BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 1117 (Cristina Garcia) - Medi-Cal: vaccination rates
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|Version: June 1, 2015 |Policy Vote: HEALTH 6 - 1 |
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|Urgency: No |Mandate: No |
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|Hearing Date: August 17, 2015 |Consultant: Brendan McCarthy |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: AB 1117 would require the Department of Health Care
Services to create a program to provide incentive payments to
Medi-Cal managed care plans for fully vaccinated children. The
incentive payments would be supported with voluntary donations
by Medi-Cal managed care plans.
Fiscal
Impact:
One-time costs of $315,000 for the Department of Health Care
Services to develop program rules and methodologies for
distributing incentive payments, apply for federal approval to
implement the program, and contract with an independent
evaluator (General Fund and federal funds).
One-time costs likely in the low hundreds of thousands for an
independent evaluation of the program (private funds and
federal funds).
Ongoing administrative costs of $125,000 per year to
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administer the program and ensure the correct processing of
incentive payments (private funds and federal funds).
Ongoing costs up to $50 million per year to make incentive
payments to Medi-Cal managed care plans for children who are
currently fully vaccinated and additional incentive payments
of about $4 million per year for each additional 5% increase
in the rate of fully vaccinated children. There are about
540,000 children under age two enrolled in Medi-Cal managed
care and currently 75% of two year olds have been fully
vaccinated. The bill requires incentive payments of $125 to be
made to Medi-Cal managed care plans per fully vaccinated
child. The cost to provide incentive payments for children in
managed care who are currently fully vaccinated would be about
$50 million. To the extent that the bill successfully
incentivizes managed care plans to increase vaccination rates,
each increase in the vaccination rate of 5% would increase
incentive payments by about $4 million.
The bill requires the program to be implemented to the extent
that federal matching funds are available. Under federal law,
voluntary contributions can be made to state Medicaid programs
to support program activities. However, federal law generally
prohibits "bona fide provider-related donations" from
including provisions that hold donors harmless or a practice
under which donations are returned to the donors. Under this
bill, Medi-Cal managed care plans would be making donations
that would be paid directly back to managed care plans, and
plans that have the highest vaccination rates are most likely
to be those plans making donations. Therefore, the program is
not likely to meet federal requirements and federal matching
funds may not be provided.
Background: Under state and federal law, the Department of Health Care
Services operates the Medi-Cal program, which provides health
care coverage to low income individuals, families, and children.
Medi-Cal provides coverage to childless adults and parents with
household incomes up to 138% of the federal poverty level and to
children with household incomes up to 266% of the federal
poverty level. The federal government provides matching funds
that vary from 50% to 90% of expenditures depending on the
category of beneficiary.
Medi-Cal covers all recommended childhood vaccines. One of the
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quality measures used by the state to evaluate the performance
of Medi-Cal managed care plans is the HEDIS measure system,
which includes vaccination rates for children under age two.
According to the most recent data, the statewide average rate
for fully vaccinated children was about 75%.
The state does not currently use HEDIS or other performance
measures to provide financial incentives to Medi-Cal managed
care plans. However, in counties where there are more than one
Medi-Cal managed care plan, the state does use certain
performance measures to assign new managed care enrollees to
higher scoring plans when the enrollee does not select a
specific plan.
Proposed Law:
AB 1117 would require the Department of Health Care Services
to create a program to provide incentive payments to Medi-Cal
managed care plans for fully vaccinated children. The incentive
payments would be supported with voluntary donations by Medi-Cal
managed care plans.
Specific provisions of the bill would:
Require the Department of Health Care services to
develop an incentive program to improve childhood
immunization rates;
Require the Department to apply for federal approval to
conduct the program and receive federal matching funds;
Make the program operational for five years;
Authorize the program to be financed by donations from
Medi-Cal managed care plans and matching federal funds;
Allocate 33% of program funds for Department
administrative costs, training for providers, and other
strategies to increase immunization rates;
Allocate 67% of funds for $125 incentive payments to
Medi-Cal managed care plans for each enrollee who receives
all the recommended vaccinations by age two;
Require at least 20% of incentive payments made to
managed care plans to be passed through to providers;
Require an independent evaluation of the program;
Require the bill to be implemented only to the extent
that federal funding is available;
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Sunset the bill upon a declaration of the Director of
Health Care Services that the program has concluded.
Related
Legislation: SB 277 (Pan and Allen, Statutes of 2015)
eliminates the personal belief exemption from the requirement
that children entering school receive specified vaccinations.
Staff
Comments: As noted above, current federal law and regulation
seem to prohibit the use of federal funds to match donations to
Medicaid programs that will be returned to the donors. It would
appear that the financing mechanism in this bill would not meet
the necessary criteria for the receipt of federal matching
funds.
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