BILL ANALYSIS �
AB 361
Page 1
Date of Hearing: April 17, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 361 (Mitchell) - As Amended: April 4, 2013
Policy Committee: HealthVote:15-3
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill, subject to federal approval as specified, authorizes
the Department of Health Care Services (DHCS) to create a
California Health Home Program (Program) consistent with federal
health reform, the Affordable Care Act (ACA). Specifically,
this bill:
1)Permits DHCS to design a program for specified populations
with chronic conditions. This includes authority for
contracting, developing a payment methodology, identifying
home health services consistent with federal guidelines, and
submitting applications to the federal Centers for Medicare
and Medicaid Services (CMS) for one or more Medicaid state
plan amendments (SPAs).
2)Authorizes DHCS to design one or more SPAs to provide home
health services to children and adults and, subject to
enhanced federal matching funds, requires specific services
including comprehensive and individualized care management,
care coordination, transitional care, individual and family
support, and referral to community and social services
supports.
3)Specifies other criteria for DHCS, including a requirement
that DHCS report on and develop an alternative plan if the
department determines a health home program for adults with
severe conditions (including frequent hospital admissions and
homelessness) is not operationally viable.
4)Requires implementation only if federal financial
participation (FFP) is available and CMS approves any SPAs
sought. Clarifies that local governments or foundations are
AB 361
Page 2
not precluded from contributing the nonfederal share of costs
if permitted under federal law. Requires an evaluation two
years after implementation.
FISCAL EFFECT
1)One-time administrative costs likely in the hundreds of
thousands of dollars to plan and develop the program and
submit the required applications. Ongoing costs likely in the
hundreds of thousands to millions of dollars to oversee and
administer the program. One-time costs in the low millions of
dollars to perform the required evaluation.
2)With enhanced (90%) FFP, the state's share would be 10%.
Grant money is expected to cover the state share. Long-term
program costs are unknown, but likely to be cost-neutral to
the state.
COMMENTS
1)Rationale . The author, sponsors (Corporation for Supportive
Housing and Western Center on Law and Poverty), and numerous
supporters believe the state should take advantage of an ACA
provision providing enhanced matching funds by creating health
homes for enrollees with two or more chronic conditions. A
health home would serve people whose needs might make them
more costly initially but for whom costs would decrease after
the intensive case management and care coordination of a
health home.
2)Related Legislation . AB 1208 (Pan) establishes the Patient
Centered Medical Home (PCMH) Act of 2013 and defines a
"medical home" and a "patient centered medical home" to refer
to a health care delivery model in which a patient establishes
an ongoing relationship with a licensed health care provider,
as specified. AB 1208 is pending in Assembly Health
Committee.
3)Prior Legislation .
a) AB 2266 (Mitchell) of 2012 would have required DHCS to
establish a program to provide health home services
designed to reduce a participating individual's avoidable
use of hospitals when more effective care can be provided
in less costly settings. AB 2266 died on the Senate Floor.
AB 361
Page 3
b) SB 393 (Ed Hernandez) of 2011 would have established a
definition for a medical home based upon specified
standards. SB 393 was vetoed by Governor Brown who stated
the medical home concept, while not new, is still evolving
and required more work.
c) AB 1542 (Jones) of 2009 would have defined a
patient-centered medical home to mean, in part, a health
care delivery model in which a patient establishes an
ongoing relationship with a physician or other licensed
health care provider, working in a physician-directed
practice team to provide comprehensive, accessible, and
continuous evidence-based primary care. AB 1542 died on the
Assembly Floor.
d) SB 1738 (Steinberg) of 2008 would have required DHCS to
establish a three-year pilot program to provide intensive
multidisciplinary services to 2,500 Medi-Cal beneficiaries
identified as frequent users of health care. SB 1738 was
vetoed by Governor Schwarzenegger who cited the state's
fiscal challenges in his veto message.
1)Drafting Concern . This bill's provisions do not take effect
without federal approval, but as drafted, the authority to
apply for federal funding comes from the bill itself. The
author may want to consider an amendment to provide for the
necessary preliminary work to be done in order to submit one
or more SPAs, with implementation of a health home contingent
on the federal funding.
Analysis Prepared by : Debra Roth / APPR. / (916) 319-2081