Governor’s revised budget contains no significant increases for Medi-Cal -AND- How first responders can keep patients out of the ER

CAL/AAEM News Service calaaem.news.service1 at gmail.com
Tue Jun 9 23:28:02 PDT 2015


 
May 18, 2015
 
Governor’s revised budget contains no significant increases for Medi-Cal
 
 
CMA Alert


On May 14, Governor Jerry Brown released his revised budget for fiscal year 2015-16, which includes an increase in overall expenditures from the General Fund to $115.3 billion, but does not include any significant increases to Medi-Cal provider reimbursement rates. Overall, the revised plan contains $169 billion in total state spending, up from $164.7 billion in January. The total includes $46.9 billion in special funds and $6.8 billion in bond funds.

The California Medical Association and other stakeholders continue to point out that beneficiaries of the Medi-Cal program are having trouble accessing needed care. Despite these concerns, the Governor is proposing an additional $200 million to provide full-scope Medi-Cal coverage, in-home supportive services and other benefits for the individuals who are covered by President Obama’s executive orders relating to undocumented immigrants. Under existing California law, an individual who is lawfully present in the state is entitled to certain health and social services, but the May budget revision assumes the legal challenges surrounding the President’s actions will ultimately be upheld.

The Brown budget estimates that the Medi-Cal program will serve 12.4 million people by the middle of 2016, an increase of 200,000 people since January and includes an additional $2.9 billion, split evenly between the state and the federal government, which would cover the enrollment increase. Brown also includes costs ($14 billion) for adults without children and parents/caretakers with incomes up to 138 percent of the federal poverty level. However, currently, the cost for this population has been financed entirely by the federal government (until the 2016-17 fiscal year).

The budget revision will open weeks of negotiations at the Capitol before adoption of a spending plan in June. By law, the budget must be passed by the Legislature by June 15.

Major spending initiatives outlined by the Governor outside of health care include an increase in the state’s deposit into the Rainy Day Fund to $633 million; an additional $633 million to pay down existing debts and liabilities; the creation of the California Earned Income Tax Credit for low-income Californians, at the cost of $380 million to the state; increases to the Proposition 98 General Fund spending by $5.5 billion for K-12 schools and community colleges; an increase of 4 percent for each of the next four years and additional funding to help with University of California employee pension obligations, in exchange for the UC agreeing to cap tuition for in-state students; and an additional $2.2 billion of one-time funding to continue the state’s response to drought impacts program.


May 18, 2015
 
How first responders can keep patients out of the ER
 
 
Fierce Healthcare


By Leslie Small

As hospitals look for ways to stem emergency department (ED) overuse in order to reduce costs and improve outcomes, their efforts are increasingly getting a boost from an unlikely source--first responders.

The city of Reno, Nevada, for example, has used a $9.8 million federal grant to pursue an overhaul of its emergency medical services, Kaiser Health News reports. Through the program, paramedics are trained to conduct home visits and redirect certain patients to urgent care or mental health clinics, and a phone line run by nurses answers callers' health questions as a 911 alternative.  

Reno's efforts have saved $5.5 million in 2013 and 2014, and helped avoid 3,483 ED visits, 674 ambulance trips and 59 hospital readmissions, according to preliminary data from a University of Nevada, Reno, evaluation of the program cited by KHN.

If Medicare was able to pursue such an effort program-wide, the federal government could save $560 million, a number that could double if private insurance companies could reimburse emergency medical services to redirect non-emergency cases, a 2013 study found. Indeed, similar federally backed efforts are under way in Arizona, Connecticut and Washington state, according to KHN.

In Denver, the South Metro Fire Rescue Authority chose to revamp the ambulances themselves, FierceHealthFinance has reported. It deploys crossover SUVs known as "mobile care units" to treat non-critical patients on-scene. The idea of house calls also has caught on with hospitals, as New York City's Mount Sinai offers a "mobile acute care program" to treat certain patients in the comfort of their own homes.

There are still some barriers to these types of programs, however. In some cases first responders require government waivers or changed laws to allow them to expand their roles, and industry groups such as a the American Nurses Association have questioned whether even specially trained paramedics are qualified to provide direct care, according to KHN.

In Reno, though, emergency medical technicians are trained to take the most serious patients to the hospital, and also will transport patients there any time they request it, the article states.
 
 
 
Bryan Sloane
Deputy Editor, CAL/AAEM News Service
 
Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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