BILL NUMBER: AB 1117 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MARCH 26, 2015
INTRODUCED BY Assembly Member Cristina Garcia
FEBRUARY 27, 2015
An act to add Article 6.3 (commencing with Section 14197) to
Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions
Code, 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 state the intent of the Legislature to
enact legislation to improve vaccination rates for persons 2 years of
age in Medi-Cal managed care. 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 program. The bill
would require the department to develop a plan for the collection and
expenditure of CCIQIF 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 demonstration project. This bill
would make these provisions inoperative on a specified date.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Article 6.3 (commencing with Section
14197) is added to Chapter 7 of Part 3 of Division 9 of the
Welfare and Institutions Code , to read:
Article 6.3. California Childhood Immunization Quality
Improvement Fund (CCIQIF) Program
14197. (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.
14197.1. 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).
14197.2. (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.
14197.3. 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.
14197.4. (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.
14197.5. 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.
14197.6. (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.
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.