GOOD. MORNING, EVERYONE HAPPY
TUESDAY. I THINK IT IS. I HAVE
TO STOP AND THINK ABOUT WHAT DAY
OF THE WEEK IS AFTER A HOLIDAY,
SO WELCOME TO THE THIS JOINT
INFORMATIONAL HEARING OF THE
ASSEMBLY HEALTH COMMITTEE IN THE
ASSEMBLY BUDGET SUBCOMMITTEE
NUMBER ONE ON HEALTH AND HUMAN
SERVICES. ENTITLED MAXIMIZING
THE OPPORTUNITY FOR MEDICAL M
CEO TAX RENEWAL. WHEN WE REACHED
THE PUBLIC COMMENT PORTION OF
THE AGENDA WILL BE USING A
MODERATED TELEPHONE SERVICE.
CALL IN FOR PUBLIC COMMENT FOR
THIS HEARING IS 877692. AND THE
ACCESS CODE IS 18501. I'LL READ
THIS AGAIN AND WE'LL DO THIS
AGAIN, PROBABLY BEFORE WE OPEN
FOR PUBLIC COMMENT THAT ONCE
AGAIN THE NUMBER IS 877692. 8957
AND THE ACCESS CODE IS 185011.
AND ALSO FIND THIS ON THE
ASSEMBLY HEALTH COMMITTEE'S
WEBSITE. AS WELL AS ON YOUR TV
SCREEN. THE OPERATOR ON THE LINE
WILL GIVE YOU THE INSTRUCTIONS
ON HOW YOU WILL BE PLACED INTO
THE INTO THE QUEUE TO PROVIDE
YOUR PUBLIC COMMENT. IF YOU'RE
CALLING IN, PLEASE ELIMINATE ALL
BACKGROUND NOISE. THIS INCLUDES
MUTING YOUR LIVESTREAM BROADCAST
AND YOU'RE SMART DEVICES TO
REDUCE THE SOUND DISTORTION.
ONCE YOU'RE PLACED IN THE QUEUE
, YOU'LL BE ASKED TO MUTE
YOURSELF UNTIL YOU'RE CALLED
UPON TO SPEAK. ALSO NOTE THAT WE
ARE ACCEPTING WRITTEN PUBLIC
COMMENT THROUGH HEALTH
COMMITTEES. PUBLIC EMAIL H E A
DOT COMMITTEE DOT ASSEMBLY DOT C
A DOT GOV WHICH CAN ALSO BE ON
OUR FOUND ON OUR WEBSITE. AND OF
COURSE, IF YOU'RE IN PERSON, YOU
CAN PROVIDE TESTIMONY IN PERSON.
SO I APPRECIATE EVERYONE COMING
TOGETHER TO DISCUSS THIS
PROPOSAL FOR THE RENEWAL OF THE
ATTACKS THAT HAS ENJOYED SUPPORT
FROM THIS BODY FOR OVER THE OVER
THE YEARS. GOING BACK. I
BELIEVED IN 2005 OR 75, I THINK
THE ADMINISTRATION'S PROPOSAL
FOR TAX RENEWAL REPRESENTS A
WATERSHED MOMENT FOR ALL OF US
WITH THE OPPORTUNITY TO MAKE
TANGIBLE, BOLD AND MEANINGFUL
INVESTMENTS IN MEDICAL I
APPRECIATE AND ACKNOWLEDGE THE
ADMINISTRATION'S HARD WORK TO
GET US TO THIS POINT, WORKING
THROUGH THE DETAILS OF THIS TAX
AND BRINGING IT FORWARD ALSO
VERY MUCH APPRECIATE THAT THE
ADMINISTRATION HAS RECOGNIZED
THE IMPORTANCE OF USING THESE
REVENUES TO INVEST IN BUILDING A
STRONG MEDICAL PROGRAM. I AGREE
WITH THE IMMEDIATE INVESTMENTS
THE ADMINISTRATION HAS PROPOSED
AS A DOWN PAYMENT. I BELIEVE WE
MUST DO MORE IN ORDER TO REALLY
MAKE A DIFFERENCE ON THE GROUND.
FOR INSTANCE, HE ADMINISTRATION
HAS PROPOSED A VERY LONG TIME
HORIZON FOR THESE INVESTMENTS,
WHICH I BELIEVE WAS
SIGNIFICANTLY WATER DOWN ANY
IMPACT OF THESE NEW FUNDS. I
UNDERSTAND THE CALL FOR FISCAL
CAUTION, AND NO, IT'S A SHARED
RESPONSIBILITY TO DELIVER TO OUR
CONSTITUENTS OF BALANCED BUDGET
NOW AND IN THE FUTURE. WE KNOW
WE ARE IN A PERIOD OF FISCAL
UNCERTAINTY, LIKELY FOR FUTURE
YEARS AND PROJECTED DEFICITS.
BUT WE HAVE REAL NEEDS RIGHT
NOW. WE HAVE VULNERABLE SMALL
AND RURAL HOSPITALS THAT WILL
CLOSE UNLESS WE PROVIDE THEM
WITH HELP TO MEET THEIR SEISMIC
SAFETY OBLIGATIONS, CUTTING OFF
ACCESS TO MEDICAL BENEFICIARIES
AND ENTIRE COMMUNITIES. I CAN
SEE THE WRITING ON THE WALL AND
WE NEED TO ADDRESS THESE ISSUES
URGENTLY. THE M C O IS A TAX IS
NOT A SILVER BULLET. IT CAN'T
SOLVE ALL OF OUR ISSUES IN
MEDICAL. WE DO NEED TO BE
THOUGHTFUL AND TARGETED WITH OUR
INVESTMENTS TO MAKE A REAL
DIFFERENCE. BUT THIS REPRESENTS
AN UNPRECEDENTED OPPORTUNITY TO
SHORE UP THE FOUNDATIONS OF THE
MEDICAL PROGRAM AND KNOW HOW
IMPORTANT THIS IS TO ALL THE
MEMBERS HERE. I LOOK FORWARD TO
DISCUSSING HOW WE CAN MAKE THE
MOST OF THIS OPPORTUNITY. WHICH
INVESTMENTS OVER WHAT PERIOD OF
TIME. WHAT OUTCOMES DO WE WANT
TO SEE? I LOOK FORWARD TO BEING
ACTIVE PARTNERS WITH THE
ADMINISTRATION OF THE TABLE AS
WE MAKE THESE DECISIONS. HEARING
TODAY IS INTENDED TO HELP OUR
MEMBERS UNDERSTAND THE
ADMINISTRATION'S PROPOSAL AS
WELL AS THE BROADER CONTEXT,
IDENTIFY KEY ISSUES FOR
LEGISLATIVE CONSIDERATION AND
HEAR PERSPECTIVES FROM
INTERESTED STAKEHOLDERS AND THE
PUBLIC. ELIO IS KINDLY PREPARED
A BACKGROUND HANDOUT FOR THIS
HEARING. I URGE YOU TO READ THAT
IT'S VERY WELL DONE, AND IT HAS
A LOT OF REALLY IMPORTANT
DETAILS. UM AND WITH THAT, I'D
LIKE TO INVITE MY FELLOW CHAIR,
DR ARAMBULA TO OFFER SOME
INTRODUCTORY COMMENTS AND THEN
WE'LL GO ON TO OUR FIRST PANEL.
GOOD MORNING. I'LL START BY
THANKING HEALTH COMMITTEE CHAIR
DOCTOR WOULD FOR HIS INTEREST IN
THE QUALITY OF THE MEDICAL
PROGRAM AND FOR HIS INITIATIVE
IN HELPING TO ORGANIZE THIS
MEETING HERE TODAY. I WOULD ALSO
LIKE TO THANK OUR PANELISTS AND
PARTICIPANTS IN THIS HEARING.
YOUR COMMITMENT TO THE MEDICAL
PROGRAM IS INSPIRATIONAL TO MY
LEGISLATIVE COLLEAGUES. I HOPE
THAT THIS HEARING HELPS TO
DEMYSTIFY AND SIMPLIFY THE TAX
AND HELPS TO ADDRESS ANY
LINGERING DISCOMFORT YOU MAY
HAVE IN SUPPORTING IT. FINALLY I
WANT TO ENCOURAGE ALL OF US TO
ROLL UP OUR SLEEVES AND GET
READY TO DO THE HARD WORK THAT'S
REQUIRED TO GET THIS RIGHT. THE
SETUPS ON A PATH THAT WE CAN ALL
AGREE WILL BE TRANSFORMED
TRANSFORMATIVE TO BOTH QUALITY
AND ACCESS IN THE MEDICAL
PROGRAM. NEARLY ONE THIRD OF
CALIFORNIANS ARE DEPENDING ON IT
AND LET'S GET TO WORK. THANK
YOU. THANK YOU VERY MUCH. WE'LL
GO AHEAD AND INVITE UP OUR FIRST
PANEL, A PANEL OF ONE. JASON
CONSTANT ARROWS, THE PRINCIPAL
FINANCIAL, FISCAL AND POLICY
ANALYSTS FOR THE LEGISLATIVE
ANALYST'S OFFICE WHENEVER YOU
RACE READY, SIR, JUST TO CHECK
TO MAKE SURE MY MIC IS WORKING.
I CAN. IT'S WORKING. GREAT.
THANK YOU. JASON KANSEN TOURO,
CELIO I'LL BE TAKING YOU THROUGH
ISSUE ONE, AND WE'LL BE WORKING
THROUGH THIS. ELIO HANDOUT HERE
THAT SHOULD BE IN YOUR
MATERIALS. UM FOR ISSUE ONE.
WE'RE GOING TO GO ABOUT HALFWAY
THROUGH THE L A HANDOUT, AND
THEN WE'LL STOP AND WE'LL MOVE
TO ISSUE TWO AND HAVE THE
ADMINISTRATION AND INTRODUCED
ITS PROPOSAL. IF YOU TURN TO
ISSUE IF YOU TURN TO PAGE ONE OF
THE AGENDA, AND JUST, UM OF THE
HANDOUT, IT PROVIDES JUST A
QUICK OVERVIEW OF WHAT WILL BE
COVERING ON ISSUE ONE. THE
PURPOSE OF THIS ITEM IS TO
PROVIDE KEY BACKGROUND ON THE
MEDICAL PROGRAM. HOW MEDICAL
PAYS PROVIDERS AND THE M C
ATTACKS. TURNING TO PAGE TWO OF
THE HANDOUT. WE PROVIDE SOME
BASIC INFORMATION ON THE MEDICAL
PROGRAM. I THINK MANY OF YOU ARE
FAMILIAR WITH THE BASICS, BUT
JUST TO QUICKLY GO OVER IT.
MEDICAL IS EFFECTIVELY THE
STATE'S MEDICAID PROGRAM. IT IS
A JOINT STATE AND FEDERAL
PROGRAM, AND IT PROVIDES HEALTH
COVERAGE FOR LOW INCOME
INDIVIDUALS CURRENTLY COVERS
HEALTH CARE FOR ABOUT 40% OF THE
STATE'S POPULATION, SO IT IS A
SIGNIFICANT PART OF THE STATES
HEALTHCARE SECTOR. MEDICAL IS A
VERY COMPLICATED PROGRAM, AND IT
DELIVERS SERVICES AND MANY
DIFFERENT WAYS. THE PRIMARY WAY
IS THROUGH THAT'S MANAGED CARE
SYSTEM UNDER MEDICAL MANAGED
CARE OF THE STATE CONTRACTS WITH
HEALTH INSURANCE PLANS.
BENEFICIARIES ENROLL IN THESE
HEALTH INSURANCE PLANS, AND THE
PLANS ARE RESPONSIBLE FOR
ARRANGING FOR THE CARE OF THE
THEIR BENEFICIARIES. THE STATE
MAKES MONTHLY PAYMENTS TO THESE
HEALTH INSURANCE PLANS TO COVER
THE COST OF PROVIDING HEALTH
CARE SERVICES. THROUGHOUT THIS
PRESENTATION WILL ALSO REFER TO
HEALTH INSURANCE PLANS AS
MANAGED CARE ORGANIZATIONS OR
POS. TRADITIONALLY THE OTHER
MAJOR DELIVERY SYSTEM IN MEDICAL
IS KNOWN AS FIFA SERVICE. THIS
IS WHERE THE STATE PAYS
PROVIDERS DIRECTLY FOR PROVIDING
SERVICES. HISTORICALLY IT WAS
THE PRIMARY DELIVERY SYSTEM. BUT
OVER TIME THE STATE HAS SHIFTED
MORE BENEFICIARIES OUT OF FIFA
SERVICE AND INTO MANAGED CARE.
BUT TODAY AROUND 6% OF MEDICAL
BENEFICIARIES ARE IN THE FIFA
SERVICE SYSTEM. AND THEN
FINALLY, IT'S IMPORTANT TO KEEP
IN MIND THAT EVEN THE MOST
BENEFICIARIES ARE IN THE MANAGED
CARE SYSTEM. SOME SERVICES ARE
STILL PROVIDED TO MANAGE CARE
BENEFICIARIES OUTSIDE OF MANAGED
CARE. A GOOD EXAMPLE. HERE IS
BEHAVIORAL HEALTH COUNTIES PLAY
A KEY ROLE IN DELIVERING
BEHAVIORAL HEALTH SERVICES TO
BENEFICIARIES AND MEDICAL
TURNING TO PAGE THREE OF THE
HANDOUT. YOU'LL SEE A SHORT
SUMMARY OF MEDICALS BUDGET. SO
AS I NOTED, MEDICAL IS A JOINT
FEDERAL AND STATE PROGRAM AND SO
ITS BUDGET IS ALSO JOINTLY
SUPPORTED BY FEDERAL FUNDS AND
STATE FUNDS. UM THE WAY THIS
WORKS IS THE FEDERAL GOVERNMENT
AGREES TO PAY A CERTAIN SHARE OF
THE COST, AND THEN THE STATE IS
RESPONSIBLE FOR PAYING THE
REMAINING SHARE. FEDERAL FUNDS
HAVE BEEN HISTORICALLY MORE THAN
HALF OF MEDICALS BUDGET. AND
THEN WHEN IT COMES TO THE STATE
SHARE, THE STATE HAS USED A
VARIETY OF DIFFERENT SOURCES.
SOURCE OF THAT HAS BEEN THE
STATE'S GENERAL FUND, BUT ALSO
STATE SPECIAL FUNDS AND FUNDING
FROM LOCAL GOVERNMENTS. AND AS
YOU CAN SEE, IN THAT FIGURE, THE
ATTACKS ALSO HAS BEEN A KEY
SOURCE OF SUPPORT FOR THE
MEDICAL PROGRAM. TURNING TO PAGE
FOUR. WE PROVIDE SOME
INFORMATION ON HOW MEDICAL PAYS
PROVIDERS. THIS WILL BECOME
RELEVANT WHEN YOU START HEARING
ABOUT THE ADMINISTRATION'S
PROPOSAL. UM IT'S EASIEST TO
UNDERSTAND HOW THIS WORKS IN THE
STATES FEE FOR SERVICE SYSTEM.
IN THIS CASE, THE STATE PAYS
PROVIDERS DIRECTLY AND SETS SUCH
THOSE RATES TO PROVIDERS. FOR
MANY OF THESE RATES.
HISTORICALLY THEY'VE INITIALLY
BEEN SET AT 80% OF WHAT MEDICARE
WOULD PAY FOR THE SERVICES. BUT
MANY OF THESE RATES ARE NOT
ADJUSTED FOR INFLATION. AND SO
OVER TIME, MANY OF THESE RATES
HAVE LAGGED BEHIND THAT
THRESHOLD. IN THAT FIRST
PARAGRAPH. WE GIVE IT WE GIVE
SOME EXAMPLES OF WHERE THE
PAYMENTS HAVE LAGGED. IN THE
MANAGED CARE SYSTEM, THINGS ARE
A BIT MORE COMPLEX. THE STATE
PAYS THE MANAGED CARE PLANS TO
PROVIDE SERVICES. BUT THE
MANAGED CARE PLANS ARE
ULTIMATELY RESPONSIBLE FOR
PAYING PROVIDERS. IT'S OUR
UNDERSTANDING THAT MANAGED CARE
PLANS TYPICALLY USE THE STATE'S
FIFA SERVICE SYSTEM AS A
STARTING POINT TO SET RATES. BUT
THAT ULTIMATELY, UH, PAYMENTS TO
PROVIDERS DO VARY QUITE A BIT
ACROSS THE STATE, AND THOSE
REFLECT DIFFERENT ARRANGEMENTS
THAT MANAGED CARE ORGANIZATIONS
HAVE MADE WITH THEIR PROVIDERS.
I ALSO WANT TO NOTE THAT IN
ADDITION TO THESE BASELINE
PAYMENTS THAT ARE PROVIDED TO
PROVIDERS THROUGH FIFA SERVICE
AND MANAGED CARE, THE STATE ALSO
PROVIDES SUPPLEMENTAL PAYMENTS.
THESE COME ON TOP OF THOSE
PAYMENTS, AND THEY'RE DELIVERED
BOTH IN FEVER SERVICE AND
MANAGED CARE. IF YOU TURN TO
PAGE FIVE WE JUST NOTE A FEW KEY
DEVELOPMENTS THAT HAVE HAPPENED
IN MEDICALS PROVIDER PAYMENTS.
FOR THE SAKE OF TIME. I'M JUST
GOING TO FOCUS ON THE FIRST TWO
PARAGRAPHS BECAUSE THOSE ARE THE
REALLY THE KEY ISSUES THAT ARE
AFFECTED BY THE ADMINISTRATION'S
PROPOSAL. SO ON THAT FIRST
PARAGRAPH. UM IT'S PART OF THE
GREAT RECESSION AND IT'S PART OF
A BUDGET SOLUTION. THE STATE
ENACTED 10% REDUCTIONS. TOO MANY
PROVIDER PAYMENTS AND MEDICAL
BOTH IN FEVER SERVICE AND IN
MANAGED CARE. THESE REDUCTIONS
ARE REFERRED TO AS A B 97
REDUCTIONS. 97 WAS THE TRAILER
BILL THAT ENACTED THEM. OVER THE
YEARS, THE STATE HAS ELIMINATED
SOME OF THESE REDUCTIONS AND
RESTORED FULL FUNDING. UM AND
UNDER THE ADMINISTRATION'S
PROPOSALS, AS YOU'LL HEAR IN A
MINUTE, SOME AND SOME ADDITIONAL
REDUCTIONS WOULD BE ELIMINATED.
JUST FOR INFORMATIONAL PURPOSES
. THE VERY LAST PAGE OF THIS
HANDOUT HAS A SHORT APPENDIX
TABLE THAT SUMMARIZES WHAT
REDUCTIONS WOULD REMAIN WERE THE
LEGISLATURE TO ENACT THE
ADMINISTRATION'S PROPOSAL. THE
OTHER MAJOR ADJUSTMENT. WE
WANTED TO NOTICE IN THAT SECOND
PARAGRAPH ON PROPOSITION 56
PROPOSITION, 56 WAS ENACTED BY
VOTERS IN 2016, AND IT INCREASED
TAXES ON CERTAIN TOBACCO
PRODUCTS. MOST OF THE FUNDING
FROM THAT TAX GOES TO THE
MEDICAL PROGRAM, AND THE STATE
HAS PRIMARILY USED THE FUNDS
FROM THIS TO PROVIDE
SUPPLEMENTAL PAYMENTS TO
PROVIDERS. CAN YOU HEAR IN A
MOMENT HOW THAT INTERACTS WITH
THE ADMINISTRATION'S PROPOSAL?
TURNING TO PAGE SIX. WE PROVIDE
SOME INFORMATION ON THE EMC
ATTACKS AGAIN. THIS IS JUST A
DESCRIPTION OF HOW THE ATTACKS
WORKS. UNDERSTANDING THAT YOU'LL
HEAR FROM THE ADMINISTRATION THE
MOMENT ON ITS SPECIFIC PROPOSAL.
NOW THE EMC ATTACKS IN SOME
SENSES. UM SOMEWHAT SIMPLE TAX.
IT'S A IT'S A TAX ON ON THE
HEALTH INSURANCE INDUSTRY AND
MORE RECENTLY ON ENROLLMENT, SO
AS ENROLLEE ENROLLMENT INCREASES
IN HEALTH INSURANCE PLANS, THEIR
TAX LIABILITY TENDS TO INCREASE.
WHAT'S UNUSUAL ABOUT THE ATTACKS
RELATIVE TO MANY OTHER TAXES IS
THAT THE PURPOSE OF THE ATTACKS
IS REALLY TO DRAW DOWN
ADDITIONAL FEDERAL FUNDING. AND
IMPOSED A RELATIVELY SMALL COST
ON THE HEALTH INSURANCE
INDUSTRY. THE WAY THIS WORKS IS
THE STATE CHARGES THE TAX ON THE
HEALTH INSURANCE INDUSTRY ON
THEIR ON ITS ENROLLMENT, IT
IMPOSES A TAX ON MEDICAL
ENROLLMENT AND COMMERCIAL OR
PRIVATE SECTOR. ENROLLMENT
ATTACKS ON MEDICAL ENROLLMENT IS
MUCH LARGER THAN THE TAX ON
COMMERCIAL ENROLLMENT. FOR THE
TAX ON MEDICAL ENROLLMENT
MEDICAL COVERS THAT COST. NOW,
REMEMBER THAT MEDIC AL IS A
JOINT STATE AND FEDERAL PROGRAM
SO MORE THAN HALF OF THAT
COVERAGE FROM MEDICAL HAS COMING
FROM DRAWING DOWN ADDITIONAL
FEDERAL SUPPORT. AND THEN THE
REMAINING PORTIONS COVERED BY
THE STATE, USING A PORTION OF
TAX PROCEEDS. THIS ADDITIONAL
FEDERAL FUNDING IS KEY TO WHY
THE EMC ATTACKS PROVIDES FISCAL
BENEFIT TO THE STATE. WITHOUT
THIS FEDERAL FUNDING, THERE
WOULD BE NO FISCAL BENEFIT. THE
STATE WOULD CHARGE ATTACKS AND
THEN MOST OF THE PROCEEDS WOULD
RETURN BACK TO THE HEALTH PLANS.
BUT BECAUSE THE FEDERAL
GOVERNMENT IS COVERING A PORTION
OF THIS COST THAT PROVIDES A
FISCAL BENEFIT TO THE STATE. TO
HELP ILLUSTRATE THIS IF YOU TURN
TO PAGE SEVEN OF THE AGENDA UM,
THAT THAT TABLE SUMMARIZES THE
MOST RECENT VERSION OF THE
ATTACKS. ITS VERSION STARTED IN
JANUARY. 2020. AND ENDED AT THE
END OF DECEMBER 2022 SO THAT IT
STARTED HALFWAY THROUGH THE
FISCAL YEAR. 2019 20 ENDED
HALFWAY THROUGH THE FISCAL YEAR
2022 23 AT THAT TABLE SHOWS THAT
TAX GENERATED ANNUAL REVENUE OF
OVER $2 BILLION. BUT AFTER
ACCOUNTING FOR THE PORTION OF
THE FUNDS THAT HELP TO COVER THE
COST OF THE TAX ON MEDICAL
ENROLLMENT UM, THE NET FISCAL
BENEFIT TO THE STATE WAS MORE
LIKE 11.5 TO $1.7 BILLION A YEAR
AGAIN. IT'S LESS THAN THOSE IN
THE FIRST AND LAST YEAR BECAUSE
IT STARTED HALFWAY THROUGH AND
ENDED HALFWAY THROUGH THOSE
YEARS. AND THEN, AS YOU CAN SEE
, MOST OF THAT FISCAL BENEFIT IS
COMING FROM THE FEDERAL
GOVERNMENT AND COMING FROM
ADDITIONAL FEDERAL FUNDING, AND
A SMALL PORTION IS COMING FROM
THE TAX ON COMMERCIAL ENROLLMENT
, BUT THAT'S MUCH SMALLER
RELATIVE TO THE TOTAL FISCAL
BENEFIT. AND THEN IMPORTANTLY,
YOU KNOW, YOU MIGHT ASK THE
QUESTION. WELL, HOW IS THE STATE
SPENT THIS FISCAL BENEFIT WHILE
HIS TRADITIONALLY THE STATE HAS
USED THIS FISCAL BENEFIT TO
MAINTAIN MEDICALS, EXISTING
BUDGET AND FUND EXIST, EXISTING
SERVICES AND MEDICAL WHAT THIS
MEANS IS THAT WITHOUT THE EMC
ATTACKS, THE GENERAL FUND HAS
HAD TO BACKFILL THAT LOST NET
FISCAL BENEFIT AND COVER THOSE
COSTS. IN YEARS WHERE THERE IS A
TAX THAT GENERAL FUND BACK FELLA
ISN'T NEEDED ANYMORE AND HAS
FREED UP AND AVAILABLE FOR OTHER
PRIORITIES. THIS IS IMPORTANT
BECAUSE, AS YOU'LL HEAR IN A
MINUTE, THE ADMINISTRATION IS
PROPOSING A SOMEWHAT DIFFERENT
ARRANGEMENT USING SOME OF THE
NET FISCAL BENEFIT TO OFFSET
GENERAL FUND SPENDING IN MEDICAL
BUT ALSO USE SOME OF THAT
BENEFIT TO AUGMENT MEDICALS
BUDGET. IF YOU TURN TO PAGE
EIGHT, THIS IS OUR FINAL PAGE ON
ISSUE ONE. AND UM, IT PROVIDES
SOME INFORMATION ON FEDERAL
RULES AROUND APPROVING THE
ATTACKS, AND THIS ADDS A LAYER
OF COMPLEXITY THAT IN ADDITION
TO, UM YOU KNOW, DESIGNING THE
TAX AND UNDERSTANDING THE IN A
WAY IT SUPPORTS THE MEDICAL
PROGRAM. STATE ALSO, UM, HAS TO
GET FEDERAL APPROVAL TO USE THE
TAX TO DRAW DOWN ADDITIONAL
FEDERAL MEDICAID FUNDS. WE
PROVIDE A REALLY SHORT SUMMARY
OF HOW THESE FEDERAL RULES WORK
ON THAT SECOND PARAGRAPH ON PAGE
EIGHT, BUT I WOULD EMPHASIZE
THIS IS A VERY HIGH LEVEL
SUMMARY. THE FEDERAL RULES ARE A
LOT MORE TECHNICAL AND COMPLEX.
GIVE YOU AN EXAMPLE. UM WHAT A
LOT OF THE RULES AIM TO ENSURE
THAT THE TAX DOES NOT FALL TO
DISPROPORTIONATELY ON MEDICAID,
AS OPPOSED TO NON MEDICAID
SERVICES. NOW THE FEDERAL
GOVERNMENT DETERMINES THIS USING
A SERIES OF MATHEMATICAL TESTS.
AND THE STATE HAS BEEN ABLE TO
DESIGN THE ATTACKS IN A WAY THAT
MEETS THOSE MATHEMATICAL
REQUIREMENTS, BUT STILL ENSURES
THAT MOST OF THE TAXES ON
MEDICAL AS OPPOSED TO COMMERCIAL
ENROLLMENT. ALSO YOU'LL SEE THAT
THE FEDERAL GOVERNMENT PROHIBITS
HOLD HARMLESS ARRANGEMENTS IN
ORDER TO GET THE TAX APPROVED.
UM, BUT THAT REQUIREMENT DOES
NOT PROHIBIT THE MEDICAL PROGRAM
FROM COVERING THE COST OF THE
TAX ON MEDICAL ENROLLMENT. UM
WHAT IT DOES IS THAT IT ENACTS A
VARIETY OF OTHER HOLD HARMLESS
RULES, FOR EXAMPLE, LIMITING THE
STATE'S ABILITY TO HOLD HARMLESS
HEALTH PLANS ON THE TAX ON
COMMERCIAL ENROLLMENT. AND ALSO
ANNEXED VARIOUS OTHER RULES LIKE
LIMITING THE AMOUNT OF REVENUE
THE STATE CAN CAN GENERATE FROM
THAT TAX AGAIN. THERE'S A LOT OF
TECHNICAL RULES HERE THAT ARE
THAT ARE SORT OF BEHIND THE
SCENES HERE. AND WE ALSO WANT TO
EMPHASIZE THAT THE FEDERAL
APPROVAL IS LIMITED TERM. UM AND
SO THE EMC ATTACKS HAS BEEN
APPROVED BY THE FEDERAL
GOVERNMENT FOR PERIODS OF TIME.
2 TO 4 YEARS OR SO. AND SO STATE
AUTHORIZATION ALSO HAS BEEN
LIMITED TERM TOO. THIS IS WHY
THE MOST RECENT VERSION SUNSET
AND THEN JUST FINALLY WANTED TO
EMPHASIZE THAT THE FEDERAL ROLES
CREATE A LOT OF UNCERTAINTY WHEN
THINKING ABOUT THE ATTACKS, FOR
EXAMPLE, THE STATE IN SOME YEARS
HAS ADOPTED AN EMC ATTACKS
SUBMITTED IT FOR APPROVAL FROM
THE FEDERAL GOVERNMENT. UH
DENIED APPROVAL OF THAT INITIAL
STRUCTURE REQUIRING THE STATE TO
GO BACK AND REWORK THE STRUCTURE
RESUBMITTED FOR FEDERAL
APPROVAL. IN ADDITION, THE
FEDERAL GOVERNMENT OVER THE
YEARS HAS CONTEMPLATED CHANGES
TO ITS ROLLS AROUND APPROVING
THE TAX. SOME OF THOSE CHANGES
HAVE BEEN ADOPTED. OTHERS WERE
NOT. AND THERE'S ALWAYS REMAINS
AN AREA OF UNCERTAINTY, EVEN IN
THE FUTURE, SO THAT MEANS THAT
ATTACKS THAT MIGHT HAVE BEEN
APPROVED IN ONE YEAR MIGHT NOT
MEET FEDERAL RULES MOVING
FORWARD TO THE EXTENT THOSE
RULES ARE CHANGED. SO AGAIN THAT
THAT CONCLUDES OUR PRESENTATION
AND ISSUE ONE AVAILABLE FOR
QUESTIONS.
I BELIEVE WE'RE NOW GOING TO
HAVE THE ADMINISTRATION COME
FORWARD AND PRESENT. THE M C O
PROPOSAL WILL THEN FOLLOW WITH
THE LEOS EVALUATION OF THE M C O
PROPOSAL AND THEN HAVE QUESTIONS
FROM MEMBERS HERE ON THE DAIS.
WE WILL BEGIN WITH DIRECTOR
MICHELLE BOSS AND JAY Z. COOPER
THE MEDICAID DIRECTOR FOR THE
STATE OF CALIFORNIA. AGAIN WHEN
YOU ARE READY. SO LOST.
UM WE WOULD NOTE THAT THE. THAT
ALL REGULAR. THE PROJECT. AND
NON MEDICAID LIABILITIES. THAT'S
THE SIZE. AVAILABLE IN THE NEXT
. HIS PROVIDER RATING. JANUARY,
1. REFINERIES. DIRECTOR BOSS.
GIVE US JUST A SECOND. IT
APPEARS THAT OVER THE INTERNET,
THEY'RE HAVING A HARD TIME
PICKING UP YOUR MIKE. AND SO I'M
OUT WANTING TO GIVE TECH A
SECOND TO SEE IF WE CAN FIGURE
THIS OUT. UM. I JUST WANT TO
MAKE SURE THAT EVERYONE IS
CAPTURING WHAT YOU'RE SAYING.
DIRECTOR BOSS, I MAY ASK THAT
YOU, UM MOVE OVER JUST A SEAT
AND USE THE ONE THAT JASON WITH
THE L. A USED AS I AM ONE WAS
CAPTURING PLEASE JUST BEGIN AND
. I MAY ASK YOU TO BEGIN AGAIN
AT THE START SINCE NO ONE OVER
THE INTERNET, WHO WAS WATCHING
WAS ABLE TO CAPTURE THAT PEOPLE
WHO WERE HERE WERE BUT UM SO
THAT THE PUBLIC IS ABLE TO
PARTICIPATE. I'LL ASK THAT YOU
BEGIN AGAIN. DIRECTOR BOSS. GOOD
MORNING, THE DEPARTMENT IS
PROPOSING TO IMPLEMENT MANAGED
CARE ORGANIZATION TAX EFFECTIVE
APRIL 1ST 2023 THROUGH DECEMBER
31ST 2026. THIS TAX WILL PROVIDE
A 19.4 BILLION IN NET REVENUE
OVER THE THREE AND THREE QUARTER
YEAR PERIOD, WHICH IS ROUGHLY
THREE TIMES HIGHER THAN THE 6.5
BILLION PROPOSED AT GOVERNOR'S
BUDGET. THESE FUNDS WILL HELP
MAINTAIN THE MEDICAL PROGRAM OF
THE 19 POINT. 4,000,000,011 0.1
BILLION IS PROJECTED OR PROPOSED
TO BE USED TO INVEST IN
ADDITIONAL RATE INCREASES AND
INVESTMENTS IN THE MEDICAL
PROGRAM OVER AN 8 TO 10 YEAR
PERIODS ABOUT 60% OF THAT 19.4
BILLION REVENUES AS AN
ADDITIONAL INVESTMENTS IN THE
MEDICAL PROGRAM AND THEN 8.3
BILLION IN FUNDS TO SUPPORT THE
MEDICAL PROGRAM, AS IT IS TODAY,
GIVEN THE STATE'S BUDGET
CHALLENGES. EXTENDING THE
EXPENDITURES OF INVESTMENTS OVER
THE 8 TO 10 YEAR PERIOD WILL
PROVIDE ADDITIONAL CERTAINTY TO
OUR PROVIDERS WITH REGARD TO
THESE RATE INCREASES BEING
AVAILABLE FOR THE FOR THE LONG
TERM AND WANTING TO IMPROVE OUR
ACCESS, QUALITY AND EQUITY IN
THE MEDICAL PROGRAM. WE WANT TO
BUILD A FOUNDATION WITH THESE
INVESTMENTS AND CERTAINTY PRO
PROVIDERS THAT THESE RATE
INCREASES ARE SUSTAINABLE. WE
WOULD NOTE THAT IN OUR
DISCUSSIONS WITH CMS, THE NOTION
OF REINVESTING THIS REVENUE
GENERATED BY THE TAX INTO
EXPANDING ACCESS AND QUALITY IN
THE MEDICAL PROGRAM HAS BEEN KEY
TO CMX IS ACCEPTANCE OF ATTACKS
SIZE THIS LARGE, UH, TO SECURE
AN APRIL 1ST EFFECTIVE DATE. WE
MUST SUBMIT THIS PROPOSAL TO THE
FEDERAL GOVERNMENT BY THE END OF
JUNE SO THAT WE CAN GO
RETROACTIVE TO THE BEGINNING OF
THE QUARTER. WE WOULD NOTE THAT
CMS HAS DECLARED ITS INTENTIONS
TO CHANGE FEDERAL REGULATIONS
ASSOCIATED WITH HEALTHCARE
RELATED TAXES TO REQUIRE THAT
TAXES BE MORE PROPORTIONAL WITH
REGARD TO THE SITE THE TAX SIZE
ON THE MEDICAID SIDE VERSUS THE
NON MEDICAL SIDE, AS THE L. A
NOTED EARLIER, SO AS SUCH, WE DO
NOT ANTICIPATE IN ATTACKS SIZE
AS AT THIS LARGE THAT WILL BE
PART OF IT. 2027 RENEWAL
PACKAGE. UM IN REGARD TO PROVIDE
A RATE INCREASES THAT WE ARE
PROPOSING IN THE MAY REVISION.
WE ARE PROPOSING A JANUARY 1ST
AFFECT 2024 EFFECTIVE DATE FOR
RATE INCREASES IN PRIMARY CARE,
MATERNITY CARE, ESPECIALLY
BEHAVIORAL HEALTH TO 87.5% OF
MEDICARE. THIS IS IN ALIGNMENT
WITH OUR COMPREHENSIVE QUALITY
STRATEGY AND CLINICAL FOCUS
AREAS ON PREVENTION, MATERNITY
CARE AND BIRTH, EQUITY OUTCOMES
AND BEHAVIORAL HEALTH
INTEGRATIONS AND REALLY FOCUSING
ON UPSTREAM PREVENTIVE EFFORTS
TO REALLY ADDRESS THE NEEDS OF
OUR MEDICAL PROGRAM AND ENSURE
THAT THEIR NEEDS ARE ADDRESSED
AS EARLY AS POSSIBLE. AH AGAIN,
THESE RATE INCREASES WILL BE
BUILT INTO THE BASE MEDICAL RATE
TO ENSURE SUSTAINABILITY
EFFICIENT AND CONSIST CONSISTENT
PAYMENT TO OUR PROVIDERS WITHOUT
THE NEED FOR RECONCILIATIONS
THAT ARE NEEDED THROUGH
SUPPLEMENTAL PAYMENTS AND TO
REALLY ENSURE CONSISTENT
REIMBURSEMENT OVER TIME. FOR THE
APPLICABLE SERVICES AND SO IN
PRIMARY CARE, MATERNITY CARE AND
NON ESPECIALLY BEHAVIORAL HEALTH
. THESE RATE INCREASES WILL ALSO
INCLUDE THE ELIMINATION OF THE
HISTORICAL MAYBE 97 REDUCTIONS
AND THE SHIFT OF PROPOSITION 56
SUPPLEMENT AND PAYMENTS INTO THE
BASE RATE INCREASES. SO AGAIN
BUILDING THAT BASE RATE THAT
FOUNDATION OF OUR PAYMENTS TO
THESE PROVIDERS. TO REALLY
ENSURE, UH INCREASED ACCESS AND
QUALITY CARE. THE DEPARTMENT
WILL ANNUALLY REVIEW AND REVISE
THE FEE FOR SERVICE
REIMBURSEMENT RATES FOR THESE
SERVICES BASED BASED ON CHANGES
IN THE MEDICARE SIDE. WE WILL
DIRECT OUR MEDICAL MANAGED CARE
PANTS TO PAY PROVIDERS AT LEAST
THESE RATES FOR SERVICES. IN
ADDITION TO THIS FIRST PHASE OF
RATE INCREASES THAT WE PROPOSE
FOR JANUARY 1 2024. WE WILL BE
COMING BACK WITH THE PROPOSAL
AND NEXT GOVERNOR'S BUDGET FOR
FUTURE RATE INCREASES IN 2025
REALLY IN THE SPACE OF PRIMARY
CARE, MATERNITY CARE, BEHAVIORAL
HEALTH AND ESPECIALLY BEHAVIORAL
HEALTH. UM UH, SPECIALTY CARE,
ACUTE CARE AND OUTPATIENT CARE
AGAIN, ALSO WITH THE FOCUS OF
ADDRESSING THE NEEDS AND
DISPROPORTIONATELY IMPACTED
COMMUNITIES, AS WE THINK ABOUT
ADDITIONAL RATE INCREASES FOR
THOSE COMMUNITIES TO ENSURE
ACCESS AND AVAILABLE CARE OUR
GOAL AND COMPREHENSIVELY LOOKING
AT OUR STRUCTURES TO REALLY
IDENTIFY THE PROVIDERS WHERE WE
KNOW A DEEP COMMITMENT TO RATE
INCREASES IS NEEDED TO ENSURE
ACCESS. AND I KNOW WE HAVE MANY
PROVIDERS THAT WILL BE SPEAKING
TO US LATER TODAY, BUT REALLY
WANTING TO ENSURE WE'RE ABLE TO
IDENTIFY TARGETED INVESTMENTS
THAT ARE GOING TO MAKE A
DIFFERENCE IN OUR MEDICAL
MEMBERS LIVES. TAKE ANY
QUESTIONS. WELL, NOW GO BACK TO
THE L. A. I JUST WANTED TO CHECK
YOUR MIC CHECK ON THIS NEW MIKE.
GREAT. UM I ALSO FOR JUST IN
CASE THIS IS HELPFUL TO FOLKS,
UM, ON THE SECOND HALF OF OUR
AGENDA. THE FIRST FEW PAGES WALK
THROUGH THE PROPOSAL, WHICH
YOU'VE JUST HEARD THE
ADMINISTRATION INTRODUCED SO WE
WON'T GO OVER THOSE PAGES AT
LENGTH BUT DIDN'T WANT TO NOTE
THAT THERE ARE A FEW TABLES
THERE THAT THAT ARE HELPFUL. IF
YOU IN CASE YOU MISSED THEM, THE
ON PAGE 10 THAT SUMMARIZES THE M
C O PROPOSED TAX RATES OF BOTH
IN THE MOST RECENT VERSION THAT
RECENTLY ENDED AND THEN THE
ADMINISTRATION'S PROPOSED TAX
RATES, AND YOU CAN SEE THERE
THAT THE TAX RATES ARE ON THE
MEDICAL SIDE ARE MUCH LARGER,
WHICH IS GENERATING A MUCH MORE
SUBSTANTIAL FISCAL BENEFIT
RELATIVE TO THE MOST RECENT
VERSION, THEN ALSO WANTED TO
NOTE PAGE 12 IS A SUMMARY OF THE
PROPOSED TAX. THE REVENUES AND
THAT THE NET FISCAL BENEFIT BUT
THEN ALSO HOW THE ADMINISTRATION
PLANS TO SPEND THAT NET FISCAL
BENEFIT AGAIN. YOU CAN SEE A
SUBSTANTIAL PORTION GOING TO
OFFSET GENERAL FUND SPENDING AND
MEDICAL BUT THEN ALSO SOME
PORTIONS AVAILABLE FOR
AUGMENTATIONS AND MEDICAL, SO I
JUST WANTED TO MAKE SURE THOSE
TABLES WERE, UH, WERE CLEAR. SO
STARTING ON PAGE 13 OF OUR
HANDOUT. WE DO GIVE SOME ISSUES
TO CONSIDER AROUND THE ATTACKS.
THERE REALLY ARE TWO KEY. AREAS
THE FIRST IS AROUND THE TAX
ITSELF. SHOULD IT BE RENEWED.
AND IF SO, WHAT? WHAT HOW SHOULD
IT BE STRUCTURED AND THE SECOND
AREA OF CONSIDERATIONS ARE HOW
TO SPEND THAT NET FISCAL
BENEFIT. SO IN THAT FIRST AREA
ON PAGE 13. I JUST WANT TO NOTE
THAT THE ATTACKS PROVIDES A
SUBSTANTIAL FISCAL BENEFIT TO
THE STATE AND THE MEDICAL
PROGRAM, UM, AT A RELATIVELY
SMALL COST TO THE HEALTH
INSURANCE INDUSTRY. AND SO WE
THINK, FOR THOSE REASONS,
RENEWING THE EMC ATTACKS WARREN
SERIOUS LEGISLATIVE
CONSIDERATION. WE ALSO WANT TO
EMPHASIZE THAT THE PROPOSED EMC
ATTACKS IS A KEY COMPONENT OF
THE GOVERNORS MAY REVISION. AND
SO, TO THE EXTENT IT'S NOT
RENEWED THAT THAT WOULD REQUIRE
ADDITIONAL SOLUTIONS ELSEWHERE
IN THE BUDGET TO HELP ADDRESS
THE BUDGET PROBLEM. AND THEN IN
TERMS OF HOW THE EMC ATTACKS
SHOULD BE STRUCTURED. WE HAVEN'T
RAISED CONCERNS WITH HOW THE
ADMINISTRATION IS PROPOSING TO
STRUCTURE THE TAX. BUT TO THE
EXTENT OF LEGISLATURE IS
CONSIDERING ALTERNATIVES. I JUST
WANT TO PROVIDE THREE KEY GOALS
TO KEEP IN MIND. THE FIRST IS TO
ENSURE THAT ANY TAX PROVIDES
SIZEABLE FISCAL BENEFIT TO THE
STATE. BUT THE TAX ALSO STANDS A
REASONABLE CHANCE OF RECEIVING
FEDERAL APPROVAL AND THAT THE
TAX PROVIDES STABLE AND
PREDICTABLE FUNDING TO THE
MEDICAL PROGRAM. TRYING TO PAGE
14. THIS AND THE NEXT PAGE. WE
GIVE SOME ISSUES TO CONSIDER
AROUND HOW TO SPEND THE FISCAL
BENEFIT. AND I WANT TO EMPHASIZE
HERE THAT A KEY CONSIDERATION
FOR THE LEGISLATURE WILL BE THE
STATE'S EXISTING BUDGET
CONSTRAINTS. UM UM UM THE
MEMBERS OF ASSEMBLY BUDGET
CHATTED A LITTLE BIT MORE ABOUT
THIS LAST WEEK. BUT UM, OUR
OFFICE RELEASED OUR OUTLOOK OF
THE GOVERNORS MAY REVISION
PROPOSAL AND PROJECTING THAT
BUDGET SHORTFALLS OF AROUND 5 TO
$20 BILLION EACH YEAR. WE THINK
THIS HAS IMPORTANT IMPLICATIONS
FOR HOW YOU VIEW THIS M CEO TAX
PROPOSAL FIRST, THE LEGISLATURE
WOULD WANT TO CONSIDER HOW MUCH
OF THE TAX SHOULD GO TOWARDS
ADDRESSING THE BUDGET PROBLEM
VERSUS AUGMENTING MEDICALS
BUDGET. I JUST WANT TO EMPHASIZE
HERE THAT, UM TO THE ANY ANY
FUNDS THAT ARE USED TO AUGMENT
MEDIC HEALTH BUDGET WOULD WOULD
THEN NOT SORT OF BE AVAILABLE TO
JUST THE BUDGET PROBLEMS. SO
THAT IS A THAT IS A KEY SORT OF
CONSIDERATION FOR THE
LEGISLATURE ON AT LEAST ON A
FISCAL SENSE. AND THEN IN TERMS
OF YOU KNOW WHAT AUGMENTATIONS
SHOULD BE CONSIDERED IN MEDICAL
AGAIN, YOU'LL HEAR FROM A LOT OF
STAKEHOLDERS ON THEIR IDEAS, BUT
WANT TO EMPHASIZE THAT, UM UM,
YOU KNOW, TO THE EXTENT THAT
THESE AUGMENTATIONS ARE ONGOING
, AND TO THE EXTENT THAT THE
ATTACKS IS NOT AS LARGE NEXT
TIME AROUND, IS THIS PROPOSED
ONE THAT WOULD CREATE A BUDGET
PRESSURE FOR THE FOR THE GENERAL
FUND, YOU KNOW, MOVING FORWARD.
AND SO THAT WOULD BE SOMETHING
THE LEGISLATURE WOULD WANT TO
CONSIDER. ONE WAY TO MITIGATE
SOME OF THIS BUDGET PRESSURE
WOULD BE TO CONSIDER MORE
LIMITED TERM USES LIKE
SUPPLEMENTAL PAYMENTS OR
CREATING A RESERVE FOR ECONOMIC
UNCERTAINTY. BUT AGAIN, THESE
ARE SOME OF THESE ARE SOME OF
THE KEY DECISIONS THAT
LEGISLATURE WILL WANT TO
CONSIDER. MOVING TO PAGE 15.
ANOTHER KEY DECISION POINT WILL
BE OVER WHAT PERIOD OF TIME TO
SPEND THE FUNDS SHOULD IT BE
OVER 8 TO 10 YEARS AS PROPOSED
BY THE ADMINISTRATION OR OVER A
SHORTER TIME, PERIOD? UM AND YOU
KNOW, THIS LONGER TIME PERIOD IS
INTENDED TO HELP MANAGE THAT
SORT OF FISCAL CLIFF FROM FUTURE
TASK TAX NOT BEING AS LARGE AS
THIS PROPOSED ONE. AND SO WE
THINK FOR THAT REASON IT, IT
DOES WARRANT CONSIDERATION. THAT
SAID IT TO THE EXTENT THAT IT IS
SPREAD OUT OVER THIS PERIOD OF
TIME THAT THAT WOULD PRESUMABLY
PROVIDE LESS OF AN IMPACT THAN
IF THE FUNDS WERE SPENT OVER A
SHORTER PERIOD OF TIME. SO THAT
IS A KEY TRADE OFF THE
LEGISLATURE WILL WANT TO
CONTEMPLATE. WE ALSO WANT TO
EMPHASIZE THAT FUTURE DECISIONS
FROM THE FEDERAL GOVERNMENT
AROUND CHANGING THE TAX ARE
UNCERTAIN. AND SO THAT THAT
CREATES SOME UNCERTAINTY AS
YOU'RE THINKING ABOUT, UM YOU
KNOW WHAT THE FISCAL CLIFF WILL
BE THAT THE STATE IS FACING. AND
THEN FINALLY, WE WANT TO
EMPHASIZE THAT REGARDLESS OF
WHAT DECISIONS THE LEGISLATURE
WILL MAKE, IT WILL WANT TO
ENSURE THAT IT IS ABLE TO BE AN
ACTIVE PARTICIPANT IN HOW THE
FUNDS ARE SPENT IN THE DESIGN OF
THE ATTACKS. WE HAVE A FEW IDEAS
HERE ON HOW TO ENHANCE THAT
PARTICIPATION, FOR EXAMPLE OF A
KEY PART OF THE ADMINISTRATION'S
PROPOSAL IS TO REVIEW SORT OF
STUDY THE ISSUE MORE CAREFULLY
AND COME BACK NEXT YEAR WITH A
COMPLETE PROPOSAL TO AND HOW TO
WHAT AUGMENTATIONS TO SUPPORT.
WE THINK THE LEGISLATURE COULD
ADOPT MORE CLEAR PARAMETERS
AROUND THE KINDS OF THINGS THAT
THE ADMINISTRATION WOULD REPORT
BACK TO THAT. WOULD THAT WOULD
ALLOW THE LEGISLATURE TO ASSESS
THE ADMINISTRATION'S PROPOSAL,
BUT ALSO ALLOW IT TO WEIGH THAT
PROPOSAL AGAINST OTHER OPTIONS.
WE ALSO THINK THAT THE THERE ARE
WAYS THE LEGISLATURE COULD
TIGHTEN THE RULES AROUND WHETHER
FUNDS ARE TRANSFERRED BETWEEN
THE DIFFERENT SPECIAL FUNDS THAT
ARE CREATED IN THIS PROPOSAL. AT
THE MOMENT, THE ADMINISTRATION
HAS A LOT OF FLEXIBILITY TO DO
THAT. THAT ARRANGEMENT HAS
WORKED HAS WORKED OKAY IN THE
PAST BECAUSE THE FUNDS WERE USED
FOR JUST ONE PURPOSE, WHICH IS
TO REPLACE GENERAL FUND SUPPORT
FOR THE MEDICAL PROGRAM. BUT NOW
THAT THE ADMINISTRATION'S
PROPOSING MULTIPLE USES THAT
THAT COULD WARRANT MORE
LEGISLATIVE CONTROL OVER HOW THE
FUNDS ARE ALLOCATED. WITH THAT
AVAILABLE FOR QUESTIONS. VERY
GOOD. WELL, THANK YOU. THANK YOU
. BOTH PANELS. UM I DO HAVE
QUESTIONS, BUT I WANT TO SEE IF
YOU WANT ME TO GO FIRST? OKAY.
ALL RIGHT. WELL, THANK YOU, UM
FIRST OF ALL APPRECIATE
APPRECIATE BOTH. I HAVE SOME
PREPARED QUESTIONS, BUT I WANT
TO GO BACK AND CLARIFY A COUPLE
OF THINGS. UM AND THIS IS FOR
YOU FOR YOU, JASON. UM IF. AND
ACTUALLY BOTH. AND DIRECTOR BOSS
CAN CAN CHIME IN ON THIS AS
WELL. BUT UM, IF THE IF THE
PACKAGE HAS TO BE RENEGOTIATED,
FOR EXAMPLE, IF THE FEDERAL
GOVERNMENT DECIDES THAT THIS IS
NOT THIS DOESN'T WORK FOR US, UM
, DOES THE LEGISLATURE HAVE ANY
ROLE IN THE CONSULTATION ABOUT
THAT RESTRUCTURED PACKAGE? AS IT
STANDS. YEAH YOU KNOW, OBVIOUSLY
, THE ADMINISTRATION CAN SPEAK
TO ITS PROPOSAL, BUT MY
UNDERSTANDING IS THE WAY THE
PROPOSAL IS DESIGNED. THERE
WOULD BE A NOTIFICATION. THE, UM
ADMINISTRATION WOULD HAVE TO
CONSULT WITH STAKEHOLDERS ON HOW
THAT TAXES REDESIGNED AND THEN
THERE WOULD BE A 10 DAY
NOTIFICATION PROCESS TO THE
LEGISLATURE ON THE REVISED
VERSION AGAIN, HAPPY TO THE
ADMINISTRATION HAS HAS MORE TO
ADD ON HOW ITS PROPOSED YEAH, I
THINK THAT'S A GOOD REFLECTION.
TYPICALLY WHAT WE DO IS WE WOULD
GET ANY CONCERNS FROM THE
FEDERAL GOVERNMENT. WE WOULD
ESSENTIALLY, UH, MAKE CHANGES TO
THE MODEL RESUBMITTED TO THEM.
MAKE SURE THAT THAT WOULD BE
AMENABLE AND THEN WE WOULD
PROVIDE PROPER NOTIFICATION TO
EVERYONE REGARDING THE CHANGE.
THIS IS SIMILAR TO WHAT HAPPENED
IN 2020. I WOULD NOTE THAT THIS
IS THE FIRST TIME THAT WE'VE
ENGAGED WITH CMS PRIOR TO HAVING
IT FINALIZED, SO WE'VE BEEN
ENGAGED WITH CMS ON THIS MODEL
SINCE FEBRUARY, SO KIND OF IT'S
THAT'S NOT TYPICAL. THE PROCESS
OF ENGAGEMENT WITH CMS. YEAH
WE'VE ALREADY MADE PRETTY
SUBSTANTIAL CHANGES TO THE MODEL
IN THOSE BACK AND FORTH
CONVERSATIONS WITH THE FEDERAL
GOVERNMENT. OKAY, UM. I'M
CURIOUS. I'M GOING. I'M LOOKING
AT THE APPENDIX ON PAGE 16 OF
THE CEOS REPORT. SO YOU,
DIRECTOR BOSS, YOU SAID
ELIMINATION OF PROP NINETIES OR
OF A B 97. BUT MY UNDERSTANDING
YOU'RE NOT ELIMINATING ALL OF
THEM. UNLESS UNLESS I HEARD WITH
YOU. YOU'RE NOT ELIMINATING ALL
OF THEM. ONLY THOSE RELATED TO
PRIMARY CARE, MATERNITY CARE AND
NON SPECIALLY BEHAVIOR HEALTH AS
PART OF THE 87.5% MAY REVISION
PROPOSED, SO I'M PUZZLED BY
THAT, BECAUSE YOU KNOW THE YOUR
THE ABILITY TO IT'S UNUSUAL THAT
WE WOULD TURN AWAY FEDERAL MONEY
. MY READING OF THIS PANICS IS
THAT THIS IS A $54 MILLION. UM,
EXPENDITURE. BUT THERE'S $150
MILLION IN FEDERAL FUNDS ON THE
TABLE. WHY WOULD WE NOT WANT TO
TAKE ADVANTAGE OF THAT? I MEAN,
THIS IS A SMALL GROUP. IT'S A
SMALL AMOUNT OF RESOURCES. AND
THESE ARE PEOPLE THAT HAVE THESE
CUTS HAPPENED A LONG TIME AGO.
WHY NOT MAKE EVERYBODY WHOLE? IN
TERMS OF ESSENTIALLY ELIMINATING
ALL THEM ALL WE'VE BEEN TRYING.
WE'VE BEEN PUSHING TOWARDS THIS
FOR YEARS. WHY WHY? WHY? WHY THE
RETICENCE HERE. WHY OUR PROPOSAL
FOR THIS FIRST ROUND OF TAX OF
INCREASES THAT GO LIVE JANUARY?
1 2024 IS REALLY BECAUSE THEY
SUPPORT OUR CLINICAL FOCUS AREAS
IN OUR COMPREHENSIVE QUALITY
STRATEGY WITH REGARD TO PRIMARY
CARE, UPSTREAM INTERVENTION, AND
SO IT'S IN LINE WITH WHAT WE
PROPOSED AT GOVERNOR'S BUDGET
RELATED TO THE DESIGNATED STATE
HEALTH PROGRAMS, THE DISH BE
RATE INCREASES FOR THOSE THREE
AREAS. IS REALLY TRYING TO
SUPPORT OUR CLINICAL FOCUS AREAS
AND BE ALIGNED IN THOSE EFFORTS.
SO CLINICAL LABORATORIES, UM
GROUND MEDICAL TRANSPORTATION.
GETTING PEOPLE TO PLACES
PHARMACY. MEDICAL SUPPLIES.
DON'T SUPPORT THAT MISSION. IS
THAT WHAT YOU'RE SAYING? I AM
JUST THAT PRIMARY CARE AND
MATERNITY CARE ARE MORE IN LINE
WITH KIND OF WHERE WE'RE WHERE
OUR COMPREHENSIVE QUALITY
STRATEGIES. CLINICAL FOCUS AREAS
ARE KIND OF OUR PRIORITIES FOR
THE DEPARTMENT. AND PRIMARY CARE
DOESN'T USE CLINICAL LABS AND
GROUND TRANSPORTATION TO GET
PEOPLE DO YOU SEE WHERE I'M
GOING? I THINK THE CASE COULD BE
MADE FOR ALL OF THE DIFFERENT
PROVIDER TYPES THAT ARE
REQUESTING RATE INCREASES. AND
SO WE'VE JUST INCREASED THEIR
ACTUALLY JUST REQUESTING PARODY
WITH THE OTHERS. BACK THROUGH
REMOVE THE CUTS. I THINK IT'S
KIND OF FROM OUR PERSPECTIVE, IT
IS ALMOST LIKE A RATE INCREASE
BECAUSE IT IS ADDING TO THEIR
RATE IN ONE OF THOSE PROVIDERS
WAITING FOR THE LAST 10, PLUS
YEARS FOR TO BE RESTORED WHEN
EVERYBODY ELSE HAS BEEN
RESTORED, SO I JUST DON'T
BELIEVE IN THE POINT HERE, BUT
I'M A LITTLE FRUSTRATED WITH
THAT WHEN WE'RE TALKING ABOUT,
YOU KNOW, BILLIONS OF DOLLARS
HERE AND THE ABILITY TO DRAW
DOWN 100 AND $50 MILLION IN
FEDERAL FUNDS. I DON'T GET IT.
QUITE FRANKLY. UM AND IF YOU'RE
SAYING THAT YOU'RE OPEN TO THAT
IN THE NEXT IN THE FUTURE,
THAT'S A DIFFERENT STORY. BUT
THAT'S NOT WHAT I HEARD. I JUST
HEARD THAT THE FIRST ARE YOU ARE
YOU OPEN TO ELIMINATING THOSE
CUTS IN THE FUTURE? SO IT IS
PART OF OUR FIRST PHASE. WE ARE
FOCUSING ON PRIMARY CARE.
MATERNITY WASN'T THE QUESTION I
THINK IS PART OF THE NEXT PHASE
WE'VE ALLUDED TO. THIS IS WHERE
WE'RE GOING TO LOOK AT KIND OF
MORE INFORMATION. MORE DETAILS
ON WHAT OUR ACTUARIES TELL US
WITH REGARDS TO HOW RATES
COMPARED TO MEDICARE. UM YOU'VE
SAID, UM. YOU KNOW, THERE'S
ALWAYS THE CONCERN THAT THE
FEDERAL GOVERNMENT'S GOING TO
CHANGE THINGS I DO REMEMBER
HEARING THE PAST WAS ALWAYS
CONCERNED. THE FEDERAL
GOVERNMENT IS GOING TO CHANGE
THINGS. I REMEMBER THIS BACK THE
FIRST TIME WE WENT, I WENT
THROUGH THIS AS WELL. YOU SAID
MORE PROPORTIONAL. UM WALK ME
THROUGH WHAT THAT MEANS. AND
WHAT DOES THAT? WHAT DO YOU
EXPECT THAT THAT COULD MEAN TO
THE FUTURE SIZE OF AN M C O TAX.
SURE UM, AND WE AGREED. THE
FEDERAL GOVERNMENT HAS BEEN
SAYING THIS FOR A WHILE. THEY
DID EMPHASIZE IT PRETTY
SIGNIFICANTLY BY THE DIRECTOR OF
CMC S HIMSELF TO CALIFORNIA AND
THESE CONVERSATIONS, SO I JUST
WANT TO BE CLEAR. WE'RE NOT.
WE'RE NOT STATING THAT BASED ON
PREVIOUS STATEMENTS OVER THE
ADMINISTRATION'S THAT WAS IN A
RECENT CONVERSATION WITH OUR
FEDERAL PARTNERS, ESSENTIALLY
WHAT THAT MEANS IS AS JASON
ACTUALLY DID A GREAT JOB OF
OUTLINING THE MODEL WHERE WE
HAVE THE HIGHER TAX ON THE
MEDICAID PORTION VERSUS THE NON
MEDICAID PORTION. ESSENTIALLY
MAKING THAT A MORE PROPORTIONAL
TAX ACROSS IT DOES PRETTY
SIGNIFICANTLY REDUCED THE
GENERAL FUND GAINED THAT THE
STATE CAN HAVE GIVEN THE WAY
THAT WE DO THE TAX IN THE MODEL
AND HOW IT WORKS. UM AND SO IF
YOU DO GET TO A MORE
PROPORTIONAL, IT'S HARD FOR US
TO COMPLETELY KNOW WHAT THAT
LOOKS LIKE AT THIS TIME BECAUSE
WE HAVEN'T SEEN WHAT THE FEDERAL
REGS WOULD CHANGE, TOO. WE DON'T
KNOW WHAT THEIR TEST WOULD BE.
WE CAN ONLY PLAY WITH THE MODELS
THAT WE HAVE TO SEE IF YOU GET
TO WHAT A MORE PROPORTIONAL
MODEL IS MAYBE A SIZE SIMILAR TO
THE NUMBER OF LIVES IN THE STATE
OF CALIFORNIA IN EACH OF THE
RESPECTIVE IT CAN SERIOUSLY
SWITCH OVER IN REGARDS TO THE
AMOUNT OF GENERAL FUND GAINED
FOR THE STATE OF CALIFORNIA. IT
WOULD BE SIZE IT WOULD BE
SMALLER THAN NOT ONLY THIS
PROPOSED TAX FOR SURE ANY OF THE
PREVIOUS APPROVED TAXES BECAUSE
WE HAVE ALWAYS HAD A
SUBSTANTIALLY HIGHER AMOUNT OF
TAX ON THE MEDICAID SIDE. VERSUS
THE NON MEDICAID SIDE AND IN ALL
OF OUR APPROVED TAXES IN
CALIFORNIA, UM AND SO WE'RE
TRYING TO JUST FLAG THAT AS A AS
A CONCERN TO EVERYBODY TAKES IT
UNDER CONSIDERATION WHEN MAKING
FINAL DECISIONS. UM SO AS I
MENTIONED WHEN WE BEGAN, I'M I
BELIEVE THE INVESTMENTS. OVER 8
TO 10 YEARS SEVERELY LIMIT THE
POTENTIAL IMPACT. UM SO WHAT
POTENTIAL IMPACT COULD WE HAVE
ON THE MEDICAL PROGRAM AND THOSE
ENROLLED IN THE PROGRAM IF WE
MADE BOLDER INVESTMENTS IN A
SHORTER PERIOD OF TIME, SAY, 4
TO 5 YEARS? SO I DON'T KNOW. I
CAN CAN SPECIFY THE IMPACT. I
WILL. NO, I MEAN THERE IS A BIG
THERE'S BIG ROOM BETWEEN THREE
AND 10 YEARS AND I KNOW
CONVERSATIONS ARE CONTINUING ON
THE TIME PERIOD OF THE SPEND,
BUT JUST RECOGNIZE WE DO WANT TO
BUILD THE FOUNDATION AND THAT
CERTAINTY FOR PROPRIETORS THAT
THOSE RATE INCREASES ARE
SUSTAINABLE, I GUESS, AND I
GUESS MY CONCERN IS ALWAYS THIS
WE'LL WE'LL GIVE YOU A LITTLE
BIT OVER A LONGER PERIOD OF
TIME. BUT THAT'S NOT ENOUGH TO
MAKE IT REALLY WORK. I MEAN, IF
THE IDEA IS TO STABILIZE THE
ONCE YOU LOSE PROVIDERS, YOU
LOSE PROVIDERS. I MEAN, IT'S
REALLY HARD TO GET THEM BACK. SO
IF YOU CAN GET THEM TO A CERTAIN
LEVEL QUICKLY I THINK YOU HAVE A
MUCH BETTER CHANCE OF
MAINTAINING ME, YOU KNOW,
KEEPING KEEPING THEM FOR A
LONGER PERIOD OF TIME, BUT IT
WAS JUST A LITTLE BIT OF AN
IMPACT. THAT PROVIDER IS GOING
TO HAVE TO SIT BACK AND DECIDE.
IS THIS WORTH IT FOR ME OR NOT?
AND I RECOGNIZE THERE ARE SOME
CATEGORIES LIKE OBSTETRICS, IN
PARTICULAR HAVE BEEN
HISTORICALLY REALLY UNDERFUNDED
AND THAT BUT AND THAT'S THAT'S
THAT'S CERTAINTY IS REALLY
IMPORTANT. SO UM SO HOW DO HOW
DO WE KNOW THESE? 87.5 NUMBER IS
THE MAGIC NUMBER. UM, HOW DO WE
HOW DO WE KNOW I'M CONCERNED,
ESPECIALLY FOR THESE SERVICES.
THEY ALREADY HAVE A PROP 56
SUPPLEMENTAL PAYMENT. NOW THAT'S
GOING TO GO INTO PREDICTING, YOU
KNOW, SETTING THE BASE RATE NOW
. SO, UM, WHICH I HAVE MIXED
FEELINGS ABOUT QUITE FRANKLY,
BECAUSE THE REASON PROBABLY ONE
OF THE BIG REASONS PROP 56 CAME
ALONG WAS BECAUSE WE COULDN'T
GET PROVIDER RATE INCREASES. UM,
AND THAT WAS THAT WAS A TOOL. UM
AND THEN, YOU KNOW. THAT TOOL,
AND SOME OF THAT MONEY HAS BEEN
TAKEN OVER THE YEARS AWAY FROM
ITS ORIGINAL PURPOSE, BUT, UM,
HOW DO WE KNOW THIS IS ACTUALLY
GOING TO MAKE THE MEANINGFUL
DIFFERENCE TO THESE PROVIDERS?
UM WHERE ARE THE NUMBERS THAT
SUPPORT THAT THIS IS A MAGIC
NUMBER? I THINK PART OF THIS IS
THE FIRST STEP AND KIND OF WHERE
WE FEEL COMFORTABLE IN TERMS OF
KNOWING THE SIZE AND SCOPE OF
THIS INVESTMENT. WE DID A
RIGOROUS ANALYSIS OVER THE FALL
TO SUPPORT OUR GOVERNOR'S BUDGET
PROPOSAL WITH REGARD TO WHAT WAS
PROPOSED RELATED TO THE DISH B
PROGRAM AND THE NEED TO DO THAT
TO GET FEDERAL APPROVAL FOR OUR
KELLUM WAIVER, AND SO WE HAVE A
GOOD SENSE FOR HOW THOSE RATES
COMPARED TO OTHER PAIRS AND TWO
OTHER TO MEDICARE, ESSENTIALLY
AND SO RECOGNIZING THAT MEDICARE
IS OFTEN USES THE STANDARD OF
RAPE, EIGHT RATE PAYMENTS USING
THAT AS KIND OF A PROXY TO
ESTABLISH WHERE WE THINK WE NEED
TO GO IN PARTICULAR FOR
MATERNITY CARE. WE KNEW THAT WE
ARE WE ARE ABOUT 60% OF MEDICARE
AND RECOGNIZING THAT THAT IS A
SIGNIFICANT INVESTMENT IN THE
SUPPORT OF THOSE PROVIDERS. HAVE
WE DONE ANY STUDIES ON THIS? OR
IS THIS JUST A GUESS? I MEAN,
YEAH, WE'RE GOING TO GET IT UP
TO THIS LEVEL AND HOPE THAT
HAPPENS. I MEAN, DO WE DO WE
ACTUALLY HAVE DATA THAT SUGGESTS
THAT THIS WILL ACTUALLY HAPPEN?
THE WAY THE WAY DO I THINK FOR
THE FOR THE GIN, ONE OF 24
PROPOSAL, ESSENTIALLY, THE WAY
WE LOOKED AT IT IS RAISE ALL
BOATS AND KIND OF HAVE A
STANDARD ACROSS THOSE THREE MAIN
COMPONENTS, KNOWING THAT WE
WOULD BE LOOKING AT POTENTIAL
ADDITIONAL AUGMENTATIONS IN THE
JAN 1 25 PROPOSAL TO FIGURE OUT
POTENTIALLY AND IT'S YOU'VE SEEN
IN OUR MEMO. SHOULD WE HAVE
VARIOUS EQUITY BUMPS, FOR
EXAMPLE, IN PHYSICIAN SHORTAGE
AREAS OR PARTS OF THE STATE
WHERE THE HP I INDEXES? ONE OR
TWO OR LOWER, MORE COMPLEXITY TO
HAVE IT HIGHER. THAT TAKES MORE
TIME TO DO TRUE ANALYTICS IN
REGARDS TO WHERE YOU WOULD HAVE
SOMETHING ABOVE THAT, 87.5. I
WOULD JUST NOTE THAT THE FEDERAL
GOVERNMENT HAS COME OUT RECENTLY
WITH AN ACCESS RULE, INDICATING
AS A BENCHMARK FOR MEDICAID, AT
LEAST 80% OF MEDICARE. NOW, THAT
DOESN'T COMPLETELY INTO, YOU
KNOW, GIVE YOU A RESPONSE TO
YOUR PIECE, BUT THAT, AT LEAST
IS WHERE THE FEDERAL GOVERNMENT
IS LOOKING AT. AND ESSENTIALLY
PROPOSING TRANSPARENCY ACROSS
THE BOARD FOR ESSENTIALLY
MEDICAID AGENCIES TO PUBLICLY
MAKE AVAILABLE WHERE WE ARE
STACKING UP AGAINST 80% OF
MEDICARE. UM BUT AGAIN, I THINK
WE WOULD BE LOOKING AT
ADDITIONAL AUGMENTATIONS IN IN
THE NEXT BUDGET FOR THOSE AREAS
, DEPENDING ON WHERE THE
STAKEHOLDER ENGAGEMENT IN
CONVERSATIONS LAND. IN REGARDS
TO THAT, BUT WE DID WANT TO AT
LEAST LIFT ALL BOATS AND THE
OTHER THING. I WOULD JUST NOTE
TO JUST MAKE SURE THAT EVERYBODY
UNDERSTANDS. 56 IS ONLY ON
CERTAIN CODES IN WHAT WE ARE
DOING IS ALL OF THE CODES UNDER
PRIMARY CARE, OBI AND NON
SPECIALTY MENTAL HEALTH, SO IT
DOES LIFT UP SOME RATES THAT
AREN'T CAUGHT UP OR HAVEN'T
HISTORICALLY HAD THAT ADDITIONAL
BUMP. AND SO THAT YOU WILL SEE
SOME THAT HISTORICALLY HAVEN'T
RECEIVED THAT IN THIS
AUGMENTATION AS WELL. SO WHEN
YOU DO THIS, THE STUDIES, I
GUESS FOR LACK OF BETTER
DESCRIPTION. AS I'M ASSUMING
YOU'LL BE DOING STUDIES ON ON
THIS. FOR THE FOR FISK FOR THE
NEXT FISCAL YEAR. WE WILL BE
LOOKING ACROSS THE BOARD OF
WHERE WE ARE PAYING WHAT THAT
INCREASE WOULD LOOK AT HOW WE
WOULD WANT TO DO THE ADDITIONAL
PIECES AS A DIRECTOR BOSS
MENTIONED FOR THE 2025 PROPOSAL
. AND HOW DOES HOW DOES THE IN
IT? HOW HOW DOES POTENTIALLY THE
LEGISLATURE INTERACT WITH YOU ON
THAT? DO WE EXACT COME TO THE
BUDGET SUBCOMMITTEE? DO WE TALK
ABOUT THAT, OR YEAH, THAT WOULD
BE PART OF NEXT YEAR'S
GOVERNMENT GOVERNOR'S BUDGET
PROPOSAL. SO THE KIND OF IT JUST
LIKE EVERY OTHER BUDGET
PROPOSAL. THAT'S BEFORE YOU
WOULD BE PART OF KIND OF THE
LEGISLATIVE PROCESS. UM OKAY,
BECAUSE MY UNDERSTANDING IS THE
WAY THIS HAS DRAFTED. THIS IS
ALL CONTINUOUSLY APPROPRIATED.
THE RATE INCREASES. THE JANUARY
1 2024 RATE INCREASES. YES THOSE
WOULD BE SO WE WOULD ALWAYS JUST
PAY THOSE RATE INCREASES AS
OUTLINED IN THE TRAILER BILL FOR
PRIMARY CARE LIKE TO TURN TO THE
L A ON THAT BECAUSE I LOVE TO
HEAR. JUST WANT TO EMPHASIZE. SO
THEY EMC. OH TAX, WHETHER THE
PROCEEDS NORMALLY GO INTO A
SPECIAL FUND. AS THIS PROPOSAL,
THIS PROPOSAL WOULD WOULD CREATE
TWO SPECIAL FUNDS. ONE WOULD BE
THE PRIMARY SPECIAL FUND THAT
THE PROCEEDS ARE PLACED INTO.
BUT THEN THERE WOULD BE A
SEPARATE RESERVED FOR FUTURE
AUGMENTATIONS, AND THAT WOULD BE
A SEPARATE ACCOUNT. BOTH OF
THESE ACCOUNTS ARE CONTINUOUSLY
APPROPRIATED. NOW THE RATE
INCREASES THAT WOULD BEGIN
JANUARY 2024. THERE IS LANGUAGE
THERE THAT SAYS THAT THAT IS
SUBJECT TO APPROPRIATION, SO
THAT WOULD BE PART OF THE BUDGET
. THAT'S THAT'S ADOPTED THIS
YEAR. BUT THE FUTURE
AUGMENTATIONS AT THE MOMENT ARE
CONTINUOUSLY APPROPRIATED. AND
SO THAT THAT EVEN THE WAY THAT
STRUCTURED THAT THE
ADMINISTRATION WOULD RETURN NEXT
YEAR FOR, UM WITH A PROPOSAL TO
SPEND THAT AUGMENTATION, BUT THE
FUNDS WOULD BE CONTINUOUSLY
APPROPRIATED. AND SO THERE THERE
WOULD BE SOME UNCERTAINTY. WOULD
THIS BE A TRAILER BILL THAT
WOULD BE ADOPTED AND THEN THE
THAT WOULD JUST PAY FOR THE
COST? OR I THINK THERE'S SOME
STILL SOME UNCERTAINTY AS TO HOW
THAT APPROVAL WOULD WORK, GIVEN
THAT THE RESERVE IS CONTINUOUSLY
APPROPRIATED. CONSIDERING THAT,
UM YOU KNOW, AS PART OF OUR, UM
ABILITY TO HAVE SOME SAY IN THE
MATTER. I MEAN, WHAT IS THE L A
. YOU HAVE ANY SUGGESTIONS FOR
GUARDRAILS? YOU KNOW WHAT I
DON'T WANT TO SEE IS THIS
SEPARATE FUND? UM THAT FOR
ADDITION FOR FUTURE FOR FUTURE
RATE INCREASES, OR WHATEVER TO
JUST SUDDENLY GETS SWEPT AWAY,
UM, WITHOUT THE ABILITY FOR THE
LEGISLATURE TO BECAUSE IF I
DON'T KNOW WHAT THE I DON'T I
DON'T FEEL LIKE THERE ARE
SUFFICIENT GUARDRAILS. QUITE
FRANKLY. YOU KNOW, I WOULD
EMPHASIZE THAT, UM, YOU KNOW,
ANY ACTION TAKEN TODAY CAN BE
YOU KNOW OVERTURNED IN NEXT
YEAR'S BUDGET. THAT'S A ISSUE
THAT THE LEGISLATURE ALWAYS
FACES. THERE ARE SOME ACTIONS
THAT LEGISLATURE COULD TAKE THAT
WOULD PROVIDE SOME GUARDRAILS.
FOR EXAMPLE, IT COULD OFFER MORE
CLARITY ABOUT THE AMOUNT OF
FUNDING THAT IS IN THE RESERVE
VERSUS UM BEING USED TO OFFSET
THE GENERAL FUND THAT THAT SORT
OF YOU KNOW, YOU CAN SEE THAT IN
THE TABLE. WHAT'S BEING PROPOSED
PROPOSED BY THE ADMINISTRATION,
BUT IT'S NOT UM, IT'S NOT
DETAILED IN THE TRAILER BILL
LEGISLATION SO THAT COULD
SPECIFY HOW MUCH FUNDING IS
GOING INTO THE RESERVE. UM YOU
COULD ALSO REVISIT SOME OF THESE
CONTINUOUS APPROPRIATIONS YOU
COULD YOU COULD MAKE THE RESERVE
SUBJECT TO APPROPRIATIONS, SO
THAT WOULD THAT WOULD GIVE THE
LEGISLATURE MORE CONTROL OVER
HOW THE FUNDS ARE SPENT. UM MY
UNDERSTANDING IS THAT THESE
CONTINUOUS APPROPRIATIONS HAVE
BEEN USED IN THE PAST BECAUSE IT
ENSURES THAT THE ADMINISTRATION
IS ABLE TO SORT OF CLAIM FEDERAL
FUNDING IN A TIMELY WAY. SO THAT
WOULD BE, UH, THAT WOULD BE
SOMETHING THAT LEGISLATURES WANT
TO WORK WITH THE ADMINISTRATION
ON. BUT THOSE ARE SOME ACTIONS
THAT LEGISLATURE COULD TAKE THEM
TO PUT MORE GUARDRAILS IN PLACE
TO PROTECT THAT RESERVE AND
PROTECT THE AUGMENTATIONS. WELL
THANK YOU. I'M I'M GONNA TAKEN
UP ENOUGH TIME HERE AT THIS
POINT, BUT I'M GOING TO GO AHEAD
AND PASS ARE TWO OTHER MEMBERS.
I KNOW MR FONG AND THEN IT LOOKS
LIKE WITH LOTS OF QUESTIONS. SO
ANYWAY, MR PHªN. THANK YOU, MR
CHAIR. UM FIRST I WANTED TO
FOCUS ON TO THE ELIO ON WHAT YOU
WROTE IN PAGE 13. HMM THERE'S A
SENTENCE THAT STOOD OUT TO ME,
WHICH IS WHICH STATES
ACCORDINGLY. WITHOUT THE KOTEX.
THE GOVERNOR'S BUDGET WOULD BE
OUT OF BALANCE BY 3.4 BILLION IN
2023 24, NECESSITATING
ADDITIONAL BUDGET SOLUTIONS OF A
LIKE AMOUNT. WITH THE HISTORY OF
THE ATTACKS. MY UNDERSTANDING IS
THAT WHEN THE EMC ATTACKS
STRUCTURE WAS WAS CREATED, IT
WAS SUPPOSED TO SUPPORT THE
MEDICAL SYSTEM. SO EXPLAIN TO ME
NOW THIS I MEAN, WE'RE WE'VE
KIND OF BEEN FLIPPING ABOUT IT
IN THE OUR CONVERSATIONS. BUT
THIS IDEA THAT YOU JUST IMPOSE A
TAX ON HEALTH PLANS AND THEN
SOMEHOW JUST GO INTO THE GENERAL
FUND TO BALANCE THE BUDGET. IT
IT TO ME. IT SEEMS THAT IS A
DIVERSION THAT PROBABLY SHOULD
BE MORE FOCUSED ON AND WE SHOULD
BE FOCUSING MORE ATTENTION ON
THAT. SO EXPLAIN TO ME THE
PURPOSE OF THE EMC ATTACKS AND
THE USE OF SOME OF IT FOR THE
GENERAL FUND. SO THE EMCEE
ATTACKS WHEN IT WAS ADOPTED IN
THE PAST VERSIONS OF IT, YOU
KNOW IT'S GENERATED TAX REVENUE
THAT TAX REVENUE HAS GONE INTO A
SPECIAL FUND, WHICH IS USED TO
SUPPORT THE MEDICAL PROGRAM. NOW
TO YOUR POINT. THE UM FUNDS HAVE
BEEN USED TO MAINTAIN FUNDING
FOR MEDICALS EXISTING BUDGET. IN
YEARS WHERE THERE'S NO ATTACKS.
THAT MEANS THAT THE GENERAL FUND
HAS TO SORT OF COVER THAT COST,
BUT WITH THE ATTACKS THAT THAT
FREES UP THAT GENERAL FUND
SUPPORT FOR OTHER PRIORITIES SO
THAT THE FUNDING IS GOING TO THE
MEDICAL PROGRAM, BUT THE SORT OF
NET EFFECT OF THAT IS THAT IT
FREES UP GENERAL FUND SUPPORT
FOR OTHER OPPORTUNITIES IN
MEDICAL OR OUTSIDE SO THAT THAT
IS SORT OF HOW THAT PROCESS
WORKS. SO IT'S NOT. SO IS IT.
ARE YOU SAYING THAT IT'S IS. ARE
YOU SAYING THAT THE EMC ATTACKS
ISN'T BEING USED FOR NON
HEALTHCARE PURPOSES? YOU WANT TO
MAKE SURE I GOT THAT NOW THAT'S
A THAT'S A I THINK. A UH, A KEY
ISSUE TO THINK ABOUT SO THE
ATTACKS DOES FREE UP GENERAL
FUND SUPPORT. BECAUSE IT'S
FREEING UP OVERALL GENERAL FUND
SUPPORT. YOU KNOW EXACTLY WHAT
IS THAT FREED UP FUNDING BEING
USED FOR ITS? YOU COULD ARGUE
IT'S GOING FOR HELP SUPPORT
AUGMENTATIONS IN THE MEDICAL
PROGRAM. YOU COULD ARGUE THAT
IT'S THAT IT'S BEING USED FOR
OTHER GENERAL FUND PURPOSES
BECAUSE IT'S FREEING UP SOME
SORT OF OVERALL GENERAL FUND
SUPPORT. IT'S HARD TO PIN IT
DOWN ON ONE SPECIFIC. IT'S
UNCLEAR ONCE ONCE. ONCE THE
GENERAL FUND SUPPORT IS RELEASED
. WE DON'T KNOW WHERE THAT
GENERAL FUND PURPOSE. WHAT WERE
THOSE JENNIFER KIND OF GOES OVER
TO OVERALL KIND OF SUPPORT THE
GENERAL FUND IT FOR THE PURPOSES
OF THE MAY REVISION. I THINK
IT'S FAIR TO THINK OF IT AS A
BUDGET SOLUTION. IT'S GOING TO
HELP ADDRESS THE BUDGET PROBLEM.
I THINK THAT'S A THAT THAT
THAT'S A HELPFUL WAY TO THINK
ABOUT IT. I THINK THAT'S WHAT
GIVES ME PAUSE IS THAT I'M NOT
SURE THE EMC ATTACKS WAS EVER
DESIGNED TO JUST FIX A BUDGET
SOLUTION. AND MAYBE THAT'S
THAT'S WHERE I'M I'M BROADLY
TAKING IT. STEP BACK. THAT'S
WHERE I THINK THERE IS A LITTLE
CONCERNED. MAYBE I'VE BECOME A
LITTLE JADED SINCE THE SEVEN
YEARS I'VE BEEN HERE. BUT THE
IDEA THAT THINGS IN THE PAST
BEFORE MY TIME HAS BEEN USED FOR
BUDGET SOLUTIONS, AS HAS CREATED
PROBLEMS IN IN THE HEALTHCARE
SPACE, WHETHER IT'S 56 OR OTHER
THINGS. SO I DON'T KNOW IF THAT
MAKES SENSE, I JUST WANNA SO I
THINK I THINK THAT IS A KEY
DECISION POINT FOR THE
LEGISLATURE. HOW SHOULD THIS
FISCAL BENEFIT BE USED? SHOULD
IT BE USED TO FREE UP GENERAL
FUND SUPPORT? SHOULD IT BE USED
TO AUGMENT THE MEDICAL BUDGET
SHOULD HAVE USED FOR A MIX OF
BOTH. THAT'S WHAT'S BEING
PROPOSED BY THE ADMINISTRATION.
HISTORICALLY THE ATTACKS HAS
BEEN SOLELY USED TO OFFSET
GENERAL FUND SUPPORT, SO IN THAT
REGARD, IT WOULD BE CONSISTENT
WITH ITS PAST USE. BUT THAT IS A
THAT IS A KEY DECISION POINT FOR
THE LEGISLATURE. DOES THAT MAKE
SENSE OR DOESN'T WANT A
DIFFERENT ARRANGEMENT, AND I
THINK THAT'S I THINK THAT'S A
BROAD QUESTION THAT WE'RE ALL
HAVING AS A COMMITTEE IS THAT IF
WE'RE GOING TO A ASSESS ATTACKS
ON ON ON THE HEALTHCARE PLANS
MOST, IF NOT ALL, OF THE MONEY
SHOULD STAY IN THE HEALTH CARE
SYSTEM IN SOME WAYS TO ENSURE
THAT, UM, IT'S USED FOR THAT
PURPOSE. UM SO I THANK YOU FOR
THAT. LET ME LET ME JUMP TO THE
TO THE, UM UH, THE DIRECTOR BASS
. UH FIRST THANK YOU FOR THE
TIME YOU GAVE ME LAST WEEK IN
TERMS OF WALKING ME THROUGH THE
PROPOSAL. I DIDN'T WANT TO KIND
OF REVISIT SOME OF THOSE AREAS.
UM FIRST AND FOREMOST IS THE
STAKEHOLDER PROCESS. I THINK YOU
AND I HAD THIS CONVERSATION. UM
MAYBE YOU CAN JUST OUTLINE TO
ME. IT'S IT SEEMS TO ME AND
CORRECT ME IF I'M WRONG WITH
THIS ASSESSMENT THAT THAT YOU'RE
ASKING THE LEGISLATURE TO
APPROVE THIS TAX MEASURE, AND
THEN THERE'S A STAKEHOLDER
PROCESS IN THE FOLLOWING YEAR,
AND IT SEEMS TO ME THAT THAT
SHOULD PROBABLY RUN CARBON THAT
SHOULD BE TOGETHER INSTEAD OF
ONE AFTER THE OTHER, SO WALK ME
THROUGH WHAT THE STAKEHOLDER
PROCESS LOOKS LIKE, SURE, SO
WE'RE PROPOSING THE TAXED KIND
OF SEPARATE FROM THE RATE
INCREASED PEACE BECAUSE WE NEED
TO GET THIS TO THE FEDERAL
GOVERNMENT TO IN ORDER TO HAVE
THIS APPROVED OR TWO CMS BY JUNE
30TH TO HAVE IT RETROACTIVE TO
APRIL 1ST, WHICH IS KEY IN TERMS
OF THE SIZE OF THE VÚI WERE
PERFORMED, PROPOSING TWO PHASES
OF THE RATE INCREASES. ONE
STARTING JANUARY. 1 2024 THAT IS
PART OF KIND OF THE MAY REVISION
PROPOSAL AND THEN THE FOLLOWING
OVER A STAKEHOLDER PROCESS AND
REALLY, BECAUSE WE NEED TO GET
SOME ACTUARY DATA WITH REGARDS
TO THE RATES OVER THE SUMMER,
THEN COMING BACK NEXT JANUARY
WITH AN ADDITIONAL PROPOSAL FOR
ADDITIONAL RATE INCREASES IN
JANUARY, 1 OF 2025. SO THEN
YOU'RE TELLING ME THAT THERE'S
GONNA BE A 1ST 1ST SET OF
PROVIDERS AND THEN ANOTHER SET,
BUT WHAT? WHO DETERMINES THE
OTHER SET OF PROVIDERS, SO WE'VE
KIND OF OUTLINED SOME OF THE KEY
AREAS THAT WE THINK WE WOULD BE
FOCUSING ON. IT'S PART OF OUR
KIND OF OUR MATERIALS WERE
RELATED TO THIS MCCOO AND
RELATED TO THE PROVIDER RATE
INCREASES. UH PRIMARY CARE,
MATERNITY CARE, NON SPECIALLY
BEHAVIOR HEALTH, ESPECIALLY CARE
SERVICES. OUTPATIENT AND ACUTE
CARE E R, FOR EXAMPLE. AND SO WE
JUST BASED ON SOME OF OUR
PRELIMINARY LOOK AT THE DATA IN
TERMS OF RATE INCREASES AND RATE
LEVELS TODAY, THOSE ARE AREAS
THAT ARE AREAS THAT WE WANT TO
HAVE FURTHER DISCUSSIONS WITH
OUR STAKEHOLDERS ON IN TERMS OF
HOW TO DESIGN A PROPOSAL FOR
JANUARY OF 2025. THIS IS MY
POINT. I THINK I'M TRYING TO
FACILITATE SOME TRANSPARENCY.
AROUND THE SECULAR PROCESS. SO
UM, YOU KNOW, THE PLAN IS GOING
TO BE PART OF THIS PROCESS ARE
LIKE ARE ARE ENTITIES OUTSIDE.
THAT HAVEN'T BEEN PART OF THE
PROCESS SO FAR, WOULD THEY BE
INCLUDED? SO THAT'S YOU KNOW,
PICK YOUR SPECIALTY. WHAT
WHETHER IT'S OPTOMETRY OR
SOMETHING ELSE. YOU KNOW WHAT
DOES THAT LOOK LIKE? OR IS
EVERYONE IN THE HEALTHCARE SPACE
GOING TO BE INVITED TO
PARTICIPATE, OR YOU GONNA OR IS,
IS THERE A PROCESS TO PICK WHICH
OTHER STAKEHOLDERS OPRAH WILL BE
PART OF THE FIRST PIECE WILL BE
LOOKING AT THE DATA AND WHAT THE
DATA SHOWS US IN TERMS OF WHERE
OUR RATES ARE TODAY AND KIND OF
STARTING THAT AS AS THE BASIS
FOR HOW DOES HAVE THESE KANSEN
STATIONS AGAIN. WE DON'T WANT TO
SPREAD THE RATE INCREASES TO
GIVE EVERYBODY A 5% RATE
INCREASE. WE REALLY WANT TO MAKE
SOME MEANINGFUL, UH, IMPACT TO
OUR PROVIDERS WHERE WE KNOW WE
WANT TO INCREASE PROVIDER
PARTICIPATION. INCREASED ACCESS,
WHETHER IT'S BY PROVIDER TYPE OR
GEOGRAPHIC, AND, UM, YOU KNOW,
HEALTHY PLACES INDEX, FOR
EXAMPLE. AND SO THAT'S HOW WE'RE
GOING TO START THE CONVERSATION
AND KIND OF LOOKING AT THE DATA
TO SEE WORDS KIND OF DIRECTING
US TO REALLY TAKE A DEEP DIVE.
AND THEN ENGAGE WITH THE
PROBLEM. THE STAKEHOLDERS IN
EACH OF THOSE DIFFERENT AREAS,
SO LET ME THEN TURN TO THE L. A
O IN TERMS OF THE STAKEHOLDER
PROCESS AND ENSURING THAT THAT
WE KIND OF UNDERSTAND WHAT THAT
LOOKS LIKE. I MEAN, WHAT ADVICE
WOULD YOU GIVE US IN TERMS OF
DETERMINING WHAT THAT LOOK
SHOULD LOOK LIKE OR WHAT
GUARDRAILS YOU SHOULD PUT IT
THERE. YOU KNOW, I THINK WE'D
HAVE TO WORK WITH STAFF A LITTLE
MORE TO WORK THROUGH THAT
CONCERN. BUT I MEAN, GENERALLY
THE KEY CONTROL THAT THE
LEGISLATURE HAS IS TO, YOU KNOW,
ENACT REQUIREMENTS IN THE
TRAILER LEGISLATION. SO IF
THERE'S MORE STAKEHOLDER PROCESS
THAT YOU WOULD LIKE TO SEE YOU,
YOU COULD YOU COULD ENHANCE SORT
OF THE EXISTING STAKEHOLDER
CONSULTATION REQUIREMENTS.
CREATE, FOR EXAMPLE, CRITERIA
OVER WHICH STAKEHOLDERS, UM,
WOULD BE INCLUDED IN THAT YOU
COULD SPECIFY HOW MANY TIMES
THEY WOULD HAVE TO BE CONSULTED.
YOU COULD YOU COULD. YOU COULD
ADJUST THE TRAILER LEGISLATION
TO SORT OF ADDRESS SOME OF THOSE
CONCERNS. THAT WOULD BE I THINK
THE PRIMARY TOOL YOU HAVE SO ON
THAT NOTE, MAYBE GO BACK TO
DIRECTOR BOSS. TAKING A STEP
BACK. IN IN IN TERMS OF LOOKING
AT THE MEDICARE SYSTEM RIGHT
NOW, I MEAN, DO WE KNOW HOW MUCH
NEEDS TO BE DONE TO KIND OF
CREATE STABILITY IN THE MEDICARE
SYSTEM WHEN IT COMES TO PROVIDER
RATES, REIMBURSEMENT RATES WE
HAD YOU DO WE HAVE DO WE HAVE A
KIND OF A SENSE RIGHT NOW, OR WE
JUST I THINK IT'S $10.3 BILLION
OVER THE OVER THE LIFE OF OR
YOUR OF THIS PLAN. I MEAN, IS
THAT IS THAT IS THAT SUFFICIENT
OR FOR JUST THAT, THAT THEY
PROVIDERS YOU'VE OUTLINED? I
MEAN, I THINK ONE COULD ARGUE
THAT WE NEED 10 TIMES THAT TYPE
OF INVESTMENT IN THE MEDICAL
SPACE TO, UM GET TO THE PLACE
WHERE WE WANT THAT OUR PROVIDERS
FEEL SUPPORTED GIVEN WHAT WE
HAVE BEFORE YOU IN TERMS OF THE
SIZE OF THE M CEO AND 11.1
BILLION THAT WE'RE TALKING ABOUT
AS PART OF THIS PROPOSAL, WE
WANT TO BE PREPARED WITH COMING
TO YOU NEXT YEAR NEXT JANUARY
WITH THE PROPOSAL THAT'S
THOUGHTFUL IN TERMS OF HOW TO
BEST DIRECT THOSE ADDITIONAL
RATE INCREASES AND WHAT VALUE WE
THINK WE WILL BE GETTING FOR
THOSE ADDITIONAL RATE INCREASES
IN TERMS OF PROVIDE A
PARTICIPATION AND ACCESS, FOR
EXAMPLE. SO AND I GUESS THAT
THAT'S THE CRUX OF THE CONCERNS
THAT I LEAST I HAVE, WHICH IS IF
YOU READ THE ANALYSIS, YOU KNOW
, THIS M CEO TAX STRUCTURE IS
NOT PERMANENT. SO WHETHER IT IS
3.5 YEARS. FIVE YEARS, 10 YEARS
THERE IS A LEVEL OF UNCERTAINTY
. SO HOW WOULD YOU MENTIONED IN
YOUR OPENING SUSTAINABILITY?
WHAT ONCE YOU RAISE THE PROVIDER
RATE TO BEING AND THERE'S A
CONTINUOUS APPROPRIATION LIKE
THAT OBLIGATES THE STATE MOVING
FORWARD. SO HOW DO YOU SUSTAIN
THAT BEYOND THE 10 YEARS? OR
WHATEVER RATE WHATEVER WHATEVER
AMOUNT OF TIME IS DETERMINED.
AND IN THIS NEGOTIATION, I THINK
THAT'S THE BALANCE THAT WE'RE
ALL TRYING TO DISCUSS BETWEEN
THREE YEARS TO 10 YEARS AND
WHERE WE CAN PROVIDE CERTAINTY
TO OUR PROVIDERS, AS AS FOR THE
LONGEVITY OF THE RATE INCREASES
, AND I THINK THAT'S PART OF THE
CONVERSATIONS THAT WE'RE ALL
HAVING, UM AND KIND OF GIVEN
KIND OF THE STATE'S FISCAL
SITUATION AS WELL. WHAT IS THE
BALANCE BETWEEN SPENDING MORE
IMMEDIATELY VERSUS SPREADING IT
OUT OVER A LONGER PERIOD OF TIME
? AND WHERE DO WE THINK THE
IMPACTS WILL BE AND TO PROVIDE A
FEEL ABOUT KIND OF THE LONGEVITY
LONGEVITY OF THOSE RATE
INCREASES. BUT LET'S SAY WHAT
WHAT HAPPENS IN UNITED DISCUSSED
THIS, BUT WHAT HAPPENS IN YEAR
11? IN YEAR 11 IT WILL. THAT
WILL BE A LONG TIME FROM NOW. I
MEAN, I THINK WE WOULD IMAGINE
THAT MANY OF THOSE THINGS WILL
PROBABLY BE KIND OF JUST BUILT
IN ON THE NATURAL AND THE RATE.
BUT THAT'S THAT'S A THAT'S A YOU
KNOW, A VERY FUTURE PERSPECTIVE
IN TERMS OF THE STATE'S BUDGET,
PHYSICAL SIPS FISCAL SITUATION.
YOU'RE ASKING THE STATE TO
OBLIGATE OURSELVES THIS YEAR FOR
YEAR 11 RIGHT? WE THINK I MEAN,
I THINK WE THINK THAT THE
MANAGED CARE TAX WILL BE
SUSTAINABLE AT THAT POINT WHERE
WE WOULD BE ABLE TO SUPPORT 1.5
BILLION, FOR EXAMPLE, ANNUAL
RATE INCREASES, WE WILL BE ABLE
TO DESIGN AN M C O THAT WILL
SUSTAIN THAT PAST PAST 11 YEARS
FROM NOW, BUT THAT IS DEFINITELY
THE FUTURE. LOTS OF UNKNOWNS
WITH REGARD TO FEDERAL
REGULATIONS BECAUSE BECAUSE I
STIPULATE THAT THE CONCERN HERE
IS YOU KNOW, TRYING TO GET A
FEDERAL APPROVAL? UH BECAUSE OF
THE AND THAT THERE IS BUILT IN
UNCERTAINTY THERE, BUT AS YOU
KICK THIS OUT, I MEAN, AS AS THE
CHAIR SAID, YOU KNOW WHERE WE'RE
DEALING WITH TRYING TO RESTORE
CUTS. THAT WERE DONE 10 YEARS
AGO. SO YOU'RE ARE WE SETTING
OURSELVES UP FOR SOMETHING THAT
COULD HAPPEN YEAR? 11 WHERE WE
HAVE THE THAT THAT LEGISLATURE
AT THAT TIME IS OBLIGATING THAT
LEGISLATOR TO ENSURE AN ONGOING
AMOUNT OF FUNDING FOR SOMETHING
THAT IS UNCERTAIN. YEAH, I THINK
THE I THINK WHAT YOU'RE RAISING
IS IT IS A GOOD POINT. I THINK
THAT'S WHY WE KIND OF BUILT
THINGS THE WAY WE DID IS, UM I
JUST WANT TO EMPHASIZE WHAT
DIRECTOR BOSS MENTIONED. UM YOU
WE WILL STILL HAVE THE ABILITY
TO DRAW DOWN IN MEXICO TAX IN
THE FUTURE THAT CAN CREATE
GENERAL FUND GAIN. IT'S HARD FOR
US TO KNOW EXACTLY WHAT THAT
AMOUNT WOULD BE BECAUSE WE DON'T
KNOW UM, WHERE THE FEDERAL
GOVERNMENT WILL GO, WHICH WOULD
HELP OFFSET THAT LONG STAND LIKE
THAT ONGOING RATE INCREASE. UM
BUT IT I THINK THAT'S WHERE YOU
HAVE TO REALLY SIZE UP. WHAT ARE
THE ACTUAL WHAT PORTION? ARE YOU
GOING TO PUT TOWARDS RATE
INCREASES IN THE ONGOING AND
THAT CHANGES VERY MUCH AS
MENTIONED FROM THREE YEARS TO 10
YEARS IN REGARDS TO WHAT YOU CAN
AFFORD IN THOSE OUT YEARS.
ADDITIONALLY OVER TIME, IT WILL
EVENTUALLY ESSENTIALLY GET BUILT
INTO THE BASE OF THE PROGRAM.
AND SO IT WON'T BE AS BIG OF A
CLIFF. IF YOU CAN RIDE THAT OUT
OVER A LITTLE BIT LONGER PERIOD
OF TIME, I THINK WITH THREE
YEARS FOR EXAMPLE, IT MAY THERE
MAY BE OBVIOUSLY A LOT LARGER
CLIFF IF THAT WERE TO BE
CONSIDERED. SO LET ME ASK THE
OBVIOUS QUESTION, WHICH IS WHY
NOT? TAKE THE REVENUE THAT'S
COLLECTED FROM THE EMBASSY
ATTACKS AND JUST USE IT FOR THE
LIFE OF THE OF THE TAX INSTEAD
OF TRYING TO SORT OF SPREADING
IT OUT. WOULDN'T WE PUT MORE
INTO THE INTO THE MEDICAL
SYSTEM? AND WOULDN'T THAT
ACTUALLY ALLOW US TO DO MORE, UH
, TO HELP PROVIDERS MANRIQUEZ
WITH THE DEPARTMENT OF FINANCE.
SO CURRENTLY, UM, ASTHMA'S BOSS
MENTIONED 8.3 BILLION OVER THE
LIFE OF THE TAX IS TO HELP
SUSTAIN THE MEDICAL PROGRAM.
WITHOUT THAT, UM, THE STATE
WOULD HAVE TO CONSIDER, UM, CUTS
IN STATEWIDE CUTS TO BALANCE OUT
THE BUDGET. OKAY BUT OKAY, THIS
GOES BACK TO THE QUESTION. I
ASKED ELLA, YOU'RE TELLING ME
THAT IF WE IF WE DID NOT DO AN 8
TO 10 YEAR SPAN OVER THIS
REVENUE THAT THERE WOULD BE CUTS
IN THE BUDGET BECAUSE YOU'RE
USING IT TO BALANCE THE BUDGET.
SO UM, THE AMOUNT THAT OF THE M
C O THAT SUSTAINS THE MEDICAL
PROGRAM ALSO, UM UM, THAT STAYS
WITHIN THE PROGRAM. SO
STATUTORILY THE M C O TAX IS
SUPPOSED TO FUND UM UM, THE
MEDICAL PROGRAM. SO WHILE IT
DOES REDUCE THE GENERAL FUND, UM
SPEND FOR MEDICAL, UM THOSE WERE
THOSE WOULD BE CAUSE THAT WOULD
OTHERWISE BE BORN BY THE GENERAL
FUND. SO WHAT PROGRAMS WOULD BE
CUT IF IT WAS RIGHT NOW, UM, IT
WOULD BE THE 3.4 BILLION WE
WOULD NEED TO FIND REDUCTIONS IN
THE MEDICAL PROGRAM OF THAT, UM
, SIZE, SO THE THEM CEO HELPS
MAINTAIN THE MEDICAL PROGRAM. SO
NOT WE DIDN'T MAKE ANY
REDUCTIONS TO MEDICAL PROGRAM AT
THE MAY REVISION. OKAY, SO
CLARIFY THIS FOR ME. IF WE TAKE
THE AMOUNT OF REVENUE THAT'S
GENERATED BY THE EMC ATTACKS,
AND INSTEAD OF SPREADING OUT
OVER 10 YEARS, WE TAKE THAT
TOTAL AMOUNT AND PUT IT INTO THE
MEDICAL SYSTEM. HOW DOES THAT
GENERATE CUTS TO THE MEDICAL
SYSTEM? LET ME JUST CLARIFY
SOMETHING. SO THERE'S TWO
DIFFERENT PIECES. THERE'S THE
8.3 BILLION, WHICH IS THE OFFSET
. I THINK WHAT? WHAT YOU'RE
HEARING IS THAT IF WE DIDN'T
MAKE THOSE INVESTMENTS WITHIN
THE THREE AND 3/4 YEAR OF THE
TAX, WE WOULD HAVE TO HAVE
SUBSTANTIAL CUTS TO THE MEDICAID
PROGRAM BASED ON THE CURRENT
BUDGET OUTLOOK, WHICH COULD
INCLUDE CUTTING COVERAGE
BENEFITS, ETCETERA. SO THAT
PORTION OF THE DOLLARS IS MEANT
TO KEEP US WHOLE. SO WE HAD TO
MAKE NO CHANGES IN THIS BUDGET,
AND IN THE NEXT FEW YEARS, THE
ADDITIONAL QUESTION IS THERE'S
ABOUT $11.1 BILLION THAT THEN
GOES TO WHAT'S THE SPECIAL
RESERVE? THAT'S WHAT'S FUNDING
THE NON FEDERAL SHARE OF THE
RATE INCREASES. UM AND THAT'S
THE PORTION THAT'S GOING OVER
EIGHT. SO THE BUDGET OFFSET IS
UH, THROUGH FISCAL YEAR 26 27
AND THAT IS EQUAL TO THE 8.3
BILLION. THAT'S JUST KEEPING OUR
BUDGET HOLE. GIVEN THE OUTLOOK
OF THE BUDGET SEPARATE APART.
THERE'S $11.1 BILLION, THAT
WOULD BE A BE ABLE TO BE SPENT
OVER THAT LONGER PERIOD OF TIME
. AND THAT'S WHAT WE'RE TRYING
TO DECIDE HOW THAT THOSE DOLLARS
ARE SPENT, AND OVER WHAT PORTION
OF TIME IN ORDER TO NOT HAVE A
FISCAL CLIFF. BUT IF YOU DID
THAT, WITHIN THE THREE YEARS OF
THE TAX, YOU COULD SEE A VERY
SIZABLE BECAUSE THAT WOULD
ESSENTIALLY BE A VERY LARGE
ANYWHERE FROM 4 TO 5, DEPENDING
ON WHAT NUMBER WE LAND ON
BILLION DOLLARS OF RATE
INCREASES THAT WOULD NOT BE
SUSTAINABLE AT THE END OF THE
TAX AFTER 3.5 YEARS, THE STATE
OF CALIFORNIA I WOULD ASK FOR
RENEWAL OF EMC ATTACKS. CORRECT
AND THE REASON WHY WE ARE
RECOMMENDING NOT GOING THAT
LARGE ONE. THIS IS THE FIRST
TIME ANY STATE FOR EXAMPLE, HAS
ASKED FOR AN ECO TAX OF THIS
SIZE. WE DON'T KNOW IF THAT
WOULD IF THAT WOULD BE A
PROVABLE IN THE FUTURE, GIVEN
THE CONVERSATIONS THAT WE'VE HAD
WITH THE FEDERAL GOVERNMENT, SO
WE'RE TRYING TO FIND A BALANCE
IN REGARDS TO HOW DO WE MAKE
SURE THAT THERE ISN'T A FISCAL
CLIFF IN CASE WE CAN'T HAVE AN
EMBASSY ATTACKS OF THIS SIZE?
COME 2027. AND THIS GETS TO THE
PROPORTIONALITY PIECE THAT WE
TALKED ABOUT EARLIER IN THE
ABILITY TO TAX OUR MEDICAL
MANAGED CARE PLANS AT A HIGHER
RATE THAN OUR COMMERCIAL PLANS,
AND SO WE ANTICIPATE THAT FIGURE
. FEDERAL REGULATION WILL CHANGE
THAT. AND SO THE SIZE OF THE CO
EVEN IF WE WERE WE WOULD PLAN TO
RENEW IN 2027 WOULD LIKELY NOT
BE AS LARGE IF THEY CHANGE THAT
FEDERAL REGULATION. AND I GUESS
HAVE YOU MODELED THAT? I MEAN, I
GUESS FROM THAT STANDPOINT,
YOU'RE SAYING YOU'RE TELLING ME
THAT IF WE IF THERE WE READ IT
IF WE DEDICATE THE AMOUNT OF
REVENUE GENERATED OVER 3.5 YEARS
AND SPENT IT IN THE LIFE OF THE
TAX, YOU'RE TELLING ME THAT IN
YEAR FOUR THERE WOULD BE FORCED
CUTS ON THE INTO THE MEDICARE
SYSTEM. NOT NECESSARILY FORCED
CUTS, BUT ADDITIONAL REVENUE
THAT WOULD BE NEEDED TO SUPPORT
THE PROGRAM. IF WE'RE NOT ABLE
TO RENEW THE M C O AT THE SAME
LEVEL AS WHAT'S BEING PROPOSED
TODAY, SHE SAID THAT THERE'S
GOING TO BE CUTS. SO THAT'S WHAT
I'M TRYING TO UNDERSTAND.
CLARIFY. MY COMMENTS ARE RELATED
TO THE 8.3 BILLION. THAT IS, UM
UM, ASSUMED IN THE MIRROR VISION
SET THE OFFSET UM, THE IF A
SHORTER AMOUNT OF TIME OR TO BE
DECIDED TO SPEND THE ADDITIONAL
M CEO TAX REVENUE, THERE WOULD
BE GENERAL FUND COST PRESSURES
IN YEAR FOUR. MAYBE I SAID,
AGREE WITH THAT ASSESSMENT. YES
SO AGAIN. THEY'RE THEY'RE TWO
DIFFERENT ISSUES. THE GENERAL
FUND OFFSET. I THINK THAT WAS
EXPLAINED. AND THEN THE SECOND
ISSUE WAS ON THE RESERVE IF THE
RESERVE WAS SPENT OVER 3 TO 4
YEARS INSTEAD OF 8 TO 10 YEARS,
AND YOU CAN SEE ON PAGE 12
THERE, BUT THAT SORT OF ANNUAL
AMOUNT THAT'S GOING TO THE
RESERVE IS ABOUT $3 BILLION OR
SO. SO IF THE EMC ATTACKS WERE
RENEWED, AT THE EXACT SAME SIZE
AS THE ONE THAT'S BEING
PROPOSED. NOW THERE WOULD BE NO
FISCAL CLIFF. WE WOULD CONTINUE
TO RECEIVE THAT SAME AMOUNT OF
REVENUE AND NEEDS THINGS WOULD
BE SORT OF OBVIOUSLY
SUPPORTABLE. THAT THE ISSUE HERE
IS IF THE IF THE TAX COMES IN,
AND IT'S A MUCH THE NEXT TAX IS
MUCH LOWER THAN THAT RAISES THE
QUESTION. YOU KNOW? HOW DO YOU
PAY FOR THIS? $3 BILLION AND
ONGOING UM, YOU KNOW, COST TO
MEDICAL. PRESUMABLY THAT WOULD
THAT WOULD COME FROM THE GENERAL
FUND. AND AS YOU AS YOU'VE SORT
OF HEARD FROM US BEFORE, WE
THINK THE STATE IS FACING SORT
OF FISCAL CONSTRAINTS AND SO
THAT THAT WOULD RAISE A COULD
COULD PUT THE LEGISLATURE IN A
DIFFICULT SORT OF FISCAL
SITUATION, YOU KNOW, IN THE
FUTURE. STRETCHING IT OUT OVER 8
TO 10 YEARS DELAYS THAT FISCAL
CLIFF TO THE EXTENT THAT THAT'S
WHAT THE LEGISLATURE IS FACING.
YOU RAISED THE KIND OF HIT THE
NAIL ON THE HEAD ON WHAT HAPPENS
IN YEAR 11 THAT THAT'S THE ONLY
QUESTION THAT'S BEFORE THE
LEGISLATURE BUT THAT THAT YOU'RE
11 SORT OF SORT SHORTFALL WOULD
BE WOULD BE MUCH LESS THAN THE
SORT OF SHORTFALL THAN IF YOU
WERE TO SORT OF HAVE $3 BILLION
AND ONGOING COST OF MEDICAL OKAY
, WELL, I MEAN, I APPRECIATE THE
CONVERSATION. I WANT TO REFER TO
MY COLLEAGUES, I THINK PROBABLY
SPEAKING, I THINK THAT WE SHOULD
ALWAYS BE CONCERNED OF THE
RATIONALE OF USING MEDICAL
DOLLARS IN ORDER TO CLOSE BUDGET
DEFICITS. THAT'S PROBABLY NOT
THE WHAT WAS ENVISIONED. THE EMC
ATTACKS THE VERY NOTION THAT YOU
CAN NOW GENERATE A LOT OF
REVENUE THIS THIS TIME. AND JUST
TRY TO MAXIMIZE IT FOR THE
BUDGET CERTAINLY GIVES ME PAUSE
. I THINK WE NEED MORE
TRANSPARENCY IN IN, UM IN THE
PROVIDER PROCESS OR THE
STAKEHOLDER PROCESS, DETERMINING
HOW WE INCREASED RATES IN THE
FUTURE AS SOMEONE THAT DOES
BELIEVE THAT WE HAVE TO INCREASE
REIMBURSEMENT RATES. WE NEED TO
KNOW, I THINK WHAT THAT LOOKS
LIKE BEFORE WE START APPROVING
THE REVENUE, UM AND THEN IN
TERMS OF THE TIMELINE, I WOULD
LOVE TO SEE THE MODELING, UH, TO
SEE IF THAT THE IDEA THAT
SOMEHOW WE IF WE PUT MORE MONEY
INTO THE MEDICAL SYSTEM, UM AT
THE AT THE AT THE OUTSET. AND
BECAUSE THERE'S NO SHORTAGE OF
NEEDS IN THE MEDICAL SPACE, I
THINK THAT ACTUALLY SOMETHING
THAT THAT WARRANTS A
CONVERSATION AND IF THAT'S GOING
TO CREATE COST PRESSURES IN THE
FUTURE THAT COST PRESSURE IS
GOING TO EXIST, NO MATTER WHAT.
WHETHER IT'S 3.5 YEARS, OR AS I
ENDED QUÊ BEFORE WE'RE CREATING
A CLIFF AT YOUR YEAR, 11 SO WE
NEED TO FIGURE THIS OUT. UM AND
WHAT? THAT STRUCTURE LOOKS LIKE
, UH, SO THOSE ARE MY CONCERNS,
AND I KNOW I'M I'M VERY GRACIOUS
TO YOU, DIRECTOR BOSS FOR THE
INFORMATION AND OF COURSE, WE
APPRECIATED THE CHAIR FOR
PUTTING THIS HEARING TOGETHER.
WE'LL GO BACK AND FORTH HERE,
BUT I DID BEFORE I FORGET
BECAUSE I MIGHT, UM SO JUST REAL
QUICK. IF WE. WE CAN RENEW THE
TAX AFTER A CERTAIN AMOUNT OF
TIME, REGARDLESS OF WHAT WE HAVE
IN ADDITIONAL FUNDS DOES NOT THE
FEDERAL GOVERNMENT LOOK AT THE
FACT THAT YOU MIGHT HAVE SAVED
PUT SOME OF THIS MONEY ASIDE AND
SAY, AND WE'RE NOT GONNA APPROVE
IT BECAUSE YOU'VE ALREADY YOU'VE
SET THIS ASIDE FOR OUT YEARS?
NO. IN FACT, WE'VE HAD SPECIFIC
CONVERSATIONS WITH THE FEDERAL
GOVERNMENT ABOUT USING THIS AS A
STRATEGY FOR INCREASING RATES,
WHICH THEY ARE VERY FAVORABLE OF
, AND WE WERE FULLY DISCLOSED
THE IDEA OF PUTTING IT IN A
SPECIAL FUND TO PAY FOR RATES IN
THE OUT YEARS AND SO THEY WERE
VERY SOON. PORTED OF OUR
PROPOSAL. AND THEN THE FINAL
PIECE OF THIS AND THEN AND THEN
I WON'T ASK ANYMORE. QUESTIONS
OF THIS PANEL IS THAT, UM, AS AS
MR FONG WAS POINTING OUT YOUR WE
GOT THIS SET ASIDE AND THEN
YOU'RE GOING TO DO SOME EXTRA
AERIALS AND TRY TO FIGURE OUT
HOW TO DO THAT. I GUESS I'LL GO
BACK TO THE ORIGINAL. I STILL
FEEL LIKE WE HAVE AN OPPORTUNITY
AND WE SHOULD BE DOING SOME
TARGETED INVESTMENTS. I MEAN,
LIKE, FOR EXAMPLE, SMALL AND
RURAL HOSPITALS THAT ARE REALLY
THAT ARE BETTER THAT ARE IN IN
POTENTIAL TROUBLE HERE. WHAT
GOOD DOES IT DO TO INCREASE
PROVIDER RATES? IF YOU
ULTIMATELY DON'T HAVE THE
HOSPITAL. UM UH, FOR OBSTETRICS
OR OTHERS. I MEAN, AND SO,
ESSENTIALLY, WHAT YOU'RE SAYING
IS WHAT I UNDERSTAND IS WELL,
WE'RE GOING TO SPEND THIS MONEY
NOW, BUT WE'RE GOING TO WAIT A
YEAR YEAR AND A HALF BEFORE HE
SAID THIS, UH, PUT, YOU KNOW,
FIGURE OUT HOW WE'RE GOING TO
SPEND THE REST OF IT. I THINK WE
CAN. I THINK WE CAN WALK AND
CHEW GUM AT THE SAME TIME. I
THINK WE CAN MAKE SOME TARGETED
INVESTMENTS. TO HELP. IN
ADDITION TO PROVIDER RATES, THE
STABILITY OF SOME OF THE SOME OF
THE SMALLER HOSPITALS THAT ARE
THAT ARE OUT THAT THAT THAT
MIGHT BE ON THE EDGE BECAUSE OF
SEISMIC, OTHER PRESSURES.
WHATEVER SO I FOLLOW UP ON THAT
QUESTION. CAN I ASK JUST ON THAT
NOTE? IS THERE THE EYE ISN'T IS
THE OPTION TO PUT SOME OF THOSE
REVENUE INTO THE UH, DISTRESSED
LOAN PROGRAM FOR HOSPITALS IS
THAT IS THAT SOMETHING WORTH THE
DEMONSTRATIONS WORTH
CONSIDERING. OKAY IT'S BEEN
RAISED MULTIPLE TIMES BY
DIFFERENT MEMBERS OF THE
LEGISLATURE. YES. OKAY. THANK
YOU, DR WEBBER. AND WE'RE GONNA
GO BACK AND FORTH HERE SO GOOD
MORNING AND THANK YOU TO BOTH
CHAIRS FOR PUTTING US ON AND
THANK YOU TO THE PANELISTS. IT
HAS DEFINITELY BEEN VERY
INFORMATIVE. I WILL, UM I'LL
KEEP MY COMMENTS SHORT FIRST.
THANK YOU. FOR ALL OF THE WORK
THAT YOU'VE DONE. UM THANK YOU
FOR, UM INCLUDING, YOU KNOW,
PRIMARY CARE, MATERNITY CARE AND
BEHAVIORAL HEALTH IN THIS
INITIAL ROUND OF PROVIDER
INCREASES, HOWEVER, UM, KIND OF
PIGGYBACKING ON WHAT SHER WOOD
SAID. I DO THINK THAT THIS IS AN
UNPRECEDENTED OPPORTUNITY. UM
ALL PROVIDERS WITHIN THE HEALTH
CARE SPACE WERE HURT
TREMENDOUSLY BY THE CUTS BEFORE.
AND BY ONLY FOCUSING ON A
CERTAIN SMALL SUBSET TO, UM, TRY
TO MAKE THEM WHOLE, I THINK
LIMITS WHAT WE CAN DO AND HOW WE
LOOK AT HEALTH CARE AS A WHOLE.
SO IF YOU CAN HAVE, UM, A
PEDIATRICIAN. WHO HAS A CHILD
THAT HAS SEIZURES. AND THEY NEED
TO SEE A PEDIATRIC NEUROLOGIST.
BUT IF WE HAVE NOT GONE INTO
THAT SPECIALTY TO MAKE THAT
GROUP HOLE THAT WILL LIMIT
ACCESS FOR THAT PATIENT AND THAT
FAMILY AND AT THE END OF THE DAY
WE WILL NOT HAVE BEEN IMPROVING
THE HEALTH CARE OF ALL
CALIFORNIANS. AND SO AS YOU ARE
GRAPPLING WITH THIS, I JUST URGE
YOU TO RECOGNIZE THAT, UM WE ALL
WORK TOGETHER WITHIN THE HEALTH
CARE SPACE WHERE THEY WERE
PRIMARY CARE PROVIDERS WERE THE
WORST SPECIALTY CARE WHETHER WE
, YOU KNOW OUR AMBULANCE DRIVERS
OR JUST TEXT THAT WORK IN THE
HOSPITAL. UM IF WE'RE ALL NOT
MADE HOLD, AND THEY'RE STILL
SIGNIFICANT GAPS AND WE'RE STILL
NOT DOING THE BEST THAT WE CAN
FOR OUR CALIFORNIA RESIDENTS.
THE SECOND THING I WANT TO POINT
OUT, WHICH HAS BEEN POINTED OUT
UM, IS WE ALL KNOW THAT THERE IS
CURRENTLY A CRISIS WITHIN OUR
HEALTHCARE SPACE? WE HAVE A
SHORTAGE OF PROVIDERS. UM WE'VE
GOT HOSPITALS CLOSING. R E R S
ARE SLAMMED. OUR HOSPITALS ARE
OVER BURDEN, AND YET AT THE SAME
TIME, WE ARE EXPANDING MEDICAL
FOR ALL. AND I WANT US TO REALLY
THINK ABOUT THAT. BECAUSE WE'RE
EXPANDING, WHO HAS COVERAGE? IN
A TIME WHEN THERE'S CRISIS. AND
WE HAVE A POT OF MONEY. AND
WE'VE DECIDED THAT WE'RE NOT
GOING TO COMPLETELY USE ALL
THOSE FUNDS RIGHT NOW. SO I
ACTUALLY KIND OF ECHO WHAT
ASSEMBLYMEMBER'S WOULD KIND OF
OPENED WITH WAS THE FACT THAT WE
NEED TO REALLY BE LOOKING AT
USING THOSE FUNDS NOW. AND NOT
TRYING TO SPARSE THEM OUT OVER
AN 8 10 YEAR PERIOD. BECAUSE WE
CAN DO SO MUCH MORE NOW AS FAR
AS BRINGING IN MORE PROVIDERS
INCREASING ACCESS IN THIS SPACE
WHERE WE'RE ALREADY AND A
SIGNIFICANT DEFICITS VERSUS KIND
OF GIVING YOU A LITTLE BIT AND
HOPING THAT WE'RE GOING TO HAVE
AN IMPROVEMENT AND OUTCOME
BECAUSE WE WON'T UM, AND THE
OTHER THING THAT
ASSEMBLYMEMBER'S PHªN KIND OF
TOUCHED ON AND I WAS ACTUALLY
QUESTIONING, UM IS HOW THIS IS
SUPPOSEDLY GOING TO IMPROVE THE
BUDGET DEFICIT. AND I JUST WANT
TO ECHO THAT. UM WHATEVER. FUND
THAT WE GENERATE FROM THE TAX
THAT SHOULD BE USED WITHIN THE
HEALTH CARE SPACE. NOT USED TO
OFFSET ANOTHER PART OF OUR
BUDGET. UM BECAUSE WE ALREADY
HAVE SIGNIFICANT ISSUES OF
FUNDING WITHIN THE HEALTH CARE
SPACE. SO AS WE'RE FIGURING ALL
OF THIS OUT, I DON'T WANT ANY OF
THIS. THESE FUNDS TO BE USED
OVER IN ANOTHER AREA. IF WE HAVE
MORE IN HEALTH CARE, THEN WE
NEED TO SPEND MORE WITHIN
HEALTHCARE. SO THANK YOU. DR
JACKSON. THANK YOU VERY MUCH, MR
. CHAIR UM, A COUPLE OF THINGS.
I DO BELIEVE 10 YEARS IS
DEFINITELY A STRETCH. I DON'T
BELIEVE IN PASSING THE BOOK ON
FOR SOMEONE ELSE TO SOLVE. UM
QUITE FRANKLY, I WOULD WERE, UM
, IF WE HAVE THE ABILITY TO
SOLVE IT NOW, AND WE NEED TO
BEGIN TO DO THE HEAVY WORK TO BE
ABLE TO DO SO. SO. I AM NOT IN
FAVOR OF WAITING, UH, SPREADING
IT OUT. UM FOR AS MUCH AS 10
YEARS. I'M SURE THERE'S A SWEET
SPOT IN BETWEEN THERE THAT WE
GOT TO FIGURE OUT. BUT I THINK
10 YEARS IS JUST A AT LEAST A
NO. GO FOR ME. UM I ALSO THINK
THAT AT THE END OF THE DAY. UM.
WHEN? WHEN DO I GUESS THE BEST
QUESTION IS WHEN DO WHEN SHOULD
WE BE HEARING FROM C M S IN
TERMS OF WHAT? A FUTURE OF THEIR
RESTRUCTURING. UM IT'S GOING TO
BE. SO I CAN'T SPEAK TO THAT. I
WOULD SAY THAT THIS IS THE
CURRENT ADMINISTRATION HAS BEEN
DROPPING A NUMBER OF FEDERAL
REGULATIONS AND THE FALL OF LAST
YEAR WE HAD A NEW FULL MEDICAID
ELIGIBILITY RULE DROP LAST MONTH
, WE HAD A ACCESS RULE AND A
MANAGED CARE RULE DROP WITH
SUBSTANTIAL CHANGES FOR THE
MEDICAID PROGRAM IN THE OUT
YEARS, AND THEY HAVE JUST
SIGNALED TO US. THIS IS ON THEIR
LIST OF FEDERAL REGULATIONS THAT
THEY ARE EXPLORING. I DO NOT
KNOW THE TIME IN WHICH THEY WILL
DROP THOSE REGS. WE DO HAVE TO
SEE THOSE REGS PROPOSED REGS. UM
OF COURSE WE WOULD COMMENT ON
THEM. BUT TYPICALLY, WHAT WE'VE
BEEN TOLD IS ANY TIME ONCE IT
DROPS ITS 18 TO 24 MONTHS FROM
DROPPED TWO FULL CLOSURE AND IN
FEDERAL REGULATIONS, AND SO THAT
IS WHY WE PROPOSE THE TAX THE
WAY WE DID BECAUSE WE KNOW WE
HAVE A FEW YEARS HERE TO BETTER
UNDERSTAND THAT IMPACT SO WE
COULD HAPPEN BETWEEN NOW AND
THREE YEARS. THAT IS CORRECT,
OKAY? UM SECONDLY, OBVIOUSLY
THERE'S A NUMBER OF CRISIS WE
HAVE TO SOLVE WITHIN OUR MEDICAL
STRUCTURE, RIGHT, MAKING SURE
THAT WE HAVE FUNDS AVAILABLE FOR
HOSPITALS TO MAKE SURE THAT
THEY'RE MORE STABLE, RIGHT,
PARTICULARLY IN RURAL AREAS AND
OTHER HOSPITALS THAT MIGHT
ACTUALLY HAVE SOME ADDITIONAL
CONCERNS DOWN THE ROAD. UM,
OBVIOUSLY, UM. UM OBVIOUSLY I
WANT TO MAKE SURE THAT, UM OH,
WE CONTINUE OUR DISCUSSIONS AND
MAKING SURE THAT IF WE HAVE AN
ABILITY TO SOLVE THE BILLING
ISSUE. UM WITH BEHAVIORAL HEALTH
. UM I WOULD CERTAINLY WANT TO
MAKE SURE THAT THAT'S A PART OF
OUR DISCUSSIONS AS WELL SO THAT
WE CAN MAKE SURE THAT WE'RE
SOLVING THAT ISSUE ALSO. OH MY
NEXT QUESTION IS MORE OF A
TECHNICAL QUESTION. I'M WE YOU
ALWAYS MENTIONED, YOU KNOW, NON
SPECIALTY MENTAL HEALTH. AND YOU
DEFINE THAT FOR ME LIKE WHAT ARE
WE TALKING ABOUT? SURE THOSE
THOSE SERVICES PROVIDE
ENVIRONMENT ACCOUNT MANAGED CARE
PLANS, SO THOSE ARE GENERALLY
CONSIDERED LIKE THE MORE MILD TO
MODERATE SERVICES THAT ARE
PROVIDED BY OUR MEN ARE MEDICAL
MANAGED CARE PLANS IN COMPARISON
TO THE SPECIALLY MENTAL HEALTH
SERVICES, WHICH ARE PROVIDED BY
A COUNTY BEHAVIORAL HEALTH PLANS
. CAN YOU GIVE ME EXAMPLES OF
SUCH SERVICES? SURE, I WOULD SAY
, YOU KNOW, JUST DEPRESSION
SCREENING MILD TO MODERATE
DEPRESSION SERVICES WOULD BE ON
THE MANAGED CARE SIDE AND THEN
KIND OF ANYTHING MORE SEVERE
WOULD BE ON THE COUNTY SIDE
CYCLE. PSYCHOLOGY IS GENERALLY
MORE ON THE MEDICAL MANAGED CARE
SIDE. YEAH SO ANY MEDICATION
MANAGEMENT GROUP THERAPY,
INDIVIDUAL THERAPY? ALL OF THAT
WOULD BE NON SPECIALTY. UM
HIGHER LEVEL CRISIS INTERVENTION
. RESIDENTIAL SERVICES INPATIENT
PSYCHIATRIC THAT'S ON THE
SPECIALTY. MENTAL HEALTH.
FANTASTIC THAT THAT'S VERY
HELPFUL. UM. WHEN WE THINK ABOUT
, UM, HAVING THIS OPPORTUNITY,
UM. OBVIOUSLY THERE'S NO DOUBT
THAT CONSISTENCY AND
PREDICTABILITY. ISN'T CRITICAL
AND WHAT WE'RE TRYING TO
ACCOMPLISH HERE. HOW QUICK. DO
YOU ANTICIPATE BEING ABLE TO
BRING FOLKS IN THE ROOM TO BEGIN
TO WORK THROUGH ALL THE OTHER
THINGS OUT? UM YOU'RE YOU SAY,
STAKEHOLDER GROUPS. UM HOW QUICK
DO YOU PLAN ON DOING THAT AND
HOW MUCH OF THEIR INPUT IS
REALLY GOING TO BE WAITED IN
THESE DISCUSSIONS? I THINK OUR
WE'RE SUPPOSED TO GET MORE
INFORMATION FROM OUR ACTUARIES
IN A MIDSUMMER, SO I THINK THAT
IS THE FIRST KIND OF THE FIRST
PIECE. WE NEED TO KIND OF HAVE
AN UNDERSTANDING FOR WHAT THE
DATA IS TELLING US. AND SO I
THINK AFTER THAT LATE SUMMER IN
THE FALL, THAT'S WHEN PROBABLY
SOME OF THE STAKEHOLDER
DISCUSSIONS WOULD WOULD BEGIN. I
AGREE, AND I AM GREATLY
APOLOGIZE, BUT I HAVE TO CATCH A
PLANE AT 12 15, SO I'VE PROBABLY
EXTENDED AS FAR AS I POSSIBLY
CAN. AND SO I HAVE TEAM MEMBERS
THAT CAN ALSO WEIGH IN IF NEEDED
. I JUST WANTED TO SAY THAT
BEFORE I WALK AWAY FROM THE
PROBLEM. THANK YOU. MISS COOPER
TRAVELS. UM AND LASTLY, UH,
OBVIOUSLY, OUR MEDICAL MEDICARE
OR OUR MEDICAL SYSTEM OR HEALTH
SYSTEM. UM. IT IS AND SURVIVAL
MODE. BASED UPON THIS PROPOSAL.
WILL THEY STILL BE IN SURVIVAL
MODE, OR WILL THEY BE OUT OF
SURVIVAL MODE? I THINK THIS IS
THIS IS A STEP IN GETTING OUT OF
SURVIVAL MODE. I MEAN, THIS IS
THE FIRST TIME THE
ADMINISTRATION EVER IS USING
DOLLARS TO DO RATE INCREASES TO
ACTUALLY INVEST AND AUGMENT THE
MEDICAL PROGRAM. IT IS, I MEAN,
KIND OF TO SOME OF THE OPENING
REMARKS UNPRECEDENTED IN TERMS
OF HOW HOW EMC $2 ARE BEING
USED, SO I THINK IT IS
ACKNOWLEDGMENT THAT WE NEED TO
BUILD UP THE FOUNDATION. WE NEED
TO BETTER SUPPORT OR PROVIDERS.
WE WANT TO INCREASE ACCESS TO
PROVIDE A PARTICIPATION AND
THEREBY INCREASE OUR MEMBERS
EXPERIENCE AND OUR MEMBERS
ABILITY TO GET THE SERVICE.
ASSES THEY NEED SO BASICALLY,
EVEN IF WE GO ALONG WITH THIS
PLAN WHERE WE'RE STILL FACING A
SYSTEM THAT'S NOT HEALTHY.
HEALTH SYSTEM. THAT'S NOT
HEALTHY. I MEAN WITH COVID.
THERE'S BEEN TREMENDOUS
CHALLENGES. I MEAN, JUST
THINKING ABOUT WORKFORCE IN
PARTICULAR, RIGHT AND SO THERE,
YOU KNOW THE ENTIRE SYSTEM. THIS
IS A STEP IN ADDRESSING SOME OF
THE CONCERNS THAT WE'RE HEARING
SOME OF THE CHALLENGES THAT ARE
BEING FACED, BUT CLEARLY THERE'S
MORE TO DO. THERE'S YOU KNOW,
AND IT'S NOT JUST AT THE
DEPARTMENT OF HEALTH CARE
SERVICES IS MULTIPLE DEPARTMENTS
THAT ARE REALLY TOUCHING THE
HEALTH CARE DELIVERY SYSTEM. AND
SO HOW COMPREHEND. HOW DO WE
COMPREHENSIVELY CONTINUE TO MEET
THOSE CHALLENGES? THANK YOU
LOOKING FORWARD TO CONTINUE
DISCUSSIONS. THANK YOU ALL.
BRING IT BACK TO THE CHAIR NOW.
AND I DO APPRECIATE ALL THE
COMMENTS FROM OUR COLLEAGUES.
I'LL BEGIN WITH THE L A O AS I
BELIEVE IT'S IMPORTANT FOR US TO
ACKNOWLEDGE THE STATE'S FISCAL
CONDITION THAT WE'RE IN. NOW
THERE'S BEEN NEW INFORMATION
THAT YOU PROVIDED EARLIER TODAY
THAT WASN'T IN THE ORIGINAL
PRESENTATION THROUGH SUB ONE
REGARDING THE MULTI YEAR FISCAL
OUTLOOK GOING FORWARD. AND WANT
YOU TO COUCH THAT IN THE
COMMENTS THAT WE JUST HEARD FROM
DIRECTOR BOSS REGARDING THE M
CEO AND THE FACT THAT PREVIOUS
VERSIONS HAVE BEEN GENERAL FUND
BACK FILLS ESSENTIALLY THAT
THEY'VE NEVER BEEN USED TO
AUGMENT THE MEDICAL RATES AND
THAT THIS IS A SIGNIFICANT
ADVANCEMENT FROM THE
ADMINISTRATION REGARDING THE M C
O PROPOSAL. TO ADDRESS THOSE
MEDICAL RAIDS, BUT WANT YOU TO
BEGIN IF YOU CAN BY GIVING US
THAT FISCAL OUTLOOK AND HELPING
THE GROUND US AS WE ARE MAKING
DECISIONS TODAY. JUST REVIEWING
OUR OUTLOOK AS YOU WERE. YOU
WERE ASKING THE QUESTION. SO ARE
YOU ARE OUR OFFICE RECENTLY
RELEASED OUR OUTLOOK? IT WAS
AVAILABLE. I BELIEVE LAST WEEK.
SO WAS AFTER WE HAD HAD OUR SORT
OF SUBCOMMITTEE DISCUSSION. SO
UNDER YOU KNOW OUR OUTLOOK WE
PROJECT REVENUES, AT LEAST IN
THE BUDGET YEAR TO BE, UH, LESS
THAN WHAT THE ADMINISTRATION
PROJECTS. WE ALSO PROJECT SOME
HIGHER SPENDING LEVELS,
PARTICULARLY IN THE OUT YEARS.
AND BECAUSE OUR OUTLOOK REFLECTS
THAT, UM YOU KNOW, WE ARE
PROJECTING BUDGET SHORTFALLS FOR
THE STATE IN THE MULTI YEAR
STARTING AT ABOUT $5 BILLION IN
THE BUDGET YEAR, BUT THEN
RANGING MORE IN THE RANGE OF 15
TO $20 BILLION IN THE IN THE
SORT OF OUT YEARS. I WILL SAY WE
DO DIFFER FROM THE
ADMINISTRATION. THE
ADMINISTRATION DOES ESTIMATE A
BALANCED BUDGET IN THE BUDGET
HERE, BUT UNDER THE
ADMINISTRATION'S OWN MULTI YEAR
THEY'RE ALSO OUR DEFICITS, TOO.
SO WE'RE IN LINE WITH THE
ADMINISTRATION, AT LEAST IN
TERMS OF ESTIMATING OUT YOUR
DEFICITS. UM I ALSO WANT TO
EMPHASIZE THAT JUST JUST TO
BRING IT BACK TO THAT POINT THAT
THIS IS A PERIOD OF FISCAL
CONSTRAINT. THIS IS ALSO COMING
WHEN YOU'RE WHEN YOU'RE FACING A
VERY LARGE EMC ATTACKS SORT OF
BRINGING IN A SORT OF
UNPRECEDENTED FISCAL OPPORTUNITY
. AND SO THESE ARE THESE ARE
SOME OF THE ISSUES YOU YOU ARE
SORT OF GRAPPLING WITH AGAIN. IT
IS IMPORTANT TO THINK ABOUT. YOU
KNOW WHAT? WHAT DECISIONS ARE
MADE. AND HOW WOULD THAT SORT
OF, UM SORT OF, UH, PUT PUT OR
NOT PUT BUDGET PRESSURE ON THE
GENERAL FUND IN THE FUTURE.
THAT'S WHY WHEN YOU'RE WHEN
YOU'RE THINKING ABOUT
AUGMENTATIONS HELPFUL TO THINK
ABOUT, YOU KNOW, HOW ARE THESE
COSTS ESTIMATED? ARE THEY
REASONABLE? IS THERE RISK THAT
THEY WOULD COME IN HIGHER? WOULD
THAT WOULD THAT PUT IT ON
UNFORESEEN IMPACT TO THE GENERAL
FUND? IT IS ALSO IMPORTANT TO
THINK ABOUT TO THE EXTENT THINGS
ARE ONGOING. WHAT HAPPENS AT THE
END OF THE CMC ATTACKS, AND
THAT'S WHY A LOT OF THIS
DISCUSSION HAS FOCUSED ON SORT
OF GAUGING THAT THAT POTENTIAL
FISCAL CLIFF SO HOPEFULLY THAT
ANSWERS YOUR QUESTION DOES AS
WE'RE TRYING TO RIGHT SIZE THIS
. IT'S ALSO HELPFUL TO REMEMBER
THAT WE'RE APPROXIMATELY THREE
TIMES THE AMOUNT OF THE PREVIOUS
ATTACKS AND THERE WERE A
APPROPRIATING APPROXIMATELY
AGAIN 60% OF THOSE REVENUES
TOWARDS MEDICAL RATES. BUT WHAT
WE'VE HEARD CONSISTENTLY BOTH ON
THIS DIET AND IN LAST SENATE
HEARING. I DO MY HOMEWORK AND
LISTEN WAS A REQUEST TO SHORTEN
THE TIME PERIOD AND I DO BELIEVE
IT WILL BE IMPORTANT FOR US TO
BE IMPACTFUL AND DIRECTED. AND
SO LOOK FORWARD TO THE
OPPORTUNITY TO REACH A
COMPROMISE HERE WITH THE
ADMINISTRATION ON WHAT THAT
SHORTER TIME PERIOD LOOKS LIKE.
SEEMS LOGICAL FOR US TO LOOK
TOWARDS AT LEAST A MINIMUM OF
FIVE YEARS FOR US TO BOTH CREATE
THAT SUSTAINABILITY, WHILE ALSO
FOCUSING THOSE DOLLARS. I'D LIKE
TO FOLLOW UP AS YOU'VE
HIGHLIGHTED THREE AREAS OF
INVESTMENT BUT HIGHLIGHTED TO
OTHERS THAT YOU WOULD LOOK TO
BEGIN IN 2025 REGARDING
SPECIALTY CARE AND ACUTE CARE.
UM. I WOULD ALSO LIKE TO ELEVATE
AND THAT SPIRIT OF COMPROMISE IF
WE CAN COME TO AN AGREEMENT AND
LOOK AT WHAT THOSE OUT YEARS
SPENDINGS ARE WHETHER WE COULD
BEGIN THOSE AS EARLY AS JANUARY
1ST OF 2024 AS A MECHANISM FOR
US TO MAKE SURE THAT WE'RE
INVESTING INTO AREAS THAT WE
KNOW THAT'S WITHOUT PREJUDICE TO
THE STAKEHOLDERS WHO WILL FOLLOW
AND ALL THE NEEDS TO INVEST IN
THE PEDIATRIC DAY HEALTHCARE
CENTERS OR EMERGENCY MEDICINE,
TRANSPORT OR AIR AMBULANCES OR
HEARING AIDS FOR CHILDREN OR ANY
NUMBER OF THEM THAT WILL COME
FORWARD. I THINK IT IS IMPORTANT
FOR US TO FOCUS AND BE A THOUGHT
PARTNER WITH YOU AND WANT TO
MAKE SURE WE'RE INVOLVED WITH IN
THOSE DISCUSSIONS. I WOULD LIKE
TO FOLLOW UP REGARDING THE
CONTINUOUS APPROPRIATION THAT
WAS DESCRIBED. I WANT TO GIVE
THE ADMINISTRATION AN
OPPORTUNITY TO EXPLAIN WHY THAT
CONTINUOUS APPROPRIATION IS
NEEDED. AND WHETHER OR NOT
THERE'S UM IF THERE'S A
RATIONALE FOR WHY YOU FEEL YOU
NEED THAT AUTHORITY. MANRIQUEZ
WITH THE DEPARTMENT OF FINANCE.
SO UM, ONE OF THE RATIONALES FOR
111 OF THE COMPONENTS OF
CONTINUOUS APPROPRIATION
SPECIFICALLY FOR MEDICAL IS THAT
WE'RE ON A CASH BASIS, SO IT
DOES HELP EXPEDITE GETTING
PAYMENTS OUT THE DOOR. OTHER
POINT I WOULD LIKE TO MAKE IS
THAT UH UM, LANGUAGE? THE DRAFT
LANGUAGE DOES SAY THAT, UM, FOR
THE FUTURE RATE INCREASES IN
2025. THAT WOULD BE SUBJECT TO
THE ANNUAL BUDGET PROCESS. SO WE
WOULD BE COMING, UM DURING
GOVERNOR'S BUDGET AND MY
REVISION WITH THOSE PROPOSALS TO
DISCUSS WITH THE LEGISLATURE I
ALSO WANTED TO FOLLOW UP. WERE
THERE ANY LESSONS LEARNED FROM
PROP 56 AND THE SUPPLEMENTAL
PAYMENTS REGARDING THE
COMPLEXITY OF GETTING THOSE
PAYMENTS OUT? YOUR STATEMENT WAS
THAT USING BASED MEDICAL WOULD
BE MORE EFFICIENT AND SO WANTED
TO GIVE YOU THE ADMINISTRATION
AN OPPORTUNITY TO EXPLAIN. YES
THANK YOU. SO THE WAY PROP 56
SUPPLEMENTAL PAYMENTS WERE
STRUCTURED THERE. THERE WAS A
RECONCILER. THERE IS A
RECONCILIATION PROCESS BETWEEN
PROVIDERS AND PLANS AND SO OFTEN
, THOSE SUPPLEMENTAL PAYMENTS
ARE OFTEN DELAYED. WE ALSO HAVE,
UM, TWO YEAR RECONCILIATION
PROCESS BETWEEN THE STATE AND
OUR PLANS WITH REGARDS TO THOSE
DOLLARS, AND SOMETIMES THOSE ARE
CLAWED BACK BECAUSE THEY WERE
NOT PROVIDED TO OUR PROVIDERS.
SO REALLY THE GOAL WITH
INCLUDING THESE AS PART OF BASES
REALLY, TO SIMPLIFY BOTH FROM
THE STATE THE PLAN AND PROVIDE
PERSPECTIVE AND REALLY, JUST TO
HAVE THIS KIND OF GUARANTEED.
HERE IS YOUR RATE, INCLUDING ALL
OF THE COMPONENTS AS PART OF
YOUR BASE. AND BY SIMPLIFY YOU
ALSO MEAN WE'RE ABLE TO GET
THESE RATES OUT SOONER AND IT'S
PART OF THEIR REGULAR PAYMENT.
IT'S NOT AN EXTRA PAYMENT OR
SOMETHING THAT THEY NEED TO
SUBMIT ADDITIONAL INFORMATION
FOR TO GET SO REALLY TRYING TO
STREAMLINE THAT THE DOLLAR IS
GOING DIRECTLY TO THE TO THE TO
THE PROVIDERS. UM, FINALLY, I
JUST WANT TO MAKE SURE WE'VE
MADE THE POINT. IT SEEMED THAT
THERE WAS CONSTERNATION THAT
THESE FUNDS WOULD GO BACK TO THE
GENERAL FUND. BUT HISTORICALLY
THESE FUNDS HAVE NOT PREVIOUSLY
GONE TOWARDS INCREASING MEDICAL
RATE. AND SO WHAT WE'RE BEING
PROPOSED TO TODAY IS A
SIGNIFICANT ADVANCEMENT. AND, UH
, MOVEMENT FORWARD FROM THE
ADMINISTRATION. JUST WANT TO
MAKE SURE WE ALL LEAVE WITH THAT
SAME UNDERSTANDING TODAY AS I
BELIEVE THE PROPOSAL THAT WE'RE
HEARING IS LOOKING TO PROVIDE
RESOURCES TO AUGMENT THE MEDICAL
PROGRAM THAT'S NEVER BEEN DONE
BEFORE. I JUST WANT TO MAKE SURE
THAT YOU AGREE. I 100% AGREE
WITH THIS IS THE M C. HAS NEVER
BEEN USED THIS WAY BEFORE.
REALLY OVER 60 OR 60% OR SO
REALLY GOING TOWARDS RATE
INCREASES OR INVESTMENTS IN THE
MEDICAL PROGRAM THAT ARE KIND OF
ABOVE AND BEYOND. WHAT IS TODAY?
AND I JUST WANTED TO REITERATE
TO THAT. WHAT'S WHAT'S NEW HERE
? IT WOULD BE THE WOULD BE THE
MEDICAL AUGMENTATIONS. THE USE
OF THE UM HMM. SO TEXAS SUPPORT
SORT OF MEDICALS EXISTING BUDGET
THAT HAS BEEN SORT OF THE WAY
IT'S BEEN USED HISTORICALLY, SO
THAT THAT IS THE HISTORICAL USE
THAT WHAT WOULD BE NEW WOULD BE
USING IT TO EXPAND MEDICAL
SERVICES. FINAL COMMENT. IF I
CAN, I WOULD AGREE WITH THE NEED
FOR US TO MAKE SURE THAT THESE
ARE SUSTAINABLE OVER A LONG
TIME. BUT AS WE HAVE CHAMPIONED
ACCESS. I ALSO BELIEVE IT'S
IMPORTANT FOR US TO GET TOWARDS
UNIVERSAL HEALTH CARE SO THAT WE
CAN FIND COST SAVINGS WITHIN OUR
SYSTEM. LONG TERM AS WELL. I'M
GRATEFUL FOR THE ADMINISTRATION
FOR CONTINUING WITH THE VISION
TOWARDS THE CALIFORNIA FOR ALL
BUT BELIEVE THAT WE'RE GOING TO
NEED TO USE ALL THE TOOLS THAT
WE HAVE ACCESSIBLE. TO PROVIDE
THAT QUALITY CARE. WE SO DESIRE
, AND THUS I'M GRATEFUL TO THE
ADMINISTRATION FOR THE PROPOSAL
AND LOOK FORWARD TO HOW WE RIGHT
SIZE IT AND WE MAKE SURE THAT
THE TIME LIMIT AND THE AMOUNT
THAT WE'RE PUTTING IN IS
APPROPRIATELY EFFECTUATING. THE
CHANGE WE ALL WANT TO SEE WITHIN
THE SYSTEM WITH THAT. I WILL
THANKS VERY MUCH THIS PANEL AND
WE WILL MOVE ON TO OUR
STAKEHOLDER PANEL NEXT THANK YOU
. THANK YOU VERY MUCH. REALLY
APPRECIATE. APPRECIATE THAT. OUR
NEXT PANEL IS, UH TWO PANELS WE
HAVE COMING UP. THIS IS THE
FIRST ONE STAKEHOLDER
PERSPECTIVES. THIS IS A LITTLE
LIKE SPEED DATING. UM AND WE
HAVE 77. PANELISTS WERE ASKING
FOR A MINUTE OR TWO EACH. SO
LINEAR KOOPMANS, CHIEF EXECUTIVE
OFFICER OF THE LOCAL HEALTH
PLANS OF CALIFORNIA CHARLES
BOCHY, PRESIDENT AND CEO OF
CALIFORNIA ASSOCIATION OF HEALTH
PLANS. DUSTIN CORCORAN, CEO OF
CALIFORNIA MEDICAL ASSOCIATION.
KATHERINE SCOTT, SENIOR VICE
PRESIDENT, STATE RELATIONS AND
ADVOCACY FOR THE CALIFORNIA
HOSPITAL ASSOCIATION. FRANCISCO
LOPEZ PRESIDENT AND CEO,
CALIFORNIA PRIMARY CARE
ASSOCIATION. JUDY HICKS, CEO
PLANNED PARENTHOOD, CALIFORNIA
AND MATT WAS A GOVERNMENT
RELATIONS FOR CI YOU CALIFORNIA
SO READY SET GO. THERE WE GO. UM
SPEED DATING. OKAY UM, GOOD
MORNING. KAREN COMMITMENT
MATTERS. LINEAR KOOPMANS, CEO
FOR THE LOCAL HEALTH PLANS OF
CALIFORNIA. LHP C. REPRESENTS
THE 16 LOCAL COMMUNITY BASED
MEDICAL MANAGED CARE PLANS THAT
COLLECTIVELY SERVE OVER 70% OF
MEDICAL MANAGED TO MANAGED CARE
BENEFICIARY STATEWIDE. HPC IS A
MEMBER OF THE COALITION TO
PROTECT ACCESS TO CARE, WHICH
INCLUDES EACH OF THE GROUPS
PARTICIPATING ON THIS PANEL. THE
COALITION, WHICH INITIALLY
FORMED IN LOS ANGELES, THROUGH
THE LEADERSHIP OF L, A CARE HAS
JOINED TOGETHER TO ADVOCATE FOR
THE RENEWAL OF AN MCO TAX THAT
WILL MAXIMIZE FEDERAL FUNDING
AND TO REINVEST THAT FUNDING
BACK INTO THE MEDICAL PROGRAM.
THE TAX REPRESENTS A HISTORIC
OPPORTUNITY TO MAKE SIGNIFICANT
INVESTMENTS IN THE MEDICAL
SAFETY NET AND TO PROVIDE TRUE
ACCESS TO CARE TO THE ONE IN
THREE CALIFORNIANS THAT RELY ON
MEDICAL BECAUSE THE LOCAL PLANS
SERVE OVER 9.3 MILLION MEDICAL
MANAGED CARE ENROLLEES IN 36
COUNTIES ACROSS THE STATE. WE
HAVE UNIQUE INSIGHT INTO THE
CHALLENGES FACED BY OUR SYSTEM.
ALL OF THE LOCAL PLANS PARTNER
WITH THE PROVIDERS IN THE
COMMUNITY AND ALL EXPERIENCED
SIMILAR CHALLENGES AND BARRIERS
IN GETTING SUFFICIENT PROVIDERS
INTO THEIR NETWORKS. THE
CLINICS, WHO IN SOME CASES
COMPRISE MORE THAN 50% OF LOCAL
PLANS. PRIMARY CARE NETWORKS ARE
STRUGGLING TO RECRUIT AND RETAIN
PROVIDERS TO SERVE THE
SIGNIFICANT VOLUME OF MEDICAL
PATIENTS WHO HAVE A CLINIC AS
THEIR MEDICAL HOME. IN OTHER
AREAS OF THE STATE PLANS.
PRIMARY CARE NETWORKS HEAVILY
RELY ON INDEPENDENT PHYSICIANS
OR SMALL GROUP PRACTICES. IN
MANY CASES, THESE PROVIDERS ARE
ONLY ABLE TO SERVE A LIMITED
NUMBER OF MEDICAL BENEFICIARIES
DUE TO THE LOW MEDICAL
REIMBURSEMENT RATES. ACCESS TO
SPECIALTY CARE IS A PROBLEM FELT
ACROSS THE STATE FOR NEARLY ALL
OF THE CORE MEDICAL SPECIALIST
PROVIDER TYPES, AND WE ALSO
UNDERSTAND THE STRAIN THAT SOME
OF OUR HOSPITAL PARTNERS, UM,
ARE FACING TODAY. I'LL CLOSE BY
SAYING WE APPRECIATE THE WORK
THE ADMINISTRATION HAS DONE TO
PUT FORWARD THE MCO TAX,
INCLUDING PROPOSING THAT A
SUBSTANTIAL PORTION OF THOSE
DOLLARS BE DEDICATED TO THE
MEDICAL PROGRAM. WE KNOW WHERE
THE NEEDS ARE IN OUR SYSTEM AND
THEREFORE WORSE WHERE
SIGNIFICANT INVESTMENTS ARE
NEEDED TO DRIVE ACCESS, QUALITY
AND EQUITY. WE LOOK FORWARD TO
CONTINUING TO WORK WITH THE
LEGISLATURE AND ADMINISTRATION
IN THE COMING WEEKS, AND I'M
HAPPY TO ANSWER ANY QUESTIONS AT
THE APPROPRIATE TIME. THANK YOU.
THANK YOU VERY MUCH, MR
CORCORAN. CHARLES BACCHI WITH
THE CALIFORNIA ASSOCIATION OF
HEALTH PLANS. WE ARE MIXED UP
OUR SEATING CHAIRS YOU HAVE. AND
I'M I'M EASILY CONFUSED. SO MY
APOLOGIES PROBLEM. CHARLES
BACCHI, THE PRESIDENT AND CEO OF
THE CALIFORNIA ASSOCIATION OF
HEALTH PLANS. WE REPRESENT 43 OF
OUR HEALTH PLANS HERE IN
CALIFORNIA, INCLUDING THOSE THAT
PROVIDE MEDICAL IN THE PUBLIC
SPACE AS WELL AS COMMERCIAL
PLANS. I WOULD LIKE TO THANK THE
ADMINISTRATION FOR THEIR BUDGET
PROPOSAL, WHICH HAS NOTED DOES
INDEED FOR THE FIRST TIME SET
ASIDE SOME FUNDING FOR THE
MEDICAL PROGRAM FROM THE CEO
TAX, AND WE APPRECIATE WORKING
WITH THEM OVER THE PAST FEW
MONTHS ON THE MECHANICS OF THE
TAX ITSELF. AS STATED. OUR
MEMBERS ARE THE ONES WHO DO PAY
THE TAX. AND WHILE THE PUBLIC
PLANS ARE REIMBURSED, THE
COMMERCIAL PLANS ARE PAYING THE
TAX UPFRONT. AND THAT MEANS THAT
OUR CUSTOMERS ARE PAYING FOR IT
. THAT MEANS PEOPLE WHO BY THEIR
OWN COVERAGE THROUGH COVERED
CALIFORNIA OR BUY COVERAGE
THROUGH THEIR EMPLOYER ARE THE
ONES WHO ULTIMATELY PAY THE
COMMERCIAL PORTION OF THIS TAX.
AND THAT'S WHY IT'S SO IMPORTANT
TO HAVE AN INDUSTRY SUPPORTED
TAX LIKE THIS, UM, BEEF WELL
THOUGHT OUT AND TO BE WELL
DIRECTED. WE HAVE HISTORICALLY
AS AN INDUSTRY SUPPORTED ATTACKS
ON OURSELVES, AND IT HASN'T
REALLY PAID OFF THIS TIME AROUND
IS A GREAT OPPORTUNITY FOR THIS
COMMITTEE AND THE LEGISLATURE TO
ACTUALLY MAKE THE TAX DO WHAT
IT'S SUPPOSED TO DO, WHICH IS
SUPPORT THE MEDICAL PROGRAM. OUR
WAYS OF LOOKING AT WHETHER
ATTACKS IS SUPPORTABLE. WE HAVE
THREE KEY COMPONENTS. THE FIRST
IS THAT THE TAX MUST DIRECTLY
IMPROVE THE MEDICAL PROGRAM FROM
OUR PERSPECTIVE, AS MISS KOOPMAN
STATED. FROM THE HEALTH PLAN
PERSPECTIVE LOOKING AT THE
ENTIRE NETWORK IN THE MEDICAL
PROGRAM, THE BIGGEST BANG FOR
OUR BUCK WE BELIEVE ARE IN THE
PRIMARY AND SPECIALTY CARE
AREAS. THAT'S TO GET PEOPLE TO
CARE THEY NEED BEFORE THEY END
UP IN EMERGENCY ROOMS, AND
THAT'S WHY IT'S ONE AND TWO FOR
US. HOWEVER WE ALSO SUPPORT THE
COALITION THAT WE'RE SITTING
WITH HERE TODAY, WHICH HAS COME
UP WITH A MUCH BROADER LIST OF
SERVICES AND WE THINK THEY ALL
ARE ALSO SUPPORTABLE. FOR THE
PROGRAM. UM SO THAT'S FIRST. THE
SECOND IS A TAX HAS TO BE
AFFORDABLE FOR OUR CUSTOMERS AND
PURCHASERS. SO AGAIN, IT CAN'T
BE SO EXPENSIVE THAT IT'S MAKING
IT DIFFICULT FOR PEOPLE TO BUY
HEALTH CARE COVERAGE. AND THEN,
SECONDLY, ANY ASSOCIATED
POLICIES THAT ARE PASSED ALONG
WITH THIS TAX SHOULD ALSO NOT
MAKE HEALTH CARE MORE AFFORDABLE
. MORE EXPENSIVE FOR ENROLLEES.
UM SO THAT'S SOMETHING THAT WILL
BE LOOKING AT AS WE GET ACROSS
THE FINISH LINE. THIRD TAX HAS
TO BE PREDICTABLE, STABLE AND IS
EQUITABLE AS POSSIBLE IN ORDER
FOR US TO, UM, HANDLE ATTACKS
LIKE THIS. WE HAVE TO KNOW WHAT
IT IS IN ADVANCE, AND I THINK
THE LACK OF CLARITY AROUND
FEDERAL APPROVAL ALWAYS IS A
CHALLENGE FOR US. SO AGAIN.
WE'RE PLAYING PLEASED TO BE HERE
AS PART OF THIS COALITION
SUPPORTING WHAT WE THINK IS A
VERY WELL PRIORITIZED LIST OF
FUNDING AUGMENTATIONS TO THE
MEDICAL PROGRAM. WE LOOK FORWARD
TO WORKING WITH THE
ADMINISTRATION, THE LEGISLATURE
IN THE COMING DAYS AND WEEKS AS
YOU GUYS BRING THIS ACROSS THE
FINISH LINE, WILLING TO ANSWER
ANY QUESTIONS. THANK YOU VERY
MUCH. THANK YOU VERY MUCH NOW,
MR CORCORAN. THANK YOU, MR
CHAIRS MEMBERS. IT'S A PLEASURE
TO BE HERE IN A PARTICULAR
PLEASURE TO FOLLOW MR BAKI IN
TESTIMONY. HE AND I HAVEN'T HAD
MUCH OPPORTUNITY TO DO THAT TO
FIND SOMETHING THAT WE AGREE
UPON. BUT HERE WE ARE AGREEING
ON THIS CRITICAL ISSUE, AND WE
CAME TOGETHER TO FOCUS ON REALLY
TWO KEY AREAS AND THAT'S ACCESS
TO CARE AND EQUITY AND CARE IN
CALIFORNIA. WHAT THE PANDEMIC
LEAD PATENTLY BEAR HERE IN THE
STATE WAS THAT THOSE ON MEDICAL
SO SUFFER DISPROPORTIONATELY.
DISPROPORTIONATELY IN TERMS OF
HOSPITALIZATION
DISPROPORTIONATELY IN TERMS OF
DEATH, THEIR ABILITY TO BE ABLE
TO GET VACCINE. THEIR ABILITY TO
BE ABLE TO GET PRIMARY CARE WAS
HIGHLY DIFFERENTIATED FROM THOSE
IN COMMERCIAL COVERAGE, AND THIS
COALITION CAME TOGETHER OUT OF
THOSE PRINCIPLES. THOSE
PRINCIPLES WERE CLEAR MADE CLEAR
, UNFORTUNATELY IN THE PANDEMIC
, BUT THEY ARE CLEAR BEFORE THAT
TO THOSE OF US IN THE HEALTH
CARE SYSTEM. SO THINKING ABOUT
ACCESS AND EQUITY AND THE SAME
CEO TAX. THIS IS FUNDAMENTALLY
IN MY VIEW, A GENERATIONAL
OPPORTUNITY TO MAKE SIGNIFICANT
INVESTMENTS IN PRIMARY CARE,
SPECIALTY CARE, BEHAVIORAL AND
MENTAL HEALTH. REPRODUCTIVE CARE
, GRADUATE MEDICAL EDUCATION SO
WE CAN INCREASE THE NUMBER OF
PHYSICIANS IN THE STATE OF
CALIFORNIA, THE WORKFORCE THAT
PROVIDES SO MANY OF THE KEY
SERVICES IN THE ENTIRETY OF OUR
STATE. THIS IS A GENERATIONAL
OPPORTUNITY TO FUNDAMENTALLY
CHANGE THOSE ACCESS AND EQUITY
QUESTIONS AND MEDICAL WHAT WE
HOPE IN THE CALIFORNIA MEDICAL
ASSOCIATION FROM OUR PERSPECTIVE
IS THAT A MEDICAL ENROLLEE HAS
THE SAME ACCESS TO CARE AS
SOMEBODY IN COMMERCIAL INSURANCE
. BETTER PROVIDER IN THEIR
COMMUNITY CAN TREAT THE
COMMUNITY AS IT PRESENTS ITSELF
. IF YOU'RE IN A COMMUNITY WITH
40, 50, 60, EVEN 70% OF MEDICAL
AND YOU'RE A PHYSICIAN. YOU
SHOULD BE ABLE TO SEE 60 70% OF
YOUR PATIENT LOAD IN MEDICAL AND
NOT HAVE TO MAKE A DECISION
ABOUT WHETHER TO KEEP YOUR DOORS
OPEN OR NOT. AND THAT,
UNFORTUNATELY, IS A DECISION
THAT TOO MANY PROVIDERS HAVE TO
MAKE RIGHT NOW. WE APPRECIATE
WORKING WITH THE ADMINISTRATION
. WE THINK SIGNIFICANT
ADVANCEMENTS HAVE BEEN MADE. IF
YOU GO BACK TO DECEMBER, THERE
WAS NO EMC ATTACKS. NOW WE'RE
CONTEMPLATING IN THE JANUARY
BUDGET, A SMALL TRADITIONAL
KOTEX CHAIR POINTED OUT, AND NOW
WE'RE TALKING ABOUT A MUCH
LARGER ONE WITH MORE SIGNIFICANT
OPPORTUNITIES FOR INVESTMENT. WE
DO THINK AN ACCELERATED TIME
FRAME IS IMPORTANT AND IS KEY
HERE. WE DON'T THINK A 10 YEAR
TIME FRAME IS GOING TO MOVE THE
NEEDLE ON ACCESS OR EQUITY. WE
HAVE SYSTEMATICALLY UNDERFUNDED
MEDICAL FOR GENERATIONS. THIS IS
AN OPPORTUNITY TO WRITE A BIT OF
THAT WRONG. WE WILL CONTINUE TO
WORK WITH THE LEGISLATURE. WE
APPRECIATE THIS HEARING. WE
APPRECIATE THE OPPORTUNITY FOR
THE ADMINISTRATION TO CONSIDER
THAT LARGER EMBASSY ATTACKS AND
AN ACCELERATED TIME FRAME TIME
FRAME AS DISCUSSED HERE, AND WE
HOPE THAT WE'RE ABLE TO ACHIEVE
THAT GENERATIONAL OPPORTUNITY TO
ADDRESS ACCESS AND EQUITY. THANK
YOU FOR YOUR TIME TO ANSWER ANY
QUESTION. THANK YOU. AND I'M NOT
SURE IF THAT'S THE MICROPHONE
WAS GONNA MAYBE YOU THINK WE'RE
GOOD AT THE ONE NEXT TO? WELL IT
WORKS IN HERE, BUT IT'S NOT
WORKING. IT WASN'T WORKING ON
THE INTERNET, SO HOW MANY IS
THIS? KNOW THAT? I DON'T KNOW.
WHICH ONE? I THINK IT WAS THAT
ONE. THAT CAT WAS MOVE OVER.
THANKS. PERFECT. THANK YOU. GOOD
ALMOST AFTERNOON, KATHRYN SCOTT
, REPRESENTING CALIFORNIA
HOSPITAL ASSOCIATION, R
CALIFORNIA HOSPITALS DO SERVE 15
MILLION CALIFORNIANS WHO ARE
ALIVE ON RELY ON MEDICAL
UNFORTUNATELY, AS MANY OF YOU
HAVE HEARD UNPRECEDENTED COST
GROWTH SINCE THE PANDEMIC, OUR
ACCESS TO HOSPITAL SERVICES IS
IN DANGER AND MANY OF THE
COMMUNITIES SERVING, UM THOSE IN
THE MEDICAL POPULATION. WE
APPRECIATE THE GOVERNOR'S
PROPOSAL. TO MOVE THE EMBASSY
ATTACKS. UH AND FOCUS IT ON
MEDICAL PATIENTS. LIKE MY
COLLEAGUES. HOWEVER WE DO NOT
AGREE THAT IT SHOULD BE DONE
OVER 8 TO 10 YEARS THAT WE NEED
THAT IMMEDIATELY INFLUX OF CASH
TO HELP SUPPORT THOSE PROVIDERS
AT THIS TABLE AND IN THOSE
COMMUNITIES. AH SPECIFICALLY FOR
HOSPITALS, FOCUSING ON
SUSTAINING RATES IN THOSE UNDER
SERVED. COMMUNITIES IS CRITICAL
AS MANY OF YOU HEARD, AND AS WE
FACE YET ANOTHER BANKRUPTCY IN
THE COMMUNITY DOWN SOUTH WE ALSO
AGREE WITH OUR MEDICAL. EXCUSE
ME ARE CMA COLLEAGUES. UM THAT G
M E IS IMPORTANT. I KNOW ARE CMA
COLLEAGUES ALSO AGAIN SITTING AT
THE TABLE TOGETHER? UM THAT
SUPPORTING OUR G M E AND
WORKFORCE IS CRITICAL. WE'RE
ABOUT 20% DOWN AND WORKFORCE
FEELING THAT EVERY DAY,
PARTICULARLY IN OUR EMERGENCY
ROOMS AS WE TRY AND MOVE
PATIENTS BOTH UP. INTO THE
HOSPITAL OR OUT INTO OTHER
ENVIRONMENTS IN THE COMMUNITY
THAT ARE ALSO LACKING WORKFORCE
. AND THEN FINALLY, WHILE WE
HAVE HISTORICALLY AND CONTINUE
TO SUPPORT COMMUNITY SERVICES
FOR BEHAVIORAL HEALTH PATIENTS,
WE ALSO SUPPORT THOSE AND
INPATIENT CARE AND NEED TO
ADDRESS THOSE IN A SYSTEMATIC
WAY AND SUPPORT INPATIENT MENTAL
HEALTH SERVICES AND AS WE MOVE
FORWARD, ALONGSIDE OUR
COLLEAGUES. FRANKLY THIS IS A
GENERATIONAL OPPORTUNITY. UM WE
HAVE AND DO APPRECIATE THE
ADMINISTRATION'S FOCUS. UM IN
MOVING THOSE DOLLARS INTO THE
MAN AT MEDICAL MANAGED CARE
SYSTEM, BUT FRANKLY, WE NEED TO
DO IT SOONER THAN THE 8 TO 10
YEARS AND LOOK FORWARD TO
WORKING WITH ALL OF YOU AS WE
MAKE THAT HAPPEN IN THE NEXT FEW
WEEKS. MR SILVA. AND I MAY ASK
THAT WE CREATE SOME SPACE. WE
HAVE ONE EXTRA PANELISTS WHO
CURRENTLY DOESN'T HAVE A SEAT. I
WANT TO MAKE SURE OUR BROTHERS
AND SISTERS FROM LABOR WE'RE
ABLE. TO GOOD MORNING. THANK
YOU, MR CHAIR AND MEMBERS OF THE
COMMITTEE. MY NAME IS FRANCISCO
SILVA. I AM THE CEO AND
PRESIDENT OF THE CALIFORNIA
PRIMARY CARE ASSOCIATION. UH
COMMUNITY HEALTH CENTERS ARE
YOUR FQ HCS REAL HEALTH CENTER
FREQUENCY CLINIC. MIGRANT HEALTH
CENTER, YOUR NEIGHBORHOOD
COMMUNITY HEALTH CENTER THAT'S
FOCUSED IN THE COMMUNITY. THIS
ISSUE IS CRITICAL TO US BECAUSE
MEDICAL IS US. UM WE SERVE ONE
IN THREE MEDICAL PATIENTS. ONE
IN FIVE CALIFORNIANS OVER A
MILLION UNINSURED. UM, SO IT'S
CRITICAL THAT WE INVEST IN
MEDICAL. WE JOINED THE
COALITION. URGING THE
SUPPLEMENTAL AND IMMEDIATE
INVESTMENT OF THEM CEO REVENUES
BECAUSE WE UNDERSTAND FROM A
FIRSTHAND PERSPECTIVE. WHAT IT
MEANS TO INVEST IN THE SAFETY
NET AND HOW CRITICAL THAT
FUNDING IS. SINCE THE PASSAGE OF
THE A CALIFORNIA HAS TAKEN BOLD
STEPS TO PROVIDE EXPANDED
COVERAGE TO LOOK AT EQUITY TO
LOOK AT SOCIAL DETERMINANTS OF
HEALTH. HAVE ER, YOU ALL KNOW,
LIKE DR WEBBER INDICATED. UM
COVERAGE DOESN'T MEAN ACCESS,
AND WITH THIS EXPANDED ACCESS
HAS COME A BROADER
RESPONSIBILITY. UM TO ENSURE
TIMELY ACCESS TO MEDICAL, DENTAL
AND BEHAVIORAL HEALTH. FOR OUR
PATIENTS. WE MUST LOOK AT THIS
INVASION INVESTMENT FROM A
PATIENT PERSPECTIVE. AND ENSURE
THAT WE INVEST IN THE BACKBONE
OF THE HEALTH CARE SYSTEM. THIS
WILL REQUIRE NOT ONLY INCREASING
MEDICAL RATES, AND THAT'S
IMPORTANT TO BROADEN ACCESS. BUT
ALSO INVESTING IN HOSPITALS AND
HEALTH CENTERS, PHYSICIAN GROUPS
AND, OF COURSE, OUR WORKFORCE.
UM WHO ARE CURRENTLY HOLDING IT
ALL TOGETHER WITH THIS MASSIVE,
BOLD AND NECESSARY STEPS THAT
WE'VE TAKEN AS A STATE.
UNFORTUNATELY WITH EXPANSION AND
WITHOUT ADDITIONAL FUNDING
AGAINST MET INCREASED COSTS.
ANOTHER WAY TO LOOK AT IT FOR
HEALTH CENTERS ALONE. THAT'S
BEEN 2027. PERCENT DECLINE IN
INVESTMENT. UM AND THAT
INVESTMENT SHOULD MEAN MORE
PATIENT ACCESS, MORE TIMELY
ACCESS AND PROVIDING MORE
RESOURCES THROUGH HISTORICALLY
UNDERFUNDED HEALTHCARE SYSTEM. I
STARTED MY MEDICAL JOURNEY. UM
THAT'S THE M A LITIGATING OVER
MEDICAL CUTS ABOUT 17 18 YEARS
AGO, SO IT IS A PLEASURE TO BE
HERE AND LOOKING AT THE
OPPORTUNITY TO INVEST BACK,
BUILD BACK THE CUTS THAT WE'VE
MADE TO THE SYSTEM AND ADD TO
IT, SO I PLEASED TO BE HERE.
PLEASED WITH THE START OF THE
DOWN PAYMENT OF EXPANDING AND
MEDICAL HAPPY TO TAKE ANY
QUESTIONS. THANK YOU. THANK YOU,
MISS SIX. THANK YOU. JODY HACKS
, PRESIDENT AND CEO OF PLANNED
PARENTHOOD AFFILIATES OF
CALIFORNIA AND WE REPRESENT
SEVEN AFFILIATES AND SERVE. UM
ABOUT 1.3 MILLION PATIENT VISITS
ANNUALLY WITH OVER 100 HEALTH
CENTERS THROUGHOUT CALIFORNIA
AND SOMEWHERE AROUND 90% OF OUR
PATIENT BASE DEPENDS ON MEDICAL
PROGRAMS THROUGHOUT THE STATE
MAJORITY OF OUR PATIENTS ARE
YOUNG HAVE LOW INCOMES BELONG TO
UNDER REPRESENTED OR UNDERSERVED
COMMUNITIES AND FOR MANY
PATIENTS, SEXUAL AND
REPRODUCTIVE HEALTH CARE CLINICS
ARE THE FIRST AND ONLY SOURCE OF
CARE. AND I WANT TO SAY WHAT
UNIQUE ABOUT THIS COALITION THAT
WE'VE BEEN MEETING ONCE OR TWICE
A WEEK FOR MANY WEEKS NOW IS NOT
JUST THAT WE'RE NOT SITTING HERE
FIGHTING WITH EACH OTHER LIKE WE
DO ON OTHER PROPOSALS, BUT ALSO
THAT WE'RE NOT GIVING YOU
INDIVIDUAL SPENDING PLANS. WE
REALLY WORK TOGETHER AS A
COALITION BECAUSE WE ARE ALL
PART OF ONE SYSTEM THAT DEPENDS
ON EACH OTHER FOR THE PATIENTS
THAT WE CARE SO DEEPLY ABOUT,
AND THE PATIENTS THAT WE SERVE.
AND REALLY HAD ACCESS TO
HEALTHCARE AS OUR NORTH STAR. SO
NOW BACKFILLING WHAT EACH OF US
MIGHT NEED BASED ON WHAT'S
HAPPENED IN THE PAST, BUT REALLY
LOOKING AT WHAT IS THE BEST WAY
TO PROVIDE MORE ACCESS TO CARE,
AND I HAVE LISTENED TO THIS
COMMITTEE AND BY THE WAY DO YOU
WANT TO ALSO THANK THE
ADMINISTRATION AND THESE
COMMITTEES FOR HAVING AN
OPPORTUNITY TO HAVE THIS
CONVERSATION? BUT LISTENING TO
WHAT IS UNCERTAINTY IN THE
BUDGET PROCESS OR UNCERTAINTY IN
THE FUTURE, AND CERTAINLY WE
UNDERSTAND THAT AS PROVIDERS, UM
REALLY, REALLY WELL, ESPECIALLY
IN THE LAST COUPLE OF YEARS,
WERE COMING OUT OF A PANDEMIC
FOR PLANNED PARENTHOOD. AS YOU
KNOW, WE HAVE A POST DOBBS
LANDSCAPE THAT CHANGES WEEK TO
WEEK. WE HAVE COURT DECISIONS
HAPPENING WHERE THINGS LIKE
MEDICATION. ABORTION ARE ON THE
TABLE, AND WE'VE WE'VE HAD TO
ADJUST TO THAT. AND QUITE
FRANKLY, IF WE HAD BEEN MORE
CAUTIOUS BECAUSE OF THAT
CHANGING LANDSCAPE, WE WOULD BE
CLOSING MANY OF OUR HEALTH
CENTERS. WE HAVEN'T WE'VE
INVESTED. WE'VE TRIED TO BE MORE
CREATIVE AND MEET THE NEEDS OF
THE COMMUNITY. WE'VE DONE THINGS
THROUGHOUT THE LAST COUPLE OF
YEARS, LIKE IN RURAL COMMUNITIES
INVESTED IN MORE TELEHEALTH. IN
CERTAIN COMMUNITIES IN OUR URBAN
POPULATIONS. WE'VE STARTED BLACK
WOMEN'S HEALTH INITIATIVES TO
WE'VE HIRED PATIENT NAVIGATORS
MORE PRO MOTORIST TO TRY AND GO
OUT IN THE COMMUNITY AND MEET
THOSE NEEDS AND WHEN THERE'S
UNCERTAINTY WHETHER THAT'S
ECONOMIC, A PANDEMIC COURT CASES
WE KNOW THAT THE NEED ACTUALLY
BECOMES GREATER AND WE HAVE AN
OPPORTUNITY RIGHT NOW TO BE BOLD
TO INVEST AND SERVE THOSE
COMMUNITIES AND I APPRECIATE
THIS LEGISLATURE THAT HAS
INCREASED COVERAGE BECAUSE IT
WAS A MORAL IMPERATIVE FOR
PEOPLE THAT NEED HEALTH CARE,
BUT IT'S A MORAL OBLIGATION NOW
WHEN WE HAVE AN OPPORTUNITY TO
INVEST. TO REALLY ENSURE THAT WE
CAN MEET THOSE NEEDS. AND WE'VE
DONE THAT WITH THIS COALITION
WHETHER ITS WORKFORCE COMMUNITY
HEALTH WORKERS ALL OF THE NEEDS
THAT WE SAW TOGETHER AND REALLY
JUST IMPLORE THIS COMMITTEE TO
HEAR WHAT WE KNOW ON THE GROUND
, HOW WE CAN BEST SERVE PATIENTS
DURING THIS TIME AND NOT JUST
THROW AROUND EQUITY BUT REALLY
ENSURE THAT PATIENTS HAVE EQUITY
WHEN THEY'RE SEEKING HEALTH
CARE. THANK YOU. THANK YOU, MR
LEE JAY. WE THINK THE OTHER
MICROPHONES WORKING SO YOU CAN.
WE DIDN'T KNOW THAT WHEN WE
ASKED MISS SCOTT, ALRIGHT,
PERFECT WORKING WELL, WE HOPE
SO. WE'LL FIND OUT IN A MINUTE.
YOU BOTH TO THE CHAIR AND MY
PANELISTS FOR MAKING ROOM FOR US
ON AIR MATTLAGE ON BEHALF OF S C
I U CALIFORNIA ARE 700,000
WORKERS. MANY OF THEM ARE
HEALTHCARE WORKERS, AND MANY OF
THEM ARE FAMILIES THAT ARE ON
MEDICAL. AND SO WE SEE THIS AS
AN URGENT AND IMPORTANT
INVESTMENT IN THE MEDICAL SYSTEM
, THEN SURE WE CAN FULFILL THIS
PROMISE OF HEALTH FOR ALL UM,
OUR WORKFORCE CRISIS EXISTED
BEFORE THE PANDEMIC. WE HAD A
SHORTAGE OF 500,000 HEALTHCARE
WORKERS IN CALIFORNIA TO BE ABLE
TO JUST MEET OUR NEEDS OF OUR
AGING POPULATION. NOW AFTER
THREE PLUS YEARS OF THE HORROR
OF THE PANDEMIC, WHERE ONE IN
FIVE HEALTHCARE WORKERS ARE
QUITTING ONE AND THREE ARE
CONSIDERING LEAVING THE
PROFESSION. WE SEE THIS AS AN
OPPORTUNITY TO TRY TO ADDRESS
THAT WORKFORCE CRISIS AND THAT
WORKFORCE NEED UM, THE
HEALTHCARE WORKFORCE,
PARTICULARLY AS WE'RE LOOKING AT
THE SUPPORT WORKERS IN THE
WORKFORCE ARE PRIMARILY WOMEN
AND PEOPLE OF COLOR, AND
UNFORTUNATELY, MANY OF THEM ARE
STUCK IN LOW PAID JOBS WITHOUT
OPERATOR OPPORTUNITIES FOR
ADVANCEMENT, AND WE SEE THIS AS
AN OPPORTUNITY TO INVEST IN THAT
WORKFORCE TO ALLOW PEOPLE TO
ADVANCE IN THEIR CAREER AND ME
ARE CARE NEEDS IN CALIFORNIA,
BUT WE MET MUST TAKE BOLD ACTION
TO DO SO. AND WE BELIEVE THAT
YOU KNOW, URGENT. INVESTMENT
WILL LEAD THAT WAY, ENSURING
THAT WORKERS HAVE A VOICE IN THE
WORKPLACE AND VOICE IN THIS
PROCESS, ENSURE THAT WE HAVE
STANDARDS IN THIS PROCESS IS
CRITICAL. UM BECAUSE WE KNOW IF
WE CAN GET THE RATES THAT ARE
GOING TO GO TO OUR PROVIDER
PARTNERS ON THIS COALITION. WE
HAVE TO ENSURE THAT IT ALSO
TRICKLES UP TO WORKERS. UM, AND
ONCE WE DO THAT UH, WE KNOW THAT
WE'RE GOING TO IMPROVE WORKER
RETENTION, INCREASED
PRODUCTIVITY, IMPROVED QUALITY
OF CARE AND SO SOME REAL
CRITICAL INVESTMENTS THAT WE CAN
MAKE TO TRY TO ENSURE THAT
ACCESS TO CARE IS FULFILLED AND
THAT WE'RE RELYING ON QUALITY
CARE. I DO WANT TO ALSO JUST
HIGHLIGHT YOU KNOW THAT THAT
HOSPITALS POINTED OUT AND
PARTICULARLY OUR PUBLIC
HOSPITALS, WHO PROVIDE 25% OF
ALL EMERGENCY CARE AND THE REAL
NEED TO MAKE INVESTMENTS THERE
BECAUSE THEY DO HAVE LONG TERM
FUNDING DEFICITS AND NEEDS AND
BELIEVE THIS COALITIONS PUT
FORWARD PROPOSALS. HELP WITH
THAT? UM ALSO TO, UM EXPAND ON
OUR PROVIDER SHORTAGES, BOTH
THAT C H A AND ALSO CMA
COLLEAGUES BROUGHT UP IS THE
INVESTMENT IN GRADUATE MEDICAL
EDUCATION IF WE CAN TRAIN
PHYSICIANS IN CALIFORNIA 72% OF
THEM ARE GOING TO STAY IN
CALIFORNIA, SO IT'S INCREDIBLE
INVESTMENT WE CAN MAKE TO
ADDRESS OUR LONG TERM PROVIDER
SHORTAGE. UM FINALLY JUST WANT
TO MAKE SURE THAT ON THE
WORKFORCE SIDE WE'RE CREATING
OPPORTUNITIES FOR WORKERS TO
HAVE A VOICE IN THOSE TRAINING
PROGRAMS. ADVANCE IN THEIR
CAREER AND CREATE PROGRAMS IS
GOING TO MEET THE INDUSTRY NEEDS
AND SO SEE THIS AS A REALLY
IMPORTANT INVESTMENT. UM AND
I'LL JUST FINALLY CLOSED BY JUST
REALLY HIGHLIGHTING THE WORK
THAT THIS COMMITTEE HAS DONE
BOTH ON SUBCOMMITTEE AND POLICY
COMMITTEE TO ENSURE THAT YOU
KNOW, WE'RE EXPANDING ACCESS TO
CARE TO EVERYONE. UM COVERAGE IS
AN AMAZING THING. BUT THAT HAS
TO RESULT IN CARE. AND SO WE
REALLY DO SEE THIS AS THAT
OPPORTUNITY TO MAKE THAT
INVESTMENT AND APPRECIATE YOUR
TIME. UM AND HAPPY TO STAY FOR
ANY QUESTIONS OF FOLKS. I'M JUST
GONNA FIRST OF ALL, THANK THE
PANEL HERE AND THEN. JUST ARE
THERE ANY QUESTIONS? WE DO HAVE
ONE MORE PANEL LEFT SO OKAY. DR
JACKSON. UM MR SILVA? UM
OBVIOUSLY, UM, I'VE BEEN RATHER
AGGRESSIVE ON, UM, THE NEED OF
SWITCHING TO SAME DAY BUILDING
WHEN IT COMES TO OUR BEHAVIORAL
HEALTH SERVICES. SOME OF THE
PUSHBACK THAT WE HEAR IS THAT
THE CURRENT RATES SHOULD BE
SUFFICIENT ENOUGH TO BE ABLE TO
TAKE CARE. OF THOSE NEEDS. UM
WOW, THEY ARE THERE. CAN YOU
TELL ME WHAT THE ANY, UM THEY
INEFFICIENCY IS OR THE WHY THE
CURRENT SYSTEM IS NOT WORKING
AND WHY THERE IS ACTUALLY A NEED
FOR SAME DAY, BILLY. THANK YOU
FOR THE QUESTION, UM SAME TEAM
BUILDING ISSUED JUST FOR
BACKGROUND. THAT'S A CHALLENGE
FOR HEALTH CENTERS IS FOR
CALIFORNIA IS ONE OF FOUR STATES
IN THE WHOLE COUNTRY THAT
DOESN'T ALLOW HEALTH CENTERS TO
BILL FOR TWO VISITS AND MEDICAL
VISIT AND EVERY HORRIBLE HEALTH
VISIT. UM, AND THAT'S BECOME A
SIGNIFICANT CHALLENGE. UM
PARTICULARLY FOR THOSE PATIENTS
THAT TRAVEL LONG DISTANCES, UH,
ASKING THEM TO COME BACK FOR A
DIFFERENT VISIT BECOMES A
PROBLEM AND PARTICULARLY
SOMEBODY WHO'S SUFFERING WITH
THE MENTAL HEALTH CRISIS. UH,
NOT BEING ABLE TO SEE HIM AT THE
TIME. IS CRITICAL. MANY HEALTH
CENTERS OF RESPONDED BY JUST
EATING THE COST. UH, THAT MEANS
PROVIDING AH FOR THAT WORKFORCE
FOR THE BEHAVIORAL HEALTH
SPECIALISTS TO BE ABLE TO DO IT
AT THAT TIME, AND FOR SOME
HEALTH CENTERS. THEY CAN'T IF
YOU'RE ON THE MARGIN,
PARTICULARLY FOR THEIR FOR OUR
HEALTH CENTERS THAT MAYBE IN
RURAL FRONTIER AREAS. UM, YOU
JUST CAN'T DO BOTH. UM
TELEMEDICINE HAS HELPED TO
PROVIDE SOME ACCESSIBILITY SINCE
THE PANDEMIC. UM BUT IT'S STILL
AN EXTREME CHALLENGE. THE
ABILITY TO BE ABLE TO DO THAT,
UH AND PROVIDE CARE IN THAT
COMPREHENSIVE MATTER IS CRITICAL
IN LONG OVERDUE. FRANKLY IT'S
ONE OF THOSE UNFUNDED MANDATES
THAT WE'VE HAD IN MEDICAL FOR A
VERY LONG TIME. THANK YOU. THANK
YOU ANYONE ELSE? DR ARAMBULA.
I'M SORRY, MR FANG. I'LL ASK THE
QUESTION OF CAT SCOTT, IF I CAN,
SO I'M GONNA FIND AGAIN.
PERFECT. UM THERE WAS A REPORT
THAT CAME OUT LAST WEEK AND
SORRY TO CATCH YOU IN REAL TIME.
BUT AS WE'RE NEGOTIATING, I
THINK IT'S IMPORTANT FOR US TO
HAVE INFORMATION BEFORE US. THE
CALIFORNIA HEALTHCARE FOUNDATION
PUT OUT A HEADING FOR AN ACUTE
CRISIS. WITHIN IT. THEY STUDIED
348 ACUTE CARE HOSPITALS AND
FOUND THAT TOTAL HOSPITAL
VOLUMES BEEN REBOUNDING AND
REACHED PRE PANDEMIC LEVELS.
QUARTER TWO OF 2021 AND NOW
EXCEEDS 2019 LEVELS BY 6. BUT
WHAT STRUCK ME IN THIS ANALYSIS
WAS THAT THEY NOTABLY FOUND THAT
THE LOWEST MARGINS WERE NOT
NECESSARILY MORE DEPENDENT ON
MEDICAL OR MEDICARE VOLUME THAN
THE AVERAGE CALIFORNIA HOSPITAL,
BUT I'M HOPING YOU CAN COMMENT
ON WHY THAT IS THE CASE TILE.
THEY ARE CONTINUING TO HAVE
HOSPITALS WITH OVER 50% OF THEIR
PAYER MIX, WHICH ARE PRIVATE.
ARE ARE STRUGGLING THAT I'M
WANTING TO HEAR FROM YOU. UM WHY
THAT? WAS FOUND 80% OF OUR
HOSPITAL BEDS ACROSS THE STATE.
SORRY, COUPLE OF THINGS, AND
WE'RE STILL ANALYZING THAT
REPORT. SO, UM, OUR DATA ANALYST
ACTUALLY SHOWED THAT THE LAST
QUARTER AND ACTUALLY HAVE IT
HERE THE LAST QUARTER THAT
BOTTOM QUARTILE ACTUALLY DID
DOES DEPEND ON MEDICAL THAT OUR
LAST QUARTER QUARTILE THAT ARE
IN THE MARKET. THE READ SO THAT
MARGINS ARE IN THE RED HAVE A
HIGHER NUMBER OF PULLING IT OUT
HERE, SO I APOLOGIZE. BUT IN THE
MEANTIME UM YOU WERE ASKING
ABOUT THE SO REBOUND 0.2 WITHIN
THE REPORT ON PAGE NINE. THE
AVERAGE HOSPITAL HAS A PAIR MIX
OF 40% MEDICARE 32% MEDICAL BUT
THE SAMPLE OF LOW MARGIN
HOSPITALS THAT BOTTOM BOTTOM
QUINTILE WAS 42% MEDICARE, 31%
MEDICAL AND 20% OF THOSE LOWEST
MARGINS HAD A PRIVATE PAYER MIX
AGAIN OF OVER 50% BUT I'M TRYING
TO REALLY MAKE SURE WE'RE ASKING
AND ANSWERING THE TOUGH
QUESTIONS REGARDING RATES AND
HOSPITAL SUCCESS. TO MAKE SURE
THAT WE'RE PROVIDING THE
RESOURCES TO WHERE WE BELIEVE
THEY WILL BE MOST IMPACTFUL TO
EFFECTUATE THE CHANGE THAT WE
NEED TO SEE WITHIN THE MEDICAL
SYSTEM, AND I APOLOGIZE. I'M
JUST LOOKING FOR, UM, OUR
ANALYSTS LOOKED AT WITH MY
GLASSES ON, UM. SHE HAS CONCERNS
. SO OUR ANALYST HAS CONCERNS
WITH THE WAY THAT SAMPLE BECAUSE
WHEN WE LOOK AT THE INPATIENT
DISCHARGES WHEN YOU ADJUST FOR
OUTPATIENT DAYS, UM HE USES THE
AVERAGE PAYER MIX WHEN WE USED
TO TWO THIRDS OF HOSPITALS IN
THE 20/5 25TH PERCENTILE,
QUARTILE OF LOWEST MARGINS. HAVE
A GOVERNMENT PARAMYXOVIRUS. THE
STATE AVERAGE, SO I THINK WE
LOOK AT SORT OF AN ADJUSTED DAY
VERSUS HE MAY HAVE LOOKED OUT OR
SAMPLED, UM, THE VOLUME, SO I
THINK WE CAN GET BACK TO YOU ON
THAT. I THINK WE HAVE SOME
DISAGREEMENT. THERE'S GENERAL
THERE'S GENERAL AGREEMENT IN THE
REPORT ON THE BACK TO THE TO THE
VOLUME. WE DO SEE AN AVERAGE
LENGTH OF STAY. THAT IS LONGER
FOR MYRIAD OF REASONS, INCLUDING
THE ACUITY PATIENTS GONE UP
SINCE COVID. AS WELL AS WE HAVE
ARE HAVING A HARD TIME
DISCHARGING PATIENTS SO OFTEN
TIMES WE CAN'T FIND A SNIFF TO
JUST CHARGE TO SKILLED NURSING
FACILITY. EXCUSE ME OR AN
INPATIENT BUT UM OR A COMMUNITY
PROGRAM THAT'S SUFFICIENT TO
SUPPORT WHETHER IT'S RESPITE
CARE OR WHATNOT. SO WE ARE
SEEING THE AVERAGE LENGTH OF
STAY GO UP. SO WE ARE SEEING
THOSE VOLUMES GO UP DOESN'T
NECESSARILY MEAN OUR REVENUE IS
GOING UP BECAUSE OFTEN TIMES
EVEN NEGOTIATED BASED ON AN
AVERAGE LENGTH OF STAY VERSUS
THAT LONGER LENGTH OF STAY, BUT
WE'LL GET BACK TO YOU ON THAT
PORTAL. THINK WE LOOK AT IT
DIFFERENTLY WHEN IT COMES TO OUR
MEDICAL, UM, HOSPITALS IN THOSE
DISHES, HOSPITALS BECAUSE WE SEE
THOSE LOWER QUARTILE IN HIGHER
AVERAGES OF RED. I HOPE WE'RE
ABLE TO SPEAK APPLES TO APPLES.
MANY OF US EXACTLY. THE
HEALTHCARE FOUNDATION AS UM,
TRUTH, SAYER. TO WHAT WE'RE
FACING AS A SYSTEM AND WANT TO
MAKE SURE THAT, UM, IF RATES ARE
AFFECTING OUR HOSPITALS,
FINANCIAL SUCCESS THAT WE'RE
AWARE OF IT AND ABSOLUTELY
CONCLUSION THAT CAME OUT IN THE
REPORT LAST WEEK, UM, HAS FLYING
CONTRARY TO MUCH OF THE
NARRATIVE WE'VE HEARD IN THE
LAST YEAR. THAT I LIKE TO MAKE
SURE AS WE'RE LOOKING AT THIS
TIME OF GENERAL GENERATIONAL
INVESTMENT THAT WE'RE FOCUSING
IT ON AREAS WHERE WE CAN BE MOST
EFFECTIVE. ABSOLUTELY WE'LL GET
BACK TO YOU ON THAT DIFFERENTIAL
IN THE, UM THOSE IN THE RED
THANK YOU, MR FONG. I THINK IT
WAS SURE I HAVE ONE QUESTION AND
ANYONE ON THE PANEL CAN CAN
ADDRESS THIS SINCE YOU GUYS ARE
SPEAKING WITH ONE VOICE, BUT IN
TERMS OF THE STAKEHOLDER PROCESS
, THAT WAS A CONVERSATION IN THE
FIRST PANEL. UM, YOU KNOW,
SEEING THAT. OTHER PROCESSES IS
LAID OUT IN THE IN THE IN THE
PROPOSAL. YOU KNOW WHAT? WHAT
GUIDANCE? WHAT ADVICE WOULD YOU
HAVE IN TERMS OF FLUSHING OUT
MORE TRANSPARENCY IN THE
STAKEHOLDER PROCESS? UM, WHAT
INPUT WOULD YOU WANT? AND UM AS,
UM AS DOCTOR EVER MENTIONED YOU
CERTAINLY WE WANT, UM MORE
RESOURCES ON IN A SHORTER PERIOD
OF TIME. SO I GUESS IN TERMS OF
FLUSHING OUT HIS PROPOSAL, YOU
KNOW WHAT? WHAT IMPROVEMENTS
WOULD YOU MAKE? MAYBE I'LL START
LINEAGE KOOPMANS WITH L HPC. UM,
I THINK BROADLY SPEAKING, ONE OF
OUR MESSAGE HAS BEEN IS THAT WE
KNOW WHERE THE GAPS AND NEEDS
ARE IN OUR SYSTEM, AND I THINK
THIS IS WELL DOCUMENTED AND WELL
KNOWN. YOU CAN LOOK AT THE YOU
KNOW, NETWORK CERTIFICATION AND
MEDICAL. YOU CAN LOOK AT OTHER
STUDIES DONE BY CH CF FOR OTHERS
THAT LOOK AT KIND OF THE
DIFFERENTIAL AND ACCESS. SO I
THINK YOU KNOW ONE OF OUR ASSETS
TO BASED ON THOSE KNOWN GAPS,
MAKE COMMITMENTS NOW NOT
DISCOUNTING KIND OF THE
IMPORTANT DETAILS AND MECHANICS
THAT WOULD NEED TO BE FLUSHED
OUT. CERTAINLY, YOU KNOW, OUR
MEDICAL FINANCING IS COMPLEX.
BUT I THINK THE KIND OF MESSAGES
EACH OF THOSE OF US THAT ARE
PART OF THE COALITION, OUR CORE
PART OF THAT DELIVERY SYSTEM,
AND WE, YOU KNOW, SEE AND FEEL
THE GAPS ON THE GROUND EVERY
DAY. AND I WOULD JUST ADD THAT
THAT IS PART OF US LOOKING AT
THE ECOSYSTEM AND CONSIDERING
ALL PARTS OF IT, BUT I DO THINK
THAT THE GAPS ARE WELL KNOWN.
WHAT HAS BEEN INTERESTING IN
THIS IN THE COURSE OF THE
CONVERSATIONS BOTH WITHIN THE
COALITION AND WITH THE
DEPARTMENT ITSELF IS CONSIDERING
ALL OUR DIFFERENT VANTAGE POINTS
. SO THE PLANS HAVE VERY, UH,
INTERESTING AND DISTINCT SET OF
DATA, AS DOES THE DEPARTMENT
HEAD TO THE PROVIDER
ORGANIZATIONS. WE ENDED UP
GENERATING A LOT OF THAT DURING
DURING THE PANDEMIC AND LOOKING
AT SOME OF THE, UH, COMPOSITIONS
OF CONCENTRATION MEDICAL LIVES
IN A PARTICULAR COMMUNITY
RELATIVE TO THE PROPORTION OF
PROVIDERS. ALL OF THAT PROVIDES
A REALLY INTERESTING SET OF DATA
POINTS TO BUILD OFF OF WHERE DO
YOU MAKE YOUR INVESTMENTS IN
WHICH CPT CODES IN WHICH
SPECIALTIES? DO YOU MAKE THOSE
INVESTMENTS DO YOU HAVE ADDED,
UH, INVESTMENTS THAT YOU MAKE
BASED ON HP, I AND SOME OTHER
THINGS. THE DEPARTMENT INDICATED
HERE EARLIER, WHICH I THINK ARE
VERY INTERESTING AND CRITICAL
POSSIBILITIES. SO I APPRECIATE
THE QUESTION. I THINK SOME OF
THAT DIALOGUES ALREADY GOING ON
NOW, BUT WE'RE TRYING TO MOVE
VERY, VERY QUICKLY AND VERY
RAPIDLY TO ADDRESS THOSE
SHORTAGES BECAUSE I THINK THE
SOONER WE MAKE THOSE INVESTMENTS
, THE BETTER AS THE CHAIR
INDICATED EARLIER. THE LONGER WE
WAIT. THE MORE WE'RE JUST
CONTINUING TO DOUBLE DOWN ON A
ON A BROKEN SYSTEM, SO I THINK
THEY'RE WELL KNOWN. WE DON'T
HAVE ENOUGH. HERE TO CONSIDER
FIXING EVERYTHING THAT'S WRONG
IN MEDICAL, AND I THINK WE NEED
TO ACKNOWLEDGE THAT UPFRONT THAT
THERE'S THERE AND WE HAD TO
ACKNOWLEDGE IT AS A COALITION TO
WE HAD ALL COME TO THE TABLE AND
UNDERSTAND THAT WE ALL HAVE
THINGS THAT WE CAN POINT TO THAT
ARE SIGNIFICANT PAIN POINTS FOR
PATIENTS AND FOR THE PROVIDERS
THAT TAKE CARE OF THEM, BUT
KNOWING FULL WELL THAT EVEN IF
WE TOOK ALL OF THE M C O MONEY,
WE WOULDN'T BE ABLE TO ADDRESS
ALL OF THOSE THINGS. SO WHERE DO
WE PRIORITIZE? WHERE DO WE GET
THE MOST ROO IN THE AND THE AND
THE GREATEST BANG FOR OUR BUCK,
KNOWING THAT IF WE JUST TOOK A
PEANUT BUTTER APPROACH, WE JUST
SPREAD IT OUT OVER THE CONTINUUM
AND IN EQUAL PROPORTION, IT
WOULD JUST BE LOST AND WE
WOULDN'T HAVE A NET EFFECT. WE
HAD TO DEAL WITH THAT IN PROP 56
PROP 56 DEAL WITH A HANDFUL OF
CODES, MOSTLY E AND M EVALUATION
MANAGEMENT CODES. NON ER BASED
EVALUATION MANAGEMENT CODES
BECAUSE WE FELT THAT WAS THE
BIGGEST GAP. THE DEPARTMENT'S
LOOKING TO BRING THOSE UP. THERE
WAS A QUESTION EARLIER THAT THE
DOCTOR WOULD BROUGHT UP WHAT
LEVEL WOULD IT NEED TO GET TO
FOR SOME OF THESE SERVICES TO BE
ABLE TO FUNCTION AND OPERATE?
WELL, WE KNOW IS WE HAVE SOME
THAT ARE WAY WAY BELOW AND SOME
THERE LET'S BLOW BUT STILL BELOW
THAT NECESSARY, SUSTAINABLE
LEVEL FOR PROVIDER TO BE ABLE TO
BRIBE THAT CARE, SO I THINK
THAT'S THE DATA POINT. WE WANT
TO LOOK AT ENGAGEMENT BETWEEN
THE PROVIDER COMMUNITY BETWEEN
THE PAYER COMMUNITY BETWEEN THE
DEPARTMENT ITSELF THAT NEEDS TO
OCCUR TO MAKE THOSE SIGNIFICANT
AND IMPORTANT INVEST. WHAT
BRIEF? WE'VE WE'VE GOT ANOTHER
PANEL AND HE SO QUICKLY IF YOU
DON'T MIND. THANK YOU. I JUST
HAD SOMETHING VERY BRIEF IS, UH
, TO ALWAYS KEEP AN EYE ON THE
PATIENT. AH AND MAKE THAT OUR
NORTH STAR AS WE HAVE TO MAKE
TOUGH DECISIONS LIKE DUST AND
INTEGRATE INDICATED, HOW DOES IT
IMPACT THE PATIENT AND PATIENT'S
ABILITY TO ACTUALLY GET THE
CHARACTER? MAKE SURE THAT'S PART
OF THE STAKEHOLDER PROCESS.
THANK YOU. THANK YOU. UM AND I
JUST I DON'T HAVE A QUESTION,
BUT JUST TO COMMENT, UM, AND
THAT'S JUST THINK IT'S NO
ACCIDENT THAT THAT FOR THERE
WERE FOUR PEOPLE UP HERE WHO
COME FROM PROVIDER BACKGROUNDS.
UH AND SO PLEASE DO NOT
MISUNDERSTAND. MISINTERPRET OUR
INTENTIONS. IT IS ABOUT MAKING
SURE WE GET THE BEST BANG FOR
OUR BUCK FOR ALL THE PATIENTS
OUT THERE. THAT'S REALLY WHY
WE'RE WHY WE ARE INTERACTING AT
THIS LEVEL AND WANT TO CONTINUE
TO DO SO. SO THANK YOU AND BRING
UP THE NEXT PANEL. I WOULD JUST
SAY THAT, UM IDEALLY, WE WOULD
HAVE HAD ALL OF YOU UP HERE. BUT
AS YOU CAN SEE, THERE AREN'T
ENOUGH CHAIRS. AND SO I
APOLOGIZE FOR THAT. BUT PLEASE
COME ON UP AND TURN THIS OVER TO
DR REGULAR. WE WILL BEGIN WITH
PETER KELLISON, WHO WAS AN
ADVOCATE WITH THE PEDIATRIC DAY
HEALTHCARE COALITION, FOLLOWED
BY LISA EPPS, PRESIDENT OF THE
CALIFORNIA ASSOCIATION OF AIR
MEDICAL SERVICES. THEN LYDIA
MISSILE LEADS EXECUTIVE DIRECTOR
OF THE CALIFORNIA ASSOCIATION OF
ADULT DAY SERVICES. STEVE HORN,
PRESIDENT OF THE CALIFORNIA
MEDICAL TRANSPORTATION AUTHORITY
, AND THEN DEAN CHELIOS,
PRESIDENT AND C E O OF THE
CALIFORNIA ASSOCIATION OF HEALTH
SERVICES AT HOME WILL BEGIN WITH
MR KELSON. THANK YOU, MR CHAIR
AND MEMBERS PETER KELSON. I AM
AN ADVOCATE AND I REPRESENTED
COALITION OF 22 PEDIATRIC DAY
HEALTH CARE AND RESPITE CENTERS
IN THE STATE AN ESSENTIAL
LIFELINE FOR MEDICAL MEDICALLY
FRAGILE CHILDREN. THESE
REMARKABLE CHILDREN SUFFER FROM
ACUTE OR CHRONIC HEALTH
CONDITIONS THAT REQUIRE SKILLED
NURSING CARE THROUGHOUT THE DAY.
HERE ARE THE CHILDREN THEY
SERVE. THERE WAS BATTLING HIV
DISEASE ARE STRUGGLING WITH
SEVERE LUNG DISEASE REQUIRING
OXYGEN OR VENTILATORS, SPINA
BIFIDA, HEART DISEASE MALIGNANCY
, CYSTIC FIBROSIS AND OTHER
COMPLEX MEDICAL CONDITIONS. I
KNOW MANY OF YOU ARE FAMILIAR
WITH THESE FACILITIES AND
APPRECIATE YOUR ATTENTION
THROUGHOUT. WHILE MANY OF THESE
CHILDREN ARE UNABLE TO SPEAK,
THEY POSSESS THE INCREDIBLE
ABILITY TO COMMUNICATE IN THEIR
OWN UNIQUE WAYS. THESE CENTERS
AND THEIR FAMILIES THEY SERVE
ARE FIGHTING DESPERATELY TO
PREVENT THE IMMINENT CLOSURE OF
THESE FACILITIES. AND HERE'S WHY
THEY FACE A MULTITUDE OF
CHALLENGES THAT THREATEN THEIR
VERY EXISTENCE, SUCH AS THE
IMPACT OF THE COVID VIRUS,
SOARING COSTS AND SEVERE
WORKFORCE SHORTAGES, AND YET
THEY MUST MAINTAIN MINIMUM
STAFFING REQUIREMENTS. THEY
CANNOT RETAIN STAFF AND THEY
MUST MAINTAIN STAFFING
REQUIREMENTS. THEY ARE TRAPPED.
THE PAST MONTH HAS BEEN NOTHING
BUT A NIGHTMARE FOR THEM. ONE
CENTER ALONE LOST A STAGGERING
60% OF ITS WORKFORCE AND AS OF
APRIL STATEWIDE, THESE CENTERS
ARE ABLE TO SERVE 23% OF ALL THE
KIDS THAT ARE AVAILABLE TO SERVE
. THERE'S A WAITING LIST OF OVER
100 CHILDREN STATEWIDE, SO THEY
ARE NOT NEARING THE METAPHORICAL
CLIFF. THEY'RE STANDING AT THE
PRECIPICE. TO ENSURE THEIR
CONTINUATION THEY'RE SEEKING.
SUPPORT OF 7 TO $9 MILLION
ANNUALLY TO BOOST WAGES THAT
WOULD ENABLE THEM TO CONTINUE
PROVIDING CARE TO THESE KIDS. IF
THEY GO AWAY. THERE ARE PLACES
THEY CAN GO INSTITUTIONS I C F D
D NURSING, WHICH AVERAGES
$150,000 A YEAR OR I, C F OR A
PEDIATRIC SUB ACUTE FACILITIES
CAN EXCEED $450,000 A YEAR AND
START CONTRAST. PD HCS COST
ABOUT $74,000 A YEAR. SO
INVESTING HERE ALLOWS CHILDREN
WITH MEDICALLY FRAGILE
CONDITIONS TO EXPERIENCING A
GENERAL QUALITY OF LIFE ENABLES
TO INCOME PARENTS TO MAINTAIN
THEIR LIVELIHOODS AND PREVENT
SINGLE PARENTS FROM RELYING ON
PUBLIC ASSISTANCE. 7 TO $9
MILLION THANK YOU FOR YOUR
ATTENTION, HAPPY TO ANSWER
QUESTIONS HAPPY TO BE PART OF
THE PROCESS. ACCEPTS. GET THE
MIC BUTTON. PLEASE. THANK YOU.
OKAY CHAIR WOULD SHARE ARAMBULA
MEMBERS OF THE HEALTH COMMITTEE
. MY NAME IS LISA UPS. I'M
PRESIDENT OF CAL AIMS. THE
CALIFORNIA ASSOCIATION OF OUR
MEDICAL SERVICES AND I REPRESENT
CALIFORNIA MEMBER PROGRAMS, WITH
AN EMPHASIS ON IMPROVING
IMPROVING SAFETY AND EDUCATION
IN THE MEDICAL TRANSPORT
ENVIRONMENT. I'VE BEEN IN THE
AIR MEDICAL INDUSTRY FOR OVER 30
YEARS, STARTING AS A FLIGHT
NURSE WITH SKY LIFE IN CENTRAL
CALIFORNIA AND REMAIN NATIONALLY
CERTIFIED. I'M CURRENTLY WORKING
AS AN ACCOUNT EXECUTIVE FOR AIR
METHODS THAT OPERATES BOTH MERCY
ERA AND SKYLIGHT PROGRAMS AND
LIVE IN FRESNO COUNTY. I'D LIKE
TO ADDRESS TODAY THE URGENT NEED
TO ADD FUNDING TO THE EMERGENCY
MEDICAL, AIR TRANSPORTATION AND
CHILDREN'S COVERAGE FUND, OR
AMADA, OR SUPPLEMENT MEDICAL
REIMBURSEMENT FOR EMERGENCY AIR
TRANSPORTATION CHAIR WOULD THANK
YOU FOR YOUR LEADERSHIP IN THE
PAST FOR THE AMADA PROGRAM,
HAVING PREVIOUSLY AUTHORED THIS
LEGISLATION EMERGENCY OR
TRANSPORT AMBULANCES, TRANSPORT
PATIENTS WITH TIME SENSITIVE
INJURIES AND CONDITIONS, OFTEN
FROM REMOTE LOCATIONS OR FROM
ONE MEDICAL FACILITY TO ANOTHER
RECENT RURAL EXAMPLE OF SKYLIGHT
BROUGHT A BLOOD DIRECTLY TO THE
REMOTE SCENE OF AN ACCIDENTAL
RANGE SHOOTING WHERE PATIENTS
CAROTID ARTERY WAS SEVERED AND
WITHOUT AIR TRANSPORT, HE WOULD
NOT HAVE MADE IT TO THE TRAUMA
CENTER AND TIME AND LIKELY WOULD
HAVE DIED. THE AMOUNT OF
PROGRAM, THOUGH, IS MORE ABOUT
FUNDING. IT'S ALSO ABOUT ACCESS
IN OUR CAREER. I HAVE SEEN RURAL
HOSPITALS IN THE SAND WALKING
VALLEY AREA CLOSE MOST RECENTLY
, AS YOU KNOW, MADEIRA HOSPITAL
BUT ALSO CHOWCHILLA DIÆN UBA
CORCORAN KINGSBURG, ANOTHER IN
HANFORD HAVE ALL CLOSED WHERE
AMBULANCES THEN BECOME THEIR
PRIMARY ACCESS FOR CRITICAL CARE
. CURRENTLY, MEDICAL REIMBURSES
AIR AMBULANCE AT $1800 PER LIFT
IN 20 TO 10. PER LOADED PATIENT
MILE FOR AN AVERAGE 70 MILE
TRANSPORT THAT'S LESS THAN 50%
OF MEDICARE REIMBURSEMENT AND
ONLY 28% OF OUR MEDIA AND COST.
THE AMOUNT OF PROGRAM WAS
CREATED TO PROVIDE ESSENTIAL
FUNDING TO ENSURE THESE MEDICAL
PATIENTS CONTINUE TO HAVE ACCESS
TO LIFE SAVING CARE FOR SPEAKING
FOR OUR METHODS. WE ROUGHLY DO
2500 TO 3000 MEDICAL TRANSPORTS
PER YEAR WITHOUT AN ALTERNATIVE
FUNDING MECHANISM. UM AMOUNT OF
FUND WILL BE COMPLETELY DRAWN
DOWN, PUTTING CALIFORNIA AT RISK
OF LOSING THESE UNDERSERVED.
CRITICAL ACCESS IN THESE
UNDERSERVED AREAS BASED ON 2022
TRANSPORTS. WE'VE ESTIMATED THAT
1/4 OF CALIFORNIA BASIS WOULD BE
PUT AT RISK FOR POSSIBLE CLOSURE
WITH ANOTHER 25% ON THE EDGE OF
OPERATIONAL VIABILITY WITH
RESPECTFULLY REQUEST THAT THE
COMMITTEE SUPPORT FUNDING TO
AUGMENT MEDICAL REIMBURSEMENT
FOR EMERGENCY MEDICAL
TRANSPORTATION. THANK YOU FOR
YOUR CONSIDERATION OF THIS
TIMELY REQUEST. NEXT. WE HAVE
THE ADULT DAY SERVICES. THANK
YOU FOR THE INVITATION TO JOIN
YOU TODAY FOR THIS IMPORTANT
CONVERSATION. WHAT? MAKES MY
HEART HAPPY IS THAT THERE'S BEEN
RECOGNITION THAT HEALTH AND
HUMAN SERVICES MAKE UP A
TAPESTRY OF CARE FOR PEOPLE WHO
ARE INDIVIDUALS AND WHOSE NEEDS
VARY GREATLY ACROSS OUR
WONDERFUL, DIVERSE STATE. I
SERVE AS THE INTERIM EXECUTIVE
DIRECTOR FOR THE CALIFORNIA
ASSOCIATION FOR ADULT DAY
SERVICES, WHICH REPRESENTS
PROVIDERS OF MEDICAL FUNDED
COMMUNITY BASED ADULT SERVICES,
OTHERWISE KNOWN AS SEA BASS.
ALSO KNOWN AS ADULT DAY HEALTH
CARE FOR THOSE OF YOU WHO HAVE
BEEN AROUND FOR A LONG TIME. UM
AND WE REPRESENT MEMBERS ACROSS
THE STATE OF ALL SIZES AND
SHAPES. CATS MEMBERS OFFER
LIFESAVING SERVICES TO MORE THAN
40,000 LOW INCOME. FRAIL ELDERS
AND PEOPLE WITH DISABILITIES,
INCLUDING PEOPLE WITH SERIOUS
MENTAL ILLNESS AND THOSE AT HIGH
RISK OF HOMELESSNESS. AT A TIME
WHEN ADULTS ARE THE FASTEST
GROWING AND HOUSED POPULATION IN
CALIFORNIA. OUR CENTERS PROVIDE
STABILITY AND ONE STOP ACCESS TO
SERVICES THAT INCLUDE REQUIRED
DAILY NURSING SOCIAL WORK.
THERAPEUTIC ACTIVITIES,
INDIVIDUAL DIETARY SERVICES,
OCCUPATIONAL THERAPY, PTS,
SPEECH AND TRANSPORTATION. AND
ONE OF THE STRENGTHS OF OUR
CENTERS THAT I AM SO PROUD OF IS
THAT THEY OFFER SERVICES THAT
ARE CULTURALLY IN LANGUAGE
CONGRUENT. IN SHORT SEA BATHS,
INSURERS VULNERABLE POPULATIONS
CAN REMAIN SAFE IN THEIR HOMES
WHILE PROVIDING THEIR CAREGIVERS
WITH RESPITE SO THEY CAN STAY IN
THE WORKFORCE AND CONTINUE TO
SUPPORT FAMILIES. NOW WHAT IF I
TOLD YOU THAT PROVIDERS OF THIS
EXEMPLARY MODEL OF CARE, ONE
THAT SERVES AS A LIFEBOAT FOR
TENS OF THOUSANDS OF VULNERABLE
CALIFORNIANS? THAT KEEPS THEM
HOUSED AND HEALTHY AND SAFE, ARE
REIMBURSED BY MEDICAL MANAGED
CARE. AT A DAILY RATE THAT
HASN'T CHANGED IN 17 YEARS. YES
17 YEARS. THE CURRENT MEDICAL
PUBLISHED RATE IS 6 $76.27. FOR
ALL THOSE SERVICES IF YOU
CALCULATE THAT TO A PER HOUR
COST THAT'S $9.50 AN HOUR FOR AN
EIGHT HOUR DAY. WITHIN THAT RATE
CENTERS ALSO HAVE TO PROVIDE OR
ARRANGE TRANSPORTATION AND
PROVIDING MEAL THE INFLATIONARY
PRESSURES TODAY. JUST ON THOSE
COSTS AND OUR WORKLOAD,
CHALLENGES AND WAGE AND BENEFIT
PRESSURES HAS BEEN PUNISHING. TO
ADD INSULT TO INJURY. THERE ARE
SEVERAL LARGE MANAGED CARE PLANS
THAT ARE STILL PAYING SEA BASS
PROVIDERS AT THE 10% REDUCED
RATE, SO THAT BRINGS US DOWN TO
$68.64 A DAY THAT YOU ALL
ADOPTED DURING THE GREAT
RECESSION, EVEN THOUGH THE
LEGISLATURE RESTORED THAT RATE
BACK IN 2019. SIMPLY TAKING
INFLATION INTO ACCOUNT GOING
BACK TO 09 PUBLISHED MEDICAL
RATES SHOULD BE CLOSER TO ABOUT
100 BUCKS A DAY, DEPENDING ON
THE REGION OF THE STATE, AND
THAT DOESN'T EVEN ACCOUNT FOR
MEDICAL INFLATION AND THE
HEALTHCARE WORKFORCE RECRUITMENT
AND RETENTION CRISIS. AND I JUST
FOUND OUT THAT THE FEDERAL VÀ
PUBLISHES RATES BY GEOGRAPHIC
AREA IN CALIFORNIA. THEY PAY
WELL OVER 100, SOMETIMES AS HIGH
AS $180 A DAY FOR THIS VERY
SERVICE. THAT'S THE FEDERAL
VETERANS ADMINISTRATION. THESE
RATES ARE NOT SUSTAINABLE FOR
CENTERS TO CONTINUE TO PROVIDE
THESE VALUABLE SERVICES AND MEET
REGULATORY REQUIREMENTS. UM,
DEAN, YOU COULD HAVE WRITTEN ALL
OF MY TALKING POINTS FOR ME.
CATS WE DEVELOPED A PROFORMA
BUDGET USING PUBLIC DATA FOR L.
A COUNTY TO COMPARE COSTS AND
STAFFING LEVELS TO CURRENT
REIMBURSEMENT, AND IT SHOWS TO
PROVIDE COMPETITIVE WAGES AND
BENEFITS AND LEAVES COSTS AND
ALL THE OTHER COSTS JUST IN L. A
COUNTY CENTERS WOULD OPERATE AND
SOME ARE OPERATING WITH THE
STRUCTURAL DEFICIT. LOSS OF
$600,000 A YEAR THAT IS NOT
SUSTAINABLE CENTERS LOSE MONEY
FOR EVERY MEDICAL PATIENT THEY
TAKE, AND THEY HAVE NO WAY TO
SHIFT COSTS TO MEDICARE OR OTHER
PAYERS, ALONG WITH THE STRAIN OF
THE PANDEMIC, AND THESE MASSIVE
MEDICAL SYSTEM CHANGES YOU'RE
ALL TALKING ABOUT CHRONIC
UNDERFUNDING IS BRINGING OUR
PROVIDER COMMUNITY TO THE BRINK.
14 CENTERS OF CLOSED SINCE THE
PUBLIC HEALTH EMERGENCY BEGAN.
THAT'S OUT OF ABOUT 270 CENTERS
AND SHARE WOULD AND YOU'RE JUST
STRICT MARIN ADULT HEALTHCARE
JUST CLOSED IN APRIL AND
FORECLOSED IN YOUR OLD ASSEMBLY
DISTRICT. JUST IN THE PAST
DECADE, DR ARAMBULA JUST AS
ANOTHER EXAMPLE IN YOUR DISTRICT
LOST A LARGE CENTER CALLED SAFE
HARBOR THAT SPECIALIZED IN CARE
FOR PEOPLE WITH MENTAL ILLNESS.
LOSSES ARE MOST ACUTELY FELT IN
RURAL COMMUNITIES WHERE THERE
MAY BE ONLY ONE OR TWO SEA BASS
CENTERS. LODI MADERA, MODESTO,
BAKERSFIELD, PTOLEMY PARADISE,
MONTEREY, AND THAT'S JUST A FEW.
I HAVE A FULL LIST OF CENTERS
THAT HAVE CLOSED OVER THE PAST
DECADE. I EVEN GO BACK 30 YEARS
IF YOU'RE INTERESTED, HAPPY TO
SHARE THAT WITH MEMBERS OF THE
COMMITTEE IF THE AIM OF THE
HEARING TODAY IS TO FIND WAYS TO
IMPROVE ACCESS USING THE EMC
ATTACKS PLEASE KNOW THAT OUR
INDUSTRY IS IN PERIL AND MANY
VULNERABLE LOW INCOME
CALIFORNIANS CANNOT ACCESS THE
SERVICES THEY DESPERATELY NEED,
AND THAT WILL ONLY INCREASE OVER
TIME. AS OUR POPULATION AGES. WE
URGE YOU TO USE WHATEVER
RESOURCES RESULT FROM THIS TAX
TO INCREASE THE BASS PROVIDER
RATES AND VERY IMPORTANT ENSURE
THAT THESE DOLLARS ARE PASSED
THROUGH THE PLANS TO REACH OUR
PROVIDERS DIRECTLY. THANK YOU
FOR YOUR TIME IN THIS
CONVERSATION TODAY GREATLY
APPRECIATE IT. THANK YOU, MR
HORN. WELL CHAIRMAN PANEL THANK
YOU FOR HAVING US TODAY AND I
MUST. STEVE HORN, PRESIDENT OF
CALIFORNIA MEDICAL
TRANSPORTATION ASSOCIATION,
SINCE 2007 AND I'M ALSO MEDICAL
PROVIDER SINCE THE EARLY TWO
THOUSANDS. CALIFORNIA MEDICAL
TRANSPORTATION ASSOCIATION WERE
THE ONLY TRADE ASSOCIATION IN
THE STATE THAT REPRESENTS BUT
NON EMERGENCY MEDICAL
TRANSPORTATION. ANY M T AND NON
MEDICAL TRANSPORTATION, WHICH IS
, UH, YOU'RE AMBULATORY CURB TO
CURB TYPE SERVICE.
TRANSPORTATION SERVICES ARE
CRITICAL FOR MILLIONS OF
CALIFORNIANS TO ACCESS NECESSARY
AND LIFE SUSTAINING HEALTH CARE
SERVICES, AND UNFORTUNATELY, THE
CURRENT RATES PAYERS OFFER MEDIC
AL AND A LOT OF THE SIGNIFICANT
M C O S, UH, DO NOT EVEN COVER,
UH, THE TRANSPORTATION PROVIDERS
COST TO PROVIDE THE SERVICES.
THEY'RE EXTREMELY INADEQUATE,
WHICH HAS LED TO A, UH, SHORTAGE
OF PROVIDERS, A INCONSISTENCY IN
SERVICES FOR MEMBERS AND FOR
PATIENTS TO HAVE REGULAR STABLE
TRANSPORTATION THAT THEY CAN
COUNT ON, ACCORDING TO THE
CALIFORNIA HEALTHCARE FOUNDATION
. RECENT STUDY ENROLLING USE
ENROLLEES USING. MEDICAL
TRANSPORTATION REPORT THAT IS
THE MAIN SOURCE OF THEIR
TRANSPORTATION TO THEIR MEDICAL
APPOINTMENTS. IN THAT SAFE,
RELIABLE TRANSPORTATION SERVICES
ARE CRITICAL TO MAINTAINING
THEIR HEALTH. RAISING MEDICAL
TRANSPORTATION RATES. AND
OVERSIGHT OF PAIRS FOR MEDICAL
IS NECESSARY NOT ONLY TO ENSURE
PATIENTS HAVE ACCESS BUT TO HAVE
A SUSTAINABLE AND ROBUST
PROVIDER NETWORK. ONE OF THE
INTERESTING PARTS WITH
TRANSPORTATION IS IT IS NOT A
BENEFIT OF MEDICARE AND SO IN
THE M C O TAX, THEY TALK ABOUT
THE PROVIDER RATES BEING 87.5%
OF THAT. AND WE PROPOSED
DIFFERENT WAYS THAT WE COULD
COME UP WITH WITH THE DEPARTMENT
TO STUDY. UM COST YEARS AGO. THE
DEPARTMENT USED TO DO COST BASED
STUDIES TO SEE WHAT IT ACTUALLY
COSTS AND AS WE KNOW, AND
DIFFERENT RURAL DISTRICTS, IT
COSTS A LOT MORE FOR PROVIDER TO
PROVIDE THAT SERVICE THAN IT
DOES IN SOME OF THE URBAN
DISTRICTS. BUT IT IS CRITICAL
THAT WE TAKE THIS OPPORTUNITY
NOW TO PUT A SUSTAINABLE RATE
TOGETHER FOR TRANSPORTATION,
BECAUSE AS I LISTENED TO THE
FIRST PANEL, AND AS I LISTENED
TO THIS SECOND PANEL
TRANSPORTATION WE INTERACT WITH
EVERY ONE OF THESE PROVIDER
TYPES. EVERYBODY TALKS ABOUT
ACCESS TO CARE, AND THEY TALK
ABOUT ALL OF THESE SERVICES.
IT'S TRANSPORTATION RELATED AND
THE MAJORITY OF THE MEDICAL
MEMBERS ARE UTILIZING EITHER MMT
OR ANY M T TO GET TO THEIR
MEDICAL SERVICES. SO IT IS A
FRONT LINE ACCESS TO CARE ISSUE
THAT NEEDS TO BE ADDRESSED.
APPRECIATE YOUR TIME. THANK YOU.
FINALLY, MR CHELIOS. THANK YOU,
DOCTOR. ARAMBULA DOCTOR WOULDN'T
MEMBERS. I'M DEAN CHAILLOT. I'M
THE PRESIDENT, CEO OF THE
CALIFORNIA ASSOCIATION FOR
HEALTH SERVICES AT HOME, AND I'M
PLEASED TO BE HERE TODAY TO TALK
TO YOU ABOUT MEDICALLY FRAGILE
KIDS AND THE IMPORTANCE OF
HAVING THEM TREATED IN THEIR
HOMES RATHER THAN IN HOSPITALS
OR OTHER HEALTH CARE FACILITIES
. THESE ARE MEDICAL
BENEFICIARIES, AND THESE KIDS
ARE REALLY SICK, AND THEY NEED
THE KIND OF CARE TO STAY AT
HOME. THAT THEIR PARENTS AND
THEIR FAMILIES SIMPLY CANNOT
PROVIDE, SO WE RELY ON WHAT WE
REFER TO AS PRIVATE DUTY NURSES
TO CARE FOR THEM. THESE ARE
HIGHLY SPECIALIZED NURSES TO
HELP WITH THEM WITH THEIR
FEEDING TUBES AND THEIR
VENTILATORS AND PROVIDE OTHER
LIFE SUSTAINING SERVICES.
UNFORTUNATELY MEDICAL
REIMBURSEMENT RATES AREN'T
ENOUGH TO PROVIDE FOR US TO FIND
THESE NURSES AND TO PAY THEM
WHAT THEY DESERVE TO TAKE CARE
OF THESE PATIENTS. AND SO THE
END RESULT IS THEY END UP
STAYING IN THE HOSPITAL AT 57
$10,000. THE DAY WHATEVER IT
MIGHT BE WHEN WE COULD CARE FOR
THEM AT HOME. FOR ABOUT $1500 A
DAY, DEPENDING ON THE LEVEL OF
CARE THAT THEY NEED, IF YOU LOOK
AT THE 40% INCREASE WE'RE ASKING
FOR IN THIS PARTICULAR AREA AND
YOU COMPARE IT TO KEEPING THESE
KIDS IN THE HOSPITAL. UH IT IS A
NET BENEFIT FOR MEDICAL IN THE
LONG RUN. THESE KIDS TRULY
SUFFER AND THEIR FAMILIES SUFFER
. IMAGINE HAVING A CHILD WHO'S
BEEN IN THE HOSPITAL FOR WEEKS,
IF NOT MONTHS ON END, AND
THEY'VE BEEN AUTHORIZED BY THE
MEDICAL PROGRAM TO GO HOME AND
TO BE WITH THEIR SURROUNDED BY
THE LOVE OF THEIR FAMILIES, AND
TO BE CARED FOR SAFELY
INADEQUATELY IN THE HOME, AND
THEY HAVE TO STAY IN THE
HOSPITAL BECAUSE WE CAN'T FIND
THE NURSES TO TAKE CARE OF THEM.
I THANK YOU FOR THE OPPORTUNITY
TO COME HERE TODAY. I COULD TALK
TO YOU ALL DAY ABOUT THIS. I
WON'T. I KNOW THAT THE HOURS
LATE, BUT I APPRECIATE BEING
HERE. I'M HAPPY TO ANSWER ANY
QUESTIONS. BRING IT UP TO THE
DIOCESE. SEE IF THERE ARE ANY
MEMBERS. QUESTIONS WILL BEGIN
WITH ASSEMBLYMEMBER'S PATTERSON.
UM THANK YOU. ESPECIALLY WANT TO
THANK UM A CHAIR ARAMBULA FOR
YOUR INTEREST IN THE NH█P DHC
CARE. UH, AND IT WAS EVIDENCED
BY A RECENT TOUR IN OUR AREA. IT
MEANS A LOT TO THOSE. FAMILIES
INTO THOSE TO THOSE CHILDREN,
AND WE ARE HEARING THE CRISIS OF
THESE. LITTLE ONES THAT NEED
EVERY HELP. WE CAN POSSIBLY GIVE
THEM. IT'S THE SPIRAL DOWNWARD
IS BREAKING MY HEART. THESE ARE
LITTLE ONES THAT REALLY NEED US.
AND I'M AFRAID THAT, UH IF THIS
. PANEL AND IF THE BUREAUCRACY
DOESN'T HIS LISTEN, HEAR AND
ACT. THIS DOWNWARD SPIRAL WOULD
GET WORSE AND WORSE AND WORSE.
AND SO I HAVE SIGNED THE. 7 TO
$9 MILLION. UH, BUT I DIDN'T
SIGN IT. A LOT OF THE PARENTS
AND A LOT OF THESE FRAGILE
CHILDREN. HELD MY HAND WHEN I
SIGNED IT, METAPHORICALLY
SPEAKING. BUT THAT'S WHAT I FELT
LIKE. SO I APPRECIATE THE
OPPORTUNITY TO, UH ASKED JUST A
COUPLE OF QUESTIONS. UH IN OUR
AREA. UM AND ONE OF THE THINGS
WE DO IS WE HAVE A VERY ROBUST
CONSTITUENT SERVICE OPERATION
AND I, MY STAFF IN IN THE FRESNO
OFFICE, REALLY SEE THIS AS A
MISSION, NOT JUST A JOB. UM,
WE'RE HEARING OF A LOT OF
WAITING LISTS. HOW LONG ARE
THESE WAITING LISTS? IT'S ONE
THING TO WAIT FOR A PERIOD AND
THEN ACTUALLY GET HELP IS
ANOTHER THING TO SIMPLY WAIT AND
WAIT AND WAIT AND NEVER GET
HELP. WHAT'S THIS? LIKE? THANK
YOU. ASSEMBLYMEMBER'S PATERSON
APPRECIATE THAT. IT'S A TOUGH
QUESTION TO ANSWER. AH! THE ONLY
WAY TO DO SO, IN A IN A FAIR WAY
IS TO INDICATE THAT WE CAN'T
SPECIFY EXACTLY WHAT HAPPENED IN
THE PAST 45 TO 60 DAYS FOR THE
STAFFING OF THESE FACILITIES,
BUT THE LOSS OF STAFF HAS BEEN
ALMOST SURREAL. IT'S HAPPENED SO
QUICKLY AND SO SEVERELY. THEY
CANNOT SO THAT FACILITIES SIMPLY
DO NOT HAVE THE STAFF. AND THE
WAITING LISTS ARE PROBABLY
INDEFINITE UNTIL UNLESS THERE IS
RELIEF. THEY CANNOT RECREATE. UH
YOU KNOW, STAFFING OUT OF
NOTHING. THEY HAVE TO OBTAIN
STAFF SOMEWHERE, AND THE ONLY
WAY TO DO THAT IS THROUGH
INCREASED WAGES TO MAKE THEM
COMPETITIVE WITH OTHER PROVIDERS
. AND FOR THAT REASON, I CANNOT
GIVE YOU ANY SORT OF DIRECT
ANSWER. AS FAR AS HOW LONG THAT
WAITING LIST MIGHT, IT MIGHT BE
. IT JUST IS THERE AND IT IS
LIKELY GOING TO INCREASE IN THE
SCOPE IF THEY CAN'T HAVE RELIEF.
ARE THE WORD INDEFINITE USED. UM
SO WHERE DO THESE CHILDREN GO?
DHC CANNOT CARE FOR THEM. THEY
GO TO INSTITUTIONS THEY EAT OR
IN SOME CASES, IF THEY'RE ABLE
TO THEY MUST GO HOME. AND THAT
REQUIRES IF THE FAMILY IS
FORTUNATE TO HAVE TWO PARENTS,
THEN ONE OF THEM HAS TO QUIT
THEIR JOB TO TAKE CARE OF THE
CHILD FULL TIME OR THEY MUST GO
TO AS I MENTIONED EITHER. AN I C
F D D OR A PEDIATRIC SUB ACUTE
FACILITY, BOTH OF WHICH ARE
EXORBITANTLY MORE EXPENSIVE AND
COSTLY FOR THE CARE. THEY ARE
INSTITUTIONS. THEY ARE FOR
INDIVIDUALS OF ALL AGES.
PEDIATRIC DAY HEALTH CARE
CENTERS ARE FOR CHILDREN AND
YOUNG PEOPLE. SO THE THERE IS
NOT. THERE IS AN ADDITION TO THE
COST EFFECT. THERE IS THE FACT
THAT THESE MOST SEVERELY OR
DISABLED OR IMPACTED CHILDREN
WILL BE AROUND A DEMOGRAPHIC
THAT IS FOREIGN AND NOT LIKE
THEM AT ALL. YEAH. YOU YOU
MENTIONED THE ALTERNATIVES AND
ALL WE HEAR FROM. PARENTS,
PARTICULARLY IN OUR DISTRICT
WHEN THEY ARE GIVEN THE OPTIONS.
THEY JUST THEIR OPTIONS THAT
THEY EITHER CAN'T AFFORD OR
CAN'T MAKE WORK WITH, WITHOUT
CONTINUED CARE. UM AND SO THE
OBVIOUS QUESTION IS, IF YOU
DON'T GET THE INCREASES IF YOU
DON'T GET THE STAFF IF YOU DON'T
TURN THIS FROM FROM, YOU KNOW A
CATASTROPHE INTO SOMETHING THAT
LEAST CAN BE HANDLED AND
MANAGED. UM WHAT? WHAT ARE YOU
GOING TO DO? IF THE RATE IF WE
DON'T INCREASE THE RATE IN MANY
CASES, SOME FAMILIES WILL HAVE
TO GO ON PUBLIC ASSISTANCE AND
MANY CASES, FAMILIES WILL HAVE
TO RELINQUISH THEIR KIDS TO
INSTITUTIONAL IN INSTITUTIONS.
THERE IS NO SATISFACTORY
ALTERNATIVE. THEY ARE ALL NOT
JUST BAD, BUT TERRIBLE OPTIONS.
APPRECIATE BEING YOU BEING HERE.
I KNOW WE VISITED. UM AND, UH,
AS MENTIONED THAT I'VE TOURED
THE CENTER THAT MEMBER ARAMBULA
TOURED AND, UM WHERE THESE
LITTLE KIDDOS ARE. YOU KNOW
THEY'RE IN VERY DIFFICULT
CIRCUMSTANCES, BUT THEY ARE SO
EASY TO LOVE. AND I HOPE WE CAN
GET THAT IN OUR HEARTS SO THAT
IT WILL HELP. MAYBE GET THE
RATES UP FOR THEIR SAKE. I'D
LIKE TO TALK A LITTLE BIT ABOUT
THE PATIENTS BEING AFFECTED. UM
WITH RESPECT TO THE MEDICAL
TRANSPORTATION ASSOCIATION, ONE
OF THE THINGS THAT'S THAT'S KIND
OF DEAR TO ME IS WE HAVE A
NUMBER OF CENTERS IN FRESNO THAT
DO DIALYSIS, AND THEY DO
EXCEEDINGLY WELL. AND ONE OF THE
CONCERNS I HAVE IS THAT THERE
ARE THERE ARE THERE ARE
PATIENTS. WHO CANNOT GET THEIR
TRANSPORTATION THAT THEY'VE
RELIED ON TO GET THEIR TO THEIR
DIALYSIS TREATMENT, AND THEN
THAT THAT PUTS THE BURDEN EITHER
ON THE FAMILY OR SOMEBODY CLOSE
OR UBER. I DON'T KNOW. BUT IT
SEEMS TO ME LIKE DIALYSIS
PATIENTS WITH THAT ADDED EXTRA
BURDEN. CAN'T GET TO THE
TREATMENT, UH OR OR PERIODICALLY
THAT'S A REAL PROBLEM. SO HELP
US UNDERSTAND HOW OUR PATIENTS
AFFECTED BY THIS WHAT DO THEY
DO? HOW IF YOUR PROVIDERS SAY
THE RATES ARE SO LOW AND YOU PUT
IT OUT? YOU KNOW, UH FOR THE
PEOPLE THAT CONNECT PEOPLE UP
WITH THE TRANSPORTATION AND THEY
SAY NO, I CAN'T DO IT BECAUSE I
LOSE MY MONEY. WHAT? WHAT DOES
THAT PATIENT Dð. THAT'S A GREAT
QUESTION, AND IT'S ONE THAT
PROVIDERS FACE ON A ON A DAILY
BASIS. DO THEY INCURRING A
FINANCIAL LOSS TO PROVIDE THAT
SERVICE AND SUBSIDIZE THE STATE
? UH IN ORDER TO MAINTAIN THAT
TRANSPORTATION FOR THAT MEMBER
AND MANY PROVIDERS HAVE DONE
THAT, UH, FOR COUNTLESS YEARS TO
WHERE THEY WILL TAKE THOSE ONES
THAT ARE AT A LOSS BECAUSE THEY
CARE ABOUT THE PATIENTS AND THEY
HIRE DRIVERS THAT ARE IN THE
COMMUNITY AND THOSE SITUATIONS
NOW, UNFORTUNATELY, IN IN, UH,
THE FRESNO AREA, UM SINCE
FEBRUARY, 1ST UNDER THE CALEN
PROJECT, WHERE THE MAJORITY OF
MEDICAL FEE FOR SERVICE MEMBERS
GOT MOVED OVER INTO MANAGED
CARE. UM THE MANAGED CARE
ORGANIZATIONS THAT COVER THAT
AREA. UH USE A TRANSPORTATION
BROKER MODEL. AND SO THEN
THERE'S ANOTHER. AH HAND IN THE
PIE THAT IS IMPACTING THOSE
REIMBURSEMENT RATES. AND SO
THOSE PROVIDERS ARE GETTING PAID
EVEN LESS THAN PROVIDERS THAT
WORK DIRECTLY WITH THE MANAGED
CARE PLAN THAT MANAGES THEIR
TRANSPORTATION IN HOUSE AND
THERE HAVE BEEN THOUSANDS OF
DIALYSIS PATIENTS THAT HAVEN'T
RECEIVED TRANSPORTATION. SINCE
FEBRUARY 1ST OF THIS YEAR AND
YES, THE PRIMARY REASON IS DUE
TO THE LOW REIMBURSEMENT RATES
IN THAT AREA. IT HAPPENS TO BE
THAT THE BROKERS ARE FORCING THE
RATES EVEN LOWER. AND SO
PROVIDERS ARE GOING OUT OF
BUSINESS OR JUST CHOOSING NOT TO
PROVIDE THE SERVICE. THEN WITH
THAT DOES IS THAT IMPACTS YOUR
ACUTE CARE HOSPITALS? THESE
PEOPLE MISS A COUPLE OF DIALYSIS
PATIENTS. THEN THEY'RE IN THE
HOSPITAL, AND THEN THE HOSPITAL
. I HEARD THEM TALK WITH THE
HOSPITAL ASSOCIATION THAT
THEY'RE SAYING, HEY, AND THEY'RE
HAVING TROUBLE. WELL DISCHARGING
THESE MEMBERS OUT OF THERE
BECAUSE A THEY CAN'T GET
TRANSPORTATION TO GET THEM
DISCHARGE EVEN IF THEY CAN FIND
A APPROPRIATE SKILLED NURSING
FACILITY, SO IT IMPACTS
EVERYBODY ACROSS THE BOARD. AND
WHEN YOU LOOK AT THE COST OF
PROVIDING, UH, TRANSPORTATION AT
A SUSTAINABLE REIMBURSEMENT RATE
, COMPARED TO ACUTE INPATIENT
HOSPITAL STAYS SKILLED NURSING
STAYS THOSE SCENARIOS. IT'S MUCH
CHEAPER TO PAY THAT ON THE FRONT
END, AND IT'S A BETTER QUALITY
OF LIFE FOR THESE INDIVIDUALS,
BUT IT HAS BEEN DAUNTING,
ESPECIALLY SINCE FEBRUARY, 1ST
ALL ACROSS THE STATE. SO I
UNDERSTAND THAT CORRECTLY THERE
THESE BROKERS HAVE BEEN
INTRODUCED RECENTLY. AND THAT
WAS BROKERS ADD TO THE TO THE
COST, RIGHT? YEAH YOU GOTTA YOU
GOTTA THIRDHAND HERE AND IN THE
EQUATION. IS THAT RIGHT? THAT'S
AH, CORRECT AND BROKERS WERE
FIRST INTRODUCED ON A SMALL
SCALE IN THE STATE OF CALIFORNIA
AND AROUND 2012, BUT IT WAS A
VERY SMALL SCALE. BUT UNDER THE
CALEN PROJECT WITH THE PUSH OF
ALMOST ALL THE MEDICAL FEE FOR
SERVICE INTO MANAGE CARE, THEN
MANAGED CARE ORGANIZATIONS HAD
TO COME UP WITH A PLAN. UM AND
THE CEO S SO IN CALIFORNIA YOU
HAVE THREE DELIVERY MODELS. YOU
HAVE MEDICAL FEE FOR SERVICE,
AND WE KNOW THAT THAT'S ONLY
ABOUT 5% OF THE POPULATION. YOU
HAVE THE M CEOS THAT MANAGED THE
TRANSPORTATION IN HOUSE AND THEN
YOU HAVE THE M CEOS THAT USE A
BROKER. THE M C. O S THAT MANAGE
IT IN HOUSE. THEY ARE QUICK TO
ADDRESS THE ISSUES THEY PAY
HIGHER RATES IMMEDIATELY. IF
THEY CANNOT GET THAT ACCESS.
THEN THEY SAY, OKAY, PROVIDER.
WHAT IS IT GOING TO TAKE? IN
ORDER FOR YOU TO DO THIS? THEY
WILL AGREE TO PAY THAT PROVIDER
HIGHER RATE TO MAKE SURE THAT
THAT ACCESS IS THERE BUT DEALING
WITH THE THIRD HAND THAT WE
TALKED ABOUT WITH THE PLANS THAT
USE THE TRANSPORTATION BROKER.
THAT HAS CREATED A HUGE ACCESS
ISSUE. UM ALL THROUGHOUT THE
STATE. AND YES, IT GOES DOWN TO
RATES AND THE RATES AT THE
BROKERS ARE WILLING TO PAY THE
TRANSPORTATION PROVIDERS. MR
CHAIR. THANK YOU FOR THE
OPPORTUNITY WE'RE SEEING BEFORE
OUR VERY EYES. THE CRUMBLING OF
ASSIST SYSTEM THAT TAKES CARE OF
THE MOST VULNERABLE THE YOUNGEST
AND THE SWEETEST. AND UM, I'M
GONNA TRY TO DO EVERYTHING I
CAN. AND I'M GRATEFUL FOR THE
HELP OF THE CHAIR AND OTHERS AS
AS WE TRY TO DO A LITTLE BIT TO
ALLEVIATE SOME OF THESE
DIFFICULTIES. BUT I THANK YOU
FOR YOUR PRESENTATION, AND I
THANK YOU FOR YOUR WILLINGNESS
TO HANG IN THERE AND DO THE WORK
EVEN WITH THESE KINDS OF
CHALLENGES. THANK YOU FOR THE
CARE AND LOVE THAT YOU SHOW EVEN
WHEN YOU ARE COMPENSATED AT A
LOSS. BRING IT BACK TO THE CHAIR
AND BE BRIEF WITH MY QUESTION SO
THAT WE CAN GET TO PUBLIC
COMMENTS BUT DO WANT TO UPLIFT
HAVING SEEN LORETTA'S LITTLE
MIRACLES. THE WORK THAT IS BEING
DONE ON THE FRONT LINES WHEN YOU
GROUND YOURSELF AND THE PEOPLE
WHO YOU ARE SERVING AND
REPRESENTING, YOU'RE BETTER ABLE
TO ADVOCATE FOR THEM AND WAS
APPRECIATIVE OF THE OPPORTUNITY
OF SEEING WHAT WE NEED TO BE
CHANGING HERE IN OUR STATE, AND
I'M GRATEFUL FOR THE AGREEMENT
HERE ON THE DAIS FOR US TO BE
WORKING IN THAT SPACE. I'M GOING
TO FOCUS ON TRANSPORTATION. IF I
CAN. I HAD THE PRIVILEGE OF
WORKING WITH SKY LIFE FOR A
NUMBER OF YEARS. AND WANT TO
JUMP INTO THE IMADA IF I CAN AND
PROVIDE A UNDERSTANDING FOR
THOSE WHO ARE AGAIN HERE ON THE
DAIS THAT WE'VE MADE RECENT
CHANGES TO IMADA BY REMOVING
FINDS THAT WE'RE ADDING INTO
THAT SYSTEM, THUS HAVE CREATED A
WHOLE AND AN ISSUE THAT WE HAVE
NOT RESOLVED, HOPING YOU CAN
PROVIDE SOME COMMENTS. YES THANK
YOU. CHAIR UM YES, CORRECT.
AMADA FUND WAS AN EMERGENCY AIR
TRANSPORTATION AND CHILDREN'S
FUND. IT WAS A $4 TAX LEVIED ON
MOVING VIOLATIONS AND THAT
EXPIRED THE END OF 2022. SO WE
HAVE A GAP RIGHT NOW WE'RE
SEEING THE FUN DWINDLING THAT
SUPPLEMENTED THESE MEDICAL
TRANSPORTATION. UM, FLIGHTS THAT
WE WERE ABLE TO DO. HAVING BEEN
THERE AGAIN, WHERE MOMENTS
MATTER? IT'S AN INVALUABLE
SERVICE TO MAKE SURE THAT WE'RE
CONTINUING TO PROVIDE FOR OUR
STATE. UM NOW MOVE ON TO MR HORN
. IF I CAN THIS TRANSPORTATION
BROKER MODEL I LOOK FORWARD TO
FUTURE CONVERSATIONS WITH YOU TO
BETTER UNDERSTAND THE IMPETUS
FOR THE TRANSITION. BUT I WANT
TO ASK. HOW IS THIS ADDITIVE?
HOW IS THIS HELPING US AS A
SYSTEM TO HAVE THESE BROKER
MODELS VERSUS ENSURING THAT THE
TRANSPORTATION DOLLARS ARE
REACHING THOSE WHO ARE
TRANSPORTING THOSE WHO HAVE
NEEDS WOULD LOVE TO SEE HOW YOU
THINK THIS IS ADDITIVE IF
POSSIBLE. UH I APPRECIATE THE
QUESTION AND I DO NOT HAVE AN
ANSWER FOR YOU. BECAUSE UM, BACK
IN 2012. I DID NOT AGREE, AND I
FOUGHT THE BROKER MODEL BECAUSE
I'VE SEEN IT. I'VE GOT A TON OF
DATA HERE AND STUDIES. UM YEAH,
AND STUDIES OF OTHER STATES THAT
WENT TO A TRANSPORTATION BROKER
MODEL AND NONE OF THEM ACHIEVED
SAVINGS. THEY HAD DIFFERENT
TYPES OF MODELS AND WHEN THEY
WENT TO A BROKER MODEL AND
REALLY, TRANSPORTATION CAN SEEM
PRETTY DAUNTING TO A MANAGED
CARE PLAN. LIKE WE'VE GOT TO
HAVE ALL THESE PHONE CALLS.
WE'VE GOT TO DO THIS. WE GOT TO
DO THAT, AND THEN IT CAN GET
SEEM LIKE IT'S OVERWHELMING. UM
BUT THERE'S A LOT OF PLANS THAT
HAVE PROVEN THAT IT HAS HIGHER
PATIENT SATISFACTION LESS NO
SHOWS PEOPLE GET TO THE SERVICES
THAT THEY NEED WHEN THE PLANS
MANAGE IT THEMSELVES. AND IT'S
BEEN NIGHT AND DAY DIFFERENCE.
ONE OF THE BEST PLANS HERE IN
THE STATE OF CALIFORNIA IS
PARTNERSHIP HEALTH PLAN. THEY
EXEMPLIFY HOW TO KEEP A ROBUST
PROVIDER NETWORK AND THEY PAY
WELL ABOVE. UM THE MEDICAL FEE
FOR SERVICE RATES AND HAVE FOR
YEARS FOR THAT TO MAKE SURE THAT
THAT ACCESS UM, FOR THEIR
PATIENTS ARE THERE AND THERE'S A
SIGNIFICANT AMOUNT OF OTHER
PLANS THAT DO THAT SAME THING. I
JUST HAPPENED TO WORK A LOT WITH
PARTNERSHIP HEALTH PLAN. AND SO
THEY EXEMPLIFY, AND THEY PUT
SOME MODELS TOGETHER THAT OTHER
PLANS. YOU KNOW ALL THESE PLANS,
TALK AND COMMUNICATE TOGETHER
AND YOU KNOW, THEY HIRE PEOPLE
THAT LIVE IN THE COMMUNITY THAT
WORKED THE CALL CENTERS THAT
KNOW THE PEOPLE THAT ARE CALLING
IN FOR THESE APPOINTMENTS. JUST
THE OUTCOME IS BETTER. BUT THE
BROKERS CAME INTO THE STATE IN
2012. AND THEY'VE BEEN HERE, UH
, SINCE THEN, AND THEY'VE
CONTINUED TO GROW THEIR THEIR
PRESENCE. BUT IN THESE TOUGH
FISCAL TIMES, I DON'T SEE HOW
IT'S SUSTAINABLE. I LOOK FORWARD
TO THOSE ONGOING DISCUSSIONS AS
WE ARE LOOKING TO MAKE
ADVANCEMENTS AND INNOVATIONS
WITHIN MEDICAL. WE SHOULD NOT BE
SIPHONING OFF DOLLARS TO THIRD
PARTIES AND INSTEAD MAKE SURE
THEY'RE GOING TO THE DESIGNATED
TRANSPORTATION AGENTS WHO ARE
CARRYING FOR OUR COMMUNITY
MEMBERS. THANK YOU. I LOOK
FORWARD TO THAT ONE OF FINAL
FOLLOW UP IF I CAN FINAL
QUESTION FOR THE ADULT DAY
SERVICES, YOU SAID THE PLANS ARE
NOT PASSING DOWN RATES, WHICH
WERE APPROVED IN 2019 AND HOPING
YOU CAN GIVE SOME COMMENTS TO
THAT AS, UM THAT SOUNDS
CONCERNING AGAIN AS THE INTENT
WAS THERE TO MAKE SURE WE WERE
SUPPORTING IN INDUSTRY. THAT IS
, UM GOING TO BE NEEDED AS WE
HELPED THE INSTITUTIONALIZED OR
FOCUS ON PROVIDING CARE TO THOSE
IN COMMUNITY. I'M HOPING YOU CAN
COMMENT ON THAT STATEMENT. HAPPY
TO AND I'M GLAD YOU ASKED.
BECAUSE WE'VE BEEN, UM ALSO
TRYING TO GET TO THE BOTTOM OF
WHY THAT IS WHEN THE VAST
MAJORITY OF PLANS DID PASS
THROUGH THAT RATE INCREASE IN
SOME ARE ACTUALLY PAYING A
LITTLE BIT MORE. UM, THE FOR
PLANS THAT WE UNDERSTAND THROUGH
A THIRD PARTY. ARE NOT PAIN HAVE
NOT PASSED THROUGH THAT 10%
INCREASE. UM I CAN'T TELL YOU
EXACTLY WHY THAT IS OTHER THAN
THE LANGUAGE AND THE 11 15
WAIVER GOVERNING THE SEA BASS
REIMBURSEMENT RATES. UM WHEN WE
SPOKE TO LEGISLATIVE COUNCIL
SEEMED CLEAR THAT THAT WAS A
REQUIREMENT THAT THAT BE PASSED
THROUGH. BUT IN TALKING WITH THE
DEPARTMENT OF HEALTH CARE
SERVICES AND OTHERS IT PERHAPS
IS NOT AS EXPLICIT AS IT COULD
BE. SO, UM, WE WOULD LOVE TO SEE
THAT CLARIFIED THAT THAT
PUBLISHED MEDICAL RATE BE THE
FLOOR AND WHEN THE LEGISLATURE
ACTS TO RESTORE RATES AS YOU DID
, UM, THAT THAT IS RESPECTED.
THERE IS ONE HEALTH PLAN THAT
HAS BEGUN VOLUNTARILY. ISSUING
REPAYMENTS FOR THOSE
UNDERPAYMENTS GOING BACK TO. I
DON'T REMEMBER NOW IF IT'S
JANUARY OR SUMMER OF 2019. BUT
THEY HAVE STARTED TO MAKE WHOLE
UM, THE CENTERS SLOWLY AND WE
JUST SAW A LETTER WHERE THEY'RE
PLANNING TO ACCELERATE THAT
TIMELINE. SO ONE OUT OF THE FOUR
HAS TAKEN SOME ACTION TO MAKE
THE CENTERS HOLE AND THOSE ARE
LARGE PLANS. UM NON COAST PLANS
, BY THE WAY AGAIN, UM, LOOK
FORWARD TO THOSE CONVERSATIONS
AS IMPLEMENTATION IS IMPORTANT
AS WE LOOK TO MAKE SURE THAT
WHAT WE'RE DOING UP HERE IS
EFFECTUATING CHANGE IN COMMUNITY
, AND SO WE NEED THAT FEEDBACK
WHEN CERTAIN SYSTEMS ARE NOT
IDEALLY WORKING, AND ONE WHO
APPRECIATE THIS ENTIRE PANEL FOR
PROVIDING THAT LEVEL OF
GRANULARITY SO THAT WE CAN GET
INTO THE DETAILS. WITH THAT I
WILL THANK VERY MUCH THIS PANEL
AND WE WILL NOW MOVE ON TO
PUBLIC COMMENT. WOULD LIKE TO
MAKE A COMMENT. PLEASE PRESS 10
AT THIS TIME OPERATOR. WE'RE
GOING TO BEGIN WITH PUBLIC
COMMENT. THAT'S HERE IN THE ROOM
FIRST, AND THEN WE WILL BE GOING
TO THE PHONE LINES AFTERWARDS.
THANK YOU. GOOD AFTERNOON, LINDA
WAY WITH WESTERN CENTER ON LAW
AND POVERTY, FIRSTLY, WANT TO
THANK THE CHAIRS FOR HOSTING
THIS HEARING AS WELL AS THE
DEPARTMENT FOR, UM, WORKING ON A
MUCH LARGER AND ACCELERATED MZ
ATTACKS TO ENSURE THAT THERE ARE
NO CUTS OR DELAYED DELAYS TO
PLAN EXPANSIONS AND FUTURE
INVESTMENTS THAT FOCUS ON
INCREASING ACCESS, QUALITY AND
EQUITY. WE SUPPORT THE PROPOSED
BASE RATE INCREASES AND TARGETED
PROVIDER RATE INCREASES FOCUS ON
KNOWN ACCESS AREAS, SOME OF
WHICH WERE HIGHLIGHTED IN THE
LAST PANEL, AND WE ALSO SHARE
THE CHAIR AND MEMBERS CONCERNS
THAT ARE MORE IMPACTFUL TAX IS
SPREAD OVER A SHORTER PERIOD OF
TIME RATHER THAN 10 YEARS. THANK
YOU. GOOD AFTERNOON CHAIRS.
THANKS FOR HOLDING THIS HEARING.
I'M ERICA MURRAY. I'M THE
PRESIDENT AND CEO OF THE
CALIFORNIA ASSOCIATION OF PUBLIC
HOSPITALS AND HEALTHCARE SYSTEMS
. WE REPRESENT THE 21 HEALTHCARE
SYSTEMS ACROSS CALIFORNIA THAT
COMPRISED JUST 6% OF ALL
HOSPITALS THAT PROVIDE 35% OF
ALL HOSPITAL BASED CARE FOR THE
STATE'S MEDICAL PROGRAM. REALLY
WANT TO THANK THE DEPARTMENT.
FOR THOUGHTFUL REINTRODUCTION OF
THE ATTACKS AND APPRECIATE
FUTURE CONVERSATIONS AS WE THINK
ABOUT WHERE THERE'S PARTICULAR
NEED IN THE MEDICAL PROGRAM, AND
TO THAT POINT, I WOULD POINT TO
OUR PUBLIC HEALTH CARE SYSTEMS
WHO, OF COURSE, SERVE EMERGENCY
TRAUMA BURN, BUT ALSO WE OPERATE
100, FEDERALLY QUALIFIED HEALTH
CENTERS AND HAVE AN IMPORTANT
SPACE IN PRIMARY AND SPECIALTY
CARE ACROSS CALIFORNIA FOR THOSE
WHO ARE MOST HISTORICALLY
MARGINALIZED, SO WE LOOK TO THE
TAX IS AN IMPORTANT OPPORTUNITY
TO STABILIZE AND PROTECT ACCESS
FOR ALL THOSE WHO ARE SERVED BY
PUBLIC HEALTH CARE SYSTEMS.
THANK YOU. THANK YOU. GOOD
AFTERNOON CHAIRS, DOCTOR WOULD
AND DR ARAMBULA OR YEAH, DOCTOR
WOULDN'T DOCTOR SORRY, UM,
CONNIE DELGADO ON BEHALF OF THE
DISTRICT HOSPITAL LEADERSHIP
FORUM. THESE ARE THE 33 DISTRICT
AND MUNICIPAL HOSPITALS AND
REALLY APPRECIATE THE
CONVERSATION HERE TODAY AND THE
RECOGNITION THAT HOSPITALS,
PARTICULARLY THOSE IN SMALL,
RURAL AND UNDERSERVED
COMMUNITIES ARE STRUGGLING. AND
APPRECIATE AGAIN THE
CONVERSATION AND WOULD LIKE TO
ALIGN OUR COMMENTS WITH HAVING
THE FUNDS DISTRIBUTED
DISTRIBUTED IN THE MOST, UM,
QUICKEST WAY POSSIBLE. THANK YOU
VERY MUCH. THANK YOU. THANK YOU.
CHAIR. THANK YOU. CHAIRS TIM
MADDEN, REPRESENTING THE
CALIFORNIA CHAPTER OF THE
AMERICAN COLLEGE OF EMERGENCY
PHYSICIANS AND EMERGENCY SINCE
RESPECTFULLY REQUEST TO BE
INCLUDED IN THE PROVIDER RATE
INCREASES WITH THE CEO TAX
BRIEFLY, EMERGENCY PHYSICIANS
DISPROPORTIONATELY OR IMPACTED
BY MEDICAL VISITS COMING INTO
EMERGENCY DEPARTMENT WE SEE MORE
THAN 6 MILLION MEDICAL
ENROLLEES, WHICH IS ROUGHLY 42.
OF THE VOLUME OF EMERGENCY
DEPARTMENT VISITS FOR
COMMUNITIES THAT HAVE 60 TO 70%
MEDICAL ENROLLEES. WE SEE 60 TO
70% OF MEDICAL ABILITIES WERE
NOT CHOOSING WHO WE SEE. IN
TERMS OF RATES WERE TYPICALLY IN
THE 54 TO 59% OF MEDICARE IN
TERMS OF REIMBURSEMENT. HOW THAT
TRANSLATES IS REALLY ACCESS FOR
THOSE COMMUNITIES THAT HAVE THE
HIGHER MEDICAL POPULATIONS.
THOSE FACILITIES MAY HAVE ONE
EMERGENCY PHYSICIAN THAT'S
THERE. 24 7 VERSUS A COMMUNITY
THAT HAS A LOWER LEVEL. THEY MAY
HAVE 2 TO 3. EMERGENCY
PHYSICIANS WERE ABLE TO INCREASE
EVERY MEMBER MOVEMENT, IT WILL
INCREASE ACCESS WITHIN THE
EMERGENCY DEPARTMENT AND
PRIORITY. BETTER EQUITY FOR ALL
OUR PATIENTS. THANK YOU. THANK
YOU. GOOD MORNING, RANDOM MARTIN
HERE ON BEHALF OF AVIANO
HEALTHCARE, WERE A MEMBER OF THE
CALIFORNIA ASSOCIATION OF HEALTH
SERVICES AT HOME. YOU WANT TO
ECHO MR CHELIOS COMMENTS EARLIER
RELATIVE TO PRIVATE DUTY NURSING
AND ADD ONE ADDITIONAL FACTOR
THAT WE'D LIKE YOU TO CONSIDER.
AND THAT IS EXCUSE ME. THERE IS
A WAITING LIST THAT WE ESTIMATED
OVER 1000 FAMILIES ACROSS THE
STATE OF CALIFORNIA. AND WAITING
LIST. I HAVE TO TELL YOU IS A
MISNOMER. IT'S ACTUALLY A DEAD
END LIST BECAUSE YOU NEVER GET
OFF OF IT. IF YOU'RE A MEDICAL
PATIENT COMMERCIAL PATIENTS, YOU
HAVE A MUCH BETTER CHANCE.
MEDICAL PATIENTS STAY ON THAT
WAITING LIST. FOREVER AND SO WE
KNOW THAT WITH THE EXPANSION OF
THE RATE FOR THEM FOR THOSE THIS
POPULATION THAT WILL SEE A
REDUCTION IN THAT WAITING LIST
OVER LONGER TIME. THANK YOU.
THANK YOU. HI THERE. KATE
MORRISON. I'M WITH MAXIM
HEALTHCARE SERVICES PROVIDER OF
PRIVATE DUTY NURSING IN
CALIFORNIA. WE HAVE OVER 21
OFFICES. WE SERVE 18,000
PATIENTS THROUGH THE STATE AND
HAVE, UM 17,000 CAREGIVERS THAT
WE EMPLOY AND I JUST WANT TO
ECHO WITH EVERYONE SAID WE HAVE
OVER 1000 KIDS WAITING IN
HOSPITALS FOR CARE. A RATE
INCREASE WILL GO A LONG WAY
TOWARDS GETTING THEM HOME WHERE
THEY WANT TO BE AND WHERE IT'S
CHEAPER. THANKS SO MUCH. THANK
YOU SEE NO FURTHER PUBLIC
COMMENT HERE IN THE HEARING ROOM
AS A REMINDER. THE PHONE NUMBER
AND ACCESS CODE IS ON THE
SUBCOMMITTEE'S WEBSITE AND
SHOULD BE APPEARING ON THE
SCREEN. IF YOU ARE WATCHING THE
LIVES LIVE STREAM, THE NUMBER
AGAIN IS 877692. AND THE ACCESS
CODE IS 1850 11 00 WITH THAT
OPERATOR, LET'S BEGIN. THANK YOU
VERY MUCH. PLEASE PRESS 10 AT
THIS TIME. IF YOU'D LIKE TO MAKE
A COMMENT AGAIN, IT'S 10. WE
HAVE A NUMBER IN Q HERE WILL GO
TO FIRST LINE NUMBER. 12, PLEASE
GO AHEAD. THANK YOU, CHAIRMAN
AND COMMITTEE MEMBERS K¾T
LEIGHTON ON BEHALF OF THEIR
CHILDREN'S SPECIALTY CARE
COALITION, TESTIFYING IN SUPPORT
OF THE INCLUSION OF PRIVATE DUTY
NURSES IN THE LIST OF PROVIDERS
ELIGIBLE FOR RATE INCREASES
UNDER THE PROPOSED EMC ATTACKS
ARE POSITIONS CAN ATTEST TO THE
DIFFICULTY OF DISCHARGING KIDS,
PARTICULARLY THOSE WHO ARE
TECHNOLOGY DEPENDENT FROM THE
HOSPITAL DUE TO LACK OF NURSES
TO TREAT THEIR NEEDS AT HOME.
MORE COMPETITIVE RATES FOR
PRIVATE DUTY NURSES ARE
NECESSARY TO MAKE THIS CARE MORE
ACCESSIBLE. WE ALSO LOOK FORWARD
TO WORKING WITH THE LEGISLATURE
AND ADMINISTRATION AS OTHER
PROVIDER TYPES ARE CONSIDERED
FOR RATE INCREASES UNDER THE MPO
TAX. PEDIATRIC SPECIALTY
PHYSICIANS TREAT CHILDREN AND
YOUTH WITH CHRONIC AND COMPLEX
CONDITIONS. GET THIS POPULATION
OF CHILDREN EXPERIENCES, SERIOUS
ACCESS, CHALLENGES AND MONTHS
LONG WAIT TIMES AND MANY
SPECIALTIES DUE TO THE SHORTAGE
OF PHYSICIANS, A SITUATION WHICH
I LIKE CONTINUES TO WORSEN RATE
INCREASES FOR THESE PROVIDERS
HAVE NOT INCREASED IN OVER TWO
DECADES AND FALL WELL BELOW
MEDICARE LEVELS IN THE
AGGREGATE. MAKING RECRUITMENT
AND RETENTION EXTREMELY
DIFFICULT. THIS IS A HEALTH
EQUITY ISSUE IS THESE POSITIONS
ARE CRITICAL SAFETY NET
PROVIDERS WHO SEE A HIGH VOLUME
OF MEDICAL CHILDREN AND FAMILIES
, SOMETIMES UPWARDS OF 70% OF
THEIR PAIR MIX. SO AGAIN, WE
LOOK FORWARD TO CONTINUED
CONVERSATIONS AROUND INCREASED
RATES FOR SPECIALTY CARE
POSITION. THANK YOU. THANK YOU.
NEXT CALLER, PLEASE. LINE 14.
GOOD MORNING. HOW ARE YOU? THIS
IS KATIE. CRUEL STRAIGHTER
CHANNEL HISTORICAL. IT'S ADULT
HEALTHCARE, COMMUNITY BASED
ADULT SERVICES, THE SENIOR LEVEL
ADULTS, INDIVIDUALS,
HISTORICALLY UNDERSERVED
COMMUNITIES. INDIVIDUALS ATTEND
OUR CENTRAL DURING THE DAY AND
OUR CARE WHAT THEM FROM THE
PLACEMENT. OF YOUR SINGLE HOMES
. HERE'S AN EXAMPLE OF ONE IN
RALEIGH, WHICH JUST HAPPENED
THIS WEEK. HIS NAME'S HAROLD AND
HE'S 95. HE HE WAS BROUGHT TO US
BY HIS SON DID. HAROLD THINKS
THAT THE DAVID IS HIS BROTHER?
NOT HIS SON. OKAY, HELIOS WITH
HIS VIBE. AND HE WAS CHAIR. HE
HAS MULTIPLE DIAGNOSE STROKE
DEMENTIA OUTSIDE DEPRESSION. HE
IS INCONTINENT. UH HE HAD
MULTIPLE FALLS AND THE LAST ONE
WAS IN MARCH, AND HE WAS
HOSPITALIZED BECAUSE OF THAT.
SHE ALSO HAS A HE HAS A
WONDERING, RISK, FORCIBLE AND
USE DIFFERENT, PHYSICALLY
ABUSIVE TO TURKISTAN IN HIS
HISTORY OF ALCOHOL AND SMOKING.
WHAT WE DO FOR THIS MAN
TRANSPORTING TO OUR CENTER AND
BACK HOME WHERE THE SOCIAL
MEDICATION WILL PROVIDE PHYSICAL
THERAPY, SOCIAL SERVICES
SIMULATION. UM ACTIVITIES HELP
HIM WITH ALL THE LIVING NEEDS
DAILY LIVING NEEDS. WE OFFER HIM
TWO HOT MEALS WITH TOILET TEAM
OR HYGIENE CARE. AND UH, NOW I
AM AT MY MAIN POINT. I'M HERE TO
SAY THAT THEY CAN GIVE A
SHORTAGE IS REAL THERE CRISIS
BECAUSE THEY ARE NOT ENOUGH TO
SUPPORT PEOPLE LIKE HAROLD
INDIVIDUAL AT HOME. SO
ORGANIZATIONS LIKE MINE
CONSUMING TWO BASED SERVICES IS
THE ONLY SOLUTION FOR THESE
INDIVIDUALS TO STAY AT HOME AND
NOT TO BE PLACED IN AN
INSTITUTION. THANK YOU. NEXT
CALLER, PLEASE. POEM NEXT LINE
53. RIGHT? I THANK. THANK YOU
FOR HEARING ME OUT TODAY, AND MY
NAME IS KATIE AND I'M MOTHER TO
BOTH ATTEND. A PEDIATRIC DAY
HEALTH CARE CENTER AND FRESNO.
UM I WANTED TO GIVE YOU GUYS A
PARENT PERSPECTIVE AND ARSON. BO
IS ONE OF ONLY 400 IN THE WORLD
LIVING WITH HIS RARE
NEUROLOGICAL DISORDER. IT IS A
PROGRESSIVE DISORDER. THAT HAS,
OF COURSE, THAT WILL ONLY GET
WORSE WITH TIME AND HE DOESN'T
WORK. HE HAS TROUBLE
COMMUNICATING HAS BEEN DIAGNOSIS
AND INTELLECTUAL DISABILITY HAS
OPTIC. NERVES ARE DYING, ABLE
EVENTUALLY GO BLIND, AND HE'S AT
RISK FOR SEIZURES AMONGST A FEW
OTHER COMPLICATIONS, AND WE'VE
BEEN WITH LORETTA FOR A LITTLE
OVER A YEAR NOW, WHICH IS OUR
LOCAL FACILITY, AND, UM, THAT
THE NURSES THAT TAKE CARE OF OUR
SON AND THE OTHER CHILDREN. THAT
GO THERE. THEY HAVE SUCH A
SPECIAL HEART, AND I THINK IT
TAKES A SPECIAL HEART TO TAKE
CARE OF KIDS LIKE THAT. NOT ONLY
ARE THEY CARED FOR MEDICALLY TO
HELP WITH THEIR THERAPIES AND
HELP WITH THEIR CARE NEEDS, BUT
THEY PROVIDE LOVE TO OUR
CHILDREN WHO ALREADY STRUGGLED
SO MUCH, SO I WANTED TO GIVE A
PERSPECTIVE THAT IS SOMETHING
LIKE THIS OR TOO CLOSE, WHICH IS
ON THAT CLIFF THAT WE'RE AT. WE
WOULD NOT BE ABLE TO MAINTAIN
OUR JOBS. MY HUSBAND, THE POLICE
OFFICER, AND I WORK IN HIGHER
EDUCATION. UM AND WE WOULD
UNDOUBTEDLY HAVE TO GO ON MARK
GOVERNMENT ASSISTANCE VERSUS
SERVING THE COMMUNITY IN THE WAY
THAT WE DO SO THANK YOU FOR
TAKING THE TIME TO LISTEN TO OUR
HEART FELT PLEASED AND KEEP OUR
KIDS TAKING CARE OF SO THAT THEY
AREN'T ANY RISK FOR SERIOUS
HEALTH COMPLICATIONS AS NORMAL
DAY CARE. NOT ONLY CAN'T TAKE
CARE OF HIM, BUT THEY REFUSED
TO. SO THANK YOU FOR YOUR TIME,
AND WE ALL APPRECIATE YOU VERY
MUCH. THANK YOU. NEXT CALLER,
PLEASE. LINE 35. HI THIS IS
CHRISTINE SCHULTZ, EXECUTIVE
DIRECTOR FOR THE CALIFORNIA
OPTOMETRIC ASSOCIATION. THANK
YOU SO MUCH FOR HOLDING THE
STEERING. WE SUPPORT THE
PROPOSAL TO REINSTATE THE TAX.
WE ENCOURAGE YOU TO INCREASE
VISION. KEURIG REIMBURSEMENT
RATES, VISION CARE IS PRIMARY
CARE MEDICAL ENROLLEES WHO DON'T
SEE A PHYSICIAN ON A REGULAR
BASIS END UP IN OUR OFFICE WHEN
THEIR VISION CHANGES. REGULAR
EYE EXAMS ARE THE FIRST LINE OF
DEFENSE AND ATTACKING EARLY
SIGNS OF I AND SYSTEMIC
CONDITIONS THAT AFFECT THE I
LIKE DIABETES, HIGH BLOOD
PRESSURE AND HYPERTENSION. WERE
ABLE TO GET THESE ENROLLEES
DIAGNOSED EARLIER AND THEREFORE
WE DO SO OVERALL HEALTH CARE
COSTS. REIMBURSEMENT RATES FOR
VISION SERVICES HAVE NOT BEEN
INCREASED IN OVER 20 YEARS.
GREAT REDUCTIONS MADE DURING THE
GREAT RECESSION HAS NEVER BEEN
RESTORED, AND AS A RESULT, THE
CALIFORNIA HAS THE THIRD LOWEST
MEDICAID REIMBURSEMENT RATE FOR
EYE EXAMS IN THE NATION. AS MUCH
AS THEY WANT TO OPTOMETRISTS ARE
INCREASINGLY CONCERNED THAT THEY
SIMPLY CAN'T AFFORD TO KEEP
PARTICIPATING IN THE MEDICAL
PROGRAM. WE DID A SURVEY AND
MORE THAN NINE OUT OF 10
OPTOMETRIST SAID PATIENTS ARE
HAVING A HARD TIME FINANCIAL
PROVIDER IN THEIR AREA.
SIGNIFICANT INVESTMENT NOW TO
MAKE SURE WE DON'T LOSE THE
PROVIDERS WE HAVE. THANK YOU FOR
YOUR CONSIDERATION. THANK YOU.
NEXT CALLER, PLEASE BLINDS. 9
37. HELLO THIS IS THANK YOU FOR
HOLDING THIS CONFERENCE. UM I'M
A PRIVATE NURSING PROVIDER AND I
SPECIALIZE IN HOME HOUSE AND
CERTAINLY BELIEVE IT WOULD
BENEFIT THE STATE OF CALIFORNIA
TO INCREASE MONEY TOWARDS HOME
HEALTH WORKERS. UM IT WOULD
INCLUDE IMPROVE THEIR QUALITY OF
LIFE. UM. DUE TO THE FACT THAT.
BECAUSE THESE WORKERS HAVE
ACCESS TO MORE RESOURCES AND
GOOD QUALITY RESOURCES AND THE
PATIENTS. QUALITY OF LIFE WILL
IMPROVE AS WELL BECAUSE THE
PATIENTS WILL FEEL A SENSE OF
FAMILIARITY BY BEING A SET OF
THEIR DOMICILE AND WHEN A
PATIENT IS CARED FOR INSIDE
THEIR DOMICILE, THEIR QUALITY OF
SWEET SLEEP IMPROVED. UM THEIR
LOVED ONES WILL BE AROUND MORE
OFTEN RATHER THAN FACILITY. UM
AND THERE WILL BE LESS LIKELY
DEVELOP CAMILLE INFECTIONS.
THANK YOU. THANK YOU. NEXT
CALLER, PLEASE. 9 55. GOOD
AFTERNOON, NICOLE WARD ULLMAN ON
BEHALF OF THE CHILDREN'S
PARTNERSHIP. THE CHILDREN'S
PARTNERSHIP SUPPORTS REVISION
PROPOSAL TO REQUEST A LARGER EMC
ATTACKS STARTING APRIL 1 2023.
ADDITIONALLY THE URGED THE
LEGISLATURE TO INCLUDE INCREASED
RATES FOR COMMUNITY HEALTH
WORKERS SUPPLEMENTAL PAYMENTS
THAT ADVANCE EQUITY SUPPORT FOR
PREVENTION ACTIVITIES FROM
MEDICAL MEMBERS AND
COMPREHENSIVE PERINATAL
SERVICES. THANK YOU. THANK YOU.
NEXT CALLER, PLEASE. LINE 47.
THANK YOU, CHAIRMAN AND
COMMITTEE MEMBERS. MY NAME IS
JESSICA AND I AM A MOTHER OF A
MEDICALLY COMPLEX CHILD. AIDEN
I'M ASKING YOU TODAY TO CONTINUE
TO SUPPORT THE 40% RATE INCREASE
FOR PEDIATRIC DAY. HELP YOUR
CENTERS. MY SON, AIDEN HAS BEEN
CARED FOR BY LORETTA LITTLE
MIRACLES FOR ALMOST TWO YEARS,
HE IT HAS BEEN DIAGNOSED WITH
THEIR VERY GENETIC DISORDER. NO
LESS. PITT HOPKINS CENTRAL THE
AGE OF 3.5. HE STILL STRUGGLES
WITH, UM, MOUTH REACHING HIS
MOUTH STONES HE CANNOT WALK.
STAND FALL OR TALK. HIS NEEDS
REQUIRES SKILLED NURSING CARE.
UNFORTUNATELY DUE TO THE CURRENT
MEDICAL GRAY LITTLE MIRACLES IS
UNABLE TO COMPETE AGAINST LOCAL
HOSPITAL. TO PUT THINGS IN
PERSPECTIVE LAST YEAR DURING A
COVID SURGE, LOCAL COMMUNITY
HOSPITALS PAID THE REGISTERED
NURSES MORE PER DAY TO WORK
OVERTIME THAN WHAT THEIR OWN
HOSPITAL DOCTORS WERE BEING PAID
PER DAY. AT THE SAME TIME LOADER
LORETTA LITTLE MIRACLES HAD TO
CLOSE FOR A WHOLE WEEK BECAUSE
THEY DID NOT HAVE ENOUGH STAFF
THERE, WHICH LED ME AS A
PHARMACIST AT A LOCAL HOSPITAL
WHO WORKS AT CRITICAL CARE TO
TAKE TIME OFF FROM WORK TO CARE
FOR MY SON, AS YOU CAN IMAGINE,
THIS WAS A HUGE ETHICAL STRUGGLE
FOR ME BECAUSE THIS WAS A TIME
WHEN MY PATIENTS MEDICAL TEAM
AND COMMUNITY NEEDED ME THE MOST
. MR PATTERSON. YOU HAD QUESTION
WHAT WILL I DO LOVE LAREDO.
LITTLE MIRACLE CLOSES IN MY IN
MY FAMILY SITUATION, WE WOULD
EITHER HAVE TO ONE
INSTITUTIONALIZED MY SON OR TWO.
I WOULD HAVE TO STOP WORKING AND
MY HUSBAND WOULD HAVE TO WORK
PART TIME BECAUSE AS ONE PERSON
I AM UNABLE TO PHYSICALLY AND
MENTALLY CARE FOR MY SON FULL
TIME. THIS WOULD MEAN THAT THE
QUALITY OF LIFE OF MY FAMILY
WOULD DECREASE. IN ADDITION, WE
BELIEVE LOSE ACCESS TO OUR
PRIVATE INSURANCE, WHICH JUST AN
2022 PAID FOR $60,000 WORTH OF
MY SON'S MEDICAL BILLS THAT
OTHERWISE MEDICAL WOULD HAVE
BEEN RESPONSIBLE FOR. I THINK
YOU SO MUCH FOR YOUR TIME TODAY
AND YOUR SUPPORT AND LISTENING
TO US AND LEARNING MORE ABOUT
OUR JOURNEY. THANK YOU. NEXT
CALLER. PLEASE LIE. LINE 52 52.
GOOD AFTERNOON, MR CHAIR AND
MEMBERS RONALD COMMON WAYS HERE
ON BEHALF OF THE CALIFORNIA
PANEL. THINK HEALTH NETWORKS PEN
PEN SUPPORTS TO ME, RIGHT?
REVISED PROPOSAL FOR A LARGER
SOONER KOTEX, WHICH PROVIDES
CRITICAL FUNDING TO INCREASE
ACCESS AND ADVANCE EQUITY AND
MEDICAL SUPPORT THE
ADMINISTRATION'S PROPOSAL TO
ENSURE ADEQUATE BASED RATES FOR
PRIMARY CARE, OBSTETRICIAN AND
GYNECOLOGY AND ALSO NON
SPECIALTY MENTAL HEALTH CARE
SERVICES, DEPENDING OVER 40
COMMUNITY BASED ORGANIZATIONS
SUBMITTED A LETTER URGING DHC S
TO INCLUDE COMMUNITY HEALTH
WORKERS IN THE IN THE RATE
CREASES RATE INCREASES AS WELL.
COMMUNITY HEALTH WORKERS ARE
ESSENTIAL FOR MANY INITIATIVES
CURRENTLY UNDERWAY, INCLUDING
KILLEEN, CHILDREN'S PREVENTATIVE
SERVICES AND OTHER EQUITY FOCUS
PROGRAMS. CHW ARE CURRENTLY PAID
LESS THAN 87.5% OF MEDICARE FOR
NON POSITION, EDUCATION AND
MANAGEMENT SERVICES, AND, AS A
RESULT, MEDICAL IS STRUGGLING TO
GET THE NEW BENEFIT OFF THE
GROUND. WE STRONGLY URGE THE
LEGISLATURE TO ENSURE THAT CHW
ARE INCLUDED IN THE TAX PROPOSAL
IN THE FINAL BUDGET. THANK YOU.
THANK YOU. NEXT CALLER, PLEASE.
LINE 60. GOOD AFTERNOON. THIS IS
DIANA DOUGLAS ON BEHALF OF
HEALTH ACCESS CALIFORNIA HEALTH
ACCESS GENERALLY SUPPORTS THE
ADMINISTRATION'S PROPOSAL FOR A
LARGER AND MORE IMMEDIATE AND
KOTEX. WE DO, HOWEVER, RECOMMEND
SPENDING OVER THE CONDENSED 3 TO
4 YEAR PERIOD TO MAKE THE MOST
OF RESOURCES AND LIMIT THE
UNCERTAINTY THAT COULD OCCUR
OVER A PROLONGED SPENDING PLAN
SUPPORT PROPOSED BASED RATE
INCREASES ALONG WITH FUTURE
STRATEGIC SUPPLEMENTAL INCREASES
THAT WOULD USE THE DATA DRIVEN
APPROACH TO TARGET GAPS AND
ACCESS TO CARE ACROSS REGIONS
AND SPECIALTIES. THANK YOU TO
THE ADMINISTRATION AND THE
LEGISLATION, LEGISLATURE. FOR
THEIR WORK ON THIS IMPORTANT
ISSUE. THANK YOU. THANK YOU.
NEXT CALLER, PLEASE. LINE 54.
YES. HI MY NAME IS AMANDA
PHILLIPS. I'M A PRIVATE DUTY
NURSE. AND I'M ALSO AN ADOPTIVE
MOTHER TO US MEDICALLY FRAGILE
CHILD. I'M CALLING TO ADVOCATE
FOR, UM OF PORTION OF THE
INTENCIÓN AX TO THE USED FOR A
RIGHT INCREASE FOR PRIVATE DUTY
NURSES. I USED TO WORK IN A
PEDIATRIC HOSPITAL. UM AND I
WENT INTO PRIVATE DUTY NURSING
BECAUSE I DOES SO MANY PATIENTS
ON OUR FLOOR STUDYING FOR WEEKS
AT A TIME, UM AT THE EXORBITANT
RATE OF BAD COSTS AT A HOSPITAL
. UM WE'RE JUST WAITING FOR A
NURSE AT HOME. AND THAT LED ME
DOWN A JOURNEY. BUT UH, I TAKE
CARE OF MY DAUGHTER AND WE ARE
WELL, AND EVERYTHING IS GREAT.
BUT AND I'VE BEEN ABLE TO KEEP
HER OUT OF HOSPITALIZATIONS MANY
TIMES BECAUSE OF THE TRUST OF
THE POSITION KNOWING THAT THE
NURSES AT HOME, HOWEVER I GET
CALLS. UM I GET FREQUENT PHONE
CALLS THAT ARE HEARTBREAKING
FROM PARENTS BECAUSE I THINK MY
NAME IS LIFTED ON REGISTRIES AS
A PROVIDER. AND THEY CALL AND
REQUEST IF I ENABLE TO CARE FOR
THEIR CHILD MIGHT SAY THAT I
DON'T HAVE THE AVAILABILITY.
BUT, UM, I. I HATE MORE OFTEN
THAN NOT, BUT PARENT AND UP IN
TEARS BECAUSE THEY HAVE STAYED
BY THE TIME THEY'RE CALLING ME.
THEY'VE CALLED EVERY AGENCY AND
THEY ARE AT THEIR THE END OF
THEIR ROBOTS TRYING TO FIND CARE
, AND I KNOW THAT THAT IS
BECAUSE THE PAY RATE FOR RN JUST
END OF IAN'S NOT SUFFICIENT TO
KEEP THEM IN THAT ROLE,
ESPECIALLY WITH WHAT HOSPITALS
ARE PAIN RIGHT NOW. SO UM, I
JUST WOULD ADVOCATE AND EMPLOY
YOU TO CONSIDER ALLOCATING SOME
FUNDS FOR THAT RATE INCREASE.
THANK YOU. THANK YOU. NEXT COLOR
, PLEASE. 9 59. HI GOOD
AFTERNOON. ASSEMBLY MEMBER. UM I
REMEMBERS MY NAME IS ROSE,
HAILING AND MY SON ELIAS. HE
ALSO ATTENDS LORETTA'S LITTLE
MIRACLES, AND I'M ASKING FOR YOU
GUYS TO STRONGLY SUPPORT THAT
40% RATE INCREASE FOR THE
PEDIATRIC. THEY HEALTH CENTERS.
I JUST WANT TO TOUCH A LITTLE
BIT UPON MY SON. HE HAS TO
REBUILD PULSE. SEE HE IS
SEVERELY DEVELOPMENTALLY DELAYED
AT RISK FOR SEIZURES. BLIND
WHEELCHAIR BOUND NOW LORETTA'S
HAS BEEN MY RESPITE NOW. A YEAR
AGO, I'VE HAD TO QUIT MY JOB. I
HAD A WAS A PHARMACEUTICAL REP I
, YOU KNOW THE WONDERFUL JOB AND
I HAD TO QUIT BECAUSE OF THE
EARLIER TIME START TIMES FOR
ELEMENTARY SCHOOL STUDENTS, AND
I WOULDN'T BE ABLE TO WORK AND
COME. YOU KNOW THE HOME BY 2 30
TO PICK UP MY SON. SO NOW I'VE
STAYED HOME, SO LORETTA'S IS
REALLY WHAT PROVIDES THE RESPITE
FOR US. UM I THINK IT WAS
ASSEMBLYMEMBER'S PATTERSON. YOU
ASKED ABOUT WHAT WE WOULD DO IF
WE DIDN'T HAVE LORETTA'S. SO
THERE'S AN OPTION OF HOME HELP.
THAT THAT IS ONE AND, OF COURSE
INSTITUTIONALIZATION. BUT WHAT
THE P D, A. THE SKILLED NURSING
FACILITY, IT ADDS MORE THAN JUST
CARE FOR THE CHILDREN. IT IS
SOCIALIZATION. UM YOU KNOW,
THESE KIDS ARE ONLY GETTING
BIGGER, SO IT'S GOING TO TAKE
MORE THAN ONE PERSON TO LET'S
SAY, CARRY THE CHILD IF THEY'RE
DOING TOILET IN NEEDS, OR, YOU
KNOW, TAKING THEM FROM A
WHEELCHAIR TO A BED. SO UM, AND
IT'S OF COURSE MEDICATION, AND
IT'S BEING ABLE TO RECOGNIZE
WHETHER THE CHILD IS GOING INTO
A SEIZURE OR NOT. IT IS
EXTREMELY COMPLICATED. AND I
KNOW THAT A BUNCH OF YOU IF
THERE ARE ARE DOCTORS AND YOU
KNOW THE IMPORTANCE OF
RECOGNIZING THIS KIND OF QUALITY
OF CARE SO, UM, I YOU KNOW, I
WOULD LIKE I'M ADVOCATING FOR US
TO PLEASE STRONGLY SUPPORT THIS
RATE INCREASE BECAUSE IT HELPS
US PARENTS, UM OUT, YOU KNOW
TREMENDOUSLY AND THAT WAY WE
DON'T HAVE TO BECOME A BURDEN ON
THE SYSTEM AND DEPEND ON A
SYSTEM WHERE WE CAN ACTUALLY
HAVE AND CONTINUE. UM YOU KNOW,
A GOOD QUALITY OF LIFE FOR OUR
FAMILIES. THANK YOU. THANK YOU.
NEXT CALLER, PLEASE. LINE 50.
MAYBE GO AHEAD. HI MY NAME IS
OURS. ALIA AND MY SON DONNIE'S
IS, UM UH, CHILD FOR LORETTA
LITTLE MIRACLES, DAYCARE AND AT
AGE FOUR HE STARTED ATTENDING.
PERFECT ABILITY FOR SKILLED
NURSING, AND FOR HIM. HE'S AN
ACTIVE CHILD, BUT HE HAS A
MINIMUM OF FIVE DIAGNOSIS IS AND
THEN WHEN YOU ASK FOR ADDITIONAL
ONES, HE'S UP TO 10, AND HE'S
ONLY GETTING BIGGER. UM, HE'S 12
YEARS OLD. AND. UM, WHEN HE'S
DISCHARGED FROM A HOSPITAL
PROCEDURE OR HOSPITALIZATION,
HE'S ABLE TO GO STRAIGHT TO A
LADDERS AND GET THE SKILLED
NURSING THAT YOU NEED. ALSO HE
NEEDS A SOCIALIZATION, UM HUGHES
THAT THEY TEACH THEIR GETS ONE
ON ONE CARE FOR SCHOOL NEEDS
BECAUSE SHE HIRED A TEACHER TO
COME HELP. UM AND YOU NOTICE THE
NEED THAT A LOT OF THE CHILDREN
WHO ARE ABLE TO GO TO SCHOOL AND
PARTICIPATE IN SCHOOL BUT STILL
NEEDS EXTRA TUTORING TUTORING.
UM THE INCREASE OF 40% IT IS
ESSENTIAL FOR HER TO KEEP, UM
SKILLED NURSES. R N L V N OR T N
A, UM, THERE AT OUR FACILITY.
SHE HAS A HIGH TURNOVER RATE
BECAUSE EVERYBODY'S NEEDING MORE
MONEY TO COME INTO THE PAYCHECK
AND THEY HEALTHCARE PROVIDERS.
NEED THAT RATE INCREASE AS WELL
, BECAUSE I JUST HEARD FROM MY
HEART RENDING STORIES WHERE A
LOT OF THEM EVEN IN L. A.
THEY'RE LIVING IN THEIR CARS.
THEY DON'T EVEN HAVE FOOD. AND
SO THIS INCREASE WILL PUT THEM
BACK IN A GOOD PLACE, AND
ESPECIALLY JUST COVID. WELL, YOU
GET COLD. ONE CHILD GETS COVID
THE WHOLE PURSE. ILYAS TO SHUT
DOWN, SO NOT ONLY DOES LORETTA'S
STAFF HAVE TO STAY HOME, THE
CHILDREN HAVE TO STAY HOME. THEN
THE PARENTS AT THE STATE HOME
BECAUSE WE DON'T HAVE ANYONE TO
CARE FOR THEM. THANK YOU. THANK
YOU. NEXT CALLER, PLEASE. GO TO
LINE. 30 PLEASE GO AHEAD. PLEASE
GO AHEAD. GOOD AFTERNOON. MY
NAME IS JENNIFER FRANCIS AND THE
MOTHER OF TWO MEDICALLY FRAGILE
CHILDREN. UM MY CHILD IS
MENTALLY THE VENTILATOR
DEPENDENT AND HE WAS IN A SUB
ACUTE PEDIATRIC UNIT. THEY
CHARGE. $450,000 A YEAR. HOME
CARE IS 74,000 YEAR. MY SON IS
SIX YEARS OLD. IN THE SIX YEARS.
IT WOULD HAVE COST $2,700,000 IN
THE PEDIATRIC SUB ACUTE UNIT IN
SIX YEARS. IT COSTS 444,000 TO
STAY AT HOME. THIS IS ONE YEAR'S
WORTH OF THE SUBSTITUTE UNIT
WITHOUT ALL THE LOVE AND CARE
AND HARD WORK OF THE L V. M S
AND R INSET COME TO TAKE CARE OF
HIM. AND THIS IS PRICELESS. AND
IT IS DEFINITELY ECONOMICALLY.
WHY TO GO THIS WAY. WE HAVE A
LOT OF HEART WRENCHING STORIES
AND A LOT OF TIME HIS LIFE HAS
BEEN SAVED, AND WE'RE JUST
GRATEFUL FOR WHAT WE HAVE. AND
WE WOULD JUST LIKE TO ATTRACT
MORE LDN, MORE RMS TO HOME
HOUSE. BUT THEY'RE GOING OFF
BECAUSE THEY SAY THEY CAN'T
SUPPORT THEIR FAMILY THAT WAY.
THANK YOU. SO MUCH FOR LISTENING
AND THANK YOU SO MUCH FOR YOUR
TIME. GOOD DAY. THANK YOU. NEXT
CALLER, PLEASE. EXT COLOR WOULD
BE LINE SIX. 62. HI MY NAME IS
TASIA. WHAT'S I'M CALLING ON
BEHALF OF THE CALIFORNIA ACADEMY
OF FAMILY PHYSICIANS AND ARE
NEARLY 11,000 MEMBERS IN SUPPORT
OF THE MARY VISION, TAX PROPOSAL
AND MEDICAL PROVIDER RATE
INCREASE FOR PRIMARY CARE.
PROPOSED MEDICAL PRIMARY CARE
RATE INCREASE WILL HELP PATIENTS
GET ACCESS TO CARE, MEDICAL
REIMBURSEMENT RATES TENDERS,
FAMILY POSITIONS, ABILITY TO SEE
MORE MEDICAL PATIENTS. PROPOSED
PRIMARY CARE RATE INCREASED
FUNDED THROUGH THE CEO TAX. ONE
MEDICAL RECIPIENTS WERE BEING
ACCESS TO CARE SUPPORTS GREATER
INVESTMENTS IN PRIMARY. CHAIRS
AND STRONG EVIDENCE SHOWS THAT
GREEN INVESTMENTS IN PRIMARY
CARE, LAWRENCE COSTS, IMPROVES
HEALTH OUTCOMES AND HEALTH
EQUITY AND INCREASING THE SUPPLY
OF PRIMARY CARE POSITION. THANK
YOU FOR YOUR TIME AND
CONSIDERATION. THANK YOU. NEXT
CALLER, PLEASE. LINE. 67, PLEASE
GO AHEAD. HI MY NAME IS MAX
SCHNEIDER. I'M WITH ACTING
ADVISERS CALLING ON BEHALF OF
TEAM SELECT AND PRIME HOME HELPS
IN SUPPORT OF THE INCLUSION OF
PRIVATE DUTY NURSING SERVICES IN
THE AGREEMENT. WE FULLY SUPPORT
THE COMMENTS OF DEAN CHELIOS
WITH THE CALIFORNIA ASSOCIATION
OF FOR HEALTH SERVICES AT HOME.
THANK YOU SO MUCH. THANK YOU.
NEXT CALLER, PLEASE. LINE. 45,
PLEASE GO AHEAD. MY NAME IS
JENNIFER MCCLELLAND AND THE MOM
IN CLOVIS, CALIFORNIA SPECIAL
THANKS TO MR PATTERSON, WHO IS
MY REPRESENTATIVES AND DR
ROMULUS, WHO ALSO REPRESENTS THE
CENTRAL VALLEY, A REGION THAT
HAS HIT HARD BY HEALTH DISPARITY
. 12 YEAR OLD SON IS
TRACHEOSTOMY AND VENTILATOR
DEPENDENT. HE'S ABLE TO LIVE
SAFELY AT HOME WITH OUR FAMILY,
THANKS TO PRIVATE DUTY NURSING
CASE WHEREBY MEDICAL CHILDREN
LIKE MY SON DEPENDS ON HOME
NURSING IN ORDER TO STAY OUT OF
THE HOSPITAL AND TO STAY ALIVE.
THE NURSES WHO TAKE CARE OF MY
SON KEEP HIS AIRWAY OPEN AND
KEEP HIM BREATHING. HOME.
NURSING IS UNDERFUNDED. ONE RISK
IS THAT KIDS GET FORCED INTO
INSTITUTIONS WHICH COST MEDICAL
MORE. THE OTHER RISK IS THAT.
THE OTHER RISK IS DEATH. KIDS
LIKE MY SON NEEDS LIFE
SUSTAINING NURSING CARE IN ORDER
IN THEIR HOMES IN ORDER TO STAY
ALIVE FOR KIDS LIKE MY SON, 40%
REENTRY. PRIVATE DUTY NURSING
PAID FOR BY THE TAX IS CRITICAL
TO KEEPING THEM SAFE IN THEIR
HOMES AND ALIVE. THANK YOU. NEXT
CALLER, PLEASE. LINE 69, PLEASE
GO AHEAD. AH GOOD AFTERNOON
CHAIRS, WOOD AND ARAMBULA. I'M
GRACE DOUGHERTY WITH TTG
STRATEGIES ON THE HOUSE FOR
CALIFORNIA AMBULATORY SURGERY
ASSOCIATION, ALSO KNOWN AS CASA
CASA STATEWIDE ASSOCIATION OF
OUTPATIENT AMBULATORY SURGERY
CENTERS, ALSO KNOWN AS A SC,
WHOSE MEMBERS ARE LEADERS AND
REDUCING COSTS OF THE HEALTH
CARE SYSTEM AS THEY ENSURE
PATIENTS RETREATED SAFELY AND
OUTPATIENT SETTINGS INSTEAD OF
OTHER COSTLY ALTERNATIVE SITES
TO SERVICE AND INTERNAL SURVEY
OF COUNCIL MEMBERS INDICATES
THAT CALIFORNIA IS PROVIDING
CARE TO HUNDREDS OF THOUSANDS OF
MEDICAL BENEFICIARIES PER YEAR
AND OFTEN INCUR SIGNIFICANT
LOSSES. MEDICAL RATES DO NOT
KEEP PACE WITH THE COST OF
PROVIDING THAT CARE. LABOR COSTS
AND THE COST OF IMPLANTABLE
DEVICES AND OTHER SUPPLIES OFTEN
FAR EXCEED THE REIMBURSEMENT
RATES PROVIDED BY MEDICAL SCS
PLAY A MAJOR ROLE IN THE OVERALL
HEALTH CARE DELIVERY SYSTEM AND
SAVE THE SYSTEM THAT PATIENTS
SIGNIFICANT COST. FOR EXAMPLE,
èC BERKELEY RESEARCH HAS SHOWN
THAT EVERY PROCEDURE PERFORMED
IN A SEC SAVES THE MEDICARE
PROGRAM 40% AND SAVE THE
MEDICARE BENEFICIARIES 50 TO 60%
IN THEIR CO PAYMENTS. THEREFORE
COSTS URGES THIS COMMITTEE.
THESE COMMITTEES, THE
LEGISLATURE AND ADMINISTRATION
TO INVEST A PORTION OF THE
ATTACKS TOWARDS MEDICAL
BENEFICIARY ENCOUNTERS IN THE
OUTPATIENT A SC SETTING. THANK
YOU VERY MUCH. THANK YOU. NEXT
CALLER, PLEASE. I 70 PLEASE GO
AHEAD. GOOD AFTERNOON CHAIR.
ARAMBULA THIS IS JENNA. SOMALI
WITH ME. CALIFORNIA JUST WANTED
TO SAY THAT WE APPRECIATE THE
LEGISLATURE'S ACTIVE ENGAGEMENT
AND DISCUSSION, UPDATING THE
ATTACKS. APPRECIATE THE WORK
THAT YOU DO AND, UM, THE WORK
THAT DOCTOR WOULD AS WELL HAS
DONE AS YOU AS YOU HAVE HEARD IN
THE HEARING TODAY, THERE ARE
MANY STAKEHOLDERS WHO HELPS
SUPPORT THE HEALTHCARE CONTINUUM
OF SERVICE. THERE ARE DESERVING
OF INVESTMENT BY WAY OF RATE
INCREASES TO MEDICAL
REIMBURSEMENT RATES. THE LOW
REIMBURSEMENT RATES HAVE
CONTRIBUTED TO STAFF REDUCTIONS
AND THE STAGNATION OF WAGES AND
BENEFITS FOR HEALTHCARE
WORKFORCE, THE COST TO DELIVER
CARE INCREASES AND PROVIDERS
ATTEMPT TO ENSURE FINANCIAL
STABILITY. UM AND AGAIN WITH THE
GREAT WORK OF THIS LEGISLATIVE
BODY TO AND MEDICAL ELIGIBILITY
TO ALL CALIFORNIANS, WE NEED TO
DO MORE TO ENSURE THAT THEY ARE
ABLE TO ACCESS HEALTH CARE
SERVICES. PANELISTS AND TODAY'S
INFORMATIONAL HEARING DISCUSSED
THE NEED FOR RATE INCREASES FOR
GROUND AMBULANCE SERVICES, WHICH
IS SORELY NEEDED YET WE HAVE
ALSO NOT SEEN AN INCREASE TO
RACE IN 911 GROUND EMERGENCY
SERVICES AND OVER A DECADE,
WHICH AGAIN LEADS TO STAGNATING
WAGES FOR EMERGENCY SERVICES
WORKERS. A WORKFORCE THAT IS
WORSENING TURNOVER YEAR AFTER
YEAR. WE WOULD APPRECIATE
CONSIDERATION, UH, FOR THE
INCLUSION OF 911 GRANT GROUND
AMBULANCE IN THE N C O TAX. MUCH
APPRECIATION. THANK YOU. THANK
YOU. NEXT CALLER, PLEASE. LINE.
57, PLEASE GO AHEAD. GOOD
AFTERNOON ASSEMBLYMEMBER'S AND
THANK YOU FOR THIS OPPORTUNITY
TO SHARE. MY NAME IS ELIZABETH
JONES. AND I AM A REGISTERED
NURSE. MY DAUGHTER, JOCELYN HAS
READ SYNDROME AND REQUIRES 24 7
CARE DUE TO BEING NON VERBAL,
NON AMBULATORY, NON PURPOSEFUL
USE OF HER HANDS AND HIS G TUBE
SAID SHE CURRENTLY RECEIVES IN
HOME NURSING CARE. NOVEMBER
JOCELYN HAD AN EIGHT HOUR SPINAL
FUSION SURGERY AND I WAS TOLD
THE ESTIMATED HOSPITAL STATE WAS
7 TO 10 DAYS. BECAUSE I AM AN RN
AND JOCELYN HAS IN HOME NURSING
CARE. THE SURGEON AGREED TO SEND
US HOME DAY, FOUR POST DOT BEING
HOME AND WITH MORE
INDIVIDUALIZED CARE, JOCELYN
RECOVERED MUCH MORE QUICKLY THAN
STAYING IN THE HOSPITAL. BEING
HOME ALSO DECREASE THE RISK OF
COMPLICATIONS SUCH AS NOSOCOMIAL
, OR HOSPITAL RELATED INFECTION
. NOVEMBER IS FLU SEASON. NOT
ONLY WAS. WE'RE COVERING JOCELYN
AT HOME IN HER BEST INTEREST,
BUT IT'S SUBSTANTIALLY SAVE THE
STATE MONEY FROM HAVING HER
HOSPITALIZED FOR THE WHOLE
ANTICIPATED POST OP TIME AND
LESSEN THE CHANCE OF A PROLONGED
STAY DUE TO AN INFECTION. HOME
NURSING HOURS COST THE STATE A
FEW $100 PER DAY AND JOPLIN
STAYING IN THE HOSPITAL WOULD
HAVE PROJECTED LEE COST THE
STATE UP TO $10,000 A DAY. IN
HOME NURSING CARE, SAVE THE
STATE OF THE $60,000. AND THIS
IS JUST ONE EXAMPLE FOR ONE
PATIENT. WHEN MY DAUGHTER IS NOT
HOSPITALIZED WITHOUT IN HOME
NURSING CARE, MY DAUGHTER WOULD
HAVE TO BE ADMITTED TO A SUB
ACUTE CARE FACILITY AS HER
MEDICAL NEEDS ARE HIGH. THIS
COSTS THE STATE AT LEAST $1000
PER DAY, WHEREAS IN HOME NURSING
CARE AGAIN IS JUST A FEW 100. I
COME TO YOU AS A TAXPAYER, A
NURSE AS WELL AS A SPECIAL
NEEDS. MOTHER I AM ASKING YOU TO
PLEASE APPROVE THE REQUEST TO
INCREASE THE PAY FOR IN HOME
NURSES. THE LOW PAY CURRENTLY
RESULTS IN A NURSING CRISIS FOR
IN HAMA NEEDS. THERE'S A
SHORTAGE BECAUSE THE PAY IS JUST
NOT ADEQUATE. THE TURNOVER RATE
FOR NURSES AND HOME IS ALSO A
CRISIS IF THEY TYPICALLY LEAVE
FOR BETTER PAYING JOBS. AND
THAT'S CRISIS IS IN YOUR HANDS.
THANK YOU FOR YOUR TIME. THANK
YOU. NEXT CALLER, PLEASE. LINE
74. PLEASE GO AHEAD. OK HELLO.
MY NAME IS TINA. I'M CALLING ON
BEHALF OF, UM, BEING A SPECIAL
NEEDS PARENTS. UH MY DAUGHTER IS
LEILA AND SHE IS 13 YEARS OLD.
SHE'S BEEN GOING TO LORETTA'S
FOR 13 YEARS. UM SINCE THEY
OPENED, UM I REALLY PRIDE. UM
MYSELF AND MY HUSBAND AND
LORETTA'S FOR KEEPING HER OUT OF
THE HOSPITAL AND 13 YEARS, HIS
ONLY BEEN HOSPITALIZED FOR BEING
SICK ONE TIME DESPITE ALL OF HER
MEDICAL NEEDS, HE IS NON
AMBULATORY, NONVERBAL. WILL
CHAIR DEPENDENT THE TUBE FED AND
. I THINK IF IT WASN'T FOR
LORETTA'S IT I MEAN, IF THEY
CLOSED DOWN, IT WOULD BE VERY
DEVASTATING FOR US. UM IN THIS
IT DOESN'T THE 13 YEARS WE'VE
BEEN ABLE TO MAINTAIN OUR
LIFESTYLE. UM GET THE BREAKS
THAT WE NEED FROM THE
SPECIALIZED CARE THAT LORETTA'S
PROVIDE TO OUR FAMILY AND EVEN
TO EVEN GROW OUR FAMILY. UM WE
JUST REALLY PLEAD AND ASK YOU TO
CONSIDER LORETTA'S IN THE
BUDGET. THANK YOU. THANK YOU. I
GOT TO MEET LEILA AND YOU'RE
DOING A GREAT JOB, MOM. NEXT
CALLER, PLEASE. AND THERE IS NO
MORE IN Q AT THIS TIME. THANK
YOU. I WILL TAKE THAT AS THE
CONCLUSION OF PUBLIC COMMENT FOR
TODAY'S HEARING, BOTH IN PERSON
AND ON THE PHONE AND WE'LL BEGIN
BY APPRECIATING THE
ADMINISTRATION AND WILL UPLIFT
DIRECTOR BASS WHO IS STILL HERE
HEARING ALL OF THE PUBLIC
COMMENT UNTIL THE END OF THE
HEARING. I ALSO WANT TO THANK
THE LAO FOR THE HANDOUT AND THE
INFORMATION AS WE ARE MAKING
DECISION, AS WELL AS ALL OF THE
STAKEHOLDERS AND PANELISTS AND
MEMBERS AND MY CO CHAIR WHO CAME
HERE TODAY ALSO WANTS TO
APPRECIATE THE TECH THE
SERGEANT'S BUT MOST IMPORTANTLY,
THE PUBLIC WHO WE ALL SERVE.
WITH THAT WE ARE ADJOURNED FOR
TODAY.