payers & providers california edition – issue of july 7, 2011

8/6/2019 Payers & providers California Edition Issue of July 7, 2011

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The Patient Protection and Affordable Care Actis expected to add millions of Californians tothe rolls of both Medi-Cal and commercialplans by 2014. However, hundreds of

thousands of immigrant children could beexcluded from coveragealtogether, according toUCLA researchers.

The latest data fromthe UCLA Center for HealthPolicy Research concludesthat as many as 220,000immigrant children tens ofthousands of whom are inthe country legally wouldbe potentially barred fromparticipating in the Medi-Calprogram or the exchange for

purchasing commercialcoverage. That numberrepresents about 20% ofall the uninsuredchildren statewide,according to data fromthe California HealthInterview Survey.

Among those potentiallyexcluded from coverage are some170,000 children without proof of legalresidency, and children of parents who are inthe U.S. legally but emigrated within the pastve years. The former are restricted from

enrolling in Medicaid or buying coverage from

the California Health Benet Exchange,although they could buy coverage outside ofthe exchange. The latter group, about 10,000children in all, would be restricted from

enrolling in Medi-Cal.UCLA researchers also

estimate that there are about40,000 children in Californiawho are U.S. citizens or legalresidents, but will not enroll

in the exchanges because theirparents are illegal immigrantsand believe their children areineligible, or fear enrollingthem would expose them todetention.

Healthcare reformrestrictions raise some very

unpleasant questions about ouwillingness as a society tolet children go withoutcare, said Ninez Ponce,an associate professor atthe UCLA School ofPublic Health and the

studys lead author.The restrictions placed on the

exchanges and the expansion ofMedi-Cal many of them the result ofcompromise by members of Congress to get

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July 11-12

July 17-19

Calendar

7 July 2011

July 17-20

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[email protected]

the details of your event, or call(877) 248-2360, ext. 3. It will be

published in the Calendar section,space permitting.

www.lakesidecommunityhealthcare.com

California Edition

Immigrants May Miss Out On ReformUCLA Says Hundreds of Thousands Are Ineligible

Continued on Next Page

Legal, But Barred From Medi-CalIllegal, Barred From Medi-CalIllegal, Barred from ExchangeLegal, But Parent is Not

10000

140000

30000

40000

Source: UCLA Center forHealth Policy Research

California Children PotentiallyBarred From Coverage Expansion
http://www.healthforum.com/healthforum/html/conferences/11Summit/Summit_home.htmlhttp://www.healthforum.com/healthforum/html/conferences/11Summit/Summit_home.htmlhttp://www.healthforum.com/healthforum/html/conferences/11Summit/Summit_home.htmlhttp://www.healthforum.com/healthforum/html/conferences/11Summit/Summit_home.htmlhttp://www.healthforum.com/healthforum/html/conferences/11Summit/Summit_home.htmlhttp://www.healthforum.com/healthforum/html/conferences/11Summit/Summit_home.htmlhttp://www.healthforum.com/healthforum/html/conferences/11Summit/Summit_home.htmlhttp://www.healthforum.com/healthforum/html/conferences/11Summit/Summit_home.htmlhttp://www.healthforum.com/healthforum/html/conferences/11Summit/Summit_home.htmlhttp://tcbi.org/index.php?conference=hu2011http://tcbi.org/index.php?conference=hu2011http://tcbi.org/index.php?conference=hu2011http://tcbi.org/index.php?conference=hu2011http://tcbi.org/index.php?conference=hu2011http://tcbi.org/index.php?conference=hu2011http://tcbi.org/index.php?conference=hu2011http://tcbi.org/index.php?conference=hu2011http://tcbi.org/index.php?conference=hu2011http://www.cahf.org/Meetings/MeetingEventListings.aspxhttp://www.cahf.org/Meetings/MeetingEventListings.aspxhttp://www.cahf.org/Meetings/MeetingEventListings.aspxhttp://www.cahf.org/Meetings/MeetingEventListings.aspxhttp://www.cahf.org/Meetings/MeetingEventListings.aspxhttp://www.cahf.org/Meetings/MeetingEventListings.aspxhttp://www.cahf.org/Meetings/MeetingEventListings.aspxhttp://www.cahf.org/Meetings/MeetingEventListings.aspxhttp://www.cahf.org/Meetings/MeetingEventListings.aspxhttp://www.healthwebsummit.com/acopushback.htmhttp://www.cahf.org/Meetings/MeetingEventListings.aspxhttp://www.healthforum.com/healthforum/html/conferences/11Summit/Summit_home.htmlhttp://tcbi.org/index.php?conference=hu2011http://www.healthwebsummit.com/acopushback.htm


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Payers & Providers Page 2

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In Brief

CDPH Reports SecurityBreach InvolvingEmployee Data

The California Department ofPublic Health has reported asecurity breach that led to the theftof the personal and workerscompensation information forabout 9,000 of its current andformer employees, as well as thoseof the California Department ofHealth Care Services.

According to a CDPHstatement, the data was copied toa computer hard drive andimproperly removed from itsoffices by an employee, who hassince been placed onadministrative leave pending aninvestigation.

The data that was removedincluded employee names,addresses, Social Securitynumbers, birthdates, informationof next-of-kin and otherdemographic information.

CDPH discovered somethingwas amiss in early April anddiscovered the data had beentaken after conducting aninvestigation.

"We regret that the personalinformation of our employees wascompromised," said CDPHDirector Ron Chapman. "We takethe breach of any securedocuments very seriously and arecommitted to taking steps tominimize any impact of this actionand further strengthen our securitypolicy."

The CDPH said it wouldreview its security measures, andprovide credit monitoring servicesto the affected employees.

Continued on Page 3

NEWS

Immigrants (Continued from Page One)

the reform legislation passed last year wassharply criticized.

It is neither prudent nor fair to lockimmigrants out of purchasing coveragethrough the exchange, said Daniel Zingale,senior vice president of the CaliforniaEndowment, which was among the studysfunders. The politicization of healthcareaccess for immigrants is unsound policy.Everyone needs access, and we know people

generally have better access to preventive carwhen they have health coverage. This helpsprevent costly health conditions."

The report concludes that despite theonset of reform and the opportunities it willprovide for coverage, community clinics willstill play a key role in provide care toimmigrant families. Nearly 400,000 immigranchildren or the kids of immigrants use theclinics for their primary care.

Union Pays Sutter Health $6 MillionSum Settles Years-Long Defamation Lawsuit

In a break from the normally contentiousenvironment between healthcare providersand labor in California, a union representinghospital housekeepers has agreed to pay $6million to Sacramento-based Sutter Health inorder to settle a defamation suit that haddragged on for years.

Additionally, the leader of the New York-based union, Unite Here, also issued a publicapology to Sutter over an inammatorypostcard sent to expectant mothers inNorthern California in 2005.

The current leadership of Unite Here

considers the postcard to have been offensiveand in poor taste, said union president JohnWilhelm. The individuals responsible for thispublication have left our union. We assureyou that the union has no intention of sendingany such communication regarding SutterHealth or its afliates in the future.

The postcard in question stemmed from adispute Unite Here had with Sutter and asubsidiary of a Georgia-based laundryservice, Angelica Corp., that specializes inthe hospital industry and services dozens ofhealthcare facilities statewide. Unite Heremailed out 11,000 postcards in 2005

suggesting that women who use Sutters

facilities were placing themselves and theirnewborns at risk of contamination from thecompanys linens.

You may be bringing home more thanyour baby if you deliver at a Sutter birthingcenter, the postcard read. It also asserted thaAngelica failed to properly clean bedding atSutter facilities of blood, feces and pathogens

Sutter sued the union, and won a $17.3million jury verdict in Placer County SuperiorCourt in 2006 for fraud and damage to itsreputation. However, the union was able toget the judgment thrown out on appeal,

claiming that the jury received improperinstructions from the trial judge. The partiesagreed to mediation to avoid the expense ofanother trial.

"Although long overdue, the unionsapology nally puts this incident behind us,said Geraldine Brinton, chairperson of SutterHealths board. Using scare tactics forpolitical purposes is shameful. The postcardhurt patients and deceived communities abouthe dedication of our hospitals to deliveringhigh-quality care.

The money Sutter received will bereinvested into healthcare delivery, according

to a statement issued by the system.
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Page 3Payers & Providers

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The Department of Managed Health Care haslevied a $25,000 ne against L.A. Care HealthPlan for its continued mismanagement ofprovider claims and its failure to payappropriate interest and penalties to providerswhen paying them late.

The enforcement action is the only thesixth levied by the agency against the LosAngeles-based Medi-Cal managed care planin the last seven years. By contrast, AnthemBlue Cross of California has had nearly 700enforcement penalties levied against it duringthat same period of time, including 172 issuedin a single day last March.

However, the penalty against L.A. Carewas the most severe ever levied against theplan, which provides coverage for about750,000 Medi-Cal and Healthy Familiesenrollees in Los Angeles County. A sharplyworded letter issued by the agency last monthto L.A. Cares legal counsel also implied thatthe issues involving misdirected claims weresystemic, calling them a demonstrable andunjust payment pattern.

According to the June 8 letter, the DMHCsaid the claims issues had arisen out of aroutine nancial audit for the 2008 calendar

year. The plan had failed to forwardmisdirected claims (to the appropriate party)in a timely manner...and failed to paypenalties and interest for late claims. Understate law, health maintenance organizationsare required to pay claims within 45 businessdays of receipt.

The problem was rst agged by theDMHC back in 2009, when it ned L.A. Care

Hospital Nursing HomeUnit Fined $80,000 For

Patient Death

The California Department ofPublic Health has fined

Community Hospital of SanBernardino $80,000 for providinginadequate care at its skillednursing facility that led to apatients death.

The incident occurred inFebruary 2008, when a patientwith asthmatic bronchitis diedafter having his ventilatordisconnected. Required alarmsdid not sound when the ventilatormalfunctioned, and it had notbeen properly inspected everyfour hours prior to the incident,which was the hospitals policy.The licensed vocational nurse incharge of his care had also not

been properly trained to care forventilator-dependent patients.

The fine was connected to aclass AA citation, the most severethe agency can issue. Fines forsuch a citation range between$25,000 and $100,000.

Kaiser Receives HighRating From Human

Rights CampaignFoundation

Oakland-based KaiserPermanente has been cited by the

Human Rights CampaignFoundation for providinghealthcare equality for paitents inthe lesbian, gay, bisexual andtransgender (LGBT) community.

Kaiser received a 100%rating for its LGBT patientpolicies, the third year in a row ithas received that score from thefoundation.

LGBT patients and theirfamilies deserve nothing less thanequality," said Ray Baxter, Kaiserssenior vice president ofcommunity benefit.

L.A. Care Fined Again Over ClaimsDMHC Says Plan Had Unjust Payment Pattern

$15,000 for not responding to misdirectedclaims 50% of the time and failing to payinterest on claims it paid late. The agencydiscovered those issues as a result of an audfor the 2006 calendar year.

The new audit suggested that L.A. Caresproblems had worsened. This time, it did notrespond in a timely fashion to misdirectedclaims 63% of the time. A sample of 50 claimalso determined that interest had beenincorrectly calculated for all of them, althou14 claimants received more interest than thewere entitled to.

The repeat nature of these violationsindicates that L.A. Care failed to successfullyimplement a corrective action plan followingthe 2006 nancial audit, the DMHCs letterread.

A statement issued by L.A. Care said itaccepted the DMHCs judgment, andrecognizes the importance of submittingtimely and accurate payments toproviders...we have made substantial changeto our claims management system, includingnew processes and new leadership, in aconcerted effort to ensure the consistentprocessing of accurate claims.

Plan of

cials did not comment further.The DMHC initially ned L.A. Care$35,000, but agreed to suspend $10,000 inlieu of it taking immediate corrective actionsand reporting to DMHC its compliance levein responding to misdirected claims andpaying interest and penalties for the remaindof 2011. That portion of the penalty may bewaived completely if L.A. Care is compliant.
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Payers & Providers PageOPINION

Self-Insuring For Medical GroupsA Way to Control Stiff Workers Compensation Cos

Henry Loubet is chief strategy officer for

Oakland-based Keenan. He is a member o

the Payers & Providers editorial board.

9-21:)!;6!


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payers & providers california edition – issue of july 7, 2011

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