BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  SB 857
                                                                  Page  1


          (  Without Reference to File  )

          SENATE THIRD READING
          SB 857 (Budget and Fiscal Review Committee)
          As Amended  June 12, 2014
          Majority vote.  Budget Bill Appropriation Takes Effect  
          Immediately

           SENATE VOTE  :Vote not relevant  
           
           SUMMARY  :  This is one of two Omnibus Health Trailer Bills for  
          2014-15.  This bill contains necessary changes related to the  
          Budget Act of 2014.  This bill makes various statutory changes  
          to implement the 2014-15 budget.  Specifically,  this bill  :

          1)Provides full scope Medi-Cal for pregnant women with incomes  
            up to 138% of the federal poverty level (FPL).  Establishes a  
            "wrap program" for women between 139% and 213% FPL which  
            allows them to opt to have both Covered California coverage  
            and Medi-Cal as a wrap to pay their premiums and co-pays and  
            to cover services not covered by their Covered California  
            plan.  Requires a stakeholder process to develop the informing  
            materials to help women understand their options and to ensure  
            access to Comprehensive Perinatal Services Program services.   
            Prohibits plans from billing the consumer directly, and if  
            they do, requires the consumer to be reimbursed by Medi-Cal.   
            Authorizes women in the wrap to go out-of-network, if  
            necessary, for Certified Nurse Midwives, Freestanding Birth  
            Centers, and family planning.

          2)Institutes various requirements regarding contracts and  
            enrollment limitations on Medicare Advantage plans in the  
            context of the Coordinated Care Initiative (CCI).   
            Specifically, requires, for the 2015 calendar year and the  
            remainder of the CCI, in CCI counties, the Department of  
            Health Care Services (DHCS) to offer Dual Special Needs Plan  
            (D-SNP) contracts to D-SNP plans that were approved for the  
            D-SNP plan's service areas as of January 1, 2013.  Requires  
            DHCS to enter into D-SNP contracts with D-SNP plans only for  
            excluded beneficiaries.  Requires, in non-CCI counties, DHCS  
            to offer D-SNP contracts to D-SNP plans.  Authorizes D-SNP  
            contracts to include various requirements on D-SNP plans.   
            Exempts beneficiaries in Fully-Integrated Dual Eligible  
            Special Needs Plan and Medicare Advantage plans, other than  








                                                                  SB 857
                                                                  Page  2


            D-SNPs, from these enrollment provisions.
           
          3)Provides statutory authority to comply with federal rules that  
            require states to report Provider Preventable Conditions  
            (PPCs) and prohibits Medi-Cal payment for costs of services  
            related to PPCs.  Authorizes DHCS to exclude from Medi-Cal  
            coverage certain increases in charges billed to the Medi-Cal  
            program that are directly related to the treatment of PPCs,  
            and to recoup any payments made for those excluded charges.   
            Requires providers to report PPCs to DHCS.

          4)Provides DHCS statutory authority to receive the results of  
            criminal background checks of applicants and providers from  
            the Department of Justice (DOJ) in order to screen or enroll  
            the Medi-Cal provider applicants and providers.  Provides DOJ  
            with legal authority to charge the providers for the  
            fingerprinting and background checks.  

          5)Exempts from Public Contract Code requirements, amendments,  
            and change orders to the Fiscal Intermediary contract.
          6)Authorizes DHCS to increase fees charged for licensure and  
            certification of all residential alcohol and other drug (AOD)  
            recovery and treatment facilities and of all outpatient AOD  
            programs.  Requires DHCS to publish the current fee structure  
            on DHCS's Web site.  Requires DHCS to notify and consult with  
            stakeholders regarding new fees or fee changes.

          7)Eliminates the Managed Risk Medical Insurance Board (MRMIB)  
            and transfers the Major Risk Medical Insurance Program, the  
            Access for Infants and Mothers (AIM) program, and the County  
            Children's Health Initiative Matching Fund Program to DHCS.   
            Renames the AIM-linked infants program to the "Medi-Cal Access  
            Program."  Transitions the responsibilities for the close-out  
            activities, related to the Healthy Families Program transition  
            to Medi-Cal and the Pre-Existing Conditions Insurance Program  
            transition to the federal government, to DHCS.  Transitions 27  
            positions at MRMIB to DHCS and Covered California.

          8)Requires DHCS to establish a list of performance measures to  
            ensure the dental fee-for-service program meets quality and  
            access criteria required by DHCS.  Requires that the measures  
            evaluate utilization, access, availability, and effectiveness  
            of preventive care and treatment.  Requires DHCS to post the  
            performance measures, dental care data, and a summary of  








                                                                  SB 857
                                                                  Page  3


            complaints on the DHCS Web site.

          9)Requires DHCS to provide information on opportunities for  
            comprehensive coverage to enrollees of state-only programs.

          10)Establishes a stakeholder workgroup to explore the use of  
            Proposition 99 (1998) funds for on-going coverage for  
            remaining uninsured populations.

          11)Requires that the Martin Luther King Jr. Community Hospital  
            continue to receive each fiscal year, the base payment amounts  
            equal to 100% of its projected Medi-Cal costs; eliminates  
            references to the prior California Medical Assistance  
            Commission, contracting and non-contracting methodologies;  
            requires the two Medi-Cal Managed Care Plans in Los Angeles  
            County serving Medi-Cal beneficiaries to pay the hospital the  
            same amount for enrollees in managed care as the hospital  
            would have received for those in fee-for-service, and ensures  
            the Medi-Cal capitation rates paid to the plans reflect that  
            obligation; maximizes federal funding; allows the hospital to  
            receive supplemental payments from Los Angeles County in order  
            to reach 100% of its projected Medi-Cal costs; maintains the  
            hospital's eligibility for disproportionate share hospital  
            (DSH) status and payments for which it may be entitled to  
            receive, pursuant to federal law; makes the hospital  
            in-eligible to receive DSH replacement payments; and provides  
            that the new hospital's projected Medi-Cal costs shall be  
            determined prospectively prior to the start of each fiscal  
            year, using the best available and reasonable current  
            estimates or projections.

          12)Suspends the annual cost of living adjustment for counties  
            for the administration of Medi-Cal eligibility work for  
            2014-15.

          13)Requires the integration of substance use disorder services  
            into local behavioral health and mental health activities.

          14)Expands the scope of the Song Brown program beyond family  
            practice to provide financial support to primary care  
            specialties, including family medicine, internal medicine,  
            obstetrics and gynecology, and pediatrics.  Authorizes the  
            program to contract with teaching health centers.









                                                                  SB 857
                                                                  Page  4


          15)Implements the federal mental health parity law by requiring  
            an individual, small group and large group health care service  
            plan contract to be in compliance with the federal law by  
            January 1, 2015.  Authorizes the director of the Department of  
            Managed Health Care (DMHC) to issue guidance to health care  
            service plans until January 1, 2016.

          16)Revises the responsibilities of the Office of Patient  
            Advocate (OPA) to clarify that it is not the primary source of  
            direct assistance to consumers; requires the OPA to track,  
            analyze, and produce reports with data collected from calls,  
            on problems and complaints by, and questions from, consumers  
            about health care coverage received by health consumer call  
            centers and helplines operated by other departments,  
            regulators or governmental entities; requires OPA to make  
            recommendations for the standardization of reporting on  
            complaints, grievances, questions and requests for assistance;  
            requires the OPA to develop model protocols, in consultation  
            with each call center, consumer advocates and other  
            stakeholders that may be used by call centers for responding  
            to and referring calls that are outside the jurisdiction of  
            the call center or regulator; and shifts funding to DMHC to  
            supplement contracts with community-based organizations to  
            provide direct consumer assistance. 

          17)Authorizes the transfer of functions, including three  
            investigator positions and $251,000, from the California  
            Office of Health Information Integrity, within the California  
            Health & Human Services Agency, to the Department of Public  
            Health (DPH) Licensing and Certification.  Authorizes DPH to  
            conduct joint investigations of individuals and health  
            facilities for violations of this statute.

          18)Authorizes the California Franchise Tax Board to share tax  
            data with the Office of AIDS (OA) for purposes of verifying  
            income eligibility for OA programs.

          19)Exempts from the Public Contract Code the California Reducing  
            Disparities Project.

          20)Authorizes the OA to pay out-of-pocket medical expenses, in  
            addition to premiums, for eligible OA Health Insurance Premium  
            Payment clients who choose to purchase insurance through  
            Covered California.








                                                                  SB 857
                                                                  Page  5



          21)Requires DPH to convene stakeholders to solicit input on  
            nutrition education and obesity prevention programs, as well  
            as on the transition from contracted to state civil service  
            staff for the operation of the Supplemental Nutrition  
            Assistance Program Education program.

          22)Requires DPH to report on a quarterly basis to the  
            Legislature and post on its Web site all workload and  
            performance metrics and specified information on aspects of  
            Licensing and Certification.  Requires DPH to hold semiannual  
            stakeholder meetings to improve the Licensing and  
            Certification Program.

          23)Authorizes DPH to investigate, apply for, and enter into  
            agreements to secure federal or non-governmental funding  
            opportunities to advance public health.

          24)Requires that a local entity that receives state funding for  
            tuberculosis control shall first allocate the moneys for  
            specified tuberculosis control activities.  Authorizes a local  
            health department that receives such funding to use the funds  
            to reimburse for the actual costs of carrying out the  
            tuberculosis control activities described in this section of  
            law.

          25)Authorizes the Health Benefits Exchange to operate under the  
            authority of emergency regulations for up to two years after  
            the initial adoption of the emergency regulation.

          26)Reappropriates Mental Health Services Fund moneys to the  
            Mental Health Services Oversight and Accountability Commission  
            until June 30, 2015.

           COMMENT  :  This bill is a budget trailer bill within the overall  
          2014-15 budget package to implement actions taken affecting  
          DHCS, DMHC, DPH, the MRMIB, the Mental Health Services Oversight  
          & Accountability Commission, and the Office of Statewide Health  
          Planning and Development.


           Analysis Prepared by  :    Andrea Margolis / BUDGET / (916)  
          319-2099









                                                                  SB 857
                                                                  Page  6



                                                                FN: 0003955