Amended in Assembly September 4, 2015

Senate Bill No. 36

Introduced by Senators Hernandez and De León

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(Principal coauthor: Assembly Member Bonta)

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December 1, 2014

An act to add begin delete Article 5.5 (commencing with Section 14184) to Chapter 7 of Part 3 of Division 9 of end delete begin insert Section 14166.253 to end insert the Welfare and Institutions Code, relating to Medi-Cal, and declaring the urgency thereof, to take effect immediately.

LEGISLATIVE COUNSEL’S DIGEST

SB 36, as amended, Hernandez. Medi-Cal: demonstration project.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. Existing law provides for a demonstration project under the Medi-Cal program until October 31, 2015, to implement specified objectives, including better care coordination for seniors and persons with disabilities and maximization of opportunities to reduce the number of uninsured individuals.

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This bill would require the State Department of Health Care Services to submit an application to the federal Centers for Medicare and Medicaid Services for a waiver to implement a demonstration project that, among other things, continues the state’s momentum and successes in innovation achieved under the demonstration project described above. The bill would require the department to consult with interested stakeholders and the Legislature in developing the waiver application.

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This bill would authorize the Director of Health Care Services, if the State Department of Health Care Services has not received adequate assurances from the federal Centers for Medicare and Medicaid Services before November 1, 2015, that the department’s application for a subsequent demonstration project, as specified, is likely to be approved with an effective date of November 1, 2015, to request one or more temporary extensions until the approved effective date of the subsequent demonstration project. The bill would require the department, under an approved temporary extension, subsequent demonstration project, or as otherwise permitted under existing federal Medicaid law, to extend and apply existing payment methodologies and allocations, as prescribed. Requirements of the bill would be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not jeopardized. The bill would authorize the department, until July 1, 2016, to implement, interpret, or make specific this section by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions without taking regulatory action.

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This bill would declare that it is to take effect immediately as an urgency statute.

Vote: ²⁄₃. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

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SECTION 1.  

Article 5.5 (commencing with Section 14184) is
added to Chapter 7 of Part 3 of Division 9 of the Welfare and
Institutions Code, to read:

 

Article 5.5.  Renewal of Health Care Coordination,
Improvement, and Long-Term Cost Containment Waiver or
Demonstration Project

 

14184.  

(a) The department shall submit an application to the
federal Centers for Medicare and Medicaid Services for a waiver
to implement a demonstration project that does all of the following:

(1) Furthers the delivery of high-quality and cost-efficient care
for Medi-Cal beneficiaries.

(2) Ensures the long-term viability of the delivery system
following the expansion of Medi-Cal eligibility under the federal
Patient Protection and Affordable Care Act.

(3) Continues California’s momentum and successes in
innovation achieved under the 2010 “Bridge to Reform” Waiver.

(b) In developing the waiver application, the department shall
consult with interested stakeholders and the Legislature.

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begin insert SECTION 1. end insert   

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begin insert Section 14166.253 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , to read: end insert

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begin insert 14166.253. end insert   

(a) If the department has not received adequate
assurances from the federal Centers for Medicare and Medicaid
Services (CMS) before November 1, 2015, that the department’s
application for a subsequent demonstration project, as defined in
subdivision (x) of Section 17612.2 and as submitted pursuant to
Section 17612.8, is likely to be approved with an effective date of
November 1, 2015, the director may request one or more temporary
extensions, as necessary to continue the operation of, and the
authorities provided under, the federal Medicaid demonstration
project titled “California Bridge to Reform Demonstration”
(waiver number 11-W-00193/9), until the approved effective date
of the subsequent demonstration project.

(b) To the extent permitted under the terms of any approved
temporary extension obtained by the department pursuant to
subdivision (a), an approved subsequent demonstration project,
or as otherwise permitted under federal Medicaid law, the
department shall, after consulting with the affected designated
public hospitals, extend and apply the payment methodologies and
allocations described in this article and in effect during the
successor demonstration project, on a state fiscal year, annual,
partial year, or other basis, consistent with any applicable
implementing provisions of the Medi-Cal state plan and
requirements imposed by the CMS. The department may make
payments on an interim basis and subject to reconciliation to
amounts payable under the payment and allocation methodologies
applicable to any approved temporary extension obtained by the
department pursuant to subdivision (a) or approved subsequent
demonstration project.

(c) This section shall be implemented only to the extent that any
necessary federal approvals are obtained and federal financial
participation is available and is not jeopardized.

(d) Until July 1, 2016, in the event of a conflict between the
terms of any federally approved extension obtained by the
department pursuant to subdivision (a) and this article, the terms
of the federally approved temporary extension shall control, and
the department shall provide notice of the conflict to the
appropriate policy and fiscal committees of the Legislature.

(e) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department may implement, interpret, or make specific this
section by means of all-county letters, plan letters, plan or provider
bulletins, or similar instructions without taking regulatory action
until July 1, 2016.

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SEC. 2.  

This act is an urgency statute necessary for the
immediate preservation of the public peace, health, or safety within
the meaning of Article IV of the Constitution and shall go into
immediate effect. The facts constituting the necessity are:

In order to make changes to state-funded health care programs
at the earliest possible time, it is necessary that this act take effect
immediately.