BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 82| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- 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 CONTINUED AB 82 Page 2 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). CONTINUED AB 82 Page 3 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. CONTINUED AB 82 Page 4 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 CONTINUED AB 82 Page 5 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 CONTINUED AB 82 Page 6 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 **** END **** CONTINUED