BILL NUMBER: AB 158 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JANUARY 24, 2008
AMENDED IN ASSEMBLY JANUARY 16, 2008
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 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. Medi-Cal: benefits for nondisabled
persons infected with chronic 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 chronic
hepatitis B infection 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.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: 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 Chronic Hepatitis B Infection
14146. (a) It is the intent of the Legislature in enacting this
article to expand eligibility for Medi-Cal benefits to persons with
chronic hepatitis B infection 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 chronic
hepatitis B infection 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 chronic hepatitis
B infection 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 shall not exceed 95 percent of the
fee-for-service equivalent costs to the Medi-Cal program for medical
services for persons with chronic hepatitis B infection.
(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.).
(l) The department may seek federal reimbursement for its initial
costs in developing and implementing the expansion of eligibility
provided for pursuant to this section. For purposes of this
subdivision, "initial costs" means those costs incurred before the
receipt of any federal waivers granted under Section 1115 of the
Social Security Act (42 U.S.C. Sec. 1315).
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.