AB 366, as amended, Bonta. Medi-Cal: annual access monitoring report.
Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which health care services are provided to qualified, low-income persons. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Under the federal Patient Protection and Affordable Care Act, existing state law extends Medi-Cal eligibility to childless adults under 65 years of age.
This bill would require the State Department of Health Care Services, by March 15, 2016, and annually thereafter by February 1, to submit to the Legislature, and post on the department’s Internet Web site, a Medi-Cal access monitoring report providing an assessment of access to care in Medi-Cal and identifying a basis to evaluate the adequacy of Medi-Cal reimbursement rates and the existence of other barriers to
access to care, as specified. The bill would require the department to hold a public meeting to present and discuss the access monitoring report at least once annually, and would require the department to accept public comment from stakeholders at the public meeting. The bill would authorize the department to enter intobegin delete an interagency agreement with the University of Californiaend deletebegin insert a contract with an independent entityend insert to perform an ongoing assessment of access to care and the adequacy of provider payments in Medi-Cal. The bill would require, to the extent funding is provided in the annual Budget Act and federal financial participation is available, rate increases to be implemented for services, provider types, or geographic areas for which rates are identified in the annual report as inadequate.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 14105.2 is added to the Welfare and
2Institutions Code, to read:
(a) The Legislature finds and declares all of the
4following:
5(1) California has significantly reduced the number of uninsured
6persons by expanding the Medi-Cal program under the federal
7Patient Protection and Affordable Care Act (Public Law 111-148).
8(2) It is important to ensure adequate access to care in the
9Medi-Cal program as new enrollees seek appropriate care.
10(3) The state needs to assess the gaps in access to care and act
11swiftly to address those gaps.
P3 1(4) One area of anticipated
need is the availability of more
2Medi-Cal providers.
3(5) California’s Medi-Cal provider reimbursement rates have
4historically been among the lowest in the nation.
5(6) During recent years, the state has reduced reimbursement
6rates to Medi-Cal providers due to budget constraints.
7(7) An assessment of gaps in access should include a
8determination of whether current provider rates are sufficient to
9ensure access to care.
10(b) Therefore, it is the intent of the Legislature that an annual
11access monitoring report provide a valid, clear, and public
12assessment of access to care in Medi-Cal, and provide a basis to
13evaluate the adequacy of Medi-Cal rates and the
existence of other
14barriers to access to care.
15(c) Notwithstanding Section 10231.5 of the Government Code,
16by March 15, 2016, and annually thereafter by February 1, the
17department shall submit to the Legislature, and post on the
18department’s Internet Web site, a Medi-Cal access monitoring
19report. The report shall be submitted in compliance with Section
209795 of the Government Code. The annual report shall:
21(1) Present results of the department’s ongoing access
22monitoring efforts in fee-for-service and managed care. For
23managed care, the report shall include results from the Department
24of Managed Health Care’s oversight of provider networks and
25timely access in Medi-Cal managed care.
26(2) Compare the level of access
to care and services available
27through Medi-Cal, to the level of access to care and services
28available to the general population in different geographic areas
29of California.
30(3) Include access measurements of sufficient granularity to
31reflect patient experience of access to particular services or provider
32types, or in particular geographic areas.
33(4) Identify particular services, provider types, or geographic
34areas for which the level of access is less than the level of access
35to care and services available to the general population in the
36geographic area. For those services, provider types, or geographic
37areas, the annual report shall assess and report on the adequacy of
38provider payment rates and identify any other factors that impede
39access.
40(5) Use language clearly understandable to the public.
P4 1(6) Use more than one valid, generally accepted method to assess
2access to care.
3(d) At least once annually, the department shall hold a public
4
meeting to present and discuss the access monitoring report. The
5department shall accept public comment from stakeholders at the
6public meeting.
7(e) The department may enter intobegin delete an interagency agreement begin insert a contract with an independent
8with the University of Californiaend delete
9entityend insert to perform an ongoing assessment of access to care and the
10adequacy of provider payment rates in Medi-Cal.
11(f) For services, provider types, or geographic areas for which
12rates are identified in the annual report as inadequate, rate increases
13shall be implemented to the extent funding is provided in the annual
14Budget
Act and federal financial participation is available.
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