BILL NUMBER: AB 859 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 30, 2015
AMENDED IN ASSEMBLY MARCH 26, 2015
INTRODUCED BY Assembly Member Medina
FEBRUARY 26, 2015
An act to add and repeal Article 4.6 (commencing with
Section 14146) to Chapter 7 of Part 3 of Division 9 of, and
to repeal Section 14146.1 of, of 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, and until January 1, 2021, 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 limit application of the plan
apply only to noncapitated payment plans in
Medi-Cal. Medi-Cal fee-for-service plans. This bill
would require the department to seek any fede ral
approvals necessary to implement the requirements of the bill and to
obtain federal financial participation, as specified.
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 noncapitated
fee-for-service Medi-Cal payment plans in
Medi-Cal. plans.
(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.
(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.
(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.
14146.2. (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.