Amended in Senate March 28, 2016

Senate Bill No. 1308

Introduced by Senator Nguyen

February 19, 2016

An act to amend Section begin delete 14087.8 of end delete begin insert 14087.6 of, and to add Section 14087.65 to, end insert the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

SB 1308, as amended, Nguyen. Medi-Cal: county begin insert organized end insert health systems.

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 authorizes the department to negotiate exclusive contracts with any county begin delete which end delete begin insert that end insert seeks to provide, or arrange for the provision begin delete of end delete begin insert of, end insert the Medi-Cal services to Medi-Cal beneficiaries, as specified. Existing law begin delete requires that when the department has entered into a contract with a county, that the department, at a minimum, monitor the level and quality of services provided in the county and the county’s expenditures pursuant to the contract, as specified. end delete begin insert authorizes a county that has contracted for the provision of services to end insert begin insert arrange for any or all of the services to be provided by subcontracting with primary care providers, health maintenance organizations, insurance carriers, or other entities or individuals. end insert

This bill would begin delete require the department to additionally report to the Legislature annually on the level and quality of services provided in the county and the county’s expenditures pursuant to the contract. end delete begin insert prohibit a county organized health system that has contracted with the department as described above from utilizing funds intended for administrative and operational expenses for staff retreats, promotional giveaways, excessive executive compensation, or promotion of federal or state legislative or regulatory modifications. The bill would prohibit a media campaign or paid advertising purchased by the county organized health system from featuring the image or voice of an elected public official or candidate for elected office, or directly represent the views of an official or candidate. The bill would permit the media campaign or paid advertising to reference an official or candidate if the name appears in a roster listing containing the names of all officers of the purchasing agency, as specified. The bill would make related legislative findings and declarations. end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert The Legislature finds and declares all of the
following: end insert

begin insert

(a) County organized health systems together serve 2.2 million
enrollees in the Medi-Cal program.

end insert begin insert

(b) Recent increases in enrollment in the Medi-Cal program
have stretched available resources and have the potential to limit
access to vital medical care.

end insert begin insert

(c) County organized health system resources should be directed
to providing direct care to the maximum extent possible.

end insert begin insert

(d) The California Health Benefit Exchange has operated with
limitations on how taxpayer funding can be used in an effort to
direct more resources into direct patient services.

end insert begin insert

(e) All advertisement and promotional material produced by
county organized health systems should be used to promote access
to health care and not to promote board members.

end insert begin insert

(f) County organized health systems are responsible for
billion-dollar annual contracts, which potentially creates perceived
or real conflicts of interest.

end insert

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 14087.6 of the end insert begin insert Welfare and Institutions Code end insert

begin insert is amended to read: end insert

14087.6.  

begin insert (a) end insert begin insert   end insert A county that has contracted for the provision
of services pursuant to this article may provide the services directly
to recipients, or arrange for any or all of the services to be provided
by subcontracting with primary care providers, health maintenance
organizations, insurance carriers, or other entities or individuals.
The subcontracts may utilize a prospectively negotiated
reimbursement rate, fee-for-service, retainer, capitation, or other
basis for payment. The rate of payment established under the
contract shall not exceed the total per capita amount that the
department estimates would be payable for all services and
requirements covered under the contract if all these services and
requirements were to be furnished to Medi-Cal beneficiaries under
the Medi-Cal fee-for-service program.

begin delete

Counties

end delete

begin insert (b) end insert begin insert   end insert begin insert Counties end insert that are responsible for providing health care under
this chapter shall make efforts to utilize existing health service
resources if these resources can be estimated by the county to result
in lower total long-term costs and accessible quality care to persons
served under this chapter. The granting of a certificate of need
pursuant to the criteria set forth in Section 127200 of the Health
and Safety Code or a certificate of exemption pursuant to the
criteria set forth in Section 127175 of the Health and Safety Code
shall satisfy the intent of this provision.

begin insert

(c) A county organized health system that has contracted for
the provision of services pursuant to this article shall not utilize
any funds intended for administrative and operational expenses
for staff retreats, promotional giveaways, excessive executive
compensation, or promotion of federal or state legislative or
regulatory modifications.

end insert

begin insert

begin insert SEC. 3. end insert   

end insert

begin insert Section 14087.65 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , to read: end insert

begin insert

begin insert 14087.65. end insert   

(a) A media campaign or paid advertising purchased
by a county organized health system that contracts for the provision
of services pursuant to this article shall not feature in any manner
the image or voice of an elected public official or candidate for
elected office, or directly represent the views of an elected public
official or candidate for elected office.

(b) A media campaign or paid advertising purchased by a county
organized health system that contracts for the provision of services
pursuant to this article may include a reference to an elected public
official or candidate for elected office if the name appears in a
roster listing containing the names of all officers of the purchasing
agency and all names in the roster appear in the same type size,
typeface, type color, and location.

end insert

begin delete

SECTION 1.  

Section 14087.8 of the Welfare and Institutions
Code is amended to read:

14087.8.  

When the department has entered into a contract with
a county pursuant to this article, the department shall, at a
minimum, through a method independent of any agency of the
county, monitor and report to the Legislature annually on the level
and quality of services provided in a county, as well as a county’s
expenditures pursuant to the contract, and shall ensure conformity
with federal law.

end delete