AB 859, as amended, Medina. Medi-Cal: obesity treatment plans.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law specifies the benefits provided pursuant to the program.
This bill would declare the intent of the Legislature to enact legislation to provide beneficiaries in the Medi-Cal program who have been diagnosed by a physician and surgeon as obese or morbidly obese with a comprehensive obesity treatment plan.
end deleteThis bill would require the department, on or before December 31, 2016, to create an Obesity Treatment Action Plan to diagnose, treat, and reduce the incidence of adult obesity in the Medi-Cal program. The bill would require the department to report the plan to the Legislature, along with any legislative recommendations to implement the plan. The bill would require the plan to include evidence-based principles and obesity treatment guidelines from specified provider associations, a plan for identifying and screening patients for obesity, and a review of coverage services to treat obesity. The bill would provide that the plan apply only to noncapitated payment plans in Medi-Cal.
end insertVote: majority.
Appropriation: no.
Fiscal committee: begin deleteno end deletebegin insertyesend insert.
State-mandated local program: no.
The people of the State of California do enact as follows:
begin insertArticle 4.6 (commencing with Section 14146) is
2added to Chapter 7 of Part 3 of Division 9 of the end insertbegin insertWelfare and
3Institutions Codeend insertbegin insert, to read:end insert
4
The Legislature finds and declares all of the following:
8(a) Obesity is a chronic disease and increases the risk of, and
9aggravates, cardiovascular disease, cancer, diabetes, and arthritis.
10Obesity is the only chronic disease for which Americans face
11prohibitions for access to treatment.
12(b) Twenty-five percent of California’s population has obesity.
13Of this population, 37.7 percent are African American and 31.3
14percent are Hispanic.
15(c) In the 2014 Medi-Cal Statistical Report, the department
16found that the proportion of adults suffering with obesity was the
17highest among adults enrolled in Medi-Cal, higher than the
18privately insured
market and the uninsured population.
19(d) Treatment of an individual with obesity should include an
20individualized treatment plan and should be able to include
21medications, very low calorie diets, surgery, and lifestyle changes
22such as diet, exercise, and behavioral therapy.
23(e) In addition to the improved health of patients, by confronting
24obesity and reducing the average Body Mass Index (BMI) by just
255 percent, significant savings can be achieved. Reducing the BMI
26by 5 percent in just five years could save California approximately
27$28.9 billion. By 2030, California’s potential savings could be 7.6
28percent in overall health care spending.
(a) On or before December 31, 2016, the department
30shall create an Obesity Treatment Action Plan (OTAP) to diagnose,
31treat, and reduce the incidence of adult obesity in the Medi-Cal
P3 1program, and shall report the plan to the Legislature along with
2any legislative recommendations to implement the plan.
3(b) The OTAP shall apply only to noncapitated payment plans
4in Medi-Cal.
5(c) The OTAP shall include evidence-based principles and
6obesity treatment guidelines from nationally recognized provider
7associations, including, but not limited to, the following:
8(1) The American Society of Bariatric Physicians.
9(2) The Endocrine Society.
10(3) The American Association of Clinical Endocrinologists.
11(4) The Academy of Nutrition and Dietetics and the American
12Society of Metabolic and Bariatric Surgery.
13(5) The Obesity Society.
14(d) The OTAP shall include all of the following:
15(1) A plan for educating fee-for-service physicians regarding
16the importance of screening for obesity and treatment options
17available in Medi-Cal.
18(2) A plan for identifying and screening patients for obesity.
19(3) A review of current coverage
of services to treat obesity and
20recommendations with evidence-based rationale on the continuum
21of coverage of additional obesity treatment services, including
22nutritional, exercise, and lifestyle counseling and
23pharmacotherapy.
24(e) (1) A report to be submitted pursuant to subdivision (a)
25shall be submitted in compliance with Section 9795 of the
26Government Code.
27(2) Pursuant to Section 10231.5 of the Government Code, this
28section is repealed on January 1, 2021.
It is the intent of the Legislature to enact
30legislation to provide beneficiaries in the Medi-Cal program who
31have been diagnosed by a physician and surgeon as obese or
32morbidly obese with a comprehensive obesity treatment plan.
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