BILL NUMBER: SB 771 AMENDED
BILL TEXT
AMENDED IN SENATE DECEMBER 16, 2009
AMENDED IN SENATE APRIL 2, 2009
INTRODUCED BY Senator Alquist
FEBRUARY 27, 2009
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. An act to amend Section 14005.25
of the Welfare and Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
SB 771, as amended, Alquist. Health care coverage:
patient-centered medical home. Medi-Cal: continuous
eligibility: semiannual status reports.
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.
Existing law, until July 1, 2012, requires the department, subject
to the availability of federal financial participation, to exercise
a federal option to expand continuous eligibility to children 19
years of age and younger for 6 months, after which date the
continuous eligibility period shall be from the date of a
determination of eligibility to the earlier of either the end of a
12-month period following the eligibility determination or the date
the child exceeds 19 years of age.
Existing law provides that the provisions limiting continuous
eligibility to 6 months shall be inoperative from March 27, 2009,
until the date the Director of Health Care Services executes a
declaration specifying that increased federal financial participation
is no longer available pursuant to the federal American Recovery and
Reinvestment Act of 2009 (ARRA).
This bill would, instead, provide that the provisions limiting
continuous eligibility to 6 months shall be inoperative from March
27, 2009, until the date the director executes a declaration
specifying that increased federal financial participation is no
longer available pursuant to ARRA or any subsequent federal
legislation, including an amendment to ARRA, that either maintains or
extends increased federal financial participation.
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.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes no .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14005.25 of the
Welfare and Institutions Code , as amended by Section 1 of
Chapter 24 of the Third Extraordinary Session of the
Statutes of 2009, is amended to read:
14005.25. (a) To the extent federal financial participation is
available, the department shall exercise the option under Section
1902(e)(12) of the federal Social Security Act (42 U.S.C. Sec. 1396a
(e)(12)) to extend continuous eligibility to children 19 years of age
and younger. A child shall remain eligible pursuant to this
subdivision from the date of a determination of eligibility for
Medi-Cal benefits until the earlier of either:
(1) The end of a 12-month period following the eligibility
determination.
(2) The date the individual exceeds the age of 19 years.
(b) This section shall be implemented only if, and to the extent
that, federal financial participation is available.
(c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking regulatory action, implement this
section by means of all county letters or similar instructions.
Thereafter, the department shall adopt regulations in accordance with
the requirements of Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code.
(d) In order to implement changes in the level of funding for
health care services, commencing on the first day of the month
following 90 days after the operative date of amendments to this
section that added this subdivision, the continuous eligibility time
period provided in paragraph (1) of subdivision (a) shall be reduced
to six months.
(e) (1) Subdivision (d) shall be inoperative from the date the act
adding this subdivision becomes effective until the date the
Director of Health Care Services executes a declaration specifying
that increased federal financial participation is no longer available
pursuant to the federal American Recovery and Reinvestment Act of
2009 (Public Law 111-5) or any subsequent federal legislation,
including an amendment to the federal American Recovery
and Reinvestment Act of 2009, that either maintains or extend
s increased federal financial participation .
(2) The department shall redetermine the continuous eligibility
period of any child whose continuous eligibility period was
determined or redetermined pursuant to subdivision (d) during the
first calendar year quarter of 2009 and shall grant to that child the
period of continuous eligibility provided for in subdivision (a),
retroactive to the date that the determination or redetermination
under subdivision (d) was made.
(f) This section shall become inoperative on July 1, 2012, and as
of January 1, 2013, is repealed, unless a later enacted statute, that
is enacted before January 1, 2013, deletes or extends that date.
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.