BILL ANALYSIS
AB 1076
Page 1
ASSEMBLY THIRD READING
AB 1076 (Jones)
As Amended June 1, 2009
Majority vote
HEALTH 19-0 APPROPRIATIONS 17-0
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|Ayes:|Jones, Fletcher, Adams, |Ayes:|De Leon, Nielsen, |
| |Ammiano, Block, Carter, | |Ammiano, |
| |Conway, De La Torre, De | |Charles Calderon, Davis, |
| |Leon, Emmerson, Gaines, | |Duvall, Fuentes, Hall, |
| |Hall, Hayashi, Hernandez, | |Harkey, Miller, |
| |Hill, Nava, V. Manuel | |John A. Perez, Price, |
| |Perez, Salas, | |Skinner, Solorio, Audra |
| |Audra Strickland | |Strickland, Torlakson, |
| | | |Krekorian |
|-----+--------------------------+-----+--------------------------|
| | | | |
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SUMMARY : Requires the Department of Health Care Services (DHCS)
to expand the Medical Case Management (MCM) Program to include
Medi-Cal beneficiaries who have two or more chronic conditions
and have used the hospital emergency department (ED) four or
more times in the previous twelve months, and specifies the type
of services which must be included in case management services.
Requires the Medi-Cal disease management benefit to include the
designation of a primary care provider as a patient's medical
home. Specifically, this bill :
1)Requires the director of DHCS, if he or she has established a
program of aggressive case management (known as the MCM
Program), to expand the program to include Medi-Cal
beneficiaries who meet all of the following conditions:
a) Have two or more chronic conditions, including substance
abuse disorders and mental health conditions;
b) Are not enrolled in a managed care plan;
c) Are not eligible for Medicare benefits;
d) Have received ED services on four or more occasions in
the previous 12 months; and,
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e) Are currently seeking care for a condition that could
have been prevented with timely primary care access and
case management.
2)Requires case management services provided to include, but not
be limited to: coordinating services to ensure continuity of
care; establishing links to health care professionals; and,
community social services resources that would assist in
stabilizing the target population, and expediting the
authorization of medically necessary services.
3)Requires the existing Medi-Cal disease management benefit to
include the designation of a primary care provider as a
patient's medical home.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)Significant annual savings of between $4 million (50% General
Fund (GF) and $8 million (50% GF) to the extent MCM improves
access to care, the provision of preventive care, and reduces
costs by shifting health care to more appropriate care
settings. Earlier estimates by DHCS in 2001-02 and 2002-03
assumed savings of more than $400,000 per year per nurse case
manager in the MCM program. An estimate of a similar Senate
Bill last year included savings of $12.5 million (50% GF) when
heard in this committee.
2)Annual increased costs of $1 million (25% GF) to $2 million
(25% GF) to DHCS to expand the MCM program. This estimate
assumes 1,000 to 2,000 additional MCM enrollees as a result of
the expanded scope of this bill.
COMMENTS : According to the author, this is a two-part bill
that seeks to improve access to medically necessary services, to
better coordinate care and to provide care in a more
cost-effective setting by reducing the use of hospital EDs. In
expanding the MCM program, the author states patients with
chronic conditions who frequently use the hospital ED will have
assistance with care coordination by linking patients to health
care providers and community social services, thereby reducing
preventable hospitalizations and frequent inappropriate
emergency room visits. By requiring the primary care provider
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be included in the benefits provided under the current Disease
Management Waiver, the author argues this bill would benefit
Medi-Cal beneficiaries in the fee-for-service program by
establishing a medical home that would integrate the current
disease management benefit with the person's primary care
provider.
The author points to a December 2008 presentation at a
conference sponsored by the California HealthCare Foundation in
which DHCS reported that several states are using medical homes
and targeted case management to increase health outcomes and
reduce avoidable ED visits and inpatient hospital stays. The
author also points to the success of the Frequent Users of Care
Initiative (Initiative), where six pilot programs designed to
test new models of care for "frequent users" of hospital EDs
resulted in reduced avoidable use of ED services, decreased
inpatient hospital utilization, and connected participants to
housing, income benefits, health insurance, and a primary care
home.
The Corporation for Supportive Housing (CSH), a national
non-profit dedicated to preventing and ending homelessness,
writes that it supports this bill out of its experience with the
Initiative. CSH writes this bill would allow California to
receive federal matching funds for Medi-Cal reimbursement for
services like case management and care coordination for
individuals who visit the EDs frequently and experience
psychosocial barriers to appropriate health care. CSH states a
significant percentage of individuals who EDs identify as
frequent users are Medi-Cal beneficiaries, and though these
beneficiaries incur disproportionately high costs for emergency
room and inpatient care, Medi-Cal restricts reimbursement for
multidisciplinary services, even though studies indicate that
these services significantly decrease expensive ED visits and
hospital stays. CSH states that programs that currently provide
these services have created positive outcomes, including reduced
homelessness, improved health outcomes, decreased substance
abuse, and less stress on EDs. Additionally, CSH argues the
previous year budget estimates show that this bill would be cost
neutral or better to the state, even in the first year of
implementation, due to resulting decreases in hospital costs.
The Western Center on Law & Poverty (WCLP) writes in support
that this bill offers a humane and cost-effective approach to
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addressing the needs of frequent users. WCLP states some
"frequent users" of Medi-Cal services, particularly emergency
room services, could receive more appropriate and less expensive
care with case management, particularly those frequent users who
are homeless and have multiple chronic illnesses, often
including a mental illness. WCLP states this bill will help
meet the needs of this population by providing them with a range
of case management services, both within the formal medical
world and with social service resources. By providing help with
both medical and social service resources, WCLP states this bill
can help vulnerable low-income populations achieve a more stable
quality of life and limit Medi-Cal expenditures.
Analysis Prepared by : Scott Bain / HEALTH / (916) 319-2097
FN: 0001210