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Testing Options | Sierra County, CA - Official Website
Health plans must cover COVID-19 tests that are FDA approved or authorized, or approved by the state, without prior authorization and at no cost to the enrollee. This includes follow-up (serial/sequential) tests. This requirement applies to such tests administered by a skilled nursing facility.  Biden-Harris Administration Requires Insurance Companies and Group Health Plans to Cover the Cost of At-Home COVID-19 Tests, Increasing Access to Free Tests (January 10, 2022)2. Does the requirement for health plans to cover COVID-19 apply to testing for asymptomatic individuals? Yes. Health plans must cover testing for COVID-19 and may not deny coverage based on lack of medical necessity. Please refer to the federal Coronavirus Aid, Relief, and Economic Security Act” (CARES Act) for additional information. 3. Does the requirement for health plans to cover COVID-19 testing apply to commercial, Medi-Cal, and Medicare Advantage plans? Yes. All of these plans must cover COVID-19 testing, without prior authorization, and at no cost to the enrollee. Similarly, recent guidance from the federal Centers for Medicare and Medicaid Services (CMS) also requires coverage of COVID-19 tests for beneficiaries in traditional Medicare coverage. 4. Does the requirement for health plans to cover COVID-19 testing apply to self-funded, employer plans (also known as ERISA plans)? Yes. Self-funded employer plans also are required to cover COVID-19 testing and screening without cost to the enrollee, and without prior authorization. Please refer to the CARES Act for additional information.

 
 
 

 

 

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Office of the Patient Advocate - State of California


of Health and Human Services) http://findahealthcenter.hrsa.gov/Search_HCC.aspx
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The 2024-25 Budget: Medi-Cal Analysis
Proposed Prospective Payment Systems Also Worth Considering, Though Further Analysis Is Warranted. In concept, prospective payment systems have certain advantages over traditional procedure‑based reimbursements for hospitals. Most importantly, because these systems pay for an episode of care, rather than for every procedure, hospitals have incentives to avoid unnecessary services and treat patients efficiently. That said, designing effective prospective payment systems is a complex exercise. Research and analysis from DHCS is warranted to ensure these new systems provide the intended incentives and avoid unintended consequences. Also, time likely will be needed for hospitals to adjust to these new systems, particularly for those hospitals that have little experience billing Medicare for services. Moreover, because Medi‑Cal also provides supplemental payments to hospitals, some of which are allocated based on cost, the overall impact of the new base payment systems on hospital behavior is uncertain.
Proposed Equity Adjustment Worth Considering, but Impact Is Uncertain. Medi‑Cal beneficiaries have different access to services depending on where they live in the state. Some regions have fewer primary care or behavioral health providers per capita than others, likely affecting access to care. The supply of specialists also varies by region. Partly in response to these supply constraints, managed care plans apply for alternative time and distance standards in some localities. An equity adjustment could better target resources and incentivize providers to serve Medi‑Cal beneficiaries in these regions. That said, whether the adjustment as proposed would be of a sufficient size to alter provider behavior is uncertain. Moreover, it is uncertain how long it would take for providers to respond to these new incentives.
In Many Cases, Assessment of Proposal Depends on Details. In many cases, more information likely will be critical to fully weigh the administration’s proposed approach. For example, in contrast to other areas of the proposal, the administration has not clarified how abortion rates would be adjusted following the increase in January 2025. While the sizable increase in 2025 might mitigate the need for annual adjustments in the short term, over the longer term, rates likely will lag again behind inflation if they are not consistently adjusted. As another example, more information likely is needed to assess the proposed directed payment program for nonhospital clinics.
Testing | Senator Scott Wiener
Visit www.projectbaseline.com/COVID19 to learn more.
SFGH has a drive-through and walk-up testing center in the hospital parking lot at 23rd Street and Potrero Avenue.
A UCSF drive-thru testing site is set-up at Laurel Heights.
Dignity Health-GoHealth Urgent Care is conducting rapid tests for anyone, even if you don’t have insurance, in the Castro. Hours are 8 am to 8 pm Monday to Friday and 9 am to 5 pm on weekends. Schedule a virtual screening process at https://www.gohealthuc.com/bayarea/virtual-visits before coming in to be tested.
Brown & Toland Physicians and Sutter are doing drive-through testing by appointment at the CPMC Pacific Heights campus. Testing is for Brown & Toland and Sutter health care workers and patients who are symptomatic.
Kaiser members can get tested at an SF site (location not identified publicly because it is only for Kaiser members) after being referred by a physician. Results come back in 24 hours. 
NEMS is doing testing by appointment at 450 Noriega St. from 2 to 3 p.m. and 735 Vallejo St. from 3 to 4 p.m. The tests are for symptomatic NEMS patients and are appointment-only.
Carbon Health urgent care centers are offering testing to anyone showing symptoms or at-risk for exposure, including essential workers. The test must be ordered by a Carbon Health provider. 
Forward, a network of primary care centers with a clinic in the Financial District, is offering testing for its members.
Sutter and OneMedical are performing tests for their existing patients at sites throughout the Bay Area.
A temporary Field Care Clinic opened in April in a tent adjacent to the Southeast Health Center in Bayview-Hunters Point. It provides primary care, urgent care and screening for COVID-19. The clinic has capacity to treat up to 100 patients daily, with a smaller tent serving as an alternative testing site for potential coronavirus patients.
Office of the Patient Advocate - State of California


The latest Total Cost of Care ratings were developed by comparing medical groups’ costs during 2020. Each medical group’s average monthly costs were calculated by assessing the total actual payments made by both health plans and patients for the care provided to patients.
 
When comparing medical groups, look for medical groups that have higher Total Cost of Care ratings and higher quality ratings. More stars are better. Groups with lower average costs received a higher star rating.​
 

 View the cost ratings for medical groups in your county
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Posted: May 11, 2022​​

2021-22 Edition of the Medical Group-Medicare Advantage Report Card
The latest Report Card has Quality of Medical Care ratings for 169 medical groups that serve Medicare Advantage members.
 
Each year, patient records are reviewed to determine if the medical care provided meets national standards for using treatments proven to be effective. The Report Card provides star ratings on overall quality of medical care and ratings on 12 specific clinical measures, including those related to diabetes care, cancer screenings, and arthritis treatment.

 
Find ratings for medical groups in your county​​

 
​​Posted: May 11, 2022​​

HMO and PPO Quality Ratings
The 2021-22 Edition of the Health Plan Report Card offers quality ratings for the 10 largest HMO plans and 6 largest PPO plans in California. Find out how your health plan rates!​
The Report Card provides overall star ratings based on evaluations of medical records and patient surveys. You also can compare health plan scores on more than 50 specific health care topics and quality measures, such as for behavioral health, immunizations for children, heart care, preventing hospital readmissions, patient satisfaction with plan doctors, and more.
 
View the health plan ratings​​
 
​​Posted: May 11, 2022

California’s Individual Health Care Mandate​

Starting January 1, 2020, Californians must have health insurance. For more information, visit www.coveredca.com.​
 
​​Posted: February 11, 2020

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The 2024-25 Budget: Medi-Cal Analysis
Were the General Fund to have limited capacity when the MCO tax shortfall begins, the Legislature could face pressure at that time to pull back some of the package’s augmentations or to sustain them by identifying reductions elsewhere. 
Recommendation
Consider Proposed Budget Solution as a Starting Point. Given the fiscal challenges in the state budget, we recommend the Legislature consider adopting the proposed MCO tax budget solution. The Legislature likely will want to condition such action on the administration demonstrating that the proposed tax increase stands a reasonable chance of receiving federal approval. To the extent the Legislature does not adopt some or all of the proposal, it will need to identify a like amount of budget solutions in other areas of the budget. Alternatively, the Legislature could consider using even more MCO tax funding to address the budget problem, potentially avoiding reductions in other areas. The Legislature likely would want to weigh such an action against its interest in increasing provider payments in Medi‑Cal, further described in the next section. 
MCO Tax‑Funded Provider Payment Increases
In this section, we analyze the Governor’s proposed provider payment increases in the MCO tax package. We first provide background on the existing way Medi‑Cal pays providers in the fee‑for‑service and managed care systems, as well as the provider payment increases enacted in last year’s budget. Next, we describe the proposed package of payment increases. We then provide our initial assessment and recommendations.
Background
Provider Payments in Fee‑for‑Service System
In Fee‑for‑Service, Medi‑Cal Pays Providers Directly. Under the fee‑for‑service system, DHCS oversees a network of providers across the state, approves the delivery of certain services, and—critically—directly pays providers. While it is Medi‑Cal’s traditional delivery system, over time the state has shifted most beneficiaries out of fee‑for‑service. Around 5 percent of Medi‑Cal’s enrollment, as well as 23 percent of program spending, is projected to be in the fee‑for‑service system in 2024‑25. 
Medi‑Cal Takes Several Approaches to Pay for Services. While fee‑for‑service often is described as a single delivery system, there is not one approach to pay providers.
The 2024-25 Budget: Medi-Cal Analysis
We therefore recommend adopting the Governor’s other proposed budget solutions in Medi‑Cal as a starting point.
Reductions, Rather Than Delays, May Be More Reflective of the Budget Situation. A number of the Governor’s proposed budget solutions, particularly in Medi‑Cal, are delays of limited‑term spending. While these solutions are warranted to address the current budget problem, we estimate that the state is likely to face significant operating deficits in the coming years. With lower revenues and higher ongoing spending obligations projected beyond the budget year, it may be difficult to fund programs that were delayed to future years. For this reason, funding delays enacted in this year’s budget may ultimately become reductions in the future. Therefore, in evaluating the Governor’s proposals to delay limited‑term spending, it may be more realistic for the Legislature to consider the proposals as spending reductions.
If Budget Situation Worsens, Additional One‑Time Funding Could Be Pulled Back. As we noted in our recent report, The 2024‑25 Budget: Overview of the Governor’s Budget, the state’s budget condition is likely to worsen in May, necessitating additional budget solutions beyond those proposed in the Governor’s budget. To minimize the impact to ongoing service levels, the Legislature could consider pulling back additional one‑time funding in Medi‑Cal. For example, we estimate around $100 million in grants in 2024‑25 could be reduced or delayed from the Children and Youth Behavioral Health Initiative, another behavioral health‑related initiative in Medi‑Cal that the Governor proposes to maintain. The Legislature also has opportunities to reconsider General Fund support for BH‑CIP, described further below. 
Recommend Shifting BH‑CIP Support if Proposition 1 Bond Is Approved. Proposition 1 on the March 2024 ballot would authorize $4.4 billion in general obligation bond authority for BH‑CIP—double the amount that has been appropriated thus far for the program. (The total general obligation bond authority is $6.4 billion.)
The 2024-25 Budget: Medi-Cal Analysis
$1

$516

$324

$841

MCO = managed care organization.

Assessment
In Concept, Tax Increase Worth Considering. As we emphasized in The 2023‑24 Budget: Analysis of the Medi‑Cal Budget, enacting an MCO tax makes budgetary sense. The tax is a key source of support for the Medi‑Cal program while imposing a minimal cost on the health insurance industry. Following this same logic, it also makes sense for the state to maximize the benefit it can achieve from the tax. Moreover, increasing the size of the MCO tax is a particularly attractive budget solution relative to other options as it does not necessitate scaling back core programs or imposing substantial new costs to California taxpayers. In considering the proposed increase, the Legislature will want to ensure the revised tax still complies with federal rules and therefore stands a reasonable chance of receiving federal approval.
Reducing Provider Payment Reserve Also Worth Considering, Though Fiscal Risks Remain. The Governor’s proposed reduction to the provider payment reserve would help address the state’s budget problem over the next few years, but also accelerate when the potential MCO tax funding shortfall occurs by around one year. The best available data strongly suggest the state is facing a notable budget problem now and likely faces budget deficits over the next few years. The state’s fiscal situation in the longer term, when the shortfall is expected, is less certain. Because of the likely fiscal constraints in the near term, tapping into the reserve to help address the immediate situation is reasonable. That said, it also would be prudent for the Legislature to begin planning for the long‑term sustainability of the MCO tax package. Were the General Fund to have limited capacity when the MCO tax shortfall begins, the Legislature could face pressure at that time to pull back some of the package’s augmentations or to sustain them by identifying reductions elsewhere. 
Recommendation
Consider Proposed Budget Solution as a Starting Point. Given the fiscal challenges in the state budget, we recommend the Legislature consider adopting the proposed MCO tax budget solution. The Legislature likely will want to condition such action on the administration demonstrating that the proposed tax increase stands a reasonable chance of receiving federal approval.
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