Amended in Assembly June 18, 2014

Amended in Senate April 17, 2013

Senate Bill No. 18

Introduced by begin delete Senator Hernandez end delete begin insert Senators Hernandez and Leno end insert

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(Principal coauthor: Senator Monning)

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December 3, 2012

An act begin delete to amend Section 127660 of the Health and Safety Code, end delete relating to begin delete health care end delete begin insert Medi-Cal, and making an appropriation therefor end insert .

LEGISLATIVE COUNSEL’S DIGEST

SB 18, as amended, Hernandez. begin delete California Health Benefits Review Program: health insurance. end delete begin insert Medi-Cal renewal. end insert

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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.

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Existing law establishes the Healthcare Outreach and Medi-Cal Enrollment Account to collect and allocate non-General Fund public or private grant funds for expenditure, upon appropriation of the Legislature, for outreach to and enrollment of target Medi-Cal populations and to compensate Medi-Cal in-person assisters.

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This bill would require the State Department of Health Care Services to accept contributions by private foundations in the amount of at least $6,000,000 for the purpose of providing Medi-Cal renewal assistance payments, as specified. The bill would also appropriate $6,000,000 from the Healthcare Outreach and Medi-Cal Enrollment Account, to be available for encumbrance or expenditure until December 31, 2016, and authorize the use of previously appropriated funds in that account for this purpose. The bill would require the department to seek federal matching funds for the contributions to the extent permissible for training, testing, certifying, supporting and compensating persons and entities providing renewal assistance and for any other permissible renewal assistance related activities and to seek all necessary federal approvals for purposes of obtaining federal funding.

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Existing law requests the University of California to establish the California Health Benefits Review Program to assess legislation proposing to mandate a benefit or service or to repeal a mandated benefit or service, and to prepare a written analysis with relevant data on specified areas, including public health, medical impacts, and financial impacts.

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This bill would include essential health benefits and the impact on the California Health Benefit Exchange in the areas to be reported on by the California Health Benefits Review Program.

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Vote: majority. Appropriation:  begin delete no end delete begin insert yes end insert . 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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begin insert (a) end insert begin insert   end insert begin insert (1) end insert begin insert   end insert begin insert The State Department of Health Care
Services shall accept contributions by private foundations in the
amount of at least six million dollars ($6,000,000) for the purpose
of providing Medi-Cal renewal assistance payments starting
January 1, 2015. end insert begin insert These contributions shall be deposited in the
Healthcare Outreach and Medi-Cal Enrollment Account that has
been created in the Special Deposit Fund within the State Treasury
for the purposes specified in this section. end insert

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(2) Six million dollars is hereby appropriated to the State
Department of Health Care Services from the Healthcare Outreach
and Medi-Cal Enrollment Account for the purposes specified in
this section, to be available for encumbrance or expenditure until
December 31, 2016.

end insert begin insert

(3) The department may expend a portion of the five hundred
thousand dollars ($500,000) authorized for expenditure in
subdivision (d) of Section 5 of Chapter 361 of the Statutes of 2013
to administer the activities described in this section. Private
foundation funding expended by the department to administer the
activities described in this section shall be expended only for filled
positions and administrative expenses directly related to this
section.

end insert begin insert

(b) (1) Notwithstanding any other law, and in a manner that
the Director of the State Department of Health Care Services shall
provide, the department may make allocations to fund Medi-Cal
renewal assistance activities as described in this section.

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(2) The department may determine the number of allocations
and the application process. The director may consult or obtain
technical assistance from private foundations in implementation
of the application and allocation process.

end insert begin insert

(3) The director may, at his or her discretion, give consideration
to distributing funds to community-based organizations in an area
or region of the state if a county, or counties acting jointly do not
seek an allocation or funds are made available.

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(c) Renewal assistance payments shall be distributed to
community-based organizations providing renewal assistance to
Medi-Cal beneficiaries. Authorized payments shall be made to
counties by the department for distribution of funds to
community-based organizations. Counties may retain an amount
for administrative costs that have been approved by the department.

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(d) The department, in collaboration with the County Welfare
Directors Association, shall develop renewal assistance training
for employees of community-based organizations that shall be
consistent with the counties’ human services agencies Medi-Cal
redetermination timeframes and process. In order to be eligible
for renewal assistance payments under this section, the
community-based organization’s employees providing the
assistance shall have completed the renewal assistance training
developed under this subdivision.

end insert begin insert

(e) (1) The funds allocated under this section shall be used only
for the Medi-Cal renewal assistance activities and may supplement,
but shall not supplant, existing local, state, and foundation funding
of county renewal assistance activities.

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(2) Notwithstanding Section 10744 of the Welfare and
Institutions Code, the department may recoup or withhold all or
part of an allocation for failure to comply with any requirements
or standards set forth by the department for the purposes of this
section.

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(f) The department shall require progress reports, in a manner
as determined by the department, from those receiving allocations
under this section.

end insert begin insert

(g) The department shall seek federal matching funds for the
contributions to the extent permissible for training, testing,
certifying, supporting, and compensating persons and entities
providing renewal assistance and for any other permissible renewal
assistance related activities and shall seek all necessary federal
approvals for purposes of obtaining federal funding for activities
conducted under this section.

end insert begin insert

(h) To the extent federal funding is received for the services
specified in this section, reimbursements for costs incurred under
the approved allocations shall be made in compliance with federal
law.

end insert begin insert

(i) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department may implement, interpret, or make specific this
section by means of all-county letters, provider bulletins, or similar
instructions.

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(j) This section shall cease to be implemented when all of the
private contributions and any federal matching funds have been
exhausted.

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SECTION 1.  

Section 127660 of the Health and Safety Code
is amended to read:

127660.  

(a) The Legislature hereby requests the University of
California to establish the California Health Benefit Review
Program to assess legislation proposing to mandate a benefit or
service, as defined in subdivision (c), and legislation proposing to
repeal a mandated benefit or service, as defined in subdivision (d),
and to prepare a written analysis with relevant data on the
following:

(1) Public health impacts, including, but not limited to, all of
the following:

(A) The impact on the health of the community, including the
reduction of communicable disease and the benefits of prevention
such as those provided by childhood immunizations and prenatal
care.

(B) The impact on the health of the community, including
diseases and conditions where gender and racial disparities in
outcomes are established in peer-reviewed scientific and medical
literature.

(C) The extent to which the benefit or service reduces premature
death and the economic loss associated with disease.

(2) Medical impacts, including, but not limited to, all of the
following:

(A) The extent to which the benefit or service is generally
recognized by the medical community as being effective in the
screening, diagnosis, or treatment of a condition or disease, as
demonstrated by a review of scientific and peer reviewed medical
literature.

(B) The extent to which the benefit or service is generally
available and utilized by treating physicians.

(C) The contribution of the benefit or service to the health status
of the population, including the results of any research
demonstrating the efficacy of the benefit or service compared to
alternatives, including not providing the benefit or service.

(D) The extent to which mandating or repealing the benefits or
services would not diminish or eliminate access to currently
available health care benefits or services.

(3) Financial impacts, including, but not limited to, all of the
following:

(A) The extent to which the coverage or repeal of coverage will
increase or decrease the benefit or cost of the benefit or service.

(B) The extent to which the coverage or repeal of coverage will
increase the utilization of the benefit or service, or will be a
substitute for, or affect the cost of, alternative benefits or services.

(C) The extent to which the coverage or repeal of coverage will
increase or decrease the administrative expenses of health care
service plans and health insurers and the premium and expenses
of subscribers, enrollees, and policyholders.

(D) The impact of this coverage or repeal of coverage on the
total cost of health care.

(E) The potential cost or savings to the private sector, including
the impact on small employers as defined in paragraph (1) of
subdivision (l) of Section 1357, the Public Employees’ Retirement
System, other retirement systems funded by the state or by a local
government, individuals purchasing individual health insurance,
and publicly funded state health insurance programs, including
the Medi-Cal program and the Healthy Families Program.

(F) The extent to which costs resulting from lack of coverage
or repeal of coverage are or would be shifted to other payers,
including both public and private entities.

(G) The extent to which mandating or repealing the proposed
benefit or service would not diminish or eliminate access to
currently available health care benefits or services.

(H) The extent to which the benefit or service is generally
utilized by a significant portion of the population.

(I) The extent to which health care coverage for the benefit or
service is already generally available.

(J) The level of public demand for health care coverage for the
benefit or service, including the level of interest of collective
bargaining agents in negotiating privately for inclusion of this
coverage in group contracts, and the extent to which the mandated
benefit or service is covered by self-funded employer groups.

(K) In assessing and preparing a written analysis of the financial
impact of legislation proposing to mandate a benefit or service and
legislation proposing to repeal a mandated benefit or service
pursuant to this paragraph, the Legislature requests the University
of California to use a certified actuary or other person with relevant
knowledge and expertise to determine the financial impact.

(4) The impact on essential health benefits, as defined in Section
1367.005 and Section 10112.27 of the Insurance Code, and the
impact on California Health Benefit Exchange.

(b) The Legislature requests that the University of California
provide every analysis to the appropriate policy and fiscal
committees of the Legislature not later than 60 days after receiving
a request made pursuant to Section 127661. In addition, the
Legislature requests that the university post every analysis on the
Internet and make every analysis available to the public upon
request.

(c) As used in this section, “legislation proposing to mandate a
benefit or service” means a proposed statute that requires a health
care service plan or a health insurer, or both, to do any of the
following:

(1) Permit a person insured or covered under the policy or
contract to obtain health care treatment or services from a particular
type of health care provider.

(2) Offer or provide coverage for the screening, diagnosis, or
treatment of a particular disease or condition.

(3) Offer or provide coverage of a particular type of health care
treatment or service, or of medical equipment, medical supplies,
or drugs used in connection with a health care treatment or service.

(d) As used in this section, “legislation proposing to repeal a
mandated benefit or service” means a proposed statute that, if
enacted, would become operative on or after January 1, 2008, and
would repeal an existing requirement that a health care service
plan or a health insurer, or both, do any of the following:

(1) Permit a person insured or covered under the policy or
contract to obtain health care treatment or services from a particular
type of health care provider.

(2) Offer or provide coverage for the screening, diagnosis, or
treatment of a particular disease or condition.

(3) Offer or provide coverage of a particular type of health care
treatment or service, or of medical equipment, medical supplies,
or drugs used in connection with a health care treatment or service.

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