Amended in Senate May 5, 2015

Amended in Senate April 20, 2015

Senate Bill No. 492

Introduced by Senator Liu

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(Principal coauthor: Senator Wolk)

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(Principal coauthor: Assembly Member Brown)

February 26, 2015

An act to add Section 14132.279 to the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

SB 492, as amended, Liu. Coordinated Care Initiative: begin delete Consumer Bill of Rights. end delete begin insert consumer educational and informational guide. end insert

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. One of the methods by which these services are provided is pursuant to contracts with various types of managed care health plans. Existing federal law provides for the federal Medicare Program, which is a public health insurance program for persons 65 years of age and older and specified persons with disabilities who are under 65 years of age.

Existing law, the Coordinated Care Initiative (CCI), requires the department to seek federal approval pursuant to a Medicare or a Medicaid demonstration project or waiver, or a combination thereof, to establish a demonstration project that enables beneficiaries dually eligible for the Medi-Cal program and the Medicare Program to receive a continuum of services that maximizes access to, and coordination of, benefits between the programs.

This bill would make legislative findings and declarations relating to the CCI and the availability of consumer protections for beneficiaries. The bill would begin delete establish the Coordinated Care Initiative Consumer Bill of Rights, which would set forth rights to which an individual receiving care under the CCI would be entitled, including, but not limited to, rights to self-direction and choice, quality, flexibility, and accessibility of service, cultural competence, and an appropriate grievance and appeals process, as specified. The bill would require the department to make the information available to providers and the public, as specified. end delete begin insert require, no later than July 1, 2016, the department to develop and post on the department’s Internet Web site, an educational and informational guide to assist consumers and patients in understanding the rights afforded to them under the CCI and how to effectively exercise those rights, as specified. The bill would require the department to distribute the educational and informational guide to specified consumer advocacy groups and programs and, upon request, to all other interested persons. end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

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

SECTION 1.  

The Legislature finds and declares all of the
following:

(a) The Coordinated Care Initiative is an innovative health care
service delivery model for Californians who are eligible for services
under both the Medi-Cal and Medicare programs.

(b) Individuals eligible for services under the Coordinated Care
Initiative represent a diverse group of older adults and persons
with disabilities, and include some of the most vulnerable members
of our population.

(c) Incorporation of services from two programs required a
variety of changes in federal and state law, and complex contractual
agreements between the state and the federal Centers for Medicare
and Medicaid Services, and between health plans and the various
administering state agencies.

(d) A key component of the Coordinated Care Initiative is the
inclusion of comprehensive beneficiary protections, to ensure that
eligible individuals receive appropriate, safe, and high-quality
care. However, these protections are provided for throughout the
various statutes and contractual documents that govern the
establishment and operation of the Coordinated Care Initiative.

(e) It is the intent of the Legislature in enacting this act to
recognize the diversity of individuals receiving services under the
Coordinated Care Initiative, and encourage implementation of an
individualized, person-centered service delivery model. The
Coordinated Care Initiative Consumer begin delete Bill of Rights end delete begin insert and Patient
Educational and Informational Guide end insert is intended to empower
beneficiaries to effectively participate in decisions affecting their
health care, by begin delete consolidating and clarifying end delete begin insert providing information
regarding end insert the protections afforded to them under the initiative.

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SEC. 2.  

Section 14132.279 is added to the Welfare and
Institutions Code, to read:

14132.279.  

(a) This section shall be known, and may be cited,
as the Coordinated Care Initiative Consumer Bill of Rights.

(b) A consumer under the Coordinated Care Initiative shall have
all of the following rights:

(1) The right to self-direction. The individual shall have the
option to coordinate his or her care and services. If due to cognitive
impairment the individual is unable to do so, a statutory option
should be made available to allow for a surrogate or informal
caregiver chosen by the individual to coordinate care.

(2) The right to choice. Plan networks should ensure that
individuals have access to, and choice of, a range of providers and
settings across the continuum of care, including health care
services, behavioral health services, and long-term services and
supports.

(3) The right to coordination. An individual shall have access
to care coordination, in accordance with his or her needs and
preferences.

(4) The right to integration of services. Services shall be
delivered to the individual in an integrated manner, regardless of
the source of payment.

(5) The right to flexibility. Services within a plan’s contracted
services shall meet the individual’s changing needs and incorporate
new modes of service and supports.

(6) The right to quality. All services and supports shall be of
high quality and shall be person-centered. Statutory standards
should be established to provide a mechanism for enforcement.

(7) The right to cultural competence. Individuals shall have
access to threshold language services. Services should be
appropriate and responsive to the needs of all populations.

(8) The right to accessibility. Services and information shall be
easy to access. In accordance with the federal Americans with
Disabilities Act, services shall be delivered in a manner that is
physically, cognitively, and programmatically accessible.

(9) The right to personal assistants and caregivers. The system
of care shall support the role of quality paid and unpaid caregivers,
including family caregivers, and shall recognize the importance
of workforce development, caregiver needs assessment, and the
availability of training.

(10) The right to independence. Services across the continuum
shall support maximum independence, full social integration, and
quality of life.

(11) The right to grievances and appeals. Participants shall have
access to an independent grievance and appeals process. Access
and resolution shall be prompt, without disruption in service
delivery.

(12) The right to timeliness. All services and supports shall be
delivered in a timely manner, in order to ensure the individual’s
optimal health and functioning.

(c) The department shall post the Coordinated Care Initiative
Consumer Bill of Rights on its Internet Web site, and shall also
provide copies to providers and the public upon request. The
department shall make the bill of rights available to the public in
prevalent languages.

(d) This section shall be implemented only to the extent
permitted by all of the following:

(1) Applicable federal Medicare law.

(2) Applicable Medi-Cal law.

(3) The “Memorandum of Understanding (MOU) between the
Centers for Medicare and Medicaid Services (CMS) and the State
of California Regarding A Federal-State Partnership to Test a
Capitated Financial Alignment Model for Medicare-Medicaid
Enrollees - California Demonstration to Integrate Care for Dual
Eligible Beneficiaries.”

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begin insert SEC. 2. end insert   

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begin insert Section 14132.279 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 14132.279. end insert   

(a) This section shall be known, and may be cited,
as the Coordinated Care Initiative Consumer and Patient
Educational and Informational Guide.

(b) By July 1, 2016, the department shall develop and post on
the department’s Internet Web site, an educational and
informational guide for consumers and patients about the
Coordinated Care Initiative (CCI). In developing the educational
and informational guide, the department shall consult with
stakeholders. The guide shall describe consumer and patient rights
under the CCI, and inform consumers and patients of effective
ways to exercise their rights and who to contact for assistance in
securing those rights. The guide shall include, but not be limited
to, all of the following information:

(1) How to determine whether a health care provider
participates in the CCI.

(2) How to file a grievance and appeal.

(3) How to change health plans.

(4) How to switch from Cal MediConnect to original Medicare
and a Medi-Cal managed care plan.

(5) How to obtain assistance in alternative languages.

(6) The toll-free telephone numbers for the following programs
to assist in problem solving:

(A) Cal MediConnect’s Ombudsperson Program.

(B) Medi-Cal Managed Care Ombudsperson Program.

(C) HMO Help Center, operated by the Department of Managed
Health Care.

(D) Medicare.

(E) Health Care Options.

(c) (1) The educational and informational guide shall include
information for each of the following groups of individuals:

(A) Dual eligibles: those individuals who are dually eligible for
Medicare and Medi-Cal.

(B) Seniors and persons with disabilities who are required to
receive long-term services and supports through a Medi-Cal
managed care plan.

(2) The department may develop a separate educational and
informational guide for each of the groups identified in paragraph
(1).

(d) (1) Upon publication, the department shall distribute the
educational and informational guide developed pursuant to this
section to all of the following organizations:

(A) Statewide senior advocacy groups.

(B) Statewide consumer advocacy groups.

(C) State and local ombudspersons.

(D) Health consumer centers.

(E) Health insurance counseling and advocacy programs.

(2) The educational and informational guide shall be made
available upon request to all other interested persons.

(e) The department shall make the educational and informational
guide easy to read and understand and available in all Medi-Cal
threshold languages, using an appropriate literacy level and in a
culturally competent manner.

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