Amended in Assembly March 4, 2015

California Legislature—2015–16 Regular Session

Assembly BillNo. 187


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 amended, Bonta. Medi-Cal: managed care: California Children’s Services program.

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Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. Existing law provides for a demonstration project, California’s Bridge to Reform Section 1115(a) Demonstration, under the Medi-Cal program until October 31, 2015, to implement specified objectives, including improved health care quality and outcomes and maximization of opportunities to reduce the number of uninsured individuals.

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Existing law provides for the department to enter into contracts with managed care systems, hospitals, and prepaid health plans for the provision of various Medi-Cal benefits. Existing law prohibits services covered by the California Children’s Services program (CCS) 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.

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This bill would extend the termination of the prohibition against CCS covered services being incorporated into a Medi-Cal managed care contract entered into after August 1, 1994, until the department has completed evaluations of specified pilot programs created as part of California’s Bridge to Reform Section 1115(a) Demonstration.

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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.

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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.

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The bill would make technical, nonsubstantive changes to the CCS managed care contract provisions.

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Vote: majority. Appropriation: no. Fiscal committee: begin deleteno end deletebegin insertyesend insert. State-mandated local program: no.

The people of the State of California do enact as follows:

P2    1begin insert

begin insertSECTION 1.end insert  

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begin insertSection 14094.3 of the end insertbegin insertWelfare and Institutions
2Code
end insert
begin insert is amended to read:end insert

3

14094.3.  

(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
P3    1with Section 14089), Article 2.95 (commencing with Section
214092); or eitherbegin delete Article 2end deletebegin insert Article 1end insert (commencing with Section
314200), or Article 7 (commencing with Section 14490) of Chapter
48, untilbegin delete January 1, 2016,end deletebegin insert the department has completed evaluations
5of the CCS pilot programs created pursuant to subdivision (c) as
6part of California’s Bridge to Reform Section 1115(a)
7Demonstration developed pursuant to Section 14180,end insert
except for
8contracts entered into for county organized health systems or
9Regional Health Authority in the Counties of San Mateo, Santa
10Barbara, Solano, Yolo, Marin, and Napa.

11(b) Notwithstanding any other provision of this chapter,
12providers serving children under the CCS program who are enrolled
13with a Medi-Cal managed care contractor but who are not enrolled
14in a pilot project pursuant to subdivision (c) shall continue to
15submit billing for CCS covered services on a fee-for-service basis
16until CCS covered services are incorporated into the Medi-Cal
17managed care contracts described in subdivision (a).

18(c) (1) The department may authorize a pilot project in Solano
19County in which reimbursement for conditions eligible under the
20CCS program may be reimbursed on a capitated basis pursuant to
21Section 14093.05, and provided all CCS program’s guidelines,
22standards, and regulations are adhered to, and CCS program’s case
23management is utilized.

24(2) During the time period described in subdivision (a), the
25department may approve, implement, and evaluate limited pilot
26projects under the CCS program to test alternative managed care
27models tailored to the special health care needs of children under
28the CCS program. The pilot projects may include, but need not be
29limited to, coverage of different geographic areas, focusing on
30certain subpopulations, and the employment of different payment
31and incentive models. Pilot project proposals from CCS
32program-approved providers shall be given preference. All pilot
33projects shall utilize CCS program-approved standards and
34providers pursuant to Section 14094.1.

35(d) For purposes of this section, CCS covered services include
36all program benefits administered by the program specified in
37Section 123840 of the Health and Safety Code regardless of the
38funding source.

39(e) Nothing in this section shall be construed to exclude or
40restrict CCS eligible children from enrollment with a managed
P4    1care contractor, or from receiving from the managed care contractor
2with which they are enrolled primary and other health care
3unrelated to the treatment of the CCS eligible condition.

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4

SECTION 1.  

Section 14094.3 of the Welfare and Institutions
5Code
is amended to read:

6

14094.3.  

(a) Notwithstanding this article or Section 14093.05
7or 14094.1, CCS covered services shall not be incorporated into
8any Medi-Cal managed care contract entered into after August 1,
91994, pursuant to Article 2.7 (commencing with Section 14087.3),
10Article 2.8 (commencing with Section 14087.5), Article 2.9
11(commencing with Section 14088), Article 2.91 (commencing
12with Section 14089), Article 2.95 (commencing with Section
1314092); or either Article 1 (commencing with Section 14200), or
14Article 7 (commencing with Section 14490) of Chapter 8, until
15January 1, 2016, except for contracts entered into for county
16organized health systems or Regional Health Authority in the
17Counties of San Mateo, Santa Barbara, Solano, Yolo, Marin, and
18Napa.

19(b) Notwithstanding any other provision of this chapter,
20providers serving children under the CCS program who are enrolled
21with a Medi-Cal managed care contractor but who are not enrolled
22in a pilot project pursuant to subdivision (c) shall continue to
23submit billing for CCS covered services on a fee-for-service basis
24until CCS covered services are incorporated into the Medi-Cal
25managed care contracts described in subdivision (a).

26(c) (1) The department may authorize a pilot project in Solano
27County in which reimbursement for conditions eligible under the
28CCS program may be reimbursed on a capitated basis pursuant to
29Section 14093.05, and provided all CCS program’s guidelines,
30standards, and regulations are adhered to, and CCS program’s case
31management is utilized.

32(2) During the time period described in subdivision (a), the
33department may approve, implement, and evaluate limited pilot
34projects under the CCS program to test alternative managed care
35models tailored to the special health care needs of children under
36the CCS program. The pilot projects may include, but need not be
37limited to, coverage of different geographic areas, focusing on
38certain subpopulations, and the employment of different payment
39and incentive models. Pilot project proposals from CCS
40program-approved providers shall be given preference. All pilot
P5    1projects shall utilize CCS program-approved standards and
2providers pursuant to Section 14094.1.

3(d) For purposes of this section, CCS covered services include
4all program benefits administered by the program specified in
5Section 123840 of the Health and Safety Code regardless of the
6funding source.

7(e) This section shall not be construed to exclude or restrict CCS
8eligible children from enrollment with a managed care contractor,
9or from receiving from the managed care contractor with which
10they are enrolled primary and other health care unrelated to the
11treatment of the CCS eligible condition.

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