BILL NUMBER: AB 1296	CHAPTERED
	BILL TEXT

	CHAPTER  641
	FILED WITH SECRETARY OF STATE  OCTOBER 9, 2011
	APPROVED BY GOVERNOR  OCTOBER 9, 2011
	PASSED THE SENATE  SEPTEMBER 7, 2011
	PASSED THE ASSEMBLY  SEPTEMBER 8, 2011
	AMENDED IN SENATE  SEPTEMBER 1, 2011
	AMENDED IN SENATE  AUGUST 30, 2011
	AMENDED IN SENATE  JULY 13, 2011
	AMENDED IN SENATE  JUNE 28, 2011
	AMENDED IN ASSEMBLY  MAY 27, 2011
	AMENDED IN ASSEMBLY  MAY 10, 2011
	AMENDED IN ASSEMBLY  APRIL 25, 2011

INTRODUCED BY   Assembly Member Bonilla

                        FEBRUARY 18, 2011

   An act to add Part 3.8 (commencing with Section 15925) to Division
9 of the Welfare and Institutions Code, relating to public health.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1296, Bonilla. Health Care Eligibility, Enrollment, and
Retention Act.
   Existing law provides for various programs to provide health care
coverage to persons with limited financial resources, including the
Medi-Cal program and the Healthy Families Program. Existing law
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care. Existing law, the
federal Patient Protection and Affordable Care Act (PPACA), requires
each state to, by January 1, 2014, establish an American Health
Benefit Exchange that facilitates the purchase of qualified health
plans by qualified individuals and qualified small employers, as
specified, and meets certain other requirements. Existing law, the
California Patient Protection and Affordable Care Act, creates the
California Health Benefit Exchange (Exchange), specifies the powers
and duties of the board governing the Exchange relative to
determining eligibility for enrollment in the Exchange and arranging
for coverage under qualified health plans, and requires the board to
facilitate the purchase of qualified health plans through the
Exchange by qualified individuals and qualified small employers by
January 1, 2014.
   This bill would enact the Health Care Reform Eligibility,
Enrollment, and Retention Planning Act, which would require the
California Health and Human Services Agency, in consultation with
specified entities, to establish standardized single, accessible
application forms and related renewal procedures for state health
subsidy programs, as defined, in accordance with specified
requirements. The bill would specify the duties of the agency and the
State Department of Health Care Services under the act, and would
require the agency to provide specified information to the
Legislature by July 1, 2012, regarding policy changes needed to
implement the bill. The application development requirements of the
bill would otherwise be operative January 1, 2014, except as
specified.



THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Part 3.8 (commencing with Section 15925) is added to
Division 9 of the Welfare and Institutions Code, to read:

      PART 3.8.  HEALTH CARE REFORM ELIGIBILITY, ENROLLMENT, AND
RETENTION PLANNING ACT


   15925.  (a) This part shall be known, and may be cited, as the
Health Care Reform Eligibility, Enrollment, and Retention Planning
Act.
   (b) (1) The California Health and Human Services Agency, in
consultation with the State Department of Health Care Services
(department), Managed Risk Medical Insurance Board (MRMIB), the
California Health Benefit Exchange (Exchange), the California Office
of Systems Integration, counties, health care service plans, consumer
advocates, and other stakeholders shall undertake a planning and
development process regarding this part and aspects of the federal
Patient Protection and Affordable Care Act (PPACA) (Public Law
111-148), as amended by the federal Health Care and Education
Reconciliation Act of 2010 (Public Law 111-152), and regulations or
guidance issued pursuant to these acts, related to eligibility for,
and enrollment and retention in, state health subsidy programs.
   (2) The planning and development process shall provide
stakeholders the opportunity to provide meaningful input into the
planning and development of the aspects of eligibility, enrollment,
and retention identified in this section. This process shall be
completed in time for all of the following to occur:
   (A) The certification and approval of the eligibility, enrollment,
and retention system, as required by PPACA and regulations and
guidance issued thereunder.
   (B) The approval of enhanced federal funding for Medi-Cal
eligibility system development, implementation, and maintenance.
   (C) The readiness of the eligibility, enrollment, and retention
processes to accept and process applications, as required by federal
law.
   (3) The planning and development process shall consider issues,
including, but not limited to, all of the following:
   (A) Whether to use the application developed by the federal
Secretary of Health and Human Services, pursuant to Section 1413 of
the PPACA (42 U.S.C. Sec. 18083), or whether to develop a separate
state form.
   (B) What process to use for Medi-Cal eligibility determinations
for non-Modified Adjusted Gross Income (MAGI) populations, including
whether to develop a supplemental application form and how the
applications will be processed.
   (C) Whether to adopt a process for hospitals to enroll infants
deemed eligible for Medi-Cal under Section 1396a(e)(4) of Title 42 of
the United States Code or the Healthy Families Program under Section
12693.70 of the Insurance Code immediately online, without an
application.
   (D) What data collection standards to utilize for the collection
of race, ethnicity, primary language, and disability status.
   (E) Whether to create a process to allow recipients to provide an
update to eligibility information in between renewal dates and to
have the option to renew eligibility at the time of the update,
resetting the renewal date.
   (F) Whether to renew eligibility for a state health subsidy
program based on information from a public benefits program, if the
recipient is otherwise eligible.
   (G) Protections for the confidentiality of personal information.
   (H) What process to use to enable applicants determined eligible
for and recipients of a state health subsidy program to choose a
health plan, if applicable.
   (4) The agency shall provide the appropriate fiscal and policy
committees of the Legislature with information reflecting the process
conducted pursuant to paragraph (1) by July 1, 2012, regarding
policy and statutory changes needed to develop and implement the
eligibility, enrollment, and retention system for health coverage in
compliance with this part.
   (c) The information reporting requirement imposed under paragraph
(4) of subdivision (b) is inoperative on January 1, 2016, pursuant to
Section 10231.5 of the Government Code.
   15926.  (a) The following definitions apply for purposes of this
part:
   (1) "Accessible" means in compliance with Section 11135 of the
Government Code, Section 1557 of the PPACA, and regulations or
guidance adopted pursuant to these statutes.
   (2) "Limited-English-proficient" means not speaking English as one'
s primary language and having a limited ability to read, speak,
write, or understand English.
   (3) "State health subsidy programs" means the programs described
in Section 1413(e) of PPACA.
   (b) An individual shall have the option to apply for state health
subsidy programs in person, by mail, online, by facsimile, or by
telephone.
   (c) (1) A single, accessible, standardized paper, electronic, and
telephone application for state health subsidy programs shall be
developed by the department in consultation with MRMIB and the board
governing the Exchange as part of the stakeholder process described
in subdivision (b) of Section 15925. The application shall be used by
all entities authorized to make an eligibility determination for any
of the state health subsidy programs and by their agents.
   (2) The application shall be tested and operational by the date as
required by the federal Secretary of the Health and Human Services.
   (3) The application form shall, to the extent not inconsistent
with federal statutes, regulations, and guidance, satisfy all of the
following criteria:
   (A) Include simple, user-friendly language and instructions.
   (B) Do not ask for information related to a nonapplicant that is
not necessary to determine eligibility in the applicant's particular
circumstances.
   (C) Require only information necessary to support the eligibility
and enrollment processes for state health subsidy programs.
   (D) May be used for, but shall not be limited to, screening.
   (E) Ask, or be used otherwise to identify, if the mother of an
infant applicant under one year of age had coverage through a state
health subsidy program for the infant's birth, for the purpose of
automatically enrolling the infant into the applicable program
without the family having to complete the application process for the
infant.
   (F) Include questions that are voluntary for applicants to answer
regarding demographic data categories, including race, ethnicity,
primary language, disability status, and other categories recognized
by the federal Secretary of Health and Human Services under Section
4302 of the PPACA.
   (d) Nothing in this section shall preclude the use of a
provider-based application form or enrollment procedures for state
health subsidy programs or other health programs that differs from
the application form described in subdivision (c), and related
enrollment procedures.
   (e) The entity making the eligibility determination shall grant
eligibility immediately whenever possible and with consent of the
applicant in accordance with the state and federal rules governing
state health subsidy programs.
   (f) (1) If the eligibility, enrollment, and retention system has
the ability to prepopulate an application form for insurance
affordability programs with personal information from available
electronic databases, an applicant shall be given the option, with
his or her informed consent, to have the application form
prepopulated. Before a prepopulated renewal form or, if available,
prepopulated application is submitted to the entity authorized to
make eligibility determinations, the individual shall be given the
opportunity to provide additional eligibility information and to
correct any information retrieved from a database.
   (2) All state health subsidy programs may accept self-attestation,
instead of requiring an individual to produce a document, with
respect to all information needed to determine the eligibility of an
applicant or recipient, to the extent permitted by state and federal
law.
   (3) An applicant or recipient shall have his or her information
electronically verified in the manner required by PPACA and
implementing federal regulations and guidance.
   (4) Before an eligibility determination is made, the individual
shall be given the opportunity to provide additional eligibility
information and to correct information.
   (5) An applicant shall not have his or her eligibility delayed or
denied for any state health subsidy program without being given a
reasonable opportunity, of at least the kind provided for under the
Medi-Cal program pursuant to Section 14007.5 and paragraph (7) of
subdivision (d) of Section 14011.2, to resolve discrepancies
concerning any information provided by a verifying entity.
   (6) To the extent federal financial participation is available, an
applicant shall be provided benefits in accordance with the rules of
the state health subsidy program, as implemented in federal
regulations and guidance, for which he or she otherwise qualifies
until a determination is made that he or she is not eligible and all
applicable notices have been provided.
   (g) The eligibility, enrollment, and retention system shall offer
an applicant and recipient assistance with his or her application or
renewal for a state health subsidy program in person, over the
telephone, and online, and in a manner that is accessible to
individuals with disabilities and those who are limited English
proficient.
   (h) (1) During the processing of an application, renewal, or a
transition due to a change in circumstances, an entity making
eligibility determinations for a public health coverage program shall
ensure that an eligible applicant and recipient of state health
subsidy programs that meets all program eligibility requirements and
complies with all necessary requests for information moves between
programs without any breaks in coverage and without being required to
provide any forms, documents, or other information or undergo
verification that is duplicative or otherwise unnecessary. The
individual shall be informed how to obtain information about the
status of his or her application, renewal, or transfer to another
program at any time, and the information shall be promptly provided
when requested.
   (2) An individual screened as not eligible for Medi-Cal on the
basis of Modified Adjusted Gross Income (MAGI) household income but
who may be potentially eligible for Medi-Cal on another basis shall
have his or her application or case forwarded to the Medi-Cal program
for an eligibility determination. During the period this application
or case is processed for a non-MAGI Medi-Cal eligibility
determination, if the applicant or recipient is otherwise eligible
for a state health subsidy program, he or she shall be determined
eligible for that program.
   (3) Renewal procedures shall include all available methods for
reporting renewal information, including, but not limited to,
face-to-face, telephone, and online renewal.
   (4) An applicant who is not eligible for a state health subsidy
program for a reason other than income eligibility, or for any reason
in the case of applicants and recipients residing in a county that
offers a health coverage program for individuals with income above
the maximum allowed for the Exchange premium tax credits, shall be
referred to the county health coverage program in his or her county
of residence.
   (i) Notwithstanding subdivisions (e), (f), and (j), before an
online applicant who appears to be eligible for the Exchange with a
premium tax credit or reduction in cost sharing, or both, may be
enrolled in the Exchange, both of the following shall occur:
   (1) The applicant shall be informed of the overpayment penalties
under the Comprehensive 1099 Taxpayer Protection and Repayment of
Exchange Subsidy Overpayments Act of 2011 (Public Law 112-9), if the
individual's annual family income increases by a specified amount or
more, calculated on the basis of the individual's current family size
and current income, and that penalties are avoided by prompt
reporting of income increases throughout the year.
   (2) The applicant shall be informed of the penalty for failure to
have minimum essential health coverage.
   (j) The department shall, in coordination with MRMIB and the
Exchange board, streamline and coordinate all eligibility rules and
requirements among state health subsidy programs using the least
restrictive rules and requirements permitted by federal and state
law. This process shall include the consideration of methodologies
for determining income levels, assets, rules for household size,
citizenship and immigration status, and self-attestation and
verification requirements.
   (k) (1) Forms and notices developed pursuant to this section shall
be accessible and standardized, as appropriate, and shall comply
with federal and state laws, regulations, and guidance prohibiting
discrimination.
   (2) Forms and notices developed pursuant to this section shall be
developed using plain language and shall be provided in a manner that
affords meaningful access to limited-English-proficient individuals,
in accordance with applicable state and federal law, and at a
minimum, provided in the same threshold languages as Medi-Cal managed
care.
   (l) The department, the California Health and Human Services
Agency, MRMIB, and the Exchange board shall establish a process for
receiving and acting on stakeholder suggestions regarding the
functionality of the eligibility systems supporting the Exchange,
including the activities of all entities providing eligibility
screening to ensure the correct eligibility rules and requirements
are being used. This process shall include consumers and their
advocates, be conducted no less than quarterly, and include the
recording, review, and analysis of potential defects or enhancements
of the eligibility systems. The process shall also include regular
updates on the work to analyze, prioritize, and implement corrections
to confirmed defects and proposed enhancements, and to monitor
screening.
   (m) In designing and implementing the eligibility, enrollment, and
retention system, the department, MRMIB, and the Exchange board
shall ensure that all privacy and confidentiality rights under the
PPACA and other federal and state laws are incorporated and followed,
including responses to security breaches.
   (n) Except as otherwise specified, this section shall be operative
on and after January 1, 2014.