BILL ANALYSIS                                                                                                                                                                                                    Ó






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          |SENATE RULES COMMITTEE            |                        SB 833|
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                                 UNFINISHED BUSINESS


          Bill No:  SB 833
          Author:   Committee on Budget and Fiscal Review  
          Amended:  6/10/16  
          Vote:     21 

          SENATE FLOOR:  Not relevant

          ASSEMBLY FLOOR:  Not available

           SUBJECT:   Health


          SOURCE:    Author


          DIGEST:  This bill is the omnibus health trailer bill, and contains  
          changes to implement the 2016-17 Budget Act.


          Assembly Amendments delete the Senate version of the bill, which  
          expressed legislative intent to enact statutory changes relating  
          to the Budget Act of 2016, and instead add the current language.
          
          ANALYSIS:  This bill is the omnibus health trailer bill, and  
          contains the following changes to implement the 2016-17 Budget  
          Act.

           1) Medi-Cal: Estate Recovery. Limits estate recovery in the  
             Medi-Cal program to only those health care services required  
             to be collected under federal law; to make it easier for  
             individuals to pass on their assets by using the narrower  
             definition of "estate" in federal Medicaid law; and to allow  
             a hardship exemption from estate recovery for a home of  








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             modest value. Budget year costs are $5.7 million General  
             Fund; $28.9 million General Fund in out years.
           
            2) Medi-Cal - Acupuncture. Restores acupuncture services as a  
             covered benefit under the Medi-Cal program. This benefit was  
             eliminated in the 2009 budget in response to the state's  
             fiscal crisis. Budget year costs are $3.7 million General  
             Fund; $4.4 million General Fund in out years.  

            3) Medi-Cal: Workers Compensation. Eliminates the sunset  
             provision and indefinitely extends the Department of  
             Industrial Relations authority to supply work-related injury  
             or claim data from the Workers' Compensation Information  
             System to the Department of Health Care Services (DHCS).

           4) Medi-Cal: Emergency Medical Air Transportation. Requires the  
             Department of Finance to report to the Legislature on the  
             fiscal impact to Medi-Cal of, and the planned reimbursement  
             methodology for emergency medical air transportation services  
             after, the termination of the certain vehicle penalty  
             assessments.

           5) Medi-Cal: Electronic Health Records. Increases the annual  
             General Fund limit, from $200,000 to $450,000, for state  
             administrative costs associated with the implementation of  
             the Medi-Cal Electronic Health Records Incentive Program.  

           6) Medi-Cal: Supplemental Drug Rebates. Makes minor technical  
             changes to correct non-sequential lettering errors and  
             inconsistent language to accurately preserve the intent and  
             purpose of SB 870 (Committee on Budget and Fiscal Review,  
             Chapter 40, Statutes of 2014) to collect supplemental drug  
             rebate revenues for certain prescription drugs based on drug  
             utilization from all eligible Medi-Cal programs.

           7) Medi-Cal: Federal Outpatient Drug Rule. Provides DHCS  
             authority to comply with the final federal rule related to  
             Medicaid reimbursement for covered outpatient drugs. The  
             final rule, issued on February 1, 2016, requires states to  
             align pharmacy reimbursements with the actual acquisition  
             cost of drugs and to pay an appropriate professional  
             dispensing fee.

           8) Medi-Cal: Behavioral Health Treatment (BHT) Transition  







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             Contract. Provides DHCS the authority to establish a contract  
             to assist specified individuals with finding comprehensive  
             health coverage. The eligible individuals are those who were  
             receiving only BHT services from a regional center as of  
             January 31, 2016, and will be losing eligibility for  
             full-scope Medi-Cal without a share of cost on March 31,  
             2017, due to the transition of BHT services from a covered  
             benefit under the California Home and Community-Based Waiver  
             program for Individuals with Developmental Disabilities to a  
             covered benefit under the California Medi-Cal State Plan. 

           9) Medi-Cal: Suspend County cost-of-living adjustments (COLA)  
             for Administration. Suspends the county COLA for county  
             eligibility administration for 2016-17. Deletes outdated  
             language referencing the Healthy Families Program which  
             transitioned to Medi-Cal in 2013-14.
           
            10)Program of All-Inclusive Care for the Elderly (PACE). Makes  
             the following changes:

             a)   Standardizes rate-setting to allow DHCS to determine  
               comparability of cost and experience between PACE and like  
               population subsets served through long-term services and  
               supports integration into managed care health plans under  
               the Coordinated Care Initiative. Statutory change is  
               necessary as DHCS is currently required to use a  
               fee-for-service (FFS) equivalent cost/upper payment limit  
               methodology to set capitation rates for PACE organizations.  

             b)   Removes existing statutory language that caps the number  
               of PACE Organizations with which DHCS can contract. 
             c)   Removes existing statutory language to align with  
               updated PACE federal rules and regulations. 
             d)   Adds new statutory language enabling DHCS to seek  
               flexibility from the Centers for Medicare and Medicaid  
               Services on several issues, including the composition of  
               the PACE interdisciplinary team, marketing practices, and  
               development of a streamlined PACE waiver process. 

           11)Long-Term Care Quality Assurance Fund. Makes the Long-Term  
             Care Quality Assurance Fund continuously appropriated without  
             regard to fiscal year. This aligns the expenditure authority  
             of programs supported by the Long-Term Care Quality Assurance  
             Fund with available fee revenues. Expenditures from the fund  







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             are used to offset General Fund expenditures for long-term  
             care provider reimbursements. 

           12)Children's Continuum of Crisis Services. Establishes a  
             one-time grant program to expand the continuum of mental  
             health crisis services for children and youth (ages 21 and  
             under) regardless of where they live in the state.  
             Specifically, this bill spells out the following objectives:

             a)   Add child/youth-specific mobile crisis and  
               community-based crisis stabilization support teams which  
               can provide in-home and community- based support to the  
               youth and family members. These teams would include  
               clinical and paraprofessional staff who can support the  
               youth/family until the crisis subsides or until appropriate  
               secure alternatives are located. Essential components  
               include:
               i)     Crisis planning
               ii)    Assessment of precipitant of crisis and behaviors  
                 that are accruing, and child/family safety
               iii)   Stabilization of functioning
               iv)    Referral and coordination
               v)     Post-crisis follow-up services

             b)   Add triage personnel who would be available at various  
               points of access, such as clinics and schools. These  
               personnel could provide the following services:  
               coordination, referral, monitoring service delivery, and  
               providing placement service assistance.

             c)   Add crisis stabilization unit services lasting less than  
               24 hours which can provide facility-based support to  
               children/youth who are in psychiatric crisis, as well as  
               providing support to their family members and natural  
               supports. The goal of crisis stabilization is to avoid the  
               need for inpatient services during the current crisis and  
               more importantly, to provide children/youth and the family  
               members with the supports needed to avoid crisis in the  
               future. 

               Crisis stabilization unit programming is designed to  
               support and assist children/youth and their caregivers to  
               prepare for the youth's rapid return to their home and  
               community environment.  The strengths-based assessment and  







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               treatment plan will address potential barriers to this.  
               These services must be provided at a licensed 24-hour  
               health care facility. Essential components include:

               i)     Assessment
               ii)    Crisis planning
               iii)   Stabilization of functioning
               iv)    Referral and coordination

             d)   Add child/youth crisis residential services which are  
               community-based treatment options in home-like settings  
               that offer safe, trauma-informed alternatives to  
               psychiatric emergency units or other locked facilities for  
               youth under the age of 18. Child/youth crisis residential  
               services are provided in the context of a comprehensive,  
               multi-disciplinary, and individualized treatment plan that  
               is frequently reviewed and updated based on the  
               individual's clinical needs, strengths, and response to  
               treatment. Essential components include:

               i)     Therapeutic programming provided seven days a week.
               ii)    Facilities limited to under 16 beds with at least 50  
                 percent of those beds in single occupancy rooms.
               iii)   Facilities include ample physical space for working  
                 with individuals who provide natural support to each  
                 child/youth and for integrating family members into the  
                 day-to-day care of the youth.
               iv)    Collaboration with each child/youth's mental health  
                 team, child and family team, and other paid and natural  
                 supports within 24 hours of intake and throughout the  
                 course of care and treatment as appropriate.

             e)   Add family respite care to help families and sustain  
               caregiver health and well-being.

             f)   Add family support services training designed to help  
               families participate in the planning process, access  
               services, and navigate programs. These services will follow  
               "a train the trainer" model which includes, at a minimum:

               i)     Training and education
               ii)    Outreach
               iii)   Engagement
               iv)    Communication







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               v)     Advocacy

           13)Office of AIDS. Makes the following changes:  

              a)   Eliminates cost-sharing for individuals enrolled in the  
               AIDS Drug Assistance Program (ADAP) with annual incomes  
               between 400 percent and 500 percent of the federal poverty  
               level. The Department of Public Health (DPH) estimates that  
               112 ADAP clients at this income level paid an ADAP share of  
               cost.  

              b)   Develops a Pre-Exposure Prophylaxis (PrEP) affordability  
               program to cover PrEP-related copays, coinsurance, and  
               deductibles incurred by all individuals accessing PrEP in  
               California with annual incomes below 500 percent of the  
               federal poverty level. The cost of this program would be  
               capped at $1 million from the Ryan White Supplemental Drug  
               Rebate Fund.  
           
             c)   Allows the Office of AIDS' Health Insurance Premium  
               Payment (OA-HIPP) Program to cover premiums, copays,  
               coinsurance, and deductibles incurred by all eligible  
               people living with HIV/AIDS in California. DPH estimates  
               that 5,966 private insurance ADAP clients did not receive  
               premium payment assistance from OA-HIPP Program.  
               Consequently, this proposal would result in expenditures of  
               $8.6 million in 2016-17 (based on calendar year 2015 data).  

            14)Alzheimer - Early Detection. Requires DPH to allocate funds  
             to the California Alzheimer Disease Centers to determine the  
             standard of care in early and accurate diagnosis, provide  
             professional outreach and education, and evaluate the  
             educational effectiveness of these efforts. (The 2016-17  
             budget provides funds for this purpose on a one-time basis.) 

            15)Hepatitis. Requires DPH to purchase and distribute hepatitis  
             B vaccines and related materials to local health  
             jurisdictions and community-based organizations; purchase  
             hepatitis C test kits and related materials; train nonmedical  
             personnel to perform hepatitis C and HIV testing; and provide  
             technical assistance to local governments and community-based  
             organizations regarding syringe exchange and disposal  
             programs. (The 2016-17 budget provides funds for this purpose  
             on a one-time basis.)  







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            16)Naloxone. Requires DPH to award funding to local health  
             departments, local government agencies, or on a competitive  
             basis to community-based organizations to support or  
             establish programs that provide Naloxone, an overdose  
             prevention drug. (The 2016-17 budget provides funds for this  
             purpose on a one-time basis.) 

            17)Covered California - Emergency Regulation Authority.  
             Provides Covered California with emergency regulation  
             authority in order to react to changes in federal regulations  
             relating to notices, the special enrollment period  
             verification process, and dental eligibility; changes related  
             to increased enrollment in the small business exchange; and  
             changes that may be necessary to timely implement a Section  
             1332 waiver.  

            18)California Office of Health Information Integrity. Makes  
             technical and clarifying changes to the California Office of  
             Health Information Integrity's duties with regard to  
             continued compliance with the federal Health Insurance  
             Portability and Accountability Act.
          
          FISCAL EFFECT:   Appropriation:    Yes         Fiscal  
          Com.:YesLocal:   No


          SUPPORT:   (Verified6/15/16)


          None received


          OPPOSITION:   (Verified6/15/16)


          None received





          Prepared by:  Michelle Baass / B. & F.R. / (916) 651-4103
          6/15/16 15:03:14







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