Legislation
“What Can Brown do for YOU?”
Not much if you rely on the State Budget. This question is no longer a catchy slogan for an all to recognizable delivery service but an inquiry many special interests are asking Gov. Brown as he enters his second year in office.
However, Oops! Gov. Brown was forced on Thursday, January 5th to cobble together a press conference to unveil his State Budget for 2012-2013, after the budget summary document was accidentally posted on the California Department of Finance website. Yours truly was in the Capitol at the time and the media was literally running down the hallway and rushing into the pressroom at 2:30 PM. Gov. Brown was originally scheduled to unveil his budget proposal on Tuesday, January 10th at 9:00 AM.
BOTTOM LINE: No proposed elimination of O&P benefits in Medi-Cal and no proposed Medi-Cal provider rate reduction!
However, the proposed budget does attempt to bridge the $9.2 billion deficit with a combination of cuts and a proposed November ballot initiative to temporarily increase income taxes on those earning more than $250,000/year and a temporary half cent sales tax increase. If the November ballot initiative fails, Gov. Brown is proposing another $5 billion reduction to public education.
A copy of the budget summary document can be found at http://www.ebudget.ca.gov/pdf/BudgetSummary/FullBudgetSummary.pdf. The Health and Human Services summary begins on page 101. You will also notice Medi-Cal cuts of $842 million and mostly attributable increases in eligibility.
Furthermore, the budget proposes a nearly 26 percent reduction in the rates paid to managed care plans that serve children enrolled in the Healthy Families Program, an expansion of managed care for children in rural counties and the wholesale transition of all 875,000 children in Healthy Families into Medi-Cal beginning in October 2012.
There are also various Medi-Cal rate cut lawsuits that have been filed and pending and even some important rulings rendered against Gov. Brown based on prior attempts to implement Medi-Cal provider rate reductions. Although none of these cases have a direct impact on O&P providers, obviously the legal challenges have staved off further Medi-Cal provider rate reduction efforts. However, O&P providers are still subject to the 10% provider rate reduction implemented in 2008.
A complete rundown of the various Medi-Cal rate reduction lawsuits can be found at http://www.californiahealthline.org/features/2012/state-starts-year-facing-multiple-lawsuits-hearings.aspx.
COPA will continue to monitor these budget developments and update you as needed. Please contact me directly with any further questions. THANK YOU for your ongoing support of COPA!
Gov. Brown May Revise Spares Medi-Cal O&P Benefit Cut
The ongoing COPA advocacy campaign to spare Medi-Cal O&P benefit cuts scored another victory as Gov. Brown releases the budget "May Revise."
California unexpectedly received a surge from income tax revenue in April. This ongoing surge is estimated to generate a surprising $6.6 billion in unexpected revenue. As a result, the dreaded "all cuts" budget has been shelved and O&P benefits have been spared for enrollees in the Medi-Cal Program.
The main impact from the "May Revise" on O&P providers will be a transfer of all the California Health Family Program enrollees into Medi-Cal managed care arrangements. Such a move will require a federal waiver. This shift is in addition to previous Medi-Cal enrollee limits approved the Legislature in February, which includes caps on physician office visits and mandatory co-payments. Lastly, O&P providers are still subject to the 10 percent provider rate cut in the Medi-Cal Program adopted as part of the 2008-2009 budget deal.
Going forward, Brown and the Legislature will pare down their forthcoming ballot initiative asking voters to approve some combination of extensions on sales, vehicle and income taxes.
The Legislature has until June 15th to approve a budget for 2011-2012. All indications are that the possibility of meeting that deadline is coming into focus as the current budget year deficit has fallen to $9.6 billion from $15 billion.
More information on the "May Revise" can be found here: www.ebudget.ca.gov
COPA Saves O&P From Budget Axe!
COPA is ecstatic to announce that Gov. Schwarzenegger has RESTORED O&P in Medi-Cal via his "May Revise" Budget for 2010-2011. Major "kudos" to all of our members, patients and national partners who helped answer the "Call to Action" over the last several months. Gov. Schwarzenegger's original budget proposal would have eliminated O&P as an "Optional" benefit in the California Medi-Cal Program.
However, we all must remain vigilant and committed to ensure that O&P stays off the chopping block! The real difficult budget negotiations have begun among Gov. Schwarzenegger and the legislative leadership now that the May Revise has been published. Other benefits that are being eliminated in the May Revise will be looking to cut services like O&P in order to justify savings that keep their programs alive!
O&P benefits were one of a handful of other "Optional" benefits that were slated to be eliminated. COPA has also been a part of a larger coalition of all optional benefits that was one key to success in addition to our individual efforts. However, some of the other coalition optional benefits did not fare as well as O&P. To that end, Gov. Schwarzenegger now proposes various utilization controls and cost-sharing measures in Medi-Cal. Key among these proposals are the following:
Limits on Services and Utilization Controls Totaling $90.2 Million- Eliminate certain over-the-counter counter drugs (Such as acetaminophen or cough and cold medicine) and nutritional supplements totaling $13.0 million
- Establish a maximum annual benefit dollar cap on hearing aids at $1,510, durable medical equipment at $1,604, incontinence supplies at $1,659, urological supplies at $6,435, and wound care supplies at $391 totaling $3.8 million
- Limit prescriptions (except life-saving drugs) to six per year totaling $4.2 million. The proposed limits are consistent with the aggregate utilization of these services at the 90th percentile of Medi-Cal enrollees.
- $5 copayments on physician/clinic/dental/pharmacy ($3 for the relatively lower cost preferred drugs and $5 for others) visits totaling $118.2 million
- $50 copayment on emergency room visits totaling $41.5 million
- $100 per day copayment and $200 maximum for hospital stays totaling $59.1 million
Much of the blow to the Health and Human Services Agency Budget was sparred to due $4.8 billion in federal funds even though $6.9 was requested. However, California's budget deficit is nearly $20 billion. Now is certainly not the time to take a victory lap for O&P but this is for sure a positive step in the right direction. Please stay tuned as this continues to unfold!
Medi-Cal "Optionals" Elimination Website Live: www.savetheoptionals.com
Even though the two budget subcommittees have rejected the elimination of O&P from the Medi-Cal Program proposed by Gov. Schwarzenegger ... THIS BATTLE IS FAR FROM OVER!!!! The income tax revenue news from April has not been encouraging and --- as we all know --- there is going to be intense pressure to make cuts wherever possible as this budget process moves forward.
In addition to our own specific battle, COPA is part of a larger collation with the other "Optional" benefits that are also slated for elimination. This coalition has hired a high profile public affairs firm that has just launched our website. This website www.savetheoptionals.com is now up and running and the "Take Action" button is live. Please share this with any and all interested parties and ask them to go on the website and send a message to their lawmakers and Gov. Schwarzenegger opposing elimination of O&P in the Medi-Cal Program. It will only take seconds and your message sends at the click of a mouse!
This effort will allow us to gather all letters submitted via the site and start populating our grassroots data for future use and targeted outreach as needed. We are also looking to build our list of allies on the site ... so please contact me directly with your specific name for inclusion on the coalition list!
Please forward any photos of O&P devices or services being performed for possible inclusion on the website. However, please be aware that photos of specific patients will need prior written consent to use their likeness on the website.
PLEASE ACT NOW … WE NEED TO SPREAD THE WORD AND GENERATE LETTERS NOW ... WE HAVE NO TIME TO LOSE!!!!
GREAT NEWS!
COPA is pleased to report that the Assembly Budget Subcommittee on Health (Sub.#1) voted to REJECT the proposed Medi-Cal elimination of O&P on Monday, April 26, 2010. This bipartisan decision was recommended by longtime friend of the O&P industry – Assembly Subcommittee Chair Dave Jones (D-Sacramento). COPA Executive Director and Legislative Advocate Bryce Docherty testified in opposition to these cuts and supported the motion made by Assembly Member Jones.
A special "Thank You" goes out to all COPA members, their patients and our national partners for answering the call to write letters to the Assembly Subcommittee. Every little bit helps!
Next we await the May Revise to be released by Governor Schwarzenegger on May 14, 2010. This revised budget proposal may or may not contain another recommendation to eliminate O&P as an "optional" benefit to Medi-Cal patients. If so, COPA will escalate our advocacy efforts to the entire Senate and Assembly Budget Committees as well as legislative leadership.
Please stay tuned as all of this continues to unfold.
Below is a link to the COPA opposition letter.
Under the Dome by Bryce Docherty
"The Trigger Proposal Will Eliminate O&P Coverage in Medi-Cal"
Governor Schwarzenegger's proposed budget for 2010-11 anticipates receipt of $6.9 billion in additional resources from the federal government. Failure to secure these funds would "trigger" a number of additional cuts, including the elimination of the remaining Medi-Cal optional benefits INCLUDING ORTHOTICS & PROSTHETICS! Other affected services include: Hearing Aids; Physical Therapy; Occupational Therapy; Independent Rehabilitation Facilities; Outpatient Heroin Detox; Medical Supplies; and Durable Medical Equipment.
While past proposals to eliminate these services have failed, a number of optional benefits were actually scratched in the current budget (most notably adult dental). Unlike other Medi-Cal cuts, the elimination of these benefits was not overturned by the courts. Given the likelihood that the requested federal funds will not be forthcoming, the lack of other cost cutting alternatives, the steadfast refusal to raise revenues and the potential "savings" associated with their elimination, it is entirely possible that O&P WILL BE ELIMINATED EFFECTIVE JULY 1, 2010.
COPA has embarked upon one of the most aggressive advocacy fights in our history to prevent these budget cuts.
We continue our aggressive campaign to prevent the proposed elimination of O&P services in the Medi-Cal Program with a special "Thank You" to Jeff Collins with Cascade, COPA Board member Harry "JR" Brandt, COPA Board member Kel Bergmann with SCOPe, and COPA Board member Bob Jensen with Lawrence Orthopedic for their extraordinary outreach on this issue. Also, special-special "Thank You" to our national partners at ACA, AOPA and AAOP for unprecedented access to their resources. Lastly, special-special-special "Thank You" to Jeff Zeller with Spectrum Prosthetics who got his local TV station to cover this issue at his facility!
The following members have also "stepped up" big time by answering the call for COPA PAC contributions: Hanger Prosthetics & Orthotics ($5,000), Nobbe Orthopedics ($1,500) and Breakey Prosthetics ($1,000).
This will continue to be an "All Hands on Deck" effort and we've only just begun!
Please see the links contained here to the fact sheet and actual DRAFT legislative language provided by the California Department of Health Care Services (CDHCS) that outlines the proposed O&P elimination. Also are links to our "Arms and Legs are NOT a Luxury" fact sheet that will accompany our other collateral materials as we visit with legislators and budget committee staff, etc. Lastly, is a link to the wonderful national press release distributed jointly by AOPA and ACA. Please use the press release to also reach out to your local newspapers and TV stations. Please also use the fact sheet as talking points when discussing this issue with the media or other stakeholders.
In addition to COPA waging our own individual effort to prevent elimination of O&P in Medi-Cal – we're also part of a larger coalition representing ALL effected optional benefit providers, businesses, etc. This coalition has hired a very high profile media and public affairs firm to coordinate the overall outreach. To this end, please continue to coordinate any and all of your specific outreach through me, so I may coordinate with the larger outreach effort as needed.
Thus far, COPA has testified before the Senate Budget Subcommittee #3: Health and Human Services to OPPOSE the proposed "trigger" elimination of O&P benefits in the Medi-Cal Program. We are delighted to report that the subcommittee unequivocally AGREED with us and recommended REJECTION of these cuts!! However, our fight is FAR from over. The Gov. Schwarzenegger Administration testified that they are analyzing the effect of the recently passed federal health care reform package mandates on the California Medi-Cal Program. Therefore, we expect a revised budget proposal by Gov. Schwarzenegger in May (referred to as the May Revise) that will reconfigure their revenue estimates and potential cuts. We also need to keep up the fight to ensure the rejection recommendation by the full Senate Budget Committee and work to ensure the Assembly Budget Subcommittee takes similar action!
COPA, our California patient and industry family in conjunction with our national partners will certainly keep you informed as all this unfolds. In the meantime, please encourage others to join COPA and contribute generously to our COPA PAC.
COPA is also in the process of obtaining a video copy of the hearing for distribution but below is ONLY ONE of the specific examples (i.e. scoliosis) that we brought the attention of the Senate Budget Subcommittee:
"This is a custom molded orthotic that is used to correct severe curvature of the spine. If not treated at a young age and before the spine has reached growth maturity, scoliosis can cause diminished lung capacity and possible death due to severe compromised organ function. If no such orthotic bracing is provided by Medi-Cal then physicians would elect neuromuscular spinal infusion to correct the curvature. An invoice for such a procedure would cost $294,000 with an expected Medi-Cal reimbursement of $14,000. The expected Medi-Cal reimbursement for a highly customized orthotic to treat scoliosis is approximately $2,000. An adolescent may need one or two braces during the course of treatment for a total Medi-Cal cost of $2,000 - $4,000. This represents an overall Medi-Cal savings of $10,000 - $12,000! BOTTOM LINE: Orthotic & Prosthetic Medi-Cal Coverage WILL SAVE MONEY!"
P.S. Lars Jensen and Bryan Hayes from Hanger have stepped up BIG TIME to provide me with a "box of love" containing various custom orthotics and prosthetics customarily provided to Medi-Cal patients. Much thanks to Bryan personally delivered and walked me through the cost, use, benefit et al of these devices. Special "Thank You" also to Bob Jensen for the specific "sad but true" real life scoliosis example.
"If you miss a day "Under the Dome" – you miss a lot!"
- CDHCS Fact Sheet
- CDHCS Draft O&P Elimination Language
- Arms and Legs are Not a Luxury Fact Sheet
- AOPA-ACA Joint Press Release
O&P Patient Equity Bill Sponsored by COPA
Ask your Lobbyist
Bryce W.A. Docherty,
Online Resources
Web Media and Organizations
CA Budget 2011-2012
CA Health Benefits Review Program (CHBRP)
CA Legislative Bill Information
CA Department of Consumer Affairs
CA Department of Health Care Services
CA Division of Workers Compensation
CA Department of Insurance
CA Department of Managed Health Care