BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 461|
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THIRD READING
Bill No: AB 461
Author: Mullin (D), et al.
Amended: 6/1/15 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 9-0, 6/10/15
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
ASSEMBLY FLOOR: 79-0, 5/14/15 - See last page for vote
SUBJECT: Coordinated Care Initiative
SOURCE: Health Plan of San Mateo
Local Health Plans of California
DIGEST: This bill 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.
ANALYSIS:
Existing law:
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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
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 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
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exceptions.
6)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.
7)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;
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 CMS; 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.
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Comments
1)Author's statement. According to the author, AB 461 will
allow dually eligible developmentally disabled individuals in
San Mateo County to voluntarily enroll in the CCI. 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
SPDs into Medi-Cal managed care; and,
c) Managed Long-Term Supports and Services: Integration of
nursing facility care, In-Home Supportive Services,
Community-Based Adult Services, and Multipurpose Senior
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Services Program as managed care benefits.
3)Health Plan of San Mateo. In 22 counties, Medi-Cal 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 four percent disenrolling. The
enrollment rate is significantly higher than any other CCI
county.
HPSM also operates a dual eligible-special needs plan (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.
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FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
SUPPORT: (Verified6/19/15)
Health Plan of San Mateo (co-source)
Local Health Plans of California (co-source)
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
OPPOSITION: (Verified6/19/15)
None received
ARGUMENTS IN SUPPORT: The HPSM writes 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.
ASSEMBLY FLOOR: 79-0, 5/14/15
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AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle,
Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina
Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,
Gordon, Gray, Grove, Hadley, Harper, Holden, Irwin, Jones,
Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low,
Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin,
Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea,
Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,
Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,
Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Roger Hernández
Prepared by:Scott Bain / HEALTH /
6/23/15 11:41:28
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