BILL ANALYSIS
AB 1606
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Date of Hearing: May 5, 2010
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
AB 1606 (Coto) - As Amended: April 22, 2010
Policy Committee: Health Vote:12-5
Urgency: No State Mandated Local Program:
Reimbursable:
SUMMARY
This bill requires the California Department of Health Care
Services to include a department-approved chronic disease
self-management program in the pending Section 1115 Medi-Cal
waiver that will run for five years 2010 until 2015. This bill
authorizes the use of nonclinical workers or volunteers for to
administer the self-management program.
FISCAL EFFECT
1)One-time GF costs of $200,000 (50% GF) to the Department of
Health Care Services (DHCS) to develop and manage a chronic
disease self-management program within the pending Section
1115 Medi-Cal waiver.
2)Significant costs to offer the chronic disease self-management
program within the Medi-Cal program. Actual costs will depend
on the structure of the benefit and the number of individuals
who utilize the program. A current DHCS contract to provide
disease management services pursuant to prior legislation is $
4 million (50% GF) per year.
3)DHCS is in the process of negotiating a multi-billion dollar
Medi-Cal waiver that may provide a bridge to major expansions
in Medi-Cal under federal health reform. If enacted, AB 1606
may create substantial DHCS work load at a time when the
department is focused on issues such as enrolling tens and
hundreds of thousands of low-income beneficiaries in public
programs.
4)Unknown, potentially significant savings to the extent this
bill reduces health care costs associated with costly chronic
AB 1606
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diseases.
COMMENTS
1)Rationale . This bill is sponsored by the Health Trust of
Silicon Valley to increase the use of a specified disease
management strategy, one oriented toward teaching patients to
manage their own chronic conditions rather than relying on
health professionals for care. The author and sponsor indicate
the approach proposed in this bill significant reduces costs
and improved health outcomes.
2)Medi-Cal Waiver Renewal . AB 6 X4 ( Evans), Chapter 6, Statutes
of 2009 requires DHCS to apply for a new waiver for the
Medi-Cal program. The current waiver ends in the fall of 2010.
The current waiver primarily addresses inpatient hospital
funding of more than $3 billion per year. The new waiver under
consideration is likely to cover a much wider funding and
programmatic landscape, including high need patient
populations, children with special health care needs,
behavioral health programs, and health coverage expansion
proposals. A comprehensive stakeholder process was established
in January 2010. Because the broad scope of what is being
considered under the waiver renewal and because of current law
authority, it appears DHCS would be authorized to pursue the
strategy in AB 1606 if the department chose to do so.
3)DHCS Disease Management . AB 1732 (Committee on Budget),
Chapter 230, Statutes of 2003 required DHCS to apply for a
waiver of federal law to test the efficacy of providing a
disease management benefit to Medi-Cal beneficiaries. The
disease management benefit was required to include
evidence-based practice guidelines, adherence to care plans,
patient education and monitoring, and healthy lifestyle
changes.
The McKesson Corporation was selected by DHCS in 2007 to
implement a disease management pilot program for chronically
ill, fee-for service Medi-Cal beneficiaries residing in Los
Angeles and Alameda counties. Disease management refers to
coordinated care provided to patients with chronic conditions
such as diabetes, chronic obstructive pulmonary disease
(COPD), and hypertension.
Analysis Prepared by : Mary Ader / APPR. / (916) 319-2081
AB 1606
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