California Legislature—2013–14 Regular Session

Assembly Bill No. 1087

Introduced by Assembly Members Torres and Mitchell

February 22, 2013

An act to amend Section 14180 of the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

AB 1087, as introduced, Torres. Medi-Cal: California’s Bridge to Reform Demonstration.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law requires the department to seek a demonstration project or federal waiver of Medicaid law to implement specified objectives, which may include better care coordination for seniors, persons with disabilities, and children with special health care needs.

This bill would make a technical, nonsubstantive change to these provisions.

Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.

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

SECTION 1.  

Section 14180 of the Welfare and Institutions
Code is amended to read:

14180.  

(a) The department shall submit an application to the
federal Centers for Medicare and Medicaid Services for a waiver
or a demonstration project to implement all of the following:

(1) Strengthen California’s health care safety net, which includes
disproportionate share hospitals, for low-income and vulnerable
Californians.

(2) Maximize opportunities to reduce the number of uninsured
individuals.

(3) Optimize opportunities to increase federal financial
participation and maximize financial resources to address
uncompensated care.

(4) Promote long-term, efficient, and effective use of state and
local funds.

(5) Improve health care quality and outcomes.

(6) Promote home-and community-based care.

(b) The waiver or demonstration project shall include proposals
to restructure the organization and delivery of services to be more
responsive to the health care needs of Medi-Cal enrollees for the
purpose of providing the most vulnerable Medi-Cal beneficiaries
with access to better coordinated and integrated care that will
improve their health outcomes, slow the long-term growth of the
Medi-Cal program, and continue support for the safety net care
system and the persons who rely on that system for needed care.
These restructuring proposals may include, but are not limited to,
the following:

(1) Better care coordination for seniors and persons with
disabilities, dual eligibles, children with special health care needs,
and persons with behavioral health conditions, which shall include
the establishment of organized delivery systems that incorporate
a medical home system and care and disease management, as well
as incentives that reward providers and beneficiaries for achieving
the desired clinical, utilization, and cost-specific outcomes.

(2) Improved coordination between Medicare and Medi-Cal
coverage.

(3) Improved coordination of care for children with significant
medical needs through improved integration of delivery systems
and use of medical homes and specialty centers, and providing
incentives for specialty and nonspecialty care.

(4) Improved integration of physical and behavioral health care.

(c) In developing the waiver or demonstration project
application, the department shall consult on a regular basis with
interested stakeholders and the Legislature.

(d) The department shall determine the form of waiver most
appropriate to achieve the purposes listed in subdivision (a).

(e) The department shall submit the waiver or demonstration
project application to the federal Centers for Medicare and
Medicaid Services by a date that allows sufficient time for the
waiver or demonstration project to be approved by no later than
September 1, 2010, or the conclusion of any extension period
granted in California’s Medi-Cal Hospital/Uninsured Care Section
1115(a) Medicaid Demonstration (No. 11-W-00193/9), whichever
happens last.

(f) In order to restructure the Medi-Cal program to improve the
delivery of care for specified populations and secure the maximum
amount of federal financial participation allowable, any waiver or
demonstration project application submitted pursuant to subdivision
(a) may specify and seek authority to enroll beneficiaries into
specified organized delivery systems. Subject to federal approval,
the specified organized delivery systems may include the utilization
of an enhanced primary care case management model, a medical
home model, or managed care model. The department is authorized
to enroll beneficiaries in an organized system of care subject to
the conditions in Section 14181. Subject to federal approval, any
waiver or demonstration project application submitted pursuant
to subdivision (a) shall include processes, and accompanying
criteria, by which the department will evaluate and grant
exemption, on an individual basis, from this section’s requirements
pertaining to the mandatory enrollment of beneficiaries in specified
organized delivery systems.

(g) (1) The department shall only implement the waiver or
demonstration project upon submittal of an implementation plan,
pursuant to Section 14181, to the appropriate policy and fiscal
committees of the Legislature at least 60 days prior to any
appropriation.

(2) Pursuant to paragraph (1), mandatory enrollment in any
organized delivery system authorized pursuant to a waiver or
demonstration project authorized pursuant to this article shall begin delete only
occur when end delete begin insert occur only after end insert funds necessary to support that effort
have been appropriated.

(3) It is the intent of the Legislature to neither impede nor limit
the department’s existing statutory authority regarding the
operation of the Medi-Cal program and its health care delivery
systems by the enactment of this article.

(h) The director shall have the discretion to utilize state plan
amendments, in whole or in part, to accomplish any or all purposes
of this article. In the event the director proceeds with state plan
amendments as specified, the department shall provide notification
in writing to the chairperson of the Joint Legislative Budget
Committee within 15 working days of that action and a brief
description and purpose of the amendment. This amendment shall
be made available to the Joint Legislative Budget Committee upon
the request of the chairperson.