BILL NUMBER: AB 187	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Bonta

                        JANUARY 27, 2015

   An act to amend Section 14094.3 of the Welfare and Institutions
Code, relating to children's services.


	LEGISLATIVE COUNSEL'S DIGEST


   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 1.  Section 14094.3 of the Welfare and Institutions Code is
amended to read:
   14094.3.  (a) Notwithstanding this article or Section 14093.05 or
14094.1, CCS covered services shall not be incorporated into any
Medi-Cal managed care contract entered into after August 1, 1994,
pursuant to Article 2.7 (commencing with Section 14087.3), Article
2.8 (commencing with Section 14087.5), Article 2.9 (commencing with
Section 14088), Article 2.91 (commencing with Section 14089), Article
2.95 (commencing with Section 14092); or either  Article 2
  Article 1  (commencing with Section 14200), or
Article 7 (commencing with Section 14490) of Chapter 8, until January
1, 2016, except for contracts entered into for county organized
health systems or Regional Health Authority in the Counties of San
Mateo, Santa Barbara, Solano, Yolo, Marin, and Napa.
   (b) Notwithstanding any other provision of this chapter, providers
serving children under the CCS program who are enrolled with a
Medi-Cal managed care contractor but who are not enrolled in a pilot
project pursuant to subdivision (c) shall continue to submit billing
for CCS covered services on a fee-for-service basis until CCS covered
services are incorporated into the Medi-Cal managed care contracts
described in subdivision (a).
   (c) (1) The department may authorize a pilot project in Solano
County in which reimbursement for conditions eligible under the CCS
program may be reimbursed on a capitated basis pursuant to Section
14093.05, and provided all CCS program's guidelines, standards, and
regulations are adhered to, and CCS program's case management is
utilized.
   (2) During the time period described in subdivision (a), the
department may approve, implement, and evaluate limited pilot
projects under the CCS program to test alternative managed care
models tailored to the special health care needs of children under
the CCS program. The pilot projects may include, but need not be
limited to, coverage of different geographic areas, focusing on
certain subpopulations, and the employment of different payment and
incentive models. Pilot project proposals from CCS program-approved
providers shall be given preference. All pilot projects shall utilize
CCS program-approved standards and providers pursuant to Section
14094.1.
   (d) For purposes of this section, CCS covered services include all
program benefits administered by the program specified in Section
123840 of the Health and Safety Code regardless of the funding
source.
   (e)  Nothing in this section shall   This
section shall not  be construed to exclude or restrict CCS
eligible children from enrollment with a managed care contractor, or
from receiving from the managed care contractor with which they are
enrolled primary and other health care unrelated to the treatment of
the CCS eligible condition.