HAN SOMETHING BUDGET
SUBCOMMITTEE ONE ON HEALTH AND
HUMAN SERVICES TO ORDER.
TODAY IS MONDAY APRIL TWENTY
SECOND.
ALL RIGHT LET'S START WITH ISSUE
NUMBER ONE OF BEFORE WE BEGIN I
DO WANT TO REMIND EVERYONE THAT --
I ELSE THAT THE WITNESSES --
LIMIT THEIR COMMENTS TO TWO TO
THREE MINUTES -- WHEN WE TAKE
PUBLIC COMMENT I WOULD ASK THAT
YOU LIMIT YOUR COMMENTS TO ONE
MINUTE?
I THANK YOU VERY MUCH.
ISSUE NUMBER ONE ARE SPARED
DEPARTMENT AND BUDGET OVERVIEW.
I DOUBTS THAT WE TESTIFY IN THE
ORDER OF THE LISTED IT AT FOR
THE PANELISTS BEGINNING WITH
ROBERT DAVID.
I THANK YOU MEDICARE -- I'M
ROBERT DAVID DEAD DIRECTOR
OFFICE OF STATEWIDE HEALTH
PLANNING.
USE ME IF YOU WOULD PLEASE WE
ARE CONVENING AS A SUB.
COMMITTEE OF THE SUB COMMITTEE --
BECAUSE CLEARLY I DON'T HAVE A
QUORUM.
A SHALLOW BEGINNER WOULD YOU
LIKE. TO BE IN THANK YOU -- AT
THE OFFICE STATEWIDE HEALTH
PLANNING AND DEVELOPMENT ARE
POSH PAD ADVANCES CALIFORNIANS
ACCESS TO SAFE HEALTHY QUALITY.
HEALTHCARE ENVIRONMENTS BY
FOCUSING IN THREE PRIMARY AREAS
HEALTHCARE WORKFORCE DEVELOPMENT.
HEALTH CARE DATA COLLECTION AND
REPORTING AND HEALTH CARE
CONSTRUCTION AND FINANCING.
OUR NINETEEN TWENTY PROPOSED
BUDGET IS ONE HUNDRED AND NINETY
NINE POINT SEVEN MILLION.
ABOUT 42% OF OUR SPEEDS BUDGET
IS GENERAL FUND THE REST IS VERY
SPECIAL FUNDS MANY WHICHER FEES
SUPPORTED.
AND WE HAVE A SMALL AMOUNT OF
FEDERAL FUNDING ABOUT ONE POINT
FIVE MILLION FOR WORKFORCE
PROGRAMS.
OUR HEALTHCARE WORKFORCE
DEVELOPMENT DIVISION AND HEALTH
PROFESSIONS EDUCATION FOUNDATION
FOCUS ON WORKFORCE DEVELOPMENT
OF HEALTH PROFESSIONALS -- THEY
SEEK TO INCREASE ACCESS TO
HEALTHCARE FOR UNDERSERVED
COMMUNITIES.
AND POPULATIONS BY INCENTIVIZING
A DIVERSE AND CULTURALLY AND
LINGUISTICALLY COMPETENT HEALTH
CARE WORKFORCE -- WE FOCUS ON
RECRUITING REACHED RETAINING
VARIOUS HEALTH PROFESSIONALS IN
AREAS OF UNMET NEED -- WE
INCREASE THE GEOGRAPHIC
DISTRIBUTION OF CALIFORNIA'S
HEALTH CARE WORK FORCE AND WE
EXPLORE NEW SERVICE DELIVERY
MODELS.
A ONE OF OUR PRIMARY HEALTH CARE
A WORKFORCE PROGRAMS IS THE SONG
BROWN PROGRAM.
SOME RANDOM WORDS FUNDING TO
HEALTHCARE TRAINING AND
RESIDENCY PROGRAMS TO INCREASE
ACCESS TO HEALTHCARE PROVIDERS
IN UNDERSERVED AREAS.
OF THIS IS DONE THROUGH THE
RECRUITMENT OF UNDER REPRESENTED
MINORITIES THROUGH CLINICAL
TRAINING IN AREAS OF UNMET NEED
AND THROUGH GRADUATE PLACEMENT
OF HEALTH CARE PROFESSIONALS IN
THOSE AREAS OF UNMET NEED -- ICE
BEDS IN THE SECOND YEAR OF
IMPLEMENTING A SERIES OF ONE
TIME THIRTY THREE POINT THREE
MILLION GENERAL FUND
AUGMENTATIONS FOR THE SONG BROWN
PROGRAM.
OF THE GOVERNOR HAS A PROPOSAL
IN THIS AREA I WHICH WILL SPEAK
TO IN THE NEXT AGENDA ITEM --
OUR INFORMATION SERVICES
DIVISION SERVES AS A HEALTHCARE
DATA COLLECTION AND REPORTING
HUB.
WE COLLECT HEALTHCARE DATA FROM
NEARLY SIX THOUSAND HEALTHCARE
FACILITIES.
OTHER SUPERVISED AND OVERSEEN BY
THE DEPARTMENT OF PUBLIC HEALTH.
A WE MAKE MUCH OF THE STATE
AVAILABLE TO THE PUBLIC -- THE
MEDIA AND POLICY MAKERS -- WE DO
REPORTS ON HEALTH CARE OUTCOMES
AND QUALITY -- WE'VE ALSO IN
THIS I KNOW OF IS OF INTEREST TO
A LEGISLATURE UP IN IMPLEMENTING
A COST TRANSPARENCY PRESCRIPTION
DRUG PRICE PROGRAM.
AND SINCE -- JANUARY FIRST.
TO OF THIS YEAR PHARMACEUTICAL
COMPANIES HAVE BEEN PROVIDING
SIXTY DAY NOTIFICATIONS DIRECTLY
TO SPECIFIED REGISTERED
PURCHASERS.
WHEN A DRUGS COST INCREASES
ABOVE A CERTAIN THRESHOLD?
AND EARLIER THIS MONTH THE US
PAID BEGAN PROVIDING QUARTERLY
REPORTS FOR MANUFACTURERS
IDENTIFYING NEW DRUGS THAT WERE
INTRODUCED TO MARKET ABOVE A
CERTAIN COST.
IN JUNE OF THIS YEAR US PEDAL
PROVIDE ADDITIONAL QUARTERLY
REPORTS FROM MANUFACTURERS.
THAT PROVIDE ADDITIONAL
INFORMATION ABOUT THE INCREASES
TO EXISTING DRUGS.
THAT HAVE BEEN SUBJECT TO THE
NOTIFICATION REQUIREMENT -- TO
PURCHASERS.
I WE'VE ALSO BEEN IMPLEMENTING
ANOTHER COST TRANSPARENCY
PROGRAM THE HEALTH CARE PAYMENTS
DATA PROGRAM A PURSUANT TO LAST
YEAR'S BUDGET ACT -- WERE
RESPONSIBLE FOR CONVENING A
REVIEW COMMITTEE. TO ADVISE US
SPREAD ON THE DEVELOPMENT AND
ESTABLISHMENT AND IMPLEMENTATION --
OF A STATEWIDE HEALTH CARE COST
TRANSPARENCY DATABASE WHICH IS
SOMETIMES CALLED IN ALL PAYER
CLAIMS DATABASE.
OTHER REVIEW COMMITTEE DID
CONVENE IN MARCH AND HAS HAD
THEIR SECOND MEETING JUST LAST
WEEK -- WITH THE ASSISTANCE OF
THE REVIEW COMMITTEE -- WE WILL
PROVIDE A REPORT TO THE
LEGISLATURE BY JULY FIRST OF
NEXT YEAR ON ITS RECOMMENDATIONS
FOR THE IMPLEMENTATION OF THE
DATABASE.
AND WE ARE ON TRACK -- OSP IS
THE BUILDING DEPARTMENT FOR
CALIFORNIA'S HOSPITALS AND
SKILLED NURSING FACILITIES -- WE
ADMINISTER THE HOSPITAL SEISMIC
SAFETY PROGRAM FOCUSED ON
STRENGTHENED CALIFORNIA'S
HOSPITAL BUILDINGS.
SO THEY CAN REMAIN OPERATIONAL
IN THE EVENT OF AN EARTHQUAKE OR
OTHER DISASTER.
A TODAY -- I WANT TO STRESS THAT
MORE THAN 95%.
OF ACUTE CARE HOSPITAL BUILDINGS
IN THE STATE NOW COMPLY WITH THE
SEISMIC SAFETY ACTS.
TWENTY TWENTY EARTHQUAKE
COLLAPSE STANDARD MEETING THEIR
RATED -- TO REMAIN STANDING
AFTER STRONG EARTHQUAKE.
BY TWENTY THIRTY THE STANDARD
WILL BE THAT ALL ACUTE CARE
BUILDINGS MUST BE CAPABLE OF
CONTINUOUS OPERATIONS.
AFTER STRONG EARTHQUAKE.
AND WITH RESPECT TO THAT TWENTY
TWENTY STANDARD LAST YEAR'S --
ASSEMBLY BILL TWENTY ONE NINETY
BY CHAIR RAY AS A PROVIDES FOR
AN EXTENSION OF UP TO THREE
YEARS FOR RETROFITTING OR
REMOVING SERVICES AND UP TO FIVE
YEARS FOR NEW CONSTRUCTION.
HOSPITALS HAD UNTIL APRIL FIRST
OF THIS YEAR. TO SUBMIT AN
APPLICATION FOR AN EXTENSION TO
THE JANUARY ONE TWENTY TWENTY
DEADLINE.
AND WE HAVE RECEIVED
APPLICATIONS FOR EIGHTY FIVE
BUILDINGS ARE REVIEWING THOSE
RIGHT NOW.
I AND THEN FINALLY -- ARE CAL
MORTGAGE PROGRAM PROVIDES HEALTH
FACILITY CONSTRUCTION LOAN
INSURANCE TO NON PROFIT AND
GOVERNMENT FACILITIES AT NO COST
TO TAXPAYERS -- IT ASSIST
CALIFORNIA'S NONPROFIT AND
PUBLIC HEALTH FACILITIES TO GAIN
ACCESS TO LOW COST FINANCING.
FOR THEIR CAPITAL CONSTRUCTION
NEEDS -- AS OF DECEMBER THE
PROGRAM'S INSURANCE PORTFOLIO
CONSISTED OF ONE POINT EIGHT
BILLION DOLLARS IN LOANS. FOR
EIGHTY FACILITY PROJECTS
THROUGHOUT THE STATE.
THAT CONCLUDES MY PRESENTATION --
IF THERE ANY QUESTIONS FOR ME OR
WE CAN MOVE ON TO THE NEXT ITEM.
RELATED -- TO GENERAL FUND FOR
HEALTH CARE WORKFORCE PROGRAMS.
UNLESS THERE IS A QUESTION I
THINK WE'RE GOING TO HOLD
QUESTIONS UNTIL -- AFTER THE THE
THIS PARTICULAR ISSUES PRESENTED
COMPLETELY [inaudible]
THANK YOU.
GOOD AFTERNOON CHAIR MEMBERS OF
THE COMMITTEE MY NAME IS USUALLY
HOWARD AND THE DEPUTY DIRECTOR
OF THE HEALTH CARE WORKFORCE
DEVELOPMENT DIVISION -- I WILL
DEFINITELY STAY WITHIN TWO TO
THREE MINUTES -- THE GOVERNOR'S
BUDGET PROPOSES AN ONGOING
ALLOCATION OF THIRTY THREE POINT
THREE MILLION -- PER YEAR -- AND
I'M GOING FUNDING STARTING IN
FISCAL YEAR -- TWENTY TWENTY
TWENTY ONE THIS WOULD MAKE ON
GOING THE ALLOCATION THAT
STARTED IN FISCAL YEAR SEVENTEEN
EIGHTEEN WERE AND THE SECOND
HERE THAT IN EIGHTEEN NINETEEN
AND WE HAVE ONE MORE YEAR AND
NINETEEN TWENTY THESE FUNDS
SUPPORT THE SONG BROWN PROGRAM
WHICH AIMS TO ADDRESS A SHORTAGE
IN MAIL.
DISTRIBUTION OF PRIMARY CARE
PROVIDERS ENDEAVOR SYFY THE
HEALTHCARE WORKFORCE.
SOME MAN PROGRAM TARGETS FUNDING
GOING TO RESIDENCY PROGRAMS AND
TRAINING PROGRAMS THAT
DEMONSTRATE SUCCESS AND LOCATING
PRACTICE SITES AND MEDICALLY
UNDERSERVED AREAS PLACING
GRADUATES AND MEDICALLY
UNDERSERVED AREAS.
AND ATTRACTING AND ADMITTING
MEMBERS OF UNDERREPRESENTED
GROUPS IN SEVENTEEN EIGHTEEN THE
SONG BROWN FUND SUPPORTED A
TOTAL OF SIXTY TWO RESIDENCY
PROGRAMS. FIVE HUNDRED FIFTY
SEVEN FIRST YEAR RESIDENTS AND
INCREASE THE NUMBER OF FIRST
YEAR RESIDENTS BY.
SEVENTY TWO THESE FUNDS ALSO
SUPPORTED THE EXPANSION OF TEN
NEW RESIDENCY PROGRAMS.
THAT CONCLUDES MY PRESENTATION.
YOU'RE RIGHT THE RECORDED A VERY
BRIEF [inaudible]
NEXT PLEASE.
FINANCE DOES NOT A COMMON -- BEN
JOHNSON WITH THE LEGISLATIVE
ANALYST'S OFFICE I JUST NOTE
THAT -- WE ARE CURRENTLY
PERFORMING AN EVALUATION OF THE
GOVERNOR'S WORKFORCE RELATED
PROPOSALS AT THE REQUEST OF THE
SUBCOMMITTEE IS.
HERE TODAY AS WELL AS THE
SUBCOMMITTEE ON EDUCATION --
WHICH ASKS THE LA -- TO EVALUATE
WORKFORCE PROPOSALS IN LIGHT OF
THE COMMISSION'S REPORT AND AND
AS PART OF THAT PROJECT OUT WE
ARE LOOKING INTO THE GOVERNOR'S
PROPOSALS AND WILL.
DELIVER ANALYSIS -- IN THE
FORTHCOMING WEEKS SO HAPPY TO
TAKE ANY.
FOLLOW UP QUESTIONS BUT THANK
YOU.
ANY QUESTIONS COMMENTS.
RIGHT IN ANY PUBLIC COMMENT ON
ISSUE NUMBER.
ONE THANK YOU MADAM CHAIR
MEMBERS MEGAN SUPERS ON BEHALF
OF CALIFORNIA HEALTH PLUS
ADVOCATES THE REPRESENTING THE
THIRTEEN HUNDRED COMMUNITY
HEALTH CENTERS AND CLINICS IN
CALIFORNIA.
IN STRONG SUPPORT OF THE
ADMINISTRATION'S PROPOSAL TO
MAKE THE THIRTY THREE MILLION
DOLLARS ON GOING FOR THE SONG
BROWN PROGRAM.
A COMMUNITY HEALTH CENTERS IN
CALIFORNIA HAVE SIX OPERATIONAL
TEACHING HEALTH CENTERS WHERE
THE RESIDENCY PROGRAM IS
CENTERED.
IN A HEALTH CENTER AND THEY
STILL DO THEIR ROTATIONS THROUGH
ALL THE OTHER OF SETTINGS BUT
THEY THEIR RESIDENCY PROGRAM IS
CENTERED IN THE WHOLE CENTER AND
WE'VE SEEN THIS PROGRAM WORK.
AND BE ABLE TO RETAIN -- THESE
DOCTORS AND HEALTH CENTERS WHICH
IS REALLY IMPORTANT AND SO WE'RE
IN VERY STRONG SUPPORT OF THAT
PROPOSAL THANK YOU [inaudible]
THANK YOU.
GOOD AFTERNOON LEN ACKERMAN TO
THE LOCAL HEALTH PLANS OF
CALIFORNIA IN SUPPORT OF
CONTINUING THE WORK FORCE
FUNDING THANK YOU.
THANK YOU.
GOOD AFTERNOON AND JDS HERE ON
BEHALF OF HEALTH ACCESS
CALIFORNIA THE STATE WIDE HEALTH
CARE CONSUMER ADVOCACY COALITION
WE SUPPORT THE ADMINISTRATION'S
PROPOSAL ESPECIALLY AS IT
RELATES TO THE IMPLEMENTATION OF
SB SEVENTEENS PRESCRIPTION DRUG
COSTS TRANSPARENCY AS WELL AS
THE HEALTHCARE COSTS -- PAYMENTS
DATABASE THAT HELP ACCESS IS
ALSO ENGAGE WITH IT THANK YOU
[inaudible]
THANK YOU.
Q. MAYOR MARTIN HERE ON BEHALF
OF THE CALIFORNIA CHILDREN'S
HOSPITAL ASSOCIATION I WE DO
SUPPORT THE ADMINISTRATION'S
PROPOSAL TO EXTEND FUNDING TO
SONG BROWN BUT WE WILL BE.
PRESENTING A MODIFICATION TO
THAT PROPOSAL AT THE MAY SIXTH
HEARINGS I JUST WANTED TO FLAG
THAT HERE.
IN RECENT YEARS A LOT OF THAT.
PATRICK RESIDENCY PROGRAMS OF A
RECEIVING MUCH LESS OF A
PERCENTAGE OF THE FUNDING TO
SONG BROWN AT THE SAME TIME AS
THE FUNDING HAS INCREASED.
AND SO WE'RE GOING TO PROPOSE TO
CARVE OUT OF ABOUT 10% OF THAT
FUNDING THREE POINT TWO MILLION
FOR PEDIATRIC PROGRAMS AND
INCREASE THE FUNDING TO THIRTY
FIVE MILLION TO DO THAT WITHOUT
PULLING MONEY AWAY FROM OTHER
RESIDENCY TYPES.
SO TALK ABOUT THAT MORE DETAILS
IN A FEW WEEKS BUT I JUST WANTED
TO SPEAK IN SUPPORT OF IT TODAY
THANKS.
THANK YOU.
BARBARA GLAZER WITH THE
CALIFORNIA HOSPITAL ASSOCIATION
IN SUPPORT OF THE OSP HAD
PROPOSAL IN PARTICULAR THE
THIRTY THREE MILLION GOING TO
THE SONG BROWN PROGRAM IN THE
CONTINUATION OF THAT FUNDING.
THANK YOU.
KELLY BE MY BEHALF THE
CALIFORNIA MEDICAL ASSOCIATION
WE ARE ALSO SUPPORTIVE OF THE
GOVERNOR'S PROPOSALS TO FIND ON
GOING INVESTMENTS ADDRESSING THE
HEALTHCARE WORKFORCE SHORTAGES.
AND I'M BEING PART OF THOSE
DISCUSSIONS MOVING FORWARD THANK
YOU THANK YOU.
WITH A FOLDER WITH A CALIFORNIA
KARAMEA FAMILY PHYSICIANS ALSO
IN SUPPORT OF THE HARSH PET
PROPOSAL PARTICULARLY THE THIRTY
THREE POINT THREE MILLION
DOLLARS FOR ON GOING S
OWN FUNDING WHICH IS
ABSOLUTELY ESSENTIAL TO SUPPORT.
FAMILY MEDICINE AND OTHER
PRIMARY CARE RESIDENCY PROGRAMS
[inaudible]
THANK YOU.
I DO WANT TO THANK YOU FOR FOR
THE THE OVERVIEW AS WELL AS THE
COMMENTS ON EACH OF THE SPECIFIC
AREAS.
AND YOU HAVE COVERED ALL OF THE
COMMENTS THAT THAT THE STAFF TO
PROVIDE TO YOU THANK YOU VERY
MUCH THE MANAGER.
IT IS ASSEMBLYMEMBER SALAS HERE.
ALL RIGHT WE WILL COME BACK.
TO ISSUE NUMBER -- TWO LET'S
MOVE ON TO ISSUE NUMBER.
THREE MSA DEPARTMENT AND BUDGET
OVERVIEW [inaudible]
WHEN [inaudible]
GOOD AFTERNOON.
GOOD AFTERNOON -- MADAM CHAIR
MEMBERS -- I'M DAN SMILEY.
CHIEF DEPUTY DIRECTOR OF THE
CALIFORNIA REGENCY MEDICAL
SERVICES AUTHORITY -- THE
GOVERNOR'S PROPOSED BUDGET FOR
TWENTY NINETEEN TWENTY RELEASED
IN JANUARY INCLUDES EXPENDITURE
AUTHORITY THE AMOUNT OF THIRTY
FOUR MILLION DOLLARS AND SEVENTY
SIX PERMANENT POSITIONS.
OF THIS AMOUNT FIFTEEN MILLION
OR 44% IS DESIGNATED FOR STATE
OPERATIONS AND EIGHTEEN POINT
NINE MILLION OR 56%.
IS FOR LOCAL ASSISTANCE.
LIAM EMERGENCY MEDICAL SERVICES
SYSTEM IN CALIFORNIA WAS CREATED
IN NINETEEN EIGHTY ONE IN THE
HEALTH AND SAFETY CODE WITH THE
INTENT OF CREATING A STATEWIDE
EMS SYSTEM.
THE NSF ALREADY IS RESPONSIBLE
FOR THE COORDINATION INTEGRATION
OF ALL STATE ACTIVITIES TO
ENSURE THE PROVISION AFFECTED
INEFFICIENT EMERGENCY MEDICAL
CARE OUR GOAL IS SIMPLY TO
ORGANIZE.
EMERGENCY CARE SYSTEMS WITHIN
CALIFORNIA TO PROVIDE HIGH
QUALITY PATIENT CARE.
IN CALIFORNIA THERE SIXTY THREE
THOUSAND EMTS AND TWENTY THREE
THOUSAND PARAMEDICS THE RESPOND
TO MORE THAN SIX MILLION
EMERGENCY CALLS FOR EMERGENCY
MEDICAL CARE ANNUALLY.
OF THOSE -- PERSONNEL THERE
ABOUT THIRTY EIGHT HUNDRED OF
AMBULANCES AND NINETY AIR
AMBULANCES THAT RESPOND AS PART
OF THAT SYSTEM.
OF THOSE RESPONSES ABOUT FOUR
MILLION PATIENTS ARE TRANSPORTED
TO THREE HUNDRED HOSPITALS --IN
CALIFORNIA THAT RECEIVING MS
PATIENTS.
IN OUR OVERSIGHT ROLE WITH THE
M. S. OF FORTY WE ALSO DEVELOP
SPECIALTY CARE SYSTEMS -- SO
MANY OF THE THREE HUNDRED
HOSPITALS ALSO HAVE SPECIALLY
DESIGNATIONS INCLUDING TRAUMA
CENTERS.
HEART ATTACKS CENTERS STROKES
CENTERS PEDIATRIC CENTERS AND WE
ALSO OPERATE A POISON CONTROL
SYSTEM -- EMSA AS A DEPARTMENT
HAVE FALLS AND OUR ACTIVITIES%
FALL INTO THREE MAJOR ACTIVITIES.
FIRST YOU MUST PERSONNEL IN PRE
HOSPITAL EMERGENCY SERVICES --
THIS IS ONE PIECE OF THE
INTEGRATED NETWORK THAT PROVIDES
ONE OF A MAJOR HEALTH CARE
SAFETY -- NETS TO EMERGENCY CARE
VICTIMS.
OF PRE HOSPITAL NINE ONE ONE
SERVICES ARE WIDELY SEEN BY THE
PUBLIC AS A GUARANTEED MEDICAL
SERVICE REGARDING INSURANCE
REGARDLESS OF INSURANCE STATUS --
IS SPECIFICALLY THE MS OF COREY
IS RESPONSIBLE FOR SETTING THE
SCOPE OF PRACTICE TRAINING
STANDARDS AND REGULATIONS FOR
EMTS AND PARAMEDICS -- AND THE
LICENSURE PROCESS AND ANY
DISCIPLINARY PROCESS THAT MIGHT
BE NECESSARY WE ALSO OVERSEE
PUBLIC SAFETY FIRST AID TRAINING
STANDARDS AND REGULATIONS
INCLUDING TACTICAL MEDICAL CARE.
AUTOMATED EXTERNAL
DEFIBRILLATION EPINEPHRINE FOR
ALLERGIC.
REACTIONS NALOXONE FOR NARCOTIC
OVERDOSE AND CPR STANDARDS --
FOR VARIOUS LEVELS OF PRE
HOSPITAL AND EMERGENCY RESPONSE
PERSONNEL.
IMPORTANT INITIATIVE FROM THE M.
S. OF FORTY IS REGARDING THE
ROLE OF COMMUNITY PARAMEDICS AS
PART OF A OFFER THE STATEWIDE
HEALTH PLANNING AND DEVELOPMENT
WORK FORCE PILOT PROJECT --
WE'VE BEEN OVER THE LAST SEVERAL
YEARS TESTING AND EVALUATING THE
USE OF PARAMEDICS IN THIS
EXPANDED MOBILE HEALTH CARE ROLE
TO FILL SOME OF THE GAPS IN THE
LOCAL HEALTH CARE SYSTEM.
AND IMPROVE ACCESS AND
INTEGRATION OF CARE.
OUR SECOND MAJOR -- COMPONENT OF
THE MS FORTY IS A COMPREHENSIVE
EMS SYSTEM ORGANIZATION AND
MANAGEMENT ROLE -- WE REVIEW AND
APPROVE PLANS FOR EMERGENCY
MEDICAL SERVICES THERE
IMPLEMENTED AND OPERATED BY --
THIRTY THREE GENERALLY COUNTY
BASED LOCAL EMS AGENCIES -- AS
PART OF THAT LOCAL SERVICE --
THE THE LOCAL EMS AGENCIES ARE
RESPONSIBLE FOR THE SELECTION OF
AMBULANCE PROVIDERS AND THE
DESIGNATION OF SPECIALTY
HOSPITALS AS NECESSARY AND AS
NECESSARY IN THEIR LOCAL SYSTEM.
FINALLY OUR THIRD MAJOR AREA OF
RESPONSIBILITY IS TO COORDINATE
MEDICAL RESPONSE DURING
DISASTERS.
IN COOPERATION WITH THE OFFICE
OF EMERGENCY SERVICES AND THE
DEPARTMENT OF PUBLIC HEALTH --
WE TOGETHER BUILD A PUBLIC
HEALTH AND MEDICAL RESPONSE
INFRASTRUCTURE FOR ANY TYPE OF
EMERGENCY -- IN PARTICULAR --
DURING THE CAMPFIRE AND OTHER
FIRES WE SUPPORTED LOCAL
JURISDICTIONS -- WITH OUR
DISASTER FIELD RESOURCES TO
EVACUATE PATIENTS FROM WILDFIRES
AND IMMOBILIZER DISASTER HEALTH
CARE VOLUNTEER NETWORK TO
SUPPORT PATIENT CARE FOR THE
CAMPFIRE IN BUTTE.
WE MOBILIZED RESOURCES INCLUDING
AMBULANCE STRIKE TEAMS.
AND SETTING UP -- MANY --
MEDICAL TREATMENT SITES FOR
PATIENT TREATMENT AND PATIENT
ISOLATION -- WE PROVIDED CARE
FOR THE SHELTER POPULATION BY
COORDINATING OVER FIVE HUNDRED
VOLUNTEERS FOR CALIFORNIA
MEDICAL ASSISTANCE TEAMS AND
DISASTER HEALTH CARE VOLUNTEERS
SYSTEM -- AND THAT PRETTY MUCH
COVERS EMERGENCY MEDICAL
SERVICES -- LAKE AND I'M
AVAILABLE ANSWER ANY QUESTIONS
YOU MIGHT HAVE [inaudible]
BRIEFLY INSISTENTLY -- LA --
DEPARTMENT FINANCE.
BRING IT TO THE NUMBERS.
ALL RIGHT PUBLIC COMMENT.
YOU SAID EVERYTHING THAT NEEDED
TO BE SENT.
I THINK IT I'M GONNA TAKE THAT
AS AS A WIN.
IT IS AN ABSOLUTE WIN THANK YOU
SO MUCH.
THANK YOU.
RIGHT NOW WE'RE GOING TO RETURN
TO ISSUE NUMBER.
TWO ASSEMBLY MEMBER RUDY SALAS.
THANK YOU MADAM CHAIR THANK YOU --
SUBCOMMITTEE MEMBERS.
IT'S ONE OF THAT TAKE TODAY.
THANK YOU FOR ALLOWING ME TO DO
THIS AND APPRECIATE THAT I THINK
I WAS -- RIGHT BEHIND YOU
TRANSPORTATION.
COMMITTEE.
SO I JUST MISSED YOU -- BUT TO
MEMBERS OF THE SUBCOMMITTEE I
KNOW THIS IS AN ISSUE THAT YOU
GUYS ARE ALL VERY FOR A FAMILIAR
WITH THIS IS AN ISSUE THAT YOU
GUYS HEARD FROM FROM THE
CALIFORNIA FUTURE HEALTH
WORKFORCE COMMISSION.
AT YOUR JOINT INFORMATIONAL
HEARING THAT YOU HAD -- I THINK
ABOUT A MONTH AGO -- SO I WANT
TO THANK YOU FOR PAYING
ATTENTION TO THIS VERY IMPORTANT
ISSUE AND THAT'S THE ISSUE OF
HEALTH.
AND MAKING SURE THAT WE WOULD
HAVE ENOUGH PROVIDERS.
OF THE CHALLENGES IN THE LIVING
HEALTH CRISIS ARE STARK AND AND
STAND. TO MOST ADVERSELY IMPACT
SOME OF THE FASTEST GROWING
REGIONS PARTICULARLY AND
UNDERSERVED LOW INCOME RURAL AND
ETHNICALLY AND LINGUISTICALLY
DIVERSE COMMUNITIES.
THE COUNCIL ON GRADUATE MEDICAL
EDUCATION RECOMMEND SIXTY TO
EIGHTY PRIMARY CARE PHYSICIANS
PER ONE HUNDRED THOUSAND A
POPULATION WITH THE STATEWIDE
AVERAGE.
IS ONLY.
FIFTY THAT NUMBER IS EVEN WORSE
WHEN YOU START LOOKING AT AREAS --
LIKE CARS THE AVERAGE NUMBER OF
PRIMARY CARE PHYSICIANS IS
SIGNIFICANTLY LOWER AND
UNDERSERVED REGIONS LIKE.
THE INLAND EMPIRE IN THE SAN
JOAQUIN VALLEY WHERE THEY'RE
ONLY THIRTY NINE AND THIRTY FIVE
PRIMARY CARE PHYSICIANS PER.
ONE HUNDRED THOUSAND COUNTIES IN
REGIONS THAT HAVE THE HIGHEST
LEVELS OF POVERTY.
ALSO TEND TO HAVE THE WORST
HEALTH OUTCOMES AND LESS ACCESS
TO HEALTH CARE.
INTO A STUDY RANKING HEALTH
OUTCOMES IN CALIFORNIA IN.
TWENTY FOURTEEN I KNOW IN MY
AREA ALL SIX SAN JOAQUIN VALLEY
COUNTIES RANK IN THE BOTTOM
THIRD OF THE STATE.
ADDITIONALLY ACCORDING TO THE
CALIFORNIA FUTURE HEALTH
WORKFORCE COMMISSION -- THE SAN
JOAQUIN VALLEY'S LONGSTANDING
HEALTH CARE PROFESSIONAL
SHORTAGES CONTRIBUTE
SUBSTANTIALLY TO ITS POOR HEALTH
OUTCOMES.
HOWEVER WE KNOW THAT.
THIS IS NOT A PROBLEM THAT ONLY
AFFECTS RULE AREAS ON THE SAN
JOAQUIN VALLEY THIS IS A
STATEWIDE PROBLEM.
THERE ARE SEVEN MILLION
CALIFORNIANS WHO CURRENTLY LIVE
IN FEDERALLY DESIGNATED HEALTH
PROFESSIONAL SHORTAGE AREAS.
THE VAST MAJORITY OF THEM 70%
ARE LATINO BLACK AND NATIVE
AMERICAN.
INTO THE COMMISSION CALIFORNIA'S
PROJECTED TO HAVE A SHORTAGE OF
FOUR THOUSAND ONE HUNDRED AND
THREE PRIMARY CARE CLINICIANS
AND TWENTY THIRTY THE COMMISSION
DEVELOPED A LIST OF TEN
PRIORITIES FRACTION.
THAT ARE PROJECTED TO ADDRESS
THE SHORTFALL AND ANOTHER
SEVENTEEN OTHER RECOMMENDATIONS
THAT WOULD COMBINE COST
ESTIMATED SIX BILLION.
THE OFFICE OF STATEWIDE HEALTH
PLANNING AND DEVELOPMENT AND
MINISTERS VARIOUS PROGRAMS THAT
WITH ADDITIONAL FUNDING WHAT
INCREASE OUR ABILITY TO ADDRESS
THE HEALTH CARE PROFESSIONAL
SHORTAGE WHILE PRIORITIZING THE
MOST MEDICALLY UNDERSERVED AREAS.
SOME OF THE PRIORITY
RECOMMENDATIONS FROM THE
COMMISSION INCLUDE INCREASING
THE NUMBER OF PRIMARY CARE
PHYSICIAN RESIDENCIES.
EXPANDING LOAN REPAYMENT
PROGRAMS.
AND IMPROVING RECRUITMENT AND
OUTRAGE FOR LOW INCOME AND
DIVERSE BACKGROUND COMMUNITIES
TO ENTER INTO HEALTH CAREERS.
INVESTING IN PROGRAMS THAT ARE
CURRENTLY UNDER FUNDED AND OVER
PRESCRIBED LIKE THE SONG BROWN
TO INCREASE PRIMARY CARE
PHYSICIAN RESIDENCIES.
AND THE STEVEN THOMPSON -- LOAN
REPAYMENT PROGRAM AND OUTREACH
PROGRAMS LIKE THE MANY GRANT.
ARE CRITICAL TO ADDRESSING THE
SHORTAGE AND TO PROVIDING
QUALITY AFFORDABLE HEALTH CARE
TO OUR COMMUNITIES.
ACCORDING TO US PAD THE WORLD A
TOTAL OF TWO HUNDRED AND FIFTY
SIX ELIGIBLE APPLICANTS. TO
RECEIVE THE TWENTY SEVENTEEN
TWENTY EIGHTEEN STEPHEN THOMPSON
Là LOAN REPAYMENT PROGRAM.
SO YOU HAD TWO HUNDRED AND FIFTY
SIX ELIGIBLE APPLICANTS BUT ONLY
FORTY FOUR WILL AWARD EASE.
AT THE AVERAGE RATE OF NINETY
THOUSAND DOLLARS AND LOAN
REPAYMENT PER OR FORTY THE
STEVEN LOAN THOMPSON PROGRAM
ALONE WOULD HAVE NEEDED AN
ADDITIONAL NINETEEN MILLION. TO
PROVIDE LOAN REPAYMENT TO ALL
ELIGIBLE APPLICANTS.
SIMILARLY THE ALLIED HEALTH
HEALTH CARE REPAYMENT PROGRAMS
LIKE TOTAL OF ONE HUNDRED AND
FIVE ELIGIBLE APPLICANTS.
BUT ONLY TWENTY SEVEN AWARDEES.
THE SONG BROWN PROGRAM ALSO SO
MANY PROPOSED EXISTING EXPANDED
A NEW PROGRAMS THAT WERE NOT
AWARDED.
IN ADDITION THE CALIFORNIA
EDUCATION SYSTEM IS NOT KEEPING
PACE WITH ARE GROWING
INCREASINGLY DIVERSE POPULATION.
THE STATE IS EXPECTED TO GROW BY
SIX MILLION PEOPLE IN.
TWENTY THIRTY BUT MEDICAL SCHOOL
ENROLLMENT.
GREAT BUT OUR MEDICAL SCHOOL
ROMAN RATE IS THE THIRD LOWEST
IN THE COUNTRY.
ALTHOUGH LATINOS MAKE UP 40% OF
THE POPULATION THEY MAKE UP JUST
7% OF DOCTORS.
AS OUR STATE STRIVES TO INCREASE
ACCESS TO HEALTH HEALTH CARE.
WE DO NOT MAKE SIGNIFICANT
INVESTMENTS IN RECRUITING
TRAINING.
AND RETAINING QUALIFIED HEALTH
CARE PROVIDERS WITH A PARTICULAR
EMPHASIS ON GROWING THE HEALTH
CARE WORKFORCE AND MEDICALLY
UNDERSERVED AREAS.
THE SIGNIFICANT GAPS AND HEALTH
CARE ACCESS AND HEALTH OUTCOMES
FOR THE MOST DISADVANTAGED
COMMUNITIES WILL CONTINUE TO
GROW.
I WOULD LIKE TO COMMEND THE
ADMINISTRATION FOR ITS
COMMITMENT TO ADDRESSING THIS
ISSUE IN THE PROPOSED BUDGET.
BY PROVIDING FUNDING TOSH PAD
FOR WORKFORCE DEVELOPMENT
SPECIFICALLY FOR MENTAL HEALTH
PROFESSIONALS.
HOWEVER WE MUST DO MORE.
I RESPECTFULLY REQUEST THAT YOU
INCLUDE AN ADDITIONAL FIFTY
MILLION TOSH PET. FOR INCREASING
PRIMARY CARE PHYSICIAN
RESIDENCIES EXPANDING LOAN
REPAYMENT PROGRAMS AND PROVIDING
OUTREACH AND RECRUITMENT TO
UNDER REPRESENTED.
AND UNDERSERVED COMMUNITIES --
TO ENTER HEALTH CAREERS -- WITH
ME HERE TO TESTIFY IS -- MISS
EASTON WHO IS THE EXECUTIVE
DIRECTOR OF KERN MEDICAL.
MADAM CHAIR MEMBERS MY NAME IS
ERICA IS TEN EXECUTIVE DIRECTOR.
OF THE KERN MEDICAL FOUNDATION I
WANTED TO THANK YOU FOR THE
OPPORTUNITY TO SPEAK TO YOU ON
BEHALF OF KERN MEDICAL AS WELL
AS THE FOUNDATION.
AND SUPPORT OF THE TH ADDITIONAL
FUNDING.
KERN MEDICALS LOCALES SAFETY NET
HOSPITAL TERTIARY TERTIARY
REFERRAL CENTER AN ACADEMIC
TEACHING INSTITUTION LOCATED IN
KERN COUNTY.
MY ROLE IS TO IDENTIFY
ADMINISTER AND STUART ADDITIONAL
FUNDING. FOR KERN MEDICAL WHICH
INCLUDES A FONT BROWN AND CAL
MED FORCE FUNDS.
AND THE CENTRAL VALLEY WHERE
WE'RE LOCATED WE HAVE A
SIGNIFICANT SHORTAGE OF
HEALTHCARE WORKERS ESPECIALLY IN
THE RURAL AND UNDERSERVED AREAS.
I WANT TO THANK ASSEMBLY MEMBER
SALAS FOR WORKING TO ADDRESS THE
STORAGE AND LOOKING FOR WAYS TO
HELP HE'S DONE A WONDERFUL JOB
OF EXPLAINING THE DATA.
THAT SUPPORTS THIS REQUEST BUT I
WANTED TO TALK ABOUT WHAT WE'VE
DONE SPECIFICALLY AT KERN
MEDICAL.
I'M IT'S DIFFICULT TO ATTRACT
PEOPLE TO RESIDENTS ISN'T
CENTRAL VALLEY UNLESS THEY'VE
GROWN UP THERE AND IT'S MORE
DIFFICULT TO GET THEM TO STAY --
WHAT WE FOUND IS WE HAVE
TREMENDOUS SUCCESS WHEN WE HAVE
WE RECRUIT PEOPLE WHO ARE
FAMILIAR WITH THE AREA?
OR AN AG COMMUNITY WITH WE GROW
OUR OWN AND IT'S SO MUCH BETTER
WHEN THAT THEY COME TO STAY.
ABOUT A YEAR AGO WE HAVE POSTED
SOME STUDENTS FROM OUR VAN WHICH
IS A SMALL RURAL COMMUNITY.
AND BECAME INSPIRED BY THE
IMPACT THE DAY HAD ON THE
STUDENTS PARTICULARLY WHEN THEY
HEARD FROM NANCY MENDOZA.
WHO IS NOW A SECOND YOUR
EMERGENCY MEDICINE RESIDENT?
NANCY WENT TO ARE IN HIGH SCHOOL.
THEN SHE WENT TO SEE A SHOULD BE
AND THEN SHE GOT A SCHOLARSHIP
TO UCLA.
NOW SHE'S BACK IN HER MEDICAL AS
OUR RESIDENT.
AND SPOKE TO THE STUDENTS ABOUT
HER TIME THERE AND I JUST WANTED
TO REACH A BRIEF QUOTABLE STACK
OF LETTERS.
THAT WE RECEIVE FROM STUDENTS --
I WAS ALSO VERY INSPIRED BY
DOCTOR MENDOZA I WAS ABLE TO
RELATE TO HER IN EVERY ASPECT
AND SHE REALLY INSPIRED ME TO
KEEP GOING.
JUST AS SHE HAD MADE HER PARENTS
PROUD I PLAN TO DO THE SAME.
DESPITE THE LACK OF CONFIDENCE
SHE HADN'T HERSELF SHE MADE IT
AND I'M SO HAPPY FOR HER.
I WANT TO BE AS GREAT AS HER AND
DETERMINED.
SO THAT'S JUST ONE AND I COULD.
READ A HOST OF OTHERS AFTER THAT
MOMENT AFTER THAT DAY WE BECAME
INSPIRED.
WE WANTED TO LOOK AT WAYS THAT
WE COULD INCREASE THAT PROGRAM
AND BRING MORE KIDS ON YOUR
CAMPUS.
SO WE DECIDED WE NEED MORE THAN
JUST A FEW OF OUR FOUNDATION
STAFF MEMBERS AND WE DEVELOPED A
PROGRAM CALLED KNOW HOW TO
SUBMIT A CENA.
WHICH IS A GROUP OF HISPANIC
WOMEN.
THAT ALL HAVE LEADERSHIP ROLES
IN THE HOSPITAL FROM A DIVERSE
GROUP -- THERE NURSES DOCTORS
BEHAVIORAL HEALTH SPECIALISTS --
ADMINISTRATORS ALL EVERY TYPE OF
AREA THAT YOU CAN IMAGINE
THROUGHOUT THE HOSPITAL IN WHAT
THEY DO IS THEY SPEND THEIR TIME.
TAKING KIDS AROUND AND SHOWING
THEM WHAT IT'S LIKE TO WORK AT A
HOSPITAL.
WE LET THEM PLAY WITH THIS ITEM
THE MANNEQUINS IN OUR SIM LAB
THEY GET TO DO SEARCH SUTURING
WE THROW IN A LITTLE -- FOOD AND
NUTRITION EDUCATION JUST BECAUSE
WE HAVE A CAPTIVE -- AND JUST
TRY TO GIVE THEM A GLANCE BEHIND
THE CURTAIN AND SEE WHAT IT'S
LIKE.
AND IT'S BEEN SO SUCCESSFUL OVER
THIS PAST YEAR SINCE WE'VE HAD
THAT ARVIN KIDS WE'VE NOW GONE
OUT TO TOP TO HIGHLAND A FOOT
HILL.
AND WITH ADDITIONAL FUNDING
RATHER THAN HAVING JUST A PART
TIME SIDE PROGRAM THAT WE HAVE
WE COULD REALLY EXPAND IT I MEAN
I ENVISION A MOBILE THING WHERE
WE COULD GO TO DIFFERENT HIGH
SCHOOLS.
AND REALLY SHARE WHAT IT'S LIKE
TO BE ALL SORT NOT JUST
PHYSICIANS BUT NURSES AND
RADIOLOGY TAX AND YOU KNOW THAT
THE GAPS ARE JUST TREMENDOUS.
AND SO ONE THING THAT I ALWAYS
TELL THEM WHEN I YOU KNOW AFTER
WE DO IT FOR ANYTHING I LOOK AT
THEM AND I SAY YOU KNOW.
SOON YOU'RE GONNA BE ONE OF MY
COLLEAGUES ARE CO WORKER SO JUST
KEEP IT UP.
AND YOU KNOW WITH YOUR HELP WILL
HAVE THE NEXT DANCE YOU MENDOZA
SO THANK YOU SO MUCH
[inaudible]
THANK YOU [inaudible]
COLLEAGUES.
THANK YOU -- I REALLY APPRECIATE
THE PROGRAM AYE AYE -- WAS
TEACHER AND DODD TIME INVOLVED
IN PART BUT I WAS ALSO SCHOOL
BOARD MEMBER AND WE PARTNERED
WITH KAISER AND THEY HAD A
JUNIOR HIGH PROGRAM CALLED
HIPPOCRATIC -- CLUB AND THEY
WOULD GO THAT TAKE THE KIDS OVER
AND IT'S REALLY SUCCESSFUL IT'S
BEEN I THINK IN PLACE NOW.
FOR HONESTY ABOUT EIGHT YEARS
BUT THE KIDS ARE SO EXCITED AND
AND WE HAVE A OUR POPULATION IS
85% HISPANIC SOLD A LOT OF THOSE
KIDS DON'T THINK THAT THEY CAN
BE DOCTORS.
OR ANY YOU KNOW ANYTHING ELSE IN
THE MEDICAL COMMUNITY SO I
REALLY APPRECIATE YOU BRING THIS
BECAUSE I THINK YOU KNOW YOU'RE
RIGHT WE HAVE -- TO BRING THEM
FROM THE COMMUNITY WE IN THE
TEACHING WORLD WE HAVE THE
TEACHER NEXT DOOR THE
FIREFIGHTER NEXT OR THAT YOU
KNOW ALL OF THOSE PROGRAMS TO
MAKE SURE THAT THOSE THOSE --
ONCE THE KIDS ARE GRADUATED OR
THEY THEY GET WHATEVER
CERTIFICATION THAT THEY COME
BACK TO THE COMMUNITIES AND I
THINK IT'S CRUCIAL FOR THE
DEVELOPMENT OF THE COMMUNITY.
AND IF YOU FEEL COMFORTABLE WITH
THE FOLKS THAT THAT YOU GREW UP
WITH AND SOLD THE AGAIN THANK
YOU I REALLY APPRECIATE AND
HOPEFULLY WE CAN.
YOU KNOW MOVE FORWARD AND WE CAN
MANAGE.
YOU KNOW WHOEVER IT MAY BE TO
MAKE SURE THAT WE CAN GET THAT
FUNDING.
THANK YOU.
MR RAHMAN.
THANK YOU MADAM CHAIR AND THANK
YOU FOR THE PRESENTATION --
MEMBERS SALAS HE DID BRING UP IN
YOUR PRESENTATION THE INLAND
EMPIRE AND THEN TRAVEL
COMMUNITIES SO INTERESTED AND
AND HOW THAT TIES INTO OF SOME
OF THE PRESENTATIONS IN THE
PROGRAM'S.
MOVING FORWARD -- WITH THIS --
FIFTY MILLION DOLLARS.
HELLO THIS IS EXACTLY WHY WE'RE
ACTUALLY TALKING ABOUT -- THE
NUMBERS AND IT WERE BELOW THE
STATEWIDE AVERAGE WHEN YOU LOOK
AT YOU KNOW WE JUST POINTED OUT
THE INLAND EMPIRE AND THE SAN
JOAQUIN VALLEY BUT EVEN WHEN YOU
LOOK AT NATIVE AMERICAN AND YOU
LOOK AT LATINO POPULATIONS AT
NUMBERS EVEN EXACERBATED SINCE
EVEN WORSE -- YOU KNOW AND WE
FIND THOSE AREAS AND I MISTER
WOULD REPRESENTS A LOT OF THE
THE ROLE NORTH.
I KNOW HE'S GOT ISSUES WITH
ACCESS AS WELL UP THERE.
AND SO THIS IS A PRO GROWING
PROBLEM SO YOU KNOW IN THIS OF
COMMITTEE WE HAVE THE
OPPORTUNITY TO TAKE SOME
LEADERSHIP AND GROW THESE
PROGRAMS THAT WILL GROW
PHYSICIANS -- THROUGH EITHER THE
STEPHEN THOMPSON LOAN REPAYMENT
PROGRAM OR SONG BROWN.
AND GOING TO THOSE HIGH SCHOOLS
IN GETTING KIDS INTERESTED IN
TWO CAREERS LETTING OTHER
OTHERWISE WOULD BE EXPOSED TO
LIKE THIS RUBIO SPOKE ABOUT.
YOU KNOW GETTING THE MIX Ñ
HAVE THAT OPPORTUNITY NOW TO
INCREASE THE FUNDING. TO TO
BRING MORE PHYSICIANS AND AND
HEALTHCARE CAREERS.
AT TO THESE FOLKS -- THAT
ACTUALLY WILL SERVE AND
ESPECIALLY FEDERALLY UNDERSERVED
AREAS THROUGHOUT THE STATE.
IN PART OF THE PROMISE ALSO IS
RETAINING THE KNOWLEDGE THERE
WITHIN THE LOCAL JURISDICTIONS
ITSELF.
YEAH I ONCE WE SET UP THOSE
PROGRAMS YOU KNOW A LOT OF A LOT
OF FOLKS LIKE TO GO BACK AND
TEACH OR ENTER CAREER.
BACK HOME WITH THEIR FAMILY IS
OR WHERE THEY BEND BUT ALSO WHAT
WE CAN BE DOING IS INCENTIVIZING
WHICH WE'VE DONE THROUGH THE
GRANT PROGRAM.
IS INCENTIVIZING PEOPLE TO TO
SERVE IN THESE UNDERSERVED AREAS
SO FOR INSTANCE LIKE THE STEPHEN
THOMPSON -- ONE REPAYMENT
PROGRAM RIGHT IF YOU SERVE AN F.
Q. H. C. THEN -- YOU KNOW I
ALWAYS TELL PEOPLE I IT JOKINGLY
BACK HOME I WAS LIKE.
YOU KNOW HEY SERVE HERE THEN
HOPEFULLY OUR JOB IS TO GET YOU
TO GROW ROOTS HERE AND STAY HERE
TO HELP WITH.
THE PHYSICIAN SHORTAGE THAT WE
ALL FACE [inaudible]
CORRECT [inaudible]
THANK YOU.
DOCTOR WOULD.
YEAH I THINK THANK YOU MISTER
SAUCIER BRING THIS BOARD I THIS
IS AN ISSUE THAT'S NEAR AND DEAR
TO MY HEART -- ACTUALLY I THINK
THE SHORES ACTUAL WORST AND AND
THEN YOU MEMBER TRADE ACCORDING
NUMBERS I'VE SEEN -- WE'RE
LOOKING AT A SHORTAGE OF FORTY
SEVEN HUNDRED PRIMARY CARE
PHYSICIAN.
BY TWENTY TWENTY FIVE AND AN
ADDITIONAL FORTY ONE HUNDRED BY
TWENTY THIRTY SO THE NUMBER IS
IS IS IS MUCH LARGER -- I THINK
IN ADDITION TO THAT I THINK WILL
BE SEEN AS STATE WHAT IS A
GROWING TREND -- THAT IS
DISTURBING -- BLUES CALIFORNIA
HEALTHCARE FOUNDATION OR THERE
WAS ANOTHER GROUP THAT DID THIS
HAS BEEN FOLLOWING THIS ISSUE.
AND THEY BREAK THE THE BREAK THE
CITY THE STATE THE STATE DOWN
INTO REGIONS AND AT THE TOP
THREE REGIONS HAVE CONSISTENTLY
PEARL FOR LACK OF PROVIDERS
CONSISTENTLY BEEN.
INLAND EMPIRE -- THE THE THE
CENTRAL VALLEY AND ACTUALLY --
ONE OF THOSE IT'S CREEK THAT
CREEPING UP THEIR CENTRAL COAST
AS WELL AND AS WELL AS NORTHERN
CALIFORNIA.
SO AS RECENTLY AS ABOUT -- THINK
TWO THOUSAND AND FIVE OF THE
NINE REGIONS IN THE STATE.
THERE WERE THERE WERE ONLY THREE
THAT WERE REALLY.
THAT REALLY WERE IT DIDN'T HAVE
EVEN CLOSE TO THE NUMBER THAT
YOU NEED WE ARE NOW AT A POINT
WHERE WE ONLY HAVE ABOUT THREE
REGIONS IN THE STATE THAT HAVE
ADEQUATE OUT OF THE NINE NOT AND
SO WITH THAT AT THE NUMBER OF
THE DO INTENSITY THIS IS.
IS GROWN DRAMATICALLY.
SO I I SUPPORT WHAT YOU'RE
YOU'RE DOING HERE IT IS A LONG
TERM IT'S IT'S IT IS THE LONG
GAME HERE.
AND THERE ARE OTHER THINGS THAT
YOU DIDN'T MENTION IN THAT ARE
STRATEGIES THERE THAT THAT WE
CAN BE DOING SHORT TERM BUT IT'S
GOING TO TAKE RESOURCES.
AND THE WORKFORCE COMMISSION
ASKED -- FOR BASICALLY LAID OUT --
THREE BILLION DOLLAR STRATEGY
OVER TEN YEARS AND IF WE DON'T --
WE DON'T PROVIDE THE WORKFORCE
WE CAN'T PROVIDE THE ACCESS TO
CARE FOR THEM AND WE CAN'T WE'RE
TELLING PEOPLE THEY'RE COVERED.
AND WE'RE NOT PROVIDING ACCESS
WE HAVE A REAL PROBLEM SO THANK
YOU VERY MUCH THANK YOU.
THANK YOU MEMBERS OF THANK YOU --
MR SALAS FOR YOUR PRESENTATION I
I AGREE WITH THE MEMBERS THAT I
THINK IT'S THE NUMBERS ARE CLEAR.
WE KNOW THERE'S A SHORTAGE AND
WE KNOW THERE'S A GREATER
SHORTAGE IN SOME AREAS AND I
APPRECIATE THAT YOU'VE MENTIONED
THE INLAND EMPIRE.
I THINK MISTER RAMOS AND MS
RUBIO NIGH.
NO IT BECAUSE WE ARE IN THE
INLAND EMPIRE WE KNOW ABOUT THE
SHORTAGE.
I APPRECIATE THE UNIVERSITIES
LIKE YOU SEE ARE WITH THE NEW
MEDICAL SCHOOL -- CAL MAD THAT
RECENTLY OPENED.
CAL MAD IS SPECIFICALLY
TARGETING THE KINDERGARTNERS AND
THEY ARE FOLLOWING THOSE
KINDERGARTENERS AND AT
THROUGHOUT THE PROCESS WILL BE
TELLING THEM ABOUT THE HEALTH
FIELD.
AND WHY THEY SHOULD ENTER THE
HEALTH FIELD WE'RE VERY EXCITED
ABOUT THAT EXCITED ABOUT WHAT
THAT MAY DO FOR FOR OUR REGION --
I WANT TO THANK YOU FOR YOUR
TESTIMONY -- I APPRECIATED THEIR
WE GROW OUR OWN I THINK WHEN THE
STUDENTS SEE SOMEONE THAT LOOKS
LIKE THEM WHO IS A MEDICAL
DOCTOR THEY ARE MORE INCLINED TO
THINK THAT.
THEY CAN ATTAIN THAT AS WELL --
THE ORGANIZATION WILL HAVE TO
SUBMIT THE CENA IS THAT STATE
WIDE OR IS THAT ONLY NO WE JUST
CAME UP WITH THAT AT THE
HOSPITAL JUST BECAUSE WE KNEW
THAT WE HAD WOMEN THAT WOULD DO
IT AND WE'RE PASSIONATE ABOUT IT
AND GOT A MALL IN A ROOM AND I
MEAN.
IT'S AMAZING WHAT WE DISCOVERED
JUST LET THE NEED TO EDUCATE
PARENTS TOO I MEAN IN THE
HISPANIC COMMUNITY ESPECIALLY
THERE'S A FEAR OF SENDING YOUR
KIDS TO SCHOOL.
AND JUST GIVING THEM THE
OPPORTUNITY TO HEAR ABOUT SOME
OF THOSE PROGRAMS AS YOU KNOW
ANOTHER GOAL OF OURS.
WELL WONDERFUL I I THANK YOU
BOTH FOR THIS PRESENTATION ANY
OTHER COMMENTS FROM THE MEMBERS.
ALL RIGHT THE LET'S OPEN IT UP
TO PUBLIC COMMENT PLEASE.
MADAM CHAIR AND MEMBERS BARBARA
GLAZER WITH THE CALIFORNIA
HOSPITAL ASSOCIATION HERE TODAY
IN STRONG SUPPORT.
BY EXPANDING THE HEALTHCARE
WORKFORCE -- IN UNDERSERVED
AREAS WILL MEAN BETTER ACCESS
FOR THE PEOPLE WHO LIVE IN THOSE
AREAS IT'S THAT SIMPLE SO WE'RE
IN STRONG SUPPORT THANK YOU.
THANK YOU.
GOOD AFTERNOON LISA FULL BURKE
AND THE CEO OF THE CALIFORNIA
ACADEMY OF FAMILY PHYSICIANS
HERE TO TESTIFY IN SUPPORT OF
THIS PROPOSAL ONE I THINK.
THE ASSEMBLYMAN IN THE TWENTY
ONE OTHER MEMBERS WHO -- SHOW
THEIR SUPPORT FOR THIS
INITIATIVE AT A FIRST STEP IN
REALLY LOOKING AT HOW WE RESOLVE
THIS CRISIS IN RURAL CALIFORNIA.
THE SONG BROWN PROGRAM THE STEVE
THOMPSON LOAN REPAYMENT PROGRAM
ARE REALLY ESSENTIAL TOOLS FOR
LOOKING AT HOW WE EXPAND PRIMARY
CARE AND UNDERSERVED AREAS.
IN FAMILY PHYSICIANS ARE REALLY
IMPORTANT PART OF GETTING
PRIMARY AND PREVENTIVE SERVICES
OUT TO FOLKS AND UNDERSERVED
AREAS FAMILY PHYSICIANS RECEIVE
SPECIALIZED TRAINING IN PRIMARY
CARE AND ARE UNIQUE.
IN THAT THE TAKE CARE FOLKS FROM
BIRTH AND TELL THE END OF LIFE.
AND THE PROGRAMS THAT TRAIN THEM
ARE VERY DEPENDENT ON Sí
BROWN FUNDING THEY DON'T RECEIVE
A LOT OF FEDERAL FUNDING FOR A
VARIETY OF REASONS.
SO THEY REALLY DEPEND ON THIS
FUNDING NOT ONLY TO MAINTAIN BUT
TO EXPAND AND IN FACT.
LAST YEAR S
ND A FEW NEW PROGRAMS
INCLUDING IN VERY NORTHERN
CALIFORNIA AS WELL AS IN THE
INLAND EMPIRE.
SO AGAIN JUST WHEN I THINK YOU
ASSEMBLY MEMBER FOR THIS
PROPOSAL AND IT APPRECIATE YOUR
ADDRESSING THE ISSUE
[inaudible]
THANK YOU.
THANK YOU MADAM CHAIR MEMBERS
MAY CONSUMERS ON BEHALF OF
CALIFORNIA HEALTH PLUS ADVOCATES
A COMMUNITY HEALTH CENTERS AND
CLINICS WE APPRECIATE.
OF THESE NUMBER BRING IN THIS
PROPOSAL FORWARD OR IN STRONG
SUPPORT IT REALLY IS JUST ONE
STEP AS HAS BEEN MENTIONED HERE
IN THE PIPELINE -- THE PREVIOUS
AGENDA ITEM TALKING ABOUT
RESIDENCY SLOTS AND MAKING SURE
WHERE A STUDENT THE GROSS UP
KICKING GET A RESIDENCY SLOT AND
THAT IN THEIR COMMUNITY AND THEN
THIS WOULD HELP RECRUIT AND
RETAIN THEM TO MAKE A CAREER.
OUT OF WHERE THEY ARE TRAINED IN
WHERE THEY LIVE AND WE REALLY
THINK IT'S IMPORTANT TO
STRENGTHEN THE HEALTHCARE SYSTEM
AND SHOULD REALLY GO HAND IN
HAND WITH THE CONVERSATION ABOUT
PROVIDING COVERAGE.
AND ACCESS AT THE SAME TIME AND
SO WE ARE IN STRONG SUPPORT
THANK YOU.
KELLY BE MY BEHALF THE
CALIFORNIA MEDICAL ASSOCIATION
WERE SUPPORTIVE OF ASSEMBLY
MEMBER SALAS IS BUDGET PROPOSAL
AND ITS ACCOMPANYING BILL AB.
SEVENTEEN FIFTY NINE AND WE
AGREE YOU CAN NEVER START TOO
EARLY INCLUDING REDUCING
BARRIERS TO ENTRY LIKE TESTING
AND THINGS TO GO TO MED SCHOOL.
WE FOR THAT AS WELL -- AND WE
LOOK FOR TO BEING PART OF THE
DISCUSSIONS OF THE BUDGET
PROCESS CONTINUE THANK YOU.
THANK YOU.
GOOD AFTERNOON MATT ROBINSON ON
BEHALF OF KAISER PERMANENTE A
WE'RE VERY PLEASED TO SUPPORT US
A MEMBER SALAS OUT BUDGET
PROPOSAL IN ADDITION ROSS SO --
PROBABLY -- SUPPORTING AB --
SEVENTEEN FIFTY NINE YOU KNOW
THERE WAS SOME DISCUSSION AROUND
HERE -- IT IS ABOUT -- NOT JUST
FINDING THE WORK FORCE BUT LIKE
SUSTAINING THE WORK FORCE GOING
AFTER EARLY -- KAISER PERMANENTE
HAS BEEN VERY MUCH INVOLVED WITH
THAT -- INLAND EMPIRE WAS
DISCUSSED.
ALTHOUGH IT'S DIFFERENT IT'S
VERY MUCH THE SAME INTENT WERE
ALSO PLEASE SUPPORT -- CENTER
ROSS BILL AND IS A MEMBER MEDINA
SPELL THAT DEALS WITH THE UC OUR
MED SCHOOL FUNDING IN AND OUT
BUILDING OUT THAT SECOND PHASE
SO THANK YOU VERY MUCH FOR
LETTING US [inaudible]
Q..
THANK YOU VERY MUCH FOR SALAS.
THANK GOODNESS PRESENTATION ANY
MEMBERS PERSIAN THANK YOU.
OKAY WE'VE ALREADY.
DEALT WITH ISSUE NUMBER THREE SO
LET'S MOVE ON TO ISSUE NUMBER.
FOUR SOME OF MANAGED HEALTHCARE
.
ALL RIGHT OKAY WHAT'S YOUR
DIRECTOR FIRST.
A GOOD AFTERNOON MADAM CHAIR
MEMBER SHELLY REALART ON THE
DIRECTOR OF THE DEPARTMENT OF
MANAGED HEALTH CARE -- HERE TO
PRESENT -- TO AN OVERVIEW OF THE
DEPARTMENT AND THEN ANSWER ANY
QUESTIONS YOU MAY HAVE ABOUT OUR
BUDGET PROPOSALS -- WE THE
DEPARTMENT'S MISSION IS TO
PROTECT CONSUMERS HEALTH CARE
RIGHTS AND ENSURE A STABLE
HEALTHCARE DELIVERY SYSTEM -- WE
LICENSE AND REGULATE
APPROXIMATELY A HUNDRED TWENTY
SEVEN HEALTH PLANS.
THE PROVIDE COVERAGE TO MORE
THAN TWENTY SIX MILLION
CALIFORNIANS.
THE DEPARTMENT REGULATES MORE
THAN 96% OF THE COMMERCIAL AND
GOVERNMENT MARKET -- HEALTHCARE
COVERAGE IN THE STATE AND THAT'S
BASED ON ENROLLMENT.
OF THE DEPARTMENTS TOTAL
PROPOSED BUDGET FOR NINETEEN
TWENTY IS ABOUT NINETY ONE
MILLION DOLLARS AND FOUR HUNDRED
EIGHTY TWO AUTHORIZED POSITIONS.
AND THIS INCLUDES THE TO BUDGET
CHANGE PROPOSALS AND SPRING
FINANCE LETTERS -- OF THE
DEPARTMENT IS FUNDED SOLELY
THROUGH ASSESSMENTS ON HEALTH
PLANS WE RECEIVE NO GENERAL FUND
MONEY -- THERE'S FIVE PROGRAMS I
WANT TO JUST MENTION BRIEFLY
THAT THE DEPARTMENT RUNS THE
FIRST AND PROBABLY THE MOST
IMPORTANT TO SOME OF US IS THE
HELP CENTER.
WHICH EDUCATES CONSUMERS ABOUT
THEIR HEALTH CARE RIGHTS AND
HELP THEM RESOLVE THEIR
COMPLAINTS AND PROBLEMS THAT
THEY'RE HAVING WITH THEIR HEALTH
PLANS.
OTHER TO THE HELP CENTER ALSO
ADMINISTERS THE INDEPENDENT
MEDICAL REVIEW PROGRAM WHERE
SOMEBODY WHO HAS BEEN DENIED
CARE CAN REQUEST.
AN INDEPENDENT ASSESSMENT --
DETERMINATION OF WHETHER WHETHER
THE SERVICES THAT THEY HAVE BEEN
DENIED ARE INTACT MEDICALLY
NECESSARY FOR THEM -- SINCE TWO
THOUSAND THE DEPARTMENT HAS
ASSISTED MORE THAN TWO POINT ONE
MILLION CALIFORNIANS WITH THEIR
PARTICULAR PROBLEMS COULD BE
DENIALS OF CARE ACCESS TO
PROVIDERS ARE BILLING DISPUTES --
THE NEXT OFFICES ARE OFFICE OF
PLAN LICENSING WHICH IS THE
OBVIOUSLY LICENSES THE HEALTH
PLANS -- HEALTH PLANS REQUIRED
TO APPLY FOR AND MAINTAIN A
LICENSE TO OPERATE AS A PLAN IN
CALIFORNIA.
AND THIS OFFICE REVIEWS ALL
ASPECTS OF THE PLANT'S
OPERATIONS INCLUDING BENEFITS
AND COVERAGE CONTRACTS WITH
DOCTORS AND HOSPITALS PROVIDER
NETWORKS COMPLAINTS AND
GRIEVANCES SYSTEMS AND TO ENSURE
THAT THEY COMPLY WITH CALIFORNIA
LAW.
THE OFFICE OF PLAN MONITORING.
IS THAT SORT OF THE NEXT STEP
WHICH IS **** AND MONITORS THE
HEALTH PLANS TO MAKE SURE THAT
THEY ARE DELIVERING SERVICES IN
COMPLIANCE WITH THE KNOX KEEN
ACT -- THERE'S TWO DIVISIONS ONE
A PLAN SURVEYS WHICH PERFORMS
BASICALLY AUDITS OF THE HEALTH
PLANS TO MAKE SURE THAT THEY ARE.
A PERFORMING THE FUNCTIONS THAT
THEY NEED TO DO IN COMPLIANCE
WITH THE LAW AND THAT THEY MEET
THEIR OBLIGATIONS TO PROVIDE
CONSUMERS WITH HIGH QUALITY
HEALTHCARE.
OF THE DIVISION OF PROVIDER
NETWORKS -- MONITORS PROVIDER
NETWORKS AND ACCESSIBILITY OF
SERVICES -- THEY DO ANNUAL
REVIEWS OF ALL OF THE HEALTH
PLAN'S PROVIDER NETWORKS -- AND
REVIEWS ANNUAL -- TIMELY ACCESS
COMPLIANCE REPORTS AT THE PLANT
SUBMIT.
OUR OFFICE OF FINANCIAL REVIEW --
MONITORS THE FINANCIAL STABILITY
OF THE HEALTH PLANS AND MEDICAL
GROUPS THROUGH REGULAR REPORTING
FINANCIAL AUDITS AND OTHER TOOLS --
WE REVIEW ANNUAL MEDICAL LOSS
RATIO FILINGS BY THE PLANS TO
ENSURE THAT THEIR APPROPRIATE
APPROPRIATELY INVESTING IN AND
REALLY HEALTH CARE SERVICES.
WE ALSO REVIEWS A PROPOSED
PREMIUM RATE INCREASES TO MAKE
SURE THAT THE PLANS ARE ABLE TO
JUSTIFY THE RATE INCREASES AND
WE DO A VERY DETAILED REVIEW OF
THOSE -- AND SINCE TWO THOUSAND
ELEVEN WHEN THAT THE THE RATE
REVIEW PROGRAM STARTED THE
DEPARTMENT HAS SAVE CALIFORNIA'S
MORE THAN TWO HUNDRED TWENTY SIX
MILLION DOLLARS IN HEALTHCARE
PREMIUMS THROUGH THAT PROGRAM --
LAST BUT NOT LEAST IS OUR OFFICE
OF ENFORCEMENT WHICH PROSECUTES
VIOLATIONS OF THE KNOX KEEN ACT.
WE HAVE A NUMBER OF TOOLS TO
ENFORCE THE LAW WHEN VIOLATIONS
ARE AND COVERED SUCH AS
CORRECTIVE ACTION PLANS
SETTLEMENT AGREEMENTS FINANCIAL
PENALTIES CEASE AND DESIST
ORDERS.
FREEZING ENROLLMENT OR IN OR IN
THE WORST CASE SCENARIO
INSTALLING A MONITOR OR A
CONSERVATORSHIP.
SO THAT INCLUDES THE BRIEF
OVERVIEW OF THE DEPARTMENT HAPPY
TO ANSWER ANY QUESTIONS IF YOU
HAVE ANY.
THANK YOU I THINK WE'LL HOLD
QUESTIONS UNTIL.
THE FULL PRESENTATION ON ISSUE
ON THIS ISSUE -- MARK THE GREEN
MARCH THE GRILL.
YES -- MARTA IS OUR CHIEF DEPUTY
DIRECTOR AND SHE'S GOING.
TO BUDGET PROPOSALS OUT YES I'M
HERE TO ANSWER QUESTIONS I THINK
THEY WERE ALL -- PLACED ON THE
SECOND HALF OF THE AGENDA SO I'M
ONLY HERE IF THEY'RE RAISED --
FOR ADDITIONAL QUESTIONS ON
THOSE FOR BUDGET CHANGE
PROPOSALS SO THAT DOES OUR
COMPLETE OUR FORMAL PRESENTATION
OKAY.
DEPARTMENT OF FINANCE.
FINANCES TO HAVE ANYTHING TO ADD.
HELLO A LA ALL AROUND WAS IT
WITH THE LA WE'VE REVIEWED THE
DEPARTMENTS PROPOSALS AND HAVE
NO CONCERNS.
IN ORDER TO HAVE LISTED ALSO
JENNY.
PHILLIPS SAYS ARE -- DEPUTY
DIRECTOR FOR LEGISLATIVE AFFAIRS.
HERE TO ANSWER QUESTIONS.
VERY GOOD.
ALL RIGHT ANY QUESTIONS OR
COMMENTS FROM THE NUMBERS.
OKAY LET'S LET'S OPEN THIS UP --
TO PUBLIC COMMENT.
HEY MAN CHAIR AND MEMBERS AND
GDS HERE ON BEHALF OF HEALTH
ACCESS CALIFORNIA THE STATE WIDE
HEALTH CARE CONSUMER ADVOCACY
COALITION HERE IN SUPPORT OF THE
TEAM AGENCIES PROPOSED BUDGET --
WHILE NOT UP FOR DISCUSSION WE
ALSO WOULD LIKE TO STATE OUR
SUPPORT IN THE RECORD FOR ISSUE.
SEVENTEEN WHICH IS THE DAMAGE
SEIZE BC PEER REQUEST FOR THE
IMPLEMENTATION OF AB FIVE NINE
FIVE ON HEALTH PLAN MERGERS AND
ACQUISITIONS WE THINK THE
DEPARTMENT SHOULD HAVE THE
PROPER RESOURCES IN ORDER TO
GARNER.
AN INDEPENDENT ANALYSIS OF THE
IMPACTS OF FUTURE MERGERS AND
ACQUISITIONS AND WE THINK THAT
WOULD FOR AUTHORING THAT
LEGISLATION THANK YOU
[inaudible]
THANK YOU.
I WILL MAKE A NOTE ON ISSUE.
SEVENTEEN ALL RIGHT WELL THANK
YOU SO MUCH OF FOR THAT OVERVIEW
AND FOR THE INFORMATION THAT WAS
NEEDED SO THAT WE CAN CONSIDER
THAT.
ISSUE NUMBER.
FIVE STRENGTHENING PREVENTATIVE
SERVICES FOR CHILDREN AND MEDI
CAL.
HI MERRY HELL DEPARTMENT OF
HEALTH CARE SERVICES THANKS FOR
HAVING ME TODAY SO THE FIRST
ITEM IS REALLY TIED TO AS YOU
ALL KNOW THE GOVERNOR HAS A VERY
STRONG INTEREST IN HEALTH CARE
IN GENERAL AS AND IN
PARTICULARLY IN IMPROVING HEALTH
CARE.
FOR CHILDREN IN THE STATE OF
CALIFORNIA AND SO -- WHEN HE
CAME INTO OFFICE HE REALLY?
TALK TO US ABOUT WHAT COULD WE
BE DOING IN THE MEDICAL PROGRAM
TO DO MORE IN TERMS OF IMPROVING
UTILIZATION OF PREVENTIVE
SERVICES.
AND MAKING SURE THAT KIDS HAVE
ACCESS.
TO THOSE SERVICES SO THIS IS THE
RESOURCES REQUEST FOR POSITIONS
AND CONTRACT FUNDING THAT WOULD
REALLY ENABLE US TO
SIGNIFICANTLY ENHANCE OUR
OVERSIGHT MONITORING OF THE
MEDICAID MANAGED CARE PROGRAM --
A FEW THINGS THAT WE WOULD DO.
SORRY I HAVE MY GREEN AND I'M
FEELING A LITTLE SICK
[inaudible]
ALRIGHT.
JUST A MOMENT I DO WANT TO KNOW
TO THAT ON THE FIRST PAGE ON
PAGE SEVENTEEN WERE YOU SEE
NUMBER. EIGHT EIGHT AND NINE AT
THE BOTTOM OF PAGE EIGHT SHOULD
NOT BE THERE SO.
WE HAVE YOUR COPIES JUST PUT AN
X. ON NUMBER.
EIGHT POLITICS THEN ON PAGE.
EIGHTEEN AT THE TOP IT HAS THREE
AND FOUR IF YOU WOULD CROSS OFF
NUMBER.
THREE THANK YOU THANK YOU UNDER.
A MINUTE SO AS EVERYTHING TO
THIS IS A RESOURCE REQUEST --
FOR BOTH STAFFING AND CONTRACT
FUNDING FOR US TO BE ABLE TO
INCREASE OUR OVERSIGHT OF THE
HEALTH PLANS AS WELL AS YOU SOME
OUTREACH ACTIVITIES.
SO IF YOU THE THINGS THAT WILL
BE DOING -- WE WILL BE ADDING
ALL OF THE ADULT AND CHILD
COURSE THAT MEASURE SO THESE ARE --
NATIONAL QUALITY MEASURES WE
HAVE A SUBSET OF THEM CURRENTLY
IN WHAT WE CALL OUR EXTERNAL
ACCOUNTABILITY CENTER EA YES AND
THAT'S WHAT WE HOLD PLANS
ACCOUNTABLE -- TO WE WILL BE
ADDING ALL OF THE MEASURES THAT
ARE IN THE CMS COURSE THAT SO
IT'S A SIGNIFICANT INCREASE IN
THE NUMBER OF MEASURES THAT WILL
BE MONITORING.
AND WE'RE ALSO CHANGING THE
MINIMUM PERFORMANCE LEVEL SO
WE'RE DOING THAT IN TWO WAYS
FIRST WERE CHANGING FROM THE
TWENTY FIFTH PERCENTILE TO THE
FIFTIETH PERCENTILE SO.
MOST QUALITY MEASURES -- ARE
DONE ESSENTIALLY ON A COMPARISON
BASIS.
SO HERE THE TOP TWENTY FIFTH
PERCENTILE OR THE TOP TWENTY
FIVE YOU KNOW 25%.
PLANS SO THAT SERVE ON A
NATIONAL BASIS AND WITH
HISTORICALLY HAD THE MINIMUM
PERFORMANCE LEVEL AT THE TWENTY
FIFTH PERCENTILE MORE INCREASING
THAT TO THE FIFTIETH PERCENTILE.
BUT GIVEN THAT -- UNDER THAT
STRUCTURE YOU CAN BE AT THE TOP
BUT STILL NOT BE PERFORMING.
GREAT -- THERE CERTAINLY
MEASURES IF YOU LOOK AT VARIOUS
HE JUST MEASURES WHERE THE
NATIONAL -- THE NATIONAL
PERFORMANCE OF OF MEDICAID PLANS
IS PRETTY POOR.
SO WE WANTED TO HAVE THOSE
MEASURES WHERE YOU CAN ACTUALLY
SET A BENCHMARK SO I'M JUST
MAKING THIS ONE UP IT'S NOT.
I DON'T KNOW WHAT THE ACTUAL
BENCHMARK IS BUT YOU KNOW
SOMETHING LIKE 90% OF ALL KIDS
IN THE PLAN HAVE ALL THEIR
IMMUNIZATIONS.
SO WE'RE GOING TO BE DOING THAT
AND ON ABOUT TWENTY ONE OF THE
MEASURES HAVING STRUCK ACTUAL
BENCHMARK SO EVEN IF YOUR AT THE
TOP OF THE PERFORMANCE
NATIONALLY.
IF YOU'RE NOT MEETING WHAT
SHOULD BE SORT OF THE STANDARD
OF CARE WE WILL BE HOLDING A
PLANS ACCOUNTABLE ON THAT BASIS
SO THAT THAT'S A NEW WAY THAT
WILL BE MEASURING.
A PLAN PERFORMANCE --
ADDITIONALLY SOME OF THE
STAFFING IS GOING TOWARDS
CHANGING THE WAY THAT WE DO YOU
ARE SANCTIONING AND CORRECTIVE
ACTION PLANS.
SO THE WAY THAT WE'VE
HISTORICALLY WORK WITH OUR
HEALTH PLANS AS IF THEY WERE NOT
MEETING THE MINIMUM PERFORMANCE.
WE WOULD PUT THEM ON WHAT WE
CALL CORRECTIVE ACTION PLAN OR
CAP.
AND THEN.
IF THE PLAN DIDN'T MEET THE
MILESTONES IN THEIR CAP THEY
WOULD BE SANCTIONED WHAT WE'RE
CHANGING TO NOW IS IMMEDIATELY
SANCTIONING A HEALTH PLAN IF
THEY'RE NOT MEETING MINIMUM
PERFORMANCE.
AND AS WELL AS DOING THE
CORRECTIVE ACTION PLAN AND
PROVIDING THEM THE TECHNICAL
ASSISTANCE TO GET THEM WHERE
THEY NEED TO GET.
AND THEN OBVIOUSLY FEET THERE
COULD BE ADDITIONAL US SANCTIONS
TO THE TO THE DEGREE THAT THE
HEALTH PLAN DOES NOT MEET.
ITS METRICS.
I'M A COUPLE OF OTHER THINGS WE
ARE CURRENTLY CONDUCTED THE SAID
THE CAPS SURVEY WHICH IS
ESSENTIALLY THE CONSUMER -- THE
CONSUMER SURVEY OF HEALTH PLAN
OF YOU KNOW HOW THEY FEEL ABOUT
THEIR HEALTH PLANS EVERY THREE
YEARS WILL BE MOVING OUT TO
EVERY TWO YEARS -- AND HAVING A
MORE ROBUST COMPLIANCE REPORT
THAT WE PUT OUT ANNUALLY
CURRENTLY WE HAVE.
A QUARTERLY DASHBOARDS THAT WE
PUT OUT WE'LL BE ADDING ALL
THESE MEASURES TO THAT AND THEN
DOING AN ANNUAL COMPLIANCE
REPORT AS WELL.
THEN FINALLY ON THE CONTRACT
FUNDING SIDE WE ARE ASKING FOR
RESOURCES TO ACTUALLY DO AN
OUTREACH CAMPAIGN TO FAMILIES.
AND PARENTS THAT TO MAKE SURE
ONE THAT THEY'RE AWARE OF THE
BENEFITS THAT THEIR CHILD HAS.
A HOW TO ACCESS THOSE SERVICES
AND ENCOURAGE THEM TO HAVE THEIR
TELL BE GETTING THE RECOMMENDED
WELL CHILD VISITS WE ARE SEEING
IN CERTAIN AGE GROUPS THAT --
THE KIDS IN OUR MEDI CAL PLANS
ARE NOT GETTING SORT OF THE
NORMAL -- NOT RECEIVING THEIR
WELL CHILD VISITS -- AS
RECOMMENDED BY THE U. S.
PREVENTIVE TASK FORCE.
SO DOING OUTREACH CAMPAIGN --
LOOKING TO WORK FOR THE
CONTRACTOR ON THAT.
WE DID TO HAVE SUCCESS WITH A
SIMILAR UP PLAN THAT WE DID ON
THE DENTAL SIDE WHERE WE HAD A
PEDIATRIC DENTAL OUTREACH
CAMPAIGN.
AND STOP PRETTY SIGNIFICANT
INCREASE IN UTILIZATION FROM
THAT SO WE'LL BE LEARNING
LESSONS FROM FROM THAT PROCESS
AND AND HOPEFULLY -- SEEING
AGAIN -- GOOD RESULTS FROM FROM
THAT REACH CAMPAIGN.
SO WITH THAT I WILL TAKE
QUESTIONS [inaudible]
RIGHT.
PUBLIC FINANCE YEAH WELCOME AND
AGAINST DEPARTMENT OF FINANCE OR
TO ANSWER ANY QUESTIONS
[inaudible]
HELLO.
I'M BEN JOHNSON WITH THE LA OUT
A WE HAVE REVIEWED THIS BEAST
PCP AND HAVE NO CONCERNS AT THIS
TIME WE WOULD I WOULD JUST SAY
THAT -- FOCUSING -- STATE
RESOURCES ON INCREASING
OVERSIGHT OF ACCESSING QUALITY
WITH MANAGED CARE DOES APPEAR TO
US TO BE A PROMISING APPROACH TO
IMPROVING THOSE OUTCOMES AND SO --
WHAT WE WE ARE HAPPY TO SEE SOME
OF THE RESOURCES THAT BEEN
PROPOSED OUT TO THAT AND?
WONDERFUL SPRING IT YES DOCTOR
WOULD.
YES THANK YOU -- APPRECIATE
APPRECIATE THE BUDGET PROPOSAL
APPRECIATE THIS COMING FOR THIS
IN RESPONSE TO THE AUDIT.
I'M IN A PART OF PART OF OUR
RESPONSE THE AUDIT IS THIS BUT
WE WERE WORKING ON THESE ISSUES
PRIOR TO THAT AUDIT COMING OUT.
BECAUSE I BECAUSE MUCH TO MY
RECOLLECTION FROM THE AUDIT --
THAT.
BUT ONLY ABOUT HALF THE CHILDREN
OUT FOR MEDI CAL IN THE STATE
WERE ACTUALLY GETTING ALL AROUND
TOWN HALL YEAH.
AND THE PERFORMANCE COMPARED TO
OTHER STATES WAS PRETTY PRETTY
POOR THAT'S CORRECT SO IS IT
BECAUSE IS THE REASON THAT I
MEAN THIS IS BEEN GOING ON FOR
AWHILE. FOR MANY YEARS AS A
REASON THAT [inaudible]
THAT.
DH CS WHAT IS IT IS IT WAS A
PERSON NOW WAS THERE WITH THIS
FALL THROUGH THE CRACKS ME WHY
IS IT THAT WHY IS IT THAT YOU
KNOW.
WE'VE GOT A WE GOT A PRETTY
ROBUST AUDIT NOW SHOWING THEM
HOW HOW POORLY WERE PERFORMING --
WHAT WHY?
TELL YOU WHAT WHY IS IT WHAT IT
TAKES SO LONG IF YOU'VE BEEN
WORKING ON THIS TO COME FOR THIS
PROPOSAL AT THIS TIME.
SO THIS WAS REALLY DRIVEN BY THE
GOVERNOR COMING INTO OFFICE SO
WE WEREN'T WORK ON THIS PRIOR TO
THE GOVERNOR THIS IS TIED TO HIS
INITIATIVES ON EARLY CHILDHOOD.
SO SO YOU SEE YOU WEREN'T AWARE
THAT THE NO I'M JUST SAYING IN
THIS PARTICULAR PROPOSAL.
NO I MEAN I THINK IT IT'S A FAIR
QUESTION AND YOU KNOW I IT WAS
VERY ROUGH FOR ME PERSONALLY TO
IT TO SEE THE DATA AND THE
PARTICULAR AREAS THAT WERE
PRETTY BAD -- WHEN I STARTED
LOOKING AT SOME OF THE MORE
DETAILED STUFF WHEN WE ARE
PRETTY MUCH PROPOSAL TOGETHER I
THINK THE REALITY IS WE OPERATE
A A VERY LARGE PROGRAM AND I'VE
HAD DIFFERENT AREAS OF FOCUS AT
DIFFERENT TIMES?
AND THE THE PHYSICAL CHILDREN'S
PHYSICAL HEALTH SIDE WAS NOT ONE
OF THIS PARTICULAR AREAS OF
FOCUS AND IT SHOULD BE IT
OBVIOUSLY SHOULD BE BY.
IT WASN'T AND SO WE'RE TRYING --
TO YOU CORRECT THAT NOW AND DO
WHAT WE CAN DO.
AS I RECALL ALSO THAT THERE ARE
SIGNIFICANT DISPARITIES IN
CERTAIN IN CERTAIN -- ETHNIC
ETHNIC.
CLASSIFICATIONS ARE CERTAINLY IN
IN CERTAIN PARTS OF THE STATE AS
WELL AND SO I'D I'D YOU KNOW I
APPRECIATE.
THAT SOMETHING'S HAPPENING NOW
BUT I'M JUST IT'S BEEN GOING ON
FOR QUITE A WHILE IT COULD HAVE
GOTTEN INTO YOU IT'S HARD TO
IGNORE THAT TWO AND A HALF
MILLION MILLION CHILDREN ARE NOT
GETTING.
PREVENTIVE CARE.
AND PART OF THAT JUST JUST TO TO
ALSO WHAT WE ALSO DON'T KNOW
BECAUSE WE THINK PART OF THAT IS
ALSO LACK OF DATA -- SO ONE OF
THE CHALLENGES WE HAVE IN IN
HAVING OUR MEDICAID PROGRAM RUN
IN A MANAGED CARE ENVIRONMENTS.
AND PARTICULARLY GIVEN THE WAY
THAT CALIFORNIA GENERALLY NOT
JUST IN MEDICAID BUT IN
HEALTHCARE IN GENERAL IS VERY
DELEGATED.
US SO YOU KNOW SO A PLAN
CONTRACTS WITH A PHYSICIAN GROUP
FOR A CAPITATED AMOUNT AND SO
THE ENCOUNTER DATA WHICH IS HOW
WE COLLECT WHAT'S HAPPENING.
WHEN THERE ISN'T PAYMENT TIED TO
ACTUALLY SUBMITTING A CLAIM?
WHICH IS HOW IT IS IN A FEE FOR
SERVICE WORLD NOT THAT WE THINK
OF YOUR SERVICE WORLD BETTER BUT
IT IS BETTER FROM A DATA
PERSPECTIVE.
SO PART OF THE STUFF THAT WE'RE
ACTUALLY LOOKING AT DOING
SEPARATE FROM THIS IS HOW DO WE
AND YOU SEE THIS WITH THE VALUE
BASED PAYMENTS AND WITH THE PROP.
FIFTY SIX DOLLARS IS.
IF WE CAN INCENTIVIZE MAKING SO
THAT WE HAVE COMPLETE DATA SO WE
KNOW WHAT IS REALLY THE GAP
VERSES.
IT'S A DATA ISSUE VERSUS NOT
BECAUSE WE WILL WE WILL SEE SOME
PROVIDERS WHO DON'T HAVE ANY
DOCUMENTATION OF ANY SORT OF OF
THE BASIC WELL CHILD VISITS EVEN
THOUGH THEY'RE SEEING.
THE PATIENTS AND SO WE JUST NEED
TO MAKE SURE THAT WERE ALSO
GETTING THE CORRECT DATA
[inaudible]
SO [inaudible]
AND ARE YOU SAYING THAT THAT THE
PROVIDERS ARE NOT DOCUMENTING
THE VISITS.
SO THERE THEY MIGHT NOT BE
DOCUMENTING ALL OF THE THINGS IN
THE VISIT THAT THEN THAT DATA IS
THAT GETTING UP TO THE PROVIDER
GROUP IS THAT GETTING UP TO THE
PLAN.
SO WE DO KNOW THAT WE'VE HAD AN
ENCOUNTER DATA.
OF LACK OF ENCOUNTER DATA THAT
WE'VE BEEN WORKING ON FOR THE
PAST I'D SAY FIVE YEARS WE'VE --
TRANSITION TO A NEW ENCOUNTER
DATA SYSTEM WE HAVE NEW
OVERSIGHT ON THE HEALTH PLANS
FOR MAKING SURE THAT THEIR THEIR
ENCOUNTER DATA IS TIMELY
COMPLETE AND ACCURATE.
BUT IT'S STILL A WORK IN
PROGRESS.
WE SEEM TO PERFORM WELL.
AT CERTAIN PERIODS FOR EXAMPLE
NGUYEN VACCINATIONS ARE CALLED
FOR AND THERE'S OVERSIGHT OR
THERE'S CORRECT.
BUT THEN THERE'S THESE HUGE GAPS
WHERE THERE'S KIDS JUST ARE
GETTING SEEN SO.
ONCE AGAIN IS THAT I KNOW THAT
FEEL LIKE THAT TRANSIT GOING ON
FOR QUITE AWHILE.
BECAUSE THE AUDITORS AND HAVING
TROUBLE FINDING THAT DATA.
SO -- I'D I'D I HOPE THAT THIS
MAKES A DIFFERENCE -- THAT --
BUT YOU KNOW I MEAN IF IF.
IF SOMEBODY'S BEEN DELEGATED DO
SOMETHING IN THERE NO ONE'S
FOLLOWING UP TO MAKE SURE
THEY'RE ACTUALLY DOING IT --
GUESS WHAT THEY'RE PROBABLY NOT
GONNA DO IT -- THERE'S NO
INCENTIVE FOR THEM TO DO IT --
AND SO SO I JUST AM DISAPPOINT
IS TAKEN SO LONG THAT SAID TO
AND HAPPENING KIDS ARE NOT
GETTING REGULAR CARE PREVENTIVE
CARE.
THEY COULD SAVE US MONEY IN THE
SYSTEM FURTHER OUT SO WE'RE
PROBABLY PAYING MORE MONEY FOR
THINGS WE SHOULDN'T HAVE.
TO AND THAT'S REALLY
DISAPPOINTED.
WE APPRECIATE YOUR THE ONE THAT
GETS TO HEAR THIS.
TAKE IT VERY SERIOUSLY IT'S IT
IS UP SETTING.
ANY IT IS AN ISSUE THAT SHOULD
BE TAKEN SERIOUSLY I I KNOW THAT
FOR MYSELF LET TESTING.
HAS COME UP A NUMBER OF TIMES
AND THERE SHOULD BE LET TESTING.
AT SIX MONTHS SOME BEFORE TWO
YEARS AND YET WE FOUND THAT SO
MANY CHILDREN.
DID NOT HAVE THE TESTING.
BUT AS YOU SAID THAT SOMETIMES
IT IS IN THE REPORTING FROM THE
PHYSICIANS THEY MAY BE DOING
SOME OF THIS.
BUT TO TO BECAUSE IT'S AN
ENCOUNTER -- THEY'RE PAID A
PARTICULAR AMOUNT JUST FOR THE
ENCOUNTER IN THE AMOUNT OF TIME
THAT IT TAKES TO TO WRITE OUT
EVERYTHING THAT THEY DID
SOMETIMES BECOMES.
AN ISSUE BUT STILL AN ISSUE THAT
NEEDS TO BE RESOLVED -- IT IN
LEAD TESTING IF WE KNOW THAT.
WE NEED TO TAKE CARE THAT JUST
AS SOON AS POSSIBLE OTHERWISE
THIS CHILD IS GOING TO BE
AFFECTED FOR THE REST OF THEIR
LIFE AND THERE IS.
NO CURE THERE'S NOTHING THAT CAN
BE DONE TO FIX THE PROBLEM --
BUT I DO APPRECIATE YOUR YOUR
PRESENTATION -- TODAY I THINK
THAT DOCTOR WOODS COMMENTS I
THINK ARE SHARED BY THE REST OF
THE COMMITTEE MEMBERS.
IN THAT THAT MAKING SURE THAT --
WHATEVER IS NEEDED TO MAKE SURE
YOU HAVE THE ACCOUNTABILITY TO
MAKE SURE THAT THE CHILDREN ARE
TESTED TO MAKE SURE THAT THE
RECORDS ARE COMPLETE. TO MAKE
SURE THAT WE DO HAVE.
WE DO HAVE THE TRANSPARENCY AND
IT CAN BE CHECKED BUT AS DOCTOR
WOULD ALSO SAID THIS WAS
SOMETHING THAT THE AUDITORS WERE
ABLE TO FIND VERY EASILY.
SO.
IT IS SOMETHING THAT JUST. TO TO
BE SURE THAT WE ARE ON TOP OF
BUT AGAIN I APPRECIATE THAT YOU
WERE HERE. TO TO MAKE THE
PRESENTATION AND TO TAKE BACK
THE COMMENTS THAT YOU HAVE
RECEIVED THANK YOU SO MUCH.
OF I'D LIKE TO IN THE NOTES FROM
THE MEMBERS.
ALL RIGHT LET'S OPEN IT UP TO
PUBLIC COMMENT.
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY WE APPRECIATE
THE DEPARTMENT'S EFFORT TO
INCREASE QUALITY IN THE MEDICARE
MANAGED CARE PLAN SPECIFICALLY.
INCREASING THAT THE MEASUREMENTS
ARE AS WELL AS THE MINIMUM
PERFORMANCE LEVEL AND AT THE
FREQUENCY OF THE CAPS SURVEY.
SO DO SUPPORT THE THE C. P. --
TO INCREASE OVERSIGHT AND
ACCOUNTABILITY -- AND DO YOU
THINK THAT INCREASE MONITORING
AND ENFORCEMENT -- WILL -- ALSO
POSITIVELY IMPACT I CHILDREN AS
WELL AS ADULTS I WE AGREE WITH
DOCTOR WOODS COMMENTS OR
REGARDING HEALTH DISPARITIES I
WOULD URGE THE DEPARTMENT TO
REQUIRE PLANS.
TO WORK DEMOGRAPHIC DATA THANK
YOU [inaudible]
THANK YOU.
SITTING AT I MEAN DOES NOT KNOW
WHAT CHILDREN NOW -- WE STRONGLY
SUPPORT THE ADMINISTRATION'S
BUDGET REQUEST FOR ADDITIONAL
RESOURCES. TO STREET AND PRINT
VENT OF SERVICES FOR CHILDREN WE
APPRECIATE DH CS COMMITMENT TO
STRENGTHEN MEDICAL SERVICES FOR
AND OUR KIDS.
ARE SUCH AS IMMUNIZATION
SCREENINGS PREVENTIVE CARE
TIMELY ACCESS TO GREATER
OVERSIGHT ACCOUNTABILITY IN
QUALITY MEASUREMENT -- WE
APPRECIATE DOCTOR WITH COMMENTS
AND WE LOOK FORWARD TO WORKING
WITH DH CS AND OTHER PARTNERS TO
ENSURE THAT THERE'S REGULAR
STAKEHOLDER INPUT FOR SUCCESSFUL
IMPLEMENTATION OF THESE
PROVISIONS.
SPECIALLY THOU WHICH CAMPAIGN.
AND THAT DH CS ADDRESS OF THE
FULL RANGE OF MEDICAID -- EPT
EPS TT SERVICES INCLUDING MENTAL
AND BEHAVIOR HEALTH CARE FOR
CHILDREN AND YOUTH THANK YOU.
THANK YOU.
GOOD AFTERNOON RENTAL COMING
HERE BEHALF OF HEALTH ACCESS
CALIFORNIA WE CERTAINLY SUPPORT --
MET THE INVESTMENTS IN MEDICAL
QUALITY AND ALSO ONLINE OUR
COMMENTS WITH THE WESTERN CENTER
ON LAW AND POVERTY THANK YOU.
THANK YOU.
WELL AGAIN THANK YOU FOR BEING
HERE AND GIVING THE PRESENTATION --
AND FOR TAKING THE COMMENTS.
THAT WERE MADE AND I KNOW YOU
TAKE THEM VERY SERIOUSLY AND
WILL TAKE THOSE BACK TO THE
DEPARTMENT [inaudible]
THANK YOU.
NOW WE WILL MOVE ON TO ISSUE
NUMBER SIX STAKEHOLDER PROPOSAL
OPTIONAL BENEFITS SOMEONE MEMBER
HEATH FLORA
.
ALL RIGHT THANK YOU CHAIR IN
MEMBERS.
I'M HERE TO ASK FOR YOUR
CONSIDERATION PROPOSED TO
REINSTALL PODIATRY SERVICES
UNDER MEDICARE I'LL MAKE
AUTHORIZATIONS BILLING POLICY
[inaudible]
CONSIDER.
ALSO CONSISTENT WITH THE WITH
THAT OF A POSITION FORMING THE
SAME SERVICES.
AS YOU MAY KNOW BUDGET CUTS OF
TWO THOUSAND I AM NINE
ELIMINATED OPTIONAL BENEFITS
UNDER MEDICARE.
BECAUSE OF THIS BUT I JUST ARE
PROHIBITED FROM FROM PHAM FROM
PROVIDING SERVICES TO PATIENTS
IN MEDI CAL UNLESS CERTAIN
CONDITIONS ARE MET.
LIMITATIONS MAY.
LIMITATIONS HAVE WILL LEAD TO A
DELAYED FOOT TREATMENT.
MOST OFTEN RESULTING IN PATIENTS
WAITING UNTIL COMPLICATIONS SO
BAD THEY'RE COSTLY ER VISITS.
THESE RESTRICTIONS OF WORSEN AN
ALREADY CUTE ACCESS PROBLEM FOR
LOW INCOME AND DISABLED
POPULATION STUDIES SHOW THAT BY
OFFERING COVERAGES PODIATRIST
CAN PREVENT COMPLICATIONS FOR
PATIENTS.
THAT ACTUALLY PROVIDE OVERALL
SAVINGS.
IS ALSO POOR AND THAT WE MAY
CONSIST OUR POLICIES PERTAINING
TO AUTHORIZATIONS ANDBILLING.
THIS PROPOSAL WOULD STREAMLINED
ADMINISTRATION ADMINISTRATIVE
BURDENS AND ALLOW FOR BETTER
HEALTH OUTCOMES FOR OUR MOST
VULNERABLE POPULATIONS.
HERE WITH ME IS -- CEMEX FIRST
ANSWER ANY QUESTIONS THE
COMMITTEE MAY HAVE [inaudible]
THANK YOU.
ONLY TO ANSWER QUESTIONS OR IS A
COURT THEY'RE GOING TO BE A
PRESENTATION OF THE PHOTOS WILL
OKAY ALL RIGHT -- AND CHAIR AND
AS SUBCOMMITTEE MEMBERS -- MY
NAME IS DOCTOR DAVID REDMAN AND
I'M A PRACTICING UP TOM JUST IN
CALIFORNIA -- TODAY TO URGE THE
RESTORATION OF EYE GLASSES
BENEFITS FOR ADULT MEDICARE
BENEFICIARIES AND TWENTY
NINETEEN TWENTY TWENTY STATE
BUDGET -- IN TWO THOUSAND NINE
FACING A SIGNIFICANT GENERAL
FUND DEFICIT THE BUDGET INCLUDED
SEVERAL REDUCTIONS IN
REIMBURSEMENT AND BENEFITS IN
THE MEDICAL PROGRAM.
LOW INCOME CALIFORNIANS WHO
DEPEND ON THAT ACCOUNT FOR THEIR
HEALTHCARE SUFFERED AND
CONTINUES SEPARATE TODAY.
HEY WE HOPE THAT IN JANUARY THE
BUDGET PROPOSAL WOULD INCLUDE
THE FUNDING NEEDED TO RESTORE
THE BENEFIT.
OF OUR VIEW IS BASED ON THE
BROAD CONSENSUS ABOUT THE NEED
FOR THIS RECIPE RESTORATION THAT
WAS REFLECTED IN THE TWENTY
SEVENTEEN HEALTH TRAILER BILL
THAT.
PROMISE RESTORATION ON THIS
IMPORTANT PROGRAM IN THAT IN
JANUARY TWENTY TWENTY CONTINGENT
ON THE APPROPRIATE ATION OF
FUNDS IN THE BUDGET.
OVER THE GENERAL BUDGET PROPOSAL
DOES NOT INCLUDE FUNDING FOR THE
RESTORATION OF THE OPTICAL
BENEFIT -- WE KNOW IN THE REAL
WORLD THERE'S A REAL NEED FOR
EYEGLASSES AND EYEGLASSES
COVERAGE FOR MEDI CAL ADULTS
WILL ALSO ENCOURAGE MORE
DIABETICS TO GET THEIR ANNUAL
EYE EXAM.
IS WILL PREVENT BLINDNESS A
COMMON COMMON A COMMON
COMPLICATION OF AND CONTROL
DIABETES -- PLEASE CONSIDER
MAKING EYE GLASSES RESTORATION
OF PRIORITY IN THIS YEAR'S
BUDGET NEGOTIATIONS THANK YOU
FOR CONSIDERATION.
THANK YOU.
HI SHERMAN WOMAN REYES THAT WAS
THE GREAT THANK YOU.
MY NAME'S JOHN CHISHOLM I'M THE
PRESIDENT OF THE CALIFORNIA.
MEDICAL ASSOCIATION.
I'M A PRIDE FIRST OF IN PRACTICE
PRIVATE PRACTICE IN CHULA VISTA
CALIFORNIA FOR OVER THIRTY YEARS.
SERVING ONE OF THE MOST
ETHNICALLY DIVERSE AND
UNDERSERVED AREAS AND STATE FOR
MY ENTIRE CAREER.
THIS POPULATION RELIES HEAVILY
ON THE MEDICAL SYSTEM.
IN THE LAST TEN YEARS HAVE
SUFFERED FROM A LACK OF ACCESS
TO QUALITY CLINICAL CARE THERE
ARE TWO REASONS FOR THIS THE
FIRST IS THAT SERVICES BY
PODIATRISTS HAVE NOT YET BEEN
FULLY RESTORED AND ALL HEALTH
CARE SETTINGS.
AND SECOND AND MOST IMPORTANTLY
PHOTOGRAPHIC SERVICES ARE
SUBJECT TO ONEROUS AND
UNNECESSARY AUTHORIZATION
BILLING AND SERVICE REQUIREMENTS
THAT FURTHER LIMIT ACCESS -- AS
ASSEMBLY MEMBER HE FLORA SAID WE
ALL KNOW THAT THE PRICE WE
SERVICES LENT LEMONADE FOR MEDI
CAL IN TWO THOUSAND AND NINE THE
INTERESTING THING IS IN THIS
CASE THE SERVICES WORK
ELIMINATED BUT THE PROVIDER OF
THE SERVICES PRIVATE FOR
SPECIALISTS AND FOOT NICKEL CARE.
WERE PREVENTED FROM PROVIDING
THE EXACT SAME SERVICES AS
POSITION FOR MEDI CAL PATIENTS
IS A RATHER UNUSUAL SITUATION.
THE THING I REALLY WANT TO BRING
HOME TO TODAY IS THAT FULL
RESTAURANT.
FULL RESTORATION ALONE WILL NOT
SOLVE THE PROBLEM OF ACCESS.
CURRENTLY SERVICES BY PRIDE
RESEARCH SUBJECT TO AN ENTIRELY
DIFFERENT SET OF AUTHORIZATION
BILLING AND SERVING SERVICE
REQUIREMENTS [inaudible]
THEN PHYSICIANS.
AND AS A MEDICAL PROVIDER FOR MY
ENTIRE CAREER I CAN ATTEST TO
THE DIFFICULTY INVOLVED IN
TRYING TO MEET ALL OF THESE
REQUIREMENTS.
WHEN GIVING EXAMPLES AS YOU ALL
KNOW THERE'S AN EPIDEMIC OF
DIABETES?
AND DIABETES RELATED FOOT AND
ANKLE DISEASE IN CALIFORNIA MY
OWN COMMUNITY IS BEING
PARTICULARLY DEVASTATED.
DIABETIC FOOT ULCERATIONS AND
AMPUTATIONS HAVE BEEN STEADILY
INCREASING.
SINCE PROVIDE FREE SERVICES WERE
ELIMINATED TEN YEARS AGO THE
PREVENTATIVE PUT CARE THAT COULD
HAVE PREVENTED THESE ALTERATIONS
IS NOT A COVERED BENEFIT.
AND I'M SORRY.
THAT'S OKAY.
TREATING THESE ALTERATIONS LIKE
ALL OF THE OPTIONAL SERVICES IS
LIMITED TO ONLY TWO VISITS PER
MONTH LIKE ANY OF THE OTHER
OPTIONAL SERVICES I TREAT
DIABETIC FOOT WOUNDS ALL DAY
EVERY DAY.
IT TAKES MANY MORE THAN TWO ONE
OR TWO VISITS A MONTH TO HEAL A
DIABETIC FOOT ULCERATION.
EVERYBODY KNOWS IN INFECTED
DIABETIC BUT WHEN IT'S AN
EMERGENCY LIMB THREATENING
CONDITION ENTRY NEW HOMES
OBVIOUSLY DOES NOT REQUIRE ANY
PRIOR AUTHORIZATION FOR A
POSITION.
BUT PRIOR AUTHORIZATION IS
REQUIRED FOR ANY PROCEDURE
TREATMENT BY A PODIATRIST
REGARDLESS OF SEVERITY SO WHILE
AUTHORIZATION IS OBTAINED.
WE WAIT TREATMENT OF THE
INFECTION IS DELAYED IT'S NOT
TREATED ADEQUATELY BECOMES LIFE
THREATENING PATIENT LOSES THEIR
LEG.
THE SCENARIO JUST PRESENTED IS
TYPICAL IT'S PREVENTABLE AND
IT'S WRONG.
WE HAVE A CHANCE TO MAKE IT
RIGHT PLEASE SUPPORT THE POINT
REINSTATEMENT OF THE ETHICS
SERVICES IN MEDI CAL AND PLEASE
ADOPT TRAILER LANGUAGE TRAILER
BILL LANGUAGE THAT WOULD
ELIMINATE THE UNNECESSARY
AUTHORIZATION.
BILLING AND SERVICE POLICIES
THAT APPLY TO PODIATRIST BUT NOT
POSITIONS WITHIN THE MEDICAL
SYSTEM.
THANK YOU FOR CONSIDERING THIS.
GOOD AFTERNOON CHAIR MEMBERS
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY WE REQUEST THE A
RESTORATION OF BENEFITS THAT
WERE CUT IN TWO THOUSAND NINE
DUE TO THE BUDGET CRISIS NOT DUE
TO ANY POLICY REASONS.
REFER TO AS OPTIONAL BENEFITS
THESE A CRITICAL BENEFITS ARE
NOT OPTIONAL TO THE MEDI CAL
ENROLLEES WHO DESPERATELY NEED
THEM.
ACCESS TO THESE SERVICES ALSO
PREVENT DETERIORATION OF HEALTH
AND THE NEED FOR COSTLY OUR
EMERGENCY SERVICES THE CHAIR
NIGHT I CAN CERTAINLY APPRECIATE
THE NEED FOR EYEGLASSES WHICH WE
HAD EXPECTED TO BE RESTORED IN
TWENTY TWENTY BASED ON PREVIOUS
BUDGET ACTIONS.
BUT REMAIN UNCERTAIN IN A TIME
OF RECOVERY IT'S PARAMOUNT THAT
THE STATE'S POOR RESIDENTS HAVE
ACCESS TO AUDIOLOGY PODIATRY
SPEECH THERAPY INCONTINENCE
SUPPLIES AND I CLASSES FOR
ADULTS THANK YOU [inaudible]
AND RUBIO.
OTHERS HAVE GOOD EYESIGHT --
PUBLIC FINANCE.
THANK YOU WELL OF AMENDED GETS
DEPARTMENT OF FINANCE SO YOUR
GENDER DOESN'T LIKE NICE JOB OF
OUTLINING THE COSTSOF THE OF
THE PROPOSAL AT HAND I WON'T
REPEAT THAT -- ON THE OPTICAL
ISSUE -- WE HAVE HEARD THE
CONCERN FROM THE LEGISLATURE WE
DON'T HAVE ANYTHING ELSE TO
SHARE AT THIS TIME BUT WILL
CONTINUE CONVERSATIONS FOR THE
MAYOR VISION.
THANK YOU THANK YOU.
BEN JOHNSON WITH THE LA ALL
HAPPY TO ANSWER ANY QUESTIONS
THAT THE COMMITTEE HAS.
WONDERFUL SPRING A BACK TO THE
COMMITTEE.
COMMENTS QUESTIONS YES DOCTOR
WOULD WELL FIRST OFF I WANT TO
THANK YOU MISTER FOR FOR
BRINGING BRING THESE ISSUES
FORWARD OBVIOUSLY CERTAINLY WE
YOU HAVE A BILL YOU HAD A BILL
BEFORE US IN THE ASSEMBLY HEALTH
COMMITTEE WHICH WHICH SAILED OUT --
SHE WALKED OUT PROBLEMS.
OF BUT BUT I THINK I THINK THE
THAT WERE THE IMPORTANT POINTS
HERE AND THIS GOES BACK -- TO
SOMETIMES I FEEL LIKE WE ARE
PENNY WISE AND POUND FOOLISH
WHEN IT REGARDS WITH REGARDS TO
THIS YOU CANNOT TREAT WOUND CARE
WOUNDS ADEQUATELY -- THEY LEAD
TO MORE EXPENSIVE MORE
DEBILITATING PROBLEMS AND SO
IT'S ALMOST UNCONSCIONABLE THAT
WE LET THIS GO FOR SO LONG -- IN
AND THEN RICK WITH REGARDS AYE
GLASSES WE'VE BEEN DOING AYE
GLASS CLINICS IN IN MY DISTRICT.
OF FOR THE LAST COUPLE OF YEARS
NOW WILL TELL YOU THAT -- IT IS --
THE PEOPLE WHO COM -- IT IS A
LIFE CHANGING THING FOR PEOPLE --
THE ABILITY TO TO SEE BILL TO
READ TO BE ABLE TO THEN.
HOPEFULLY BE ABLE TO BE A BETTER
PART OF THE WORK FORCE ONCE
AGAIN -- THESE ARE LIFE CHANGING
BY CHANGING THINGS AND I WOULD
HOPE THAT WE CAN FIND THE
RESOURCES YOU HAVE MY COMPLETE
SUPPORT BUT I HOPE THAT WE CAN
FIND IN THE BUDGET THE RESOURCES
TO RESTORE THESE MUCH NEEDED
SERVICES THANK YOU.
THANK YOU MS RUBIO.
AS A TEACHER I CAN'T TELL YOU
WHAT A DIFFERENCE IT MAKES AND A
LOT OF TIMES -- THE PARENTS SAID
IN PARTICULAR EMBARRASSED TO TO
ACTUALLY SAY ANYTHING AND SO --
WHEN WE STE WHEN I WAS TEACHING
AND WE SENT THE KIDS TO GET
TESTED -- THE PARENTS -- YOU
KNOW AUTOMATICALLY.
SAID I CAN AFFORD IT AND SO IT'S
JUST CRITICAL NOT JUST FOR THE
HEALTH OF THE KIDS BUT FOR THEIR
SELF ESTEEM AND WE KEEP TALKING
ABOUT HOW KIDS ARE THE FUTURE OF
CALIFORNIA EXCEPT WE DON'T WANT.
TO INVEST IN SIMPLE THINGS THAT
ARE GOING TO MAKE A DIFFERENCE
NOT ONLY IN THEIR LIVES BUT IN
THEIR EDUCATION SO THANK YOU
AGAIN FOR AND AGAIN WE HOPE THAT
WE CAN.
RESTORE THIS I'D JUST.
PENNY WISE POUND FOOLISH IS I
THINK -- RIGHT ON AYE.
IT JUST FEELS THAT WAY -- AND
SINCE WE'VE BEEN HERE THE LAST
TWO AND A HALF YEARS.
AND THAT WE KEEP DOING THAT AND
NOT JUST IN THIS DEPARTMENT BUT
IN A LOT OF THE OTHER ISSUES YOU
KNOW WE COULD THIS IS THE FIRST --
THESE ARE THE FIRST PROGRAMS ARE
CUT WHEN WE HAVE A MAJOR --
BUDGET CRISIS BUT THEN THIS IS
THE THE THE PROGRAM THAT'S THE
MOST EXPENSIVE BECAUSE WE CUT SO
MANY OF THOSE PROGRAMS SO THANK
YOU FOR BRINGING THIS FORWARD
MISTER FLOOR I REALLY
APPRECIATED.
WELL AGAIN HONEST FLOOR THANK
YOU. FOR FOR PRESENTING THIS FOR
BEING THE CHAMPION ON THIS ISSUE.
SOMETIMES THE ISSUES NEED TO BE
HEARD BUT EVERYBODY NEEDS TO
HAVE A CHAMPION SO THANK YOU FOR
BEING THE CHAMPION ON THIS
[inaudible]
THANK YOU.
ALL RIGHT LET'S OPEN IT UP TO
PUBLIC COMMENT DON'T GO AWAY
YEAH.
KELLY BEING ON BEHALF OF THE
CALIFORNIA MEDICAL ASSOCIATION
WE SUPPORT ASSEMBLY MEMBER
FLOORS BUDGET PROPOSAL TO
RESTORE THE PROVIDE FREE BENEFIT.
AND TO ALSO REMOVE THE
RESTRICTIONS AND MEDI CAL FOR
PARTY AFTER SERVICES TO ENSURE
PATIENTS RECEIVE TIMELY CARE.
AND TO AVOID COSTLY OR MORE
ACUTE COMPLICATIONS DOWN THE
LINE THANK YOU.
THANK YOU -- BROUGHT DISABILITY
RIGHTS CALIFORNIA WHISPER
RESTORATION OF THE OPTIONAL
BENEFITS LINER COMMENTS BUT
THOSE MADE BY WESTERN CENTER ON
LAW AND POVERTY [inaudible]
THANK YOU.
AFTERNOON RUNNING COMING HERE
BEHALF OF HEALTH TEXAS
CALIFORNIA ALSO ONLINE OUR
COMMENTS WITH WESTERN CENTER ON
LAW AND POVERTY AND SUPPORT TO
BE OPTIONAL -- BENEFITS
EXPANSION THANK YOU.
THANK YOU.
VERY GOOD THANK YOU SO MUCH FOR
THIS PRESENTATION.
ISSUE NUMBER.
SEVEN DURABLE MEDICAL EQUIPMENT
COMPLEX REHAB TECHNOLOGY AND
CLINICAL LAB RATES.
GOOD AFTERNOON MADAM CHAIR AND
MEMBERS BOB ACT ON BEHALF OF THE
CALIFORNIA.
ASSOCIATION MEDICAL PRODUCTS
SUPPLIERS.
TALK ABOUT DURABLE MEDICAL
EQUIPMENT THE ANALYSIS OF THE
COMMITTEE BACKGROUND OR HAS A
LOT OF DETAIL I WANT JUST TOP
LINE THAT IN A VERY BRIEF MANNER
BUT A DO IT JUSTICE AS WELL SO.
DURABLE MEDICAL EQUIPMENT.
IS A WIDE VARIETY OF EQUIPMENT --
SOMETHING AS SIMPLE AS A WALKER
TO SOMETHING AS COMPLICATED AS A
VENTILATOR FOR LIFE SUPPORT THE
PATIENT'S HOME.
OF MEDI CAL REIMBURSEMENT IS ALL
INCLUSIVE -- TO INCLUDE THE
PROVIDERS COST OF DELIVERY SET
UP BUILDING OFTEN PRIOR
AUTHORIZATION OR TARA TO THE
MEDI CAL PROGRAM -- AND A LOT OF
IN INTENSIVE OVERSIGHT IN TERMS
OF RESPIRATORY CARE SERVICES
HAVING TWENTY FOUR SEVEN
COVERAGE FOR A ISSUES THAT
ARRIVE WITH EQUIPMENT AS WELL SO.
FOR MORE THAN THE LAST DECADE OR
SO MEDI CAL AS HIS BASE ITS
REIMBURSEMENT RATES FOR DM ME.
ON THE MEDICARE RATES USING
EITHER AND 80% OF THE MEDICARE
RATE FOR MOST DIEM ME AND HOW 2%
OF MEDICARE RATES FOR CUSTOMER
WE HAVE OR WHEELCHAIR MOBILITY
DEVICES AND ACCESSORIES.
OF UP UNTIL THIS POINT THAT HAS
WORKED IN TERMS OF NOT BEING AN
EXCELLENT RATE OF REIMBURSEMENT
CERTAINLY SUSTAINABLE -- WE ARE
NOW DEALING WITH CHANGES TO THE
MEDICARE PROGRAM IN TERMS OF
COMPETITIVE BIDDING -- THAT A
DRAMATICALLY REDUCED OF THE
MEDICARE RATES THE MEDICAL
PROGRAM HAS NOT KEPT PACE WITH
THOSE CHANGES AS A RESULT THEY
HAVE SUBMITTED A STATE PLAN
AMENDMENT.
THAT WOULD GREATLY REDUCE THOSE
RATES AS OF JANUARY FIRST OF
THIS YEAR.
THAT SPOT IS SUBMITTED BUT NOT
YET APPROVED.
IF AND WHEN IT IS APPROVED IT WE
RETROACTIVE TO JANUARY FIRST --
SO PROVIDERS WOULD BE IN FOR
QUITE A SHOCK IN TERMS THE
REDUCTIONS IN REIMBURSEMENT --
OF THE RATES FOR MOST COMMON DME
ITEMS HAVE BEEN REDUCED BY 4260%
THROUGH THE COMPETITIVE BIDDING
PROCESS WHICH HAS ITS OWN SET OF
FLAWS IN TERMS OF HOW THE
PROCESS WORKED OUT.
IT IS CAUSED A PAUSE THE FEDERAL
LEVEL BY CMS TO NOT CONTINUE
ANOTHER ROUND OF COMPETITIVE
BIDDING AND MAKE CHANGES IN THE
COMPETITIVE BIDDING PROCESS.
WE'RE VERY CONCERNED THAT IF
MEDI CAL MOVES FORWARD WITH
THESE RATE REDUCTIONS BASED UPON
USING THESE FLAWED COMPETITIVE
BID RATES.
OF WILL HAVE PROVIDERS THAT WILL
NOT BE ABLE SUSTAIN THEIR
INVOLVED IN THE MEDICAL PROGRAM.
OVER THE LAST EIGHTEEN MONTHS
43% OF PROVIDERS IN CALIFORNIA
HAVE LEFT THE MARKET PLACE --
YOU'RE SEEING THIS NOW IN TERMS
OF ACCESS -- BY OF VARIOUS TYPES
OF DISCHARGE PLANNERS IN
HOSPITALS OF THE IN THE OFFICE
HE IS A VERY COST EFFECTIVE.
THE IN PATIENT CENTERED WAY OF
GETTING PATIENTS OUT OF THE
QUEUE CARE FACILITIES.
AND SKILLED NURSING FACILITIES
INTO A INTO THE HOME SETTING
WHERE THEY CAN MANAGE THE
CONDITIONS AND IMPROVE THE
QUALITY OF LIFE.
SO THAT THE ANNOUNCES POINTS OUT
THAT LUCILLE PACKARD FOUNDATION
RECENTLY CAME OUT WITH A STUDY
LAST YEAR -- THE TALKED ABOUT
CCS PATIENT DELAYS AND ACCESS TO
DB EQUIPMENT WHICH IS QUITE
DRAMATIC -- BRIEFLY HIGHLIGHT
VENTILATOR DEPENDENT CHILDREN IN
CALIFORNIA THOSE RATES HAVE GONE
DOWN BY A 20% AS WELL AS A
RESULT OF CHANGE THE FEDERAL
LEVEL.
OF THOSE ARE TWENTY FOUR SEVEN
AVAILABILITY IN TERMS OF SERVICE
AND PROBLEMS STAFF BY RESERVOIR
THERAPISTS.
OF AND VERY -- DON'T GET THE
TUITION TERMS OF MAINTAINING THE
CHILDREN THOUGH IN THAT
ENVIRONMENT SO THE LOOK THAT
ALSO IS RESULTING IN.
A DRAMATIC REDUCE REDUCTION THE
NUMBER PROVIDERS WERE SERVICING
MENTALLY TO PATIENTS -- ONE
MAJOR PROVIDER LAST YEAR LET THE
STATE OF CALIFORNIA -- AND THEY
HAD TO FIND A REPLACEMENT
PROVIDERS FOR TWO AND FIFTY
CHILDREN ON VENTILATORS SELL
VERY IMPORTANT AND DRAMATIC
CHANGES.
CUSTOMER HAVE TECHNOLOGY
SOMETHING WITH THIS WE'LL TALK
ABOUT THAT IN TERMS OF THE
UNIQUENESS OF THOSE SERVICES AND
WHY THEY NEED TO BE MAINTAINED
AT CURRENT LEVELS.
SO WE ARE ASKING FOR THE
COMMITTEE TO CONSIDER LANGUAGE
THAT WOULD MOVE THE MEDI CAL
REIMBURSEMENT 2100% OF MEDICARE.
WOULD USE A BLENDED RATE FOR
THOSE REIMBURSEMENT.
BECAUSE MEDICARE RECOGNIZES BOTH
NON WORLD AND RURAL RATES REAL
RATES ARE I WAS A VERY
DRAMATICALLY HIGHER.
SORE VERY CONCERNED THAT IF THEY
FOLLOW THE NON RURAL RATE IN A
PLACE LIKE READING OR THE
CALIFORNIA.
THOSE RATES ARE NOT A A BID THAT
ANYBODY EVER MADE TO THE
MEDICARE PROGRAM WORK READ
PROVIDE SERVICES CONCERNED ABOUT
ACCESS THERE WITH A VERY LIMITED
NUMBER PROVIDER SO.
RESPECTFULLY ASK YOU TO CONSIDER
THAT IN YOUR YOUR BUDGET
DELIBERATIONS OF AN RECOGNIZING
IN THE IN THE CUSTOM REHAB AREAS
WELL THE UNIQUE MODIFIER THAT
MEDICARE USES REIMBURSEMENT THE
QUE YOU MODIFIER WHICH TALKS
ABOUT THE DIFFERENCES IN THE
WHEEL CHAIR BASE THAT ARE
IMPORTANT.
AND DIFFERENT MEDI CAL THE
SUBTRACT THOSE REIMBURSEMENT
LEVELS AS WELL AS THEIR
EFFECTIVELY TRACKING MEDI CAL OR
MEDICARE RATES SO THANK YOU
[inaudible]
THANK YOU [inaudible]
NEXT WITNESS.
GOOD AFTERNOON I'M CHRISTY FOR
HERE ON BEHALF OF THE CALIFORNIA
CLINICAL LABORATORY ASSOCIATION.
AND THE ASSOCIATION AS PART OF A
COALITION OF ORGANIZATIONS
INCLUDING THE CALIFORNIA SOCIETY
OF PATHOLOGISTS CALIFORNIA
REALLY RADIOLOGICAL SOCIETY.
AND OTHERS AND WE'RE REQUESTING
THE REPEAL OF THE AB 9710% CUTS
TO THE MEDIC HOW FEE FOR SERVICE
PROVIDER RATES.
IT'S IMPORTANT TO REMEMBER THAT
IN TWO THOUSAND ELEVEN THE CROSS
THE BOARD 10% RATE CAP WAS
CAUSED.
NOT TO BE A DETERMINATION THAT
THE RATES WERE EXCESSIVE BUT
SOLELY BECAUSE OF THE SIZE OF
THE OVERALL STATE BUDGET AT THE
TIME WHICH IS TWENTY FIVE
BILLION.
THE 10% CUT HAS NOT BEEN APPLIED
TO SOME PROVIDER TYPES AND OTHER
PROVIDER CATEGORIES HAVE HAD
SUPPLEMENTAL RATE INCREASES.
THERE REMAIN SOME GROUPS SUCH AS
PHYSICIANS CLINICAL LABS AND
MEDICAL SUPPLIES SERVICES THAT
CONTINUE TO BE SUBJECT TO THE
10% REDUCTION.
THE REIMBURSEMENT FOR THE
SERVICES HAS NOT BEEN INCREASE
IN OVER A DECADE IN FACT IN THE
CASE OF PATHOLOGY AND LABORATORY
SERVICES.
MANY OF THE SERVICES HAVE
FURTHER REDUCED BEYOND THE 10%
REDUCTION.
IN THE TIME SINCE THE TWO
THOUSAND ELEVEN ENACTMENT OF AB
NINETY SEVEN THE HARD COST TO
PROVIDERS TO RENDER MEDICAL
SERVICES HAS CONTINUED TO
INCREASE.
COSTS FOR FACILITIES STAFF
BENEFITS AND EQUIPMENT FOR ALL
PROVIDERS HAVE INCREASED WITH NO
RECOGNITION OF THOSE COST AND
THE REIMBURSEMENT SCHEDULE.
IT IS DIFFICULT TO ESTIMATE THE
COST ELIMINATE THE 10% PROVIDER
RATE REDUCTIONS SINCE THE VAST
MAJORITY OF MEDI CAL PATIENTS
ARE NOW SIR TO MEDI CAL MANAGED
CARE ORGANIZATIONS ON A
CAPITATED BASIS.
FEE FOR SERVICE RATES HOWEVER
REMAIN IMPORTANT SINCE THE NCOS
AND OTHERS BASE THEIR FEE FOR
SERVICE PAYMENTS ON THOSE MEDI
CAL RATES. FOR THAT REASON WE
ASK FOR THE REPEAL OF THE 10%
CUT.
WE APPRECIATE THE CONSIDERATION
OF THIS ISSUE AND THE IMPORTANCE
TO RETAINING ESSENTIAL ACCESS TO
SERVICES BY MEDI CAL
BENEFICIARIES.
AS THE NUMBER OF MEDI CAL AND
QUIRK ENROLLEES CONTINUES TO
GROW THROUGH EXPANSION AN
INCREASE POPULATION.
IT IS IMPERATIVE THAT PAYMENT
RATES REMAIN EQUITABLE AND FAIR.
THE REPEAL OF THIS BUDGET
DEFICIT DRIVEN CUT SHOULD HAPPEN
THIS YEAR.
THIS IS WHY WE ASK THAT THE AB
9710% CUT BE ELIMINATED.
THANK YOU.
NEXT WITNESS FLICKS HI MY NAME
IS TANYA HAMMETT I AM HERE
REPRESENTING NATIONAL SEEING A
LITTLE THE AS WELL AS THE
NATIONAL COALITION FOR ASSISTIVE
AND REHAB TECHNOLOGY AND IT'S
EIGHT CALIFORNIA.
MEMBER COMPANIES WE ARE
PROVIDERS OF COMPLEX WE HAVE
TECHNOLOGY SERVICE SERVING
CHILDREN AND ADULTS WITH
SIGNIFICANT DISABILITIES.
COMPLEX REHAB TECHNOLOGY
INCLUDES MEDICALLY NECESSARY
CUSTOMIZED MENU ON POWER
WHEELCHAIRS SEATING AND
POSITIONING SYSTEMS AND OTHER
ADAPTIVE EQUIPMENT CRITICAL FOR
CHILDREN AND ADULTS WITH IS THAT
DISABILITIES SUCH AS SPINAL CORD
INJURY.
TRAUMATIC BRAIN INJURY CEREBRAL
PALSY A. L. S. MULTIPLE
SCLEROSIS AND SPINA BIFIDA.
THE SPECIALIZED EQUIPMENT IS
VERY DIFFERENT THAN STANDARD
DURABLE MEDICAL EQUIPMENT SUCH
AS WALKERS OF HOSPITAL BEDS.
THE PRODUCTS ARE MORE COMPLEX IN
THE C. R. T. EVALUATION
PROVISION AND ONGOING SUPPORT
PROCESSES.
ARE LABOR INTENSIVE REQUIRING
CREEK.
REQUIRING CREDENTIALED STAFF AND
FOCUSED OPERATION [inaudible]
OPERATIONAL INFRASTRUCTURES.
THERE ARE VERY LIMITED NUMBER OF
QUALIFIED C. R. T. PROVIDERS IN
CALIFORNIA.
AND AS NOTED IN THE COMMITTEE
ANALYSIS RECENT STUDIES SHOW
THERE ARE STAY ARE STRUGGLING TO
SURVIVE.
THE MEDI CAL POPULATION DUE TO
THE ONGOING AB 9710% CUTS UPPER
BILLING LIMIT RESTRICTIONS AND
READ AND A RECENTLY SUBMITTED
STATE PLAN AMENDMENT THAT WILL
FURTHER CAT REIMBURSEMENT FOR
DME PARTICULARLY IN RURAL AREAS.
THE IMMEDIATE THREAT TO ADEQUATE
ACCESS IS DISTRESSING FROM MY
COMPANY'S PERSPECTIVE WE
CONTINUE TO PROVIDE THESE
CRITICAL SERVICES HOWEVER WITH
REIMBURSED WITHOUT REIMBURSEMENT
CONCESSIONS WE WILL BE FORCED TO
MAKE DIFFICULT DECISIONS.
THIS WILL LIKELY RESULT IN
LIMITING PRODUCT CHOICES NO
LONGER PROVIDING REPAIRS
SERVICES IN THE HOME.
AND SCALING BACK FACILITIES AS
WE RECENTLY HAD TO CLOSE OUR
LOCATION IN TO LARRY.
THIS WILL HAVE NEGATIVE IMPACTS
ON PATIENT CARE AND RESULT IN
HIGHER MEDI CAL COST OTHER AREAS
SUCH AS HOSPITALIZATION AND NON
EMERGENCY MEDICAL TRANSPORTATION.
ALTHOUGH MANY CHANGES ARE NEEDED
TO STABILIZE THE C. R. T.
PROVIDER NETWORK THERE ARE TWO
IMMEDIATE ACTION IS THE
LEGISLATURE CAN MAKE TO AVOID
FURTHER NEGATIVE IMPACTS. TO
ACCESS REPEAL AB 9710% CUTS TO
SEE ALREADY C. R. T. PRODUCTS.
AND MODIFY THE UPPER BUILDING
LIMIT POLICY AS IT APPLIES TO C.
R. T. PRODUCTS TO ALLOW.
INCLUSION OF LABOR COSTS AND
APPLY A SINGLE YOU B. L. AT THE
CONFIGURED WHEELCHAIR LEVEL.
THE C. R. T. PROVIDER NETWORK
SUPPLIES CRITICAL PRODUCTS AND
SERVICES TO CALIFORNIA'S MOST
MEDICALLY FROM LOOK VULNERABLE
RESIDENTS WE APPRECIATE THE
COMMITTEE'S.
CONSIDERATION CONSIDERING OUR
PROPOSAL AND TAKING THE STEPS
NEEDED TO PROTECT ACCESS FOR
THIS IMPORTANT POPULATION.
THANK YOU AND I'M ALSO SPEAKING
ABOUT THE THIRD PROPOSAL IT AND
IF YOU WANT ME TO DO THAT NOW
I'D BE HAPPY.
TO AND THIS IS IN REGARD TO THE
CLINICAL LABORATORY RATE
METHODOLOGY.
CERTAINLY I HAD TWO ITEMS SO.
LOOK AT YOUR SECOND ITEM HERE SO
FOR MY SECOND ITEM -- THIS IS
SPECIFIC TO CLINICAL LABORATORY
RATE REIMBURSEMENT.
AND IN TWO THOUSAND THREE IN
ORDER TO ADDRESS ABOVE BUDGET
DEFICIT AT THE TIME.
A LABORATORY SERVICES WERE
CAPPED AT NO MORE THAN 80% OF
THE MEDICARE RATE.
AND SO IT'S IMPORTANT AT THE CAP
THERE WERE MANY TESTS THAT
REIMBURSED LESS THAN THAT BUT
THEY CANNOT BE REIMBURSED MORE
THAN THAT.
AND THEN IN TWO THOUSAND TWELVE
AND WE HAD THE OTHER BUDGET
CRISIS.
AND THE LEGISLATURE MADE A
POLICY DECISION TO SET THE MEDI
CAL REIMBURSEMENT RATES FOR
CLINICAL LABORATORIES AT THE
CALIFORNIA MARKET RATE.
AND IT WAS THE AVERAGE OF THE
LOWEST AMOUNT THAT OTHER PAIRS
REIMBURSING.
AND SO SINCE THAT TIME --
LABORATORIES IN CALIFORNIA HAVE
BEEN SUBMITTING THIRD PARTY DATA
SO ESSENTIALLY WHAT OTHER PAYER
SUCH AS BLUESHIELD HELP THAT
HAVE BEEN PAIN.
THE DEPARTMENT VINCE TAKES THOSE
NUMBERS AND CALCULATES OUT THE
LOWEST AVERAGE RATE FOR THE
CALIFORNIA MARKET RATE.
SO THOSE ARE NOW BEEN THE RATES.
OF THAT 80% CAP HAD NOT BEEN AN
ISSUE BEFORE THIS BECAUSE
MEDICARE RATES WERE ALWAYS SO
MUCH HIGHER THAN THE MEDI CAL
RATES.
BUT ALL OF THAT CHANGED LAST
YEAR BECAUSE IN TWO THOUSAND
EIGHTEEN CM ASSN THE FEDERAL
GOVERNMENT BASICALLY LOOKED AT
WHAT CALIFORNIA HAD DONE WITH
THE MARKET RATE APPROACH AND
THOUGHT THAT LOOKS LIKE A GOOD
IDEA.
SO THEY DECIDED TO ADOPT THE
SAME MARKET BASED APPROACH -- ON
THE NATIONAL LEVEL.
IN THE LAST YEAR THEY
IMPLEMENTED -- WITH THE
BASICALLY DID IS THEY ASKED ALL
THE NATIONAL LABS TO ALSO SUBMIT
ALL THE THIRD PARTY PAYER DATA.
AND THEY DEVELOPED THE MARKET
RATE FOR THE MEDICARE RATES FOR
LABORATORY REIMBURSEMENT.
IN SO ALL OF THOSE RATES HAVE
NOW BEEN ADJUSTED DOWN TO THE
NATIONAL MARKET RATE.
SO WHERE THE PROBLEM NOW THAT IN
CALIFORNIA WE STILL HAVE THAT
OLD RULE THAT YOU CANNOT PAY
MORE THAN 80% OF MEDICARE RATE
WELL NOW THAT MEDICARE IS OUT
THE NATIONAL RATE.
WE NO LONGER CAN USE THAT MEDIC
HOW CALIFORNIA RIGHT AND I CAN
GIVE YOU A QUICK EXAMPLE TO KIND
OF EXPLAIN IT.
IF YOU LOOK AT TO SICKBAY A
COMPLETE BLOOD COUNT WHICH IS
THE CBC.
THE MEDICARE RATE WAS TEN
DOLLARS AND SIXTY SIX CENTS.
THE MEDICARE RIGHT NOW THAT IT'S
BEEN SET TO THE NATIONAL RATE IS
SIX DOLLARS AND EIGHTY EIGHT
CENTS SO IT'S QUITE A DROP. FOR
CALIFORNIA THE MEDI CAL MARKET
BASED CALIFORNIA RATE IS SIX
DOLLARS AND SEVENTY FIVE CENTS
SO YOU CAN SEE THAT THAT MARKET
BASED APPROACH SEEMS TO BE
WORKING BECAUSE WE FIND THAT
MARKET RATE.
HOWEVER IF THE DEPARTMENT THEN
APPLIES 80% CAP TO THE MEDI CAL
NUMBER.
IT GETS PUSHED DOWN TO FIVE
DOLLARS AND FIFTY CENTS AN AND
REMEMBER WE STILL HAVE THE AB
9710% CUT SO THAT PUSHES THAT
NUMBER DOWN TO FOUR DOLLARS AND
NINETY FIVE CENTS.
SO WE'VE GONE THROUGH ALL THIS
TROUBLE TO CALCULATE OUT THE
CALIFORNIA MARKET RATE AT SIX
DOLLARS AND SEVENTY FIVE CENTS.
BUT THEN THEY WOULD ONLY
REIMBURSE AT FOUR DOLLARS AND
NINETY FIVE CENTS.
SO THAT'S REALLY THE CONCERN IS
THAT THESE REPEATED CUTS PLACE
BOTH THE PATIENT LIVES AT RISK
DUE TO THE ACCESS CONCERNS.
AND THEN ALSO EMPLOYEE JOBS IN
JEOPARDY.
AND SO IN CONCLUSION -- THE CAP
ENTIRELY UNDERMINES THE PURPOSE
BEHIND THE LEGISLATURE'S POLICY
DECISION TO HAVE THE
REIMBURSEMENT RATE SET TO THE
LOWEST CALIFORNIA MARKET RATE.
AND LABS CANNOT PROVIDE TESTING --
FOR EXAMPLE YOU TALKED ABOUT THE
LEAD TESTING THAT THE LABS
PROVIDE AND IT'S DIFFICULT TO DO
THAT AT A RATE THAT'S ACTUALLY
AT THIS POINT 30% BELOW WHAT IS
BEEN CALCULATED OUT TO BE THE
CALIFORNIA MARKET RATE.
AND SO THE UNINTENDED AND
RESULTS CAN REALLY BE FIXED BY A
REPEAL OF THAT 80% CAP.
THAT WAS ADOPTED BACK IN TWO
THOUSAND THREE SO THAT'S THE
OTHER PROPOSAL IS FOR A REPEAL
OF THAT 80% CAP.
THANK YOU THANK YOU [inaudible]
KAREN FARLEY.
HELLO I'M KAREN FARLEY WITH THE
CALIFORNIA WITH.
WITH ASSOCIATION AND ALONG WITH
THE CALIFORNIA BREASTFEEDING
COALITION WERE ASKING FOR SEVEN
MILLION DOLLAR.
BUDGET PROPOSAL TO INCREASE THE
REIMBURSEMENT RATE FOR THE PUMPS
PROVIDED IN MEDI CAL.
WE PROVIDED THE AN ANALYSIS OF
THE BIRTH RATE IN THE BREAST
FEEDING RATE ON THE UPTAKE ON
BREAST PUMPS AND THAT.
IS THE AMOUNT THAT WOULD BE
NEEDED IF ALL WOMEN WERE SERVED
BY THEIR HEALTH PLANS FOR THE
REST FEEDING NEEDS BUT WICK
DOESN'T EXCELLENT JOB OF
PROVIDING BREAST FEEDING SUPPORT
AND PROVIDES EXCELLENT PUMPS.
SO THAT REMEMBERS THAT BUDGET
PROPOSAL WOULD REALLY COME IN
MUCH LOWER THAN THAT BUT WE JUST
WANT YOU TO HAVE THE THE NUMBERS
FOR THE MOTHERS IF THEY ONLY USE
MEDI CAL.
S THE RATE THAT'S IN MEDI CAL
NOW TO ISN'T.
CAPABLE REALLY PROVIDING A PUMP
THAT CAN REALLY MIMIC THE ACTION
OF A HEALTHY TERM INFANTS. TO
INITIATE BREAST FEEDING AND
SUSTAIN THE MILK AND WOMEN ARE
BEING STRONGLY ENCOURAGED TO
BREAST FEED.
MAJORITY WOMEN EVEN THE LOW
INCOME WOMEN ARE BACK AT WORK
AND WE'RE NOT REALLY GIVING THEM
THOSE MOMS THAT ARE.
A USING PUMPS THROUGH MEDI CAL
IT CONSISTENTLY A PUMP THAT CAN
DO THE JOB THAT WE'RE ASKING
THEM TO DO.
SO WE'RE ASKING FOR THE
REIMBURSEMENT RATE TO BE
INCREASED SO THAT THE MOMS IN
THE MEDICARE PLANS AS MOMS
ANOTHER PLANTS HAVE ACCESS TO
PUMPS.
THERE OF A QUALITY THAT CAN
SUSTAIN THEIR BREAST FEEDING SO
[inaudible]
THANK YOU [inaudible]
HELLO [inaudible]
NO ROOM.
MARIE CAN'T.
ALL RIGHT.
ANY QUESTIONS FROM THE COMMITTEE
.
THIS CAN'T -- ONE TWO QUESTIONS --
DO YOU -- DOES DEPARTMENT
BELIEVE THAT THE RATE REDUCTIONS
THAT ARE OCCURRING.
ARE NECESSARY OR THE JUSTIFIABLE --
AND DO THEY CREATE.
NO CONCERNS ABOUT ACCESS TO THE
SERVICES AND EQUIPMENT SHORE SO
WITH THE STATE PLAN THAT IS
PENDING WE DID SUBMIT AN ACCESS
ASSESSMENT TO CMS -- AND SO AT
THIS POINT WE YOU KNOW.
WE FIND THAT WE BELIEVE THEY
WILL NOT IMPACT ACCESS -- AND
CERTAINLY YOU KNOW APPRECIATE
THE ISSUES THAT HAVE BEEN RAISED.
TODAY -- AND YOU KNOW I AND I
THINK.
NOTED THAT IF IF WE WERE TO DO
SOMETHING DIFFERENT WOULD
REQUIRE STATUTORY CHANGE A GIVEN
THAT THE STATE GENERALLY HAS AN
80% CAP TO MEDICARE EXCEPT FOR
THE REALTORS THAT WERE MENTIONED
EARLIER.
IT IS IS IT ALLOWABLE.
UNDER FEDERAL LAW TO PAY THESE
PROVIDERS A 100%.
MEDICARE.
UNDER FEDERAL LAW WOULD BE THAT
THE CAP.
BECAUSE OF THE CURE'S ACT FROM A
COUPLE OF YEARS AGO IT THEY
DON'T PROVIDE ANY -- MEDICAID F.
P. ABOVE A 100% OF MEDICARE.
BUT IT COULD BE FOR THOSE WHERE
WE HAVE CURRENT STATE CAPS AT
80% IF THEY COULD GO UP TO A
100% WITH US A LOT CHANGE. FOR
WHAT REASON WOULD WE NOT DO WITH
THEM -- YOU KNOW IT'S ALWAYS --
CHOICES ABOUT WHAT PRIORITIES --
THE LEGISLATURE AND THE GOVERNOR
HAVE AS PART OF THE BUDGET --
AND SO OBVIOUSLY EACH DECISION
HAS A PARTICULAR COST TO IT --
SO IT IT'S REALLY AT THE END OF
THE DAY A DECISION ABOUT WHETHER
THAT IS THE PRIORITY OF THE
LEGISLATURE AND THE GOVERNOR.
GET ME OTHER QUESTIONS OR
COMMENTS COMMITTEE.
ALL RIGHT LET'S OPEN IT UP -- TO
PUBLIC COMMENT.
GOOD AFTERNOON MADAM CHAIR
BEHALF THE CALIFORNIA CHILDREN'S
HOSPITAL CESSATION PLEASE TO
SUPPORT BOTH PROPOSALS TO
INCREASE -- WELL OR AT LEAST
MAINTAIN.
MEDI CAL RATES FOR DMV -- I
THINK THAT'S ALL THIS PROPOSAL
REALLY WILL DO IS TRY TO KIND OF
KEEP STATUS QUO FROM WHERE WE
ARE NOW WE SUPPORTER PROPOSALS
IN PAST YEARS THAT AT THAT TIME
MIGHT HAVE ACTUALLY BEEN A RATE
INCREASE BECAUSE WE WERE SAYING
ACCESS PROBLEMS FOR DIEM IN OUR
HOSPITALS.
IS TO GIVE AN EXAMPLE OF WHAT'S
HAPPENING WITH VENTILATORS WE
HAVE A NUMBER OF CHILDREN'S
HOSPITALS THAT RUN THEIR OWN
VENTILATOR PROGRAMS TO HELP GET
CHILDREN OUT OF THE HOSPITAL AND
BACK INTO THE HOME.
I'M RIGHT NOW THERE WITH THE
LATEST SET OF CUTS THEY'RE BEING
REIMBURSED AT ABOUT SEVEN
HUNDRED DOLLARS SEVEN HUNDRED
AND FORTY FOUR DOLLARS I THINK
IT IS FOR VENTILATOR SERVICES
THAT'S INCLUDING THE RESPIRATORY
NURSES AND ALL OF THE HOME CARE
THAT'S PROVIDED TO MAINTAIN THE
VENTILATOR.
AND OUR HOSPITALS ESTIMATE THAT
THAT COST BETWEEN THREE AND FOUR
THOUSAND DOLLARS A MONTH TO
PROVIDE SO THEY'RE JUST EATING
THAT COST RIGHT NOW BECAUSE THEY
WANT TO MAKE SURE THAT THAT KID
IS IN.
THE LEAST RESTRICTIVE
ENVIRONMENT BUT THAT TYPE OF
SHORTFALL APPLIES TO ALL SORTS
OF DURABLE MEDICAL EQUIPMENT WE
KNOW THE CHILDREN IN THE CCS
PROGRAM AND AND ALSO IN MEDI CAL
THEIR FAMILIES ARE PAYING FOR
DIEM IN A POCKET BECAUSE THEY
CAN'T FIGURE OUT HOW TO GET TO
PROVIDERS.
ESPECIALLY IN RURAL COMMUNITIES
AND WHEN WE TALK TO THE FOLKS AT
VALLEY FOR EXAMPLE OUT IN MADERA
COUNTY -- THEY'RE VERY WORRIED
THAT THEY'LL JUST LOSE ALL OF
THE MOM AND POPS THAT ARE LEFT
AND ALL YOU'LL HAVE LEFT IS THE
HOSPITAL IS THE PROVIDER SO WE
HOPE THAT THE COMMITTEE WILL
CONSIDER IT AND SUPPORT THAT.
THANK YOU.
HI.
MY NAME IS JOHN MCCLELLAND I'M A
PARENT OF A VENTILATOR DEPENDENT
EIGHT YEAR OLD HE DOES NOT READ
WHEN HE'S A SLEEPY DEPENDS ON A
MACHINE TO BREATHE FOR HIM
WITHOUT IT HE WILL DIE.
THE SEVEN HUNDRED SEVENTEEN
DOLLARS.
FIFTY SIX SENT RATE THAT IS PAID
FOR VENTILATORS IN CALIFORNIA
CAUSES DIEM MEANS TO SHORT
CHANGE PATIENTS ON NEEDED
MEDICAL EQUIPMENT.
MY SON'S VENTILATOR BROKE LAST
WEEK THE PARTY NEEDED TO REPLACE
IT SHOULD HAVE COST ABOUT THREE
THOUSAND DOLLARS FOR A MEDICALLY
APPROPRIATE PART.
ARE DME MADE A FINANCIAL
DECISION TO SEND US A PART A
HEATER HUMIDIFIER THAT'S ABOUT
THREE HUNDRED DOLLARS.
IT IS MEDICALLY INADEQUATE AND
THEY MADE THAT DECISION BASED ON
COST MY SON WAKES UP COUGHING UP
BLOOD [inaudible]
V. COST OF THESE LOW
REIMBURSEMENT RATES ON
VENTILATORS IS REAL HUMAN
SUFFERING SICKNESS AND DEATH
[inaudible]
THANK YOU.
THANK YOU SO SORRY YOUR SON IS
GOING THROUGH THAT BUT CLEARLY
IT MAKES A DIFFERENCE WHEN WE
HEAR TESTIMONY.
FROM SOMEONE WHO.
THE HUMAN FACE TO SOMETHING THAT
WE'RE TALKING NUMBERS WERE
TALKING -- DETAINEES -- WOULD
YOU'RE TALKING ABOUT YOUR SON
YOUR SON'S LIFE.
AND I APPRECIATE YOUR BEING HERE.
I ACTUALLY HAD TO ORDER THE
MEDICALLY APPROPRIATE PART FROM
A A RESELLER OF USED VETERINARY
EQUIPMENT ON EBAY WHICH IS NOT A
VALID SOLUTION.
IT IS NOT.
THANK YOU FOR BEING HERE.
MADAM CHAIR AND MEMBERS DON
GILBERT FOR QUEST DIAGNOSTICS I
WANTED TO ASSOCIATE.
MY COMMENTS WITH CHRISTY FOYERS
AND CC LA.
A COUPLE QUICK -- ITEMS ONE
WOULD HAVE TO REALLY TAKE ISSUE
WITH THE ASSERTION THAT THERE
WON'T BE -- ACCESS ISSUES YOU
KNOW WHEN THERE WAS AT TWENTY
FIVE BILLION DOLLAR DEFICIT THE
CLINICAL LAB INDUSTRY WORK WITH
THE DEPARTMENT FOR OVER A YEAR A
YEAR. TO HELP IT IMPLEMENT THE
CUTS THAT WE WOULD TAKE BECAUSE
WE UNDERSTOOD THE SITUATION THE
STATE WHICH IS NO LONGER THE
CASE -- AND WITH DUE RESPECT I
DON'T THINK THAT THE EGGS THAT I
THINK WE PROVIDED THE EXPERTISE
THAT WAS NECESSARY TO ENABLE THE
DEPARTMENT TO EXECUTE ON THIS.
ON THE LAW -- WAS QUEST
DIAGNOSTICS HAS A SIGNIFICANT
INVESTMENT IN THE STATE'S SIXTY
SIX HUNDRED EMPLOYEES.
OVER FOUR HUNDRED PATIENTS
SERVICE CENTERS TOO ESOTERIC LAB
WHICH IS SOPHISTICATED TAX
TESTING FIFTEEN RAPID RESPONSE
LABS.
WE DON'T HAVE TO HAVE THAT
INVESTMENT UNDER THE CURRENT
REINVESTMENT -- THE IN CURRENT
REIMBURSEMENT RATE AS DISCUSSED
WE'RE GONNA HAVE TO CONSOLIDATE
OR HAVE TO CREATE EFFICIENCIES
SOME OF WHAT I JUST TOLD YOU
WILL BE SIGNIFICANTLY REDUCED
WE'VE DONE THAT ALREADY WE'RE WE
FACE EXACT SAME SITUATION.
IN OTHER STATES LIKE MICHIGAN IN
SEVERAL STATES IN NEW ENGLAND SO
THERE WILL BE CONSEQUENCES
BECAUSE YOU CAN'T JUST PRINT
MONEY IT HAS TO COME FROM
SOMEWHERE AND IT'S NOT GOING TO
PENCIL OUT.
SO WE WOULD REALLY ENCOURAGE YOU
WE KNOW THIS IS A COMPLEX ISSUE
ARCANE ISSUE WITH COURAGE YOU
THE LOOK AT IT SERIOUSLY BECAUSE
THERE'S GOING TO BE A PROBLEM
THANK YOU.
THANK YOU KNOW I UNDERSTOOD THE
ADMINISTRATION'S RESPONSE WAS
THAT THEY HAD SUBMITTED.
THE ISSUE ON ACCESS -- TO CMS
AND YOU'RE WAITING FOR A
RESPONSE THE YOU DON'T BELIEVE
THERE'S GOING TO BE A PROBLEM
RIGHT THERE WAITING FOR C. M.
S.'S RESPONSE RECORDS PART OF
THE STATE PLAN.
REQUIREMENTS WHEN YOU SEE WHEN
YOU DO SOMETHING LIKE THIS.
THANK YOU I'M MARIN PIN IT ON
BEHALF OF THE CHILDREN'S
HOSPITAL LOS ANGELES -- ALSO IN
SUPPORT TO ESTABLISH THAT ALL
CATEGORIES OF DME BE REIMBURSED
AT A 1100% -- WE HAVE A LOT OF
LOW INCOME CHILDREN THAT WERE
SERVING -- WHICH MAKES A I'M
MORE THAN 50% OF OUR PATIENTS --
SO WE ASK FOR YOUR SUPPORT THANK
YOU.
THANK YOU AND GOING BACK TO THE
ISSUE ONE ACCESS -- THE IT.
CLEARLY THERE THERE'S GOING TO
BE SOME PROBLEM WITH ACCESS.
IF WE HAVE THE THE VENDORS WHO
SAY IT'S NOT GOING TO PENCIL OUT
WE CAN'T PROVIDE IT -- BECAUSE
WE'RE NOT THE REIMBURSEMENT RATE
IS SO LOW -- ACCESS FOR JUST AS
THE THE THE WITNESS WAS TALKING
ABOUT HER SON SO THERE THERE.
I WOULD IMAGINE THAT IN THE END
C. AMASSES RESPONSE HAS TO
INCLUDE SOME ISSUES REGARDING.
ACCESS IN THE VERY LEAST
POTENTIAL ISSUES OF ACCESS.
BUT THANK YOU FOR FOR FOR THAT
COMMENT YES HI GOOD EVENING MY
NAME IS DONNA COLIN AND I MY
CAMPAIGN DIRECTOR FOR MOMS
RAISING.
WE ARE AN ONLINE AND ON THE
GROUND MOVEMENT OF PARENTS
WORKING TO PROMOTE POLICIES THAT
STRENGTHEN FAMILY ECONOMIC
SECURITY.
I'M I'M HERE TODAY IN SUPPORT OF
KERN CHARLIE'S EYES SEVEN
MILLION DOLLAR ASK FOR MEDICAL
BREAST PUMP REIMBURSEMENT RATES --
IN FRONT OF YOU SHOULD HAVE
ABOUT TWO THOUSAND SIGNATURES
FROM OUR MEMBERS ACROSS
CALIFORNIA WE HAVE ABOUT A
HUNDRED AND TWENTY THOUSAND HERE
IN CALIFORNIA.
WHO CARE PASSIONATELY ABOUT
IMPROVING ACCESS TO HIGH QUALITY
BREAST PUMP FOR MOMS REGARDLESS
OF THEIR BACKGROUND WE KNOW THAT
RATES HAVEN'T BEEN INCREASED IN
CLOSE TO THIRTY YEARS SO THE
TIME IS NOW TO MAKE THIS AN
EQUITABLE MOVE?
FOR ALL MOMS IN CALIFORNIA THANK
YOU FOR YOUR CONSIDERATION
[inaudible]
THANK YOU.
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY IN SUPPORT OF
INCREASING THE DURABLE MEDICAL
EQUIPMENT RATE WE'VE HEARD FROM
OUR LEGAL AID ADVOCATES ACCESS
ISSUES.
OBTAINING AND MAINTAINING DME
EQUIPMENT [inaudible]
THANK YOU.
DEBORAH DISABILITY RIGHTS
CALIFORNIA UP FOR MANY OF OUR
CLIENTS PEOPLE WITH DISABILITIES
DEPENDENCE ON DURABLE MEDICAL
EQUIPMENT MAKES THE DIFFERENCE
BETWEEN.
BEING ALIVE AND NOT BEING ALIVE
LIVING WITH DIGNITY LIVING WITH
INDEPENDENCE LIVING WITH CHOICE
IN THESE ARE ALL REASONS WHY WE
A SUPPORT ACCESS TO APPROPRIATE
DURABLE MEDICAL EQUIPMENT
[inaudible]
THANK YOU.
GOOD AFTERNOON KELLY MAC KNOWN
ON BEHALF OF CHILDREN ESPECIALLY
CARE COALITION REPRESENTING
TWENTY FIVE HUNDRED PEDIATRIC
SUB SPECIALISTS WERE IN SUPPORT.
OF A 100% A REIMBURSEMENT ON
THIS EQUIPMENT IS A VERY
IMPORTANT TO OUR MOST VULNERABLE
CHILDREN IN THE STATE THANK YOU.
THANK YOU.
GOOD EVENING I'M ROBBIE GONZALEZ
DOW WITH THE CALIFORNIA
BREASTFEEDING COALITION IN WHERE
IN STRONG SUPPORT OF INCREASING
THE REIMBURSEMENT RATE FOR
BREAST PUMPS UNDER MEDI CAL.
AS WAS MENTIONED THEY HAVE NOT
BEEN INCREASE NOW PROBABLY
THIRTY ONE YEARS AGO SINCE THE
PROGRAM WAS STARTED.
AND WE REALLY SEE THE RATE --
INCREASE PROVIDING MORE ACCESS
AN EQUITABLE ACCESS FOR LOW
INCOME -- SO THANK YOU VERY MUCH
[inaudible]
THANK YOU.
HI MY NAME IS DEBBIE ALBERT AND
I AM THE PRESIDENT OF THE
SACRAMENTO BREASTFEEDING
COALITION.
AND I WOULD ALSO LIKE TO OF
SUPPORT THE INCREASE IN RATES
BUT I'M ALSO A CLINICAL NURSE
THREE LACTATION CONSULTANT AT UC
DAVIS.
AND WE DO MUCH RESEARCH ON THE
BIKE ROMA THE MICROBIOME AND
WHAT IT DOES FOR THE DEVELOPMENT
OF THE HUMAN BEING.
AND WE ARE RESEARCH INDICATES
THAT IT'S VERY IMPORTANT FOR
BABIES NOT ONLY TO BE BORN
VAGINALLY BUT ALSO TO BE
BREASTFED.
AND WHEN WE DON'T HAVE THIS
INCREASE WE DON'T TAKE CARE OF
OUR MOST -- NEEDY PERSONS IN THE
STATE OF CALIFORNIA AND I THINK
IT'S VERY IMPORTANT THAT WE DO
THAT THANK YOU.
THANK YOU [inaudible]
ALL RIGHT.
NO MORE PUBLIC COMMENT TO THAT
CONCLUDES ISSUE NUMBER SEVEN I
THANK YOU ALL FOR YOUR
PRESENTATIONS THANK YOU.
ISSUE NUMBER EIGHT HOME AND
COMMUNITY BASED ALTERNATIVES
WAIVER OVERSIGHT AND STAKEHOLDER
PROPOSAL.
ON CALIFORNIA COMMUNITY
TRANSITIONS
[inaudible]
JENNY MCCLELLAN.
YES MA'AM FIRST.
MY NAME IS JENNIFER MCCLELLAND
I'M A PARENT OF AN EIGHT YEAR
OLD WHO IS VENTILATOR DEPENDENT
AND WHO ACCESS IS MEDI CAL
THROUGH THE H. C. B. A WAIVER.
THE H. C. B. A WAIVER SERVES TO
POPULATIONS FIRST IT SERVES
CHILDREN LIKE MY SON.
WERE MIDDLE CLASS FAMILY AND OUR
PRIVATE INSURANCE DOES NOT COVER
THE AMOUNT OF HOME NURSING CARE
THAT HE NEEDS IN ORDER TO LIVE
SAFELY AT HOME.
HE USES THE HCV A WAIVER FOR
INSTITUTIONAL DEEMING IN ORDER
TO ACCESS MEDI CAL EPS D. T.
SKILLED NURSING.
THE H. C. B. A WAIVER ALSO
SERVES A POPULATION OF DISABLED
ADULTS WHO NEED MORE NURSING AND
PERSONAL SUPPORT SERVICES THAN
IN HOME SUPPORTIVE SERVICES
ALONE CAN PROVIDE.
IN ORDER TO LIVE SAFELY AT HOME.
THE H. C. B. A WAIVER.
SERVICE THE MOST MEDICALLY NEEDY
POPULATIONS IN A WAY THAT
RESPECTS THEIR CIVIL RIGHTS AND
ALLOWS THEM TO LIVE SAFELY IN
THE COMMUNITY AND PARTICIPATE IN
NORMAL LIFE.
THE H. C. B. A WAIVER WAS
RECENTLY TRANSITIONED TO WAVER
AGENCY MANAGEMENT MODEL SO
RATHER THAN HAVING.
NURSES WHO ARE EMPLOYED BY THE
STATE COME UP WITH TREATMENT
PLANS.
IT'S BEEN CONTRACTED OUT TO
PRIVATE COMPANIES.
THESE COMPANIES.
FROM WHAT I HAVE HEARD OF OTHER
PARENTS OF SERIOUSLY DISABLED
CHILDREN.
ARE NOT.
HAVE NOT HIRED SUFFICIENT STAFF
TO DEAL WITH THE CASE LOAD THAT
THEY'VE BEEN ASSIGNED.
I AM AWARE OF CHILDREN WHO HAVE
BEEN WAITING SIX MONTHS TO A
YEAR FOR THEIR PAPERWORK TO BE
PROCESSED.
THE STATE IMPLEMENTED A PRIORITY
PROCESSING.
RULES SO THAT CHILDREN AREN'T
SUPPOSED TO GO ON THE WAITING
LIST WHICH IS ABOUT THREE YEARS
LONG HOWEVER.
THE ACTUAL PROCESS FROM START TO
FINISH OF FINDING OUT ABOUT THE
WAIVER APPLYING FOR THE WAIVER
AND THEN ACTUALLY GETTING THE
SERVICES YOU NEED IS DRAGGING ON
FOR MONTHS.
AND WHAT I WOULD LIKE TO SEE
TODAY IS A PLAN. TO REDUCE THE
TIME SPENT.
ON PAPER WORK.
AND A PLAN. TO REDUCE THE WAIT
LIST OVERALL WE WOULDN'T HAVE A
NEED TO EXEMPTS CHILDREN FROM
THE WAITING LIST IF THERE WASN'T
A WAITING LIST [inaudible]
THANK YOU.
GOOD AFTERNOON MADAM CHAIR AND
COMMITTEE MEMBERS MY NAME IS
ALYSSA GROSJEAN I'M WITH
DISABILITY RIGHTS CALIFORNIA I
WILL ALSO BE SPEAKING OF FOR
KAREN KIESLER WAS NOT ABLE TO
MAKE IT TODAY SO.
I WILL TRY TO KEEP -- MY
COMMENTS FREE -- I HAD INTENDED
TO SPEAK ABOUT THE H. C. B. A
WAIVER I WILL ALSO BE SPEAKING
ABOUT OUR BUDGET PROPOSAL FOR
THE CALIFORNIA COMMUNITY
TRANSITIONS PROGRAM -- THEY DO
INTERSECT ALTHOUGH THEY ARE WHO
THEY ARE DIFFERENT PROGRAMS --
JENNY HAS COVERED A LOT OF WHAT
I WAS GOING TO SAY ABOUT THE
WAIVER -- BUT WE APPRECIATE YOU
HEARING THIS OVERSIGHT MATTER
AND I WANT TO SAY A FEW MORE
WORDS ABOUT THE WAIT LIST
PROBLEM -- THERE THERE IS A
PARTICULAR PROBLEM WITH CHILDREN
WHO READ WHO NEED THIS WAIVER IN
ORDER TO BECOME ELIGIBLE FOR
MEDICARE OUT AND GET THE FULL
SCOPE OF SERVICES THAT THEY
SHOULD BE ABLE TO GET --
INCLUDING PRIMARY CARE AS WELL
AS IN HOME SUPPORTIVE SERVICES
AND THE DEPARTMENT TO ITS CREDIT
HAS INITIATED THIS PRIORITY
REVIEW -- BUT WE STILL GET
REFERRALS FROM FAMILIES WHO ARE
PLACED ON THE WAIT LIST AND ARE
NOT -- GETTING PROCESSED AS
QUICKLY AS THEY SHOULD -- THE
DEPARTMENT HAS ADDRESSED THESE
INDIVIDUAL SITUATIONS AS WE
BROUGHT THEM UP BUT THAT'S NOT
THAT'S NOT AFFECTED WE CAN ONLY
HANDLE THEY BE.
THE PEOPLE WHO COME TO US AND WE
JUST DON'T KNOW WHO ISN'T COMING
TO US SO WE WOULD LIKE TO SEE A
BROADER APPROACH WHERE THE
DEPARTMENT IS TAKING A LOOK AT
THE TWO HUNDRED AND FIFTY KIDS
WHO CURRENTLY ARE ON THE WAIT
LIST WHO WERE UNDER.
EIGHT AGE EIGHTEEN AND IDENTIFY
THOSE CHILDREN WHO ARE WAITING
TO BECOME ELIGIBLE FOR MEDICARE
ALL THROUGH THE WAIVER BUT ALSO
THOSE CHILDREN WHO MAY BE ON
MEDICARE AL AND IT NEED WAIVER
SERVICES OR MAYBE NEED.
TO HAVE MEDI CAL SERVICES AND
DON'T UNDERSTAND THAT THEY HAVE
A RIGHT TO GET THEM AND THERE IS
A MEANS TO GET THEM OUTSIDE OF
THE WAIVER THESE CHILDREN SHOULD
NOT BE WAITING THERE THERE.
THERE TOO MUCH IN DESPERATE NEED
OF OF SERVICES.
BUT OVERALL THE WAIT LIST IS A
IS A PROBLEM FOR ADULTS AS WELL --
THE WAY.
I SINCE THE RENEWAL OF THE
WAIVER WE UNDERSTAND THAT IN
TWENTY SIXTEEN THERE WERE ABOUT
EIGHTEEN HUNDRED PEOPLE ON THE
WAIT LIST -- THE WAIT LIST WE
UNDERSTOOD WAS ABOUT TWO TO
THREE YEARS LONG.
IN OUR TWENTY EIGHTEEN THE WAIT
LISTS SKYROCKETED TO TWENTY
SEVEN HUNDRED PEOPLE I DON'T
EVEN KNOW HOW LONG ONE WOULD
WAIT IF YOU'RE NUMBER TWENTY
SEVEN HUNDRED ON THE WAIT LIST.
I WE JUST GOT NEW NUMBERS FROM
THE DEPARTMENT AND ACCORDING TO
THAT INFORMATION ABOUT EIGHT TO
RID.
OF EIGHT HUNDRED AND FORTY
PEOPLE HAVE BEEN PROCESS FROM
THE WAIT LIST SINCE JULY OF
TWENTY EIGHTEEN SOME OF THEM
HAVE GONE TO INTAKE WE DON'T
KNOW WHAT HAPPENED TO THE
REMAINDER OF THEM.
ARE THEY HAVE THEY BEEN
HOSPITALIZED OR
INSTITUTIONALIZED HAVE THEY DIED
WE DON'T KNOW -- BUT ANOTHER
FOUR FIVE HUNDRED PEOPLE HAVE
BEEN ADDED TO THE WAIT LIST SO
IT'S IT'S NOT MOVING AS QUICKLY
AS IT SHOULD AND WE REALLY.
NEED TO UNDERSTAND BETTER WHAT
WHAT'S THE HOLD UP -- I THINK
PART OF THE PROBLEM IS AS AS
JENNY SPOKE TO SOME OF THE
WAIVER AGENCIES DON'T HAVE THE
CAPACITY LEBRETON OF THAT HAS A
VERY LARGE CATCHMENT AREA
INCLUDING.
KERN COUNTY FRESNO COUNTY LARGE
PARTS OF THE CENTRAL VALLEY AS
PART AS WELL AS PARTS OF LA IN
ORANGE COUNTY HAS OVER A
THOUSAND PEOPLE ON THE WAIT LIST --
WE UNDERSTAND AT SOME POINT THEY
HAD ONE NURSE WHO WAS DOING
ASSESSMENTS SO EVEN IF YOUR NAME
COMES UP ON THE WAIT LIST YOU
GET THE GOLDEN TICKET BUT THEN
YOU MAY WAIT FOR MONTHS TO EVEN.
GET AN ASSESSMENT AND GET
SERVICES IN PLACE SO.
I'M TREMENDOUS PROBLEMS THAT
BETTER AND BETTER GREATLY
CONCERNING BECAUSE THESE ARE
PEOPLE WHO ARE IN THE COMMUNITY
NOT GETTING THE SERVICES THEY
NEED -- SO I THINK YOU KNOW WE
JUST TO JUST TO WRAP THAT PART
UP I THINK THE WAIT LIST IS IS --
ONE STRIKING EXAMPLE OF THE
DELAYS THAT WE'RE SEEING BUT
WE'RE ALSO SEEING DELAYS IN
INITIATION AND AUTHORIZATION OF
SERVICES -- WE HAVE ONE CLIENT
WHO IS ACTUALLY A CONSTITUENT OF
SENATOR PAN AND HAS WORKED
CLOSELY WITH HIS OFFICE AND SHE
HAS BEEN WAITING ALMOST A YEAR
AND A HALF. TO OUT TO GET HER
WAIVER SERVICES STARTED IN THIS
IS SOMEONE WHO -- ESPECIALLY
NEEDS THAT THE TWENTY FOUR HOUR
CARE THAT SHE THAT SHE WAS
GETTING THROUGH THE REGIONAL
CENTER AND THEN I WAS TERMINATED
BUT IN ORDER TO BE ABLE TO
REMAIN SAFELY IN HER OWN HOME.
ABSOLUTELY NEEDS THE WAIVER
THERE SHE HAS NO OTHER.
NO OTHER OPTIONS SO WE ARE YOU
KNOW COUNTING THE DAYS -- WHAT
SO -- THAT THAT BRINGS ME TO THE
C. C. T. PORTION OF OF MY
COMMENTS -- THE C. C. T. PORTION
IS A BUDGET REQUEST THAT WE HAVE
WHICH IS -- TO WILL CONTINUE THE
NINETEEN MILLION DOLLARS THAT --
FUNDED THE PROGRAM LAST YEAR
ALONG WITH A TWO POINT FIVE
MILLION GENERAL FUND
AUGMENTATION A GIVEN THE
UNCERTAINTY IN THAT FEDERAL
FUNDING.
OF THAT PROGRAM -- TO TO BACK UP
FOR A SECOND THE CCT PROGRAM IS
A FEDERAL DEMONSTRATION.
GRANT THAT CALIFORNIA WAS
AWARDED AND HAS BEEN PROVIDING
SERVICES SINCE -- TWO THOUSAND
SEVEN THE PROGRAM WAS
ANTICIPATED TO SUNSET AT THE END
OF DECEMBER TWENTY EIGHTEEN AND
IT HAS RECEIVED A COUPLE OF
SHORT TERM EXTENSIONS.
THE LAST INFORMATION WE HAVE
FROM DH CS IS THAT THEY WILL
CONTINUE -- PROVIDING SERVICES
FOR PEOPLE WHO ARE IN NURSING
FACILITIES THROUGH JUNE
THIRTIETH AND ASSISTING PEOPLE
TO TRANS TO TRANSITION FROM
NURSING FACILITIES INTO THE
COMMUNITY AND THEN THE CCT
PROGRAM OFFERS A FULL YEAR OF A
DEMONSTRATION SERVICES IN THE
COMMUNITY AT WITH AN ENHANCED
FEDERAL MATCH SO -- AT THIS
POINT -- WE HAVE CLIENTS WHO ARE
IN NURSING FACILITIES THEY NEED
TO BE OUT BY JUNE THIRTIETH OR
THEY LOSE THEIR ELIGIBILITY FOR
THE PROGRAM UNLESS THERE'S BEEN
SOME.
SOME FURTHER UPDATE THAT WE'RE
THAT WE'RE NOT AWARE OF SO.
WE'RE HOPEFUL THAT THERE WILL BE
A FEDERAL CONTINUATION OF THE
PROGRAM THE EMPOWER CARE ACT IS
MAKING ITS WAY THROUGH CONGRESS
BUT WILL PROBABLY BE HEARD AS
PART OF THE FEDERAL BUDGET SO.
WHO KNOWS -- WHEN AND IF THAT
WILL BE PASSED BUT THAT WOULD BE
A FIVE YEAR EXTENSION IN THE
MEANTIME WHAT WE ARE HOPING TO
DO IS TO CODIFY THIS PROGRAM?
INTO STATE LAW BECAUSE DESPITE
THE FACT THAT IT'S BEEN
OPERATING FOR TEN YEARS -- THIRD
IT'S NEVER BEEN STATUTORILY
AUTHORIZED IN CALIFORNIA -- IT'S
A TREMENDOUSLY SUCCESSFUL
PROGRAM IT'S TRANSITIONED OVER
FORTY TWO HUNDRED PEOPLE FROM
NURSING FACILITIES INTO THE
COMMUNITY -- IT'S ACHIEVED --
INCREDIBLE SAVINGS OF ABOUT
SIXTY THOUSAND DOLLARS PER YEAR
PER PERSON SO -- WITH MY POOR
MATH SKILLS THAT THAT I THAT
AMOUNTS TO ABOUT A TWO HUNDRED
FIFTY MILLION DOLLAR SAVINGS
OVER THAT. FOR THE FIRST DECADE
OF THE PROGRAM -- WE ARE
STRONGLY ENCOURAGING THIS
PROGRAM TO CONTINUE -- THE BILL
THAT -- THAT ACCOMPANIES THIS
BUDGET REQUEST IS SENATE BILL
TWO FOURTEEN MICE -- SPONSORED
BY SENATOR DODD AND THAT BILL
WOULD -- THAT WOULD REQUIRE THE
STATE TO CONTINUE PARTICIPATING
ASSUMING THAT THE FEDERAL
DEMONSTRATION CONTINUES AND IF
IT DOESN'T THEN I THE STATE
WOULD WOULD SEEK OTHER.
OTHER WAYS OF OF TRYING TO
MAXIMIZE FEDERAL FUNDING BUT WE
SEE THAT SAYS THIS IS A
CRITICALLY IMPORTANT PROGRAM --
WE WE WOULD LIKE TO SEE IT
CONTINUE -- AND I JUST WANT TO
ADDRESS ONE FINAL POINT WHICH IS
THE OVERLAP BETWEEN.
THE CCT PROGRAM AND THE A CB A
WAIVER BECAUSE WE UNDERSTAND
THAT THE DEPARTMENT'S POSITION
IS THAT THE H. C. B. A WAIVER.
AND THE WAIVER PROGRAM WILL
REPLACE THE CCT PROGRAM AND WE
WE JUST DON'T SEE THAT HOW THAT
WORKS THAT DOESN'T IN FACT WORK --
BECAUSE THE WAIVER AGENCIES THAT
ARE TASKED WITH ASSISTING PEOPLE
WHO ARE IN NURSING FACILITIES TO
TRANSITION TO THE COMMUNITY CAN
ONLY WORK WITH PEOPLE WHO ARE
GOING TO ENROLL IN THE HCB A
WAIVER UPON DISCHARGE.
THE LAST OUT I WAS ABLE TO FIND
IS THAT ONLY 11% OF C. C. T.
PARTICIPANTS ENROLLED IN THE
WAIVER UPON DISCHARGE SO THE
OTHER 89% OF PEOPLE WHO.
HAVE BEEN SUCCESSFULLY
TRANSITIONED FROM NURSING
FACILITIES TO THE COMMUNITY WITH
THE ASSISTANCE OF CCTV WOULD
HAVE NO MEANS OF OF RECEIVING
THE ROBUST CASE MANAGEMENT THE
TRANSITION COORDINATION.
AND THE PURCHASE OF SERVICES
THAT ENABLE CC T. TO BE
SUCCESSFUL -- SIGNIFICANTLY --
OVER 40% OF C. C. T.
PARTICIPANTS -- LEAVE NURSING
FACILITIES AND GO HOME WITH JUST
AYE HSS -- OR INFORMAL SUPPORTS
WHICH ARE SIGNIFICANTLY CHEAPER
THAN REMAINING IN A NURSING
FACILITY AT OVER SEVENTY FIVE
THOUSAND DOLLARS A YEAR -- ENDS
ALSO SIGNIFICANTLY ABOUT 38% OF
ELDERLY CCT PARTICIPANTS WENT
INTO A DIFFERENT WAY FOR THE
ASSISTED LIVING WAIVER SO IF THE
WAIVER AGENCIES -- REPLACE THE
CCT PROGRAM -- NONE OF THESE
PEOPLE WOULD BE ABLE TO LEAVE
THE NURSING FACILITIES -- THE
STATE WOULD CONTINUE PAYING.
MUCH HIGHER RATE AND THEIR
QUALITY OF LIFE AND THEIR
PREFERENCES WOULD NOT BE HONORED.
COM WE ALSO NOTE THAT THE H. C.
B. A WAIVER DOCUMENT --
CONTEMPLATES PARTNERING WITH THE
C. C. T. PROGRAM AND THAT THAT
WOULD BE AN EFFECTIVE
PARTNERSHIP IN WHICH CCTV WORKS
TO OUR REGION TO THE NURSING
FACILITIES WORK WITH PEOPLE WHO
HAVE A DESIRE TO LEAVE.
AND THEN -- ESSENTIALLY REFERS
AND DOES A WARM HAND OFF TO THE
WAIVER AGENCIES UPON DISCHARGE
SO THAT THERE'S A SEAMLESS
TRANSITION.
FROM -- PLACEMENT IN A NURSING
FACILITY TO A PLACEMENT ON THE
WAIVER OR OTHER APPROPRIATE
COMMUNITY BASED SERVICES.
MY FINAL POINT IS THAT -- EVEN
TO THE EXTENT THAT -- SOME
INDIVIDUALS WHO ARE IN NURSING
FACILITIES -- DO AND ROLE IN THE
HCB A WAIVER -- AFTER
PARTICIPATING IN C. C. T. OR
WHILE PROCEEDS PARTICIPATING IN
THE CCT PROGRAM -- CCT PERFORMS
DIFFERENT FUNCTIONS -- AND AND
FRANKLY IS IS -- FUNDED --
HIGHER RATE IS LOWER STAFF
RATIOS AND HIGHER REIMBURSEMENT
FOR PRE AND POST TRANSITION.
COORDINATION SERVICES -- IT HAS
HIGHER ALLOWANCES FOR THINGS
LIKE HOME MODIFICATIONS AND
HOUSEHOLD SET UPS AND ALSO FUNDS
THINGS LIKE VEHICLE ADAPTATIONS
AND ASSISTIVE DEVICES THAT THE
H. C. B. A WAIVER CANNOT PAY FOR
SO. FOR THOSE REASONS WE WE
ENCOURAGE THAT SUPPORT FOR THIS
BUDGET PROPOSAL TO CONTINUE THE
CCT PROGRAM.
THANK YOU THANK YOU.
THINK OF A WAY FOR US.
HI MERRY CAN'T WILL PART OF
HEALTH CARE SERVICES -- REALLY
APPRECIATED -- HEARING THE OTHER
PANELISTS TODAY CERTAINLY --
WITH THE ECB A WAIVER ONE OF THE
REASONS WE MADE THE TRANSITION
THAT WE DID IS WE BELIEVED.
AND STILL BELIEVE THAT THE IN
THE LONG TERM LONG RUN THE
WAIVER AGENCIES BEING AT A LOCAL
LEVEL.
WE'LL BE ABLE TO PROVIDE A
BETTER LEVEL OF CARE AND CASE
MANAGEMENT THEN WE WERE ABLE TO
PROVIDE WITH OURS -- STATE
EMPLOYED NURSES THAT WORK YOU
KNOW FROM HERE IN SACRAMENTO.
AND IN LOS ANGELES AND SO THAT
WAS REALLY SORT OF THE ONE OF
THE DRIVING FACTORS BEHIND --
THE CHANGE AS WELL AS BEING ABLE
TO THEN EXPAND CAPACITY SO WE
DID INCREASE THE OVERALL NUMBER
OF WAIVER SLOTS -- UNDER THE
WAIVER I KNOW YOU HAD A QUESTION.
FOR ME ABOUT THAT THE CURRENT
NUMBER IS -- SEVENTY FIVE
HUNDRED AND IT WILL GO UP TO
JUST UNDER NINE THOUSAND AND
TWENTY TWENTY ONE PRIOR TO THAT
WE READ ABOUT LITTLE UNDER --
FOUR THOUSAND IN TERMS OF SLOT I
TOTALLY APPRECIATE AND
ACKNOWLEDGE THAT THE TRANSITION
HAS TAKEN LONGER AND THE RAMP UP
OF GETTING THE WAIVER AGENCIES
ON BOARD -- THEY SPENT THE FIRST
SIX MONTHS AND ESSENTIALLY IT'S
BEEN JUST ABOUT SIX MONTHS SINCE
WE GOT THEM.
ON BOARD A ASSESSING.
THEIR ENROLLEES TO MAKE SURE
THAT THE APPROPRIATE LEVEL OF
KERR WAS BEING PROVIDED AND SO
WE HAVEN'T HAD AS MANY --
INCREASES IN ENROLLMENT THAT
THAT I THINK WE HAD EXPECTED
THAT WE WOULD LIKE TO SEE -- I
HAVE BEEN MADE AWARE OF THE
ISSUE WITH RESPECT TO THE
CHILDREN -- AS WAS MENTIONED WE
DID PUT IN A PROCESS BUT IT
SOUNDS LIKE.
THAT PROCESS IS NOT A SOLVING
THE PROBLEM SO I KNOW THAT THE
TEAM IS LOOKING INTO THIS STILL
TO TRY TO FIGURE OUT WHAT CANWE
DO TO TO RESOLVE THE PARTICULAR.
CONCERNING ISSUE WITH THE
CHILDREN -- AND THEN I WOULD
JUST SAY LONG TERM YOU WE ARE
TAKING A YOU'VE HEARD ME TALK
ABOUT THIS AND OTHER HEARINGS
ARE TAKING A LARGER -- VIEW OF
WHAT WE WANT THE MEDICAL PROGRAM
TO LOOK LIKE THE USE OF HOME AND
COMMUNITY BASED SERVICES IS ONE
OF THOSE THINGS THAT WE REALLY
WOULD LIKE.
TO SEE MORE OF BE ABLE TO EXPAND
NOT HAVE. FIVE DIFFERENT
PROGRAMS BUT YOU KNOW ONE THAT'S
A MORE HOLISTIC APPROACH THAT
REALLY PEOPLE ARE JUST GETTING
THE SERVICES THEY NEED AND THEY
DON'T HAVE TO APPLY TO A
SEPARATE.
WEAVER IN ORDER TO GET.
THE SERVICES I TALK ABOUT IT AS
YOU KNOW YOU HAVE TO BE.
PURPLE WITH THINK STRAIGHT TO BE
IN THIS WAIVER AND THEN BLEW
WITH ORANGE POLKA DOTS TO BE IN
THAT AND THAT'S CONFUSING.
TO US IS CONFUSING TO
BENEFICIARIES AND SO WE ARE
LOOKING LONG TERM AND HOW TO
LEAST STREAMLINED SO THAT IT'S
NOT THAT THEY'RE YOU DON'T HAVE
TO GO THROUGH MULTIPLE.
THROUGH APPLICATION PROCESS
THESE TO GET THE TYPE THESE
TYPES OF SERVICES.
SO IT'S STILL A WORK IN PROGRESS
OBVIOUSLY -- WE VIEW THE
IMPORTANCE OF EIGHT OF HOME
COMMITTEE BASED SERVICES AS
CRITICAL NOT JUST -- FROM A COST
PERSPECTIVE BUT REALLY.
ALLOWING PEOPLE TO REMAIN IN
THEIR COMMUNITY AND THEIR HOME
TO LIKE HOW HAVE THE QUALITY OF
LIFE THAT THEY CAN HAVE THEIR
BUT NO ONE WANTS SOMEONE TO BE
IN AN INSTITUTION IF THEY DON'T
ACTUALLY NEED TO BE.
AND SO WE WILL CONTINUE TO WORK
ON IMPROVING THESE AND YOU KNOW.
CONTINUE TO WORK WITH WITH FOLKS
LIKE LIKE THE PANELISTS TODAY --
WHO CONTINUE TO PROVIDE US IN
PORT -- SO THAT WE CAN CONTINUE
IMPROVE THESE PROGRAMS.
DO YOU HAVE ONE OTHER QUESTION
FOR ME.
THERE ARE TWENTY FOUR HUNDRED
AND THIRTY ONE APPLICANTS ON THE
WAITLIST. FOUR HUNDRED THIRTY
ONE YES.
HOPEFULLY THAT MATCHES AROUND
THE NUMBER WHAT'S A DIVISION
BETWEEN THE ADULTS AND CHILDREN
OF THE KIDS IS IT ABOUT THE TWO
FIFTY THAT WAS MENTIONED -- SO
IT'S MOSTLY ADULTS WHICH IT
SHOULD BE ALL ADULTS AS AS THE
POINT BEING MADE KIDS SHOULD NOT
BE BEING ADDED TO THE WAIT LIST.
THAT'S WHERE WE NEED TO WORK TO
RESOLVE THAT [inaudible]
OR ANY.
MORE CHILDREN BEING ADDED TO THE
WAITING LIST SO THAT'S WHERE I
THINK WE'RE TRYING TO FIGURE OUT
WHAT'S HAPPENING BECAUSE THEY
SHOULD NOT BE.
BUT THAT IS THE WHAT YOU KNOW
AND WE APPRECIATE THE EXAMPLES
AND AS AS WAS SAID WHEN WE ART
WHEN IT'S POINTED OUT TO US WERE
ABLE TO DEAL WITH IT BUT WE DO.
IT SHOULDN'T BE HAPPENING AT ALL
AND SO THAT'S WHAT THE TEAM IS
REALLY TRYING TO INVESTIGATE AS
WHY IS THIS HAPPENING HOW DO WE
MAKE SURE.
PEOPLE ARE BEING ADDED THAT
SHOULDN'T BE ADDED THAT THEY
SHOULD BE GETTING THE SERVICES
THAT THEY NEED RIGHT AWAY.
CAN WE GET THE REPORT BACK ON
WHETHER OR NOT.
MORE CHILDREN ARE BEING ADDED TO
THE WAIT LIST ABSOLUTELY.
AND IF THE CHILDREN ARE ARE
DEEMED ELIGIBLE FOR THE PROGRAM.
CAN WE CONFIRM.
pAND THEM GETTING SERVICES.
YES I MEAN YEAH I THINK THERE WE
DO KNOW THAT THEIR BESIDES I
SHOULD MENTION THIS.
BESIDES THE WEIGHTLESS ISSUE I
THINK.
A APPROPRIATELY RAISED IS THAT
THE WE WERE AGENCIES ARE NOT AS
X. X..
SORRY THEY BRING PRETTY MAKES IT
HARD TO TALK.
ARE NOT DON'T HAVE AS MUCH
EXPERTISE WITH A PEDIATRIC
POPULATION AND SO I THINK THAT
IT'S ALSO SOME OF THE CHALLENGES
THAT WE'RE SEEING IS THAT.
THESE ARE EIGHT ENTITIES THAT
REALLY ARE USED TO DEALING WITH
THAT WITH THE TYPICAL EIGHT CB A
POPULATION WHICH IS.
OLDER ADULTS AND SO WHAT WE'RE
TRYING TO TAKE A LOOK AT IS DO
DOES THAT MEAN WE NEED TO DO
SOMETHING DIFFERENT IN TERMS OF
TO EACH TO TAKE THE KIDS BACK TO
BEING STATE CASE MANAGED.
OR DO WE DO SOMETHING ELSE AND
SO THAT'S WHAT WE'RE TRYING TO
LOOK AT SO THAT WE CAN FIGURE
OUT HOW DO WE MAKE SURE WE'RE
PROVIDING.
THE MOST EFFECTIVE SERVICES --
AND IT IF IT'S NOT THROUGH THE
WAIVER AGENCIES FOR CHILDREN AND
WE CERTAINLY WANT -- TO CORRECT
THAT ISSUE.
GIVEN THE LONG WAITING LIST AND
THE OBVIOUS NEED.
AND THE DEMAND FOR THE SERVICES.
WHAT ARE THE REASONS A DH CS
DOES NOT PURSUE SIGNIFICANTLY
EXPANDING THE PROGRAM?
SO IT'S A IT'S SO THE PROGRAM IS
EXPANDING.
THE GETTING THE WAIVER SLOTS
HAVE GROWN FROM THE RENEWAL.
THROUGH THE RENEWAL TO ASSESS
ESSENTIALLY THE DOUBLE THE SIZE
THE CHALLENGE IS THAT IT IS.
YOU KNOW THE COMPLEX POPULATION
WITH.
AND SO THE CAPACITY TO ACTUALLY
BRING PEOPLE IN AND GET THE
MUSTACHE DIDN'T FOR SERVICES AND
ALL OF THAT THAT IS.
RIGHT NOW WE'RE LIMITED WE HAVE
THE SEVEN WE READ IN SEASON WE
HAVE THE STATE STUFF THAT WE
HAVE.
AND SO THE ONLY SO MANY PEOPLE
CAN BE SERVED IN THAT WAY BUT WE
ARE CONTINUING TO TRY TO FIND
WAYS TO EXPAND THAT -- BUT IT IS
IT'S IT'S A SLOWER PROCESS AND I
THINK ANY OF US.
WOULD LIKE BUT IT'S ALSO JUST
THE REALITY OF THE CAPACITY OF
THE SERVICES THAT WE CAN FIND.
THE THE POPULATION.
DOESN'T CHANGE IF WE KNOW THAT
THESE ARE MEDICALLY FRAGILE --
ADULTS OR CHILDREN -- SO.
IS THERE A PLAN.
ALREADY OR IS THERE AN INTENTION
TO TO PUT A PLAN TOGETHER ON YOU
YOU SAY THAT THE PROGRAM IS
EXPANDING IF YOU EXPAND BUT
YOU'RE NOT PROVIDING THE SERVICE.
THEN.
OUR REALLY EXPANDING -- WE HAVE
TO BE ABLE TO PROVIDE THE
SERVICE WHETHER IT'S TO THE
ADULTS OR TO THE CHILDREN.
I APPRECIATE ALSO THAT WE HAVE
MORE MORE WAIVERS.
BUT AGAIN IF.
WHAT WAS THE NUMBER TWENTY FOUR
TO TWENTY FOUR HUNDRED PEOPLE ON
A WAITING LIST?
SO WE'RE PUTTING THEM IN NURSING
HOMES BECAUSE WE CAN'T KEEP THEM.
IN THEIR HOME WHERE CLEARLY
COSTS LESS.
SO WHEN WE DO THE VALUATIONS ARE
WHO IS DOING THAT THAT
EVALUATION.
I AM SO.
AGAIN I THINK WE TOTALLY AGREE
ON THE COST SAVING NATURE OF THE
CBS AND IT JUST BEING A BETTER
CHOICE IT'S IS THERE THE
CAPACITY TO PROVIDE THE SERVICES
IN THE COMMUNITY AND THAT'S
WHERE WE ARE STRUGGLING.
TO EXPAND FASTER THAN WE ARE --
BUT WE ARE EXPANDING IT'S JUST
IT'S JUST NOT.
WE JUST DON'T HAVE THE CAPACITY
TO JUST ADD A THOUSAND PEOPLE
AND ACTUALLY HAVE THEM PROVIDE
GET THE SERVICES RIGHT I MEAN
YOU CAN.
SORT OF GET TO THE POINT OF YOU
SAY THEY'RE ON THE WAIVER BUT IF
THEY'RE NOT ACTUALLY GETTING
THERE SERVICES THAN THAT WE'RE
NOT REALLY DOING ANYTHING. FOR
THEM AND SO WERE WHAT WE WANT TO
MAKE SURE THAT WE'RE DOING OF IT
IN A THOUGHTFUL WAY WHERE WE
HAVE.
THE APPROPRIATE SERVICES IN
PLACE AND SO THAT PEOPLE CAN
ACTUALLY RECEIVE THEM.
IT CONCERNS ME -- THAT
[inaudible]
WE HAVE.
WE ARE SPENDING MONEY.
IN AND WHAT WHAT WAS THE PHRASE
YOU USED DOCTOR WOULD -- THAT'S
RIGHT IF WE KNOW.
THAT THE AMOUNT OF MONEY WE'RE
GOING TO BE SPENDING ON THESE
PATIENTS IS SO MUCH MORE.
IF WE DON'T TAKE CARE OF THE
ISSUE THEN IT SEEMS WE TO TAKE
CARE OF THE ISSUE.
SO THAT WE FIGURE OUT A BETTER
WAY -- WE KNOW THAT MOST PEOPLE
WANT TO BE AT HOME OR BE AS
CLOSE TO HOME AS POSSIBLE THEY
DON'T WANT TO BE IN A NURSING
HOME.
AND THE NURSING HOMES SO MUCH
MORE EXPENSIVE -- NO REGARDING
THE CCT PROGRAM.
WOULD IT NOT BE.
FISCALLY PRUDENT TO FUND THE
PROGRAM WITH STATE FUNDS IN THE
ABSENCE OF FEDERAL FUNDS.
GIVEN THAT THE HELP [inaudible]
IT.
DID HELPING MOVE PEOPLE OUT OF
INSTITUTIONALIZED CARE.
IS BOTH GOOD FOR THE PEOPLE AND
COST THE STATE LESS.
THE FIRST.
YEAH MADAM CHAIR AND MEMBERS
WELL OPEN MINDED GUESTS OF THE
DEPARTMENT OF FINANCE SO THIS IS
AN ISSUE THAT WE ARE LOOKING AT
CLOSER TO GET YOU -- YOU KNOW
THE FISCAL IMPACT PROGRAMMATIC --
IMPACT -- THE CCT PROGRAM TODAY
IN ITS EXISTING FORM DOES RESULT
IN A NET GENERAL FUND SAVINGS TO
THE STATE -- AS A PANELIST NOTED
AND ALSO AS NOTED IN ON IN YOUR
AGENDA THE FEDERAL FUNDING --
THE GRANT IS ENDING AND SO
WITHOUT AN EXTENSION IT WOULD BE
A GENERAL FUND -- AS GENERAL A
SOLELY GENERAL FUNDED PROGRAM SO
WE WILL GET MORE DETAILED
INFORMATION INTO THE COMMITTEE
WHEN AVAILABLE.
OKAY BECAUSE THAT WAS.
THE LAST QUESTION ON A ON THE
THE STAFF COMMENTS DOES A CCT
RESULT IN THAT SAVINGS TO THE
STATE SO THE ANSWER IS YES.
IN ITS EXISTING FORM CORRECT
WITH THE FEDERAL GRANT BEHIND --
AND YOU WILL PROVIDE.
ADDITIONAL INFORMATION THEM
REGARDING THAT YES WE'RE LOOKING
AT A CLOSER.
IT SEEMS TO ME AND CORRECT ME IF
I'M WRONG AND OF AS OF NOW WOULD
YOU SAY THE SAVINGS ARE HUGE --
STILL COPY ADDING THAT THE
PROGRAM IS COMING TO AN END SO
WE HAVE BEEN PHASING OUT -- IN
THE CURRENT YEAR WE'RE SAVING
TEN POINT EIGHT MILLION GENERAL
FUND -- AND BUDGET YEAR IT
DECREASES TO ONE POINT ONE
MILLION GENERAL FUND BUT THE
COPY AT THAT THE PROGRAM HAS
BEEN PHASING PHASING DOWN GIVEN
THE THE FEDERAL GRANT -- ENDING
[inaudible]
ANY QUESTIONS [inaudible]
YES.
PART OF MY FRUSTRATION.
IS.
IT'S ROUTINE WHETHER IT'S THIS
COMMITTEE OR OTHER BUDGET.
OVERSIGHT COMMITTEES THAT.
WE ALWAYS HEAR THE PROBLEM OF
CAPACITY.
AND THEN WE HEAR THAT WE HAVE A
PROCESS.
THAT'S GOING TO IMPROVE CAPACITY.
AND THEN WE HEAR.
THAT THE PROCESS.
ISN'T ACHIEVING THE CAPACITY
GROWTH IT IS.
DOING JUST THE OPPOSITE.
SO WHAT I'VE HEARD IS THAT YOU
ARE [inaudible]
REVIEWING A PROCESS.
IN ORDER TO TRY TO AFFECT BETTER
OUTCOMES BUT PLEASE HELP ME
UNDERSTAND I TO ME PROCESS MEANS
NOTHING UNLESS IT AFFECTS
OUTCOMES.
AND I'D AND WE'RE WE'RE HEARING
FROM THOSE WHO ARE ON THE FRONT
LINES OF CARING FOR THESE.
SPECIAL PEOPLE THAT.
THE DECISION IN AUGUST OF TWENTY
EIGHTEEN TO TRANSITION. TO THE
WAIVER AGENCIES.
HAS BEEN A PROCESS CHANGE BUT IT
HAS AFFECTED.
OUTCOMES NEGATIVELY.
AND YET.
WHAT I HEARD I THOUGHT?
IT WAS.
WE'RE GOING WE'RE NOT LOOKING AT
THE PROCESS THAT MADE.
THE CHANGE THAT CREATED THE LESS
EFFECTIVE OUTCOMES WERE TRYING
TO FIX A PROCESS.
THAT HAS CAUSED THOSE.
EFFECTS.
SO I WOULD SAY THAT.
YES WE ARE STILL LOOKING AT HOW
WE CAN IMPROVE IT IMPROVE IT
WITH THE WAIVER AGENCIES WE
STILL BELIEVE THAT AT THAT WILL
BE.
THE BETTER WAY OF DELIVERING
CARE I THINK THERE WAS GENERAL
SUPPORT FOR US MOVING IN THAT
DIRECTION WHEN WE WHEN WE DID
THIS WAIVER RENEW ALL.
I THINK THE CHALLENGES THAT HAVE
COME TO LIGHT ARE WHAT WE'RE
WORKING TO ADDRESS.
IT WE DON'T SEE IT THOUGH AS
NECESSARILY THAN THROWING OUT
THE ENTIRE PROCESS OF USING WAY
REGENCIES AND THE BENEFITS THAT
THEY BRING BUT THAT WE NEED TO
MAKE SURE THEY'RE ACTUALLY
PROVIDING THE SERVICES THAT THAT
THEY ARE BEING CONTRACTED.
FOR SHOW THEM THE ISSUE HERE IS.
IN THE MEANTIME WHILE YOU ARE
TRYING TO WORK A PROCESS FIX
[inaudible]
WE HAVE.
COUNT IDON'T KNOW WHAT THE
NUMBER IS BUT IT'S AN AWFUL LOT
OF PEOPLE.
WHO ARE FALLING THROUGH THE
CRACKS?
AND I'M TELLING YOU THESE ARE
THE PEOPLE.
LEAST [inaudible]
ABLE.
THE DEAL WITH THE PROCESS THAT
IS WORKING AGAINST THEIR VERY
BEST [inaudible]
INTEREST.
HI THERE THESE ARE THESE ARE
FRAGILE KIDS THESE ARE
[inaudible]
VULNERABLE ADULTS.
IS THERE NOTHING INTERNET
EMERGENCY OR IMMEDIATE SHORT
TERM WHERE YOU WHILE YOU TRY TO
MEND THE PROCESS.
YOU CAN CAPTURE THESE WHO ARE
FALLING THROUGH THE CRACKS AND
IF YOU CAN HOW DO YOU DO THAT
AND HOW SOON CAN THAT HAPPEN.
THAT I I CAN'T ANSWER HOW WE
COULD DO THAT AND HOW SOON IT
COULD HAPPEN AS I MENTIONED ONE
OF THE THINGS THAT WE'RE LOOKING
AT NOW THAT.
TO INSTITUTING THE
PRIORITIZATION FOR THE KIDS
DIDN'T WORK IS WHAT WE NEED TO
DO TO CHANGE THAT WHAT WHAT DO
WE STILL NEED TO USE A WAIVER
AGENCIES DO WE NEED TO BRING IT
BACK TO THE STATE RECOGNIZING
THAT THERE ARE.
THEIR OWN CHALLENGES I DON'T.
WE DID THIS TO IMPROVE THE
PROGRAM I DON'T THINK LIKE I
DON'T THINK THAT JUST GOING BACK
TO THE WAY IT WAS I THINK PEOPLE
ARE STILL FALLING THROUGH THE
CRACKS SO IT'S REALLY HOW DO WE
CONTINUE TO TRY TO WORK TO
IMPROVE -- BUT WE CAN I CAN
CERTAINLY GO BACK TO THE TEAM
THAT'S WORKING ON IT AND AND
BRING A WE HAVE A PROCESS CHANGE.
AND THE VERY FOLKS THAT ARE ON
THE FRONT END.
FRONT LINES WHO ARE THE ONES
TOUCHING THESE.
INDIVIDUALS ARE TELLING US THAT
YOU HAVE A PROCESS ARE TO GO
THIS WAY.
BUT YOU HAD A SERVICE.
PROVIDING ARTIST ON THIS WAY.
HOW ARE YOU GOING TO STOP THIS
DOWNWARD TREND?
SOON NOT YEARS FROM NOW.
I CAN CERTAINLY GO BACK TO WORK
WITH THE TEAM AND WE WILL REPORT
BACK TO YOU WITH THE PLAN OF
WHAT WE'RE GONNA DO.
I DIDN'T WANT TO SAY THIS BUT
THIS IS VERY REMINISCENT OF
HEARINGS I'VE HAD.
IN FRONT OF THE DMV.
I MEAN HONESTLY WE HAVE SYSTEMS
THAT ARE PROMISING THINGS TO
PEOPLE THAT GET MILLIONS OF
TAXPAYER DOLLARS THAT HAVE
PROVIDERS READY EAGER AND
WAITING TO DO THIS [inaudible]
AND YET.
THE ANSWER MY BASIC QUESTION IS
I DON'T KNOW I'LL GET BACK TO
YOU -- I DON'T NEED TO COME TO
HEARINGS -- TO BE TOLD I I I
DON'T KNOW WELL GET BACK TO YOU.
THE PROBLEM IS THAT.
RARELY IF EVER.
I'M NOT SAYING YOU DO THIS BUT
RARELY IF EVER.
ARE THOSE WHO SAY I WILL GET
BACK TO YOU.
DO I EVER GET.
AN ANSWER AND WEBER GET.
A RETURN COMMITMENT.
SO I'M I'M REALLY AM LOOKING.
FOR SOME REAL SHORT TERM
SOLUTIONS HERE BECAUSE WE HAVE
SOME VERY VERY FRAGILE PEOPLE.
AND THE SOONER WE GET THIS.
FIXED THE SOONER THESE
INDIVIDUALS ARE GOING TO BE
MOVED FROM A PLACE [inaudible]
UP.
HI I WOULDN'T WISH THE
INSTITUTIONALIZATION ON ANYBODY.
AND WE HAVE AN OPPORTUNITY TO
MOVE THEM INTO HOMES COMMUNITY
BASED AND WE'RE TALKING PROCESS
AND WHILE REAL HUMAN BEINGS ARE
FALLING THROUGH THE CRACKS.
PLEASE HAVE AN URGENCY ABOUT
THOSE REAL HUMAN BEINGS.
ABSOLUTELY DO YOU I WOULDN'T DO
THE JOB THAT I DO IF I DID NOT
HAVE.
A STRONG HEART AND COMMITMENT
ALL OR ENTIRE POPULATION --
UNFORTUNATELY CAN'T BE AN EXPERT
ON ALL THE PROGRAMS WITHIN THE
MEDICAID SIDE BUT I AM VERY
COMMITTED TO MAKING SURE THAT WE
GET BACK TO YOU AND I I DON'T
MAKE COMMITMENTS THEY DON'T
FOLLOW.
THANK YOU WILL BE HEARING THAT.
I THINK ONE OF THE DIFFERENCES
IS THAT DMV.
IT'S JUST SOMEBODY LOOKING FOR A
LICENSE YES THEY WANT TO DO IT
ON TIME HERE WE'RE TALKING ABOUT
PEOPLE.
WE'RE TALKING ABOUT CHILDREN
WE'RE TALKING ABOUT ADULTS
ADULTS WERE TALKING ABOUT AS YOU
SAID THE MOST FRAGILE.
AND THEY DO DESERVE TO HAVE AN
ANSWER -- CAN WE GET A RESPONSE
FROM THE DEPARTMENT [inaudible]
MAY SIXTH.
WE CAN HAVE WHATEVER RUN HAVE
SURE YEAH THAT WAS THAT THE NEXT
HEARING THAT MIGHT THAT THEY
KNOW WHO IT IS JUST -- IT'S JUST
THE DATE.
JUST TO DATE IT'S TWO WEEKS.
OKAY.
AND IF MORE TIME IS REQUIRED
WOULD YOU LET US KNOW.
I'D LIKE TO BE ABLE TO TELL THE
MEMBERS.
THAT WE HAVE AN ANSWER OR LIKE
TO BE ABLE TO TELL THE MEMBERS
THAT HAD AN ADDITIONAL. TWO DAYS
WAS NEEDED [inaudible] TWO
MONTHS.
I APPRECIATE YOUR YOUR YOUR
PROVIDING INFORMATION.
YOU CAN HEAR THE FRUSTRATION IN
THE QUESTIONS -- BECAUSE MOST
PATTERSON IS CORRECT WHEN WHEN
WE ASK A QUESTION.
YES WE ARE SEEING IT FROM A
DIFFERENT VANTAGE POINT YOU ARE
INSIDE.
BUT YOU WERE INSIDE AT THE TOP.
AND THERE ARE PEOPLE WHO ANSWER
TO YOU THE ANSWER TO THE
DIRECTOR WHO -- IT IS YOU ALL
WHO CAN EVALUATE AND DETERMINE
WHAT NEEDS TO BE DONE WHAT NEEDS
TO BE MOVED -- WHAT REQUEST NEED
TO BE MADE OF THE LEGISLATURE --
SO THAT.
WE DON'T HAVE. TWO HUNDRED AND
FIFTY CHILDREN.
AND TWENTY FIVE HUNDRED ADULTS.
INSTITUTIONALIZED.
AND ON WAITING LISTS.
I THINK UNNECESSARILY.
THERE WILL BE SOME I AM SURE.
BUT TO HAVE THOSE NUMBERS.
IF WE JUST LOOK AT THE FINANCIAL
SAVINGS.
FROM GETTING THEM OFF THAT LIST
AND GETTING THE SERVICES
PROVIDED GETTING THEM PLACED IN
THEIR HOME BURKE CLOSE TO HOME
AND COMMUNITY BASED
ORGANIZATIONS.
INSTEAD OF INSTITUTIONS.
IF WE JUST LOOK AT THAT PART OF
IT.
RATHER THAN JUST THE HUMAN SIDE
OF IT IT'S STILL A GOOD DECISION.
BUT MORE IMPORTANTLY WE HAVE TO
LOOK AT THE HUMAN SIDE OF IT.
VERY GOOD -- ANY QUESTIONS
COMMENTS FROM MEMBERS.
THIS IS RUBIO -- I THINK WE'VE
HAD THIS CONVERSATION MULTIPLE
TIMES THAT YOU KNOW WE TALK
ABOUT NUMBERS AND FIGURES AND
I'VE TOLD THE STORY AND I WANT
TO TELL IT AGAIN JUST TO TO MAKE
AN IMPACT WHEN I WAS A TEACHER.
I OUR CONTRACT SAID THAT I CAN
ONLY HAVE THIRTY TWO KIDS IN MY
CLASSROOM AND I HAD THIRTY THREE
WILL THAT DIRECTION FROM THE
DISTRICT OFFICE.
ON THE SET A VERY SIMPLE YOU CAN
TO HAVE THIRTY TWO AND A HALF IN
THIS CLASSROOM AND THIRTY TWO
AND A HALF IN THIS CLASSROOM.
AND I WAS LIKE -- WHICH CHILD
WOULD YOU LIKE ME TO CUT UP.
NOW AND I TELL THAT STORY
BECAUSE THEY LOOK WE LOOK UP
HERE WE LOOK AT NUMBER LINES AND
AND AND THE SHEETS IN NUMBERS
AND FIGURES AS OPPOSED TO ACTUAL
HUMANS.
AND THE IT'S FRUSTRATING AND
I'VE TOLD THAT STORY OVER AND
OVER AGAIN FOR THE AND THE LAST
WEEK AND A HALF YEARS.
HOPING THAT AT SOME POINT WE
START THINKING ABOUT THE HUMAN
FACTOR.
IN THIS AND YOU KNOW I
APPRECIATE ALL THAT NUMBER
CRUNCHING BUT IN THE END.
THIS IS NOT THE DMB THIS IS NOT
WE'RE NOT BUILDING CARS DID THIS
IS CRITICAL SERVICES FOR PEOPLE
FOR CHILDREN THAT -- WE KEEP
SAYING THAT WE CARE ABOUT BUT
WE'RE NOT DEMONSTRATING IT IN
YOU KNOW IN ON OUR ACTION SO
THANK YOU -- MADAM CHAIR BECAUSE
IT'S FRUSTRATING THAT WE DO ASK
FOR INFORMATION AND WE GET.
PUSHED OFF AND I ALSO WANT TO
REMIND FOLKS THAT THE THE THIS
CLASS IS GOING TO BE HERE FOR AT
LEAST ANOTHER TEN YEARS.
AND WHAT HAPPENED IN THE PAST
WAS THAT OUR OUR ASSEMBLY
MEMBERS WERE HERE FOR ONLY SIX
YEARS SO THE FIRST TWO YEARS
WERE KIND OF GETTING TO KNOW YOU
AYE I CALL IT YOU KNOW GETTING
TO KNOW WHERE THE BATHROOM IS.
AND THEN THE SECOND TWO YEARS
YOU KNOW YOU HAD TO TWO GOOD
YEARS OF YOU KNOW THOUGHT FULL --
PRODUCTIVE SESSIONS IN THE LAST
TWO YEARS USUALLY THEY WERE
RUNNING FOR SOMETHING ELSE AND
SO THE BUILDING -- IT SEEMS TO
BE IN THE HABIT OF LET'S PUSH
HIM OUT BECAUSE THEY'RE GOING TO
BE GONE WILL I WANT TO REMIND
EVERYBODY THAT THIS CLASS IS
HERE FOR ANOTHER TEN YEARS WE IN
THE CLASS NO WE'RE RIGHT.
AND SOLD SO EVEN IF WE DON'T GET
IT THIS TIME AND I THINK YOU'VE.
SEEN WHAT WE'VE DONE IN THE LAST
YEAR OR TWO IS THAT WE'RE GOING
TO KEEP ASKING FOR THIS
INFORMATION AND AT SOME POINT.
I WOULD LIKE TO NOT TALK ABOUT
NECESSARILY THE FIGURES BUT
ABOUT THE KEY THOUGH HUMAN
FACTOR IN IS STILL THANK YOU
ABSOLUTELY I MEAN I THINK IT IS
I CAN SPEAK FOR MYSELF AND THAT
THE DIRECTOR IT AS A WHOLE.
THE REASON THAT WE WORK IN THE
MEDICAL PROGRAM IS BECAUSE WE
REALLY WANT TO HELP PEOPLE GET
HEALTH CARE THAT THEY NEED.
I DON'T WORK IN THE JOB THAT I
DO TO ANALYZE NUMBERS INTO
MODELS I COULD DO A MILLION
OTHER JOBS TO DO THAT BUT I'VE
SEEN FIRST HAND.
HOW IT CAN SAVE PEOPLE'S LIVES?
AND SO THAT'S WHY I DO MY JOB SO
I JUST WANT TO ASSURE YOU THAT
THAT'S ALSO WHERE WE COME FROM
AND IT'S NOT JUST ABOUT THE
NUMBERS WE HAVE TO GET TO THE
QUESTIONS AND IT IS ALWAYS MORE
COMPLICATED THAN WE WOULD LIKE
IT TO BE AND I KNOW.
THAT THAT SUPER FRUSTRATING --
BUT I JUST WANT TO BE CLEAR THAT
OUR HEART IS IN HELPING PEOPLE
WELL AND AND AND THANK YOU I
APPRECIATE THAT BUT IN THE LAST
TWO YEARS I HAVEN'T SEEN THAT --
IN THE END THAT'S MIGHT WHAT THE
PROBLEM IS SO YOU KNOW I
APPRECIATE THAT YEARS THAT
KNOWLEDGE IN YET BUT I WANT TO
SEE IT.
NOT JUST IN IN A CONVERSATION I
THINK THE DEMONSTRATION OF THAT
YOU KNOW AND THAT THE AND AND
REALLY TRULY -- THE LOVE FOR THE
WORK THAT WE HAVE TO DO HAS TO
BE DEMONSTRATED NOT JUST IN
WORDS WE HAVE TO SEE IT SO I
APPRECIATE THAT THANK YOU.
THANK YOU AND IF I MAY ADD A
WELCOME AND YOU GUYS WITH THE
DEPARTMENT OF FINANCE IF THERE'S
EVER ANY INFORMATION THAT YOU'RE
NOT GETTING -- FEEL FREE -- TO
YOU KNOW.
ANDREA WELL I'M MORE HAPPY TO
RESPOND OR GIVE YOU NEED TA BUT
AT JUST -- LETTING YOU KNOW YOU
CAN REACH OUT TO US.
ALL RIGHT.
I WANT TO THANK YOU ALL SO MUCH
FOR THE TESTIMONY -- I LOOK
FORWARD TO THE UPDATE -- MAY SIX
OR BEFORE -- YEAH.
I'VE SAID THIS BEFORE IN THESE
HEARINGS.
YOU HAVE WILLING PARTNERS.
WE WANT TO WE WE AS IS RUBIO
SAID WE'RE GOING TO BE HERE FOR
AWHILE WE GET TO REALLY STUDY
THESE THINGS WE GET TO REALLY.
FIGURE OUT AND WORK WITH YOU WAS
PARTNERS. TO TO HELP.
BECAUSE THAT IS OUR JOB WE HAVE
TO DELIVER TO OUR CONSTITUENTS
AND BEING MEMBERS OF THE
SUBCOMMITTEE WE HAVE TO DELIVER
TO THE REST OF CALIFORNIA.
IN THIS AREA.
AND THAT'S WHY WE ASK THE
QUESTIONS AND WE APPRECIATE THE
ANSWERS AND WE APPRECIATE THE
FOLLOW UP. TO THE QUESTIONS IN
ADDITION TO THE ANSWERS.
I THANK YOU SO MUCH -- AND THIS
CONCLUDES ISSUE NUMBER.
EIGHT OKAY PUBLIC COMMENT I'M
SORRY.
MY APOLOGIES NO PROBLEM LINDA
IT'S LATE IN THE DAY LINDA WAY
WITH WESTERN CENTER ON LAW AND
POVERTY JUST LIKE TO ALIGN OUR
COMMENTS WITH.
A DISABILITY RIGHTS CALIFORNIA
AND TO MISTER PATTERSON'S POINT
ABOUT PROCESS.
IT REMAINS UNCLEAR.
TO WESTERN CENTER WHETHER HAVE
THEIR WAIT LIST IS DUE TO THE
THE LONG PROCESS OR IF IT'S I DO
TOO CAPACITY IF -- THE OF NUMBER
OF PARTICIPANTS IS IS AT FULL
CAPACITY AND THAT'S WHY THE THE
WAIT LIST -- SO LONG OR ALSO IS
IT UP DUE IN PART BECAUSE OF THE
THE LONG PROCESSING TIME THANK
YOU [inaudible]
THANK YOU [inaudible]
ALL RIGHT.
ISSUE NUMBER.
NINE PROP FIFTY FIVE MEDI CAL
FUNDING OVERSIGHT
[inaudible]
OPEN YEAH.
OKAY CAN WE BEGIN WITH MEYER
SCHNEIDER PLEASE.
GOOD EVENING MADAM CHAIR AND
MEMBERS HI MY NAME IS MAYA
SCHNEIDER I'M THE EXECUTIVE
DIRECTOR OF BUSINESS DEVELOPMENT
FOR MARSHALL MEDICAL CENTER.
WE ARE LOCATED IN PLACERVILLE
AND WE SERVE THE WESTERN SLOPE
OF ELDORADO COUNTY WITH A ONE
HUNDRED AND TWENTY FIVE BED
ACUTE CARE GENERAL HOSPITAL.
AS WELL AS EIGHTEEN PRIMARY AND
SPECIALTY CARE CLINICS SCATTERED
ALL AROUND EL DORADO COUNTY.
WE ARE ONE OF THE LAST
INDEPENDENT NOT FOR PROFIT
HOSPITALS IN THE STATE OF
CALIFORNIA.
AND WE SERVE ONE OF THE OLDEST
POPULATIONS IN CALIFORNIA.
WE ARE ALSO A DISPROPORTIONATE
SHARE HOSPITAL WITH -- LARGE
POPULATION OF MEDICARE AND
MEDICAID ALL PATIENTS.
ON BEHALF OF MARSHALL AND THE
CALIFORNIA HOSPITAL ASSOCIATION
I'M HERE TODAY TO EXPRESS.
OUR DISAPPOINTMENT THAT THE
GOVERNOR'S TWENTY NINETEEN
TWENTY TWENTY PROPOSED BUDGET
ALLOCATION.
INCLUDED NO PROPOSITION FIFTY
FIVE FUNDING FOR THE MEDI CAL
PROGRAM.
AND I'M ALSO HERE TO ASK FOR A
REVIEW OF THAT CALCULATION.
ENSURING THAT CHILDREN AND THEIR
FAMILIES ACCESS THE CARE THEY
NEED IS A PRIORITY FOR MY
HOSPITAL AND FOR ALL CALIFORNIA
HOSPITALS.
HOWEVER AS YOU KNOW PATIENT
ACCESS IS CHALLENGED BY BOTH THE
RISING COST OF CARE AND SEVERE
STATEWIDE WORK FOR SHORTAGES IN
BEHAVIORAL HEALTH.
PRIMARY CARE PHYSICIANS AND
OTHER PATIENT CARE PROFESSIONALS
YOU HEARD ABOUT THIS EARLIER
TODAY AND OTHER ISSUES AND IT
CAN BE ESPECIALLY HARD FOR RURAL
AND SEMI RURAL HOSPITALS LIKE
MINE TO RECRUIT PHYSICIANS.
CALIFORNIA VOTERS CLEARLY SHARE
HOSPITALS GOALS OF PROTECTING
PATIENTS ACCESS TO CARE
EVIDENCED BY THEIR TWENTY
SIXTEEN PASSAGE OF PROPOSITION.
FIFTY FIVE TO STRENGTHEN FUNDING
FOR CRITICAL EMERGENCY ACUTE AND
PREVENTIVE CARE HEALTH CARE
SERVICES FOR CHILDREN AND THEIR
FAMILIES AND ROLLED IN MEDI CAL.
YET CALIFORNIA'S MOST VULNERABLE
RESIDENTS ARE BEING SHORT
CHANGED BY AN ESTIMATED SEVEN
HUNDRED MILLION DOLLARS JUSTIN
THIS FISCAL YEAR ALONE.
DESPITE A TWENTY BILLION DOLLAR
STATE BUDGET SURPLUS.
PROPOSITION FIFTY FIVE FUNDING
WOULD HELP TO BOLSTER IMPORTANT
SERVICES FOR MEDI CAL
BENEFICIARIES SUCH AS MENTAL
HEALTH CARE.
AND TRAINING MORE MENTAL HEALTH
CARE WORKERS TO HELP ADDRESS THE
STATE'S BEHAVIORAL HEALTH CRISIS
[inaudible]
EXCUSE ME.
TARGETED FUNDING COULD INCREASE
THE NUMBER OF NEW PRIMARY CARE
PHYSICIANS AND PSYCHIATRISTS AND
UNDERSERVED AREAS LIKE OURS.
FURTHER IMPROVING PATIENTS
ACCESS TO CARE.
MARSHALL MEDICAL CENTER ALREADY
STRETCHES TO PROVIDE SOME OF
THESE SERVICES NOW FOR OUR
COMMUNITY FOR EXAMPLE WE
SUCCESSFULLY RECRUITED A
PSYCHIATRIST LAST YEAR AND WORK
HE KEEP KEEPING OUR FINGERS
CROSSED.
OTHER WE MIGHT BE ABLE TO ON
BOARD A SECOND MENTAL HEALTH
PRACTITIONER THIS YEAR.
WE ALSO RECENTLY OPENED ARE
CLINICALLY ASSISTED RECOVERY IN
EDUCATION SERVICES CLINIC
TREATING SUBSTANCE ABUSE AND
INCLUDING OPIOID USE DISORDERED
PATIENTS WITH WHOLE PERSON CARE.
OUR COMMUNITY KERR NETWORK
PROVIDES MULTI DISCIPLINARY CARE
MANAGEMENT SERVICES AT NO CHARGE
TO THE MOST MEDICALLY VULNERABLE
MEMBERS OF OUR COMMUNITY.
AND LIKE OTHER ALL HOSPITALS IN
CALIFORNIA WE'VE EXPERIENCED AN
UNPRECEDENTED INCREASE IN THE
NUMBER OF MENTAL HEALTH PATIENTS
ACCESSING OUR EMERGENCY
DEPARTMENT.
AND THE COMMENSURATE RISE IN THE
NUMBER OF THOSE PATIENTS WHO ARE
ACTUALLY BOARDED IN OUR
EMERGENCY ROOM.
DUE TO A LACK OF FACILITIES TO
RECEIVE THEM.
WITH APPROPRIATE LEVELS OF
FUNDING.
WE COULD PARTNER WITH LOCAL
STAKEHOLDERS TO DEVELOP
STABILIZATION AND STEP DOWN
SERVICES FOR THOSE PATIENTS.
AND WORK WITH OUR COUNTY
PARTNERS TO IMPROVE ACCESS TO
INPATIENT SERVICES.
WE WOULD ALSO LOOK TO EXPAND
SUBSTANCE ABUSE TREATMENT AND
OTHER SITES IN THE COUNTY AND
IMPROVE ACCESS TO PRIMARY CARE
WITH EXTENDED CLINIC HOURS.
AND URGENT CARE OPTIONS.
IN FACT WE COULD DO SO MUCH MORE
FOR OUR COMMUNITY WITH
ADDITIONAL FUNDING.
AS YOU KNOW PROPOSITION FIFTY
FIVE REVENUES EXPECTED TO VERY
SUBSTANTIALLY FROM YEAR TO YEAR
TO THE ECONOMY IN THE STATE
BUDGET.
SO THERE WILL BE LIMITED
OPPORTUNITIES FOR ADDITIONAL
INVESTMENT IN MEDI CAL.
GIVEN THIS YEAR'S BUDGET SURPLUS
AND THE CURRENT ECONOMY IT'S
DIFFICULT TO IMAGINE A YEAR THAT
WOULD BE A FIT FOR PROP.
FIFTY FIVE IF NOT THIS YEAR.
THEREFORE IT'S CRITICAL THAT THE
LEGISLATURE TAKE A HARD LOOK AT
HOW PROPOSITION FIFTY FIVE
FORMULA IS CALCULATED.
AND WHETHER THE INTENT OF THE
VOTERS IS BEING CARRIED OUT.
THANK YOU VERY MUCH.
MADAM CHAIR AND MEMBERS BARBER
GLAZER WITH THE CALIFORNIA
HOSPITAL ASSOCIATION.
FIRST OF ALL I'D LIKE TO THANK
YOU IN THE SUBCOMMITTEE PER
HEARING THIS ISSUE TODAY WE VERY
MUCH APPRECIATE YOU TAKING THE
TIME TO HEAR IT.
SPECIFICALLY CH A IS REQUESTING
SEVEN HUNDRED MILLION DOLLARS IN
ONE TIME FUNDING FOR MEDI CAL IN
POOR AREAS.
FIRST WE'D LIKE TO ADDRESS THE
HEALTH WORKFORCE SHORTAGE WITH
AN EMPHASIS IN BEHAVIORAL HEALTH
WE WOULD LIKE TO SEE TWO HUNDRED
AND FIFTY MILLION DOLLARS
ALLOCATED. TO BOLSTER THE
STATE'S PHYSICIAN WORKFORCE BY
EXPANDING HE NUMBER PRIMARY
CARE IN PSYCHIATRISTS TRAINED.
IN SUPPORTING EFFORTS TO RETAIN
THEM.
IF MANAGED IN ACCORDANCE WITH
FEDERAL REQUIREMENTS THIS
FUNDING COULD SERVE AS THE NON
FEDERAL SHARE TO DRAW DOWN
FEDERAL MATCHING DOLLARS.
THIS ONE TIME INVESTMENT WOULD
FUND MULTI YEAR RESIDENCY
PROGRAMS ADDING VALUE FOR YEARS
TO COME WITHOUT ANY DISRUPTION
IN POSITION TRAINING.
AS WE'VE LEARNED TO RESIDENTS
WHO TRAIN HERE IN CALIFORNIA ARE
HIGHLY LIKELY TO STAY IN THE
AREA WHERE THEY ARE TRAINED.
IN ADDITION BASED ON A
RECOMMENDATION FROM THE
CALIFORNIA FUTURE HEALTH
WORKFORCE COMMISSION THE FUNDS
COULD ALSO BE USED TO DEVELOP A
PSYCHIATRIC NURSE PRACTITIONER
PROGRAM THE RECRUITS FROM.
AND TRAINS PROVIDERS TO SERVE AN
UNDERSERVED RURAL AND URBAN
COMMUNITIES.
AS OUTLINED IN THE COMMISSION'S
REPORT AND INVESTMENT OF ABOUT
TWENTY FIVE MILLION DOLLARS
COULD ADD THREE HUNDRED
PSYCHIATRIC MENTAL HEALTH NURSE
PRACTITIONER.
TENSIONERS OVER FIVE YEARS.
THE SECONDARY WE WOULD LIKE TO
SEEN INVESTMENT IN IS IN THE
STATE'S BEHAVIORAL HEALTH
INFRASTRUCTURE.
WE WOULD DIRECT A HUNDRED
MILLION DOLLARS IN GRANTS TO
IMPROVE INFRASTRUCTURE IN CARE
SYSTEMS FOR INDIVIDUALS IN
CRISIS WITH BEHAVIORAL HEALTH
NEEDS.
KAREN TREATMENT FOR PATIENTS
WITH MENTAL HEALTH AND OR
SUBSTANCE USE DISORDERS CAN BE
HANDLED IN SETTINGS MORE
APPROPRIATE THAN HOSPITAL
EMERGENCY ROOMS.
INCREASED CRISIS STABILIZATION
SERVICES CAN DIRECT THESE
PATIENTS TO CARE SETTINGS THAT
BETTER MEET THEIR NEEDS WHILE
ALSO SUPPORTING THE BROADER
COMMUNITY.
GRANTS COULD ALSO BE USED FOR
HOSPITAL EFFORTS TO MEDICATE
LIGATURE RISK IMPROVE WHICH
WOULD IMPROVE PATIENT SAFETY.
THIS IS ESPECIALLY IMPORTANT TO
OUR HOSPITALS WITH PSYCHIATRIC
BEDS.
WE WOULD LIKE TO THIRDLY EXPAND
ACCESS TO CARE AND RURAL
COMMUNITIES.
ALLOCATE ONE HUNDRED MILLION
DOLLARS TO HOSPITALS IN RURAL
REMOTE OR LOW POPULATION DENSITY
AREAS TO SUPPORT GREATER ACCESS
TO MEDICAL SERVICES PARTICULARLY
TELUS PSYCHIATRY AND REGIONAL
CRISIS STABILIZATION SERVICES.
MEDI CAL PATIENTS IN THESE
COMMUNITIES SHOULD BE ABLE TO
ACCESS CARE FROM PSYCHIATRISTS
SPECIALISTS AND OTHER PROVIDERS
WITHOUT HAVING TO DELAY
TREATMENT OR DRIVE HUNDREDS OF
MILES.
THE FOURTH AREA WOULD BE PER
DISPROPORTIONATE SHARE HOSPITALS
WE WOULD PROPOSE ALLOCATING TWO
HUNDRED AND FIFTY MILLION TO
ENHANCE PAYMENTS. FOR PROVIDERS
THAT SERVE A DISPROPORTIONATE
NUMBER MEDI CAL AND UNINSURED
PATIENTS.
THIS IS PARTICULARLY IMPORTANT
GIVEN RECENT POSSIBLE PAYMENT
CUTS AT THE FEDERAL LEVEL.
ALSO AS A RESULT OF FEDERAL
CHANGES TO PUBLIC CHARGE
REGULATIONS HOSPITALS ARE SEEN
AN INCREASED NUMBER OF
INDIVIDUALS TO LANE NEEDED CARE.
WHEN THESE PATIENTS GO TO
HOSPITAL EMERGENCY DEPARTMENTS
THEY TYPICALLY REQUIRE MORE
COSTLY AND LESS EFFICIENT
SERVICES?
THESE ONE TIME INVESTMENTS WOULD
BENEFIT MILLIONS OF MEDI CAL
CHILDREN AND THEIR FAMILIES FOR
YEARS TO COME.
CJ STAND UNITED WITH VOTERS IN
URGING THE LEGISLATURE TO
REQUEST THAT THE DEPARTMENT OF
FINANCE RECONSIDER THE
METHODOLOGY THEY USE.
IN MAKING THE PROPOSITION FIFTY
FIVE CALCULATION.
THE REVENUES RAISED UNDER
PROPOSITION FIFTY FIVE ARE
INTENDED TO INCREASE REQUIRED
SPENDING ON SCHOOLS.
INCREASE RESERVE REQUIREMENTS
AND DEBT PAYMENTS.
IN ADDITION PROPOSITION FIFTY
FIVE AIM TO INCREASE FUNDING FOR
MEDI CAL IN GOOD ECONOMIC TIMES.
CLEARLY WE ARE IN GOOD ECONOMIC
TIMES THANK YOU.
AND PHONE SERVICE.
AND HAULING SORT OF LEGISLATIVE
ANALYST'S OFFICE -- YOU SHOULD
HAVE A HAND OUT IN FRONT OF YOU
THAT I WILL BE SPEAKING FROM --
THIS IS BASED PER MY PRIMARILY
ON ANALYSIS OUR OFFICE RELEASED
LAST YEAR -- BUT MANY OF THE
FINDINGS FROM NOT REPORT ARE
STILL APPLICABLE TO THE TWENTY
NINETEEN TWENTY POPULATION.
SO I'M GONNA GIVE JUST A BRIEF
OVERVIEW OF WHAT THE MEASURE
SAYS ABOUT HOW PROPOSITION FIFTY
FIVE POPULATION IS SUPPOSED TO
WORK WITH RESPECT -- TO
ADICIONAL SPENDING REQUIREMENT
FOR MEDI CAL AND THEN ALL
DISCUSS BRIEFLY THE
ADMINISTRATION'S APPROACH IN
ADMINISTERING THIS CALCULATION
IN.
TWENTY NINETEEN TWENTY SO ON THE
FIRST PAGE ARE THE FIGURE AT THE
TOP JUST PROVIDES.
A BRIEF OVERVIEW OF THE THREE
STEPS INVOLVED IN THE PROP FIFTY
FIVE CALCULATION FIRST -- IT
DIRECTS THE DEPARTMENT OF
FINANCE TO TAKE AN ESTIMATE OF
AVAILABLE REVENUES WHICH THE
TOTAL AMOUNT OF REVENUE GENERAL
FUND REVENUES AVAILABLE. FOR
TWENTY NINETEEN TWENTY TO
SUBTRACT FROM THAT -- THE
GENERAL FUND SPENDING
REQUIREMENT ON PROPOSITION
NINETY EIGHT FOR SCHOOLS THE
MINIMUM SPENDING APARTMENT FOR
SCHOOLS AND COMMUNITY COLLEGES.
TO SUBTRACT FROM THAT AN
ESTIMATE OF THE WORKLOAD BUDGET
I'LL COME TO WHAT THAT IS IN A
MINUTE BECAUSE IT'S REALLY
IMPORTANT TO UNDERSTANDING HOW
THE ADMINISTRATION CALCULATES
THIS.
AND THEN IF THERE IS A SURPLUS --
THAT RESULTS FROM THESE THREE
STEPS HALF OF THAT UP TO TWO
BILLION DOLLARS WOULD BE
DEDICATED TO MEDIC HOW THAT
WOULD.
BE AN ADDITIONAL SPENDING
REQUIREMENT ON YOU KNOW GENERAL
FUND SPENDING REQUIREMENT FOR
MEDICAL.
SO WHAT IS THE WORK BUT BUDGET.
IN JUST SORT OF CONCEPTUAL TERMS
THE WORKLOAD BUDGET IS THE COST
TODAY OF PROVIDING SERVICES THAT
WERE AUTHORIZED ON JANUARY FIRST --
TWENTY SIXTEEN BUT MORE SORT OF
TECHNICALLY PROP FIFTY FIVE
DEFINES IT AS THE QUOTE BUDGET
YOUR COST OF CURRENTLY
AUTHORIZED SERVICES THAT PHRASE
IS REALLY IMPORTANT.
ADJUSTED FOR A VARIETY OF
FACTORS THERE'S A NUMBER OF
FACTORS THAT ARE LAID OUT BY THE
MEASURE THIS INCLUDES THINGS
LIKE ENROLLMENT CASELOAD
POPULATION CHANGES INFLATION AT
CETERA -- THAT IS SO THE
CURRENTLY OPERATES SERVICES THAT
WERE IN EXISTENCE ON JANUARY
FIRST.
TWENTY SIXTEEN BUT THE MEASURE
ALSO GIVE THE DIRECTOR OF
FINANCE VERY JUST SIGNIFICANT
DISCRETION IN DETERMINING WHAT
THIS MEANS -- AND IN PARTICULAR
THE MAKE THE MEASURE SAYS THAT
THESE PROVISIONS ARE SET FORTH
WITH THE MEANING -- THAT THIS A
SECTION OF GOVERNMENT CODE RED
AND QUOTE WAS INTERPRETED BY THE
DIRECTOR OF FINANCE ON JANUARY
FIRST TWENTY SIXTEEN SO I THE
LEGISLATURE DOESN'T HAVE SORT OF
INDEPENDENT AUTHORITY TO CHANGE
THIS INTERPRETATION.
UNLIKE IN OTHER PARTS OF THE
BUDGET.
SO THE SECOND PAGE JUST PROVIDES --
VERY HIGH LEVEL OVERVIEW OF HALL
DEPARTMENT OF FINANCE MINISTERS
THIS CALCULATION AND TWENTY
NINETEEN TWENTY AVAILABLE
REVENUES ARE UNDER THE
ADMINISTRATION'S INTERPRETATION
ASSUMPTIONS ARE ONE HUNDRED AND
FORTY TWO POINT SIX BILLION.
THE MINIMUM FUNDING GUARANTEE
THAT'S THE GENERAL FUND SPENDING
ON EDUCATION IS FIFTY FIVE POINT
THREE BILLION.
THEIR WORKLOAD BUDGET ESTIMATE
COST IS EIGHTY EIGHT POINT EIGHT
BILLION AND THAT GETS YOU TO A
DEFICIT OF ONE POINT FIVE
BILLION.
SO HOW IS IT THAT THE BUDGET HAS
AN ESTIMATED SURPLUS YOU KNOW
FROM OUR OFFICE OF ABOUT TWENTY
BILLION DOLLARS BUT THIS
CALCULATION GOT TO TO ADOPT A
CENT.
WELL IT'S THE WAY THAT THE
ADMINISTRATION IS INTERPRETING
THAT PHRASE CURRENTLY AUTHORIZED
SERVICES SO THE ADMINISTRATION
BASICALLYSAYS.
AS LONG AS A SERVICE WAS
PROVIDED ON JANUARY FIRST TWENTY
SIXTEEN THAN ANY CHANGING COSTS
ABOUT SERVICE IS GOING TO BE
CONSIDERED WORKLOAD BUDGET
REGARDLESS OF WHETHER THAT
CHANGING COST WAS DISCRETIONARY
OR NOT.
SO FOR EXAMPLE -- OUR OFFICE YOU
KNOW ROUTINELY IDENTIFIES THE
NEW PROPOSALS THAT THE
ADMINISTRATION PUTS FORTH IN
JANUARY FOR EXAMPLE FUNDING TO
EXPAND KINDERGARTEN FACILITIES
WAS A BIG PROPOSAL THIS YEAR
INCREASING POWER X. GRANT
PAYMENTS -- GIVING MORE FUNDING
TO LOCAL GOVERNMENTS TO EXPAND
HOUSING PRODUCTION THE
ADMINISTRATION COUNTS ALL OF
THIS IS WORKLOAD BUDGET.
UNDER AN ALTERNATIVE APPROACH
THAT WE LAID OUT IN OUR REPORT
LAST YEAR THE ADMINISTRATION IT
WOULD BEGIN WITH AN ESTIMATE OF
THE ACTUAL EXPENDITURE LEVEL
FROM THE FIFTEEN SIXTEEN BUDGET.
AND THEN GROW IT BY THAT LIST OF
ALLOWABLE CHANGES GROWTH FOR
CASELOAD BROUGHT FOR ENROLLMENT
COURT MANDATES THAT CENTER ON
THIS WOULD.
EXCLUDE THINGS THAT LIKE ON THAT
LIST THAT I JUST MENTIONED YOU
KNOW ADDITIONAL FUNDING FOR
KINDERGARTEN FACILITIES IT'S
ULTRA -- AND WOULD THEREFORE BE
MUCH MORE LIKELY TO RESULT IN A
SURPLUS UNDER THE MEASURE. TO
TAKE ANY QUESTIONS [inaudible]
THANK YOU -- IT'S ALL IN THE
MATH.
ALL RIGHTS -- CREATIVE MATH THAT --
OKAY.
NO NO COMMENTS YET -- DEPARTMENT
FINANCE THANK YOU -- CAR LIKE A
SEA OF THE DEPARTMENT OF FINANCE
IN THE LEGISLATIVE ANALYST'S
OFFICE -- SORT OF ANSWER THE
QUESTION THAT WE WERE ASKED TO
ELABORATE ON HOW WE DEFINE THAT
WORKLOAD BUDGET AND WE AS AS
THEY SAID LOOK AT THE COST OF A
PROGRAM. FOR THE BUDGET YEAR --
AND AS I SAID COSTS IN THE
PROGRAM IF THE PROGRAM WAS
AUTHORIZED ON JANUARY FIRST
TWENTY SIXTEEN WE CONSIDER THIS
PART OF OUR CLUB BUDGET AND
THOSE ARE ADJUSTED BY THE ANNUAL
OPERATING EXPENSES FOR THAT
PROGRAM.
SO THAT MAY INCLUDE IN PLACE
ALLERGIES THAT COULD INCLUDE
COST OF LIVING ADJUSTMENTS -- TO
THE EXTENT THERE HAVE BEEN
CHANGES IN THE POPULATION SERVED
OR SOME ADJUSTMENTS IN THE
PROGRAMS AS A AMENDED BY THE
LEGISLATURE IN LEGISLATION.
THOSE WOULD ALSO BE CONSIDERED
WORKLOAD [inaudible]
THANK YOU.
ANY OTHER WITNESSES.
OKAY HOMES BRING IT TO THE
COMMITTEE STE BETTERS
[inaudible]
WELL.
FEEL LIKE HERE WE GO AGAIN -- SO
THE LA -- LAYS OUT WHY WHY DOES
DO ES CALCULATION RESULT IN A
DEFICIT AND AS FOR STATED
BROADLY -- INTERPRETED -- SO
THERE IS A USE OF SORT OF A
DISCRETIONARY -- THE
CONSTRUCTION OF OF THE OF THE
CALCULATION -- I'M ON A KIND OF
SIMPLE FLY THIS JUST A LITTLE
BIT.
SEEMS TO ME THAT THE DEPARTMENT
OF FINANCE IS BROADLY.
USING THAT DISCRETION TO SHARPEN
ITS PENCIL TO SAY NO
[inaudible]
THE ALTERNATIVE APPROACH THAT
HAS BEEN SUGGESTED BY
[inaudible]
LA -- WHICH BEGINS WITH AN
ESTIMATE.
BUT THE ACTUAL EXPENDITURE LEVEL
TWENTY FIFTEEN SIXTEEN AND THEN
ADJUST THAT LEVEL FOR THE LIST
OF ALLOWABLE CHARGES UNDER THE
MEASURE [inaudible]
AS DAILY -- SUGGESTED.
THIS LOOKS TO ME AS IF IT IS AN
EFFORT -- THAT YOU COULD JUST AS
EASILY -- APPROACH AND UTILIZE
IF YOU WERE TRYING TO SHARPEN
YOUR PENCIL TO SAY YES
[inaudible]
WHY [inaudible]
IS THE INTERPRETATION.
CONSTRUCTED IN SUCH A WAY.
THAT IT IS A DE FACTO NO.
THERE'S NO MONEY LEFT
[inaudible]
WHEN?
I SAID ON THE BIG BUDGET
COMMITTEE.
WE KEEP PATTING OURSELVES ON THE
BACK FOR TWENTY TWENTY SOME ODD
BILLION DOLLARS -- IN -- SAVINGS
ACCOUNTS.
WHY CAN'T YOU UTILIZE THE
SUGGESTED CALCULATION BY?
THE LA -- TO SAY YES.
OR AT LEAST TO GET TO A BETTER
PROSPECT.
UP ACCURATELY ANALYZING SO THAT
THERE'S A BETTER POSSIBILITY
THAT.
THE REAL SURPLUS CAN BE
IDENTIFIED AND USED FOR ITS
INTENDED PURPOSE -- SO I WILL
TRY TO ANSWER.
IN -- BUT I THINK IT'S A LOGICAL
ORDER SO YOU MAY NEED LEADER OF
REPHRASE -- FOR THE SURPLUS THE
TWENTY MILLION DOLLAR SURPLUS
THAT IS ACTUALLY THE RESULT OF
PRIOR YEARS AS AS WELL AS THE
BUDGET YEAR SO WHEN WE'RE
LOOKING AT THE CALCULATION BEING
A BUDGET YEAR EVALUATION AND
IT'S ONLY DONE AT THAT.
AT ITS DETERMINED AT THE BUDGET
ACT -- YOU WOULDN'T CONSIDER A
GOOD PORTION OF THAT UP.
IN THE NEIGHBORHOOD OF ABOUT
FOURTEEN BILLION THE IS FROM.
SAVINGS IN PRIOR YEARS
ADDITIONAL MEMBERS IN PRIOR
YEARS AS FAR BACK AS BEFORE --
SEVENTEEN EIGHTEEN THAT WAS THE
FIRST -- ONE THE OTHER POINT I
WANTED TO MAKE WAS WE WILL
UPDATE THIS SO THAT THIS WAS
BASED ON THE GOVERNOR'S BUDGET
PROPOSAL -- THE PRIORITIES OF
THE ADMINISTRATION AT AT THE
TIME AND HOW THOSE ARE
CONSIDERED WORKLOAD BECAUSE
PROGRAMS EXISTED IN.
TWENTY SIXTEEN WHEN WE UPDATE
FOR THE MAYOR VERSION THAT WILL
BE UPDATED AGAIN FOR ANY CHANGES
IN WHATEVER THOSE FUNDING LEVELS
WILL BE.
BUT AGAIN THIS WILL BE UPDATED
AT THE BUDGET ACT FOR WHAT THE
FINAL.
FINAL APPROVED BUDGET BY THE
LEGISLATURE SO IF THERE ARE
DIFFERENT PRIORITIES AND THEY
REFLECT.
EITHER NEW PROGRAMS OR A
DIFFERENT LEVEL OF FUNDING FOR
THE CURRENTLY ALL THREE SERVICES
THAT WOULD BE TO MAKE SURE I
UNDERSTAND WHAT YOU JUST SAID
[inaudible]
THAT [inaudible]
MAY REVISE.
WE'LL HAVE A DIFFERENT
CALCULATION AN UPDATED ONE YES.
A DIFFERENT CALCULATION.
WILL YOU USE [inaudible]
A DIFFERENT.
CONSTRUCTION OF THE CALCULATION.
CAN YOU NOT.
UTILIZE THE ONE THAT IS
SUGGESTED BY THE LA -- SEEMS TO
ME THAT IT'S FISCALLY SOUND AND
AN ALTERNATIVE THAT YOU COULD --
UTILIZE WITH CONFIDENCE -- WE
WOULD HAVE TO LOOK AT IT AGAIN I
I THINK -- AS WE WERE DEVELOPING
THE THE METHODOLOGY.
INTERPRETING THE SUCH AS AT THE
TIME LOOKING FOR A PRACTICAL
IMPLEMENTATION BECAUSE AS
PROGRAMS CHANGE FROM YEAR TO
YEAR AND THE FUNDING OF THIS
PROGRAM CHANGE FROM YEAR TO YEAR --
THAT'S A LITTLE MORE COMPLICATED
AND SO -- THIS FELT LIKE A MORE
STRAIGHTFORWARD EVALUATION BUT I
THINK THAT THERE WILL ALWAYS BE
OPPORTUNITIES TO DISCUSS WHETHER
CERTAIN.
A PROPOSED EXPENDITURE IS REALLY
WORKLOAD. TO LET TO MAYBE.
WE WE WILL EVALUATE THE NUMBERS
FOR ME.
ABOUT A POT.
TRY TO MAKE A LITTLE CLEARER --
HOW?
HOW DOGGONE GOOD IS THIS ECONOMY
HAVE TO BECOME? FOR THE
ADMINISTRATION WAS FESS UP TO
THE FACT THAT MEDI CAL -- FROM
THIS BOND WAS WHAT THE TAXPAYERS
EXPECTED THE SURPLUSES AND THE
EXTRA MONEY THAT THEY'VE BEEN
PAYING IN TAXES TO GO.
TO I MEAN HOW GOOD DOES IT HAVE
TO BE BEFORE YOU CHANGE THE
BASIC PRESUMPTIONS OF HOW YOU
CALCULATE THIS.
I DON'T HAVE AN ANSWER FOR THE
IT'S AWFULLY GOOD NOW.
THANK YOU.
AS A FOLLOW UP TO PATTERSON'S
QUESTION.
I THINK WE HAVE EXAMPLES OF SOME
OF THE DISCRETIONARY SPENDING
PROPOSALS THAT WERE INCLUDED --
SO I THINK A VERY SPECIFIC
QUESTION WOULD BE.
WILL THE NEW CALCULATIONS STILL
INCLUDE THE ONE POINT THREE
BILLION FOR GRANTS AND LOANS TO
LOCAL GOVERNMENTS TO INCREASE
HOUSING PRODUCTION.
WE WILL EVALUATE AMERICANS SO
WHETHER THAT REMAINS THE SAME
AMOUNT -- OR IF IT'S A DIFFERENT
AMOUNT OR IF THERE ARE OTHER
CONCERNS RAISED WITH WHAT THAT
PROGRAM TURNS OUT TO BE.
WE WILL HAVE TO RECONSIDER AND
THEN.
WILL THE NEW PROPOSALS
CALCULATION.
STILL INCLUDE THE SEVEN HUNDRED
AND FIFTY MILLION DOLLARS FOR
CONSTRUCTING NEW OR RETROFITTING
EXISTING SCHOOL FACILITIES.
THAT WAS LISTED AS DISCRETIONARY
SPENDING PROPOSALS.
THEY WERE PUT INTO THE THE
FORMULA WE CAN CERTAINLY DISCUSS
WITH WITH OUR PROGRAM EXPERTS ON
THAT I I THINK IT TO THE EXTENT
ALL OF THE FACTORS WERE THE SAME
WE WOULD INCLUDED AGAIN BUT WE
CAN CERTAINLY EVALUATE WHETHER
THE WITH THE PROPOSED
AUGMENTATION IS.
STILL UNDER THE SAME --
STRUCTURE.
AND YOU KNOW I'M GONNA ASK THE
LAST.
ONE IS IT GOING TO INCLUDE THE
NEARLY THREE HUNDRED AND FIFTY
MILLION TO INCREASE CAL WORKS
GRANT PAYMENTS AGAIN WE'RE
TALKING ABOUT IT AND THE ANSWER
MEASURES SAYING.
THESE ARE DISCRETIONARY SPENDING
PROPOSALS.
THAT WERE INCLUDED THEY DON'T
HAVE TO BE INCLUDED -- SO THAT
THE CALCULATION.
GOES BACK TO WHAT WAS SAID
EARLIER [inaudible]
WE CAN [inaudible]
INCLUDE.
THESE NUMBERS THESE
DISCRETIONARY SPENDING PROPOSALS.
TO EITHER SAY YES WE HAVE A
SURPLUS WE'RE GOING TO GIVE MORE
MONEY.
OR TO SAY NO THERE IS NO SURPLUS
AND WE'RE DONE.
OUT BECAUSE YOU GET ONE HAVE A
ZERO OR NEGATIVE NUMBERS YOU GET.
ZERO OF SAID SO OUR REQUEST THEN.
IS THAT WE DO WANT TO THE
CALCULATION. TO BE RE DONE. TO
BUY BY THE LETTER.
AND THE SPIRIT.
OF PROP.
FIFTY FIVE ANY OTHER QUESTIONS
OR COMMENTS FROM MEMBERS.
ALL RIGHT LET'S OPEN IT UP TO
PUBLIC COMMENT.
FIRST WANT TO START BY THANKING
THE CHAIR AND THE STAFF FOR
INSURING THIS IS A CHEN DICED
AND THAT THE COMMITTEE MEMBERS
HAVE DONE SUCH A GOOD JOB OF
MAKING SURE THOSE IMPORTANT
QUESTIONS ARE ASKED -- I
REPRESENT A SET SHORT I.
REPRESENT PEACH THE PRIVATE
CENTRAL ACCESS COMMUNITY
HOSPITALS.
I'M OUR HOSPITALS ARE ON ARE
DISPROPORTIONATE SHARE HOSPITALS
WHICH MEAN THEY SEE THIS PORTION
OF THE MEDICAID AND MEDICARE
POPULATION BY DEFINITION THEY
ARE IN OUR UNDERSERVED AREAS --
AND WE ARE FULLY SUPPORTIVE OF
THE PROPOSALS THAT -- IS GLAZER
PUT FORWARD -- REGARDING THE
MENTAL HEALTH SERVICES ARE
HOSPITALS ARE SEEING MORE AND
MORE AND HAVE BEING ASKED TO
MORE AND MORE -- FOR TREATING
BEHAVIORAL HEALTH CLIENTS IN OUR
EMERGENCY DEPARTMENTS AND
ELSEWHERE IN THOSE FUNDS ARE
DESPERATELY NEEDED.
I'M AGAIN BECAUSE OF THE DISH
CUTS AT THE FEDERAL LEVEL ARE
BEING DISCUSSED -- FOR
IMPLEMENTATION THIS YEAR -- THE
DISH BACK FILL WOULD BE
INCREDIBLY IMPORTANT FOR OUR
HOSPITALS -- WE ARE SEEING
BECAUSE OF THE PUBLIC CHARGE
CONVERSATION AT THE FEDERAL
LEVEL MORE OF OUR PATIENTS ARE
AFRAID TO GET ACCESS TO THE
MEDIC HOW COVERAGE OR MORE
AFRAID TO GET ACCESS TO ANY
PUBLICLY FUNDED AND SUPPORTED --
COVERAGE AND SO OUR CHARITY CARE
RATES ARE GOING UP AT THE SAME
TIME WE WOULD EXPECT THEM TO BE
GOING DOWN SO AGAIN THOSE
RESOURCES ARE DESPERATELY NEEDED
WE SUPPORT.
THE ALLEY OWES PROPOSAL WE
SUPPORT CH REYES PROPOSAL -- AND
HOPE THAT YOU WILL APPROPRIATE
THOUGH SEVEN HUNDRED MILLION
DOLLARS FOR THESE REALLY
DESPERATELY NEEDED SERVICES IN
YOUR COMMUNITIES [inaudible]
THANK YOU.
WHERE MARTIN HERE BEHALF OF THE
CALIFORNIA CHILDREN'S HOSPITAL
ASSOCIATION AND AGAIN WHEN I
THINK THE COMMITTEE FOR YOUR
SUPPORT ON THIS ISSUE AND WHAT
SUPPORT YOUR REQUEST OF THE
DEPARTMENT TO USE?
OF THE ALEJO'S CALCULATION
FORMULA THANK YOU.
THANK YOU.
KELLY BROOKS I'M HERE THIS
EVENING ON BEHALF OF THE
CALIFORNIA ASSOCIATION OF PUBLIC
HOSPITALS AND HEALTH SYSTEMS I'M
ALSO HERE IN SUPPORT OF AN
ALTERNATIVE CALCULATION ON ON
PROP FIFTY FIVE AND THANK YOU.
TO THE COMPANY FOR YOUR
CONVERSATION THIS EVENING
[inaudible]
THANK YOU.
STEPHANIE WAS LET OUT ON BEHALF
OF CEDARS SINAI MEDICAL CENTER
AND VERY MUCH IN SUPPORT OF THE
COMMITTEE'S REQUEST.
THIS IS ABOUT A FOUR YEAR THIS
IS THE YEAR THAT I THINK VOTERS
IMAGINED.
THIS FORMULA BE UNDERTAKEN THE
WEATHER VOTED ON IT WE VERY MUCH
SUPPORT.
THANK YOU.
GOOD AFTERNOON WELCOME HERE
BEHALF OF HEALTH ACCESS
CALIFORNIA WE ABSOLUTELY SUPPORT
THE COMMITTEE'S REQUEST WE
SUPPORT CHS PROPOSAL AND DO
THINK THAT -- THIS FUNDING
SHOULD BE USED TO MAKE
IMPROVEMENTS AND ENHANCEMENTS
WITHIN THE MEDICAL PROGRAM
INCLUDING -- COVERAGE EXPANSIONS
THANK YOU [inaudible]
THANK YOU.
THAT CONCLUDES PUBLIC COMMENTS
ON ISSUE NUMBER NINE I WANT TO
THANK THE PANELISTS. FOR FOR
PROVIDING TESTIMONY IN FOR
ANSWERING THE QUESTIONS THE EASY
ONES ON THE HARD ONES.
I THANK YOU ALL WE LOOK FORWARD
TO THE NEW CALCULATION BY THE
MAY REVISE [inaudible]
WHO KNOWS?
THANK YOU ALL
[inaudible]
SURE.
IT'S A TWENTY SIXTEEN FOR ALL
RIGHT ARE THAT WE HAVE AND A
NUMBER OF ISSUES THEIR NON
DISCUSSION ITEMS BUT DOES
ANYBODY CAN PUBLIC WISH TO
PROVIDE PUBLIC COMMENT.
ON ISSUE ITEMS. TEN THROUGH.
TWENTY FOUR SEEING AND HEARING
NONE.
THIS HEARING IS ADJOURNED.
I THINK THE BOTTOM [inaudible]
UHHUH [inaudible]
I HAVEN'T.
YES SIR WE CAN CALL IT
[inaudible]
FOR HE'S NOW