AB 187, as introduced, Bonta. Medi-Cal: managed care: California Children’s Services program.
The California Children’s Services Program (CCS program) is a statewide program providing medically necessary services required by physically handicapped children whose parents are unable to pay for those services. The State Department of Health Care Services administers the CCS program. Counties, based on population size, are also charged with administering the program, either independently or jointly, with the department. The services covered by the CCS program include expert diagnosis, medical treatment, surgical treatment, hospital care, physical therapy, occupational therapy, special treatment, materials, and the supply of appliances and their upkeep, maintenance, and transportation. Funding for the program comes from county, state, and federal sources. In order to be eligible for the CCS program, an applicant must be under 21 years of age, have or be suspected of having a condition covered by the program, and meet certain financial eligibility standards established by the department.
Existing law prohibits services covered by the CCS program from being incorporated into a Medi-Cal managed care contract entered into after August 1, 1994, until January 1, 2016, except with respect to contracts entered into for county organized health systems in specified counties.
The bill would make technical, nonsubstantive changes to the CCS managed care contract provisions.
Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 14094.3 of the Welfare and Institutions
2Code is amended to read:
(a) Notwithstanding this article or Section 14093.05
4or 14094.1, CCS covered services shall not be incorporated into
5any Medi-Cal managed care contract entered into after August 1,
61994, pursuant to Article 2.7 (commencing with Section 14087.3),
7Article 2.8 (commencing with Section 14087.5), Article 2.9
8(commencing with Section 14088), Article 2.91 (commencing
9with Section 14089), Article 2.95 (commencing with Section
1014092); or either
begin delete Article 2end delete (commencing with Section
1114200), or Article 7 (commencing with Section 14490) of Chapter
128, until January 1, 2016, except for contracts entered into for county
13organized health systems or Regional Health Authority in the
14Counties of San Mateo, Santa Barbara, Solano, Yolo, Marin, and
16(b) Notwithstanding any other provision of this chapter,
17providers serving children under the CCS program who are enrolled
18with a Medi-Cal managed care contractor but who are not enrolled
19in a pilot project pursuant to subdivision (c) shall continue to
20submit billing for CCS covered services on a fee-for-service basis
21until CCS covered services are incorporated into the Medi-Cal
22managed care contracts described in subdivision (a).
23(c) (1) The department may authorize a pilot project in Solano
24County in which reimbursement for conditions eligible under the
25CCS program may be reimbursed on a capitated basis pursuant to
26Section 14093.05, and provided all CCS program’s guidelines,
27standards, and regulations are adhered to, and CCS program’s case
28management is utilized.
29(2) During the time period described in subdivision (a), the
30department may approve, implement, and evaluate limited pilot
31projects under the CCS program to test alternative managed care
P3 1models tailored to the special health care needs of children under
2the CCS program. The pilot projects may include, but need not be
3limited to, coverage of different geographic areas, focusing on
4certain subpopulations, and the employment of different payment
5and incentive models. Pilot project proposals from CCS
6program-approved providers shall be given preference. All pilot
7projects shall utilize CCS program-approved standards and
8providers pursuant to Section 14094.1.
9(d) For purposes of this section, CCS covered services include
10all program benefits administered by the program specified in
11Section 123840 of the Health and Safety Code regardless of the
begin deleteNothing in this section shall end deletebe
14construed to exclude or restrict CCS eligible children from
15enrollment with a managed care contractor, or from receiving from
16the managed care contractor with which they are enrolled primary
17and other health care unrelated to the treatment of the CCS eligible