BILL ANALYSIS                                                                                                                                                                                                    Ó

          |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


           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.


          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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          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  

          7)Excludes from enrollment in the CalMediConnect demonstration  
            project specified Medi-Cal beneficiaries, including  

             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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          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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                                                                    Page  5

               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  

            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  

          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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