California Healthcare News

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Health Net Fined For Denying Transgender Coverage Premium Content
Aug 17, 2017

The Department of Managed Health Care has fined Woodland Hills-based Health Net $200,000 for its apparent refusal to cover gender reassignment surgeries and related benefits for its enrollees.

            The administrative penalty and fine is the first ever levied by the DMHC against a health plan for rejecting such coverage wholesale, and is the largest such fine associated with disputes over gender dysphoria treatments.

RVs Deliver Mental Health Services To Rural Areas Premium Content
Aug 17, 2017

Ana Magaña has struggled with schizophrenia for more than 30 years, and she even landed in the hospital a couple of years ago after she stopped taking her medications.

When the Woodlake resident was discharged, she received additional support.

But she didn’t get it by traveling 15 miles to the closest county mental health clinic, in Visalia. The clinic came to her.

Magaña, 74, was treated in one of Tulare County’s two mobile mental health units, custom-made recreational vehicles that serve isolated adults in rural areas.

Blue Shield Claims Significant Drop In Opioids Use Premium Content
Aug 17, 2017

San Francisco-based Blue Shield of California has claimed a significant reduction in opioid use among its enrollees who are prescribed the medications other than to mitigate cancer pain.

            According to data from Blue Shield’s narcotic safety initiative, overall opioid consumption has been cut by 32%. That includes a 46.8% reduction in the number of enrollees receiving high doses of the medication, and a 17.8% reduction in the average dose of opioids for long-time users of the drug, typically to address chronic pain issues.

Trump Administration Says It Will Make August CSR Payments Premium Content
Aug 17, 2017

The Trump administration said it would make cost sharing reduction payments to health plans this month, just days after a Congressional Budget Office (CBO) report concluded that halting the payments would cause both health insurance premiums and the federal deficit to skyrocket.

Medi-Cal Covering Meals For Some Sicker Enrollees Premium Content
Aug 10, 2017

Federico Guzmán moved from Mexico to San Francisco in 1992, fleeing anti-gay sentiment and searching for AIDS treatment.

            He couldn’t find a job and sometimes went hungry until friends introduced him to Project Open Hand, a nonprofit organization that began serving free, nutritious meals to HIV patients in 1985.

            The people there “were like angels from the sky,” said Guzmán, 50, who went home from his first visit with vegetables, eggs, bread and beans. He continues to receive medically tailored meals from the group.

FQHCs Play Key Roles In Healthcare Delivery Premium Content
Aug 10, 2017

Federally qualified health centers (FQHCs) are providing critical deliveries of healthcare services to the poorest patients in both California and elsewhere. But their funding is often on a precipice, particularly with ongoing uncertainties surrounding the Affordable Care Act.

            That’s the conclusion of UCLA researchers, which delved into the importance of FQHCs in a report released last week.

DMHC Fines Kaiser $30,000 For Data Breach Premium Content
Aug 10, 2017

The Department of Managed Health Care has fined Kaiser Foundation Health Plan $30,000 for an Internet glitch that led to the exposure of confidential patient information.

Union Moves To Place Dialysis Measure On 2018 Ballot Premium Content
Aug 10, 2017

The Service Employees International Union/United Healthcare West has announced plans to put on the November 2018 ballot a measure that would more closely regulate the state’s 570 dialysis clinics.

            According to the proposed measure, called the Kidney Dialysis Protection Act, clinics would undergo annual inspections, require mandatory staffing ratios and place caps on charges for dialysis care. Its text was recently submitted to the state attorney general’s office for review.

Covered California Keeps 2018 Rates Mostly Stable Premium Content
Aug 3, 2017

Covered California announced this week 2018 premium hikes lower than a year ago on average, as well as a containment plan should the Trump administration carry out its multiple threats to end cost-sharing subsidies for lower-income enrollees.

Medicaid Initiative Makes Strides In Controlling Blood Pressure Premium Content
Aug 3, 2017

California faces a big challenge in controlling the blood pressure of low-income residents with hypertension, but a state-led program has shown some signs of progress.

CDPH Fines Gardena Nursing Home $100,000 Premium Content
Aug 3, 2017

The California Department of Public Health has fined a Gardena-based nursing home $100,000 for an incident last February that led to the death of a patient.

                According to the CDPH’s investigation, the patient, a 61-year-old woman who was mobile and mentally alert, had recently undergone an outpatient vascular procedure and was also receiving dialysis. But when she returned to the Greenfield Care Center of Gardena after undergoing the procedure, she was neglected by staff in a manner that endangered her life.

DMHC Fines Cigna $90,000 Premium Content
Aug 3, 2017

The Department of Managed Health Care has fined Cigna Healthcare of California $90,000 for not resolving enrollees grievances appropriately.

Covered California Issues More Dire Warnings On ACA Repeal Premium Content
Jul 27, 2017

As the United States Senate begins debate on whether to repeal and/or replace the Affordable Care Act, Covered California has issued another series of reports raising doubts about the stability of the individual marketplace should any bill come to fruition.

The Senate Healthcare Debate: What’s In Store Premium Content
Jul 27, 2017

So the Senate has voted to start debate on a bill to replace the Affordable Care Act. Now what?

            Well, it gets wonky.

            The rules for budget reconciliation, the process the Senate is using that limits debate and allows a bill to pass with only a simple majority, comes with a set of very specific rules. Here are some of the big ones that could shape whatever final bill emerges:


Matters of Timing


Senate Unable To Pass Repeal And Replace Legislation Premium Content
Jul 27, 2017

After voting Tuesday to begin debate to repeal and replace the Affordable Care Act, Senate Republicans have yet to agree on legislation in any concrete form.

            As of late Wednesday, the Senate voted down the Better Care Reconciliation Act, its version of the House bill that passed last month. It also voted down a repeal-and-delay bill. Both bills would have the net effect of taking health insurance away from tens of millions of people, the Congressional Budget Office has reported.

Providence St. Joseph, Well Being Trust Grant $10 Million For Mental Health Premium Content
Jul 27, 2017

Providence St. Joseph healthcare system has joined forces with the Well Being Trust to grant $10 million to initiatives throughout California to shore up the state’s delivery of mental healthcare services.

It’s Time For ACA Saboteurs To Repair Their Damage Premium Content
Jul 20, 2017

After seven-plus years of seething threats, it turns out the Party of Personal Responsibility never actually planned to go through with repealing and/or replacing the ACA, as illustrated by its inability this week to gather a majority of votes in the Senate to do so.

Kaiser, DMHC Reach Settlement On Mental Health Services Premium Content
Jul 20, 2017

The Department of Managed Health Care and Kaiser Permanente have announced a settlement in a years-long tussle over access to mental healthcare services offered by the Oakland-based health plan.

            Under the terms of the settlement, which was announced on Tuesday, Kaiser agreed to hire more mental health service staff and hire an outside consultant to monitor progress and craft an ongoing plan to provide mental health services for a period of at least one and as long as three years.

Covered California Running Behind On 2018 Premium Release Premium Content
Jul 20, 2017

California’s health insurance exchange scrubbed its annual rate announcement this week, the latest sign of how the ongoing political drama over the Affordable Care Act is roiling insurance markets nationwide.

CDPH Fines Bakersfield Nursing Home $100,000 Premium Content
Jul 20, 2017

The California Department of Public Health has fined a Kern County nursing home $100,000 in connection with a patient fall that led to his death earlier this year.

            The penalty against Valley Convalescent Hospital in Bakersfield is tied to an 80-year-old patient who fell out of their bed in late February 2017, causing a high spinal fracture. The patient died at the facility a few days later.