HomeMy WebLinkAbout11.24.20 FW_ SYASL COVID-19 Update
From:Ring, Brian
To:Alpert, Bruce;Bennett, Robin;Clerk of the Board;Connelly, Bill;Cook, Holly;Lambert, Steve;Lucero, Debra;
McCracken, Shari;Paulsen, Shaina;Pickett, Andy;Ring, Brian;Ritter, Tami;Rodas, Amalia;Sweeney, Kathleen;
Teeter, Doug
Cc:Pickett, Andy;Snyder, Ashley
Subject:FW: SYASL COVID-19 Update
Date:Tuesday, November 24, 2020 4:54:49 PM
Attachments:SYASL COVID-19 Update 11.24.20.pdf
Good afternoon Board – FYI.
Brian Ring
Assistant Chief Administrative Officer
Administration
25 County Center Drive, Oroville, CA 95965
From: SYASL County Info <SYASLCountyInfo@SYASLpartners.com>
Sent: Tuesday, November 24, 2020 3:59 PM
To: SYASL County Info <SYASLCountyInfo@SYASLpartners.com>
Subject: SYASL COVID-19 Update
ATTENTION: This message originated from outside Butte County. Please exercise judgment before opening
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attachments, clicking on links, or replying.
To: County Administrative Officers and Interested Parties
From: Paul J. Yoder and Karen Lange
Date: November 24, 2020
RE: SYASL COVID-19 Update
Please find attached our daily SYASL COVID-19 update.
-Paul and Karen
COVID-19 Updates
www.covid19.ca.gov
November 24, 2020
Newsom Administration - Resources / Mutual Aid / Executive Orders
Today, California Health and Human Services Secretary Dr. Mark Ghaly expressed continued
concern over rising COVID-19 case rates. He urged Californians to be mindful during the
Thanksgiving holiday, consider alternative plans, eat outdoors, and adapt as necessary to keep
physically distanced and mitigate spread.
He also provided an update on the County Tier status as of today:
o Purple: 45 (back to Purple: Colusa, Del Norte, Humboldt, and Lassen)
o Red: 8 (back to Red: Calaveras)
o Orange: 5 (back to Orange: Alpine, Mariposa)
o Yellow: 0
here, and SYASL staff notes here.
Also today, Governor Newsom issued the States first Innovation Impact Report highlighting
public-private-partnerships that have contributed S-19 response,
and more. View here.
Please check the California Department of Public Health website here for the latest guidance
documents.
Vote Safe California
CalMatters has obtained documents that provide a behind-the-scenes look at the controversial
contract for Vote Safe California, view here.
Legislative / Budget News
Yesterday, the Senate Health Committee held an informational hearing: COVID Care: Role of
Private Insurance. You may view hearing materials here, and SYASL staff notes here.
-19 here page for updates.
The LAO has been releasing a series of reports regarding Federal actions affecting California
related to developments around COVID-19. View here.
COVID CARE:
ROLE OF PRIVATE HEALTH INSURANCE
November 23, 2020
1:30 pm
Senate Chamber
I. Opening Remarks
II. COVID-19 Testing Requirements, Guidelines, and Cost
Surprise COVID Bill
David Sharp, Resident of Alameda County
Federal and other states
Sabrina Corlette, J.D., Research Professor, Center on Health Insurance Reforms,
Georgetown University McCourt School of Public Policy
California
Sarah Ream, Acting General Counsel, Department of Managed Health Care
Bruce Hinze, Senior Health Policy Attorney, California Department of Insurance
Kathleen Jacobson, MD, Center for Infectious Disease, California Department of
Public Health
III. Experience on the ground
Kelsey R. Waldronalth Consumer Center
William M. Isenberg, M.D., PhD, Chief Quality & Safety Officer, Sutter Health
Dierdre "Dede" Kennedy, President, BenAssist Health Insurance Services, Chair,
Legislative Committee, Los Angeles Association of Health Underwriters
Trina Gonzalez, Vice President, Policy, California Hospital Association
William Barcellona
Kristi Foy, Executive Director, California Clinical Laboratory Association
Nick Louizos, Vice President of Legislative Affairs, California Association of
Health Plans
IV. COVID-19 Vaccines and Treatment
Federal and other states
Sabrina Corlette, J.D., Research Professor, Center on Health Insurance Reforms,
Georgetown University McCourt School of Public Policy
California
Sarah Ream, Acting General Counsel, Department of Managed Health Care
Bruce Hinze, Senior Health Policy Attorney, California Department of Insurance
Tricia Blocher, Deputy Director, Emergency Preparedness Office, California
Department of Public Health
V. Experience on the ground
David Lubarsky, M.D., MBA Chief Executive Officer, UC Davis Health & Vice
Chancellor, Human Health Sciences and Timothy E. Albertson, M.D., M.P.H.,
Ph.D. Distinguished Professor and Chair, Department of Internal Medicine and
Principal Investigator for the Pfizer COVID-19 vaccine trial at UC Davis Health
Trina Gonzalez, Vice President, Policy, California Hospital Association
Jeanette Thornton, Senior Vice President of Product, Employer, and Commercial
Policy, Americas Health Insurance Plans
Diana Douglas, Policy and Legislative Advocate, Health Access California
VI. Public Comment
*Tenga en cuenta que los documentos traducidos quizá no se actualicen tan rápido
como las versiones en inglés.
California tiene un proyecto para reducir la COVID-19 en el estado que incluye criterios
revisados para reducir y ajustar las restricciones en las actividades. Se asigna un nivel
a cada condado de California de acuerdo con los resultados positivos de las pruebas y
el índice de casos ajustado para la asignación del nivel. Además, una métrica de
equidad en materia de salud entró en vigor el 6 de octubre de 2020.Para poder avanzar
al siguiente nivel menos restrictivo, cada condado tendrá que cumplir con una métrica
de equidad o demostrar inversiones destinadas a eliminar las disparidades en los
niveles de transmisión de COVID-19, según su tamaño. La Métrica de Equidad en
Materia de Salud de California está diseñada para ayudar a guiar a los condados en
sus esfuerzos constantes por reducir los casos de COVID-19 en todas las comunidades
y requiere de esfuerzos más intensos para prevenir y mitigar la propagación de la
COVID-19 entre los californianos que se han visto afectados de manera
desproporcionada por esta pandemia.
Actualizaciones a partir del 11/16/2020:
Debido al reciente aumento sin precedentes de la tasa de aumento de casos, a
pesar de la estrategia del proyecto que se describe a continuación, los
siguientes cambios están en vigor hasta nuevo aviso:
o La asignación de niveles puede llevarse a cabo cualquier día de la
semana y puede realizarse más de una vez por semana si el CDPH
determina que los datos fiables más recientes indican que se necesita
una acción inmediata para abordar la transmisión de la COVID-19 en un
condado.
o Es posible que los condados retrocedan más de un nivel si el CDPH
determina que los datos justifican una intervención más intensiva. Las
consideraciones clave incluirán la tasa de aumento de nuevos casos o los
resultados positivos de las pruebas, datos más recientes como se indica
a continuación, la capacidad de la salud pública y otros factores
epidemiológicos.
o Se utilizarán los datos fiables más recientes para realizar la evaluación.
o Ante las circunstancias extremas que requieren una acción inmediata, los
condados deberán aplicar cualquier cambio de sector al día siguiente del
anuncio del nivel.
Se actualizó la Tabla de datos del proyecto de California (Excel) para mostrar el
estado del nivel del condado, la fecha de asignación del nivel, la tasa de casos
ajustada para la asignación del nivel y la cantidad de resultados positivos de las
pruebas.
Las solicitudes de los condados para la asignación de niveles no mantendrán al
condado en el nivel actual durante la asignación; además, debido al entorno
actual de rápido aumento de casos y transmisión generalizada de la enfermedad
en todo California, es poco probable que se aprueben las solicitudes de
asignación de niveles, a menos que se presenten circunstancias y datos únicos
y extremos que justifiquen cómo el condado no se ve afectado por los aumentos
en todo el estado.
Más información sobre el proyecto:
Consulte el estado de las actividades de su condado
Conozca qué actividades y negocios están abiertos en los cuatro niveles(PDF)
Obtenga más información sobre la Métrica de Equidad en Materia Salud de
California y los Planes de inversión en equidad específicosde cada condado
Solicitud de adjudicación del nivel del condado
Explore los datos completos por condado: Tabla de datos del proyecto de
California(Excel)
Encuentre las tablas de datos archivadas del proyecto de California
Proyecto para una economía más segura| Para otros idiomas, visite
nuestrapágina de documentos multilingües.
Plan para reducir la COVID-19 y acomodar las actividades
permitidas en el sector con el fin de mantener la salud y
seguridad de los residentes de California
Esta guía detalla la estrategia actualizada para progresar de manera segura con la
apertura de más negocios y actividades teniendo en cuenta la pandemia. La estrategia
informada en esta guía se desarrolló teniendo en cuenta el mayor conocimiento sobre
las vulnerabilidades en la transmisión de la enfermedad, así como los factores de riesgo,
y tiene los siguientes objetivos:
1.Avanzar con las fases según los niveles de riesgo y con un tiempo apropiado
entre cada fase y en cada condado, para poder evaluar detenidamente los
impactos de cualquier cambio.
2.Reducir de manera resolutiva la transmisión de casos al mínimo posible en todo
el estado para que la potencial carga de la gripe y la COVID-19 a finales del
otoño y durante el inverno no generen complicaciones en la capacidad del
sistema de atención médicade administrar el espacio, los insumos y el personal.
Además, como el clima frío hace que más actividades se realicen bajo techo, los
bajos niveles de transmisión en la comunidad reducirán la probabilidad de que
se produzcan brotes importantes en estos entornos más riesgosos.
3.Simplificar la estrategia y establecer objetivos claros sobre la transmisión de la
enfermedad en los condados para el trabajo futuro.
Estrategia en niveles
Esta estrategia detalla las medidas que cada condado debe tomar, de acuerdo con los
indicadores que analizan la carga de la enfermedad, las pruebas y la equidad sanitaria.
Un condado puede optar por ser más restrictivo que esta estrategia. Esta estrategia
también destaca las señales de preocupación, como el impacto en la capacidad de la
atención médica que puede atenuar la intervención. Esta estrategia reemplaza a las
métricas anterioresde monitoreo de datos del condado. Amedida que la pandemia de
la COVID-19 continúe siendo una situación en desarrollo y haya nueva evidencia y
conocimientos al respecto, el Departamento de Salud Pública de California (CDPH, por
sus siglas en inglés), en colaboración con otros funcionarios estatales, continuará
reevaluando las métricas y los límites.
Consulte en la siguiente tabla las métricas de la estrategia establecidas según los
niveles basados en el riesgo de transmisión comunitaria de la enfermedad. El cálculo
de las métricas se describe en el Apéndice 1.Consulte la descripción de la métrica de
equidad en materia desaluden la página de Métrica de equidad en materia de salud.
Mayor riesgo Menor riesgo
de transmisión comunitaria de la enfermedad***
Nivel 1Nivel 2Nivel 3Nivel 4
PropagadoSignificativoModeradoMínimo
Medida
Índice de casos >74-71-3.9<1
ajustado según
el nivel**
(Índice cada 100,000
personas*, excepto
los casos en
prisiones^; promedio
de 7 días con retraso
de 7 días)
Resultados positivos >8%5-8%2-4.9%<2%
de las pruebas^
(Excepto los casos en
prisiones^; promedio
de 7 días con retraso
de 7 días)
Las métricas con valores mayores o menores que los puntos de división de los niveles
por 0.05 se redondearán hacia arriba o hacia abajo, implementando las reglas de
redondeo convencionales.
^No incluye los reclusos estatales y federales, losdetenidos encentros de detención del
Servicio de Inmigración y Control de Aduanas (ICE),los reclusos del hospital estatalni
los detenidos en el Servicio de Alguaciles de los Estados Unidos.
*Denominadores de población del Departamento de Finanzas: Proyecciones de la
población del estado:Población total por condado -Tabla P-1
**El índice de casos se determinará según los casos confirmados por PCR.
*** Se asignará un nivel a los condados según dos métricas: los resultados positivos de
las pruebas y el índice de casos.Los condados grandes con más de
106,000habitantes también deben cumplir con la métrica de equidad en materia de
salud que se describeen la página de la métrica de equidad en materia desalud, para
avanzar a un nivel menos restrictivo.
El índice de casos se ajusta según el volumen de pruebas cada 100,000habitantes,
como se describe a continuación. Debidoa la variabilidad de los datos, este ajuste no
aplica a los condados pequeños (es decir, los que tienen una población inferior a
106,000habitantes).
A medida que los condados se concentran en realizar más pruebas en sus cuartiles de
equidad en materia de salud y en incentivar la apertura de escuelas, es posible que
tengan una mayor cantidad de casos. Queremos evitar que se detenga el aumento de
pruebas, dado que los resultados positivos son pocos y se dispone de capacidad
suficiente para rastrear los contactos estrechos e implementar el aislamiento. Por lo
tanto, aumentaremos el ajuste para que se realice un mayor volumen de pruebas.
Para los condados que tienen un volumen de pruebas superior a la mediana del
estado, el factor es inferior a 1, el cual disminuye de manera lineal de 1.0 a 0.5,
a medida que el volumen de pruebas aumenta al doble de la mediana del
estado. Elfactor permanece en 0.5si el volumen de pruebas es superior al doble
de la mediana del estado.
Para los condados que tienen un volumen de pruebas inferior a la mediana del
estado, el factor es superior a 1, el cual aumenta de manera lineal de 1.0 a 1.4, a
medida que el volumen de pruebas disminuye de la mediana del estado a cero.
Sinembargo,este ajuste para el volumen bajo de pruebas no aplicará a los
condados con resultados positivos de las pruebas <3.5%.
Factor de ajuste del índice de casos de COVID-19 en California
Volumen de pruebasFactor de ajuste del índice
de casos*
01.4
0.25*Media del estado1.3
0.50*Media del estado1.2
0.75*Media del estado1.1
Media del estado1
1.25*Media del estado0.875
1.5*Media del estado0.75
1.75*Media del estado0.625
2.0*Media del estadoy superior0.5
Los condados con menos de 106,000 habitantes estaránexentos de los ajustes
de las tasas de casos, y los condados con una cantidad de resultados positivos
de las pruebas <3.5% estarán exentos de los ajustes de las tasas de pruebas
inferiores a la media del estado.
Si las dos métricas no están en el mismo nivel, la asignación de nivel del
condado se determinará según la métrica más restrictiva. Porejemplo, si los
resultados positivos de las pruebas de un condado corresponden al Nivel 3
(naranja, moderado), pero el índice de casos corresponde al Nivel 1 (violeta,
propagado), se asignará el Nivel 1 al condado.El cambio de nivel se
determinará de acuerdo con los criterios que se describen a continuación.
Avanzar por los niveles
Las reglas de la estrategia:
1.El CDPH evaluará los indicadores una vez por semana, todos los lunes, y
publicará las asignaciones de nivel actualizadas los martes.
2.Un condado debe permanecer en un nivel por un mínimo de tres semanas, antes
de poder avanzar a un nivel menos restrictivo.
3.Un condado solo puede avanzar de a un nivel a la vez, aunque las métricas
califiquen para un nivel más avanzado.
4.Si el índice de casos ajustado de un condado para la asignación del nivel y la
medición de resultados positivos de las pruebas están en dos niveles diferentes,
se asignará al condado al nivel más restrictivo.
5.La métrica de equidad en materia de salud se aplicaa jurisdicciones con una
población de más de 106,000habitantes. Las reglas de la métrica de equidad en
materia de saludse describen en la página de la métrica de equidad en materia
de salud.
6.En las métricas generales, se incluirán los datos de la jurisdicción sanitaria local
(LHJ, por sus siglas en inglés) de la ciudad y se asignará a las LHJ de la ciudad
el mismo nivel que el condado circundante.
7.Una LHJ puede continuar implementando o manteniendo medidas sanitarias
públicas más restrictivas si el funcionario de salud local determina que las
condiciones sanitarias de esa jurisdicción justifican dichas medidas.
8.El estado del nivel entra en vigor el miércoles siguiente acada anuncio semanal
de asignación que se realiza los martes.
Para avanzar:
1.Un condado debe haber estado en el nivel actual por un mínimo de tres
semanas.
2.Un condado debe reunir los criterios del siguiente nivel menos restrictivo para el
índice de casos ajustado y los resultados positivos de las pruebas durante las
dossemanas previas consecutivas para pasar al siguiente nivel.
3.Además, el estado establecerá las medidas de equidad sanitarias para
demostrar la capacidad de un condado para abordar a sus comunidades más
afectadas.
Para retroceder:
1.Durante la evaluación semanal, si elíndice de casos ajustado o los resultados
positivos de las pruebas de un condado han caído en un nivel más restrictivo por
dos períodos semanales consecutivos, el estado revisará los datos de los
últimos 10días y, si el CDPH determina que existen señalesobjetivas de
mejora, el condado podrá permanecer en el nivel. Si los datos de los últimos
10días del condado no incluyen señales objetivas de mejora, el condado deberá
revertir el nivel más restrictivo. Para evaluaciones de semanas subsiguientes,
rigen las reglas que se especificanarriba.
2.En cualquier momento, los funcionarios de salud pública estatales y de los
condados pueden trabajar juntos para determinar las intervenciones específicas
o las modificaciones necesarias en todo el condado para abordar la capacidad
hospitalaria afectada y los factores que impulsan la transmisión dela
enfermedad, según sea necesario, incluido el cambio de un nivel a otro. Las
consideraciones clave también incluirán la tasa de aumento de nuevos casos o
losresultados positivos en las pruebas, los datos más recientes como se ha
señalado anteriormente, la capacidad de salud pública y otros factores
epidemiológicos.
3.A los condados con una población inferior a 106,000habitantes se les aplicará
un criterio de condado pequeño para garantizar que el pasoa un nivel más
restrictivo sea adecuado. A continuación,se describe la estrategia para los
condados pequeños.
4.Los condados tendrán tres días, a partir del miércoles después de que se
anuncien las asignaciones de nivel los martes, para implementar cualquier
cambio o cierre en el sector, a menos que circunstancias extremas ameriten una
acción inmediata.
Estrategia para condados pequeños
Debido a que lamétrica de índice de casos de California está normalizada por cada
100,000 habitantes, varios condados con poblaciones pequeñas han experimentado
grandes oscilaciones en su índice de casos diarios como resultado de una pequeña
cantidad de casos nuevos informados. En algunos condados, esto ha hecho surgir la
necesidad de volver a un nivel más restrictivo, a pesar de la estabilidad general de la
enfermedad y de la capacidad demostrada para rastrear, hacer un seguimiento,
investigar y tratarlos casos.
Por ejemplo, una vez que un condado pequeño se encuentra en el nivel amarillo, una
pequeña cantidad de casos (tan solo 1 caso por semana durante 2 semanas
consecutivas) podría hacer que volviera a un nivel más restrictivo. Sibien la proporción
general de casos puede ser la misma que la de un condado más grande, la cantidad
absoluta de casos también es un factor importante para evaluar la capacidad del
condado de controlar la transmisión mediante la investigación de la enfermedad, la
localización de los contactos y el aislamiento.
No redunda en interés de la salud pública de las comunidades cerrar o restringir
sectores empresariales enteros sobre la base de una cantidad tan pequeña de casos, y
en algunas situaciones un pequeño giro en el recuento de casos semana tras semana
puede hacer que un condado pase del nivel amarillo al nivel violeta. Comoel estado
quiere evitar cambios rápidos en el estado del nivel sobre la base de pequeños
cambios en la cantidad absoluta de casos, estamos creando una medida alternativa de
evaluación de casos que se aplicará a los condados pequeños. Loscondados
1
pequeños se definen como aquellos que tienen menos de 106,000 habitantes.
Medida alternativa de evaluación de casos. Loscondados pequeños están sujetos a
todas las reglas existentes del proyecto (umbrales de resultados positivos de las
pruebas, duración mínima de 3 semanas en un nivelantes de pasar a un nivel menos
restrictivo, imposibilidad de saltarse un nivel mientras se pasa de una designación de
nivel más restrictiva a otra menos restrictiva, etc.) con la excepción de los umbrales del
índice de casos que se describen a continuación.
1
Veintidós condados de California tienen una población de menos de 100,000 habitantes.Sutter, que
tiene una población de 106,000 habitantes, también se incluye ya que comparte un oficial de salud con el
condado de Yuba.Los condados por debajo de este tamaño tienen desafíos y oportunidades similares
para controlar la transmisión de la COVID-19 y, en general, no tienen ciudades grandes o densamente
pobladas. Esta distinción influye en la rapidez con que la transmisión de la COVID-19 puede aumentar
más allá de los hogares y en la capacidad del condado para identificar y contener rápidamente los brotes
con los recursos existentes de rastreo de contactos, aislamiento y cuarentena.
La medida alternativa de evaluación de casos proporciona una protección a los
condadospequeños contra los cambios de nivel repentinos como resultado de
pequeños cambios en los casos durante un período de dos semanas.
En el caso de un condado pequeño que tenga resultados positivos en las pruebas que
cumplan el umbral del nivel actualmente asignado a ese condado, pero que esté
marcado para pasar posiblementea un nivel más restrictivo sobre la base de su
evaluación semanal del índice de casos, se aplicarán los siguientes criterios en lugar
delos umbrales del índice de casos del proyecto.
Si el condado excede los siguientes números de casos semanales absolutos en función
de su población y su nivel durante dos semanas consecutivas, deberá pasar a un nivel
más restrictivo:
Nivel actualHab. 35K-70KHab. 70K-106K
Amarillo71421
Naranja142128
Rojo354249
Paso al nivel amarillo
Al pasar del nivel violeta al rojo, o del rojo al naranja, los condados pequeños quedan
sujetos a todas las reglas actualesdel Proyecto (umbrales de resultados positivos,
duración mínima de tres semanas en un nivel antes de pasar a un nivel menos
restrictivo, incapacidad de omitir un nivel al pasar de un nivel más restrictivoa uno
menos restrictivo, etc.)
Para que un condado pequeño pase del nivel naranja al amarillo, debe alcanzar el
umbral existente de resultados positivos de menos del 2%. Sin embargo,en lugar de
alcanzar el umbral diario establecido de la tasa de casos de menos de 1 caso por cada
100000, un condado pequeño puede tener una tasa de casos diarios menor o igual
que 2casos por cada 100000. Cabe destacar que estos son los mismos parámetros
que se usan para los criterios de aceleración de la equidad en materia de salud del
nivel amarillo.
Criterios de riesgo
Las actividades y los sectores comenzarán a abrirsegún su nivel específico basado en
los criterios de riesgo(PDF), como se detalla a continuación. Lasactividades o los
sectores de menor riesgo pueden abrir antes y las actividades o los sectores de mayor
riesgo no pueden abrir hasta que se encuentren en fases más avanzadas. Muchas
actividades o sectores pueden incrementar el nivel de las operaciones y la capacidad, a
medida que un condado reduzca su nivel de transmisión.
Criterios utilizados para determinar los sectores de riesgo bajo/medio/alto
Capacidad de permitir el uso de mascarilla en todo momento (p.ej., para comer y
beber, uno debe quitarse la mascarilla)
Capacidad de mantener la distancia física entre personas de diferentes hogares
Capacidad de limitar la cantidad de personas por pie cuadrado
Capacidad de limitar la duración de la exposición
Capacidad de limitar la cantidad de personas de diferentes hogares y
comunidades juntas
Capacidad de limitar la cantidad de interacciones físicas entre visitantes y dueños
Capacidad de optimizar la ventilación (p. ej., en interiores vs. aire libre, cambio de
aire y filtración)
Capacidad de limitar las actividades que aumenten la propagación (p.ej., cantar,
gritar, respirar profundo; los ambientes ruidosos harán que las personas eleven la
voz)
Escuelas
Las escuelas pueden reabrir parala enseñanza en persona según los criterios
equivalentes de laEstrategia para la reapertura de escuelas(PDF) del 17 de julio,
previamente anunciada.Esa estrategia permanecerá en vigor, salvo que el Nivel 1 se
reemplaza por la Lista previa de monitoreo de datos del condado (que tiene criterios para
el índice de casos equivalentes a los del Nivel 1). Las escuelas de los condados que
pertenezcan al Nivel 1 no pueden reabrir para la enseñanza en persona, pero los
departamentos de salud locales otorgaron algunas exenciones para los grados kínder de
o
transición a 6.. Las escuelas que no están autorizadas a reabrir, incluidas las escuelas
o
de kínder de transición a 6.grado que no recibieron una exención, pueden proporcionar
supervisión y servicios estructurados en persona a los estudiantes de acuerdo con
laGuía para cohortes/grupos pequeños de niños y jóvenes.
Las escuelas serán elegibles para reabrir parcialmente para la enseñanza en persona
de acuerdo con las pautas específicas del sector para las escuelas de California
cuando el condado haya salido del Nivel 1 (y, por lo tanto, esté en el Nivel 2) por 14
días, como mínimo, lo cual es similar a estar fuera de la Lista de monitoreo de datos del
condado por 14 días, como mínimo. Comose mencionó antes, una LHJ puede
continuar implementando o manteniendo medidas sanitarias públicas más restrictivas si
el funcionario de salud local determina que las condiciones sanitarias de esa
jurisdicción justifican dichas medidas.
Como se indicó en laestrategia de reapertura de escuelas(PDF) del 17 de julio,las
escuelas no deben cerrar si un condado regresa el Nivel 1, pero sí deben considerar
realizar pruebas del personal para controlar la situación.
Proceso de adjudicación de nivelesdel condado
Para obtener más información, visite nuestra página de Solicitud de adjudicación del
nivel del condado.
APÉNDICE 1: Cálculo de las métricas
Métrica Definición
Índice de casos Se calcula como el número diario promedio (la media) de casos de
(índice cada 100,000 COVID-19, excepto los casos de (a) personas que no son del estado o
personas, excepto los cuyo condado de residencia se desconoce y (b) personas encarceladas
casos en prisiones; en prisiones estatales o federales, personas detenidas en centros de
promedio de 7 días detención del Servicio de Inmigración y Control de Aduanas (ICE), o
con retraso de 7 días) personas que se encuentran en el Departamento de Hospitales Estatales
(identificados como casos con un nombre o una dirección de instalación
asociados con estas ubicaciones), durante 7 días (según la fecha del
episodio), dividido por la cantidad de personas que vive en el condado/la
región/el estado. Luego, este número se multiplica por 100,000. Debido a
los retrasos en los informes, este cálculo tiene un retraso de 7 días. Por
ejemplo, para los datos actualizados el 8/22/20, el índice de casos será
del 8/15/20 e incluirá el índice de casos promedio desde el 8/9/20 hasta
el 8/15/20.
Índice de casos lineal Se calcula como el índice de casos multiplicado por el factor de ajuste del
ajustado cada 100,000 índice de casos que se basa en la diferencia entre el volumen de pruebas
personas por día, del condado (volumen de pruebas, pruebas cada 100,000 personas por
excepto los casos en día, como se describe a continuación) y el volumen de pruebas medio del
prisiones (promedio condado calculado en todos los condados. Por lo tanto, el volumen de
de 7 días con retraso pruebas medio pasa a ser la referencia para este ajuste y se recalcula
de 7 días) cada cuatro semanas para evitar la fluctuación excesiva y seguir teniendo
en cuenta las tendencias en desarrollo de las pruebas. Para los condados
que tienen un volumen de pruebas superior a la mediana, el factor de
ajuste es inferior a 1, el cual disminuye de manera lineal de 1.0 a 0.5, a
medida que el volumen de pruebas aumenta al doble del punto de
referencia. El factor de ajuste permanece en 0.5si el volumen de pruebas
del condado es superior al doble de la mediana del estado. Para los
condados que tienen un volumen de pruebas inferior a la mediana del
estado, el factor de ajuste es superior a 1, el cual aumenta de manera
lineal de 1.0 a 1.4, a medida que el volumen de pruebas del condado
disminuye de la mediana del estado a cero. La fórmula del ajuste lineal
puede expresarse de manera matemática del siguiente modo:
Para condados con pruebas por encima de la media del estado:
1-(((índice de pruebas del condado - índice de pruebas medio del
estado)/índice de pruebas medio del estado) * 0.5)
Para condados con pruebas por debajo de la media del estado:
1-(((índice de pruebas del condado - índice de pruebas medio del
estado)/índice de pruebas medio del estado) * 0.4)
Hay dos condiciones en las que no se aplica esta fórmula. La primera son
los condados pequeños, que tienen una población inferior a 100,000,
aproximadamente, de acuerdo con las proyecciones de población del
Departamento de Finanzas de California (consulte la referencia * en la
tabla de la estrategia en niveles). La excepción de condado pequeño
evita el posible ajuste falso a causa de las fluctuaciones en las pruebas
influenciadas por los eventos seculares que no están relacionados con el
riesgo subyacente de transmisión. Como segunda condición para la
excepción del ajuste, no se ajustarán los condados que tengan un
volumen de pruebas inferior a la mediana del estado y resultados
positivos de las pruebas <3.5 %, de acuerdo con la suposición de que el
volumen de pruebas en estos condados puede ser inferior si los
resultados positivos de las pruebas son bajos. En ambas condiciones, el
índice de casos ajustado es igual al índice no ajustado.
Resultados positivos Se calcula como el número de pruebas positivas de la reacción en
generales de las cadena de la polimerasa (PCR, por sus siglas en inglés) para la COVID-
pruebas, excepto los 19 durante un período de 7 días (según los datos de las muestras
casos en prisiones, recopiladas) dividido por la cantidad total de pruebas de PCR realizadas;
durante 7 días (solo esto excluye las pruebas (a) de las personas que no son del estado o
PCR, con retraso de 7 cuyo condado de residencia se desconoce y (b) las pruebas realizadas a
días)
personas encarceladas en prisiones estatales o federales, centros de
detención del ICE y hospitales estatales (identificados como casos con un
nombre o una dirección de instalación asociados con ubicaciones de
prisiones u hospitales estatales). Luego, este número se multiplica por
100 para obtener un porcentaje. Debido a los retrasos en los informes
(los cuales pueden ser diferentes entre las pruebas positivas y
negativas), existe un retraso de 7 días.
Por ejemplo: Para los datos acumulativos recibidos el 6/30/20, los
resultados positivos informados de las pruebas son del 6/23/20 y se
calculan según las pruebas con fecha de recolección de la muestra entre
el 6/17/20 y el 6/23/20.
Pruebas cada 100,000 Se calcula como el número de pruebas de reacción en cadena de la
personas por día, polimerasa (PCR) por día durante un período de 7 días (según la fecha
excepto los casos en de recolección de la muestra), excepto las pruebas realizadas a personas
prisiones (promedio encarceladas en prisiones estatales o federales, centros de detención del
de 7 días con retraso ICE y hospitales estatales (identificados como casos con un nombre o
de 7 días)
una dirección de instalación asociados con ubicaciones de prisiones u
hospitales estatales), dividido por la cantidad de personas que viven en el
condado/la región/el estado. Luego, este número se multiplica por
100,000. Debido a los retrasos en los informes, existe un retraso de 7
días en el cálculo.
Por ejemplo: para los datos acumulativos recibidos hasta el 8/22/20, la
cantidad promedio informada de pruebas durante 7 días será del 8/15/20
e incluirá las pruebas de PCR con fechas de recolección de la muestra
entre el 8/9/20 y el 8/15/20.
Fuente de datos: CalREDIE
Enlaces útiles
Consulte el estado de las actividades de su condado
Conozca qué actividades y negocios están abiertos en los cuatro niveles(PDF)
Más información sobre la Métrica de equidad en materia de salud de Californiay
losPlanesde inversión en equidad específicosde cada condado
Solicitud de adjudicación del nivel del condado
Explore los datos completos por condado(Excel)
Encuentre las tablas de datos archivadas del proyecto de California
Estrategia de reapertura de escuelas(PDF)
Guía para cohortes o grupos pequeños de niños y jóvenes
www.covid19.ca.gov
Proyecto para una economía más segura| Para otros idiomas, visite
nuestrapágina de documentos multilingües.
Última actualización de la página: 16de noviembrede 2020
COVID-19 Response and Statewide CHHS Update, November 24, 2020
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Nice to be with you on Tuesday, focused on a few things
Tier assignments
Walk you through our data, continued concern
o Highlight hospitals
o Get into Holiday Messaging
COVID-19 Cases Continue to Increase Nationally
o Cases throughout the nation are rising and will most likely continue to rise through the
holidays
o Cases in CA are growing faster than ever, we are in the midst of a surge
o Need to continue to dig in and do what we can
November 24
o 15,329 cases
7-day average
o 12,532
Total Tests v. Test Positivity Rate
o 283,819 tests
One day high
o 5.6% 14-day positivity
7-day test positivity
o 5.9%
14-day positivity
o 5.6%
Closer look
o Nov 10
3.7%
o Nov 24
5.6%
o 51% increase
COVID-19 hospitalizations have increase 81.3% over last 14 dayscurrently 5,844
COVID-19 ICU hospitalizations have increased 57.1% over last 14 dayscurrently 1,397
o All based on case numbers from two weeks ago, two-week lag time in hospitalization
rates
o Pressure on hospitals will continue
o Numbers have doubled in last two weeks
Hospital System is stretched
o Nov 1
2,537 hospitalized
708 ICU
o Nov 23
5,844 hospitalized
1,397 ICU
o 175 hospitals operating with staffing waivers
o Intensive Care Units in parts of the state are already being pressed
o Something we track is hospitals asking us for waivers
Permission to operate with some additional patients being seen with existing
staff
Calculating your risk for COVID-19
o Your chance of infection = likelihood of exposure x duration of exposure/ level of
protection (masks + social distancing)
o Different elements that we can control
o We can reduce our risk
o Today we are at a higher risk than a month ago
Blueprint for a Safer Economy Emergency Brake County Tier Movement
o Nov 10
Purple: 13
Red: 22
Orange: 17
Yellow: 6
o Nov 16
Purple: 41
Red: 11
Orange: 4
Yellow: 2
o Today
Purple: 45
Red: 8
Orange: 5
Yellow: 0
Counties moving back to Purple: Colusa, Del Norte, Humboldt and Lassen
Moving back to Red: Calaveras
Moving back to Orange: Alpine and Mariposa
o Are any counties holding steady?
Some have met the threshold metrics to move to a less restrictive tier, they have
only met that threshold for one week so no reported movement this week
Pulled emergency break, looking at each county
Thanksgiving during a Pandemic
o It is disappointing for many of us that Thanksgiving will look different this year
o It is necessary to modify to pause our usual traditions this year to keep each other safe
and to help stop the surge
o Safest way to celebrate Thanksgiving this year is at home with members of your
household or virtually
The COVID Chat
o Saying no to people
than ever to pass up the opportunity to gather with family or friends
o But knowing howand whento say no is the first step to protecting your health and
the health of the people you care about
o Be clear
Saying no effectively starts with just thatsaying no. A simple, direct no, is the
best way to make yourself understood and closes the door for negotiations
o Offer alternatives
Ask if there is another way to connect with the person who invites you to a
gathering. Acknowledge you really want to see them but want to keep everyone
o Be honest
Excuses are tempting, but they can easily backfire when your convenient excuse
is met with an equally convenient solution. Take the time to explain that the
reason you do not feel comfortable getting together because you love your
friends and family
o ation going
Th
o Celebrate with members of your own household
o
o Think of creative ways to share the experience remotely
o Drop off Thanksgiving meals for older loved ones and those with medical condition so
they can stay home
o Take necessary precautions to protect your family and friends because you love them
Thanksgiving in CA
o Most of the state is fortunate to have sunny weather forecast for Thanksgiving Day
o Take advantage of the sunshine and consider moving your celebration outside especially
if you plan to celebrate with people from outside your household
o Have Thanksgiving lunch instead of dinner to maximize the sunshine and warmth of
mid-day
Travel Advisory
o Traveling or having others travel to your home could potentially cause an increase in
transmission of COVID-19
o This is not a travel ban or restriction. This is a travel advisory
o We encourage Californians to stay close to home and avoid non-essential travel to other
states or countries
o People arriving in CA from other states or countries should self-quarantine for 14 days.
They should limit their interactions to their immediate families
Simple acts can make a big difference for COVID-19 and the flu:
o Wear a mask
o Maintain six feet of distance
o Wash our hands
o Minimize mixing
o Get your flu shot
Together, we can stop the surge
o As the rate of transmission gets stronger, we will too
vǒĻƭƷźƚƓƭ
Could you talk a bit about, I noticed that San Francisco, Marin, San Mateo, no movement,
counties?
o I think each county is slightly different
o A couple weeks ago SF was in the yellow tier
o Significant surge in cases there too
o Some of the tools they put in place will be helpful and we hope they hold steady, but
they may not
o Certain communities and counties do take the guidance more to heart in others
o Not sure i
counties with similar attention to detail who are already in purple
o I commend them, we will see
o Thank you to local leaders and community leaders, a number of health care
professionals are sounding the alarm and that will make the difference
o Hope we can stop the surge and get people not just to hold steady but to see these
trends turn around
Based on current trends, do you expect that the average daily deaths in the winter will be
worse than the peak at the end of summer, HIME model forecasts cumulative death total to be
double what it is now, do you agree? LA County is being hit hard; do you think a modified stay
at home is prudent? Do you know whether surge in Imperial county has required them to
move people out of the county?
o I think that certainly the numbers of deaths will likely go up and as we are exceeding our
highest number of cases and seeing our hospital systems pressed, the idea that the
o Want CA to be a state that exercises its alarms well in advance
o Part of why we have taken the actions we have seen
o We know that the various models that have predictions, the models that have been
proven wrong before because we come together and prove them wrong
o Makbefore; those are the things that will allow us to turn
things around for the beginning of next year
o When people ask about the models, I would say the model is based on inputs today and
we have a decision to change those
o As it relates to LA, this is where I live and work, many of the leaders are taking this very
seriously
o
increase than in the past 24 hours
o Prudent for the public health and elected leaders in this county to be considering what
comes next
o
but really move this decision
o Everyday matters, regions and states that delay these hard decisions end up having
more difficulty turning it around
o I know they are taking this seriously
LA exceeding the threshold they issued yesterday, they are probably discussing that now, why is
the situation so much worse in LA and what is the likelihood of another statewide stay-at-home
o Differences across the state
o Even in LA, we have communities that are densely populated, number of communities
where households are multi-generational
o Have to acknowledge household transmission
Different from gatherings
Essential workers come home and infect their family members
Those individuals become at risk
o In LA because of the unique and broadscale nature of our communities, you see how
transmission can occur
o Halloween, holidays, sports, not surprising to see places as densely populated as LA to
see this kind of transmission
o Statewide we are watching the same things, trying to be thoughtful and more targeted
o Know a number of communities and people are fatigued and tired
o Trying to have actions we recommend being low risk with the least number of
restrictions
o Looking at data all the time, multiple times per day
o Looking to see when our data runs
o Trying to make thoughtful decisions
CA tier system is supposed to help control the spread, continually hearing warning signs, is CA
has a lot to do on masks, do we need stronger enforcement?
o We said this on the very first presentation on the Blueprint, we said clearly what the
rules are for moving a county forward, what they would be for backward movement, we
know COVID goes from 0 to 60 really fast and we had this emergency brake option
o we did, certainly we all want to keep close ties on the data and conditions
o No perfect system under COVID, continually working to improve systems
o Using emergency brake function was important to do, available in CA in many ways that
es
o Other states wait until they are clearly overwhelmed in hospitals, we have a tool in the
blueprint to sound that emergency alarm, pull that brake sooner than other states
o blueprint; they understand our tiers to be targeted and decisive
Taking a look at some of the numbers on DPH website, indicated there were 1500 ICU patients,
indicated 2100 ICU beds available in the state, means there are 3600 ICU beds in the state, my
understanding in March there were around 7300 ICU beds so how is DPH determining these
numbers?
o We have always talked about our health care delivery system not just to be available for
COVID
o We continue to see people who have heart attacks, strokes, emergency surgery
o When you take the collection of need and covering that need, commend hospitals
saying we need to continue to deliver care outside of COVID
o In March, many health systems preemptively cancelled surgeries, some people needing
emergency care stayed home
o
o We want to make sure our hospital system has what they need
o Know that we can bring on additional beds, not infinitely so, but many more because of
our efforts to plan around surge
o We have spaces identified in certain facilities that can be brought on, with the right
staffing, staffing is very important
o Continue to increase bed capacity
o Have alternative care sites which are poised and ready to be stood up, some are being
mobilized now
o
o Doing what I can to not just ask people to modify their behaviors to reduce
transmission, but to take care of the people who need care in our hospital systems
I wanted to follow up with yesterday on vaccines, when they are available, how much will they
cost including for the uninsured, will health workers be mandated, how are manufacturers
deciding how many doses?
o All excellent questions
o Currently there is no consideration at the state level to require health care workers to
get the vaccine, we have a lot to learn about it
o Continue to evaluate it, at this point that is not a decision
o
covered
o For uninsured and Medicare patients the state will step in to make sure cost in no way
gets in the way of a decision to be vaccinated
o This is a very important decision
o As it relates to the allocation strategies from fed gov and manufacturers, will be done
based on state conditions led by populations and size
o
firm picture of what that looks like
o The timing will be important, not each of these vaccines will come out at the same time
o Pfizer and Moderna may be on a closer timeline though they are distributed differently
Can you clarify who in CA is designated as an essential worker in terms of distribution, hearing
some confusion about that
o I think the first order of business is determining that 1A priority group, which will be
focused on the healthcare space
o -health care
essential workers
o We expect that some of those decisions will be made over the next weeks, they will be
posted to our website after all the right conversations
o Assimilation and working with drafting and community guidance group
o High priority but the first order of business is the 1A group
Now that state has had time to look at data, have you been able to look at where cases are
primarily coming from in Southern CA, is there potential stay-at-home to prevent travel?
o As it goes toward pinpointing transmission, we continue to hear from different counties
different things
Private gatherings are important points of transmission
Restaurants as well
o Any time you get together when your guard comes down, mask is off, there is a risk of
transmission
o Because of asymptomatic spread, you create a risk
o In Southern CA, as those activities increase,
o The hardest part is young people infecting older relatives
o Take extra precautions while we approach period of family gatherings
o
way that people gather, any activity that allows us to take our guard down is a potential
transmission risk and hotspot
o
toolboxink in a targeted way
o What the Blueprint does in part is allow us to be targeted
o
exactly where the plan will go
o on the table, looking at effective
methods
o
being open and how to balance risk of transmission with kids needing interaction, have you
sent your own kids back to school and would you?
o My youngest does attend a child center, I have good conversations, feel confident
o Very concerned
o Other three children are in a school district that only offer distance learning
1st grader, 5th grader, and 7th grader
All getting through it
o
but if the chance afforded us to do that, we would
o I believe schools have many tools available to do that, urge us to look at how we keep
our teachers and staff protected
o Know there are tools and always interested to talk to a specific district about how we
can create lowest risk environment
o This is a local decision; characteristics of each community are important to take into
account
o Making sure principals are applied in a local and unique way
o Allowing us to have all the tools, PPE and masks, keep cohorts together, go outside,
making sure those with underlying conditions are protected even above and beyond
o All of these tools give me confidence
o Look forward as we continue to bring down case numbers to creating more paths to
address concerns of our school community and make sure when time is right to bring
kids back
When you talk about the alternative care sites, where would the case get staffing for them, if
a lot of back and forth with restaurants, can I get your thoughts? The argument I keep hearing is
who avoids the rules but it seems if people started getting tickets
for not wearing them then they might comply?
o Certainly, the question about outdoor dining is important
o
o Outdoor dining becomes concerning for spread
o Not only area I would be concerned
o indoors; we hope
o make those
decisions
o As it relates to the masking question, remember the mask order, the statewide order, is
indeed enforceable and that some local jurisdictions have enforced
o Not certain how many there are that are doing that, but that is an option on the table
o
and cooperation first
o Hopefully all the messages we communicate can help break through to a number of
people
o
wear the mask, feel they are protected from COVID
o
nd them of the importance
o Continuing to beat the drum of education and info
o Reminding that local officials have expressed that they can enforce
o I know one person asked a question about Imperial County, we are watching those
closely
o I believe hospitals in that county do occasionally transfer;
o We are watching it closely
o
guidance is where we expect our state to take account except where local guidance is
more restrictive
o In gatherings when local guidance is to not gather outside of your household, we at the
restrictive
o We at the state, have the unique responsibility to identify guidance that works
statewide, and counties have the ability to be more restrictive than the state
o I know we went for a full hour, grateful for your attention and questions
o In a period of thanks and this holiday, my favorite holiday, an opportunity to count
our blessings and be thankful for so much
o Thankful to be in a place like CA, a place that is working hard to be led by science and
data
o Even though it means short term hardship and sacrifice, it will allow us to get through
this pandemic in a strong way
o Do holidays with your household and do it safely
Sen. Health Comte. COVID Care: Role of Private Insurance
November 23, 2020
Chair Pan (Opening)
Hearing all panels before public comment
Once heard all witnesses, have a public comment period
I want to thank all of you for coming to discuss private insurance
We have learned so much, but have so much more to learn
The COVID-19 pandemic started less than a year ago
Health system has come so far, been stretched so much
Hospitals are overflowing with patients
In CA we have done better than most, but still in the woods
Thank healthcare workers
We can all agree that in order to get on the other side of this pandemic it will take widespread testing,
tracing, vaccination
There have been many directives, bulletins, FAQs, E.O.s, etc. to outline roles and responsibilities
No wonder there is confusion
Identify today what policy measures are necessary to get clarity
We will now begin with our first witness, who is David Sharp, a resident of Alameda County
Questions from members before we move on
David Sharp, Resident of Alameda County
Thank you for having me
My son had a potential COVID exposure
Researched locations on Sept.12th to find COVID testing
He asked to be tested due to a possible exposure
He was asked to come back next day
Arrived next day and then the person said testing was moved inside due to smoke
He waited a long time
Wanted answers
Doctor showed up, he was asked why he was there he said to get COVID test
Finally got swabbed, texted
Mom called hospital
Not free testing, insurance would cover
Charged for emergency visit
Told person to cancel it
Misled, would not understand paperwork
Following instructions
Trying to be proactive
Should not be charged for an emergency room visit that he did not intend
Asking that ER charges of $1900 be reversed
I went back down to the tent and they were unapologetic and said we would be charged for E.R. visit
Unfortunate incident
Never got the test
Monning
I want to thank you, Mr. Chair, unfortunately we are hearing reports such as that by Mr. Sharp
You did receive a bill; did they complete the COVID test?
Mr. Sharp
No, they did not
Monning
No result, yet a bill
Does your son have private insurance coverage?
Mr. Sharp
We have Anthem Blue Cross
They picked up about 40% of that bill
Bill did contain a charge for the test
Monning
Is your son doing okay?
Mr. Sharp
No, he did not as far as we know
We did quarantine him
Monning
No result of COVID test, yet you were charged for it, you said they would pay 40% but that would leave
Mr. Sharp
Majority of it was E.R. visit which was $1800
Monning
With respect to Anthem Blue Cross, did they provide you with a policy interpretation that said they were
only responsible for 40%?
Mr. Sharp
Yes, there was a breakdown with costs and coverages
Monning
It raises several layers of poor communication and unclear policy
Mr. Chair, I think others would have questions but this helps clarify
Mr. Sharp thank you for sharing
Pan
I want to recognize Senator Rubio is now joining us remotely
I want to thank you, Mr. Sharp
Senator Monning covered a lot of the ground
Sorry that this occurred
Hopefully this will be resolved in your favor
Keep us apprised as to what transpires in the future
Thank you
Move on to next sub-panelist
Take federal perspective
Keep remarks to three minutes
Following that we will have a CA respective
Sabrina Corlette
Testing for COVID-19: Federal Requirements under FFCRA, as amended by CARES
o Plans must cover and waive cost-sharing for:
FDA-approved diagnostic testing for COVID-19
Items and services delivered during provider office, urgent
-19 test; may be in-person or via
telehealth
o Prohibits use of prior authorization
o Requires plans to reimburse testing providers either the negotiated rate or the full cash price
listed by the provider on a public website
o Applies through the public health emergency
Tri-agency Guidance: Clarifies Scope of FFCRA Mandate
o
care professional
Plans and insurers not required to cover workplace testing, or testing for public health
purposes
o
o Clarifies that at-home tests are included, but must be ordered by an attending provider
State Action Stronger than Federal Standard
Pan
Sarah Ream, DMHC
State agency responsible for licensing and regulating insurance plans
Regulate more than 96% of healthcare and commercial enrollment
DMHC has adopted an emergency regulation providing clarity and certainty
o Outlines when and how plans must cover testing
When plans may charge cost sharing
o Requires health plans to absorb cost of testing
Clarity with health plans reimbursement for providers
Three categories of enrollees for testing
o Enrollees who have symptoms/been exposed
Under federal law can get tested in or out of network without cost sharing
o
Who are essential workers is provided
Regs state COVID-19 testing is medically necessary
Worker must contact plan or in network provider
If plan fails within 48 hours to provide test, enrollee can go anywhere
o Asymptomatic people who are not essential workers
Must cover when medically necessary
Ordinary cost sharing
Must offer within 96 hours, if not they can go out of network
Cost for tests
o Prohibits plans from passing costs to providers unless specifically negotiated
o Important because many pre-COVID agreements were requiring providers to assume risk of cost
o Financial risk under emergency regs states plans is responsible
Lawsuit filed one week ago against DMHC by plans to get this repealed
Bruce Hinze, CA Department of Insurance
Top priority is to protect health of Californians
First response was to eliminate cost-sharing
Eliminate copays, deductibles
After state of emergency declared, Commissioner directed insurance to submit emergency plans
Commissioner directed health insurance companies to increase telehealth services
o Parity
o Must continue to provide access to medically necessary care
Department issued an FAQ related to COVID-19 testing
With regard to the question before you, regarding who pays for testing
o Department says testing should be readily available for greatest number of people
Consumer cost should not be a barrier to testing
o Should not be limited on number of tests
o Guard rails in place for limiting costs providers can charge
Provider balance bills should be prohibited for COVID testing
Kathleen Jacobson, CDPH
On testing task force
As of Sept. 22nd, testing prioritization guidance was released based on turnaround time improving
Everyone has equal priority for testing
In Sept. state released general guidance for responding to pandemic in workplace for employers
Testing all workers in workplace should be first strategy considered
May be done at a single point in time or repeated
Must be onsite or at occupational provider
All workers must be offered and provided testing
Local health depts. May help facilitate testing options if needed
Sept. 12th the COVID Disease 2019 mitigation plans for residents at SNFs was revised
o Recommends baseline testing of all SNF residents and all healthcare personnel at nursing
facilities
o Conduct baseline testing for all residents and healthcare personnel that did not have a positive
case at the time and report all results to CDPH by June 2020
o Updated guidance has recommendations for testing newly admitted and re-admitted residents
o If hospital does not test patient within 72 hours of transfer, resident must be tested before
admission
o If tested at the hospital, two negative tests are not required
o Residents newly admitted should be quarantined for 14 days and then retested
o SNFs may consider acute care hospital days as part of that 14-day quarantine
o Screening testing of healthcare personnel, recommendation is minimum of weekly screening
o In facilities with positive cases, should implement response-driven testing
Weekly testing, continue of two rounds of negative tests
Pan
Questions?
Monning
To Ms. Corlett on fed declaration of emergency, you said that expires on Jan. 20th, can that be extended
by E.O.?
Corlette
Can be extended anytime between now and then
Most expect it will be extended
Monning
Is there any evidence, has there been health plans sited or penalized for non-compliance?
Sarah Ream
Not that we are aware of, although our reg went into effect in mid-July
Typically, there is a lag time, so if an insurer is not complying, there is typically a lag
Plan would need to deny or limit coverage, enrollee would need to appeal through plan
Monning
Complaints that have been filed?
Ream
Handful of complaints, some calls to health center
I would have to go and take another look
Monning
Did you hear the testimony of Mr. Sharp?
In your view, did that violate your understanding of the responsibility of an insurance plan?
Ream
Does sound like there was some things the hospital and/or his carrier under federal law, because the
son had exposure to COVID-19 the CARES Act and FFCRA is very clear that the carrier must cover COVID-
19 test and ER visit cost
Monning
. Sharp did file any complaint with agencies
Where do members of public go if they receive a large bill for a test?
Ream
We regulate majority of coverage
lates, they should call our help
center or file a complaint online
If health plan is covered under DMHC we can provide assistance, if not we can help navigate
Monning
Is your department doing outreach to inform consumers about their rights and protections?
Ream
We have been
Speaking with provider groups, consumer advocacy orgs, health plans, trying to get message out there
about rights and steps they should take
Monning
If other two witnesses are aware if their departments have received complaints of overbilling or
violation of patient rights?
DOI
Our department has received in the neighborhood of 5 complaints related to concerns around COVID bill
Federally regulated plans
Maintaining vigilance in response to complaints, very aware of these situations
Want to make sure they are enjoying full benefit of the law
Monning
officers by county
Lead agency on enforcing the tiers
Is CDPH doing anything to monitor or educate the public about their right to COVID testing and their
right for it to be paid for?
Jacobson
Have been working on communications to public about right to test and how that testing is covered
In regard to enforcement, I know CDPH has put together an enforcement task force
een in the works
Monning
Close with all of these reps, encouraging extraordinary redoubling of efforts
You are the link to the public
The people who have been exposed
Would encourage massive public education
Cooperation of local media, PSAs
Pan
One q
federally regulated, do you help filing with federal if someone with a fed plan comes?
Ream
gency
Can help with self-insured product that is administered with a CA licensed health plan, assist them with
finding federal department who can help them
We get them connected
Rubio
Let me take a moment so say thank you to all our first responders, nurses and doctors in the throesof
this
I think Sarah Ream, you discussed the layers in terms of when they must pay, cost sharing
knowledgeable in this space, is there a mandate that health
care plans are required to post? Where would they go, how can they search if they are tier 1 or 2?
Ream
I agree, it is complex
o FAQs
o Letter to plans
o COVID Q and A
Excellent resource
Look to health plan partners to assist in spreading message about how people can get tested and what
cost share may be
Trying to get that message out there
Rubio
I think I heard on Tier 2 you said asymptomatic essential workers
o You included teachers; I know several teachers who do not know this
o
o Are there efforts to work with the school districts?
We need to collaborate closer
Ream
We have a dedicated team on outreach and I will take that back to them
Pan
position if they have a self-regulated pl
Corlette
Challenges, state is preempting from imposing requirements for those plans under ARISA
-regulated that is covered under federal law
Could affect bill because he asked test to be removed
If no COVID-19 test on bill, then coverage requirement would not kick in under federal law
Pan
Sounds like we have to ask federal partners there
For both Mr. Hinze and Sarah Ream, you testified if someone is out of network it should be a reasonable
cost
What kind of guardrails has DOI put in place or plans to put in place?
For Sarah Ream, could you comment on what are plans expected to pay in terms of tests if you get a bill
that you may think is large or excessive?
Hinze
Right now, the environment that controls compensation is that provided for by the Federal Families First
Act and CARES Act
provider posts on a public website
o Limited to duration of fed emergency
o Should we look forward to when state may wish to have longer emergency than fed gov,
Legislature may consider moving some of that over
Ream
Echo what Mr. Hinze said, add that under DMHC regs, with respect to enrollees who are asymptomatic
and do not have recent exposure, health plans would be expected to pay either negotiated rates or if
they do not then provider would be compensated at reasonably customary rate
Keeping in line with Knox-Keene Act
Pan
For Dr. Jacobson, I understand you are on the testing task force
Know you are focused on public health risks
The Department looks at establishing surveillance and other types of testing
Discussion as to who is expected to pay for surveillance testing in workplaces or in the community?
Discussions about which entity who should be paying for it?
Jacobson
Happy to try to find those answers
Some of the guidance do have references to occupational health that does have some of that info
available
Happy to find more detail
Pan
I know you establish the care
Move onto similar question for Sarah Ream and Bruce Hinze, in terms of paying for these surveillance
workforce safety
One could distinguish between those done due to workplace or those required by CDPH
Should the health insurance be responsible for that or someone else?
Required by CDPH
should be paying?
Ream
under CARES and FFCRA, if someone has symptoms or has exposure, they can be tested out of network
with no cost
But for essential workers who are asymptomatic, our structure contemplates that they will go and get
tested in plan
Does not contemplate third party involvement with workforce testing
If essential worker chose to be tested multiple testing in a week, plan would have to pay
With respect to question, under Knox Keene Act health plan must pay for essential worker when they go
through insurance
Hinze
Proposed regulations from OSHA, proposal for workplace exposures, these CalOSHA proposals would
require the employer to pay for testing in the context of that exposure
The current fed law, Families First and CARES Act require coverage by insurer if an attending provider
fed law apply
We get to the question regarding importance of asymptomatic spread, that you may not have a
situation where the proper filter is waiting for people to have symptoms
The fed approach with medically appropriate opens the door to possibilities for the appropriate testing
of asymptomatic persons who do not have an occupationally defined exposure
State may wish to establish a structure that provides that level of coverage where insurers will be paying
for such testing, separate and apart from current temporary fed law
Pan
So, a plan, they get the request for reimbursement from provider, how are providers and insurance
companies supposed to distinguish the essential workers from the others?
How to sort who is in which tier?
Ream
Admittedly, I could see that in practice there could be difficulties
Put in reg and further guidance that the health plan can ask the provider, was this an essential worker
and if provider says yes, that is all the evidence that the health plan can ask for putting that person in
the tier
Wanted to make sure plans and providers did not get in back and forth
All enrollee needs to do is say yes,
Pan
Thank you
Not seeing any hands up, I want to thank each of you for testimony
Now move onto our responders
Seven witnesses from many perspectives on this issue for access to testing
Kelsey Waldron, Attorney with Bay Area Legal Aid
Part of health consumer alliance
The health consumer alliance provides free legal services for all health insurance related issues
Two client stories
Both clients sought medical services for COVID testing and both have private plans regulated by DMHC
First has one year old daughter, she had symptoms
Parents took daughter to E.R.
In late March no COVID-19 tests on the child
Tested positive for flu and was sent home
Family received bill for $2000
Confused and frustrated
Led family to believe this would be fully covered
Second client had symptoms and got test from hospital, bill for $100
Unclear whether hospital will continue to bill after it was disputed
Throat specialist ordered test
Received explanation of benefits that stated patient portion was $400
No bill but concern that this provider will bill
Any Californian who does not know who their health plan is or who can provide this can reach out
William Isenberg, Chief Quality and Safety Officer at Sutter Health
Ap
Regulations create barriers by providing guidance on how health plans may pose utilization
management restrictions and cost sharing on enrollees
DMHC places burden on physicians to determine if essential workers
Consumes times for doctors
Hardly an action that makes sense
Emergency regs contemplate that health plans make determination, in practice impracticable
Delay ability to obtain testing
Cost sharing is a barrier to accessing testing, particularly for vulnerable populations and minorities
Health equity barriers must be removed
Testing deserts in rural communities
Individuals should be able to get a test where they can, regardless of in network or not
Requires expansive testing and tracing and treatment
Diagnostic testing should be medically necessary basic test for all Californians
Dierdre Kennedy, BenAssist Health Insurance Services
I am serving as Leg Chair for LA Association of Health Underwriters
My son was exhibiting symptoms, called doctor, referred to hospital, hospital did test, balanced bill for
$100 later
Called billing office, charge was dropped, when I questioned why receiving bill, the billing clerk could not
get off the phone fast enough
Awareness that this was an inappropriate bill
We have talked to a lot of our members about prevalence of balanced billing, not quite as prevalent
In my role, it is my job to gather knowledge and provide guidance to employers
When CARES Act and others were passed, we really took a strong role with employers to make sure they
understood what benefits covered and we developed a series of employee-facing communications
Had a great deal of opportunity to support employees and when they have an issue with a balanced bill,
turn to us
Trina Gonzalez, CA Hospital Association
I will take us to the beginning pandemic, we had limited capacity
We now have better capacity
Thanks to investments by state and hospitals
Inadequate still
Now able to do more testing, conflicting requirements has created confusion amongst patients and
providers
Clarity is needed
Priorities for utilization of finite testing supplies
Uniform protocols and authorities
Welcome opportunity to work with stakeholders to develop list of priorities
Once priorities are established, payment policies should be aligned
Most Californians are protected by balanced bills, however gaps still exist
Patients should be shielded from these unexpected bills
Health care workers are working tirelessly
Professional association of physician orgs
Serve 18 M patients in CA
Capitated medical groups required to provide free COVID testing without copay to patients
Set up testing centers
Members are required to pay third party testing costs that are submitting
Had existing relationships with testing providers at beginning of pandemic
New charges were set by labs at beginning of pandemic
Medical groups still required to pay charges
Important aspect is availability to testing results to primary physician
Been an issue, lack of testing data access
Current COVID costs are running $2-$3 per member per month
Waiting to see what vaccine will add
Some orgs are developing own testing capabilities
o UC Medical Groups
o Provides more affordable and some more rapid results
APG has been in regular communication with DMHC, concerned about lawsuit
Huge shifting to medical groups but remain committed
Kristi Foy, CA Clinical Laboratory Association
Quest and LabCorp, academic labs, etc.
Appreciate emergency regs issued by DMHC that intended to allow more testing
CCLA disagrees with conclusion that antibody testing is not required for diagnostic purposes
CDC currently emphasizes appropriateness and importance
Concerned about billing for asymptomatic, non-exposed essential workers
o Essential worker determination
Health plans are responsible, not labs
Should not be permitted to deny or withhold payment
Should not impose cost sharing
o In cases of delegation, responsible party remains health plan unless explicitly delegated
Info is hard to get
IPAs should be required to respond to claims about COVID testing
Provide complete and accurate insurance info
Nick Louizos, CA Association of Health Plans
CA Health plans take seriously the need to provide testing
State and fed regs are well-intentioned
Members are witnessing unintended consequences
Through a survey, our plans have indicated that about 50% of enrollees in group plans are in industries
considered essential
Universe of individuals subject to regs is massive
Challenging for all parties
CAP members identified areas of concern
o Dramatic increase in number of out of network
o Variability of cost between in and out of network
According to national survey of health plans determine a quarter of tests are out-of-network
Receive claims that are three times the payment of Medicare payment rate
Max bill charges
Out of network costs for entire system
Could outpace premiums being collected
Pan
Appreciate all the different perspectives
Questions?
I will ask a few questions
Want to thank everyone
Several of you have talked about the challenges of trying to determine who is an essential worker, will
tiers and how does the plan sort this out?
Louizos
I wish I had a solution
We are sympathetic to this issue
Asymptomatic and symptomatic distinction is an issue with plans and providers
Many of plans who are providing non-mandatory guidance on preferred coding, however, coding to
determine whether someone is an essential worker is unclear
Not all labs using same practices and codes
Hard for health plans to make determination
Trying to work with providers and providing guidance
Pan
For Kelsey Waldron, you shared some stories about people who were balanced billed, in your work what
seems to be the main trigger for this to happen? Where do people get tripped up, you made some
Do you have broader day in terms of where does it seems like the ball gets dropped?
Kelsey Waldron
One of the biggest gaps is consumers feel confused, see headlines saying COVID testing will be covered
A
Consumers in the dark about what is covered
Lack of communication, could be fixed by plans communicating
Does seem people are unclear and people are scared when they have symptoms and want to get a test
Not thinking about will insurance cover
Pan
Dr. Jacobson, are you still on?
I did want to ask you, we heard that some of this is confusing but at the same time, should the message
nsurance?
From a public health standpoint can you speak to the message that should be out there? Should we be
trying to cover everyone?
Jacobson
Should we be encouraging folks to get tested?
Pan
health plan
Jacobson
Strictly public health, it should be to go get tested
If you have concerns, if you have symptoms, we want you to get tested
Pan
I realize it gets complicated and this involves money but I think we want to get to a place where people
can do what we want them to do
I think our regulatory agencies have been leaning that direction
Follow up, with Dr. Isenberg, on the frontlines for physicians, what should physicians be telling their
patients when it comes to getting tested? Check your health plan?
Isenberg
If you think there is a possibility, you should be tested
of the doctor patient relationship to determine if
this is an eligible patient, find out if they should wait
Pan
What I heard earlier, if a doctor says they should get tested, they are covered
Isenberg
pandemic, first contact should be with a provider
Pan
Ms. Gonzalez, we heard the story from Mr. Sharp, what guidance is your association giving its members
about people showing up for tests?
Gonzalez
We have been in constant contact with our members regarding law changes
We have a web page dedicated to COVID for our members on state guidance
Mistakes do happen and we want to hear about it and know
Pan
Nick Louizos, mentioned high percentage of out of network bills on testing
Telling people to go to places like Verily, testing is not always widely available
Can you touch on, are you concerned that people are trying to get tested unnecessarily?
I hear what you said about issues with particular providers
Can you speak to, it may not be unexpected that you would have a large number of out of network
tests, but
Louizos
Via AHIP, did a survey nationally, 50% of out of networks with prices that are out of cost are done at
stand-alone labs
A lot of this out of network activity is coming from, it appears many employers have either taken DMHC
regs or otherwise to mean they can contract with their own testing vendors and submit the bill to the
health plans and we believe this is a misinterpretation and leading to a high number of out of network
charges being forwarded to plans
Plans are majority paying for these, but there is a limited reimbursement rate for those charges that are
out of plan
Not all of these testing facilities are listing that cash price on their website
No parameters associated with this
That is what we suspect is leading to a lot of that activity
Pan
Want to thank all the members of this panel
I think this will be very helpful as we move forward as COVID continues
Move on to next section of hearing
With announcement of three vaccines that have shown promising results we wanted to touch on
coverage for vaccines once we have approval and then with treatment of COVID in terms of what are
federal and state regs recognizing COVID is a contagious disease
Sabrina Corlette
Coverage of a COVID-19 Vaccine Federal Requirements
o ACA: Plans must cover and waive cost-sharing for:
Plans/insurers have up to 2 years to implement
o CARES: plans/insurers have 15 days to implement
o Federal rules (Oct. 29, 2020) require:
OON coverage for vaccine and administration
Providers must receive reasonable payment; cannot balance bill
Similar to Medicare payment
Vaccine Coverage: Potential Gaps for Consumers
o ACIP recommendation required
o Non-ACA compliant health plans exempt
Health care sharing industries, grandfathered plans, fixed indemnity products
o Which vaccines?
Not required to cover all three vaccines
o OON protections apply on through public health emergency
o Void if ACA is overturned in California v. Texas
Limited state action to date
Sarah Ream, DMHC
Regarding COVID-19 vaccines, to echo what Professor Corlette said, under fed law must cover without
cost sharing all preventative services with A or B rated from U.S. preventative services task force and
CDC recommended vaccines
Additionally, under current law health plans must assume risk for adult and child vaccines
o Cannot pass to providers
For treatment, plans must cover all medically necessary services and treatments
Bruce Hinze, DOI
Fed requirements regarding COVID-19 vaccination only apply to non-grandfathered ACA required
coverage
Section 101.2 of Insurance Code only apply to non-grandfathered ACA coverage
Fine line baked in is obligation to provide this preventative care only comes in one year when federal
advisory comte. makes recommendation
State Legislature may also consider that grandfathered coverage also applies
To extent that treatment may not be covered, may be that Insurance Code may not require basic health
care coverage does not apply to non-grandfathered coverage
Legislature may want to pass legislation that all coverage applies
Tricia Blocher, Emergency Preparedness Office, DPH
Provide update on vaccine distribution planning
Using data and science to guide planning and implementation
CA planning process ensures vaccine makes safety requirements, delivered equitably, and ensure
transparency
GGN recently named Scientific Safety Workgroup
WA, OR, NV joined effort
Vaccine trials, reviewing safety and efficacy, and providing recommendations
Drafting and Guidelines Workgroup
o Develop allocation framework
Community Vaccine Advisory Comte.
o Ensure equitable vaccine distribution and administration
Planning with local public health departments
Leveraging well-established existing immunization framework
Local public health departments will administer vaccines
Role of different providers will depend on supply and stage of distribution
Several phases of plan
o Planning
o Limited doses
o Sufficient widespread supply
Vaccination Communication plan focused on timely, accurate, actionable info about vaccine plan
CDPH subject matter experts will work closely with federal and local partners
CDPH is in early processes of recruiting and enrolling vaccine providers
Work is underway to ensure that IT infrastructure is robust and will meet requirements
Developing statewide backup plans for local storage
I appreciate your interest
Number of unknowns about timing, implementation, etc.
Pan
Member questions?
Seeing none
I have a few questions
implemented own laws for requirements, does that subject us to additional state costs?
If state moved on its own to fold plans in
Corlette
defray costs
Pan
For Sarah Ream and Bruce Hinze, in terms what are your respective agencies plans for issuing guidance
to the health plans you regulate?
Could have two or three vaccines out there, may have varying accessibility
Will be an issue having enough vaccines initially
Any guidance thinking about in terms of coverage of potential vaccines?
Ream
We are looking into that issue now and developing recommendations and guidance on what we would
expect plans to do if multiple vaccines are available
Pan
Possible we can have different vaccines at different price points, CDPH will have priorities, but for
example, is there thought that plan will be required to cover whatever vaccine is available in that area?
Is that being considered?
Ream
Priority is to get as many people vaccinated as quickly as possible
Still looking into what guidance will provide, not contemplating a plan could deny coverage for a vaccine
available in that area at that time
Our expectation is plans would widely cover vaccines
Pan
How much coordination is going on with DOI? I recognize different characteristics, but how much
coordination?
Ream
We talk very frequently, try to coordinate in these issues that touch both
Pan
Do you want to answer the question Bruce?
Hinze
In terms of vaccine availability and payment, the final federal rule that was released is that the vaccine is
paid for by the federal government
If the vaccinator, cannot balance bill or copayments
No cost to person who receives it, including insured person
of guidance
Pan
ut coverage for storage and etc.
What will happen with regards for administrative costs related to delivery vaccine, health professional
time, supplies associated with administering vaccination, do you see any issues in that regard with
appropriate payment and some of these places delivering this vaccine is not going to all providers, so
can you speak to some of the issues you are considering?
Hinze
Again, the federal law is good about this
son
Confident insurers will cover administrative costs and ancillary costs
Ream
Nothing to add, echo what DOI said
Expectation is plans will cover administration costs
Pan
For both of you in regard to treatment, right now if you have COVID and need trea
-regulated plans or
a non-state regulated plan?
Ream
We would view that situation as similar to if someone contracted another type of communicable disease
at hospital for treatment, treatment would be
carrier to figure that out rather than allowing plan to turn away enrollee
Hinze
-carrier to resolve that later
Pan
, for cost sharing or anything?
Hinze
That happens now for any workplace injury, questionnaire you fill out with that
Not new or unusual
Pan
For Tricia Blocher, appreciate your presentation about what the plans are to get the vaccine to the
public, so from your perspective in CDPH what are the things we should do as a state that would help
facilitate distribution, access to, and then acceptance of vaccine? What should we be looking at as a
Legislature?
Blocher
I think as with entire vaccine program, communication will be one of the most challenging
If anything, to do it would be to help with communication
The most helpful
Pan
Want to be sure people know they can get it and without financial barriers
Other questions?
I want to thank all of our panelists for this presentation so we will now move onto our reactionary panel
Move on to reactor panel
Dr. David Lubarsky, UC Davis Health
Over the last several weeks news about efficacy of COVID-19 vaccine travels has been very promising
Give us hope as we double efforts
While news is encouraging, many issues needed to be addressed
Planning to coordinate vaccine distribution and communicate with public, coverage should be provided
without cost sharing
o
o Providers must accept and provide vaccine regardless of ability to pay
We want every person working as hard as possible to get that vaccine out
What we are trying to make sure is that state entities consult with physician experts, provided by CMA
and others, as trusted partners in developing guidelines and distribution plans
Should not take away flexibility to decide which patients need vaccine first
Physicians must be included and it needs to be a guideline, not a mandate
Trina Gonzalez, CA Hospital Association
COVID vaccine could be available as soon as next month
Hospitals will play pivotal role in distributing vaccine, particularly when vaccine is distributed to health
care workers
Many hospitals will serve as volunteers for closed points for dispensing
Centers for Medicare and Medicaid has released final rule on this
Through this rule, CHHS and labor and treasury implement CARES Act requirement that plans must
cover all doses, administration, and office visit
Under Families First Act, states are entitled in temp 6.2% increase to FMAP on condition that state
covers without cost sharing vaccine for certain Medicare enrollees
Important there is CA specific guidance
Smooth way for health care workers and public
Develop clear priorities and guideposts
New therapeutic treatments will continue to be developed
16 in pipeline
Went to ensure new treatments are all covered
Jeanette Thornton, Americas Health Insurance Plans
Dedicated and committed to partnering with policymakers and state to ensure rolled out in safe and
comprehensive way
Must cover vaccine for all regardless of out of network and regardless of coverage
Must cover vaccine within 15 business days, but we will need to be ready immediately
Preparing to enroll providers and accept payments for COVID-19 admin fee
Receiving claims from COVID entities that have not traditional billed
Stand ready to assist, informing if they need vaccines and where can get it, follow up with second dose,
track adverse events, data challenges
Interested in working to make sure we are part of data flow
Credible source of info on vaccine effectiveness and readiness
Areas we can do further partnership
o State needs to make data on administration to plans
o Transparent on vaccine supply
o Size and timing of allotments
o Location of allotments
Steps will help plans understand full scope
Stand ready to assist the state
Diana Douglas, Health Access CA
enrollees are not being affected by cost sharing and premiums
Appreciate health plans that have waived cost sharing, unclear how many plans have done this and of
what they are responsible to pay
Importance for clarification, important also that folks know what they will be responsible for
Any requirements for treatment coverage have to extend pass public health emergency
Concerns about whether all plans will cover within 15 days and questions about interplay of fed gov,
workgroup, reviewing coverage
Must address issues head on so Californians will be covered once vaccine is distributed
Pan
Member questions?
I want to remind people to call in now if they want to participate
Member questions?
Seeing no hands
I did have a question
Is Tricia Blocher still on?
We heard from AHIP about data transparency and their willingness to work on tracking, maybe you can
speak to in your vaccine distribution plan, are you planning or partnering with health plans on who has
In terms of providing data to people about how many vaccine doses we have and where they are
Blocher
We are, as I mentioned, a lot of data requirements CDC has for all vaccinations
That will be the first place where we
much is administered
Working on those elements right now on how we will report that
More to come there, working to be able to describe the best way we can how and who is getting the
Pan
Health plans have talked about their role, have you engaged with health plans?
Blocher
rtunities to talk with health plans and DMHC to make sure we coordinate and
have an info flow
Pan
Thank you
I have a question for Dr Albertson, you are the principal investigator for Pfizer COVID-19 trial
Are there things providers need to know and their medical groups or health plans in terms of storing,
administering the vaccine that people should be aware of as we set policies for coverage and for those
who need to know what to do for receiving and distributing?
Dr. Albertson
This will be a huge issue
Data exchange between state, providers, insurers will be key
Two vaccines that will be approved have different intervals between them in their studies
o One is 21 days and one is 28 days
o Need to know what drug people have, what time, what lot
Going to be a real challenge, something the providers will be excited about
Think we will need info
Hope database gives that kind of info, hope not a CURES type database
Some sort of interface with one of the major EMRs
Giving it to 130 patients, not many problems
This will be our inflection point to make a change
Pan
vaccine and then one of another?
Albertson
No
Pan
Albertson
As you know, we have a mobile population
We will have to track to make sure they come for second dose
Will be a lot of work to make sure we get second dose at the right time
Pan
If, coming up on open enrollment, possible that they will change plan after one dose, is that something
you see being a problem?
Thornton
There will be separate code for each vaccine and dose
If someone changes plan to different health insurer, we would not have record of that
Pan
Would it be simpler if we said whoever covers the first dose has to cover second dose?
which plan they switched to
Thornton
For all of the doses the fed gov has purchased, the vaccinator has to vaccinate whether they are insured
or not
We get the claim at the back end and if we get a claim, we have to cover
For the person it will be very seamlessly
Pan
there are a lot coming down the line
Some have had questions, what are the health plans doing in relation to different treatments in deciding
which treatments will be covered?
Thornton
A number of members have waived cost sharing around treatment during the pandemic and some
beyond
All of our plans have Chief Medical Officers who look at the data
We know they review the evidence and help make those decisions
Closely monitoring FDA
Pan
In a follow up I understand Medical Director providing guidance, how is that communicated to provider
community?
Thornton
Some of them have been in short supply
In general plans work had to keep coverage policies up to date and provide resources for providers on
e
Pan
Dr. Lubarsky did you want to make a comment?
Dr. Lubarsky
The whole key is we cannot anticipate what exactly will go on
Enlist CMA and CA Hospital Association to make sure everyone is doing right thing
Right decision for every patient
Trina Gonzalez
I think Dr. Lubarsky covered a lot
Those are the kinds of things we want to make sure our providers have access points
Diane Douglas
As far as access to treatments, folks need to know what treatments are covered
Provide clarity
orried about bills and not seeking treatment
Pan
There are many people who have survived COVID but are still suffering
Becoming an increasingly large number and they need ongoing treatment
With that, any other questions?
Seeing no other questions, I want to thank our panels
Thank you for testimony
Appreciate you taking your time out and sharing with us perspectives
Public Comment
Anti-Vaxxers
CA Health Plus Advocates
o Health centers are required to see any patient who walks through the door regardless of ability
to pay
o Clinics required to pay
o Requires plans to reimburse provides, some plans are non-responsive
o Only reimburse if providers post testing fees, but that has created some confusion with MediCal
and uninsured who thinks they have to upfront
o CARES Act is contingent on fed public health emergency
o Imperative that everyone is ensured a test
Western Center on Law and Poverty
o Pandemic disproportionately affected POCs
o Working outside the home should be considered presumptively exposed
o State and local public health authorities have not provided data
o Plans profiting
o Plans must be held accountable
o Plans should help provide for chronic conditions
o Distrust around vaccine
CA Dental Association
o care; dental offices will need to provide this
regardless of exposed contact
o Ability to use tests to screen will be crucial for public health surveillance
o Both the necessity for patients to be unmasked force dental offices to assume everyone is a
carrier
o Not available for test to be reimbursed by plans
o Prevalence of asymptomatic individuals and nature of dentistry, tests should be covered by
insurance
CA Association of Health Underwriters
o Agents solve problems, first to be called with questions about insurance
o Agents can often get problems, including surprised billing resolved quickly
o Consumer services to small businesses
o Health insurance agents bring human touch
o Understand there are and will be many questions
o Ask an agent