BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON HEALTH
                          Senator Ed Hernandez, O.D., Chair

          BILL NO:                    AB 1568             
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          |AUTHOR:        |Bonta and Atkins                               |
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          |VERSION:       |June 2, 2016                                   |
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          |HEARING DATE:  |June 8, 2016   |               |               |
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          |CONSULTANT:    |Scott Bain                                     |
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           SUBJECT  :  Medi-Cal:  demonstration project

           SUMMARY  : Enacts specified statutory provisions of "Medi-Cal 2020," the  
          state's recently approved five-year federal Section 1115 waiver,  
          which runs through December 31, 2020, including the Dental  
          Transformation Initiative, the Whole Person Care program and the  
          evaluations required under the Special Terms of Conditions  
          (STCs) of Medi-Cal 2020. Requires the Department of Health Care  
          Services to conduct or arrange to have conducted studies,  
          reports and assessments required under the STCs. Urgency bill.
          
          Existing law:
          1)Establishes the Medi-Cal program, which is administered by the  
            Department of Health Care Services (DHCS) and under which  
            qualified low-income persons receive health care benefits.  
            Emergency and essential diagnostic and restorative dental  
            services are part of the covered benefits of the Denti-Cal  
            program.

          2)Establishes a Medicaid Section 1115 demonstration project  
            under the Medi-Cal program until October 31, 2015 known as  
            California's Bridge to Reform, to implement specified  
            objectives, including better care coordination for Seniors and  
            Persons with Disabilities (SPDs) and maximization of  
            opportunities to reduce the number of uninsured individuals.

          3)Provides for payments under the state's Bridge to Reform  
            waiver to designated public hospitals (DPHs are the University  
            of California [UC] and county hospitals), and for federal  
            disproportionate share (DSH), payments to private hospitals  
            (referred to as "DSH replacement payments") and non-designated  
            public hospitals (NDPHs are now referred to as  
            District/Municipal Public Hospitals or DMPH) through October  







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            1, 2015. 

          This bill:
          1)Requires DHCS to establish and operate the Whole Person Care  
            (WPC) pilot program as authorized under Medi-Cal 2020 to allow  
            for development of WPC pilots focused on target populations of  
            high-risk, high-utilizing Medi-Cal beneficiaries in local  
            geographic areas. 

          2)Establishes as the goal of WPC is the coordination of health,  
            behavioral health, and social services, as applicable, in a  
            patient-centered manner to improve beneficiary health and  
            well-being through more efficient and effective use of  
            resources.

          3)Requires WPC pilots to provide an option to a county, city and  
            county, a health or hospital authority or a consortium of any  
            of these entities to receive support to integrate care for  
            particularly vulnerable Medi-Cal beneficiaries who have been  
            identified as high users of multiple systems and who continue  
            to have or are at-risk of poor health outcomes. 

          4)Defines the WPC target population as the population or  
            populations identified by a WPC pilot through a collaborative  
            data approach across partnering entities that identifies  
            common Medi-Cal high-risk, high-utilizing beneficiaries who  
            frequently access urgent and emergency services, including  
            across multiple systems. Permits, at the discretion of the WPC  
            lead entity, and in accordance with guidance as may be issued  
            by DHCS during the application process and approved by DHCS,  
            the WPC target population to include individuals who are not  
            Medi-Cal patients, subject to the funding restrictions in the  
            STCs regarding the availability of FFP for services provided  
            to these individuals.

          5)Requires WPC pilots to include specific strategies to increase  
            integration among local governmental agencies, health plans,  
            providers, and other entities that serve high-risk,  
            high-utilizing beneficiaries, increase coordination and  
            appropriate access to care, reduce inappropriate inpatient and  
            emergency room utilization, improve data collection and  
            sharing among local entities, improve health outcomes for the  
            WPC target population and permits it to include other  
            strategies to increase access to housing and supportive  
            services.








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          6)Requires WPC pilots to be approved by DHCS through the process  
            outlined in the STCs.

          7)Makes receipt of WPC services voluntary, and permits  
            beneficiaries to opt out at any time.

          8)Requires the WPC lead entity to be responsible for operating  
            the WPC pilot, conducting ongoing monitoring of WPC  
            participating entities, arranging for the required reporting,  
            ensuring an appropriate financial structure is in place, and  
            identifying and securing a permissible source of the  
            nonfederal share for WPC pilot payments.

          9)Requires each WPC pilot to include, at a minimum, all of the  
            following entities as WPC participating entities in addition  
            to the WPC lead entity: 

                a)      At least one Medi-Cal managed care plan operating  
                  in the geographic area of the WPC pilot;
                b)      The health services agency or agencies or  
                  department or departments for the geographic region  
                  where the WPC pilot operates, or any other public entity  
                  operating in that capacity for the county or city and  
                  county; 
                c)      The local entities, agencies, or departments  
                  responsible for specialty mental health services for the  
                  geographic area where the WPC pilot operates; 
                d)      At least one other public agency or department,  
                  which may include, but is not limited to, county alcohol  
                  and substance use disorder programs, human services  
                  agencies, public health departments, criminal justice or  
                  probation entities, and housing authorities, regardless  
                  of how many of these fall under the same agency head  
                  within the geographic area where the WPC pilot operates;  
                  and, 
                e)  At least two other community partners serving the  
                  target population within the applicable geographic area.

          1)Permits a WPC lead entity to request an exemption from this  
            requirement from DHCS if a   WPC lead entity cannot reach an  
            agreement with a required participant.

          2)Requires DHCS to enter into a pilot agreement with each WPC  
            lead entity approved for participation in the WPC pilot  








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            program. 

          3)Permits the sharing of health information, records, and other  
            data with and among WPC lead entities, and allows WPC  
            participating entities to share health information, records,  
            and other data with and among prospective WPC lead entities  
            and WPC participating entities in the process of identifying a  
            proposed target population and preparing an application for a  
            WPC pilot.

          4)Permits WPC pilots to target the focus of their pilot on  
            individuals at risk of or are experiencing homelessness who  
            have a demonstrated medical need for housing or supportive  
            services. Requires, in these instances, WPC participating  
            entities to include local housing authorities, local continuum  
            of care programs, community-based organizations, and others  
            serving the homeless population as entities collaborating and  
            participating in the WPC pilot. 

          5)Permits the housing interventions to include tenancy-based  
            care management services, defined as supports to assist the  
            target population in locating and maintaining medically  
            necessary housing, and countywide housing pools.

          6)Permits WPC participating entities to include contributions to  
            a countywide housing pool that will directly provide needed  
            support for medically necessary housing services, with the  
            goal of improving access to housing and reducing churn in the  
            Medi-Cal population.

          7)Requires payments to WPC pilots to be disbursed twice a year  
            to the WPC lead entity following the submission of required  
            reports.

          8)Requires DHCS to issue a WPC pilot application and selection  
            criteria consistent with the STCs, requires DHCS to approve  
            applicants that meet the WPC pilot selection criteria  
            established by DHCS, and requires DHCS to allocate available  
            funding to those approved WPC pilots up to the full amount of  
            FFP authorized under the demonstration project for WPC pilots  
            during each calendar year from 2016 to 2020.

          9)Requires that payments to the WPC pilot are intended to  
            support infrastructure to integrate services among local  
            entities that serve the WPC target population, to support the  








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            availability of services not otherwise covered or directly  
            reimbursed by Medi-Cal to improve care for the WPC target  
            population, and to foster other strategies to improve  
            integration, reduce unnecessary utilization of health care  
            services, and improve health outcomes. 

          10)Requires WPC lead entities to submit mid-year and annual  
            reports to DHCS, in accordance with the schedules and  
            guidelines established by DHCS and consistent with the STCs. 

          11)Requires the nonfederal share of any payments under the WPC  
            pilot program to consist of voluntary IGTs of funds provided  
            by participating governmental agencies or entities, in  
            accordance with this bill and the terms of the pilot  
            agreement.

          12)Requires DHCS to claim FFP for WPC pilot payments using  
            moneys from the IGTs and FFP, and requires moneys disbursed  
            from the fund, and all associated FFP to be distributed to WPC  
            lead entities.

          13)Requires DHCS to implement the Dental Transformation  
            Initiative (DTI) in accordance with the STCs, with the goal of  
            improving the oral health care for Medi-Cal children zero to  
            20, inclusive, years of age.

          14)Establishes as the purpose of the DTI is to improve the oral  
            health care for Medi-Cal children with a particular focus on  
            increasing the statewide proportion of qualifying children  
            enrolled in the Medi-Cal Dental Program who receive a  
            preventive dental service by 10 percentage points over a  
            five-year period.

          15)Requires the DTI to include the following four domains as  
            outlined in the STCs:

               a)     Increase Preventive Services Utilization for  
                 Children;
               b)     Caries Risk Assessment and Disease Management Pilot;  

               c)     Increase continuity of care; and,
               d)     Local Dental Pilot Projects (LDPPs).
                
          1)Requires, under the DTI, incentive payments within each domain  
            to be available to qualified providers who meet the  








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            requirements of the domain.

          2)Requires the DTI to be funded at a maximum of $148 million  
            annually, and for five years totaling a maximum of $740  
            million, except as provided in the STCs. Permits unspent funds  
            to be rolled over to subsequent years.

          3)Permits DHCS to earn additional demonstration authority, up to  
            a maximum of $10 million to be added to the DTI Pool for use  
            in paying incentives to qualifying providers under DTI by  
            achieving higher performance improvement, as indicated in the  
            STCs.

          4)Permits providers in either the dental FFS or dental managed  
            care Medi-Cal delivery systems to participate in the DTI. 

          5)Requires DHCS to make DTI incentive payments directly to  
            eligible contracted service office locations. 

          6)Requires incentive payments to be issued to the service office  
            location based on the services rendered at the location and  
            that service office location's compliance with the criteria  
            enumerated in the STCs.

          7)Requires that incentive payments from the DTI Pool are  
            intended to support and reward eligible service office  
            locations for achievements within one or more of the project  
            domains. Prohibits incentive payments from being considered as  
            a direct reimbursement for dental services under Medi-Cal.

          8)Requires service office locations to submit all data in a  
            manner acceptable to DHCS within one year from the date of  
            service or by January 31 for the preceding year that the  
            service was rendered, whichever occurs sooner, to be eligible  
            for DTI incentive payments associated with that timeframe.

          9)Permits DHCS to implement this bill or the STCs by means of  
            letters or bulletins without taking regulatory action.  
            Requires notification to the Joint Legislative Budget  
            Committee and to the Senate Committees on Appropriations,  
            Budget and Fiscal Review, and Health, and the 
          Assembly Committees on Appropriations, Budget, and Health within  
            10 business days after the above-described action is taken.

          10)Permits DHCS to enter into exclusive or nonexclusive  








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            contracts or amend existing contracts on a bid or negotiated  
            basis. Exempts these contracts from specified provisions of  
            the Public Contract Code and Department of General Services  
            (DGS) review.

          11)Requires DHCS to seek any federal approval as necessary to  
            implement Medi-Cal 2020, this bill and any changes to the STCs  
            as deemed necessary. Implements this only to the extent  
            federal financial participation (FFP) is available and is not  
            otherwise jeopardized.

          12)Permits the DHCS director to modify any process or  
            methodology in this bill to the extent necessary to comply  
            with federal law or the STCs, but only if the modification is  
            consistent with the goals of this bill.

          13)Requires the DHCS director develop a methodology by which  
            payments under Medi-Cal 2020 are reduced if the amount of FFP  
            is reduced due to the application of penalties in the STC, the  
            enforcement of the budget neutrality limit or other similar  
            occurrence.

          14)Permits DHCS to claim FFP for expenditures associated with  
            designated state health programs (DSHP) identified in the  
            STCs.

          15)Establishes the continuously appropriated WPC Pilot Special  
            Fund in the State Treasury. 

          16)Requires DHCS to conduct or arrange to have conducted any  
            study, report, assessment, evaluation or other similar  
            demonstration project activity required under the STCs,  
            including 
          the two evaluations of the Global Payment Program, the PRIME  
            evaluation, the WPC evaluations, and the DTI evaluation.

          17)Makes this bill operative contingent upon the enactment of SB  
            815 (Hernandez and DeLeon).

          18)Would take effect immediately as an urgency statute

           FISCAL  
          EFFECT  :  According to the Assembly Appropriations Committee of  
          the previous version of this bill: 









          AB 1568 (Bonta)                                    Page 8 of ?
          
          
          1)DHCS has requested administrative resources through an April  
            2016 Spring Finance Letter totaling $33.6 million for waiver  
            implementation over its five-year lifetime, $14 million of  
            which is for contract costs. DHCS requests $10.8 million in  
            2016-17. Funding will pay for staff and contract costs for  
            implementation, monitoring, oversight, evaluation and  
            assessment, technical assistance, program development, and  
            related activities (General Fund/federal).


          2)Federal matching funds available by waiver program component  
            are as follows: 


             PRIME                         $3.73 billion 
             Global Payment Program        $236 million* 
             Dental Transformation Initiative $375 million 
             Designated State Health Programs$375 million 
             Whole Person Care        $1.5 billion 
             -------------------------------------------------------------- 
        ---------------- 
                                   Total $6.21 billion

            *GPP does not include the federal DSH component of funding.  
            Federal DSH funding over  the five-year life of the waiver is  
            projected to be about $5.8 billion. In addition, only the  
            first year of federal funding for GPP is shown here. Funding  
            in subsequent years is based on a study on DPH uncompensated  
            care.

           PRIOR  
          VOTES  :  
          
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          |Assembly Floor:                     |80 - 0                      |
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          |Assembly Appropriations Committee:  |20 - 0                      |
          |------------------------------------+----------------------------|
          |Assembly Health Committee:          |17 - 0                      |
          |                                    |                            |
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           COMMENTS  :
          1)Author's statement. According to the author, this bill is  
            needed to provide the statutory framework for implementation  








          AB 1568 (Bonta)                                    Page 9 of ?
          
          
            of "Medi-Cal 2020." While the STCs outline the programmatic  
            and financing elements of Medi-Cal 2020, state law changes are  
            required, to appropriate funds for the waiver-related WPC  
            provisions, to enable data sharing as part of WPC projects,  
            and to codify the provisions of the STCs establishing the DTI  
            and the WPC. In addition, this bill would require DHCS to  
            conduct or contract for the waiver-required evaluations. This  
            bill is a companion measure to SB 815 (Hernandez and De Leon).  


          2)Federal Section 1115 Medicaid Waivers. Section 1115 of the  
            Social Security Act authorizes the federal Secretary of Health  
            and Human Services to allow states to receive federal Medicaid  
            matching funds without complying with all of the federal  
            Medicaid rules. Traditionally designed as research and  
            demonstration programs to test innovative program improvements  
            and to facilitate coverage expansions to populations not  
            otherwise eligible for Medicaid, waivers are also used to  
            allow states to change how services are delivered, and to  
            change how services are reimbursed. In addition, under Section  
            1115, states are allowed to use federal Medicaid funds in ways  
            that are not otherwise allowed under federal law and  
            regulation (referred to expenditure authority for "costs not  
            otherwise matchable" or CNOM). 

          Section 1115 waivers are approved at the discretion of the  
            Secretary of HHS through negotiations between a state and CMS  
            for projects that the Secretary determines promote Medicaid  
            program objectives. Section 1115 waivers are generally  
            approved for a five-year period and then must be renewed.  
            Although not required by statute or regulation, longstanding  
            federal administrative policy has required waivers to be  
            "budget neutral" for the federal government, meaning that  
            federal spending under a waiver must not be more than  
            projected federal spending in the state without the waiver.

            On December 30, 2015, DHCS received CMS approval of  
            "California Medi-Cal 2020 Demonstration" (Medi-Cal 2020). The  
            five year waiver begins January 1, 2016 and ends December 31,  
            2020. Medi-Cal 2020 is anticipated to provide $6.2 billion in  
            federal funds over the five years of the waiver. 

          3)DTI. The DTI is a new feature of Medi-Cal 2020. It is funded  
            at $750 million total funds ($375 million in federal funds)  
            generated from federal waiver funding drawn down for  








          AB 1568 (Bonta)                                    Page 10 of ?
          
          
            Designated State Health Programs. Of this amount, $10 million  
            in total funds is contingent upon the state meeting statewide  
            metrics. DTI consists of four domain areas as follows:

               a)     Domain 1: Increase Preventive Services Utilization  
                 for Children. The goal of this domain is to increase  
                 statewide proportion of children ages 20 and under  
                 enrolled in Medi-Cal who receive a preventive dental  
                 service by 10 percentage points over a five-year period  
                 (the 2014 rate for children was 37.84%). Incentive  
                 payments will be made annually to providers for  
                 utilization and provider participation and will be used  
                 to determine the subsequent year's threshold. Semi-annual  
                 incentive payments will be made to dental provider  
                 service locations that provide preventative services to  
                 an increased number of Medi-Cal children, as compared to  
                 the DHCS-determined baseline. Incentive payments will be  
                 made to the service office locations for rendered  
                 preventive services once they have met the  
                 DHCS-established goal. As of September 2015, there were  
                 5,370 service office locations in California that  
                 participated in Denti-Cal.

               b)     Domain 2: Caries Risk Assessment and Disease  
                 Management. The goal of this domain is to diagnose early  
                 childhood caries (cavities) by utilizing Caries Risk  
                 Assessments (CRA) to treat caries as a chronic disease  
                 for children ages six and under. The CRA would be a model  
                 that proactively prevents and mitigates oral disease  
                 through the delivery of preventative services in lieu of  
                 more invasive and costly procedures (restorative  
                 services). Children will have treatment plans prescribed  
                 based on caries risk level. DHCS will use a baseline year  
                 with statewide data for the most recent state fiscal year  
                 preceding implementation of the domain. DHCS will track  
                 and report the following measures: 

                       i.             Number of, and percentage change in,  
                         restorative services; 
                       ii.            Number of, and percentage change in,  
                         preventive dental services; 
                       iii.           Utilization of CRA CDT codes and  
                         reduction of caries risk levels (not available in  
                                the baseline year prior to the waiver  
                         implementation); 








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                       iv.            Change in use of emergency rooms for  
                         dental-related reasons among the targeted  
                         children for this domain; and,
                       v.             Change in number and proportion of  
                         children receiving dental surgery under general  
                         anesthesia. 

               Dentists must opt-in by completing a DHCS recognized  
               training program. Treatment plans and associated procedures  
               will be carried out as follows, over a 12 month period, as  
               follows: 

                       i.             "high risk" children will be  
                         authorized to visit four times; 
                       ii.            "moderate risk" children will be  
                         authorized to visit three times; and,
                       iii.           "low risk" children will be  
                         authorized to visit two times.

               Incentive payments will be made to providers for successful  
               completion of caries treatment plan and improvement in  
               "elevated risk" levels. 

             a)   Domain 3: Increase Continuity of Care. The goal of this  
               domain is to increase continuity of care for beneficiaries  
               ages 20 and under for two, three, four, five, and six  
               continuous periods. DHCS will establish a baseline year  
               will be based on data from the most recent complete state  
               fiscal year using claims data to determine the number of  
               beneficiaries who received an examination each year from  
               the same service office location for two, three, four,  
               five, and six year continuous periods. Incentive payments  
               will be available to service office locations that provide  
               examinations to an enrolled Medi-Cal child for two, three,  
               four, five, and six continuous periods. The incentive  
               payment will be an annual flat payment for providing  
               continuity of care to the beneficiary.

             b)   Domain 4: Local Dental Pilot Programs (LDPPs). LDPPS  
               will address one or more of the three domains through  
               alternative programs, potentially using strategies focused  
               on rural areas including local case management initiatives  
               and education partnerships. DHCS will solicit proposals  
               once at the beginning of the demonstration and will review,  
               approve, and make payments for LDPPs in accordance with the  








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               requirements stipulated in the waiver. A maximum of 15  
               LDPPs will be approved, and no more than 25% of the total  
               funding in the DTI pool can be used for LDPPs. The specific  
               strategies, target populations, payment methodologies, and  
               participating entities will be proposed by the entity  
               submitting the application for participation and included  
               in the submission to DHCS. Each pilot application must  
               designate a responsible county, Tribe, Indian Health  
               Program, UC or CSU campus as the entity that will  
               coordinate the pilot. 

          1)WPC. WPC is a new feature of Medi-Cal 2020. WPC is essentially  
            a grant program over the five years of the waiver. The  
            overarching goal of the WPC pilots is the coordination of  
            health, behavioral health, and social services, as applicable,  
            in a patient-centered manner with the goals of improved  
            beneficiary health and well-being through more efficient and  
            effective use of resources. WPC pilots will provide an option  
            to participating entities to receive support to integrate care  
            for beneficiaries who are high-risk and high-utilizers of  
            multiple systems and continue to have poor health outcomes.  
            WPC pilots will include collaboration between two or more  
            public entities (e.g. county mental health plans and local  
            housing authorities), at least one Medi-Cal managed care  
            health plan, and other community entities with the goal of  
            improving health outcomes for the WPC population. Program  
            strategies would include increasing integration, data sharing  
            and coordination among county agencies, health plans,  
            providers, and other entities within the participating county  
            or counties that serve high-risk, high-utilizing beneficiaries  
            and develop an infrastructure that will reduce inappropriate  
            emergency and inpatient utilization, increase coordination and  
            appropriate access to care and increase collaboration and  
            integration among the entities participating in the WPC Pilots  
            over the long term. The WPC target populations, include, but  
            are not limited to individuals:

               a)     With repeated incidents of avoidable emergency use,  
                 hospital admissions, or nursing facility placement; 
               b)     With two or more chronic conditions; 
               c)     With mental health and/or substance use disorders; 
               d)     Who are currently experiencing homelessness; and/or,  

               e)     Who are at risk of homelessness, including  
                 individuals who will experience homelessness upon release  








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                 from institutions (e.g. hospital, skilled nursing  
                 facility, rehabilitation facility, jail/prison, etc.)

            To test interventions that achieve these improved health  
            outcomes and cost savings, WPC Pilots may focus on Medi-Cal  
            beneficiaries with a demonstrated medical need for housing and  
            supportive services. These Pilots would ensure that the  
            entities collaborating and participating in the Pilot would  
            include local housing authorities, community-based  
            organizations, and others serving the homeless population. WPC  
            pilots with a focus on housing may include interventions such  
            as tenancy-based care management services and county housing  
            pools. 

            Up to $300 million in federal funding is available annually  
            for WPC. No single WPC pilot will be awarded more than 30% of  
            total available funding unless additional funds are available  
            after all initial awards are made. The non-federal share of  
            funds used to draw down federal funding is through IGTs.  

            The STCs establish an early implementation schedule for WPC.  
            DHCS is required to publish a WPC pilot application process,  
            detailed timeliness and selection criteria by April 1, 2016,  
            or within 90 days following CMS approval of WPC Pilot  
            attachments, whichever is later. WPC lead entities must submit  
            WPC Pilot applications to DHCS by May 15, 2016, or 45 days  
            after DHCS issues the WPC Pilot application process (whichever  
            is later). DHCS must complete its review of the application  
            within 60 days of submission, and will respond to the WPC  
            Pilot Lead Entity in writing with any questions, concerns or  
            problems identified. Within 30 days after submission of final  
            responses to questions about the application, DHCS will take  
            action on the application and promptly notify the applicant  
            and CMS of that decision. 

          1)Waiver required reports, assessments and analyses. The Waiver  
            also contains several independent analyses of the Medi-Cal  
            program and evaluations of the Waiver programs, including:

       a)          Medi-Cal Managed Care Access Assessment (language  
                      contained in SB 815); 
       b)          Uncompensated Care Assessments for California hospitals  
                      (one due in 2016 and one due one in 2017); 
       c)          GPP Evaluations (2 required); 
       d)          PRIME Evaluation; and, 








          AB 1568 (Bonta)                                    Page 14 of ?
          
          
       e)          Report on CCS pilots

            This bill requires DHCS to conduct or arrange to have  
            conducted any study, report, assessment, evaluation or other  
            similar demonstration project activity required under the  
            STCs. 

          1)Related legislation. SB 815 (Hernandez and De Leon), is a  
            companion measure to this bill currently pending in the  
            Assembly Health Committee.  The Medi-Cal 2020 waiver includes  
            four major components: GPP, PRIME, WPC, and DTI. SB 815 bill  
            contains the provisions implementing the GPP and PRIME and the  
            access assessment requirements while AB 1568 contains the WPC  
            and DTI provisions, including all the required evaluations of  
            the four waiver components. SB 815 is scheduled to be heard in  
            the Assembly Health Committee on June 8, 2016.


          2)Prior legislation.
               a)     SB 36 (Hernandez and De Leon, Chapter 759, Statutes  
                 of 2015), authorized DHCS to request one or more  
                 temporary waiver extensions to continue the operation of,  
                 and the authorities provided under, the current  
                 "California Bridge to Reform Demonstration," the state's  
                 Section 1115 Medicaid waiver. Requires DHCS to extend and  
                 apply the existing hospital payment methodologies and  
                 allocations on a state fiscal year, annual, partial year,  
                 or other basis, to the extent permitted under any  
                 approved temporary waiver extension, an approved  
                 subsequent waiver, or as otherwise permitted under  
                 federal Medicaid law.

               b)     AB 1066 (John A. Pérez, Chapter 86, Statutes of  
                 2011), made further statutory changes to implement the  
                 Bridge to Reform for funding DPHs.  AB 1066 continued the  
                 FFS cost-based reimbursement for DPHs, with those  
                 hospitals providing the required federal match using  
                 their own funds through CPEs. In addition, AB 1066  
                 established under the waiver a new distribution  
                 methodology for DSH and SNCP funds to DPHs, as specified.

               c)     AB 342 (John A. Pérez, Chapter 723, Statutes of  
                 2010), enacted the LIHP to provide health care benefits  
                 to uninsured adults up to 200% of the FPL, at county  
                 option through a Medi-Cal waiver demonstration project.








          AB 1568 (Bonta)                                    Page 15 of ?
          
          

               d)     SB 208 (Steinberg, Chapter 714, Statutes of 2010),  
                 implemented provisions of the 2010 Section 1115 waiver  
                 including establishing the Public Hospital Investment,  
                 Improvement and Incentive Fund (known as DRSIP)  
                 consisting of IGTs from counties or other specified  
                 governmental entities, to be matched with federal funds  
                 and to be used for investment, improvement and incentive  
                 payments for DPHs and the affiliated governmental  
                 entities (counties and UC); authorized DHCS to require  
                 the mandatory enrollment of SPDs in a Medi-Cal managed  
                 care plan commencing on the later of either June 1, 2011,  
                 or obtaining federal approval; and requires DHCS to  
                 implement pilot projects to provide coordinated care to  
                 children in CCS and to persons who are dually eligible  
                 for Medi-Cal and Medicare.

               e)     SB 1100 (Perata, Chapter 560, Statutes of 2005),  
                 enacted the statutory framework for implementing a  
                 five-year waiver of federal Medicaid requirements that  
                 provides federal Medicaid funding under the terms of the  
                 waiver to pay DPHs, private, and district hospitals for  
                 services provided to Medi-Cal and uninsured patients. 

          3)Support. This bill is supported by hospitals and consumer and  
            labor groups, which write in support of the $6.2 billion in  
            federal funds and the new waiver funding components, including  
            PRIME, GPP and WPC. The California State Association of  
            Counties (CSAC) states that the WPC Pilots will test new care  
            innovations and leverage lessons learned to improve outcomes;  
            contain costs; and more effectively coordinate care beyond  
            traditional health services. CSAC concludes that the Medi-Cal  
            2020 Waiver renewal is a strong and ambitious blueprint for  
            building on the success of the Medi-Cal program and its  
            continued transformation. 

            Western Center on Law & Poverty (WCLP) writes in support of  
            the WPC and DTI provisions. WCLP states it supports the WPC  
            element of the waiver, which would provide federal matching  
            funds to local collaboratives working to improve health  
            outcomes for high-risk Medi-Cal beneficiaries by integrating  
            physical health and behavioral health services together with  
            social service supports. Because being homeless or at risk for  
            homelessness is such a significant risk factor and because it  
            is so difficult to improve health outcomes for people who are  








          AB 1568 (Bonta)                                    Page 16 of ?
          
          
            homeless, WCLP urges a stronger emphasis on serving this  
            population. WCLP also requests the strategies to increase  
            access to housing and supportive services be required instead  
            of optional. 

            WCLP also writes that it supports the inclusion of the DTI in  
            the waiver and the bill as access to dental services for  
            children on Medi-Cal has received important attention due to  
            recent audits and reports and the DTI takes some important  
            steps to address inadequate access to Denti-Cal services for  
            children. WCLP states it would have liked to have seen  
            elements aimed at access for adults as well as dental care for  
            pregnant women is particularly important. WCLP writes that it  
            supports the provision stating that dental managed care  
            providers are eligible for the incentive payments.

           SUPPORT AND OPPOSITION (prior version)  :
          Support:  Antelope Valley Hospital 
                    Association of California Healthcare Districts 
                    Bear Valley Community Healthcare District 
                    California Association of Public Hospitals and Health  
               Systems 
                    California Hospital Association 
                    California Primary Care Association 
                    California State Association of Counties 
                    Coalinga Regional Medical Center 
                    Contra Costa County 
                    County Health Executives Association of California 
                    County of San Bernardino 
                    District Hospital Leadership Forum 
                    El Camino Hospital 
                    Hazel Hawkins Memorial Hospital
                    Health Access California
                    Kern County Hospital Authority 
                    Kern Valley Healthcare District 
                    Mammoth Hospital 
                    Marin General Hospital 
                    Mayers Memorial Hospital District
                    Northern Inyo Hospital 
                    Palo Verde Hospital 
                    Palomar Health 
                    Pioneers Memorial Healthcare District 
                    Plumas District Hospital 
                    Salinas Valley Memorial Healthcare System 
                    San Bernardino Mountains Community Hospital District 








          AB 1568 (Bonta)                                    Page 17 of ?
          
          
                    San Gorgonio Memorial Hospital 
                    San Joaquin General Hospital 
                    Santa Clara County Board of Supervisors 
                    SEIU California 
                    Seneca Healthcare District 
                    Sierra View Medical Center 
                    Tahoe Forest Hospital District 
                    Tri-City Medical Center 
                    University of California 
                    Urban Counties of California 
                    Western Center on Law and Poverty
                    Ventura County Board of Supervisors 
                    Washington Hospital Healthcare System

          Oppose:   None received
          
                                      -- END --