Three Los Angeles ILCs, filed suit today, (July 2, 2014), to - TopicsExpress



          

Three Los Angeles ILCs, filed suit today, (July 2, 2014), to obtain court orders From: lynnscarman@hotmail To: [email protected], [email protected], [email protected], [email protected], nancybk@aol, blane10@juno, [email protected] CC: barnonhill@aol, nmazina@mazinalaw Sent: 7/3/2014 3:00:00 A.M. Pacific Daylight Time Subj: MEDICAID DEFENSE FUND RELEASE 7 2 14 MEDICAID DEFENSE FUND July 2, 2014 404 San Anselmo Ave. San Anselmo, CA 94960 Fax : (415) 256-9632 Email : lynnscarman@hotmail _nmazina@mazinalaw_ (mailto:nmazina@mazinalaw)   FOR IMMEDIATE RELEASE Three Los Angeles ILCs, -- independent living centers who assist persons with disabilities to live independently, -- filed suit today, (July 2, 2014), in Sacramento Superior Court, to obtain court orders, as soon as can be done, to stop the States Medi-Cal program from involuntarily enrolling 456,000 of the most elderly, frailest, disabled population in eight counties of California, – 200,000 in Los Angeles County alone, – into federal-and-state funded private managed care plans called Cal MediConnect for all their Medi-Cal and Medicare services. An endorsed filed copy of the suit, (Civil No. 34-2014-080001884), is attached. (Last attachment, on the right.) The ILCs plaintiffs are: - Communities Actively Living Independent & Free - Westside Center for Independent Living - Southern California Rehabilitation Services, Inc. The Independent Living Center of Southern California, Inc., is also supporting the state lawsuit, and is considering possible federal litigation in federal court to stop this program, if the state suit is not successful. This population is the elderly poor and persons with permanent disabilities, who receive health care services from both Medi-Cal and Medicare (and are called Medi-Medis or duals). WHO: The plaintiffs are: - Communities Actively Living Independent & Free Contact: Lillibeth Navarro, Ex. Director, lnavarro@calif-ilc - Westside Center for Independent Living Contacts: Alan Toy, [email protected] Neal Richman, [email protected] - Southern California Rehabilitation Services, Inc. Contact: James Baker, [email protected] - Nancy Becker Kennedy, Medicare and Medi-Cal beneficiary, in Los Angeles Email: nancybk@aol - Blane Beckwith, same, in Berkeley, California Email: blane10@juno NOTE: Independent Living Center for Southern California, Inc., (VanNuys), is supporting the action, and, is considering possible federal litigation, if needed. Contact: Norma Vescovo, Executive Director. [email protected]   The Los Angeles County Medical Association (LACMA) joined them as co-plaintiffs (through their own counsel), to stop the forced auto-enrollment of duals into the untried Cal MediConnect program for their Medicaid and Medicare services. Their counsel: Rockard J. Delgadillo, at _rdelgadillo@linerlaw_ (mailto:rdelgadillo@linerlaw) . Delgadillo was formerly City Attorney for Loss Angeles. Co-plaintiff MANUAL PUIG-LLANO, MD., a medical doctor specializing in ophthalmology in Chula Vista, is represented by the law firm, Hooper Lundy Bookman, P.C. (Mark A. Johnson, _mjohnson@health-law_ (mailto:mjohnson@health-law) ). The basis of the suit is that the state Medi-Cal agency -- Dept. of Health Care Services (DHCS) - is violating state protective laws, (Cal. Welf.& Inst.Code § 14182.17), which require that duals be able to keep their regular fee-for-service Medicare services, such as doctors and hospitals, outside of any Cal MediConnect plan. This statute requires DHCS to notify duals, 60 days before auto-enrollment, – in no more than 6th grade reading level, – which plainly state that they may opt out of Cal Medi-Connect for their Medicare services, by simply returning the notice form to indicate their opt out choice. Instead, the ILCs charge, DHCS is sending out notices which are so complicated few can figure them out, and prevent duals from opting out. The notices actively and deceptively prevent duals from keeping their chosen Medicare doctors and hospitals, by hiding the fact they have this option; and give them no opt out form to send back (as required by the above state law), so as to be able to continue to receive their Medicsre doctor and hospital services from their regular Medicare fee-for-service doctors and hospital. Instead, the forms deceptively mislead by presenting only a Choice Form (see attached press packet) which only gives a choice between managed care plans (not, any choice to opt out for Medicare services). With a joker (hidden in fine print) that if the dual checks a Medi-Cal managed care plan for their Medi-Cal services, that in that case, alone, will they be able to continue their regular Medicare doctors and hospitals, chosen by them, and without whom, many duals cannot survive outside a nursing home. Indeed, as stated by Alan Toy, Executive Director of Westside Independent Living Center: Ironically, we find that this form has been structured to prevent any real choice, and therefore threatens the basic rights of people in our community to choose the health coverage that best fits their needs. Lynn S. Carman, chief counsel for Medicaid Defense Fund: Contact: lynnscarman@hotmail Or, co-counsel Natallia Mazina: nmazina@mazinalaw which is filing the state suit for the ILCs, says that the MediConnect program is really a Medi Disconnect program, because the way it is being operated, is to disconnect the most needful from their tried and true fee-for-service specialists, and instead, lock them into managed care where the fewer and cheaper the services provided, the more profit for the managed care plans. Also, Senator Rockefeller, who wrote part of the Affordable Care Act under which a CMS sub-agency was created to facilitate integration of Medicare and Medicaid benefits, warned the Secretary of HHS in July 2012 that mass auto-enrollment of duals into unproven managed care would undoubtedly lead to disruptions in access to care, significant confusion among seniors and their families; and that duals should not be moved out of their current fee-for-service coverage without their affirmative consent. (I.e., that they opt in, rather than being auto-enrolled unless they succeed in opting out.) (See, Senator Jay Rockefeller July 12, 2012 letter to Secretary of HHS, in news packet attached.) Then, plans that were to provide MediConnect services to more than half the 456,000 test population in California, have already either been banned by the federal agency, (Centers for Medicare and Medicaid Services (CMS), for being a serious threat to the health and safety of duals, or postponed because they became bankrupt or lack the necessary data capability. Thus, - CMS banned the managed care plan in Orange County for constituting a serious threat to the health and safety of duals. (See, California Senate Budget and Health Oversight Committees report, at pages 14-15, Feb. 6, 2014, in the news packet). - Alameda Countys plan went bankrupt and currently cannot participate. - Santa Clara plans cannot participate for lack of data capability. - Further, CMS has banned auto-enrollment of duals into L.A. Care, in Los Angeles, – the largest municipal public health plan in the country, – for Medicare services, due to a low-performing icon (LPI) based on its Medicare quality scores. (Source: Ibd. at 13). In sum, the foregoing history of mandatory auto-enrolled managed care for duals is the background for the filing of this newest suit, to stop the entire program because of the illegal, misleading notices, contrary to the state Welf. & Inst. Code, which DHCS is passing out. (See also, the background for forced auto-enrollment of duals into managed care, which is in the attached news packet.) Contact person for this media release: Lynn S. Carman, lynnscarman@hotmail --Forwarded Message Attachment-- Rockefeller, MedPAC: Focus Dual Eligibles Overhaul On Care Over Costs By _Mary Agnes Carey_ (kaiserhealthnews.org/Reporters/MAC.aspx) , _Kaiser Health News_ (kaiserhealthnews.org/) , July 12, 2012 _Benefits_ (tilrc.org/assests/benefits.html) | _Home Page_ (tilrc.org/index.html) Sen. Jay Rockefeller, D-W.Va., has asked the Department of Health and Human Services to overhaul _a demonstration project_ (https://cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid -Coordination-Office/FinancialModelstoSupportStatesEffortsinCareCoordination ..html) aimed at changing the way millions of individuals who qualify for both Medicare and Medicaid receive health care. Sen. Rockefeller (Photo by Sen. Rockefellers office via Flickr) In a _letter to HHS_ (rockefeller.senate.gov/public/index.cfm/files/serve?File_id=09a71f20-77e5-4082-b78c-06b50f8f874d&SK=416A9A4E3615F7B9614 6811AB7464C97) , Rockefeller asked Secretary Kathleen Sebelius to “take immediate steps to halt this initiative as currently structured and to take the time necessary to develop a well-designed and thoroughly evaluated care coordination model for dual eligibles that meets the standards outlined in the law.” A release from Rockefeller’s office said the West Virginia Democrat authored language in the health law that created the Federal Coordinated Health Care Office, which is overseeing the duals demonstration. Finding high-quality, cost-effective ways to care for the 9 million people known as “dual eligibles” is among the brass rings of health policy. The population includes some of the sickest and poorest Americans who must navigate a fragmented system that can impede their care. Managing their care is important because they account for a disproportionate share of health spending: They account for approximately 20 percent of Medicare’s beneficiaries, for instance, but 31 percent of its spending, and 15 percent of Medicaid beneficiaries, but nearly 40 percent of that program’s spending, according to federal officials. Twenty-six states have submitted demonstration proposals to the Centers for Medicare and Medicaid Services to integrate care for three million duals, exceeding an earlier CMS target of one to two million beneficiaries, according to the Medicare Payment Advisory Commission, which has also expressed concerns about the project. The states’ proposals aim to better coordinate care and to reduce costs for both Medicare and Medicaid. Rockefeller said that any programs testing new models of care for duals should focus on providing better care rather than saving money, especially since “some states are proposing to enroll dual eligibles in plans that have not demonstrated their ability to deliver high quality care for this population.” Rockefeller also wrote that any new care coordination ideas should be rigorously tested before they are expanded to a state’s entire population of duals, and that duals retain all the rights and the same access to care as all other Medicare beneficiaries. HHS referred questions about the letter to CMS. In an email Wednesday, CMS spokesman Brian Cook said that the agency was “implementing important reforms that will improve care for these millions of Americans. Given the diversity and significant health care needs of dual eligibles, we recognize how critical it is to have beneficiary protections in place to achieve the highest-quality health care possible. We are taking the input from Congress, MedPAC, and others very seriously moving forward.” In a _separate letter_ (medpac.gov/documents/07112012_MedPAC_Comment_CMS_demos_states_integratedcare_dualeligibles.pdf) sent Wednesday to CMS, MedPAC members said the scope of demonstrations as proposed is too broad and that only a few health plans have experience managing the full range of services that many duals need, which include medical and long-term care and behavioral health services. MedPAC urged CMS to conduct the demonstrations in a limited number of states rather than enroll millions of beneficiaries at once. The panel also recommended that beneficiaries be notified about the demonstrations and be given the chance to opt out before they are automatically enrolled in a plan that they could opt-out of later. Sarah Barr contributed. capsules.kaiserhealthnews.org/index.php/2012/07/rockefeller-medpac-fo cus-dual-eligibles-overhaul-on-care-over-costs. --Forwarded Message Attachment-- Rockefeller, MedPAC: Focus Dual Eligibles Overhaul On Care Over Costs By _Mary Agnes Carey_ (kaiserhealthnews.org/Reporters/MAC.aspx) , _Kaiser Health News_ (kaiserhealthnews.org/) , July 12, 2012 _Benefits_ (tilrc.org/assests/benefits.html) | _Home Page_ (tilrc.org/index.html) Sen. Jay Rockefeller, D-W.Va., has asked the Department of Health and Human Services to overhaul _a demonstration project_ (https://cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid -Coordination-Office/FinancialModelstoSupportStatesEffortsinCareCoordination ..html) aimed at changing the way millions of individuals who qualify for both Medicare and Medicaid receive health care. Sen. Rockefeller (Photo by Sen. Rockefellers office via Flickr) In a _letter to HHS_ (rockefeller.senate.gov/public/index.cfm/files/serve?File_id=09a71f20-77e5-4082-b78 c-06b50f8f874d&SK=416A9A4E3615F7B96146811AB7464C97) , Rockefeller asked Secretary Kathleen Sebelius to “take immediate steps to halt this initiative as currently structured and to take the time necessary to develop a well-designed and thoroughly evaluated care coordination model for dual eligibles that meets the standards outlined in the law.” A release from Rockefeller’s office said the West Virginia Democrat authored language in the health law that created the Federal Coordinated Health Care Office, which is overseeing the duals demonstration. Finding high-quality, cost-effective ways to care for the 9 million people known as “dual eligibles” is among the brass rings of health policy. The population includes some of the sickest and poorest Americans who must navigate a fragmented system that can impede their care. Managing their care is important because they account for a disproportionate share of health spending: They account for approximately 20 percent of Medicare’s beneficiaries, for instance, but 31 percent of its spending, and 15 percent of Medicaid beneficiaries, but nearly 40 percent of that program’s spending, according to federal officials. Twenty-six states have submitted demonstration proposals to the Centers for Medicare and Medicaid Services to integrate care for three million duals, exceeding an earlier CMS target of one to two million beneficiaries, according to the Medicare Payment Advisory Commission, which has also expressed concerns about the project. The states’ proposals aim to better coordinate care and to reduce costs for both Medicare and Medicaid. Rockefeller said that any programs testing new models of care for duals should focus on providing better care rather than saving money, especially since “some states are proposing to enroll dual eligibles in plans that have not demonstrated their ability to deliver high quality care for this population.” Rockefeller also wrote that any new care coordination ideas should be rigorously tested before they are expanded to a state’s entire population of duals, and that duals retain all the rights and the same access to care as all other Medicare beneficiaries. HHS referred questions about the letter to CMS. In an email Wednesday, CMS spokesman Brian Cook said that the agency was “implementing important reforms that will improve care for these millions of Americans. Given the diversity and significant health care needs of dual eligibles, we recognize how critical it is to have beneficiary protections in place to achieve the highest-quality health care possible. We are taking the input from Congress, MedPAC, and others very seriously moving forward.” In a _separate letter_ (medpac.gov/documents/07112012_MedPAC_Comment_CMS_demos_states_integratedcare_dualeligibles.pdf) sent Wednesday to CMS, MedPAC members said the scope of demonstrations as proposed is too broad and that only a few health plans have experience managing the full range of services that many duals need, which include medical and long-term care and behavioral health services. MedPAC urged CMS to conduct the demonstrations in a limited number of states rather than enroll millions of beneficiaries at once. The panel also recommended that beneficiaries be notified about the demonstrations and be given the chance to opt out before they are automatically enrolled in a plan that they could opt-out of later. Sarah Barr contributed. capsules.kaiserhealthnews.org/index.php/2012/07/rockefeller-medpac-fo cus-dual-eligibles-overhaul-on-care-over-costs/ _Go to Benefits_ (tilrc.org/assests/benefits.html) _Go to Home Page_ (tilrc.org/index.html) _Go to Top of Page_ (tilrc.org/assests/news/0712news/0712bene12.html)
Posted on: Mon, 07 Jul 2014 01:22:52 +0000

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