BILL ANALYSIS Ó
AB 1494
Page 1
( Without Reference to File )
CONCURRENCE IN SENATE AMENDMENTS
AB 1494 (Budget Committee)
As Amended June 25, 2012
Majority vote. Budget Bill Appropriation Takes Effect
Immediately
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|ASSEMBLY: | |(March 22, |SENATE: |21-14|(June 27, |
| | |2012) | | |2012) |
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(vote not relevant)
Original Committee Reference: BUDGET
SUMMARY : Contains necessary statutory changes to achieve
savings assumed in the 2012 Budget Act related to both the
Managed Risk Medical Insurance Board and the Department of
Health Care Services and implements the transition of all
children in the Healthy Families Program to Medi-Cal.
The Senate amendments delete the Assembly version of this bill,
and instead:
1)Implement the transition of all children in the Healthy
Families Program to Medi-Cal. Specifically, the bill:
a) Increases eligibility for the Medi-Cal program, for
children ages 6 through 18, to family incomes up to and
including 200% of the federal poverty level (FPL), and
exempts all resources and disregards income at or above
200% and up to and including 250% FPL. Exempts Access for
Infants and Mothers-linked infants, with incomes above 250%
FPL, from this transition.
b) Eliminates premiums for children with incomes at or
below 150% FPL and requires premiums of all children above
150% FPL at the Healthy Families category B level.
c) Requires that the Healthy Families Program cease to
enroll new subscribers no sooner than the date that this
transition begins.
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d) Requires counties to perform final eligibility
determinations and annual redeterminations, utilizing
reporting and performance standards established in this
bill.
e) Provides presumptive eligibility for Medi-Cal for the
children transferring from Healthy Families, which will
continue until final determinations are made within one
year of the children's Healthy Families Program annual
review dates.
f) Requires that children transfer from Healthy Families to
Medi-Cal in four phases as follows:
i) Phase 1 - Children enrolled in a Healthy Families
Program health plan that is also a Medi-Cal managed care
plan shall transfer to the same plan no sooner than
January 1, 2013.
ii) Phase 2 - Children enrolled in a Healthy Families
managed care plan that is a subcontractor of a Medi-Cal
managed care plan, will be enrolled into a Medi-Cal
managed care plan that includes the child's current plan,
beginning no earlier than April 1, 2013.
iii) Phase 3 - Children enrolled in a Healthy Families
managed care plan that is not a Medi-Cal managed care
plan and does not contract or subcontract with a Medi-Cal
managed care plan will be enrolled in a Medi-Cal managed
care plan in that county, beginning no earlier than
August 1, 2013.
iv) Phase 4 - Children living in a county that is not a
Medi-Cal managed care county will transition into
fee-for-service Medi-Cal, no earlier than September 1,
2013. Should Medi-Cal managed care be implemented in
these counties, children in Medi-Cal will transition into
managed care.
g) Requires the following to be in place prior to
implementation of all phases of the transition: a) Managed
care plan performance measures must be integrated and
coordinated with the Healthy Families Program performance
standards and in compliance with Medi-Cal managed care
performance measurements, including network adequacy and
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linguistic services; and, b) Medi-Cal managed care plans
must allow enrollees to remain with their current primary
care provider, or report to the department on how
continuity of care will be ensured.
h) Requires the California Health and Human Services
Agency, in consultation with the Managed Risk Medical
Insurance Board (MRMIB), the Department of Health Care
Services (DHCS), the Department of Managed Health Care
(DMHC), and a stakeholder group, to provide the Legislature
with a strategic plan for implementing this transition by
October 1, 2012. Requires the strategic plan to address
administrative components, methods for diverse stakeholder
engagement throughout the transition, state monitoring of
managed care health plans' performance and accountability,
and health and dental delivery system components.
i) Requires implementation plans to be developed prior to
each phase of this transition to ensure continuity of care
and to prevent disruptions in service. Requires the
implementation plans to include information on health and
dental plan network adequacy, continuity of care,
eligibility and enrollment requirements, consumer
protections, and family notifications. Requires DHCS to
consult with stakeholders, including consumers, families,
advocates, counties, providers, and health and dental plans
on the development of implementation plans.
j) Requires dental care to be provided through
fee-for-service Medi-Cal for children in all counties
except Sacramento and Los Angeles.
aa) Requires, for children in Sacramento County, dental
coverage to continue to be provided by a child's Healthy
Families dental managed care plan if the plan is also a
Medi-Cal dental managed care plan. If a child's plan is
not a Medi-Cal plan, the family will choose a Medi-Cal
dental managed care plan, or be assigned to a plan with
preference for a plan with the child's current provider.
Children in Sacramento County may access the beneficiary
dental exception process adopted through AB 1467 (the 2012
omnibus health trailer bill).
bb) Requires, for children in Los Angeles County, dental
coverage to continue to be provided by the child's Healthy
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Families dental managed care plan if that plan is a
Medi-Cal dental plan in Los Angeles. If the child's plan
is not a Medi-Cal plan, the family may select a Medi-Cal
plan or choose fee-for-service.
cc) Requires managed care health and dental plans to report
to DHCS specified information on transition implementation
issues, enrollees, and providers, including grievances
related to access to care, continuity of care requests and
outcomes, and changes to provider networks.
dd) Requires DHCS to consult and collaborate with DMHC in
assessing Medi-Cal managed care health plan network
adequacy for purposes of the required transition plans.
ee) Requires DHCS to provide monthly status reports to the
Legislature on the transition beginning no later than
February.
ff) Requires DHCS to provide written notice regarding this
transition to families at least 60 days prior to the
transition of children in Phase 1, and at least 90 days
prior to the transition of children in Phases 2 and 3.
Specifies various requirements for these notices.
gg) Requires DHCS to provide a process for ongoing
stakeholder consultation and for making information
publicly available, including the achievement of
benchmarks, enrollment data, utilization data and quality
measures.
hh) Requires DHCS to designate department liaisons
responsible for the coordination of the Healthy Families
Program.
ii) Appropriates $400,000 from the Managed Care Fund to
DMHC for administration of the call center to assist
individuals with the Healthy Families transition and any
other aspects of health plan readiness and coordination
with DHCS and MRMIB.
2)Restore current law by overriding provisions contained AB 1467
(the 2012 omnibus health trailer bill) that prohibited the
California Children's Services (CCS) program from covering the
cost of medical therapy services for any child who has an
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individualized education program (IEP) and these services are
identified as educationally related within the child's IEP.
3)State the Legislature's intent to develop new payment rates
for clinical laboratory services that are comparable to the
payment amounts received from other payers of services.
Provides that reimbursement for laboratory services shall not
exceed the lowest of the following: a) the amount billed; b)
the charge to the general public; c) 80% of the lowest maximum
allowance established by the federal Medicare Program for the
same or similar services; or, d) a reimbursement rate based on
an average of the lowest amount that other payers and other
state Medicaid programs pay for similar services. Imposes a
10% rate reduction, to achieve $7.7 million in General Fund
savings in 2012-13, for laboratory services beginning July 1,
2012, and continuing until this new rate methodology has
received federal approval. Exempts the Family Planning,
Access, Care and Treatment program from this 10% rate
reduction. Establishes rate data reporting requirements for
laboratories to the state to be utilized for developing the
new rate methodology. Requires DHCS to seek stakeholder input
in the development of the rate methodology. Replaces similar
provisions contained in AB 1467 (the 2012 omnibus health
trailer bill).
4)Add an appropriation allowing this bill to take effect
immediately upon enactment.
AS PASSED BY THE ASSEMBLY , this bill expressed the intent of the
Legislature to enact statutory changes relating to the Budget
Act of 2012.
Analysis Prepared by : Andrea Margolis / BUDGET / (916)
319-2099
FN: 0004267