Amended in Assembly April 30, 2015

Amended in Assembly March 26, 2015

California Legislature—2015–16 Regular Session

Assembly Bill No. 859

Introduced by Assembly Member Medina

February 26, 2015

An act to add begin insert and repeal end insert Article 4.6 (commencing with Section 14146) to Chapter 7 of Part 3 of Division 9 begin delete of, and to repeal Section 14146.1 of, end delete begin insert of end insert the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

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 require the department, on or before December 31, 2016, begin insert and until January 1, 2021, end insert 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 begin delete provide that end delete begin insert limit application of end insert the plan begin delete apply only end delete to begin delete noncapitated payment plans in Medi-Cal. end delete begin insert Medi-Cal fee-for-service plans. This bill would require the department to seek any federal approvals necessary to implement the requirements of the bill and to obtain federal financial participation, as specified. end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

Article 4.6 (commencing with Section 14146) is
added to Chapter 7 of Part 3 of Division 9 of the Welfare and
Institutions Code, to read:

 

Article 4.6.  Treatment and Reduction of Obesity Act

 

14146.  

The Legislature finds and declares all of the following:

(a) Obesity is a chronic disease and increases the risk of, and
aggravates, cardiovascular disease, cancer, diabetes, and arthritis.
Obesity is the only chronic disease for which Americans face
prohibitions for access to treatment.

(b) Twenty-five percent of California’s population has obesity.
Of this population, 37.7 percent are African American and 31.3
percent are Hispanic.

(c) In the 2014 Medi-Cal Statistical Report, the department
found that the proportion of adults suffering with obesity was the
highest among adults enrolled in Medi-Cal, higher than the
privately insured market and the uninsured population.

(d) Treatment of an individual with obesity should include an
individualized treatment plan and should be able to include
medications, very low calorie diets, surgery, and lifestyle changes
such as diet, exercise, and behavioral therapy.

(e) In addition to the improved health of patients, by confronting
obesity and reducing the average Body Mass Index (BMI) by just
5 percent, significant savings can be achieved. Reducing the BMI
by 5 percent in just five years could save California approximately
$28.9 billion. By 2030, California’s potential savings could be 7.6
percent in overall health care spending.

14146.1.  

(a) On or before December 31, 2016, the department
shall create an Obesity Treatment Action Plan (OTAP) to diagnose,
treat, and reduce the incidence of adult obesity in the Medi-Cal
program, and shall report the plan to the Legislature along with
any legislative recommendations to implement the plan.

(b) The OTAP shall apply only to begin delete noncapitated end delete begin insert fee-for-service
Medi-Cal end insert payment begin delete plans in Medi-Cal. end delete begin insert plans. end insert

(c) The OTAP shall include evidence-based principles and
obesity treatment guidelines from nationally recognized provider
associations, including, but not limited to, the following:

(1) The American Society of Bariatric Physicians.

(2) The Endocrine Society.

(3) The American Association of Clinical Endocrinologists.

(4) The Academy of Nutrition and Dietetics and the American
Society of Metabolic and Bariatric Surgery.

(5) The Obesity Society.

(d) The OTAP shall include all of the following:

(1) A plan for educating fee-for-service physicians regarding
the importance of screening for obesity and treatment options
available in Medi-Cal.

(2) A plan for identifying and screening patients for obesity.

(3) A review of current coverage of services to treat obesity and
recommendations with evidence-based rationale on the continuum
of coverage of additional obesity treatment services, including
nutritional, exercise, and lifestyle counseling and pharmacotherapy.

begin delete

(e) (1) A report to be submitted pursuant to subdivision (a)
shall be submitted in compliance with Section 9795 of the
Government Code.

(2) Pursuant to Section 10231.5 of the Government Code, this
section is repealed on January 1, 2021.

end delete begin insert

(e) The department shall seek any federal approvals necessary
to implement the requirements of this section and to obtain federal
financial participation to the maximum extent permitted by federal
law.

end insert

begin insert

begin insert 14146.2. end insert   

(a) A report submitted pursuant to Section 14146.1
shall be submitted in compliance with Section 9795 of the
Government Code.

(b) Pursuant to Section 10231.5 of the Government Code, this
article is repealed on January 1, 2021.

end insert