BILL ANALYSIS
AB 2787
Page 1
Date of Hearing: April 20, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 2787 (Committee on Health) - As Introduced: March 9, 2010
SUBJECT : Medi-Cal: Disease Management Waiver.
SUMMARY : Extends the due date on the evaluation of the Medi-Cal
Disease Management pilot from January 2008 to January 2011 and
requires the Department of Health Care Services (DHCS) to
include recommendations for any modifications to the program in
order to expand it statewide.
EXISTING LAW :
1)Establishes Medi-Cal, administered by DHCS, to provide
comprehensive health care services and long-term care to
pregnant women, children, and people who are aged, blind, and
disabled.
2)Requires, under federal law, benefits to be offered to all
beneficiaries in a comparable fashion and each beneficiary
must have a choice of provider, but authorizes states to apply
for waivers.
3)Requires DHCS to apply for a waiver of federal law to test the
efficacy of providing a disease management benefit to Medi-Cal
beneficiaries. This waiver is known as the Disease Management
Waiver.
4)Requires DHCS to evaluate the effectiveness of providing a
Medi-Cal disease management benefit by January 1, 2008.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee
COMMENTS :
1)PURPOSE OF THIS BILL . This bill is necessary as part of the
oversight responsibilities of this committee. DHCS entered into a
contract with McKesson Health Solutions beginning August 1, 2007
to implement the Disease Management Program. DHCS has also
contracted with the University of California Los Angeles (UCLA),
Center for Health Policy Research to evaluate the outcomes as
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compared to a control group in non-pilot counties. The evaluation
was due January of 2008 and has not yet been supplied to the
Legislature. DHCS is proposing to enroll over 2 million
beneficiaries with disabilities and chronic disease conditions
into organized system of care through a new Section 1115
Hospital/Uninsured waiver. In order for the Legislature to
evaluate the DHCS proposal, it is important to obtain the results
of the existing evaluation and review the recommendations and
cost-benefit. In addition, there are variations in approaches to
disease management as well as a recent trend toward a medical home
approach as an alternative. The results of this study will assist
the legislature in assessing new proposals.
2)BACKGROUND . The purpose of the Disease Management Waiver was to
test the effectiveness of providing a Medi-Cal disease management
benefit. Eligibility for the Disease Management Waiver was
limited to those persons who are eligible for the Medi-Cal Program
as Seniors or Persons with Disabilities, or those persons over 21
years of age who are not enrolled in a Medi-Cal managed care plan,
or are ineligible for Medicare, and who are determined by DHCS to
be at risk of, or diagnosed with, select chronic diseases,
including, but not limited to, advanced atherosclerotic disease
syndromes, congestive heart failure, and diabetes.
Disease management services are being provided in Alameda County
(3,700 enrollees as of February 2010) and in parts of Los Angeles
County (15,000 enrollees as of February 2010). Each contract is
capped at $4,000,000 per year. Each project will operate for
three years.
The UCLA Center for Health Policy Research evaluation is to include
the following outcomes as compared to a control group in non-pilot
counties:
a) Financial measures: whether the provision of services is a
cost neutral or cost savings benefit;
b) Beneficiaries: whether it improved health outcomes;
c) Organizational measures: if there is provider satisfaction;
the effectiveness of community case workers, nurse triage line,
and an outbound calling system; and,
d) Clinical measures: vendor collected scores of a diabetic
measure; access to medications and a measurement used to
compare health plan performance.
3)DISEASE MANAGEMENT : The Disease Management Association of America
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has defined disease management as "a system of coordinated health
care interventions and communications for populations in which
patient self-care efforts are significant." Disease management is
used to describe a wide range of approaches designed to identify
patients with potentially costly health conditions and encourage
adherence to recommended treatment plans and self-care strategies.
Traditional disease management programs focus on a defined
population of members with a specific health condition such as
diabetes or asthma. Almost 70% of the Medi-Cal beneficiaries with
disabilities live with two or more chronic conditions and almost
one-quarter of the population have four of more chronic
conditions. In addition, over 16% of these beneficiaries with
disabilities have diabetes, compared to 7% of the U.S. population
overall. In recent years, the trend has evolved from disease
specific programs and towards a more whole patient, coordinated
system of care.
4)RELATED LEGISLATION . AB 1076 (Jones) of 2009 required DHCS to
expand the Medi-Cal Case Management Program to include Medi-Cal
beneficiaries who have two or more chronic conditions and have
used the hospital emergency department four or more times in the
previous twelve months, and specifies the type of services which
must be included in case management services and required the
Medi-Cal disease management benefit to include the designation of
a primary care provider as a patient's medical home. AB 1076
passed the Senate Health Committee on July 15, 2009 but has been
amended to delete these provisions.
REGISTERED SUPPORT / OPPOSITION :
Support
None on file.
Opposition
None on file.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097