BILL NUMBER: AB 187	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  MAY 28, 2015
	AMENDED IN ASSEMBLY  MARCH 4, 2015

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.
   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. 
    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.
   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.   January 1,   2017. 
   Vote: majority. Appropriation: no. Fiscal committee: yes.
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 1
(commencing with Section 14200), or Article 7 (commencing with
Section 14490) of Chapter 8, until  the department has
completed evaluations of the CCS pilot programs created pursuant to
subdivision (c) as part of California's Bridge to Reform Section 1115
(a) Demonstration developed pursuant to Section 14180,  
January 1, 2017,  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 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.