BILL NUMBER: AB 495 CHAPTERED
BILL TEXT
CHAPTER 648
FILED WITH SECRETARY OF STATE OCTOBER 10, 2001
APPROVED BY GOVERNOR OCTOBER 9, 2001
PASSED THE ASSEMBLY SEPTEMBER 14, 2001
PASSED THE SENATE SEPTEMBER 13, 2001
AMENDED IN SENATE SEPTEMBER 7, 2001
AMENDED IN SENATE AUGUST 31, 2001
AMENDED IN SENATE AUGUST 20, 2001
AMENDED IN SENATE JULY 17, 2001
AMENDED IN SENATE JULY 9, 2001
AMENDED IN SENATE JULY 3, 2001
AMENDED IN ASSEMBLY JUNE 4, 2001
AMENDED IN ASSEMBLY APRIL 26, 2001
AMENDED IN ASSEMBLY APRIL 5, 2001
INTRODUCED BY Assembly Members Diaz and Cohn
(Coauthors: Assembly Members Alquist, Calderon, Canciamilla,
Cardenas, Cedillo, Chan, Chavez, Correa, Firebaugh, Florez, Frommer,
Goldberg, Havice, Horton, Koretz, Liu, Longville, Lowenthal, Nakano,
Negrete McLeod, Oropeza, Papan, Reyes, Salinas, Shelley, Simitian,
Steinberg, Vargas, Wayne, Wesson, and Wiggins)
(Coauthors: Senators Figueroa, Kuehl, Ortiz, Polanco, Romero,
Soto, and Vasconcellos)
FEBRUARY 21, 2001
An act to add Part 6.4 (commencing with Section 12699.50) to
Division 2 of the Insurance Code, relating to health care coverage,
and declaring the urgency thereof, to take effect immediately.
LEGISLATIVE COUNSEL'S DIGEST
AB 495, Diaz. Health care coverage.
Existing law provides for health care coverage for children in
low-income households through the Healthy Families Program and for
the provision of health benefits to qualifying individuals through
Medi-Cal. Existing law also provides for services for handicapped
persons under 21 years of age pursuant to the California Children's
Services Program. Under existing law, a county may organize a
prepaid health plan, which is designated as a local initiative, to
provide health care to eligible Medi-Cal beneficiaries.
This bill would create the Children's Health Initiative Matching
Fund in the State Treasury, which would be administered by the
Managed Risk Medical Insurance Board, in collaboration with the State
Department of Health Services, for the purpose of providing matching
state funds and local funds received by the fund through
intergovernmental transfers to a county agency, a local initiative,
or a county organized health system to provide health insurance
coverage to certain children in low-income households who do not
qualify for health care benefits through the Healthy Families Program
or Medi-Cal. The bill would also provide for the referral of
eligible children to the California Children's Services Program, as
specified.
This bill would declare that it is to take effect immediately as
an urgency statute.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Part 6.4 (commencing with Section 12699.50) is added to
Division 2 of the Insurance Code, to read:
PART 6.4. CHILDREN'S HEALTH INITIATIVE MATCHING FUND
12699.50. This part shall be known and may be cited as the
Children's Health Initiative Matching Fund.
12699.51. For the purposes of this part, the following
definitions shall apply:
(a) "Administrative costs" means those expenses that are not
incurred for the direct provision of health benefits.
(b) "Applicant" means a county agency, a local initiative, or a
county organized health system.
(c) "Board" means the Managed Risk Medical Insurance Board.
(d) "Child" means a person under 19 years of age.
(e) "Comprehensive health insurance coverage" means the coverage
described in Section 12693.60.
(f) "County organized health system" means a health system
implemented pursuant to Article 2.8 (commencing with Section 14087.5)
of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions
Code and Article 1 (commencing with Section 101675) of Chapter 3 of
Part 4 of Division 101 of the Health and Safety Code.
(g) "Fund" means the Children's Health Initiative Matching Fund.
(h) "Local initiative" has the same meaning as set forth in
Section 12693.08.
12699.52. (a) The Children's Health Initiative Matching Fund is
hereby established within the State Treasury. The fund shall accept
intergovernmental transfers as the nonfederal matching fund
requirement for federal financial participation through the State
Children's Health Insurance Program (Subchapter 21 (commencing with
Section 1397aa) of Chapter 7 of Title 42 of the United States Code).
(b) The board shall administer this fund and the provisions of
this part in collaboration with the State Department of Health
Services for the express purpose of allowing local funds to be used
to facilitate increasing the state's ability to utilize federal funds
available to California. These federal funds shall be used prior to
the expiration of their authority for one-time programs designed to
improve and expand access for uninsured persons.
12699.53. (a) An applicant that will provide an intergovernmental
transfer may submit a proposal to the board for funding for the
purpose of providing comprehensive health insurance coverage to any
child who meets citizenship and immigration status requirements that
are applicable to persons participating in the program established by
Title XXI of the Social Security Act, except as specified in Section
12693.76, whose family income is at or below 300 percent of the
federal poverty level in specific geographic areas, as published
quarterly in the Federal Register by the Department of Health and
Human Services, and who does not qualify for either the Healthy
Families Program (Part 6.2 (commencing with Section 12693) or the
Medi-Cal Act (Chapter 7 (commencing with Section 14000) of Part 3 of
Division 9 of the Welfare and Institutions Code). The proposal shall
guarantee at least one year of intergovernmental transfer funding by
the applicant at a level that ensures compliance with the
requirements of an approved federal waiver and shall, on an annual
basis, either commit to fully funding the necessary intergovernmental
amount to meet the conditions of the waiver or withdraw from the
program. The board may identify specific geographical areas that, in
comparison to the national level, have a higher cost of living or
housing or a greater need for additional health services, using data
obtained from the most recent federal census, the federal Consumer
Expenditure Survey, or from other sources. The proposal may include
an administrative mechanism for outreach and eligibility.
(b) The applicant may include in its proposal reimbursement of
medical, dental, vision, or mental health services delivered to
children who are eligible under the State Children's Health Insurance
Program (Subchapter 21 (commencing with Section 1397aa) of Chapter 7
of Title 42 of the United States Code), if these services are part
of an overall program with the measurable goal of enrolling served
children in the Healthy Families Program.
(c) If a child is determined to be eligible for benefits for the
treatment of an eligible medical condition under the California
Children's Services Program pursuant to Article 5 (commencing with
Section 123800) of Chapter 3 of Part 2 of Division 106 of the Health
and Safety Code, the applicant shall not be responsible for the
provision of, or payment for, those authorized services for that
child. The proposal from an applicant shall contain provisions to
ensure that a child whom the applicant reasonably believes would be
eligible for services under the California Children's Services
Program is referred to that program. The California Children's
Services Program shall provide case management and authorization of
services if the child is found to be eligible for the California
Children's Services Program. Diagnosis and treatment services that
are authorized by the California Children's Services Program shall be
performed by paneled providers for that program and approved special
care centers of that program and approved by the California Children'
s Services Program. All other services provided under the proposal
from the applicant shall be made available pursuant to this part to a
child who is eligible for services under the California Children's
Services Program.
12699.54. (a) The board and the State Department of Health
Services, in consultation with participating entities, including the
Healthy Families Advisory Committee, and other appropriate parties,
shall establish the criteria for evaluating an applicant's proposal,
which shall include, but not be limited to, the following:
(1) The extent to which the program described in the proposal
provides comprehensive coverage including health, dental, and vision
benefits.
(2) Whether the proposal includes a promotional component to
notify the public of its provision of health insurance to eligible
children.
(3) The simplicity of the proposal's procedures for applying to
participate and for determining eligibility for participation in its
program.
(4) The extent to which the proposal provides for coordination and
conformity with benefits provided through Medi-Cal and the Healthy
Families Program.
(5) The extent to which the proposal provides for coordination and
conformity with existing Healthy Families Program administrative
entities in order to prevent administrative duplication and
fragmentation.
(6) The ability of the health care providers designated in the
proposal to serve the eligible population and the extent to which the
proposal includes traditional and safety net providers, as defined
in regulations adopted pursuant to the Healthy Families Program.
(7) The extent to which the proposal intends to work with the
school districts and county offices of education.
(8) The total amount of funds available to the applicant to
implement the program described in its proposal, and the percentage
of this amount proposed for administrative costs as well as the cost
to the state to administer the proposal.
(9) The extent to which the proposal seeks to minimize the
substitution of private employer health insurance coverage for health
benefits provided through a governmental source.
(10) The extent to which local resources may be available after
the depletion of federal funds to continue any current program
expansions for persons covered under local health care financing
programs or for expanded benefits.
(b) The board, in collaboration with the State Department of
Health Services, shall adopt regulations, setting forth the criteria
it uses to evaluate an applicant's proposal.
12699.55. The board, in collaboration with the State Department
of Health Services, shall review each funding proposal submitted by
an applicant in accordance with the criteria described in Section
12699.54 and based on that criteria, approve or reject the proposal.
12699.56. (a) Upon its approval of a proposal, the board, in
collaboration with the State Department of Health Services, may
provide the applicant reimbursement in an amount equal to the amount
that the applicant will contribute to implement the program described
in its proposal, plus the appropriate and allowable amount of
federal funds under the State Children's Health Insurance Program
(Subchapter 21 (commencing with Section 1397aa) of Chapter 7 of Title
42 of the United States Code). Reimbursement provided from the
Children's Health Initiative Matching Fund shall consist of
intergovernmental transfers from applicants, as defined in
subdivision (b) of Section 12699.51, and the appropriate and
allowable federal State Children's Health Insurance Program funds.
Not more than 10 percent of the Childrens' Health Initiative Matching
Fund shall be expended for administrative costs, including the costs
to the state to administer the proposal. The board, in
collaboration with the State Department of Health Services, may audit
the expenses incurred by the applicant in implementing its program
to ensure that the expenditures comply with the provisions of this
part. No reimbursement may be made to an applicant that fails to
meet its financial participation obligation under this part.
Reasonable start up costs and ongoing administrative costs for the
program shall be reimbursed by those entities applying for funding.
(b) Each applicant that is provided funds under this part shall
submit to the board a plan to limit initial and continuing enrollment
in its program in the event the amount of moneys for its program is
insufficient to maintain health insurance coverage for those
participating in the program.
12699.57. Each health care service plan and specialized health
care service plan that contracts to provide health care benefits
under this part shall be licensed by the Department of Managed Health
Care or be a county organized health system.
12699.58. The board, in collaboration with the State Department
of Health Services, shall administer the provisions of this part and
may do all of the following:
(a) Administer the expenditure of moneys from the fund.
(b) Adopt regulations, including the adoption of emergency
regulations, in accordance with the Administrative Procedure Act
(Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code).
12699.59. All expenses incurred by the board and the State
Department of Health Services in administering the provisions of this
part shall be paid from the fund.
12699.60. Nothing in this part creates a right or an entitlement
to the provision of health insurance coverage or health care
benefits. No costs shall accrue to the state for the provision of
these services.
12699.61. The Governor, in collaboration with the Managed Risk
Medical Insurance Board and the State Department of Health Services,
shall apply for a waiver pursuant to the federal State Children's
Health Insurance Program (Subchapter 21 (commencing with Section
1397aa) of Chapter 7 of Title 42 of the United States Code) in
coordination with the Managed Risk Medical Insurance Board and the
State Department of Health Services to allow a county agency, local
initiative, or county organized health system to apply for matching
funds through the federal State Children's Health Insurance Program
(Subchapter 21 (commencing with Section 1397aa) of Chapter 7 of Title
42 of the United States Code) using local funds for the state
matching funds.
12699.62. (a) The provisions of this part shall be implemented
only if all of the following conditions are met:
(1) Federal funds are appropriated for this purpose.
(2) Federal participation is approved.
(3) The Managed Risk Medical Insurance Board determines that
federal State Children's Health Insurance Program funds will remain
available in the relevant fiscal year after providing funds for the
following groups:
(A) All current enrollees and eligible children and parents that
are likely to enroll in the Healthy Families Program in that fiscal
year, as determined by a Department of Finance estimate.
(B) Rollover funds are determined to be available from the State
Children's Health Insurance Program. For this purpose, "rollover
funds" are those funds that are available on a one-time only basis
through the federal State Children's Health Insurance Program
(Subchapter 21 (commencing with Section 1397aa) of Chapter 7 of Title
42 of the United States Code) and are not committed for use by those
groups described in subparagraph (A).
(b) The State Department of Health Services and the Managed Risk
Medical Insurance Board may accept funding necessary for the
preparation of the federal waiver application described in Section
12699.61 from a not-for-profit group or foundation.
(c) The submission and approval of federal waivers for State
Children's Health Insurance Program funds that use state General Fund
moneys for the addition of children or parents shall take precedence
over the submittal of the waiver required by Section 12699.61.
12699.63. The state shall be held harmless for any federal
disallowance resulting from this part. An applicant receiving
supplemental reimbursement pursuant to this part shall be liable for
any reduced federal financial participation resulting from the
implementation of this part with respect to that applicant. The
state may recoup any federal disallowance from the applicant.
SEC. 2. This act is an urgency statute necessary for the immediate
preservation of the public peace, health, or safety within the
meaning of Article IV of the Constitution and shall go into immediate
effect. The facts constituting the necessity are:
In order to expand the availability of insurance coverage for
children in low-income households and to make available funding for
that purpose as soon as possible, it is necessary that this act take
effect immediately.