THE ASSEMBLY BUDGET SUB
COMMITTEE NUMBER ONE ON HEALTH
AND HUMAN SERVICES AND TODAY'S
HEARING COVERS OVERSIGHT ISSUES
AND NEW PROPOSALS AFFECTING
MEDICAL. IN PARTICULAR WE WILL
BE DISCUSSING CAL AIM NURSING
HOME CARE AND MEDICARE ALL
DENTAL SERVICES. THIS IS THE
LAST SOMEONE HEARING ON HEALTH
ISSUES FOR THE FIRST ROUND OF
HEARINGS COVERING THE G.
GOVERNOR'S JANUARY BUDGET. AND
OVERSIGHT ON THE TWENTY TWENTY
TO BUDGET. LIKELY MORE HEARINGS
WILL BE SCHEDULED AND ASSOCIATED
WITH THE MAY REVISE AND DETAILS
WILL BE SHARED AS SOON AS THEY
ARE FINALIZED. AS USUAL I HAVE
BEEN ASKED TO READ SOME
DIRECTIONS REGARDING PUBLIC
PARTICIPATION IN TODAY'S HEARING
TO HELP INSURE THE SAFETY OF
EVERYONE HERE TODAY WHILE ALSO
ALLOWING FOR FULL PUBLIC ACCESS
TO TODAY'S DISCUSSION. TODAY'S
HEARING WILL BE AT THE STATE
CAPITOL IN ROOM ONE TWENTY
SEVEN. MANY OF THE PANELISTS
WILL BE TESTIFYING REMOTELY
WHILE OTHERS ARE HERE IN PERSON
AT THE CAPITOL. WE ARE ACCEPTING
PUBLIC COMMENT AT THE END OF THE
HEARING BOTH IN THE HEARING ROOM
AND ON THE PHONE THE PHONE
NUMBER TO CONNECT IS ON THE
COMMITTEE WEBSITE AND SHOULD BE
ON THE SCREEN IF YOU ARE
WATCHING OVER THE INTERNET THE
NUMBER IS TOLL FREE. ONE EIGHT
SEVEN SEVEN SIX NINE TWO EIGHT
NINE FIVE SEVEN. THE ACCESS CODE
IS. ONE THREE ONE FIVE ONE TWO
SEVEN IF YOU ENCOUNTER ANY
PROBLEMS YOU CAN CONTACT THE
ASSEMBLY BUDGET COMMITTEE AT
916-319-2090 NINE AND A STAFF
MEMBER WILL ASSIST YOU. WE WILL
BEGIN PUBLIC COMMENT AFTER ALL
MEMBERS HAVE CONCLUDED THEIR
QUESTIONS FOR ALL OF THE
PANELISTS. THERE WILL BE NO VOTE
TAKEN IN TODAY'S HEARING.
FINALLY WE WILL BE ACCEPTING
WRITTEN PUBLIC COMMENTS AND
FEEDBACK THROUGH THE SUB ONE
EMAIL ACCOUNT. AND THE ADDRESS
IS BUDGET SUB ONE AT ASM DOT CA
DOT GOV. A FEW BRIEF OPENING
COMMENTS BEFORE WE BEGIN. THE
FOCUS OF THIS HEARING IS THE
MEDICAL PROGRAM AND THAT THE
NEED FOR SIGNIFICANT REFORMS. IT
IS CLEAR TO ME AND NO DOUBT TOO
MANY OF US THAT THE STATUS QUO
IS NO LONGER ACCEPTABLE. THIS IS
TRUE FOR SOME ASPECTS OF THE
MEDICAL PROGRAM MORE THAN OTHERS
AND IT'S ESPECIALLY TRUE FOR
NURSING HOME CARE. IT'S HIGH
TIME AND LONG OVERDUE THAT WE
TAKE THE CONCERNS AND
RECOMMENDATIONS OF LABOR AND
OTHER STAKEHOLDERS VERY
SERIOUSLY. WE CAN'T CONTINUE TO
IGNORE THE NURSING HOME INDUSTRY
OR THIS VERY VULNERABLE
POPULATION OF PATIENTS. BUT
BEFORE WE DIG INTO THE DETAILS
ON NURSING HOMES WE'LL START
WITH THE DISCUSSION ON CAL
EIGHTEEN WHICH IS THE STATE'S
INSPIRING EFFORTS TO END THE
STATUS QUO FOR MUCH OF THE
MEDICARE PROGRAM. CAL AIM AT
LAST SEEKS TO ADDRESS THE
FRAGMENTATION THE INEFFICIENCIES
AND THE INEQUITIES THAT HAVE
PLAGUED THE MEDICARE PROGRAM FOR
FAR TOO LONG. AND WHILE CAL AIM
SEEMS TO BE THE RIGHT APPROACH
OVERALL IT IS IMPERATIVE THAT
THE LEGISLATURE HOLD THE
ADMINISTRATION ACCOUNTABLE. FOR
ENSURING THAT CAL AIM DOES IN
FACT LIVE UP TO ITS PROMISE.
WITH THAT LET US BEGIN. HER
FIRST PANEL TODAY WILL BE ON
ISSUE ONE COVERING CAL AIM WE
WILL HAVE THREE PRESENTERS ON
THIS PANEL DIRECTOR MICHELLE
BOSS OF THE DEPARTMENT OF HEALTH
CARE SERVICES J. C. COOPER WHO
IS OUR STATE MEDICAID DIRECTOR
AND SANDRA SIGNS WHO IS THE
CHIEF DEPUTY OF BEHAVIORAL
HEALTH. FOR SOLANO COUNTY.
ALTHOUGH LISTED ON THE AGENDA DR
RYAN QUEST WITH SACRAMENTO
COUNTY HAS BEEN PULLED AWAY BY
JURY DUTY. LET US PLEASE BEGIN
WITH DIRECTOR BOSS. THIS IS JC
COOPER ACTUALLY I'M DO MOST OF
OUR COMMENTS TODAY IN A DIRECTOR
POSSIBLE BE AVAILABLE FOR
QUESTIONS LATER ON IN APPRECIATE
THE OPENING COMMENTS. I'M IN
REGARDS TO LEVEL SETTING YOU
KNOW HOW LAME IS BEING EXTREMELY
ASPIRATIONAL AND IN A HUGE UP
HE'S BIRTH ALL TO WORK
COLLECTIVELY TO IN OTHER
DEPARTMENT IS VERY COMMITTED TO
THE SUCCESSFUL IMPLEMENTATION.
OF THE POLICY PIECES I THINK
OVERALL CALLIE MS MOVING
MEDICARE TOWARDS A POPULATION
HEALTH APPROACH THAT REALLY
PRIORITIZES PREVENTION AND WHOLE
PERSON CARE APPROACHES. THE
VISION IS TO REALLY MEET PEOPLE
WHERE THEY ARE AND LYFT ADDRESS
SOCIAL DRIVERS OF HEALTH AND
BREAK DOWN THE WALLS OF HEALTH
CARE. HOW HE WILL OFFER MEDICARE
ENROLLEES COORDINATED AN
EQUITABLE ACCESS TO SERVICES AT
THAT ADDRESS THEIR PHYSICAL
BEHAVIORAL DEVELOPMENTAL DENTAL
AND LONG TERM CARE NEEDS. KELLY
REALLY ALIGNS ALL ELEMENTS OF
MEDIC CAL INTO A SYSTEM THAT IS
STANDARDIZED SIMPLIFIED IN
FOCUSED ON. HELPING ENROLLEES
LIVE. BE HEALTHIER I SUCCESS
REQUIRE THE END. INSIST COME OF
A- NETWORK OF PARTNER. INCLUDING
OUR MANAGED CARE PLANS PROVIDERS
COUNTIES THE END COMMUNITY BASED
ORGANIZATION THIS IS NOT
SOMETHING JUST ONE OF US CAN DO
WE ARE COLLECTIVELY HAVE TO WORK
TOGETHER TO MAKE THIS
SUCCESSFUL. IDES WAS VERY HAPPY
TO ANNOUNCE AT THE END OF LAST
YEAR- THE FEDERAL APPROVAL OF
OUR PEERS WEAVERS IN TELLING KEY
INITIATIVES. THEIR SUPPORT IS
INSTRUMENTAL IN REGARDS TO US
BEING ABLE TO MOVE FORWARD. ON
AS WE ARE IMPLEMENTING THE
ENHANCED CARE MANAGEMENT OR WHAT
WE CALL ECM- IN PHASES HERE IN
CALIFORNIA AND ON JANUARY FIRST
TWENTY FIVE COUNTIES THAT
PREVIOUSLY SERVED WHOLE PERSON
CARE. AND OR HEALTH PROBLEMS
MEMBERS I WENT LIVE-
APPROXIMATELY NINETY FIVE
THOUSAND INDIVIDUALS WERE
SUCCESSFULLY TRANSITION INTO
ENHANCE CARE MANAGEMENT. THE
NEXT IMPLEMENTATION BELIEVES IS
ON JANUARY FIRST OUR JULY FIRST
OF TWENTY TWENTY TWO. A
POPULATIONS OF FOCUS INCLUDE
INDIVIDUALS AND FAMILIES
EXPERIENCING HOMELESSNESS HOW TO
UTILIZE OUR ADULTS AND ADULTS.
WITH SERIOUS MENTAL ILLNESS.
THREE TWENTY TWENTY D. FOURTH.
AND HE YOUR MAN TO- SEPARATE
ADDITION. COPULATIONS OF FOCUS-
INTO THREE WALL JANUARY OF
TWENTY THREE INDIVIDUALS
TRANSITIONING FROM INCARCERATION
TO THE COMMUNITY. I'M MEMBERS
ELIGIBLE FOR LONG TERM CARE OR
AT RISK OF INSTITUTIONALIZATION
AND NURSING HOME RESIDENTS
TRANSITIONING TO THE COMMUNITY.
COME JULY ONE OF TWENTY THREE WE
WILL ALSO FOCUS ON CHILDREN AND
YOUTH. EASING OF ENHANCED YOUR
MANAGEMENT WAS CRITICAL AND
REALLY WAS DONE BASED ON
EXTENSIVE STAKEHOLDER FEEDBACK
THAT IN ORDER TO MAKE THIS TYPE
OF CHANGE HAPPENED OVER TIME WE
NEEDED TO EXIT OUT THE PLANS AND
PROVIDERS CAN FOCUS ON KEY
POPULATIONS AS THEY BUILD THEIR
NETWORKS. BUILD THEIR
RELATIONSHIPS AND BUILD CHANGE
AT THE LOCAL. LEVEL TO HAPPEN
OVER TIME. EACH THE ALSO PARTNER
WITH PLANS IMPROVE TO. LAUNCHED
SUPPORTS GNU ONE OF TWENTY
TWENTY TWO. I'M WE HAVE ADOPTED
AND ARE PROVIDED A LIST OF
FOURTEEN COMMUNITY SUPPORTS. IN
JANUARY TWENTY FIVE MANAGED CARE
PLANS IN FORTY SEVEN COUNTIES
BEGAN OFFERING MORE THAN FIVE
HUNDRED TWENTY COMMUNITY SUPPORT
ACROSS THE STATE OF CALIFORNIA.
APPROXIMATELY FORTY THOUSAND
MEMBERS TRANSITION TO COMMUNITY
SUPPORTS FROM WHOLE PERSON CARE.
AND WHILE COMMUNITY SUPPORT ALL
ARE VOLUNTARY FOR MANAGED CARE
PLANS TO OFFER BY JULY ONE OF
TWENTY TWENTY TWO NEARLY ALL
MANAGED CARE PLANS IN ALL
COUNTIES WERE WILL OFFER SOME
LEVEL OF COMMUNITY SUPPORT. ON
AVERAGE MANAGED CARE PLANS HAVE
ELECTED TO INITIALLY FOCUS ON
OFFERING FIVE TO SIX COMMUNITIES
THE COURTS IN EACH COUNTY. I
WITH MOST PLANS STARTING WITH
HOUSING RELATED SERVICES
MEDICALLY TAILORED MEALS AND ASK
THE REMEDIATION. OUR TWENTY
TWENTY THREE AND TWENTY TWENTY
FOUR MANAGED CARE PLANS WILL
CONTINUE TO EXPAND THEIR
COMMUNITY SUPPORT ELECTIONS. DH
CS HAS POSTED THE LIST OF
COMMUNITY SUPPORTS BY MANAGED
CARE PLANNING COUNTY ON ITS
WEBSITE FOR FULL TRANSPARENCY
FOR ALL INDIVIDUALS. REGARDING
THE OTHER KALYAN BEHAVIORAL
HEALTH REFORMS DHT HAS ISSUED
GUIDANCE. AS TO UP THE CRITERIA
FOR ACCESS TO SPECIALTY MENTAL
HEALTH SERVICES THE GUIDANCE
CLARIFIES THAT SPECIALTY MENTAL
HEALTH SERVICES CAN BE PROVIDED
DURING THE ASSESSMENT PERIOD
INCLUDING THE FOR A DIAGNOSIS IS
MADE AND ESTABLISHES SEVERAL
CRITERIA FOR CHILDREN AND YOUTH
UNDER THE AGE OF TWENTY ONE. TO
ACCESS SPECIALTY MENTAL HEALTH
SERVICES FOR VIRTUE OF BEING A
HIGH RISK UPPER MENTAL HEALTH
DISORDER DO YOU TO EXPERIENCE OF
TRAUMA. IN ADDITION THE ACS IS
IMPLEMENTING A DOCUMENTATION
REFORM POLICY THAT WILL BECOME
EFFECTIVE JULY ONE OF TWENTY
TWENTY TWO JUST STREAMLINED AND
STANDARDIZED CLINICAL
DOCUMENTATION REQUIREMENTS
ACROSS SPECIALTY MENTAL HEALTH
DRUG MEDI CAL IN DRUG MEDI CAL
ORGANIZED DELIVERY SYSTEMS.
FINALLY DCS IS DEVELOPING
GUIDANCE TO IMPLEMENT THE WROTE
NO WRONG DOOR POLICIES THAT WILL
ALSO BECOME EFFECTIVE JULY ONE
OF TWENTY TWENTY TWO SO THAT
INDIVIDUALS ARE ABLE TO ACCESS
NEEDED BEHAVIORAL HEALTH
SERVICES REGARDLESS OF THE
DELIVERYSYSTEM WHERE THEY ARE
SEEKING CARE. I'M TO GET SOME
UPDATES IN REGARDS TO YOU SOME
OF THE PLANNING PHASES FOR THE
LONG TERM CARE A BENEFIT. FOR
PLANS TO CURRENTLY COVER LONG
TERM CARE IF THEY'RE NOT TO GET
A AFFECTED JANUARY TWENTY TWENTY
THREE ON DEC HAS HAS BEEN
CONVENING A LARGE NUMBER OF
STAKEHOLDERS. AND THAT INCLUDES
DISTANCE FOR MANAGED CARE PLANS
HOSPITAL ASSOCIATIONS A
DEVELOPMENTAL SERVICES JUSTICE
IN AGING AND OTHER KEY PARTNERS-
THIS WORKGROUP THAT CAN BEAT.
HELP INFORM THE OVERALL
IMPLEMENTATION IT TO PROVIDE
FEEDBACK ON MEMBER
COMMUNICATIONS FACILITY
COMMUNICATIONS DATA SHARING
NEEDS FACILITY OVERSIGHT NEEDS
AND NETWORK ADEQUACY. THE GOAL
OF THE WORKGROUP IS TO CREATE A
RECOMMENDATIONS BY MANY OF THIS
YEAR I WISH DH YES WILL CONSIDER
FOR THE FINAL POLICY
IMPLEMENTATION OF THESE VERY
LARGE. MOVEMENTS COMING NEXT
YEAR. WE ARE ALSO READ OUR OUR
ARE BEHAVIOR HEALTH REFORM WHICH
IS CURRENTLY ON SCHEDULED TO BE
IMPLEMENTED IN JULY OF TWENTY
THREE. I REMEMBER BIRDS ARE
BROKEN INTO A VARIETY OF
COMPONENTS THAT INCLUDED THEIR
TRANSITION TO A NEW CODING
SYSTEM ACROSS ALL OF BEHAVIORAL
HEALTH WITHIN MEDIC.
TRANSITIONING IN DEVELOPMENT OF
I. G. T. PROCESS WITH OUR COUNTY
PARTNERS AND THEN OF COURSE THE
DEVELOPMENT AND IMPLEMENTATION
OF A NEW SCHEDULE FOR ALL
SPECIALTY MENTAL HEALTH AND
SUBSTANCE USE DISORDER SERVICES
IN OUR PROGRAM. IN REGARDS TO
THE INTERSECTION WITH SACRAMENTO
AND SOLANO COUNTIES D. H. THAT
HAS ENGAGE SACRAMENTO SOLANO AND
KAISER IN AN EFFORT TO ENSURE A
SMOOTH TRANSITION FOR
BENEFICIARIES SERVED IN THESE
COUNTIES. AS A PART OF THE
CONVERSATION THE ADMINISTRATION
AGREED TO. POSTPONE THE
TRANSITION DATE FROM JULY
JANUARY ONE OF TWENTY TWENTY TWO
TO JULY ONE AT TWENTY TWENTY
THREE TO ALIGN THE START DATE
WITH KELLY'S BEHAVIORAL HEALTH
PAYMENT REFORM INITIATIVES. THIS
DELAY WILL ALLOW THE COUNTIES IF
THEY SO CHOOSE THE CONTRACT BACK
WITH KAISER TO PROVIDE THE
SERVICES IN THE COUNTY THIS WAS
THE REQUEST MADE BY THE
COMPANIES THAT HAVE THAT
FLEXIBILITY. IN THE
ADMINISTRATION AGREED THAT
FLEXIBILITY WAS A CRITICAL
COMPONENT TO A SUCCESSFUL
TRANSITION. CONSIDERING THE
RELEASE OF THE FIRST TELLING
PROPOSAL IN OCTOBER TWO THOUSAND
AND NINETEEN AND THE SUBSEQUENT
YEAR AND A HALF DELAYED TO JULY
ONE OF TWENTY THREE. DH CS
BELIEVES THAT SACRAMENTO SOLANO
AND KAISER THAT HAD TO BE ABLE
TIME TO ENSURE A SMOOTH
TRANSITION OF BENEFICIARIES. D.
H. U. S. WILL CONTINUE TO
PROVIDE TECHNICAL ASSISTANCE AS
NEEDED. ADDITIONALLY DO YOU YES
NO IT'S A SMALL BUT IMPORTANT
HAVE YOU GOTTEN THE DESCRIPTION
OF THE REALIGNMENT REVENUES
INCLUDED IN THE AGENDA. PURSUANT
TO STATE STATUTE THE
ADMINISTRATION DEVELOPED THE
REALIGNMENT ALLOCATION
METHODOLOGY IN CONJUNCTION WITH
COUNTY PARTNERS. THAT IS BASED
ON THE ANNUAL NUMBER OF
BENEFICIARIES IN ANNUAL
BEHAVIORAL HEALTH EXPENDITURES
IN EACH COUNTY BECAUSE
SACRAMENTO AND SOLANO COUNTIES
DID NOT PAY FOR BEHAVIORAL
HEALTH SERVICES PROVIDED TO
KAISER BENEFICIARIES IN MY
COUNTY. THOSE COSTS WERE NOT
CAPTURED IN THE REALIGNMENT
ALLOCATIONS DH CS NOTES THE
RESPONSIBILITY TO PROVIDE
BEHAVIORAL HEALTH SERVICES FALLS
WITHIN THE COUNTY'S REALIGNMENT
RESPONSIBILITIES. KAISER
RECEIVED PAYMENT FOR THE
SPECIALTY MENTAL HEALTH SERVICES
IN SACRAMENTO IN SOLANO COUNTY
AS A PART OF THEIR CAPITATION
PAYMENTS. THERE ARE NO
ADDITIONAL PAYMENTS MADE. TO
KAISER FOR THESE SERVICES. IT
ESTIMATES THE END TO COUNTY YEAR
TWENTY TWENTY TWO RAISE IS A-
FIFTEEN POINT FIVE MILLION IT'S
- IN FOURTEEN POINT SEVEN
MILLION IN SOLANO. AS PART OF
THIS TRANSITION THESE COSTS
WOULD NO LONGER BE INCLUDED IN
KAISER'S CAPITATION PAYMENTS.
NOW WANTED TO KIND OF CONCLUDE
COMMENTS IN REGARDS TO THREE
QUESTIONS AROUND HOW WILL
MEASURE CALLIN SUCCESS. A DH CS
WILL MEASURE THE SUCCESS OF
TELLING IN SEVERAL WAYS
INCLUDING TRACKING PERFORMANCE
RATES ON A CORE SET OF MEASURES
ASSESSING WHETHER MEASURE SO A
DECREASE IN HEALTH DISPARITIES
WHETHER ACCESS AND PERFORMANCE
RATES IMPROVED OVER THE LIFETIME
OF KELLY. WELL IF HE DID AND
QUANTITATIVE ANALYSIS OF MEMBER
EXPERIENCE SURVEYS TRACKING
OUTCOMES FOR STATEWIDE CALLIE
RELATED INCENTIVE PROGRAMS AND
WHETHER PLANTS AND COUNTIES ARE
REACHING PARTICULAR MILESTONES
RELATED TO THE ACCOUNTING
IMPLEMENTATION. IN ADDITION AS A
PART OF THE ELEVEN FIFTEEN
CAROLINE WEAVER EVALUATION THE
DEPARTMENT WILL CONTRACT OUR
CONTRACT WITH AN OUTSIDE
EVALUATOR TO CONDUCT AN INITIAL
EVALUATION WHICH WILL BE DUE TO
CMS IN TWENTY TWENTY FIVE. N. S.
AT THE END OVERALL EVALUATION
WHICH WOULD BE DO YOU TWENTY
TWENTY EIGHT. DH CS WILL SUBMIT
AN EVALUATION PLAN TO CMS IN
JUNE OF THIS YEAR THAT WHAT
OUTLINED THE DETAILS OF THOSE
EVALUATIONS AND HOW WILL WE
EVALUATE THE SUCCESS OF MANY OF
THE COMPONENTS OF QALINGE IN THE
COMING YEARS. THE EVALUATION
WILL OUTLINE RESEARCH QUESTIONS
AND HYPOTHESES TO MEASURE THE
IMPACT OF TELLING INITIATIVES
ARE IN RALEIGH ACCESS QUALITY OF
CARE AND HEALTH OUTCOMES AS WELL
AS REDUCTIONS IN HEALTH
DISPARITIES IN ADVANCEMENT OF
HEALTH EQUITY. INCLUDING B.
INITIATION AND ENGAGEMENT WITH
TREATMENT REDUCTIONS IN
INAPPROPRIATE MERGES YOU
DEPARTMENT UTILIZATION AND
REDUCTIONS IN INAPPROPRIATE
INPATIENT HOSPITALIZATION ACROSS
MANY DELIVERY SYSTEM BUT ALSO
SPECIFICALLY IN REGARDS TO-
INTERSECTION WITH THEIR DNC ODS
PROGRAM. I THANK GOODNESS OF THE
CONTINGENCY MANAGEMENT BENEFITS
PROVIDED TO QUALIFYING AND
ROWLEY'S INCREASE ACCESS TO
COMMUNITY BASED PROVIDERS
THROUGH ENHANCED CARE MANAGEMENT
AND COMMUNITY SUPPORT. AND
IMPROVED. ACCESS AND UTILISE
ASIAN AB HELPED SERVICE. AT THE
COMMUNITY LEVEL ASSIST WITH THE-
FUNDING HI TO THESE INITIATIVE.
HELPED OUT COMES REDUCE IN A
PER. UTILIZATION UTILIZATION
REDUCTION AND IMPATIENT A LONG
TERM UTILIZATION WILL ALSO BE
TIED DIRECTLY TO COMMUNITY
SUPPORT TO ENSURE THAT THEY ARE
MEDICALLY APPROPRIATE COST
EFFECTIVE IN IMPROVING THE
HEALTH OUTCOMES OF OUR
BENEFICIARIES. ADDITIONALLY AS A
PART OF THE NINETEEN FIFTEEN BE
WEBER DH CS WILL BE CONDUCTING A
COMPREHENSIVE ACCESS ASSESSMENT
ACROSS ALL DELIVERY SYSTEMS
MANAGED CARE DENTAL SPECIALTY
MENTAL HEALTH IN OUR SUBSTANCE
USE DISORDER SERVICES. DHS WILL
MONITOR AND EVALUATE VARIOUS
CALLUM INITIATIVES USING THE
CRITERIA OF IMPROVING HEALTH
CARE INFRASTRUCTURE MEMBER
EXPERIENCE ACCESS UTILIZATION
AND QUALITY. DTS IS A LIST OF
RELEVANT MEASURES AND
INITIATIVES REGARDING THE
MONITORING AND EVALUATION AND
THIS CONCLUDES MY COMMENTS AND.
HAPPY ANSWER QUESTIONS WHEN THE
TIME IS RIGHT. NEXT NEXT WE'LL
HEAR FROM SANDRA- SINCE CHIEF
DEPUTY FOR BEHAVIORAL HEALTH AND
SOLANO COUNTY. GOOD AFTERNOON
CHAIR MEMBERS THANK YOU- FOR
ALLOWING ME TO SPEAK TODAY I'M
SANDRA SINCE I'M THE COUNTY
BEHAVIORAL HEALTH DIRECTOR FOR
SOLANO COUNTY TESTIFYING ON
BEHALF OF SOLANO COUNTY
SACRAMENTO COUNTY AND- THE
COUNTY BEHAVIORAL HEALTH
DIRECTORS ASSOCIATION- I
APPRECIATE THE OPPORTUNITY TO
TALK SPECIFICALLY ABOUT THE
TRANSFER OF THE KAISER SPECIALTY
MENTAL HEALTH. CARE TO THE
COUNTIES IN THE IN SACRAMENTO
AND SOLANO AND AS MENTIONED- BY
J. C. JC COOPER JUST A MOMENT
AGO. AND WE DO APPRECIATE THE
ALIGNMENT OF THE BEHAVIORAL
HEALTH CARVE OUT THROUGHOUT THE
STATE. WE SUPPORT DH CS SAYS
GOAL THE STANDARDIZED SPECIALTY
BENEFITS ACROSS COUNTY THEN AND
WE ALSO BELIEVE THAT COUNTY
SYSTEMS ARE DESIGNED TO SERVE
THIS POPULATION WITH A SEVERE
AND SPECIALIZED NEEDS. WE DO
HOWEVER HAVE MAJOR CONCERNS
ABOUT THE JULY TWENTY TWENTY
THREE TIMING. ON BECAUSE WE HAVE
NOT BEEN ABLE TO BEGIN ACTUAL
PLANNING WITHOUT IMPORTANT
DETAILS REGARDING BOTH
COMMITMENT OF FUNDING AND
DETAILS OF THE CLIENT
POPULATION. THE FOR EXAMPLE WE
HAVE ONLY IN THE LAST SEVERAL
WEEKS AGREED WITH AT UP WITH DTS
AND KAISER UPON A PARTICULAR
METHODOLOGY TO PROVIDE AN
ESTIMATE OF THE NUMBER OF
CLIENTS. THAT WE BELIEVE WOULD
BE. IMPACTED BY THE TRANSFER AND
THAT NUMBER IS FORTY EIGHT
HUNDRED THIRTY SIX INDIVIDUALS
IN SACRAMENTO IN TWO THOUSAND
NINETY ONE AND SOLANO. AND SO
WE'RE TALKING ABOUT OF THE
TRANSFER OF CARE POTENTIALLY
SEVEN THOUSAND CLIENTS. AND FOR
ON. BASED UPON THIS PARTICULAR
AT THE MET THIS WOULD REQUIRE
FOR SACRAMENTO AN ADDITIONAL
THIRTY SIX MILLION DOLLARS FOR
SERVICES AND FOR SOLANO COUNTY
AN ADDITIONAL. SEVENTEEN MILLION
DOLLARS FOR SERVICES. ONLY AFTER
COMMITTING OF FUNDING COULD BE
BEGIN PLANNING- AT THE
DEVELOPMENT OF EXTENDED NETWORK
AND THAT IN CAN IN A IN A COUNTY
WOULD TAKE. I ROUGHLY TWENTY
FOUR TO THIRTY SIX MONTHS THE
TIME IS REALLY IMPORTANT. THIS
IS TREMENDOUS SYSTEM BUILD OUT
AND IN SOLANO COUNTY FOR EXAMPLE
IF THE ESTIMATES PROVE ACCURATE
HI THERE IS A VERY LARGE MEDICAL
FOOTPRINT AND THIS WOULD BE A
40% INCREASE IN THE ANNUAL
NUMBER OF PEOPLE SERVED BY.
COUNTY MENTAL HEALTH- AND FOR
BOTH COUNTY IS THE SPRING CARE
TO INCLUDE **** UP YOUR A
PROCUREMENT PROCESS ARE PEAS
CONTRACTING DEVELOPING SITES
HIRING ON ALL OF THOSE THINGS WE
NEED TO OCCUR TO CREATE AN
ACCEPTABLE NOT WORK BEFORE WE
COULD BEGIN TRANSFER OF ANY
CLIENTS- I'M AND ONE SHOULD ALSO
NOTE THAT HIRING A BEHAVIORAL
HEALTH PROFESSIONALS IS VERY
DIFFICULT RIGHT NOW. AND SOLANO
COUNTY HAS HAD THE EXPERIENCE
OF- POSTING OUR OF PEAS AND
HAVING NO INTERESTED BIDDERS SO
THERE ARE A LOT OF PIECES THAT
NEED TO FOLLOW TO PLACE AN ORDER
FOR IT THIS. TRANSCRIPT HERE TO
BE SUCCESSFUL. ADDITIONALLY AND
THE PLANNING REQUIRES IMPORTANT
INFORMATION THAT WE HAVE NOT YET
BEEN ABLE TO RECEIVE REGARDING
THE KAISER CLIENTS SUCH AS-
INFORMATION REGARDING THE AGES
OF THE CLIENTS THEIR DIAGNOSES
AND EVEN THE CITIES WHERE THEY
LIVE SO THAT WE KNOW WHERE AND
FOR WHOM SERVICES. NEED TO BE
DEVELOPED AND EXPANDED. SO ONLY
APPLY AND ONLY ONCE ALL THAT
HAPPENS COULD BE BEGIN
TRANSFERRING CLIENTS. ON AND AT
THAT POINT WE ALSO WOULD
RECOMMEND I'M- HAVING A MONTHLY
CAP- NO MORE THAN 10% OF THE
ANNUAL PLAN TRANSFERRING IN ANY
GIVEN MONTH- THE- MS COOPER
MENTIONED EARLIER THAT- THAT
THERE ARE FUNDS- THAT ARE
INCLUDED IN THE CAPITATED RATE
THAT'S BEEN PAID TO KAISER. AND
IN SERVING THIS POPULATION AND
SO WE DO BELIEVE IT'S REASONABLE
IF THE STATE WOULD TRANSFERRED
THESE SERVICES AND IN
TRANSFERRING THOSE SERVICES
WOULD TRANSFER THE FUNDS. I TO
THE TO THE RECEIVING HEALTH PLAN
WHICH IS THE WHICH ARE THE TWO
COUNTIES- WE DO NOT LEAVE ANY
MEDIC CAL PLAN BUT AGREED TO
CARE FOR THOUSANDS MORE
BENEFICIARIES WITHOUT ADEQUATE
FUNDING AND- TIME TO TRANSITION
. I'M WE SHOULD NOTE THAT- ONE
OF THE OP ONE OF THE OPTIONS
THAT WAS PROPOSED BY THE STATE
WAS TO TRY TO GET A
RECALCULATION OF REALIGNMENT
DOLLARS WHICH WOULD NEGATIVELY
IMPACT ALL COUNTIES AND THAT IS
NOT SOMETHING THAT WE WANT TO DO
WE DON'T THINK OTHER COUNTIES-
THAT ARE ALREADY STRETCHED IN
THE REALIGNMENT DOLLARS SHOULD
BE NEGATIVELY IMPACTED BY THE
NEEDS OF OUR TWO COUNTIES. WHEN
YOU KNOW THAT THE LAST BUDGET
CYCLE INCLUDED- SOME GROWTH FOR
OUR BEHAVIOR HEALTH AND
REALIGNMENT. BUT ALSO NOTE THAT
AT THE SAME TIME- THAT THIS
OCCURRED THE STATE IS PROPOSING
SEPARATE RECRUITMENT- WHICH IS
EQUIPPED WHICH ARE EQUIVALENT TO
THREE TIMES. ANY POTENTIAL
GROWTH THAT WE WILL SEE.
CONDITIONALLY BECAUSE THIS
IMPLEMENTATION IS MULTI
FACTORED- WE SUGGEST- IN A
REPORTING TO THE SENATE AND
ASSEMBLY HEALTH COMMITTEES AND
BUDGET COMMITTEES FROM BOTH DH
CS IN THE COUNTIES ON THE STATUS
OF THE TRANSITION AND
ACHIEVEMENT OF KEY MILESTONES
FOR IT TO BE SUCCESSFUL. IN
CLOSING AND SACRAMENTO COUNTY IN
SOLANO COUNTY BOTH SEEK
INTENTIONAL TIME AND
SPECIFICALLY GUARANTEED FUNDING.
INCLUDING ONGOING AT INCREASES
FOR INFLATION AND OTHER MARKET
FACTORS. IN ORDER TO. ACT
ADEQUATELY PLAN FOR AN DEVELOPER
SYSTEMS AND HUMANELY TRANSFER ON
THIS LARGE POPULATION OF
INDIVIDUALS. ABSENT ANY ABSENT
ACTION TO ENSURE A SAFE
TRANSITION. BOTH THE KAISER
MEMBERS AND THOSE CURRENTLY
SERVED BY OUR COUNTY BEHAVIORAL
HEALTH PLAS WILL BE NEGATIVELY
IMPACTED AND THAT'S SOMETHING
THAT WE ALL WANT TO AVOID. THANK
YOU VERY MUCH. THANK YOU IS
THAT'S THE CONCLUSION OF
PANELISTS ALL NOW BRING IT UP TO
THE DÍAS FOR ANY QUESTIONS. I
WILL BEGIN I'M GONNA START WITH-
YOU MISS COOPER I HAVE A NUMBER
OF QUESTIONS I- EAGERLY READ THE
FIRST CALLING REPORT THAT CAME
OUT IN OCTOBER OF TWENTY
NINETEEN OF FOLLOWED EVERY
ITERATION. THUS FAR THAT IS
WE'RE GETTING CLOSER TO
IMPLEMENTATION I WANT TO MAKE
SURE TO ASK SOME OF THESE
QUESTIONS AND HOPEFULLY GET SOME
RESPONSES- I WILL BEGIN WITH
QUESTIONS ON THE ENHANCED CARE
MANAGEMENT- IN OUR DISCUSSION IT
IT SAID THAT IT WAS INVOLVING
THE CHILD WELFARE SYSTEM BUT IT
DIDN'T X. PLEASANTLY SAY THAT.
IT WAS GOING TO BE AVAILABLE FOR
ALL KIDS WHO ARE WITH IN FOSTER
CARE- I WANT TO MAKE SURE TO ASK
YOU THAT AS WELL AS TO
UNDERSTAND IF IT WILL ALSO BE
INCLUSIVE OF- THOSE WHO ARE IN
THE HIT IN FOSTER CARE SYSTEM AS
WELL. THANK YOU FOR THAT
QUESTION SO BORING HERE TO
SECURE MANAGEMENT- WE ARE
CURRENTLY SCHEDULING HAVING BE
ON CHILDREN AND YOUTH ECM BUCKET
WHICH WOULD INCLUDE. CHILDREN
AND YOUTH IN THE FOSTER CARE OUR
CHILD WELFARE SYSTEM WOULD GO
LIVE JULY ONE OF TWENTY TWENTY
THREE AND THAT WAS REALLY BASED
OFF OF A LOT OF STAKEHOLDER
FEEDBACK THAT WE JUST NEED MORE
TIME. TO UNPACK ON THAT
PARTICULAR ELIGIBILITY CRITERIA
WHO WOULD BE IN AND OUT WHAT
DOES IT MEAN ESPECIALLY GIVEN
ALL OF THE DIFFERENT SYSTEMS
THAT CAN IMPACT SOME OF OUR MOST
VULNERABLE. INDIVIDUALS THAT
WOULD NEED ENHANCE CARE
MANAGEMENT SO THAT'S ONE PIECE
OF ADVICE SO WE ACTUALLY HAVE A
FULL STAKEHOLDER ADVISORY GROUP
RIGHT NOW THAT WE ARE WORKING ON
TO BUILD. THAT CHILDREN AND
YOUTH ENHANCE YOUR MANAGEMENT
THAT WOULD GO LIVE NEXT YEAR.
HOWEVER I WOULD JUST SAY ENHANCE
YOUR MANAGEMENT IS NOT FOR
EVERYONE RIGHT I THINK IT IS
MEANT TO TOUCH THE HIGHEST MOST
COMPLEX INDIVIDUALS OFTEN WHICH
IS WHY YOU'RE PROBABLY ASKING
QUESTIONS AROUND CHILDREN AND
YOUTH IN THE CHILD WELFARE.
BECAUSE OFTENTIMES THEY ARE SOME
OF OUR MOST COMPLEX. INDIVIDUALS
AND SO WE DO ANTICIPATE A LARGE
NUMBER OF THE OF THOSE CHILDREN
WOULD NEED SOME LEVEL OF
ENHANCED YOUR MANAGEMENT
SUPPORT- BUT WE WOULD BE MORE
THAN HAPPY TO REPORT THAT ONCE
WE KNOW MORE. IN REGARDS TO THE
ADVISORY COMMITTEE THAT WE ARE
CONSULTING. WITH REGARDS ABOUT
THAT LOOKS LIKE IN THE FUTURE.
I'M GONNA DIG INTO LITTLE BIT SO
THE PAGED. OF THE- THERE TALK OF
THE IN. COORDINATION OF CARE.
THE FOURTH BULLET DOWN TALKS
ABOUT ENSURING CONTINUOUS AND
INTEGRATED CARE. HOW ARE THE
PLANS ACTUALLY PLANNING TO
OPERATIONALIZE THAT WHAT DOES
THAT LOOK LIKE I'M- ALWAYS
WORRIED ABOUT. THE INTEGRATION
IT'S EASY TO SAY BUT IT'S HARD
TO OPERATIONALIZE WOULD LOVE
MORE DETAILS. I AGREE WITHYOU
1100% ON THAT COMMENT IS WHAT
I'D SAY BUT- SO ONE OF THE
THINGS THAT'S VERY DIFFERENT
WITH ENHANCE CARE MANAGEMENT-
THEN WHAT YOU'RE GOING TO SEE
ANYTHING ELSE THE OTHER KIND OF
CASE MANAGEMENT THAT WE PROVIDE
OUR COMPLEX CASE MANAGEMENT-
WHEN SOMEONE SIGNS ON AS A
PROVIDER TO BE AN ENHANCED YOUR
MANAGEMENT PROVIDER. WE HAVE A
STANDARD CONTRACT FOR ALL ECM
PROVIDERS STATEWIDE REGARDLESS
OF MANAGED CARE PLAN THAT LET
OUTLINED THE KIND OF VERY
DETAILED EXPECTATIONS SOMEBODY
IS OUR NEED TO MEET IF THEY
BECOME AN ECM PROVIDER IN ONE OF
THOSE IS BEING WILLING TO BE DE
CORPS. A CASE MANAGER CARE
MANAGER OF FOR THAT PATIENT
REGARDLESS OF DELIVERY SYSTEM I
THOUGHT OFTENTIMES PEOPLE WHO
COULD BE ELIGIBLE FOR ECM I
THINK CAN HAPPEN YOU KNOW
ANYWHERE FROM THREE FOUR FIVE
YOU SEEN MATCH ON WITH SOME OF
OUR EXAMPLES. OF TO YOU KNOW
TWELVE PLUS CASE MANAGERS ACROSS
VARIOUS SYSTEMS ARE BECAUSE OF
THE COMPLEXITY OF THAT
PARTICULAR INDIVIDUAL BECOMING
AN ECM. PROVIDER MEANS THAT YOU
ARE WILLING TO BE THE MAIN POINT
OF CONTACT FOR THAT PERSON
FAMILY- TO BE ABLE TO WORKING
ACROSS THOSE VERY SYSTEMS ARE TO
ENSURE THAT WE ARE BUILDING A
CARE PLAN TO IMPROVE THE HEALTH
OUTCOMES OF THAT INDIVIDUAL I'M
IN SO IT IS UNIQUE IN THAT
REGARD. VERSUS THE OTHER TYPES
OF CASE MANAGEMENT WE HAVE
HISTORICALLY FUNDED WHERE YOU
CAN HAVE MULTIPLE PEOPLE
PROVIDING CASE MANAGEMENT
SERVICES NOW THIS DOESN'T MEAN
AN ENHANCED YOUR MANAGEMENT
PROVIDER MAYBE WORKING WITH A
NUMBER OF OTHER CASE MANAGERS OR
SYSTEM. BUT THAT'S KIND OF THE
OBLIGATION THAT THEY ARE TAKING
ARE WHEN THEY ARE WORKING ACROSS
THE SYSTEMS AS AN ENHANCED YOUR
MANAGEMENT PROVIDER IT'S ALSO
WHY THE POPULATIONS THE FOCUS
THAT WE HAVE ZEROED IN ON ARE
REALLY THOSE POPULATIONS THAT
ARE YOU MOST VULNERABLE IN
COMPLEX. OFTEN TOUCHING MULTIPLE
SYSTEMS ACROSS OUR MEDIC COW-
SYSTEM AND THAT'S WHY IT WAS
REALLY IMPORTANT FOR US TO HAVE
THAT STANDARD CONTRACT LANGUAGE
AND EXPECTATIONS THAT WE CAN
HAVE. A SIMILAR OUTCOME ACROSS
THE STATE OF HOW. THE HERE'S THE
MINIMUM OF WHAT YOU MUST YOU TO
BE THE TYPE OF. AND THEN THERE
BE OTHER THINGS ADDED AND THAT
IS WHY OF THE WAYS WERE HOPE
FOR. AMERICANS OUTCOME AND WE'RE
TRYING TO PUSH THE INTEGRATION
ACROSS OUR SYSTEMS BUT IT WILL
BE. A CHANGE THIS WILL BE
DIFFERENT THIS IS HARD TO DEAL
ON IT SO WE WILL CONTINUE TO
PROVIDE TECHNICAL ASSISTANCE FOR
MANAGED CARE PLAN. IN ENHANCE
CARE MANAGEMENT PROVIDERS AS
THEY WORK THROUGH THAT
TRANSITION. I'M ON PAGE THIRTEEN
OF THE AGENDA WE TALK ABOUT
COMPREHENSIVE TRANSITIONAL CARE.
ENDED DESCRIBES IT AS THE NEED
TO FACILITATE TRANSITIONS FROM.
AND AMONG TREATMENT FACILITIES-
I I'D LIKE TO. UNDER'S WHETHER
THAT IS GOING TO WORK WITH THE
ENHANCED COORDINATION OF CARE
THAT WE JUST MENTIONED ARE WE-
PLANNING TO ENSURE AS WE'RE
TRANSITIONING FROM- ONE SITE TO
ANOTHER THAT WERE COORDINATING
I. LIKE TO SPECIFICALLY ASK DOES
THIS INCLUDE OUR CRISIS
STABILIZATION UNITS- AS WE HAVE
HERE IN. SACRAMENTO ARE WE ABLE
TO ENSURE THEY'RE CONNECTED TO
THE CONTINUUM OF CARE. YEAH
THANKS FOR THE QUESTION A FEW
PIECES HERE AND I'LL TOUCH ON
ENHANCE YOUR MANAGEMENT PER
SECOND A LITTLE TOUCH ON SOME OF
OUR AND FORTHCOMING CHANGES IN
POPULATION HEALTH MANAGEMENT I
THINK TOUCH ON BOTH OF THE ITEMS
THAT YOU'RE RAISING HERE. SO YES
IT ENHANCE CARE MANAGEMENT
PROVIDER I WOULD BE RESPONSIBLE
FOR A TRANSITION YOU ACROSS THE
DELIVERY SYSTEM- AS WELL AS FOR
EXAMPLE IF YOU HAVE SOMEONE WHO
IS IN A UP IN INPATIENT STAY
RECENTLY DISHED CHARGE ENSURING
THAT ON THEIR SUCCESSFULLY
WORKING WITH THAT BENEFICIARY.
TO WHETHER IT'S MAKE SURE MEN
RECONCILIATION HAPPENS UPON I'M
HOME MAKING SURE THAT THEY HAVE
ALL OF THE SUPPORT THEY NEED
WHEN THEY TRANSITION HOME OR TO
IS IN ASSISTED LIVING
ENVIRONMENTS. WHATEVER THE
ENVIRONMENT MAY BE ON TO BE
SUCCESSFUL IN THAT TRANSITION
AND SO THAT WOULD BE A ROLE THAT
ENHANCE YOUR MANAGEMENT A
PROVIDER WOULD PLAY ON BEFORE
THESE INDIVIDUALS WHETHER THAT'S
YOU KNOW. ALSO TO YOUR EXAMPLE A
CRISIS UNIT SO SOMEONE WHO MAYBE
IS ELIGIBLE FOR THE- B. AS YOUR
YOU KNOW INDIVIDUALS WITH
SERIOUS MENTAL ILLNESS OR A
COMPLEX A SUBSTANCE USE
DISORDER. ISSUES THAT THEY HAD A
RECENT STATE OF CRISIS UNIT OF
MAKING SURE THAT THEY ARE
HELPING APPROPRIATELY FOLLOW UP
AND MAKE SURE INDIVIDUALS ARE
GETTING INTO THE CARE THAT THEY
NEED. AND MAKING SURE THAT
THERE'S ACTUALLY DATA FEED BACK
AND FORTH BETWEEN THESE ENTITIES
TO BE AWARE OF WHEN THOSE
INSTANCES HAPPEN- I THINK YOU
KNOW ONE OF THE BIGGEST PIECES
THAT WE KNOW. WE NEED TO IMPROVE
IS ALL OF THE VARIOUS DATA
TRACKING POINTS AND HOW DO WE
HAVE MORE REAL TIME ACCESS TO
THOSE ON YOUR SHARING OF HEALTH
INFORMATION SO THE- CASE
MANAGERS CARE MANAGERS AND
OTHERS WHO ARE ASSISTING
INDIVIDUALS WITH THESE CRITICAL
TRANSITIONS. ARE AWARE OF WINDY
SERVICES TAKE PLACE SO THAT THEY
CAN DO APPROPRIATE FOLLOW UP ON
AND THERE'S A NUMBER OF
INVESTMENTS THAT WE ARE FUNDING
WITH HALF OF FUNDING TO BE ABLE
TO HELP PROVIDERS AND OTHERS
IMPLEMENT THOSE KIND OF KEY DATA
SHARING POINTS. WITHIN TELLING-
AND WE ARE HOPING TO WATCH THOSE
THAT. LATER THIS YEAR THAT
PROVIDE CAN. BE ABLE TO ARE. THE
SYSTEM TO BE ABLE DO THAT. YOUR
OTHER POINT I WOULD ADD IS WE
OUR- HELP MANAGEMENT. STRUCTURE
THAT WILL BE ROLLING OUT IN
TWENTY TWENTY THREE ONE OF THE
KEY ON PLACES AS AROUND A
STANDARDIZATION AND HIGH
EXPECTATIONS AROUND TRANSITIONS
OF CARE. OF WHETHER THAT IS
INPATIENT EMERGENCY ROOMS
SKILLED NURSING FACILITY. OR THE
VARIOUS BEHAVIORAL HEALTH
TRANSITIONS YOU ARE MENTIONING
OF MAKING SURE THAT THERE ARE
KEY. REQUIREMENTS FOR MANAGED
CARE PLANS IN HALF YOUR
MANAGEMENT OR THE FACILITIES TO
MEET TO MAKE SURE THAT WE ARE
HAVING A- SMOOTHER AND HIGHER
QUALITY TRANSITIONS. ARE BECAUSE
THEY ARE OFTEN THE TIMES WHERE
OUR MOST VULNERABLE CAN FALL
THROUGH THE CRACKS IN WE DO KNOW
THAT IT IS A KEY IMPORTANT PART
OF THE PROVING HEALTH OUT COMES
IN MAKING SURE THAT WE ARE
TRANSITIONING SOMEONE
SUCCESSFULLY. DO THAT NEXT. YOU
KNOW CONTINUE ONE. OF SERVICE. I
LOOK FORWARD TO THAT DAY I WILL
MENTION WHEN WE TOWARD A CS YOU
HERE I DID NOT SEE THAT LEVEL OF
COORDINATION AND- REALLY WOULD
HOPE AS WERE ADVANCING AND
INNOVATING MEDIC CAL THAT WE CAN
GET THERE. WERE WERE ABLE TO
MAKE SURE WHAT YOU HAVE THE
RIGHT TO TREATMENT AT THE RIGHT
TIME AND- OFTENTIMES YOU DON'T
GET TO CHOOSE WHICH STORE.
PEOPLE COME INTO AND- THEN WE
JUST HAVE TO MAKE SURE WE'RE
COORDINATING WELL AND SO THAT'S
WHY I. AM ASKING SO MANY
QUESTIONS ABOUT THIS NEW
BENEFIT- I WOULD I WOULD LIKE TO
KNOW TRANSITION TO COMMUNITY
SUPPORTS IF I CAN- I WILL JUST
FOR TRACKING PURPOSES MENTIONED
THIS. HAS BEEN CALLED IN LIEU OF
SERVICES BEFORE HAND- WILL SAY I
PREFERRED THE NEW TERM I. THINK
IT IS MORE FITTING. BUT I WOULD
LIKE TO ASK WHY THIS IS OPTIONAL
WHY WE HAVE CREATED SO MUCH
FLEXIBILITY- IS. IS IT. SO THAT
WE CAN BE ADDITIVE. TO THE
COMMUNITY SUPPORTS. HOW WILL WE
AND- THAT IT WILL BE ROBUST
ENOUGH. YOU'RE ON MUTE MISS
COOPER. THANK YOU. CAN YOU HEAR
ME. WHEN IT. YES WE CAN. I THANK
YOU FOR A SECOND AFTER YOU SAID
IN LIEU OF SERVICES AND I
GREATLY APOLOGIZE TO ASK YOU TO
CAN YOU RESTATE YOUR QUESTION
WHY ARE THE COMMUNITY SUPPORTS
OPTIONAL WHY HAVE WE CREATED SO
MUCH FLEXIBILITY. IS IT SO THAT
WE CAN BE ADDITIVE TO THE-COMMUNITY SUPPORTS HOW WILL YOU
HOW WILL WE MAKE SURE THAT. THE
SUPPORTS THAT ARE ROBUST ENOUGH
. THANK YOU I'M SO YEAH I THINK
YOU KNOW ONE OF THE THINGS THAT
WHEN WE ARE TRYING TO FIGURE OUT
HOW DO WE KIND OF MOVE THE
NEEDLE ON SOCIAL DRIVERS OF
HEALTH- AND REALLY GETTING MORE
PREVENTIVE IN UPSTREAM IN A
COMPREHENSIVE WAY ACROSS THE
STATE- WITHIN FEDERAL GOT. THIS
OPPORTUNITY IN WHAT WE CALL AND
BELOVED- AND IT ALLOWED US
PRETTY BROAD FLEXIBILITY TO BE
ABLE TO IMPLEMENT SOMETHING IN
MEDICAID- AND REALLY SEE HOW
WOULD YOU GROW THAT ACROSS THE
STATE OF CALIFORNIA. I WE KNEW
IF WE CAME IN WITH A
COMPREHENSIVE LIST OF FOURTEEN
COMMUNITY SUPPORTS ALL GOING
LIVE. ON AT ONE TIME- THAT WOULD
BE VERY CHALLENGING WE ALSO KNOW
THAT MANAGED CARE PLANS
CURRENTLY DON'T ALWAYS HAVE.
THESE CURRENT RELATIONSHIPS ARE
CONTRACTS AND CHANGE NEEDS TO
HAPPEN OVER TIME- THERE IS A
CLEAR ENOUGH GUARD RAILS AND I
STRUCTURE WITHIN THE FEDERAL
GUIDANCE. THAT WE DID THINK
THOUGH IT IS A REALLY GOOD
AVENUE FOR US TO BE ABLE TO
REALLY ADDRESS SOCIAL DRIVERS
AND HELP. INTO INVEST IN THESE
ACROSS THE STATE OF CALIFORNIA
IT REALLY ALLOWS US TO BUILD
NETWORKS OVER TIME WHICH IS WHY
WE HAVE THE INCENTIVE PROGRAM TO
NOT JUST IMPLEMENTED. THE REALLY
INCENTIVIZE THE UTILIZATION THE
PARTNERSHIPS THE RELATIONSHIPS
AS WELL AS THE- REALLY MASSIVE
INFRASTRUCTURE IN CHANGE
MANAGEMENT NEEDS TO HAPPEN AT
THE LOCAL LEVEL TO BE SUCCESSFUL
WITH THIS TYPE OF LARGE SCALE
CHANGE. ON THAT SO THAT'S WHY WE
WERE COMFORTABLE WITH SOME OF
THE FLEXIBILITY OF THE IN LIEU
OF SERVICES. WE DO KNOW THAT
OVER TIME WE WILL BE CONSTANTLY
EVALUATING IF AND WHEN WE NEED
TO SWITCH FROM WHAT IS A IN LIEU
OF SERVICE WHERE IT'S MORE
FLEXIBLE. TO A POTENTIAL FULL
TIME BENEFIT RIGHT AWAY THERE
ARE DIFFERENT OF GUARD RAILS IN
FEDERAL FLEXIBILITY- BUT FROM A-
FEDERAL PERSPECTIVE THEY ALSO
CONSIDER THIS A CAR A PART OF
WHAT THEY CALL CORD MEDICAID- SO
IT HAS A NUMBER OF PROTECTIONS
IN GUARD RAILS WITH IT- AND SO.
I THINK THAT IS WHY WE REALLY
THOUGHT THAT IT WOULD STILL NEED
THE NEEDS OF ON ADDRESSING
SOCIAL DRIVERS OF HEALTH
ALLOWING FOR THAT. PHASE THEN
BUILD ACROSS THE STATE OF
CALIFORNIA. AND ALLOWS US TO
KIND OF BUILD THE INFRASTRUCTURE. NECESSARY FOR THE LONG RUN.
YOUR TO MENTION CORE MEDICAID
AND THAT MADE THE- FOR THE NEXT
FEW QUESTIONS I HAVE. BUT WHAT
HAPPENS IF THE PLANS DON'T OFFER
THESE SPECIFIC COMMUNITY-
SUPPORTS THAT WE'RE ALKING
ABOUT OR THEY CHANGE THEM AFTER
SIX MONTHS AS IS- ALLOWABLE. IN
THE AGENDA. HOW WILL WE TRACK
THOSE RESULTS AND HOW DO WE HAVE
ACCOUNTABILITY WITH DOLLARS TO
MAKE SURE THEY RESULT IN GOOD
OUTCOMES. SURE YOU PIECES HERE
SO WE ARE THE GOOD THING IS AS
YOU HEARD IN OUR OPENING
COMMENTS A VERY BROAD TAKE UP OF
COMMUNITY SUPPORT ACROSS ALL
MANAGED CARE PLANS IN ALL
COUNTIES- ACROSS THE STATE OF
CALIFORNIA. WE WERE EXTREMELY
HAPPY WITH THE MANAGED CARE
PLANS PICKING UP THE VARIOUS
PIECES OF COMMUNITY SUPPORT OVER
THE FIRST TWO YEARS AS WHAT WE
CURRENTLY HAVE ON OUR OUR
WEBSITE. AND SO I WE WILL
CONTINUE TO WATCH THAT WE WILL
CONTINUE TO ALLOW FOR MANAGED
CARE PLANS TO. ADD NEW COMMUNITY
SUPPORTS I THINK THE ONE THING I
WOULD ADD AS MANY OF THESE
CONVERSATIONS WERE IN
PARTNERSHIP WITH HER. LANCE WHO
SAID THAT THESE ARE CRITICAL
SERVICES THEY NEED TO MEET THE
NEEDS OF THEIR BENEFICIARIES.
I'M ESPECIALLY WHEN IT COMES TO
THE INTERSECTION WITH SOME OF
THE HOME AND COMMUNITY BASED AND
LONG TERM SERVICES AND SUPPORTS.
A THAT WERE ADDED INTO THE
COMMUNITY SUPPORTS LIST OF
SERVICES- IT'S A WE WILL MONITOR
THAT VERY CLOSELY IF FOR SOME
REASON BC MANAGED CARE PLANS
ELECTING TO. END A COMMUNITY
SUPPORT IN WHICH THEY HAVE
OFFERED A WE WILL TRACK THAT
BERRY CLOSELY. IN FOR THOSE WHO
HAVE ELECTED TO PICK THEM UP WE
ARE HAVING VERY ROBUST REPORTING
REQUIREMENTS BY MANAGED CARE
PLANS TO TRACK. A TO A TO TRACK
THE KIND OF. UPTAKE AND
UTILIZATION OF THESE SERVICES-
WE ARE ALSO WORKING WITH THEM
CLOSELY IN REGARDS TO YOU
ENSURING THAT THEY HAVE. ON THE
OUTCOMES THAT ARE INTENDED FOR
THEM NOT JUST IMPROVING OUTCOMES
FOR INDIVIDUALS IN REGARDS TO
REDUCTION OF YOUR INFORMATION OR
SKILLED NURSING FACILITY BUT
ALSO THE IMPROVED HEALTH
OUTCOMES. ON THE QUALITY
MEASURES THAT WE HAVE SEEN- SO
SUCCESSFULLY WITHIN THE WHOLE
PERSON CARE PILOTS. WE DIDN'T DO
THIS IN A BOX WE REALLY TOOK A
LOT OF THE LESSONS LEARNED FROM
WHOLE PERSON CARE AND HEALTH
PROBLEMS YOU MOVE THEM INTO KIND
OF STATEWIDE STRUCTURE. OF AND
SO WE ARE REALLY. HOPEFUL AND
HAVE SEEN GREAT OUR COMMITMENT
BUYER MANAGED CARE PLANS- AND
WILL CONTINUE. TO MONITOR THIS
VERY CLOSELY. I'M TO TRAIN NOW
TO THE MATH CARE INCENTIVE. ON
PAGE SEVENTEEN OF THE AGENDA AS
WELL AS- PATH HI. I'M TRYING TO
ASK HOW WE ENSURE THAT FUNDS
ARE. GOING TO BE EQUITABLY
DISTRIBUTED- WILL COUNTIES WHO
HAVE IMPLEMENTED WHOLE PERSON
CARES AND HOME HEALTH. BE FIRST
IN LINE FOR INFRASTRUCTURE
DOLLARS WILL THEY GET RESOURCES
FIRST. WILL THERE BE FUNDING FOR
LAGGING COUNTIES LATER OR WILL
IT BE THAT THE SAME COUNTIES
GETTING THE MAJORITY OF THE
FUNDING THAT ARE CURRENTLY
GETTING THE FUNDING TODAY. WE
ARE HAPPY TO ANSWER THAT SO-
INCENTIVE DOLLARS AND PASS A
DOLLARS ARE DISTRIBUTED
DIFFERENTLY I'M SO FOR THE
CALLANAN SENSITIVE PROGRAM- THAT
IS BROADLY ACROSS THE ENTIRE
STATE OF CALIFORNIA ALL COUNTIES
WILL. OF OUR PARTICIPATING ALL
PLANS ARE PARTICIPATING IN THE
US SO ANY PLAN MEETING THOSE
MEASURES WILL BE ABLE TO HAVE
THE OPPORTUNITY TO DRAW DOWN
THOSE INCENTIVE FUNDS WERE WE
ARE REALLY INCENTIVIZING THE
BUILDING OUT OF PROVIDER
NETWORKS- AND IT THAT INCLUDES
ANY COUNTIES THAT ARE NON WHOLE
PERSON CARE A COUNTIES ARE JUST
REALLY WANT TO EMPHASIZE THAT.
WHEN IT COMES TO THE PATH FUNDS
IT IS WHY WE SPECIFICALLY NEW WE
NEED TO HAVE ANOTHER PATHWAY FOR
DIRECT PROVIDER A GRANTS THAT
WOULD BE ABLE TO HELP US REALLY
ACHIEVE WHAT WE'RE HOPING TO
ACHIEVING TELLING FOR BOTH AND
HE HAS CARE MANAGEMENT. IN
COMMUNITIES. AMAZING IN IN ARE
TRANSITIONING INTO CALIFORNIA-
WELL WE KNOW SOME OF THEM MAY
NEED TO GROW THEIR CAPACITY OR
TAKE ON NEW POPULATIONS OF FOCUS
WITHIN THOSE COUNTIES YOU KNOW
THAT THERE ARE NUMBER PROVIDERS
IN COUNTIES ACROSS THE STATE OF
CALIFORNIA THAT NEEDED THAT
REALLY CRITICAL INVESTMENT
FUNDING TO GET UP AND RUNNING.
PARTNER WITH MANAGED CARE PLANS
SO WE ARE- THINKING BROADLY
AROUND HOW THIS HAPPENS GET
DISTRIBUTED WE'VE BEEN VERY
CLEAR THIS IS AROUND STATE WIDE
EXPANSION OF IN HIS CARE
MANAGEMENT AND COMMUNITY SPORTS
NOT JUST IN THE WHOLE PERSON
CARE. YES IT'S ALSO WHY WERE
ALLOWING FOR SOME PLANNING
DOLLARS TO GO OUT FOR SMALLER OR
WHAT AREAS THAT MAY NEED TAX
BRING SOMEONE IN AND HELP THEM
DEVELOP A PLAN AND THEN BE ABLE
TO FUND VARIOUS PIECES WERE
PROVIDING TECHNICAL ASSISTANCE-
COLLABORATION DOLLARS LOCALLY
BECAUSE WE REALLY WANT THIS TO
REACH ALL OF THE RIGHT PROVIDERS
TO COME TO THE TABLE AND PARTNER
WITH MANAGED CARE PLANS TO
ACHIEVE WHAT WE ARE TRYING TO
ACHIEVE. AND WE ARE MAKING SURE
THAT THERE ARE DOLLARS AVAILABLE
FOR THOSE RURAL AREAS ORANGE
COUNTY'S ARE THAT ARE NOT
CURRENTLY OPERATING WHOLE PERSON
CARE SERVICES AND SO WE WILL BE
A VERY INTENTIONAL AND MAKING
SURE THAT THESE DOLLARS GO TO.
ALL THE COUNTIES ACROSS THE
STATE OF CALIFORNIA IN REACHED
THE PROVIDERS THAT REALLY NEED
TO COME TO THE TABLE PARTNER
WITH OUR PLANS. THANK YOU FOR
THAT INTENTIONALITY- I'M GONNA
STICK WITH PATH IF I CAN- IT
STATES THAT IT THERE ARE WARM
HANDOFFS THAT WILL OCCUR FROM
OUR COUNTY JAILS TO OUR
BEHAVIORAL HEALTH SYSTEMS AS
WELL AS OUR MANAGED CARE PLAN.
AGAIN OUR WE OPERATIONALIZE IN
SOME OF THOSE WARM HAND OFFS- I
THINK IT'S INCREDIBLY IMPORTANT-
THAT BUT I JUST WANT TO. HAVE
YOU. HAD A LITTLE DETAILS YOU
CAN. SURE SO ON ONE OF THE AN
ISSUE WHICH IN CAL PULLED. AND
WE ARE STILL NEGOTIATING WITH
THE FEDERAL GOVERNMENT IS THE
JUSTICE PACKAGE THAT REALLY
FOCUSES ON- PROVIDING SERVICES
WHILE SOMEONE IS INCARCERATED IN
A- PRISON JAIL OR JUVENILE
FACILITY. FOR NINETY DAYS PRIOR
TO RELEASE AND THEN UP ON
RIPLEY'S DOING WHAT WE'RE
CALLING A ACCORD NEEDED RE ENTRY
OR DEPENDING ON THE TYPE OF
SERVICES. ARE BEHAVIORAL HEALTH
SERVICES BEING PROVIDED FOR
EXAMPLE WE'RE MANDATING WHAT'S
CALLED A WARM HANDOFF. YOU ARE
MOST LIKELY WOULD BE THE COUNTY
FOR SPECIALTY MENTAL HEALTH OR-
SUBSTANCE USE DISORDER SERVICES
BUT IN THE CASE THAT IT.
INCLUDES A MORE MILD TO
MODERATE. AD BEHAVIORAL HEALTH
SERVICE TO THE MANAGED CARE
PLAN. THIS WAS. APPROVED AND AB
ONE THIRTY THREE LAST YEAR I'M
AND WE ARE WORKING THROUGH HOW
WE DO THAT WORK NEEDED RE ENTRY
SO SOME OF THOSE TAX DOLLARS
THAT. HE FUNDED IS REALLY HELP
SUPPORT- OUR JUSTICE PARTNERS IN
OUR COUNTY PARTNERS TO BE ABLE
TO SUCCESSFULLY IMPLEMENT THOSE
WARM HAND OFF TO BE ABLE TO
IDENTIFY PEOPLE WITHIN THOSE
CORRECTIONAL SETTINGS. DID YOU-
EARLY ASSESSMENTS WHEN POSSIBLE
I'M IDENTIFIED IN START
TREATMENT WHEN POSSIBLE AND THEN
DO A HAND OFF TO THE
CORRESPONDING COUNTY BEHAVIORAL
HEALTH AND THOSE DOLLARS ARE TO
REALLY HELP FUND- THAT
IMPRESSION INFRASTRUCTURE START
UP. ON THE AND TO BE ABLE TO
SUCCESSFULLY DO THOSE WARM HAND
OFF AND SO WE LOOK FORWARD AND-
I WOULD JUST NOTE WE HAVE A VERY
ROBUST A JUSTICE ADVISORY
COMMITTEE THAT INCLUDES JUSTICE
PARTNERS COUNTY PARTNERS
PROVIDERS. A LARGE NUMBER OF AS
SUBJECT MATTER EXPERTS HELPING A
CHIC WHAT THAT LOOKS LIKE AND
HOW. TO DO IT WELL ACROSS THE
STATE OF CALIFORNIA. I WILL STAY
THEN WITH PATH FOR ONE MORE. ON
WERE FORCE- WITHIN THE ENHANCED
MANAGEMENT- BENEFIT EARLIER
WHICH DOES INVOLVE OUR JUSTICE
INVOLVED POPULATION WE'VE
IDENTIFIED IN THE NEED FOR
EMPLOYMENT ASSISTANCE I'D LIKE
TO UNDERSTAND HOW THAT- WHETHER
OR NOT THAT ASSISTANCE WILL BE
AS ROBUST AS THE PATH WORKFORCE
DEVELOPMENT PROGRAM. THAT
IDENTIFIED SPECIFICALLY WITHIN
THE PAST PROPOSAL HOW WILL THEY
BE DIFFERENT WILL ONE BE
STRONGER THAN THE OTHER HOW DO
WE MAKE SURE WE DON'T DUPLICATE.
DUPLICATE SERVICES. THANK YOU I
THINK I THINK I UNDERSTAND WHAT
YOU'RE ASKING I THINK THAT
DOMINANTLY THE YOUNG ONE OF THE
BIGGEST PIECES THAT WE KNOW THAT
WE NEED TO DO WITH IN THE PAST
FUNDING IS TO ACQUIRE MORE WORK
FORCE TO BE ABLE TO DO ENHANCE
CARE MANAGEMENT AND COMMUNITY
SUPPORT. TO HAVE THE RESOURCES
TO GET THEM TRAINED UP TO HAVE
THE RESOURCES TO BRING THEM ON
TIMELY AND INTO YOU I'M IN BED
THEN INTO THE WORKFLOW AND SO I
THINK THAT'S WHAT MANY OF THE
DOLLARS ARE MEANT TO YOU TO
FUNDS OF BOTH THE CROSSED YOU
KNOW ENHANCE YOUR MANAGEMENT OUR
COMMUNITY SUPPORTS IN THE
JUSTICE PACKAGE BROADLY YOU KNOW
THAT- THESE ARE BRINGING A NEW
RESOURCES AIR- AND SO THE
TRAINING AND THE TECHNICAL
ASSISTANCE NEEDED THAT WELL IT'S
PRETTY EXPENSIVE TO BE HONEST
WITH YOU. I'M IN SO WE ARE
TRYING TO MAKE SURE THAT WE CAN
FUND THAT BECAUSE WE KNOW IT'S
HARD FOR PROVIDERS TO TAKE ON
THAT THAT RISK- WHEN YOU ARE
MAKING THIS LEVEL OF CHANGE AND
SO WE ARE HOPING TO YOU AUGMENT
THAT WITH SOME OF THE- FUNDING.
I WILL TRY. OUT THE POPULAR
HEALTH MANAGEMENT ON PAGE
EIGHTEEN OF THE AGENDA- WE HAVE
SIGNIFICANT GOALS IN THE SPACE-
DO WE HAVE SUFFICIENT H. I. T.
WORK FORCE- FOR THE POPULATION
HEALTH MANAGEMENT EFFORTS WERE
UNDERTAKING AS A STATE.
HI WE LOST YOU AGAIN. MY
DAUGHTER BY DOCTOR IMAGES IN A
NATIONAL PEACE I'M IN A HOTEL
ROOM IT'S NOT THE IDEAL
SITUATION FOR I'M CONNECTIVITY'S
I APPRECIATE YOUR PATIENCE WITH
ME BUT I DIDN'T LOSE YOU CAN YOU
REFRAME YOUR QUESTION YEAH I'M
JUST TRYING TO- DO WE HAVE A
SUFFICIENT H. I. T. WORK FORCE
TO IMPLEMENT THE POPULATION.
HEALTH MANAGEMENT EFFORTS WERE
TAKING AS THE STATE. GOT IT IM
NOT FOR THAT PARTICULAR ONE WE-
DONNELLY WILL BE USING OUR
POPULATION HEALTH MANAGEMENT
SERVICE WHICH WAS FUNDED IN THE
BUDGET. LAST YEAR WHERE WE WILL
BE GOING OUT FOR AN RFP TO
REALLY TAKE ALL OF THE DATA AND
INFORMATION THAT WE HAVE. YOU
KNOW TWO YEARS YES HAS ACCESS TO
SO MUCH INFORMATION AND DATA. ON
WHETHER IT'S OUR ENCOUNTER DATA
CLAIMS DATA- AND THEN OUR SISTER
DEPARTMENTS LIKE I JUST SAT OR
DEVELOPMENTAL. DISABILITY
SERVICES- IN BOULDER INTO ONE
PLATFORM. WE ARE REALLY EXCITED
TO GET THAT MOVING AND I THINK
THAT LEVEL OF INFORMATION WILL
ALLOW US DO YOU. A NUMBER OF
THINGS INCLUDING RISK
STRATIFICATION. AS WELL AS
SHARING INFORMATION WITH.
PROVIDERS IN OUR VENDORS THIS
YEAR SO WE LOOK FORWARD TO A
BUILDING THAT OUT- IN THE FUTURE
AND DO YOU FEEL THIS TIME WE
HAVE A LOT OF THAT INFORMATION.
ABOUT COURSE AS EACH I. D.
NEXANS. IN A FEW. WANT TO
LEVERAGE ALL OF THAT INFORMATION
FOR SOME OF THAT ADDITIONAL DATA
THAT CAN BE. THE. OR CALL.
MISTER PRESIDENT FOR BEING
POPULOUS IN STRONG- IT WOULD SAY
WE ARE HEADING IN A NEW TO IN US
WORK AND PATHWAY MAY NEED TO BE
TO AS WELL- HENCE WHY WE'RE
TRYING TO ASK THE QUESTION AND I
WOULD LOVE TO BE ABLE TO FOLLOW
UP- I WILL MOVE NOW TO FEE FOR
SERVICE- BENEFITS THAT ARE
CARVED OUT- EARLIER MEDIC WELL
APART CONDITION. AND HAD AN
UPDATE HOPING YOU CAN PROVIDE AN
UPDATE ON HOW THINGS ARE LOOKING
TODAY AND THE DIRECTION THAT
THEY'RE GOING. SURE- AND
APPRECIATE THE ABILITY TO GIVE
THAT UPDATE SO- OUR CALL TIMES
ARE READ THE REDUCED WE ARE ABLE
TO PICK UP VERY TIGHTLY ON ON
CALLS COMING INTO OUR CALL
CENTER WE ALSO FOR US SINCE.
EARLY FEBRUARY HAVE BEEN ABLE TO
GET OUR PRIOR AUTHORIZATION
TURNAROUND TIME- WITHIN THE
TWENTY FOUR HOUR PERIOD AND SO I
WE ARE VERY HOPEFUL HOPEFUL- IN
REGARDS TO WHERE WE ARE ON THE
TEAM IS WORKING EXTENSIVELY WITH
MAGELLAN TO FIGURE OUT OUR
FUTURE FORWARD TRANSITION PLAN-
AS YOU KNOW WE HAVE A NUMBER OF
THE INDIVIDUALS WHO ARE UNDER. A
GRANDFATHERING OF COLOR SEE- FOR
THE FIRST SIX MONTHS UNTIL WE
ARE DEVELOPING WHAT THAT FUTURE
RIVER TRANSITION A LOOKS LIKE IN
REGARDS TO YOU SLOWLY MOVING
INTO YOU ARE WHERE PRIOR
AUTHORIZATION WILL TAKE PLACE IN
THE FUTURE- FORTHCOMING GUIDANCE
THE DEPARTMENT WILL COME OUT
ONCE WE HAVE A FULL. A PLAN AND
HOW WE ARE GOING TO APPROACH
THAT- BUT AT THIS POINT WE ARE-
YOU'RE FULLY ENGAGED WITH
PROVIDERS WE ARE WORKING WITH A
NUMBER OF INDIVIDUALS FOR
FEEDBACK LOOPS I TO IMPROVE OUR
OUR PROGRAMS AND POLICIES. THAT
ARE IN A LOT OF PLACES LAST TIME
WE DID YOU AND EIGHT. THE
MEDIGAP TAX- DO ONE OF THE
ADMIN. TO LISTENING TO MANY OF
THE CAN. THAT COMMUNITY WAS
BRINGING UP IN MAKING THE
NECESSARY CHANGES SET. I WAS
BOTH TIMELY AND IMPORTANT AND
GLAD- YOU DID- I WOULD LIKE TO
MOVE ON NOW TO LTSS INTEGRATION
AND THE LONG TERM SERVICES AND
SUPPORTS IF I CAN- WITHIN IT YOU
SAY THAT THERE IS SELECTIVE
CONTRACTING- WHO IS THIS. HAVE
WE ALREADY IDENTIFIED- OR
SELECTED AN ENTITY- IT SAYS THE
DH CS INTENDS TO USE SELECTIVE
CONTRACTING. TO MOVE TOWARDS
ALIGNED ENROLLMENT OF MEDICAL.
MANAGED CARE AND DE SNAPS
OPERATED BY ONE INTEGRATED
ORGANIZATION. CAN YOU SPEAK MORE
TO THE SELECTIVE CONTRACTING.
I'M NOT QUITE SURE- ALL THE
GIANTS FOR MY CONNECTION ISSUES
TODAY. WE WILL COME BACK TO
SELECTIVE CONTRACTING THEM-
HOPING I CAN STICK WITH THE
SNAPS- I I'M TRYING TO
UNDERSTAND WHY WE'RE MOVING TO
THE ALIGNMENT AND I'M WONDERING
WHAT EVIDENCE HELPS US TO
SUPPORT THIS TRANSITION IS THERE
ARE DATA THAT WE HAVE THAT HELPS
US TO SUPPORT IT IS THEIR- DATA
FOR THE NON ALONE ALIGNED DE
SNAPS. HOW ARE WE MAKING THE
RECOMMENDATION FOR THIS
TRANSITION IS WHAT I'M TRYING TO
UNDERSTAND. SURE I'M JUST TO
MAYBE HELP WITH MY CONNECTION
I'M GONNA TURN MY VIDEO OFFICE
THAT'S OKAY. I'LL STILL BE HERE
. SO WHEN IT COMES TO YOUR MIND
ENROLLMENT I MEAN REALLY AT THE
CORE OF WHAT WE ARE TRYING TO
ACHIEVE I'M HERE IS I'M THAT WE
ARE ABLE TO KIND OF INTEGRATE
THE MEDICARE AND MEDICAID
SERVICES TOGETHER ON IT YOU KNOW
REALLY WHAT WE'RE TALKING ABOUT
HERE IS DO INDIVIDUALS WHO. I'M
SHOULD HAVE A COORDINATED
BENEFIT ON IN THE EXCLUSIVELY
AND LYFT IN ROME IT ALSO ALLOWS
US TO DO THAT IT ALLOWS US TO
HAVE THE- BENEFICIARY STILL HAVE
THEIR CHOICE OF THE MEDICARE
ENROLLMENT INTO A LINE THAT WITH
THE MEDIC HOW- PLAN THAT ALSO
OFFERS THAT SEEM SERVICES. IT
ALLOWS ONE PLANNED TO BE
RESPONSIBLE FOR ALL OF THE
BENEFITS MEDICARE AND MEDICAID
HOW IT TO MAKE SURE THAT WE ARE
DOING THAT IN THE MOST WORK
NEEDED WAY WE REALLY HAVE SO
MANY LEARNINGS FROM CCI AND IF
ONE OF LEARNING THAT WE HAVE IS
REALLY THAT INTEGRATION OF THOSE
SERVICES TO COORDINATE ALL OF
THE SERVICES MEDICARE AND
MEDICAID TOGETHER. REALLY ALLOWS
FOR A BETTER OUTCOMES AND SO
THAT'S WHY WE REALLY FEEL LIKE
IT'S IMPORTANT FOR YOU-
BENEFICIARIES TO HAVE THAT
ALIGNED ENROLLMENT. SO THAT THEY
AREN'T MANAGING TO DIFFERENT
MANAGED CARE PLANS TO DIFFERENT-
SETS OF EXPECTATIONS BUT ONE
PLAN ONE POINT OF CONTACT WORK
NEEDING ALL OF THEIR SERVICES
AND HOW CRITICAL THAT IS UPPER
OUTCOMES. IN THESE REALLY
PARTNERED WITH CMS IN REGARDS TO
THIS AND THEY ARE REALLY.
LEVERAGING THIS UP IN REGARDS TO
YOU ON THAT ARE JUST BEING A
BEST PRACTICE AND SO WE WERE
REALLY HAPPY THAT THIS WAS
APPROVED IN EIGHTY ONE THIRTY
THREE LAST YEAR IN PARTNERSHIP
WITH THE LEGISLATURE TO MOVE
THIS FORWARD BECAUSE WE THINK
IT'S SO CRITICAL. TO MAKE SURE
THAT WE ARE DOING BETTER. FOR
DUAL BENEFICIARIES IN
CALIFORNIA. I'M I'M GONNA TO THE
BEHAVIORAL HEALTH PAYMENT THREE
FOUR- EARLIER WE HEARD. THAT IT
WAS IMPORTANT TO GET ANNUAL
UPDATES FOR THE ESTABLISHED
RATES TO ENSURE THAT.
REIMBURSEMENT REFLECTS THE COST
OF PROVIDING SERVICES. HOW CAN
WE MAKE SURE THAT THE
LEGISLATURE IS- INCLUDED IN
THOSE UPDATES. SO THAT WE CAN
TRACK THESE COST TRENDS- CAN WE-
EXPECT FROM THE ADMINISTRATION-
THIS INFORMATION SO THAT WE CAN
MAKE SURE TO BE INVOLVED IN
THOSE DISCUSSIONS. SURE SO AND
THE DEPARTMENT HAS COMMITTED IN
BEEN WORKING CLOSELY WITH
COUNTIES IN REGARDS TO YOU-
PAYMENT REFORM IN THE FEE
SCHEDULES WE KNOW WHEN WE'RE
MAKING THIS LARGE OF A
TRANSITION ACROSS THE STATE WITH
THIS MANY SERVICES YOU WILL HAVE
TO WATCH THIS CLOSELY. ON
INTENSELY MAKE ADJUSTMENTS EACH
YEAR WITHIN THOSE FIRST FEW
YEARS AND THEY'RE COMMITTED TO
THAT AND COMMITTED TO KEEPING
THE LEGISLATURE UPDATED. EACH
YEAR WITH ANY OF THOSE
RESPECTIVE TO EACH. I WAS HOPING
TO FOLLOW UP WITH- MISS SENDS I
BELIEVE FROM- SOLANO COUNTY- HE
YOUR COMMENT WAS THAT THE
INFRASTRUCTURE IS NOT BEEN BUILT
BECAUSE IT'S ONLY AFTER THE
FUNDING- CAN THE COUNTY BEGIN TO
PLAN- I DID WANT TO ASK ABOUT
PRUDENT RESERVES THAT COME FROM
THE MENTAL HEALTH SERVICES. ACT
THAT WE HAVE HEARD ARE-
RECEIVING HIGHER THAN
ANTICIPATED REVENUES THIS PAST
YEAR THEY'RE NOT FUNDS FOR US TO
BEGIN SUPPORTING SOME OF THE
EXPECTED TRANSITION WHILE THOSE
OF US HERE AND THE LEGISLATURE
AND THE ADMINISTRATION DISCUSS
HOW WE CAN- INSURE WE ARE
SUPPORTING YOU- EFFECTIVELY AS
WELL. HOPING YOU CAN COMMENT ON
THAT. I THINK I THINK THAT
SPEAKS TO THE SEVERAL THINGS ONE
IS THAT- WHAT WE'RE TALKING
ABOUT IS THE COR MEDIC CAL
BENEFIT SO- I'M- SERB CROSSING
OVERIN USING ME TO SAY TO
PROVIDE THE COURSE THE COURSE
SERVICE DELIVERY SYSTEM IS. NOT
REALLY WHAT OUR COMMUNITY
STAKEHOLDERS AND WHAT ARE AN HSA
PLANS ARE ABOUT- EVEN SLOW-
SOLANO COUNTY IN PARTICULAR IS
THE COUNTY THAT DOES NOT HAVE A
LOT OF PRUDENT RESERVE I THINK
WE HAVE WE HAVE LESS THAN THREE
MILLION DOLLARS. IN IMPORTANT
RESEARCH AND SO THAT'S NOT
SOMETHING THAT WOULD BE VIABLE
FOR US I'M SORRY I CAN'T SPEAK
FOR SACRAMENTO- THERE. NO THAT'S
VERY HELPFUL INFORMATION AND I
APPRECIATE THAT FEEDBACK THAT
ALLOWS ME THAN TO ASK MISS
COOPER HOW WE ARE- RECENTLY
EXPECTING THESE COUNTIES TO
BUILD OUT THE INFRASTRUCTURE TO
ABSORB THESE PATIENTS- WHAT
TYPES OF FUNDS ARE WE EXPECTING
THEM. TO FRONT HOW DO WE- MAKE
SURE THAT WE CAN- SUPPORT THESE
COUNTIES DURING THIS TRANSITION
- I MEAN I THINK YOU KNOW WE ARE
A DCS CONTINUE TO HAVE
CONVERSATIONS WITH BOTH-
SACRAMENTO AND IN SOLANO IN YOUR
GARCIA THIS. ON THE USE OF A
REALIGNMENT AND OPTIONS THAT WE
CAN EXPLORE IN THE FUTURE AND AS
THOSE CONVERSATIONS CONTINUE TO
BE HAPPY TO KEEP. YOU UPDATED AS
A ABOUT. WITH THAT I WOULD LIKE
TO THANK VERY MUCH PANEL ONE WE
WILL NOW MOVE ON TO PANEL TO.
WHICH IS ON THE TRAILER BILL
PROPOSAL TO EXTEND THE DURATION
OF THE SUSPENSION OF MEDIC CAL
ENROLLMENT FOR ADULT INMATES. WE
WILL HAVE ONE PRESENTER ON THIS
PANEL WHO WILL BE- RENEE MAILLOT
THE DEPUTY DIRECTOR. FOR HEALTH
CARE BENEFITS AND ELIGIBILITY
WITH DH CS. THE SMALL- CAN YOU
PLEASE BEGIN. YES THE CHAIR AND
MEMBERS SO- DH CS PROPOSES THAT
EFFECTIVE JANUARY ONE OF TWENTY
TWENTY THREE THE DURATION OF
SUSPENSION MEDIC HEALTH. FOR
DAHLE INCARCERATED INDIVIDUALS
WOULD BE EXTENDED FROM A ONE
YEAR TIME LIMIT SUSPENSION.
SUSPENSION THAT REMAINS IN
EFFECT UNTIL THE INDIVIDUAL IS
NO LONGER INCARCERATED IN A
PUBLIC INSTITUTION IF THEY ARE
OTHERWISE ELIGIBLE FOR THE
MEDICARE. UNDER CURRENT LAW THE
SUSPENSION SHELL AND- ON THE
DATE THE INDIVIDUAL IS EITHER NO
LONGER AN INMATE AT A PUBLIC
INSTITUTION. ONE YEAR FROM THE
DATE THAT THEY BECOME AN INMATE
AT THAT PUBLIC INSTITUTIONS
WHICH ARE VERY SIMILAR.
ELIMINATING THE CURRENT-
EXISTING ONE YOUR LIMIT ON
SUSPENSION OF MEDICAL BENEFITS
FOR ADULT INMATES WILL ALLOW
KERN COUNTY ELIGIBILITY WORKERS
TO SIMPLY LIFT THE SUSPENSION ON
THE INDIVIDUALS RELEASED FROM
THE CORRECTIONAL CENTER. THIS
PROPOSAL OUTLINES FEDERAL LAW IN
SUPPORT WHICH ELIMINATES TIME
LIMITED SUSPENSIONS FOR ELIGIBLE
. PRIOR TO THE PASSAGE OF THE
SUPPORT ACT FEDERAL LAW REQUIRED
ANNUAL READ DETERMINATION FOR
MOLD THE VISUALS EACH YEAR.
MORNING PARTS RAINY INDIVIDUAL
THIS WOULD HAVE NECESSITATED
ANGLE RETIREMENT THROUGHOUT THE
PERIOD OF THEIR INCARCERATION.
EMPIRE TO THE FEDERAL SUPPORT
ACTOR WITH NO PREVIOUS FEDERAL
GUIDANCE THAT OFFERS EASE THE
ABILITY TO LOOK AT THE
PROVISIONS SUSPENSION FROM MY
BENEFIT PERSPECTIVE VERSUS AN
ELIGIBILITY PERSPECTIVE. WITH
THE NEW FEDERAL GUIDANCE THAT
WAS DERIVED FROM THE SUPPORT ACT
STATES NOW HAVE AN ABILITY TO
DEVELOP A SUSPENSION PROCESS.
USING THE TWO PATHWAYS EITHER
ELIGIBILITY FOR BENEFITS
EXPANSION. WHEN WE USE THE
ELIGIBILITY PATHWAY IT DOES NOT
NECESSITATE AND OVERRULES AND AS
SUCH THE SUSPENSION POLICY WILL
BE APPLIED SIMILARLY ACROSS OUR
BENEFICIARIES WHO ARE ENFORCING
. AND THAT CONCLUDES MY REMARKS
IN TERMS OF OUR TRAILER BILL
PROPOSAL THANK YOU THANK YOU
MISS MELO BRING IT UP TO THE DIS
FOR ANY QUESTIONS I WILL SIMPLY
PROVIDE A COMMENT ON BOTH
APPRECIATIVE AND SUPPORTIVE OF
THIS PROPOSAL. ESPECIALLY IN THE
CONTEXT OF THE HEIGHTENED
ATTENTION AND FOCUS ON THE HIGH
NEED TO CRIMINAL JUSTICE
INVOLVED POPULATION I WANT TO
THANK YOU FOR BRINGING A PART. I
WOULD. THANK PANEL TO WE WILL
NOW HEAR FROM PANEL THREE ON TWO
PROPOSALS RELATED TO SHORT TERM
RESIDENTIAL THERAPEUTIC PROGRAMS
WE WILL HAVE ONE PRESENTER ON
THIS PANEL IT WILL BE DR KELLY
PFEIFER THE DEPUTY DIRECTOR FOR
BEHAVIORAL HEALTH AT THE
DEPARTMENT OF HEALTH CARE
SERVICES DR FIVE FOR WHEN YOU
ARE READY. THANK YOU SO MUCH.
IT'S REQUESTING ONE POINT THREE
MILLION ARM GOING AND THE
CONVERSION AND NINE LIMITED TERM
RESOURCES TO PERMANENT POSITIONS
ANY DOWN GOING FOR CLOSURE SO
SEATED WITH OVERSIGHT AND
MONITORING FOR THE SHORT TERM
RESIDENTIAL TREATMENT THERAPY
PROGRAMS MENTAL HEALTH PROGRAM
APPROVAL GRANDCHILDREN CRISIS
RESIDENTIAL PROGRAMS. HE'S
REQUIRED TO RESOURCES ARE
NECESSARY TO SUPPORT THE
INCREASING NUMBER OF THIS YEAR
TO DECEMBER TRANSITIONAL CARE
MANAGEMENT PROGRAMS REQUIRING A
MENTAL HEALTH PROGRAM APPROVAL
YEAH I'M GOING OVERSIGHT AND
MONITORING OF THAT SHARE TO
DESCEND POLICY DIALOGUE TO
SUCCESSFULLY IMPLEMENT CONTINUUM
OF CARE REFORM IN THE FAMILY
CHURCH PREVENTIONS EXACT
REQUIREMENTS. HE HAS DIRECT
OVERSIGHT OVER HERE TO BE THE
FORTY A. COUNTY ONLY NINE OF THE
MENTAL HEALTH PLAN TO THEIR OWN
MENTAL HEALTH PROGRAM APPROVAL
SO WE DO NEED IS RESOURCES TO
MAINTAIN AND HIGHLY ONGOING
MONITORING OVERSIGHT OF THE
REQUIRED NOW PROGRAM IS
APPROVALS FOR PROXY TWENTY
TWENTY NINE NEXT YEAR TEACHING.
AND DEVELOPING. THROUGH P. R. P.
MEDIA FOR SECOND- JUST WANT TO
KNOW WE HAVE TO BE SEEN RELATED
TO THEIR T. R. T. P. TRUNG. AND
THIS IS FOR TO KEEP THE SEVENTY
EIGHT WITH THE TECHNICAL AROUND
THE I AM ECHO TREND. THE EXTRA
CLEAR TWENTY ONE TWENTY TWO OUR
SEVEN. FOREIGN AND NEED FROM OUT
HOW PLANS ARE CONTRACT TO WORK
WITH US CHARITY AND WHEN I TRIED
THIS PLAN. WHEN FEDERAL MATCHING
BLOCK TO THE- AND- DETERMINE
THAT ABILITY AN INSULT FROM WE
ARE ALSO REQUESTING. POINT SEVEN
NAY MILLION THE SAME AMOUNT OF
COURSE ISN'T YEAR TWO TWO THREE.
FOR ANY CHEROKEE PETERS TERM THE
AND- ALLOW THE THAT JULY FIRST
TRYING TO TWO. MANY I NEEDED TO
HELP SANTA T. PAY TRACKING TO.
SHOULD COUNT BOARD FOR THAT TO
THE I NEED TERMINATE. THE
IMPLEMENTED A- PLAN TO BE COMPLY
WITH FEDERAL. AND I AM VERY.
WE'VE ALREADY DOESN'T THREE
ELEVEN SMALLER JUGGLING AND JUST
. BUT LACKS PEER NUMBER TO THE I
NEED BUT THEN THAT GROUP OF
CHARITY PEOPLE WHO IN JULY
TWENTY AND GOOD THING. DECEMBER
TWO TWENTY. BECAUSE I'M A TWENTY
BULLETIN BECAUSE ON THE REQUIRE
LONGER APPEARING TIME
INFORMATION AND WHY CHANGES AND
CAP IMPROVE. I'M RELATED TO KEEP
ABLE WHICH WAS MANAGED IN THE
AGENDA FOR THE HEARING ON THE-
AND- MADE. EVAN TWELVE IN THE
CURRENT AND MILLION. OF THE
COMPLAINING ABOUT YEAR. HAS THE
POTENTIAL CALL TO SERVE PROVIDED
IN TELL THEM. WHILE THERE WERE.
IN NEXT YEAR G. P. TO CLASS OF
AS A I AM THE SPEAKER CAL POLY
NOT ELIGIBLE FEDERAL MATCH. FOR
ANY MEDICAL SERVICES.
MODERNIZATION THERE AND THEN I.
WHICH COULDN'T MEDICAL SERVICES
DENTAL. OR ANY OTHER SERVICES
NOT COVERED BY COUNTY. AND THEN
MY PRESENTATION. THANK YOU.
THANK YOU DR FIVE FOR OPEN IT UP
TO THE DÍAS FOR ANY QUESTIONS I
WILL KEEP IT HERE AT. THE I'M
HOPE YOU CAN PROVIDE A LITTLE
MORE CONTEXT ON- AND DETAIL
ABOUT S. T. R. T. P.'S- IN
GENERAL HOW MANY. BEDS ARE THERE
FOR US AS A ST TAMMANY.
FACILITIES DO WE HAVE AN
UNDERSTANDING OF THE- NEED. OF
BEDS AT S. T. R. T. P.'S DO WE
HAVE ENOUGH- ARE THERE'D
DISPARITIES GEOGRAPHIC
ASSOCIATED WITH THE
DISTRIBUTION- HOPING YOU CAN
ALSO TALK ABOUT SOME OF THE
LICENSED AND UNLICENSED ISSUES
THAT WE HAVE- AS I'M TRYING. TO
FIGURE OUT IF WE NEED OTHER
OPTIONS AS WE FILL OUT OUR
CONTINUUM OF CARE- THAT I'D LIKE
TO UNDERSTAND THE NEEDS ANALYSIS
FROM YOUR DOCTOR FIVE FOR IF YOU
CAN. THANK YOU REALLY AN
IMPORTANT QUESTION THAT THE
SOCIAL SERVICES DEPARTMENT OR WE
ARE WORKING ON CLOSELY BECAUSE
THE ACTOR TV'S ARE DEVELOPED AS
PART OF AN EVOLUTION.
RECOGNIZING THAT THE MOST
IMPORTANT THING PER CHILD AND
PARENTING AND TO BE PART OF A
FAMILY. AND THAT'S HOW COME
THEY'RE NOT GOOD FOR CHILDREN
WHO ARE IN THESE CONGREGATE CARE
FACILITIES ARE GROUP CONTACT
JACQUI PEACEFUL REALLY DEVELOPED
TO CHANGE THE MODEL OF. FIFTEEN
OF PUTTING A BUNCH OF KIDS IN A
GROUP HOME INDEFINITELY AND NOT
WORKING TO MAKE SURE THAT
THEY'RE THERE BECAUSE THEY NEED.
SPECIALIZED SERVICES THAT WAS
REALLY A PROFESSIONALIZATION OF
THESE GROUP HOMES AND MAKE SURE
THAT THEY'RE THERE FOR SHORT
TERM OR A SHORT TERM PART OF THE
DEFINITION. AND OTHER
THERAPEUTIC WILL BE DESIGNED TO
PROVIDE ROBUST MENTAL HEALTH
SERVICES AND THAT'S WHAT WE'VE
DONE A LOT OF OVERSIGHT AND
TRAINING TO MAKE SURE THAT THE
THAT THEY GET NOW PROGRAM
APPROVAL THAT THAT WILL
PROVIDING SERVICES. ULTIMATELY
WE ARE ACTIVELY WORKING AS PART
OF THE- LARGER DISHES EITHER
YOU'RE VERY WELL AWARE OF THE
CONTINUAL CALIFON THAT'S BEEN
GOING ON FOR YEARS TO BUILD OUT.
OTHER CHOICES ABOUT WE DON'T
HAVE TO PUT PEOPLE IN THE
ECONOMY AND CARE SETTINGS OKAY
WHAT'S THE RIGHT NUMBER OF-
DANCER I THINK THAT'S A REALLY
DIFFICULT QUESTION ANSWER
BECAUSE I THINK. MANY WOULD SAY
LESS THAN WE HAVE NOW BUT IF WE
DON'T KEEP THOSE BAD ACTIVE NOW
THAN WE WILL GREATLY RESPECT
CHILDREN WILL HAVE A CRISIS OF
PLACEMENT AND CAN READ
COMMONSENSE HAVING LOTS OF
FOLLOW UP SO. OUR GOAL HAS BEEN
TO WORK HAND IN HAND WITH THE
ASSOCIATION OF COUNTIES THAT
PROVIDERS AND SOCIAL SERVICES SO
HAS IT LIVED. THAT WE MAINTAIN
THE- BETTER AVAIL HAS GO AGAIN
ALTERNATIVES AND FOR THE THAT
SITUATION YEARS NOW VERY
DIFFERENT THAN ADULTS. AND THAT
IS A WHY WE YOU TRIED. BUNGALOW
TO. OF ALL UNDER REALLY. I THAT
- IN REFERENCE. TO BE IN. FROM
AROUND THE THESE AND HIS SMALLER
. AND THEN ULTIMATELY MARK. THEY
STOPPED. SO I CAN PROVIDE YOU
AFTER FACT WITH THE- NUMBER OF
DEAD BUT HAVE TO. KEEPING IN
THAT. HOW THAT SHE- AND THE
EXACT THEM OF THE TWO. THAT WE
OF COURSE. BUT OUR GOAL COURSE
TO GET THEM COUNT. TO REYES A
FAMILY AND NOT TO BE. HUNDRED
GRANDMOTHER KNOW THAT. MANY
CHILDREN HAVE COME NEEDS THAT
THEIR NEEDS ARE MORE THAN
CAPABLE NURSING HOME THAT'S WHY
WE CREATED MODEL FATAL IDENTIFY
. IF IT DOES ALTHOUGH IT BRINGS
UP OTHER QUESTIONS AFTER IT- I
WOULD LIKE TO TRY TO UNDERSTAND
IT IT SOUNDED LIKE COUNTIES ARE
A PARTNER HERE THAT. DH CS IS-
WORKING TO GALLAGHER DELEGATE.%
SOME OF THE AT THE- ARE YOU
EIGHT THE I. M. D. I'D LIKE TO.
ON WHY AREN'T MORE COUNT HELPING
TO A VALUE TEN TO PREFER THESE
TO. SINCE IT SEEMS THAT THERE
ARE. S. T. R. T. P.'S THERE
CURRENTLY ARE NOT. LICENSED WHAT
IS THE- DIFFICULTY IN OBTAINING
A LICENSE. CURRENTLY FOR SOME OF
THESE S. T. R. T. P.'S IS IT A
STAFFING ISSUE. THAT WE HAVE A
DH CS WAS AT. COUNTIES WHO NEED
TO HELP US TO PARTICIPATE. HOW
CAN WE MAKE SURE THAT WE HAVE
THE CAPACITY- WITHIN THE SYSTEM-
IF WE'RE NOT- EVALUATING THE
FACILITIES. YEAH AND NOT TO BE
ABLE TO FIGURE OUT IF WE CAN GET
THEM LICENSED I THINK I'M TRYING
TO FIGURE OUT IF IT'S A ISSUE OF
STAFFING FROM THE DEPARTMENT OR
HOW WE CAN ASSIST YOU- TO. GET
MORE OF THESE FACILITIES
EVALUATED. THANK YOU SO MUCH AND
WE BELIEVE THAT THE PROPOSAL WE
PUT FORWARD WHERE FLEX STAFFING
THAT WE NEED TO DO THE MENTAL
HEALTH PROGRAM APPROVAL SHOULD
BE CEAR WE DON'T LICENSE
CORRECT HERE TO BE THE DHS. BUT
WE DO PROVIDE A MENTAL HEALTH
PROGRAM APPROVAL SO THAT- THE
NUANCES THAT WORK APPROVING
ABOUT HEALTH COMPONENT. NDSS IS
RESPONSIBLE FOR THE OVERSIGHT OF
THE SHOULD THE COMPLAINTS- SO WE
DO THINK THAT WITH THE RESOURCES
OF THE OF THE QUESTION WE HAVE
THE STAFFING WE NEED. THAT WE
TAKE SOME OF THE CHALLENGES FOR
THOSE FACILITIES THAT HAVE NOT
YET GOTTEN OUT PROGRAM APPROVALS
REALLY HAVE TO DO WITH. THE
CHALLENGES OF ALL BEING ON TRACK
TREATMENT MODEL WHERE IF YOU HAD
A GROUP HOME. THAT GROUPON THAT
MAY NOT HAVE SEEN IT SO BAD THAT
PROVIDER MENTAL HEALTH SERVICES
SO WHEN SHE CHANGED A GROUP HOME
INTERNET CARE DEEPLY WITH. OUR
LITTLE BUDGET QUITE HONESTLY
FAMILY NEEDED A PRETTY INTENSE
AS- LEVEL OF STAFFING TO PROVIDE
TECHNICAL ASSISTANCE AND WORK
WITH THOSE PROVIDERS IN THE
UNDERSTAND THE RULES. THEY KNOW
WHAT THEY NEED TO DO TO COMPLY
WITH THE RULES. AND THEY'RE ABLE
TO. BUILD UP THOSE SERVICES-
FINAL QUESTION I'M TRYING TO
UNDERSTAND OF SOME THE ARE-
ROWING IN THE SAME DIRECTION AS
WE ARE REGARDING C. C. R.
REFORM. ARE ARE THEY FOLLOWING
THE DIRECTION AS YOU WERE SAYING
OF ATTEMPTING TO. MOVE AWAY FROM
CONGREGATE CARE IS THAT LEADING
TOWARDS SOME OF THE LICENSING
ISSUES WERE HAVING WITH TIME DE
HOW ARE WE ABLE TO ENSURE THAT-
S. T. R. T. P.'S ARE EMPOWERED
TO DO WHAT THEY DO BEST. THANK
YOU I HAVE BEEN REALLY IMPRESSED
WITH THEIR COLLECTIVE
PARTNERSHIP WHICH IS B. THE
ALLIANCE OF THE PROVIDERS OF
PATIENTS. AND THE OR LICENSING
AND CERTIFICATION DIVISION
WORKING HAND IN HAND TO TRY AND
HELP YOU GET YOUR G. P. AND IN
HAND WITH THE COUNTY. TO SUPPORT
THEM TRANSITIONING THIS MODEL
BECAUSE WE WE'VE BEEN WORKING
WITH SOME VERY VERY LARGE
CAMPUSES THAT WERE PRETTY
DAUNTED BY THE REQUIREMENTS AND
JUST A SEPARATE THINGS OUT RIGHT
NOW I'M TALKING ABOUT THE
DETERMINATION OF WHAT MAKES. A
FACILITY ME THINK FEDERAL
REQUIREMENT TRANSPORTATION
COLLECTIVITIES AND WHAT ALLOWS
THEM TO FUNCTION WITHOUT
DESIGNED TO DETERMINATION
BECAUSE ABOUT THE I AM
DETERMINATION GOT ON FEDERAL
ACTUALLY SEEN AT GREAT
WILLINGNESS ON THE PART OF
PROVIDERS TO LOOK AT. HOW YOU
CAN TAKE A LARGER CAMPUS AND
DIVIDE THEM UP INTO MORE
SEPARATE AND INDEPENDENT
FUNCTIONAL UNITS ARE YOU
CREATING AN ENVIRONMENT. THAT
LOOKS LASSEN HAS. CANFIELD'S
LETTER EDUCATIONAL AND MORE LIKE
A SMALL FAMILY HOME AND BY.
PHYSICALLY HARD WORK BUT I FEEL
A WEDNESDAY'S GREAT. ACROSS.
NEEDS OF PATIENTS THAT OF VISION
AND- IN THE OTHER TO. AND
SERVICES. WITH THE I WILL THANK
VERY PANEL AND WE WILL NOW MOVE
TO FOR WHICH IS ON THE NURSING
FACILITY FINANCING AND QUALITY
OF CARE WE WILL HAVE FOUR
PRESENTERS ON THIS PANEL WE WILL
BEGIN WITH DEPUTY DIRECTOR LINDA
HARRINGTON WITH HEALTH CARE
FINANCING. FOR DH CS WE WILL
THEN HAVE TO FROM THE WHITEN
WITH SEIU ANTHONY CHUCKLE TELL
STAFF ATTORNEY WITH CALIFORNIA
ADVOCATES FOR NURSING HOME
REFORM AND JENNIFER SNYDER THE
LEGISLATIVE ADVOCATE FOR
CALIFORNIA ASSOCIATION OF HEALTH
FACILITIES. LET US BEGIN WITH
LINDA LINDY HARRINGTON WITH DH
CS. I'M LINDA HARRINGTON DEPUTY
DIRECTOR FOR HEALTH CARE
FINANCING I'M HERE AT THE
DEPARTMENT OF HEALTH CARE
SERVICES AND THANK YOU FOR THE
OPPORTUNITY- TO PRESENT TODAY-
DCS RECOGNIZES THE IMPORTANCE
OF- LONG TERM FINANCING
STABILITY. FOR THE HEALTH OF THE
MEDICARE PROGRAM ONE OF THE KEY
COMPONENTS OF HOW AIM IS A FOCUS
ON TRANSFORMING THE DELIVERY
SYSTEM THROUGH BACK VALUE BASED
INITIATIVES MODERNIZATION AND
PAYMENT REFORM TO FURTHER THIS
FOCUS DH CS IS FINALIZING A
PROPOSAL THAT RECOGNIZES BOTH
COST. AND INCENTIVIZES QUALITY
WHICH WE ANTICIPATE RELEASING IN
THE NEAR FUTURE I WOULD TEACH
YES HELD A BROAD STAKEHOLDER
MEETING IN NOVEMBER OF TWENTY
TWENTY ONE I'VE ENGAGE WITH A
CALIFORNIA ADVOCATES FOR NURSING
HOME REFORM AND CONTINUES TO
ENGAGE WITH STAKEHOLDERS
INCLUDING SEIU. AND THE
CALIFORNIA ASSOCIATION OF HEALTH
FACILITIES AS. WE FINALIZE THIS
PROPOSAL. RELATIVES YOU CAN OF
BAKER REMEMBER METHODOLOGY
APPROPRIATELY ACCOUNT FOR
INCENTIVIZE INVESTMENT IN LABOR
THE DEPARTMENT HAS SHARED WITH
STAKEHOLDERS THAT WE WOULD
RESPOND TO THIS CONCERN BY
SEPARATELY ESTABLISHING THE
ANNUAL RATE INCREASE PERCENTAGE.
FOR THE LABOR COST CATEGORIES
AND NON LABOR COST CATEGORIES
WITH A HIGHER PERCENTAGE TIED TO
LABOR COSTS THE MEDIC HOW
ESTIMATE CURRENTLY ASSUMES A
PLACEHOLDER 5% FOR THIS LABOR
INCREASE. THIS WOULD BETTER
REFLECT COSTS FROM FACILITIES
AND DIRECTLY INCENTIVIZE
FACILITIES TO INVEST MORE IN
LABOR RELATED TO CONCERNS THAT
THE CURRENT COST PROGRAM DOESN'T
APPROPRIATELY INCENTIVIZE
QUALITY THE DEPARTMENT HAS
SHARED AND DISCUSSED WITH
STAKEHOLDERS AND SHIPPED FROM A
PERCENTILE BASED PROGRAM. THAT
LIMITS THE SUPPLEMENTAL PAYMENT
TO A SUBSET OF FACILITIES TWENTY
THRESHOLD PROGRAM ALLOWING ALL
FACILITIES THAT NEED FOR QUALITY
THRESHOLDS. TO RECEIVE
ADDITIONAL QUALITY FUNDING.
RELATIVE TO THIS PROPOSALS
WITHIN THE AGENDA AT DEPARTMENT
OF HEALTH CARE SERVICES HAS NOT
HAD AN OPPORTUNITY TO FULLY
EVALUATE AND SEVERAL BUT FALL
OUTSIDE OF OUR EXPERTISE COMMENT
- RELATIVE TO- THE- OVERSIGHT
CAN BE PERFORMED DTS PERFORMS AN
EAGLE ON IT AND EACH NURSING
FACILITY'S PROPHETIC COST
REPORT. THE AUDIT INCLUDES A
REVIEW OF THE COST REPORT TO
ENSURE ONLY MEDIC HOW ELIGIBLE
COSTS ARE UTILIZED FOR RATE
SETTING PROCESS FOR EXAMPLE DH
CS WILLETT JESTER AND LEMONY ANY
NOT ELIGIBLE OR EXCESSIVE COSTS.
INCLUDING PROFITS FROM RELATED
PARTY TRANSACTIONS WHAT IS THE
BIG COST REPORTS INCLUDE ALL
FACILITY COST NOT JUST COSTS
ASSOCIATED WITH MEDICARE
BENEFICIARIES ONLY MEDICAL
ELIGIBLE COSTS ARE INCLUDED WHEN
SETTING THE ANNUAL PER DIEM
RATE. WHICH IS PAID FOR. PAY FOR
SERVICES PROVIDED TO MEDICARE
BENEFICIARIES EACH YES OVERSIGHT
PROCESS EASIER AND EVER EVOLVING
FUNCTION BUT WE DO BELIEVE WE
HAVE THE APPROPRIATE PROCESSES
IN PLACE TO ENSURE ADEQUATE
OVERSIGHT OF THE FINANCIAL DATA.
UTILIZED TO SET RATES AND HAPPY
TO ANSWER ANY QUESTIONS. YOU MAY
HAVE AT THE APPROPRIATE TIME.
THANK YOU NEXT WE WILL HEAR.
MISS IN WITH SEIU. IF ANY RIGHT
WITH US EIGHT CALIFORNIA THANK
YOU DOCTOR ARAMBULA COMMITTEE
MEMBERS AND STAFF FOR THE
OPPORTUNITY TO DISCUSS MEDICARE
REIMBURSEMENT SYSTEMS IN NURSING
HOMES AND HOW WE CAN WORK
TOGETHER TO RE AUTHORIZE IT IN A
WAY THAT PRIORITIZES THE
RELENTLESS WORK OF CARE GIVERS
AND THE THOUSANDS OF RESIDENTS
THAT RELY ON THEM FOR SAFE AND
LONG TERM CARE. SEIU LOCAL
TWENTY FIFTEEN REPRESENTS TWENTY
THOUSAND NURSING HOME WORKERS IN
A VARIETY OF POSITIONS IN MORE
THAN TWO HUNDRED SKILLED NURSING
FACILITIES THROUGHOUT THE STATE
OUR MEMBERS HAVE BEEN AT THE
FOREFRONT OF THE PANDEMIC AND
FOR YEARS HAVE EXPERIENCE
PERSISTENTLY LOW WAGES LIMITED
BENEFITS AND A DANGEROUS
WORKPLACE THE REAUTHORIZATION OF
AB SIXTEEN TWENTY NINE PRESENTS
AN OPPORTUNITY FOR THE STATE TO
ADDRESS MANY OF THESE ISSUES.
AND WE ARE EAGER TO PRESENT OUR
PROPOSAL THAT WE BELIEVE WILL
TRANSFORM THE SYSTEM INTO A
TRULY QUALITY BASED ONE. MANY'S
NETWORKERS ARE BURNT OUT THEY'RE
BURNT OUT FROM UNDERSTAFFING NOT
BEING VALUED AND PUTTING THEIR
LIVES ON THE LINE TO CARE FOR
STATES VULNERABLE RESIDENTS THAT
ARE REQUIRED TWENTY FOUR HOUR
CARE DURING THE PANDEMIC
UNFORTUNATELY THIS IS NOT NEW
FOR OUR MEMBERS WHO HAVE FACED
THESE CHALLENGES LONG BEFORE THE
PANDEMIC. THE INDUSTRY NEEDS TO
BE REFORMED SO AS WE DISCUSSED
FINANCING REFORM WE HAVE THE
OPPORTUNITY TO MAKE CHANGES THAT
NOT ONLY AFFECT THE LIVES OF
WORKERS AND RESIDENTS BUT ALSO
HOLDS AND IF INDUSTRY-
ACCOUNTABLE FIRST SPENDING
TAXPAYER DOLLARS APPROPRIATELY
INCLUDING MAKING TARGETED
INVESTMENTS TOWARD WORK FOR
STABILITY WHICH WILL IMPROVE
OVERALL QUALITY OF CARE. WE
BELIEVE THE LEGISLATURE AND
ADMINISTRATION SHOULD MAKE
SIGNIFICANT ADJUSTMENTS TO THE
METHODOLOGY AND INVESTMENTS IN
ORDER TO STABILIZE THE WORKFORCE
AND IMPROVE QUALITY OF RESIDENT
CARE. THE MOST PRESSING PROBLEM
IS THAT THE CURRENT METHODOLOGY
DOES NOT FULLY REIMBURSED LABOR
COSTS OF NURSING AND SUPPORT
STAFF. NOR DOES IT ENCOURAGE
INVESTMENT TO IMPROVE WORK FOR
STABILITY. RATE INCREASES HAVE
BEEN GIVEN READILY TO FACILITIES
WITHOUT A COMMITMENT TO RAISING
WAGES BENEFITS OR INVESTING IN
QUALITY IMPROVEMENT. WE PROPOSE
A FEW SOLUTIONS THAT WILL
IMPROVE QUALITY THROUGH ENHANCED
DIRECT AND INDIRECT KERR LABOR
COST REIMBURSEMENT AND INCENTIVE
OPPORTUNITIES. CURRENTLY THE
SYSTEM REMEMBERS DIRECT AND
INDIRECT KERR LABOR UP TO THE
NINETY FIFTH PERCENTILE.
ADMINISTRATIVE COSTS OF THE
FIFTIETH PERCENTILE AND NON
LABOR COSTS LIKE SUPPLIES- AT
THE SEVENTY FIFTH PERCENTILE.
THERE IS ALSO A COST CNTAINMENT
MECHANISM KNOWN AS THE GLOBAL
CAP. THAT REDUCES OFFICE YLIDES
PER DIEM RATES IF OVERALL
SPENDING PROJECTIONS IF THE
EXCEED THE STATUTORY. IS GIVEN
THE STATUTORY CAP. WE KNOW
OTHERS ARE PROPOSED MOVING THE
DIRECT AND INDIRECT KERR LABOR
PERCENTILE TO THE 100% TILE BUT
THIS WILL NOT SOLVE THE PROBLEM.
SINCE THE GLOBAL CAP IS IMPOSED
AFTER FACILITY SPECIFIC PER DIEM
RATES ARE CALCULATED. THE GLOBAL
CAP REDUCTION IMPOSES A GREATER
BURDEN ON FACILITIES THAT SERVE
A HIGHER POP PROPORTION OF
MEDICARE RESIDENTS. THIS IS WHY
WE ARE PROPOSING TO EXEMPT
DIRECT AND INDIRECT CARE COST
FROM THE GLOBAL CAPTAIN MAINTAIN
THE NINETY FIFTH PERCENTILE CAP
ON LABOR COSTS. IT IS IMPORTANT
TO NOTE THAT MOST FACILITIES
THAT HAVE LABOR BECAUSE ABOVE
THE NINETY FIVE NINETY FIFTH
PERCENTILE SERVE LESS MEDICARE
RESIDENTS THAN THE STATE
AVERAGE. THIS APPROACH WILL
PRIORITIZE INVESTMENTS IN THE
WORK FORCE BY ALLOWING MORE
FACILITIES TO BE AND REIMBURSE
FOR A LARGER PORTION OF THEIR
LABOR COSTS. IT'S ALSO CRITICAL
THAT THE STATE ADDRESSES THE
RATE INCREASES THAT FACILITIES
HAVE RECEIVED DURING THE
PANDEMIC THROUGH AB EIGHTY ONE.
SMITH RECEIVED A 10% INCREASE
AND MEDICARE RATES TO ASSIST
WITH THE- ADDITIONAL COST DUE TO
THE PANDEMIC WE ESTIMATE THAT
EQUATED TO NEARLY FOUR HUNDRED
AND THIRTY THREE MILLION
ADDITIONAL. FUNDS TO THESE
FACILITIES ALTHOUGH AB EIGHTY
ONE REQUIRED THE STATE TO
CONDUCT AUDITS NO AUDITS HAVE
BEEN RELEASED TO THE PUBLIC TO
DETERMINE IF THE FUNDS WERE
SPENT APPROPRIATELY. SINCE
WORKERS PAY DID NOT
SIGNIFICANTLY INCREASE AND CARE
GIVERS ARE LEAVING THE INDUSTRY
IN DROVES AT THE STATE AND IF
THE STATE INTENDS TO RETAIN THIS
10% INCREASE RATHER THAN LET IT
EXPIRE AT THE END OF THE
DECLARED EMERGENCY PERIOD. IT IS
VITAL THAT ONE WE KNOW HOW THE
MONEY ALREADY GIVEN TO THE
SENATE'S WAS SPENT AND TO- HAVE
ACCOUNTABILITY MECHANISMS IN
PLACE BEFORE FURTHER INCREASES
ARE GIVEN. WE PROPOSE THAT THE
10% KOBE DELAYED A RELATED
INCREASE BE REPURPOSED AND
REDISTRIBUTED INTO A VOLUNTARY
WORK FOR STABILIZATION RATE
INCREASE PROGRAM. MODELED AFTER
CALIFORNIA'S NET WAGE ADJUSTMENT
WAIT PROGRAM THAT WAS PREVIOUSLY
APPROVED BY CMS. FACILITIES WILL
APPLY FOR THE RATE INCREASE TO
APPROVE BASE WAGES UP 210% OR
TWENTY DOLLARS HICHEVER IS
HIGHER. PROVIDE STAFF RETENTION
BONUSES AND WAGE ENHANCEMENTS
FOR COMPLETING ADDITIONAL
TRAINING AND EXPAND BENEFITS.
FACILITIES WE NEED TO PROVIDE
LEGALLY BINDING WRITTEN
AGREEMENTS WITH THEIR EMPLOYEES
TO ENSURE ACCOUNTABILITY ALONG
WITH THE ABILITY FOR THE STATE
TO RECOUP ANY FUNDS THAT ARE NOT
SPENT APPROPRIATELY. THIS TYPE
OF PROGRAMWOULD AVOID THE
PITFALLS OF WAGE PASS THROUGHS
WHICH DO NOT GUARANTEE THAT
NURSING HOME WORKERS WAGES WILL
INCREASE BECAUSE THE CURRENT
SYSTEM LACKS THE MECHANISM TO
ENSURE THAT FUNDS ARE SPENT
APPROPRIATELY. WE SUPPORT THE
STATE'S GOAL TO YOU THE MORE
QUALITY BASED REIMBURSEMENT
SYSTEM. THE ACS HAS INDICATED
THEY PREFER AT LEAST 40% OF
FUTURE RATE INCREASES BEING TIED
TO QUALITY PERFORMANCE HOWEVER
WE ARE EXTREMELY CONCERNED THAT
THIS PORTION OF THE FUTURE RATE
INCREASE IS DEDICATED TO THE
EXISTING COST BASED. METHODOLOGY
MAY NOT BE SUFFICIENT TO
REIMBURSE INCREASE DIRECT AND
INDIRECT CARE LABOR COSTS AND IF
OUR GLOBAL CASH EXEMPTION- IS
NOT ADOPTED WILL RESULT IN
LARGER RATE REDUCTIONS FOR
FACILITIES THAT CARE FOR MOSTLY
MEDICARE RESIDENTS. FOR YEARS
NEVER HAVE BEEN REWARDED WITH
RATE INCREASES AND QUALITY
PAYMENTS WHILE NEGLECTING TO
MAKE MAJOR IMPROVEMENTS IN THEIR
OPERATIONS ANY SET OF QUALITY
METRICS MUST BE WORK FOR CENTURY
TO RECOGNIZE THE DIRECT
CONNECTION BETWEEN CARE GIVERS
AND QUALITY OF CARE. THERE MUST
BE A SET OF STANDARDS THAT EACH
SNIFF IS REQUIRED TO MEET BEFORE
THEY ARE EVEN CONSIDERED FOR A
QUALITY RATE INCREASE A SNIFF
THAT HAS A HISTORY OF DANGERS A.
AND DOUBLE A. CITATIONS OR THAT
IS NOT ABIDING BY CURRENT RAGE
LAWS AND ORDINANCES OR THAT FAIL
TO PAY THEIR QUALITY ASSURANCE
BE. A SHOULD NOT BE GIVEN THE
PPORTUNITY TO RECEIVE MORE
MONEY FROM THE STATE IT'S ALSO
CRUCIAL THAT THE QUALITY
INCENTIVE PAYMENTS REMAIN
SEPARATE AND DISTINCT FROM THE
DAILY RATE THE CURRENT- QUALITY
AND ASSURANCE UP LAMENTO PAYMENT
PROGRAM ALSO KNOWN AS THE COST.
STRUCTURE PROVIDES A SEPARATE
PAYMENT AND MANY WORKERS ARE
ABLE TO SHARE AND THOSE QUALITY
BONUS PAYMENTS A FEW OTHER
THINGS TO CONSIDER ARE PLACIG
DOLLAR CAPS ON CERTAIN
ADMINISTRATIVE COSTS SUCH AS
MANAGEMENT AND HOME OFFICE CROSS
IN ADDITION TO MAINTAINING THE
FIFTIETH PERCENTILE COST CENTER
CAP AND RESTRUCTURING THE PEER
GROUPING SYSTEMS TO BETTER
REFLECT SNIFF. RESIDENTS SOCIO
ECONOMIC GROWTH RISK FACTORS
ADDITION AT LEAN MORE STRINGENT-
AUDITS AND RECOUPMENT ARE NEEDED
SINCEOUR ANALYSIS SHOWS THAT
SEVERAL FACILITIES THAT RECEIVED
ADDITIONAL FUNDING TO MEETING
THE MINIMUM STAFFING STANDARDS
RECEIVED STAFFING WAIVERS AND
SOME ACTUALLY REDUCE THEIR
STAFFING LEVELS FROM THE PRIOR
YEAR. BUT OUR AB SIXTEEN TWENTY
NINE SOLUTIONS ADDRESS ONLY THE
FINANCING ISSUES AND OTHER LONG
STANDING ISSUES IN THE NURSING
HOME REMAIN WE STRONGLY BELIEVE
THAT THE TRANSFORMATION OF THE
INDUSTRY CAN BE BEST ACHIEVED BY
INVOLVING WORKERS EMPLOYERS
ADVOCATES AND THE GOVERNMENT AND
THE STANDARD SETTING PROCESS.
THAT CAN HELP EMPOWER WORKERS
IMPROVE WORKING CONDITIONS AND
ENSURE THAT STANDARDS ARE LEVEL
ACROSS THE INDUSTRY OUR MEMBERS
STAND STRONG AND PROUD ALONG SIT
ALONGSIDE SENATOR STERN AND
ASSEMBLY MEMBER SANTIAGO AS WE
PROPOSED TO CREATE A
CALIFORNIA'S FIRST SKILLED
NURSING FACILITY QUALITY
STANDARDS BOARD. CALIFORNIA CAN
TRANSFER- NURSING HOMES PER FROM
CENTERS TO CARE CENTERS BUT ONLY
WHEN WORKERS ARE AT THE ABLE
QUALITY STANDARDS BOARD OUR
PUBLIC BODIES COMPOSED OF
WORKERS EMPLOYEES GOVERNMENT
AGENCIES AND OTHER STAKEHOLDERS.
CALIFORNIA'S NET QUALITY
STANDARDS BOARD WITH THAT WORK
FOR STANDARDS SUCH AS MINIMUM
WAGE RATES BENEFITS TRAINING AND
MINIMUM STAFFING STANDARDS FOR
SNIFF INDUSTRY IN ORDER TO
STABILIZE THE WORKFORCE AND
IMPROVE RESIDENT CARE QUALITY.
THE QUALITY STANDARDS BOARD WILL
ALSO AIM TO DECREASE
LONGSTANDING RACIAL DISPARITIES
AND RESIDENT QUALITY CARE
OUTCOMES INDUSTRY WIDE STANDARDS
CREATE A LEVEL PLAYING FIELD
WHERE HIGH ROAD EMPLOYERS. THAT
PROVIDE GOOD WAGES AND BENEFITS
ARE NOT UNDERCUT BY LOW ROAD.
OPERATORS THE SOLUTIONS WE HAVE
PRESENTED TODAY WILL ADDRESS THE
EXISTING DISPARITIES AND THE
REIMBURSEMENT WHILE ENHANCING
THE DEPARTMENT'S GOAL OF
FOCUSING ON QUALITY CARE AND
SNIFFS. AS A SHIFT INTO MEDICARE
MANAGED CARE SYSTEM. THESE
CHANGES FALL IN LINE WITH THE
BITE AN ADMINISTRATION PROPOSAL
TO SUPPORT STATE EFFORTS TO
IMPROVE STAFFING AND WORK FOR
STABILITY SUCH AS TYING MEDICAID
PAYMENTS TO NURSING STAFF WAGES
AND BENEFITS. INCLUDING
ADDITIONAL PAY FOR EXPERIENCE
AND SPECIALIZATION IT IS CLEAR
THAT BOTH ON A STATE AND
NATIONAL LEVEL COMPREHENSIVE
REFORM OF THE NURSING HOME
INDUSTRY MUST BE UNDERTAKEN TO
PROTECT WORKERS RESIDENTS AND
THEIR LOVED ONES. CAREGIVERS ARE
THE BACKBONE OF THIS INDUSTRY
AND HAVE ALREADY AND DOOR TO
MATCH AND LOST TOO MUCH IT'S
TIME TO MAKE MEANINGFUL LONG
LASTING CHANGES IN THE FITNESS
INDUSTRY THANK YOU SO MUCH FOR
THE OPPORTUNITY TO SHARE WITH
YOU TODAY. THANK YOU. NEXT WE
WILL HEAR FROM ANTHONY- CHUCKLE
TELL STAFF ATTORNEY WITH
CALIFORNIA ADVOCATES FOR
NURSING. HOME REFORM. THANK YOU.
GOOD AFTERNOON THANK YOU FOR THE
OPPORTUNITY TO TESTIFY TODAY MY
NAME IS TONY I'M UPSET SENIOR
STAFF ATTORNEY FOR CALIFORNIA
BECAUSE FOR NURSING HOME REFORM.
ALSO KNOWN AS SCANNER. PART OF
THE PANDEMIC UNDERSTAFFING WAS
AN EMBARRASSMENT JANICE
INVOLVES. BUT NOW WHAT HAD BEEN
EMBARRASSING IS BEING FEATURED
RIGHT NATIONWIDE CAMPAIGN THAT
CHRONIC UNDERSTAFFING SHOULD
NEED MORE REVENUE GOING TO
NURSING HOMES FUNDED BY
TAXPAYERS. THE WORKFORCE
SHORTAGE CRISIS IS NOT A
SHORTAGE OF AVAILABLE WORKERS
AND SHORTAGE OF WILLING WORKERS.
IT'S A SHORTAGE OF NURSING HOME
OPERATORS THE TREE WORKERS AND
RESIDENTS FAIRLY. ISIS IS IN THE
CONDITIONS OF THE CARE AND THE
CONDITIONS OF WORK. THE FRAMING
OF THE ISSUE HAS BEEN
MISLEADING. IT IS IF WE THROW A
PARTY AND PROMISED EVERYONE HAVE
A TERRIBLE TIME MACINNES OR FOOD
OR DRINKS THERE'S NO MUSIC
THERE'S NO BUTTONS AND THE
CONVERSATION IS GUARANTEED TO BE
BORING. LET NO ONE SHOWS UP AND
WE ASK. A DOZEN ANYONE LIKE
PARTIES ANYMORE. WORKING IN A
NURSING HOME IS THE OPPOSITE OF
A PARTY THESE DAYS. WHEN PEOPLE
ARE STAYING AWAY. OUR FOCUS
SHOULD BE ON MAKING WORK
CONDITIONS BETTER MAKING THE
WORK A CALL IN A WAY THEY CAN
ACT A WAY TO HELP AND NOT FEEL
OVERWHELMED AND UNDER
APPRECIATED. ONE THING I WANT TO
MAKE CLEAR. CANTOR 1100%
ENDORSES MORE FINANCING TO
SUPPORT NURSING HOME CARE ONE
HUNDRED PERCENT. AND WE
WHOLEHEARTEDLY SUPPORT THE SEIU
QUALITY STANDARDS FOR PROPOSAL
IT SOUNDS AMAZING. WHAT IS
CONCERNED IS FOR DECADES IS THAT
DESPITE THE INCREASED SPENDING
YEAR AFTER YEAR THEY CARE
STUBBORNLY DOES NOT IMPROVE.
WHAT ARE WE DOING. AB SIXTEEN
TWENTY NINE PROMISED IN TWO
THOUSAND FOUR PROMISED TO MAKE
NURSING HOME CARE BETTER FOR
RESIDENTS AND WORKERS MORE
EQUITABLE BUT REALLY THE ONLY
TWO THINGS IT IS PRODUCED ARE
BILLION OUR OPERATORS AND RECORD
LEVELS OF CONSUMER COMPLAINTS.
THE STATE IS GETTING PLAYED. ARE
WE NOT SPENDING ENOUGH. WITHOUT
AUDITED CONSOLIDATED FINANCIAL
STATEMENTS WE CANNOT REALLY
KNOW. WE DO KNOW THAT NURSING
HOMES ARE EXPERTS IN HIDING
MONEY PRIMARILY THROUGH RELATED
PARTY TRANSACTIONS WHERE THEY
SET UP. RELATED COMPANIES JUNE
OUTSOURCED SERVICES IN A
THEMSELVES. WHAT'S HAPPENING IN
NEW YORK IS INSTRUCTIVE. IN
TWENTY TWENTY NEW YORK PASSED A
LAW SIMILAR TO THIS YEAR'S AB
TWENTY SEVENTY NINE. THAT WOULD
BE HEARD TOMORROW IN THE
ASSEMBLY- COMMITTEE. IN THIS NEW
YORK LAW REQUIRES 70% OF ALL
NURSING REVENUES TO BE SPENT ON
DIRECT CARE. IN THIS LAWSUIT
THAT WAS FILED VERY RECENTLY.
TWO HUNDRED THIRTY EIGHT NURSING
HOMES SUED THE STATE OF NEW YORK
TO STOP THE IMPLEMENTATION OF
THIS 70% SPENDING REQUIREMENTS.
IN THEIR COMPLAINT WITH THE
SAUDIS REPORTED EIGHT HUNDRED
AND TWENTY FOUR MILLION DOLLARS
. IN EXCESS INCOME OR REVENUE
DIVERTED AWAY FROM THE MINIMUM
CARE. THREE AND A HALF MILLION
DOLLARS HER NURSING HOME
DIVERTED TO PURPOSES NOT
CONNECTED TO THE CHARACTER OF
THE- ELECTIVELY THAT EQUALS TENS
OF MILLIONS. OF CERTIFIED
NURSING ASSISTANT HOURS. ONE
MEDIA SOURCE CALLED THIS LAWSUIT
THE MAGNA CARTA OF NURSING HOME
DEBAUCHERY. SKINNER IS ONE OF
FOURTEEN ORGANIZATIONS THAT
TOGETHER WROTE TO THE DEPARTMENT
HEALTHCARE SERVICES TO MAKE
RECOMMENDATIONS FOR IMPROVING
OUR NURSE FINANCING SYSTEM. OUR
RECOMMENDATIONS ARE ON THE
AGENDA FOR TODAY'S HEARING
STARTING ON PAGE THIRTY FOUR.
SINCE WE SENT THE
RECOMMENDATIONS TO DH CS IN
NOVEMBER WE'VE NOT RECEIVED ANY
RESPONSE. YOU'RE THE RESIDENTS
WILL BE RELEGATED TO THE
SIDELINES ONCE AGAIN AS THE
STATE IN THE INDUSTRY COME UP
WITH THE POLICY BEHIND CLOSED
DOORS. THIS IS SUPREMELY
FRUSTRATING. OUR SYSTEM IS
DESIGNED TO PROVIDE THE PROGRAMS
THAT WE GET. PROFITABILITY HAS
NOT BEEN ALIGNED WITH QUALITY.
AND TO ADDRESS CHAIRPERSON
ARAMBULA OPENING COMMENT WE HAVE
IGNORED RESIDENTS TO SOME DEGREE
WE BIG NOR. WE HAVE WE CERTAINLY
HAVE NOT IGNORE RESIDENTS WITH
OUR TAXPAYER DOLLARS WHAT WE
REALLY NEED NORD IS THE
ACCOUNTABILITY THAT WE WANT ANY
ENFORCEMENT THAT WE NEED. THANK
YOU FOR YOUR TIME IN YOUR
ATTENTION ON THIS VERY IMPORTANT
ISSUE. THANK YOU NEXT WE WILL
HEAR FROM JENNIFER SNYDER THE
LEGISLATIVE ADVOCATE FOR THE
CALIFORNIA ASSOCIATION OF HEALTH
FACILITIES. THANK YOU MR
CHAIRMAN AND MEMBERS I AM REALLY
APPRECIATE THE OPPORTUNITY TO BE
HERE TODAY AND- SPEAK TO YOU
REGARDING THAT THE SKILLED
NURSING FACILITY MEDICO RATE
SETTING FORMULA AND IT'S RE
AUTHORIZATION- THIS YEAR IN
TWENTY TWENTY TWO. AND THE
CALIFORNIA ASSOCIATION HEALTH
FACILITY STRONGLY SUPPORTS THE
RE AUTHORIZATION THE MEDICARE
FUNDING FRAMEWORK FOR NURSING
HOMES AND THE ASSOCIATION
BELIEVES THAT OVERALL THIS
FRAMEWORK CONTINUES TO ASSURE
FACILITY BASED REIMBURSEMENT
REWARD FACILITIES FOR QUALITY
CARE. BACK IN TWO THOUSAND FOR
OUR STATE'S NURSING FACILITY
STEPPED UP TO THE PLATE WERE ONE
OF THE VERY FIRST PROVIDERS TO
PROPOSED TO PAY A QUALITY
ASSURANCE FEE. FUND MEDICAL
RESEARCH NURSING HOME CARE ALL
ELEVEN HUNDRED LICENSED NURSING
FACILITIES IN CALIFORNIA TAX
THEMSELVES AND GENERATE FIVE
HUNDRED MILLION DOLLARS ANNUALLY
FOR THE MEDICARE PROGRAM WHICH
IS MATCH TO FILTER FEDERAL
DOLLARS AND PROVIDES ONE BILLION
IN TOTAL REVENUES EVERY YEAR.
CAST MEMBERS BELIEVE THAT THE
CURRENT MEDICARE RATES SYSTEM IS
WORTH OUR CONTINUED INVESTMENT
HOWEVER DUE TO THE LAST TWO
YEARS WITH THE CODEPENDENT MAKE
AND AS WE ALL OF KNOWLEDGE OF
THE CURRENT HEALTHCARE WORK FOR
SHOWED SHORTAGES WE ALSO
STRONGLY BELIEVE THAT THE
MEDICARE RATE NEEDS TO BE
REFLECTIVE. OF GROWING PATIENT
CARE COST AND SUPPORTS AND
ADDRESS DRYER STAFFING NEEDS AND
LONG TERM CARE. NURSING
FACILITIES WERE ALREADY
STRUGGLING PRIOR TO THE PANDEMIC
TO RECRUIT AND RETAIN NURSING
STAFF ESPECIALLY CERTIFIED
NURSING ASSISTANT. THE COBY
NINETEEN PANDEMIC HAS FURTHER
DECIMATED THIS CARE GIVER WORK
FORCE TO CRISIS PROPORTIONS NAY
FOUR HUNDRED THOUSAND CARE
GIVERS BUT THE LONG TERM CARE
PROFESSION JUST IN CALIFORNIA
FROM TWENTY NINETEEN TO TWENTY
TWENTY THE DEPARTMENT OF HEALTH
CARE ACCESS AND INFORMATION H.
CAI ESTIMATES THAT THIRTY SEVEN
HUNDRED C. N. A.'S LEFT THE
PROFESSION. SO THAT'S JUST FROM
TWENTY NINETEEN TO TWENTY TWENTY
WE HAVE NO IDEA WHAT'S HAPPENED
SINCE THEN WITHOUT NECESSARY
STAFF NURSING FACILITIES ARE
FORCED TO REDUCE THEIR CENSUS
WHICH IS THE LOWEST IT'S BEEN IN
OVER TWENTY YEARS. AT 78% BENDS
ARE CURRENTLY NOT AVAILABLE. FOR
MEDICARE PATIENTS IN NEED A
PLACEMENT. SKILLED NURSING
FACILITIES IN CALIFORNIA AS WE
KNOW- A 100% GOVERNMENT FUNDED
WITH ABOUT TWO THIRDS OF THEIR
OF FUNDING COMING FROM THE
MEDICARE PROGRAM. THE REST
USUALLY AROUND 20% CUT
EXCLUSIVELY FOR MEDICARE. AT
SIXTY SIX AVERAGE MEDICAL
PATIENT CENSUS NURSING HOMES ARE
ONLY PAID 53% OF THEIR COSTS BY
THE MEDICARE PROGRAM. ANOTHER
WAY TO ILLUSTRATE THIS
UNDERFUNDING IS TO COMPARE RATES
LET'S SAY BETWEEN NURSING
FACILITY CARE AND IN HOME
SUPPORTIVE SERVICES FOR EXAMPLE
MEDICARE REIMBURSES THE AVERAGE
NURSING FACILITY TWO HUNDRED
FIFTY DOLLARS A DAY. AND THAT IS
SUPPOSED TO PRIDE RESIDENT WITH
ALL THE ATTENDANT SERVICES THEY
NEED AND THEY DESERVE.
CALIFORNIA PAYS AN AVERAGE I
DOLLARS A DAY AND WE WOULD SAY
THAT STILL ISN'T ENOUGH FOR THE
HSS WORKER. BUT THAT COVERS AN
EIGHT HOUR SHIFT IN SOMEONE'S
HOME IT DOESN'T COVER NURSING
CARE MEALS UTILITIES RENT FULL
SERVICES AND SUPPORTS. THAT A
NURSING HOME- PROVIDES. AT RIGHT
NOW AN AVERAGE OF TWO HUNDRED
AND FIFTY DOLLARS A DAY. THE
MEDICARE RATE IS TWICE THE
MEDICAL RATE AT THE LOW END AND
AT THE HIGH END WHICH INCLUDES
THERAPY SERVICES IT'S UPWARDS OF
EIGHT HUNDRED AND TWENTY DOLLARS
. SO CAST MEMBERS ARE COMMITTED
TO PROVIDING SERVICES TO
MEDICARE PATIENT BUT IT IS
GOVERNMENT FUNDS THAT ULTIMATELY
DICTATE WHAT RESOURCES CAN BE
MADE AVAILABLE TO PAY ADEQUATE
STAFF WAGES. AND SUPPORT QUALITY
PATIENT CARE. THERE ARE THREE
KEY ITEMS WHICH WE FEEL MUST BE
ADDRESSED IN THE SNIFF MEDICARE
RATE WE AUTHORIZATION TO ASSURE
NURSING FACILITIES CAN RECOVER
FROM THE PANDEMIC AND PROVIDE
QUALITY CARE. FIRST NURSING
FACILITIES SHOULD REMAIN FUNDED
AT THEIR CURRENT MEDICARE RATE
THIS INCLUDES THE CODE NINETEEN
FUNDS AND THEY'RE ALLOCATED THAT
ARE GOING SPECIFICALLY TOWARD
STAFFING AND NEEDED PP. MEDICARE
PROGRAM IS TO PAY NURSING
FACILITIES FOR THEIR FULL LABOR
COSTS AND SIMILAR TO WHAT I SEE
I YOU TALKED ABOUT THIS MEANS
RECOGNIZING THOSE FULL LABOR
COSTS NOT THREE YEARS AFTER THE
DOLLARS HAVE BEEN SETS AS SPENT
WHICH IS HOW THEY ARE
CALCULATED. AND NOR WITH THE
CERTAIN LESSER PERCENTILES THE
CAPS THAT SEIU AND THAT- THAT
WORD AND THE TOLL BY SEIU OR
BUDGETARY ASIDE OUR ADJUSTMENTS.
AND LASTLY CAPS SUPPORTS THE
STATES EFFORTS ACTUALLY TO
RESTRUCTURE PAYMENTS TO
INCENTIVIZE QUALITY- BUT WE WANT
TO MAKE SURE THOSE QUALITY
MEASURES REQUIRES OUR
TRANSPARENT AND DO NOT
DISQUALIFY GOOD PROVIDERS. UP
FROM BEING ELIGIBLE FOR THOSE
DOLLARS. SO CAST MEMBERS ARE
INDEBTED TO THEIR STAFF FOR THE
CARE THEY PROVIDED DURING THE
PANDEMIC AND UNDERSTAND THAT
THEIR DIRECT CARE STAFF ARE THE
BACKBONE OF THE FACILITY AND
PATIENT CARE. THAT'S RIGHT CALF
RECENTLY RELEASED A SKILLED
NURSING FACILITY REFORM PACKAGE
WHICH IS OUTLINED IN THE
COMMITTEE ANALYSIS TODAY- IT
INCLUDES FOUR KEY COMPONENTS
FIRST AND FOREMOST WE'RE CALLING
IN OUR DRIVE TO TWENTY FIVE.
REQUIRE FACILITIES TO PAY TWENTY
FIVE DOLLARS TO EVERY CNA BY THE
YEAR TWENTY TWENTY. NOW THIS AS-
IS MY ACCOUNT TO PAY TWO THIRDS
OF THAT COST BECAUSE THEY PAY
TWO THIRDS OF COST OF OUR
SKILLED NURSING FACILITIES BUT
THAT. FACILITIES WILL KICK IN
THE REST AND THAT REQUIREMENT
WILL GO THE DRIVES TO TWENTY
FIVE. AND WE'RE ASKING FOR A
CONTINUED STRONG INVESTMENT IN
WORKFORCE DEVELOPMENT MAKING
SURE WE BUILD ON WHAT THE SUB
COMMITTEE DID LAST YEAR- AND
INFESTED FUNDS AND CNA TRAINING
WE WANT TO SEE THAT CONTINUE AND
TO. GET BIGGER- WE'RE SUPPORTING
ENHANCE REGISTERED NURSING CARE
IN OUR SMALLER BUILDINGS MOVING
MANY OF A FACILITY STARRING CARE
TWENTY FOUR HOURS A DAY SEVEN
DAYS A WEEK. AND LASTLY CALF
SUPPORTS A SIFF EVIDENCE BASED
STAFFING STUDY TO DETERMINE WHAT
STAFFING NEEDS ARE REQUIRED. FOR
LONG TERM CARE FOR THE LONG TERM
CARE A PROFESSION POST PANDEMIC
. THESE REFORM IDEAS WE BELIEVE
ARE WHAT ARE NEEDED ALONG WITH A
FULLY FUNDED MEDICARE RATE
REIMBURSEMENT. SYSTEM FOR
SKILLED NURSING FACILITIES HAVE
THAT ALREADY SECURELY IN PLACE.
AND THAT FULLY FUNDS FACILITY
COSTS FOR LABOR AND THEN WE LOOK
AT OUR DRIVE TO TWENTY FIVE IN
THE IMPORTANT ASPECTS OF MAKING
SURE THAT WE- WE BUILD OUR WORK
FORCE AND WE SUPPORT OUR WORK
FORCE. TO ANSWER THE QUESTIONS
RAISED IN THE COMMITTEE. I FIRST
WANT TO SAY THAT CASTRO WE
SUPPORTS COST AND RESOURCE
TRANSPARENCY FOR NURSING HOMES.
NOW WE ALL OF HER THAT THE
STATE'S MEDICAID PROGRAM ALREADY
AUDITS ALL COSTS INCURRED. BY A
NURSING FACILITY DISALLOWING ANY
UNAUTHORIZED FUNDS. THAT CAP IS
STILL OPEN TO ANY ADDITIONAL
OVERSIGHT OR SAFEGUARDS RELATED
TO THOSE FUNDS AND ANYTHING ELSE
WE THINK. IS NEEDED TO BETTER
ADDRESS- THAT AUDIT PROCESS.
LEGISLATION WAS PASSED LAST YEAR
WITH. IT WAS SB SIX FIFTY IS IT-
SENATOR STERN BILL WHICH CALF
WORK WITH THE AUTHORED SPONSORS
TO MOVE TO A NEUTRAL POSITION.
IT REQUIRES ADDITIONAL REPORTING
REQUIREMENTS FOR NURSING
FACILITIES INCLUDING DETAILED
CONSOLIDATED FINANCIAL REPORTS.
DISCLOSURES OF RELATED AND
UNRELATED PARTIES AND FULL
DISCLOSURE INCOME EXPENSES AND
ARE PRETTY SURPLUS. AND DEFICITS
AND THAT ALL GOES TO LEARN NEW.
ARSHAD H. CHI- AND WE HOPE THAT
STARTS BY NEXT YEAR. EVIDENCE
SHOWING THAT MEDIC. IS NURSE. TO
BE FOUND ON THE H. K. H. WEBSITE
. AND DO YOU. RATE SETTING
PROCESS ASSURES THAT PHYLLIS
FACILITIES ARE NOT ONLY PAID A
PERCENTAGE ARE ONLY PAID A
PERCENTAGE OF WHAT THEIR. THAT
MEDICARE PROGRAMS DO NOT PRODUCE
PROCESS PROFITS BUT RATHER UNDER
FUND COST OF SERVICES. IN
NURSING HOMES. AS I MENTIONED
THE MEDICARE RATE IS
CONSIDERABLY HIGHER THAN THE
MEDICARE RATE. AND THIS RATE
STILL REPRESENTS REALLY ONLY A
SMALL PROPORTION OF PATIENTS IN
NURSING HOMES NURSING HOMES DO
YOU SOME OF THESE FUNDS TO BACK
FILL THE LOW MEDI CAL RATES. BUT
ALSO THE ALSO MISUSE THIS FUNNY
PROVIDE MEDICARE PATIENTS MORE
COMPLEX NURSING THERAPY SERVICES
AND ACUTE REHAB. FOR RECOVERY TO
RETURN HOME. WE LOOK FORWARD TO
WORKING WITH THE COMMITTEE AND
THE MINISTRATION LEGISLATURE ON
A STRONG MEDICARE REIMBURSEMENT
FORMULA FOR NURSING HOMES THAT
FULLY SUPPORTS LABOR COSTS AND
INCENTIVIZE QUALITY. CARE THANK
YOU. THANK YOU I WILL BRING IT
UP TO THE DÍAS FOR ANY MEMBER OF
QUESTIONS- SEEING NONE AT THE
MOMENT I WILL BEGAN AYE I WOULD
LIKE TO BE ABLE TO ASK THE
ADMINISTRATION- WHY WE STILL
DON'T HAVE A PROPOSAL- OBVIOUSLY
FOR MANY OF US WE WERE
SYMPATHETIC AS THE PANDEMIC
HELPED TO SLOW DOWN MANY
PROPOSAL. HELLO HOWEVER LAST
YEAR DH CS HAD COMMITTED TO
ENGAGING IN A ROBUST STAKEHOLDER
PROCESS. THIS LAST FALL TO
DEVELOP THE PROPOSAL AND YET WE
HAVE NOT HEARD OF SUCH A PROCESS
OCCURRING NOR DO WE HAVE THE
PROPOSAL. I WOULD I WOULD LIKE
TO BE ABLE TO ASK SINCE THE
LEGISLATURE REALLY IS NOT
INHERENTLY LOOKING TO EXTEND.
THE EXISTING PROGRAM FOR OTHER
HERE. BUT IF YOU DO NOT HAVE THE
SUFFICIENT TIME TO IT WAIT. A
COME. AND THAT IS WE WILL HAVE
TO DO. HOPING YOU PROVIDE A
UNDER OF ONE WE WILL HAVE AN
EXPECTATION TO RECEIVE THAT
PROPOSAL. WHEN YOU HEARING TO
MAKE IT RIGHT THE DEPARTMENT WE
ARE WORKING TO FINALIZE THAT
PROPOSAL AS DILIGENTLY AS
POSSIBLE AND WORKING WITH OUR
STAKEHOLDER PARK PARTNERS- AND
WE WILL CAN COMMIT THAT THERE
WILL BE A PROPOSAL. BY THE MAY
REVISION. HAVING TO BUY THE MAY
REVISION MAKES IT AWFULLY TOUGH
FOR US TO BE ABLE TO TURN AROUND
IN A MEANINGFUL TIME AND SO WE
JUST ASK THE ADMINISTRATION- TO
REMEMBER THAT COMMITMENTS TATE
TOWARDS A STAKEHOLDER PROCESS
AND TO- LIVE UP TO IT IS I
BELIEVEIT'S IMPORTANT. TO HAVE
ALL STAKEHOLDERS HAVE THEIR
VOICE BE HEARD IN THIS PROCESS-
I WOULD LIKE TO FOLLOW UP MISTER
ERRINGTON IF I COULD WE'VE
RECENTLY INCREASED- LABOR COSTS
FROM 90% 295% TAKES STILL WOULD
. LIKE THE RATIONALE IF I COULD
FOR WHY WE ARE NOT- REIMBURSING
OUT A HUNDRED. PERCENT I'M
HOPING YOU CAN PROVIDE SOME
CLARITY TO THAT. SURE YOU WANT
TO MAKE IT CLEAR I MEAN WE HAVE
HELD A PUBLIC STAKEHOLDER
MEETING AS WELL AS MATT WITH
MULTIPLE- GROUP STATE TO
CONTINUE THAT STAKEHOLDER AND
ENGAGEMENT PROCESS SO WE HAVE-
CONDUCTED A STAKEHOLDER PROCESS
AND ARE CONTINUING TO WORK
THROUGH THAT- RELATIVE TO THE
RAISING OF THE- NINETY FIFTH
PERSON FROM THE NINETY. FROM
NINETY TO NINETY FIFTH
PERCENTILE REALLY THAT WAS SPEAK
TO ENSURE THAT WE WERE
CAPTURING- THE APPROPRIATE COST
AND AGAIN THAT WE ARE SAYING
THAT ALL LABOR COST UP TO THAT
NINETY IF IT FIFTH PERCENTILE
ARE INCLUDED SO FOR FACILITIES
COSTS WERE BELOW THAT NINETY
FIFTH PERCENTILE. THEIR TOTAL
COSTS ARE INCLUDED SO IT'S JUST
REALLY FOR THOSE OUT LIAR
pFACILITIES THAT MAY HAVE- HIGHER
COSTS AND I WAS- JUST WOULDN'T-
TESTIFY TO YOU THAT IS GENERALLY
YOU OF THOSE FACILITIES THAT
HAVE LOW MEDIC HOW-
PARTICIPATION- AND SO THOSE ARE
KIND. OF OUT LIAR REAP WAGES.
FOLLOWING UP ON WITH MY WHAT MAY
. WHITE HAD SAID REGARDING THE
GLOBAL TAP CAN YOU PROVIDE THE
RATIONALE FOR WHY WE MAINTAIN
THAT AND- IF THERE IS-
FLEXIBILITY FOR US TO ADDRESS
THAT. SO OF COURSE IN THE GLOBAL
CAP IS INCLUDED AS PART OF. THE
STATUTORY REQUIREMENTS FOR WHAT
THE ANNUAL RATE INCREASE WILL BE
FOR THE FACILITIES AND HAS I'VE
MENTIONED WE ARE LOOKING AT-
I'VE JUST SEEN THAT- HAVE AS
PART OF- THE PROPOSAL THAT THAT
IS COMING FORWARD BY SEPARATING
OUT LABOR AND NON LABOR COSTS.
AND BUT BUT YOU KNOW WE DO
BELIEVE IT IS IMPORTANT TO HAVE
SOME FIDUCIARY. RESPONSIBILITY
TO ENSURE THAT WE HAVE
REASONABLE RATES MOVING FORWARD-
WOULD LIKE TO KNOW TRANSITION TO
THE WORK FORCE ON PAGE THIRTY
TWO- WE HEAR THAT. THE NURSING
INDUSTRY HAS LOST SIXTEEN
THOUSAND WORKERS SINCE TWENTY
TWENTY THAT THAT ACCOUNTS TO
ELEVEN POINT 3% OF THE ENTIRE
WORK FORCE HAVE WE REPLACED THE
11% OF WORK FORCE SENSE TWENTY
TWENTY. IT SEEMS THAT WE WERE ON
A WHOLE BACK THEN ARE WE DIGGING
IT DEEPER HOW ARE WE GOING TO
GET OURSELVES OUT OF THIS WHOLE-
WOULD LOVE TO HEAR FROM THE
ADMINISTRATION WHAT ARE SHORT
AND OUR LONG TERM PLANS ARE TO
ADDRESS WORKFORCE SHORTAGES.
THIS IS. WHAT THE DEPARTMENT OF
HEALTH CARE SERVICES THAT
UNFORTUNATELY I DON'T HAVE A
RESPONSE TO THAT TO THE BROAD-
WORK FORCE AND THAT DOES NOT
FALL TO THE DEPARTMENT OF HEALTH
CARE SERVICES UNFORTUNATELY. I
WOULD HOPEFULLY REMIND THE
ADMINISTRATION THAT A ONE POINT
SEVEN BILLION DOLLAR CARA
KANEMI. PROPOSAL AND WOULD HOPE
THAT WE COULD FIND ROOM TO
ENSURE THAT WORK FORCE FOR
SKILLED NURSING FACILITY WAS
INCLUDED IN THAT IT'S IMPORTANT
FOR US TO- I AGREE WITH THE
STATEMENT THAT- FOR US TO
IMPROVE QUALITY OF CARE WE NOT
WE MUST FIGURE OUT HOW TO
SUPPORT OUR WORK FORCE. AND THAT
MUST START WITH HAVING
SUFFICIENT WORKFORCE IN PLACE-
AND SO WOULD LOVE TO BE ABLE TO
FOLLOW UP ON HOW WE HAVE BOTH
THE- SHORT AND LONG TERM PLAN
FOR US TO ADDRESS THIS AS THIS
DOES NOT APPEAR TO BE SOMETHING.
WE CAN SOLVE ANY ONE BUDGET YEAR
BUT WILL NEED A MULTI YEAR PLAN
FOR US TO ADDRESS THIS AND LOOK
FORWARD TO THAT PARTNERSHIP AND-
COORDINATION. I'D LIKE TO-
FOLLOW UP IF I CAN ON SOME OF
THE WAIVERS THAT CURRENTLY HAVE
BEEN- ALLOWABLE. AND AM- IF THAT
HI- SOME OF THE WORK FORCE
SHORTAGES THAT WE REALLY HAVE
AND A WAR. EXACERBATES SOME OF
THE BURN OUT FROM THE WORKERS
WHO ARE SHOWING UP- WHEN WE ARE-
CONTINUING THOSE- WAIVERS AND
I'M HOPING TO HEAR FROM THE
ADMINISTRATION IF THERE'S- A
PLAN FOR US TO ADDRESS THOSE
WAIVERS AS- AS I BELIEVE IT.
WILL BE IN. A FOR US TO FOCUS ON
THE WORK FORCE FOR US TO
ACKNOWLEDGE HOW OFTEN FACILITIES
ARE USING THOSE WAIVERS. THAT
I'D LOVE TO HEAR A COMMENT FROM
YOU ON- WHAT THE THOUGHT IS ON
WAIVERS GOING FORWARD. MICHELLE
POTTS I JUST STEPPING ON THIS
QUESTION SO THE DEPARTMENT OF
PUBLIC HEALTH PROCESSES THAT A
TWO POINT FOUR THREE POINT FIVE
OF THE WORK FORCE AND- AND
ACUITY WAIVER SO I THINK IT'S
BEST FOR THEM TO ANSWER THAT
QUESTION BUT TO YOUR YOUR
QUESTION EARLIER ON WORK. AND
MENTIONING THE ONE POINT SEVEN
BILLION YOU KNOW THERE'S DOLLARS
IN THEIR PARTICULARRELATED TO
NURSING SOCIAL WORKER IN
PSYCHIATRIC- I WORKFORCE I THINK
ALL COULD TOUCH ON BUILDING OUT
THAT THE SKILLED NURSING
FACILITY WORKFORCE IN THE FUTURE
SO. I WE LOOK FORWARD TO
PARTNERING WITH- EACH CRY AS
THOSE EFFORTS ARE STILL
UNDERWAY. I WILL THANK YOU
DIRECTOR BOSTON AYE- REALLY.
ENJOYED THAT THE LEGISLATURE
TOOK A LEADERSHIP ROLE LAST
YEAR. TO INVEST IN TO WORK FORCE
AND- REALLY WANTS TO PARTNER
WITH THE ADMINISTRATION THIS
YEAR TO ENSURE WERE- CREATING A
PLAN GOING FORWARD- I. WOULD
LIKE TO FOLLOW UP IF I CAN- AS
WE ARE- TRANSITIONING TO MANAGED
CARE PLANS CARVING THIS IN AS AN
L. T. S. S- HOW ARE WE GOING TO
ENSURE. THAT WE DON'T TRANSITION
PEOPLE FROM NURSING HOMES INTO A
COMMUNITY BASED CARE WHICH MANY
OF US ACKNOWLEDGES OUR DEFAULT
PREFERENCE. BUT HOW DO WE ENSURE
THAT OUR MANAGED CARE PLANS ARE
NOT PUSHING PEOPLE FROM OUR
SNAPS. WHO ACTS ARE PUSHING
PEOPLE TO THE COMMUNITY BASED
CARE WHO ACTUALLY WILL NEED
SNIFF CARE IN ORDER FOR THEM TO
REDUCE COSTS WHAT TYPES OF
MECHANISMS ARE WE LOOKING AT AND
EVALUATING TO ENSURE THAT THIS
DOES NOT OCCUR. I WOULD NOTE
THAT- AS PART OF THE NURSING
HOMES MUST COMPLETE IT AND YES
SECTION Q. WHICH GOES THROUGH A
BUNCH OF QUESTIONS TO THE
RESIDENT ASKING THEIR PREFERENCE
I THINK THAT INFORMATION WILL BE
ONE ONE I'M ACTIVISM TO ENSURE
THAT. RESIDENTS HAVE A CHOICE IN
WHERE THEY WANT TO RECEIVE CARE
AND KIND OF THE LEVEL OF CARE
THAT MIGHT BE NEEDED. USING THAT
INFORMATION AND MONITORING THAT
I THINK WOULD BE ONE AVENUE TO
ENSURE THAT INDIVIDUALS WHO MADE
ME MOVE. SERVICE HAS HAD. TO DO
THAT. THIRTEEN THANK YOU MR
CHAIRMAN I GUESS I JUST MISSED
HERRINGTON- DO YOU CONSIDER THE
LEGISLATURE A STAKEHOLDER. WE DO
- I DON'T THINK WE'VE BEEN
CONTACTED. IT IS THERE A REASON
FOR THE A MISSION. YOU KNOW I
MEAN WE HELD A OF RIDE IT
STAKEHOLDER MEETING ASSOCIATED
WITH THE TRANSITION OF THE COST
PROGRAM AS REQUIRED AND IT WAS
PUBLICIZED. BUT BUT NOW WE HAVE
NOT HAD A SEPARATE INTERACTION.
WELL MY ADVICE TO YOU IS IF YOU
DON'T GIVE US SOMETHING SOON
WANTED TO SAID WANTED TO RELEASE
IT JUNE SIXTEENTH. BECAUSE
THAT'S WHEN WOULD YOU
CONSIDERING. HOW'S THAT TIME
LINE SOUND TO YOU. SO I'M HAPPY
TO STEP IN HERE WENDY I'M
COMPLETELY EGGNOG GENE YOUR
COMMENTS ON THIS YOU KNOW WHAT'S
THE DEPARTMENT ADMINISTRATION
HAS GONE THE PROPOSAL TO THE
LEGISLATURE WE ARE VERY
COMMITTED TO YOU I'M GIVING YOU
A PROPOSAL AS SOON AS POSSIBLE I
CONTINUE WITH DAVID ACT I DON'T
REALLY KNOW WHAT THE DEDUCTED AS
MY CALENDAR. THAT DIDN'T IN MY
TIME WHEN AS SOON AS POSSIBLE OF
YESTERDAY BECAUSE MY STAFF HOW
THEY- REACT TO THAT. SO I DON'T
GET A PROPOSAL. SO IS A SINCE
POSSIBLE. I THINK WE'RE VERY
COMMITTED TO GETTING US WHEN HE
SAID- NO LATER THAN MAY REVISE
IT WE'RE WORKING IT'S USUALLY.
NOT ALREADY TOLD ME REVISED TO
LATE DON'T SUBMIT THEM. WE HAVE
ANOTHER DATE. I CAN GIVE YOU ONE
ARE TODAY BUT I WILL COMMIT TO
YOU ARE ENGAGING WITH OUR OUR
PARTNERS- YOU WE CONTINUE TO
HAVE EXTENSIVE CONVERSATIONS
AROUND THIS AND WE'LL GET YOU
SOMETHING I DID THAT WE CAN WORK
TOWARDS AFTER THAT RELEASE IN
THE FUTURE AND APOLOGIZE FOR
WHAT. COMMITTEE YOU THAT. ONE
MINUTE I THOUGHT IT. EVERYTHING
POSSIBLE TO NOT IT OF MY COMMAND
. BECAUSE UNDERSTAND TO COVER
THE DEMONSTRATING A COMPLETE
LACK OF DESIRE TO WORK WITH THE
LEGISLATURE. ARE ITS COMPLETE
LACK OF DESIRE FOR TRANSPARENCY
AND OPENNESS IS VERY. SERIOUS
ISSUE WE SAW DURING KOBE ED HOW
MANY DEATHS OCCURRED IN NURSING
QUESTIONS. BUT IF- YOU'RE NOT
WILLING TO TAKE THIS ISSUE
SERIOUSLY. THEN CLEARLY. WE'LL
HAVE TO PUNT UNTIL NEXT YEAR
WHICH IS VERY UNFORTUNATE
BECAUSE I THINK IT'S A VERY
IMPORTANT ISSUE. IT'S A VERY
SERIOUS ISSUE FROM ALL THE
OPERATORS FROM THE EMPLOYEES
FROM THE PATIENTS. SO I THINK
WE'RE WAITING FOR ENGAGEMENT BUT
I DON'T THINK WE'VE- BEEN
CONTACTED ABOUT A MEETING OR-
ANY DISCUSSION TO SOLICIT WHAT
ARE OPINION OR FEEDBACK IS. I'M
SO WHAT I WOULD SAY IS WE ARE
TAKING THIS PROPOSAL EXTREMELY
I'M SERIOUSLY HERE WE HAVE BEEN
FULLY ENGAGED IN THIS AREA FOR A
LONG- AN EXTENSIVE TIME YOU'VE
BEEN HAVING- EXTENSIVE
CONVERSATIONS WITH- STAKEHOLDERS
INCLUDING CAP AS HE ARE YOU AND
OTHERS- AND WE WILL WORK TO GET
SOMETHING TO THE BROADER
COMMUNITY YEAH- OBVIOUSLY THE
LEGISLATURE. I'M A STUDENT
BECAUSE THEY CAN'T BUT I JUST
WANT TO HOW A CRITICAL WE THINK
THIS IS WE HAVE BEEN A DRIVING
TO AND NOT THE QUALITY IS
EMBEDDED INTO THE RATES THAT WE
PAY IN THAT IT IMPROVES THE
OUTCOMES FOR OUR- INDIVIDUALS
AND BENEFICIARIES- IN MEDICARE
AND WE ARE I CONTINUE TO BE
ADDED TO. IN BEING. PASSED WE
CAN. GET YOU KNOW FOR I'LL COME
. THE PROPOSAL EVER HOW MANY
STATE MEETING HAVE YOU HEARD.
WHEN THE I WOULD HAVE TO DEFER
TO YOUR REGARDS TO STATE
MEETINGS YOU'VE BEEN FOR THE
LICENSE THE THREE TWELVE MONTHS
. I WOULD SAY UPWARDS OF TWELVE
AND FIFTEEN. AND OVER THOSE
TWELVE FIFTEEN WERE ANY MEMBERS
OF THE LEGISLATURE INVITED. ARE
YOU LEGISLATIVE STAFF
STAKEHOLDER MEETING INCLUDED AT
LUNCH LEGISLATIVE STAFF BUT I
HAVE TO GO BACK AND LOOK AS WE
WORK WITH OUR ALLIES CD PH
PARTNERS ON ESTABLISHING THAT
MEETING IN AND THERE WAS ONE OUT
OF THE TWELVE MEETINGS. YES
THROUGH THE REASON THAT YOU
DECIDED TO IGNORE THE
LEGISLATURE. PERHAPS YOU DON'T
REALLY NEED OUR SUPPORT. REALLY
WE THINK THE LEGISLATURE IS AN
IMPORTANT PARTNER AND I MEAN
WE'RE HAPPY TO ENGAGE AND HAVE
DETAILED DISCUSSIONS WITH THE
LIKES OF THE LEGISLATURE
LEGISLATIVE LAPTOP ON THE
STRUGGLE IT IS A VERY TECHNICAL
AND LOTS OF DATA BEHIND SOME OF
THESE CONVERSATIONS WHICH IS.
WHICH IS SOME OF THE REASONS WHY
THERE BEEN SOMEONE OFF
CONVERSATIONS WITH THE DIFFERENT
STAKEHOLDERS SOME OF OUR
TECHNICAL CONVERSATIONS AND THE
PROPOSAL THAT WORK WE'RE
THINKING THROUGH IS A SAME
PROPOSAL THAT WE HAD. A SIMILAR
TOOK TO LAST YEAR- AND IN THE
PAST SO THAT IT'S KIND OF THE
BUILDING BONE OF A WE'RE
THINKING THROUGHOUT THE NIGHT OF
DIRECTOR I WOULD HAVE TO
COMPLETE DISAGREE WITH YOU I
DON'T KNOW IT'S A IT'S SORT OF-LIKE IF. YOU DON'T INVITE
ANYBODY TO THE PARTY CLEARLY YOU
DON'T CARE OF. CARE ABOUT THEIR
OPINION. SO IT DOESN'T SHOW ANY
DESIRE FOR ANY INTEREST TO
ENGAGE OR DISCUSS OR TO SOLICIT
OPINIONS FROM THE LEGISLATURE.
IN MY IN MY MISSING SOMETHING.
IT IS MY UNDERSTANDING THAT THAT
LEGISLATIVE STAFF WERE INVITED
TO ONE OF THE CONVERSATIONS AND
SO I MEAN I WOULD DEFINITELY
WANT OVERLOOKED ON THIS TEAM
CONVERSATIONS. WELL I GUESS
GIVEN THE COMPLEXITY I COULD A
SECOND CENTRIST AND HOW ONE
MEETING COULD JUST SOLVE ALL THE
PROBLEMS. SO I DON'T UNDERSTAND
YOU SAID IS A VERY COMPLEX ISSUE
AND YET YOU ONLY INVITED US TO
ONE MEETING. SO IS IT A SIMPLE
ISSUE IS A COMPLEX ISSUE I'M I'M
KIND OF CONFUSED. IT IS
DEFINITELY A COMPLEX ISSUE THAT
INVOLVES A LOT OF DISCUSSION BUT
A LOT OF WORKING FOR SOME OF THE
DETAILS. I CAN. I COMPLETED SO I
THOUGHT THAT I COMPLETELY CONCUR
WITH YOU. ABOUT WHAT I'M
UNDERSTOOD FRONTRUNNER JUST AS
HOW CAN WE HAVE BEEN INVITED TO
ANY OF THOSE DISCUSSIONS. EXCEPT
FOR ONE OF THE FUNDS ARE THERE
IS ONE OF THEM. THAT WE WERE
INVITED TO. I THINK WE WOULD
HAVE TO GET BACK TO YOU ON THAT
KIND OF THE DETAILS OF THE STATE
CULTURAL I DON'T KNOW THAT WE
WERE PREPARED WITH THE LISTING
OF ALL THE CONVERSATIONS TODAY-
TO TALK THROUGH THIS WITH YOU.
NO I'M JUST ASKING WHY WERE WE
INVITED ANY THE CONVERSATIONS.
BUT ENOUGH FOR A THE DETAILED
MINUTES FOR ALL FIFTEEN. I THINK
WE JUST YEAH I HAVE TO GET BACK
TO ONE KIND OF ALL THE MEETINGS
THAT OCCURRED IN WHO WAS INVITED
TO WHICH MEANS I I'M NOT. I
DON'T I'M NOT TRACKING THE
DETAILS OF ALL THE CONVERSATIONS
OVER THE LAST FEW MONTHS- COULD
YOU TELL US AT LEAST GIVE US A
BROAD BRUSHSTROKE WHO'S INVITED
TO THE MEETINGS. WOULD LIKE TO
KNOW WHO'S INVITED SINCE WE'VE
BEEN EXCLUDED. WE CAN.
DEFINITELY GET BACK TO YOU WITH
THAT INFORMATION. THE REASON WHY
NOBODY FROM STAFF IS PREPARED TO
TALK ABOUT. THAT AT THIS
PRESENTATION. I APOLOGIZE I
DON'T HAVE THE LIST FROM THE
FROM THE LARGE AND STAKEHOLDER
MEETING THAT WE HELD ABOUT WHO.
WHO WHO YOU INVITED TO THE SMALL
STAKEHOLDER MEETINGS BECAUSE
CHRIS CLEARLY WERE INVITED TO
THE BIG ONE SO WE KINDA KNOW.
WHO'S IN THE BIG ONE WHO ARE WHO
ARE. WHO WHO ARE IN THE OTHER
SECRET. THE MAIN GROUPS THAT WE
MET WHEN I FIRE AT SEA ARE YOU
HAVE CANNER AND- OR OR MAIN
FOCUS AS WELL AS OUR- PARTNERS
WITHIN THE ADMINISTRATION. SO
EVERYBODY WHO'S TESTIFYING HERE
TODAY EXCEPT FOR US. I MEAN
GENERALLY WE- DON'T INVITE
LEGISLATIVE STAFF MEMBERS TO IT
TO THOSE TYPES OF MEETINGS AND
BE- COORDINATE WITH THE
LEGISLATURE AS PART OF OUR
PROPOSAL WHEN IT'S PRESENTED TO-
I I'M NOT I'M NOT SURE. ASSEMBLY
COORDINATION WHEN YOU JUST
SENATE'S PROPOSALS CALLED
FUNDING THE PROPOSAL NOT A
COORDINATION I GUESS. BUT IT'S
OKAY I MEAN IF YOU DON'T WANT TO
PASS THIS TO THE FOREFRONT WE
CAN WE CAN YOU KNOW ANSWER I
WANT TO BELABOR THE POINT NO
NEED TO. SPEND TOO MUCH TIME ON
SOMETHING THAT MAY BE NIPPING
AND I CONSIDER THE SHIFT. SO I
WOULD LIKE TO GET. FROM THE
OTHER STAKEHOLDERS- YOU KNOW
GOING TO- JUST THE- DISSOCIATION
IF WE COULD- I- YOU KNOW IN THE
AGENDA WE HAVE THE CALIFORNIA
ADVOCATES FOR NURSING HOME
REFORM I SEE YOU ARE FOUR POINTS
WHICH I FOUND WAS INTERESTING-
FOR CALF- UNFORTUNATELY THESE
ARE ALL THINGS THAT OTHER PEOPLE
ARE. THE YOU'RE ASKING OTHER
PEOPLE TO DO IN TERMS OF MORE
MONEY MORE TRAINING- MORE
INVESTMENTS I'M CURIOUS AS TO
WHAT THE ASSOCIATION'S GOING.
FIVE I EIGHT TO RESPOND YOUR
QUESTION THANK YOU FOR THAT SOME
OF THEM RETAIN I THINK- OUR
INDUSTRY AND OUR ASSOCIATION ARE
DOING MANY MANY THINGS WE
BELIEVE TO RESPOND- AND TO TRY
TO GROW- BACK OUR WORK FORCE AND
SUPPORT OUR PATIENTS- I THINK
FOR MOST OF OUR FOLKS- EVERY
DAY. IS A DAY WERE BIGGER BURKE
I'M TRYING TO MAKE SURE THAT
THEY PROVIDE QUALITY PATIENT
CARE THAT THEY'RE TRYING TO GET
MORE OF FOLKS TO COME WORK IN
THEIR BUILDINGS- AND TRYING TO
RECRUIT AND RETAIN AS MANY FOLKS
AS THEY CAN- IT'S A STRUGGLE FOR
ALL OF THEM- THE ASSOCIATION
ITSELF I THINK IT IS- IS IN THE
MIDDLE OF FIRST YOU KNOW
THEY'VE- THEY'VE- ACTUALLY HAVE
THIS PROPOSAL. WHICH THEY'RE
COMMITTING TO MAKING SURE THAT
THEY'LL MOVE FORWARD YOU KNOW
WITH A DRIVE TO TWENTY FIVE
MAKING SURE THAT THEY ARE
COMMITTED TO INCREASING WAGES
FOR THEIR CERTIFIED NURSING
ASSISTANTS- THEY MANY OF OUR-
FACILITIES OF STEPPED UP TO DO
MORE TRAINING PROGRAMS- AND TO
MAKE SURE THAT THEY'RE INVOLVED
WITH THEIR COMMUNITY COLLEGES
ARE LOCAL- LABOR EXPERTISE- AND
OTHER FOLKS THAT ARE DOING
WORKFORCE TRAINING THEY'RE VERY.
THEY'RE TRYING THEIR BEST TO
STEP UP TO THE PLATE TO DO THAT-
CALF IN AN OF ITSELF HAS DONE A
TON OF OUTREACH TO ITS MEMBERS
OF BOTH DURING THE PANDEMIC
MAKING SURE THAT WE COULD
PROVIDE EVERY SUPPORT SERVICES
IF THEY COULD FOR THEIR AND- FOR
THEIR MEMBERS- TO BE ABLE TO
RESPOND TO THE PERTINENT
PANDEMIC EVERY. YOU KNOW TIME
THERE. IMPORT ISSUE OR THINGS
THAT CHANGED OR ANNOUNCEMENTS
FROM C. PH I THINK IT WAS A IT
WAS A REALLY HARD TIME FOR IT
FOR EVERYBODY. I'M IN SO I THINK
THE ASSOCIATION IN OF ITSELF
WANTS TO BE AT THE FOREFRONT OF
SUPPORTING ITS MEMBERS. TOWARDS
MOVING TOWARDS QUALITY- I THINK.
MOST OF OUR FOLKS FEEL LIKE
EVERYDAY IS A STRUGGLE TO TRY TO
MAKE SURE THAT THEY'RE DOING THE
RIGHT THING AT THE RIGHT TIME-
AND MAKING SURE THAT GOT THE
RIGHT PEOPLE WORKING FORM SO.
HOPE I ANSWERED YOUR QUESTION AS
WELL AS I COULD. APPRECIATE THAT
IN TERMS OF BY BY GUESS MY
QUESTION IS. SO IF WE ARE ABLE
TO INCREASE THE MEDICARE RATES
WILL WILL. DISSOCIATION BE DOING
ANY WAGE INCREASES ARE NOT
COMPLETE DEPEND ON MEDICARE. SO
IT IS MEDIC COW IS- A PRIMARY
FUNDER- SO THERE ANY OTHER
GOVERNMENT REPRESENTS I MEAN AT
LEAST THE MEDICARE PROGRAM
REPRESENTS TWO THIRDS OF THAT
SO- WE CAN'T WE WOULD SAY IT
CAN'T BE DONE WITHOUT IT. NOW
THERE WERE ADDITIONAL FUNDS THAT
WERE PROVIDED DURING THE
PANDEMIC AND CONTINUE WITH THE
TEN PERCENT- RATE ADJUSTMENT
THROUGH THE MEDICARE PROGRAM.
AND FACILITIES WERE REQUIRED TO
USE THOSE FUNDS BOTH FOR AND
WAGE INCREASES AND INFECTION
CONTROL PP. MANY IF NOT MOST OF
OUR FACILITIES UTILIZE THOSE
ADDED FUNDS TO INCREASE WAGES
FOR PROVIDE BONUSES OR
RECRUITMENT RETENTION TYPES OF
PROGRAMS FOR THEIR- THIRD FOR
THEIR EMPLOYEES SO I CAN SAY IN
MANY CASES NURSING FACILITIES
I'VE ALREADY RACED REACHES- TO
TRY TO ADDRESS ON THE WORK FORCE
SHORTAGES AND KEEP THEIR FOCUS-
A WORKING DURING THE PANDEMIC-
SO. ON IF FIRST I WOULD SAY THAT
THAT FOR THE MEDIC HEALTH
PROGRAM THE MEDICARE PROGRAM
DOES HAVE TO PROVIDE AT LEAST
TWO THIRDS OF THE FUNDS. TO PAY
FOR INCREASES IN WAGES BECAUSE
THEY REPRESENT TWO THIRDS OF THE
FUNDING FOR NURSING FACILITIES
BUT THAT DOESN'T MEAN THAT THE
NURSING FACILITIES ARE GOING TO
KICK IN THE OTHER THIRD. AND SO
THEY'RE SAYING LOOK WE'LL
COMMIT. TO RAISING WAGES BUT WE
NEED. OUR GOVERNMENTS OUR STATE
MEDICAID PROGRAM BECAUSE WE ARE
A PARTNER WITH YOU WITH THAT
PROGRAM. AND TO HELP US DO THAT
AND WE CAN'T DO WITHOUT
KNOWLEDGE THAT THE WHIMS MY
QUESTION IS YOU YOU SORT OF MADE
IT YOUR OF ONE THIRD DEPENDED ON
OUR TWO THIRDS AND- IF R. TWO
THIRDS DOESN'T HAPPEN WHILE
YOU'RE STILL WHAT WERE YOUR
ONCE. YOUR SECURE ONE THIRD
STILL COMMAND. AND AT AND I
WOULD ARGUE ARE ONE THIRD IS
ALREADY TRYING. IT'S ALREADY
THERE TO SOME EXTENT WITH THE
MONIES THAT WERE ALREADY
ALLOCATED THROUGH MEDICAL
PROGRAM AND ALSO. FACILITIES
NEED AND WANT- TO HAVE QUALITY
CARE GIVERS IN THEIR BUILDING SO
THEY ARE DOING EVERYTHING
POSSIBLE TO MAKE THAT HAPPEN AND
SO I CAN SAY THEY'RE PROBABLY
ALREADY DOING THAT PERSONALLY I
CAN'T I CAN'T TELL YOU FROM
FACILITY FACILITY. THE MITCHELL
SMITH WITH WASHINGTON BUT THINK
ABOUT THAT STATEMENT THE ONE
THIRTY THIRD IN THE WE ARE THE
WHICH IS ALREADY THERE. THE
WAGES ARE NOT ALREADY THERE. MR
NOT WHERE WE WOULD LIKE THEM TO
BE FOR SURE. THANK THIS IS YOUR
NO THEY ARE NOT THERE WHICH IS
WHY WE WOULD LIKE THE 10% OF TO
BE REPURPOSE BECAUSE AS OF RIGHT
NOW WE DON'T HAVE ANY AUDITS I
THINK WE HEARD FROM DH CS AND
ONE OF OUR MEETINGS THAT THEY
PROMISED TO GET IT TO US AND-
THEY'RE- HOPING THAT THEY KEEP
THAT PROMISE SO WE CAN SEE WHAT
HAPPENED TO THAT 10% BECAUSE
AGAIN. IF THIS IS GOING TO
CONTINUE POST- THE PANDEMIC WHAT
HAPPENED TO THE FIRST CHUNK OF
MONEY AND THEN WHAT'S GOING TO
HAPPEN AS A CONTINUE SO I WOULD
LIKE TO SAY IT'S NOT THERE
BECAUSE WE HAVEN'T SEEN. SUCH A
THING GOING BACK TO MISS SNYDER
SO YOU GOT. YOU GOT THE- THE
UNION SAYING THEIR WORKERS
AREN'T SEEING IT SO WHERE
WORKERS WERE THE MONEY. I THANK
THE I THINK WHAT MISS WHITTEN
WAS SAYING IS IF THEY HAVE THEY
DON'T KNOW BECAUSE FACILITIES
HAVE NOT BEEN AUDITED A NOW
FACILITIES ARE TRACKING THAT
INFORMATION REQUIRED TO HAVE IT.
SO I CAN SAY THAT IN MOST CASES
POLICE THAT I TALKED TO I'VE
SPOKEN TO THEY UTILIZE THAT
MONEY TO PAY MORE FOR WAGES AND
TO USE IT FOR BONUS PAYMENTS
RECRUITMENT RETENTION- IT LEAST
IN THE CONVERSATIONS I'VE HAD
WITH NURSING FACILITIES THAT'S
WHAT THEY USE THE MONEY FOR.
AGAIN MEDICAL PROGRAM HAS NOT.
BEEN PROVIDED THE INFORMATION SO
WE DON'T KNOW FOR SURE BUSH A
SIMPLE BONUSES ARE VERY
DIFFERENT FROM WAGE INCREASES.
TRIP SORRY TALKING ABOUT I
THOUGHT WE WERE TALKING YOUR
YOUR YOUR DRIVE TO TWENTY FIVE
IS TWENTY FIVE DOLLARS AN HOUR
RIGHT OKAY SO THAT'S A WAGE
INCREASE YOU'RE YOU'RE SAYING
YOU BY YOUR LAST STATEMENT IT
SAID IT WAS WORRIED THERE SO
YOU'RE SAYING THAT IT'S NOT
THERE IN TERMS OF WAGES BECAUSE
WHAT YOU MENTIONED WERE- BONUSES
AND RETENTION BONUSES WHICH I
THINK ARE ARE WONDERFUL BUT
THEY'RE NOT THAT'S NOT A WAGE
INCREASE. NO I APOLOGIZE IF I
SEEM TO IMPLY THAT. AT THAT THE
WAGES WERE ALREADY AT TWENTY
FIVE DOLLARS I DON'T KNOW OKAY.
YOUR ONE THIRD OF THAT DRIVE TO
TWENTY FIVE WAS A READER THAT'S
KIND OF WHERE YOU HAVE. AN
INTIMATE OKAY AND I APOLOGIZE
FOR THAT AS WELL ALL I CAN SAY
IS THE NURSING FACILITIES THAT I
HAVE SPOKEN WITH- THEY- HAVE
SAID THAT THERE THAT THE MONIES
THAT THEY HAVE. THEY'RE USING AS
MUCH AS THEY CAN TO GO TOWARDS
INCREASED WAGES FOR- OF FOR IN
THEIR EMPLOYEES. WHAT CALF IS A
TESTING TO IS THE FACT THAT.
AGAIN IT IS A GOVERNMENT-
NURSING FACILITY PARTNERSHIP
THAT. REQUIRES THAT THE MEDICAL
PROGRAM INVEST. THE DOLLARS. TO
MAKE SURE THAT THE FUNDING IS
THERE TO RAISE THE WAES AND
UNTIL THE MEDICARE PROGRAM CAN
AT LEAST PAY THE MAJORITY OF
WHAT IT'S RESPONSIBLE FOR.
NURSING FACILITIES WILL NOT HAVE
THE FUNDS TO BE ABLE TO RAISES
WAGES. OKAY SO SOUNDS LIKE THE
ANSWER'S. NO THAT EVEN IF WE
DON'T DO THE TWO THIRDS YOU
WON'T KICKING YOUR ONE FOR.
THAT'S WHAT THAT'S WHAT I GET TO
TWENTY FIVE CORRECT. OKAY SO
IT'S TWO VERY DIFFERENT THAN
WHAT YOU JUST SAID A MINUTE AGO
OKAY GOT IT. ARMY SO FROM- THE
ADVOCATES THERE'S A LIST OF.
ISSUES THAT THEY HIGHLIGHTED I
GUESS IT'S ON OF THESE OF THEIR
WARS ARE THE STAFF'S
REINTERPRETATION OF A WORSE
BAND. SELF DEALING SCHEMES TO
PREVENT DIVERSION OF PUBLIC
FUNDS INTENDED FOR CARE AND
STAFFING- I DON'T KNOW IF YOU'VE
READ ANY OF THESE BULLETS ON OF
THOSE ANY OF THESE ISSUES THAT
YOU WOULD AGREE WITH OR- YOU
FEEL LIKE YOU'RE WORKING ON. AND
IF YOU THE METER READ READ
RECITE IT PUTS HERE YOU MIGHT
NEED TO YEAH SURE- THAT THE
POINTS WERE PROHIBITS AN EXCUSE
BILLION PER MY REQUEST IS
PROHIBITED- LICENSEES FROM
CONTRACTING WITH MANAGEMENT OR
ADMINISTRATIVE SERVICE COMPANIES
TO CIRCUMVENT. THE
RESPONSIBILITIES TO OPERATE
STEPS IN ACCORDANCE WITH STATE
AND FEDERAL PERMITS. SUCH
ARRANGEMENTS ARE OFTEN BEING
USED TO ENRICH OPERATORS BY
FUNNELING MEDICARE PAYMENTS TO
UNREGULATED ON ACCOUNT. TO BOWL
COMPANIES THEY OWN OR CONTROL.
LOS NEXT BULLET CLOSE RELATED
PARTY LOOPHOLES AT TWENTY TWENTY
MINISTRY PEEL DECISION NARROWED
THE MEANING OF RELATED PARTY
QUORUM COURT RELATED PARTY AND
EXPANDED OPPORTUNITIES TO HIGH
PROFITS AND AVOID TRANSPARENCY.
NEXT BULLET IS IMPOSED STRICT
CAPS ON RENTS AND LEASE BACK
ARRANGEMENTS OPERATION OPERATORS
CALMLY CHARGE. INFLATED RATES
FOR LEASE PAYMENTS OFTEN USING
LAYERS OF SHELL COMPANIES TIE
PROFIT TO MAXIMIZE
REIMBURSEMENT. NEXT BOYS AND TAX
PAYER REIMBURSEMENT FOR
WORTHLESS A RELATED PARTY
INSURANCE OPERATORS ARE PAYING
EXORBITANT PREMIUMS TO
THEMSELVES FOR INSURANCE
PROVIDED BY RELATED PARTIES.
MEMBERS BEFORE INSURANCE SHOULD
BE LIMITED TO FAIR MARKET- RATED
ONLY FOR POLICIES FROM
INDEPENDENT INSURERS THAT
PROVIDE ERROR RELIABILITY
COVERAGE- BUT A BULLET IS
PREVENT TO REIMBURSEMENT OF
EXCESSIVE INTEREST RATES NURSING
HOMEOWNERS CAN PROFIT A
RESIDENTS EXPENSES. BY MAKING
LOANS TO NURSING HOME OPERATOR
COMPANIES THAT CONTROL EXCESSIVE
RATES EVEN THAT'S 10% MORE THIS
IS JUST ON PAGE. THIRTY FOUR OF
THE ANALYSIS. I NO THANK THANK
YOU DOCTOR I WOULD HAVE A MUCH
EASIER. I'M SORRY I SEE THIS IS
WHAT HAPPENS WHEN YOU DON'T
BRING YOUR READING GLASSES TO.
THANK YOU DR WORK OUR LEMONADE
NURSING HOME OWNERSHIP DRAWS.
CURRENTLY OWNERS MAY DRAW OR
TAKE ANY AMOUNT OF. OUT OF THE
NURSING HOME OPERATING BUDGET.
AT THE DISCRETION REDUCING
AVAILABLE FUNDS AND THEN LASTLY
PROHIBIT REIMBURSEMENT OF
NURSING HOMES ASSOCIATION DUES
NURSING HOME. SO SOLUTIONS ARE
BASIC LOBBY ORGANIZATION FOR THE
INDUSTRY THEY ARE USED TO SEEK
INCREASE STATE FUNDING. FOR
STRICTER OVERSIGHT AND DIMINISH
ENFORCEMENT CALIFORNIA SHOULD
NOT PAY FOR THESE TWOS. SO I
GUESS THE QUESTION IS JUST GOING
BACK TO MY EARLIER COMMENTS- YOU
KNOW IN IN THE THINGS YOU LISTED
WERE ALL THINGS THAT YOU WANT
OTHER PEOPLE TO DO FOR THE
INDUSTRY I'M STILL TRYING TO
FIGURE OUT WHAT YOUR DOING SUCH
TODD JUST WANT TO SEE IF YOUR-
COMMENTS ON THIS PARTICULAR BOSS
. THANK YOU SOME INTERPRETING I
APPRECIATE THAT- AND I
APPRECIATE YOU GOING THROUGH
THESE NOW I ACTUALLY HAVE THEM
IN FRONT OF ME SO IT'S A LITTLE
BIT MORE EFFECTIVE. AND SO FEW
THINGS I'D LIKE TO SAY IN
RESPONSE TO SOME OF THE- THE-
CALIFORNIA ADVOCATES FOR NURSING
HOME REFORM SOME OF THEIR-
THINGS THEY TALK ABOUT HERE SO
I. THINK SOME OF WHAT THEY- ARE
RAISING- WE HAVE BEEN PART OF
DISCUSSIONS IN THE LAST COUPLE
YEARS TO MAKE SURE THAT- MUCH OF
THIS CAN BE TRANSPARENT GONG
FORWARD- AND I THINK IT'S
IMPORTANT. YOU KNOW AS I
MENTIONED EARLIER SB SIX FIFTY
ASSEMBLY MEMBER WHAT HAD A BILL
COUPLE THREE YEARS AGO. THAT
THAT MAKE SURE NURSING
FACILITIES. ARE VERY TRANSPARENT
ABOUT. AS ALL OF THE RELATED
PARTIES- ALL OF THEIR AND- ANY
ANY OTHER TYPES OF RELATED
PARTIES THAT THEY OWN AND WHAT
REVENUES GO TOWARDS THOSE
PARTIES- SO I WOULD SAY FIRST
AND FOREMOST SOME OF WHAT THEY-
REYES HERE. WILL BE ADDRESS
GOING FORWARD IN THE REPORTING
THAT IS REQUIRED AND AGAIN. WE
PARTICIPATED IN THOSE
CONVERSATIONS WE WERE SUPPORTIVE
OF THE TRANSPARENCY- AND- ENDED
UP GOING TO A NEUTRAL POSITION
ON THAT BILL AS WE TALK THROUGH
IT WITH THE PROPONENTS INCLUDING
CANNER- I THINK- WHEN. IT'S ALSO
IMPORTANT TO NOTE THAT ON THE
MEDICARE PROGRAM DOES. CLEARLY
AUDIT WHERE FUNDS MEDIC MEDICAID
FUNDS GO. AND DISALLOW ANY FUNDS
THAT RE NOT APPROPRIATE ARE NOT
AT MARKET VALUE OR IF THEY
DEEMED TO NOT BE A MEDIC CAL
DIRECT COST. SO THE MEDICARE
PROGRAM HAS AN AUDITING PROGRAM
THAT FACILITIES MUST YOU KNOW.
PROVIDE CLEAR DOCUMENTATION AND
INFORMATION TO THE PROGRAM AND
THEY COME IN ANNUALLY TO ON IT.
SO I THINK THAT'S AN IMPORTANT
PART TO IT BACK TO TRANSPARENCY
IN TRACKING THATINFORMATION. I
ALSO SAID EARLIER THAT OFF IS
OPEN TO OTHER FORMS OF LOOKING
AT- TRANSPARENCY WHERE THERE CAN
AND SHOULD BE REASONABLE COSTS-
I DO THINK IT'S IMPORTANT THAT
IN. EVERY AREA OF HEALTH CARE.
WE HAVE ENTITIES THAT OWN
DIFFERENT PARTS OF IT. AND THAT
DOESN'T MAKE NURSING FACILITIES-
YOU KNOW THEY'RE NOT ANY
DIFFERENT THAN ANY OTHER HEALTH
CARE PROVIDER- THEY MIGHT OWN-
YOU KNOW A POSSIBLY THE NURSING
FACILITY ITSELF BUT THEY ALSO
MIGHT OWN A LIP THERAPY COMPANY.
AND SO THE PAYMENTS THAT THEY
MAKE TO THAT THERAPY COMPANY.
SOMETIMES ACTUALLY DO SAVE
MONEY- AS OPPOSED TO COST MONEY
AND SO I THINK. TO CONSIDER-
NURSING FACILITY IS IT ANY
DIFFERENT THAN ANY OTHER. ENTITY
FOR PURPOSES OF ONLY DIFFERENT
COMPANIES I THINK WE'RE OPEN TO
MAKING SURE THAT WHATEVER THOSE
TRANSACTIONS ARE ARE TRANSPARENT
AND WE'RE OPEN TO ANY. OTHER IS-
ANY OTHER IDEAS THE LEGISLATURE
HAS SENT TO MAKE THAT MORE
CLEAR. WELL SEEMS LIKE FIRST YOU
NEED A LITTLE MORE TRANSPARENCY
ON YOUR WAGES COULD YOU HAVE THE
PERSON REPRESENTING THE LABOR
FOR SAYING THAT THEY TURNOUT
SAYING THE WAGES- SO ARE YOU ARE
YOU SAYING IN TERMS OF- RENTS
AND LEASE BACKS- INSURANCE
CHARGERS- AS WELL AS- INTEREST
RATES THAT THESE ARE ALL MARKET
- THE THESE ALL STAND UP TO
MARKET BECAUSE THE- THE
ADVOCATES ARE SAYING THEY'RE WAY
ABOVE MARKET. I CAN'T GET
PERSONALLY I CAN'T SPEAK TO THAT
ALL I DID SAY ONE WAS NOT OR NOT
YOUR YOUR RIBS IN THE INDUSTRY I
UNDERSTAND THAT- WHAT I SAID WAS
THAT THE MEDICARE PROGRAM HAS A
CERTAIN WAY THAT THEY CALCULATE-
PAYMENTS TO NURSING FACILITIES
FOR PURPOSES OF RENTS AND LEASES
AND IT'S- IT'S BASED ON A
PARTICULAR FORMULA IT'S NOT
BASED ON WHAT. THE FACILITY PAYS
IN RENT OR LEASES- I WOULD- I
WOULD SAY AND I'VE ACTUALLY HAD
THIS CONVERSATION JUST RECENTLY
WITH A CONSTANTLY WITH ASSEMBLY
MEMBER WOULD STAFF ABOUT. A WEEK
WE ACTUALLY THINK THAT'S AN AREA
THAT NEEDS A LITTLE BIT MORE
ATTENTION BECAUSE- IN MORE CASES
THAN OFTEN- IT'S NOT THE NURSING
FACILITY OPERATOR THAT OWNS THE-
THE- ACTUAL BUILDING ITSELF
IT'S- OTHER FORMS OF. REITS OR
OTHER THINGS AND A LOT OF CASES
ARE FOLKS ARE CONCERNED ABOUT
WHAT THOSE COSTS ARE AS WELL-
IT'S OVER AT LEAST FROM MY
PERSPECTIVE I THINK IT'S AN AREA
WHERE WE NEED TO WORK ON THAT-
AND WE'RE OPEN TO IT TO TALKING
MORE ABOUT. WAYS THAT WE CAN
LOOK AT RECENT COSTS IN THAT
REGARD. GREAT THANK YOU I'M I'M
JUST GOING TO GO BACK TO- MISTER
CHIP. TO TELL THANK YOU THANK
YOU DEAR DEAR RESPONSE BECAUSE-
FROM THE STARTERS RESPONSE
BECAUSE I DID THANK YOU MUCH OF
AN ANSWER. SO THESE ARE YOUR
BOARDS. YEAH I THINK YOU
ASSEMBLY MEMBER TEAM I HAVE A- A
FEW RESPONSES I THINK IT'S
IMPORTANT TO NOTE THAT THIS
SYSTEM IS REIMBURSEMENT SYSTEM
WAS DEVISED IN TWO THOUSAND FOUR
WITHOUT ANY PARTICIPATION ANY
MEANINGFUL PARTICIPATION FROM
RESIDENT ADVOCATES IT WAS SORT
OF A LAST MINUTE DEAL. WITH THEM
WE WERE EXCLUDED FROM AND WE
SUBMIT THAT SINCE TWO THOUSAND
FOUR THERE HAVE BEEN PLENTY OF
DOLLARS AVAILABLE TO BUY GOOD
CARE IN NURSING HOMES SINCE TWO
THOUSAND FOUR PAYMENTS TO
NURSING HOME FROM THE STATE HAVE
GONE UP OVER ONE HUNDRED
PERCENT. AND THE AMOUNT PAID IN
WAGES TO STAFF IS ABOUT 50%
INCREASE THERE'S A BIG DISPARITY
THERE- WE'VE BEEN RICH. OWNERS
THE- MULTIPLE IN THE STATE HAVE
BEEN ENRICHED- BUT THERE'S BEEN
LONG LONG STANDING UNDER
INVESTMENT. IN THE WORKFORCE SO
OUR OUR PROPOSAL WE HAVE A LOT
OF- RECOMMENDATIONS AND THANK
YOU FOR EXPLORING A LOT OF THEM
THAT THEY'RE ALL STILL VERY
VIABLE BUT WHAT WE REALLY WOULD
LIKE. IS FOR ANY FUTURE
INCREASES CAN BE TIED DIRECTLY
TO STAFF TO INCREASING THE
STAFFING MINIMUM SO THAT WE KNOW
THAT WHAT WE'RE PAYING FOR IS AT
LEAST SOMEWHAT RELATED. TO
INCREASE STAFF- WE DO HAVE AGAIN
WE'RE ALL FOR INCREASING WAGES
JUST TO FRONTLINE WORKERS
MEETING THAT THAT'S A VERY GOOD
IDEA- BUT ONE OF OUR CONCERNS
ABOUT. SUBSIDIZING CNA'S IS THAT
THEY MIGHT END UP IF. THEY MIGHT
END UP REPLACING LPNS ARE
REGISTERED NURSES. ARE ONES THAT
C. N. A.'S I WILL PAYING THEM
MORE WE GET THEM IN THE BUILDING
BUT THEN THERE'S NOTHING TO STOP
THE FACILITIES FROM THAN LAYING
OFF OTHER DIRECT CARE WORKFORCE.
INSTEAD BECAUSE NOW THAT IT'S
CHEAPER TO HIRE THIS UNITS SO-
LOTS OF CONCERNS ABOUT HOW THIS
WOULD BE DONE BUT AGAIN. WE'RE
TOTALLY FOR INCREASING WAGES
INCREASING. WORKFORCE NURSING
ABSOLUTE. WELL FRANKLY YOU I
APPRECIATE THAT THE FEEDBACK ARE
WHAT WE QUESTION HAD IS THE TO
BACK TO WHAT MR IT IS. YOU MET
MEDICARE'S A FORMULA IT'S ALL
THESE THINGS ARE REIMBURSED IS
IT. IS IT IS THIS ONE OF THE
ISSUES THAT YOU ARRANGE FOR
MEDIC CAL IS BEING TOO
PERMISSIVE THAT THESE. YOU KNOW
THE RENTS THE LEAST BACKS THE-
INSURANCE THE INTEREST RATES
THAT THIS REALLY. CAN US NOT
DOING OUR JOB TO TIGHTEN
MEDICARE. YEAH WE SUBMIT THAT
THERE'S- TONS OF INFLATED RATES
BEING PAID TO RELATED PARTY
ENTITIES. THERE ARE ON THE BOOKS
MEDI CAL AUDITS AND JUST
ALLOWANCES FOR CERTAIN. COSTS
ARE ONE OF THE PROBLEMS THOUGH
IS WHEN YOU HAVE SO MANY
OPERATORS INFLATING THEIR RATES
THAT RISE THE AVERAGE RATE UP
SO. YOU COST MIGHT NOT LOOK SO-
OUTLOOK SO MUCH LIKE AN OUT LIAR
OF EVERYONE ELSE IS DOING IT.
ANOTHER PROBLEM WITH THE JUST
ALLOWANCES IS THAT IT DOESN'T
REQUIRE THAT THE FACILITY REFUND
THE MONEY. IT JUST GETS BAKED
INTO THEIR FUTURE MEDICARE RIGHT
MAYBE THE MEDICARE RATE GETS
LOWERED IN THE FUTURE BUT THAT
GIVES THEM AN OPPORTUNITY. TO
RAISE OTHER COSTS. IN RETURN SO
IF YOUR COSTS ARE HIGH YOU CAN
JUST KEEP RAISING UNKNOWNS OSCAN
THE QUESTION. BECAUSE EVERYONE'S
COSTS ARE HIGHER THAN NO ONE CAN
THAT. THAT'S THAT JUST COMES
WITH THE MARKETERS. PRECISELY SO
OKAY. ARE KICKING WE GO MISS.
AARON TURNER NO SHE'S. WELL INTO
AND SEARCH IT JUST GOING BACK TO
MEDICARE ALL- HOW IS THIS YEAR
WHAT WHAT THE ADVOCATES ARE
RAISING THOSE ISSUES THIS IS
REALLY AN ISSUE THAT WE WOULD
THAT SOUND IN OUR HANDS THAT WE
HAVE TO GO OVER FOR MEDICAL. SO
WHAT I WOULD SAY IS THAT I THINK
REALLY STATE WE DO HAVE A IN ALL
HONESTY IT BUT IT JUST OR
LEMONADE ANY OF THE NON ELIGIBLE
OR EXCESSIVE COST- INCLUDING
THINGS LIKE PROFITS FROM RELATED
PARTY TRANSACTIONS- IN ADDITION
YOU KNOW. IF THERE ARE
INDICATORS OF FRAUD THAT ARE
IDENTIFIED DURING THE COURSE OF
ANY OF THE ANNUAL FACILITY
AUDITS WE- WILL OPEN A FRAUD
INVESTIGATION AND OUR
INVESTIGATIONS ARE ALSO. OPEN
BASED ON COMPLAINTS RECEIVED
FROM ALL SOURCES INCLUDING THE
PUBLIC AND OTHER REGULATORY OR
LAW ENFORCEMENT AGENCY. AND IF
WE DO DETERMINE IF THERE'S A
CREDIBLE ALLEGATION OF FRAUD.
AND WE WILL WORK FOR THE CASE.
TO WILL TALK ABOUT FRAUD I.
THINK YOU YOU HEARD- MISTER TELL
WHAT HE WAS TALKING ABOUT WAS
THE INDUSTRY. AND IF THE AID THE
ENTIRE IF EVERYONE IN THE
INDUSTRY IS INFLATING THE COST
BECAUSE THEY CAN GET. MONEY BACK
FROM MEDICAL- IS THAT SOMETHING
THAT WERE REVIEWING BECAUSE
THAT'S WHAT HE'S- ARTICULATE.
DOCTORS ARE LOOKING AT RELATED
PARTY- COST AND LOOKING TO
DETERMINE WHETHER OR NOT THOSE
ARE APPROPRIATE ME CAPTURED- WE-ARE ALSO LOOKING TO IDENTIFY ANY
OVERPAYMENTS THAT ARE RECOVERED
FROM THE FACILITY- THESE COULD
BE DUPLICATE PAYMENTS- PAYMENTS
AT WORK. WOULDN'T TALK TO
BRUSSELS WHEN YOU TALK ABOUT THE
AUDITORS ARE HOW HOW DID THE
WHAT HE'S SAYING IS THE BASELINE
IS SO HIGH THAT WE'VE ACCEPTED
THIS REALLY HIGH BASELINE AND
WE'RE GETTING KIND OF YOU KNOW
WERE WERE FOR PAN- A LOT TO THE
OPERATORS WHO OWN THE INSURANCE
COMPANIES THEY ON THE BUILDINGS. THEY ARE LENDERS. OR NOT PAINS
SEEMS LIKE WE'RE NOT PAYING THE
WORKERS THAT'S BEEN ESTABLISHED-
SO I GUESS WHEN YOU LOOK AT WHEN
THE AUDITORS A LOOK AT THAT HOW
DID THEY DETERMINE WHAT THE
BASELINE READ WHAT THE BASELINE-
YOU KNOW INSURANCE PAYMENT
SUPPOSED TO BE WHAT THE BASELINE
INTEREST RATES SUPPOSED TO BE.
I'M A 10% INTEREST IT SOUNDS
PRETTY PRETTY HIGH. I AM J.
ASSEMBLY MEMBER I DON'T HAVE
SPECIFIC DETAILS OF HOW THEY DO
THAT CALCULATION- HOWEVER I DO
KNOW THAT THEY THEY WORK AT
EXTENSIVELY AMONGST THEMSELVES
STARTED TO WORK THROUGH AND
ENSURE THAT WHEN THERE ARE
RELATED PARTIES THAT THAT THEY
ARE LOOKING- ARE BROADLY TO
DETERMINE WHAT'S APPROPRIATE. WE
GET AN ANSWER BY NEXT WEEK
REGARDING THE SPECIFICS TO THESE
QUESTIONS I WILL TAKE THAT BACK
YES- THEN- JUST GO GO GO INTO
THE WORK FORCE I THINK THIS IS
YOU KNOW- I'M NOT A WORK FORCE
EXPERT YOU KNOW WE HAVE WE
ACTUALLY HAVE WORKFORCE EXPERTS
HERE SO I'LL TRY TO BE FAST AND
WHAT THE EXPERTS CRACKS OR
QUESTIONS BUT WHAT WHAT IS VERY
CLEAR IS ON WE HAVE AN INDUSTRY
THAT EMPLOYS PEOPLE WHO CAN'T.
LIVE ON THE JOBS. THAT THEY'RE
WORKING. AND WHAT I MEAN BY THAT
IS IT DOESN'T SEEM LIKE- THE
LOWEST PAID WORKERS IN THE WORK
FORCE TO PAY FORTY HOURS- WE SAW
WE HEARD DOING COVERT QUITE
OFTEN. THE LOWEST PAID WORKERS
WERE SPREADING COVERT BECAUSE
NOT NOT BECAUSE THEY WERE OUT
HAVING A GOOD TIME IS BECAUSE
THEY WERE GOING FROM ONE NURSING
HOME TO THE NEXT NURSING HOME TO
THE NEXT NURSING HOME BECAUSE
THERE WERE TWO OR THREE JOBS. SO
I GUESS- YOU'RE GOING BACK TO
AGAIN WHAT IS THE INDUSTRY DOING
MISTER CAN YOU TALK ABOUT. HOW
YOU'RE WORKING TO TRY TO. NOT
HAVE NOT BE TOTALLY RELIED ON A
PART TIME WORK FORCE PER FULL
TIME WORK FORCE AND ARE. YOU
KNOW BETTER BETTER PAID WORK
FORCE THEY DON'T HAVE TO WORK.
THREE JOBS THREE FACILITIES. I
WOULD SAY THAT THAT WAS ONE OF
THE MANY ONE OF THE MOST
IMPORTANT GOALS FIRE- NURSING
FACILITY WAS- YOU KNOW TRYING TO
MAKE SURE THAT THEY USE THOSE
PANDEMIC FUNDS. TO RAISE
SALARIES WAGES- BECAUSE EVEN IF
IN SOME CASES C. N. A.'S WERE
FULL TIME WORKERS THEY WOULD
NEED TO WORK MULTIPLE JOBS TO BE
ABLE TO. TO MAKE THINGS YOU KNOW
I WORK SO- APPRECIATE THAT AND I
DO APPRECIATE- YOU KNOW THIS
THAT SITUATION AND WAGES- FOR
OUR NURSING HOME WORKERS I
THINK- THAT IS WHY. A CALF HAS
PROPOSED. THE PROPOSAL THAT THEY
HAVE WHICH THEY SAID WHICH IS
THE DRIVE TO TWENTY FIVE AND
MAKING THAT COMMITMENT- IN
PARTNERSHIP WITH MEDICAL PROGRAM
AS WE MOVE FORWARD TO GET TO
THAT TWENTY FIVE DOLLARS AN HOUR
FOR THEIR C. N. A.'S AND MOVE
THE INDUSTRY FORWARD. IN
PARTNERSHIP WITH THEIR DIRECT
CARE WORKFORCE OKAY I GET THAT
BUT IT'S CLEAR YOU KNOW YOU WANT
MORE MONEY FROM US YOU WANT MORE
MONEY FOR US FOR TRAINING YOUR
MORE MONEY FOR US FOR MEDIC CAL.
WHAT I DIDN'T HEAR IS WITH THE
INDUSTRY PUTTING ON THE TABLE I
DIDN'T HEAR ANY INDUSTRY MONEY
COME THE TABLE. EXCEPT FOR THE
ONE THIRD THAT MIGHT COME A FIVE
MINUTE CAL COMES BUT OUTSIDE OF
THAT LIKE YOU KNOW. AND AGAIN I
DON'T I DON'T I'M NOT. I'M NOT
SAYING THAT THIS IS TRUE WITH MR
JUNCKER TELLS CENTER. I HAVE
NOTHING TO BELIEVE THAT IS NOT
TRUE. BUT IS THERE ANY BELT
TIGHTENING IS THERE ANY
EFFICIENCY WHAT WHAT'S THE
INDUSTRY BRING TO THE TABLE
EXCEPT FOR. A LITTLE MORE MONEY
ON TOP OF A MEDICARE RATING
CHRIS. I WOULD SAY THAT. WHAT WE
HAVE DONE IN THE PAST WHAT WE'RE
CONTINUING TO DO IS TO MAKE SURE
THAT WHERE THERE IS POSSIBLY.
ABUSES THAT TONY TO TELL HAS
MENTIONED THAT THE ADVOCATES OF
MENTION. THAT THERE WERE WILLING
AS AN INDUSTRY TO BE TRANSPARENT
ABOUT THAT AND TO ALLOW FOR THE
STATE TO LOOK AT THAT. AND
DETERMINE IF THOSE COSTS ARE
REASONABLE OR NOT- YOU'RE ASKING
US FOR MORE MONEY ON TRADE RIGHT
SO HOW MUCH IS THE ASSOCIATE HOW
MUCH IS YOUR COLLECTION OF.
OPERATORS GOING UPON TABLE FOR
TRAINING. YOU KNOW HOW HOW HOW
ARE THEY GOING TO BE. TAKING A
LOOK AT TIGHTENING THEIR BELTS I
MEAN ALL I ALL I SAW ON YOUR
FOUR POINTS WAS GOVERNMENT THIS
GOVERNMENT THAT DISPUTE. YOU'RE
MOSTLY A FOR PROFIT INDUSTRY.
SEOUL I UNDERSTAND I UNDERSTAND
I MEAN IT'S IT SOUNDS LIKE
YOU'RE COMPLETELY RELIANT ON
GOVERNMENT TO RUN YOUR INDUSTRY
WHICH I DON'T THINK IT'S TRUE
THOUGH BUT THAT'S BASED ON THE
FOUR POINTS YOU BROUGHT FORWARD
TO THIS COMMITTEE I DIDN'T SEE
HEY THIS IS WHAT WE WANT YOU TO
DO THIS IS WHAT WE'RE DOING DOT
THE WHAT WE'RE DOING IS MISSING
AT LEAST INTRODUCED IN THIS
ANALYSIS OF MAYBE IT'S AN
OVERSIGHT FROM OUR CONSULTANT
WHO. MAY NOT HAVE THAT
INFORMATION BUT I WOULD HAVE
BEEN INFORMATION ABOUT WHAT
YOU'RE DOING. FOR THEM. WHAT MY
PURPOSE WAS FOR TODAY WAS TO.
RELATE WHAT WE HAD HOPED WOULD
HAPPEN WITH THE SIXTEEN TWENTY
NINE REIMBURSEMENT PROGRAM. AND
WITH MEDIC CAL AS A PARTNERSHIP
WITH OUR FACILITIES. I APOLOGIZE
IF I AM NOT PREPARED TO ACTUALLY
GIVE YOU WHAT THE INDUSTRY IS
DOING. I KNOW THAT THEY ARE- I
KNOW THAT THEY ARE DOING
SOMETHING AND THEY'RE DOING A
LOT SO. MAYBE WHAT I CAN DO
TODAY IS COMMIT TO YOU. THAT WE
WILL PROVIDE YOU WITH THAT
INFORMATION AS SOON AS POSSIBLE
HI AT THE SOONEST ALL TO MAKE.
SURE THAT YOU HAVE THAT. EXACTLY
WHERE THEIR COMMITMENT LIES YOU
KNOW WE'RE GONNA. YOU KNOW
SOMEHOW I DON'T GET PAID IF I
DON'T GET THE BUDGET DONE BY
JUNE FIFTEENTH THAT'S A DATE. SO
WHAT I'D SAY IS HOW ABOUT NEXT
WEEK. SURE THANK YOU THANK YOU.
THANK YOU JORDAN DR WHAT IS
GOING TO FOLLOW UP ON A COUPLE A
COUPLE OF THINGS- THAT'S THE
QUESTION SO- V. AUDITS THE YARD
IS RELATED TO- RELATED PARTIES
WENT NGUYEN HAVE HOW HOW MANY
HAVE HOW MANY HAVE BEEN
COMPLETED AND IF WE HAVE A
COMPLETED. WHICH IS WHAT I THINK
IS HAPPENED WHEN CAN WE EXPECT
THOSE AUDITS TO HAPPEN. BECAUSE
THE QUESTION BAGS THAT AND THIS
IS WHERE MR TANG WAS GOING. IT
WE DON'T KNOW WHAT THE WHAT'S
HAPPENING OUT THERE HOW DO WE
KNOW. YOU KNOW WHAT'S REASONABLE
GOING FORWARD SO WIN HOW MAY I
HAVE THE ODDS HOW MANY AUDITS
HAS BEEN AVAILABLE AND IF NOT
WHEN CAN WE EXPECT THAT BECAUSE-
I THINK THIS WAS SET. PRETTY
SURE BECAUSE IT WAS PROBABLY MY
WORK THAT WE SET THIS IN MOTION
QUITE AWHILE AGO SO. HELP US
UNDERSTAND WHERE WE ARE IN THE
PROCESS. SO THANK YOU AS A
MEMBER AND I JUST WANT TO CLEAR
FOR YOU ASKING ABOUT THE AUDITS
ASSOCIATED WITH THEIR COPING
RELATED EXPENDITURES OR THE
RELATED EXPENDITURES NO NO PER
PRIOR TO THAT THE. THE THIRD
THE- RELATED PARTIES. I WILL
HAVE TO TAKE THAT BACK TO THEM
AND ASK OUR AUDITS AND
INVESTIGATIONS YOU EXACTLY HOW
MANY HAVE BEEN- COMPLETED I KNOW
THAT THAT DOES AUDIT THAT IS
PART OF THE AUDIENCE THAT THEY
ARE DOING NOW- DAY INCLUDE A
REVIEW OF THE RELATED PARTY-
COMPONENTS AND EXPENSES BUT I
DON'T HAVE A NUMBER OF HOW MANY
HAVE HAD TO PRODUCTION TO
ASSOCIATED WITH THAT- AVAILABLE
BUT I TAKE THAT BACK AND HAVE
THAT BE PART OF OUR RESPONSE. AT
THIS POINT I INTERESTED IN
REDUCTIONS I'M JUST INTERESTED
IN WHERE WE ARE IN THE PROCESS
MAYBE MISS WINDOWS BUT WHEN THIS
ANSWER I DO NOT KNOW YOU DO NOT
OKAY. I'M INTERESTED. I WONDER
WHAT AND THEN. THE INCLUSION OF
THAT REVIEW OF THE RELATED PARTY
IS HAPPENING TODAY. AND THAT IS
THAT IS HAPPENING IN THIS PART
OF THE AUDITS THAT ARE COMPLETED
. AND WE- ON AN ANNUAL BASIS I
HAVE TWO YEARS IN ARREARS. OKAY
OKAY APPRECIATE THAT SO- AND I'M
JUST GOING TO FOLLOW UP I WANT
TO FOLLOW UP ON SOMETHING THAT
THAT THAT IS A LITTLE BIT
TROUBLING AND SO. I APPRECIATE
THE DRIVE TO TWENTY FIVE AND HOW
THAT IS GOING TO BE DEPENDENT
ON. WHETHER THE STATE CAN
PROVIDE FOR PROVIDE MORE MONEY
BUT I DO WANT TO POINT OUT A
COUPLE OF THINGS- NUMBER ONE.
IT'S MY UNDERSTANDING THAT- IN
THIS COUNTRY MET PACKED SO ISN'T
MY THIS ISN'T MY INFORMATION-
THAT CONSOLIDATION IN HEALTH
CARE- IS A GROWING ISSUE.
CONSOLIDATION AND THE HIGHEST
PERCENTAGE WISE CONSOLIDATION AS
FAR AS- IS IN NURSING HOMES. AND
I BELIEVE WAS ELEVEN POINT 4% IS
WHAT I'M RECALLING AND IF I'M
WRONG I'M WRONG BUT BUT I.
CONSOLIDATION AND PRIVATE EQUITY
. PRIVATE EQUITY IS ALL ABOUT
PROFIT SO I'M TROUBLED THAT-
WE'VE HEARD YOU HAVE
BILLIONAIRE- OPERATORS- YOU
HAVE- CONSOLIDATION- WE HAVE ALL
THESE RELATED PARTIES HERE- WITH
INCLUDE THINGS LIKE UNNECESSARY
INSURANCE AND HIGH INTEREST
RATES AND- AND. AND WE'VE HAD WE
HAD WE HAD YOU KNOW CHALLENGES
OBVIOUSLY DURING CODED AS WELL
SO. I A- I. I'M JUST I'M
STRUGGLING IT BECAUSE LIKE LIKE
MR TANG SAID YOU KNOW THE
INDUSTRY IS LARGELY FOR PROFIT-
SO WHY ISN'T THAT TRICKLING DOWN
- IF ALL OF THESE THINGS IT AND
MAYBE NOT EVERYTHING HERE IS
HAPPENING TO THE LEVEL THAT IS
BEING PRESENTED TO US I DON'T
KNOW THAT THAT'S WHY THESE
AUDITS ARE SO IMPORTANT. AND SO
WOULD LIKE TO SEE THOSE AS SOON
AS POSSIBLE SO THAT WE CAN
ACTUALLY UNDERSTAND WHAT'S GOING
ON. BUT YOU KNOW- IN OWNING AND
LEASING BUILDINGS IT'S IT IS
REALLY DIFFICULT I KNOW IN MY
OWN DISTRICT THERE'S OPERATORS
IT'S REALLY REALLYDIFFICULT TO
UNDERSTAND WHAT THE HELL IS
GOING ON QUITE FRANKLY. AND YOU
KNOW YOU OPERATORS. BRING IN
DIFFERENT PEOPLE TO SET UP A
DIFFERENT ENTITY AND- AND- EVEN
ENTITY FOR LAUNDRY- INTERVIEW
ALL ENTITY FOR ALL THESE OTHER
THINGS. THEY'RE ALL REALLY TIED
BACK TO. A CORE GROUP OF PEOPLE-
AND IT FEELS LIKE THE ONLY.
PURPOSE IS TO GET MORE PROFIT.
SO IF THEY'RE PROFITABLE
ALREADY. AND MAKING YOU KNOW
MAKING THESE PROFITS WHICH- YOU
KNOW AT GOVERNMENT EXPENSE. WHY
WHY CAN'T I AND I'M ALL FOR
PROFIT DON'T GIVE. ME I HAD MY
OWN BUSINESS I NEEDED TO BE
PROFITABLE TO SURVIVE THAT'S-
THAT. BUT AT WHAT POINT. ARE WE
SACRIFICING THE LEVEL OF CARE
FOR PEOPLE- HAS CERTAINLY WHAT
POINT WE SACRIFICING THE
SALARIES OF THE PEOPLE TO TAKE
CARE OF PEOPLE. I JUST. AND
THAT'S WHY THIS THAT'S WHY THE
THAT'S WHY THAT'S WHY GO BACK
THESE AUDITS WENT YOU KNOW WHEN
WE GOING TO GET THEM SO WE CAN
REALLY UNDERSTAND THIS. AND YOU
KNOW. AND I APPRECIATE THAT THE
TRANSPARENCY- AND I HOPE THAT
THE TRANSPARENCY WHAT IT OFTEN
LEADS TO WAS. IF THERE'S THINGS
GOING ON YOU CAN BET THAT THIS
LEGISLATURE IS GOING TO DO
SOMETHING ABOUT IT BECAUSE- BUT
I WANTED TO BE. I HOPE WE'RE
GETTING TRANSPARENCY THAT. YEAH
HE CAN YOU CAN SEE THROUGH ALL
THE WAY ALL THE WAY DOWN DOWN
THE STREET BECAUSE- I THINK
THERE'S A IT JUST FEELS LIKE
THERE'S A LOT GOING ON IN THE
BACKGROUND. AND- LIKE TO GET TO
THE BOTTOM OF IT. THANK YOU
DOCTOR WOULD AND I WOULD LIKE TO
THANK THIS ENTIRE PANEL FOR THE
ROBUST DISCUSSION. WE WILL NOW
MOVE ON IN HERE OUR FINAL PANEL
PANEL NUMBER FIVE. WHICH IS ON
THE MEDICAL DENTAL PROPOSALS AND
ISSUES. WE WILL HAVE TO
PRESENTERS ON THIS PANEL
BEGINNING WITH RENEE MAILLOT.
THE DEPUTY DIRECTOR FOR HEALTH
CARE BENEFITS AND ELIGIBILITY AT
DH CS. AND MONICA MON TANO.
REGULATORY AND LEGISLATIVE
ADVOCATE FOR CALIFORNIA DENTAL
ASSOCIATION. LET US BEGIN WITH
RENAME ALL OF. THANK YOU SO MUCH
SHARE I'M SO FIRST I'M GOING TO
COVER OUR EVIDENCE BASED
PRACTICES AT THE HELP OKAY AND
THEN I'LL TALK ABOUT THE DEMO.
SO THE DEPARTMENT OF HEALTH CARE
SERVICES WERE PROPOSING TO THE
EXISTING LAW ALAINA SCHEMERS AND
DENTAL CARE WITH EVIDENCE BASED
PRACTICES. AND NATIONALLY
RECOGNIZED GUIDELINES FOR THE
MEDICARE POPULATION BY ADDING
HAS A COVERED BENEFIT LABORATORY
PROCESS CROWNS FOR INDIVIDUALS
OVER THE AGE OF TWENTY ONE. THE
BUDGET INCLUDES A THIRTY SEVEN
MILLION IN TOTAL FUNDS THIRTEEN
MILLION GENERAL FUND IN THE
BUDGET FOR THIS PROPOSAL. UNDER
CURRENT LAW INDIVIDUALS WHO ARE
UNDER THE AGE OF TWENTY ONE
LABORATORY PROCESS CROWNS ON
POSTERIOR TEETH. ARE NOT A
COVERED BENEFIT EXCEPT FOR WHEN
THERE'S A POSTERIOR TOON THAT IS
NECESSARY AS AN APARTMENT TO ANY
FIXED OR REMOVABLE FEAST. THE
EXISTING REIMBURSEMENT RATE
COMPORTS WITH OTHER SIMILAR
SERVICES COMPLEXION WE NEED
BASED ON LAFAYETTE. AND AS AN AS
AN EXAMPLE IN IS ALSO ELIGIBLE
THAT LABORATORY THE CROWNS THAT
WE COVER IN THE MEDICAL PROGRAM
IT IS ALSO ELIGIBLE FOR A 40% A
SCHEDULE OUT MAXIMUM ALLOWANCES
SUPPLEMENTAL PAYMENTS UNDER OUR. FIFTY SIX A SUPPLEMENTAL
PAYMENTS TODAY. THE NEXT
PROPOSAL I'M GOING TO COVER IS
ON OUR DENTAL MANAGED CARE
EXTENSION BUDGET PROPOSAL. SO WE
DO HAVE PROPOSED CUTS IN THE
OPERATION THE OPERATING- THE
EXISTING DENTAL MANAGED
CONTRACT. DECEMBER THIRTY FIRST
OF TWENTY TWENTY TWO TO THE
FOLLOWING YEAR I'M IN BEING
HIDDEN TWENTY TWENTY THREE. THIS
EXTENSION IS NECESSARY IN ORDER
FOR US TO PROCURE AND EXECUTE
NEW CONTRACTS TO CONTINUE THE
DOMINANCE CARE DELIVERY SYSTEM
IN SACRAMENTO AND THE LOS
ANGELES COUNTY. THE END OF THE
NINETEEN FIFTEEN BE RIGHT. AND
AGAIN THIS IS THE WAY OF OUR
THAT WAS JUST APPROVED BY CMS.
AB THAT WAS A RENEWAL OF OUR
FIRE. NINETEEN FIFTEEN THE WAY.
SO CONTRA WORTH FROM THE FOR
WOULD BE A- NO SOONER CHEN ONE
OF TWENTY TWENTY FOUR. AND DO
YOU SEE THAT IS COMMITTED TO
INCREASING MEDICAL BENEFITS YOUR
UTILIZATION OF DENTAL SERVICES
STATEWIDE. EXTENSION TIMELINE
FOR THE DENTAL MANAGED CARE
PLANS WILL FORCE BOND WITH THE
TIME FRAME THAT IS WHEN YOU GET
FOUR DEFEATS THE ASCOT BERKSHIRE
NEW CONTRACTS. VIA A COMPETITIVE
PROCUREMENT PROCESS. WE INTO TO
MAINTAIN OVERSIGHT AND
ACCOUNTABILITY OF ALL OF OUR DMC
CONTRACTORS OR DENTAL MANAGED
CARE CONTRACTORS. THE EXTENDED
CONTRACT TAKE INCREASE MEMBER
UTILIZATION OF DENTAL SERVICE.
ADDITIONALLY OUR FEDERAL
PARTNERS THE CENTERS FOR
MEDICARE AND MEDICAID SERVICES
HAVE SHARED AN INTEREST IN
SEEING DENTAL UTILIZATION RATES
IMPROVING AND OUR DENTAL MANAGED
CARE COUNTY AGAIN THAT IS IN
SACRAMENTO AND THE LOS ANGELES
COUNTY AND THROUGH THE NINETEEN
FIFTEEN BE WAIVER OF ALL WHICH
REQUIRED BEACH YES TO DO THE
FALL. WE ARE REQUIRED TO MONITOR
PLAN PERFORMANCE ON KEY QUALITY
MEASURES. WERE ALSO TO CONSIDER
PRIOR PERFORMANCE FOR MANAGED
CARE PLANS OPERATING IN THE
DENTAL MANAGED CARE PROGRAM AS A
COMPONENT IN THE REAPER CARE. AS
A POTENTIAL- AWARDEES FIVE YEAR
HISTORIC PERFORMANCE ON THE
PERFORMANCE MEASURES THAT WE
MEASURE IS BELOW THE HISTORIC
PERFORMANCE OF THE STATE THE FOR
SERVICE IN THE PROGRAM. THEN THE
STATE MUST PROVIDE JUSTIFICATION
TO SEE A MASS FOR BOARDING THE
CONTRACT TO THAT GIVEN MANAGED
CARE. THE STATE. ACCIDENT OF THE
DENTAL MANAGED CARE PROGRAM AND
THEN SUBMIT THESE FINDINGS
NINETY DAYS AFTER THE END OF THE
SECOND YEAR. WE MUST ALSO
ESTABLISH PAYMENT WITHHOLD
ARRANGEMENTS THAT ARE LINKED TO
PERFORMANCE IMPROVEMENT TARGETS.
BY TWENTY TWENTY THREE. WE MUST
ALSO SUBMIT ANY CORRECTIVE
ACTION PLANS TO ADDRESS
IDENTIFIED MANAGED CARE PLAN
DEFICIENCIES TO SEE AMOUNTS. AND
THE STATE IS ALSO REQUIRED TO.
LOOK AT PARITY OF PERFORMANCE
BETWEEN THE DENTAL MANAGED CARE
PROGRAM IN OUR FEE FOR SERVICE
DELIVERY SYSTEM. IF IT DOES NOT
ACHIEVED IN EACH OF THE MEASURE
BY DECEMBER THIRTY FIRST OF THIS
YEAR THAN BENEFICIARIES IN
COUNTIES WHERE WE HAVE MANDATORY
ENROLLMENT INTO DENTAL MANAGED
CARE WHICH WOULD BE IN
SACRAMENTO COUNTY I'M THOSE
BENEFICIARIES MUST BE ALLOWED TO
DECIMAL FROM ANY MONEY AND THAT
IS NOT ASSURING- ADEQUATE
QUALITY OF SERVICES AND THEN THE
STATE MUST UNDERTAKE A REVIEW OF
THAT MANAGED CARE PLAN WITHIN
FOUR MONTHS. AND THEN MAKE A
DETERMINATION ON WHETHER THAT
MANAGED CARE PLANS CONTRACT
SHOULD BE SUSPENDED OR
TERMINATED SO AGAIN- THESE
REQUIREMENTS THAT I JUST WALK
THROUGH ARE ALSO INCLUDED IN THE
AND NINETEEN FIFTEEN BE WAIVER
THE SPECIAL TERMS AND CONDITIONS
THAT ARE SPECIFIC TO OUR DENTAL. MANAGED CARE CONTRACTS. AT
THIS TIME I WILL ALSO PROVIDE.
WANTS TO ASK SOME OF THE
CONCERNS THAT HAVE BEEN RELEASED
BY THE CALIFORNIA DENTAL
ASSOCIATION AND AGAIN THESE
WERE- AT QUESTIONS THAT WE WERE
ASKED TO RESPOND TO THAT ARE
LAID OUT IN THE AGE. SO AGAIN I
HAVE A QUESTION OR THAT THE
COMMENTS BY I CBA. THEY
EXPLAINED THAT UNDER TELLING THE
NINETEEN FIFTEEN BE WAIVER
SPECIAL TERMS AND CONDITIONS
WHICH I JUST WALK THROUGH. I
WORK HARD DENTAL MANAGED CARE TO
PERFORMANCE CHARITY WITH FEE FOR
SERVICE AND THEREFORE CDA RIGHT
THAT MEANS THAT THE EIGHT CST
MARC WATTS O MONITORING AND
TRACKING. OF DENTAL. MANAGED
CARE PERFORMANCE MEASURES. AND A
AND- WE DO MONITOR BALLPARK FEE
FOR SERVICE AND R. DENTAL
MANAGED CARE PLANS ACROSS THE
PUBLISHED PERFORMANCE MEASURES.
AND ALSO IN ALIGNMENT WITH THE
SPECIAL TERMS AND CONDITIONS
THAT I JUST WALK THROUGH. A
SPECIFIC TO THE DENTAL MANAGED
CARE PLANS. WE WILL HAVE TO DO
THE MONITORING I THAT I HAD
IDENTIFIED AND AGAIN I'LL JUST
TOUCH ON A COUPLE OF POINTS. OUT
WE WILL BE ESTABLISHING
PERFORMANCE MEASURES THAT ARE
SPECIFIC TO THE UTILIZATION OF
PREVENTIVE SERVICES FOR CHILDREN
AND ADULTS ANNUAL DENTAL VISITS
FOR CHILDREN AND ADULTS AND
SEALANTS FOR CHILDREN ACROSS TWO
AGE GROUPS. AGES SIX TO NINE IN
AGES TEN TO FOURTEEN. PLANS MUST
BE ACCOUNTABLE TO WORKS THE-
WHILE ALSO AS I INDICATED
DEVELOP HE- WITH WHOLE
METHODOLOGY FOR DENTAL MANAGED
CARE PLANS THAT DO NOT MEET
THAT- IDENTIFY PERFORMANCE
TARGETS. WE WILL ALSO UTILIZE
THEIR HISTORIC OUTPERFORMANCE OF
THE DENTAL MANAGED CARE PLANS
AGAINST THAT FEE FOR SERVICE. AS
A FACTOR IN AWARDING FUTURE
CONTRACTS WALL REAPER CARING NEW
DENTAL MANAGED CARE CONTRACTS.
AND THEN AGAIN TO THE EXTENT
THAT THAT DENTAL MANAGED CARE
PLAN DOES NOT KEEP PACE WITH THE
REALIZATION OF THE FOR SERVICE.
THEN WE CAN GET SOME MORE
MEMBERS FROM THAT. AND THEN TO
THE EXTENT THAT A MEMBER DOES
CHOOSE TO DECIMAL FROM THE DOWN
MANAGED CARE AND THEN AGAIN
WE'RE REQUIRED TO DO A REVIEW OF
THE DENTAL MANAGED CARE PLAN
WITHIN FOUR MONTHS. TO THEN
DETERMINE IF THAT PLANE SHOULD
BE SUSPENDED OR TERMINATED. THE
NEXT. SET OF COMMENTS FROM CDA.
I DEALS WITH DH CS- IDENTIFYING
A FORTY MILLION DOLLAR SHORTFALL
THAT'S ASSOCIATED WITH SERVICES
THAT ARE PROVIDED UNDER. THAT
DENTAL TRANSFORMATION INITIATIVE
AGAIN WHICH WAS ONE OF THE
INITIATIVES UNDER OUR FIRE MEDIC
HELPED ONE TWENTY WAIVER AND NOW
CONCLUDED. AT THE END OF LAST
YEAR. AND THEIR COMMENTS ARE
THAT THIS WOULD RESULT I IN
TERMS OF SOME PROVIDERS NOT
BEING REIMBURSED. FOR GETTING
UNDER REIMBURSED FOR SOME
SERVICES AND SEE THE A STATE
THAT THIS WAS THE STATE'S ERROR.
AND THAT THERE ARE PROVIDERS
THAT. SHOULD NOT BE PENALIZED IN
THIS WAY. SO M. UNDER THE ADDED
TRANSFER INITIATIVE. WELL
CLOTHING DURING THE PUBLIC
HEALTH EMERGENCY THAT INITIATIVE
IN THOSE EFFORTS WERE LARGELY
UNSUCCESSFUL AND THEY ON THE
GENERAL- TRANSFORMATION
INITIATIVE WAS CARRIED THROUGH
INTO A SIX YEAR FOR AN EXTENSION
THERE IT WHILE WE WERE WORKING
ON THE RENEWAL OF THE CURRENTLY
APPROVED NINETEEN FIFTEEN. RIGHT
AS A RESULT OF THE CONTINUATION
THERE WAS A REAL POTENTIAL TO
EXCEED THE FUNDING AUTHORITY ON
WHICH WAS A BOX- APPROXIMATELY
EIGHT HUNDRED AND NINETY THREE
MILLION DOLLARS. AS SOON AS TCS
BECAME AWARE OF THE ANTICIPATED
SHORTFALL I BASED UPON REAL IME
AND PROJECTED CLAIMS DATA WE
WERE VERY PROACTIVE IN
TRANSPARENT WITH BOTH PROVIDERS
AND STAKEHOLDERS. AND NOW PERSON
WENT TO THE NOW EXPIRED MEDICAL
TWENTY TWENTY WAIVER TO THE
EXTENT WARRANTED DH YEAH. DOES
HAVE AN ABILITY TO ISSUE PROGRAM
IF HE MEANT IF GIVEN DTI DOMAIN
OR DOMAINS WORK RISK OVER
EXPENDITURES AND AGAIN THIS
PROGRAM ABOUT OUR REQUIREMENT
WAS IDENTIFIED IN THE FIRE
MATAGAL TWENTY TWENTY WE WERE
UNDER WORDS THAT DTI OPERATE. AT
THIS TIME IT IS NOT OUR TEAM TO
NOT PROVIDERS FOR ACTUAL
SERVICES RENDERED BUT WHAT IS IN
QUESTION IS THE AMOUNT OF
FUNDING THAT WE WILL HAVE
AVAILABLE FOR THE INCENTIVE
PAYMENTS. AND WHAT THAT WILL
LOOK LIKE ON A PROGRAM BASED.
PROVIDERS ARE BEING REIMBURSED
FOR THEIR COVERED SERVICES
HOWEVER DUE TO THE SHORTFALL
THAT WE HAVE IDENTIFIED
PROVIDERS MAY NOT RECEIVE THEIR
DTI INCENTIVE PAYMENTS. FOR
CALENDAR YEAR TWENTY TWENTY ONE
PERFORMANCE. AND WE HAVE
CONTINUED TO KEEP PROVIDERS AND
STAKEHOLDERS OF THE THAT. ARE
VIABLE ATTENDS AS WELL AS THE
VERY STAKEHOLDER MEETINGS THAT
WE HOLD REGARDING CARDINAL PARK.
AND THAT CONCLUDES MY REMARKS ON
THE ISSUE- THANK YOU VERY MUCH.
THANK YOU NEXT WE'LL HEAR FROM
MONICA MON TUNNEL WITH THE
CALIFORNIA DENTAL ASSOCIATION.
THANK YOU MONTHS WITH THE
CALIFORNIA DENTAL ASSOCIATION
THANK YOU CHEN MEMBERS FOR THE
OPPORTUNITY TO SPEAK TO YOU TO
THEM. ON BEHALF OF THE
CALIFORNIA DENTAL ASSOCIATION'S
TWENTY SEVEN THOUSAND MEMBER
DENTISTS FIRST I WANT TO START
OFF WITH STATING THAT CDA
APPLAUDS THE DEPARTMENT'S
AMBITIOUS GOALS AND EFFORTS IN
CALLAHAM. THE MEDICAL DENTAL
PROGRAM HAS SEEN TREMENDOUS
SUCCESS IN INCREASING ACCESS
AMONG BENEFICIARIES AS WELL AS A
STEADY INCREASE OF MEDICAID
DENTAL PROVIDERS. I'M HERE TODAY
BECAUSE WE WANT TO CONTINUE TO
SEE THE MEDICAL DENTAL PROGRAM
IMPROVE. CDA IS SUPPORTIVE OF
DECSS PROPOSAL TO EXPAND THE LAB
PROCESS CRIME BENEFIT. AS THIS
IS BEEN A LONG STANDING GAP A
MEDIC CAL DENTAL COVERAGE. THE
DENTAL CROWN IS A COMMON
RESTORATIVE PROCEDURE THAT
ALLOWS THE DENTIST TO SAVE THE
TOOTH WAS SIGNIFICANT DECAY
OFTEN AVOIDING A COSTLY REPAIR
NOW OR THE LOSS OF A TOOTH. CDA
BELIEVES MEDICARE MEMBER SHOULD
HAVE A DENTAL BENEFIT THAT MEETS
THE STANDARD OF CARE. HOWEVER WE
ARE VERY CONCERNED THAT THIS
PROPOSED BENEFIT WILL NOT
TRANSLATE INTO ACCESS AS A
PROPOSED RATE DOES NOT EVEN
COVER THE COST OF PROVIDING THE
SERVICES. THE PROPOSED RATE IS
WELL BELOW THE ACTUAL COST TO
PROVIDE A CROWN. THE COST IS
HIGH BECAUSE A CUSTOM CROWN MUST
BE CREATED TO ACQUIRING THE
DENTIST EITHER PAY AN OUTSIDE
LAB FEE OR INVEST OVER A HUNDRED
AND FIFTY THOUSAND DOLLARS IN
SPECIALIZED EQUIPMENT TO PROCESS
THEM IN OFFICE. IN ADDITION A
CROWN PLACEMENT REQUIRES
SIGNIFICANT CHAIR TIME BUT THE
LEAST TWO VISITS. AT THE
EXISTING PROPOSED REIMBURSEMENT
RATES DENTISTS WILL BE UNABLE TO
PROVIDE THE EXPANDED NUMBER OF
CROWNBET OF COVER CROWNS WITHOUT
SUFFERING SIGNIFICANT FINANCIAL
LOSSES. AND AS YOU KNOW A
BENEFIT WITHOUT A FUNCTIONAL
GREAT IS NOT A REAL BENEFIT AND
IT WILL LEAD TO INSUFFICIENT
ACCESS FOR BENEFICIARIES. CDA IS
SEEKING AN INCREASE IN THE
SCHEDULED MAXIMUM ALLOWANCE TO
SIX HUNDRED AND EIGHTY DOLLARS
WHICH ROUGHLY EQUATES TO AN
ADDITIONAL. THIRTY MILLION TO DH
CS IS PROPOSAL. THIS IS A- TO
MAKE THIS IMPORTANT COVERAGE
EXPANSION MEANINGFUL FUNCTIONAL
AND MOST OF ALL A REAL BENEFIT.
REGARDING DENTAL MANAGED CARE
IDES IS ALREADY GONE OVER
BROADLY THE SPECIAL TERMS AND
CONDITIONS- BUT I DO WANT TO
POINT OUT THAT THESE
REQUIREMENTS OVERALL A LEAD ON
THE SPECIAL TERMS AND CONDITIONS
SEEK TO IMPROVE THE UTILIZATION
AND ACCESS GAP BETWEEN DENTAL
MANAGED CARE AND THE FEE FOR
SERVICE DELIVERY SYSTEM THAT IS
LONG CONCERNED CDM. UTILIZATION
RATES OF DENTAL MANAGED CARE
PLANS CONTINUE TO LAG BEHIND FEE
FOR SERVICE. ESPECIALLY FOR
PREVENTIVE SERVICES FOR CHILDREN
AND YOUTH. TO PUT THIS IN
PERSPECTIVE THERE'S BEEN A 627%
LOWER UTILIZATION RATE FOR
CHILDREN AND YOUTH RECEIVING AN
ANNUAL DENTAL VISIT AND DENTAL
MANAGED CARE. COMPARED TO FEE
FOR SERVICE. AND THIS
UNFORTUNATELY HAS BEEN THE CASE
SINCE TWO THOUSAND SEVENTEEN. I
BRING UP THE LOWER RATES OF
DENTAL MANAGED CARE BECAUSE PER
THE SPECIAL TERMS AND CONDITIONS
AT DH CS AS MENTIONED. IF THERE
IS NOT PERFORMANCE PARITY BY THE
END OF THIS CALENDAR YEAR DENTAL
MANAGED CARE PLANS COULD BE
SUSPENDED OR TERMINATED. BASED
ON THIS DATA GIVEN THE VARIOUS
TIMELINES FOR THE SPECIAL TERMS
AND CONDITIONS THIS WILL LIKELY
LEAD TO SIGNIFICANT CHANGES AND
THE DENTAL MANAGED CARE PROGRAM.
THE SIGNIFICANT CHANGES WEREN'T
EVER BUST TRANSITION PLAN
INCLUDING BENEFICIARY
NOTIFICATIONS PROVIDER OUTREACH
AND CONTINUITY OF CARE. WE URGE
THE ADMINISTRATION AND
LEGISLATURE TO WORK TOGETHER TO
MONITOR UTILIZATION AND INSURE
THAT WHEN AND IF EXISTING PLANS
ARE SUSPENDED OR TERMINATED.
THAT THERE BE A ROBUST
TRANSITION PLACE. TRANSITION
PLAN IN PLACE. LASTLY AS NOTED
IN THE AGENDA CDA IS CONCERNED
WITH THE A FUNDING SHORTFALL
AFFECTING THE TWENTY TWENTY ONE
DJI'S CHILDREN PREVENTATIVE
SERVICES. THE TDI TRANSFORMATION
INITIATIVE ALSO KNOWN. I ALSO
KNOWN AS THE TI PROVIDED A
CRITICAL SOURCE OF FUNDING FOR
CHILDREN'S PREVENTION SERVICES
AND THIS WAS THE FIRST TIME THAT
THE MEDICAL DENTAL PROGRAM
IMPLEMENTED PAY FOR PERFORMANCE
INCENTIVES. THE SUCCESSFUL PARTS
OF DTI HAVE TRANSITIONED TO
CALLAHAM AND DTI WAS EXTENDED-
ANOTHER YEAR AS DEEDS DH CS HAS
MENTIONED. BUT AGAIN THE FUNDING
SHORTFALL OF FORTY MILLION
DOLLARS MEANS A DENTIST WHO HAVE
PROVIDED SERVICES UNDER DTI
TWENTY TWENTY ONE WILL NOT
RECEIVE THE FULL PAYMENTS. IT'S
IMPORTANT TO NOTE THAT YES WHILE
THIS IS DTI INCENTIVE PAYMENTS.
THERE ARE. THIS IS ACTUALLY
CREATED A NEW INCENTIVE PAYMENTS
THAT NEVER EXISTED BEFORE ALONG
WITH ADDITIONAL INCENTIVE
PAYMENTS THAT RANGE FROM A THIRD
275% OF THE BASE RATE SO THESE
ARE SUBSTANTIAL AMOUNTS OF
PROVIDERS ARE RELYING ON. THIS A
ROADS THE TRUST BETWEEN
PROVIDERS IN THE MEDICARE
PROGRAM AND WE BELIEVE THE
SHORTFALL SHOULD BE BACK FILLED.
WE URGE THE ADMINISTRATION AND
LEGISLATURE TO ADDRESS THIS GAP
IN FUNDING AS PROVIDERS DELIVER
THESE SERVICES AND GOOD FAITH TO
THEIR PATIENTS. THANK YOU. THANK
YOU I WILL BRING IT UP TO THE
DYESS WILL BEGIN WITH DOCTOR
WITH. YES THANK YOU- TO. A
SMALL- AND- AND- MISS MANTEGNA-
FOR THEIR PRESENTATION I'M
CURIOUS- WELL COUPLE THINGS I'M
GONNA AGREE- I ABSOLUTELY AGREE
WITH CDA. THAT THE THREE HUNDRED
AND EIGHTY DOLLAR RATE IS- FOR A
CROWN IS COMPLETELY INADEQUATE
BASED ON MY OF NEARLY THIRTY
YEARS PRACTICING DENTISTRY- I
DON'T SEE HOW THAT REALLY WORKS
IN THE REAL WORLD- I HAVEN'T
PRACTICED IN A WHILE. BUT I WILL
TELL YOU WHEN I WAS PRACTICING
MY CROWN. RATES FROM MY PRIVATE
LAB WHICH I HAD- WERE IN
OFTENTIMES A DEPENDING ON THE
PRICE OF METALS WHICH IS ALSO AN
ISSUE- TWO HUNDRED. PLUS UP INTO
MAYBE INTO A THREE HUNDRED
DOLLAR SOMETIMES- TO PROVIDE
QUALITY SERVICE TO MY- TO MY
PATIENTS SO- THAT DIDN'T COUNT
THE CHAIR TIME. AND AND THEN MY
RATE TO ACTUALLY DO THAT- YEAH
YOU'RE YOU'RE ESSENTIALLY WE'RE
WE'RE PROBABLY IN THE THIRTY.
45230% REIMBURSEMENT RATE AND I
DON'T KNOW HOW I KNOW HOW THE
DENTIST MAKES IT. QUITE FRANKLY
BASED ON THAT DON'T KNOW ABOUT
THE SIX HUNDRED EIGHTY DOLLAR
HOW ABOUT HOW TO MAKE IT ON THAT
EITHER BUT I DON'T KNOW I DON'T
KNOW WHAT THE APPROPRIATE NUMBER
IS BUT THAT WHAT YOU'VE GOT IS
IT. IS IT DOESN'T DOESN'T WORK
SO- FROM MY PERSPECTIVE- THE
SECOND PIECE OF THAT I'M CURIOUS
ABOUT- I KNOW IN OUR BUDGET
ACTIVE OF TWENTY TWENTY ONE WE
CALLED FOR- THE PROCUREMENT OF-
REAL. REGARDING THE DENTAL
MANAGED CARE ABOUT- CONTRACTS.
AND THAT NEVER CALLING FOR BY BY
DECEMBER OF THIS YEAR AND NOW
WE'RE CALLING FOR AN EXTENSION
OF ANOTHER YEAR- CAN. WITH WHAT
IS THE WHAT IS THE REASON FOR
THE EXTENSION AND- BECAUSE WE
CALL FORD IN THE BUDGET EVERY
ALL THREE PARTIES AGREED THE
ASSEMBLY THE SENATE GOVERNOR.
WHY WHY. WHY ARE WE NOT WHITE
WHY WE'VE EXTENDED A YEAR. SO
BECAUSE OF THE PRIOR DISCUSSIONS
REGARDING DENTAL MANAGED CARE
AND BECAUSE DOWN ON MANAGED CARE
IS A COMPONENT PART OF THE
SPECIAL TERMS AND CONDITIONS I'M
IN THE REQUIREMENTS THAT WE NEED
TO GO THROUGH A VERY PROCUREMENT
BECAUSE THE EXISTING CONTRACTS
TO DATE. HAVE EXPIRED SO THEY
HAVE BEEN EXTENDED WE HAVE AN
ABILITY TO EXTEND THEM THE
EXTENSION IS ONLY IN PLACE SO
THAT WE CAN THEN CONDUCT THE
NEED OF PROCUREMENT TO THEN GO
OUT TO IDENTIFY. HOPEFULLY I'M
DIFFERENT MANAGED CARE PLANS
THAT WOULD COME TO THE TABLE TO
WANT TO PARTICIPATE IN OUR
PROGRAM BUT WE HAVE TO HAVE THAT
TIME. IN ORDER TO DO THE REPORTS
ARE MEANT FOR THOSE NEW
CONTRACTS AND WE CANNOT DO THAT
WITHOUT CONTRACTS JUST BE AN
EXTENDED THROUGH THE END OF THIS
YEAR- WHEN WAS THE LAST TIME WE
PROCURED. THE LAST REPORT CARE
MEANT I WANT TO SAY IT WAS
AROUND- NINE OH TEN I BELIEVE I
DON'T HAVE THE EXACT THE ARMY
BUT IT WAS SOMEWHERE AROUND
THERE IS THAT A NORMAL INTERVAL.
TWELVE YEARS. THAT SEEMS LIKE A
LONG TIME. WELL THERE ARE THERE
ARE CONTRACT EXTENSION YEARS ON
THE CONTRACT EXTENSION IS
DIFFERENT THAN A PROCUREMENT
HEALTH UNDERSTOOD WHAT IT WHAT
IS THE TIP WHAT WHAT IN IN THE
REAL IN THE WORLD OF THIS WHAT
IS OF- WHAT WHAT WOULD WHAT
SHOULD WHAT SHOULD ENTITIES OUT
THERE WHO MIGHT WANT TO
PARTICIPATE IN THESE PROGRAMS
RECENTLY EXPECT. FOR IT'S A TIME
FRAME FOR REPORT RE PROCUREMENT
. SO BECAUSE OF THE TIME THAT IT
TAKES TO DO WAY PROCUREMENTS ME
TECHNICALLY WILL HAVE AT A BASE
NEAR OUT FIVE YEARS AND THEN
IDENTIFY EXTENSION YEARS OUR ONE
YEAR EXTENSION YEARS TO WHERE IT
MIGHT THEN GO FOR- EIGHT YEARS.
BUT IT ALSO DEPENDS UPON THE
TINY AND THEN THE OTHER
INTERVENING FACTORS BY TYPICALLY
CONTRACTS WOULD BE SOMEWHERE
BETWEEN SAY FIVE MAYBE SEVEN
YEARS AND THEN WITH EXTENSION
YEARS THEREAFTER AB TWO I
TYPICALLY WE SEE LIKE- FIVE IT'S
NOT FIVE I'M SORRY LIKE THREE
ONE YEAR EXTENSION TIME. AFTER
THAT NUMBER BUILT ON. OUR FORMAT
BECAUSE- SO THE LAST REPORT HERE
IT WAS INTO THE AND NINE AND
WE'RE NOW LOOKING AT.
POTENTIALLY THE END OF TWENTY
TWENTY THREE THAT'S FOURTEEN
YEARS IF MY MATH IS CORRECT-
THAT. I'M SORRY THAT DOESN'T
SEEM RIGHT. NO UNDERSTOOD
UNDERSTOOD. BUT I THINK THEY GET
A NUMBER BUT THERE'S NOTHING WE
CAN DO TO SPEED UP THE PROCESS
WE JUST CONTINUE TO EXTEND THE
CONTRACTS EXISTING CONTRACTS.
WELL I GUESS I GUESS THE POINT
I'M TRYING TO MAKE IS. WE HAD A
BUDGET ACT THAT EVERYBODY AGREED
ON. ALL THREE PARTIES. AND HERE
WE ARE THE NEXT WE'RE GONNA PUSH
IT OUT ANOTHER YEAR. ARE WE
GONNA PUSH IT IF WE IF WE COME
TO AGREEMENT THIS YEAR WE'RE
GOING TO PUSH IT OUT AGAIN. THAT
IS NOT OUR INTENT WE ARE
ACTIVELY IN THE PROCESS OF
DEVELOPING THEM REPORTS SHERMAN-
PACKAGE. TO GO OUT AND SO WE DO
HAVE- TIMELINE FOR THAT. AND
AGAIN WITH OUR BOLD TO GET NEW
CONTRACTS IN PLACE NO SOONER
THAN JANUARY ONE OF TWENTY
TWENTY FOUR. AND AGAIN. IN THE
INTERVENING TIME PERIODS. WE
STILL HAVE THE SPECIALTERMS AND
CONDITIONS THAT WE HAVE TO WAIT
HERE. SO AGAIN IF WE ARE
CONTINUING TO SEE A LACK OF
PERFORMANCE THEN WE WILL EXECUTE
ON THOSE PROVISIONS THAT ARE IN
THE SPECIAL TERMS AND
CONDITIONS. AND TERMS ARE.
CORRECTIVE ACTION PLANS THE
ASSEMBLY MEMBERS FROM THE PLANT
AND THEN ALSO DOING AN
EVALUATION IN TERMS OF ARE
MOVING FORWARD TO THEN. TO THEN
RELEASE THOSE CONTRACTS FROM
THOSE MANAGED CARE PLANS THAT
CONTINUE TO HAVE OR PERFORM SO
WAS THAT YOUR INTENT LAST YEAR
WHEN WE DID THE BUDGET TO. I
MEAN. DID WAS THE INTEL. WE DID
I MEAN. IS IT LIKE IT WAS THE
INTENT TO HAVE THESE CONTRACTS
DONE BY THIS YEAR WHEN WE ALL
AGREED AND SIGNED ON TO THE SIDE
THE BUDGET LAST YEAR. I THINK AS
WE WERE WORKING ON THE WORK THAT
WE WERE DEALING WITH THE WAIVER
AND THE TERMS AND CONDITIONS.
AND GIVEN WHERE WE WORK ACT
WHERE HAVING THE BUDGET AND THAT
THAT WAIVER AND THAT MANAGED
CARE PLANS. THE AN EXTENDED
THROUGH TWENTY TWENTY TWO WE
DON'T HAVE TO DEAL WITH WHAT THE
FINAL OUTCOMES WERE I'VE BEEN
NEGOTIATIONS. FOR THAT. SPECIAL
TERMS AND CONDITIONS OF THAT'S
WHAT WE'RE WORKING FOR NOW. ARE
WHAT THOSE FINAL TERMS AND
CONDITIONS WORK THAT WAY TO WORK
READ ON AND FIND. YOU KNOW BY
THE FEDERAL GOVERNMENT- AND SO
THAT'S KIND OF WHERE WE'RE WHERE
WE'RE AT TODAY. SO I RECOGNIZE
THE FRUSTRATION- AND AGAIN WE'RE
WORKING AS FAST AS WE CAN IN
TERMS OF THE PROCUREMENT. I
TYPICAL PROCUREMENTS IN THE
DEVELOPMENT THE EXECUTION THE
SCORING AND ALL. AND TAKE
ANYWHERE FROM EIGHTEEN TO TWENTY
FOUR MONTHS AND WE ARE LOOKING
TO WRAP THAT UP AND WE JUST NEED
THAT TIME. TO GET BOTH THAT
PROCUREMENT RELEASED ON THE
STREETS. TO YOU KNOW HOW PEOPLE
RESPOND TO THE REQUEST DO THE
EVALUATIONS AND THEN WORK TO GET
NEW PLANS IN PLACE TO THE EXTENT
THAT WE HAVE THE ABILITY. TO DO
THAT USING THE PROCUREMENT
PROCESS. AND I GUESS MY BIGGER
POINT THERE IS THAT WE'VE HEARD
THAT THERE'S CONCERNS ABOUT. THE
DELIVERY OF CARE THROUGH THE
SYSTEM. YEAH WE'RE TWICE THE TO
BUY TWENTY TWENTY THREE WILL
TWICE. THE YEP TWO TIMES WHAT
WOULD A NORMAL BY A NORMAL.
PROCESS SO WE'RE JUST ENABLING
THINGS TO NOT. BE EFFICIENT TO
NOT ROVIDE THE BEST QUALITY
CARE- ALONG THE WAY AND SO
THAT'S THAT'S WHAT'S THAT'S MY
FRUSTRATION. IS THAT WHY WE
TWICE AS LONG I MEAN EARLY. YEAH
ABSOLUTELY I UNDERSTAND BUT I
THINK ALSO WITH THE PROVISIONS
THAT ARE IN THAT SPECIAL TERMS
AND CONDITIONS. AND THENGIVES
US SOME ADDED LEVERAGE SO TO
SPEAK IN TERMS OF OUR OVERSIGHT
AND MANAGEMENT OF THESE PLANTS
OUR FEDERAL PARTNERS. I'M HAVE
SIGNIFICANT CONCERNS IN TERMS OF
WHAT THEY HAVE SEEN TO DATE
REGARDING AND THE DELIVERY OF
SERVICES AND A LACK OF. OUT
APPROPRIATE UTILIZATION OF OUR
POPULATIONS SO IN THE
INTERVENING TIME KERRY WE HAVE
THESE- I REQUIREMENTS THAT WE
ARE LOOKING TO IMPOSE UPON THESE
PLANS AND TO BE CLEAR WE NEED TO
JUST LIKE OUR FEDERAL PARTNERS
HAVE THOSE SAME CONCERNS WE HAVE
BEEN ON THE RECORD WITH THIS. IN
TERMS OF THE DENTAL MANAGED CARE
PROGRAM- PREVIOUSLY YOU KNOW OUR
PROPOSALS WERE NOT ADOPTED I
UNDERSTAND THAT BUT WHERE WE'RE
AT TODAY AND WHAT THE SPECIAL
TERMS AND CONDITIONS DO ALLOW US
TO DO. IS. TO BE- MORE
FORTHRIGHT AND IT'S CRYSTAL
CLEAR TO EVERYONE THEN BY THOSE
SPECIAL TERMS AND CONDITIONS
BACK ACTIVE STEPS THAT WE WILL
THEN TAKE. AS WE CONTINUE TO SEE
OUR PERFORMANCE BY THESE MANAGED
CARE. SO SO IS CAN WHAT KINDS OF
ASSURANCES CAN YOU GIVE US THAT
THAT ACTUALLY THAT ACTUAL PRE
PROCUREMENT WILL HAPPEN BY THE
END OF TWENTY TWENTY THREE. OR
ARE WE GOING TO BE HERE NEXT
YEAR TALKING ABOUT AN EXTENSION
TO THE END OF TWENTY TWENTY FOUR
. IT IS NOT OUR INTENT TO BE
HERE. I'M AT THE END OF TWENTY
TWENTY THREE ASKING FOR AN
EXTENSION WE ARE ACTIVELY
WORKING ON THE PROCUREMENT. WE
HAVE THE SAME GOALS AS YOU DO.
TO EITHER MOVE FORWARD WITH NEW
CLIENTS IN OUR PROGRAM OR TO THE
EXTENT WE DO NOT HAVE FINAL
PLANS. THEN THE EXISTING PLANS
WOULD BE TERMINATED. IN
ACCORDANCE WITH THE REQUIREMENTS
THAT WE HAVE BECAUSE OF THEIR
LACK OF BECAUSE OF THEIR
CONTINUED OR PERFORM. SO AGAIN
WE HAVE LEVERS THAT IN THE
INTERIM KIND. IF THEY ARE NOT
MEETING THE METRICS THAT WE HAVE
SET OUT AND WITH OUR OVERSIGHT
AND MONITORING OUR ABILITY TO DO
THIS ENROLLMENT BASED UPON THAT
OR QUALITY OF THOSE PLANS DURING
CORRECTIVE ACTION PLANS HAVING
TO SUBMIT IF THERE WAS. YOU KNOW
WHAT POTENTIAL FOR ANY OF THE
EXISTING PLANS TO PARTICIPATE
THEY WOULD HAVE HAD TO HAVE A
PROGRAM PERFORMANCE METRICS MET
OVER THE PAST FIVE FIVE YEARS.
THEY HAVE NT BEEN ABLE TO
DEMONSTRATE THAT AS IT COMPARES
TO OUR FEE FOR SERVICE DELIVERY
SYSTEM SO WE DO HAVE THE LEVERS
THAT WE'VE WE NEED IN ORDER TO
HELP INSURE THAT EITHER THROUGH
THE WE PROCUREMENT PROCESS. OR
THROUGH OUR MONITORING AND
OVERSIGHT WE WILL THEN HAVE
PLANS EITHER IN PLACE THAT CAN
MEET OUR NEEDS ARE THOSE PLANS
WILL NO LONGER BE IN PLACE
BECAUSE OF THE TOOLS THAT WE
HAVE FOR. YOU KNOW TO LEVERAGE
THROUGH OUR SPECIAL TERMS AND
CONDITIONS. THAT I RECOGNIZE YOU
HAVE THE TOOLS THAT I AND I
APPRECIATE THAT- BUT BUT IT
DOESN'T BELIE THE FACT THAT
THERE MAY BE OTHER ENTITIES OUT
THERE AVAILABLE QUALIFIED. THEY
WOULD HAVE TO USE THOSE LEVERS
IF WE HAD A DIFFERENT DIFFERENT.
PROIDERS IN PLACE DO YOU SEE MY
POINT. I DO. AND OUR GOAL HERE
IS TO TRY TO GET TO THE TABLE
THOSE PLANS THAT WE BELIEVE CAN
MEET THE NEEDS OF OUR BUSINESS.
AND THEN TO THE EXTENT THAT YOU
CANNOT. BUT BUT SADLY WE FIXED
WORKS YOU'RE ASKING US TO EXTEND
ONCE AGAIN SO- ANYWAY I WE'RE
WE'RE IN A CIRCULAR DISCUSSION
AND I JUST DON'T WANT TO GET I
DON'T WANNA BE HERE NEXT YEAR
AND HAVE THE SAME DISCUSSION.
PUSHED OUT. I I'VE I DON'T.
THINK THAT'S AN UNREASONABLE
REQUEST ON OUR PART. RIGHT SO
WE'RE LOOKING AT I'M LOOKING FOR
SOME CERTAINTY AND I JUST
HEARING IT'S NOT OUR INTENT SO
WE'D LIKE. I'D LIKE SOMETHING
STRONGER QUITE FRANKLY. WE'RE
NOW NOT FOR TODAY YEAH YEAH BUT
I THINK I THINK WE DESERVE
SOMETHING STRONGER THAN THAT.
BUT I THINK THE DEPARTMENT IS
MORE THAN HAPPY TO FULLY COMMIT
TO RELEASING THE RPG'S FLOORING
IT BEING GET THE FULL INTENT TO
HAVE NEW MANAGED- DENTAL MANAGED
CARE PLANS IN PLACE BY THE
JANUARY TIME PERIOD THAT WE PUT
FORWARD. WE ARE COMMITTED TO
THAT THE DEPARTMENT AYE YOU KNOW
HAS BROUGHT FORWARD FOR QUITE A
FEW BUDGET CYCLES NOW OF
SOLUTIONS TO THIS PROBLEM THAT
WE ARE ALL GRAPPLING WITH AN OF
YOUR DUTY ARE YOU KNOW THAT IS.
EXTREMELY HARD RIGHT NOW TO PULL
THIS TOGETHER AND NEED TO TIME
HERE IS THAT WE HAVE OR IN THE
BUDGET- AND HAVE NO PROBLEM
HOLDING OUR DENTAL MANAGED CARE
PLANS FULLY ACCOUNTABLE FOR
THEIR LACK OF- YOU KNOW
INCREASED ACCESS UTILIZATION. OF
OUR ATHLETES NEEDED FOR MEDICARE
BENEFICIARIES AND SO LOOK
FORWARD TO UPDATING YOU ON
REGARDS TO HOW WE'RE HOLDING
THOSE MANAGED CARE PLANS
ACCOUNTABLE. AS WELL AS UPDATES
ON THE PROCUREMENT. AND I WANT
TO ASK AND I GOING TO ASK ABOUT
THE FORTY MILLION DOLLAR
SHORTFALL. CAN CAN SOMEBODY
DESCRIBE WAS OUT A FORTY MILLION
DOLLAR ERROR THAT SOMEBODY. I
MEAN DESCRIBE THE SHORTFALL FOR
ME WHERE WHERE DID IT HOW DID
ORIGINATE HOW DO YOU FIGURE IT
OUT- CLEARLY YOU KNOW THE
DENTIST THAT PROVIDED THE
SERVICES- DID SEPARATE TAB DONE
SO IN IN EXPECTATION OF BEING
PAID. SO DID SOMEBODY. YOU KNOW
NOT BALANCE THE CHECKBOOK I MEAN
WHAT HAPPENED WHERE DID THAT
WHERE THE SHORTFALL COME FROM
WITH THAT THE FEDERAL GOVERNMENT
WAS IT AN ERROR. CAN SOME CAN
YOU CAN EXPLAIN THAT TO ME. YES
SO ONE I AND THANK YOU FOR THE
QUESTION. NUMBER ONE IT'S THE
ONE I WOULDN'T SAY IT WAS AN
ERROR I'M AGAIN IN THE WAIVER
THE WAIVER WHAT THAT AMOUNT OF
FUNDING FOR THE DTI WHAT WE WANT
OUR THROUGH OUR OUTREACH EFFORTS
EDUCATION OF OUR PROVIDERS IT
BECAME VERY SEXY. SO THROUGH
THAT SIXTH SENSE AND ALSO FOR
THE TERMS AND CONDITIONS WE HAVE
THE ABILITY TO DO- YOU KNOW
ADJUSTMENTS BASED UPON
BENCHMARKS THAT ARE PROVIDERS
WOULD MEET. AND IF WE STARTED TO
SEE THAT WE WERE GOING TO GET
ACT TO- THAT CAPPED ALLOTMENTS
THAT WE HAVE AVAILABLE THEN WE
COULD DO PROGRAM TO KEEP. AGAIN
WE DID NOT ANTICIPATE THE PUBLIC
HEALTH EMERGENCY AND IT'S REALLY
AND THAT LAST YEAR WHERE WE'RE
NOW SEEING YOUR FOR THAT
EXTENSION NEAR IN TERMS OF SEEN
WHERE THE EXPENDITURES. THAT
HAVE BEEN MADE TO DATE WHERE
WERE STARTING TO SEE THAT
THEY'RE GOING TO HIT THAT CAP ON
THAT A LOT. AS THE TEAM HAS BEEN
MONITORING BOTH INCOMING
RECEIPTS AS WELL AS PROJECTED
EXPENDITURES BASED UPON OUR
PRIOR PERFORMANCE IS WHERE WE
THEN RAISE THE SIGNAL THAT WE
ARE LOOKING AT HAVING A
SHORTFALL SO WE HAD TO
COMMUNICATE TO OUR PROVIDERS. WE
ASK FOR THEM TO SUBMIT- CLAIMS
INFORMATION FOR US TO THE END OF
DECEMBER OF TWENTY TWENTY ONE SO
WE CAN THEN MAKE AN ASSESSMENT
OF THE AMOUNT OF THAT SHORTFALL
AND AGAIN- WHAT IT HAS BEEN AN
ANTICIPATORY YOU KNOW WHAT WE
HAVE PROJECT IT. WAS THE FORTY
MILLION DOLLARS SMEARS CARPET
CONTINUING TO DO OUR DUE
DILIGENCE IN EVALUATING THE-
INFORMATION THAT HAS BEEN
PROVIDED TO THE DEPARTMENT AND
THEN TAKING A LOOK AT WHAT KIND
OF. HAVE TO MAKE TO THE EXTENT
THAT THERE IS NOT MOVES BACK FOR
ONE DOLLAR SO BASED UPON WHAT WE
WERE ALLOWED TO EXPAND IT. UNDER
THIS WAY BURKE I'M WITH THE
FEDERAL AUTHORITY IS WHY WE'RE
LOOKING AT BECAUSE OF THE
PROGRAM AND NOW. FOR THE PART.
AND IT GRANT PARK THAT PROGRAM
AMOUNTS ARE BASED OF THE IN.
PAYMENTS THAT THEY WANT OTHER BE
IN. TO FOR THE SERVICES THEY ARE
. THEIR BEING REMEMBER IT'S YES
THE ANSWER FINANCE- THAT ARE
WHAT'S BEING HELD BACK UNTIL
SUCH THAT WE CAN BEING. THE HAVE
FALLEN AVAILABLE AND THEN HOW
THAT WOULD BE DISTRIBUTED
AMONGST. PROVIDERS IN ACCORDANCE
WITH OUR TERMS AND CONDITIONS
AND THE DOMAINS IN WHICH THAT
WAS INCENTIVE PAYMENTS WOULD BE.
I GUESS WHAT FEELS INHERENTLY
UNFAIR IS THAT YOU THAT WE'VE
GOT THIS INCENTIVE FOR PEOPLE
THEY PROVIDE THE SERVICE AND
POTENTIALLY THEY'RE NOT GONNA
GET PAID FOR SO THAT'S NOT AN
INCENTIVE. ANY LONGER IT'S LIKE
A BAIT AND SWITCH IT MEANS LIKE
LIKE HAVING TO ASKING FOR A
GLAZED DONUT GET A PLAIN ONE YOU
KNOW I. MEAN I. LCDA BELIEVES IS
AN ERROR IN THEIR PROVIDE SHOULD
HAVE TO BE PENALIZED WITHOUT. ME
YOU'RE YOU'RE YOU'RE YOU'RE-
YOU'RE SAYING IT'S NOT AN ERROR
THAT PEOPLE WERE WARNED HOWEVER
THEY WARNED AND WHEN WERE THEY
WALL. AFTER THEY PROVIDED
SERVICES. NO BUT THAT
INFORMATION WAS ALWAYS IN THE
SPECIAL TERMS AND CONDITIONS
THERE IS THE INFORMATION THAT IS
IDENTIFIED ON THE REMITTANCE
DETAILS SO WHEN THEY'RE
SUBMITTING OUR CLAIMS. THERE
ARE- LINE ITEMS ON THAT CLAIM
THAT WILL SHOW LIKE- PAYMENT
FOR- INSTEAD OF PAYING YOU KNOW
LIKE THEIR REGULAR CLAIMS THAT
OUR- PAYMENT FOR THE- INCENTIVE
PAYMENT AND THEN THERE'S ALSO A
LINE THAT SAYS PROGRAM. AND TO
DATE THAT PRO RATA SHARE. SOME
TO SPEAK HAS ALWAYS BEEN.
CELTICS THAT WE NOW HAVE TO DO A
PROGRAM THAT PAYMENT IT WITHIN
SHALL WE GET A WHAT THAT
PROVIDER WOULD RECEIVE. WE HAVE
ALWAYS BEEN CLEAR. THAT UNDER
THE IDTI THERE IS A CAP THE LAW.
YEAH IT WAS A FEDERAL WAIVER WE
HAD A CERTAIN AMOUNT OF MONEY
THAT WE WERE ABLE TO EXPAND WE
HAVE THE ABILITY TO EXPAND THOSE
DOLLARS OVER THE COURSE. OF THE
FIVE YEAR WE REPAIR IT WITH THE-
ADDITIONAL EXTENSION YEAR THEN
WE HAVE AN ADDITIONAL YEAR- THE
AVAILABILITY OF A HUNDRED AND
FORTY NINE ABOUT A HUNDRED AND
FORTY EIGHT MILLION DOLLARS. FOR
REIMBURSEMENT PURPOSES OF THE
PROVIDERS BUT UNDER THE FEDERAL
LABOR IT IS A CAPPED A LOT SO
ANYTHING THAT EXCEEDS THAT
ALLOTMENT THEN WOULD BECOME AN
OBLIGATION WITH EIGHT GENERAL
FUND HOMES WE CANNOT DRIVE DOWN.
THAT FEDERAL FUNDS THAT WE DON'T. HAVE THE AUTHORITY TO DRAW. I
GUESS AND THE BIGGER POINT HERE
IS THAT- YOU KNOW DENTIST.
DISSIPATED IN THIS THROUGH
BECAUSE OF THE INCENTIVE. AND
INCENTIVE IS TO HELP BECAUSE THE
COST TO WRITE CARE IS HIGHER
THAN THAN. IT THAN WHAT THEY'RE
TYPICALLY RE REIMBURSED FOR SO
MY POINT HERE IS THAT IF YOU
BURN US ARE YOU BURN NOT I SAYS
A PROFESSION AND YOU WANT OFFER
SOMETHING IN THE FUTURE. GOOD
LUCK. BECAUSE THERE'S NOT GONNA
BE TRUST. PEOPLE ACTUALLY GONNA
GET PAID FOR THE SERVICES THEY
PROVIDE. SO I WOULD URGE THE
ADMINISTRATION TO CONSIDER THE
BACK FILL FOR THAT. AN HONOR THE
INTENT OF THE PROGRAM. THANK
THANK YOU DOCTOR- MISS HOLLOW
I'M GONNA STICK WITH YOU FOR A
SECOND IF I CAN- EARLIER YOU HAD
SAID THAT- IT PART OF YOUR
RESPONSIBILITY TO MONITOR PLANT
PERFORMANCE AND CONSIDER PRIOR
PERFORMANCE- I'VE ALWAYS HEARD
THAT PRIOR PERFORMANCE IS THE
BEST PREDICTOR FOR FUTURE
PERFORMANCE AND SINCE WE HEARD
ABOUT HOW THESE MANAGED CARE
PLANS HAVE HAD LOWER UTILIZATION
RATES FOR THE LAST SEVERAL
YEARS. IS IT YOUR EXPECTATION
THAT BY THE END OF THE YEAR THEY
WILL REACH PARITY OR IS THE
EXPECTATION THAT WE WILL BE
READY FOR THE TRANSITION AND IF
WE ARE TO TRANSITION CAN WE
FOLLOW UP ON WHAT CDA HAD SAID
FOR THE NEED FOR US TO HAVE
CONTINUITY OF CARE TO COME UP
WITH THE ROBUST TRANSITION PLAN
HOPING TO- HAVE YOU PROVIDE SOME
INITIAL COMMENTS. YES THANK YOU
FOR THAT QUESTION SO AGAIN IN
LOOKING AT BETTER TERMS AND
CONDITIONS- WE DO QUESTION. IF
THE PLANS WILL BE ABLE TO MEET
THOSE REQUIREMENTS COME THE END
OF THE WEEK. SO TO THE EXTENT
THAT THEY HAVE NOT MET THOSE
REQUIREMENTS THEN WE WILL START
TO TAKE THE NECESSARY STEPS FOR
THE DESCENDANTS. AND TO THE
EXTENT BASED UPON WHAT THAT WAS
JUST A MOMENT TO LOOK LIKE THEN
ABSOLUTELY WE WOULD THEN WORK
TOWARDS- AT AN APPROPRIATE
TRANSITION. ON AS YOU ALL MAY
RECALL PREVIOUSLY ONE WE HAVE
BUT THIS PROPOSAL ON THE TABLE-
OUR BUDGET CYCLES. THE TEAM HAVE
WORKED ON. A TRANSITION PLAN AND
SO TO THE EXTENT THAT WE THEN
NEED TO EXECUTE ON THAT PLAN WE
WOULD THEN LEVERAGE THAT AND
WORK WITH YOU KNOW OUR
BENEFICIARIES ARE PROVIDERS
STAKEHOLDERS. AND TERMS OF THE
IN THE EXECUTION OF THAT
TRANSITION PLAN BUT AGAIN WE
HAVE TO DO OUR DUE DILIGENCE AND
MONITORING AND OVERSIGHT. AND
THEN START TO EXECUTE WITH THE
NECESSARY STEPS BUT IT WOULD BE
INFORMED BY A TRANSITION PLAN
BASED UPON WHAT WE ARE SEEING
HOW FAR. THAT PLAN AT THAT POINT
IN TIME. I'M GONNA FALL UP ON-
DA WOULD QUESTIONS ON THE DENTAL
TRENDS. INITIATIVE IF I CAN IT
SEEMS THAT. PART OF YOUR
RESPONSE WAS THAT THE FEDERAL
MATCHING FUNDS WOULD NOT BE
AVAILABLE SINCE IT WAS NOT- PART
OF THE CAPITAL. OUTLAY AT THE
BEGINNING CAN YOU COMMENT ON
WHAT WE BELIEVE THE STATE
PORTION OF THAT SHORTFALL TO BE
OUT OF THE FORTY MILLION THAT
HAS BEEN IDENTIFIED AS IT SIMPLY
THAT WE CAN'T. PULL DOWN THE-
FEDERAL MATCHING FUNDS ARE IS
THERE A STATE PORTION THAT WE
SHOULD BE- AT A MINIMUM LOOKING
TO. MAKE SURE THAT WE'RE
REIMBURSING PROVIDERS WITH. IT
TOUGH FORTY MILLION IS THE TOTAL
SOLAR WOULD BE WITHOUT THAT
FEDERAL. SO THAT WOULD BE
COVERING BOTH THE STATE AND WHAT
WOULD HAVE OTHERWISE BEEN THE
CATALYST. WITH THE FEDERAL
PARTICIPATION HOW MUCH OF THAT
FORTY MILLION WOULD HAVE BEEN
COVERED BY THE FEDERAL
GOVERNMENT AYE YOUR- ANSWER
RIGHT THERE WAS THAT THE STATE
IS NOW RESPONSIBLE FOR ALL OF
THE FORTY MILLION- WHAT WAS IT.
PRIOR TO THIS IS WHAT I WAS
TRYING TO. OH I'M SORRY IT WOULD
HAVE BEEN BASED UPON- SO FOR THE
CHILDREN WE HAVE DIFFERENT
FEDERAL MATCHING RATE. SO WOULD%
BE ASED UPON THOSE THOSE
FEDERAL MATCHING RATE SENT AS AN
AVERAGE OF WITH LIKELY BEEN LIKE
THAT. PROBABLY AT A SIXTY FORTY
SPLIT BECAUSE WE GET A HIGHER
MATCHING READ ON SOME OF OUR
CHILDREN'S POPULATIONS I WITH
THE FEDERAL GOVERNMENT. AND THEN
WE HAVE TYPICALLY IT'S FIFTY
FIFTY. AND THEN- IT THAT THE
BALANCE WOULD HAVE BEEN MADE UP
BY THAT THE FEDERAL FUNDS. IF MY
MATH IS RIGHT THAT THEN IS THAT
A MINIMUM SIXTEEN MILLION THAT
THE STATE WOULD HAVE NEEDED TO
CONTRIBUTE TO. ENSURE THAT THIS
WAS HAPPENING- WHY WAS THERE NOT
. AN ABILITY TO COME BACK TO THE
LEGISLATURE WAS AT THE
APPLICATION PROCESS OR HOW COULD
WE HAVE SUPPORTED TO ENSURE THAT
WE WERE CONTINUING THESE
INCENTIVES. I THINK THAT THE
CHALLENGES SO WE WERE OPERATING
UNDER THE WEIGHT. SO UNDER THE
WAIVER ITSELF IN TOTALITY THE
WAIVER AND THE DTI PAYMENTS WERE
CAPPED IN TOTALITY AT SEVEN
HUNDRED AND FIFTY MILLION
DOLLARS. SO WE GET ALL OVER THE
FIVE YEAR PERIOD. AND SO THAT IS
FUNDED IN PART AND I WANT TO
CORRECT MY STATEMENT SO IN TERMS
OF THE FEDERAL FUNDING IT'S
FIFTY FIFTY. SO WE WOULD HAVE
RECEIVED- FOR THAT THE STATE
GENERAL FUND WHICH WE USE TO-
OUR DISH THE FUNDING WHICH WAS
FAR STATE DESIGNATED- HEALTH
PROGRAMS THAT WE USE IN FACT.
FINDING AND THE SAVINGS FROM
THOSE STATE DESIGNATED HEALTH
PROGRAMS WHERE WE COULD THEN
CLAIM ADDITIONAL FEDERAL FUNDING
TO MAKE UP THE BALANCE OF THAT
SEVEN HUNDRED AND FIFTY MILLION
DOLLARS. SO FOR THE FIVE YEAR
PERIOD THAT. WE WOULD GET YOU
KNOW- THREE HUNDRED AND SEVENTY
FIVE MILLION STATE GENERAL FUND
THREE HUNDRED SEVENTY FIVE
MILLION. FOR THE ADDITIONAL YEAR
. WE WERE ABLE TO THEN GET-
ADDITIONAL STATE GENERAL FUND TO
MAKE UP FOR THAT ADDITIONAL
EXTENSION. SO AGAIN BECAUSE
WE'RE OPERATING UNDER THE
AUTHORITY OF THE WAIVER WE ARE
THEN CAPPED AT THE ADDITIONAL
SETTLED HERE THAT WOULD BE
ALLOWED TO US AND SAID THAT WAS
APPROXIMATELY A HUNDRED AND
FORTY EIGHT MILLION DOLLARS. AND
SELL HALF OF THAT WOULD BE BORNE
BY THE FEDERAL GOVERNMENT HALF
OF THAT WILL BE BORNE BY- THE
STATE JOURNAL. SO LOOKING AT
EXPENDITURES TO DATE. WHAT THE
TEAM HAS REJECTED IS THAT WE
WOULD BE- BURKE THOSE
EXPENDITURES BY APPROXIMATELY
FORTY MILLION. ISN'T TO SAY
THOUGH THAT THOSE PROVIDERS NOW
ARE UNDER FORTY MILLION DOLLARS
AS WELL. AND HOW HOW DO WE-
INSURANCE THE THRUST GOING
FORWARD IF FOR NOT FULLY
REIMBURSING I'M SENSITIVE TO
WHAT DOCTOR WHAT WAS SAYING IS I
BELIEVE THE TRUST IS VERY
IMPORTANT WITH PROVIDERS AND
WITH THE ADMINISTRATION AND SO
WOULD LOVE TO HEAR HOW WE COULD
HAVE IMPROVED THIS- SO THAT THIS
DOESN'T HAPPEN AGAIN. NO
UNDERSTOOD AND AGAIN I THINK
THERE WOULD BE AN A WAIVER
PROGRAM AND THERE BE AN AYE AYE
CAPTAIN A LOT BUT IT WASN'T LIKE
IT WAS AN OPEN ENDED. FUNDING
SIMILAR TO WHAT WE SEE ON OUR
MEDICAID PROGRAM SO DO
UNDERSTAND THE CONCERNS THAT
EVERYONE IS RACING BUT AGAIN WE
WERE OPERATING UNDER THE
AUTHORITIES THAT WE HAVE FOR
THAT DTI. AND SO WITH THAT
ADDITIONAL YEAR. YOU KNOW THAT
WAS A FUNDING MCAT AGAIN WE HAVE
ALSO RECOGNIZE THE SUCCESS OF
THE WAIVER PROGRAM AND-
APPRECIATE GREATLY THE
PARTICIPATION BY OUR PROVIDERS
IN THAT PROGRAM. BUT AGAIN WERE
ALSO FOUND BY THE SPECIAL TERMS
AND CONDITIONS AND DO UNDERSTAND
THE CONCERNS THAT IT IS NOW
REYES BECAUSE WE NOW HAVE
IDENTIFIED. THIS THIS DEFICIT-
FOR THIS PROGRAM- I WILL THANK
THIS PANEL VERY MUCH AND LOOK
FORWARD TO FUTURE LEGISLATIVE
DISCUSSIONS ON HOW WE CAN
APPROPRIATELY PRIORITIZE AND-
MAKE SURE WE ARE WORKING WITH
PROVIDERS- WITH THAT I WILL
THANK YOU VERY MUCH ALL OF OUR
PANELISTS IF THERE'S NO
ADDITIONAL COMMENTS OR QUESTIONS
FROM. MEMBERS WE WILL NOW BEGIN
PUBLIC COMMENT WE DO HAVE A
SUBSTANTIAL NUMBER OF PEOPLE WHO
WOULD LIKE TO PROVIDE PUBLIC
COMMENT AND THEREFORE I WANT TO
URGE YOU TO KEEP YOUR OMMENTS.
BRIEF SO THAT WE CAN HEAR FROM
EVERYONE. WE WILL START WITH ANY
IN PERSON PUBLIC COMMENT IN THE
HEARING ROOM IF YOU CAN PLEASE
COME FORWARD TO THE MICROPHONE
IF YOU WOULD LIKE TO MAKE A
COMMENT. JENNIFER SIDE I'M HAVE
THE CALIFORNIA ASSOCIATION HELP
FACILITIES LIKE TO COMMENT ON
THE FIRST ITEM RELATED TO
CAROLINE. AND JUST WANT TO SAY
THAT YOU KNOW FROM OUR
PERSPECTIVE WE KNOW THAT FOR
HEALTH PLANS- LONG TERM CARE IS
A WHOLE NEW WORLD FOR MANY OF
THEM. AND THE CALVARY CESSATION
HELP FACILITIES HAS BOTH SKILLED
NURSING FACILITIES AND ALSO
INTERMEDIATE CARE FACILITIES FOR
THE DEVELOPMENTALLY DISABLED.
AND IN BOTH CASES SO IT'S REALLY
IMPORTANT FOR THEM AND TO HAVE
CLEAR GUIDANCE ON CONTRACTING
AND BILLING AND OTHER THINGS
THAT ARE REALLY IMPORTANT- THAT
THEY HAVE STARKLY HANDLED
STRAIGHT WITH THE MEDICARE
PROGRAM MEDICARE FEE FOR SERVICE
AND NOW IT'S GOING TO BE
INCORPORATED INTO HEALTH PLAN
MANAGEMENT FOR THEM. IT'S
REALLY IMPORTANT HAVE CLEAR
GUIDANCE I'M FROM THE DEPARTMENT
WITH RESPECT TO CONTRACT IN
BILLING AND OTHER REIMBURSEMENT
ISSUES. I'M FOR THE ICF DD'S IN
PARTICULAR- THESE ARE SMALL SIX
BED FACILITIES THAT ARE IN THE
COMMUNITY- THEY HAVE NOT BEEN
PART OF ANY MANAGED CARE PLAN UP
UNTIL NOW- SO HEALTH- CAP HAS
SIGNED ONTO A LETTER. WITH OTHER
INTEREST GROUPS LIKE ARCA IN
ACTUALLY CALIFORNIA ASSOCIATION
OF HEALTH PLANS TO ENCOURAGE THE
DEPARTMENT HAS POSTPONED THE
INCLUSION OF ICF TD'S INTO
MANAGED CARE- CAL AIMED EXCUSE
ME- UNTIL JANUARY FIRST TWENTY
TWENTY FOUR. A TO MAKE SURE THAT
WHEN WE TRANSITION THE SMALL
FACILITIES. THAT WE DO IT RIGHT
SO THANK YOU. THANK YOU. STEVE
COONEY WITH MEN- REPRESENTING
WESTERN DENTAL SERVICES AND IN
STRONG SUPPORT OF THE CDA
PROPOSALS TO MAKE WHOLE FOLKS
WHO CLOSE TO CLOSE OUT THE- DTI
PROGRAM AND- AND DEFINITELY- TWO
THE PROPOSAL TO PROVIDE AN
ADEQUATE REIMBURSEMENT RATE FOR-
FOR LAB PROCESSED CROWNS THANKS
VERY MUCH. THANK YOU. WE WILL
NOW GO TO THE PHONE LINE FOR
PUBLIC COMMENT AS A REMINDER THE
PHONE NUMBER AND PASSCODE IS ON
THE COMMITTEE WEBSITE AND SHOULD
BE ON THE SCREEN IF YOU ARE
WATCHING OVER THE INTERNET THE
TOLL FREE NUMBER IS.
1-877-692-8957 AND THE PUBLIC
ACCESS CODE IS ONE THREE ONE
FIVE ONE. TWO SEVEN. IF YOU
ENCOUNTER ANY PROBLEMS PLEASE
CONTACT THE ASSEMBLY BUDGET
COMMITTEE. 916-319-2090 NINE
AND A STAFF MEMBER WILL ASSIST
YOU. OPERATOR WE ARE READY TO
BEGIN PUBLIC COME. THANK YOU FOR
PUBLIC COMMENT YOU MAY PRESS ONE
THEN ZERO AGAIN TAT'S ONE THEN
ZERO FOR ANY PUBLIC COMMENT. AND
WE WILL GO TO LINE THIRTEEN YOUR
LINE IS OPEN. GALLERY ON BEHALF
OF THE CALIFORNIA MEDICAL
ASSOCIATION INTEREST LIKE THE
LIMITED TIME FRAME HERE TODAY
EMI HAS ALREADY PROVIDED THE
SUBCOMMITTEE WITH SEVERAL
LETTERS COMMENTING ON AND
VOICING CONCERNS REGARDING
COMPONENT OF CALLIN
IMPLEMENTATION. WE WOULD LIKE
THE LEGISLATURE TO DATE TO
CONSIDER ENCOURAGING THE HCI TO
EXPAND IMPLEMENTATION OF THE
COMPONENT OF CAL IN RESTRICTING
A BENEFIT RICH A BENEFICIARY'S
RIGHT TO CHOOSE A MEDICARE DOOR
ELIGIBLE SPECIAL NEEDS PLAN AT
THE FACT. BEGINNING IN JANUARY
TWENTY TWENTY THREE AND HEALTH
CERTAIN NECESSARY BENCHMARKS
HAVE BEEN ACHIEVED IN ORDER TO
ENSURE A CAREFUL AND JUDICIOUS
TRANSITION OF THIS EXTREMELY
VULNERABLE POPULATION. I WE HAVE
SEEN PREVIOUS TRANSGRESSIONS
INVOLVING SENIORS AND PERSONS
WITH DISABILITIES IN THE
MEDICAID PROGRAM THE PATIENT
CRAP PATIENT PROVIDER
RELATIONSHIP IT'S AN EXTREMELY
IMPORTANT ONE. AND SOMETIMES
IT'S THE DIFFERENCE BETWEEN LIFE
AND DEATH FOR A PATIENT. CALLING
IS AN AMBITIOUS AND FAR REACHING
INITIATIVE THAT WAS SUPPORTED IN
LARGE PART BY THE IN MAY LAST
YEAR WHEN IT WAS HURT BY THE
LEGISLATURE WE CONTINUE TO
SUPPORT THE OVERALL GOALS AND
OBJECTIVES ACCOUNT. HOWEVER EACH
YES IT'S ALREADY JUGGLING MANY
COMPETING INITIATIVES AND
PRIORITIES THAT MAY HOLD A
THREAT TO BE ADMINISTRATIVE AND
PROGRAMMATIC DETAILS OF A
TRANSITION OF DEATH BY THE CULT.
AT A MINIMUM THERE WILL BE TENS
OF THOUSANDS OF THE MOST FRAIL
ELDERLY SENIORS FORCED TO CHANGE
THEIR HEALTH PLAN AND LIKELY
THEIR PROVIDER IN JANUARY OF
TWENTY TWENTY THREE. AS WE SAW
DURING IMPLEMENTATION OF THE
COORDINATED CARE INITIATIVES CCI
IN TWENTY THIRTEEN FOURTEEN THE
LEVEL OF ENGAGEMENT AND
INVOLVEMENT OF POSITION BOTH
MINIMAL. AS A RESULT THERE WERE
TENS OF THOUSANDS OF PATIENTS
THAT DESCEND ROLLED FROM THE CPI
BECAUSE THEIR PROVIDER WAS NOT
INVOLVED WITH. A MAGNETIC HOW
MANAGED CARE PLANS. BETTER THAN
ANY DOT UNDERSTAND THE AND- OF
COORDINATING CARE ACT RIGHT
COPULATION. RECOGNITION THAT A
TRANSITION SUCH AS BACK
ENVISIONED IN CALLING NEEDS TO
BE DONE WITH DUE CONSIDERATION
TO THE NATURE OF THE AFFECTED
POPULATION IS CRITICAL TO
MAINTAINING ACCESS TO CARE.
ADHERENCE TO TREATMENT REGIMEN
AND THE OVERALL HEALTH AND WELL
BEING OF THE FINGERS THANK YOU
SO MUCH FOR THE OPPORTUNITY TO
COMMENT TODAY. THANK YOU NEXT
CALLER PLEASE. WE WILL GO TO
LINE OF FIFTEEN YOUR LINE IS
OPEN PLEASE GO AHEAD. GOOD
EVENING THIS IS ADRIAN SHELTON
WITH THE CALIFORNIA ALLIANCE OF
CHILD AND FAMILY SERVICES WE ARE
COMMENTING ON TWO ITEMS TODAY.
FIRST ITEM ONE UNDER CALLING WE
ARE APPRECIATIVE OF THE ONGOING
CAL AND UPDATES FROM THE
DEPARTMENT OF HEALTH CARE
SERVICES WE LOOK FORWARD IN
PARTICULAR TO UNDERSTAND THE
DETAILS OF THE TIMELINE ON
PAYMENT REFORM. WHAT IS
ABSOLUTELY CRITICAL FOR THE
SUCCESS OF CALAMP IS NOT THE
ESTABLISHED RATE OF BOTH THE
COUNTY THE NONPROFIT COMMUNITY
BASED PROVIDERS. CAN CONTINUE TO
NOT ONLY PROVIDE THE FOR THE
SERVICES OF THOSE IN THE STATE
THAT WOULD EXPAND THAT TO REACH
ALL OF THOSE ELIGIBLE
CONSERVATIVE. AN ADEQUATE RATE
LEADS TO PROVIDER SHORTAGES AND
WE NEED TO DO EVERYTHING WE CAN
TO EXPAND THE WORK FOR.
ESPECIALLY NOW I SERVICE THE MAN
OF THE FIELD ARE INCREASING AND
WE HAVE A YOU'D BE ABLE HEALTH
CRISIS. WE ALSO WANT TO EXPRESS
SUPPORT FOR ITEM THREE THE
TYPICALLY THE SUPPORT FOR YOUR
KEYS. WANT TO THANK THE H. TWO
GAS AND FOR THE UPKEEP TODAY THE
FUNDING WILL ENSURE FEDERALLY
ELIGIBLE YOU HAVE ACCESS TO
MEDICAL BENEFITS WHILE IN CARE
AND. THAT IS ABSOLUTELY CRITICAL
THANK YOU. THANK YOU. NOT CALLER
PLEASE. THANK YOU COMPLY AT ONE
YOUR LINE IS OPEN PLEASE GO
AHEAD. GOOD EVENING CHEN
ARAMBULA MEMBERS TYLER RANDY
WITH THE CALIFORNIA ASSOCIATION
OF ALCOHOL AND DRUG PROGRAM
EXECUTIVES WE'RE EXCITED TO SEE
THE LAUNCH AND IMPLEMENTATION OF
CALLINEX MANY IMPORTANT TRACK-
COMPONENTS FOR THE
TRANSFORMATION A PAIR. OF
BEHAVIORAL HEALTH IN CALIFORNIA
. KEEP IT BRIEF ARE FOCUSED ON
ON TWO PLANES- BEHAVIORAL HEALTH
PAYMENT REFORM AND DOCUMENTATION
REFORM ARE CRITICAL FOR OUR
PUBLIC SUBSTANCE USE DISORDER
DELIVERY SYSTEM TO ATTRACT AND
RETAIN QUALIFIED STAFF THAT
DELIVER SERVICE AT THE TIME A
PAGE WITH THE GREATEST NEED.
WE'RE HOPEFUL THAT PAYMENT
REFORM WILL BE TO HIGHER RATES
THAT'LL MAKE DRAMATIC HOW
COMPETITIVE RIGHT NOW PROVIDER
RATES ARE TOO LOW TO OFFER
COMPETITIVE PAY PROVIDE
SUFFICIENT ACCESS AND ALLOW FOR
SYSTEM TRANSFORMATION. WE LOOK
FORWARD TO A MORE DETAILED
INFORMATION AND ENGAGEMENT ON
REDEVELOPMENT ADDITIONALLY WE
WOULD LIKE TO MENTION BACK WE'RE
EXCITED ABOUT THE OPPORTUNITY
UNDER THE GALLEON JOHNSON PAPA
FIVE THREE WORKER PARTICULARLY
THE OPPORTUNITY TO FIND SERVICE
AND- HE NINETY DAYS PRE
RELEASE. BUT WHAT I CAN NOTE
THAT- TO FOCUS ON NOT MODEL
BETTER EXISTING AND WORKING AND
ON REENTRY I'M FOR JOBS THAT
INVOLVE. POPULATION THANK YOU.
THANK YOU. NEXT CALLER. THANK
YOU COME FROM IT'S EIGHT YOUR
LINE IS OPEN PLEASE GO AHEAD. HI
GOOD EVENING REYES RETIRED BUT
I'M ONE OF THE PETER HERBAGE
QUALITY BOTH OF THE CALIFORNIA
PAN ETHNIC HEALTH NETWORK- B. I
JUST WANTED TO SPEAK IN SUPPORT
OF THE LAST PROCESS CURRENT
BENEFIT UNDER MEDICARE- A COUPLE
YEARS AGO MY FATHER ACTUALLY
MEANS A CROWN AFTER LEAVING A
ROOT CANAL- AND AFTER GOING TO
ENTER THE CONTEST- TAKING HOURS
OTHERS DAY TO MAKE IT TO THE
APPOINTMENT- ONLY TO FIND OUT
THAT. ALL DENTIST NEAR US ONLY
OFFERED OR WORKERS LACK PROCESS
GROUND THAT THEIR CLINICS WHICH
IS CURRENTLY NOT A BENEFIT UNDER
MEDICARE- AND HIS FAMILY FORCED
TO GIVE UP ON HIS SEARCH AND- IF
YOU DO NOT BEING ABLE TO GET.
DENTAL CARE HE NEEDED HE
DEVELOPED AN INFECTION WHICH-
ENDED UP MAKING HAS EXISTING
HEART DISEASE THE CONTROLLERS-
AND SO. HAS WHAT HAS BEEN
CROWNED BEEN A COVERED BENEFIT
UNDER MEDICARE SO HE WOULD HAVE
EASILY BEEN ABLE. TO CARRY. ON
TIME IT- HAVE PREVENTED HIM TO
FIFTEEN CONDITIONS FROM
WORSENING- AND AS RACIAL
DISPARITIES CONTINUE TO PROCESS
AND ARAFAT- WE SHOULD WORK
TOWARDS ALLEVIATING DISPARITIES
TO ACHIEVE HEALTH EQUITY WHICH
ALSO INCLUDES OR A HOME EQUITY-
ASKED FOR- DENTAL MANAGED CARE.
AND UTILIZATION ACCESSORY FOR
DENTAL MANAGED CARE REMAIN LOW
COMPARED TO THE FIRST SERVICE-
WHICH THE ADMINISTRATION SHOULD
ALSO IMPROVE- BUT BECAUSE THAT'S
WHAT MANAGED CARE CAN. CONTINUE
DEVELOP GOAL OF IMPROVING ACCESS
TO DENTAL CARE WE OPPOSE THE
EXPANSION. OF THE COMMENTS CARE
CONTRACTS THANK YOU. AND YOU
NEXT CALL PLEASE. YOU'RE A
COMPROMISE TWENTY NINE YOUR LINE
IS OPEN PLEASE GO AHEAD. THANK
YOU MR CHAIRMAN MEMBERS BUT I
THINK CAN ON BEHALF OF CALPE FOR
STATEWIDE. OF PROGRAMS OF ALL
INCLUSIVE CARE FOR THE ELDERLY
ONE ISSUE WHEN DEALING WITH CAL
IN IMPLEMENTATION. THE MORE
FRAIL ELDERLY PEOPLE WITH BOTH
MEDICARE MEDICARE WILL FEATURE
LTFS BENEFITS INTEGRATED INTO
MANAGED CARE GROUP PEACE BUT
PEACE PROGRAMS WILL BE PRESENTED
OF MINERAL THAT OPTION BENEFITS
YOUR RESOURCE SUBJECT MANAGED
CARE ENROLLMENT IN MANAGED CARE
AS PART OF COUNTY BEGINNING IN
TWENTY TWENTY THREE JANUARY. WE
LOOK FORWARD TO WORKING WITH THE
DEPARTMENT ON THE DEVELOPMENT OF
AN ALMOND OUTREACH MATERIALS HE
ONLY INTEGRATED CARE OPTION FOR
SENIORS WHO ARE NURSING HOME
ELIGIBLE LIVE ALREADY ACHIEVING
ALL OF ITS GOALS RELATED TO
CALLIE INCLUDING PERSON CENTERED
THE WHOLE PERSON CARE COMPLETION
INTEGRATION SERVICES. NO. AS
SERVICES TO ADDRESS SOCIAL
NEEDS. THE ON ISSUE COURTS. WE
SUPPORT A- OF MEDITATION TO EACH
. FUNDING PLAN. PEOPLE PRETEND
PLAY A ROLE IN SEVERAL OF THE
DEPART FINISH UNDER THE PLAN.
ANON I H. A THE CARE MEETING IN
SUPPORT. IMPORTANT TO RECOGNIZE
THE CONTRIBUTIONS AND SACRIFICES
OF H. C. B. S. DIRECT CARE
WORKERS VERONICA THE NINETEEN
PANDEMIC THANK YOU VERY MUCH.
THANK YOU NEXT CALLER PLEASE.
THANK YOU THAT'LL COME FROM
MINUS THIRTY ONE YOUR LINE IS
OPEN PLEASE GO AHEAD. GOOD
EVENING RENDON AWAY WITH WESTERN
CENTER ON LAW AND POVERTY D. TO
COMMENT ON SEVERAL ITEMS
PERSONALLY WE APPRECIATE THE
WORK IN DEVELOPING THE CALLIN
PROPOSAL BUT REMAIN CONCERNED
WITH PLANS ABILITY TO PROVIDE
EXPANDED SERVICES WHEN THEY'RE
UNABLE TO MEET CURRENT
OBLIGATIONS. HIGHLIGHTING THE
NEED FOR PARTNERSHIPS WITH
TRUSTED COMMUNITY PROVIDERS
CONSIDERING THE SIGNIFICANT
INVESTMENT IN PASSING PLAN
INTENDED TO BUILD CAPACITY WE
RECOMMEND MAKING HOUSING SUPPORT
SERVICES A STATEWIDE BENEFIT AND
LOOK FORWARD TO WORKING WITH THE
DEPARTMENT ON METRICS. WE FULLY
SUPPORT AND APPRECIATE THE
PROPOSAL TO MAKE ALLOW PROCESS
CROWNED THE BENEFIT AS CLIENTS
REPORT GOING WITHOUT NEEDED CARE
PULLING AFFECTED TEETERING
CURRENT DEBT TO PAY OUT OF
POCKET. WE SUPPORT THE POLICY
CHANGE WE NEED TO WORK WITH THE
DEPARTMENT TO ENSURE THE MEDICAL
NECESSITY TO FIND AT THE MANUAL
CRITERIA WILL ENSURE BROAD
ACCESS. WE'RE NEUTRAL ON THE
EXTENSION OF DENTAL MANAGED CARE
BUT CONSIDERING THE LOW
UTILIZATION RATE OF DENTAL
MANAGED CARE PLANS WE REQUEST
MORE OVERSIGHT SPECIFICALLY
REQUIRED DENTAL PLANS TO REPORT
OUT MEMBER SPECIFIC OUTREACH AND
OUTCOMES INTEL TARGETS ARE MET.
AND FINALLY WE SUPPORT THE
PROPOSAL TO SUSPEND RATHER THAN
TERMINATE MEDICARE ENROLLMENT
DURING INCARCERATION WHICH WILL
ALLOW IMMEDIATE ACCESS UPON
RELEASE. RATHER THAN HAVING TO
RE ENROLL INTO MEDICARE AS WELL
AS PROVIDE THE KNOWN TOUCH POINT
WHERE MEDIC HOW CAN CONTACT ITS
EMOJIS PRIOR TO RE ENTRY INTO
THE COMMUNITY. THANK YOU. THANK
YOU. THE CALLER PLEASE. GIVE IT
A COME FROM LINE TWELVE PLEASE
GO AHEAD YOUR LINE IS OPEN. GOOD
EVENING THIS IS TIM LYNCH FROM
PLATINUM ADVISORS ON BEHALF OF
LIBERTY DENTAL PLAN CALLING IN
SUPPORT OF THE GOVERNOR'S
PROPOSAL TO REPAIR DURING THE
DENTAL MANAGED CARE CONTRACTS
AND STUFF EXPENDED ALL MANAGED
CARE PROGRAM. THE PROGRAM
CONTINUES TO PROVIDE A MORE
ROBUST AND COMPREHENSIVE SYSTEM
OF CARE FOR BENEFICIARIES IN
SACRAMENTO AND LOS ANGELES
COUNTIES. THE PLANS ARE BOUND BY
AND PATIENTS BENEFIT FROM ALL
THE PROTECTIONS GUARANTEED BY
THE KNOX KEEN ACT. THE DEL
MANAGED CARE PLAN OFFERS
ACCOUNTABILITY IN CONSUMER
PROTECTIONS THAT ARE NOT
FEATURES OF THE FEE FOR SERVICE
DENTAL PROGRAM. AND THE
GOVERNOR'S PROPOSAL PROVIDES FOR
CONTINUITY OF CARE FOR MEDI CAL
BENEFICIARIES AND PROVIDES A
THOUGHTFUL POWER FORWARDS. I
ALSO LIKE TO COMMENT BRIEFLY ON
THE SUGGESTION THAT SOMEHOW THE
DENTAL MANAGED CARE PLANS ARE
UNDERPERFORMING RELATIVE TO FEE
FOR SERVICE AS WE TESTIFIED
BEFORE THIS COMMITTEE IN THE
PAST. THESE PROPOSALS HAVE BEEN
EXAMINED THE DATA SETS BEING
USED TO COMPARE MANAGED CARE AND
FEE FOR SERVICE ARE NOT THE SAME
THE INPUTS GOING INTO MEASURING
UTILIZATION OF THE FOR SERVICE
INCLUDE DATA THAT ARE SIMPLY NOT
ALLOWABLE UNDER THE DENTAL
MANAGED CARE PROGRAM. AND ONE
EQUALIZED- PERFORMANCE IN THE
DENTAL MANAGED CARE- PROGRAM IS
AT PAR OR ABOVE THAT IF YOU FOR
SERVICE AS A RESULT WE SUPPORT
THE GOVERNOR'S PROPOSAL. FOR
EXTENSION IN RETIREMENT THANK
YOU. THANK YOU NEXT CALLER
PLEASE. THANK YOU KNOW COME FROM
NINE THIRTY THREE YOUR LINE IS
OPEN PLEASE GO AHEAD. THANK YOU
CHAIR MEMBERS- KATHY MOSSBERG ON
BEHALF OF THE DEVELOPMENTAL
SERVICES THAT WORK AN
ORGANIZATION THAT REPRESENTS
OVER A THOUSAND SMALL
INTERMEDIATE CARE HOMES IN
CALIFORNIA SERVING CALIFORNIANS
WITH DEVELOPMENTAL DISABILITIES
I. WANTED TO BRIEF COMMENTS ON
THE ISSUE ONE CALAIS IMPLICIT TO
THE LTSS IMMIGRATION YES SIR.
I'M SORRY DSN ALONG WITH OUR
PARTNER ORGANIZATIONS INCLUDING
OUR CURRENT CALIFORNIA SITUATION
HEALTH PLANS AS WELL AS CATFISH
IS ASKING FOR AT LEAST A ONE
YEAR DELAY IN MOVING OUR ICE YOU
HAVE TO BE HOMES AND MEDICARE
MANAGED CARE. THANKS TO THE
SUPPORT OF THE SUBCOMMITTEE THE
LEGISLATURE ON THE MINISTRATION
OUR HOMES HAVE BEEN TAKING PART
IN STAKEHOLDER MEETINGS AND
FUTURE ALONG WITH EACH YEAR
SOMEONE HELP BODIES BEEN HELPFUL
THEY HAVE BEEN CLEAR THAT THE
CONDITIONS ARE NOT RIGHT FOR
HOMES TO MOVE INTO MEDICARE.
MEDICAID MEDICARE AT THIS MOMENT
THE OVERALL MEDICARE MANAGED
CARE DELIVERY SYSTEM. AND
PARTICULARLY ICF DD HOME TO
RESIDENTS CONTINUE TO FACE
UNPRECEDENTED CHALLENGES RELATED
TO KOBE NINETEEN ARE HOME DURING
DURING SIGNIFICANT HARDSHIP AND
DISTRESS WITH THE WORST STAFFING
SHORTAGES. REASONS WE ARE ASKING
FOR A DATE DELAY OF AT LEAST ONE
YEAR BEFORE HOMES WERE GOING TO
BED CAL THE H. CARE ADDITIONALLY
WE ARE ALSO SUPPORTED PUBLIC
QUEST INTO THE SUB COMMITTEE TO
MAINTAIN OUR CURRENT 10% RATE
pCURRENTLY SET TO EXPIRE IN JUNE
ONE TWENTY TWENTY TWO BEFORE
HOMES CAN MOVE INTO A NEW SYSTEM
OF CARE WE NEED TO MAKE SURE
FINANCES ARE STABLE. WITHOUT
THESE DOLLARS THEY WILL NOT BE
OUR HOMES ARE 1100% RELIANT A
MEDIC CAL REIMBURSEMENT FOR
REIMBURSEMENT AND WE HAVE NO
OTHER FUNDING TO SUPPLEMENT OUR
LOSSES. DUE TO THE INCREASED
COSTS AND LOSSES YOU CAN
EXPERIENCE DUE TO THE PANDEMIC A
NUMBER OF A WHOLE OTHER HOMES
HAVE BEEN FORCED TO CLOSE AND
MORE CONSIDERING CLOSING WITHOUT
THE TO DO IT CONTINUATION OF THE
SPOT. I THANK YOU FOR YOUR TIME
TODAY AND WE LOOK FORWARD TO
WORKING WITH THE SUBCOMMITTEE IN
THE LEGISLATURE MOVING FORWARD
INTO THE BUDGET PROCESS. THANK
YOU THANK YOU. NEXT CALLER
PLEASE. THANK YOU. COME FROM
MINUS THIRTY EIGHT. YOUR LINE IS
OPEN. GOOD AFTERNOON MR CHAIRMAN
MEMBERS THAT'S TIM BLL DRAMA
WITH THE VITAMIN GROUP ON BEHALF
OF OUR CLIENT CAN TO QUEST. I
WOULD LIKE TO MAKE A BRIEF
COMMENT ON ITEM FIVE RELATED TO
DENTAL DENTAL MANAGED CARE IN
LOS ANGELES AND SACRAMENTO
COUNTIES WERE SUPPORTIVE. OF THE
MOVE TOWARDS FULLY INTEGRATED
PLANS INCLUDING DENTAL THAT'S
IMPATIENT UNDER CALLAHAM AND
WERE ALIGNED WITH THE THRUST OF
THE GOVERNOR'S PROPOSED TBL
THREE PROCURE DMC CONTRACTS AS A
MECHANISM TO IMPROVE THE PROGRAM
- WE ARE HOWEVER CONCERNED THAT
THE LANGUAGE IN THE TVL DOESN'T
TECHNICALLY REQUIRE THE RE
PROCUREMENT TO BE INITIATED BY
THE DEPARTMENT. WE APPRECIATE
THE QUESTIONS POSED TODAY BY
DOCTOR WOULD- AND THE COMMENTS
THAT WERE MADE BY BOTH MISSED
MOLLOHAN MISS COOPER INDICATING
THAT APARTMENT DOES INTEND TO RE
PROCURE THE CONTRACT ON THE
TWENTY TWENTY FOUR TIME FRAME-
WE WOULD JUST REQUEST THAT THE
PROPOSED TBL BE AMENDED- SO THAT
THE LANGUAGE IS ALIGNED WITH
THAT COMMITMENT- THE SMALL
AMENDMENT WILL FACILITATE THE
PROGRAM. IMPROVEMENT ON A
REALISTIC TIME FRAME AND WILL
PROVIDE CERTAINTY TO PLAN
PROVIDERS AND BENEFICIARIES. CAN
THESE PILOT CALLUM'S. OR TO
WORKING WITH YOU ON THAT STRIP.
THANK YOU FOR YOUR TIME. THANK
YOU NEXT CALLER PLEASE. GIVE IT
A COME FROM NINE OF FORTY YOUR
LINE IS OPEN PLEASE GO AHEAD.
GOOD AFTERNOON. THIS IS DOCTOR
SOON AND- AND YOU. INTERJECTED
AFFECT WINTER COMMUNITY CLINIC
HOSHINO. I THE END TO TOTAL THE
UNDERSERVED COUNT SIMPLE. I
SUPPORT GOOD. BY GOVERNMENT
BECAUSE IN THE DENTAL AND CARE
PRO FISH WILL BE IMPLEMENTED
HEALTH DENTAL IN THE CABIN.
THANK YOU. THANK YOU NEXT CALLER
. GIVE IT A COME FROM CHINA
FORTY TWO YOUR LINE IS OPEN
PLEASE GO AHEAD.
I SUPPOSE THE PROFESSION FROM
AROUND MANAGEMENT. EACH OPENED
OKAY I THANK. THANK YOU NEXT
CALL PLEASE. GIVE IT A COME FROM
FOR FOUR YOU LINE OF THE PLEASE
GO AHEAD. SHE MISTER MEMBERS
BROUGHT LANE THE CAL COUNCIL OF
COMMUNITY BEHAVIOR HEALTH
AGENCIES WERE HERE TO SUPPORT
ITEM ONE CAL AIM IMPLEMENTATION
. REFORMIST INTERVAL THE CALLIN
IMPLEMENTATION AND DIRECTLY
LINKED TO OUR ABILITY TO
CONTINUALLY PROVIDE HIGH QUALITY
CARE WE'RE CURRENTLY WORKING
WITH T. H. C. S. MATTERS TO
IMPLEMENT THIS IMPORTANT
INITIATIVE. ADDITIONALLY WE ARE
ALSO CLOSELY WATCHING PAYMENT-
PAPERWORK REFORM AND CONTINUE TO
WORK WITH THE H. YES CALIFORNIA
PROVIDERS THEIR DISPROPORTIONATE
BURDEN OF PAPERWORK COMPARED TO
NOT THE NATIONAL STANDARDS WE
KNOW YOU'RE AWARE OF THIS ISSUE
AND I LOOK FORWARD TO WORKING
WITH THE STATE AND OTHERS ON
THIS MUCH NEEDED TAX. THANK YOU.
THANK YOU NEXT CALLER PLEASE.
GIVE IT A COME FROM NINE FORTY
YOUR LINE IS OPEN.
BUT IN GENERAL DENTISTRY. AND
IT'S GRAPHIC QUITE PROGRAM
SACRAMENTO COUNTY I SUPPOSE THE
DECISION RIGHT COVERED AND
SOMETHING THAT CARE PROBABLY.
COMING PATIENTS. AND TOLD AND
HEALTH PROGRAM. PROGRAMS TO
SURVIVE WILL AND I AM COMMITTED
TO SUPPORT A POINTER PACING THE
LEGISLATURE YOUR RECORDS FOR
DACA CLICK AND CONTINUE ITS CARE
TO THE MOST NEED CLEAN HOPE.
NEXT CALL PLEASE. YOUR LAST ONE
WE HAVE IN QUEUE IS COME FROM
LINE FORTY TWO YOUR LINE IS OPEN
PLEASE GO AHEAD.
NINE FORTY TO PLEASE GO AHEAD. I. WELCOME TO MOUNTAIN. THANK YOU
OPERATOR. NEXT CALLER PLEASE. WE
HAVE NO FURTHER PUBLIC COMMENT
THANK YOU AT THIS TIME THANK YOU
OPERATOR WILL TAKE THAT AS THE
CONCLUSION FOR PUBLIC COMMENTS
TODAY BEFORE WE ADJOURN FOR THE
NIGHT I WOULD LIKE TO TAKE A
MOMENT TO THANK THE
ADMINISTRATION AND DEPARTMENT AS
WELL AS ALL OF THE PANELISTS WHO
PARTICIPATED I'D LIKE TO THANK
THE GLS. TACK THE SERGEANTS AND
STAFF FOR PREPARING SUCH A
THOROUGH AND APPROPRIATE AGENDA
FOR US TODAY BUT MOST OF ALL IT
I WOULD LIKE TO THANK THE PUBLIC
FOR MAKING THIS THE PEOPLE'S
HOUSE AND IMPROVING OUR PROCESS
WITH YOUR PARTICIPATION WITH
THAT WE ARE ADJOURNED FOR THE
NIGHT. HAVE A GOOD NIGHT.