THERE WE GO. ALL RIGHT. GOOD
AFTERNOON. THIS IS THE ASSEMBLY
BUDGET SUB-COMMITTEE NUMBER ONE
ON HEALTH. I AM DOCTOR AKELA
WEBER, THE NEW CHAIR, AND I'D
LIKE TO WELCOME EVERYONE FOR
COMING TODAY. THIS IS THE FIRST
SUB ONE HEARING OF 2024 AND THE
FOCUS OF TODAY'S HEARING IS ON
THE VARIOUS PROPOSALS RELATED TO
THE MANAGED CARE ORGANIZATION
ALSO KNOWN AS THE M èC Ó TAX
THAT ARE CONTAINED IN THE
GOVERNOR'S BUDGET. AS A PART OF
THE FIRST PANEL. WE HAVE ASKED
DHCS TO PRESENT ALL FOUR M èC
Ó TAX RELATED PROPOSALS AND THE
L A Ó TO SHARE THEIR ANALYSIS
AND RECOMMENDATIONS ON THESE
PROPOSALS. PANEL TWO IS FOR KEY
STAKEHOLDERS TO SHARE THEIR
REACTIONS AND FEEDBACK TO THE
PROPOSALS. BEFORE WE BEGIN. I
WOULD LIKE TO SEE IF ANY OF MY
COLLEAGUES HAVE ANY OPENING
REMARKS THAT THEY WOULD LIKE TO
MAKE. OK? SO WE WILL GO AHEAD
AND BEGIN WITH OUR FIRST PANEL.
WHICH INCLUDES MICHELLE BASS,
THE DIRECTOR OF THE DEPARTMENT
OF HEALTH CARE SERVICES. RAPHAEL
DAVITIAN, DEPUTY DIRECTOR OF
HEALTH CARE FINANCING AT THE
DEPARTMENT OF HEALTH CARE
SERVICES, AND I DO APOLOGIZE IF
I SAID YOUR LAST NAME
INCORRECTLY. A Dð BOETTI, STAFF
FINANCE BUDGET ANALYST WITH THE
DEPARTMENT OF FINANCE AND JASON
CONSORS PRINCIPAL FISCAL AND
POLICY ANALYST WITH THE
LEGISLATIVE ANALYST OFFICE. WE
WILL HEAR FROM ALL OF THE
PANELISTS, AND THEN WE WILL TAKE
QUESTIONS FROM MEMBERS OF THE
SUB COMMITTEE DIRECTOR, BOSS,
PLEASE BEGIN. AFTERNOON CHAIR.
DEPARTMENT OF HEALTH CARE
SERVICES. THE GOVERNOR'S BUDGET
INCLUDES FOUR PROPOSALS RELATED
TO THE MANAGED CARE ORGANIZATION
TAX AND REALLY KIND OF TWO WAYS
TO THINK ABOUT IT. THE FIRST IS
REALLY GIVEN THE STATE UH,
BUDGET FISCAL SHORTFALL. THE
GOVERNOR'S BUDGET INCLUDES, UH
CHANGES TO THE M èC Ó TO USE
THESE DOLLAR TO SUSTAIN AND
MAINTAIN THE MEDICAL PROGRAM
AGAIN, GIVEN THE STATE'S FISCAL
SITUATION, AND THEN SECOND, THE
GOVERNOR'S BUDGET PROPOSES TO
MAINTAIN ITS COMMITMENT TO THE M
èC Ó TAX RELATED, UH RATE
INCREASES AS AGREED UPON IN LAST
YEAR'S BUDGET. WE KNOW THESE
RATE INCREASES WILL DRIVE
GREATER ACCESS, UH, TO PROVIDER
PARTICIPATION IN THE MEDICAL
PROGRAM. IN TERMS OF THE
PROPOSAL TO USE M èC Ó TO
SUSTAIN AND MAINTAIN THE MEDIC
HEALTH PROGRAM. THE BUDGET
PROPOSES FIRST TO AMEND THE M
èC Ó TAX THAT WAS APPROVED BY
THE FEDERAL GOVERNMENT IN
DECEMBER TO ACHIEVE AN
ADDITIONAL $1.5 BILLION IN TAX
REVENUE. M èC Ó TAX REVENUE
COMPARED TO THE APPROVED M èC
Ó TAX. UM AND THESE DOLLARS 1.5
BILLION. UM UH FROM 2024, 25 AND
26 TOTAL WILL BE USED TO SUPPORT
THE MEDICAL PROGRAM. WE ARE
SEEKING EARLY ACTION FROM THE
LEGISLATURE SO THAT WE CAN
SUBMIT THIS PROPOSAL TO èC M S¼
BY THE END OF MARCH SO THAT THE
TAX UH, CHANGE CAN BE EFFECTIVE.
THE BEGINNING OF THE QUARTER
JANUARY 1 2024 SO WE CAN ACHIEVE
A MAXIMUM NEW REVENUE. UH THIS
PROPOSAL, UH, MAINTAINS, UM, OUR
ABILITY TO MEET FEDERAL
REQUIREMENTS FOR PROVIDER FEES,
AND WE DO NOT THINK THAT THERE
ARE OPPORTUNITIES TO GO HIGHER
IN TERMS OF THE M èC Ó TAX.
THAT WAS ONE OF THE QUESTIONS IN
THE AGENDA. THERE ARE CERTAIN
RULES AND REQUIREMENTS THAT WE
MUST MEET TO GET APPROVAL FROM
THE FEDERAL GOVERNMENT. UM AND
BRINGING IN THIS ADDITIONAL 1.5
BILLION. UH, WE THINK IS THE
MAXIMUM AMOUNT THAT WE CAN DO
WITH THE AMENDMENT. ADDITIONALLY
WE ARE PROPOSING TO SHIFT ABOUT
THREE BILLION DOLLARS FROM THE
MEDICAL PROVIDER PAYMENT RESERVE
FUND TO THE GENERAL FUND ACROSS
THE CURRENT YEAR AND THE BUDGET
YEAR. AS PART OF THE 23 BUDGET
ACT. THESE FUNDS WERE GENERALLY
INTENDED TO BE USED TO SUPPORT
RATE INCREASES IN 2028 AND 2029.
HOWEVER GIVEN THE BUDGET
SHORTFALL AND TO NOT CUT THE
MEDICAL PROGRAM, THESE FUNDS
WILL BE USED IN THE CURRENT YEAR
AND BUDGET YEAR TO SUPPORT THE
EXISTING MEDICAL PROGRAM. UH,
DISCUSSIONS REGARDING THE
REVENUE SOURCE TO SUSTAIN BUDGET
YEAR PLUS THREE RATE INCREASES
WOULD NOW OCCUR A YEAR EARLIER.
SECOND IN TERMS OF THE
ADMINISTRATION'S PROPOSAL TO THE
M èC Ó TAX RELATED TARGETED
RATE INCREASES, AS AGREED UPON
IN LAST YEAR'S BUDGET AND IN
TRAILER BILL PHASE. ONE OF THESE
RATE INCREASES WERE EFFECTIVE
JANUARY 1 2024. WE BROUGHT A
PRIMARY CARE, MATERNITY CARE AND
NON SPECIALLY MENTAL HEALTH
SERVICES TO 87.5% OF MEDICARE.
UH, IN ADDITION, WE ELIMINATED
THE A B 97 PROVIDER PAYMENT
REDUCTIONS RELATED TO THOSE
SERVICES AND INCORPORATED
APPLICABLE PROPOSITION 50. SIX
SUPPLEMENTAL PAYMENTS INTO THE
BASE. ADDITIONALLY AS REQUIRED
BY LAW. THE GOVERNOR'S BUDGET
INCLUDES OUR PROPOSAL FOR THE
SECOND PHASE OF THESE RATE
INCREASES THAT BEGAN JANUARY 1
2025 ALL OF THE CATEGORIES AND
TERMS OF THESE RATE INCREASES
WERE INCLUDED AS PART OF LAST
YEAR'S TRADER BILL AND AS PART
OF THE AGREEMENT AS PART OF THE
2020 2023 BUDGET ACT. I'LL SPEAK
A LITTLE BIT IN TERMS OF THESE
CATEGORIES OF RATE INCREASES AND
PROVIDE A, UM SOME ADDITIONAL
DETAILS AS PART OF THIS SO
PROFESSIONAL SERVICES, SO THIS
IS FOR PRIMARY CARE, MATERNITY
CARE, NON SPECIAL BEHAVIORAL,
HEALTH AND SPECIALTY CARE
SERVICES. WE ARE PROPOSING TO
INCREASE SOME OF THOSE RATES TO
UP TO 100% OF MEDICARE AND ALL
THE WAY UP TO 80% OF MEDICARE.
SO 100% FOR PRIMARY CARE,
SPECIALLY OFFICE VISITS,
PREVENTIVE SERVICES AND CARE
MANAGEMENT, MATERNAL CARE
SERVICE, NON SPECIALLY MENTAL
HEALTH SERVICES VACCINE,
ADMINISTRATION VISION SERVICES
AND THEN 90% OF MEDICARE FOR E
Dð PHYSICIAN VISITS. 80% OF
MEDICARE FOR OTHER PROCEDURE
CODES COMMONLY USED BY PRIMARY
CARE SPECIALIST AND E Dð
PROVIDERS. WE ALSO PROPOSE TO
INCLUDE HEARING AIDS AND
AUDIOLOGY SERVICES WITHIN THIS
DOMAIN AND INCREASE THE BENEFIT
CAP ON HEARING AIDS. WE ALSO
PROPOSED AS PART OF THESE RATE
INCREASES TO ADOPT THE MEDICARE
LOCALITIES. THEY'RE 32
LOCALITIES AS PART OF THE
MEDICARE. UM UH, RATE STRUCTURE
TO SET ME RATES TO THE TARGET
PERCENT OF MEDICARE. UM,
APPLICABLE IN THAT LOCALITY.
THIS WILL IMPROVE THE ALIGNMENT
OF MEDI RATES TO LOCAL COST
DIFFERENCES. IN FUTURE YEARS.
THE DEPARTMENT PROPOSES TO MAINE
GEOGRAPHIC RATES IN RELATION TO
THE MEDICARE RATE, IN EFFECT FOR
THE LOCALITY. WE ALSO PROPOSE TO
USE 800 MILLION OF THE M èC Ó
TAX REVENUE OR THE PROVIDER
RESERVE FUND, UH, TO BE, UH,
USED TO DRAW DOWN ADDITIONAL
FEDERAL DOLLARS, SO 200 MILLION
TOTAL FOR EQUITY ADJUSTMENTS TO
THESE RATES. UH, WE WANT TO LOOK
, UM, KIND OF WITH AN EQUITY
INDEX TO LOOK AT HEALTH
PROFESSION SHORTAGE AREAS. LOOK
AT AREAS THAT ARE DESIGNATED,
UH, RURAL FRONTIER, URBAN HEALTH
DESERTS AND ALSO LOOK AT THE
HEALTHY PLACES INDEX. UH, QUARTS
, ONE AND TWO TO DEVELOP A
MECHANISM TO PRO, UH, PAY
PROVIDERS IN THESE AREAS,
ADDITIONAL BUMP WITH REGARD TO
ENSURING THAT THEY HAVE THE
RESOURCES TO PROVIDE FOR THE
MEDICAL COMMUNITY. IN TERMS OF
OUTPATIENT AND E Dð FACILITY
SERVICES WE ARE TARGETING, UM,
ANNUAL INVESTMENTS OF 245
MILLION FROM THE, UH, PROVIDER
PAYMENT RESERVE FUND FOR
COMMUNITY AND HOSPITAL.
OUTPATIENT UH, SERVICES. THIS
INCLUDES HOSPITALS AND
AMBULATORY SURGERIES, SURGICAL
CENTERS WE PROPOSE TO TRANSITION
THESE SERVICES. UM UH, FROM, UH,
TO AN OUTPATIENT PERSPECTIVE
PAYMENT SYSTEM, STARTING IN 2027
AND AS PART OF THE TRANSITION
FOR 2025 AND 2026 PROVIDE A 10.
RATE INCREASE FOR THESE
SERVICES. UH FOR, UH, ABORTION
SERVICES EFFECTIVE JANUARY. 1
2025. WE ARE PROPOSING
INVESTMENTS OF 90 MILLION, UM,
IN THE PROVIDER RESERVE FUND.
UH, 75 MILLION FOR BASE RATE
INCREASES AND 15 MILLION TO
CONTINUE THE ABORTION
SUPPLEMENTAL PAYMENT PROGRAM. WE
ARE PROPOSING TO INCREASE RATES
FOR ABORTIONS TO 1150, INCLUDING
FOLDING IN EXISTING PROPOSITION
56 SUPPLEMENTAL PAYMENTS. WE
PROPOSE TO VARY THESE RATES
BASED ON THE GEOGRAPHICAL
MEDICARE REGIONS, UM, AND TO
CONTINUE THE, UH, ABORTION
SUPPLEMENTAL PAYMENT PRO PROGRAM
, UH, THROUGH THE PERIOD OF THE
M èC Ó TAX. IN TERMS OF GRAND
GROUND EMERGENCY MEDICAL
TRANSPORTATION SERVICES. WE ARE,
UH, TARGETING INVESTMENTS OF 50
MILLION FROM THE M èC Ó. UH UH
M èC Ó, UH, MEDICAL PROVIDER
RESERVE FUND, UH, PROPOSING TO
INCREASE BASE RATES TO 50 TO 60%
OF MEDICARE. UM, AS PART OF
THIS, ELIMINATING THE A B 97
REDUCTION, UH AND, UH, IN FUTURE
YEARS TO MAINTAIN MEDICAL BASE
RATES IN RELATION TO THE
MEDICARE RATES AS WELL. WITH
REGARD TO OUR DESIGNATED PUBLIC
HOSPITALS. WE ARE TARGETING
INVESTMENTS OF 150 MILLION OF
THE RESERVE FUND, BRINGING IT TO
ABOUT THREE 170 75 MILLION TOTAL
FUND FOR, UH, DESIGNATED PUBLIC
HOSPITALS. WE ARE PROPOSING TO
TRANSITION FROM, UH, THE, UH,
COST BASED, CERTIFIED PUBLIC
EXPENDITURE APPROACH TO PAYING
OUR PUBLIC HOSPITALS TO A Dð RG,
OR DIAGNOSTIC RELATED GROUP
METHODOLOGY, SO MOVING FROM A
COST BASE TO A Dð G METHODOLOGY.
UM, WE ARE ALSO UH ADDITIONAL
PAYMENTS TO RECONCILE PUBLIC
HOSPITALS TO 100% OF COST IF
CERTAIN CONDITIONS ARE MET. I
MEAN, WE CONTINUE TO ENGAGE WITH
THE CALIFORNIA PUBLIC HOSPITAL.
UM UH, ON THIS PROPOSAL AND
THEIR CONCERNS RELATED TO THE
SETTLING OF COST RECONCILIATION,
HAVING GOOD DISCUSSIONS ON THAT.
IN TERMS OF OUR FEDERALLY
QUALIFIED HEALTH CENTERS AND
RURAL HEALTH CENTERS EFFECTIVE
JANUARY 1 2025. WE ARE TARGETING
INVESTMENTS OF 50 MILLION FROM
THE MEDIC, HEALTH PROVIDER
RESERVE FUND AND 100 MILLION
TOTAL, UH FOR SERVICES AND
SUPPORTS FOR OUR, UM FQ HÌ, èC
S¼ AND RURAL HEALTH CENTERS. WE
ARE ADDING THESE DOLLARS TO THE
EXISTING SUPPLEMENTAL PAYMENT
PROGRAM, UH, FOR NONHOSPITAL 340
B COMMUNITY CLINICS BUT
PROPOSING TO CHANGE IT TO A
DIRECT MANAGED CARE, UH, UH,
PROGRAM VERSUS A FEE FOR
SERVICE. IT'S KIND OF BASED
SUPPLEMENTAL PROGRAM, UH, FOR
EFFICIENCIES AND IN PARTNERSHIP
WITH OUR CLINICS, WHO ALSO, UM
ARE èC ARE LOOKING FOR THIS
KIND OF MORE EFFICIENT WAY TO
PAY FOR THESE SERVICES. AND THEN
FINALLY, JUST, UH, ONE OF THE
QUESTIONS IN THE AGENDA OF THE
REMAINING A B 97 REDUCTIONS. UH
THE 2025 TARGETED RATE INCREASES
ELIMINATES ALL OF THE A B 97
REDUCTIONS FOR PHYSICIANS AND
GROUND EMERGENCY MEDICAL
TRANSPORTATION. THE REMAINING A
B 97 REDUCTIONS ARE FOR CLINICAL
LABS. IT'S ABOUT 7 MILLION
GENERAL FUND ANNUALLY. PHARMACY
MEDICAL SUPPLIES ABOUT 7 MILLION
GENERAL FUND ANNUALLY AND THEN
MISS MISCELLANEOUS PROVIDER
TYPES AT ABOUT 1 MILLION
ANNUALLY. WILL NOW TURN IT OVER
TO MY COLLEAGUE, ARA, UH, DEPUTY
DIRECTOR RAFAEL DÂN TO, UH UH,
ANSWER SOME OF THE OTHER
QUESTIONS IN THE AGENDA. THANK
YOU, DIRECTOR BASSETT. THANK
YOU. THANK YOU. CHAIR AND
MEMBERS OF THE COMMITTEE. RAFAEL
DAFT, DEPUTY DIRECTOR FOR HEALTH
CARE FINANCING AT THE DEPARTMENT
OF HEALTH CARE SERVICES. UH,
I'LL TAKE A FEW MOMENTS JUST TO
ADDRESS SOME OF THE QUESTIONS
THAT THAT AROSE WITH RESPECT TO
THE EXISTING FQ HÌ èC
SUPPLEMENTAL PAYMENT PROGRAM AND
THE Dð P HÌ Dð RG PROPOSAL
WITHIN, UM WITHIN THE GOVERNOR'S
BUDGET. UH, SO WITH RESPECT TO
THE, UH, WITH RESPECT TO THE FQ
HÌ E SUPPLEMENTAL PAYMENT
PROGRAM, THE AGENDA HAD POSED A
QUESTION. I SUPPOSE THE QUESTION
REGARDING PAYMENT ISSUES PAYMENT
CHALLENGES THAT THE CURRENT
PROGRAM HAS EXPERIENCED AND
ESSENTIALLY ASKING HOW? HOW THE
CURRENT, UM HOW THE PROPOSED NEW
PROGRAM WOULD ADDRESS SOME OF
THOSE. SO UM THERE HAVE BEEN
SOME SOME PAYMENT CHALLENGES
PAYMENT DIFFICULTIES WITH WITH
THE EXISTING PROGRAM. IT IS A
FEE FOR SERVICE SUPPLEMENTAL
PAYMENT METHODOLOGY THAT IS
BASED ON THAT INCLUDES AN
INTERIM AND FINAL, UH, FINAL
PAYMENT COMPONENT OR FINAL
PAYMENT METHODOLOGY AS WELL AS
UH, ULTIMATELY IS A POOL BASED
METHODOLOGY SO THE METHODOLOGY
IS DESIGNED TO EXPAND A
PARTICULAR POOL AMOUNT. WHAT WE
ARE PROPOSING AS PART OF THE
GOVERNOR'S BUDGET TO TRANSITION
THAT PROGRAM TO A MANAGED CARE
DIRECTIVE PAYMENT PROGRAM, WHICH
WOULD ENTAIL ROLLING OVER THE
EXISTING VALUE OF THE CURRENT
FEE SERVICE SUPPLEMENTAL PAYMENT
PROGRAM, PLUS THE ADDING THE
ADDITIONAL $50 MILLION IN M èC
TAX FUNDED INVESTMENTS THAT
DIRECTOR BOSS INDICATED AND, UM.
ESTABLISHING A PROGRAM THAT
INCLUDES BOTH A UTILIZATION
BASED AND A UTILIZATION BASED
COMPONENT, AS WELL AS A
PERFORMANCE BASED PAYMENT
COMPONENT. THE ADDITIONAL
FLEXIBILITIES AND ADMINISTRATIVE
SIMPLIFICATION OF THE MANAGED
CARE PROGRAM WOULD ALLOW US TO,
UH, ALLOW THE DEPARTMENT TO
DIRECT MANAGED CARE PLANS TO
REIMBURSE FQ HÌ èC S¼ AND N R
HÌ èC S¼ FOR ELIGIBLE VISITS AS
THE SERVICES ARE PROVIDED, UH
AND THEN TO HAVE AN ADDITIONAL
RECONCILIATION TO, UH TO THE
TARGETED POOL AMOUNT AT THE END,
ESSENTIALLY A BALANCER THROUGH
THE PERFORMANCE BASED
METHODOLOGY. AND SO WE ARE
HOPING THAT THROUGH THAT
TRANSITION AND ANTICIPATING THAT
THROUGH THAT TRANSITION, WE BE
ABLE TO, UH ADDRESS SOME OF THE
PAYMENT CHALLENGES THAT HAVE
THAT WE HAVE SEEN WITH THE
CURRENT PROGRAM AS WELL AS
ACCELERATE THE FLOW OF PAYMENTS
THE FLOW OF CASH TO OUR FQ, HÌ
èC AND R HÌ èC PARTNERS WITH
RESPECT TO THE Dð P HÌ Dð RG
PROPOSAL. SHARING JUST A COUPLE
OF DETAILS. ONE ONE QUESTION ON
THE AGENDA WAS WHETHER WE
BELIEVE THAT THE PROPOSED Dð RG
INVESTMENTS OF 100 AND 50
MILLION ANNUALLY WILL BE
SUFFICIENT TO COVER, UH COVER
HOSPITALS EXISTING COSTS. SO WE
HAVE A MODEL. OF COURSE, WE HAVE
MODELED A RANGE A RANGE OF
DIFFERENT ESTIMATES, BUT AS
DIRECTOR BOSS INDICATED, REALLY
ARE INTENDING TO WORK CLOSELY
AND CONTINUE WORKING CLOSELY
WITH THE CALIFORNIA ASSOCIATION
OF PUBLIC HOSPITALS AND OUR
DESIGNATED PUBLIC HOSPITAL
PARTNERS TO FURTHER FURTHER TO
EVALUATE THE EXTENT TO WHICH
THESE INVESTMENTS WILL WILL BE
SUFFICIENT TO MEETING A PORTION
OF A PORTION OR THE ENTIRETY OF
DPH COSTS. THOSE MODELS ARE
REALLY THOSE MODELS AND ANA
ANALYSIS ARE HE DEPENDENT ON
ASSUMPTIONS RELATED TO UH,
ENROLLMENT AND UTILIZATION,
WHICH ARE CURRENTLY BEING
HEAVILY IMPACTED BY BOTH BY
RECENT COVERAGE EXPANSIONS AS
WELL AS UM, AS WELL AS BY THE
ONGOING REDE TERMINATIONS
FOLLOWING THE END OF THE PUBLIC
HEALTH EMERGENCY, AND SO WE ARE
EXPECTING THAT, UH, WE WILL HAVE
SIGNIFICANTLY MORE CLARITY ON ON
THOSE ENROLLMENT AND UTILIZATION
COMPONENTS IN THE COMING MONTHS.
UM AND THEN TO THE QUESTION
REGARDING THE IMPACT OF THE
PROPOSAL ON COST BASED
SUPPLEMENTAL PAYMENTS TO Dð P
S¼, UM. WE HAVE WE. THE MEDICAL
PROGRAM INCLUDES A NUMBER OF CO
COST BASED OR OTHER SUPPLEMENTAL
PAYMENT PROGRAMS FOR DESIGNATED
PUBLIC HOSPITALS. UH THIS THIS
PROPOSAL THIS Dð P HÌ Dð P Dð RG
PROPOSAL REALLY DOES NOT AFFECT,
UH, DOES NOT AFFECT THOSE EXCEPT
DOES NOT AFFECT THOSE EXCEPT FOR
THE, UH, THE EXISTING
REIMBURSEMENT METHODOLOGY THAT
IS IN PLACE FOR, UH FOR
INPATIENT SERVICES AND THE FEE
FOR SERVICE DELIVERY SYSTEM FOR
Dð P S¼ TODAY. UNDER THAT
METHODOLOGY, DPH HAS RECEIVE AN
INTERIM PER DIEM RATE, AND THEN
SUBSEQUENTLY RECONCILED TO 100%
OF COST. BUT THAT IS A èC PE
BASED METHODOLOGY WHERE THE
CERTIFIED PUBLIC EXPENDITURE
CONSTITUTES THE NONFEDERAL SHARE
. WHAT WE ARE PROPOSING IS TO
TRANSITION THAT INTERIM PAYMENT
FROM A PER DIEM TO A DRG
METHODOLOGY AND TO LEVERAGE, UH,
TO LEVERAGE. M èC Ó TAX FUNDS
TO LEVERAGE STATE FUNDS FOR THE
NONFEDERAL SHARE OF THAT PAYMENT
AND THEN, ADDITIONALLY IF
CERTAIN CONDITIONS ARE MET
RELATED TO SUFFICIENCY OF THAT
REIMBURSEMENT AND MEETING
MEETING PUBLIC HOSPITAL COSTS TO
EVENTUALLY SUNSET. THE SUNSET
THE COST BASED RECONCILIATION
METHODOLOGY FOLLOWING A PHASED
APPROACH THAT IS DESIGNED TO
ENSURE ENSURE THAT WE DO NOT
JEOPARDIZE Dð P HÌ FINANCES.
THANK YOU. UM DID YOU HAVE A
DEPARTMENT OF FINANCE? UH, NÓ
FURTHER COMMENTS AT THIS TIME,
BUT I'M HAPPY TO ANSWER
QUESTIONS AS THEY ARISE. UH,
GOOD AFTERNOON COMMITTEE, JASON
KANTOS WITH THE LEGISLATIVE
ANALYST'S OFFICE. YOU HAVE A LOT
OF ISSUES TO GRAPPLE WITH IN
YOUR AGENDA TODAY. IT MIGHT BE
HELPFUL JUST TO, UH, WORK FOR
SOME, UM, VISUAL GUIDES IN YOUR
AGENDA. SO IF YOU TURN TO PAGE
TWO OF YOUR AGENDA THAT
SUMMARIZES THE FOUR KEY
PROPOSALS ON ON TODAY'S AGENDA,
UM, FOR THE PURPOSES OF JUST,
UM, OF KEEPING THINGS, UM OF
SORT OF MEETING TIME CONSTRAINTS
, I'LL FOCUS MY COMMENTS ON, UH,
THE FIRST THREE PROPOSALS, WHICH
ARE THE MOST SIGNIFICANT, UH,
PROPOSALS ON TODAY'S AGENDA. UH,
BUT WE ARE. I AM AVAILABLE TO
ANSWER ANY QUESTIONS THAT COME
UP ON ANY PARTS OF THE AGENDA.
SO AGAIN, LOOKING AT PAGE TWO,
STARTING WITH THE FIRST PROPOSAL
. THE FIRST PROPOSAL, UH IS
AROUND INCREASING THE SIZE OF
THE M èC Ó TAX AND GENERATING
ADDITIONAL $1.5 BILLION UM, IF
YOU TURN TO PAGE THREE OF YOUR
AGENDA THERE IS A TABLE ON THE
TOP OF PAGE THREE THAT
SUMMARIZES THE M èC Ó TAX
RATES. IT SUMMARIZES THE TAX
RATES AS THEY WERE ENACTED IN
LAST YEAR'S PACKAGE. AND THEN
THE PROPOSED INCREASE IN THE TAX
RATES. UM, UNDER THE GOVERNOR'S
BUDGET. AND, YOU KNOW, GENERALLY
, OUR ASSESSMENT HERE IS THAT
THIS PROPOSAL IS A MERITS.
CONSIDERATION UH, THE M èC Ó
TAX IS A TAX THAT'S DESIGNED SO
THAT, UM UM MOST OF THE COST IS
COVERED BY THE MEDICAL PROGRAM
INSTEAD OF, UH BY PRIVATE
INSURANCE, AND IT COVERS THE
COST LARGELY BY DRAWING DRAWING
DOWN ADDITIONAL FEDERAL FUNDS.
UH, SO THIS IS A TAX INCREASE
THAT, UM HAS THE BENEFIT OF
DRAWING DOWN ADDITIONAL FEDERAL
FUNDING AND POSING A RELATIVELY
MINOR COST ON, UM TAXPAYERS IN
CALIFORNIA AND, UM, DOES NOT
COME WITH, UH, REDUCING CORE
ONGOING PROGRAMS, UH, IN THE
MEDICAL PROGRAM. SO GIVEN THOSE
THINGS, WE, WE THINK THIS
PROPOSAL WARRANTS CONSIDERATION
AND RECOMMEND ADOPTING IT. UH
THAT SAID, WE DO WANT TO NOTE
THAT UNDER STATE LAW, THE TAX
INCREASE IS CONDITIONED ON
RECEIVING FEDERAL APPROVAL. THE
ADMINISTRATION HAS SAID THAT THE
PROS INCREASE FITS WITHIN THESE
FEDERAL RULES. AND THAT'S VERY
PLAUSIBLE. THERE WAS ROOM WITHIN
LAST YEAR'S M èC Ó TAX PACKAGE
TO WITHIN THE FEDERAL LIMITS.
UH, BUT WE DO RECOMMEND THAT THE
ADMINISTRATION PROVIDE THE
LEGISLATURE AN UPDATED ANALYSIS,
UH, DEMONSTRATING THAT IT FITS
WITHIN THESE RULES PRIOR TO THE
LEGISLATURE, ENACTING IT.
TURNING TO US TO THE SECOND
PROPOSAL. THE SECOND PROPOSAL
INVOLVES THE PROPOSED SHIFT OUT
OF THE MEDICARE PROVIDER PAYMENT
RESERVE, UM, TO HELP PROVIDE
ADDITIONAL SUPPORT TO OFFSET
GENERAL FUND SPENDING AND MEDI
CAL. AND AGAIN IF YOU WANT A
BASIC ILLUSTRATION OF THIS
FIGURE, UH, ON ON THE SAME PAGE
THREE IN YOUR AGENDA ON THE
BOTTOM OF THAT PAGE, THERE IS A
TABLE THAT SUMMARIZES HOW THE M
èC Ó TAX FUNDS ARE USED, UM, U
UNDER LAST YEAR'S PACKAGE AND
THEN UH, AS PROPOSED BY THE
GOVERNOR'S BUDGET, AND IN THAT
TOP LINE, YOU CAN SEE THAT THE
ADMINISTRATION'S PROPOSING TO
REDUCE THE AMOUNT THAT GOES INTO
THE PROVIDER PAYMENT RESERVE
FROM AROUND 11 BILLION TO AROUND
8 BILLION THAT PROVIDES AN
ADDITIONAL $3 BILLION TO HELP
OFFSET GENERAL FUND SPENDING.
AND GENERALLY WE FIND THIS
PROPOSAL. UM, ALSO MERITS
CONSIDERATION AS THE
ADMINISTRATION STATED. THE, UM
INTENT HERE IS NOT TO AFFECT THE
ANNUAL COST OF THE PROPOSED
AUGMENTATIONS, BUT RATHER
ADVANCE THE TIMELINE TO WHEN THE
RESERVE IS DEPLETED. SO UM,
UNDER LAST YEAR'S PACKAGE, THAT
TIMELINE WAS ANTICIPATED TO BE
AROUND, UH, THE END OF 2029.
ANOTHER UNDER THE
ADMINISTRATION'S PROPOSAL, THE
ADMINISTRATION PROJECTS THAT
THAT WOULD ADVANCE IT TO AROUND
MID 2028 WHEN THE RESERVE IS
DEPLETED. NOW WHEN THE RESERVE
IS DEPLETED, THERE IS AN
ANTICIPATED SHORTFALL IN THE M
èC Ó TAX PACKAGE, SO TO
SUSTAIN THE AUGMENTATIONS ON AN
ONGOING BASIS, THE GENERAL FUND
WOULD HAVE TO ADD, YOU KNOW,
ADDRESS THAT SHORTFALL OR THE
LEGISLATURE WOULD HAVE TO
IDENTIFY ANOTHER REVENUE SOURCE.
AND WE THINK, GIVEN THE VERY
REAL BUDGET PROBLEM FACING THE
STATE IN THE NEAR TERM, WE THINK
THIS PROPOSAL MERITS
CONSIDERATION. THAT SAID, WE
ALSO THINK IT WOULD BE PRUDENT
FOR THE LEGISLATURE TO BEGIN
THINKING ABOUT THE LONG TERM
VIABILITY OF THE PACKAGE AND TO
START THINKING ABOUT THAT
SHORTFALL. THAT'S A POINT. I'M
ALSO GONNA RETURN TO WHEN I GET
TO THE THIRD PROPOSAL. I THINK
AND SPEAKING ABOUT THE THIRD
PROPOSAL, I'LL TURN TO THAT NOW.
SO THE THIRD PROPOSAL IS IT
INVOLVES THE PROPOSED PACKAGE OF
PROVIDER PAYMENT INCREASES IN ME
AGAIN. THIS IS A EXPANSIVE
PROPOSAL INVOLVES MANY DIFFERENT
AREAS OF ME IF YOU'RE LOOKING
FOR, UM, SOME VISUAL REFERENCES,
UH, PE THE PAGE SIX ON YOUR
AGENDA IS A REASONABLE STARTING
POINT. IT SHOWS THE DIFFERENT,
UH, ALLOCATIONS OF FUNDING TO
EACH AREA WITHIN ME. UM BUT
THERE ARE TWO KEY POINTS THAT WE
THINK ARE WORTH KEEPING IN MIND
HERE ABOUT THE PROPOSAL. THE
FIRST IS THAT THE ADMINISTRATION
NOT SIMPLY PROPOSING TO INCREASE
PROVIDER PAYMENTS, BUT ALSO
PROPOSING TO CHANGE THE WAY ME
PAYS PROVIDERS IN MANY WAYS, SO,
FOR EXAMPLE, UH, ADOPTING THE
APPROACH TAKEN IN MEDICARE FOR
PHYSICIAN SERVICES, OR ADOPTING
A NEW PROSPECTIVE PAYMENT SYSTEM
FOR HO FOR CERTAIN HOSPITAL
SERVICES. AND THE SECOND KEY
POINT TO KEEP IN MIND ABOUT THE
PROPOSAL THAT IT'S STILL BEING
DEVELOPED. UH, PARTS OF IT ARE
ARE SOMEWHAT CONCEPTUAL. FOR
EXAMPLE, THE ADMINISTRATION
PROPOSES TO ADOPT, UM, EQUITY
ADJUSTMENTS, UM, BUT HASN'T YET
FINALIZED. HOW THAT EQUITY
ADJUSTMENT EXACTLY WOULD LOOK
UM, ALSO, THE ADMINISTRATION
PROPOSES TO TRANSITION TO
PROSPECTIVE PAYMENT SYSTEMS. BUT
UH, BUT PROPOSES A FEW YEARS, UH
TO RESEARCH THAT AND DEVELOP IT
FURTHER BEFORE IT BECOMES
ONLINE. SO THIS IS AN AREA WHERE
THE LEGISLATURE IS UNDERSTANDING
OF THE PACKAGE IS GOING TO
CONTINUE TO EVOLVE IN THE COMING
MONTHS TO HELP GUIDE LEGISLATIVE
DECISION MAKING. WE OFFERED SOME
KEY POINTS FOR THE LEGISLATURE
TO KEEP IN MIND. THOSE KEY
POINTS ARE SUMMARIZED ON PAGES,
17 AND 18 OF YOUR AGENDA. AND
AGAIN. I KNOW YOU HAVE A LOT OF
GROUND TO COVER TODAY. SO RATHER
THAN GO THROUGH EVERY POINT I
WANNA TOUCH ON THREE KEY PARTS
OF THOSE POINTS. UH, THE FIRST
IS THAT, UM, YOU KNOW, THIS IS
AN AREA WHERE THE LEGISLATURE
HAS MANY OPPORTUNITIES TO
CONSIDER NEW WAYS TO EXPAND MEDI
CAL AND TO CONSIDER CHANGES IN
THE WAYS MEDICAL PAYS PROVIDERS,
SO WE THINK IT'S REASONABLE. THE
LEGISLATURE SERIOUSLY WEIGH ITS
OPTIONS AND WHERE IT SEES THE
HIGHEST NEEDS AND WHERE IT THESE
OPPORTUNITIES TO CHANGE PROVIDER
. UH, PAYMENT THE METHODOLOGY TO
PAY PROVIDERS. IN CASES WHERE
THE LEGISLATURE THINKS IT'S
WARRANTED TO CHANGE THE WAY
MEDIC PAYS. PROVIDERS RECOMMEND
ON FOCUS ON APPROACHES THAT
MAKES THE SYSTEM MORE RATIONAL
AS AN EXAMPLE OF MEDIC'S CURRENT
APPROACH FOR PAYING FOR
PHYSICIAN SERVICES IS SOMEWHAT
OUTDATED. IT'S BASED ON A SYSTEM
THAT GOES BACK TO THE 19 SIXTIES
AND, UM, SEVERAL RATES, UM OR
MANY RATES WITHIN THAT SYSTEM
HAVE NOT BEEN ADJUSTED FOR MANY
YEARS FOR THINGS LIKE INFLATION.
THE ADMINISTRATION IS PROPOSING
TO TIE THESE PAYMENTS TO THE WAY
MEDICARE PAYS PROVIDERS AND
MEDICARE IS MORE REGULARLY
ADJUSTED. IT DOES INCLUDE
INFLATIONARY ADJUSTMENTS OR TENS
TO YEAR OVER YEAR. SO ANNETTE.
THAT'S A PROPOSAL THAT THAT
COULD MAKE THE SYSTEM MORE
RATIONAL AND MORE RESPONSIVE TO
CHANGES IN THE ECONOMY AND IN IN
SERVICES. THAT SAID IN IN MANY
OTHER CASES, THE DETAILS REALLY
MATTER HERE. SO UM, FOR EXAMPLE,
UH, YOU KNOW, A PROSPECTIVE
PAYMENT SYSTEM FOR HOSPITAL
SERVICES THAT THAT COULD PROVIDE
A BETTER BASIS FOR PAYING FOR
SERVICES. BUT THE DETAILS MATTER
TO ENSURE THAT THAT SYSTEM
PROVIDES THE RIGHT KINDS OF
INCENTIVES. SIMILARLY THE
ADMINISTRATION SPOKE ABOUT A
PROPOSAL TO INCREASE
SUPPLEMENTAL OR TO PROVIDE AN
ADDITIONAL SUPPLEMENTAL PAYMENT
IN THE MANAGED CARE SYSTEM FOR
CLINICS. THAT'S ANOTHER SYSTEM
THAT COULD HAVE MERIT. IT JUST
DEPENDS EXACTLY ON HOW THE HOW
THE PAYMENTS WOULD BE ALLOCATED.
AND ALSO EMPHASIZE THAT THE
ADMINISTRATION INDICATES THAT
THERE WILL BE PROPOSED TRAILER
BILL LEGISLATION TO EFFECTUATE
MANY OF THESE CHANGES. BUT THAT
HASN'T BEEN RELEASED, EITHER. SO
THESE SOME OF THESE DETAILS
COULD BE ANSWERED IN THE COMING
MONTHS. ONCE WE GET MORE, UH,
TRAILER BILL LEGISLATION THE
SECOND POINT I WANT TO EMPHASIZE
IS THAT UM, IMPLEMENTATION AND
LEGISLATIVE OVERSIGHT ARE ARE
KEY ISSUES HERE, SO THE
ADMINISTRATION IS PROPOSING MANY
DIFFERENT CHANGES IN THE MEDICAL
PROGRAM AND GIVEN ITS EXPANSIVE
NATURE THERE, THERE COULD BE
RISKS ASSOCIATED WITH
IMPLEMENTATION THAT COULD RESULT
IN DELAYS OR DELAYS IN WHEN
PROVIDERS RECEIVE PAYMENTS. I
WILL SAY THAT WHEN WE WROTE OUR
ANALYSIS, WE REACHED OUT TO MANY
STAKEHOLDERS AND MANY
STAKEHOLDERS AT THE TIME COULD
PROVIDE US VERY LIMITED
INFORMATION BECAUSE THE, UH,
PROPOSAL HAD ONLY BEEN RECENTLY
RELEASED. SO THIS IS AN AREA
WHERE THE LEGISLATURE IS
UNDERSTANDING WILL ALSO CONTINUE
TO EVOLVE. SO WE RECOMMEND THE
LEGISLATURE WORK WITH THE
DEPARTMENT WORK WITH
STAKEHOLDERS TO UNDERSTAND THE
POTENTIAL IMPLE IMPLEMENTATION
ISSUES AND CHALLENGES. IF THE
LEGISLATURE FINDS UH UH, ISSUES
WITH THE INTENDED TIMELINE, IT
HAS OPTIONS. IT COULD FOR
EXAMPLE, UH, YOU KNOW A STRETCH
OUT THE PERIOD OF PHASE IN THE
PERIOD IN WHICH CHANGES HAPPEN
OVER OVER MORE YEARS AND ALLOW
FOR MORE TIME FOR, UM PROVIDERS
AND MANAGED CARE PLANS IN THE
DEPARTMENT TO EFFECTUATE THESE
CHANGES. WE ALSO THINK THAT, UH,
ADDITIONAL REPORTING IN THE
PROPOSAL WILL BE WARRANTED TO
BETTER TRACK THE IMPLEMENTATION
AND THE IMPACT OF THE OF THE
PAYMENT, SO WE RECOMMEND SOME
REPORTING LANGUAGE AS WELL. AND
THEN FINALLY, I WANT TO RETURN
TO MY POINT ABOUT THE LONG TERM
FINANCIAL SUSTAINABILITY OF THE
M èC Ó TAX PACKAGE. NOW THE
ADMINISTRATION ANTICIPATES THERE
TO BE A SHORTFALL IN THE M èC
Ó TAX PACKAGE, AND THAT
SHORTFALL IS THE RESULT OF THE
OF THE NEXT M èC Ó TAX,
POTENTIALLY BEING SMALLER THAN
THIS ONE. AND SO BECAUSE IT
COULD BE SMALLER THAN THIS ONE
THAT THAT WOULD MEAN THAT
EXISTING FUNDING IN THE M èC Ó
TAX WOULD, UH, NOT BE ENOUGH TO
COVER THE FULL COST OF THE
AUGMENTATIONS. THIS IS NOT A
CERTAIN OUTCOME, BUT IT'S
THERE'S POTENTIAL. THE FEDERAL
GOVERNMENT HAS PUBLICLY SAID
THAT IT INTENDS TO CHANGE RULES
AROUND ADOPTING TAXES LIKE THE M
èC Ó TAX, AND DEPENDING ON
THOSE RULE CHANGES, THOSE COULD
IMPACT THE SIZE OF THE FUTURE. M
èC Ó TAX NOW, UM, YOU KNOW,
ABSENT FINDING ANOTHER REVENUE
SOURCE THAT WOULD FALL ON THE
GENERAL FUND TO BACKFILL ANY
SHORTFALL IN THE PACKAGE.
HOWEVER AS WE'VE NOTED IN OTHER
PUBLICATIONS, THE GOVERNOR'S
BUDGET AND OUR OFFICE AS WELL
PROJECT THERE TO BE A DEFICITS
IN THE OUT YEARS AND TYPICALLY
WHEN THERE ARE DEFICITS. THE
GENERAL FUND, UH, DOESN'T HAVE
MUCH CAPACITY TO ABSORB NEW
COSTS. WERE THAT TO HAPPEN, THE
LEGISLATURE COULD FACE PRESSURE
TO UNDO SOME OF THE SOME OF THE
CHANGES IN THE PACKAGE, AND THAT
COULD BE VERY DISRUPTIVE,
PARTICULARLY TO PROVIDERS AND
MANAGED CARE PLANS THAT HAD
SPENT THE NEXT FEW YEARS YOU
KNOW, ADJUSTING TO THE NEW
PAYMENT SYSTEM. TO RECOMMEND THE
LEGISLATURE IF IT IF IT IS
SERIOUSLY CONSIDERING DOING
ONGOING AUGMENTATIONS AND
PERMANENT CHANGES IN THE WAY
MEDIC PAYS PROVIDERS WE
RECOMMENDED ADOPT A BUDGET
PACKAGE THAT ANTICIPATES THAT
THAT ANTICIPATES THEIR NEXT M
èC Ó TAX TO BE SMALLER AND TO
AND TO BETTER BUILD CAPACITY IN
THE GENERAL FUND TO ABSORB ANY
SHORTFALLS IN THE FUTURE. AND
THERE ARE MANY OTHER COMPONENTS
OF THE PROPOSAL ARE AVAILABLE TO
ANSWER QUESTIONS AS NEEDED.
THANK YOU. THANK YOU. DO EITHER
OF MY COLLEAGUES HAVE ANY
QUESTIONS? MEMBER, PATTERSON.
DIRECTOR BASS. I WANT, UH, CALL
YOUR ATTENTION TO THE PEDIATRIC
DAY HEALTHCARE. PROVIDERS. AND
UH, THESE ARE MEDICALLY FRAGILE
KIDS. THEIR DEVELOPMENTALLY.
DISABLED. I HAVE. SUCH A
PROVIDER IN FRESNO. LORETTA'S
LITTLE MIRACLES. UM. MY
UNDERSTANDING IS THAT THE P Dð
HÌ èC PROVIDERS ARE NOT
INCLUDED IN THE M èC Ó TAX AND
APPARENTLY WILL NOT BE RECEIVING
TARGETED RATE INCREASES. IS THAT
CORRECT? YES, THAT IS CORRECT.
THEY WERE NOT PART OF THE
TRAILER BILL LANGUAGE LAST YEAR
TO THE UH, TRADER BILL LANGUAGE
LAST YEAR, A B 119 THAT WAS
PASSED BY THE LEGISLATURE AS
PART OF LAST YEAR'S BUDGET ACT
THAT GOVERN THE PROPOSALS AND
KIND OF THE CATEGORIES OF
SPENDING FOR THE TARGETED RATE
INCREASES. SO OUR PROPOSAL THIS
YEAR IS PART OF GOVERNOR'S
BUDGET IS REALLY, UH, FOLLOWS
WHAT WE WERE REQUIRED TO SUBMIT
TO THE LEGISLATURE AS PART OF
GOVERNOR'S BUDGET AND THE
CATEGORIES OF RATE INCREASES, DO
YOU UNDERSTAND THAT THESE.
PEDIATRIC DAY CARE HEALTH
FACILITIES ARE RIGHT ON THE EDGE
OF CLOSING. DO YOU REALIZE HOW
SERIOUS NOT BEING INCLUDED IN
THIS IS AND HE REALIZED HOW
SERIOUS IT IS FOR THESE
MEDICALLY FRAGILE KIDS. WHAT
WOULD IT TAKE? TO GET P Dð HÌ E.
IN THE M èC Ó. IT'S NOT PART
OF THE ADMINISTRATION'S PROPOSAL
, AND THIS IS KIND OF THIS IS
THE GOVERNOR'S BUDGET PROPOSAL
RELATED TO THE MANAGED CARE
ORGANIZATION. TAX TARGETED RATE
INCREASES IS THEIR PROPOSAL. UM
AND I, YOU KNOW, I KNOW THERE'S
LOTS OF DELIBERATION THAT
HAPPENS THROUGH THE BUDGET
PROCESS. AND SO I WOULD LEAVE IT
AT KIND OF THIS IS OUR PROPOSAL
AT THIS TIME. WELL, I JUST WANT
YOU TO KNOW THAT, UH. AND I HAVE
CLOSE PERSONAL RELATIONSHIPS AND
FRIENDSHIPS WITH PARENTS AND
WITH THOSE LITTLE KIDS AND THE
RED IS LITTLE MIRACLES. IT IS
BEYOND UNCONSCIONABLE TO ME.
THAT WE WOULD LET THESE PLACE
CLOSE THESE PLACES CLOSE THEY
ARE THE LIFELINE. TO PARENTS.
WHO CAN STILL WORK. STILL GET
WONDERFUL CARE. AND I HAVE BEEN
AT IN THOSE PLACES I'VE HELD
THOSE CHILDREN. AND I CAN TELL
YOU THAT THE PARENTS AND THE AND
IT'S NOT JUST THE ONE IN FRESNO.
THESE ARE UP AND DOWN THE STATE
OF CALIFORNIA. UM SO I'M GONNA
JUST MAKE THIS VERY CLEAR UNDER
NÓ CIRCUMSTANCES WILL I SUPPORT
YOUR PLAN? ON THE FLOOR FOR THE
TAX INCREASE IF IT DOES NOT
INCLUDE SOME HELP FOR THESE P Dð
HÌ èC S¼. I KNOW YOU NEED TWO
THIRDS BUT I WILL NOT VOTE FOR
IT. TO LEAVE THESE KIDS OUT. IS
UNCONSCIONABLE. NOW, I I'M
WILLING TO WORK WITH YOU. I'M
WILLING TO FIGURE OUT WAYS. BUT
IF THIS THING COMES TO THE FLOOR
AND THEY'RE NOT IN IT I WILL NOT
VOTE FOR UNDER ANY
CIRCUMSTANCES. THANK YOU. IT CAN
REMEMBER B. THANK YOU CHAIR. UH,
SO FIRST I WANT TO THANK YOU ALL
FOR I THINK COMING FORWARD WITH
A VERY CREATIVE SOLUTION TO BE
ABLE TO ADDRESS THE EXTENSIVE
NEED THAT WE HAVE. UM I KNOW
THAT THERE HAS BEEN A LOT OF
WORK PUT INTO THIS, AND I WANNA
APPRECIATE YOU ALL MEETING WITH
ME PREVIOUSLY, AND, UH,
ANSWERING A LOT OF MY QUESTIONS
BEFORE I DID WANNA HIGHLIGHT,
UH, THE CONCERN. I THINK THAT
WAS RAISED BY L A Ó AROUND THE
ESSENTIALLY KIND OF PUSHING
FORWARD. UM THE DEPLETION OF THE
RESERVE. UH, BY 20. 8 2029 ALSO
COMPOUNDED BY THE FACT THAT THE
FEDERAL GOVERNMENT HAS ALREADY
INDICATED TO US THAT THE M èC
Ó TAX WILL BE SMALLER, UM
MOVING FORWARD. THAT SOUNDS TO
ME LIKE WE ARE, UH, DEFERRING A
SIGNIFICANT CHALLENGE AND KIND
OF A STRUCTURAL REVENUE
CHALLENGE, UH, THAT WE NEED TO
ADDRESS SO ANY INSIGHTS THAT
EITHER ELIO OR DO F OR THE
DEPARTMENT HAS AROUND HOW YOU
MIGHT BE ABLE TO DRESS UP SO I
WILL SAY THE FEDERAL GOVERNMENT
TO MAKE THIS CHANGE SO THAT WE
HAVE TO HAVE A SMALLER M èC
THAT WOULD REQUIRE FEDERAL
REGULATION CHANGES. AND SO IT
WOULD NOT BE A KIND OF AN
IMMEDIATE, UM, CHANGE BECAUSE
THEY WOULD HAVE TO CHANGE THE
REGULATIONS. UM, FOR TO NOT BE
ABLE TO KIND OF DO A SIMILAR M
èC Ó IN IN 2027, SO I THINK WE
HAVE SOME TIME TO KIND OF IF THE
FEDS DO PROPOSE THIS. THEY'VE
BEEN SAYING THIS FOR YEARS NOW
THAT THEY WANT TO CLOSE THE
LOOPHOLE WITH REGARD TO THE WAY
THE TAX STRUCTURE WORKS. UM AND
SO I THINK AT THIS POINT, UM, WE
KNOW IF THEY DO MAKE THE CHANGE,
WE WILL HAVE IT PROBABLY TWO
YEARS OR SO, AT LEAST TO KIND OF
UNDERSTAND THAT CHANGE BEFORE
THE FEDERAL RULE TAKES EFFECT,
BUT IT IS IT IS NOT A GUARANTEE
BECAUSE THEY THEY DO NEED TO
MAKE A CHANGE. YEAH. JUST ALSO
WANTED TO EMPHASIZE A COUPLE
BUILD UPON SOME OF THE POINTS
THAT WERE MADE BY THE
ADMINISTRATION THERE. UH, THE
FIRST IS THAT, UM, YOU KNOW,
THIS IS A THIS IS AN AREA THAT
DOESN'T MAKE IT CHALLENGING FOR
BUDGET PLANNING PURPOSES THAT
YOU KNOW THE FUTURE IS UNCERTAIN
IT IT DEPENDS ON THE FEDERAL
GOVERNMENT PUTTING FORTH
REGULATIONS AND THEN ENACTING
THEM AND THEN AND THEN THE
REGULATIONS THAT YOU KNOW THE
IMPACT OF THE M èC Ó TAX ARE
VERY DEPENDENT ON WHAT THOSE
REGULATIONS COULD BE. SO THERE'S
A LOT OF AREAS OF UNCERTAINTY
HERE. UM, BUT THE MOST OF YOU
KNOW, GENERALLY THE, UH, THE YOU
KNOW, THE AS WE SEE AT THE MOST
FUNDAMENTAL WAY THE LEGISLATURE
CAN ENSURE BUDGET CAPACITY IS
REALLY PART OF ITS OVERALL
BUDGET DELIBERATIONS AND SORT OF
ENSURING THAT THERE THAT SORT OF
IT HAS AN OUT YOUR PLAN TO, YOU
KNOW, TO THE EXTENT THAT THERE
IS A SMALLER TAX TO BACKFILL THE
IT. SURE THERE'S CAPACITY TO
BACKFILL THAT, UM, THAT, UM OF
ALL. THANK YOU. I WANT TO MOVE
ON A BIT TO THE RATE METHODOLOGY
, SO I APPRECIATE THAT. Dð Dð HÌ
èC S¼ IS PROPOSING, UH, NOT
JUST THE RATE INCREASE, BUT THE
METHODOLOGY AROUND THAT, UH,
JUST TO KIND OF BRING IT BACK TO
REAL TIME. UM UH, I HAPPEN TO
HAVE A LOT OF FQ HÌ èC IS IN MY
DISTRICT I VISITED WITH THEM FOR
YEARS. ONE OF THE CRITICAL
CONCERNS THAT THEY HAVE IS THE
METHODOLOGY ASSOCIATED WITH
THEIR PAYMENT. THIS IS SOMETHING
THAT WE HEAR. NOT ONLY FROM, UH
THE FQ HÌ èC S¼ PROVIDERS. IT'S
A VERY, VERY, UH, ANYONE WHO'S
DEALING WITH KELLY IS A VERY,
VERY COMPLICATED SYSTEM WHERE
THEY DON'T HAVE THE ABILITY TO
ACTUALLY WITH VERY NARROW
MARGINS. UH, KIND OF FRONT. THE,
UH STATE IN TERMS OF PAYMENT.
SO, UH, TO THE DEPARTMENT. HAVE
YOU? UH, WHY HAVE YOU CHOSEN TO
RESTRUCTURE THE MEDICAL? UM THE
WAY MEDICAL PAYS CERTAIN
PROVIDERS ARE THESE PROPOSED
CHANGES INFORMED BY STAKEHOLDER
INPUT, AND IF NOT, UH, KIND OF
MORE ROBUSTLY. HOW WILL THAT
HAPPEN? AND HOW WILL THESE
CHANGES BENEFIT THE PROGRAM SO
WITH REGARD TO THE PROPOSAL
RELATED TO OUR FQ, HÌ, èC S¼
AND RURAL HEALTH CENTERS, WE
WORKED VERY CLOSELY WITH THE
PROVIDERS ON THAT PIECE OF IT,
SO WE ARE PROPOSING TO AUGMENT
PROGRAM AND REALLY KIND OF KEEP
THE PROGRAM AS IT IS, BUT
AUGMENT IT AND PAY FOR IT A
LITTLE BIT MORE EFFICIENTLY
THROUGH A DIRECTED PAYMENT
VERSUS A FEE FOR SERVICE
UTILIZATION. IT WAS REALLY AS A
MECHANISM BY HOW WE KIND OF PAY
FOR IT. IT'S THE CURRENT PROCESS
IS PRETTY MANUAL AND BY DOING IT
VIA THE MANAGED CARE DIRECTED IT
BECOMES A LITTLE BIT MORE
AUTOMATED BUT REALLY MAINTAINING
THE EXISTING PROGRAM AND ADDING
ADDITIONAL DOLLARS TO IT. SO
IT'S REALLY NOT A CHANGE TO HOW
THEY GET THIS PIECE OF THIS
PROGRAM'S FUNDS. UM, BUT IT'S AN
AUGMENTATION. I THINK WHAT I'VE
HEARD IS THAT THERE NEEDS TO BE
A CHANGE TO IT. SO I'M HOPING
THAT WE CAN, UH, WORK TO. I
THINK THE CHANGE THEY WANT IS TO
TURN IT INTO A DIRECTED PAYMENT,
WHICH WE ARE PROPOSING TO DO.
MHM THANK YOU. I WANNA ADDRESS
THE EQUITY PAYMENTS. UM, VERY I
UH, INTRIGUED AND EXCITED ABOUT
THIS IDEA OF ENSURING THAT WE
HAVE, UM, A WAY TO BE ABLE TO
SUPPORT. UH, DIFFERENT
PHYSICIANS AND NON PHYSICIANS.
UM, THROUGH THIS, UH, DIFFERENT
PROFESSIONAL SERVICE CODE. UM. I
AM CURIOUS, THOUGH, ABOUT HOW WE
WILL MEASURE THE OVERALL
OUTCOMES ASSOCIATED WITH THESE
PROPOSED EQUITY PAYMENTS. AND
WHAT THE SPECIFIC METRICS WE
WILL USE TO DEMONSTRATE THAT
THESE PAYMENTS HAVE THE INTENDED
OUTCOME THAT WE THAT WE HOPE,
UH, AND ALSO IS THE FORMULA
INTENDED TO CLOSE RACIAL
DISPARITIES, UH, IN ACCESS TO
CARE. IT. I CAN TAKE THIS ONE.
SO TO YOUR, UH, TO YOUR FIRST
QUESTION WITH RESPECT TO, UH,
WITH RESPECT TO MEASUREMENT, I
THINK THAT'S THAT'S AN THAT'S AN
AREA AS PART OF BROADER
CONVERSATIONS WITH, UH, WITH OUR
STAKEHOLDER PARTNERS REGARDING
EQUITY. THAT IS AN AREA THAT WE
UH, WE WOULD LOOK TO HAVE
FURTHER CONVERSATIONS ABOUT ONE
OF THE ONE OF THE CHALLENGES
THAT, UM ONE OF THE CHALLENGES
THAT WE NEED TO ADDRESS WHEN IT
COMES TO, UH, TO EVALUATION IS
REALLY ATTEMPTING TO DISENTANGLE
THE IMPACT OF 11 PARTICULAR
COMPONENT OF THIS PROPOSAL,
VERSUS VERSUS OTHERS, AS WELL AS
MORE BROADLY JUST DISENTANGLE
THE IMPACT FROM A LARGER CHANGES
EITHER IN THE MEDICAL PROGRAM,
FOR EXAMPLE, OUR CAL, UH, THE
IMPLEMENTED THE TRANSFORMATION
THAT BROUGHT ABOUT AND CONTINUES
TO BRING ABOUT, UH, AS WELL AS
OTHER OTHER INITIATIVES WITHIN
ME, AND THEN BROADER, BROADER
CHANGES IN THE HEALTH CARE AND
THE HEALTH CARE SPACE. UM, BUT
IT IS. IT IS SOMETHING THAT IT
IS SOMETHING THAT WE HAVE HEARD
HEARD FEEDBACK ON AND WHAT WOULD
IT LOOK TO CONTINUE TO EXPLORE
AND DISCUSS WITH OUR WITH OUR
STAKEHOLDER PARTNERS IN TERMS OF
THE MECHANISM FOR THE EQUITY
ADJUSTMENT AND WHETHER, UM,
WHETHER THAT WOULD WOULD LOOK TO
CAPTURE FOR EXAMPLE, RACIAL
DISPARITIES. WE ARE ENVISIONING
ENVISIONING AN EQUITY ADJUSTMENT
THAT LEVERAGES A MULTITUDE OF
DATA SOURCES TO ESSENTIALLY
DEVELOP A DEVELOP A COMPOSITE
INDEX. UM THOSE DATA SOURCES
WOULD LOOK AT A VARIETY OF
FACTORS SUCH AS, UM HEALTHCARE
HEALTHCARE WORKER SHORTAGE
SHORTAGES WITHIN A PARTICULAR
GEOGRAPHIC AREA DESIGNATION OR,
YOU KNOW, URBAN VERSUS RURAL
VERSUS FRONTIER DESIGNATIONS.
UH, BUT ALSO BROADER MEASURES OF
SOCIAL DRIVERS OF HEALTH, SUCH
AS SUCH AS THE HEALTHY PLACES
INDEX, WHICH WE WHICH WE HAVE
LOOKED AT. CLOSELY AND OUR AND
OUR AND, UH, HIGHLIGHTED AS ONE
POTENTIAL OPTION WITHIN, UH,
WITHIN OUR OUR POLICY PAPER TO
REALLY BE ABLE TO BRING TOGETHER
MULTIPLE, UM, MULTIPLE, MULTIPLE
SOURCES OF DATA THAT GET AT GET
AT THE ISSUE OF EQUITY AND HELP
IDENTIFY THOSE AREAS OF THE
STATE STATE OR THOSE PARTS OF
THE STATE THAT HAVE THE LARGEST,
UH, EQUITY EQUITY NEEDS IN TERMS
OF, UH, IN TERMS OF HEALTH.
LOOKING FORWARD TO THAT, AND I
KNOW THAT OUR CHAIR HAS BEEN
LEADING THE LEGISLATURE, UH, FOR
A VERY LONG TIME, PARTICULARLY
AROUND THE SOCIAL DRIVERS OF
HEALTH INDEX, AND SO I'M
THANKFUL THAT THAT WILL BE
CONSIDERED. AND, UM AND I'M SURE
TIMING WILL DICTATE A LOT OF A
LOT OF THIS. UH, I HAVE, UH,
JUST ONE OTHER QUESTION. AND
THEN I'LL MOVE TO THE CHAIR AND
MAYBE AN, UH UH, ANSWER SOME
AFTER. UH IF THINGS DON'T COME
UP, UH, I'M A PARTICULARLY
INTERESTED IN THE DISTRESSED
ROLL LOAN PROGRAM. SO UH, WE
KNOW THAT WE ALLOCATED 200
MILLION ACROSS THE DISTRESSED
HOSPITAL LOAN PROGRAM AND THE
SMALL AND RURAL HOSPITALS, UH,
FOR SEISMIC RELIEF IN ASSOCIATED
WITH THE M èC Ó TAX. UH, IT
WAS ONE TIME FUNDS FOR SURE. UM
MY UNDERSTANDING IS THAT THE
THAT THOSE TWO PROGRAMS HAVE
BEEN FULLY EXPENDED AND, UH AND
WE HAVE SEVERAL HOSPITALS THAT
DIDN'T NECESSARILY RECEIVE A
LOAN PROGRAM THAT FULLY MEETS
THE NEED THAT THEY HAVE, OR, UM,
AND WE HAVE A SET OF HOSPITALS
THAT EITHER DID NOT QUALIFY OR
DID NOT RECEIVE FUNDING FROM THE
FIRST TRANCHE OF FUNDING. UH, MY
MAIN CONCERN IS THAT I'VE TALKED
TO, UH, SOME LEGISLATORS, UH AND
, UH, AND WRITERS WERE
ESSENTIALLY THERE COULD BE A
SITUATION WHERE WE HAVE, UM
PEOPLE TRAVELING UP TO TWO HOURS
. UH, FOR HOSPITAL CARE SHOULD
THERE, UM, SHOULD THEIR
PARTICULAR HOSPITAL CLOSE FOR
HAVING NOT RECEIVED ANY FUNDING
RELATED TO THE JUST HOSPITAL
LOAN PROGRAM. UM, I'M
PARTICULARLY CONCERNED ABOUT IT,
AS RELATES TO MATERNITY WARDS.
UH, AND THE LACK OF ACCESS TO BE
ABLE TO, UH, HAVE THAT
AVAILABLE. SO, UM JUST WANT TO
PUT ON THE TABLE FOR YOUR
CONSIDERATION THAT WE HAVE A
BROADER CONVERSATION AROUND THE
DISTRESSED HOSPITAL LOAN PROGRAM
. AS WE PRIORITIZE THE
EXPENDITURES, AND IF THERE'S ANY
COMMENT THAT YOU CAN MAKE RIGHT
NOW ABOUT, UH, ABOUT THAT IT
WOULD BE HELPFUL. HAVE OUR
COLLEAGUE FROM THE DEPARTMENT OF
HEALTH CARE, ACCESS AND
INFORMATION WHO RUNS THE
DISTRESS HOSPITAL LOAN PROGRAM.
ALL RIGHT. GOOD AFTERNOON. SCOTT
CHRISTMAN, CHIEF DEPUTY DIRECTOR
OF DEPARTMENT OF HEALTH CARE,
ACCESS AND INFORMATION. IF HELP
BY JUST WAS GOING TO GIVE A
QUICK UPDATE, UH, AND WITH WITH
DETAILS, SO, UM IN ALL, WE
RECEIVE 30 APPLICATIONS AND 17
HOSPITALS WERE PROVIDED WITH
LOAN AWARDS. THIS WAS THIS WAS
LAST YEAR. SO AS OF TODAY, 13 OF
THE 16 HOSPITALS, UH, HAVE
COMPLETED THE LOAN TRANSACTION
DOCUMENTS WITH OUR PARTNERS, UH
AND DISBURSEMENTS HAVE BEEN MADE
TOTALING 222.4 MILLION. SO
WHAT'S REMAINING? UH UH,
SPECIFICALLY, THREE LOANS AND A
TOTAL AMOUNT OF 70.1 MILLION.
UH, ONE TRANSACTION WITH SONOMA
VALLEY, UH, SHOULD BE CLOSED IN
THE NEXT FEW WEEKS. IN THE TWO
REMAINING TRANSACTIONS, ONE FOR
HAZEL HAWKINS MEMORIAL HOSPITAL
AND ONE FOR MADEA COMMUNITY
HOSPITAL. BOTH OF THOSE
HOSPITALS ARE IN BANKRUPTCY, SO
THERE'S AN ADDITIONAL SORT OF
SET OF PROCESSES TO GET THROUGH
THE BANKRUPTCY COURT TAKING MORE
TIME. UM BUT BEYOND THAT, YES.
THE PROGRAM WAS SORT OF FULLY
SUBSCRIBED AND THAT HAS BEEN THE
OUTCOME. AGAIN AS WE KNOW MADEA
COMMUNITY HOSPITAL REMAINS
CLOSED. WE'RE WORKING WITH THEM
RIGHT NOW. EVALUATING THEIR
FINANCIAL TURNAROUND PLAN, UH,
AND WORKING TOGETHER ON A
REOPENING PLAN THERE. SO THAT'S
UH YOU KNOW, ESSENTIALLY THE
STATUS OF THE PROGRAM. AS OF
TODAY. IS THERE A PARTICULAR
ANSWER OR PARTICULAR QUESTION? I
COULD ADDRESS FOR HOSPITAL AND
THERE'S ANOTHER HOSPITAL IN
THERE. UH, OK? IN UH, IN THE
REPORT, THERE WAS A BRIDGE LOAN
PROVIDED TO MADEIRA HOSPITAL TO
BE ABLE TO KIND OF SUPPORT. THE
UM THE LOAN PROGRAM. UM UH, I'M
SURE THAT THAT WILL BE AN
ONGOING EFFORT. UH, I JUST WANNA
BE SURE THAT WE DON'T HAVE A
SITUATION WHERE WE HAVE
HOSPITALS, UH, IN THE MIX THAT
ARE RURAL, UH, IN PARTICULAR, OR
THAT ARE SORT OF A CRITICAL
COMMUNITY. UH, NEED WHERE WE
HAVE A SITUATION WHERE WE HAVE
AN OVERSUBSCRIBED. FULLY SPENT
OUT. DISTRESSED HOSPITAL LOAN
PROGRAM. FUND AND NÓ WAY TO BE
ABLE TO ADDRESS. UH, THE A
CONCERN AROUND LACK OF ACCESS TO
CARE. WE CANNOT IN THE STATE OF
CALIFORNIA HAVE PEOPLE TRAVELING
FOR TWO HOURS TO BE ABLE TO GET
TO A HOSPITAL. I JUST THIS IS
VERY PERSONAL FOR ME. BOTH OF MY
CHILDREN WERE BORN THEY ALL
THREE OF MY CHILDREN WERE BORN.
IN LESS THAN 1.5 HOURS. MY
CHILDREN HAVE BEEN BORN IN A
CAR. IF I HAD TO TRAVEL TWO
HOURS TO GET TO A HOSPITAL. SO I
JUST WANNA MAKE SURE THAT WE
HAVE SOME VISIBILITY INTO HOW
WE'RE GOING TO ADDRESS THAT NEED
WELL. MÀ, PLEASE. UH, WITH
RESPECT TO THE, UM. BANKRUPTCY
THERE IS NOW AN APPROVED. UH,
PROGRAM TO GET OUT OF
BANKRUPTCY. BY THE COURT. UM,
AND SO IT'S ESSENTIAL THAT ALL
OF THE. PRESUMPTIONS IN THE
NEGOTIATIONS. UH, THEY.
ORGANIZATION HAS A HISTORY OF
COMING IN AND GETTING CLOSED
HOSPITALS BACK UP. IN RURAL
AREAS. UH THIS COMES WITH THE
BOARD OF DIRECTORS OF THE
HOSPITAL'S APPROVAL. THE BOARD
OF SUPERVISORS APPROVAL, UH
THERE HAD BEEN DISPUTES AND SORT
OF BICKERING AND SORT OF
POLITICAL NONSENSE THAT WENT ON.
EARLY ON IN THIS, BUT THERE IS
NOW A SETTLED UNDERSTANDING THAT
THE PROCESS THAT IS COMING OUT
OF BANKRUPTCY. UH, IS A SOLID
ONE THAT THAT HAS SUPPORT OF THE
HOSPITAL BOARD AS WELL AS, UH,
THE BOARD OF SUPERVISORS AND I
WAS ENGAGED IN HELPING MY
COLLEAGUES THERE Ó ON THE
HOSPITAL BOARD. MANY OF THEM ARE
PEOPLE THAT I'VE KNOWN FOR
YEARS. AS WELL AS THE BOARD OF
SUPERVISORS IN POINTING TO THIS
ORGANIZATION'S HISTORY OF BEING
ABLE TO ACHIEVE THESE REOPENINGS
, UH OF SMALLER RURAL HOSPITALS.
AND SO THERE IS A MOVEMENT NOW
OUT OF BANKRUPTCY. AND SO I ECHO
THE HOPE HERE THAT UH, WHAT
PROMISES WERE MADE ARE GOING TO
HAVE TO BE PROMISES THAT ARE
KEPT. AND YOU THIS FUND WILL BE
A PART OF A SOLUTION. THAT IS
HAS UNIVERSAL ACCEPTANCE. THE
BOARD THE COURT THE BOARD OF THE
HOSPITAL. UM AND SO I JUST WANNA
SAY. WE BETTER GET TO THE FINISH
LINE AND HAVE THE FUNDS THAT WE
ANTICIPATED ALL ALONG, AND SO I
JOIN MY COLLEAGUE WITH WITH
THOSE, UH, KINDS OF CONCERNS. I
DON'T THINK THERE'S ANY OTHER
RURAL HOSPITAL IN THE STATE OF
CALIFORNIA THAT IS MORE
SIGNIFICANT TO A LARGER AMOUNT
OF PEOPLE THAN MADEA. BECAUSE IT
IT WHAT'S HAPPENING IS ALL OF
THE MADEA PATIENTS UP IN THAT
WHOLE AREA. THEY'RE THEY'RE
GETTING SENT DOWN TO FRESNO. UH
AND IT'S JUST NOT WORKING. BUT
THERE IS AN ORGANIZATION THAT
HAS A HISTORY OF COMING IN AND
SAVING AND REOPENING THOSE
HOSPITALS. IT'S COMING OUT OF
BANKRUPTCY JUDGES ALREADY
APPROVED IT JUST A MATTER OF
PROCESSING IT OUT AND THROUGH
AND PART OF THAT IS GOING TO
HAVE TO BE TO ACCESS THE FUNDS
NECESSARY. FRANKLY, THE KEEP
GOING. BUY DOWN SOME OF THE YOU
KNOW THE COSTS AND THE
INDEBTEDNESS AND THOSE KINDS OF
THINGS. BUT THERE IS A ROBUST
PLAN TO DO IT AND I HAVE
CONFIDENCE THAT THE ORGANIZERS
OF IT THE COURT HAS HAS LOOKED
AT IT AND SIGNED OFF ON IT.
WE'RE HAVING PROGRESS THERE OF
SIGNIFICANCE, AND I DON'T WANT
ANYTHING TO GET IN THE WAY OF
IT. SO I I'M I'M I'M SAYING IT
WITH YOU. III I DON'T MEAN TO
INTERRUPT. I WANNA THANK MY
COLLEAGUES FOR BRINGING THAT UP.
I THINK THE ISSUE WITH HOSPITAL
CLOSURE UM IS REAL. IT IS ONE
THAT THOSE IN THE HEALTHCARE
PROFESSION, UM, HAVE BEEN
DISCUSSING FOR A VERY LONG TIME,
UM, GRATEFUL FOR THE HOSPITAL
DISTRESS LOAN, BUT WE KNOW THAT
THAT ONE TIME FUNDING IS NOT
NECESSARILY GOING TO SUSTAIN ALL
OF OUR HOSPITALS LIKE WE NEED IT
TO. UM BUT I ALSO WANT TO REMIND
EVERYONE HERE THAT WE DO HAVE
ANOTHER HEARING SPECIFICALLY ON
HOSPITAL FINANCING AND THE
LITTLE DISTRESS ALONE ON MARCH
11TH, SO WE WILL BE ABLE TO DIG
A LITTLE DEEPER INTO THIS AT
THAT HEARING. BUT I'M SORRY. GO
AHEAD. A DEPARTMENT OF FINANCE.
UM, I JUST WANTED TO MAKE A
COUPLE OF POINTS. UH, ONE THAT,
UH, YOU KNOW, AS THE CHAIR HAD
MENTIONED, UH, THE ONE TIME
FUNDING THAT WAS PROVIDED, UH,
PROVIDED MATERIAL SUPPORT TO
THOSE HOSPITALS THAT WERE MOST
IN NEED THROUGH THAT COMPETITIVE
PROCESS. UM, AND MY SECOND POINT
WOULD BE THAT, UH YOU KNOW, UH,
AS YOU AS YOU'RE AWARE THE
GENERAL FUND OUTLOOK HAS NOT
BEEN FAVORABLE SINCE JANUARY. SO
UH, WE'RE GONNA HAVE COMPETING
DEMANDS FOR SCARCE RESOURCES
DURING THIS BUDGET CYCLE. THANK
YOU. I RECOGNIZE THAT I JUST
THINK THAT THERE ARE ARE WHEN
YOU. AND DESTROY THE WELL WHEN
WE ALLOW FOR UM OUR HOSPITAL
INFRASTRUCTURE TO BE DECIMATED
IN PARTICULAR AREAS. IT'S MUCH
EASIER TO TRY TO KEEP A HOSPITAL
OPEN THAN IT IS TO HAVE A CLOSE
AND THEN AND THEN REOPEN. AND SO
PART OF THIS IS JUST KIND OF
UNDERSTANDING. UH, THE
IMPLICATIONS IN IN PARTICULAR
AREAS I'LL MOVE ON FROM THE
POINT. I JUST WANTED TO
HIGHLIGHT THAT FOR ME. THIS IS A
VERY CRITICAL CONCERN, UH, THAT
I'M HOPING WE WILL CONTINUE TO
WORK IN PARTNERSHIP WITH THE
ADMINISTRATION ON, UH, MOVING
FORWARD. UM AND WITH THAT I WILL
HOLD THE REST OF MY QUESTIONS
HERE. WELL, FIRST OF ALL, I
WANNA THANK EVERYONE ON THE
PANEL. UM GIVEN THE TIME I WILL
CUT DOWN MY QUESTIONS TO JUST A
FEW. UM THERE WAS A QUESTION
THAT WAS IN THE IN THE, UH, THE
PACKET THAT WASN'T REALLY
COMPLETELY ADDRESSED DEALING
WITH, UM THE ISSUES CURRENTLY
WITH ACCURATE PAYMENTS GOING OUT
IN A TIMELY WAY WITH EXISTING
SUPPLEMENTAL PAYMENT POOL
UNDERSTAND THAT THE PROPOSAL
WILL HELP THE FUTURE BUT RIGHT
NOW, HOW ARE WE GOING TO ADDRESS
THE PROBLEMS? THAT WE'RE HAVING
RIGHT NOW BEFORE WE IMPLEMENT
THESE NEW PROPOSALS. DO WE HAVE
ANY THOUGHTS ON HOW WE'RE GOING
TO ADDRESS THE CURRENT PROBLEM?
SO WE DID, UM. THE CHALLENGE.
THE CHALLENGE WE ENCOUNTERED
MOST MOST RECENTLY RELATED TO,
UH, RELATED TO A AAA PAYMENT, A
REGULAR, A REGULARLY SCHEDULED
PAYMENT CYCLE, UH, THAT OCCURRED
IN IN DECEMBER, BUT THAT THAT
DID NOT CAPTURE. UM DID NOT
CAPTURE. UH, ALL, UH, ALL FQ ALL
ELIGIBLE COMMUNITY CLINICS THAT
SHOULD HAVE RECEIVED A PAYMENT
THAT THAT IS THAT ISSUE. UM,
THAT ISSUE WE WERE ABLE TO
IDENTIFY AND TRIAGE IN IN
PARTNERSHIP WITH OUR, UM, IN
PARTNERSHIP WITH OUR PROVIDER
PARTNERS, UH, AND, UH, PUT PUT
US ESSENTIALLY PUT A PUT A
SOLUTION INTO INTO PLACE TO
ADDRESS THAT ONE IN PARTICULAR.
I THINK WITH WITH RESPECT TO,
UH, WITH RESPECT TO THE BROAD
YOUR BROADER QUESTION OF
ADDRESSING THOSE ADDRESSING
THOSE PAYMENT CHALLENGES
ESSENTIALLY BETWEEN NOW AND THE
IMPLEMENTATION OF THE OF THE NEW
PROGRAM WHEN THOSE PAYMENTS TAKE
TAKE OVER, UM WE ARE ARE WORKING
CLOSELY WITH, UH, WITH OUR, UH,
WITH OUR WITH OUR PROVIDER, UH,
WITH OUR PROVIDER PARTNERS,
INCLUDING WITH THE CALIFORNIA
PRIMARY CARE ASSOCIATION TO
REALLY UNDERSTAND THE CHALLENGES
THAT THAT COMMUNITY CLINICS ARE
FACING WITH RESPECT TO, UM
WITHIN WITHIN THE CONTEXT OF
THIS PROGRAM AND TO TRY TO TRY
TO IDENTIFY IDENTIFY AND RESOLVE
THOSE ONCE ONCE THEY ARISE, BUT
ALSO TO TRY TO, UH, IDENTIFY AND
ADDRESS THEM BEFORE THEY ARISE,
IF POSSIBLE, SO WE DO INTEND TO
CONTINUE CONTINUE THOSE THOSE
ACTIVE CONVERSATIONS AS PART OF,
UM THE LARGER, ONGOING
DISCUSSIONS TO TRANSITION THE
PROGRAM INTO INTO A MANAGED CARE
DIRECTIVE PAYMENT. THANK YOU. UM
I WOULD STRONGLY ENCOURAGE
CONTINUED CONVERSATION. UM SO
THAT YOU CAN PROACTIVELY PREVENT
THE PROBLEMS RATHER THAN HAVING
TO RETROACTIVELY, UM. FIX THEM.
ANOTHER QUESTION I HAD IS, UH,
WE TALKED ABOUT THE HEARING AIDS
WILL THE RATES FOR THE HEARING
AID COVERAGE FOR THE CHILDREN'S
PROGRAM INCREASE TO TRACK WITH
THE PROPOSED CREASE IN MEDICAL
RATES FOR THE HEARING AIDS? FOR
HEARING AIDS. WE ARE, UH, WE ARE
PROPOSING TO, UH TO EFFECT
EFFECTIVELY INCREASE THE, UM
INCREASE THE CAP THE INDIVIDUAL
CAP ON HEARING AIDS THAT IS IN
PLACE IN PLACE CURRENTLY, UM
BECAUSE HEARING AIDS DO NOT HAVE
THERE'S NOT REALLY AAA MEDICARE
EQUIVALENT FOR HEARING AIDS.
WE'RE NOT ABLE TO EXACTLY
BENCHMARK HEARING AIDS TO A
PARTICULAR TO A PARTICULAR
PERCENT OF MEDICARE. UH BUT
INSTEAD INSTEAD, OUR PROPOSING
TO RAISE THE EXISTING STATUTORY
CAP ON HEARING AIDS FOR
INDIVIDUALS. MHM. SO THERE IS A
CURRENT ISSUE WITH OUR HEARING.
OH, GO AHEAD. SORRY, SIR. YES,
I'M I. I THINK I MISSED PART OF
YOUR QUESTION. AND YES, FOR THE
THERE IS AN INCREASE FOR THE FOR
THE HEARING AIDS FOR A
CHILDREN'S PROGRAM. SO IT WILL
TRACK ALL RIGHT. RIGHT?
MISUNDERSTOOD YOUR QUESTION.
THANK YOU, UM. PIGGYBACKING ON,
UH, ASSEMBLY MEMBER BONTA. THE
ISSUE OF EQUITY PAYMENTS IS, UM,
A VERY NOVEL IDEA. I HAVE TWO
QUESTIONS AROUND IT. ONE HAVE
YOU ALL SEEN ANYTHING ELSE LIKE
THIS IN THE COUNTRY? ANY OTHER
STATE DOING SOMETHING LIKE THIS
IN THE COUNTRY AND. TWO WHEN YOU
DEVELOP YOUR MEASURES OF OUTCOME
, LIKE WHAT ARE YOU LOOKING AT?
LIKE, WHAT WOULD BE THE OUTCOMES
THAT YOU'RE LOOKING FOR? AND HOW
OFTEN ARE YOU GONNA BE REPORTING
TO THE LEGISLATURE ON SUCH
OUTCOMES? SO I WOULD SAY OUR
REPORTING ON OUTCOMES RELATED TO
DISPARITIES IN HEALTH EQUITIES,
AS AS, UH, THE DEPUTY DIRECTOR
MENTIONED. THERE ARE MANY
INITIATIVES THAT THE DEPARTMENT
IS UNDERTAKING WITH REGARD TO
REDUCING DISPARITY SO AND THE
ABILITY TO ISOLATE KIND OF THIS
PROGRAM OR THIS INITIATIVE OR
THIS PROGRAM AND THIS INITIATIVE
IT IT'S KIND OF ALMOST IT WILL
BE VERY DIFFICULT. I AM NOT SURE
EVEN IF POSSIBLE, UH, BECAUSE WE
HAVE A LOT OF WE HAVE THE HEALTH
OF THE EQUITY AND PRACTICE
TRANSFORMATION GRANTS. WE HAVE
OUR COMPREHENSIVE QUALITY
STRATEGY AND ALL THE WORK WE'RE
DOING WITH OUR MANAGED CARE
PLANS. UM AND SO WE WILL REPORT
ON THESE THESE METRICS ANNUALLY
BUT NOT NECESSARILY RELATED JUST
TO THESE TARGETED RATE INCREASES
IN THE HEALTH EQUITY BUMP. IT IS
KIND OF A BROADER CONVERSATION
OF EVERY EFFORT THAT THE
DEPARTMENT IS DOING TO REDUCE
DISPARITIES ACROSS THE STATE.
AND REALLY, UH, KIND OF WE JUST
CAME OUT WITH OUR MEDICAL
MANAGED CARE, QUALITY AND
SANCTIONS AND REPORTING ON SOME
OF THESE DATAS KIND OF FROM AN
EQUITY LENS PERSPECTIVE AND HOW
WE'RE WATCHING THE DATA AND HOW
WE'RE MAKING PROGRESS TO ACHIEVE
OUR BOLD GOALS FOR 2025 WITH
REGARD TO REDUCING SOME OF THESE
SPECIFIC METRICS, OK, THEN, CAN
YOU GO INTO FURTHER DETAIL WHEN
YOU TALK ABOUT YOUR PROPOSED
EQUITY PAYMENTS. WHAT EXACTLY
ARE YOU REFERRING TO? THEN? IF
YOU'RE NOT IF IT'S SO
COMPLICATED THAT YOU CAN'T
REALLY UM. SINGLE OUT TO
DETERMINE OK, THESE ARE THE
OUTCOMES THAT WE'RE LOOKING FOR.
SO CAN YOU PLEASE EXPLAIN TO ME
WHAT DO YOU MEAN BY YOUR
PROPOSED EQUITY PAYMENT PLAN,
FOR EXAMPLE? UH, LET'S JUST USE
FOR EXAMPLE, A PRIMARY CARE
RATES. WE'RE PROPOSING TO BRING
THOSE TO 100% OF MEDICARE,
APPLYING AN EQUITY ENHANCEMENT.
ON TOP OF THAT SOME OF THOSE
RATES MIGHT GET TO LET'S JUST
SAY, FOR EXAMPLE, 100 AND 10% OF
MEDICARE, UM, RECOGNIZING THAT
MAYBE, YOU KNOW, A SMALL
PROVIDER PRACTICE IN IN IN INNER
CITY OR KIND OF AN URBAN HEALTH
DESERT. BE SERVING 90% ME
MEMBERS AND SO THEY'RE NOT ABLE
TO CROSS SUBSIDIZE. WE WANT TO
GROW THEIR PARTICIPATION IN THE
MEDIC SPACE. WE WANT THEM TO
HAVE THE FUNDING THAT THEY NEED
TO SUPPORT THE MEDIC MEMBERS IN
THEIR COMMUNITY. SO IT'S THIS
RECOGNITION THAT SOME PROVIDERS
IN OUR COMMUNITIES MAY NEED A
HIGHER BUMP. THEY MAY NEED TO
GET MORE THAN 100% OF MEDICARE
JUST BECAUSE OF KIND OF THE
COMMUNITIES THAT THEY THAT THEY
ARE EMBEDDED IN. SO, UM. ARE YOU
ENVISIONING THAT THIS IS
SOMETHING THAT THE CLINICS
HOSPITALS PROVIDERS WOULD HAVE
TO APPLY FOR, OR IS IT SOMETHING
THAT YOU ALL WOULD RECOGNIZE AND
SAY, HEY, YOU KNOW, THIS CLINIC
OVER HERE HAS A REALLY
IMBALANCED PAIR MIX. THEY MAY BE
ON THE BRINK. MAYBE WE NEED TO
GIVE THEM A LITTLE EXTRA. HOW
ARE YOU ENVISIONING THAT? WAS IT
KIND OF THE FACTORS THAT WE'RE
GOING TO TRY TO LOOK AT, AND
WE'RE GOING TO BE ENGAGING WITH
STAKEHOLDERS, BUT OUR INITIAL
THINKING IS LOOKING AT HEALTH,
PROFESSION, SHORTAGE AREAS,
RURAL FRONTIER URBAN HEALTH.
NATION HEALTHY PLACES INDEX,
CORAL, ONE AND TWO AND BRINGING
THOSE DATA SOURCES TOGETHER TO
DO THIS ADJUSTMENT ON ON RATES.
THANK YOU. AND FINALLY, UM, HOW
WOULD YOUR PROPOSED TRANSITION
TO SUPPLEMENTAL PAYMENT POOL AND
MANAGED CARE AFFECT THE PROGRAM
AND WITH THE PROGRAM HAVE THE
SAME RECIPIENTS. OH THE SCOPE
THE SCOPE OF THE PROGRAM IN
TERMS OF PROVIDER ELIGIBILITY.
WE ARE PROPOSING TO KEEP THE
SAME, SO WE'RE NOT PROPOSING TO
CHANGE WHO WOULD BE ELIGIBLE FOR
THE PROGRAM? UM REALLY, JUST TO
CHANGE THE, UH, THE PAYMENT
MECHANISM FROM THE EXISTING
PEOPLE SERVICE FOR SERVICE
DELIVERY SYSTEM, SUPPLEMENTAL
PAYMENT PROGRAM. UM THAT IS
ESSENTIALLY CAL, UH, CALCULATED
AND PAID ON A RETROSPECTIVE
BASIS, UM, TO A MANAGED CARE UH,
MANAGED CARE, DIRECTED PAYMENT
ARRANGEMENT WHERE WE WOULD BE
ABLE TO, UM ESSENTIALLY DE
DEVELOP, DEVELOP A DEVELOP AND
REQUIRE MEDICAL MANAGED CARE
PLANS TO PAY ON A ON AN ONGOING
BASIS, AS CLAIMS ARE AS SERVICES
ARE PROVIDED, AND CLAIMS ARE
RECEIVED TO MAKE MAKE ADD ON
PAYMENTS TO ELIGIBLE FQ HÌ, èC
S¼ AND R HÌ èC S¼ AND WORK TO,
UM AND ENSURE THAT THAT REVENUE
IS FLOWING AND THAT WOULD BE THE
UTILIZATION. BASED COMPONENT OF
THE PAYMENTS AND THEN THE
PERFORMANCE BASED COMPONENT OF
THE PAYMENTS WOULD BE INTENDED
TO FUNCTION AS A BALANCER,
ESSENTIALLY, UH, AT THE AT THE
END OF A YEAR OR AT THE END OF A
PROGRAM PERIOD TO LOOK BACK AND
SAY, IF THE IF THE TOTAL
PAYMENTS THAT THAT WENT OUT WERE
, FOR EXAMPLE, UH, LESS THAN
LESS THAN THE TOTAL TOTAL
AVAILABLE POOL AMOUNT THAT WAS
ANTICIPATED, WE WOULD LOOK TO
LEVERAGE THAT PERFORMANCE BASED
COMPONENT TO, UM TO PROVIDE
ADDITIONAL REQUIREMENT. MANAGED
CARE PLANS TO PROVIDE ADDITIONAL
PERFORMANCE BASED PAYMENT. TO
COMMUNITY CLINICS THAT. MET A
DESIGNATED METRICS TO BE TO BE
DEVELOPED THROUGH, UM, TO BE
DEVELOPED BETWEEN NOW AND THE
IMPLEMENTATION OF THE PROGRAM.
THANK YOU, UM. ONCE AGAIN THANK
YOU TO OUR FIRST PANEL. UM IF
ANY OF YOU ARE ABLE TO REMAIN IN
THE HEARING ROOM IN CASE WE HAVE
FOLLOW UP QUESTIONS WITH THE
SECOND PANEL REALLY APPRECIATE
THAT. BUT WE AT THIS POINT ARE
GONNA MOVE TO OUR SECOND PANEL.
OUR SECOND PANEL INCLUDES STUART
THOMPSON, SENIOR VICE PRESIDENT
OF GOVERNMENT RELATIONS FOR THE
CALIFORNIA MEDICAL ASSOCIATION.
ERICA MURRAY PRESIDENT AND èC E
Ó OF THE CALIFORNIA ASSOCIATION
OF PUBLIC HOSPITALS AND HEALTH
SYSTEMS. DENNIS CUEVAS ROMERO,
VICE PRESIDENT OF GOVERNMENT
AFFAIRS FOR THE CALIFORNIA
PRIMARY CARE ASSOCIATION. MARK
FAROOK, VICE PRESIDENT OF STATE
ADVOCACY WITH THE CALIFORNIA
HOSPITAL ASSOCIATION. LISA MET
ZORA. CHIEF LEGAL AND ADVOCACY
OFFICER FOR PLANNED PARENTHOOD
OF CALIFORNIA. WE DON'T HAVE
ENOUGH SEATS FOR EVERYBODY.
WE'LL LET YOU ALL GO AHEAD AND
START AND THEN WE WILL MOVE TO
OUR OTHER TWO SINCE WE ARE
LIMITED ON SEATS, SO WE'LL START
WITH STUART YEP. MEMBERS UH,
STUART THOMPSON WITH THE
CALIFORNIA MEDICAL ASSOCIATION.
I WANNA THANK YOU FOR, UH, HERE
HAVING THIS MEETING AND GIVING
US AN OPPORTUNITY TO TALK ABOUT
OUR PERSPECTIVES AS IT PERTAINS
TO, UH, THE M èC Ó TAX DEAL
LAST YEAR, THIS LEGISLATURE
ALONG WITH THE ADMINISTRATION,
UH, PASSED A B 119, WHICH
REFLECTS THE LARGEST INVESTMENT
IN THE MEDICAL PROGRAM. UM IT IT
EXISTED IN A IN ITS EXISTENCE.
UH, FOR US ON THE PHYSICIAN SIDE
, WE HAVE NOT SEEN, UH, BASE
RATE INCREASES. WE LOOKED THIS
UP SINCE 1998. UH, SINCE THAT
PERIOD, THE META CULP PROGRAM
HAS GROWN EXPONENTIALLY IN IN
TERMS OF THE PATIENTS, THE
CALIFORNIANS THAT IT COVERS AND
IT EXPANDED BENEFITS. UH TO
RESULT IN ONE OF THE MOST
BENEFICIAL MEDICAL PROGRAMS IN
THE NATION. FOR US ONE LEG OF
THAT THREE LEGGED SCHOOL
REIMBURSEMENT RATES TO THE
PROVIDERS HAS NOT KEPT UP AND
THE IMPORTANT PART OF THE M èC
Ó DEAL FROM LAST YEAR IS ITS
LEGISLATURE WAS THE FIRST TIME
THAT WE REALLY ADDRESSED THIS
AND I THINK FOR US ACCESS WITHIN
THE SYSTEM, UM THROUGHOUT THE
STATE, UH, IS A HUGE, HUGE
PROBLEM AND THE OVERALL GOAL
THAT WE WANT TO ADDRESS WITH
THIS TAX DEAL. UM WHEN WE LOOK
AT THIS. OUR OVERALL GOAL IS TO
INCREASE PROVIDERS PARTICIPATING
IN THIS SYSTEM. THAT MEANS
GETTING PHYSICIANS WHO HAVEN'T
PARTICIPATED IN THE MEAL PROGRAM
INTO THE SYSTEM AND ALLOWING
PHYSICIAN PRACTICES. UH, THAT
MAY TAKE ONLY A CERTAIN AMOUNT
OF ME, UH, BASED ON THEIR
FINANCIAL CONDITIONS TO ACCEPT
MORE MEDICAL PATIENTS WHAT THAT
WHAT THEY NEED IN ORDER TO
EXPAND THOSE ROLES IS CLARITY
FROM THE STATE AS TO WHERE
EXACTLY THOSE FUNDS ARE GOING TO
GO, UH, HAVE IT TRANSPARENT AS
WE FLOW FROM THE STATE TO THE
MANAGED CARE PLANS TO THE
PROVIDERS, UM SOMETIMES THAT
SYSTEM CAN GET A LITTLE BIT
GUMMED UP, AND IT TAKES A LONG
TIME FOR THE PROVIDERS TO
ACTUALLY SEE, UM, THOSE RATED
INCREASES. JUST FOR EXAMPLE,
LAST YEAR 2024 THE STATE AND THE
AND THE ADMINISTRATION DID PASS
NEW RATE INCREASES AS A AS IT
PERTAINS TO PRIMARY CARE. THE
VAST MAJORITY OF THE PROVIDERS
WHO ARE ELIGIBLE FOR THAT MONEY
WILL FIRST SEE THAT INCREASE IN
DECEMBER OF THIS YEAR. AND SO
THERE'S ABOUT A YEAR AND A HALF
A TWO YEAR LAG TIME BY AND THE
STATE MIGHT PASS AN INCREASED
REIMBURSEMENT RATE TO THE TIME
WE ACTUALLY SEE THAT, UH, HIT
THE GROUND WITH THE PROVIDERS,
ACTUALLY, UM, SEE THAT AND COULD
EXPAND THEIR PRACTICES. UM, SO
OVERALL, WE DO WANT TO THANK THE
ADMINISTRATION FOR THEIR
PROPOSAL. UM THIS IS IN LINE
WITH THE DEAL THAT WE WERE ALL
AGREED UPON LAST YEAR, AND WE
WOULD URGE THE LEGISLATURE TO
KEEP, UH, THE FRAMEWORK OF THE M
èC Ó DEAL THAT WE REACHED LAST
YEAR INTACT, LARGELY BECAUSE THE
PROVIDERS IN THE STATE DO NEED
SOME STABILITY, AND THEY
CONFIDENCE THAT THEY THEY DO
EXPAND THEIR ROLES, AND THEY DO
ACCEPT MORE MEDICAL PATIENTS, UM
, THAT THEY'RE PRACTICE WILL BE
ABLE TO ACCEPT, UM, THAT
INCREASED POPULATION. UM SO FOR
THAT, UM, WE'RE HERE TO ANSWER
ANY QUESTIONS. OBVIOUSLY THERE'S
A LOT OF DETAILS THAT WE STILL
NEED TO FIGURE OUT AS FAR AS THE
Tð R. I PROPOSAL HOW EXACTLY
THAT MONEY IS GOING TO FLOW OUT.
UH, BUT WE WANNA THANK UH UH,
DIRECTOR BOSS AND HER TEAM FOR
THE ONGOING DIALOGUE. WE HAD A
GREAT DIALOGUE, UH, WITH THE
ADMINISTRATION, HER DEPARTMENT
SO WE LOOK FORWARD TO WORKING
WITH THEM. AS WE FINALIZE SOME
OF THESE DETAILS WITH OVERALL
GOALS CONCERNING THAT THESE
FUNDS FLOW IN A MANNER WHICH
EXPANDS ACCESS TO MOST OF WITHIN
THE SYSTEM HERE TO ANSWER ANY
QUESTIONS. THANK YOU. GOOD
AFTERNOON. MADAM CHAIR, THE
MEMBERS OF THE COMMITTEE. MY
NAME IS ERICA MURRAY. I'M THE
PRESIDENT AND èC E Ó OF THE
CALIFORNIA ASSOCIATION OF PUBLIC
HOSPITALS AND HEALTH SYSTEMS. WE
REPRESENT THE 21 PUBLIC HEALTH
CARE SYSTEMS ACROSS CALIFORNIA
THAT ARE MOSTLY COUNTY OWNED AND
OPERATED. WE ALSO REPRESENT THE
FIVE UNIVERSITY OF CALIFORNIA
HEALTH SYSTEMS, THREE OF WHICH
USED TO BE THE COUNTY HOSPITAL.
TOGETHER IN STATUTE AND, UH, FOR
PURPOSES OF THE M èC Ó TAX.
THESE ARE REFERRED TO AS
DESIGNATED PUBLIC HOSPITALS. WE
REFER TO OURSELVES AS PUBLIC
HEALTH CARE SYSTEMS, PRIMARILY
BECAUSE WE ARE MORE THAN
HOSPITALS WE PROVIDE, UH,
COMPREHENSIVE ARRAY OF PRIMARY
PREVENTIVE SPECIALTY EMERGENCY
TRAUMA AND TRAINING SERVICES
ACROSS THE STATE. BECAUSE OF
VERY LOW MEDICAL RATES. THE M
èC Ó TAX REPRESENTS A HUGE
OPPORTUNITY TO HELP SUPPORT
PUBLIC HEALTH CARE SYSTEMS TO
MAINTAIN ACCESS FOR LOW INCOME
AND MARGINALIZED COMMUNITIES.
AND WE ARE VERY APPRECIATIVE,
UH, WITH THE GOVERNOR'S PROPOSED
BUDGET THAT IT THAT IT PROTECTED
THOSE M èC Ó TAX DOLLARS, EVEN
IN THESE DIFFICULT BUDGET TIMES
AS HAS BEEN MENTIONED. UH, WE
ESPECIALLY APPRECIATE THAT THE M
èC Ó TAX TARGETS $150 MILLION
SPECIFICALLY FOR A DESIGNATED
PUBLIC HOSPITALS AND WANTED TO
EXPLAIN TO YOU HOW THAT CAME
INTO BEING. THERE'S TWO REAL
REASONS. THE FIRST IS THAT MANY
OF OUR IF NOT ALMOST ALL OF THE
PRIMARY CARE SERVICES THAT, UH
PUBLIC HEALTHCARE SYSTEMS
PROVIDE ARE IN PUBLIC. FEDERALLY
QUALIFIED HEALTH CENTERS. FQ HÌ
èC S¼, WHICH HAS BEEN
EXPLAINED, ARE NOT DO NOT
BECAUSE OF THE WAY FFQ HDS ARE
PAID. UH, WE CANNOT BENEFIT FROM
THE $291 MILLION IN BUCKET THAT
BEGAN IN 2024, NOR THE $975
MILLION BUCKET THAT BEGINS IN
2025. AND YET THOSE PRIMARY CARE
SERVICES ARE SO ESSENTIAL TO
SUPPORT TO MAKE SURE THAT LOW
INCOME COMMUNITIES HAVE
RESOURCES TO PREVENT THEM FROM
NEEDING TO GO TO THE HOSPITAL IN
THE FIRST PLACE. THE SECOND
REASON THAT THE DESIGNATED
PUBLIC HOSPITALS HAVE THEIR OWN
CALLED OUT BUCKET IS, UH, IT'S A
REFLECTION OF CONVERSATIONS THAT
WE HAVE BEEN HAVING WITH THE
ADMINISTRATION AND THE
LEGISLATURE AND MANY
STAKEHOLDERS FOR SEVERAL YEARS,
THE PUBLIC HEALTH CARE SYSTEMS
ARE STARING AT A 3 TO $4 BILLION
DEFICIT, PRIMARILY DUE TO THE
FACT THAT WE PUT UP BILLIONS AND
BILLIONS OF STATE SHARE. AND IT
IS WHY, UH, THIS $150 MILLION IS
INCLUDED, AND IT IS WHY IT IS
PROPOSED TO REPLACE, UH, THIS
LOCAL SHARE OF 100 AND 50
MILLION WITH STATE GENERAL FUND
THROUGH THE M èC TAX ANY TIME
WE CAN SWAP OUT LOCAL
SUPPLEMENTAL, SO SOURCES FOR
STATE GENERAL FUND THAT HELPS
STABILIZE UH UH, FINANCING FOR
PUBLIC HEALTH CARE SYSTEMS. AND
WE ARE, UH, COMFORTABLE AND
SUPPORTIVE OF THE CONCEPT OF
CONVERTING OUR PAYMENTS FOR
MEDICAL FEE FOR SERVICE
INPATIENT TO A DIAGNOSTIC
RELATED GROUP, OR Dð, RG BASED
STRUCTURE TO MOVE TOWARDS A
VALUE BASED PAYMENT, AS HAS BEEN
MENTIONED. WHAT WE HAVE CONCERNS
ABOUT IS THE PROPOSAL TO
POTENTIALLY ELIMINATE OR PHASE
OUT THE COST BASE, SUPPLEMENTAL,
UH, THAT WOULD ACCOMPANY SUCH A
PAYMENT A Dð RG PAYMENT OF 100
AND 50. WOULD COME NOWHERE CLOSE
TO COVERING OUR COSTS, AND SO IF
WE ELIMINATED OR PHASED OUT THAT
THAT OTHER SUPPLEMENTAL WE COULD
FIND OURSELVES IN A SITUATION
WHERE SOME PUBLIC HEALTH CARE
SYSTEMS COULD ACTUALLY LOSE
MONEY, WE HAVE BEEN, UH,
ENCOURAGED BY THE CONVERSATIONS
THAT WE'RE HAVING WITH THE
DEPARTMENT THAT THAT WAS
CERTAINLY NOT THEIR INTENTION,
NOR ANYONE'S INTENTION. SO WE'RE
HOPEFUL THAT THIS UM THESE
CONCERNS WILL BE ADDRESSED IN IN
THE COMING WEEKS AND MONTHS. WE
ALSO, UH, SPECIFIC TO THE
SERVICES THAT PUBLIC HEALTH CARE
SYSTEMS PROVIDE, UH, EXPECT TO
BENEFIT FROM OTHER BUCKETS IN
THE M èC Ó TAX, AS IS AS TO
REFLECT THAT BROAD ARRAY OF
SERVICES THAT WE PROVIDE
TRAINING EMERGENCY ROOM
SERVICES, TRAUMA BURN, UH, YOU
NAME IT. PUBLIC HEALTHCARE
SYSTEMS PRETTY MUCH PROVIDE IT,
SO WE LOOK FORWARD TO HAVING
CONVERSATIONS WITH YOU AND THE
DEPARTMENT AND OTHERS ABOUT HOW
THAT PARTICIPATION WILL LOOK.
THANK YOU FOR THE OPPORTUNITY
AND THANK YOU FOR YOUR
LEADERSHIP. GOOD AFTERNOON.
MADAM CHAIR MEMBERS. DENIS
CUEVAS ROMERO, VICE PRESIDENT
FOR GOVERNMENT AFFAIRS AT THE
CALIFORNIA PRIMARY CARE
ASSOCIATION. THANK YOU SO MUCH
FOR HAVING US, UH, REALLY JUST
WANT TO APPRECIATE THE
ADMINISTRATION'S WORK ON
ELEVATING PRIMARY CARE AND THE
INVESTMENT IN PRIMARY CARE. WE
ALL KNOW THAT INVESTMENT IN
PRIMARY CARE REALLY DOES, UH,
SAVE THE SYSTEM, UH, DOLLARS AND
REALLY FOCUSES ON HEALTH EQUITY,
SO REALLY APPRECIATE THAT AND WE
HOPE TO CONTINUE WORKING WITH
THE ADMINISTRATION. THE
LEGISLATURE, UH, TO KEEP THAT
FOCUS IN PRIMARY CARE. I DO
WANNA MENTION, UM, YOU KNOW,
REALLY APPRECIATE THE
CONVERSATION THAT WE'VE BEEN
HAVING WITH THE DEPARTMENT ON
OUR, UH, SUPPLEMENTAL PAYMENT
POOL AND THE ISSUES THAT, UH,
HEALTH CENTERS ARE TRYING TO
RESOLVE WHAT THE DEPARTMENT. WE
REALLY APPRECIATE THE ENGAGEMENT
WITH THE DEPARTMENT IN TRYING TO
RESOLVE THOSE ISSUES. THERE ARE
SOME OUTSTANDING ISSUES AS THE
DEPARTMENT MENTIONED AND WE HOPE
TO CONTINUE THOSE CONVERSATIONS.
UH, TO TRY TO ADDRESS THOSE
THOSE ISSUES AS AS, UH, THE
CHAIR MENTIONED, RIGHT? WE WANNA
MAKE SURE THAT THOSE ISSUES ARE
RESOLVED BEFORE WE TRANSITION TO
THE DIRECTED PAYMENT. AND UH,
REALLY DO WANNA APPRECIATE OUR
OUR CONTINUED WORK WITH THE
DEPARTMENT. WE HAVE BEEN HAVING
CONVERSATIONS WITH THE
DEPARTMENT FOR THE PAST YEAR TO
TRANSITION THAT TO A DIRECTED
PAYMENT BECAUSE WE DO, UH, SEE
THE VALUE IN ENSURING THAT IT'S
BASED ON, UM QUALITY INCENTIVES,
UM, AND THAT THERE'S AAA MORE
EFFICIENT WAY OF GETTING THE
FUNDING OUT. SO WE REALLY
APPRECIATE THE OPPORTUNITY TO BE
HERE. UM AND HAPPY TO ANSWER ANY
QUESTIONS. THANK YOU, MADAM
CHAIR MARK FAROOK ON BEHALF OF
THE CALIFORNIA HOSPITAL
ASSOCIATION. UH, CALIFORNIA'S
HOSPITALS PROVIDE A CRITICAL, UH
, SOURCE OF CARE FOR THE NEARLY
15 MIL MILLION VULNERABLE
CALIFORNIANS THAT ARE COVERED
IN, UH, ME. WE ALREADY KNOW AS
WE'VE HAD A DISCUSSION HERE
TODAY ABOUT LOW REIMBURSEMENT
RATES IN MEDI CAL THAT DO NOT
COVER THE COST OF PROVIDING CARE
WHILE AT THE SAME TIME HOSPITALS
HAVE EXPERIENCED HUGE PANDEMIC
RELATED LOSSES, UNPRECEDENTED
INFLATIONARY PRESSURE AND A
SEVERE WORKFORCE SHORTAGES, ALL
FACTORS CONTRIBUTING TO OVER
HALF OF HOSPITALS OPERATING
FINANCIALLY IN THE RED. ONE IN
FIVE HOSPITALS AT RISK OF
CLOSURE. GIVEN THESE ACUTE
CHALLENGES WE APPRECIATE AND
COMMEND THE GOVERNOR AND THE
LEGISLATURE FOR COMING TOGETHER
TO REAUTHORIZE THE MANAGED CARE
ORGANIZATION TAX TO PRO PROVIDE
THIS CRUCIAL FUNDING FOR THE
MEDI CAL PROGRAM. AND WE ALSO
APPRECIATE THE GOVERNOR
MAINTAINING HIS COMMITMENT TO
USING THE $2.7 BILLION ANNUALLY
IN M èC Ó TAX REVENUES TO
IMPROVE ACCESS TO ME, DESPITE A
SIGNIFICANT STATE BUDGET
DEFICIT. THIS FUNDING IS VITAL
AND NECESSARY TO SUPPORT THE
MEDICAL PROGRAM AND THE WORK OF
HOSPITALS AND OTHER PROVIDERS TO
PROVIDE PATIENT CARE AND ACCESS.
AS WE ALL KNOW, HOSPITALS FACE
AN ONGOING EMERGENCY ROOM
OVERCROWDING CRISIS THAT HAS
PERSISTED SINCE COVID-19
PANDEMIC. IMPROVING FUNDING FOR
EMERGENCY ROOM ACCESS IS
FOUNDATIONAL TO RELIEVING THE
BURDEN CURRENTLY ON HOSPITAL
EMERGENCY ROOMS, A BURDEN SHARED
BY STAFF AND PATIENTS ALIKE.
MEDICAL OUTPATIENT SERVICES
SERVICES REIMBURSEMENTS. BASE
RATES HAVE BEEN NEGLECTED FAR
TOO LONG, RESULTING IN ENORMOUS
PAYMENT DISPARITIES WITH OTHER
TYPES OF COVERAGE, HARMING
ACCESS TO CRITICALLY NEEDED
COMPLEX CARE. BASED ON DHCS OWN
REPORTING AND MANAGED CARE BASE
LEVEL REIMBURSEMENT FOR
OUTPATIENT SERVICES, INCLUDING
EMERGENCY DEPARTMENTS IS LESS
THAN 33% OF MEDICARE. THE
GROWING BEHAVIORAL HEALTH CRISIS
CONTRIBUTES SIGNIFICANTLY TO
EMERGENCY ROOM OVERCROWDING.
TODAY ONE IN FIVE VISITS INVOLVE
A PATIENT WITH A BEHAVIORAL
HEALTH DISORDER, GIVEN THE LACK
OF ALTERNATIVES TO EMERGENCY
DEPARTMENTS AND POST HOSPITAL
CARE OPTIONS. WE SEE EVERY DAY
THE CHALLENGE OF ENSURING THAT
PATIENTS GET ACCESS TO THE
BEHAVIORAL HEALTH TREATMENT THEY
NEED. THE BEHAVIORAL HEALTH
ALLOCATION IN THE M èC Ó TAX
IS A KEY PIECE OF THE
SIGNIFICANT CHANGES CALIFORNIA
IS MAKING. TO IMPROVE ACCESS TO
MENTAL HEALTH CARE FOR MENTAL
PATIENTS. WE HAVE A CRITICAL
SHORTAGE OF MENTAL HEALTH BEDS
AT ALL TREATMENT LEVELS. WE
WOULD ENCOURAGE SWIFT ENGAGEMENT
AND DISCUSSION WITH HOSPITALS TO
ENSURE THAT WE MEET THIS NEED
WITHOUT FURTHER DELAY. DHCS IS
PROPOSED. METHODOLOGIES ARE
COMPLEX AND CRITICAL. DETAILS DO
REMAIN OUTSTANDING. WE ARE
HOPING FOR FOCUS AND SUBSTANTIVE
ENGAGEMENT WITH THE DEPARTMENT
TO ADDRESS THESE COMPLEXITIES
FILL IN THE MISSING DETAILS AND
PARTNER WITH THEM TO ENSURE A
SMOOTH AND SWIFT IMPLEMENTATION.
THE FIRST STEP TO GETTING
HOSPITALS IN A STRONGER
FINANCIAL PATH AND PROTECTING
PATIENT ACCESS CAN START WITH
SUCCESSFUL M èC Ó TAX
IMPLEMENTATION. ADDRESSING THESE
EXIST EXISTING PROBLEMS WITH
HOSPITAL REIMBURSEMENT AND
MEDICAL IS EXTREMELY COMPLEX AND
IMPORTANT WORK AND WE LOOK
FORWARD TO WORKING WITH THE
DEPARTMENT, WORKING WITH THE
ADMINISTRATION AND WORKING WITH
YOU TO FINALIZE THIS PLAN. THANK
YOU. THANK YOU. I WILL NOW HAVE
MATT LEGER GOVERNMENT RELATIONS
ADVOCATE FOR S¼ èC IU,
CALIFORNIA. OH, I. COUNCIL AND
THEN WE'LL ALSO MAKE ROOM FOR
LINA KOPMAN, UH, CHIEF EXECUTIVE
OFFICER OF THE LOCAL HEALTH
PLANT OF CALIFORNIA. AND WE WILL
GO WITH LISA. CHAIR OF MEMBERS
OF THE COMMITTEE. I'M LISA MONAR
I'M THE CHIEF LEGAL AND ADVOCACY
OFFICER AT PLANNED PARENTHOOD
AFFILIATES OF CALIFORNIA,
REPRESENTING THE SEVEN PLANNED
PARENTHOOD AFFILIATES THAT
OPERATE OVER 100 HEALTH CENTERS
THROUGHOUT THE STATE, UH, WITH
OVER 1.3 MILLION PATIENT VISITS
ANNUALLY, PLANNED PARENTHOOD IS
COMMITTED TO PROVIDING EQUITABLE
AND AFFORDABLE ACCESS TO THE
FULL RANGE OF SEXUAL
REPRODUCTIVE HEALTH CARE AND IS
A TRUSTED COMMUNITY PROVIDER FOR
MEDICAL AND FAMILY PACK
PATIENTS. IN FACT, THOSE
PATIENTS REPRESENT 80 TO 90% OF
THE PATIENT VOLUME OF OUR
AFFILIATES WHILE ABORTION,
FAMILY PLANNING S¼ Tð, I CARE
AND OTHER PREVENTATIVE SERVICES
ARE THE CORE SERVICES OF PLANNED
PARENTHOOD. THE AFFILIATES DO
PROVIDE AN EXPANDING RANGE OF
ADDITIONAL SERVICES THAT BETTER
ENCOMPASS THEIR PATIENTS' NEEDS,
INCLUDING NONSPECIALTY,
BEHAVIORAL, HEALTH, GENDER
FORMING CARE AND PRIMARY CARE.
PLANNED PARENTHOOD IS PART OF
THIS COALITION TO ADVOCATE FOR
NEW FOR THE NEW M èC Ó TAX
THAT PROVIDES SUSTAINABLE
FUNDING SOLUTION TO ENSURE THAT
PATIENTS THAT RELY ON ME CAN
RECEIVE HIGH QUALITY AFFORDABLE,
APPROPRIATE AND TIMELY CARE.
WE'RE GRATEFUL FOR THE
COMMITMENT AND THE COLLECTIVE
WORK OF THE LEGISLATURE, THE
ADMINISTRATION AND THE
DEPARTMENT TO IMPLEMENT THIS
MULTIYEAR SPENDING PLAN THAT
OFFERS SUSTAINABLE, PREDICTABLE
AND LONG TERM FUNDING FOR
MEDICAL PROVIDERS IN A WAY THAT
TRULY TRANSFORMS THE QUALITY OF
CARE PATIENTS RECEIVE AND
REFLECTS OUR STATE'S COMMITMENT
TO HEALTH EQUITY. WITH REGARDS
TO THE DEPARTMENT'S 2024 25
PROPOSAL FOR THE TARGETED RATE
INCREASES SPECIFICALLY AS IT
RELATES TO FAMILY PLANNING AND
ABORTION. WE SUPPORT THE
PROPOSED INCREASES TO THE BASE
RATES FOR ABORTION SERVICES. WE
KNOW THAT IMPROVING MEDI
REIMBURSEMENT FOR ABORTION. WILL
SERVE TO STRENGTHEN AND EXPAND
CALIFORNIA'S NETWORK OF ABORTION
PROVIDERS. A RECENT STUDY BY
GUTTMACHER, UH, UNDERSCORES THE
CRITICAL ROLE THAT MEDICAID HAS
IN IMPROVING AND ADDRESSING IN
INEQUITIES AND ACCESS TO
ABORTION. WE ALSO APPLAUD THE
DEPARTMENT'S PROPOSAL TO RELY ON
BASE RATE INCREASES RATHER THAN
SUPPLEMENTAL PAYMENTS TO IMPROVE
OVERALL REIMBURSEMENT RATES AND
REDUCE ADMINISTRATIVE BURDEN,
WHILE SUPPLEMENTAL PAYMENTS HAVE
BEEN CRUCIAL FOR ABORTION AND
FAMILY PLANNING SERVICES, OUR
AFFILIATES HAVE FACED
CONSIDERABLE CHALLENGES IN
OBTAINING PAYMENT IN A TIMELY
MANNER AND AS A FREEDOM OF
CHOICE PROVIDER. PLANNED
PARENTHOOD CONTINUES TO
PRIMARILY BE DEPENDENT ON
MEDICAL FEE FOR SERVICE RATES,
WHICH LEADS TO CONSIDERABLE
ADMINISTRATIVE BURDENS, NOT JUST
FOR OUR AFFILIATES, BUT ALSO FOR
THE HEALTH PLANS. PLANNED
PARENTHOOD IS EAGER TO BE PART
OF THE MEDICAL TRANSFORMATION IN
IS ACTIVELY EXPLORING NEW
CLINICAL AND FUNDING MODELS THAT
WILL MOVE MOVE THEM TOWARDS A
VALUE BASED REIMBURSEMENT MODEL
THAT INTEGRATES WITH THE
DEPARTMENT'S VISION FOR MEDIS
FUTURE. THERE IS A CRITICAL
OPPORTUNITY FOR SEXUAL AND
REPRODUCTIVE HEALTH CARE,
PROVIDE. AND ME TO HELP THE
STATE MEET KEY QUALITY METRICS
FOR MATERNAL HEALTH S¼ Dð I
CANCER SCREENINGS AND OTHER GAPS
IN HEALTH EQUITY. ACCORDINGLY WE
URGE THAT THE DEPARTMENT ALSO
ALLOCATE FUNDS TO FAMILY
PLANNING INVESTMENTS THAT
MAXIMIZE THE IMPACT OF THE M èC
Ó TAX THROUGH FEDERAL MATCHING
FOR FAMILY PLANNING SERVICES,
AND WE APPRECIATE THE
DEPARTMENT'S WILLINGNESS TO
CONTINUE CONVERSATIONS ABOUT HOW
TO OPERATIONALIZE PROPOSED
INVESTMENTS FOR ABORTION AND
FAMILY PLANNING IN A WAY THAT
BEST SUPPORTS CALIFORNIA'S
MEDICAL BENEFICIARY.
BENEFICIARIES AND FURTHERS
INCLUSION OF SEXUAL REPRODUCTIVE
HEALTH CARE PROVIDERS IN THE
MEDICAL TRANSFORMATION. I
APPRECIATE HAVING THIS
OPPORTUNITY TO SPEAK TODAY AND I
WILL BE AVAILABLE FOR ANY
QUESTIONS. UH, THANK YOU VERY
MUCH. MOUNT LEE B S¼ èC A U
CALIFORNIA IN OUR 700,000
MEMBERS HERE, UH, TO SPEAK IN
SUPPORT OF THE ADMINISTRATION'S
PROPOSALS HERE, UM THERE ARE
MANY OF THEM, UM, REALLY ON THE
M èC TAX. I WOULD ECHO A LOT OF
THE COMMENTS OF THE PANEL AND
THAT WE THINK THAT THIS IS AN
INCREDIBLE INVESTMENT IN, UH,
THE STATE MEDICAL SYSTEM, WHICH
HAS EXPANDED TO MORE THAN 15
MILLION PEOPLE COVERING THE
STATE OF CALIFORNIA ABOUT 40% OF
OUR POPULATION, WHICH IS JUST A
FANTASTIC, UH, NUMBER TO MAKE
SURE THAT WE'RE DOING ALL WE CAN
ON ACCESS, BUT WE ALSO WANNA
MAKE SURE THAT WE'RE DELIVERING
ON THAT PROMISE OF ACCESS AND
DELIVERING ON CARE. UM
SPECIFICALLY, YOU KNOW, WE WANNA
MAKE SURE THAT AS WE'RE LOOKING
AT THIS, WE'RE INCLUDING
STANDARDS FOR QUALITY ACCESS,
WORKFORCE, THOSE THINGS THAT WE
WANT TO MAKE SURE THAT YOU KNOW,
WHEN THE MONEY GETS OUT THE
DOOR, IT'S ACTUALLY LIFTING UP
AND SERVING THESE PATIENTS. UM,
WELL, UM SO, UH, ADDITIONALLY, I
DID WANNA, YOU KNOW, ECHO THE
COMMENTS AROUND. UH, MY
COLLEAGUE HERE ON THE, UH,
PUBLIC HOSPITAL. UH, FUND TO
MAKE SURE THAT WE'RE ADDRESSING
THAT AND DO WANT ALSO COMMEND
THE ADMINISTRATION. UH, FOR, UH,
EARLY ENGAGEMENT ON THAT IN
THEIR THOUGHTFULNESS TO, UM, TRY
TO MOVE THROUGH TO MAKE SURE
THAT WE'RE SUPPORTING OUR PUBLIC
HOSPITAL SYSTEM. UM, HEALTH CARE
SYSTEM? UM IN ADDITION TO THAT,
TO MAKE SURE THAT WE'RE
DELIVERING ON ACCESS TO CARE, OF
COURSE, WE NEED TO MAKE SURE
THAT WE HAVE ENOUGH PROVIDERS.
AND SO THAT, UH UH, WE SEE THAT
WITH THE $75 MILLION IN GRADUATE
MEDICAL EDUCATION, WHICH WE
THINK IS A FANTASTIC INVESTMENT.
UM YOU KNOW, CALIFORNIA HAS THE
DISTINCTION OF HAVING THE
HIGHEST RATE OF RETENTION OF
PEOPLE WHO DO THEIR RESIDENCY
PROGRAM IN CALIFORNIA. 71% OF
THEM STAY IN CALIFORNIA. THAT IS
THE HIGHEST RATE OF THE COUNTRY.
AND SO, UH, WE DO A GREAT JOB.
ONCE WE TRAIN THEM. WE HAVE TO
KEEP THEM HERE. AND SO THIS
INVESTMENT IS GONNA EXPAND THAT
OPPORTUNITY TO ACTUALLY KEEP
PEOPLE IN CALIFORNIA SO THAT WE
CAN HAVE PHYSICIANS TO MEET OUR
GROWING CARE DEMAND. UM IN
ADDITION TO THAT, WE ALSO SEE
$75 MILLION WITH THE MEDICAL
WORKFORCE POOL, AND SO THAT
WOULD GO TO LABOR MANAGEMENT
COOPERATIONS TO DO SOME OF THOSE
LOCAL INDUSTRY DRIVEN TRAINING
SOLUTIONS THAT WOULD ACTUALLY
MEET THE NEEDS WHETHER THAT BE
SPANISH SPEAKING ALLIED HEALTH
PROFESSIONALS OR, UM, YOU KNOW,
TRAINING UP LVNS TO R N.
THERE'S A NUMBER OF PROGRAMS
THAT COULD HAPPEN THAT REALLY
WANTS WORKERS AND, UH,
MANAGEMENT COME TOGETHER, THEY
COULD DESIGN THE PROGRAMS THAT
ARE GONNA BE ATTRACTIVE THAT ARE
GONNA UH, MAKE SURE THAT WORKERS
ARE ADVANCING THEIR CAREER OR
BRINGING NEW WORKERS INTO THE
HEALTH CARE INDUSTRY BECAUSE WE
DO AS WE MENTIONED FROM THE
CALIFORNIA HOSPITAL ASSOCIATION
HAVE AN INCREDIBLE SHORTAGE THAT
WE NEED TO ATTRACT MORE PEOPLE
INTO THE WORKFORCE. AND SO THE,
UM WE DO THINK THAT THE 75
MILLION IS A REALLY IMPORTANT
INVESTMENT FOR THAT, UM SO YOU
KNOW, I DID WANNA HIGHLIGHT. UM,
JUST A COUPLE OF THOSE, UM, ALSO
, YOU KNOW, DID WANNA, YOU KNOW,
PARTICULARLY, UH, THROUGH OUR
SUPPORT AROUND THE
ADMINISTRATION'S PROPOSAL TO
MAXIMIZE FEDERAL FUNDING BY
GETTING ANOTHER 1.5 BILLION, UM
OR AT LEAST, UH, A ATTEMPTING TO
BECAUSE WE THINK YOU KNOW TO THE
MAXIMUM EXTENT YOU CAN TRY TO
BRING DOWN FEDERAL FUNDS TO
SUPPORT OUR PROGRAM. WE THINK
THAT'S ABSOLUTELY VITAL. UM SO
WITHOUT JUST, YOU KNOW, REALLY
SUMMARIZED BY SAYING WE THINK
OVERALL FOR THE FIRST TIME
REALLY INVESTING IN THE MEDI CAL
PROGRAM, WHICH WE THINK IS IN
FACT. UH, FANTASTIC. WE THINK
THAT THESE INVESTMENTS SHOULD
RESULT IN QUALITY CARE, AND WE
WANT TO MAKE SURE THAT THOSE
STANDARDS TO MAKE SURE UM YOU
KNOW OUR CLINIC PARTNERS ARE YOU
KNOW, HOSPITAL PARTNERS. ALL OF
THEM ARE MEETING THOSE STANDARDS
OF, UH, INCREASING ACCESS OR
PHYSICIAN PARTNERS, UH,
INCREASING ACCESS AND DELIVERY
OF CARE, UM, AND THINK THAT THE
WORKFORCE INVESTMENTS ARE
CRITICAL TO REALIZING THAT
PROMISE, SO THANK YOU VERY MUCH.
RIGHT GOOD AFTERNOON CHAIR AND
COMMITTEE MEMBERS. LIN KINS. I'M
THE èC E Ó FOR THE LOCAL
HEALTH PLANS OF CALIFORNIA L HÌ
P èC REPRESENTS THE 17 LOCAL
COMMUNITY BASED MEDICAL MANAGED
CARE PLANS THAT COLLECTIVELY
SERVE OVER 70% OF ALL MEDICAL
MANAGED CARE BENEFICIARIES IN 51
, OF, UH, CALIFORNIA'S 58
COUNTIES. SINCE LAST YEAR, LPC
HAS BEEN A MEMBER OF THE
COALITION OF PLANS, PROVIDERS
AND WORKERS THAT HAVE JOINED
TOGETHER TO ADVOCATE FOR COL FOR
REINVESTING M èC Ó TAX REVENUE
BACK INTO THE MEDIC PROGRAM TO
IMPROVE QUALITY AND ACCESS TO
CARE FOR THE ONE IN THREE
CALIFORNIANS THAT RELY ON MEDI
CAL. WE COMMEND THE
ADMINISTRATION FOR ITS PROPOSAL
TO CONTINUE TO INCLUDE
INVESTMENTS THAT WERE COMMITTED
TO DURING LAST YEAR'S BUDGET
PROCESS, INCLUDING SIGNIFICANT
NEW FUNDING FOR PRIMARY CARE,
SPECIALTY CARE, HOSPITAL CARE
COMMUNITY CLINICS. AND WORKFORCE
BECAUSE THE LOCAL PLAN SERVE
NEARLY 10 MILLION MEDI CAL
ENROLLEES ACROSS THE STATE IN
THEIR LOCAL COMMUNITIES. WE HAVE
UNIQUE INSIGHT INTO THE NEEDS
AND CHALLENGES FACED BY OUR
SYSTEM. THE MCO TAX FUNDING IS
CRITICAL IN THE SHORT TERM TO
SUPPORT INCREASING PROVIDER
PARTICIPATION IN ME, AND IT'S
CRITICAL IN THE LONG TERM TO
SUPPORT THE ONGOING VIABILITY OF
THE MEDICAL SAFETY NET AND THE
PIPELINE OF FUTURE MEDIC
WORKFORCE. MEDICAL MANAGED CARE
PLANS ARE THE LINCHPIN IN THE
SUCCESS OF THE TARGETED RATE
INCREASE PROPOSAL. UM IN THE
GOVERNOR'S BUDGET. THE PLANS ARE
RESPONSIBLE FOR CONTRACTING AND
PAYING PROVIDERS FOR A BROAD
RANGE OF SERVICES DELIVERED TO
MEDIC BENEFICIARIES, INCLUDING
NEARLY ALL OF THE PROVIDERS
INCLUDED IN THE M èC Ó, UH,
PROPOSAL, GIVEN THE COMPLEXITY
OF THE MEDICAL DELIVERY SYSTEM,
INCLUDING CAPITATION AND
DELEGATED ARRANGEMENTS, EVEN
SEEMINGLY SIMPLE RATE INCREASES
HAVE SIGNIFICANT IMPLICATIONS
FOR IMPLEMENTATION. SINCE THE
INITIAL RATE INCREASES INCREASES
WERE APPROVED AS A PART OF LAST
YEAR'S BUDGET. LOCAL PLANS HAVE
WORKED CLOSELY WITH Dð HÌ èC S¼
TO BEST TO DISCUSS HOW TO BEST
OPERATIONALIZE THE RATE
INCREASES IN MANAGED CARE. AS
THE LEGISLATURE CONTINUES TO,
UH, CONSIDERS THE PROPOSAL TO
INCREASE FUNDING FOR MANY
DIFFERENT MEDICAL SERVICES AND
PROVIDERS IN 2025 AND ONWARD. WE
URGE THE CONSIDERATION OF THE
FOLLOWING PRINCIPLES FIRST
ACCESS AND QUALITY. THE FUNDING
SHOULD LEAD TO VISIBLE
IMPROVEMENTS IN ACCESS AND
QUALITY IN ME MEANINGFUL IMPACT
THAT THE FUNDING SHOULD BE
TARGETED IN SUCH A WAY THAT IT
CHANGES PROVIDER BEHAVIOR AND
THIRD SIMPLICITY AND EXPEDIENCY.
THE FUNDING SHOULD BE
ADMINISTERED THROUGH KNOWN
FINANCING MECHANISMS SO THAT IT
CAN EFFICIENTLY EFFICIENTLY FLOW
TO PROVIDERS. WE ARE ALIGNED
WITH THE ADMINISTRATION AND
WANTING TO ENSURE THAT THE
FINANCING MECHANISMS FOR THE
PROVIDER RATE INCREASES WILL
IMPROVE ACCESS AND QUALITY IN
ME, HOWEVER, THE DETAILS OF THE
MECHANICS OF HOW TO ACHIEVE
THESE GOALS ARE VERY IMPORTANT
AND WE RECOMMEND THERE BE
CONSIDERATION OF OPPORTUNITIES
TO REDUCE THE COMPLEXITY OF THE
PROPOSED RATE INCREASE
METHODOLOGIES, AS MENTIONED.
PREVIOUSLY LOCAL PLANS HAVE BEEN
WORKING CLOSELY WITH Dð HÌ èC
S¼ ON THE IMPORTANT
IMPLEMENTATION DETAILS AND WE
LOOK FORWARD TO CONTINUING TO
WORK WITH THE DEPARTMENT TO
SIMPLIFY ITS APPROACH WHILE
ALLOWING PLANS OF FLEXIBILITY TO
RESPOND TO LOCAL PROVIDER NEEDS
SHORTAGES AND SPECIFIC
DISPARITIES IN CARE. UM I'LL
CLOSE BY SAYING THAT WE REALLY
DO APPRECIATE THE COMMITMENT BY
BOTH THE ADMINISTRATION AND THE
LEGISLATURE, UM, TO USING THE M
èC Ó TAX AS AN OPPORTUNITY TO
MAKE AN IMPACT FOR MEDICAL
BENEFICIARIES. THANK YOU. THANK
YOU, UM, ASSEMBLY MEMBER OF
BANTA, DO YOU HAVE ANY
QUESTIONS, OK. WELL I DO. I
ACTUALLY I'M GONNA GO AHEAD AND,
UH, ASK YOU MY FIRST QUESTION
YOU JUST TALKED ABOUT REDUCE THE
COMPLEXITY OF PROVIDER RATE
INCREASES. CAN YOU ELABORATE ON
THAT A LITTLE BIT MORE. SO I
THINK, UM AND WE'RE WE'RE
LEARNING. I THINK FROM THE
EXPERIENCE OF THE RATE INCREASES
THAT WERE APPROVED IN LAST
YEAR'S BUDGET, AND I THINK YOU
KNOW ON ON ITS FACE. IT'S A IT'S
A IT'S A SIMPLE AND ELEGANT
POLICY SOLUTION TO INCREASE THE
MEDICAL FEE SCHEDULE. AS HAS
BEEN DISCUSSED. IT'S BEEN YOU
KNOW, THE LAST TIME IT WAS
SIGNIFICANTLY UPDATED WAS ALMOST
20 YEARS AGO. UM HOWEVER, UM,
YOU KNOW 99 OF ME. 99% OF MEDIC
BENEFICIARIES ARE IN MANAGED
CARE. AND THE CONSTRUCTS FOR
FINANCING ARE OF COURSE
DIFFERENT. THE STATE PAYS PLANS.
CAPITATION PLANS PAY PROVIDERS
EITHER FEE FOR SERVICE OR
CAPITATION. AND THEN THERE'S
DELEGATION AND SO I THINK, UM,
WE ARE HOPING AND ARE WORKING
CLOSELY WITH THE DEPARTMENT AND
OUR PROVIDER PARTNERS. UM TO
THINK THROUGH, IS THERE ARE
THERE OPPORTUNITIES TO KIND OF
TO STREAMLINE OUR SIMPLIFY WHERE
POSSIBLE, SO THAT SO THAT
DOLLARS CAN GET OUT THE DOOR AND
MAKE AN IMPACT AND ACCESS WHICH
IS WHAT OUR OUR SHARED GOAL
RIGHT, SO THAT'S HOPEFULLY THAT
THAT HELPS ILLUMINATE A LITTLE
BIT OF WHAT I WAS SAYING ABOUT
THE COMPLEXITY. THANK YOU. UM
AND IF WE CAN HAVE STUART
THOMPSON, COME BACK UP. I JUST
WANTED YOU TO ELABORATE FOR ME A
LITTLE BIT MORE ON, UM, THE
ISSUE WITH THE FUNDS ACTUALLY
GETTING TO PROVIDERS. IT'S UH,
KIND OF PART AND PARCEL OF THE
SAME, UH, TOPIC. WE'RE JUST
DISCUSSING, UM PART OF AND LIN.
I MIGHT BE ABLE TO ANSWER THIS,
UH MORE ELOQUENTLY ON THE PLAN
SIDE. UM BUT AS PART OF THE
CAPITATION RATE THEY HAVE TO
BASICALLY BUILD IN THE
SUPPLEMENTAL PAYMENTS, THERE'S
USUALLY ACCOUNTING THAT HAPPENS
TOWARDS THE END OF THE YEAR. UM
OFTEN TIMES DIFFERENT PLANS HAVE
DIFFERENT, UH, WAYS OF DOING
THIS SO OFTEN TIMES, THERE MIGHT
BE AN INTERIM PAYMENT. UH, THEY
WAIT TILL THE END OF THE YEAR TO
KIND OF RECONCILE THAT, UH, WHEN
THEY DO THE UM, UH, BUT
GENERALLY SPEAKING, IF ON THE
SUPPLEMENTAL PAYMENTS AS IT
FLOWS THROUGH MANAGED CARE, UM
THERE'S A MULTIPLE DIFFERENT
MANAGED CARE PLANS, AND THEY
EACH HAVE A SLIGHTLY DIFFERENT
SYSTEM. UM SO SOME OF THE PLANS
SOME OF THAT MONEY WILL BE
FLOWING EARLIER. UM UH, BUT THE
UM THERE'S AN ALL PLAIN LAYER
THAT JUST WENT OUT THAT
BASICALLY SAID THESE PAYMENTS
HAVE TO HAPPEN GENERALLY, BY
DECEMBER, UM, IN OUR EXPERIENCE
IS WITH THIS AND BOTH WITH A
PROP 56 PAYMENTS, WHICH WERE
SUPPLEMENTAL PAYMENTS. THERE IS
OFTEN ABOUT A YEAR AND A HALF
LAG. SO THE PROVIDERS WOULDN'T
THAT MONEY UNTIL OFTEN A YEAR
AND A HALF, TWO YEARS AFTER THE
SERVICE WAS PROVIDED, IN OUR
CONCERN WITH THAT IS KIND OF TO
THE POINT. IT DIDN'T EFFECTUATE
CHANGE IN THE WAY I THINK WE
WOULD HAVE LIKED TO SEE. SO IT'S
NICE THAT SUPPLEMENTAL PAYMENTS
CAN BE TARGETED. YOU CAN GO IN
AND MAKE SURE THAT THEY FLOW
EXACTLY TO WHERE YOU WANT TO.
THERE'S OFTEN A LACK, THOUGH, SO
THERE'S A TRADE OFF BETWEEN
GOING AT A BASE RATES, UM, IN IN
IN FOCUSING ON SUPPLEMENTALS,
AND I THINK, LOOKING AT THE
AMOUNT OF FUNDS WE HAVE
AVAILABLE AND KIND OF OUR
EXPERIENCE, UH, MAKING SURE THAT
THE SUPPLEMENTAL PAYMENT. WE
HAVE TO DO IT IN A MANNER THAT
THAT'S QUICK. THE PROVIDER KNOWS
WHAT IS EVENTUALLY GOING TO GET
TO THEM, WHICH I THINK IS REALLY
IMPORTANT TO SOMETIMES. UM
THERE'S CONFUSION AS TO WHAT
SERVICES MIGHT KIND OF GET THE
RATE OR, UH, HOW MUCH THEY MIGHT
GET AT THE END, AND SO IT'S ALL
IT'S VERY TECHNICAL. AND I WILL
COMMEND THE Dð HÌ S¼ FOR WORKING
WITH US AND TRYING TO THINK
THROUGH BALANCING MAKING SURE WE
HAVE TARGETED PAYMENTS THAT GO,
UH, TO INCREASING THE MOST
IMPACT, BUT DOING IT IN A WAY
WHERE THE PROVIDERS ACTUALLY
MAYBE CHANGE THEIR BEHAVIOR AND
SEE A THANK YOU. AND YOU KNOW,
ONE OF THE THINGS THAT WAS
DISCUSSED IN THE LAST PANEL WITH
THE L A Ó IS JUST THE
UNCERTAINTY OF WHAT WILL COME
ONCE THESE FUNDS ARE NÓ LONGER
AVAILABLE WITH THIS CURRENT M
èC Ó TAX AND WITH THE NEW
BUDGET, WE'RE ACTUALLY CUTTING
IT DOWN BY ONE YEAR, SO JUST
WANTED TO KIND OF, UM HEAR FROM
THIS PARTICULAR PANEL ON UM YOUR
THOUGHTS CONCERNS. ANYONE. I'LL
TAKE THE FIRST CRACK AT IT. UH,
YOU KNOW, I'D I'D SAY THAT'S A
REAL CONCERN. UH, OBVIOUSLY, WE
DON'T WANT TO CREATE A SCENARIO
IN WHICH WE HAVE A PROGRAM THAT
GOES FOR FOUR YEARS. AND THEN WE
REACH A CLIFF. UM I THINK, UH,
THE ADMINISTRATIONS HAD THAT
CONCERN. I THINK I THINK, UH,
THE COALITION TOO HAS HAD THAT
CONCERN. UM YOU KNOW, THERE WILL
BE AN OPPORTUNITY TO RENEW THE M
èC Ó TAX IN A NUMBER OF
DIFFERENT MANNERS. AND SO I
THINK AS A COALITION AS A STATE,
WE HAVE TO DETERMINE WHERE THE
FEDS ARE GONNA BE AT, UM IN
THREE OR FOUR YEARS WHEN, UH,
POTENTIALLY THE M èC Ó TAX
COULD BE RENEWED, BUT I THINK,
UM THERE'S DEFINITELY A PATHWAY
TO, UM, RENEW THE TAX AT A AT A
AT A LATER POINT WHEN IT DOES
EXPIRE, AND I THINK AT THAT
POINT WE'LL HAVE TO GRAPPLE WITH
WHAT ARE THE ACTUAL FINANCIAL
SCENARIOS THAT, UM ARE PRESENT
AT THE TIME AT THIS POINT THAT
WE SAY WE'RE DOING A LITTLE BIT
OF A HYPOTHETICAL SITUATION, SO
IT'S A REAL CONCERN. UM IT'S ONE
DOWN THE ROAD. THAT ONE WE'RE
TAKING VERY SERIOUSLY. UM AND
WE'LL LOOK FORWARD TO WORKING
WITH THE ADMINISTRATION
LEGISLATURE TO MAKE SURE THAT WE
DON'T UH UH, CREATE A CLIFF. UH,
FOR THE PROVIDERS BASED ON THIS
AND IF I, I COULD JUST ADD TO
THAT, I THINK, UM, ABSOLUTELY
AGREE IT IS. IT IS A REAL AND
LEGITIMATE CONCERN. ALSO I THINK
TO THE TO THE POINTS MADE BY
DIRECTOR BOSS EARLIER, UM IN
ORDER TO MAKE SUCH SIGNIFICANT
CHANGES THAT WE WOULD SEE IT.
YOU KNOW, A HUGE REDUCTION IN
THE TAX REVENUE THAT WE WERE
ABLE TO, YOU KNOW, TO BENEFIT
FROM FROM HAVING AN M èC Ó TAX
. UM èC M S¼ WOULD HAVE TO GO
THROUGH THE FORMAL RULEMAKING
PROCESS. THERE ARE MANY OTHER
STATES WHO HAVE SIMILAR TAXES IN
PLACE, AND SO I THINK THEY IT.
EVEN IF THOSE CHANGES ARE
PROPOSED. I GUESS THE POINT IS,
THERE'S A LONG YOU KNOW THERE'S
A LONG RUNWAY IN A PROCESS TO
SEE IF AND HOW THEY ULTIMATELY
ARE ARE IMPLEMENTED. THANK YOU
AND, UM YOU KNOW MY FINAL
QUESTION. UM. A FEW OF YOU CAN
PROBABLY ANSWER IT. THIS IS, UM,
A HUGE INVESTMENT IN OUR MEDICAL
SYSTEM THAT IS LONG OVERDUE. UM.
AND I'M VERY GRATEFUL FOR, UH,
THE LEGISLATURE AND THE
GOVERNOR, GOVERNOR. WORKING AND
ALL OF THE STAKEHOLDERS COMING
TOGETHER. HOWEVER ONE OF THE
THINGS THAT CAME OUT UH, LAST
UH, WHEN WE WERE DISCUSSING THIS
BEFORE, IS THE FACT THAT WE'RE
NOT REALLY MAKING THE ENTIRE
HEALTH CARE SYSTEM WHOLE. AND UM
, I'LL JUST GIVE AN EXAMPLE WHEN
I CAME BACK AND I STARTED
PRACTICING IN, UH, SAN DIEGO. UM
THERE WAS AN ISSUE WITH BEING
ABLE TO FIND UH, GYNECOLOGY
ONCOLOGIST. THOSE ARE, UM
GYNECOLOGISTS THAT SPECIALIZE IN
TREATING CANCER. VERY DIFFICULT
TO FIND THOSE KIND OF
SPECIALISTS THAT WOULD TAKE ME
SO YOU CAN HAVE A PRIMARY CARE
PROVIDER WHO CAN DIAGNOSE YOUR
HEART CONDITION AND SAY YOU NEED
TO GO TO A CARDIOLOGIST. BUT IF
IT'S HARD TO ACCESS A
CARDIOLOGIST BECAUSE WE HAVEN'T
FIGURED OUT HOW TO TOUCH THAT
SPECIALTY. HOW ARE WE REALLY
IMPROVING ON OUR OVERALL HEALTH
CARE SYSTEM? SO YOU KNOW WE
WOULD HAVE PATIENCE AND I WOULD
BE LIKE, I DON'T KNOW WHERE TO
SEND YOU. I THERE'S ONLY SO MUCH
THAT I CAN DO OR ANYONE CAN DO
IF YOU CAN'T IF YOU DON'T HAVE
ACCESS TO SPECIALTY PHYSICIANS
AS WELL THAT ARE NOT COVERED IN
THIS AND SO JUST WONDERING FROM,
UM, YOUR DIFFERENT PERSPECTIVES.
IF YOU'VE HEARD ANYTHING OF YOUR
CONCERNED ABOUT ANYTHING,
BECAUSE THIS IS AN IS AN ACCESS
ISSUE AS WELL. I. I THINK IT'S
AN INCREDIBLY IMPORTANT POINT
AND ONE THAT WE SHOULD
CONSTANTLY KEEP IN MIND THAT THE
M èC Ó TAX IS A HUGE
OPPORTUNITY AND ONE THAT WE HAVE
NOT BEEN ABLE TO CONSIDER FOR
DECADES HAS BEEN MENTIONED AND
IS ONLY ONE PIECE OF WHAT WILL
HAVE TO BE A MUCH LARGER
SOLUTION THAT THAT THAT YOU'RE
EXACTLY RIGHT. UH, IF WE IF WE
JUST CONGRATULATE OURSELVES ON
ON THIS PIECE, AND THEN THINK
THAT THE HEALTH CARE SAFETY NET
SYSTEM IN CALIFORNIA IS GONNA BE
FINE, WE WILL DELUDE OURSELVES
SO IT IT REQUIRES AN ONGOING
CONVERSATION AND ONGOING PROBLEM
SOLVING WITH ALL STAKEHOLDERS IN
THE DEPARTMENT AND THE
LEGISLATURE FOR YEARS TO COME.
THANK YOU. I JUST WANNA PUT THAT
OUT THERE FOR EVERYONE WHO'S
WATCHING LISTENING IN THE ROOM.
WE'RE ON THE PATH TO PROGRESS,
BUT WE ARE NOT THERE YET. AND IF
WE DO NOT MAKE OUR ENTIRE HEALTH
CARE SYSTEM WHOLE, WE WILL
CONTINUE HAVING THE SAME HEALTH
DISPARITIES THAT WE ARE SEEING.
AND POTENTIALLY EVEN WORSE. SO
ASSEMBLY MEMBER FONTE THIS ALONG
THOSE SAME LINES AND MAYBE THIS
MIGHT BE FOR UH, MISTER LEGER
FROM S¼ IU. UH AS WELL, UH, WE
RECENTLY HELD A, UM. HEARING ON
ENSURING THAT WE HAD THE KIND OF
NECESSARY DIVERSIFICATION OF OUR
WORKFORCE. UH, HEALTH CARE
WORKFORCE KNOW THAT WE
ESSENTIALLY ACROSS THE DIFFERENT
KINDS OF TYPES OF HEALTHCARE
PROVIDERS WE NEED TO PRODUCE
ABOUT 90,000 DIVERSE PROVIDERS A
YEAR IN THE STATE OF CALIFORNIA,
SO WE HAVE A VERY LONG WAY TO
THE CHER POINT AND MAKING SURE
THAT WE'RE MOVING TOWARDS
PROGRESS ON OVERALL WORKFORCE.
UH, THIS 75 MILLION FOR THE
MEDICAL WORKFORCE TO INCREASE
THE MEDICAL WORKFORCE POOL OR
THE 75 MILLION, UH, FOR OUR
UNIVERSITIES IS A STEP IN THE
RIGHT DIRECTION. BUT NOT
COMPLETE ENOUGH. UH, IS THERE AN
OPPORTUNITY TO SPEAK EITHER FROM
èC MA OR FROM S¼ èC IU AROUND
THE WAYS IN WHICH WE NEED TO
MAKE SURE THAT WE'RE
DIVERSIFYING THAT WORK POOL IN A
WAY THAT WE HAVE CONCORDANT, UH
AND CULTURALLY COMPETENT, UH,
PROVIDERS AVAILABLE. I SO I
REALLY APPRECIATE THAT QUESTION.
AND IT UM AND I APPRECIATE YOUR,
UM, COMMITTEE HOLDING THAT AS
WELL. IT'S OF COURSE, AN
INCREDIBLY IMPORTANT ISSUE TO
MAKE SURE THAT YOU'RE NOT ONLY
PROVIDING CARE BUT CULTURALLY
COMPETENT CARE. I MEAN, THAT
THAT'S THE THING WE HAVE TO DO.
UM YOU KNOW EACH GUY, UH, JUST
RELEASED, UM, SOME, UH SOME OF
THE BEST DATA I'VE SEEN. I'VE
BEEN FOLLOWING THIS ISSUE FOR A
LONG TIME ON THE SHORTAGES BY
PROVIDER TYPE OF LANGUAGE. AND
YOU KNOW, I WAS LOOKING IN L A
AND IT WAS 15% DIFFERENCE FROM
THE NUMBER OF PROVIDERS WHO
SPEAK SPANISH VERSUS WHAT OUR
NEED IS OF THE GENERAL
POPULATION. SO SOMETHING THAT
YOU KNOW INCREDIBLE IMPORTANCE.
THERE NOW $75 MILLION FOR BOTH,
OR YOU KNOW, 100 AND 50, FOR
BOTH IS A GOOD INVESTMENT IN
TERMS OF GRADUATE MEDICAL
EDUCATION AND ALSO FOR THE LABOR
MANAGEMENT COOPERATIONS TO THE,
UM, POOL. WE THINK PARTICULARLY
THE LM èC PIECE WILL GIVE THAT
OPPORTUNITY TO TARGET YOU KNOW,
SO FOR IN L A. IF YOU'RE LOOKING
FOR MORE SPANISH SPEAKERS, YOU
COULD TARGET PROGRAMS LOOKING AT
INCUMBENT SPANISH SPEAKERS AND
TRY TO TRAIN THEM UP TO BECOME
NURSES TO BECOME, YOU KNOW, UH,
MENTAL HEALTH PROFESSIONALS OR
RATHER, UM, TYPES THERE, YOU
KNOW, IT'S NOT SPECIFIC, OR AT
LEAST, UM, THE CONVERSATIONS YOU
HAVE HAVEN'T BEEN SPECIFIC
AROUND THE TYPES OF, UH, MONEY
THAT THE LM èC, UH, POOL COULD
FOCUS ON. UM BUT WE ALSO DO
THINK IN SACRAMENTO. POTENTIALLY
YOU HAVE A LITTLE BIT OF A
DIFFERENT DEMOGRAPHIC. SO ONE OF
THE THINGS THAT AT LEAST FROM S¼
èC A U PERSPECTIVE. WE LIKE
ABOUT THE PROPOSAL AROUND THE LM
èC IS IT DOES YOUTUBE
REGIONALIZE A LITTLE BIT WHAT
YOU WOULD DO SO IT'S NOT A ONE
SIZE FITS ALL WHERE YOU COULD
SAY HEY, MAYBE YOU KNOW, IN
SACRAMENTO, WE HAD A HUGE NEED
FOR PROVIDERS OR SPEAKERS. WE
COULD FOCUS. WE COULD FOCUS THE
INVESTMENT THAT WAY. UM
DEPENDING ON SORT OF THE
INDUSTRY NEEDS, SO THAT'S WHY
WE'RE REALLY IN FAVOR OF THAT.
UM I WISH I COULD TELL YOU HOW
MUCH MONEY WE WOULD NEED FOR
THAT. BUT I YOU KNOW, IT'S A
IT'S A GROWING PROBLEM THAT
DIDN'T HAPPEN OVERNIGHT, AND IT
IS GOING TO TAKE A LONG
COMMITMENT TO MAKE SURE THAT WE
GET THERE. WE THINK THAT THIS IS
A GOOD DOWN PAYMENT, BUT WE NEED
MORE AND WILL CONTINUE TO DO
THAT. THE LAST THING I'LL JUST
SAY ON THAT, PARTICULARLY ON THE
LM èC SIDE, WE THINK THAT THIS
IS AN OPPORTUNITY TO SET UP
THESE PROGRAMS WHERE YOU KNOW,
IN CALIFORNIA WE HAVE UP AND
DOWN BUDGETS, AND SO YOU KNOW
WHAT WE SAW. ON THE OTHER SIDE
OF THE, UM, WORKFORCE SIDE IS A
LOT OF CUTS. UM ON A LOT OF OUR
WORKFORCE INVESTMENT. UM AND SO
ONE OF THE THINGS WE WANNA DO IS
MAKE SURE THAT THE INDUSTRY IS
REALLY AT THE TABLE BUYING INTO
IT, BECAUSE I THINK YOU KNOW,
ONE OF THE FIRST CONVERSATIONS
WE HAD WAS REALLY AROUND THE
NEED FOR THE WORKFORCE. AND IF
WE HAVE THE SHORTAGE. WE REALLY
HAVE TO BRING FOLKS TO THE TABLE
AND SAY, HOW ARE WE GOING TO
ADDRESS THIS IN THE LONG TERM,
PARTICULARLY COMING OUT OF THE
PANDEMIC? WHEN WE HAVE SO MANY
WORKERS ARE JUST SAYING ENOUGH?
UM AND SO WE THINK THIS IS A
GOOD OPPORTUNITY, BUT THIS IS
THE START AND IT'S GONNA TAKE
CONTINUED COMMITMENT. UM SO
QUICKLY. I JUST ADD ON THE
POSITION SIDE. WE'VE, UM TO YOUR
POINT. THIS IS GONNA BE A LONG
ISSUE. IT'S A IT'S A BIG ISSUE
THAT WE'RE FACING RIGHT NOW. UM
èC MA SPONSORED A BILL LAST
YEAR THAT BASICALLY ALLOWS
LANGUAGE COURSES TO BE, UH, USED
FOR èC M SO YOU CAN JUST TAKE A
STRAIGHT LANGUAGE COURSES AS
PART OF YOUR CONTINUING
EDUCATION REQUIREMENT. UM ARE
CONTINUING MEDICAL EDUCATION.
THERE'S A CULTURAL COMPETENCY
ELEMENT THAT IS CONTAINED IN IN,
UM EACH èC ME COURSE. BUT
THAT'S OFTEN POST PIPELINE,
RIGHT. WE'RE NOT ACTUALLY WE'RE
KIND OF ADDRESSING, UM UM THINGS
KIND OF DOWN DOWN THE LINE. I'D
SAY THE GRADUATE MEDICAL
EDUCATION FUNDING WITHIN THE M
èC Ó TAX PROPOSAL IS CRUCIAL.
WHAT WE HAVE USED THIS MONEY FOR
IS TYPICALLY, RESIDENCY PROGRAMS
HAS BEEN, YOU KNOW LARGE
TEACHING HOSPITALS WHERE MOST
PHYSICIANS GO TO DO THEIR
RESIDENCY. THIS FUNDING HAS
ALLOWED US TO MAYBE DO A
ROTATION OUT IN A CLINIC IN A
RURAL AREA AND TRY TO FIND
NONTRADITIONAL SETTINGS FOR
RESIDENCY PROGRAMS. ONE THAT
GETS A DO. THE RESIDENT IS A
PRACTICING PHYSICIAN. SO THAT
GETS HIM OUT IN THE WORKFORCE
ALREADY AND TO, UH, YOU STRONG
CORRELATION BETWEEN WHERE YOU DO
YOUR RESIDENCY AND WHERE YOU END
UP PRACTICING, AND SO WE WOULD
LIKE TO BUILD ON THAT IF WE
COULD KIND OF FIGURE OUT A
PIPELINE. WHERE WHERE TRAINING
UH PEOPLE FROM THEIR OWN REGION.
MAYBE THERE'S A LOCAL U èC THAT
THEY CAN GO TO WORK ON IT. AND
THEN WE HAVE A GRADUATE MEDICAL
EDUCATION PROGRAM. THAT KIND OF
RETURNS THEM TO THAT COMMUNITY.
SO UH, WE'VE BEEN TRYING ON IT,
BUT BUT TO YOUR POINT, THERE'S A
LOT MORE WORK TO BE DONE. SO
WE'D LOVE TO COME IN WITH YOUR
OFFICE AND FIGURE OUT IDEAS OF
HOW TO MAKE IT BETTER. THANKS.
THANK YOU. CAN I ADD A LITTLE
BIT TO THAT? UM JUST TO POINT
OUT THAT, YOU KNOW, UM MADAM
CHAIR TO YOUR POINT TOO, ON
MAKING SURE THAT IT'S NOT JUST
COVERAGE THAT WE DO NEED TO HAVE
TRUE ACCESS TO THE ACTUAL CARE,
HELPING PATIENTS BE ABLE TO GET
TO THEIR APPOINTMENTS. BE ABLE
TO HAVE APPOINTMENTS AVAILABLE.
UM YOU KNOW, IN TERMS OF THE
PIPELINE, I WOULD LIKE TO MAKE
SURE THAT WE INCLUDE COMMUNITY
HEALTH WORKERS, AS WELL AS OTHER
WORKERS SUCH AS DOULAS. UM,
THOSE, UM, HEALTH CARE WORKERS
ARE CRUCIAL TO OUR PATIENT
POPULATION IN ACCESSING CARE,
HELPING THEM, NAVI. UM THE
HEALTHCARE SYSTEM, WHICH WE ALL
KNOW IS INCREDIBLY COMPLICATED.
UM EVEN HARD FOR FOLKS WHO WORK
IN HEALTH POLICY TO BE ABLE TO
NAVIGATE AND SO, UM, AS WE START
THINKING THROUGH PIPELINE, UM,
WITH AN EYE TOWARDS HEALTH
EQUITY, I JUST WANT TO MAKE SURE
THAT WE'RE INCLUDING SORT OF NON
CLINICIANS LIKE DOULAS AND
COMMUNITY HEALTH WORKERS AS
WELL. WELL, THANK YOU SO MUCH
FOR YOUR RESPONSES, AND I WANT
TO THANK ASSEMBLY MEMBER BANTA
FOR THAT QUESTION AND BRINGING
IT UP. I. I DID KIND OF SHUDDER
A LITTLE BIT WHEN YOU MENTION
THE FACT THAT THE VAST MAJORITY
OF THE PEOPLE THAT WE TRAIN STAY
HERE, WHICH IS GREAT, BUT WHEN
WE LOOK AT OUR MED SCHOOLS,
THEY'RE NOT NECESSARILY AS
DIVERSE AS THE COMMUNITIES THAT
THEY END UP SERVING. UM AND SO
WHEN WE TALK ABOUT, UM YOU KNOW,
DIFFERENT EQUITY PROGRAMS AND
HOW ARE WE GOING TO DIVERSIFY
OUR OVERALL HEALTH CARE? UH WORK
FILL WITH WE MAY NEED TO BE A
LITTLE BIT MORE CREATIVE AND
THINK OUTSIDE THE BOX AND
DEVELOP PARTNERSHIPS WITH, UM,
SCHOOLS OR OTHER OUTSIDE OF
CALIFORNIA TO, UM IN ENCOURAGE
MORE PEOPLE TO COME IN, AND, UH
AND LIVE AND PRACTICE HERE AND
SERVE THE RESIDENTS HERE SO UM,
JUST THANK YOU SO MUCH FOR THAT
QUESTION. UM WELL, IF THERE ARE
NÓ OTHER COMMENTS OR QUESTIONS
FROM MEMBERS, WE WILL GO TO
PUBLIC COMMENT. UM IF YOU WANT
TO HAVE A STATEMENT, YOU CAN,
UH, COME UP TO THE MIC.
YOU WILL HAVE ONE MINUTE TO MAKE
YOUR COMMENT. THANK YOU. DOCTOR
WEBER. THANK YOU FOR WE'RE
HEARING TERRY MCHALE AND AARON
REID AND ASSOCIATES. WE TAKE
CARE OF 81% OF MEDIC HEALTH THAT
I CAN THIS DISCUSSION. FUTURE
DISCUSSIONS. GO. THANK YOU VERY
MUCH. OK? FOR PRIORITY BUTTON IS
ON AND THAT'S WHY THE MICROPHONE
HØI NÓ SO NÓ YEP. ALL RIGHT.
THANK YOU FOR HAVING US HERE
TODAY. UM, SO GOOD AFTERNOON.
I'M RICHARDSON DAVIS WITH THE
CALIFORNIA COUNCIL OF COMMUNITY,
BEHAVIORAL HEALTH AGENCIES. UM
AND, UH ALL OF OUR MEMBERS WERE
HIT REALLY HARD BY THE PANDEMIC
AS A WELL KIND OF ALIGNING. SOME
OF MY COMMENTS WITH MR ALEGI WAS
SAYING EARLIER FROM THAT èC IU,
UM SO WE DEFINITELY SUPPORT AN
INTEGRATED WORKFORCE. UM UH,
BEST TO SUPPORT THE DIVERSE
NEEDS OF MEDICAL PATIENTS AND,
UM, PHASING OUT THE COST BASED
SERVICES TO A DIRECTED, UH,
DIRECTED PAYMENT. AND THEN YOU
KNOW WHATEVER FLEXIBILITY IS
AVAILABLE IN EXISTING FOR
FUNDING SERVICES AND MM èC Ó
FUNDS IS SUPPORTED BY, UH èC B
HÌ A THANK YOU. HØI GOOD
AFTERNOON, JANICE O'MALLEY WITH
THE AMERICAN FEDERATION OF
STATE, COUNTY AND MUNICIPAL
EMPLOYEES JUST WANTED TO ALSO
ECHO THE COMMENTS MADE BY MY, UH
UH AND COUNTERPARTS. UM GRATEFUL
TO THE ADMINISTRATION, UM, AND
THE LEGISLATURE FOR BRINGING
TOGETHER, UH, INDUSTRY AND LABOR
AND ALL THE STAKEHOLDERS TO UH,
SUPPORT THE INVESTMENT IN COURSE
AND IN MEDICAL REIMBURSEMENTS. I
JUST WANTED TO SPECIFICALLY
HIGHLIGHT, UM ONE AREA THAT
WASN'T SPOKEN ABOUT AND. DOLLARS
TOWARDS GROUND EMERGENCY
TRANSPORTATION. UM, ASKS, ASKS
ME REPRESENTS. THE EMTS AND
PARAMEDICS, UH, THAT PROVIDE A
SERVICE THROUGH AMR. UM THEY
HAVE. TYPICALLY THE INDUSTRY HAS
BEEN HAS RECEIVED LOW COST
REIMBURSEMENT, UM, FOR MEDICARE
AND MEDICAID PAYERS. UM ABOUT
50% OF TRANSPORTS RECEIVED BELOW
COST REIMBURSEMENT AND THIS
UNDER COMPENSATION OF CARE
REALLY INHIBITS THE ABILITY OF
THESE FIRMS TO MEET COSTS LIKE
WAGES, UH, TO PAY FOR GAS TO
STOCK THE RIGS. SO JUST WANTED
TO AGAIN. THANK THE LEGISLATURE
AND, UM, THE ADMINISTRATION FOR
MAINTAINING THOSE INVESTMENTS.
THANK YOU. GOOD AFTERNOON, MADAM
CHAIR CONNIE DELGADO ON BEHALF
OF THE DISTRICT HOSPITAL
LEADERSHIP FORUM. THESE ARE THE
33 DISTRICT AND MUNICIPAL
HOSPITALS IN THE STATE STAND
ALONE FACILITIES, AND WE
APPRECIATE THE ADMINISTRATION'S
CONTINUED, UM, COMMITMENT TO
USING A PORTION OF THE M èC Ó
PROCEED PROCEED FOR THE MEDI
RATE INCREASE. WE BELIEVE THESE
INVESTMENTS ARE CRITICAL TO THE
STATE AND THE HEALTH CARE
DELIVERY SYSTEM, ESPECIALLY FOR
LIKE COUNTIES LIKE TULARE, WHERE
60% OF THE POPULATION ARE
ENROLLED IN ME, YOU KNOW, WE
THIS AS A REALLY IMPORTANT STEP
FORWARD. UH, WE URGE THE
CONTINUED COMMITMENT, UM TO
THESE TARGET MEDICAL INVESTMENTS
, AND WE ALSO WOULD LIKE TO
ENSURE THAT DISTRICT HOSPITALS
CONTINUE TO BE ELIGIBLE FOR
THESE FUNDS. THANK YOU VERY
MUCH. GOOD AFTERNOON, KATIE
LEIGHTON ON BEHALF OF THE
CHILDREN'S SPECIALTY CARE
COALITION. WE REPRESENT OVER
THREE 1000 PEDIATRIC SPECIALTY
PHYSICIANS THROUGHOUT THE STATE
WHO ARE CRITICAL OF SAFETY NET
PROVIDERS FOR CHILDREN AND YOUTH
WITH MEDICAL COMPLEXITY. UM ON
PROPOSAL ONE. WE SUPPORT THE
STATE'S PROPOSED EFFORT TO
INCREASE THE M èC Ó TAX BY
$1.5 BILLION ON PROPOSAL TWO. WE
ARE CONCERNED ABOUT THE FUND
SHIFT FROM PROVIDER RATE
INCREASES INTO THE GENERAL FUND,
UM, AS PREDICTABLE AND
SUSTAINABLE RATE INCREASES ARE
CRITICAL TO THE MEDICAL PROVIDER
NETWORK. UM ON PROPOSAL THREE.
WE'RE VERY PLEASED TO SEE THE
FOCUS ON SPECIALTY CARE IN THE
2000. UM 2025 TARGETED RATE
INCREASES. THE PEDIATRIC
SPECIALTY CARE WORKFORCE IS
AILING FROM CHRONIC UNDERFUNDING
OVER THE LAST 20 YEARS, UM, FOR
A NUMBER OF PEDIATRIC
SUBSPECIALTIES 50% OF FELLOWSHIP
SLOTS ARE NOW GOING UNFILLED AND
FAMILIES ACROSS, UH, CALIFORNIA
ARE FEELING THE RESULTS OF, UM
THE YOU KNOW THE EFFECTS OF THE
RESULTING ACCESS CHALLENGES. SO
WE THANK DHCS FOR PROPOSING TO
RAISE E AND M CODES FOR
SPECIALTY CARE OFFICE VISITS TO
100% OF MEDICARE AND THE
INCLUSION OF THE EQUITY AND
GEOGRAPHIC ADJUSTMENTS. UM
WITHOUT FURTHER DETAIL, THOUGH,
ON THE OTHER PROCEDURE CODES
INCLUDED IN THE PLAN, WE DO
REMAIN CONCERNED THAT GREATER
INVESTMENT IS NEEDED TO
STABILIZE THIS NETWORK, IMPROVE
THE PIPELINE AND MOVE THE NEEDLE
ON ACCESS. SO WE HAVE SUBMITTED
SOME MORE. UM SPECIFIC
RECOMMENDATIONS TO Dð HÌ èC S¼
AND LOOK FORWARD TO WORKING WITH
THE ADMINISTRATION AND THE
LEGISLATURE OVER THE COMING
MONTHS. THANK YOU. GOOD
AFTERNOON, ABBY ALVAREZ WITH THE
CALIFORNIA ASSOCIATION FOR ADULT
DAY SERVICES, WHICH, UH, WHICH
SERVES 35,000 VULNERABLE
CALIFORNIANS LIVING AT THE
INTERSECTION OF BEING LOW INCOME
, ELDERLY AND DISABLED FIRST èC
A Dð SUPPORTS THE POLICY
DESCRIBED WITHIN PROPOSAL THREE
BULLET THREE IN THE AGENDA THAT
CREATES THE MEDICAL FEE FOR
SERVICE RATE AS THE FLOOR BELOW
WHICH MANAGED CARE CANNOT PAY.
THIS IS SOMETHING WE'VE BEEN
WORKING TO CODIFY WITHIN OUR
PROVIDER NETWORK. UM, AS WE HAVE
FOUND SEVERAL M èC, UH èC P S¼
ARE PAYING BELOW THE, UH, FLOOR
AT THE AT THE CURRENT MOMENT.
SECONDLY THE èC A Dð Tð S¼
PROVIDER NETWORK IS NOT PART OF
THE M èC Ó TAX DEAL AND
DESPERATELY NEEDS GREAT RELIEF,
SEA BASS OR, UH, COMMUNITY BASED
ADULT SERVICES HAS NOT HAD A
MEDICAL RATE ADJUSTMENT IN 15
YEARS AND THE IMPACT OF THAT
CLOSURES AND CENTERS ON THE
BRINK. THANK YOU. GOOD AFTERNOON
, I CHAIR JED HAMPTON OUT WITH
THE CALIFORNIA ASSOCIATION OF
HEALTH PLANS THAT REPRESENTING
40 THREE Kò Kò LICENSE PLANS,
UH, DELIVERING HIGH QUALITY
COORDINATING CARE TO 27 MILLION
PLUS CALIFORNIANS. UH, INCLUDING
14.1 MILLION. UH, MEDICA MANAGED
CARE MEMBERS. UH, THANK YOU FOR
THE OPPORTUNITY TO SPEAK TODAY
AND FOR AND FOR HOLDING THIS
HEARING, UM, YOU KNOW,
CALIFORNIA'S HEALTH PLAN
SUPPORTED AN M èC Ó TAX IN
LAST YEAR'S BUDGET BECAUSE IT
WAS AFFORDABLE AND THE REVENUE
WILL BE USED TO SUPPLEMENT AND
NOT SUPPLANT RESOURCES FOR THE
MEDI PROGRAM. WE ARE PLEASED
THAT THE GOVERNOR'S PROPOSED
BUDGET IS HONORING ITS
COMMITMENT TO INCREASE FUNDING
FOR MEDICAL PROVIDERS, UH, WHICH
WILL SIGNIFICANTLY IMPROVE
ACCESS TO COVERAGE FOR MEDICAL
ENROLLEES. HEALTH PLANS ARE ALSO
SUPPORTIVE OF THE
ADMINISTRATION'S BUDGET PROPOSAL
TO INCREASE THE MEDI CAL
COMPONENT OF THE M èC Ó TAX TO
GENERATE ADDITIONAL REVENUE
DURING OUR BUDGET CRISIS. UH,
YOU KNOW CAPS MEMBERS, UM, IN
THE COMMERCIAL MARKET, AS WELL
AS IN THE PUBLIC PROGRAMS. UM,
OUR FUNDING THE MANAGED CARE
ORGANIZATION TAX, AND WE'LL PLAY
A CRITICAL ROLE IN DISTRIBUTING
THE ASSOCIATED TARGET RATE
INCREASES. NÓ OUR MEMBERS ARE
CURRENTLY WORKING WITH PERMANENT
HEALTHCARE SERVICES ON MAKING
THESE IMPROVEMENTS AND PRIMARY
AND SPECIALTY CARE, UM, A
REALITY THROUGH THESE TARGET
RATE INCREASES. SO AGAIN. WE
THANK YOU VERY MUCH FOR THE
TIME. UH, WE DO HAVE A FEW, UM
OTHER ELEMENTS THAT WE'D LIKE TO
TALK TO YOU AT A AT A LATER
DATE. SO APPRECIATE IT. THANK
YOU. SORRY. MUCH SHORTER THAN
JED. ALL RIGHT, UH, RYAN SPENCER
ON BEHALF OF SEVERAL CLIENTS.
FIRST THE AMERICAN COLLEGE OF Ó
BGY N S¼ DISTRICT NINE,
APPRECIATES THE LATEST AND LONG
OVERDUE PROPOSAL TO INCREASE THE
SWAP OF OBSTETRIC. RATES FROM
87% TO 100% IN 2025 WITH REGARD
TO SPECIALTY CARE, THE
CALIFORNIA PEDIATRIC MEDICAL
ASSOCIATION SPORTS A TARGETED
STRATEGY AS STATED IN THE AGENDA
THAT PROVIDES UNIFORM RATE
INCREASES FOR PROFESSIONAL
SERVICE PROCEDURAL CODES,
REGARDLESS OF THE PROVIDER,
SPECIALLY, SUCH AS PODIATRY, WHO
ARE BILLING THE SERVICE ON
BEHALF OF THE CALIFORNIA SOCIETY
OF PATHOLOGISTS IN THE
CALIFORNIA RADIOLOGICAL SOCIETY.
WE APPRECIATE THE RECENT
COMMENTS AND COMMUNICATIONS WITH
THE DEPARTMENT REGARDING THE Tð
R. I S¼ APPLICATION TO
RADIOLOGISTS PATHOLOGISTS.
HOWEVER, THE INCREASE IS STILL
UNCLEAR, WHILE THE M èC Ó
PROPOSAL INCLUDES ALL PHYSICIAN
SERVICES FOR RADIOLOGY AND
PATHOLOGY, IS SPECIFICALLY
EXEMPTS CLINICAL LAB AND
RADIOLOGY SERVICES, WHICH ARE
BROADLY DEFINED IN REGULATION.
IN RADIOLOGY AND PATHOLOGY. THEY
ARE PROFESSIONAL AND TECHNICAL
OPPONENTS FURTHER CLARIFICATION.
WE APPRECIATE ON WHAT HAPPENS
WHEN A RADIOLOGY OR PATHOLOGY
GROUP WHO OWN A FREESTANDING
IMAGING CENTER OR LAB
RESPECTFULLY BUILD A GLOBAL
CHARGE, WHICH INCLUDES BOTH
COMPONENTS. THANK YOU FOR YOUR
TIME. AND I THANK YOU, MADAM
CHAIR, UH, SAY YOUR BRIDGE ON
BEHALF OF THE ASSOCIATION OF
CALIFORNIA HEALTH CARE DISTRICTS
. WE REPRESENT THE 77 HEALTH
CARE DISTRICTS THROUGHOUT THE
STATE OF CALIFORNIA THAT ARE
ALSO PUBLIC PROVIDERS. I JUST
WANT TO TAKE A MOMENT TO THANK
THE ADMINISTRATION AND THE WORK
OF THIS COMMITTEE AS WELL AS THE
PANEL ECHO THE COMMENTS OF THE
DISTRICT HOSPITAL LEADERSHIP
FORUM, AS WELL AS THE CALIFORNIA
HOSPITAL ASSOCIATION, HOWEVER,
DO WANT TO MENTION THAT WE SHARE
THE SAME CONCERN AS YOU THAT THE
MONEY ACTUALLY GOES TO
ADDRESSING ACCESS TO CARE AND
BARRIER ISSUES THAT ARE FELT IN
OUR RURAL COMMUNITIES. THANK YOU
SO MUCH FOR YOUR TIME. GOOD
AFTERNOON CHAIR AND MEMBERS
ANDRE RIVERA ON BEHALF OF THE
CALIFORNIA PAN ETHNIC HEALTH
NETWORK. èC P IS SUPPORTIVE OF
THE ADMINISTRATION'S PROPOSAL TO
RAISE THE M èC Ó TAX. FEDERAL
DRAW DOWN BY 1.5 BILLION IN
ORDER TO AVOID FURTHER CUTS TO
THE PROGRAM. WE ALSO APPRECIATE
THE INCLUSION OF EQUITY
ADJUSTMENTS PROPOSED FOR THE M
èC Ó TAX TO INCENTIVIZE
QUALITY AND EQUITY AND CARE.
HOWEVER WE DO EXPRESS CONCERNS
PERTAINING TO THE LACK OF
BENCHMARKS THAT REQUIRE A
SPECIFIC REDUCTION IN RACIAL
DISPARITIES. UM, THE, UH, NÓ.
FOR UH, FOR PROVIDERS TO
PARTICIPATE IN THE DATA EXCHANGE
FRAMEWORK AND THE LACK OF A
RIGOROUS PUBLIC, UH, STAKEHOLDER
ENGAGEMENT PROCESS WITH Dð HÌ
èC S¼ TO DEVELOP THE EQUITY
INDEX. WITHOUT THESE SPECIFIC
PARAMETERS, THE ENHANCEMENTS
WILL FAIL TO TARGET COMMUNITIES
BASED ON RACE, ETHNICITY AND
OTHER SOCIO DEMOGRAPHIC
INDICATORS, WHICH ARE NOT
ACCOUNTED FOR IN PLACE BASED
INDEX MODELS, AND WE DO MISS THE
OPPORTUNITY TO INTENTIONALLY
IMPROVE. UH, RACIAL EQUITY AND
CLINICAL CARE. WE URGE THE
LEGISLATURE TO, UH, CONSIDER
ADDITIONAL QUALITY MEASURES TO
SUPPORT THE DISTRIBUTION OF
RESOURCES AND LOOK FORWARD TO
ENGAGING WITH YOU IN THE
PROCESS. GOOD AFTERNOON, MADAM
CHAIR DIANA DOUGLAS WITH HEALTH
ACCESS CALIFORNIA HEALTH ACCESS
SUPPORTS THE PROPOSED REQUESTED
INCREASE IN THE M èC Ó TAX,
ALONG WITH TARGETED RATE
INCREASES, MOVING US CLOSER TO
100% OF MEDICARE WITH A GOAL TO
IMPROVE ACCESS FOR THE 14
MILLION CALIFORNIANS IN ME, WE
ALSO SUPPORT THE EQUITY
ADJUSTMENTS AND ENCOURAGE
THOUGHTFUL CONSIDERATION OF HOW
THE ADJUSTMENTS WILL BE TARGETED
TO ENSURE THE BEST REACH INTO
COMMUNITIES THAT ARE MOST IN
NEED. FINALLY HEALTH ACCESS ALSO
SUPPORTS INVESTMENTS IN
COMMUNITY HEALTH WORKERS FOR THE
CRITICAL ROLE. THEY PLAY IN OUR
SAFETY NET AND ENSURING THEY
HAVE THE REIMBURSEMENTS
AVAILABLE TO DO WHAT THEY NEED.
THANK YOU SO MUCH. THANK YOU,
MADAM CHAIR MARISSA MONTANO AT
THE CALIFORNIA ACADEMY OF FAMILY
PHYSICIANS REPRESENTING OVER
10,000 FAMILY MEDICINE. UH,
PROVIDERS IN CALIFORNIA, CAL. UH
èC, A FP APPRECIATES THE
LEGISLATURE AND ADMINISTRATION
COMMIT COMMITMENT TO IMPROVING
ACCESS TO PRIMARY CARE AND
SUPPORT THE STATE PROPOSALS TO
INCREASE THE M èC TAX AND
GENERATED ADDITIONAL REVENUE FOR
PROVIDERS IN THE MEDICAL PROGRAM
. WE DO LOOK FORWARD TO SEEING
MORE DETAIL, ESPECIALLY AROUND
THE TARGETED RATE INCREASES FOR
PRIMARY CARE PROVIDERS. UM, THIS
IS AN IMPORTANT IN HEALTH
BECAUSE INVESTING IN PRIMARY
CARE LOWERS COST IMPROVED HEALTH
OUTCOMES AND ADVANTAGES. HEALTH
EQUITY RIGHT NOW. PRIMARY CARE
IS GROSSLY UNDERFUNDED, WHERE
NATIONAL DATA SHOWS THAT WE ONLY
SPEND 5 TO 7% OF HEALTHCARE
DOLLARS ON PRIMARY CARE IN
CALIFORNIA DOESN'T DO MUCH
BETTER, THE MORE WE INVEST IN
PRIMARY CARE, INCLUDING BRIDGING
GAPS AND PAY, THE MORE WE CAN
GROW AND EXPAND THE PRIMARY CARE
WORKFORCE. UM THANK YOU FOR YOUR
TIME AND CONSIDERATION, AND WE
LOOK FORWARD TO WORKING WITH THE
ADMINISTRATION AND LEGISLATURE
TO ENSURE THAT CALIFORNIA
CONTINUES TO BUILD THE PRIMARY
CARE PHYSICIAN WORKFORCE. GOOD
AFTERNOON, MADAM CHAIR. MY NAME
IS TRENT MURPHY AND I'M SPEAKING
ON BEHALF OF THE CALIFORNIA
ASSOCIATION OF ALCOHOL AND DRUG
PROGRAM EXECUTIVES ALSO KNOWN AS
èC, A Dð P. MOST OF OUR MEMBERS
ARE MEDICAL PROVIDERS PROVIDE
MENTAL HEALTH AND SUBSTANCE USE
DISORDER SERVICES STATEWIDE. èC
A Dð P SUPPORTS THE MCO TAX
PROPOSAL AS IT WILL HELP BOOST
RATE INCREASES FOR MEDICAL
PROVIDERS AND THE STATE CAN USE
M èC Ó TAX REVENUE TO AUGMENT
MEDICAL PROVIDER RATES. WE
BELIEVE THESE RATE INCREASES
WILL PROMOTE GREATER PROVIDER
PARTICIPATION IN THE MEDI CAL
PROGRAM. WHICH WILL IN TURN
EXPAND THE HEALTHCARE WORKFORCE.
THE SECOND PHASE OF RATE
INCREASES AND INVESTMENTS WILL
FOCUS ON ADDITIONAL INCREASES
FOR PRIMARY CARE, MATERNITY CARE
AND NONSPECIALTY MENTAL HEALTH
SERVICES, INCLUDING BEHAVIORAL
HEALTH CARE FOR MEMBERS IN
HOSPITAL, EMERGENCY DEPARTMENTS
AND INSTITUTIONAL LAWN CARE
SETTINGS. THANK YOU FOR YOUR
TIME. GOOD EVENING. MY NAME IS
Kò YAMAMOTO. I'M WITH THE
CALIFORNIA PAN ETHNIC HEALTH
NETWORK. UH, FIRST, I'D LIKE TO
EXPRESS APPRECIATION FOR THE
INCLUSION OF EQUITY ENHANCEMENTS
IN THE N èC Ó TAX. I WOULD
LIKE TO URGE THE LEGISLATURE TO,
UH, USE THE M èC Ó TAX AND
ALREADY ALLOCATED BUT UNUSED
FUNDS TO SUPPORT UM, TEAM BASED
CARE MODELS LIKE, UH, COMMUNITY
HEALTH WORKERS, FROMME TOROS AND
, UH, REPRESENTATIVES. UM,
GROUPS LIKE THAT ARE, UH, A
CULTURALLY. AND LINGUISTICALLY
DIVERSE. UH WORKFORCE. UM THEY
INCREASE ACCESS. THEY PLAY A
CRITICAL ROLE IN, UH, PROVIDING
EQUITABLE QUALITY CARE, UH, FOR
ALL CALIFORNIANS, AND THEY'RE
SEVERELY UNDERPAID. THEIR
CURRENT RATES, UH, ONLY COVER
38% OF THEIR TOTAL COST. SO AT
THE SAME TIME THAT THEY'RE
PROVIDING, UH, EXTREMELY
IMPORTANT CARE THEY THEMSELVES
ARE FIGHTING AGAINST, UH, THE
CEILING OF POVERTY AS WE'D LIKE
TO, UH, URGE THE LEGISLATURE TO
USE THOSE FUNDS TO SUPPORT UH,
PHYSICIAN. AS WELL AS NON
PHYSICIANS IN IN THIS INCREDIBLY
IMPORTANT WORK, AND THANK YOU
FOR YOUR WORK. GOOD AFTERNOON,
MADAM CHAIR. I'M BRYCE DOCHERTY
ON BEHALF OF THE CALIFORNIA
ORTHOTIC AND PROSTHETIC
ASSOCIATION WERE REQUESTING M
èC Ó TAX INVESTMENT IN
ORTHOTIC OUTPATIENT SERVICES FOR
OUR MOST VULNERABLE MEDICAL
PATIENTS THAT ARE SUFFERING FROM
AN AMPUTEE. TO LIMB LOSS TO LIMB
INDIFFERENCE. ACCORDING TO THE
JOURNAL OF NEUROG ENGINEERING
AND REHABILITATION. PATIENTS WHO
RECEIVE TIMELY ORTHOTIC AND
PROSTHETIC CARE HAD COMPARABLE
OR LOWER TOTAL HEALTH CARE COSTS
THAN A COMPARISON GROUP OF
UNTREATED PATIENTS, SPECIFICALLY
PATIENTS WHO RECEIVE LOWER
EXTREMITY ORTHOTICS OR PATIENTS
WHO RECEIVE SPINAL ORTHOTIC
TREATMENT HAD EPISODES OF CARE
THAT WERE THOUSANDS OF DOLLARS
LOWER THAN COMPARABLE NON
TREATED PATIENTS, AMONG OTHER
IDENTIFIED BENEFITS TO
PROSTHETIC CARE. PROSTHETIC USE,
PROSTHESIS USERS HAD A
SIGNIFICANTLY LOWER
HOSPITALIZATION RATE THAN THAN A
COMPARISON GROUP OF PATIENTS,
FURTHER, RESULTING IN LOWER
MEDICARE PAYMENTS FOR ACUTE CARE
HOSPITALIZATIONS ACROSS THEIR
ANALYSIS. THE RESULTS CUMULATIVE
SUGGESTS THAT ORTHOTIC AND
PROSTHETIC SERVICES PROVIDE
VALUE TO THE MEDICARE PROGRAM
AND POTENTIALLY TO OTHER PAYERS
AS WELL AS THE PATIENTS. BOTTOM
LINE HERE IS THE ME M èC Ó TAX
INVESTMENT IN ORTHOTICS AND
PROSTHETICS. SERVICES WILL
PROVIDE VALUE AND COST SAVINGS
TO THE MEDICAL PROGRAM AND TO
THE PATIENTS. THANK YOU. GOOD
AFTERNOON, MADAM CHAIR WHITNEY
FRANCIS WITH THE WESTERN CENTER
ON LAW AND POVERTY. UM, I JUST
WANTED TO START BY SAYING THAT
WE ARE ALIGNED WITH THE
CALIFORNIA PAN ETHNIC HEALTH
NETWORK ON THE INCLUSION OF
EQUITY ENHANCEMENTS. UM WE ALSO
SUPPORT INCREASING THE M èC Ó
TAX TO BRING TO THE MAXIMUM
FEDERALLY ALLOWED AMOUNT TO
BRING IN ADDITIONAL STATE
REVENUE AND GENERAL FUND SHIFT
TO AVOID CUTS IN SAFETY NET
PROGRAMS THAT LOW INCOME
CALIFORNIANS RELY ON. WE ALSO
REQUEST THE LEGISLATURE
INCREASE. THE COMMUNITY HEALTH
WORKERS MEDICAL REIMBURSEMENT
RATE TO INCREASE ACCESS TO
COMMUNITY HEALTH WORKERS,
RECOGNIZING THAT THEY PLAY A KEY
ROLE AS TRUSTED PARTNERS AND
SUPPORTING ME MEMBERS IN
ADVANCING HEALTH EQUITY. THANK
YOU. GOOD AFTERNOON, MADAM CHAIR
AND MEMBERS THE COLE WEDMAN ON
BEHALF OF THE CHILDREN'S
PARTNERSHIP, ECHOING èC, P AND
WESTERN CENTER ON LAW AND
POVERTY IN SUPPORT OF INCREASING
RATES FOR COMMUNITY HEALTH
WORKERS AND VERY APPRECIATIVE OF
THE EQUITY MEASURES IN THE M èC
Ó TAX. WELL, ONCE AGAIN, I
WOULD LIKE TO THANK, UM THE
ADMINISTRATION, THE L, A Ó, ALL
OF THE STAKEHOLDERS AND THE
PUBLIC FOR, UH, FOR COMING AND
PARTICIPATING. NOT ONLY TODAY,
BUT THIS HAS BEEN, UM, OVER A
YEAR LONG PROCESS. AND SO I
REALLY WANT TO THANK EVERYONE,
UM, FOR THEIR PARTICIPATION. MY
HOPE IS THAT WHAT WE HAVE DONE
DESPITE WHAT OUR BUDGET OUTLOOK
LOOKS IS REALLY JUST THE
BEGINNING OF A FINALLY MAKING
OUR HEALTH CARE SYSTEM. AND WE
CAN ONLY DO THAT IF WE ALL WORK
TOGETHER. SO ONCE AGAIN, I WANNA
THANK EVERYONE AND THIS HEARING
IS ADJOURNED.