BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 586
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|AUTHOR: |Hernandez |
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|VERSION: |February 26, 2015 |
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|HEARING DATE: |April 22, 2015 | | |
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|CONSULTANT: |Scott Bain |
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SUBJECT : Children's services
SUMMARY : Requires the Department of Health Care Services (DHCS) to enter
into contracts with one or more Kids Integrated Delivery System
(KIDS) authorized by this bill to provide the full range of
California Children's Services Program (CCS) and Medi-Cal
services to children eligible for the CCS and Medi-Cal. Allows
an individual on Medi-Cal who is up to 26 years of age who was
previously treated for a CCS-eligible condition in the twelve
months prior to his or her 21st birthday to remain in a KIDS
plan that accepts individuals up to age 26 under its contract
with DHCS. Makes permanent, the CCS "carve out" of CCS services
from Medi-Cal managed care, except for existing counties and for
the newly created KIDS established by this bill.
Existing law:
1.Establishes the Medi-Cal Program, administered by DHCS, which
provides comprehensive health benefits to low-income children
up to 266 percent of the federal poverty level (FPL), parents
and adults up to 138 percent of the FPL, pregnant women, and
elderly, blind or disabled persons, who meet specified
eligibility criteria.
2.Establishes the CCS Program to provide specified medical care
and therapy services to children with eligible conditions.
3.Authorizes the state to contract for comprehensive managed
health care services for Medi-Cal beneficiaries, and to
require mandatory enrollment of Medi-Cal beneficiaries in
specified eligibility categories into managed care plans.
4.Prohibits CCS covered services from being be incorporated into
any Medi-Cal managed care contract entered into after August
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1, 1994 until January 1, 2016, except for contracts entered
into for county organized health systems or Regional Health
Authority in the Counties of San Mateo, Santa Barbara, Solano,
Yolo, Marin, and Napa. This is known as the CCS "carve out."
5.Requires the Director of DHCS to establish, by January 1,
2012, organized health care delivery models for CCS-eligible
children. Requires these models to be chosen from the
following:
a. An enhanced primary care case management
program;
b. A provider-based accountable care
organization;
c. A specialty health care plan; or,
d. A Medi-Cal managed care plan that includes
payment and coverage for CCS-eligible conditions.
This bill:
1.Permanently extends the CCS "carve out" from Medi-Cal managed
care except for either or both of the following:
a. Contracts entered into for county organized
health systems or Regional Health Authority in San
Mateo, Santa Barbara, Solano, Yolo, Marin, and Napa
counties; or,
b. Contracts entered into under this bill
establishing a KIDS.
2.Requires, no later than January 1, 2018, in counties or
regions where there is no CCS demonstration project, DHCS to
select and enter into contracts with one or more Kids
Integrated Delivery System (KIDS), to provide comprehensive
health care services to eligible children.
3.Defines a "KIDS" as an entity selected by DHCS to coordinate
and manage the provision of Medi-Cal and CCS services for
eligible children, on a county or regional basis, consistent
with managed care principles, techniques, and practices, to
ensure access to cost-effective, quality care for enrolled
children. Permits KIDS plan to include either of the following
organizational models:
a. An entity coordinated through a children's
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hospital with a shared governance structure comprised
of providers who are held jointly accountable for
achieving measured quality improvements and reductions
in the rate of spending growth for Medi-Cal services
for enrolled children; or,
b. An entity coordinated by a CCS-approved
provider with a shared governance structure comprised
of providers, including participation by at least one
children's hospital, who are held jointly accountable
for achieving measured quality improvements and
reductions in the rate of spending growth for Medi-Cal
services for enrolled children.
4.Defines an "eligible child" for the purposes of KIDS to mean
either of the following:
a. A minor child under 21 years of age, who is
eligible for both Medi-Cal and CCS, except for those
children eligible under CCS for neonatal intensive
care services; and,
b. An individual up to 26 years of age, if the
individual was previously treated for a CCS-eligible
condition in the twelve months prior to his or her
21st birthday, is eligible for full-scope Medi-Cal
services, and voluntarily chooses to remain in a KIDS
plan that accepts individuals up to age 26 under its
contract with DHCS.
5.Requires a KIDS plan to contract with DHCS to coordinate,
integrate, and provide or arrange for the full range of
Medi-Cal and CCS services to eligible children enrolled in the
KIDS plan.
6.Requires a KIDS plan contract to exclude, at a minimum,
specialty mental health services provided by county mental
health plans and neonatal intensive care (NICU) services.
Permits a KIDS contract to exclude other Medi-Cal services, as
determined by DHCS, including, but not limited to, long-term
care, transplantation, and dental services;
7.Permits benefits of the CCS Medical Therapy Program to be
provided or coordinated by a KIDS plan, in collaboration and
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consultation with the designated county CCS agency or agencies
in the KIDS plan service area;
8.Requires a KIDS plan to:
a. Provide services to enrollees through a
team-based, patient-centered health home model, ensure
that enrolled children receive services in the most
appropriate and least restrictive setting, and adopt
effective strategies to manage and coordinate care and
services for enrolled children;
b. Report and comply with quality measures,
including, but not limited to, Medi-Cal Healthcare
Effectiveness Data and Information Set (HEDIS)
measures appropriate for enrolled children, the
national Pediatric Quality Measurement System for
children's hospitals, and other quality measures
developed by DHCS in consultation with stakeholders;
c. Participate in a nationally recognized
pediatric patient safety organization;
d. Comply with readiness criteria, network
adequacy standards, and other appropriate standards
applicable to Medi-Cal managed care plans, as
determined by DHCS in consultation with stakeholders,
and any terms of the federal approvals obtained by
DHCS; and,
e. Establish and maintain a family advisory
council composed of families of eligible children and
convene the advisory council at least quarterly.
9.Requires DHCS to give special consideration in the KIDS
selection process to entities that meet specified criteria,
including an entity that demonstrates experience in
effectively serving eligible children and providing services
in compliance with CCS program standards and requirements,
that includes in the plan a sufficient number of CCS-paneled
providers to ensure continuity of care and timely access to
quality services, that develops the KIDS plan through a local
collaborative stakeholder process, and that incorporates
specific strategies to actively engage families as partners in
decisions affecting the health care and well-being of children
enrolled in the KIDS plan.
10.Permits contracts with KIDS plans to include opportunities to
share in the risk of providing services to KIDS enrollees
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under an agreement between DHCS and the KIDS plan. Requires
any shared savings that result from these arrangements to be
reinvested in services provided to children enrolled in the
KIDS plan.
11.Prohibits DHCS from entering into risk-sharing arrangements
with a KIDS plan for specific covered services unless the KIDS
plan is responsible for the management and authorization of
those services.
12.Requires payments to a KIDS plan that agrees to accept
risk-sharing to be actuarially sound.
13.Requires eligibility for enrollment in a KIDS plan to be
determined in accordance with all of the following:
a. Requires children to be deemed eligible for
enrollment in a KIDS plan based on eligibility for the
CCS program, except a child receiving NICU services is
be eligible for enrollment until the child is
discharged from the NICU and meets other requirements;
and,
b. Requires eligible children to be enrolled on a
mandatory basis, to the extent that DHCS obtains
federal approval to require eligible children to
enroll in an available KIDS plan in order to receive
Medi-Cal and CCS services.
14.Requires enrollment in a KIDS plan to be, at a minimum, for
the period of a child's CCS eligibility plus an additional six
months, provided that the child remains eligible for Medi-Cal.
15.Allows KIDS plan enrollees who continue to remain eligible
for Medi-Cal to remain in the KIDS plan for up to 12 months
following the termination of CCS eligibility if the KIDS
program and the parent, guardian or person responsible for
care of the child agree that it is in the best interests of
the child.
16.Requires the child to be enrolled in the available KIDS plan,
if a KIDS plan becomes newly available in a service area, or
if a child becomes newly eligible for a KIDS plan.
17.Requires DHCS to determine, in consultation with counties,
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KIDS plans, local KIDS family advisory councils, and existing
Medi-Cal managed care plans in the service area, the timing
and process for enrollment in KIDS plans to ensure a smooth
transition for eligible children.
18.Permits the parent, guardian, or person responsible for the
care of the eligible child to select the KIDS plan in which
the child will be enrolled if there is more than one KIDS plan
in the county or region in which the child lives. Requires the
child to be assigned to a KIDS plan in a manner that ensures
the least disruption in existing patient-provider
relationships if the family does not select a KIDS plan.
19.Requires, upon enrollment of an eligible child in a KIDS
plan, the parent, guardian, or person responsible for the care
of the child to be informed that the child may choose to
continue an established patient-provider relationship if his
or her treating provider is a primary care provider or clinic
contracting with the KIDS, has the available capacity, and
agrees to continue to treat that eligible child. Requires KIDS
plans to comply with a continuity of care requirement
applicable to health plans.
20.Requires, within 30 days of notice that a child is no longer
eligible for a KIDS plan, a child who continues to be eligible
for Medi-Cal to be enrolled in the Medi-Cal delivery system in
the county in which he or she resides. Requires DHCS to ensure
that families receive information about the Medi-Cal delivery
systems available in their county and the process for
enrolling in and selecting among the available options.
21.Requires, when children are disenrolling from a KIDS plan
because they are no longer eligible, children to be enrolled
in Medi-Cal delivery systems as follows:
a. Requires the child to be enrolled in the
Medi-Cal managed care plan if there is a Medi-Cal
managed care plan in the county of the child's
residence;
b. Requires, if the family does not choose a plan
for the child within 30 days of notice of
disenrollment from the KIDS in counties where there is
more than one Medi-Cal managed care plan, the child to
be enrolled into the Medi-Cal managed care health plan
that contains his or her primary care provider.
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Requires the child to be assigned to one of the health
plans containing his or her primary care provider in
accordance with the assignment process applicable in
the county if the primary care provider participates
in more than one managed care health plan in the
county; and,
c. Requires, in a county that is not a managed
care county, children no longer eligible for KIDS to
be provided services under the Medi-Cal
fee-for-service (FFS) delivery system.
22.Requires DHCS to instruct KIDS plans, counties, and managed
care plans, by means of all-county and all-plan letters or
similar instruction, as to the processes to be used to enroll
and disenroll children in KIDS plans and to re-enroll eligible
children in local Medi-Cal coverage options, to ensure each
child experiences a smooth transition among coverage types
with no gap in coverage or care.
23.Requires that a child who is enrolled in a KIDS plan to
retain all rights to CCS program appeals and fair hearings of
denials of medical eligibility or of service authorizations.
24.Requires DHCS to seek all necessary federal approvals to
ensure federal financial participation in expenditures under
this section. Prohibits the KIDS provisions of this bill from
being implemented until necessary federal approvals have been
obtained.
25.Permits DHCS to seek federal approval to require all eligible
children to enroll in an available KIDS plan during the length
of their eligibility for CCS plus an additional six months.
Permits a child to voluntarily remain in the KIDS for up to 12
months following termination of CCS eligibility if the child
remains Medi-Cal-eligible.
26.Makes legislative findings and declarations regarding CCS,
and states legislative intent to modernize the CCS program
through development of specialized integrated delivery systems
focused on the unique needs of CCS-eligible children, and to
protect the unique access to pediatric specialty services
provided by CCS while promoting modern organized delivery
systems to meet the medical care needs of eligible children.
FISCAL
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EFFECT : This bill has not been analyzed by a fiscal committee.
COMMENTS :
1.Author's statement. According to the author, this bill
authorizes the creation of KIDS to improve and modernize the
CCS program. CCS provides diagnosis, treatment, and case
management to approximately 180,000 medically fragile children
under the age of 21 with complex medical needs who meet
certain eligibility criteria. CCS has been carved out of
Medi-Cal managed care since 1993 because the Legislature
recognized this population required a unique approach. In the
twenty-three years since that time, the carve-out has been
extended numerous times, and the state has engaged in
periodic, unsuccessful, efforts to modernize the program.
December 31, 2015 marks the end of the current carve-out and
the Administration has clearly signaled that they will support
an extension of the carve-out only if it is accompanied by a
plan for a more organized delivery system. This bill provides
that system. This bill extends the carve-out, preserves the
CCS standards of care, and creates networks responsible for
providing or coordinating all medical care services to CCS
children through a patient-centered medical home, thus
improving coordination between primary and specialty care
services for beneficiaries. Additionally, the bill requires
CCS providers to work collaboratively with each other and
families, in order to ensure CCS children continue to receive
access to the highest quality care.
2.CCS. The CCS program provides diagnostic and treatment
services, medical case management, and physical and
occupational therapy health care services to children under 21
years of age with CCS-eligible conditions (e.g., severe
genetic diseases, chronic medical conditions, infectious
diseases producing major sequelae, and traumatic injuries)
from families unable to afford catastrophic health care costs.
A child eligible for CCS must be a resident of California,
have a CCS-eligible condition, and be in a family with an
adjusted gross income of $40,000 or less in the most recent
tax year. Children in families with higher incomes may still
be eligible for CCS if the estimated cost of care to the
family in one year is expected to exceed 20 percent of the
family's adjusted gross income.
The CCS program is administered as a partnership between county
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health departments and DHCS. In counties with populations
greater than 200,000 (independent counties), county staff
perform all case management activities for eligible children
residing within their county. This includes determining all
phases of program eligibility, evaluating needs for specific
services, determining the appropriate provider(s), and
authorizing for medically necessary care. For counties with
populations under 200,000 (dependent counties), the Children's
Medical Services Branch of DHCS provides medical case
management and eligibility and benefits determination through
its regional offices. CCS authorizes and pays for specific
medical services and equipment provided by CCS-approved
specialists. CCS rates for physician services provided under
CCS are reimbursed at rates which are 39.7 percent greater
than applicable Medi-Cal rate. CCS hospital inpatient rates
are the same as those in Medi-Cal.
As of January, 2010, there were 178,530 children enrolled in
CCS. According to DHCS, 90 percent of CCS enrollees are also
eligible for Medi-Cal and 10 percent were CCS-only or were
covered by other insurance.
3.Medi-Cal managed care and the CCS carve out. Most Medi-Cal
beneficiaries, including children, are required to enroll in
Medi-Cal managed care plans. However, for children who are
enrolled in both Medi-Cal and CCS, CCS services were carved
out of Medi-Cal managed care pursuant to SB 1371 (Bergeson),
Chapter 917, Statutes of 1994. Under the carve out,
CCS-covered services for CCS-eligible children are not
incorporated into Medi-Cal managed care, and are instead
provided and paid for on a FFS basis through the CCS Program.
The initial carve out under SB 1371 was for three years. The
CCS carve out has been extended repeatedly since then, usually
for three or four year periods. The first extension allowed
the COHS in the counties of San Mateo, Santa Barbara, Solano,
and Napa to include CCS services. Later extensions also
allowed Yolo and Marin counties to include CCS services. DHCS
indicates the division of payment and care between CCS and the
primary Medi-Cal managed care plan has posed challenges,
including delays in care for children, fragmentation and a
lack of coordination, and increased cost to the state.
4.Medi-Cal Waiver and CCS pilots. SB 208 (Steinberg), Chapter
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714, Statutes of 2010, was one of two bills in 2010
implementing the 2010 Medi-Cal waiver renewal. One provision
of SB 208 was a requirement that the DHCS director establish,
by January 1, 2012, organized health care delivery models for
CCS-eligible children, from four specified models. Five
demonstration applicants (San Mateo Health Plan, Alameda
County, LA Care, Children's Hospital Orange County, and Rady
Children's Hospital in San Diego) were approved in 2011, but
only the San Mateo Health Plan pilot has been implemented. The
Rady Children's Hospital in San Diego is for a subset of
CCS-eligible children with specified conditions but it has not
been implemented.
5.CCS Redesign Stakeholder Advisory Board. DHCS has implemented
a stakeholder process to investigate potential improvements or
changes to the CCS program in partnership with the UCLA Center
for Health Policy Research. A CCS Redesign Stakeholder
Advisory Board (RSAB) composed of individuals from various
organizations and backgrounds with expertise in both the CCS
program and care for children and youth with special health
care needs, was assembled in September of 2014 to lead this
process. According to DHCS, the CCS RSAB goals are to:
a. Implement Patient and Family Centered Approach: provide
comprehensive treatment, and focus on the whole-child
rather than only their CCS eligible conditions.
b. Improve Care Coordination through an Organized Delivery
System: provide enhanced care coordination among primary,
specialty, inpatient, outpatient, mental health, and
behavioral health services through an organized delivery
system that improves the care experience of the patient and
family.
c. Maintain Quality: ensure providers and organized
delivery systems meet quality standards and outcome
measures specific to the CCS population.
d. Streamline Care Delivery: improve the efficiency and
effectiveness of the CCS health care delivery system.
e. Build on Lessons Learned: consider lessons learned from
current pilots and prior reform efforts, as well as
delivery system changes for other Medi-Cal populations.
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f. Cost-Effective: ensure costs are no more than the
projected cost that would otherwise occur for CCS children,
including all state-funded delivery systems. Consider
simplification of the funding structure and value-based
payments, to support a coordinated service delivery
approach.
1.Related legislation. AB 187 (Bonta), would extend the CCS
carve out until DHCS has completed evaluations of the CCS
pilot programs established under SB 208.
2.Prior legislation.
a. AB 301 (Pan), Chapter 460, Statutes of 2011, extended
the CCS carve out sunset date from January 1, 2012, to
January 1, 2016.
b. SB 208 (Steinberg), Chapter 714, Statutes of 2010,
implemented the new 2010 Medi-Cal Section 1115 Waiver, and
required DHCS to establish a pilot project and seek
proposals to test four models exploring potential options
to redesign the CCS Program.
c. AB 2379 (Chan), Chapter 333, Statutes of 2007, extended
the CCS carve out sunset date from August 1, 2008, to
January 1, 2012.
d. SB 1103 (Committee on Budget and Fiscal Review),
Chapter 228, Statutes of 2004, extended the sunset on the
carve-out from August 1, 2005 to September 1, 2008.
e. AB 3049 (Committee on Health), Chapter 536, Statutes of
2002, extended the CCS carve out sunset on the carve-out
from August 1, 2003 to August 1, 2005 and added COHS in
Yolo and Marin counties to the list of exceptions to the
carve-out.
f. AB 1107 (Cedillo), Chapter 146, Statutes of 1999,
extended the CCS carve out sunset date until August 1,
2003.
g. AB 469 (Papan) of 1999 would have allowed Medi-Cal
beneficiaries in the CCS Program to disenroll from
mandatory managed care if certain conditions are met. AB
469 was vetoed by then Governor Davis.
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h. SB 391 (Solis), Chapter 294, Statutes of 1997, extended
the CCS carve-out until August 1, 2000, except for
contracts entered into for COHS in the counties of San
Mateo, Santa Barbara, Solano, and Napa.
i. SB 1371 (Bergeson), Chapter 917, Statutes of 1994,
required that CCS-eligible services be carved out of any
Medi-Cal managed care contract until three years after the
effective date of the contract.
3.Support. This bill is sponsored by the California Children's
Hospital Association (CCHA), which argues this bill would
protect CCS and create KIDS to modernize the delivery system.
CCHA argues the KIDS networks will use a whole child approach
to health care, improving coordination between primary and
specialty care services while retaining the high quality
health care available through CCS because the CCS program will
only remain statutorily carved out of Medi-Cal managed care
until the end of 2015. CCHA argues this bill is a thoughtful,
provider driven, patient-centered approach that preserves the
positive aspects of the CCS program while creating a delivery
system tailored to the needs of children with complex medical
needs and their families. CCHA states KIDS networks would be
responsible for providing primary and specialty medical care
services to enrolled children through a team-based,
patient-centered health home model in the least restrictive,
most appropriate setting. CCHA argues this bill would ensure
that CCS standards are retained to ensure pediatric expertise,
preserve access to high quality providers, and ensure that
families are involved in decisions around the medical care
provided to their children, CCS providers would be required to
work together in order to improve care coordination and health
outcomes, and the regional system of care comprised of CCS
hospitals, physicians, and special care centers benefit not
only those children who receive services through CCS as these
same providers form the regional backbone for all pediatric
specialty care in California for children who are privately
insured as well as those receiving government-subsidized care.
Western Center on Law & Poverty (WCLP) writes in support that
it hopes that coordinating the care of these vulnerable
children with existing CCS providers and requirements for
coordinating, integrating and arranging for both Medi-Cal and
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CCS services will provide better care than the current
bifurcated system. WCLP argues the provision of the bill which
allows an individual to continue to receive services through a
KIDS plan up to the age of 26 is very important as when
CCS-eligible children turn 21, they have a very difficult
transition off of the program and difficulty forming an
appropriate network of specialty providers. WCLP writes that
this bill allows KIDS plans to have the opportunity to share
in the risk of providing the services, and whether plans
decide to assume risk or not, WCLP urges that the plans be
subject to Knox-Keene requirements, preferably through
licensure but at a minimum through contract. WCLP states
Knox-Keene includes innumerable consumer protections from
required benefits to grievance, appeal and Independent Medical
Review procedures. WCLP also writes that it supports the
request by Disability Rights California to ensure that
Medi-Cal due process rights apply and it appreciates the
author's willingness to add language to that effect.
9.Support if Amended. Disability Rights California (DRC) writes
it supports the provisions of this bill having all services
delivered through a managed care plan consisting of
CCS-paneled physicians and special care centers, continuing
CCS eligibility up to age 26 as this option addresses the
unique and very difficult transition problems faced by
children "aging out" of CCS, and the provisions providing for
continuing coverage through a KIDS. DRC argues Medi-Cal due
process and fair hearing rights under the Medi-Cal program
should apply, including Medicaid managed care regulations. DRC
also urges any initial period of managed care not be at risk
and be used as a means of establishing actuarial data. DRC
concludes that if the KIDS are not Knox-Keene licensed, then
relevant Knox-Keene consumer protections be incorporated into
any contract.
10.Opposition. The American Academy of Pediatrics, California
(AAPC) writes in opposition that children with CCS-eligible
conditions are among the most vulnerable in the state, and the
state should not decide upon a specific model for redesign of
this essential system of care in advance of data currently
being collected and a robust stakeholder process that is
underway. AAPC argues that changing to a new model requires
policies/elements that cannot be fully understood until the
pilots and stakeholder process are complete and
recommendations are available to those involved.
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The California Association for Health Services at Home
(CAHSAH) argues that it is concerned about the impact of
managed care expansions on home and community-based services,
especially given the problems that have already occurred with
the Coordinated Care Initiative (CCI). CAHSAH argues managed
care entities do not understand the home health services of
this unique population, and they have experienced denials of
care and delayed authorizations that were approved under
Medi-Cal FFS. CAHSAH argues managed care delivery systems
reimbursement rates must take into account the acuity level
differences in this population, the need for a long-term
guarantee of coverage to beneficiaries, timely authorizations
of care, that managed care case managers understand the full
nature of services available under Medi-Cal, and that the
managed care delivery system address provider grievances and
resolution of those grievances using the same medically
necessity criteria used FFS Medi-Cal.
11.Oppose unless amended. The California Medical Associations
(CMA) states it believes that any redesign of CCS should be
informed by both the state's RSAB and by evaluation of data
from the two pilot projects currently underway to assess the
benefit and cost of directions for change for CCS. CMA argues
it would be prudent to not move forward with this bill this
year to allow those processes to play out. CMA indicates it
would remove its opposition to the bill if it is amended to
extend the current managed care carve out of CCS for an
additional year while the stakeholder board completes its work
and the state reports back on data from the pilot projects.
Kaiser Permanente (KP) writes this bill will unnecessarily
disrupt the coordinated and centralized primary and
specialty care its over 11,000 CCS-eligible kids already
receive through its four CCS-certified tertiary medical
facilities 64 CCS-certified special care centers. KP argues
that, under this bill, it appears that in order to be
allowed to continue to provide care to CCS children in KP,
it would be required to contract with a free-standing
children's hospital as part of a separate KIDS network. KP
seeks an amendment to allow CCS children to remain in KP.
12.Concerns. The California Association of Health Plans (CAHP)
writes expressing concern with the requirement that health
care practitioners be CCS paneled providers as there is a
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backlog of approvals. CAHP argues the ability to panel
providers should be given to children's hospitals and DHCS.
CAHP also expresses concern with continuity of care as
children will be moving back and forth between KIDS and health
plan networks. CAHP argues there is a need for a careful
detailed analysis of CCS-eligible conditions to redefine
medical eligibility for the CCS program to reduce children
moving back and forth across networks. CAHP also argues there
needs to be a stronger requirement for facilitated
communications between DHCS, KIDS, counties and health plans
to be fully outlined and understood as the lack of
coordination between these systems is an issue today that is
not sufficiently addressed in the bill as currently drafted.
CAHP also states that it is unclear how children with chronic
conditions will be transitioned out of the program at age 21
or 26 as transitions to appropriate adult specialists should
be done in a collaborative manner in order to protect the
individuals and ensure age appropriate care is provided.
13.Proposed author's amendment. The author is offering amendment
below to allow additional CCS providers with appropriate
expertise to form KIDS networks:
(2) "Kids Integrated Delivery System (KIDS)" means an
entity selected by the department to coordinate and manage
the provision of Medi-Cal and CCS services for eligible
children, on a county or regional basis, consistent with
managed care principles, techniques, and practices, to
ensure access to cost-effective, quality care for enrolled
children. A KIDS plan may include either of the following
organizational models:
(A) An entity coordinated through a children's hospital
with a shared governance structure comprised of providers
who are held jointly accountable for achieving measured
quality improvements and reductions in the rate of spending
growth for Medi-Cal services for enrolled children.
(B) An entity coordinated by a CCS-approved provider with a
shared governance structure comprised of providers,
including participation by at least one children's
hospital, hospital or a hospital that was designated, prior
to January 1, 2016, as a CCS tertiary hospital, and as of
that date, holds a designation as a CCS tertiary hospital
pursuant to the Standards for Tertiary Hospitals set forth
in the California Children's Services Manual of Procedures,
who are held jointly accountable for achieving measured
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quality improvements and reductions in the rate of spending
growth for Medi-Cal services for enrolled children.
SUPPORT AND OPPOSITION :
Support: California Children's Hospital Association (sponsor)
California WIC Association
Children's Hospital of Los Angeles
Children's Hospital and Research Center Oakland
Children's Hospital of Orange County (CHOC) Children's
Children's Hospital of Orange County (CHOC) Physician
Network
Children's Specialty Care Coalition
Lucille Packard Children's Hospital Stanford
Together We Grow
Rady Children's Hospital San Diego
Valley Children's Healthcare, Inc.
Valley Children's Primary Medical Group, Inc.
Oppose: American Academy of Pediatrics
California Association for Health Services at Home
California Medical Association (unless amended)
Kaiser Permanente (unless amended)
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