BILL NUMBER: AB 158 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JANUARY 7, 2008
AMENDED IN ASSEMBLY MAY 1, 2007
AMENDED IN ASSEMBLY APRIL 10, 2007
INTRODUCED BY Assembly Member Ma
JANUARY 18, 2007
An act to add Part 8 (commencing with Section 122430.10)
to Division 105 of the Health and Safety Code, relating to public
health, and making an appropriation therefor. An act
to add Article 4.6 (commencing with Section 14146) to Chapter 7 of
Part 3 of Division 9 of the Welfare and Institutions Code, relating
to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 158, as amended, Ma. Public health.
Medi-Cal: benefits for nondisabled persons infected with hepatitis B.
Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services and
under which qualified low-income persons receive health care
benefits. Counties are responsible for making eligibility
determinations under the Medi-Cal program. One of the methods by
which services are provided under the Medi-Cal program is through
enrollment of recipients in Medi-Cal managed care plans.
This bill would require the State Department of Health Care
Services to expand eligibility for benefits under the existing
Medi-Cal program to include nondisabled persons with hepatitis B who
would be eligible for Medi-Cal if disabled. This bill would provide
that the expansion would be implemented on the date all applicable
federal waivers are granted, as specified. The bill would provide
that enrollment in Medi-Cal pursuant to the bill would be limited
pursuant to an allocation system to be developed by the department.
The bill would require the department to meet federal revenue
neutrality requirements through the savings generated by voluntary
enrollment into Medi-Cal managed care of persons who are disabled as
a result of hepatitis B, and who are either receiving Medi-Cal
benefits on a fee-for-service basis as of January 1, 2009, or who
become eligible to receive Medi-Cal benefits on or after that date.
The bill would condition its implementation upon the receipt of
federal financial participation and would prohibit the department
from enrolling persons in the program established by this bill until
the department can ensure sufficient savings equal to or greater than
the cost of providing benefits to these persons.
By increasing counties' responsibilities for Medi-Cal eligibility
determinations, this bill would impose a state-mandated local
program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to these
statutory provisions.
Existing law establishes the State Department of Public Health and
sets forth its duties and responsibilities, including, but not
limited to, responsibilities related to the development and
implementation of a hepatitis C public education and outreach
program.
This bill would require the department to establish a hepatitis B
and C prevention and management pilot program within its Office of
Multicultural Health to provide matching grants to public and
not-for-profit organizations in the Los Angeles area and the San
Francisco Bay area for the purposes of providing culturally and
language appropriate public awareness and other activities relating
to the prevention and management of hepatitis B and C.
This bill would establish the Hepatitis B Prevention and
Management Pilot Program Fund, the moneys in which would be used by
the department exclusively for purposes of this bill, and would
appropriate $4,000,000 from the General Fund to the department for
deposit into the fund. The bill would require the department to
report to the Legislature by January 1, 2011.
Vote: 2/3 majority . Appropriation:
yes no . Fiscal committee: yes.
State-mandated local program: no yes .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Article 4.6 (commencing with Section
14146) is added to Chapter 7 of Part 3 of Division 9 of the
Welfare and Institutions Code , to read:
Article 4.6. Medi-Cal Managed Care Benefits for Nondisabled
Persons with Hepatitis B
14146. (a) It is the intent of the Legislature in enacting this
article to expand eligibility for Medi-Cal benefits to persons with
hepatitis B who are not disabled, but who, if disabled, would qualify
for Medi-Cal benefits.
(b) It is further the intent of the Legislature that this
expansion of the existing Medi-Cal program be funded by cost savings
achieved through the voluntary enrollment into the existing Medi-Cal
managed care program of persons who are disabled as a result of
hepatitis B, and who are either receiving Medi-Cal benefits on a
fee-for-service basis as of January 1, 2009, or who become eligible
to receive Medi-Cal benefits on or after January 1, 2009.
(c) It is further the intent of the Legislature that the
department encourage the voluntary enrollment into the existing
Medi-Cal managed care program of persons described in subdivision (b)
in order to obtain sufficient cost savings to provide Medi-Cal
benefits to the maximum feasible number of persons with hepatitis B
subject to the constraints of this article.
(d) It is further the intent of the Legislature that all
protections of state and federal law and regulations that apply to
the state's Medi-Cal managed care program shall apply to those
persons who become eligible for Medi-Cal pursuant to this article.
14146.1. (a) Subject to subdivisions (b) and (c), paragraph (2)
of subdivision (f), and subdivision (k), the department shall,
commencing July 1, 2009, or the date that all necessary federal
waivers have been obtained, whichever is later, expand eligibility
for benefits under this chapter to any person with hepatitis B who
would otherwise qualify for Medi-Cal benefits if the person were
disabled as defined in subdivision (h).
(b) Any person eligible for benefits pursuant to subdivision (a),
and seeking enrollment in Medi-Cal pursuant to this article shall be
enrolled on a first-come-first-served basis pursuant to an allocation
mechanism that shall be developed by the department.
(c) Any person who is eligible for enrollment in Medi-Cal pursuant
to this article shall be required to elect a Medi-Cal managed care
plan in those counties in which a managed care plan is available,
unless the department determines that the cost-neutrality
requirements provided for in subdivision (f) and the enrollment goals
provided for in this article can be achieved without this
requirement.
(d) In implementing this article, the department shall ensure that
all of the following standards are met:
(1) All state and federal laws and regulations that apply to the
state's Medi-Cal managed care program shall apply to the expansion
provided by this article and to the beneficiaries eligible for
Medi-Cal pursuant to this article.
(2) All participating plans that assume full risk for all health
care services, including inpatient and outpatient services, shall be
licensed pursuant to the Knox-Keene Health Care Service Plan Act of
1975 (Chapter 2.2 (commencing with Section 1340) of Division 2 of the
Health and Safety Code), except as provided in Section 1343 of the
Health and Safety Code.
(3) Health care service plans participating in the Medi-Cal
managed care program shall comply with the applicable sections of the
Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2
(commencing with Section 1340) of Division 2 of the Health and Safety
Code), including Sections 1367 and 1374.16 of the Health and Safety
Code and the regulations adopted pursuant to Section 1374.16 of the
Health and Safety Code.
(4) Primary care case management plans participating in the
Medi-Cal managed care program shall comply with the applicable
sections of Article 2.9 (commencing with Section 14088). Primary care
case management plans are required to maintain grievance and appeal
procedures consistent with the existing Medi-Cal managed care
program, to address beneficiary grievances.
(e) The department shall establish capitation rates to be paid to
Medi-Cal managed care plans for services provided pursuant to this
section. These capitation rates may not exceed 95 percent of the
fee-for-service equivalent costs to the Medi-Cal program for medical
services for persons with hepatitis B.
(f) (1) The department shall meet federal revenue neutrality
requirements through the savings generated by the voluntary
enrollment into Medi-Cal managed care of persons who are disabled as
a result of hepatitis B, and who are either receiving Medi-Cal
benefits on a fee-for-service basis as of January 1, 2009, or who
become eligible to receive Medi-Cal benefits on or after January 1,
2009. The savings generated by increased voluntary enrollments in
Medi-Cal managed care shall be used to fund enrollment by individuals
eligible for the expansion of Medi-Cal eligibility provided for
pursuant to subdivision (a). Nothing in this subdivision shall
preclude the department from implementing other means of meeting the
federal revenue neutrality requirements, provided that all
requirements of this article are met.
(2) The department shall not enroll individuals described in
subdivision (a) until the department can ensure sufficient savings,
pursuant to paragraph (1), equal to or greater than the cost of
providing benefits to these individuals.
(g) The department shall encourage the voluntary enrollment into
Medi-Cal managed care of persons who are disabled as a result of
hepatitis B. The department shall conduct all outreach and awareness
activities necessary to implement this requirement in a manner
consistent with Section 14407 to ensure that persons who enroll in
managed care do so voluntarily. These outreach and awareness
activities shall include information on how electing managed care may
alter provider relationships and how persons may revert to
fee-for-service if they prefer to return to fee-for-service.
(h) For the purposes of this section, "disabled" means a person
who meets the eligibility criteria for the federal Supplemental
Security Income for the Aged, Blind and Disabled program (Subchapter
16 (commencing with Section 1381) of Chapter 7 of Title 42 of the
United States Code).
(i) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall implement this article, without taking any
regulatory action, by means of an all-county letter or similar
instruction. 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.
(j) Commencing January 1, 2009, the department shall seek the
appropriate federal waiver under Section 1115 of the Social Security
Act (42 U.S.C. Sec. 1315) to implement the expansion of eligibility
provided for pursuant to this section. The department shall maximize
the federal reimbursement received for services provided under this
article to those eligible pursuant to this section.
(k) This article shall be implemented only if, and to the extent
that, the department determines that federal financial participation
is available pursuant to Title XIX of the federal Social Security Act
(42 U.S.C. Sec. 1396 et seq.).
SEC. 2. If the Commission on State Mandates
determines that this act contains costs mandated by the state,
reimbursement to local agencies and school districts for those costs
shall be made pursuant to Part 7 (commencing with Section 17500) of
Division 4 of Title 2 of the Government Code.
SECTION 1. Part 8 (commencing with Section
122430.10) is added to Division 105 of the Health and Safety Code, to
read:
PART 8. HEPATITIS B
122430.10. The Legislature finds and declares all of the
following:
(a) Approximately 1.4 million Americans are chronically infected
with the hepatitis B virus (HBV).
(b) HBV is extremely infectious, transmitted from mother to
newborn at birth, through infected blood or injections contaminated
by infected blood, and through unprotected sex.
(c) Persons chronically infected with HBV are at a higher risk of
developing cirrhosis of the liver or liver cancer.
(d) Asian Pacific Islander Americans make up more than one-half of
HBV carriers in the United States.
(e) Liver cancer that is primarily caused by HBV is the leading
cause of cancer death among Asian Pacific Islander men living in
California and is the most significant health disparity between Asian
Pacific Islanders and Caucasians.
(f) Chinese Americans have a three to four times higher risk for
liver cancer caused by HBV than Caucasian Americans.
(g) Korean Americans have a five to six times higher risk for
liver cancer caused by HBV than Caucasian Americans.
(h) Vietnamese Americans have a seven to eight times higher risk
for liver cancer caused by HBV than Caucasian Americans.
(i) There exists a vaccination for HBV that is safe, effective,
and widely available.
(j) Early diagnosis of HBV can reduce the risk of further
transmission and, where appropriate, treatment can reduce the risk of
progression to liver cancer. HBV diagnosis can be made with a simple
blood test.
(k) Regular monitoring of those chronically infected with HBV can
lead to the detection of liver cancer at a stage where cure is still
possible.
(l) The annual health care cost attributable to HBV in the United
States is estimated to be approximately $2.5 billion.
122430.15. (a) The State Department of Public Health shall
establish within its Office of Multicultural Health, a hepatitis B
and C prevention and management pilot program to provide education,
outreach, counseling, and social services to ethnic populations that
are at high risk of hepatitis B and C infection and to individuals
among those populations suffering from this disease.
(b) The program shall utilize existing programs and systems
operated by public and not-for-profit organizations to provide the
services described in subdivision (a).
(c) The department shall make and administer grants to the public
and not-for-profit organizations from funds appropriated by the
Legislature or donated to the state in order to provide these
services.
122430.20. (a) There is hereby established the Hepatitis B and C
Prevention and Management Pilot Program Fund.
(b) The fund shall be available to the Office of Multicultural
Health in the department, upon appropriation of the Legislature,
exclusively for to the support of existing and ongoing programs
operated by nonprofit or academic organizations that provide
culturally and language appropriate health education, public
awareness campaigns, and community outreach activities, especially to
the ethnic communities with high rates of hepatitis B and C
infection and other high-risk groups, to promote public awareness and
knowledge about the value of hepatitis B and C immunization, risk
factors, the transmission and prevention of hepatitis B and C , and
the value of screening for early detection of hepatitis B and C
infection, and to conduct at least two of the following:
(1) Testing programs to screen the high chronic hepatitis B or C
prevalence populations in order to identify chronically infected
individuals, and provide vaccines to protect susceptible adults.
(2) Programs for high-prevalence populations that provide
client-centered information, education, and counseling concentrating
on any of the following:
(A) Testing of family members.
(B) Modifying behaviors that place individuals at risk of
hepatitis B or C virus infection.
(C) Reducing the risk of dying from end-stage liver disease or
liver cancer among individuals with hepatitis B or C .
(D) Culturally appropriate health information for pregnant women
or those of childbearing age who are chronically infected with
hepatitis B or C to alleviate their fears of becoming pregnant or
raising a family.
(E) Referring persons with chronic hepatitis B or C for further
medical evaluation, monitoring, and treatment, as appropriate.
(3) The training of health care professionals and health educators
to make them aware of the high rates of chronic hepatitis B or C in
certain adult ethnic populations, and the importance of prevention,
detection, and medical management of hepatitis B and C and of liver
cancer screening.
(c) Funds appropriated to the fund shall be distributed to
nonprofit or academic organizations in the greater Los Angeles and
San Francisco Bay areas that during 2008 met the requirement set
forth in subdivision (b) and have conducted at least two or more of
the programs set forth in subdivision (b).
(d) In order to receive distributions from the fund, a recipient
organization shall do all of the following:
(1) Submit audited financial statements setting forth its
expenditures made in 2008 for activities described in subdivision (b)
to demonstrate a history of successfully providing those services,
including, but not limited to, conducting two or more of the programs
as set forth in subdivision (b), along with a report on the specific
activities engaged in and an analysis of the impact of the programs
and activities.
(2) Commit to using all distributions from the fund in the 2009-10
fiscal year to meet the requirements of subdivision (b), including
conducting two or more of the programs set forth in subdivision (b).
(3) Submit audited financial statements setting forth expenditures
made in the 2009-10 fiscal year demonstrating that it has met the
requirements of subdivision (b), including, but not limited to,
successfully conducting two or more of the programs set forth in
subdivision (b) during that fiscal year.
122430.25. Distributions from the fund shall be on a matching
dollar-for-dollar basis for each organization's expenditures up to
the total amount of funds available in the fund. However, funds shall
be distributed equally between the two geographic areas.
122430.30. The department shall report to the Legislature by
January 1, 2011, reguarding implementation of, and recommendations
for, the pilot program. The department may contract with another
entity to draft the report.
SEC. 2. The sum of four million dollars
($4,000,000) is hereby appropriated from the General Fund to the
State Department of Public Health for deposit into the Hepatitis B
and C Prevention and Management Pilot Program Fund established
pursuant to Section 122430.20 of the Health and Safety Code.