And steep pay cuts to state workers would be offset. California. In 2018‑19, the Legislature approved budget‑related legislation establishing the San Mateo Health Plan Dental Integration Pilot, whereby San Mateo’s Medi‑Cal managed care plan would cover its beneficiaries’ dental services in addition to physical health services. 37. Notably, the state recently applied for approval of the most recent iterations of the hospital QAF and the MCO tax. On the heels of one rare gray wolf’s epic journey into California, another arrives. Following this section, we provide analysis and recommendations on a series of key issues: We conclude this report with a summary table of our recommendations. This section also analyzes the two new prescription drug affordability proposals by the Governor that primarily impact Medi‑Cal or DHCS—(1) to consider international prices in the negotiation of drug rebates and (2) to authorize DHCS to collect rebates on drugs that are not paid for through Medi‑Cal. No Major Concerns With Adopting Proposed Statutory Change. For more information on the interaction between the 340B program and Medi‑Cal, see our report, The 2018‑19 Budget: Analysis of the Governor’s 340B Medi‑Cal Proposal. Toxic Substances Control. By ADAM BEAM June 29, 2020. In October 2019, the federal government released draft regulations related to financing and oversight in the Medicaid program. The modified MCO tax proposal would generate a smaller annual General Fund benefit ($1.3 billion to $1.7 billion) than the original proposal (around $2 billion) and have different impacts on MCOs’ tax liability. In preparation for the date of transition, managed care plans need to have plans for the winding down of their capacity to administer the pharmacy services benefit. The Governor has proposed budget‑related legislation that would end dental managed care in the pilot counties, and, instead, have all Medi‑Cal beneficiaries statewide access dental services exclusively through FFS. A key component of the final deal between Newsom and Democratic lawmakers was how much new coronavirus relief California might receive this year from President Trump and Congress and what to do until it arrives. California Budget Includes Major Revenue Raisers and Other State Tax Law Changes. Percent. Gov. This report analyzes the Governor’s pharmacy‑related proposals that implicate Medi‑Cal and the Department of Health Care Services (DHCS), including (1) changes to facilitate the transition of Medi‑Cal pharmacy services from a managed care to a fee‑for‑service (FFS) benefit, which include proposed supplemental payments for clinics to mitigate associated financial losses, and (2) budget‑related legislation authorizing DHCS to collect rebates on drugs not paid for through Medi‑Cal. County Administration Performance Standards. …But Could Give State Greater Control Over Quality Incentives, Provided Most Managed Care Plans Pay FFS Rates. In Los Angeles County, about 10 percent of Medi‑Cal enrollees have opted to obtain their dental benefits through dental managed care. (The department already withholds Medi‑Cal payments to SNFs that are past due on QAF obligations.). Medi‑Cal Covers Dental Services, Predominantly on an FFS Basis. Gavin Newsom On California's Huge Budget Surplus, Recall Election ... California’s population shrank in 2020 for the first time in more than a century, dropping 0.46 percent, said estimates released Friday by the … The Mercury News. Ask the administration to comment on the current status of QAF collections and the potential budgetary impact of enhanced collection tools. California Budget 2020. Deductions for net operating loss, where deductions total more than taxable revenues, will be canceled for three years retroactive to Jan. 1 on net incomes of more than $1 million. The spending plan includes a list of more than $11 billion in spending cuts that will be reversed if at least $14 billion in new federal dollars arrive this fall. Recommend Approving in Concept. Recent estimates indicate that there are likely more than 1.5 million uninsured undocumented immigrants in the state, which represents as much as 50 percent of the state’s remaining uninsured. California Gov. Such payments—also known as capitated payments—also are intended to cover dental managed care plans’ costs of administering the benefit. The federal government pays for a portion of undocumented immigrants’ restricted‑scope Medi‑Cal services according to standard FMAP rules. Comparison of DHCS and LAO Estimates of Net Savings Under the Medi‑Cal Pharmacy Services Carve Out. Following implementation, what evidence exists on the impact of the new rate‑setting framework on SNF quality? Therefore, to receive federal approval, a state must prove to the federal government that the burden of paying a health care‑related tax does not fall too disproportionately on Medicaid as opposed to non‑Medicaid services. SACRAMENTO – Governor Gavin Newsom submitted his 2020-21 State Budget proposal to the Legislature today which makes responsible investments in the state’s economic future while tackling head-on persistent challenges facing the state. For 2020‑21, the Governor proposes half‑year funding of $26 million General Fund ($53 million total funds). Also increase authority to collect delinquent QAF. Despite it all, California managed to collect $10.5 billion more in taxes than predicted, putting the state on track for a $19 billion surplus to spend by … Because the MCO tax would increase federal Medicaid funding, it requires federal approval. Gavin Newsom and state Democratic lawmakers are at odds over a budget compromise that will be more pain than gain. These details could significantly affect the incentives created for SNFs that are paid the FFS rate. California Gov. Given the lower utilization, higher costs, and low participation where it is voluntary, dental managed care does not appear to be fulfilling the pilot’s legislative intent of achieving savings while ensuring access and quality. Governor Proposes Fully Moving SNF Benefit Into Managed Care. Governor Proposes Reauthorizing Rate‑Setting Framework and QAF, With Several Changes. by Laurel Rosenhall June 7, 2020 June 6, 2020. The Governor’s budget proposes $25. Local officials are already involved in this effort under the state-local partnership known as Project Roomkey, though the local effort in Los Angeles has struggled and Newsom’s push met with early resistance in other communities. Ten months into a pandemic that has overwhelmed hospitals and prompted government shutdowns that left millions of people out of work and forced many small businesses to close, California Gov. This means 340B discounts are passed along to the state in Medi‑Cal FFS. This report begins with some high‑level background on the Medi‑Cal program, followed by an overview of the major drivers of year‑over‑year spending changes in the Governor’s budget. What you need to know, California, Los Angeles get billions in federal relief money for pandemic costs, Caitlyn Jenner, longtime registered Republican, hedges on party status. Gavin Newsom discusses his revised 2020-2021 state budget during a news conference in Sacramento, Calif. Gov. The administration’s thinking in regards to timing of required revisions to the county Medi‑Cal administration budgeting methodology. 327. Allow DHCS to require SNFs to provide information about other entities or facilities that have certain financial relationships (such as being owned or operated by the same parent organization) in order for DHCS to offset Medi‑Cal payments to those entities to recover past due QAF payments. The Governor proposes to specifically require Medi‑Cal managed care plays to pay SNFs the rate determined under the proposed revised rate‑setting framework, unless the managed care plan and the SNF mutually agree to a different, higher rate. Additionally, we question whether the Governor’s proposed supplemental payments for clinics serve a public purpose in the long run, and recommend either making the payments temporary or, if made ongoing as proposed, tying them to quality and/or access improvements. Proposes Repurposing Temporary Positions Provided to Develop New Budgeting Methodology for Ongoing County Oversight Workload. Additional services will be offered to treat opioid use disorders. The Governor’s budget proposes $25.9 billion General Fund ($103.5 billion total funds) in 2020‑21, an increase of $2.9 billion (12.4 percent) over estimated 2019‑20 levels. Unprecedented for this stage of the budget process, the Assembly and Senate arein agreement on the State Budget for 2020-21. However, delaying the effective date for the carve out comes with significant challenges. Administration Has Submitted a Modified MCO Tax Proposal for the Federal Government to Consider. 9 b illion (excluding federal and bond funds in 2019‑20), an increase of 2 p ercent over revised totals for 2018‑19. To gain federal approval, the administration has modified the MCO tax proposal in a way that increases the net tax liability on a number of MCOs, specifically by lowering the enrollee threshold for taxation on non‑Medi‑Cal membership. The state also began implementing new rules for determining Medi‑Cal eligibility for most enrollees known as “modified adjusted gross income,” or MAGI. We recommend that the Legislature direct DHCS and counties to update the Legislature at budget hearings on current county performance and plans for changes to state oversight in the coming months. By the end of 2020, the COVID-19 pandemic eviscerated roughly 1.6 million jobs in California and slashed the value of business properties by more than 30%. Reports should compare spending on pharmacy services prior to and after the carve out, and include at least the following elements: Many systems changes need to be completed to ensure the smooth transition of pharmacy services from managed care to FFS. For more information on the reauthorized MCO tax, see our Budget and Policy Post: The 2019‑20 Budget: California Spending Plan—Health and Human Services. Pesticide Regulation. Provide a COLA for county administration. Over time, managed care plans may make arrangements with SNFs to pay different, higher rates than would be paid under FFS. Questions Remain About Administration’s Proposed Next Steps. California governor OKs budget closing $54.3 billion deficit. (Transitioning benefits from managed care to FFS is referred to as “carving out” a service.) In addition to providing health care services to Medi‑Cal enrollees, local governments also contribute toward financing the nonfederal share of cost in Medi‑Cal. The Governor proposes to reauthorize the rate‑setting system with several changes. Despite lower utilization, per capita Medi‑Cal spending is around 50 percent higher in dental managed care compared to dental FFS. (The modified MCO tax discussed earlier, however, could be approved under existing federal rules.) However, many questions remain about the proposal, such as how the proposed rate system would function in the managed care environment. Federal Government Rejected the State’s Initial Proposal for a Reauthorized MCO Tax. This decline in funding is Version number CQ2DDvMG2BB5g7vg K-12 EDUCATION MAY REVISION — 2020-21 33. approximately 23 percent of the 2019 Budget Act Proposition 98 funding level. Authorizing DHCS to consider international prices for drugs will not change this aforementioned authority. We describe these nonfederal funding sources below. Process 95 percent of discrepancies where county records are not reflected in MEDS to be effective at the beginning of the next month if received by the 10th working day or by the end of the month after the next month if received after the 10th working day. Further, the analytical basis for the state’s approach to budgeting for county administrative activities has significantly eroded. Figure 5 compares the fiscal impact in the first year of implementation. For many of the state’s supplemental payments, the state periodically seeks reauthorization from the federal government to continue the program. Under DHCS’ proposed time line, the department will outline an updated process for monitoring County Performance Standards during 2020 and would begin evaluating county performance relative to the standards beginning in January 2021. The downward adjustment primarily reflects (1) savings from reduced expected enrollment in the program and (2) a number of other, primarily technical adjustments that largely offset one another. by Laurel Rosenhall June 7, 2020 June 6, 2020. Overall Medi‑Cal Budget Picture. We believe such a change could result in state savings on prescription drugs, while also potentially streamlining state negotiations on drug prices. 30 Jun 2020 7:38 pm. Senate Bill 74 – 2020-21 Main Budget Bill I voted against SB 74 – the main budget bill. For financing mechanisms that are disallowed, the Legislature would need to make a choice as to whether to replace the non‑General Fund sources with General Fund, restructure the financing mechanism (where feasible) to make it compliant with the regulations (which would likely require either the state or other entities to increase their contribution toward Medi‑Cal costs), or reduce spending in the Medi‑Cal program to account for the lost funding. 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