California Healthline: Health Plans

Kaiser, DMHC Settle Dispute Over Therapy Coverage

Thu, 31 May 2012 08:00:00 GMT

Under a settlement reached with the California Department of Managed Health Care, Kaiser Permanente has agreed to cover medically necessary physical, occupational and speech therapy and reimburse members who paid for such services out-of-pocket since January 2009. As part of the settlement, Kaiser has 60 days to contact members who have filed complaints about denial of such services. Sacramento Business Journal, Payers & Providers.

13.5M U.S. Residents Have High Deductibles, Health Savings Accounts

Thu, 31 May 2012 08:00:00 GMT

A report from America's Health Insurance Plans finds that about 13.5 million U.S. residents are enrolled in a high-deductible health plan paired with a health savings account. The number of enrollees in such plans has increased by 18.4% since 2011. Kaiser Health News/NPR et al.

Study: Most Individual Health Plans Fall Short of Reform Law Standards

Thu, 24 May 2012 08:00:00 GMT

A new Health Affairs study finds that more than half of all currently available individual health insurance policies do not meet the coverage standards established by the health reform law. However, most job-based health plans meet the federal standards. New York Times et al.

Second Insurer Joins Probe of Lap-Band Surgery Centers

Thu, 24 May 2012 08:00:00 GMT

Anthem Blue Cross is working with authorities to investigate the business practices of weight-loss surgery centers associated with the 1-800-GET-THIN marketing initiative, making it the second insurer to conduct a probe into possible medical fraud related to the Lap-Band weight-loss surgery. In January, Aetna announced that it is conducting a similar investigation. KPCC's "KPCC News."

Harold Miller of the Network for Regional Healthcare Improvement Discusses Innovation

Wed, 23 May 2012 08:00:00 GMT

Harold Miller, president and CEO of the Network for Regional Healthcare Improvement, spoke with California Healthline about the importance of pursuing innovative health care improvement strategies that are tailored to local needs.

Insurance Rate Regulation Plan Moves Closer to Ballot

Mon, 21 May 2012 08:00:00 GMT

On Friday, California Insurance Commissioner Dave Jones and Consumer Watchdog officials submitted to state officials 800,000 voter signatures for a proposed ballot measure that would give the state greater regulatory authority over health insurance rates. At least 504,760 valid signatures are necessary to qualify the measure for the November ballot. A coalition of hospitals, physicians and other stakeholders oppose the measure. Sacramento Bee et al.

HHS Issues Guidance, Releases New Details on Health Plan Exchanges

Thu, 17 May 2012 08:00:00 GMT

Yesterday, HHS said states have until Nov. 16 to submit plans for operating health insurance exchanges under the federal health reform law. HHS also released guidance on how it will facilitate exchanges for states that opt not to administer their own marketplaces. Reuters et al.

Insurers To Lose $1T if Reform Law Is Struck Down, Report Finds

Wed, 16 May 2012 08:00:00 GMT

If the U.S. Supreme Court overturns the federal health reform law, health insurers stand to lose nearly $1 trillion in new revenue and nearly $174 billion in profits between 2013 and 2020, according to a recent report by Bloomberg Government. The Hill's "Healthwatch" et al.

Kaiser, Union Coalition Reach Tentative Contract Deal

Tue, 15 May 2012 08:00:00 GMT

On Friday, Kaiser Permanente and the Coalition of Kaiser Permanente Unions -- which represents nearly 100,000 Kaiser workers -- announced a tentative agreement on a new three-year contract. The contract includes annual wage increases of 3% for California workers and 2% for workers in all other regions. The tentative deal maintains health care, pensions and retiree benefits and improves dental care, according to the announcement. If the local unions ratify the deal, it would take effect Oct. 1. San Francisco Business Times.

Bill Would Offer Benefits to Domestic Partners of Federal Employees

Tue, 15 May 2012 08:00:00 GMT

Tomorrow, a Senate panel is scheduled to mark up legislation that would extend certain health benefits to domestic partners of gay and lesbian federal employees. Meanwhile, more companies are offering health benefits to workers' domestic partners. Washington Times et al.

Many GOP Lawmakers Not Moving Forward on Health Plan Exchanges

Mon, 14 May 2012 08:00:00 GMT

Several Republican governors and state lawmakers are not taking steps to implement health insurance exchanges required by the health reform law. Some lawmakers say they are awaiting the Supreme Court's decision on the overhaul before moving forward. Washington Post et al.

Kaiser's Net Income Down 16% as Capital Spending Increases

Mon, 14 May 2012 08:00:00 GMT

On Friday, Kaiser Foundation Hospital, Kaiser Foundation Health Plan and their subsidiaries reported a net income of $770 million in the first quarter of 2012, down 16% from $921 million in Q1 2011. Kaiser noted that capital spending increased from $623 million in Q1 2011 to $861 million in Q1 2012 because of investments in technology and hospital construction projects to comply with the state's seismic standards. Sacramento Bee, San Francisco Business Times.

HHS Releases Final Rule on Health Reform Law's Premium Rebate Checks

Mon, 14 May 2012 08:00:00 GMT

A new final rule requires health insurers to inform consumers that their premium rebates are a result of the federal health reform law. The requirement is seen as part of an attempt by the Obama administration to boost the law's popularity. Wall Street Journal, Time's "The Page."

Key Leadership Changes on O.C.'s CalOptima Board

Thu, 10 May 2012 08:00:00 GMT

On Tuesday, Cal-Optima Vice Chair James McAleer, CEO of the Alzheimer's Association of Orange County, announced his resignation as investigations continue into allegations of improper dealings by Edward Kacic, then-chair of CalOptima's board. CalOptima is Orange County's Medi-Cal managed care plan. During a meeting following McAleer's announcement, the board voted 6-3 to remove Kacic as chair of the board and named Orange County Health Agency Director Mark Refowitz as interim chair. Payers & Providers.

Health Plans Could Offer New 'Specialty' Rx Strategies

Thu, 10 May 2012 08:00:00 GMT

As more patients begin using costly "specialty" drugs, many employer-based insurance plans could begin to offer new ways to manage the high cost of the medications. One strategy that employers might use is value-based insurance design, which ties employees' costs to the value of medical services, making treatments that are seen as providing important clinical benefits less costly to workers. Kaiser Health News/Washington Post.

Report Calls for Limiting Number of Plans in Exchanges

Wed, 09 May 2012 08:00:00 GMT

A report published Monday in the journal Health Affairs recommends that states follow Massachusetts' example and limit the number of health plans consumers can choose from in state health insurance exchanges required under the federal health reform law. Authors of the report say that consumers prefer choosing from a few carefully vetted and clearly explained health plan options. The Hill's "Healthwatch."

Health Net Expands Low-Cost HMO Plan to Orange County

Fri, 04 May 2012 08:00:00 GMT

Insurer Health Net has expanded its low-cost HMO SmartCare into Orange County one year after it launched the plan in Los Angeles, San Bernardino and San Diego counties. The plan provides a 25% discount on premiums compared with a full insurance network. Health Net has contracted with nine health care provider groups in Orange County. Payers & Providers.

L.A. Program Provides Care to Undocumented Restaurant Workers

Thu, 03 May 2012 08:00:00 GMT

In Los Angeles, a community clinic and a restaurant workers group have launched a cooperative to offer health coverage to undocumented residents working in restaurants. The program is believed to be the first of its kind in the U.S. Los Angeles Times.

S.F. Employee Unions, Mayor Wrestle Over Benefits, Taxes

Tue, 01 May 2012 08:00:00 GMT

San Francisco Mayor Ed Lee and 27 city public employee unions are locked in contract negotiations that would affect about 21,000 workers. Service Employees International Union Local 1021, San Francisco's largest union, wants the taxes on businesses to be raised to help keep city workers' wages and health care benefits at 2011-2012 levels. San Francisco Chronicle.

Insurance Rate Regulation Ballot Proposal Draws Support

Tue, 01 May 2012 08:00:00 GMT

On Monday, Consumer Watchdog reported $1.5 million in contributions, including donations from several high-profile business leaders, for a proposed ballot measure that would give the California Department of Insurance greater regulation of health insurance rates. A group of insurers, hospitals, doctors and business groups who oppose the proposal has reported $367,200 in donations. Los Angeles Times.

GAO: Millions of U.S. Adults Have Pre-Existing Conditions

Mon, 30 Apr 2012 08:00:00 GMT

An estimated 36 million to 112 million U.S. adults have pre-existing conditions -- such as diabetes, hypertension and mental health disorders -- that could lead health insurers to deny coverage, according to a recent Government Accountability Office report. America's Health Insurance Plans downplayed the report, saying that the number of individuals with pre-existing conditions who are uninsured is low. The Hill's "Healthwatch," Modern Healthcare.

KFF: Insurers To Issue $1.3B in Medical-Loss Ratio Rebates This Year

Fri, 27 Apr 2012 08:00:00 GMT

As a result of the federal health reform law's medical-loss ratio rule, at least 436 health plans covering 15.8 million U.S. residents are expected to issue about $1.3 billion in rebates this year, according to a Kaiser Family Foundation report. The Hill's "Healthwatch" et al.

Kaiser Permanente Officials Tout Success of Android App

Fri, 27 Apr 2012 08:00:00 GMT

This week, Kaiser Permanente officials touted the success of its Android-based mobile phone application, which the insurer released in January. Officials said that the Android app has been downloaded 94,367 times and that the insurer is preparing to release an iPhone version of the app. San Francisco Business Times' "Bay Area BizTalk."

Employers Say Reform Law Will Increase Health Costs, GOP Report Finds

Fri, 27 Apr 2012 08:00:00 GMT

A report by Republicans on a House committee finds that certain companies on President Obama's jobs council expect the federal health reform law to increase their health care costs, which could lead them to drop health coverage for employees. Wall Street Journal et al.

Calif. Assembly Bill Targets 'Try and Fail' Drug Coverage

Tue, 24 Apr 2012 08:00:00 GMT

The California Assembly is considering legislation that would address health insurers' use of step-therapy, in which patients are asked to try as many as five prescription painkillers before health plans agree to cover the drugs. Under the bill, insurers would be prohibited from asking patients to try more than two prescription medications before providing coverage. KQED's "The California Report."

UnitedHealth Group Reports Rise in Earnings, Membership in Q1 2012

Fri, 20 Apr 2012 08:00:00 GMT

Yesterday, UnitedHealth Group reported a 3.1% rise in earnings, a 7.3% rise in revenue and an increase of more than one million members for the first quarter of 2012. The health insurer noted that medical costs are its biggest expense. Wall Street Journal, AP/New York Times.

Kaiser Permanente Launches Wellness Tool for Employers

Thu, 19 Apr 2012 08:00:00 GMT

Kaiser Permanente has released a toolkit that seeks to help employers create a wellness committee for workers. The toolkit provides a checklist for creating the committee, a member recruitment email template, a guide for conducting initial meetings and a pledge for prospective committee members to sign. All employers are able to acquire the toolkit, regardless of whether they offer Kaiser Permanente as a health plan. Sacramento Business Journal.

UnitedHealthcare, DOI Reach Settlement on Autism Therapy

Wed, 18 Apr 2012 08:00:00 GMT

UnitedHealthcare has agreed to a settlement with the state Department of Insurance to provide immediate coverage of applied behavioral analysis for people with autism. Many insurers have argued that the treatment is not a medical service. Sacramento Business Journal.

CMS Announces First 27 Participants in Medicare Shared Savings Program

Wed, 11 Apr 2012 08:00:00 GMT

Yesterday, CMS announced the first participants in Medicare's Shared Savings Program, which provides incentives for health care providers to form accountable care organizations. Two of the first 27 participants in the ACO program are based in California. Modern Healthcare et al.

Survey: Annual Health Plan Costs To Increase by Less Than 10%

Tue, 10 Apr 2012 08:00:00 GMT

A new survey by Buck Consultants estimates that the average annual costs for all types of health plans will increase by less than 10% in 2012, marking the firm's smallest projections for health plan rate hikes since 2001. Sacramento Business Journal.

HHS Sets New Deadline for Adopting Medical Billing Code System

Tue, 10 Apr 2012 08:00:00 GMT

Yesterday, HHS released a proposed rule that calls for delaying the ICD-10 compliance deadline by one year, to Oct. 1, 2014. The proposed rule also includes a provision to assign a unique health plan identifier number to all health insurers. Modern Healthcare et al.

New Claims Format Cause of Processing Delays, Gold Coast Says

Mon, 09 Apr 2012 08:00:00 GMT

Gold Coast Health Plan officials say delays in processing claims are the result of billing companies adapting to new electronic claims requirements. The federal government will enforce the shift to the 5010 format in July. Ventura County Star.

SAG-AFTRA Must Develop Combined Health Plan

Fri, 06 Apr 2012 08:00:00 GMT

As of this week, the Screen Actors Guild and the American Federation of TV and Radio Artists are operating as a joint union, but members still must negotiate how to combine the groups' respective health plans. KPCC's "KPCC News."

Consumers Union To Help Review Insurers' Rate Hikes

Fri, 06 Apr 2012 08:00:00 GMT

The California Department of Managed Health Care has awarded a $225,000 contract to Consumers Union to help DMHC evaluate health insurers' proposed premium rate increases. The contract is funded by the federal health reform law. Although DMHC is not authorized to reject proposed premium rate hikes, legislation that went into effect in 2011 gives the agency the power to review insurers' proposals and make recommendations. Payers & Providers.

Report: Medical-Loss Ratio Rule Would Have Led to Rebates for 2010

Thu, 05 Apr 2012 08:00:00 GMT

If the federal health reform law's medical-loss ratio rule had gone into effect in 2010, private health insurers would have paid their customers about $2 billion in rebates for that year, according to a recently released report from the Commonwealth Fund. National Journal et al.

State, Anthem Remain at Odds Over Claims Processing

Tue, 03 Apr 2012 08:00:00 GMT

The state Department of Managed Health Care continues to press Anthem Blue Cross to audit and reprocess all late claims dating back to July 2007. DMHC's latest order calls for Anthem to provide a new corrective plan and training for claims processors, as well as to conduct an audit of procedures that identify delayed claims and prove that interest and penalties have been paid. Payers & Providers.

Lawmakers Consider Workers' Compensation Rules at Recent Hearing

Thu, 29 Mar 2012 08:00:00 GMT

California lawmakers recently examined rules governing the workers' compensation system. Stakeholders have criticized rules enacted in 2004 for too tightly controlling medical care and not providing adequate compensation to workers. Sacramento Bee's "Capitol Alert."

Health Trust for California Schools To Report Travel

Wed, 28 Mar 2012 08:00:00 GMT

This week, the Los Angeles attorney for the California Schools Voluntary Employees Benefits Association -- which provides health care and other benefits to school districts in California and across the U.S. -- said the not-for-profit health insurance trust's board has been asked to report its travel benefits on state disclosure forms and revise its past filings to reflect that information. U-T San Diego.

Medi-Cal Commission Discusses Concerns With Gold Coast Health Plan

Tue, 27 Mar 2012 08:00:00 GMT

The Ventura County Medi-Cal Managed Care Commission recently discussed complaints about Gold Coast Health Plan, which administers Medi-Cal for county residents. A health care provider at the meeting said the plan is months behind on payments. Ventura County Star.

Medco To Pay $2.7M To Settle Case Involving CalPERS Pay

Mon, 26 Mar 2012 08:00:00 GMT

On Friday, the Office of the California Attorney General Kamala Harris announced that pharmacy benefits manager Medco Health Solutions has agreed to pay $2.7 million to settle allegations that it made improper payments to a former CalPERS board member. Medco did not admit any wrongdoing under the deal. AP/U-T San Diego, Sacramento Bee.

Claims Processing Efficiency Project To Expand in Calif.

Fri, 23 Mar 2012 08:00:00 GMT

Blue Shield of California and the Hospital Association of Southern California say their joint project to improve claims processing efficiency has been successful and will be expanded to other portions of the state. The pilot project, known as the Partnership in Operational Excellence and Transparency, has cut the claims cycle time from 32 days to 28 days. Payers & Providers.

Union Merger Could Affect Entertainers' Health Plans

Thu, 22 Mar 2012 08:00:00 GMT

Members of the Screen Actors Guild and the American Federation of TV and Radio Artists have until March 30 to return ballots on a proposed merger of the two unions. A pending lawsuit against the merger argues that SAG's board has breached its fiduciary duty because it has not analyzed how the merger would affect members' pensions and health plans. KPCC's "KPCC News."

Editorial Calls for Open Debate on Santa Clara Health Plan

Wed, 21 Mar 2012 08:00:00 GMT

A San Jose Mercury News editorial argues that Santa Clara County supervisors should hold a "full, transparent debate" on whether county officials should take over the community-run Santa Clara Family Health Plan. The editorial states that such a move would "threate[n] the collaborative relationships among [health care] providers that are essential for the county's transition to health care reform." It notes, "The county supervisors need to involve the public and the providers in the debate about the plan's future." San Jose Mercury News.

Kaiser Nabs Top Spot Again in Insurer Satisfaction Study

Wed, 14 Mar 2012 08:00:00 GMT

For the fifth year in a row, Kaiser Foundation Health Plan ranked highest in member satisfaction among California health plans, according to J.D. Power and Associates' U.S. Member Health Plan Study released this week. Kaiser received a score of 769 out of 1,000 possible points, compared with the state average of 705. San Francisco Business Times.

Workers' Comp Costs Up Slightly in 2011, Report Finds

Tue, 13 Mar 2012 08:00:00 GMT

The average cost of workers' compensation insurance for California employers increased slightly from $2.32 per $100 of payroll in 2010 to $2.37 in 2011, while payouts to injured workers and their health care providers increased from $7.8 billion in 2010 to $8.1 billion in 2011, according to the Workers' Compensation Insurance Rating Bureau's annual report. Sacramento Bee's "Capitol Alert."

Stakeholders React to Final Rule on Health Insurance Exchanges

Tue, 13 Mar 2012 08:00:00 GMT

Some groups have praised HHS' newly released final rule on health insurance exchanges, saying it emphasizes flexibility. However, some GOP governors have criticized the rule for failing to offer details on how the exchanges run by the federal government will operate. Reuters et al.

Payment Delays, Personnel Issues Plague Medi-Cal Plan

Mon, 12 Mar 2012 08:00:00 GMT

Ventura County health care providers say Gold Coast Health Plan, a managed care system that administers Medi-Cal in the county, is significantly behind in processing claims. Meanwhile, the group's CEO resigned on Thursday. Last month, the plan's human resources director and interim director of operations were dismissed, and its chief financial officer resigned in January after an allegation of driving under the influence. Ventura County Star.

HHS Issues Final Rule on State Health Insurance Exchanges

Mon, 12 Mar 2012 08:00:00 GMT

Today, HHS released the final rule for state-based health insurance exchanges under the health reform law. However, many states are delaying work on such exchanges until the Supreme Court rules on the law's constitutionality. Modern Healthcare et al.

Health Care Lobbying in California Tops List in Record Year

Mon, 12 Mar 2012 08:00:00 GMT

Health care issues generated $35.7 million in lobbying last year in California, leading the way to a record year. Lobbyists earned more money from more clients in California in 2011 than ever before, according to the secretary of state.

Hollywood Union Contract Talks To Focus on Health Costs

Thu, 08 Mar 2012 08:00:00 GMT

Because of rising medical costs, health and pension benefits are expected to dominate contract negotiations between the International Alliance of Theatrical Stage Employees and the Alliance of Motion Picture and Television Producers. The groups began contract negotiations on Wednesday and have set aside four weeks for the discussions. Los Angeles Times.

Ventura County Board Votes To Keep Results of Health Plan Audit Private

Wed, 07 Mar 2012 08:00:00 GMT

A Ventura County Medi-Cal panel has voted to keep findings from an audit of an area health plan private. The Department of Health Care Services ordered the audit of Gold Cost Health Plan following complaints regarding late payments and poor management. Los Angeles Times.

Most Medical Services Are More Costly in U.S. Than in Other Countries

Mon, 05 Mar 2012 08:00:00 GMT

A report by the International Federation of Health Plans finds that U.S. residents pay more than residents of other countries for most medical services. According to the report, a routine physician appointment costs about $89 in the U.S. and about $11 in Spain. Washington Post et al.

Lawmaker Questions $111B Boost in Subsidies for Insurance Exchanges

Mon, 05 Mar 2012 08:00:00 GMT

Last week, Rep. Dave Camp sent a letter asking the Obama administration to explain why its fiscal year 2013 budget plan includes $111 billion more than last year for subsidies to help people purchase coverage through state health insurance exchanges. The Hill's "Healthwatch," CQ HealthBeat.

Health Reform in California Inevitable, Health Leaders Say

Mon, 05 Mar 2012 08:00:00 GMT

Health industry officials say that health care reform will happen in California regardless of whether the federal overhaul is upheld. They note that higher costs and lower reimbursements necessitate a statewide overhaul. Sacramento Business Journal.

U.S. Senate Votes Down Blunt Amendment on Health Care Coverage

Fri, 02 Mar 2012 08:00:00 GMT

Yesterday, the U.S. Senate voted 51-48 to table an amendment by Sen. Roy Blunt that would have allowed employers and health plans to deny coverage of any health service for moral or religious reasons. California Insurance Commissioner Dave Jones praised the Senate's action. Politico et al.

Opinion: Single-Payer Bill Could Return Next Session

Thu, 01 Mar 2012 08:00:00 GMT

In January, a Democratic-led bill that would create a single-payer health care system in California stalled in the Senate, but the measure likely will return in the next session, retired pediatric dentist William Snaer writes in a Palm Springs Desert Sun opinion piece. He notes that bill author Sen. Mark Leno likely will offer the proposal again, and that it "might have a better chance" because the redrawing of legislative districts could "strengthen the Democratic majority in the California Legislature." In addition, Snaer notes that Gov. Brown "won't veto" a single-payer proposal. Palm Springs Desert Sun.

Small Businesses Turn to High Deductible Plans To Cut Costs

Tue, 28 Feb 2012 08:00:00 GMT

Some of California's small business owners are attempting to reduce their share of insurance premium costs by shifting employees into high deductible health plans. Advocates of using high deductible plans say that workers will be compelled to take greater responsibility for their health care when they have to pay more for treatment. However, critics say high deductible plans can cause cash-strapped residents to delay medical care and become sicker. Riverside Press-Enterprise.

Health Plans Looking for Strategies To Curb Costs After Reform Rollout

Tue, 28 Feb 2012 08:00:00 GMT

After the federal health reform law is fully implemented in 2014, health insurers are expected to look for new ways to control costs through greater monitoring of individuals with chronic conditions, better coordination with physicians and new payment models. New York Times.

Health Insurers Opening Retail Stores To Provide Resources to Consumers

Tue, 28 Feb 2012 08:00:00 GMT

Several health insurers have opened retail stores to help consumers purchase health plans or resolve coverage issues. Some experts say the stores could be part of the insurers' attempt to create a positive public perception. Kaiser Health News/Washington Post.

Major Calif. Health Plans Raise Premiums at Rates Outpacing Medical Costs

Thu, 23 Feb 2012 08:00:00 GMT

Major state health insurers are increasing premiums for individual plans at rates outpacing medical care costs. Insurers say they are raising rates based on claims experience with policyholders and because healthier individuals are leaving the market. Los Angeles Times.

Health Plans Boost Diabetes Care, Struggle With Other Treatments

Wed, 22 Feb 2012 08:00:00 GMT

California's Office of the Patient Advocate reports that major health plans improved care for patients with diabetes in 2010. However, the plans fell below national standards for treating other conditions. Contra Costa Times, Los Angeles Times.

Column Touts Effort To Boost Health Plan Rate Regulation

Tue, 21 Feb 2012 08:00:00 GMT

By continuing to increase premiums, health insurers "are demonstrating that they care more about their bottom lines than their policyholders," Wendell Potter -- iWatch News columnist and former Cigna executive -- writes in an iWatch News column. Therefore, Potter writes, it is "all the more imperative" for California voters to support a proposed ballot measure that would allow the state insurance commissioner to reject excessive health insurance rate hikes. iWatch News.

10 Counties Expand Access to Health Care for Low-Income Residents

Tue, 21 Feb 2012 08:00:00 GMT

A group of 10 counties has expanded access to health coverage for hundreds of thousands of low-income residents through California's Bridge to Reform program, which seeks to prepare the state for the implementation of federal health reform law provisions. Los Angeles Times.

Changes to Contraceptive Coverage Rules Draw Mixed Reaction

Mon, 13 Feb 2012 08:00:00 GMT

The U.S. Conference of Catholic Bishops argues that the White House's changes to contraceptive coverage rules do not go far enough, while women's groups said the plan accomodates religious groups but still ensures access to contraception. Washington Post et al.

HHS Unveils Final Rules on Easy-to-Read Health Insurance Summaries

Fri, 10 Feb 2012 08:00:00 GMT

Yesterday, HHS released final rules requiring health insurers to provide consumers with a standardized form that includes an easy-to-read summary of what their plans cover and cost. The regulation was required under the federal reform law. AP/San Francisco Chronicle et al.

Democrats Pledge To Contine Pursuing Pension Reform

Fri, 10 Feb 2012 08:00:00 GMT

California political observers say the suspension of a conservative group's campaign to place a public employee pension reform proposal on the November ballot should not absolve Democrats of the responsibility to lead on the issue. Meanwhile, Senate President Pro Tempore Darrell Steinberg on Thursday said that Democrats are "committed to getting pension reform done" and that they will address Gov. Brown's 12-point pension reform plan. Contra Costa Times.

S.F. Archbishop Blasts Federal Govt.'s Contraceptive Policy

Thu, 09 Feb 2012 08:00:00 GMT

San Francisco Archbishop George Niederauer has joined other Catholic bishops nationwide in opposing a new Obama administration policy that requires employers to cover birth control and other contraceptive services under their health plans. California since 2001 has had a law in place requiring employers that offer prescription insurance to cover contraception. San Francisco Chronicle.

Group Halts Pension Reform Ballot Measure Campaign

Thu, 09 Feb 2012 08:00:00 GMT

On Wednesday, the conservative group California Pension Reform suspended its campaign to place a public employee pension reform proposal on the November ballot because of fundraising problems and other issues. Group officials blamed the issues on a "false and misleading" summary of their proposal by the state Attorney General's office. AP/Contra Costa Times, Sacramento Bee.

State Choices on Essential Benefits May Become More Complicated

Wed, 08 Feb 2012 08:00:00 GMT

Stakeholders are responding to HHS' recent bulletin giving states a large hand in determining "essential health benefits" to be offered through insurance exchanges in 2014. In California, officials are trying to determine how to handle a growing list of state-mandated benefits within the exchanges.

Democrats Question State-Based 'Essential Benefits' Plan

Wed, 08 Feb 2012 08:00:00 GMT

In a letter sent on Monday to HHS Secretary Kathleen Sebelius, House Democrats expressed concern that the agency's decision to grant states authority to determine "essential health benefits" in state-based insurance exchanges would give insurers more power. They noted that allowing states to choose their essential benefits would "undermine" the objectives of the federal health reform law by enabling insurers "to continue avoiding sicker individuals rather than competing on quality and efficiency." The Hill's "Healthwatch.

Court: Social Security Beneficiaries Cannot Drop Medicare Eligibility

Wed, 08 Feb 2012 08:00:00 GMT

A court ruled that U.S. residents enrolled in Social Security cannot forgo Medicare eligibility. The plaintiffs sought to give up their eligibility because their health plans limit benefits for those who qualify for Medicare. The Hill's "Healthwatch," AP/San Francisco Chronicle.

Pleasant Hill Mulls New Plan To Cut City Officials' Benefits

Tue, 07 Feb 2012 08:00:00 GMT

The Pleasant Hill City Council is considering a proposal that would eliminate no-cost dental and vision benefits for Pleasant Hill council members, as well as for the city clerk and treasurer. The plan -- which also includes cuts to the council's technology fund -- would save the city $25,195 annually, advocates say. If approved, the new policy would take effect in November. Contra Costa Times.

Opinion: California Voters Should Act on Pension Reform

Tue, 07 Feb 2012 08:00:00 GMT

In a recent Orange County Register opinion piece, Rich Danker -- project director for economics at the American Principles Project in Washington, D.C. -- argues in favor of two proposed November ballot measures that seek a "shift toward the defined-contribution model of pension funding for future state employees." Danker concludes, "California has been a forerunner for trends -- good and bad -- in American public policy. There is still time for it to be on the vanguard of state pension reform, the leading public finance issue of our time." Orange County Register.

Task Force Considers Insurer Coverage of Autism Therapies

Fri, 03 Feb 2012 08:00:00 GMT

On Wednesday, California's new autism advisory task force launched a series of public meetings to develop recommendations on autism services that health insurers should cover. The panel -- chaired by Brent Barnhart of the Department of Managed Health Care -- will look at various treatments, including applied behavior analysis. The panel will deliver its recommendations to Gov. Brown by the end of the year. KQED's "The California Report."

State Medicaid Leaders Worried About New Tax on Premium Revenue

Thu, 02 Feb 2012 08:00:00 GMT

Many state Medicaid directors are concerned about a provision of the federal health reform law that requires insurers to pay a tax on premium revenue. Some directors hope the federal government will exempt Medicaid managed care plans from the tax. Kaiser Health News/McClatchy.

Sen. Feinstein Stumps for Health Plan Rate Regulation

Thu, 02 Feb 2012 08:00:00 GMT

In an email to more than two million registered California voters this week, Sen. Dianne Feinstein endorsed a proposed state ballot measure that would give California regulators the authority to approve health plan premium increases. Feinstein urged voters to sign petitions in support of the measure, which needs 505,000 signatures to qualify for the November ballot. Los Angeles Times' "Money & Co."

Blue Shield, CDI Reach Settlement on Coverage of Autism Therapy

Wed, 01 Feb 2012 08:00:00 GMT

Blue Shield of California has reached a settlement with the California Department of Insurance to cover behavioral therapy as a treatment for autism under the state's Mental Health Parity Law. Los Angeles Times, AP/San Jose Mercury News.

Kaiser Workers Set To Hold One-Day Strike on Tuesday

Mon, 30 Jan 2012 08:00:00 GMT

On Tuesday, the National Union of Healthcare Workers plans to hold a one-day strike at Kaiser Permanente hospitals over proposed cuts to health and retirement benefits and long wait times for psychiatric care. In addition to the 4,000 NUHW members, about 17,000 members of the California Nurses Association and 650 members of the Stationary Engineers Local 39 plan to strike in sympathy. Kaiser facilities plan to remain open during the walkout. San Francisco Chronicle.

Personal Stories Highlight Oral Chemotherapy Bill

Mon, 30 Jan 2012 08:00:00 GMT

New legislation proposed by Assembly member Henry Perea (D-Fresno) would require health plans to provide chemotherapy in pill form, in some cases.

"This bill will provide greater access for oral chemotherapy treatment," Perea said on the Assembly floor late last week. "This is the right thing to do, to allow people access to lifesaving drugs."

Perea introduced the measure with his personal account of caring for his mother, who he said was diagnosed with stage 2 lung cancer just over a year ago. During the long, eight-hour chemo infusion in the hospital, he learned quite a lot about cancer and chemo from patients and professionals.

Legislature Takes Action on Several Health-Related Bills

Fri, 27 Jan 2012 08:00:00 GMT

The Assembly has passed bills that would expand coverage of mental health care services and require insurers to cover oral chemotherapy treatments. Meanwhile, a bill to establish a universal health care system in California stalled in the Senate. Sacramento Bee et al.

WellPoint Reports Drop in Q4 Profit; Cites Calif. Plan Loss

Fri, 27 Jan 2012 08:00:00 GMT

On Wednesday, health insurer WellPoint -- the parent company of Anthem Blue Cross in California -- announced that it earned $335.3 million in the fourth quarter of 2011, a 39% decline from the $548.8 million in earned during the final quarter of 2010. The company attributed the drop to a $50 million loss in the quarter through a Northern California plan that drew more customers with higher risk profiles who generated more in claims than the premiums they paid. The plan was discontinued on Jan. 1. AP/Sacramento Bee.

Insurer Says State Has Launched Fraud Probe of Lap-Band Surgery Clinics

Fri, 27 Jan 2012 08:00:00 GMT

The California Department of Insurance is examining the business practices of Lap-Band surgery centers affiliated with a state-based marketing campaign, according to health insurance company Aetna. Marketing campaign officials say they are unaware of the investigation. Los Angeles Times.

Judge Likely To Strike Down Ban on Benefits for Same-Sex Partners

Fri, 27 Jan 2012 08:00:00 GMT

On Thursday, a federal judge indicated that she likely will strike down a federal law that prevents same-sex partners from receiving long-term health care benefits. The case stems from a lawsuit that UC-San Francisco employees filed against CalPERS. San Francisco Chronicle.

HHS Reaffirms Reform Law's Birth Control Coverage Rule

Tue, 24 Jan 2012 08:00:00 GMT

On Friday, HHS confirmed that most health insurers and employers by Aug. 1 must comply with a federal health reform law regulation to cover at no cost preventive services and contraceptives for women. The Obama administration rejected a request for a broad exemption by not-for-profit religious groups and employers that oppose birth control on religious grounds. However, such church-affiliated organizations will have additional time -- until Aug. 1, 2013 -- to comply with the requirement. New York Times et al.

Health Industry Groups Donate Funds for Brown's Tax Initiative

Tue, 24 Jan 2012 08:00:00 GMT

The California Association of Hospitals and Health Systems and Blue Shield of California have made contributions to Gov. Brown's November tax initiative. Brown said support from Kaiser Permanente will be announced soon. KQED's "Capital Notes" et al.

Panel Sends Single-Payer Health Care Bill to Full Senate

Fri, 20 Jan 2012 08:00:00 GMT

On Thursday, the California Senate Appropriations Committee voted 6-2 to approve a bill, by Sen. Mark Leno, that would create a single-payer health care system, clearing the way for a vote in the full Senate. An analysis of the bill found that creating a single-payer system to serve all 37 million state residents could cost up to $250 billion annually. The measure does not include any taxes or fees to offset the cost of the system, which would be run by a new state agency. Sacramento Bee's "Capitol Alert."

Kaiser Permanente To Switch to Eco-Friendly Equipment

Fri, 20 Jan 2012 08:00:00 GMT

On Thursday, Kaiser Permanente announced it will convert its intravenous equipment to safer alternatives that are devoid of two chemicals that have negative effects on health and the environment. Kaiser will begin purchasing medical products that are free of the chemicals PVC and DEHP, which can cause reproductive problems and other negative health effects, and pollute the environment. The announcement reflects a broader push by the U.S. health care system to encourage medical equipment suppliers to use safer chemicals when manufacturing products. Washington Post.

HP, Blue Shield Sign 5-Year Agreement To Improve Care

Thu, 19 Jan 2012 08:00:00 GMT

Hewlett-Packard's Enterprise Services division and Blue Shield of California have signed a five-year contract agreement that will give Blue Shield access to new services from HP to improve health care affordability and efficiency. In addition, HP will continue to provide Blue Shield with technology infrastructure and other support. Financial details of the contract were not disclosed. Silicon Valley/San Jose Business Journal, Healthcare IT News.

HHS Says 28 States Have Taken Steps on Health Benefit Exchanges

Thu, 19 Jan 2012 08:00:00 GMT

HHS has announced that 28 states have made progress in establishing health insurance exchanges under the health reform law. Some states have established their authority to set up the exchanges, while others have used executive orders to prepare for the exchanges. Reuters et al.

Calif. Pre-Existing Condition Plan Enrollment Ranks Highest in U.S.

Thu, 19 Jan 2012 08:00:00 GMT

Federal data show that enrollment in California's Pre-Existing Condition Insurance Plan is the highest in the nation. As of Nov. 30, 2011, more than 4,900 Californians had enrolled in PCIP, according to the federal statistics. Sacramento Business Journal.

Senate Panel Delays Vote on Single-Payer Health Care Bill

Wed, 18 Jan 2012 08:00:00 GMT

On Tuesday, the California Senate Appropriations Committee suspended until Thursday action on a bill that would create a single-payer health care system. The panel said it put the bill, by Sen. Mark Leno, on hold to give it further consideration after a legislative analysis found that it would cost $200 billion to $250 billion annually. The measure does not include any taxes or fees to offset the cost of the single-payer system, which would be run by a new state agency. However, Leno said the bill would reduce costs by eliminating private insurers as the middlemen. Los Angeles Times' "PolitiCal" et al.

Public Health Plans To Compete With Private Plans in California

Tue, 17 Jan 2012 08:00:00 GMT

Under the state's insurance exchange mandated by the federal health reform law, public health plans will compete with private health plans. Currently, county-administered public health plans provide coverage to 2.5 million California residents. KQED/Kaiser Health News.

Consumer Advocates Push for Greater Health Plan Rate Regulations

Tue, 17 Jan 2012 08:00:00 GMT

Last year, a state law took effect that gave regulators greater power to review health insurers' plans for premium hikes. However, consumer advocates are seeking expanded regulations that would let the state reject rate increases deemed excessive. Contra Costa Times.

Calif. Senate Panel To Review Single-Payer Health Care Bill

Tue, 17 Jan 2012 08:00:00 GMT

On Tuesday, the California Senate Appropriations Committee is scheduled to consider a bill by Sen. Mark Leno that would create a single-payer health care system. The California Universal Health Care Act would establish a California Healthcare Agency to run the single-payer system, which would pool employer and employee payments, administer finances and negotiate rates with health care providers. The cost of the measure has not yet been determined, but a similar bill that was introduced during the 2009-2010 session was estimated at $200 billion annually. Sacramento Bee.

State Orders Anthem To Pay Back Providers for Outstanding Claims

Fri, 13 Jan 2012 08:00:00 GMT

The Department of Managed Health Care is directing Anthem Blue Cross to pay health care providers for outstanding claims dating back to 2007 because the insurer failed to comply with an audit. AP/San Francisco Chronicle, Sacramento Business Journal.

Sutter Health, Aetna Agree to Two-Year Contract Renewal

Fri, 13 Jan 2012 08:00:00 GMT

On Thursday, Sutter Health and Aetna announced that they have reached a two-year contract renewal agreement. Under the agreement, northern California members of Aetna's commercial plans will continue to receive in-network rates at Sutter Health hospitals and ancillary facilities. In addition, physicians and health care providers at Sutter facilities will keep their designation as participating network providers. Sacramento Bee.

Groups Seek Extra Time for 'Essential Benefits' Comments

Fri, 13 Jan 2012 08:00:00 GMT

In a letter to HHS, a coalition of patient advocacy groups asked the department to extend the public comment period beyond Jan. 31 on a proposal defining "essential benefits" in state-based health insurance exchanges under the federal health reform law. The letter states that more time is needed because of the complexity of the issue and because the bulletin was released right before the holidays. The groups asked for an extension of 45 days to respond. The Hill's "Healthwatch."

HHS Says Trustmark's Proposed Premium Hike Is 'Unreasonable'

Fri, 13 Jan 2012 08:00:00 GMT

Yesterday, HHS declared that a proposed 13% premium increase from Trustmark Life Insurance in Alabama, Arizona, Pennsylvania, Virginia and Wyoming is "unreasonable." HHS cannot reject rate increases, but it can publicize those it deems too high. Modern Healthcare et al.

CMS Names Final Recipients of Health Overhaul Waivers

Tue, 10 Jan 2012 08:00:00 GMT

Last week, CMS released a list of the final recipients of one- to three-year waivers that exempt certain health plans from coverage-level mandates in the federal health reform law. The waivers went to 1,231 health plans and employers that cover 3.9 million individuals. Under the waivers, the minimum annual dollar limit on essential benefits that the recipient must provide is $750,000 in 2011, $1.25 million in 2012 and $2 million in 2013. Beginning in 2014, the health reform law prohibits dollar limits on essential benefits. The Hill's "Healthwatch," Modern Healthcare.

HHS Rule Aims To Streamline Electronic Transfer of Funds

Fri, 06 Jan 2012 08:00:00 GMT

On Thursday, HHS released an interim final rule detailing standards for the electronic transfer of funds in the health care industry. The rule was mandated by the federal health reform law. The new rule outlines the standards for the format and content of the data that a health insurer sends to its bank when it seeks to pay a claim to a health care provider electronically. The rule also requires the use of a trace number to automatically link medical bills from health care providers with payments from health plans. HHS noted that the interim final rule became effective Jan. 1, and all HIPAA-covered health insurers must comply with the regulations by Jan. 1, 2014. HHS estimated that the new standards would reduce administrative costs in the health care industry by $4.5 billion over the next 10 years. Modern Healthcare, Healthcare IT News.