5 Things California: Ballot measures, Legislative update, MMC procurement lawsuits - State of Reform

5 Things California: Ballot measures, Legislative update, MMC procurement lawsuits – State of Reform

This newsletter features an overview of 2 upcoming ballot initiatives that have significant implications for health policy, a legislative update following the conclusion of the eventful 2021-2022 legislative session, and an overview of some health plans’ litigation against DHCS following the controversial announcement of 2024 Medi-Cal Managed Care contract awardees.

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Eli Kirshbaum
State of Reform

1. Health-related proposals on the ballot

Californians will vote on Proposition 29 next month, which aims to impose stricter regulations on kidney dialysis centers in an effort to better protect dialysis patients. It would require a state dialysis center to have a physician, nurse practitioner, or physician assistant on-site at all times, as well as to report specified information under threat of penalty. It would also prohibit dialysis clinics from refusing to treat a patient based on the payer of their care. Opponents of the measure say it would take physicians, nurse practitioners, and physician assistants away from places they are needed and put them into places they are not.

Another ballot initiative, Proposition 1, would amend the state constitution to include an individual’s right to obtain an abortion. While somewhat controversial, organizations like the CMA and Kaiser Permanente say the measure will protect access to affordable and comprehensive reproductive health care in the state. Opponents of the proposition, including the California Council of Catholic Bishops, say it is costly and doesn’t actually advance women’s health. A recent poll showed 69% of likely voters plan to vote “yes” on Prop. 1, 25% plan to vote “no,” and 6% are undecided.

2. Update on recently passed health legislation

A bill intended to increase transparency in the patient-provider relationship is among the several health care-related bills Gov. Newsom signed at the close of the 2021-2022 legislative session. The legislation builds on existing law requiring providers to share the results of clinical laboratory tests to also include imaging scans, it allows providers time to review test results prior to sending them to the patient, and it prevents minors’ parents/guardians from accessing their child’s sensitive medical information.

Newsom also signed a bill that loosens e-prescribing requirements for certain providers to minimize delays in patients receiving their medications. Additional recently passed legislation includes a bill to prevent prospective physicians or surgeons from receiving a license if they have been disciplined for sexual assault in the last 7 years, as well as a bill requiring health plans to cover FDA-approved COVID-19 therapeutics when they ‘re prescribed by a licensed provider.

3. What They’re Watching: Mohit Ghose, Elevance Health

In this edition of our “What They’re Watching” series, Mohit Ghose, State Affairs Officer at Elevance Health, says it’s a “very exciting time to be in health care” due to California’s recent, unprecedented policy movement. He emphasized the increasing levels of integrated care that are being realized in the state.

“We are now on the cusp of getting true, integrated health care. Of actually having behavioral health be a focus of everything that we do. To look at everything that we perform within the state through the lens of equity and quality improvement.” Ghose emphasizes, however, that work remains to be done to achieve full care integration. This includes aligning Medi-Cal provision to the state’s population health model and facilitating interagency cooperation on things like behavioral health integration and children and youth health care.

4. CalOptima pursues sustainable school behavioral health partnerships in Orange County

CalOptima is drawing on California’s Student Behavioral Health Incentive Program to use up to $25 million in funding for partnerships with school districts to bolster behavioral health early intervention for students. The county-wide initiative will equip schools with additional counselors, wellness programs, crisis screenings, and other resources in order to streamline behavioral health service delivery for children and youth.

Implementation of these SBHIP initiatives will begin in 2023, pending DHCS approval. CalOptima says 17 school districts in Orange County have expressed interest in collaborating so far. “[This is] going to bring all the different systems together that are serving our children in Orange County so that we can streamline those services and have better access for these children,” Katsarov said. “This needs to meet the students where they’re at, and how they want to get behavioral health care.”

5. Health plans sue DHCS over MMC contracts

Several of the state’s current Medi-Cal Managed Care carriers are pursuing legal action against DHCS in continuation of their protest against the department’s choice of insurers it will contract with for its updated 2024 managed care contracts. Blue Shield of California, Centene Corporation (which owns Health Net), and Community Health Group are all suing the state following its request to deny the appeals these plans made in protest of the contract decision.

Blue Shield argues that DHCS violated the Public Records Act by refusing to provide the scoring process, methodology, and communications for its contract decision. Another request in Blue Shield’s appeal was for DHCS to allow more time for the state-appointed hearing officer—who is an IT professional, which the health plan says isn’t the appropriate position to be overseeing this process—to process appeals. DHCP denied this request.

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