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