BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 492| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- UNFINISHED BUSINESS Bill No: SB 492 Author: Liu (D) Amended: 6/25/15 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 SENATE FLOOR: 29-7, 5/22/15 AYES: Allen, Beall, Berryhill, Block, Cannella, De León, Galgiani, Hall, Hancock, Hernandez, Hertzberg, Hill, Hueso, Jackson, Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning, Nguyen, Pan, Pavley, Roth, Vidak, Wieckowski, Wolk NOES: Anderson, Fuller, Moorlach, Morrell, Nielsen, Runner, Stone NO VOTE RECORDED: Bates, Gaines, Huff ASSEMBLY FLOOR: 72-5, 8/17/15 - See last page for vote 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 SB 492 Page 2 consumers and patients of effective ways to exercise their rights and who to contact for assistance in securing those rights. Assembly Amendments require DHCS 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 CCI. ANALYSIS: Existing law: 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. SB 492 Page 3 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. 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. SB 492 Page 4 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 Office of the Ombudsperson, 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 (SPDs) 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 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)Require DHCS 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 CCI. 7)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 SB 492 Page 5 generated great confusion among beneficiaries, both in terms 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, SB 492 Page 6 c) Managed Long-Term Supports and Services (MLTSS): Integration of nursing facility care, In-Home Supportive Services, Community-Based Adult Services, and Multipurpose Senior Services Program as managed care benefits. FISCAL EFFECT: Appropriation: No Fiscal Com.:YesLocal: No According to Assembly Appropriations Committee, cost to DHCS is unlikely to exceed $150,000 (50% GF, 50% federal) for development of the informational guide, translation, and printing and mailing costs. The number of guides required to be produced and mailed, as well as the size of the brochures, is indeterminate. The bill only requires provision of an unspecified number of guides to specified consumer advocacy groups, not to all beneficiaries SUPPORT: (Verified8/19/15) American Federation of State, County, and Municipal Employees California Alliance for Retired Americans California Association of Public Authorities for IHSS California Commission on Aging Government Action and Communications Institute SEIU California United Domestic Workers/American Federal of State, County and Municipal Employees Local 3930 OPPOSITION: (Verified 8/19/15) California Association of Health Plans Department of Finance Department of Health Care Services ARGUMENTS IN SUPPORT: The Government Action and Communications Institute (GACI) writes in support that DHCS SB 492 Page 7 provides a partial list of rights to about 20 percent of the CCI 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. DHCS argues the information required to be included in the guide is already available to CCI consumers and providers through various informing materials, the costs associated with creating and distributing the guide would be significant, and the goals of the guide are already accomplished through existing materials. ASSEMBLY FLOOR: 72-5, 8/17/15 AYES: Achadjian, Alejo, Baker, Bigelow, Bloom, Bonilla, Bonta, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Weber, Wilk, SB 492 Page 8 Williams, Wood, Atkins NOES: Brough, Gallagher, Harper, Patterson, Waldron NO VOTE RECORDED: Travis Allen, Beth Gaines, Melendez Prepared by:Scott Bain / HEALTH / 8/19/15 21:02:58 **** END ****