Today is

May 2010 Policy Updates for City/Local, State, and Federal.

Policy Updates: City/Local

1) SFCCC Legislative Advocacy Training for Member Clinics Set for May 20 

“Legislative Advocacy – What Can Clinics Legally Do; What Can They Not Do” – a 
two hour training for health center leadership who want to develop a better understanding of the regulations governing health center legislative advocacy will take place Thursday, May 20, 2010 • 9:30am to 11:30am; Hamm’s Building Penthouse 1550 Bryant Street.

Advocacy is critical to the successes that health centers have achieved over the years.  It is important to have a clear understanding of what are allowable and prohibited activities.   Accordingly, the training topics will be:

• Allowable advocacy and education of public officials on issues effecting CHC patients
• Staff involvement in activities
• CHC volunteer involvement in activities, e.g., Board Members
• Patient recruitment & involvement in activities
• The (h) election for CHCs:  rationale, tracking & application process
• Q & A

If you wish to attend (SFCCC member clinics only) and have not already registered, please contact Drew Staffen (dstaffen@sfccc.org; 415 355-2223).  

2) SFCCC Briefing for Member Clinics on Serving Seniors and Persons with Disabilities (SPDs) Under Medi-Cal Mandatory Managed Care is Slated for June 10     

“California’s Medi-Cal Waiver  – Is Your Clinic Ready to Serve Seniors and Persons With Disabilities (SPDs) in Mandatory Managed Care?”  is scheduled for Thursday, June 10, 2010; 9:00am to 11:00am; Hamm’s Building Suite 200; 1550 Bryant Street.

Under California’s Medi-Cal waiver renewal, seniors and persons with disabilities (SPDs) will soon be switched from voluntary to mandatory managed care.  The San Francisco Health Plan expects to have the City’s Medi-Cal SPDs assigned to it and will be contracting with clinics and other providers to serve these populations and meet the State’s  service requirements.      

Accordingly, the training topics will be:

• The Medi-Cal Waiver and the State’s Implementation Plan
• What SPD populations will be moving to mandatory Medi-Cal managed care?
• What will be the State’s requirements for serving these populations?
• What are the clinical and logistical challenges of serving these populations?
• What has been the experience of the voluntary managed care SPD population?
• Q and A   

Trainers are being finalized.  Registration will open shortly.

Please contact Dick Hodgson (rhodgson@sfccc.org; 415 355-2230) if questions. 

3) SF Health Commission to Hold Second Hearing on DPH Budget on May 18; $12.6 Million Reduction Proposed for Mega RFP Projects Funding

Per the SF Human Services Network:

The Commission will hold its second hearing on the DPH budget. (See the agenda (pdf link) on their website.) They reviewed the initial proposal on May 4. Only minor changes have been made from this first hearing. The final proposed budget relies on $86.9 million in new revenues and $24.7 million in cuts. While it falls short of the Mayor's $138 million reduction target by about $34.4 million, the budget memo states that the Mayor's Office has reviewed and approved this budget package.

About $16 million of the general fund cuts represent service reductions. The largest component is a $12.6 million cut to Behavioral Health Services contracts through the RFP process. Because of this mechanism, the actual impacts on clients and services can't be determined until negotiations with contractors are complete.

The budget package also includes several cuts that were included in the past but restored by the Board, such as HIV benefit counseling and advocacy, HIV outreach and testing contract reductions, 10% reduction to HIV/AIDS Housing Subsidies, eliminating funding for the SRO housing collaborative, and reprogramming mobile assistance patrol transportation. Other controversial proposals include prioritizing mental health services to persons with serious mental illness, outsourcing security services, cohorting acute psych, and closing the Trauma Recovery Center.

As in past years, the Board of Supervisors is liable to add-back some of these latter cuts.

[ Return to Top ]

Policy Updates: State

1) Governor Releases May Budget Revise on May 14; Large Cuts Proposed to Medi-Cal and Healthy Families; Some Major Program Eliminations – Including  Adult Day Health Centers

Per Health Access and CPCA:
May Revise "Would Eliminate CalWORKS, Adult Day Health Care, CAPI, CFAP, Etc. Despite federal "maintenance of effort" requirement, Medi-Cal gets $523 million cut. Gov proposes limits on drugs (6/month) and doctor visits (10x/year) Health cuts would also cap benefits, raise cost sharing for 7 million in Medi-Cal. Healthy Families children would see increased premiums and co-pays.
CPCA’s Quick Analysis of the May Revise is here (pdf link).

Per CPCA:
Senate Budget Subcommittee No. 3 met today (5/13) to vote on several issues relevant to community clinics and health centers. The subcommittee, which is comprised of Senator Mark Leno (D), Chair, Senator Elaine Alquist (D), and Senator Roy Ashburn (R), voted along party lines to reject to Governor’s proposals to eliminate full-scope Medi-Cal for Newly Qualified Legal Immigrants (NQI) and Persons Permanently Residing Under Color of Law (PRUCOL), eliminate Adult Day Health Care (ADHC), and roll back family planning rates for eight specific services. Additionally, the subcommittee voted to approve the extension of six positions for the Breast and Cervical Cancer Treatment Program in an effort ensure that individuals have access to treatment.
As mentioned in previous alerts, these subcommittee actions come at a very early stage of the budget process (and on largely party-line votes).  As the process moves to the Assembly and Senate floors, more bi-partisan votes are needed to pass legislation.

Per Health Access:
Despite the Capitol bracing for the bad budget news, there was a sense of optimism in the air, as yesterday (May 13), the California state legislature held a special joint hearing of both the Senate and Assembly Health Committees to review the challenges and opportunities of health reform. While legislators have already begun consideration of over a dozen specific bills to implement and improve aspects of health reform, (pdf link) this is their first sustained examination of federal health reform since its passage over a month ago.

Senator Elaine Alquist, chair of the Senate Health Committee, heralded the “once in a lifetime opportunity” to implement health reform, and indicated her personal goal to not just implement but to “build upon” the federal law.

Assemblyman Bill Monning, chair of the Assembly Health Committee, indicated his “excitement and enthusiasm” for “maximizing the opportunities” under health reform. He expressed his approval that the Governor had directed his staff to implement reform. “This is good news,” he said.

Marian Mulkey from the California HealthCare Foundation started the hearing with a broad overview of the federal health reform, the state’s role, and the provisions that need to be implemented in both the short and long term. She projected that of the 7 million uninsured in California, 2 million of them will be newly enrolled in Medi-Cal; and another 2-4 million will newly get private coverage, with help of the new subsidies or new market rules. That will leave still leave 1-2 million uninsured in California alone.

We will provide additional information on health care reform implementation in California as it becomes available

[ Return to Top ]

Policy Updates: Federal

Per NACHC
1) HRSA Kicks Off Rulemaking Process to Change Shortage Designation Methodology

The Patient Protection and Affordable Care Act required HRSA to use the Negotiated Rulemaking process to start immediately to update the shortage designation for MUPs and HPSAs. The notice published May 11th starts a year-long process that will include a representative group of stakeholders, and is geared towards reaching consensus in order to ensure the regulation HRSA issues is supported by those most impacted by the changes. Congress mandated that HRSA use this rulemaking process after the last shortage designation rulemaking in 2008 ended with no agreement. NACHC has supported negotiated rulemaking as a way to engage stakeholders and make sure any policy changes help and don’t hurt health centers and their patients. This process is designed to do just that.

2) Congressional Budget Office (CBO) Report Skews Health Reform Funding Levels

As we have reported many times, the health reform legislation created the Community Health Center Fund. The fund includes $9.5 billion in operations funding and $1.5 billion in capital, which is $11 billion in total direct appropriations from FY 2011 through FY 2015. This is currently the only funding directly appropriated (read: real money) to health centers in health reform. Health centers are authorized to receive $3.86 billion in FY 2011 within the health reform law, but this is not real money. In reality, there will be $1 billion available to health centers in FY 2011 from the Community Health Center Fund, in addition to regular appropriated funding, which was $2.19 billion in FY 2010. Health centers are urging Congress to keep our discretionary funding at least at that FY2010 level of $2.19 billion, meaning there would be a total of $3.19 billion in total Health Centers program funding for FY2011, which is below the authorized level but more accurately reflects what will actually be spent next year. …For this reason, the recent CBO blog and report that indicates health centers could receive $34 billion over the next 10 years is somewhat misleading.

Please call or email Dick Hodgson at 415 355-2230/ rhodgson@sfccc.org if you have questions or need additional information on any of these topics.

[ Return to Top ]