BILL NUMBER: AB 1759	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JULY 1, 2014
	AMENDED IN ASSEMBLY  MAY 23, 2014
	AMENDED IN ASSEMBLY  APRIL 21, 2014
	AMENDED IN ASSEMBLY  MARCH 25, 2014

INTRODUCED BY   Assembly Members Pan and Skinner
   (Coauthor: Assembly Member Bonta)

                        FEBRUARY 14, 2014

   An act to add Section 14105.197 to the Welfare and Institutions
Code, relating to health care services.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1759, as amended, Pan. Medi-Cal: reimbursement rates: care:
independent assessment.
   Existing law establishes the Medi-Cal program, administered by the
State Department of Health Care Services, under which basic health
care services are provided to qualified low-income persons. The
Medi-Cal program is, in part, governed and funded by federal Medicaid
provisions. Existing law requires the director of the department to
prescribe policies regarding the Medi-Cal program, including polices
regarding rates of payment for health care services.
   This bill would  request the University of California to
annually conduct   require the department to contract
with an independent entity for purposes of conducting  an
independent assessment of Medi-Cal provider reimbursement rates,
access to care, and the quality of care received in the Medi-Cal
program, reflecting the variety of providers and services offered in
the program.  The bill would exempt contracts entered into
pursuant to these provisions from generally applicable provisions of
law governing contracts for the acquisition of goods and services by
state entities.  The bill would also require the director to
annually review the findings and recommendations of that assessment
and suggest adjustments to the reimbursement rates as necessary to
ensure that quality and access in the Medi-Cal fee-for-service
program and in Medi-Cal managed care plans are adequate to meet
applicable state and federal standards. The bill would require that
the findings and recommendations of the independent assessment and
the director's suggested adjustments to provider reimbursement rates
be submitted to the Legislature annually as part of the Governor's
Budget. The bill would also create an advisory committee composed of
16 members appointed by the Governor and the Legislature, as
specified, to  meet periodically with the University of
California and  provide input on  the selection of the
independent entity and the work of the independent entity. The bill
would require the advisory committee to meet periodically with the
independent entity selected and provide input on  the assessment
conducted pursuant to the bill's provisions.  The bill would
require meetings of the advisory committee to be open. 
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 14105.197 is added to the Welfare and
Institutions Code, to read:
   14105.197.  (a) The  Legislature requests the University
of California to annually conduct an   department shall
contract with an independent entity for purposes of conducting an
annual  independent assessment of Medi-Cal provider
reimbursement rates, access to care, and the quality of care received
in the Medi-Cal program  , which shall include the different
geographic areas of the state and the access to care and quality
received by different populations enrolled in the Medi-Cal program.
The independent entity assessment   shall include, but not
be limited to, the use of existing quality measures and existing
requirements for access to care and timeliness of care  . The
assessment should reflect the variety of providers and services
offered in the Medi-Cal program.
   (b) (1) An advisory committee is hereby created to be composed of
16 members representing health care stakeholders, including, but not
limited to, patients, providers, public and private health delivery
systems, payers, and state officials  to provide input on the
selection of the independent entity and the work of the independent
entity  . The Governor shall appoint eight members, the Senate
Committee on Rules shall appoint four members, and the Speaker of the
Assembly shall appoint four members.
   (2) Except for the initial appointments described in paragraph
(3), members of the committee shall be appointed for a term of four
years, and each member shall hold office until the appointment and
qualification of his or her successor or until one year has elapsed
since the expiration of the term for which he or she was appointed,
whichever occurs first.
   (3) (A) Of the initial members appointed by the Governor, two
shall serve a term of one year, two shall serve a term of two years,
two shall serve a term of three years, and two shall serve a term of
four years.
   (B) Of the initial members appointed by the Senate Committee on
Rules, one shall serve a term of one year, one shall serve a term of
two years, one shall serve a term of three years, and one shall serve
a term of four years.
   (C) Of the initial members appointed by the Speaker of the
Assembly, one shall serve a term of one year, one shall serve a term
of two years, one shall serve a term of three years, and one shall
serve a term of four years.
   (4) Members of the committee shall publicly report financial and
other potential conflicts of interest.
   (5) The committee shall establish an open process for the conduct
of its affairs that enables all health care stakeholders to provide
feedback on those affairs.
   (6) The committee shall meet periodically with the 
University of California   independent entity selected
 and provide input to the  University of California
  independent entity  on the assessment conducted
pursuant to subdivision (a).
   (c) The director shall annually review the findings and
recommendations of the assessment conducted under subdivision (a) and
suggest adjustments to the reimbursement rates as necessary to
ensure that quality and access in the Medi-Cal fee-for-service
program and in Medi-Cal managed care plans are adequate to meet
applicable state and federal standards. 
   (d) Meetings of the advisory committee shall be open for
presentation, discussion, and public comment on each agenda item, and
in accordance with the Bagley-Keene Open Meeting Act (Article 9
(commencing with Section 11120) of Chapter 1 of Part 1 of Division 3
of Title 2 of the Government Code).  
   (e) In order to provide for quicker implementation of the
independent assessment required by this section, contracts made under
this section are exempt from Chapter 2 (commencing with Section
10290) of Part 2 of Division 2 of the Public Contract Code. 

   (d) 
    (f)  Notwithstanding Section 10231.5 of the Government
Code, the findings and recommendations of the independent assessment
conducted under subdivision (a) and the director's suggested
adjustments to provider reimbursement rates provided pursuant to
subdivision (c) shall be submitted to the Legislature annually as
part of the Governor's Budget submitted pursuant to Section 13337 of
the Government Code.