BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 833|
|Office of Senate Floor Analyses | |
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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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