BILL NUMBER: SB 771	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 2, 2009

INTRODUCED BY   Senator Alquist

                        FEBRUARY 27, 2009

    An act relating to Medi-Cal.   An act to add
Section 1367.28 to the Health and Safety Code, and to add Section
10133.4 to the Insurance Code, relating to health care coverage.




	LEGISLATIVE COUNSEL'S DIGEST


   SB 771, as amended, Alquist.  Medi-Cal.  
Health care coverage: patient-centered medical home.  
   Existing law provides for licensure and regulation of health care
service plans by the Department of Managed Health Care. Existing law
provides for the regulation of health insurers by the Department of
Insurance. A willful violation of provisions governing health care
service plans is a crime.  
   This bill would require a health care service plan or a health
insurer, or a medical group that contracts with a plan, that uses a
pay-for-performance system for the payment of providers to provide a
differential payment to providers who provide patients with a
patient-centered medical home. Because a willful violation of this
provision relative to a health care service plan would be a crime,
this bill would impose a state-mandated local program.  
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.  
   This bill would provide that no reimbursement is required by this
act for a specified reason.  
   Existing law establishes the Medi-Cal program, administered by the
State Department of Health Care Services, under which basic health
care services are provided to qualified low-income persons. The
Medi-Cal program is partially governed and funded under federal
Medicaid provisions.  
   This bill would declare the intent of the Legislature to enact
legislation that would implement and complement changes in federal
provisions affecting the Medi-Cal program, including, but not limited
to, changes enacted as part of any federal economic stimulus
package, as passed by the 111th Congress and signed by the President,
in order to ensure that California receives its share of new federal
funds, and benefits from any changes in eligibility, benefits, or
funding enacted as part of any federal economic stimulus package.

   Vote: majority. Appropriation: no. Fiscal committee:  no
  yes  . State-mandated local program:  no
  yes  .


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

   SECTION 1.    Section 1367.28 is added to the 
 Health and Safety Code   , to read:  
   1367.28.  (a) A health care service plan, or a medical group that
contracts with a health care service plan, that uses a
pay-for-performance system for the payment of providers shall provide
a differential payment for providers who provide patients with a
patient-centered medical home, in accordance with standards
established by the National Committee for Quality Assurance. This
section shall not apply to specialized health care service plans.
   (b) For the purposes of this section, a "pay-for-performance
system" means a payment system that rewards physicians, hospitals,
medical groups, and other health care providers for meeting
prescribed performance measures for quality and efficiency. 
   SEC. 2.    Section 10133.4 is added to the  
Insurance Code   , to read:  
   10133.4.  (a) A health insurer that uses a pay-for-performance
system for the payment of providers shall provide a differential
payment for providers who provide patients with a patient-centered
medical home, in accordance with standards established by the
National Committee for Quality Assurance.
   (b) For the purposes of this section, a "pay-for-performance
system" means a payment system that rewards physicians, hospitals,
medical groups, and other health care providers for meeting
prescribed performance measures for quality and efficiency. 
   SEC. 3.    No reimbursement is required by this act
pursuant to Section 6 of Article XIII B of the California
Constitution because the only costs that may be incurred by a local
agency or school district will be incurred because this act creates a
new crime or infraction, eliminates a crime or infraction, or
changes the penalty for a crime or infraction, within the meaning of
Section 17556 of the Government Code, or changes the definition of a
crime within the meaning of Section 6 of Article XIII B of the
California Constitution.  
  SECTION 1.    It is the intent of the Legislature
to enact legislation that would implement and complement changes in
federal Medicaid provisions affecting the Medi-Cal program that are
enacted as part of any federal economic stimulus package, as passed
by the 111th Congress and signed by the President, in order to ensure
that California receives its share of new federal funds, and
benefits from any changes in eligibility, benefits, or funding
enacted as part of any federal economic stimulus package.