BILL ANALYSIS                                                                                                                                                                                                    



                                                                            



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                                    THIRD READING


          Bill No:  AB 82
          Author:   Assembly Budget Committee
          Amended:  6/14/13 in Senate
          Vote:     21

           
           ASSEMBLY FLOOR  :  Not relevant


           SUBJECT  :    Budget Act of 2013:  Health

           SOURCE  :     Author


           DIGEST :    This is the Omnibus Health Trailer Bill for 2013-14.   
          It contains necessary changes related to the Budget Act of 2013.  
           

           Senate Floor Amendments  of 6/14/13 require the Department of  
          Health Care Services coordinate covered services across all  
          delivery systems of care in order to minimize disruption in  
          services for children transitioning from the Healthy Families  
          Program to Medi-Cal.  

          Senate Floor Amendments  of 6/13/13 add diagnostic and preventive  
          services and anterior root canal therapy as part of the  
          restoration of Medi-Cal dental benefits.

           ANALYSIS  :    This bill makes the following key changes:

            1. Affordable Care Act (ACA) - General Fund (GF) Savings  
             Estimate from State Receiving Enhanced Federal Funding for  
             Currently Eligible.   This bill requires the Administration to  
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             estimate and display in the Medi-Cal Program Estimate the GF  
             savings attributable to the receipt of enhanced federal  
             funding for Medi-Cal eligibles who were previously calculated  
             as being currently eligible and for whom the state received  
             only a 50% federal matching assistant payment.

            2. ACA - Enhanced Federal Funds for Preventive Services and  
             Adult Vaccines.  This bill exempts preventative services and  
             adult vaccines from cost-sharing in order to be eligible for  
             enhanced federal funding under the ACA.  This provides for  
             $7.5 million GF savings.

            3. ACA - Medi-Cal Enrollment Assistance and Outreach Grants.    
             This bill requires the Department of Health Care Services  
             (DHCS) to accept a grant from the California Endowment for  
             Medi-Cal Enrollment Assistance ($14 million) and Medi-Cal  
             Outreach and Enrollment Grants to Community-Based  
             Organizations ($12.5 million) and obtain $26.5 million in  
             matching federal funds for these purposes. 

            4. Medi-Cal: Adult Dental Benefits.   This bill partially  
             restores Medi-Cal Adult Dental Benefits effective May 1,  
             2014, for $55.3 million ($16.9 million GF).  This partial  
             restoration includes preventive/diagnostic services,  
             restoration services (amalgams, composite and stainless steel  
             crowns, anterior root canal therapy), and full mouth  
             dentures. (These benefits were eliminated as an "optional"  
             Medi-Cal benefit in 2009, due to the state's fiscal crisis.)   
             With the expansion of Medi-Cal up to 138% of poverty for  
             childless adults, under the ACA, the state will take  
             advantage of 100% federal funding (January 1, 2014 through  
             December 31, 2016) for these new enrollees.  

            5. Medi-Cal to Foster Care Youth Turning 21.   This bill  
             provides for the continuation of Medi-Cal coverage for foster  
             care youth who turn 21 between July 1, 2013, and December 31,  
             2013, for $900,000 GF.  Effective January 1, 2014, per the  
             ACA, these youth will remain eligible for Medi-Cal until age  
             26. 

            6. Medi-Cal:  Enteral Nutrition Benefits.   This bill restores  
             Medi-Cal enteral nutrition benefits starting May 1, 2014, for  
             $3.4 million ($1.7 million GF).
           

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           7. Medi-Cal:  Eliminate Physician and Clinic Seven-Visit Cap.    
             This bill eliminates the seven-visit cap on physician and  
             clinic visits, as it is evident that this would not be  
             approved by the federal Centers for Medicaid Services (CMS).
           
           8. Medi-Cal:  Lab Rate Methodology Data Reporting Extension.    
             This bill extends the time period for which laboratory  
             service providers have to submit data reports specifying the  
             lowest amounts other payers are paying. This is necessary as  
             the process to develop the new rate methodology has taken  
             longer than anticipated. 
           
           9. Medi-Cal:  Eliminate Sunset Date for Specialty Provider  
             Contracting.   This bill eliminates the sunset date for  
             specialty provider contracting. The elimination of this  
             sunset date achieves ongoing $6.9 million GF savings.
           
           10.Medi-Cal:  Low Income Health Program and Public Hospitals.    
             Current law allows Low Income Health Programs (LIHPs) to be  
             reimbursed under a capitated model.  It also requires an LIHP  
             to agree to a capitated rate with DHCS during a given  
             demonstration year.  That rate may then be implemented  
             retroactively back to the first day of the demonstration year  
             if it is agreed upon during the same demonstration year.  

              Public hospital systems are evolving their Low Income Health  
             Programs from feeforservice to riskbased programs to using  
             capitated rates.  This bill contains technical language to  
             preserve the states option under the existing 1115 Medi-Cal  
             Waiver with the federal government to utilize a capitation  
             rate under the LIHP.  
           
           11.Medi-Cal:  Behavioral Health Services Plan.  This bill  
             requires DHCS to consult with stakeholders prior to the  
             submittal of the Behavioral Health Services Plan to the  
             federal CMS.
           
           12.Medi-Cal:  Transparency of State Plan Amendments (SPAs) and  
             Waivers.   This bill requires DHCS to post on its website  
             proposed SPAs, waiver amendments, and waiver renewals that it  
             has submitted to the federal government.  This provides  
             legislative staff and stakeholders with the opportunity to  
             review and comment on the state's implementation of policy.
           

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           13.Medi-Cal Managed Care and Early and Periodic Screening,  
             Diagnostic and Treatment (EPSDT).   This bill incorporates the  
             measuring and evaluating of Medi-Cal managed care plans'  
             screenings for mental health needs and their referrals for  
             these services (to both Medi-Cal fee-for-service providers  
             and county mental health plans) into the EPSDT performance  
             outcome system.  This effort is informed by stakeholders, and  
             a plan for the incorporation of these factors into the  
             outcome system is due to the Legislature by October 1, 2014.
           
           14.Medi-Cal Coverage of County Medical Parole and Compassionate  
             Release.   This bill adopts technical amendments to ensure the  
             cost neutrality of SB 1462 (Leno, Chapter 837, Statutes of  
             2012), which provides Medi-Cal to eligible county inmates on  
             medical parole and inmates granted compassionate release.  

           15.Access for Infants and Mothers (AIM)-Linked Infants Transfer  
             to DHCS.   This bill transitions AIM-linked infants, born to  
             women whose income is from 250 to 300% of the federal poverty  
             level, from the Managed Risk Medical Insurance Board (MRMIB)  
             to DHCS.  

           16.Pre-Existing Condition Insurance Plan.   This bill ends the  
             Managed Risk Medical Insurance Board's responsibility  
             regarding the Pre-Existing Condition Insurance Plan (PCIP)  
             effective July 1, 2013, as the federal government will take  
             over administration of this program.
           
           17.Managed Risk Medical Insurance Program.   This bill extends  
             the date through which MRMIB can subsidize the premium  
             contributions paid to individuals receiving coverage in  
             MRMIP. This change is necessary as MRMIP will remain a  
             program beyond December 31, 2013.
          
           18.Transfer of Licensing of Mental Health Facilities to DHCS.    
             This bill transfers mental health facility licensing and  
             quality improvement functions from the Department of Social  
             Services to DHCS.  

           19.Long Term Care Quality Assurance Fund.   This bill makes the  
             funds available in the Long Term Care Quality Assurance Fund  
             borrowable for General Fund cash flow purposes.
           
           20.Every Woman Counts Fiscal Information.   This bill requires  

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             that supplemental Every Woman Counts fiscal information  
             regarding clinical service activity expenditures be included  
             in budget documents to ensure that the Legislature and  
             stakeholders have the information necessary to make informed  
             decisions.
           
           21.Mental Health Services Act - Prevention and Early  
             Intervention Regulations.   This bill provides technical  
             clarification regarding the Mental Health Services Oversight  
             and Accountability Commission's ability to issue regulations  
             regarding the prevention and early intervention program. 
           
           22.AIDS Drug Assistance Program (ADAP).   This bill requires the  
             Department of Public Health (DPH) to report to the  
             Legislature if the assumptions it used to determine the  
             transition of ADAP clients to the LIHP may result in an  
             inability to provide ADAP services to eligible ADAP clients. 

            23.Infant Botulism/BabyBIG.   This bill requires DPH to submit a  
             plan to the Legislature on how it will address the findings  
             and recommendations from its review of the BabyBIG program to  
             ensure that an adequate supply of the vaccine is available to  
             meet demand. 

            24.Safe Cosmetics Website.   This bill defines and clarifies the  
             purpose and structure of the Safe Cosmetics Program website  
             and requires that the website be operational by December 31,  
             2013.

            25.Reappropriation of Consumer Assistance Federal Grant.   This  
             bill reappropriates federal funds to the Department of  
             Managed Health Care for purposes of continuing operation of  
             consumer assistance programs to help uninsured individuals  
             obtain health coverage.

            26.Healthy Families Transition  .  This bill requires the  
             Department of Health Care Services coordinate covered  
             services across all delivery systems of care in order to  
             minimize disruption in services for children transitioning  
             from the Healthy Families Program to Medi-Cal.

           FISCAL EFFECT  :    Appropriation:  Yes   Fiscal Com.:  Yes    
          Local:  No


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          According to the Senate Budget and Fiscal Review Committee, the  
          funding related to the changes in this bill is contained in the  
          2013-14 Budget.  This bill reappropriates about $1 million in  
          federal funds to the Department of Managed Health Care for  
          purposes of continuing operation of consumer assistance programs  
          to help uninsured individuals obtain health coverage.




          JL:nl  6/14/13   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  NONE RECEIVED

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