BILL NUMBER: SB 997	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 20, 2016
	AMENDED IN SENATE  APRIL 6, 2016

INTRODUCED BY   Senator Lara

                        FEBRUARY 10, 2016

   An act to add and repeal  Section   Sections
 14007.81  and 14   007.82  of the Welfare and
Institutions Code, relating to health care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 997, as amended, Lara. Health care coverage: immigration
status.
   Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which qualified low-income individuals receive health care services.
The Medi-Cal program is, in part, governed and funded by federal
Medicaid program provisions. Existing law extends eligibility for
full-scope Medi-Cal benefits to individuals under 19 years of age who
do not have, or are unable to establish, satisfactory immigration
status, commencing after the Director of Health Care Services
determines that systems have been programmed for implementation of
this extension, but in no case sooner than May 1, 2016.
   Existing law requires individuals under 19 years of age enrolled
in restricted-scope Medi-Cal at the time the director makes the
above-described determination to be enrolled in the full scope of
Medi-Cal benefits, if otherwise eligible, pursuant to an eligibility
and enrollment plan, as specified. Existing law requires an
individual who is eligible pursuant to these provisions to enroll in
a Medi-Cal managed care health plan, where available, but does not
preclude a beneficiary from being enrolled in any other children's
Medi-Cal specialty program that he or she would otherwise be eligible
for.
   This bill, until January 1, 2019, would authorize the enrollment
of eligible children who, as of May 1, 2016, were enrolled in
comprehensive, low-cost coverage provided by a health care service
plan with a total enrollment in excess of 5 million lives, in
full-scope Medi-Cal with the same health care service plan,
notwithstanding any other  law or existing Medi-Cal managed
care contract.   law. The bill would   provide
that this authorization is applicable only in a county in which a
health care service plan with a total enrollment in excess of 5
million lives has a contract or a subcontract for Medi-Cal managed
care. The bill would also, until January 1, 2019, authorize the
enrollment of eligible children who, as of May 1, 2016, were enrolled
in comprehensive, low-cost coverage provided by a Medi-Cal managed
care health plan, in full-scope Medi-Cal with the same Medi-Cal
managed care health plan, notwithstanding any other law.  The
bill would require a health care service plan  or Medi-Cal
managed care health plan  described above to provide specified
 information   information, subject to approval
by the department,  to the child's representative regarding the
child's transition into the Medi-Cal program. The bill would require
the department to provide notice to the child's representative before
the child's transition to full-scope Medi-Cal, and would require
this notice to contain specified  information, including that
the child may choose not to transition into the Medi-Cal program,
and what this choice will mean for his or her health care coverage
and access to health care services.   information. 
The bill would require the department, using  its
third-party liability database,   info  
rmation provided to it by health care service plans,  to
determine whether prior to May 1, 2016, an eligible child was
enrolled in coverage with a health care service plan with a total
enrollment in excess of 5 million lives.  The bill would require
a Medi-Cal managed care health plan and its designees to work with
the department and its designees to facilitate continuity of care and
data sharing for the purpose of implementing these provisions. 

   This bill would require the department to adopt necessary
regulations to implement these provisions, and until those
regulations are adopted, would authorize the department to implement
these provisions by means of all-county letters, provider bulletins,
or other similar instructions without taking regulatory action. The
bill would require the department to provide a semiannual status
report to the Legislature on the implementation of these provisions,
as specified. 
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  The Legislature finds and declares all of the
following:
   (a) No child in California should endure suffering and pain due to
a lack of access to health care services.
   (b) Expanding access and increasing enrollment in comprehensive
health care coverage benefits the health and welfare of all
Californians.
   (c) Through the enactment of Senate Bill 75, the California
Legislature has extended eligibility for full-scope Medi-Cal benefits
to all children in California, regardless of immigration status.
   (d) Prior to the enactment of Senate Bill 75, some children who
otherwise would have been ineligible for full-scope Medi-Cal benefits
as a result of their immigration status obtained comprehensive,
low-cost coverage as a result of the community benefit program of a
health care service plan with an enrollment of more than 5,000,000
Californians. It is the intent of the Legislature in enacting this
act to provide for continuity of care for these children, while
allowing them to be enrolled in full-scope Medi-Cal.
  SEC. 2.  Section 14007.81 is added to the Welfare and Institutions
Code, immediately following Section 14007.8, to read:
   14007.81.  (a) In order to maximize continuity of care and
coverage, children eligible for full-scope Medi-Cal benefits pursuant
to Section 14007.8 who, as of May 1, 2016, were enrolled in
comprehensive, low-cost coverage provided by a health care service
plan with a total enrollment in excess of five million lives, shall
be enrolled in full-scope Medi-Cal with the same health care service
plan if he or she is determined eligible for full-scope Medi-Cal
benefits under this chapter, notwithstanding any other  law
or existing Medi-Cal managed care contract.   law. This
requirement shall apply   only in a county in which a health
care service plan with a total enrollment in excess of five million
lives has a contract or a subcontract for Medi-Cal managed care.

   (b) (1) The health care service plan described in subdivision (a)
shall provide the following information to the child's
representative:
   (A) How the child may be determined eligible for full-scope
Medi-Cal benefits under this chapter.
   (B) How the child may remain enrolled with the health care service
plan from which the child obtained health care coverage as of May 1,
2016, if the child's representative chooses.
   (C) How the child may obtain coverage from another Medi-Cal
managed care health plan contracting with the department under this
chapter or Chapter 8 (commencing with Section 14200) or through
fee-for-service Medi-Cal, consistent with  the  law.
   (2) The information provided pursuant to this subdivision shall be
 subject to approval by the department and shall be 
provided in a fair and accurate manner  consistent with the
regulations adopted by the board of the California Health Benefit
Exchange for the regulation of certified plan-based enrollers
pursuant to Section 100503 of the Government Code.  
that informs the child's representative of the availability of other
Medi-Cal managed care health plans and how to contact the department
to obtain coverage. 
   (c) In order to facilitate continuity of care and coverage, the
department shall, using  its third-party liability database,
  information provided to it by health care service
plans consistent with Section 14124.90,  determine whether prior
to May 1, 2016, a child who is eligible for full-scope Medi-Cal
benefits pursuant to Section 14007.8 was enrolled in coverage with a
health care service plan with a total enrollment in excess of five
million lives.
   (d)  Before the child's transition to full-scope Medi-Cal
pursuant to subdivision (a), the  The  department
shall provide the child's representative with timely, linguistically
appropriate notice of  the transition.   the
child's enrollment into Medi-Cal and health plan options.  This
notice shall contain all of the following information:
   (1) Which Medi-Cal managed care health plan or plans contain the
child's existing primary care  provider in those counties
  provider, including those instances  in which the
health care service plan does not directly contract as a Medi-Cal
managed care health plan with the department under this chapter or
Chapter 8 (commencing with Section 14200).
   (2) That the child, subject to his or her ability to change his or
her health plan as described in paragraph (4), will be assigned to
his or her existing health care service plan if enrolled in
full-scope Medi-Cal benefits after May 1, 2016. If the child wants to
keep his or her primary care provider, no additional action will be
required.
   (3) That if the child's existing primary care provider is not
contracted with any Medi-Cal managed care health plan in the enrollee'
s county of residence or if the enrollee's existing health care
service plan is not an available Medi-Cal managed care health plan in
the child's county of residence, he or she will receive all provider
and health plan information required to be sent to new enrollees. If
the child does not affirmatively select one of the available
Medi-Cal managed care health plans within 30 days of receipt of the
notice, he or she will automatically be assigned a plan through the
department-prescribed auto-assignment process.
   (4) That the child may choose any available Medi-Cal managed care
health plan and primary care provider in his or her county of
residence, if more than one  such   Medi-Cal
managed care health  plan is available in the county where he or
she resides, and he or she will receive all provider and health plan
information required to be sent to new enrollees and instructions on
how to choose or change his or her health plan and primary care
provider.
   (5) That the child does not need to take any action to retain his
or her health plan and primary care provider if he or she is enrolled
in full-scope Medi-Cal benefits pursuant to subdivision (a).

   (6) That the child may choose not to transition into the Medi-Cal
program, and what this choice will mean for his or her health care
coverage and access to health care services.  
   (7) That in counties where no Medi-Cal managed care health plans
are available, the child will be transitioned into fee-for-service
Medi-Cal, and provided with all information that is required to be
sent to new Medi-Cal enrollees, including the assistance telephone
number for fee-for-service beneficiaries, and that, if a Medi-Cal
managed care health plan becomes available in the residence county,
he or she will be enrolled in a Medi-Cal managed care health plan
according to the enrollment procedures in place at that time.

   (e) The health care service plan described in subdivision (a) and
its designees shall work with the department and its designees to
facilitate continuity of care and data sharing for the purposes of
delivering Medi-Cal services.
   (f) This section shall apply only to an enrollee in a service area
of the health care service plan approved as of  January 1,
2017.   the effective date of this section.  
   (g) (1) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code, the
department, without taking any further regulatory action, shall
implement, interpret, or make specific this section by means of
all-county letters, plan letters, plan or provider bulletins, or
similar instructions until the time any necessary regulations are
adopted. Thereafter, the department shall adopt regulations in
accordance with the requirements of Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code.  
   (2) Commencing six months after the effective date of this
section, and notwithstanding Section 10231.5 of the Government Code,
the department shall provide a report on the status of the
implementation of this section to the Legislature on a semiannual
basis. The submission of the report shall comply with Section 9795 of
the Government Code.  
   (g) 
   (h)  This section shall remain in effect only until
January 1, 2019, and as of that date is repealed, unless a later
enacted statute, that is enacted before January 1, 2019, deletes or
extends that date.
   SEC. 3.    Section 14007.82 is added to the 
 Welfare and Institutions Code   , to read:  
   14007.82.  (a) In order to maximize continuity of care and
coverage, children eligible for full-scope Medi-Cal benefits pursuant
to Section 14007.8 who, as of May 1, 2016, were enrolled in
comprehensive, low-cost coverage provided by a Medi-Cal managed care
health plan shall be enrolled in full-scope Medi-Cal with the same
Medi-Cal managed care health plan pursuant to the requirements of
this subdivision, notwithstanding any other law.
   (b) (1) The health care service plan described in subdivision (a)
shall provide the following information to the child's
representative:
   (A) How the child may be determined eligible for and obtain
full-scope Medi-Cal benefits under this chapter.
   (B)  How the child may obtain coverage from another Medi-Cal
managed care health plan contracting with the department under this
chapter or Chapter 8 (commencing with Section 14200) for the child's
county of residence, or through fee-for-service Medi-Cal, consistent
with the law.
   (C) That, if the child is determined eligible for full-scope
Medi-Cal and does not take any action pursuant to subparagraph (B),
the child will be enrolled in the Medi-Cal managed care health plan
described in subdivision (a).
   (2) The information provided pursuant to this subdivision shall be
subject to approval by the department and provided in a fair and
accurate manner that informs the child's representative of the
availability of other Medi-Cal managed care health plans and how to
contact the department to obtain coverage.
   (c) A Medi-Cal managed care health plan described in subdivision
(a) and its designees shall work with the department and its
designees to facilitate continuity of care and data sharing to the
extent permissible for the purposes of implementing this section and
delivering full-scope Medi-Cal services.
   (d) The department shall provide the child's representative with
timely, linguistically appropriate notice of the child's enrollment
into Medi-Cal and of health plan options consistent with the
applicable provisions of subdivision (d) of Section 14007.81. The
notice shall contain all of the following information:
   (1) Which Medi-Cal managed care health plan or plans contain the
child's existing primary care provider, including those instances in
which the health care service plan does not directly contract as a
Medi-Cal managed care health plan with the department under this
chapter or Chapter 8 (commencing with Section 14200).
   (2) That the child, subject to his or her ability to change his or
her health plan as described in paragraph (3), will be assigned to
his or her existing health care service plan if enrolled in
full-scope Medi-Cal benefits after May 1, 2016. If the child wants to
keep his or her primary care provider, no additional action will be
required.
   (3) That the child may choose any available Medi-Cal managed care
health plan and primary care provider in his or her county of
residence, if more than one Medi-Cal managed care health plan is
available in the county where he or she resides, and he or she will
receive all provider and health plan information required to be sent
to new enrollees and instructions on how to choose or change his or
her health  plan and primary care provider.
   (4) That the child does not need to take any action to retain his
or her health plan and primary care provider if he or she is enrolled
in full-scope Medi-Cal benefits pursuant to subdivision (a).
   (e) (1) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code, the
department, without taking any further regulatory action, shall
implement, interpret, or make specific this section by means of
all-county letters, plan letters, plan or provider bulletins, or
similar instructions until the time any necessary regulations are
adopted. Thereafter, the department shall adopt regulations in
accordance with the requirements of Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code.
   (2) Commencing six months after the effective date of this
section, and notwithstanding Section 10231.5 of the Government Code,
the department shall provide a report on the status of the
implementation of this section to the Legislature on a semiannual
basis. The submission of the report shall comply with Section 9795 of
the Government Code.
   (f) This section shall remain in effect only until January 1,
2019, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2019, deletes or extends
that date.