BILL NUMBER: SB 18 AMENDED BILL TEXT AMENDED IN ASSEMBLY JUNE 18, 2014 AMENDED IN SENATE APRIL 17, 2013 INTRODUCED BYSenatorHernandezSenators Hernandez and Leno(Principal coauthor:SenatorMonning)DECEMBER 3, 2012 An actto amend Section 127660 of the Health and Safety Code,relating tohealth careMedi-Cal, and making an appropriation therefor . LEGISLATIVE COUNSEL'S DIGEST SB 18, as amended, Hernandez.California Health Benefits Review Program: health insurance.Medi-Cal renewal. 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 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. 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.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.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.Vote: majority. Appropriation:noyes . Fiscal committee:noyes . State-mandated local program: no. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. (a) (1) 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. These contributions shall be deposited in the Healthcare Outreach and Medi-Ca l Enrollment Account that has been created in the Special Deposit Fund within the State Treasury for the purposes specified in this section. (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. (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. (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. (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. (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. (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. (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. (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. (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. (f) The department shall require progress reports, in a manner as determined by the department, from those receiving allocations under this section. (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. (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. (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. (j) This section shall cease to be implemented when all of the private contributions and any federal matching funds have been exhausted.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.