BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 461
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|AUTHOR: |Mullin |
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|VERSION: |June 1, 2015 |
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|HEARING DATE: |June 10, 2015 | | |
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|CONSULTANT: |Scott Bain |
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SUBJECT : Coordinated Care Initiative.
SUMMARY : Authorizes a Medi-Cal beneficiary receiving services through a
regional center or who is enrolled in a Medi-Cal home- and
community-based waiver who resides in San Mateo County to
voluntarily enroll in the CalMediConnect demonstration project
for individuals dually eligible for Medicare and Medi-Cal under
the Coordinated Care Initiative.
Existing law:
1)Establishes, under federal law, the Medicare program, which is
a public health insurance program for persons 65 years of age
and older and specified persons with disabilities who are
under the age of 65.
2)Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), under which
qualified low-income individuals receive health care services,
including home- and community-based services (HCBS).
3)Requires DHCS to seek federal approval to establish a
demonstration project under a Medicare or a Medicaid
demonstration project or waiver. Authorizes DHCS, under a
Medicare demonstration, to contract with the federal Centers
for Medicare and Medicaid Services (CMS) and demonstration
sites to operate the Medicare and Medicaid benefits in a
demonstration project that is overseen by the state as a
delegated Medicare benefit administrator, and to enter into
financing arrangements with CMS to share in any Medicare
AB 461 (Mullin) Page 2 of ?
program savings generated by the demonstration project. This
demonstration project is known as CalMediConnect.
4)Requires DHCS, after federal approval is obtained, to
establish the CalMediConnect demonstration project that
enables dual eligible beneficiaries to receive a continuum of
services that maximizes access to, and coordination of,
benefits between the Medi-Cal and Medicare programs and access
to the continuum of long-term services and supports (LTSS) and
behavioral health services, including mental health and
substance use disorder treatment services. The purpose of this
demonstration project is to integrate services authorized
under Medi-Cal and Medicare.
5)Requires CalMediConnect demonstration sites to be established
in up to eight counties, and to include at least one county
that provides Medi-Cal services via the two-plan model of
Medi-Cal managed care.
6)Requires DHCS to enroll dual eligible beneficiaries into a
CalMediConnect demonstration site unless the beneficiary makes
an affirmative choice to opt out of enrollment, with specified
exceptions.
7)Requires DHCS to require dual eligibles to be assigned as
mandatory enrollees into new or existing Medi-Cal managed care
health plans for their Medi-Cal benefits in Coordinated Care
Initiative (CCI) counties. CCI counties are the Counties of
Alameda, Los Angeles, Orange, Riverside, San Bernardino, San
Diego, San Mateo, and Santa Clara. Allows individuals to opt
out of Medi-Cal managed care for the Medicare portion of their
benefits.
8)Excludes from enrollment in the CalMediConnect demonstration
project specified Medi-Cal beneficiaries, including
beneficiaries:
a) With a prior diagnosis of end-stage renal disease,
except where authorized by the DHCS director;
AB 461 (Mullin) Page 3 of ?
b) With other health coverage;
c) Enrolled in a Medi-Cal home- and community-based waiver
that is a Medi-Cal benefit, beneficiaries receiving
services through a regional center or state developmental
center, except for persons enrolled in the Multipurpose
Senior Services Program;
d) Residing in a geographic area or ZIP Code not included
in managed care, as determined by DHCS and the federal
Centers for Medicare and Medicaid Services; and,
e) Residing in one of the Veterans' Homes of California.
This bill: Authorizes a dually eligible Medi-Cal beneficiary who
resides in San Mateo County and who is receiving services
through a regional center or who is enrolled in a Medi-Cal home-
and community-based waiver to voluntarily enroll in the
CalMediConnect demonstration project.
FISCAL
EFFECT : According to the Assembly Appropriations Committee,
this bill has a negligible fiscal effect, given that the
impacted individuals currently incur costs as Medi-Cal
beneficiaries, and allowing them to enroll in a different
delivery system should not increase costs for their care.
PRIOR
VOTES :
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|Assembly Floor: |79 - 0 |
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|Assembly Appropriations Committee: |17 - 0 |
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|Assembly Health Committee: |17 - 0 |
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COMMENTS :
1)Author's statement. According to the author, AB 461 will
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allow dually eligible developmentally disabled individuals in
San Mateo County to voluntarily enroll in the Coordinated Care
Initiative. By allowing them to join CCI, Health Plan of San
Mateo (HPSM) will be able to continue providing them with the
option of managed care.
2)CCI. The CCI is a program intended to integrate and coordinate
the delivery of health benefits, including behavioral health
benefits and LTSS to dual eligibles and seniors and persons
with disabilities (SPDs) living in seven California counties:
Los Angeles, Orange, Riverside, San Bernardino, San Diego, San
Mateo and Santa Clara (state law allows for CCI implementation
in eight counties, but CCI will not be implemented in Alameda
County). Goals for the CCI include coordinating Medi-Cal
benefits and Medicare benefits across health care settings and
improving continuity of acute care, long-term care, and HCBS,
coordinating access to acute and long-term care services for
dual eligibles, maximizing the ability of dual eligibles to
remain in their homes and communities with appropriate
services and supports in lieu of institutional care, and
increasing the availability of and access to home- and
community-based alternatives. The three major components of
the CCI are as follows:
a) CalMediConnect Program: A three-year demonstration
project designed to coordinate medical, behavioral health,
long-term institutional, and HCBS services for dual
eligibles by combining Medicare and Medi-Cal benefits into
one integrated health plan;
b) Mandatory enrollment of dual eligibles and Medi-Cal-only
seniors and persons with disabilities into Medi-Cal managed
care; and,
c) Managed Long-Term Supports and Services (MLTSS):
Integration of nursing facility care, In-Home Supportive
Services, Community-Based Adult Services, and Multipurpose
Senior Services Program as managed care benefits.
3)Health Plan of San Mateo. In twenty-two counties, Medi-Cal
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managed care is operated by one of six County Organized Health
System (COHS) plans. San Mateo County is a COHS county, and
HPSM is the single plan to serve all Medi-Cal beneficiaries
enrolled in managed care. HPSM operates the CalMediConnect
plan, which is called CareAdvantage. Passive enrollment into
CareAdvantage commenced in April 2014. HPSM indicates it has
approximately 10,300 dual eligibles actively enrolled in
CalMediConnect. San Mateo County has a much higher enrollment
rate (84 percent) in CalMediConnect, with 13 percent of dual
eligibles opting out of CalMediConnect, and 4 percent
disenrolling. The enrollment rate is significantly higher than
any other CCI county.
HPSM also operates a D-SNP for developmentally disabled
individuals receiving care from a regional center are
enrolled. The D-SNP has approximately 900 members who are
ineligible for its CalMediConnect Plan, of whom 600 are
developmentally disabled. A D-SNP is a type of Medicare
Advantage plan that limits membership to people with specific
diseases or characteristics, and tailors their benefits,
provider choices, and drug formularies to best meet the
specific needs of the groups they serve. D-SNPs serve dual
eligibles, and similar to CalMediConnect plans, D-SNPs combine
Medicare and Medicaid benefits into one plan.
Under the CCI, D-SNPs operated by plans that also operate a
CalMediConnect plan will be phased out. In January 2015,
beneficiaries enrolled in a D-SNP operated by a CalMediConnect
plan were transitioned into CalMediConnect. HPSM indicates it
originally intended to close its D-SNP after 2015 and operate
just the CCI program going forward, but because of the
uncertainty surrounding CCI long-term (as mentioned in the
Governor's January Budget), it will review its decision to
continue to operate a D-SNP annually.
4)Related legislation. SB 492 (Liu) would enact the "Coordinated
Care Initiative
Consumer and Patient Educational and Informational Guide,"
which requires DHCS to develop and post on its Internet Web
site an educational and informational guide for consumers and
patients about the CCI. SB 492 is pending hearing in Assembly
Health Committee.
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5)Prior legislation.
a) SB 857 (Committee on Budget and Fiscal Review, Chapter
31, Statutes of 2014), institutes various requirements
regarding contracts and enrollment limitations on D-SNP
plans in the context of the CCI.
b) SB 1008 (Committee on Budget and Fiscal Review, Chapter
33, Statutes of 2012), establishes the main components of
the CCI, including the provisions for the CalMediConnect
Program, mandatory Medi-Cal managed care for SPDs, and
MLTSS.
c) SB 1036 (Committee on Budget and Fiscal Review, Chapter
45, Statutes of 2012), authorizes other components of the
CCI, includes provisions that require the development and
pilot implementation of a universal assessment tool as well
as data-sharing agreements between managed care plans and
HCBS administrators.
d) SB 208 (Steinberg, Chapter 714, Statutes of 2010),
authorizes a pilot project in up to four counties, to
integrate the full range of Medicare and Medi-Cal services,
including LTSS and behavioral health services for dual
eligible individuals.
6)Support. The HPSM writes as a co-sponsor that it serves 600
developmentally disabled individuals in its D-SNP, but that
the D-SNP is costly and inefficient to operate for only a
small number of members, and it intends to close the D-SNP in
the next year or two. HPSM states this would leave the 600
developmentally disabled members without a consolidated health
plan for their Medi-Cal and Medicare benefits. HPSM states
that this bill will correct this problem by allowing this
special needs population to voluntarily enroll in
CalMediConnect.
Golden Gate Regional Center (GGRC), the regional center
serving San Mateo County, argues that persons with
developmental disabilities who are enrolled in HPSM's D-SNP
should have the option to continue with HPSM through the CCI.
GGRC states that the inability of these individuals to
continue with HPSM through the CCI would be extremely
disruptive to their care, and without the option for voluntary
CCI enrollment created under this bill, the alternative for
these beneficiaries will be a fragmented system between
fee-for-service Medicare and Medi-Cal through HPSM.
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7)Concerns. The California Advocates for Nursing Home Reform
(CANHR) states that, while HPSM is seen as a model managed
care plan with regard to the CCI, plans in other counties are
struggling to provide coordinated care and have a large number
of problems that seriously harm enrollees. As such, CANHR
states that the CCI is currently in jeopardy of being
terminated because of failure to meet projected savings, and
if the transition of regional center clients in San Mateo is
successful, other counties and plans may push to expand
voluntary enrollment of this population in other counties as a
way to meet savings goals and keep the CCI afloat. Further,
CANHR states that if the CCI fails, this new vulnerable
population will have their continuity of care interrupted
along with thousands of other beneficiaries enrolled,
surrogate decision-makers will face challenges. CANHR
concludes that regional center clients have surrogate
decision-makers, many of whom will run into roadblocks when
they want to assist beneficiaries to disenroll from a plan or
change doctors within the plan.
8)Requested amendment. The Regional Center of Orange County
(RCOC) writes requesting an amendment to allow residents with
developmental disabilities in Orange County to voluntary
participate in the CCI. RCOC writes that the OneCare Program
(a D-SNP) in Orange County is scheduled to be retired, and not
all of the consumers enrolled in it will quality for the new
OneCare CalMediConnect program that will replace it. RCOC
argues that including Orange County residents in this bill
will give these consumers the option to voluntarily join
OneCare CalMediConnect when the current OneCare program ends.
SUPPORT AND OPPOSITION :
Support: Health Plan of San Mateo (co-sponsor)
Local Health Plans of California (co-sponsor)
Association of Regional Center Agencies
California Association of Public Authorities for IHSS
Congress of California Seniors
Golden Gate Regional Center
Regional Center of Orange County
San Mateo County Board of Supervisors
Oppose: None received
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