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Highlights of Cuts Proposed to the Medi-Cal Program in The Governor's May Revise
PCR Scholarship to NIWI
Nurse in Washington (NIWI) Program Scholarship Information
DCA Enforcement Progress Report
New newsletter from our congressional lobbyist now available
The fight for Health Care Reform needs your support!
Governor Schwarzenneger Signs Budget; Uses Blue-Pencil Authority for Additional Cuts
New California rules re MRSA
Pacific Coast Region Government Affairs Update, 3/14/2009
Suggested Letter for Nevada constituents to Noridian
Contact your Senator, Congressmen/women or Representative
It's Easy To Be An Activist
Highlights of Cuts Proposed to the Medi-Cal Program in The Governor's May Revise
Following are highlights of the cuts proposed to the Medi-Cal program in the Governor's May Revise. I have also made some notes in italic based on a conversation with the Department of Health and Human Services. Click here to view the full section of the Governor's proposal pertaining to Medi-Cal.
The Governor's Budget included $750 million in savings from a Medi-Cal Cost · Containment proposal. The May Revision includes the following specific savings proposals to contain costs in the Medi-Cal program for $523 million (proposed policies require a state plan amendment or federal waiver and include the federal stimulus impact):
- Limit services and establish utilization controls for $90.2 million
Eliminate certain over-the-counter drugs (such as acetaminophen or cough and cold medicine) and nutritional supplements ($13.0 million). This will not include liquid Tylenol
Establish a maximum annual benefit dollar cap on hearing aids at $1,510, durable medical equipment at $1,604, incontinence supplies at $1,659, urological supplies at $6,435, and wound care supplies at $391 ($3.8 million). Note: The cap on DME will not include compressed oxygen or respirators. Also exempt from the caps will be some disposables for tracheotomy and ostomy patients. Additional exemptions for long-term care, pregnancy related treatment and beneficiaries under 21 years of age.
Limit prescriptions (except life-saving drugs) to six per month ($4.2 million) - Prescriptions will also have a mandatory co-payment of $3 per preferred prescription and $5 per non-preferred prescription.
Limit the number of physician or clinic visits to 10 per year ($69.2 million). The proposed limits are consistent with the aggregate utilization of these services at the 90th percentile of Medi-Cal enrollees. |
PCR Scholarship to NIWI
PCR is pleased to support attendance to NIWI by offering a $1500 scholarship. This program will be held March 14-16, 2010 in Washington, D.C. It is an exciting time to go to Washington DC! Application is available - http://www.pcr.org/scholarship.html. Please note the eligibility criteria. Due date is Jan 8, 2010. The winner will be notified by Jan 22, 2010. For the PCR scholarship, please send your application and a request letter detailing why this program would benefit you and how you could benefit our membership by your attendance. Send application to Judy Harwood judyh03@sbcglobal.net at the address printed on the application.
For more information about the Nurse in Washington Internship Program, you may call the Nursing Organizations Alliance at 859/514-9157 for a brochure or go to their website at www.nursing-alliance.org/niwi.cfm
The Nursing Alliance also offers a full scholarship to attend NIWI (Nurse in Washington Internship) each year. Application & more information can be read on the Nursing Alliance website: www.nursing-alliance.org/content.cfm/id/niwi#scholarship
Application to attend must be accomplished prior to scholarship process: www.amrms.com/ssl/alliance/2010niwi.cfm |
Nurse in Washington (NIWI) Program Scholarship Information
To All WOCN Members:
We are pleased to announce the availability of WOCN NIWI Tuition Scholarships to assist Region/Affiliate members attend the Nurse in Washington Internship Program. These scholarships cover the $725 cost of registration. This program will be held March 14-16, 2010 in Washington, D.C. Please note that five partial scholarships will be awarded this year; compensation of the $725 registration fee only. It is hoped that, through the availability of these scholarships, your Region/Affiliate will be better able to co-sponsor and send individuals to this worthwhile educational program. The Nurse in Washington Internship Program offers an intense learning experience for WOCN leaders interested in becoming more involved in the legislative and regulatory aspects of healthcare. The WOCN NIWI Tuition Scholarship Application may be downloaded from the WOCN webpage or may be obtained by calling the WOCN National Office at: (888) 224-9626. The application deadline is December 30, 2010, so please promptly complete and return your application to: WOCN 15000 Commerce Parkway Suite C Mt. Laurel, NJ 08054 Scholarship winners will be notified by the end of January 2010. For more information about the Nurse in Washington Internship Program, you may call the Nursing Organizations Alliance at (859) 514-9157 for a brochure or go to their website at www.nursing-alliance.org/niwi.cfm Good luck. Hope to see you in Washington, D.C. in March 2010. |
DCA Enforcement Progress Report
Governor Schwarzenegger has mandated that all healing arts boards at the Department of Consumer Affairs (DCA) are to overhaul the enforcement and disciplinary processes and the department is heeding this call. DCA will continue to make changes to ensure consumer protection is the number one priority for the Board of Registered Nursing and all of its health-related boards and bureaus. This new report represents the DCA's commitment to consumer protection; it is also an effort to increase transparency and awareness of all enforcement actions currently underway at DCA and it will issue the Enforcement Progress Report on a monthly basis to document progress on enforcement reform.
You can view DCA's Enforcement Progress Report at the following link: www.dca.ca.gov/about_dca/epr_1.pdf
- California Board of Registered Nursing |
Bryan Cave Health Reform Update

October 13, 2009, Issue 20
Click here to download the lastest newsletter (PDF format) from our congressional lobbyist with an update on health care reform and where the legislation is at. |
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August recess is looming, health care negotiations are taking on increased urgency, and the stakes are high. Senate Finance Committee negotiations continue, their current draft reportedly doesn't include a public insurance plan option. House Energy and Commerce Committee leadership bridged an impasse with conservative democrats and resumed consideration of the bill - which they hope to complete today. While the progress is promising, the agreement that was reached seriously weakened the public plan provisions in the bill.
We still have a long way to go before any of these plans are finalized, but the next few weeks are a critical time what your Members of Congress hear this month will shape the debate when they reconvene in September.
We need you to help make sure that momentum isn't lost, and so that real insurance reform including a meaningful public plan option - remains on the table. |
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Write your Members of Congress Today
There is strength in numbers and Congress has taken notice of the role nurses are playing. Write to your Members of Congress and let them know how important real health care reform is to you and your patients. Urge them to pass health insurance reform that includes a strong public plan option this year!
Kind regards,
The Health Care Reform Team ANA Government Affairs |
 July 29, 2009
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Governor Schwarzenneger Signs Budget; Uses Blue-Pencil Authority for Additional Cuts to Health and Human Services
Yesterday, July 28, Governor Arnold Schwarzenegger signed ABX4 1 (Evans) and 28 budget trailer bills which were all a part of a $24 billion "budget solution." However, the Legislature did not approve the Big 5's package in its entirety, prompting Schwarzenegger to use his veto pen to eliminate an additional $489 million in spending. Below is a summary of the impact the line item vetoes have on aging services providers in California:
California Department of Aging - Reduction of $6,160,000 and 0.5 personnel from the Linkages Program ($3,879,000) and the Community-Based Services Programs ($2,281,000). The governor noted, "Funding of these non-mandated cannot be continued due to the state's severe budget constraints."
Alzheimer's Research Centers - Additional reductions to ARCC's in the amount $80,473,000 bringing the total reduction to $143,440,000. Budget adjustments agreed to by the Legislature that affect California aging services providers include:
Department of Social Services - Community Care Licensing Division - Includes a 10% increase in licensing fees for Residential Care Facilities for the Elderly.
Medi-Cal Skilled Nursing Facilities - $96.4 million in budget solutions result by expanding the amount of revenue which the AB 1629 fee is assessed to include Medicare revenues ($6.4 million), and suspending the estimated 5% statutory rate adjustment for AB 1629 skilled nursing facilities and non-AB 1629 intermediate care providers.
Adult Day Health Care - Limits services to no more than 3 days per week and freezing program rates as of August 1, 2009 and performing on-site treatment authorization request reviews. Reforms also include the authorization of the establishment of a definition of medical acuity (necessity), and direct a stakeholder workgroup process to proceed with implementation aspects of the definition.
Additional Medi-Cal Reforms - Authorizes the Department of Health Care Services broad authority under a demonstration project or waiver to utilize managed care or other specialized delivery systems.
Supplemental Security Income/State Supplementary Payment (SSI/SSP) - A reduction of $5 per month for individuals and a reduction of approximately $82 per month for couples to the federal minimum.
Cost-of-Living Adjustments (COLAs) - Eliminates automatic statutory COLAs for IHSS and Department of Developmental Services programs.
In-Home Supportive Services (IHSS) - A $263,500,000 reduction which includes fraud prevention ($130 million), limitation of services ($79.2 million), eliminating state share-of-cost contributions ($41.1 million), and reducing IHSS Public Authority administrative funding ($13.3 million). Reform measures include:
Additional information on the budget can be found on the California Department of Finance's website. For more information, contact Eric Dowdy, Associate Director of Public Policy at edowdy@aging.org. | |
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New California rules re MRSA
Gov. Arnold Schwarzenegger (R) signed two measures that will increase the state's scrutiny of hospital-acquired infections.
Under SB 1058 by Sen. Elaine Alquist (D-San Jose), hospitals will have to:
- Screen high-risk patients for methicillin-resistant staphylococcus aureus within 24 hours of admission to the hospital; and
- Report rates for the most serious infection outbreaks to the state.
The law will take effect next year, and the state Department of Public Health will begin posting infection rates for individual hospitals online in 2011.
In addition, SB 158, by Sen. Dean Florez (D-Shafter), will require hospitals and skilled nursing facilities to develop patient safety plans and new staff training procedures aimed at preventing hospital-acquired infections (Schultz, Fresno Bee, 9/25).
Here is the article - www.californiahealthline.org |
Suggested Letter for Nevada constituents to Noridian, re nonpayment of multi layer compression wraps.
Below is a suggested letter that Nevada constituents may send to their CMS physical Intermediary, Noridian, re nonpayment of multi layer compression wraps. This issue on compression wraps was presented in the spring and is still current as Noridian has not yet backed off from its claim that these wraps "can be safely applied by family members". Any Nevada member who has not contacted Noridian is encouraged to do so.
Noridian Administrative Services Medicare B P.O. Box 6711 Fargo, N.D. 58108-6711
To Whom It May Concern:
I am writing in response to your recent billing clarification regarding high compression bandage systems. I am a certified wound nurse and have clinical experience with these multiplayer wraps. From my personal experience in caring for patients with venous stasis leg ulcers, the suggestion that the patient and/or caregiver can safely apply these products independently is simply unfounded.
Sustained, graduated compression delivered by the multiplayer wraps is more therapeutic. The disadvantage is that the application of them is actually more complex than an Unna boot and requires advanced skill, training and experience of a health care professional. My rationale is as follows:
An Unna boot delivers a pressure range between 12-18 mmHg. When applied to a leg with a venous ulcer, the main function is the protection of the wound with the application of minimal compression. Ideally, the most effective therapeutic compression to treat venous ulcers requires 25-45 mmHg at the ankle reducing to 15-20 mmHg at the knee.
Sustained, graduated compression delivered by a multiplayer-wrap is a more complex procedure than the application of an Unna boot. There is an application of multiple layers, usually 3-4 layers. Each layer is applied with a different technique and pressure such as spiral or figure-eight. Additionally, each layer must be applied in a specific order as instructed per the manufacturer's recommendations. Evidence has shown that the effectiveness of these wraps is dependent upon the training, skill and experience of the health care professional applying the compression. Application of this system requires more time, skill and training when compared to the application of an Unna boot.
Because the sustained, graduated compression wrap delivers a high amount of pressure, confirmation of adequate circulation is required before and after application. This is more critical than with the Unna boot application and requires more advanced assessment skills of a health care practitioner.
Because venous insufficiency can result in very delicate skin, maceration and dermatitis, additional skin preparation is usually needed with emollient lotions, steroid creams or barrier ointments prior to the application of a sustained, graduated compression wrap. The clinical judgments of the health care professional in this regard are necessary to prevent further skin injury.
The decision by Noridian to deny reimbursement for these wraps as not medically reasonable and necessary because patients and/or their caregivers can independently apply them is not based in fact. I am asking for a reconsideration of this ruling. |
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