Plaintiffs in Medi-Cal reimbursement case request rehearing
SACRAMENTO, Calif. — Plaintiffs in CMA et al. v. Douglas et al. have filed a request for a rehearing of the case on the heels of a reversal of the Federal District Court’s decision by a three-judge panel of the Ninth Circuit Court of Appeals.
The plaintiffs in the case — the California Medical Association (CMA), California Hospital Association (CHA), California Dental Association (CDA), California Pharmacists Association (CPhA), National Association of Chain Drug Stores (NACDS), California Association of Medical Product Suppliers (CAMPS), AIDS Healthcare Foundation (AIDS) and American Medical Response (AMR) — had 45 days from the day of the three-judge panel’s decision to ask for an en banc review. During that time, the injunction issued by the Federal District Court has remained in place.
“Cutting payment to Medi-Cal providers by 10% will have a huge impact on patient access to care,” stated Paul R. Phinney, CMA president. “The state is in much better fiscal shape now than when these cuts were initially proposed in 2011, and with millions of new Medi-Cal patients entering the program under the Affordable Care Act, the elimination of the Healthy Families Program and the shift of dual-eligible patients, we simply cannot continue to cut resources and expect successful implementation of health reform in California.”
Plaintiffs in CMA et al. v. Douglas et al. argue that reducing payments in the Medi-Cal system will force providers out of the program at a time when millions of new patients will be diverted into the Medi-Cal system.
CHA president and CEO C. Duane Dauner noted that the state’s acute care hospitals face an even more severe payment cut than other providers because the reductions are based on rates in effect in 2008-2009.
“Hospitals that operate skilled nursing units are facing a 25% cut in their Medi-Cal reimbursement,” Dauner stated. “These units provide complex medical care for elderly patients that is not available in any other care setting. If these cuts are implemented, access to care for thousands of elderly, frail patients will be compromised, and some rural or safety net hospitals may be forced to close.”
Tom Hayes, CEO of Eastern Plumas Health Care, noted that the Medi-Cal cuts would decimate hospital services in rural Plumas and Sierra Counties.
“These cuts will amount to a $2.4 million loss to our hospital if state officials go ahead with retroactive recoupment,” Hayes added. “To put this in perspective, over the past five years, our hospital’s average net income was $439,950. If we are required to pay this amount of money, it would not only cause us to close our skilled nursing facilities, it would cause the demise of our entire organization.”
CMA, CPhA and CDA successfully sued in the past to enjoin prior Medi-Cal cuts and expect to once again demonstrate that federal law, which ensures that Medi-Cal patients have equal access to health care, was not followed. That decision was made by the Ninth Circuit Court of Appeals.
“With the shift of 875,000 children from the Healthy Families Program to Medi-Cal as well as the implementation of the Affordable Care Act that will cover an additional 1.2 million children, the state’s attempt to cut reimbursement rates would harm patients’ oral health and their ability to access care,” stated CDA president Lindsey Robinson, a pediatric dentist. “California has among the lowest reimbursement rates in the nation, and this is not the time to make further cuts.”
"California is working hard to implement the Affordable Care Act, which includes moving 5 million Californians into the Medi-Cal system, plus another million children from Healthy Families into Medi-Cal," noted Jon Roth, CEO of the California Pharmacists Association. "If the Medi-Cal provider cuts are implemented, it will have a disastrous effect on real healthcare reform and will cause irreparable damage to California’s most vulnerable citizens. The California Pharmacists Association and other providers will continue to fight these cuts in order to protect access to care for all Californians."
Of added concern, the California Department of Health Care Services has repeatedly given numbers of practicing Medi-Cal physicians that are higher than the number of total physicians practicing in California. Plaintiffs raise this as a point of distress because it further shows that the state is unaware of the number of providers that patients are able to see.
“Cutting rates to Medi-Cal providers will impact the ability of Medi-Cal beneficiaries to access needed healthcare services,” stated Bob Achermann, CAMPS executive director. At the same time California is moving to implement the Affordable Care Act and transition existing beneficiaries to managed care plans they are endangering the ability of exiting Medi-Cal providers to participate in these programs.
“If affirmed, this decision will have a terrible impact on the health of Californians with HIV/AIDS,” added Tom Myers, AIDS Healthcare Foundation General Counsel. “Much of healthcare reform rests on expanding the number of people, including those with HIV/AIDS, on Medicaid, which due to these cuts will have even fewer doctors participating. This will further limit access, make people sicker, increase HIV infections in California, and undermine the very goals and purpose of healthcare reform.”
The injunction on the Medi-Cal cuts will remain in place until the full Ninth Circuit Court of Appeals has ruled.
“This is an important public policy issue that the 9th Circuit should review,” added Thomas R. Wagner, AMR Region CEO. “Reductions in Medi-Cal reimbursements for 911 emergency ambulance services may force municipalities to lower the high standards of EMS that Californians currently receive.”
The Federal District Court’s ruling in February of 2012 stated that, “California’s fiscal crisis does not outweigh the serious irreparable injury patients would suffer absent the issuance of an injunction.”
"Many Californians rely on services provided by community pharmacies, such as flu shots, medication counseling and health screenings. If implemented, these devastating Medi-Cal cuts could compromise patient health and access to pharmacy services, which also would drive up healthcare costs,” noted NACDS president and CEO Steve Anderson. "We are hopeful the Court will rule in favor of preserving patient access to pharmacy care."
Changing of the guard at 99¢ Only Stores as acquirer Ares Management fills top exec spots
CITY OF COMMERCE, Calif. — 99¢ Only Stores last week announced that Richard Anicetti has assumed the role of interim CEO. In addition, Michael Fung will join the company as interim chief administrative officer overseeing finance, information technology, real estate and various administrative functions of the company.
In connection with the foregoing changes, the original family management team Eric Schiffer, Jeff Gold and Howard Gold are no longer employed by the company.
"Since the first 99¢ Only store opened in 1982, the company has grown into one of the most impressive and differentiated extreme value retailers in the country," stated David Kaplan, chairman and senior partner of Ares Management, which acquired 99¢ Only Stores a year ago. "The Gold/Schiffer family has been instrumental in creating this valuable business and establishing the widely-admired culture at 99¢ Only Stores. As a result, the company has flourished and today is positioned for continued growth and success."
Anicetti has served on the board for the past eight months, and brings more than 20 years of senior management experience in the food retail business, including serving for eight years as president and CEO of Food Lion grocery stores, a subsidiary of the Delhaize Group. In addition, he has been a member of the boards of directors at several other food industry companies, the company noted.
Fung brings more than 30 years of experience in value-oriented retail and finance, most recently serving as SVP and CFO of Walmart Stores’ U.S. operations.
"Over the next several weeks, Mike and I will be working with other members of the senior management team and the board of directors to ensure a smooth transition," Anicetti said. "We expect that business will continue as usual, and we are excited to get to work on fulfilling the company’s vision as one of the leading extreme value retailers in the country."
99¢ Only Stores also reported continued revenue growth for the holiday season and the third quarter of fiscal 2013 ended Dec. 29, 2012. Net sales increased $35.6 million, or 8.8%, to $439.5 million for the third quarter of fiscal 2013. Same-store sales, calculated on a comparable 13-week period, increased 4.3%.
Meijer digital coupon program hits 1 million subscribers
GRAND RAPIDS, Mich. — Meijer’s digital coupon program has reached 1 million subscribers, the mass merchandise chain said.
Meijer announced that the program, called mPerks, generated 101,000 new members, 13.7 million clipped offers and more than $5 million in savings in December.
"Meijer is always looking for ways to save our customers money, and the mPerks program is doing just that in an extremely convenient way," Meijer VP customer marketing and loyalty Michael Ross said. "It’s great to see so many of our customers take advantage of this money-saving program."
Meijer launched the program in 2010 and plans to expand it with a coupon rewards program later this winter.