BILL NUMBER: AB 301 CHAPTERED
BILL TEXT
CHAPTER 460
FILED WITH SECRETARY OF STATE OCTOBER 4, 2011
APPROVED BY GOVERNOR OCTOBER 4, 2011
PASSED THE SENATE SEPTEMBER 6, 2011
PASSED THE ASSEMBLY SEPTEMBER 7, 2011
AMENDED IN SENATE AUGUST 30, 2011
AMENDED IN SENATE JUNE 23, 2011
AMENDED IN SENATE JUNE 14, 2011
INTRODUCED BY Assembly Member Pan
(Coauthors: Assembly Members Beall, Carter, Dickinson, Logue, and
Solorio)
FEBRUARY 9, 2011
An act to amend Sections 14094.3 and 14105.18 of the Welfare and
Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 301, Pan. Medi-Cal: managed care.
Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services,
pursuant to which medical benefits are provided to public assistance
recipients and other low-income persons. Existing law provides for
the department to enter into contracts with managed care systems,
hospitals, and prepaid health plans for the provision of various
Medi-Cal benefits. Existing law prohibits services covered by the
California Children's Services program (CCS) from being incorporated
into a Medi-Cal managed care contract entered into after August 1,
1994, until January 1, 2012, except with respect to contracts entered
into for county organized health systems in specified counties.
This bill would extend to January 1, 2016, the termination of the
prohibition against CCS covered services being incorporated into a
Medi-Cal managed care contract entered into after August 1, 1994.
Existing law requires the provider rates of payment for services
rendered for the Healthy Families Program to be identical to the
rates of payment for the same service performed by the same provider
type pursuant to the Medi-Cal program if the services are provided by
a Medi-Cal provider.
This bill would require identical rates only if the service was
provided by a Medi-Cal provider pursuant to specified contracts.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) The State Department of Health Care Services is currently
pursuing pilot projects to examine organized health care delivery
models for children eligible for the California Children's Services
program (CCS). These delivery models may include an enhanced primary
care case management program, a provider-based accountable care
organization, a specialty health care plan, and a Medi-Cal managed
care plan. The services provided under these models will be
comprehensive and coordinated through a medical home. These models
must establish clear standards and criteria, provide care
coordination, establish appropriate networks, as defined, coordinate
out-of-network access, ensure children enrolled in the model receive
care for their CCS-eligible medical conditions from CCS-approved
providers consistent with the CCS standards of care, and establish
and support medical homes, incorporating specified principles.
(b) The department is required to conduct an evaluation to assess
the effectiveness of each model in improving the delivery of health
care services for children who are eligible for the CCS program
simultaneously with the development and implementation of the model
delivery systems, to compare the care provided to, and outcomes of,
children enrolled in the models with those not enrolled in the
models. The department plans to have the evaluation and outcomes of
the tested models by September 2015 in conjunction with California's
Section 1115 Medi-Cal Demonstration Project Waiver established
pursuant to Section 14180 of the Welfare and Institutions Code.
(c) Therefore, it is the intent of the Legislature to continue the
prohibition of services covered by the CCS program from being
incorporated solely into Medi-Cal managed care until the department
is able to consider the pilot evaluations, along with stakeholder
input, and demonstrate the most appropriate organized health care
delivery models for children eligible for CCS program services, which
may include continuation of the current system of care.
SEC. 2. Section 14094.3 of the Welfare and Institutions Code is
amended to read:
14094.3. (a) Notwithstanding this article or Section 14093.05 or
14094.1, CCS covered services shall not be incorporated into any
Medi-Cal managed care contract entered into after August 1, 1994,
pursuant to Article 2.7 (commencing with Section 14087.3), Article
2.8 (commencing with Section 14087.5), Article 2.9 (commencing with
Section 14088), Article 2.91 (commencing with Section 14089), Article
2.95 (commencing with Section 14092); or either Article 2
(commencing with Section 14200), or Article 7 (commencing with
Section 14490) of Chapter 8, until January 1, 2016, except for
contracts entered into for county organized health systems or
Regional Health Authority in the Counties of San Mateo, Santa
Barbara, Solano, Yolo, Marin, and Napa.
(b) Notwithstanding any other provision of this chapter, providers
serving children under the CCS program who are enrolled with a
Medi-Cal managed care contractor but who are not enrolled in a pilot
project pursuant to subdivision (c) shall continue to submit billing
for CCS covered services on a fee-for-service basis until CCS covered
services are incorporated into the Medi-Cal managed care contracts
described in subdivision (a).
(c) (1) The department may authorize a pilot project in Solano
County in which reimbursement for conditions eligible under the CCS
program may be reimbursed on a capitated basis pursuant to Section
14093.05, and provided all CCS program's guidelines, standards, and
regulations are adhered to, and CCS program's case management is
utilized.
(2) During the time period described in subdivision (a), the
department may approve, implement, and evaluate limited pilot
projects under the CCS program to test alternative managed care
models tailored to the special health care needs of children under
the CCS program. The pilot projects may include, but need not be
limited to, coverage of different geographic areas, focusing on
certain subpopulations, and the employment of different payment and
incentive models. Pilot project proposals from CCS program-approved
providers shall be given preference. All pilot projects shall utilize
CCS program-approved standards and providers pursuant to Section
14094.1.
(d) (1) The department shall submit to the appropriate committees
of the Legislature an evaluation of pilot projects established
pursuant to subdivision (c) based on at least one full year of
operation.
(2) The evaluation required by paragraph (1) shall address the
impact of the pilot projects on outcomes as set forth in paragraph
(4) and, in addition, shall do both of the following:
(A) Examine the barriers, if any, to incorporating CCS covered
services into the Medi-Cal managed care contracts described in
subdivision (a).
(B) Compare different pilot project models with the
fee-for-service system. The evaluation shall identify, to the extent
possible, those factors that make pilot projects most effective in
meeting the special needs of children with CCS eligible conditions.
(3) CCS covered services shall not be incorporated into the
Medi-Cal managed care contracts described in subdivision (a) before
the evaluation process has been completed.
(4) The pilot projects shall be evaluated to determine whether:
(A) All children enrolled with a Medi-Cal managed care contractor
described in subdivision (a) identified as having a CCS eligible
condition are referred in a timely fashion for appropriate health
care.
(B) All children in the CCS program have access to coordinated
care that includes primary care services in their own community.
(C) CCS program standards are adhered to.
(e) For purposes of this section, CCS covered services include all
program benefits administered by the program specified in Section
123840 of the Health and Safety Code regardless of the funding
source.
(f) Nothing in this section shall be construed to exclude or
restrict CCS eligible children from enrollment with a managed care
contractor, or from receiving from the managed care contractor with
which they are enrolled primary and other health care unrelated to
the treatment of the CCS eligible condition.
SEC. 3. Section 14105.18 of the Welfare and Institutions Code is
amended to read:
14105.18. (a) Notwithstanding any other provision of law,
provider rates of payment for services rendered in all of the
following programs shall be identical to the rates of payment for the
same service performed by the same provider type pursuant to the
Medi-Cal program.
(1) The California Children's Services Program established
pursuant to Article 5 (commencing with Section 123800) of Chapter 3
of Part 2 of Division 106 of the Health and Safety Code.
(2) The Genetically Handicapped Person's Program established
pursuant to Article 1 (commencing with Section 125125) of Chapter 2
of Part 5 of Division 106 of the Health and Safety Code.
(3) The Breast and Cervical Cancer Early Detection Program
established pursuant to Article 1.3 (commencing with Section 104150)
of Chapter 2 of Part 1 of Division 103 of the Health and Safety Code
and the breast cancer programs specified in Section 30461.6 of the
Revenue and Taxation Code.
(4) The State-Only Family Planning Program established pursuant to
Division 24 (commencing with Section 24000).
(5) The Family Planning, Access, Care, and Treatment (Family PACT)
Program established pursuant to subdivision (aa) of Section 14132.
(6) The Healthy Families Program established pursuant to Part 6.2
(commencing with Section 12693) of Division 2 of the Insurance Code
if the health care services are provided by a Medi-Cal provider
pursuant to subdivision (b) of Section 12693.26 of the Insurance
Code.
(7) The Access for Infants and Mothers Program established
pursuant to Part 6.3 (commencing with Section 12695) of Division 2 of
the Insurance Code if the health care services are provided by a
Medi-Cal provider.
(b) The director may identify in regulations other programs not
listed in subdivision (a) in which providers shall be paid rates of
payment that are identical to the rates of payments in the Medi-Cal
program pursuant to subdivision (a).
(c) Notwithstanding subdivision (a), services provided under any
of the programs described in subdivisions (a) and (b) may be
reimbursed at rates greater than the Medi-Cal rate that would
otherwise be applicable if those rates are adopted by the director in
regulations.
(d) This section shall become operative on January 1, 2011.