BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 492|
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THIRD READING
Bill No: SB 492
Author: Liu (D)
Amended: 5/5/15
Vote: 21
SENATE HEALTH COMMITTEE: 7-0, 4/29/15
AYES: Hernandez, Hall, Mitchell, Monning, Pan, Roth, Wolk
NO VOTE RECORDED: Nguyen, Nielsen
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
SUBJECT: Coordinated Care Initiative: consumer educational
and informational guide
SOURCE: Author
DIGEST: This bill enacts the "Coordinated Care Initiative
Consumer and Patient Educational and Informational Guide," which
requires the Department of Health Care Services (DHCS) to
develop and post on its Internet Web site an educational and
informational guide for consumers and patients about the
Coordinated Care Initiative (CCI). Requires the guide to
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.
ANALYSIS:
Existing law:
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1)Establishes, under federal law, the 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 the age of 65.
2)Establishes the Medi-Cal program, administered by the DHCS,
under which qualified low-income individuals receive health
care services, including home and community-based services
(HCBS).
3)Requires DHCS to seek federal approval to establish a
demonstration project under a Medicare or a Medicaid
demonstration project or waiver. Authorizes DHCS under a
Medicare demonstration, to contract with the federal Centers
for Medicare and Medicaid Services (CMS) and demonstration
sites to operate the Medicare and Medicaid benefits in a
demonstration project that is overseen by the state as a
delegated Medicare benefit administrator, and to enter into
financing arrangements with CMS to share in any Medicare
program savings generated by the demonstration project.
4)Requires DHCS, after federal approval is obtained, to
establish the demonstration project that enables dual eligible
beneficiaries to receive a continuum of services that
maximizes access to, and coordination of, benefits between the
Medi-Cal and Medicare programs and access to the continuum of
long-term services and supports and behavioral health
services, including mental health and substance use disorder
treatment services. The purpose of this demonstration project
is to integrate services authorized under Medi-Cal and
Medicare.
5)Requires demonstration sites to be established in up to eight
counties, and to include at least one county that provides
Medi-Cal services via the two-plan model of Medi-Cal managed
care.
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6)Requires DHCS to enroll dual eligible beneficiaries into a
demonstration site unless the beneficiary makes an affirmative
choice to opt out of enrollment, with specified exceptions.
7)Requires DHCS to require dual eligibles to be assigned as
mandatory enrollees into new or existing Medi-Cal managed care
health plans for their Medi-Cal benefits in CCI counties. CCI
counties are the Counties of Alameda, Los Angeles, Orange,
Riverside, San Bernardino, San Diego, San Mateo, and Santa
Clara. Allows individuals to opt out of Medi-Cal managed care
for the Medicare portion of their benefits.
8)Requires all Medi-Cal long-term services and supports (LTSS)
to be services that are covered under Medi-Cal managed care
health plan contracts and to be available only through managed
care health plans to beneficiaries residing in CCI counties,
except for specified exemptions.
This bill:
1)Requires DHCS, by July 1, 2016, to develop and post on DHCS'
Internet Web site, an educational and informational guide for
consumers and patients about the CCI. Requires DHCS, in
developing the educational and informational guide, to consult
with stakeholders.
2)Requires the guide to 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. Requires the guide to
include, but not be limited to, all of the following
information:
a) How to determine whether a health care provider
participates in the CCI.
b) How to file a grievance and appeal.
c) How to change health plans.
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d) How to switch from Cal MediConnect to original Medicare
and a Medi-Cal managed care plan.
e) How to obtain assistance in alternative languages.
f) Toll-free telephone numbers for the Cal MediConnect's
Ombudsperson Program, the Medi-Cal Managed Care
Ombudsperson Program, the HMO Help Center, operated by the
Department of Managed Health Care, Medicare, and Health
Care Options.
3)Requires the educational and informational guide to include
information for individuals who are dually eligible for
Medicare and Medi-Cal (dual eligibles), and seniors and
persons with disabilities who are required to receive
long-term services and supports through a Medi-Cal managed
care plan. Permits DHCS to develop a separate educational and
informational guide for dual eligibles and seniors and persons
with disabilities (SPDs).
4)Requires DHCS to distribute the educational and informational
guide developed to specified consumer advocacy and
ombudsperson organizations, and to make it available upon
request to all other interested persons.
5)Requires DHCS to 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.
6)States legislative intent in enacting this bill that the
Coordinated Care Initiative Consumer and Patient Educational
and Informational Guide is intended to empower beneficiaries
to effectively participate in decisions affecting their health
care, by providing information regarding the protections
afforded to them under the initiative.
Comments:
1)Author's statement. According to the author, CCI consumers
remain one of the most vulnerable populations in California's
health care system. The recent implementation of CCI has
generated great confusion among beneficiaries, both in terms
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of the enrollment process and of the rights they have under
this program. Currently, DHCS publishes a guide with a partial
list of rights made applicable to approximately 20 percent of
CCI participants in the Cal MediConnect program. This list is
incomplete and a similar list of rights needs to be written
and distributed for those who receive managed long-term
services and supports (MLTSS) under the CCI. This bill
requires DHCS to create and distribute a consumer-friendly
informational guide that describes beneficiaries' rights in
both Cal MediConnect and MLTSS. This guide must also include
information on CCI services and supports and additional
resources for filing appeals and grievances. In doing so, this
bill increases consumer awareness of the CCI, and places an
emphasis on serving the individual with truly integrated care.
2)CCI. The CCI is a program intended to integrate and coordinate
the delivery of health benefits, including behavioral health
benefits and LTSS to dual eligibles and SPDs living in seven
California counties: Los Angeles, Orange, Riverside, San
Bernardino, San Diego, San Mateo and Santa Clara (state law
allows for CCI implementation in eight counties, but CCI will
not be implemented in Alameda County). Goals for the CCI
include coordinating Medi-Cal benefits and Medicare benefits,
across health care settings and improving continuity of acute
care, long-term care, and home- and community-based services,
coordinating access to acute and long-term care services for
dual eligibles, maximizing the ability of dual eligibles to
remain in their homes and communities with appropriate
services and supports in lieu of institutional care, and
increasing the availability of and access to home- and
community-based alternatives. The three major components of
the CCI are as follows:
a) Cal MediConnect Program: A three-year demonstration
project designed to coordinate medical, behavioral health,
long-term institutional, and home and community-based
services (HCBS) services for dual eligibles by combining
Medicare and Medi-Cal benefits into one integrated health
plan;
b) Mandatory enrollment of dual eligibles and Medi-Cal-only
seniors and persons with disabilities into Medi-Cal managed
care; and,
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c) MLTSS: Integration of nursing facility care, In-Home
Supportive Services, Community-Based Adult Services, and
Multipurpose Senior Services Program as managed care
benefits.
3)Select Committee on Aging and Long-Term Care Hearing. In
August 2014, the Select Committee on Aging and Long Term Care
held an informational hearing entitled "California's Service
Delivery System for Older Adults: Envisioning the Ideal." At
the hearing, one of the presenters from the SCAN Foundation
presented "California in Comparison to Other States: A Look at
the LTSS Scorecard" which was a framework for assessing LTSS
System Performance among the 50 states and the District of
Columbia. One of the five recommendations in that presentation
was that California establish a "Dual Eligible Bill of Rights"
that outlines in statute the rights of dual eligible
individuals including access to an array of services in an
integrated setting, consumer choice, and empowerment. These
rights would establish the foundation of system change
efforts, establish accountability for the health plans, and
communicate what people can expect from coordinated services
that are grounded in meeting the needs, desires, and
preferences of consumers.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
SUPPORT: (Verified5/18/15)
American Federation of State, County, and Municipal Employees
Government Action and Communications Institute
United Domestic Workers/American Federal of State, County and
Municipal Employees Local 3930
OPPOSITION: (Verified5/18/15)
California Association of Health Plans
ARGUMENTS IN SUPPORT: The Government Action and
Communications Institute (GACI) writes in support that DHCS
provides a partial list of rights to about 20 percent of the CCI
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participants (the dual eligible in CalMediConnect). GACI states
the CCI shifts nearly 800,000 low-income seniors and persons
with disabilities from Medi-Cal fee-for-service into managed
care. GACI argues DHCS provides a partial list of rights to
about 20 percent of the CCI participants (those who are in
CalMediConnect plans). GACI argues this partial list of rights
needs work, and a similar list of rights needs to be written and
distributed for those who receive managed long term services and
supports. GACI argues the extensive nature of the changes the
CCI brings to the health and social services of hundreds of
thousands of Californians gives weight to its belief that the
Legislature should require DHCS to inform consumers of their
rights.
ARGUMENTS IN OPPOSITION:The California Association of Health
Plans (CAHP) writes in opposition that this bill is unnecessary
because DHCS currently publishes an existing guidebook that
contains almost identical information to the bill. CAHP states
the only difference is that the guidebook refers the reader to
the plan's online directory, and this bill requires that the
directory be provided. CAHP concludes the development of a new
guide is duplicative of current efforts managed by the state.
Prepared by:Scott Bain / HEALTH /
5/21/15 9:36:17
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