Policy Advisory Group AGENDA Monday, February 12th, 2018 9:30am-12:00noon CCALAC, 700 S. Flower Street, Suite 3150 (Conf. Room A) Los Angeles, CA 90017 Call-in: (888) 585-9008 Conference Room #: 529-954-253
Time Item – Presenter Action* Corresponding Document**
9:30am Call to Order and Introductions – Tamra King A
9:35am Agenda and January Minutes – Tamra King A • January 8th Minutes (2)
9:45am Federal Issues –Courtney Powers, Sara Watson A. Federal Budget & Health Centers Funding I/D • Federal Updates Memo** (4) B. Immigration I/D • Immigration Memo** (7) • Protecting Immigrant Families Coalition: Public C. NACHC Policy & Issues Forum (P&I) I/D Charge Fact Sheet (10) • P&I Memo (12) • P&I List of Members in Districts (13)
10:30am State Issues –Becky Lee A. Governor’s Budget Analysis I/D • CPCA Budget Analysis (18) B. State Legislation I/D • CPCA State Legislation Memo (21) • Day at the Capitol Memo (25) C. Day at the Capitol (DAC) I/D • DAC List of Clinics in Districts (26) D. CPCA State Initiatives I • State Initiatives Memo**(34)
11:00am County Issues – Louise McCarthy, Courtney Powers, Becky Lee, Sara Watson A. My Health LA I/D • My Health LA Memo** (36) B. LA County Initiatives I/D • MHLA Letter to HRSA - Sept. 2014 (40) • MHLA PIN 18-01 Dental Changes**(43) 1. Whole Person Care • MHLA December Renewal Report (44) 2. Homelessness • LA County Initiatives Memo** (45) C. Behavioral Health I/D • Behavioral Health Memo**(47) 1. Behavioral Health Task Force • Managed Care Memo** (48) 2. DMH Indigent Services Contracting • L.A. Care Health Plan Update** (50) D. LADPH Service Planning Area (SPA) Meetings D E. Managed Care I/D
11:40am Other Business –Elaiza Torralba, Sara Watson A. Policy Café D B. LA County Board of Supervisors Quarterly Health D Deputy Meetings
12:00pm Adjournment – Tamra King A
Next Policy Advisory Group Meeting – Monday, March 5th via CONFERENCE CALL/WEBINAR ONLY
1 A = *Action D = Discussion (no materials) I = Information (no discussion) ** handout provided in complete packet of materials Policy Advisory Group Meeting Minutes January 8th 2018 9:30am – 12:00pm CCALAC Conference Room A&B
Attendees: Alicia Mardini, Tamra King, Nik Gupta, John Nyguen, Karen Lauterbach, Corrine Sanchez, Katja Nelson, Patti Wagonhurst, Jann Hamilton Lee, Chona de Leon, Warren Brodine, Clifford Shiep, Richard Veloz, Ana Grande, Mario Chavez
Teleconference: Elisa Nicholas, Jina Lawler, Kim Wyard, Audrey Simons, Lisa Abdishoo, Eduardo Gonzalez, Franklin Gonzalez, Maria Dia, Julie Hudman, Adel Syed, Carmen Ibarra, Margie Martinez, Bettina Lewis , Kazue Shibata
Staff: Louise McCarthy, Courtney Powers, Nina Vaccaro, Joanne Preece, Becky Lee, Elaiza Torralba, Candace Metoyer, Sara Watson
TOPIC / PERSON DISCUSSION ACTION Welcome and Al Ballasteros, Co-Chair, called the meeting to order at 9:35am. Louise introduced CCALAC’s new Al called to order. Introductions Director of Gov and Ext Affairs, Courtney Powers, Esq. Approval of Agenda Al asked for motions to approve the agenda and past meeting minutes. Motion: Corinne Sanchez, and Minutes Second: Richard Veloz. Motion carries. No opposition.
Federal Issues A. Federal Budget & Appropriations No actions. 1. Health Centers Funding Cliff – Update on status of health centers funding. No funding included in CR. Discussion ensued regarding advocacy strategy. 2. Tax Reform – Updates on tax reform bill per memo. B. Immigration - Discussion regarding an FAQ available for employers regarding employees who lose DACA and TPS status. C. P&I – Discussion re P&I Prep re memo. State Issues A. 2018 State Budget/Landscape – Staff provided overview of legislative landscape and possible No actions. CPCA sponsored bills for 2018. B. Dental Transformation Initiative: Domain 4 - Staff discussed grantees, and programs. C. Medi-Cal Changes Effective 2018 and Beyond – Discussion per memo. Question raised re chiropractic coverage. Staff will follow up. 1 2 D. CPCA State Initiatives – Overview per memo. Members encouraged to participate as process slated to wrap up by March 31. E. Covered California - Joanne discussed implication sof tax reform bill and individual mandate repeal. No changes for 2018, changes to start 2018. County Issues A. LA County Initiatives – Discussion of Whole Person care and Homeless initiatives. Members asked No actions. about Health Homes. First phase to commence July 20, 2018, LA slated to start in July 2019. Possibly will be delayed further. B. Behavioral Health –Discussed of Integration Summit, and update on DMH contracting. C. LADPH Service Planning Area (SPA) Meetings – Update on SPA meetings, upcoming meeting dates and highlights of past meetings. D. Managed Care – Discussion of upcoming meeting with RAC in Sacramento. Reminder of new Managed Care Advisory Workgroup, asked people who want to participate to contact Joanne. E. My Health LA (MHLA) – Discussion regarding My Health LA Annual Report.
Other Business A. New PAG Co-Chair – Tamra King nominated and approved as new PAG Co-Chair. ACTION: (Richard Veloz B. Meeting Evaluation– Members asked to complete evaluation. nominated Tamra. Tamra accepted nomination. Corrine Sanchez moved. Ana Grande seconded. Motion carried. No opposition.)
Adjournment There being no further business, the meeting ended at 11:25 a.m.(early) Meeting adjourned by Chair.
2 3
Member Driven. Patient Focused.
Date: February 12, 2018
To: Policy Advisory Group, CCALAC
From: Joanne Preece, Assistant Director of Policy
Re: Federal Updates - REVISED (Information/Discussion)
This memo provides information and updates related to health center funding, and the federal budget and appropriations process for fiscal years (FY) 2018 and 2019.
Health Centers Funding Cliff Fixed! In the very early hours of Friday morning, Congress passed a continuing resolution (CR) through March 23, which includes two-years of funding for community health centers, the National Health Service Corp (NHSC) and the Teaching Health Center (THC) program, and funding for a number of other health programs and high priority areas.
The cliff fix comes over four months after mandatory funding for the health centers program expired on September 30, 2017. During those months Congress passed a series of CRs that did not include health centers, including the one passed on January 22 that provided funding for the Children’s Health Insurance Program (CHIP), but not health centers, effectively severing health centers and CHIP, programs that had been on the same funding timeline for many years. It remains to be seen how this will impact our advocacy efforts the next time we need a cliff fix, which will be less than two years from now, September 30, 2019.
Federal Budget and Appropriations FY2019 starts on Oct. 1, 2018. For at least the next six weeks, the FY2018 and FY2019 budget processes will be underway simultaneously.
FY2018 Budget: Possible Omnibus in Late March Congress now has until March 23 to pass another FY2018 government spending measure. The budget deal included in the February 9 CR increases the defense and nondefense discretionary spending caps for two years and suspends the debt ceiling for one year. The deal also includes a number of other priorities for both parties, including nearly $90 billion for disaster relief, $6 billion to address the opioid crisis, an additional four-year extension of funding for CHIP, and funding for most of the other so-called health extenders. The deal, however, did not include a fix for the Deferred Action for Childhood Arrivals (DACA) program, setting up an immigration fight in the coming days and weeks.
The inclusion of the most contentious items in the CR will possibly clear the way for an omnibus bill in late March to see out the remainder of FY2018. Increasing the non-defense spending limit reduces the threat of large cuts to domestic programs for strictly budgetary reasons. CCALAC will continue to monitor the FY2018 budget process to see how health centers and other critical programs fare on the discretionary side.
Budget Resolution or No Budget Resolution?
700 South Flower Street, Suite 3150, Los Angeles, CA 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org 4 It is unclear if Congress will take the step of adopting a FY2018 Budget Resolution since the recent budget deal included FY2018 and 2019 spending levels.
The Budget Resolution is also the vehicle that can contain Budget Reconciliation instructions; this is the vehicle whereby the Senate can pass budget-related measures with only a simple majority vote (this was the vehicle used to try to repeal the Affordable Care Act last year). If there is no FY2018 Budget Resolution, there will be no Budget Reconciliation, thus no opportunity to push partisan proposals through the Senate with only Republican votes. Without the Budget Reconciliation vehicle, the threat of a large scale, structural Medicaid overhaul would be reduced.
FY2019 Budget: President’s Budget Expected February 12 On Monday, February 12, President Trump is expected to release his budget proposal for FY2019. The President’s budget is non-binding and essentially a statement of the White House’s priorities for the year. The President’s budget release launches the FY2019 appropriations process in Congress.
The bipartisan budget deal increases the FY2019 defense and nondefense discretionary spending caps (by $85 billion and $68 billion respectively). Since the Administration has been working on the President’s budget request for months, it will adhere to the old spending caps. An addendum is expected to accompany the Budget release on Monday, outlining the White House’s intended use of the additional funding.
Under the normal budget process, following the release of the President’s budget, the House and Senate work toward adoption of a non-binding Budget Resolution, which sets spending levels for each of the 12 departments.
For at least the next six-weeks, Congress is expected to be focused on wrapping up the FY2018 budget process and addressing DACA.
Administration Announces New Religious Protections for Health Care Workers The Department of Health and Human Services (HHS) announced the creation of a new Conscience and Religious Freedom Division under the Office of Civil Rights (OCR) responsible for investigating complaints filed by workers claiming that their employers have violated their religious rights. This is a major shift for the OCR, which generally focuses on enforcing patient safety and privacy concerns. Workers who believe they have experienced discrimination because they refused to participate in specific medical procedures, including abortion, or were coerced into doing so, can reportedly now file a complaint with the office.
There is concern that this new division could potentially allow health care workers to refuse to perform, accommodate, or assist with provision of health care services on religious or moral grounds. Opponents also worry this new HHS division may take actions that would permit unlawful discrimination or deny access to appropriate health care services based on gender, gender identity, sexual orientation, race, ethnicity or other personal characteristics. The American Civil Liberties Union (ACLU) plans to take legal action.
CCALAC issued a statement in response to the announcement, expressing our concerns, and will continue to monitor this closely.
Guidance Released for Work Requirements in State Medicaid Programs The administration recently unveiled guidance that would allow states to impose work requirements in their Medicaid programs. This is a major shift in Medicaid policy; work requirements have not been allowed in the 50-year history of the program. Opposition groups argue that the administration does not have the power to make these changes without action from Congress; lawsuits have been filed.
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
The change opens the door for states to receive approval for Medicaid waivers that include requiring enrollees to work as a condition of coverage. According to CMS officials, work requirements would only apply to adults able to work, and there will be exemptions for children, the elderly, pregnant women and people with disabilities. States can also designate other activities, such as job training, education, substance use treatment or caregiving, to satisfy work requirements, those details would be up to each individual state.
When the guidance was released ten states had already applied, or were in the process of applying, to impose work requirements in Medicaid (Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin). So far, Kentucky and Indiana have received federal approval. California is not expected to try to impose work requirements for the Medi-Cal program.
Senate Confirms Azar as Head of HHS The Senate has confirmed Alex Azar as the new head of the Department of Health and Human Services (HHS) by a 55-43 vote. Six Democrats and Independent Sen. Angus King (Maine) joined all but one Republican in support of the nominee. Sen. Rand Paul (R-Ky.) was the one Republican to vote against his confirmation. Azar replaces Tom Price, who resigned in September over controversial use of taxpayer money for flights and travel.
Please email Joanne Preece at [email protected] with any questions.
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
Member Driven. Patient Focused.
Date: February 12, 2018
To: Policy Advisory Group, CCALAC
From: Joanne Preece, Assistant Director of Policy
Re: Immigration Update (Information/Discussion)
This memo provides updates on immigration-related issues impacting health centers, their patients and communities.
Leaked Draft Public Charge NPRM A leaked draft copy of a Notice of Proposed Rulemaking (NPRM) related to public charge has been picked up by the media (Reuters and Vox). CCALAC and our immigrant advocate and legal partners were aware of the NPRM, but not expecting it to be officially released for another month or two. The draft NPRM includes, in much more detail, the public charge changes that were called for in last years’ draft Executive Order, which was never signed.
Under the changes proposed in the draft NPRM, immigration officers would be able to consider an applicant for legal permanent residence’s use of a broad list of taxpayer-funded public benefits to determine if they are likely to become a public charge in the future. Some of the programs listed as permitted for consideration would include: • The Children’s Health Insurance Program (CHIP) • The Supplemental Nutrition Assistance Program (SNAP) • Temporary Assistance for Needy Families (TANF) • SNAP for Women, Infants and Children (WIC) • Head Start • Certain Benefits under the Medicaid Program • Transportation Vouchers • The Housing Choice Voucher Program • Low-Income Home Energy Assistance Program • “Any other Federal, State, or local public benefit program”
The draft rules would be a sharp departure from current guidelines, which specifically bar the consideration of non-cash benefits in the public charge consideration. The draft lists some exceptions, such as disaster relief benefits, soup kitchens, school lunch programs and public health immunizations. The rule does not appear to be retroactive, meaning use of such benefits prior to when the rule is finalized are not likely to be used as a factor in a public charge determination. In addition, the rule would not affect the types of immigrants who are by law exempt from a public charge determination, including refugees and asylees.
Important: This is Just a Leaked Draft; Nothing Has Changed Yet This NPRM is not a final or even officially proposed rule yet. There are many unknowns and we do not know what will be included in the NPRM when officially released. Immigrant advocates DO NOT recommend broadly discussing this or
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7 advising immigrant families about the possibility of future changes, because we do not want to create unnecessary fear and confusion and there are still many unknowns.
The Protecting Immigrant Families Coalition has shared the following resources: • An updated guide “Things to Keep in Mind When Talking with Immigrant Families” in light of the leaked NPRM; • A Fact sheet on proposed changes to public charge (included with this memo and will be updated soon); and • Recommended Talking Points.
CCALAC recognizes that this news will circulate quickly in our immigrant communities and that patients will likely start to ask questions and express concerns. Additional guidance and talking points will be forthcoming.
When the NPRM is officially released, there will be a public comment period. CCALAC will likely submit comments. From the broad list of programs, we anticipate a wide range of advocates and organizations will likely be involved in advocating against these changes.
DACA Update: No Solution in Spending Bills, March 5 Deadline Looms The Trump administration announced on September 5, 2017 the rescission of the Deferred Action for Childhood Arrivals (DACA) program. Congress has until March 5, 2018 to find a legislative solution. There was a push in December to include a DACA fix in the government spending bills; however that did not occur.
Currently, an estimated 122 DACA recipients are losing their status and work permits every day. If Congress does not act by March 5, 2018, that number is expected to jump to 1,400 per day. Without Congressional action, all approximately 700,000 DACA recipients will lose their status over the next two years.
None of the many continuing resolutions passed by Congress have included a DACA fix. The February 9 budget deal resolved a number of contentious issues, potentially freeing up Congress to take on immigration in the coming weeks.
Federal Judge Rules USCIS Must Accept DACA Renewal Applications San Francisco federal judge William Alsup in January issued a nationwide injunction ordering the Trump administration to resume the DACA program while a legal challenge to the president’s September decision to end the program goes forward. In his ruling, Judge Alsup said that previous DACA beneficiaries must be allowed to renew their status, including reapplication for previous beneficiaries whose status has lapsed, but that the government is not required to accept new applications from people who have never previously had DACA.
The USCIS website is updated with detailed information and instructions regarding renewals: • Individuals who were previously granted deferred action under DACA (even if their status has expired) may request renewal by filing the appropriate form with the appropriate fee or approved fee exemption request. • USCIS is not accepting requests from individuals who have never before been granted deferred action under DACA. • USCIS will not accept or approve advance parole requests from DACA recipients.
Administration’s Immigration Framework Met with Opposition from Both Sides The White House in January revealed a one-page framework for an immigration deal the President would approve. The framework includes a fix for DACA, but that solution appears contingent upon the other elements also being included. Elements of the framework are proving unpalatable to lawmakers on both sides of the aisle. The four main components include: • Providing a pathway to citizenship for as many as 1.8 million young immigrants who are covered by DACA or who are eligible but did not apply (they would have to meet certain work and education requirements that would be spelled out by Congress and it would take 10-12 years to earn citizenship); • Establishing a $25 billion trust fund earmarked mostly for building a wall along the U.S.-Mexico border;
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8 • Changes to family immigration rules to only allow U.S. citizens and permanent residents to sponsor their immediate families, including spouses and minor children --other relatives, like parents and siblings, would be excluded; and • Ending the visa lottery system and reallocating the visas to clear a backlog of people waiting for family-based and high-skilled worker visas.
Administration Announces End to TPS Designation for El Salvador The Trump administration announced in January that it is ending Temporary Protected Status (TPS) for 262,500 immigrants from El Salvador. Affected immigrants were given until September 2019 to either leave the country or find another means of legally staying in the United States. Salvadoran TPS holders are concentrated in California, Texas, the D.C. area, and New York. There are estimated to be about 40,000 Salvadorans with TPS in the Los Angeles area.
The El Salvador announcement is the fourth such change to TPS designation made by the Trump administration. TPS designations have already been terminated for immigrants from Sudan, Haiti and Nicaragua. The Honduran designation is up for renewal in July 2018.
FAQ for Employers of DACA/TPS Recipients The termination of the DACA program, the phasing out of certain TPS designations, and the heightened focus on immigration issues under the new administration have raised a number of questions for employers. Public Counsel has created a comprehensive resource, Immigrant Work Authorization FAQ for Employers, addressing some of the most common questions they are receiving in the area of employee hiring and Employment Eligibility Verification Form (Form I-9) compliance.
The law on the topics discussed in the resource is highly context-specific, and Public Counsel has requested that rather than disseminate the FAQ directly to members, we invite members to contact Public Counsel to receive the FAQ and/or additional support. Health centers may contact Public Counsel’s Community Development Project at (213) 385-2977, ext. 200.
Please contact Joanne Preece at [email protected] with any questions.
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
9 The Trump Administration’s “Public Charge” Attack on Immigrant Families INFORMATION ABOUT AN UPCOMING PROPOSED RULE
Last revised JANUARY 29, 2018
nder a draft executive order leaked in Jan- health care or go hungry to keep their families to- uary 2017,1 the Trump administration gether. U threatens to deny green cards to or even deport immigrants who receive public benefits How soon could the regulation be issued? aimed at promoting health and nutrition. While The NPRM is being drafted by USCIS and may the actual executive order has not been issued, the go to OMB soon. The White House may ask OMB December 2017 Unified Agenda indicates that the to expedite its process, which would mean that the administration plans to release a Notice of Pro- NPRM could be published in the Federal Register posed Rulemaking (NPRM) implementing changes much sooner than the originally anticipated July to the “public charge” guidance in July 2018.2 We 2018 release date. recently learned that U.S. Citizenship and Immi- gration Services (USCIS) is drafting the NPRM What would the proposed rule do? and that it could soon go to the Office of Manage- Under current policy, receipt of cash assis- ment and Budget (OMB) for review. tance such as Temporary Assistance for Needy In anticipation of forthcoming regulations, the Families (TANF), Supplemental Security Income Protecting Immigrant Families Campaign is pre- (SSI), and General Assistance — as well as govern- paring to fight back. Any policy forcing millions of ment-funded long-term care — are already rele- families to choose between the denial of status (or vant to a determination of whether a person is or is even deportation) and food or health care would likely to become a public charge. The NPRM is exacerbate serious problems like hunger, unmet likely to alter public charge rules by allowing gov- health needs, child poverty, and homelessness. ernment officials to consider a much broader array of critical services and work supports in the public What’s a t risk? charge determination. This could include health Federal law allows immigration authorities to and nutrition programs such as Medicaid, the deny entry or a “green card” (lawful permanent Children’s Health Insurance Program, and the residence, or LPR, status) to people who cannot Supplemental Nutrition Assistance Program support themselves or who are likely in the future (SNAP, or food stamps). It might expand even fur- to depend on the government for their subsistence ther, to reach programs that provide critical hous- — people who are likely to become a public charge. ing and energy assistance; transportation services; The law also allows for people to be deported on nutrition assistance for pregnant women, infants public charge grounds, in extremely limited cir- and children; and possibly early childhood educa- cumstances. Longstanding policy ensures that im- tion programs. migrants receiving services such as health care and Efforts to expand public charge–related rea- nutrition are not considered public charges on that sons for denying immigrants LPR status or deport- basis. That is, an immigrant’s or family member’s ing them will create a chilling effect on immigrant use of services (other than cash for monthly in- families’ use of health, nutrition, and other pro- come maintenance or government-funded long- grams. Such a policy would make child poverty term care) has not been considered in the public worse by discouraging enrollment in the various charge determination. This has ensured that immi- programs that address health, hunger, and eco- grant families have not had to forego needed
1 http://bit.ly/2kqrv7L (PDF). 2 http://bit.ly/2n4KZi4.
The Trump Administration’s “Public Charge” Attack on Immigrant Families PAGE 1 of 2 10 The Trump Administration’s “Public Charge” Attack on Immigrant Families PAGE 2 of 2 nomic security. This would have lasting conse- homelessness, and other serious problems. Gov- quences on families’ well-being and long-term suc- ernment should be finding solutions to these prob- cess. lems, not creating new ways to make them worse. Immigrants have higher rates of employment Who would be affected? than U.S.-born citizens but often work in jobs that Immigrant families, including those with U.S. pay them less than their U.S.-born counterparts. citizen children, already worry that using govern- Billions in taxes paid by immigrant families help ment programs will harm their immigration status support all government programs. For all people or their future opportunities. Changes to the pub- working low-wage jobs, health and nutrition assis- lic charge policy would increase these fears. tance helps them and their families stay healthy, The public charge policy primarily affects low- thrive, and contribute to society. income immigrants who are applying for a green card through a family-based visa petition. This What can we do to resist? type of policy change could also make it easier to We suggest that you do what you can to edu- deport immigrants on public charge grounds. It is cate policymakers, your state and local legislators, important to note that, under the law, some immi- and local community leaders about the contribu- grants are not subject to the public charge test. tions immigrant families make to your state’s These include refugees; asylees; survivors of traf- economy and culture — about the critical role ac- ficking, domestic violence, or other serious crimes; cess to nutrition and health care play in promoting VAWA self-petitioners; special immigrant juve- community health and strengthening local econo- niles; and certain people who have been paroled mies. They need to hear about the sweeping nega- into the U.S. Public charge is not a factor in natu- tive consequences of any effort to expand the ralization applications — for LPRs seeking citizen- grounds for determining that a noncitizen is or is ship. These rules cannot be changed by executive likely to become a public charge. or administrative action. As soon as we know more about the content or timeline of proposed changes to public charge pol- How should we talk about this? icy, the Protecting Immigrant Families Campaign Investing in nutrition, health care, and other will schedule a call to provide information. If and essential needs keeps children learning, parents when an NPRM or executive order is released, we working, and families strong, and allows all of us will immediately share action steps and talking to contribute fully to our communities. Policies points for advocates. To sign up for updates, visit such as those outlined in the leaked draft executive http://bit.ly/PIFCampaign. order and the anticipated proposed rule are meant In the meantime, you are welcome to reach out to terrify immigrant families, discourage hard- to us directly if you have any questions. You can working people from immigrating, and deter im- contact Jenny Rejeske at the National Immigration migrant families, most of which include U.S. citi- Law Center ([email protected]) or Madison Hardee zen children, from seeking the help they need. at the Center for Law and Social Policy Already, low-income children with foreign- ([email protected]). born parents are less likely to receive SNAP or Medicaid than are children with U.S.-born par- How can you learn more? ents. And one million Latino children, 95 percent NILC’s website has additional resources, in- of whom are U.S. citizens, are eligible for Medicaid cluding an overview of public charge and advice on or CHIP but not enrolled. talking about these issues with immigrant fami- Targeting low-income families will only lies.3 worsen hunger, unmet health care needs, poverty,
3 Overview: www.nilc.org/wp- 2013-10-01.pdf; advice: www.nilc.org/exec-orders-and- content/uploads/2015/12/public-charge-overview- access-to-public-programs/.
11
Member Driven. Patient Focused.
Date: February 12, 2018
To: Policy Advisory Group
From: Sara Watson, Event Coordinator
Re: 2018 NACHC Policy & Issues (P&I) Forum (Information/Discussion)
The National Association of Community Health Centers’ (NACHC) 2018 Policy & Issues (P&I) Forum will take place March 14 ‐ 18, 2018 at the Marriott Wardman Park Hotel in Washington, D.C. The 2018 P&I Forum comes as health centers face another funding cliff in less than two years, coupled with the potential of proposals to restructure key federal programs, including Medicaid.
Travel & Scheduling CCALAC will coordinate legislative visits for each of the Congressional offices from LA County. Members should plan to fly in and arrive by Monday, March 12, with legislative visits starting Tuesday, March 13. Due to the large size of LA County’s Congressional delegation, meetings may be scheduled through the close of business Friday, March 16.
Registration Registration is now open with CCALAC, CPCA and NACHC. Please note there are three separate registration links below, please be sure to RSVP as appropriate. • CCALAC: Please RSVP each person planning to participate in legislative visits, including any board members. The information provided during registration will help CCALAC stay in contact with you, schedule visits and match you with the legislator(s) in your home and clinic district(s). (RSVP link: https://goo.gl/5a9vVJ ) • CPCA: Click here to register with CPCA for the California state delegation meeting will take place on Wednesday, March 14 at 7:00pm. During the delegation meeting members will get updates from NACHC, the Margolin Group and CaliforniaHealth+ Advocates. Advocates will provide light hors d’ oeuvres and refreshments. • NACHC: To attend the NACHC Policy & Issues Forum Conference, please register at the Policy & Issues Forum site.
Clinics that have registered with CCALAC include: • AltaMed Health Services Corp. • South Central Family Health Center • The Achievable Foundation • Via Care Community Health Center • El Proyecto del Barrio • White Memorial Community Health Center
CCALAC P&I Prep Webinar – Thursday, March 8 CCALAC’s P&I Prep webinar is scheduled for 3:00 – 4:00pm on Thursday, March 8. Webinar information will be sent to all participants registered with CCALAC (members and affiliates). CCALAC staff will review meeting logistics, talking points and materials. NACHC will provide a federal landscape overview. All participants are encouraged to participate.
District List – Check Now! Included with this memo is a list of clinics in each Congressional district. Please check the list and make sure your organization is listed in all the correct districts. This is the list that will determine participants at each legislative visit. Email Sara Watson at [email protected] with updates.
Please contact Sara Watson at [email protected] with any questions. 12
Member Driven. Patient Focused.
CCALAC Members by U.S. Congress Districts /U.S. House Representatives District 30 – Brad Sherman (D) Eisner Health District 23 – Kevin McCarthy (R) El Proyecto del Barrio House Majority Leader Mission City Community Network Antelope Valley Community Clinic Northeast Valley Health Corporation Tarzana Treatment Centers Planned Parenthood Los Angeles Tarzana Treatment Centers District 25 – Steve Knight (R) Antelope Valley Community Clinic District 32 – Grace Napolitano (D) Bartz-Altadonna Community Health AltaMed Northeast Valley Health Corporation Asian Pacific Health Care Venture Planned Parenthood Los Angeles ChapCare Tarzana Treatment Centers BAART Community Healthcare East Valley Community Health Centers District 27 – Judy Chu (D) El Proyecto del Barrio ChapCare Mission City Community Network Chinatown Service Center Planned Parenthood Los Angeles Garfield Health Center Our Saviour Center / Cleaver Family Wellness Center Herald Christian Health Center Southern California Medical Center Planned Parenthood of Pasadena and SGV District 33 – Ted Lieu (D) District 28 – Adam Schiff (D) Planned Parenthood Los Angeles All for Health, Health for All Saban Community Clinic All-Inclusive Community Health Center South Bay Family Health Care AltaMed Venice Family Clinic APLA Health and Wellness Westside Family Health Center Asian Pacific Health Care Venture City Help Wellness Center District 34 – Jimmy Gomez (D) Comprehensive Community Health Centers AltaMed Institute for Multicultural Counseling and Education APLA Health and Wellness Services Arroyo Vista Family Health Center Los Angeles LGBT Center Asian Pacific Health Care Venture Mission City Community Network BAART Community Healthcare Planned Parenthood Los Angeles Chinatown Service Center QueensCare Health Centers Clinica Msr. Oscar A Romero Saint Anthony Medical Centers Complete Care Community Health Centers Saban Community Clinic Comprehensive Community Health Centers Eisner Health District 29 – Tony Cárdenas (D) Institute for Multicultural Counseling and Education AAA Comprehensive Healthcare Services Comprehensive Community Health Center JWCH Institute El Proyecto del Barrio KHEIR CLINIC Eisner Health Los Angeles Christian Health Centers M.E.N.D. Northeast Community Clinic Mission City Community Network Planned Parenthood Los Angeles Northeast Valley Health Corps Planned Parenthood of Pasadena and San Gabriel Planned Parenthood Los Angeles Valley Valley Community Healthcare QueensCare Health Centers Updated 2.1.18- sw 13
Saint Anthony Medical Centers Northeast Community Clinic St. John’s Well Child and Family Center Planned Parenthood Los Angeles QueensCare Health Centers District 35 – Norma Torres (D) South Central Family Health Centers East Valley Community Health Center UMMA Community Clinic Mission City Community Network Universal Community Health Center Planned Parenthood Los Angeles Parktree Community Health Center District 43 – Maxine Waters (D) District 37 – Karen Bass (D) APLA Health and Wellness The Achievable Foundation Mission City Community Network APLA Health and Wellness Northeast Community Clinic Benevolence Health Centers Planned Parenthood Los Angeles Central Neighborhood Health Foundation Saint Anthony Medical Centers Eisner Health St. John’s Well Child and Family Center Kedren Community Health Center South Bay Family Health Care Northeast Community Clinic T.H.E. Health and Wellness Centers Planned Parenthood Los Angeles Watts Healthcare Corporation St. John’s Well Child and Family Center Wilmington Community Clinic T.H.E. Health and Wellness Centers Yehowa Medical Services UMMA Community Clinic District 44 – Nanette Barragán (D) Venice Family Clinic AltaMed Watts Healthcare Corporation APLA Health and Wellness Westside Family Health Centers BAART Community Healthcare Eisner Health District 38 – Linda Sánchez (D) Harbor Community Clinic AltaMed JWCH Institute ChapCare Kedren Community Health Center Family Health Care Center of Greater Los Angeles Northeast Community Clinic JWCH Institute Planned Parenthood Los Angeles Planned Parenthood Los Angeles St. John’s Well Child and Family Center Southern California Medical Center South Bay Family Health Care The Children’s Clinic, Serving Children and Their South Central Family Health Centers Families The Children’s Clinic Watts Healthcare Corporation District 40 – Lucille Roybal-Allard (D) Wilmington Community Clinic AltaMed Yehowa Medical Clinic BAART Community Healthcare Bienvenidos Community Healthcare District 47 – Alan Lowenthal (D) Central City Community Health Center APLA Health and Wellness Central Neighborhood Health Foundation Planned Parenthood Los Angeles Eisner Health The Children’s Clinic Family Health Care Centers of Greater Los Angeles Tarzana Treatment Center JWCH Institute Kedren Community Health Center
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Legislators by CCALAC Members Via Care Federal District 40 – Lucille Roybal-Allard (D) AAA Comprehensive Healthcare Federal District 29 – Tony Cardenas (D) Central City Community Health Center Federal District 40 – Lucille Roybal-Allard (D) The Achievable Foundation Federal District 37 – Karen Bass (D) Central Neighborhood Health Foundation Federal District 40 – Lucille Roybal-Allard (D) All for Health, Health For All Federal District 28 – Adam Schiff (D) Chinatown Service Center Federal District 27 – Judy Chu (D) All-Inclusive Community Health Center Federal District 34 – Jimmy Gomez (D) Federal District 28 – Adam Schiff (D) City Help Wellness Center AltaMed Health Services Corporation Federal District 28 – Adam Schiff (D) Federal District 28 – Adam Schiff (D) Federal District 34 – Jimmy Gomez (D) Federal District 32 – Grace Napolitano (D) Federal District 34 – Xavier Becerra (D) Clinica Msr. Oscar Romero Federal District 38 – Linda Sanchez (D) Federal District 34 – Jimmy Gomez (D) Federal District 40 – Lucille Roybal-Allard (D) Federal District 44 – Nanette Barragan (D) ChapCare Federal District 27 – Judy Chu (D) Antelope Valley Community Clinic Federal District 32 – Grace Napolitano (D) Federal District 23 – Kevin McCarthy (R) Federal District 38 – Linda Sanchez (D) Federal District 25 – Steve Knight (R) Complete Care Community Health Centers APLA Health and Wellness Federal District 34 – Jimmy Gomez (D) Federal District 28 – Adam Schiff (D) Federal District 34 – Xavier Becerra (D) Comprehensive Community Health Centers Federal District 37 – Karen Bass (D) Federal District 28 – Adam Schiff (D) Federal District 43 – Maxine Waters (D) Federal District 29 – Tony Cardenas (D) Federal District 44 – Nanette Barragan (D) Federal District 34 – Jimmy Gomez (D) Federal District 47 – Alan Lowenthal (D) East Valley Community Health Centers Arroyo Vista Family Health Center Federal District 32 – Grace Napolitano (D) Federal District 34 – Jimmy Gomez (D) Federal District 35 – Norma Torres (D)
Asian Pacific Health Care Venture Eisner Health Federal District 28 – Adam Schiff (D) Federal District 29 – Tony Cardenas (D) Federal District 32 – Grace Napolitano (D) Federal District 30 – Brad Sherman (D) Federal District 34 – Jimmy Gomez (D) Federal District 34 – Jimmy Gomez (D) Federal District 37 – Karen Bass (D) BAART Community Healthcare Federal District 40 – Lucille Roybal-Allard (D) Federal District 32 – Grace Napolitano (D) Federal District 44 – Nanette Barragan (D) Federal District 34 – Jimmy Gomez (D) Federal District 40 – Lucille Roybal-Allard (D) El Proyecto del Barrio Family Health Care Clinic Federal District 44 – Nanette Barragan (D) Federal District 29 – Tony Cardenas (D) Federal District 30 – Brad Sherman (D) Bartz-Altadonna Community Health Center Federal District 32 – Grace Napolitano (D) Federal District 25 – Steve Knight (R) Family Health Care Centers of Greater LA Benevolence Health Centers Federal District 38 - Linda Sanchez (D) Federal District 37 – Karen Bass (D) Federal District 40 – Lucille Roybal-Allard (D) 3
15 Federal District 25 – Steve Knight (R) Garfield Health Center Federal District 29 – Tony Cardenas (D) Federal District 27 – Judy Chu (D) Federal District 30 – Brad Sherman (D)
Harbor Community Clinic Our Saviour Center / Cleaver Family Wellness Federal District 44 – Nanette Barragan (D) Center Federal District 32 – Grace Napolitano (D) Herald Christian Health Center Federal District 27 – Judy Chu (D) Planned Parenthood Los Angeles Federal District 25 – Steve Knight (R) Institute for Multicultural Counseling and Federal District 28 – Adam Schiff (D) Education Services Federal District 29 – Tony Cardenas (D) Federal District 28 – Adam Schiff (D) Federal District 30 – Brad Sherman (D) Federal District 34 – Jimmy Gomez (D) Federal District 32 – Grace Napolitano (D) Federal District 33 – Ted Lieu (D) JWCH Institute Federal District 34 – Jimmy Gomez (D) Federal District 34 – Jimmy Gomez (D) Federal District 35 – Norma Torres (D) Federal District 38 – Linda Sanchez (D) Federal District 37 – Karen Bass (D) Federal District 40 – Lucille Roybal-Allard (D) Federal District 38 – Linda Sanchez (D) Federal District 44 – Nanette Barragan (D) Federal District 40 – Lucille Roybal-Allard (D) Federal District 43 – Maxine Waters (D) Kedren Community Health Center Federal District 44 – Nanette Barragan (D) Federal District 37 – Karen Bass (D) Federal District 47 – Alan Lowenthal (D) Federal District 40 – Lucille Roybal-Allard (D) Federal District 44 – Nanette Barragan (D) Planned Parenthood of Pasadena and SGV Federal District 27 – Judy Chu (D) KHEIR CLINIC Federal District 34 – Jimmy Gomez (D) Federal District 34 – Jimmy Gomez (D) Parktree Community Health Center Los Angeles Christian Health Centers Federal District 35 – Norma Torres (D) Federal District 34 – Xavier Becerra (D) QueensCare Health Centers Los Angeles LGBT Center Federal District 28 – Adam Schiff (D) Federal District 28 – Adam Schiff (D) Federal District 34 – Jimmy Gomez (D) Federal District 40 – Lucille Roybal-Allard (D) M.E.N.D. Federal District 29 – Tony Cardenas (D) Saban Community Clinic Federal District 28 – Adam Schiff (D) Mission City Community Network Federal District 33 – Ted Lieu (D) Federal District 28 – Adam Schiff (D) Federal District 29 – Tony Cardenas (D) Saint Anthony Medical Centers Federal District 30 – Brad Sherman (D) Federal District 28 – Adam Schiff (D) Federal District 32 – Grace Napolitano (D) Federal District 34 – Jimmy Gomez (D) Federal District 35 – Norma Torres (D) Federal District 43 – Maxine Waters (D) Federal District 43 – Maxine Waters (D) St. John’s Well Child and Family Center Northeast Community Clinic Federal District 34 – Jimmy Gomez (D) Federal District 34 – Jimmy Gomez (D) Federal District 37 – Karen Bass (D) Federal District 37 – Karen Bass (D) Federal District 44 – Nanette Barragan (D) Federal District 40 – Lucille Roybal-Allard (D) Federal District 43 – Maxine Waters (D) South Bay Family Health Care Federal District 44 – Nanette Barragan (D) Federal District 33 – Ted Lieu (D) Federal District 43 – Maxine Waters (D) Northeast Valley Health Corporation Federal District 44 – Nanette Barragan (D) 4
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Southern California Medical Center Federal District 32 – Grace Napolitano (D) Federal District 38 – Linda Sanchez (D)
South Central Family Health Centers Federal District 40 – Lucille Roybal-Allard (D)
Tarzana Treatment Centers Federal District 23 – Kevin McCarthy (R) Federal District 25 – Steve Knight (R) Federal District 30 – Brad Sherman (D) Federal District 47 – Alan Lowenthal (D)
T.H.E. Health and Wellness Centers Federal District 37 – Karen Bass (D) Federal District 43 – Maxine Waters (D)
The Children’s Clinic Federal District 38 – Linda Sanchez (D) Federal District 44 – Nanette Barragan (D) Federal District 47 – Alan Lowenthal (D)
UMMA Community Clinic Federal District 37 – Karen Bass (D) Federal District 40 – Lucille Roybal-Allard (D)
Universal Community Health Center Federal District 40 – Lucille Roybal-Allard (D)
Valley Community Healthcare Federal District 29 – Tony Cardenas (D)
Venice Family Clinic Federal District 33 – Ted Lieu (D) Federal District 37 – Karen Bass (D)
Watts Healthcare Corporation Federal District 37 – Karen Bass (D) Federal District 43 – Maxine Waters (D) Federal District 44 – Nanette Barragan (D)
Westside Family Health Center Federal District 33 – Ted Lieu (D) Federal District 37 – Karen Bass (D)
Wilmington Community Clinic Federal District 43 – Maxine Waters (D) Federal District 44 – Nanette Barragan (D)
Yehowa Medical Services Federal District 43 – Maxine Waters (D) Federal District 44 – Nanette Barragan (D)
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17 (916) 503-9130 healthplusadvocates.org 1231 I Street, Suite 400, Sacramento, CA 95814
Governor Brown’s 2018-19 Proposed State Budget Impact on Community Health Centers January 17, 2018
Overview
Governor Brown’s 2018-19 Proposed Budget (Proposed Budget) shows a continued commitment to balancing fiscal responsibility while remaining committed to protecting core priority issue areas: education, infrastructure, and health care. We are encouraged by the Administration’s continued commitment to maintain the Medi-Cal program, the Children’s Health Insurance Program (CHIP), and the Affordable Care Act in California at a time when shifting federal policy could have a detrimental impact on these programs and the state. While grateful for the commitments this Proposed Budget signals, we are concerned, and deeply disappointed, to again find the administration seeking to destabilize and eliminate the 340B program.
Similar to 2017, the Proposed Budget does acknowledge the shifting federal policy arena and prepares Californians tofor expected budgetary revisions in May that will adjust for this environment.
Budget Details Most Relevant to Health Centers
340B: The Governor’s Proposed Budget seeks to eliminate 340B program participation for Medi- Cal fee-for-service and Medi-Cal managed care effective July 1, 2019.
CHC Impact: Like 2017, the Administration is again seeking to make significant changes to the 340B Program. This year, however, the Administration goes farther and instead of restricting contract pharmacies in 340B Medi-Cal managed care, it overtly eliminates 340B altogether. The results of such a policy could be extremely detrimental to health centers that rely on 340B savings to enhance patient services, pay for capital projects, and support and improve operations. According to the Department of Health Care Services (DHCS) Budget Highlights, the proposal aims to ensure that the state is complying with federal law, eliminating unnecessary costs, and addressing administrative burdens. The start date is targeted for July 1, 2019. Being a 340B covered entity remains optional, but, to note, as a requirement of being a federally qualified health center (FQHC), health centers must purchase drugs at 340B or better prices. DHCS claims these changes will have no anticipated impacts on Medi-Cal beneficiaries, however the cuts to services that will certainly follow would surely impact beneficiaries.
Medi-Cal and Affordable Care Act: With an expected general fund investment of nearly $22 billion in FY 18-19, the Proposed Budget includes an estimate $1.5 billion increase in Medi-Cal General Fund costs to provide care to the 13.5 million Californians that rely on the program.
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CHC Impact: The Governor’s Proposed Budget continues to see health care coverage, the Medi-Cal program and Covered California, as critical components to our state’s network of health and human services. The Budget continues to reflect existing state and federal law, however should there be significant federal funding changes or ACA repeal there will likely be a disruption to benefits and coverage. The percentage of health center patients enrolled in Medi-Cal, which has increased every year since the Affordable Care Act’s implementation, has a direct impact on the fiscal health of California’s health centers. Health centers continue to have a large percentage of their patients eligible for PPS reimbursement.
Children’s Health Insurance Program (CHIP): The Governor’s Proposed Budget assumes CHIP reauthorization and maintains a commitment to this program and the families it serves. CHC Impact: In the DHCS Budget Highlight the CHIP funding extension was quantified as the funding to provide coverage for approximately 32,000 pregnant women and children, persons that would not otherwise be eligible for Medi-Cal. However, should CHIP funding not be provided beyond March 2018, the broader Medi-Cal program will be impacted, and not just the coverage for these 32,000 beneficiaries. Health centers that care for patients that rely on Medi-Cal should be mindful of the reauthorization of CHIP funding.
Workforce – Residency: The Governor’s Proposed Budget includes a continuation of the Song- Brown funding commitment.
CHC Impact: After a 2017 attempt to eliminate $100 million in new funding commitments to Song-Brown, and a successful campaign to reinstate those funds in the FY 17-18 Budget, we are glad to see the proposed Office of Statewide Health Planning and Development (OSHPD) budget includes $33.3 million in general fund commitment to primary care residency. This installment is critically necessary to stabilize, expand, and launch primary care residency programs, including Teaching Health Centers. These funds are essential to guarantee the primary care workforce shortage does not get worse.
Workforce – Residency: The Governor’s Proposed Budget includes new investments in an initial Medicaid Graduate Medical Education (GME) Program.
CHC Impact: While there is no immediate direct impact on health centers, this commitment will further buoy California’s ability to support residency. The new funding allocation will bring two new positions to DHCS in order to implement a limited GME program under which payments will be made to Designated Public Hospital residency programs. If successful, this program could be the necessary catalyst to launch a more significant Medicaid GME investment in our state.
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Workforce -- MFT Billable Providers: With a Final 17-18 Budget that included a new July 1, 2018 implementation date, the Proposed Budget reaffirms this implementation commitment with new dedicated staff.
CHC Impact: In anticipation of a new workload, DHCS is seeking limited-term resources for the Audits and Investigations unit. This is a promising sign and indicates the state commitment to working with health centers as they seek to expand behavioral health access through the utilization of Marriage and Family Therapists (MFTs).
Proposition 56: The Proposed Budget includes increased funding for supplemental payments for dental and physician services and maintains supplemental payments for the other three provider types – women’s health providers, developmental disability providers, and HIV/AIDS providers.
CHC Impact: As part of the FY 17-18 Budget, DHCS determined rules for allocating the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56) funds for supplemental payment purposes. This year’s plan includes an increase of approximately $232 million in proposition funding. The total proposed FY 18-19 Proposition 56 funding for providers, including the increase for doctors and dentists, is $649.9 million. FQHCs continue to be eligible for the supplemental payments for Family Planning, Access, Care and Treatment (FPACT ) services, but will not be eligible for any other Prop. 56 supplemental payments. FQHCs will be eligible for the supplemental payments for FPACT services. The time-limited supplemental reimbursements under the program will be available to all FPACT providers for the Evaluation and Management portion of office visits rendered for the purpose of comprehensive family planning services. FQHCs will not be eligible for any other supplemental payments, including Medi-Cal and/or Denti-Cal fee-for-service or managed care supplemental payments that could cause challenges during reconciliation.
Drug Medi-Cal Organized Delivery System Pilot: The DMC-ODS pilot allows counties to opt-in to a demonstration to provide an expanded continuum of care for substance use disorder (SUD) services. This budget includes expected expansion of the number of counties choosing to participate in the waiver, demonstrating a willingness on the part of the state to continue to invest in behavioral health and SUD services.
CHC Impact: DHCS estimates that 15 counties will implement the DMC-ODS waiver in FY 2017-18 and an additional 20 counties in FY 2018-19. FQHC patients will benefit from greater availability and breadth of SUD services available under the DMC-ODS pilot in counties that opt-in to the demonstration. In addition, and furthered by the implementation of SB 323 (Mitchell), counties may be seeking to grow additional SUD resources , and FQHCs who wish to offer medication assisted treatment (MAT) or other SUD services may have expanded opportunity to become a part of the county delivery system.
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20 DISCUSSION
Date: January 11, 2018 To: Legislative Committee From: Beth Malinowski, Deputy Director of Government Affairs Re: 2018 State Legislative Approach and Sponsored Bill Concepts
MEMORANDUM
As we enter the second year of a two year state legislative cycle, we aim to continue legislative efforts launched in 2017 while introducing and supporting additional bills that are in keeping with our 2018 policy priorities.
To promote healthy people and healthy communities, CPCA will be working with CaliforniaHealth+ Advocates (Advocates) to strengthen California’s community clinics and health centers through the following priorities: (1) Coverage and Access for All; (2) Delivery of Culturally Competent Whole Person Health Care, Preventive Care, and Support Services; and (3) Building Healthy Communities. In the paragraphs below, I outline two‐year bills, potential sponsored bills, and additional state legislative conversations that are in keeping with CPCA’s 2018 Public Policy Platform:
I. Coverage and Access for All SB 562 (Lara)[Two Year Bill] – In 2017, Senator Lara, with a track record of expanding coverage, and buoyed by activists committed to finding a California solution to federal coverage challenges, introduced universal coverage legislation. Once advanced to the Assembly, Speaker Rendon launched the Select Committee on Health Care Delivery Systems and Universal Coverage to continue thoughtful debate on this important topic. While Advocates continues to have no formal position on this bill, staff have participated in stakeholder meetings and will be tracking closely additional developments on this bill in 2018.
Fight4OurHealth Coalition – CaliforniaHealth+ Advocates continues to participate in Health Access led statewide coalition to defend the Affordable Care Act, Medicaid, and immigrant communities. Similar to 2017, we expect legislation to be introduced that will respond to the changing dynamics at the federal level, including legislation to address the individual mandate repeal and further protect our immigrant patients.
Declared Emergencies [Potential Advocates Sponsored Legislation] – This year too many health centers found themselves caught in dangers way. The devastating 2017 fire season has brought home the need to build additional protections to guarantee that health centers can continue to provide timely access to care during, and immediately after, a declared emergency. CPCA’s Government Affairs team, in dialog with impacted members and consortia, have identified legislative solutions that are needed to better prepare health
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Legislative Committee/Page 11 of 24 21 centers for future emergencies. To this end, Advocates, on behalf of CPCA, is currently exploring sponsoring declared emergency‐related legislation that could address payment for telephonic visits; local jurisdictional permitting and building standards for temporary sites, and timeliness of clinic pharmacy permitting.
II. Delivery of Culturally Competent Whole Person Health Care, Preventive Care, and Support Services SB 456 (Pan) [Sponsored Two Year Bill] – Sponsored by CaliforniaHealth+ Advocates, this bill seeks to improve the health of California’s most vulnerable people by allowing FQHCs to be directly reimbursed for services that promote continuity of care and wellness in ways not covered by PPS, including services associated with innovative projects like the Whole Person Care pilots. While we expect that this bill will reduce overall costs to the health care system through better care coordination, addressing social determinants of health, and incentivizing wellness services that keep patients healthy and out of the emergency room, DHCS has significant concerns with the bill. With this in mind, and working closely with the author, it was determined that this bill would become a two‐year bill effort to allow for greater discussion with DHCS. We look forward to having necessary dialog with DHCS partners this winter.
Same Day Billing [Potential Advocates Sponsored Legislation] – This Fall, with strong encouragement from CPCA members and behavioral health advocates, CaliforniaHealth+ Advocates has moved forward with exploring the reintroduction of Same Day Billing. With the Steinburg Institute, Advocates is aiming to co‐sponsor this critical legislation. While prior efforts have fallen short, we believe the policy environment has shifted significantly enough to warrant a renewed effort. With a raging opioid epidemic, a greater appreciation for the intersection of primary care and mental health services, and the need to increase access to behavioral health preventive and diagnostic services, Advocates is excited to be working with the Steinburg Institute on this important effort. This legislation, if introduced, will also help start an important dialog with gubernatorial candidates regarding the role of health centers in the behavioral health delivery system.
Consolidated Licensing [Potential Advocates Sponsored Legislation] – In 2017, upon identifying implementation challenges with AB 2053 (Gonzalez‐Fletcher, 2016), it has been a commitment of CPCA to identify the appropriate legislative or administrative path needed to see the full intended benefits of the consolidated license. After extensive research, it has been determined that legislation is the appropriate path. Advocates have been in close dialog with Gonzalez‐Fletcher staff and are now working on the introduction of legislation that will (1) Allow an FQHC which chooses to add a facility through the consolidated license process to include the additional facility in their PPS rate and bill accordingly, (2) allow the new site to have choice in how their rate is determined, (3) and or allow the new site to be enrolled with Medi‐Cal through the existing site. This bill would also seek to create parallel permissions for consolidated‐like sites established prior to AB 2053.
Workforce – Educational Equity [Potential Advocates Sponsored Legislation] – After successfully coordinating a well‐attended third statewide Workforce Policy Coalition meeting in November 2017, The Coalition successfully ended the year by jointly agreeing to prioritize three issues areas in 2018; residency redesign, equity in education (focused on college pipeline programs), and researching primary care specific tax incentive programs. Advocates,
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Legislative Committee/Page 12 of 24 22 on behalf of CPCA, has already initiated conversation with legislative staff regarding these three priority areas. The area of educational equity has drawn a particular interest. Advocates is currently working with the Campaign for College Opportunity on specific legislative concepts that could be introduced to support community college students and create the necessary conditions to allow diverse students to pursue training and careers in health care. Of note, any workforce legislation introduced, will be in addition to the expected budget advocacy that will be needed to draw down the remaining $66 million of the $100 million general fund commitment.
Proposition 64 [Potential Advocates Sponsored Legislation] – Proposition 64, the California Marijuana Legalization Initiative, will be allocating approximately $650 million to help fund substance abuse disorder (SUD) education, prevention, intervention, and treatment for youth. With strong encouragement from CPCA members and advocates, CaliforniaHealth+ Advocates began participating in the Proposition 64 Stakeholder Coalition that is looking at how these funds should be spent. This year, it is expected that multiple proposals, will be submitted to the legislature. While it’s unlikely that introduced legislation will make it to the Governor’s desk, it’s probable that these bills will impact budget negotiations that take place later in the session. To best position health centers for these budget negotiations, Advocates is currently considering sponsoring or cosponsoring legislation that would direct revenues towards increasing training opportunities on SUDs for providers interested in offering this service, implementing and widely utilizing the new FaCES adolescent SBIRT tool, and increasing the utilization of ECHO, among other things.
AB 1250 (Jones‐Sawyer) [Two Year Bill] – In 2017, for the first time in some years, health centers were at the center of an opposition campaign (AB 1250) – Counties and Contracts for Personal Services. AB 1250 was held in the Senate Rules Committee and was not brought to the floor. While the decision to hold the bill, was seen as a significant short‐term victory, this bill may resurface in 2018. Advocates, on behalf of CPCA, continues to work with a coalition of organizations opposed to the bill and has already started 2018 strategy conversations. While we cannot let our guard down, we are hopeful that political shifts in the capitol, including the change in Senate leadership, could have a significant impact on this bills future.
III. Building Healthy Communities AB 1003 (Bloom) [Sponsored Two Year Bill] – Sponsored by the Coalition for a Healthy California, to which CaliforniaHealth+ Advocates was a leading member, sought to address Type 2 diabetes, dental disease, heart disease, stroke – debilitating epidemics in California ‐ by creating a dedicated revenue source for prevention and care. The author, aware of significant opposition at time of introduction, worked with Assembly leadership to commit this bill for assignment to the proper committee for study. This fall, the Coalition for a Healthy California, partnered with Assemblymember Bloom on the Select Committee on Diabetes and Heart Disease Prevention. The committee, tasked with examining the epidemics of type 2 diabetes, obesity, heart disease, tooth decay, and other associated health outcomes, has held two hearings and is currently planning a third hearing for later this winter. While this bill is not expected to move out of the house of origin, it has continued an important conversation.
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Legislative Committee/Page 13 of 24 23 In addition to the bill concepts and legislation listed above, CaliforniaHealh+ Advocates is also currently engaging with a variety of legislative offices, providing technical support and feedback, on elected driven conversations on a variety of topics from immigration to addressing childhood trauma. Advocates role in being a trusted thought partner is critically important to advancing health center interests and building capitol champions.
As we prepare for the year ahead, we must also reflect on the capitol environment in which we will be working. Like 2017, the destabilizing policies of the Trump Administration will continue to challenge California and, like last year, we expect state elected officials to be quick to introduce legislation in direct response to Federal Tax Reform and other threats. While we are hopeful some of the capitol unity of 2017, a unity forged in a commitment to defend California values on health care, immigration, and the environment, will continue, we must also recognize that this unity is already being challenged. While the 2018 elections, senate leadership transitions and other political jockeying, was always expected to influence this year, what could not have been forecasted was the sexual harassment news that continues to reverberate in the capitol community. As we walk into 2018, we will continue to update the membership on how the capitol environment will influences our priorities.
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Legislative Committee/Page 14 of 24 24 Member Driven. Patient Focused.
Date: February 12, 2018
To: Policy Advisory Group
From: Becky Lee, Policy Analyst, and Sara Watson, Event Coordinator
Re: CPCA Day at the Capitol (Information/Discussion)
This memo provides information on CaliforniaHealth+ Advocate’s Day at the Capitol. It also includes a list of Member Clinics with legislators. If you need to update your clinic’s information, please contact Sara Watson at [email protected].
Save the Date & Book Travel The CaliforniaHealth+ Advocates’ Day at the Capitol will be Wednesday, April 25.
The Day at the Capitol is an annual event that welcomes physicians, clinicians, directors, and patients and health center advocates to Sacramento to engage with legislators and legislative staff about budget and legislative priorities impacting community health centers. For more information from CPCA, check out the event website.
Registration is Open Please be sure to register with both CCALAC and CPCA! • Click here to register with CCALAC. • Click here to register with CPCA.
CCALAC will provide additional information in the coming weeks. Please contact Sara Watson at [email protected] with any questions.
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Member Driven. Patient Focused.
Day at the Capitol Legislative Information for CCALAC Members
CALIFORNIA ASSEMBLY Assembly District 36 –Tom Lackey (R) Assembly District 46 – Adrin Nazarian (D) Antelope Valley Community Clinic Eisner Health Bartz–Altadonna Community Health Center Mission City Community Network Planned Parenthood Los Angeles Northeast Valley Health Corporation Tarzana Treatment Centers Planned Parenthood Los Angeles Valley Community Healthcare Assembly District 38 – Dante Acosta (D) Northeast Valley Health Corporation Assembly District 48 – Blanca Rubio (D) AltaMed Assembly District 39 – VACANT Central City Community Health Center AAA Comprehensive Healthcare East Valley Community Health Center All for Health, Health for All El Proyecto del Barrio El Proyecto del Barrio Planned Parenthood Pasadena and San Gabriel Valley M.E.N.D. Southern California Medical Center Mission City Community Network Northeast Valley Health Corporation Assembly District 49 – Ed Chau (D) Asian Pacific Health Care Venture Assembly District 41– Chris Holden (D) Central City Community Health Center ChapCare Chinatown Service Center Mission City Community Network ChapCare Planned Parenthood Pasadena and San Gabriel Valley Garfield Health Center Herald Christian Health Center Assembly District 43 – Laura Friedman (D) Planned Parenthood Los Angeles All for Health, Health for All Planned Parenthood Pasadena and San Gabriel Valley All–Inclusive Community Health Center AltaMed Assembly District 50 – Richard Bloom (D) Asian Pacific Health Care Venture Los Angeles LGBT Center Comprehensive Community Health Center Planned Parenthood Los Angeles Institute for Multicultural Counseling and Education St. Anthony Medical Centers Services Saban Community Clinic Mission City Community Network Venice Family Clinic Planned Parenthood Los Angeles Westside Family Health Center QueensCare Health Centers Assembly District 51 – Wendy Carrillo (D) Assembly District 45 – VACANT AltaMed Eisner Health Arroyo Vista Family Health Center El Proyecto del Barrio Asian Pacific Health Care Venture Mission City Community Network BAART Programs Northeast Valley Health Corporation Via Care Planned Parenthood Los Angeles Chinatown Service Center Tarzana Treatment Centers City Help 26 Clinica Msr. Oscar A. Romero Comprehensive Community Health Center Assembly District 59 – Reginald Jones–Sawyer (D) Los Angeles Christian Health Centers Central City Community Health Center Planned Parenthood Los Angeles Central Neighborhood Health Foundation Planned Parenthood Pasadena and San Gabriel Valley Eisner Health QueensCare Health Centers Kedren Community Health Center St. John’s Well Child and Family Center St. John’s Well Child and Family Center Northeast Community Clinic T.H.E. Health and Wellness Centers Northeast Community Clinic Assembly District 52 – Freddie Rodriguez (D) UMMA Community Clinic East Valley Community Health Center Universal Community Health Center Mission City Community Network Planned Parenthood Los Angeles Assembly District 62 – Autumn Burke (D) Parktree Community Health Center Mission City Community Network South Bay Family Healthcare Center Assembly District 53 – Miguel Santiago (D) St. John’s Well Child and Family Center Central City Community Health Center T.H.E. Health and Wellness Centers Eisner Health Northeast Community Clinic Institute for Multicultural Counseling and Education Venice Family Clinic Services Yehowa Medical Services KHEIR Center South Central Family Health Center Assembly District 63 – Anthony Rendon (D) St. Anthony Medical Centers Speaker St. John’s Well Child and Family Center AltaMed Saban Community Clinic BAART Programs Northeast Community Clinic Complete Care Community Health Center Eisner Health Assembly District 54 – VACANT Family Health Care Centers of Greater Los Angeles APLA Health and Wellness JWCH Institute, Inc. Benevolence Health Centers Planned Parenthood Los Angeles Eisner Health South Central Family Health Center Planned Parenthood Los Angeles St. John’s Well Child and Family Center T.H.E. Health and Wellness Centers The Children’s Clinic The Achievable Foundation Northeast Community Clinic Watts Healthcare Corporation Westside Family Health Center Assembly District 64 – Mike Gipson (D) AltaMed Assembly District 57 – Ian Calderon (D) APLA Health and Wellness Majority Leader Eisner Health BAART Programs Kedren Community Health Center ChapCare Planned Parenthood Los Angeles East Valley Community Health Center South Bay Family Health Care JWCH Institute St. John’s Well Child and Family Center Planned Parenthood Los Angeles St. Anthony Medical Centers Northeast Community Clinic Assembly District 58 – Cristina Garcia (D) Watts Healthcare Corporation AltaMed Wilmington Community Clinic Family Health Care Centers of Greater Los Angeles Yehowa Medical Services JWCH Institute, Inc Southern California Medical Centers Assembly District 66 – Al Muratsuchi (D) The Children’s Clinic South Bay Family Health Care Center 2 27 Northeast Community Clinic Planned Parenthood Los Angeles The Children’s Clinic Assembly District 70 – Patrick O’Donnell (D) APLA Health & Wellness CALIFORNIA SENATE Harbor Community Clinic Asian Pacific Health Care Venture Senate District 18 – Robert Hertzberg (D) BAART Programs AAA Comprehensive Healthcare Via Care Comprehensive Community Health Centers Chinatown Service Center Eisner Healths City Help El Proyecto del Barrio Clinica Msr. Oscar A. Romero M.E.N.D. Complete Care Community Health Center Mission City Community Network Comprehensive Community Health Centers Northeast Valley Health Corporation Eisner Health Planned Parenthood Los Angeles Institute for Multicultural Counseling and Education Tarzana Treatment Centers Services Valley Community Healthcare JWCH Institute KHEIR Center Senate District 20 – Connie Leyva (D) Los Angeles Christian Health Centers East Valley Community Health Center Mission City Community Network Mission City Community Network Northeast Community Clinic Planned Parenthood Los Angeles Planned Parenthood Los Angeles Parktree Community Health Center Planned Parenthood Pasadena and San Gabriel Valley QueensCare Health Centers Senate District 21 – Scott Wilk (R) St. Anthony Medical Centers Antelope Valley Community Clinic St. John’s Well Child and Family Center Bartz-Altadonna Community Health Center Saban Community Clinic Northeast Valley Health Corporation Planned Parenthood Los Angeles Senate District 25 – Anthony Portantino (D) Tarzana Treatment Centers All for Health, Health for All All-Inclusive Community Health Center Senate District 22 – Ed Hernandez (D) ChapCare AltaMed Comprehensive Community Health Centers Asian Pacific Health Care Venture Institute for Multicultural Counseling and Education BAART Programs Services Chinatown Services Mission City Community Network ChapCare Planned Parenthood Los Angeles East Valley Community Health Center Planned Parenthood Pasadena and San Gabriel Valley El Proyecto del Barrio Garfield Health Center Senate District 26 – Benjamin Allen (D) Herald Christian Health Center Los Angeles LGBT Center Our Saviour Center Planned Parenthood Los Angels Planned Parenthood Los Angeles Saba Community Clinic Planned Parenthood Pasadena and San Gabriel Valley South Bay Family Health Center Southern California Medical Center St. Anthony Medical Centers Venice Family Clinic Senate District 24 – Kevin de León (D) Westside Family Health Center President pro Tempore AltaMed Senate District 27 – Henry Stern (D) APLA Health and Wellness Eisner Health Arroyo Vista Family Health Center El Proyecto del Barrio 3 28 Mission City Community Network The Children’s Clinic Northeast Valley Health Corporation Planned Parenthood Los Angeles Senate District 33 – Ricardo Lara (D) Tarzana Treatment Centers AltaMed APLA Health & Wellness Senate District 30 – Holly Mitchell (D) BAART Programs The Achievable Foundation Central City Community Health Center APLA Health and Wellness Complete Care Community Health Center BAART Programs Eisner Health Benevolence Health Centers Family Health Care Centers of Greater Los Angeles Central Neighborhood Health Foundation JWCH Institute Eisner Health Northeast Community Clinic JWCH Institute Planned Parenthood Los Angeles Kedren Community Health Center South Central Family Health Center Los Angeles Christian Health Centers St. John’s Well Child and Family Center Northeast Community Clinic The Children’s Clinic Planned Parenthood Los Angeles South Central Family Health Center Senate District 35 – Steven Bradford (D) St. Anthony Medical Centers AltaMed St. John’s Well Child and Family Center APLA Health and Wellness T.H.E. Health and Wellness Centers Eisner Health UMMA Community Clinic Harbor Community Clinic Universal Community Health Center Kedren Community Health Center Watts Healthcare Corporation Mission City Community Network Westside Family Health Center Northeast Community Clinic Yehowa Medical Services Planned Parenthood Los Angeles South Bay Family Health Care Center Senate District 32 – Tony Mendoza (D) St. John’s Well Child and Family Center AltaMed The Children’s Clinic Family Health Care Centers of Greater Los Angeles Watts Healthcare Corporation JWCH Institute Wilmington Community Clinic Planned Parenthood Los Angeles Yehowa Medical Services Southern California Medical Center AltaMed Health Services Corporation Legislators by CCALAC Members CA Assembly District 43 – Michael Gatto (D) AAA Comprehensive Healthcare CA Assembly District 48 – Roger Hernandez (D) CA Assembly District 39 – CA Assembly District 51 – Wendy Carrillo (D) CA Senate District 18 – Robert Hertzberg (D) CA Assembly District 58 – Cristina Garcia (D) CA Assembly District 63 – Anthony Rendon (D) The Achievable Foundation CA Assembly District 64 – Mike Gipson (D) CA Assembly District 54 – CA Senate District 22 – Ed Hernandez (D) CA Senate District 18 – Robert Hertzberg (D) CA Senate District 24 – Kevin de León (D) CA Senate District 30 – Holly Mitchell (D) CA Senate District 32 – Tony Mendoza (D) CA Senate District 33 – Ricardo Lara (D) All for Health, Health For All CA Senate District 35 – Steven Bradford (D) CA Assembly District 39 – CA Assembly District 43 – Michael Gatto (D) Antelope Valley Community Clinic CA Senate District 25 – Carol Liu (D) CA Assembly District 36 – Tom Lackey (R) CA Senate District 21 – Scott Wilk (R) All-Inclusive Community Health Center CA Assembly District 43 – Michael Gatto (D) APLA Health and Wellness CA Senate District 25 – Carol Liu (D) CA Assembly District 54 – CA Assembly District 64 – Mike Gipson (D) 4 29 CA Assembly District 70 – Patrick O’Donnell (D) CA Assembly District 49 – Ed Chau (D) CA Senate District 24 – Kevin de León (D) CA Assembly District 51 – Wendy Carrillo (D) CA Senate District 30 – Holly Mitchell (D) CA Senate District 22 – Ed Hernandez (D) CA Senate District 33 – Ricardo Lara (D) CA Senate District 24 – Kevin de León (D) CA Senate District 35 – Steven Bradford (D) CA Senate District 25 – Carol Liu (D)
Arroyo Vista Family Health Center City Help Wellness Center CA Assembly District 51 – Wendy Carrillo (D) CA Assembly District 51 – Wendy Carrillo (D) CA Senate District 24 – Kevin de León (D) CA Senate District 24 – Kevin de León (D)
Asian Pacific Health Care Venture Clinica Msr. Oscar Romero CA Assembly District 43 – Michael Gatto (D) CA Assembly District 51 – Wendy Carrillo (D) CA Assembly District 49 – Ed Chau (D) CA Senate District 24 – Kevin de León (D) CA Assembly District 51 – Wendy Carrillo (D) CA Senate District 22 – Ed Hernandez (D) ChapCare CA Senate District 24 – Kevin de León (D) CA Assembly District 41– Chris Holden (D) CA Assembly District 49 – Ed Chau (D) BAART Community Healthcare CA Assembly District 57 – Ian Calderon (D) CA Assembly District 51 – Wendy Carrillo (D) CA Senate District 22 – Ed Hernandez (D) CA Assembly District 53 – Miguel Santiago (D) CA Assembly District 57 – Ian Calderon (D) Complete Care Community Health Centers CA Senate District 22 – Ed Hernandez (D) CA Assembly District 63 – Anthony Rendon (D) CA Senate District 24 – Kevin de León (D) CA Senate District 24 – Kevin de León (D) CA Senate District 30 – Holly Mitchell (D) CA Senate District 33 – Ricardo Lara (D) CA Senate District 33 – Ricardo Lara (D) Comprehensive Community Health Centers Bartz-Altadonna Community Health Center CA Assembly District 43 – Michael Gatto (D) CA Assembly District 36 – Tom Lackey (R) CA Assembly District 51 – Wendy Carrillo (D) CA Senate District 21 – Scott Wilk (R) CA Senate District 18 – Robert Hertzberg (D) CA Senate District 24 – Kevin de León (D) Benevolence Health Centers CA Senate District 25 – Carol Liu (D) CA Assembly District 54 – CA Senate District 30 – Holly Mitchell (D) East Valley Community Health Centers CA Assembly District 48 – Roger Hernandez (D) Via Care CA Assembly District 52 – Freddie Rodriguez (D) CA Assembly District 51 – Wendy Carrillo (D) CA Assembly District 57 – Ian Calderon (D) CA Senate District 24 – Kevin de León (D) CA Senate District 20 – Connie Leyva (D) CA Senate District 22 – Ed Hernandez (D) Central City Community Health Center CA Assembly District 48 – Roger Hernandez (D) Eisner Health CA Assembly District 49 – Ed Chau (D) CA Assembly District 45 – CA Assembly District 53 – Miguel Santiago (D) CA Assembly District 46 – Adrin Nazarian (D) CA Assembly District 59 – Reginald Jones–Sawyer (D) CA Assembly District 53 – Miguel Santiago (D) CA Senate District 33 – Ricardo Lara (D) CA Assembly District 54 – CA Assembly District 59 – Reginald Jones–Sawyer (D) Central Neighborhood Health Foundation CA Assembly District 63 – Anthony Rendon (D) CA Assembly District 59 – Reginald Jones–Sawyer (D) CA Assembly District 64 – Mike Gipson (D) CA Senate District 30 – Holly Mitchell (D) CA Senate District 18 – Robert Hertzberg (D) CA Senate District 24 – Kevin de León (D) Chinatown Service Center CA Senate District 27 – Fran Pavley (D)
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org 30 CA Senate District 30 – Holly Mitchell (D) CA Senate District 35 – Steven Bradford (D) CA Senate District 33 – Ricardo Lara (D) CA Senate District 35 – Steven Bradford (D) KHEIR CLINIC CA Assembly District 53 – Miguel Santiago (D) El Proyecto del Barrio Family Health Care Clinic CA Senate District 24 – Kevin de León (D) CA Assembly District 43 – Michael Gatto (D) CA Assembly District 45 – Los Angeles Christian Health Centers CA Assembly District 48 – Roger Hernandez (D) CA Assembly District 51 – Wendy Carrillo (D) CA Senate District 18 – Robert Hertzberg (D) CA Senate District 24 – Kevin de León (D) CA Senate District 22 – Ed Hernandez (D) CA Senate District 30 – Holly Mitchell (D) CA Senate District 27 – Fran Pavley (D) Los Angeles LGBT Center Family Health Care Centers of Greater Los Angeles CA Assembly District 50 – Richard Bloom (D) CA Assembly District 58 – Cristina Garcia (D) CA Senate District 26 – Benjamin Allen (D) CA Assembly District 63 – Anthony Rendon (D) CA Senate District 32 – Tony Mendoza (D) M.E.N.D. CA Senate District 33 – Ricardo Lara (D) CA Assembly District 39 – CA Senate District 18 – Robert Hertzberg (D) Garfield Health Center CA Assembly District 49 – Ed Chau (D) Mission City Community Network CA Senate District 22 – Ed Hernandez (D) CA Assembly District 39 – CA Assembly District 41– Chris Holden (D) Harbor Community Clinic CA Assembly District 43 – Michael Gatto (D) CA Assembly District 70 – Patrick O’Donnell (D) CA Assembly District 45 – CA Senate District 35 – Steven Bradford (D) CA Assembly District 46 – Adrin Nazarian (D) CA Assembly District 51 – Jimmy Gomez (D) Herald Christian Health Center CA Assembly District 62 – Autumn Burke (D) CA Assembly District 49 – Ed Chau (D) CA Senate District 18 – Robert Hertzberg (D) CA Senate District 22 – Ed Hernandez (D) CA Senate District 20 – Connie Leyva (D) CA Senate District 24 – Kevin de León (D) Institute for Multicultural Counseling and Education CA Senate District 25 – Carol Liu (D) Services CA Senate District 27 – Fran Pavley (D) CA Assembly District 43 – Michael Gatto (D) CA Senate District 35 – Steven Bradford (D) CA Assembly District 53 – Miguel Santiago (D) CA Senate District 24 – Kevin de León (D) Northeast Community Clinic CA Senate District 25 – Carol Liu (D) CA Assembly District 51 – Wendy Carrillo (D) CA Assembly District 53 – Miguel Santiago (D) JWCH Institute CA Assembly District 59 – Reginald Jones–Sawyer (D) CA Assembly District 57 – Ian Calderon (D) CA Assembly District 62 – Autumn Burke (D) CA Assembly District 58 – Cristina Garcia (D) CA Assembly District 63 – Anthony Rendon (D) CA Assembly District 63 – Anthony Rendon (D) CA Assembly District 64 – Mike Gipson (D) CA Senate District 24 – Kevin de León (D) CA Assembly District 66 – Al Muratsuchi (D) CA Senate District 30 – Holly Mitchell (D) CA Senate District 24 – Kevin de León (D) CA Senate District 32 – Tony Mendoza (D) CA Senate District 30 – Holly Mitchell (D) CA Senate District 33 – Ricardo Lara (D) CA Senate District 33 – Ricardo Lara (D) CA Senate District 35 – Steven Bradford (D) Kedren Community Health Center CA Assembly District 59 – Reginald Jones–Sawyer (D) Northeast Valley Health Corporation CA Assembly District 64 – Mike Gipson (D) CA Assembly District 38 – Dante Acosta (D) CA Senate District 30 – Holly Mitchell (D) CA Assembly District 39 –
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org 31 CA Assembly District 45 – CA Assembly District 46 – Adrin Nazarian (D) QueensCare Health Centers CA Senate District 18 – Robert Hertzberg (D) CA Assembly District 43 – Michael Gatto (D) CA Senate District 21 – Scott Wilk (R) CA Assembly District 51 – Wendy Carrillo (D) CA Senate District 27 – Fran Pavley (D) CA Senate District 24 – Kevin de León (D)
Our Saviour Center / Cleaver Family Wellness Center Saban Community Clinic CA Assembly District 49 – Ed Chau (D) CA Assembly District 50 – Richard Bloom (D) CA Senate District 22 – Ed Hernandez (D CA Assembly District 53 – Miguel Santiago (D) CA Senate District 24 – Kevin de León (D) Planned Parenthood Los Angeles CA Senate District 26 – Benjamin Allen (D) CA Assembly District 36 – Tom Lackey (R) CA Assembly District 43 – Michael Gatto (D) Saint Anthony Medical Centers CA Assembly District 45 – CA Assembly District 50 – Richard Bloom (D) CA Assembly District 46 – Adrin Nazarian (D) CA Assembly District 53 – Miguel Santiago (D) CA Assembly District 49 – Ed Chau (D) CA Assembly District 64 – Mike Gipson (D) CA Assembly District 50 – Richard Bloom (D) CA Senate District 24 – Kevin de León (D) CA Assembly District 51 – Wendy Carrillo (D) CA Senate District 26 – Benjamin Allen (D) CA Assembly District 52 – Freddie Rodriguez (D) CA Senate District 30 – Holly Mitchell (D) CA Assembly District 54 – CA Assembly District 57 – Ian Calderon (D) St. John’s Well Child and Family Center CA Assembly District 63 – Anthony Rendon (D) CA Assembly District 51 – Wendy Carrillo (D) CA Assembly District 64 – Mike Gipson (D) CA Assembly District 53 – Miguel Santiago (D) CA Assembly District 70 – Patrick O’Donnell (D) CA Assembly District 59 – Reginald Jones–Sawyer (D) CA Senate District 18 – Robert Hertzberg (D) CA Assembly District 62 – Autumn Burke (D) CA Senate District 20 – Connie Leyva (D) CA Assembly District 63 – Anthony Rendon (D) CA Senate District 21 – Scott Wilk (R) CA Assembly District 64 – Mike Gipson (D) CA Senate District 22 – Ed Hernandez (D) CA Senate District 24 – Kevin de León (D) CA Senate District 24 – Kevin de León (D) CA Senate District 30 – Holly Mitchell (D) CA Senate District 25 – Carol Liu (D) CA Senate District 33 – Ricardo Lara (D) CA Senate District 26 – Benjamin Allen (D) CA Senate District 35 – Steven Bradford (D) CA Senate District 27 – Fran Pavley (D) CA Senate District 30 – Holly Mitchell (D) South Bay Family Health Care CA Senate District 32 – Tony Mendoza (D) CA Assembly District 62 – Autumn Burke (D) CA Senate District 33 – Ricardo Lara (D) CA Assembly District 64 – Mike Gipson (D) CA Senate District 35 – Steven Bradford (D) CA Assembly District 66 – Al Muratsuchi (D) CA Senate District 26 – Benjamin Allen (D) Planned Parenthood of Pasadena and San Gabriel CA Senate District 35 – Steven Bradford (D) Valley CA Assembly District 41– Chris Holden (D) Southern California Medical Center CA Assembly District 48 – Roger Hernandez (D) CA Assembly District 48 – Roger Hernandez (D) CA Assembly District 49 – Ed Chau (D) CA Assembly District 58 – Cristina Garcia (D) CA Assembly District 51 – Wendy Carrillo (D) CA Senate District 32 – Tony Mendoza (D) CA Senate District 22 – Ed Hernandez (D) CA Senate District 24 – Kevin de León (D) South Central Family Health Centers CA Senate District 25 – Carol Liu (D) CA Assembly District 53 – Miguel Santiago (D) CA Assembly District 63 – Anthony Rendon (D) Parktree Community Health Center CA Senate District 30 – Holly Mitchell (D) CA Assembly District 52 – Freddie Rodriguez (D) CA Senate District 33 – Ricardo Lara (D) CA Senate District 20 – Connie Leyva (D)
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org 32 Tarzana Treatment Centers Wilmington Community Clinic CA Assembly District 36 – Tom Lackey (R) CA Assembly District 54 – CA Assembly District 45 – CA Senate District 35 – Steven Bradford (D) CA Senate District 18 – Robert Hertzberg (D) CA Senate District 21 – Scott Wilk (R) Yehowa Medical Services CA Senate District 27 – Fran Pavley (D) CA Assembly District 62 – Autumn Burke (D) CA Assembly District 64 – Mike Gipson (D) T.H.E. Health and Wellness Centers CA Senate District 30 – Holly Mitchell (D) CA Assembly District 54 – CA Senate District 35 – Steven Bradford (D) CA Assembly District 59 – Reginald Jones–Sawyer (D) CA Assembly District 62 – Autumn Burke (D) CA Senate District 30 – Holly Mitchell (D)
The Children’s Clinic CA Assembly District 58 – Cristina Garcia (D) CA Assembly District 63 – Anthony Rendon (D) CA Assembly District 70 – Patrick O’Donnell (D) CA Senate District 32 – Tony Mendoza (D) CA Senate District 33 – Ricardo Lara (D) CA Senate District 35 – Steven Bradford (D)
UMMA Community Clinic CA Assembly District 59 – Reginald Jones–Sawyer (D) CA Senate District 30 – Holly Mitchell (D)
Universal Community Health Center CA Assembly District 59 – Reginald Jones–Sawyer (D) CA Senate District 30 – Holly Mitchell (D)
Valley Community Healthcare CA Assembly District 46 – Adrin Nazarian (D) CA Senate District 18 – Robert Hertzberg (D)
Venice Family Clinic CA Assembly District 50 – Richard Bloom (D) CA Assembly District 62 – Autumn Burke (D) CA Senate District 26 – Benjamin Allen (D)
Watts Healthcare Corporation CA Assembly District 54 – CA Assembly District 64 – Mike Gipson (D) CA Senate District 30 – Holly Mitchell (D) CA Senate District 35 – Steven Bradford (D)
Westside Family Health Center CA Assembly District 50 – Richard Bloom (D) CA Assembly District 54 – CA Senate District 26 – Benjamin Allen (D) CA Senate District 30 – Holly Mitchell (D)
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org 33
Member Driven. Patient Focused.
Date: February 12, 2018
To: Policy Advisory Group, CCALAC
From: Joanne Preece, Assistant Director of Policy
Re: State Initiatives (Information/Discussion)
This memo provides updates on initiatives led by CPCA at the state level.
Alternative Payment Methodology (APM) Pilot The Centers for Medicare and Medicaid Services (CMS) indicated to DHCS in late summer that the FQHC APM project cannot move forward in a state plan amendment (SPA), it would need to be done through an 1115 Waiver. Following a legal analysis of the risks of moving forward in a waiver, CPCA has informed the state that we cannot proceed with an APM pilot that includes a waiver.
CPCA is engaging with health plans, including L.A. Care, to explore other potential options. CPCA is advising health centers engaged in CP3 to continue with their transformation efforts.
State Plan Amendment (SPA) Conversations DHCS is proposing changes to the Prospective Payment Reimbursement section (PPS) of the California Medicaid State Plan. For the past year, CPCA and the California Association of Public Hospitals (CAPH) have met biweekly with DHCS to review and share feedback on the components of the proposed SPA.
The issues addressed to-date include productivity standards, a 90-day requirement, Marriage and Family Therapists as billable providers implementation, and Change in Scope of Service Requests (CSOSR). CPCA is still waiting for DHCS to share their final proposed SPA language on these components. CPCA and DHCS were slated to discuss “four walls” in January. It is unclear if any of those conversations have occurred.
DHCS has cancelled several of their scheduled meetings with CPCA; as a result, CPCA has cancelled recent member webinars. It is unclear if this will delay the timeline for submitting language to CMS. The goal was to submit proposed language on all issues by March 31, 2018.
To engage with CPCA around the SPA, email Daisy Po'oi at [email protected] to join the distribution list. Please send comments, questions and feedback for DHCS to Ginger Smith at [email protected].
Restored Outpatient Acupuncture Services for FQHCs DHCS in late January released a Medi-Cal NewsFlash, Restored Outpatient Acupuncture Services for FQHC/RHC Providers clarifying that effective retroactively for dates of service on or after July 1, 2016, outpatient acupuncture services for FQHC/RHC providers are restored as acupuncture benefits provided to Medi-Cal recipients. This followed
700 South Flower Street, Suite 3150, Los Angeles, CA 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
34 DHCS’ confirmation, in December, that acupuncture services provided by a licensed acupuncturist was added to the FQHC visit definition. This reportedly occurred because of the restoration of optional benefits, but DHCS did not provide notification or guidance at the time. CPCA worked with DHCS to develop an FAQ for FQHC providers which CPCA shared with members on January 29.
According to CPCA, if health centers want to submit any past claims, they have only 90 days (from Jan 24) to submit them. Billing staff should call Medi-Cal with any questions about submitting claims for past services and using the correct delay reason code.
Please contact Joanne Preece at [email protected] with any questions.
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
35 Member Driven. Patient Focused.
Date: February 12, 2018
To: Policy Advisory Group, CCALAC
From: Joanne Preece, Assistant Director of Policy
Re: MHLA Updates (Information)
This memo provides information and updates pertaining to My Health LA (MHLA).
MHLA Report to Health Deputies Raises Budget Issues On February 7, the MHLA Program Director presented finance and program updates to the LA County Board of Supervisors’ Health Deputies. CCALAC was in attendance and provided public comment (per the talking points included following this memo). Key highlights include: • MHLA participants average 3.29 visits per year. • 64 percent of participants had at least one primary care visit; 36 percent had no visit during the fiscal year (FY). • MHLA anticipates a $930,000 deficit in the current FY. • MHLA anticipates a $7 million deficit in FY 2018-19. • The MHLA Program has identified several 2018 Initiatives for collaboration with CCALAC including: o Continued work on increasing enrollment of referrals from LADHS; o Exploring how to use encounter data to look at quality and outcomes; o Patient education around accessing substance use services; o Addressing repeat audit deficiencies; and o Rolling out LADHS’s new MAPLE system for encounter and dental claims submission.
Budget Deficits The Board allocation of $61 million, plus a small amount of supplemental funding from the LADHS budget, is intended to fund 146,000 enrolled participants. MHLA enrollment exceeds 146,000; as of the end of December, 147,581 individuals were enrolled. Using current growth rates, MHLA enrollment is projected to reach 154,061 in FY2017-18 and 163,370 in FY 2018-19. In the current FY, MHLA had a small amount of carry over funds from the previous year that was allowing for enrollment slightly over 146,000. Recent dental changes (see below) have also disrupted the current year budget.
FY2017-18: $930,000 Deficit For the current fiscal year, higher enrollment, full dental spend-down, recent dental rate increases, and higher dental and pharmacy spending associated with higher enrollment are projected to result in a $930,000 deficit. Possible solutions presented by the program include freezing new sites, capping enrollment or considering contract options to avoid paying the dental rate increases. The MHLA Program indicated that realistically, their options are limited.
FY2018-19: $7 Million Deficit For the next fiscal year, the program faces a much larger deficit due to higher enrollment, continuation of increased dental rates, an anticipated COLA, and continued higher dental and pharmacy spending associated with higher enrollment. MHLA projects a $7 million deficit in FY18-19. A number of potential solutions were presented for further consideration: • Not pay the COLA (unclear whether this would require a contract amendment) 36 • Cap enrollment (per the contract, this is at the Board’s discretion, they must direct the program to take this step) • Cap new dental sites • Do not pay the Denti-Cal increases (would require a contract amendment) • Explore not paying MGF for patients with no visits (would require a contract amendment) • Do not begin paying MGF until the patient’s first visit (would require a contract amendment) • The Board could allocate additional funding for the program (not directly suggested by the MHLA program, but was raised)
CCALAC and MHLA Leadership Meeting CCALAC will meet with MHLA leadership on February 22. Discussion items will include the budget and the potential solutions proposed by the program. CCALAC’s Director of Clinical Services and Dr. Michael Owens, Deputy Director of Managed Care Services for LADHS, will also be in attendance to discuss some specialty referral issues raised by CCALAC’s Clinical Advisory Group (CAG). Given some of the issues and ideas raised by the program, CCALAC anticipates engaging closely with LADHS in the coming months.
MHLA Dental Program Changes CCALAC has been monitoring two items with regard to their potential impact on MHLA dental, Prop 56 supplemental Denti-Cal reimbursements and the full restoration of adult dental as included in the FY2017-18 state budget.
Prop 56 Supplemental Denti-Cal Payments The state is rolling out the Prop 56 dollars in the form of a 40 percent supplemental rate increase for a specific set of Denti-Cal codes. The MHLA Program had previously indicated that because the increased reimbursements are structured as “supplemental,” MHLA dental rates would not increase; however, we recently learned that, per County Counsel’s analysis, the MHLA Program will increase MHLA reimbursement rates in accordance with the increased Denti-Cal payments.
Full Adult Dental Restoration: New MHLA Reimbursable Codes The FY17-18 state budget provided for full restoration of the optional adult dental benefits, effective January 1, 2018. The MHLA Program analyzed the list of newly reimbursable codes and determined that MHLA already pays CPs for the majority (of those that are not restricted and do not require prior authorization). The MHLA Program has advised that four (4) new codes will become reimbursable under MHLA.
PIN 18-01 The MHLA Program released PIN 18-01 (included with this memo) and an updated list of MHLA Eligible CDT Codes for Supplemental Payment, effective January 1, 2018 through June 30, 2018. Rate increases beyond June 30 will depend whether the state continues the supplemental payments in the next fiscal year.
Audit Repeat Deficiencies (2018 Initiative) During CCALAC’s MHLA contract review process this year, members identified a need to review the audit criteria examined during the medical record review (MRR) portion of the MHLA annual audit. CCALAC initiated this work with the Clinical Advisory Group and Nursing Leadership Roundtable; however, engagement in the process has been low.
The MHLA Annual Report identified the top areas where audit findings reveal repeat deficiencies year-over-year.
Top 5 Medical Record Review (MRR) Repeat Top 5 Facility Site Review (FSR) Repeat Deficiencies: Deficiencies: • No Evidence of Tdap/Td Immunization or • Immunization Screening Vaccination • Seasonal Flu Vaccine • No Evidence of Flue Vaccine • TB Screening • Annual PE Not Completed
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
37 • Colorectal Cancer Screening • No Training on MHLA Referral Process/Procedures • Abuse/Neglect Screening • No Evidence of TB Skin Test or Chest X- Ray/Questionnaire (tie) • Compliant Procedure Training Not Provided (tie) • Training on Sensitive Services/Minors’ Rights Not Provided (tie)
The MHLA Program is requesting CCALAC work with them in 2018 around repeat deficiencies. Since CCALAC was already reviewing audit criteria, we will adapt that work to include analysis of the top repeat deficiencies as identified by the annual report.
Mental Health/SUD Messaging and Patient Education (2018 Initiative) The MHLA Program is convening a stakeholder workgroup over the next three months to explore how to increase awareness of SUD benefits in the MHLA program and improve utilization. Participants include CCALAC, Asian Americans Advancing Justice and Community Health Councils among others.
Please contact Joanne Preece at [email protected] with any MHLA questions.
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
38 My Health LA Annual Report Fiscal Year (FY) 2016-17
Enrollment While we recognize enrollment is over target, we consider this a success. Especially in the current immigration environment.
Utilization In FY 16-17, MHLA participants had an average of 3.29 primary care visits per year. • The average visit rate is just slightly higher than that used by LADHS/CCALAC in the developing the MHLA payment methodology. • In initial negotiations, DHS advocated for the methodology to be based on a much lower average, 2.8 visits per year. Ultimately we agreed on 3.2 (per attached letter). • Current utilization trends are therefore in line with the program design.
Non-Utilizers In FY 16-17, 64% of MHLA participants had at least one primary care visit while they were enrolled during the year, 36% did not. 17% of patients had between 5-9 visits. • 1/3 non-users is in line with the utilization of the population in Medi-Cal managed care. Since the only difference between this population and Medi-Cal is their documentation status, this rate seems reasonable. • One of the purposes of moving from per-visit funding to a monthly grant amount was to incentivize prevention and value over volume of services. As such, clinics can provide as much or as little services as the patient really needs, and still be assured a reasonable payment. • Activities such as health education and counseling, group visits, and other services that help patients stay health do not require a face-to-face visit. These activities aren’t currently measured in any program, and we are interested in working with LADHS to find ways to quantify how clinics help patients stay healthy and prevent avoidable conditions. • Potential Question for DHS: how many of the FY16-17 non-utilizing enrollees used services in the months prior to or after this report?
Audits/Compliance • CCALAC has been working with LADHS regarding the oversight of the program, including audits. • Last summer we worked through a number of issues related to communication of audit requirements, needed documentation, and consistent application of audits by individual auditors. • Last Fall we made major headway, with LADHS providing the audit tool itself and establishing an open channel of communication about the audit process. • We still face some challenges with what is being measured, and how, and continue to work with our members and DHS in this area. (For example, clinics audited in the fall, before the start of the flu season, will have lower vaccinations to report. Those audited in the spring will have more).
Other • Pharmacy Phase II: All CPs are now live on Pharmacy Phase II. We recognize the amount of support and troubleshooting DHS provided CPs in this process. • Addition of SUD services: CCALAC is participating in DHS’ stakeholder engagement process to develop patient engagement/education strategies to improve utilization of SUD services.
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
39 40 41 42 43
My Health LA (MHLA) Program Renewal and Reenrollment Rates Report Fiscal Year 2017 - 18
The Renewal Rate is defined by the percentage of MHLA Participants who completed a renewal before their term date and received an additional 12 months of MHLA coverage. Reenrollment Percentage is defined as the percentage of MHLA Participants who were disenrolled for failure to renew their application but re-enrolled in the subsequent 12 months. This metric is updated monthly with a 12 month “lookback” period beginning in August of each fiscal year.
MHLA Program Renewal and Reenrollment Rates Did not Renewal Rate – Reenrolled After Reenrolled MONTHLY Renewal Cohort Month / Renewal was Renewal was attempt to Percentage Disenrollment* Percentage RATE Total due to renew approved denied renew approved 7/2017 6370 2759 61 3550 43% 1219 19% 62% 8/2017 7758 3744 74 3940 48% 1269 16% 65% 9/2017 11669 6687 98 4884 57% 1726 15% 72% 10/2017 19016 11788 165 7063 62% 2591 14% 76% 11/2017 15090 8848 96 6146 59% 1873 12% 71% 12/2017 12269 7051 83 5135 57% 932 8% 65% 01/2018 02/2018 03/2018 04/2018 05/2018 06/2018 72,172 40,877 577 30,718 57% 9,610 13% 70% *Each month’s reenrollment number will be updated monthly to reflect new reenrollments within fiscal year 2017-18.
Notes: • “No longer eligible” means the Participant attempted to renew but was not renewed because they became eligible for Medi-Cal, moved out of County, etc. • Cohort Month = the month in which a participant must complete a renewal to continue coverage in My Health LA.
Page 1 of 1 44
Member Driven. Patient Focused.
Date: February 12, 2018
To: Policy Advisory Group, CCALAC
From: Becky Lee, Policy Analyst
Re: Los Angeles County Initiatives (Information/Discussion)
CCALAC continues to work on the following county initiatives:
Homeless Initiatives In January, the Homeless Health Advisory Committee (HHAC) met to provide input on various Measure H strategies.
Countywide Supplemental SSI and Disability Benefits Advocacy (CBEST) (C4/5/6) CCALAC recently discussed with DHS Housing for Health CBEST regarding disability evaluation training for providers and co-location of services. Dr. Sony Ta with CBEST is willing to provide training and technical assistance on medical documentation for SSI applications to providers and other clinic staff. With the feedback from HHAC, CCALAC and CBEST are working on identifying clinics who are interested in receiving this training.
Currently, CBEST does not have the budget/resources to co-locate CBEST advocates at clinic sites. However, CBEST expressed that they would like to request for the resources to spearhead a pilot in their next fiscal year budget. CBEST asked for an approximation of clinics who are interested so that CBEST can request for resources in their budget. Many of the clinics who were at the last HHAC meeting expressed interest in the pilot and recommended that the model can mirror the DPSS Eligibility Workers program.
Resources (links) • CBEST Clinical Work Flow • CBEST Outreach/Referral Flyer • CBEST Disability Training Slides • CBEST Outcomes Data
Services and Rental Subsidies for Permanent Supportive Housing (D7) HHAC will continue to discuss ways to identify the infrastructure needs of clinics to participate in initiatives like and Housing for Health ICMS and Whole Person Care Re-Entry. CCALAC will work with a few clinics to determine a methodology to calculate this information.
Multidisciplinary Outreach Teams (E6) Elizabeth Boyce and Shannon Smith-Bernardin from DHS Housing for Health Street Based Engagement came to present at the last HHAC meeting. DHS and LAHSA are developing a dispatch system that will improve coordination of outreach teams in each SPA. They are also increasing outreach teams to 36 teams by July 1, 2018. They emphasized that certain organizations that are leading outreach teams and hiring their own medical staff may not be familiar with clinics. DHS
700 South Flower Street, Suite 3150, Los Angeles, CA 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
45 recommends that clinics should build relationships with those teams. CCALAC also provided maps of clinics per SPA to DHS.
DHS is also working on finalizing their RN Standardized Procedures for street outreach and is looking for feedback. They will submit their final draft to the National Health Care for the Homeless Council.
Some HHAC members expressed concerns that there needs to be more coordination between outreach teams and clinics. For example, some outreach teams are utilizing pediatric-centered clinic sites for medical appointments for their adult clients. Clinics also discussed there is a need for trainings on ways to screen of homeless patients and cultural competency education for staff.
Resources • RN Standardized Procedures • E6 Outreach Teams Roster
Strengthen the Coordinated Entry System (E7) HHAC discussed how their clinics operationalize inputting their patients into the Coordinated Entry System (CES). Clinics agreed that they do not always enter or screen their patients using VISPDAT and enter them into CES for various reasons. For example, CES is mostly used to connect people to housing resources. If a clinic has a patient who may be homeless, they may not be entered into CES because they are looking for services rather than housing. Therefore, it may be the case that there are homeless patients the clinics see and are not entered into CES.
Whole Person Care: CCALAC continues to work with WPC on engaging clinics in WPC programs. WPC is developing two documents:
1. Framework for Participation: This document will translate to a non-financial MOU. WPC shared an initial draft and provided feedback to include additional operational items such as information sharing, consent forms, caseload, services, etc. CCALAC and WPC will continue to refine this document.
2. Community Clinic Readiness for WPC Participation: WPC is working to draft a document that outlines their expectations of clinic “readiness” for WPC participation. The goal of this document is to objectively identify clinics that are equipped to serve the WPC population. Once themes of the document have been agreed upon, CCALAC and WPC can then discuss the most suitable format e.g. application, checklist, etc.
Please contact Becky Lee at [email protected] with any questions.
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
46
Member Driven. Patient Focused.
Date: February 12, 2018
To: Policy Advisory Group
From: Becky Lee, Policy Analyst
Re: Behavioral Health Task Force (Information/Discussion)
In January, the Behavioral Health Task Force discussed various models to co-manage patients in primary care and behavioral health.
Venice Family Clinic Recently, Venice Family Clinic started collaborating with Edelman Westside Mental Health Center to improve communication between primary care and mental health providers. They have developed a system to assist with exchanging information that can inform treatment planning. In summary, the two agencies utilize faxing and Excel spreadsheets to exchange information on patients they are co-managing. The Edelman Nurse and Coordinator from Venice Family Clinic communicate daily through emails and faxes on referrals and client summaries. This pilot is very new and Venice will report more updates when they become available.
Behavioral Health Services BHS has identified “ambassadors” within their clinic and their partner as care coordinators. These ambassadors serve as the go-to people that understand the two agencies and constantly communicate with each other on shared clients. However, BHS acknowledge that this system could disappear when there is staff turnover. BHS will use their HRSA Access Increases for Mental Health and Substance Abuse Services (AIMS) funding to hire a care coordinator to help with co-managing of patients.
Arroyo Vista Family Health Center Arroyo Vista is working on an MOU with a DMH provider that includes language on scope of practices, communication, case conferencing, care coordinators, and cross-training. Arroyo Vista shared that they purposely included these items to best co-manage shared patients.
Co-managing next steps BH Task Force members requested for sample MOU language that could improve co-management. Also, they requested for a factsheet that outlines the difference between HIPPA and 42 CFR.
DMH mentioned that they have created a universal consent form; however, the adoption of it varies across agencies. DPH SAPC shared that as they are ramping up the SAPC program, they will be providing more technical assistance to providers on case management.
Integration Summit II CCALAC is planning another Integration Summit to disseminate findings and resources from the Behavioral Health Task Force.
47 Member Driven. Patient Focused.
Date: February 12, 2018
To: Policy Advisory Group, CCALAC Clinical Advisory Group, CCALAC Chief Operating Officers Roundtable, CCALAC
From: Joanne Preece, Assistant Director of Policy
Re: Managed Care (Information/Discussion)
CCALAC continues to work with our members and key partners to address and understand issues related to managed care. The following is a brief update on our progress .
State Level Managed Care Convening On January 16th, CCALAC Clinical Services, Member Programs and Government Affairs staff participated in a half-day strategy convening with our statewide and regional consortia counterparts. The aim was to prioritize managed care issues to address in 2018 and develop a managed care strategy that leverages existing relationships between consortia and local Medi-Cal plans.
Participants agreed to focus on four issues: • Develop relationships with the incoming Administration and leadership at DHCS with the goal of preserving Medi-Cal funding, benefits and coverage, and highlighting the central role of health centers; • Focus on DHCS commercial plan procurement by assessing plan performance and relationships with health centers and leveraging health centers’ track record on quality and performance on HEDIS to strengthen partnerships with plans; • Improve quality alignment (P4P/HEDIS) by building capacity for quality performance on HEDIS measures and ensuring the quality of encounter data going from health clinics to plans and vice versa; and • Improve enrollment efficiency/default assignment by modernizing the enrollment system, standardizing patient assignment processes based on quality scores and improving how health centers receive information on assigned members from plans.
CCALAC Engagement with Plans CCALAC staff met with both L.A. Care and Health Net in recent weeks as part of our Managed Care Planning Roundtable meetings. We discussed workforce expansion, status of the APM pilot, operational issues (including Health Net’s upcoming system migration), social determinants of health (Health Homes and Whole Person Care), CCALAC’s homeless workgroup, dental enrollment and activities, pay for performance and patient experience initiatives.
LA County Managed Care Advisory Group – Seeking Participants and First Meeting CCALAC is starting a Managed Care Advisory Group to help inform CCALAC’s discussions with health plans and to better understand members’ issues with plans. To date, we have representatives of Health Care LA IPA, Altamed IPA and members affiliated with other IPAs participating. Alex Cotte, Director of Managed Care Services at Arroyo Vista, will chair the group and we are coordinating with Alex to schedule the group’s inaugural meeting. Members interested in participating should reach out to Joanne at [email protected].
48 Operational Issue: All Plan Letter (APL) 17-019 CPCA recently shared an update in follow-up to All Plan Letter (APL) 17-019, which states that all Medi-Cal Managed Care Plans must require their providers to enroll in Medi-Cal or an equivalent plan-based process. The APL did not provide specific instructions to plans about how this requirement applies to FQHCs, since FQHCs enroll at the facility level and are not required to enroll each FQHC-based clinician. There has been confusion about this APL at both the plans and at FQHCs.
DHCS last week released an APL 17-019 FAQ clarifying the enrollment requirements for FQHC-based clinicians in the Medi-Cal Program. As indicated in question 30 of the FAQ, FQHC providers must enroll in Medi-Cal as Ordering/Referring/Prescribing (ORP) providers to meet the new requirement outlined in APL 17-019. According to CPCA, most FQHCs have already done this because the ORP enrollment was a requirement with the implementation of the ACA and members have been informed of this since 2014. (Medi-Cal has a host of ORP Enrollment resources here, including FAQs and simple directions here)
CPCA also clarified that Medicare ORP enrollment will bring FQHCs into compliance with the requirements. Providers already ORP-enrolled either by Medicare or Medi-Cal, can use the ORP Enrollment Validation Lookup tool to verify current ORP enrollment status.
For questions about APL 17-019, please contact Meaghan McCamman at [email protected] and for questions regarding the ORP enrollment, contact Emily Shipman, [email protected].
Please contact Joanne Preece at [email protected] with questions.
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
49
Member Driven. Patient Focused.
Date: February 9, 2017
To: Policy Advisory Group, CCALAC
From: Louise McCarthy, President & CEO
Re: L.A. Care Health Plan Update (Information)
The L.A. Care Board of Governors met on February 8th for our regular business meeting.
FEBRUARY MEETING ACTIONS The Board approved the following motions during the business meeting: • Revised 2018 Board and Committee Meeting Schedule: To approve the revised 2018 Board of Governors meeting schedule as submitted. • Employee Wellness Program: Authorize $59,615.92 through September 30, 2018 for staff to continue offering Fresh Fruit Friday. • Quarterly Investment Report: To accept the Quarterly Investment Report for the quarter ending December 31 , 2017, as submitted. • Cloudera/CenturyLink Contract: To authorize staff to execute a contract in the amount of $1,210,435 with CenturyLink to provide and deploy a data science platform software suite for the period of April 1, 2018 to May 31, 2021, to provide professional services for the deployed software and training for L.A. Care staff from April 1, 2018 to September 30, 2018. • RCAC Membership: To approve Rosaura Peraza, Consumer, to the Regional Community Advisory Committee (RCAC 5) as reviewed by the Executive Community Advisory Committee (ECAC) during the January 20, 2018 ECAC meeting. • Ratify Elected ECAC Chair and Vice Chair: To ratify the election of Cristina Deh-Lee as Chairperson and Ana Rodriguez as Vice Chairperson of the Executive Community Advisory Committee (ECAC) from February 201 8 - December 2018 . • Ratify Elected CHCAC Chair and Vice Chair: To ratify the re - election of Lyndee Knox, PhD as Chairperson and Reena John as Vice Chairperson of the Children’s Health Consultan t Advisory Committee for 201 8 . • Approval of the revisions to the Consumer Advisory Committee (CAC) Operating Rules: To approve the revisions to the Consumer Advisory Committee (CAC) Operating Rules with the exception of the member recertification grace period; keeping the current 60 - day grace period in the Operating Rules for the recertification of CAC members. • L.A. Care’s 2018 State and Federal Policy Agenda: To approve L.A. Care’s 2018 State and Federal Policy Agenda (attached). • Financial Reports: To accept the Financial Report for the period ended November 2017, as submitted.
In addition to these action items, the Board discussed a report from Safety Net Initiatives and Community Benefit on the Housing for Health, Brilliant Corners and Whole Person Care Initiatives. The Board also heard reports from the CEO on the organization’s progress toward its strategic goals and from the CMO on several initiatives related to quality improvement.
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