BILL NUMBER: SB 2139 CHAPTERED
BILL TEXT
CHAPTER 717
FILED WITH SECRETARY OF STATE SEPTEMBER 23, 1996
APPROVED BY GOVERNOR SEPTEMBER 21, 1996
PASSED THE SENATE AUGUST 31, 1996
PASSED THE ASSEMBLY AUGUST 31, 1996
AMENDED IN ASSEMBLY AUGUST 30, 1996
AMENDED IN ASSEMBLY AUGUST 29, 1996
AMENDED IN ASSEMBLY JULY 10, 1996
AMENDED IN SENATE MAY 1, 1996
AMENDED IN SENATE APRIL 22, 1996
INTRODUCED BY Senator Haynes
FEBRUARY 23, 1996
An act to amend Section 14089.05 of the Welfare and Institutions
Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
SB 2139, Haynes. Medi-Cal: San Diego County project.
Existing law provides for the Medi-Cal program, administered by
the State Department of Health Services, under which qualified
low-income persons are provided with health care services.
Existing law requires the department, upon approval by the Board
of Supervisors of the County of San Diego, to establish a multiplan
managed care pilot project for the provision of Medi-Cal services.
This bill would, instead, permit the department to implement this
program upon approval of the county. It would also make various
revisions in the provisions relating to geographic managed care
programs, including the specification of various criteria for the
contract between the state and the plans.
This bill would also express the intent of the Legislature that,
in the event the department contracts with one or more plans for the
provision of dental services to Medi-Cal beneficiaries in San Diego
County, the provisions relating to this project shall apply to these
contracts in the same manner as required for contracts issued for
other Medi-Cal services.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14089.05 of the Welfare and Institutions Code
is amended to read:
14089.05. (a) (1) Pursuant to subdivision (g) of Section 14089,
the department and the California Medical Assistance Commission may
implement a multiplan project in the County of San Diego, upon
approval of the Board of Supervisors of the County of San Diego, for
the provision of benefits under this chapter to eligible Medi-Cal
recipients. The multiplan project implemented in San Diego County
pursuant to this section shall provide diagnostic, therapeutic, and
preventive services provided under the Medi-Cal program, and
additional benefits including, but not limited to, medical-related
transportation, comprehensive patient management, and referral to
other support services.
(2) The County of San Diego shall be eligible to receive funds
transferred pursuant to paragraph (1) of subdivision (p) of Section
14163 for the development and implementation of this section. These
funds in the amount allocated by the department for the County of San
Diego shall be paid by the department upon the enactment of this
section to the County of San Diego to reimburse a portion of the
costs of the development of the project. To the full extent
permitted by state and federal law, these funds shall be distributed
by the department for expenditure by the County of San Diego in a
manner that qualifies for federal financial participation under the
medicaid program and the department shall expedite the payment of the
federal funds to the County of San Diego. The department shall seek
additional state, federal, and other funds to pay for costs that are
incurred by the County of San Diego to develop the multiplan project
in excess of the payment required by this section, and the
department shall assist the county in obtaining the additional funds.
(b) (1) The County of San Diego may establish two advisory boards,
one of which shall be composed of consumer representatives and the
other of which shall be composed of health care professional's
representatives. Each board shall advise the Department of Health
Services of the County of San Diego and review and comment on all
aspects of the implementation of the multiplan project. At least one
of the members of each advisory board shall be appointed by the
board of supervisors. The board of supervisors shall establish a
number of members to serve on each advisory board, with each
supervisor to appoint an equal number of members from his or her
district. Each advisory board shall vote on all pilot project
policies and issues that are submitted to the board of supervisors.
(2) Notwithstanding any other provision of law, a member of an
advisory board established pursuant to this section shall not be
deemed to be interested in a contract entered into by the department
within the meaning of Article 4 (commencing with Section 1090) of
Chapter 1 of Division 4 of Title 1 of the Government Code if the
member is a Medi-Cal recipient or if all of the following apply:
(A) The member was appointed to represent the interests of
physicians, health care practitioners, hospitals, pharmacies, or
other health care organizations.
(B) The contract authorizes the member or the organization the
member represents to provide Medi-Cal services under the multiplan
project.
(C) The contract contains substantially the same terms and
conditions as contracts entered into with other individuals or
organizations the member was appointed to represent.
(D) The member does not influence or attempt to influence the
joint advisory board or another member of the joint advisory board to
recommend that the department enter into the contract in which the
member is interested.
(E) The member discloses the interest to the joint advisory board
and abstains from voting on any recommendation on the contract.
(F) The advisory board notes the member's disclosure and
abstention in its official records.
(3) Members of the advisory boards shall not be paid compensation
for activities relating to their duties as members, but members who
are Medi-Cal recipients shall be reimbursed an appropriate amount by
the County of San Diego for travel and child care expenses incurred
in performing their duties under this section.
(c) At the discretion of the department, the County of San Diego,
the department, or other appropriate entities may perform any of the
following in a manner that accomplishes the integration of the intake
of eligible beneficiaries to the project, the assessment of
beneficiary individual and family needs and circumstances, and the
timely referral of beneficiaries to health care and other services to
respond to their individual and family needs:
(1) Determine the eligibility of Medi-Cal applicants and
recipients in a manner and environment that is accessible to the
recipients and applicants.
(2) Perform enrollment activities in a manner that ensures that
recipients be given the opportunity to select the provider of their
choice in a manner and environment that is accessible to the
recipients.
(3) The department may negotiate and amend its contract with the
county to provide for specified quality improvement activities, and
may require each of the health plans to participate in those
activities. The department shall also participate in the county's
quality improvement activities.
(d) Notwithstanding Section 14089 or any other provision of law,
the County of San Diego, when contracting with the department
pursuant to this section or subdivision (d), (i), or (j) of Section
14089, shall not be liable for damages for injury to persons or
property arising out of the actions or inactions of the department,
the department's other contractors, or providers of health care or
other services, or Medi-Cal recipients. This section shall not
relieve the County of San Diego from liability arising out of its
actions or inactions.
(e) The County of San Diego, when contracting with the department
pursuant to Section 14089 or this section, shall have no legal duty
to provide health care or other services to Medi-Cal recipients, and
shall have no financial responsibility for the department's other
contractors or providers of health care or other services, except to
the extent specifically set forth in contracts between the department
and the county.
(f) Notwithstanding Section 14089.6, the department may terminate
any existing managed care contract with either a prepaid health plan
or a primary care case management plan for services in the County of
San Diego in accordance with the terms and conditions set forth in
the existing contract, at any time that the department determines
that termination is in the best interest of the state. The
department shall notify an existing prepaid health plan at least 90
days prior to termination. The department shall notify a primary
care case management plan at least 30 days prior to termination.
(g) All contracts entered into by the department and the County of
San Diego pursuant to Section 14089 or this section shall not be for
the benefit of any third party, and no third-party beneficiary
relationship shall be established between the county and any other
party, except as may be specifically set forth in contracts between
the department and the County of San Diego.
(h) The department shall report to the appropriate committees of
the Legislature on the project implemented pursuant to this section.
(i) (1) For purposes of this section, "multiplan project" means a
program authorized by this section in which a number of Knox-Keene
licensed health plans designated by the county and approved by the
department to negotiate with the California Medical Assistance
Commission shall be the only Medi-Cal managed care health plans
authorized to operate within San Diego County, with the exception of
special projects approved by the department.
(2) Designated health plans shall include, but not be limited to,
health plans sponsored by traditional Medi-Cal physicians,
neighborhood health centers, community clinics, health systems,
including hospitals and other providers, or a combination thereof.
(3) Participating health plans shall first be designated by the
county for approval by the department. Health plans approved by the
department shall be eligible to negotiate contract rates, terms, and
conditions with the California Medical Assistance Commission.
Designation by the county and approval by the department provides the
health plan only with the opportunity to compete for a contract
through negotiations with the California Medical Assistance
Commission and does not guarantee a contract with the state.
(4) Designation requirements imposed by the county shall not
conflict with the requirements imposed by the department, the federal
medicaid program, and the Medi-Cal program, and may not impose
stricter requirements, without the department's approval, than those
imposed by the department, the federal medicaid program, and the
Medi-Cal program.
(5) Designation of health plans by the county will continue for
the term of the Medi-Cal contract.
(j) Nothing in this section relieves the county of duties or
liabilities imposed by Part 5 (commencing with Section 17000) or
which it has assumed through contract with entities other than the
department.
(k) Indian health facilities in San Diego County may contract
directly with the department as Medi-Cal fee-for-service case
management providers apart from the geographic managed care program
or may participate in the network of one or more of the geographic
managed care plans. Indian health service facilities that contract
with the department as fee-for-service case management providers may
enroll Medi-Cal recipients, including, but not limited to, recipients
who are in any of the geographic managed care mandatory enrollment
aid codes.
SEC. 2. It is the intent of the Legislature that, in the event the
department contracts with one or more plans for the provision of
dental services to Medi-Cal beneficiaries in San Diego County,
Section 14089.05 of the Welfare and Institutions Code shall apply to
these contracts in the same manner as required for contracts issued
for other Medi-Cal services.