BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 1568|
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THIRD READING
Bill No: AB 1568
Author: Bonta (D) and Atkins (D), et al.
Amended: 6/2/16 in Senate
Vote: 27 - Urgency
SENATE HEALTH COMMITTEE: 7-0, 6/8/16
AYES: Hernandez, Nguyen, Mitchell, Monning, Nielsen, Pan, Roth
NO VOTE RECORDED: Hall, Wolk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 6/20/16
AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen
ASSEMBLY FLOOR: 80-0, 5/31/16 - See last page for vote
SUBJECT: Medi-Cal: demonstration project
SOURCE: Author
DIGEST: This bill enacts specified statutory provisions of
Medi-Cal 2020, the states 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.
ANALYSIS: Existing law 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
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benefits. Emergency and essential diagnostic and restorative
dental services are part of the covered benefits of the
Denti-Cal program.
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) 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.
3) 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
federal financial participation (FFP) for services provided
to these individuals.
4) 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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5) 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.
6) Requires each WPC pilot to include, at a minimum, specified
entities as WPC participating entities in addition to the WPC
lead entity, including at least one Medi-Cal managed care
plan, the health service agency where the WPC operates, the
local agency responsible for specialty mental health
services, at least two community partners and at least one
other public agency. 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.
7) Requires DHCS to enter into a pilot agreement with each WPC
lead entity approved for participation in the WPC pilot
program.
8) 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.
9) Requires payments to WPC pilots to be disbursed twice a year
to the WPC lead entity following the submission of required
reports.
10)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
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.
11)Requires WPC lead entities to submit mid-year and annual
reports to DHCS, in accordance with the schedules and
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guidelines established by DHCS and consistent with the STCs.
12)Requires the nonfederal share of any payments under the WPC
pilot program to consist of voluntary intergovernmental
transfers (IGTs) of funds provided by participating
governmental agencies or entities, in accordance with this
bill and the terms of the pilot agreement.
13)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.
14)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.
15)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.
16)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).
17)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.
18)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.
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19)Permits providers in either the dental FFS or dental managed
care Medi-Cal delivery systems to participate in the DTI.
20)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.
21)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.
22)Makes this bill operative contingent upon the enactment of
SB 815 (Hernandez and DeLeón).
23)Takes effect immediately as an urgency statute
Comments
1)Author's statement. According to the author, this bill is
needed to provide the statutory framework for implementation
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).
FISCAL EFFECT: Appropriation: Yes Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
The following information represents the fiscal impact of the
entire Section 1115 waiver. Although AB 1568 contains only a
portion of the implementing language for the new waiver, this
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bill is contingent on SB 815 (the other implementing bill) and
the federal government has approved Medi-Cal 2020 as a single
waiver. Therefore, the fiscal information below reflects the
complete fiscal impact of the waiver.
Over the course of the five-year waiver period, the state will
be able to access at least $6.2 billion in additional federal
funding that the state would not be eligible for without the
waiver. The state is eligible for the additional funding under
the waiver for two primary reasons. First, the state's
continuing use of Medi-Cal managed care reduces costs relative
to the alternative fee-for-service system. The federal
government will allow the state to use a portion of those
projected savings for waiver programs. Second, the federal
government will allow the state draw down federal matching funds
for certain "state only" health care programs that are not
currently eligible for federal funding. The General Fund savings
from receiving those additional federal funds will be redirected
to a specific waiver program.
The following are the major elements of Medi-Cal 2020. Note that
the funding amounts are for the five-year waiver period, unless
otherwise noted.
1)PRIME - $3.7 billion (federal funds). The PRIME program
authorizes federal matching funds to make incentive payments
to Designated Public Hospitals and District/Municipal Public
Hospitals in order to improve care delivery and strengthen
their ability to take on risk-based payments.
2)Global Payment Program - at least $236 million (federal
funds). The Global Payment Program restructures the
distribution of federal funding for uncompensated care. This
includes disproportionate share hospital funding (DSH) to
designated public hospitals (excluding University of
California hospitals) in order to incentivize improvements in
care delivery and provision of care in appropriate settings.
Medi-Cal 2020 maintains the DSH funding methodology for other
hospitals, with DSH funding for UC hospitals capped by fiscal
year. The $236 million in federal funding is only for the
first year of the waiver. Additional funding in subsequent
years will be determined based on future uncompensated care.
Also, the figures above do not include existing DSH funding of
about $5.9 billion in federal funds over the waiver period.
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3)Dental Transformation Initiative - $375 million (federal
funds). The Dental Transformation Initiative permits incentive
payments to qualified dental providers to improve dental care
and utilization among children enrolled in Medi-Cal. The state
share of funding for this program is provided through the
redirection of existing General Fund support for specific
state only health care programs which will be eligible for
federal matching funds under the waiver.
4)Designated State Health Programs - $375 million (federal
funds). The waiver authorizes the state to access federal
matching funds for several existing health care programs that
are currently funded only with state and local funds. By
making these programs eligible for federal matching funds, the
waiver frees up state funding to support the Dental
Transformation Initiative and to draw down federal matching
funds.
5)Whole Person Care - $1.5 billion (federal funds). This program
allows participating lead entities (primarily counties) to
claim federal matching funds for efforts to coordinate health,
behavioral health, and social services for high-risk Medi-Cal
beneficiaries who are high-utilizers of health care services.
Federal matching funds will be available for a variety of
social services and supports that are not eligible for federal
matching funds absent the waiver.
DHCS has requested additional administrative funding to oversee
Medi-Cal 2020 of $34 million over the five-year waiver period,
including $11 million in the Budget Year (General Fund and
federal funds).
SUPPORT: (Verified6/21/16)
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
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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
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
OPPOSITION: (Verified6/21/16)
None received
ARGUMENTS IN 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
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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.
ASSEMBLY FLOOR: 80-0, 5/31/16
AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker,
Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke,
Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley,
Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth
Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto,
Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper,
Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim,
Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis,
Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte,
O'Donnell, Olsen, Patterson, Quirk, Ridley-Thomas, Rodriguez,
Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting,
Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon
Prepared by:Scott Bain / HEALTH / (916) 651-4111
6/22/16 17:53:47
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