BILL ANALYSIS Ó
SENATE COMMITTEE ON BUDGET AND FISCAL REVIEW
Senator Mark Leno, Chair
2015 - 2016 Regular
Bill No: AB 94 Hearing Date: June 18,
2015
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|Author: |Committee on Budget |
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|Version: |January 7, 2015 > |
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|Urgency: |Yes |Fiscal: |Yes |
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|Consultant|Michelle Baass |
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Subject: Budget Act of 2015
Summary: This bill is the omnibus health trailer bill for 2015-16. It
contains necessary changes related to the Budget Act of 2015.
Proposed
Law: This bill makes the following statutory changes to
implement the 2015-16 budget:
1.Medi-Cal: Coverage for Undocumented Children. This bill would
provide Medi-Cal coverage to children who are otherwise
eligible for Medi-Cal except for their immigration status,
effective no sooner than May 1, 2016.
2.Medi-Cal: Elimination of Dental Provider Payment Reductions.
This bill would eliminate the ten percent Medi-Cal payment
reductions pursuant to AB 97 (Committee on Budget), Chapter 3,
Statutes of 2011, for dental providers effective July 1, 2015.
3.Hepatitis C Linkage to and Retention in Care Projects. This
bill establishes hepatitis C linkage to care demonstration
pilot projects for three years to allow for innovative,
evidence-based approaches to provide outreach, hepatitis C
screenings, and linkage to, and retention in, quality health
care for the most vulnerable and underserved individuals
living with or at risk for hepatitis C viral infection.
4.Syringe Exchange Program. This bill authorizes the Department
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of Public of Health to purchase sterile hypodermic needles and
syringes, and other materials, for distribution to syringe
exchange programs.
5.Pre-Exposure Prophylaxis (PrEP) Access and Outreach. This bill
establishes a PrEP navigator program to develop protocols to
conduct outreach to targeted populations, to provide PrEP
education to clients and to assess and refer to appropriate
clinical care and prevention services.
6.Robert F. Kennedy Health Plan. This bill requires the
Department of Health Care Services (DHCS) to allocate $2.5
million Major Risk Medical Insurance Fund on a one-time basis
to the Robert F. Kennedy Health Plan for purposes of
purchasing stop loss insurance.
7.LifeLong Community Clinic. This bill requires DHCS to allocate
$2 million Major Risk Medical Insurance Fund on a one-time
basis to the LifeLong Medical Care clinic in Contra Costa
County.
8.Licensing and Certification Long-Term Care Facility Complaint
Investigation Timelines. This bill specifies that the
Department of Public Health is required to:
a. For complaints that involve a threat of imminent danger
or death or serious bodily harm that are received on or
after July 1, 2016, the department shall complete the
investigation within 90 days of receipt. This time period
may be extend up to an additional 60 days if the
investigation cannot be completed due to extenuating
circumstances. If there is an extension, the department
shall notify the facility and the complainant in writing of
this extension and the extenuating circumstances and
document the extenuating circumstances in its final
determination. Any citation issued as a result of the
complaint investigation shall be issued and served within
thirty days of the completion of the complaint
investigation.
b. For all other categories of complaints received on or
after July 1, 2017, the department shall complete the
investigation within 90 days of receipt. This time period
may be extend up to an additional 90 days if the
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investigation cannot be completed due to extenuating
circumstances. If there is an extension, the department
shall notify the facility and the complainant in writing of
this extension and the extenuating circumstances and
document the extenuating circumstances in its final
determination. Any citation issued as a result of the
complaint investigation shall be issued and served within
thirty days of the completion of the complaint
investigation.
c. For all complaints received on or after July 1, 2018,
the department shall complete the investigation within 60
days of receipt. This time period may be extend up to an
additional 60 days if the investigation cannot be completed
due to extenuating circumstances. If there is an extension,
the department shall notify the facility and the
complainant in writing of this extension and the
extenuating circumstances and document the extenuating
circumstances in its final determination. Any citation
issued as a result of the complaint investigation shall be
issued and served within thirty days of the completion of
the complaint investigation.
d. Report on an annual basis (in the Licensing and
Certification Fee report) data on the department's
compliance these new timelines.
e. Beginning with the 2018-19 Licensing and Certification
November Program budget estimate, the department shall
evaluate the feasibility of reducing investigation
timelines based on experience implementing the timeframes
described above.
f. States the intent of the Legislature that the department
continues to seek to reduce long-term care complaint
investigation timelines to less than 60 days with a goal of
meeting a 45-day timeline.
1.Hospital Complaint Investigation Notification. This bill
requires the Department of Public Health to notify the
hospital and complainant if any, if an investigation regarding
hospital complaints is not completed in the required
timeframe. This notification shall document the extenuating
circumstances as to why the investigation has not been
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completed and the anticipated completion date.
2.Coordinated Care Initiative: Multipurpose Senior Services
Program (MSSP) Transition Timeline. This bill extends the date
in which MSSP transitions from a federal waiver to a managed
care benefit in the CCI counties. This bill extends the date
to December 31, 2017, but would allow an earlier transition in
a county or region when the MSSP site and managed care plan
mutually agree they are ready to transition, want to
transition early, and have demonstrated that they have met
readiness criteria. Existing law states that MSSP would
transition after 19 months of MSSP beneficiary enrollment into
managed care. This bill also specifies that if CCI is
terminated, MSSP would revert to a waiver benefit.
3.CalHEERS Electronic MAGI Determination. This bill removes the
sunset provision to allow for continued electronic
verification of Medi-Cal eligibility information.
4.Medi-Cal: Ground Emergency Medical Transportation Supplemental
Reimbursement Program. This bill modifies the existing ground
emergency medical transportation (GEMT) Supplemental
Reimbursement Program in order to maximize federal financial
participation for public GEMT provider's services, subject to
federal approval.
5.Health Home Program. This bill provides the Department of
Health Care Services with the authority to establish a Health
Home Program (HHP) Account in the Special Deposit Fund within
the State Treasury in order to collect and allocate
non-General Fund public or private grant funds, to be expended
upon appropriation by the Legislature, for the purposes of
implementing the HHP pursuant to AB 361 (Mitchell), Chapter
642, Statutes of 2013.
6.Medi-Cal: Eliminate Nonemergency Emergency Room Copay. This
bill would eliminate the statutory references implementing a
nonemergency emergency room copay in Medi-Cal, as this policy
has been removed from the Medi-Cal budget. The budget removes
the assumption that the state would implement a copayment for
nonemergency emergency room usage pursuant to AB 97 (Committee
on Budget), Chapter 3, Statutes of 2011 and AB 1467 (Committee
on Budget), Chapter 23, Statutes of 2012 which was expected to
result in about $34 million ($17 million General Fund)
savings. This copay has never been implemented as it had not
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received approval from the federal Centers for Medicare and
Medicaid.
7.Medi-Cal: County Eligibility Administration Cost-of-Living
Adjustment (COLA). This bill suspends the COLA for county
eligibility administration for 2015-16.
8.Limited Benefit and Special Populations Programs Enroller
Education. This bill requires enrolling providers who
participate in Every Woman Counts (EWC), Family Planning
Access Care and Treatment (FPACT), and IMProving Access,
Counseling, and Treatment for Californians with Prostate
Cancer (IMPACT), to provide to the enrolling individuals,
information on how to apply for insurance affordability
programs, in a manner determined by the Department of Health
Care Services (DHCS).
9.Child Health and Disability Prevention (CHDP) Program Dental
Referral. This bill requires CHDP programs and providers to
refer all Medi-Cal-eligible children participating in CHDP who
are one year of age and older to a dentist participating in
the Medi-Cal program, rather than at age three.
10.Food Safety Stipulated Judgment. This bill authorizes the
deposit into the Food Safety Fund of awards to the Department
of Public Health pursuant to court orders or settlements for
food safety-related activities.
11.Genetic Disease Screening Program (GDSP) Prenatal Screening
Program. This bill clarifies that private health insurance
plans cannot consider the GDSP Prenatal Screening Program to
be an out-of-network provider.
12.California Gambling Education and Treatment Services
(CalGETS). This bill deletes outdated verbiage related to the
CalGETS program.
13.Investment in Mental Health Wellness Grants. This bill allows
the California Health Facilities Financing Authority to use up
to $3 million in unencumbered Mental Health Wellness Grant
funds, authorized by SB 82 (Committee on Budget and Fiscal
Review), Chapter 34, Statutes of 2013, for peer respite
programs.
14.Clinical Laboratories Test Procedures. This bill authorizes
clinical laboratories to use the federally-approved equivalent
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quality control testing approach until December 31, 2015 and
individualized quality control plan commencing January 1, 2016
pursuant to the federal state operations manual adopted by the
federal Centers for Medicare and Medicaid Services.
15.Office of Systems Integration. This bill requires the Office
of Systems Integration to report to the Legislature by April
1, 2017 on the feasibility, benefits, costs, and risks of
installing the Modified Adjusted Gross Income (MAGI)
Eligibility Decision Engine in all, two, or just one of the
SAW Consortia systems.
16.Covered California Regulatory Authority. This bill extends
Covered California's current emergency regulations rulemaking
authority for an additional year until January 1, 2017;
extends Covered California's ability to readopt emergency
regulations until January 1, 2020 for emergency regulations
adopted prior to the effective date of the Budget Act of 2015;
and provides limited statutory exemptions from the
Administrative Procedure Act's (APA) rulemaking requirements
for (i) standard plan designs, and (ii) separate regulations
for each procurement.
17.ADAP Modernization. This bill updates financial eligibility
for AIDS Drug Assistance Program (ADAP) and the Office of AIDS
Health Insurance Premium Payment program to consider family
size and to increase the income limit of $50,000 for these
programs, which is estimated to be 447 percent federal poverty
level (FPL) to 500 percent FPL or $58,350 for a single
individual and $98,950 for a three-person household.
18.Medi-Cal: Enrollment Application Assistance Payments. This
bill reallocates any remaining funds for Medi-Cal application
assistance payments, for eligible applications submitted
through June 30, 2015, to county outreach and enrollment
grants and to extend the date by which county outreach and
enrollment grant funds can be spent from June 30, 2016 to June
30, 2018.
19.Major Risk Medical Insurance Program (MRMIP). This bill
expedites the MRMIP and Guaranteed Issue Pilot (GIP)
reconciliation process.
Fiscal
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Effect: This bill appropriates $50 million from the Health Home
Program Account to DHCS to implement the Health Home Program.
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