BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 1308
---------------------------------------------------------------
|AUTHOR: |Nguyen |
|---------------+-----------------------------------------------|
|VERSION: |March 28, 2016 |
---------------------------------------------------------------
---------------------------------------------------------------
|HEARING DATE: |April 6, 2016 | | |
---------------------------------------------------------------
---------------------------------------------------------------
|CONSULTANT: |Scott Bain |
---------------------------------------------------------------
SUBJECT : Medi-Cal: county health systems
SUMMARY : Prohibits a Medi-Cal managed care plan known as a county
organized health system (COHS) from utilizing 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. Prohibits a media campaign or paid advertising
purchased by a COHS from featuring 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, unless 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.
Existing law:
1)Establishes the Medi-Cal program, which is administered by the
Department of Health Care Services (DHCS), under which
qualified low-income individuals receive health care services.
2)Requires that DHCS has exclusive authority to negotiate the
rates, terms, and conditions of COHS contracts and contract
amendments.
3)Permits any county or counties to establish a special
commission in order to meet the problems of the delivery of
publicly assisted medical care in the county or counties and
to demonstrate ways of promoting quality care and cost
efficiency.
4)Permits a county board of supervisors, by ordinance, to
SB 1308 (Nguyen) Page 2 of ?
establish a commission to negotiate the exclusive COHS and to
arrange for the provision of health care services under the
Medi-Cal program.
This bill:
1)Prohibits a COHS from utilizing 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.
2)Prohibits a media campaign or paid advertising purchased by a
COHS from featuring 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.
3)Permits a media campaign or paid advertising purchased by a
COHS to 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.
4)Makes the following legislative findings and declarations:
a) COHS collectively serve 2.2 million enrollees
in the Medi-Cal program, recent increases in
enrollment in the Medi-Cal program have stretched
available resources and have the potential to limit
access to vital medical care;
b) COHS resources should be directed to providing
direct care to the maximum extent possible;
c) The California Health Benefit Exchange (known
as Covered California) has operated with limitations
on how taxpayer funding can be used in an effort to
direct more resources into direct patient services;
d) All advertisement and promotional material
produced by COHS should be used to promote access to
health care and not to promote board members; and,
e) COHS are responsible for billion-dollar annual
contracts, which potentially create perceived or real
conflicts of interest.
FISCAL
SB 1308 (Nguyen) Page 3 of ?
EFFECT : This bill has not been analyzed by a fiscal committee.
COMMENTS :
1)Author's statement. According to the author, this bill would
ensure that funds allocated to COHS are used for direct
services to the greatest extent possible. The bill will also
ensure that COHS funding is not used for political purposes.
The bill would mirror the protections in the statutes applying
to the California Health Exchange (Covered California) and
Proposition 99 (The Tobacco Tax and Health Protection Act).
2)COHS. There are two main systems for the delivery of services
to Medi-Cal beneficiaries: fee-for-service (FFS) and Medi-Cal
Managed Care (MCMC). MCMC is an organized system for the
delivery of medical services in which DHCS contracts with
public and private managed care plans to provide health care
coverage for Medi-Cal beneficiaries. COHS are one model of
Medi-Cal managed care, whereby DHCS contracts with a COHS
created by a County Board of Supervisors to be the sole
administrator of Medi-Cal benefits for an entire county. There
are six COHS operating in 22 counties serving approximately
2.1 million Medi-Cal beneficiaries. Almost all
Medi-Cal-eligible beneficiaries in COHS counties are
mandatorily enrolled into the COHS plan. The chart below is a
list of the COHS, the counties they serve, and the number of
Medi-Cal beneficiaries in each COHS as of February 2016:
----------------------------------------------------------
| COHS | Counties | Number of |
| | | enrollees |
| | | as of May 2015 |
|-----------------+---------------------+------------------|
| CalOptima | Orange | 765,580 |
|-----------------+---------------------+------------------|
| CenCal Health | Santa Barbara | 173,082 |
| | San Luis Obispo | |
|-----------------+---------------------+------------------|
| Central | Santa Cruz, |345,723 |
| California | Monterey, Merced | |
| Alliance for | | |
| Health | | |
|-----------------+---------------------+------------------|
| Gold Coast | Ventura | 205,004 |
SB 1308 (Nguyen) Page 4 of ?
| Health Plan | | |
|-----------------+---------------------+------------------|
| Health Plan of | San Mateo | 112,885 |
| San Mateo | | |
|-----------------+---------------------+------------------|
| Partnership |Del Norte, Humboldt, | 567,682 |
| Health |Lake, Lassen, Marin, | |
| Plan of | Mendocino, Modoc, | |
| California | Napa, Shasta, | |
| | Siskiyou, Solano, | |
| |Sonoma, Trinity, and | |
| | Yolo Counties | |
----------------------------------------------------------
-----------------------------------------------------------
|Total COHS Enrollment |2,169,956 |
| | |
-----------------------------------------------------------
3)Bill provisions mirror existing law governing Covered
California and Proposition 99 funded media campaign. The
author's background material and the legislative bill findings
cite major changes that could occur in the Medi-Cal program
and potentially result in increased General Fund costs as high
as the low billions of dollars annually as the phase-in of the
state's share of cost for the ACA optional expansion
population begins. The author argues the increase in the
Medi-Cal caseload, combined with increasing cost pressures,
make it imperative that taxpayer funding is not diverted from
direct medical services. To address this, this bill contains
language modeled on a provision in the state law establishing
Covered California, and a provision in the anti-tobacco media
campaign funded by Proposition 99 fund, as follows:
-----------------------------------------------------------
| Existing law | SB 1308 |
|-------------------------------+---------------------------|
|Prohibits Covered California |Prohibits a COHS from |
|board or its staff from |utilizing any funds |
|utilizing any funds intended |intended for |
|for the administrative and |administrative and |
|operational expenses for staff |operational expenses for |
|retreats, promotional |staff retreats, |
|giveaways, excessive executive |promotional giveaways, |
|compensation, or promotion of |excessive executive |
|federal or state legislative |compensation, or promotion |
SB 1308 (Nguyen) Page 5 of ?
|or regulatory modifications. |of federal or state |
|(Government Code Section |legislative or regulatory |
|100520.) |modifications. |
| | |
|Prohibits an Exchange from | |
|utilizing any funds intended | |
|for the administrative and | |
|operational expenses of the | |
|Exchange for staff retreats, | |
|promotional giveaways, | |
|excessive executive | |
|compensation, or promotion of | |
|Federal or State legislative | |
|and regulatory modifications. | |
|(Sec. 1311 of the federal | |
|Affordable Care Act.) | |
| | |
|-------------------------------+---------------------------|
|Prohibits any Proposition |Prohibits a media campaign |
|99-funded media campaign from |or paid advertising |
|featuring in any manner the |purchased by a COHS from |
|image or voice of any elected |featuring in any manner |
|public official or candidate |the image or voice of an |
|for elected office, or |elected public official or |
|directly represent the views |candidate for elected |
|of any elected public official |office or directly |
|or candidate for elected |represent the views of an |
|office. (Health and Safety |elected public official or |
|Code Section 104375,) |candidate for elected |
| |office. |
| | |
| |Permits a media campaign |
| |or paid advertising |
| |purchased by a COHS |
| |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 |
SB 1308 (Nguyen) Page 6 of ?
| |location. |
| | |
-----------------------------------------------------------
4)Opposition. Four county organized health system plans write in
opposition to this bill, stating that COHS have publicly
appointed boards or commissions with oversight responsibility
over the plan, and this bill undermines the concept of local
control and responsibility. Opponents argue this bill
erroneously takes language that is currently applied to
Covered California and applies it to COHS, and singles out
COHS among the Medi-Cal managed care models when COHS have
among the lowest percentage of administrative costs of any
Medi-Cal managed care model, and there is no demonstrated
example of the need to apply spending and operational
prohibitions to COHS. Opponents argue the promotional items
almost always include the plan name and contact information,
and this information ensures that as many eligible
beneficiaries as possible know who their health plan is and
how to contact the plan. Finally, opponents argue it may be
advantageous for COHS to use an elected official in an
advertisement or media campaign to promote the plan and to
encourage their constituents to use the plan's services as the
elected official has credibility with his or her constituents
and can better convince people to enroll in the program.
5)Proposed author's amendment. The author is proposing
amendments to delete the prohibition in this bill against the
use of any funds for the promotion of federal or state
legislative or regulatory modifications.
SUPPORT AND OPPOSITION :
Support: None received
Oppose: Central California Alliance for Health
Gold Coast Health Plan
Health Plan of San Mateo
Partnership Health Plan
-- END --
SB 1308 (Nguyen) Page 7 of ?