BILL ANALYSIS Ó
AB 187
Page 1
ASSEMBLY THIRD READING
AB
187 (Bonta)
As Amended May 28, 2015
Majority vote
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|Committee |Votes |Ayes |Noes |
| | | | |
| | | | |
|----------------+------+--------------------+----------------------|
|Health |16-0 |Bonta, Maienschein, | |
| | |Bonilla, Burke, | |
| | |Chávez, Chiu, | |
| | |Gomez, Lackey, | |
| | |Nazarian, | |
| | |Patterson, | |
| | |Ridley-Thomas, | |
| | |Rodriguez, | |
| | |Santiago, Thurmond, | |
| | |Waldron, Wood | |
| | | | |
|----------------+------+--------------------+----------------------|
|Appropriations |17-0 |Gomez, Bigelow, | |
| | |Bonta, Calderon, | |
| | |Chang, Daly, | |
| | |Eggman, Gallagher, | |
| | | | |
| | | | |
| | |Eduardo Garcia, | |
| | |Gordon, Holden, | |
| | |Jones, Quirk, | |
AB 187
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| | |Rendon, Wagner, | |
| | |Weber, Wood | |
| | | | |
| | | | |
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SUMMARY: Extends the sunset date on the prohibition on
incorporating California Children's Services (CCS) covered
services in a Medi-Cal managed care (MCMC) contract for one year
to January 1, 2017.
EXISTING LAW:
1)Establishes the Medi-Cal Program, administered by the Department
of Health Care Services (DHCS), which provides comprehensive
health benefits to low-income children, their parents or
caretaker relatives, pregnant women, elderly, blind or disabled
persons, nursing home residents, and refugees who meet specified
eligibility criteria.
2)Establishes the CCS Program to provide specified medical care
and therapy services to children with eligible conditions.
3)Prohibits, until January 1, 2016, CCS covered services from
being incorporated into MCMC contracts, except in county
organized health systems plans originally established.
FISCAL EFFECT: According to the Assembly Appropriations
Committee, there is no direct increase in state costs, as this
continues the current practice of "carving out" CCS services.
This bill prohibits the incorporation of CCS services into managed
care contracts for one year. It is unlikely to have a fiscal
impact as compared to the status quo, as a current stakeholder
process is underway to redesign the CCS delivery system and it is
unlikely that children would enroll in managed care before January
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1, 2017.
COMMENTS: 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. Some
examples of CCS-eligible conditions include chronic medical
conditions such as cystic fibrosis, hemophilia, cerebral palsy,
heart disease, cancer, traumatic injuries, and certain infectious
diseases. CCS also provides medical therapy services that are
delivered at public schools.
Mandatory enrollment of families and children into a MCMC full
risk plan was authorized as part of the state budget of 1992. In
implementing this mandatory enrollment, the former Department of
Health Services (now DHCS) released a strategic plan in 1993.
With regard to CCS, the Strategic Plan stated that the department
desired Medi-Cal children participating in managed care to
continue to have direct access to the level of highly specialized
services provided under the CCS Program. In order to assure that
CCS-eligible children received the benefit of fully-coordinated
care, it would be the responsibility of the managed care plan to
identify children with CCS-eligible conditions, arrange for
referral to the local CCS office and coordinate the provision of
care. CCS services would continue to be provided through the CCS
program while children would be mandatorily enrolled in a health
plan in the counties covered by the managed care expansion for
purposes of receiving primary care and other services unrelated to
the conditions being treated by the CCS Program.
Consistent with the Strategic Plan, SB 1371 (Bergeson), Chapter
917, Statutes of 1994, was enacted to provide that CCS-covered
services, for CCS-eligible children, would not be incorporated
into managed care, termed a "carve out" and would be provided and
paid for on a fee-for service basis through the CCS Program for
three years. The carve out has been extended repeatedly since
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then, usually for three or four year periods.
According to the Children's Specialty Care Coalition, CCS
carve-out has been extended repeatedly to protect access to the
specialty care for this vulnerable population. Recently, DHCS, in
its effort to strengthen the program, assembled the CCS Redesign
Stakeholder Advisory Board (RSAB). The RSAB is composed of
stakeholders including the Children's Specialty Care Coalition to
assess the CCS program in its current state and develop a
framework for a new model of care going forward. The development
and implementation of any new model will take time, and must be
phased in slowly. The Children's Specialty Care Coalition
believes that this bill is necessary to ensure the care that
children receive through CCS is not disrupted, while efforts are
underway by DHCS and RSAB to explore new ways to enhance delivery
of care.
This bill has no known opposition.
Analysis Prepared by: Paula Villescaz /
HEALTH / (916) 319-2097 FN: 0000848