BILL ANALYSIS
AB 2233
Page 1
ASSEMBLY THIRD READING
AB 2233 (Nielsen)
As Amended May 28, 2010
Majority vote
PUBLIC SAFETY 7-0 APPROPRIATIONS 17-0
-----------------------------------------------------------------
|Ayes:|Ammiano, Hagman, Beall, |Ayes:|Fuentes, Conway, Ammiano, |
| |Gilmore, Hill, | | |
| |Portantino, Skinner | |Bradford, Charles |
| | | |Calderon, Coto, |
| | | |Davis, Harkey, Miller, |
| | | |Monning, |
| | | |Nielsen, Norby, Ruskin, |
| | | |Skinner, |
| | | |Solorio, Torlakson, |
| | | |Torrico |
|-----+--------------------------+-----+--------------------------|
| | | | |
-----------------------------------------------------------------
SUMMARY : Requires the California Department of Corrections and
Rehabilitation (CDCR), in conjunction with University of
California (UC) and the Federal Receiver, to engage in a study
to assess the concept of turning the delivery of inmate health
care over to the UC system, with the goal of significantly
reducing costs while more efficiently providing the
constitutionally mandated level of care to inmates.
Specifically, this bill :
1)Provides that the CDCR must include in its study a review of
similar reorganizations in other states.
2)States that the study must consist of the following:
a) Streamlining the leadership structure within the
California correctional health care system;
b) Separating duties where one entity assesses quality and
controls budgets, while a separate entity is accountable
for execution and delivery of care;
c) Evaluating the efficacy of the existing decentralization
of leadership of the current 33 independent entities, as
AB 2233
Page 2
well as the divisions of medical, dental, and mental
health;
d) How to best leverage the existing academic health care
centers;
e) Implementing true electronic medical records instead of
printing and scanning;
f) Expanding telemedicine; and,
g) Centralizing pharmacy, supplies, and materials
management.
3)Requires that the study be completed and CDCR report the study
results to the Legislature by September 1, 2011. The
requirement for submitting a report imposed by this bill shall
become inoperative on September 1, 2015.
EXISTING LAW :
1)States that it is the intent of the Legislature that the CDCR
operate in the most cost-effective and efficient manner
possible when purchasing health care services for inmates. To
achieve this goal, it is desirable that CDCR have the benefit
and experience of the California Medical Assistance Commission
in planning and negotiating for the purchase of health care
services. The CDCR shall consult with the Commission to
assist the department in planning and negotiating contracts
for the purchase of health care services. The Commission
shall advise the CDCR, and may negotiate directly with
providers on behalf of the CDCR, as mutually agreed upon by
both parties.
2)Provides that the CDCR may contract with providers of health
care services and health care network providers, including,
but not limited to, health plans, preferred provider
organizations, and other health care network managers. CDCR
may only reimburse a non-contract provider of hospital or
physician services at a rate equal to or less than the amount
payable under the Medicare Fee Schedule, regardless of whether
the hospital is located within or outside of California.
Until regulations or emergency regulations are adopted, the
CDCR shall not reimburse a contract provider of hospital
AB 2233
Page 3
services at a rate that exceeds 130% of the amount payable
under the Medicare Fee Schedule, a contract provider of
physician services at a rate that exceeds 110% of the amount
payable under the Medicare Fee Schedule, or a contract
provider of ambulance services at a rate that exceeds 120% of
the amount payable under the Medicare Fee Schedule.
3)Creates Phase I of the Public Safety and Offender
Rehabilitation Services Act of 2007 that allows the CDCR to
design, construct, or renovate housing units, support
buildings, and programming space in order to add up to 12,000
beds at facilities under its jurisdiction.
4)Creates Phase II of the Public Safety and Offender
Rehabilitation Services Act of 2007 that authorizes the CDCR
to complete site assessments at facilities where it intends to
construct or renovate additional housing units, support
buildings, and programming space in order to add up to 4,000
beds at facilities under its jurisdiction. After completing
these site assessments, CDCR shall define the scope and costs
of each project.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)One-time costs to CDCR in the range of $50,000 for the study.
COMMENTS : According to the author, "California's prison health
care costs are two to four times what other large states pay.
The entire health care management and delivery systems need to
be reconstituted based on best practices and not a patchwork of
court-compliance measures that have created a large, inefficient
and costly system.
"The current system is antiquated and has not drawn on success
stories from outside California. Fiscal management and physical
delivery of services are combined into a single entity, where
best practices suggest a separation of these duties into two
categories. CDCR operates 33 independent entities with
little-to-no coordination of services or benefits from economies
of scale. Medical, dental and mental health divisions are
currently 'siloed' which has lead to redundant overhead expenses
and impaired sharing of resources, ideas and data.
AB 2233
Page 4
"Part one of this bill directs CDCR to create a PPO or HMO-style
management system to reign in mushrooming costs of inmate health
care, while streamlining its delivery.
"Part two directs this creation process to include examining the
possibility of using the UC system as the delivery vehicle.
This method is showing great promise in three other states and
should be examined in California. Using the UC is in no way
mandated by this bill. In fact, all qualified providers
desiring to provide this care will bid on the contract, just as
in other state procurement efforts.
"With an inmate population of 168,000, California should be
enjoying the economic benefits of economies-of-scale, and paying
among the lowest per-inmate-cost, not the highest. This bill is
a step toward achieving that goal."
Please see the policy committee for a full discussion of this
bill.
Analysis Prepared by : Melina Nelson / PUB. S. / (916)
319-3744
FN: 0004605