BILL NUMBER: SB 485	AMENDED
	BILL TEXT

	AMENDED IN SENATE  MARCH 24, 2011

INTRODUCED BY   Senator Hernandez

                        FEBRUARY 17, 2011

    An act relating to Medi-Cal.   An act to add
Section 14134.7 to the Welfare and Institutions Code, relating to
Medi-Cal. 



	LEGISLATIVE COUNSEL'S DIGEST


   SB 485, as amended, Hernandez. Medi-Cal.
   Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services and
under which qualified low-income persons receive health care
services.  Existing law requires the department to develop a
program to provide information and assistance to enable Medi-Cal
beneficiaries to understand and successfully use the services of the
Medi-Cal managed care plans in which they enroll.  
   This bill would declare the intent of the Legislature regarding
legislation that would require the department to provide specified
information regarding community clinics to Medi-Cal beneficiaries who
do not have a primary care physician, but who utilize the emergency
unit of a general acute care hospital for care of routine physical
ailments.  
   This bill would require the department to establish a pilot
program to facilitate collaboration between a federally qualified
health clinic and a general acute care hospital to provide a Medi-Cal
beneficiary with an alternative to the use of the emergency unit of
a general acute care hospital for care and services if the Medi-Cal
beneficiary, after a medical screening, is determined by a physician
and surgeon to not have an emergency medical condition and the
Medi-Cal beneficiary is provided the specified information, in
writing, before nonemergency medical care is provided in the
emergency unit. 
   Vote: majority. Appropriation: no. Fiscal committee: no
  yes  . State-mandated local program: no.


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

   SECTION 1.    Section 14134.7 is added to the 
 Welfare and Institutions Code   , to read:  
   14134.7.  (a) The department shall establish a pilot program to
facilitate collaboration between a federally qualified health clinic
and a general acute care hospital, as a benefit of the Medi-Cal
program, to provide a Medi-Cal beneficiary with an alternative to the
use of the emergency unit of a general acute care hospital for care
and services if the Medi-Cal beneficiary, after a medical screening,
is determined by a physician and surgeon to not have an emergency
medical condition and the Medi-Cal beneficiary is provided the
following information, in writing, before nonemergency medical care
is provided in the emergency unit:
   (1) The name and address of an available and accessible provider
of nonemergency medical care who does not charge a copay or may
charge a lower copay than the general acute care hospital.
   (2) A referral from the general acute care hospital if necessary
to coordinate the scheduling of treatment.
   (b) The department shall submit any necessary application to the
federal Centers for Medicare and Medicaid Services for a waiver to
implement the pilot project described in this section. The department
shall determine the form of waiver most appropriate to achieve the
purposes of this section. The waiver request shall be included in any
waiver application submitted within 12 months after the effective
date of this section, or shall be submitted as an independent
application within that time period. After federal approval is
secured, the department shall implement the waiver within 12 months
of the date of approval.
   (c) The department shall develop a timeline and process for
monitoring and evaluating the pilot project and provide this timeline
and process to the appropriate fiscal and policy committees of the
Legislature.
   (d) For purposes of this section, an available and accessible
provider of nonemergency medical care includes the office of a
physician and surgeon, health clinic, community health center, and
hospital outpatient department, provided that the provider of
nonemergency medical care is able to diagnose or treat
contemporaneously within the same amount of time that a physician
within the emergency unit of a general acute care hospital would have
taken to provide the same nonemergency services.  
  SECTION 1.    It is the intent of the Legislature
to enact legislation that would, as a pilot program, require the
State Department of Health Care Services to mail a letter to Medi-Cal
beneficiaries who do not have a primary care physician, but who
utilize the emergency unit of a general acute care hospital for care
of routine physical ailments, that explains the availability of, and
identifies, nearby clinics to visit for care of these ailments.