Amended in Assembly March 26, 2015

California Legislature—2015–16 Regular Session

Assembly Bill No. 1117

Introduced by Assembly Member Cristina Garcia

February 27, 2015

An act begin insert to add Article 6.3 (commencing with Section 14197) to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, end insert relating to vaccinations.

LEGISLATIVE COUNSEL’S DIGEST

AB 1117, as amended, Cristina Garcia. Medi-Cal: vaccination rates.

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 requires each county to establish a community child health and disability prevention program to include, among other things, health screening and evaluation services for all children that include immunizations and an assessment of immunization status.

This bill would begin delete state the intent of the Legislature to enact legislation to improve vaccination rates for persons 2 years of age in Medi-Cal managed care. end delete begin insert require the State Department of Health Care Services to establish and administer the California Childhood Immunization Quality Improvement Fund (CCIQIF) program to improve childhood immunization rates, and would require the department to submit an application to the federal Centers for Medicare and Medicaid Services for a waiver to implement a 5-year demonstration project to implement the end insert begin insert program. The bill would require the department to develop a plan for the collection and expenditure of CCIQIF end insert begin insert moneys according to specified guidelines, including voluntary contributions from Medi-Cal managed care plans to be used for provider support payments and reward payments to Medi-Cal managed care plans, as specified. The bill would require the department to contract with specified researchers to develop and submit to the Legislature an evaluation of the effectiveness of the end insert begin insert demonstration project. This bill would make these provisions inoperative on a specified date. end insert

Vote: majority. Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program: no.

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

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert Article 6.3 (commencing with Section 14197) is
added to Chapter 7 of Part 3 of Division 9 of the end insert begin insert Welfare and
Institutions Code end insert begin insert , to read: end insert

begin insert

 

Article begin insert 6.3. end insert   California Childhood Immunization Quality
Improvement Fund (CCIQIF) Program

 

begin insert 14197. end insert   

(a) The Legislature finds and declares all of the
following:

(1) The 2014--15 outbreaks of vaccine-preventable diseases
threaten the health and safety of the California public.

(2) Only 71 percent of young children in California between
the ages of 19 to 35 months are immunized, which is below the
national average of 75 percent, according to 2010 data reported
by the Kaiser Family Foundation.

(3) In 2013, 39,000 two year olds lacked one or more
recommended immunizations, according to the State Department
of Health Care Services.

(4) The social and direct economic costs of ensuring each child
receives the Centers for Disease Control and Prevention Advisory
Committee for Immunization Practices recommended schedule for
vaccines far outweighs the costs of not providing routine
immunizations. It is estimated that for every $1 spent on
vaccinations, as many as $29 can be saved in direct and indirect
costs.

(5) California children are required to be fully vaccinated before
they enter kindergarten, with some exceptions. However, there are
no official requirements for younger children who are often more
susceptible to dire consequences from vaccine-preventable
diseases.

(b) It is the intent of the Legislature, by enacting this chapter,
to ensure that all possible steps are taken to ensure that two year
old children who are enrolled in Medi-Cal managed care receive
all recommended immunizations.

begin insert 14197.1. end insert   

For purposes of this article, “Medi-Cal managed
care plan” means any prepaid health plan or Medi-Cal managed
care plan contracting with the department to provide services to
enrolled Medi-Cal beneficiaries under this chapter or Chapter 8
(commencing with Section 14200).

begin insert 14197.2. end insert   

(a) The department shall establish and administer
the California Childhood Immunization Quality Improvement Fund
(CCIQIF) program to improve childhood immunization rates.

(b) (1) The department shall submit an application to the federal
Centers for Medicare and Medicaid Services for a waiver or
demonstration project to implement the CCIQIF program no later
than 120 days after the operative date of this article. The
department shall determine the form of waiver most appropriate
to achieve the purposes of this article.

(2) The demonstration project shall operate for a period of five
years.

(c) In developing the waiver or demonstration project
application, the department shall consult with interested
stakeholders, including the Medi-Cal Children’s Health Advisory
Panel and the Managed Care Advisory Workgroup. The department
shall work with stakeholders to incorporate public comment into
the waiver or demonstration project application.

begin insert 14197.3. end insert   

The department shall develop a plan for the collection
and expenditure of CCIQIF moneys according to all of the
following guidelines:

(a) The CCIQIF program may be financed through voluntary
contributions from Medi-Cal managed care plans that shall be
used to draw down federal financial participation consistent with
federal law.

(b) The department shall allocate 33.3 percent of CCIQIF
expenditures for provider support payments to support providers
in employing strategies to improve immunization rates in their
practices, which may include patient reminders, promotion of
colocation vaccination delivery with other services, and other
strategies as specified by the department after consideration of
public comment.

(c) (1) The department shall allocate 66.7 percent of CCIQIF
expenditures for reward payments to Medi-Cal managed care
plans. The rate of the reward shall be $125 for each enrollee who
receives all recommended vaccinations by the time he or she
reaches two years of age, as determined by the Childhood
Immunization Status measure of the Healthcare Effectiveness Data
and Information Set (HEDIS).

(2) Any unearned reward payment expenditures shall roll over
to the subsequent demonstration project year. If all reward payment
expenditures are earned within a demonstration project year, no
additional reward payments shall be distributed until the next
demonstration project year begins.

(d) At least 20 percent of the CCIQIF expenditures used for
reward payments pursuant to subdivision (c) shall be passed
through to contracted providers based on the number of Medi-Cal
enrollees who are under two years of age in each provider’s
respective panel.

begin insert 14197.4. end insert   

(a) The department shall contract with the University
of California or any other researchers to develop and submit, in
compliance with Section 9795 of the Government Code, to the
Legislature an evaluation of the effectiveness of the demonstration
project using data collected from the first three years of the waiver
period or demonstration project. That evaluation shall be submitted
within the fourth year of the waiver period or demonstration
project.

(b) The evaluation shall, at a minimum, include an assessment
of the most effective administrative support strategies.

(c) The evaluation shall be financed with no more than five
percent of the total annual CCIQIF program expenditure dollars.
During the waiver or demonstration project year that the
evaluation is commissioned, CCIQIF provider support expenditures
shall be reduced, commensurate with available funds, to offset the
cost of the evaluation contract.

begin insert 14197.5. end insert   

This chapter shall be implemented only if and to the
extent that federal financial participation is available and any
necessary federal approvals have been obtained.

begin insert 14197.6. end insert   

(a) This chapter shall become inoperative on the
date that the Director of Health Care Services executes a
declaration, which shall be retained by the director, stating that
the demonstration project has concluded, and shall, six months
after the date the declaration is executed, be repealed.

(b) In addition to the requirements specified in subdivision (a),
the director shall post the declaration on the department’s Internet
Web site and the director shall send the declaration to the
appropriate policy committees of the Legislature and to the
Legislative Counsel.

end insert

begin delete

SECTION 1.  

It is the intent of the Legislature to enact
legislation to improve vaccination rates for persons two years of
age in Medi-Cal managed care.

end delete