SENATE BUDGET SUB COMMITTEE
NUMBER THREE AND HEALTH AND
HUMAN SERVICES WILL COME TO AN
ORDER GOOD MORNING EVERYONE WE
HAVE A VERY LIGHT AGENDA TODAY
NOTHING BIG TO TALK ABOUT SO
WE'LL GO PRETTY QUICKLY- WE
CONTINUE TO WELCOME PUBLIC IN
PERSON IN PERSON PUBLIC COMMENT
AS WELL AS THROUGH A
TELECONFERENCE TODAY'S NUMBERS.
1-877-226-8160 THREE WITH AN
ACCESS CODE OF SEVEN THREE SIX
TWENTY EIGHT THIRTY FOUR AS
ALWAYS WE ARE IN ROOM TWELVE
HUNDRED IN THE- STREET BUILDING.
AND I'LL GET US FOR THE REST OF
MY COMMITTEE MEMBERS TO JOIN US
SO WE CAN ESTABLISH A QUORUM.
WE'RE GOING START OFF WE GO INTO
THE VOTING PORTION WORSE GOING
TO START OFF WITH THE MCO TAX
PANEL- WE WERE GOING TO BE WILL
BE HEARING FROM THE
ADMINISTRATION ON THEIR POWER ON
THEIR PLAN FOR THEM STILL TAX
AND THE PROVIDER INCREASED
PROPOSAL WILL ALSO BE JOINED BY
SOME STAKEHOLDERS OF COALITION-
REGARDING THE- THERE INSIDE AND
HOW IT'S GOING TO IMPACT TO THEM
. AND THEN WE'LL GO IT WILL
CONCLUDE OUR AND GENDER WITH OUR
WITH OUR- BOTH ONLY CALENDAR
CONSISTING OF ITEMS FROM-
CALIFORNIA HEALTH AND HUMAN
SERVICES S. C. COUNCIL ON
DEVELOPMENTAL DISABILITIES I AM
SO. THE PART IN A VARIETY OF
DEPARTMENTS AFTER THAT WHEN WE
THEM EVERY SINGLE ONE SO WE CAN
BEGIN WITH OUR PANEL- I WILL ASK
. RIGHT I WILL ASK THE HVS TO
COME UP TO THREE FOUR SIX WE
HAVE NINE CHEERS AND WE'RE GONNA
HAVE TO BE DOING A LITTLE BIT OF
SWAPPING BACK AND FORTH. L. A.
O. DEPARTMENT OF FINANCE TO JOIN
US. SO. M. AS WE GET SETTLED IN
CONSULTANT WE CAN ESTABLISH A
QUORUM. SENATORS MENJIVAR HERE
ARE HERE. EGGMAN EGGMAN HERE
GROWTH. OVER HERE ROTH. BROUGHT
HERE. TO SECURE. LOCATION. THERE
SHOULD. THIS IS WHAT HAPPENS
WHEN. THE THREE WOMEN ISN'T MADE
FOR WOMEN'S BODIES AND THEN YOU
GET. CHRONIC BACK PAIN. GOOD
THING TO HAVE A ROOM OF HEALTH
CARE PROVIDERS TO HELP ME OUT
HERE. WELCOME D. H. C. S. WE'LL
START OFF WITH YOU BE COULD
PLEASE GO AHEAD AND RESPOND TO
THE QUESTIONS IN THE AGENDA.
THIRTEEN ED CHAIR MEMBERS OF THE
SUBCOMMITTEE MICHELLE FOSTER
RECTOR OF THE DEPARTMENT OF
HEALTH CARE SERVICES. START
PROVIDING- BY PROVIDING AN
OVERVIEW OF MCO TAX PROPOSAL IN
THE PROVIDER RATE INCREASES THE
DEPARTMENT IS PROPOSING TO
IMPLEMENT A NEW MCO TAX
EFFECTIVE APRIL FIRST TWENTY
TWENTY THREE THROUGH DECEMBER
THIRTY FIRST TWENTY TWENTY SIX
THE TAX WILL PROVIDE NINETEEN
POINT FOUR BILLION AND THAT
REVENUE OVER THE THREE AND THREE
QUARTER YEAR PERIOD WHICH IS
LIKE ROUGHLY THREE. TIMES HIGHER
THAN THE SIX POINT FIVE BILLION
OVER THE THREE YEARS PROPOSED A
GOVERNOR'S BUDGET OF THE
NINETEEN POINT FOUR BILLION
ELEVEN POINT ONE BILLION WILL BE
AVAILABLE TO SUPPORT ADDITIONAL
INVESTMENTS IN THE MEDICARE
PROGRAM. THIS TAX HAS NO NET
IMPACT TO MEDICAID MANAGED CARE
PLANS THE MINIMAL IMPACT IS A
SUBSET OF COMMERCIAL HEALTH
PLANS. FUNDS WILL HELP MAINTAIN
THE MEDICAL PROGRAM AND SUPPORT
INVESTMENTS THAT WILL HELP
SECURE ACCESS QUALITY AND EQUITY
IN THE MEDICAL PROGRAM OVER AN
EIGHT TO TEN YEAR PERIOD.
EXTENDING EXPENDITURES OVER THIS
LONG PERIOD INSTEAD OF
MAXIMIZING ONE TIME SPENDING
WILL ALLOW FOCUS AUGMENTATIONS
TO BE SUSTAINABLE OVER A LONG
PERIOD OF TIME. AND GIVE
CERTAINTY TO OUR PROVIDERS WHILE
ATTENDING TO THE STATE'S NEED OF
NOT CREATING IT OUT YOUR BUDGET
CHALLENGES. CMS HAS INDICATED
THAT IT PLANS TO CHANGE
REGULATIONS GOVERNING PART
PROVIDER TAXES WITH THIS CHANGE
WE DO NOT ANTICIPATE THAT THE
PROPOSED MODEL THAT YOU HAVE
BEFORE YOU WILL BE APPROVAL IN
THE FUTURE. WE WANT TO BUILD A
FOUNDATION WITH THESE
INVESTMENTS AND CERTAINTY FOR
OUR PROVIDERS THAT THESE RATE
INCREASES ARE SUSTAINABLE. TO
SECURE THE APRIL FIRST EFFECTIVE
DATE THE LEGISLATURE MUST
APPROVE THE TAX STRUCTURE AND
THE DEPARTMENT MUST SUBMIT THE
FINAL TAX PROPOSAL TO CMS NO
LATER CHEN THEN JUNE THIRTIETH
OF. TWENTY TWENTY THREE. WE
WOULD ALSO NOTE THAT THE FEDERAL
GOVERNMENT AS AS I MENTIONED
EARLY HAS PROPOSED THEIR
INTENTION TO CHANGE THE FEDERAL
TAX REGULATIONS REGARDING THIS
MCO TAX- WITH REGARD TO THE
PROPORTIONALITY. I'M IN MAKING
THE REQUIREMENT THAT THE TAX BE
MORE PROPORTIONAL BETWEEN THE
MEDICAID AND NON MEDICAID
LIABILITIES. THUS THE DEPARTMENT
DOES NOT ANTICIPATE THIS
PROPOSED MODEL TO BE APPROVAL
BUT IN THE FUTURE AT THIS RATE I
CANNOT ASSUME FUTURE TAX I'M
STILL TAXES WILL PROVIDE SUCH A
HIGH NET BENEFIT TO THE STATE.
WE WANT TO BE CLEAR THAT WE
PROPOSED TO RENEW THE TAX IN
TWENTY TWENTY SEVEN HOWEVER
BASED ON CONVERSATIONS WITH CMS
WE EXPECT THAT THIS- THIS LEVEL
OF MCO REVENUE WILL NOT BE
SUSTAINABLE IN THE OUT YEARS.
THIS WOULD NOTE THAT THE MC IS
EXPECTED TO BRING THREE POINT
SEVEN BILLION IN CALLIN YOUR
YEAR TWENTY TWENTY THREE. FIVE
BILLION IN CALENDAR YEAR TWENTY
TWENTY FOUR FIVE POINT TWO
BILLION IN CALENDAR YEAR TWENTY
TWENTY FIVE AND FIVE POINT FOUR
BILLION IN CALLUM YOUR CALENDAR
YEAR TWENTY TWENTY FIVE IN STATE
SENATE. BENEFIT ON AN ACCRUAL
BASIS. IN TERMS OF THE PROPOSED
PROVIDER RATE INCREASES
EFFECTIVE JANUARY ONE TWENTY
TWENTY FOUR THE DEPARTMENT
PROPOSES TO INCREASE RATES AT.
TO AT LEAST EIGHTY SEVEN POINT
5% OF MEDICARE FOR PRIMARY CARE
INCLUSIVE OF NURSE PRACTITIONERS
AND PHYSICIAN ASSISTANTS.
MATERNITY CARE INCLUSIVE OF
OBGYN AND DOULAS AND NON
SPECIALLY BEHAVIORAL HEALTH OR
MENTAL HEALTH SERVICES SUBJECT
TO ALL FEDERAL APPROVALS. THESE
INVESTMENTS SUPPORT ARE CRITICAL
A COMPREHENSIVE QUALITY STRATEGY
OUR FOCUS AREAS APART PREVENTIVE
CARE MATERNAL CARE AND BIRTH
EQUITY OUTCOMES AN INTEGRATION
OF BEHAVIORAL HEALTH. ALIGNING
OUR EFFORTS TOWARDS UPSTREAM AND
PREVENTIVE PRIMARY CARE PURPOSES
I'M WHICH WE KNOW IS
FOUNDATIONAL TO PROVIDING KIND
OF THE COMP COMPREHENSIVE. OF
CARE AT THE HIGHEST QUALITY.
TYPICALLY PRIMARY CARE AND NON
SPECIALLY MENTAL HEALTH-
REIMBURSED AT 72100% MEDICARE.
AND MARK MEDIC MATERNITY CARE IS
REIMBURSED AT 6270% OF MEDICARE
THERE ARE SIGNIFICANT VARIATION
ACROSS INDIVIDUAL CODES ACROSS
THE FEE FOR SERVICE AND MANAGED
CARE DELIVERY SYSTEMS AND
BETWEEN MEDIC HOW MANAGED CARE
AND PLANTS IN THAT IN THE
DELIVERY SYSTEM. THIS PROPOSAL
WORKS TO SECURE THAT ACCESS AND
LONG TERM GROWTH AND PROVIDER
PARTICIPATION AND MEDICARE ALL
THROUGH HIGHER PROVIDER
REIMBURSEMENT IS MORE STABLE.
EQUITABLE AND MORE STREAMLINED
THESE RATE INCREASES WILL BE
MADE TO THE FEE FOR SERVICE
BASIS AND NOT A SUPPLEMENTAL
PAYMENTS ALLOWING THE INCREASES
TO BE PASSED ON DIRECTLY
EFFICIENTLY AND CONSISTENTLY TO
PROVIDERS. THIS APPROACH WILL
PROBABLY RAISE THE REIMBURSEMENT
FLOOR FOR APPLICABLES SERVICES
TO BE CLOSER TO MEDICARE
STANDARDS I SURE PROVIDERS
CONSISTENCY REIMBURSEMENT OVER
THE LONG TERM AND READ REDUCES
UNEVENNESS AND REIMBURSEMENT
LEVELS ACROSS CODES WITHIN THE
SAME AT SERVICE AREAS.
ADDITIONALLY BY BUILDING THESE
RATE INCREASES INTO THE BASE WE
ELIMINATE THAT ADMINISTRATIVE
BURDEN FOR PLANS PROVIDERS AND
THE STATE'S WITH REGARD TO
SUPPLEMENTAL PAYMENTS. FOR
EXAMPLE PROVIDERS IMPLANTS HAVE
TO RECONCILE SUPPLEMENTAL
PAYMENTS AND AS SUCH THERE MAY
BE DELAYS AND SUPPLEMENTAL.
PAYMENTS GOING TO OUR PROVIDERS.
FOR THE APPLICABLES. THESE RATE
INCREASES WILL INCLUDE THE
ELIMINATION OF THE HISTORICAL AB
NINETY SEVEN REDUCTIONS AND THE
SHIFT OF PROPOSITION FIFTY SIX
SUPPLEMENTAL PAYMENTS INTO THE
BASE RATE. THE DEPARTMENT WILL
ANNUALLY REVIEW AND REVISE THE
FEE FOR SERVICE REIMBURSEMENT
REIMBURSEMENT RATES FOR THE
APPLICABLE SERVICES BASED ON
CHANGES TO MEDICARE RATES. THE
DEPARTMENT WILL DIRECT MEDICAID
MANAGED CARE PLANS TO PAY
NETWORK PROVIDERS AT LEAST THE
FEE FOR SERVICE RATES INCLUDING
EQUIVALENT REQUIREMENTS FOR
CATHOLIC CAPITATED PROVIDER
ARRANGEMENTS. NETWORK PROVIDERS
WHO ARE ALREADY PAID AT OR ABOVE
EIGHTY SEVEN POINT 45% OF
MEDICARE FOR SOME OF THESE CODES
WILL SEE INCREASES FOR CODES
THAT ARE BELOW THAT EIGHTY SEVEN
POINT 5% OF MEDICARE RATE. SINCE
THE IMPLEMENTATION AB NINETY
SEVEN REDUCTIONS THE DEPARTMENT
IN CONJUNCTION WITH THE
LEGISLATURE HAS ELIMINATED
REDUCTIONS FOR VARIOUS PROVIDER
TYPES OR SERVICES INCLUDING IN
LAST YEAR'S BUDGET. THE
DEPARTMENT BY WILL BE SHARING
WITH LEGISLATIVE STAFF- TO DATE-
THE INCLUDING THE REMAINING AB
NINETY SEVEN FIVE REDUCTIONS IN
PLACE TODAY IN THE FISCAL- THAT
ESTIMATE ASSOCIATE WITH THOSE
REDUCTIONS. IN ADDITION TO THE
RATE INCREASES PROPOSED FOR
JANUARY FIRST TWENTY TWENTY FOUR
REFLECTED IN THE MAY REVISION
THE DEPARTMENT WILL RETURN WITH
A PROPOSED SET OF INVESTMENTS
AND AUGMENTATIONS THAT WILL BE
FOR PUT FORWARD TO THE
LEGISLATURE AND THAT. TWENTY
TWENTY FOUR TWENTY FIVE
GOVERNOR'S BUDGET WITHIN TEN AND
EFFECTIVE DATE JANUARY FIRST
TWENTY TWENTY FIVE. THE FOCUS
WILL BE TO LOOK AT ADDITIONAL
AUGMENTATIONS TO PRIMARY CARE
MATERNAL CARE BEHAVIORAL HEALTH
AS WELL ESPECIALLY CARE
OUTPATIENT IN THE QUEUE CARE
SYSTEMS WITH AN ATTENTION ON HOW
TO INCREASE THE COMMITMENT OF
PROVIDERS TO SERVE MEDI CAL
MEMBERS. SUPPORT PROVIDERS AND
DISPROPORTIONATELY IMPACTED
AREAS AND BUILD ROBUST TEAMS IN
PROGRAMS WITH A STRONG WORK
FORCE TO ENSURE CARE IS PROVIDED
AT THE RIGHT. SETTING AT THE
RIGHT TIME AT THE HIGHEST
QUALITY. IN TOTAL STARTING IN
TWENTY TWENTY FIVE WE WOULD BE
PROVIDED OPPOSING THREE POINT
SEVEN BILLION TOTAL FUN ONE
POINT FIVE BILLION GENERAL FUND
OR MCO TAX REVENUE ON GOING. FOR
RATE INCREASES BEGINNING AGAIN
IN TWENTY TWENTY FIVE FOR
ROUGHLY EIGHT TO TEN YEARS. THE
GENERAL GOAL OF OUR APPROACH IS
TO INVEST IN THE MEDICAL SYSTEM
IN WAYS THAT PROMOTE ADDITIONAL
FEDERAL DOLLARS AND REALLY
WANTING TO MAXIMIZE ADDITIONAL
FEDERAL MATCHING FUNDS TO THE
MEDICAL SYSTEM. THE SCHOOL
REQUIRES DHS TO ASSESS THE
DIFFERENT APPROACHES TO SAY
SUSTAINABLE RATE AUGMENTATIONS
WHICH OPTIMIZE THIS APPROACH.
FOR THIS REASON WE NEED THE TIME
TO ADEQUATE ACCESS PROGRAM
INVESTMENTS THROUGH THEY ARE NOT
ONLY TARGET PRIORITIES BUT DO SO
IN A DEFICIENT MANNER. HAPPY TO
ANSWER ANY QUESTIONS. THE GAME
IS SET THE SIX QUESTION THE SIX.
QUESTION. DURING THE SUPPORT.
INCLUDED IN MY ABLE KIND OF
INCLUDING MY OKAY THERE'S- A
COMPLETE AND WE'RE GOING TO BE
TO ANSWER- LA OWNING IN. RECENT
CONCENTRA SOLELY OVER. WELL WE
RELEASED A NEW NAME AND ALSO ON
THE GO FOR MC. TAX PACKAGE. LAST
WEEK AND ALSO. ASSURED SOME
INITIAL THOUGHTS WITH THE
COMMITTEE ALSO LESS WEEK. THE
COMMITTEE ALSO WILL HEARING FROM
THE NUMBERS. THAT WE UNDER THAT-
IT WOULD BE. SEVENTY TO KEEP OUR
COMMENTS RELATIVELY BRIEF FOR
THAT REASON I THOUGHT IT WOULD
BE HELPFUL TO JUST KIND. ARE
COMMON TO THREE KEY POINTS. FOR
THE FIRST IS JUST AN UPDATE TO
THE COMMITTEE LAST WEEK WE NOTED
THAT THERE WERE SOME KEY
INFORMATION THAT THE
ADMINISTRATION SO I DON'T
PROVIDED ON THE INSURTECHS
PUZZLE. AND WANTED TO
ACKNOWLEDGE IT LATER IN THE WEEK
THE ADMINISTRATION TO PROVIDE
THAT INFORMATION. THE CRUX OF
THAT INFORMATION IS SUMMARIZED
ON PAGE FORTY SIX OF YOUR
AGENDA. WHICH SHOWS THE OF YOUR
BY YOUR IMPACT. OF THE PROPOSED
MCO TAX. THE CLEAR SHOWS THE
AMOUNT OF REV THAT THE WOULD
GAIN. ON THE NET BENEFIT TO THE
STATE AFTER FACTORING IN- THE
COST TO THE STATE TO HELP COVER
THE MEDICAL PORTION OF THE MCO
TAX. YOU CAN ALSO SEE THE
PROPOSED THREE USES OF THAT NET
NET FISCAL BENEFIT THE AMOUNT
THAT'S GOING TOWARDS THE GENERAL
FUND BUDGET PROBLEM. AND ALSO
THE AMOUNT THAT WOULD BE FOR
PROPOSED RATE INCREASES AND ALSO
FOR FUTURE AUGMENTATION SO
THAT'S TABLE SUMMARIZES THE
ADMINISTRATION'S PROPOSAL. FOR
SECOND POINT WE WANTED TO
EMPHASIZE IS THAT THE STATE'S
OVERALL FISCAL SITUATION IS
GOING TO BE A SALIENT ISSUE WHEN
WEIGHING THE ADMINISTRATION'S
PROPOSAL- THIS IS A
UNPRECEDENTED FISCAL OPPORTUNITY
FOR THE COMMITTEE BECOMES A
TRADE OFFS. THE NEW. THE
ADDITIONAL AMOUNT OF FUNDING
THAT'S USED FOR MEDICAL
AUGMENTATIONS I WOULD NOT BE
AVAILABLE TO ADDRESS THE BUDGET
PROBLEM AND SO THIS IS A KEY A
TRADE OFF FOR THE LEGISLATURE TO
CONSIDER. IN ADDITION THE
LEGISLATURE IS FACING SOME
UNCERTAINTIES HERE- WITH FOR
EXAMPLE WITH WHAT FEDERAL
CHANGES MIGHT COME DOWN IN A FEW
YEARS AND HOW THAT MIGHT IMPACT
THE MCO TAX. AND SO WHEN WE DID
MANAGE THAT UNCERTAINTY WOULD BE
TO CONSIDER LIMITED TERM-
AUGMENTATIONS FOR EXAMPLE
LIMITED TERM SUPPLEMENTAL
PAYMENTS. SETTING ASIDE FUNDS IN
A RESERVE FOR ECONOMIC
UNCERTAINTY. THAT'S IT IS GOING
TO ON THE- SPRITE. OF THE
LEGISLATURE IS INTERESTED. IN
ADOPTING MORE ONGOING AND
SECURE. PAYMENTS TO PROVIDERS
AND FOCUSING ON BASE PAYMENTS
COULD BE WARRANTED IN THAT CASE.
OUR EMPHASIS IS THAT THAT DOES
COME WITH A SCHOOL TRADE OFF.
AND THEN FINALLY GIVEN THAT THIS
IS AN UNPRECEDENTED FISCAL
OPPORTUNITY FOR THE LEGISLATURE
WE THINK IT'S IMPORTANT THAT THE
LEGISLATURE ENSURE THAT IT HAS
THE OPPORTUNITY TO WEIGH IN ON
THESE AUGMENTATIONS AND SENATE'S
PRIORITIES FOR THEM. FOR EXAMPLE
WE RECOMMEND- MODIFYING THE
PROPOSED TRAILER LEGISLATION TO
MORE CLEARLY ESTABLISHED THE
PARAMETERS. THAT THE
ADMINISTRATION WOULD LOOK AT
WHEN- CONSIDERING HIS PROPOSED
AUGMENTATIONS TO PROVIDE
INFORMATION TO THE LEGISLATURE
TO ENSURE CAN. FINALLY ASSIST
THE GOVERNOR'S PROPOSAL BUT ALSO
WEIGH IT AGAINST OTHER
OPPORTUNITIES. WE ALSO THINK
THERE ARE OTHER OPPORTUNITIES
LEGISLATURE COULD EXPLORE TO
ENSURE IT HAS ADEQUATE OVERSIGHT
AND CONTROL OVER THE FUNDS. FOR
EXAMPLE HAS PROPOSED THE TWO
SPECIAL FUNDS. WOULD BE
CONTINUOUSLY APPROPRIATED THAT
MEANS THAT THE FUNDS COULD BE
SPENT WITHOUT APPROPRIATION IN
THE BUDGET. THE REGION HAS
WORKED IN IN PAST VERSIONS OF
THE MC ATTACKS WERE GIVEN THAT
SOME PORTION OF THE FUNDING
WOULD BE USED FOR SPECIFIC
AUGMENTATIONS. SOMETHING
LEGISLATURE COULD LOOK AT AND
MAYBE CONSIDER REQUIRING
APPROPRIATION OR OR- ADDING SOME
MORE OF OUR GUARD RAILS TO
ENSURE THAT THE FUNDS ARE BEING
USED ACCORDING TO THE-
LEGISLATURE'S- PRIMARIES- THAT
WOULD BE A TO. ANSWER THANK YOU.
THANK YOU REFINEMENTS ADDITIONAL
COMMENTS. HI TERM NUMBERS CAN
YOU TELL FROM THE- FINANCE
NOTHING. FOR TO ADD HAPPY THAT
ANSWER QUESTIONS. GREAT M. I
WOULD LIKE TO HEAR THE REST OF
THE PANEL BEFORE WE GO INTO
QUESTIONS TO THE DEPARTMENT SO
I'M GONNA WELCOME. SEE IF WE CAN
SQUEEZE AS MANY HERE. MAYBE LOL
DEPARTMENT OF LA- AND
DEPARTMENTS IF YOU COULD. RENDER
YOUR SEATS FOR IT RIGHT NOW.
BECAUSE WE'RE GOING TO BRING.
ARE THERE YOU GO PERFECT. WE. SO
I'D LIKE TO WELCOME UP- FROM THE
LOCAL HEALTH PLANS OF CALIFORNIA
SEE OLIVIA COLMAN'S. FROM
ALTERNET SENIOR VICE PRESIDENT
OF GOVERNMENT RELATIONS
BRITTANY'S. I HATE HIM- A CMA
REPRESENTING CMA STORE THOMPSON
. I'M REPRESENTING S. YEAH YOU
MAT. LEDGE LEACH. J. J. NOT EVEN
CLOSE. OF THE TWO. YOU'RE
LOOKING AT THE- AND THEN BEND.
FROM A. AND REPRESENTING THE
ASSOCIATION OF PLANS THE NEW FOR
YOU HI NICK. LISA MONTHS. TO THE
PROJECTED TO HIM SORRY PLAN PER
. PERFECT WE HAVE ENOUGH JUST
RIGHT. THE.
SO WE'RE GONNA START WITH THE
LOCAL PLANS OF CAN FUTURE THE
THREE QUESTIONS THAT WERE
PROPOSED TO YOU. MORNING HEARING
IMPAIRED NOT ON. THAT WOULD HELP
YES THERE WE GO THE MORNING CARE
MEMBERS LENNIX TO THE LOW HEALTH
OF HOW. WE THE STATE LOW CAN
BASED HOW MAY CARE ARE THE STATE
SURVEY MORE THAN SO PERCENT OF
MEDIC HOW MAY CARE THINGS FOR
HOW ME TO THIS MORNING-
REGARDING PROPOSED RENEWAL THEM
CO TAX AND INVESTMENTS IN
MEDICAL PROVIDER RATES. ALEX HE
SEES A MEMBER OF THE COALITION
TO PROTECT ACCESS TO CARE WHICH
INCLUDES EACH OF THE GROUPS
PARTICIPATING ON THE PANEL THIS
MORNING THIS GROUP REPRESENTS
CORE PARTNERS IN THE DELIVERY OF
MEDICAL SERVICES INCLUDING
CLINICS DOCTORS HOSPITALS HEALTH
CARE WORKERS AND PLANS. TO JOIN
TOGETHER TO COLLECTIVELY
ADVOCATE FOR RENEWAL OF AN MCO
TAX THAT'LL MAXIMIZE AVAILABLE
FEDERAL FUNDING FOR CALIFORNIA
AND TO REINVEST THOSE DOLLARS
BACK INTO THE MEDICAL PROGRAM.
THE COALITION WHICH INITIALLY
FORMED IN LOS ANGELES TO THE
LEADERSHIP OF ALLEY CARE BEGIN
OUR WORK TOGETHER WITH THE
UNDERSTANDING THAT TO IMPROVE
ACCESS TO CARE TO THE ONE IN
THREE CALIFORNIANS ENROLLED IN
MY ACCOUNT. CALIFORNIA NEEDS TO
COMMIT TO ADEQUATELY FUND THE
PROVIDERS THAT ARE PART OF THAT
CRITICAL SAFETY NET. THE GROUPS
REPRESENTED HERE TODAY HAVE
CELEBRATED THE LEADERSHIP OF THE
ADMINISTRATION AND LEGISLATURE
AND TAKING STEPS TO GET TO
UNIVERSAL COVERAGE BY EXPANDING
ELIGIBILITY TO UNDOCUMENTED
CALIFORNIANS OF ALL AGES. AND
PURSUE TRANSFORMATION OF THE
MEDICARE PROGRAM THROUGH MAJOR
INITIATIVES LIKE HOW LAME
HOWEVER TO FILL THE PROMISE OF
ACCESS EQUITY AND QUALITY THERE
NEEDS TO BE SIGNIFICANT
ADDITIONAL INVESTMENTS IN THE
DELIVERY SYSTEM. WE WILL THE MCO
TAX A OP TO MAKE AN IMPACT ON
ACCESS AND THE COALITION HAS
COME TOGETHER TO BROWSE
INVESTMENTS. BASED ON KNOWN GAPS
AND NEEDS IN MY ACCOUNT. BECAUSE
THE LOCAL PLANS SERVE OVER NINE
POINT THREE MEDICARE
BENEFICIARIES AND THIRTY SIX
COUNTIES ACROSS THE STATE. WE
HAVE UNIQUE INSIGHT INTO THE
CHALLENGES FACED BY OUR SYSTEM.
WELL THERE'S DIVERSITY IN
VARIATION ACROSS COUNTIES BASED
ON GEOGRAPHY ENVIRONMENTAL
CONDITIONS AND OTHER FACTORS ALL
OF THE LOCAL PLANS PARTNER WITH
THE PROVIDERS IN THEIR COMMUNITY
TO SERVE THE MEDIC HOW MEMBERS.
YET ALL LOCAL PLAN MEMBERS
EXPERIENCE SIMILAR CHALLENGES
AND GETTING SUFFICIENT PROVIDERS
TO PARTICIPATE IN THE PROGRAM.
THE CLINICS TO COMPRISE IN SOME
CASES MORE THAN 50% OF LOCAL
PLANS PRIMARY CARE NETWORKS. ARE
STRUGGLING TO RECRUIT AND RETAIN
PROVIDERS TO SERVE A SIGNIFICANT
VOLUME OF MEDICARE PATIENTS TO
THE CLINIC AS THEIR MEDICAL
HOME. IN OTHER AREAS OF THE
STATE LOCAL PLAN PRIMARY CARE
NETWORKS RELY HEAVILY ON
INDEPENDENT PHYSICIANS OR SMALL
GROUP PRACTICES. HOWEVER IN MANY
CASES THESE PROVIDERS ARE ONLY
ABLE TO SERVE A LIMITED NUMBER
OF MEDICARE BENEFICIARIES. DUE
TO LOW MEDICAID REIMBURSEMENT
RATES. ACCESS TO SPECIALTY CARE
IS A PROBLEM FELT ACROSS THE
STATE FOR NEARLY ALL OF THE COR
MEDIC HOUSE SPECIALIST PROVIDER
TYPES. WE ALSO UNDERSTAND THE
FINANCIAL STRAIN FACED BY SOME
OF OUR HOSPITAL PARTNERS.
ESPECIALLY THOSE THAT ARE UNABLE
TO HAVE A BALANCED PAYER MIX
OFFSET LOWER MEDICARE
REIMBURSEMENT RATES. TO BRIEFLY
SPEAK TO THE QUESTIONS POSED BY
THE COMMITTEE. FIRST WITH
RESPECT TO HOW LOCAL PLANTS THAT
PROVIDER RATES. GENERALLY
SPEAKING IN ORDER TO ESTABLISH
ADEQUATE NETWORKS DESPITE ALL OF
THE CHALLENGES THAT I'VE
DISCUSSED. PLANS DO YOU
GENERALLY HAVE TO NARROW THE GAP
BETWEEN MEDICARE AND MEDICARE
PROVIDER RATES. HOWEVER
PARTICULARLY IN THE PRIMARY CARE
SIDE AND FOR NON SPECIALLY CARE
THERE'S SIGNIFICANT VARIATION.
AND WHAT RATES ARE PAID TO
PROVIDERS BASED ON THE LOCAL
MARKET. PROVIDERS SUPPLY AND
PAYMENT ARRANGEMENTS. FOR
SPECIALTY CARE IT'S NOT UNCOMMON
FOR PLANTS TO PAY AT OR NEAR
MEDICARE RATES. PARTICULARLY FOR
PRINT PROFESSIONALLY TYPES
RETURN KNOWN WORKFORCE SHORTAGES
AND HIGHER RATES ARE NECESSARY.
TO GET PROVIDERS INTO THE
NETWORK'S. SECOND REGARDING HOME
MCO TAX INVESTMENTS WILL.
SUPPORT LOCAL PLANS AND
MAINTAINING ADEQUATE IT WORKS.
WE KNOW THERE ARE GAPS IN OUR
DELAY SYSTEM AND THAT A
SIGNIFICANT DRIVER INEQUITABLE
ACCESS. IS MEDICARE
REIMBURSEMENT RATES. WE ALSO
KNOW THAT APPROACH FOR A PROGRAM
THAT SERVES OVER FIFTEEN MILLION
CALIFORNIANS WILL TAKE
SUBSTANTIAL INVESTMENTS TO
REALLY MAKE A DIFFERENCE.
NEARING THE PAYMENT DIFFERENTIAL
BETWEEN MEDIC CAL AND OTHER
PAYERS. IS WHAT IS NEEDED TO
SUPPORT MORE ROBUST NETWORKS AND
ACCESS AND MEDICARE. LASTLY TO
THE QUESTION ABOUT HOW PLANS
WILL ENSURE THAT PROVIDERS ARE
BENEFITING FROM ADDITIONAL
FUNDING. THROUGH THE MCO TAX.
THE REASON FOR LOCAL PLANTS
PARTICIPATION IN THE COALITION
IS ADVOCATE WITH AND FOR
PROVIDERS WHO NEED ADDITIONAL
FUNDING TO SERVE THE MEDICAL
POPULATION THERE SO THERE'S A
COMMITMENT. TO ENSURE THAT
PROVIDERS ARE THE RECIPIENTS OF
ENHANCE FUNDING. MECHANICALLY
THIS WOULD LOOK DIFFERENT-
DEPENDENT ON THE PAYMENT
APPROACH TAKEN BY DH CS. HOWEVER
THERE ARE WAYS TO CONFIRM THAT
PAYMENTS ARE FLOWING DOWN TO THE
PROVIDERS DELIVERING CARE. IN
CLOSING I'LL SAY THAT WE
APPRECIATE THEIR WORK THE
ADMINISTRATION HAS DONE TO PUT
FORWARD A PROPOSED TAX THAT WILL
ALLOW CALIFORNIA TO MAXIMIZE
FEDERAL FUNDING. AND UTILIZE
THOSE DOLLARS TO REINVEST BACK
INTO THE MEDICAL PROGRAM. WE
KNOW WE'RE THERE AND WE KNOW
WHERE THE NEEDS ARE IN THE
SYSTEM. AND ARE THEREFORE WE'RE
SIGNIFICANT INVESTMENTS ARE
NEEDED TO DRIVE ACCESS QUALITY
AND EQUITY. WE LOOK FORWARD TO
WORKING WITH THE LEGISLATURE AND
ADMINISTRATION. THE COMING WEEKS
THANKS. THANK YOU SO MUCH
REPRESENT C. P. IS GOING TO BE A
BIT AND HE'S FROM. GOOD MORNING
MADAM CHAIR AND MEMBERS OF THE
COMMITTEE MY NAME IS BRITTANY
SAID YES CONSTAND OF THE SENIOR
VICE PRESIDENT OF GOVERNMENT
RELATIONS AT ALTERNATE HEALTH
SERVICES. THE LARGEST FQHC IN
CALIFORNIA SERVING NEARLY FIVE
HUNDRED THOUSAND. MEDICARE
PATIENTS IN LA IN ORANGE COUNTY
FOR MORE THAN FIFTY FOUR YEARS.
I'M HERE ON BEHALF OF THE
CALIFORNIA PRIMARY CARE
ASSOCIATION TO REGISTER OUR
SUPPORT. OF THE COALITION'S
PROPOSAL FOR RENEWAL OF THE MCO
TAX. AND TO HIGHLIGHT SPECIFIC
DEDICATED ALLOCATIONS IN THE
PROPOSAL. FOR DIRECT PAYMENTS
SAME DAY PAYMENTS AND COMMUNITY
HEALTH WORKERS. ALLOCATING THE
MCO TAX IN VERY SPECIFIC WAYS
AND IN WITH A VERY SPECIFIC
TIMELINE. IS IMPERATIVE TO
ENSURING. THAT COMMUNITY CLINICS
GENERALLY AN FQHC SPECIFICALLY.
CAN CONTINUE TO PROVIDE THE
HIGHEST QUALITY HEALTHCARE TO
CALIFORNIA'S EXPANDING MEDICARE
POPULATION. TODAY OUR FUNDING
FORMULA FOR COMMUNITY HEALTH
CENTERS WHICH RECALL THE
PROSPECTIVE PAYMENT SYSTEM OR
PPS DOES NOT ACCOUNT OR DOES IT
REQUIRES VERY SPECIFIC
TRIGGERING EVENTS IT DOESN'T
ALLOW US. TO ACCOUNT FOR VALUE
BASED CARE INNOVATIONS AND
COMPREHENSIVE SERVICES AT OUR
PATIENTS NEED. TO THRIVE IN AND
BE HEALTHY THE CITY CALIFORNIA-
THIS IS WHY WE NEED THE ADOPTION
OF THE MCO TAX AS ENVISIONED BY
THE COALITION. IT WILL GO A LONG
WAY TO HELP US ADDRESS THIS
FUNDAMENTAL PROBLEM. AT ALL
TONIGHT AND ACROSS CALIFORNIA'S
COMMUNITY HEALTH CENTERS WE
SERVE THE MOST VULNERABLE PEOPLE
THAT FACE DISPARITIES THAT SHOCK
THE CONSCIENCE. THOSE WHO WORK
AT AN FQHC SETTING ARE MISSION
DRIVEN HARD WORKING PEOPLE
PEOPLE WHO ARE COMMITTED TO THE
BELIEF THAT WE CAN ELIMINATE
DISPARITIES IN HEALTH CARE
ACCESS. AND OUTCOMES FOR ALL
REGARDLESS OF INSURANCE COVERAGE
TYPE ABILITY TO PAY OR
IMMIGRATION STATUS OF THANK YOU
FOR YOUR WORK ON THAT. OUR
WORKERS COME FROM THE VERY SAME
COMMUNITY THAT WE CARE FOR AND
WE ARE DEEPLY COMMITTED
COMMITTED TO LIFTING BOTH UP.
DURING THE PANDEMIC WE WERE DOG
IN OUR DETERMINATION TO CARE FOR
OUR COMMUNITIES BUT WE DID NOT
COME THROUGH AND SKI. TODAY THE
WHOLE CARE TO SYSTEM IS IN
CRISIS. DUE TO WORK FOR
SHORTAGES AND SAFETY NET
HOSPITAL CLOSURES MADE WORSE
ONLY BY OUR MEDICAL
REIMBURSEMENT RATES GENERALLY IN
OUR CLINIC RATES. UNLIKE OTHER
FACTIONS OF THE HEALTHCARE
DELIVERY SYSTEM CLINICS ARE
PREDOMINATELY MEDIC CAL BASED.
THIS MEANS WE ARE GETTING PAID
SEVENTY CENTS ON THE DOLLAR FOR
EVERY PATIENT WE SEE WITH NO WAY
TO SPREAD COSTS ACROSS- ANOTHER
LIVES IT'S JUST SIMPLY AN
UNSUSTAINABLE- FORMULA FOR US.
AND IF WE CAN'T SUSTAIN ON
OURSELVES THE ENTIRE MEDICAL
SERVICE SERVICE DELIVERY
BACKBONE FALLS APART AT THE
EXACT MOMENT. WHERE YOU ARE ALL
MOVING IN THE EXACT RIGHT
DIRECTION OF THIS HISTORIC
MEDICAID EXPANSION FOR ALL AND
IT WE'RE ALL IN THE MIDDLE OF
IMPLEMENTING TELLING. TO AVOID
THIS WE MUST ENSURE THAT THE MCO
TAX DOLLARS ARE DIRECTED TO THE
MEDICARE PROGRAM. RATHER THAN
USED FOR OTHER PURPOSES PURPOSES
AND WE MUST ALSO ENSURE THAT
THESE DOLLARS ARE EXPENDABLE
IMMEDIATELY. NOW IS WHEN THE
SYSTEM AND THE VULNERABLE
POPULATIONS WE SERVE NEED THESE
DOLLARS THE MOST. THIS CURRENT
CRISIS WILL ONLY BE MADE WORSE
IF WE ARE OVERLY PRUDENT WITH
ALLOCATING THESE DESPERATELY
NEEDED HEALTH CARE DOLLARS. WHAT
WE ARE SUPPORTIVE OF THE
COALITION'S PROPOSAL AS A WHOLE
THERE ARE THREE ELEMENTS OF THE
PROPOSAL I WOULD LIKE TO
HIGHLIGHT FOR YOU TODAY. FIRST
WE PROPOSE THAT THE MCO TAX
ALLOCATION INCLUDES TWO HUNDRED
FIFTY MILLION FOR AN ENHANCED
ACCESS AND CALL POOL FOR OUR
COMMUNITY CLINICS. TO IMPROVE
EQUITY QUALITY AND ACCESS FROM
ACCOUNT MANAGED CARE PATIENTS.
WE ENVISION THIS BEING
ADMINISTERED TO A MANAGED CARE
DIRECTED PAYMENT PROGRAM WHICH
WOULD PROVIDE COMMUNITY CLINICS
THE ADDITIONAL RESOURCES NEEDED.
TO MEET HEALTH PLAN GOALS OF
VALUE BASED CARE WHILE ALSO
ACHIEVING COUNTY AIM AND
MEDICAID EXPANSION GOALS AND
ACCESS AND EQUITY PRIORITIES.
SECOND WE PROPOSED FIFTY MILLION
AND M. C. O. TAX ALLOCATIONS BE
DIRECTED TOWARD SAME DAY
ENCOUNTERS. FOR FQHCS AND OTHER
COMMUNITY CLINICS. FOR BOTH
HEALTH AND MENTAL HEALTH
SERVICES THIS PROPOSAL WILL
ENSURE THAT OUR PATIENTS WILL BE
ABLE TO RECEIVE THEIR HEALTH.
AND MENTAL HEALTH SERVICES.
DURING THE SAME VISIT WHICH WILL
HELP THEM ADDRESS THE CURRENT
NET WHAT WHICH WILL HELP US
ADDRESS. TOGETHER THE CURRENT
MENTAL HEALTH CRISIS FOR THE
UNDER UNDERSERVED BUT ALSO WILL
TAKE AWAY ANY UNDUE BURDEN FOR
THESE PATIENTS OF HAVING TO
TAKE. MULTIPLE DAYS OFF FROM
WORK AND REALLY MAKE THE
ACCOMMODATIONS TO BE ABLE TO
RECEIVE THE SERVICES THAT THEY
DESERVE. FINALLY WE PROPOSE A
FIFTY MILLION DOLLAR ALLOCATION
FOR COMMUNITY HEALTH WORKERS. AS
AN ALLOWABLE ENCOUNTER FOR
CLINICS. THESE WORKERS ARE
CRITICAL RESOURCE TO HELP US
REACH OUR COMMUNITIES WHERE THEY
ARE. AND IN THEIR LANGUAGE IN A
CULTURALLY COMPETENT WAY. THESE
ARE THE NECESSARY COMPONENTS TO
REALLY AT CHIEF TRUE ACT. IN
CONJUNCTION WITH OTHER ELEMENTS
OF THE COALITION'S PROPOSALS
SUCH AS PRIMARY CARE AND
SPECIALTY CARE FUNDING. THE
THREE FUNDING PRIORITY AREAS I
JUST PRESENTED WILL ENSURE THAT
THE PREDOMINATELY LATINO SPANISH
SPEAKING AND LOW INCOME
COMMUNITIES WE SERVE. CONTINUE
TO RECEIVE THE HIGH QUALITY CARE
THEY DESERVE. BUT WITH THE
ENHANCED AND MORE EQUITABLE
ACCESS AND IMPROVE HEALTH
OUTCOMES. THAT ARE THAT THEY'RE
ENTITLED TO. TOGETHER THIS WILL
OF OUR PATIENTS TO RECEIVE THE
COMPREHENSIVE SERVICES THEY NEED
WHEN THEY NEED THEM WHAT THE
APPROPRIATE SUPPORT. AND WITHOUT
ADDING UNDUE BURDENS. OUR MORE
THAN FIFTY YEAR HISTORY HERE IN
THE STATE OF CALIFORNIA IS
PROOF. THAT THIS NEEDED FUNDING
WILL LEAD TO ENHANCED AND MORE
EQUITABLE ACCESS AND IMPROVED
HEALTH OUTCOMES FOR THE
POPULATIONS WE SERVE. THANK YOU
FOR THE OPPORTUNITY SHARE THE
TRANSFORMATIVE WORK THAT IS
BEING DONE BY CALIFORNIA'S
COMMUNITY HEALTH CENTERS. AND WE
LOOK FORWARD TO PARTNERING WITH
YOU TO ENSURE AN ENHANCED AND
MORE EQUITABLE DELIVERY OF
MEDICAL SERVICES IN CALIFORNIA
FOR THOSE WHO NEED IT MOST.
THANK YOU. THANK YOU SO MUCH FOR
THAT- WE'RE GOING TO MOVE ON NOW
TO SEE A ME STORE. THANK YOU
MADAM CHAIR MEMBERS TO THOMPSON
SENIOR VICE PRESIDENT FOR
GOVERNMENT RELATIONS FOR THE
CALIFORNIA MEDICAL ASSOCIATION
HAS MORE THANK THE COMMITTEE FOR
ENGAGE IN THESE DISCUSSIONS OF
THE ADMINISTRATION OF FOR
PUTTING FORWARD A PROPOSAL- THE
PRINT THAT PRESENTS A
GENERATIONAL OPPORTUNITY REALLY-
TWO INVESTMENT ACCOUNT RATES. OF
PHYSICIAN REIMBURSEMENT RATES
HAVE NOT BEEN RAISED SINCE THE
LATE NINETEEN NINETIES AND
ACTUALLY HAVE GONE THROUGH- USE
THE MCO TAX A IS ONE OF THE
BIGGEST OPPORTUNITIES WE HAVE
SEEN- TO MAKE CRITICAL
INVESTMENTS IN THE MEDICAL
SYSTEM. WE WERE ASKED TO-
PRESENT ANSWERS TO IT TO THREE
GENERAL QUESTIONS ABOUT THE
MEDICAL SYSTEM THE FIRST IS
BARRIERS TO PHYSICIAN
PARTICIPATION IN THE PROGRAM. TO
HELP POTENTIAL SPENDING FROM THE
MCO TAX COULD BE BEST ALLOCATED
TO IMPROVE ACCESS AND THREE
OTHER POTENTIAL INVESTMENTS
OUTSIDE OF REIMBURSEMENT RATES
THAT WE WOULD SEE MOVEMENT IN
THE MEDICAL SYSTEM. ALSO
STARTING ON ON BARRIERS TO THE
MEDICAL SYSTEM- FIRST AND
FOREMOST- IT'S REALLY AN ISSUE
ABOUT SOLVENCY AND ABILITY-
MEDIKAL RATES OFTEN DON'T COVER
THE COST OF PROVIDING THE CARE-
FOR MANY DIFFERENT SERVICES IN
THE MEDICAL SYSTEM. SO PHYSICIAN
GROUPS- PRACTICES SYSTEMS WHAT
HAVE YOU HAVE TO MAKE A DECISION
ABOUT HOW MUCH MEDICO- BASICALLY
THAT THEY CAN. ACTUALLY TECH-
WITHOUT JEOPARDIZING- THE
FINANCIAL UNDERPINNINGS OF THEIR
PRACTICE- FOR CMA'S PERSPECTIVE.
OUR GOAL IS TO ENSURE THAT IF A
PROVIDER IS IN A COMMUNITY THAT
HAS 60% MEDIC CALLIN MEDICARE
THAT THEY ARE ABLE TO SEE. 60%
OF PATIENT BASE IS MEDIC CAL AND
MEDICARE. RIGHT NOW WE ARE NOT
FALLING SHORT OF THAT OVERALL
GOAL- IT IN PART SOME OF THE
POSITIONS BECAUSE OF THESE LOW
REIMBURSEMENT RATES ACTUALLY
PROVIDE A SUBSIDY TO THE SYSTEM
AND THAT SINCE THEY CANNOT
ACHIEVE COST- IN THE SERVICES
THAT THEY PROVIDE- THE
ARTIFICIALLY HAVE TO CAP. THE
AMOUNT OF MEDI CAL PATIENTS WE
SEE AND AGAIN WE'VE WE FIND THIS
TAXES IS REALLY A GENERATIONAL
OPPORTUNITY- TO GET MORE
PHYSICIANS TO PARTICIPATE IN THE
SYSTEM AND TO ENSURE THAT WE ARE
RETAINING THE CURRENT POSITIONS
WERE WORKING THERE- TO SEE THEIR
THEIR. CURRENT PATIENT
POPULATION- IT ACTUALLY WE LOOK
THERE'S A TWENTY. HEALTH HEALTH
. FOUNDATION STUDY THAT LOOKED
AT IT PHYSICIAN PARTICIPATION IN
THE MEDICARE PROGRAM- IN THAT IN
THAT FOUND THAT PHYSICIANS WERE
PARTICIPATING IN A RATE THAT WAS
LOWER- THEM BOTH NATIONAL AND
STATE STANDARDS- ENSURING ACCESS
TO CARE FROM CMS PERSPECTIVE
THERE'S REALLY THREE
OPPORTUNITIES WITHIN THE MEDICAL
SYSTEM THAT WE CAN IMPROVE UPON-
ONE IS INCREASING. REIMBURSEMENT
TATE RATES- TO ALLEVIATE
ALLEVIATED ADMINISTRATIVE
BURDENS THAT PHYSICIANS FACE AND
PARTICIPATE IN THE PROGRAM AND
THREE REALLY MAXIMIZING
INCREASING OPPORTUNITIES FOR
ADDITIONS TO TRAIN AND SERVE IN
THE COMMUNITIES THAT THEY ARE
MOST NEEDED. AND WE BELIEVE THAT
THIS- THIS PROPOSAL REALLY-
PROVIDES US AN OPPORTUNITY TO
MAKE REAL PROGRESS ON THOSE
THREE ISSUES. LOOKING AT THE MCO
TAX- THERE IS A CRITICAL NEED
BOTH IN PRIMARY CARE AND
SPECIALTY CARE- WE INVEST IN
PRIMARY CARE AS MOST OF THE
MEMBERS OF THE COMMITTEE NO
WE'RE KEEPING PEOPLE HEALTHIER
EARLIER. AND MAKING SURE THAT
WORK THERE STAINED AT ER'S- AND
THEIR THEIR SICKNESSES OTHER
TREATMENTS DON'T PROGRESS INTO A
STATE IN WHICH WE- ARE NOW
PROVIDING KARAKUM EMERGES
APARTMENT AFTER WHICH WE COULD
HAVE ADDRESS SOME OF THESE
ISSUES EARLIER- SO FOR US-
REALLY MAXIMIZING. PRIMARY CARE
RATES AND INVESTMENT IN PRIMARY
CARE ONE KEEPS PEOPLE HEALTHIER
AND TO KEEP PEOPLE OUT OF THE
MOST COSTLY HEALTH CARE
SETTINGS- BUT AS YOU HEARD
EARLIER SPECIALTY CARE
OBVIOUSLY. IT'S A CRITICAL NEED
I THINK WHEN WE LOOK AT CLINICS
WHO ARE OFF ON THE FRONT LINES
OF- PROVIDING PRIMARY CARE- WHEN
THERE'S A REAL NEED TO REFER A
PATIENT TO A SPECIALIST. IT'S
OFTEN VERY HARD TO FIND A
SPECIFIC SPECIALIST OR THE WAIT
TIMES ARE SUCH THAT- IT'S NOT
REAL ACCESS IS THAT WE BELIEVE A
- LARGE INVESTMENT IN BOTH
PRIMARY CARE AND SPECIALTY CARE
IS NEEDED- TO BUTTRESS UP THE
SYSTEM. IN A FOR US I. ARE ASPER
GOAL AND WE THINK THE
ADMINISTRATION WE CANNOT DO THIS
IN ONE FELL SWOOP AGAIN IS TO
GET MEDICARE RATES ARE MEDICAL
RATES USE ME CLOSE TO MEDICARE-
SOMETIMES MEDICARE OFTEN. CAN
CAN- NOT PROVIDE- THE COST OF
PROVIDING THE SERVICE BUT IT FOR
PHYSICIANS OFFICE LEE- AT A MUCH
HIGHER REIMBURSEMENT RATE LEVEL
THAT WE ARE EXPIRING THE MEDICAL
PROGRAM TO ACHIEVE. AND FINALLY
ALL ON SOME OF THE INVESTMENTS
THAT WE CAN MAKE- A NON
PHYSICIAN REIMBURSEMENT ROLES A
GRADUATE MEDICAL EDUCATION GME
FUNDING WE FIND IS- AN AMAZING
INVESTMENT OF IMPROV FIFTY SIX
WHICH WAS THE INCREASE IN
TOBACCO TAX IN TWENTY SIXTEEN.
OTHERS FORTY MILLION DOLLARS
ANNUALLY- THE PROVIDED FOR NEW
GRADUATE MEDICAL EDUCATION SPOTS
AND THE RETURN ON INVESTMENT OF
THOSE DOLLARS HAS BEEN
INCREDIBLE AND WE'VE ALSO BEEN
TRYING TO FOCUS SOME OF THOSE
DOLLARS. INTO NONTRADITIONAL
TRAINING CENTERS- TRADITIONALLY
THERE'S BEEN LARGE HOSPITALS IN
LARGE POPULATED AREAS THAT HAVE
BEEN- THE GENERAL TRAINING
GROUNDS FOR OUR NEXT GENERATION
OF PHYSICIANS. AND WE HAVE BEEN
WORKING WITH OUR PARTNERS TO
CREATE GME PROGRAMS WHERE THERE
MIGHT BE A ROTATION OUT INTO A
RURAL AREA OR WERE A CLEAN IT
CONSERVE- AS A TRAINING CENTER
AND ONE. WHAT THAT DOES IS
PLEASE WHEN YOU HAVE A RESIDENT
PHYSICIAN IN A CERTAIN AREA ONE
THAT'S ADDICTED IMMEDIATE. A
WORK FORCE HELP THAT PHYSICIANS
AND HOSPITALS IN A CLINIC IS IN
THE COMMUNITY PROVIDING CARE AND
TWO THERE IS A- STRONG
CORRELATION TO WEAR A PHYSICIAN
DOES THE RESIDENCY. TO WHERE
THEY END UP PRACTICING AND SO
FOR US IS THE SOLUTION THAT- ONE
IMMEDIATELY PUTS A PHYSICIAN.
INTO THE WORK FORCE AND A NEEDY
AREA AND TO REALLY STRENGTHENS-
THE CHANCES THAT POSITION ENDS
UP- STAINED. IN THAT REGION. AND
I WOULD JUST WANT TO HIGHLIGHT
AGAIN WE WANT TO THANK THE
ADMINISTRATION FOR THEIR
PROPOSAL ONE OF THE ISSUES THAT
WE ADVOCATING FOR AS WE
UNDERSTAND- THE- THE- NEED FOR
OR THE- UNDERLYING JUSTIFICATION
FOR SPENDING THESE DOLLARS OVER
EIGHT TO TWO. YEARS WE WOULD
ADVOCATE FOR SPENDING DOLLARS
OVER THE THREE POINT FIVE YEARS
UP THE TAX- FOR US TRYING TO
MAXIMIZE THESE DOLLARS INTO THE
MEDICAL PROGRAM OVER THE LIFE OF
THE TAX WE BELIEVE PROVIDES THE
GREATEST CHANCE TO. IMPROVE
ACCESS AND REALLY CHANGED OF THE
UNDER PART UNDERPINNING
FINANCIAL A SITUATION OF THE
MEDICAL PROVIDERS. ENTER ANY
QUESTIONS BUT AGAIN THANK YOU
FOR THE COMMITTEE FOR THIS
OPPORTUNITY. THANK YOU SO MUCH
MORE WE'RE GONNA MOVE ON NOT TO
S. CI YOU MAP. THANK YOU- THAT
WAS ABOUT THE AS YET YOU
CALIFORNIA- THE COMMITTEE CAN
THE TIME HERE THIS PROPOSAL
TODAY AND GIVING US OPPORTUNITY
SPEAK ON THIS. WOULD YOU SEE THE
MCO TAXES OPPORTUNITY TO INVEST
IN THE HEALTHCARE WORKFORCE
WHICH IS REALLY IN CRISIS.
PARTICULARLY YOU KNOW BEFORE THE
PANDEMIC WE'RE LOOKING AT A
SHORTER ABOUT FIVE HUNDRED
THOUSAND HEALTH CARE WORKERS IN
CALIFORNIA TO MEET OUR CARE
NEEDS. AFTER THE HORRORS THE
PANDEMIC WE'RE SEEING ONE IN
THREE HEALTH CARE WORKERS
CONSIDERING LEAVING THE
PROFESSION ONE FIVE ACTUALLY
LEAVING THE PROFESSION THIS IS
OPPORTUNITY NOT JUST TO. GROW
OUR EXISTING WORKFORCE BUT ALSO
NEEDING TO MAKE INVESTMENTS TO
RETAIN OUR WORK FORCE AS WELL.
OUR WORK FORCE IS MADE UP
PRIMARILY OF WOMEN AND PEOPLE OF
COLOR PARTICULARLY THE ALLIED
HEALTH JOBS OR IN THE NURSING
PROFESSION- IN YOU KNOW MANY OF
THESE JOBS ARE. ENTRY LEVEL JOBS
WITH NO CAREER LADDER AND THAT
STOCK IN LOW WAGES AND SO WE SEE
THIS AS OPPORTUNITIES TO TAKE
THAT BOLD ACTION TO TRY TO
INVEST IN OUR WORK FORCE AND-
PROVIDE CAREER PATHWAYS TO LIFT
WORKERS UP AS WELL- WE- WANT TO
ENSURE THAT THIS IS THE
OPPORTUNITY TO. SEE THE
INVESTMENTS THAT THE STATE WOULD
BE MAKING INTO THIS TO HAVE IT
TRICKLE UP TO WORKERS INSTEAD OF
TRICKLE DOWN. I SEE ARE YOU A
LITTLE BIT DIFFERENT THAN SOME
OF MY PANELISTS ON HERE WOULD
NOT SEE IN A DIRECT
REIMBURSEMENT. RATES GOING
DIRECTLY TO WORKERS POCKETS WE
WOULD SEE THOSE RATES THROUGH
OUR EMPLOYERS AND THEN NEEDING
OUR EMPLOYERS TO NEGOTIATE-
RATES AND SO WE URGE THAT
COMEDIAN THE LEGISLATURE
ADMINISTRATION. TO THINK ABOUT
YOU KNOW WHAT ARE SOME STANDARDS
SO THAT WE CAN PUT ON- THE
PROGRAMS TO ENSURE THAT THE
RESOURCES AND INVESTMENTS ARE
ACTUALLY TRICKLING UP TO WORKERS
AS WELL. AND THAT WORKERS HAVE A
VOICE IN THE PROCESS- BECAUSE
KNOW ONCE WE WORKERS A VOICE
RETURNED. CALL OF CARE. IN OUR
DELIVERY SYSTEM- INVEST SOME
WORKERS BEEN SHOWN TO REDUCE-
PRESSURE SORES REDUCE PATIENT
FALLS. AND INCREASE PRODUCTIVITY
AND IMPROVE QUALITY HEALTH
OUTCOMES- SPECIFICALLY REGARDING
THE COALITION'S PROPOSAL- WE
WOULD LIKE TO- HIGHLIGHT A
COUPLE OF PARTICULAR ONE SO- THE
INVESTMENTS IN OUR PUBLIC
HOSPITALS IN OUR HOSPITALS IN
GENERAL BUT PARTICULAR PUBLIC
COST BILLS TO PROVIDE BUT TO. A
25% OF- FIVE BY THE MERGER
SECURES ALL MEDICAL PATIENTS WHO
HAVE CHRONICALLY BEEN UNDER
FUNDED AND ARE GOING TO NEED
SIGNIFICANT INVESTMENT IN THE
LONG TERM- THIS OPPORTUNITY TO
NOT JUST INVEST IN HIGH ROAD
EMPLOYERS BUT ALSO ENSURE THAT.
THOSE THAT ARE PROVIDING THEIR
SHARE OF MEDICAL PATIENTS CAN
CONTINUE TO SERVE THOSE
PATIENTS- IN- ALSO TOUCHING ON-
CMA'S POINTS AROUND GM ME I
WOULD JUST REALLY HIGH LIKE THAT
AGAIN- CALIFORNIA HOUSE A
PROVIDER SHORTAGE BUT THE GREAT
THING ABOUT CALIFORNIA'S WAS
RETRAIN A PHYSICIAN HERE.
THEY'RE GOING TO STAY HERE
CALIFORNIA HAS THE HIGHEST RATE
OF RESIDENT PHYSICIANS STAYING
IN THE STATE OF AROUND SEVENTY
TWO PERCENT- WHICH YOU KNOW JUST
REALLY UNDERSCORES THE NEED TO
MAKE THOSE INVESTMENTS. I'M FINE
CREATING A FUND TO. IN LABOR
PARTNERSHIPS I WILL GIVE WORKERS
SOME OF THE OPPORTUNITY ALTHOUGH
THIS IS SOMETHING- IN TERMS OF
STANDARD PROPOSAL WE LOOK ACROSS
ALL OF THESE INVESTMENTS- BUT IN
PARTICULAR TRYING TO CREATE
PATHWAYS TO THE WORKERS CAN-
ADVANCE IN THEIR CAREER. CAN
MOVE FROM A MEDICAL ASSISTANT TO
ALVY AND TO OUR ENEMY ARE ACCESS
TO CARE NEEDS BY- ENSURING WE
HAVE A QUALITY WORKFORCE.
FINALLY I'LL JUST CLOSE BY
HIGHLIGHTING THE IMPORTANT
COMMITMENTS AND AS OF SUCH ON
EARLIER AROUND HEALTH FOR ALL-
WE HAVE SEEN THAT- EXPANDING
COVERAGE FOR ALL IS A FANTASTIC
THING IMPROVE THE HEALTH OF OUR
COMMUNITIES. BUT WE WANT TO MAKE
SURE THAT THAT INVESTMENT ALSO-
IS COUPLED WITH THE BY FILLING
THAT PROMISE OF ACCESS WITH
ACTUALLY QUALITY CARE. AND SO
FOR THOSE REASONS WE WOULD
CONTINUE TO ADVOCATE FOR THIS
INVESTMENT TO. HAPPEN
IMMEDIATELY HOPPING OVER THE
FOUR YEARS THREE AND A HALF
YEARS OF THE TAX- AND ALSO SEE
THAT- THROUGHOUT THE INVESTMENTS
WERE REALLY ASKING THOSE
QUESTIONS OF HOW WE IMPROVING.
QUALITY CARE WHICH I THINK THIS
PROPOSAL DOES BUT ALSO HOW ARE
WE ENSURING THAT WORKERS HAVE A
VOICE IN THAT PROCESS. AND THAT
THE INVESTMENTS GO AND AWAY TO
LIFT WORKERS UP. SO WITHOUT OUR
CLOTHES AND HAPPY TO TAKE ANY
QUESTIONS AND PREDICT THE TIME.
THANK SO MUCH BEN. FROM CITRIX.
GOOD MORNING TO THE COMMITTEE MY
NAME IS BEN JOHNSON FOR- VICE
PRESIDENT OF POLICY AT THE
CALIFORNIA HOSPITAL ASSOCIATION.
REPRESENTING OVER FOUR HUNDRED
OF THE STATE'S HOSPITALS. CJ
APPRECIATES THE OPPORTUNITY TO
SHARE HOW WE BELIEVE FUNDING
FROM THE MCO TAX COULD. BE USED
TO STABILIZE AND IMPROVE ACCESS
TO CARE IN THE MEDICAL PROGRAM.
CALIFORNIA'S HOSPITALS PROVIDE
CARE TO THE FIFTEEN MILLION.
CALIFORNIANS WHO RELY ON THE
MEDICARE PROGRAM. BUT
UNFORTUNATELY ACCESS TO
HOSPITALS IS THERE IS IN DANGER
AND UNDERSERVED COMMUNITIES
ACROSS CALIFORNIA FOLLOWING
YEARS OF STAGNANT REIMBURSEMENT.
AND. SINCE THE ONSET OF THE
COVERT NINETEEN PANDEMIC. THE
CAL RATES FOR HOSPITAL SERVICES
HAVE BEEN FROZEN SINCE TWENTY
TWELVE THIRTEEN AND IN THE
DECADE SINCE PRICES AND GOODS
INCLUDING FOR THE LABOR- THE END
OF MEDICAL SUPPLIES THAT WE PAY
FOR. HAVE GROWN BY OVER THIRTY
PERCENT- AND THE SITUATION IS
NOW BECOME UNTENABLE AS THE
STATE ONLY REIMBURSES SEVENTY
FOUR CENTS FOR EVERY DOLLAR IN
COSTS AT HOSPITALS- INCUR WHEN
CARING FOR MEDICAL PATIENTS. IN
A CHALLENGING STATE FISCAL
ENVIRONMENT. WE BELIEVE THEM SHE
ATTACKS REALLY PRESENTS THE
OPPORTUNITY FOR ADDRESSING THE
INADEQUACIES OF REIMBURSEMENT-
FOR MEDIC CAL. AND WE DO
APPRECIATE THE CHANGES- THE
RECENT CHANGES TO THE GOVERNOR'S
PROPOSAL TO THE MCO TAX TO BOTH
THOUGHTFULLY MAXIMIZE THE
REVENUES THAT WOULD BE GENERATED
BY THE TAX. AND THE STATE A
CLEAR INTENT TO DEDICATE THE
FUNDING TO PROVIDER PAYMENT
INCREASES HOWEVER WE ARE WORRIED
THAT IT COULD BE TOO LITTLE
GIVEN- THE PROPOSAL TO ALLOCATE
THE FUNDING OVER AN EIGHT TO TEN
YEAR WINDOW. AND IT COULD BE TOO
LATE GIVEN THAT KEY DECISIONS
OVER HOW THE STATUS SPEND THE
FUND MONEY- WOULD BE DEFERRED
UNTIL NEXT YEAR- WITH MY FUNDING
ACTUALLY NOT FLOWING TO
PROVIDERS FOR LAW IT LIKELY A
LONGER TIME PERIOD THEREAFTER.
GIVEN THE NEEDS TO OBTAIN
FEDERAL APPROVAL. AND HOSPITALS
WITH ONGOING FINANCIAL- DEFICITS
IN HIGH MEDICAL PATIENT MIXES. I
DO NOT HAVE THIS KIND OF TIME.
ADDITIONALLY WE KNOW WHERE THE
FUNDING INADEQUACIES LIE AND-
AND WHAT FUNDING MECHANISMS ARE
AVAILABLE TO THE STATE- TO
ADDRESS THEM. TO SPECIFICALLY CJ
SEEKS- STRUCTURAL PAYMENT
REFORMS IN THREE AREAS. FIRST WE
THINK THE REVENUES MUST MUST
ADDRESS THE FUNDING SHORTFALL-
FOR HOSPITAL SERVICES STEMMING
FROM THE 201-220-1220 THIRTEEN-
RAPHE FREEZE FOR HOSPITAL
INPATIENT SERVICES. AND THIS IS
NECESSARY TO STABILIZE AND
ULTIMATELY SUSTAIN ACCESS TO
THESE SERVICES. AND THEN SECOND
WHILE WE RECOGNIZE THAT LONG
NEEDED INVESTMENTS ARE NECESSARY
ON THE COMMUNITY BASED- THE
COMMUNITY SIDE OF MENTAL HEALTH
SERVICES. EVERY DAY WE ARE
SEEING CRISES IN OUR EMERGENCY
ROOMS- WITH PATIENTS THAT ARE
COMING IN AND DON'T HAVE
ANYWHERE TO GO. AND THEY'RE
AWAITING INPATIENT HOSPITAL
BEDS- FOR DAYS SOMETIMES WEEKS
AND SO TO ENSURE THAT THESE
PATIENTS WHO ARE IN MENTAL
HEALTH CRISIS CAN RECEIVE THE
RIGHT CARE AT THE RIGHT TIME THE
RIGHT PLACE. WE BELIEVE-
REIMBURSEMENT INCREASES AND
IMPROVEMENTS IN OUR CAPACITY TO
PROVIDE INPATIENT MENTAL HEALTH
CARE ARE ABSOLUTELY NEEDED. AND
THEN FINALLY ALONG SIDE OUR
MEDICAL ASSOCIATION AND S. YEAH
YOU COLLEAGUES WE RECOGNIZE THAT
PERSON CENTER HIGH QUALITY CARE.
IS ABSOLUTELY DEPENDENT ON
HAVING A ROBUST HEALTH CARE
WORKFORCE AND SO AND WE KNOW
THAT THE BEST WAY TO GROW THAT
WORKFORCE IS TO SUPPORT IT AT
HOME AND SO WE SUPPORT-
INVESTMENTS AND ENHANCE PAYMENTS
FOR. GRADUATE MEDICAL AND
MEDICAL EDUCATION AS WELL AS THE
OTHER- WORKFORCE INVESTMENTS
THAT ARE COALITION. PARTNERS ARE
PUTTING FOR TODAY. SO IN
CONCLUSION PROUD TO STAND WITH
OUR COALITION PARTNERS TO
ADDRESS REALLY ONE OF THE MAJOR-
REMAINING AREAS BARRIERS TO
EQUITABLE CARING CALIFORNIA- AND
GRASS TO ADDRESS THE INADEQUATE
REIMBURSEMENT RATES. IN MEDIC
CAL THANK YOU FOR THE
OPPORTUNITY SHARES TEACHERS
PERSPECTIVE AND HAPPY TO TAKE
QUESTIONS. THANK YOU BEN WILL
TURN OVER TO- NICK FOR NOT A
REPRESENT ON BEHALF DISSOCIATION
OF HEALTH PLANS. THANK YOU MADAM
CHAIR MEMBERS NICK LEWIS ON
BEHALF OF THE CALIFORNIA
ASSOCIATION OF HEALTH PLANS.
THANK YOU FOR INVITING US TO
COMMENT- ON THE MCO TAX
PROPOSAL- JUST THE BUT WAY BACK
ON CALPERS IN FORTY THREE- NOSKE
LICENSE HEALTH PLANS IN- BOTH
THE COMMERCIAL MARKETS- AND IN
PUBLIC PROGRAMS- WE DELIVER HIGH
QUALITY AND CORDY TO CARE TO
TWENTY SEVEN MILLION
CALIFORNIANS. MOST OF OUR
MEMBERS DELIVER MEDICAL SERVICES
UP AND DOWN THE STATE OF
CALIFORNIA. ARE MEMBERS OF THE
ENTITIES THAT ARE PAYING THE TAX
ALONG WITH ONE A. AS MEMBERS OF
COURSE THE TAX IT IS BEST
REMEMBER HEALTH PLANS IN BOTH
THE COMMERCIAL MARKETS- AND THE
PUBLIC PROGRAMS- THUS WE CARE
DEEPLY. ABOUT BOTH THE TAX
FORMULA AND WHERE THE MONEY IS
BEING INVESTED IN THE MEDICAL
PROGRAM FROM THIS REVENUE
SOURCE. ON CALIFORNIA'S ôLTH
PLANS- SUPPORTED THE VERY FIRST
MCO TAX- WHEN IT WAS DESIGNED TO
SAVE THE HEALTHY FAMILIES
PROGRAM. THE ORIGINAL TAX BEARD
PREMIUM PAYERS AT THE TIME AS IT
WAS ONLY APPLIED TO MEDICAL
MANAGED CARE PLANS ON YOUR
MEMBERSHIP. SINCE THAT TIME
HEALTHY FAMILIES OF COURSE HAS
BEEN DISCONTINUED IN THE TAX
PROCEEDS HAVE BEEN USED TO
BACKFILL THE GENERAL FUND
INSTEAD. ON THE SAME TIME
APPROXIMATELY THE FEDERAL
GOVERNMENT DECLARED THAT ON
HEALTH PLAN COMMERCIALIZE OF
BUSINESS- MUST ALSO BE ASSESSED
ON THE TAX. THUS IMPACTING
PREMIUMS FOR BUSINESSES AND
INDIVIDUALS PURCHASING HEALTH
COVERAGE. OF THESE CHANGES OF
COURSE ARE NECESSITATED A CLOSER
INSPECTION OF NEMCO TAX PROPOSAL
BY OUR MEMBERSHIP- OUR POSITION
IN THE LAST CONTINUES TO BE.
BASED ON THE SAME FUNDAMENTAL
PRINCIPLES- HEALTH PLANS BELIEVE
IT THE MCO TAX MUST ACHIEVE THE
FOLLOWING- PRINCIPLES. NUMBER
ONE DIRECTLY BENEFIT AND IMPROVE
THE MEDICARE PROGRAM- THE TAXES
BE AFFORDABLE TO THOSE-
PURCHASING COVERAGE. IN THREE
ATTACKS MISSILES TO BE
PREDICTABLE STABLE AND AS
EQUITABLE AS POSSIBLE. UCORE FOR
A MEMBERS AT THE MCO TAX MUST BE
USED TO SUPPLEMENT AND NOT
SUPPLANT ON RESOURCES- IN THE
MEDICAL PROGRAM. AND THIS
PRINCIPLE ESPECIALLY RELEVANT AS
YOU KNOW THE STATE IS EXPANDING
A MEDIC CAL IN A VARIETY OF
WAYS- IN THE COMING YEARS-
FOCUSING ON PRIMARY AND
SPECIALTY CARE- IS A VERY
IMPORTANT PLACE TO START. OUR
MEMBERS DELIVER MEDICAL SERVICES
IN A DIVERSE SET OF REGIONS
ACROSS THE STATE- SOME OF THESE
REGIONS HAVE CONCERNS ABOUT
ACCESS AND DELIVERY TO HEALTH
CARE SERVICES. THIS IS
ESPECIALLY TRUE IN RURAL PARTS
OF THE STATE. WE'RE HEALTH PLANS
OF INITIATED A SERIES OF
INITIATIVES TO TRY TO BOLSTER
NETWORK ON ACCESS TO CARE BUT
MORE DEFINITELY NEEDS TO BE
DONE. ON THIS IS WHY I WERE
EXCITED TO FINALLY HAVE A
DISCUSSION ABOUT HOW TO USE THIS
REVENUE SOURCE- TO IMPROVE THE
MEDICARE PROGRAM- INSTEAD OF
USING THE MONEY TO FIX THE
BUDGET- YOU KNOW AND I YOU KNOW
I WOULD ECHO THE- THE SUPPORT
FOR INVESTING. SOME OF THIS SOME
IN GRADUATE MEDICAL EDUCATION AS
WELL- TO ADDRESS WORKFORCE
ISSUES- NAY WITH LHC REALLY
ADDRESS THREE QUESTIONS THAT
WERE- DIRECT TOWARDS THE PLANS-
AND- INTO THE YOU KNOW THE ONLY
OTHER THING I WOULD ADD IS THAT
ON THE THIRD QUESTION IN TERMS
OF ENSURING THAT THE- BE USED
AND INSURE THAT IT DOES-
IMPROVE- BASE RATES TO
PROVIDERS- AGAIN. OUR POSITION
HAS ALWAYS BEEN THAT THE MCO TAX
BE USED TO BENEFIT AND IMPROVE
THE MEDICAL PROGRAM- WE'RE GLAD
TO FINALLY BE SITTING AT A TABLE
WITH THIS IS BEING TAKEN
SERIOUSLY. SO WE ARE COMMITTED
TO DO EVERYTHING POSSIBLE TO
ENSURE THAT THE PROVIDER RATES-
ARE REFLECTIVE OF THE SPIRIT OF
THIS PROPOSAL IF INDEED THERE IS
A TAX AND- THE MONEY IS BEING
USED- IN IN THE LEGISLATURE
AGREES OF PASTRIES WILL BE
SUPPLEMENTED- AS A RESULT- IN
FACT WE'VE ALREADY BEGUN
TECHNICAL DISCUSSIONS WITH THE
DEPARTMENT AND SOME OF OUR
PEOPLE- TO MAKE SURE THIS
HAPPENS WITHIN THE CAPITATED
ARRANGEMENTS ARE PLANS ARE WITH
MEDICAL GROUPS AND I PA'S SO-
WE'RE WE'RE- EXCITED TO CONTINUE
THOSE CONVERSATIONS ON IF THIS
IS THE DIRECTION THAT THE
LEGISLATURE THE ADMINISTRATION
FINALLY GO ON THAT SO. I'LL
DAHLE DISCLOSED THANK YOU FOR
YOUR TIME WE DO LOOK FORWARD. TO
CONTINUED- CONVERSATIONS WITH
THE LEGISLATURE IN THE
ADMINISTRATION ON THIS- AND TO
FIND- DYNAMICS EOTECH. THAT MEET
THE IMPACT TO CONSUME AS MUCH AS
POSSIBLE. I WILL JUST ALSO AT
THE KNOW WE'VE HAD A SERIES OF
CAR. WE YOU TO. WE HAVE ASKED
THEM TO SEE WITHIN THE CONFINES
OF FEDERAL CONSTRAINTS AND
WITHIN THE FORMULA WHETHER. ON
THERE'S THE ABILITY TO- IMPROVE
OR LOWER THE TAX ON THE
COMMERCIAL MARKETS AS MUCH AS
POSSIBLE- BUT IN. ANY CASE- WE
DO YOU- YOU KNOW LOOK FOR DEBT
TO CONTINUE THOSE CONVERSATIONS
WITH YOU AND- TO MAKE TANGIBLE
INVESTMENTS IN MEDICAL PROGRAM-
THAT CAN. GARNER BROAD BASED
HELPLINE SUPPORT THANK YOU.
THANK YOU NICK OUR LAST
PENALISES FROM PLANNED
PARENTHOOD. THE MORNING CARE
MEMBERS OF THE COMMITTEE. LISA
OF OUR CHIEF LEGAL AN ADVOCACY
OFFICER AT PLANNED PARENTHOOD
AFFILIATES OF CALIFORNIA.
REPRESENTING THE SEVEN PLANNED
PARENTHOOD AFFILIATES OPERATING
OVER A HUNDRED HEALTH CENTERS
THROUGHOUT THE STATE. TOGETHER
THESE HEALTH CENTERS PROVIDE
OVER ONE POINT THREE MILLION
PATIENT VISITS ANNUALLY WITH UP
285% OF WHOM DEPEND ON MEDICAID
FUNDING. PLANNED PARENTHOOD
HEALTH CENTERS ARE COMMITTED TO
THE MISSION OF PROVIDING
EQUITABLE AND AFFORDABLE ACCESS
TO THE FULL RANGE OF SEXUAL
REPRODUCTIVE HEALTH CARE. WITH
DIGNITY AND FREE FROM JUDGMENT.
IT'S WHY PATIENTS KNOW THAT WHEN
THEY NEED BIRTH CONTROL WHEN
THEY NEED TESTING AND- TREATMENT
FOR S. T. EYES. WHEN THEY NEEDED
ABORTION THEY TURNED TO PLANNED
PARENTHOOD BECAUSE THEY KNOW
THAT THEY CAN GET CARE NO MATTER
WHAT. 90% OF THE PATIENTS SEEN
EMPOWER PARENTHOOD HEALTH
CENTERS. HAVE INCOMES BELOW
2100% OF THE FEDERAL POVERTY
LEVEL AND DEPEND ON VARIOUS
MEDICAL PROGRAMS TO ACCESS
ESSENTIAL HEALTH CARE SERVICES.
INCLUDING PRIMARY CARE
BEHAVIORAL HEALTH SERVICES IN
ADDITION TO SEXUAL REPRODUCTIVE
HEALTH CARE. THE MAJORITY OF
PLANNED PARENTHOOD PATIENTS ARE
YOUNG. HAVE LOW INCOMES AND ARE
BELONG TO UNDERREPRESENTED OR
UNDERSERVED COMMUNITIES. FOR
MANY PATIENTS SEXUAL
REPRODUCTIVE HEALTH CARE CLINICS
LIKE PLANNED PARENTHOOD. ARE THE
FIRST AND ONLY SOURCE OF HEALTH
CARE. PARENTHOOD IS PROUD TO BE
PART OF CALIFORNIA'S NETWORK OF
COMMUNITY BASED SAFETY NET
PROVIDERS WORKING TOWARDS A GOAL
THAT EVERYONE IN THE STATE.
REGARDLESS OF WHERE THEY LIVE OR
THEIR ABILITY TO PAY HAVE NOT
ONLY COVERAGE BUT MEANINGFUL AND
EQUITABLE ACCESS TO QUALITY
HEALTHCARE SERVICES. LIKE MANY
OTHER COALITION MEMBERS HERE
TODAY PLANNED PARENTHOOD
AFFILIATES WORKED TO MAINTAIN
AND PROVIDE CARE TO PATIENTS
DURING THE CALL THAT NINETEEN
PANDEMIC. WHILE KEEPING PATIENTS
AND THEIR STAFF SAFE. AFFILIATE
HEALTH CENTERS IMPLEMENTED
INNOVATIVE CARE DELIVERY MODELS
SUCH AS DRIVE BY APPOINTMENTS
AND ADVOCATED FOR THE EXPANSION
OF TELEHEALTH IN THE MEDICAL
PROGRAMS. BUT THE LAST THREE
YEARS ALSO HIGHLIGHTED HEALTH
CARE DISPARITIES AND BROUGHT
WITH IT MANY CHALLENGES
INCLUDING INFLATION RISING
COSTS. INCREASED STI RATES AND
INCREASED DEMANDS FOR ABORTION
AND BIRTH CONTROL GENDER FOR ME
CARE AND BEHAVIORAL HEALTH CARE
AND RELATED SERVICES. THIS AT A
TIME WHEN THE U. S. SUPREME
COURT OVERTURN ROE VERSUS WADE.
AND STATES ARE PASSING ABORTION
BANS AND BANS ON GENDER
AFFIRMING CARE. THREATS ARE NOT
LIMITED TO LEGISLATION PASSED IN
OTHER STATES SEVERAL LAWSUITS
ALSO THREATEN ACCESS TO
MEDICATION ABORTION AND THE
ABILITY FOR MINORS TO CONSENT TO
FAMILY PLANNING SERVICES.
CONTRIBUTING TO THE UNCERTAINTY
AND THE NEED TO STRENGTHENED
CALIFORNIA'S REPRODUCTIVE HEALTH
CARE NETWORK. THE REVENUE FROM
THEM YOU AT THE RE AUTHORIZE MCO
TAX WOULD BE CRUCIAL TO MAINTAIN
AND ADVANCE CALIFORNIA'S MEDI
CAL SYSTEM. A PROGRAM THAT
SERVES A THIRD OF OUR STATE'S
POPULATION. SPECIFICALLY WE
SPEAKS WE SEEK SERVICE SPECIFIC
FUNDING FOR A COMPREHENSIVE
SEXUAL REPRODUCTIVE HEALTH CARE.
FOR REPRODUCTIVE HEALTH CARE
PROVIDERS MEDICARE
REIMBURSEMENTS DO NOT COVER THE
FULL COST OF PROVIDING FAMILY
PLANNING AN ABORTION CARE.
NEARLY ALL ABORTION SERVICES
PROVIDED TO MEDICARE. PATIENTS
ARE PROVIDED AT A LOSS. SINCE
NINETEEN EIGHTY FIVE THERE'S
BEEN ONLY ONE INCREASE THE META
CAL BASE RATE FOR ABORTION
SERVICES. MEANWHILE COSTS HAVE
RISEN STEADILY OVER THE LAST
THIRTY EIGHT YEARS. WITH
INFLATION PRODUCING A CUMULATIVE
110080% PRICE INCREASE SINCE THE
LAST BASE RATE ADJUSTMENT. WHAT
SUPPLEMENTAL PAYMENTS MADE
POSSIBLE THROUGH PROP FIFTY SIX
REVENUE HAVE IMPROVED
REIMBURSEMENT THEY OFTEN STILL
DO NOT MEET THE COST OF
PROVIDING CARE AND ARE PART OF A
COMPLICATED SYSTEM OF BILLING
THAT REQUIRES CONSIDERABLE
RESOURCES TO TRACK DOWN.
PAYMENTS WITH ACTORS LEGISLATURE
AND THE GOVERNOR FOR CONTINUING
THE PROP FIFTY SIX PAYMENTS FOR
FAMILY PLANNING AND WOMEN'S
HEALTH SERVICES. AND FOR ME IN
THE MOMENT LAST YEAR TO MAKE
HISTORIC INVESTMENTS IN
CALIFORNIA'S ABORTION PROVIDER
NETWORK. THE ONE TIME FUNDING
HOWEVER PRESENTS A NEED FOR MORE
SUSTAINABLE SOLUTIONS IN AN
UNCERTAIN LANDSCAPE. SO
CALIFORNIA'S REPRODUCTIVE HEALTH
CARE PROVIDERS LIKE PLANNED
PARENTHOOD CONTINUE TO MAINTAIN
AND- CAN CONTINUE TO MAINTAIN
AND EXPAND PATIENT CENTERED
SERVICES. BUILD CAPACITY
INVESTOR WORKFORCE AND PROVIDE
HIGH QUALITY CARE AND RELATED
HEALTH SERVICES TO MEDICARE
BENEFICIARIES. IT IS TIMES OF
UNCERTAINTY AND DEFICITS ONE
BOLD INVESTMENTS A MEDIC CAL
SHOULD BE MADE. THESE ARE THE
TIMES THAT DISPROPORTIONATELY
IMPACT PEOPLE OF COLOR PEOPLE
WITH LOW INCOMES ARE USED AND
OTHERS WHO ALREADY FACE
SIGNIFICANT BARRIERS TO
ACCESSING HEALTH CARE. AND THESE
ARE THE TIMES A SIGNIFICANT
IMMEDIATE AND ONGOING INVESTMENT
TO MEDICARE NECESSARY TO
MITIGATE THESE IMPACTS. TO
IMPROVE EQUITABLE ACCESS FOR
CALIFORNIANS WELL MAKING SURE
THAT CALIFORNIA'S PROVIDERS HAVE
THE CAPACITY TO SERVE ANYONE WHO
MAY SEEK CARE HERE. AGAIN THANK
YOU FOR THE OPPORTUNITY TO
PARTICIPATE TODAY WE'RE GRATEFUL
FOR THE STATE'S EFFORT TO
FULFILL ITS ROLE AS A
REPRODUCTIVE FREEDOM STATE THANK
YOU. THANK YOU SO MUCH
PANELISTS. OKAY WE'RE GONNA DIVE
IN- WHILE PROBABLY ALL MY
QUESTIONS COULD TAKE UP THE NEXT
TWO HOURS I RECOGNIZE I HAVE. MY
COLLEAGUES HERE SO WE'LL BOUNCE
BACK AND FORTH. I'M GONNA START
WITH THE DEPARTMENT HERE-
DIRECTOR BRAD. YOU KNOW. YOU YOU
MENTION AND RESPONDING TO THEM.
WHY WE'RE EXPANDING IT TO EIGHT
TO TEN YEARS. TO BRING CERTAINTY
TO THE PROVIDERS YOU KNOW WE
HAVE STAKEHOLDERS REPRESENTING
SO MANY PROVIDERS TODAY WARSAME
THE CONTRARY OF THAT THAT THE
EIGHT TO TEN DOESN'T BRING
SEARCHING TO THEM IN FACT. THEY
WOULD HAVE MORE CERTAINTY IF
THEY ACTUALLY WAS IMPLEMENTED
WITHIN THE PLANS OF THE THREE TO
FIVE YEARS COULD YOU SPEAK TO
THAT OF WHAT INSIDE YOUR PER
YOUR BRING IN READ REGARDING.
THE NEED OF FOR EIGHT TO TEN AND
HOW IT CONTRADICTS FROM WHAT
PROVIDERS ARE SAYING. SURE THANK
YOU FOR THE QUESTION I WILL SAY
YOU KNOW I THINK WE ARE ALL
UNITED HERE IN TERMS OF WANTING
TO INVEST IN THE FOUNDATION OF
MANY CAL AND RECOGNIZING THAT
PROVIDER RATE INCREASES HAVEN'T
BEEN ADDRESSED IN MANY YEARS I
THINK I THINK I WOULD I THINK I
LOOK AT THE TABLE AND WE ALL
KIND OF USE THAT IS KIND OF.
WHERE WE'RE ALL COMING FROM OUR
GOAL IN THE IN KIND OF THE
PROPOSAL FOR EIGHT TO TEN YEARS
IS THAT WE DON'T WANT TO HAVE A
FISCAL CLIFF AFTER THE THREE AND
THREE QUARTER YEARS OF THE OF
THIS PROPOSAL WHAT WE KNOW THE
FEDERAL GOVERNMENT AS YOU KNOW
WE'VE BEEN IN TECHNICAL
ASSISTANCE CONVERSATIONS WITH
THEM AND- I THINK THAT IT'S AND-
IT'S THE MODELS IN A PLACE WHERE
THEY WILL APPROVE. BUT THEY HAVE
SIGNAL TO US THAT THEY ARE
INTENDING TO CHANGE REGULATIONS
TO CLOSE KIND OF THE LOOPHOLE
WITH REGARD TO PROPORTIONALITY
AND SO THE VALUE OF THE MCO-
POST TWENTY TWENTY SIX. WE DO WE
DON'T KNOW THAT WE CAN GET IT TO
THE PLACE WHERE THIS MODEL IS
AND SO. WE WANT TO PROVIDE
CERTAINTY THAT THE RATE
INCREASES THE ONE POINT FIVE
BILLION ANNUALLY AND- AND
GENERAL FUND RATE. INCREASES
OVER THREE BILLION TOTAL FUNDS.
IS AVAILABLE TO OUR PROVIDERS
FOR A LONGER PERIOD OF TIME
EIGHT TO TEN YEARS. UNDER OUR
PROPOSAL. IF WE MOVE FORWARD
WITH THE PROPOSAL AS- AS
PROPOSED BY THE PROVIDERS HERE
IN THAT KIND OF A THREE YEAR
TERM. WE DON'T HAVE THE
CERTAINTY THAT WE WILL BE ABLE
TO MAINTAIN THOSE PROVIDER RATE
INCREASES COME TWENTY TWENTY
SEVEN. OKAY YOU KNOW. GIVEN IN
THE BACKGROUND YOU'LL SEE. CUT
MEMBERS ON PAGE FORTY SEVEN THE
HISTORY OF THE PREVIOUS. SEASON
TAXES BUT EACH TIME SINCE TWO
THOUSAND AND THREE.
ADMINISTRATION STAKEHOLDERS HAVE
BEEN ABLE TO COME TOGETHER. AND
REALLY TRUST. EACH TIME THE
FEDERAL GOVERNMENT SAID- WE'RE
GONNA DISALLOW THE- QUALITY
IMPROVING FEE FROM TOP TWO
THOUSAND AND THREE. OREGANO WE
NEED A MORE. UNIFORM D. ACROSS
MEDICARE. INCOME PLAN. FOR TO BE
EQUITY. YOU KNOW I MEAN WHAT.
THIS WE HAVE NOW THAT SHOULD
CHANGE AND TWENTY TWENTY SIX WE
DON'T HAVE THE BRAINS IF YOU
WILL. TO FIND A DIFFERENT WAY TO
ADJUST THE MOVE FOR WITH THE NEW
TAX. HI GZ COOPER STATE MEDICAID
DIRECTOR. THE DIFFERENCES IN THE
PREVIOUS TAXES WE'VE SUBMITTED
VARIOUS TAX MODEL. CAN YOU HEAR
ME NOW. GREAT WE'VE SUBMITTED A
PREVIOUS TAX MODELS TO THE
FEDERAL GOVERNMENT TYPICALLY
WHAT HAPPENS WE SUBMITTED TO
THEM AND THEY ARE GOING TO LOOK
AT THE METHODOLOGY WITHIN THEIR-
TO TWO WEEKS. SOMETIMES IT WILL
BE REJECTED SOMETIMES IT'S
APPROVED TO MOVE FORWARD. ON
THAT'S WITHIN THE EXISTING AND
LONG STANDING FEDERAL
REGULATIONS INCLUSIVE OF THE
LOOPHOLE ON PROPORTIONALITY THAT
DIRECTOR BOSSED UP WAS
MENTIONING. IN OUR CONVERSATIONS
WITH CMS. THEY HAVE MADE TO A
TENSE THROUGH PREVIOUS- OF
LOOKING AT THIS AND HAVE SIGNAL
THIS FOR QUITE SOME TIME I WOULD
NOTE THAT THEY HAVEN'T MOVED
FORWARD WITH THE FEDERAL
REGULATIONS. HOWEVER IN OUR
CONVERSATIONS THAT YOU HAD VERY
CLEAR LANGUAGE WAS SAYING THAT
THIS TAX IS A PROVABLE WE DID
BACK AND FORTH TO MITIGATE THOSE
HISTORICAL CHANCE DOES
HISTORICAL TIMES WHERE WE CAME.
SUBMITTED BACK TO THE FEDERAL
GOVERNMENT HOW TO MAKE CHANGES
AFTER THE FACT. WE WANTED TO
MAKE SURE IT WAS APPROVAL FOR
RESUBMITTED IT. BUT THEY DID
MENTION A VERY SPECIFICALLY THAT
WOULD BE MOVING FORWARD WITH A
FEDERAL REGULATION PACKAGE TO
CLOSE THE HISTORICAL LOOPHOLE
THAT EXISTS IN REGARDS TO THE
PROPORTIONALITY OF THE TAX. THAT
IS NOT THE THAT HAS NOT IMPACTED
THE PREVIOUS TAX SO THAT IS THE
DIFFERENCE WITH THIS PARTICULAR
ONE- THEY HAVE MENTIONED THAT
THEY MAY. EVEN INDICATE THAT IN
OUR APPROVAL LETTER TO THE STATE
OF CALIFORNIA SO IT'S CLEAR THAT
THEY'RE PUTTING US ON NOTICE
THAT. THEY THINK THE TAX WOULD
BE A PROVABLE THROUGH THE TWENTY
TWENTY SIX TIME PERIOD. BUT BY
THE TIME THAT THE REGULATIONS
WOULD BE TO HIT IT TAKES ABOUT.
EIGHTEEN TO TWENTY FOUR MONTHS
FOR FEDERAL RAGS TO GO THROUGH
BASED ON WHAT THEY HAVE TOLD US.
AND THEY FELT THAT THEY COULD
CLEAR THROUGH THE TWENTY SIX
TIME PERIOD WHICH IS WHY WE FELT
COMFORTABLE PUTTING THIS FOR TO
THE LEGISLATURE- HOWEVER WE DO
FEEL IT'S IMPORTANT IN OUR DUE
DILIGENCE TO INFORM PEOPLE THAT
THAT IS THAT THE FEDERAL
GOVERNMENT HAS INFORMED US OF.
I'M AT THIS TIME AND WE NEED TO
MAKE SURE THAT WE'RE MAKING
BUDGET DECISIONS AND ACCORDING
TO THAT GUIDANCE FROM THE
FEDERAL GOVERNMENT. I WAS TO
WORK. AND THEN TURN TO MY CALL-
DIRECTOR BASS ON. NUMBER TWO.
RELATED TO WHAT PROVIDER. ARE
UNDER A- NINETY. YOU SAID WE'RE
GOING TO KEEP GET THAT IN. LATER
TODAY. I'D LOVE TO SEE IF
THERE'S ANYTHING INSIDE ON
THEIR- ON. THE REMAINING
PROVIDERS SAID HOW DIDN'T OR
WON'T BE. GETTING THERE ARE 10%
CUTS. CREE AND- STATED. SURE SO
I MEAN IF I CAN GO THROUGH A
MINUTE READ. YES I MEAN TO GIVE
ME I CAN GIVE YOU SOME
HIGHLIGHTS- WE HAVE.
CHIROPRACTORS CLINICAL
LABORATORIES- PHARMACY. PHYSICAL
THERAPISTS. GROUND MEDICAL
TRANSPORTATION- INDEPENDENT
DIAGNOSTIC TESTING FACILITY
CROSSOVER PROVIDERS. IT IS A
HIGHLIGHT OF SOME OF THEM. THAT
MOST OF AB NINETY SEVEN
REDUCTIONS HAVE BEEN. RESTORED
AND PARTICULARLY LAST YEAR IN
THE IN THE LAST YEAR'S BUDGET SO
I MEAN IT'S A SHORT LANCEL YES-
SHORTLIST FOR PARENTS. THANK YOU
AND THEN REGARDING KEY YOU KNOW
I HEARD IT. THIS WILL BE MY I'LL
SWITCH OVER- SOME OF THE
STAKEHOLDERS YOUR SPOKE ABOUT
FROM THE CONCERN OF IT BEING A
HOLLOW IT'S GOING TO BE
DISTRIBUTED DOWN TO THE ACTUAL
PROVIDERS RIGHT. COULD YOU SPEAK
A LITTLE BIT MORE OF THAT PLAN
BACCHUS- THE PLAN PROTECTIONS
AND BASED CHANGES. AND THE TALKS
ON A PLEASE. SO HAPPY TO- SO- WE
WOULD PUT FORWARD TO FEDERAL
THEY HAVE TWO DIFFERENT TYPES OF
DIRECT PAYMENTS ONE THAT A LOT
ESSENTIALLY MANDATES THAT
PAYMENT TO PROVIDER AND THEN
THEM ONE THAT DRIVES KIND OF
SUPPLEMENTAL PAYMENTS. WE WOULD
PUT FOR TO THE FEDERAL
GOVERNMENT REQUEST THAT- THAT
MANAGED CARE PLANS BE REQUIRED
TO PAY AT A MINIMUM- THE RATE
THAT WE PUT ON FILE THAT IS WHY
WE'RE RECOMMENDING TO INCREASE
TO THE BASE RATE SO IT'S
GUARANTEED THAT THAT CAN FLOW
DOWNSTREAM TO PROVIDERS. WE KNOW
THAT SOME MANAGED CARE PLANS FOR
A FEE FOR SERVICE IN SOME IS
CARE PLANS PAY CAPITATION RATE
TO THEIR PROVIDERS AS WELL I'M
IN THE IN AN INSTANCE WHERE THEY
PAY A FEE FOR SERVICE IS A VERY
STRAIGHT. INSTANCE WHERE THEY
WOULD PAY OUT THAT EIGHTY SEVEN
POINT 5% FOR EXAMPLE IN WHAT'S
IN THE BUDGET OR HIGHER IF THAT
IS THE RATE ON FILE. IN THERE
ARE SOME THAT ARE HIGHER IN THAT
WOULD BE A HOLD HARMLESS FOR ALL
PROVIDERS IN REGARDS TO ANY RATE
ON FILE. UNDER THE CAPITATION
ARRAIGNMENT WE ALSO CAN HAVE A
AYE DIRECTED AYE. DIRECTING THEM
TO ENSURE THAT THEY LOOK AT THE
CAPITATION ARRANGEMENT BETWEEN
THEMSELVES IN THE PROVIDER. LOOK
AT THE RATE IN WHICH THE
CAPITATION WAS AGREED TO. I'M IN
ENSURE THAT THE DOLLARS PASSED
THROUGH THROUGH THAT CAPITATION
ARRAIGNMENT ARRANGEMENT BETWEEN
THEM AND THE PROVIDER. OF
MANAGED CARE PLANS WOULD BE
REQUIRED TO ATTEST TO THE STATE
OF CALIFORNIA THAT THEY HAVE.
PASSED THOSE DOLLARS DOWN TO
THOSE PROVIDERS TO ENSURE THAT
THOSE DOLLARS ARE GOING TO THE
INTENDED PARTY WHICH IS THE
PROVIDERS IN THESE CASES- AND
THEN THERE COULD BE SUBJECT TO
AUDITS ARE VARIOUS PIECES IN THE
FUTURE. WE TRY TO REDUCING
ADMINISTRATIVE BURDEN OFF OF THE
PLANS THE STATE AND THE
PROVIDERS. ON THAT IS ONE THING
WE'VE SEEN WITH PROP FIFTY SIXTY
MINISTRY TO BURDEN IN REGARDS TO
HOW THE SUPPLEMENTALS HAVE BEEN
IMPLEMENTED. HAS BEEN EXTREME AT
THE PROVIDER LEVEL HAVING TO
RECONCILE- BUT THE PLAN THAT
WE'RE DOING TWO TO THREE YEARS
AFTER. CALL BACK AND AT THE
STATE LEVEL OR SO WE'RE REALLY
TRYING TO DO ADMINISTRATIVELY
LESS BURDENSOME IMPLEMENTATIONS
WITH THESE BASE RATE INCREASES.
I DIRECTED PAYMENT APPROVED BY
THE FEDERAL GOVERNMENT TO ENSURE
THAT PROVIDERS CAN GET THESE
PAYMENTS. OKAY. JUST A QUICK
ONE. BEFORE TURN OVER. EVERY
CARE PROVIDERS HIS ANKLE PA'S
AND- YESTERDAY. OKAY THANK YOU.
SO WE'RE GONNA GO CAUGHT.
THROUGH WITH AND MEN- THANK YOU
IN THANK YOU ALL FOR THE
PRESENT. ALL COMING. I AM A
FIRM. THAT HEALTH CARE IN OUR
HEALTH CARE SYSTEM IS THE MOST
IMPORTANT THING THAT WE DO IN
CALIFORNIA. IT IMPACTS EVERY
OTHER ASPECT OF. ANYBODY'S LIFE.
BUT NO MATTER WHERE THEY'RE
SITTING- SO THANK YOU ALL FOR
THE WORK YOU DO- I GUESS IS. THE
DEPARTMENT I'M I'VE BEEN A LONG
TIME CHAMPION OF A SAME DAY
PAYMENTS- FOR CLINICS. IS AT
ANYWHERE IN THE ADMINISTRATION'S
PLAN AND IF- IF NOT IS DUE TO
SEE A PATH WITH THAT. I THINK
IT'S ONE OF IT. AS WE THINK
ABOUT BEHAVIORAL HEALTH
INTEGRATION AS WE THINK ABOUT
PRIMARY CARE WHICH ARE BECAUSE
SOME OF THE KEY AREAS THAT WE'RE
THINKING THROUGH I THINK IT'S
SOMETHING THAT WE YOU KNOW WE
WOULD BE. WE WOULD WANT TO TALK
THROUGH AND KIND OF THINK ABOUT
WHAT ARE THE OPPORTUNITIES WITH
REGARD TO ENSURING THAT.
INDIVIDUALS GET THE CARE THEY
NEED AT THE RIGHT PLACE AT THE
RIGHT TIME. OKAY GOOD FOR THE
CLINICS CAN YOU TALK A LITTLE
BIT ABOUT- HOW YOU SEE IT
FUNCTIONING IN THE CLINICS WITH
HAVING BEEN ABLE TO BILL FOR X.
TWO THINGS ON THE SAME DAY. YEAH
ABSOLUTELY AND THANK YOU FOR
BEING A CHAMPION ON THIS ISSUE-
I WOULD SAY DON'T JUST GIVE YOU
AN EXAMPLE OF A PATIENT THAT
COMES THROUGH OUR DOORS RIGHT.
IMAGINE ST UNIT ROSADO WHO HAS
IS A NEW THE MEDIC HOW ELIGIBLE
FOR MEDICAL. POTENTIALLY HAS NOT
HAD ACCESS TO HEALTH CARE THAT
HER ENTIRE TIME THAT SHE'S BEEN
CALIFORNIA STABLE. RATE IS
COMING THROUGH OUR DOORS WITH
THE COMPLEXITY OF HER SITUATION
HAS LIKELY BEEN AN ESSENTIAL
WORKER OVER THE PANDEMIC. MAYBE
SHE LEFT THE WORK FORCE DURING
THAT TIME- HAS A MYRIAD OF
THINGS AS A COMMITTEE CLINICS
REALLY HAVE TO HAVE TO TAKE ON
THIS VERY COMPLEX SITUATION-
PERHAPS SHE HAS ALSO. YOU KNOW
HOW TO TAKE SOME TIME OFF OF
WORK- AND IT IS REALLY HARD TO
DO SO GIVEN YOU KNOW THAT SHE'S
PROBABLY A FRONTLINE ESSENTIAL
WORKER- AND SO THAT'S A REALLY
COMPLICATED EQUATION. THEY COME
THROUGH OUR DOORS TODAY- WITH A
MYRIAD OF NEEDS. AND WE ARE ONLY
ABLE TO PROVIDE THEM WITH THE
SERVER ONE SERVICE THAT DAY.
THAT'S OLD THAT'S WHAT WE'RE
ABLE TO BILL. AND WE'RE EVEN
LIMITED TO THE PROVIDER THAT CAN
PROVIDE THAT SERVICE AS A
BILLABLE PROVIDER- AND SO THEN
SHE HAS TO GO HOME. AND
HOPEFULLY WE CROSS OUR FINGERS
AND HOPE THAT SHE'S ABLE TO MAKE
THAT TIME TO COME BACK. AGAIN
AND SO IT IS A VERY COMPLICATED
EQUATION AND IT'S- ONLY DICTATED
BECAUSE OF THE WHAT THAT IS
BECAUSE SHE'S A MEDICAL PATIENT.
THAT RECEIVES CARE AT A AT A AT
A COMMUNITY CLINIC OR TO SEE IF
YOU KNOW HOW TO TWEAK CLINIC
BECAUSE WE'RE- WE'RE ONLY
SUBJECT TO THAT LIMITATION. AND
THEN THE FINAL THING I'LL SAY ON
THIS IS THAT. YOU KNOW THIS.
THIS IT EQUATION. YOU KNOW
SOMEONE SHOULD NOT- RECEIVE LESS
COMPREHENSIVE. CARE SIMPLY
BECAUSE THEY ARE A ON MY CAL.
RIGHT IT'S BE TO. ON THEIR
HEALTH INSURANCE COVER AND IT'S
IF WE REALLY WANT TO ASK. IF YOU
WANT TO FIX THIS. THIS ISSUE OF
HEALTH EQUITY THAT WE ALL KEEP
TALKING ABOUT. THEN WE HAVE TO
ADDRESS THESE TYPES OF ISSUES
AND SAME DAY- PAYMENT STATE THAT
IS ONE WAY TO DO THAT. THANK
YOU- SO THAT. THE
ADMINISTRATION'S PLAN AS I
UNDERSTAND IT IS TO INCREASE
RATES TO EIGHTY SEVEN. POINT 9%
OF MEDICARE RATES. IT'S FIVE.
FOR PRIMARY CARE A MATERNITY
CARE AND NOT SPECIALLY BEHAVIOR
HEALTH FOR STARTING JANUARY
FIRST TWENTY TWENTY FIVE AND
THEN COMING BACK. TECH
GOVERNOR'S BUDGET FOR ADDITIONAL
RATE INCREASES STARTING JANUARY
ONE TWENTY TWENTY FIVE. OKAY AND
I GUESS STUDENTS TO THE
PROVIDERS IS THAT IS THAT
ADEQUATE FACING WHAT WE'RE
LOOKING AT NOW- I THINK THE I
WANT TO START WITH WITH ST AGAIN
I THINK IT ON THE TABLE AS THE
SINGLE LETTER TO DIRECTOR BOSSES
EARLIER STATEMENT. THEY NEEDED
MEDICARE I'LL FRANKLY IS GREATER
THAN WHAT THIS MC ATTACKS COULD
PROVIDE AND SO- IS EIGHTY
SPEAKER IT'S A GREAT FIRST STEP
I THINK TO IMPROVE ACCESS TO THE
MEDICAL SYSTEM. I THINK PART OF
THE REASON THAT WE'RE ADVOCATING
FOR A SPEND OVER A THREE POINT
FIVE YEARS THE LENGTH OF THE
TAX. IS TO MAXIMIZE. ACCESS
WITHIN THE PROGRAM AND WE CAN
ONLY DO THAT WITH FUNDING AND SO
WE UNDERSTAND THAT THERE'S WE
CERTAINLY UNDERSTAND THAT THE
CMS IN THE FEDERAL GOVERNMENT
MIGHT HAVE A FEW. OF THIS TAX I
THINK WE WOULD SAY LET'S SEE IF
THEY CHANGE THE REGULATION AND
DEAL WITH IT THEN- ED IN THIS IS
REALLY AN OPPORTUNITY TO INVEST
IN THE SYSTEM SO- THE IN THE
GOVERNOR'S PROPOSAL- IT'S A
GREAT FIRST STEP BUT- FOR US BUT
I DO THINK FROM THE PHYSICIAN
REIMBURSEMENT RATE. AGAIN THIS
HASN'T BEEN RAISED SINCE THE
NINETIES THE NEED IS VERY GREAT
SO DO WE THINK THAT WILL
CERTAINLY IMPROVE ACCESS YES BUT
WE THINK THAT THE BEST CASE TO
PROVIDE ACCESS TO THE SYSTEM
WOULD BE INVESTED OVER THE
THREE. AND A HALF. AND I THAT I
GUESS TO THE PLANS IF THE
FEDERAL GOVERNMENT DOES CHANGE
THE- THE- THE FORTUNATELY
LOOPHOLE. DO WE HAVE A BACKUP
PLAN THEN TO BE ABLE TO AVERAGE
IT ALL OUT AND STILL MAKE IT THE
TAX FUNCTION. YEAH OR- THE TIME
TO THE PLANTS- I. WANNA MAKE
SURE THAT I UNDERSTAND THE
QUESTION- SENATORS SO THAT IF-
IF THE TAXES SOMEHOW
DISCONTINUED OR LOWERED.
PROPORTIONALLY LOOPHOLE IS GONE
AND SO THE MEDICO BRIDGE WITH
THE SAME AS THE COMMERCIAL RATES
MMHM HE HAD TO DO THAT THE SAME
. IT WITH THE TAX STILL BE
FUNCTIONAL AS A TOOL WELL I MEAN
WILL THAT THE YOU KNOW IF. THE
TAX SET TO EXPIRE IN THREE AND A
HALF YEARS SO I THINK YOU'RE THE
LEGISLATURE WOULD HAVE TO COME
BACK AT THAT TIME AND DETERMINE-
YOU KNOW THE PATH MOVING FORWARD
WITH RESPECT TO THE TAX FORMULA-
YOU KNOW AND I IN THE END AND I
THINK THAT WOULD THAT WOULD HOLD
TRUE WITH THE SPEND AS WELL I
MEAN. I THINK THE LEGISLATURE
WOULD HAVE TO COME TOGETHER AND
WORK WITH THE ADMINISTRATION THE
PLANTS AND STAKEHOLDERS HERE AT
THIS TABLE TO FIGURE OUT YOU
KNOW- THE WHAT THE MOST
EFFECTIVE AND EFFICIENT WAY IS
TO YOU KNOW MAINTAIN. YOU KNOW
THOSE SERVICE OBVIOUSLY YOU KNOW
OUR RATES COME FROM THE STATE
THEY'RE DEVELOPED BY THE STATE
AND I THINK- YOU KNOW THE MCO
TAX IS JUST ONE CONSIDERATION OF
IN IN IN A VARIETY OF
CONSIDERATIONS ARE USED TO
DEVELOP THE RATES FOR THE PLANS
THAT ARE THEN USED YOU KNOW TO
CONTRACT WITH PROVIDERS SO. I
THINK IT'S VERY CALM-
COMPLICATED IS VERY COMPLICATED
SITUATION HERE. I THINK THAT'S
IT THE MINISTRATIONS SUGGESTING
THAT THREE AND A HALF YEARS.
HELLO VERY COMPLICATED SITUATION
. MIAC I ADD- AND- A- SPEAKING.
THE TAX FOR. THAT I THINK. YOU
KNOW KIND OF REITERATING. THE
ASK FOR THAT THE SPEND TO ALIGN
WITH THE PERIOD OF THE TAX AND
PARKING OF. APPRECIATING THE
DEPARTMENT IS HAVING
CONVERSATIONS WITH CMS BUT WE
ALSO KNOW THAT. THE MASS FOR YOU
KNOW THE PAST SEVERAL TAXES HAVE
SAID THAT. THEY'RE GOING TO
CHANGE THOSE RULES AND WE
HAVEN'T SEEN THAT ACTUALLY
HAPPENED YET. AND WE ALSO KNOW
THAT IF THEY'RE THEY'RE CHANGING
THE RULES ON PROVIDER TAXES
THERE'S- A LOT OF IMPLICATIONS
FOR NOT JUST CALIFORNIA THE
OTHER STATES SO I THINK THERE'S
SORT OF. A LONG ROAD BETWEEN
WHERE WE ARE NOW IN ANY. FUTURE
CHANGES WERE THEY TO TAKE EFFECT
. I DEFINITELY AGREE ON THAT.
PART YEAH OKAY AND TO THE- THE
TO THE MINISTRATION IN THE
HOSPITAL SAYS. I SEE THE
PROVIDER RATES GOING UP. AND
WE'RE ALL KIND OF STRUGGLING
WITH THIS IS HOSPITAL CRISIS-
CAN YOU TALK ABOUT WHAT THE
ADMINISTRATION'S PLAN IS FOR
THE- PERSONAL CRISIS THAT WE'RE
FACING NOW- AND- AND THE
DIFFERENCE BETWEEN WHAT. WHAT
THE HOSPITAL ASSOCIATION IS
ASKING FOR. I'LL START AND THEN
TURNED OVER TO- THE STATE
MEDICAID DIRECTOR COOPER SO IT'S
PART OF OUR PROPOSAL I KNOW
THERE IS THAT YOU KNOW NOT PART
OF THE MC A PROPOSAL BUT WE HAVE
THE DISTRESS. OF HOSPITAL LOAN
PROGRAM THAT IS BECAUSE I THINK
WITH INTENDED OR IS INTENDED TO
REALLY ADDRESS THE IMMEDIATE
NEEDS FACING HOSPITALS TODAY. AS
PART OF OUR PROPOSAL A FEW
MILLION CORRECT. THE ONE HUNDRED
FIFTY. AS PART OF OUR M. C. O.
PROPOSAL WE'VE IDENTIFIED FOR
TWENTY TWENTY FIVE ACUTE CARE
INCLUDING EDIE YOU CERTAINLY ARE
USED. AND OUTPATIENT SERVICES IS
PRAYER A PRIORITY AREAS FOR US
IN TWENTY TWENTY FIVE AND SO
THAT. DIRECTLY RELATES TO
HOSPITAL FINANCING. WE ALSO
WOULD WANT TO POINT OUT THAT WE
WANT TO MAXIMIZE OUR ABILITY TO
DRAW DOWN ADDITIONAL FEDERAL
DOLLARS WITH THE MCO AND SO.
THAT IS WHY WE'RE WE'RE WAITING
WE'RE PROPOSING TO SUBMIT THOSE
RATE INCREASES AND IN JANUARY
FOR A STARTED JANUARY TWENTY
TWENTY FIVE. BECAUSE THERE ARE
LOTS OF INTEREST BECAUSE THESE
RELATED TO HOSPITAL FINANCING
RELATED TO UPPER PAYMENT LIMIT.
ADDITIONAL SUPPLEMENTAL PAYMENTS
I'VE BEEN WANTING TO HAVE A
COMPLETE UNDERSTANDING FOR HOW
WE CAN MOST EFFICIENTLY AND MOST
EFFECTIVELY. DRIVE DOWN
ADDITIONAL FEDERAL DOLLARS WITH
THESE M. C. O. REVENUES AND NOT
LEAVE ANYTHING ON THE TABLE. AND
IF I MAY BEN JOHNSON FROM CJ- WE
DO APPRECIATE THE LEGISLATURE
PROVING THAT DISTRESS HOSPITAL
LOAN PROGRAM BUT WE DO FIND THAT
IT IS ONLY A BRIDGE. TO GET
THOSE HOSPITALS THAT ARE MOST
CRITICALLY AT THE EDGE OF
SURVIVAL MAYBE A DOZEN OR SO
HOSPITALS. THROUGH UNTIL
STRUCTURAL REFORMS CAN BE MADE.
TO ADDRESS THE LONG STANDING A
SHORTFALL IN MEDICAL
REIMBURSEMENT- THAT HOSPITALS
ESPECIALLY WITH HIGH MEDICAL
PAYER MIXES ARE EXPERIENCING.
AND IF THE IF THE FUNDING WERE.
NOT TO COME FASTER THAN YOU KNOW
TWO YEARS DOWN THE LINE. THAT'S
THAT CAN EXTEND OUT THOSE LOSSES
AND- PUT ADDITIONAL HOSPITALS.
CLOSER TO THE EDGE AND
ADDITIONALLY- THERE WITH THE
FUNDING THAT WOULD GO INTO THE
RESERVE THERE'S JUST REALLY
THERE THERE ISN'T I DON'T THINK.
BUT NOT CERTAINTY ABOUT WHERE
THAT FUNDING WILL END UP AND
IT'S REALLY DIFFERS A LOT OF
THOSE REALLY KEY DECISIONS WHEN
WE REALLY NEED TO ADDRESS WHAT
HAS BEEN A LOOMING AND GROWING
CRISIS FOR A DECADE BUT
ESPECIALLY WITH COVERED
NINETEEN. MAYBE TO TURKEY SEASON
AND THAT WILL BE MY LAST FROM
FOR NOW- WHAT WHAT WHAT IS OUR
DO YOU KNOW WHAT OUR CURRENT
HOSPITAL REIMBURSEMENT RATE IS
AS COMPARED TO THE MEDICARE RATE
- IF YOU WITH IT THE SEVENTY
FOUR CENTS TO A DOLLAR ONE ARE
WE TALKING. THAT WAS PRIMARY
CARE OKAY SO WHAT I WOULD SAY
IT'S HOSPITAL FINANCING IS
COMPLICATED- IT'S GOING TO VARY
BETWEEN FEE FOR SERVICE THANK
YOU- IT'S GOING TO VARY BETWEEN
FEE FOR SERVICE AND- MANAGED
CARE- BOTH OF THEM HAVE A WHAT'S
CALLED THE BASE RATE AND THEN WE
HAVE SUPPLEMENTAL PAYMENTS. FOR
HOSPITALS WHEN IT COMES TO THE
FEE FOR SERVICE SIDE FOR EXAMPLE
WE ARE ALREADY AT THE WHAT'S
CALLED THE UPPER PAYMENT LIMIT
WHEN IT COMES TO FEDERAL
GOVERNMENT MEANING THAT WE'RE
PAYING OUT OR- NEARLY MEDICARE
RATES WHEN IT COMES TO THOSE-
AND THAT'S NOT BENEFIT- WHEN IT
COMES TO MANAGED CARE- THE BASE
RATE PLUS SUPPLEMENTAL HAS A
DIFFERENT BAR IN REGARDS TO THAT
AND THAT'S ESSENTIALLY AVERAGE
COMMERCIAL RATING WE AREN'T.
NECESSARILY THERE- SO THERE'S
TWO WAYS THAT THAT CAN CHANGE
YOU CAN NEGOTIATE RATES WITH
YOUR MANAGED CARE PLANS WHICH
ARE HOSPITALS TO ON A REGULAR
BASIS AND THEN WE HAVE OUR
SUPPLEMENTAL PAYMENTS WHICH IS
OUR HALL- ARE H. FOUGHT FOR
HOSPITAL- QUALITY ASSURANCE
FAITH. AND IN THEIR- WE ARE HAVE
WORKED CLOSELY WITH OUR HOSPITAL
PARTNERS FOR BOTH TWENTY THREE
AND TWENTY FOUR AND WE'VE
INCREASED THAT BY ONE POINT SIX
BILLION DOLLARS- IT TO ENSURE
THAT WE CAN HAVE ADDITIONAL
SUPPLEMENTALS WE STILL HAVE ROOM
IN REGARDS TO THAT AND WE WORK
CLOSELY WITH OUR HOSPITAL
PARTNERS IN REGARDS TO. ALWAYS
LOOKING AT OUR SUPPLEMENTAL
PAYMENTS- BUT TO ANSWER YOUR
QUESTION FOR CALENDAR YEAR
TWENTY TWENTY TWO AND MANAGED
CARE THE NET BENEFIT
REIMBURSEMENT IN THE NET BENEFIT
BECAUSE SOME OF THIS IS. SELF
FINANCED WITH FEES ETCETERA- BUT
IN MANAGED CARE THE NET BENEFIT
REIMBURSEMENT ON AVERAGE FOR
PRIVATE HOSPITALS AROUND FOUR
THOUSAND ONE HUNDRED DOLLARS PER
DAY- INTO DESIGNATED PUBLIC
HOSPITALS AROUND FOUR THOUSAND
THREE HUNDRED DOLLARS PER DAY-
AND SO WHEN CONSIDERED KIND OF
STATEWIDE. A GROSS PAYMENT
LEVELS FOR HOSPITALS. A MATCH OR
EXCEED THE MEDICARE
REIMBURSEMENT RATES ARE
CURRENTLY- BUT THEN AGAIN WE
STILL HAVE ROOM ON THE- AVERAGE
COMMERCIAL RATE FOR
SUPPLEMENTALS ON THE MANAGED
CARE SIDE. OF COME JANUARY ONE
OF TWENTY TWENTY FOUR- ABOUT
NINETY NINE POINT 5% OF OUR
LIVES ARE GOING TO BE IN MANAGED
CARE WHICH DOES ALLOW US TO AS
DIRECTOR BOSS MENTIONED.
CONTINUE TO MAXIMIZE FEDERAL
FUNDS WHERE WE CAN ON
SUPPLEMENTAL PAYMENTS ON THE
MANAGED CARE SIDE- BUT- I THINK
THAT'S WHY YOU SEE THE
ADMINISTRATION FOCUSING ON SOME
OF THE- OUTPATIENT HOSPITAL
RATES- WHETHER THAT'S EMERGENCY
ROOM SPECIALTY CARE OUTPATIENT
HOSPITAL SERVICES- THOSE ARE
THINGS WE WANT TO CONSIDER IN
THE TWENTY TWENTY FIVE THREE
AUGMENTATION. AS DIRECTOR PULSE
MENTION THOUGH IT'S VERY
COMPLICATED WITH VARIOUS FEDERAL
UPPER PAYMENT LIMITS AND RULES
AND RAGS. AND HOW THAT WORKS AND
SO WE WANT TO BE THOUGHTFUL AND
USE DATA TO DRIVE WHAT WE
RECOMMEND- AND WORK CLOSELY WITH
OUR HOSPITAL PARTNERS ON WHAT IS
NEEDED. CRAFTING PROCEDURE AND
THEN WILL YEAH IF I MAY JUST
RESPOND AND WE'VE APPRECIATED
THAT PARTNERSHIP OVER MANY YEARS
IN TERMS OF. THAT REALLY
IDENTIFYING IT NON GENERAL FUND-
LOOKS RESOURCES TO SUPPLEMENT
WHAT THE STATE PAYS ON THE
MEDICAL SIDE. BUT WHAT IS
OCCURRED OVER THE LAST DECADE IS
A IS IT A TRUE INCREASING
RELIANCE ON. THOSE SUPPLEMENTAL
PAYMENTS AND THOSE- TWO VERY.
DEGREE ARE SELF FINANCE BY THE
HIGH- BY THE HOSPITALS
THEMSELVES. AND SO WHEN THE WHEN
THE HOSPITAL'S PUT UP THE NON
FEDERAL SHARE. IT MEANS REALLY
FOR EVERY- EVERY DOLLAR IN GROSS
PAYMENT TO TRULY GETS TRANSLATES
INTO FIFTY CENTS THAT- THAT THE
HOSPITALS ARE RECEIVING BACK.
AND SO AS THAT RELIANCE ON
THESE- NON GENERAL FUND
RESOURCES HAS INCREASED IT'S
REALLY INCREASE THAT THAT GAP
BETWEEN WHAT IT COSTS- TO
PROVIDE CARE AND THE TOTAL
REIMBURSEMENT THAT MEDIC CAL- IS
PROVIDING SO HAPPY TO CONTINUE
TO WORK I KNOW IT IS VERY
COMPLICATED- AND WE'RE HAPPY OF
COURSE TO. TO MEET WITH YOU ALL
IF YOU HAVE ANY FURTHER
QUESTIONS ON THE- I THINK YOU'VE
BEEN AROUND. THANK YOU MADAM
CHAIR YOU GENERALLY I THINK THE
MCO TECH SHOULD BE USED FOR
HEALTH PURPOSES. I REALIZE THE
BUDGET IS A ZERO SUM GAME. BUT
WHEN I LOOK AT THE PROVIDER RATE
INCREASES FOR OUTPATIENT AND
SPECIALTY MENTAL HEALTH SERVICES
I ASKED MY COLLEAGUE IS MUCH
SMARTER THAN I WHAT THAT MEANT
AND- SHE TOLD ME BUT- HOW DOES
THAT. ABOUT PATIENT MENTAL
HEALTH. SERVICES PIECE RELATES
TO THE NEED FOR ADDITIONAL IN
PATIENT. BEHAVIORAL HEALTH
CAPACITY. RIGHT NOW THAT I WOULD
MAYBE START I THINK PART OF IT
IS ALSO KIND OF THAT PREVENTION
IN PRIMARY CARE KIND OF
PERSPECTIVE THE MORE WE CAN DO
ONE MILE TO MINOR OR NON
SPECIALLY SERVICES TO PREVENT
YOU KNOW. VISITS TO THE ARE
PREVENT CRISIS THE BETTER IT IS
FOR THE ENTIRE CONTINUUM AND SO-
KIND OF. JUST WITH THE VEIN AND
THEN THE VIEW OF OUR
COMPREHENSIVE QUALITY STRATEGY
AND REALLY TRYING TO FOCUS ON
SOME OF THESE CLINICAL AREAS OF
PREVENTION. AND INTEGRATION OF
BEHAVIORAL HEALTH AND PHYSICAL
HEALTH SERVICES- USING THIS
FIRST ROUND THAT BREED INCREASES
FOR JANUARY ONE TWENTY TWENTY
FOUR TO FOCUS ON SOME OF THOSE
PRIMARY. PREVENTION THE TYPES OF
SERVICES. YOU KNOW WE- WE
OBVIOUSLY IN THEM YOU ALL NOT ME
HEALTH CARE PROVIDER BUT YOU TRY
TO DRIVE. HEALTH CARE NEEDS TO
THE LOWEST POSSIBLE DENOMINATOR
SO URGENT CARE CLINICS CLINICS
OTHER SERVICES THAT DO NOT
INVOLVE AN ACUTE CARE SETTING.
BUT THE REALITY IN THE NON
BEHAVIORAL SIDE IS AT SOME POINT
PEOPLE NEED TO BE ADMITTED TO AN
ACUTE CARE FACILITY. AND MY
CONCERN. IN THE BEHAVIORAL
HEALTH ARENA. IS THE
REIMBURSEMENT RATES GENERALLY
ARE SO LOW. THAT THE CUTE CARE
PROVIDERS WHO HAVE AN
OPPORTUNITY TO CHOOSE CHOOSE NOT
TO. BUILD AND STAFF BEHAVIORAL
HEALTH BEDS SO IF WE INCREASE
THE OUT PATIENT NINE SPECIALLY
MENTAL HEALTH SERVICES
EMPHASIZING. BEHAVIORAL HEALTH
CARE AT THE COMMUNITY IN
RESIDENTIAL LEVEL WHICH WE
SHOULD OF COURSE. WHEN SOMEONE
NEEDS TO BE ADMITTED. TO AND
COULD CARE FACILITY THERE WILL
BE A FACILITY. OR BED TO ADMIT
THEM TO OTHER THAN THE WALL OF
AN EMERGENCY DEPARTMENT ON A
GURNEY. AND I DO THINK WE NEED
TO FIGURE AND I KNOW WE HAVE
GENERAL FUND BACK FILL BUILT IN
HERE BUT I DO THINK WE NEED TO.
FIGURE OUT A WAY TO BEGIN TO
LOOK ADDRESS THE- NEED FOR A
CUTE KERR- BEHAVIORAL HEALTH
INPATIENT CAPACITY IN THE STATE
- YOU'VE HEARD ME SAY IT BEFORE
OR YOU KNOW. WE ARE RIVERSIDE
COUNTY OF SEVENTY SEVEN PUBLIC
BEDS FOR A COUNTY OF TWO POINT
FIVE MILLION PEOPLE. THERE'S NOT
A HOSPITAL. ASSEMBLY ACUTE CARE
HOSPITAL FACILITY- IN THE CITY
OF RIVERSIDE THREE HUNDRED AND
FIFTY THOUSAND PEOPLE. TO MY
KNOWLEDGE THAT HAS A SINGLE
ACUTE CARE INPATIENT. BEHAVIORAL
HEALTH BED. TWO THERE MAY BE A
PRIVATE- PROFIT FOR PROFIT
FACILITY WITH SOME LIMITED BED
CAPACITY. BUT WITH THAT THERE IS
. TO SAY IT'S A DIRE NEED IS
CERTAINLY AN UNDERSTATEMENT I
DON'T NEED TO GIVE YOU A LECTURE
YOU ALL KNOW IT BETTER THAN I
BECAUSE YOU WORK IT EVERY SINGLE
DAY IN. AND PERSONALLY I'M
THANKFUL FOR THE FACT THAT YOU
DO IN THAT WE HAVE YOU. ALL OF
YOU WORKING THE ISSUE. SO I
GUESS OF MIKE REQUEST IS THAT WE
TAKE ANOTHER LOOK AT. HOW WE'RE
DEALING WITH THESE PROVIDER
RATES AND WHETHER OUTPATIENT
SOLELY. IS THE RIGHT WAY TO
ALLOCATE THE MONEY THAT WE DO
RECEIVE AS A RESULT OF THIS MCO
TAX. OVER WHATEVER PERIOD OF
TIME. WILL DECIDE TO HAVE IT
APPLY TO- THE FUNDING NEEDS. AND
THE SECOND- MISTER THOMPSON I
DON'T ALWAYS AGREE ON
EVERYTHING. BUT ON THIS
PARTICULAR ISSUE HAVING TO DO
WITH WORKFORCE DEVELOPMENT
RESIDENCY GMAT. PRECEPTORS SHIP
FOR THOSE WHO ARE NOT PHYSICIANS
IN TRAINING. I DO THINK WE NEED
TO TAKE ANOTHER LOOK AT THE
ABSENCE OF THAT IN THE FUNDING-
MODEL IN THE LEAST IT'S BEEN
PRESENTED TO US AND- I DO THINK
WE NEED TO TAKE AN INNOVATIVE
APPROACH AS HE SUGGESTED- TO THE
USE OF GME INWARD SUPPLIED AND-
WE FOCUS ON ACUTE CARE- GENERAL
HOSPITAL FACILITIES FOR TRAINING
IN SOME OF THE TRAINING NEEDS TO
BE CONDUCTED THERE BUT WE HAVE A
WHOLE. RAFT OF A CLINICS AND
AMBULATORY CARE FACILITIES
SPREAD OUT ACROSS THE STATE IN
MANY. MANY PLACES WHERE THERE IS
NO A CUTE CUTE CARE FACILITY AND
PERHAPS WE'LL HAVE MORE OF THOSE
IN THE FUTURE IS OUR- ACUTE CARE
HOSPITALS SUFFER CONTINUED
DISTRESS. AND WE OUGHT TO FIGURE
OUT A WAY TO UTILIZE THAT
NETWORK OF FACILITIES BEYOND
ACUTE CARE HOSPITALS- TO CONDUCT
OUR ENHANCE TOTALLY. GME
TRAINING PROGRAMS AND OTHER
PRECEPTORS SHIP PROGRAMS IN THE
HEALTHCARE DELIVERY SYSTEM
PERHAPS THE EMPHASIZING- AND
DRIVING WORKFORCE DEVELOPMENT
FUNDING DOWN TO. NOT EXCLUSIVELY
BUT- AB PRIMARILY OUR PUBLIC AND
NONPROFIT FACILITIES THAT ARE
LOCATED TRAINING FACILITIES THAT
ARE THAT ARE GENERALLY PRESENT
PROVIDING MOST OF THE TRAINING.
IN OUR UNDERSERVED AREAS. WHERE
THERE'S NOT A GENERAL HOSPITAL
WHERE THE TRAINING CAN BE
CONDUCTED THE CAN TRAININGS
CONDUCTED IN IN CLINICS AND
AMBULATORY CARE FACILITIES AND
THEN WE'D HAVE TO FIGURE OUT A
WAY TO INCENTIVIZE- CLICK TO
CARE GENERAL HOSPITALS WITH THE
FACILITIES. TO PROVIDE CLINICAL
ROTATIONS BECAUSE RIGHT NOW-
PERHAPS ARE USING THOSE FOR
THEIR OWN PURPOSES AND I
UNDERSTAND THAT BUT WE NEED TO
FIGURE OUT A WAY TO DO THIS. SO
I GUESS MY REQUEST IS THAT WE
TAKEN A LOOK MAYBE AT THIS
GENERAL FUND BACK FILL WE'RE
GOING TO HAVE TO WORK WITH YOU
TO FIGURE OUT HOW TO. FILL THE
GAP ELSEWHERE IN THE BUDGET BUT
THIS IS OUR OPPORTUNITY TO USE
THE SAME CO TAX. TO REALLY BUILD
UP OUR HEALTHCARE DELIVERY
SYSTEM IN PARTICULAR IN THE
MEDICAL ARENA. THANK YOU MANAGER
THINGS IN IRAQ WERE GONNA MOVE
ON TO CENTER GROVE. THANK YOU
MADAM CHAIR- I DIDN'T NOTICE ANY
ANYBODY'S COMMENTS AT THE TABLE
. S. BUT I START WITH I THINK
THAT WE FOUND OURSELVES IN THIS
SITUATION BECAUSE THE
CATASTROPHIC LOSS SAID THE
MADERA HOSPITAL. AND PART OF IT
WAS PART OF IT NOT ALL OF IT WAS
MEDICARE REIMBURSEMENT RATES. I
KNOW THAT COULD BE A DELTA WAS
NEXT ON THE LIST WHICH IS IN MY
DISTRICT SIX HUNDRED SEVENTY
BEDS. THE TWO TRAUMA CENTER IN
THE CENTRAL VALLEY WHICH WAS
ALREADY- IN FINANCIAL DISTRESS-
BECAUSE THEY DO SERVE OVER 70%
OF THE MEDICARE POPULATION. AND
THERE'S NOT A WELL BALANCED-
COMMERCIAL PLAN RATE IN THE
MEDICAL RATE BECAUSE- IT'S
PREDOMINATELY HIGH MEDICARE
POPULATION THAT WE SERVE. SO THE
RATES ARE INADEQUATE TO START
LIKE MY COLLEAGUES HAVE SAID.
AND SO I APPRECIATE THE
DISCUSSION I APPRECIATE THE
GOVERNOR WORKING WITH US ALL OF
US. AND COMING UP WITH THE FIFTH
DOWNTURN THE FIFTY MILLION
DOLLAR LOAN PROGRAM THANK GOD
OUR THAT MAY. HASN'T HAPPENED
YET BUT MAKE IT OUR HOSPITALS
OUT OF THE SITUATION THAT THEY
FIND THAT THEY'RE IN- BECAUSE OF
THE MEDICARE REIMBURSEMENT RATE.
BUT GOING BACK TO THE PANEL
DISCUSSIONS WHEN EVERYONE OF YOU
AT THE TABLE PRESENTED. EVERYONE
OF YOU PRESENTED AT THE TABLE-
DOES ANYONE BECAUSE NO ONE
RECOGNIZED IT WHERE'S THIS
THIRTY TWO. BILLION DOLLARS
COMING FROM ROUGHLY THIRTY TWO
BILLION DOLLARS NO ONE RECOGNIZE
THAT. NO IN ST THE PLANS FOR
COMING TO THE TABLE IN DOING
THIS. NO ONE SAID I MEAN
EVERYONE OF YOU I MEAN AND ALL
OF YOU AND I APPRECIATE THE
HOSPITALS AND I APPRECIATE WHAT
YOU GUYS DO TO DELIVER CARE AND
I APPRECIATE THE
ADMINISTRATION'S PARTICIPATION.
AND I APPRECIATE YOU KNOW THE
HOW YOU KNOW PEOPLE REPRESENTING
WHAT THEY NEED IN THIS DOLLAR
BUT NO ONE SAID THANK YOU TO THE
PLANS FOR COMING TO THE TABLE.
TO ADDRESS THIS ISSUE. AND SO I
WANT TO PERSONALLY THANK THE
PLANS FOR DOING THAT BECAUSE
YOU'RE PROVIDING THIRTY TWO
BILLION DOLLARS WHICH I THOUGHT.
IN GOOD FAITH WITH WORDS WORKING
WITH. THE ADMINISTRATION AND
OTHER INDIVIDUALS. I THOUGHT IN
GOOD FAITH MAKING AN AGREEMENT
TO SUPPORT OR TO ADDRESS OR AT
LEAST BRING TO THE TABLE THIS
CONVERSATION. ABOUT AN MCO TAX
WOULD GO TO THE DIRECT BENEFIT.
OF MEDIC CAL PROVIDERS IN
HOSPITALS. NOT NO OFFENSE BUT
HOSPITALS THAT DIDN'T NEEDED IN
AREAS WHERE THERE ARE
FINANCIALLY SECURE- BUT
SPECIFICALLY ADDRESSING THE
POOREST PEOPLE IN OUR STATE. FOR
HEALTH CARE BECAUSE YOU CAN SEE
ACCESS TO HEALTH CARE HEALTH
CARE FOR ALL BUT IF YOU'RE NOT
PROVIDING ACCESS TO HEALTH CARE
BECAUSE DOCTORS AND PROVIDERS
AREN'T TREATING HEALTH CARE. FOR
YOU CAN ONLY BILL FOR ONE. A
TREATMENT PER DAY IN ORDER TO
KEEP YOUR DOORS OPEN THAT'S NOT
HEALTH CARE FOR ALL. SO I
PERSONALLY THINK THE PLANS
BECOMING FOR WITH ANY ANY AN APT
THIRTY TWO BILLION DOLLARS THIS
ESTIMATE THAT I HAVE THAT
CORRECT. THIRTY TWO BILLION
DOLLARS SO START THERE. AND
BECAUSE EVERYBODY ELSE IS A
TAKER- PROVIDER- I DO HAVE
QUESTIONS I THINK IT'S FOR THE
ADMINISTRATION AND THE IDEA. I
WANT TO FOCUS ON THE PRIMARY
CARE INSTRUCTORS OBSTETRICS AND
THE- NON SPECIALTY MENTAL HEALTH
SERVICES IS THERE A SPECIFIC
CODE FOR SPECIFIC CODES. AND IN
THE REIMBURSEMENT THAT WILL- BE
AFFECTED. IS IF I GUESS WHAT I'M
TRYING TO GET TO BECAUSE THEY'RE
NOT A LOT OF SPECIFICITY. AND
NON SPECIALTY MENTAL HEALTH LIKE
MY COLLEAGUE FROM RIVERSIDE IF
THE CODE SECTIONS TO TREAT
PEOPLE THAT COME IN AND DAY ARE.
MEET A. B. C. D. AND E. AND THEN
YOU'RE GOING TO DO INCREASE IN
MEDICAL PAYMENTS FOR THAT
PARTICULAR INDIVIDUAL. BUT 95%
OF THE PATIENTS THAT COME IN
THAT GET TREATED BY THE CLINIC
ARE THE HOMELESS PEOPLE THAT
WALK IN THE HEAVEN CARE THAT
ADDITIONALLY HAVE MENTAL HEALTH
WHICH CAN ADDRESS THE WOUND
CARE. BECAUSE YOU'RE ONLY
ALLOWED ME TO HEALTH
REIMBURSEMENT FOR ABC INDY
PATIENT IN THIS PERSONALLY WITH
A REQUIREMENTS SO I'M INTERESTED
IN THIS SPECIFIC CODES. THAT
WILL BE INCREASED FOR THOSE
THREE THINGS PRIMARY CARE
OBSTETRICS AND NON SPECIALTY
MENTAL HEALTH. WHO CAN PROVIDE
ME WITH THAT LIST- YES SO HAPPY
TO PROVIDE YOU WITH A QUICK
LITTLE OVERVIEW AND THEN YOU
HAVE TO PROVIDE THE LIST OF
CODES. THE FOR- OB IT WOULD BE
MATERNITY CARE BROADLY SO THIS
WOULD INCLUDE PRENATAL POSTNATAL
CARE WILL BE ON PROVIDER
PAYMENTS ON THAT'S INCLUSIVE OF
DOULA AND THERE'S A VARIETY OF
CODES THAT THAT INCLUDES. FOR
EXAMPLE THOUGH IT WOULD NOT
INCLUDE VARIOUS PER SEPARATE
PROCEDURES ARE HOSPITAL
PROCEDURES OR ANYTHING THAT IS
OUTSIDE OF THAT I'M IT DOES
INCLUDE DELIVERY SO WE CAN
PROVIDE YOU THAT THE LIST OF
CODES THAT YOU HAVE A GOOD
UNDERSTANDING OF WHAT'S INCLUDED
IN THE MATERNITY CARE- PIECES.
ME A COUPLE OF EXAMPLES OF
WHAT'S NOT COVERED- SO FOR.
WE'RE CHANGE ANCILLARY SERVICES
FOR LIKE AN ULTRASOUND PAYMENT
FOR EXAMPLE- OR IF THERE WAS A
SEPARATE YOU KNOW- PROCEDURE A
BROADLY ANY PROVIDER PAYMENTS
TIED TO MATERNITY CARE FOR A
PRENATAL POSTNATAL. DELIVERY I
SHOULD BE INCLUDED IN THE LIST
SO IF SOMEONE ON MEDIC CAL IN MY
DISTRICT OR ANYWHERE ELSE IN THE
STATE AGAIN WE SERVE A HIGHER
MEDICARE POPULATION OR CENTRAL
VALLEY. SOMEONE ON MEDICARE ALL
WALKS INTO A HOSPITAL FOR
MATERNITY CARE THEIR DELIVERY IS
COVERED WITH AN INCREASE IN THIS
REIMBURSEMENT RATE HI THIS IS
DOMINIQUE FOCUSED ON THE
PROVIDER PAYMENTS WITHIN THIS
PARTICULAR AUGMENTATION- AND
THEN I WOULD WANT TO MAKE SURE I
LOOK SPECIFICALLY IN REGARDS TO
HOW IT IMPACTS ANY IMPATIENT SO
I'D WANT TO GET BACK TO YOU ON
THAT TO MAKE SURE I'M WORKING
WITH MY SNEEZE ON THAT
PARTICULAR COULD PLEASE DO THAT
BECAUSE MY HOSPITAL'S TELL ME
THAT EVERY META CAL BABY THEY
DELIVER. THERE IS A SIGNIFICANT
LOSS OF THAT TO ALMOST TEN
THOUSAND DOLLARS PER DELIVERY.
YES WE'RE HAPPY TO GIVE SEE IF
THAT IN. SURE OKAY- ON THE NON
SPECIALTY MENTAL HEALTH SO WITH
THE WAY WE PROVIDE SERVICES IN
THE MEDICARE PROGRAM WE HAVE
WHAT WE CALL NON SPECIALTY
MENTAL HEALTH THAT IS THE
RESPONSIBILITY OF OUR- MEDICARE
MANAGED CARE PLANS- TO PROVIDE
THAT INCLUDES- MEDICATION
MANAGEMENT THERAPY SERVICES
PSYCHOLOGY SERVICES- IN WE HAVE.
A LIST OF THOSE SERVICES FOR
MORE THAN HAPPY TO PROVIDE YOU
THAT COULD SET. THAT IS DONNELLY
WHAT WE ARE FOCUSED ON WITH THIS
INITIAL- EIGHTY SEVEN POINT 5%
AUGMENTATION- THAT IS THE BOOK
OF THE UPSTREAM PREVENTATIVE-
OFTEN DONE IN PRIMARY CARE ALSO
THEN ALSO SENT TO YOU- NETWORKS
LIKE BEGINNER MAGELLAN IF YOU'RE
FAMILIAR WITH THOSE FOR THAT-
KIND OF. MILD TO MODERATE IS
ALSO A TERM THAT'S BEEN USED FOR
THOSE MENTAL HEALTH SERVICES.
FOR SPECIALTY MENTAL HEALTH
SERVICES OR SUBSTANCE USE THAT'S
CARVED OUT TO OUR COUNTY
PARTNERS. WE CURRENTLY HAVE A
FEE SCHEDULES BASED ON COST
BASED REIMBURSEMENT SO THAT'S A
SEPARATE REIMBURSEMENT. THAT IS
NOT INCLUDED IN OUR PROPOSAL SO
THIS IS JUST FOR THE NON
SPECIALTY MENTAL HEALTH SERVICES
AND AGAIN WE CAN PROVIDE YOU
THAT CODE LIST. IT'S A VERY EASY
TO FIND CODE LISTS WE USE THAT
OFTEN WITH OUR MEDICAID MANAGED
CARE PART PARTNERS AND IT'S IN
OUR PROVIDER MANUAL WE WERE
HAPPY TO PROVIDE THAT FOR YOU. I
APPRECIATE THAT SPECIFIC LIST.
IS THERE ANY SPECIFIC INCREASE
FOR RATES FOR HOSPITALS
THEMSELVES. BUT WHEN IT COMES TO
MENTAL HEALTH SERVICES NOT AT
THIS TIME THAT IS NOT CURRENTLY
PROPOSED WHAT ABOUT HOSPITALS IN
GENERAL JUST FOR GENERAL
SERVICES I MEAN. WHEN YOU LOOK
AT- THE REIMBURSEMENT RATES FOR
HOSPITALS WERE IN THE TOP OR THE
BOTTOM FIVE. OF THE ENTIRE
COUNTRY. AND WE ARE THE MOST
EXPENSIVE. AND OUR HOSPITALS ARE
THE MOST EXPENSIVE FIVE. SEVEN
ONE OF MY COLLEAGUES AS ABOUT A
DAILY REIMBURSEMENT RATE I THINK
IT'S LIKE. FORTY EIGHT HUNDRED
DOLLARS TO PROVIDE SOMEBODY A
SERVICE TO BE IN A HOSPITAL
WHERE THE AVERAGE IS LIKE. TWO
THOUSAND TWENTY TWO HUNDRED
STATE ARE NATIONWIDE. AND I
THINK- MISERY OR SOMEBODY IS A
LOSS OF THIRTEEN HUNDRED DOLLARS
TODAY. SO WE ARE AT OBVIOUSLY
THE EXPENSIVE MOST EXPENSIVE BUT
I THINK THAT COMES FROM THE
REGULATORY PROCESS. SEISMIC ALL
THOSE THINGS THAT HOSPITALS HAVE
TO I DON'T RUN HOSTAGE. BUT I
HEAR FROM A LOT OF THAT DO RUN A
HOSPITAL. AND IT'S ALMOST AND-
TO COMPLY WITH ASHTEAD. HATED TV
FIFTY FIVE HUNDRED DOLLARS YOU
KNOW. BRISKER IN THE WALKING THE
TV IT'S THAT SIMPLE BUT THEY
HAVE TO GET. CERTAIN
REQUIREMENTS FOR CERTAIN FOR
HOSPITALS IS WAY DIFFERENT SO
THE COST. TO RUN A HOSPITAL IS
MORE EXPENSIVE. ARE THERE ANY
UNDER THIS IN CO TAXES ANY OF
THIS MONEY GOING DIRECTLY TO
HOSPITALS. THAT WOULD BE
INCLUDED AS PART OF OUR TWENTY
TWENTY FIVE RATE INCREASES WERE
WE'VE IDENTIFIED OUTPATIENT AND
ACUTE CARE AS AS AS CATEGORIES
WHERE WE- ARE GOING TO. ADD
PROVIDES. A RECOMMENDATION IN
TERMS OF THAT THE NEXT
GOVERNOR'S BUDGET ON IT READING
CREASES FOR UP HOSPITAL
OUTPATIENT IN ACUTE CARE
SERVICES INCLUDING. THE DVR-
TYPE SERVICES. HAVE YOU GUYS
CONSULTED WITH ANY OF THE
HOSPITALS THE NINE
CATASTROPHICALLY AFFECTED
HOSPITALS IN THE STATE OF
CALIFORNIA WE THINK THERE COULD
BE ELEVEN- BECAUSE- I'VE JUST.
TEXT THREE OF THEM. AND THEY
CAN'T MAKE IT TILL TWENTY TWENTY
FIVE IS THERE AN ALTERNATIVE
SOLUTION FOR THOSE HOSPITALS ARE
WE GOING TO DISCONTINUE HEALTH
CARE. WITH THOSE HOSPITALS. I
THINK THAT THAT'S PART OF THE
DISTRESS HOSPITAL LOAN PROGRAM
KIND OF IS IN TERMS OF AN
IMMEDIATE NEED. FOR THOSE
HOSPITALS. YOU KNOW IF THEY
QUALIFY FOR THOSE TO THAT TYPE
OF LOAN I THINK THAT IS ONE AREA
WHERE WHERE THERE'S AN
INVESTMENT AND WE HAVE HEARD
FROM HOSPITALS THAT THERE TWENTY
TWENTY TWO REVENUE CYCLE. WITH
VERY DIFFERENT FROM WHAT THEY'RE
SEEN IN TWENTY TWENTY THREE AND
SO- YOU KNOW LOTS OF CHANGES
HAPPENED IN TWENTY TWO WITH
REGARD TO KIND OF THE END OF THE
COBIT. SUPPLEMENTAL PAYMENTS-
AND SO I THINK- CONTINUE TO WORK
WITH HOSPITALS. AS AS ISSUES
COME UP. OKAY- THE CENTER REAL
QUICK BUT I WILL SAY TO. MEAL
LEAST ONE. WANT MY DISTRICT.
JUST MILLION DOLLAR IN DEBT.
THAT'S JUST ONE HOUSE. WITH THE
HUNDRED FIFTY MILLION THAT WE
JUST APPROVED IN EARLY ACTION. I
DO NOT A WIN WE'RE NOWHERE NEAR
ENOUGH. TO COVER SO I DON'T
THINK I KNOW WE'VE HEARD IT A
COUPLE TIMES FOR ME DIRECTOR.
THAT'S NOT THE END OFFER THESE
HOSPITALS WHATSOEVER TO THE
DESTRUCTION SERVICE I DON'T
THINK THAT. IS GOOD ENOUGH TO
SAY WHAT WE HAVE THIS PART FOR
THEM. I APPRECIATE THE TEARS
COME IN BECAUSE AND BETWEEN HER
HOSPITAL IN MY HOSPITAL AND ONE
OTHER THAT HUNDRED FIFTY MILLION
IS GONE. IF IT'S ALLOCATED TO
THOSE HOSPITALS. SO ON AND THAT
JUST TO KEEP. AT IT JUST KEEP
THE DOORS OPEN IT DOESN'T COMPLY
WITH. YOU KNOW THE OTHER THINGS
THAT ARE AND WE'RE FUTURE
MEDICAL PAYMENTS ARE. AVAILABLE
PLEDGED ALREADY FOR SEISMIC-
PELAGE TO THE FOUR OH ONE K.
PLAN- PLEDGE HERE. AND SO- YOU
KNOW I THINK WE HAVE A VERY
SCARY SITUATION. GOING ON WITH
OUR DELIVERY OF OUR HEALTHCARE
SYSTEM. AND I WAS CURIOUS ABOUT.
THE IMMEDIATE RESPONSE. OR
INCREASES TO HOSPITALS BUT
YOU'RE TELLING ME THAT'S NOT
TILL TWENTY TWENTY FIVE. AS PART
OF THIS MCO PROPOSAL I WILL JUST
AS AS MISS COOPER NOTED COME
202499% OF OUR MEDICAL MEMBERS
WILL BE AND MANAGE MANAGED CARE
PLANS. HOSPITALS TODAY NEGOTIATE
WITH THEIR WITH THEIR MANAGED
CARE PLANS AND CAN I CAN USE
THIS YEAR TO NEGOTIATE RATES FOR
TWENTY TWENTY FOUR AS PART OF
THIS PROCESS THE STATE IS NOT
DIRECTLY INVOLVED IN THOSE RIGHT
NEGOTIATIONS BUT THAT IS ALSO AN
OPPORTUNITY TO INCREASE. REVENUE
TO HOSPITALS- IN SHORT ORDER.
OKAY SO ANOTHER QUESTION I HAVE
YOU TALK ABOUT EQUITY RIGHT NOW
THE PLANS ARE FUNDING THE THIRTY
FOUR BILLION DOLLARS AND THE-
ROUGHLY. THAT'S THE NUMBER I
HAVE IN FRONT OF ME IF IT'S
WRONG PLEASE CORRECT ME. HERE'S
VISIT. THIRTY TWO BILLION SORRY
I THIRTY TWO BILLION DOLLARS THE
PLANS ARE FINDING THAT. BUT I
MADE SOME PHONE CALLS TO SOME
FRIENDS I HAVE BACK EAST AND I
ASKED THEM ABOUT HOW WE GET
WAIVERS BECAUSE WE CAN INCREASE
SO I LEARNED SOMETHING ABOUT
MEDICARE HOW CALIFORNIA CAN
ACTUALLY INCREASE THEIR MEDICARE
RATES. AND THEN THEY CAN
ACTUALLY GET A WAIVER FROM CMS.
TO BE ABLE TO GET THAT
REIMBURSEMENT BACK. TO
CALIFORNIA SO IS THERE A WAY TO
ALLEVIATE THE COMPLETE COST- LED
PART OF THE CLASS COSTS THAT
PLANS ARE PUTTING FORTH BECAUSE
THAT'S JUST A TAX ON THOSE THAT
HAVE. YOU KNOW BLUE THE BLUE
PLANS THAT MANAGED HEALTH CARE
PLANS COMMERCIAL YOU KNOW LOCAL
PLANS. IT'S JUST TO INCREASE TAX
ON THOSE THAT HAVE MEDICAL
INSURANCE. A COMMERCIAL PLANS I
GUESS YOU WOULD SAY SO IS THERE
A WAY TO PRE CREATE EQUITY IN
THE FUNDING MECHANISM SO THAT.
AND THAT MEDICARE REIMBURSEMENT
RATES ARE INCREASING CALIFORNIA
THE FEDS. REIMBURSE CALIFORNIA
FOR THAT IN ALLEVIATE THE COST
OFFICE SOME OF THE PLANS. I KNOW
IT'S COMPLICATED BUT THAT'S KIND
OF THIS CHAIR SO THE SHORT
ANSWER IS ESSENTIALLY THAT'S
WHAT WE'RE DOING THE THIRTY TWO
BILLION ON THAT'S MENTION IS THE
TOTAL. A MAJORITY OF THAT IS
FEDERAL FUNDS JUST TO BE CLEAR-
THAT ARE COMING IN- WE THEN
BUILD THE- BY THE PRICE OF THE
TAX INTO THE MEDICARE MANAGED
CARE PLANS RATE SO ESSENTIALLY
IT'S COVERED THE MEDICAID
MANAGED CARE PLANS. A SENSUALLY
I DON'T HAVE AN IMPACT FROM THIS
ATTACKS ON THE COMMERCIAL PLANS
DO THOUGH WITH NON MEDICAID
LIVES AND WE THE WAY WE BUILD
THE MODEL THEIR TEARS SO THERE
ARE SOME TEARS WERE THERE'S NO
TAX APPLIED TO THOSE SLICE.
SMALLER PLANS WE TRIED TO. THE
LIVE SO THERE'S TEARS AND THEN
THERE'S TAX AND APPLIES TO
CERTAIN LIVES WITHIN THEIR- AND
WE DID WHAT WE COULD TO MITIGATE
THE IMPACT TO OUR COMMERCIAL
PARTNERS IN FACT- WE ACTUALLY
EVEN THE SIZE OF THIS TAX
INCREASE WE HAVE A SMALLER
IMPACT TO OUR COMMERCIAL
PARTNERS. AND THEN WE DID
HISTORICALLY IN THIS TAX TO TRY
TO WORK VERY CLOSELY. WITH OUR
PLAN PARTNERS TO MITIGATE THE
IMPACT- AND WE ARE VERY
APPRECIATIVE OF THE TAX AND THE
ABILITY TO BRING THESE DOLLARS
INTO. I'M NOT ONLY A KNOB
IMPACTS THE MEDICARE PROGRAM BUT
TO TALK ABOUT THE THINGS WE'RE
TALKING ABOUT TODAY INCREASING
OUR MEDICARE RATES AND SO. WE'RE
HAPPY TO PROVIDE YOU A YEAR OVER
YEAR THE IMPACT OF THE
COMMERCIAL PLANS. HOW WE'VE
TRIED TO REDUCE THE IMPACT TO
THEM- BUT THERE'S ALSO SOME
CHARTS WE CAN PROVIDE YOU IN
YOUR OFFICE WITH THE FEDERAL
FUNDS COMING IN AND HOW WE-
OFFSET THOSE DOLLARS. JUST TO
STRESS COMPARED TO THAT TAX THAT
EXPIRED IN TWENTY TWENTY TWO
WE'VE REDUCE THE IMPACT TO
COMMERCIAL PLANS AND FOR SOME OF
OUR SMALLER AND MIDSIZE PLANS
WE'VE ACTUALLY ELIMINATED THE
IMPACT A COMMERCIAL PLAN SO.
WE'VE DONE A LOT OF WORK WITH
OUR PLAN PARTNERS IN TRYING TO
BUILD A MODEL THAT I'M REALLY
REFLECTS KIND OF THE GOALS TO
ADJUST TO LEVERAGE FEDERAL
FUNDING. FOR CLEAR RIGHT RIGHT
IN TWENTY TWENTY TWO IT WAS
THIRTY THREE POINT EIGHT MILLION
FOR THE NON MEDICAL FOR
COMMERCIAL PLANTS. AND FOR THIS
FIRST YEAR WILL BE TWENTY SIX
TWENTY POINT TWO MILLION. SO
THIS- YEAH YOU'RE TWENTY THREE
THREE B. TWO. POINT TWO. ABOUT
EIGHTEEN MILLION LOWER THAN LAST
YEAR MURSCHEL. BUT IT'S A
HUNDRED AND TWELVE MILLION TO
THE PLANS OVER FOUR YEARS.
CORRECT OR NOT. THAT MIGHT BE
THE METHODS. TWENTY POINT TWO.
THIS YEAR TWENTY SIX POINT NINE
TWENTY TWENTY FOUR. THIRTY POINT
SEVEN IN TWENTY TWENTY FIVE AND
THIRTY FOUR POINT SIX. BILLION
AND THAT SOUNDS ABOUT RIGHT.
RIGHT PAGE FIFTY I KNOW THAT AT.
THE FRONT OF MY COLLEAGUES ON
THE DÍAS HAVE A LOT MORE
QUESTIONS ABOUT AYE- AND I WISH
I COULD ASK ALL THESE QUESTIONS
THAT I HAVE BUT I DO HAVE A
COUPLE OF QUESTIONS. ON AND. IN
WRITING LIKE WHAT'S THE
GUARANTEE LIKE. FIRST ALEJO
THERE YOU ARE. M. AS- WHAT'S
ESTIMATED ANNUAL BUDGET DEFICIT
YOU THINK THAT WILL FACE NEXT
YEAR- WE- WERE JUST IN THE MIDST
OF RELEASING A MULTI YEAR-
OUTLOOK SO- I DON'T HAVE THOSE
NUMBERS IN FRONT OF ME BUT- I'M
GONNA BE RELEASED VERY SHORTLY.
WE INITIALLY WE DID ESTIMATE
THAT- THROUGH TWENTY THREE
TWENTY FOUR- REVENUES WOULD BE-
WOULD BE ABOUT ELEVEN BILLION
DOLLARS LOWER THAN- ESTIMATED BY
THE ADMINISTRATION. FROM AND
EVEN IN THE ADMINISTRATION'S
OWN- MULTIYEAR PROJECTIONS AT
THE PROJECT OFFICE IT'S IN THE
OUT YEARS SO THIS IS A
CONSTRAINED FISCAL SITUATION
THAT THE LEGISLATURE CENTERING
INTO. THANK YOU AND THE REASON
WHY I ASK THAT IS I'M REALLY
CONCERNED THAT. THERE'S NOTHING
IN WRITING IT JUST SAYS THAT.
YOU KNOW THAT I'VE SEEN UNLESS
YOU CAN PROVIDE IT TO ME- FOR
INSTANCE. IN THE TWENTY TWENTY
THREE TWENTY TWENTY FOUR BUDGET
THAT'S COMING UP IN. THIRTY DAYS
ROUGHLY. THREE POINT THREE
BILLION DOLLARS. TO THREE POINT
THREE BILLION DOLLARS OF THIS
MONEY IS GOING TO GO TO BACK
FILL THE GENERAL FUND. BUT ONLY
NINETY EIGHT MILLION IS GOING TO
GO TO THE RATE INCREASES. TO
PEOPLE DELIVERING OUR HEALTH
CARE. FOR ACCESS TO ALL IN IN
IT'S THE IT'S THE ACTUAL NUMBER
THAT I HAVE IS THREE THREE
THREE. POINT THREE POINT THREE
EIGHT EIGHT BILLION CORRECT. YES
IT'S AN THOUSANDS THERE'S A LOT
NUMBERS AND I'M JUST AN AVERAGE
EVERYDAY CALIFORNIANS SO
BILLIONS AND MILLIONS KIND OF
GET AWAY FROM ME A LITTLE BIT-
IN NINETY EIGHT MILLION IS GOING
TO BE DELIVERED TO OUR- HEALTH
CARE PLANS. OR NOT HEALTH CARE
PLANS I APOLOGIZE HEALTH CARE
ACCESS. TO THE PEOPLE WHO ARE ON
THE GROUND PROVIDING THE DOLLARS
ARE PROVIDING THE SERVICES THAT
THESE DOLLARS ARE SUPPOSED TO
PAY FOR. THEM THAT'S NOT
SWITCHED AND WE DON'T GIVE
NINETY EIGHT MILLION DOLLARS TO
THE GENERAL FUND AND THREE POINT
THREE BILLION DOLLARS TO THE
PEOPLE ACTUALLY DELIVERING
ACCESS TO HEALTH CARE. TO OUR
POOREST CALIFORNIANS. THAT'S
WITH THE SAME CO TAXES SUPPOSED
TO DO IS MY UNDERSTANDING
UNLESS. I HAVE A
MISUNDERSTANDING OF WHAT THAT
TAX IS SUPPOSED TO DO- SO WE'VE
PROVIDED TO A DIFFERENT CUTS OF
THIS SO BAD THAT'S ON A CASH
BASIS AND SO THE DIFFERENCE ON A
CASH BASIS AND ACCRUAL BASIS SO-
RECOMMEND- IF. IF YOU DON'T HAVE
IT ALREADY WILL PROVIDE YOU
THEIR CRUEL. PIECE BUT
ESSENTIALLY A FOR EACH YEAR YOU
HAVE A TOTAL TAX OF THAT COMES
IN WE HAVE TO BUILD A CERTAIN
AMOUNT INTO THE MANAGED CARE
PLANS RATES THAT WILL COME OUT.
OF THAT AND THEN YOU HAVE A
GENERAL FUND GAINED- AND WHAT
YOU HAVE THE GENERAL FUND GAIN.
WE HAVE ALSO TAKEN OUT A PORTION
WHICH YOU ARE MENTIONING IN
REGARDS TO WHAT'S COVERED THE
MEDICAID PROGRAM SO THERE'S NO
LOSSES FOR EXAMPLE IN CALENDAR
YEAR TWENTY TWENTY THREE IT'S- A
TWO POINT FIVE BILLION DOLLARS-
AND- AND THEN THERE ARE
ADDITIONAL- ODD PIECES WHEN YOU
CUT THAT INTO A FISCAL YEAR
COULD BE SUBMIT TO THE FEDERAL
GOVERNMENT ON A CALENDAR YEAR.
WE CUT IT IN THE FISCAL YEAR AND
THEN ONCE YOU APPLY THE CASH
FLAG ON THAT IT'S REALLY JUST A
CASH PART OF WHEN CASH IS COMING
IN CASH IS GOING OUT- I
RECOMMEND YOU LOOK AT THE A
CRUEL SCHEDULE THEY'LL GIVE YOU
A BETTER SENSE OF WHAT THE TAX
BRINGS IN EVERY YEAR- BOTH FROM
A FEDERAL FUND PERSPECTIVE WHAT.
GOES TOWARDS THE BUDGET
PROPORTION FOR THAT TIME PERIOD-
AND THEN WHAT WOULD BE GOING
INTO THE RESERVE TO FUND ON THE
RATE INCREASES THAT WE'VE BEEN
TALKING ABOUT HERE TODAY. THAT
MIGHT BE A BETTER PICTURE SO
THAT THE- EASIER THAN THE CASH
FLAG. THAT CAN GET A LITTLE BIT
COMPLICATED OF WHEN THE FEDERAL
FUNDS COME IN AND OUT WE HAVE.
WHEN WE HAVE TO BUILD IT INTO A
MANAGED CARE PLAN. RATE SO
LET'S. TO THE- OF. THE ROOF.
IT'S ABOUT. PERCENT BASED ON THE
INFORMATION THAT I HAVE THAT THE
GENERAL FUND WILL RETAIN. SO IF
WE ADDRESS IN A CRUEL SITUATION
WHERE WE HAVE CAT- THE TOTAL
DOLLAR AMOUNT OVER THE- TIME
PERIOD. FOR A CRUEL. AND WE HAVE
CASH COMMUNITY CASH GOING OUT-
AND THEN YOU HAVE A BUILD UP
LIKE YOU SAID ON THE GENERAL
FUND- AT THE END OF THIS
PROCESS. WHAT PERCENTAGE WILL
THE GENERAL FUND RETAIN WHAT
PERCENTAGE WILL GO TO. THE I'M
AND I REALIZE. I GET IT I OWN A
BUSINESS IN THE REAL WORLD I'M
THE BUSINESS OWNER I GET A CRUEL
I GET ALL THAT MONTHLY CASH IN
CASH OUT STAFF. YOU HAVE TO SET
MONEY ASIDE FOR. YOU KNOW IF I
COULD FEDERAL FOOD CDD WORKERS
COMP EVERYTHING THAT YOU HAVE TO
SET ASIDE. WHEN YOU HAVE
EMPLOYER SO I GET IT. SO BUT AT
THE END OF THAT TIME FRAME IN MY
BUSINESS. I CAN SAY. 3% WHEN
HERE 2% WENT THERE AND 5% WITH
THEIR- WHAT'S- AT THE END OF THE
TIME FRAME. HOW MUCH. WHAT'S THE
PERCENTAGE RATE THAT. PROVIDERS
AND HOSPITALS ARE GOING TO GET
FROM THE TAX PROVIDED BY THE
PLANS. IT'S GOING TO GET US OUT
OF THE SITUATION THAT WE'RE IN
TO STILL DELIVER CARE. SO THE
TOTAL REVENUE IN GENERAL FUND
OFFSET IS NINETEEN POINT FOUR
BILLION OVER THE COURSE. OF THE
MCO PERIOD. ELEVEN POINT ONE
BILLION WILL BE AVAILABLE. TO
INVEST IN THE MEDICAL PROGRAM
THIS IS THE FIRST TIME AND I
THINK EVERYBODY AT THE TABLE IF
KNOWLEDGE IS THIS IS THE FIRST
TIME THAT WERE USING MCO DOLLARS
TO. INVEST ADDITIONALLY INTO THE
MEDICARE PROGRAM NOT JUST BEING
USED TO SUPPORT KIND OF AND
MAINTAIN THE PROGRAM. AND THEN
SO EIGHT POINT THREE BILLION SO
FORTY TWO PERCENT. WILL BE. USED
TO MAINTAIN SUPPORT IN THE
MEDICAL PROGRAM. BUT I DO WANT
TO HIGHLIGHT THIS IS AGAIN THE
FIRST TIME THE ADMINISTRATION
HAS PROPOSED AN MCO. THAT IS
USING A MAJORITY OF THOSE
DOLLARS TO ACTUALLY AUGMENTED
THE MEDICAL PROGRAM. AS WE'VE
DISCUSSED HERE WE ALL HAVE
DIFFERENT APPROACHES AND
DIFFERENT TIME FRAME. BUT THE
COMMITMENT TO WHAT TO AUGMENT
THE MEDICAL PROGRAM. IS THE
FIRST TIME IN THE MCO IT'S BEEN
USED TO DO THAT. IS BECAUSE OF
THE FEDERAL REGULATIONS THAT IS
YOU MUST PUT ON US TO BE ABLE TO
GET THIS APPROVED. THIS IS PART
OF THE ADMINISTRATION'S PROPOSAL
WE'VE WE'VE FOR AND- STEVEN. TO
PER. MORE RESOURCES TO BUILD
THE- IN THE MEDICAL PROGRAM THIS
WAS IMPORTANT TO US IMPORT TO
OUR FEDERAL PARTNERS AS WELL.
BUT RECOGNIZING THE NEED TO
BUILD THIS FOUNDATION. THAT'S
WHY WE CAME FORWARD WITH THIS
PROPOSAL. JUST BECAUSE THE
TERRORISTS THAT QUESTION ON THE
FEDERAL ADMINISTRATION. I GUESS
I WOULD LIKE TO KNOW WHO HAS-
ANY OTHER. ANY APPLICATIONS THAT
THE CASCADE CALIFORNIA HAS
EMBEDDED. HAS THERE ALWAYS BEEN
A WAIVER TO EXTEND THAT- FOR THE
FOR THE- FOR TAX INCREASE OR
SEES ME- RATE INCREASES. OR HAVE
WE EVER BEEN DENIED- THEY HAVE
A- WE'VE HAD TO DO NEGOTIATIONS
WITH THE FEDERAL GOVERNMENT ON
THE METHODOLOGY FOR THEM TO.
FIND A PROVABLE- BUT ULTIMATELY
THEY OF A APPROVED EVERY MCO TAX
THAT WE PUT FORWARD TO THEM.
OKAY SO. SO IS THERE
NEGOTIATIONS GOING ON WITH THE
FEDERAL GOVERNMENT TO YOU. AND
ALLOW US TO INCREASE OUR MEDIC
CAL RATES IN ORDER TO BE MORE
EQUITABLE WITH THE DOLLARS THAT
THE PLANS ARE PUTTING FORTH-
BECAUSE WE'RE GONNA GET RESERVE
BASE REIMBURSE FROM THE FEDERAL
GOVERNMENT SINCE THEY HAVEN'T
DENIED THIS BEFORE AND- YOU
KNOW. REALISTICALLY POLITICALLY
WE'RE DEALING WITH A DEMOCRATIC
MINISTRATION IN A DEMOCRATIC
MINISTRATION AND THERE'S
PROBABLY GOING TO GIVE US A
WAIVER AGAIN SO WHAT'S THE- ARE
YOU NEGOTIATING WITH FEDERAL
GOVERNMENT NOW. TO ALLEVIATE
SOME OF THE COST OFF OF OUR
PLANS BUT WE HAVE WORKED WITH
THEM TO GET THE- PROPOSAL THAT'S
BEFORE YOU ESSENTIALLY THE TEAM
DID A APPROVAL- WE'VE DONE BACK
AND FORTH ON THE METHODOLOGY TO
ENSURE THAT WE ARE MEETING THE
FEDERAL EXPECTATIONS AND
REQUIREMENTS. WE EXPECT THE MCO
TALKS TO BE APPROVED UPON
SUBMISSION TO THE FEDERAL
GOVERNMENT. WHEN IT COMES TO THE
MANAGED CARE PLAN RATES- WE HAVE
A STANDARD PROCEDURE IN PLACE
FOR HOW WE HOW WE BUILD THAT
INTO MANAGED CARE PLAN RATES AND
WE'VE NEVER HAD ANY ISSUES WITH
THE FEDERAL GOVERNMENT IN ANY
ADMINISTRATION- IN ORDER TO GET
THOSE. APPROVED I WOULD SAY
THOUGH- THEY DO HAVE TO BE AT AS
WERE INCREASING RATES. I WOULD I
WOULD SAY CMS ALSO HAS A-
FEDERAL RULE OUT RIGHT NOW. ON
ACCESS WHERE THEY ARE. I'M
WANTING ALL MEDICAID PROGRAMS TO
LOOK AT THEIR BUT BASS RATES IS
WHAT THEY'RE VERY FOCUSED ON-
THEY'VE ALSO FOCUS ON PRIMARY
CARE- MATERNITY CARE AND-
BEHAVIORAL HEALTH SERVICES GIVEN
THE- CRITICAL NATURE OF WHAT.
MEDICARE ALL AND MEDICAID
NATIONWIDE- DOES- SO I THINK
RIGHT NOW WE'RE VERY MUCH IN
ALIGNMENT OF WHERE THE FEDERAL
GOVERNMENT IS IN REGARD TO THEIR
PRIORITIES FOR MEDICAID- AS WELL
WITH THIS PROPOSAL AND SO AT
THIS TIME WE DON'T ANTICIPATE
ANY. BARRIERS WITH FEDERAL
APPROVAL- AND THEY WORK VERY
CLOSELY WITH US. WE ESSENTIALLY
TOOK THIS TAX FROM WHAT WE'VE
HISTORICALLY DONE AND OVER
DOUBLE THAT- AND SO THEY HAVE
PROVIDED. A LOT OF TECHNICAL
ASSISTANCE TO US TO FOR A PAST
PATH FORWARD THIS PURPOSE. TO
BE. BY THE LEGISLATURE. THANK
YOU AND I'M JUST GONNA MAKE ONE
LAST COMMENT JUST SO THAT IT'S-
IT'S ON THE RECORD- AS- I DRIVE
I WOULD TALK PERSONALLY TO THE
CHAIR ABOUT. HER ISSUES WITH HER
HOSPITALS BUT I CAN TELL YOU
THAT THE HOSPITALS AND THE
CENTRAL VALLEY. AND IN THE HIGH
DESERT. WHERE IT'S NINETY FIVE
MILES TO THE NEXT AVAILABLE
HOSPITAL WHICH IS A LONG WAYS.
WOULD HAVE A HEART ATTACK OR
STROKE- AND- THEY WILL NOT
SURVIVE. UNTIL TWENTY TWENTY
FIVE AND I APPRECIATE THE
HUNDRED FIFTY MILLION DOLLARS. I
THINK IT WAS. GRACIOUS AND BUT
IF YOU'RE RELYING ON THAT TO GET
THE HOSPITAL'S THROUGH TWENTY
TWENTY FIVE. IT'S NOT GONNA WORK
UNLESS THERE IS SOME TYPE OF. AT
THREE LEVY ASIAN. FOR SEISMIC. A
LEVY ASIAN FOR BILLS THAT ARE
COMING THROUGH THE DOOR TO
INCREASE COST- YOU KNOW. ONE
HOSPITAL SAYS THAT A PARTICULAR
BILL COMING THROUGH IS GOING TO
INCREASE THEIR COST. BY TEN
MILLION DOLLARS AND THEY DON'T
HAVE THE MONEY TO MEET THE FOUR
OH ONE K. OBLIGATIONS. IN THE
NEXT NINETY DAYS SO HOW DO YOU
HAVE THAT TEN MILLION DOLLAR
INCREASE. AND IF WE'RE NOT
LOOKING AT A GOOD FAITH PROPOSAL
TO INCREASE THE HOSPITAL- RATES.
UNTIL TWENTY TWENTY FIVE ICE I
WANTED ON THE RECORD. THAT TODAY
ON THIS STATE I WARNED YOU OF
THE CATASTROPHIC HEALTH CARE
SITUATION WE WILL FIND OURSELVES
IN. WHEN THESE HOSPITALS CAN'T
SURVIVE. THANK YOU MANAGER FOR
THE LEEWAY THANK YOU SO MUCH I'M
WE SPOKE. WELL LET ME LET ME.
CAN DEPARTMENT A LITTLE BIT OF A
BREAK HERE- AUTOMAT BRITTANY'S
CUES. AND MAYBE I'M MISSING YOUR
AND SCREEN- YOU KNOW I KNOW WHAT
THE PPS OR SOME RESTRICTION TO
LIKE WAGE INCREASES AND SO
FORTH. CAN YOU SPEAK A LITTLE
BIT MORE OF THE DIRECT IMPACTS
THIS CURRENT AS PROPOSED UNTIL
TAX WILL HAVE BEEN COMMUNITY
CLINICS. I KNOW YOU SHARED THREE
ADDITIONAL REQUESTS. FOR JUST AS
IS HOW WOULD DIRECTLY IMPACT.
CLOSURE I THINK I THINK YOU FOR
THAT QUESTION- TO THE PP IT PPS
RATE STRUCTURE TODAY. DOES NOT
ALLOW FOR FF TWO EIGHT CITIES TO
BUILD DIRECTLY- FOR SERVICES
PROVIDED BY CLINIC STAFF SUCH AS
SOCIAL WORKERS CAN BE HEALTH
WORKERS. SO THIS WOULD ALLOW US
TO DO THAT X. YOU KNOW. EXTEND
AMPLE FIREPOWER BILLABLE
PROVIDERS. THE COST OF THE
SERVICES PROVIDED BY THESE
PROVIDERS TYPES HAVE TO BE BUILT
INTO OUR PPS RATE- SO THAT. IT
JUST DOESN'T HAVE TO BE A
PHYSICIAN PROVIDING IT SO THAT
COULD BE HELPFUL- THE STRUCTURE
ALSO DOESN'T ADEQUATELY
RECOGNIZED- THE PAYMENT THAT
FQHCS WOULD HAVE TO MAKE TO
THESE PROVIDERS. AND CAN BE A
BARRIER FOR LIKE THAT CULTURALLY
COMPETENT LOW COST- WORKFORCE-
TO ADDRESS OUR SOCIAL TERMS OF
HEALTH- SIMILARLY IT DOES NOT
RECOGNIZE HOME AND COMMUNITY
BASED SERVICES. WHICH IS A BIG
PIECE OF WHAT OUR COMMUNITIES
NEED- AND SO THIS WOULD ALLOW US
TO BE ABLE TO PROVIDE THAT AS A
SERVICE. AND THEN INCREASING
INVESTMENTS IN. THE MEDICAL
PROGRAM- WITH THIS NECESSARY
PAYMENT- IS KEY FOR CHC
SUPPORTERS. IN THE STATE'S KELLY
QUALITY. INITIATIVES AND SO
THAT'S JUST TO SAY THAT. THE WAY
THAT OUR PPS STRUCTURE IS FUNDED
DAYS IS THAT CREATED TODAY
THERE'S VERY SPECIFIC EVENTS
THAT ARE CALLED TRIGGERING
EVENTS THAT HAVE TO OCCUR. FOR
US TO BE ABLE TO KIND OF
RENEGOTIATE OUR OUR PROSPECTIVE
PAYMENT- AND SO THE VALUE BASED
CARE INITIATIVES CAL LAME ALL
THOSE THINGS THAT ARE HAPPENING
RIGHT NOW ARE NOT BUILT INTO OUR
RATES TODAY SO ESSENTIALLY-
WHERE IT'S NOT REALLY BEING
ACCOUNTED FOR AND I WOULD JUST
ADD THE COMPLEXITY OF WHO WERE
SERVING. IS ALSO ANOTHER FOR THE
- TRICKY- COMPLICATED THING FOR
US BECAUSE- SOMEONE WHO'S COMING
THROUGH OUR DOORS TYPICALLY-
THERE ARE CASES WHERE WE PROVIDE
THE SAME DAY SERVICE THAT AND WE
BY FOR MENTAL HEALTH AND UP-
MEDICAL SERVICE- BUT THAT'S JUST
FOR CLINICS THAT ARE ABLE TO DO
THAT AND TO SUSTAIN THAT. BUT
THAT IS OBVIOUSLY TAKING AWAY
FROM OTHER SERVICES- AND- WE
REALLY DON'T EVEN HAVE THE WORK
FORCE TO REALLY PEOPLE TO DO
THAT AND SO THAT'S JUST A LITTLE
BIT MORE ABOUT WHAT. THE
LIMITATIONS OF OUR CURRENT
PAYMENT STRUCTURE AND WHAT
SOMETHING LIKE THE CURRENT
PROPOSAL THAT WERE PUT THAT HAS
BEEN PUT FORTH WOULD HELP US
AMPLIFIER SERVICES. THANK YOU
AND ON THE THIRD IT REQUIRES YOU
US ARE YOU MENTIONED A FIFTY TO
FIFTY MILLION FOR COMMUNITY
HEALTH WORKERS AND IN THE SUB WE
HEARD- A BUDGET SOLUTION FOR THE
DELAYED. PROPOSES UNDER AGE KIND
BEST MAN IN SOME WORK FOR
SOMEONE OF THEM WITH COMMUNITY
HEALTH WORKERS. I'M I'M
WONDERING GIVEN THAT YOU KNOW
THE MINISTRATION PROPOSED THAT
BEING DELAYED HELLO THIS TAX
COMMENSAL CLEMENT COMMUNITY
HEALTH WORKERS KNOWING THAT'S
CORDIALLY COMPETENT IT'S A WAY
TO ADDRESS. THE BERMAN BONTA
SYSTEM AT LEAST FOR MY DISTRICT
IS THE NUMBER ONE UTILIZED
APPROACH. TO GETTING I'M
INDIVIDUALS TO CARE. ON TO THE
IS HERE'S A OF THE COMMUNITY
HEALTH WORKER BUT I WOULD SET. A
BENEFIT THAT WAS ADDED INTO
MEDIC CAL JULY FIRST OF TWENTY
ODD TWENTY TWO- BUT I WOULD SAY
IS THE H. CHI IS FOR THE
CERTIFICATION THAT THEY ARE
RUNNING HOWEVER THAT DOES NOT
STOP ANY OF THE COMMUNITY HEALTH
WORKER. OF GROWTH WITHIN THE
MEDICARE PROGRAM WE HAVE A
SEPARATE REQUIREMENTS THAT ALLOW
SOMEBODY WITH LIVED EXPERIENCE
FOR EXAMPLE TO BE CERTIFIED AND
TO MOVE FORWARD OR TO BE WHAT
WE- OUGHT TO ESSENTIALLY BE
DEEMED. ELIGIBLE TO PROVIDE
THOSE SERVICES WE HAVE A LARGE
NUMBER OF OUR MANAGED CARE PLANS
TODAY ALREADY CONTRACTING IN
PROVIDING COMMUNITY HEALTH
WORKER SERVICES- ACROSS THE
STATE OF CALIFORNIA WE'RE
LOOKING TO SEE THAT GROWTH IN
FACT AS A PART OF OUR- PLAN
INCENTIVE PROGRAM THAT IS PART
OF CALAMP. ONE OF OUR INCENTIVES
THIS YEAR'S TO INCREASE THE
UTILIZATION OF COMMUNITY HEALTH
WORKERS ACROSS THE STATE OF
CALIFORNIA BECAUSE WE AGREE WITH
YOU 1100% GETTING HEALTH WORKERS
IN THE COMMUNITY DOING
PREVENTIVE EDUCATION AND- A POST
ACUTE CARE. I'LL FOLLOW UP
SERVICES- IS KEY TO WHAT WE ARE
ALSO TRYING TO ACHIEVE WITH IN
THE MEDICARE PROGRAM. ONE OF OUR
OUR PARTNERS OR IF YOU SEE THERE
ARE ALSO LOOKING THIS I THINK
THAT PIECE HERE IS THAT-
COMMITTEE HEALTH WORKERS IS NOT
A BILL IN INDEPENDENT BILLABLE
VISIT FOR AN FQHC IN THAT PART I
JUST WANT TO BE TRANSPARENT.
ABOUT TODAY YEAH. AND I WHICH IS
THAT WE ALSO HAVE- WE KNOW SOME
OF OUR- LOCAL MANAGED CARE PLANS
ARE ALSO WORKING WITH COMMUNITY
COLLEGES IN THEIR AREAS TO KIND
OF WORK ON THE CHW PIPELINE AS
WELL IN BUILDING SOME OF THOSE
LOCAL PARTNERSHIPS THAT KIND OF
DIRECTLY DEVELOP THE WORK FORCE-
AS. AS THE PLAN IN THE COMMUNITY
NEEDS. THE YOU FOR THAT.
CLARIFICATION MAY JUST I JUST
FOR IMAGES. COLOR I THINK. THANK
YOU FOR CALLING OUT THE PART
ABOUT THE BILLABLE SERVICE IT IS
NOT TODAY SO. THAT DOESN'T MEAN
WE DON'T PROVIDE THIS IS THESE
ARE ONE OF THE THINGS THAT WE
PROVIDE ANYWAY- BUT- WE WOULD BE
NICE TO BE ABLE TO HAVE THAT
SUPPORT RIGHT. IF WE REALLY WANT
TO IMPLEMENT MEDICAID EXPANSION
IN THE WAY THAT IS INTENDED TO
REALLY REACHING THE UNDERSERVED
COMMUNITIES- WE NEED TO HAVE.
THAT TOUCH POINT ALL THE WAY TO
THEIR FRONT DOOR IN SOME CASES.
AND COMMUNITY HEALTH WORKERS
WILL BE ABLE TO HELP US DO THAT.
THE LANGUAGE PIECES SUPER
IMPORTANT AND SO I'VE JUST.
ASKED YOU ALL TO THINK ABOUT
THIS COVERAGE. AS YOUR COVERAGE
DOES NOT EQUAL ACCESS. AND WHAT
ACCESS ACTUALLY MEANS FOR OUR
COMMUNITY. IS TO BE ABLE TO SEE
A PROVIDER. THAT UNDERSTANDS
THEM THEIR CULTURE- SPEAKS OUR
LANGUAGE IS ABLE TO PROVIDE THE
SERVICES THAT THEY NEED. AT THE
TIME THAT THEY NEED THEM. AND SO
JUST YOU KNOW COVERAGE DOES NOT
EQUAL ACCESS AND WE'RE PUSHING
FOR ACCESS THANK YOU WE SPENT
SOME TIME RIGHT NOW ON THE TRAIN
TALKING ABOUT HOW WE FEEL
REGARDING THE EIGHT TO TEN YEAR.
IMPLEMENTATION PLAN FOR FROM.
THE DEPARTMENT ON THAT BUT I
ALSO WANT TO TALK ABOUT. THE
IMPLEMENTATION GOING INTO
JANUARY TWENTY TWENTY FOUR.
VERSUS PERHAPS IT BEING APPROVED
IN A COUPLE WEEKS AND THAT BEING
INTO A GOING INTO EFFECT RIGHT
AWAY. WE'VE HEARD YOU KNOW I'M
TALKING ABOUT THEY TO TEN YEARS
HOSPITALS ARE IN DISTRESS RIGHT
NOW PEOPLE NEED ACCESS TO HEALTH
RIGHT NOW. THIS CALL BID. YOU
KNOW WILL HAVE LONG LASTING
IMPACT. AND WE'RE- THEM NOW-
HEALTH AT THE HIGH RATES WITH.
ILLNESSES ARE HIGH HI RATES FOR
YOU AND SO FORTH. FROM
PRODUCTIVE. IT'S HAPPENING RIGHT
NOW AND IF MY MOM HERE IN. WE
HER RELIGIOUS HOT YOU WOULD SAY
WELL THE WORLD BE OVER IN. YEARS
RIGHT- INVESTMENT SHOULD HAPPEN
RIGHT NOW SO CAN WE TALK A
LITTLE BIT MORE ABOUT- NOT BEING
ABLE TO IMPLEMENT THAT. DURING
THIS CALENDAR YEAR. PURSES AND-
STRIDING INTO AND JANUARY FOR
THE PROVIDER RATE INCREASE.
DEPARTMENT PLEASE- SO JUST WANNA
FIRST AND WHY WE CAN'T START THE
EIGHTY SEVEN POINT 5% INCREASE
TWENTY TWENTY THREE- SO WE'VE
ALREADY SENT. TO THE MINISTRY
TECH WE'VE ALREADY SUBMITTED OUR
ON CAPITATION RATES- FOR MANAGED
CARE PLANS FOR THE CALENDAR
TWENTY TWENTY THREE TWENTY THREE
TO THE FEDERAL GOVERNMENT- TO BE
APPROVED- SO MID YEAR RATE
INCREASES. ARE HARD. TO ACHIEVE
OFTENTIMES- IT'S WHY WE ALWAYS
RECOMMEND RATE INCREASES TO
START AT THE BEGINNING OF THE
CALENDAR YEAR- IT ALLOWS US TO
BUILD IT INTO OUR SYSTEM TO GET
FEDERAL APPROVAL- AND TO
IMPLEMENT THOSE. TYPES OF
THINGS- THAT IS TYPICALLY WHAT
WE THAT WE'VE DONE SO I WERE
PROPOSING THE RATE INCREASES
START JANUARY ONE OF TWENTY FOUR
AND THEN- THE SUBSET- DIED. DEAD
JANUARY OF TWENTY TWENTY FIVE-
SO THAT'S TYPICALLY THAT IS WHY
WHEN IT COMES TO THE NCO TAX. WE
WOULD BE ABLE TO ON THAT.
SUBMITTED BACK TO EIGHT FIRST IS
THE LATEST WE CAN GET IT NOW OF
TWENTY TWENTY THREE FORGET THAT
APPROVAL- BUT THAT REQUIRES A
SUBMIT TO THE FEDERAL GOVERNMENT
BY JUNE THIRTIETH OF TWENTY
TWENTY THREE IN ORDER SECURE
THOSE FEDERAL FUNDS- THAT THEY
CAN OFTEN THAT RATE INCREASE I
JUST WANTED TO PUT THE TWO. ON
THE TABLE. SO JUST LOGISTICALLY
IT ALL WITH A LINE TO START IN
JANUARY- THAT'S CORRECT TO GET
FEDERAL APPROVAL AND TO MAKE
SURE IT'S BUILT INTO OUR MANAGED
CARE PLANS RATE SO THAT THEY CAN
MAKE SURE THAT THOSE DOLLARS GET
TO THE PROVIDERS. PERFECT THANK
YOU AND THEN TALKING TO MY
COLLEAGUE TALKED A LOT ABOUT
LIKE SPECIALTY AN IMPLANT YOU
KNOW MY COLLEAGUES OVER HERE
TALKING ABOUT THE IMPATIENT SO
FORTH. YOU KNOW I'M NOT WITH THE
STATE STAKEHOLDER GROUPS UNDER
PSYCHIATRISTS FOR CHILDREN AND
SO FORTH THERE DEEMED SPECIALTY
THERE UNDER THE COUNTY
JURISDICTION THAT YOU HAVE
MENTIONED- AND THEY'RE ONE OF
MANY. UNDER THE SPECIALTY CARE.
AFTER HEARING SOME OF THIS
DISCUSSION JUST WANTED TO HEAR A
LITTLE BIT MORE OF WHAT WE
THINKING ABOUT POTENTIALLY
INCLUDING THEM. YOU KNOW YOU YOU
KNOW I BROKE DOWN IN WITH ALL
WITH ALL DUE RESPECT TO FEEL
LIKE WE'RE DOING THE BARE
MINIMUM HERE IN- AND BEEN IN.
THESE PROVIDER RATES- I JUST
GAVE YOU KNOW THE DIRE SITUATION
THAT THE STATE IS IN IN THE
NATION AS A WHOLE. WHY WE'RE NOT
JUST DOING A GREATER. INVESTMENT
RIGHT NOW IN INCLUDING MORE
PROVIDERS AND WE ARE NOW. FROM
OUR PERSPECTIVE WE WANT TO GO
DEEP WITH SOME OF OUR
INVESTMENTS TO ACTUALLY MAKE
MEANINGFUL CHANGE VERSUS
SPREADING YOU KNOW. THE LIMITED
DOLLARS MORE BROADLY ACROSS A
PROVIDER TYPES WE WANT TO MAKE A
DIFFERENCE IN HOW THESE DOLLARS
REALLY ADDRESS ACCESS- AND
THAT'S HOW WE'RE APPROACHING IT-
DIRECTOR COOPER OFTEN USE THE
TERM DISCIPLINE IN TERMS OF HOW
WE THINK ABOUT THIS BECAUSE WE
DO WANT TO MAKE SURE AGAIN. THAT
THESE ARE VERY TARGETED
INVESTMENTS THAT MAKE A
DIFFERENCE IN KIND OF PROVIDING
THE ACCESS THAT WE KNOW WE NEED.
TO BUILD OUT IT FOR AS PART OF
OUR FOUNDATION. THE ONLY THING I
WOULD ADD IS THE SPECIALTY
SERVICES THAT YOU'RE
REFERENCING. IT'S A DIFFERENT
REIMBURSEMENT METHODOLOGY WITH
THE FEDERAL GOVERNMENT
ESSENTIALLY WHAT WE USE IS THE
COUNTIES COST. TO THEN BUILD THE
RATE AND REIMBURSE THEM. SO
THERE ARE THEY'RE CURRENTLY
GETTING PAID COST FOR THOSE
SERVICES AND SO THAT'S WHY IT
WASN'T CONSIDERED IN THIS
INITIAL SWAP- IN. PAYMENT REFORM
FOR BEHAVIOR HEALTH COLLEAGUES
WILL GO LIVE JULY ONE OF THIS
YEAR- AND WE WILL BE WORKING
VERY CLOSELY WITH. OUR COUNTY
PARTNERS TO ENSURE THAT THOSE
RATES ARE I OVER THE NEXT FEW
YEARS- SO SINCE WE ARE THE FAR
WITH BEHAVE HEALTH PAIN. REFORM
THAT'S WHY WE ARE. THE PARTS OF
BEHALF PAYMENT THAT WERE NOT
ADDRESSED- WITH THE AUGMENTATION
UNDER CALAIS MYTH THAT'S HELPFUL
AS WELL. THANK YOU AND LAST
THING THEN. FOR TERM BACKED MY
COLLEAGUES FOR ANOTHER ROUND OF
QUESTIONS SHOULD THEY HAVE ANY-
IT'S- A PERSONAL THING FOR ME-
YOU KNOW I'VE- I'VE- I'VE BEEN
PUSHING IT THIS YEAR- AND I I'VE
BEEN PASSIONATE ABOUT IT IS.
SOME INFERTILITY SERVICES IBF
FOR MEDICARE PATIENTS- THERE ARE
ABOUT TWENTY ONE STATES THAT
COVER THIS THIRTEEN COVER IDEA
SPECIFICALLY. I'M I'M WONDERING
YOU KNOW GIVEN THIS OPPORTUNITY
THIS CHUNK OF MONEY HOW WE CAN
INVEST INTO THIS POPULATION. WE
TALK ABOUT REPRODUCTIVE JUSTICE
I BELIEVE THIS IS BEING THIS
INCLUDES UNDER THAT UMBRELLA YOU
KNOW HOW. PROVIDING INDIVIDUALS
THE ABILITY TO START A FAMILY. I
THANK YOU FOR I PER DO YOU ARE
YOU KNOW REALLY DIVING INTO
ENSURE THAT THE IMPACT IS FELT
VERSUS PUTTING DIFFERENT
POCKETS. BUT I WANTED TO MAKE
SURE THAT WAS OUT THERE- I JUST
FEEL LIKE THAT'S A HUGE JOB. THE
STATE OF CALIFORNIA HASN'T I'M
CLOSE TO HIM FOR MEDICARE
PATIENTS ARE MOST VULNERABLE.
PATIENTS AT YOUR SENIOR I KNOW
THE EVEN THE SENATOR YOU KNOW-
YOU KNOW WE ALL HAVE INDIVIDUALS
OR WE KNOW INDIVIDUALS THAT.
HAVE GONE THROUGH THIS PROCESS.
I A LESBIAN MYSELF I ABOUT TO
PER MAYBE IN A YEARS ON SURE. GO
THROUGHOUT THE TO THOUSAND
DOLLAR RIGHT- I'M NOT A MEDICAL
PATIENT- BUT I HAVE FRIENDS
WHO'VE TRIED TO DO IT OF THEIR
OWN POCKETS AND THAT'S NOT A-
DECISION THAT THEY- SHOULD HAVE
TO DO. SO PUTTING OUT THERE IS
THE AS A POINT OF PRIVILEGE FOR
THE CHAIRS ONE OF THE TERMS
PRIORITIES UNDER THIS AND SEEN
IF. THERE'S ROOM. TO SEE HOW WE
CAN GET MEDICAL COVERAGE FOR
THIS. WHAT THAT TELLS IT OVER
SENATOR GROCERY MORE QUESTIONS
THANK YOU THANK YOU MADAM CHAIR
FOR BRINGING THAT UP I KNOW THAT
WE HEARD THAT BILLION- COMMITTEE
AND- I WAS SO EXCITED I HAVE A-
STAFFER. THE HEALTH CARE
COVERAGE IS BEING OFFERED AT THE
STAFF LEVEL IN THIS BUILDING
THIS IS A SAVING EVERY SINGLE
DYING SHE GETS FREE TO GATHER
AND EVERY THREE YEARS. SHE GOES
THROUGH THIS PROCESS. AND THEN I
WAS GREATLY DISAPPOINTED THAT
THE MAN WAS TAKEN TO EXCLUDE
MEDICARE L. ACT BECAUSE YOU KNOW
WHAT FOR FAMILIES THAT WANT TO
START A FAMILY. AND THE
COMMANDED ON THE PLANS AGAIN AND
THE COST OF THE PLANS. THAT POOR
FAMILIES THAT ARE ON MEDICARE L.
DON'T HAVE ACCESS AND IT'S
BECAUSE CALIFORNIA DOESN'T IT'S
ALL ABOUT BUDGET PRIORITIES
RIGHT. EITHER ONE OFFENDED OR
YOU DON'T. HI ARE YOU FEEL TO
ASK THIS QUESTION I APPRECIATE
THE TEACHERS INDULGENCE ON THIS.
AND IT'S WEEKS SO WE AS A
LEGISLATURE THE WAY I SEE THIS
ARE ASKING TO YOU'RE ASKING US
TO APPROVE THIS TAX NOW TO GO
OVER. A PERIOD OF YEARS. BUT
THERE'S NO. FRAMEWORK OR- ADD.
ANYTHING IN WRITING THAT SAYS
THIS IS ACTUALLY GOOD TO GO TO
THE PEOPLE WHO ARE DELIVERING
THE SERVICES. AND NOT GO TO A
BUDGET BACK FILL THE AND SO LIKE
I SAID BASED ON THE INFORMATION
I HAVE ROUGHLY 40% GOES. BACK TO
THE BUDGET FOR A BACK FILL. IN I
JUST- AND I REALIZE THAT WERE IN
LEAN BUDGET YEARS AND I REALIZE
THERE HAS TO BE A MECHANISM. FOR
ADDRESSING THOSE LEAN BUDGET
YEARS. AND EVEN THE DEFICIT
YEARS AS THE ELLIE IT WAS
PUTTING THEIR MULTI YEAR
PROJECTION. AVAILABLE ARE OUT
WHEN. IS THAT GONNA BE OUT SIR.
WELL THIS. IT'LL BE UP THIS
MORNING. SO WE HAVE THIS MULTI
YEAR. THAT BE A- WHAT'S OUR
GUARANTEE LET'S. IN A- IF THIS
GUY. OF THIS GOING TO GO TO.
MEDICARE L. REMEMBER. RATES
PROVIDING HEALTH CARE. TO OUR
MOST VULNERABLE. IN THE STATE OF
CALIFORNIA A LARGE NUMBER WHICH
I REPRESENT AND HOSPITAL
REIMBURSEMENT SO THAT WE CAN
STILL ACCESS. HEALTH CARE IN THE
CENTRAL VALLEY WHETHER IT'S
NORTHERN SINCE VALLEY OR
SOUTHERN CENTRAL VALLEY. AND
BECAUSE IF WE VOTE TO APPROVE
THIS TAX. I DON'T SEE ANYTHING I
HAVEN'T SEEN ANYTHING IN WRITING
THAT SAYS THAT THAT'S WHERE IT'S
GONNA GO SO. HOW DO WE ENSURE
IT'S NOT JUST GOING TO BE A
BUDGET BACK FILL. BOARD I MEAN
I'M NOT TRYING TO BE NEGATIVE I
WANT TO BE HELPFUL. BUT I JUST
HAVE I WANT TO MAKE SURE THAT IF
THIS GOES FORWARD. AND IT HAS-
IT AT A PARTY SUPPORT YOU KNOW
FROM BOTH SIDES OF THE AISLE.
YOU KNOW. I'VE NEVER VOTED FOR
TAX IN MY LIFE AND I FARMING OF
THE FOR THIS TAX I WANT TO MAKE
SURE THE PEOPLE I REPRESENT ARE
COVERED. AND THEY HAVE ACCESS TO
HEALTH CARE AND THAT NGUYEN A
HOMELESS PERSON WALKS IN AND
THEY GIVE YOU A MEDICARE CARD OR
WHATEVER IT IS AND THEIR ARM HAS
OPEN WOUND CARE. THE LOSE MONEY
FOR TREATING THAT PATIENT
BECAUSE THEY DON'T HAVE THE CODE
SECTION TO BILL FOR THAT. OR
THAT AND- I JUST DON'T WANT TO
GO BACK FILLING THE BUDGET. IS
WHAT I DON'T WANT AND I WANT
SOME KIND OF GOOD FAITH
STATEMENT. THAT THE MONEY IS
GOING TO BE USED FOR WHAT IT'S
INTENDED TO BE USED FOR. WHICH
IS MEDICARE REIMBURSEMENT RATES
IS THE WAY I UNDERSTAND IT. SO
ACCESS TO HEALTH CARE COULD
CONTINUE. I'D LIKE TO CO AUTHOR
THAT QUESTION AS WELL. THANK YOU
MADAMS. SO THE BUDGET MATERIALS
THAT WE RELEASED INCLUDING THE
TRAILER BILL LANGUAGE WHICH
WHICH WOULD TURN INTO A STATUE
REALLY OUTLINE HOW THESE DOLLARS
WOULD BE USED AND KIND OF. SEE
THAT THE DOLLARS WOULD GO INTO
THE SPECIAL FUND THAT WOULD BE
USED FOR PROVIDER RATE INCREASES
IN. YOU KNOW WITH THIS SPECIFIC
ON THE TWENTY TWENTY FOUR RATE
INCREASES THAT WE'VE WE'VE
DISCUSSED AND THEN. IT INDICATES
THAT WE WOULD COME BACK IN
TWENTY TWENTY FIVE TWENTY FOUR
TWENTY FIVE BUDGETED A PROPOSED
ADDITIONAL RATE INCREASES.
WITHIN THE TRAILER BILL LANGUAGE
THAT WE PROPOSED- BUT HAPPY TO
YOU KNOW ENTERTAIN CONVERSATIONS
ABOUT ADDITIONAL CLARIFICATIONS
THERE. I THINK THERE SHOULD BE
SOME GUARD ROSE BECAUSE AT LEAST
YOU KNOW INCREASE OVER OTHER
INVESTMENTS IN THAT STATEMENT.
I'M I'M WORRIED ABOUT IT IN THIS
SUB COMMITTEE WE'VE HEARD. YOU
KNOW. WE'RE TAKING. THE
REQUESTED 50% OUT OF THE SAFETY
NET MISTER. THE REQUESTED TO
CALL BACK THE THREE HUNDRED AND
THIRTY THREE MILLION FROM THE
COVER CALIFORNIA FIND. RIGHT SO
THOSE ARE EXAMPLES THAT WE HEAR
IN THIS SUB. BECAUSE THERE'S NO
SPECIFIC GUARD RAILS SO THIS IS
ANOTHER EXAMPLE OF THAT MAYBE
NEXT YEAR WE'RE GOING TO HEAR
PROPOSAL. THAT WE NEED A CLOT IS
BACK BUT WILL PAY IT BACK WE
JUST NEED A CLAPBACK SO THAT'S-
THE GUARDRAILS. PARAMETERS
AROUND THAT I THINK. WE MAY BE
OF US WOULD LIKE TO SEE IN THE
TVO. SHE THAT MANAGER HEAD MA'AM
SORRY. NO JUST I WANTED. TO KIND
OF SPEAK TO THIS- DISCUSSION
AROUND HAVE A SENSE OF URGENCY
TO MAKE THE COMMITMENTS- TO
INCREASING PROVIDER RATES I
THINK. THAT IS PART OF WHAT THE
COALITION HAS KIND OF COME.
TOGETHER AROUND WHICH IS THAT WE
KNOW WHERE THE NEEDS ARE AND I
DON'T WANNA DISCOUNT THE YOU
KNOW HOW COMPLICATED MEDICAL
FINANCING IS AND THE IMPORTANCE
OF THE DETAILS MECHANICS. DO YOU
THINK WE KNOW WE KNOW WHERE
THEY'RE ACCESS PROBLEMS WE KNOW
WHERE THE NEEDS ARE AND THAT.
YOU KNOW THE COMMITMENTS CAN BE
MADE NOW AND CAN WORK TOGETHER
TO FIGURE OUT THE DETAILS FOR
IMPLEMENTATION. I WOULD SAY THAT
IN THE YEAR TWENTY TWENTY THREE
THERE YOU CAN FIND FIVE HUNDRED
STUDIES FOR ANYTHING THE
QUESTION YOU'RE ASKING NOW WE'RE
AT A POINT WHERE. BURKE LEE.
UCLA HAS EVER. FOR EVERY SINGLE
THING I THINK WE ARE NO LONGER
IN THE PHASE WHERE LIKE I WONDER
WHICH DEMOGRAPHIC NEEDS THE MOST
HELP. I WONDER WHICH SERVICE
SHOULD BE INVESTED IN. SO IT'S
HARD FOR ME TO LISTEN TO SAY HEY
WE NEED TO DO MORE DUE DILIGENCE
TO LOOK INTO WHAT SERVICE NEEDS
HELP OR NOT. WE ARE DEFINITELY
IN A PHASE WHERE WE HAVE ALL
THAT INFORMATION FOR US TO
INVEST INTO THESE SERVICES NOW.
APPLY THE CHAIR AGAIN I'D LIKE
TO ASK THE LA OF THE SAME
QUESTION ARE THERE GUARDRAILS
THAT THE LEGISLATURE COMPETE IN
PLACE. TO MAKE SURE THAT THIS
FUNDING MECHANISM THAT THE PLANS
ARE PAYING FOR GOES TO- THE MOST
VULNERABLE CITIZENS AND ARE. THE
MOST VULNERABLE PEOPLE IN OUR
STATE. YEAH THAT'S A THAT'S A
TRICKY QUESTION TO SOME EXTENT
BECAUSE ANY ANY ACTION TAKEN
TODAY CAN BE. MANDHANA PROPOSED
TO BE UNDONE IN NEXT YEAR'S
BUDGET THAT'S ALWAYS A- RISK
THAT THE LEGISLATURE FACES WHEN
IT'S CONNECTING GUARDRAILS. FULL
OF- GUARDRAILS THE LEGISLATURE
COULD CONSIDER. A ONE IS TO- ONE
Q. TOOL THAT WE RECOMMEND THE
LEGISLATURE OFTEN CONSIDER AS-
FAR AS SETTING ASIDE FUNDS AND
RESERVED. FOR ECONOMIC
UNCERTAINTY THAT THAT COULD
HELP. PROTECT- ANY INITIATIVES
THAT ARE ADOPTED SO THAT IF
THERE IF THE BUDGET SITUATION
DOESN'T WORSEN THAT THAT COULD
BE TAPPED INTO BEFORE HAVING TO.
OVERTURN OTHER COMMITMENTS THAT
ARE MADE IN THE BUDGET- ANOTHER-
THERE ARE THE LANGUAGE WE ALSO
THINK COULD BE. COULD BE
TIGHTENED A LITTLE BIT TOO. FOR
EXAMPLE AS WE AS WE NOTED OUR
TESTIMONY ON THE BOTH FUNDS AND
THE TRAILER BILL WOULD BE
CONTINUOUSLY APPROPRIATED. WHICH
MEANS THAT THE- ADMINISTRATION
COULD SPEND THE FUNDS WITHOUT
NECESSARILY HAVING APPROPRIATION
IN THE BUDGET. WE THINK WE THINK
THAT THE LEGISLATURE COULD PUSH
MORE GUARDRAILS AROUND THAT
ESPECIALLY GET OUT THAT THAT
ARRANGEMENT WAS COMMON IN
PREVIOUS. UNTIL TAX- BUT BECAUSE
THE ANSWER PREVIOUS WAS JUST FOR
GENERAL FUND BACK FILL NOW
THERE'S A THERE'S A PROPOSAL TO
EXPAND IT AUGMENTATIONS THAT
THAT'S SOMETHING THAT COULD BE
REVISITED FOR EXAMPLE REQUIRING.
APPROPRIATION FOR THE PROVIDER
RESERVE OR ALSO A SPECIFYING-
PUTTING MORE GUARDRAILS AROUND
HOW MUCH FUNDING IS ALLOCATED TO
THAT RESERVE SO THAT THAT THAT
THE LEGISLATURE CAN ENSURE THAT
MENSTRUATION IS. IS PROVIDING
THOSE- MONIES. AND TO THAT POINT
I THINK I'M IF I COULD TURN THIS
NEXT QUESTION TO THE PLANTS
HERE- BECAUSE IF YOU MENTION
IT'S BEEN DONE BEFORE. CAN YOU
SPEAK TO THAT PREVIOUS CHANGE
THAT DEPARTMENT HAD TO DO-
SHOULD IF MY MEMORY SERVES ME
RIGHT. THE MANAGER ARE YOU
TALKING ABOUT HOW THE- THERE WAS
ONE INSTANCE WHERE CMS. THE
STATE TO GO BACK TO THE DRAWING
BOARD. YES AND THEY CHANGED IT
WITHOUT COMING BACK YEAH THAT
WAS- THAT HAD TO DO IN THE
DEPARTMENT CORRECT ME ON THIS I
HAD TO DO WITH- THE PORTION OF
FEDERAL REGULATION THAT DEALS
WITH- HOLD HARMLESS- YOU KNOW
THERE'S THERE THERE'S SOME RULES
AROUND THAT. I THINK THAT- THE
STATE HAD TO GET AND AN EQUAL
DISTRIBUTION OF THE TAX SO THERE
WAS A MODIFICATION IN THE TEARS-
AND THAT IMPACTED THE TAX RATE
AT SOME OF THE PLANS HAD TO PAY-
THERE WERE A COUPLE PLANS WERE
INITIALLY EXEMPTS FROM AT MCO
TAX END UP HAVING TO PAY A TAX
ON THOSE SURPRISE- AND- YOU
KNOW. THIS PERSONALLY YOU KNOW
IN THE IN THE COMMERCIAL MARKETS
WHEN YOUR RATES ARE APPROVED. SO
FAR IN ADVANCE THAT IS- YOU KNOW
THAT THAT FINANCIAL BURDEN IS
REAL- AND IN CAN IMPACT THE
CONSUMERS AS WELL SO- THAT IS
SOMETHING THAT WE REMEMBER IN
THAT WE HOPE. IS TAKEN INTO
CONSIDERATION AS AS A PROTECTION
FOR CONSUMERS- YOU KNOW WITH
RESPECT- TO THE SAME CO TAXING
OF THE DEPARTMENT HAS STATED
THAT- YOU KNOW THIS TIME THEY'RE
TAKING A DIFFERENT APPROACH AND
NEGOTIATE WITH SEEN AS EARLY AS
OPPOSED TO. APPROVING A TAX AND
GO SHE ON THE BACK IN AND SO-
YOU KNOW BE THAT AS IT MAY I
THINK YOU KNOW SOME SOME
CONSIDERATION ABOUT- MAKING SURE
THAT- YOU KNOW THAT. THE THERE
ARE NO SURPRISES- FOR OUR OUR
CONSUMERS- AT AS A RESULT OF
THIS BEING ENACTED I THINK THAT
WOULD BE- YOU KNOW WHAT WAS IN
THE LEGISLATURE TO CONSIDER. AND
WE'RE THOSE. GUARDRAILS
RECOMMENDED BY LEO. ADDRESS THIS
KIND OF SITUATION YOU KNOW I
THINK- THOSE ARE THOSE- THOSE
ARE SEPARATE YEAH I THINK THEY
WOULD NEED TO BE SPECIFIC
LANGUAGE YOU KNOW STATING THAT-
THAT YOU KNOW THE- YOU KNOW.
BASICALLY PRETTY SOME
LIMITATIONS ON THE DEPARTMENT
CHANGED FACTS ARE. CHANGE THE
TAX AFTER IT'S APPROVED BY THE
LEGISLATURE OR HAVING TO GO BACK
TO THE LEGISLATURE ARE NOT
PRACTICAL THAT IS BUT I. IT WAS
JUST THROWING STUFF OUT THERE
THAT COULD BE PART OF THE
DEBATE. SECTION WHICH I SAID
SOMETHING ELSE OR. FOR FREE. LET
ME TURN ON. WELL IT'S A SAME
IT'S JUST GO AHEAD. SORRY SIR.
IT IS MY COLLEAGUE FROM RISK ONE
OF UP ON THE IS IT IS IT MAY. OF
WITH THERE BE A- TO THE LEDGE.
NOT A CA. NOT WORKING I MEAN
WOULD YOU OBJECT OR THE- OF TO
A- NOT I'LL- ALLOWING IT CAN. TO
PER. BUT IF THOSE DOLLAR. NEEDED
TO BE APPROVED COULD. IT COME
BACK TO THE- SO THAT WE HAVE
SOME OF SPACE WHERE THEY MANY GO
IN THE IN THE CAN TO. YEARS
ACCORDING. FOR ME I MEAN THE TWO
PIECE OF IT CAN TO PER. THE
FIRST PIECE CHANGE THAT WERE
ABLE TO PAYER PLANS TO REIMBURSE
THEM FOR THE TAX SO THAT THAT
THAT IS KIND OF THE TRADITIONAL
MODEL THAT CONTINUES TO
PREPARATION PIECE OF IT. AND
THEN THE SECOND PIECE IS
REGARDING KIND OF THE PROVISION
OF HOW WE'RE PROPOSING TO USE
THE DOLLARS FOR RATE INCREASES
AND SO THAT'S GOVERNED BY THE
TRAILER BILL THAT IS BEFORE YOU
AND THAT WILL BE BEFORE YOU AND
ANNEX THAT GOVERNOR'S BUDGET. SO
THAT WE CAN JUST PAY THOSE RATE
INCREASES ON IT YET WITHOUT IT
WITHOUT ADDITIONAL APPROVAL AND
GOVERNED BY THE TRAILER BILL
THAT IS WOULD BE APPROVED. I'M
JUST TRYING TO ADDRESS THE
GUARDRAILS AND THE L. A. WOULD
YOU COMMENT ON THAT FOR ME JUST
I WANT TO DRESS THE GUARDRAILS I
GUESS MY QUESTION IS I WANT TO
MAKE SURE THAT THE MONEY THAT IS
APPROPRIATE IT. GOES TO WHERE
WE- SAY. EVERYBODY AGREES AT
THIS MOMENT IT'S GOING TO BE
APPROPRIATED AND CAN'T CHANGE.
NEXT YEAR. YES SIR. YES FORMER
FINANCE. HOLDEN ENDED UP IN A
PART OF FINANCE. DELAYING THAT
FOR THE MEDICAL PER. RATE AND-
CURRENTLY. DOES HELPS. TO
LANGUAGE IN AT. FOR THE MEASURE
. COME BACK THE LARGEST- FOR THE
TWENTY FOUR TWENTY FIVE-
GOVERNOR'S BUDGET- WOULD ALSO
LIKE TO REITERATE THAT THE- MCO
IS A CRITICAL COMPONENT TO THE
BUDGET FRAMEWORK WITH A THIRTY
ONE POINT FIVE BILLION DOLLAR
DEFICIT. AND WE WILL BE
RETURNING. IN JANUARY WITH A
SUBSEQUENT INVESTMENTS. THANK
YOU. I'LL SIDE OF THAT. IF
SOMETHING WERE CHANGE IN TWENTY
TWENTY SIX THERE'S NO LANGUAGE.
TWENTY TWENTY FIVE. THE SO THE-
NINETEEN POINT FOUR BILLION. OF
THAT. WE HAVE TEN POINT THREE
BILLION. WHICH IS GOING INTO THE
PROVIDER RATE RESERVE. AND WE
HAVE- EIGHT HUNDRED SIXTY NINE I
BELIEVE FOR THE TWENTY TWENTY
FOUR PROVIDER RATE INCREASES-
IT'S THE PROPOSAL FOR
LEGISLATURE THE MOMENT- TO FOR
CONSIDERATION AND ANY CHANGES
WOULD COME BACK TO LEGISLATURE.
DISCUSS THANK. WHEN DOES THAT
RESERVE GET ALLOCATED TO THE
PROVIDERS THAT ARE ACTUALLY ON
THE GROUND PROVIDING THE SERVICE
SO THAT RESERVE WOULD BE FOR THE
STATE'S ATTORNEY. SAYS THAT THE
ONE THAT IS EIGHT TO TEN YEAR
RESERVE THE RESERVE WOULD BE FOR
THE- JANUARY ONE TWENTY TWENTY
FIVE RATE INCREASES OVER THE
ADMINISTRATION'S COME FORWARD TO
LEGISLATURE- AND- THAT GENERATES
. OF NEXT NEXT YEAR FOR THE
PROPOSAL. OKAY THANK YOU THANK
YOU. MENTOR FOR THE LEEWAY ON
THAT I AM NOT AN NOT COMFORTABLE
WITH THAT BUT I WOULD LIKE SOME
OTHER TYPE OF GUARD SOMETHING
THAT SHOWS THAT. YOU KNOW IF WE
APPRECIATE THE LEGISLATURE
BRUISES TAX NOT THAT I HAVEN'T.
I MEAN I THINK THAT THE
ADMINISTRATION ON THIS ONE
HUNDRED FIFTY MILLION DOLLARS I
FIND MYSELF IN THIS WEIRD
POSITION BECAUSE I THINK THEY-
COMPLETELY THE GOVERNOR OPERATED
IN REALLY GOOD FACE TO MAKE SURE
THIS FINANCIALLY DISTRESSED
HOSPITALS WERE TAKING CARE OF.
AND I JUST WANT TO MAKE SURE OF
IT OVER THE NEXT FEW YEARS THAT
CONTINUES NOT THAT I DOUBT THAT
IT WILL BUT I THINK THAT. YOU
KNOW THERE'S THREE BRANCHES OF
GOVERNMENT FOR A REASON AND WE
SHOULD HAVE SOME TYPE OF SAY SO
IN THAT OVER THE NEXT FEW YEARS
TO MAKE SURE. THAT WHAT WE
AGREED UPON- WHAT'S AGREED UPON
OVER THE NEXT IT THE BUDGET
CYCLE THIS BUDGET CYCLE COMING
UP IN THIS TRAILER BILLING WHICH
IS BEFORE US. AND CONTINUES TO
GO TO MAKE SURE THAT. AS THE
EXPANSION MEDIC CAL PROVIDING
SERVICES THAT THERE'S ACTUALLY
SERVICES PROVIDED AND THE PEOPLE
PROVIDING THAT SERVICE ARE
GETTING PAID FOR IT. AND I KNOW
WE HAD A STAKEHOLDER MEETINGS
WITH A LOT OF PEOPLE BUT THERE
ARE A LOT OF PEOPLE WITH
DIFFERENT OPINIONS IN THE
STAKEHOLDER MEETINGS- ONE OF THE
COMMENTS MADE TO ME AS A
BUSINESS OWNER. IS JUST INCREASE
YOUR BUDGET OR JUST TREAT MORE
PEOPLE SO THAT YOU CAN GET MORE
DOLLARS AND WHEN YOU'RE LOSING.
THAT FIFTY CENT. FORTY SIX CENTS
ON THE DOLLAR FOR EVERY PATIENT
YOU TREAT. THAT AS A PATHWAY TO
BANKRUPTCY NO MATTER HOW YOU
LOOK AT IT. SO YOU CAN'T TREAT
MORE PATIENTS AND GET MORE
REVENUE- I THINK THEY WERE
LOOKING AT IT IS MORE CASH
PAYMENTS WOULD BE COMING IN BUT
SHOULD STILL BE LOSING DOLLARS-
THEY DON'T LOOK AT THE OUTSIDE.
AND I JUST- IT TO ME IT'S A VERY
SCARY SITUATION TO REPRESENT AN
AREA. THE COULD POSSIBLY LOSE.
HORRENDOUS ACCESS TO HEALTH
CARE. AND WHEN YOU TALK ABOUT
THE HOSPITAL SITUATION IS GOING
ON IN MY DISTRICT AND I KNOW
THAT YOUR SISTER SO. THANK YOU
MEASURE FOR THE LEEWAY AND THANK
YOU FOR. HOPEFULLY EXPANDING ON
THAT BECAUSE- I WOULD LIKE TO
HEAR FROM MY COLLEAGUE THAT. YOU
HAVE CONCERNS ABOUT THIS AS
WELL. SENATE ROTH. THANK YOU
MADAM CHAIR THE YOU'VE HEARD ON
JUST TEST. BEFORE I NOT SURE.
THAT WE CAN INCREASE THE MEDICAL
REIMBURSEMENT RATES ENOUGH TO.
TAKE CARE OF SOME OF THE
HOSPITALS IN THESE RURAL AREAS
THAT ARE PRESENTLY DISTRESSED. I
THINK IT'S GOING TO REQUIRE A
MUCH LARGER EFFORT ON THE PART
OF THE ADMINISTRATION THIS
LEGISLATURE TO. ESSENTIALLY
RESTRUCTURE THE WAY WE DELIVER
HEALTH CARE SERVICES IN THESE
AREAS IN THE TRADITIONAL WAY.
MAY NOT BE THE WAY THAT WE NEED
TO DELIVER THEM. IN THE FUTURE
BUT- BURKE FROM THAT I WANT TO
STEP BACK FROM THIS SPECIFIC-
MCO PROPOSALS THAT YOU ALL ARE.
MAKING AND WILL HAVE TO
IMPLEMENT AND JUST. TOUCH ON THE
BACK FILL AGAIN. YOU KNOW GIVEN
THE DIRE STATE OF OUR BEHAVIORAL
HEALTH SERVICE SYSTEM. MODEL IN
THE STATE OF CALIFORNIA FROM.
YOU KNOW WORKFORCE DEVELOPMENT
TO PROVIDERS TO CAPACITY TO
SERVICES. WHAT I'D LIKE TO SEE
NOT NECESSARILY FROM YOU ALL BUT
FROM THE ADMINISTRATION AS WE
MEET MOVE FORWARD TO THE FINAL
BUDGET. IS WHAT OUR OPTIONS ARE
WITH RESPECT TO THIS BACK FILL
RECOGNIZING THAT THE BUDGET IS A
ZERO SUM GAME. ARE THERE
DECISION POINTS AND DECISIONS
THAT WE CAN MAKE. IN TERMS OF
TRIAGING AND PRIORITIZING- THIS
AND OTHER ASPECTS OF THE BUDGET
TO TRY TO DRIVE MORE MONEY.
AGAIN WITHIN THIS FOUR CORNERS
OF THE BUDGET. TO THE MENTAL
HEALTH. AND BEHAVIORAL HEALTH
SYSTEM AND THE DELIVERY OF
SERVICES TO THOSE MOST IN NEED-
I'M I'M UNABLE AT THIS POINT. TO
PUT A LIST OF THOSE OPTIONS
TOGETHER BUT I'M CERTAIN THAT
THERE ARE FOLKS IN THE
ADMINISTRATION AND THE HEALTH
CARE PORTION OF THE BUDGET. THEY
CAN HELP US DO THAT ALONG WITH
THE OTHER PIECES OF THE BUDGET
AND- AND YOU KNOW. MAYBE WE NEED
TO TAKE A LOOK AND- FIGURE OUT
WHETHER CLIMB IT'S MORE
IMPORTANT THAN. ME YOU KNOW
HEALTH CARE SERVICES IN THE
DELIVERY OF BEHAVIORAL HEALTH
SERVICES. OR TRANSPORTATION IS
OR IS NOT MORE IMPORTANT THAN
SOME OF THESE OTHER ISSUES AND-
AND THAT'S IT I THINK IT'S A
VERY VERY IMPORTANT THAT WE TALK
ABOUT THOSE THINGS IN THE NEXT
COUPLE WEEKS BECAUSE- I THINK
THERE'S SOME. SOME NEED HERE
THAT'S NOT BEING ADDRESSED AND
IT'S NOT BECAUSE YOU ALL HAVE
BEEN TRIED. SO WE APPRECIATE YOU
AND LOOK FORWARD TO CONTINUING
CONVERSATION. THANK YOU MADAM
CHAIR. THAT ARGUMENT. THANK YOU
NICK HELLO LINE MY COMMENTS WITH
MY WITH MY COLLEAGUES I- I ALSO
THINK YOU KNOW THE ONE POINT
FIVE- MILLION WAS GREAT. BUT
THERE IT IS IT SERVE AS A BRIDGE
BUT I JUST DON'T THINK THE
BRIDGE GOES GOES FAR ENOUGH. SO
WHEN PEOPLE TALK ABOUT THE
GENERATIONAL OPPORTUNITY WE HAVE
HERE. I THINK. I THINK WE NEED
TO SET UP SOME KIND OF FUN TO BE
ABLE TO HELP THE HOSPITALS IF WE
CAN'T DO REIMBURSEMENT RATES AND
IT'S GOING TO BE. ANOTHER WAY
THAT WE CAN- SUPPLEMENTED
ESPECIALLY THE EMERGENCY ROOMS
THE BEHAVIORAL HEALTH BEDS AS
HAS BEEN MENTIONED. I WAS DOWN
IN. DOWN IN THE THIS DISPLAY
WEEK AT THE END TULARE LAKE AND
YOU JUST REALLY STRUCK. WITH THE
VAST NEED THAT EXISTS DOWN- AND
OUR HOTEL WAS ACROSS FROM. ONE
OF THE HOSPITALS IN ANYWAY THAT.
THE ECONOMY DOWN THERE IS ROCKY
AS IT IS AN I. FIVE SAID BEFORE
I THINK HEALTH CARE IS THE MOST
IMPORTANT THING THAT WE DEAL
WITH. SO LIKE THE LIKE THE
GENERAL LIKE I DON'T KNOW IF IT.
YOU KNOW MAYBE THIS NEW PRISON
THING SHOULDN'T PLAY OUT LIKE
IT'S CALL MAYBE SOME OF THE
CLIMATE STUFF MAYBE SOME
INTEREST FOR TATIAN STUFF. BUT I
JUST THINK TO BACK THAT UP AND I
THINK WE ALL AGREE WE ALL
ACKNOWLEDGE THAT THERE'S A- A
BUDGET SHORTFALL IN THIS WE
DON'T HAVE A WAY TO SPEND IT. OR
FEEL IT I DON'T I DON'T KNOW
THAT TAKING IT OUT OF THE BACKS
OF MEDIC CAL IS THE WAY TO DO IT
AND SO I THINK I WOULD JUST
CONTINUE TO ADVOCATE. THAT OUR
TIME LIMIT BE SMALLER THAT ARE-
THAT ARE- INCREASE OF RATES AND
ARE STABILIZATION OF OUR
HOSPITALS. COMES EARLIER THAN
LATER. THANK YOU- I THINK WE'VE
EXHAUSTED. THE QUESTIONS
COMMENTS. I'M DOING PRETTY GOOD
OVER HERE GENERAL. IF YOU ARE. I
WENT TO SOME. SOME OF THE MAIN.
THIRTY WE TODAY- YOU KNOW WE
HEARD THE EIGHT TO TEN YEARS.
IT'S NOT SOMETHING THAT AT LEAST
HERE IN THE DÍAS WE FEEL
COMFORTABLE WITH- WE NEED THESE
THOSE INVESTMENT INVESTMENTS NOW
WITHIN THE THREE AND A HALF
YEARS- TO SEE WHAT WE BELIEVE A
GREATER GOOD. WE ARE WORRIED
AROUND THE FRAME OF OTHER
INVESTMENTS IN THE FUTURE- WE
WOULD LIKE LANGUAGE GUARDRAILS.
I MEAN IF WE'RE LOOKING AT IT'S-
NINE HUNDRED TWENTY TWO MILLION
DOLLARS FOR THE FIRST YEAR AND
IT. DRASTICALLY INCREASES TO
BILLIONS OF DOLLARS THROUGHOUT
THE NEXT THREE YEARS FOR THIS
RESERVE INVESTMENTS THAT PEOPLE
NEED RIGHT NOW- WE HEARD WE
HEARD A COMMON THEMES AROUND-
SO. THE PARTY. OUR HOSPITALS NOW
. IS THERE HURTING NOW AND THEY
COULD BE SOME COULD GO AND CLOSE
LIKE WE SAW. JUST THIS YEAR
WITHIN THE NEXT TWO YEARS AS THE
ADMINISTRATION PROPOSES THE
TWENTY TWENTY FIVE SUPPORT
REGARDING EMERGENCY ROOMS.
ADDRESSING THE EMERGENCY ROOM-
PATIENCE- WE HEARD AROUND IT YOU
KNOW AND I'M I DON'T KNOW HOW I
DON'T THINK ANYONE ELSE AT THIS
BUT I DO AS A CHURCH GOING TO
SAY THE COMMUNITY HEALTH WORKER
BILLION PART. REALLY STOOD OUT
FOR ME THE SAME DAY BILLION
REALLY STOOD OUT FOR ME- THOSE
ARE REALLY ON THE GROUND
INVESTMENTS- THAT YOU WE SEE TEN
A. B. TECH PULLED RETURNED- IN
PREVENTATIVE CARE AND SO FORTH
THERE'S THERE ARE COMMON THEMES
AROUND SPECIALTY CARE- THAT'S
VERY IMPORTANT ON THE BEHAVIOR
OF THIS IS A GROUP THAT- IS
REALLY INVESTED IN THE
BEHAVIORAL ASPECT. OF IT ALL-
AND INVESTMENTS ON THE PIPELINE.
THE GM ME WORKFORCE INVESTMENTS-
YOU KNOW I KNOW WE'RE LOOKING AT
PERHAPS A RULE- CYCLING IN THEIR
RESIDENTS YEAR BUT ALSO
INCREASING THAT- AND YOU KNOW
SLU IS ON BOARD WORK
REPRESENTING WORK WELL-
WORKPLACE. EMPLOYEES THOSE
PATHWAYS TRAINING TOWARD BALANCE
I DO THINK THAT SPORT WE'RE IN A
TIME COULD WE PROVIDE IS A
BATSMAN CEMENT ON THE LINE WHICH
I WILL BE HERE DOWN THE LINE IN
TWELVE YEARS I DON'T COULD TURN
BACK AND SAY. THIS IS THE RETURN
WE GOT FROM INVESTING IN. TWENTY
TWENTY THREE IT INTO THAT. I
WANT TO MAKE SURE I'M COVERED IT
. ANYMORE COMMENTS- ENSURING THE
IS THAT PART. FOR THE PER. THE
PASSED THROUGH YOU TALK TO. A
BILL DIRECT BASS AND- DIRECTOR
COOPER. I THINK THOSE ARE.
THEMES RIGHT WHEN YOU SEE
SOMETHING MADE ME FEEL OF
SOMETHING THAT SHE BE ADDRESSED.
YOU BROUGHT IT NIGHT HAD TWENTY
TWO MILLION THAT DIDN'T
MULTIPLIES AND IF BILL. AT THE
FINAL NUMBER THAT I HAVE IS TEN
BILLION TO EARN SIXTY SIX
MILLION EIGHT HUNDRED AND NINETY
FOUR THOUSAND I MEAN ROUGHLY
COULD BE. DIFFERENT BUT ROUGHLY
TEN BILLION DOLLARS WHERE THAT
NUMBER CAME FROM ME CAN'T YOU
HOLD FIVE BILLION AND DISTRIBUTE
THE OTHER FIVE BILLION I MEAN WE
SPLIT THE DIFFERENCE- I MEAN
WHITE WHAT WERE THAT NUMBER COME
FROM THAT YOU HAVE TO HOLD TEN
BILLION BACK I MEAN CAN'T WE- IN
THAT FUND CAN'T. CAN'T WE
DISTRIBUTE FIVE BILLION TO THAT.
DESPERATELY NEEDED PEOPLE THAT
ARE. RECEIVING SERVICES FOR
PROPOSING TO SPEND THAT ENTIRE
TEN BILLION IN MATHEMATICAL
PROGRAM IN TERMS OF AUGMENTATION
THIS IS THE PLAN THAT THEY'RE
LOOKING TO SPREAD IT OUT RIGHT
OVER A LONGER PERIOD OF TIME
VERSUS JUST THE TIME PERIOD OF
THE TAX YES IT'S THE SAME DOLLAR
AMOUNT I THINK WE ALL IN
AGREEMENT WITH THAT. THE DOLLAR
AMOUNT- TO BE INVESTED IN THE
MEDICAL PROGRAM BUT IT'S THE BUT
TEMPERED BY WHICH THOSE DOLLARS
WOULD BE ALLEN HOW DID YOU
ALLOCATE THE TIRE HAD COME UP
WITH A FOR ME TO COME OVER THE
TIME PERIOD CAN'T. I MEAN IF THE
TAX IS GONNA LAST. WHAT FOUR
YEARS AS A FOR YEARS AND A HALF
THREE AND A HALF YEARS HAS BEEN
THAT MANY CAN'T BE SENT SO IN
OUR DISCUSSIONS WITH CMS- AT THE
SIZE OF THE MCO TAX WHICH
ANNUALLY. UNDER THIS PROPOSAL IS
ABOUT FIVE BILLION DOLLARS. WE
THEY'VE INDICATED TO US THAT THE
WILL BE CHANGING. FEDERAL
REGULATIONS WITH REGARD TO THE
PER PROPORTIONALITY OF THAT TAX
SO WE DO NOT THINK THAT WE WILL
BE ABLE TO RAISE FIVE BILLION
ANNUALLY IN REVENUE STARTING IN
TWENTY TWENTY SEVEN. AND SO WE
DON'T WANT TO FISCAL CLIFF JUST
TO OCCUR TWENTY TWENTY SEVEN AND
SO WE'VE SPREAD THOSE DOLLARS
OUT FOR A LONGER PERIOD OF TIME.
PROVIDES SUSTAINABILITY LONG
TERM FISCAL CERTAINTY TO OUR
PROVIDERS SAID THAT THAT RATE
INCREASE WILL BE AVAILABLE FOR
EIGHT TO TEN YEARS INSTEAD OF
THREE YEARS. WITH THE POTENTIAL
OF A CLIFF SO TO THAT SO- I GET.
SORRY MADAM TERABIT. I MEAN IF
THE RATE IS STILL NOT ADEQUATE
ENOUGH TO KEEP THE PROVIDERS A
LIVE IN PROVIDING SERVICES. M.
WE- AND IT MY CHANGES TACK. WITH
IT ENDS IN FOR YEARS IN THE
EIGHT YEAR. I MEAN IF YOU'RE
NOT. ADEQUATE REIMBURSE. RATES
LIKE MY COLLEAGUE FROM. SAID WE
STILL HAVE THIS CLIFF FOR
DELIVERY OF SERVICES THAT WE'RE
GOING TO FACE. WHETHER WE FACE
IT THIS YEAR NEXT YEAR FOR YEARS
NOW OUR- EIGHT YEARS FROM NOW.
IF THIS MONEY ISN'T ADEQUATELY
APPLIED TO THE PEOPLE PROVIDING
SERVICES WHICH THE STATE OF
CALIFORNIA IS REQUIRING. THE
EXPANSION OF MEDICARE OUT OF
PATIENCE IT'S AN ERA KEEP ME TO
GO OVER THAT BUT IT'S- IT'S A
MEDICARE REIMBURSEMENT RATE
PROBLEM THAT WE HAVE. THE WINTER
WE CAN ADDRESS THAT WE HAVE TO
ADDRESS IT AND WE CAN ADDRESS IT
SIX YEARS FROM NOW CENTER WOULD
SAY THAT. THAT IS. THE OUR MAIN
POINTS THAT WERE MY RECAP OF.
OUR OR OUR COMMON TEAMS HERE
THAT IS THAT WITH. YES THAT'S
RIGHT THAT WAS LIKE THE FIRST
ONE I MENTIONED. OF THAT WE ALL
SHARE THE SAME THING ON WE'RE
NOT COMFORTABLE WITH THE EIGHT
TO TEN YEAR. I'M SORRY I DO WANT
TO ECHO YOUR COMMENTS I'M ON
BOARD WITH YOUR COMMENTS I AM-
AND I THINK. I THINK THAT WAS
ALL THE COMMON THEMES. I WAS
ABLE TO RECAP ON MY COLLEAGUES.
MAIN POINTS HERE. I WANT TO
THANK EVERY. FOR YOUR PURCHASE-
FOR INCLUDING YOUR INSIGHTS FOR
COMING TO THE TABLE AND TALKING
ABOUT THIS A BIG SHOT OUT THANK
YOU DEPARTMENTS IT'S NOT ALWAYS
EASY. YOU KNOW YOU DID RECEIVE
MOST OF THE BRUNT OF NOT ALL OF
THE BRUNCH IN THIS CONVERSATION
TO BUT YOU KNOW THAT'S NOT GONE
UNNOTICED HERE. THANK YOU AGAIN
FOR THAT- WE'RE GOING TO HOLD
THIS ITEM OPEN. AS THURSDAY IS
OUR LAST HEARING AND WILL HAVE
OUR DECISION THERE. THANK YOU
FOR THIS I DON'T. THINK.
SO BEFORE WE MOVE ON TO THE
VOTING PORTION OF IT. WE'RE
GOING TO HEAR PUBLIC COMMENT ON
THIS ISSUE. I'D LIKE TO WELCOME
THOSE WHO WOULD PROVIDE A PUBLIC
COMMENT IN PERSON TO COME
FORWARD. I WOULD LIKE YOU TO
LIMIT YOUR YOUR COMMENTS TO A
MINUTE WITH MY DISCRETION OF
LEARNING THAT DEPEND- AND THEN
WE'LL TURN TO THOSE IN
TELECONFERENCE. YOU MAY BEGIN
GOOD MORNING LINDA WAY WITH
WESTERN CENTER ON LAW AND
POVERTY WE SUPPORT A LARGER AND
XCELERATED MCO TAX TO ENSURE
RECENT MEDICARE ELIGIBILITY AND
BENEFIT EXPANSIONS AND PLANNED
INVESTMENTS INCLUDING CONTINUOUS
MEDICARE ELIGIBILITY AND SHARE
COST REFORM ARE IMPLEMENTED
WITHOUT CUTS OR DELAY AND
PROVIDE FOR FUTURE INVESTMENTS
TO INCREASE MEDICARE ACCESS
QUALITY AND EQUITY. WE SUPPORT
THE PROPOSED A BASE RATE
INCREASES AND WE BELIEVE FUTURE
PROVIDER RATE. I SHOULD BE
FOCUSED ON KNOWN ACCESS GAPS AND
TIED TO QUALITY AND EQUITY
MEASURES AND WE SUPPORT LONG
TERM SUPPORT BY PLANNING FOR
TIMELY ONGOING RENEWAL OF THE
TAX RATHER THAN SPREADING OUT
THE RESOURCES OVER A LONGER
PERIOD OF TIME WHICH DID MANAGE
IS THE POTENTIAL ANNUAL
INVESTMENT THANK YOU THANK YOU.
GOOD MORNING KOREA YALA
REPRESENTING MAXIM HEALTHCARE IN
CAMPS 
MEDICAL PRODUCTS SUPPLIERS. WE
URGE THE COMMITTEE TO CONSIDER A
RATE INCREASE FOR PRIVATE DUTY
NURSING USING MCO DOLLARS HOME
HEALTH COMPARE PROVIDERS LIKE
MAXIM ARE NOT ABLE TO PROVIDE
THE PDN HOURS NEEDED TO
MEDICALLY FRAGILE. KIDS THAT
MUST HAVE NURSING CARE TO REMAIN
LIVING AT HOME WITH THEIR
FAMILIES WE CAN'T COMPETE WITH
THE HIGHER PAYING HEALTH CARE
EMPLOYERS AT THE CURRENT MEDICAL
RATE. PROOF PROVIDING BETTER PAY
FOR PBMS WILL ACTUALLY SAVE THE
STATE MONEY BY ALLOWING MORE
CHILDREN TO LIVE AT HOME. WITH
THEIR FAMILIES RATHER THAN
INDOOR LONG HOSPITAL STAYS TO
RECEIVE CARE- TWO CAMPS CAMPS IS
ONE OF THE PROVIDERS MADAM CHAIR
THAT HAS NOT HAD THE 10%
REIMBURSEMENT CUT RESTORED- FOR
MEDICAL SUPPLIES NON RESPIRATORY
MEDICAL EQUIPMENT AND TRONG
NUTRITION PRODUCTS. WE ASKED THE
COMMITTEE TO CONSIDER USING THAT
ENERGY- DOLLARS THANK YOU CAME.
HELLO MADAM CHAIR CALLOUS NON
BEHALF TO CLIENTS THE FIRST IS
THE CALIFORNIA ASSOCIATION FOR
HEALTH SERVICES AT HOME WHICH IS
SUPPORT OF THE I. P. AND REQUEST
WAS PREVIOUSLY MADE. THE OTHER
ONE IS FOR THE PEDIATRIC DAY
HEALTH CARE COALITION THESE ARE
NINETEEN FACILITIES IN
CALIFORNIA TO PROVIDE INTENSIVE
NURSING CARE TO PETE THE MOST
SEVERELY DISABLED PEDIATRIC-
KIDS. IN THE LAST MONTH THIS
THERE IN THE NINETEEN FACILITIES
AND THEY'RE LOCATED IN STOCKTON
NORTH HOLLYWOOD BAKERSFIELD
FRESNO AND LAST MONTH THEY HAVE
LOST 64% OF THEIR STAFF THEY ARE
NOT NEARING THE CLIFF THEY ARE
AT THE CLIFF. THEY CANNOT
COMPETE WITH THE OTHER-
EMPLOYERS AND- THEY'RE LOSING
STAFF AT SUCH A RATE THAT THEY
WILL BE MANY OF THE FACILITIES
WILL BE CLOSING THIS SUMMER. SO
WE UNDERSTAND THAT THERE IS A
PROCESS HERE WE ARE RAISING THE
RED FLAG THAT IF THERE IS AN
ABILITY TO PROVIDE RATE
INCREASES FOR THESE FACILITIES
TO CONTINUE TO ENABLE FAMILIES
TO CONTINUE TO LEAD ACTIVITIES
OF DAILY LIVING. THAT WOULD BE
TERRIFIC. THANK YOU VERY MUCH
THANK YOU. GOOD MORNING KELLY
BROOKS ON BEHALF OF THE
CALIFORNIA ASSOCIATION OF PUBLIC
HOSPITALS AND HEALTH SYSTEMS. WE
ARE GRATEFUL THAT THE- THE
REVISION INCLUDES A REFORMATTED
MCO TAX- AND THINK THE
ADMINISTRATION FOR THEIR
LEADERSHIP AND VISION TO PROPOSE
A TAX TO HELP STABILIZE THE
MEDICAL PROGRAM WE ALSO WANT TO
THANK THE SENATE FOR YOUR
LEADERSHIP ON DISTRESSED
HOSPITAL ISSUES- AND FOR THE
CONVERSATION HERE THIS MORNING.
INCREASE FUNDING IS CRITICAL FOR
OUR SYSTEMS WHICH FACE A LOOMING
FISCAL CRISIS BROUGHT ON BY
DECADES OF INSUFFICIENT FUNDING
AND RAISING COSTS PUBLIC HEALTH
SYSTEMS PROVIDE APPROXIMATELY
TWENTY FIVE PERCENT. OF THE
INPATIENT HOSPITAL DAYS MEDICAL
RECIPIENTS WHILE ALSO PROVIDING
WILK WORLD CLASS TRAUMA AND BURN
CARE TO ANYONE WHO NEEDS IT. AND
WE PROVIDE A PRIMARY SPECIALTY
AND BEHAVIORAL HEALTH CARE
THROUGH A FEDERALLY QUALIFIED
HEALTH CENTERS AND CLINICS GOING
BEYOND THE TRADITIONAL ROLE OF A
HOSPITAL FOR OUR PATIENTS.
IMPORTANTLY PUBLIC HEALTH CARE
SYSTEMS ARE ARE ALSO KEY TO WORK
FOR STRATEGIES AND CALIFORNIA BY
TRAINING HALF OF ALL DOCTORS IN
THE STATE. SUCH TRAINING
PROGRAMS HELP ENSURE THERE ARE
ENOUGH PROVIDERS. TO ENSURE
ACCESS FOR LOW INCOME
HISTORICALLY MARGINALIZED
COMMUNITIES WE ASK THAT ARE
IMPORTANT ALL THE SAFETY NET
BECAUSE ROUTER AND PRIORITIZED-
AND WE SHARE MANY OF THE SAME
CONCERNS OF THE PANELISTS DID
ABOUT THE OBSCURE TAX PROPOSAL.
THE LENGTH OF TIME I AM JUST NOT
BIG ENOUGH TO MEET OUR NEEDS
THANK YOU. COULD I. GOOD MORNING
MADAM CHAIRMAN COME DEAL GOT ON
BEHALF THE TO COST LEADERSHIP
FORUM THESE OF THE THIRTY THREE
DISTRICT MUNICIPAL HOSPITALS IN
THE STATE. REALLY APPRECIATE THE
COMMENTS THAT YOU ALL HAVE MADE
IN REGARDS TO SOME OF THESE VERY
FRAGILE HOSPITALS THE HLF IS
SUPPORTIVE OF THE INCREASE
FUNDING IN THE- THAT WOULD BE
GENERATED BY THE TAX- THE
MANAGED CARE ORGANIZATIONS. DUE
TO THE FINANCIAL INSTABILITY
EXISTING AND HEALTHCARE- WHICH
SICKNESS WHICH WAS SIGNIFICANTLY
EXACERBATED BY THE PANDEMIC AND
THE ONGOING EFFECTS OF- OF
UNDERFUNDING. A SAFETY NET
PROVIDERS SUCH AS THE HOSPITAL'S
PROVIDING EMERGENCY AND OTHER
NEEDED. SERVICES MUST BE
PRIORITIZED WHEN CONSIDERING
DISTRIBUTION. OF FUNDING FROM
THE MCO TAX AND IT'S IMPORTANT
THAT THE DISTRIBUTION OCCUR
SOONER RATHER THAN LATER A TOPIC
OF THE CONVERSATION TODAY.
ALMOST ALL CALIFORNIA HOSPITALS
BESET ESPECIALLY THE STANDALONE
FACILITIES THROUGHOUT THE STATE.
IT FUNDING DUE TO THE DECADES OF
UNDERFUNDING BY GOVERNMENT
PAYERS PRIMARILY I'M INCLUDING.
HEALTH SERVICES FOR THESE
REASONS WE ARE VERY MUCH- IN
SUPPORT OF THE MCO TAX THANK YOU
THANK YOU. GOOD MORNING MADAM
CHAIR MEMBERS OF THE COMMITTEE-
SAY OVER TEN AND FOR THE
UNIVERSITY OF CALIFORNIA. THE
UNIVERSITY OF CALIFORNIA
SUPPORTS THE GOVERNOR'S PROPOSAL
TO REINSTATE THE MCO TAX. WE
BELIEVE THAT THE MCO TAX WILL
SUPPORT ACCESS. TO QUALITY AND
EQUITY AND MEDIKAL A PER
SERVICES. OF THE UNIVERSITY OF
CALIFORNIA ARE DESIGNATED PUBLIC
HOSPITALS. AND THE IMPORTANT
ROLE OF THE PUBLIC HEALTH
SYSTEMS AND THE SAFETY NET NEEDS
TO BE REFLECTED IN THE ONGOING
MCO DISCUSSIONS BY ENSURING THAT
A PORTION OF THE REVENUES BE
USED TO SUPPORT PUBLIC
HOSPITALS. THANK YOU VERY MUCH
FOR YOUR TIME. MADAM CHAIR
MEMBERS TO MADDEN REPRESENT THE
CALIFORNIA CHAPTER OF THE
AMERICAN COLLEGE OF EMERGENCY
PHYSICIANS IN RESPECTFULLY
REQUESTING FOR EMERGENCY
PETITIONS TO BE INCLUDED IN THE
PROVIDER RATE INCREASES AS IT
RELATES TO PROVIDING MENTAL
HEALTH SERVICES. MADAM CHAIR
WHEN YOU SPOKE TO THE MEDICAL
ASSOCIATION YOU ASKED HIM ABOUT
WHAT ARE THE BARRIERS WITH THE
LOW REIMBURSEMENT FOR TREATING
MEDICAL PATIENTS FOR EMERGENCY
PHYSICIANS THERE ARE NO BARRIERS
WE ARE REQUIRED BY STATE AND
FEDERAL LAW TO TREAT ANY PATIENT
COME IN THE MERCY DEPARTMENT. AS
RESULT 42% OF THE PATIENTS
COMING INTO EMERGENCY
DEPARTMENTS ARE MET ACCOUNT
BRAWLEY'S. SO HOW DOES THIS
IMPACT ACCESS WE DON'T HAVE THE
ABILITY TO LIMIT THOSE PATIENTS
IN TERMS OF SEEING THEM OR NOT.
AND OUR FOLKS SIGNED UP FOR THIS
UNDERSTANDING THAT SO WHAT THEY
DO IS THEY REDUCE COVERAGE
EMERGENCY DEPARTMENTS SO YOU MAY
HAVE AN EMERGENCY DEPARTMENT
THAT WOULD NORMALLY HAVE THREE
EMERGENCY PHYSICIANS. BASED ON
THE MEDICAL AND ROMAN THEY MAY
ONLY BE ABLE TO HAVE ONE OR TWO.
EMERGENCY PHYSICIAN STAFFING THE
EMERGENCY DEPARTMENT THAT
EQUATES TO LONGER WAIT TIMES
WHICH EQUATES TO WORSE OUTCOMES.
AND THAT'S WHAT EVERYBODY SO WE
APPRECIATE YOUR CONSIDERATION.
AND LOOK FORWARD TO WORKING WITH
YOU THANK YOU. THANK YOU MADAM
CHAIR MEMBERS OF THE COMMITTEE
DAVID GONZALES ON BEHALF OF
AMERICA'S PHYSICIAN GROUPS. ARE
PROVIDER GROUPS RESPONSIBLE FOR
THE CARE OF ABOUT SIX MILLION
MEDICARE BENEFICIARIES-
CALIFORNIA'S OF A GREAT JOB
EXPANDING COVERAGE AND NOW
ALMOST ALL CALIFORNIANS HAVE
COVERAGE BUT NOW. WE HAVE TO
INVEST IN OR A PROVIDER
INFRASTRUCTURE. AND SO THE MCO
TAX PROVIDES THAT OPPORTUNITY
AND WE'RE HAPPY TO BE IN
SUPPORT. THANK YOU. THE SET
SHORT ON BEHALF OF PEACH WHICH
REPRESENTS THE- HOSPITAL SAFETY
NET. I'M IN MY WE SUPPORT THE
MCO TAX AND APPRECIATE THE ON
GOING CONVERSATIONS- IN MY
PREVIOUS WRITTEN TESTIMONY I HAD
TO. TO HIGHLIGHT FOR YOU ALL
THAT NONE OF THE FUNDS THAT ARE
CURRENTLY IN MCO PROPOSAL GO TO
SAVE THE SAFETY NET HOSPITALS
BUT- YOU WANTED ME TO REMIND YOU
OF THAT. TIME SO WE LOOK FORWARD
TO THE ON GOING CONVERSATIONS WE
SUPPORT THE SENATE PLAN THAT
INCLUDES BUDGET YOUR FUNDS TO
HELP SAVE OUR SAFETY NET
HOSPITALS. I LOOK FORWARD TO ON
THOSE ONGOING CONVERSATIONS
APPRECIATE ALL OF YOUR ADVOCACY
THANK YOU. CHECK OUT THE
TORRICELLI CARE. AS THE FOUNDING
MEMBER OF THE COALITION FOR-
PROTECT PROTECT ACCESS TO CARE
WE'RE PLEASED TO SUPPORT THE MCO
TAX. WE ALSO WOULD LIKE TO SEE
THE- TAX FUNDS USED MORE QUICKLY
AS DESCRIBED BY THE CONVENIENT
COMMITTEE MEMBER. AND TO THE GO
DIRECTLY TO MEDICAL PROVIDERS
THANK YOU THANK YOU. I'M SURE
MEMBERS RANDY MARTIN HERE ON
BEHALF OF A HOBBY ON HEALTHCARE
WE APPRECIATE THE TEARS
WILLINGNESS TO EXPLORE THIS
ISSUE OF PRIVATE DUTY NURSING
FURTHER. I'M OVER THE LAST FEW
WEEKS- AND WE ALIGN OURSELVES
WITH A LOT OF COMMENTS MADE
TODAY ABOUT- ACCESS TO HEALTH
CARE FOR MEDICALLY CONTROLLED
WITH MEDICAL. COMPLEX MEDICAL
CONDITIONS I'M WE DO WANT TO
POINT OUT THAT. UNLIKE MOST OF
THE OTHER PROPOSALS THIS ONE IS
TO- GENERATORS COST SAVINGS WE
APPRECIATE THE FACT THAT THERE'S
A GROWING RECOGNITION THAT OUR
PREMISE. IS ACTUALLY REASONABLE-
AND THAT THERE IS THE POTENTIAL
FOR A NET COST SAVINGS ON THERE
SEEMS TO BE SOME. UNCERTAINTY
ABOUT WHAT THAT NUMBER IS WE'VE
DONE OUR BEST TO PROVIDE THAT
INFORMATION TO YOU. TO STUDIES
FROM REPUTABLE SOURCES WE HOPE
TO CONTINUE TO HAVE THIS
CONVERSATION ABOUT HOW WE CAN
FIND A WAY. TO FUND THIS PROGRAM
AND SAVE THE STATE MONEY AT THE
SAME PROGRAM AT THE SAME TIME
THANK YOU SO MUCH RENT.
MODERATING QUEUE UP THOSE
WISHING TO PROVIDE A COMMON
THREE- THE TELECONFERENCE AND
PLEASE LET ME KNOW HOW MANY WE
HAVE IN Q. CERTAINLY AND IT IS
ONE ZERO MAKE A COMMENT DAN IT'S
ONE ZERO. GIVE ME A MOMENT HERE
. THE FOREIGN Q. RIGHT NOW IF
YOU COULD PLEASE. KEEP YOUR
COMMENTS TO FORTY FIVE SECONDS
WE CAN GO AHEAD. THANK YOU BLIND
TWELVE YEAR AND- GOOD MORNING
THIS IS DIANA DOUGLAS. ACTOR
CALIFORNIA. PERFECT GENERALLY
SUPPORT IT IS A STATION PROPOSAL
FOR LARGER AND MORE IMMEDIATE
AND YOU KNOW TAX INSURED IT FOR
OUR MEDIC HEALTH EIGHTEEN AT. AT
THE START TIMELY IMPLEMENTATION
OF. SANCTIONS ON OFFENSE AND
HELPING. WE DO HAVE SOME HEAT
SUGGESTED. ADDING THE FUNDS OVER
AND- FOR YOUR- SUPPOSED TO BURKE
SEVEN WOMEN THE POSSIBILITIES
THE FUNDS BE FIVE. IN THE EVENT
OF A MARKET FOR A LONG I THINK I
AM. THANK VERGE LONG FROM FOR.
RENEWAL INSTABILITY ON. THE
SUPPORTING CONCEPT OF A FUNDED
REVENUE WERE USED THEM YEAH
SACRAMENTO. REQUESTED FROM
DOLLARS THAT- TO THE LIMITED
RIGHT THAT THE- RIGHT. AND BEST
THE PRO DEPUTY I CAN ACCESS ALL
AND I'M PRETTY. WE THANK FOR SO
MUCH FOR YOUR CALL MAY INCREASE.
THANK YOU FOR ITS COLOR. A
MIDDLE INCREASE THAT H. ALIGN
FOR. PLEASE GO AHEAD. GOOD
MORNING MADAM CHAIR SUBCOMMITTEE
MEMBERS EMBRACED WITH TO ON
BEHALF CALIFORNIA MILITARY
SURGERIES. A. K. KA POSSIBLE BIG
ONE IS THE- ABOUT VISION
INVESTORS THIRTY CENTER MEMBERS
. LEADERS IN REDUCING HELLO
SYSTEM AT THE END ASIAN
COUNTRIES THE THING ABOUT IT
SETTINGS THE OTHER CALL HER TO
THE- TYPES OF SERVICE. AN
INTERNAL CALL SURVEY OF MY IN
THE THAT FIFTY THREE OVER
MILLION BUT AND- OFF OCCURS.
LOSS THAT'S NOT RAZORBACK PACE
COST OF PROVIDING CARE YES THESE
PLAN MADE ROLE NEW. HEALTH CARE
TO SYSTEM SIXTY DISCRIMINATION.
OFF FOR EXAMPLE YOU SEE
RESEARCHERS THAT PERSON PERFORM
IN A IF THE STATEMENT PROGRAM.
40% OF. FOR YOUR COMMON. THANKS
SO MUCH NEXT CALL.
COMMENTS AT THE J. FROM S. YEAH
YOU BUT- THE CURRENT ATMOSPHERE
TAX INSTRUCTION LEAVES. IN
MEDICAL SERVICE IS WOEFULLY
UNDERFUNDED CHRONIC UNDERFUNDING
OF THESE CRITICAL SERVICES
CREATED A CRISIS AND JENNIFER I
THANK YOUNG THAT WORK FORCE AND
THE DEGRADATION OF THE REGION.
AND BENEFITS. QUITE A 3% OF THE
FUNDS RATE BY THE END OF TAX
USED. PROOF PAYMENT FOR NINE ONE
ONE GRANDA MARGIN IN MEDICAL.
SERVICES FOR PRIVATE AMBULANCE
PROVIDERS HOPING TO CLOSE THE
FUNDING GAP CRY PROVIDERS AND IN
AGENT THANK YOU SO MUCH YOU'RE
MY MAYOR MEDICAID REIMBURSED
THANK YOU MUCH AND CALLER. AND
ACTUALLY LINE EIGHT PLEASE GO
AHEAD. HELLO MANAGER RUN KOEMAN
BY ON BEHALF OF THE CALIFORNIA
SENATE AND HELP THEM WORKS THE
WITH THE POWER FOR THE M. BACK
PROPOSAL NUMBER REPLY WE
GENERALLY SUPPORT PUBLIC RECORDS
LAW TACK. COURT BASED RATE
INCREASES IN MEDIC OUT AT LEAST
EIGHTY SEVEN POINT 5% OF
MEDICARE. AND WE HEARD CONSIDER
TOWARDS THIS PLAN FOR THE FOUR
YEARS HOWEVER WE ALSO WE THREE.
OF USE WE AND GET BACK TO YOU AS
WELL WE THINK SHOULD BE RAISED
IN SEVEN POINT FIVE PER OF THE
MEDIC RATE PER. THE EDUCATE
MATTERS SERVICE COMMENCEMENT
COMMENSURATE WITH OTHER PROPOSED
PROVIDER RATE INCREASE. THIS IS
ESSENTIAL TO ENSURE ON OF.
BENEFIT CONCERTS THE PEDDLING
WAY WHILE WE UNDER THAT IT'S TO
LET MAY TEMPORARILY DELAYED BY
SPEECH THE OF THE STORY WE HAVE
TO THE JANUARY ARE COMMON
GRAYSON. MODERATE THESE NEXT.
YOU AND A MAN CURRENTLY Q. I
WILL NEED REMIND IDEAS FOR ZERO
WORK IF WE CAN PLEASE LET ME
THIRTIES. YOUR WILL HAVE A
COUPLE LEFT BEFORE WE HAVE TO
BREAK. REALLY NOBODY IN Q. NO.
SO WE'RE GONNA WE HAVE A COUPLE
MINUTES WITH ON TO THE ONLY ITEM
. FOR THOSE WHO DIDN'T PROVIDE A
COME FROM YOU CAN WRITE IT IN
THE- COMMITTEE ERIN VISITOR
WEBSITE. NO MORE ON TO THE BALL
ONLY EITHER. WE'RE GOING TO BE
BOTH IN THREE FOR CAL. HELLO ONE
RESPONSE OF ITEM TO FOUR NINE
ELEVEN THIRTEEN. SEVEN THROUGH
NINETY. TWENTY ONE THROUGH FIVE
TWENTY SEVEN THROUGH. TWENTY
NINE THIRTY ONE THREE THIRTY
FOUR THIRTY SIX THIRTY SEVEN
THIRTY NINE FORTY FORTY THREE TO
FORTY FIVE FORTY SEVEN FORTY
NINE. FIFTY TWO THROUGH SIXTY
NINE SEVENTY ONE THROUGH EIGHTY
FIVE AND EIGHTY SEVEN THROUGH
ONE OH THREE. THE MOTION ACCEPT
THE FACT RECOMMENDATIONS FOR
THESE ITEMS. ARE MOVED BY FROM
EGGMAN CONTROL TO PLEASE CALL
ROLL. SENATORS MANY OF OUR HIGH
END OF OUR AYE EGGMAN AYE EGGMAN
AYE GROWTH. PROVI ROTH. ROTH I
GOT DEFINITION OR WE DID IT.
THOSE ITEMS A DOT ON A FOR ZERO
VOTE. A CALENDAR TO WILL OF I'D
. ONE FIVE SEVEN EIGHT TEN
TWELVE FIFTEEN SIXTEEN TWENTY
SIX THIRTY FIVE THIRTY EIGHT
FORTY ONE FORTY SIX AND FORTY
EIGHT WE HAVE A MOTION TO ACCEPT
THOSE. RECOMMENDATIONS FOR THESE
ITEMS MOVED BY SENATOR RALPH
CONSULTANT PLEASE CALL THE ROLL.
SENATORS MENJIVAR ALL RIGHT AND
YOU ARE AYE EGGMAN FIGMENT HIGH
GROWTH. GROVE NO ROTH. ROTH AYE
THOSE ITEMS ARE. ON A THREE TO
ONE VOTE OUR LAST CALENDAR OR
LAST VOTE WOULD BE ENCOUNTERED
WHICH ONES WE WILL COME OF ITEM
TWENTY THIRTY OR FORTY TO FIFTY
FIFTY ONE AND EIGHTY SIX CAN I
GET A MOTION TO ACCEPT THOSE
RECOMMENDATIONS ON THOSE ITEMS.
RIGHT CENTER EGGMAN CONSOLE TO
CAN WE GET A ROLL. SENATE
MENJIVAR ALL RIGHT AND- I EGGMAN
AYE EGGMAN AYE GROWTH. ROTH
THANK ROTH. FIVE THANK YOU THOSE
ARE THE ARE DAHLE. ON THE OTHER
THREE OH BAA. THANK YOU FOR
EVERY. I JUST. SEVEN ITEM ARE ON
THE MOVE ALONG I'D ITEM A STEP
D. I'M CONSULTANT I GET A- YES
BROKE ON THE WITH THE MANAGER
JUST BRING. I WANT TO THANK YOU
SEPARATING OUT THIS ITEM I THINK
HAVE A HUGE ISSUE I AYE MINISTER
THE BILL. BUT I WANT TO MAKE THE
COMMON THAT THAT THERE ARE TWO
THOUSAND PEOPLE IN THE
DEVELOPING WE JUST COMMUNITY
THEY'RE GONNA LOSE THEIR JOB
BECAUSE OF THIS. WAGE ISSUE
REALIZE WHAT BACK FOR EMPLOY.
BUT I THINK THIS REALLY TO BE AT
SURPLUS THAT YOU'RE THIS OUT AND
WE'LL MOVE THAT MOTION. FOR A
THIRTY BEEN. YEAH KNOW HOW TO
THE- HUMAN SENATOR OF GROPING
MOVED ITEM ISSUES. OUR
CONSORTIUM WE GET A ROLL. CALL
CENTER MENJIVAR ALL RIGHT AND- I
EGGMAN. THAT HIGH GROWTH HIGH
GROVE AYE ROTH BROUGHT. THAT I
IS A FORTY ZERO THINK EVERYONE
FOR YOUR PAY. AND COOPERATION WE
HAVE COMPLETE TODAY'S HEARING.
BUDGET SUB MEMBER ON HEALTH AND
HUMAN HAS AN QUICKLY.