State May Delay Provider Cuts Until After December Court Date

There are reports that the state Department of Health Care Services may delay the implementation of 10 percent Medi-Cal provider rate cuts until after a key federal court date scheduled for December 19th. 

The Medicaid Defense Fund has filed a federal suit seeking a preliminary injunction to halt the cuts in this budget year, with a motion to also permanently prevent the provider reductions in the future. 

The lawsuit – Managed Care Pharmacy, Independent Living Center of Southern California, et al v. Kathleen Sebelius and Toby Douglas - was filed on November 4 in the U.S. District Court in Los Angeles. 

The state recently received federal approval to enact up to $623 million in cuts to the state’s Medi-Cal program as part of the 2011-12 budget. The Centers for Medicare and Medicaid Services (CMS) approved a 10 percent provider rate reduction for outpatient services, which affects physicians, clinics, optometrists, therapists, and laboratories, as well as for services like dental, durable medical equipment, and pharmacy. CMS also approved new 10 percent provider rate reductions for freestanding nursing and adult subacute care facilities as well as rate freezes for certain nursing homes. 

The state’s Medi-Cal program serves more than 7.6 million enrollees, and California spends more than $14 billion on the program annually.

State Reaches Settlement on Adult Day Health Care Lawsuit

The Department of Health Care Services (DHCS) has announced reaching a settlement on a lawsuit challenging the elimination of the Adult Day Health Care (ADHC) program. 

The settlement calls for the creation of a new program called Community-Based Adult Services (CBAS), which will become effective on March 1, 2012. 

Eligibility for the new CBAS program will be based on medical necessity as determined by a state medical professional, and benefits will be coordinated and provided by managed care plans. 

The state will still phase out the existing ADHC program by March 2012 as part of the 2011-12 budget plan, and, under the new settlement, still anticipates saving approximately $28 million in 2011-12 and $92 million in 2012-13. 

The lawsuit had been brought by Disability Rights California and several plaintiffs affected by the elimination of the ADHC program. To view the case, Esther Darling et. al. v. Toby Douglas, Director of California Department of Health Care Services (formerly Brantley v. Maxwell-Jolly and Cota v. Maxwell-Jolly), click on the case name.

CSAC Annual Meeting Offers Workshops and Meetings on Top HHS Issues

The 117th CSAC Annual Meeting in San Francisco City and County will offer county professionals a wide array of workshops and meetings on critical health and human services issues of note in counties today. Conference registration is available on-site during the annual meeting, which runs November 29 through December 1. Please join us for the following events: 

Health Care Reform – What Happens After 2014?

As California remains focused on implementation of federal health reform, there are many unexplored issues for California counties post-implementation. Learn about the county health care reform challenges after 2014 – measuring and funding care for the residual uninsured population; transforming public health systems, and counties’ health care obligations after the Affordable Care Act is implemented. Panelists will also explore potential opportunities for counties, including cost saving ideas, health system development, and strategic planning in public health. 

Tuesday, November 29, 3:00 pm to 4:30 pm
211 – The San Diego Story

Join San Diego County Supervisor Greg Cox to learn how counties are implementing 2-1-1 referral systems for everything from social services to public safety to disaster assistance. See how 2-1-1 systems have evolved into innovative, indispensable, and cost-effective tools for communicating and serving all county residents, from veterans to young children. 

Tuesday, November 29, 3:00 pm to 4:30 pm
Realignment 2011: Everything Changes

Realignment 2011 challenges counties to rethink how to fit new clients and populations into existing service models. To what extent, however, are the new families that counties will be serving the same families they have always served? How can counties think broadly about their service delivery models in way that recognize this reality? When service populations are interrelated, success in one area breeds success, and savings, in others. This workshop will help county leaders develop the mindset to implement this cycle of success. Wednesday, November 30, 10 a.m. to noon. 

Wednesday, November 30, 2:00 pm - 4:00 pm
Health and Human Services Policy Committee

Join CSAC Health and Human Services Policy Committee chair and Santa Clara County Supervisor Liz Kniss for a wide-ranging conversation on the delivery of health and human services in California today. 

We are especially pleased to announce that California Health and Human Services Agency Secretary Diana Dooley will join the meeting to offer her remarks on the agency’s role during these challenging fiscal times. The committee will also hear a panel discussion on the human services and behavioral services aspects of 2011 Realignment. Other features include presentations on health care delivery innovation within public hospital systems and an update on Congressional reauthorization of a key FDA law.