BILL ANALYSIS Ó
AB 1117
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Date of Hearing: April 29, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
AB
1117 (Cristina Garcia) - As Amended March 26, 2015
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill creates a 5-year program to provide $125 incentives
per fully vaccinated child to Medi-Cal managed care plans, in
order to increase the rate of 2 year-olds in Medi-Cal who are
fully vaccinated.
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The bill relies on voluntary provider contributions to leverage
federal funds. It also allocates 1/3 of the funding raised to
providers employing strategies to increase immunization rates.
FISCAL EFFECT:
1)DHCS would incur costs in the range of low hundreds of
thousands of dollars (GF/federal), to develop and seek federal
approval for a program. The annual administrative costs would
be of a similar magnitude.
2)It is unclear precisely how much funding would be raised. A
successful incentive program could be about $30 million per
year (GF/federal), with $10 million allocated to provider
support.
COMMENTS:
1)Purpose. According to the author, this bill will bring
additional resources to the health care system to help improve
California's relatively low vaccination rates for 2-year-olds.
The author notes Medi-Cal has been plagued by low childhood
immunization rates, creating a serious public health risk, as
demonstrated by the recent whooping cough and measles
outbreaks.
2)Current Programs. Managed care plans measure quality of
services delivered by providers, and vaccination rates are a
key pediatric quality measure. Plans may currently provide
incentives to providers, but it is not always done on a
centralized basis-though some private collaborations exist,
such as the Integrated Healthcare Association which measures
and rewards performance of provider groups. The program
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created by this bill would leverage federal funds to create an
incentive program that would reward all Medi-Cal managed care
providers with a consistent incentive, regardless of the plan.
3)Related Legislation. SB 277 (Pan and Allen), pending in the
Senate, eliminates the personal belief exemption for vaccines
required for school admission.
4)Staff Comments.
a) Administrative costs. The bill does not provide for
administrative costs of DHCS to be reimbursed by funds from
CCIQIF. The required evaluation can be reimbursed from the
CCIQIF, but only an amount not exceeding 5% of the
donations can be spent.
b) Requirements on DHCS. This bill allows DHCS only 120
days from its effective date to submit a waiver request to
CMS. Given significant other workload, and the
Legislature's general preference that waivers be subject to
ample public input and review prior to submittal, this
timetable seems abrupt.
c) Is the incentive adequate? The program will have to
raise enough funds so that providers and plans can be
assured they will receive a payment for vaccinating more
children than they currently vaccinate.
d) Incentivizing what? Some plans, such as Kaiser
Permanente, have more sophisticated and integrated data
systems that allow quality of care data to be reported with
greater ease. Incentives as those contemplated in this
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bill may encourage plans to improve data collection in
order to qualify for incentives (a positive thing in its
own right), but separating improved documentation from
actual improvements in quality of care may be difficult.
It is challenging, but the author may wish to consider
whether there are ways to ensure these incentives target
improvements in quality of care, not just better data
collection.
e) Voluntary Contributions. It is unclear how the voluntary
contributions could work in practice. If a plan was aware
its data quality is low and it would be difficult to
substantiate full vaccination, it would have little
incentive to contribute money to a pot whose rewards flow
to higher-performing competitors. Additionally, plans may
wish to ensure dollars provided to DHCS to encourage are
targeted equitably throughout California, and they are
getting their money's worth for the contributions they
provide.
f) Public Health May Be a Better Fit for Provider
Education. The author may wish to consider providing
funding to the California Department of Public Health
through a cross-department collaboration, instead of to
DHCS. As purchaser of health care services, DHCS may be
less equipped to do work on the ground to support
providers. Improving vaccination rates is a core public
health goal and the provider support strategies appears
suited to a "grant" model of funding, which is familiar to
public health departments. Locals have strong public
health departments, and provide much of the care themselves
to Medi-Cal enrollees through the public health care
system. Public health, and particularly in the area of
vaccination, has a strong history of community partnership
and collaboration with providers to improve practice and
encourage alignment with professional standards. At the
state level, the CDPH Immunization Branch administers the
federal Vaccines for Children program, which works directly
with providers, runs the immunization registry, and tracks
data on immunizations. Indeed, the Institutes of Medicine
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promotes integration of primary care and public health.
Finally, definition of services to be provided in the
provider support portion could use clarification.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081