BILL ANALYSIS Ó
AB 357
Page 1
Date of Hearing: January 14, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 357 (Pan) - As Amended: January 6, 2014
SUBJECT : Children's Health Advisory Board.
SUMMARY : Renames the Healthy Families Advisory Board (HFAB) the
Children's Health Advisory Board (CHAB) and transfers the
panel's advisory and reporting capacity from the Major Risk
Medical Insurance Board (MRMIB) to the Director of the
Department of Health Care Services (DHCS). Specifically, this
bill :
1)Repeals the HFAB and reinstates it as the CHAB.
2)Reassigns the authority to make appointments to the CHAB in
the following manner:
a) Authorizes the Governor to appoint one licensed
practicing dentist, a representative from a licensed
nonprofit primary care clinic, one representative of the
mental health provider community, one representative from
the health plan community, and one representative from the
business community;
b) Authorizes the Senate Committee on Rules to appoint one
physician and surgeon who is board certified in the area of
family practice medicine, one representative from a
licensed hospital that is on the disproportionate share
list maintained by DHCS, one representative of the
substance abuse provider community, one representative of
the county public health provider community, and one
representative from the education community; and,
c) Authorizes the Speaker of the Assembly to appoint three
representatives from the Medi-Cal population, one physician
and surgeon who is board certified in pediatrics, and one
representative from a family with children with special
needs.
3)Requires DHCS to provide staff assistance to CHAB.
4)States the intent of the Legislature that this bill does not
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result in a new board, but is a continuation of the prior
HFAB, and that no new board members be appointed until a
vacancy occurs.
5)States various findings and declarations regarding the health
and well-being of California's children.
EXISTING LAW :
1)Establishes HFAB, a 15 member advisory panel to advise MRMIB
regarding the provision of health care services to
participants in the Healthy Families Program (HFP).
2)Specifies the HFAB be composed of the following 15 members
appointed by MRMIB:
a) One member who is a licensed, practicing dentist;
b) One representative from a licensed nonprofit primary
care clinic;
c) One representative of the mental health provider
community;
d) One representative from the health plan community;
e) One representative from the business community;
f) One physician and surgeon who is board certified in the
area of family practice medicine;
g) One representative from a licensed hospital that is on
the disproportionate share list maintained by DHCS;
h) One representative of the substance abuse provider
community;
i) One representative from the education community;
j) Three representatives from the Medi-Cal population;
aa) One physician and surgeon who is board certified in
pediatrics; and,
bb) One representative from a family with children with
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special needs.
3)Requires HFAB members to have expertise in providing
health-related services to children 18 years of age and
younger, if applicable.
4)Requires HFAB members to elect a chair from among its members.
5)Specifies HFAB's powers and duties include, but are not
limited to, the following:
a) To advise MRMIB on all policies, regulation, and
operation of the Medi-Cal Program;
b) To consider all written recommendations of HFAB and
respond in writing when MRMIB rejects the advice of HFAB;
and,
c) To meet at least quarterly, unless deemed unnecessary by
the chair.
6)Requires HFAB members to be reimbursed for all necessary
travel expenses.
7)Transfers participants in the HFP to Medi-Cal starting no
sooner than January 1, 2013.
8)Requires a time certain for the transfer of the HFAB to DHCS.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, as
implementation of the Patient Protection and Affordable Care
Act (ACA) moves forward, HFP participants transition to
Medi-Cal, and Medi-Cal enrollment increases, it is critical
that we have a process for providing stakeholder feedback
regarding Medi-Cal services provided to California's children.
Following the transition of all children in the HFP, nearly
five million children are expected to be enrolled in Medi-Cal.
Additionally, many of the approximately 460,000 children who
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are currently eligible but not enrolled in Medi-Cal are
expected to enroll as outreach efforts associated with ACA
implementation increase. Once the transition of children from
HFP into Medi-Cal is complete, close to 50% of all children
under the age of 18 in California will be enrolled in
Medi-Cal.
The author further states that, given the unique health needs of
children and in light of recent and impending changes to the
Medi-Cal program, the need is greater than ever for children
in Medi-Cal to benefit from an effective and efficient
stakeholder advisory process so that California can insure
that they are receiving the best possible care.
2)BACKGROUND . The HFAB was established statutorily to advise
MRMIB on HFP policies, regulations, operation, and
implementation. It is comprised of 15 members, appointed by
MRMIB, who serve three year terms, and consists of subject
matter experts such as providers, health care delivery
organizations, medical and dental providers, a business
representative, and subscriber parents. Effective January 1,
2014, HFAB transitioned to DHCS along with the rest of HFP.
The role of HFAB after transition is currently unclear.
Stakeholders and the Advisory Board itself have made
suggestions regarding the future role. These include more
frequent meetings, direct reporting to the Director of DHCS
and expansion of the role, to advise on all children in
Medi-Cal. The HFAB also recommends maintaining the existing
scope which includes advising on all policies, regulations and
operations, submitting recommendations formally in writing and
a written response, when not implemented on the reasoning for
the non-implementation. In addition HFAB would have
responsibilities with regard to monitoring and performance
reports including evaluating aspects of the program and making
recommendations.
Recent U.S. Census Bureau numbers show there were about 9.3
million children under the age of 18 in California during July
2012. During the same month there were 3.6 million children
enrolled in the Medi-Cal program, accounting for roughly 39%
of all children under the age of 18 in the state.
3)SUPPORT . The California children's health coverage coalition,
comprised of the Children's Partnership, Children Now,
Children's Defense Fund-California, PICO California, the
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California Coverage and Health Initiatives, and United Ways of
California support this bill, stating that in the 15 years
that the HFAB has been operating, it has made recommendations
that have helped to improve the quality of care for children
in HFP, and has been an important space for parents of
enrollees and other experts to discuss ways to improve the
program, and that this bill is a means to ensure that children
and families will continue to have a strong voice at DHCS.
The California Medical Association supports this bill writing
that given the significant programmatic and eligibility
changes currently underway in Medi-Cal, a strong stakeholder
advisory group process is vital to ensure access and quality
of care is not compromised. The California Teachers
Association also writes in support, stating that there is a
lack of focus on the health of children, and this important
legislation shines the spotlight on a vulnerable population.
4)SUGGESTED AMENDMENT . As currently drafted the bill requires
the CHAB to advise the DHCS Director on all Medi-Cal program
policies, regulations, and operations. Committee staff
suggest the bill be amended as follows:
On page 4, line 28 after the word "program," insert:
"related to providing health care services to
children"
5)RELATED LEGISLATION . AB 209 (Pan) enacts the Medi-Cal Managed
Care Quality and Transparency Act of 2013 and requires DHCS to
develop and implement a plan to monitor, evaluate, and improve
the quality and accessibility of health care and dental
services provided through Medi-Cal managed care. AB 209 is
currently on the Senate inactive file.
6)PREVIOUS LEGISLATION .
a) AB 1494 (Committee on Budget), Chapter 28, Statutes of
2012, provides for the transition of children from HFP to
Medi-Cal in four phases, starting no earlier than January
1, 2013.
b) AB 1468 (Committee on Budget), Chapter 438, Statutes of
2012, requires a time certain for the transfer of the HFAB
to DHCS.
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REGISTERED SUPPORT / OPPOSITION :
Support
American Academy of Pediatrics, California
California Academy of Family Physicians
California Academy of Physician Assistants
California Children's Hospital Association
California Coverage & Health Initiatives
California Medical Association
California Optometric Association
California Teachers Association
Children's Defense Fund - California
Children Now
Community Clinic Association of Los Angeles
PICO California
The Children's Partnership
United Ways of California
Opposition
None on file.
Analysis Prepared by : Lara Flynn / HEALTH / (916) 319-2097