BILL NUMBER: AB 2197 CHAPTERED
BILL TEXT
CHAPTER 684
FILED WITH SECRETARY OF STATE SEPTEMBER 18, 2002
APPROVED BY GOVERNOR SEPTEMBER 18, 2002
PASSED THE ASSEMBLY AUGUST 30, 2002
PASSED THE SENATE AUGUST 28, 2002
AMENDED IN SENATE AUGUST 5, 2002
AMENDED IN SENATE JUNE 28, 2002
AMENDED IN ASSEMBLY MAY 23, 2002
AMENDED IN ASSEMBLY APRIL 4, 2002
INTRODUCED BY Assembly Member Koretz
(Coauthors: Assembly Members Alquist, Cedillo, Firebaugh, and
Wiggins)
(Coauthor: Senator Vasconcellos)
FEBRUARY 20, 2002
An act to add Article 4.9 (commencing with Section 14149) to
Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions
Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 2197, Koretz. Medi-Cal: benefits for persons infected with
HIV who are not disabled.
Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Services, pursuant to
which medical benefits are provided to public assistance recipients
and certain other low-income persons. Counties are responsible for
making eligibility determinations under the Medi-Cal program. One of
the methods by which services are provided under the Medi-Cal
program is through enrollment of recipients in Medi-Cal managed care
plans.
This bill would require the State Department of Health Services to
expand eligibility for benefits under the existing Medi-Cal program,
with certain exceptions, to include nondisabled persons with HIV
enrolled in the AIDS Drug Assistance Program, and who would be
eligible for Medi-Cal if disabled. This bill would provide that the
expansion would be implemented on the date all applicable federal
waivers are granted, as specified. The bill would provide that
enrollment in Medi-Cal pursuant to the bill would be limited pursuant
to an allocation system to be developed by the department. The bill
would require the department to meet federal revenue neutrality
requirements through the savings generated by voluntary enrollment
into Medi-Cal managed care of persons who are disabled as a result of
AIDS, and who are either receiving Medi-Cal benefits on a
fee-for-service basis as of January 1, 2003, or who become eligible
to receive Medi-Cal benefits on or after that date. The bill would
require the department to seek appropriate federal waivers. The bill
would prohibit the department from enrolling persons in the program
established by this bill until the department can ensure sufficient
savings equal to or greater than the cost of providing benefits to
these persons.
By increasing counties' responsibilities for Medi-Cal eligibility
determinations, this bill would impose a state-mandated local
program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement, including the creation of a State Mandates Claims Fund
to pay the costs of mandates that do not exceed $1,000,000 statewide
and other procedures for claims whose statewide costs exceed
$1,000,000.
This bill would provide that, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to these
statutory provisions.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Article 4.9 (commencing with Section 14149) is added to
Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions
Code, to read:
Article 4.9. Medi-Cal Managed Care Benefits for Nondisabled
Persons with HIV
14149. (a) It is the intent of the Legislature in enacting this
article, to expand eligibility for Medi-Cal benefits, with the
exception of prescription drug benefits provided by the AIDS Drug
Assistance Program (ADAP), to persons with HIV who are enrolled in
ADAP and who are not disabled, but who, if disabled, would qualify
for Medi-Cal benefits.
(b) It is further the intent of the Legislature that this
expansion of the existing Medi-Cal program be funded by cost savings
achieved through the voluntary enrollment into the existing Medi-Cal
managed care program of persons who are disabled as a result of AIDS,
and who are either receiving Medi-Cal benefits on a fee-for-service
basis as of January 1, 2003, or who become eligible to receive
Medi-Cal benefits on or after January 1, 2003.
(c) It is further the intent of the Legislature that the State
Department of Health Services encourage the voluntary enrollment into
the existing Medi-Cal managed care program of persons described in
subdivision (b) in order to obtain sufficient cost savings to provide
Medi-Cal benefits to the maximum feasible number of persons with HIV
subject to the constraints of this article.
(d) It is further the intent of the Legislature that all
protections of state and federal law and regulations that apply to
the state's Medi-Cal managed care program shall apply to those
persons who become eligible for Medi-Cal pursuant to this article.
14149.3. (a) Subject to subdivisions (b) and (c), paragraph (2)
of subdivision (f), and subdivision (k), the department shall,
commencing July 1, 2003, or the date that all necessary federal
waivers have been obtained, whichever is later, expand eligibility
for benefits under this chapter, with the exception of those
prescription drug benefits provided pursuant to ADAP, to any person
with HIV who meets both of the following criteria:
(1) The person is enrolled in the ADAP program pursuant to Section
120960 of the Health and Safety Code, and maintains enrollment in
that program.
(2) The person would otherwise qualify for Medi-Cal benefits if
the person were disabled as defined in subdivision (h).
(b) Any person eligible for benefits pursuant to subdivision (a),
and seeking enrollment in Medi-Cal pursuant to this article shall be
enrolled on a first-come-first-served basis pursuant to an allocation
mechanism that shall be developed by the department.
(c) Any person who is eligible for enrollment in Medi-Cal pursuant
to this article shall be required to elect a Medi-Cal managed care
plan in those counties in which a managed care plan is available,
unless the department determines that the cost-neutrality
requirements provided for in subdivision (f) and the enrollment goals
provided for in this article can be achieved without this
requirement.
(d) In implementing this article, the department shall ensure that
all of the following standards are met:
(1) All state and federal laws and regulations that apply to the
state's Medi-Cal managed care program shall apply to the expansion
provided by this article and to the beneficiaries eligible for
Medi-Cal pursuant to this article.
(2) The Medi-Cal benefits provided under this article shall
include prescription drugs not provided by the AIDS Drug Assistance
Program.
(3) All participating plans that assume full risk for all health
care services, including inpatient and outpatient services, shall be
licensed pursuant to the Knox-Keene Act (Article 1 commencing with
Section 1340) of Chapter 2.2 of Division 2 of the Health and Safety
Code), except as provided in Section 1343 of the Health and Safety
Code.
(4) Health care service plans participating in the Medi-Cal
managed care program shall comply with the applicable sections of the
Knox-Knee Act (Article 1 (commencing with Section 1340) of Chapter
2.2 of Division 2 of the Health and Safety Code), including Sections
1367 and 1374.16 of the Health and Safety Code and the regulations
adopted pursuant to Section 1374.16 of the Health and Safety Code.
(5) Primary care case management plans participating in the
Medi-Cal managed care program shall comply with the applicable
sections of Article 2.9 ( commencing Section 14088). Primary care
case management plans are required to maintain grievance and appeal
procedures consistent with the existing Medi-Cal managed care
program, to address beneficiary grievances.
(e) The department shall establish capitation rates to be paid to
Medi-Cal managed care plans for services provided pursuant to this
section. These capitation rates may not exceed 95 percent of the
fee-for-service equivalent costs to the Medi-Cal program for medical
services for persons with HIV.
(f) (1) The department shall meet federal revenue neutrality
requirements through the savings generated by the voluntary
enrollment into Medi-Cal managed care of persons who are disabled as
a result of AIDS, and who are either receiving Medi-Cal benefits on a
fee-for-service basis as of January 1, 2003, or who become eligible
to receive Medi-Cal benefits on or after January 1, 2003. The
savings generated by increased voluntary enrollments in Medi-Cal
managed care shall be used to fund enrollment by individuals eligible
for the expansion of Medi-Cal eligibility provided for pursuant to
subdivision (a). Nothing in this subdivision shall preclude the
department from implementing other means of meeting the federal
revenue neutrality requirements, provided that all requirements of
this article are met.
(2) The department may not enroll individuals described in
subdivision (a) until the department can ensure sufficient savings,
pursuant to paragraph (1), equal to or greater than the cost of
providing benefits to these individuals.
(g) The department shall encourage the voluntary enrollment into
Medi-Cal managed care of persons who are disabled as a result of
AIDS. The department shall conduct all outreach and awareness
activities necessary to implement this requirement in a manner
consistent with Section 14407 to ensure that persons who enroll in
managed care do so voluntarily. These outreach and awareness
activities shall include information on how electing managed care may
alter provider relationships and how persons may revert to
fee-for-service if they prefer to return to fee-for-service.
(h) For the purposes of this section, "disabled" means a person
who meets the eligibility criteria for the federal Supplemental
Security Income for the Aged, Blind and Disabled program (Subchapter
16 (commencing with Section 1381) of Chapter 7 of Title 42 of the
United States Code).
(i) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall implement this article, without taking any
regulatory action, by means of an all-county letter or similar
instruction. Thereafter, the department shall adopt regulations in
accordance with the requirements of Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code.
(j) Commencing January 1, 2003, the department shall seek the
appropriate federal waiver under Section 1115 of the Social Security
Act (42 U.S.C. Sec. 1315) to implement the expansion of eligibility
provided for pursuant to this section. The department shall maximize
the federal reimbursement received for services provided under this
article to those eligible pursuant to this section.
(k) This article shall be implemented only if, and to the extent
that, the department determines that federal financial participation
is available pursuant to Title XIX of the federal Social Security Act
(42 U.S.C. Sec. 1396 et seq.).
SEC. 2. Notwithstanding Section 17610 of the Government Code, if
the Commission on State Mandates determines that this act contains
costs mandated by the state, reimbursement to local agencies and
school districts for those costs shall be made pursuant to Part 7
(commencing with Section 17500) of Division 4 of Title 2 of the
Government Code. If the statewide cost of the claim for
reimbursement does not exceed one million dollars ($1,000,000),
reimbursement shall be made from the State Mandates Claims Fund.