BILL ANALYSIS Ó
AB 187
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Date of Hearing: April 22, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
AB
187 (Bonta) - As Amended March 4, 2015
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill prohibits services covered through the California
Children's Services (CCS) program from being incorporated into
Medi-Cal managed care contracts, until the Department of Health
Care Services (DHCS) completes an evaluation of specified CCS
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pilot programs.
FISCAL EFFECT:
There is no direct increase in state costs, as this continues
the current practice of "carving out" CCS services. However,
this bill prohibits the incorporation of CCS services into
managed care contracts for an open-ended period of time, and
could result in foregone cost savings, potentially in the
millions of dollars (GF/federal funds) if it hampers the state's
ability to make program improvements. Cost savings could
potentially come from administrative streamlining, better care
coordination, reduced utilization or duplication, or other
program improvements.
COMMENTS:
1)Purpose. The author states extending the sunset on
prohibiting the integration of CCS services into managed care
contracts maintains CCS as a separate, organized system that
meets the needs of eligible children. They contend without
extending the January 1, 2016, sunset on this prohibition,
CCS-eligible children with catastrophic and chronic medical
conditions will not be protected from potential disruption of
services. This measure is sponsored by the Children's
Specialty Care Coalition, a coalition of providers of
pediatric specialty medical care.
2)Background. Originally established in 1927, the CCS Program
provides diagnostic and treatment services, medical case
management, and physical and occupational therapy services to
children under age 21 with CCS-eligible medical conditions.
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Examples of CCS-eligible conditions include, but are not
limited to, serious and chronic medical conditions such as
cystic fibrosis, hemophilia, cerebral palsy, heart disease,
cancer, traumatic injuries, and certain infectious diseases.
3)CCS Carve-out. During the 1990s, as California began
enrolling increasing numbers of Medi-Cal beneficiaries
(including children) into managed care plans, providers and
children's advocates became concerned that CCS-eligible
children would fail to receive the same quality of care as
they did through CCS. As a result, in 1994, a "carve-out" for
CCS-eligible children, who are enrolled in Medi-Cal managed
care, became law, requiring these children to continue
receiving highly specialized care for their CCS-eligible
condition through CCS, while receiving preventive and general
care through a managed care plan. The law contained a sunset
that has since been extended several times. Most recently, AB
301 (Pan), Chapter 460, Statutes of 2011, extended this sunset
until January 1, 2016.
4)CCS Redesign. While the CCS carve-out has been effective in
providing access to high-quality pediatric specialty care for
eligible children, it has also been identified by stakeholders
as a barrier to effective care coordination because children
are forced to seek care through two separate systems.
Furthermore, independent reviews have identified a broad array
of other program challenges, including significant program
variation across counties, a complex and burdensome financial
structure, various access problems, and an inefficient
authorization process for services. The 2010 "Bridge to
Reform" Medi-Cal waiver authorized pilot programs to test new
models of care in CCS. Due to myriad challenges, only two
pilots have gone forward: those proposed by San Mateo Health
Plan and Rady Children's Hospital. This bill would continue
the carve-out until these pilots have been evaluated.
Meanwhile, DHCS, with support from UCLA, convened stakeholders
in 2014, to further discuss ways to improve the CCS program.
At a December 2, 2014 stakeholder meeting, DHCS stated,
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"without regard to sunset of the CCS "carve-out," DHCS is not
predisposed to mandatorily enroll CCS eligible children into
managed care for CCS services."
1)Related Legislation. SB 586 (Ed Hernández), scheduled to be
heard today in the Senate Health Committee, removes the CCS
carve-out sunset date and creates a new health plan, the Kids
Integrated Delivery System (KIDS) plan. The KIDS plan is
required to coordinate, integrate, and provide or arrange for
the full range of Medi-Cal and CCS services.
5)Prior Legislation. In addition to AB 301, discussed above, AB
2379 (Chan), Chapter 333, Statutes of 2007, extended the
sunset date from August 1, 2008, to January 1, 2012,
on the CCS carve-out. Several other bills prior to AB 2379
have also extended the sunset.
SB 208 (Steinberg), Chapter 714, Statutes of 2010, required
DHCS to seek proposals for the CCS pilots whose evaluations
are the trigger of this bill.
2)Staff Comments. This bill raises three issues. First, it is
unclear when the evaluations will be completed, making it
difficult to ascertain the true effect of the bill. Second,
it may hamper the state's ability to pursue improvements to
the program until such evaluations have been completed. For
example, the current stakeholder process may identify program
improvements that necessitate incorporating some CCS services
into managed care contracts. If this bill became law, however,
this would be prohibited. Third, it is unclear that waiting
until the pilots are evaluated is an appropriate trigger for
removing the prohibition. As there are only two pilot
programs going forward, it is unclear whether even the
evaluation will be sufficiently robust to offer meaningful
conclusions that can inform the potential design of the
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program statewide. For example, there may be local factors
that influence the success or failure of aspects of the pilot
in the two specific areas. Instead of tying the prohibition
to evaluation of the pilots, the author may wish to consider
an alternate way to balance the intent to preserve the current
protections offered by the carve-out with flexibility to
pursue improvements that may otherwise be prohibited for
years.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081