Commissioner Dave Jones issues emergency regulation

On Monday, January 5, California’s Insurance Commissioner Dave Jones was sworn-in for a second term. Immediately after being sworn-in, Commissioner Jones issued an emergency regulation to establish stronger requirements for health insurers to create and maintain sufficient medical provider networks to provide timely access to medical care.

In 2014, consumers identified problems with access to doctors, hospitals, and other medical providers. Consumer complaints included trouble getting appointments with doctors, traveling long distances to receive in-network medical care or seeking care from doctors who appeared to be in their provider directory, but were not.

• The Commissioners emergency regulation requires health insurers to:
• Include an adequate number of primary care providers accepting new patients to accommodate recent and ongoing anticipated enrollment growth;
• Include an adequate number of primary care providers and specialists with admitting and practice privileges at network hospitals;
• Consider frequency and type of treatment needed to provide mental health and substance use disorder care when creating a provider network;
• Adhere to and monitor new appointment wait time standards;
• Report information about networks and changes to the networks to the Department of Insurance on an ongoing basis;
• Provide accurate provider network directories to the Department and make them available both to policyholders and the public;
• Make arrangements to provide out-of-network care at in-network prices when there are insufficient in-network care providers;
• Require network facilities to inform patients that an out-of-network medical provider will participate in the non-emergency procedure or care, before the care is provided, allowing the patient to decline if they so choose.

The Department of Justice issues a press release regarding Commissioner Jones’ emergency regulation, which can be found here.

Senate Committee Membership

Senate President pro Tempore De León announced his nominees for Senate standing committee membership, which was later formally adopted by the Senate Rules Committee. Committee membership for Health and Human Services related committees are as follows:

Budget Subcommittee #3 – Health and Human Services:

Senator Holly Mitchell will chair Budget Subcommittee # 3. Members include Senators William Monning and Jeff Stone.

Senate Health Committee

Senate Health Committee will continue to be chaired by Senator Ed Hernandez alongside Senator Janet Nguyen serving as vice chair. Committee members include Senators Isadore Hall, Holly Mitchell, Jim Neilsen, Richard Pan, Richard Roth and Lois Wolk.

Senate Human Services Committee

Newly elected Senator Mike McGuire will chair the Senate Human Services Committee with Senator Tom Berryhill serving as vice chair. Members include Senators Loni Hancock, Carol Liu, and Janet Nguyen.

California State Auditor deems the Department of Developmental Services’ Parental Fee Program ‘woefully inefficient and inconsistent’

This week, the California State Auditor released its audit report of the Department of Developmental Services’ (DDS) Parental Fee Program. The State Auditor found the parental fee assessments to be:

• Riddled with unnecessary delays, lack of documentation, incorrect calculations, and inconsistent staff interpretations;
• Lacking requirements for parent documentation for all income and expenses;
• Untimely for certain families as regional centers are not required monthly reports;
• Out of compliance with requirements to annually reassess parental fee accounts;
• Inadequate as 95 percent of appealed fee assessments from fiscal years 2011-12 through 2013-14 were reduced; and
• Lacking standardization for subsequent reassessment of the fee as it is currently based on the judgment of a four-member committee.

The State Auditor also determined that DDS collects only about 60 percent of assessed fees.

Additional information including the full report can be found here.

New Bill pertaining to Laura’s Law

AB 59
Request for Comment

Assemblymember Marie Waldron introduced AB 59, a bill pertaining to assisted outpatient treatment for mental health services in regards to Laura’s law.

Recall that in 2002, Governor Gray Davis signed AB 1421 (Chapter 1017, Statutes of 2002) into law, also known as Laura’s Law, in memory of Laura Wilcox, a 19-year-old college student who was killed by a severely mentally ill man who was not adhering to prescribed mental health treatment. Laura’s Law gives counties the option to implement involuntary assisted outpatient treatment programs for individuals who have difficulty maintaining their mental health stability in the community and have frequent hospitalizations and contact with law enforcement related to untreated or undertreated mental illness. Laura’s Law requires a county board of supervisors to authorize implementation by resolution and to make a finding that access to voluntary mental health programs would not be reduced as a result of implementation.

AB 59, as introduced, would no longer allow counties the option, but would instead require all counties to implement Laura’s law. Among the 58 California counties, 7 have adopted resolutions to implement Laura’s law – Contra Costa, Los Angeles, Nevada, Orange, Placer, San Francisco, and Yolo.

This bill would also extend provisions in current law to allow the court to order a person to obtain assisted outpatient treatment for an initial period up to 12 months, if they meet the requisite criteria. Additionally, AB 59 would, upon release of a person from an intensive or postcertification treatment, authorize staff from where the treatment was provided to evaluate whether the person meets the criteria for assisted outpatient treatment. If the professional staff determines the person meets the criteria for assisted outpatient treatment, they would then request that the county mental health director file a petition with the superior court. Please note the provisions in this bill would constitute a state mandate.

CSAC has not yet taken a position on this bill. We welcome your input and comments as this bill moves forward.

AB 85 Diversion

Governor Brown’s budget included an estimate of $698 million in county health realignment funds to be diverted back to the state in 2015-16. This estimate is roughly $26 million lower than the current year redirection. Please note that the Department of Health Care Services will be working directly with each county that chose the formula option in AB 85 to update the 2015-16 estimates for the May revise. The county-by-county breakdown of the $698 million, although subject to change, are provided below.

2013-14 County Caseload – 1991 Realignment

For your information, the 2013-14 county caseload numbers for 1991 Realignment are provided here.

Continuum of Care Reform

One proposal in the budget relates to Congregate (or Continuum of) Care Reform (CCR), related to reforming the group home system and services for foster youth. The Department of Social Services released its report outlining the CCR recommendations, which can be found here.