BILL ANALYSIS Ó
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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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