BILL ANALYSIS                                                                                                                                                                                                    Ó

                                                                       AB 187

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          187 (Bonta)

          As Amended  May 28, 2015

          Majority vote

          |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         |                      |
          |                |      |                    |                      |
          |                |      |                    |                      |

          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