BILL NUMBER: SB 1341	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 7, 2014

INTRODUCED BY   Senator Mitchell

                        FEBRUARY 21, 2014

   An act to amend Section 10823 of the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 1341, as amended, Mitchell. Medi-Cal: Statewide Automated
Welfare System.
    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 requires the
Office of Systems Integration in the State Department of Social
Services to implement a statewide automated welfare system for 6
specified public assistance programs, including Medi-Cal.
   This bill would require the Statewide Automated Welfare System to
be the system of record for Medi-Cal and to contain all Medi-Cal
eligibility rules and case management functionality. The bill would,
notwithstanding this provision, authorize the California Healthcare
Eligibility, Enrollment, and Retention System (CalHEERS) to house the
business rules necessary for an eligibility determination to be
made, as specified, pursuant to the federal Patient Protection and
Affordable Care Act. The bill  would   would, if
the department exercises that authority,  require CalHEERS to
make the business rules available to the Statewide Automated Welfare
System consortia to determine Medi-Cal eligibility. The bill would
 require the Statewide Automated Welfare System to house the
functionality to create and send Notices of Action for the Medi-Cal
program, as specified, no later than January 1, 2016.  
specify,   effective January 1, 2016, the manner in which
the functionality to create and send notices of action for the
Medi-Cal and premium tax credit programs would be implemented,
including a requirement that the Statewide Automated Welfare System
be used to generate noticing language and notice of action documents.

   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 10823 of the Welfare and Institutions Code, as
amended by Section 9 of Chapter 13 of the First Extraordinary Session
of the Statutes of 2011, is amended to read:
   10823.  (a) (1) The Office of Systems Integration shall implement
a statewide automated welfare system for the following public
assistance programs:
   (A) The CalWORKs program.
   (B) CalFresh.
   (C) The Medi-Cal program.
   (D) The foster care program.
   (E) The refugee program.
   (F) County medical services programs.
   (2) Statewide implementation of the statewide automated welfare
system for the programs listed in paragraph (1) shall be achieved
through no more than four county consortia, including the Interim
Statewide Automated Welfare System Consortium, and the Los Angeles
Eligibility, Automated Determination, Evaluation, and Reporting
System.
   (3) Notwithstanding paragraph (2), the Office of Systems
Integration shall migrate the 35 counties that currently use the
Interim Statewide Automated Welfare System (SAWS) into the C-IV
system within the following timeline:
   (A) Complete Migration System Test and begin User Acceptance
Testing on or before June 30, 2009.
   (B) Complete implementation in at least five counties by February
28, 2010.
   (C) Complete implementation in at least 14 additional counties on
or before May 31, 2010.
   (D) Complete implementation in all 35 counties on or before August
31, 2010.
   (E) Decommission the Interim Statewide Automated Welfare System on
or before January 31, 2011.
   (4) Notwithstanding paragraph (2), the Office of Systems
Integration shall oversee the migration of the 39 counties composing
the C-IV Consortium into a system jointly designed by the 39 counties
plus Los Angeles County under the LEADER Replacement System
contract. This migration shall result in a new consortium to replace
the LEADER and C-IV Consortia.
   (5) The consortia and the state shall take any action necessary to
ensure that the current SAWS maintenance and operations agreements
are extended for the LEADER and C-IV Consortia, pending the
completion of the LEADER Replacement System and migration of the C-IV
Consortium as set forth in paragraph (4), and for the continuation
of the Welfare Client Data System Consortium.
   (6) Each SAWS consortium shall provide a seat on its governing
body for a representative of the state and shall allow for the
stationing of state staff at the project site.
   (b) Nothing in subdivision (a) transfers program policy
responsibilities related to the public assistance programs specified
in subdivision (a) from the State Department of Social Services or
the State Department of Health Care Services to the Office of Systems
Integration.
   (c) (1) On February 1 of each year, the Office of Systems
Integration shall provide an annual report to the appropriate
committees of the Legislature on the statewide automated welfare
system implemented under this section. The report shall address the
progress of state and consortia activities and any significant
schedule, budget, or functionality changes in the project.
   (2) The report provided pursuant to this subdivision in 2012 shall
also include the projected timeline and key milestones for the
development of the LEADER Replacement System and of the new
consortium described in paragraph (4) of subdivision (a).
   (d) Notwithstanding any other law, the Statewide Automated Welfare
System consortia shall have the authority to expend within approved
annual state budgets for each system as follows:
   (1) Make changes within any line item, provided that the change
does not create additional project costs in the current or in a
future budget year.
   (2) Make a change of up to one hundred thousand dollars ($100,000)
or 10 percent of the total for the line item from which the funds
are derived, whichever is greater, between line items with notice to
the Office of Systems Integration, provided that the change does not
create additional project costs in the current or in a future budget
year.
   (3) Make requests to the Office of Systems Integration for changes
between line items of greater than one hundred thousand dollars
($100,000) or 10 percent of the total for the line item from which
the funds are derived, which do not increase the total cost in the
current or a future budget year. The Office of Systems Integration
shall take action to approve or deny the request within 10 days.
   (e) (1) The Statewide Automated Welfare System shall be the system
of record for Medi-Cal and shall contain all Medi-Cal eligibility
rules and case management functionality.
   (2) Notwithstanding paragraph (1), the business rules necessary
for an eligibility determination to be made under the Modified
Adjusted Gross Income (MAGI) rules pursuant to the federal Patient
Protection and Affordable Care Act (Public Law 111-148) may be housed
in the California Healthcare Eligibility, Enrollment, and Retention
System developed pursuant to Section 15926, hereafter referred to as
CalHEERS.  The   If the department exercises
that authority, the business rules  contained in CalHEERS
 shall be made available  as a service  to the
Statewide Automated Welfare System  consortia  
consortia, through an automated interface,  in order for the
consortia to determine eligibility for Medi-Cal  under the MAGI
rules  . 
   (3) The functionality to create and send Notices of Action for the
Medi-Cal program, including notices related to MAGI-based
eligibility, shall be housed within the Statewide Automated Welfare
System. This paragraph shall be implemented no later than January 1,
2016.  
   (3) Effective January 1, 2016, the functionality to create and
send notices of action for Medi-Cal and premium tax credit programs,
as described in Section 36B of Title 26 of the United States Code,
shall be implemented consistent with the following:  
   (A) Except as specified in subparagraphs (B) and (C), the
Statewide Automated Welfare System shall be used to generate noticing
language and notice of action documents and to send notice of action
documents for all Medi-Cal programs, including, but not limited to,
MAGI and Non-MAGI based programs.  
   (B) If the department exercises its authority pursuant to
paragraph (2), CalHEERS shall be used to generate noticing language
for the premium tax credit program, including, but not limited to,
Medi-Cal denial noticing language related to tax subsidy approvals,
and shall be used to generate and send notice of action documents for
the premium tax credit only program.  
   (C) If the department exercises its authority pursuant to
paragraph (2), in any mixed eligibility cases that include an
approval or approvals for MAGI Medi-Cal eligibility determinations,
non-MAGI Medi-Cal eligibility determinations, or both, and premium
tax credit approvals, the Statewide Automated Welfare System shall be
used to combine the noticing language for Medi-Cal programs
generated by the Statewide Automated Welfare System and the noticing
language for the premium tax credit program generated by CalHEERS
into one notice, and the Statewide Automated Welfare System shall be
used to send the document, as one combined notice, for all programs.