Monthly Archives: April 2014

SB1322(Hernandez) Amended to focus on Quality Improvement and Cost containment

 

SB1322(Hernandez)

Amended to focus on Quality Improvement and Cost containment

California Health Care Quality Improvement and Cost Containment Commission.

http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB1322

Intent of original SB1322 to be considered in 2015?

California Health Care Quality Improvement and Cost Containment
Commission.

Comisión de contención de calidad asistencial del Cuidado de Salud  de
California

http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB1322

http://www.legtrack.com/bill.html?bill=201320140SB1322

Summary

Existing law establishes health care coverage programs to provide
health care to segments of the population meeting specified criteria who
are otherwise unable to afford health care coverage and provides for the
licensure and regulation of health insurers and health care service
plans.

This bill would state the intent of the Legislature to make available
valid performance information to encourage health care providers and
facilities to provide care that is safe, medically effective,
patient-centered, timely, efficient, and equitable. The bill would
require the Governor to convene the California Health Care Quality
Improvement and Cost Containment Commission and would specify the
composition of the commission. The bill would require the commission to
examine and address specified health care issues. The bill would require
the commission to issue a report to the Legislature and the Governor, on
or before July 1, 2015, or within 6 months of the commission being
convened, whichever occurs later, making recommendations for health care
quality improvement and cost containment. The bill would provide that
the commission not be convened until sufficient private or federal funds
have been received and appropriated for that purpose.

Dicen que tal vez el proximo ano  se trate otra vez.

AMENDED  IN  SENATE  APRIL 01, 2014

 

CALIFORNIA LEGISLATURE— 2013–2014 REGULAR SESSION

 

SENATE BILL No. 1322

 

Introduced by Senator Hernandez
February 21, 2014

 

An act to add Section 14132.04 to the Welfare and Institutions Code, relating to Medi-Cal. Sections 127670 and 127671 to the Health and Safety Code, relating to health care.



LEGISLATIVE COUNSEL’S DIGEST

SB 1322, as amended, Hernandez. Medi-Cal: preventive services: providers. California Health Care Quality Improvement and Cost Containment Commission.
Existing law establishes health care coverage programs to provide health care to segments of the population meeting specified criteria who are otherwise unable to afford health care coverage and provides for the licensure and regulation of health insurers and health care service plans.
This bill would state the intent of the Legislature to make available valid performance information to encourage health care providers and facilities to provide care that is safe, medically effective, patient-centered, timely, efficient, and equitable. The bill would require the Governor to convene the California Health Care Quality Improvement and Cost Containment Commission and would specify the composition of the commission. The bill would require the commission to examine and address specified health care issues. The bill would require the commission to issue a report to the Legislature and the Governor, on or before July 1, 2015, or within 6 months of the commission being convened, whichever occurs later, making recommendations for health care quality improvement and cost containment. The bill would provide that the commission not be convened until sufficient private or federal funds have been received and appropriated for that purpose.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law provides for a schedule of benefits under the Medi-Cal program, which includes specified preventive services.

This bill would require the department to reimburse Medi-Cal providers for, and would require Medi-Cal managed care plans to cover, preventive services provided by a health care practitioner not subject to professional licensure by the state, that have been recommended by a physician or other licensed practitioner of healing arts acting within the scope of that physician’s or practitioner’s license. The bill would provide that this coverage is available only to the extent that federal financial participation in the cost of providing these services is available. The bill would require the department to convene a working group, as specified, to determine the types of health care practitioners eligible to provide preventive services pursuant to these provisions and to develop a summary of practitioner qualifications for those practitioners to be included in any state plan amendment necessary to implement these provisions.

DIGEST KEY

Vote: majority   Appropriation: no   Fiscal Committee: yes   Local Program: no


BILL TEXT

THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

SECTION 1.

Section 127670 is added to the Health and Safety Code, to be added to Chapter 8 (formerly commencing with Section 127670) of Part 2 of Division 107, to read:

 

127670.

(a) It is the intent of the Legislature to make available valid performance information to encourage health care providers and facilities to provide care that is safe, medically effective, patient-centered, timely, efficient, and equitable. It is also the intent of the Legislature to put provider performance information into the hands of consumers and purchasers so that they are able to understand their financial liability and find the best quality and value.

(b) It is the intent of the Legislature to encourage health care service plans, health insurers, and providers to develop innovative approaches, services, and programs that may have the potential to deliver health care that is both cost effective and responsive to the needs of enrollees.

 

SEC. 2.

Section 127671 is added to the Health and Safety Code, to be added to Chapter 8 (formerly commencing with Section 127670) of Part 2 of Division 107, to read:

 

127671.

(a) The Governor shall convene the California Health Care Quality Improvement and Cost Containment Commission to research and recommend appropriate and timely strategies for promoting high-quality care and containing health care costs.

(b) The commission shall be composed of 13 members who are knowledgeable about the health care system and health care spending.
(c) The Governor shall appoint five members of the commission, the Senate Committee on Rules shall appoint three members, and the Speaker of the Assembly shall appoint three members. The membership shall be comprised of at least one of each of the following:
(1) A representative of California’s business community.
(2) A representative from organized labor.
(3) A representative of consumers.
(4) A health care practitioner.
(5) A hospital industry representative.
(6) A representative of the health insurance industry.
(7) A representative of the legal community with expertise in health and ethics.
(8) A representative of persons with disabilities.
(9) A health care economist.
(d) The Secretary of the California Health and Human Services Agency and the Executive Director of Covered California shall serve as members of the commission.
(e) The Governor shall appoint the chairperson of the commission.
(f) The commission shall, on or before July 1, 2015, or within six months of the convening of the commission, whichever occurs later, issue a report to the Legislature and the Governor making recommendations for health care quality improvement and cost containment. The commission shall, at a minimum, examine and address the following issues:
(1) Assessing California health care needs and available resources.
(2) Containing the cost of health care services and coverage.
(3) Improving the quality of health care.
(4) Increasing the transparency of health care costs and the relative efficiency with which care is delivered.
(5) Use of disease management, wellness, prevention, and other innovative programs to keep people healthy while reducing costs and improving health outcomes.
(6) Consolidation of existing state programs to achieve efficiencies where possible.
(7) Efficient utilization of prescription drugs and technology.
(g) The commission established pursuant to this section shall not be convened until sufficient private or federal funds have been received and appropriated for that purpose.

 

SECTION 1.(a)The Legislature finds and declares both of the following:

(1)Research suggests that 50 percent of a physician’s time is spent providing preventive care and screenings, much of which can be provided by other health care practitioners.

(2)On July 15, 2013, the Centers for Medicare and Medicaid Services released an update to federal Medicaid regulations that permits state Medicaid programs to reimburse for preventive services recommended by a physician or other licensed health care practitioner.

(b)It is the intent of the Legislature in enacting this act to maximize federal funds to provide critical preventive services to Medi-Cal beneficiaries by amending state law to reflect the July 15, 2013, update to federal Medicaid regulations.

SEC. 2.Section 14132.04 is added to the Welfare and Institutions Code, to read:

14132.04.(a)(1)The department shall reimburse Medi-Cal providers for preventive services, as defined in Section 440.130(c) of Title 42 of the Code of Federal Regulations, provided by a health care practitioner not subject to professional licensure by the state, including, but not limited to, a community health worker, that have been recommended by a physician or other licensed practitioner of healing arts acting within the scope of that physician’s or practitioner’s license.

(2)Medi-Cal managed care plans shall cover preventive services, as defined in Section 440.130(c) of Title 42 of the Code of Federal Regulations, provided by a health care practitioner not subject to professional licensure by the state, including, but not limited to, a community health worker, that have been recommended by a physician or other licensed practitioner of healing arts acting within the scope of that physician’s or practitioner’s license.

(3)Coverage for preventive services pursuant to this section shall be available only to the extent that federal financial participation in the cost of providing these services is available.

(b)By June 30, 2015, the department shall convene a working group to determine the types of health care practitioners eligible to provide preventive services pursuant to this section and the summary of qualifications for those practitioners to be included in any state plan amendment that may be necessary to implement this section. The working group shall include representatives from consumer advocacy groups, community health worker organizations, community clinics, physicians’ groups, and health plans. The summary of practitioner qualifications shall reflect widely supported perspectives.

 

PrepareAthon! FEMA National Day of Action April 30, 2014

Cloudy stormy sky image. National Day of Action April 30. Be smart. Take part. Prepare. And Join America's Movement To Stay Safe During Disasters. Logo of America's PrepareAthon!Aviso de Asuntos Intergubernamentales

Seminario web en español del PreparAtón de América 

Una campaña popular para incrementar la preparación a nivel individual y comunitario

Campaña nacional que alienta al público a practicar medidas de preparación

 

Estimados colaboradores de preparación,

La familia federal ha creado el PreparAtón de América (America’s PrepareAthon! SM) como un esfuerzo para continuar mejorando la capacidad de recuperación del país. El Preparatón es una campaña comunitaria para mejorar la preparación para emergencias de la comunidad de acuerdo a la Directiva Presidencial (PPD-8) de Preparación Nacional. Le invitamos a que participe del seminario web para la comunidad hispana el 23 de abril de 2014, a las 2 p.m. (horario del este), para aprender cómo usted puede unirse al esfuerzo y ayudarnos a difundir el mensaje de preparación en su comunidad. El seminario se llevará a cabo en español. A continuación puede encontrar los detalles.

Detalles del seminario web:

https://icpd.adobeconnect.com/americas-prepareathon5a/event/event_info.html

Gracie Huerta – la co-creadora de Listos en Santa Barbara, Ca – hablará sobre los eventos y actividades de preparación que se llevan a cabo en su comunidad que hacen la misma más resistente y mejor preparada para emergencias. La Directora de Vision y Compromiso del Norte de California Chely Romero, participará en el seminario y hablara de la importancia del trabajo que realizan los Promotores con sus esfuerzos para llegar a las comunidades.

 

Esperamos que puedan participar del seminario web. Si no tiene la oportunidad de unirse a la sesión en vivo, podrá acceder una grabación en línea ya que el mismo será grabado y hecho disponible al público posteriormente. 

Para más preguntas, comuníquese con la División de Asuntos Intergubernamentales de FEMA llamando al (202) 646-3444 o por correo electrónico a FEMA-IGA@fema.dhs.gov.

La misión de FEMA es apoyar a todos los ciudadanos y a las agencias de primera respuesta y garantizar que como país trabajemos juntos para desarrollar, mantener y mejorar nuestra capacidad de preparación, protección, respuesta, recuperación y mitigación ante todos los peligros.

 

National Community Health Worker Survey (NCHWS)

National Community Health Worker Survey (NCHWS) ( Click to take the Survey)

Dear CHWs and CHW Allies!

I am writing to let you know about the National Community Health Worker Survey (NCHWS) and to encourage you to share this information with CHWs in your state!  So far over 1500 Promotoras/CHW/CHRs have participated in the survey – the final survey date is Friday May 2 !

The NCHWS is the largest survey of Promotoras/CHWs ever conducted and has the potential to provide much needed information about the workforce. Data gathered will be ‘open source’ and available for states and Promotoras/CHWs networks to use for planning and workforce sustainability efforts. Promotoras/CHWs workforce data collected by NCHWS includes; gender, race/ethnicity, education, salary, experience, work environment, training, and health and social areas of focus, professional affiliation and leadership, engagement in ACA outreach and enrollment, and Promotoras/CHWs advocacy efforts to improve the social determinants of health among Promotoras/CHWs communities and Promotoras/CHWs -led initiatives to sustain the Promotoras/CHWs workforce. I have attached two publications that resulted from the last national Promotoras/CHWs survey so that you can get a sense of just how useful this information is.

Please consider forwarding the email below to CHWs networks and other CHW allies or employers in your state! Attached are 2 publications that resulted from our first NCHWS conducted in 2010 – we hope you find this information useful!

Thank you !

Sam Sabo and Ashley Wennerstrom

 

Samantha Sabo DrPH, MPH

Assistant Professor

Division of Health Promotion Sciences

Zuckerman College fo Public Health

University of Arizona

520.419.2671

520.626.5204

sabo@email.arizona.edu

skype: samanthasabo

 

 

Urban institute- CareWorks: The Community Health Worker Project

4.1.204
Urban Institute    
 contact:   publicaffairs@urban.org     Publications Office at (202) 261-5687

CareWorks: The Community Health Worker Project

Prevention, wellness, and management of chronic conditions are attracting policymakers’ attention as solutions to the problems of growing costs and demands in US health care. Growing appreciation for how nonclinical services can help creates an important opportunity for community health workers (CHWs) to contribute and expand their numbers. CHWs are laypeople whose close connections with communities, health care knowledge, and interpersonal skills enable them to provide strategic education and other supports, especially in underserved communities. Effectively targeted CHWs can help people manage chronic conditions, coordinate services, and guide at-risk patients through the complexities of health services, including insurance enrollment. They can also help address social determinants of health at a neighborhood or community level, connecting clients to social and family services. In short, they create bridges between those in need and those who provide or pay for needed services, often going beyond clinical care. CHWs are also versatile. They can readily work with health care teams, other service providers, health insurers, or public health practitioners.

This project assesses how CHWs can help achieve better care, better health, and lower costs—the key goals of reform—and what action steps can further integrate CHWs into evolving health care and public health. This series of papers, funded by the Rockefeller Foundation, is based on relevant literature and interviews of both experts and practitioners.

FEATURED RESEARCH

Urban Institute—contact publicaffairs@urban.org     Publications Office at (202) 261-5687

Integrating Community Health Workers into a Reformed Health Care System
by Randall R. Bovbjerg, Lauren Eyster, Barbara Ormond, Theresa Anderson, and Elizabeth Richardson

This capstone brief summarizes opportunities and challenges for CHWs in the ACA era. The act recognizes CHWs as an important health profession, but how well CHWs will achieve their potential to improve health, services, and efficiency remains unclear because permanent financing structures are only beginning to evolve. Moreover, for CHWs to meet growing demand for services, their training must emphasize valued skills and personal attributes, and CHWs must meet the needs of employers. This paper highlights the roles, training, and evaluation of CHWs under health reform and assesses strategies for further growth.Read more

The Evolution, Expansion, and Effectiveness of Community Health Workers
Lauren Eyster, Theresa Anderson, and Christin Durham
The CHW profession has increased in visibility over the past decade, but still lacks widespread support for its integration into the US health care system. Lessons from CHWs’ current contributions to health care are important to understand as the ACA’s implementation continues. This research report describes CHWs’ current achievements, traditional barriers to their employment, and the need for new business models to support valuable CHW services. Read more

Opportunities for Community Health Workers in the Era of Health Reform
Randall R. Bovbjerg, Lauren Eyster, Barbara Ormond, Theresa Anderson, and Elizabeth Richardson
The ACA and other health reform efforts have expanded insurance coverage and focused on improving both health and health services while constraining health spending. This reform has created a watershed era for the CHW profession to expand its contributions. Working with insurers, CHWs can increase enrollment and help high-risk patients utilize care more appropriately. Working with health providers, CHWs can help improve practitioner-patient communication, effectuate referrals across levels of care, and improve management of chronic conditions between office visits. Working with public health and other professionals, CHWs can educate communities and build bridges to nonclinical services. This paper assesses the opportunities for and impediments to increased CHW employment under reform. It also analyzes changing roles for CHWs, as in insurance enrollment, access to services, and support for public health and prevention. Read more

Promising Approaches to Integrating Community Health Workers into Health Systems: Four Case Studies
Lauren Eyster and Randall R. Bovbjerg, editors
Interest is growing in the CHW profession among US policymakers and industry stakeholders, but little has been documented both about the scope of practice, supervision, and professional standards implemented by states and employers of CHWs, and about how CHWs are financed. Understanding these matters is important to show the value of CHWs and to help integrate them into health care as well as public health and social services. This research report presents case studies from Texas, Minnesota, North Carolina, and Ohio that draw lessons from different approaches to credentialing CHWs and delivering CHW services. Read more

Case Studies:
The Texas Community Health Worker Certification System. Texas created the first state certification program for CHWs. This legislative success for CHWs showed the importance of advocates, employers, and payers in enacting, designing, and operating such credentialing. Yet growth in employment lagged. More recently, state leaders have reconsidered how to best support, educate, and oversee CHWs in the interests of educators, employers, patients, and CHWs themselves.
The Minnesota Community Health Worker Training Program.Minnesota spent years compiling research evidence and stakeholder opinions before enacting legislation both to credential and to pay for CHW services. The effort was spearheaded by a partnership between the health services and education industries. Together, they helped achieve both state legislation and federal approval for some Medicaid payment for CHW services.
CHW Initiatives in Health Care and Public Health in Durham, North Carolina. Duke Medicine is this region’s largest health care employer and has integrated CHWs into many of its programs. Thought leaders see CHW services are important for caring for chronic conditions, high utilizers of hospital services, and underserved populations. They are also exploring community outreach for prevention of important health conditions as identified by a community participatory process. The approach often emphasizes CHWs’ ability to help offset their costs through savings from prevention and education, either for Medicaid managed care or, for Duke, as a safety net provider of free and reduced-fee services. Beyond that, Duke’s integrated system seeks to learn how to thrive in a future that emphasizes accountability for whole populations. Duke is investigating ways to replicate its model in other communities.
The Pathways/Community HUB Model and Ohio Certification of CHWs.The Community Health Access Project (CHAP) addresses community health through its pathway model of coordinated care. In this model, community hubs connect payers with CHW care managers, who educate at-risk clients and connect them with clinical, behavioral, or social services. Each pathway plan’s success is measured by a patient-specific outcome, such as enrollment in an effective insurance plan or the healthy delivery of a baby, and CHWs earn more for good results. CHAP has had early successes, state leaders are supporting expansion to other regions, and there has been national interest as well. The CHAP model features in some projects funded by the federal Center for Medicare and Medicaid Innovation.

(SAMHSA) “A Practitioners Resource Guide: Helping Families to support Their LGBT Children.”

3.29.2014
The Substance Abuse and Mental Health Services Administration (SAMHSA) is releasing “A Practitioners Resource Guide: Helping Families to support Their LGBT Children.” This resource Guide is designed to help health care and social service practitioners provide greater insight to families on how they can support their children who are coming out or identifying themselves as lesbian, gay, bisexual and transgender (LGBT). SAMHSA produced this Guide based in part on research from the Family Acceptance Project, which indicates that LGBT young adults who reported high levels of family rejection during adolescence, compared with peers from families that reported no or low levels of family rejection, were: