CSAC Bulletin Article

Health and Human Services 03/15/2013

Senator Introduced Package of Bills to Alleviate Medical Provider Shortage

Senator Ed Hernandez, chair of the Senate Health Committee, introduced a three-bill package yesterday to allow existing medical professionals to expand their scope of practice to provide specified medical services. 
The package of bills – SB 491, SB 492 and SB 493 – would expand the scope of practice for optometrists, nurse practitioners, and pharmacists. Senator Hernandez is an optometrist himself, and he is leading efforts to implement the Affordable Care Act (ACA) in the state. At a press conference yesterday, he noted that as many as seven million more Californians will enter the health care system under the ACA, and that the state already suffers from a shortage of medical providers, especially in rural or low-income areas. 

“We are working hard at the state level to ensure every Californian has access to affordable, quality health coverage, but what good is a health insurance card if you can’t get in to see a health care provider when you need one?” Senator Hernandez said at the press conference. 

The bills would allow nurse practitioners to see Medicaid and Medicare patients regardless of whether the doctors they work with take these patients or not. Optometrists would be able to check for high blood pressure, and pharmacists could screen for diabetes, including ordering lab testing. Senator Hernandez said he chose these professionals because they are trained, practice throughout the state, and regulated by independent boards that monitor patient safety. 

The bills were introduced in conjunction with a joint informational hearing of the Senate Committees on Health and Business, Professions, and Economic Development that focused on the provider shortage and health care accessibility. To view the materials on the provider shortage presented at that hearing, click here. The hearing was held on March 13.

Assembly Republican Caucus Introduces Bill Package in Wake of Newtown Tragedy

The Assembly Republican Caucus, led by Assembly Member Connie Conway, has introduced a five-bill package to craft policy to help prevent school shootings in the wake of the Newtown, Connecticut tragedy.
The package focuses on increasing penalties for criminals who possess weapons and increasing the confidentiality of concealed weapons permit applications, making changes to the mental health system, and improving school safety. The package consists of: 

  • AB 1084 (Melendez) – Firearms: Punishment. This measure, among other things, increases the penalties that were decreased as part of 2011 Realignment for felons who possess firearms. Also bolsters the current state audit underway to assist the Department of Justice in tracking firearm possession by felons in the state. 
  • AB 1225 (Maienschein) – State and Local Fund Allocations. This measure would allow for an additional 10 percent fund transfer from other subaccounts to the mental health subaccount within the 1991 Realignment financing superstructure. 
  • AB 1264 (Conway) – Comprehensive School Safety Plans: Tactical Response Plan. Requires schools to include tactical plans in their school safety plans in the event of a shooting and policies for identifying and reporting pupils with potential mental health issues. 
  • AB 1265 (Conway) – Mental Health: Assisted Outpatient Treatment. Would require implementation of Laura’s Law, or mandatory assisted outpatient treatment, and allow the use of Proposition 63 Mental Health Services Act funds for this purpose. Would also extend the initial period of court-ordered treatment from six months to up to one year and allow for screening of patients released from involuntary civil commitments for court-ordered assisted outpatient treatment. 
  • AB 1367 (Mansoor) – Mental Health: Mental Health Services Fund. Allows the use of Proposition 63 Mental Health Services Act funding for school personnel training to identify mental health issues that may result in violence, and bolsters a current state audit examining the use of MHSA funds at the local level. 

These measured have significant implications for the provision of behavioral health services at the local level and the CSAC Administration of Justice and Health and Human Services teams, as well as county affiliate organizations, will be following them closely.

Health Care Special Session

SBX1 3 (Hernandez) – Support
As Amended on March 6, 2013

SBX1 3, by Senator Ed Hernandez, would create a health care “Bridge Plan” to create a low-cost health plan through Covered California that would help ensure provider continuity for low-income individuals as they move between eligibility for public and private health coverage. 

The CSAC Executive Committee supported as similar measure by Senator Hernandez last year (SB 703) that would have created a Basic Health Plan. 
The current Bridge Plan will allow low-income individuals to affordably purchase health insurance while maintaining provider continuity and a medical home. The Bridge targets individuals with incomes approximately between $15,000 and $22,000 – those most at risk of being unable to afford coverage. Even with federal subsidies, these individuals will still have monthly premiums and co-pays. Developing affordable coverage options is crucial to ensure individuals and families enroll in coverage, particularly since we know that under best case scenarios 3 to 4 million Californians will remain uninsured five years after health reform implementation.

Additionally, the Bridge Plan would allow low-income individuals to retain their existing health care providers. Many individuals with incomes between 138% and 200% of the federal poverty level are currently enrolled in Low Income Health Programs. The Bridge can help ensure continuity of care for these patients and a seamless transition into managed care.
Twelve counties own and operate county hospitals and health systems. Additionally, a number of other counties own and operate primary care and specialty care clinics. The Bridge Plan would help ensure that county safety net providers maintain a diverse payer mix with Covered California enrollees. Counties believe the Bridge will help counties continue to serve the remaining uninsured.

For these reasons, CSAC supports SBX1 3. The measure has not yet been assigned to a committee.

Human Services

AB 197 (Stone) – Support
As Introduced on January 29, 2013

AB 197, by Assembly Member Mark Stone, would delete existing requirements for assessing the value of a motor vehicle for purposes of eligibility for public aid, including the CalWORKs program. 

The current vehicle limit of $4650 for those seeking CalWORKs cash assistance and employment services often requires families to choose between seeking temporary cash aid or retaining a working automobile. In California, owning a working automobile is often a necessity for securing and maintaining employment and self sufficiency. In short, the current vehicle asset test may hinder employment prospects for the very families who most need to access cash aid and employment services. The asset test is also presents administrative costs for counties and county eligibility workers. 

It is for these reasons that CSAC supports AB 197, and has supported similar incarnations of this measure in years past. The measure is scheduled to be heard in the Assembly Human Services Committee – of which Assembly Member Stone is chair – on April 2.

Medi-Cal

AB 900 (Alejo) – Support
As Introduced on February 22, 2013

AB 900, by Assembly Member Luis Alejo, would exempt skilled nursing facilities (SNF) that are a distinct part of a general acute care hospital from Medi-Cal provider rate cuts enacted by the state in 2009. 

Those rate cuts of either 1, 5 percent, or 10 percent, were recently validated by the state appellate courts, meaning that they now go into effect and facilities must also reimburse the state retroactively for the funds received as far back as June 2011 and March 2009. For many facilities, these retroactive repayments are enormous and threaten their ability to continue to operate, and may threaten the viability of the hospitals to which they are attached. 

AB 900 is an urgency statute, and counties that have SNFs that are part of general acute care hospitals strongly support the measure. The measure is an urgency statute, meaning it requires a two-thirds vote in both houses and, if successfully passed, would go into effect immediately. It has been referred to the Assembly Health Committee, but not yet set for a hearing.

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