BILL ANALYSIS Ó
SENATE COMMITTEE ON BUDGET AND FISCAL REVIEW
Senator Mark Leno, Chair
2015 - 2016 Regular
Bill No: AB 1605 Hearing Date: June 13,
2016
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|Author: |Committee on Budget |
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|Version: |June 13, 2016 As amended |
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|Urgency: |No |Fiscal: |Yes |
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|Consultant|Michelle Baass |
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Subject: Health
Summary: This bill is the omnibus health trailer bill, and contains
changes to implement the 2016-17 budget.
Proposed
Law: The bill makes technical and clarifying statutory revisions
necessary to implement the Budget Act of 2016. Specifically,
this bill:
1.Medi-Cal: Estate Recovery. Limits estate recovery in the
Medi-Cal program to only those health care services required
to be collected under federal law; to make it easier for
individuals to pass on their assets by using the narrower
definition of "estate" in federal Medicaid law; and to allow a
hardship exemption from estate recovery for a home of modest
value. Budget year costs are $5.7 million General Fund; $28.9
million General Fund in out years.
2.Medi-Cal - Acupuncture. Restores acupuncture services as a
covered benefit under the Medi-Cal program. This benefit was
eliminated in the 2009 budget in response to the state's
fiscal crisis. Budget year costs are $3.7 million General
Fund; $4.4 million General Fund in out years.
3.Medi-Cal: Workers Compensation. Eliminates the sunset
provision and indefinitely extends the Department of
Industrial Relations authority to supply work-related injury
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or claim data from the Workers' Compensation Information
System to the Department of Health Care Services (DHCS).
4.Medi-Cal: Emergency Medical Air Transportation. Requires the
Department of Finance to report to the Legislature on the
fiscal impact to Medi-Cal of, and the planned reimbursement
methodology for emergency medical air transportation services
after, the termination of the certain vehicle penalty
assessments.
5.Medi-Cal: Electronic Health Records. Increases the annual
General Fund limit, from $200,000 to $450,000, for state
administrative costs associated with the implementation of the
Medi-Cal Electronic Health Records Incentive Program.
6.Medi-Cal: Supplemental Drug Rebates. Makes minor technical
changes to correct non-sequential lettering errors and
inconsistent language to accurately preserve the intent and
purpose of SB 870 (Committee on Budget and Fiscal Review),
Chapter 40, Statutes of 2014, to collect supplemental drug
rebate revenues for certain prescription drugs based on drug
utilization from all eligible Medi-Cal programs.
7.Medi-Cal: Federal Outpatient Drug Rule. Provides DHCS
authority to comply with the final federal rule related to
Medicaid reimbursement for covered outpatient drugs. The
final rule, issued on February 1, 2016, requires states to
align pharmacy reimbursements with the actual acquisition cost
of drugs and to pay an appropriate professional dispensing
fee.
8.Medi-Cal: Behavioral Health Treatment (BHT) Transition
Contract. Provides DHCS the authority to establish a contract
to assist specified individuals with finding comprehensive
health coverage. The eligible individuals are those who were
receiving only BHT services from a regional center as of
January 31, 2016, and will be losing eligibility for
full-scope Medi-Cal without a share of cost on March 31, 2017,
due to the transition of BHT services from a covered benefit
under the California Home and Community-Based Waiver program
for Individuals with Developmental Disabilities (DD) to a
covered benefit under the California Medi-Cal State Plan.
9.Medi-Cal: Suspend County COLA for Administration. Suspends the
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county cost-of-living adjustment (COLA) for county eligibility
administration for 2016-17. Deletes outdated language
referencing the Healthy Families Program which transitioned to
Medi-Cal in 2013-14.
10.Program of All-Inclusive Care for the Elderly (PACE). Makes
the following changes:
a. Standardizes rate-setting to allow DHCS to determine
comparability of cost and experience between PACE and
like population subsets served through long-term services
and supports (LTSS) integration into managed care health
plans under the Coordinated Care Initiative. Statutory
change is necessary as DHCS is currently required to use
a fee-for-service (FFS) equivalent cost/upper payment
limit methodology to set capitation rates for PACE
organizations.
b. Removes existing statutory language that caps the
number of PACE Organizations with which DHCS can
contract.
c. Removes existing statutory language to align with
updated PACE federal rules and regulations.
d. Adds new statutory language enabling DHCS to seek
flexibility from the Centers for Medicare and Medicaid
Services (CMS) on several issues, including the
composition of the PACE interdisciplinary team, marketing
practices, and development of a streamlined PACE waiver
process.
11.Long-Term Care Quality Assurance Fund. Makes the Long-Term
Care Quality Assurance Fund continuously appropriated without
regard to fiscal year. This aligns the expenditure authority
of programs supported by the Long-Term Care Quality Assurance
Fund with available fee revenues. Expenditures from the fund
are used to offset General Fund expenditures for long-term
care provider reimbursements.
12.Children's Continuum of Crisis Services. Establishes a
one-time grant program to expand the continuum of mental
health crisis services for children and youth (ages 21 and
under) regardless of where they live in the state.
Specifically, this bill spells out the following objectives:
a. Add child/youth-specific mobile crisis and
community-based crisis stabilization support teams
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which can provide in-home and community- based support
to the youth and family members. These teams would
include clinical and paraprofessional staff who can
support the youth/family until the crisis subsides or
until appropriate secure alternatives are located.
Essential components include:
i. Crisis planning
ii. Assessment of precipitant of crisis and
behaviors that are accruing, and child/family safety
iii. Stabilization of functioning
iv. Referral and coordination
v. Post-crisis follow-up services
b. Add triage personnel who would be available at
various points of access, such as clinics and schools.
These personnel could provide the following services:
coordination, referral, monitoring service delivery,
and providing placement service assistance.
c. Add crisis stabilization unit services lasting
less than 24 hours which can provide facility-based
support to children/youth who are in psychiatric
crisis, as well as providing support to their family
members and natural supports. The goal of crisis
stabilization is to avoid the need for inpatient
services during the current crisis and more
importantly, to provide children/youth and the family
members with the supports needed to avoid crisis in
the future.
Crisis stabilization unit programming is designed to
support and assist children/youth and their caregivers
to prepare for the youth's rapid return to their home
and community environment. The strengths-based
assessment and treatment plan will address potential
barriers to this. These services must be provided at a
licensed 24-hour health care facility. Essential
components include:
i. Assessment
ii. Crisis planning
iii. Stabilization of functioning
iv. Referral and coordination
d. Add child/youth crisis residential services
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which are community-based treatment options in
home-like settings that offer safe, trauma-informed
alternatives to psychiatric emergency units or other
locked facilities for youth under the age of 18.
Child/youth crisis residential services are provided
in the context of a comprehensive, multi-disciplinary,
and individualized treatment plan that is frequently
reviewed and updated based on the individual's
clinical needs, strengths, and response to treatment.
Essential components include:
v. Therapeutic programming provided seven
days a week.
vi. Facilities limited to under 16 beds with
at least 50 percent of those beds in single
occupancy rooms.
vii. Facilities include ample physical space
for working with individuals who provide natural
support to each child/youth and for integrating
family members into the day-to-day care of the
youth.
viii. Collaboration with each child/youth's
mental health team, child and family team (CFT), and
other paid and natural supports within 24 hours of
intake and throughout the course of care and
treatment as appropriate.
e. Add family respite care to help families and
sustain caregiver health and well-being.
f. Add family support services training designed
to help families participate in the planning process,
access services, and navigate programs. These
services will follow "a train the trainer" model which
includes, at a minimum:
i. Training and education
ii. Outreach
iii. Engagement
iv. Communication
v. Advocacy
1.Office of AIDS. Makes the following changes:
a. Eliminates cost-sharing for individuals enrolled in
the AIDS Drug Assistance Program with annual incomes
between 400 percent and 500 percent of the federal
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poverty level. DPH estimates that 112 ADAP clients at
this income level paid an ADAP share of cost (SOC).
b. Develops a Pre-Exposure Prophylaxis (PrEP)
affordability program to cover PrEP-related copays,
coinsurance, and deductibles incurred by all individuals
accessing PrEP in California with annual incomes below
500 percent of the federal poverty level. The cost of
this program would be capped at $1 million from the Ryan
White Supplemental Drug Rebate Fund.
c. Allows the Office of AIDS' Health Insurance Premium
Payment (OA-HIPP) Program to cover premiums, copays,
coinsurance, and deductibles incurred by all eligible
people living with HIV/AIDS in California. DPH estimates
that 5,966 private insurance ADAP clients did not receive
premium payment assistance from OA-HIPP Program.
Consequently, this proposal would result in expenditures
of $8.6 million in 2016-17 (based on calendar year 2015
data).
1.Alzheimer - Early Detection. Requires the Department of Public
Health (DPH) to allocate funds to the California Alzheimer
Disease Centers to determine the standard of care in early and
accurate diagnosis, provide professional outreach and
education, and evaluate the educational effectiveness of these
efforts. (The 2016-17 budget provides funds for this purpose
on a one-time basis.)
2.Hepatitis. Requires DPH to purchase and distribute hepatitis B
vaccines and related materials to local health jurisdictions
and community-based organizations; purchase hepatitis C test
kits and related materials; train nonmedical personnel to
perform hepatitis C and HIV testing; and provide technical
assistance to local governments and community-based
organizations regarding syringe exchange and disposal
programs. (The 2016-17 budget provides funds for this purpose
on a one-time basis.)
3.Naloxone. Requires DPH to award funding to local health
departments, local government agencies, or on a competitive
basis to community-based organizations to support or establish
programs that provide Naloxone, an overdose prevention drug.
(The 2016-17 budget provides funds for this purpose on a
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one-time basis.)
4.Covered California - Emergency Regulation Authority. Provides
Covered California with emergency regulation authority in
order to react to changes in federal regulations relating to
notices, the special enrollment period verification process,
and dental eligibility; changes related to increased
enrollment in the small business exchange; and changes that
may be necessary to timely implement a Section 1332 waiver.
5.California Office of Health Information Integrity. Makes
technical and clarifying changes to the California Office of
Health Information Integrity's duties with regard to continued
compliance with the federal Health Insurance Portability and
Accountability Act.
Fiscal
Effect: This bill continuously appropriates the Long-Term Care Quality
Assurance Fund.
Support: None on file.
Opposed: None on file.
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