Amended in Assembly June 25, 2015

Amended in Senate May 5, 2015

Amended in Senate April 20, 2015

Senate BillNo. 492


Introduced by Senator Liu

(Principal coauthor: Senator Wolk)

(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: consumer educational and informational guide.

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 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.begin insert The bill would require the department to update the educational and informational guide annually, or as necessary, to keep the information contained in the guide up to date regarding changes to the Cend insertbegin insertCend insertbegin insertIend insertbegin insert.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:

P2    1

SECTION 1.  

The Legislature finds and declares all of the
2following:

3(a) The Coordinated Care Initiative is an innovative health care
4service delivery model for Californians who are eligible for services
5under both the Medi-Cal and Medicare programs.

6(b) Individuals eligible for services under the Coordinated Care
7Initiative represent a diverse group of older adults and persons
8with disabilities, and include some of the most vulnerable members
9of our population.

10(c) Incorporation of services from two programs required a
11variety of changes in federal and state law, and complex contractual
12agreements between the state and the federal Centers for Medicare
13and Medicaidbegin delete Services,end deletebegin insert Servicesend insert and between health plans and the
14various administering state agencies.

15(d) A key component of the Coordinated Care Initiative is the
16inclusion of comprehensive beneficiarybegin delete protections,end deletebegin insert protectionsend insert
17 to ensure that eligible individuals receive appropriate, safe, and
18high-quality care. However, these protections are provided for
19throughout the various statutes and contractual documents that
P3    1govern the establishment and operation of the Coordinated Care
2Initiative.

3(e) It is the intent of the Legislature in enacting this act to
4recognize the diversity of individuals receiving services under the
5Coordinated Care Initiative, and encourage implementation of an
6individualized, person-centered service delivery model. The
7Coordinated Care Initiative Consumer and Patient Educational
8and Informational Guide is intended to empower beneficiaries to
9effectively participate in decisions affecting their health care, by
10providing information regarding the protections afforded to them
11under the initiative.

12

SEC. 2.  

Section 14132.279 is added to the Welfare and
13Institutions Code
, to read:

14

14132.279.  

(a) This section shall be known, and may be cited,
15as the Coordinated Care Initiative Consumer and Patient
16Educational and Informational Guide.

17(b) By July 1, 2016, the department shall develop and post on
18the department’s Internet Web site, an educational and
19informational guide for consumers and patients about the
20Coordinated Care Initiative (CCI). In developing the educational
21and informational guide, the department shall consult with
22stakeholders. The guide shall describe consumer and patient rights
23under the CCI, and inform consumers and patients of effective
24ways to exercise their rights and who to contact for assistance in
25securing those rights. The guide shall include, but not be limited
26to, all of the following information:

27(1) How to determine whether a health care provider participates
28in the CCI.

29(2) How to file a grievance and appeal.

30(3) How to change health plans.

31(4) How to switch from Cal MediConnect to original Medicare
32and a Medi-Cal managed care plan.

33(5) How to obtain assistance in alternative languages.

34(6) The toll-free telephone numbers for the following programs
35to assist in problem solving:

36(A) Cal MediConnect’s Ombudsperson Program.

37(B) Medi-Cal Managed Carebegin delete Ombudsperson Program.end deletebegin insert Office
38of the Ombudsperson.end insert

39(C) HMO Help Center, operated by the Department of Managed
40Health Care.

P4    1(D) Medicare.

2(E) Health Care Options.

3(c) (1) The educational and informational guide shall include
4information for each of the following groups of individuals:

5(A) Dual eligibles: those individuals who are dually eligible for
6Medicare and Medi-Cal.

7(B) Seniors and persons with disabilities who are required to
8receive long-term services and supports through a Medi-Cal
9managed care plan.

10(2) The department may develop a separate educational and
11informational guide for each of the groups identified in paragraph
12(1).

13(d) (1) Upon publication, the department shall distribute the
14educational and informational guide developed pursuant to this
15section to all of the following organizations:

16(A) Statewide senior advocacy groups.

17(B) Statewide consumer advocacy groups.

18(C) State and local ombudspersons.

19(D) Health consumer centers.

20(E) Health insurance counseling and advocacy programs.

21(2) The educational and informational guide shall be made
22available upon request to all other interested persons.

23(e) The department shall make the educational and informational
24guide easy to read and understand and available in all Medi-Cal
25threshold languages, using an appropriate literacy level and in a
26culturally competent manner.

begin insert

27(f) The department shall update the educational and
28informational guide developed pursuant to this section annually,
29or as necessary, to keep the information contained in the guide up
30to date regarding changes to the CCI.

end insert


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