAFF BECAUSE THE
SAME STAFF THAT COME TO OUR
FACILITIES ALSO GO INTO THE NICK
USE THAT WORK THERE AND THEY GET.
A LOT MORE MONEY --
BUT THERE ARE ONLY SO THERE'S
FOR FREE FREE STANDING PEDIATRIC
SUBACUTE WE HAVE TWO HUNDRED
FIFTY TWO BEDS --
SIR TOGAS UP HERE IN SARATOGA.
ALL SAINTS AND TOTALLY KIDS ARE
IN -- THE LA
AREA AND THERE'S ONE IN SAMBHAR
INTO YOU KNOW --
WE'RE FULL WERE ALWAYS FULL WITH
A WAITING LIST --
IN SO AND I WILL TELL YOU THIS
THANK YOU AGAIN FOR GIVING US A
LIFELINE LAST YEAR --
BECAUSE ALL WE'RE ALL HERE
TOGETHER BECAUSE WE WILL CLOSE
IF WE DON'T SEE AN INCREASE --
AND WHAT THAT MEANS THEN IS IS
TO OUR FIFTY TWO KIDS THAT WE
HAVE GO BACK INTO THE ICU AND
THEY'RE TO BE HOUSE TO THE I SEE
YOU.
WERE GETTING EIGHT HUNDRED
DOLLARS A DAY FOR THESE KIDS
THANKS YOU GETS.
MORE THAN THREE THOUSAND DOLLARS
A DAY.
IN ADDITION TO THAT THE KIDS WHO
REALLY NEED TO BE IN THE I SEE
YOU ARE GOING TO BE ABLE TO JUST
NOT GONNA MANY BEDS.
IN SO THIS THREE MONTH.
THIS --
THREE TO HAVE HER HEART DEVELOP
YOUR DOCTOR YOU HAVE A HEART
DEVELOP HER LUNGS ABILITY TO GO
IN AND OUT OF SURGERIES.
BUT WE GET THESE KIDSHOME WE
GET HIM OFFENSE WE CAN WALKING
AROUND WE GET THEM YOU KNOW
THINKING THAT THEY'RE HAVING
MEETINGS WITH US AND TELLING US
WHAT TO DO.
IN ADDITION WHERE POWER IN THE
FAMILIES AND AND EXPOSING THEM
TO ADD THESE KIDS TO WORLD THEY
WOULDN'T HAVE IN THE NICK YOU.
SO I'M HERE WE GOT FUNDING LAST
YEAR WE'RE NOT IN THE BUDGET
THIS YEAR --
SO WE NEED --
A SMALL NOT ASKING FOR PROPERTY
SIX MONEY AGAIN IN ADDITION TO
WORKING WITH YOU TO RE --
RIGHT OUR RATE --
IN SO I THINK THAT'S ON MY CHECK.
MY CHECKLIST BUT THANK YOU.
THANK YOU SO MUCH TO THIS PANEL
OF BRING IT UP TO THE DíAS FOR
ANY QUESTIONS WE MAY HAVE
ASSEMBLY MEMBER ON THIS.
THANK YOU A MISS NIGHT OF FOR
BRINGING THAT. TO OUR ATTENTION
I DO IT I AM FAMILIAR WITH THE
TOTALLY KIDS SEVEN SUMMER DO YOU
KNOW AND THE WORK THAT'S BEING
DONE THERE.
AND IF THERE'S ANYTHING --
AS FAR AS COLLECTING DATA --
THROUGH THE CHAIR WE CAN GET
THAT DATA TO OUR OFFICE SO WE
COULD --
GENERALLY LOOK AT IT WOULD BE
GREATLY --
WITHOUT THE REASON WHY WE VAST
THIS PANEL TO COME FORWARD IS AS
WE HAVE A LARGER DISCUSSION
ABOUT PROP FIFTY SIX WANTED TO
MAKE SURE THOSE THAT.
HAVE NOT BEEN INCLUDED IN THE
DISCUSSIONS HAD THEIR
OPPORTUNITIES TO PRESENT --
I'M QUITE WELL AWARE OF ALL
THREE OF YOU BUT JUST WANTED TO
MAKE SURE THE REST OF THE DíAS
AND COMMITTEE WERE ALSO A WHERE
AND HOW --
NOT PROVIDING TRANSPORTATION OR
HEALTH CARE DAY HEALTH CARE
REALLY DID IMPACT OUR
COMMUNITIES AND THE NECESSITY
THAT YOU PROVIDED SO.
THANK YOU FOR COMING FORWARD AND
PROVIDING YOUR TESTIMONY IN WILL
NOW MOVE ON TO PANEL
[inaudible]
THREE HELLO KELLY I'M HERE ON
BEHALF OF THE CALIFORNIA MEDICAL
ASSOCIATION REPRESENTING OVER
FORTY FOUR THOUSAND PHYSICIANS
THANK YOU FOR THE OPPORTUNITY TO
COMMENT TODAY.
PROVIDERS THROUGHOUT THE STATE
APPRECIATE THE CONTINUED
COMMITMENT OF THE LEGISLATURE TO
IMPROVE COVERAGE OF CARE FOR THE
OVER THIRTEEN MILLION LOW INCOME
CALIFORNIANS AND ROLLED MEDI CAL.
CMA ALSO COMMANDS THE GOVERNOR'S
GOVERNOR FOR HIS INTENT TO
RETURN ALL OF PROPOSITION FIFTY
SIX FUNDING TO SUPPORT PROVIDER
PAYMENT INCREASES.
THE MAIN CHALLENGE FACING
PROVIDERS WHO WANT TO
PERMANENTLY SEE AND SPEND MORE
TIME WITH THAT HOW PATIENTS ARE
THE DELAYS AND ANY HOPE
APPROVALS OF THE SUPPLEMENT
PAYMENTS BYCMS AND THE FACT
THAT THE FUNDING IS NOT
GUARANTEE.
PROVIDERS DON'T KNOW IF THEY'LL
GET THE PAYMENTS EACH YEAR WHAT
THE LEGISLATURE GOVERNOR AND CMS
APPROVE THAT YEAR.
WHEN ALL THE PAYMENTS GO OUT?
FOR EXAMPLE THE MEDI CAL MANAGED
CARE -- FOR
MEDICAL MANAGE CARE THE MAJORITY
OF PLANTS AREN'T YET ISSUE IN
TWO THOUSAND EIGHTEEN NINETEEN
FUNDS BECAUSE THEY HAVEN'T
RECEIVED PAYMENT FROM DH CS.
THERE ARE FEW MANAGED CARE PLANS
ARE VOLUNTARILY ISSUING THE
SUPPLEMENTAL PAYMENTS BUT THE
VAST MAJORITY DON'T ISSUE THEM
UNTIL DH CS ISSUES THEN THE
PAYMENTS.
THE PLAN THEN HAS NINETY DAYS
FROM RECEIPT OF THE MONEY TO
ISSUE THE SUPPLEMENTAL PAYMENTS.
SO IF EVERYTHING GOES RIGHT
PROVIDERS WILL SEE THE IMPACT OF
THE TWO THOUSAND EIGHTEEN
NINETEEN FUNDING IN JUNE.
TWO THOUSAND NINETEEN YEAR BE ON
THE EFFECTIVE DATE OF JUNE.
TWO THOUSAND EIGHTEEN CME HAS
PUBLICIZE THE AVAILABILITY OF
THE FUNDS AS A MEANS OF
ENCOURAGING MORE PHYSICIANS TO
OPEN THEIR PRACTICE TO MEDI CAL
PATIENTS.
WE PERFORMED AN INTERNAL SURVEY
IN MAY OF TWO THOUSAND EIGHTEEN
BASED ON YOU'RE ONE OF THE
SEVENTEEN EIGHTEEN C. P. T. CODE
SELECTED WHICH DID NOT INCLUDE
THE ADDITIONAL CODES THAT.
FOR EIGHTEEN NINETEEN HALF OF
THE PROVIDERS SURVEYED INDICATED
THEY HAD NOT YET RECEIVED ANY
SUPPLEMENTAL PAYMENTS ON THE
FIRST SET OF CODES THUS FAR.
A SIMILAR NUMBER OF PROVIDERS
INDICATED THE AVAILABILITY OF
THE SUPPLEMENTAL PAYMENTS FOR
THE SPECIFIC CODES IMPACTS THEIR
DECISIONS REGARDING THE NUMBER
OF MEDI CAL PATIENTS THEY ARE
ABLE TO SEE IN THEIR PRACTICE.
TOP RESPONSES WHEN ASKED WHAT
CHANGES TO THE MEDICAL PROGRAM
WOULD BE IDEAL AND DRIVE
PRACTICES TO OPEN OR EXPAND
ACCESS FOR MEDI CAL PATIENTS.
WERE INCREASE REIMBURSEMENT OF
COURSE ELIMINATING DELAYS IN
PAYMENT OR A REDUCTION IN THE
GENERAL MINISTRY.
TO FOR ANOTHER CHALLENGES THE
OVERALL TIMING OF DISTRIBUTION
BETWEEN PERSPECTIVE.
RETROACTIVE FEE FOR SERVICE AND
MANAGE CARE PAYMENTS.
IT IS ALSO COMPLICATED THIS YOU
MAY HAVE TO CREATE OUR OWN
TIMELINE INFOGRAPHIC TO
ILLUSTRATE THE FISCAL YEAR
SEVENTEEN EIGHTEEN DISTRIBUTIONS
FOR PHYSICIANS WHO SEE THE TWO
POPULATIONS.
LESSEN BY THE UNEXPECTED
ADMINISTRATIVE TASKS ASSOCIATED
WITH THE SUPPLEMENTAL PAYMENTS.
TRACKING DOWN THE PAYMENTS AND
PATIENT LEVEL DATA FROM THE
PLANS OR MATCHING UP MULTIPLE
SUB WHEN A PAYMENTS BASED ON
FUNDING TIMELINES.
PROVIDERS WILL BE ABLE TO
RECLAIM CLINICAL TIME TO SPEND
WITH BENEFICIARIES IF THE
ADMINISTRATIVE BURDEN OF THE
PAYMENTS ARE STREAMLINED.
MEDIC HELL'S FAR FROM FIXED AND
CMA DOESN'T WANT TO SLOW THE
PROGRESS MADE THUS FAR IN TWO
YEARS OF PAYMENTS.
THAT HAVE BEEN APPROVED BY THE
LEGISLATURE THE PAST
ADMINISTRATION AND CMS.
SO REGARDING THE GOVERNOR'S
PROPOSALS --
WE'RE SUPPORTIVE OF THE
GOVERNOR'S THREE NEW PROGRAMS
FUNDED BY PROPOSITION FIFTY SIX
AND LOOK FORWARD TO WORKING WITH
ALL OF YOU.
THE ADMINISTRATION AND DH CS
DEVELOP THE DETAIL WE SEE THE
CURRENTLY SUPPLEMENTED CPT CODES
AS CRUCIAL TO THE SUCCESS OF THE
NEWLY PROPOSED VALUE BASED
PAYMENT PROGRAM PROPOSAL. FOR
THE VALUE OF IT VALUE BASED
PAYMENT PROGRAM TO FUNCTION
THERE MUST BE ENOUGH ACCESS
POINTS TO PREVENTIVE CARE AND
THAT INCLUDES MAINTAINING THE
STABILITY OF THE MEDICAL HOME
MODEL IF.
LACK OF A BETTER TERM.
AS A GATEWAY TO ADDITIONAL
SERVICES IN MEDI CAL MANAGED
CARE.
THOSE PROVIDERS NEED TO BE ABLE
TO DEDICATE TIME TO THE
CORONATION OF CARE IN ORDER TO
BEST MANAGED BENEFICIARIES
VARIED AND OFTEN COMPLEX
CONDITIONS.
PROGRESS HAS BEEN MADE IN
EXPANDING ACCESS TO PRIMARY CARE
IN.
CERTAIN SETTINGS AS EVIDENCED BY
THE MEDI CAL MANAGED CARE PLANS
ABILITY TO LARGELY MEET THE
STATE'S NETWORK ADEQUACY
STANDARDS.
WHY WOULD WE DESTABILIZE OR ROAD
THAT PROGRESS IN THOSE PROVIDER
NETWORKS AND RECREATE THE
PROBLEM WE HAVE NOW REMEDIED
WITH THE CURRENT SUPPLEMENTAL
PAYMENT STRUCTURE?
AND YOU WANT TO GO OVER THE
PROPOSAL'S --
FEEL FREE PLEASURE OKAY.
WE SUPPORT THE CONVERSION OF THE
CURRENTLY AND SUPPLEMENTED CPT
CODES TO PERMANENT MEDIC HOW
BASE RATE INCREASES.
THIS INCREASE TO BASE RATES WILL
RETURN CLINICAL TIME BACK TO
PROVIDERS ALLOWING THEM TO SPEND
MORE TIME WITH THE Q. PATIENTS
CORDONING CARE AND IMPROVING
HEALTH OUTCOMES.
PROVIDERS WILL BE ABLE TO SPEND
MORE CLINICAL TIME WITH PATIENTS
IF THEY CAN COUNT ON THE FUNDING
WITHOUT DELAYS RELAXING PAYMENTS.
AND ARE MORE EASILY ABLE TO
RECONCILE AND ADMINISTER THE
SUPPLEMENT OKAY.
IN ADDITION IF THEY'RE ABLE TO
REDUCE ADMINISTRATIVE BURDEN OF
RECONCILING THREE SETS OF
SUPPLEMENTAL PAYMENTS FROM
MEDICARE MANAGED CARE PLANS.
THEY COULD INSTEAD USE RETAIN A
CARE COORDINATOR TO FOLLOW UP ON
APPOINTMENTS OR PERFORM HOME
VISITS.
SEEM IS WORKING WITH THE
ADMINISTRATION THE DEPARTMENT ON
THE TECHNICAL ASPECTS OF THIS
PROPOSAL ON HOW WOULD BE
ADMINISTERED.
ADDITIONALLY IT ONCE FEDERAL
PAROLE IS RECEIVE FOR THESE
MEDICAL BASE RATE INCREASES.
WE BELIEVE CONTINUED OVERSIGHT
AND TRANSPARENCY OF THE PROGRAM
IS NECESSARY TO ENSURE THAT THE
BENEFIT OF THESE PROPOSITION
FIFTY SIX DOLLARS CONTINUE TO
FLOW FROM THE MEDIC MEDIC HOW
MANAGED CARE PLANS TO PROVIDERS
AS INTENDED.
THE END I'M PRESENTING IS OUT OF
ORDER BUT THE SECOND --
ONE IS.
TO PROPOSE THE ADDITION OF FOR
ADDITIONAL PER IT'S FOR WOMEN
OVER FORTY YEARS OF AGE.
AS THEY WERE NOT INCLUDED IN THE
PREVENTIVE CODES ADDED LAST YEAR.
FROM WHAT WE CAN UNDERSTAND --
THE CPT CODES ARE NOT INCLUDED
AS THEY ARE PAID BY REPORT.
MEANING THEY DON'T HAVE A MEDI
CAL RATE ATTACHED TO THEM IN THE
FEE SCHEDULE.
INSTEAD THE PROVIDER SUBMITS THE
CLAIM AND MEDICAL RECORDS AND DH
CS DECIDES ON A CASE BY CASE
BASIS WHAT IT WILL PAY.
WE ARE WORKING ON OBTAINING
UTILIZATION DATA ON THESE FOR
CODES FOR THE PART AND WE'LL GET
BACK TO YOU WITH A COST ESTIMATE.
THE FOURTH PROPOSAL OUT WE
PROPOSE QUARTERLY BONUSES TO
HOSPITAL BASED PHYSICIANS WHEN
THE THRESHOLD OF VISITS IN THAT
QUARTER EXCEEDS A CERTAIN
PERCENTAGE.
IN MANY MORE THAN AND MANY
MEDICALLY UNDERSERVED AREAS
THESE HOSPITAL BASED PHYSICIANS
PROVIDE CRITICAL SERVICES TO
MEDI CAL PATIENTS WHO HAVE NO
OTHER CARE ACCESS POINTS
AVAILABLE TO THEM AND SHOULD NOT
BE EXCLUDED FROM INCENTIVES TO
IMPROVE OR MAINTAIN ACCESS.
THE INCENTIVE CRITERIA WOULD BE
DESIGNED MY DH CS IN CONJUNCTION
WITH CURRENT REGIONAL
UTILIZATION DATA IN ORDER TO
ENSURE PROVIDERS PRACTICING IN
THESE IMPORTANT SAFETY NET
SETTINGS CONTINUE TO DO SO.
THS MAY BE ABLE TO BE INCLUDED
OTHER VALUE BASED PAYMENT
PROGRAM AND WE LOOK FORWARD TO
WORKING WITH PCS FOR THE DETAILS
ON TO TOP DESIGNING THIS NEW
PROGRAM.
SO.
I WE RECENTLY LEARNED --
AND OPPOSE --
A PROPOSAL BY CMS TO COLLAPSE
TEN EVALUATION AND MANAGEMENT
CODES SOME OF WHICH WE CURRENTLY
SUPPLEMENT.
SO WE SUGGEST TRAILER BILL
LANGUAGE ALLOWING DH CS TO
REASSIGN REASSESS CODES AFFECTED
BY THIS POTENTIAL CHANGE WITHOUT
A TRIGGER FOR AN ACCESS STUDY.
THE COULD COLLAPSE WILL RESULT
IN REDUCED PAYMENT.
ESSENTIALLY IS THERE OR NO
PAYMENT FOR SOME CODES BECAUSE
IT WILL ELIMINATE THEM BUT PROP
FIFTY SIX A MEDIC HOW WILL STILL
BE PAYING THEM.
JUST CONDENSED UNDER DIFFERENT
CODE.
SO SEE ME THINKING IS THAT WE
DON'T WANT TO MAKE DH CS TO AN
ACCESS STUDY AT GREAT COST IF
THE SERVICE REALLY IS NOT BEING
ELIMINATED OR PAYMENT IS NOT BE
REDUCED.
ITS BEING RENAMED.
A CO CLASS OF THIS NATURE HAS
NOT BEEN ENACTED BUT CMS IS
PURSUING IT FOR TWENTY TWENTY
AND IS FACING GREAT OPPOSITION
FROM THE PROVIDER COMMUNITY.
COMMUNITIES WE WANT TO PROTECT
WHAT CALIFORNIA HAS DONE --
THUS FAR [inaudible]
LASTLY CMA SUGGEST THAT ANY NEW
PROGRAM FUNDING PROPOSED UNDER
FIFTY SIX THAT DOES NOT GET
DESIGN AND APPROVED BY CMS AND
TIME.
SHOULD INSTEAD BE DIRECTED TO
PHYSICIAN AND DENNIS LOAN
REPAYMENT.
WE SPOKE A LITTLE BIT ABOUT THIS
EARLIER BUT THE PROPOSAL SIMILAR
TO THE EIGHTEEN NINETEEN
SPENDING PLAN WORD TWENTY TWENTY
MILLION AND ONE TIME AND SPENT
PROPOSITION FIFTY SIX FUNDING.
FROM THE PREVIOUS YEAR WAS
DEDICATED TO CREATING A
PHYSICIAN AND DENNIS STUDENT
LOAN REPAYMENT.
PROGRAM.
THE PROGRAM WILL BE ORDER OVER
TO LOANS OF PHYSICIANS AND%
DENNIS TO SERVE OUR 30%
THRESHOLD OF MEDI CAL PATIENTS.
THE CRITERIA ARE CURRENTLY BEING
FINALIZED AND APPLICATIONS WILL
BE AVAILABLE THE SECOND QUARTER
OF TWO THOUSAND NINETEEN AND
AWARDS LIKELY ANNOUNCED IN THE
FALL OF THIS YEAR SO VERY QUICK
TURNAROUND.
THANK YOU FOR THIS OPPORTUNITY
AND I'M AVAILABLE FOR ANY
QUESTIONS.
THANK YOU SO MUCH.
NEXT SPRING.
A GOOD AFTERNOON BRANDED HIM AND
SPENCER WITH THE CALIFORNIA
DENTAL ASSOCIATION REPRESENTING
TWENTY SEVEN THOUSAND MEMBER
DENNIS ACROSS THE STATE --
REALLY APPRECIATE THE
OPPORTUNITY TO BE HERE --
I DO I HAVE TO SAY YOU KNOW THIS
CDA LOOKS AT PROPOSITION FIFTY
SIX IS SOMETHING REALLY JUST OF
A SEA CHANGE FOR THE MEDICAL
DENTAL --
PROGRAM AFTER DECADES OF RATE
STAGNATION WE'RE ACTUALLY SEEING
THESE THESE RATES COME IN AND I
THINK ONE OF THE DIFFERENCES ON
THE MAT ON THE GENOCIDE IS
BECAUSE SO MUCH OF WHERE OF THE
DENTAL SERVICES ARE FEE FOR
SERVICE.
THERE AREN'T THE SAME
COMPLICATIONS AS UNDER THE MAN
IT MEDI CAL MANAGED CARE SO
DENNIS ARE GETTING THOSE TRACKS
THEY'RE GETTING THEM IN A SINGLE
CHECK WHERE THEY GET A YOU KNOW --
AN EXPLANATION OF BENEFITS THAT
THIS IS YOUR RATE AND THIS IS
YOUR SUPPLEMENTAL BUT
ESSENTIALLY THEY'RE GETTING ONE
PAYMENT AND THEY ARE SEEING
THOSE THERE ARE SOME DELAYS --
THAT WE'RE SEEING AT THE
BEGINNING OF BOTH THREE YEARS
THERE TOOK SOME MONTHS BEFORE
THOSE RATES ACTUALLY GOT OUT THE
DOOR SO DENNIS DIDN'T START
SEEING THAT I'M THE PAYMENTS
UNTIL SIX ABOUT FIVE TO SIX
MONTHS AFTER.
BUT THEY ARE GETTING THEM RIGHT
NOW AND THEY'RE THEY'RE GETTING
THEM AT WITH THE REST OF THEIR
CHECKS AND SO THEY ARE REALLY
SEEING THAT --
SO ANECDOTALLY WE'RE HEARING
FROM THOSE MEMBERS THAT --
THIS REALLY THESE ARE MAKING
CHANGES TO THEIR PRACTICES
THEY'RE MAKING THE MORE
SUSTAINABLE THAT THEY'RE
INTERESTED IN EXPANDING WE GET
COMPLIMENTARY CALLS FROM MEMBERS
TALKING ABOUT HOW MEDI CAL AND
THAT THEY'RE EXCITED ABOUT IT --
YOU KNOW NOT TO SAY THAT
EVERYTHING SPACE VERY PLEASED
WHEN WE GET THOSE PHONE CALLS --
AND THEY CALL US AND THEY SAY
YOU KNOW WHAT I'M LOOKING AT
WHERE I CAN EXPAND I'M LOOKING
AT BRINGING A NEW ASSOCIATE ON
I'M LOOKING AT BRINGING MEDI CAL
AND SO.
ANECDOTALLY WE DO BELIEVE THAT
THAT MEDI CAL RATES ARE DOING
WHAT THE VOTERS AND THIS
LEGISLATURE INTENDED --
WE THINK BEYOND THE ANECDOTES
THAT THERE ARE SOME NUMBERS
AGAIN I THINK ONE OF THE
DIFFERENCES BETWEEN THE MEDICAL
THE DENTAL SIDE IS THAT WHEN FEE
FOR SERVICE.
IT'S A LITTLE BIT EASIER TO GET
THAT DATA WE HAVE ANNUAL DENTAL
VISITS WE HAVE HOW MANY KIDS ARE
GETTING PREVENTIVE VISITS WE
HAVE.
NUMBER OF DENNIS TOUR AND ROLLED
I'M ACTUALLY RIGHT NOW WE'RE
GETTING A MONTHLY UPDATES OF
THROUGH THE DTI --
PILOT PROGRAM SO WE ACTUALLY
HAVE PRETTY UP TO DATE DATA AND
WE ARE SEEING --
I THINK AFTER OVER EIGHTEEN
MONTHS.
SINCE THE PROP FIFTY SIX
SUPPLEMENTAL RATES WENT INTO
EFFECT WE'VE SEEN AT NEARLY 10%
INCREASE IN PROVIDERS --
SO WHICH IS --
TWO HUNDRED NINETY ONE NEW
DENTAL OFFICES AND NINE HUNDRED
AND TEN PROVIDERS SO AGAIN YOU
KNOW IT'S A PROGRAM THAT SERVING
THIRTEEN MILLION PEOPLE.
THERE'S A LOT MORE WORK TO BE
DONE BUT THIS IS COMING AFTER
DECADE OF DECADES OF STAGNATION
AND DROPS AND SO FOR US THIS IS
REALLY POSITIVE --
WE'VE ALSO SEEN UTILIZATION
ESPECIALLY ON THE CHILDREN SITE
IMPROVING IT'S A LITTLE HARDER
ON THE ADULT SIDE JUST WITH ALL
THE MORE RECENT CHANGES. TO A
MEASURE THAT --
AND AGAIN THE DTI WE HAVE BETTER
DAYS DOLE'S BUT WE'VE SEEN A 3%
INCREASE THEIR SORT OF A A
PRETTY STEEP DIFFERENT JUMP
201-320-1420. 1620173% KIDS
UTILIZATION AGAIN DOESN'T
COMPLETELY SOLVE THE PROBLEM BUT
IF IT'S POSITIVE TO US --
WERE VERY SUPPORTIVE OF THE
GOVERNOR'S PROPOSAL TO CONTINUE
THE RATES AND OUR BIG ASK THIS
YEAR IS STABILITY THE SAME AS A
CNA --
DENNIS ARE MAKING FINANCIAL
DECISIONS ABOUT WE KNOW WHETHER
TO OPEN A PRACTICE AND THEY NEED
THAT STABILITY.
BECAUSE WE ONLY HAVE ONE YEAR.
MRS BECAUSE WE ONLY HAVE ONE
YEAR SPAS.
BUT WE WE CAN'T TELL THEM WHEN
WE PROMOTE THIS OUT TO OUR
DENNIS AND SAY HEY TAKE ANOTHER
LOOK -- AT
THE DENTAL HEALTH PROGRAM WE
ALWAYS HAVE TO BE VERY CAREFUL
WE SAY ONE YOUR SUPPLEMENTAL
RATES WE CAN'T SAY THESE RATES
ARE INCREASING --
THE DAY SHE'S BEEN RAISED THAT
WE DON'T HAVE ANY EVALUATION AND
I WOULD SUGGEST THAT'S BECAUSE
WE JUST HAVEN'T CREATED ONE YET --
THERE'S NOTHING TO STOP US FROM
DOING THAT.
ON THE DENTAL SIDE WE DO HAVE
DATA WE CAN LOOK AT SO WE JUST
NEED TO DEVELOP AN EVALUATION
PROGRAM AND I THINK THAT WE
WOULD ENCOURAGE THAT.
AND FROM CITIES POINT OF VIEW WE
DON'T THINK THAT STABILITY AND
EVALUATION ARE NECESSARILY
MUTUALLY EXCLUSIVE YOU COULD DO
BOTH WHETHER THAT WAS PERMANENT
BASE RATE CHANGES WHICH IS WHAT
WE WOULD REALLY LIKE TO SEE --
AND SOME KIND OF EVALUATION
NOTHING TIES YOUR HANDS OF THE
OF THE HANDS OF THE FUTURE
LEGISLATOR ABOUT MAKING
DECISIONS DOWN THE LINE BASED ON
EVALUATIONS REPORTS BUDGET
BUDGETARY NECESSITIES --
THE ONE ISSUE THAT I WOULD BRING
BEFORE YOU AYE IS ACTUALLY NOW
YOUR ISSUE IT'S AROUND KIDS
PREVENTION --
PROPOSITION FIFTY SIX DOES NOT
HAVE ANY RATE INCREASES FOR KIDS
PREVENTION IT'S ADULTS AND KIDS
TREATMENT AND THAT'S BECAUSE THE
DENTAL TRANSFORMATION INITIATIVE
WHICH IS FOCUSED SOLELY ON KIDS
PREVENTION WAS PUT IN PLACE
BEFORE WE HAD.
FIFTY SIX SO WE'RE TESTING SOME
REALLY INNOVATIVE --
VALUE BASED CARE --
AND WE'RE PRETTY EXCITED ABOUT
WE THINK ARE WORKING --
IT'S KIND WHEN BEEN SLOW TO GET
OFF THE GROUND BUT WERE SEEING
SOME IMPROVEMENT THERE SO THAT
IN THAT PILOT PROJECT WILL AND
WITH THE ELEVEN FIFTEEN WAIVER
IN TWENTY TWENTY AND I KNOW THAT
THIS IS BEEN TALKED ABOUT IN
OTHER SETTINGS.
BUT IT'S DEFINITELY A PROBLEM
WE'RE GONNA HAVE TO SOLVE AND AS
WE LOOK AT THE GOVERNOR'S
PROPOSAL FOR THE VALUE BASED --
PAYMENTS IT ALL THE LANGUAGE SO
FAR AS TALKED ABOUT MEN AT
MANAGED CARE AND PHYSICIANS BUT
WE WOULD REALLY ENCOURAGE
LOOKING AT SOME OF THE LESSONS
WE'VE LEARNED THROUGH THE DTI
AND I'M TRYING TO DECIDE IF
THERE'S WAYS WE CAN BRING DENTAL
INTO THAT BECAUSE THERE ARE HUGE
CONNECTIONS.
BETWEEN CHRONIC CARE AND ORAL
HEALTH AND GETTING AN EARLY AND
DOING SOME OF THIS PREVENTION
COULD -- AB
INVOLVE A LOT OF COST SAVINGS
FOR THE STATE.
THINK WE ALSO SECOND THE
COMMENTS OF CMA ON THE LOAN
REPAYMENT WE'RE VERY EXCITED
THAT THAT'S GETTING UP AND
RUNNING THE DEPARTMENT HAS
WORKED REALLY WELL WITH THE CMA
FOUNDATION.
ON GETTING THOSE OUT THE DOOR
AND I BELIEVE WE'RE LOOKING AT
HAVING AND FOLKS WE'RE GONNA BE
STARTING TO GET THOSE PAYMENTS
MADE THIS YEAR WHICHIS VERY
FAST.
AND IF THERE ARE EXTRA DOLLARS
WE THINK THAT THAT WOULD BE A
GREAT PLACE TO REALLY CONTINUE
TO EXPAND ACCESS.
THANK YOU THANK YOU SO MUCH.
WHEN YOU'RE READY?
AFTERNOON CHAIR NUMBERS --
MY NAME IS ANDREAS AND MAKE
ALLEN THE POLICY ADVOCATE FOR
PLANNED PARENTHOOD AFFILIATES OF
CALIFORNIA.
NEAR REPRESENTING ALL SEVEN OF
OUR AFFILIATES IN THE STATE AND
THE ONE HUNDRED AND TWELVE
LOCATIONS --
THAT WE ARE IN ALL OF YOUR
DISTRICTS --
THANK YOU SO MUCH FOR PROVIDING
THIS OPPORTUNITY TO DISCUSS OUR
EXPERIENCE SO FAR --
IN THE TWENTY SEVENTEEN EIGHTEEN
BUDGET THERE WAS AN ALLOCATION
FOR A AS YOU'RE AWARE.
OF FOR SUPPLEMENTAL RATES FOR
WOMEN'S HEALTH SERVICES SO SINCE
SEPTEMBER OF TWENTY SEVENTEEN
ARE HEALTH CENTERS HAVE BEEN
RECEIVING SUPPLEMENTAL PAYMENTS
FOR THE FAMILY PRACTICE OFFICE
VISITS.
AS WELL AS NON MEDICATION
ABORTION SERVICES IN MEDI CAL --
I JUST WANT TO TAKE THE TIME
THAT WE HAVE TODAY TO SHARE SOME
DATA THAT DEMONSTRATES WHY
INVESTING IN FAMILY HEALTH
FAMILY PLANNING AND REPRODUCTIVE
HEALTH IS.
IS A WISE INVESTMENT WITH THIS
FUNDING --
AND KIND OF REVISIT THOUGHT%
WHAT'S THE PURPOSE OF THIS --
PANEL TODAY SO WE'VE BEEN REALLY
FOCUSING ON A LINING THE USE OF
THE SUPPLEMENTAL PAYMENTS WITH
THE STATED GOALS OF PROPERTY.
SIX TO INCREASE TIMELY ACCESS
AND QUALITY CARE AND ADDRESS
SOME OF THOSE GEOGRAPHIC
SHORTAGES.
IT'S IMPORTANT TO NOTE --
THAT EVEN WITH A COMMITMENT TO
MAKE ANY EXISTING ALLOCATION OF
FUNDING ON GOING --
AS IS THE CASE FOR THE OTHER
PROVIDERS.
FUNDS DO NEED TO BE DRAWN DOWN
FIRST [inaudible]
ADVANCEMENTS HE CAN BE REALIZED --
REFERRING SPECIFICALLY TO STAFF
CAPACITY IN INFRASTRUCTURE.
DOT SAID --
I'M REALLY EXCITED TO BE ABLE TO
SHARE SOME HIGHLIGHTS WITH YOU
TODAY.
SO -- WE'VE
BEEN WORKING WITH THE AFFILIATES
TO PER TO BRING UP SOME DATA TO
THE STATE LEVEL --%
SO I WANT TO START WITH SAYING
AT THE STABILIZING EFFECT FROM
THIS FROM THE RATES.
WITHOUT ALL AFFILIATES WERE ABLE
TO MAINTAIN THEIR LEVELS OF
SERVICE.
AS WELL AS A MAJORITY OF HEALTH
CENTERS HAVE BEEN ABLE TO EXPAND
THE AVAILABILITY OF CERTAIN
SERVICES IN THEIR COMMUNITIES
WHERE THEY'RE ABLE TO IDENTIFY
WHAT'S NEEDED AT THE LOCAL LEVEL.
THIS CAN INCLUDE ADDITIONAL
ACCESS TO HIV PREVENTION GENDER
AFFIRMING CARE AS TI IS --
TESTING IT FOR PREGNANT WOMEN.
EARLY PREGNANCY CARE SUCH AS
MISCARRIAGE EVALUATION AS AS
WELL AS SOME PRENATAL CARE AND
ALL ICAL PROCEDURES --
THEY'RE WANTING TO PROVIDE
MAINTENANCE AND SERVICES AND
THIS.
YOU KNOW NOW WITH THIS DEBILITY
THAT'S BEEN PROVIDED --
THIRTY BILL TO ADDRESS THOSE
PATIENTS NEEDS MORE --
AT LEAST TWENTY HEALTH CENTERS
HAVE INCREASED THEIR HOURS OF
OPERATION THUS INCREASING ACCESS
TO SERVICES WHEN AND WHERE
THEY'RE NEEDED MOST.
SEVERAL AFFILIATES INCLUDING
THOSE --
WITH HEALTH CENTERS IN RURAL
AREAS --
SURE THAT THEY HAVE BEEN ABLE TO
IMPROVE ACCESS FOR PATIENTS AT
TARGETED LOCATIONS.
BY PROVIDING APPOINTMENTS ON
EVENINGS SATURDAYS AND IN THE
LEAST ONE CASE EVEN EXPANDING
SEVEN DAYS PER WEEK.
SO FAR WAIT TIMES FOR HIGH NEED
LOCATIONS AND CERTAIN KEY
SERVICES --
HAVE BEEN CUT ROUGHLY IN HALF
THE VERY SPECIFIC AMOUNT OF
INFORMATION BUT WITH THIS
EXAMPLE --
THE AVERAGE WAIT TIMES FOR A
LONG ACTING REVERSIBLE
CONTRACEPTIVES ARE GETTING A
LARK OR AN ARM IMPLANT --
AT AN APPOINTMENT FLAT IN THE LA
REGION HAS BEEN REDUCED BY 72% --
OVER THE PERIOD OF TIME THAT WE
REQUESTED THE STATE FOR HALF AT
THE CHICO LOCATIONS SO AGAIN
HIGHLIGHTS --
WE ALSO LOOKED INTO SOME OF THE
QUALITY OF PATIENT SERVICES AND
KIND OF HOW OUR YOU KNOW PHILLY
AT STAFF ON THE GROUND HAVE BEEN
SEEING CHANGES IN QUALITY.
THEY HAVE MENTIONED TO US THAT
THERE'S BEEN IMPROVEMENT BY
HIRING SOME SPECIALIZED STAFF --
AS AS MUCH AS THEY'RE ABLE TO
MOVE FOR WITH ANY OF THAT SO
QUICKLY.
THIS WOULD INCLUDE LICENSE
TRAINERS PEER ADVOCATE
COORDINATORS PATIENT NAVIGATORS
AND CASE MANAGERS --
I'D LIKE TO SEE SPECIFICALLY
ABOUT CASE MANAGERS THERE SO
CRITICAL TO TIMELY CARE FOR
PATIENTS WHO NEED AND CANCER
PREVENTION --
AN EARLY EARLY TREATMENT FOLLOW
UP VISITS ALSO AS HE EYES I
HEARD CONGENITAL SYPHILIS EARLY
MENTIONED EARLIER --
THIS HAS BEEN YOU KNOW WE KNOW
WE HAVE HEALTH CENTERS AND SOME
OF THOSE HOT SPOTS AND SO HAVING
THE CASE MANAGERS ABLE.
TO REALLY MAKE SURE THAT THEY'RE
AVAILABLE IN GETTING PATIENTS IN
FOR WHAT THEY NEED ESPECIALLY
FOR THINGS LIKE SYPHILIS --
CASE MANAGERS A LOAN ON IN
SOUTHERN CALIFORNIA AFFILIATES.
HAVE -- BEEN
ABLE.
TO SERVE MORE THAN FIVE THOUSAND
PATIENTS PER MONTH WHEN WE
COLLECTED THE STAFF.
THE NUMBER OF MEDICAL RESIDENTS
IN THE ALLEY REGION AND THE
NUMBER OF MID LEVEL CLINICIANS
IN ORANGE COUNTY AND SAN
BERNARDINO COUNTIES ARE NOW TWO
AND A HALF TIMES WHAT THEY WERE
IN.
TWENTY SIXTEEN SO THE TIME THAT
THEY WERE SORT OF HOPING LET'S.
SOME OF THESE OPENINGS --
THAT WAS ALLOWED IN CERTAIN
LOCATIONS BECAUSE OF THIS
FUNDING.
ALSO AN ORANGE COUNTY SAN
BERNARDINO AREA THERAPISTS --
BEEN AN OPPORTUNITY TO IMPLEMENT
A FEW WORK FORCE RECRUITMENT AND
RETAIN IT MEASURES I KNOW
EVERYONE'S ON BOARD WITH
RECOGNIZING THAT AS AS A LARGE
UP HILL ISSUE OF SO THIS IS SORT
OF A SILVER LINING --
THEY WERE ABLE TO IMPLEMENT
SOMETHING TO DECREASE CLINICIAN
TURNOVER BY 19% WITHIN ONE YEAR --
IN NOT AFFILIATE AND INCREASED
NUMBER PATIENTS OBVIOUSLY
BECAUSE OF RETAINING AS
PROVIDERS.
SO THIS WAS LARGELY --
A SUCCESS AND THAT IT IT ALSO
HELPS.
GET RID OF HUNDREDS OF THOUSANDS
OF DOLLARS OF COSTS THAT ARE
SEXY TURNOVER --
SO THAT'S THAT'S A LOT OF A LOT
OF HIGHLIGHTS.
I DON'T KNOW IF WE STILL HAVE
MORE.
TIME.
NO I APPRECIATE THAT AND IF WE
CAN MOVE ON TO MR CLUBS.
IT'S LIKE YOU.
TURN THAT ON THANK YOU DOCTOR
INTO AND COMMITTEE MEMBERS --
MY NAME IS MARK CLAUS ON THE
PRESIDENT AND CEO FOR HOME OF
GUIDING HANDS.
HOME THE GUIDING HANDS IS A
COMMUNITY BASED NONPROFIT
ORGANIZATION --
THAT WAS FOUNDED IN NINETEEN
SIXTY SEVEN AND IN SAN DIEGO
COUNTY WE CURRENTLY.
PROVIDE SUPPORT TO ONE HUNDRED
AND FIFTY INDIVIDUALS WITH
DEVELOPMENTAL DISABILITIES THAT
LIVE AND TWENTY FIVE ARE IN THE
INTERMEDIATE CARE COMMUNITY
BASED I SEE OF HOMES --
THOSE HOMES AS YOU KNOW ARE
ALMOST ENTIRELY FUNDED BY
MEDICARE --
IN IN BY ALMOST --
I SAY THAT --
IS ORGANIZATIONS LIKE MINE RELY
VERY HEAVILY ON FUND RAISING --
IN FUND RAISING TO PROVIDE
QUALITY SERVICES QUALITY
STAFFING AND QUALITY OUTCOMES
FOR OUR RESIDENTS.
IN ADDITION TO MY ROLE AS THE
CEO -- YOU
ALSO SERVE ON THE SAN DIEGO
REGIONAL CENTER BOARD OF
DIRECTORS AND ALSO AS A BOARD
MEMBER FOR DEVELOPMENTAL
SERVICES NETWORK.
YES AND IS A STATEWIDE
ASSOCIATION THAT REPRESENTS
APPROXIMATELY THREE HUNDRED ICF
ORGANIZATIONS I SEE AFTER MANY
BASS TONE THROUGHOUT THE STATE --
IN IN TOTAL THERE ABOUT SEVEN
THOUSAND INDIVIDUALS UP THE ICS
IN CALIFORNIA.
DROPS FIFTY SIX FUNDS --
BOTTOM LINE IS THEY HAVE BEEN A
LIFE LINE A TRULY A LIFELINE TO
ICF PROVIDERS IN THE STATE OF
CALIFORNIA.
WITHOUT THESE FUNDS MY
ORGANIZATION WOULD HAVE BEEN
FORCED TO CLOSE SEVERAL.
IF NOT ALL OF OUR PHONES --
A AND PEOPLE THAT WE HAVE
SUPPORTED FOR MANY YEARS WOULD
HAVE LOST THEIR HOUSES --
IN NINETY IN TWO THOUSAND AND
NINE OUR RATES WERE FROZEN AT
THE LEVELS THAT THEY WERE IN TWO
THOUSAND AND EIGHT SO.
BUT SOME OF THE OTHERS YOU FOR
TODAY OUR RATES BEEN FROZEN FOR
ELEVEN YEARS --
YOU KNOW SET SET TIME ALMOST ONE
HUNDRED ICF HOMES SMALL
COMMUNITY BASED HOMES HAVE HAVE
CLOSE THROUGHOUT OUR STATE.
PROP FIFTY SIX FOR THE ICF SAYS
DEFINITELY HAD A SIGNIFICANT
BENEFIT FOR OUR RESIDENTS --
FOR THEIR FAMILIES AND OUR
COMMUNITIES.
PROP FIFTY SIX FUND'S HAVE
ALLOWED US IN ORGANIZATIONS LIKE
HOME OF GUIDING HANDS. TO RETAIN
GOOD QUALITY STAFF ESPECIALLY
THOSE STAFF --
WITH SENIORITY.
WE'VE GOT --
OUR ORGANIZATION OUR AVERAGE TEN
YOUR FIRST AFTER A SIX POINT
EIGHT YEARS WE HAVE MANY STAFF
THAT HAVE BEEN WITH US. TWENTY
FIVE THIRTY SEVERAL OF THEM OVER
FORTY YEARS AND THESE THESE ARE
INDIVIDUALS THAT HAVE GIVEN
THEIR LIVES GIVEN THEIR THEIR
TIME TO PROVIDE GOOD QUALITY
CARE SO THIS THESE FUNDS OF A
ENABLED US. TO MAKE SURE THAT WE
CAN KEEP THOSE TENURED STAFF IS
PAIN OR ATTRACT IF YOU WILL
QUALITY STAFF --
THE MINIMUM STANDARDS IN OUR IN
OUR OPERATIONS FOR MANY OF OUR
STAFF FOR EIGHTEEN WITH A HIGH
SCHOOL DIPLOMA.
WE HAVE NINE HUNDRED STAFF WE
HAVE ONE PERSON AT EIGHTEEN
YEARS OLD.
WHAT WHAT WE'RE ASKING FOR OUR
STAFF -- WE
NEED EXPERIENCE QUALITY
INDIVIDUALS THAT ARE COMMITTED
TO PROVIDING GOOD QUALITY STEHR --
CARE -- IT'S
ALSO ALLOWED US. TO MAKE SOME
MUCH NEEDED MODIFICATIONS AND
SOME OF OUR HOMES TO ALLOW
INDIVIDUALS AS THEY AGE TO AGE
IN PLACE TO AGE WITH WITH
DIGNITY --
INDIVIDUALS THAT WE SUPPORT
MOVING TO A NURSING HOME --
IS IS NOT THE BEST OPTION.
SO PROPERTY PROP FIFTY SIX FUNDS
HAVE DEFINITELY ASSURED
CONTINUED --
ACCESS TO MEDICARE RECIPIENTS.
DS THEN --
WOULD LIKE TO WORK
COLLABORATIVELY WITH THE
DEPARTMENT OF HEALTH CARE
SERVICES. TO DEVELOP A RATE THAT
ADEQUATELY FUNDS SERVICES.
THAT CAPTURES THOSE COSTS --
TO PROVIDE QUALITY SERVICES.
AND TO MEET LEE LIFT THE RATE
FREEZES IMPLEMENTED IN TWO
THOUSAND AND EIGHT TO THE BOTTOM
LINE AND IT REALLY ISN'T ABOUT.
HOME OF GUIDING HANDS IT'S
REALLY NOT ABOUT I SEE A
PROVIDERS.
IT'S ABOUT THE PEOPLE THAT WE
SUPPORT.
IT'S ABOUTPEOPLE LIKE TERRY --
TERRY'S ONE OF OUR RESIDENTS
TERRY MOVED IN TO OUR HOMES IN
AUGUST OF NINETEEN SIXTY SEVEN
SO IT TRULY IS THE ONLY HOME
THAT TERRY HAS EVER KNOWN.
AND WITHOUT THESE FUNDS TERRY
WOULD BE SOMEWHERE ELSE SO I I
APPRECIATE YOUR TIME I
APPRECIATE THE OPPORTUNITY AND I
THANK YOU VERY MUCH.
THANK YOU MISTER CLAUS.
I WANT TO GIVE THE DEPARTMENT --
CHANCE TO RESPOND TO ANY OF THE
LAST TWO PANELS IF YOU SO WEST.
AND ALSO TO OPEN IT UP AND TO
PUBLIC COMMENT FOLLOWED BY
QUESTIONS FROM THE DICE.
RIGHT SO I WOULD JUST SAY --
BOTH FOR THIS PANEL AS WELL AS
THE PREVIOUS --
WE WOULD CERTAINLY AGREE THAT --
THE USE OF THE PROPOSITION FIFTY
SIX FUNDS HAS --
PRESENTED US BOTH AN OPPORTUNITY --
TO CHANGE THE WAY WE DO ACTRESS
IN THE MEDICAL PROGRAM OBVIOUSLY
WE'RE REALLY EXCITED AROUND SOME
OF THE THINGS THAT WE HAVE USED
THE FUNDING FOR I THINK WE WOULD
CERTAINLY AGREE THAT.
SOME OF THE CHALLENGES THAT
WE'VE HAD IN TERMS OF
OPERATIONALIZE IN THE FIFTY SIX
FUNDS -- IS
CONCOMITANT WITH YOU KNOW THE
FEDERAL APPROVALS THAT WE HAVE
TO GET AND THE REQUIREMENTS THAT
WE HAVE AROUND HOW FUNDING IS
DIRECTED THROUGH THE MANAGED
CARE PLAN SO WE CERTAINLY.
BOTH APPRECIATE AND SOMETIMES
FEEL VERY MUCH THE PROVIDER --
STRESS AROUND HOW THOSE FUNDS
FLOW BUT I THINK THAT WE ARE
CERTAINLY COMMITTED --
TO BEING THOUGHT FULL PARTNERS
IN THE USE OF THESE FUNDS WITH
THE LEGISLATURE IN THE
STAKEHOLDERS BECAUSE ULTIMATELY --
IT DIDN'T IT'S BETTER FOR OUR
PROGRAM IS BETTER FOR
BENEFICIARIES AND SO WE'RE HAPPY
TO CONTINUE THOSE DISCUSSIONS AS
WELL AS IN PLACES WHERE WE CAN --
DO THOUGHTFUL INVESTMENTS OR
CHANGES WERE CERTAINLY COMMITTED
TO DOING THAT.
THANK YOU WITHOUT WILL NOW HEAR
PUBLIC COMMENT ON ISSUE.
FIVE HI MY NAME IS KEN REQUIRING
THE PRESIDENT CEO OF INNOVATION
TELL SYSTEMS WE OWN THE SARATOGA
PEDIATRIC SUBACUTE.
COUPLE THINGS THAT WERE
MENTIONED EARLY THAT I THOUGHT
WERE IMPORTANT THERE'S FOR
PEDIATRIC SUB ACUTE IN THE IN
THE STATE OF CALIFORNIA WERE ALL
SNIFFS.
THERE'S TWELVE HUNDRED AND FORTY
SNIFFS IN CALIFORNIA AND WE WERE
ALL PART OF AB SIXTEEN TWENTY
NINE WE'RE WE AGREED TO PAY Q. A
FEES IN ORDER TO GET AN ANNUAL
INCREASE.
THE FOR SUBACUTE SNIFFS ARE
FORCED NOT RECEIVED THE THE
BENEFIT OF THOSE Q. A FEES SO
THAT'S THE FIRST THING I WANTED
TO BRING UP --
WE ARE VERY BLESSED TO BE
INCLUDED IN PROP FIFTY SIX FOUR
AND A TWELVE FORTY MAKES YOU
ENDANGERED SPECIES IN THE
FUNDING STAY THE WAY IT WAS WE
WOULD BE GONE --
BUT WE'RE TOLD TODAY THAT WE
DON'T KNOW WHEN OUR PROP FIFTY
SIX MONEY'S GONNA GET PAID IN
ONE OF THE THINGS I GOT
INDICATED IT MAY NOT BE PAID
TILL JUNE.
AND IT GOES ALL THE WAY BACK TO
AUGUST FIRST OF LAST YEAR.
SO THAT'S REALLY PROBLEMATIC FOR
US THE LAST THING I WANT TO TALK
ABOUT IS A LITTLE DIRTY SECRET
AROUND MEDI CAL PAYMENTS --
INDIVIDUALS TAX PAYERS LIKE
MYSELF BUSINESS MEMBERS WE
EXPECT TO HAVE MEDI CAL DELAYS
WHEN THERE'S A BUDGET ISSUE.
BUT FOR THE LAST THREE OR FOUR
YEARS WE HAVE THAT THOSE TWO
WEEKS IN JULY WHERE THEY SKIP
OUR PAYMENTS TO GO TO THE NEXT
FISCAL YEAR.
YOU DON'T EXPECT THAT IN BUDGET
SURPLUSES.
AND I'VE HEARD RUMBLINGS ABOUT
WHAT IT WOULD COST THE STATE THE
BUY BACK THOSE TWO WEEKS.
AGAIN THAT'S NOT SOMETHING YOU
EXPECT YOU KNOW WHEN THERE'S
BUDGET SURPLUSES TO HAVE A TWO
WEEK DELAY AND FOR US MY
FACILITIES ALONE.
PAYROLL IS FIVE HUNDRED THOUSAND
DOLLARS EVERY TWO WEEKS.
I'M IN CUPERTINO WHICH ARE I
MEAN SARATOGA WHICH IS FIVE
MILES FROM CUPERTINO WHERE HOME
CELL FOR A THOUSAND DOLLARS A
SQUARE FOOT.
PEOPLE THAT WORK IN --
YET WORKING CAR WASHES MAKE MORE
THAN MY CERTIFIED NEEDS NURSE'S
ASSISTANTS.
SO WE'RE HAVING A LOT OF TROUBLE
KEEPING STAFF.
THANK YOU THANK YOU SIR.
KATIE LATE NOT BE HALF OF THE
CHILDREN SPECIALTY CARE
COALITION REPRESENTING OVER
TWENTY FIVE HUNDRED PEDIATRIC
SUB SPECIALIST IN CALIFORNIA.
PEDIATRIC SUB SPECIALISTS HAVE A
MEDIC HOW PATIENT POPULATION NOT
CAN OFTEN EXCEED 60% AND MANY
REGIONS OF THE STATE.
AND ARE STILL PREDOMINANTLY
REIMBURSED THREE FEE FOR SERVICE
WITH RATES BETTER SOME OF THE
LOWEST IN THE NATION.
THE PROP FIFTY SIX PAYMENTS HAVE
BEEN BENEFICIAL TO IMPROVE RATES
AND HELP RECRUIT AND RETAIN
PEDIATRIC SUB SPECIALISTS WHERE
THERE ARE DEMONSTRATED SHORTAGES
WE WANT TO EXPRESS OUR STRONG
SUPPORT FOR THE EXTENSION AND
EXPANSION OF THE PROP FIFTY SIX
SUPPLEMENTAL PAYMENTS.
AS WELL AS MAKING THEM PERMANENT
WE WERE IN STRONG SUPPORT OF
HOSPITAL BASED PHYSICIAN BONUS
PAYMENTS AND LOOK FORWARD TO
WORKING WITH CMA THE
ADMINISTRATION AND THE
LEGISLATURE HONEST MEANINGFUL
OPPORTUNITY.
AND FINALLY WE WERE THRILLED TO
SEE THE ESTABLISHMENT OF THE
LOAN REPAYMENT PROGRAM AND I
LOOK FORWARD TO SEEING IT
PROGRESS.
THANK YOU MA'AM.
GOOD AFTERNOON MY NAME IS PAMELA
REP AND I'M HERE WITH SARATOGA
AND TOTALLY KIDS AND I'M WITH
ALL SAINTS HEALTH CARE --
WE HAVE A OBVIOUSLY --
VERY WE'RE VERY HAPPY AND I AM
PLEASED THAT WE GOT OUR PROP
FIFTY SIX MONEY AND WE'RE HERE
TO ASK IT WE CONTINUED --
UNTIL WE CAN RIGHT RIGHT SIZE
IRATE I JUST WANTED TO GIVE YOU
A LITTLE INFORMATION SINCE THE
INCEPTION.
OF PEDIATRIC SUB ACUTE --
THAT I'VE BEEN INVOLVED WITH FOR
ABOUT TWENTY TWO YEARS --
THOSE WHO HAD THE FORWARD
THINKING APPROACH IN THE CARE OF
THESE MEDICALLY FRAGILE CHILDREN
SUCH AS DOCTOR COOK.
WAS INSTRUMENTAL IN WRITING THE
REGULATIONS FOR PEDIATRIC
SUFFOCATES.
THE PROGRAM HAS BEEN SO
INCREDIBLY SUCCESSFUL IN SO MANY
WAYS THAT THESE CHILDREN HAVE
HOPE.
THAT THEY NEVER HAD.
OTHERWISE THEY WOULD BE
RELEGATED TO BE IN AN
ENVIRONMENT THAT DOESN'T LEND
ITSELF. TO A REAL QUALITY OF
LIFE BY THAT WE'RE ABLE TO
ASSIMILATE THESE KIDS BACK INTO
SOCIETY THESE ARE KIDS ON
VENTILATORS.
TRICKS FEEDING TUBES AND WE CAN
TAKE OUR TIME WINNING THEM.
AND GETTING THEM HOME WITH THEIR
FAMILIES THESE FAMILIES ARE IN
CRISIS.
AND THE PROP FIFTY SIX MONEY HAS
HELPED US STAY IN BUSINESS
WITHOUT THAT MONEY I DON'T KNOW
WHAT WHAT HAPPENED WE HAVEN'T
HAD A RATE INCREASE AS IT'S BEEN
REITERATED.
FOR WE'RE GOING ON ELEVEN YEARS --
THESE KIDS ARE MEDICALLY FRAGILE
BUT THE GOOD NEWS IS THAT
PEDIATRIC SUB ACUTE.
AND HAVE AMAZING SUCCESS STORIES
AND I'LL JUST LEAVE YOU WITH ONE
OF THOSE SUCCESS STORIES.
WE HAD -- A
BOY THAT WAS WITH US SINCE HE
WAS TEN AND WHEN HE TURNED
EIGHTEEN WE WERE ABLE.
TO TRANSITION HIM HOME.
AND HE HAS A COMPLETELY
DISFIGURED FACE AND SO ONE DAY
HE CAME BACK TO SEE ME AND I
ASKED HIM WHAT HE WAS DOING HE
SAID HE WAS LOOKING FOR A JOB
AND NO ONE COULD HIDE WOULD HIRE
HIM.
SO AS HE WAS AFTER WE FINISHED
OUR CONVERSATION HE WAS WALKING
OUT AND WHEN HE WAS WALKING DOWN
THE HALL I SAID TO MYSELF.
WHY DON'T I HIRE HIM?
AND SO I DID AND THAT WAS FIVE
YEARS AGO AND HE WORKS WITH
GIVES BACK TO OUR PEDIATRIC KIDS.
AND HE WORKS IN ACTIVITIES AND
HE'S AN AWESOME KID.
AND HE UNDERSTANDS THOSE KIDS
BETTER THAN WE DO ACTUALLY SO I
JUST THANK YOU FOR THE THE
OPPORTUNITY TO SPEAK TO YOU AND
AND REALLY ASK RESPECTFULLY.
THAT YOU WOULD SERIOUSLY
CONSIDER EXTENDING MONEY SO THAT
WE CAN SERVE THESE MEDICALLY
FRAGILE CHILDREN THANK YOU THANK
YOU MA'AM.
DOCTOR CHAIR MEMBERS TO MADDEN
REPRESENT CALIFORNIA CHAPTER OF
THE AMERICAN COLLEGE OF
EMERGENCY PHYSICIANS WHO WAS ONE
LETTER VOICE IN SUPPORT.
OF A NUMBER OF CMA'S PROPOSALS
AS RELATES TO PROP.
FIFTY SIX IN JUST AS A QUICK
REFRESHER FOR PHYSICIANS AS NOT
BEING EMPLOYED BY HOSPITALS ARE
REIMBURSEMENT IS TIED DIRECTLY
TO THE PATIENTS THAT WE SEE.
AND WE WILL LOOK AT SOME OF THE
FACILITIES THROUGHOUT THE STATE
LOOKING AT LET'S SAY THE THIRTY
FACILITIES --
THE NUMBER MEDI CAL RELEASE THEY
SEE IS AN ENORMOUS 91%. 91% IS
THE HIGHEST VOLUME FOR A
FACILITY IN THIS IS NOT A SMALL
FACILITY THIS IS A FACILITY.
THAT SEIZE ON AN ANNUAL BASIS A
HUNDRED AND ELEVEN THOUSAND
PATIENTS. NINETY THREE THOUSAND
PATIENTS ARE MEDI CAL ENROLLEES
SO WHEN YOU LOOK AT THAT GROUP.
AND THEIR ABILITY TO CONTINUE TO
STAFF THAT EMERGENCY DEPARTMENT
WITH EMERGENCY PHYSICIANS IT
BECOMES REALLY CHALLENGING SO
HOW THEY DO IT IS A TEN THE RIDE
A LITTLE BIT MORE MID LEVEL
PRACTITIONERS.
AND WHAT THAT DOES TO YOUR
THROUGHPUT VOLUME AND YOUR WAIT
TIMES THAT INCREASES BECAUSE A
PA OR AN ANTI JUST CAN'T SEE AS
MANY PATIENTS.
AS AN EMERGENCY PHYSICIAN CAM SO
WE THINK OF AN IDEA OF LOOKING
AT QUARTERLY --
SUPPLEMENTAL PAYMENTS BASED ON
CERTAIN UTILIZATION WOULD BE OUR
SUGGESTION TO LOOK AT THOSE HIGH
VOLUME FACILITIES.
AND REALLY TRY TO GET THEM A
LITTLE BIT MORE --
MAINTAIN THEIR STAFFING AT
CURRENT LEVELS THANK YOU THANK
YOU SIR.
THANK YOU MISTER CHAIR MEMBERS
MEGAN SUBER'S HERE ON BEHALF OF
CALIFORNIA HEALTH PLUS ADVOCATES
WHICH REPRESENTS THE OVER
THIRTEEN HUNDRED COMMUNITY
HEALTH CENTERS IN CALIFORNIA.
AND THEY SERVE ABOUT SIX AND A
HALF A LITTLE OVER SIX AND A
HALF MILLION PATIENTS AT THIS
TIME I WANTED TO FIRST THANK THE
DEPARTMENT AND THE PANELISTS --
FOR THE IMPLEMENTATION THIS FAR
ON THE PROP FIFTY SIX EFFORTS
AND WE LOOK FORWARD TO WORKING
WITH THE PREVIOUS PANELISTS AND
SOME OF THE EFFORTS ARE LOOKING
TO TO PURSUE THIS YEAR.
I JUST WANTED TO RAISE ONE ITEM
AS IT RELATES TO PROP FIFTY SIX
AND THAT'S THE VALUE BASED
PAYMENT PROPOSAL WE ARE EXCITED
TO SEE THAT PROPOSAL --
IN THE BUDGET --
BUT AT OUR EARLY CONVERSATIONS
HAVE A SORT OF RAISING QUESTIONS
FOR US ABOUT IF OUR HEALTH
CENTERS WOULD BE ELIGIBLE FOR
THAT THOSE INCENTIVE PROGRAMS --
HEALTH CENTERS PARTICIPATE NOW
WITH THEIR MANAGED CARE PLANS
AND LOTS OF INCENTIVE PROGRAMS
AROUND A CHRONIC DISEASE
MANAGEMENT BEHAVIORAL HEALTH
PROVIDER INTEGRATION --
DIABETES PREVENTION AND THEY'RE
WORKING --
WE HAVE ABOUT FOUR MILLION MEDI
CAL BENEFICIARIES THAT WE SERVE
AND WE FEEL LIKE THIS IS A
POPULATION --
THAT WE SHOULD BE PROVIDING
THESE SORT OF A QUALITY BASED
INCENTIVE PROGRAMS TO SO WE
WOULD LIKE TO JUST AS THIS
PROPOSAL MOVES FORWARD WORK WITH
THE DEPARTMENT AND WITH THE
LEGISLATURE TO BETTER UNDERSTAND --
WHICH PROVIDERS ARE ELIGIBLE
UNDER THE PROGRAM AND HOW WE
MIGHT BE ABLE TO UP TO WORK WITH
THAT PROPOSAL THANK YOU.
THANK YOU MA'AM.
JENNIFER SENATOR BEHALF THE
CALIFORNIA ASSOCIATION OF HEALTH
FACILITIES INCLUDED IN OUR
MEMBERSHIP IS BOTH THE PEDIATRIC
SUB ACUTE FACILITIES THE FREE
STANDING.
ON THAT DID AN EXCELLENT JOB --
SPEAKING ON BEHALF OF THEMSELVES
TODAY AND THEN WE ALSO HAVE THE
NEAR INTERMEDIATE CARE
FACILITIES FOR THE
DEVELOPMENTALLY DISABLED AGES IN
THE ENDS WITH ABOUT FIVE HUNDRED
INCLUDED IN OUR MEMBERSHIP OF
THE AND SEVEN THOUSAND THAT ARE
HEARING CALIFORNIA FORT --
THAT COMMENTS MADE BY BOTH THE
PEDIATRIC SUB ACUTE --
PROVIDERS AND ALSO --
ARE ICY FTD AN H. IN AND
REPRESENTATIVE TODAY I THINK
IT'S IMPERATIVE THAT THE PART
FIFTY SIX FUNDS CONTINUE FOR
BOTH OF THOSE PROVIDERS.
IT'S IMPORTANT TO REMIND FOLKS
HOW.
HOW MUCH A COST EFFECTIVE
PROVIDER BOTH OF THESE ENTITIES
ARE PEDIATRIC SUBACUTE SORRY I'M
A THIRD OF THE COST OF A
INPATIENT HOSPITAL STAY?
THE ICY FTTH IS AN ENDS ARE AN
EXCELLENT COMMUNITY PROVIDER
THAT IS A LICENSED HEALTH CARE
FACILITY --
THAT PROVIDES A HOME LIKE
ENVIRONMENT AT PROBABLY THE
LEAST AMOUNT OF OF COST TO THE
GENERAL FUND --
MEDI CAL MATCHING FUNDS --
MANY THINGS THAT THEY DO WELL
AND THEY'RE ALSO COST EFFECTIVE
PROVIDER SO WE WANT TO EXPRESS
OUR SUPPORT FOR THE CONTINUATION
OF THE PROP FIFTY SIX FUNDS I
THINK IT'S ALSO IMPORTANT TO
NOTE THAT THERE NEEDS TO BE SOME
LONG TERM SOLUTION FOR THESE
PROVIDERS OVER TIME --
THE ICF -- A
SPOKESPERSON TALKED ABOUT THE
FACT THAT --
THEY PAY A QUALITY ASSURANCE FEE --
SKILLED NURSING FACILITIES
GENERALLY THAT'S THE WHOLE I
MEAN THE PEDIATRIC SUB ACUTE SO
I APOLOGIZE --
SAID THAT THEY PAY THEIR THE
QUALITY ASSURANCE EVEN ARE
INCLUDED IN THE RATE --
OVER TIME HEY SHOULD BE PART OF
THAT BUT THEY NEED TO GET THEIR
COSTS RIGHT SIDED THEY NEED A
PERIOD OF TIME WHERE THEY CAN
ADJUST.
AND MOVE INTO A COST BASED
REIMBURSEMENT SYSTEM SO IN BOTH
CASES BOTH TYPES OF PROVIDERS
NEED THEIR RATES AND FROZEN BUT
THEY DO NEED A PLAN TO MAKE SURE
THEY STAY HOLE AND THEY MOVE
FORWARD AND THE PROP FIFTY SIX
FUNDS CAN BE THAT --
THAT SOLUTION FOR A PERIOD OF
TIME BUT I DO THINK WE NEED A
LONG TERM SOLUTION SO THESE
FOLKS CAN BUDGET.
CAN ACTUALLY PROVIDE INCREASES
TO STAFF THAT THEY KNOW THAT
THEY CAN KEEP --
IN CAN HIRE NEW STAFF KNOWING
THAT THEY CAN BUDGET FOR THAT IN
THE FUTURE SO THANK YOU.
THANK YOU MA'AM.
GOOD AFTERNOON CHAIRED LINDA OF
WAY WITH WESTERN CENTER ON LAW
AND POVERTY WERE PLEASED TO SEE
THE VALUE BASED PURCHASING
PROPOSED SO FOCUSED ON QUALITY
OUTCOMES BUT WOULD ALSO
RECOMMEND LOOKING AT REDUCING
HEALTH DISPARITIES --
IN WHAT WE ALSO SUPPORT
RESTORING THE AB NINETY SEVEN
CUTS ARE LEGAL AID.
PARTNERS REPORT TO DIFFICULTY
ACCESSING TRANSPORTATION BOTH
NON EMERGENCY MEDICAL
TRANSPORTATION IN ON MEDICAL
TRANSPORTATION AS WELL AS
DURABLE MEDICAL EQUIPMENT AND SO --
WOULD RECOMMEND AT RESTORING
THOSE CUTS FOR THOSE PROVIDERS --
CONSIDERING THE ACCESS
CHALLENGES AS WELL AS THOSE
SERVICES TEND TO BE UTILIZED BY
OUR SICKEST PATIENTS --
IN ADDITION WE DO --
AGREE WITH THE MONITORING AND
EVALUATION A SPECIFICALLY WE
RECOMMEND SPECIAL ATTENTION BE
PAID TO A SERVICES PROVIDERS IN
GEOGRAPHIC REGIONS WITH KNOWN
SHORTAGES.
ARE LEGAL AID OR PARTNERS NO
DIFFICULTY ACCESSING
ENDOCRINOLOGIST NEUROLOGISTS
ORTHOPEDIC SURGEONS AND DEAD TO
CAL PROVIDERS AS WELL AS OTHER
SPECIALIST.
AND AS WELL AS GEOGRAPHIC AREAS
TO FOCUS ON INCLUDE THE THE
CHAIRS OWN AREA AS WELL AS RURAL
AREAS.
THANK YOU THANK YOU MA'AM.
RETURN MEMBERS BOB BACK ON
BEHALF OF A COUPLE DIFFERENT
PROVIDERS --
VERY BRIEFLY --
RADIOLOGIST PATHOLOGISTS ARE A
PROCEDURE LIST OF THE PROP FIFTY
SIX RELIEF TO DATE IS VERY VERY
NARROWLY APPLY TO SIT OFFICERS A
CODE SO. THOUSAND THE PROCEDURES
ARE PERFORMED BY RADIOLOGISTS
PATHOLOGISTS ORTHOPEDIC SURGEONS
ALL KINDS OF DIFFERENT SESSIONS
HAVE NOT BEEN IMPACTED BY THAT
READY JUSTIN STILL LIVING WITH A
10% CUT.
BUT AS WE ALL KNOW WAS NOT DONE
BECAUSE RATES WERE TOO HIGH
SIMPLY WAS A FISCAL EMERGENCY
SITUATION THAT EXIST AT THE TIME
SO.
REALLY ENCOURAGE YOU TO LOOK AT
RESTORING THAT 10% CUT.
DO WELCOME --
THE EFFORTS OF THE CMA WITH
REGARD TO A SUPPLEMENTAL PAYMENT
FOR HOSTILE THESE POSITIONS --
WELL I THINK WE WOULD ENCOURAGE
YOU TO LOOK AT THOSE RATES IN
TERMS OF WHAT THE CURRENT
PERCENTAGES AS OPPOSED TO CAN
YOU REACH INCREASED LEVELS.
OF A PATIENT LOAD.
OF THOSE WAS USED DON'T CAN.
AS MR BAN SAID IF YOU'RE PATIENT
BASIS VERY HIGH MEDI CAL ALREADY
THE SUPPLE PAYMENT SHOULD BE
DIRECTED MORE TOWARDS YOU THEN
SOMEONE WAS LOW VERY LOW
PERCENTAGE.
SO THAT'S OF THE POSITION SIDE --
ON THE DMV SIDE TROUBLE MEDICAL
EQUIPMENT ON BEHALF OF THE
CALIFORNIA ASSOCIATION MEDICAL
PRODUCTS SUPPLIERS TWO YEARS AGO
WE WARNED YOU ABOUT THE PENDING
IMPACT OF THE DME CUTS THAT WERE
COMING AS RESULT OF MEDICARE
COMPETITIVE BIDDING.
RATES FOR DMA HAVE BEEN GOING
DOWN IT WILL GO DOWN FURTHER
UNDER SPOT IT WAS SUBMITTED --
IN JANUARY BY THE DEPARTMENT
VERY CONCERNED ABOUT THE IMPACT
ON ACCESS THEY HAVE A 10% CUT IN
EFFECT AS WELL --
KNOW WHAT 80% OF MEDICARE WOULD
MEDICARE RATES ARE TRENDING
DOWNWARD AT A RAPID PACE --
INSTILL CITY TO RECOUP GOING
BACK THREE YEARS SO THIS
PROVIDERS ARE HAVING A PAYMENTS
RECLAIMED FROM PRIOR PAIN WAS
THE SAME TIME SO --
CCS REPORT FROM LUCILLE PACKARD
SHOW THE THE IMPACT ON CCS
PATIENT ACCESS TO THE ENEMY
DELAYS IN GETTING EQUIPMENT
DELAYS AND FINING PROVIDERS.
NUMBER ROOFTOPS IN CALIFORNIA
HAS DECLINED BY 40% IN THE LAST
TWO YEARS OR CMA NUMBERS
SOURCING IMPACT ON ACCESS REALLY --
WELCOME THE OPPORTUNITY TO
EXPLORE THE NEED TO ADJUST THOSE
RATES THANK YOU THANK YOU SIR.
THANK YOU TURN MEMBERS ON THE
TENER WITH ON BEHALF OF THE
CALIFORNIA PAN ETHNIC HEALTH
NETWORK WE ARE APPRECIATIVE OF
THE GOVERNOR'S PROPOSAL TO USE
PROP FIFTY SIX DOLLARS. TO
DELIVER IMPROVED OUTCOMES IN THE
MEDICAL PROGRAM HOWEVER WE
BELIEVE PROVIDER INCENTIVE
SHOULD BE REWARDED BASED ON
REDUCING DISPARITIES ACROSS
CONDITIONS.
OF BY RACE ETHNICITY LANGUAGE
SOCIO ECONOMIC FACTORS AT CETERA
OUR CONCERN IS NOT SHARED A
CERTAIN PART PATIENT POPULATION
DO TREMENDOUSLY BETTER THAN
OTHER POPULATIONS.
THAT MAY APPEAR TO BE AN
INDICATION OF OVERALL
IMPROVEMENT AND REALLY MASK THE
WORSENING OF CONDITIONS FOR
OTHER GROUPS --
SO THOSE ARE THE KINDS OF TRENDS
THAT WE DON'T WANT TO SO LAST
LEE IS WE ANTICIPATE TRAILER
LANGUAGE YOU WE WOULD URGE A
REQUIREMENT FOR DH CS TO WORK
WITH STAKEHOLDERS IN CRAFTING.
THE METHODOLOGY SO THAT WE CAN
REALLY --
BASS AND IMPROVEMENTS IN
OUTCOMES OFF OF DEMOGRAPHIC
INEQUITIES THANK YOU SO MUCH
THANK YOU MA'AM.
MICHELLE GIVENS OF THE COUNTY
HEALTH EXECUTIVES ASSOCIATION OF
CALIFORNIA WE REPRESENT LOCAL
HEALTH DEPARTMENTS THROUGHOUT
THE STATE AND WE JUST WANTED TO
EXPRESS OUR APPRECIATION SUPPORT.
FOR AND THE GOVERNOR'S PROPOSAL
TO USE PROPOSITION FIFTY SIX
FUNDING FOR BOTH ON THE
DEVELOPMENTAL SCREENINGS AND THE
TRAUMA SCREENINGS RETICULAR
EARLY ON THE TELESCREENS RATE
WE'RE EXCITED TO KNOW THAT --
TERM IS GOING TO BE IDENTIFIED
IN INDIVIDUALS BOTH CHILDREN AND
ADULTS AND THAT AS WE DO
IDENTIFY MORE THESE ISSUES WILL
BE ABLE TO BUILD --
THE SUPPORTS AROUND THEM AND
ALSO -- LOOK
AT FROM A GLOBAL PERSPECTIVE
ABOUT HOW HOW WE CAN BUILD
SYSTEMS IN IN OUR COMMUNITIES
I'M FROM A PUBLIC HEALTH
PERSPECTIVE TO AVOID SOME OF
THESE TRAUMAS FROM HAPPENING
THANK YOU.
THANK YOU SO MUCH.
SEEING NO FURTHER PUBLIC COMMENT
ON BRING IT UP TO THE DIES FOR
ANY COMMENTS WE MAY HAVE ON
ISSUE.
FIVE SEEING NONE FROM OTHER
MEMBERS I DO JUST WANT TO ECHO
SOME OF THE PROPOSAL FROM CMA
PARTICULARLY REGARDING HOSPITALS.
JUST HAVING PRACTICED IN THAT
SETTING I KNOW THAT THEY PLAY A
KEY ROLE IN.
HOW WE DELIVER HEALTHCARE AND IT
IS IMPERATIVE I DO WANT TO SEE
MORE DETAILS SPECIFICALLY
REGARDING THE CODE COLLAPSE AND
JUST WILL FOLLOW UP?
AGAIN WITH THE DEPARTMENT IF I
CAN.
AND WE WERE VERY INTENTIONAL ON
WHO WE TO THIS SECOND PANEL.
AND JUST WANT TO MAKE SURE TO
EXPRESS MY SUPPORT PARTICULARLY
TO SEE MTA --
AND BEING ONE OF THE MORE RURAL
PARTS OF OUR STATE HOW WE
TRANSPORT AND SEEK SERVICES IS
QUITE IMPORTANT.
BUT I'M ENCOURAGED BY WHAT WE'RE
SEEING OUT OF PROP FIFTY SIX ON
THE WORK THAT WAS DONE BY THE
DEPARTMENT.
PARTICULARLY I WANT TO
ACKNOWLEDGE THEM FOR THEIR LOAN
REPAYMENT PROGRAM ONE THAT I'M
EXCITED ABOUT AND REALLY DO
THINK WE SHOULD TAKE AN ACCESS
FUNDS THAT ARE NOT SPENT IN THE
CURRENT WAY AND LOOK TOWARDS
BOTH THE REPROGRAM --
THE LOAN REPAYMENT FOR
PHYSICIANS AS WELL AS THE
RELOCATION THAT OCCURS FOR
DENTISTS TO MAKE SURE WE HAVE
PROVIDERS THAN THE RIGHT PARTS
OF OUR STATE.
BUT WE HAVE NOT SEEN THE END OF
THIS AND I LOOK FORWARD TO THESE
DISCUSSIONS GOING ON THROUGHOUT
THE REST OF THE YEAR.
THE WITH THAT WILL HOLD ISSUE
FIVE OPEN.
SEEING AS HOW ISSUE SIX AND
THIRTEEN ARE NON DISCUSSION
ITEMS ACTUALLY GOING TO LOOK TO
SEE IF ANY OF YOU HAVE.
ANY OF THE NON DISCUSSION ITEMS
YOU WANT TO BRING UP.
IF NOT THE ONLY ONE I WANTS TO
FLAG IS ITEM OR ISSUE.
EIGHT ON THE AGENDA --
WHICH IS THE CHILD LEAD
POISONING PREVENTION.
THERE'S A B. C. P. THAT WE WILL
BE HEARING ON APRIL TWENTY NINTH
BUT I JUST WANTED TO ASK THE ITS
THE US.
WHEN IT WILL BE PROVIDING THE
DEPARTMENT OF THE MEDI CAL
ELIGIBILITY DATA?
PER THE REQUIREMENTS OF THE BILL
AND IF I CAN HAVE YOU FOLLOW UP
WITH MY OFFICE.
ITS THE ONLY --
ISSUE IN THAT THAT I FELT LIKE I
NEEDED TO BE ADDRESSED.
BUT WITH THAT WE WILL HOLD
ISSUES SIX THROUGH THE
THIRTEENTH.
OPEN AND WILL NOW TAKE ANY
PUBLIC COMMENT THAT WE HAVE ON
ISSUES SIX THROUGH.
THIRTEEN MR CHAIRMAN MEMBERS OF
FRED MAIN ONBEHALF OF CAL PACE
THE PROGRAM FOR THE ALL
INCLUSIVE CARE. FOR THE ELDERLY
WE JUST WANTED TO THANK THE
ADMINISTRATION FOR THAT TOO
BCP'S.
I CAL PAGE PRO OUR PACE PROGRAMS
ARE GROWING UP QUITE FAST IN THE
STATE AND BCP'S WILL ALLOW THE
DEPARTMENT --
TO DO THE ANALYSIS AND REVIEW OF
THE APPLICATIONS TO MAKE SURE
THAT THEY CAN MOVE THROUGH THE
PROCESS.
EXPEDITIOUSLY WE'RE WORKING WITH
THE DEPARTMENT AT THE SAME TIME
TO SEE WHERE WE CAN ELIMINATE
REDUNDANCIES IN THAT APPROVAL
PROCESS AND WE LOOK FORWARD. TO
KEEPING THE COMMITTEE UPDATED
ABOUT THAT AS WELL AS THEY
CONTINUE TO WORK WITH DEPARTMENT
SECOND.
ON BEHALF OF THE PEDIATRIC AND
WE WANT TO THANK THE DEPARTMENT
FOR EXTENDING THE INCREASED
PAYMENTS THE COMMITTEE WORKED ON
THAT VERY --
IT'S HARD A LAST YEAR AND WE
THANK THE COMMITTEE ARE THAT --
DEPARTMENT FOR CONTINUING THAT
THANK YOU THANK YOU SIR.
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY WE SUPPORT THE
B. C. P. ON CHILDHOOD LEAD
POISONING AND WE SUPPORTED THE
BILL AS ON THE THE NUMBER OF
MEDI CAL CHILDREN.
ARE BEING TESTED FOR BLOOD LEAD
POISONING IS FAR LESS THAN THE
THE MANDATE A WHICH IS THAT ALL
CHILDREN --
TWELVE AND FOR TWENTY FOUR
MONTHS BE TESTED IN ADDITION WE
ALSO SUPPORT THE EXTENSION OF
THE HEALTH HOME PROGRAM FUNDING
TRAILER.
BILL LANGUAGE --
THE THE PROGRAM --
DUE TO DELAYED IMPLEMENTATION --%
SO --
EXTENDING THAT WOULD WOULD
ENSURE THAT THE TO TO CONTINUE.
THANK YOU.
THANK YOU MA'AM.
SEEING NO FURTHER PUBLIC COMMENT
THAT WILL CONCLUDE TODAY'S
SOMEONE HERE.
THANK YOU VERY MUCH