Our MS Action Network and the Government Relations Committee work in concert with MS-CAN, the Multiple Sclerosis California Action Network (MS-CAN). MS-CAN is the state advocacy arm of the three California chapters of the National Multiple Sclerosis Society. The mission of MS-CAN is to improve the quality of life for people with multiple sclerosis through public policy development and reform. MS-CAN and its network of chapters educate decision makers in the state and work with them to advance sound public policies that have a positive impact on individuals with multiple sclerosis.
The California chapters of MS-CAN include:
Northern California Chapter
Pacific South Coast Chapter
Southern California & Nevada Chapter
Department of Health Care Services to Implement Changes to Complex Rehabilitation Technology; Need for AB 582 Eliminated
On December 18, 2013, MS-CAN joined other advocates in a meeting with officials from the Department of Health Care Services (DHCS) to discuss AB 582 and its proposed changes for the complex rehabilitation technology (CRT) program. AB 582 is authored by Assemblyman Wes Chesbro (D-Humboldt) and co-sponsored by MS-CAN. AB 582 creates a new category for complex medical technology that will be separate from other durable medical equipment (DME) in the state’s Medi-Cal program. The new CRT category will include customized mobility devices (e.g. manual or power wheelchairs and adaptive seating or alternative positioning systems). Creating a separate CRT category will ensure Medi-Cal clients and consumers have access to appropriate CRT technology and support services, including wheelchair repairs and rentals.
Provider enrollment changes
DHCS convened the stakeholder meeting to report that it will be implementing system changes in its durable medical equipment provider enrollment categories for fee-for-service Medi-Cal. DHCS said that its objective is to mirror the criteria in AB 582, which was good news for MS-CAN and the other advocates. Stakeholders emphasized the need to include managed care in the system changes for provider enrollment, and not just fee-for-service Medi-Cal. Most of the adults needing CRT are enrolled in Medi-Cal managed care and are dual eligibles. Therefore, they would be left out if these changes only applied to Medi-Cal fee-for-service. Medi-Cal fee-for-service beneficiaries primarily includes children using CRT who are enrolled through the California Children’s Services Program (CCS).
Provider billing changes
DHCS also announced it will adopt stakeholder recommendations to separate providers of CRT from those that provide other DME and establish a distinct category and associated billing and service codes for CRT. Under the new system, CRT providers would have to meet specific criteria, including certification.
While pleased with this announcement, the stakeholders urged DHCS to utilize the provider standards that are contained in AB 582 as well as those the federal government is considering for Medicare.
DHCS agreed to follow-up on the following stakeholder recommendations:
DHCS agreed to determine the feasibility of including managed care in its system change for provider enrollment;
DHCS will review the provider standards in AB 582 and those considered for the Medicare program for inclusion in its system change for provider enrollment;
Providers will provide DHCS with any data they have as evidence of access problems to CRT;
DHCS and stakeholder group will continue coordinating on the issues
Given that DHCS has confirmed it will be implementing system changes to the CRT program, Assembly member Chesbro has decided that AB 582 is not needed at this time and has dropped the bill. However, MSCAN will be monitoring the implementation of the DHCS reforms to assure that they are moving forward and will continue to participate in any further discussions on the issue.
As the second year of the two year legislative session begins, legislators will introduce hundreds and hundreds of new bills. The last day for new bills to be introduced is February 24, 2014. MS-CAN will be reviewing these bills to determine if and how they impact people living with multiple sclerosis. However, some of the MS-CAN priority bills from last year continue to wind their way through the legislative process.
Following is the status of MS-CAN’s priority bills that are still being considered by the legislature:
AB 582 (Chesbro, D - Humboldt) Complex Rehabilitation Technology
AB 582 establishes a separate category in the state’s Medi-Cal program for complex medical technology (CRT) including customized mobility devices (manual or power wheelchairs, and adaptive seating or alternative positioning systems), that is distinct from all other types of durable medical equipment. (See info on AB 582 above.)
Status: In Senate Appropriations Committee
Sponsor: MS-CAN Co-Sponsor
AB 809 (Logue, R – Sutter) Telehealth: oral consent
AB 809 is an update to AB 415 (Logue, Chapter 547, Statutes of 2011) “The Telehealth Advancement Act of 2011.” AB 809 requires the health care provider initiating the use of telehealth at the originating site to obtain verbal or written consent from the patient for the use of telehealth. AB 809 would require that health care provider document the consent in the patient’s medical record and to transmit that documentation with the initiation of any telehealth to a distant-site health care provider. The bill would require the distant-site health care provider to either obtain confirmation of the patient’s consent or separately obtain and document consent from the patient. A telehealth stakeholder group continues to negotiate on issues concerning oral consent with Assemblyman Logue and the California Medical Association and Kaiser. AB 809 will be heard in Senate Health Committee in April 2014.
Status: In Senate Health Committee
SB 391 (DeSaulnier, D – Contra Costa) The California Homes and Jobs Act of 2013
SB 391 will put a $75 recordation fee on real estate transactions – excluding home sales in order to build safe and affordable single-family homes and apartments for Californians in need, including families, seniors, veterans, and people with disabilities. The bill targets funds for accessibility improvements.
Status: In Assembly Appropriations Committee
Sponsor: California Housing Consortium and Housing California
Governor Brown Releases FY 2014-15 Proposed Budget
On January 9, 2014, Governor Brown submitted his proposed FY 2014-15 budget to the Legislature. The proposed budget offers no real program restorations or big spending initiatives in health and human services. Despite an estimated $6 billion budget surplus, the Governor’s budget reflects restraint in program spending. He allocated most of the surplus funds to education, paying down debt, restoration of aging infrastructure, and maintaining a rainy day fund to cover the state’s long term liabilities, such as state employee pension payments.
The Governor’s proposals in health and human services of interest to individuals living with MS include:
Medi-Cal Expansion: The budget proposes funding for the Medi-Cal expansion of health care services targeted to parents and childless adults at 138% of federal poverty level ($15,856 for an individual in 2013).
Medi-Cal Provider Rate Cut: The proposed budget maintains a 10 percent cut to payments for doctors and other Medi-Cal providers, while partially rolling back the retroactive portion of this cut. The Governor/DHCS began implementing this provider payment reduction in September 2013, with the cut being retroactive to June 2011. The Governor says he will forgive the retroactive portion of the cut for certain providers and services, including physicians and clinics and for certain high-cost drugs, and dental services. This forgiveness will require federal approval.
Although health advocates welcomed the proposed roll back of the retroactive reimbursement rate cut, they are extremely disappointed that the 10 percent cut will be maintained going forward. The health care consumer community, including MS-CAN, has been calling for repeal of the Medi-Cal reimbursement rate reduction since it was implemented in 2011. Low reimbursement rates are a deterrent to providers accepting Medi-Cal patients and affect the ability of patients, including individuals living with MS, to access appropriate and timely medical care.
In Home Supportive Services (IHSS): The Governor’s proposed budget reflects an 8 percent across-the-board cut, implemented in July 2013 as part of a court settlement, to the total hours of care each IHSS consumer may receive. Under current law, this reduction is scheduled to scale back to 7 percent in FY 2014-15, and the Governor does not propose to reduce or repeal this cut.
In September 2013, the US Department of Labor issued new rules that extend minimum wage and overtime protections to home care workers, including IHSS providers. The rules go into effect January 1, 2015. The Governor has decided to implement this new rule by prohibiting IHSS providers, including those that are family members, from working overtime. IHSS recipients who need more than 40 hours of care a week would have to hire an additional provider from a “Provider Backup System” or temporary worker pool that would be established to help connect IHSS consumers with additional providers.
The prohibition on overtime hours may affect the ability of people disabled by MS in the IHSS program from receiving the most appropriate care and services from people who know their needs best.
Supplemental Security Income/State Supplementary Payment (SSI/SSP): The Governor’s proposed budget does not restore the annual state Cost of Living Increase (COLA) for SSI/SSP grants that was eliminated in 2009. It does, however, pass through the federal SSI increase to recipients, increasing monthly grant levels by $11 for an individual and $16 for a couple, effective January 2014.
Coordinated Care Initiative (CCI) – Cal MediConnect: The state Medi-Cal program and the federal Medicare program have partnered to launch a three-year project to promote coordinated health care delivery to seniors and people with disabilities who are dually eligible for both of these public health insurance programs, “dual eligible beneficiaries.” The program is called Cal MediConnect. People living with MS who receive both Medicare and Medi-Cal will be affected by this new program.
DHCS announced that the following changes will occur in the Coordinated Care Initiative/Cal MediConnect Program:
Dual eligibles in Medicare fee for service will be passively enrolled for both Medicare and Medi Cal benefits beginning April 2014 in all participating counties except Los Angeles, Alameda, and Santa Clara. Passive enrollment means that the state will enroll eligible individuals into a health plan that combines their Medicare and Medi-Cal benefits unless the individual actively chooses not to join and notifies the state of this choice. In Los Angeles, dual eligibles may voluntarily enroll in Cal MediConnect or opt out beginning April 2014 and the remaining dual eligibles will be passively enrolled beginning July 2014. Alameda and Santa Clara counties will passively enroll dual eligibles no sooner than July 2014.
Dual eligibles in Medicare Advantage plans and those opting out of Cal MediConnect in all participating counties will be enrolled in managed care for Medi Cal benefits beginning in July 2014. Dual eligibles in Medicare Advantage plans who do not opt out of Cal MediConnect will be enrolled into Cal MediConnect for Medicare benefits in January 2015.
Those individuals only eligible for Medi Cal or for partial Medicare coverage in all participating counties will have long term supports and services and home and community based services included in managed care beginning July 2014.