BILL NUMBER: AB 1253 CHAPTERED 10/10/99 CHAPTER 1025 FILED WITH SECRETARY OF STATE OCTOBER 14, 1999 PASSED THE SENATE SEPTEMBER 9, 1999 PASSED THE ASSEMBLY SEPTEMBER 9, 1999 AMENDED IN SENATE SEPTEMBER 8, 1999 AMENDED IN SENATE AUGUST 26, 1999 AMENDED IN ASSEMBLY APRIL 6, 1999 INTRODUCED BY Assembly Member Nakano FEBRUARY 26, 1999 An act to add and repeal Chapter 8 (commencing with Section 124960) of Part 4 of Division 106 of the Health and Safety Code, relating to health. e law without Governor's signature. Filed with Secretary of State October 14, 1999.) LEGISLATIVE COUNSEL'S DIGEST AB 1253, Nakano. Health services pilot program: uninsured working poor families. Existing law establishes 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 also provides for the Healthy Families Program, and for the Managed Risk Medical Insurance Board to administer the program. This bill would require the department to establish a 3-year pilot program to provide health care services to certain uninsured poor children and adults through a specified participating community care clinic. This bill would authorize the School of Public Health of the University of California, Los Angeles, with the consent of the Regents of the University of California, to participate in the pilot program by developing an evaluation design and evaluating the pilot program. This bill would authorize the department, in consultation with the participating community clinic, to appoint an advisory group to provide assistance and advice to the pilot program. This bill would make its provisions inoperative on July 1, 2003, and would repeal them as of January 1, 2004. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. (a) It is the intent of the Legislature to establish a pilot program that will team community clinics with local hospitals, small employers, and the School of Public Health of the University of California, Los Angeles, to create a complete system of health care for poor children and adults who are ineligible for public health programs or private health plans or insurance. (b) The purpose of the pilot program is to accomplish all of the following: (1) To demonstrate the potential for profound reductions in the cost of health care services provided to uninsured working poor families by tracking the cost of the care and the impact of access to care on those families. (2) To achieve a better understanding of the overall social and financial implications of moving uninsured working poor families to a fully covered status. (3) To learn what the baseline utilization of health care services is for uninsured working poor families when they have access to a full range of health care services. (4) To learn the actual cost of providing comprehensive health care to this population. (5) To learn how a managed care system for uninsured working poor families might be used to change the structure of health care delivery in California. SEC. 2. Chapter 8 (commencing with Section 124960) is added to Part 4 of Division 106 of the Health and Safety Code, to read: CHAPTER 8. HEALTH PILOT PROGRAM FOR WORKING POOR FAMILIES 124960. The department shall establish and administer a three-year pilot program to provide health care services to poor children and adults, who are not eligible for public or private health coverage. 124961. The pilot program shall be implemented through the participation of the community health clinic known as the Venice Family Clinic. 124962. The participating community clinic shall do all of the following: (a) On or before June 30, 2000, enter into an agreement with a local partner hospital to implement the pilot project. (b) On or before June 30, 2000, with the consultation and assistance of the department, and with the participation of its local hospital partner, develop a managed health care delivery system to provide to uninsured poor children and adults a standard health benefit package that meets the requirements of Section 124964, including, but not limited to, primary and preventive health care services, specialty health care services, emergency health care services, inpatient hospital services, laboratory, radiological, and other diagnostic services, and medications related to all of these health services. (c) On or before June 30, 2000, with the consultation and assistance of the department, develop recruitment and enrollment materials and procedures. (d) On or before June 30, 2000, recruit, hire and train staff, conduct outreach to small employers in order to enroll poor children and adults into the pilot program, and collect baseline data. (e) Commencing July 1, 2000, enroll approximately 350 uninsured poor children and adults and begin providing health care services. (f) Utilize managed care principles, including utilization review and quality assurance, in operating the system. 124963. By January 1, 2001, each participating community clinic shall have its pilot program in full operation, and shall conduct ongoing data collection and analysis for the duration of the pilot program. 124964. The standard health benefit package provided to the uninsured poor children and adults enrolled in the pilot program shall be the same as, or comparable to, the benefit packages available to the employees of those public agencies who have elected to have their employees participate in the Public Employees' Medical and Hospital Care Act, Part 5 (commencing with Section 22751) of Division 5 of Title 2 of the Government Code. 124965. The School of Public Health of the University of California, Los Angeles may, with the consent of the Regents of the University of California, participate in the pilot program by doing the following: (a) On or before June 30, 2000, develop an overall evaluation design for the pilot program, including, but not limited to, methods for evaluating the quality of care provided, measuring the impact on public health, and assessing the health outcomes of participants. (b) On or before March 30, 2003, prepare an evaluation of the pilot program and a financial analysis that includes the amounts expended by the program in each year of operation and for what purposes expenditures were made. 124966. The department may, in consultation with the participating community clinic, appoint a small business and health care industry advisory group to provide assistance and advice to the pilot program. 124967. This chapter shall be implemented only to the extent funding is made available by the Legislature. It is the intent of the Legislature that no more than three hundred seventy-five thousand dollars ($375,000) be appropriated for the purpose of implementing this chapter. 124968. This chapter shall become inoperative on July 1, 2003, and, as of January 1, 2004, is repealed, unless a later enacted statute that is enacted before January 1, 2004, deletes or extends the dates on which it becomes inoperative and is repealed.