AB 187, as amended, Bonta. Medi-Cal: managed care: California Children’s Services program.
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
begin delete 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.end delete
begin deleteExisting law provides forend delete
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.
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
begin delete the department has completed evaluations of specified pilot programs created as part of California’s Bridge to Reform Section 1115(a) Demonstration.end delete
Vote: majority. Appropriation: no. Fiscal committee: yes. 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 Article 1 (commencing with Section 14200), or
11Article 7 (commencing with Section 14490) of Chapter 8, until
begin delete the department has completed evaluations of the CCS pilot except for contracts
13programs created pursuant to subdivision (c) as part of California’s
14Bridge to Reform Section 1115(a) Demonstration developed
15pursuant to Section 14180,end delete
16entered into for county organized health systems or Regional
17Health Authority in the Counties of San Mateo, Santa Barbara,
18Solano, Yolo, Marin, and Napa.
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
P3 1CCS program may be reimbursed on a capitated basis pursuant to
2Section 14093.05, and provided all CCS program’s guidelines,
3standards, and regulations are adhered to, and CCS program’s case
4management is utilized.
5(2) During the time period described in subdivision (a), the
6department may approve, implement, and evaluate limited pilot
7projects under the CCS program to test alternative managed care
8models tailored to the special health care needs of children under
9the CCS program. The pilot projects may include, but need not be
10limited to, coverage of different geographic areas, focusing on
11certain subpopulations, and the employment of different payment
12and incentive models. Pilot project proposals from CCS
13program-approved providers shall be given preference. All pilot
14projects shall utilize CCS program-approved standards and
15providers pursuant to Section 14094.1.
16(d) For purposes of this section, CCS covered services include
17all program benefits administered by the program specified in
18Section 123840 of the Health and Safety Code regardless of the
20(e) Nothing in this section shall be construed to exclude or
21restrict CCS eligible children from enrollment with a managed
22care contractor, or from receiving from the managed care contractor
23with which they are enrolled primary and other health care
24unrelated to the treatment of the CCS eligible condition.