BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
1200 (Leno)
Hearing Date: 5/17/2010 Amended: 4/28/2010
Consultant: Katie Johnson Policy Vote: Health 5-0
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BILL SUMMARY: SB 1200 would require the Department of Managed
Health Care (DMHC) and the California Department of Insurance
(CDI) in their timely access regulations to consider timely
access to care for schoolage children who must receive medically
necessary services during school hours.
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Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12 2012-13 Fund
DMHC regulations $30 - $60 $115 -
$175 $25 ongoing Special*
Potential Medi-Cal and Healthy unknown General/*
Families increased costs Federal/
County
*Managed Care Fund
**Medi-Cal: 38 percent county funds, 62 percent federal funds
until December 31, 2010; 50 percent county funds, 50 percent
federal funds thereafter
**Healthy Families: 35 percent General Fund, 65 percent federal
funds
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STAFF COMMENTS: This bill meets the criteria for referral to the
Suspense File.
This bill would require DMHC and CDI's timely access regulations
to consider timeliness of care for schoolage children who must
receive medically necessary services during school hours as an
indicator of timely access to services. If DMHC needed to update
its regulations, costs could be approximately $30,000 - $60,000
in FY 2010-2011, up to $115,000 - 175,000 in FY 2011-2012, and
$25,000 in FY 2012-2013 and ongoing. This set of regulations
would likely involve not only health care and insurance market
experts, but would also need significant input from education
experts and the California Department of Education (CDE). Any
costs to CDI would be minor and absorbable.
It is impossible to predict the final form of the regulations
and their fiscal impact on health care service plans, health
insurers, Medi-Cal managed care plans, school districts, and
county offices of education. However, discussions and
considerations could include, 1) do the current timely access
regulations already cover timely access to medically necessary
services during the school day? 2) What services are included in
medically necessary services? 3) for which aspects of
school-based health care would the carrier and the school
district each be responsible? 4) Mechanically, how would
carriers reimburse school districts as health care providers? 5)
Would the reimbursement scheme be compulsory and standardized
statewide?
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SB 1200 (Leno)
If the established regulations resulted in a requirement that
carriers were required to reimburse local education agencies
(LEAs) for specific services provided to students during school
hours, there could be increased costs to Medi-Cal managed care
plans and to other carriers to the extent they would not be
reimbursing such services now. Medi-Cal managed care payments
are shared 38 percent General Fund and 62 percent federal funds
until December 31, 2010, and will be shared at 50 percent
General Fund and 50 percent federal funds thereafter. Healthy
Families costs are shared 35 percent General Fund and 65 percent
federal funds. Also, to the extent that school districts and
county offices of education were to receive General Fund and
federal and private funds as described above, a district or
county office of education could choose to use those new monies
to either supplement or supplant their existing health care
services expenditures.
Additionally, the Department of Health Care Services (DHCS)
operates the Local Education Agency (LEA) Program, outside of
the Medi-Cal managed health care system, that permits school
districts and county offices of education to be reimbursed by
the federal government through a certified public expenditure
(CPE) process for services rendered to Medi-Cal eligible
children with Independent Education Plans (IEPs) and a few other
services under specified conditions. The costs are shared 50
percent county/school district funds and 50 percent federal
funds. If school districts and county offices of education were
able and decided to claim more funds from the Medi-Cal LEA
program as a result of this bill, there could be an increased
federal fund cost. However, those federal funds would be part of
the federal Medicaid entitlement; there is no limit provided an
appropriate non-federal share is paid.