BILL ANALYSIS Ó
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UNFINISHED BUSINESS
Bill No: SB 857
Author: Senate Budget and Fiscal Review Committee
Amended: 6/12/14
Vote: 21
PRIOR VOTES NOT RELEVANT
ASSEMBLY FLOOR : Not available
SUBJECT : Budget Act of 2014: Health
SOURCE : Author
DIGEST : This is the Omnibus Health Trailer Bill for 2014-15.
It contains necessary changes related to the Budget Act of 2014.
Assembly Amendments delete the Senate version of this bill,
which expressed legislative intent to enact statutory changes
relating to the Budget Act, and instead add the current
language.
ANALYSIS : This bill makes the following statutory changes to
implement the 2014-15 Budget:
1.Medi-Cal: Pregnancy . This bill provides full-scope Medi-Cal
coverage to pregnant women with incomes at or below 138% of
the federal poverty level (FPL) and creates an affordability
and benefit program for pregnant women with incomes above 138%
and up to 208% of the FPL who enroll in a Qualified Health
Plan (QHP) through Covered California. This bill requires the
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Department of Health Care Services (DHCS) to cover the
out-of-pocket expenditures of the women enrolled in a QHP
through Covered California. These out-of-pocket expenditures
include the premium amounts owed after premium tax credits
have been applied, applicable cost-sharing, copayments, or any
other covered costs that are required during their pregnancy
and postpartum coverage. The woman shall receive all of her
covered benefits via her QHP and may access additional
medically necessary pregnancy-related Medi-Cal services
outside of the QHP, under Medi-Cal fee-for-service (referred
to as Pregnancy Benefit Wrap) to the extent they are not
otherwise provided by the QHP. The affordability and benefit
program shall be made available January 1, 2015, or when DHCS
determines that the California Healthcare Eligibility,
Enrollment and Retention System is operational to effectuate
this policy. This bill also requires DHCS to consult with
stakeholders on the processes and procedures to inform
affected applicants and beneficiaries of their enrollment
options under the Medi-Cal program and Covered California and
the manner in which they may receive benefits and services.
This bill also requires DHCS to monitor birth outcomes of
women who are receiving full-scope and limited-scope Medi-Cal
and women who are receiving services through the QHP with
Medi-Cal as the benefit wrap.
2.Medi-Cal: Cal MediConnect (CMC) and Medicare Advantage and
Dual Eligible Special Needs (D-SNP) Plans . This bill
authorizes: (a) DHCS to offer Medicare Improvements for
Patients and Providers Act of 2008 to D-SNPs for 2015 and the
duration of Cal MediConnect, with certain limitations, (b)
gives DHCS the authority to place an enrollment cap on Fully
Integrated Dual-Eligible SNPs operating in Los Angeles,
Riverside, and San Bernardino Counties, and (c) allows
beneficiaries who are enrolled in an Alternative Health Care
Service Plan (AHCSP), who age into Medicare while enrolled in
the AHCSP, to elect to enroll in the AHCSP's D-SNP. The AHCSP
would be required, upon mutual agreement between the CMC plan
operated by a health authority or commission, to take full
financial and programmatic responsibility for the Long-Term
Supports and Services, and services of the D-SNP enrollee.
Lastly, this bill requires DHCS to take into account certain
considerations when assigning Medi-Cal managed care
beneficiaries to a Medi-Cal managed care health plan
subcontracting with an AHCSP.
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3.Medi-Cal: County Eligibility Administration Cost-of-Living
Adjustment (COLA) . This bill suspends the COLA for county
eligibility administration for 2014-15.
4.Medi-Cal: Denti-Cal Metrics and Monitoring . This bill
requires DHCS to monitor dental fee-for-service utilization in
the Denti-Cal program using identified program metrics and to
post this information on DHCS' Internet Web site at least on
an annual basis.
5.Medi-Cal: the California Medicaid Management Information
System (CA-MMIS) Contract Modifications . This bill exempts
contract amendments, modifications, and change orders for
CA-MMIS Fiscal Intermediary contract from Public Code
requirements.
6.Medi-Cal: Provider Preventable Conditions . This bill makes
statutory changes to comply with federal rules that require
states to report provider preventable conditions (PPCs) and
prohibit Medicaid (Medi-Cal) payment for costs of services
related to PPCs. Specifically, this bill 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. Additionally, this bill requires
providers to report PPCs to DHCS as specified by DHCS and
prohibits the Medi-Cal enrollee from being billed for these
procedures.
7.Medi-Cal: Fingerprinting and Background Checks . This bill
provides DHCS with the 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. This bill
also clarifies that applicants and providers are responsible
for reimbursing DOJ for the costs to complete the expanded
background checks and fingerprinting, and that In-Home
Supportive Services providers will follow the current
fingerprinting and background check process required in
Welfare and Institutions Code Section 15660.
8.Eliminate Managed Risk Medical Insurance Board (MRMIB) - This
bill eliminates MRMIB and transfers its programs, the Major
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Risk Medical Insurance Program (MRMIP), the Access for Infants
and Mothers (AIM) program, and the County Children's Health
Initiative Matching (CHIM) Fund Program, to DHCS. This bill
proposes no changes to these programs, other than their
transfer to DHCS. This bill also (a) renames the AIM program
to the Medi-Cal Access Program, (b) transitions the
responsibility 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, (c) deletes reference to adults
from the CHIM Program provisions as the program was never
expanded to cover parents, and (d) changes the allocation of
Cigarette and Tobacco Products Surtax Fund (Proposition 99) to
MRMIP to be contingent on what is included in the Budget Act.
9.Future of MRMIP . This bill requires DHCS to convene a
stakeholder workgroup by August 1, 2014, composed of
stakeholders, including health care providers, county
representatives, labor, consumer advocates, immigrant policy
advocates, and employers of low-wage workers to develop a plan
to utilize available Major Risk Medical Insurance Funds,
including Managed Care Administrative Fines Penalties Funds,
and the Cigarette and Tobacco Products Surtax Fund to continue
to provide health coverage to individuals that are not
eligible for other full-scope programs or subsidies.
10.Notification to Enrollees in State Health Programs . This
bill requires DHCS by August 1, 2014, to work with
stakeholders to develop a notification to be sent to enrollees
in the state-only and non-comprehensive health programs to
inform them that they may qualify for comprehensive coverage
through Covered California or Medi-Cal. Requires this
notification to be sent annually prior to the open enrollment
period for Covered California.
11.Substance Use Disorder Residential and Outpatient License Fee
Increase . This bill allows DHCS to increase licensure,
application, and certification fees for non-medical
residential and outpatient alcohol and other drug
detoxification, treatment, or recovery services facilities
upon approval of the Legislature through a provider bulletin.
12.California Institute for Mental Health (CiMH) and Substance
Use Disorder Services . This bill expands CiMH's
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responsibilities to include the ability to provide technical
assistance and training on substance use disorder services
given its merger with the Alcohol and Drug Policy Institute on
July 1, 2014.
13.Martin Luther King (MLK) Jr. Community Hospital . This bill
ensures that the new MLK, Jr. Community Hospital receives at a
minimum the financing committed to it in 2010 in a manner that
continues to guarantee a cap on the state's contribution.
14.Cross Match of ADAP Data with Franchise Tax Board (FTB) .
This bill provides the FTB with authority to share state tax
data with the Office of AIDS at the Department of Public
Health (DPH) for verifying applicant/client income eligibility
for the federally funded Ryan White HIV/AIDS Program AIDS Drug
Assistance Program (ADAP).
15.California Reducing Disparities Project (CRDP) . This bill
provides DPH with a statutory exemption from the Public
Contract Code for CRDP that would allow DPH to complete the
Strategic Plan (Phase I) and commence Phase II of the CRDP, a
$60 million (Mental Health Services Act Funds) endeavor to
implement and evaluate community-defined mental health
practices.
16.Federal Fund Authority. This bill clarifies DPH's authority
to apply for federal grants within the purview of public
health.
17.Office of AIDS-Health Insurance Premium Assistance Payment
Program (OA-HIPP) Medical Cost Sharing Wrap . This bill
provides the authority to develop the capacity to pay
out-of-pocket medical expenses, in addition to premiums for
eligible OA-HIPP clients, for clients who choose to purchase
insurance through Covered California. This would encourage
more ADAP clients to enroll in comprehensive coverage and
would result in a reduction in ADAP costs of $9.9 million in
2014-15.
18.Licensing and Certification (L&C ). This bill requires DPH,
beginning October 2014 and on a quarterly basis, to report
metrics on (a) investigations of complaints related to
paraprofessionals certified by DPH, (b) long-term care health
facility complaints, investigations, state relicensing, and
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federal recertification surveys, and (c) vacancy rates and
hiring within L&C. This bill requires DPH by October 2016, to
report the previously specified information for all facility
types.
This bill also requires DPH to report by October 2014, on the
status of the $1.4 million appropriated in fiscal year 2014-15
from the Internal Departmental Quality Improvement Account for
the "Licensing and Certification Program Evaluation," and the
outcomes from this effort, DPH's efforts to evaluate and
reform the L&C timekeeping systems and estimate methodology,
and an update on the Los Angeles County contract and Licensing
and Certification's oversight of this contract.
This bill requires DPH by December 1, 2014, to assess the
possibilities of using professional position classifications
other than Health Facility Evaluator Nurses to perform
licensing and certification survey or complaint workload.
This bill requires DPH beginning August 2014, to hold
semiannual meetings for all interested stakeholders to provide
feedback on improving the L&C program to ensure that
Californians receive the highest quality of medical care in
health facilities. Once they are available, DHCS will present
the quarterly workload and performance metrics at these
meetings.
19.Supplemental Nutrition and Education Assistance Program
(SNAP)-Ed Stakeholder Workgroup. This bill requires DPH to
convene a quarterly meeting of stakeholders, between July 1,
2014, and October 31, 2015, to solicit input and receive
feedback on nutrition education and obesity prevention
programs and to help minimize any disruption of services in
the SNAP during the transition of work from contracted vendors
to civil service.
20.Tuberculosis Control Mandate. This bill specifies that funds
allocated as part of DPH's tuberculosis control subvention
grant to local jurisdictions shall be used to support certain
tuberculosis control activities.
21.Federal Mental Health Parity. This bill provides DMHC with
the authority to enforce federal mental health parity rules
and conforms to federal rules to impose these requirements on
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large group products.
22.Office of Patient Advocate (OPA). This bill revises the
responsibilities of the OPA to (a) clarify that OPA is not the
primary source of direct assistance to consumers, (b) clarify
OPA's responsibilities 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, (c) require OPA to make recommendations for the
standardization of reporting on complaints, grievances,
questions, and requests for assistance, and (d) requires 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.
23.Song-Program Residency Program. This bill expands the
eligibility for Song-Brown residency program funding to
teaching health centers and increases the number of primary
care residents specializing in internal medicine, pediatrics,
and obstetrics and gynecology.
24.Medical Privacy Breach Enforcement. This bill combines the
authority of two existing programs (at the California Health
and Human Services Agency and DPH) charged with enforcing
medical privacy violations. To do this, the authority of the
California Health and Human Services Agency's California
Office of Health Information Integrity over medical privacy
breaches by individuals is combined with DPH's authority over
medical privacy breaches at health facilities.
25.Covered California Emergency Regulation Authority. This bill
allows emergency regulations adopted by Covered California to
be readopted for one more year (no further readoptions would
be allowed after January 1, 2017).
FISCAL EFFECT : Appropriation: Yes Fiscal Com.: Yes
Local: Yes
JL:e 6/15/14 Senate Floor Analyses
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SUPPORT/OPPOSITION: NONE RECEIVED
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