BILL ANALYSIS
AB 1037
Page 1
Date of Hearing: April 21, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
AB 1037 (Bonnie Lowenthal) - As Amended: April 15, 2009
SUBJECT : Medi-Cal: managed care.
SUMMARY : Requires the Department of Health Care Services
(DHCS) to develop and implement the Mandatory Medi-Cal Managed
Care (MCMC) Pilot Project to enroll seniors and persons with
disabilities (SPDs) in San Bernardino and Riverside Counties,
with enrollment to begin no later than January 1, 2011, and
establishes specific requirements and timelines. Specifically,
this bill :
1)Expresses legislative intent, including the intent to enact
legislation that enables SPDs to receive a continuum of
health, social and other services that maximizes community
living through integrated and flexible managed care models.
2)No later than January 1, 2011, requires DHCS to provide all
SPDs who reside in Riverside or San Bernardino counties,
except for persons specifically excluded by this bill, with an
opportunity to enroll in a MCMC plan in the two counties, in
accordance with this bill and existing state and federal laws.
If the person is already enrolled in a MCMC plan, requires
DHCS to provide the enrollee the opportunity to enroll in MCMC
upon annual re-determination, or through a notice.
3)Requires DHCS to assign individuals who fail to select either
fee-for-service (FFS) Medi-Cal or a MCMC plan, at initial
enrollment, to a MCMC plan. Requires DHCS to assign to a MCMC
plan individuals offered a choice at annual re-determination,
or at the time of a notice, who fail to make a choice within
60 days. Requires DHCS to allow individuals who choose FFS
Medi-Cal to remain in FFS.
4)Authorizes individuals subject to assignment under 3) above to
opt out of MCMC at any time and requires the disenrollment to
be effective at the end of the month in which the individual
requests disenrollment. Clarifies that nothing in this bill
precludes a person from selecting a different MCMC plan as
allowed under existing law and policy. Requires the
assignment process to take into account the MCMC plan that has
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a contract with the beneficiary's existing primary physician
or specialists, based on a review of Medi-Cal paid claims, and
the default assignment procedures of the MCMC plan, as
specified.
5)Excludes from the pilot project persons eligible for both
Medicare and Medi-Cal, SPDs eligible with a share of cost,
those on a major organ transplant list (except kidney),
persons enrolled in specified Medi-Cal home- and
community-based waiver programs, and services covered by the
California Children's Services (CCS) program. Allows SPDs
enrolled in the Program of All-Inclusive Care for the Elderly
(PACE) to enroll in a PACE project if one is available, rather
than being enrolled in the pilot project.
6)Requires the official endorsement of the county-operated
public hospital prior to implementation of the pilot project
in either county.
7)Requires DHCS to seek all necessary federal Medicaid waivers
to implement this bill and to submit any state plan
amendments, waiver applications or waiver amendments to the
Legislature, as specified.
8)Requires DHCS to develop an implementation plan (IP) no later
than July 1, 2010, for the pilot program, in consultation with
the stakeholder advisory committee established by this bill,
and requires the IP to specifically address the multiple and
complex needs of SPDs, and the specific strategies DHCS will
use to ensure the pilot project has at least the following
specified elements:
a) Criteria, performance standards, and indicators to
ensure that MCMC plan services meet the multiple and
complex needs of SPDs and comply with the provisions of
this bill. Requires the performance standards to
incorporate, at a minimum, existing statutory and
regulatory requirements applicable to two-plan and Medi-Cal
geographic managed care plans (GMC), and the protections
available under the Knox-Keene Health Care Service Plan Act
of 1975 (Knox-Keene), and in addition, standards in all of
the following areas:
i) Plan readiness;
ii) Availability and accessibility of services,
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including physical access and communication access;
iii) Care coordination and care management;
iv) Beneficiary participation;
v) Measurement and improvement of health outcomes;
vi) Network capacity, including travel time and
distance and specialty care services;
vii) Performance measurement and improvements;
viii) Quality care; and,
ix) Timely contact and screening of new enrollees to
identify clinical and access needs.
b) Requires any standards developed in addition to those
described in 8) a) above to be guided by the "Performance
Standards for MCMC Organizations Serving People with
Disabilities and Chronic Conditions," published by the
California HealthCare Foundation in November 2005;
c) A process and timeline for enrollment and beneficiary
selection of a MCMC plan, including revising the health
care options and enrollment process to meet the needs of
SPDs, in compliance with state and federal laws and
regulations. Requires DHCS to explore the feasibility of
developing a broker or enrollment support system to provide
assistance to SPDs who need enrollment assistance.
Requires the enrollment process to include both of the
following:
i) Provisions to ensure that Medi-Cal beneficiaries
receive information and assistance related to their
rights, including their right to accessible facilities;
and,
ii) Identification of categories of SPDs who may need
enrollment assistance and those with special health care
needs or other conditions that warrant immediate contact
by a plan at initial enrollment.
d) Requirements for the coordination of services for SPDs
receiving services from other state or local government
programs or institutions;
e) An appropriate awareness and sensitivity training
program on the multiple and complex needs of SPDs for staff
in the Office of the MCMC Ombudsman, in consultation with
the stakeholder advisory committee (stakeholder committee)
established by this bill;
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f) A system for responding to and resolving complaints,
available 24 hours per day, seven days a week, including
language assistance and adaptive technology for those who
need it, and requires public complaint information to be
available to the stakeholder committee. Requires DHCS to
develop and coordinate the complaint response system in
consultation with the Department of Managed Health Care HMO
Help Center and the Health Insurance Counseling and
Advocacy Program administered by the California Department
of Aging;
g) The system for assessing ongoing compliance of MCMC
plans consistent with the requirements of this bill.
Authorizes DHCS to cease new enrollments in any plan it
finds not in compliance with the requirements of this bill,
or if a MCMC plan fails to meet any requirements and DHCS
determines the failure to comply jeopardizes health,
safety, or access to quality care for beneficiaries;
h) The specific methodology for developing the capitation
rates to be paid to any MCMC plan participating in the
pilot project, as specified;
i) Budgetary projections on the effect of managed care on
the total Medi-Cal budget for fiscal years 2009-10 to
2013-14, including an evaluation of cost-effectiveness
compared to FFS Medi-Cal;
j) An outreach and education program for SPDs in the pilot
project regarding enrollment options, rights and
responsibilities, and benefits and services provided, to be
developed in consultation with the stakeholder committee,
including strategies to inform and coordinate with
community organizations providing services to SPDs;
aa) The process and timeline for outreach, education,
enrollment, and beneficiary selection of health plans and
providers, including the health care options process and
policies for assigning beneficiaries who do not choose a
FFS health plan within 30 days;
bb) Requires DHCS to develop assignment distribution
policies, as specified;
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cc) The process, timelines, and criteria for evaluating the
pilot program;
dd) Review of the current overlap in regulations and
authority and recommendations for clear assignment of
responsibilities to DHCS and the Department of Managed
Health Care (DMHC). Specifically assigns to DMHC
responsibility for ensuring consumer protections, adequacy
of network and financial solvency, and to DHCS
responsibility for ensuring compliance with additional
standards appropriate for SPDs within Medi-Cal; and,
ee) Identify any additional state or federal legislation and
authority needed to implement this bill.
9)Requires DHCS to establish a stakeholder committee to provide
advice in the development of the IP and regarding
implementation of the pilot, with specified membership and
duties. Requires the stakeholder committee to also solicit
input from SPDs in the community and to review publicly
available data on grievances, complaints, and requests for
disenrollment. Authorizes DHCS to seek grants or other
private funding for the development of the IP and the
stakeholder committee. Establishes the membership of the
stakeholder committee as follows:
a) A maximum of six Medi-Cal beneficiaries who are persons
with disabilities in the Counties of Riverside and San
Bernardino, representing a broad spectrum of disabilities;
b) Two Medi-Cal beneficiaries who are seniors living in the
Counties of Riverside and San Bernardino;
c) One representative of a community-based organization
serving persons with disabilities in the Counties of
Riverside and San Bernardino, nominated by local
community-based organizations and disability organizations;
d) Two representatives from statewide advocacy
organizations serving persons with disabilities;
e) One representative from a statewide organization or
local community-based organization serving seniors in the
Counties of Riverside and San Bernardino, nominated by
local community-based organizations and disability
organizations;
f) One representative from a statewide advocacy
organization serving low-income communities;
g) One representative from a local or statewide advocacy
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organization serving communities of color or multilingual
communities, nominated by local community-based
organizations and disability organizations;
h) One representative from each participating MCMC plan;
i) Two physicians participating in the MCMC plans;
j) One representative from each of the two public hospitals
in the Counties of Riverside and San Bernardino and two
individuals who represent other hospitals contracting with
one or both of the participating health plans; and,
aa) One representative of the exclusive collective
bargaining agents for hospital workers of affected
hospitals.
10)Prior to initiating the pilot program, requires DHCS to
provide the MCMC plans with both of the following:
a) Identification of seniors and persons with disabilities
who may need special assistance in the enrollment process
and those with special health care needs or other
conditions that warrant immediate contact by a plan at
initial enrollment. Requires DHCS to provide the list to
those entities administering the enrollment process, and to
the MCMC plans, to ensure that beneficiaries receive
necessary assistance; and,
b) A list of FFS Medi-Cal providers who are actively
providing services to beneficiaries within the pilot area
to allow the MCMC plans to actively recruit these providers
to participate in plan networks and maintain existing
patient-provider relationships.
11)Requires DHCS to develop capitation rates in a manner that
ensures that rates are actuarially sound, comply with federal
requirements and are based on data specific to SPDs. Requires
DHCS, in determining and evaluating capitation rates, to take
into account the full range of reimbursements for all covered
medical procedures and services. Authorizes DHCS to require
MCMC plans to submit financial and utilization data, as deemed
necessary, and as specified, and requires the rate to meet the
restorative and health maintenance needs of SPDs. Requires
DHCS to provide MCMC plans with an opportunity to review and
comment on the rate and rate development methodology, and to
respond, within specified timeframes. Requires DHCS to review
and update rates at least annually to reflect cost and
utilization.
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12)Requires DHCS to develop and implement continuity of care
policies and standards, including Knox-Keene continuity of
care standards for terminated providers. Requires DHCS to
include policies that permit enrollees to continue an
established patient-provider relationship, as specified, and
to provide notice to beneficiaries of the right to continuity
of care, including the ability to select another provider in
the MCMC plan or to opt out of MCMC.
13)Requires DHCS to ensure compliance of the pilot project with
applicable state and federal laws at all times, as specified.
Requires DHCS to develop the pilot program in a manner that
accomplishes all of the following:
a) Protects the safety net providers in the community;
b) Recognizes the multiple and complex needs of SPDs,
including the need for specialized care and out-of-network
services;
c) Provides sufficient compensation for coordination of
care among multiple providers and care management by
providers;
d) Reflects the need to attract and retain providers,
particularly those with specialized expertise in the care
of SPDs;
e) Makes all relevant notices accessible to seniors or
persons with disabilities through methods that may include,
but need not be limited to, assistive listening devices,
sign language interpreters, and translation in appropriate
languages; and,
f) Requires that MCMC beneficiaries retain and are informed
of all rights to grievances and appeals processes available
under state and federal laws and regulations.
14)Requires DHCS to evaluate the readiness of the participating
MCMC plans, based on specific readiness criteria outlined in
this bill. The readiness criteria include, among other
things, plan policies for: standing referrals to specialists;
the opportunity to select a specialist as a primary care
provider; access to inpatient and outpatient rehabilitation
and therapy services, as defined; access to assessments and
evaluations for wheelchairs including, when necessary a home
assessment; communication access for SPDs, including
alternative formats or methods; advance planning, care
coordination, and referral for high risk and special needs
enrollees; adequate participation by safety net and
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traditional providers; communications with local agencies and
programs; and, evidence of specified agreements and
coordination with the CCS and county mental health programs.
15)Requires DHCS to ensure that contracting MCMC plans meet
specified requirements at all times, including, among other
things, timely access to specialists and specialty providers,
as specified; access to appropriate, accessible care and
services; availability of a toll-free "800" nurse advice
telephone service, as specified; and compliance with
applicable state and federal laws; readiness criteria and
standards; implementation of MCMC plan policies and
procedures; contract deliverables and other submissions; and,
establishment of internal patient advocate programs.
16)No later than September 30, 2010, requires participating MCMC
plans to file an accessibility plan, as specified.
17)Requires MCMC plans to, when feasible, partner with academic
and research institutions to identify and test new clinical
and service performance measures.
18)Requires DHCS to contract with an independent third-party to
conduct an evaluation of the pilot program, as specified, with
results to be reported to the Legislature by March 1, 2014,
specifies the parameters of the evaluation, and requires DHCS
to provide the stakeholder committee with an opportunity to
review and comment on the report in advance. Requires DHCS to
recommend the continuation, expansion, or termination of the
pilot project.
19)Sunsets the provisions of this bill on July 31, 2017.
EXISTING LAW
1)Establishes the Medi-Cal program, administered by DHCS, which
provides comprehensive health benefits to low-income children,
their parents or caretaker relatives, pregnant women, elderly,
blind or disabled persons, nursing home residents, and
refugees who meet specified eligibility criteria.
2)Authorizes DHCS to contract, on a bid or nonbid basis, with
any qualified individual, organization, or entity to provide
services to, arrange for or case manage the care of Medi-Cal
beneficiaries. Permits the contract to be exclusive or
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nonexclusive, statewide or on a more limited geographic basis,
and requires that the contracts include specified provisions.
3)Defines a MCMC plan as any entity that enters into one of
several types of contracts with DHCS including county
organized health systems (COHS), GMC plans, and local
initiatives.
4)Requires DHCS to evaluate and determine the readiness of
managed care plans prior to geographic expansion of MCMC.
5)Requires enrollment of aged, blind and disabled persons in
MCMC plans to be voluntary, except in COHS counties.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . Currently, in the Medi-Cal Two-Plan
model counties, including Riverside and San Bernardino
counties, SPDs have the choice to enroll in Medi-Cal FFS or a
MCMC plan. If a Medi-Cal beneficiary chooses neither, DHCS
enrolls the beneficiary in Medi-Cal FFS by default. The
author contends that FFS systems do not guarantee access or
establish care coordination services for beneficiaries.
According to the author, Medi-Cal FFS beneficiaries are forced
to call around to find providers that will accept Medi-Cal
coverage. The author argues that the current default
enrollment policy is an inefficient, disjointed care delivery
system; and suggests that Medi-Cal policy should favor the
system that guarantees access and encourages care
coordination. The author also states that many Medi-Cal
beneficiaries often are unaware of the option to enroll in a
MCMC plan. The author offers that the pilot program in this
bill will provide the state an opportunity to measure health
plan performance in serving SPDs. The author states that
coordinated care systems bring significant value to Medi-Cal
beneficiaries by coordinating the services of all. MCMC
health plans have systems set up to find out the needs of the
members and ensure that beneficiaries are getting the care
that they need. The author points to MCMC plan care
management programs which use multidisciplinary teams
including nurses, social workers, health educators, and other
coordinators to work with physicians to facilitate access to
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medically necessary services and ensure that services are
provided in a timely manner appropriate for the beneficiary's
medical condition(s).
2)BACKGROUND . Under the traditional Medi-Cal FFS arrangement,
providers are reimbursed for every service they provide and
assume no financial risk. Under MCMC, DHCS reimburses health
care plans on a "capitated" basis, a per-person, per-month
payment, regardless of the number of services, if any, a
Medi-Cal beneficiary receives. The contracting health plans,
in return, assume financial risk, in that it may cost them
more or less money than the capitated amount paid to them to
deliver the care.
Currently, some form of MCMC serves approximately 3.2 million
Medi-Cal beneficiaries, and about 280,000, or about 9%, are
SPDs. Approximately 2.8 million Medi-Cal beneficiaries are
in medical managed care and approximately 400,000 are in
dental managed care plans.
MCMC plans operate in 22 of the state's 58 counties -
generally those with greater populations. There are three
major types of MCMC plans. COHS operate in eight counties,
Two-Plan model programs operate in 12 counties, and GMC
systems operate in two counties.
Most families and children residing in MCMC counties are
enrolled in managed care on a mandatory basis. SPDs in those
same counties generally have the option of participating in
FFS or managed care. The exceptions are the eight COHS
counties, where nearly all Medi-Cal beneficiaries are required
to receive their care from a COHS plan. As a result, SPDs are
about 42% of the population receiving FFS care statewide, but
only represent 10% of those enrolled in managed care.
a) COHS Plans. Under this model, in operation since 1983,
there is one health plan run by a public agency and
governed by an independent board that includes local
representatives. All Medi-Cal enrollees residing in the
county receive care from this system on a mandatory basis,
including SPDs. There are federal limits on the number of
COHSs the state can implement and the number of
beneficiaries who can be served with this model. In order
to operate a new COHS, California would need a change in
federal law. In recent years, the trend with COHSs is to
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add new counties to existing COHSs where the new counties
are geographically contiguous. COHS plans operate in
Monterey, Napa, San Luis Obispo, San Mateo, Santa Barbara,
Santa Cruz, Solano, Yolo counties. There are just over
565,000 enrolled beneficiaries in the eight COHS counties.
b) Two-Plan Model Counties. Implemented in 1993, in the 12
two-plan counties, DHCS contracts with only two managed
care plans. There are some exceptions but generally
two-plan counties have a publicly organized plan,
originally developed by the county with local stakeholders,
the Local Initiative, and one commercial plan.
Approximately 2.4 million Medi-Cal beneficiaries are
enrolled in two plan counties in eight Local Initiatives,
and 3 commercial health plans. The local initiative in Los
Angeles County, LA Care Health Plan, sub-contracts with
five other commercial plans and the commercial plan in LA,
Health Net, also subcontracts with two other plans. In
Stanislaus and Fresno, Blue Cross and Health Net are the
two plans offered.
c) GMC Plans. Implemented in 1993, the GMC program offers
Medi-Cal beneficiaries a choice of one of many commercial
HMOs operating in a county. As of January, 2009 GMC
Counties are Sacramento (175,000) and San Diego (181,000).
Placer County is scheduled to join with Sacramento GMC in
June of 2009. Sacramento participating plans are: Blue
Cross; Health Net; Kaiser; Molina Healthcare; and, Western
Health Advantage. San Diego participating GMC plans are:
Community Health Group, Care First, Health Net, Molina, and
Kaiser.
1)SAN BERNARDINO AND RIVERSIDE COUNTIES . San Bernardino and
Riverside Counties are two-plan counties for Medi-Cal with the
local initiative, Inland Empire Health Plan (IEHP), and the
commercial plan, Molina Health Care. In these two counties,
families and children residing in Medi-Cal are enrolled in
MCMC on a mandatory basis and SPDs on a voluntary basis.
According to DHCS, as of February 2009, 220,466 Medi-Cal
beneficiaries were enrolled in MCMC in San Bernardino County,
including 11,306 SPDs enrolled on a voluntary basis. In
Riverside County, 187,334 were enrolled in MCMC, including
9,690 SPDs.
2)SENIORS AND PERSONS WITH DISABILITIES . According to federal
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law and Medicaid regulations, an individual is considered
disabled if he or she is unable to engage in any substantially
gainful activity by reason of any medically determinable
physical or mental impairment that can be expected to result
in death or which has lasted or can be expected to last for a
continuous period of not less than twelve months. Different
definitions apply for children, people who are visually
impaired, and people who qualify for Medi-Cal's working
disabled program. To be eligible for Medi-Cal, people with
disabilities must also meet Medi-Cal's requirements for
income, assets, residence, and citizenship. In general,
people with disabilities who qualify for Medi-Cal can be
grouped into one of two broad categories: a) Those
that are categorically needy and therefore automatically
qualify for Medi-Cal; or, b) Those that are medically needy
and may become eligible by incurring medical expenses each
month. In addition, a small number of people qualify for
Medi-Cal through federal waiver or state-only programs.
Nearly 90% of non-elderly beneficiaries with disabilities are
categorically needy, and qualify for Medi-Cal based on their
eligibility for cash assistance under the Supplemental
Security Income/State Supplemental Program (SSI/SSP).
People who qualify for Medi-Cal based on eligibility for SSI/SSP
are extremely heterogeneous. Some are relatively high
functioning individuals who qualify primarily based on age and
income. Among the disabled, there is no single category of
illness or disability that applies. People have a wide
variety of physical impairments, mental, developmental, and
other chronic conditions. The California HealthCare
Foundation (CHCF) reports that many SPDs in managed care also
have limited access to primary and preventive care, use a
complex array of specialty, ancillary, and supportive
services, are likely to have multiple, complex or chronic
conditions and experience a range of physical, communication,
and program barriers.
3)MCMC COST SAVINGS . According to the CHCF, SPDs represent only
23% of Medi-Cal beneficiaries, but account for 63% of
expenditures. Of these expenditures, 28% are for seniors and
35% are for individuals with disabilities. In 2004, The Lewin
Group studied a variety of state Medicaid managed care
programs and found significant cost savings -between 2% and
19% over the more expensive FFS programs. The Legislative
Analyst's Office reported in the analysis of the 2004-05
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Budget that "Enrolling Medi-Cal beneficiaries in managed care
instead of fee-for-service for their health care has resulted
in significant savings to the state. While the data to exactly
calculate these savings is not publicly available, the
Department of Health Services (now DHCS) has estimated that
the three types of managed care plans cost the state between
81% and 87% of what would otherwise have been spent on
patients if they were in fee-for-service medicine. We estimate
that the state is probably saving in the hundreds of millions
of dollars annually on patient care because of the shift of
beneficiaries into managed care." In 2005, the Legislative
Analyst's Office estimated that enrolling SPDs in managed care
in the 14 existing managed care counties and 13-14 managed
care expansion counties would save the state $89 million
General Fund annually.
4)PERFORMANCE MEASUREMENT PROJECT . In November 2005, CHCF
completed and released a set of recommended health plan
performance standards and measures to improve the way people
with disabilities and chronic conditions receive services in
MCMC program. The report resulted from a two-month
feasibility study involving three consulting groups. The
consulting team found that in a mandatory program, more
extensive standards and measures are practical, desirable, and
potentially cost-efficient over time. Among other things, the
CHCF report identifies 53 recommendations to improve the MCMC
Care Program. These 53 recommendations were categorized into
23 that are essential, 21 that are important, and nine that
are ideal. This bill requires DHCS to develop standards for
the pilot project based on the CHCF recommendations.
5)Managed Care Expansion in Process . In 2005, DHCS proposed and
the Legislature approved an expansion of mandatory managed
care for an additional 13 counties, with the goal of serving
an additional 300,000 families and children. As of this
writing, ten counties are still pursuing possible expansions,
six through joining existing COHS plans; Fresno, Kings, and
Madera are developing a tri-county regional two-plan approach;
and, Placer is joining Sacramento GMC. San Luis Obispo county
joined with the Santa Barbara Regional Health Authority on
3/1/09 and Placer is set to implement GMC 6/1/09. The
remaining implementation dates, which have been pushed back
numerous times, are set for late 2009 or 2010.
6)SUPPORT . Partners in Care Foundation (Partners), the sponsor
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of this bill, writes, as an organization devoted to
identifying ways to better deliver health care services,
especially to disadvantaged populations, that MCMC plans can
provide a medical home to SPDs, encourage preventive care,
coordinate care among a variety of health care and community
providers, and provide care management programs that treat
high-cost, chronic conditions. Partners reports that MCMC
plans use state funds more efficiently, providing
month-to-month budget predictability, reducing preventable
hospitalizations, and lowering costs, while strengthening care
coordination and quality of care. St. John's Well Child and
Family Center (St. John's) writes in support that the pilot
project will establish performance standards for MCMC plans
serving SPDs and plan performance will be tested and
evaluated. St. John's notes that the pilot project includes a
stakeholder committee to ensure thorough input from the
community. The California Association of Health Plans
supports this bill and states that research has consistently
shown that managed care environments for public program
beneficiaries produce better health care results than FFS.
The California Association of Physician Groups (CAPG) writes
that this bill will provide SPDs with the flexibility to
determine which delivery system most improves their access to
health care. CAPG reports that it is important for SPDs to
receive the most comprehensive health care available, which is
the intention of this pilot project. Molina Health Care
writes in support that MCMC plans must provide all medically
necessary care and MCMC plan membership is not the "license to
shop" for a provider and for care, which characterizes the FFS
system. Molina continues that because MCMC plans must have a
complete network of primary care and specialty providers in
the network, and must make arrangements for care when a member
needs services not in the network, disabled beneficiaries will
experience a significant improvement in access through the
pilot project.
7)SUPPORT IF AMENDED . The Congress of California Seniors writes
that if SPDs were given a chance to opt in instead of an opt
out; this bill would bring the benefits of coordinated care to
more SPDs.
8)OPPOSE UNLESS AMENDED . Service Employees International Union
(SEIU) is opposed unless this bill is amended to provide
adequate protections for consumers, workers and public
hospitals. Specifically, SEIU requests that this bill be
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amended to assure no diminution in funding or patients served
by the county hospitals in Riverside and San Bernardino
counties. SEIU would also like a stronger medical exemption
than the continuity of care provisions applicable to the pilot
project. SEIU wants clarification that nursing home care and
in-home supportive services are not included in the pilot
project as they are in all existing MCMC contracts. SEIU is
concerned that the existing rate methodology for MCMC is not
tethered to any protections for consumers or those who care
for them. Finally, SEIU maintains there is no need for
mandatory managed care in the two counties because the local
initiative, IEHP, has been very successful in encouraging
voluntary enrollment of SPDs. Western Center on Law and
Poverty is opposed to mandatory enrollment of SPDs, even if
only in instances of default enrollment, because it violates
the principle of choice. Western Center writes on the prior
version of this bill that it is opposed to the lock-in of an
individual defaulted into MCMC for 12 months.
9)OPPOSITION . The California Medical Association opposes this
bill with the concern that the pilot project will cause major
disruptions for established provider networks currently
serving the most vulnerable citizens. The Riverside County
Medical Association opposes this bill with the concern that
SPDs currently working with networks of primary and specialty
care physicians in FFS Medi-Cal could have their network
disrupted if any one of the physicians did not contract with
the MCMC plan into which they were defaulted.
10)PREVIOUS LEGISLATION .
a) SB 1332 (Negrete-McLeod) of 2008, similar to this bill,
was held on suspense in Senate Appropriations Committee,
and would have authorized DHCS to create a MCMC pilot
project in San Bernardino and Riverside counties.
b) AB 2607 (De La Torre) of 2006, held on suspense in
Senate Appropriations Committee, would have enacted the
Mandatory MCMC Pilot Program in two counties contingent on
the passage of subsequent legislation approving or revising
the implementation plan submitted by DHS (now DHCS) as
specified.
REGISTERED SUPPORT / OPPOSITION :
Support
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Partners in Care Foundation (sponsor)
California Association of Health Plans
California Association of Physician Groups
California Society for Clinical Social Work
Molina Health Care
St. John's Well Child and Family Center
SynerMed Medi-Cal Managed Care Services Organization
Numerous individuals
Oppose Unless Amended
Service Employees International Union
Western Center on Law and Poverty
Opposition
California Medical Association
Riverside County Medical Association
Analysis Prepared by : Deborah Kelch / HEALTH / (916) 319-2097