Proposed Federal Rules for Exchange & Market Standards
The Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) released proposed rules for Exchange and Insurance Market Standards for 2015 and Beyond on March 21. The following are a list of key provisions that relate to ACA designated consumer assistance entities (Navigators, Non Navigator Personnel and Certified Application Counselors).
Non-Interference with Federal law and non-discrimination standards: The proposed rule would amend non-discrimination language to exempt organizations that receive federal funds to serve a defined population (i.e. Ryan White HIV/Aids program or Indian health provider) from providing enrollment assistance to anyone outside this population. However, these entities would be required to provide a referral to the Exchange call center or another entity to provide enrollment assistance.
Licensing, certification and other non-federal regulations: States would be able to implement these regulations for consumer assistance entities as long as they do not prevent ACA provisions from being implemented. The ACA provisions include:
➤Referring to other agencies that are not required to provide fair accurate, impartial information
➤Not providing services to all persons requiring assistance
➤Not allowing entities to provide information on Qualified Health Plans (QHPs) that would help consumers make an informed decision
➤Requiring an agent’s license or errors/ omissions insurance
➤Imposing standards that would limit the types of entities eligible
➤Placing unreasonable requirements making it impossible for entities to perform federally required duties.
Prohibitions & other requirements: States would not be able to pay consumer assistance entities per application, per individual or per enrollment. Additionally, consumer assistance entities would be required to abide by additional rules including:
➤Being prohibited from charging consumers, providing incentives (unless of a nominal value), using unsolicited means of direct contact to help consumers fill out applications (i.e. door-to-door or cold calls)
➤Being required to request an authorization from consumers to handle personally identifiable information and maintain a physical presence in the exchange service area.
Penalties: Creates a process and criteria for imposing civil penalties on consumers and consumer assistance entities that provide false or fraudulent information to an Exchange or improperly use or disclose information. Community Health Councils provided comments on the above and other provisions. An update will be provided once the rules are final. For more information, contact CHC Policy Analyst Anulkah Thomas.
After eliminating adult dental benefits for nearly three million low-income Californians in 2009, Denti-Cal will finally be reinstated May 2014. The benefits will include preventative care, crowns, and full sets of dentures, but leaves out periodontal work and partial dentures. The program was allotted $93.9 million over two years, significantly less than the $131 million advocates were seeking to restore full benefits.
Even with the partial reinstatement of Denti-Cal, access may still prove to be an obstacle for beneficiaries. A recent policy brief by UCLA highlighted considerable disparities in the distribution of dentists, ranging from 2.4 per 5,000 population in San Joaquin Valley Counties to 5.1 per 5,000 population in Greater Bay Area Counties. According to the Department of Health Care Services, only about half of active licensed dentists in California are Denti-Cal providers. It is unclear, however, how many of these participating providers are accepting new patients despite the influx of newly eligible beneficiaries as a result of the Affordable Care Act’s Medicaid expansion. The low participation of providers in Denti-Cal may be further exacerbated by the 10% provider reimbursement cuts that began in January.
For additional questions, please contact CHC Policy Analyst Ine Collins.
Covered CA Draft Budget Signals Adjustments in Outreach & Enrollments Strategies
At the April 17 Covered California Board meeting, staff presented a preliminary 2014-15 budget and potential adjustments to program strategies. Among several key areas, the following recommendations were proposed for outreach and enrollment assistance:
➤Transition Certified Enrollment Counselors from a per application payment to grant funding
➤Transition from the current separation of outreach and enrollment activities to a combined payment for the full spectrum of outreach, education and enrollment.
Staff noted that they would work with the existing community-based enrollment and outreach structure through open enrollment 2014 while providing entities the opportunity to apply for this new Navigator grant program. The grant process is expected to launch in the summer of 2014. For more information, contact CHC Policy Analyst Anulkah Thomas.
California Legislative Updates
Following are updates on the legislation CHC is watching in the 2013-2014 session. For more information on these and other bills, visit the California Legislative Information website or contact the CHC policy analyst indicated at the end of the bill.
SB 1183 (Vehicle Registration Fee for Bicycle Infrastructure), originally proposed as a sales tax on new bicycle purchases, has been changed to a proposed motor vehicle registration surcharge (not to exceed $5). Revenues would go to improving bicycle infrastructure on both existing and new recreational trails, and include maintenance purposes.
If passed, SB 1183 would not automatically impose any fees. Cities, counties and/or regional park districts would be allowed to propose fees for the ballot and seek approval from two-thirds of local jurisdiction voters. The East Bay Regional Park District, one of the bill’s sponsors, recognized the change as an effort to avoid a point of sale tax that may discourage bike riding. SB 1183 would provide a steady funding source to operate and maintain trails.
The bill was passed out of the Senate Transportation Committee on a 6-4 vote and is currently on the Appropriations Committee suspense file. – Naomi Iwasaki AB 2398 (Vulnerable User Road Law) currently proposed in the California State Assembly would raise fines for drivers convicted of causing bodily injury to a vulnerable road user, such as a pedestrian or bicyclist. If you were walking across the street today and happened to be hit by a car that driver could be fined up to $95 (or as little as $70). If passed, AB 2398 would increase the fine to a minimum of $220 and a maximum of $1,000 for “great bodily injury.” The bill would also require the convicted driver to have their license suspended for six months if the crime was repeated within three years.
The bill was passed through the Assembly Transportation Committee on a 13-0 vote and is currently in the Appropriations Committee under suspense file. – Naomi Iwasaki SB 1132 (Well Stimulation) would halt well stimulation treatments like hydraulic fracturing and acidization until a legislatively required study on the safety of the practice is completed and the Governor confirms well stimulation treatments can occur without harming the public’s health. SB 1132 has passed through the Natural Resources and the Environmental Quality Committees. It goes before the Senate Appropriations Committee next. The California Legislature has debated, but failed to pass, well stimulation moratoriums before. Community Health Councils is among the bill’s supporters. – Erin Steva
Healthcare AB 1805 (Medi-Cal Reimbursement Rates) reverses the 10% Medi-Cal provider rate cuts that were implemented in January. Passed the Committee on Health 19 to 0.
SB 1005 (Health For All) extends the Medi-Cal expansion and create a “mirror exchange” for all income eligible Californians regardless of immigration status. The bill passed the Committee on Health 6 to 1 and will be heard in the Appropriations Committee May 19.
AB 1759 (Medi-Cal Provider Payments) reverses the 10% Medi-Cal provider rate cuts that were implemented in January. Passed the Committee on Health 19 to 0.
AB 2325 (Communi-Cal Translation) establishes medical interpretation services for Medi-Cal beneficiaries. Passed the Committee on Public Employees, Retirement and Social Security 5 to 1.
SB 964 (Healthcare Service Plans: Timeliness of Standards) requires DHCS to survey health plans to ensure timeliness of access to care. Passed the Committee on Health 5 to 1.
For additional questions, please contact CHC Policy Analyst Ine Collins.
AB 2385 (Market Match), known as the Supporting Nutrition through Access to Produce (SNAP) Act, seeks to double the value of federal nutrition assistance benefits — like CalFresh (food stamps) — when used to purchase fresh produce at Certified Farmer’s Markets. The bill would also create a statewide Market Match Nutrition Incentives Program (MMNIP) and account within the California Department of Food and Agriculture (CDFA). SB 2385 would require the CDFA to establish minimum standards, funding schedules, and procedures for awarding and allocating funds to qualified entities that meet certain priorities.
As of 2014, 150 farmers’ markets across the state offer Market Match. The program’s success has generated interest by California Policy Makers who see it as an innovative way to encourage the purchase and consumption of fresh California fruits, nuts, and vegetables. Advocates champion the effort as an innovative food strategy to support community health given the drastic cuts to the Supplemental Nutrition Assistance Programs (SNAP) that happened earlier this year when the Farm Bill passed. The bill was heard by the Assembly Committee on Agriculture on April 20, 2014. – Hector Gutierrez
AB 2561 (Neighborhood Food Act) seeks to change restrictive zoning by ensuring the right of individuals and groups to cultivate and, in certain cases, sell edible plants even when local zoning laws, private land covenants, or lease restrictions prohibit such activities.
AB 2561 adds new provisions to the Government Code and the civil code by increasing opportunities for growing fresh produce in the following three ways:
➤Tenants’ Rights: The bill requires that tenants be able to grow produce on land they are renting as long as it does not interfere with other tenants’ use of the property or create hazards.
➤Homeowners’ Association Members Rights: The bill would make it illegal for a homeowners’ association contract to prohibit the use of private (not shared) property for growing produce and having occasional on-site sales.
➤ City and County Zoning: The bill would prohibit cities and counties from barring produce growing in any zones for personal use or for commercial use.
Advocates champion the bill’s ability to empower individuals to grow food at home and promote opportunities for micro-enterprises and food access in food insecure communities. The bill has been read a second time, amended and re-referred to the Committee on Appropriations. – Hector Gutierrez
SB 1000 (SSB Warning Labels) would require all sodas and other sweetened beverages sold in the state to display a warning label about the potential health hazards associated with sweetened beverage consumption including obesity, tooth decay and diabetes. The warning label would be applied to sugary drinks containing 75 calories or more per 12-ounce serving.
Despite claims that SB 1000 will lead to a substantial reduction in long-term health costs associated with obesity, the Senate Appropriations committee moved the bill to the suspense file due to concerns regarding the cost of implementation. Senator Monning, the author, has committed to working to reduce the $390,000 in initial implementation costs before reintroducing the bill. – Breanna Morrison