BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 366 (Bonta) - Medi-Cal: annual access monitoring report
-----------------------------------------------------------------
| |
| |
| |
-----------------------------------------------------------------
|--------------------------------+--------------------------------|
| | |
|Version: July 7, 2015 |Policy Vote: HEALTH 9 - 0 |
| | |
|--------------------------------+--------------------------------|
| | |
|Urgency: No |Mandate: No |
| | |
|--------------------------------+--------------------------------|
| | |
|Hearing Date: August 17, 2015 |Consultant: Brendan McCarthy |
| | |
-----------------------------------------------------------------
This bill meets the criteria for referral to the Suspense File.
Bill
Summary: AB 366 would require the Department of Health Care
Services to prepare an annual report on access to Medi-Cal
services. The bill would require provider rate increases to be
implemented, to the extent that provider rates are found to be
inadequate and funding is provided in the annual budget act
Fiscal
Impact:
Likely annual costs up to $1 million per year to collect
analyze data and prepare the required report by the
Department of Health Care Services (General Fund and
federal funds).
Unknown costs for increased provider payments (General
Fund and federal fund). The bill requires provider rate
increases to be implemented, to the extent that provider
rates are found to be inadequate and funding is provided in
the annual budget act. The extent to which the required
report will find that provider rates are a barrier to
AB 366 (Bonta) Page 1 of
?
access is unknown. Therefore, the extent to which the bill
will require future rate increases is unknown.
Background: Under state and federal law, the Department of Health Care
Services operates the Medi-Cal program, which provides health
care coverage to low income individuals, families, and children.
Medi-Cal provides coverage to childless adults and parents with
household incomes up to 138% of the federal poverty level and to
children with household incomes up to 266% of the federal
poverty level. The federal government provides matching funds
that vary from 50% to 90% of expenditures depending on the
category of beneficiary.
Over the last several years, there have been a variety of
attempts by the state to reduce payment rates to Medi-Cal
providers, in an effort to reduce state spending on the program.
Many of those rate reductions have been enjoined by the courts
or repealed and replaced by different budget actions.
As part of the 2011-12 budget (AB 97, Committee on Budget,
Statutes of 2011), the state imposed a 10% reduction in the
rates paid to many fee-for-service Medi-Cal providers and
required the capitated rates paid to managed care plans to be
reduced by an actuarially equivalent amount. In addition,
payment rates for distinct part skilled nursing facilities
(located on a hospital campus) were "rolled back" to the payment
rates in place in 2008-09 and then reduced by 10%. Rate
reductions were made retroactive to June 1, 2011 for all
fee-for-service providers.
Many of those rate reductions were enjoined by the courts until
June 2013. At that point, the state had legal authority to both
reduce provider rates going forward and to "claw back" rate
reductions for services provided between June 2011 and June
2013. (Providers subject to claw backs include pharmacies,
durable medical equipment providers, clinical laboratories,
distinct part nursing facilities, and radiology services.) Rate
reductions for Medi-Cal managed care providers will be made
going forward but the state will not recoup unrealized savings.
Since the enactment of the 2013-14 Budget Act, several
categories of providers have been exempted from Medi-Cal rate
reductions by statute or administrative action of the
Department.
AB 366 (Bonta) Page 2 of
?
Proposed Law:
AB 366 would require the Department of Health Care Services to
prepare an annual report on access to Medi-Cal services.
Specific provisions of the bill would:
Require the Department to prepare an annual access
monitoring report, to allow an assessment of access to care
in Medi-Cal and provide a basis to evaluate the adequacy of
provider rates and the existence of other barriers to care;
Specify the information required to be included in the
report;
Require at least one public meeting to present the
report;
Authorize the Department to enter into a contract with
an independent entity to perform an assessment of access to
care and the adequacy of provider rates;
Require provider rate increases to be implemented,
subject to budget act funding, for provider types or
geographic areas for which rates are found to be
inadequate.
Related
Legislation: SB 243 (Hernandez) would require the Department of
Health Care Services to raise a variety of rates paid to
Medi-Cal providers and require the Department to rescind
existing rate reductions to specified providers. That bill was
held on this committee's Suspense File.
Staff
Comments: Concerns have been raised by providers and advocates
that low reimbursement rates in the Medi-Cal program result in
providers limiting their participation in the program. Providers
may accept no Medi-Cal patients, refuse new Medi-Cal patients,
or limit the number of Medi-Cal patients in their practice.
Surveys of providers performed by the Medical Board of
California and the National Centers for Health Statistics Data
Brief have found that providers accept new Medi-Cal patients at
lower rates than new patients with other sources of health care
coverage and at lower rates than providers in other states.
Currently, about 80% of Medi-Cal beneficiaries are enrolled in
Medi-Cal managed care plans. Commercial Medi-Cal managed care
plans are subject to network adequacy and timely access to care
AB 366 (Bonta) Page 3 of
?
requirements under the Knox-Keene Act and regulations adopted by
the Department of Managed Health Care. Non-commercial Medi-Cal
managed care plans (such as county organized health systems) are
not directly regulated by those requirements. However, the
Department of Health Care Services includes substantively
similar requirements in its contracts with managed care plans.
-- END --