Amended in Assembly June 1, 2015

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 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 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: 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 begin delete 2014--15 end delete begin insert 2014-15 end insert 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 begin delete two year olds end delete begin insert two-year-olds end insert 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 begin delete outweighs end delete begin insert outweigh end insert the costs of not providing
routine immunizations. It is estimated that for every begin delete $1 end delete begin insert one dollar
($1) end insert spent on vaccinations, as many as begin delete $29 end delete begin insert twenty-nine dollars
($29) end insert 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
begin delete no end delete begin insert fewer end insert 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 begin delete two year
old end delete begin insert two-year-old end insert 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 begin delete 120 end delete begin insert 270 end insert 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 begin delete for provider support payments end delete begin insert for use by the
department for administrative staff, training, and other resources end insert
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. begin insert The funds shall also be used to
pay for the department’s staffing and administrative costs directly
attributable to implementing this article, including costs related
to developing and seeking federal approval for the CCIQIF and
administering the fund. end insert

(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 begin delete $125 end delete begin insert one hundred twenty-five
dollars ($125) end insert 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 begin delete chapter end delete begin insert article end insert 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 begin delete chapter end delete begin insert article end insert 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.