Amended in Assembly March 21, 2013

California Legislature—2013–14 Regular Session

Assembly Bill No. 390

Introduced by Assembly Member Logue

February 15, 2013

An act to begin delete amend Section 14000 of the Welfare and Institutions Code, relating to health care. end delete begin insert add Section 13335.1 to the Government Code, relating to the State Budget end insert begin insert . end insert

LEGISLATIVE COUNSEL’S DIGEST

AB 390, as amended, Logue. Health care.

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The California Constitution requires the Governor to submit annually to the Legislature a budget itemizing state expenditures and estimating state revenues and requires the Legislature to pass the Budget Bill by midnight on June 15. Under existing law, a state agency for which an appropriation is made is generally required to submit to the Department of Finance for approval a complete and detailed budget setting forth all proposed expenditures and estimated revenues for the ensuing fiscal year.

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Under the federal Patient Protection and Affordable Care Act (PPACA), each state is required to, by January 1, 2014, establish an American Health Benefit Exchange that makes available qualified health plans to qualified individuals and small employers. Existing state law establishes the California Health Benefit Exchange (Exchange) within state government, specifies the powers and duties of the board governing the Exchange, and requires the board to facilitate the purchase of qualified health plans through the Exchange by qualified individuals and small employers by January 1, 2014.

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The bill would require the Exchange to submit to the department and the Legislative Analyst’s Office a complete and detailed budget utilizing performance-based budgeting, as defined, that sets forth all proposed expenditures and estimated revenues for the ensuing fiscal year. The bill would require the Exchange to, if necessary, develop a process for consulting with contractors or other responsible entities and stakeholders to develop information related to performance standards and program performance. The bill would require the department to include specified performance-based budgeting information for the Exchange in the Governor’s Budget proposal and to post that information on the department’s Internet Web site. The bill would also require the Legislative Analyst’s Office to review the adequacy of performance metrics and progress toward targeted outcomes in preparing its review of the Governor’s Budget proposal as it relates to the Exchange.

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Existing law requires the State Department of Health Services, whenever possible and feasible, to give due consideration to the appropriate organization and the ready accessibility and availability of the facilities and resources for health care to eligible persons, and to new and innovative approaches to the delivery of health care services.

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This bill would make technical, nonsubstantive changes to these provisions.

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Vote: majority. Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program: no.

The people of the State of California do enact as follows:

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begin insert SECTION 1. end insert   

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The Legislature finds and declares all of the
following:

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(a) State government must focus on the outcomes of public policy
decisions and public programs to ensure opportunities are
available for all Californians to achieve a high quality of life.

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(b) The Legislature must ensure that policymakers, public
program administrators, and rank-and-file state workers have
access to relevant and timely information so that they can make
informed decisions in the design and delivery of public programs.

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(c) The focus of that information must be on the goals of those
public programs and the performance of the public agencies in
administering those programs.

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(d) Goal and performance information should be widely
available, relevant, and timely for informing budget, policy, and
oversight decisions.

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(e) In order to identify performance measurements relevant to
budget, policy, and oversight decisionmaking, public agencies
must consult with the public, rank-and-file state workers,
supervisors, and other officials responsible for the delivery of
public programs.

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(f) Performance measurements, including information on
outcomes and other metrics relevant to improving those outcomes,
should be designed to ensure that limited public resources are well
spent.

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(g) Establishing goal, performance, and outcome information
for public programs should be part of a systematic review of the
effectiveness and efficiency of those programs.

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(h) Goal, performance, and outcome information should be
made widely available to the public.

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(i) Goal, performance, and outcome information should be used
in the annual budget and policymaking process to inform fiscal
and policy decisions and by the Legislature to enhance oversight
of public programs and to ensure results-based accountability.

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(j) As a component of legislative oversight, goal, performance,
and outcome information should be used to identify programs that
require fundamental reforms to improve outcomes and programs
subject to elimination because they are ineffective.

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begin insert SEC. 2. end insert   

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begin insert Section 13335.1 is added to the end insert begin insert Government Code end insert begin insert , to
read: end insert

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begin insert 13335.1. end insert   

(a) As used in this article, the following definitions
shall apply:

(1) “Exchange” means the California Health Benefit Exchange
established pursuant to Title 22 (commencing with Section 100500)
of the Government Code.

(2) “Performance-based budgeting” means a system of
budgeting that uses information on performance to inform resource
allocation decisions, thereby establishing clear accountability.

(b) The purpose of performance-based budgeting is to inform
policy, fiscal, and oversight decisions by the Governor and
Members of the Legislature; to focus managers, supervisors, and
rank-and-file workers on achieving desired goals; and to
communicate to the public the value of public programs, progress
toward desired results, and the choices available to improve the
expenditure of public funds.

(c) The Exchange shall submit to the Department of Finance
and the Legislative Analyst’s Office a complete and detailed budget
at the time and in the form prescribed by the department that sets
forth all proposed expenditures and estimated revenues for the
ensuing fiscal year.

(d) The budget submitted pursuant to subdivision (c) shall use
performance-based budgeting to make clear to policymakers and
the public the value and results of existing operations and proposed
changes.

(e) The budget submitted pursuant to subdivision (c) using
performance-based budgeting shall identify and update all of the
following:

(1) The mission and goals of the Exchange.

(2) The activities and programs focused on achieving those
goals.

(3) Performance metrics that reflect desired outcomes for
existing and proposed activities and a targeted performance level
for the following year.

(4) Prior year performance data and an explanation of deviation
from previous year targets.

(5) Proposed changes in statute, including the creation of
incentives or elimination of disincentives that could improve
outcomes or hold down costs.

(6) A description of the impacts and consequences to parties
affected by an activity or program proposed for modification or
elimination.

(7) A five-year projection of estimated assessment levels on
health plans to pay for Exchange expenditures.

(f) Performance-based budgeting shall be used by the Exchange
and shall allow the public and policymakers to understand the
effectiveness and efficiency of the Exchange. The Exchange shall,
if necessary, develop a process for consulting with contractors or
other responsible entities, and stakeholders to develop information
related to performance standards and program performance.

(g) The Department of Finance shall include performance-based
budgeting information for the Exchange in the Governor’s Budget
proposal in both printed and electronic formats if prepared, and
post the information on its Internet Web site where the department
routinely posts budget information. That information shall include,
but not be limited to, information on all of the following:

(1) The mission and goals of the Exchange’s provided spending
authority in the budget proposal.

(2) The activities and programs focused on achieving those
goals.

(3) Performance metrics that reflect desired outcomes for
existing and proposed activities and a targeted performance level
for the following year.

(4) Prior year performance data and an explanation of deviation
from previous year targets.

(5) A description of the impacts and consequences to parties
affected by an activity or program proposed for modification or
elimination.

(h) The Legislative Analyst’s Office shall review the adequacy
of performance metrics and progress toward targeted outcomes
in preparing its review of the Governor’s Budget proposal as it
relates to the Exchange.

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SECTION 1.  

Section 14000 of the Welfare and Institutions
Code is amended to read:

14000.  

The purpose of this chapter is to afford to qualifying
individuals health care and related remedial or preventive services,
including related social services which are necessary for those
receiving health care under this chapter.

The intent of the Legislature is to provide, to the extent
practicable, through the provisions of this chapter, for health care
for those aged and other individuals, including family members
who lack sufficient annual income to meet the costs of health care,
and whose other assets are so limited that their application toward
the costs of such care would jeopardize the individual’s or family’s
future minimum self-maintenance and security. It is intended that
whenever possible and feasible:

(a) The means employed shall allow, to the extent practicable,
an eligible individual to secure health care in the same manner
employed by the public generally, and without discrimination or
segregation based purely on his or her economic disability. The
means employed shall include an emphasis on efforts to arrange
and encourage access to health care through enrollment in
organized, managed care plans of the type available to the general
public.

(b) The benefits available under this chapter shall not duplicate
those provided under other federal or state laws or under other
contractual or legal entitlements of the individual or individuals
receiving them.

(c) In the administration of this chapter and in establishing the
means to be used to provide access to health care to individuals
eligible under this chapter, the department shall emphasize and
take advantage of both the efficient organization and ready
accessibility and availability of health care facilities and resources
through enrollment in managed health care plans and new and
innovative fee-for-service managed health care plan approaches
to the delivery of health care services.

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