ACP American College of Physicians - Internal Medicine - Doctors for Adults

ISSUE

SPECIFICS

Year 2000 GRADE

Comments

Access to care

1.Expanding Childrens

Health Initiative Program (CHIP)

C+

Attempts to simplify enrollment but well short of goal

Goal: All eligible children and their parents up to 250% of federal poverty level.

2.CHIP extended to parents

B

Plans to use surplus funds to expand eligibility

Goal: Subsidize enrollment in private non-MediCal plans

3. Prevent loss of federal funds for CHIP

A

Timely action preserves funds otherwise lost

Goal: Expand program by requiring the state to apply for the maximum amount of available federal funds.

4. MediCal physician fee schedule

B

First effort in a decade; but state still 44^th lowest reimbursement rate in nation; physician participation in program remains threatened

Goal: 80% of Medicare fee schedule as floor. This will result in more physicians being willing to participate in program.

Public Health

1. Tobacco funds

B

For the 2001 budget, Davis proposed spending $468 million from the tobacco settlement against tobacco companies on health-related programs. Previously, Davis said the settlement money should simply be dumped into the state's general fund with no strings attached.

Goal: Use funds exclusively for healthcare programs.

2. Elder abuse reporting

D

Well intended but creates dangerous potential of physician criminal liability

Goal: Revise law to place physician reporting responsibility more in line with the role of the physician in patient care — e.g., reporting those instances of abuse involving the health status of the patient.

Managed care

1. Medical group viability

D

Epidemic of contracting group bankruptcies due to pervasive under funding; health plans not held responsible for services provided

Goal: Actuarially sound capitation; reasonable arbitration/negotiation ability (e.g. AB32 -Richman)

2. Actuarially sound capitation

D-

Market share allows health plans to offer capitation rates which are below the cost to provide services.

Goal: Legislation to require actuarially sound capitation rates.

3. Independent review of health plan denials of care

A

New law in effect 2001 allows patient access to review of care denial

Goal: Implement in patient-friendly way with desired results, consumer confidence.

4. Access to fee schedule information

D-

Continued widespread health plan abuse of providers, unfair contracting and fee changes

Goal: Enforceable legislation and/or regulations with teeth

5. Medical Director Liability

D-

Out of state medical directors of health plans doing business in California are not held liable for making treatment decisions.

Goal: Require licensure by the Medical Board of California for medical directors.

State Budget Priorities

1. Funding for healthcare programs

C

Increased spending proposed for FY 2001-need to maintain increased funding proposed by Governor of $468 million in tobacco settlement money earmarked to expand health care programs including prostate and breast cancer treatment for the uninsured. Increased spending for Medi-Cal, California's health care program for the poor, will increase by

$204 million to $9.5 billion.

Goal: Support Governor’s proposed budget for healthcare.