BILL NUMBER: SB 616	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 26, 2011
	AMENDED IN SENATE  MARCH 22, 2011

INTRODUCED BY   Senator DeSaulnier
    (   Coauthor:   Senator   Alquist
  ) 

                        FEBRUARY 18, 2011

   An act  to add Article 5.7 (commencing with Section 14187) to
Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions
Code,  relating to public health.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 616, as amended, DeSaulnier. Medi-Cal:  grants.
  grants   : prevention of chronic diseases
  . 
   Existing law establishes the Medi-Cal program, administered by the
State Department of Health Care Services, under which basic health
care services are provided to qualified low-income persons. The
Medi-Cal program is, in part, governed and funded by federal Medicaid
provisions.
   Under federal law, the Patient Protection and Affordable Care Act,
the Centers for Medicare and Medicaid Services will award grants
pursuant to the Medicaid Incentives for Prevention of Chronic
Diseases Program to selected states for a program that provides
financial and nonfinancial incentives to Medicaid beneficiaries who
participate in prevention programs and demonstrate changes in health
risk and outcomes.
   This bill would require the department to pursue this grant. This
bill would also require, if California is awarded a grant, the
department to design, implement, and report on the program, as
prescribed.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


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

  SECTION 1.  The Legislature finds and declares all of the
following:
   (a) The President of the United States signed comprehensive health
reform into law on March 23, 2010. The federal Patient Protection
and Affordable Care Act (Public Law 111-148) and the federal Health
Care and Education Reconciliation Act of 2010 (Public Law 111-152)
represent a significant reform of the nation's health delivery
system, including many provisions designed to promote prevention,
wellness, and patient-centered health outcomes.
   (b) Federal health reform has several provisions that focus on
prevention and health promotion, including community-based obesity
prevention programs, community transformation grants, nutrition
labeling, individualized wellness plan pilots, and workplace wellness
programs.
   (c) Under the federal Patient Protection and Affordable Care Act
(Public Law 111-148), states may apply to the federal Centers for
Medicare and Medicaid Services (CMS) for grants to fund programs that
demonstrate changes in health risk and outcomes, including, but not
limited to, the adoption of healthy behaviors.
   (d) CMS has announced an invitation for proposals from states to
compete for grant awards under the Medicaid Incentives for Prevention
of Chronic Diseases Program for a program that provides financial
and nonfinancial incentives to Medicaid beneficiaries who participate
in prevention programs and demonstrate changes in health risk and
outcomes. The purpose of the Medicaid Incentives for Prevention of
Chronic Diseases Program is to test and evaluate the effect of state
grant awarded programs on the use of health care services by Medicaid
beneficiaries participating in the program, the extent to which
populations, including, but not limited to, adults with disabilities,
adults with chronic illnesses, and children with special health care
needs, are able to participate in the program, the level of
satisfaction of Medicaid beneficiaries with respect to the
accessibility and quality of health care services provided through
the program, and the administrative costs incurred by state agencies
responsible for the administration of the program.
   (e) California has a strong history of public health prevention
programs, including, but not limited to, one of the nation's leading
tobacco control programs. Since 1989, there has been a 35 percent
decrease in smoking prevalence, a 61 percent decline in per capita
cigarette consumption, and a decrease in lung cancer incidence that
is over three times the rate of decline seen in the rest of the
nation. Collectively, the program's efforts have saved the state $86
billion in direct health care costs.
   (f) Unfortunately, California's priority populations remain at
greater risk of tobacco use, disease, and death. African American
males continue to have the highest smoking prevalence, 21.3 percent,
compared to their counterparts in all other major race and ethnicity
groups who smoke at a range between 14.9 percent and 17.2 percent,
inclusive. African American and non-Hispanic white females also have
significantly higher smoking prevalence rates, of 17.3 percent and
12.5 percent respectively, compared to Hispanic and Asian and Pacific
Islander females whose smoking prevalence rates are 7.1 percent and
5.5 percent, respectively. However, the most startling evidence of
disparity lies with smoking prevalence among low-income populations.
   (g) Rising health care costs are recognized as an unsustainable
growing component of the state budget. A National Health Policy Forum
paper reported that, "unless the need for health care is reduced by
significantly improving the health of the American people, it will be
difficult if not impossible to bring health care costs under
control." Further, it has been noted that offering interventions that
address the behavioral or social circumstances that influence
participation in preventive health services may contribute to
improving health and decreasing growth in health care expenditures.
   (h) California will be a national model for public health
interventions and prevention and wellness programs. Communities and
individuals must be empowered to make changes that best address their
circumstances and resource needs. 
  SEC. 2.     
  SEC. 2.    Article 5.7 (commencing with Section 14187) is
added to Chapter 7 of Part 3 of Division 9 of the Welfare and
Institutions Code, to read: 

      Article 5.7.   Incentives for Prevention of Chronic
Diseases Program


    14187.  (a) The State Department of Health Care Services
shall pursue a Medicaid Incentives for Prevention of Chronic
Diseases Program grant, as established pursuant to the federal
Patient Protection and Affordable Care Act (Public Law 111-148), to
offer incentives to Medi-Cal enrollees who adopt healthy behaviors
and habits.
   (b) The department shall submit a notice of intent to apply and a
complete grant application to the federal Centers for Medicare and
Medicaid Services (CMS). The application shall address at least one
of the following prevention goals:
   (1) Tobacco cessation.
   (2) Controlling or reducing weight.
   (3) Lowering cholesterol.
   (4) Lowering blood pressure.
   (5) Avoiding the onset of diabetes or improving the management of
the condition.
   (c) If California is awarded a Medicaid Incentives for Prevention
of Chronic Diseases Program grant, the department shall do all of the
following:
   (1) Apply annually for incremental funding.
   (2) Design and implement a program in accordance with the Medicaid
Incentives for Prevention of Chronic Diseases Program that operates
for at least three years to provide financial and nonfinancial
incentives to Medi-Cal beneficiaries of all ages who participate in
prevention programs and demonstrate changes in health risk and
outcomes, including, but not limited to, the adoption of healthy
behaviors. The program shall be designed and uniquely suited to
address the needs of Medi-Cal beneficiaries to help individuals
achieve one or more of the following:
   (A) The cessation of the use of tobacco products.
   (B) Control or reduction in weight.
   (C) Lower cholesterol.
   (D) Lower blood pressure.
   (E) The avoidance of the onset of diabetes, or in the case of a
diabetic, an improvement in the management of that condition.
   (3) Ensure that the program is comprehensive, evidence-based,
widely available, and easily accessible. The program shall use
relevant evidence-based research and resources, including, but not
limited to, the Guide to Community Preventive Services, the Guide to
Clinical Preventive Services, and the National Registry of
Evidence-Based Programs.
   (4) Engage in an outreach and education campaign to make Medi-Cal
beneficiaries and Medi-Cal participating providers aware of the
program.
   (5) Work collaboratively to develop the program, incorporate
stakeholders in the process, conduct a state-level evaluation, and
fulfill reporting requirements specified by CMS.
   (6) Develop and implement a system to do all of the following:
   (A) Track Medi-Cal beneficiary participation in the program and
validate changes in health risk and outcomes with clinical data,
including, but not limited to, the adoption and maintenance of health
behaviors by participating beneficiaries.
   (B) To the extent practicable, establish standards and health
status targets for Medi-Cal beneficiaries participating in the
program and measure the degree to which the standards and targets are
met.
   (C) Evaluate the effectiveness of the program and provide any
evaluations to the United States Secretary of Health and Human
Services and the relevant fiscal and policy committees of the 
California  Legislature.
   (D) Report to the United States Secretary of Health and Human
Services and the relevant fiscal and policy committees of the 
California  Legislature on processes that have been developed
and lessons learned from the program.
   (E) Report on preventive services as part of required reporting on
quality measures for Medicaid managed care programs.
   (d) The  requirements   reporting
requirements to the relevant fiscal and policy committees of the
California Legislature  in subparagraph (C) or (D) of paragraph
(6) of subdivision (c)  to provide a report to committees of
the Legislature  shall become inoperative on January 1,
2016.
   (e) The department may enter into arrangements with providers
participating in Medi-Cal, community-based organizations, faith-based
organizations, public-private partnerships, Indian tribes, or
similar entities or organizations to carry out the program.
   (f) To the extent permitted by federal law, any incentives
provided to a Medi-Cal beneficiary participating in a program
described in this section shall not be taken into account for
purposes of determining the beneficiary's eligibility for, or amount
of, benefits under the Medicaid program or any program funded in
whole or in part with federal funds.