SENATE BUDGET FISCAL REVIEW
SUBCOMMITTEE NUMBER THREE ON
HEALTH AND HUMAN SERVICES.
WE ARE GOING TO BE HEARING --
ESSENTIALLY ON TWO MAIN AREAS
DEPARTMENT OF HEALTH CARE
SERVICES.
AND THEN -- THE DEPARTMENT OF
PUBLIC HEALTH -- AND WE HAVE
MANY ISSUES AND IN EACH CATEGORY --
PARTICULARLY -- MEDI CAL AND
PROP FIFTY SIX ON THE HEALTH
CARE SERVICES OTHER WE HAVE
SEVERAL OTHER ITEMS AS WELL AND
THEN OF RITE AID FROM ITEMS --
RELATED AND APART PUBLIC HEALTH
PARTICULAR AROUND LICENSING
CERTIFICATION BUT ALSO MANY
OTHER THINGS AS WELL -- SO I
WANT TO WELCOME ROOM HERE FOR
ALL THE HEALTH GROUPIES I KNOW
YOU WERE HERE VERY LATE LAST
NIGHT WITH ME.
AFTER THAT I THINK I SPENT.
AT SEA I START WITH EDUCATION
COMMITTEE NINE IN THE MORNING IN
THIS ROOM SO WE SPENT A LOT OF
TIME IN THIS ROOM TOGETHER -- SO --
I'M HOPING THAT -- I WANNA BE
SURE WE DO A THOROUGH JOB TODAY
BUT ALSO APPRECIATED PEOPLE
COULD STAY TO THE POINTAND
BREVITY WOULD BE APPRECIATED.
WE HAVE SOME BOTH OF US WERE
HERE AND I WANT TO AGAIN A
MY GOOD MY GOOD FRIEND IN THE
VICE CHAIR OF THE HEALTH
COMMITTEE AS WELL AS MY PARTNER
HERE ON SUB -- THREE FOR HIS
OUTSTANDING JOB YESTERDAY
CHAIRING A FAIRLY CONTENTIOUS --
BILL -- NO PROBLEM AT THE BILL'S
SCIENTIFICALLY BUT PEOPLE AT
DIFFERENT OPINIONS.
SO ANYWAY -- I WILL TALK ABOUT
WHETHER THE SERGEANTS HAD TO DO
ANYTHING WITH THIS ROOM BETWEEN
THE LAST HEARING IN THIS HEARING.
SO ANYWAY AND I ALSO THINK THE
SERGEANTS AS WELL -- SO WITH
THAT ACTUALLY LET'S.
LET'S GO AHEAD AND MOVE ON SO
LET'S BEGIN WITH THE PART HEALTH
CARE SERVICES I WANT TO START
OFF WITH ISSUE NUMBER ONE MEDI
CAL DENTAL SERVICES AND WE HAVE
AN OVERVIEW SO WILL WELCOME UP.
HEALTH CARE SERVICES IN OUR LA --
AND OUR FINANCE PARTNERS.
SO.
WE CAN HAVE A FIRST EVERYONE
INTEREST DEUCE THEMSELVES FOR
THE RECORD.
STARTING WITH THE THE PART
HEALTHCARE SERVICES WELCOME.
A GOOD MORNING JENNIFER CAN'T
DIRECTOR FOR DEPARTMENT OF
HEALTH CARE SERVICES I'M I'M TO
TAKE JUST A QUICK MOMENT OF
PERSONAL PRIVILEGE.
SO I HAVE BIANCA GRAY LIST WITH
ME -- IT'S BRING YOUR CHILD TO
WORK DAY AND SO -- WE'RE TRYING
TO GROOM NEW LEADERSHIP AT THE
DEPARTMENT STARTING IN A YOUNG.
ENVIRONMENT SO I HAVE BIANCA I
HAVE IS A BILL THAT I HAVE MY
AND I HAVE KENNEDY HERE SO.
SAY HI LOW HI AND THEN YOU KNOW
THIS IS HOW WE TRY.
TO START.
THE YOUNGEST DIRECTOR AND CHIEF
DEPUTIES BY BRINGING THEM TO THE
COMMITTEE SO THANK YOU VERY MUCH
FOR INDULGING US.
I WILL REMIND YOU THAT THE
LEGISLATURE IS ALWAYS RIGHT.
IT AND WE AGREE BIANCA.
DID YOU AS IF YOU DO AS
INTRODUCE YOURSELF AND TELL US A
LITTLE BIT ABOUT YOURSELF VERY
BRIEFLY.
WE'RE NOT LIKE WE'RE FROM THE
GROUP.
YEAH.
I AM ELEVEN YEARS OLD.
WHAT SCHOOL DO YOU GO?
TO ALSO METAL AND WE'RE GOING TO
BE WHEN YOU GROW A REALTOR.
ALL RIGHT OKAY WE'RE GOING TO
WE'RE GOING TO TAKE HER OVER TO
SAT YEAH WE'RE GOING TO WE'RE
GONNA WORK ON OR A LITTLE BIT
MORE.
OKAY ALL RIGHT OKAY THANK YOU SO
MUCH SELL OF COURSE SO IT ALWAYS
VERY MUCH WELCOME ALL RIGHT.
AND THE MARY CAN'T WELL PART OF
CARE SERVICES OKAY ALEJO -- BEN
JOHNSON LEGISLATIVE ANALYST'S
OFFICE RIGHT WILL THE
LEGISLATIVE ANALYST'S OFFICE
THANK YOU.
RYAN MILLER AND IF I'M IN A
FINANCE OKAY ACTION SO -- BIANCA
YOU ONE ACTUALLY BE THEM KELLY
I'LL.
OKAY.
NO YOU DON'T.
OKAY AND THE YEAR OF THE ALL
RIGHT WE WON'T WE WON'T THERE'S
JUST.
OKAY ALRIGHT WELL LET'S GO AHEAD
AND BEGIN.
AND ISSUE NUMBER ONE MEDICAL OR
DENTAL SERVICES.
SO -- IT IN TERMS OF AN UPDATE
ON WHAT WE'RE SEEING WITH
UTILIZATION WE ARE SEEING
POSITIVE MOVEMENT IT'S IT'S SLOW
AND IT'S NOT AS FAT YOU KNOW
HIGH AND FAST AS WE WANT -- WITH
RESPECT TO KIDS WE SEE ABOUT
FORTY SEVEN AND A HALF PERCENT
WHO ARE GETTING ANNUAL DENTAL
VISIT ABOUT 44%.
PREVENTIVE SERVICES AND THEN WE
WE DON'T A COUPLE OF THINGS TO
TO REALLY UNDERSTAND IS IT THAT
THE SAME KIDS ARE COMING IN
EVERY YEAR OR IS THAT YOUR THEIR
KIDS ARE NOT COMING.
EVERY YEAR BUT THEY'RE COMING
SOMETIMES AND SO OVER THE COURSE
OF THE YEAR WE SEE ABOUT 54% OF
TWO YEARS WE SEE ABOUT 70% OF
THE KIDS.
SO THAT WITH THAT WHICH IS
HELPFUL FOR US TO SORT OF
UNDERSTAND THAT IT'S NOT
NECESSARILY THAT HALF THE KIDS
AREN'T GETTING SERVICES IS THAT
THEY'RE NOT COMING IN ANNUALLY.
SO THAT'S HELPING US AS WE THINK
ABOUT SORT OF WHAT WE WANT TO DO
FOR THE FUTURE ON THE ADULT SIDE
YOU KNOW WE'RE STILL PRETTY LOW
POST EXPANSION WE HAVE 23% WHO
ARE GETTING AN ANNUAL DENTAL
VISIT.
US ABOUT 14% PREVENTIVE SERVICES
AND THEN AGAIN FOR USING THOSE
OTHER.
THE NATION'S -- ABOUT 27% IN A
SINGLE YEAR AND WE SEE ABOUT 39%
OVER TWO YEARS.
SO STILL NOT GREAT NUMBERS BUT
WE ARE CONTINUING TO YOU -- WORK
ON GETTING THOSE UP AND AGAIN WE
ARE SEEING SORT OF IT TRENDING
IN THE RIGHT DIRECTION AND A LOT
OF THAT I THINK DOES HAVE TO DO
WITH AND THE QUESTIONS THAT YOU
HAD FOLLOWING WHICH WAS REALLY
ABOUT THE OUTREACH EFFORTS. TO
WE HAVE AN IT'S PRETTY MUCH THE
SAME FOR BOTH SO I I DON'T THINK
ANY TO SPLIT BETWEEN KIDS AND
ADULTS BUT WE HAVE A A NEW
OUTREACH CAMPAIGN CALLED SMILE
CALIFORNIA HAS ITS OWN WEBSITE
SMILE CALIFORNIA DOT ORG FOR
ANYONE WHO WANTS TO GO.
CHECK IT OUT -- AND SO WE HAVE A
LOT OF MEMBER RESOURCES ON THAT
WE HAVE FAQS BULLETINS WE HAVE
VIDEOS THAT WILL HELP PEOPLE
UNDERSTAND HOW TO ACCESS THE
SERVICES -- SO THAT'S REALLY A
BIG PLACE FOR FOR BOTH ADULTS
AND KIDS IN ADDITION WE DO HAVE --
DELTA DENTAL IS GOING TO LOCAL
COMMUNITY -- PLACES LIKE THE
WICK OFFICE IS IN A MEETING
DIRECTLY WITH MEMBERS OF THEIR
TO MAKE SURE THEY UNDERSTAND HOW
THEY CAN ACCESS THEIR SERVICES --
AND THEN FROM THE ADULT SIDEOR
I GUESS THIS IS TRUE FOR KIDS DO
WE DO WHAT WE DO ALSO HAVE ADULT
IS DOING LOTS OF SOCIAL MEDIA
CAMPAIGNS.
AND ALSO DOING -- IF PEOPLE
AGREE DOING TEXT MESSAGE
REMINDERS OF LIKE WHEN YOU'RE
DUE FOR A VISIT OR IF YOU HAVE
AN APPOINTMENT OR THINGS LIKE
THAT SO.
THOSE ARE REALLY THE THINGS WERE
FOCUSED ON AS WE CONTINUE TO
MOVE FORWARD AND THEN OBVIOUSLY
WE STILL HAVE THE PROP FIFTY SIX
MONEY IN THE DTI.
AND IT WILL BE TALKING ABOUT
THOSE LATER TODAY.
ANY COMMENTS FROM OHIO.
FINANCE.
QUESTIONS FROM COMMITTEE MEMBERS --
SO X. SO IN TERMS OF OUT REACH A
AND APPRECIATE -- MAY THE THINGS
THAT YOU'RE DOING -- SINCE
YOU'RE ALSO THE PART HEALTHCARE
SERVICES WRIT LARGE -- IF -- I
DON'T KNOW FOR EXAMPLE -- IS
THERE ANY EFFORT TO THINK ABOUT
HOW.
SAMPLED THE PEDIATRICIANS AND
FAMILY PHYSICIANS OR SEEING THE%
KIDS MIGHT BE ABLE TO HELP OUT
AND GETTING KIDS AND I WILL TELL
YOU IS A PEDIATRICIAN WHO TOOK
CARE MEDI CAL PATIENTS.
BY BIGGER CHALLENGE WAS ACTUALLY
AT THAT TIME WAS ACTUALLY
FINDING SOMEONE WHO WOULD
ACTUALLY SEE THEM.
I WOULD TELL THEM THEY NEED TO
BE SEEN I'D EVEN CALL AND TRY TO
MAKE THE APPOINTMENT AND
SOMETIMES HAD TROUBLE GETTING
THROUGH.
SO I ASSUME WE'RE TRYING TO FIX
THAT PROBLEM BUT AND BUT I THINK
YOU KNOW.
WE DO REMIND THEM THAT ARE WELL
CHILD VISITS THAT THEY NEED TO
GET THEIR TEETH EXAMINED -- THE
FIRST TO THIRD BIRTHDAY SO FORTH --
BUT THINKING ABOUT THAT AND THEN
ALSO I WOULD SAY WHAT ABOUT A
WEEK OFFICES AS WELLS ARE
TALKING MONEY TRADITION A HAVE
YOU GOTTEN YOUR DENTAL CHECKUP
YET.
AND SO FORTH SO -- ESPECIALLY ON
THE KIDS PART WHETHER WE CAN DO
SOME OUT REACH WITH OTHER
PROVIDERS -- TO ALSO BY THE WAY
ARE YOU GUYS AND AND STATE
PROGRAMS.
SO DEFINITELY ON THE AS I
MENTIONED WE ARE DOING DELTA
DOES GO TO LITTLE LOCAL
COMMUNITY RESOURCE CENTERS LIKE
WEEK OFFICES TO WORK DIRECTLY
WITH -- MEMBERS AND THEN I WOULD
SAY ON THE OTHER PIECE -- FROM A
PIECE OF LEGISLATION FROM A
COUPLE OF YEARS AGO WE INCREASE
THE REQUIREMENTS ON OUR HEALTH
PLANS TO HAVE -- ESSENTIALLY
DIRECT CONNECTIONS BETWEEN
HEALTH PLANS AND YOU KNOW THE
DOCTORS AND THEN HOW TO GET TO
THE DENTAL SERVICES SINCE IT'S
NOT IN THAT MODE OF MEDI CAL
MASTER PLAN BUT WANTED TO MAKE
SURE THAT.
BOTH SIDES BOTH THE DENTAL AND
THE PHYSICAL HEALTH SIDE KNEW
WHO THEY SHOULD CONTACT SO THAT
PEOPLE CAN GET THE SERVICES IN
THE MULTI DIRECTIONAL.
SERVICES AND IF YOU WANT THAT WE
CAN I JUST SAY THE OBVIOUSLY THE
PROPOSITION -- FIFTY SIX FUNDING
HAS BEEN HELPFUL IN A VARIETY OF
WAYS ALSO WHEN YOU COUPLE THAT
WITH THE DENTAL TRANSFORMATION
INITIATIVE AND THEN AS PART OF
THE GOVERNOR'S -- JANUARY
PROPOSAL AROUND VALUE BASED
PURCHASING THERE HAVE BEEN SOME
INCENTIVES ON THE WELL CHILD
AREA THAT WE'VE PROPOSED THAT
WOULD -- ALLOW FOR PEDIATRICIANS
AND OTHER PROVIDERS TO BE DOING
DENTAL SEALANTS AND HAVING THAT
BE A COMPONENT SO YOU KNOW A LOT
OF DIFFERENT -- BOTH
INTERVENTIONS AND INTERACTIONS
THAT WE'VE TRIED FROM A MULTI
YOU KNOW MULTITUDE OF AREAS TO
TRY TO KIND OF CAPTURE THIS
POPULATION BOTH IN THE PROVIDER
OFFICES.
FROM A PEDIATRICIAN AREA CLINIC
AREA AS WELL AS IN THE DENTAL
PROVIDERS THEMSELVES OKAY YEAH
THE CERTAINLY THIS NOTE SEALANTS
IS SOMETHING WE CAN DO IN THE
OFFICE AND I APPRECIATE THE MEDI
CAL DOES NOW DOES REIMBURSED FOR
THAT -- SAYS THAT THE YOU OUT
TERMS OF GETTING ACTUALLY INTO
DENTAL CARE AND WHETHER SOME
MECHANISMS THAT COULD BE PUT IN
PLACE THAT'S ALL TELL YOU KNOW I
MEAN THEY GET IT'S A WHILE AGO
BUT YOU KNOW SOMETIMES I COULD
GET THROUGH TO ANYONE EXCEPT
FIRST ASK THE PATIENT.
AND THEN THEY COME BACK SAID
HAVE YOU SEEN A DENTIST YET WELL
WE'VE TRIED AND I'M LIKE OKAY.
AND IT ACTUALLY SAID WILL DEAL
TO BE ON BOARD IT IS I'M A CALM
RIGHT NOW AND MAKE THE
APPOINTMENT FOR YOU AND THEN I
FIND OUT I CAN'T GET THROUGH.
RIGHT SO -- WHETHER THERE'S SOME
WAY -- TO TO SO IT'S REALLY
WORKS THAT SOME OF THE DENTAL
PLANS FOR ON THE MEDICARE SIDE
BUT THE FEE FOR SERVICE I WERE
SOME MECHANISM BY WHICH A AND
MORE TO THE S..
A PHYSICIAN WHO WHO'S NOTICES
THAT THE TEETH LOOK BAD BECAUSE
WE DO LOOK IN THE MOUTH -- AND
SAY WILL YOU NEED SEE DENTAL
CARE CAN CAN SOMEHOW YOU KNOW.
CALL SOMEONE TO HAVE SOMEONE
THEN TAKE IT FROM THERE.
AND SIX A DUMP THAT BE GREAT YES
ANDERSON -- DEVICE WHEN A
COMPLIMENT YOU ON REACHING OUT
AT THE WAKE CENTERS FOR FOR THE
DENTAL SERVICES ARE WE ALSO
GOING TO REGIONAL CENTERS AND
NOT BECAUSE THAT'S A WHOLE.
DIFFERENT CHALLENGE THAT -- I
HEARD.
FIVE AFTER.
THAT MIGHT BE A GREAT PLACE TO
THAT -- KNOW THAT DAY THEY COULD
BE THERE YEAH YEAH THANK YOU.
THERE'S THERE'S A LOT OF
DIFFERENT WE ALWAYS TALK ABOUT
HOW PEOPLE TOUCH LOTS OF
DIFFERENT PLACES AND THINKING
ABOUT HOW WE BRING THAT ALL
TOGETHER.
SO.
SO I APPRECIATE THAT IT'S GOING
UP HEY IT'S STILL AS YOU POINTED
OUT NOT VERY GOOD -- AND THE
TRUE CONSEQUENCE OF THAT IS IS
THAT -- PEOPLE GET MORE OR
HEALTH PROBLEMS SO I MEAN THAT'S
WHY WE WANNA BUMP IT UP THAT ARE
AS YOU SAY.
IT'S NOT JUST ABOUT HOW HIGH IT
IS IS THIS IS THE RIGHT NUMBER
AT THE RIGHT TIME RIGHT AND I
WOULD STILL SAY THAT PROBABLY
THAT'S WE'RE NOT QUITE THERE
WERE STILL AT THE LOW END AND
THINKING ABOUT OTHER THINGS WE
CAN DO -- SO WHAT'S THE GOAL
THEN WERE AT FORTY THREE POINT.
NINE THE HOPE IS THAT I MEAN I
KNOW IF SO BUT SO UNDER THE
DENTAL TRANSFORMATION INITIATIVE
THE MOLE -- WAS TO GO UP TEN
PERCENTAGE POINTS -- FROM THE
BASE OVER THE FIVE YEARS RENTS
WHAT BUT THAT WAS ONLY HOW HIGH
THAT WAS IT.
IT WOULD PROBABLY BE FIFTY FIFTY
FOUR YEAH.
I DON'T KNOW I'M SORRY I DON'T
KNOW THAT I MIGHT HAVE IT IN
HERE IF I ACTUALLY THERE IS A
LOW NUMBER TO A NOT SO LOW
NUMBER IT'S 10% AND I'M NOT
SAYING IT'S EASY TO DO THE 10%.
EVEN EVEN AT 10% IT'S THE WHOLE
YEAH AND I THINK WE'VE TALKED
ABOUT AND HIS MERRY SAID THE
NUMBERS DEPENDING ON HOW YOU CUT
THEM WHETHER THEY COME IN
ANNUALLY OR THEY COME IN EVERY
SIX MONTHS AS AS RECOMMENDED.
I THINK WE'VE ALWAYS SAID THAT
WE'RE LOOKING FOR AT LEAST A 60%
GLOBALIZATION RATE FOR CHILDREN
AND SO THAT IS KIND OF CERTAINLY
THE OVERALL GOAL AND I KNOW THAT --
UNDER THE DTI WE HAVE BEEN --
IMPROVING OUR UTILIZATION MORE
THAN WE HAD ORIGINALLY AGREED TO
RISE TO TERMS OF THE WAIVER SO I
THINK.
YOU KNOW LIKE I SAID A LOT OF
PROGRESS HAS BEEN MADE BUT AGAIN
WE'RE STILL ALWAYS LOOKING FOR
THAT AT LEAST 60% WOULD BE KIND
OF THE THE PLACE IN WHICH WE
WOULD CONSIDER THAT TO BE
ACCEPTABLE OKAY.
ALL RIGHT SO.
I THINK A LITTLE BIT ABOUT
STRETCH GOALS IS BECAUSE BECAUSE
EVEN AT THE GOAL WE SAT.
AND I UNDERSTAND WHAT HE SAID IT
THERE AND THERE'S SOME
CONSEQUENCES NOT MEETING THAT
PARTICULAR GOAL.
EVEN WE HAD IT I'M LIKE OKAY
THAT'S BETTER.
BUT IT'S NOT NECESSARILY GOOD
YET AND SO AND SO THE HOPE I
HOPE WE CAN THINK BEYOND AND AND
AND THEN AND THEN HAVE PEOPLE
THINK OKAY -- IT'S NOT JUST
ENOUGH TO HIT THAT GOAL IT'S
ABOUT TRYING TO LEAP BEYOND IT.
AND SEE WHAT WE CAN TRY TO DO
[inaudible]
ALL RIGHT.
AS IT IS I KNOW IT'S NOT EASY
BUT IF YOU THINK ABOUT THAT OKAY
[inaudible]
RIGHT [inaudible]
OKAY.
ALL RIGHT SO I THINK WE HAVE ON
THE OF THE FUSION CYCLICALS YEAH.
OKAY.
ALL RIGHT SO WELL WE DO HAVE
OKAY AS ANYTHING ELSE ON ON THE
OVERVIEW ALRIGHT SO WE DO HAVE
TO STAKEHOLDER PROPOSALS.
READY TO THAT THAN TO CAL
OVERVIEW CELL ACTUALLY GOING TO
ASK YOU TO SHIFT AROUND AND MAKE
SOME ROOM.
FOR HIS PROPOSALS.
SHE CAN SHIFT AROUND TO SHE
WANTED TO BUT THAT'S OKAY SHE
WASN'T.
BEEN EDGING TO GET OUT OF OKAY
NO NO THAT'S GOOD I CAN
UNDERSTAND THANKS THAT'S ALMOST
THAT'S HOW MY SON FEELS ABOUT
THESE THINGS TO USE LIKE OKAY
GIVE ME ON THE SPOT RIGHT NOW.
I'M TOO CLOSE TO YOU.
ALL RIGHT SO WE'RE GONNA FIRST
START OFF WE HAVE A THE PROPOSAL
FOR TRAILER BILL LANGUAGE FOR
CLARIFYING THE SALVATION OF
PATIENTS FOR CLINICS AND WE HAVE.
WHO'S PRESENTING HERE.
OKAY ALL RIGHT SO -- YEAH WE ASK
THREE MINUTES FOR THE
PRESENTATION MAX FOR ALL THE
SPEAKERS.
A GOOD MORNING AT CHERRY MEMBERS
I AM ERRORS ALL THE NAVARRO WITH
THE CHILDREN'S PARTNERSHIP --
TCP IS REQUESTING TRAILER BILL
LANGUAGE TO MAKE SPECIFIC THE
INTENT OF LEGISLATION WAS PASSED
SPONSORED IN.
TWENTY FOURTEEN AB.
ELEVEN SEVENTY FOUR WE WOULD
LIKE TO MAKE CLEAR THAT
FEDERALLY QUALIFIED HEALTH
CENTERS AND RURAL HEALTH CENTERS
MAY ESTABLISH A PATIENT FOR THE
PURPOSES OF BILLING THROUGH
STORE AND FORWARD TYLER
DENTISTRY.
WE SPONSORED AB ELEVEN SEVENTY
FOUR SO THAT SUCCESSFUL VIRTUAL
DENTAL HOME -- COULD SPREAD --
TO REACH MORE UNDERSERVED
CHILDREN AND ADULTS ESPECIALLY
THOSE ENROLLED IN MY ACCOUNT TO
REDUCED HEALTH ORAL HEALTH
DISPARITIES.
IN FACT AROUND AS WE HEARD
AROUND 50% OF CHILDREN RULED IN
MEDIC HOW -- DON'T GET OR
RECEIVE LIMITED -- DENTAL
SERVICES AT ALL.
THE VIRTUAL DENTAL HOME OUR
SYSTEM ADDRESSES BARRIERS SUCH
AS THE LACK OF TRANSPORTATION IN
ABILITY TO TAKE TIME OFF WORK
AND THE AND THE LIKE BY
PROVIDING DENTAL CARE.
COMMUNITY SETTING SUCH AS
SCHOOLS HEAD START SITES AND I'M
NURSING HOMES THIS TECHNICAL FIX --
THAT WE ARE REQUESTING WILL
ENSURE THAT THE VIRTUAL DONE A
HOME CAN CONTINUE TO MAKE AN
IMPACT ON REDUCING ORAL HEALTH
DISPARITIES -- AND TO OUR MOST
VULNERABLE POPULATIONS THANK YOU
FOR YOUR TIME AND CONSIDERATION
IN MY HAND IT OVER.
TO THE CLASS.
DR PROGRESS FOR YOU TO RECEIVE
PACIFIC SCHOOL OF DENTISTRY A
LITTLE BIT OF BACKGROUND I KNOW
DOCTOR PAN YOU'RE VERY FAMILIAR
WITH THE VIRTUAL DEL HOME SYSTEM
BUT FOR THE RECORD IT'S A SYSTEM
THAT WAS.
ESTABLISHED DESIGN AND
ESTABLISHED BECAUSE OF THE FACT
THAT WE KNOW THAT MOST PEOPLE
WHO ARE DENTED CAL BENEFICIARIES
IN CALIFORNIA ARE NOT GETTING
DENTAL CARE AND THIS IS A SYSTEM
DESIGNED TO BE ABLE TO USE SOME
OF THE FABULOUS NEW PREVENTIVE
TECHNOLOGIES THAT WE HAVE.
THAT WE KNOW CAN ACTUALLY KEEP
MOST PEOPLE HEALTHY AND
COMMUNITY SITES LIKE SCHOOLS AND
HEAD START CENTERS AND REGIONAL
CENTER -- HOMES AND THIS IS A
SYSTEM WHERE WE HAVE SPECIALLY
TRAINED DENTAL HYGIENISTS AND
ASSISTANTS ACTUALLY GO INTO
THOSE COMMITTEE LOCATIONS.
THE EVIL TO USES PREVENTIVE
TECHNOLOGIES ARE ABLE.
TO WEBER WITH DENNIS FOR
DIAGNOSTIC AND MORE COMPLICATED
SERVICES AND REACH A LOT OF
PEOPLE WHO ARE NOT GETTING CARE
OTHERWISE.
NOW WE ALSO KNOW THAT FOR A
HEALTH CENTER TO BE ABLE TO
PARTICIPATE IN THIS.
SYSTEM THEY HAVE TO ESTABLISH A
PATIENT AS THEIR PATIENT AND SO
IN A IN TWENTY FOURTEEN BILL
ELEVEN SEVENTY FOUR WAS INTENDED
TO BE ABLE TO MAKE SURE THAT
THAT HEALTH CENTERS COULD
PARTICIPATE IN THE LANGUAGE AND
THAT BILL WAS ACTUALLY THE FACE
TO FACE CONTACT.
BETWEEN HEALTH CARE PROVIDER
PATIENTS NOT REQUIRED ON THE
MEDICAL PROGRAM.
PURTELL OPTIMAL G. TOLD ARE
INTELLIGENT TELL DENTISTRY BY
STORE AND FORWARD.
UNFORTUNATELY WE BECOME TO
REALIZE MORE RECENTLY.
THAT IT WASN'T COMPLETELY CLEAR
IN TWENTY FOURTEEN IN THAT BILL
THAT THAT ALSO ALLOWED THE
HEALTH CENTER TO ESTABLISH THE
PATIENT BY CONTACTING THE
PATIENT OUT IN THE SCHOOL USING
STORE AND FORWARD TOLD DENTISTRY
SO.
THE TECHNICAL FIXES BEING
PROPOSED NOW WOULD ACTUALLY MAKE
SPECIFIC THE INTENT OF THAT BILL
FROM TWENTY FOURTEEN BY
SPECIFYING THAN RAC OR OR FQHC.
CAN ESTABLISH A PATIENT USING
STORE AND FORWARD TELE DENTISTRY.
ON THE PROPOSAL NOT TRYING TO
ESTABLISH ANYTHING NEW IT'S ONLY
TRYING TO CLARIFY THE LANGUAGE
OF THE CONTINUE TO DO WHAT'S
ALREADY BEEN DONE.
AND REALLY APPRECIATE YOUR
CONSIDERING THIS AND SEE IF WE
CAN DO SOMETHING TO KEEP THIS
PROJECT WHICH IS REACHING
THOUSANDS OF PEOPLE GOING BACK
THANK YOU THANK YOU -- ANY
OBSERVATIONS FROM THE PARK HAS A
SERVICES -- AO.
FINANCE COMMENTS OKAY COMMITTEE
MEMBERS -- SO WHICH I DID HAVE A
QUESTION JUST FOR THE THE PART
HEALTHCARE SERVICES SO THIS
PROPOSAL IS OF COURSE.
WE HAVE -- TELE DENTISTRY IT'S
BUT IT'S BASED DATA COMMITTEE
HEALTH CENTER RIGHT SO LET'S CUT
CALATHEA ON THE WALLS BUT WITHIN
THE ALSO.
WHEN IT COMES TO PPS AND SO
FORTH THERE THERE'S SOME ISSUES
WITH THIS THAT -- IN TERMS OF
WHAT'S BEING PROPOSED IN
RELATION TO POLICY THAT YOU HAVE
REGARDING -- FQHCS AND ART SEES --
AND BE ABLE TO DO THIS -- TELE
DENTISTRY FROM.
THOSE BASES I WOULD I WOULD HAVE --
TO TAKE A LOOK AT THIS OKAY X.
AROUND THE PROPOSAL BUT I THINK
YOU KNOW WE HAVE -- CLINICS THEY
ARE ALLOWED TO HAVE PATIENCE
ESTABLISHED PATIENTS I'VE SEEN
IN A DENTAL CLINICOUTSIDE OF
THE FOUR WALLS AND SO TO THE
EXTENT THAT THAT'S CONSISTENT
WITH THE POLICY WE HAVE THEN YOU
KNOW WE WOULD BE HAPPY TO TAKE A
LOOK AT IT.
OKAY YES THAT OUR CLASS AND MAKE
A COMMENT ON THAT ISSUE WHICH IS
THAT.
THERE WAS SOME CONCERN RAISED
ABOUT THE SEPARATE MECHANISM
WHICH IS THAT HEALTHCARE IS
ALLOWED TO CONTRACT WITH OUTSIDE
PROVIDERS.
AND THERE'S SOME CONCERN ABOUT
PATIENT GOING RIGHT TO THE
OUTSIDE PROVIDER NOT BEING
ESTABLISHED FIRST AND SO IN THE
PROPOSED LANGUAGE TO TRY TO MAKE
IT VERY CLEAR THIS IS NOT THAT.
THIS IS A HEALTH CENTER USING
ITS OWN EMPLOYEES IN THEIR OWN
EITHER REGISTERED A LICENSED OR
INSIGHTS OF CERTAIN PLEASE OUR
OWN SITES IT'S NOT THE CONTRACT.
SO WE TRY TO BE VERY CLEAR ABOUT
NOT SPILLING OVER TO AND DOES SO --
SO CERTAINLY VERY SYMPATHETIC
WHAT YOU'RE SAYING I JUST WANNA
BE SURE TO TO OUR CONNECTING
ABOUT THAT BECAUSE YOU KNOW.
THE OF CMS RULES YES THE RULES
AND THEN HOW THEY ALL INTERFACE
THAT WE CAN ACHIEVE WHAT I THANK
YOU DESIRE -- INSIDE SO I
APPRECIATE THAT CERTAINLY IN
DEVELOPING YOUR LANGUAGE YOU
PROBABLY THOUGHT ABOUT SOME OF
THESE THINGS BUT IT'S THE
DECISION WILL BE MADE BY THE
AGENCY'S WHETHER IT'S OUT OR NOT
SO I THINK HOPEFULLY THAT
DIALOGUE WILL HELP -- LEAD TO IF
THE THE SURE THAT WE HAVE THE
RIGHT LANGUAGE TO ACCOMPLISH
WHAT YOU HOPE TO ACCOMPLISH
WHICH THAT DIALOGUE OKAY --
ENCOURAGED THE DIALOGUE SO --
ALL RIGHT OKAY WELL THANK YOU
VERY MUCH -- OF A MOVE ON TO OUR
SECOND THAT STAKEHOLDER PROPOSAL
FROM.
ON SILVER DYNAMITE FLUORIDE
COVERAGE AND DENTAL CAROLINE
WITH THE WITH THE CALIFORNIA
DENTAL ASSOCIATION HERE FOR THAT.
I'M NOT SURE WHY I SEEM TO KNOW
SO MUCH ABOUT THE DENTAL
PROPOSALS.
OKAY -- WONDERFUL HOW ARE
EIGHTEEN ANOTHER CHAIR
[inaudible]
OKAY.
DO I INTRODUCED YOUR LITTLE ONE
FIRST WE WILL TAKE THAT OFF YOUR
TIME [inaudible]
TELL ME.
THIS IS LILAH BLANCHARD I LEVEL.
SHE'S FOUR YEARS OLD --
WONDERFUL ALL RIGHT WELL WELCOME.
ALL RIGHT SO ALL RIGHT SO THREE
MINUTES TOTAL.
THANK YOU.
A GOOD AFTERNOON CHAIR MEMBERS --
AN INSTRUCTOR STUFF ME SEND RT.
ACCESSING DENTIST HERE IN
SACRAMENTO I'M HERE TODAY ON
BEHALF OF CDA WAS NEARLY TWENTY
SEVEN THOUSAND MEMBER DENTISTS
ACROSS THE STATE. TO TALK TO YOU
ABOUT THE NEED TO MAKE SILVER
DIAMINE FLORIDA MEDICAL DENTAL
BENEFIT.
IN TWO THOUSAND FOURTEEN THE FDA
APPROVED STF PAVING THE WAY FOR
WIDESPREAD USE IN THE US.
AND IT HAS BEEN USED IN OTHER
COUNTRIES SUCH AS JAPAN AND
AUSTRALIA. FOR DECADES AND IS
CURRENTLY IN ESTABLISHED
MEDICAID BENEFITS SEVERAL OR
STATES SUCH AS OREGON.
PRIVATE COMMERCIAL DENTAL
INSURANCE PLANS ARE REIMBURSING
FOR THE STF CODE AND PATIENTS
WITHOUT INSURANCE ARE PAYING OUT
OF POCKET FOR THIS ALTERNATIVE
CARRIES ARRESTING METHOD -- STF
IS PARTICULARLY BENEFICIAL IN
THE CARE OF PEOPLE WITH
DISABILITIES THE FOR FRAIL
ELDERLY PATIENTS YOUNG CHILDREN
AND CHILDREN WITH SPECIAL NEEDS
WE'RE NOT ABLE TO RECEIVE
TRADITIONAL FRUSTRATIONS.
ALTHOUGH STF IS NOT APPROPRIATE
FOR ALL PATIENTS IT IS A LOW
COST SAFE NON SURGICAL APPROACH
THAT CAN BE APPLIED IN A MATTER
OF MINUTES WITHOUT THE NEED FOR
INJECTABLE DENTAL ANESTHETICS.
SEDATION OR DRILLING.
I HAVE STAFF DOES NOT FULLY
ELIMINATE THE NEED FOR
TRADITIONAL DENTAL CARE -- BUT
IT DOES ARE DIRECTLY.
WHEN IT'S PLACED DIRECTLY ON THE
DECAY ARE STOP THE DAYCARE FROM
FORGETTING FURTHER OR SLOW IT
DOWN -- AS ARRESTING THE DECAY
MAY ALLOW FOR A CHILD TO BECOME
MORE COOPERATIVE AS THEY GET
OLDER -- OR EVEN THE BABY TO TO
FALL OUT WITHOUT THE NEED FOR
TRADITIONAL RESTORATION.
IT'S IMPORTANT TO KNOW THAT THE
MAIN SIDE EFFECT OF STF IS
THOUGHT THE APPLICATION OF THE
LIQUID SIGNIFICANTLY DOES COLORS
THE TOOTH INTO A DARK BLACK
COLOR.
WELL THIS ON A STATIC SIDE
EFFECTS CAN BE TROUBLESOME I
WHOLEHEARTEDLY BELIEVE THAT THE
BENEFITS OUTWEIGH THIS RESULT.
I IN THE RIGHT SITUATION
FURTHERMORE SB HOT ONE ONE FOUR
EIGHT REQUIRES THAT PROVIDERS
DISCUSS THE SIDE EFFECTS.
AND OBTAIN INFORMED CONSENT
PRIOR TO TREATMENT.
AS A PRIVATE PRACTITIONER -- I
ACTUALLY APPLIED STF TO A TWO
YEAR OLD AND EVEN A NINETY TWO
YEAR OLD LAST WEEK -- THE TWO
YEAR OLD HAD BABY BOTTLE TO QUE
IN THEM ON DECIDED TO CHOOSE --
STF OVER TRADITIONAL NITROUS
OXIDE INJECTIONS A NORMAL
FEELINGS AND THINGS LIKE THAT --
THE NINETY TWO YEAR OLD HAD
DEMENTIA AND HIS FAMILY DID NOT
WANT.
TO EXPAND YOU KNOW A TREMENDOUS
AMOUNT OF TIME AND ENERGY INTO
RESTORING HIS TEETH SO WE'RE
ABLE TO REMOVE THE DECAY QUICKLY
PLACE STF AND GO ABOUT OUR WAY.
SO EXPANDING COVERAGE OF STF AS
A MEDICAL DENTAL BENEFIT WOULD
ENCOURAGE PROVIDERS TO EXPLORE
ALTERNATIVE CHANNELS FOR KERRY'S
MANAGEMENT.
THAT EXTEND BEYOND MORE
TRADITIONAL AND BASS OF
RESTORATIVE THERAPIES.
AS THE OFFICE CURRENTLY BEING
CORPORATE INTO MONEY DOWN TO A
PRACTICES ACROSS THE STATE AND
THEREFORE IS SIGNAL AGING HOW
EFFECTIVE IT IS.
SB ONE ONE FOUR EIGHT WOULD
ALLOW ACCESS TO THIS TREATMENT
ALTERNATIVE TO PATIENTS IN THE
DENTAL HEALTH PROGRAM THANK YOU
SO MUCH YOUR TIME.
THANK YOU.
GOOD AFTERNOON MR TURN MEMBERS
ANGELA BLANCHARD HERE TODAY AS A
PARENT WHO CHOSE STF FOR HER
DâN THREE YEAR OLD NOW BIG GIRL
FOUR YEAR OLD.
HI LAST FALL WE WERE SHOCKED TO
LEARN AT A ROUTINE DENTAL
APPOINTMENT AND THAT OUR
DAUGHTER HAD SIGNIFICANT DECAY
AND ONE OF HER TEETH AND
OBVIOUSLY GIVEN THAT SHE'S THREE
YEARS OLD WE WERE NOT GOING TO
CHOOSE A DRILL OR OTHER MORE
TRADITIONAL RESTORATIVE
PROCEDURES.
ARE DENNIS EXPLAINED TO US THE
STF WAS GOING TO BE A FIRST LINE
OF DEFENSE AND THAT WE WOULD
CONTINUE TO MONITOR.
AND IF WHEN AND SHOULD THAT
CAVITY BECOME BIGGER THAN WE
WOULD HAVE TO EXPLORE MORE
TRADITIONAL OPTIONS.
SO SHE JUST HAD HER APPOINTMENT
A COUPLE OF WEEKS AGO AND GREAT
NEWS WE HAVE AND NOT ONLY HAS
THE DECAY COMPLETELY STOPPED BUT
THE TWO SCINTIGRAPHY APPEARS
ACTION TO BE BETTER.
MY HUSBAND AND I OPTED TO PAY
FOR THE SERVICE OUT OF POCKET WE
RECOGNIZE THAT THAT'S NOT VIABLE
FOR EVERY WORKING FAMILY AND
WE'RE HERE TODAY IN STRONG
SUPPORT OF CITIES PROPOSAL THANK
YOU.
THANK YOU WE DID AT THE TIME OF
IT IT'S A GOOD ALL RIGHT.
EXCELLENT.
OKAY -- ANY THOUGHTS FROM OUR
HEALTHCARE SERVICES NO ALEJO
[inaudible]
FINANCE.
BUDGET COMMITTEE MEMBER CSS
UNDERTONE THANK YOU -- COULD YOU
JUST -- CAPITAL ABOUT HOW THE
SILVER DIAMOND FLUORIDE IS --
CAP APPETITE IS IT IS IT LIKE
YOUR OLD FLUORIDE TREATMENTS AND
LITTLE -- IT'S VERY SIMILAR --
SO IT'S ON A TOOTH BY TOOTH
BASIS IT'S NOT SOMETHING THAT'S
APPLIED TO EVO MOUTH LIKE
FLUORIDE WOULD BE TRADITIONALLY --
TYPICALLY WE USE A A SMALL HAND
INSTRUMENT TO EITHER SCRIPTED K.
OUT OR A VERY SLOW ROUND BURGER
WHICH IS BASICALLY JUST.
VERY SLOWLY REMOVING ANY SOFTER
OR STICKY MESS OUT OF THE TOOTH
AND THEN THE STF IS APPLIED IT'S
A CLEAR LIQUID IT'S APPLIED WITH
A BRUSH DIRECTLY TO THE DECAY --
IT TAKES ABOUT A MINUTE OR TWO
BEFORE THE DARK COLOR STARTS TO
SET IN AND THE DARK COLOR ONLY
SETS IN WHERE TO QUE IS SO IT
DOESN'T COLOR THE ENTIRE TO
SPOCK JUST WHERE THE COMPANY WAS
SO IT'S A IT'S A IT'S NOT A
PRESENT A PROPHYLACTIC TREATMENT.
IS -- IT'S AN AND Q. TREATMENT --
FRONT FOR DENTAL CARE IS HE
DIAGNOSED AS PRESIDENT -- IN
ORDER TO USE IT NOW YOU COULD
PLACE IT IN THE GROUP'S
PROVOCATIVELY ALMOST LIKE A
SEALANT YOU COULD SY BUT IF
THERE'S NO ACTUAL TO KATE WILL
NOT BONTA THE TOOTH -- AND IT
WILL NOT TURN THE THE TO STARK I
WISH I WOULD HAVE KNOWN ABOUT
THIS MY GRANDDAUGHTERS A SIX
YEAR OLD AUTISTIC CHILD THEY
FOUND SHE HAS SOME SIGNIFICANT
THE K..
AND THAT ACTUALLY AND THAT'S A
SIZER TO TO DO THE WORK TO BE
NICE TO KNOW OF THIS TREATMENT
BUT WHICH MUCH FOR NON INVASIVE --
COULD HAVE BEEN MADE AVAILABLE
FOR HER SO THANK YOU FOR
EDUCATING ME ON IT.
RIGHT -- SO EXIT AND THEN
NINETIES YOU JUST SPOKE TO THE
STORY OF I JUST WONDER.
IF THEY HAVE YOU EXPLAIN AGAIN
BECAUSE WE'RE SO THE BIGGEST ONE
OF THE BIGGEST CONCERNS I'VE
HEARD ABOUT.
THIS TREATMENT US SORT I MIGHT
IS IS THAT IS IS THE ASCETIC
AFFECT THE BLACK NEED TO SO.
UNFORTUNATELY I THINK SOME
PEOPLE HAVE GONE AROUND CALLING --
YOU HAVE THE BLACK TO SPILL HER
EIGHT AND AND AND I THINK
THERE'S CERTAINLY YOU KNOW THE
AESTHETICS IS IMPORTANT PEOPLE
DON'T WANT TO GO AROUND WITH THE
DARK TEASE THAT MAY.
HAVE BEEN DONE FROM LETS IT FLY
MAKE THEM -- ANXIOUS TO APPLY
FOR A JOB OR MAKE FRIENDS OR
SOMETHING LIKE THAT AND
CERTAINLY IS A DENTIST I KNOW
YOU KNOW HOW IMPORTANT THAT IS --
TO PEOPLES -- YOU KNOW THE
WELLBEING PSYCHOLOGICALLY AS
WELL OF COURSE OR HEALTH.
SO WHAT DO YOU SAY TO PEOPLE SAY
WELL I DON'T KNOW I'M AFRAID
YOU'LL DENNIS AGAIN USES TOO
MUCH AND NOW WE ARE AND PEOPLE
ARE GOING TO BE HARMED BECAUSE
WELL CERTAINLY YEAH WE'RE STUCK
HERE TO DECAY BUT THERE MIGHT BE
A FINANCIAL INCENTIVE TO OVER
USE THAT.
AND NOW PEOPLE ARE NOT DOING I
FEEL ASHAMED OF THEIR TEETH AND
SO FORTH.
SO IT IS IT IS IS THAT A REAL
ANY AND HOW MUCH OF A CONCERN IS
THAT.
IT'S DEFINITELY SOMETHING THAT
COMES UP FOR WITH PARENTS
ESPECIALLY IN NO WE'RE TALKING
ABOUT VERY YOUNG CHILDREN THAT
WE TYPICALLY USE THIS ON OR
CHILDREN WITH SPECIAL NEEDS --
WITH THE THE LIKE THE YOUNGEST
I'VE USED IT ON HIS ONE YEAR OLD
IT'S IT'S UNREALISTIC TO EXPECT
A ONE YEAR OLD TO BE ABLE.
TO YOU KNOW SENATE DENTAL CHAIR
AND GET NITROUS OXIDE OR GO
UNDER SEDATION OR SOMETHING LIKE
THAT.
SO THIS IS A GOOD WAY TO KIND OF
PAUSE THE DECAY AND MAYBE EVEN
SAVE THE TOOTH FROM EXTRACTION
OR SOMETHING LIKE THAT UNTIL THE
PATIENT IS.
OLD ENOUGH TO SIT IN THE DENTAL
CHAIR AND DO NOT YOU KNOW
REGULAR TRADITIONAL.
RESTORATIONS OR IF THEY'RE OLDER
YOU KNOW THE OLDER THEY GET.
YOU KNOW POTENTIALLY SAFER OR IT
COULD BE TO PUT THEM UNDER AN
ASCETIC ARE GENERAL ISSUES ARE
SOMETHING LIKE THAT SO.
IT'S JUST ANOTHER TOOL WE HAVE
IN OUR IN OUR BAG OF TRICKS TO
HELP STOP DECAY AND AND KEEP
TEETH AROUND OKAY SO YOU CAN
QUITE ANSWER MY QUESTION WITH.
THAT THIS SO I APPRECIATE IT'S
ANOTHER TOOL RIGHT.
BUT PEOPLE ARE AFRAID I'VE HEARD
SOME CONCERNS THAT.
IT'S A TOOL IF IT'S BUSINESS AS
A CONSEQUENCE WHEN IT'S USED AND
IF IT'S OVER USED.
RIGHT.
SO NO IT'S OKAY AND I KNOW YOU
WOULD NEVER DO THIS BUT NOW IT'S
OKAY SOME DATA SAID YOU KNOW
WHAT I'M GOING TO USE A LOT OF
IT I CAN BILL FOR AT NOW THERE'S
AN OPPORTUNITY UPPER SAY THE
PATIENT TO GET IT.
AND THE CONSEQUENCES THAT THE
PATIENTS GOING AROUND WITH BLACK
TEAS AND THOU THERE YOU KNOW AND
I I GUESS I DON'T KNOW THERE'S A
WAY TO REVERSE THE BLACKNESS ITS
SILVER DINER SO IT THAT TENDS TO
GET.
PRETTY IMBEDDED IN THERE BUT
EXACTLY HOW BLACK TO THE TEETH
TURN AND IS THERE A WAY AND AND
AND WHAT'S THE DEAL WHAT IS THAT
THE RISK OF OF THAT KIND OF HARM
POTENTIALLY HAPPENING.
SO SOON AS HE'S QUITE DARK OR
ONE NOT I'M SURE CUT BY.
THAT TIME IT IS QUITE DARK ITEM
AND YEAH I MEAN IT'S IT'S I
THINK THAT'S WHERE THE INFORMED
CONSENT REALLY HAS TO COME INTO
PLAY I MEAN I CAN'T SPEAK TO
OTHER PEOPLE DOCTORS ARE GOING
TO OVER USE IT I DON'T THINK
THERE'S LOTS OF THINGS THAT
AREN'T.
OVER USED OR NOT UNDER UNDER
USED.
BUT IT'S FOR SURE A CONCERN I A
SHOW ALL OF MY PATIENTS THE
PICTURES OF IT SO THAT THE
PARENTS CAN MAKE AN INFORMED
DECISION -- BUT THERE ARE WAYS
TO COVER UP THE BLACK YOU CAN
PUT REGULAR FILLING OVER ME ARE
ON TOP OF IT AND KIND OF BLENDED
IN WITH THE TO THE LITTLE BIT
MORE -- I'VE DONE NOT FOR
PATIENTS THAT ARE MORE
COOPERATIVE AND THEY'RE STILL
NOT GETTING ANESTHETICS ARE
STILL NOT GETTING DRILLED ON OR
ANYTHING LIKE THAT IT DOES COVER
IT UP SO IT'S NOT AS DARK IT'LL
BE A LITTLE BIT GRAY KIND OF A
GREATER TONE -- SO THERE ARE
WAYS OF MAKING IT LOOK MORE
AESTHETIC -- MORE AESTHETIC -- I
THINK IT'S MOSTLY A CONCERN FOR
FRONT TEETH I DON'T THINK
PARENTS ARE SINCERELY CARE TOO
MUCH ABOUT THE BACK TEETH IT'S
MORE WHEN IT IS CLEAN THE FRONT
TEETH -- AND SO I THINK THAT SHE
MAY HAVE SOME SOME GOOD COMMENTS
GOOD KNOWING THAT HER DAUGHTER
HAS HAD IT.
BEST SO AND THANK YOU FOR THAT
SO WE WE WERE WELL AWARE THAT
THE TOOTH MAY BECOME DARKER AND
I THINK WHEN YOU HEAR BLACK TO
USE IT'S REALLY SCARY.
LIFELESS TO THIS NOT BLACK IT IS
IT IS DARK WHERE THE TWO K. WISE
AND IT LOOKS ACTUALLY LIKE A
SMALL SILVER FILLING.
I SHE ONE OF HER MOUTH TO SHOW
YOU I TRIED OUT -- FIVE JUSTIN.
BUT IT'S AND YOU KNOW WHEN WHEN
WAYNE THE OPTIONS IT WAS STF OR
ANASTASIA AND I'M SORRY BUT AS A
PARENT I'M GOING TO CHOOSE STF
OVER ANASTASIA ANY DAY.
AND WE KNEW THAT THIS WAS THE
FIRST LINE OF DEFENSE AND
ULTIMATELY IF WE NEEDED TO
EXPLORE FURTHER OPTIONS WITH OUR
DENTIST WE WOULD DO THAT BUT YOU
KNOW A BLACK SMALL BLACK SPOT IS
IS.
RELATIVELY SMALL PRICE TO PAY.
AND IN THE END YOU MENTIONED
ONLY THE REALLY ONLY STICKS TO
THE PART THAT WAS THE CASE SO
IT'S NOT LIKE ONE TO APPLIES IT
IT'S GOING LIKE COME ALL OF THE
TEETH IT'S JUST KIND OF THE
SPOTS GOING TO THE DARK SPOTS
GOING TO BE WEIRD AT THE K..
WHATSOEVER DECAY AS I MEAN I THE
MOVE DOCUMENT ACTUALLY COVERS
THE WHOLE TOOTH WHEN YOU'RE
PLACING IT THERE'S NO WAY TO
PREVENT THAT -- HOWEVER IT WILL
ONLY SIXTEEN WHERE TO QUE OKAY --
SOMETIMES IT CAN STAY IN THE
GUMS A LITTLE BIT BECAUSE
THERE'S BACTERIA PRESENT ON THE
GUMS BUT THAT WAS A A TRANSIENT
THING IT WILL GO AWAY WITHIN A
COUPLE DAYS OF BRUSHING THE
BLACK SPOT WILL STAY PERMANENT --
UNTIL THE TO THIS EITHER FOLD OR
FALLS OUT OR WHATEVER HAPPENS
THAT TOO SO IT'S ONLY COMES BACK
TO ME AND SAYS OH THAT'S THAT
BLACK TO THING WE'RE NOT TALKING
ABOUT PEOPLE'S ALL THEIR TEETH
OR TALKING ABOUT BLACKNESS WHERE
DID THE QUE WAS BUT IT'S AND
IT'S NOT.
GOING TO STICK TO THE REST OF
THE TEETH CORRECT ONLY WHERE THE
DECAY WAS WILL IT STAY DARK
RIGHT NOW OBVIOUSLY THERE'S A
SENSE OF THE CABLE.
BUT STILL IT'S IT'S ONLY WITH
THE CASES OKAY.
THANK YOU I APPRECIATE THAT
CLARIFICATION OF ANY OTHER
QUESTIONS.
OKAY ALL RIGHT WELL THANK YOU
VERY MUCH SO WITH THAT -- WILL
GO AHEAD TAKE PUBLIC COMMENTS ON
MEDICAL DENTAL SERVICES DEAL
REVIEW AND THE STAKEHOLDER
PROPOSALS AND SENATOR STONE I
JUST WOULDN'T WANT A I GOT A
RESPONSE.
WE WE ARE ACTUALLY OUR DELTA
DENTAL IS ACTUALLY TODAY DOWN AT
A REGIONAL CENTER DOING TRAINING
AND THAT WE HAVE MORE PLANNED SO.
SO I DECIDED TO CALL BACK LATER.
OKAY ALL RIGHT TO HEAR THEIR
SENSES SO -- AND JUST TO HAVE
FORGOTTEN THE INTRODUCTION TO
ANNOUNCE WE'RE NOT ACTUALLY
TAKING ANY VOTES TODAY AND YOU
CAN SEE AT THIS POINT.
I DON'T HAVE ENOUGH MEMBERS TO
TAKE ANY VOTES -- BUT SO THANK
YOU VERY MUCH OF YOU AND ONE
MINUTE -- COMMENTS ON BOTH THE
OVERVIEW AND ALSO EITHER THE
STAKEHOLDER PROPOSALS WE SHOULD
EXPRESS SUPPORT FOR THEM WELCOME.
STATE COUNTY FROM WESTERN DENTAL --
AND SUPPORT THE STAKEHOLDER
PROPOSAL HONESTY F. AS WELL AS
THE CHAIRS LEGISLATION WHICH WE
THINK WOULD MAKE A VERY NICE
TRAILER BILL.
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY WE APPRECIATE
THIS OVERSIGHT AS ACCESS TO
DENTAL SERVICES BEEN A LONG
STANDING ISSUE AS EVIDENCED IN
THAT THE EXCELLENT ANALYSIS --
CONSIDERING THE LOW GROWTH OF
THAT ACCOUNT PROVIDERS IN FEE
FOR SERVICE VERSES SACRAMENTO
DENTAL MANAGED CARE 2% VERSUS
NEARLY 50% WE WOULD RECOMMEND
REACHING OUT TO DENTAL MANAGED
CARE PLANS TO SEE IF THERE ARE
RECRUITMENT PRACTICES TO
REPLICATE.
AND AT THE AT THE ALICE'S
INDICATE LESS THAN 14% OF MEDI
CAL ADULTS RECEIVED A DENTAL
PREVENTED OF SERVICE IN THE PAST
YEAR SO WOULD SUPPORT FOR
CHILDREN HOMES AS WE BELIEVE
THAT WOULD INCREASE PREVENTATIVE
UTILIZATION THANK YOU.
THANK YOU WELCOME.
BUT IT'S NOW WHAT'S WITH THE
CALIFORNIA PAN ETHNIC HEALTH
NETWORK WE'RE ALSO IN STRONG
SUPPORTER THE VIRTUAL DENTAL
HOME STAKEHOLDER PROPOSAL.
WE ALSO CONTINUE TO BE CONCERNED
ABOUT THE LANGUAGE ACCESS AND
THE DENTAL PROGRAM -- YOU'VE
RECEIVED ARE NUMEROUS COMPLAINTS
FROM CONSUMERS BEING DENIED A
LANGUAGE ACCESS SERVICES AND SEE
VERY LOW NUMBERS OF LIMITED
ENGLISH PROFICIENT CONSUMERS
BEING SERVED TO THE TELEPHONE
SERVICE LINE -- SO WE HOPE TO
WORK WITH BOTH THE DEPARTMENT OF
HEALTH CARE SERVICES AS WELL AS
THE LEGISLATURE TO WORK ON THAT
ISSUE THANK YOU.
THANK YOU.
WELCOME.
THANK YOU MISTER CHAIRMAN BURRS
MEGAN SUPERS ON BEHALF OF
CALIFORNIA HEALTH PLUS ADVOCATES
IN THE THIRTEEN HUNDRED
COMMUNITY HEALTH CENTERS AND
CLINICS IN CALIFORNIA AND STRONG
SUPPORT OF BOTH STAKEHOLDER
PROPOSALS YOU HEARD TODAY.
A FOR VIRTUAL DENTAL HOME FQHCS
IN OUR EACH SEES AND FOR THE STF
TREATMENT THANK YOU THANK YOU
[inaudible]
WELCOME.
HELLO KATY ANDREW CHILDREN NOW
HERE IN STRONG SUPPORT OF BILL
STAKEHOLDER PROPOSALS AMBLED THE
VIRTUAL DENTAL HOME PROPOSAL AS
WELL AS THE SILVER DIAMOND FOR I
PROPOSAL THANK YOU.
THANK YOU WELCOME.
RIGHT SPENT ON BEHALF OF THE
WEST HEALTH INSTITUTE IN SUPPORT
OF BOTH STICKLE POSES WELL THE
VIRTUAL DENTAL HOME IN THE SOBRE
DAMMIT.
BALLS THANK YOU THANK YOU.
WELCOME -- SELLING OR WITH THE
CHILDREN'S PARTNERSHIP IN
SUPPORT OF THE BOTH PROPOSALS
BUT ALSO WANNA THINK DH CS FOR
THE EFFORTS AROUND UTILIZATION
WE ALSO FEEL THAT THEY ARE LOW
AND LOOK FORWARDTO WORKING WITH
THEM -- AND HOW TO INCREASE THAT.
THANK YOU.
WELCOME.
A BREANNA PITTMAN SPENCER WITH
THE CALIFORNIA DENTAL
ASSOCIATION -- OBVIOUSLY IN
SUPPORT OF STF BUT ALSO OF THAT
VIRTUAL DOWN HOME PROPOSAL -- I
THINK JUST ONE ECHOES IN THE
COMMENTS OF YOU KNOW WE'RE
STARTING TO SEE GROWTH IN BOTH
UTILIZATION AND PROVIDER
ENROLLMENT NOT AS MUCH AS WE
WOULD LIKE TO SEE BUT WE DO
BELIEVE THAT THE EXTRA RATES
BOTH THROUGH THE DTI INTHE
FIFTY SIX ARE WORKING AND WANT.
TO CONTINUE THAT AND WANT THE
STABILITY THERE -- IT'S IT'S
ENCOURAGING FOR US WHEN WE START
TO GET CALLS FROM OUR MEMBERS
COMPLEMENTING DONE ACCOUNTING
HEY THIS IS ACTUALLY GREAT THIS
IS WORKING.
THOSE ARE -- SOMETIMES NEW CALLS
FOR US SO IT'S ALWAYS GOOD
RATHER THAN THE COMPLAINT CALLS
THAT WE HISTORICALLY HAVE GOTTEN --
I WOULD NOTE THAT IN THE THE DTI
PROGRAM YOU'RE TO REPORT THE
NUMBER OF MEDI CAL.
DENNIS PROVIDING PREVENTIVE
DENTAL SRVICES TO AT LEAST AT
TEN CHILDREN AGES ONE TO TWENTY
INCREASED BY A I'M 7% FROM --
TWENTY FOURTEEN TO TWENTY
SEVENTEEN I KNOW SOME OF THE THE
DATA THAT WE WERE LOOKING AT
EARLIER IN THE AND WAS SORT OF
LOOKING AT SMALLER CHUNKS SO WE
ARE SEEING INCREASES -- WE WE
ARE ENCOURAGED BY THAT AND ARE
VERY I KNOW CONTINUE TO WORK
WITH EACH YES TO BUILD THOSE
NUMBERS THANK YOU.
THANK YOU.
WELCOME AGAIN FOR US AGAIN
UNIVERSITY PACIFIC SCHOOL OF
DENTISTRY OBVIOUSLY SUPPORT THE
VIRTUAL DEL HOME TECHNICAL FIX
BUT ALSO.
JUST WANT TO SAY SOMETHING ABOUT
SERVER DIAMINE FLOORED WHICH IS
THAT WE HAVE IS BEING USED ALL
OVER THE COUNTRY NOW.
AND OVERWHELMINGLY DENNIS
REPORTING WHEN YOU PERCENT THE
ISSUE TO A PARENT OF YOU WANT TO
HAVE YOUR CHILD EITHER IF THEY
ON CRAWFORD HELD DOWN GET
INJECTIONS THE REALLY
FRIGHTENING FOR ABOUT A DENTAL
CARE AND FUTURE OR EVEN WORSE
HAVE TO GO UNDER GENERAL
ANESTHESIA WITH THE RISK OF
BRAIN.
DAMAGE OVERWHELMINGLY PARENTS
ARE CHOOSING THE STF AND THE
SMALL BOX POLITICS IS PRETTY
MINOR THING COMPARED TO SOME OF
THOSE OTHER CONSEQUENCES.
OKAY THANK YOU ONLY SEE ABOUT I
THINK WILL ALSO APPLY IN VIRTUAL
DENTAL HOME.
TO OKAY ALL RIGHT.
OKAY WELL THANK YOU SO VERY MUCH --
IT'S ONE OTHER QUESTION BEFORE
YOU WRAP THIS UP SO WE HEARD
FROM C. PAN ABOUT.
TRY CHALLENGES LANGUAGE ACCESS
WE'RE THINKING ABOUT WELL HOW
WE'RE TRYING TO INCREASE TWELVE
UTILIZATION ARE GET THE RIGHT
UTILIZATION I THINK IS A MORE
APPROPRIATE WAY TO SAY IT -- BUT
WE LOOKED INTO FOR EXAMPLE HAVE
YOU LOOKED INTO HOW MUCH OF A
BARRIER LANGUAGE ACCESS MAY BE
BECAUSE WE HAVE A VERY DIVERSE
STATE.
AND PEOPLE SPEAKING WRESTLING
WITH THAT THAT COULD BE A
SIGNIFICANT BARRIER IF PEOPLE
ARE HAVING LANGUAGE BARRIERS AND
WE'RE NOT PROVIDING ENOUGH
EFFORT.
TO THAT THERE'S POPULATION WE
HAVE A DIFFICULTY IN TERMS OF
GETTING ACCESS TO OUR SO IS
REQUIRED TO PROVIDE LANGUAGE
LINE SERVICES FOR ALL
BENEFICIARIES AND SO WE DO GET
ABOUT SIX HUNDRED THOUSAND CALLS --
ACROSS. ELEVEN MOBILE MORE THAN
ELEVEN LANGUAGES BUT MORE BUT
MOST ARE IN. ELEVEN LANGUAGES SO
WE DO WE ARE TRYING TO PROVIDE
THAT BUT CERTAINLY TO THE DEGREE
THERE'S MORE THINGS WE CAN BE
LOOKING OUR HAPPY TO DO THAT.
OKAY A SAID I I DON'T KNOW IF
THERE'S ANY SORT OF VALUATION
IT'S BEEN DONE LOOKING AT EVERY
DISPROPORTIONATELY -- THE FOLKS
WHO ARE.
HILL WHO ENGLISH IS A PRIME
LANGUAGE OR NOT UTILIZING SO I I
THINK SERVE GETTING SOME DATA
THE LOOK AT YOU KNOW IS THERE
ARE WE DOING EVENLY ACROSS THE
BORDER.
IF THAT'S THEIR Và LOT LOWER
THAN THE BORING THAN THIS OKAY
WE NEED TO WORK ON THAT BECAUSE
WE CAN TRY.
TO PUSH IN OTHER WAYS.
BUT YEAH THOSE ARE GREAT
SUGGESTIONS AND WE CAN LOOK INTO
IT A LITTLE BIT MORE IN TERMS OF
WHAT WE ASK FOR AND AND GIVE A
BETTER RESPONSE BUT THANK YOU.
OKAY ALL RIGHT WELL THANK YOU
APPRECIATE ANY FOLLOW UP ON THAT
THEN OKAY.
RIGHT NOW THE OKAY NOTHING ELSE
LET'S MOVE ON TO MEDI CAL
PHARMACY SERVICES.
AND I KNOW THAT SIR.
THURSTON WOULD HAVE SOME GREAT
INSIGHTS BUT HE HAS A VERY
IMPORTANT AND I APPRECIATE HIS
PRIORITIES -- FAMILY -- NEED TO
TEND TO SO -- I'LL TRY TO DO AS
WELL AS I CAN THE COVER FOR HIM
AS WELL ON PHARMACY ISSUES.
THANK YOU AND OKAY AND BEGAN.
SO -- AS JUST AS YOU KNOW -- THE
GOVERNOR WHEN HE CAME INTO
OFFICE IN JANUARY ONE OF THE
FIRST IF NOT THE FIRST THING
THAT HE DID HE SIGNED AN
EXECUTIVE ORDER -- AROUND
PRESCRIPTION DRUGS -- PRICE
SCENE AND OBVIOUSLY EXPRESSED
DEEP CONCERN ABOUT THE IMPACT OF
THOSE PRICES AND THE COSTS THAT
WERE BEING BORN BY.
CONSUMERS -- IN THE STATE OF
CALIFORNIA AS WELL AS PURCHASERS
ANOTHER BIG PROGRAMS SUCH AS
MEDICARE ALL AND SO AS A
COMPONENT OF THAT -- EXECUTIVE
ORDER WE THE DEPARTMENT OF
HEALTH CARE SERVICES -- HAVE TO
KIND OF DISTINCT EFFORTS -- WITH
EMBEDDED IN THAT EXECUTIVE ORDER
ONE WAS THE REMOVAL OF THE
PHARMACY BENEFIT AND ASSOCIATED
COSTS THERE WITH -- FROM ALL OF
THE MEDICAL MANAGED CARE PROGRAM
EFFECTIVE JANUARY OF TWENTY
TWENTY ONE ON WHICH I CAN SPEAK
TO IN JUST A LITTLE BIT FURTHER
DETAIL IN A MINUTE.
AND THEN THE SECOND -- PART OF
THE EXECUTIVE ORDER CALLED FOR
US TO NOT ONLY WORK WITH THE GS
AS THEY LOOK AT SOME OF THEIR
BOOK PURCHASE SCENE -- EFFORTS
IN THE STATE BECAUSE WERE PART
OF THEIR DRUG -- COLLABORATIVE.
BUT ALSO.
CHALLENGING US IS A DEPARTMENT
TO WORK WITH OTHER PURCHASERS IN
THE STATE AND PAYERS TO COME UP
WITH RECOMMENDATIONS FOR HOW WE
CAN CHANGE -- THE OVERALL COST
OF PRESCRIPTION DRUGS IN THE
STATE OF CALIFORNIA AND SO WE
ARE WORKING ON DEVELOPING THOSE
RECOMMENDATIONS -- FOR THE
GOVERNOR.
AND OBVIOUSLY IT'S BEYOND JUST
THE STATE -- PROGRAM -- IN THAT
WE AS MEDI CAL HAVE -- VERY
CONCRETE FEDERAL AND STATE
STATUTE AROUND WHAT WE CAN DO AS
A MEDICAID PROGRAM THE PRICING
THAT WERE ALLOWED TO RECEIVE AS
A AS A COMPONENT OF OUR UNIQUE
STATUS.
AND THEN OBVIOUSLY WE AS A STATE --
NEGOTIATE AND RECEIVE
SUPPLEMENTAL REBATES ON THE FEE
FOR SERVICE -- PROGRAM AS IT
EXISTS TODAY AS WELL AS THE
MANDATORY RIVER REBATES THAT
WERE SET IN PLACE NOT ONLY BY
THE FEDERAL GOVERNMENT IT BUT
ENHANCE UNDER THE AFFORDABLE
CARE ACT.
SO I THINK -- IN ALL OF THAT --
WE CONTINUE -- TO SPEND
APPROXIMATELY TWELVE BILLION
DOLLARS AS A STATE PROGRAM
ACROSS BOTH MANAGED CARE AND FEE
FOR SERVICETODAY -- OBVIOUSLY
THE EXECUTIVE ORDER IS LOOKING --
TO AGGREGATE THAT PURCHASE SEEN
OUT -- F. TWO DISTINCT YOU KNOW
AREAS IN TERMS OF WE ONLY GET
THE SUPPLEMENTAL PAYMENTS ON
THAT FEE FOR SERVICE POPULATION
AND INSTEAD RETURN ALL OF THOSE --
LIVES INTO FEE FOR SERVICE SUCH
THAT WERE NEGOTIATING RECEIVING
SUPPLEMENT A REBATES FOR THE
ENTIRE THRTEEN MILLION --
MEMBER PROGRAM -- BUT OBVIOUSLY
REBATES OR NOT THE GOING TO
CHANGE THE UNDERLYING COST OF
THE DRUGS SO I THINK THAT'S
WHERE THE OTHER ADDITIONAL
THINKING AND RECOMMENDATIONS
CERTAINLY COME AND FOR FOR
PURPOSES OF THE BROADER
EXECUTIVE ORDER REQUESTS -- AS
IT PERTAINS TO THE CAR ABOUT --
SPECIFICALLY -- WE HAVE SEVERAL
REASONS FOR DOING THIS NOT JUST
FOR THE REBATES AND FOR THE
AGGREGATION OF THE PURCHASING
POWER.
BUT AS WE LOOK TO THE RENEWAL OF
OUR WAIVERS AND TO THE CONTINUED
KIND OF EVOLUTION OF OUR PROGRAM --
THE STANDARDIZATION OF THE
MANAGED CARE BENEFIT ACROSS THE
VARIOUS MODELS ACROSS THE
COUNTIES -- ACROSS PLAN TO PLAN
WE HAVE RECOGNIZE THAT NOT JUST
FOR PHARMACY BUT FOR A LOT OF
OTHER BENEFITS -- BENEFICIARIES
DEPENDING ON THE COUNTY THAT
THEY LIVE AND HAVE DIFFERENT --
ACCESS TO DIFFERENT SERVICES AT
DIFFERENT TIMES AND SO THE
STANDARDIZATION OF THE PHARMACY
BENEFIT IS ONE THAT WE THINK IS
BOTH -- IMPORTANT BUT ALSO IN
RETURNING IT TO FEE FOR SERVICE --
THE CONTRACTING PHARMACIES THAT
WE HAVE IN FEE FOR SERVICE --
REPRESENT APPROXIMATELY 97% OF
THE PHARMACIES IN THE STATE OF
CALIFORNIA -- INDIVIDUALS WILL
NO LONGER -- HAVE CHANGES IF
THEY CHANGE FROM EITHER COUNTIES
OR DIFFERENT MANAGED CARE PLAN
ASSIGNMENTS FROM THE STANDPOINT
THAT WE WOULD BE -- OBVIOUSLY
JUST MANAGING THAT PHARMACY
BENEFIT ON A FEE FOR SERVICE
BASIS SO YOU WOULDN'T HAVE THAT.
CHALLENGE WHICH I THINK IS IN
SOME CASES ARE THE LARGEST
NUMBER OF COMPLAINTS THAT WE GET --
AROUND PURSE TIONS IN MANAGED
CARE WHEN PEOPLE.
CHANGE AND ROLE IN PLANS AND SO --
THE CAR ABOUT -- WILL CONSIST OF
A LOT OF DIFFERENT -- ACTIVITIES
RELATING -- TO THE REMOVAL OF
THE COSTS -- FROM THE RATES AND
THE MANAGED CARE CONTRACTS TODAY
AND OBVIOUSLY LOOKING -- TO
IMPROVE THE EXISTING DATA THAT
WE GIVE TO THE PLAN SO RIGHT NOW
IT'S INDIVIDUALS ARE RECEIVING --
DRUGS THAT ARE CARVED OUT OF THE
MANAGED CARE BENEFIT FOR EXAMPLE --
A LOT OF THE ANTI PSYCHOTICS AND
BLOOD FACTOR ARE NOT PAID FOR BY
THE PLANS TODAY WE DO PROVIDE
THAT DATA BACK TO THE PLANS --
THE PLANTS HAVE BEEN TALKING
WITH US ABOUT THIS PROPOSAL AND
INDICATED THAT THE DATA DOESN'T
COME TO THEM.
IN A MANNER THAT THEY CONSIDER
TO BE TIMELY WE WOULD AGREE AND
SO A LOT OF THE WORK THAT WE ARE
WORKING ON RIGHT NOW UP.
TO TWENTY TWENTY ONE IS TRYING
TO MAKE SURE THAT WE ARE
PROVIDING THAT DATA SUCH AS THE
PLANS WOULD HAVE THE FULL --
PICTURE OF A INDIVIDUALS
PRESCRIPTION HISTORY SUCH THAT
THEY CAN CONTINUE TO DO A LOT OF
THE CARE MANAGEMENT -- AND CARE
COORDINATION ACTIVITIES THAT WE
HOLD THEM ACCOUNTABLE FOR SO --
WITH THAT I'M HAPPY -- TO ANSWER
SPECIFIC QUESTIONS BUT IN AND
AND QUICK SNAPSHOT THOSE ARE THE
DISTINCT ACTIVITIES THAT WE'RE
DOING AROUND PRESCRIPTION DRUG
PRICING [inaudible]
OKAY -- I THINK WITH SOME OTHER
QUESTIONS SO -- IN TERMS OF I
THINK HE DID SORT OF ADDRESS THE
ISSUE ABOUT MANAGED CARE PLANS
ABILITY TO ACCESS OR MANAGE THE
PHARMACY BENEFIT AND DID YOU
HAVE ANYTHING MORE TO SAY ABOUT.
THAT I MEAN IT'S EASY TO
DISCOVER SAID OF WHAT THREE
FORTY B. -- REALLY IS SO WE HAVE
HAD.
A COUPLE OF YEARS OF ONGOING
DIALOGUE WITH THE THREE FORTY BE
COVERED ENTITIES -- IN THAT --
WHEN A THREE FORTY B. AND TO T.
BILLS THE FEE FOR SERVICE --
PROGRAM TODAY THEY BILL
ACQUISITION COSTS AND REIMBURSE
ACQUISITION COST PLUS THE
DISPENSING FEE.
AND MANAGE CARE THERE'S A
DIFFERENT.
PHENOMENON THAT HAS BEEN GOING
ON IN THAT THE MANAGED CARE
PLANS ARE REIMBURSING THOSE
THREE FORTY BE ENTITIES -- AN
AMOUNT -- THAT MAY OR MAY NOT --
THAT WE MAY OR MAY NOT AND NO
BECAUSE THE THREE FORTY BE
DISCOUNTS AND PRICING IN THAT
THE ENTITIES THEMSELVES
NEGOTIATE DIRECTLY WITH THE
MANUFACTURERS IS NOT KNOWN TO US --
SO WE HAVE HAD ONGOING DIALOGUE
ABOUT HOW DO WE KIND OF BOTH
UNDERSTAND THE DIFFERENTIAL BUT
ALSO WANTING TO MAKE SURE THAT
WE THE STATE ARE NOT PAYING.
MORE FOR DRUGS THAN WE OTHERWISE
SHOULD BECAUSE TO THE EXTENT
THAT MANAGED CARE PLANS ARE
PAYING.
A PRICE THAT IS NOT A THREE
FORTY BE PRICE THEY THEN TURN
THOSE COSTS BACK TO US AS A
STATE SO THERE'S A CONCERN
AROUND.
PAIN -- FOR PAIN FOR COSTS THAT
OTHERWISE WE WOULDN'T HAVE TO IF
THEY WERE IN A FEE FOR SERVICE
ENVIRONMENT.
I THINK AS PART OF THE
GOVERNOR'S EXECUTIVE ORDER AND
THE CARVE OUT FOR THE PHARMACY
BENEFIT WE HAVE INDICATED AND
OPENNESS AND WILLINGNESS -- TO
UNDERSTANDS THE REVENUES THAT
THE THREE FORTY BEENTITIES
RECEIVED TO DATE -- DUE TO THESE --
ARRANGEMENTS WITH MANAGED CARE --
WE WOULD OBVIOUSLY WANT TO SEE --
WHERE THOSE COSTS ARE AND WHAT
THOSE REVENUES ARE BEING USED
FOR IN TERMS OF ADDITIONAL
SERVICES OR PROVISION OF OTHER
BENEFITS WHICH WE HAVE HEARD
ANECDOTALLY BUT CERTAINLY REMAIN?
OPEN TO UNDERSTANDING WHAT THOSE
LOOK LIKE AND THEN AS THE STATE
WE WOULD HAVE TO MAKE AND WHEN I
SAY STATE WOULD OBVIOUSLY BE.
YOU KNOW BETWEEN THE
ADMINISTRATION AND THE
LEGISLATURE -- TO UNDERSTAND IF
THOSE REVENUES NEED TO CONTINUE
TO SUPPORT THE SAFETY NET --
THAT'S A POLICY DECISION THAT
WOULD HAVE TO BE MADE IN TERMS
OF YOU KNOW.
BEEN GOING TO THOSE ENTITIES TO
PROVIDE SERVICES -- WE THE STATE
HAVE MADE A DECISION THAT WE
COLLECTIVELY WANT TO CONTINUE TO
FUND THAT -- IN ADDITION TO THE
WORK THAT IS BEING DONE ON THE
CAR ABOUT AND SO WE REMAIN OPEN
TO THAT DISCUSSION BUT TO DATE
HAVE NOT SEEN SEEN THE DATA
[inaudible]
OKAY.
OF OUR FOLLOW UP ON THAT.
AND THEN -- THE SERVICE CORPS OF
THE SPECIMEN ON THE SAVINGS TO
MEDI CAL PROGRAM FROM THIS
BENEFIT TRANSITION YES THE WILL
BE RELEASING THAT WITH THE MAY
REVISION OKAY SO NO ANSWER AT
THE MOMENT AND I'LL ANSWER THERE
IS SAVINGS ESTIMATE BUT JUST NOT
TELLING YOU WHAT IT.
AND THE QUESTION WAS ARE WE
RELEASING IT AS PART OF THE MAY
YES YES THE ANSWER IS YES ALL
RIGHT.
I CAN BE PATIENT.
A LITTLE WHILE.
I DOES NOT THAT MUCH LONGER
[inaudible]
AND THEN.
OKAY RIGHT WHAT COMES FROM LA --
FIRST.
BEN JOHNSON WITH THE LA SO -- WE
RECENTLY RELEASED REPORT
ANALYZING THE CARVE OUT OF
PHARMACY SERVICES AND MEDI CAL --
WHERE WE FIND THAT -- WE'RE WE
AGREE REALLY WITH THE
ADMINISTRATION THAT THE CAR
ABOUT IS LIKELY TO RESULT IN
THAT SAVINGS FOR THE STATE --
AND POTENTIALLY IN THE HUNDREDS
OF MILLIONS OF DOLLARS AS WAS
NOTED IN THE IN THE GALLEY OR IN
THE BUDGET -- WE EAGERLY AWAIT
THE THE THE FISCAL ESTIMATE AS
WELL WE THINK THAT A LOT MUCH OF
THE SAVINGS COULD COME IN THE
FORM OF THAT TRANSFER OF SAVINGS
FROM THREE FORTY BE -- COVERED
ENTITIES OVER TO THE STATE
THROUGH -- THE STATE ULTIMATELY
PURCHASING THOSE DRUGS AT AT
LOWER COSTS -- THE OTHER SAVINGS
ARE LIKELY TO COME -- FROM JUST
THE TRANSITION OF SPENDING FROM
MANAGED CARE PLANS TO THE STATE
OBVIOUSLY FOR THE ACTUAL DRUG
BENEFIT WE WOULD BEAR THOSE
COSTS AND SO THERE'D BE
OFFSETTING COSTS.
BUT A PORTION OF THAT TRIP --
THAT TRANSFER OVER TO THE STATE --
COULD BE IN SAVINGS THAT THROUGH
LESSER ADMINISTRATIVE AND MAY I
SAY PROFIT ACCESS.
FUNDING -- FOR FOR THOSE MANAGED
CARE PLANS.
ULTIMATELY WITH THE THE CARD
THAT IS LIKELY TO HAVE A MAJOR
IMPACT ON THE VERY STAKEHOLDERS
WITHIN THE MADE MEDI CAL PROGRAM
WE AGREE THAT THE STANDARD OF
THE STANDARDIZATION OF THE
BENEFIT COULD BE BENEFICIAL --
FOR FOR BENEFICIARIES.
MANAGED CARE PLANS BEAU WOULD
WOULD RECEIVE SIGNIFICANTLY LESS
FUNDING GOING FORWARD --
INCLUDING POTENTIALLY ON THERE
FOR THE TIME FOR THEIR
ADMINISTRATIVE COSTS AND SO
FORTH -- THREE FORTY BE ENTITIES
WHAT POTENTIALLY LOSE -- SOME OF
THE NET REVENUES THAT THEY
AREN'T CURRENTLY ON ON THE THREE
FORTY BE SIGNED AND SO -- WE
DEFINITELY THINK WE I THINK WE
AGREE WITH THE ADMINISTRATION
THAT -- YOU KNOW TO THE EXTENT
THAT THOSE -- OF THIS THE
TRANSFER OF THOSE SAVINGS
RESULTS IN SORT OF HARM TO THOSE
INDIVIDUALS PRO -- TO THOSE
INDIVIDUAL COVERED ENTITIES AND
THAT THAT CAN BE DEMONSTRATED --
THAT YOU KNOW A SPECIFIC STATE
POLICY CAN BE CRAFTED TO TWO
INCH -- THEIR CONTINUED
VIABILITY -- AND THEN -- WHAT WE
DON'T ANTICIPATE THEN ON THE
OTHER END MAJOR IMPACT ON DRUG
MANUFACTURERS -- THE
ADMINISTRATION HAS ASSERTED THAT
IT DOES HAVE UNILATERAL
AUTHORITY TO UNDER CURRENT STATE
LAW TO AFFECT THE CARVE OUT --
AND WE DON'T DISAGREE WITH THAT --
WITH THAT ASSESSMENT HOWEVER WE
DO STILL THINK THAT THE
LEGISLATURE DOES HAVE
SIGNIFICANT AUTHORITY -- TO AND
AN OPPORTUNITY REALLY TO PROVIDE
INPUT INTO BOTH WHETHER AND HOW
THIS CARVE OUT PROCEEDS.
WE BELIEVE THAT THIS -- THAT THE
COVER WILL ULTIMATELY REQUIRED
NEW STATE RESOURCES -- FOR DH
YES -- TO CONDUCT PRIOR
AUTHORIZATION REVIEWS -- AND TO
DO A VARIETY OF OTHER ACTIVITIES
TO THE ULTIMATELY SEND THE
INFORMATION -- FROM THE STATE TO
MANAGED CARE PLANS TO ENSURE
CONTINUED COULD CARE
COORDINATION AT THE MANAGEDCARE
PLAN LEVEL AND SO THE STATE
CAN'T THE LEGISLATURE REALLY CAN
PROVIDE -- STRONG OVERSIGHT --
AND REALLY BEEN PUT INTO WHETHER
AND HOW THAT CARVE OUT PROCEEDS
TROUGH ITS APPROVAL OR
REJECTION OF THE STATE RESOURCES.
THERE IS A THERE IS MUCH
INFORMATION THAT IS MISSING ON
ULTIMATELY HOW THIS CARVE OUT
WOULD BE IMPLEMENTED AND IT'S
LIKELY IMPACTS -- AND SO WE DO
RECOMMEND THAT THE LEGISLATURE
CONDITION APPROVAL OF ANY FUTURE
RESOURCES REQUEST BY THE
ADMINISTRATION ON DH CS
PROVIDING THIS KEY INFORMATION
THIS INCLUDES THAT -- THAT
FISCAL ESTIMATE.
AS WELL AS A PLAN TO UPGRADE THE
STATE'S IT INFRASTRUCTURE SO AS
TO PROVIDE MORE TIMELY
INFORMATION ON THE DRUG
UTILIZATION OF MANAGED CARE
MEMBERS.
WOULD LIKE TO SEE PERSPECTIVE
GUIDANCE FOR MANAGED CARE PLANS
CONTINUED ROLE IN REALLY
OVERSEEING THAT BENEFIT FOR
THEIR BENEFICIARIES SINCE THEY
WOULD CONTINUE TO HAVE THAT ROLE --
CONTINUE KERR WITH -- LET'S SEE
IF THEY'RE ANY CONTINUED --
CONTINUITY OF CARE PROTECTIONS
PUT IN PLACE SO THAT -- MANAGE
CARE MEMBERS WHO ARE NOW SUBJECT
TO A DIFFERENT YOU KNOW -- FOR
MILITARY OR CONTRACT ARE
PREFERRED DRUG LIST -- CAN STILL
ACCESS DRUGS THAT THEY FOUND
BENEFICIAL GOING FORWARD.
AND THEN -- ALSO ANALYSIS OF OF
FEASIBLE ALTERNATIVES TO TO THIS
PURSUIT SO WE DO IN OUR REPORT
PROVIDE CERTAIN ALTERNATIVES --
BUT AND ULTIMATELY HERE HAPPY TO
TAKE ANY QUESTIONS ON THOSE OR
OTHER ASPECTS OF THE INITIATIVE.
I DO HAVE QUESTIONS WITH
FINANCING ENDING ALL RIGHT.
SO I'VE BEEN LISTENING CAREFULLY
TO WHAT YOU'RE SAYING
[inaudible]
SO.
WHAT I HEARD YOU SAY?
SO WE HAVE A POTENTIAL FOR WE'RE
GOING AGAIN ESTIMATES FOR
SEVERAL HUNDRED MILLION. NINETY
THOUSAND SURF KIND OF
ANTICIPATED REPOSE BUT ALSO WAY
HEARD YOU SAY WAS OF MOST OF
THAT WAS GOING TO COME FROM
ESSENTIALLY SHUTTING DOWN THREE
FORTY BE.
I'M NOT NOTS FROM ACTUALLY
SAVINGS FROM PHARMACEUTICAL
MANUFACTURERS TECHTV SPECIALLY
SAID THAT.
NOT REALLY GOING TO SAY MY FIVE
SOON AFTER ACTORS BUT ASTHE
MONEY'S COMING FROM CLOSING
THREE FORTY B. WHICH IS NOT WHAT
I THINK WHEN PEOPLE HEARD THE
GOVERNOR ANNOUNCED THAT THEY
WERE DISSIPATING THEY WERE
THINKING THAT.
STATE WAS GOING TO USE OUR
PURCHASING LEVERAGE IN ORDER TO
BE ABLE TO PURCHASE DRUGS OUT
LOWER PRICE AND THAT THAT'S
WHERE THE SAVINGS TO COME FROM.
WE THINK THERE'S A LOT OF
UNCERTAINTY REGARDING HOW MUCH
SAVINGS THE STATE CAN GET FROM
THE SUPPLEMENTAL REBATES.
ARE IT IS OUR UNDERSTANDING THAT
MANAGED CARE PLANS CURRENTLY
NEGOTIATE REBATES WITH DRUG
MANUFACTURERS IN ORDER FOR THOSE
STRUT THEIR DRUGS TO BE PLACED
ON THE FORMULARIES.
WE DO BELIEVE THAT THOSE REBATES
DID INCREASE SIGNIFICANTLY
FOLLOWING THE INTRODUCTION OF
MANAGE CARE REBATES WITHIN THE
MEDICAID OUT WITHIN MEDICAID PER
PER GRAMS NATIONWIDE BUT WE
DON'T HAVE A SOLID UNDERSTANDING
OF THE EXTENT OF THOSE REBATES.
ULTIMATELY WHATEVER THE STATE
DOES RECEIVE IN SUPPLEMENTAL
REBATES -- THROUGH SORT OF THE
FEE FOR SERVICE SYSTEM -- THOSE
SAVINGS WOULD BE OFFSET AGAINST --
ANY SAVINGS THAT ARE CURRENTLY
PASSED ON TO THE STATE THROUGH
MANAGED CARE PLANS -- REBATES
WITH DRUG MANUFACTURERS
ULTIMATELY WE REALLY DON'T KNOW
THE NET IMPACT BUT WOULD LOOK WE
LOOK FOR TO EVALUATING THAT WHEN
WE DO SEE THE FISCAL ESTIMATE SO.
NOTE NOT THERE'S NOT CERTAINTY
HERE AT ALL I MEAN THERE THERE
WOULDN'T BE ONCE WE SEE A FISCAL
ESTIMATE BUT WE SHOULD WE DO
HOPE FOR A LITTLE MORE CLARITY
ONCE THAT DOES COME OUT.
THE ESTIMATE WILL BE ABLE TO
SHOW WHAT WHERE THE COMPONENTS
OF THE SAVINGS ARE COMING FROM.
OKAY.
ALL RIGHT.
IT IS SO I'VE MET BUNCH ALARM
BELLS ARE GOING OFF RIGHT NOW.
BECAUSE THEY MOST OF IT IS
COMING FROM THAT GIVE YOU.
OKAY.
RIGHT WELL I MY CONCERN ITSELF
FIRST OF ALL I MEAN WE CAN.
WE CAN HAVE A LITTLE BIT DEBATE
ABOUT THREE FORTY BE IN.
YOU KNOW IS.
IS A WHAT WE DO KNOW IS THAT.
NO ENTITIES ARE USING THESE MEN
AND YES AT SOMEWHAT ANECDOTAL.
AND I WAS THAT AGE RIGHT BUT
THEY'RE USING THEM TO PROVIDE
OTHER SERVICES MAYBE THERE'S A
DESIRE FOR MORE ACCOUNTABILITY
OF EXACTLY HOW THEY'RE SPENDING
THAT MONEY -- BUT ESSENTIALLY
WHAT I SEE THOUGH IN THE END IS
IS THAT WE'RE STRIPPING THAT
MONEY AWAY FROM THE PEOPLE WHO
ARE PROVIDING THE SERVICES THE
CLINICS PLANNED PARENTHOOD OTHER
PEOPLE WHO GET THREE FORTY B..
THEN WE GOT A GET THAT MONEY
BACK TO THEM IN SOME WAY TOO
RIGHT TO PAY FOR THE SERVICES
THEY WERE PAYING FOR UNLESS WE
JUST WANT TAKE WITH THE SERVICES
AS WELL -- SO THAT ESSENTIALLY
IS NOT A SAVINGS -- IT'S IT DID
IT IS BETTER TO TRANSFER SO OKAY
FINDER NOT GETTING IT THIS WAY
WE HAD TO PAY FOR ANOTHER WAY
UNLESS WE ACTUALLY SAY WE DON'T
WANT TO SERVICES ANYMORE.
MY GUESS IS THE TYPE OF SERVICES
THEY'RE PROVIDING -- ARE
PROBABLY ONES THAT.
WE'LL HEAR FROM PEOPLE SAYING NO
THEY NEED TO HAVE THOSE SERVICES
I A I I I I I DON'T SEE THIS
GROUPS BASICALLY TAKING MONEY
AND TO STICK IN YOUR POCKET AND
WALKING AWAY WITH IT I THINK
THEY'RE USING IT.
TO PROVIDE OTHER PEOPLE SERVE WE
CAN ARGUE ABOUT WHAT THEY ARE
WHAT THE VALUE OF IT IS AND SO
FORTH.
BUT IT'S LIMITING THREE FORTY
BP'S.
WITH THAT MONEY ESSENTIALLY
SPRITE GOING BACK AND SOME OTHER
MECHANISM. TWO PEOPLE FOR STUFF
I DON'T.
THE SERVICES IT'S NOT GOING TO
IT.
I I DON'T SEE THAT LIKE -- WELL
NOW WE HAVE SOME NEW MONEY.
THE INSTITUTE IT THOUGH I THINK
THAT'S TO TO MY COMMENTS EARLIER
THAT SAYS.
CERTAINLY THAT TRANSPARENCY OF
THOSE REVENUES AND WHAT THOSE
SERVICES ARE DOING TO SUPPORT
THE SAFETY NET TODAY IS THE
DIALOGUE THAT THE ADMINISTRATION
AND LEGISLATURE NEED TO HAVE
WHICH IS ARE THE SERVICES THAT
WE COLLECTIVELY AGREE NEED TO BE
PROVIDED AND IF SO.
THEN THERE'S A AN APPROPRIATION
IN A FUNDING MECHANISM TO
ACKNOWLEDGE THAT RIGHT NOW WHAT
WE'RE SEEN AS A AS A DEPARTMENT
IS WE DON'T KNOW EITHER IT RIGHT
IT'S IT'S ANECDOTAL AND SO WE
REMAIN OPEN TO SEEING WHAT THAT
DATA IS AND WHAT THOSE SERVICES
ARE WITH THOSE REVENUES.
BEING GENERATED AND OBVIOUSLY IT
WOULD BE A A JOINT DECISION
BETWEEN THE LEGISLATURE IN THE
ADMINISTRATION AS TO WHETHER OR
NOT TO CONTINUE TO FUND THE
SERVICE.
AND AND MAYBE THE ONLY THING I
WOULD ADD IS THAT I THINK THERE
IS THAT A LITTLE MORE
UNCERTAINTY HERE THAN THERE WAS
IN UNDER LAST YEAR'S PROPOSAL TO
REALLY ELIMINATE THE USE OF
THREE FORTY B..
WE DON'T UNDERSTAND THAT SAY THE
DIFFERENTIAL BETWEEN WHAT FEE
FOR SERVICE PAYS AND WHAT
MANAGED CARE PLANS CURRENTLY PAY
FOR A GIVEN THREE FORTY B. DRUG --
WHEREAS I THINK THAT THE SORT OF
AND SO HOW MUCH OF A HIT SAY AT
THREE FORTY BE COVERED ENTITY IS
TAKING IS UNCERTAIN AT LEAST AT
THIS POINT UNTIL WE SEE A FISCAL
ESTIMATE -- SO THERE COULD IT IT
IT JUST IS THERE IS THERE JUST
IS UNCERTAINTY HERE AS TO ITS
ULTIMATE MAGNITUDE AND I
REMEMBER DISCUSSION CORRECTLY
LAST YEAR THE PROBLEM WAS THAT
YES THE STATE SAVES MONEY.
BUT THE AMOUNT OF MONEY THAT THE
GETS TAKEN AWAY SO THE MATH
MINUS THE STATE SAVES IS
ACTUALLY LESS ABOUT HALF.
OF WHAT THE ENTITIES ESSENTIALLY.
ADD SO WHICH MEANS OF THAT
ACTUALLY WE'VE JUST.
CHOPPED IN HALF THAT WE NOT ONLY
DO WE HAVE.
TO TAKE THE STOCK QUOTE SAVINGS
WE GOT AND FINALLY THE CHANNEL
BACK WE'VE GOT TO FIND MORE EVEN
MORE MONEY.
OTHERWISE IT'S STILL A CUTS.
THE YEAH THE ONLY THING I MIGHT.
ADD TO THAT IS -- THE IF TO THE
EXTENT THAT WE DID THAT REINVEST
THIS THE SAVINGS THAT WE DID GET
WE WOULD ALSO GET THE FEDERAL
MATCH THERE AS WELL SO IT WOULD
BE YOU KNOW DOUBLE THE YOU KNOW
THAT WHATEVER WE SAID THE
SAVINGS THAT WE GOT AND WE SAY.
EXPANDED COVERAGE OR PROVIDED A
TARGETED RATE INCREASE WHERE WE
FIND AN ACCESS ISSUE WE WOULD
ALSO BE SORT OF LEVERAGING
FEDERAL FUNDS THERE AS WELL --
DATA YOU SAID THAT -- LET'S SAY --
THE ADMINISTRATION MAY FEEL IT'S
THEY CAN DO THIS WITHOUT.
MUCH.
BUT AS THE AYE AYES CERTAINLY
TALKING TO MY COLLEAGUES I THINK
THE LEGISLATURE WANTS TO BE VERY
VERY VERY VERY VERY INVOLVED IN
THIS.
WE ARE NOT GOING TO BE -- VERY.
AT THAT EIGHT OF THE
CONSEQUENCES OF THIS IS DONE
WITHOUT LEGISLATIVE OVERSIGHT
APPROVAL.
ESPECIALLY GIVEN THE
CONSEQUENCES THAT I'M HEARING
RIGHT NOW.
BECAUSE THIS IS NOT THE KIND OF
HIGH.
WHAT THIS IS THE SITE?
AND CERTAINLY LOOK FOR THE
ESTIMATE BUT THIS IS ANY WHAT
PEOPLE WERE THINKING WHEN WE
HEARD AN ANNOUNCEMENT WAS THAT
THIS IS AN OPPORTUNITY TO
LEVERAGE.
OUR PURCHASING POWER TO LOWER
OUR PHARMACEUTICAL PURCHASING
PEOPLE AND WHILE PEOPLE SAID
WELL WHAT'S GONNA HAVE A THREE
FORTY BEATER NOT THINKING LIKE
WELL THAT'S FOR MRS SAVINGS ARE
GOING TO BE COMING FROM IT AT
ALL SUPPOSED TO COME FROM.
MAGGOTS ARE PURCHASING POWER --
AND ACTED SOME QUESTIONS ABOUT
WELL SO WHAT OUR FORMULARY
HAVING A LEVERAGE THAT BUT OUR
HEARING LIKE WELL NOT SO MUCH
WE'LL FIND ON THE ESTIMATE.
BUT I THINK -- THERE'S AND
CERTAINLY THINK CERTAINLY I'VE
HER HEARD FROM ME MY COLLEAGUES
I THINK TO BE SIGNIFICANT
CONCERN.
IF THE THIS BASICALLY
ESSENTIALLY BECOMES A PROPOSAL
PRIMARILY TO ELIMINATE THREE
FORTY BE.
I THINK THERE'S GONNA BE
TREMENDOUS CONCERN.
WE LOOK FOR THIS SORT OF
ANALYZING THE ASSUMPTIONS IN THE
FISCAL ESTIMATE TO SEE THE
EXTENT TO WHICH THREE FORTY B.
IS REALLY A SORT OF PRIMARY
GENERATOR OF THE SAVINGS --
VERSUS SOME OF THE OTHER SORT OF
TRANSFERS OF I OR SOME OF THE
OTHER SAVINGS OPPORTUNITY SO
STILL A LOT OF UNCERTAINTY HERE.
OKAY.
ALL RIGHT AND WE'LL SEE WHAT THE
PUBLIC HAS ANY COMMENT ABOUT
THAT -- TOO THE AND THEN I THANK
YOU APPRECIATE THERE'S
CONVERSATIONS THE MANAGED CARE
PLANS ABOUT -- A MEDIC YO BUT
DON'T LET AND I RELATED TO TALK
WITH VALUE BASED PURCHASING BUT
OBVIOUSLY -- MEDICATION
TREATMENT IS SERVE A COMPONENT
IN TRYING TO PUT TOGETHER A PLAN
AND SO THE WAY WE CALL CARVE IT
OUT AND IS A SEPARATE THING IN
TERMS OF FOR DOING VALLEY'S
PURCHASING ARE THE TYPES OF
THINGS.
WE GOT THINK ABOUT HOW THAT ALL
KIND OF COMES BACK TOGETHER
BECAUSE IT'S FOR APPLE SOMETIMES
WHEN THE OPPORTUNITIES TO TRY TO
IMPROVE -- QUALITY AND REDUCE
COSTS IS ACTUALLY.
TO INCREASE MEDICATION.
ADHERENCE AND THEREFORE
UTILIZATION OF CERTAIN TYPES OF
MEDICATIONS FRAMPOL ASTHMA TRY
TO GET MORE PEOPLE ON CONTROLLER
MEDICATIONS SO FORTH AND AND BUT
THAT SAVINGS COMES FROM
REDUCTION AND UTILIZATION THINGS
LIKE EMERGENCY ROOMS AND
HOSPITALIZATIONS AND SO FORTH
SELF MEDICATIONS CARVED OUT.
HOW DOES THAT WORK RIGHT BECAUSE
NOW YOU HAVE [inaudible]
THAT.
THAT THAT ART OF THE FUNDING IS
SEPARATED FROM.
THE OTHER PIECE AND SO HOW DO
YOU.
HOW DO YOU GET THE VALUE OUT HOW
DO YOU PROVIDE INCENTIVE IS THIS
IS THE -- AND THEY'RE GOING TO
BE FROM THE MEDICATION SIDE WELL
GEE YOU DON'T PUSH UP YOUR
PUSHING EXPENSE ON TO THEM
MEDICATION SIDE WELL THAT'S
BECAUSE THAT'S GONNA HELP US
DECREASE.
SO HOW THOSE THINGS COME
TOGETHER AS OUR AS WE TRY TO
PROMOTE.
NOT A VALUE BASED PURCHASING BUT
QUALITY IMPROVEMENT ACTIVITIES
[inaudible]
OKAY.
RIGHT ANY OTHER QUESTIONS OR
COMMENTS NO ALL RIGHT ANY PUBLIC
COMMENT ON THIS ITEM
[inaudible]
POSTED.
OKAY ACTUALLY ALL RIGHT WILL
TAKE PUBLIC COMMENT ON THIS AND
WE HAVE TO HAVE COUPLE
STAKEHOLDER PROPOSALS WILL HERE.
SEVERAL COATS GO AHEAD AND TAKE
SOME PUBLIC COMMENT ON THIS ITEM
FOR THE STAKEHOLDER PROPOSALS.
OKAY WELCOME.
THANK YOU A DAY NUGENT I AM THE
P. I. FOR THE HEARSE OF
HEMOPHILIA TREATMENT CENTER
NETWORK.
AND I FIRST OF ALL WOULD LIKE TO
THANK THE DH CS.
FOR MOVING HIM LIBRA FROM PARTY
TO PARTY TO BE WE WERE HAVING
SIGNIFICANT HEALTH INEQUITIES
FROM ONE COUNTY TO THE NEXT
BECAUSE OUR PATIENTS WERE NOT
GETTING ACCESS TO THIS REALLY
CRITICALLY IMPORTANT DRUG.
BUT IN ADDITION I'D LIKE TO TAKE
TEN SECONDS TO RECOGNIZE AND
THANK SENATOR PAN -- FOR
IDENTIFIED THAT THREE FORTY B.
IS HELPING PATIENTS IN THE STATE.
AND UNLIKE THE DHS HOSPITALS
HAEMOPHILIA DOES HAVE AN HM
DESIGNATION AND THE RECENT WHITE
PAPER FEDERAL WHITE PAPER
DEMONSTRATES THAT.
THE NET INCOME CAN BE TRACKED IT
CAN BE PATIENT SPECIFIC AND IT
DOES BECAUSE SIGNIFICANT SAVINGS
FOR THE STATE SO THANK YOU VERY
MUCH.
THANK YOU.
WELCOME DOCTOR PANDA NUMBERS
TERRY CALGARY HELLO BEHALF OF
THE HIM TO FLEE COUNCIL OF
CALIFORNIA I WOULD LIKE TO ECHO
THE COMMENTS OF OUR LONG TIME
MEDICAL ADVISER DOCTOR DIANE
NUGENT.
OF MACHINE PROVIDES ALL KINDS OF
ADVICE AND COUNSEL TO THE THE
HUMAN PHILLY COUNCIL WHICH
REPRESENTS PATIENTS.
SO WE TO SUPPORT THE THREE FORTY
B. PROGRAM AND HOW IT HELPS OUR
PATIENTS WE ALSO ARE VERY.
SUPPORTIVE OF THE CAR ABOUT FOR
HIM LIBRA WE RECENTLY HAD A TEN
YEAR OLD CHILD IN THE CCS WHOLE
CHILD MODEL IN NAPA.
THEY NEEDED THEIR CLOTTING
FACTOR INFUSION AS WELL AS THE
DRUG THE THE NEW HIM LEVER DRUG
WHICH IS SUBCUTANEOUS SHOT.
AND I HAVE TO COMPLEMENT THE
DEPARTMENT FOR WORKING WITH US
QUICKLY ON THAT PARTICULAR
PATIENT TO MAKE SURE THEY GOT
THERE BOTH OF THE DRUGS THAT
WERE PRESCRIBED BY THE DOCTOR SO
IT'S AN ACCESS ISSUE AND WE
APPRECIATE THE NEW CAR ABOUT
THEIR THANK YOU.
THANK YOU WE WILL BE HEARING
STAKEHOLDER RIPPLES ON HIM THE
RATTLE THAT AFTER THE PUBLIC
COMMENT ON THIS THANK YOU.
THANK YOU MISTER CHAIR MEMBERS
MEGAN SUPERS ON BEHALF OF
CALIFORNIA HEALTH PLUS ADVOCATES --
AND THE COMMUNITY HEALTH CENTERS
SO I'VE JUST FIRST WANTED TO SAY
THAT WE ABSOLUTELY.
AGREE WITH THE ADMINISTRATION
AND TRYING TO LOWER DRUG COSTS
AND SO MY COMMENTS I WANTED TO
JUST FOCUS ON THE IMPACT OF
THREE FORTY B. PROGRAM IN THE
SAFETY NET.
PROVIDERS IN CALIFORNIA SO FOR
HEALTH CENTERS THREE FORTY BE A
SAVINGS ARE OBVIOUSLY IMPORTANT
AND I TOTALLY I HEARD THE
CONVERSATION HERE FROM THE
DEPARTMENT AND I APPRECIATE DR
PANTS COMMENTS ABOUT.
ARE ALL THE SAVINGS GOING TO BE
CAPTURED ON THE BACKS OF THE
SAFETY NET I DON'T THINK THAT IS
THE INTENT -- AND SO -- WE ARE
IN THE MIDDLE OF A A BROAD
SURVEY PROCESS WITH OUR MEMBERS
TO GET A HOLD OF THE AMOUNT OF
SAVINGS THAT ARE CAPTURED TO THE
THREE FORTY B. PROGRAM AND
SPECIFIC -- PROGRAMS THAT ARE
SERVICES THAT ARE USED.
TO BUT THAT THREE FORTY BE
SAVINGS ARE USED TO FIND AND
WHILE I WAS SITTING HERE
LISTENING TO THE CONVERSATION I
DID ASK ONE HEALTH CENTER TO
QUICKLY GIVE ME SOME OF THE
SERVICES THAT THEY THEY USE THAT
THEIR HEALTH CENTER THINGS LIKE
OF DEFINE THEIR IN HOUSE
PHARMACY. TO PAY FOR INDIGENT
AND EDUCATOR SUPPORT CASE
MANAGEMENT SERVICES SUBSTANCE
ABUSE TREATMENT -- AND I I I
HEAR THE DEPARTMENT ASKING FOR
THAT DATA WHICH IS WHY WE'RE IN
THE MIDDLE OF THAT SURVEY
PROCESS -- WE HOPE TO HAVE IT
WRAPPED UP -- NEXT WEEK AND BE
ABLE TO PROVIDE IT TO THE IT TO
THE LEGISLATURE AND THE
DEPARTMENT AND I JUST HOPE THAT
WE CAN HAVE THIS CONVERSATION IN
THE LEGISLATURE TO MAKE SURE
THAT THE SAFETY NET IS PROTECTED
THANK YOU.
THANK YOU [inaudible]
WELCOME.
BARBARA GLAZER WITH THE
CALIFORNIA HOSPITAL ASSOCIATION
WE HAVE ABOUT -- ONE HUNDRED
EIGHTY HOSPITALS HERE IN
CALIFORNIA THE PARTICIPATING
THREE FORTY B. SO THAT IS SO
THAT IS THE PART OF THIS
CONVERSATION THAT WE'RE
CONCERNED ABOUT WE CERTAINLY
SUPPORT THE GOVERNOR'S EXECUTIVE
ORDER TO LOWER OVERALL DRUG
PRICES.
BUT THE SAVINGS ON TO THE STATE
AS YOU WELL ARTICULATED SENATOR
THIS SAVINGS -- MOST OF THOSE
WILL COME FROM THREE FORTY BE
PROVIDERS SO I THINK IT IS VERY
IMPORTANT THAT WE HAVE A
COMPLETE UNDERSTANDING OF THE
IMPACT ON OUR SAFETY NET
PROVIDERS BECAUSE THERE WILL BE
AN IMPACT THANK YOU.
THANK YOU WELCOME.
NEARLY HALF OF THE CALIFORNIA
CHILDREN'S HOSPITAL CESSATION
ALSO WITH CONCERNS ABOUT THE
PROPOSAL RELATED TO THE THREE
FORTY BE PROPOSAL I WOULD JUST
ADD ONE NEW ONES.
AND IT'S RIGHT NOW HOSPITALS AND
OTHER COVERED ENTITIES ARE
CURRENTLY REQUIRED TO BE ALL
INTO THREE FORTY B. OR ALL OUT
OF THREE FORTY VIEW CAN'T BE AN
ON COMMERCIAL AN OUT ON MEDI CAL.
FEE FOR SERVICE BILLING FOR
THREE FORTY B. IS MUCH MORE
BURDENSOME FOR THE PROVIDERS
THIS PROPOSAL WOULD ELIMINATE
THE SAVINGS THEY GET ON THE
MEDICAL SIDE AND INCREASE THE
BURDEN TO ACTUALLY BILL FOR
THOSE DRUGS.
AND SO THE LEGISLATURE MIGHT
CONSIDER IF THIS PROPOSAL MOVES
FORWARD THAT WE ALLOW COVERED
ENTITIES TO BE ABLE TO OPT IN
COMMERCIAL AND OUT ON MEDI CAL
SO THEY DON'T ACTUALLY INCREASE.
IN THEIR ADMINISTRATIVE BURDEN
WHILE LOSING THEIR SAVINGS THANK
YOU.
THANK YOU.
OKAY GOOD AFTERNOON SIR HAS GOT
WITH THE CALIFORNIA ASSOCIATION
OF PUBLIC HOSPITALS AND HEALTH
SYSTEMS AND WHAT ECHO THE
COMMENTS OF OF MY COLLEAGUES
HERE.
OUR PUBLIC HEALTH CARE SYSTEMS
ARE ALL ELIGIBLE FOR THREE FORTY
B. AND YOU ARE CORRECT THAT.
WITH THIS PROPOSAL THEY WILL
LOSE ALL OF THEIR THREE FORTY BE
SAVINGS IN MANAGED CARE AS WELL
AS ON SOME ASSOCIATED
SUPPLEMENTAL REVENUE THAT THEY
GET IN MANAGED MEDICARE MANAGED
CARE TODAY -- BUT WE REMAIN
COMMITTED TO WORKING CLOSELY
WITH THE STATE TO PROVIDE
INFORMATION ON WHAT THAT
ESTIMATE LOOKS LIKE.
AND REALLY HIGHLIGHTING A LOT OF
THE SERVICES THAT WE PROVIDE
THAT THEY COULD BE CHALLENGED
WITH THIS PROPOSAL THANK YOU.
THANK YOU [inaudible]
WELCOME.
GOOD AFTERNOON JENNIFER ALLEY
WITH THE CALIFORNIA ASSOCIATION
OF HEALTH PLANS -- IN YOU KNOW
CAPS APPLAUDS THE GOVERNOR'S
EFFORT -- TO ADDRESS THE RISING
COST OF PRESCRIPTION MEDICATION --
THE SKYROCKETING DRUG PRICES
HAVE BEEN A MAJOR IMPACT ON
HEALTH CARE OVERALL IN THE
EXPENSE OF THAT.
SOME ARE MEMBER PLANTS WERE EVER
TO HAVE QUESTIONS AND GET SOME
CONCERNS REGARDING THE EXECUTIVE
ORDER AND HOW IT WILL IMPACT
THAT HEALTH PLANS ABILITY TO
MANAGE CARE FOR THEIR ENROLLEES --
WE'VE YOU THE PHARMACY BENEFIT
AS MORE THAN JUST PURCHASING
DRUGS ON HEALTH PLANS UTILIZED
PRESCRIPTION DATA.
DAT TO MANAGE CHRONIC CONDITIONS
AND MONITOR REFILLS OF SPECIFIC
MEDICATIONS IS UNCLEAR HOW THE
SERVICES -- WILL BE IMPACTED BY
THE CARVE OUT AND HOW IT WILL
ULTIMATELY LOWER THE COST THANK
YOU THANK YOU.
WELCOME.
THANK YOU TERM MEMBERS CUT THE
CHAIR SORRY CATHY MOST WITH THE
LOCAL HEALTH PLANS A CALIFORNIA
WE WOULD ASSOCIATE OURSELVES
WITH THE COMMENTS OF MY
COLLEAGUE FROM CAP BUT TRULY IS
AS YOU POINTED OUT.
THE PHARMACY DATA IS
INTERCULTURAL TO PROVIDE CARE
THAT WE PROVIDE IN THAT ARE THAT
THE FOLKS WHO UTILIZE OUR
SERVICES GET WHEN YOU ALL TELL
US TO PUT TOGETHER AN ASTHMA
PROGRAM. TO TO ALLEVIATE FOLKS
ON CONDITION THAT INVOLVES
GETTING THAT DATA IN A TIMELY
FASHION -- WE DO HAVE CONCERNS
WE HAVE SHARED THOSE CONCERNS
WITHTHE DEPARTMENT AND WISH TO
CONTINUE TO DO THAT WE THINK IT
SHOULD BE VERY CLEAR BEFORE WE
ENTER THIS.
THIS -- NEXT PHASE AS TO HOW WE
WILL BE GETTING THAT DATA WE
HAVE A LOT OF CONCERNS ABOUT
THAT I THINK THAT WE BELIEVE
FROM THE LOCAL HEALTHCARE
PERSPECTIVE THAT THERE IS AN
ALTERNATIVE TO BE MET HERE WE
HOPE TO CONTINUE THOSE
CONVERSATIONS WITH THE
DEPARTMENT BUT WE THINK.
YOU CAN STILL GET THE SAVINGS
CERTAINLY ASSURE YOU KNOW
ASSOCIATE OURSELVES WITH OUR
COMMENTS FROM OUR THREE FORTY BE
PARTNERS.%
BUT WE THINK THERE'S A PLACE TO
GO HERE WOULD LIKE TO CONTINUE
THOSE DISCUSSIONS THANK THANK
YOU.
WELCOME HI GOOD AFTERNOON CHAIR
MEMBERS MICHELLE COVERED IT UP
WITH SCA YOU CALIFORNIA AND WE
ARE SUPPORTIVE OF THE GOVERNOR'S
PROPOSAL TO RE LOOK AT HOW WE DO
OUR PRESCRIPTION DRUG SPENDING
ACROSS THE STATE -- WE THINK
THAT A MEDI CAL IT'S IMPORTANT
TO UNDERSTAND WHAT THREE FORTY
B. AS FUNDING AND IF APPROPRIATE
TO BACK FILL OR REINVEST THOSE
SAVINGS T MAKE SURE THAT WE
HOLD THE SAFETY.
NET HARMLESS -- FOR GOOD
SERVICES THAT THEY'RE PROVIDING
AND IF THERE'S A WAY TO DRAW
DOWN ADDITIONAL FEDERAL MATCH
EVEN BETTER SO WE ENCOURAGE THE
ADMINISTRATION'S REVIEW OF THIS
AND WOULD LIKE TO ENCOURAGE.
GREATER TRANSPARENCY ON BOTH
SIDES THANK YOU THANK YOU
[inaudible]
WELCOME.
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY WE APPRECIATE
THE ADMINISTRATION'S EFFORT TO
CONTROL COSTS AND WOULD LIKE DIE
THERE'S TO BE AN ACKNOWLEDGEMENT
THAT THERE WILL ALWAYS AND BE
ENROLLEES WHO NEED DRUGS NOT ON
THE SO.
ON THE LIST SO ANY.
MOVE TO STANDARDIZE OR RESTRICT
PRESCRIPTION DRUGS SHOULD
CONSIDER THAT MEDI CAL COVER
SOME OF THE THE SICKEST
INDIVIDUALS AND SO THERE SHOULD
BE A ROBUST PROCESS. TO ENSURE
THAT INDIVIDUALS HAVE ACCESS TO
MEDICALLY NECESSARY TRUCKS
THANKS.
THANK YOU.
RIGHT THANKS FOR MUCH ALRIGHT SO
LET'S MOVE ON WE HAVE TO
STAKEHOLDER PROPOSALS -- RELATE
TO THIS SO WE FOR THE FIRST ONE
IS ACTUALLY ON HIM LIBRA WHICH
WE DID HEAR A LITTLE BIT ABOUT
THE PUBLIC COMMENT ON THE
PHARMACY SERVICES OVERVIEW.
AND I THINK WE HAVE SOMETHING
GENETEC [inaudible]
IT'S HERE. 70% ON THAT YOUR COME
UP HERE.
THAT'S THIS IS A PROPOSAL A
STAKEHOLDER DATA PUBLIC COMMENT
SO OKAY WELL WELCOME.
THANK YOU MISTER CHAIR.
THANK YOU -- FOR ONE MEETING UP
SORRY MISTY JOHNSON WITH OF
NIELSEN MARK SUMMER HERE ON
BEHALF OF SYMANTEC THANK YOU FOR
MEETING WITH US EARLIER THIS
YEAR.
ON THIS PARTICULAR ISSUE WE ALSO
LIKE TO THANK THE DEPARTMENT
WE'VE HAD A NUMBER OF DAYS HOURS
IF YOU WILL TALKING WITH
INDIVIDUALS WITHIN THE
DEPARTMENT ABOUT HIM LEVER AND
THE POTENTIAL FOR CAR ABOUT SO
THAT PATIENTS COULD ACCESS.
MEDICATION LATE LAST WEEK WE
LEARNED THROUGH SOME OF OUR
MANAGED CARE PARTNERS THAT THE
DEPARTMENT HAD ACTUALLY TAKEN
ACTION ON THAT AND WE WELCOME
THAT.
WE LOOK FORWARD TO WORKING WITH
HIM ON IMPLEMENTATION SO THAT
THESE PATIENTS CAN ACCESS THIS
MEDICATION.
THANK YOU.
THANK YOU ANY COMES FROM PARKER
CENTER AND I WOULD JUST SAY WE
IT WILL BE A CARVED OUT
RETROACTIVELY TO TWENTY
SEVENTEEN TO THE DATE SO THAT
THERE WON'T BE ANY ISSUES WE DID.
WE DID END UP UNDERSTANDING SORT
OF EVEN THOUGH IT'S NOT THE SAME
AS BLOOD FACTOR IT'S CLOSE
ENOUGH IN THE IN THAT SORT OF
GENRE THAT THAT HAS BEEN
SOMETHING WE'VE ALWAYS -- YOU
KNOW HAVE FOUND TO MAKE IT
EASIER TO HAVE AN FEE FOR
SERVICE SO WE ARE IN THE PROCESS
OF DOING THAT AND CERTAINLY WILL
BE WORKING WITH YOU GUYS.
THANK YOU LA -- COMMENTS FINANCE.
SO JUST TO CLARIFY DO EAT
BECAUSE THE PROPOSAL FOR TRAILER
BILL LANGUAGE WE NEED THAT
ANYMORE.
OKAY THAT'S OKAY SWUNG CLARIFY
THAT.
OKAY THANK YOU VERY MUCH
APPRECIATE SEE WE DON'T.
THE AGENCY ACTUALLY CAN ACT
FASTER THAN WE CAN ALL RIGHT
THANK YOU.
THERE YOU GO.
I LIKE IT WHEN YOU DO IT WITHOUT
WAITING FOR US ALL RIGHT.
OKAY.
NEXT WE HAVE A PROPOSAL FOR A
CARVE OUT.
OF HIGH CUTS STROKES FROM
POSSIBLE REIMBURSEMENT FROM
CALIFORNIA CHILDREN'S HOSPITAL
ASSOCIATION WELCOME.
THANK YOU MISTER CHAIR AND MERE
MARTIN TODAY AND HAVE THE
CALIFORNIA CHILDREN'S HOSPITAL
ASSOCIATION -- WE'RE DOING KIND
OF A NEW WANTS TO ASK RELATED TO
HOW HOSPITALS ARE REIMBURSED FOR
HIGH COST DRUGS WHEN THEY
ADMINISTER THEM ON AN INPATIENT
BASIS TO MEDI CA PATIENTS.
THAT ARE REIMBURSED A FEE FOR
SERVICE.
THE VERY NARROW -- AND WORD
DEFINING HIGH COST DRUGS IN THE
LANGUAGE AS MORE THAN FIFTY
THOUSAND DOLLARS WHOLESALE
ACQUISITION COST.
THE CURRENTLY WHEN A FEE FOR
SERVICE MEDICAL PATIENT IS
ADMINISTERED A PRESCRIPTION DRUG
ON AN INPATIENT BASIS THE
HOSPITAL'S REIMBURSE AS PART OF
A D. R. G. WHICH IS A BUNDLED
AVERAGE PAYMENT TO TREAT THAT
PATIENT INCLUDING EVERYTHING
INCLUDING THE DRUG -- BUT WHEN
THERE'S A NEW HIGH COST DRUG ON
THE MARKET THAT'S NOT BEEN PART
OF THE STANDARD OF CARE OFTEN
THE DRG PAYMENT WILL NOT CAPTURE
THAT COST AND PARTICULARLY WON'T
CAPTURE FOR A NUMBER OF YEARS.
OR IF THE DRUG IS TRADITIONALLY
ADMINISTERED OUTPATIENT AND ONLY
SOMETIMES IS THE PATIENT
HOSPITALIZED AND THEN IT'S PETER
DEAR G. THE DEAR G. WILL NOT
CAPTURE THAT BECAUSE IT'S NOT
CONSIDERING IT PART OF THE IN
PATIENT CARE.
SO IN THOSE CASES THE LOSS TO
THE HOSPITAL CAN BE QUITE
SUBSTANTIAL WE HAD A TRUCK LAST
YEAR CAMERA OUT FOR LEUKEMIA.
THE LOSS OF THE HOSPITAL WAS
ABOUT THREE HUNDRED THOUSAND
DOLLARS EVERY TIME THEY
ADMINISTER THIS AND THE PATIENT
WAS HOSPITALIZED IF THEY WERE A
MEDI CAL FEE FOR SERVICE
PATIENTS.
JUST MOSTLY WHO ARE HOSPITAL SEE --
WE DID REACH OUT TO THE
DEPARTMENT AT THE END OF TWENTY
SEVENTEEN AND BY EARLY THIS YEAR
THEY AGREED TO CARVE THAT DRUG
OUT OF OUT OF THE DRG SYSTEM AND
REIMBURSE IT BASED ON ITS COST.
TO MAKE SURE THAT THE HOSPITALS
WERE MADE WHOLE AND NOT AND
PENALIZED FOR OFFERING THE DRUG.
SO WHAT WE'RE SEEKING TO DO HERE
IS BASICALLY CODIFY THAT
PRACTICE FIND THE RIGHT TARGET
FOR ON FOR THESE REALLY HIGH
COST DRUGS.
AND MAKE SURE THAT THE HOSPITAL
IS MADE WHOLE WHEN THEY
ADMINISTER THOSE DRUGS ON AN
INPATIENT BASIS AND I'M HAPPY TO
ANSWER ANY QUESTIONS.
THANK YOU ANY COMMENTS FROM THE
DEPARTMENT OKAY ELIO.
FINANCE.
ALL RIGHT.
OKAY THANKS VERY MUCH THANK YOU.
ALL RIGHT -- I KNOW OF ANY
PUBLIC COMMENT ON EITHER OF THE
US TO STAKEHOLDER PROPOSALS.
OKAY GOOD.
ALL RIGHT.
OKAY THANK YOU VERY MUCH ALL
RIGHT SO -- WILL BE WAITING WITH
BATED BREATH.
AND THE ESTIMATES SINCE HE SAID
HAVE TO WAIT.
BUT I THINK THAT -- NO
[inaudible]
THE COLOR.
THEY SAID THAT THEY WERE THERE'S
TREMENDOUS INTEREST IN THE
LEGISLATURE -- IN TERMS OF HOW
WE IMPLEMENT -- THE GOVERNOR'S
VISION -- REGARDING SINGLE
PURCHASING WHILE I THINK
GENERALLY PEOPLE VERY SUPPORTIVE.
THE DETAILS MATTER AND AND IN
WHAT PEOPLE ARE EXPECTING AT
WHAT MAY HAPPEN WHAT PEOPLE
EXPECTING ME NOT NECESSARY
MATCHUPS SO THERE MAY BE SOME
DISCUSSIONS ABOUT THAT
[inaudible]
ALL RIGHT.
NEXT ISSUE IS THE CAN OKAY SO
I'VE FIVE A SIX FORMALLY SAY FOR
ISSUE NUMBER ONE WE'RE HOLDING
OPEN THE TO STAKEHOLDER
PROPOSALS FOR MEDICAL DENTAL
SERVICES ISSUE TO ROLLING OPENED
THE STICKER PROPOSALS MAKE.
A SOLO.
OKAY SO NEXT ISSUE IS THE ELEVEN
FIFTEEN WAIVER FOR MEDI CAL
TWENTY TWENTY SO THAT'S COMING
DOWN THE LINE.
VIEW.
SO -- YOU TO ASK FOR A BRIEF
UPDATE IS OKAY I JUST WANNA MAKE
SURE YOU STILL WANT THAT.
BEFORE I START TALKING YOU SAID
TO BE BRIEF SO YOU KNOW -- BUT
SO THERE ARE FOUR I WAS ALLOWED
TO DETAILS.
THAT THERE ARE THE FOUR MAJOR
PROPOSALS THAT WE THINK OF
OBVIOUSLY THE FIFTH IS THE ODS
WAIVER WE'VE HAD OTHER
CONVERSATIONS ABOUT THAT SO I
MORE.
ONLY BE TALKING ABOUT THE SORT
OF FOR THAT PEOPLE USUALLY
ASSOCIATE -- THE FIRST BEING THE
GLOBAL PAYMENT PROGRAM SO THAT
IS THE PROGRAM WHERE WE MET
ESSENTIALLY REQUIRE RE PURPOSING
THE DISH FUNDS AND SAFE IN A
COUPLE FUNDS TO MOVE AWAY FROM A
HOSPITAL BASED AND COST BASED
SYSTEM.
IN ORDER TO ENCOURAGE OUR PUBLIC
HEALTH CARE SYSTEMS TO UTILIZE --
PRIMARY CARE AND SPECIALTY CARE
FOR THESE POPULATIONS -- AND WE
NEED TO DO THAT THROUGH ELEVEN
FIFTEEN WAIVER BECAUSE OF THE
WAY THAT DISH TYPICALLY -- NEEDS
TO BE ALLOCATED SO WE HAVE SEEN
SOME PRETTY GOOD SUCCESS IN THE
SHIFTING FROM IMPATIENT TO OUT
PATIENT AND REDUCED EMERGENCY
ROOM UTILIZATION -- WE HAD OUR
FIRST INTRO VALUATION THAT CAME
OUT LAST YEAR THAT SHOWED SOME
OF THAT OBVIOUSLY THOSE IT WAS
STILL THE EARLY YEARS OF THAT
BUT WE BUT YOU KNOW IT IS IT IS
IT DOES LOOK LIKE IT'S
ACCOMPLISHING WHAT.
WE HAD DESIRED WHICH WAS REALLY
TO PROVIDE -- YOU KNOW WHAT AN
ACCESS POINT TWO PRIMARY CARE
SPECIALTY CARE FOR THOSE WHO
STILL REMAIN UNINSURED IN THE
SEATS -- WE HAVE -- PAID OUT
ABOUT FOUR POINT TWO BILLION
DOLLARS IN AFFECT -- AND AGAIN
OBVIOUSLY WE STILL HAVE MORE TO
TO COME GIVEN THAT WE STILL HAVE
ANOTHER YEAR AND A HALF INCH OF
OF THE PROGRAM -- THE SECOND
PROGRAM IS THE PRIME PROGRAM --
AND I NEVER REMEMBER WHAT PRIME
STANDS FOR SO I'M JUST GONNA AND
NOT SAY IT.
BOB SPITTLE REDESIGN AND
ADMITTED AS AN MEDICARE YES AND
THERE'S LIKE MISSING LETTERS
LETTERS THAT ARE TO CAPITAL I
YEAH SO I WE WERE WE WERE
STRIVING FOR A A A A GOOD ACTORS
AND THEIR SO WE ARE NEARING THE
END OF THE FOURTH YEAR OF
IMPLEMENTATION SO LIKE.
WITH A G. P. V. THESE PROGRAMS
RUN ON A FISCAL YEAR BASIS EVEN
OUR WEAVER'S A CALENDAR YEAR IT
GETS CONFUSING -- SO THERE ARE
FIFTY TWO HEALTH SYSTEMS THAT
PARTICIPATE IN PRIME WE DID HAVE
TO HEALTH SYSTEMS DROP OUT
BECAUSE THE HOSPITAL'S CLOSED --
MEANT SO WE DO HAVE ALL OF OUR
DESIGNATED PUBLIC HOSPITALS SO
ARE COUNTY AND YOU SEE
FACILITIES AND NOW ALL EXISTING
ARE ALMOST ALL DISTRICT
MUNICIPAL HOSPITALS --
PARTICIPATING AS WELL -- THE
PROGRAM REALLY ESSENTIALLY
REQUIRES A STANDARD SET OF
PROJECTS AND METRICS.
AND THEN THERE'S A MENU OF
ADDITIONAL ONES THAT THAT THE
HOSPITAL SYSTEMS CAN CHOOSE AND
THEY THEY'RE IN THE OUTPATIENT
DELIVERY SYSTEM TRANSFORMATION
REALM TARGETED HIGH COST HIGH
RISK AND THEN RESOURCE
UTILIZATION EFFICIENCY.
THAT WHICH SOUNDS SUPER BORING
BUT IS SUPER IMPORTANT.
AND SO -- ESSENTIALLY THE WAY
THE PROGRAM IS STRUCTURED IS
THAT THERE WAS IN THE EARLIER
YEARS MORE PAY FOR REPORTING.
NOW IN THE CURRENT YEAR -- OVER
90% OF THE METRICS ARE PAY FOR
PERFORMANCE AND WILL BE GOING
295% IN IN THE FINAL YEAR OF THE
PROGRAM -- SO WE HAVE LET'S SEE
WE'VE PAID OUR ROADS -- ABOUT
ONE POINT. SIX BILLION DOLLARS A
YEAR IN TOTAL FUNDS SO I DIDN'T
WRITE DOWN MY MY FEDERAL FUNDS
IT'S LOTS LOTS OF FEDERAL FUNDS.
LIKE THREE THREE BILLION FEDERAL
FUNDS.
AND THEN I AM.
AND WE ARE WE HAVE BEEN HAVING A
SIGNIFICANT ENGAGEMENT WITH OUR
PUBLIC HOSPITAL SYSTEMS INDUSTRY
TO MUNICIPAL HOSPITALS -- OUR
OFFICE OF THE MEDICAL DIRECTOR --
HAS PRETTY MUCH CONSTANT CONTACT
WITH THE PRIME TEAMS AND WE ARE
HOSTING TO IN PERSON
COLLABORATIVE CONFERENCES IN
TWENTY NINETEEN WE DO THIS EVERY
MAY AND ONE COMING UP IN OCTOBER
AND THIS IS WHERE.
THEY CAN DO PEER TO PEER
LEARNING IN AND SHARE BEST
PRACTICES -- SO WE'LL HAVE BE
HAVING THAT COMING UP BUT THE
THIRD IS THE DENTAL
TRANSFORMATION INITIATIVE THAT
WE BRIEFLY TOUCHED ON EARLIER --
THAT HAS FOUR CATEGORIES --
INCENTIVE PAYMENTS TIED TO
PREVENTIVE SERVICES UTILIZATION
THE TEN PERCENTAGE POINT
INCREASE THAT WE TALKED ABOUT --
THE ESSENTIALLY A PILOT TING
TYPE PROCESS FOR THE CARRIES
RISK MANAGEMENT MODEL THAT IS
NOW IN TWENTY NINE COUNTIES WE
ACTUALLY ALSO HAVE A HUGE
INCREASE THE NUMBER OF PROVIDERS
WHO HAVE NO REGISTERED FOR THAT
IT WAS.
WE ONLY HAD TWO HUNDRED TEN
PROVIDERS IN DECEMBER AND WE NOW
HAVE OVER.
ELEVEN HUNDRED PARTICIPATING SO
WE'RE REALLY EXCITED ABOUT THAT.
AND THE THIRD WAS THE CONTINUITY
OF CARE ESSENTIALLY A INCENTIVE
PAYMENTS SO.
IF YOU CONTINUE TO SEE THE SAME
CHILD A YEAR AFTER YOU WOULD BE
YOU WOULD BE RECEIVING
ADDITIONAL MONEY THAT HAS NOW
EXPANDED TO THIRTY SIX COUNTIES
WERE THAT IS.
THAT IS HAPPENING IN OUR FORCE
WAS -- WE SOLICITED LOCAL DENTAL
PILOT PROGRAMS WE CURRENTLY HAVE.
THIRTEEN THAT HAVE BEEN FULLY
EXCUTED -- WE'VE WE'VE SPENT
ABOUT EIGHT EIGHTY MILLION
DOLLARS SO FAR ON THAT IT WAS A
SLOWER START GIVING SOME OF THE
LONGER TIME FRAME -- BECAUSE THE
APPLICATION PROCESS AND GETTING
CONTRACTS SIGNED AND ALL THAT
KIND OF STUFF.
AND THE FINAL ONE IS THE WHOLE
PERSON CARE PILOT PROGRAM -- WE
HAVE TWENTY FIVE PILOT SWITCHER
IN -- TWENTY FIVE COUNTIES AND
ONE CITY -- WE AS OF SEPT THE
SEPTEMBER DIETZ.
AT SEPTEMBER QUARTER HAD EIGHTY
FIVE THOUSAND TWO HUNDRED AND
SEVENTY FOUR PEOPLE ENROLLED IN
THE PROGRAM WE ARE PRETTY
CONFIDENT BECAUSE WE'RE
FINALIZING THE DECEMBER DATA NOW
THAT WE WILL BE OVER A HUNDRED
THOUSAND PEOPLE -- AND SO YOU
KNOW WE SPENT ABOUT FIVE HUNDRED
AND THIRTY MILLION OF THE DOLLAR
SO WE ARE -- BEHIND I WOULD SAY
IN THE AMOUNT OF MONEY IT IS
THREE HUNDRED MILLION DOLLARS A
YEAR IN FEDERAL FUNDS.
AND WE'VE SPENT FIVE HUNDRED
THIRTY IN TWO AND A HALF YEARS
SO WE ARE WORKING WITH THE PILOT
PROGRAMS THEY ARE RAMPING UP A
LOT MORE IT WAS IT TOOK ALL IT
DID TAKE SOME TIME BUT WE WERE
WORKING WITH THEM ON ROLLING
OVER MONEY SO THAT.
WE'RE NOT LEAVING THAT MONEY ON
THE TABLE BUT THAT WE WILL YOU
KNOW OUR GOAL IS TO SPEND AT ALL
BY THE END OF THE FIFTH YEAR SO.
WE SHOULD SEE A BIG INCREASE IN
SPENDING -- BY THAT BY THE END
OF OF THE PROGRAM AND I YOU KNOW
THINK WE'RE REALLY EXCITED
ABOUT THIS PROGRAM IT'S IT'S
DOING.
PRETTY AMAZING THINGS AND REALLY
HELPING PEOPLE'S LIVES CHANGE --
SO JUST SOME OF THE THINGS THAT
AND I ONE OF MY FAVORITES IS THE
CAN TO PEER LA COUNTY PROGRAM I
DON'T KNOW IF YOU'VE HEARD ABOUT
THAT PROGRAM BEFORE.
SO -- FOR PARTICULAR POPULATIONS --
WHO ARE ESSENTIALLY HOMELESS ARE
VERY ISOLATED THEY ARE ASSIGNED
AN INDIVIDUAL WHO TALKS THEM
PRETTY MUCH EVERY DAY TAKES THEM
TO THE GROCERY STORE HELPS THEM?
GET COULD GET.
CONNECTED TO THEIR COMMUNITY IF
THEIR FAMILY IS SOMETHING THEY
COULD BE SAFELY RECONNECTED WITH
SAFELY RECONNECT THEM.
AND SO REALLY IS THAT THINGS ARE
CHANGING CHANGING PEOPLE'S LIVES
OBVIOUSLY WE HAVE HAD SUCCESS
ALSO WITH GETTING PEOPLE INTO
HOUSING BECAUSE OF SOME OF THE
SUPPORT OF HOUSING STUFF THAT WE
CAN DO IN TERMS OF TENDENCY
SUPPORT OF THAT FIRST FIRST AND
LAST MONTH'S RENT SECURITY UPON
THE KIND.
OF THINGS AND THEN SOME OF OUR
COUNTIES OBVIOUSLY ALSO DO
PROVIDE DIRECT HOUSING SUPPORT --
WITH THE NON FEDERAL MONEY THAT
IS IN THE PROGRAM SO WE'RE
REALLY EXCITED ABOUT IT AND I
THINK YOU KNOW IT IS A BIG PART
OF WHAT WE'RE TRYING TO THINK
ABOUT HOW DO WE DO THIS.
ON A STATEWIDE BASIS -- AFTER
THIS WAIVER IS OVER AND REALLY
JUST INCORPORATING THESE TYPES
OF SERVICES INTO OUR BROADER
MEDI CAL SYSTEM.
THANK YOU LA ECHO COMMENTS
[inaudible]
FINANCE [inaudible]
SO.
SO IN TERMS OF THESE WAIVERS AND
THEN THIS WAIVER AND ALL THE
VARIOUS THINGS YOU'RE DOING
RIGHT AND SOME OF THEM AS YOU
INDICATED TAKE SOME TIME TO WRAP
THINGS UP SO WE GOT THE WAIVER.
IT TAKES SOME TIME TO RAMP IT UP --
WHEN THE WAIVER EXPIRES -- AT
HOW MUCH DATA HAVE ABOUT CELLS
YEAH WE TALKED ABOUT WITH THIS
WE SPENT THIS MUCH WE DID IT-CETERA.
AND THEN OF COURSE I SOON WILL
BE APPLYING FOR ANOTHER WAIVER
WHAT CROSS OUR FINGERS AND SEE
WHAT CNN AS RIGHT AND WASHINGTON
IS A LITTLE INTERESTING RIGHT
NOW.
AND I KNOW THERE'S SOME ANXIETY
ABOUT THAT TOO BUT IT'S TERM.
I MEAN WE'LL SEE BY THE TIME THE
WAIVERS OVER.
WELL YOU WOULDN'T HAVE DATA FOR
THAT LAST YEAR YET BECAUSE
YOU'RE STILL DOING AT RATE.
YOU'D SELL THE LATEST DATA WOULD
HAVE PERHAPS IS THE YEAR BEFORE.
I I GUESS I'M TRY TO FIGURE OUT
HOW TO CAPTURE LIKE WHAT
HAPPENED WITH THE WAIVER RIGHT
AND AND AND AND AND AND HOW DO
WE MOVE FORWARD BECAUSE I THINK
AT LEAST TO BE PART OF THE
PURPOSE OF OF THESE PROGRAMS IS
THE SAY WELL WHAT WORKED WHAT.
DIDN'T WORK WHAT WE WANT TO
CONTINUE TO MOVE FORWARD WITH --
WHAT WE PITCH TO CMS THAT WE
WANT TO CONTINUE RIGHT -- I MEAN
IT SO I GUESS IT WILL MAYBE ALL
OF THEM BUT BUT I MEAN IT'S
HELPFUL TO BE ABLE TO SAY LOOK
WE'VE GOTTEN SOME INFORMATION TO
SHOW THAT WE MADE A DIFFERENCE
SO.
HOW DO YOU SEE THAT ROLLING OUT
AND HOW AND HOW DO YOU SEE
REPORTING OUT TO YOU KNOW THE
LEGISLATURE AND OTHER PEOPLE
ABOUT WHAT THE?
RESULTS ARE LIKE QUITE.
BEYOND THEY'LL HAVE SOME GREAT
CASE STORIES AND SO FORTH BUT
EXACTLY WHAT.
WHAT HAPPENED?
SURE SO WE DO HAVE --IN MOST OF
THE PROGRAMS WE HAVE MID MID
EVALUATION OR HOWARD SO WE'VE
DONE SOME OF THOSE.
I THINK WE HAVE ONE COMING UP
FROM ONE I'M SORRY I DON'T
REMEMBER THEM OFF THE TOP OF MY
HEAD WE ALSO DO QUARTERLY AND
ANNUAL REPORTS ON THE WAIVER TO
SEE A MASS -- AND SO WE ARE
ESSENTIALLY COMBING THROUGH THAT
INFORMATION AND LOOKING AT THE
OTHER DATA THAT WE HAVE YOU KNOW
EVEN IF THE EVALUATION ISN'T
DONE YET.
AS A BASIS FOR HAVING THAT
CONVERSATION THAT WE THINK WILL
STAR IN THE FALL OF WHAT THINGS
WORKED AND SO HOW DO WE THEN I
THINK THE POINT YOU'VE MADE A
LOT LIKE HAVE IT NOT TO BE
PILOTS ANYMORE BUT REALLY HOW DO
WE IF SOMETHING'S WORKING HOW DO.
WE MAKE IT INTO THE MEDICAID
PROGRAM AS A WHOLE JUST CLARIFY
I MEAN THAT.
SOME PEOPLE SAY RIGHT WE I
SUBMIT REPORTS. TO THOSE REPORTS
ARE JUST LIKE WHAT WE SPEND THIS
MUCH MONEY AND WE DELIVERED EX
NUMBER SERVICES SO FORTH I MEAN
THAT'S BEEN A WE HAVE ACTUAL.
VALUATION.
SO I THINK WHAT THEY MIGHT BE
HELPFUL IS.
THAT BIT OF A A BROADER TIMELINE
ON THE VALUATION THE KIND OF
RESULTS YES WE'RE GOING TO YET I
MEAN THE ON THE OUR REPORTING WE
SPENT.
HOWEVER MUCH MONEY OBVIOUSLY IS
BUDGET COMMITTEE AND CARE ABOUT
MONEY A LOT.
BUT ALSO I'M THINKING ABOUT THE
EMIGRATE AND AND ALSO RECOGNIZE
FOR EXAMPLE OKAY SO THE WAIVERS.
DONE WE HOPE THAT IT WILL
CONTINUES ON THESE PROGRAMS
CONTINUE IN A FUTURE WAIVER BUT
IS OR HOW ARE WE GOING TO DO.
YOU KNOW THE DEAD OR CAPTURED A
LAST YEAR RIGHT AND DEPENDING
HOW LONG IT TOOK TO RAMP UP AND
SO AND BY WE WILL HAVE TO RAMP
UP.
YEAH WE WANT YOU DON'T DOES NOT
THINK THINGS SO HAPPEN ONLY ONE
YEAR BUT THE OF MAY TAKE A FEW
YEARS BEFORE YOU SEE THE IMPACT.
IS THERE'RE SOME SORT OF PLANNED
FOR EVALUATION TO OR YOU KNOW
TWO YEARS OUT FROM THE
CONCLUSION OF THIS WAIVER NOW OF
THE THIRD LACKEY WEEKS WE'RE
STILL CONTINUE THE PROGRAM BUT
EVEN THE PROGRAM FOR SOME REASON
WAS NO LONGER FUNDED DUMMIES OR
SOME.
WAY TO LOOK AT WHAT THE
CONCLUSION OF THAT WAY FOR ALL
OF THE PROGRAMS ALSO REQUIRE
FINAL EVALUATIONS THAT LOOK
ACROSS THE FIVE YEARS SO.
OBVIOUSLY WE DON'T GET THAT WAS
DONE UNTIL AFTER THE PRO RIGHTS
OVER BUT YES IT WAS WITH THE
WINDOWS EXPECT TO HAPPEN AND BY
THE FINAL EVALUATIONS LIKE A
YEAR LATER TWO YEARS LATER.
I WILL NEED TO GET BACK TO YOU
IT IS MORE THAN A YEAR LATER.
I GET -- KNOW IF IT'S EXACTLY A
YEAR LATER FOR EIGHTEEN MONTHS
LATER -- WITH THERE'S PARTICULAR
TIME FRAME SO I'D HAVE BUT I'LL
I'LL FOLLOW UP BY JUST ON OKAY
YES TO BE INTERESTED IN KNOWING
WHAT THE THE FINAL AND ALSO YOU
SAID THE MID TERMS.
YEAH I LIKE HAVE SOME OF THOSE
THAT WE CAN SHARE RIGHT AT THE
END AND AND THE ONES YOU DON'T
HAVE YET WHEN YOU EXPECT TO GET.
I THINK THAT BE HELPFUL BECAUSE
IT WILL BE VERY.
I WAS AROUND WHEN YOU SAID
YOU'RE PROPOSING IS WAIVERS AND
SO OKAY GOT A LOT OF GOOD IDEAS
OF PRIDE AT SOME OTHER ONES TOO
BUT THE OF INTERESTING THINGS
THAT YOU'RE TRYING TO DO AND BE
GOOD TO KNOW WHAT THE RESULTS
ARE THAT.
THAT THOSE ARE SO THANK YOU.
IS LA ARE GOING TO BE INVOLVED
IN LOOKING AT SOME OF THESE
THINGS ARE LOOKING AT THE
VALUATION MAYBE COMPILE SOME
REPORTS ABOUT THE THE THE WAIVER.
RESULTS I THINK IT'S MORE WORK
WHEN YOU'RE NEAR.
WE CERTAINLY ARE TRACKING THE
EVALUATIONS AS THEY COME OUT AND
WE'RE HAPPY TO LOOK MORE CLOSELY
AT AT THOSE REPORTS AND PROVIDE
ASSISTANCE AS NEEDED.
OKAY WELL I YEAH I THINK IT'S
SINCE YOU GUYS WORK FOR US.
THE I I THINK COULD BE HELPFUL
TO BE ABLE.
TO TRY TO DRAW OUT WATER LESSONS
LEARNED FROM THE THIS WAIVER SO
THAT WAS WE'RE LOOKING AT POLICY
MOVING FORWARD AND IS IS I'D.
WATCH WE LOOK FOR IN THE NEXT
WEBER OBVIOUSLY IT'S TIME THAT
WE DECIDE BY ADMINISTRATION BUT
THEN ALSO FOR THE ONES THAT CMS
MAY OF DECLINED TO FUNDER FUND
DIE LOWER SCALE. TO WHAT DEGREE
MIGHT WE WANT TO BE THE PUT IN
STATE RESOURCES ARE NOT PUT IN
STATE RESOURCES TO CONTINUE SOME
OF THE WORK.
DEPENDING ON THE LEVEL OF
SUCCESS AND WHAT SCALE THAT WE
NEED TO DO IT AT TO STILL.
BE ABLE TO GET THE RESULTS SO.
RATES OF ED PRECIADO AREAS AND
PUT INTO THAT.
AND WE ARE TRYING TO WORK TO GET
YOU A FEW MORE RESOURCES
[inaudible]
OKAY.
I THINK THE NEW LA L. TRIUMPHS
SHARES BIGGER VISION OKAY.
ALL RIGHT -- OKAY WE NOTICED A
COLD LOS ANGELES WHEN OKAY OKAY
WITH THAT -- LET'S GO AHEAD TAKE
PUBLIC COMMENT ON THIS --
WELCOME I AM A GROUP CALIFORNIA
DENTAL ASSOCIATION.
WANT TO SPEAK TO THE DTI -- THE
SPECIFIC DENTAL SPECIFIC ASPECT
OF THE ELEVEN FIFTEEN WAIVER --
WE ARE VERY PLEASED WITH THE
RESULTS SO FAR THE THE PROGRAM
YOUR ANALYSIS SO FAR.
ARE ACTUAL STE SHOWING
QUANTIFIABLE INCREASES IN
CHILDREN'S.
ACCESS TO DENTAL CARE -- THEY
THEY DO USE -- ILLUSTRATE REAL
GAMES AND REAL ODD NEW BEST
PRACTICES THIS IS.
THE THE DTI IS THE THE FIRST
FORAY INTO VALUE BASED PAYMENT
IN THE FOR SERVICE DENTISTRY AND
WE HAVE REAL CONCERNS ABOUT
LOSING THAT MOMENTUM WHEN THE
LIVE ELEVEN FIFTEEN WAIVER
EXPIRES.
INDICATION FROM THE FEDERAL
GOVERNMENT IS THAT THEY BOB DUE
TO THEIR NEW RULES WILL WILL NOT.
APPROVE A A DENTAL COMPONENT --
FOR AT ANY NEXT ELEVEN FIFTEEN
WAIVER AND SO WE ARE.
VERY HOPEFUL THAT WE CAN START
THOSE CONVERSATIONS NOW ABOUT
CONTINUING THE BEST PRACTICES A
THREE STATE PLAN AUTHORITY -- IT
IS SO THAT THERE IS NOT STOPPING
AND STARTING WE DON'T WANT TO
HAVE TO WAIT UNTIL ON THE FINAL
EVALUATION IN ORDER TO THEN SAY
THESE ARE THE BEST PRACTICES
THAT CAME OUT OF THE TI AND THEN.
YOU KNOW WORK ON IMPLEMENTING
WE'RE HOPING TO HAVE THOSE
CONVERSATIONS NOW.
THANKS OKAY THANK YOU EXCELLENT
POINT OKAY WELCOME.
GOOD AFTERNOON SIR HAS GOOD FOR
THE CALIFORNIA ASSOCIATION OF
PUBLIC HOSPITALS AND HEALTH
SYSTEMS.
AS YOU KNOW PUBLIC HEALTH CARE
SYSTEMS ARE MAJOR PROVIDERS IN A
NUMBER OF THE WAIVER PROGRAMS
INCLUDING PRIME WHOLE PERSON
CARE IN THE GLOBAL PAYMENT
PROGRAM.
AND OVER THE LAST FEW YEARS
WE'VE SEEN SUBSTANTIAL
IMPROVEMENTS IN BOTH HEALTH
OUTCOMES AND CLINICAL CARE AS A
RESULT OF THESE EFFORTS.
IN PRIME IN ABOVE OUR SYSTEMS
ARE MEETING TOP PERFORMANCE --
AND OVER 90% OF THEIR OVERALL
PERFORMANCE MEASURES IN THE
GLOBAL PAYMENT PROGRAM AS WAS
MENTIONED THE EARLY EVALUATION
INDICATES GOOD TRENDS AROUND
INCREASES AN OUTPATIENT SERVICES
AND REDUCTION IN IN PATIENT FOR
UNINSURED PATIENTS.
AND WHOLE PERSON CARES REALLY
SHOWING SOME PROMISING RESULTS
IN TERMS OF IMPROVED ACCESS AND
ROLL MIGHT IN COORDINATION AT
THE LOCAL LEVEL -- THE
OPPORTUNITY TO INVEST IN THIS
KIND OF WORK AND THE FUNDING
THAT'S ASSOCIATED WITH IT IS
ABSOLUTELY ESSENTIAL FOR OUR
HEALTH SYSTEMS.
AND THE PATIENTS THAT WE SERVE
WE HAVE OVER TWO BILLION DOLLARS
A YEAR IN REVENUE THAT WOULD BE
ASSOCIATED WITH THESE PROGRAMS
THAT WILL AND IN.
TWENTY TWENTY AND SO A LOT OF
THE WORK THAT WERE INVOLVED IN
NOW AND CERTAINLY WORKING
CLOSELY WITH THE STATE IS REALLY
THINKING ABOUT WHAT COMES NEXT
WE HAVE DONE A SERIES OF
DIFFERENT REPORTS ASSOCIATED
WITH THESE PROGRAMS AND I'M
HAPPY TO SHARE THIS WITH YOUR
TEAM.
THANK YOU.
I THANK YOU LET'S SEE THIS
REPORT I ALL I KEEP THIS BRIEF
MICHELLE COVERED I WITH SCA YOU
CALIFORNIA AND WE SUPPORT --
EXPLORING WAYS TO MAKE SURE THAT
OUR PUBLIC HEALTH SYSTEMS
CONTINUE. TO RECEIVE THE OVER
TWO POINT FIVE BILLION ASH THAT
THEY GET THROUGH THE EXISTING
ELEVEN FIFTEEN WAIVER -- PUBLIC
HOSPITAL SELF FINANCED THEY PUT
UP NON FEDERAL SHARE AND SO
THEY'RE NOT CURRENTLY GETTING --
THE STATE GENERAL FUND MATCH FOR
MUCH OF THEIR OPERATIONS AND WE
THINK THAT A PUBLIC HEALTH CARE
SAFETY NET IS VITAL -- TO LOW
INCOME CALIFORNIANS BOTH IN MEDI
CAL AND WHO ARE UNINSURED SO WE
WOULD -- URGE YOU TO CONTINUE TO
LOOK AT THE WAIVERS AND ALSO THE
WHAT IF -- IF WE DO NOT AT
CHOOSE TO PURSUE AN ELEVEN
FIFTEEN THANK YOU [inaudible]
THANK YOU.
THANK YOU MR CHAIRMAN MEMBERS
I'M VERY MCDADE TING ON BEHALF
OF THE CALIFORNIA STATE
ASSOCIATION OF COUNTIES
REPRESENTING ALL FIFTY EIGHT
COUNTIES IN CALIFORNIA I WILL
ALIGN MY COMMENTS WAS SEE A PAGE
AND SEIU.
THAT CRITICAL FUNDING STREAM OF
THESE WAIVERS BRING IN THE
MEDICAID WAIVER SPECIALLY WE
LOOK FORWARD TO WORKING WITH THE
H. YES TRY TO FIND SOME
INNOVATIVE SOLUTIONS TO ENSURE
THAT OUR SAFETY NET HOSPITALS
CAN CONTINUE TO OPERATE THANKS.
THANK YOU.
WELCOME HI MARTY A MOTOR FAMILY
MEMBER CALIFORNIA DISPLACING
YOUR COMMUNITY ACTION NETWORK
CALIFORNIA PRISONS AND ADVOCACY
PARTNERSHIP FIRST.
WANT TO COMMEND THE
ADMINISTRATION THE DEPARTMENT
SPECIFIC FOR THE INNOVATIONS
UNDER LAB FIFTEEN WAIVERS
SPECIALLY THE WHOLE PERSON CARE --
AND BUT I DO WE DO STRONGLY
SUPPORT YOUR REQUEST OF SENATOR
PAN REGARDING THE EVALUATIONS
AND REALLY MEASURING.
THE IMPACT ON INDIVIDUAL SOME
PEOPLE NOT JUST NUMBERS.
AND NOT JUST UTILIZATION ISSUES
OR WHETHER SOMEONE YOU KNOW.
HOSPITALS OR WHATEVER IT IS IT
REALLY NEEDED THE DIFFERENCE ON
THE IMPACT OF INDIVIDUALS
BECAUSE THAT'S THE WHOLE POINT
OF THIS.
BUT AGAIN PRE SHAPED WORKING
WITH THEDEPARTMENT ON THIS AND
WILL HELP YOU WITH THE BETTER
ABBREVIATIONS ON SOME OF THE I
BLAME CA PH FOR PRIME JUST TO
PUT THAT ON THE RECORD.
THANK YOU.
GOOD AFTERNOON SENATOR FOUND I'M
LYDIA MISLEADING AND I'M THE
EXECUTIVE DIRECTOR FOR THE
CALIFORNIA ASSOCIATION FOR ADULT
A SERVICES -- WE REALLY HAVEN'T
HAD A CHANCE TO SPEAK WITH YOU
OR WITH -- THE DEPARTMENT WITH
MERRY ABOUT THIS BUT I JUST
DIDN'T WANT ANYONE TO OVERLOOK
THE FACT THAT IN THE ELEVEN
FIFTEEN WAIVER.
OF THE COMMUNITY BASED ADULT
SERVICES PROGRAM THAT WAS
CREATED UNDER FEDERAL LAWSUIT.
A SETTLEMENT -- EXISTS ONLY IN
THAT WAIVER.
AND SO -- I KNOW MARIE IS VERY
AWARE OF THIS AND WE WILL ENGAGE.
AS SOON AS WE CAN TO TALK ABOUT
THE STATUS OF SEA BASS GOING
FORWARD BUT OBVIOUSLY WE'RE VERY
CONCERNED THERE IS NO STATUTORY
FRAMEWORK.
FOR THE MEDIC HELP PORTION OF
ADULT DAY HEALTH CARE IT ONLY
EXISTS IN THE WAIVER SO JUST
WANTED TO MAKE NOTE OF THAT AS A
PLACE HOLDER FOR FUTURE
DISCUSSION THANK YOU.
THANK YOU THANK YOU FOR POINTING
OUT WELCOME.
AM DOCTOR SENATOR PAN AM MY NAME
IS DEBBIE TELL THEM THAT
PRESIDENT AND CEO OF CHOICE AN
AGING.
AND WE ARE A C. BASS PROVIDER
AMONG OTHER THINGS SO I DID WANT
TO ELEVATE THAT AS WELL SO I'LL
ECHO LYDIA'S COMMENTS AND ALSO
TO SPEAK TO MARTY'S COMMENTS ONE
OF THE THINGS THAT WE'RE
EMBARKING ON AN CONTRA COSTA
COUNTY IS.
HOW WE DEFINE HEALTH AND LOOKING
AT THAT AND FOR SOME FOLKS?
IT'S FOOD ON THE TABLE AS
OPPOSED TO WHETHER OR NOT
THEY'RE CHRONIC CONDITIONS ARE
BEING TREATED IN THE WAY THAT WE
LOOK AT HISTORICALLY IN MEDICINE
AND SO.
I WOULD JUST ENCOURAGE JUST AS
WE MEASURE THINGS IN THE ELEVEN
FIFTEEN WAIVER TO LOOK AT MAYBE
A BROADER DEFINITION OF WHAT
HEALTH THIS OF THANK YOU.
THANK YOU [inaudible]
WELCOME.
GOOD AFTERNOON RENTAL COMING
HERE ON BEHALF OF HEALTH ACCESS
CALIFORNIA WE JUST LOVE A LINE
IN ECHO MY COMMENTS WITH AT THE
AYE YOU MY COLLEAGUE MICHELLE
CABRERA.
THANK YOU VERY MUCH FOR HAVING
THIS CONVERSATION WE LOOK FOR TO
THE CONTINUING DISCUSSION MOVING
FORWARD.
THANK YOU WELCOME.
NO MY BOTTOM A CALIFORNIA RURAL
LEGAL ASSISTANCE FOUNDATION AS
AN ORGANIZATION WORKING IN THE
COUNTY THAT HAS THESE PROGRAMS
WE ALIGN OUR COMMENTS OF HEALTH
ACCESS ANY OTHER ADVOCATES OF
THANK YOU VERY MUCH.
THANK YOU.
RIGHT THANK YOU RUN TESTIFYING
AT JUST ONE OTHER QUESTION SO IN
TERMS OF WELL THIS WAIVER SO
WHEN WHEN THIS PLANNING START
FOR THE NEXT ONE WE HEARD FOR
THE DENTAL ASSOCIATION THAT
THEY'LL THAT.
THE NEW GUIDELINES MEANS SO BUT
WHAT POINT DO WE SAY WE'RE SORRY
THE NEXT ONE AND GETTING SOME
INFORMATION AS TO WHAT YOU LOOK.
WERE YOU EXPECTING TO PUT IN --
NOT OR WORSE THINGS THAT LOOK
LIKE THAT WE ARE CURRENTLY DOING
THAT YOU FEEL THAT WILL PROBABLY
IN GIVEN THE CURRENT FEDERAL
GUIDELINES MAY UNFORTUNATELY NOT
BE ABLE TO BE PUT INTO A WAIVER
OBVIOUSLY CMS STORE.
YEAH SO -- WE HAVE STARTED OUR
INTERNAL PROCESS -- GZ COOPER
WHO IS MY SENIOR ADVISER HER
DAUGHTER KENNEDY WAS HERE
EARLIER.
THEY HAD TO LEAVE THAT SHE HAS
BEEN REALLY SHE'S GOING TO BE
OUR LEAD PERSON IN TERMS OF
ORGANIZING THIS PROCESS AND IT
REALLY IS SOME OF THE STUFF I
TALKED WITH YOU ABOUT ME THE
LAST TIME I TO THE FUTURE OF
MEDIC HOW. THREE OF CONCEPTS
THAT REALLY IS FOR STARTING WITH
NOT JUST THIS WAIVER BUT THE
NINETEEN FIFTEEN MENTAL HEALTH
WAIVER THAT'S EXPIRING.
AND SO WE'RE REALLY DOING THAT
INTERNAL PROCESS RIGHT NOW --
AND THEN WITH THE ADMINISTRATION
AND SO PROBABLY LIKE LATE SUMMER
EARLY FALL IS WHEN WE WILL START
TO HAVE A MORE ROBUST
STAKEHOLDER PROCESS WE ARE
CERTAINLY HAVING CONVERSATIONS
WITH THE WITH THOSE WHO ARE MOST
SIGNIFICANTLY AFFECTED JUST TO
SERVE HAVE THOSE EARLY
CONVERSATION SO CERTAINLY -- THE
DENTAL COMPONENT WILL BE ONE OF
THOSE -- I THINK PROBABLY JUST A
CLEAR FIVE REALLY WHAT PEOPLE
HAVE HEARD ME SAY IT WASN'T
EXACTLY WHAT.
I HAVE BUT WHAT.
OUR BELIEF IS THAT WE THERE IS
NOT A POSSIBILITY FOR LARGE
ELEVEN FIFTEEN WAIVERS IN THE
FUTURE BECAUSE OF THE RULES THAT
CMS IS PUT IN PLACE FOR THE
BUDGET NEUTRALITY COMPONENT --
BUT THAT DOES NOT MEAN THAT OUR
INTENTION IS TO NOT CONTINUE THE
PROGRAMS THAT ARE WORKING SO ON
THE DENTAL SIDE WE WILL WE WOULD
HAVE TO FIND ANOTHER WAY TO DO
IT -- THERE ARE OTHER
AUTHORITIES JUST LIKE THERE'S
OTHER AUTHORITIES WE COULD USE
FOR OR ANY OF THESE OTHER
COMPONENTS SO THAT IS REALLY THE
CURRENT WORK WE'RE DOING THE
ANALYSIS ON WHAT AUTHORITIES.
CAN WE USE AND AND YOU KNOW I
WOULD ALSO SAY THERE SO --
BENEFIT TO USING A LESS
SUBJECTIVE AUTHORITY -- AND NOT
THE AUTHORITY THAT THEY'RE DOING
WORK REQUIREMENTS THROUGH SO I
MEAN I THINK THAT'S IT'S PART OF
THAT CALCULUS WHAT I ACT
ACTUALLY THINK MATHEMATICALLY
WE'RE NOT.
GOING TO BE ABLE TO DO WHAT YOU
KNOW WE'VE DONE FOR THE PAST
THREE THREE WAIVER CYCLES BUT IT
DOESN'T MEAN WE'RE NOT TO BE
ABLE TO DO THE SAME PROGRAMS.
THEY MIGHT LOOK A LITTLE
DIFFERENT BUT WE CAN DO THEM
UNDER OTHER AUTHORITY SO WILL
HAVE DEFINITELY MUCH MORE
CONVERSATION IT USER LATE SUMMER
EARLY FALL WITH -- SORT OF
EVERYONE WHO'S INTERESTED WHICH
IS EVERYBODY SO.
HELLO PLANET AND I'M INTERESTED
I KNOW I HAD THAT I WAS
INCLUDING YOU [inaudible]
YOUR OFFICE.
OKAY.
ALRIGHT SO THE AND SO I JUST
WANT YES SENSE OF WHAT OUR TIME
LINE IS AN WATER EXPECTS.
SO IT'S IT'S THAT LATE SUMMER
EARLY FALL TO START THE
STAKEHOLDER PROCESS WE WOULD
WANT TO HAVE A PLAN A SO WE
WOULD HAVE.
GENERALLY THE WHAT WERE THINKING
THAT WE CAN SHARE AT THAT TIME
IN IT SOME OF IT IS COMING OUT
OF THE CARE COORDINATION GROUP
THAT WE HAD LAST YEAR.
THAT WAS REALLY HELPFUL IN IN
SORT OF THINKING ABOUT THE
FUTURE OF THE PROGRAM -- SO YEAH
SO WE'LL HAVE SOME STUFF COMING
OUT THEN AND THEN HAVE A LOT OF
ROBUST CONVERSATIONS LIKE WE
ALWAYS DO.
IN TERMS OF WHAT IS THE PROPOSAL
GOING TO LOOK LIKE -- AGAIN I
THINK IT WILL BE A LITTLE
DIFFERENT BECAUSE I DON'T THINK
IT WILL BE A LARGE ELEVEN
FIFTEEN WE WILL WE WILL STILL
NEED SOME ELEVEN FIFTEEN
AUTHORITY FOR SEA BASS FOR
EXAMPLE AND TO THE ODS WEAVER
BUT THOSE -- ANGIE PP BUT THOSE
ALL AREN'T DON'T HAVE BUDGET
NEUTRALITY ISSUES IT'S THE OTHER
THINGS I HAVE A HOUSING TRIAL
THE ISSUE SO THAT'S WHY WE'RE
LOOKING AT A MAYBE NINETEEN
FIFTEEN B. HEALTH AUTHORITIES
ARE STATE PLANT ORTIZ TO BE ABLE
TO CONTINUE.
I LOOK FOR TO YOU EDUCATING ME
ON THESE THINGS.
ALL RIGHT OKAY THANKS VERY MUCH.
LET'S MOVE ON TO THE WHOLE
PERSON CARE HOUSING SERVICES.
SURE SO -- THE GOVERNOR AND HIS
JANUARY BUDGET WAS IS PROPOSING
A ONE TIME ONE HUNDRED MILLION
DOLLAR AUGMENTATION THAT WOULD
BE GOING TO THE WHOLE PERSON
CARE PILOT ROGRAMS. TO SUPPORT
HOUSING SERVICES SO THIS WOULD
INCLUDE LIKE LONG TERM AND SHORT
TERM HOUSING COULD BE RENTAL
SUBSIDIES AS WELL AS CAPITAL
INVESTMENT AND BUILDINGS YOU
KNOW ESSENTIALLY BUILDING
HOUSING PROJECTS -- THE IT IS
NOT MATCH THIS IS WHY WE CAN DO
THESE THINGS BECAUSE THEY CAN'T
DO ANY OF THAT WITH WITH FEDERAL
MONEY.
WE DID RELEASE WAS IT JUST
EARLIER THIS WEEK YES LAST WEEK
YOU PUT IT IN YOUR AGENDA SO YOU
HAD AT SOME POINT -- THE THE
PROPOSED ALLOCATION ACROSS THE
ACROSS ALL OF THE PILOTS -- MAY
WAS A MIXTURE OF BUT YOU KNOW
THE POINT TIME HOMELESSNESS THE
MEN'S YOU KNOW MENTAL ILLNESS
AND THE FAIR MARKET.
RENT -- EFFICIENCY AMOUNT SO IT
WAS IT WAS BASED ON SORT OF A
COMBINATION OF THOSE THINGS --
SO OUR INTENTION IS THAT THAT
MONEY WILL BE AVAILABLE TO EACH
OF THOSE PILOTS.
THE CABBIE OUGHT WE HAVE IS THAT
IF A PILOT IS NOT CURRENTLY
PERFORMING -- WE'VE HAD FIVE
PILOTS BEEN BE UNDER CORRECTIVE
ACTION PLANS TO STILL ARE -- SO
WE WOULD NOT BE PROVIDING THE
MONEY UNTIL THOSE ISSUES ARE
RESOLVED.
THANK YOU ARE COMING TO MILLION --
BEN JOHNSON ALEJO WE PROVIDE
ANALYSIS OF THE WHOLE PERSON
CARE HOUSING SERVICES EARLIER
THIS -- THAT THIS YEAR WE HAD
SOME QUESTIONS AND THAT -- THAT
WERE LARGELY ANSWERED BY THE
DEPARTMENT THE ONLY ONES THAT --
WE STILL HAVE OUTSTANDING ARE
HOW THIS FUNDING WOULD
ULTIMATELY RELATE TO SORT OF
FORTHCOMING MONEY THROUGH NO
PLACE LIKE HOME AND SO FORTH TO
BETTER COORDINATE -- THE VARIOUS
SORT OF POTS OF FUNDING THAT
WE'RE PROVIDING [inaudible]
FINANCE [inaudible]
COMMENTS OKAY.
YEAH I THINK WHEN THE A BECAUSE
I PREACH IN WE HAVE TREMENDOUS
NEEDS AROUND ADDRESSING HOUSING
THOUSAND DOES THAT WE HAVE THE
PART HERE POP THEIR POT THERE
AND SO HOW RECORD.
HOW ARE YOU BE SURE THAT THE?
WHAT'S ARE ALL WORKING WITH EACH
OTHER NOT AGAINST EACH OTHER
OKAY -- PUBLIC COMMENT.
THANK YOU MISTER CHAIR FOR
ADVOCATING ON BEHALF OF THE
CALIFORNIA STATE ASSOCIATION OF
COUNTIES AGAIN IN STRONG SUPPORT
OF THE GOVERNOR'S PROPOSAL --
FOR SOME STATE GENERAL FUND TO
SUPPORT A WHOLE PERSON CARE AND
THE HOUSING SIDE OF IT --
BECAUSE WE'RE BRINGING ALL OF
OUR SERVICES TO BEAR AND USING A
LOT OF FEDERAL FUNDING AND OTHER
THINGS TO MAKE ALL PERSON CARE
WORK BUT IT'S THE HOUSE IS THE
MISSING PIECE WHICH WE HEAR
ACROSS ALL OF OUR ISSUES.
AND SO WE REALLY APPRECIATE THE
PROPOSAL ARE STRONGLY SUPPORTING
THE WELCOME.
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY WE ALSO STRONGLY
SUPPORT THIS PROPOSAL BUT ALL OF
WOULD ALSO RECOMMEND FOR THE
METHODOLOGY THE DEPARTMENT
CONSIDER.
INDIVIDUALS EXPERIENCING CHRONIC
HOMELESSNESS INSTEAD OF HOME
WITH.
MATH GENERALLY AS PRIORITY
SHOULD BE GIVEN TO THE MOST
VULNERABLE POPULATION -- IN
ADDITION THERE'S THERE'S A
QUESTION WHETHER OR THE FUNDING
GOES TO THE COUNTY OR THE LEAD
ENTITY.
A REGARDLESS WE BELIEVE THERE
SHOULD BE A CONNECTION WITH
HOUSING SUPPORTIVE SERVICES
INCLUDES THE INCLUDING HOUSING
NAVIGATION IN TENNESSEE SUPPORT
EITHER THROUGH THE WHOLE PERSON
CARE PILOT OR HEALTH HOMES
PROGRAM. TO ENSURE OF
EFFECTIVENESS OF THESE FUNDS
THANK YOU THANK YOU.
WELCOME MICHELLE CAM DATA WITH
US YEAH YOU CALIFORNIA WE ALSO
ARE IN STRONG SUPPORT OF THIS
PROPOSAL AND AGREE WITH YOUR
POINT THAT WE NEED TO LOOK
HOLISTICALLY AS WELL IF POSSIBLE --
THE HOMELESSNESS CRISIS AS AND
JUST SORT OF ALREADY HIT IT'S
DEEPENING AND CONTINUING WE ARE
LOSING HOUSING SUPPLY --
CONSTANTLY BECAUSE PROPERTY
VALUES ARE SO HIGH AND WE DON'T
REIMBURSABLE -- FOLKS AT
ADEQUATELY TO KEEP LOW INCOME
FOLKS -- HOUSE AND WE WOULD ALSO
LIKE TO SUPPORT THE IDEA OF
MAKING SURE THAT WE'RE LOOKING
AT THIS FROM THE STANDPOINT OF
SUPPORTIVE SERVICES AS WELL
THANK YOU.
WELCOME THAT AFTERNOON SIR HAS
GETS WITH THE CALIFORNIA
ASSOCIATION OF PUBLIC HOSPITALS
IN MY COMMENTS ARE ARE BOTH
REPRESENTING SEE PAGE AS WELL AS
THAT OF THE COUNTY HEALTH
EXECUTIVES ASSOCIATION GEAC.
WE ALSO IN STRONG SUPPORT OF THE
BUDGET PROPOSAL AND WHAT OFFER
TWO RECOMMENDATIONS AS WE MOVE
FORWARD TO ENSURE ITS SUCCESS
WITH THE METHODOLOGY ONE WOULD
BE TO MAINTAIN THE KERN
ELIGIBILITY FOR HOUSING SUPPORT
SERVICES WHOLE PERSON CARE
ALREADY HAS A DEFINED.
ELIGIBLE POPULATION AND WE'D
LIKE TO SEE THE BUDGET PROPOSAL
BE CONSISTENT WITH WHAT IS
ALREADY CURRENTLY IN PLACE AND
ALLOW THAT FLEXIBILITY LOCALLY.
AND THEN THE SECOND WOULD BE TO
ENGAGE STAKEHOLDERS IN
DETERMINING HOW TO ASSESS
PERFORMANCE OUR COMMUNITIES HAVE
SOME REALLY STRONG LESSONS
LEARNED AROUND HOW WE'VE BEEN
DOING THIS AT THE LOCAL LEVEL
AND WE THINK WE CAN BE HELPFUL
IN AND IDENTIFYING.
KIND OF HOW TO MEASURE
PERFORMANCE ACT REALLY THANK YOU
THANK YOU.
WELCOME HI MARTY EMOTO FAMILY
MEMBER CALIFORNIA DISPLACING YOU
CAN ACTION NETWORK CALIFORNIA
PERSON CENTERED ADVOCACY
PARTNERSHIPS IS STRONG SUPPORT.
FOR THIS PROPOSAL AND ALSO --
ECHO THE COMMENTS MADE BY THE
PREVIOUS SPEAKERS.
THANK YOU WELCOME.
NICOLE ORNAMENT ON BEHALF OF THE
ORANGE COUNTY BOARD OF
SUPERVISORS ALSO SUPPORTING THIS
PROPOSAL OKAY THANK YOU.
ALL RIGHT WELL AGAIN I DO
APPRECIATE THE GOVERNOR'S
PROPOSAL FOR THIS AS A PHYSICIAN.
I KNOW THAT WHEN I PATIENTS TO
HAVE ARE HOMELESS OR HAVE
UNSTABLE HOUSING IT'S VERY HARD
TO GET SERVICES BECAUSE
PRACTICALLY THE FIRST QUESTION
YOU GET ASKED WE REQUEST
SERVICES THAT WHAT'S YOUR
ADDRESS.
AND THE FACT THAT THE FINES OR
YOUR ADDRESS TO FIND OKAY NOW
YOU GET SERVICE IN THIS PERSON
CONCERNED IS COUNTY OR JUST
NEIGHBORHOOD OR WHATEVER ELSE SO --
SO SIDE THEN IN ADDITION OF
COURSE HAVING A STABLE POINT AND
SO I THINK THIS.
IS OFTEN THE MISSING PIECE IN
AND SHE MENTIONED THAT
UNFORTUNATELY THIS IS THE PART
THAT WE HAVE TO PUT THE MONEY UP
FOR BECAUSE WHEN I GET YOU A
FEDERAL MATCH WE'RE NOT GETTING
IT CETERA CELL.
I APPRECIATE THE GOVERNOR
PUTTING THIS.
FOR ALL RIGHT LET'S MOVE ON TO
ISSUE NUMBER FIVE PRIVATE
HOSPITAL DIRECTED PAYMENT
QUALITY INSTEAD OF FOR SURE SO
THIS IS A RESOURCE REQUEST --
FOR FOR PERMANENT POSITIONS IN
EIGHT A FIVE YEAR LIMITED TERM
RESOURCES REALLY FOR US TO
IMPLEMENT THESE TWO PROGRAMS --
THE THESE ARE PROGRAMS THAT
GENERALLY HAVE BEEN FUNDED BY.
THE HOSPITAL QUALITY ASSURANCE
BE AN INTERGOVERNMENTAL
TRANSFERS FROM OUR PUBLIC
HOSPITALS -- THIS IS JUST A NEW
STRUCTURE ESSENTIALLY BECAUSE OF
THE MANAGED CARE RULE AND IT'S
UNFORTUNATELY MORE COMPLICATED
HENCE THE NEED FOR MORE
RESOURCES.
OKAY COMES MILLENNIAL.
FINANCE ANY PUBLIC COMMENT ON
THIS OKAY WELL WE LIKE TO KEEP
THEIR QUALITY JERSEY COMING IN
SO.
HIS PHONE WE NEED PEOPLE TO DO
THE WORK ALL RIGHT SO ISSUE
NUMBER SIX IS THE HOME AND
COMMUNITY BASED SERVICES WAIVER
PROGRAMS.
SURE SO -- YOUR ASSETS.
THEM THAT WE WILL HOLD THE
PREVIOUS ITEM SORRY.
I SURE SO YOU'D SPECIFICALLY
ASKED FOR AN UPDATE ON THE
ASSISTED LIVING WEAVER.
SO WE DID HAVE OUR WEAVER
RENEWED EFFECTIVE MARCH FIRST OF
THIS YEAR -- IT IS A FIVE YEAR
RENEWAL WE DID HAVE WE HAD DONE
AN AMENDMENT LAST YEAR AT TWO
THOUSAND ADDITIONAL SLOT SO THE
WAIVER RENEWAL ALSO INCLUDES
THAT SO WE DO HAVE -- THE TOTAL
CAPACITY IS ABOUT FIVE THOUSAND
SEVEN HUNDRED AND FIFTY
INDIVIDUALS WE ARE RELEASING
THOSE SLOTS AT AT A RATE OF
ABOUT FIVE HUNDRED A MONTH IN
ORDER TO MAKE SURE THAT THE CARE
COORDINATION AGENCIES YOU KNOW
HAVE THE CAPACITY TO DO THE
ASSESSMENTS OF OF THE SERVICES
THAT.
ARE NEEDED AND JUST AS A
REMINDER WE DO HAVE A
REQUIREMENT THAT AT LEAST 60% OF
THE INDIVIDUALS AND ROLLING IN
THE IN THE PROGRAM ARE ACTUALLY
COMING FROM FACILITIES.
SO THEY'RE REMOVING OUT INTO THE
COMMUNITY AT THE THE REMAINING
40% CAN COME FROM THE COMMUNITY
ESSENTIALLY PREVENTING THEM FROM
BEING -- PUT INTO AN
INSTITUTIONAL SITUATION -- WE
ARE YOU KNOW IT SORT OF THINKING
ABOUT THE NEXT PHASE EVEN THOUGH
THIS WAIVER WAS JUST RENEWED.
IT WAS A SORT OF AGAIN PART OF
WHAT WE'VE TALKED ABOUT HERE
BEFORE HOW DO WE THINK MORE
HOLISTICALLY ABOUT THE MEDI CAL
PROGRAM IN ALL OF THESE WAIVERS --
AND NOW PEOPLE WHO'VE HEARD ME
TALK ABOUT THESE WE HAVE NOW
HEARD ME SAY THIS BUT BECAUSE
RIGHT NOW RIGHT PURPLE STRIPES.
POLKA DOTS YOU GET THIS PROGRAM
BUT NOT THAT AN ORANGE I ALWAYS
PICK DIFFERENT COLOR SO ORANGE.
ORANGE SKIN THAT'S MAYBE NOT A
GOOD ONE GREEN SKIN AND A PURPLE
STRAIGHT SAY IS ANOTHER AND
THAT'S CONFUSING FOR THE
BENEFICIARIES IT'S CONFUSING FOR
ALL OF YOU AS YOU TRY TO DO
OVERSIGHT OVER THESE PROGRAMS
AND IT'S ALSO CONFUSING FOR US
AS AN ADMINISTRATOR.
SO WE WILL BE LOOKING AT HOW DO
WE THINK MORE HOLISTICALLY ABOUT
EIGHT CBS AND NOT.
ALL THESE INDIVIDUAL WAIVERS BUT
AND AGAIN SIMILAR TO THE
PHYSICAL HEALTH SIDE IN THE
DENTAL SIDE OF THE MENTAL HEALTH
AND BEHAVIOR A WHOLE SIDE THAT
WE REALLY WANT TO BE THINKING
ABOUT HOW DO WE MAKE.
THINGS MORE STANDARDIZED AND HOW
DO WE MAKE IT EASIER FOR PEOPLE
TO ACCESS SERVICES SO THAT WILL
BE PART OF THE CONVERSATION THAT
I MENTIONED.
THAT WILL BE HAVING LATER THIS
YEAR AS WE REALLY CONSIDER WHAT
WE WANT THE FUTURE OF ALL THESE
WAIVERS TO LOOK LIKE.
OKAY IN A NOTRE AND OUR
DESCRIPTION WITH SEVEN DIFFERENT
WAIVERS.
YES EIGHT YES.
OKAY FINANCE ALL RIGHT AND WE DO
HAVE THREE STAKEHOLDER PROPOSALS
RELATED -- TO THESE WAIVERS SO
THE FIRST IS -- SEE WE HAVE
PROPOSAL FOR CALIFORNIA
COMMITTEE TRANSITIONS PROGRAM
FOR DISABILITY RIGHTS CALIFORNIA
HERE PERCENT.
ON THAT.
ONE AND THEN AFTER YOU DO THE
STATE CALLED PROPOSAL TO PUBLIC
COMMENTS SO IF THREES.
THE THREE SIGNALED PROPOSALS
RELATED TO THIS [inaudible]
OKAY WELCOME.
MINOR THREE MINUTES FOR ALL THE
TESTIMONY AND THEN OBVIOUSLY
WHEN WE ASK QUESTIONS YOU HAVE
MORE CHANCES.
WELCOME THANK YOU MISTER
CHAIRMAN DEBORAH DISABILITY
RIGHTS CALIFORNIA.
MAY I SPEAK BRIEFLY ON THE HOME
AND COMMUNITY BASED.
ALTERNATIVES WAIVER BECAUSE THAT
RELATES TO SEE CITY IT IS AN
INNER URINALYSIS AS ONE OF THE
SEVEN WAIVERS.
AND THEN I'LL ASK MY COLLEAGUE
FROM EAST BAY INNOVATIONS TALK
ABOUT CCT.
WITH THAT WORK FOR YOU.
I'LL BE FAST ON EVEN IF SO AND
YOU ALSO CAN MAKE A PUBLIC OUT
AND I'M GONNA BE REALLY REALLY
FAST WE HAD A WITNESS HERE WHO'S
AT THE CONSISTENT CONSTITUENT OF
YOUR SYSTEM WORKING WITH YOUR
OFFICE.
WHO HAS BEEN ON THE WAITING LIST
FOR THE HOME AND COMMUNITY BASED
SERVICES WAIVER HER NAME IS
MERRY KERR?
SHE HAS SOMETHING CALLED I'LL
GET IT WRONG MUSCULAR.
SPINAL ATROPHY SHE KELLY IN YOUR
OFFICE HAS BEEN HELPING HER
SINCE LAST SUMMER SHE
APPRECIATES THAT.
WE KNOW THAT LAW A WAIVER SLOTS
HAVE INCREASED WE DO HAD A VERY
ROBUST HEARING IN.
THE OTHER HOUSE SO IN AND MAY
SIXTH IS A DATE BY WHICH THE
DEPARTMENT HAS BEEN ASKED TO
PROVIDE AN UPDATE ON THE H. C.
B. WE WERE WHEN WE VERY MUCH ASK
YOU TO CONCUR IN THAT REQUEST
OKAY [inaudible]
ALL RIGHT.
LIVVIE CENTERS ON BEHALF OF EAST
BAY INNOVATIONS -- REGARDING UP
THE CALIFORNIA COMMUNITY
TRANSITIONS BUDGET REQUEST ON
BEHALF OF THE R. C. AND E. B. I.
FOR NINETEEN POINT ONE MILLION
DOLLARS.
OF STATE GENERAL FUND FUNDING --
TO CONTINUE CALIFORNIA COMMUNITY
TRANSITIONS WE'VE BEEN.
IN THIS KIND OF LIMBO WITH
CONTINUED FEDERAL FUNDING -- FOR
CALIFORNIA COMMUNITY TRANSITIONS
IT WAS SUPPOSED TO EXPIRE.
DECEMBER THIRTY FIRST -- TWENTY
EIGHTEEN WE THEN WOULD HAVE A
YEAR TO CONTINUE -- FOLLOW UP
BUT NO LONGER BE ABLE TO
TRANSITION WE SINCE THEN GOT A
THREE MONTH EXTENSION AND A SIX
MONTHS AS EXTENSION FROM THE
FEDS THE PROBLEM WITH THAT IS
TWO FOLD.
IT LEAVES OUR COMMUNITY
TRANSITIONS LEAD ORGANIZATIONS
IN TURMOIL WE HAVE EMPLOYEES
LEAVING THEY CAN'T STAY IF THEY
DON'T KNOW THEY'RE GOING TO HAVE
A JOB LONGER THAN TWO MONTHS.
NUMBER ONE NUMBER TWO WE CAN'T
SUCCESSFULLY TRANSITION THE
INDIVIDUALS THAT WE HAVE BEEN
ABLE TO TRANSITION WE'VE
TRANSITIONED OVER THIRTY FIVE
HUNDRED INDIVIDUALS WHO
OTHERWISE WOULD BE STRANDED
SKILLED NURSING FACILITIES ARE
INSTITUTIONAL SETTINGS.
AND THESE ARE COMPLICATED VERY
DETAILED TIME INTENSIVE
TRANSITIONS THAT WE CANNOT
COMPLETE IN THE TIMELINE
NECESSARY UNLESS WE HAVE A
STABLE FUNDING SOURCE FOR HOPE
WE OPTIMISTIC THE FEDS WILL GIVE
A LONGER EXTENSION.
BUT WE CAN'T JUST KEEP BEING IN
THIS LIMBO PHASE THE DEPARTMENT
CAN'T GIVE US A LOT OF ADVICE
ABOUT HOW TO PROCEED UNLESS WE
HAVE SOME STABLE FUNDING SO WE
ARE ASKING FOR THAT STABILITY.
AND SHE FORGOT TO SAY THE WAIVER
IS NOT FOR EVERYBODY SO THAT'S
THE OTHER BIG ISSUE IS WE CAN'T
JUST RELY ON THE EIGHT CPA
WAIVER BECAUSE FOR THE ASSISTED
LIVING WAIVER OR ANYTHING ELSE
BECAUSE IT.
IT'S NOT A ONE SIZE FITS ALL WE
ARE ABLE TO TRANSITION
INDIVIDUALS -- AND SUPPLEMENT
EIGHT CB A WAIVER SUPPLEMENT ALE
W. WAIVER SUPPLEMENT IHS US BUT
WE NEED TO KEEP THE CCC CCT
PROGRAM IN PLACE IN CALIFORNIA
THANK YOU.
THE MOVE YET.
ANY COMMENTS FROM THE EIGHTY S.
ALEJO.
FINANCE SO IS NOT CLEAR IF I SO
THE REQUEST HERE AND SO YOU WANT
TO CONTINUE THE CCT THE
COMMUNITY.
THE CALIFORNIA COMMITTEE
TRANSITION SERVICES SO THE
REQUEST BECAUSE YOU SAID THERE'S
FOR THE VINE HEARING YOU SAY IS
THERE'S UNCERTAINTY ON THE
FEDERAL SIDE RIGHT BECAUSE
UNFORTUNATELY.
CONGRESS DOES WHAT CONGRESS DOES
AND WE SOMETIMES DO THAT HERE IN
THE LEGISLATURE RIGHT NOW WE'RE
NOT SURE WE'D SUPPORT AND WILL
KEEP YOU GOING FOR THREE MONTHS
AND FIGURED OUT RIGHT AND OF
COURSE IN THE MEANTIME YOU'RE
LIKE TO HAVE A JOB IN THREE
MONTHS ARE NOT.
GOING TO ACTUALLY KEEP GOING --
YEAH DON'T WORRY WE KEEP GOING
OUT BUT WE NOT SURE RIGHT -- SO
WITH THIS MONEY IS HE SAID
AUTHORITIES THIS IS TO SAY THAT
IN CASE IT DOESN'T THERE WILL I
MEAN THIS IS LIKE A BACKUP
PROMISES THAT WE'RE TRYING.
TO I'M TRYING TO UNDERSTAND
EXACTLY WHAT THE REQUEST IS.
SENATOR PENN LAST YEAR WE CAME
BEFORE THIS COMMITTEE RIGHT TO
MAKE IT.
PRACTICALLY IDENTICAL REQUEST
BECAUSE THE PROGRAM WAS
SCHEDULED TO END AT THE FEDERAL
LEVEL.
AND NOW WE ARE HERE BECAUSE EVEN
THE WERE OPTIMISTIC ABOUT
FEDERAL MONEY.
THERE WAS TREMENDOUS DISRUPTION
IN THE PROGRAM AS A RESULT OF
THE A TIME LAG BETWEEN THE DATE
WAS SCHEDULE TO END THE
SUBSEQUENT TEMPORARY EXTENSIONS
AND THIS DEMONSTRATES THE VITAL
REASON. FOR THE STATE PUTTING UP
THAT MONEY TO SAY WOW WILL
RECEIVE HAS STRONG BIPARTISAN
SUPPORT IN CONGRESS.
IF THEY CAN'T GET IT TOGETHER
THIS YEAR WE'RE GOING TO FIND IT
BECAUSE WE DON'T WANT THIS
PROGRAM STOP AND IT SAVES MONEY.
AND THIS THIS IS FOR ONE YEAR --
THE PROPOSAL BEFORE YOU WOULD BE
TO ENSHRINE IT IN LAW I'M TO
PROVIDE FUNDING FOR ONE YEAR BUT
WE DO HAVE A POLICY BILL SB TWO
FOURTEEN DODD. FOR THE SENATE
PROGRAM CLARIFIED AND THIS IS A
REQUEST FOR ONE YEAR FUNDING.
IN THE EVENT THAT THE FEDERAL
GOVERNMENT.
DOESN'T COME THROUGH OUR HOUSING
GAP OR SOMETHING SO WE COULD
BASICALLY AT LEAST DEAR THAT
THAT THE NONPROFITS WHO ARE
DOING THIS TO HAVE THEIR
EMPLOYEES TO LOOK.
YOU KNOW YOU WILL DEFINITELY
HAVE A JOB FOR THE NEXT YEAR
BECAUSE THE MATTER WHAT HAPPENS
THERE IS A WAY IN WHICH THIS
WILL BE A FUNDED.
AND MORE IMPORTANTLY SO WE CAN
SUCCESSFULLY CONTINUE TO
TRANSITION PEOPLE THE PROBLEM IS
WE WERE IN A POSITION WHERE
PEOPLE HAD TO STOP STOP OKAY.
ALL RIGHT.
OKAY IT BY ANY FROM TEACHERS
RESPECTIVE I MEAN WELL I MEAN I
THINK WE ARE WE HAVE COMMITTED
AGAIN THERE WAS A SIGNIFICANT
CONVERSATION IN THE ASSEMBLY ON
MONDAY.
AND SO IN ADDITION TO SOME OF
THE OTHER ISSUES WE DID ALSO
COMMIT WITH THE DEPARTMENT OF
FINANCE ON HELPING TO UNDERSTAND
WHAT THE FISCAL RESULT IS IF ALL
THE FEDERAL MONEY IS GONE AND
IT'S ALL STATE FUNDING.
WHAT IS THE SAVINGS IF THERE IS
SAVINGS JUST SO THAT THAT CAN BE
A PART OF THE DECISION MAKING SO
WE ARE WORKING ON THAT?
OKAY M. TO EXPLAIN THE LOG JAM
BECAUSE WE THINK THERE ARE SLOTS
AVAILABLE THEY'RE JUST NOT BEING
FILLED OKAY AND THERE'S A VERY
LONG LIKE TWENTY EIGHT HUNDRED
PERSON WAITING LIST.
OKAY AND AND THIS IS.
IN A SU MOST OF THESE PEOPLE IN
THE NURSING HOMES AT THEM TO BE
A MEDICAL.
SO IN GENERAL YES MOST PEOPLE IN
HER SING SILLY IS RIGHT YEAH I
THINK IT'S 80% -- IF WE ACTUALLY
GOT ABOUT NURSING HOMES ENTER
HOMES WOULD SAVE SOME MONEY TO
WRITE YES AND THAT IS THE BASIS
WHY WE HAVE THESE WEAVERS I
THINK IT'S A CHALLENGE OF HOW DO
YOU DO THAT OR IS THAT.
WHAT ARE THE COMMUNITY RESOURCES
ARE WE DOING IT APPROPRIATELY SO
THAT IS OUR GOAL AS WELL FOR
SURE -- AND AGAIN I THINK A YOU
KNOW AS AS WE COMMITTED TO COME
BACK -- IN A COUPLE OF WEEKS ON
SORT OF SOME OF THE PARTICULAR
CONCERNS HAVE BEEN RAISED THAT
PARTICULAR ON CHILDREN OR OTHERS.
THAT WE THAT WE'RE TRYING TO
ADDRESS BUT YES WE WE ARE A 100%
AND ON HOME COMMUNITY BASED
SERVICES WE JUST.
WE WANT TO MAKE SURE WE'RE DOING
IT RIGHT THERE'S ALSO
UNFORTUNATELY AS YOU ARE VERY
FAMILIAR WITH THERE'S LOTS OF
VERY SPECIFIC FEDERAL
REQUIREMENTS.
THAT ALSO TAKE TIME THAT YOU
KNOW I THINK WE WOULD ALL LIKE
THINGS.
TO MAGICALLY BE EASIER BUT
THEY'RE NOT ALWAYS BUT WE THAT
WE ARE COMMITTED TO TRYING TO
FIGURE OUT.
HOW TO IMPROVE WHAT'S GOING ON
RIGHT BUT AT A AT THE ON THE
BUDGETARY STANDPOINT SO I
UNDERSTAND LIKE OKAY IF THE FED
DOESN'T?
AT ALL BUT PRICE SOME KIND OF A
FINANCIAL I DON'T CARE TO USE
RIGHT WORD BUT BUT IT IS BY WAY
OF IT TURNS OUT WERE FUNDING IT
WE CAN CHANGES WE CAN MAKE THE
RULES LAW HE'S HEARD IT'S OUR
MONEY.
YES.
BUT I MEAN I'M JUST THINKING
ABOUT.
THIS IS A PROGRAM TO GET PEOPLE
OUT OF NURSING HOMES INTO THEIR
HOMES.
THAT'S SAVING US MONEY.
SO WHAT WE KNOW FOR SURE IS IT
SAVED US MONEY BUT BECAUSE WE
HAD ALL FEDERAL MONEY FOR THEIR
PART -- YEAH I THINK THAT'S
WHERE DOES THAT'S THE AMOUNT
THAT WE LOOK AT NINE SO JUST TO
MAKE SURE THAT WE ALL UNDERSTAND
WHAT IT IS IN THE CONTEXT OF IF
THE FEDERAL GOVERNMENT DESN'T
AND WE FIND IT WHAT IT WHAT IS
THAT LOOK LIKE FROM WHAT I TO
TERRY.
PERSPECTIVE OKAY SO I AM VERY
INTERESTED IN YES I NEED AT OUT
BECAUSE MY GUESS IS THAT.
IT.
CERTAINLY THE REQUEST IS FOR
NINETEEN POINT. NINETY POINT ONE
MILLION BUT THE ACTUAL COSTS TO
US.
BECAUSE THE CONSEQUENCE OF NOT
DOING IT.
MAY TURN OUT TO BE A LOT MORE
MAY TURN OUT TO BE EQUALLY
EXPENSIVE.
OR EVEN POTENTIALLY EVEN MORE
SELF OKAY SO IT'S GREAT THAT
YEAH SO IT'S GREAT THE FEDS ARE
PROVIDING NOW BUT EVEN IF THEY
DIDN'T.
WE MAY WANT TO THINK ABOUT OKAY
VERY GOOD.
RIGHT THANK YOU VERY MUCH ALL
RIGHT -- NEXT STAKEHOLDER
PROPOSAL IS THE TO EXPAND CARE
GIVER RESOURCE CENTER FUNDING
AND SERVICES WE OF THE SUSPICION
OF CALIFORNIA CARE GIVER
RESOURCE CENTERS HERE -- WILL
COME [inaudible]
HI.
THANK YOU.
THANK YOU -- BUDGET YOUR PAN
MEMBERS OF THE BUDGET COMMITTEE
THANK YOU FOR THE OPPORTUNITY TO
SPEAK TODAY I'M CATHY KELLY I'M
EXECUTIVE DIRECTOR FAMILY
CAREGIVER ALLIANCE IN THE BAY
AREA.
YOUR RESOURCE CENTER SOME
SPEAKING TO THE REQUEST FOR THE
CALIFORNIA RESOURCE CENTER
SYSTEM TO SUPPORT -- UNPAID
FAMILY CARE GIVERS. FOR A ONE
TIME BUDGET INCREASE OF TEN
MILLION OVER THE NEXT THREE
YEARS EACH YEAR. TO EXPAND AND
RETOOL THE SYSTEM TO RECOGNIZE
THE CHANGING DEMOGRAPHICS OF THE
CALIFORNIA FAMILY CARE GIVERS.
AND THE COMPLEXITY OF CARE.
THAT THEY NEED WE KNOW -- TOO
WELL WHAT THE STATISTICS ARE IN
TERMS OF DEMOGRAPHICS I'M NOT
GONNA TALK ABOUT THE AGING.
DEMOGRAPHICS AS MUCH AS I WANTED
TO HIGHLIGHT SOME OF THE
CHANGING DEMOGRAPHICS OUT.
OF DON'T TELL INTO THE KIND OF
DIRECTION THAT WERE WE WOULD
LIKE TO TAKE.
THE CALIFORNIA SYSTEM AND THAT
IS THAT THE FAMILY CARE GIVERS
ARE TRENDING YOUNGER THEY'RE
MORE DIVERSE THEY'RE MORE LIKELY
BE IN THE WORKPLACE THEY HAVE
CHILDREN AT HOME -- THEY ARE
ALSO PROVIDING ABOUT TWENTY
HOURS A WEEK ON AVERAGE OF IN
HOME ASSISTANCE -- THERE ARE
REALLY THE ONES THAT ARE STUCK
IN THE MIDDLE ALTHOUGH WE SERVE
ALL INCOME BRACKETS -- THE ONCE
A REALLY STOCK OR THE ONES THAT
ARE NOT FAR ENOUGH TO QUALIFY.
FOR INCOME ELIGIBLE PUBLIC
SERVICES NOT RICH ENOUGH TO PAY
FOR PRIVATE SERVICES THIS IS A
GREAT MIDDLE THIS IS THE
MAJORITY OF FAMILY CARE GIVERS.
IN THE STATE.
AND THEIR STOCK -- MANY OF THOSE --
CARE GIVERS ALSO AND THIS IS
SORT OF EMERGING DATA THAT WE'RE
HAVING NOW SO YOU'RE HEARING
SOMETHING BRAND NEW FROM
NATIONAL.
DATA AND ALSO SKIN FROM OUR OWN
DATA COLLECTION EFFORTS -- IN
SAN FRANCISCO AND AND LOS
ANGELES CA OR SEE ON THE SPECIAL --
A RESEARCHER PROJECT THAT WERE
UNDERTAKING IS A UPWARDS OF HALF
OF ALL CARE GIVERS ARE ACTUALLY
CARING FOR VERY COMPLEX CASE.
IN A COMPLEX CARE RECIPIENTS.
AND THAT IS THAT THERE PERFORMED
A MAJORITY OF VOTES OF THESE A
DAILY LIVING IN AN INSTRUMENTAL.
TO ACTIVITIES OF DAILY LIVING
AND THEY ARE PERFORMING A
COMPLEX MEDICAL TO HOUSES TO
FIND.
AS THE SIXTEEN NURSE DELEGATED
MEDICAL TASKS A UNIVERSALLY
ACCEPTED.
SO THINK OF IT THIS WAY HALF OF
FROM OF CALIFORNIA CARE GIVERS
ARE REALLY PROVIDING AN ASSISTED
LIVING OR A SKILLED NURSING
FACILITY.
EXPERIENCE FOR ONE IN THEIR OWN
HOME.
AND THESE ARE THE FOLKS THAT WE
SEE THAT ARE THE MOST STRESSED.
SO THEY NEED THEY ARE DOING
THESE KINDS OF THINGS OF WITHOUT
TRAINING GUIDANCE INSURANCE THAT
THEY'RE DOING THIS HOUSE
CORRECTLY -- AND THEY HAVE GREAT
PHYSICAL AND EMOTIONAL RISKS OF
THEMSELVES AS A RESULT.
THIS BUDGET.
EXCUSE ME THIS BUDGET REQUEST US
TWO THINGS.
FIRST IT DRAMATICALLY RAMPS UP
THE STRUCK SERVICES THE FAMILY
CARE GIVERS BY WORKING TOWARDS
TRIPLING THE KINDS OF SERVICES
THAT WE HAVE.
CAN'T CARE GIVERS RECEIVE.
EXCUSE ME HIGH AND LOW INTENSITY
SERVICES -- YOU HAVE THE
SPECIFIC -- INFORMATION ABOUT
THE THE LEVEL SERVICES UNDER
DIFFERENT CATEGORIES -- AS WELL
AS RAMPING UP WHAT WE CALLED
CONSUMER DIRECTED RESPITE
SERVICES TO GIVE A BREAK TO VAN
NESS AND GAS WRAP UP OKAY.
SO -- WE'RE ALSO DOING THIS AS A
AS A HYBRID -- USING TECHNOLOGY
TO BE ABLE TO SCALE SOME OF OUR
SERVICES AS WELL AS RE
ESTABLISHING A UNIFORM
ASSESSMENT ELECTRONIC RECORD SO
WE CAN SHOW SOCIAL IMPACT -- AND
OUTCOMES SO WE'RE PROPOSING TO
CHANGE THE DIRECTION OF THE
FAMILY CARE GIVER SUPPORT SYSTEM
IN THE STATE OF CALIFORNIA AND
WE THINK THIS ALLIANCE WITH THE
INTENTIONS OF MASTER PLAN ON
AGING SO WE WELCOME YOUR SUPPORT
ON THIS.
MISSION THANK YOU THANK YOU SO
MUCH ANY COMMENTS FROM PERHAPS
OF SERVICES [inaudible]
HELLO [inaudible]
FINANCE [inaudible]
OKAY.
ALL RIGHT WELL THANK YOU SO MUCH
FOR PRESENTING YOUR PROPOSAL
CERTAINLY -- AS WE LOOK AT OUR
AGING POPULATION PROVIDING
SPORTS FOR CARE GIVERS IS
SOMETHING THAT'S GONNA BE VERY
IMPORTANT AND BLUE FORD SELF
THANK YOU THANKS FOR MUCH THANK
YOU FOR YOUR TIME.
ALL RIGHT -- NEXT THE PROPOSAL
IS -- AROUND -- AN ACTUAL STUDY
FEASIBILITY NOW SEXUAL STUDY FOR
DEVELOP LONG TERM SERVICES
SUPPORT BENEFIT PROGRAMS
CALIFORNIA AGING DISABILITY
ALLIANCE [inaudible]
WELCOME.
I THINK I KNOW A LITTLE
SOMETHING ABOUT THIS
[inaudible]
ONE OKAY EXCELLENT. THREE
MINUTES.
I THINK IT PAN AND A MEMBER OF
THE COMMITTEE HAD JET HAMPTON
WITH LEADING AIDS CALIFORNIA
REPRESENTING OVER SIX HUNDRED
NOT FOR PROFIT PROVIDERS A
SENIOR FOR A HOUSING CARE AND
SERVICES HERE IN CALIFORNIA.
ALSO A MEMBER OF THE CAT
CALIFORNIA AGING AND DISABILITY
ALLIANCE QUEDA.
I THANK YOU AGAIN FOR HEARING
THIS ITEM AND WE'VE BEEN BEFORE
CAN FOR SMALL ATTEMPT TO BE AS
BRIEF AS I CAN BE AND JUST WANT
TO PROVIDE THE COMMITTEE WITH A
FEW UPDATES -- REGARDING THE
PROPOSAL -- SENT TO US BEFORE
YOUR COMMITTEE WITH US AND HAD
FURTHER DISCUSSIONS WITH BERMAN
OF HEALTH CARE SERVICES
SPECIFICALLY WITH THAT
CALIFORNIA PARTNERSHIP LONG TERM
CARE -- REGARDING WHETHER
POTENTIAL EXISTING DATA TO HELP
INFORM OUR EFFORTS -- EXISTS AND
AFTER THOSE CONVERSATIONS IT
APPEARS THAT THE NECESSARY DATA
THAT WE'RE LOOKING. FOR FOR THE
DESIGN AND IMPLEMENTATION OF A
CORRESPONDING BENEFIT IN FUNDING
SOURCE -- DOES NOT EXIST AT THIS
TIME.
FURTHERMORE WE'VE MET WITH AND
HAVE CERTAINLY DISCUSSIONS WITH
THE ACTUARIAL FIRM THAT HAS DONE --
MUCH OF THIS WORK IN OTHER
STATES INCLUDING WASHINGTON MAIN.
AND THE LIKES -- FOR A BETTER
UNDERSTANDING OF THE PRINTERS AN
ACTUARIAL ANALYSIS.
AND I WANT TO AGAIN REAFFIRMED
THAT WE BELIEVE THAT THIS WORK
WILL ALLOW US TO COMMENCE THE
ANALYTICAL PROCESS IMMEDIATELY
UPON FUNDING.
AVAILABLE AND OBTAIN THE RESULTS
MORE QUICKLY I JUST WANT TO FIND
A VERY BRIEF UPDATE FOR THE
COMMITTEE AS WELL.
THAT THE STATE OF WASHINGTON ON
APRIL SIXTEENTH PASSED HOUSE
BILL TEN EIGHTY SEVEN THE LONG
TERM CARE TRUST ACT.
AND IS EXPECTED TO BE SIGNED BY
GOVERNOR JAY INSLEE IN THE
COMING WEEKS -- WE ARE MODELING
MUCH OF THE WORK THAT WE ARE
DOING OFF OF THE STATE OF
WASHINGTON -- AND THAT THEY ALSO.
PRODUCE AND AND FUNDED NEXT
RIGHT NOW SAYS BACK IN TWENTY
FIFTEEN THE REFORM THESE RESULTS
ON THE SAME DAY AS WELL HAWAII.
IS THERE THERE FUNDING FOR
COMPANY CARE WHICH IS ALSO A
LONG TERM CARE GIVING.
OUT PROGRAM IN THEIR STATE AND
SO WE ARE VERY EXCITED
CALIFORNIA IS GOING TO BE A PART
OF THE PROCESS.
ALL MY NAME IS DAVID FIBER WITH
A. R. P. VOLUNTEER.
ALL ON THIS KIND OF ISSUE I HAVE
A PERSONAL EXPERIENCE I HAVE A
MOTHER WHO IS IN A MENTAL.
HEALTH UNIT TODD RECEIVING
MEMORY CARE THE COST THAT
PROGRAM IS FOURTEEN THOUSAND
DOLLARS A MONTH FOR TWO THOUSAND
DOLLARS WORTH OF SOCIAL SECURITY
AND VETERANS PAYMENTS PLUS THE
FIVE THOUSAND SHE RECEIVES FROM.
ALL.
THE SERVICES FROM VERY MILLED
MEDICAL SERVICES TO SCOTT NEARLY
BEGIN TO COVER THE COSTS THAT
EXTRA FIVE THOUSAND DOLLARS A
YEAR COMES OUT OF MY POCKET. TO
SUPPORTER.
THAT REDUCES THE AMOUNT OF FUNDS
MY WIFE AND I WILL HAVE FOR OUR
OWN MEDICAL NEEDS AS WE BEGIN TO
H..
PROBES NECESSARY ON THAT BASIS.
THANK YOU.
ALL RIGHT ANY ERA COMMENTS FROM
THE EIGHTY S. ALEJO.
WE WOULD JUST NOTE ON THIS
PARTICULAR PROPOSAL THAT IF THE
LEGISLATURE WANTS TO MOVE
FORWARD ON THIS IT APPEARS THAT
THERE WOULD BE A NEED FOR THE
LEGISLATURE TO DEFINE SOME
PARAMETERS ABOUT WHAT SORT OF A
PROGRAM -- WOULD BE MODEL SOME
OF THESE THINGS COULD BE
DETERMINED LATER ON BUT THE
LEGISLATURE HAS AN IMPORTANT
OPPORTUNITY SHOULD IT WISH TO
PROCEED WITH THIS.
TYPE OF A BENEFIT TO EXPLORE
WHAT THE MAIN -- OVER ARCHING
PARAMETERS WOULD BE.
THANK YOU FINANCE.
OKAY WELL -- SINCE I'VE THIRTY
AUTHOR THE POLICY VEHICLE WE WE
ARE DEFINITELY -- THE THE SORT
OF DETERMINING THAT AND I THINK
WE'RE AGAIN WE'RE LOOKING AT
LONG TERM SUPPORT SERVICES SO
THAT'S BOTH.
THE IN HOME AS WELL AS ATTENTION
INSTITUTIONAL BUT PROVIDING THE
KIND OF SUPPORTS THAT WE NEED
FOR MIDDLE CLASS FAMILIES SO --
BUT I APPRECIATE THE YOUR YOUR
YOUR YOUR COMMENT OBSERVATION
THAT.
WE NEED TO KNOW EXACTLY WHAT
SCOPE IS BECAUSE THE HOUSE WE DO
AN ACTUAL ANALYSIS IF WE CAN'T
FIND WHAT WE'RE TRYING TO PAY
FOR ITSELF.
THANK YOU.
ALL RIGHT OKAY SIR THANK YOU
VERY MUCH OBVIOUSLY SOMETHING I
HAVE.
A GREAT INTEREST IN AS WELL
THANK YOU.
ALL RIGHT EXCELLENT OKAY -- SO
WITH THAT -- ACTUALLY JUST ONE
OTHER QUESTION ABOUT -- ONE OF
THE SEVEN WAIVERS HERE BECAUSE I
THINK THIS ONE ACTUALLY SEEMS
UNFORTUNATELY SEEMS TO BE GOING
AWAY DID PEDIATRIC PALLIATIVE
CARE I THINK IT DID GET WINTER
WHAT ARE WENT AWAY ACTUALLY
SINCE YOU WENT AWAY TO SERVICES
ARE NOW AVAILABLE STATE WIDE TO
ALL CHILDREN WHO MIGHT REQUIRE.
THEM THROUGH THE MANAGED CARE
PLANS OKAY SO THE SERVICE I GOT
AWAY IT'S JUST THAT THE WAY
WRECK JUST THE WAIVER WRITER OF
THE HOPEFULLY THE GOAL FOR ALL
OF THIS RIGHT HAVE IT BE
STATEWIDE BECAUSE WELL.
OKAY ALL RIGHT VERY GOOD LET'S --
GO AHEAD TAKE PUBLIC COMMENT --
ASK IF -- SO WE HAVE THREE
STAKEHOLDER POLLS AND OF COURSE
THE OVERALL OVERVIEW THE WAIVERS --
TRY TO KEEP YOUR COMMENTS TO A
MINUTE.
WELCOME.
THANK YOU MISTER CHAIRMAN FRED
MAY REPRESENTING CAL PACE THE
PROGRAM FOR ALL INCLUSIVE CARE
FOR THE ELDERLY.
WE WOULD JUST LIKE TO SUPPORT
THAT.
STAKEHOLDER PROPOSALS ON THE
CARE GIVER RESOURCE CENTER
BUDGET AUGMENTATION AND THEN
ALSO THE L. T. S. S..
A STUDY AND WE'RE VERY
APPRECIATIVE FOR THE WORK THAT
YOU'VE DONE ALREADY ON THAT SO
WE WOULD SUPPORT BOTH OF THOSE
ITEMS THANK YOU THANK YOU
[inaudible]
WELCOME.
GOOD AFTERNOON CHAIR PAN --
DEBBIE TOLD FROM CHOICE AND
AGING WE ARE A C. C. T. PROVIDER
HERE IN SACRAMENTO AND SOLANO
AND CONTRA COSTA COUNTIES WE'VE
BEEN DOING IT FOR OVER A DECADE.
I LOST TWO STAFF PEOPLE BECAUSE
OF THE UNCERTAINTY OF WHAT WAS
GOING TO HAPPEN.
DEPARTMENT OF HEALTH CARE
SERVICES ASTOR AGENCY TO GOING
TO A TRADITION TRANSITION IN
MARIN DURING THE HEIGHT OF THIS
UNCERTAINTY SAYING THEY WERE
GOING TO STOP SERVICES IN
DECEMBER.
AND WE WERE MADE TRANSITION WHEN
WE DIDN'T HAVE SOMETHING PASSED
AT THE FEDERAL LEVEL AND THE
GENTLEMAN WHO HAD BEEN IN THE
SENATE FOR A YEAR AND A HALF WAS
IN A BAD CAR ACCIDENT WHOSE
YOUNG.
THOUGHT THAT HE WAS GONNA THEN
SPEND THE REST OF HIS LIFE IN A
SKILLED NURSING FACILITY BECAUSE
WE WERE MADE TRANSITION AND I
GOT STOPPED SO I CAN'T EVEN.
EXPRESS TO YOU THE IMPORTANCE OF
ENSURING THAT WE DON'T HAVE THAT
UNCERTAINTY MOVING FORWARD ALSO
THE THE THE AMOUNT OF
INTELLIGENCE AND INFRASTRUCTURE
IN ONE PERSON'S BRAIN TO DO A
TRANSITION IT'S NOT SOMETHING
THAT CAN BE REPLACED BECAUSE WE
WAITED SIX MONTHS.
AND THEN RESTARTED THE PROGRAM
AT THE FEDERAL LEVEL ALSO NOT
EVERYBODY WHO'S IN A SKILLED
NURSING FACILITY QUALIFIES FOR A
TO THE BE A WEAVER SERVICES.
AGENCY BE WAIVER SERVICES DO NOT
COVER THE COST OF THE TRANSITION
THEY DO NOT COVER THE COST OF
THE HOME SET UP THERE IS SUCH A
PROBLEM THERE SO.
I HAVE A LOT MORE TO SAY AND I'M
HAPPY TO MEET WITH YOU
INDEPENDENTLY OKAY THANK YOU.
BUCKLEY A FUTILE PROJECTS AND WE
MANAGE A C. R. C. AND IN
MISSISSIPPI PROGRAM OUR STRONG
SUPPORT FOR THE CARRIER RESEARCH
CENTER -- AUGMENTATION WHO WE
REALLY NEED THAT TO HELP FUND TO
SERVE MORE PEOPLE AND MODERNIZES
SO WILL TO RECRUIT STAFF
MODERATE TO CONNECT WITH
MILLENNIALS I ALSO URGE YOU
ALTHOUGH NOT ON THE DOCKET WAS
TO SUPPORT THE M. S. S. P.
AUGMENTATION.
AS THAT IS A FLAT FOOTED FORUM
THE DOES TRUE WHO RULE QUIRK
EVERY DAY -- FOR KEEPING FUEL IN
THEIR HOME AS OPPOSED TO BEING
PLACED IN A NURSING FACILITY AND
IT'S TREMENDOUS PROGRAM HERE AS
WELL AS SUPPORTING THE ASSISTED
LIVING WAIVER PROGRAM BECAUSE
NOT ALL THE PEOPLE THAT ARE
APPROPRIATE FOR SKILLED NURSING
FACILITY.
THEY STILL NEED HELP BUT THEY'RE
NOT A CABLE LIVING ON THEIR OWN
IT'S A PERFECT FIT AND VERY COST
EFFECTIVE WAY TO DO THAT.
THANK THE GREAT WORK YOU DO I
THANK YOU.%
WELCOME.
GOOD AFTERNOON LEASE A COMMON
WITH THE CALIFORNIA LONG TERM
CARE OMBUDSMAN ASSOCIATION --
BUT SINCE WORK VERY HARD TO
SUPPORT RESIDENTS LIVING IN THE
LEAST RESTRICTIVE ENVIRONMENT
POSSIBLE BUT THEY'RE NOT
MAGICIANS AND YOU CAN'T MOVE A
PERSON OUT IF YOU DON'T HAVE
PROGRAMS TO SUPPORT THEM IN THE
COMMUNITY SO WE'RE IN STRONG
SUPPORT.
OF THE THE HOME AND COMMUNITY
BASED WAIVERS IN THE C. C. TEAS
AND ASSISTED LIVING ALL OF THOSE
RIVERS.
AND CHALCO AS PROUD MEMBERS OF
KATE AT ARE ARE ARE REALLY
GRATEFUL TO STAND WITH SENATOR
PAN.
CALIFORNIA NEEDS TO FIGURE OUT
SOMETHING FOR OUR LOW AND MIDDLE
INCOME OLDER ADULTS AS WE AGE
THANK YOU THANK YOU.
WELCOME -- ALSO FROM THE
CALIFORNIA COMMISSION ON AGING
THE COMMISSION IS PLEASED TO BE
A CO SPONSOR OF THE CARE GIVER
RESOURCE CENTER BUDGET REQUEST
AND WE URGE YOUR SUPPORT.
AND WE THANK YOU FOR YOUR WORK
ON THE ACTUARIAL STUDY FUNDING
PIECE THANK YOU THANK YOU.
WELCOME GOOD AFTERNOON SUSAN THE
MORRIS ON BEHALF OF THE
ALZHEIMER'S ASSOCIATION HERE IN
SUPPORT OF THE CARE GIVER REESE
CARE GIVER RESOURCE CENTER
BUDGET AUGMENTATION.
AS WELL AS THE ONE MILLION
DOLLAR ACTUARIAL STUDY THANK YOU
FOR LEADING THAT EFFORT.
THANK YOU WELCOME -- CHILD
DISABILITY RIGHTS CALIFORNIA.
IN SUPPORT -- AND IS A MEMBER OF
THE ALIVE THAT KATO ALLIANCE IN
SUPPORT OF THE ACTUARIAL STUDY
THANK YOU.
THANK YOU WELCOME HI DOCTOR PAN
MEMBERS OF THE COMMITTEE WHO ARE
NOT HERE -- CRISTINA BUYS
HAMILTON WITH UT W. -- MEMBER
KATE A STRONG SUPPORT FOR THE
ONE MILLION FOR THE ACTUARIAL
AND ALSO FOR THE C. C. T..
N. B. CARE GIVER RESOURCE CENTER
AND LET'S JUST SAY THE
WASHINGTON ONE YESTERDAY MAYBE
CALIFORNIA CAN BE NUMBER THREE
IN THE COUNTRY SETTING UP A
UNIVERSAL LTE US US THANK YOU
OKAY WE HAVE TO CATCH UP WITH
THOSE GUYS.
WELCOME.
I GET AFTERNOON MY NAME'S
KRISTEN AIM AND I'M WITH THE
CALIFORNIA ASSOCIATION FOR ADULT
DAY SERVICES HERE IN SUPPORT FOR
THE COMMUNITY TRANSITION
PROGRAMS PROPOSAL TO CONTINUE TO
FUNDING FOR ONE YEAR.
THE CARE GIVER RESOURCE RESOURCE
CENTERS OF FUNDING PROPOSAL AND
AS A MEMBER OF THE ALLIANCE WERE
ALSO IN SUPPORT OF YOUR PROPOSAL
FOR THE ONE MILLION DOLLARS FOR
AT AN ACTUARIAL STUDY THANK YOU.
THANK YOU [inaudible]
WELCOME.
GOOD AFTERNOON CARMEN ESTRADA
DIRECTOR OF INLAND CARE GIVER
RESOURCE CENTER FROM SAN
BERNARDINO.
I'M ALSO CAUGHT IN THE MIDDLE
LIKE -- KATHY JUST MENTIONED TO
ONE OF THOSE INDIVIDUALS WHO HAS
TO CARE FOR MY MOTHER WHO HAS
MULTIPLE MYELOMA BUT ALSO FROM
MY SON WHO HAS CEREBRAL PALSY
AND AUTISM.
SO IN STRONG SUPPORT OF THE C.
R. C.'S CONTINUE TO GET MORE
ADDITIONAL FUNDING AND ALSO ALL
THE WAIVER PROGRAM BECAUSE A
TRULY NEED ALL OF THOSE AND AS A
SINGLE PARENT THEY CANNOT STOP
WORKING TO CARE FOR MY LOVED
ONES THANK YOU.
THANK YOU [inaudible]
WELCOME.
HI EMBODY VEGA I AM ON THE
EXECUTIVE ASSISTANT OF THE
AILING CARE GIVER RESEARCH
CENTER FROM SOME IN NOW -- I AM
HERE IN SUPPORT OF THE BUDGET --
ASK -- AS I WATCH MY MOTHER
WATCH MY MY SISTER FOR TWENTY
YEARS WITH THEM AS I UNDERSTAND
THAT THERE ARE SOME -- STRUGGLE
THAT THEY DEAL WITH AND THIS
AGENCIES AND WHAT THEY DO FOR ON
THE CARE GIVERS IT'S AMAZING SO
I DEFINITELY SUPPORT THE COSTS.
THANK YOU [inaudible]
WELCOME.
GOOD AFTERNOON GAVE -- PROGRAM
MANAGER WITH VALLEY CAKE EVERY
RESOURCE CENTER IN -- SUPPORT OF
THE CHECK EVERY RESOURCE CENTER --
BUDGET REQUEST [inaudible]
THANK YOU [inaudible]
WELCOME.
GOOD AFTERNOON I'M ALEXANDER
GONZALEZ AND I'M HERE FROM THE
LA OUR CARE GIVER RESOURCE
CENTER AND I'M IN STRONG SUPPORT
OF THE ICRCBUDGET PROPOSAL OKAY.
THANK YOU THANK YOU [inaudible]
WELCOME.
OF CRISTINA RAIN I'M WITH FAMILY
CAREGIVER ALLIANCE THE BAY AREA
CARE GIVER RESOURCE CENTER AND
IN SUPPORT OF THE BUDGET REQUEST
FOR THE CARE GIVER RESOURCE
CENTER SYSTEM.
THANK YOU [inaudible]
WELCOME.
ANY ROCHE FAMILY CAREGIVER
ALLIANCE BEAR CARE RESOURCE
CENTER STRONG SUPPORT THIS YEAR
SEE BUDGET REQUEST.
THANK YOU.
WELCOME HELLO AMANDAHARTREE
FAMILY CAREGIVER ALLIANCE FAIR
CARE GIVER RESOURCE CENTER
STRONG SUPPORT FOR THE BUDGET
REQUEST THANK YOU THANK YOU.
WELCOME MCCORD FAMILY CAREGIVER
ALLIANCE STRONG SUPPORTER OF THE
SEARS C. BUDGET.
PLEASE HELP THESE PEOPLE BECAUSE
I SEE THEM EVERY DAY AND I KNOW
HOW MUCH THEY NEED [inaudible]
THANK YOU [inaudible]
WELCOME.
HELLO I'M A CELL NEVINS I'M THE
EXECUTIVE DIRECTOR OF DEL ORAL
CARE GIVER RESOURCE CENTER
SERVING THIRTEEN NORTHERN
CALIFORNIA COUNTIES.
AND JUST IN STRONG SUPPORT OF
THE BUDGET REQUEST WE HAVE --
HUNDREDS OF PEOPLE ON THE WAIT-LIST JUST TO BECOME A CLIENT --
AND THEY'VE BEEN WAITING QUITE
SOME TIME THANK YOU I THANK YOU
[inaudible]
WELCOME.
HI GOOD AFTERNOON I'M CAN REAL
WEBSTER DIRECTOR OF THE COAST
CARE GIVER RESOURCE CENTER IN
THE SANTA BARBARA AREA.
I'VE ACTUALLY WORKED WITH THE
CARE GIVER RESOURCE CENTER SINCE
TWO THOUSAND ONE WHEN I WAS AT
THE DEL MAR PROGRAM IN SANTA
CRUZ.
I'M IN STRONG SUPPORT OF OF WIND
IT ON NINETY OUR BUDGET AND
GETTING MORE SERVICES OUT TO
CARE GIVERS.
AND IMPROVING TECHNOLOGY --
ACCESS FOR CARE GIVERS AS WE'RE
SEEING MORE AND MORE PEOPLE AS A
KID HE SAID -- IN THE WORKING
WORLD TRYING TO MANAGE ALL OF
THOSE THINGS AND CAN'T
NECESSARILY DO IT BETWEEN THE
NINE TO FIVE WORK DAY.
AND SO WE NEED TO HAVE-TECHNOLOGY THAT THEY CAN ACCESS
AT HOME IN THE EVENING ON THE
WEEKENDS.
OKAY THANK YOU [inaudible]
WELCOME.
HELLO I'M HERE I'M FROM TEL ORAL
CARE GIVER RESOURCE CENTER AND
I'M HERE TODAY TO GIVE VOICE TO
THE MANY FAMILY CAREGIVERS IN
THIS GREAT STATE OF CALIFORNIA.
THEY ARE AT HOME CARING FOR
THEIR AGING LOVED ONES THEIR
SPOUSE OR THEIR TO THEIR PARENT
IN THERE ARE UNABLE TO BE HERE
OR THERE AT WORK AND HAVING TO
RUSH HOME TO ATTEND TO THEIR
LOVED.
ONE NEEDS IT IS THE WISH OF MOST
OF US TO STAY IN OUR HOME EVEN
IF WE HAVE ALZHEIMER'S
PARKINSON'S A STROKE.
THESE FAMILIES ARE TRYING TO
SUPPORT THAT WISH YOU CAN
SUPPORT THEM BY SUPPORTING THE
CARE GIVER RESOURCE CENTERS.
THANK YOU FOR YOUR TIME AND
CONSIDERATION.
THANK YOU.
WELCOME.
I'M NANCY POWER STONE ON THE
DIRECTOR OF REDWOOD CARE GIVER
RESOURCE CENTER AND WE SERVE
SEVEN NORTHERN CALIFORNIA
COUNTIES I'M ALSO ONE OF THOSE A
PROFESSIONAL WORKING WOMEN WHO
HAS THE ALONG WITH MY HUSBAND
HAS RESPONSIBILITY TO CARE FOR
OUR EIGHTY NINE YEAR OLD MY
HUSBAND'S EIGHTY NINE YEAR.
OLD PARENTS WERE ABLE NOW TO
KEEP THEM AT HOME BUT IT
CERTAINLY TAKES MORE IT WILL
TAKE MORE THAN WHAT WE ARE ABLE
TO DO ON OUR OWN SO.
I AM VERY MUCH IN SUPPORT OF THE
CARE GIVER RESOURCE CENTER
BUDGET REQUEST.
THANK YOU [inaudible]
WELCOME.
HI GOOD AFTERNOON THANK YOU ALL
FOR BEING HERE WE DEFINITELY
APPRECIATE YOUR TIME AND EFFORTS
MY NAME IS GAINES THE TURN AND I
AM A SOCIAL WORKER WITH DEL ORAL
CARE GIVER RESOURCE CENTER.
I'M ACTUALLY HERE TO REPRESENT
TWO HUNDRED OF MY CLIENTS ALONE
ON MY CASELOAD WHO CANNOT BE
PRESIDENT TODAY TO SPEAK ON
BEHALF OF THIS BUDGET REQUEST
FOR THE CALIFORNIA CARE GIVER
RESOURCE CENTER SO WE ASK FOR
YOUR SUPPORT IN SUPPORTING --
OUR AGENCY AND THE REST OF THE
CALIFORNIA CARE GIVER RESOURCE
CENTERS THINK ILL THANK YOU
[inaudible]
WELCOME.
MY NAME IS AMBER HENNING AND I'M
WITH THE ORAL CARE GIVER
RESOURCE CENTER I'VE WORKED
THERE SINCE TWO THOUSAND ONE
WATCHING HOW THE DEMOGRAPHICS OF
CARE GIVERS HAVE CHANGED FROM
SOUTH IS CARRYING FOR CELSUS TWO
ADULT CHILDREN CARING FOR THEIR
PARENTS.
AND DOT ON CHANGING DEMOGRAPHIC
WHERE -- THOSE FAMILY CARE
GIVERS ARE MORE APT TO USE THE
ELECTRONIC.
VERSION AN ONLINE VERSIONS OF
GETTING IN CONTACT WITH OUR
AGENCY HAS INCREASED AND SO I'M
HERE TO SUPPORT THIS
AUGMENTATION OF OUR BUDGET TO
HELP THOSE FAMILY CARE GIVERS
REACH OUT.
AFTER HOURS AND AT A TIME THAT'S
CONVENIENT FOR THEM THANK YOU
VERY MUCH.
THANK YOU [inaudible]
WELCOME.
ANYONE WITH A C. R. U.
CALIFORNIA I'M IN SUPPORT OF THE
L. D. AS A STUDY THAT CCT
PROPOSAL AS WELL AS THE THE CARE
GIVER RESOURCE PROPOSAL THANK
YOU.
THANK YOU [inaudible]
WELCOME.
AMY BLOOMBERG ON BEHALF OF THE
CALIFORNIA ASSOCIATION OF HEALTH
FACILITIES REPRESENTING NINE
HUNDRED SKILLED NURSING
FACILITIES AND FOUR HUNDRED AND
FIFTY INTERMEDIATE CARE
FACILITIES ON THE STATE.
AND SUPPORT OF THE L. TSS
ACTUARIAL STORY STUDY THANK YOU
[inaudible]
WELCOME.
GOOD AFTERNOON HUNDRED
CONTROLLERS OF THE CALIFORNIA
FOUNDATION FOR INDEPENDENT
LIVING CENTERS WE ARE STATEWIDE
ASSOCIATION A TWENTY TWO
INDEPENDENT LIVING CENTERS
LOCATED THROUGHOUT STATE.
AND A MEMBER OF QUEDA WE
STRONGLY SUPPORT THE CCT
PROPOSAL AND THE FEASIBILITY AN
ACTUARIAL STUDY FUNDING THANK
YOU.
THANK YOU [inaudible]
WELCOME.
LINDA AWAY WITH WESTERN CENTER
ON LAW AND POVERTY IN SUPPORT OF
THE CONTINUATION OF THE CCT
PROGRAM.
THANK YOU.
WELCOME.
LOGIN CHEN HAMPTON LEADING EDGE
CALIFORNIA JUST WANT TO AFFIRM
OUR SUPPORT FOR ALL OF THE THE
WAIVER PROGRAM PROPOSALS
PARTICULARLY THE ASSISTED LIVING
WAIVER PROPOSAL AND AGAIN RE
FROM OUR SUPPORT FOR AT THE LCS
AS ACTUARIAL STUDY THANK YOU CAN
[inaudible]
THANK YOU.
WELCOME YET.
A DAVID FIBER GROUP SAYING HEY
YOU.
A A RP REACHED IN STRONG SUPPORT
OF FUNDING OF THE ALL RESOURCE
CENTER TO FEEL THAT IT IS
NECESSARY IN ORDER TO PROVIDE
CITIZENS A NEXUS TO SERVICE.
THANK YOU WELCOME.
GOOD AFTERNOON MY NAME IS KEY
LEASE STEVENSON AND I'M AT
TECHNOLOGY ENTREPRENEUR AND HAVE
A CAREER IN PRIVATE EQUITY THE
MOST IMPORTANT ROLE I'VE EVER
PLAYED HAS BEEN AS A FAMILY CARE
GIVER.
SO I TOOK TIME OFF WORK TODAY TO
COME DOWN HERE AND TO EXPRESS
HOW IMPORTANT IT IS TO HAVE
THESE CARE GIVER RESOURCE
CENTERS AND HOW CUTE AS TO YOU
KNOW IF ALL OF THEM TO BE
SERVING PEOPLE LIKE ME.
WHO ARE STRUGGLING TO TAKE CARE
OF THEIR PARENTS MY FATHER USED
TO WORK HERE IN THE CAPITAL IS A
STATE POLICE OFFICER BEFORE IT
WAS C. H. P.?
MY MOM WAS A AND AT A PUBLIC
SCHOOL TEACHER HERE IN
SACRAMENTO THE WOULD LOVE TO
STAY IN THEIR HOME AND BE IN IT
FOR VERY VERY MANY YEARS MUCH
MORE HAPPY.
FEAR THERE SO I'M IN STRONG
SUPPORT OF MAKING SURE THAT AS
WE'RE AGING AND IT DOESN'T
BECOME A DRIVER OF INEQUALITY
AND MORE SUFFERING IN POVERTY
AND IN FACT.
WE CAN LEAD AS CALIFORNIA AND BE
AMAZING IN SO MANY WAYS IN TERMS
OF CARING FOR THOSE SUPER HEROES
THAT ARE AT HOME.
THANK YOU THANK YOU.
WELCOME HI MARTY EMOTO CD CAM
CALIFORNIA SPACE IN YOUR
COMMUNICATION NETWORK CALIFORNIA
PERSON CENTERED AT THE T.
PARTNERSHIP.
AND ALSO A FAMILY MEMBER FIRST
JUST WANT EXPRESS MY DEEP
APPRECIATION AS A FAMILY MEMBER
TO THE C. C. T. PROVIDERS BUT
ALSO THE CARE A CAREGIVER
RESOURCE CENTER IS VERY
IMPORTANT.
ALWAYS UNDERFUNDED STRONG
SUPPORT FOR ALL THREE OF
PROPOSALS -- IS INCLUDING THE
FITS FEASIBILITY STUDY WHICH IS
CRITICAL AND LASTLY STRONG
SUPPORT FOR EVERYTHING THAT
DEBBIE TOLD.
SET [inaudible]
THANK YOU [inaudible]
WELCOME.
I CENTER PAN.
VERY MUCH MEMBERS OF THE
COMMITTEE CONNIE ARNOLD FROM ELK
GROVE CALIFORNIA.
IN SUPPORT OF ALL OF THE ITEMS
THAT HAVE ALREADY.
BEEN TALKED ABOUT CC T. ARE
TRANSITIONING PEOPLE OUT OF
NURSING HOMES -- THIS IS A
LIVING WETTER WAIVER -- HOME
FAMILY MEMBER -- FAMILY CARE
GIVER.
ITEMS AND ALSO -- BASICALLY THE
LONG TERM SERVICES FOR PEOPLE
WITH DISABILITIES AND SENIORS.
THOSE NEED TO BE STRENGTHENS
STRENGTHENED I'M ON A WAIVER I
MONO I HOLE WAIVER -- WHERE
PERSONAL CARE SERVICES WANT TO
THANK YOU FOR WHAT YOUR OFFICE
DID TO SUPPORT MARRY?
HER IN HER EFFORTS TO NOT FALL
THROUGH THE CRACKS.
I AM WORKING WITH THEM.
GOT SOME TO GOTTEN THàNH
CONTACT WITH ME WHO KNOWS ME AND
THERE'S A WOMAN NAMED LYNN
GALLAGHER WITH THEM AS DOWN IN
SANTA CRUZ.
AND SHE NEEDS THESE PROGRAMS SO
MUCH.
SHE HAS MS THERE'S TIMES CARE
GIVERS DON'T SHOW UP THEY TRAIN
AND THEY LEAVE THEY NEVER SHOW
UP.
SHE'S TRIED TO PUT HERSELF TO
BED FALLING ON THE FLOOR UNTIL
SOMEBODY FINDS HER YOU KNOW.
SHE'S BY HERSELF.
AND I'M TRYING TO GIVE HER INNER
CARE GIVERS ADVICE TO EVEN UP
THE HOURS THAT SHE'S NOT GETTING
FOR I AGES SAYS.
I CENTER TO THE BOARD OF
SUPERVISORS.
IN -- SANTA CRUZ THEY TOLD HER.
CONTACT YOUR CASE WORKER
BASICALLY THEY COULDN'T DO
ANYTHING FOR I THINK THAT'S
RIDICULOUS.
AND I THINK SOME OF THE THINGS
BESIDES THE FAMILY MEMBER
PROVIDERS.
HAVE A PROBLEM WITH -- THEIR%
INDIVIDUAL SENIORS.
THAT NEED SUPPORTS WHO CAN'T
AFFORD. TO PROVIDE THEIR CARE
WHEN IT'S SOMETHING URGENT
HAPPENS SO THANK YOU VERY MUCH
THANK YOU THANKS VERY MUCH RIGHT
[inaudible]
OKAY.
SINGLE OTHER COMMENTS.
IT WILL HOLD THE STAKEHOLDER
PROPOSALS OPENED THANK YOU.
NO OTHER.
OKAY BUT ALL RIGHT OKAY AND NEXT
ITEM IS THE STATE WIDE
TRANSITION PLAN EXTENSION. FOR
SO -- AS YOU MAY RECALL -- THE
FEDERAL GOVERNMENT HAD RELEASED
A FINAL SETTINGS RULE RELATED
HOME COMING COMMUNITY SETTINGS
THAT-- FUNDAMENTALLY REQUIRED A
LOT OF CHANGE IN ASSESSMENT --
AND FOR US YOU KNOW WE ARE
TALKING ABOUT FIVE HUNDRED
THOUSAND INDIVIDUALS WHO ARE
AFFECTED BY THIS.
THE ORIGINAL TRANSITION PERIOD
WAS SUPPOSED TO BE BY MAY OF
THIS YEAR -- THE FEDERAL
GOVERNMENT DID RECOGNIZE THAT
FOR MANY STATES BEING ABLE TO
MAKE THAT MAKE ALL OF THE
TRANSITIONS.
HAPPEN AND MAKE ALL OF THE
SETTINGS COMPLIANCE -- BY THAT
TIME WAS NOT POSSIBLE SO THEY
HAVE DONE AN EXTENSION AND SO --
THE REQUIREMENTS ARE STILL THE
SAME BUT WE ARE REQUESTING THAT
WE CONTINUE TO EXTEND SO LIMITED
TERM STAFF IN ORDER TO COMPLETE
THAT ADDITIONAL WORK.
INCOMES FAMILIAL THIS FINANCE.
OKAY -- ANY PUBLIC COMMENT ON
THIS ITEM.
OKAY SEEING NONE.
RIGHT CERTAINLY WILL HOLD THAT
ITEM -- CONCERNING MAKES LOS
SENSE.
ALL RIGHT -- I AIMED AT ITS ONE
FIFTY RIGHT NOW I WOULD -- GONNA
TAKE A TAKE A FIVE MINUTE
STRETCH BREAK I COULD USE A
STRETCH FRANKLY.
SO.
AND SO IT SAYS STRETCH FOR FIVE
MINUTES AND THEN WE'LL DIVE INTO
PROP FIFTY SIX SO ALL RIGHT
THANKS [inaudible] FIVE MINUTES
--
SO WE'RE NOW ON ISSUE NUMBER
EIGHT SO WE HAVE A SERIES OF
ISSUES AROUND PROP FIFTY SIX AND
PAYMENT SO -- LET'S GO AHEAD AND
BEGIN WITH ISSUE NUMBER EIGHT
PROPERTY SIX MEDI CAL PROVIDER
REIMBURSEMENT RATES. FOR SO IN
TERMS OF THE THINGS FOR THE
CURRENT YEAR THEY ALL ARE NOW IN
A FACT -- SOME HAVE BEEN IN
EFFECT FOR AWHILE -- THE MOST
RECENT ONE I THINK ON THE THE
HOME HEALTH IT WENT INTO EFFECT
AT THE END OF DECEMBER -- WE ARE
STILL LOOKING TO PROCESS THE
RETROACTIVE -- ADJUSTMENTS BACK
TO JULY -- ONE THAT THAT WILL BE
HAPPENING PROBABLY NEXT MONTH --
BUT OTHERWISE EVERYTHING IS BEEN
GOING GOOD WE HAVE THE FEDERAL
APPROVALS ON THE MANAGED CARE
SIDE SO THE PHYSICIAN PAYMENTS --
JUST WENT TO THE PLAN SO THOSE
SHOULD BE GETTING OUT TO THE
POSITIONS AS WELL -- SO IN
GENERAL EVERYTHING FOR THE
CURRENT YEAR PROPOSALS IS IS IN
EFFECT IN AND WORKING --
OBVIOUSLY THERE ARE PROPOSAL
WILL BE TALKING ABOUT FOR THE
FOR THE NEXT YEAR THAT WILL BE --
HAVE SOME ADDITIONAL MONEY AND
I'M AND THEN IN TERMS OF THE
QUESTION ABOUT THE EVALUATION
ABSOLUTELY -- WE WE THINK WE
NEED TO DO AN EVALUATION THAT IS.
LOOKING AT WHAT IS THE AFFECT
NOT JUST ON A STATEWIDE LEVEL
BUT ON A REGIONAL LEVEL IN TERMS
OF ARE WE REALLY SEEING.
UTILIZATION INCREASE ARE WE
SEEING DIFFERENT PROVIDERS
PARTICIPATING IN THE PROGRAM I
THINK AS AS WE TALK ABOUT IN
THIS COMMITTEE AND I KNOW A
CONCERN THAT YOU HAD BEFORE IS
THE STOP AND START NATURE THAT
WE'VE HAD FOR THE FIRST COUPLE
OF YEARS AND I THINK THAT THAT
HAS.
HAD AN EFFECT ON SEEING ANY
AFFECTS SO WHEN WE HAVE LOOKED
AT THE DATA WE HAVEN'T REALLY
SEEN ANY CHANGES OTHER THAN
PAYMENTS ARE GOING OUT BUT WE'RE
NOT SEEING ANY FUNDAMENTAL
SHIFTS IN UTILIZATION OR OR
PROVIDER PARTICIPATION WE ARE
HOPING THAT.
GIVEN THAT.
THIS YEAR'S UP.
THIS YEAR'S AMOUNTS ARE REALLY
CONTINUING NEXT YEAR SO THERE
WON'T BE ANY STOPPING IN BETWEEN --
JUST CONTINUE THAT -- HOPEFULLY
WHEN WE HAVE THIS CONVERSATION
NEXT YEAR WILL HAVE SOME BETTER
DATA THAT WILL START TO
HOPEFULLY SHOW -- ALTHOUGH I
WOULD SAY I THINK PROBABLY IS
BUT TAKE ANOTHER YEAR. TO HAVE
REAL COMPLETE DATA OF AN ON
GOING NATURE BUT THAT IS THAT IS
CERTAINLY OUR PLAN -- AND WE
BECAUSE WE AGREE WE WANT TO MAKE
SURE IS IS DOING WHAT.
IT WAS THEY WERE SUPPOSED TO BE
DOING OR SHOULD WE BE LOOKING AT
DOING SOMETHING ELSE.
I THANK YOU AYE COMES FROM ALEJO.
THANK MISTER CHAIR AROUND WILL
THE WITH THE LA -- EARLIER THIS
YEAR OUR OFFICE RELEASED A
REPORT -- ASSESSING ABOUT THE
VARIETY OF PROPOSALS IN THE
GOVERNOR'S BUDGET RELATED TO
PROPOSITION -- FIFTY SIX AND WE
HAVE COMMENTS ON THOSE SOME OF
THEM WILL BE ADDRESSED IN LATER
ITEMS ON ON THIS AGENDA BUT WANT
TO IN PARTICULAR JUST.
MAKE SOME COMMENTS ABOUT IN
PARTICULAR THE PHYSICIAN --
PAYMENTS WHICH MAKE UP A VERY
LARGE PORTION OF OF THE
ALLOCATION -- HERE TO FOUR AND
AND IN THE UPCOMING -- THE
PROPOSED THAT AMOUNT FOR THIS
YEAR -- IN JUST TO START OFF
WITH THAT -- ONE TOO NOTE THAT --
THE LEGISLATURE HAS --
DETERMINED IN THE STATE IS
DETERMINED OVER.
MANY YEARS TO MOVE A LOT OF THE
MEDICARE PROGRAM INTO THE
MANAGED CARE SYSTEM IN WHICH THE
STATE MAKES CAPITATED PAYMENTS
MANAGED CARE PLANS AND
CONTRACTUALLY REQUIRES THEM. TO
GUARANTEE A CERTAIN LEVEL OF
ACCESS AND THAT'S MEASURED
THROUGH COMPLIANCE WITH TIME AND
DISTANCE STANDARDS IN NETWORK
ADEQUATE STANDARDS.
AND WHEN MANAGED CARE PLANS ARE --
CHALLENGE -- TO PROVIDE ACCESS
CONSISTENT WITH STATE
REQUIREMENTS THEY ARE ABLE TO AN
OFTEN DO PAY ABOVE -- FEE FOR
SERVICE RATES -- AND THEN THE
STATE -- SUBSEQUENTLY -- CAN
INCREASE THE CAPITATION THAT
THEY RECEIVE TO COMPENSATE FOR
THOSE FOR THOSE CHANGES SO IN
SOME SENSE.
THE SYSTEM THAT THE MAJORITY OF
THIS CARE IS TAKING PLACE AND IS
IT IS SET UP -- TO TO PROVIDE
FOR THIS ACCESS TO BE TO BE --
IN PLACE -- THAT ALSO LEADS TO A
SITUATION WHERE THE EXISTING
PAYMENTS ARE A SPECIFIC DOLLAR
AMOUNT THAT'S ON TOP OF WHATEVER
THE MANAGED CARE PLAN IS PAYING
IN BECAUSE THE MANAGED CARE
PLANS.
ARE IN THE POSITION OF
NEGOTIATING WITH PROVIDERS ABOUT
WHAT THOSE RATES COULD BE -- WE
DON'T KNOW NECESSARILY WHAT THE
RATES ARE GETTING TO AFTER THE
SUPPLEMENTAL PAYMENTS ARE MADE
AND THIS MEANS THAT WE MAY NOT
BE TARGETING.
THE SUPPLEMENTAL PAYMENTS TO THE
PLACES WHERE THEY ARE MOST
NEEDED SINCE MANAGED CARE PLANS
COULD ALREADY BE MAKING
ADJUSTMENTS -- IN SOME CASES TO
TO TRY AND INCREASE THE ACCESS.
IN LIGHT OF THAT -- WE THINK
IT'S CRITICAL AS A AND THE
DEPARTMENT HAS MENTIONED THAT.
THIS BE EVALUATED TO ENSURE THAT
IT'S THE MOST COST EFFECTIVE WAY --
TO GUARANTEE THE LEVEL OF ACCESS
IN THE MEDICARE PROGRAM THAT THE
LEGISLATURE ONCE.
AND WE ALSO NOTE THAT AND THERE
ARE OTHER.
WAYS TO GET AT ENSURING THAT
THERE'S ACCESS IN THE PROGRAM A
ONE OF THOSE.
IS THROUGH COMPLIANCE AND
ENFORCEMENT ACTIVITIES WITH
MANAGED CARE PLANS.
AND ONE EXAMPLE OF THAT THAT
WILL BE DISCUSSED LATER IN THE
AGENDA IS THE ADMINISTRATION'S
PROPOSAL WITH -- REGARD -- TO
STRENGTHENING PREVENTIVE
SERVICES FOR CHILDREN IN IN THE
MEDICARE PROGRAM -- THIS HAS THE
POTENTIAL TO BE A COST EFFECTIVE
WAY TO IMPROVE ACCESS -- AS IT --
FOCUS ON HELPING THEM.
ENSURING THE MEASURE PLANS ARE
MEETING THEIR CONTRACTUAL
REQUIREMENTS WITH RESPECT. TO TO
ACCESS [inaudible]
FINANCE [inaudible]
COMMENTS. EIGHT SO FOR A FIRST
OF ALL I WOULD SAY IS THAT --
STATE THAT IT WILL TAKE SOME
TIME TO SEE RESULTS RIGHT
BECAUSE WHAT HAPPENED IS THAT
YOU MAKE THE CHANGE PEOPLE TO
KNOW THE CHANGES HAPPENED SO
THEY HAVE TO CHANGE BEHAVIOR.
AND THEN TAKE SOME TIME TO
MEASURE IT AND THEN REPORTED OUT
SO -- I APPRECIATE RECOGNITION
OF ACTUALLY HAVING SOME
CONSISTENCY SO THAT PEOPLE WILL
ACTUALLY CONSIDER BEHAVIOR
CHANGE AND THAT'S ULTIMATELY --
WHAT'S.
MATTERS IN TERMS OF ON THE END
SO WE WANT MORE PEOPLE WILLING
TO ACCEPT MEDI CAL PATIENTS -- I
APPRECIATE -- THE ALLEY AS
COMMENTS -- AGAIN I GUESS WHAT I
SAY IS THAT -- CERTAINLY TIME
AND DISTANCE AND WE USE THAT FOR
IN IN -- AND OUR COMMERCIAL SIDE
AS WELL -- HIDE THIS IT'S A
BETTER FOR STILL FAIRLY NARROW
WAY OF LOOKING AT AT ACCESS IN
THE FACT.
I THINK THE STANDARDS ONLY APPLY
TO CERTAIN SPECIALTY IS CERTAIN
TYPES OF SERVICES SO -- SO I
THINK THAT AND ONE WITH A LOOK
AT OTHER MEDICAID PROGRAMS I
MEAN I I I I I IT IN WHAT WERE
YOU HERE.
FOR FREQUENTLY BUT I ALSO SEE
PEOPLE GETTING BACKED UP TRYING --
TO THOSE WEEDS OUT NO WE CAN
BRACE MEDI CAL EXPANSION
MEDICAID EXPANSION SO FORTH I
KNOW WE'RE STILL STRUGGLING WITH
THIS ISSUE OF OF PEOPLE BUT BE
ABLE TO GET IN -- AND WHILE
CERTAINLY US SOME MANAGED CARE
PLANS HAVE MADE SOME ADJUSTMENTS
VERTICALLY FOR SPECIALTY CARE
WHICH HAS BEEN.
THOSE PROBLEMATIC.
DEPENDING ON WHERE YOU ARE --
THERE'S ALSO CHALLENGES SO -- SO
IS SO I APPRECIATE THAT AND WE
CERTAINLY NEED TO CONTINUE TO TO
EVALUATE THAT AND ALSO LOOK AT
THE FULL RANGE OF THE ACCESS
SERVICES WHICH ACTUALLY FRANKLY
IS -- THE BIGGER CHALLENGES ON
THE SPECIALTY SIDE.
NOW RECOGNIZING THE REASON ON
THE PRIMARY CARE SIDE WE TEND TO
HAVE A LITTLE LESS IS BECAUSE OF
OUR FQHCS AND ARE AT AND LOOK
LOOK LIKES AND SO FORTH AND IN
SOME SENSES -- AND THEY GET
FEDERAL SUBSIDIES SO -- SO FOR
EXAMPLE WITH THE LOWEST
DISSIPATION RATE OF PRIVATE
PRACTICE PEDIATRICIANS.
IN OUR MEDICAID PROGRAM OF ANY
STATE.
SO THE QUESTION IS IS THAT IS
THAT A PROBLEM OR NOT WELL YOU
KNOW IF WE CAN GET INTO A
DIFFERENT ONE RIGHT TO GET TO A
CLINIC.
BUT ARE A LARGE NUMBER CAN IT
THERE IN URBAN AREAS FINE OF
CLINICS AROUND BUT THE STAT IS
THAT GOOD ENOUGH.
FOR MORE RURAL COMMUNITIES OTHER
PLACES WHERE PEOPLE MORE
DISPERSED AND WHILE THEY'RE
CERTAINLY VERY EXCELLENT.
COMMITTEE HEALTH CENTERS RURAL
HEALTH CENTERS.
SOME OF THE MORE CHALLENGING
WHEN THE BASIC INFRASTRUCTURE TO
PHYSICIANS -- ISN'T
PARTICIPATING NOW BUT TO MY
COMMENT.
YEAH THE ONLY THING I MIGHT ADD
IS THAT WE DO WE DO REALLY AGREE
THAT THERE IS -- WHILE BROADER
CONSTELLATION OF ACCESS OR
QUALITY MEASURES THAT REALLY
MATTER FOR HOW WELL THE MEDI CAL
PROGRAM IS A IS SUCCEEDING AND
SO FORTH AND THAT THAT IS WHY WE
DO THINK THE APPROACH THAT WE
WILL DISCUSS AT THE END OF THE
DH CS AGENDA.
IN TERMS OF INCREASING THE
NUMBER OF HE THIS MEASURES THAT --
PLANS ARE -- HELD ACCOUNTABLE.
TO FULLY UTILIZING THE SURVEYS
OF BENEFICIARY SATISFACTION AND
SO FORTH AND SO WE REALLY DO --
WE DO REALLY DO THINK THAT THAT
LOOKING AT ENFORCEMENT AND
ACCOUNTABILITY TO A LOT OF THESE
OUTCOMES MEASURE DOES HOLD
PROMISE IN TERMS OF INCREASING
QUALITY AND ACCESS.
AND THE SONY SIKORA PROVEN HE
THIS IS GREAT -- BUT IT'S THE
MYSTERY OF DATA AND IT'S USUALLY
ON FAIRLY CALM CONDITIONS SO IF
YOU HAVE RARE CONDITIONS THERE'S
USUALLY NOT A HE THIS MEASURE
BECAUSE IT'S MORE EPISODIC.
WE DO CAPS I APPRECIATE THE
REMOVING THE CAPS EVERY.
YEAR BUT SO FAR WE HAVEN'T DONE
VERY WELL ON CAP SO WHAT --
EVERY OTHER YEAR OKAY THIS IS A
VERY THREE YEARS EVERY TWO YEARS
SO -- BUT FRANKLY YOU KNOW IF
YOU LOOK AT COMMERCIAL PLANS
STIR GENTLY FOR FIVE STARS IF WE
HAVE A THREE STAR MEDI CAL PLAN
THAT'S REALLY REALLY REALLY WELL
I KNOW WE HAVE SOME CARDS ARE
PLANS ARE UP AT FOUR FEIST I
APPRECIATE THAT YES AND WE WE
NEED TO TAKE.
A LOOK AT THIS MEASURES.
ALL RIGHT WELL WE DO HAVE --
NUMEROUS -- STAKEHOLDER
PROPOSALS DO WE HAVE HERE.
LET'S SEE 1-234-567-8910 ELEVEN
TWELVE OKAY.
WE DO HAVE TWELVE SPEAKER A
HOLDER PROPOSALS RELATED TO MEDI
CAL PROVIDER REIMBURSEMENT RATES
SO WHAT WE'RE GOING TO DO IS WE
ARE GOING TO HEAR THEM ALL AND
THEN WE'LL TAKE PUBLIC COMMENTS.
WHICH MAY END UP BEING JUST TELL
ME WHICH OF THE TWELVE YOU
REALLY LIKE -- BECAUSE HE ALWAYS
STILL GOT A MINUTE -- AND YOU
HAVE MORE YOU I TELL ME ABOUT
THEM YOU CAN.
PROVIDE.
SCOTT HERE'S HAPPY TO LISTEN TO
YOU.
OKAY ALL RIGHT THERE YOU GO.
SO MY BUT IN RIGHT ALL RIGHT SO
THE FIRST -- ONE IS THE
CALIFORNIA MEDICAL ASSOCIATION
FOR THE PROPOSAL DIRECT DTS
MINUTE THREE YEAR STATE PLAN
AMENDMENT WELCOME.
ON BEHALF OF THE CALIFORNIA
MEDICAL ASSOCIATION REPRESENTING
OVER FORTY FOUR THOUSAND
PHYSICIANS THANK YOU --
PROVIDERS THROUGHOUT THE STATE
APPRECIATE THE CONTINUED
COMMITMENT OF THE LEGISLATURE TO
IMPROVE COVERAGE AND CARE FOR
THE OVER THIRTEEN MILLION LOW
INCOME CALIFORNIANS ENROLLED IN
MEDICARE AL.
AND WE ALSO COMMEND THE
GOVERNOR'S RETURN OF ALL
PROPERTY SIX FUNDING TO SUPPORT
PROVIDER PAYMENTS.
AND THE MAIN CHALLENGE FACING
PROVIDERS WHO WANT TO
PERMANENTLY SEE AND SPEND MORE
TIME WITH MEDI CAL PATIENTS ARE
THE DELAYS AN ANNUAL APPROVALS
OF THE SUB MODEL PAYMENTS BY CMS
AND THE FACT THE FUNDING IS NOT
GUARANTEED EACH YEAR. FOR
EXAMPLE THE MEDICARE MANAGED
CARE -- THE TO TO THE TWO
THOUSAND EIGHTEEN NINETEEN
SUPPLEMENTAL PAYMENTS STATE PLAN
AMENDMENT WAS JUST APPROVED BY
CMS AND ALMOST A FULL YEAR AFTER
THE LEGISLATURE APPROVED
PAYMENTS IN THE BUDGET.
SO THEME IS SUPPORTING A BUDGET
REQUEST DRAFTING DH CS TO SUBMIT
A THREE YEAR FEDERAL STATE PLAN
AMENDMENT VERSUS A SINGLE --
CURRENT YEAR APPROVAL TO SMOOTH
AND MAKE MORE CERTAIN THE
PROPOSITION FIFTY SIX REVENUE
STREAM SUPPORTING INCREASE
ACCESS TO HEALTHCARE FOR MEDI
CAL BENEFICIARIES.
IN ADDITION THE ADMINISTRATIVE
BURDEN FOR DCS OF OBTAINING
APPROVAL BY CMS EACH YEAR WILL
BE LESSENED GIVING THEM MORE
CAPACITY TO MONITOR THE MEDI CAL
MANAGED CARE PLANS AND ENFORCE
ACCURATE AND TIMELY DISTRIBUTION
OF THE FUNDING.
ONCE FEDERAL APPROVAL IS
RECEIVED -- WE BELIEVE THE
CONTINUED OVERSIGHT AND
TRANSPARENCY OF THE PROGRAM IS
NECESSARY TO ENSURE THAT THE
BENEFIT OF PROP FIFTY SIX
DOLLARS.
CONTINUE TO FLOW FROM MEDICARE
MANAGED CARE PLANS PROVIDERS AS
BENEFICIARIES INTENDED.
AND WE APPRECIATE YOUR COMMENTS --
ON THE ALLEY -- REPORT --
INTERVIEW AND WE SEE THAT
SUPPLEMENT PAYMENT STRUCTURE AS
A WAY TO LEAPFROG THE CAREFULLY
BALANCED -- CAPITATED RATE
ECOSYSTEM AND DIRECTLY -- AFFECT
PROVIDER BEHAVIOR -- AND WE ARE
SUPPORTIVE -- OF MOST OF THE
PROPOSALS THAT YOU'LL HEAR TODAY
ALL -- TWELVE BUT WE ARE LOOKING
AT THE WHOLE PICTURE AND WE'LL
GET BACK TO YOU WITH AN UPDATED
LETTER THANK YOU.
AND I BROUGHT MY FRIEND FROM CA
THANK YOU.
DARIA GREW CALIFORNIA DENTAL
ASSOCIATION ECHOING THE REQUEST
FOR MULTI YEAR SPA -- FOR THE
REASONS MOST OF THE REASONS THAT
SAM MAY IN FEE FOR SERVICE --
DENTISTRY WE HAVE PRELIMINARY
EVIDENCE THAT THE BEHAVIOR
CHANGE YOU'RE ASKING ABOUT IS
STARTING SINCE JULY OF TWENTY
SEVENTEEN OVER NINE HUNDRED
DENTAL PROVIDERS HAVE NEWLY
ENROLLED IN THE MEDICAL DENTAL
PROGRAM -- THESE PROVIDERS NEED
SOME CONTINUITY IN THE RATES TO
FULLY REALIZE THE GOALS OF PROP
FIFTY SIX THOUGH.
IT IS NOT ACHIEVING THE BEST
POSSIBLE USE OF THE FUNDS --
WITH SINGLE YOUR SPOT.
ALLOCATIONS THREE YOUR SPOT THAT
WOULD BE A GOOD WAY TO ACHIEVE
SOME CONTINUITY BUT ALSO
ALLOWING FOR EVALUATION TIME IN
THE FUTURE THANK YOU.
THANK YOU ANY COMMENTS FROM THE
FARM HEALTHCARE SERVICES ALL
RIGHT LA L..
THE COMMENTS ON THREE YEARS ARE
JUST ONE YEAR [inaudible] ONE WE
WE HAVE NOTED THE CONCERNS ABOUT
SORT OF THEM AND THE PAYMENTS
NOT BEING SORT OF VERY
PERSPECTIVE IN THERE FOR NOT
HAVING IT A STRONG BILLY SHIFT
BEHAVIOR.
SO -- IN -- IN PREVIOUS REPORTS
WE FASTER -- WE'VE SAID THAT THE
LEGISLATURE SHOULD CONSIDER AT
LEAST A MULTI YEAR APPROVAL --
BUT THAT IT SHOULD BE LIMITED
TERM TO ALLOW FOR THAT PROPER
EVALUATION [inaudible]
FINANCE.
I THINK THE LEGISLATURE'S ALWAYS
BEEN OPEN AND THAT AND I THINK
THE ADMINISTRATION'S BEEN HAVING
TO WORK WITH CMS.
THAT CAN BE WORKED OUT.
CHOOSE LEAVE AT THAT.
OKAY THANK YOU VERY MUCH.
ALL RIGHT NEXT THE SPEAKER
PROPOSAL IS. TO INCREASE
MEDICARE REIMBURSEMENT BREAST
PUMPS FROM THE WITH ASSOCIATION
[inaudible]
ALL RIGHT.
NEXT UP AFTER THAT WOULD BE THE
CALIFORNIA ASSOCIATION AIR
MEDICAL SERVICES OF PEOPLE LOST
OR FIGURE OUT WHAT ORDERED
ECONOMIC COMING IN.
RIGHT
ALL RIGHT WELCOME.
KAREN FARLEY THE CALIFORNIA WITH
ASSOCIATION WE APPRECIATE YOU
HEARING THIS PROPOSAL.
REIMBURSEMENT RATES SET FOR THE
PUMPS PROVIDED TO MOMS IN MEDI
CAL WAS SET THIRTY YEARS AGO.
THE TECHNOLOGY HAS CHANGED AND
WE NEED TO PROVIDE MOMS PUMPS IT
WILL INITIATE AND MAINTAIN
BREAST FEEDING WERE ASKING THEM
TO BREAST FEED IN A MAJORITY OF
THEM ARE WORKING OUTSIDE THE
HOME. TO REALLY NEED TO GET THE
REIMBURSEMENT RATE UP SO WE CAN
GET THOMPSON SAID ARE ADEQUATE
AND AND SERVICE THEM -- THE WE
PROVIDED TO AN ELSIE'S ONE AN
ACTUARIAL ANALYSIS AS WE MADE
THAT PROPOSAL -- IN ACTUALITY
THE READ THE THE IMPACT ON THE
BUDGET WOULD PROBABLY BE MUCH
LESS BECAUSE WITH WILL CONTINUE
TO DO THAT THE JOB IT DOES TO
PROVIDE MOMS OF PUMPS.
BUT THEY CAN'T DO IT ALL AND
ACTUALLY MEDI CAL SUPPOSED TO BE
THE FIRST PROVIDER.
SO IT'S A SEVEN MILLION DOLLAR
ASK IT'S PROBABLY SIGNIFICANTLY
LESS THAN THAT BUT WE WANT TO
GIVE YOU THE PHONE NUMBERS IT
WAS ONLY ONE SYSTEM BUT WE DO
HAVE A LEAST.
LOCALLY WORKED ALSO PROVIDE THAT
CARE.
THANK YOU YOUR NUMBER OKAY ANY
COMMENTS FROM THE PART
HEALTHCARE SERVICES LA --
FINANCE NO OKAY WELL CERTAINLY
UNDERSTAND THAT THE OF THE
BREAST PUMP TECHNOLOGIES
IMPROVED AND ALSO AT THE
IMPORTANCE OF TRYING TO BE SURE
WE CAN.
THAT -- WE HAVE GIVE PROVIDE
EQUIPMENT THAT'S NECESSARY FOR
WOMEN TO CONTINUE TO BREASTFEED
THEIR BABIES SO APPRECIATE YOU
BRING THIS FORWARD.
THANK YOU ALL RIGHT EXCELLENT
OKAY SO -- NEXT UP IS -- AS ANY
PROS INCREASE MEDICARE
REIMBURSEMENT FOR AIR AMBULANCE
PROVIDERS FOR THE CALIFORNIA
SAYS HERE MEDICAL SERVICES AND
THE SUN VALLEY SPECIALLY
HEALTHCARE WANTS TO HANG OUT
AROUND THE FRONT.
YOUR NEXT UP OKAY WELCOME.
THANK YOU BILL BRYANT -- FOR CAL
AIMS.
AMBULANCES ARE PART OF THE
EMERGENCY MEDICAL RESPONSE
YSTEM AVAILABLE TWENTY FOUR
HOURS A DAY SEVEN DAYS A WEEK --
RESPOND PRETTY MUCH LIKE A FIRE
DEPARTMENT DOES EXCEPT FOR
PRIVATELY FUNDED -- WE DON'T
SELF DISPATCH WE DON'T HAVE ANY
CONTROL OVER OUR VOLUME IT IS
ALL DRIVEN BY THE REQUEST MADE
BY ON SCENE FIRE DEPARTMENT EMS
FIRST RESPONDERS AT CENTER --
THE WE ARE SO FUNDED IT AND THE
PROBLEM IS WITH MEDICAID THE
RATES THE BASE RATES HAVE NOT
BEEN ADJUSTED SINCE.
NINETEEN NINETY THREE THERE WAS
A TEMPORARY FIX PUT IN ABOUT TEN
YEARS AGO CALLED THE AMADA FUND
WHICH PUT A FOUR DOLLAR PENALTY
ON MOVING VIOLATIONS SET UP A
SPECIAL FUND IT CETERA.
THE LEGISLATURE HAS DECIDED TO
DO AWAY WITH WITH -- THESE KIND
OF OF FUNDING MECHANISMS SO THE
A MODEL PROGRAM EXPIRES DECEMBER
THIRTY FIRST SO WE'RE LOOKING TO
NOW REFUNDED THAT THROUGH
THROUGH THE BUDGET -- WE HAVE
MET WITH -- WITH DEPARTMENT OF
FINANCE AND WE'RE OPEN TO
STRUCTURING THAT HOWEVER IS THE
MOST APPROPRIATE WAY -- BUT WE
WERE LOOKING TO BACK FILL THAT
AMOUNT OF PROGRAM.
SO I'LL JUST FINALLY POINT OUT
THIS IS THE SAME PROPOSAL THAT --
PASSED.
IN YOUR BILL LAST YEAR.
THANK YOU.
I THANK YOU ANY COMMENTS IN PART
ELDER SERVICES.
FINANCE I MEAN HELLO.
FINANCE OKAY AND YOU'VE BEEN
CONVERSATIONS ON ALL RIGHT THANK
YOU.
I THANK YOU VERY MUCH ALL RIGHT
SO -- NEXT UP.
OKAY THANK YOU SO MUCH SO WE
HAVE THE TO ELIMINATE THE RATE
FREEZE INCREASE REIMBURSEMENT
FOR FREE STANDING PEDIATRIC
ACUTE FACILITIES SUN VALLEY
SPECIALTY HEALTH CARE AND JUST
PUT -- CALIFORNIA ASSOCIATION OF
ADULT DAY SERVICES NEXT UP ON
THE BATTERED CIRCLE OKAY WELCOME
THANK YOU DOCTOR PAN IN THE
MEMBERS OF THE PANEL WE'VE HAD A
CHANCE TO TALK TO FINANCE
ELEGIDO THE DEPARTMENT -- MY
NAME IS BOB NINE MM REPRESENTING
SUN VALLEY SPECIALTY HEALTH CARE
WE'RE A FREE STANDING PEDIATRIC
SUBACUTE.
THAT CARES FOR MEDICALLY FRAGILE
CHILDREN PRIMARILY TO DEPENDED
ON VENTILATORS FOR THEIR
SURVIVAL -- I WANT TO THANK YOU
FIRST AND FOREMOST I WAS SITTING
HERE LAST YEAR WE WERE COMING IN
AND SAYING WE'VE GOT IT VERGE OF
FINDING FINANCIAL CRISIS AND YOU
GUYS DID THAT AND YOU DON'T KNOW
HOW APPRECIATIVE I AM -- YOU PUT
US IN THE PROP FIFTY SIX FUNDS
AND IT REALLY SAVE THE FACILITY
ALONG WITH THREE OTHER FREE
STANDING PEDIATRIC SUB ACUTE.
GOOD JOB -- WHERE WE ARE NOW
WE'VE BEEN HAD A RATE FREEZE FOR
TEN YEARS GOING ON ELEVEN YEARS
HASN'T CHANGED SINCE -- TWO
THOUSAND EIGHT THE COURSE THE
PROP FIFTY SIX FUNDS WHAT SAID
DONE FOR US.
LONG DELAYED CAPITAL
IMPROVEMENTS ARE BEING FIX ROOFS
AIR CONDITIONING HEATING FOR ALL
THESE THINGS THAT HAVE BEEN
DELAYED WE'RE MAKING ADJUSTMENTS
TO COMPENSATION -- IMPROVEMENTS
TO THE DURABLE MEDICAL EQUIPMENT
GOOD THINGS -- IT DE.
THESE FACILITIES ARE.
TOTALLY FUNDED TO MEDICAL FUNDS.
TWO HUNDRED FIFTY TWO CLIENTS
THEY THEY SAVE MEDI CAL FIVE
HUNDRED THOUSAND DOLLARS A DAY.
BECAUSE OF THESE KIDS WEREN'T IN
OUR FACILITY THEY WOULD BE
TRAPPED IN AND I SEE YOUR IN THE
QUEUE.
AT THREE THOUSAND PLUS A DAY
OKAY THAT WAS THE ORIGINAL
INTENT IN THE NINETEEN NINETIES
OF CREATING THIS PROGRAM.
SO THIS PROGRAM GOES WAY.
THIS IS A BUDGET COMMITTEE YOU
CAN SEE THE DOLLARS AND CENTS
THERE -- THE KIDS WE SERVE WE'RE
REALLY TRYING TO CREATE A
HOLISTIC ENVIRONMENT A HOME LIKE
ENVIRONMENT A PLACE WHERE THEY
CAN THRIVE THEM AND THEIR
FAMILIES -- WHAT REALLY COMING
HERE TODAY IS TO ASK FOR FOR ITS
FISCAL SUSTAINABILITY -- WE'VE
GOT A ONE YEAR WE HADN'T PROP
FIFTY SIX FOR ONE YEAR -- WE
CAN'T GIVE A BUNCH IT WE CAN'T
RIGHT SIZE WAGES AND GIVE PEOPLE
INCREASES WHEN WE HAVE NO
GUARANTEE OF MORE MONEY NEXT
YEAR.
IF WE CAN'T DO SOMETHING ABOUT
THIS WE'RE GOING TO END UP IN
THE SAME FINANCIAL CRISIS AGAIN
NEXT YEAR SO ARE REAL REQUEST
HERE.
IS TO CORRECT SELF COULD TO
CORRECT THE RATE FREEZE CORRECT
RIGHT SIZE THE RATE -- SO WE
WANT TO LIFT THAT RATE FREEZE
THAT'S BEEN ON FOR TEN YEARS
THAT'S HUGE.
AND THEN RIGHT SIZE THE RATES
ARE REQUEST IS A GENERAL FUND
EXPENDITURE AUTHORITY OF TEN
MILLION TO INCREASE
REIMBURSEMENT RATES.
TRAILER BILL LANGUAGE TO REMOVE
STATUTORY RATE FREEZE -- YOU
KNOW WITHOUT THAT WE'RE GONNA BE
BACK WHERE WE WERE LAST YEAR
JUST JUST PLEASE SAVE US.
WE CAN'T GO BACK THERE.
THE KIDS WE'VE WITH THE KIDS WE
SERVE A BEAUTIFUL AND WE NEED TO
TAKE CARE OF ALL AND WE NEED
YOUR HELP ON THAT.
I THANK YOU ANY COMMENTS BY AS
SERVICES L. L. [inaudible]
FINANCE.
AND JUST TO CLARIFY BECAUSE HE
SAID THAT REMOVED THE ROOFS
GREAT FREEZE WILL THEN.
MISTER WHAT'S THE RATE.
OF ITS NOT FROZEN I GOT THE IDEA
THAT IDEA BUT I MEAN IS THERE
SOME STANDARD BY WHICH GETS
ADJUSTED WELL I CAN EXPLAIN THAT
TO YOU SO IF YOU LIFT THE RATE.
IF YOU DO A RATE FREEZE YOU KNOW
WE'RE IT'S BASICALLY SEVEN
HUNDRED SIXTY TWO DOLLARS A DAY
OR OKAY SO SO LET IS THERE SOME
BENCHMARKING WHICH THE RATE
WOULD THAT CHANGE.
IF WE TAKE AWAY THE FREEZE MY
PROPOSAL BUT WHAT THESE NUMBERS
ARE BASED ON IS IF YOU LOOK AT
TWO THOUSAND EIGHT THERE ARE
FREE STANDING PEDIATRIC SUB
ACUTE INSTINCT PART PEDIATRIC
SUB ACUTE.
THEY PROVIDE THE IDENTICAL
SERVICE WITH THE IDENTICAL STAFF
THE ONLY DIFFERENCE IS THE
DISTINCT PART AS PART OF A
HOSPITAL.
OKAY WITH THEIRS IF YOU WALKED
IN THERE NO DIFFERENT OKAY WITH
THEIR HEAD 7% MORE THAN WE DID
IN TWO THOUSAND EIGHT OKAY SO
YOU'RE YOU'RE BENCHMARKING
AGAINST -- SIMILAR FACILITIES
ARE CASH APPLES TO APPLES AND
THEY GOT A C. CPI INDEX
CALIFORNIA CONSUMER PRICE INDEX
FOR THE LAST TEN THOSE ARE ALSO
FUNDED BY MEDICARE I'LL THEY ARE
HUNDRED AND MEDICAL OKAY THEY SO
BASICALLY WHAT BE TREATED THE
SAME AS SIMILAR FACILITIES
ATTACHED HOSPITAL RACK BUT THEY
GOT. 7% MORE BECAUSE THEY'RE
ATTACHED A HOSPITAL HOSPITAL
INFRASTRUCTURE THERE NOW 40%
MORE OKAY WE ARE ALL RIGHT I'M
JUST TRYING TO UNDERSTAND.
THAT THE WAY TO TALK ABOUT
STRUCTURING THE THAT THE
PAYMENTS THAT IT OKAY READY
SIMPLE APPLES TO APPLES
COMPARISON OKAY ALL RIGHT VERY
GOOD ALL RIGHT THAT'S UNDERSTOOD.
THE COLOR BY THAT THANK YOU SO
VERY MUCH ALL RIGHT.
NUMBER LED TO KNOW WE WERE ABLE
TO HELP WELL MORE POORLY
[inaudible]
BETTER UP -- GOOD AFTERNOON
CENTER PAN I'M LYDIA MISLEADING
AS THE EXECUTIVE DIRECTOR FOR
THE CALIFORNIA ASSOCIATION FOR
THE ALL TE SERVICES GETTING
OVER LEARNED TITUS -- WE ARE
NONPROFIT ASSOCIATION IS YOU
KNOW THAT'S BEEN SUPPORTING
ADVANCING AND LEADING ADULT DAY
HEALTH SERVICES SINCE.
NINETEEN SEVENTY SEVEN OUR TWO
HUNDRED FORTY ONE CENTERS SERVE
THIRTY SEVEN THOUSAND PEOPLE
WITH COMPLEX CHRONIC CONDITIONS
THROUGH MEDIC HELL.
WITH THE GOAL OF IMPROVING AND
MAINTAINING HEALTH TO REDUCE
UNNECESSARY USE OF HIGH COST
HEALTH CARE AND LONG TERM
SERVICES.
A TWO OF OUR PROVIDER MEMBERS OF
TRAVEL FROM THE BAY AREA AN
ORANGE COUNTY TO SPEAK WITH YOU
TODAY ABOUT SEA BASS.
AND WHY THIS IS SECTION URGENT
REQUEST TO INCREASE THE RATES OF
DEBBIE TOTH WILL BE A FIRST.
THE GOOD AFTERNOON SENATOR PAN.
THANK YOU TO YOU AND YOUR STAFF
FOR THIS OPPORTUNITY -- TO TALK
ABOUT THIS IMPORTANT BUDGET
ISSUE MY NAME IS DEBBIE TOTH AND
I AM THE CHIEF EXECUTIVE OFFICER
FOR CHOICE MEETING.
LOCATED IN CONTRA COSTA COUNTY
WE ARE A SEVENTY YEAR OLD
NONPROFIT ORGANIZATION PROVIDING
L. TSS FROM MS US PC BASSY CITY
EVERY ACRONYM YOU CAN COME UP
WITH CARE GIVER SUPPORT.
WHAT'S UNIQUE ABOUT OUR PROGRAMS
AS WE HAVE MULTI CULTURAL
PROGRAMS AN INTERGENERATIONAL
PROGRAMS IN OUR ADULT DAY HEALTH
CARE C. BEST PROGRAMS -- SEA
BASS SUPPORT SOME OF THE MOST
COMPLEX AND VULNERABLE ADULTS
MEDI CAL RECIPIENTS BY MANAGING
AND MONITORING THEIR CHRONIC
HEALTH CONDITIONS OVER TIME.
IT'S RECOGNIZED AS ONE OF
CALIFORNIA'S MOST VALUABLE AND
COST EFFECTIVE LONG TERM
SERVICES AND SUPPORTS TO ASSIST
FRAIL ELDERS AND DISABLED ADULTS
TO LIVE IN THE COMMUNITY.
HOWEVER THE PROGRAM IS AT RISK
BECAUSE THE MEDICAL PUBLISHED
REIMBURSEMENT RATE HAS BEEN
FROZEN FOR ELEVEN YEARS.
AS IT RELATES TO THE PROVIDER AN
ACCESS TODAY WE CURRENTLY HAVE
TWO HUNDRED FIFTY ONE CENTERS
OPEN ACROSS THE STATE HOWEVER
FIFTY THREE CENTERS HAVE CLOSED
SINCE JANUARY.
TWENTY ELEVEN WE'RE HEARING FROM
OUR MEMBERS THAT CENTER CLOSURES
CONTINUE TO THREATEN ACCESS TO
CARE FOR THIS COMPLEX POPULATION.
THE STATE'S AGING POPULATION IS
DRIVING A NEED TO THAT WE ARE
NOT PREPARED TO MEET EVEN TODAY.
THAT IS WHY IT'S URGENT TO
REBUILD CAPACITY UNSTABLE ICY
BASS PROGRAMS THAT WERE MOST
AFFECTED BY THE RECESSION SO
THEY CAN CONTINUE TO SERVE
PEOPLE IN CALIFORNIA.
OUR PROGRAM HAS BEEN CHRONICALLY
UNDERFUNDED FOR YEARS AND NOW IS
THE RIGHT TIME TO SUPPORT A
SUSTAINABLE RATE THANK YOU FOR
YOUR CONSIDERATION.
GOOD AFTERNOON SENATOR PAN.
THANK YOU FOR ALLOWING ME THIS
OPPORTUNITY MY NAME IS MALLORY
VEGA I'M THE VICE PRESIDENT OF
DIRECT CARE SERVICES FOR
OCCASIONS ALL DAY SERVICES.
AND SELF COUNTY ADULT DAY
SERVICES LOCATED IN ORANGE
COUNTY.
BETWEEN THE TWO SIDES WE SERVE
OVER THREE HUNDRED AND
DUPLICATED FRAIL OLDER ADULTS
FROM ALL OVER THE ETHNICALLY
DIVERSE.
ARE COUNTY EACH YEAR.
IN ADDITION TO OUR REQUEST TO
RESTORE THE A. B. 9710% CUT WE
ARE ALSO REQUESTING A 15%.
COST OF LIVING INCREASE TO THE
PUBLISHED MEDI CAL RATE TO TAKE
INTO ACCOUNT MORE THAN A DECADE
OF COST INCREASES INCLUDING
MINIMUM WAGE THE RISING COST OF
RENT UTILITIES FUEL AND FOOD IN
ADDITION TO INCREASED
UNCOMPENSATED COSTS. TO END TO
IMPLEMENT NEW FEDERAL AND STATE
REGULATIONS.
OUR CENTERSHAVE BEEN STRAINING
FOR MANY YEARS TO ATTRACT.
ARE HIGH QUALITY REVIEW SKILLED
HEALTH CARE PROFESSIONAL STAFF
MEMBERS AT OUR REYES.
ARE WE HAVE EVIDENCE THAT USE OF
SEE BEST RESULTS IN DECREASED
USE OFMORE COSTLY SERVICES
INCLUDING EMERGENCY ROOM VISITS
HOSPITAL EMISSIONS READMISSIONS
AND SKILLED NURSING CARE.
IT MAKES FISCAL SENSE TO INVEST
IN THE HEALTH OF THIS PROGRAM --
THE RESTORATION OF THE 10% CUT
TO THE CURRENT PUBLISHED RATE
WITH THE ADDITION OF A MODEST
15% COLA MAKES UP FOR A DECADE
OF LOSSES TO AVOID NEW CLOSURES.
THANK YOU THANKS FOR MUCH ANY
COMMENTS FROM PARK HOSTS WAS
OKAY ALEJO [inaudible]
FINANCE.
AND IS THERE AN SO I KNOW YOU
TALK ABOUT THE RESTORATION THE
REDUCTION AND 15% BECAUSE LIVING
INCREASED IS OR AT AND THAT'S
ABOUT WHAT THE TOTAL COST OF
THAT WOULD BE.
WE DON'T HAVE A CURRENT ESTIMATE
BACK IN TWENTY TWELVE I BELIEVE.
A DEPARTMENT OF FINANCE AND
HEALTH -- FOR CREATED AN
ESTIMATE AT THAT TIME OF TWENTY
TWELVE MILLION DOLLARS.
STATE COSTS -- BUT THAT WOULD
HAVE TO BE UPDATED TO CURRENT
TIME A HIS ANY CONVERSATIONS OF
FINANCE ABOUT GETTING AN UPDATED
ESTIMATES YET -- YES AND THEY
ARE I BELIEVE AT YOUR DIRECTION
PREPARED TO TO THEM BUT WITHOUT
THAT -- WE'RE ONE OF MANY MANY
PROPOSES THAT NEED AN ESTIMATE
CREATED SO -- YEAH WE DON'T WE
WE DON'T INDEPENDENTLY HAVE US
OKAY OR YOU OKAY SO WE HAVE JUST
SO YOU'RE WILLING TO GIVE SOME
TECHNICAL ASSISTANCE ON THIS.
WE CAN FOLLOW UP WITH YOUR STAFF
OKAY YEAH ALL RIGHT OKAY THANK
YOU THANKS FOR MY THANK YOU ALL
RIGHT WELL THANK YOU THANK YOU
pDOING.
I THANK YOU.
OKAY NEXT UP WE HAVE -- THE
PROPOSAL TO RECREATE
REIMBURSEMENT METHODOLOGY
CLINICAL LABORATORY SERVICES
CALIFORNIA CLINICAL LABORATORY
ASSOCIATION AND ON THE BETTER
CIRCLES THE DEVELOPMENTAL
SERVICES NETWORK.
OKAY WELCOME.
THANK YOU GOOD AFTERNOON
CHRISTIE FOR A ON BEHALF OF THE
CALIFORNIA CLINICAL LABORATORY
ASSOCIATION WE HAVE QUESTION LAP
CORE THAT OUR MEMBERS.
AND WE HAVE A BIT UNIQUE
SITUATION WE'RE NOT ASKING FOR A
RATE INCREASE WE'RE JUST
ACTUALLY ASKING THAT ARE MEDI
CAL RATE BE LEFT THE SAME.
AND NOT BE CUT BECAUSE IT'S
SOMETHING THAT'S HAPPENING AT
THE FEDERAL LEVEL SO HOW THAT
WORKS AS THE FEDERAL GOVERNMENT
IN CMS HAS MADE THE DECISION TO
CHANGE THE WAY THEY CALCULATE.
A MEDICARE REIMBURSEMENT RATES
FOR CLINICAL LABORATORIES SO
THEY HAVE CUT ALL OF THE RATES
DOWN TO THE NATIONAL MARKET RATE.
AND THE REASON THIS IS AN ISSUE
NOW IS BECAUSE WE HAVE SOMETHING
ON THE BOOKS IN CALIFORNIA.
THAT'S BEEN HERE SINCE TWO
THOUSAND THREE THAT SAYS UP OUR
MEDICAL RATES CANNOT BE MORE
THAN 80% OF THE MEDICARE RATE.
AND SO THE PROBLEM IS THAT NOW
THAT WE HAVE THESE NEW REDUCE TO
MEDICARE RATES FOR THE FIRST
TIME.
THIS IMPACTS WHAT OUR RATES ARE
FOR MEDI CAL AND I CAN GIVE YOU
A QUICK EXAMPLE KINDA HELPS
ILLUSTRATE THAT.
SO AS A PART OF THE MEDI CAL
PROGRAM WE DO CHILDHOOD LEAD
BLOOD TESTING.
AND SO AS YOU KNOW BETTER THAN
ME -- WHEN THEY TESTING ON A
LEAD IN THE BLOOD IT'S THE SAME
TEST FOR A CHILD AND MEDI CAL AS
IT IS FOR AN ADULT IN THE
MEDICARE PROGRAM?
AND SO THE RECENT -- MEDICARE
PRICE WAS SIXTEEN DOLLARS AND
SIXTY ONE CENTS THE NEW
CALCULATION THAT PUT IT UP
MRKET RATE BROUGHT IT DOWN TO
TEN DOLLARS AND SIXTY CENTS.
SO IN CALIFORNIA BACK IN TWO
pTO A MARKET RATE SO THE STATE
FORTY COPULATE OUT THE MARKET
RATE AND THE CURRENT MARKET RATE
FOR THIS TEST.
IS TEN DOLLARS AND SIXTY THREE
CENTS SO YOU CAN SEE IS VERY
SIMILAR TO THAT MARKET RATE.
THE PROBLEM IS WITH THIS NEW
PROVISION OUR WEBSITE WITH HIS
OLD PROVISION IT WILL CAUSE THAT
RATE TO BE CUT 20% DOWN TO EIGHT
DOLLARS AND FORTY EIGHT CENTS.
AND THEN WE STILL HAVE THE AB
9710% CUT SO THAT BRINGS IT DOWN
TO SEVEN DOLLARS AND SIXTY THREE
CENTS.
SO IF YOU CAN SEE THE CURRENT
MEDI CAL RATE IS TEN DOLLARS AND
THE NEW RATE WOULD BE UNDER
SEVEN DOLLARS SO WE ABSOLUTELY
THINK IS GOING TO HAVE AN IMPACT
ON ACCESS. FOR NOT JUST
CHILDHOOD BLOOD LEAD TESTING BUT
A LOT OF OTHER TESTS.
TO SO BASICALLY IN CONCLUSION --
ARE ISSUE WE'RE JUST ASKING.
AS A MATTER PRIORITIES THE YOU
LOOK AT THE BUDGET YOU MAKE
DECISIONS NO ONE IN CALIFORNIA
REALLY LOOKED AT CLINICAL
LABORATORY RATES AND SAID THEY
NEED TO BE CUT 30%.
IT IS BECAUSE OF WHAT'S
HAPPENING AT THE FEDERAL LEVEL
SO WE'RE ASKING FOR A FIX TO GET
RID OF THAT 80% CAP AND I CAN
ANSWER ANY QUESTIONS IF YOU HAVE
THAT.
THANK YOU COMMENTS PER HAS RISEN
SALLY -- FINANCE [inaudible]
OKAY SO.
ME NO CURSO IS A OKAY SO I MEAN
WHAT WE HAVE A SITUATION WHERE
WHERE CERTAINLY I THINK -- I
MEAN LOTS A WINDFALL FOR MEDI
CAL IF WE JUST SIMPLY LET THIS
HAPPEN BUT AND ITS POTENTIAL
AXIS ISSUE AN ANSWER.
YOU KNOW WE WE WE WE PUT IN A
TENT QUOTE 10% CUT BACK IN BUT
THIS IS THIS SO IN OTHER WORDS.
IS IT FAIR TO JUST TAKE THE
WINDFALL AND RISK THE PROBLEMS
ARE TOO WE JUST MAKE AN
ADJUSTMENT SO THAT I MEAN
THEY'RE NOT REALLY LOOKING
THEY'RE NOT LOOKING FOR AN
INCREASE OR JUST LOOKING FOR
PARITY BEFORE OR SO SURE SO WE
WILL NEED TO ASSESS ANY ACCESS
POTENTIAL.
ACCESS ISSUES BECAUSE AS AS AS
WAS MENTIONED THIS IS A CURRENT
STATE LAW LIMITATION SO IT'S NOT
SOMETHING THAT WE CAN DO.
THAT SO THIS WAY -- BUT WITH
YOUR HELP -- FOR THIS IS EVEN
WITH YOUR ACQUIESCENCE.
BECAUSE OBVIOUSLY LAWS REQUIRE
WHAT WE COULD OVERRIDE THE
GOVERNOR'S VETO BUT I DON'T
THINK WE'RE LOOKING TO DO THAT --
IF IF THE LEGISLATURE SO CHOSE
TO MAKE A CORRECTION.
WE JUST LIKE TO KNOW THE
ADMINISTRATION BE OPEN TO THE
IDEA AND PERHAPS.
THE GOVERNOR SAID.
NO YOU CAN'T.
IT IS TECHNICALLY POSSIBLE TO DO
NINETY OKAY AND WE WITH THE
TECHNICAL ASSISTANCE FROM YOU TO
VOTERS TO DO THAT.
AND THEN A STATE PLAN CHANGED TO
REMOVE BECAUSE OF THE STATE
LODGE.
PROVISION IS IN THE STATE PLAN
OKAY ALL RIGHT SO CELL VIEW
COULD PROVIDE SOME TECHNICAL
ASSISTANCE FOR APPROPRIATE
TRAILER BILL LANGUAGE THAT WOULD --
THOUGH IT OF FACILITATE THIS
OCCURRING CORRECT AND WE GOT YES
AND SO I KNOW WE'RE WORKING WITH
SCOTT AND HIS LIST OF THE PRIDE
NOT HIS LAST BUT THE LIST OF
RIGHT -- KIDS THERE ARE AS
YOU'VE NOTED MANY MANY
STAKEHOLDER PROPOSALS AND SO I
THINK BETWEEN US AND THE
DEPARTMENT OF FINANCE WE'RE WE
CAN'T REALLY DO ALL NINETY I
THINK THERE'S NO I I UNDERSTAND
THAT I BUT I PLAY I THINK FOR
THIS.
ONE PARTICULAR I MEAN THIS IS
NOT.
THE SICKLY IS THAT THIS IS A
WINDFALL FOR BACK I I DON'T EVEN
KNOW WHAT THE DATE WAS BUDGETED
FOR THAT OR NOT -- IN THE
REGIONAL THAT AND I AND I THINK
THERE'S A THERE'S A FAIRNESS
ANDERSON ACCESS ISSUES THAT SO
I'M NOT SURE WE WERE OVER PAYING
THEM BEFORE.
AND SO BUT WE WOULD NEED YOUR
TECHNICAL ASSISTANCE TO BE SURE
WE CRAFT THE SOLUTION THE RIGHT
WAY.
SORRY AS MUCH AS YOU MIGHT Y.
INCREASE I THINK WE WANT TO TRY
TO FOLLOW THE LINES OF WHAT YOU
SUGGESTED AND JUST TRY TO COME
UP WITH A REASONABLE --
METHODOLOGY THAT WOULD
ESSENTIALLY CHIEF WHAT THE
LABORATORIES -- UP PROPOSED
SWITCHES YOU OF BEING SURE THAT
THERE'S SOME PARITY WITH
PREVIOUS.
THAT MAKES SENSE TO SURE WE HAVE
THE SAME -- ACCESO APPRECIATE
APPRECIATE YOUR ASSISTANCE ABOUT
ASSISTANCE FROM FINANCES WELL
I'D TELL OKAY.
RIGHT THANK YOU VERY MUCH OKAY
THANK YOU.
AND THEN WE'LL DO OUR PART.
OKAY -- DEVELOPED SURVEY SO WE
HAVE -- PROPOSAL TO ELIMINATE
THE RATE FREEZE INCREASE
REIMBURSEMENT RATES FOR AYE CFT
DIS FOR THE GOVERNMENTAL
SERVICES NETWORK AND THE NEXT UP
ON THE BETTER CIRCLES CALIFORNIA
HOSPITAL ASSOCIATION.
RIGHT WELCOME TO PAN THANK YOU
VERY MUCH MY NAME IS MARK CLAUS
FROM THE PRESIDENT AND CEO FOR
HOME OF GUIDING HANDS WERE A
FIFTY TWO YEAR OLD A COMMUNITY
BASED -- PROVIDER NONPROFIT --
IN SAN DIEGO -- I WASN'T HERE TO
ELEVEN PM WHEN I WAS AT THE
AIRPORT FOR FIFTEEN THIS MORNING
SO I I FEEL YOUR PAIN -- BUT YOU
KNOW -- WHAT WE'RE HERE TO TALK
ABOUT OUR IMMEDIATE INTERMEDIATE
CARE FACILITIES ICO AND -- WHAT
WE'RE TALKING ABOUT OUR SMALL
COMMUNITY BASED HOMES WE OWN AND
OPERATE TWENTY FIVE HOMES --
THEY EACH SUPPORT SIX
INDIVIDUALS KNOWS HOMES -- GIVE
YOU AN EXAMPLE -- YOU KNOW THE
THE OTHER PROVIDERS ABOUT ELEVEN
HUNDRED HOMES -- I SEE OF HOMES
IN THE STATE OF CALIFORNIA --
THE PROPOSITION FIFTY SIX FUNDS
THAT WE ARE CURRENTLY RECEIVING
I CAN TELL YOU HAVE BEEN AN
ABSOLUTE LIFELINE THEY ALLOWED
US IN MONEY OTHER PROVIDERS.
TO SURVIVE -- WITHOUT THESE
FUNDS OUR ORGANIZATION WAS
LOOKING AT CLOSING A NUMBER OF
THESE HOMES.
IN TWO THOUSAND AND NINE OUR
RATES WERE FROZEN AT TWO
THOUSAND ELEVEN ARE EXCUSE ME
TWO THOUSAND AND EIGHT LEVELS --
SO THEY WERE LOOKING AT A RATE
FREEZE OF ABOUT ELEVEN YEARS
YOU'VE HEARD THIS BEFORE.
DURING THIS TIME THE COST OF
LIVING INDEX OF IN CALIFORNIA IS
INCREASED ABOUT 27% -- WHAT
WE'RE ASKING FOR IS TO DO THE
SUPPORT TO UNFREEZE THE RATES --
BUT YOU HAVE TO FOR EARLIER --
FROM OTHER PROVIDERS AND ALSO A
15% RATE INCREASE USING
PROPOSITION FIFTY SIX FUNDS.
REQUIRED MINIMUM WAGE INCREASES
HAVE HAVE LEFT -- US UNABLE TO
BE COMPETITIVE IN TERMS OF OUR
STAFF IN TERMS OF QUALITY DIRECT
CARE STAFF OUR CURRENT TURNOVER
RATE IN OUR HOMES IS IN EXCESS
OF 40% -- ARE THE MEDICAL COSTS
TRYING TO FIND NURSES TO WORK ON
OUR OWN -- OUR HOMES HAVE SEVEN
NURSES BETWEEN ALL TWENTY FIVE
OF THEM.
OUR COSTS EXCEED OUR
REIMBURSEMENT RATES BY ABOUT TWO
HUNDRED THOUSAND DOLLARS -- TO
TRY TO FIND GOOD QUALITY NURSING
AND MEDICAL STAFF TO SUPPORT
RESIDENTS THE COMMUNITY IS IS
ALMOST IMPOSSIBLE TO DO --
SERVICE -- THIS 15% -- WOULD
ALLOW US TO BE COMPETITIVE
REDUCE AT STAFF TURNOVER RATE
AND CONTINUE THE IMPROVE THE
LIVES OF THOUSANDS OF
INDIVIDUALS WITH DEVELOPMENTAL
DISABILITIES -- PECAN ON THESE
HOMES FOR MANY MANY YEARS.
THANK YOU HI THANK YOU.
THE PROPOSAL.
BARBARA GLAZER WITH THE
CALIFORNIA HOSPITAL ASSOCIATION
FIRST OF ALL I'D LIKE TO SAY
THANK YOU FOR INCLUDING THIS
PROPOSAL -- IN THE ON THE AGENDA
TODAY WE ARE REQUESTING THAT THE
DEPARTMENT OF FINANCE
RECALCULATE THE PROPOSITION
FIFTY FIVE FORMULA SO THIS IS I
AM GONNA HOLD SO.
WE HAVE GOT TO THAT PROPOSAL YET
HAS OUT. TO YOU I THOUGHT YOU
ARE ALSO PART OF THIS ONE SO
THAT'S OKAY YOU JUST WAIT
BECAUSE THEY'RE ALL RIGHT.
ANY COMMENTS FROM THE PART
HEALTHCARE SERVICES -- A. L.
[inaudible]
FINANCE [inaudible]
OKAY -- ALL RIGHT AND LET'S SEE
WHAT'S THE CURRENT -- WHICH I
GUESS THAT'S THE FOR FOR THE
SEAT DO YOU KNOW HOW MUCH SO
BASED ON THE CURRENT
REIMBURSEMENT HOW MUCH WHAT'S
THE SIZE OF THE BUDGET
[inaudible]
FOR THESE SERVICES.
BRENAN TRAMP.
ROUGH TO TELL ME YEAH.
THE 15% WE WILL I THINK WE
PROVIDED A A ROUGH NUMBER -- I
KNOW WE'RE WORKING DEPARTMENT
HEALTH CARE SERVICES ON ON SOME
MORE CURRENT INFORMATION AND
BETTER TENDONS WERE LOOKING AT
ACOSTA SOMEWHERE AROUND THIRTY
MILLION DOLLARS [inaudible]
OKAY.
HI THAT'S VERY HELPFUL OKAY WELL
THANK YOU THANKS VERY MUCH OKAY
SO THE NEXT ACRE PROPOSAL IS THE
RECALCULATION OF PROP.
FIFTY FIVE SHOPFOR
HOSPITALIZATION AND NEXT PERSON
UP IS THE CALIFORNIA BIRTH
CENTER ASSOCIATION ON WILL BE
AFTER -- HOSPITALS AS IT OKAY
WELCOME AND THANK YOU AND THANK
YOU FOR INCLUDING THIS TODAY
BARBARA GLAZER WITH THE
CALIFORNIA HOSPITAL ASSOCIATION.
WE ARE REQUESTING THAT THE
DEPARTMENT OF FINANCE
RECALCULATE PROPOSITION FIFTY
FIVE MORE IN ACCORDANCE WITH THE
PROPOSITION AND IN LINE WITH
VOTER INTENT WE DO BELIEVE THAT
IF THEY WERE TO DO THAT.
IT COULD MEAN AS MUCH AS AN
ADDITIONAL SEVEN HUNDRED MILLION
DOLLARS FOR THE MEDIC CAL
PROGRAM.
WE WOULD PROPOSE THAT THOSE
DOLLARS BE SPENT -- ON A ONE
TIME BASIS AS INVESTMENTS FIRST
OF ALL WE'D LIKE TO SEE TWO
HUNDRED AND FIFTY MILLION
DOLLARS PUT INTO WORKFORCE
SHORTAGES WITH AN EMPHASIS ON
BEHAVIORAL HEALTH.
THEY COULD BE USED TO FUND --
PRIMARY CARE RESIDENCIES AND
PSYCHIATRIC RESIDENCIES -- AND
IF THIS WERE DONE IN ACCORDANCE
WITH FEDERAL LAW WE THINK THIS
COULD BE WE COULD UTILIZE THIS
IN SUCH A WAY THAT IT WOULD ALSO
DRAW DOWN FEDERAL DOLLARS.
AND IT COULD BE A ONE TIME
INVESTMENT THAT COULD BE
UTILIZED OVER THE NEXT THREE TO
FIVE YEARS.
THOSE DOLLARS COULD ALSO BE
SPENT TO TRAIN MORE NURSE
PRACTITIONERS IN PSYCHIATRY THIS
IS A PROPOSAL THAT CAME OUT OF A
WORKFORCE COMMISSION REPORT THAT
CAME OUT ABOUT SIX WEEKS AGO.
WITH THE TWENTY FIVE MILLION
DOLLAR INVESTMENT WE COULD TRAIN
THREE HUNDRED MORE -- NURSE
PRACTITIONERS OVER THE NEXT FIVE
YEARS.
AND THEN WE'D LIKE TO SEE SOME
GRANT MONEY GO -- GO OUT AS WELL
TO HOSPITALS AND OTHER PROVIDERS
THINK THEY COULD SPEND IT ON
BEHAVIORAL HEALTH INFRASTRUCTURE
SUCH AS MORE CRISIS
STABILIZATION UNITS -- HOSPITALS
COULD USE IT FOR SOME OF THE
RENOVATION AND RETROFITTING THEY
NEED TO DO TO MEET SOME FEDERAL
LIGATURE REQUIREMENTS THIS IS
ESPECIALLY IMPORTANT IN OUR
PSYCHIATRIC HOSPITALS.
AND THEN WE'D LIKE TO SEE SOME
OF THAT MONEY PUT TOWARDS --
IMPROVING ACCESS IN OUR RURAL
AREAS ARE RURAL HOSPITALS
STRUGGLE ON THE AGAIN THEY COULD
IT COULD BE GRANT MONEY THAT
COULD BE YOU SOMEONE TIME BASIS --
FOR TELUS IJCAI A TREE AND MORE
REGIONAL CRISIS STABILIZATION
SERVICES AND THEN LASTLY WE
WOULD LIKE TO SEE TWO HUNDRED
AND FIFTY MILLION GO TOWARDS
DISPROPORTIONATE SHARE HOSPITALS.
CURRENTLY THERE IS A POSSIBLE.
STRONG POSSIBILITY OF A CUT AT
THE FEDERAL LEVEL WE ARE WORKING
HARD TO STOP THAT BUT THEY COUD
BE FACING A SIGNIFICANT CUT AS
EARLY AS THIS FALL.
SO VERY QUICKLY THOSE THAT THAT
IS WHAT WE WOULD LIKE TO SEE
THOSE DOLLARS SPENT ON MOST MOST
IMPORTANTLY THOUGH I THINK WE'D
LIKE TO SEE A RECALCULATION OF
PROPOSITION.
FIFTY FIVE WHICH I THINK WAS IN
THE SPIRIT OF THAT OF THAT LAW
WHEN IT PASSED IN.
TWENTY SIXTEEN OKAY THANK YOU
ANY COMMENTS FROM DCS ALEJO.
WE CAN PROVIDE SOME BACKGROUND
IF THE CHAIR WOULD LIKE ON HOW
THE CALCULATION IS DONE AND AND
HOW IT WOULD BE DIFFERENT --
THIS IS SOMETHING WE BROUGHT UP
IN PAST YEARS -- BUT HAPPY TO TO
REITERATE THAT IF THAT WOULD BE
HELPFUL.
WELL ACTUALLY WE DID HAVE A
RATHER EXTENSIVE CONVERSATION
ABOUT THIS -- NOT ONLY LAST YEAR
BUT EVEN THIS YEAR.
HI THANK YOU FOR I RECALL -- AND
I DID ADMONISH THE PARTNER OF
FINANCE -- ABOUT.
THE WAY THEY CALCULATED BUT ALSO
HAD TO ACKNOWLEDGE THAT THE
PEOPLE WHO WROTE THE INITIATIVE.
AND PERHAPS YOU KNOW AND NEGOCIO
THE GOVERNOR PUT THE SAN.
LEFT IT ENTIRELY TO THE
DEPARTMENT OF FINANCE. TO
DETERMINE WHATEVER METHODOLOGY.
AND WHILE I COULD INVITE ISSUE
AGAIN THE PART OF FINANCE WHICH
JERRY DID THIS YEAR ACTUALLY
YOU'VE YOU PLAY BACK THE TAPE IS
QUITE.
WHO? TO PRY THE DEVICE ON GO
THROUGH THE AND I DON'T KNOW AS
IS QUITE A COOL AS A QUITE A
LONG CONVERSATION -- I HAD TO
ADMIT THAT LEGALLY I HAD NO.
ABILITY TO DO THIS IT'S AN
INITIATIVE I MEAN WE ALLEN THINK
THE LEGISLATURE COULD TRY TO
PASS A BILL. TO TO FIX THAT SO --
SO I WILL TELL YOU THAT I SHARE
YEAR -- CONCERN I HAVE.
MAN MADE THAT POINT POINTEDLY
AND AT LEAST IN THE A AND
SEVERAL OCCASIONS HERE -- BUT IN
THE END -- AS MUCH AS I'D LIKE
TO AND I WILL URGE AGAIN I HOPE
THAT WITH THE HOSPITALS THAT --
FINANCE LOOK AT THAT BUT SO
WE'LL SEE WHAT HAPPENS IN MAY
BU WHATEVER THEY DECIDE THAT WE
HAVE.
VERY LITTLE ABILITY TO CHANGE IT
BECAUSE OF THE NATURE OF THE WAY
THE INITIATIVE WAS WRITTEN SO.
I WILL APPEAL ONCE AGAIN TO
FINANCE TO HONOR WHAT I CONSIDER
TO BE THE SPIRIT THE ACTUAL
SPIRITS AND INTENTION OF THE
VOTERS.
AND I SAID PREVIOUSLY I WON'T.
GO THROUGH ALL OF IT BUT THAT
ARE.
WHEN VOTERS -- PASS INITIATIVES --
AND DAY -- AND WE DON'T UNDER
DURING TENSIONS WE CAN DOWN LIKE
THE STRICT BUT LEGAL WE DON'T
HONOR TENSIONS THAT UNDERMINES
TRUST.
BY THE VOTERS AND THEN WE HAVE
TO GO BACK TO THEM AGAIN AND ASK
THEM TO PROVIDE MORE RESOURCES
FOR VERY IMPORTANT THINGS FOR
THE PEOPLE CALIFORNIA.
THEY RIGHTFULLY BECOME A LITTLE
LESS.
OPEN TO THOSE IDEAS BECAUSE
THAT'S WHY I OFTEN HEAR SAY THAT
ONE COMES INITIATIVE MONEY WE
NEED TO SPEND IT THE WAY THE
VOTERS INTENDED.
BECAUSE OTHERWISE WE CAN KEEP
GOING BACK TO THEM AND ASK THEM
FOR HELP AGAIN AND WHEN THEY
POINT TO THE FACT AND THE WE'D
HAVE TO ADMIT THAT IT'S NOT
BEING DONE THE WAY THAT WAS
PRESENTED TO THEM SO.
NOW I'M REALIZE PART OF IT ALSO
IS THE WAY WE WRITE THESE THINGS
TO BUT SO I HOPE.
BECAUSE OF WHILE I SAID THE WAY
IS WRITTEN THE TORIES ENTIRELY
IN THE HANDS OF THE PARK FINANCE.
I HOPE THAT.
THE GOVERNOR WHO IS THE BOSS --
WILL -- THINK CAREFULLY ABOUT --
AT ABOUT THIS AND RECOGNIZE THAT --
THAT WHILE THERE HE HAS THE
POWER PLANTS HAS THE POWER TO DO
HOWEVER THEY WANT THAT I THINK
THE WAY IT'S BEING DONE NOW.
DOES NOT ACTUALLY REFLECT MY
INTERPRETATION AND I THINK SOME
OTHERS -- THE INTENT OF THE
VOTERS AND I'M VERY CONCERNED
ABOUT THAT.
DO YOU WANNA SEE MORE ABOUT THAT.
WELL THE ONLY THING I'D LIKE TO
ADD IS PARTICULARLY IN SUCH GOOD
ECONOMIC TIMES I THINK CLEARLY
VOTERS WOULD THINK -- THERE
SHOULD BE SOME ADDITIONAL MONEY
FOR MEDI CAL NOW IF NOT NOW WHEN
WHEN WOULD IT OCCUR [inaudible]
ALL RIGHT.
I WILL LEAVE IT AT THAT.
OKAY.
THANK YOU THANK YOU SO MUCH.
ALL RIGHT -- NEXT UP WE HAVE THE
CALIFORNIA -- BIRTH CENTER
ASSOCIATION TO OKAY SO WE HAVE
AN ELIMINATION REIMBURSEMENT
RATE PRODUCTION UNDER AB NINETY
SEVEN FOR CERTIFIED NURSE WAS
FIVES CERTIFIED NURSE MIDWIVES
APOLOGIZED.
AND TURNED BIRTHING CENTERS AND
THANK YOU WITH CALIFORNIA BIRTH
SO STATION AND NEXT UP AFTER
THEM WILL BE THE CALIFORNIA
ASSOCIATION MEDICAL PRODUCTS
SUPPLIERS.
OKAY WELCOME.
THANK YOU FOR HAVING US.
MY NAME SHOULD COME MEANS AND
I'M A CERTIFIED NURSE MIDWIFE AN
OWNER OF THE BIRTH CENTER HERE
IN SACRAMENTO.
I AM HERE'S A MEMBER THE
CALIFORNIA PERCENTER ASSOCIATION
TO SPEAK TO THE REQUEST FOR
REINSTATEMENT MONIES.
AFTER THE 10% REDUCTION IN MEDI
CAL REIMBURSEMENT FOR MIDWIVES
NUMBER CENTERS.
THAT HAS REMAINED FROM THE
ORIGINAL 10% CUT TO MEDI CAL
PROVIDER RATE IN.
TWO THOUSAND ELEVEN WE WANT TO
THANK SENATOR BATES FOR HER
SUPPORT TO BRING THIS IMPORTANT
ISSUE TO THE BUDGET DECISIONS.
AB NINETY SEVEN BUDGET TWO
THOUSAND ELEVEN PUT INTO PLACE A
10% REDUCTION IN MEDICAL
PAYMENTS FOR ALL PROVIDERS AND
FACILITIES TO THE BUDGET CRISIS
AT THE TIME.
WITH THE REBOUND IN THE ECONOMY
IN CALIFORNIA THIS 10% REDUCTION
WAS NOT REVERSE FOR ALL
PROVIDERS ONLY TO PHYSICIANS AND
HOSPITALS.
THIS IS CURIOUS PERHAPS JUST AN
OVERSIGHT AS MIDWIFE TEMPER
CENTERS ARE NOTED AS MANDATED
SERVICES FOR MEDI CAL
BENEFICIARIES.
HOWEVER BECAUSE THE LANGUAGE DID
NOT SPECIFICALLY NAME MIDWIVES
AMBER CENTERS THE RESTORATION OF
RATES WERE NOT INCLUDED.
WE HAVE BEEN WORKING WITH DH CS
TO HAVE OUR RATES REINSTATED BUT
WERE ADVISED THAT WE WOULD NEED
TO HAVE SPECIFIC BUDGET OR BILL
LANGUAGE. TO RESTORE RATES TO
THE PRE AB NINETY SEVEN LEVEL.
PER CENTERS ARE AN INTEGRAL PART
OF THE WOMEN'S HEALTH CARE
SYSTEM AND WERE INCORPORATED
INTO MEDICAL SERVICES FOLLOWING
THE FEDERAL GUIDELINES IN.
TWENTY TEN CALIFORNIA'S ALWAYS
RECOGNIZE THE SAFE AND COST
EFFECTIVE SERVICES OF MIDWIVES
AND HAVE SUPPORTED THE POLICY
THAT MIDWIVES WOULD RECEIVE A
100% A PHYSICIAN FEE SCHEDULE
FOR SAME SERVICES PROVIDED.
AT THIS TIME MIDWIVES ARE NOT
RECEIVING A 100% OF THE
PHYSICIANS PHYSICIAN FEE
SCHEDULE AS WE REMAIN UNDER THE
CUT.
REDUCED RATES MEAN REDUCED
ACCESS WITH A SIGNIFICANT IMPACT
ON EARLY ENTRY ADEQUATE PRENATAL
CARE.
LASTLY PERCENTERS ARE NOT ONLY
PROVIDING HIGH QUALITY CARE BUT
ARE CRITICAL TO THE STATE GOAL
OF REDUCING CAESAREAN SECTION
RATES.
CARE PROVIDED BY MIDWIVES AMBER
CENTERS HAVE DEMONSTRATED A
REDUCTION OF CAESAREAN SECTION
RATES ARE 10220% LOWER.
THAN TRADITIONAL KERR WITH
COMPARABLE OUTCOMES.
THERE ARE TWELVE LICENSE PER
CENTERS IN CALIFORNIA AND MORE
ARE BEING DEVELOPED YEARLY.
THIS MODEL WILL CONTINUE TO SAVE
THE STATE REAL HEALTH CARE
DOLLARS.
WE ASK THE 10% REDUCTION OF MEDI
CAL RATES FOR MIDWIVES
SUPERCENTERS BE REVERSED.
MIDWIFE NUMBER CENTERS ARE
POISED TO PROVIDE INCREASED
ACCESS TO CARE FOR MEDI CAL
BENEFICIARIES.
BUT CANNOT WITHOUT ADEQUATE
REIMBURSEMENT WE ASK THAT THE
SUBCOMMITTEE INCLUDE RESTORATION
OF MEDICAL RATES FOR MIDWIVES
NUMBER CENTERS THANK YOU FOR
YOUR SUPPORT.
THANK YOU INCOMES PERHAPS OF
SERVICES ALEJO [inaudible]
FINANCE OKAY.
RIGHT I'D DAY WOULD MAKE NOTICE
WE ARE HEARING THESE --
PROPOSALS.
FOR WE'RE TALKING ABOUT CUTS
THAT WENT BACK TO THE GREAT
RECESSION [inaudible]
THAT -- NO I THAT FIRST OF ALL
WITH ITS -- IN TERMS OF REVENUE
RESOURCES FOR RESTORING THOSE
CUTS -- THEY WERE ABSENT FOR A
VERY LONG TIME -- AND THE ONES
THAT WERE VERSES BECAUSE THOSE
ENTITIES WORKED TO BRING IN MORE
REVENUE AND THAT'S THOSE
REVENUES THAT WE'RE USING TO
REVERSE AS RATES THAT'S WHY THIS
IS UNDER PROP FIFTY SIX IT WAS.
A CAMPAIGN TO BRING IN MORE
REVENUE THROUGH PROPOSITION --
FIFTY SIX AND THE THE ENTITIES
THAT WORKS TO MAKE THAT HAPPEN
OF COURSE -- YOU KNOW.
IF THEY HAD TO BRING IN NEW
REVENUE THEY DIDN'T JUST ASK FOR
THE MONEY -- SO -- THAT DOESN'T
MEAN THAT WE SHOULDN'T TRY TO
ADDRESS THAT FOR OTHER --
PROVIDERS BUT I JUST WANT TO
MAKE NOTE OF THAT -- AND SO
CERTAINLY.
NOT SAYING THAT THAT SHOULD BE A
REQUIREMENT FOR DOING THAT BUT
THAT IS WHAT THE CELL PHONE AS
YOU SAY WELL HOW COME THEY GOT
IT AND I DIDN'T.
UNFORTUNATELY THAT IS PART OF
HOW HOW THAT EVOLVED BUT WE ARE
IN BETTER ECONOMIC TIMES AND
PERHAPS YOU KNOW WE CAN.
LOOK AT WHAT OTHER REVENUES WE
HAVE -- COMING IN -- TO TO
ADDRESS SOME OF THESE ISSUES BUT
THANK YOU SO MUCH FOR YOUR
PRESENTATION.
ALL RIGHT NEXT UP WE HAVE THE
CALIFORNIA ASSOCIATION THAT'S OF
MEDICAL PRODUCTS PLAYERS TO
PRISON PROPOSAL MADE CHANGES
REIMBURSEMENT METHODOLOGY FOR
DURABLE MEDICAL EQUIPMENT AND
AND AND THE BETTER CIRCLE IS THE
NATIONAL COALITION FOR SYSTEM IN
REHAB TECHNOLOGY.
WELCOME.
GOOD AFTERNOON MISTER CHAIR OF
BOB ACKERMAN BEHALF FOR THE
CALIFORNIA ASSOCIATION OF
MEDICAL PRODUCTS SUPPLIERS.
SO AS YOU KNOW DURABLE MEDICAL
EQUIPMENT COMES IN A VARIETY OF
SHAPES AND FORMS FROM THE
SIMPLEST THING A WALKER TO A
COMPLICATED I DON'T LIKE A
VENTILATOR OR COMPLEX REHAB
WHICH YOU HEARD.
ABOUT THE SECOND.
SUCH STORY METHODOLOGY FOR MEDI
CAL SAYS THEY PAY 80% OF THE
MEDICARE RATE FOR MOST DIEM IN
UNDER PERCENT OF MEDICAREFOR
CUSTOMER YOU HAVE.
THAT IS FOR THE REDUCE CURRENTLY
BY THE 10% PROVIDER -- ACROSS
THE BOARD REDUCTION YOU JUST
SPOKE ABOUT.
SO OF THAT HAS EXISTED FOR I
THINK ABOUT FIFTEEN YEARS THOSE
RATES IN URBAN GREAT BUT BUT
SUSTAINABLE IN OUR FACE WITH
CHANGES AND HOW MEDICARE'S
CALCULATING THEIR REIMBURSEMENT.
SO SEVERAL YEARS AGO MEDICARE
BEGAN A COMPETITIVE BIDDING
PROGRAM FOR DME A MOSTLY FOCUSED
ON URBAN AREAS -- AND MUCH OF
CALIFORNIA OF THOSE RATES
GREATLY REDUCED THE ALLOWABLE
UNDER MEDICARE SO.
NOW WE'RE FACED WITH MEDI CAL
THE BEGINNING TO USE THESE LOWER
RATES EFFECTIVE JANUARY FIRST OF
THIS YEAR.
A SPA IT'S BEEN SUBMITTED --
WOULD MAKE THOSE RATES
RETROACTIVE ONCE A SPA IS
APPROVED AND IT WOULD BE --
THOSE MEDICARE RATES ARE RE
BEING REDUCED FOR C. PAP FOR
BEDS FOR SENATE WHEELCHAIRS BY
4260%.
MEDI CAL WOULD THEN TAKE 80% OF
THAT AMOUNT AS THE PAYABLE. TO
THE REDUCTIONS ARE MORE THAN
MINOR THEY ARE A REALLY
SIGNIFICANT WE'VE ALREADY SEEN --
IMPACT IN THE PROVIDER COMMUNITY
WITH ACCESS TO DME THERE WAS A
LUCILLE PACKARD -- STUDY FOR CCS
WHICH SHOW 37% OF PATIENTS HAD
DIFFICULTY IN ACCESSING OFFENDER.
BECAUSE OF LOW REIMBURSEMENT
BECAUSE OF UNWILLING TO PROVIDE
CERTAIN TYPES OF EQUIPMENT AND
LONG DELAYS IN GETTING ACCESS
THE NUMBER PROVIDERS IN
CALIFORNIA HAS GONE DOWN BUT FOR
OVER 40% THE LAST EIGHTEEN
MONTHS BECAUSE OF COMPETITIVE
BIDDING.
MEDICARE HAS NOW SLOW DOWN THE
COMPETITIVE BIDDING PROCESS
DELAYED ANY NEW ROUNDS OF
COMPETITIVE BIDDING UNTIL UNTIL
TWO THOUSAND TWENTY ONE AND
CHANGING THE REQUIREMENTS.
SO WE'RE VERY CONCERNED THAT
THAT MEDI CAL PROGRAM IS GOING
TO HAVE TO SERIOUS ACCESS ISSUES.
WITH ACCESS TO DM ME IF THESE
RATES ARE IMPLEMENTED IN
ADDITION PROVIDERS ARE TOTALLY
UNAWARE THE WHAT THESE RATES ARE
GOING TO BE THE PROVIDING
SERVICE RIGHT NOW UNDER FEE
SCHEDULE IS PUBLISHED.
THE CLUE IS GOING TO BE SO SLASH
DRAMATICALLY -- ONCE THE SPAS
APPROVED -- QUICKLY HIGHLIGHT
VENTILATOR WE HEARD FROM EARLIER
AND SUBACUTE THE VENTILATORS ARE --
A PRODUCT THAT THAT FEW DE ME
COMPANIES PROVIDE BECAUSE THE
COMPLEXITY BECAUSE THE TWENTY
FOUR SEVEN CARE. FOR RESPIRATORY
THERAPY EXCEPT FOR A THAT RATE
WAS REDUCED BECAUSE OF MEDICARE
CHANGES A COUPLE OF YEARS AGO
FROM ELEVEN AND ALWAYS A MONTH
LATER DOLLARS A MONTH.
SOUNDS LIKE A LOT OF MONEY BUT
THE EQUIPMENT'S EXPENSIVE DOES
NOT INCLUDE ALL THE SUPPLIES
THAT ARE REQUIRED TO BE REPLACED --
THE BREEDING CIRCUITS THE TUBING
ETCETERA THOSE ARE ALL PART OF
THE RENTAL RATE.
SO OF BEEN ACCESS IS BECOMING AN
ISSUE YOU'LL HEAR FROM -- CCS
PROGRAM A PROPENSITY TO GETTING
A DELAYS IN GETTING KIDS OUT OF
HOSPITALS BECAUSE A LACK OF OF
THAT PATIENTS -- VENTA EQUIPMENT
SO WE ARE ASKING FOR THE PROGRAM
TO MOVE TO UNDER PERCENT
MEDICARE RATES WHICH FEDERAL LAW
ALLOWS HIM TO DO -- AND TO USE A
BLENDED RATE BECAUSE THE REAL
RATES UNDER MEDICARE IN
CALIFORNIA DRAMATICALLY HIGHER
WE'RE VERY CONCERNED ABOUT THESE
VERY LOW RATES IMPACTING.
NORTHERN CALIFORNIA -- AND NON
URBAN AREAS WITH RATES THAT ARE
NOT SUSTAINABLE -- ALSO ASKING
THE TO RECOGNIZE IN THE CUSTOM
REHAB AREA OF THE MEDICARE --
ALLOWABLE AMOUNTS WITH THE USE
OF MODIFIERS THAT UPGRADE OF THE
REIMBURSEMENT CERTAIN ITEMS OF
CUSTOMER YEAH BECAUSE THE
COMPLEXITY.
THANK YOU I TALK FAST.
THANK YOU I HATE EIGHT COUNTS OF
OUR HEALTH SERVICES ALEJO
[inaudible]
FINANCE OKAY.
WE'VE ACT I MEAN IS ARE WE
MONITORING ACCESS TO THE ME --
YES SO -- THE STATE PLAN THAT
WAS MENTIONED HAS BEEN SUBMITTED
TO CMS IT IS STILL PENDING THAT
DID INCLUDE AN ACCESS ASSESSMENT
ON OUR PART TO THAT IT WILL BE
PART OF CMS IS EVALUATION OF A
APPROVING.
THE THE REDUCTIONS.
AND AS MENTIONED THIS IS REALLY
NECESSITATED BY THE STATE LAW
LIMITATION OF 80% OF MEDICARE
AND THE FACT THAT.
AT THIS POINT MEDICARE'S BEEN
COMING DOWN AND SO THAT'S WHY --
OUR STATE PLAN AND OURS OUR
STATE PLAN IS BASED OFF OF THE
STATE LAW.
OKAY SO DO WE NEED TO WELL I
MEAN SO WE BENCHMARKED AGAINST
MEDICARE RATE AND WE CITY
PERCENT MEDICARE MEDICARE WAS
OLD.
A LOT HIGHER.
THE FORMER IT'S BEEN COMING DOWN
PRETTY THIN COMING DOWN A COMMON
EXAMPLE LOCSIN CONCENTRATOR
WHICH IS PRIME A RESPIRATORY
TOOL CURRENTLY MEDI CAL IS
REIMBURSING HUNDRED AND FORTY
FIVE DOLLARS A MONTH.
THE NEW RATE WOULD BE FIFTY
DOLLARS A MONTH THAT'S A
SIGNIFICANT YEAH.
SO I MEAN I THINK.
APPRECIATE IN THAT AS WELL IF IT
IS A SITE.
NOW WE CAN ARGUE HOW MUCH OF A
MARGIN MEDICARE TRIES TO BUILD
AND I GET THE IDEA OF LIKE --
MAYBE SHE COME IN UNDER MEDICARE
BUT IT'S MEDICARE'S REALLY
COMING DOWN ON THEIR RATES AND
THEY'RE TRYING TERM INTO RATES
BASED ON ACTUAL COSTS AND
SQUEEZING OUT PROFIT MARGIN AND
WE'RE SAYING THEN YOU HAVE TO GO
SUB PROFIT -- MORGADO I THINK WE
HAVE SOME ISSUES SO -- I THINK
WE MAY HAVE TO SOUNDS LIKE HIM
HEARING A PATTERN HERE WHETHER
V. NEED TO RE LOOK AT WHETHER
THAT'S RIGHT BENCHMARK AND 80%
OF MEDICARE OR OR IT'S A
MEDICARE RATE OR SOME OTHER AND
MORE INDEPENDENT BENCHMARKS THAT.
ALLOWS US TO SURE ACCESS WITHOUT
THE REPAIR WANTS TO BE UPROOTED
PURCHASER.
SO -- WE I THINK SOUNDS LIKE
IT'S TIME TO MAYBE LOOK AT THAT
BENCHMARK SOUNDS LIKE IT'S BUILT
INTO A LOT OF IT'S A GENERAL IS
GENERALLY HOW THE MEDICAID RATES
ARE SET -- A LESS THERE'S A
DIFFERENT METHODOLOGY SO FOR
MOST OF THE TYPES OF SERVICES
THAT YOU'RE HEARING ABOUT THAT
AREN'T SORT OF FACILITY SERVICES
OR THINGS LIKE THAT IT IS.
TYPICALLY BENCHMARKS 280% OF
MEDICARE -- AND SO THEN WE HAVE
TO UPDATE THAT SOMETIMES BECAUSE
OF THESE OF MEDICARE CHANGING
THEIR RATES IN TERMS OF THE
ACTUAL RATE THAT'S BEING PAID
BUT YES THEY IT IS A GENERAL
REQUIREMENT FOR MOST OF OUR
OUTPATIENT AND SORT OF
CANCELLARIA TYPE SERVICES AND IS
THIS.
TYPICAL OF OTHER STATES SEVEN
THAT IS ACTUALLY PRETTY TYPICAL
BECAUSE ESSENTIALLY -- IT'S AN
80% OF MEDICARE ARE BECAUSE IN
MEDICARE RIGHT THAT'S THE
PAYMENT FROM THE MEDICARE.
PROGRAM AND THE 20% IS THE COST
SHARING FROM THE BENEFICIARY --
SO THAT IT IS A VERY TYPICAL
STANDARD.
OKAY THAT IS WHERE IT REGIONALLY
CAME FROM WHENEVER HOWEVER MANY
YEARS AGO BEFORE I WAS HERE THAT.
RIGHT BUT BUT I THINK WHAT IT
BUT I'VE OBVIOUSLY THEN ON THE
MEDICARE SIDE IS IS THAT THERE'S
THE BENEFICIARY COST SHARING
YOUR PAIN THE OTHER 20% OR TO
HAVE A MEDIGAP PLAN OR SOMETHING
THAT COVERS AT THIS CASE.
WE'RE NOT EXPECTING LOW INCOME
FAMILIES TO COUGH UP THE OTHER
IMPORTANT.
SO.
SO WE I THINK WE'RE CLOSE THE
SAY WE'VE THE THE ALMOST MANY
OCCASIONS HERE IN THIS.
THE SUBCOMMITTEE SINCE I'VE BEEN
IN HERE WE'VE HAD RULES THAT ARE
IN PLACE FOR DECADES THAT THE
LONGER WORK AND I THINK IT'S
PERHAPS TIME TO RE LOOK AT THEM.
AND I DON'T KNOW WHETHER THERE'S
A CMS ISSUES RELATED TO THAT BUT
I MEAN IT THEY WOULD ALL
REQUIRES FEDERAL APPROVALS
BECAUSE THEY 80% LIMITATION IS
IN ANY ANY OF OUR STATE PLANS --
THE ONLY LIMITATION -- OTHERWISE
AND IT'S SPECIFIC TO THE ARMY IS
THE LIMITATION TO A 100% OF
MEDICARE THAT ACTUALLY DOES NOT
EXIST FOR ANY OTHER SERVICES BUT
THAT WAS PART OF THE CURE'S ACT.
SO THAT THAT LIMITATION -- IS A
FEDERAL LIMITATION BUT OTHERWISE.
MEDICARE ITSELF IS NOT ACTUALLY
A LIMITATION -- IN GENERAL I
MEAN ON THE FACILITY SIDE UPPER
PAYMENT LIMITS ARE BASED ON A
MEDICARE WOULD PAY BACK ON THESE
TYPES OF SERVICES IT WAS A BIT
THIS WAS A VERY SPECIFICALLY
CALLED OUT.
IN THAT IN THAT BILL OKAY SO SO
I GUESS THAT'S WHAT YOU'RE
SUGGESTING PERHAPS WE JUST SINCE
IT'S A LIMIT AND THEN JUST DO A
100% OF MEDICARE AND IT'S
MEDICARE'S REALLY CRANKING DOWN
THEN.
THAT MAY MAKE MORE SENSE THAN.
EIGHTY OKAY AND I WOULD ALSO
VENTURE TO SAY IT'S A MEASURING
ACCESS NOW BEFORE THESE NEW
RATES ARE IN PLACE IS REALLY NOT.
A BAROMETER WHAT'S GOING TO
HAPPEN I MEAN ONCE PEOPLE
REALIZE THIS THROUGH PAID
THEY'RE NOT GONNA PROVIDING THE
SERVICE A LOT OF PARTS OF
CALIFORNIA RIGHT WELL RIGHT NEW
MEASURE NOW IT'S THE SITUATION
NOW.
SO IT'S NOT THEN WHEN WHEN DO WE
EXPECT THIS TO HAPPEN.
SO THE STATE PLAN IS WITH CMS I
WILL I ASSUME FOLKS KNOW THIS
PART OF THEIR PROCESS ALSO IS
TAKING.
A STAKEHOLDER INPUT ON THE
POTENTIAL IMPACTS FOR ACCESS --
MOST SO YOU KNOW AT WE RARELY
GET A STATE PLAN APPROVED IN THE
NINETY DAY TIME FRAME SO I MEAN
I I WOULD GUESS WERE PROBABLY
STILL A FEW MONTHS AWAY FROM
APPROVAL IF I MEAN AND AGAIN AND
THEY COULD NOT GIVE APPROVAL.
AS ANOTHER AS ANOTHER OPTION BUT
IT IS CURRENTLY SLATED TO BE
RETROACTIVE TO JANUARY OF THIS
YEAR OKAY.
AND OF GIVEN THE SITUATION
SHOULD BE LEE LOOKING AT SOME
PERHAPS LANGUAGE BECAUSE RIGHT
NOW THE STATE LAW SAYS 80% THAT
PROVIDE SOME FLEXIBILITY TO BE
ABLE TO BE MORE RESPONSIVE.
OTHERWISE YOU AROUND YOU TELL ME
WELL YOU JUST.
STATE LAW SAYS IT'S 80% SO EVEN
IF WE WANTED TO WE CAN BECAUSE
YOU TOLD THIS WEEKEND SO SHOULD
WE BE LOOKING AT THAT NOW.
AND IN ANTICIPATION AND DOING
SOME KIND OF SOMETHING THAT CAN
GIVE YOU THE FLEXIBILITY TO BE
ABLE TO RESPOND.
I WOULD NEVER DEEM TO SAY WHAT
YOU SHOULD.
SAY I SINCE I'M THE ONE
SUGGESTING IT.
YOU HAVE THE YOU CAN COMMENT ON
WHETHER THAT WOULD BE ADVISABLE
OR NOT -- SINCE I'M THE ONE
SUGGEST YOU BECAUSE I KNOW I'M
THE ONE WHO WOULD HAVE TO DO IT.
I I AGAIN I WOULD HAVE TO DEFER
TO THE GOVERNOR IN TERMS OF HOW
HOW HE WOULD DO THAT TYPE OF
PROPOSAL OKAY WELL LET'S HAVE
THE CONVERSATION AND WE CAN WE
HAVE A LITTLE PATIENCE -- BUT I
AND ALSO LOOKING OUR BUDGET
PROCESS IS IF WE WANT TO DO IT
NOW WOULD BE THE TIME TO DO IT
RIGHT.
BECAUSE OKAY.
VERY GOOD THANK YOU.
OKAY.
THE NEXT PROPOSAL IS. TO MAKE
CHANGES TO REIMBURSEMENT
METHODOLOGY FOR COMPLEX REHAB
HAS FROM NATIONAL COALITION
ASSISTED AND THANK YOU VERY MUCH
RIGHT UP HERE AND THEN THE
CALIFORNIA MEDICAL
TRANSPORTATION SAYS EACH YEAR IN
THE BATTER CIRCLE SO FOR THE
NEXT.
FOLLOW UP.
FOR THANK YOU SENATOR THANK YOU
FOR THE AFTER TO BE HERE.
MY NAME IS DON CLAY BACK I'M
EXECUTIVE DIRECTOR OF THE
NATIONAL COALITION FOR SISTER
RIYA TECHNOLOGY I'M HERE
REPRESENTING OUR EIGHT MEMBER
COMPANIES IN CALIFORNIA --
COMPLEX READ TECHNOLOGY IS
SPECIALIZED EQUIPMENT USED BY.
CHILDREN AND ADULTS WITH HIGH
LEVEL DISABILITY SO -- IT'S
SOMETHING THEY DEPEND ON ON A
DAILY BASIS BUT INCLUDE SUCH
THINGS AS SPECIALIZE WHEELCHAIRS
AND SEATING SYSTEMS -- OTHER
ADAPTIVE EQUIPMENT LIKE STANDING
DEVICES IN GAY TRAINERS -- IT'S
PROVIDED THROUGH A VERY -- TIME --
LABOR INTENSIVE PROCESS INVOLVES
THE PHYSICIAN THAT TYPICALLY
OCCUPATIONAL THERAPIST OR
PHYSICAL THERAPIST.
AND THEN -- THE SUPPLIER ALONG
WITH POTENTIALLY OTHER
CLINICIANS AND THEN OBVIOUSLY
THE INDIVIDUAL AND SOMETIMES
THEIR FAMILY OR CARE GIVERS.
IT'S VERY INTENSE A SERVICE
INTENSIVE AND IT'S FOR A REALLY
A SMALL POPULATION AGAIN PEOPLE
THAT HAVE.
VERY COMPLEX NEEDS AND ONE OF
OUR CHALLENGES IS THAT IT GETS
LOST SOMETIMES IN THE BROADER
MEDICAL EQUIPMENT CATEGORY
BECAUSE IT'S A SMALL PIECE OF
THAT IT'S A SMALL POPULATION.
SO -- THE CHALLENGES THAT
PROVIDERS ARE FACING IT IS JUST
THE COMMITMENT THAT'S REQUIRED
TO RUN A BUSINESS IN THIS ARENA
THAT TO HAVE THE INFRASTRUCTURE
AND THE CREDENTIAL PEOPLE. TO DO
THE EVALUATION TO NOT ONLY GET
THE EQUIPMENT RIGHT THE FIRST
TIME BUT THEN ONCE SOMEONE HAS
THIS KIND OF EQUIPMENT.
IT'S PART OF THEIR DAILY LIFE SO
IF THERE'S A REPAIR THAT'S
NEEDED -- IF THERE'S MAINTENANCE
NEED TO BE RESPONSIVE TO THAT IN
A SIMPLE EXAMPLE LIKE A
WHEELCHAIR SOMEONE IS A
WHEELCHAIR WAS SPECIALIZED
SEATING.
THAT WHEELCHAIR BREAKS DOWN A
LOS AND TELL THAT SHARES FIX
THEIR PROBABLY GOING TO BE IN
THEIR BAD -- IN THAT THE FLIES
WHETHER AGAIN YOU'RE TALKING
ABOUT A CHILD ADULT SOMEONE
WHO'S GOING TO SCHOOL WE'RE
GOING TO WORK -- SO OUR
CHALLENGE REALLY IS -- WHO IS
THE -- COVERING THOSE COST AND
ALSO MAKING IN -- THE
ENVIRONMENT SUITABLE FOR
COMPANIES TO STAY IN THIS
BUSINESS AS A MENTION IS ONLY
EIGHT COMPANIES AND CALIFORNIA
THAT ARE PROVIDING THAT AND
AGAIN IT'S BECAUSE OF THE
CHALLENGES THAT COMPANIES FACE --
SO WHAT WE'RE LOOKING TO DO IS --
REALLY REQUESTING TWO THINGS ONE
IS THE RESURGENT RELIEF FROM THE
AB 9710% CAUGHT.
AND ALSO THE MODIFICATION OF THE
UPPER BILLION LIMIT THAT APPLIES
TO THESE ITEMS AND LOOKING
FORWARD TO BE MODIFIED TO ALLOW
SOME LABOR COMPONENT TO BE ADDED
TO THE CALCULATION -- AND ALSO
TO LOOK AT THE TOTAL WHEELCHAIR
VERSES INDIVIDUAL LINE ITEMS --
WHAT WE THINK IS THIS REALLY FOR
LEASE PROVIDE -- SOME --
ADDITIONAL FINANCIAL SUPPORT FOR
COMPANIES THAT ARE PROVIDING
THIS WE ALSO HAVE THE SAME
CONCERNS ABOUT MENTION ABOUT THE
SPA THAT'S BEING THAT IT'S BEING
PROPOSED.
AGAIN IT'S GOING TO HAVE
REDUCTIONS IN IMPACT ALSO THIS
ARENA AND WITH THE ADDITIONAL
PRESSURES THAT COMPANIES ARE
UNDER IT'S ONLY GONNA MAKE
ACCESS AND EVEN BIGGER ISSUE --
AND THEN THE FINAL THING JUST
FROM A BUDGET PERSPECTIVE IS
THIS EQUIPMENT REALLY DOES
SIGNIFICANTLY CONTROL REDUCE
COSTS.
ON FROM A MEDICAL SO -- MEDI CAL
PERSPECTIVE -- THINGS LIKE
PREVENTING MEDICAL TREATMENTS
BECAUSE YOU'RE MINIMIZING IN --
SKIN PRESSURE -- ISSUES OR
ORTHOPEDIC COMPLICATIONS -- IF A
LOT OF THIS EQUIPMENT IN THE
EVALUATION ARE DONE IN THE HOME
SETTING. ONE OF THE THINGS THAT
PROVIDERS ARE DOING RIGHT NOW IS --
LOOKING AT NOT BEING ABLE TO GO
OUT TO THE HOME AND REQUIRING
PEOPLE TO COME INTO THEIR
BUSINESSES FOR REPAIRS OR FOR
EVALUATIONS.
THAT COSTS WILL HAVE TO BE
PICKED UP BY THE STATE SO IT'S
ANOTHER THING TO KIND OF FACTOR
AND SO -- SOCREATE THE
ATTENTION AND HAPPY ANSWER ANY
QUESTIONS THANK YOU ANY COMMENTS
AND FOR HALF OF SERVICES ALEJO
[inaudible]
FINANCE [inaudible]
OKAY.
OKAY WELL I CERTAINLY SOMEONE'S
TAKING CARE OF CHILDREN SPECIAL
NEEDS RECOGNIZE HOW THE
SPECIALIZED EQUIPMENT.
I MEAN IS ESSENTIAL TO THEIR
ABILITY TO BE MOBILE AND AND FOR
THE FAMILIES HELP GET THEM
AROUND AND AND SO FORTH SO I
APPRECIATE THE CHALLENGES THAT
YOU'RE.
BRINGING UP IN HOW WE CAN HELP
THESE FAMILIES CELL THANK YOU.
SO MUCH IN HIS TALKS I GUESS
THANK YOU THESE ARE MUCH.
ALL RIGHT -- FINALLY WE HAVE A
DETAILED FOR MEDICAL TRANSPORT
IS ASSOCIATION PROPOSAL TO
INCREASE REIMBURSEMENT RATES FOR
NON EMERGENCY MEDICAL
TRANSPORTATION [inaudible]
WELCOME.
GOOD AFTERNOON MADAM CHAIR
MISTER CHAIR AND MEMBERS.
LONG AFTERNOON -- I'M BILL BAR
TO BE HERE ON BEHALF OF THE
CALIFORNIA MEDICAL
TRANSPORTATION SOCIAIS XIN.
OUR PRESIDENT -- STEVE HORN WHO
IS IN THE BUSINESS WOULD GIVE
YOU A MORE PRACTICAL IMPACT BUT
HE HAD TO LEAVE ON FAMILY
BUSINESS.
BUT I'M HERE.
OF REGARDING ANY EMPTY RATES I'M
HERE TO REQUEST ASK IN LITERALLY
BEG.
FOR AN INCREASE OF OF THE MEASLY
FIVE MILLION DOLLARS.
THAT WOLD GO A LONG WAYS IN.
ONE OF RESTORING THE 10% CUT IN
THE FAX SINCE.
TWO THOUSAND ELEVEN AND ADDING
50% TO DEAL WITH AN ACCESS
PROBLEM.
DISPLACING PAPER SERVICE
PATIENTS.
WHO WHO'S CONDITIONS MEDICALLY
JUSTIFY ANY EMPTY THAT'S A
MANDATED BENEFIT UNDER EXISTING
LAWS AND REGULATIONS WE
DISCUSSED THIS WITH FINANCE AND
WITH THE LA ALE?
AND OTHERS.
BUT WHAT IS HAPPENING NOW TRIPS
BEYOND TEN MILES ARE NOT
ECONOMICALLY FEASIBLE SO
PATIENTS PARTICULARLY DIALYSIS
PATIENTS TO RURAL AREAS ARE NOT
GETTING THE SERVICES THEY'RE
ENTITLED.
TO AND IF THEY MISDIAGNOSIS
PATIENT -- TREATMENTS YOU KNOW
THE RESULT MORE OF EMERGENCY
ROOM VISITS OF THE AND MORE
DIFFICULTY FOR THESE PATIENTS.
INTERESTINGLY ENOUGH A LOT OF
MEDICARE MANAGED CARE PLANS PAY
A LOT MORE FOR ANY EMPTY
SERVICES KAISER FOR EXAMPLE
PARTNERSHIP SAN JOAQUIN COUNTY
HEALTH PLAN.
IF OF MEDICARE AND MEDICAID OUR
TO BEAT THE SAME REQUIREMENTS --
THAT WOULD GO A LONG WAYS IN
RESOLVING THIS PROBLEM.
THE OTHER INTERESTING THING IS
THAT THE DEPARTMENT WILL MAKE
CERTAIN EXCEPTIONS THAT THEY'RE
FACED WITH LAWSUITS OR
ADMINISTRATIVE LAW DECISIONS
THAT ARE ADVERSE.
THEY WILL MAKE ALL KINDS OF
EXCEPTIONS PAY -- FOR UNLOADED
MILES -- ADICIONAL MILEAGE
REIMBURSEMENT RATES WAITING
TIMES BUT THEY SHOULDN'T HAVE.
TO THE ONLY MAKE THESE
EXCEPTIONS ON THESE UNUSUAL
SITUATIONS WHEN THEY'RE INVOLVED
LEGAL ISSUES OR A HIGH HIGHLY
VISIBLE PATIENTS.
SO WE THINK THE THE SITUATION
JUSTIFIES THE INCREASE WOULD
TAKE CARE OF THESE PEOPLE WHO
HAVE MEDICAL CONDITIONS IT
JUSTIFY.
ANY EMPTY ENTERED YOUR OF
SUPPORT FOR INCREASING THIS.
MUCH NIGHT NEEDED SERVICE THANK
YOU VERY MUCH THANK YOU.
ANY COMMENTS FROM FOR HIS
SERVICES HELLO.
FINANCE OKAY AND THAT PEOPLE
LOOK I MEAN THE LOOK AT IT LOOK
THAT.
OF PEOPLE NOT ABLE TO GET TO
THEIR I GUESS -- DIALYSIS POINT
MINUTES OTHER APPOINTMENTS HE
SAID THIS SOMEONE SOMEONE.
LOOKED SYSTEMATICALLY AT THE
SEVEN I'M SURE THE SITUATIONS
REAL BUT NOW.
SELL THEM AT SOME.
BUTTONS BUT I CASE BASIS UP THE
COMPLAINT SYSTEM IN THE IN.
THE A CS OR IT AND AND AND
DEPARTMENT MANAGED HEALTHCARE AS
WELL.
DOESN'T WORK TERRIBLY WELL WE'VE
HAD PEOPLE IN OUR OFFICE TRY TO
LODGE COMPLAINTS THEY'LL LOGIC
COMPLAINT OF BUT A NEEDED
DIALYSIS TRIP AND GET A CALL
BACK A MONTH LATER.
AND SO THAT DOESN'T WORK SO THE
COMPLAINT SYSTEM THAT IS HEAVILY
RELIED UPON BY SO I EVENT OF A I
GUESS IN SOME SENATE ANNE AND I
GET THAT A CALL FOR THE
COMPLAINT NOTHING YOU KNOW DON'T
BUT I MEAN THE LOGGING OF THE
COMPLAINTS ALSO HELPS.
SO I REALIZE IT DOESN'T REALLY
SOLVE THE PROBLEM I AM -- I'M
JUST TRYING -- TO POSES A I'M
TRYING TO MAKE AN ARGUMENT FOR
YOU THAT ARE WE Là.
IS THERE A WAY I CAN ARGUE THAT.
USES THIS FAIRLYSMALL AMOUNT
THAT WERE ACTUALLY LOSING MORE
MONEY BECAUSE WE'RE NOT DOING
THIS BECAUSE PEOPLE ARE BUSY
TREATMENTS AND NOW THAN SAID OF
GAINED ALICE'S STAND UP IN THE
HOSPITAL AND BOY THAT WITH THAT
COUPLE HOSPITALIZATIONS MAY MAKE
UP THE WHOLE AMOUNT.
OR NOT IS THERE SOME WAY TO
QUANTIFY THAT THAT THAT WOULD BE
HELPFUL.
I REALIZE THAT THERE MAY NOT BE
THAT EASY TO DO THAT YEAH I MEAN
I DON'T KNOW WE HAVEN'T LOOKED
AT IT FROM THAT PRSPECTIVE I
THINK.
AS MENTIONED THE VAST MAJORITY
OF THIS IS A MANAGED CARE -- AND
pMEMBERS ARE SMALLER -- I DON'T
KNOW THAT WE'VE SEEN ANY SORT OF
SPECIFIC CHANGES IN UTILIZATION
OF OF TRANSPORTATION THAT WOULD
IMPLY THAT BUT I DON'T KNOW.
MY TEAMMATE BE ABLE TO HAVE MORE
THAT I CAN ASK THEM I JUST DON'T
KNOW.
WHAT THE FEE FOR SERVICE PATIENT
LOAD IS DIMINISHING IT'S TURNING
ALL THE TIME PEOPLE FALL IN AND
OUT OF MANAGED CARE SO THEN THEY
GO FOR MANAGED CARE WHERE THEY
WERE GETTING GOOD SERVICE?
BACK TO FEE FOR SERVICE BECAUSE
THEY FAILED TO FILE RIGHT
PAPERWORK OR SOMETHING OR OTHER
SO THEN -- BACK -- WITHOUT TO
SERVICE FOR SIX EIGHT TEN MONTHS
TILL THEY GET BACK ON MANAGED
CARE SO IT'S A CONSTANT THE
MATTER AND THERE'S ALWAYS NEW
FEE FOR SERVICE PATIENTS COMING
UP ON TO THE PROGRAM BEFORE
THEIR SIDE.
SO THEY MAY BE SMALL IN NUMBER
BUT IT TO CONTINUALLY --
EXISTING GROUP OF ABOUT 20% OF
THE PATIENTS SOLELY THEY'RE NOT
TO BE -- JUST DISMISSED AS BEING
A SMALL GROUP BUT IF THE THE FOR
SERVICE WERE TO PROVIDE ANYWHERE
NEAR WHAT MANAGED CARE DOES IT
WOULD END TO DISCRIMINATION
AGAINST THESE PEOPLE.
SO WE WOULD URGE FAVORABLE
CONSIDERATION ALRIGHT I
APPRECIATE THAT THE THOSE
HELPFUL THE SIN THIS BUDGET
COMMITTEE BE ABLE. TO TO BE ABLE
TO MAKE THE ARGUMENT THAT IF WE
DON'T DO THIS ACTUALLY GONNA
COST US MORE MONEY IF POSSIBLE
SO -- SO SO ANYWAY BUT THANK YOU
VERY MUCH APPRECIATE IT.
OKAY SO WE'RE NOW GOING TO TAKE
PUBLIC COMMENTS I WILL YOU KNOW
WE HAVE A LOT OF STAKEHOLDER
PROPOSALS OUT MAKE NOTE THAT
THERE IS A PRESENTATION ON EACH
ONE SO -- THE ARGUMENTS HAVE
BEEN MADE ALTHOUGH IF YOU WISH
TO MAKE A NEW ONE YOU CAN BUT
IT'S PROBABLY BEST FIRST OF ALL
IF YOU HAVE ANY GENERAL COMMENTS.
ON THE PROPERTY SIX MEDIC -- CAL
PROVIDER REIMBURSEMENT RATES AND
JUST INDICATE WHICH STAKEHOLDER
PROPOSALS.
YOU REALLY LIKE -- I REALIZE A
LONG LIST OF THEM AND I DON'T
THINK YOU NEED TO WORRY AS MUCH
ABOUT MAKING AN ARGUMENT FOR THE
ONES THAT YOU LIKE I THINK THE
PROPONENTS THREE HAD A CHANCE TO
DO THAT SO.
WELCOME AND THANK YOU.
THANK YOU MAYOR MARTIN HERE ON
BEHALF OF THE CALIFORNIA
CHILDREN'S HOSPITAL CESSATION IN
SUPPORT OF SAME IS PROPOSAL FOR
THREE YEARS BONTA READ THE RATE
INCREASE AND FUNDING SUSTAINABLE
FUNDING FOR AIR AMBULANCE
SERVICES.
RATE INCREASE FOR STANDALONE
PEDIATRIC SUB ACUTE FACILITIES
AND BOTH THE ANY RATE INCREASES
IN REGARDS TO PROP FIFTY FIVE WE
ARE SUPPORTIVE OF CJ'S PROPOSAL
AND I WOULD JUST ADD.
THAT WE DO NOT BELIEVE THE
LEGISLATURE IS SO MUCH AT THE
MERCY AT THE DEPARTMENT OF
FINANCE IN THE ADMINISTRATION AS
MIGHT HAVE BEEN INDICATED.
IT'S TRUE THAT PROP FIFTY FIVES
GIVES DEPARTMENT OF FINANCE
DISCRETION OVER THAT FORMULA BUT
IT DOESN'T SPECIFY THE FORMULA
AND SO WE'VE YOU THIS IS
SOMETHING THAT'S COMPLETELY UP
FOR NEGOTIATION LIKE ANYTHING
ELSE THAT'S IN THE BUDGET.
AND IT MIGHT BE HELPFUL IF THE
COMMITTEE WAS INCLINED TO
CONSIDER IT IF ONE HOUSE OF THE
LEGISLATURE OR BOTH WOULD ADOPT
A BETTER FORMULA THAT WE THINK
IS MORE IN KEEPING WITH VOTER
INTENT AN AMOUNT OF MONEY THEY
THINK THAT FORMULA GENERATED WE
MIGHT HAVE A MORE ROBUST.
CONVERSATION WITH THE DEPARTMENT
IN LATE MAY SO WE WOULD
ENCOURAGE YOU TO CONSIDER THAT
AS ONE OF YOUR OPTIONS THANK YOU
OKAY THANK YOU [inaudible]
WELCOME.
BUT AFTER A LINDA WAY WITH
WESTERN CENTER ON LAW AND
POVERTY WE CONCUR WITH THE
CHAIRS COMMENTS REGARDING --
EVALUATION OF PROP FIFTY SIX
FUNDING TO ENSURE THAT IT IS
DOING IS -- VOTER INTENDED
INCREASING ACCESS FOR MEDI CAL
PATIENTS.
IN ADDITION OUR LEGAL AID
ADVOCATES REPORT DIFFICULTY
ACCESSING TRANSPORTATION BOTH
NON EMERGENCY MEDICAL
TRANSPORTATION AND NON MEDICAL
TRANSPORTATION AS WELL AS
DURABLE MEDICAL EQUIPMENT SO
WOULD SUPPORT THE PROPOSALS TO
INCREASE BOTH DME AS WELL AS
TRANSPORTATION.
THANK YOU.
THANK YOU WELCOME.
MR KERRY MEMBERS JOHN WHEN
YOU'RE ON THE OFF AND CART THE
C. R. T. -- PROVIDERS AND
MANUFACTURERS OBVIOUSLY IN
SUPPORT OF OUR OWN BUDGET OUT IN
THE MISTER CLAY BACK ALREADY
TALKED ABOUT BUT THEY JUST WANT
TO PUT A FINER POINT ON THE AXIS
ISSUE.
WE ARE SEEING A LOT OF ACCESS
ISSUES RELATED TO CCS AND JUST
IN THE BROADER AREA -- ONE OF
OUR MEMBER COMPANIES HAS ALREADY
HAD TO SHUT DOWN THE FACILITY
AND TULARE -- THOSE COMPANIES
ARE GOING TO BE FORCED UNDER THE
SPA AND WITH THE NINETY SEVEN
BECAUSE TO CONTINUE TO LOOK FOR
WAYS TO REDUCE -- THEIR THEIR
COSTS WHICH IS GONNA COME FROM --
REDUCING PRODUCTS SUPPLIES --
THE ELIMINATING THE THE SERVICES
AT HOME FOR MAINTENANCE AND
POTENTIALLY IS SHUTTING DOWN
OTHER FACILITIES WE HAVE HAD
SOME GOOD DISCUSSIONS WITH DH CS
SO WE DO LOOK FORWARD TO
CONTINUING THOSE CONVERSATIONS
BUT WOULD LIKE YOUR FAVORABLE.
CONSIDERATION ON THE NINETY
SEVEN RESTORATION THANK YOU.
THANK YOU.
WELCOME HI GOOD AFTERNOON ALLEN
OUR PARTY HERE WITH A C. ARE YOU
ON BEHALF OF ART I'M ROUGHLY
SEVEN HUNDRED I SEE FTD WORKERS
LOW PAID VERY HARD WORKING FOLKS
MANY OF WHOM HAVE SECOND JOBS
BECAUSE THIS JOB IS.
NOT ENOUGH IN IN SUPPORT OF THAT
TIME FOR THAT PROPOSAL THE RATE
INCREASE THANK YOU.
THANK YOU WELCOME.
GOOD AFTERNOON CENTER PAN --
MICROBES IN HERE ON BEHALF OF
QUEST DIAGNOSTICS AND TAKE YOUR
ADVICE AND NOT REPEAT ANYTHING
THAT CHRISTY FOR A SAID ON THE
ON THE CLINICAL LAB PIECE JUST --
PRECIADO HERE -- YOUR
ENCOURAGEMENT TO THE DEPARTMENT
TO TO FIGURE TO HELP YOU WITH
THAT SOME TECHNICAL EXPERTISE
AND WE WE LOOK FOR TO WORK ON
THE DEPRTMENT ON THAT.
AND IT LOW END AND ON BEHALF OF
QUESTION IT'S FIFTY MILLION
DOLLAR CONTRIBUTION AND TAXES
HOPEFULLY WE CAN -- WORK
SOMETHING OUT THANKS THANK YOU
[inaudible]
WELCOME.
JENNIFER CIDER BE HAVE THE
CALIFORNIA ASSOCIATION HEALTH
FACILITIES AND INCLUDED IN THEIR
MEMBERSHIP IS THE FIVE FREE
STANDING PEDIATRIC SUB ACUTE
FACILITIES WHICH YOU HEARD FROM
ONE OF THOSE MEMBERS TODAY AND
ALSO THE INTERMEDIATE CARE
FACILITIES FOR THE
DEVELOPMENTALLY DISABLED.
IN SAME EFFORT NOT TO REPEAT THE
WONDERFUL TESTIMONY THAT BOTH
THOSE INDIVIDUALS TALKED ABOUT
ON BEHALF OF OF THOSE TWO REALLY
REALLY IMPORTANT TYPES OF
FACILITIES I JUST WANT.
TO RE EMPHASIZE HIS ARE 100%
MEDI CAL FACILITIES PROVIDING
EXTREMELY IMPORTANT LONG TERM
CARE SERVICES TO OUR SAFETY NET.
KIDS AND FRAGILE KIDS -- PERSONS
WITH DEVELOPMENTAL DISABILITIES
IT IT IS ESSENTIAL THAT WE
THEM TO PROVIDE NECESSARY
SERVICES TO THOSE FOLKS SO WE'D
LIKE TO CONTINUE TO MAKE SURE
THAT THEM WE AB.
ADD TO THE SUPPORT THAT WAS
ALREADY.
OFFERED SO THANK YOU THANK YOU.
WELCOME.
THE TURNING ON BEHALF OF WESTERN
DENTAL SERVICES AND WERE IN
STRONG SUPPORT OF THE GOVERNOR'S
PROPOSED ALLOCATION.
FOR DENTAL PROVIDER RATE RECENT
REIMBURSEMENT AMBER PARTICULARLY
GRATEFUL FOR THE PROPOSAL TO
MAKE THOSE PROVIDER IT'S
PERMANENT.
WE THINK THE BEST ROUTE TO DO
THAT IS TO IS TO FALL THOSE
SUPPLEMENTAL PAYMENTS INTO
PERMANENT RATES AS SOON AS THEY
CAN BE DONE.
THOSE WILL PROVIDE ADEQUATE
RATES GOING FORWARD AND RELIABLE
RATES AND WITH THAT IN MIND WE
ALSO SUPPORT THE CMA AND CGA
PROPOSAL [inaudible] TO FOR A
MULTI YEAR -- STATE PLAN MEMBER
BUT WE THINK THAT NEEDS TO BE
COMBINED WITH PERMANENT RATES AS
WELL THANKS.
THANK YOU.
WELCOME GOOD AFTERNOON MISTER
CHAIR ELIZABETH THAT'S BEEN --
SOME BEHALF OF THE CALIFORNIA
ASSOCIATION OF PUBLIC HOSPITALS
AND HEALTH SYSTEMS IN SUPPORT OF
THE PROPOSAL TO RECALCULATE
PROPOSITION -- FIFTY FIVE WE
BELIEVE AND ALTERNATIVE
CALCULATION IS CERTAINLY IN LINE.
WITH THE INTENT OF THE VOTERS
AND WILL BENEFIT THE MEDICAL
PROGRAM AND THE PEOPLE WHO ARE
SURF THROUGH THAT PROGRAM THANK
YOU.
THANK YOU [inaudible]
WELCOME.
AFTERNOON LINDA TO NARROW ITS ON
BEHALF OF THE CALIFORNIA PAN
ETHNIC HEALTH NETWORK WE LIKE TO
APPRECIATE THE DEPARTMENTS
RECOGNITION OF THE NEED FOR A
GOOD EVALUATION.
ON DATA ON THE ACCESS TO CARE --
THIS IS AN ISSUE ARE ORG HAS
CONTINUED TO RAISE AND WE WOULD
STRESS THE IMPORTANCE OF
EVALUATING ACCESS TO CARE FOR
DIVERSE POPULATIONS AS A RESULT
OF THE SUPPLEMENTAL PAYMENT
METHODOLOGY THANK YOU.
THANK YOU [inaudible]
WELCOME.
GOOD AFTERNOON I'M DONNA THOMAS
I'M WITH VALLEY VILLAGE WE
PROVIDE SERVICES TO INTELLECTUAL
AND DEVELOPMENTALLY DISABLED
ADULTS.
IN THE SEA BASS IN THE COMMUNITY
BASED ADULT SERVICES AND WE
STRONGLY AGREE WITH THE REQUEST
THROUGH RESTORED A 10% REDUCTION.
IN THE COMMUNITY BASED ADULT
SERVICES PROGRAM PURSUANT TO THE
A. B. NINETY SEVEN AS WELL AS
THE 15% COST OF LIVING INCREASE.
ALSO WE STRONGLY AGREE WITH THE
REQUEST FOR RESOURCES TO
ELIMINATE THE TO THOUSAND EIGHT
MEDI CAL WAITE.
RATE RE FREEZE A. N. ADJUST
RATES BY 15% FOR INTERMEDIATE
CARE FACILITIES FOR INDIVIDUALS
WITH DEVELOPMENTAL DISABILITIES.
THANK YOU THANK YOU [inaudible]
WELCOME.
BY BOB ACKERMAN -- ON BEHALF THE
CALIFORNIA STARTED WITHOUT JUST
ENDORSED THE RECOMMENDATIONS OF
THE CLINICAL LABORATORIES AS
USUAL ELABORATE MYTHOLOGY TO
MAKE IT.
IT MORE FAIR PROCESS AND ABOUT
FOR THE CALIFORNIA CELS USED
METAL PRODUCTS PLAYER SUPPORT
THE WITH PROPOSAL ON BREAST
PUMPS -- OUR MEMBERS DON'T
DISPENSE A LOT OF THOSE THEY
LOSE MONEY ON EVERYONE THEY SELL
SO IT'S IT'S TIME TO JUST THE
RATES THANK YOU.
THANK YOU [inaudible]
WELCOME.
CATHERINE YOU'RE GONNA ON BEHALF
OF CALIFORNIA MENTOR WE'RE IN
SUPPORT OF TSN'S PROPOSAL.
FOR I SEE A FACILITIES A WE
BELIEVE THIS ESSENTIAL TO
PROVIDE CARE FOR INDIVIDUALS
WITH ABOUT DEVELOPMENTAL
DISABILITIES THANK YOU.
THANK YOU [inaudible]
WELCOME -- REBEKAH HOLIC WITH
VALLEY VILLAGE -- LIKE SHE SAID
WE SERVE ADULTS WITH
DEVELOPMENTAL DISABILITIES IN
THE SEA BASS PROGRAM THE
COMMUNITY BASED ADULT SERVICES.
WE'VE BEEN STRUGGLING FOR QUITE
SOME TIME AS EVERYBODY ELSE WITH
THE THE RATE DECREASES AND
FREEZES -- WE STRUGGLE.
TO KEEP STAFF TO FIND STAFF TO
HIRE THEM AND THEY CAN GO DOWN
THE STREET WORK FAST FOOD THE
SAME AMOUNT OF MONEY WE PM AND
WITH US THEY HAVE TO DO.
A A LOT OF HARD WORK -- ALL OVER
OUR PARTICIPANTS ARE EXTREMELY
DISABLED AND REQUIRE LIKE TOTAL
CARE.
SO WE WE REALLY NEED MORE MONEY
SO WE CAN KEEP SERVING OUR
POPULATION [inaudible]
THANK YOU.
WELCOME.
OF MARTY MOTO A FAMILY MEMBER
ALSO WITH THE CALIFORNIA
DISPLACING YOUR COMMUNICATION
NETWORKS YOU CAN THE CALIFORNIA
PERSON CENTERED ADVOCACY
PARTNERSHIP STRONG SUPPORT OF
THE PROPOSAL.
OF FOR THE FUNDING INCREASES FOR
SEA BASS CALLED OF THE COMMUTE --
AND ALSO FOR THE ICF DD'S ALSO
STRONG SUPPORT FOR ALL THE OTHER
PROPOSALS I KNOW THE LEGISLATURE
IN ADMINISTRATION AND US TO STAY
CLOSE WHAT TO PRIORITIZE.
THOSE PROPOSALS BUT I THINK IT'S
A REFLECTION OF HOW DESPERATE
OUR COMMUNITY IS WE HAVE NOT
FULLY RECOVERED.
FROM THE RECESSION AND I THINK
IT'S ABOUT TIME THAT WE DO THANK
YOU.
THANK YOU.
WELCOME.
GOOD AFTERNOON SUSAN TO MORRIS
ON BEHALF OF THE ALZHEIMER'S
ASSOCIATION WE'RE HERE IN STRONG
SUPPORT OF THE COMMUNITY BASED
ADULT SERVICES SEA BASS PROPOSAL
THANK YOU.
THANK YOU WELCOME.
GOOD AFTERNOON KELLY MAC MILLAN
ON BEHALF OF REST CARE BRIGHT
SPRING HEALTH SERVICES AND
CHILDREN SPECIALLY CARE
COALITION.
IN SUPPORT OF EXTENSION
EXPANSION OF PROP FIFTY SIX
MEDICAL PROVIDER REIMBURSEMENT
RATES ALSO FOR THE CHILDREN
SPECIALLY CARE COALITION WERE
SUPPORT OF THE A STAKEHOLDER
PROPOSAL FOR THE DM ME AND CRT.
THANK YOU BYE THANK YOU WELCOME
THANK YOU MISTER CHAIRMAN
CONSUMERS ON BEHALF OF
CALIFORNIA HEALTH PLUS ADVOCATES
HERE IN SUPPORT OF THE WITH.
THANK YOU THANK YOU WELCOME.
CAROL SUE ON BEHALF OF THE
CALIFORNIA COMMISSION ON AGING
AND ALSO REPRESENTING THE
CALIFORNIA LONG TERM CARE
OMBUDSMAN ASSOCIATION IN SUPPORT
OF THE SEA BASS INCREASE.
THANK YOU [inaudible]
WELCOME.
GOOD AFTERNOON SENATOR PAN DONNA
CALLING ON BEHALF OF MOMS
RAISING WE ARE A GRASSROOTS
ONLINE AND ON THE GROUND
MOVEMENT OF PARENTS WORKING TO
HAVE POLICIES THAT PROMOTE
FAMILY ECONOMIC SECURITY
POLICIES WITHOUT OVER A MILLION
MEMBERS NATIONWIDE -- WE'RE HERE
IN SUPPORT OF THE CALIFORNIA
WITH ASSOCIATIONS ASK ON BREAST
PUMP REIMBURSEMENT RATES FOR
MEDICAL.
WE SENT THIS OUT TO OUR MEMBERS
AND RECEIVED OVER TWO THOUSAND
SIGNATURES AND COMMENTS BACK
FROM CONCERNED PARENTS ACROSS
THE STATE WHO ARE DIRECTLY
IMPACTED BY THIS WE VIEW THIS AS
AN EQUITY ISSUE WE KNOW THAT
MOMS RECEIVE PUMPS THROUGH.
THE AFFORDABLE CARE ACT IN WOMEN
WHO RELY ON MEDICAL SHOULD HAVE
THE SAME BENEFIT THANK YOU.
THANK YOU [inaudible]
WELCOME.
GOOD AFTERNOON IN A WIDER HER
WELL WITH A. R. P. WE STAND WITH
HER PARTNERS A CHILD'S AND WE
STAND IN SUPPORT OF THE SEA BASS
FUNDING INCREASE THANK YOU OKAY
THANK YOU.
ALL RIGHT WELL THANK YOU SO MUCH
FOR BUT I DO WANT TO BEFORE WE
MOVE ON THANK KNOWLEDGE -- AT
THIS POINT MY ADMONITION ON PROP --
FIFTY FIVE THAT THE GOVERNOR IS
WORKING TO HONORED THE PROMISES
THE VOTERS AROUND PROP FIFTY SIX
AND WE HAD SOME DISCUSSION FOR
THE PREVIOUS ADMINISTRATION BUT
I THINK WE'RE MOVING IN THE
RIGHT DIRECTION THERE AND I
DON'T WANT.
TO PASS I DON'T WANNA NOT
MENTION THAT.
IN THIS -- PROCESS -- MAYBE SO
YOU IT OFFER BUT VERY VERY
BRIEFLY -- PROP FIFTY FIVE FROM
THE OHIO I MEAN.
FINANCE SO THIS IS -- ARGUMENTS
MAY WELL ACTUALLY FINANCE
DOESN'T GET TO DECIDE
NECESSARILY WE CAN PROPOSE AN
ALTERNATIVE I GUESS WE CAN
ALWAYS PROPOSE AN ALTERNATIVE.
DO I JUST VERY BRIEFLY COMMENT
ON THAT SURE THE CONSTITUTION --
OUTLINED SEVERAL COMPONENTS OF
THE FORMULA ESSENTIALLY YOU
START WITH AVAILABLE REVENUES
AND THEN SUBTRACT OUT.
FUNDING DEDICATED TO EDUCATION
THROUGH PROPOSITION NINETY EIGHT
AND THEN SOMETHING CALLED THE
WORKLOAD BUDGET THE WORKLOAD
BUDGET IS -- I THINK THEM THE
PRIMARY ISSUE -- AT THIS POINT --
IF THE WORKLOAD BUDGET IS AS
SPECIFIED IN THE MEASURE -- TO
CONSIST OF THE ESSENTIALLY THE
COST OF PROGRAMS THAT WERE
CONSIDERED CURRENTLY AUTHORIZED
AS OF JANUARY FIRST.
TWENTY SIXTEEN HOWEVER THE
MEASURE ALSO STATES THAT --
CURRENTLY AUTHORIZED IS TO BE
INTERPRETED AS IT WAS
INTERPRETED BY THE DEPARTMENT OF
FINANCE ON JANUARY FIRST TWENTY
SIXTEEN SO.
IN THIS WAY THE THE MEASURE DOES
GIVE SIGNIFICANT DISCRETION AND
FLEXIBILITY TO THE
ADMINISTRATION AND HOW THE
FORMULA IS INTERPRETED
[inaudible]
THANK YOU [inaudible]
ALL RIGHT.
ALL RIGHT ANY OTHER COMMONSENSE.
FINANCE YES -- ACTUALLY I WAS I
WAS HOPING THAT I MIGHT BE ABLE
TO JUST OFFER SOME GENERAL
COMMENTS ON ANY KIND OF GONE
THROUGH THE WHOLE -- PROP FIFTY
SIX PACKAGE -- I MEAN I THINK
FIRST CONCERNING PROP FIFTY FIVE
I MEAN I APPRECIATE MISTER CHAIR --
YOUR YOUR OFFER EARLIER NOT TO
REHASH A LOT OF THE DEBATE I
MEAN WHILE WE THINK THAT WE WE
CONTINUE TO THINK THAT OUR
APPROACH IS REASONABLE.
AND IT MEETS THE REQUIREMENTS OF
THE LAW I DID WANT TO TAKE A
MOMENT TO ACKNOWLEDGE YOUR
PERSPECTIVES IN THOSEOF MISS
GLAZER -- AND I I ALSO WANT TO
THANK YOU FOR POINTING OUT THAT
THE THAT THE GOVERNOR AND AND
THIS ADMINISTRATION DOES HAVE A
DIFFERENT APPROACH FOR PROP --
FIFTY SIX WE ARE COMMITTING ALL
OF THE FUNDING TO ENHANCE THE
MEDICAL PROGRAM -- AND WHILE OUR
INTENTION IS TO TRY TO MAKE SOME
OF THESE COMMITMENTS -- ON A
MULTI YEAR BASIS INCLUDING THE
VALUE BASED PAYMENTS --
INITIATIVE THAT WILL BE
DISCUSSING SHORTLY -- YOU KNOW
THERE IS A FUNDAMENTAL.
ISSUE HERE AND THAT THIS IS A
DECLINING FUNDS ARE SAYING OTHER
WE'VE POINT OUT BEFORE SO I
WON'T BELABOR THE POINT BUT
EVENTUALLY THERE WILL BE A
SQUEEZE HERE AND YOU KNOW AS AN
ADMINISTRATION WE JUST WANT TO
BE COGNIZANT OF WHAT WE'RE
COMMITTING.
TO SO THANK YOU.
THANK YOU APPRECIATE THAT
[inaudible]
ALL RIGHT.
BUT THAT WITH THIS MOVE ON
TUITION NUMBER NINE WHICH IS THE
PHYSICIAN DENTIST LOAN REPAYMENT
PROGRAM.
HUESO YES SO THIS WAS AS PART OF
A LAST YEAR'S THE PROPERTY --
SIX AGREEMENTS AND WE HAVE NOW
CONTRACTED WITH PHYSICIANS FOR A
HEALTHY CALIFORNIA TO ADMINISTER
WHAT WE ARE CALLING THE CAL
HEALTH CARE'S PROGRAM -- THEY'RE
DOING THE MINISTRY SHOULD THE
MINISTRY OF PIECES BUT THE
DEPARTMENT IS WHO'S RESPONSIBLE
FOR DETERMINING -- AT THE END
THE DAY WHICH WHICH PHYSICIANS
AND DENTISTS ARE ACTUALLY
RECEIVING THIS LOWER PAYMENTS --
WE DO HAVE AN ADVISORY COUNCIL
THAT WE HAVE A DIFFERENT SUBJECT
MATTER EXPERTS ON TO HELP US
UNDERSTAND WHAT THE CRITICS%
SCORING CRITERIA SHOULD BE
--
THE APPLICATION PERIOD ENDS TO
MORROW IT STARTED ON APRIL FIRST --
AS OF THIS MORNING AS I GOT WERE.
AFTERNOON I GOT UPDATED
INFORMATION WHILE WE'VE BEEN
SITTING HERE.
WE HAVE RECEIVED THIRTEEN
HUNDRED AND ELEVEN APPLICATIONS
[inaudible]
RATES
CONTACTS WHAT THAT WHAT
THAT SUPPOSED TO MEAN SO I MEAN
THIS IS A LITTLE BACK IN AN
ACTING CALCULATION BUT A QUARTER
MILLION PEOPLE GETTING ACCESS.
BEING AT FINALLY HAVING AND
DENNIS STIR A PHYSICIAN WHO
WOULD BE ABLE SEE THEM THAT.
BECAUSE THE RESULT OF THIS
PROGRAM SINCE IS BEING
OVERSUBSCRIBED ASSUME YOU'LL BE
GIVING OUT ALL THE MONEY THAT
OKAY.
ALRIGHT SO YES EXCELLENT ALL
RIGHT WELL THANK YOU ALL RIGHT --
PUBLIC COMMENT.
REALLY BEAM ON BEHALF OF THE
CALIFORNIA MEDICAL ASSOCIATION --
SEEM IS A STATIC DH CS SOME PAGE
SEE WERE ABLE TO DESIGN AND
IMPLEMENT THE PROGRAM SO QUICKLY
AND HAVE A MULTI YEAR IMPACT
WITH ONE TIME FUNDING -- IT'S
NOT MENTIONED HERE ON THE AGENDA
TODAY BUT WE DO HAVE A PROPOSAL --
FOR ANY TECHNICALLY UNSPENT
PROPOSITION FIFTY SIX FUNDING BE
DIRECTED TO ONE TIME FUNDING FOR
THIS -- TO PUT INTO THIS ALREADY
DESIGNED AND PHYSICIAN DENNIS
LOAN REPAYMENT PROGRAM SIMILAR
TO LAST YEAR WHEN THERE WAS ONE
TIME FUNDING OF TWO HUNDRED
TWENTY MILLION -- AND I THINK WE
HEARD IT'S IT'S PRETTY OF A
PRESCRIBED TO BE GREAT APPS MORE
FUNDING THAT POT THANK YOU.
THANK YOU WELCOME I'D ARGUMENT
GREW ON BEHALF OF THE CALIFORNIA
DENTAL ASSOCIATION WE WANT TO
COMMEND THE PHYSICIANS FOR
HEALTHY CALIFORNIA AND DTS ON
STANDING UP THE NEW.
PROGRAM SO QUICKLY AND DOING
INCREDIBLE AMOUNT OF WORK TO GET
IT UP AND RUNNING -- WE HAVE
DENTISTS.
SERVING ON THE ADVISORY COUNCIL
AND THEY'VE DONE A LOT OF WORK.
TO THE CRITERIA AND AND BE VERY
THOUGHTFUL AND HOW THE THE BEST
WAY TO ALLOCATE THE MONEY
THROUGHOUT THE STATE WE JUST
KNOW THAT THE THE NUMBERS THAT
YOU WERE JUST SPEAKING OF OUR
FOR OUR PER YEAR AND RIGHT NOW
THE ONE TIME FUNDING IS FOR FIVE
CO HEARTS.
OVER THE NEXT FIVE YEARS SO A
REAL POTENTIAL.
TO MOVE THE NEEDLE ON SOME
PROVIDER ACCESS IN THE STATE
OKAY SO YOU'RE TALKING ONE POINT
TWO MILLION OVER FIVE YEARS. ONE
POINT TWO MILLION PEOPLE.
BUT THESE POTENTIALLY BEING
SERVED I THAT WAS A CALCULATION
BASED ON AN AVERAGE [inaudible]
OKAY.
WELCOME.
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY WE DO APPRECIATE
THE EFFORT TO INCREASE.
BY THE MEDI CAL WORK FORCE TO
ENSURE ACCESS.
SIMILAR TO OUR PREVIOUS COMMENT
WE WOULD LIKE TO SEE AN
EVALUATION OF THE LOAN REPAYMENT
PROGRAM AND CONSIDERING THE OVER
SUBSCRIPTION WE WOULD LIKE FOR
OUR PREVIOUS OUR RECOMMENDATIONS
TO BE CONSIDERED IN FUTURE YEARS
SPECIFICALLY.
ARE RAISING THE MEDI CAL
THRESHOLD -- LOAD FROM 30% TO
POTENTIALLY A HIGHER NUMBER AS
WELL AS OTHER LOAN REPAYMENT
PROGRAMS OF THAT MAYBE REDUCING
THE AMOUNT SO THAT THERE ARE
MORE -- AWARD AMOUNTS AVAILABLE
INSTEAD OF A HUNDRED AND FIFTY
AWARDS PER YEAR THANK YOU.
THANK YOU WELCOME THE AFTERNOON
KELLY MAKANAN ON BEHALF OF
CHILDREN'S CARE SPECIALLY
COALITION -- WE APPLY THE
MINISTRATION AND THE LEGISLATIVE
FOR INVESTMENT IN THIS LOAN
REPAYMENT PROGRAM.
IT'LL HELP US RECRUIT AND RETAIN
PEDIATRIC SUB SPECIALISTS IN
CALIFORNIA IN THOSE AREAS THAT
ARE MOST NEEDED THANK YOU.
THANK YOU ALL RIGHT.
OKAY SEEN OTHER COMMENTS -- TO I
ALSO WANT TO ECHO -- THE
STATEMENTS BY SOME OF THE CDA
ABOUT THE THEY KNOW TAKES TIME
BUT THESE PROGRAMS UP AND YOU'VE
DONE EVER.
DONE A VERY QUICKLY AND
SOMETIMES WHAT HAPPENS IS THAT
WE DON'T KNOWLEDGE TIMES WHEN
OUR STATE GOVERNMENT AND OUR
EMPLOYEES INTERACTION.
THINGS QUICKLY WE JUST LOOK AT
THE TIMES WHEN THINGS DON'T GO
SO FAST.
I THINK SO SHE DOES THE TEAM
WHO'S WORKED ON IT HAS DONE A
TREMENDOUS JOB YES EXCELLENT WE
LOOK FORWARD TO THE RESULTS OF
THEIR WORK CELL.
ALL RIGHT WE'RE GONNA MOVE ON TO
ISSUE NUMBER TEN IT'S THE
PROPOSITION VALUE BASED PAYMENT
PROGRAM OR SO AS PART OF THE
JANUARY BUDGET THE GOVERNOR DID
PROPOSE -- IS THREE HUNDRED
SIXTY MILLION DOLLAR A YEAR FOR
THREE YEARS VALUE BASED PAYMENT
PROGRAM WE DID RELEASE AS NOTED
IN THE AGENDA AT THE DOOR THE
INITIAL LIST OF OF MEASURES.
WITHIN SORT OF THE FOR DOMAIN
AREAS THAT YOU KNOW THE GOVERNOR
AND THE AGENCY REALLY FELT WE
SHOULD BE FOCUSING ON AND THAT'S
PRENATAL AND POST PARTUM CARE
EARLY CHILDHOOD PREVENTION.
CHRONIC DISEASE MANAGEMENT AND
BEHAVIORAL HEALTH INTEGRATION --
MET JUST TO QUICKLY HI LATE OVER
BECAUSE IT BECAUSE I KNOW IT.
THIS PROGRAM IS A LITTLE
DIFFERENT AND I THINK SOME
PEOPLE WOULD HAVE EXPECTED IT TO
BE AN AND REALLY THAT IS YOU
KNOW WE HAD TO STRUCTURE IT IN A
WAY.
THAT WE ACTUALLY HAD THE DATA TO
DO THIS AND THIS IS DOING VALUE
BASED PAYMENT ON THE PHYSICIAN
LEVEL.
IT IS NOT AT THE PLAN OR THE
GROUP LEVEL.
SO WE NEEDED TO MAKE SURE THAT
WHATEVER DATA WE WERE USING YOU
COULD ACTUALLY YOU KNOW THAT
DETERMINE PAYMENTS FROM THAT SO
JUST A FLAG THAT BECAUSE I KNOW
IT IS DIFFERENT THAN YOU KNOW
SORT OF SOME MORE OTHER TYPICAL
VALUE BASED PAYMENT PROGRAMS --
MET SO WE AS NOTED DID DID
RECEIVE COMMENTS WE ARE JUST
FINALISING -- THE REVIEW OF
THOSE I KNOW THE QUESTION WAS
WOULD IT BE CHANGING SUBSTANDARD
OR SIGNIFICANTLY -- I DON'T KNOW
THAT SIGNIFICANTLY BUT WE ARE
LOOKING AT SOME ADDITIONAL
MEASURES THAT WERE SUGGESTED --
THAT WE THINK COULD COULD MAKE
SENSE TO ADD AND SO WERE THE
TEAM IS COMPILING ALL OF THAT
RIGHT NOW BUT HOPEFULLY WE'LL BE
ABLE TO HAVE THAT OUT PRETTY
SOON -- SO THAT FOLKS CAN SEE
THE FINAL AND THEN AS WE HAD
NOTED IN THE RELEASE OF THE
DRAFT THERE WAS NO -- VALUATION
OF THE MEASURES LIKE HOW MUCH
MONEY YOU WOULD GET FOR
PARTICULAR ACHIEVEMENT.
WE FELT WE NEEDED TO FINALIZE
THE MEASUREMENT LAST BEFORE THEN
WE COULD START TO HAVE THAT SO
ONCE WE GET THAT FINALIZE WILL
START TO TALK ABOUT SRT OF THE
BEGINNING OF THE MONEY INTO THE
FOR AREAS.
AND HOW WE THINK -- THE
DIFFERENT MEASURE SHOULD BE
VALUED.
SARAH COMES MEGLIO.
IN A REPORT WE DID THE WE DID.
PRELIMINARILY EVALUATE THIS AND
SORT OF WE DID PROPOSE
ALTERNATIVELY -- THAT THE
LEGISLATURE COULD USE THIS
FUNDING TO PROVIDE -- VALUE
BASED PAYMENTS MORE ON THE
MANAGED CARE LEVEL -- GIVEN THE
SORT OF DELEGATED MODEL WE WOULD
YOU KNOW -- ASSESS THEIR
PERFORMANCE ACCORDING TO THESE
MEASURES AND THEN PAY THEM AND
THEY WOULD -- PAY PROVIDERS AS
NEED BE SO THAT IS AN
ALTERNATIVE CONSTRUCT TO WHAT
THE GOVERNOR HAS -- HAS A
PROPOSED TO DO WITH THIS FUNDING --
IN IN LIGHT THOUGH.
OF THE THE THE NAME PREVENTIVE
SERVICE FOR CHILDREN AS WELL AS
THE SORT OF MORE GENERAL
INCREASED ENFORCEMENT.
OF HE THIS MEASURES ANOTHER --
ACCESSING QUALITY MEASURES WE DO
HAVE QUESTIONS ABOUT WHETHER OR
NOT SOME OF THE VALUE BASED
PAYMENTS ARE SOMEWHAT
DUPLICATIVE WITH WHAT WE ARE
DOING A LOT MORE ON THE
OVERSIGHT SIDE OF THINGS -- SO
WE'LL GET INTO THAT I THINK --
ON THE ON THE NEXT ITEM AS WELL
SO ARE THERE MEASURES THAT WE
ARE NOW REALLY ENFORCING HOLDING
MANAGED CARE PLANS ACCOUNTABLE
FOR ACHIEVING -- AND THEN ALSO --
SORT OF ON THE OTHER SIDE ALSO
PAYING A SUPPLEMENTAL PAYMENT
NOTHING WRONG WITH NECESSARILY
BEEN DOING BOTH BUT ONE ONE
OPTION MAY BE A MORE COST
EFFECTIVE WAY. TO DO SO AND
MOREOVER MANAGED CARE PLANS
MIGHT NEED TO BE PAID FOR SOME
OF THE MORE -- FOR THE GREATER
ADHERENCE -- TO THE HIGHER
STANDARDS THAT THE STATE IS
IMPOSING SO WE JUST TO HAVE SOME
QUESTIONS ABOUT WHETHER OR NOT --
AT LEAST FOR SOME OF THE NEW
VALUE BASED PAYMENTS WHETHER OR
NOT THEY REPRESENT A COST
EFFECTIVE SOLUTION IN LIGHT OF
THE FACT THAT WE ARE -- THE
STATE IS REALLY INCREASING ITS
ENFORCEMENT ACCOUNTABILITY
MEASURES [inaudible]
FINANCE. THIRTY MIGHT BE
INTERESTING TO LOOK AT THE
PLACES WATER SOME OVERLAP AND
SEE HOW MUCH THAT MOVES THE
NEEDLE VERSES THE PLACES WHERE
THERE ISN'T.
OF ANY THOUGHT ABOUT THAT.
FROM A VALUATION STANDPOINT.
AT THE RADICALLY YOU THINK ALL
WOULD DUPLICATING SO THEREFORE.
YOU KNOW THEM IT'S JUST THAT
DOUBLING UP OR WERE DOUBLE
PAYING FOR SOMETHING BUT I I
JUST A POSE THAT QUESTION TO YOU
IS SOMEONE WHO ACTUALLY DID
RESEARCH ON QUALITY IMPROVEMENT
SO.
YEAH I MEAN AS A AS A RESEARCHER
AT THAT DEFERRED YOUR EXPERTISE
THERE THE MEASURES CAN BE A
LITTLE BIT DIFFERENT I THINK SO
MAYBE ON THE BEHAVIORAL HEALTH
INTEGRATION I'M NOT SURE OR YOU
KNOW WHETHER OR NOT THERE'S SORT
OF A CORRESPONDING -- SAY -- HE
THIS ENFORCEMENT MEASURE THAT'S
GOING ON AND HOW DO YOU SORT OF
COMPARE SAY THE BEHAVIOR HEALTH
INTEGRATION -- TO YOU KNOW A
DEVELOPMENTAL SCREENING OR WELL
CHILD VISIT SO.
RECOGNIZE THAT THERE IS
POTENTIAL PROMISE THERE -- BUT
WE HAVE TO EVALUATE IT FOR THEIR
ALL RIGHT -- SO I DO APPRECIATE
THE THIS -- AFTER VALUE BASED
PAYMENT -- AND IN FACT -- AND
THE FACT APPRECIATE THAT AND
WE'RE LOOKING AT THIS ON THE
MEDI CAL SIDE WE HAD A HEARING
ON IMMIGRATION OF CARE AND THERE
WAS SOME CONVERSATION ABOUT --
THING THAT WE SHOULD FIGURE OUT
SAMPLE ON THE COMMERCIAL SIDE
AND THE MEDIC OUTSIDE TRYING
[inaudible]
TO A LINE -- RIGHT AS SO THAT.
SO WHILE WE DO HAVE I THINK WE
DO HAVE A LITTLE BIT OF
SEGREGATION AND THE NATURE OF
PROVIDERS TO BE -- GIVEN THAT
OUR LOW REIMBURSEMENT SO FORTY
SEND TEND TO HAVE LIKE THIS
GROUP DOES MEDI CAL THAT GROUP I
MEAN THERE ARE MANY WHO DO BOTH.
AND AND IF YOU REALLY WANT TO
GET TO THAT WHAT CAUGHT TIPPING
POINT CHANGING BEHAVIOR AND
SOMEONE'S PRACTICE.
IT'S GOOD IF YOU KNOW EVERY
PAYER ARE ALMOST ALL THE PLAYERS
ENOUGH PAIRS OF THEIR PRACTICE
ALL WANT THE SAME THING BECAUSE
I'LL TELL YOU AS A PHYSICIAN IF.
NO ONE CARES LIKE 20% OF MY
PRACTICE AS A DO AX.
AND OTHER ONE IS 15% READ THOSE
WHY A AND THE OTHER ONES IS THE
YOU KNOW THE YOU CAN GO ALL
RIGHT WELL THAT'S GREAT EXCEPT.
NO I TO MAKE THE CHANGE ACROSS
OUR PRACTICE IS NOT LIKE I GO
LOOK AT INSURANCE CARDS ALONG A
TREAT THIS PERSON THIS WAY AND
THAT ONE THAT WAY RATES THAT'S
THE SYSTEM YOU PUT IN PLACE YOUR
PRACTICE YOU KNOW YOUR NURSES
YOUR CLERK SOONER THEY'LL AND
HOW AND WE DO.
CORPORATION CARE AROUND WHICH
DISEASES AND LIKE A CELL.
ALSO -- WHEN THINGS I'M HOPING
THAT AS THIS IS DEVELOPED TO
THINK ABOUT IT WE HAVE SOME
OPPORTUNITIES ALSO ON THE
COMMERCIAL SIDE GIVING THE FACT
THAT YOU KNOW WE PAY FOR
COMMERCIAL INSURANCE FOR CALPERS
AND WE HAVE COVERED CALIFORNIA
SO? FOR TO TO TO BUILD ON THIS
AND THINK ABOUT HOW.
WE MIGHT WANT TO THINK ABOUT YOU
KNOW SO APPRECIATE YOU HAVE THIS
PROPOSAL HERE AND THAT.
SAYING THAT OKAY WELL SUPPOSE
HAVING SOME DISCUSSIONS SAYING
OKAY LET'S HAVE SOME COMMERCIAL
PEOPLE THINK ABOUT DOING THE
SAME THING AND SEE HOW WE CAN
COORDINATE.
SO BASICALLY YOU'RE GETTING THE
SAME SIGNAL THAT'S GOING OUT TO
THE REVISED HERS AROUND THESE
PARTICULAR AREAS RIGHT OKAY.
SO THE VALUE BASED PAYMENT ISN'T
DOES THIS ONE JUST BE FROM THE
MEDI CAL SIDE FOR THAT MAY BE
ACROSS BOTH MEDI CAL AND NOW
THEY'RE MAJOR COMMERCIAL PAYERS
WE MAY NOT GET ALL THE PLAYERS
BUT ENOUGH THAT IT'S LIKE OKAY
WELL THAT'S PLAY THAT'S YOU KNOW
72% MY PATIENTS.
FALLEN THAT IT MAKES SENSE FOR
ME TO NOW CHANGE THE WAY I DO
THINGS MY PRACTICE -- BECAUSE
IT'S JUST IT DID HAVE A BIG
IMPACT.
SO I'M HOPING THAT WE CAN HAVE
SOME OF THOSE QUESTIONS AND I'M
IS SINCE SINCE THAT HEARING --
J. C. COOPER WHO WAS AT THE THE
THE PART ONE LEADING NETWORK WE
HAVE REACHED OUT TO A CALPERS
AND COVER CALIFORNIA START ON
THIS IS QUESTIONS ABOUT THE
VALUE METRICS AND OTHER THINGS.
OT SPECIFICALLY RELATED TO THIS
PROPOSAL BUT I THINK WHAT YOU
HAD SUGGESTED TO US AND NOT
HEARING LIKE WHAT WHAT QUALITY
MEASURES ARE WE LOOKING AT HOW
CAN WE HAVE SOME.
CONSISTENCY WHERE IT MAKES SENSE
WHEN YOU KNOW SOMETIMES WE HAVE
DIFFERENT POPULATIONS BUT SO
WE'RE DEFINITELY GOING DOWN THAT
PATH AS PART OF SORT OF OUR
FUTURE MEDI CAL PLANNING THAT
THAT I MENTIONED EARLIER SO
DEFINITELY AGREE THAT WE WANT TO
TRY.
TO DO WHAT WE CAN SO THAT WERE
CHANGING THE DELIVERY SYSTEM AND
YOU CAN ONLY DO THAT IF IF
YOU'RE AFFECTING SORT OF A
LARGER PERCENT OF THE POPULATION.
OKAY.
WELL I I APPRECIATE THAT.
NAM AGAIN AND TAKE THE
PARTICULAR MEASURES THAT.
THERE IS A SAID PLEASE THROW.
IT'S NOT ON THE LIST THERE BUT
YOU KNOW THIRTY SCREENING FOR
PRE DIABETES.
THE SERVER SO.
CLOSE THROW THAT OUT THERE --
YOU SUBMIT US ANY COMMENTS THAT
THE TWO ARE I DON'T THINK I I
WILL TAKE YOUR COMMENT EVEN
THOUGH IT'S PAST VIA.
WE GET TO TALK TO YOU HERE.
THE AYE AYE NO I WAS LOOKING AT
I THINK YOU HAVE A REALLY GREAT
SET OF MEASURES -- AND THAT NOT
LOOKING TO UPSET THE APPLE CART
BUT YOU KNOW AT NIGHT AND SEE DO
YOU HAVE A MEASURE OF DIABETES
CARE ITSELF BUT MY THINK ABOUT.
AND THAT'S YOU KNOW IT'S IT'S IN
THE WAS IT.
US PREVENTIVE TASK FORCE THING
RIGHT -- THE GUIDELINES AND
GIVEN THE FACT THAT WE'RE
HEARING THAT ALMOST HALF OF ALL
CALIFORNIANS ARE PRE DIABETIC
AND THEN YOU THINK ABOUT WELL IF.
YOU DON'T IDENTIFY THEM BUT
BECAUSE YOU'RE NOT DIABETIC YET
THEY'RE OFTEN NOT IDENTIFIED.
AND THEN IF YOU DON'T KNOW THAT
YOU'RE NOT TRYING TO WORK STOP
THEM FROM DIABETIC.
AND THE NAME THE SO SO SO DEBTS
CAL ITSELF ANYWAY.
SORRY.
WATCHING SO THEY'RE PROBABLY
LATER RARELY GO GREAT I GOT SIR
PAUL.
RIGHT OKAY ANYWAY.
I'M NOT GOOD TRIED UP TO THE TOP
OF CARD ANYMORE NOW YOU HAVE
SOME EXCELLENT MEASURES HERE.
AT THAT WAS JUST THE ONE I WAS
LIKE WELL I DON'T KNOW MAYBE
THAT ONE OUT.
OKAY -- EXCELLENT ALL RIGHT ANY
OTHER COMMENTS THEN ALL RIGHT --
SO WE DO HAVE TO STAKEHOLDER
PROPOSALS -- WHO I GUESS PEOPLE
OF MORE SUGGESTIONS -- ALL RIGHT --
SO THE FIRST WE HAVE THE
PROPOSAL TO PRIORITIZE METRICS
TO REDUCE HEALTH DISPARITIES --
THAT'S FROM THE CALIFORNIA TO
IMPROVE HEALTH OUTCOMES -- THE
AREAS FOCUSED ON PRE AND
POSTNATAL CARE CHRONIC DISEASES
AND BEHAVIORAL HEALTH ARE AREAS
WITH -- PERSISTENT AND WELL
DOCUMENTED DISPARITIES -- WE
ENCOURAGE THE DEPARTMENT --
SIMILARLY TO CONSULT WITH COVER
CALIFORNIA OTHER PAIRS AND WE
KNOW THAT MEDICARE AT THAT --
CMS JUST UPDATED THEIR VALUE
BASED PAYMENT -- PROPOSALS WHILE --
AS A WHOLE SYSTEM MOVES TOWARD
VALUE BASED PAYMENT WE NEED
PERFORMANCE MEASURES THAT ACCESS
AND MONITOR DISPARITIES IN
HEALTH AND HEALTH CARE OUTCOMES.
A RECENT EVIDENCE SUGGESTS THAT
FAILURE TO PRIORITIZE HEALTH
EQUITY IN EMERGING KERR MODELS
ACTUALLY HAS THE POTENTIAL TO
EXACERBATE THEM.
AND THEREFORE WE'RE REQUESTING
THE DEPARTMENT INCLUDE A
REQUIREMENT IN THE VALUE BASED.
PAYMENT PROGRAM THAT PRIORITIZES
THE REDUCTION OF DISPARITIES --
AND THE DH CS CONSULT WITH A
BROAD SET OF STAKEHOLDERS ON THE
MECHANICS OF THE PROPOSAL -- THE
METRICS AT WE WE PROVIDE A
COMMENTS ON THE METRICS AND I
THINK THE METRICS THEMSELVES ARE
YOU KNOW VERY.
BE ABROAD AND WE APPRECIATE.
APPRECIATE THEM I THINK AS
PROPOSED THOUGH -- THAT THERE'S
A FAILURE TO CLEARLY STATE THE
DISPARITIES REDUCTION IS A GOAL
TO TIE PAYMENTS EXPLICITLY TO
HAVE HELPED THE SPURS REDUCTION
OR TO IMPROVED COLLECTION AND
REPORTING OF PATIENT DATA -- BY
SPECIFIC SUBPOPULATIONS -- AND
THERE'S ALSO AN IMPORT.
THIS IS AN IMPORTANT OPPORTUNITY
TO ENSURE THAT -- MANAGED CARE
PLANS ARE ADEQUATELY INVESTING
AND IMPROVEMENTS AND TO CLINICAL
PROCESS SEES AND CONSUMER
EXPERIENCE AT THE PROVIDER LEVEL --
ARE ARE.
YOU KNOW PROPOSED AMENDMENTS
WOULD ADD ADDITIONAL INCENTIVES
TO STRENGTHEN THE COLLECTION AND
REPORTING.
OF PATIENT DATA BY RACE
ETHNICITY LANGUAGE LGBT Q..
STATUS AND OTHER FACTORS -- TIES
PAYMENTS TO HEALTH DISPARITIES
REDUCTIONS AS MEASURED BY
CHANGES AND OUTCOMES NOT JUST
PROCESS SEES -- INVEST IN
IMPROVEMENTS TO THE CLINICAL
PROCESSES OF CARE -- FOR EXAMPLE
BY INCENTIVIZING COMPLETION OF
COMMUNITY HEALTH RISK
ASSESSMENTS ON THE ADOPTION OF
FEDERAL -- AND SEE.
HEALTH INFORMATION TECHNOLOGY
TWENTY FIFTEEN STANDARDS -- FOR
EHR CERTIFICATION AMONGST OTHER
OF PROPOSALS -- THAT WE THINK
WOULD HELP TO STRENGTHEN --
PATIENT EXPERIENCE -- INCLUDING
AVAILABILITY OF EVENING AND
WEEKEND APPOINTMENTS AT CETERA --
YOU KNOW THIS IS A I THINK THIS
IS A REALLY IMPORTANT
OPPORTUNITY THAT CALIFORNIA HAS
TO IMPROVE HEALTH OUTCOMES AND
REDUCE DISPARITIES BUT ONLY IF
WE MAKE THE THAT COMMITMENT
EXPLICIT -- SO WE REALLY URGE
THE DEPARTMENT TO PRIORITIZE --
DESPAIRS REDUCTION AS A GOAL AS
PART OF THIS PROGRAM.
THANK.
YOU COMMENTS FROM THE EIGHTY S..
I THINK THE ONLY COMMENT I HAVE
I THINK IT GOES BACK TO MY PRIOR
STATEMENT ABOUT THE CHALLENGES
OF THIS PARTICULAR TYPE OF VALUE
BASED PAYMENT PROGRAM BEING AT A
PROVIDER LEVEL.
AND SO THE KINDS OF DATA THAT
YOU HAVE AVAILABLE I THINK WE
SHARED THAT THE DESIRE TO REDUCE
DISPARITIES I I THINK WE
STRUGGLED WITH HOW COULD WE
ADDRESS THAT.
IN THE TYPE OF STRUCTURE THAT
THE GOVERNOR IS PROPOSING AND SO --
I KNOW WE DID RECEIVE COMMENTS
OR OR STILL GOING THROUGH THOSE
BUT I JUST WANTED TO FLAG IT'S
NOT THAT IT'S NOT A PRIORITY
IT'S CAN YOU ACTUALLY DO IT AND
THAT YOU KNOW DATA AS YOU KNOW
CAN BE CHALLENGING -- AND AS
IDENTIFIED YOU KNOW THE DATA
COLLECTION THAT WE SO OUR RACE
ETHNICITY DATA TODAY AND MEET IN
AND IT HAS TO BE OPTIONAL.
AS OURS YOU KNOW SOME OF THE
SOME OF THE OTHER THINGS LIKE
THAT AND SO WE DON'T NECESSARILY
ALSO HAVE THAT INFORMATION --
FOR A WIDE.
PERCENTAGE THERE I THINK WE'RE
LIKE AT 20% A KNOWN OR OTHER IN
GENERAL IN OUR MEDICAL
ELIGIBILITY DATA SO.
AGAIN TOTALLY APPRECIATE AND
AGREE THAT THAT IS A GOAL BUT
HOW I THINK WE STRUGGLE WITH HOW
DO WE ACTUALLY ACCOMPLISH THAT
IN A STRUCTURE LIKE THIS
[inaudible]
OKAY.
HELLO ANY COMMENTS FINANCE.
OKAY -- CERTAINLY APPRECIATE IT --
THE PROPOSAL AND SHARED GOALS IS
CERTAINLY SOMEONE WHO -- HAS
BEEN FIGHTING ABOUT TRYING TO
DRESS -- DISPARITIES IN -- AND
THAT SHE FOR THE API COMMUNITY
TRYING TO ACTUALLY DISAGGREGATED
SO SHE FIND OUT WHAT'S GOING ON
TODAY DOING ANY OF THAT
INFORMATION -- BUT ALSO REACT --
RECOGNIZING UM AS SOMEONE WHO'S
THAT PRACTICE SPACE RESEARCH SO
OKAY SO WE'RE TALKING ABOUT AT
THE PROVIDER LEVEL.
THE KINDS OF INFORMATION SO WE
CAN CERTAINLY HAVE THE OFFICES
ASK INFORMATION LIKE YOU KNOW
WHAT YOUR RATES AND AND AND SO
FORTH.
WE CAN'T COMPEL SOMEONE ANSWER
IT IS GONNA BE SELF IDENTIFIED
SO WHEN WE WE THERE ARE ELEMENTS
TO DO THAT -- BUT IT'S PROBABLY
NOT GOING TO BE QUITE AS NEAT
CLEAN AS PEOPLE EXPECT WILL BE
AT MIGHT BE PRETTY FUZZY AND
DEPENDING ON IT I THINK WHEN YOU
AGGREGATE EVERYONE YOU MAY GO
GET A BETTER IDEA BUT IT CAN BE
HARD -- TO FOR PARTICULAR SO AS
YOU GET DOWN TO A PARTICULAR
POSITION AT SEA ON THIS BENT ON
THE PATIENT BASE RIGHT -- AIDS
IS THAT IT YEAH SAID TYPICAL
PRICE YOUR PHYSICIAN ABOUT
FIFTEEN HUNDRED TWO THOUSAND
PATIENTS -- THEN WHAT HAPPENS IS
DEPENDING ON WHAT THE MEASURES
IF YOUR PEDIATRICIAN AND YOU'RE
LOOKING AT WELL CHILD WILL.
THAT COVERS A GOOD PORTION OF
THEM BUT THEN YOU'RE TALKING
ABOUT THE DIABETICS THAT'S A
FAIRLY SMALL NUMBER AND SO --
I'M NOT SAYING THAT WE CAN'T DO
ANYTHING ABOUT IT AND I THINK
THAT THERE ARE YOU KNOW WE WANT
TO TRY TO REDUCE -- THE SPIRIT
IS THE THING IS IS THAT YOU HAVE
A HANDFUL OF PATIENCE.
HOW DO YOU DO THAT ON A SENTENCE
OF SIDE -- FOR THAT PARTICULAR
DIE YOU CAN TRY TO DO AN
AGGREGATE BUT THAT'S MORE AT THE
HEALTH PLAN -- MEDICAL GROUP
LEVEL.
AND SO -- BUT I THINK WE SHOULD
YOU KNOW CERTAINLY FIGURE OUT
HOW.
TO CHIP CHIP AWAY AT THAT MAYBE
OVER TIME YOU MAY BE ABLE TO GET
MORE SO IF YOU DON'T HAVE POINT
OF TIME WITH NUMBERS OF PATIENTS
OVER TIME YOU MAY BE ABLE TO
FIND SOME WAYS TO LOOK AT SOME
OF THESE THINGS.
AS WELL AND I CERTAINLY THINK --
ONE THING WE CAN BE COMMITTED TO
YOU IS BASED ON THE DATA THAT WE
DO HAVE A VALUE WAIT.
THEN THE RESULTS AT THE
AGGREGATE LEVEL TO SEE YOU KNOW
NOT ONLY AT THE AGGREGATE LEVEL
BUT YOU KNOW NOT AGGREGATE TOTAL
POPULATION BUT AGGREGATE BUT
BREAKING BROKE BROKEN DOWN BY
THE POPULATION INFORMATION THAT
WE HAVE. TO SEE WHAT EFFECT IT
DID HAVE WHAT WAS THERE A
DIFFERENTIAL IMPACT IT OVERALL
AGAIN NOT OUT THE PHYSICIAN.
LEVEL BECAUSE AGAIN THE NUMBER
OF PATIENTS AND ALL OF THAT SO I
THINK THAT'S CERTAINLY ONE THING
WILL WILL BE LOOKING AT AND
THINKING ABOUT FOR THE
EVALUATION COMPONENT OF THE
VALUE BASED. TO AT LEAST SEE IF
IT IF IT DID HAVE DIFFERENTIAL
IMPACTS AND IF SO THAT MAY BE
THINKING ABOUT YOU KNOW IN THE
FUTURE AS WE LOOK AT STUFF IT
ARE THERE OTHERS OTHER THINGS WE
SHOULD BE CONSIDERING AS WE LOOK
AT THE MEDICARE PROGRAM.
PHOTO LOG THE OTHER LEVEL THAT
WAS ALSO RECRUITMENT SWITCH.
WHO'S PARTICIPATING IN WHICH
COMMUNITIES -- AND RIGHT.
BECAUSE THEN YOU'RE LOOKING AT
TALKING ABOUT.
OVERSTOCK OTHER ANTI GOT ABOUT
THIS FOR WAY TOO LONG.
BUT SO ANYWAY ONE OF THE REASONS
WHY I THINK WE US ALSO FOR
STAKEHOLDER PROCESS TO BECAUSE
AS AS WE CANSEE JUST HERE
THERE'S THERE'S A LOT MORE
UNDERNEATH THE SURFACE AS WE
TALK ABOUT THE SENATE.
WE CERTAINLY RECOGNIZE THAT IT
THIS IS A COMPLICATED QUESTION
TO MEASURE AND APPRECIATE THAT
WE SHARE THE SAME GOALS SO I
THINK.
YOU KNOW FOR FOR FROM OUR
PERSPECTIVE YOU KNOW WE WE WOULD
LIKE TO BE ABLE TO CONTINUE THAT
CONVERSATION AND REALLY.
FIGURE OUT HOW HOW WE CAN DO
THIS BUT I THINK ONE OF THE
PARTS THAT NOTE TO GET TO WHAT
YOU'RE.
TALKING ABOUT IS IS ACTUALLY IT
IS GOING TO BE PROVIDER.
GROUPS INVOLVEMENT WHICH ONES
ARE IN PART OF THE VALUE EIGHT
SO.
SO BECAUSE INHERENTLY WE MAY NOT
BE A MEASURE ON THE MEL TO GIVEN
THE NUMBER OF PATIENTS PER
PHYSICIAN BUT YOU KNOW THERE'S
CERTAIN POSITIONS OF A VERY HIGH
PERCENTAGE OF PATIENTS IN
DIFFERENT.
YELL AT THE GROUP'S DIFFERENT
SOCIOECONOMIC CLASSES AND SO YOU
DON'T WANT TO DO IS YOU GO BACK
I HAVE A VALUE BASED PACE AND
SAVE SYSTEM AND ALL THE YOU KNOW.
90% OR 80% OF THEM ALL PRACTICE
IN THEM YOU KNOW HELLO THIS IS
NETTA CAL BUT YOU KNOW THERE.
ARE CERTAIN THERE BUT THERE ARE
CERTAIN PARTS OF YOU KNOW
CERTAIN RIGHT AND THAT AND YOU
KNOW ALL THE ONES WHO ARE TO YOU
KNOW ALL THE ONES ARE TAKING A
KERIO WHO ARE IN THE COMMUNITIES
THAT ARE.
YOU KNOW HIGHLY -- NOW AFTER
AMERICAN OR SOMETHING ARE
PARTICIPATING OUR OR OR AREN'T
PERFORMING.
LET'S SAY THAT'S THE OTHER THING
TO BE INCLUDED BUT THEIR QUOTE
NOT PERFORMING IN.
YUP THINK LIKE -- WHAT'S GOING
ON IT IS IT.
IS IT THE WAY WE STRUCTURED THIS
IS IT YOU KNOW WHAT CELL BECAUSE
THAT THAT'S WHERE THE
DISPARITIES MAY SHOW UP TO WE
ALSO UNDERSTAND THAT THERE ARE
DIFFERENCES IN ADOPTION OF EHR
TECHNOLOGY PARTICULARLY FOR YOU
KNOW WHEN YOU'RE GETTING TO THE
INDIVIDUAL PROVIDER LEVEL AND
THE AMOUNT OF TA.
I MEAN.
THAT'S ANOTHER I THINK FOCUS
THAT WE PUT OUT THERE'S YOU KNOW
ARE THERE THINGS THAT WE CAN BE
DOING TO HELP BUILD UP
INDIVIDUAL YOU KNOW CLINICS AND
PRACTICES TO MAKE IT.
EASIER FOR THEM TO COLLECT AND
REPORT THE STATE AS WELL.
YEAH WELL THAT'S SO THAT THE
WHOLE INFRASTRUCTURE ISSUE ON
TOP OF THAT.
OKAY WHOA I THINK WE'RE GOING TO
PAUSE THERE BEFORE WE STRIVE TO
DESIGN THE SYSTEM HERE.
AND WE'LL FINISH SOMETIME
TOMORROW -- SO THANK YOU THANKS
SO MUCH FOR THAT STAKEHOLDER
PROPOSAL OKAY NEXT UP WE HAVE --
THE CALIFORNIA PRIMARY CARE
ASSOCIATION REQUEST VALUE BASED
PAYMENT PROGRAM FOOD FQHCS RURAL
HEALTH CLINICS [inaudible]
WELCOME.
I'M THINKING MISTER CHAIR
OMINOUS TROUBLE AND I'M THE
ASSOCIATE DIRECTOR POLICY OF THE
CALIFORNIA PRIMARY CARE
ASSOCIATIONS -- WE SUPPORT
ADMINISTRATION EFFORT TO CREATE
A VALUE BASED PAYMENT PROGRAM.
THAT WILL INCENTIVIZE PROVIDERS
TO IMPROVE -- CLARITY OF CARE
AND MEETING CERTAIN METRICS THE
PROPOSED BY THE DEPARTMENT
HOWEVER WE HAVE CONCERNS WITH
THE CAR AND TRY TO BE LANGUAGE.
IN THAT IT -- DOES NOT SPECIFY
DOES DOES NOT -- IN.
COMPREHENSIVELY INCLU ALL
PROVIDERS -- MEDICAL PROVIDER IN
THE PROGRAM SO WE PROPOSE
AMENDMENTS SPECIFICALLY -- TO
ENSURE THAT ALL MEDICAL PROVIDER
WILL BE ELIGIBLE TO PARTICIPATE
IN DESK VALUE BASED PAYMENT
PROGRAM.
TODAY ONE PART OF THE MEDIC COW
POPULATIONS ARE COMMUNITY HEALTH
CENTER PATIENTS THESE PATIENTS
OFTEN LIVE IN POVERTY THEY ARE
SICKER AND MORE VULNERABLE
[inaudible]
AND THEY HAVE RELIED ON
COMMUNITY HEALTH CENTERS AS THE
ONLY SOURCE OF CARE.
THESE PATIENTS ARE ENTITLED TO
THE QUALITY CARE INTO ENTITLED
TO THE SAME SERVICES THAT ARE
AFFORDED -- WELL TO AUTOMATIC
HOW -- PATIENCE AND THEY WILL
BENEFIT GREATLY FROM THIS
PROGRAM -- FOR MY RESEARCH -- WE
DIDN'T FILE THEY ARE KNOLL --
SPECIFIC LAW REGULATIONS THAT
PROHIBIT -- COMMUNITY HEALTH
CENTERS FROM PARTICIPATING IN
THIS KIND OF PROGRAM.
SO -- WE ASK THAT WE SUBMIT THAT
THE AMENDMENTS AND WE ASK THAT --
YOU ADOPTED THE CHANGES THAT WE
PROPOSE AND I'M TO THE POINT
THAT YOU TALK ABOUT FAIRNESS AND
EQUITY A THING ONE THIRD OF THE
MEDICAID POPULATION THESE ARE.
THOSE TYPE OF SERVICES AND DATA
PROVIDERS ARE ALSO LOOKING AND
EAGER TO PROVIDE THOSE SERVICES.
THANK YOU [inaudible]
OKAY.
COMMENTS FROM PARKER SERVICES.
NO I MEAN I THINK YOU KNOW.
GIVEN THE DIFFERENT
REIMBURSEMENT STRUCTURES THIS IS
WHY YOU KNOW WE MADE WE MADE
THIS CHOICE AGAIN TO TRY TO HAVE
THE MONEY GO SORT OF AS FAR AS
IT COULD -- THE IT IT IS TRUE
THAT THERE'S NO FEDERAL
PROHIBITION ON ON THIS.
THAT BEING EXTENDED TO TO THE
CLINIC I THINK IT'S IN THE END --
YOU KNOW DECISION BETWEEN THE
LEGISLATURE AND THE GOVERNOR
[inaudible]
OKAY HELLO [inaudible]
FINANCE.
THE PERSON HI.
GEORGE THIS IS YOURSELF FOR THE
RECORD.
WHAT I LOOK FOR MAGIC IS
DEPARTMENT OF FINANCE OKAY
EXCELLENT?
AND OF THAT BEFORE BUT FOR THE
RECORD OKAY -- GIVEN THE
SIGNIFICANT ROLE THAT.
CLINICS PLAY IN MEDIC HOW.
HOW HOW MUCH OF THE PROGRAM CAN
WE HAVE WITHOUT THE CLINICS I
MEAN I ASSUME THAT THAT'S NOT
THE INTENTION RIGHT -- THROUGH I
MEAN IT'S SIMILAR TO THE OTHER
PROP FIFTY SIX SUPPLEMENTAL
PAYMENTS THAT WERE DOING ON THE
PHYSICIANS AND THE DENTIST WE
DID THOSE DO NOT GO TO FQHCS AN
ARTERY SO IT WAS JUST.
REMAINING THE SAME AS AS SORT OF
ENHANCED PAYMENT BEING DIRECTED
AT THOSE PROVIDERS WHO ARE UNDER
A NON PPS REIMBURSEMENT
STRUCTURE [inaudible]
OKAY.
AND ALL RIGHT.
AND SO WHAT YOU'RE LOOKING AT IS.
GETTING IT DONE.
PAYMENTS THROUGH THE VALUE BASED
PAYMENT SYSTEM SO ME PERFORM A
CERTAIN LEVEL BEYOND THE PBS YES
AND IN.
JUST FOR THE RECORD THE PPS WILL
CREATED IN -- TWO THOUSAND TO
PROVIDE THE FINANCIAL --
SAFEGUARD FOR COMMUNITY HEALTH
CENTER. TO TO IN EXCHANGE FOR
THE CONTINUED COMMITMENT TO
PROVIDE SERVICES TO UNINSURED
POPULATIONS AND INTO PPS -- WHEN
IT WAS CREATED IT WASN'T
INTENDED TO CALL OF A THE
SERVICES THAT ARE PROPOSING THAT
THE V. P. PROGRAM?
SEOUL WHEN WHEN TRYING TO LIE --
THOSE SORT OF SERVICES TOGETHER
IT'S IT'S UNFAIR FOR THE FOR THE
PROVIDER AND UNFAIR FOR THE
PATIENTS -- THE MAJORITY OF THEM
ARE A MINORITY AND THE MAJORITY
OF THEM ARE -- LIVING IN POVERTY
AND AND TOLD ME CLEAR THOUGH THE
SERVICES ARE ALREADY REQUIRED
SERVICES TO BE PROVIDED THIS IS
JUST PROVIDING A QUALITY
INCENTIVE PAYMENT SO IT'S NOT
I WOULDN'T I WOULD DISAGREE WITH
THE STATEMENT THAT THE PPS
DOESN'T COVER THE SERVICES THAT
ARE BEING TALKED ABOUT HERE
THESE ARE WELL CHILD VISITS
THESE ARE.
THE CASE MEANT NEO DIABETES CASE
MANAGEMENT SO I JUST I JUST WANT
TO BE CLEAR IT'S NOT THAT.
IT'S NOT PAYING FOR SERVICES FOR
THOSE POPULATIONS IT'S NOT
PROVIDING AN ADDITIONAL
INCENTIVE PAYMENT TO THE
PROVIDER [inaudible]
OKAY.
AT THANK YOU AMERICANS WHO WERE
GONNA HAVE A CALIFORNIA HELPLESS
ADVOCATES AND TOTALLY UNDERSTAND
UNDERSTAND THE CONCERNED COMMENT
AND I WOULD JUST SAY THAT AS YOU
KNOW.
THE DOCTOR PAN YOU WORKED WITH
US PREVIOUSLY ON A BILL AND WE
ALSO WORK WITH THE DEPARTMENT
AND WE THANK THEM FOR THEIR
EFFORTS THROUGH YOU -- TO
CLARIFY SOME INCENTIVE PROGRAMS
AT A HEALTH CENTERS ALREADY DO
PARTICIPATE IN OUTSIDE OF THE
PPS RATE AND ARE ABLE TO
PARTICIPATE IN THOSE PROGRAMS AS
LONG AS THEY'RE NOT -- ALSO
BILLING FOR THAT AND THEY'RE PPS
RATE AND WE WOULD HOPE THAT THIS
WOULD BE A PROGRAM THAT WE COULD
PARTICIPATE IN A SIMILAR MANNER
SO.
OKAY.
YEAH.
DATES OF THESE ARE THE THIS IS
THIS IS A VALUE BASED PAYMENT
MEANING THAT YOU GET A FOR FOR
PERFORMING THEM YOU GET
REIMBURSED FOR THE SERVICE BUT
WE WON'T WE WHAT IF YOU ACHIEVE
A CERTAIN STANDARD THAT'S THE
VALUE PART RIGHT.
AND YOU GET AN ADDITIONAL
PAYMENTS INCENTIVE TO TO DO THAT
OKAY ALL RIGHT [inaudible]
OKAY.
ANY OTHER COMMENTS ON THIS.
OKAY WELL THANK YOU THANKS VERY
MUCH OKAY SO WE'RE GONNA TAKE
PUBLIC COMMENT ON THE VALUE
BASED PURCHASING AND THE TWO
STAKEHOLDER OF PROPOSALS.
WELCOME.
RAIN SPENCER ON BEHALF OF THE
CALIFORNIA ACADEMY OF FAMILY
PHYSICIANS -- THE FAMILY
PHYSICIANS SHARE IN THE DESIRE
TO CHEAP TRUE VALUE BASED.
PAYMENT THAT BESIDES THE CURRENT
AND FUTURE NEEDS OF CALIFORNIANS
TO DO THIS SO WE BELIEVE ANY
BEEP B..
B. B..
BY PAY STATEMENTS PROGRAM SHOULD
AT LEAST HAVE SOME PAULINE --
CONDITIONS REWARD BEHAVIOR OVER
OUTCOMES ALIGN INCENTIVES WITH
EXISTING PROSPECTIVE PAYMENT AND
PEACE PCMH MODELS CONSIDER THE
MERITS OF THE PAPER PERFORMANCE
COULD RELATIVE TO TRUE
PROSPECTIVE PAYMENT.
ENSURE THE TIMING AND SIZE OF
INCENTIVE.
PAYMENTS AND FOR DESIRABLE
BEHAVIOR AT A FAMILY PHYSICIANS
DID PREVIOUSLY SUBMIT COMMENTS
TO THE APARTMENT AND BE HAPPY TO
SHARE THEM WITH THE COMMITTEE AS
WELL AND I'M TRYING TO SAY SAY
V. B. V. B. P. CORRECT SOME
REASON KEPT.
SAYING IT SO THANK YOU RIGHT
OKAY THANK YOU.
WELCOME.
THERE'S ALL THE DOOR WITH THE
CHILDREN'S PARTNERSHIP -- WE'RE
ALSO IN SUPPORT -- WE DO HOPE
THAT -- DH CS ALSO INCLUDES
METRICS TO REWARD PEDIATRIC --
PRACTICES FOR COORDINATION AND
REFERRALS TO COMMUNITY BASED
PROVIDERS MENTAL HEALTH
PROVIDERS AND SPECIALTY CARE
PROVIDERS THANK YOU.
THANK YOU.
WELCOME AT THREE DEGREE GONE ON
BEHALF OF THE FIRST FIVE BILLION
FOR SERVICES YUSHIN IN SUPPORT
OF THE GOVERNOR'S PROPOSAL FOR
THE VALUE BASED PAYMENT PROGRAM.
WE SUPPORT THE DEPARTMENT OF
HEALTH CARE SERVICES INTEREST IN
BUILDING QUALITY IN THE INTO THE
PAYMENT STRUCTURE.
I WOULD ENCOURAGE THE DEPARTMENT
TO CONSIDER ADDITIONAL STEPS TO
STRENGTHEN THE SYSTEM OF EARLY
IDENTIFICATION REFERRALS LINKAGE
TO APPROPRIATE SERVICES AND HIGH
QUALITY INTERVENTIONS THANK YOU.
THANK YOU [inaudible]
WELCOME.
ON BEHALF OF THE CALIFORNIA
MEDICAL ASSOCIATION WE
APPRECIATE -- THE ABILITY TO
PROVIDE COMMENTS AND INPUT INTO
THE THESE NEW THREE INCENTIVE
PROGRAMS -- AND WE LOOK FORWARD
TO HEARING THE RESULTS OF THAT
PROCESS -- AND WE ALSO AGREE
WITH YOU THAT ANY NEW INCENTIVE
PROGRAM SHOULD ALSO ALIGN WITH --
OTHER COMMERCIAL PROGRAM SO THAT
PHYSICIANS ARE MORE EASILY ABLE
TO COMPLY THANK YOU.
THANK YOU.
WELCOME.
LINDA WAY WITH WESTERN SEND
ONLINE POVERTY WE APPRECIATE THE
ADMINISTRATION'S.
PROPOSAL AND ALIGN OUR COMMENTS
WITH THE PEN IN ADDITION THE OF
FQHC PROPOSAL I MAKE SENSE TO US
ESPECIALLY CONSIDERING ONE OF
THE MATRIX IS -- COLOCATION OF
PRIMARY CARE BEHAVIORAL HEALTH
SERVICES THE NOTE ON THAT
COMMUNITY CLINICS -- TO DO THAT
THANK YOU THANK YOU [inaudible]
WELCOME.
RICHARD FRANCIS WITH CHILDREN
NOW CHILDREN NOW SUPPORTS THE V.
B. P. PROPOSAL AND SOMEWHAT WITH
SEVERAL PARTNERS WE'VE ALREADY
MADE SPECIFIC RECOMMENDATIONS TO
TEACH CS ON HOW THEY CAN
STRENGTHEN THEIR CURRENT
PROPOSAL.
WHILE THE PROPOSED VALUE BASED
PAYMENT INCENTIVES ARE VALUABLE
FOR STAFF WE ALSO RECOMMEND THAT
THE DEPARTMENT CONTINUE TO
REFINE AND IMPROVE THESE EFFORTS
OVER TIME TO THAT END WE EXPECT
THE FCS TO CONVENE STAKEHOLDERS
TO BEGIN TO CONSIDER FUTURE
PROPOSALS. FOR VALUE BASED
PAYMENTS THAT WILL ADDITIONALLY
IMPROVE QUALITY OF CARE FOR
CHILDREN AND EXPECTING MOTHER.
THANK YOU [inaudible]
WELCOME.
NO WAY BOTTOMLESS EERILY
FOUNDATION IN SUPPORT OF C.
PENCE PROPOSAL THANK YOU.
THANK YOU WELCOME HI MICHELLE
CUT IT OUT WITH A C. R. U.
CALIFORNIA AND IF YOU WILL --
HUMOR ME I WANT TO KICK OUT AS
WELL A LITTLE BIT ON C. PENS
VALUE BASED PURCHASING PROPOSAL --
WE THINK THAT DATA ISN'T
COLLECTED AS WELL IN TERMS OF
RACE ETHNICITY IN THE MEDICARE
PROGRAM IN ANOTHER HEALTH CARE
PROGRAMS BECAUSE THEY'RE IT
DOESN'T REALLY SERVE A PURPOSE
RIGHT NOW OTHER THAN IN THE
AGGREGATE LIKE CD PH REPORTING
KIND OF SENSE.
BUT WE THINK THERE'S A TON OF
POTENTIAL IF WE WERE TO
INCENTIVIZE AND REALLY DRIVE
DATA COLLECTION TOWARD AN END I.
E..
DISPARITIES REDUCTION THAT WE
COULD.
KIND OF DO BOTH THINGS WE COULD
WE COULD GET THE DATA WE NEED
AND THEN START TO DRIVE FOR
MEANINGFUL CHANGE THIS IS REALLY
ABOUT MOVING FROM THE TRIPLE
AIMS TO THE QUADRUPLE AIMS RIGHT.
AND IN CALIFORNIA WE ARE SO
LUCKY -- YOU KNOW I STUDIED THIS
LITTLE BIT TOO AND I SAW THAT IN
MASSACHUSETTS THEY TRIED
SOMETHING SIMILAR BUT THEY
DIDN'T HAVE ENOUGH PEOPLE OF
COLOR TO DO IT.
WE HAVE AN OVER REPRESENTATION
OF PEOPLE OF COLOR IN MEDIC HAL
AND SO JUST FROM A SORT OF A
NUMBERS PERSPECTIVE WHAT WE
COULD DO POTENTIALLY TO TO TRY
TO FIGURE OUT WHAT'S WORKING AND
WHAT'S NOT BUT IS IS IS
IMPORTANT AND IT'S EVEN MORE
MEANINGFUL IN A PROGRAM.
THAT'S OVERWHELMINGLY PEOPLE OF
COLOR AND SO WE THINK IT'S WORTH.
THE EFFORT TO TRY TO TAKE IT TO
THAT NEXT LEVEL TO EXPLORE WHAT
VB P. PROGRAM AROUND DISPARITIES
PRODUCTION MIGHT LOOK LIKE.
IN MEDIC COW -- CAL COVERED
CALIFORNIA WHICH IS MUCH SMALLER
OBVIOUSLY HAS STARTED A DOWN
THIS PATH HAD MAY HAVE SOME
LESSONS LEARNED FOR US BUT WE
WOULD ENCOURAGE YOU TO CONSIDER
APPROVAL OF THAT PROPOSAL.
THANK YOU.
I APPRECIATE THAT OBSERVATION
AND I THINK.
I THINK I THINK IT'S MORE ABOUT
HOW WE GO ABOUT DOING IT THEN.
WHETHER WE DO IT OR NOT SELL.
THAT OKAY WELL APPRECIATE THE
PUBLIC COMMENT AT JUST THE ONE
OTHER QUESTION THEN -- WILL SO
YOU'VE HEARD A LOT OF YOU GOT
LOT OF SUBMITTED COMMENTS IT'S A
WIN WIN DO WE WHEN DO YOU EXPECT.
TO COME UP WITH THE FINAL
PROPOSAL -- MET.
SO I HAVE NOT GOTTEN IT FROM MY
TEAM AT SOCCER SO IT'S GOING TO
PROBABLY BE AT LEAST A COUPLE OF
WEEKS I WOULD SAY BECAUSE
OBVIOUSLY WE NEED TO SHARE IT.
IN THE ADMINISTRATION BUT I AM A
I BELIEVE IT'S COMING TO ME SOON
SO HOPEFULLY E CAN GET THAT OUT
PRETTY QUICKLY.
OKAY SO.
FEW WEEKS HE SAID I THINK SO
OKAY ALL RIGHT IF I'M TOTALLY
WRONG I'M SURE SOMEONE'S GOING
TO TEXT ME AND BE LIKE YOU
SHOULDN'T HVE SAID THAT BUT AND
A LOT'S GOT NO THAT I WAS WRONG.
I AM.
I THINK THAT'S RIGHT I BELIEVE
I'M SUPPOSED TO BE GETTING IT
LIKE TOMORROW OKAY ALL RIGHT SO
SO IN FEW WEEKS WE SHOULD YEAH
BECAUSE YOU KNOW I GOT IT OKAY.
WITH MY COLLEAGUES.
SHARE WITH US.
TO OKAY.
I KNOW ALL RIGHT OKAY ALL RIGHT
WELL I I THINK THE OTHER THING I
WAS ME NO NINETIES ON A COMMENT
ABOUT THIS IS THAT YOU KNOW THIS
IS THE START OF SOMETHING AND SO
I REALIZE AND BELIEVE ME I CAN
COME WITH A LOT MORE MEASURES
AND SO.
FORTH LET'S START WITH -- SAID
DOOM WELL SEE HOW IT GOES AND
THEN WE SHOULD THERE'S MANY
OTHER WORTHY MEASURES OTHER
THINGS AND WE CAN BUILD ON THAT
AND CERTAINLY HOPE THAT THERE
WILL BE AN ON GOING PROCESS I
MEAN.
WE WE HAVE TO GET THIS ONE
STARTED FIRST WHERE -- IT'S THIS
PROVES SUCCESSFUL -- AND I KNOW
WHAT THE FUSES TOO MUCH OUT SO
THAT WE CAN TEST HOW SUCCESSFUL
WE CAN BE WITH THIS AND THAT AND
FIGURE OUT HOW.
WE CAN SHOW WE CAN DO THIS WITH
THE MEASURES THAT YOU HAVE THEN
BUILD OUTS BECAUSE CERTAINLY
DOES MANY OTHER MEASURES MANY
OTHER ISSUES THAT COME UP AS
WELL.
AND THEN -- BE ABLE TO BUILD ON
THAT SO [inaudible]
OKAY.
I THANK YOU.
ALL RIGHT -- THEY WERE VERY
EXCITED ABOUT IT.
ALL RIGHT -- ISSUE NUMBER ELEVEN
DEVELOPMENTAL AND TRAUMA
SCREENING.
SO AS PART OF THE JANUARY BUDGET
THEY GOT TALKING TO A
PEDIATRICIAN YEAH IT IS A
PROPOSING -- MED IS SCREENINGS
FOR PAYING ESSENTIALLY
SEPARATELY FOR DEVELOPMENTAL AND
TRAUMA SCREENINGS -- TODAY IN
THE FEE FOR SERVICE WORLD THE
DEVELOPMENTAL SCREENING IS A
BILLABLE SERVICE -- IN MANAGED
CARE THE LIKELIHOOD IS IT'S NOT
SEPARATELY PAID FOR IT IT'S PAID
AS PART OF THEIR CAPITATION OR
OR OR OR WHATEVER ELSE THERE
HOWEVER ELSE THEY'RE PAID.
SO THIS WOULD REQUIRE IN THE
MANAGED CARE SIDE A NEW DIRECTED
PAYMENT SO THAT TO THE DEGREE OF
PROVIDER DOES -- NOTE IN IT
THEIR ENCOUNTER THAT THEY
PROVIDED THE DEVELOPMENTAL
SCREENING OBVIOUSLY IN.
IT HAS TO BE IS PART OF THE
NORMAL BRIGHT FUTURES IS GAY OR
NOT JUST ANY HI OR THAT THEY
WOULD RECEIVE THE ADDITIONAL
PAYMENT AND THEN SIMILARLY.
ON THE TRAUMA SCREENING SIDE
OBVIOUSLY THIS IS A LITTLE NEWER
IN TERMS OF THE DIFFERENT TOOLS
THAT ARE OUT THERE -- WE DID
HAVE THE EIGHTY THREE FORTY
WORKGROUP -- RECOMMENDATION TO
USE THE PEARLS TOOL FOR CHILDREN --
AND SO WE ARE WE WE ARE MOVING
FORWARD WITH THAT OBVIOUSLY WE
ARE VERY FORTUNATE TO HAVE A
SURGEON GENERAL WHO IS VERY WELL
VERSED IN IN IN CHILDHOOD TRAUMA
ISSUES AND TOXIC STRESS AND SO
SHE'S.
PROVIDING US A LOT OF GUIDANCE --
AS WE LOOK AT HOW DO WE YOU.
SORT OF GET THIS OUT OF THE DOOR --
FOR ADULTS THE THE SCREENING
WOULD BE THE ASUS TOOL WHICH IS
THE YOU KNOW SORT OF THE
STANDARD THAT WAS FROM THE
KAISER STUDY MANY YEARS AGO --
AND AND REALLY WE WE BELIEVE IN
AND YOU KNOW THE GOVERNOR AND
WANTING TO DO THIS REALLY
EMPHASIZING -- EARLY CHILDHOOD
AND JUST THE NEED TO BETTER
IDENTIFY THE NEED THAT WHAT
NEEDS PEOPLE HAVE -- SPEAKING AS
SOMEONE WHO HAS EXPERIENCE WITH
THIS I THINK -- YOU KNOW FOR FOR
PATIENTS THAT NOT HAVING TRAUMA
IDENTIFIED APPROPRIATELY LEADS
TO MISDIAGNOSES ON A MENTAL
HEALTH SIDE IT LEAVE IT AT DOES
THAT HELP TODAY AND EXPLAIN WHY
THERE'S CHRONIC DISEASE THAT'S
HAPPENING IN IN THE BODY AND SO
WE'RE REALLY EXCITED ABOUT THIS.
WE DO RCOGNIZE A COUPLE OF
THINGS THAT THAT I WOULD FLAG --
ONE AND I KNOW THERE'S A
STAKEHOLDER PROPOSAL WE ARE
THINKING ABOUT HOW CAN WE MAKE
SURE PROVIDERS ARE APPROPRIATELY
TRAINED ON THE TRAUMA SCREENINGS --
GIVEN THAT IT ISN'T NEW IT'S NOT
SOMETHING THAT'S IT YOU KNOW.
IT'S NOT SOMETHING THAT'S
TYPICALLY DONE TODAY SO THAT OF
COURSE THAT NEEDS TO BE DONE IN
A WAY THAT SENSITIVE AND UNDER
YOU KNOW.
THAT THE FAMILY UNDERSTANDS
WHAT'S GOING ON AND THEN YOU
KNOW RECOGNIZING THAT IF THE
SCREENING IS LITTLE BALD LIKELY
IDENTIFY GAPS IN AVAILABLE
SERVICES FOR PEOPLE AND SO HOW
DO WE THEN TAKE THIS INFORMATION
AND USE IT TO MAKE SURE THAT
THAT PEOPLE ARE GETTING THE
SERVICES THAT THEY NEED.
BUT WE DO THINK THIS IS AN
IMPORTANT FIRST STEP IN ORDER
FOR US TO IDENTIFY WHAT WHAT
THOSE NEEDS ARE.
THANK YOU COLLEGE MILIEU.
YEAH RYAN ANDERSON WITH THE
LEGISLATIVE ANALYST'S OFFICE --
I HAVE A A FEW -- COMMENTS ARE
SPECIFIC TO THE DEVELOPMENTAL
SCREENING SOME OF THESE WILL
ALSO APPLY TO THE TRAUMA STRUM
SCREENINGS.
BUT WHO FIRST START WITH -- OUR
OFFICE AGREES WITH THE
ADMINISTRATION AND IDENTIFYING I
CALIFORNIANS ACTUALLY REQUIRED
TO IDENTIFY AND PROVIDE EARLY
INTERVENTION SERVICES ALL
INFANTS AND TODDLERS THAT HAVE
SIGNIFICANT DEVELOPMENTAL DELAYS
BUT RESEARCHERS -- SUGGESTS THAT
AS FEW AS ONE OUT OF FIVE
ELIGIBLE CHILDREN ARE CURRENTLY
BEING I IDENTIFIED AND SERVED
WITH IN THE STATE.
OUR OFFICE HAS SPENT THE LAST
SEVERAL YEARS -- DIVING INTO
THIS AND OTHER ISSUES IN EARLY
INTERVENTION IN SPEAKING WITH
PARENTS AND PROVIDERS AND
RESEARCHERS ACROSS THE STATE --
THE LACK OF DEVELOPMENTAL
SCREENINGS RARELY COMES UP AS A
PRIMARY REASON WHY WE'RE NOT
SERVING ALL ELIGIBLE CHILDREN.
AMONG THE REASONS THAT WE
COMMONLY HERE ARE THAT.
SOME PARENTS COULD DISCOURAGE
SOMEWHERE BETWEEN -- THE WELL
CHILD VISIT AT WHICH THERE
THEY'D RECEIVE A SCREENER AT
THAT IDENTIFIES SOME ISSUES.
AND I'M GOING TO THE FORMAL
PROCESS OF BEING DETERMINED
ELIGIBLE FOR EARLY INTERVENTION
SERVICE AT REGIONAL CENTERS SAID.
VARIES ACROSS THE STATE THE
EXACT PROCESS BUT IS OFTEN.
COMPLEX AND DIFFICULT TO
NAVIGATE FOR PARENTS WHO ARE NEW
TO THIS OR EVEN ONCE A PARENT
HAS -- SUCCEEDED IN GETTING THE
URGE CHILD IDENTIFIED IS
ELIGIBLE -- PARENTS OFTENTIMES
GET DISCOURAGED BECAUSE THEY'RE
NOT ABLE TO FIND A PROVIDER --
PARTICULARLY PROVIDERS ARE
WILLING TO ACCEPT MEDICARE ALL
RATES.
AND PARTICULARLY PROVIDERS WHO
ARE WILLING TO SERVE THE CHILD
IN THEIR NATURAL ENVIRONMENT
MEANING TEIR HOME WHICH IS NOT
ONLY OF COURSE CONVENIENT FOR
PARENTS BUT ALSO.
REQUIRED BY FEDERAL LAW AS
DEVELOPMENTALLY APPROPRIATE --
SO IN ADDITION TO SOME OF THE
GENERAL COMMENTS WE'VE GIVEN TO
OTHER ASPECTS OF THE PROPOSITION
FIFTY SIX PACKAGE TO THE
QUESTION OF WHETHER SUPPLEMENTAL
PAYMENTS ARE COST EFFECTIVE.
OPTIONS PARTICULARLY GIVEN THE
MOVE SOMEWHERE MAKING TO
INCREASE ENFORCEMENT OF CURRENT
CONTRACTS WHICH INCLUDE A
REQUIREMENT THAT THESE
DEVELOPMENTAL SCREENINGS BE
PROVIDED.
AS PART OF A WELL CHILD VISIT.
WITH AND TO THINK THAT THERE RE
OTHER OPTIONS THAT WOULD BE MORE
EFFECTIVE AT IDENTIFYING AND
SERVING MORE ELIGIBLE CHILDREN --
WE LAY THOSE OUT IN OUR RECENT
BUDGET ANALYSIS BUT AS ONE
EXAMPLE WE COULD OFFER
SUPPLEMENTAL PAYMENTS
SPECIFICALLY TO PROVIDERS WHO
ARE WILLING TO PROVIDE SERVICES
IN THEIR NATURAL ENVIRONMENT
SAYS FEDERAL LAW SUGGESTS THEY
SHOULD -- ONE ADDITIONAL THOUGHT
IS THE GIVEN THE LARGE
POPULATION OF CHILDREN WHO ARE
LIKELY ELIGIBLE FOR THESE
SERVICES THAT ARE NOT CURRENTLY
BEING SERVED.
WE SHOULD BE THINKING AS PART OF
ANY STRATEGY TO IDENTIFY AND
SERVE MORE CHILDREN HOW WE'RE
GOING TO ACCOMMODATE THAT NEED --
LIKELIHOOD IS THAT IF WE DID
IDENTIFY AND SERVE ALL CHILDREN
THAT ASSOCIATED COSTS ON THE DDS
SIDE OF THE BUDGET.
WHO WOULD INCREASE BY HUNDREDS
OF MILLIONS OF DOLLARS THAT'S
NOT ACCOUNTED FOR IN THE
GOVERNOR'S BUDGET?
AND WE ALSO KNOW THAT RIGHT NOW
WITH THE CURRENT POPULATION WERE
SERVING OVER EXPERIENCING --
NOTABLE PROVIDER SHORTAGES
PARTICULARLY IN CERTAIN AREAS OF
THE STATE.
IN AN INTERESTING THOSE MIGHT
REQUIRE SOME UP FRONT --
EXPENDITURES FROM THE STATE AND
THOSE COULD EASILY BE WITHIN
THAT TENS OF MILLIONS OF DOLLARS
ON THIS EARTH [inaudible]
FINANCE [inaudible]
COMMENTS OKAY.
WELL -- CERTAINLY -- I AGREE
THAT -- WE BUY A LOT OF I MEAN
FOR THE REASON WE'RE PROPOSING
THAT'S BEING THIS IS BEING
PROPOSED BY THE GOVERNOR AND IS
BECAUSE WE'RE PROBABLY UNDER
DIAGNOSED SAYING -- AND ANYWAYS
I THINK WHEN IT COMES TO
DEVELOPMENTAL SCREENING.
IF YOU THINK OF IT ALWAYS
SERVICE FROM A MORE INFORMAL
PROCESS.
AND THEY ALSO THE PEDIATRICIAN
AND WE HAD THE THE DENVER A
DENVER TO WHICH ACTUALLY IS. TO
OKAY IT DOESN'T REALLY WORK AND
YOUNG A YES NO AND WHAT TIME DID
YOU WALK IN ROLL OVER AND SO
FORTH -- TO DOING MORE FORMAL
MORE VALIDATE SCREENINGS -- AND
THOSE SCREENINGS ARE MORE
STRUCTURED -- SOMETIMES THEY MAY
TAKE MORE TIME.
AND FRANKLY -- SOME OF THEM AND
THEY ALL DO DIFFERENT TO THE
PEOPLE WHO WORKED VERY HARD TO
DEVELOP THEM AND VALIDATE THEM
AND SO FORTH SOMETIMES EVEN
CHARGE MONEY FOR THEM RIGHT
SOMEONE THAT'S INTELLECTUAL
PROPERTY.
RIGHT BUT BUT THE REASON -- SO
USEFUL BECAUSE SOMEONE TO DO ALL
THAT WORK TO VALIDATE AND SO
FORTH AND I THINK AS WE'VE MOVED
FORWARD IT'S BEEN A CHALLENGE
FOR PEDIATRICIANS AND OTHER
PHYSICIANS TO TAKE CARE OF
CHILDREN. TO SAY WELL WE'RE
GONNA USE THE LATEST TECHNOLOGY
MEANS WHAT IT IS IT'S NOT A
COMPUTER SOMETHING TECHNOLOGY --
IT'S COSTING MORE IT'S CAUSING
MORE TIME IS BECAUSE WE HAVE TO
PAY THE LICENSING FEES AND STUFF
LIKE THAT TO TO USE THESE TOOLS
AND SO -- I APPRECIATE THAT THE
GOVERNOR'S PUTTING SOME MORE
FUNDS INTO THAT SO THAT WE CAN
ALLOW ALL CHILDREN TO BE ABLE TO
HELP SCREENS NOW THE CONSEQUENCE
OF THAT IS AN HOUR GOING DOWN TO
FIND MORE CHILDREN WE ME
HOPEFULLY WITH THE FIVE MORE
ACTUALLY.
TOO AND WHAT YOU DO WITH ALL OF
THEM RIGHT SO THE PROCESS WE
HAVE THEN OF THE DRESSING THAT
YOU KNOW GETTING THEM IN EARLY
INVENTION TO REGIONAL CENTERS.
GETTING TO OUR SCHOOL DISTRICTS
BY THE WAY -- SO.
WE'VE HAD DISCUSSION AROUND
SPECIAL EDUCATION RIGHT MOST
PEOPLE DON'T KNOW SPECIAL IT
STARTS AT THREE YEARS.
NOT SCHOOL ROMAN THREE YEARS OLD.
OKAY AND RIGHT NOW WE DON'T EVEN
PAY OUR SCHOOL DISTRICTS FOR
THREE YEAR OLDS.
TELL THOSE IT IS ADDED TO JUST
GETS ADDED TO THEIR SPECIAL ED
BUDGET OR SO THAT'S ON THE
SCHOOL DISTRICT SITE AND THEN
OUR COURSE OF GOVERNMENTAL
CENTERS SO.
CERTAINLY I THINK THAT'S
SOMETHING WE'RE GOING TO NEED TO
TACKLE I APPRECIATE LA --
BRINGING THAT UP IT MAY HAVE
SOME SERIOUS BUDGET --
IMPLICATIONS BUT AT THE SAME
TIME I'M NOT SURE I WANT TO SIT
AND THEN NOT LOOK RIGHT SO YEAH
BECAUSE THE ALTERNATIVE SAY WELL
YOU KNOW WHAT. OH MY GOD YOU
KNOW SWEDES WON'T LOOK AND THEN
WE WON'T KNOW THAT WE COULD
PRETEND LIKE NOTHING'S GOING ON
AND BUT BUT THE PROBLEM IS IT'S
NOT BECAUSE IF IT ISN'T IT.
SOMETHING IS GOING ON JUST
HAPPENS WE DIDN'T SEE IT BECAUSE
WE DIDN'T WANT TO LOOK THAT WAY
AND I THINK I'M NOT SURE THAT'S
THE RIGHT ANSWER EITHER I KNOW
THAT SOMEBODY APPLYING I THINK
YOU'RE.
YOU'RE JUST GIVING US THAT
YOU'RE LOOKING AND GIVING US A
HEADS UP LIKE OKAY THIS IS THE
IMPLICATION OF THAT AND WE'LL
WALK INTO THIS.
AND THEN I THINK YOU KNOW THIS
LEGISLATION GOVERNOR WILL HAVE
TO WORK TOGETHER AND FIGURE OUT
HOW WHAT WE'RE GONNA DO.
AND AND TO DO THIS AND MAYBE
THERE'S A THERE MIGHT BE SOME
MORE EFFICIENT WAYS OF DOING
THINGS AS WELL THAT WE CAN LOOK
INTO ETCETERA.
BUT I THINK WE FIRST GOT TO KNOW
WHAT THE FIND THE SIZE OF THE
PROBLEM FIRST AND WITH THAT WE
NEED TO MEASURE IT AND I
APPRECIATE THE GOVERNOR
PROPOSING THAT WE ACTUALLY --
THAT IF I MEASURE -- FOR THIS IS
AS IMPORTANT FIRST STEP YES.
YEAH AND WE DO APPLIED THAT
EFFORT -- TO TO DO BETTER AND
IDENTIFYING A ONE OF ONE OF THE
ISSUES THAT DOES ARISE THROUGH A
MANAGED CARE PLANS AS WE DON'T
WE DON'T PAY FOR THE INDIVIDUAL
SCREENING AND LIKE WE WOULD IN
THE FEE FOR SERVICE ENVIRONMENT
AND THAT RESULTS IN DATA GAPS IN.
IN THE NUMBER SCREENINGS THAT
ARE ULTIMATELY REPORTED WE
WORKED WITH THE DEPARTMENT TO
TRY TO UNDERSTAND TO WHAT EXTENT
ARE DEVELOPMENTAL SCREENINGS
OCCURRING TODAY AND I DON'T
THINK THAT THEY HAD GOOD DATA.
THAT COULD ACTUALLY ANSWER THAT
QUESTION SO WE HAVE A WE DON'T
KNOW WHETHER OR NOT WE'RE
CURRENTLY SCREENING 50% OF KIDS
90% OF KIDS AND SO FORTH.
SO IT IT IS A IT IS A PROBLEM
HOWEVER I WOULD JUST NOTE THAT
THE THE EXPANSION IN THE
OVERSIGHT OF MANAGED CARE
INCLUDES A SPECIFIC -- DATA
MEASURE ON APPROPRIATE
DEVELOPMENTAL SCREENINGS
OCCURRING BY AGE THREE SO AND TO
THE EXTENT THAT MANAGED CARE
PLANS WOULD NOT MEET THAT --
THEY COULD BE SUBJECT TO CAP --
TO A CORRECTIVE ACTION PLAN OR
SANCTIONS SO WE DO THINK THAT
THERE ARE -- ADDITIONAL EFFORTS
THAT ARE OCCURRING THAT COULD
SOLVE THIS IN A MORE EFFECTIVE A
COST OF OF MANNER.
THANK YOU AND I WOULD MAKE A
NOTE -- THAT I WOULD THINK THAT --
FOR THIS PAYMENT -- WE NEED TO
HAVE FAIRLY WELL DEFINED
CRITERIA SO THE PROBLEM IS WE
SAVE YOU DON'T KNOW WHAT
PERCENTAGE OF PEOPLE BEING
SCREEN I'LL TELL YOU THE
QUESTION.
THE REAL QUESTION IS IS THAT TO
WHAT LEVEL SCREENING.
RIGHT SO EVERYONE OF ACCESS TO A
PEDIATRICIAN VISIT HAS BEEN
DEVELOPMENTALLY SCREENED
QUESTIONS IS IT -- THE
EVERYTHING LOOKS OKAY AND WHAT
YOU COULD WALK AROUND WHICH IS A
LEVEL DEVELOPMENTAL SCREENING
FOR YOUR AGE AND ALL.
HE DEVELOPED THE EYE FOR THAT
BUT IT'S BUT THAT'S NOT WHAT
WE'RE TALKING ABOUT HERE WE'RE
TALKING ABOUT US MORE FORMALIZED
VALIDATED.
RIGHT SO AT THAT LEVEL SCREENING
WHAT PERCENTAGE THAT THEN SEARCH
RANKING RIGHT SO AND I THINK
THAT'S THE EXPECTATION I PRESUME --
FOR TO RECEIVE A PAYMENT I THINK
THAT'S THAT'S CORRECT AND WE'RE
STILL FINALIZING POLICY ON HOW
WE WOULD TRACK BOTH THAT BEING
TRUE ON BOTH THE DEVELOPMENTAL
SIDE AND THE DRAMA OUTSIDE RIGHT --
TO MAKE SURE AGAIN THAT.
WHOEVER'S THAT THAT THEY'RE
GIVING AN APPROPRIATE SCREENING
AND THAT THEY ARE DOING IT
APPROPRIATELY.
RIGHT I MEAN AGAIN I THINK AS I
THINK YOU KNOW I THINK ON THE
DRAMA SIDE IN PARTICULAR RIGHT
IT'S CAN TRIGGER PROBLEMS IF YOU
JUST ASK QUESTIONS IN A CALLOUS
WAY SO -- MAKING SURE THAT THE
RIGHT QUESTIONS AND THAT THAT
THAT PEOPLE KNOW HOW TO DO THAT
SO THAT IS WHAT WE'RE STILL
LOOKING AT IS HOW DO WE IN AGAIN
WE'RE WORKING WITH THE SURGEON
GENERAL AND ON BOTH THESE
PROPOSALS. TO MAKE SURE THAT IN
THE END IT'S IT'S ACCOMPLISHING
WHAT WE WANT WHICH IS
APPROPRIATE SCREENINGS HAPPENING
APPROPRIATELY.
WELL IN SOME SENSES AND WE JUST
CAME OUT THIS GUY SING ABOUT
VALUE BASED PAYMENT WHAT WE
WANNA DO IS WITH THESE PAYMENTS
BUT ALSO WITH THE STANDARDS
ASSOCIATE OF CHANGE THE CULTURE.
RIGHT AND IT'S NOT JUST ABOUT
THE DOCTORS AND THEIR STAFFS IT
ALSO BECOMES ABOUT THE PATIENT'S
RIGHT SO.
IF IT BECOMES ROUTINE FOR
EVERYBODY THEN IT'S NOT LIKE
WELL YOU JUST ASKING ME BECAUSE
YOU THINK SOMETHING'S GOING ON
IN MY FAMILY RIGHT NOW IT'S LIKE.
EVERYBODY WHO GOES -- YEAH I
THEY ASKED ME THAT TOO IN THE
BOX OFFICE THEY ASK ME THAT TO
THE DOCTOR'S OFFICE.
THIS IS WHAT'S NORMALLY SUPPOSED
TO HAPPEN RIGHT AND AND THE ONLY
THING I WOULD ADD IS THAT WE WE
DID TRY TO CONSIDER THE THE THE
PROPERLY EVALUATING QUESTION
WHEN WE WERE.
CONDUCTING OUR ANALYSIS AND IT
DOES IT IS OUR UNDERSTANDING
AMERICA CORRECT ME IF -- IF IF I
AM WRONG BUT THE CURRENT
CONTRACTUAL REQUIREMENTS ON
MANAGED CARE PLANS REQUIRE USING
AN APPROVED -- USING ONE OF THE
RECOMMENDED TOOLS.
SO HOPEFULLY WE'LL LOOK INTO NOW
BRIGHT FUTURE SAYS SOME GOOD
GUIDELINES BUT SOME THAT HAS TO
BE SOME VERY SPECIFIC TOOLS AT
THIS.
PARTICULAR AGES THAT WOULD
TRIGGER THIS OKAY WE MIGHT NEED
TO REACH OUT TO YOU TO GET SOME
INSIGHT SINCE NO.
ONE HAPPY TO TALK ABOUT FOR ME
THERE YOU GO ALL RIGHT.
I'LL BE HAPPY TO MEET YOU IN THE
OFFICE.
OKAY.
ALL RIGHT OKAY.
AND MYSTICAL PROPOSALS.
AND WE OKAY WE DO HAVE A
STAKEHOLDER PROPOSAL REGARDING
FOR FIGHTER TRAINING FROM THE
CALIFORNIANS FOR SAFETY AND
JUSTICE IN THE CALIFORNIA WELL
FOR DIRECTORS ASSOCIATION.
WELCOME AND THANK YOU DOCTOR PAN
FRANK MECCA WITH THE COUNTY WILL
FOR DIRECTORS ASSOCIATION ALSO
HERE ON BEHALF OF JOHN POWDERS
OF CALIFORNIANS FOR SAFETY AND
JUSTICE.
ARE ORGANIZATIONS CO SPONSORED A
B. THREE FORTY WHICH HAS BEEN
DISCUSSED ALREADY AND WAS LAID
OUT IN YOUR AGENDA.
OBJECTIVELY -- WE'RE REALLY --
PLEASED TO BE HERE AND WE'RE
REQUESTING AN AUGMENTATION
ONETIME AUGMENTATION FOR
PROVIDER TRAINING IN DATA
COLLECTION -- THAT'S ACTUALLY
BEEN DISCUSSED ALREADY --
LEADING UP TO THE REQUEST FOR
ASKING FOR FIFTEEN MILLION
DOLLARS ON A ONE TIME BASIS.
WE HAVE TO THANK THE DEPARTMENT
OF HEALTH CAR SERVICES FOR THE
WORK THEY DID LEADING THAT THE A
B. THREE FORTY WORKING GROUP.
AS A MEMBER OF THE WORKING GROUP
AND AS A SPONSOR OF THE BILL
THAT THEY DID EXCELLENT WORK
WE'RE INCREDIBLY PLEASED THAT
THE GOVERNOR DECIDED TO
IMPLEMENT THE RECOMMENDATIONS OF
THE WORK GROUP AND TO PROVIDE
THE FUNDING. TO REIMBURSE
PROVIDERS OFFER DOING THE
SCREENINGS THE MEMBERS OF THE
WORKGROUP FEEL REALLY STRONGLY
THAT TRAINING AND DATA
COLLECTION REALLY CRITICAL. FOR
THE REASONS THAT MISS CAVELL
ALREADY LAID OUT -- SO WE'RE
LOOKING FORWARD TO CONTINUING TO
WORK WITH THE ADMINISTRATION AS
A CONTAINER TO CONTINUE. TO
PONDER THESE ISSUES AS WELL --
AND I'M AVAILABLE FOR ANY
QUESTIONS IF YOU HAVE ANY.
THANK YOU HE COMES FROM THE
AGENCY.
HELLO THE FOR THE COMMENTS
FINANCE.
OKAY APPRECIATE IT -- CERTAINLY
WE CAN EXPECT HE'LL DO THINGS
NOT TEACH THEM HOW TO USE THE
TOOLS OF THEIR SUPPOSED TO USE.
IT SCREENINGS HAPPENING
APPROPRIATELY TERRY GO EXACTLY
EXCELLENT I'M GOING TO USE THAT.
WITH THAT TRADITION.
ALL RIGHT PUBLIC COMMENT.
ON THE NO WAY WITH WESTERN
CENTER ON LAW AND POVERTY WE
SUPPORT THE ADMINISTRATION'S
DEVELOPMENTAL AND TRAUMA
SCREENING PROPOSAL AS WELL AS C.
W. D. A.'S DATA COLLECTION OF
BOTH AND SHOULD PROVIDE A
TRAINING PROPOSAL THANK YOU
THANK YOU.
WELCOME.
SELLING OF OUR WITH THE
CHILDREN'S PARTNERSHIP ALSO IN
STRONG SUPPORT -- WE WOULD LIKE
TO ALSO RECOMMEND -- THAT A
COMPLIMENTARY INVESTMENT ME DONE
WITH FOLLOW UP TO THE SCREENING --
JUST TO BE MINDFUL ABOUT THAT
SECOND PIECE AS WAS DISCUSSED --
AND THEN WE'RE ALSO HAPPY TO
DISCUSS INNOVATIVE MODELS ON HOW
TO GET KIDS TO CARE [inaudible]
THANK YOU.
WELCOME WAS ON FRANCIS WHICH
CHILDREN NOW ALSO IN SUPPORT OF
THE GOVERNOR'S PROPOSAL ANC
WTA'S PROPOSAL FOR AN ADDITIONAL
INVESTMENT WE ALSO WANT TO
HIGHLIGHT THE NEED TO LINK
PROVIDERS WITH RESOURCES IN THE
COMMUNITY SO AS THEY SCREAM AND
THINGS.
MAY COME UP POSITIVE THEY KNOW
WHERE TO SEND PATIENTS AND THEIR
FAMILIES THANK YOU THANK YOU.
WELCOME.
GOOD AFTERNOON MY NAME IS A
FORMER TEST BY -- ON BEHALF OF
THE CENTER FOR YOUTH WELLNESS WE
ARE ALSO IN SUPPORT OF THE ASUS
GREEN PROPOSAL OR WANT TO STRESS
THE NEED FOR PROVIDER TRAINING.
AS WELL AS GUIDANCE AS WE THINK
ABOUT MAKING SURE THAT FAMILIES
ALL -- HAVE THE SUPPORT AND CARE
COORDINATION THAT THEY NEED AS
WE ROLL OUT THIS PROGRAM IT'S
IMPORTANT THAT THERE IS
SUCCESSFUL ADOPTION INSISTED
SUSTAINABILITY OF IT.
THANK YOU.
WELCOME MICHELLE GALLONS OF THE
COUNTY HEALTH EXECUTIVES
ASSOCIATION OF CALIFORNIA HERE
TO SUPPORT THE ADMINISTRATION'S
AS SCREENING PROPOSALS AND ALSO
TO JUST SAY THAT I'M OUR MEMBERS
FROM THE PUBLIC HEALTH
PERSPECTIVE LOOK FORWARD TO
HAVING AN ENGAGING IN A
CONVERSATION ABOUT WHAT HAPPENS
NEXT.
OKAY THANK YOU WELCOME.
AT THREE DEGREE GONE ON BEHALF
OF FIRST FIVE WE ARE IN SUPPORT
OF THE GOVERNOR'S PROPOSAL FOR
DEVELOPMENTAL SCREENINGS EARLY
IDENTIFICATION OF DEVELOPMENTAL
DELAYS THROUGH SCREENING AS THE
FIRST STEP. TO CONNECTING
CHILDREN WITH THE SUPPORTS THEY
NEED FOR OPTIMAL DEVELOPMENT AND
THIS ENSURES THAT EACH CHILD HAS
THE OPPORTUNITY TO REACH HIS OR
HER FULL POTENTIAL.
WE WOULD ALSO ENCOURAGE THE
DEPARTMENT TO ENGAGE WITH EARLY
CHILDHOOD ACES AND BEHAVIORAL
HEALTH EXPERTS TO INCLUDE
RECOMMENDATIONS.
ON APPROPRIATE SCREENING TOOLS
AND GUIDELINES FOR CHILDREN
BIRTH THROUGH THROUGH FIVE THANK
YOU.
THANK YOU.
WELCOME.
WE WENT TO DINNER WITH WITH THE
CALIFORNIA PAN ETHNIC HEALTH
NETWORK WERE ALSO SUPPORTIVE OF
THE GOVERNOR'S PROPOSAL AND
STAKEHOLDER PROPOSAL AND WE
WOULD JUST REQUESTS THAT THE
PROVIDER TRAINING ALSO INCLUDE
AN IMPLICIT BIAS COMPONENT.
THANK YOU THANK YOU.
ALL RIGHT THANKS VERY MUCH -- I
AM KEEPING IN THE BACK OF MY
MIND -- WAS GIVEN THAT SUCH A
DELAY -- COMMENT -- THAT SINCE
THE SUBCOMMITTEE ALSO OVERSEES
DEPARTMENT SOCIAL SERVICES AND
DEVELOPMENTAL CENTERS.
IT'S NOT THAT IT.
IT'S IT'S DEFINITELY IN MIND --
BUT AS A IS THIS A SAID BEFORE
AND SO THANK YOU THANKS VERY
MUCH ALRIGHT WE'RE GOING.
TO THAT SO WILL HOLD OF THOSE
ITEMS OPEN WILL MOVE ON TO ISSUE
NUMBER TWELVE WHICH IS -- FAMILY
PLANNING SUPPLEMENTAL PAYMENT
FOR SO -- IN THE ORIGINAL AND A
COUPLE OF YEARS OF PROP FIFTY
SIX THERE WAS FIFTY MILLION
DOLLARS ALLOCATED FOR WOMEN'S
HEALTH SERVICES -- THE VAST
MAJORITY IN IN FAMILY AND FAMILY
AND THAT'S PACKED PROGRAM -- WE
REALLY FELT LIKE IT WAS
APPROPRIATE.
AS WE WERE LOOKING AT RECESS YOU
KNOW THAT WE THOUGHT WE SHOULD
BE SPENDING THIS MONEY TO
ACTUALLY ADD SUBLIMINAL PAYMENTS
TO THE MEDIC HOW FAMILY PLANNING --
MOST SIDE AS WELL -- TO REALLY
TRY TO YOU KNOW MAKE IT MORE
EQUIVALENT OBVIOUSLY THE THE
POPULATION IN F. PACKED IS A
MUCH SMALLER POPULATION -- ABOUT
A MILLION INDIVIDUALS RECEIVE
SERVICES THROUGH THAT PROGRAM
BUT OBVIOUSLY WE HAVE THIRTEEN
MILLION NOT ALL OF THEM FAMILY
PLAN.
BUT SO.
THE WHAT SO WHAT WE HAD PUT OUT
ORIGINALLY WAS A TWENTY DOLLAR
SUPPLEMENTAL PAYMENT FOR THE
SAME CPT CODES THAT WERE BEING
USED -- FOR THE F. PACKED I WILL
SAY WE WE RECOGNIZE THERE'S A
DEAD ISSUE IS THAT THERE WAS A
DATA ISSUE SO WE ARE RE
EVALUATING THAT AND CERTAINLY
EVALUATING THE PROPOSAL FOR THAT
YOU WILL HEAR FROM THE STAKE
HOLDERS -- MISS SO I WOULD SAY
TO STAY TUNED TO FLORIDA IT'S
STILL THE SAME DOLLARS IT'S JUST --
WHAT THE ACTUAL PAYMENTS
SUPPLEMENT PAYMENTS WOULD BE?
OKAY THANK YOU L. L..
THE ONLY THING I WOULD ADD IS
THAT WE W RECOGNIZE AND MAKING
PARITY WITH THAT FACT IS A
POTENTIALLY GOOD YOU KNOW GOOD
REASON -- TO AUGMENT AND USING
PROPOSITION FIFTY SIX IN THIS
AREA WOULD ALSO -- RECOMMEND
LOOKING AT ACCESS ISSUES AND
WHETHER THOSE ARE OCCURRING IN
SORT OF JUSTIFY THE REASON --
JUSTIFY THE THE PAYMENT INCREASE
IN THIS AREA.
THANK YOU FINANCE OKAY -- I
APPRECIATE THE COMMON THAT --
WERE GONNA BE HEARING FROM
STAKEHOLDERS RAY SHORTLY -- YEAH
I THINK MY CONCERN SO I SHE
SHOULD SAYING ALWAYS TREAT YOUR
COLLIDES IS THAT -- IN ORDER TO
GET THE MAXIMUM I GUESS IMPACT
IN TERMS OF ACCESS AND SERVICES
THAT -- THE FUNDS ARE DISBURSED
SO MUCH THAT ACTUALLY THAT IS AN
INCENTIVE FOR SO BASICALLY I
MEAN IT'S GREAT PEOPLE ARE GOING
TO GET A LITTLE EXTRA PAYMENT
BUT NOW PEOPLE AREN'T REALLY YOU
KNOW IT IS IT REALLY GOING TO
INCREASE ACCESS OR IS IT JUST
THE WELL I GOT.
PAID A LITTLE MORE BECAUSE IT'S
NOT BIG ENOUGH TO MAKE ME CHANGE
SOMETHING NEEDS TO SELL THEM
THEY ALWAYS APPRECIATE AN
INCREASE.
BUT IT YOU KNOW BUT LANDS NOW WE
SPREAD IT OUT SO THIN.
AND PEOPLE GOT LITTLE PAYMENTS
AND SO CUMULATIVELY.
IT'S NOT MOVING THE NEEDLE ON ON
WHAT PEOPLE ARE DOING SELVES
GREAT PEOPLE ARE DOING WHAT
THEY'RE DOING THEY SHOULD BE
PAID MORE FOR WHAT YOU'RE DOING
BUT I'M HOPING THAT.
THE GUIDING THE GOAL OF THE
FUNDING SINCE THE TIME YOU KNOW
WITH FOR WE FIRST STARTED IT IS
TO REALLY TRY TO FOCUS AND TRY
TO BUILD CAPACITY.
AROUND FAMILY PLANNING AND HERE
IN THE STATE OF CALIFORNIA SO I
APPRECIATE THAT AS A
JUSTIFICATION BUT I'M.
BUT I AND I I THINK THAT IS.
THAT SWEAR I HOPE WE CAN GO AT
THAT AND PERHAPS THE STAKE
HOLDERS MY I DON'T KNOW THEY'LL
SAY THE SAME THING OR NOT I OKAY
WITH THAT -- WHEN WE GO AHEAD
AND BRING UP STAKEHOLDER
PROPOSAL SO I THINK WE HAVE
PLANNED PARENTHOOD HERE
[inaudible]
WELCOME [inaudible]
THANK YOU.
CAN'T FORGET AT THE BUTTON --
GOOD AFTERNOON -- CHAIR MEMBERS
MY NAME AS WELL OUR STAFF -- MY
NAME IS ANDREAS AND THE GAL IN
THE POLICY ADVOCATE FOR PLANNED
PARENTHOOD AFFILIATES OF
CALIFORNIA REPRESENTING SEVEN
AFFILIATES -- THROUGHOUT THE
STATE WHICH SERVE MORE THAN
SEVEN HUNDRED THOUSAND PATIENTS
AT A HUNDRED APPLICATIONS I'M
JOINED BY MY COLLEAGUE TODAY
KILL THE LENS OF THE DATA
COORDINATOR PEACOCK -- SO THANK
YOU AGAIN FOR PROVIDING THIS
OPPORTUNITY TO DISCUSS OUR
THOUGHTS ON THE GOVERNOR'S
PROPOSAL WHICH WOULD DOUBLE THE
STATE'S INVESTMENT IN
REPRODUCTIVE HEALTH CARE THROUGH --
PROP FIFTY SIX DOLLARS.
THE GOVERNOR'S PROPOSED JANUARY
BUDGET AUGMENTATION FOR FAMILY
PLANNING IS ABOUT BUILDING OFF
OF THE EXISTING -- INVESTMENTS
THAT HAVE BEEN MADE SO FAR
THANKS TO THE SUPPORT OF THE
LEGISLATURE THE LAST TWO YEARS --
WE'VE ALREADY BEGUN TO SEE MORE
PATIENTS -- AND TO DECREASE WAIT
TIMES THROUGH FACILITY
IMPROVEMENTS AND ALSO THROUGH
SOME WORK FORCE INVESTMENTS.
HOWEVER EVEN WITH THESE
INVESTMENTS THERE IS STILL A
GROWING ON MEN NEED FOR SEXUAL
AND REPRODUCTIVE HEALTH CARE.
THROUGHOUT THE STATES -- WHICH
WE'D BE HAPPY TO TALK MORE ABOUT
A LATER TIME WHEN THERE AREN'T
MORE ITEMS IN FRONT OF YOU --
THIS UNMET NEED IS CONTRIBUTING
TO PUBLIC HEALTH CRISES -- AND
WE BELIEVE DIRECTLY RESULTING IN
HIGH RATES OF PREVENTABLE
MATERNAL AND INFANT MORTALITY
AND MORBIDITY -- AS A TRUSTED
PROVIDER FOR SENSITIVE SERVICES
AND OFTEN THE ONLY PROVIDER --
THAT MANY OF OUR PATIENTS WILL
SEE DUE TO OTHERWISE BEING YOUNG
AND HEALTHY -- THERE'S A
QUESTION OF HOW PLANNED
PARENTHOOD CAN PROVIDE MORE
SERVICES THAT CONNECT WITH
MATERNAL HEALTH BEHAVIORAL
HEALTH -- AND CHILD DEVELOPMENT --
NAMELY INFANT HEALTH -- SO HOW
DO WE MAKE SURE THAT THIS MONEY
HAS A REAL MEASURABLE KLEINFELD
IMPACT FOR THOSE PATIENTS.
WHO NEED CARE THE MOST WITH ALL
OF THIS IN MIND WE SPENT SEVERAL
MONTHS RESEARCHING WITH OUR
AFFILIATES -- TO DETERMINE THE
BEST WAY THEY BELIEVE ON THE
GROUND TO MEET THE GOALS LAID
OUT NOT JUST BY THE GOVERNOR BUT
BY.
THE PROP -- FIFTY SIX INITIATIVE
ITSELF.
LIKE MANY OF THE OTHER SPACES IN
THE BUDGET WE APPLAUD THE
GOVERNOR'S DESIRE TO ENTER WE'VE
DIFFERENT FUNDING STREAMS.
AND MAKE SURE INVESTMENTS BUILD
UPON EACH OTHER SO WE CAN ALL
GET THE MOST OUT OF IT --
BECAUSE WE REALLY UNDERSTAND THE
ISSUES FACED BY CALIFORNIANS IN
OUR PATIENT BASE IN PARTICULAR.
ARE NOT SILO ROAD LIKE OUR
BILLING STRUCTURES SOMETIMES
INCENTIVIZE WHICH IS WHY WE'RE
SEEING THINGS LIKE MORE VALUE
BASED PAYMENT DISCUSSIONS AND
AND EVERYTHING SO EVERYTHING'S
HEADING IN OUR DIRECTION -- BUT
THAT THE NEED IS STILL THERE SO
THIS ARGUMENT AUGMENTATION FOR
UP TO ANOTHER FIFTEEN MILLION
PER YEAR.
IN STATE DOLLARS IS NOT AND
SHOULD NOT.
BE JUST ANOTHER WAY TO INCREASE
RATES AS YOU WERE SAYING -- AS
LOW AS THEY ARE.
THAT'S THAT'S NOT THE THE
OBJECTIVE IN THE MIND OF OUR
AFFILIATES -- IT SHOULD BE ABOUT
OUTCOMES FOR INCREASING CARE --
INCREASING CARE FOR THOSE WITH
THE HIGHEST NEEDED IN THE ARAS
OF THE HIGHEST NEED AND FOCUSING
ON ADDITIONAL KERR WERE PATIENTS
ARE ALREADY AND HEALTH CENTER --
SO THIS IS WHY OUR PROPOSAL
SHIRT WITH DH CS -- WHICH WE
APPRECIATE HAVING DISCUSSIONS --
HAS SUCH A WIDE RANGE OF
PROVISIONS WHICH I'LL LET YOU
ALL READ ABOUT -- OUR BIGGEST
CONCERN RIGHT NOW IS IS JUST
THAT THIS ALLOCATION IS FINE IT
IN ITS FINAL FORM CAN BE DRAWN
DOWN PRIMARILY BY TRUSTED
PROVIDERS -- AND BELIEVE THAT
OUR PROPOSAL REALLY ADDRESSES --
YOU KNOW A RANGE OF OPTIONS FOR
THE FINAL -- DECISION AND ALSO
TAKE SOME IMPLEMENTATION
CONSIDERATIONS INTO ACCOUNT --
AND SOME THOSE TECHNICAL ASPECTS
OF MAKING SURE THE MONEY FLOWS
WELL -- ARE REALLY IMPORTANT TO
THE HEALTH CENTERS SO -- WE LOOK
FOR TO INCREASING THE NUMBER OF
PATIENTS AND ADDRESSING SOME OF
THESE ADDITIONAL ISSUES -- AND
ARE HAPPY TO ANSWER NY
QUESTIONS ABOUT THE PROPOSAL NOW
OR AT A LATER TIME.
THANK YOU.
ALL RIGHT.
SORRY SHE KNEW IF SHE REFUSED.
TO GET HER HEAD.
ANY COMMENTS FROM THE H. YES NO
VALUE [inaudible]
FINANCE.
SO.
SO I DO SEE THAT WE HAVE A
DESCRIPTION OF TH ALTERNATIVE
INVESTMENTS HERE WHICH I KNOW
THAT YOU DON'T REALLY HAVE TIME
TO GET INTO THE SPECIFICS -- BUT
YOU DID MENTION THAT HE THAT --
HE WANTED. TO ENTER MEMBER YOU
SAID AT THE END -- THAT IT'S NOT
JUST ABOUT THE REIMBURSEMENT
RATE BUT IT'S ABOUT THE FUN
GOING IN THE MONEY GOING TO
TRUSTED PROVIDERS.
CAN YOU ELABORATE A LITTLE BIT
ON THE WHAT YOU'RE SUGGESTING
THERE YEAH I MEAN I THINK WE'RE
YOU KNOW IT SOUNDS LIKE EVERYONE
THAT'S BEEN ENGAGING ALL THESE
CONVERSATIONS ABOUT THIS.
OUT PART OF THE BUDGET HAVE -- A
STRONG CONCERN AN INVESTMENT IN
MAKING SURE WE HAVE -- COLD YOU
KNOW BECAUSE CULTURALLY
COMPETENT.
PROVIDERS THAT ARE REALLY
WANTING TO MAKE SURE LIKE FOR
ALL GIVE YOU AN EXAMPLE ONE OF
THE THINGS WE'VE BEEN ABLE TO DO
WITH THE EGGS.
INVESTMENT -- THUS FAR HAS --
BEEN TO DO WHATEVER WORK FORCE --
ADJUSTMENTS ARE NEEDED TO BE
ABLE TO OPEN MORE HOURS
EMPLOYMENT SLOTS AND WALK IN
TIME ON WEEKENDS AND AND IN THE
EVENING AND WE'RE SEEING
IMMEDIATE DEMAND FOR THAT.
A NOT AS SOMETHING THAT REALLY I
THINK COMES FROM YOU KNOW YOU'LL
SEE THE TYPES OF PROVIDERS THAT
HAVE.
IT'S VERY MISSION BASED RIGHT
IT'S A IT'S ABOUT MAKING SURE
THAT.
THE THE THE FOLKS THAT ARE
SERVED BY THE PROGRAMS THAT
LARGELY FROM THE SERVICES
RENDERED -- HAVE CERTAIN
BARRIERS TO CARE AND AND OUR
AFFILIATES AND A LOT OF OTHER
HEALTH PROVIDERS IN OUR CLIP IN
OUR TYPE.
ARE -- ARE VERY FOCUSED ON THAT
AND SO I THINK THAT'S AND ALSO
YOU KNOW WANTING TO BE ABLE.
TO QUANTIFY AND MEASURE AND
SHARE THAT OUT -- I THINK IS --
IS SOMETHING THAT WE WOULD HOPE
WOULD BE OF INTEREST TO THE
COMMITTEE.
THANK YOU AND I APPRECIATE --
THAT YOU ARE SUGGESTING -- IN
TERMS OF FEES IT AROUND THE
PUBLIC HEALTH AND THE
INTERVENTIONS -- BECAUSE I THINK
WE HAD A HEARING ON THE SEG
CRISIS AND APPRECIATE THAT VERY
HARD WORKER PUBLIC HEALTH
DEPARTMENTS ARE DOING -- MANY
WHO ARE UNFORTUNATE UNDERFUNDED
AND UNDERSTAFFED AND THE
RECOGNIZING THAT TO TACKLE THAT
CRISIS IT'S A PARTNERSHIP BOTH
BETWEEN -- SORT OF PUBLIC HEALTH
DEPARTMENTS BUT ALSO PRIVATE
PROVIDERS -- LIKE PLANNED
PARENTHOOD AND OTHERS WHO ARE
PROVIDING REPRODUCTIVE HEALTH
BUT THEN CAN ALSO HELP ON ON THE
SUB PUBLIC HEALTH ISSUES ARE
RELATED.
HELLO OKAY.
ALL RIGHT ANY OTHER COMMENTS
THEN ALL RIGHT PUBLIC COMMENT.
AND OVERALL FAMILY PLANNING
SUPPLY -- PAYMENT AS WELL AS THE
STAKEHOLDER PROPOSAL.
RIGHT SPENCER MAP THE CALIFORNIA
ACADEMY OF FAMILY PHYSICIANS IN
SUPPORT OF THE MINISTRATIONS
PROPOSAL BUT ON THE SIDE BAR
AFTER LISTEN THE STICKER
PROPOSALS WELL LIKE TO BRING
THAT BACK TO THE CABIN FOR THEIR
CONSIDERATION AS WELL.
OKAY THANK YOU [inaudible]
WELCOME.
YOUR MEMBERS CUT THE MUSTARD
WITH THE CENTRAL ACCESS HEALTH
JUST WANT TO GO ON RECORD IN
SUPPORTING THE STAKEHOLDER
PROPOSAL HERE WE THINK IT'S VERY
MUCH NEEDED AND CERTAINLY WE
HEAR YOUR POINTS ON STDS WE KNOW
WE'LL BE TALKING ABOUT THAT
LATER IN THE AGENDA.
THANK YOU THANK YOU.
ALL RIGHT IN ELSE THANK YOU VERY
MUCH APPRECIATED THANK YOU.
SO ALL THOSE ITEMS OPEN.
ACTUALLY ALL THE PREVIOUS ITEMS
OPEN AS WE'RE NOT VOTING ON
ANYTHING.
SO ALL RIGHT SO -- ISSUE NUMBER
THIRTEEN PROP FIFTY SIX STAFFING
ALL THE STUFF YOU'RE DOING YOU
REALLY NEED MORE STAFF.
YES EXISTING STAFF RIGHT.
THIS IS A REQUEST FOR EIGHTEEN A
STAFF -- REALLY TO IMPLEMENT THE
VALUE BASED PAYMENT.
PROPOSAL -- GIVE IN IT'S GOING
TO BE A LOT OF DATA AND I SAY
IT'S AN ASSESSMENT -- AND DOING
GREAT SETTING WITH OUR HEALTH
PLANS AND ALL OF THAT WE REALLY
WE REALLY THINK THESE POSITIONS
ARE NECESSARY IN ORDER FOR US TO
ACTUALLY ACCOMPLISH WHAT WE'VE
BEEN TALKING ABOUT.
THOMAS MILIEU OF GET SHOULD THE
VALUE BASED PAYMENT PROGRAM BE
IMPLEMENTED AS PROPOSED WE DON'T
HAVE CONCERNS WITH THIS RESOURCE
REQUEST FINANCE.
OKAY PUBLIC COMMENT ON THIS
SEEING NONE ALL RIGHT.
WE'LL HOLD THIS ITEM OPEN AND
YOU CAN BITE ME TODAY INTERVIEWS.
JUST KIDDING I HAVE A ALL RIGHT.
MAYBE THE MANAGER TALKED TO THAT.
OKAY.
ALL RIGHT ISSUE NUMBER FOURTEEN
PROGRAM FOR ALL INCLUSIVE CARE
FOR ELLIE EXPANSIONS SURE SO
WITH OUR PACE PROGRAM WE'VE
STARTED TO SEE PRETTY
SIGNIFICANT EXPANSION -- IN
RECENT YEARS WE HAVE LIFTED THE
CAP ON THE NUMBER OF PEACE
ORGANIZATIONS THAT CAN BE
OPERATING IN SO WE ARE SEEING --
EVERY YEAR AT SEVERAL NEW A
PEACE ORGANIZATIONS COMING ON
BOARD SO WE ARE REQUESTING TO
ADDITIONAL STAFF. TO IN ORDER TO
BE ABLE TO BRING THOSE PEACE
ORGANIZATIONS ON BOARD AND DO
THE CONTRACT MANAGEMENT AND
MONITORING AND OVERSIGHT.
OKAY THANK YOU COME THIS MILIEU.
FINANCE.
THE STATE FROM DIFFICULT. ONE
OKAY.
OKAY I THINK THERE'S A
STAKEHOLDER PROPOSAL --
REGARDING AMENDMENTS TO THE PACE
MODERNIZATION ACT.
WELCOME.
THANK YOU MISTER CHAIR OF PTO SO
CAL PAYS WERE THE ASSOCIATION
AND THE PROGRAMS OF ALL
INCLUSIVE CARE FOR THE ELDERLY --
TO START WITH WE DO APPRECIATE
THE STAFFING INCREASE WE DO -- I
THINK THAT'S IMPORTANT PART OF
KEEPING UP WITH PACE GROWTH AND
WE DO.
APPRECIATE THE STATE SUPPORT FOR
PACE -- IT IS A RAPIDLY GROWING
MODEL OF CARE -- SHOWING GREAT
PROMISE IN OUR COMMUNITY OF
FRIEL SENIORS AN AT RISK ADULTS.
OF THE PROPOSAL WE HAVE FOR YOU
IS AND WOULD MAKE ADJUSTMENTS TO
THE PAYMENT METHODOLOGY FOR PACE
PACE IS A COMPREHENSIVE CARE
PROGRAM AS YOU KNOW -- PEACE
PROGRAMS ARE CAPITATED THEY'RE
AT RISK FOR THE ENTIRE RANGE OF
ACUTE CARE AND LONG TERM CARE
SERVICES THAT THEY'RE
BENEFICIARIES NEED.
AND THAT PAYMENT DOESN'T CHANGE
SO IT'S REALLY IMPORTANT FOR
THAT PAYMENT TO BE -- SUPPORTIVE
OF ALL THE THINGS THAT PACE DOES --
PACE OF BENEFITS REASON ROLLING
PACE IN LIEU OF RICK SAVING ANY
OTHER SERVICES AND FEE FOR
SERVICE OR MEDICARE ALSO PACES
ESSENTIALLY THEIR SOLE PROVIDER --
IS NOTED IN THE AGENDA THAT PACE
MODERNIZATION ACT OF TWO
THOUSAND SIXTEEN CHANGE THE
METHODOLOGY. TO A MORE OF A
EXPERIENCE BASTER COST BASED
METHODOLOGY -- SHOULD SIMILAR TO
THE WAY THAT OUR DEPARTMENT IS
PAYING MANAGED CARE PLANS.
WE SUPPORTED THAT MOVE -- IN
CONCEPT AND IT CERTAINLY CAN
WORK FOR PACE BUT WE ARE FINDING
SOME PROBLEMS WITH -- GETTING
ALL THE COSTS RECOGNIZED -- THAT
METHODOLOGY SO THAT'S WHY WE'RE
SUPPORTING THESE CHANGES --
EXAMPLES OF AREAS WERE HAVING
PROBLEMS ARE IN THE AREA OF
CAPITAL COSTS SO PEACE IS A
CAPITAL INTENSIVE MODEL -- IT
REQUIRES ME UP TO TEN MILLION
DOLLARS OR MORE TESTS TO START A
PEACE CENTER -- IN TODAY'S
ENVIRONMENT -- THERE'S REALLY
NOTHING IN THE METHODOLOGY NO
WAY TO RECOGNIZE THOSE COSTS AND
ALLOW THEM TO BE RECOUPED IN A
TIMELY WAY -- AND THE PROGRAMS --
YOU DO HAVE TO MAKE SIGNIFICANT
INVESTMENTS -- THE PROGRAM IS
ALSO -- ON TO A HIGHER DEGREE OF
RISK AND VOLATILITY BECAUSE IT'S
COVERING EXCLUSIVELY NURSING
HOME ELIGIBLE BENEFICIARIES
THERE'S REALLY NO RISK SHARING
OUR OUR SPRING I SHOULD SAY --
AMONG THE BENEFICIARIES LIKE YOU
MIGHT HAVE BEEN A TRADITIONAL
MANAGED CARE PLANS SO THERE'S A
A NEED FOR A LITTLE BIT HIGHER
MARGIN TO HANDLE THE THE
VOLATILITY AND THAT'S THAT'S
ALSO NOT ACCOUNTED.
FOR IN THE METHODOLOGY AND THEN
FINALLY THE START UP PROGRAMS
WHICH WERE SEEING MANY TAKE TAKE
ON STARTING UP THE PROGRAM WHICH
IS GREAT.
BUT THE METHODOLOGY DOESN'T
REALLY TAKE INTOACCOUNT THAT
THEIR COST STRUCTURE IS HIGHER
WHEN THEY START BECAUSE THEY
HAVE HIGHER OVER -- OVER HIM OUT
THERE SPREADING FIXED COSTS OVER
A VERY SMALL.
DAYS SO ANYWAY THE PROPOSAL
WOULD MAKE SEVERAL ADJUSTMENTS
IN THE METHODOLOGY WE THINK THE
REASONABLE -- WE HAVE HAD SOME
PROMISING DISCUSSIONS WITH THE
DEPARTMENT I THINK WE MAY BE ON
THE SAME PAGE ON SOME OF THE
PROVISIONS IN THE AND THE
PROPOSAL BUT NOT ALL -- BUT I
GUESS I DO WANT TO POINT OUT
THAT EVEN WITH THE ADJUSTMENTS
TO THE METHODOLOGY INCLUDING IF
WE DO THIS SORT OF FLOOR FOR THE
PAYMENTS -- THE PAYMENT STILL
HAVE TO PEOPLE -- WITH THE STATE
WOULD PAY FOR CARING FOR THESE
TYPES OF BENEFICIARIES OUTSIDE
OF PAYS SO IT'S STILL WALK A
COST EFFECTIVE MODEL -- IN SO
ANYWAY LOOK FORWARD TO WORKING
HOPEFULLY WITH THE DEPARTMENT TO
COME UP WITH SOMETHING AND WE
HOPE WILL HAVE YOUR SUPPORT --
AT THE PROPER TIME.
THANK YOU COMMENTS FROM THE BAR
HAS SERVICES OKAY HELLO.
FINANCE SO WE'VE BEEN TALKING
RIGHT YEAH I THINK I WAS NOT IN
THE MEETING I THINK THEY JUST
MET WITH MY TEAM LIKE TWO DAYS
AGO OR SOMETHING.
OKAY ALL RIGHT OKAY SO NOT VERY
LONG AGO OKAY ALL RIGHT.
OKAY -- PRECIADO THE YEAH I MEAN
I THINK SOUNDS AND IT'S NOT LIKE
THERE'S A LOT OF JUST INSIDE
DON'T KNOW ENOUGH FOR THE
DETAILS UNDERSTAND WHAT THEY ARE
SO I'M LOOKING FORWARD TO THE
CONVERSATION AND HAVE A FURTHER
ANALYSIS OKAY.
THAT A PUBLIC COMMENT ON THE
THIRD DAY OVERALL -- THE
POSITIONS ARE THE SINGLE REQUEST.
WELCOME PETER CALLOUS ON BEHALF
OF TWO TO SUPPORTERS THE FIRST
IS LEADING AIDS CALIFORNIA --
WHICH REPRESENTS A NOT FOR
PROFIT AFFORDABLE SENIOR HOUSING
ASSISTED LIVING AND RETIREMENT
COMMUNITIES SUPPORT OF OF BOTH
THE PROPOSAL FOR THE
ADMINISTRATION AND THE CAL PAY
STAKEHOLDER PROPOSAL.
AND THEN SECONDLY FOR SAINT PAUL
SENIOR HOMES AND SERVICES WHICH
IS IN SAN DIEGO -- AND IS A PACE
AS THE SANDY EIGHT ONE OF THE
SAN DIEGO PACED PROGRAMS
STAKEHOLDER PROPOSAL -- SAINT
PAUL'S OFFERS UNIQUE AND
INNOVATIVE SENIOR HOMELESS --
SUPPORTS AND SERVICES AND HAS
EXTENSIVE CAPITAL OUTLAY IS
MISTER HANSEL MENTIONED AND
WOULD BE AND ARE VERY SUPPORTIVE
OF THE CAL PEACE PROPOSAL IN
PARTICULAR THE FLOOR THAT WAS
MENTIONED THAT WILL BE FURTHER
DISCUSSED.
THANK YOU [inaudible]
WELCOME.
KELLY BROOKS ON BEHALF OF THE
CENTER FOR ELDERS INDEPENDENCE
THE P. SITE IN ALAMEDA AND
CONTRA COSTA COUNTIES AND WE ARE
ALSO HERE IN SUPPORT OF THAT
CALPE STAKEHOLDER PROPOSAL --
SEA ICE ACTUALLY EXPANDED --
INTO MULTIPLE SITES AND
EXPANDING FURTHER INTO CONTRA
COSTA COUNTY AND THIS ISSUE
AROUND THE CAPITAL OUTLAY
ASSOCIATED WITH THE RATE HAS
BEEN -- SIGNIFICANT FOR THEM
THANK YOU THANK YOU [inaudible]
WELCOME.
HELLO LAURA PART IN BEHALF OF
ULTIMATELY PAYS ORGANIZATION AND
LOS ANGELES COUNTIES SERVING
OVER TWO THOUSAND SENIORS IN A
DIFFERENT PACE ORGANIZATIONS IN
SUPPORT OF THE PEACE PROPOSAL
[inaudible]
THANK YOU [inaudible]
WELCOME.
GOOD AFTERNOON SUSAN TO MORRIS
ON BEHALF OF THE ALZHEIMER'S
ASSOCIATION WE SUPPORT THE PACE
STAKEHOLDER PROPOSAL THIS IS
ABSOLUTELY A PROGRAM WE WANT TO
SEE X. BAND AND WE WANNA MAKE
SURE THAT IT'S SUSTAINABLE THANK
YOU.
THANK YOU [inaudible]
WELCOME.
GIRLS WHO REPRESENT IN THE
CALIFORNIA COMMISSION ON AGING
AND THE CALIFORNIA LONG TERM
CARE OMBUDSMAN ASSOCIATION IN
SUPPORT OF THE STAKEHOLDER
KELPIES PROPOSAL OKAY THANK YOU
[inaudible]
RIGHT.
THAT ANY OTHER COMMENTS SEEN ON
OUR EIGHT THANK YOU SO VERY MUCH
PROPOSAL AND LOOKING FORWARD TO
HEARING THE RESULTS OF THAT AND
WILL HOLD THOSE ITEMS OPEN --
MOVING ON TO THE ISSUE FIFTEEN
PROVIDER ENROLLMENT WORKLOAD
INCREASE.
OR SO I AM NOW PINCH HITTING FOR
THERE ARE OTHER CHIEF DEPUTY
DIRECTOR SINCE I WAS ALREADY
GOING TO BE HERE ALL DAY SHE
DIDN'T.
HAVE TO COME. FOR TWO TWO ITEMS
SO -- SO THIS IS PURELY A
WORKLOAD INCREASES AT REQUEST WE
WE ARE ASKING FOR LIMITED TERM
RESOURCES FOR TWO YEARS
ACQUITTAL INTO TWENTY THREE
POSITIONS.
I WOULD KNOW WHAT IT IS AT A 75%
FEDERAL MATCHING RATE SO IT'S A
LOW GENERAL FUND COST.
THIS REALLY IS RELATED TO A FEW
THINGS THAT HAVE BEEN HAPPENING
ON THE PROVIDER ENROLLMENT SIDE
I MEAN JUST IN GENERAL BUT THE
PROGRAM GROWING.
ALWAYS MORE WORKLOAD FIGHT --
THE PROVIDER ROLE DIVISION ALSO
HAS TAKEN OVER THE ENROLLMENT OF
OUR DRUG MEDI CAL -- PROVIDERS
AND AS WELL THE CURES ACT HAD
SOME REQUIREMENTS AROUND --
MANAGED CARE MANAGED CARE
PROVIDERS BEING IN ROLLED
THROUGH ESSENTIALLY THE SAME
PROCESS AS FEE FOR SERVICE AND I
THINK ORIGINALLY WHEN WE WERE
LOOKING AT THIS THE IMPACT OF
SECURES.
OUR PLANS INITIALLY THOUGHT THEY
WOULD STILL DO THEIR OWN PROCESS
AND THAT YOU KNOW AS LONG AS IT
MET THE REQUIREMENTS -- BUT NOW
WE'RE AT A POINT WHERE ALMOST
ALL OF OUR PLANS OR AT LEAST
HAVING SOME OF THEIR PROVIDERS
AND ROLL THROUGH THE FEE FOR
SERVICE SYSTEM SO IT'S REALLY
CREATED A SIGNIFICANT BACKLOG.
FOR US AND SO THAT'S WHY WE'RE
ASKING FOR JUST THESE LIMITED
TERM RESOURCES TO CLEAR TO CLEAR
UP THAT BACKLOG.
OKAY INCOMES MILIEU FINANCE.
THE PUBLIC COMMENT ALL RIGHT
VERY GOOD WELL ALWAYS.
LIKE GETTING MORE PROVIDERS ON
BOARD QUICKER ALL RIGHT.
THANK YOU ALL RIGHT LET'S MOVE
ON TO ISSUE NUMBER.
SIXTEENS OFFICE CIVIL RIGHTS
INCREASED WORKLOAD.
SURE SO THIS IS A AGAIN A
WORKLOAD -- DRIVEN REQUESTS WERE
ASKING FOR TWO ADDITIONAL
PERMANENT POSITIONS IN OUR
OFFICE OF CIVIL RIGHTS -- JUST
TO PUT IN CONTEXT WE HAVE FOUR
THOUSAND EMPLOYEES IN THIRTEEN
POINT TWO MILLION BENEFICIARIES
AND WE HAVE A CURRENTLY IN
OFFICE OF SIX PEOPLE IN OUR
OFFICE OF CIVIL RIGHTS -- IT HAS
NOT CHANGED IN SIZE SINCE THE
PROGRAM HAS GROWN AND THAT THE
DEPARTMENT HAS ALSO GROWN PRETTY
SIGNIFICANTLY SO WE REALLY THINK
THIS IS CRITICAL FOR US TO BE
ABLE TO CONTINUE TO DO THE WORK
IN THAT AREA.
OKAY COMMENTS MILIEU.
FINANCE PUBLIC COMMENT.
ALL RIGHT SO WHILE WE WILL PUT
THAT ON HOLD AS WELL.
THANK YOU.
ALL RIGHT THROUGH THAT -- ISSUE
NUMBER SEVENTEEN FQHC DRUG MEDI
CAL PROVIDERS.
SURE SO WITH THIS REQUEST WE ARE
ASKING FOR ONE POSITION -- IT.
IN OUR IN OUR SUBSTANCE USE
DISORDER AREA. TO DO SOME OF THE
SOME ADDITIONAL WORK RELATED TO
THIS BILL SO THERE WAS A
QUESTION ABOUT -- THAT TO A TEAM
HE IS THAT WE WERE RECEIVED LAST
YEAR AND THAT WAS REALLY FOR
DOING THE FQHC BILLING AND
CLAIMS PROCESSING.
THIS IS REALLY TO DO THE PROGRAM
MONITORING SIDE ON THE ON THE
CAR ABOUT PEACE AND MAKING SURE
THAT WE'RE PROVIDING THE
APPROPRIATE TRAINING AND
TECHNICAL ASSISTANCE TO THE
ACCURATE SEASON ARE TO USE YOU
MAY BEGIN TO BE PROVIDING THE
SERVICES.
EXCELLENT.
HELLO WE'VE REVIEWED THIS AND
THE REMAINING -- ITEMS ON THE
AGENDA AND HAVE NO -- FOR DH CS
AND HAVE NO CONCERNSOKAY TANK
YOU FINANCE ALL RIGHT PUBLIC
COMMENT.
OKAY.
YOU'LL HOLD THIS ITEM OPEN AS
WELL.
ALL RIGHT.
ISSUE NUMBER EIGHTEEN
REAPPROPRIATION BEHAVIORAL
HEALTH MODERNIZATION RESOURCES
FIRST AND THIS IS JUST A
REAPPROPRIATION OF A OF A OF A
REQUEST THAT WE'VE HAD
PREVIOUSLY APPROVED. FOR THE
CONSULTING RESOURCES THAT WE
NEED TO COVER THE PLANNING COSTS
OF OUR COMPREHENSIVE BEHAVIORAL
HEALTH DATA SYSTEMS
MODERNIZATION PROJECT -- THE
EVERY ORIGINAL ACTIVITIES WERE
DELAYED -- AS CMS WAS REQUIRING
SOME ADDITIONAL PERF APPROVALS
BEFORE WE COULD SECURE THE
CONSULTING SERVICES SO NOW WE'RE
READY TO MOVE FORWARD AND ARE
ASKING THAT THAT MONEY BE RE
APPROPRIATED FOR THAT PURPOSE.
LA -- WE'RE GOOD FINANCE PUBLIC
COMMENT OKAY SO WE WANT TO
CONTINUE TO WORK FOR RE
APPROPRIATE ALRIGHT.
WE WILL PUT THAT ON OLD AS WELL.
THE ONE MISSING ONE MISINTERPRET.
BECAUSE I DON'T HAVE ENOUGH
COMMITTEE MEMBERS OF IT I OKAY
ISSUE NINETEEN STRESSING
PREVENTIVE SERVICES FOR CHILDREN
ON AND MEDIC HOUSE.
SURE SO THIS IS A PRETTY
COMPREHENSIVE -- A PROPOSAL THAT
WAS REALLY DRIVEN OUT OF OUR
INITIAL DISCUSSIONS WITH THE
GOVERNOR WHEN HE CAME INTO
OFFICE ABOUT HIS DESIRE TO
REALLY IMPROVE SERVICES FOR KIDS.
IN MEDIC HOLLAND SO WE WERE
TAKING A MORE COMPREHESIVE LOOK
AT HOW COULD WE D ENHANCED
COMPLIANCE AND MONITORING AND
OVERSIGHT -- OF OUR HEALTH PLANS
AND SO WE ARE ASKING -- FOR
STAFF RESOURCES TWELVE PERMANENT
NINE LIMITED TERM TO REALLY DO A
WIDE VARIETY OF THINGS AND WE'VE
TALKED ABOUT SOME OF IT ALREADY
TODAY -- ONE IS ADDING ALL OF
THE CHILD AND ADULT COURSE THAT
MEASURES TO YOUR EXTERNAL
ACCOUNTABILITY SET -- I THINK AS
WE TALKED ABOUT BEFORE WHEN I'M
STUCK ON THE ON THE MEASURES
WERE MEASURING AND HOLDING PLANS
ACCOUNTABLE -- TO THEY DO
THEY'RE DOING BETTER ON THESE
MEASURES THAT WE HAVE NOT BEEN.
PARTICULARLY DOING THAT WELL --
AND SO WE WANT TO ADD ALL OF THE
MEASURES AS A WAY TO HAVE
ENHANCED COMPLIANCE MONITORING
WE'RE ALSO DOING A COUPLE THINGS
WITH RESPECT TO THE BENCH MARKS --
ONE WE ARE MOVING OUR MINIMUM
PERFORMANCE LEVEL FROM THE
TWENTY FIFTH PERCENTILE TO THE
FIFTIETH PERCENTILE -- SO THAT
AGAIN THROUGH THE HIGHER BAR OF
ACHIEVEMENTS FOR PLANS AND THEN --
THIS IS ONE OF THOSE THINGS I
COULD GEEK OUT ON SO I'M NOT I
WON'T BUT I'LL JUST -- YOU KNOW
I THINK QUALITY IMPROVEMENT
MEASUREMENT.
IN THE WAY THAT HE DOES DOES IT
WITH THE PERCENTILES IS ALWAYS
POTENTIALLY QUESTIONABLE BECAUSE
YOU COULD BE TERRIBLE BUT STILL
BE THE BEST OR YOU COULD BE
REALLY GOOD BUT BE THE WORST --
AND I THINK THERE'S SOME
PARTICULAR MEASURES IF YOU IF
YOU LOOK AT THEM PARTICULARLY
WITH SUCH AS YOU SCREENING AND
OTHER THINGS FOR ADOLESCENTS
WERE LIKE THE NATIONAL.
THAT LIKE THE TOP IS 25% OF KIDS
SO IT'S YOU KNOW WE DID THAT.
SO WE WE REALLY WANTED SORT OF
CHANGE HOW WERE HOLDING PLANS
ACCOUNTABLE SO THERE ARE TWO I
BELIEVE IT'S TWENTY THREE OF THE
MEASURES.
DO YOU HAVE NATIONAL BENCHMARKS
JUST LIKE STREET BENCHMARKS -- I
ALWAYS USE THIS WHEN I TOTALLY
MAKE IT UP BECAUSE I DON'T KNOW
THAT THIS IS ONE BUT LIKE YOU
KNOW 90% OF KIDS TO GET YOU KNOW
IT UP HIGH ACHIEVEMENT IS 90% OF
KIDS GETTING ALL THEIR
IMMUNIZATIONS I DON'T KNOW THAT
THAT'S ACTUALLY ONE BUT I USE.
IT AS AN EXAMPLE BECAUSE IT'S
THE ONLY ONE I CAN THINK OF SO
WE'RE ACTUALLY GONNA BE SETTING
THOSE STANDARDS AND HOLDING
PLANS NOT JUST TO THE FIFTIETH
PERCENTILE MPO BUT FOR THOSE
MEASURES FOR WHICH STANDARDS
EXIST.
THAT ARE YOU KNOW PROVEN TO BE
APPROPRIATE WE WILL BE HOLDING
PLANS ACCOUNTABLE TO THOSE AS
WELL -- AND AGAIN I IT MY TEAM
KNOWS BECAUSE OVER THE YEARS
I'VE ALWAYS TALKED ABOUT HOW
QUALITY MEASUREMENT HAS ALWAYS
DRIVEN ME CRAZY FROM A
MATHEMATICAL PERSPECTIVE.
JUST THAT THAT YOU'RE BETTER
THAN EVERYONE ELSE DOESN'T MEAN
YOU'RE GOOD -- MISS SO I'M
EXCITED ABOUT THAT AND HOPEFULLY
YOU KNOW WE'RE GOING TO CONTINUE
TO LOOK AT OUR ARE THERE OTHER
WAYS THAT A STANDARDIZED
BENCHMARKS CAN BE ADDED FOR THE
REST OF THE MEASURES -- BUT JUST
STARTING WITH THE ONES FOR WHICH-THEY EXIST TODAY -- EDITION ONLY --
HISTORICALLY THE DEPARTMENT HAS
WHEN A PLAN HAS NOT BEEN MEETING
ITS PERFORMANCE LEVELS HAS THE
FIRST STEP IS ALWAYS BEEN A
CORRECTIVE ACTION PLAN.
WHERE WE WORK WITH THE PLAN --
AND DO A TECHNICAL ASSISTANCE
AND PROVIDE MILESTONES THAT THEY
HAVE TO MEET AND THEN ONLY IF
THEY DON'T.
COME INTO COMPLIANCE WITH THOSE
MILESTONES DID WE SANCTION THE
HEALTH PLANS -- ON ON THE ON
THESE QUALITY MEASURES -- WE
HAVE DECIDED TO TAKE A DIFFERENT
APPROACH AND NOW WITH WITH THESE
HIGHER -- STANDARDS THAT IF A
PLAN IS IS FAILING TO MEET THOSE
STANDARDS WE WOULD IMMEDIATELY
ISSUE A SANCTION AND TO DO THE
CORRECTIVE ACTION PLAN.
THAT COULD LEAD TO FUTURE
SECTIONS -- AGAIN WE WE HAVE
FOUND AND I THINK WE HAVE SEEN --
AS WE HAVE SORT OF IN MORE
RECENT YEARS BEEN USING THE
SANCTION TOOL THAT IT HAS DRIVEN
CHANGE IN A FASTER WAY THAN
WE'VE BEEN SEEING WHEN WE
WEREN'T DOING IT -- SO WE THINK
IT IS A TOOL IN THE TOOLBOX THAT
WE SHOULD BE USING -- MORE
APPROPRIATELY AND MORE OFTEN --
THE OTHER THINGS WHERE YOU
TALKED ABOUT REMOVING THE THE
CAPS SURVEY FROM EVERY THREE
YEARS TO EVERY TWO YEARS AND
WE'RE ALSO LOOKING AT DOING SO
WE DO WE ALREADY HAVE OUR
REPORTS THAT WE DO FROM ARE YOU
CURL AND WE HAVE.
OUR QUARTERLY DASHBOARDS BUT
WE'RE ALSO LOOKING AT NOW WITH
THESE INCREASED A WITH THE
INCREASED NUMBER OF MEASURES
SORT OF A A MORE ROBUST ANNUAL
COMPLIANCE REPORTS THAT WE WOULD
BE ABLE TO PROVIDE SO THAT FOLKS
COULD SEE A HEALTH PLAN
PERFORMANCE SORT OF INDIVIDUALLY
ON ALL OF THESE.
MEASURES.
OKAY THANK YOU OHIO FINANCE
[inaudible]
HELLO.
AND I APPRECIATE -- WH WHAT --
YOUR PRESENTATION AND WHAT YOU
SAID -- A SOMEONE WHO ALSO DID
WORK AND QUALITY PRE. FOR I WE
GOT IN THE LEGISLATURE AND I
MEAN I THINK THE THE AUDITOR'S
REPORT WAS QUITE DISMAYING.
RIGHT AND CERTAINLY IS A
PEDIATRICIAN.
I MEAN WHAT WE THINK WE WE JUST
TALKED ABOUT DEVELOPMENTAL
TRAUMA SCREENING RIGHT AND IT'S
ONLY.
WAS IT 20% SOME PLANS RATE FIFTY
THAT ARE GETTING BETTER THEN
THEN WE'RE DONE OR TALK ABOUT
FRACTION O THAT SO BECAUSE THE
PEOPLE AREN'T AREN'T.
SO -- AND AND THE OTHER THING IS
IS I APPRECIATE WHAT YOU SAID
ABOUT -- NOW I'M THEN I I
CERTAINLY A BELIEVER OF OKAY
SOMEONE ISN'T SURE HOW TO DO
SOMETHING WITH HIM CORRECTIVE
ACTION PLAN AND YOU TELL HIM
WHAT TO DO [naudible]
THIS.
IS SOMETHING THAT.
THEY SHOULD ALREADY KNOW IT
RIGHT I MEAN THERE'S NOTHING NEW
ABOUT GETTING KIDS IN FOR
REGULAR CHECK UPS THAT'S BEEN
AROUND FOR DECADES.
SO SOMEONE WHO SAYS I'M A HEALTH
PLAN.
CHOUDARY KNOW HOW TO DO THIS NOW
HE IS SO I THINK IT'S A LITTLE
HARD TO SAY WELL YOU KNOW WHEN I
GET HOT NOW I GET A CHANCE TO
FIX THIS THING LIKE THAT WAS
SUPPOSED TO A PAGE IN THE FIRST
PLACE USED WHEN YOU APPLIED TO
DO.
THIS.
I MEAN THIS IS SO CORE I MEAN
THIS IS NOT ONE OF THESE -- IT'S
A NEW MEASURE WE'RE STILL
FIGURING IT OUT KIND OF THING I
MEAN THIS IS A STANDARD THAT'S
BEEN AROUND FOR A VERY LONG TIME.
AND IF A IF YOU DO AND AND SO --
SO WELL CERTAINLY PEOPLE CAN
ALWAYS LEARN THINGS AND ACTUALLY
WE SHOULD THINK ABOUT HOW WE GET
PEOPLE TOGETHER AND THE
DIFFERENT PLANS A SHARE BACK
FAXES ETCETERA.
BUT YOU CERTAINLY.
I MEAN.
I MEAN THE FACT THAT YOU HAVE
PLANS THAT ARE BELOW 20% OF KIDS
GETTING SCREENED.
THAT -- AND AND YOU THINK ABOUT.
BY THE WAY THE PROBLEM IS NOT
LIKE SOMEONE GOES BACK AND
CATCHES UP ON EVERYTHING AT W.
MISSED THAT WINDOW OF TIME YOU
MISSED THAT WINDOW OF TIME FOR
THE SCREENING OF STAY OR HAVE A
LEARNING DISABILITY OR SOMETHING.
I MEAN IT'S NOT LIKE YOU CAN SAY
OH WELL TWO YEARS LATER UP I'M
NOW GOING TO GO AND FIND OUT AND
CATCH UP ON ALL THE PEOPLE WE
MISS I MEAN THAT YOU MAY HAVE
MISSED THE WINDOW SO -- I I'D
SAY I APPRECIATE THE FOCUS ON
THIS -- IN RESPONSE -- IDEM
LITTLE DISAPPOINTED THAT WE HAVE
TO FIND THIS OUT NOW I MEAN THIS --
BUT I THINK THAT -- I APPRECIATE
THAT THE SITE HE YOU SHOULD
ALREADY KNOW WHAT TO DO AND IF
YOU HAVEN'T HAD IT AND I ALSO
APPRECIATE ALSO THAT THE
MEASURES THAT WE SHOULD BE
BASING MORE ON ABSOLUTE MEASURES
AND NOT JUST RELATIVES YOU SAID.
DO YOU BE WITH ME ON THAT END
WITH YOU ON THAT RIGHT NOW YOU
KNOW I THINK WE ALSO NEED TO
FIGURE OUT HOW TO HELP PEOPLE
GET TO WHERE THEY NEED TO GO
RIGHT -- AND DOES COME UP WITH
BEST PRACTICES AND SO FORTH BUT
AT A CERTAIN POINT ALSO IS THAT
YOU SIGNED UP TO DO THIS YOU
SHOULD ARRAY OF KNOWING HOW TO
DO THIS -- NOW YOU COULD COULD
YOU DO BETTER YEAH WE YOU AND
MAYBE LEARN HOW TO DO BETTER BUT
YOU SHOULD BE STARTING OFF LIKE --
I DIDN'T DO VERY WELL TO START
WITH.
I MEAN THAT'S JUST.
AND I DON'T KNOW WHAT YOU'RE
DOING A CONTRACT THEN AT THAT
POINT SO.
ALL RIGHT WELL -- THIS IS I
APPRECIATE WAT YOU'RE DOING
WITH I KEEP A CLOSE EYE ON THIS
BECAUSE THIS IS A SIGNIFICANT
CONSEQUENCES FOR NOT ONLY THE
CHILDREN THOSE CHILDREN BECOME
THE ADULTS AND THE STATE OF
CALIFORNIA AND JOAN OF PEOPLE
KNOW THE HISTORY OF U. P. S. D.
T..
THE FEDERAL PROGRAM.
DON'T KNOW THE HISTORY OF IT NOW
OKAY I REALIZE IT'S LATE BUY ME
A VERY.
AND IT'S I WENT OFF ON MY IN MY
QUALITY MEASUREMENT THING SO YOU
KNOW.
SO BY THE WAY SO HE PST TEA IN
THE MED AND THE MEDICAID PROGRAM
OBVIOUSLY F. AS IN EVERY STATE.
WAS ACTUALLY ESTABLISHED AROUND
THE TIME OF THE VIETNAM WAR.
AND THE REASON IT WAS
ESTABLISHED IS BECAUSE WE HAD A
DRAFT FOR THE WAR.
AND AND THE MILITARY WOULD BACK
AND SAID OKAY ALL THESE RECRUITS
WE HAVE SO MANY RECRUITS WITH.
DISABILITIES ARE PREVENTABLE
CHILDHOOD.
THIS IS A NATIONAL SECURITY
ISSUE EVERY CHILD SHOULD HAVE
ACCESS TO EARLY DETECTION AND
THAT'S WHY THAT'S WHY I GOT A
BGS D. D. STARTED THE MEDICAID
PROGRAM.
BECAUSE THE MILITARY SAID THIS
IS A NATIONAL SECURITY ISSUE WE
CANNOT HAVE THIS PROPORTION OF
OF PEOPLE -- DOWN.
SHOW UP AND WE DRAFT THEM AND TO
HAVE THIS LEVEL DISABILITY NOW I
MEAN I'M.
NOT SURE THAT'S THE MAIN REASON
WE WANT TO BE DOING THIS THING.
BUT CERTAINLY THERE IS IT BUT I
MEAN BUT IF THE SPEAKS TO THAT
RIGHT.
AND SO THIS IS OUR OPPORTUNITY
FOR NOT NECESSARILY WE'RE NOT
TALKING FOR OUR FUTURE HERE IN
CALIFORNIA BE SURE TO CHILDREN
CALIFORNIA BY THE WAY MAJORITY
NOW MAJORITY PEOPLE LIVING HOUSE
CELL.
OF THE CALIFORNIANS ARE PEOPLE
GREW UP IN CALIFORNIA ARE ARE
THE ARE HEALTHY ENOUGH AND AND
AND ABLE TO CONTRIBUTE TO OUR
STATE OUR ECONOMY SO.
AND I INTEND AND WHILE EVERYONE
CAN BUT I MEAN IT'S A STEP THAT
THE INTO THEIR FULL POTENTIAL SO
I APPRECIATE BUT I'M WE WANT TO
FOLLOW THIS VERY.
CAREFULLY.
NOT JUST LIKE GO UP ANOTHER ODD
AND FIND THAT NO NO I DON'T
BELIEVE WE WE TAKE IT VERY
SERIOUSLY AND WANT TO MAKE SURE
THAT WE'RE DOING EVERYTHING WE
CAN OKAY WELL LET ME KNOW I CAN
HELP.
OKAY THANK YOU.
ALL RIGHT PUBLIC COMMENT.
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY WE APPRECIATE
THE DEPARTMENT'S EFFORT TO
IMPROVE QUALITY THROUGH
INCREASED MEASURES -- INCREASE --
MINIMUM PERFORMANCE LEVEL AS
WELL AS FOR INCREASED FREQUENCY
OF THE CAPS SURVEY ESPECIALLY IN
LIGHT OF THE AUDITOR'S REPORT WE
SUPPORT PROVIDING THE DEPARTMENT
WITH THE RESOURCES TO IMPROVE
MONITORING AND ENFORCEMENT.
I BELIEVE THEY'RE STILL A
BENEFIT NOT ONLY CHILDREN BUT
ADULTS AS WELL WE ALSO URGE THE
DEPARTMENT TO LOOK AT HEALTH
DISPARITIES BY REQUIRING PLANS
TO REPORT.
THEY COLLECT DATA A DEMOGRAPHIC
DATA THANK YOU.
THANK YOU ALL RIGHT WELCOME.
THE DINNER WITH WITH THE
CALIFORNIA PEN I THINK HEALTH
NETWORK WE WOULD ALSO URGE -- DH
CS TO CONSIDER -- THE REDUCTION
OF RACIAL ETHNIC AND LINGUISTIC
DISPARITIES IN THE REFORMS AS A
RESULT OF OF THE AUDIT -- IN
PARTICULAR WE WOULD ASK THAT THE
CHANGES TO THE QUALITY
IMPROVEMENT PROGRAM INCLUDING
THE EXPANDED METRICS THAT.
MPL IN CAPS LOOK AT DISPARITIES
AND SET BENCHMARKS FOR HEALTH
PLANS THAT PRIORITIZE THE
REDUCTION OF THESE DISPARITIES
THANK YOU [inaudible]
THANK YOU.
I UNDERSTAND FROM THE DAD THE
LOWEST ONES WERE ACTUALLY UP IN
THE NORTHERN CALIFORNIA
FOOTHILLS.
I DIDN'T PREPARE FOR THAT
QUESTION -- YEAH I DIED I DON'T
I DON'T REMEMBER OKAY MY HEAD I
MEAN IT IT IT DID THAT IT'S NOT
THAT SURPRISING I WOULD SAY
GIVEN SORT OF YOU KNOW WHAT WE
KNOW ABOUT SORT OF GENERAL AREA
BUT YEAH I MEAN I THINK.
THE PROBLEM IS ALL AROUND IT WAS
NOT GOOD SO.
WE WE NEED TO SORT OF DO BETTER
ALL AROUND SO SO I MEAN I THINK
WE HAVE SO WE WILL LOOK AT
DISPARITIES AND MUSHERS YET
GEOGRAPHIC AND AND ALSO THINK
ABOUT WHAT ARE THE TWO BIGGEST
BARRIERS AND PARTICULAR
COMMUNITIES AS WELL I MEAN PART
OF IT ALSO IS -- WHAT'S CULTURE
OR IN TERMS OF PEOPLE GETTING
REGULAR CHECKUPS AND SO FOR THE
REVIEW TOWARD PREVENTIVE
SERVICES THAT'S WHAT THIS IS
CELL AND AND SOMETIMES OUR VIEW
TOWARD.
WELL I MEAN MOST OF FIGHTERS
AREN'T AS A GOVERNMENT BUT STILL
THEIR VIEW TOWARD GOVERNOR CAN
BE.
YEAH WE HAVE A WE DID START THIS
YEAR WITH SOME OF OUR MEASURES
HAVING -- A DISPARITIES
COMPONENT WHERE WE'RE LOOKING AT
IT BY RACE ETHNICITY THAT OUR
PLAN IS THAT ALL OF THEM WILL BE
WILL BE DOING THAT WITH AN ARI
CARR REPORTS SO WE DEFINITELY
AGREE AGAIN AS WE SAID EARLIER
THAT IT DISPARITIES.
NEEDS TO BE FOCUSED ON AND STEP
ONE IS IDENTIFYING WHAT THOSE
ARE SO THAT WE CAN THEN FIGURE
OUT THE STEPS TO TAKE.
OKAY ALL RIGHT WELL.
HOPEFULLY WE CAN DO BOTH.
A REALLY YOU KNOW WE HAVE BOTH --
CONSEQUENCES BUT ALSO MAYBE
CONTINUOUS QUALITY IMPROVEMENT
ACROSS ALL PLANS TO IMPROVEMENT
OKAY.
THANK YOU ALL RIGHT.
WELL.
THAT I THINK -- WE'VE CONCLUDED
THE SECTION ON THE PRIVATE
HEALTH CARE SERVICES.
ALRIGHT I HAVE TO SAY YOU PUT
THAT TO MY TWO FAMOUS FAVORITE
TOPICS TOGETHER IN THE SAME
HEARING.
NOT THAT THE BY THE WAY DR
SOCIAL SERVICE I LOVE YOU.
TOO OKAY THANK YOU SO VERY MUCH
OKAY.
ALL RIGHT -- LET'S.
PEOPLE NEED TO USE THE RESTROOM
OR NOT.
WELL GOOD.
OKAY LET'S GO AHEAD AND BRING UP
THE DEPARTMENT PUBLIC HEALTH AND
EIGHT SO.
I HAVE A I LOVE FOR DDS AS WELL
IN FACT WE'RE ABOUT TO SEND THEM
A LOT MORE PEOPLE I UNDERSTAND.
OKAY SO FOR SOME REASON THIS
WEEK WE'RE DOING PUBLIC HEALTH
LATE INTO THE NIGHT SO I THINK.
THAT ALL RIGHT OF THE NOT TOO
LATE OKAY WELL WELCOME AND I
KNOW WE HAVE A RIGHT TO
DIFFERENT PROGRAMS WILL BEGIN
THE COVERING AND DEPARTMENT
PUBLIC HEALTH -- SO FOR THE
RECORD -- WE SHOULD -- DO THE
ROUND ROBIN INTRODUCTIONS
ALTHOUGH I UNDERSTAND WE HAVE
DIFFERENT PEOPLE FOR DIFFERENT
PROGRAMS FOR C. P. EIGHT SO
LET'S START OFF. FOR THE RECORD
MONICA MORALIS FOR THE
DEPARTMENT OF PUBLIC HEALTH FOR
PRESENTING THE CENTER FOR
HEALTHY COMMUNITIES THANK YOU
HELLO SONYA PEDICLE JUST LIGHT
OF ANALYST'S OFFICE.
Q. FINANCE.
NOT A CALL THE DEPARTMENT OF
FINANCE.
IN THE AROMAS UPON A FINANCE
OKAY.
EXCELLENT ALL RIGHT SO WE'RE
GONNA BEGIN ISSUE NUMBER ONES
ALL TIME REGRET AWARDS AND
GOVERNOR'S TASK FORCE ON
ALZHEIMER'S PREVENTION AND
PREPAREDNESS.
THIS PROPOSAL IS -- REFLECTS A
THREE MILLION INCREASE IN
GENERAL FUND EXPENDITURE AND TWO
DIFFERENT CATEGORIES THE
ORIGINAL PROPOSAL HAS TWO POINT
SEVEN MILLION FOR LOCAL
ASSISTANCE.
AND THREE HUNDRED THOUSAND STATE
OPERATIONS TO SUPPORT -- FUNDING
FOR ALZHEIMER'S AND FOCUSED ON
WOMEN AND COMMUNITIES OF COLOR.
AND ALSO PROPOSES ESTABLISHING
THE GOVERNOR'S TASK FORCE ON NOW
SUMMERS PREVENTION AND
PREPAREDNESS -- I WILL NOTE
THOUGH HOWEVER.
I WILL KNOW HOWEVER THERE IS
SOME UPDATES WERE CURRENTLY
GOING THROUGH THE MAY REVISE SO
THOSE NUMBERS ARE SLIGHTLY
DIFFERENT.
SO WHAT WE'RE PROPOSING -- WITH
THE MAY REVISE IT IS TRIPLE FOUR
MILLION IN LOCAL ASSISTANCE TO
SUPPORT THE GRANTS.
AND SIX HUNDRED THOUSAND STATE
OPERATIONS SO THE STATE
OPERATIONS WILL FOCUS ON
IMPLEMENTING THE TASK FORCE
PUTTING THAT IN PLACE.
AND IN ADDITION TO POSITIONS FOR
THE DEPARTMENT OF PUBLIC HEALTH
TO REALLY WORK ON THE
MINISTRATION THE GRAND
MONITORING THE VALUATION.
AND ALL OF THE REPORTING
ACTIVITIES PERTAINING TO THE
FUNDING -- SO THAT'S REALLY IN A
SUMMARY OF THE PROPOSAL
[inaudible]
HELLO [inaudible]
FINANCE.
JUST LIKE TO CLARIFY THAT -- THE
PROPOSAL BEFORE YOU IS TO DO A
NET ZERO CHANGE FROM LOCAL
ASSISTANCE IS THAT OPERATIONS
AND IT'S PART OF THE APRIL ONE
FINANCE LETTERS THAT YOU'VE
RECEIVED.
OKAY THANK YOU.
ALL RIGHT A PUBLIC COMMENT.
HELLO AGAIN I'M SUSAN DIVORCE
WITH THE ALZHEIMER'S ASSOCIATION
WERE VERY EXCITED ABOUT THE
GOVERNOR'S PROPOSED FUNDING FOR
RESEARCH AS WELL AS THE TASK
FORCE.
AND WE FULLY SUPPORT THIS SHIFT --
TO STATE OPERATIONS OUR PUBLIC
HEALTH INFRASTRUCTURE IS UNDER
RESOURCE.
AND THERE'S NO AREA IN OUR
OPINION WHERE IT'S MORE
PRONOUNCED THAN WHERE AND WITH
RESPECT TO ALZHEIMER'S DISEASE
SO WERE WERE VERY PLEASED THAT
THERE WILL BE STATE OPERATIONS
FUNDING SO THAT WE CAN.
WE CAN START DOING MORE IN THIS
AREA IN PUBLIC HEALTH THANK YOU.
I THANK YOU.
WELCOME HI A GOOD EVENING DOCTOR
PAN -- I APOLOGIZE BUT I
ACTUALLY AT THIS IS MICHELLE
COVERED IT WITH A C. A. YOU AND
WE BROUGHT A MEMBER UP TO
TESTIFY ON I ISSUES TWO AND
THREE AND HE HAS A FLIGHT TO
CATCH.
SO -- IF YOU WOULD PLEASE HUMOR
US COULD HE SAY A COUPLE OF
WORDS ON THOSE ITEMS BEFORE HE
READ IS ACTUALLY.
THE CAN I AFTER WE FINISH PUBLIC
COMMENTS ON SITE.
YES -- TIMERS AND THEN WE CAN
LET HIM GO AND SPEAK OF THAT'S
OKAY WAIT JUST A FEW MORE
MOMENTS OKAY ANYONE ELSE --
PUBLIC COMING ALZHEIMER'S JUST
SO WE HAVE CONTINUITY OF
DISCUSSION.
GOOD EVENING MADELINE COOPER ON
BEHALF OF THE COUNTY OF SAN
DIEGO IN SUPPORT OF THIS
PROPOSAL THANK YOU THANK YOU
[inaudible]
WELCOME.
NO WAY BOTTOM ALWAYS FAIRLY
FOUNDATION UPON REVIEW OF THE
PROPOSAL I HAD SOME CONCERNS
THAT YOU'RE TAKING FUNDING FROM
THE LOCAL ASPECT.
THAT PROVIDES FOCUS ON WOMEN AND
CAN USE OF COLOR BUT UPON -- FOR
ADDITIONAL REVIEW.
WE LOOKED AT IT'S A POSITIVE
THING BECAUSE IT'S NOW ALSO PUT
IN A IN.
A AN ADVISORY BODY THAT'S GONNA
LOOK AT CAN USE A COLOR AND AS A
SON OF A FARM WORKER WHO.
DAD PASSED AWAY FROM ALZHEIMER'S
THAT WE COME OUT WITH SOUND
POLICIES PARTICULARLY FOR THOSE
ISOLATED RURAL FARMER
COMMUNITIES TO ADDRESS THESE
ISSUES THAT THEY ALSO.
NEED THANK YOU VERY MUCH WE
SUPPORT IT OKAY THANK YOU I SEEN
OTHER COMMENT WILL HOLD THIS I'M
OPEN -- DO YOU WISH TO USE I
MAKE SOME ROCKS ABOUT ISSUES TWO
AND THREE I KNOW WE HAVEN'T
HEARD THEM YET THANK YOU I COME
UP.
HERE ARE YOU A DO IT FROM THERE
THAT'S FINE.
THANK YOU SO MUCH HI MY NAME IS
TODD YEOMANS AND REGISTERED
NURSE I'M ALSO A SENIOR HEALTH
FACILITIES EVALUATOR NURSE WITH
THE COUNTY OF LOS ANGELES -- I
WAS HIRED ASA RESULT OF THE
PREVIOUS LEGISLATURES INVESTMENT
LA COUNTY'S LICENSING AND
CERTIFICATION WORK -- S. CI I'M
ALSO A MEMBER OF SEIU -- SEVEN
TO ONE SEIU SUPPORTS THE
GOVERNOR'S PROPOSAL TO FULLY
FUND LOS ANGELES COUNTY'S
LICENSING AND CERTIFICATION
PROGRAM HEALTH FACILITIES
INSPECTION INSPECTION DIVISION --
THESE FINDS ENABLE US -- TO HAVE
ENABLED US TO WORK ON I AM I
BACKLOG OF COMPLAINTS AS WELL AS
TO MEET AND EXCEED SOME OF THE
WORK THAT WE'VE AGREED UPON IN
OUR LAST CONTRACT -- SO PLEASE
INVEST IN LOS ANGELES COUNTY IN
AND TRUST US TO CONTINUE TO
PROTECT.
THE HEALTH AND WELL BEING OF THE
MOST VULNERABLE PEOPLE HONOR.
AND COMMUNITY THANK YOU THANK
YOU VERY MUCH AND PLEASE HAVE A
SAFE FLIGHT OKAY.
ALL RIGHT SO WOULD LET'S GO
AHEAD AND MOVE ON THEN -- TO
WILL HOLD THIS ITEMS OPENS AND
ONE THIS MOVE ON TO ISSUE NUMBER
TWO WHICH IS THE CENTER FOR
HEALTH CARE QUALITY LACING
CERTIFICATION PROGRAM
[inaudible]
WELCOME.
AND DEATH PLEASE INTRODUCE
YOURSELVES FOR THE RECORD FIRST
AND THEN -- PLEASE BEGIN THANK
YOU MY NAME IS HEIDI SIGN OCCUR
AND THE NEW DEPUTY DIRECTOR AT
THE CENTER FOR HEALTH CARE
QUALITY AT C. P..
EIGHT GIVE AND I'M SICK OF GOING
FROM TO THE PITCH.
WELCOME ALL RIGHT LET'S GO AHEAD
AND BEGIN.
THANK YOU THAT'S A GOOD EVENING.
THAT THE CENTER FOR HEALTH CARE
QUALITY WE REALLY SERVE TWO
MAJOR FUNCTIONS FOR THE ST ONE
WE HAVE OUR LICENSING AND
CERTIFICATION PROGRAM WHICH
OVERSEES THE REGULATORY AND
COMPLIANCE FOR QUALITY AND
SAFETY MEASURES FOR OVER TEN
THOUSAND FACILITIES.
IN THIRTY DIFFERENT FACILITY
TYPES.
THE OTHER MAIN FUNCTION FOR CC
QUEUE IS OUR HEALTHCARE
ASSOCIATED INFECTIONS PROGRAM
THAT REALLY FOCUSES MORE ON
EDUCATION AND PREVENTION.
OF HEALTH CARE -- ACQUIRED
INFECTIONS AND WORKS WITH
INFECTION PREVENTION EDUCATION
AND NURSES.
SO FOR THIS YEAR FOR THE CURRENT
YEAR WE'RE LOOKING AT AND WE
HAVE AN APPROPRIATED. TO TWO
HUNDRED EIGHTY ONE POINT ONE
MILLION TO CV PH MORE PRODUCTION
REVISED EXPENDITURE.
THIRTY OF AN INCREASE OF TEN
POINT TWO MILLION OR THREE POINT
6% COMPARED TO THE TWENTY
EIGHTEEN BUDGET ACT FOR BUDGET
YEAR TWENTY NINETEEN TWENTY CCQ
ESTIMATES EXPENDITURES WILL
TOTAL THREE HUNDRED ELEVEN POINT
FOUR MILLION WHICH IS AN
INCREASE OF THIRTY POINT THREE
MILLION OR TEN POINT 8% COMPARED.
TO THE TWENTY EIGHTEEN BUDGET
ACT.
AS FOR NOVEMBER ESTIMATE
OVERVIEW.
RIGHT NOW WE'RE DOING BASICALLY
A DEEP DIVE SINCE I'VE BEEN HERE
IN DECEMBER WE'RE REALLY LOOKING
AT ALL OF OUR PERFORMANCE AND
QUALITY IMPROVEMENT -- PROCESSES
OUR FIRST GOAL IS TO STREAMLINE
ALL OF OUR PROCESSES INFUSE
TECHNOLOGY RATHER THAN HAVING
MANUAL AND AND PAPER PROCESSES
INTO OUR AN EXISTING REGULATORY
FUNCTIONS AND LICENSURE AND
CERTIFICATION.
BUT AFTER WE DO THAT DEEP DIVE
AFTER WE LOOK AT THE STREAMLINE
WE WANTED TO JUST LET YOU BE
AWARE FOR THE NOVEMBER ESTIMATE
THAT WERE ALSO PROBABLY GONNA BE
LOOKING AT A FIFTY SIX POINT
FIVE HEALTH FACILITY BELL THE
CITY'S.
EVALUATOR NURSE POSITIONS AND
THIRTY POINT TO SUPPORT AND
SUPERVISOR SUPERVISOR POSITIONS
FOR A TOTAL OF EIGHTY SIX POINT
SEVEN POSITIONS IN TOTAL AND THE
NOVEMBER ESTIMATE JUST WANTED TO
PUT THAT OUT THERE NOW.
IN THIS PROCESS.
WOULD YOU LIKE ME TO GO THROUGH
THE THE QUESTIONS THAT YOU HAD
OKAY.
SUIT THE FIRST QUESTION WAS
ASKED ABOUT OUR HAVE BEEN --
VACANCY RATE.
SO AS OF MARCH THIRTY FIRST
TWENTY NINETEEN SEATS ACCUSE
OVERALL VACANCY RATE HAS DROPPED
DOWN TO SIX POINT 2%.
AND HEAVEN VACANCY RATE IS NOW
FOUR POINT 2% WE'RE CONTINUING
TO DROP THOSE VACANCY RATES EACH
MONTH -- AS FOR ITEM NUMBER.
THREE AND ONE IN AN UPDATE ON
OUR IS OUR MOST CURRENT TIMELINE
METRICS.
AND WIN POSTED OUR QUARTER ONE
TWENTY EIGHTEEN TWENTY NINETEEN
METRICS FOR TIMELY COMPLETION OF
LONG TERM CARE COMPLAINTS WILL
SHOW THAT CCQ COMPLETED 77% OF
COMPLAINTS RECEIVED AFTER JULY
FIRST IN TWENTY EIGHTEEN WITHIN
SIXTY DAYS.
THIS COMPARES WITH THE FORMER --
EVALUATION TOOL WHICH IS WAS
NINETY DAYS WE USED TO BE ABLE
TO HAVE 82% PERCENTAGE
COMPLETION RATE -- WITH A NINETY
DAY TRADER BUT NOW THAT WE'RE
MOVING DOWN TO THE SIXTY DAY
METRIC THAT IS SHIFTED A BIT.
THIS IS A VERY SLIGHT DECREASE
IN PERFORMANCE IN THE TIMELY FOR
COMPLETION -- HOWEVER SEE TO
CARE RIGHT NOW AS I SAID WE'RE
UNDERGOING -- ROOT CAUSE
ANALYSIS OF ALL OF OUR COMPLAINT
PROCESSES AND WORKING ON ONE SET
STANDARDIZE WAY THAT WE WILL
HAVE COMPLAINTS REVIEWS
THROUGHOUT THE STATE.
ANY OTHER FURTHER QUESTIONS
RIGHT NOW.
AND L. A. L. [inaudible]
FINANCE -- SO.
FIRST OF ALL I APPRECIATE -- YOU
STARTED IN DECEMBER.
RIGHT CONGRATULATIONS -- THIS IS
THE AREA IS A DEPARTMENT THAT
SAID SOME CHALLENGES -- SO I
APPRECIATE HEARING THAT THE
VACANCY RATE IS -- I GUESS WAY
DOWN ACTUALLY -- WHEN I REMEMBER
ATTENDING A MEETING OR -- AND
LOTS OF ACTING FOLKS AND YOU
KNOW AND I THINK THERE WAS --
SEEM LIKE MORALES PRE POORER AND
THINGS ARE TOTALLY BACKLOG LOTS
OF EXCUSES FOR REASONS THINGS
ONE I MEAN I GUESS THAT'S A
TWENTY FOURTEEN L. OUT AND ALL
THAT STUFF SO -- AND PEOPLE ARE
DEPENDING ON YOUR DEPARTMENT TO
KEEP THEM SAFE SO -- AND THEN
TELL YOUR LOTS VACANCIES IN
TURNOVER SO.
HAD TO SEE THAT -- YOU'RE
LOOKING INTO THIS I MEAN THAT
CERTAINLY THINGS ARE MUCH BETTER
THAN THEY WERE THEN ALTHOUGH I'M
SURE THINGS CAN STILL CONTINUE
TO IMPROVE.
A A A A I KNOW YOU DON'T HAVE
ANY COMMENTS FROM LA -- I MEAN
TERMS OF YOUR OBSERVATION OF
THIS DEPARTMENT.
BUT SONY PARTICULARLY -- I MEAN
WE WOULD JUST SAY THAT -- THIS
AT THE CENTER FOR HEALTH CARE
QUALITY AS YOU POINTED OUT AS AS
YOU POINTED OUT -- HAS REALLY.
BEEN UNDERGOING A LOT OF CHANGES
IN RECENT YEARS TO RESPOND TO
SOME OF THE SERIOUS PROBLEMS
THAT WERE OCCURRING IN THE LOW
MORALE AND THE HIGH VACANCY
RATES AN OLD BACKLOGS OF
COMPLAINTS.
AND SO THIS IS IT AN AREA THAT
OUR OFFICE CONTINUES TO KEEP AN
EYE ON IT AND I DON'T THINK WE
CAN EXPECT -- TO SEE LIKE
DRASTIC CHANGES FROM ONE CORNER
TO THE NEXT BUT WE'LL YOU KNOW
WE'LL BE KEEPING AN EYE ON THE
TRENDS OVER TIME AND AS AS SOME
OF THESE NEW PROCEDURES ARE
EMPLOYEES AND AS THE ELLIE THE
NEW ELLIE A PERFORMANCE BASED
CONTRACT -- IS IN PLACE YOU KNOW
WILL BE CONTINUING TO WATCH
THOSE TRENDS OVER TIME.
ALL RIGHT -- WE DO HAVE A
STAKEHOLDER PROPOSAL FROM THE
CALIFORNIA NURSES ASSOCIATION.
WELCOME.
MISTER CHAIR.
THANK YOU FOR THE OPPORTUNITY
PRESENTS ON THIS PROPOSAL --
ORGANIZATION FEELS IT WILL
ULTIMATELY IMPROVE THE INTEGRITY
OF HOSPITAL INSPECTIONS AS
CURRENTLY CONDUCTED BY THE
DEPARTMENT OF PUBLIC HEALTH.
UNDER CURRENT LAW CV PH IS
MANDATED TO DEPLOY A HOSPITAL
INSPECTORS IN ORDER TO CONDUCT
THE INSPECTIONS OF HOSPITALS FOR
UNSPECIFIED PURPOSES.
JUNE THESE INSPECTIONS ARE
INTENDED FOR INSPECTORS TO MAKE
FINDINGS AS WELL AS RESPOND
TIMELY AND PROPERLY TO ISSUES
IDENTIFIED DURING THE INSPECTION
PROCESS.
HOWEVER AS WE'VE HEARD FROM OUR
MEMBERS THE PRESENCE OF
MANAGEMENT DURING THESE
INSPECTIONS HAD HAS HAD A
STIFLING EFFECT ON HOSPITAL
PERSONNEL.
OFTENTIMES INTIMIDATING
PERSONNEL SO MUCH THAT THEY ARE
DETERRED FROM PROVIDING
MEANINGFUL FEEDBACK ABOUT
PATIENT SAFETY ISSUES AND
POTENTIALLY REGULATORY.
VIOLATIONS.
THEREFORE AS NOTED AND
SUBCOMMITTEE AGENDA WE LIKE TO
RESPECT RESPECTFULLY REQUEST
THAT THE SUBCOMMITTEE ADOPT
TRAILER BILL LANGUAGE TO AMEND
SECTION -- ONE TWO SEVEN EIGHT
POINT FIVE OF THE HEALTH AND
SAFETY CODE TO ALLOW EMPLOYEES
OF ENTITIES INSPECTED BY THE PH
TO HAVE THE RIGHT TO DISCUSS.
POSSIBLE REGULATORY VIOLATIONS
ARE PATIENTS SEEKING CONCERNS
WITH INSPECTOR PRIVATELY DURING
THE COURSE OF AN INVESTIGATION
OR INSPECTION BY DPH.
ALSO AS NOTED THIS PROVISION
WOULD -- BE CONSISTENT WITH
LABOR SECTION SIX THREE ONE FOUR
WHICH ALLOWS EMPLOYEES TO SPEAK
PRIVATELY WITH INSPECTORS -- AT
THE DIVISION OF OCCUPATIONAL
HEALTH AND SAFETY OR OSHA.
UNDER EXISTING LAW IF CAL OSHA
INSPECTOR COMES INTO THE
HOSPITAL TO CONDUCT AN
INSPECTION.
THE NURSE THE NURSES AND OTHER
PERSONNEL CAN ASK TO SPEAK
PRIVATELY WITH THAT INSPECTOR.
BUT IF A DPH INSPECTOR COMES
INTO THE SAME HOSPITAL FOR
INSPECTION THE SAME EMPLOYEES DO
NOT HAVE THAT SAME RIGHT TO
SPEAK PRIVATELY.
WE'RE SIMPLY SEEKING PARITY AND
CONSISTENCY UNDER THE LAW THE
PRESENCE OF MANAGEMENT DURING
THESE INSPECTIONS HAS NO
CORRELATION TO IMPROVE QUALITY
OR OUTCOMES -- HAS A CHILLING
EFFECT ON PERSONNEL AND IF
ANYTHING HAS ONLY RESULTED IF
ANYTHING HAS ONLY RESULTED IN
THE EMISSION OF POTENTIALLY
IMPORTANT ISSUES PERSONNEL MAY
SEEK TO HAVE ADDRESSED.
WE ALSO FEEL AS THOUGH ADOPTING
THESE PROVISIONS WILL
POTENTIALLY IMPROVE EFFICIENCY
AS INSPECTORS WILL GET A MORE
ACCURATE DEPICTION.
OF WHAT THE STATE OF AFFAIRS ARE
AT THE END GIVEN HOSPITAL.
WHICH ME ALSO LIKELY RESULT IN
CURBING THE NUMBER OF ADDITIONAL
OR FOLLOW UP INSPECTIONS BEEN
CONDUCTED BY DPH -- PROMPTED BY
PERHAPS ANONYMOUS CALLS FROM
HOSPITAL PERSONNEL FOR EXAMPLE
OR OR OTHERWISE.
WE PREACHER CONSIDERATION OF
THIS IMPORTANT PROPOSAL AND ASK
FOR YOUR SUPPORT IN ADOPTING
TRADING TRAINER BILL LANGUAGE
WHICH WOULD HELP IMPROVE THE
INTEGRITY AND EFFECTIVENESS OF
INSPECTIONS.
AS THE CALIFORNIA DEPARTMENT OF
PUBLIC HEALTH BY ENSURING THAT
EMPLOYEES ARE ABLE TO SPEAK.
UP PRIVATELY WITH CV PH
INSPECTORS JUST LIKE CAL OSHA
EMPLOYEES ARE ALLOWED TO SPEAK
PRIVATELY WITH INSPECTORS.
THANK YOU FOR YOUR ATTENTION TO
THIS IMPORTANT MATTER THANK YOU
ANY COMMENTS FROM C. PH YES CITY
PH M. HAS NO ISSUE WITH THIS
TRAILER LANGUAGE.
OKAY THANK YOU.
ELIA [inaudible]
FINANCE.
WE HAVE NOT SEEN A COPY OF THE
TRAILER BOWLING WHICH I HAVE NO
POSITION AT THIS TIME OKAY ALL
RIGHT WELL CERTAINLY I
APPRECIATE THE PROPOSAL AND VERY
SUPPORTIVE OF THIS -- TELL YOU
AS A RESIDENCY DIRECTOR ON
WEDNESDAY ACCREDITATION BODY
CAME BY TO DO THEIR REVIEW --
THEY HAD THE RIGHT TO TALK TO
THE RESIDENCE WITHOUT ANY OF THE
FACULTY PRESENT AND THAT WAS ALL
RIGHT -- AND I HAD NO FEAR OF
THAT.
BECAUSE I KNEW I WAS DOING THE
RIGHT THING.
AND AND SO I THINK IT'S
IMPORTANT INSPECTORS HAVE AND
THAT'S OUR JOB IS TO INSPECT SO
WHAT HAPPENS IS THAT THEY HEAR
SOMETHING AND THEY'LL POSSIBLES
THERE'S A DISGRUNTLED PLAY BUT
THEY ONCE BACKED AND THEN
THEY'LL SEE WHETHER IT'S TRUE OR
NOT THEY'LL STATE BUT THEY'LL
HAVE A LEAD. TO FOLLOW UP ON AND
THEY AND THEY CAN JUDGE BUT WE
DON'T WANT IS WE DON'T WANT
THINGS BEING HIDDEN AND WHERE
EMPLOYEES ARE TOLD WELL YOU YOU
CAN MEET AND SO FORTH SO WE WANT
TO HELP THE INSPECTORS THAT
INSPECTORS DO THEIR JOB.
GIVEN THE INFORMATION THAT THEY
NEED THEY CAN SORT OUT THE WHEAT
FROM THE CHAFF IF THERE'S ANY IF
THERE'S ANY CIRCUMSTANCE LIKE
THAT.
BUT APPRECIATE THE PRESENTATION
THANK YOU ALL RIGHT EXCELLENT.
OKAY WITH THAT I'LL TAKE PUBLIC
COMMENT.
ON THIS -- ITEM SO WE HAVE THIS
IN THE STAKEHOLDER PROPOSAL SO
THE OVERALL CENTER FOR HEALTH
CARE QUALITY LACING
CERTIFICATION PROGRAMS THE
COLORS OKAY WELCOME.
SENATOR PAN BARBER GLASER WITH
THE CALIFORNIA HOSPITAL
ASSOCIATION I'M NOT A 100% SURE
THIS IS THE RIGHT TIME TO BRING
THIS UP BUT IT HAS TO DO WITH --
LICENSING FEES OF C. H. A. HAS
CONCERNS ABOUT THE RATE AT WHICH
LICENSING FEES ARE INCREASING --
THIS IS THE SIXTH YEAR IN A ROW
THAT AN INCREASE IS BEING
PROPOSED IT'S WORKING OUT TO BE
ABOUT 20% EVERY YEAR AND IN LA
COUNTY IT'S GOING TO BE EVEN
HIGHER.
SO OUR FEES NOW ARE ABOUT A
HUNDRED AND 50% MORE THAN THEY
WERE IN TWO THOUSAND AND
FOURTEEN FIFTEEN AND WE'RE JUST
CONCERNED -- IF THIS RATE
CONTINUES TO INCREASE WHETHER
THAT'S A SUSTAINABLE RATE OR NOT
IT'S IT'S REALLY ADDING TO THE
COST OF HEALTH CARE.
AND WE HAVEN'T SEEN IT.
AN IMPROVEMENT IN OVERALL
QUALITY I KNOW THAT THAT.
THE DEPARTMENT IS TRYING TO
RIGHT SIZE -- BUT THESE FEES
JUST KEEP GOING OUT UP QUITE A
BIT EVERY SINGLE YEAR AND
THEREFORE WE'RE OPPOSED TO THIS
YEAR'S P. INCREASE.
OKAY.
YEAH WE DON'T HAVE A PARTICULAR
MARKER FOR THAT SO THIS IS --
CAN KEEP CAN YOU JUST.
I REALIZE FEES RIGHT VERY ON
SIZE INSTITUTION I MEAN CAN YOU
TELL ME WHAT KIND OF SCALE OF
FEES WERE TALKING ABOUT FOR A
HIGH I GUESS A TYPICAL HOSPITAL
AND OTHER SUCH THING AS A
TYPICAL HOSPITAL BUT YEAH THAT'S
IT THAT IS A DIFFICULT QUESTION
I WAS HAVING.
THIS CONVERSATION WITH SOMEONE
THE OTHER DAY BUT I THINK -- I
WAS LOOKING AT OPERATING MARGINS
IN CALIFORNIA RIGHT NOW ABOUT.
38% OF THE HOSPITAL SEVEN
NEGATIVE OPERATING MARGIN IN SO
IT'S THOSE HOSPITALS THAT ARE
GOING TO FEEL THIS AND IT MAIL
IT MAY BE A TWENTY THOUSAND OR
THIRTY THOUSAND INCREASE BUT
IT'S HAPPENING EVERY YEAR NOW.
AND IN LOS ANGELES COUNTY IT'S
EVEN GREATER FOR HOSPITAL THAT'S
NOT I MEAN IT'S DOING PRETTY
WELL FINANCIALLY IT'S NOT AS BIG
A DEAL BUT IT'S FOR THOSE OTHER
HOSPITALS.
WHERE BASICALLY?
ANY KIND OF P. INCREASES CAN
IMPACT THEM NEGATIVELY SO IT'S I
I CAN'T REALLY ANSWER YOUR
QUESTION OKAY ALL RIGHT NO
PREACH AND JUST TO SCAN A SENSE
OF SCALE SO OVER THAT THAT HELPS
ME SEE TWENTY THOUSAND HERE TO
USE.
THE RIGHT.
WAY YES.
JENNIFER CENTER MAY HAVE THE
CALIFORNIA ASSOCIATION OF HEALTH
FACILITIES AND AGAIN IN THE SAME
POSITION AS THE BAR PLEASE WITH
THE COMPANY POSSIBLE CESSATION
WE WE WE WANT TO BRING UP.
SOME OF OUR CONCERNS RELATED TO
THE INCREASE IN LICENSING FEES
OVER THIS PERIOD OF TIME SINCE --
TWENTY FOURTEEN TWENTY FIFTEEN
YOU WERE LOOKING FOR SOME
EXAMPLES OF KIND OF A A
DIFFERENTIAL -- BACK IN --
TWENTY FOURTEEN NURSING
FACILITIES WERE ASSESSED ABOUT
THREE HUNDRED AND TWELVE DOLLARS
PER BED -- IN LA COUNTY IN
PARTICULAR NOW THAT PROPOSED
THIS YEAR -- PER BED IT'LL BE
OVER A THOUSAND DOLLARS -- IS SO
THAT'S JUST SINCE TWENTY
FOURTEEN OF FOUR FACILITIES IN
OTHER PARTS OF THE STATE -- IT'S
RISEN FROM THREE HUNDRED AND
TWELVE DOLLARS UP TO SEVEN
HUNDRED AND SEVENTY DOLLARS PER
BED SO -- YOU CAN SEE THE
EXPONENTIAL INCREASE THAT WE'VE
SEEN OVER THE LAST THREE YEARS.
WE ARE VERY ENCOURAGED BY THE
NEW NEW LEADERSHIP -- AT THE
CENTER -- AND VERY MUCH -- ENJOY
THE THE DISCUSSIONS AND THAT AND
THAT COOPER ABILITY WE HAVE BUT
JUST CONTINUE TO BE CONCERNED
WITH THAT EXPONENTIAL INCREASES
THAT WE'VE SEEN IN LICENSING
FEES AND WE JUST NEED TO MAKE
SURE THAT FOLKS ARE AWARE OF
THAT.
OKAY THANK YOU SO MUCH.
WELCOME I AM A SUCKER DATA WITH
SEIU CALIFORNIA AND ON BEHALF OF
OUR MEMBERS WHO WORK FOR BOTH
THE STATE AS WELL AS ELLIE
COUNTY AS HEALTH FACILITY
INSPECTION PERSONNEL -- WE
SUPPORT THE STATE'S PROPOSALS
AND WE WOULD LIKE TO AGREE WITH
SOME OF THE COMMENTS AT THE LA --
MADE -- WE'VE BEEN UNDERGOING A
KIND OF A LONG REACH
TRANSFORMATION PROCESS -- AND I
I THINK IT'S IMPORTANT TO
REMEMBER IT STARTS PRIOR TO EVEN
WHEN THE SOME OF THOSE INITIAL
CHANGES STARTED IN BAD BUDGET
YEARS THE LEGISLATURE HELD OFF
ON OR OR I THINK EVEN LOWERED
SOME OF THESE FEES FOR HOSPITALS
BECAUSE WE WERE CUTTING THEM SO
SEVERELY ON THE MEDICAL.
SIDE -- AND THERE WAS JUST THERE
IS SORT OF THIS UNDERSTANDING
DURING THE BAD BUDGET YEARS THAT
WE NEEDED TO NOT GO THERE BUT
WHAT HAPPENED IN THE INTERVENING
TIME IS.
THE PROGRAM CONTINUED TO GROW
AND WE STARTED TO SEE PEOPLE
SUFFER -- THERE WERE DEATHS THEY
WERE REALLY BAD QUALITY OUTCOMES
FOR EVERY HUMANS FOR PATIENTS
AND FAMILIES AND SO WE THINK
IT'S IMPORTANT TO REMEMBER THAT --
WE ARE MAKING PROGRESS WE'RE
MAKING SIGNIFICANT PROGRESS THAT
PROGRESS IS TIED TO TANGIBLE
OUTCOMES AND METRICS THAT THE
LEGISLATURES TRACKING THANKS TO
THAT WORK THAT YOU'VE DONE -- WE
ALSO WANT TO SUPPORT THE CNA
PROPOSAL -- IT AND AGREE WITH
EVERYTHING THAT -- THEY SAID IN
THEIR STATEMENTS THANK YOU.
THANK YOU WELL CERTAINLY WE WANT
TO TRY TO KEEP AS EFFICIENT AS
POSSIBLE IN TERMS OF FEES BUT
RECOGNIZING THAT THAT IS A COST
BUT ALSO OF COURSE WE NEED TO
SUPPORT A REQUEST AND EFFECTIVE.
INSPECTION SYSTEM TO ENSURE
SAFETY SO.
SO GO TO WORK AT THAT AND PLEASE
SEE THE TERROR HAVE BEEN NOW
CERTAINLY SIGNIFICANT MISSING
EVERY IMPROVEMENT SINCE I HAD.
TO JUST AS BEFORE AND SO
APPRECIATE HAVING LEADERSHIP NOW --
THIS AT THE TIME THERE WASN'T
EVEN COULD NAIL THOSE
INSTABILITY EVEN AT THE TOP AND
SO -- BUT ALSO HOPE WE CAN LOOK
AT THIS WERE MOVING FORWARD --
NOT CONTINUING HAVE TO INCREASE
THE INSPECTION COSTS BUT WE WANT
WE WANT YOU TO THE RIGHT SIZE
RIGHT.
NOT TOO HIGH NOT TOO LOW THE
RIGHT SIZE SO I'M SURE YOU'LL
FIGURE THAT OUT.
OKAY SO THE NEXT.
ITEM IS WELL WE PEOPLE MADE
REFERENCE TO IT LOS ANGELES.
ALL RIGHT ISSUE THREE LOS
ANGELES COUNTY CONTRACT.
SO I'M GONNA DO IS THREE AS
GOVERNOR FOR THE DEPARTMENT.
THIS PROPOSAL PROVIDES SEVENTEEN
POINT TWO MILLION DOLLARS IN
FISCAL YEAR TWENTY OF NINETEEN
TWENTY THIRTY POINT TWO MILLION
DOLLARS AND TWENTY TWENTY ONE
AND FIFTY SEVEN POINT THREE
MILLION DOLLARS AND TWENTY ONE
TWENTY TWO FROM FUND. THREE
NINETY EIGHT FOR ADDITIONAL
WATER CITY TO EACH OF THE M.
POSITIONS NURSE POSITIONS.
AND NINETY FIVE SUPPORT STAFF --
COMPANY THOSE NERVES POSITIONS --
THE GOAL OF THIS PROJECT THE
GOAL OF HIS PCP IS TO PROVIDE
FULL FUNDING FOR LOS ANGELES
COUNTY TO ASSUME.
THE THE ABILITY TO COMPLETE ALL
THEIR WORKLOAD ALL THE
COMPLAINTS OLDER BACKLOGS
OVERTIME WE SURVEYS -- WE'RE
HAPPY TO REPORT THAT WE ARE
NEARING THE CONCLUSION OF OUR
CONTRACT NEGOTIATIONS WITH LOS
ANGELES COUNTY.
IT'S BEEN A VERY FRUITFUL A
CONVERSATION THIS LAST NINE
MONTHS OR SO -- WE'VE EXCHANGED
DOCUMENTS BACK AND FORTH BETWEEN
US IN LOS ANGELES COUNTY WE'RE
NEARING THE STAGES OF SIGNING
THE DOCUMENTS GOING FORWARD --
WE FULLY EXPECT THAT WE'LL HAVE
A SIGNED CONTRACT IN PLACE BY
JULY ONE A PART OF OUR
CONVERSATION WITH THEM.
ON THE ON OUR SIDE IS WE'LL ALSO
BE TAKING ONE OF OUR EXISTING
POSITIONS AND DEDICATING IT TO
TO REALLY A CONTRACT MONITORING
OF THE RELATIONSHIP.
TO HELP FOSTER THE ROUTE THE THE
GIVE AND TAKE IN THE DISCUSSIONS
BACK AND FORTH BETWEEN OUR TWO
DEPARTMENTS A SLEW CAN REALLY
EFFECTIVELY MONITOR AND LOOK AT
THE CONTRACT DELIVERABLES
[inaudible]
HELLO.
WE DON'T HAVE ANY SPECIFIC
COMMENTS AT THIS TIME OTHER THAN
TO NOTE THAT -- AS WE REVIEWED
THIS BUDGET CHANGE PROPOSAL --
WE JUST NOTE THAT SOME OF THE
PERFORMANCE MEASURES THAT WILL
BE INCLUDED IN THE CONTRACTOR --
STILL UNCLEAR BECAUSE THEY ARE
UNDERGOING CONTRACT NEGOTIATIONS
IS SORT OF HARD TO ASSESS
WHETHER -- YOU KNOW JUST JUST TO
ASSESS THE THE QUALITY OF THOSE
MEASURES -- AND ALSO NOTE THAT --
OVERALL THE THE CENTER FOR
HEALTH CARE QUALITY IS NOT
REQUESTING ANY NEW.
POSITIONS AT THE STATE.
LEVEL BUT PRESUMABLY -- THE
ADDITION OF OF WORK FORCE IN LA
COUNTY WILL FREE UP SOME OF THE
STATE WORKERS DO THE WORKLOAD
DOWN THERE NOW.
SO -- THE CENTER HAS INDICATED
THAT THERE'S PLENTY OF STATE
WORKLOAD -- TO BE ABSORBED BY IT
BY THOSE FOLKS -- BUT THAT'S
JUST AN ISSUE THAT WE'RE ALSO
GOING TO BE KEEPING AN EYE ON TO
SEE.
HOW IT AFFECTS THE RATE SIZING
OF THE?
OF THE CENTER -- AND FEES ARE
ANOTHER ISSUE THAT WERE KEEPING
AN EYE ON GIVEN THE THE SORT OF
RAPID INCREASE IN FEES
PARTICULARLY IN LA COUNTY GIVEN
THE APPROVAL GIVEN LAST YEAR TO
ASSESS A SUPPLEMENTAL FEE THERE.
WE'RE NOT SURE THAT IT -- YOU
KNOW AT SOME POINT WE EXPECT THE
FEES WILL SORT OF STABILIZE ONCE
ONCE THE CENTER AND LA COUNTY OF
KIND OF REACHED A YOU KNOW
PROPER A STAFFING LEVEL BUT
ANYWAYS JUST TO KNOW THAT THOSE
ARE SOME OF THE THE ISSUES THAT
OUR OFFICE IS KEEPING AN EYE.
ON BUT WE DON'T HAVE ANY
SPECIFIC COMMENTS ABOUT THE
PUZZLE.
ALL RIGHT FINANCE.
HEY YEAH I MEAN WE WE SELL.
IT YEAH YEAH YOU STILL PROCESS
OF NEGOTIATING SELL THE GETTING
CLOSE.
THE QUESTION IS GOING TO BE A
YOU KNOW WHAT THE FEE
DIFFERENTIAL BETWEEN LA COUNTY
SINCE.
AND THE REST OF THE STATE AND
THEN AT WHAT POINT IS THIS
THOUGH IS THAT THE THERE'S A
STABILIZER SO WE HAVE.
SO YOU'RE WORKING ON TRYING TO
DO THAT BUT ALSO SINCE YOUR
CONTRACT WITH THE LA COUNTY WHEN.
IS THE IS THE HOUSE THAT BUILT
INTO THE CONTRACT RIGHT I MEAN
IS THIS A STRAIGHT LINE
EVERYTHING KEEPS GOING UP
CONTRACTORS OR SOME POINT.
THAT IT'S GONNA LEVEL THE THE
THE ZONE IT AGAIN WE HEARD ABOUT
FEES. FOR SO I I DON'T KNOW HOW
TO USE I DON'T HAVE YOU CAN
SPEAK TO THAT YET OR NOT SO
OBVIOUSLY THIS IS THE FIRST
YOU'RE AUGMENTATION THEY WERE
BUILDING IT INTO THE SHOW'S FEES.
IS IS THE THREE YEAR CONTRACT AS
OF THE HIRE MORE STAFF OF THE
OLD POLICY BE.
INCREASES BY THE END OF YOUR
THREE THOUGH WE'RE HOPING THAT
IT WILL BE MORE OR LESS A
THEN YOU MIGHT HAVE THE COOL
EFFECTS OF OF SALARY INCREASES
AND WHATNOT SO -- WE'RE HOPING
TO ESTABLISH THE RIGHT METRICS
TO DETERMINE HOW MANY STAFF.
ACTUALLY NEEDS TO PERFORM THE
WORKLOAD AND THEN DEPENDING IF
MORE WERE COMES IN -- YOU KNOW
CMS GIVES US MORE WORK TO DO
OTHER SOME UP TICK IN THE NUMBER
OF SLEAZE -- COMING INTO --
OPERATIONS THAT MIGHT DRIVE
ADDITIONAL OF POSITIONS BUT
THERE SHOULD BE A LEVELING OFF
AFTER YOUR THREE OKAY.
US ALL RIGHT.
THE KNOWLEDGE THAT DEGREE FOR
NURSING HOMES -- WERE THE MAIN
PAIR.
SELLS THE FEES GO UP I'M NOT
SURE WE'RE PAYING AT THE OTHER
END [inaudible]
BECAUSE AFTER HOTEL THEY PAY FOR
THEIR FEES BY WHAT WE PAY THEM
TO CERTAIN EXTENT NOW AT LEAST
EIGHTY ROUTE 80% I THINK SO.
ALL RIGHT.
OKAY.
PUBLIC COMMENT.
GOOD AFTERNOON MY NAME IS ANGELA
BLOWN LIME DEPUTY DIRECTOR FOR
PICK UP THE PUBLIC HEALTH
DEPARTMENT IN LA COUNTY.
AND WE WANT TO START OF COURSE
BY THANKING THE GOVERNOR FOR HIS
PROPOSAL TO INCREASE FUNDING IN
OUR CONTRACT WITH ST DPH WERE
ALSO VERY OPTIMISTIC ABOUT THE
CHANGE IN LEADERSHIP AT THE AT
THE DEPARTMENT -- WE ON WE WHO
ALSO WANT TO MENTION THAT OUR
BOARD OF SUPERVISORS STRONGLY
SUPPORTS THE ADMINISTRATION'S
PROPOSAL.
LA COUNTY AS I THINK MOST OF YOU
KNOW SINCE THE NINETEEN SIXTIES
HAS BEEN CONTRACTED BY THE STATE
TO PERFORM THESE INSPECTIONS.
IN ABOUT THREE THOUSAND
FACILITIES IN IN THE COUNTY OF
LOS ANGELES -- THERE WAS AT ONE
POINT IN TWO THOUSAND FOUR
FOURTEEN AS YOU MENTIONED MEDIA
REPORTS ABOUT.
A POOR PERFORMANCE NOT ONLY IN
LA COUNTY BUT STATE WIDE.
THERE WAS A RIGHT SIZING OF THE
PROGRAM IN LA COUNTY BOY WHAT
THAT RIGHT SIZING DID IS IT IT
FUNDED US SUFFICIENTLY TO TAKE
ON ABOUT 60% OF THE WORKLOAD.
AND DOT NOW WHAT WE'RE DOING
OVER THE COURSE OF THIS NEW
CONTRACT IS TO GRADUALLY
TRANSITION ALL OF THE WORKLOAD
IN LA COUNTY. TO THE COUNTY OF
LOS ANGELES AND THAT'S THE UP
THE BASIS FOR THIS.
AS OF SCOTT MENTIONED IT THE
LEVELING OFF WILL OCCUR IN IN
THE THIRD YEAR OF THAT CONTRACT
AND THEN WE'RE SUBJECT TO JUST
ANNUAL COST INCREASES.
LET ME JUST SAY A COUPLE OF
OTHER THINGS IN TWO THOUSAND
FIFTEEN WITH SUPPORT OF THE
ADMINISTRATION.
ACTUALLY WOULD SUPPORT OF THIS
SUBCOMMITTEE THE COUNTY DID.
MAKE THAT INCREASE THAT I
MENTION THAT RIGHT SIZE I THINK
WE'VE COVERED THAT AND THE
PROGRAM GREW FROM A
1-005-122-0020.
FOUR THE PROGRAM WHEN IT'S FULLY.
CAPABLE OF ASSUMING THE FULL
WORKLOAD IN LA COUNTY WILL GROW
BY ABOUT ANOTHER 50% SO WE'RE
WE'RE TALKING ABOUT SIGNIFICANT
GROWTH HERE.
BUT JUST AS WE WERE ABLE TO
PERFORM VERY WELL IN MET ALL OF
OUR EXPECTATIONS ON THE LAST
CONTRACT WE'RE COMMITTED TO
DOING THE SAME WITH THIS NEW
CONTRACT -- WE'RE FINALIZING THE
TERMS OF THE CONTRACT AS WAS
SAID THE CONTRACT SPECIFIES
METRICS.
FOR A HOW TO MEASURE THE
COUNTY'S PERFORMANCE IN THREE
AREASTHE QUALITY OF OUR WORK
THE QUANTITY OF OUR WORK AND
CUSTOMER SERVICE.
THERE IS ALSO A PROVISION THERE
THAT IF THE COUNTY DOESN'T EET
ANY OF THE ANY OF THE TARGETS
THAT ARE ESTABLISHED.
ALTHOUGH WE'RE COMMITTED TO
DOING THAT THERE IS AN ABILITY
FOR THE STATE TO WITHHOLD SOME
OF THE FUNDING IF WE DO NOT MEET
THOSE TARGETS.
FINALLY WITH REGARD TO THE
BACKLOG BECAUSE THAT'S BEEN A
CONCERN THAT THE SUBCOMMITTEE
AND DOUBT MANY OTHERS IN THE
STATE HAVE SHARED WITH WITH OUR
COUNTY DEPARTMENT.
THAT GROWING BACKLOG HOW WE'RE
GOING TO HANDLE THAT IS THAT THE
CONTRACT PROVIDES -- FOR
SUFFICIENT FUNDING SO THAT IN
TERMS OF NEW COMPLAINTS THEY
WILL ALL BE OB RESOLVED IN THE
TIME FRAMES THAT ARE SPECIFIED.
AND NO NEW COMPLAINT THAT'S
RECEIVED WILL GO BEYOND THE YEAR
THAT IT'S RECEIVED BEFORE ITS
RESULTS SO THAT'S HOW WE DEAL
WITH NO GROWTH IN THE IN THE
BACKLOG.
AND THEN NOT WITH REGARD TO THE
EXISTING BACKLOG THAT WILL BE
CUT IN HALF AT THE END OF THE
THIRD YEAR AND THEN WE IN THE
STATOR TALKING ABOUT HOW WE MAKE
THAT FINAL PUSH.
WE UNDERSTAND THAT THE ITEM IS
GONNA BE HELD OPEN TODAY BUT WE
REQUEST YOUR BUDGET
SUBCOMMITTEES OUGHT TO APPROVE
THE GOVERNOR'S PROPOSAL.
IN UPCOMING HEARINGS THANK YOU
VERY MUCH.
THANK YOU AND NORMALLY -- FOR
PUBLIC COMMENTS ONE MINUTE BUT
SINCE YOU IN A UNIQUE POSITION
AND IT'S SOMEPLACE REALLY COMEDY
ON THIS FRIDAY IT INFORMATION
THIS PROPOSAL I WANT TO LET YOU
CONTINUE.
AND I I JUST WANTED TO SAY THAT
A MOCCA OR ON TO SEE WHO IS THE
CHIEF OF THE HEALTH FACILITIES
INSPECTION DIVISION WITHIN OUR
LA COUNTY HAS A FEW REMARKS AS
WELL.
OKAY AND IF YOU CAN KEEP THEM
BRIEF I'D APPRECIATE IT THANK
YOU.
GOOD AFTERNOON I'M A MACARON CM
THE CHIEF OF LOS ANGELES COUNTY.
PUBLIC HEALTH HEALTH FACILITIES
INSPECTION DIVISION IN JUNE
TWENTY FOURTEEN THE COUNTY
HEALTH FACILITIES INSPECTION
DIVISION WAS PLACED UNDER MY
DIRECTION.
LOS ANGELES COUNTY'S CURRENT
CONTRACT EXPIRES ON JUNE.
THIRTY TWENTY NINETEEN AND I AM
PROUD TO SAY THAT THE COUNTY HAS
MET.
I NEED SOME CASES EXCEEDED ITS
CONTRACTUAL OBLIGATIONS IN THE
FIRST THREE YEARS OF THIS
CONTRACT -- WE ARE ON TRACK TO
MEET OUR OBLIGATIONS THROUGH THE
END OF A CONTRACTOR.
UNDER THE NEW CONTRACT LA COUNTY
WILL GRADUALLY AS IN FULL
RESPONSIBILITY OF WALKING --
GENERATED BY HEALTHCARE
FACILITIES AND THE COUNTY OVER
THE COST OF THE THREE YEAR TERM.
WE BELIEVE WE HAVE DEMONSTRATED
IN THIS CURRENT CONTRACT THAT WE
ARE CAPABLE [inaudible]
KILLED.
STRATEGIC AND ENTHUSIASTIC ABOUT
PROVIDING THESE VITAL SERVICES
TO THE MOST VULNERABLE
POPULATION IN LA COUNTY.
THANK YOU -- WE APPRECIATE THE
OPPORTUNITY TO PROVIDE INPUT AS
YOU CONTINUE YOUR BUDGET
CONSIDERATIONS THANK YOU THANK
YOU VERY MUCH.
HI MICHELLE COVERED IT WITH A C.
A. U. CALIFORNIA AND AGAIN
BRINGING SOME HISTORICAL
PERSPECTIVE HERE -- LA COUNTY
ACCOUNTS -- FOR RATIONALLY ABOUT
A THIRD OF THE STATE'S WORKLOAD
IN TERMS OF THE OF LICENSING AND
CERTIFICATION PRIOR TO THE START
OF THE RIGHT SIZING.
THEY GOT ABOUT 15% OF THE
STATE'S FUNDING AND SO THERE WAS
A LONG PERIOD OF TIME WHERE WE
WERE REALLY -- IN ESSENCE IN
THOSE FEES WERE SPREAD OUT
THROUGHOUT THE STATE OF THAT AT
THAT TIME IT WAS ONLY LAST YEAR
THAT WE STARTED ADDING ON THE
SUPPLEMENTAL FOR LA ONLY.
IT DOESN'T HAVE TO BE DONE THAT
WAY MOVING FORWARD IT WAS
DECISION BY THAT PRIOR
ADMINISTRATION TO DO IT THAT WAY
BUT I WOULD JUST NOTE THAT WE
WERE PIGGY BACKING OFF OF LA. TO
FUND THE AT THE REST OF THE
STATE IN ESSENCE FOR AWHILE HELL
AND THEN WE DECIDED TO START TO
RIGHT SIZE AND NOW WE'RE SORT OF
CONCENTRATING AN EXTRA -- FOR
YOU KNOW FEE ON LA SO I THINK
MOVING FORWARD WE SHOULD THINK
ABOUT THAT A LITTLE BIT IF WE
ARE CONCERNED ABOUT THE
DISPARITY BETWEEN LA AND THE
OTHER PARTS OF THE STATE OKAY
THANK YOU.
THANK YOU THANKS VERY MUCH.
OKAY.
GOOD WELL WE WILL BE HOLDING THE
SIDE OF OPEN AND I DON'T HAVE.
MEMBERS HERE TO VOTE ON IT
ANYWAY SO.
THAT THE APPRECIATE THE THE
TESTIMONY.
ALL RIGHT SO -- THE MOVING ON WE
HAVE OUR ISSUE NUMBER FOUR
SECRETION A CENTRALIZED PROGRAM
FLEX UNITS.
RIGHT THANK YOU THIS PROPOSAL
PROVIDES NINE EARN SEVENTY THREE
THOUSAND FROM FUND -- THIRTY
NINETY EIGHT TO FOR AN ON GOING
FOR SIX POSITIONS JUST I WAS A
CENTRALIZED PROGRAM FLEX UNIT SO
PROGRAM FLEXES ARE JUST
BASICALLY -- WAIVERS IF YOU WILL
WHERE AND FACILITIES ARE ABLE TO
TRY TO MEET SEE AN ALTERNATE
MEANS OF COMPLIANCE.
SO SOMETIMES THESE HAPPEN IF WE
HAVE OUTDATED -- REGULATIONS
WHERE THEY NEED TO PRY PROVIDE A
PROGRAM FLEX OR IT MIGHT ALSO BE
IN SOMETHING IN THE CASE LIKE
RECENTLY IN CHICO AFTER THE
FIRES.
WE HAD TO PROVIDE LOTS OF
PROGRAM FLEXES FOR LET'S SAY
EMERGENCY RESPONSE SIR YOU KNOW --
ALTERNATE MEANS OF COMPLIANCE
GIVEN THAT THIS SITUATION.
SO WE'RE REQUESTING FOR THESE
FUNDS FOR THE TWENTY NINETEEN
TWENTY EARLIER.
FINANCE PUBLIC COMMENT.
CASEY NONE.
RIGHT THANK YOU -- WILL HOLD
THAT ITEM OPEN -- LET'S MOVE ON
TO ISSUE NUMBER FIVE INCREASED
IT CUSTOMER SUPPORT.
THIS PROPOSAL PROVIDES NINE
HEARD ELEVEN THOUSAND FROM FUND
309-842-01920 AN ONGOING FOR SIX
I TST POSITIONS TO ADDRESS IT
SUPPORT NEED.
AS WE ARE TRYING TO MODERNIZE
OUR PROCESSES AND HAVE MORE
TECHNOLOGY OUT OF THE FIELD
THERE FOR WE NEED MORE IT
SUPPORT.
TO HELP THE STUFF WITH THOSE
TOOLS.
THANK YOU L. L..
FINANCE PUBLIC COMMENT.
OKAY SO I THE I GUESS ONE TIME
AND I WOULD JUST MAKE -- AND
TERMS OF OUR I. T. I THINK I'VE
MADE IT FOR IS THAT -- AS WE
MAKE OUR EIGHTEEN INVESTMENTS --
ALSO LIKE TO SEE HOW WE MAKE
THESE INVESTMENTS -- HOW THAT
EITHER HELPS IMPROVE THE THE
QUALITY OF SERVICE OR DEFICIENCY
OF THE PERSONNEL WE HAVE SO THAT
PEOPLE ARE ABLE TO DO THINGS
FASTER BE ABLE TO MANAGE MORE?
AND CETERA SO -- CERTAINLY WE
WANT MORE OF THAT BUT WE ALSO
WANT TO DEMONSTRATE WE BUILT
INCREASED CAPACITY IN SOME WAY
WITH OUR INVESTMENTS.
CERTAINLY.
AND THAT'S SOMETHING I'VE SAID
TO MANY PEOPLE SO YOU'RE NOT.
OKAY IT NEXT ISSUES ISSUE NUMBER
SIX TIME LINES FOR HOSPITAL
LICENSING APPLICATIONS.
THIS PROPOSAL PROVIDES THREE
POINT FOUR MILLION FROM FROM
309-842-01920 AND ON GOING FOR
TWENTY ONE POSITIONS TO COMPLETE
THE DECISIONS. FOR THIS TIME TO
COMPLETE THE LICENSING
APPLICATIONS THIS IS BACKED FOR
AB TWENTY SEVEN NINETY EIGHT
JUST TO FIND -- BE ABLE TO FIND
US TO BE ABLE TO COMPLY WITH
TWENTY SEVEN NINETY EIGHT WHERE
WE NEED TO MAKE SURE THAT WE'RE
SUBMITTING IT -- OUR ANSWERS ON
THE AND GAC APPLICATION WITHIN
HUNDRED DAYS A RECEIPT -- ALSO
THE TRAILER BILLING WHICH HERE
IS IMPORTANT AND THAT WE ARE
REQUESTING IT TO USE FUN THIRTY
NINETY EIGHT AM TO DO THIS
RATHER THAN THE ID Q. A. FUNDS
THAT'S MORE APPROPRIATE -- I
THINK THAT WAS JUST LEFT OUT
INITIALLY OKAY.
HELLO COMMENTS.
FINANCE OKAY SO YOU'RE GOOD WITH
DURING DINNER FOR FUN THEN.
HE SAID YOU'RE GOOD WITH THEIR
PROPOSAL USE THE OTHER THAN
OTHER FUNDS MORE APPROPRIATE.
OKAY GOOD PUBLIC COMMENT.
OKAY CNN ALL RIGHT.
THANK YOU -- WALL THAT ITEM OPEN
AS WELL -- ISSUE NUMBER SEVEN
ONLINE DISTANCE LEARNING NURSE
ASSISTANT TRAINING PROGRAMS OKAY
SO THIS PROPOSAL PROVIDES ONE
POINT TWO MILLION DOLLARS FROM
FUND THIRTY NINETY EIGHT AND
TWENTY NINETEEN TWENTY AN
ONGOING FOR NINE POSITIONS%
REVIEW APPROVE MONITOR --
APPLICATIONS FOR NEW ONLINE AND
DISTANCE LEARNING NURSE
ASSISTANT TRAINING PROGRAMS
INSTRUCTORS AS REQUIRED BY
CHAPTER OF SOME SIXTY NINE FROM
LAST YEAR.
OKAY.
THOMAS MILLION -- FINANCE PUBLIC
COMMENT.
OKAY WELL I APPRECIATE.
THE THIS INVESTMENT -- WE HAVE A
SHORTAGE OF C. N. A.'S AND SO
ANYTHING WE CAN DO TO HELP --
INCREASE THE SUPPLY WE HAVE BOTH
WE HAVE SHORT BECAUSE THE
TURNOVER WE HAVE GEORGE IN TERMS
OF ENTRY SO.
ONE SO APPRECIATE THAT WE'RE
DOING THIS OKAY -- ISSUE NUMBER
EIGHT ASSISTING IN
IMPLEMENTATION OF PROJECTS
BENEFIT NURSING HOME RESIDENTS
OKAY SO THIS PROPOSAL PROVIDE
SIX SEVENTY THOUSAND DOLLARS IN
NINETEEN TWENTY FOUR AND THIRTY
ONE THOUSAND AND TWENTY TWENTY
ONE TO FUND CMS APPROVED NURSE
ALICIA PROJECT.
AND REQUEST A HUNDRED FORTY NINE
THOUSAND DOLLARS IN TWENTY
TWENTY ONE AND ON GRANT TO
SUPPORT ONE POSITION TO MOUNT
MANAGE AND MONITOR ALL OF OUR C.
MUST APPROVE CONTRACTS -- WE
ALSO ARE ASKING FOR TROUBLE
LANGUAGE THAT WILL ALLOW.
US -- TO WITH NOTICE TO THE
LEGISLATURE INCREASE OUR
APPROPRIATIONS AT CMS APPROVED
PROJECTS THROUGHOUT THE THE THE
FISCAL YEAR.
OKAY EXCELLENT HELLO.
FINANCE PUBLIC COMMENT.
OKAY.
SEE NONE -- EXCELLENCE WILL HOLD
THIS ITEM OPEN AS WELL AND PRE
SHEET -- BEGINS OPPORTUNITY --
FOR HELPING DIZZY FIZZY FUN OKAY
SO THANK YOU -- THANKS SO MUCH
FOR BEING HERE AND YOUR
PRESENTATIONS RIGHT.
THANK YOU I PRESUME YOU'RE NOT
HERE FOR THE CENTER EFFECTS
DISEASES ALL RIGHT.
OKAY CENTER.
FOR OKAY IT'S MOVING ON TO THE
CENTER FOR INFECTIOUS DISEASES
[inaudible]
AND WE ACTUALLY HAVE.
SERVE IN A REVIEW AND THEN WE
HAVE NUMEROUS STAKEHOLDER
PROPOSAL SO.
I THINK -- THE GUY AND YOU.
THAT SOUNDS LIKE I KNOW YOURS I
KNOW YOU'RE STILL HERE BUT WE
GOT NEW PEOPLE AROUND THE TABLE
SOME ABLE TO JUST DO A QUICK
ROUND ROBIN OF INTRODUCTIONS SO
YOU KNOW WHO'S HERE [inaudible]
YES.
YOU'LL COME.
DIRECTOR FOR INFECTIOUS DISEASES
OKAY [inaudible]
HELLO FINANCE.
WELCOME THE NUMBERS ALL FINANCE.
IN THE ANIMALS FINANCE OKAY.
WELCOME SO BLACK PEOPLE
INTERESTED FAXES THESE IS NOW
ALL RIGHT.
WANTED -- TO YOU YOU ACTUALLY
HAVE GREAT WRITE UP OF OUR
CENTER YOUR OWN HOME.
DOCUMENTS TODAY SO I WANT ON I
LOVE VERY MUCH ON THAT OTHER
THAN TO SAY THAT.
OUR CENTER ON I BELIEVE THERE IS
A VERY IMPORTANT FUNCTION IN
PUBLIC HEALTH.
OUR MAIN GOAL IS ONE OF
PROTECTING HEALTH.
AND AND WE DO THAT VERY
DILIGENTLY.
WE HAVE A NUMBER OF SURVEILLANCE
MONITORING SYSTEMS ARE WE HAVE
LABORATORIES THAT ARE ON I MAKE
A VERY PROUD THAT OUR NATIONAL
EXAMPLE.
NOW WE CARRY OUT ON A NUMBER OF
PROGRAMS -- WE ALSO PROVIDE AND
DISPENSE MEDICATIONS TO PEOPLE
THAT NEED THEM FOR ON SOME OF
THE CHRONIC COM AFFECTIONS.
BUT I THOUGHT I MIGHT JUST A
LITTLE BIT OF MY TIME WITH YOU
TODAY TO GIVE YOU AN UPDATE ON
THE MISSILE SITUATION I KNOW
THAT'S AN ITEM OF INTEREST TO
YOU.
OUR IS SO THAT'S OKAY WITH OU
WILL TAKE A COUPLE MINUTES JUST --
TO FILL YOUR WHAT IS STILL
HAPPENING.
AS YOU KNOW -- WE HAVE -- BEEN
EXPERIENCING AN INCREASE IN THE
NUMBER OF MEASLES CASES IN
CALIFORNIA -- JUST FROM LAST
WEEK TO THIS WEEK AND WE SAW AN
INCREASE OF FIFTEEN CASES WE NOW
HAVE.
THIRTY EIGHT CASES ARE IN
CALIFORNIA.
THOSE CASES ARE ALL ON YOU SOME
FORM RELATED TO TRAVEL -- WE
HAVE ON A FIFTEEN OF THOSE CASES
DIRECTLY THEMSELVES TRAVELED TO
INTERNATIONAL LAW THIS THE
NATION'S -- IMPORTANT TO NOTE
THAT THIS INITIALS OF TRAVEL
HAVE A LOT TO DO WITH THEIR OWN
GOING ON THE SITUATION IN
CALIFORNIA -- THERE ARE.
THE WORLD HEALTH ORGANIZATION
REALLY LARGE OUTBREAKS.
OF THE WORLD INCLUDING THE
UKRAINE AND INCLUDE IN THE
PHILIPPINES.
HI AND THOSE ARE AREAS THAT --
CALIFORNIA TRAVELERS FREQUENT ON
QUITE A LOT.
SO ARE RETURNING TRAVELERS FROM
THOSE AREAS AND A FEW OTHERS --
HAVE ON HAVE RETURNED TO
CALIFORNIA AND THEN -- INFECTED
OTHER CALIFORNIANS HERE -- WE
HAVE HOT ON OR WE HAVE A TOTAL
OF FOUR OUTBREAKS SO FAR IN
DIFFERENT PARTS OF THE STATE.
WE HAVE A ONE WE HAD ONE SMALL
OUTBREAK IN THE BAY AREA THAT IS
CONTROLLED.
WE HAVE A VERY SIGNIFICANT
OUTBREAK IN BUTTE COUNTY.
THAT NOW HOUSES ON NINETEEN
CASES AND THAT'S ALL FOR ONE
SINGLE TRAVELER WHO.
EFFECT AT ALL THERE SO ALL
OTHERS EFFECTED OTHERS.
WE HAVE -- SMALL OUTBREAK IN --
LA AND ONE IN SACRAMENTO.
HI END SO THAT APARTMENT HOUSE
AROUND TOP OUR PUBLIC HEALTH
SYSTEM TO MAKE SURE THAT WE REST
RESPOND AGGRESSIVELY -- WE
BELIEVE THAT GIVEN THE
INTERNATIONAL SITUATION.
OF THE FACT THAT WE HAVE HAD AS
A FEW SECONDARY CASES AS WE HAVE
IS A GOOD TESTAMENT OF THE
PUBLIC HEALTH RESPONSE.
WE HAVE A NUMBER OF TRAVELERS
WHO HAVE EFFECTED NO -- ONE AND
THAT'S NOT BUT COINCIDENCE THINK
OF A PART OF THAT IS THERE HIGH
RATES OF IMMUNIZATION THAT WE
HAVE IN CALIFORNIA THANKS TO
YOUR LEADERSHIP.
NOW IN CALIFORNIA ALL ABOUT 95%
OF FROM SCREEN -- KINDERGARTNERS
COP THAT COUPLED WITH OUR VERY
SWEET PUBLIC HEALTH ACTION IN
CONTAINING EXPOSURES IN AND AND
MAKING SURE PEOPLE GET TREATED
ON VACCINATED HUSBAND QUITE
SUCCESSFUL.
NONE THE LESS WE HAVE ACTIVATED
OUR EMERGENCY RESPONSE SYSTEM --
AND TODAY WE ACTUALLY HAD A
PRESS CONFERENCE THERE WAS A LOT
OF INTEREST IN THE MEDIA -- AND
SO I THINK TONIGHT YOU WILL SEE
ON THE NEWS QUITE A LOT OF NEWS.
ABOUT THAT OUR MAIN POINT HAS
BEEN TO MAKE SURE THAT
CALIFORNIANS THAT TRAVEL
OVERSEAS.
I INSURED OTHER FULLY VACCINATED.
ANA AND SO THAT'S BEEN OUR MISS
ME MESSAGE COUPLE BY A MESSAGE
THAT IF YOU'RE TRAVELING YOU'RE
SICK.
I MAKE SURE TO CALL YOUR HEALTH
CARE PROVIDER NOT BASE IN THE E.
R. -- VISITED THE DOCTOR'S
OFFICE AND GET SOME INSTRUCTIONS
ON WHAT TO DO AND DON'T EXPOSE
OTHERS. TO THINK THAT'S AN
UPDATE ON ME SO SOME OF YOU HAVE
OTHER QUESTIONS WE CAN CONTINUE.
THANK YOU ACTUALLY THIS IS THE
BUDGET COMMITTEE AND I KNOW I
ASKED YOU THIS QUESTION ABOUT.
THE OUTBREAK IN. TWENTY FOURTEEN
FIFTEEN AND I KNOW THAT PART OF
THE RESPONSE WAS THAT YOU KNOW.
WHEN THERE'S AN OUTBREAK YOU'RE
JUST TOO BUSY RIGHT TO SIT THERE
AND?
KEEP A TALLY ON EXACTLY HOW MUCH
TIME PEOPLE ARE SPENDING ON ARE
YOU -- GIVEN BY THE TIME THE
CASE IS NOW 383-8 CASES.
ARE YOU TRACKING THE COST OF THE
ALL THE WORK THAT'S ASSOCIATED
WITH THESE OUTBREAKS HOW MUCH
IT'S COSTING THE STATE HOW MUCH
IT'S COSTING THE VARIOUS
COUNTIES -- TO DO THIS THE THE
NATURE OF THE FACT THAT.
WE WE HAD A HEARING BEFORE THAT
PERSONNEL BEING PULLED OFF OF
THE REGULAR TASKS. TO OTHER DO
OTHER PUBLIC HEALTH FUNCTIONS.
TO DEAL WITH THE THESE OUTBREAKS --
CAN CAN YOU PERHAPS SPEAK A
LITTLE BIT.
TO THE THE COST OF THE OVER
BUDGET SUBCOMMITTEE ON WITH THE
TO BE BUDGETING MONEY FOR THIS
NOW.
CORRECT SO YOU'RE ABSOLUTELY
RIGHT AND HE'S NOT JUST THE THE
THIRTY EIGHT CASES ON IT IS THAT
EVERYONE OF THOSE CASES RESULT
IN HUNDREDS AND HUNDREDS OF
EXPOSURES.
ARE FREQUENTLY IN AIRPLANES --
IN DIFFERENT VENUES THOUGHT
CALIFORNIA FROM SHOPPING CENTERS.
TO MALLS TO JAMS AND SO EVERYONE
OF THOSE EXPOSURES HAS TO BE
CONTACTED.
BY A PUBLIC HEALTH WORKER AND
PROVIDE AN INSTRUCTIONS ON WHAT
TO DO AND FREQUENTLY THOSE ARE
VERY.
DIFFICULT TO THE WE HAVE TAKEN
YOUR INSTRUCTIONS VERY SERIOUSLY
AND JUST YESTERDAY WE HOT.
ON ALL COUNTY CALLED WHERE WE
BASICALLY A TALL FOLKS WE HAVE
IMPLEMENTED ON OUR EMERGENCY
RESPONSE SYSTEM HERE'S THE
UPDATE ON MISSILES.
AND ONE OF THE THINGS THAT WE
ARE TAKING VERY SERIOUSLY IS
ASKING EVERYONE OF THOSE FOLKS
AT THE LOCAL LEVEL. TO HELP US
KEEP TRACK OF THE COSTS DURING
CURRENT -- IMPORTANT TO NOTE TO
THEM TO NOT JUST KEEPING TRACK
OF COSTS FOR MEASLES CASES ABOUT
ANYTHING THAT THEY DO RELATED TO
MEASLES OR INTO.
A DIFFERENT A RESPONSE SO
DOCTORS MADE HERSELF WAS AT THE
MEETING AND SHE MADE A PLEA.
THAT THAT NEEDS TO HAPPEN AND WE
HAVE FORMED A GROUP THAT WOULD
BE MEETING REGULARLY TO MAKE
SURE THAT THAT'S HAPPENING.
THANK YOU -- BECAUSE THE WE
TALKED ABOUT THE IN THE PUBLIC
HEALTH INFRASTRUCTURE AND IF
GOING -- TO KNOW WHAT RESOURCES
WE NEED FOR THAT AND WE NEED TO
HAVE.
THE CAPACITY. TO BE ABLE TO DEAL
WITH THESE OUTBREAKS -- IDEALLY
WE CAN PREVENT THEM THAT'S WHY
WE IMMUNIZE AND THAT CERTAINLY
THE MAIN PURPOSE IS NOT TO SAVE
MONEY IT'S TO PROTECT PEOPLE'S.
HEALTH AND AND PREVENT
DISABILITY AND INJURY.
BUT WE ALSO NEED WE DO HAVE TO
THIS IS A BUDGET COMMITTEE NOW
THIS POLICY COMMITTEE AROUND
HEALTH -- WE NEED TO ALSO BE
SURE WE HAVE THE RESOURCES RIGHT
SO WHAT HAPPENS IS THESE
RESOURCES ARE TAKEN AWAY SO LABS
SO WE'RE DOING A BUDGET.
WE'RE GONNA BE BUDGET CERTAIN
AMOUNT OF MONEY FOR YOUR
DEPARTMENT YOU KNOW COUNTIES ARE
VOTING FOR THE HEALTH
DEPARTMENTS -- WE HAD A BUDGET
FIGURE -- THAT WE HAD SUCH A
DISCUSSION ABOUT -- ACTUALLY --
EARLIER AROUND THE GOVERNOR'S
PROPOSAL AROUND -- MONEY THAT
DOWN THE NINETY ONE REALIGNMENT
REAL PULAK SOMEBODY IN ORDER TO
HELP FUND AND YOU KNOW IT'S ADISEASE AND HEALTH DEPARTMENT
SAY WAIT A MINUTE WE'RE GETTING
OUR BUDGET CUT RIGHT AND SO
WHAT'S THE CONSEQUENCES OF THAT.
AND IN TERMS OF CAPACITY AND SO
FORTH SO WE NEED TO QUANTIFY.
THE NEEDS AND THE FLEX NEEDS A
SOMEONE WE HAD WILD FIRES -- YES
TELLS US IN CAL FIRE TELLS US
OKAY WE SPENT THIS MUCH MONEY.
THAT'S WHAT YOU HAVE TO THINK
ABOUT WHEN THE GOVERNMENT WHEN
GOVERNOR BROWN THE PREVIOUS
GOVERNOR TALKED ABOUT THE NEW
ABNORMAL.
AS WE DO OUR BUDGETING PROCESS
WE HAVE TO FIGURE OUT HOW WE
BUDGET.
THE SPACE TO PAY FOR THESE
THINGS BECAUSE THEY CAN'T JUST
COME FROM OTHERWISE WE'RE
ACTUALLY.
HIDDEN TAXING EVERYTHING ELSE
RIGHT WHEN WE'RE PULLING THE
PERSONNEL OUT OF WELL WE GAVE
MONEY FOR THIS BUT ACTUALLY THAT
THAT YOU KNOW FOR LET'S SAY.
DIABETES PREVENTION BUT IT
HAPPENED BECAUSE THE PERSON GOT
PULLED OUT THE ID'S PREVENTION
TO DEAL THAT OUTBREAK AND THEY
COULDN'T WORK ON THAT.
SO WE MY BUDGET MONEY FOR
DIABETES PREVENTION DIDN'T
HAPPEN IF WE'RE NOT EXPLICITLY
MEASURING THE COST AND SAYING
OKAY AND WE NEED TO BUDGET FOR
THAT.
THOSE TYPES OF THINGS ARE LEAST
ACCOUNT FOR IT AND MAYBE IT'S A
FAX FILL IN THE NEXT BUDGET --
OR SOMETHING LIKE THAT.
SO I DON'T KNOW FROM FINANCES
PERSPECTIVE SORRY ARE YOU
LOOKING AT THESE THINGS I MEAN
THESE THESE CASES I MEAN IT AT
LEAST I'VE SEEN PREVIOUS REPORTS.
YOU KNOW PEOPLE ARE SPENDING
MILLIONS OF DOLLARS ON TRYING TO
CONTAIN OUTBREAKS IS NOT LIKE --
IT'S A FEW THOUSAND WE'RE
TALKING ABOUT POTENTIALLY
MILLIONS OF DOLLARS FOR COUNTIES
IN THE STATE. TO TRY TO GET THE
PENNY HOW BIG IT GETS TO TO
CONTAIN THESE OUTBREAKS YOU WANT
ONE OF THE THINGS THAT HAPPENED
JUST.
FOR THE HOUR THE CONTEXT EVEN
TODAY DOT AND WE WILL BE
SPEAKING ABOUT SEXUALLY
TRANSMITTED INFECTIONS LAY RIGHT.
THAT IN MANY COUNTIES EVERYBODY
STOPS EVERYTHING THEY'RE DOING
INCLUDING FOLLOWING UP ON
SYPHILIS CASES BECAUSE NOW THEY
HAVE TO DEAL WITH A MEASLES
CRISIS AND SO.
THERE'S ONLY SO MUCH BANDWIDTH
PRESENTLY TO DEAL WITH THIS
CRISIS NOW SELL.
ARE WE BUDGET FOR EMILY BUT TO
FURTHER EMERGENCIES TO WRITE SO.
WE ARE ALMOST UPON A FINANCE.
ALSO ONE OF THE THINGS THAT
WE'VE DONE FOR PUBLIC HEALTH
EMERGENCIES AS EVERY YEAR AS
PART OF THE BUDGET PROCESS
BECAUSE THERE IS SOME FUNDING --
PUT ASIDE FOR CONTINGENCIES ON
EMERGENCIES SHOULD THE GOVERNOR
DECLARE EMERGENCY THAN THAT
MONEY COULD BECOME AVAILABLE FOR
SOME OF THIS I BELIEVE IN TWO
THOUSAND SEVENTEEN SOME OF THAT
FUNDING WAS USED TO PROVIDE
VACCINES.
TO SAN DIEGO [inaudible]
OKAY -- I DON'T KNOW IF WE GET
TO THE POINT WHERE THE GOVERNOR
DECLARES AN EMERGENCY SO WE CAN
TAP IN THE FUNDING FOR ALL THIS
CONTACT TRACING AFTER NOW YET
THIRTY EIGHT CASES OF MEASLES.
SO HOW.
OKAY [inaudible]
ALL RIGHT.
OKAY IDENTIFIED ON ON THIS
ISLAND.
OKAY NOW MANY COMMENTS FROM LA --
OKAY ANY FURTHER COMMENTS FOR
FINANCE.
ALL RIGHT SO -- AND I APPRECIATE
AGAIN THE THE WORK OF THIS
APARTMENT WE HAVE SEVERAL --
STAKEHOLDER PROPOSALS -- SEE.
ONE TWO THREE FOUR FIVE SIX
SEVEN EIGHT OKAY EIGHT
STAKEHOLDER PROPOSALS ON HERE SO
WE'LL START WITH THE TALENT
COUNTY HEALTH EXECUTIVE
ASSOCIATION CALIFORNIA.
PROPOSAL FOR COMMUNICABLE
DISEASE INFRASTRUCTURE FOR LOCAL
HEALTH DEPARTMENTS.
ALL RIGHT NOW.
SO WE'RE GONNA DO THEM ONE AT
TIMES I WONDER IF YOU'RE PART OF
THIS PROPOSAL COME OUT THE OTHER
WAY SUITE FOR YOUR TO BE CALLED
UP NEXT FOR NEXT ONE SO AND
AGAIN -- HOW MANY PEOPLE
SPEAKING ON THIS?
ONE WE'LL DO OKAY SO YEAH THE
THREE MINUTES MAXELL ARI.
GOOD AFTERNOON ALMOST EVENING OR
EVENING AT MICHELLE GIVENS OF
THE COUNTY HEALTH EXECUTIVES
ASSOCIATION CALIFORNIA AND I'M
GONNA INTRODUCE DOCTOR ROBLEDO
FROM PLASTER COUNTY WHO'S GONNA
PRESENT ON OURS ARE ABDEL
REQUEST.
BUDGET REQUEST SKEWS ME THANK
YOU. EIGHT A SPECIAL THANKS TO
OUR PANEL MEMBERS.
MY NAME'S ROB OLDHAM I
APPRECIATE THE OPPORTUNITY TO
COMMENT ON THIS PROPOSAL I
SERVICES HEALTH OFFICER AND
PUBLIC HEALTH DIRECTOR FOR
PLASTER COUNTY.
IN THAT DUAL ROLE I AM A MEMBER
BOTH OF CHI ACT WHICH IS THE
COUNTY HEALTH EXECUTIVES
ASSOCIATION OF CALIFORNIA.
AND ALSO HO ACT THE HEALTH
OFFICER'S ASSOCIATION CALIFORNIA --
JACKSON HOLE ACT COLLECTIVELY
REPRESENT CALIFORNIA SIXTY ONE
LOCAL HEALTH DEPARTMENTS AND
HEALTH OFFICERS.
AND IN THE INTEREST OF TIME I'M
REPRESENTING BOTH JACK AND WHO
ACT THIS EVENING -- REQUESTING
YOUR CONSIDERATION APPROVAL OF
AN ONGOING GENERAL FUND
APPROPRIATION OF FIFTY MILLION
DOLLARS TO IMPROVE LOCAL HEALTH
DEPARTMENTS INFRASTRUCTURE TO
PREVENT CONTROL THE SPREAD OF
INFECTIOUS DISEASES.
CALIFORNIA HAS SEEN A DRAMATIC
INCREASE IN THE NUMBER OF
INFECTIOUS DISEASE CASES
REPORTED TO LOCAL HEALTH
DEPARTMENT OVER THE LAST DECADE.
NOW THERE ARE APPROXIMATELY
THREE INTERNS SIXTY THOUSAND
TITLE SEVENTEEN MANDATED
REPORTABLE CASES EACH YEAR.
THEY'RE ALSO MILLIONS MORE CASES
OF NON REPORTABLE DISEASES LIKE
INFLUENZA AND CHICKEN POX WHERE
HEALTH DEPARTMENTS ARE OFTEN
INVOLVED IN SURVEILLANCE FOR IN
RESPONSE TO THESE ILLNESSES AS
WELL.
WE FREQUENTLY SEE EVIDENCE OF
THE SURGE OF NEW CASES IN THE
NEWS -- THERE WAS THE TWENTY
SEVENTEEN TWENTY EIGHTEEN
HEPATITIS A OUTBREAK --
PRIMARILY IN POPULATIONS OF
PEOPLE EXPERIENCING HOMELESSNESS --
WE'RE HEARING ABOUT THE DRAMATIC
RISE IN SEXUALLY TRANSMITTED
INFECTION RATES OVER THE LAST
DECADE AND RELATED TO THIS THE
WE'RE NOW SEEING FAR TOO MANY
CASES OF CONGENITAL SYPHILIS --
THAT IS BABIES BEING BORN --
WITH OFTEN LIFE LONG AND
PERMANENT DISABILITIES AND
POTENTIALLY FATAL COMPLICATIONS
OF SELFLESS PASSED DOWN FROM --
THEIR UNTREATED MOTHERS.
THE GENERAL SERVICES 1100%
PREVENTABLE AND SIMPLY SHOULD
NEVER HAPPEN ANYWHERE ESPECIALLY
NOT IN CALIFORNIA IN.
TWENTY NINETEEN WE CONTINUE TO
HEAR ABOUT LEGIONNAIRES DISEASE
OUTBREAKS -- IN THE ALREADY
PROVIDE PERVASIVE VALLEY FEVER
IN THE CENTRAL VALLEY WE'RE
SEEING INCREASED NUMBERS OF
CASES -- THEN OF COURSE THERE'S
THE ON GROWING -- MEASLES
OUTBREAK THAT YOU'RE JUST
TALKING ABOUT THAT SIGNIFICANTLY
IMPACTED MANY JURISDICTIONS
INCLUDING MY OWN.
THEN THERE ARE THE EVERYDAY
DISEASES THEY DON'T MAKE THE
HEADLINES ON THINGS LIKE
SHIGELLA SALMONELLA.
OF CHLAMYDIA GONORRHEA -- WE'RE
WE SEE -- LARGE INCREASES IN
THOSE NUMBERS OF CASES TO THOSE
ARE VERY RESOURCE INTENSIVE THEY
HAVE HUGE COST AS FAR AS THE
HEALTHCARE COSTS BUT ALSO --
SOCIETAL COSTS -- PARTS TO
FAMILY ECONOMIES IN OF OF
COMMUNITIES PARTICULARLY
DISADVANTAGED FAMILIES AND
COMMUNITIES NOT HAVING TO TAKE
TIME OFF OF WORK EXCEPT WHEN
THEY'RE EXCLUDED FROM SENSITIVE
OCCUPATIONS.
SO IT'S CLEAR THAT -- THAT OUR
HEALTH DEPARTMENTS FACE THESE
CHALLENGES AND THREATS --
AFFECTED CITIES OUTBREAKS BUT
WE'RE NOT ADEQUATELY RESOURCE TO
CARRY OUT OUR UNIQUE AND
CRITICAL ROLE AN OUTBREAK
INVESTIGATION AND DISEASE
CONTROL RESPONSIBILITY FORCE
THERE IS NO OTHER ENTITIES
ACCOUNTABLE.
YOUR TIME IS UP OKAY.
WRAP IT UP.
LOCAL HEALTH DEPARTMENTS RECEIVE
FUNDING FROM A VARIETYOF
SOURCES BUT THE MAJORITY OF
FUNDING FOR COMES FROM NINETEEN
NINETY ONE REALIGNMENT -- WHICH
CURRENTLY IS OVER ONE HUNDRED
MILLION DOLLARS BELOW THE FISCAL
YEAR -- TWO THOUSAND SEVEN EIGHT
ALLOCATIONS AND IS INTO OUR
VARIOUS DIVERSIONS TO ADDRESS
OTHER PARTIES IN RECENT YEARS.
SO I'LL JUST BE BRIEF TO WRAP IT
UP SOLD OUT DEPARTMENTS ARE
REQUESTING AN ONGOING CONTINUES
APPROPRIATION OF FIFTY MILLION
DOLLARS CHERYL FINE THE REASON
BEING IS YOU HEARD THERE'S A
NUMBER OF OUTBREAKS AND THAT WE
WILL ALWAYS HAVE TO FACE AND SO
LOCAL DEPARTMENTS ARE GRAPPLING
TODAY AND REALLY.
COULD USE THAT INVESTMENT INTO
THE INFRASTRUCTURE.
THANK YOU ANY COMMENTS FROM CITY
PH OKAY HELLO.
THE SONY PEDIGO AO THE ONLY
COMMENT THAT WE WOULD MAKE AND
IT'S THIS IS SOMETHING THAT WE
NOTED OR AND NOW ANALYSIS OF THE
REALIGNMENT PROPOSAL.
WHICH IS THAT IT'S REALLY HARD
TO KNOW THE RIGHT AMOUNT TO
INVEST IN PUBLIC HEALTH EFFORTS
BUT ONE THING THAT WE DO KNOW IS
TRUE ABOUT THE CURRENT PUBLIC
HEALTH BUDGETS AT BOTH.
THE STATE LEVEL AND THE LOCAL
LEVEL IS THAT THE FUNDING IS
VERY CATEGORICAL AND LAX --
FLEXIBILITY -- FOR IT YOU KNOW
PUT LOCAL AREAS TO RESPOND TO TO
THEIR LOCALIZED NEEDS -- AND SO
THAT'S I GUESS ONE THING TO KEEP
IN MIND AS YOU CONSIDER VARIOUS
PROPOSALS IN THIS AREA OKAY
THANK YOU FINANCE COMMENTS.
SO A SERVER CRASH IS OKAY YOU'RE
REQUESTING FEES -- FIFTY MILLION --
IS IT GETS PASSED IN THE BUDGET --
THAT THE HOUSE WAS TO DISPENSE
THIS.
HOW DO YOU SEE IT BEING
DISPENSED YES I THINK THAT WOULD
THAT WOULD BE -- POBABLY UP TO
CHECK AND SEE SELECTOR WITH ME
TO DOWN THE ROAD THAT UP SO
WOULD BE AN ALLOCATION THAT
WOULD BE CREATED BY THE
DEPARTMENT OF PUBLIC HEALTH AND
CONCERNS IN CONSULTATION WITH
CHECK AND HOW ACTS SO -- IN
THAT'S DONE ON A MYRIAD OF
FUNDING SOURCES.
WE LOOK AT PREVALENCE OF CERTAIN
FACTORS IN THE COMMUNITIES AND
THEN BUILD A FUNDING STRUCTURE
BASED ON THAT.
ALL RIGHT I'M I'M GOING TO
PROPOSE A SUGGESTS A FRAMEWORK
TO THINK ABOUT THIS -- THIS IS
WE TALK ABOUT VARIOUS OUTBREAKS
SOME MORE IMMEDIATE OTHERS PRESS
MORE I'M GOING TO TALK ABOUT
STDS IS OVER THAT'S NOT JUST
ABOUT COMMUNICABLE DISEASES TO I
NEED I KNOW THAT'S WHAT'S IN THE
HEADLINES NOW -- I THINK WHEN I
THINK ABOUT HOW WE'RE HAVING TO
DO WITH WILD FIRES RIGHT AND WE
HAVE A MUTUAL AID SYSTEM.
AND YOU KNOW -- YES BUYS FIRE
TRUCKS FOR LOCAL HOLLERED FIRE
DEPARTMENTS WHO JUST THEN CAN
USE THEM FOR THAT MEET THE NEEDS
OF WILD FIRES AND OTHER TYPES OF
THINGS -- THAT PERHAPS WE SHOULD
THINK ABOUT MUTUAL AID W. AT
THERE'S A MUTUAL AID STRUCTURE
BUT THINK ABOUT FINDING -- A
SYSTEM WHERE PRHAPS WHAT
HAPPENS IS THE PART OF A PUBLIC
HEALTH THE THE STATE FARM FILED
GIVES GRANTS OUT TWO COUNTIES --
THAT TO HELP FUND POSITIONS THAT
COULD BE PULLED.
OUT FOR TO TAKE CARE OF ME IT
BUT THEN WONDERED.
WHEN THEY'RE NOT NEEDED FOR AN
ON GOING PRESENT EMERGENCY THEN
THAT PERSON YOU'VE KIND ENOUGH
FIVE WHICH KIND OF PEOPLE YOU
NEED?
AND THEN THEY WOULD BUT THEY
WOULD BE FINE HEALTH COUNTY
EMPLOYEES WOULD BE PAID YOU KNOW
WHO FUNDED THROUGH THESE GRANTS
WHO THEN WOULD DO SOMETHING
WHATEVER TASK NEEDS TO BE DONE
AT THE COUNTY BUT THEN COULD BE
PULLED.
OUT THAT YOU MIGHT NOT PULL EVEN
MORE PEOPLE BUT PEOPLE FOR A SO
THINKING ABOUT A A SOME FORM OF
THAT THESE I UNDERSTAND FROM OUR
LAST HEARING IT'S REALLY STAFF
AND STAFF CAPACITY THAT YOU NEED
IS NOT LIKE YOU CAN -- THERE'S
OUTBREAK I'M JUST GONNA HIRE
PUBLIC HEALTH NURSE SO IT'S NOT
LIKE THEY'RE SITTING AROUND
WAITING AROUND FOR SOMETHING TO
DO. TO HAVE THAT KIND OF READY
CAPACITY WITH THE EXPERTISE BILL
BAKED INTO THE SYSTEM.
WHERE BASICALLY THERE ARE YOU
KNOW CARRIED ANOTHER SCENES ONLY
HAS TO BE PERSONNEL BUT I HEARD
THAT WAS LIKE THE TOP THING YOU
KNOW MAYBE SOME LEFT PASS AND SO
FORTH THAT?
BASICALLY SEE PH WORKING WITH --
THE YEAH COUNTIES AND HOW ACTIVE
SO FOR THINKING ABOUT WHAT
WHAT'S THE WHAT ARE THE KIND OF
PEOPLE DO WE NEED IS BUILT FOR
THAT COVERAGE IS A CAPACITY IN
AND SAYING OKAY FINE WE'LL GIVE
GRANTS OUT.
WE HAVE SOME PUBLIC HEALTH
NURSES STATION AND NOW WORKING
AT DIFFERENT COUNTIES BUT WHEN
THERE'S AN OUTBREAK THEY GET
PULLED.
THE DEAL TO HELP YOU KNOW.
HELP EACH OTHER OUT IN THE AREA
I MEAN.
COME THROW THAT OUT AS AN IDEA
OF THE FREE BUT I JUST TRIED TO
COME OF THE FRAMEWORK OTHER JUST
THAT LIKE HERE'S SOME MONEY AND
YOU GUYS GO TO FIGURE OUT
BECAUSE I MEAN ELLIE -- PREGGO
WELL.
THAT THAT'S A LITTLE TOO OPEN
ENDED.
SENATOR WE APPRECIATE THAT NIGHT
THAT'S SOMETHING THAT WE CAN
TAKE INTO CONSIDERATION THE
THING THAT I WOULD SAY THOUGH IS
THAT IT'S REALLY DIFFICULT TO
CREATE A MUTUAL AID FREE MARK
WHEN ALL LOCAL HEALTH
DEPARTMENTS ACROSS THE BORDER
SEVERELY UNDERSTAFFED SO IT'S
NOT THAT WE'RE REALLY.
LEADING FOR THE OUTBREAK THAT
THIS MONEY IS NOT OUTBREAK MONEY
IT'S ACTUALLY MONEY TO TO BUILD
OUR INFRASTRUCTURE SO THAT'S WHY
I'M SAYING IT'S ENTRANCE FOR
PEOPLE RIGHT HERE SURE THAT'S I
MEAN THAT'S A THAT'S WHAT THIS
WAY MIGHT MY OBSERVATION IS IS
THAT IF IT'S SIMPLY.
A CHUNK OF MONEY THAT GOES UP
THE NEXT RECESSION HAPPENS IT'S
GONE.
I'M NOT SAYING IT WILL BE GONE
ANYWAY BUT I THINK IF THERE'S A
FRAMEWORK TO THINK ABOUT IT.
SEVENTEEN HAPPY TO HAVE FURTHER
DISCOUNT AS WELL OKAY THE DEAD
ALL RIGHT.
THE PRESENTATION AND CERTAINLY I
THINK THE WE'VE HAD
INFORMATIONAL HEARING AND
UNDERSTAND THE NEED IS THERE AND
WE WE NEED TO FIGURE OUT HOW.
TO BUILD THAT INFRASTRUCTURE WE
HAVE -- AND IT'S A MULTIPLE
LATER ONE RIGHT COUNTY AND STATE
AND EVEN A FEDERAL COMPONENT BUT
THAT'S FOR CONGRESS TO FIGURE
OUT SO.
OKAY.
ALRIGHT ANYTHING OKAY THANK YOU
ALL RIGHT OUR NEXT TAKEOVER
PROPOSALS FROM THE CALIFORNIA
MUSICIAN COALITION -- REGARDING
THE CALIFORNIAN STATION REGISTRY.
WELCOME.
A CATHERINE MARTIN MARTIN AND
I'M EXECUTIVE DIRECTOR OF THE
CALIFORNIA DECISION COALITION A
STATEWIDE NONPROFIT FOCUSING ON
IMMUNIZATION EDUCATION AND
ADVOCACY. ONE OF OUR HIGHEST
PRIORITIES AS A COALITION IS TO
SUPPORT THE DEVELOPMENT AND
MAINTENANCE OF THE CALIFORNIA
STATION INFORMATION SYSTEM ALSO
KNOWN AS CARE.
THE CALIFORNIA IMMUNIZATION
REGISTRY WHICH HAS BEEN IN PLACE
FOR OVER TWENTY YEARS.
THE REGISTRY IS AN ONLINE
DATABASE OF ASSIST HEALTHCARE
PROVIDERS HEALTH DEPARTMENTS
SCHOOLS HEALTH PLANS AND
PHARMACIES TO KEEP TRACK OF
IMMUNIZATIONS FOR CHILDREN AND
ADULTS.
IT ENABLES PROVIDERS TO PROVIDE
IMPORTANT INFORMATION MANAGE
BACK SCENE INVENTORY AND PROVIDE
DATA IN THE AGGREGATE ABOUT HOW
OUR COMMUNITIES ARE DOING TO
KEEP VACCINATION RATES STRONG.
IT CONSOLIDATES RECORDS FROM
MILLIONS OF PATIENTS FROM
THOUSANDS OF HEALTH CARE
PROVIDERS AND PHARMACIES AND AS
OF FEBRUARY THERE OVER TWENTY
NINE MILLION PATIENCE AND CARE
WITH OVER TWO HUNDRED FIFTY
MILLION TOTAL IMMUNIZATIONS.
AND WE CAN DO BETTER.
CALIFORNIA'S IMMUNIZATION
PROGRAMS ARE ALMOST ENTIRELY
FUNDED THROUGH FEDERAL DOLLARS
AND IS SUBJECT TO THE UNCERTAIN
AVAILABILITY OF EVER FEDERAL
DOLLARS -- STATE FUNDING FOR THE
REGISTRY WAS ELIMINATED DURING
CALIFORNIA BUDGET REDUCTIONS IN
TWENTY TEN AND ALL EIGHTEEN
MILLION DOLLARS OF A LOCAL
ASSISTANCE FINDING THAT THE CITY
PH IMMUNIZATION PROGRAM.
HAD A STARKLY RECEIVED WAS
ELIMINATED.
AND THREE POINT TWO DOLLARS OF
THAT FUNDING WAS FOR THE
REGISTRY.
BUT THE REGISTRY CONTINUED AND
THE EIGHTEEN MILLION DOLLARS THE
CALIFORNIA -- SEES FROM FEDERAL
FUNDING BY THE CDC. FOUR MILLION
OF THAT IS USED FOR THE
REGISTRIES WITH WHICH LIMITS THE
DOLLARS THAT ARE LOCAL HEALTH
DEPARTMENTS GET.
SO BASED ON DATA FROM THE CITY
PH THE REGISTRY IS CURRENTLY
UNDER FUNDED BY AT LEAST TWO
POINT FOUR MILLION DOLLARS PER
YEAR. TO BE A STATE OF THE ART
SYSTEM WE NEED TO HAVE A STABLE
FUNDING SYSTEM FOR ENHANCEMENTS
MAINTENANCE AND GROWTH.
OUR BIGGEST FAN CHANNEL IS THAT
RELIANCE ON LIMITED FEDERAL
FUNDING.
AS IT IS THE STATE RECEIVES
LEVEL FUNDING FROM THE CDC YEAR
AFTER YEAR WHICH IS ACTUALLY A
CUT BECAUSE OUR STATE'S COSTS GO
UP YOU'RE AFTER HERE AGAIN STAFF.
AND IN THE WORK WE DO THEY DO.
FULL FUNDING REQUIRE FULL THE
FULL FUNDING REQUIRES AT LEAST
SEVEN POINT FOUR MILLION DOLLARS
A YEAR SO OUR CURRENT.
OUR AND I'M BECAUSE WE PARTNER
WITH THE HEALTH DEPARTMENT IS
THAT OUR THEIR CURRENT FUNDING
EQUALS APPROXIMATELY SIX MILLION
DOLLARS RIGHT NOW FOUR MILLION
FROM THE EIGHTEEN MILLION
DOLLARS FEDERAL GRANT FOR
IMMUNIZATION PROGRAMS. ONE POINT
THREE MILLION IN MEDICAID FUNDS
THAT EXPIRE IN TWENTY TWENTY ONE
SO THEY'RE BUILDING OTHER CUT
COMING.
AND ONE MILLION DOLLARS IN STATE
GENERAL FUNDS TO SUPPORT
REGISTRY FLEW ACTIVITIES THAT
STUFF THAT THOSE DOLLARS TO
STATE TO SUPPORT INFLUENZA
VACCINATION.
THE FUNDING THAT IS NEEDED. ONE
POINT THREE MILLION ANNUALLY AT
pAND THEN I'M GOING TO REPLACE
THAT MEDICAID FUNDING THAT
EXPIRES IN.
TWENTY TWENTY ONE AND ONE POINT
ONE MILLION ANNUALLY FOR
EXPANDED MAINTENANCE SUPPORT AND
STUFF.
IMPORTANTLY WITH SUSTAINED AND
CONSISTENT FUNDING THE STATE
WOULD ALSO BE ELIGIBLE FOR
MEDICAID MATCHING FUNDS AT 75%
FOR THE REGISTRY ENHANCEMENTS
AND 50% FOR MAINTENANCE AND
OPERATIONS AS LONG AS WE HAVE A
STATE MATCH.
WILL BE ELIGIBLE FOR THE FEDERAL
MATCHING FUNDS.
CALIFORNIA AS YOU KNOW IS THE
LARGEST NUMBER HAS THE LARGEST
NUMBER OF CHILDREN AND ADULTS TO
KEEP TRACK OF YET
PROPORTIONATELY WE ARE NOT
CURRENTLY INVESTING AS MUCH AS
WE NED.
TO IN THIS DECISION MAKING TOOL
THAT PROVIDES DATA.
AND I'M INFORMATION PROTECT OUR
CHILDREN AND SAVE OUR HEALTH
DEPARTMENTS AND HEALTH CARE
PROVIDERS A LOT OF RESOURCES
TIME AND EFFORT.
THE ADDITIONAL INVESTMENT WILL
MAKE A TREMENDOUS DIFFERENCE IN
OUR PUBLIC HEALTH ACTIVITIES.
CALIFORNIA'S CHILDREN AND
FAMILIES DESERVE A STATE OF THE
ART SYSTEM AND WE ASK FOR YOUR
SUPPORT.
THANK YOU -- COUPLES WANT TO ADD
THAT I SUPPORT THE I CAN GET YOU
CAN STILL SUPPORT THE A T. AKA.
YOU HAVE A CHANCE ALSO OKAY
PUBLIC COMMENTS SO -- ANY
COMMENTS FROM C. PH [inaudible]
HELLO [inaudible]
FINANCE OKAY SO.
SEEMS TO ME THAT WE'RE GONNA BE
SPENDING MORE THAN THIS AMOUNT
OF MONEY ON THE CURRENT.
MEASLES OUTBREAK.
THEN WE'RE ASKING FOR THE
REGISTRY.
SOUNDS LIKE A GOOD INVESTMENT.
ALL RIGHT AND THE SPECIALLY WE
CAN PULL DOWN MORE.
FEDERAL MONEY FROM MEDIC HOW
KLAY IT'S YOU THAT DEFINITELY
GOOD VESTMENT THANKS VERY MUCH
OKAY THANK YOU OR IS THIS THE
FIRST YOU'RE HEARING ABOUT THIS.
YES WE WE WE PULL OURSELVES
TOGETHER WITH A LOT OF AND ALSO
BETTER CLIMATE IN CALIFORNIA I
THINK IT'S A OKAY FOR YEARS WE
HAVE BEEN TALKING ABOUT THIS AND
IT DIDN'T SEEM WE DID NOT GET
THE ENTHUSIASM -- ENTHUSIASTIC
SUPPORT AS FAR AS DATA IN THE
PAST BUT THIS YEAR WE GOT IT SO
OKAY TIME BECAUSE I KNOW AND AS
A PEDIATRICIAN BEEN USING THE
REGISTRY FOR A WHILE AND HOPING
THAT BUILDS CAPACITY SO.
BEING THE TECH CENTER OF YOU
KNOW THE COUNTRY WE WE NEED TO
DO BETTER.
THANK YOU OKAY THANK YOU.
ALL RIGHT NEXT UP IS THE H. I.
V. ALLIANCE -- PROPOSAL TO
PREVENT FIGHT HIV PREVENTION
GRANTS TO LOCAL HEALTH
JURISDICTIONS COMMUNITIES
ORGANIZATIONS.
IT CAN BE SEEN IN STDS
ALTOGETHER.
WE CAN THAT'S OKAY WITH YOU OKAY
SO IT'S A THE NEXT THREE ALL
RIGHT SO YOU WANNA DO ALL THREE
TOGETHER IS ONE PROPOSAL
ESSENTIALLY OKAY ARE YEP THAT'S
FINE.
WHILE WORKING TOGETHER AS WELL
RIGHT EXCELLENT.
A GOOD AFTERNOON CORRECT PULLS
FOR FROM A KELLY HEALTH ON
BEHALF OF THE CALIFORNIA HIV
ALLIANCE.
WE'RE HERE TODAY REQUESTING
TWENTY EIGHT MILLION DOLLARS ON
GOING IN TO SUPPORT
COMPREHENSIVE HIV PREVENTION
SERVICES INCLUDING HIV TESTING
LINKAGE TO CARE.
INCREASE PROP UP TAKE AND
SERVICES FOR PEOPLE WHO USE
DRUGS.
AS YOU'RE WELL AWARE WE NOW HAVE
HIGHLY EFFECTIVE TOOLS TO
LITERALLY STOP HIV IN ITS TRACKS
BUT TOO FEW PEOPLE HAVE ACCESS
TO THESE TOOLS.
NEARLY HALF OF PEOPLE LIVING
WITH HIV IN CALIFORNIA DID NOT
HAVE ACCESS TO TREATMENT OR
CONSISTENT CARE.
THE CDC ESTIMATES THE ONLY ABOUT
15% OF PEOPLE WHO COULD BENEFIT
FROM PROPER CURRENTLY TAKING
THAT.
AND AS A RESULT OF CALIFORNIA'S
SIGNIFICANT LACK OF PUBLIC
HEALTH INVESTMENT NEW HIV
INFECTIONS DECREASE JUST TWO
POINT 4% OVER THE LAST FOUR
YEARS AND HEALTH DISPARITIES ARE
INCREASING.
WE HAVE THIS COMES AS NO
SURPRISE TO HIV ADVOCATES THE
STATE CUT OVER THIRTY MILLION
DOLLARS FROM HIV PREVENTION IN.
TWO THOUSAND NINE VERY LITTLE
HAS BEEN RESTORED SINCE THEN
ABOUT SEVEN TO EIGHT MILLION.
WE HAVE THE ABILITY TO AND THESE
EPIDEMICS NOT HAPPEN WITHOUT
SIGNIFICANT INVESTMENT
IMPROVEMENT HIV PREVENTION
SERVICES SO URGE YOUR SUPPORT.
THANK YOU.
HI GOOD EVENING MY NAME IS
COURTNEY AMONG HER PEERS AND
FROM THE SAN FRANCISCO AIDS
FOUNDATION HERE ON BEHALF OF THE
CALIFORNIA HEPATITIS ALLIANCE --
CALIFORNIA'S RESPONSE OF
HEPATITIS C. EPIDEMIC HAS BEEN
UNDERFUNDED AND ADEQUATELY
COORDINATED WITH PRIMARY CARE
AND NOT STRATEGICALLY ALIGNED TO
AN OVERALL STATE STRATEGY.
THE HCV EPIDEMIC HAS LARGELY
GONE UNNOTICED BY STATE
LEADERSHIP DESPITE THE FACT THAT
MORE THAN FOUR HUNDRED THOUSAND
CALIFORNIANS ARE LIVING WITH HCV
WE HAVE THE TOOLS AND
UNPRECEDENTED OPPORTUNITY TO
ELIMINATE HCV IN CALIFORNIA --
AND SO WE'RE REQUESTING A TWENTY
MILLION DOLLAR GENERAL FINE
ANNUALLY TO SUPPORT STRATEGIC
EVIDENCE BASED HDV PREVENTION
AND LINKAGE TO AND RETENTION AND
CARE SERVICES.
CALIFORNIA HAS BEEN A LEADER IN
EXPANDING ACCESS TO EACH TV CARE
AND TREATMENT.
HOWEVER THE STATE PROVIDES
CURRENTLY ALMOST NO FUNDING FOR
HCV PREVENTION AND LINKAGE TO
AND RETENTION AND KAREN
TREATMENT.
IN FY FIFTEEN SIXTEEN CALIFORNIA
ALLOCATED TWO POINT TWO MILLION
A YEAR. FOR THREE YEARS FOR HCV
TESTING AND LINKAGE TO CARE
DEMONSTRATION PROJECTS BUT
DESPITE THE SUCCESS OF THESE
PROJECTS TESTING OVER THIRTY
FIVE THOUSAND PEOPLE WITH AN
ESTIMATED 95% CURE RATE. FOR
THOSE LINKED TO AND RETAINING
CARE THE PROJECT FUNDING WAS NOT
RENEWED LAST YEAR.
SO THE TWENTY MILLION DOLLARS
WERE REQUESTING FIFTEEN MILLION
WOULD GO FOR H. TV PREVENTION
TESTING AND LINKAGE TO ENTER
ATTENTION AND CARE.
AND TREATMENT. FOR PEOPLE WHO
INJECT DRUGS -- AND FIVE MILLION
WOULD GO FOR MY GIRL EMENDATION
FOR H. C. VI N. H. ID -- HCV CO
INFECTED PERSONS WE URGE YOUR
SUPPORT THANK YOU.
RESEARCHER RAND MORE NOT BE HALF
OF THE AIDS HEALTHCARE
FOUNDATION TO TALK ABOUT THE LCD --
PROPOSAL AND WE TALKED ABOUT
THIS MANY MANY TIMES OVER THE
LAST FEW YEARS I'M NOT GONNA GO
INTO MUCH DETAIL WELL -- AT RISK
OF REPEATING MYSELF I DO WANT TO
POINT OUT ONE STATISTIC ON THAT
IS PARTICULARLY TROUBLING AND
THAT IS IN THE LAST FULL YEAR OF
DATA -- THERE WERE THIRTY
STILLBORN -- DEATHS OUT OF TWO
HUNDRED EIGHTY THREE CONGENITAL
SYPHILIS CASES -- THAT'S THAT'S
ABSOLUTELY UNACCEPTABLE IN THIS
STATE AND WE NEED TO DO
SOMETHING ABOUT IT GOVERNOR NEW
SOME -- TO HIS CREDIT HAS ROLLED
OVER THE TWO MILLION THAT YOU
ALL PUT IN THE BUDGET LAST YEAR --
FOR THIS COMING YEAR WE'RE
ASKING FOR AN ADDITIONAL
EIGHTEEN MILLION FOR A TOTAL OF
TWENTY MILLION TO FINALLY SEE IF
WE CAN GET AHEAD OF THIS
EPIDEMIC THAT KEEPS GROWING YEAR
AFTER YEAR AFTER YEAR -- IT'S
TIME THAT WE GET AHEAD OF IT --
WE HAVE ALSO SUBMITTED LANGUAGE
I DON'T KNOW IF YOU'RE AWARE BUT
THERE'S TWO SENTENCES IN
CALIFORNIA STATE LAW THAT
DESCRIBE WHAT THE DEPARTMENT
DOES RELATIVE TO S. T. D. WE
NEED MORE DIRECTION TO THE
DEPARTMENT OF PUBLIC HEALTH --
ON STD PREVENTION AND CONTROL WE
ENCOURAGE YOU NOT ONLY TO ACCEPT
THE TWENTY MILLION BUT ALSO TO
ACCEPT THE LANGUAGE TO GIVE THEM --
ADDITIONAL DIRECTION AS TO HOW
TO SPEND THAT MONEY MORE
EFFECTIVELY -- WITHOUT I'LL
LEAVE IT -- TO AND TURN OVER TO
THE FOURTH PERSON ON OUR PANEL.
A QUICK THE LAST COMPONENT OF
THIS IS AS YOU'VE HEARD HERE
THESE ARE THE PIECES THAT WE
THINK EED TO BE FUNDED
IMMEDIATELY WHAT WE HAVE --
BROUGHT FORWARD TO YOU IS TO DO
A ONE TIME INVESTMENT OF TWO
MILLION DOLLARS FOR TASK FORCE
TO PULL ALL OF THE DISCUSSIONS
AROUND ALL OF THESE DISEASES
TOGETHER TO REALLY PUT FORWARD A
COMPREHENSIVE APPROACH WE'VE
SEEN THIS APPROACH WORK IN NEW
YORK GOVERNOR CUOMO PUT THIS
FORWARD AS RELATED. TO HIV THERE
K. DIAGNOSIS OF HIV IS GONE DOWN
20% SO WE THINK THAT A PART OF
THAT IS REALLY LOOKING AT ALL
THAT WE HAVE TO BRING TO BEAR WE
DO KNOW AS MR PULLS FOR SAID
HERE WE HAVE A CHANCE TO END.
IT BASICALLY ON HIV TO REALLY
AND THE EPIDEMIC HERE AND SO WE
WOULD LIKE TO PUT TWO MILLION
DOLLARS INTO AN END THE EPIDEMIC
TASK FORCE SO THANK YOU.
THANK YOU.
ANY COMMENTS FROM CITY PA EACH
HELLO [inaudible]
FINANCE.
NIGHT THE THEY APPRECIATE THIS I
MEAN I THINK THAT -- SAID THAT
THE STD -- EPIDEMIC I MEAN
THAT'S NOT GETTING THIS IS NOT
AS FLASHY AS MEASLES BECAUSE
IT'S THE FACT THAT WE HAVE.
THE TWENTY SEVEN TWENTY
STILLBORN. THIRTY THIRTY OKAY --
TO INTERNET RIGHT I MEAN OVER
THOSE ASIDE WHEN PEOPLE TALK
ABOUT SYPHILIS WE THINK ABOUT
THE VICTORIAN ERA RIGHT AND WELL
AND YET WE HAVE SYPHILIS TODAY
AND THEN THAT WHAT WE'VE GOT A
REAL WERE TALKING ABOUT -- YOU
KNOW MULTI DRUG RESISTANCE IF WE
DON'T.
STOP AS TRACKS AND CERTAINLY HIV.
IS IS THE DISEASE AS NOT GONE
AWAY AND WE NEED TO NOW BEND THE
CURVE ON THAT -- AND AND FALL.
THERE'S A LOT OF TALK ABOUT
FOR TRACTION AND DOG HEPATITIS
C. AS WELL THE IT'S GREAT WE NOW
HAVE IT.
ACTUALLY TREATMENT THAT WILL
ACTUALLY.
TERROR FIC OTHER DOESN'T VENTURE
RE RE SUPPOSED AGAINST OVER
REALLY GONNA TACKLE THAT WE NEED
TO BE AGGRESSIVE OTHERWISE WE'RE
GOING TO BE TREATING PEOPLE THEY
GET ME IN FACT WE TREAT PEOPLE
AGAIN.
SO -- LIKE WE COULD THROW IN A
FEW OTHER THINGS ON TOP OF THAT
YOU KNOW LOOK FOR THANK GOD WE
HAVE A VACCINE FOR HPV THAT'S IN
THOSE ACTUALLY -- WE TALK WE
HAVE TIES BE -- ETCETERA SO I
MEAN -- LOT TENSORS LOCK CO
INJECTIONS -- WITH WITH THOSE AS
WELL AND WELL WE CERTAINLY HAVE.
A SOME OPPORTUNITIES THERE --
WITH WITH THE VACCINE FOR BOTH
OF THOSE CONDITIONS -- WE THINK
ABOUT COLIN TRACTION. EIGHTY
THREE OF I APPRECIATE THE IDEAS
COMING OF THE MASTER STRATEGY
WERE CALLED BIRDIES INSTRUCTIONS
ALL TRAVEL TOGETHER.
RIGHT AND SO WHAT CAN WE DO TO
TO TO KNOCK THEM OUT YOU KNOW
BOTH INDIVIDUALLY AND
COLLECTIVELY -- SO FORTH SO --
APPRECIATE THE THE THE THE
REQUEST IN THE PRESENTATIONS.
SEARCH YOUR PHONE AS YOUR REPORT
ABOUT MEASLES IS REALLY A VERY
RELEVANT POINT.
IT GETS THE HEADLINES A COUPLE
YEARS AGO EBOLA GOT THE
HEADLIGHT.
ISSUES LIKE.
IT EVEN H. I. V. THAT GETS A LOT
MORE HEADLINES AN S. U. V. THEIR
PRINT PERNICIOUS EPIDEMICS
BECAUSE THEY CONTINUE TO
ESCALATE.
WHILE THE SAME TIME THEY'RE NOT
GETTING THE ATTENTION THAT AN
OUTBREAK OF MEASLES DOES OR AN
OUTBREAK OF EBOLA.
WELL MEASLES WE SHOULD HAVE A
LEMON AT ELECTION WE DID
ELIMINATED FROM THE U. S. WE
HAVE A BROAD AND WE SHOULD HAVE
HER ADVOCATED LEE L. -- IF WE
ONLY COULD HAVE GOTTEN PEOPLE I
MEAN.
IT'S CHALLENGE AND JUST LIKE
POLIO WE'RE THIS CLOSE.
RIGHT AFTER LAST NIGHT I HOPE
WE'RE GONNA BE THERE AGAIN.
YEAH ME IS SO ALL RIGHT WELL
THANK YOU THANK YOU VERY MUCH.
WE WILL TALK ABOUT HOW MUCH IT
COSTS ON THE MEDICAL SIDE IF WE
DON'T RATE THAT'S ALL THE
DIRECTIONS AND SO FORTH OKAY.
MEXICO THE PROPOSAL FROM THE
DRUG POLICY ALLIANCE TO FUND
TREATMENT NAVIGATORS HARM
REDUCTION PROGRAMS.
WELCOME.
THE NEXT TWO WERE BOTH MINDS
WELL RUN THEM TOGETHER NEGATIVE
TIME CATCHER.
LORE THOMAS W. STATE DIRECTOR
DRUG POLICY ALLIANCE I'M HAPPY
TO BE IN FRONT OF YOU EARLIER
THAN I WAS YESTERDAY EVENING --
WE HAVE -- TO BUDGET REQUESTS
THE FIRST ONE IS TO ADD STAFF TO
OUR HARM REDUCTION IN SYRINGE
ACCESS PROGRAMS AROUND THE STATE
CALIFORNIA IS.
CURRENTLY -- DRAMATICALLY
EXPANDING OUR MEDICATION
ASSISTED TREATMENT PROGRAMS
AROUND THE STATE WHICH IS
DESPERATELY.
NEEDED IN ADDING USING FEDERAL
FUNDS TO EXPAND BUPRENORPHINE
ACCESS IN PARTICULAR THIS
PROPOSAL WOULD ADD TREATMENT
NAVIGATORS TOUR SYRINGE ACCESS
PROGRAMS -- THESE ARE PLACES
THAT ARE OFTEN THE ONLY PLACE
THAT PEOPLE INJECT DRUGS ENGAGE
WITH THE HEALTH CARE SYSTEM AND
STAFF FOR THEIR IDEALLY LOCATED
TO WORK WITH PEOPLE -- PROVIDE
THEM WITH OVERDOSE EDUCATION
MATERIALS HARM REDUCTION
SUPPLIES -- BUT ALSO TO HELP
THEM CONNECT INTO THESE OTHER --
TREATMENT PROGRAMS -- SO THERE'S
A SIMILAR -- PROPOSAL LAST YEAR
TO PUT STAFF IN EMERGENCY
DEPARTMENTS THAT THAT'S NOW
BEING FUNDED THESE WE THINK
MANY OF THE FOLKS WHO INJECT
DRUGS.
ACCESS THE HEALTHCARE SYSTEM ARE
SYRINGE ACCESS PROGRAMS IN
EMERGENCY DEPARTMENTS WE WANT TO
MAKE SURE THEY WERE FULLY
STAFFED IN BOTH PLACES SO THAT
WE CAN ENSURE THAT THE FOLKS
MOST IN NEED.
OF GETTING INTO TREATMENT ARE
ABLE TO BE FIRST IN LINE MANY OF
OUR STRANGE ACCESS PROGRAMS IN
THE STATE OUR VOLUNTEER RUN A
VERY LOW BUDGET SHOE STRING --
OPERATIONS AND THEY COULD REALLY
BENEFIT FROM HAVING STAFF. TO BE
ABLE TO HELP WORK WITH THE FOLKS
THERE THIS IS A REQUEST FOR
FIFTEEN MILLION DOLLARS TO BE
SPENT OVER FOUR YEARS IT'S A
VERY SMALL INVESTMENT IN THE
HEALTH AND WELL BEING OF SOME
VERY VULNERABLE FOLKS -- WHO
WOULD LIKE TO BE CONNECTED TO
SERVICES?
EXCELLENT THANK YOU ANY COMMENTS
FROM C. PH [inaudible]
OHIO.
FINANCE.
ALL RIGHT ALL RIGHT THE SECOND
ONE IS CLOSELY RELATED --
CALIFORNIA HAS HAD FOR A COUPLE
OF YEARS NOW A SYRINGE SUPPLY
CLEARING HOUSE THAT DOES BULK
PURCHASING FOR THE SYRINGE
ACCESS PROGRAMS -- THEY ARE --
CURRENTLY RUNNING THROUGH THOSE
SUPPLIES VERY QUICKLY AND WE'RE
ASKING FOR AN INCREASE FROM
THREE MILLION A YEAR TO SIX
MILLION A YEAR -- THE NUMBER OF
PARTICIPANTS IN STRANGE ACCESS
PROGRAMS WENT UP BY 50% IN JUST
TWO YEARS -- ONCE THESE -- FUNDS
STARTED GOING OUT AND PROGRAMS
WERE REALLY ABLE TO EXPAND WHAT
THEY'RE TICKET SO THE NEED IS IS
VERY.
MUCH THERE IT'S A SMALL AMOUNT
OF MONEY -- AND IT'S WORTH THE
INVESTMENT.
OKAY THANK YOU ANY COMMENTS C.
PH HELLO.
FINANCE OKAY THANK YOU SO MUCH
THANK YOU PRESENTATIONS.
THANK YOU ALL RIGHT SO WE'RE
GOING TO NOW TAKE PUBLIC
COMMENTS ON BOTH THE REVIEW --
FOR THE CENTER FOR INFECTIOUS
DISEASES AND STAKEHOLDER
PROPOSALS I'D MAKE NOTE THAT
EACH OF THE PROPOSALS THAT HAVE
A PRESENTATION SO.
IT'S MAINLY IF YOU WANT TO
INDICATE WHICH ONES YOU OR YOUR
FAVORITE ONES -- THAT BE GREAT --
CELL THANK YOU WELCOME.
THIS IS KAREN CONNELLY AND THE
HIV PREVENTION MANAGER WITH
FAMILY HEALTH CENTERS OF SAN
DIEGO I'M HERE TO SUPPORT.
INCREASE FUNDING FOR HIV HABSI
ENDS REJECTIONS ACCESS I CAN'T.
EXPRESS NOT THE IMPORTANCE OF
HAVING NAVIGATORS GET PEOPLE
INTO TREATMENT AND THROUGH
TREATMENT.
OKAY THANK YOU [inaudible]
WELCOME.
HELLO MY NAME IS BRONZE COURTNEY
AND THE DIRECTOR OF OPERATIONS
FOR THE HIV EDUCATION PREVENTION
PROJECT OF ALAMEDA COUNTY ALSO
KNOWN AS HAVE PACKED WHEN THE
PRIMARY SYRINGE EXCHANGES IN
OAKLAND.
IF YOU AND WE WANT TO SUPPORT
THE CORY BUDGET BECAUSE THE
CLEARING HOUSE SUPPORTS BOTH
COUNTIES ALAMEDA AND CONTRA
COSTA COUNTY AND WILL EXPAND THE
REACH FOR MOBILE SERVICES.
AND SERVES AS WE DO OUR VERY
INTEGRATED SO WE'VE GOT --
LINKAGE TO CARE -- SUCH AND SHE
USE TREATMENT OVERDOSE
PREVENTION EDUCATION A LOT SOME
DISTRIBUTION SO WE ARE THUMBS UP
FOR THE CORY BUDGET.
OKAY THANK YOU.
WELCOME.
I AM ROBIN LEARN AND I AM THE
HARM REDUCTION MANAGER AT THE
GENDER HEALTH CENTER HERE IN
SACRAMENTO -- THREE YEARS AGO WE
STARTED DOING SYRINGE EXCHANGE
WORK JUST BECAUSE TRANS FOLKS
NEEDED NEEDLES FOR THEIR
HORMONES.
IN THE LAST YEAR WE ARE
DISTRIBUTED OVER TWO HUNDRED AND
SIXTY THOUSAND SURRENDERS FOR
FOLKS INJECTING DRUGS THAT'S
WITH NO OUT REACH WHATSOEVER.
WE HAD OVER FIVE THOUSAND
ENCOUNTERS OVER FIVE HUNDRED OF
THOSE WERE NEW ENCOUNTERS JUST
LAST YEAR.
AND THIS IS A PROGRAM THAT HAS
NO FUNDING.
THAT'S WHY THIS CORE BUDGET IS
SO ESSENTIAL ALSO THE NAVIGATOR.
TREATMENT -- MATT TREATMENT
MODEL.
WE'RE RIGHT THEY'RE TALKING TO
THE FOLKS BUT I DON'T HAVE TIME
TO TALK TO ANYBODY WHEN I'M
TRYING TO RUN THE PROGRAM ALSO.
SO I'D I'D ASK FOR ALL OF THAT
AND ALL OF THE HABSI HIV -- CAN
STI MONIES THAT IS SO ESSENTIAL
IF WE'RE EVER GETTING TO ZERO WE
CAN'T LOOK AT IT AS A SEPARATE
THING.
I STAND IN SUPPORT OF ALL OF
THOSE THANK YOU THANKS MUCH.
HELLO MY NAME'S RAFFAELLO MERIT
IN THE CO FOUNDER AND DIRECTOR
OF INLAND EMPIRE HARM REDUCTION
OUT OF RIVERSIDE.
RIVERSIDE IS AN AREA THAT HAS
HISTORICALLY LOCKED HARM
REDUCTION SERVICES I AM
ORIGINALLY FROM THE BAY AREA OF
CALIFORNIA AND MOVED TO
RIVERSIDE COUNTY.
THERE ARE NO SERVICES THERE SO
HE STARTED SOMETHING OUT OF MY
HOUSE AND NOW FROM THE ONLY.
OVERDOSE PREVENTION BLOCKS AND
DISTRIBUTION COUNTY -- PROGRAM
IN RIVERSIDE SAN BERNADINO
IMPERIAL COUNTY IS.
LIKE OUT OF MY HOUSE SO THE CORY
BUDGET WOULD ALLOW FOR ME TO BE
PAID FOR THE WORK THAT I HAVE
BEEN DOING -- AND WOULD ALLOW
FOR ME MUCH TIME AS ROBIN IS
SEATED -- TO ACCESS TO TO BLINK
PEOPLE TO MATCH TREATMENT WHICH
HAS BEEN ALWAYS LIKE HIGHLY
EFFECTIVE SO.
HERE IN SUPPORT OF COREY IN
SUPPORT OF CLEARING HOUSE AND
ALSO THE AND THE ACADEMICS
COALITION THANK YOU THANK YOU.
WELCOME HI MY NAME IS JENNA HEY
WITH THEM -- KIM -- CAPACITY
BUILDING AND COMMUNITY
DEVELOPMENT MANAGER WITH HARM
REDUCTION COALITION -- WE HAVE
THE PRIVILEGE OF WORKING WITH
SYRINGE SERVICE PROGRAMS ALL
THROUGHOUT CALIFORNIA.
AND MANY OF THEM WERE NOT ABLE
TO MAKE IT TODAY TO TALK ABOUT
WHY THE TRUMAN NAVIGATOR
POSITIONS AND THE INCREASE TO
THE CLEARING HOUSE BUDGET WOULD
BE SO IMPORTANT TO THEIR WORK.
BUT WE KNOW THAT THROUGH DOING --
SURVEYS AND THROUGH DOING
LISTENING SESSIONS WITH THESE
PROGRAMS ALL THROUGHOUT
CALIFORNIA THE NUMBER ONE THING
THAT THEY EXPRESSED THAT THEY
NEED.
IS FUNDING FOR STAFF -- AS LAURA
SAID THE INCREASE IN DEMAND IS
GOING UP AND UP AND THERE'S NOT
ENOUGH MONEY FOR THEM TO HAVE
THE SUPPLIES THAT THEY NEED.
AND TO HELP LINK PEOPLE TO
TREATMENT THAT THEY'RE THAT
THEY'RE ASKING FOR AND THAT WE
KNOW IS SO IMPORTANT TO PREVENT
OVERDOSE DEATHS IN CALIFORNIA --
IN ADDITION THEY DO.
NEED MORE FUNDS TO DECREASE THE
RISK OF HIV HABSI STDS IS WORK
THAT THEY DO EVERY DAY SO
WEREN'T STRONG SUPPORT.
AND THE EPIDEMICS -- BUDGET
REQUEST AS WELL THANK YOU THANK
YOU [inaudible]
WELCOME.
HI AM SEVEN O'NEILL ALSO FROM
HARM REDUCTION COALITION.
AND I'VE SPENT THE LAST TWELVE
YEARS IN CALIFORNIA DOING WORK
AROUND STRANGE ACCESS AND HIV
PREVENTION AND I SAW IT YOU KNOW
I WORKED IN ALL VOLUNTEER RUN
PROGRAMS AND PROGRAMS OF STAFF.
THE CONSISTENTLY LIKE HARD
DECISIONS WE HAD TO MAKE AROUND
WHAT SUPPLIES TO ACTUALLY BE
ABLE TO OFFER AND HAVING TO
DECIDE BETWEEN A BIO HAZARD
CONTAINER AND A HYGIENE KIT
BECAUSE YOU CAN'T AFFORD TO BUY
BOTH.
WHEN THEY'RE ALL ESSENTIAL
PUBLIC HEALTH INTERVENTIONS SO I
STRONGLY SUPPORT THE CLEARING
HOUSE REQUEST TO INCREASE THE
CAPACITY OF PROGRAMS TO GIVE OUT?
LIFE SAVING SUPPLIES AND WE KNOW
THAT THE TRIBUNAL IN MY TIME AS
A STAFF AT DIFFERENT PROGRAMS I
SPENT.
HOURS AND HOURS TRYING TO
CONNECT PEOPLE TO TREATMENT
SUPPORT PEOPLE NAVIGATING
THROUGH THESE DIFFICULT SYSTEMS
WHILE ALSO TRYING TO TEST
SOMEONE AND GIVE OUT NO LOCKS
OWN AND MANAGE A DROP IN CENTER
SO REALLY HAVING A DEDICATED
PERSON. TO INSURE PEOPLE GET TO
TREATMENT IS INCREDIBLY
IMPORTANT AND WE ARE DOING A
GREAT JOB BUILDING UP THE
INFRASTRUCTURE FOR MEDICATION
ASSISTED TREATMENT IN THE STATE
OF CALIFORNIA.
BUT IF WE DON'T FIND SYRINGE
SERVICE PROGRAMS WERE GONNA MISS
THE MOST VULNERABLE PEOPLE WHO
USE DRUGS.
THANK YOU [inaudible]
WELCOME.
NICOLE ORNAMENT ON BEHALF OF THE
ORANGE IN SAN BERNADINO COUNTY
BOARDS OF SUPERVISORS SUPPORTING
THE FIFTY MILLION DOLLARS AN ON
GOING FOR PUBLIC HEALTH
INFRASTRUCTURE OKAY THANK YOU
[inaudible]
WELCOME.
X. HERE ON BEHALF OF THE BOARD
OF SUPERVISORS OF LOS ANGELES
RIVERSIDE IMAGE TRICOUNTY IS IN
SUPPORT OF THE FIFTY MILLION
DOLLARS -- FOR LOCAL HEALTH
DEPARTMENTS.
ADDITIONALLY THE LOS ANGELES
COUNTY BOARD OF SUPERVISORS
SUPPORTS THE FUNDING FOR THE AND
BACK EPIDEMICS PROPOSAL.
THANK YOU [inaudible]
WELCOME.
UPHOLSTERY KELLY HEALTH IN
SUPPORT OF THE PROPOSALS FROM
DRUG POLICY ALLIANCE AS WELL AS
THE PROPOSALS TO ADDRESS A CHEVY
HCV AND STDS.
THANK YOU WELCOME.
CARNIVAL HER PEERS OVER THE SAN
FRANCISCO AIDS FOUNDATION SO IN
ADDITION TO OUR SUPPORT FOR THE
HIV STDS PROPOSAL WE WANNA --
OFFER SUPPORT FOR THE SYRINGE
ACCESS PROPOSALS WE OPERATED
VERY LARGE FRIENDS ACCESS
PROGRAM AND WE KNOW HOW
IMPORTANT THOSE SERVICES ARE AND
SEE THE NEED AND JUST REALLY
URGE YOUR SUPPORT FOR THAT THAT
REQUEST -- AND WE ALSO SEE HOW --
EFFECTIVE HEALTH NAVIGATION CAN
BE AND REALLY WANT TO SEE THAT
REPLICATED IN OTHER PARTS OF THE
STATE THANK YOU THANK YOU.
WELCOME.
GOOD EVENING IN MUNICH AT THE
JOB FOR YOU CALL THE NADIR.
OF THE HEAD UNIT A BULLETIN ON
CENTER.
A NONPROFIT ORGANIZATION IN
ORANGE COUNTY WE SERVE ON IT TO
BE POSITIVE PLANS ALLOWING
COMPLAINTS.
ON THE FEELING ON THE PERSON IS
A PART.
OF THE LEGISLATION THE PROPOSAL.
FOR IT'S IN THE LANDS ON IN.
THANK YOU THANK YOU.
WELCOME TO THE SHOW GIVENS WITH
THE COUNTY HEALTH EXECUTIVES
ASSOCIATION BUT ALSO HERE ON
BEHALF OF THE CALIFORNIA STATE
ASSOCIATION OF COUNTIES ARE
LOCAL DEPARTMENTS ARE MANDATED
TO PROTECT FOLKS FROM MEDICAL
DISEASES AND WE NEED THE
APPROPRIATE RESOURCES TO DO SO
SO YOUR CONSIDERATION OF THE
FIFTY MILLION DOLLARS.
IT'LL COST PER MONTH IS
APPRECIATED THANK YOU
[inaudible]
WELCOME.
AT THE WORK WITH THE HEALTH
OFFICER'S ASSOCIATION OF
CALIFORNIA REGISTERING ARE
SUPPORTING CO SPONSORSHIP OF THE
REQUEST FOR FIFTY MILLION
DOLLARS FOR LOCAL HEALTH
DEPARTMENTS TO FIGHT
COMMUNICABLE DISEASE THANK YOU.
THANK YOU.
WELCOME.
LAURA THOMAS DRUG POLICY
ALLIANCE IN STRONG SUPPORT OF
THE FULL ENDING EPIDEMICS
APPROACH AS WELL THANK YOU THANK
YOU.
ALL RIGHT.
THANKS VERY MUCH RIGHT SO WE
WILL HOLD ALL THOSE ITEMS OPENED
AND AGAIN.
OKAY LET'S MOVE ON TO ISSUE
NUMBER TEN WHICH IS THE AIDS
DRUG ASSISTANCE PROGRAM A DEAF
PROGRAM.
YES -- MY COLLEAGUE A TERM
BERASA IS JOINING ME -- TO
PROVIDE AN OVERVIEW OF THE
PROPOSAL.
JUST WANTED TO SAY BRIEFLY THAT
THE A. THAT PROGRAM IS A PROGRAM
THAT WE'RE VERY PROUD OFF AND
IT'S SORT OF A CORNER PIECE OF
OUR HIV PREVENTION EFFORTS AS
YOU KNOW.
THE MORE PEOPLE THAT WE CAN GET
INTO A CHEVY TREATMENT THE LESS
PEOPLE THAT WILL TRANSMIT THE
DISEASE AND THE MORE.
AND THE CLOSER WILL BE TO
ACTUALLY ELIMINATING THE DISEASE --
MY COLLEAGUE WILL PROVIDE AN
OVERVIEW OF WHAT WE'RE PROPOSING
TO DO THROUGH OUR ON GOING ON
WITH -- BUDGET PROCESS.
OKAY THANK YOU WE HAVE A GREAT
RIGHT UP TO HERE SO I JUST HIT
THE HIGHLIGHTS.
A GOOD EVENING A DRIVER OUT OF
OFFICE.
YEAH.
BETTER.
GET SOME DENTISTS ARE JUST TURN
IT ON WHEN THEY DON'T HEAR YOU
TURN IT ON THEN YOU'RE TURNING
IT OFF SO YEAH THOSE ALL THE RED
LIGHTS ON ITS GOOD OKAY.
I'M SORRY JUST PROVIDE A VERY
BRIEF OVERVIEW OF THE EIGHT OUT
NOVEMBER ESTIMATE -- SO THE TWO
THOUSAND EIGHTEEN BUDGET ACT
INCLUDED EIGHT UP LOCAL SYSTEMS
FINDING A FOUR HUNDRED AND
THIRTY FOUR MILLION DOLLARS WITH
NO.
FEDERAL STATE A GENERAL FUND
APPROPRIATION.
THE REVISED CURRENT YEAR -- TWO
THOUSAND EIGHTEEN BUDGET IS FOUR
HUNDRED SEVEN POINT NINE MILLION
WHICH IS A THREE A DECREASE OF
TWENTY SIX POINT. TWO MILLION OR
6% WHEN COMPARED TO THE TWO
THOUSAND EIGHTEEN BUDGET ACT.
AND THE REASON FOR THE DECREASE
PRIMARILY AS A DECREASE IN
MEDICATION EXPENDITURES. FOR
MEDICATION ONLY CLIENTS WHO ARE
ESSENTIALLY CLIENTS WHO DO NOT
HAVE COMPREHENSIVE HEALTH
COVERAGE AND FOR WHOM WE PAY THE
ENTIRE COST MEDICATION -- FOR
BUDGET YEAR FISCAL YEAR TWO
THOUSAND NINETEEN TWENTY A
PROPOSED EIGHT AT LOCAL SYSTEMS
FINDING IS FOUR HUNDRED FORTY
NINE POINT EIGHT MILLION WHICH
IS AN INCREASE OF FIFTEEN POINT
SEVEN MILLION OR THREE POINT 6%
WHEN COMPARED TO THE TWO
THOUSAND EIGHTEEN BUDGET OUT AN
INCREASE OF FORTY ONE POINT.
NINE MILLION WHEN COMPARED TO
THE REVISED COUNT YOUR BUDGET.
AND INCREASE HERE IS PRIMARILY
DUE TO AN INCREASE IN OVERALL
MEDICATION EXPENDITURES AS WELL
AS THE INCREASE AND INSURANCE
PREMIUM EXPENDITURES.
AND THEN THERE'S ALSO FOR THE
SAKE OF TIME I JUST WANT TO DRAW
ATTENTION TO ONE ITEM BECAUSE I
BELIEVE -- THERE WAS A REQUEST
IN THE AGENDA -- RELATED TO THE
EIGHT UP -- ENROLLMENT SYSTEM
AND TELL BROAD PROJECT.
SO FOR CURRENT YEAR THERE'S NO
CHANGE IN BUDGET AUTHORITY --
FROM THE FOUR POINT FOUR MILLION
THAT WAS ESTABLISHED IN THE TWO
THOUSAND EIGHTEEN BUDGET ACT --
BUT FOR BUDGET YEAR -- THERE IS --
AN ONGOING REQUESTS FOR THREE
POINT THREE MILLION JUST FOR
THAT -- FOR FOR BUDGET YOU'RE
ESSENTIALLY.
AND THAT PRIMARILY CONSIST OF
TWO POINT EIGHT MILLION RELATED
TO THE EIGHT UP IN ROMAN SYSTEM.
AND ANOTHER. TWO HUNDRED TWENTY
EIGHT THOUSAND FOR THE PROJECT
ITSELF.
I THANK YOU ANY COMMENTS FROM
MALAYO.
FINANCE RIGHT ANY PUBLIC COMMENT.
RIGHT WELL IT SAYS THANK YOU SO
MUCH IT'S A WE HEARD FROM SOME
PREVIOUS STAKEHOLDERS AS WELL
AND THEN -- PROPOSAL WE NEED TO
CONTINUE TO WORK AND AND FREE
SHEET AT DEATH IS.
VERY POOR PROGRAM TO HELP YOU
SURE WE GET PEOPLE ON TREATMENT
FOR HIV AND HOPEFULLY WE CAN TRY
TO ELIMINATE HIV EVENTUALLY SELL
THANK YOU SO MUCH WE WORK.
ALL RIGHT SO -- NEXT ISSUE --
ISSUE LEVIN IS S. T. D.
PREVENTION SOMETHING WE'VE.
THREE BEEN TALKING A LOT ABOUT
BUT HAVEN'T ENDED YET HI YOU
WILL PRESENT THE PROPOSAL ON AS
YOU HEARD TODAY ON THE NEWS ON
THE S. TO THE FRONT IS NOT GOOD --
THEIR RATES OF STV'S IN
CALIFORNIA CONTINUED TO INCREASE.
OUR PROVISIONAL DATA FOR TWO
THOUSAND EIGHTEEN SHOWS ABOUT
THE RATE OF INCREASE OF ALL
MAJOR STV'S HE'S.
STILL ON THE RISE.
OUR LAST YEAR THROUGH A
STAKEHOLDER PROPOSAL ON WE
RECEIVED AN AUGMENTATION OF TWO
MILLION DOLLARS.
THAT WAS -- UNFORTUNATELY ONLY A
ONE TIME A ROMAN TATIAN -- OLDER
THERE HAS BEEN VERY HELPFUL TO A
LOCAL HEALTH DEPARTMENTS IN
INCREASING THEIR CAPACITY AND I
CAN.
I WILL COME BACK IN A MINUTE
TELL YOU MORE WHEN THEY'VE DONE
WITHOUT.
THE CHALLENGE FOR THEM HAS BEEN
THAT BEING THAT IS A ONE TIME
AUGMENTATION THEY HAVE BEEN
UNABLE TO SECURE PERSONAL
RESOURCES TO DO THAT MUCH NEEDED
WORK THEY NEED TO DO.
SO A LOT OF WHAT THEY'RE DOING
IS -- ACTIVITIES THAT DO NOT
REQUIRE STAFF RESOURCES SO OUR
PROPOSAL IS -- IN THE HOPES THAT
WE CAN MAKE THAT TWO MILLION
DOLLAR -- AUGMENTATION PERMANENT
SO THAT LOCAL HEALTH DEPARTMENTS
DON'T HAVE TWO YET AND DO
ANOTHER REDUCTION IN THIS TO THE
FUNDING.
THANK YOU OF COMES FROM OHIO
[inaudible]
FINANCE [inaudible]
OKAY.
SO I KNOW THIS IS THE GOVERNOR'S
BUDGET SO -- THAT I'D SAY.
REACHED HER PROPOSAL FOR TWENTY
MILLION REQUESTS -- SO I KNOW
YOU CAN'T REALLY GIVE YOU A
DIFFERENT ANSWER BUT THIS TWO
MILLION REALLY ENOUGH.
NO BUT I THINK.
IT'S FAIR TO SAY THAT TWO
MILLION DOLLARS IS NOT ENOUGH I
MEAN I THINK WE HAVE AN
INCREASING PROBLEM ABOUT HI
SONYA GETTING WORSE.
SO ARE CLEARLY TWO MILLION
DOLLARS IS IS JUST -- TO KEEP US
WHERE WE ARE TODAY IT'S NOT
GOING TO HELP -- IN IMPROVING
THE SITUATION MORE THAN THAT --
I THINK THERE ARE.
A BUDGET ESTIMATES THAT.
AND PROJECTIONS THAT CAN BE MADE
USING CDC.
ARE GORY FILMS THAT WILL TELL
YOU THAT TO ACTUALLY TURN THE
CURB ON STDS WE NEED A MUCH
LARGER INVESTMENT OKAY.
OR MAYBE WE CAN GET SOME
TECHNICAL ASSISTANCE IN LOOKING
AT THAT AND I MEAN I I THINK THE
OTHER PART IS THE THINK ABOUT SO
ON THE PUBLIC HEALTH SIDE RATE
WE'RE TALKING HOW MUCH MONEY WE
NEED TO PUT IN.
I DON'T KNOW HOW MUCH YOU'RE
SPENDING ON THE MEDICAL SIDE
WHEN PEOPLE YELL NEED DIRECT
HEALTH SERVICES FROM THESE STDS.
AND HOW MUCH WERE SO I KNOW WE
WE TALKED A LITTLE BIT OUT PROP
FIFTY SIX AND SOME OF THAT BUT
ALSO ON THE ON TERMS OF THE ON
THE MEDIC HAL AND GREAT BECAUSE
WHEN SOMEONE HAS AN STD.
THEY'RE ALSO GONNA SIR FOR
HEALTH CONSEQUENCES THAT THEN.
IF THEY'RE A MEDIC HOW THAT'S
GOING TO COST MEDICAL PROGRAM
RIGHT NOW -- SO -- WE TALK ABOUT
THOSE BABY THE ONLY TALK ABOUT
THIRTY BABIES WHO ARE STILL BORN
BUT AND THAT'S TERRIBLE BUT WE
ALSO HAVE A LOT OF OTHER BABIES
WERE BORN YOU NOW HAVE --
INJURIES STRAIGHT AND AND SOME
OF THEM HAVE LONG TERM AND SO
THAT HEALTH COSTS THAT.
EDUCATION COSTS DEVELOPMENTAL
COSTS.
SO I HOPE WE CAN LOOK AT THIS IN
TERMS OF NOT JUST LIKE OH WELL
TWO MILLION AND DO WE WANT TO DO
WATER AND HOW MUCH THAT COSTS
BUT WHAT'S THE COST OF NOT DOING
ANYTHING HOW MUCH ARE WE
SPENDING NOW.
BECAUSE WE'RE NOT DOING ENOUGH
AND NOT CHANGING THE CURVE.
SO I KNOW THAT'S SOMETHING I
PREVIOUS OFTEN POSE IT SAID THIS
ONE'S PRIVATE OVER COMPLICATED
FIGURE OUT BUT FOR A A BUT YEAH.
YEAH I CERTAINLY CAN'T ANSWER
THAT QUESTION RIGHT NOW AND I I
MEAN I GUESS ONE THING OUR
OFFICE WOULD SAY ABOUT THIS
PROPOSAL OR NOT WELL WE WOULDN'T.
NECESSARILY HAVE A AN
ALTERNATIVE AMOUNT TO RECOMMEND
RIGHT NOW THE TWO MILLION
DOESN'T REALLY HAVE AN ANALYTIC
PIECE IS ONLY BASED ON THE FACT
THAT TWO MILLION ONE TIME WAS
PROVIDED LAST YEAR.
RIGHT SO THAT WAS ONE OF OUR
CONCERNS WHEN WE SAW THIS
PROPOSAL THAT.
BASICALLY THE TWO MILLION
REQUIRES THE DEPARTMENT TO
PRIORITIZE ONE TERRIBLE.
DISEASE OVER ANOTHER -- SO IT
YOU KNOW SO I I THAT'S WHY IS IT
IN THE RECOGNIZING THAT THIS IS
THE CURRENT PROPOSAL BUT USING
THE ANALYTICS WE SHOULD FIND OUT
LIKE HOW MUCH YOU REALLY NEED TO
BEND THE CURVE RIGHT BECAUSE
THAT'S WHAT WE WANT.
OR WHAT HOW MUCH WE REALLY NEED.
SO OBVIOUSLY TOO MANY IS BETTER
THAN NOTHING BUT HOW MUCH ARE WE
REALLY DOING A TWO MILLION AND
WE REALLY WANTED TO CHANGE THE
SITUATION AND HOW MUCH DO WE
REALLY NEED.
AND WE SHOULD BE KNOWING WHAT
THAT NUMBER IS AND THEN WE HAVE
A DISCUSSION ABOUT WHERE IT IS
IN THE PRIORITY RIGHT THAT'S
WHAT WE DO AND BUDGETSBUT AT
LEAST WE KNOW WHAT.
HOW MUCH WE NEED TO TO MAKE THE
CHANGE THAT WE WANT SO I'M
HOPING -- I REALIZE THIS IS
PRETTY LATE IN THE GAME BUT I
THINK SOME WE NEED TO START
LOOKING AT THAT WHETHER IT'S
THIS BUDGET NEXT BUDGET OR
SOMETHING -- BUT WE ONLY HAVE A
SINGLE PROPOSAL FOR TWENTY
MILLION FOR LET ME HAVE THIS
SWITCH OVER I APPRECIATE THAT
THE GOVERNOR IS PROPOSING TO DO
AN ON GOING SINCE AS A ONE TIME
INITIALLY BUT LET'S FIGURE OUT
WHAT IS THAT.
AMOUNT THAT WE NEED. TO TO
ACTUALLY MAKE THE CHANGE AND IF
THERE'S A MECHANISM TO DO THAT
YOU MENTIONED CDC HAS SOME SORT
OF A THING.
MAY WE CAN APPLY THAT AND COME
UP WITH A NUMBER.
SO WE CAN START CHANGING THESE
NUMBERS.
OKAY.
OUR RIGHTS IS CITY WHO'S GONNA
DO THAT.
FINANCE.
WE'RE HAPPY TO CONTINUE
DISCUSSIONS TO EXTEND THE
PRIORITY AS YOU MENTION OKAY SO
I GUESS WHAT IT IS.
TECHNICAL SO WHAT YOU SEE WILL
HAVE A DISCUSSION AS TO EXACTLY
HOW MUCH EVENTUALLY BUT IN TURN
ORDER FORM THAT DISCUSSION I
THINK IS THE ALLEY AS SUGGESTED
AT LEAST CAN WE COME UP WITH AN
ESTIMATE AS TO THIS IS NOT
LIKE EXACTLY HOW MUCH OF AN
ISSUE.
THIS MUCH IS FOR SO I GOT A WHAT
THE TARGET IS RIGHT ITSELF WE
CAN HAVE SOME HELP IN TURNING TO
TARGET THAT WOULD BE GREAT
[inaudible]
THAT OKAY [inaudible]
I MEAN.
YEAH WE HAVE FURTHER
CONVERSATIONS ABOUT WHAT SORT OF
DATA YOU MIGHT BE LOOKING FOR
OKAY WELL THE DATE I'M LOOKING
FOR IS HOW MUCH WEIGHT DO WE
NEED TO GET THE RESOURCES TO
CHANGE THE CURVE ON THIS.
THAT'S WHAT I WANT SO THERE'S
SOME MODELS OUT THERE SOME
MECHANISM SET OUT TO DO THAT YES
AND I AM HAPPY TO FOLLOW UP WITH
BOTH THE DEPARTMENT AND
APARTMENT OF FINANCE TO MAKE
SURE THIS QUESTION GETS ANSWERED
FOR YOU OKAY.
THANK YOU THANK YOU VERY MUCH
ALL RIGHT [inaudible]
PUBLIC COMMENT.
SO GIVEN THAT THE COUNTY HEALTH
EXECUTIVES ASSOCIATION
CALIFORNIA REPRESENTING LOCAL
HEALTH DEPARTMENTS WE DO
APPRECIATE THAT THE FUNDING IS
CONTINUOUS IT'S NOT IT'S NO
LONGER ONE TIME WE DO ALSO
RECOGNIZE THAT A TWO MILLION
DOLLAR INVESTMENT TO REALLY
TACKLE THAT THE HUGE STD ISSUE
THAT WE'RE HAVING THROUGHOUT OUR
STATE.
IS NOT ENOUGH -- AND WE WOULD BE
HAPPY TO BE A PART OF THAT
CONVERSATION AROUND WHAT IS
REALLY NEEDED TO MAKE.
AN INVESTMENT TO REALLY ADDRESS
THESE ISSUES I WOULD ALSO SAY
THAT THE CONVERSATION SHOULD BE
MUCH BROADER BECAUSE A LOT OF
THE SKILL SETS THAT WILL ADDRESS
STDS WILL ALSO ADDRESS OTHER
DISEASES AS THEY COME ALONG SO
WE THANK YOU FOR THAT DISCUSSION.
OKAY THANK YOU.
ALL RIGHT.
SO YOU HAD AN ON ITEM TWO HERE
AND I KNOW WE'RE RUNNING OUT OF
TIME YOU.
CAN JUST TELL YOU THAT THE THE
INVESTORS FROM LAST YEAR ARTISTS
ARE BEING USED VERY WELL.
WE ARE LOCATED THE FUNDING TO
LOCAL HEALTH DEPARTMENTS USING A
FORMULA THAT THEY HELPED US
DEVELOP TO TARGET THE HIGHEST
RISK AREAS -- WE WANTED TO HAVE
MINIMUM A WARTS THAT WHERE AT
LEAST GOOD -- FOR BASIC CONCEPT
OF ACTIVITIES SO WEAK ARE HOT
FUNDING FROM 270-002-60020
THOUSAND DOLLARS -- AND WE FOUND
THAT FIFTY LOCAL HELL
JURISDICTIONS THAT HAVE 86% OF
THE CONGENITAL SYPHILIS CASES --
AN 89% OF ALL SYPHILIS CASES AND
SO WE WE GET THE NEW FUNDING WE
WOULD DO A SIMILAR FORMULA TO
MAKE THE DECISION ON ONGOING
FUNDING.
COUNTY SO USING THE FUNDS TO
ENHANCE AND HAD A SEXUAL HEALTH
AND EDUCATION ON FOREST TO THE
SCREENING TESTING AND TREATMENT.
FOR PUBLIC OUT OF REACH HI FOR
ENHANCING POLITICAL SERVICE.
OKAY THANK YOU AND I'M SURE YOU
MAKE VERY EFFECTIVE USE OF WHAT.
MONEY YOU DO GET CELL AND
APPRECIATE THAT AND THEY KNOW
PUBLIC HEALTH PEOPLE ARE DRIVEN
BY DATA CELL.
MISTER YOU'RE TRYING TO MAKE THE
MOST YOU CAN BUT NICE MY GUESS
IS THAT IT'S NOT ENOUGH TO DO
THIS MUCH IS NOT JUST WHAT YOU
WANT BUT THE CHANGE CURVE WHICH
IS I KNOW WHAT YOU WANT AND I
WANT AND I THINK PEOPLE
CALIFORNIA.
ONE CELL [inaudible]
THANK YOU.
ALL RIGHT -- NEXUS -- I THINK
IT'S A CUT TO A LAB -- YEAH
RICHMOND LAB VIRAL RICKETS ILL
DISEASE LAB ENHANCED UPGRADE
[inaudible]
RIGHT.
COM.
ALL RIGHT.
WE HAVE SOME ADDITIONAL
INTRODUCTIONS HERE NEW PEOPLE AT
THE TABLE.
THE EVENING SENATOR.
THAT EVENING NAMES ROBERT
BLASIER I AM THE BRANCH CHIEF AT
THE CALIFORNIA DEPARTMENT PUBLIC
HEALTH AND ONE OF YOUR
CONSTITUENTS.
HERE BEFORE WITH YOU -- CAPITAL
OUTLAY B. C. P. THAT WOULD BE A
MILLION EIGHTY THOUSAND DOLLARS
REQUESTED TO FULLY FUND THE
CONSTRUCTION NECESSARY FOR THE
BIOSAFETY LEVEL THREE LAB IN OUR
RICHMOND FACILITY.
THE RICHMOND LABORATORY THE
PUBLIC HEALTH LAB THERE WAS
STATE OF THE ART WHEN IT WAS
BUILT IN TWO THOUSAND OBVIOUSLY
MET ALL THE REQUIREMENTS.
BUT IN TWO THOUSAND SIX THE CDC
IN THE N. I. H. INCREASE THE
STANDARDS FOR SAFETY LEVELS AND
REQUIREMENTS AND SO THIS WOULD
BRING US TO BE IN COMPLIANCE
WITH ALL OF THOSE -- TGS WENT
OUT FOR A BIT IN TWO THOUSAND
EIGHTEEN THIS LAST FALL AND WE
HAD ONE BITTER COME IN IN
JANUARY OF THIS YEAR THAT WAS
21% OVER THE CONSTRUCTION COST.
SO THE APPROVAL OF THIS ONE
MILLION EIGHTY THOUSAND WOULD BE
ABLE TO FULLY FND THAT BID
THAT'S BEEN IN SO THAT WE COULD
pFINALLY BEGIN CONSTRUCTION WHICH
WOULD BE IN AUGUST OF THIS YEAR
CONSTRUCTION WOULD BE COMPLETED
IN AUGUST OF NEXT YEAR.
BE ABLE TO HELP US MAINTAIN THIS
CRITICAL COMPONENT OF OUR LABS
THERE SO THAT SAFETY FOR ALL OF
CALIFORNIANS AND THOSE THAT WORK
IN OUR LAPS [inaudible]
THANK YOU [inaudible]
NO OUR SPRINKLER PART OF FINANCE
OKAY ALL RIGHT THE FIRST LINE
ANSWER ANY COMES FROM LA -- NO
FINANCE ANY COMMENTS.
SO I UNDERSTAND THAT WE HAD
BUDGETED MONEY BEFORE WHEN OUT
THERE'S ONLY ONE PERSON WHO DID.
WE DIDN'T ACCEPT THAT DID.
WE WENT BACK WE GOT ONE PERSON
DOWN THE SAME PERSON WHO WHO
GOOD EXCEPT THE PRICE WENT UP.
AGAIN OKAY.
SO DUE TO THE EVERYBODY REALIZES
THAT WE IDEALLY DO ONE ANIMAL TO
BOWL BIDS BUT WE'RE JUST GOING
TO GO AND GET THIS DONE NOW
WE'RE NOT GONNA WAIT AND HAVE
THE PRICE GO UP AGAIN.
IS AT THE ANDERSON WE GO FORWARD
WITH THIS THIS A BITTER HAS
AGREED TO LOCK IN AND STAY FOR
INTERNET OKAY SO WE'LL BE ABLE
TO SEND AND THAT'S INTENTION
ADMINISTRATION THAT IF WE DO
THIS IS IN THE BUDGET AND THEN
WE'RE JUST GONNA GO AHEAD AND
GET IT.
DONE THEN CORRECT AND THAT IN
THE MEAN. FOR MOST PART I
REALIZE THAT IT'S NOT AS LOW AS
YOU WANT IT I MEAN IT.
BUT STILL WITHIN REASON RIGHT
BACK OKAY ALL RIGHT.
OKAY.
HI ALL RIGHT VERY GOOD HOPEFULLY
WE WON'T HAVE. TO HOPEFULLY THE
NEXT TIME WE TALK -- HAVE A
UPDATED UPGRADED LAB AND NOT
ANOTHER BUDGET REQUEST OKAY
THANK YOU HOLD ON BEFORE A
PUBLIC COMMENT.
ALL RIGHT NO PUBLIC COMMENT
THANK YOU ALL THAT OPEN SORRY
HAVE TO SOMEONE PUBLIC MIGHT
HAVE A COMMENT.
ABOUT THAT ALL RIGHT.
NEXT ITEM IS INFANT BOTULISM
TREATMENT AND PREVENTION AND
COMPLIANCE COSTS FOR BABY BIG.
YES SO THAT'S THE LAST OF MY
ITEMS AND AS YOU KNOW FROM.
YOUR OWN TRAINING I AM FROM
BOTULISM.
IS -- A VERY TERRIBLE DISEASE ON
IN THOSE VERY ABOUT THINGS TO
BABIES -- THANKS TO A PUBLIC
HEALTH OF THE CALIFORNIA PUBLIC
HEALTH AND LEADERSHIP OF THE
LEGISLATURE A BILL WAS
INTRODUCED MANY YEARS AGO THAT --
ALLOW THE CREATION OF A MIRACLE
DRUG TRULY CALL BABY BIG ABOUT
SAVES THE LIVES OF THESE BABIES
BUT ALSO SAVES.
A LOT OF MONEY YOU HEALTHCARE
COST.
HI IT'S SAFE SO MUCH MONEY THAT
EVEN WHEN THE DRUG IS EXPENSIVE --
HELL CARRY SHOOTERS ARE HAPPY TO
PAY FOR IT BECAUSE IT'S STILL
SAVES THEM A TON OF MONEY -- THE
ACTIVITIES FOR THESE ARE THE
PRODUCTION OF THESE DRUGS --
VERY FROM YEAR TO YEAR SO OUR
BUDGETING IS VERY DIFFICULT TO
DO FROM YEAR TO YEAR SO WE
FREQUENTLY HAVE TO COME TO YOU
AND ASK -- FOR RELATED WHERE WE
SAVE THE FUNDS THAT WE COLLECT
SO THAT WE CAN PAY FOR THE
EXPENSES FOR THE FOLLOWING YEARS.
HI THIS YEAR WE'RE DOING A THREE
YEAR -- PROPOSAL SO THAT WE
DON'T HAVE TO COME TO YOU EVERY
YEAR -- THAT BASICALLY WILL GIVE
AS THE S. SPENDING AUTHORITY.
THAT THAT WE NEED SO THAT WE CAN.
CONTINUE TO DEVELOP THE THE
PRODUCTION OF THIS DRUG WE HAVE
AN AWFUL DRUG MANUFACTURER NOW
FOR THE NEXT SEVERAL YEARS WHILE
THE CYNICS LOTS BEING PRODUCED.
SON EL AL.
NO NO CONCERNS THAT THEY WON
MONEY AND EVEN THOUGH IT INTERIM
AND OVERSIGHT AUTHORITY WE
SHOULD BE EXERCISING OVER THIS.
OKAY.
ALL RIGHT FINANCE [inaudible]
OKAY [inaudible]
PUBLIC COMMENT.
ALL RIGHT SOUNDS GOOD I
APPRECIATE THAT WERE PRODUCING A
LIFE SAVING DRUG HERE IN CITY
CALIFORNIA THIRD PART OF THE
HEALTH THANK YOU AND THANK YOU
SO MUCH DOCTOR SHOT IS SET FOR
YOUR WORK AND BEING HERE THANK
YOU.
SO MUCH IF.
HEY ISSUE NUMBER FOURTEEN PUBLIC
HEALTH CRISIS RESPONSE GRANTS.
SERVICE IS CONTINUING LANGUAGE
LANGUAGE FROM LAST YEAR SEASON
FINALES CHIEF DEPUTY FOR BASIC
HEALTH -- THIS LANGUAGE IS JUST
A CONTINUATION FROM LAST YEAR
CDC HAS PUT IN PLACE A PROCESS
WHERE.
WE BASICALLY APPLY FOR A GRANT
IT'S NOT FUNDED UNTIL AN
EMERGENCY HAPPENS AND SO WE HAVE
OUR NEW VERSION IT'S AN EIGHTEEN
MONTH LONG -- AWARD -- AND SO I
THINK WE JUST WANNA PUT IT BACK
INTO THE BUDGET AGAIN.
OKAY SO I. L. L. [inaudible]
FINANCE.
SO BASICALLY THIS IS AN ACCOUNT
SO THAT IF THERE'S AN EMERGENCY
IN THE FEDS GIVE US MONEY WE
HAVE A PLACE TO PUT IT.
RIGHT IN THE EYE AND QUICKLY PUT
IT INTO PLAY ALL RIGHT EXCELLENT
OKAY PUBLIC COMMENT.
NONE ALL RIGHT WE'LL HOLD THIS
ITEM OPEN BUT I EXPECT THIS
SHOULD HOPEFULLY NOT BE AN ISSUE
THANK YOU [inaudible]
ALL RIGHT.
OKAY SO WE HAVE -- SEVERAL --
FOR ADDITIONAL STEAK. THREE OF
THREE LITTLE BY LITTLE.
OKAY JUST WANT TO OKAY SO WE
HAVE -- THREE STAKEHOLDER
PROPOSALS ADDITIONAL PROPOSALS
ARE FAST AND RELATE TO PUBLIC
HEALTH -- SO WE HAVE FIRST THE
CALIFORNIA RULE SYSTEM FIVE
ASSISTANCE FUND -- PROPOSAL TO
FUND THE FARMWORKERS HEALTH
STUDY WELCOME.
SO YOU CAN KEEP YOUR
PRESENTATION THE THREE MINUTES
COLLECTIVELY.
GOOD EVENING SENATOR PAN -- MY
NAME IS JOEL DERRINGER I'M HERE
WITH NO A BOTTOM -- FROM THE
CALIFORNIA RURAL LEGAL
ASSISTANCE FOUNDATION -- WE
APPRECIATE THE OPPORTUNITY EVEN
AT THIS LATE HOUR TO COMMENT ON
THE PROPOSAL FOR FARM WORKER
HEALTH STUDY -- AND I WANT TO
THANK SENATOR CUP I YADDO FOR
HELPING MOVE THIS ALONG WHO
WOULD HOPE TO BE HERE -- AS WE
WERE DEVELOPING NEW POLICY
PROPOSALS FOR HELP WITH THE HELP
OF FARM WORKERS WHICH REALLY THE
BACKBONE OF OUR STATES FIFTY
BILLION DOLLAR AG INDUSTRY.
WE WERE STRUCK BY THE LACK OF
DATA.
I MEAN YOU JUST MENTIONED A
PUBLIC HEALTH DATA -- THE LAST
SIGNIFICANT STUDY ON HEALTH
ACCESS AND HEALTH STATUS FOR
FARM WORKERS WAS OVER TWENTY
YEARS AGO.
I WAS INVOLVED WITH THAT AS A
PROGRAM OFFICER AT THE
CALIFORNIA ENDOWMENT.
WE'VE DONE NOTHING SINCE THEN TO
ACTUALLY UPDATE THIS WE HAVE A
LOT OF ANECDOTAL DATA BUT WE
DON'T KNOW IS WHAT'S BEEN GOING
ON EVER SINCE THEN -- WHAT'S
HAPPENED IN THE PAST TWENTY
YEARS HOW IS THE AFFORDABLE CARE
ACT.
WITH ITS EXPANDED ACCESS TO
COVERAGE IN MEDIC HAL AND THE
EXCHANGE FOR WHICH FARM WORKERS
ARE NOT NECESSARILY ELIGIBLE
REALLY AFFECTED FARM WORKERS OR
HOW IS THE LARGE EMPLOYER
MANDATE.
WHICH DOES AFFECT FARM WORKERS --
HOW WOULD THAT WORK FOR THEM?
HOW IS ALL THE EXPANDED CLINIC
CAPACITY IN RURAL AREAS IMPACTED
FARM WORKERS SAID THEY ACTUALLY
GETTING MORE SERVICES?
HOW IS THE HELP OF FARM WORKERS
BEING?
SUPPORTED BY ALL THE PREVENTIVE
HEALTH EFFORTS WHICH YOU HEARD
OF TODAY.
AND THEN ALSO HOW WOULD BE
EXPANDED MEDIC HOW PROPOSAL THE
HEALTH FOR ALL THEIR MEDICAL FOR
ALL PROPOSE A REALLY AFFECT
FARMER CHRIS AND WHAT WOULD IT
TAKE.
SO WHAT WE'RE PROPOSING HERE TO
DEVELOP EFFECTIVE POLICY OPTIONS
IS TO ACTUALLY GET SOME REAL
DATA -- THREE WAYS ONE IS BY A
RENEWING THIS SURVEY OF FARM
WORKERS AND WE DID I THINK EIGHT
HUNDRED LAST TIME.
IN DIFFERENT REGIONS AROUND THE
STATE.
SECOND ONE IS TO GATHER DATA
FROM AG EMPLOYERS -- WHITE IS
THERE UNDER YOU KNOW WHAT IF
THEY'VE BEEN DOING IN HEALTH AND
WELLNESS HOW ARE THEY OFFERING
HEALTH INSURANCE AND MORE
IMPORTANTLY HOW IS IT BEING
TAKEN UP.
AND THEN THIRDLY IS TO LOOK AT
THE CURRENT PROGRAMS AND FUNDING
STREAMS TO SEE HOW THEY CAN
BETTER HOW ARE THEY SERVING AND
HOW CAN THE BETTER SERVE FARM
WORKERS.
SO THAT'S OUR REQUEST YOU TWO
DAYS TO ACTUALLY HELP FIND MOVE
THIS ALONG.
BECAUSE WE DON'T WANT TO COME
HERE WITH POLICY OPTION GO WE
HAS THE DATA WELL I I CAN TELL
YOU WHAT I THINK IT IS.
BUT I'D RATHER HAVE RELOCATED TO
BRING HERE SO WE CAN DEVELOP
SOME VERY TARGETED POLICY
OPTIONS [inaudible]
THANK YOU.
THANK YOU FOR OUR PRESENTATION
TODAY.
ANY COMMENTS FROM LA -- FINANCE.
THE PUBLIC COMMENT.
WITH YOUR PERMISSION I JUST LIKE
TO SHARE ON BEHALF OF CALIFORNIA
PAN ETHNIC HEALTH NETWORK THEY
STAND IN SUPPORT OKAY AND WE
THANK YOU.
A LIST OF TWENTY FIVE SUPPORTING
ORGANIZATIONS WHICH YOU MAY HAVE
BEFORE YOU OKAY.
I DON'T SEE FIVE PEOPLE HERE.
ARE YOU KNOW I KNOW IT'S GETTING
LATE TOO SO -- SO THIS WOULD
THIS WOULD BE SOMETHING WHERE
THE STATE WITH WITH THAT FIRST
THIS WAS BUDGETED WITHIN
CONTRACT OUR SIM FOR THE RIGHT
YEAH THE THE LAST SEARCH THE
ORIGINAL STUDY WAS DONE BY THE
CALIFORNIA INSTITUTE FOR RURAL
STUDIES WHICH IS A CO SUPPORTER
OF THIS.
OF ALL STRIPES SUPPORT WITH THE
UC BERKELEY LABOR CENTER TO
REALLY HELP ON THE COVERAGE
ISSUES AND THEIR NUMBER OF OTHER
ORGANIZATIONS.
WHO WERE REALLY EAGER TO
PARTICIPATE OKAYALL RIGHT VERY
GOOD THANK YOU THANKS VERY MUCH
THANK YOU OKAY OUR NEXT --
STAKEHOLDER PROPOSALS -- FROM
THE RICE CENTER HOPE TO
PRONOUNCE IT CORRECTLY --
PROPOSAL TO ESTABLISH AN OFFICE
OF HEALTHY AND SAFE COMMUNITIES.
ARE THEY HERE [inaudible]
OKAY [inaudible]
CHECK.
OKAY WELL LOOKS LIKE THEY'RE NOT
PRESENTS -- WE DO HAVE A SUMMARY
OF THEIR PROPOSAL AND THE RIGHT
UP THEN FINALLY WE HAVE OF THE
SICKLE CELL DISEASE FOUNDATION
CALIFORNIA IN THE CENTER FOR HAD
A BLOOD DISORDERS A PROPOSAL TO
ESTABLISH AN INTEGRATED NETWORK
OF PRIMARY SPECIALTY CARE
PROVIDERS FOR INDIVIDUALS TO
CYCLE CELL [inaudible]
WELCOME [inaudible]
OKAY SO.
WE GOT THREE MINUTES BETWEEN THE
END OF YOUR BIRTH PRESENTING
OKAY.
THANK YOU THANK YOU.
EVEN THE MAYOR BROWN PRESIDENT
CIRCLE SO DISEASE AND ASIAN
CALIFORNIA ARE YOU MY TIME TO
DOCTOR NEW JERSEY.
I'LL BE BRIEF THANKS AGAIN I WAS
HERE EARLIER BUT THIS IS. TO
COMMENT BUT THIS IS ACTUALLY THE
REAL REASON I'M HERE -- IN
CALIFORNIA US SENATOR PAN YOU
KNOW THAT WE DO A GREAT JOB WITH
PEDIATRIC SICKLE CELL DISEASE.
AND 95% OF SICKLE CELL PATIENTS
GET TO ADULTHOOD IN OUR PROGRAM
IT'S EXCELLENT.
UNFORTUNATELY AFTER THAT THEY
HAVE NO ADULT CENTERS TO GO TO
LIFE EXPECTANCY IN CALIFORNIA IS
SHORTER THAN ALMOST ANY OTHER
STATE.
IN THE UNITED STATES SICKLE CELL
LIFE EXPECTANCY IS ROUGHLY SIXTY
ONE YEARS IN THE U. K. BUT
SEVENTY AND IN CALIFORNIA NOW.
BASED ON PH I. TRACKING
CALIFORNIA DATA IT'S DOWN TO
FORTY THREE YEARS AVERAGE LIFE
EXPECTANCY.
IN SOUTHERN CALIFORNIA WE HAVE
YOUNG FOLKS DINE IN THEIR LATE
TWENTIES AND THIRTIES.
SO WE COME TO YOU WITH THE
PROPOSED SOLUTION AT LEAST A
START.
AND THAT IS HOME TO HAVE --
FIFTY MILLION DOLLARS DIVIDED IN
FOUR AREAS THE FIRST IS TO
URGENTLY SET UP SPOKE CLINICS
AMONGST OUR COMMUNITY BASED --
COUNTY PLANS WE MET -- WITHOUT A
WONDERFUL MEETING WITH BRAD
GILBERT IN I. E. H. P. -- WHO
IMMEDIATELY EMBRACED THE PROGRAM
IT'S TO SET UP SPOKE CLINICS
WHERE THE DENSITY IS GREATEST --
WITH THE CORE TEAMS THE PRIMARY
CARE TEAMS AND THEN HAVE
HEMATOLOGIST GO OUT AND MEET AS
NEEDED WEEKLY OR TWICE A WEEK
DEPENDING ON THE DENSITY BUT ON
A REGULAR BASIS.
WE CAN ACT -- TO TWENTY FOUR
SEVEN WITHOUT HEMATOLOGIST
THROUGH TELEMEDICINE.
WHICH WE'VE BEEN ABLE TO
IMPLEMENT VERY SUCCESSFULLY FROM
OUR HUB AND FROM OTHER HUBS IN
THE STATE -- WE'RE ANXIOUS TO
IMPLEMENT THIS IN AREAS THAT ARE
GEOGRAPHICALLY CHALLENGED AND
PRIMARILY BECAUSE OF WORK FORCE
HAVE NO FACILITIES THE SECOND
PART OF THIS -- FIFTY MILLION
WOULD BE USED FOR WORK FORCE
EXPANSION THE THIRD IS FOR THE
DEVELOPMENT OF A COMMUNITY BASED.
HEALTH CARE WORKER NAVIGATORS
FOR PATIENTS WHO HAVE
SIGNIFICANT FRONTAL LOBE
EXECUTIVE FUNCTION ISSUES FROM
SILENT STROKES.
OF THROUGHOUT THEIR LIVES IN THE
LAST PART IS REALLY TO PROVIDE
EDUCATION TO THE HOSPITALS
MEDICAL SCHOOLS IN E. OURS THIS
IS WHERE PATIENTS ARE GETTING
THEIR CARE NOW.
IT ISN'T THIS POOR THERE'S NO
CONTINUITY OF CARE THEY DON'T
RECOGNIZE A MORBIDITY SUCH AS
ACUTE CHEST SYNDROME.
AS BEING SOMETHING OTHER THAN
BRONCHITIS AND THE PATIENTS GO
HOME TO DIE.
THIS IS -- A THREE YEAR PROPOSAL --
WE THROUGH SURVEILLANCE AGAIN
WORKING WITH PH I WILL
DEMONSTRATE IMPROVED ACCESS TO
CARE OUTCOMES AND OF LONG TERM
DRIVE DOWN THE SCOTT COSTS FROM
THE ARSON HOSPITALIZATION THANK
YOU.
FOR ALL RIGHT THANK YOU ANY
COMMENTS FROM OHIO [inaudible]
FINANCE.
IN PUBLIC COMMENT [inaudible]
OKAY [inaudible]
SO -- THAT ONE TIME THREE YEARS
AND THEN THAT.
AFTER THE THREE YEARS IS DONE
WOULD YOU STILL NEED MORE MONEY
HERE WITH THAT THAT MEANS THERE
ARE AS YOU LOOK.
SUSTAINABILITY PLAN YEAH I ARE
BUILT INTO THIS IS THE
SUSTAINABILITY UP PLAN THERE'S A
PORTION OF THE FIRST CHUNK OF
MONEY. TO DEMONSTRATE IMPROVED
OUTCOMES WE TALK ABOUT BUNDLED
CARE BY DID IT DEMONSTRATING
THAT WE'RE RAISING THE CAPACITY
AND THE LEVEL OF CARE WITHIN THE
COMMUNITY.
COUNTY BASED SYSTEM WE'RE HOPING
TO GENERATE A BUNDLED CARE MODEL
WORKING WITH THE PLANTS AND AND
WE'VE RECEIVED REALLY POSITIVE
FEEDBACK FROM THEM WE UNDERSTAND.
IT'S A ONE TIME OKAY EXCELLENT
ALL RIGHT WELL THANK YOU THANK
YOU VERY MUCH I APPRECIATE YOU
SHARING AND I KNOW THAT THE LAST
YEAR YOU I'D.
GIVE THE FALLS ON THE THE THE
MORTALITY -- BUT LIFE EXPECTANCY
OF SALT SICKLE CELL ON
CALIFORNIA'S.
THAT WAY TOO LOW AND SAID WE WE
DO BETTER IN THE STATE WE OTHER
STATES HAVE DONE BETTER WE CAN
DO BETTER TO SELL THANK YOU
THANKS FOR ENGLISH.
THANK YOU.
ALL RIGHT THANKS AGAIN FOR OKAY
WELCOME ALL RIGHT WELL I THINK
WITH THAT -- WE HAVE CONCLUDED
THE AGENDA FOR THIS HEARING OF
THE BUDGET FISCAL REVIEW
SUBCOMMITTEE ON HEALTH AND HUMAN
SERVICES SOMEWHAT THANK EVERYONE
FOR HANGING IN THERE -- TO THE
EVENING -- SO WITH THAT -- SAYS
WE FLEW THE AGENDA THIS HEARING
IS NOW ADJOURNED