BILL ANALYSIS Ó SB 75 Page 1 (Without Reference to File) SENATE THIRD READING SB 75 (Committee on Budget and Fiscal Review) As Amended June 16, 2015 Majority vote. Budget Bill Appropriation Takes Effect Immediately SENATE VOTE: Vote not relevant SUMMARY: This is the Omnibus Health Trailer Bill for 2015-16. It contains necessary changes related to the Budget Act of 2015. This bill makes various statutory changes to implement the 2015-16 Budget. Specifically, this bill: 1)Requires enrolling providers in the Every Woman Counts, Improving Access, Counseling, and Treatment for Californians with Prostate Cancer (IMPACT), and Family Planning Access Care and Treatment (FPACT) programs to provide enrolling individuals information on how to apply for insurance affordability programs. 2)Codifies the existing practice of providing dental referrals to children in the Children's Health and Disability Program at one year of age. SB 75 Page 2 3)Extends the timelines for incorporating the Multipurpose Senior Services Program (MSSP) into the Coordinated Care Initiative. Requires MSSP services to transition from a federal waiver to a managed care benefit in Coordinated Care Initiative (CCI) counties no later than December 31, 2017, or on the date the managed care plans and MSSP providers jointly satisfy the readiness criteria. Requires DHCS to notify the Legislature of its intent to transition MSSP services to a managed care benefit at least 30 days prior to the MSSP services transition. Requires MSSP services to be offered in its current structure should the CCI become inoperative. 4)Eliminates the sunset on the use of Modified Adjusted Gross Income (MAGI) eligibility determinations within the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS). 5)Suspends the annual Cost of Living Adjustment (COLA) for the budget year for counties for Medi-Cal eligibility administration funding. 6)Creates the Health Home Program Account to collect and allocate non-General Fund public or private grants to implement the Health Home Program. Authorizes the department to accept funding from local governments, foundations, or other organizations for the Health Home Program. 7)Requires Department of Health Care Services (DHCS) to make Medi-Cal enrollment assistance payments for applications received through June 30, 2015, after which any remaining funds shall be allocated to the county outreach and enrollment grants. Requires remaining funds not allocated to be distributed to community-based organizations providing enrollment assistance to enrollees. Requires DHCS to make an SB 75 Page 3 initial allocation to the counties of these funds no later than January 1, 2016, and the final allocation no later than June 30, 2016. 8)Authorizes a transition from using certified public expenditures to inter-governmental transfers in order to increase federal funding in the Ground Emergency Medical Transportation Supplemental Reimbursement Program. 9)Requires the Office of System Integration to report to the Legislature by April 1, 2017, on the feasibility, benefits, costs and risks of installing the MAGI Eligibility Decision Engine in one, two, or all of the Statewide Automated Welfare System consortia systems. 10)Requires DHCS to consult with health care service plans on reconciling Major Risk Medical Insurance Program and Guarantee Issue Program costs, and stipulates various requirements associated with these reconciliations. Requires health care service plans to remit payment to DHCS within 60 days of the date of notice from DHCS, and authorizes 7% annual interest to accrue, unless waived by DHCS. Extends the reconciliation period for DHCS with health care service plans from six to 18 months. 11)Eliminates copays in Medi-Cal for non-emergency care provided in emergency rooms. 12)Expands full-scope Medi-Cal coverage to children, regardless of immigration status, who currently would be eligible for Medi-Cal if not for immigration status, beginning when the department declares that systems are ready for implementation, but no sooner than May 1, 2016. Requires children eligible in this category to enroll in Medi-Cal managed care. Requires SB 75 Page 4 DHCS to seek federal financial participation (FFP), but requires coverage to be provided regardless of FFP. Requires DHCS to provide a semiannual status report to the Legislature until regulations have been adopted. 13)Eliminates the 10% rate reduction, adopted through AB 97 (Budget Committee), Chapter 3, Statutes of 2011 (budget trailer bill), for dental care providers in the Medi-Cal program, beginning July 1, 2015. 14)Authorizes DHCS to make grants to health benefit plans for 2015-16 that are funded by contributions made by agricultural employers, where 85% or more of the plan's eligible participants are agricultural employees for work performed and covered under a collective bargaining agreement, and meet other specified requirements. 15)Authorizes DHCS, for 2015-16, to provide a grant to LifeLong Medical Care, a federally qualified health center in Contra Costa County, to support extended urgent care hours. 16)Updates the language, and codifies the activities, that govern the Office of Problem Gambling that provides gambling treatment services. 17)Authorizes legal settlement funds to be deposited into the Food Safety Fund. 18)Prohibits insurance coverage to utilize copayments, coinsurance, deductibles, or any other form of cost sharing for the Prenatal Screening Program fee. Requires reimbursement for services covered under this program to be paid at the amount set in statute and regulations. SB 75 Page 5 19)Modernizes the acquired immune deficiency syndrome (AIDS) Drug Assistance Program eligibility standards by changing eligibility from a maximum modified adjusted gross income of $50,000 to 500% of the federal poverty level based on family size and household income. Authorizes the sharing of information between the Department of Public Health and the Franchise Tax Board in order to verify the income of applicants. 20)Requires the licensing fees for skilled nursing facilities to be increased in order to generate $400,000 for the Department of Aging's Long-Term Care Ombudsman Program for its work investigating complaints made against skilled nursing facilities and increasing visits to those facilities. 21)Clarifies that regulations meet the requirements of the Clinical Laboratory Improvement Act (CLIA), as in effect January 1, 2015, and may include the clinical laboratory's use of the following alternative quality control testing procedures recognized by the federal Center for Medicare and Medicaid Services (CMS): until December 31, 2015, equivalent quality control procedures; and commencing January 1, 2016, an Individualized Quality Control Plan as included in the State Operations Manual adopted by CMS. 22)Establishes the Pre-Exposure Prophylaxis (PrEP) Navigator Services Program, a competitive grant program for community-based organizations or local health departments. Requires grantees to develop protocols to conduct outreach to targeted populations, provide PrEP education to clients and providers, and to assess and refer persons to clinical care and prevention services. Requires the department to develop and distribute PrEP educational materials statewide, provide training and support for any related activities, and conduct SB 75 Page 6 oversight and evaluation of the program. 23)Authorizes the Department of Public Health to purchase necessary supplies for syringe exchange programs and distribute those supplies to syringe exchange programs. 24)Establishes a three-year hepatitis C Linkage to Care demonstration pilot project to allow for innovative, evidence-based approaches providing outreach, hepatitis C screening, and linkage to, and retention in, quality health care for individuals with, or at high risk of hepatitis C. Authorizes this project for 2015-16, 2016-17, and 2017-18. Requires utilization of a competitive grant process for community-based organizations or local health jurisdictions and stipulates the qualifications required of grantees. 25)Establishes timelines for nursing home complaint investigations of: 90 days with a possible 90-day extension beginning July 1, 2016 (for complaints that involve a threat of imminent danger of death or serious bodily harm); 90 days with a possible 60-day extension beginning July 1, 2017; and 60 days with a possible 60-day extension beginning July 1, 2018. Requires the department to report to the Legislature, within the Licensing and Certification Program estimates, beginning in 2018-19, on the feasibility of reducing the complaint investigation timelines. Establishes the Legislature's intent that the department seek to reduce the amount of time to complete investigations as much as possible with a goal of 45 days. Extends the time period for the department to issue and serve any citation from three to 30 days. Requires the department, when it fails to meet the statutorily required deadline for hospital-based complaint investigations, to document the extenuating circumstances explaining why it could not meet the timeframes, and notify the facility and the complainant in writing of the basis for the extension and estimated completion date. SB 75 Page 7 26)Extends Covered California's emergency regulations authority for one year and provides limited statutory exemptions from the rulemaking provisions of the Administrative Procedure Act. 27)Authorizes the California Health Facilities Financing Authority to use up to $3 million in unencumbered Investment in Mental Health Wellness grant funds for peer respite programs. 28)Appropriates $50 million from the Health Home Program Account to DHCS to implement the Health Home Program. Makes this appropriation available for encumbrance or expenditure until June 30, 2020. COMMENT: This bill is a budget trailer bill within the overall 2015-16 budget package to implement actions taken affecting the Departments of Health Care Services and Public Health, Covered California, and the California Health Facilities Financing Authority. Analysis Prepared by: Andrea Margolis / BUDGET / (916) 319-2099 FN: 0001030 SB 75 Page 8