BILL ANALYSIS �
------------------------------------------------------------
|SENATE RULES COMMITTEE | AB 62|
|Office of Senate Floor Analyses | |
|1020 N Street, Suite 524 | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
------------------------------------------------------------
CONSENT
Bill No: AB 62
Author: Monning (D)
Amended: 6/27/11 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 7/6/11
AYES: Hernandez, Strickland, Alquist, Anderson, Blakeslee,
De Le�n, DeSaulnier, Rubio, Wolk
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 78-0, 5/19/11 - See last page for vote
SUBJECT : Medi-Cal: dual eligibles: pilot projects
SOURCE : Author
DIGEST : This bill permits the Department of Health Care
Services (DHCS) to establish pilot projects for individuals
eligible for both Medicare and Medi-Cal (dual eligibles)
pursuant to a request for proposal from the federal Centers
for Medicare and Medicaid Services, and requires DHCS to
consult with specified stakeholders on a regular basis
throughout the development and implementation of the dual
eligible pilot projects.
ANALYSIS :
Existing federal law:
CONTINUED
AB 62
Page
2
1. Establishes the federal Medicare program, which is a
public health insurance program for individuals age 65
years and older and specified persons with disabilities
who are under age 65.
2. Establishes, as part of federal health care reform, the
Federal Coordinated Health Care Office (Office) within
the federal Centers for Medicare and Medicaid Services
(CMS).
3. Requires the purpose of the Office to be to bring
together officers and employees of the Medicare and
Medicaid programs at CMS in order to:
A. More effectively integrate benefits under the
Medicare and Medicaid programs; and
B. Improve the coordination between the federal
government and the states for dual eligibles to
ensure that such individuals get full access to the
items and services to which they are entitled under
Medicare and Medicaid.
Existing state law:
1. Establishes the Medi-Cal program, which is administered
by DHCS and under which qualified low-income persons
receive health care benefits. The Medi-Cal program is,
in part, governed and funded by federal Medicaid
provisions.
2. Requires DHCS, to the extent that federal financial
participation is available, and pursuant to a
demonstration project or waiver of federal law, to
establish pilot projects in up to four counties, to
develop effective health care models to provide services
to persons who are dually eligible under both the
Medi-Cal and Medicare programs.
3. Requires DHCS, not sooner than March 1, 2011, to
identify health care models that can be included in a
pilot project, to develop a timeline and process for
selecting, financing, monitoring, and evaluating the
pilot projects, and to provide this timeline and process
CONTINUED
AB 62
Page
3
to the appropriate fiscal and policy committees of the
Legislature.
This bill:
1. Permits DHCS to establish pilot projects for dual
eligibles pursuant to a request for proposal (RFP) from
CMS, in addition to the requirement in existing law that
requires DHCS to establish pilot projects in up to four
counties to provide services to persons who are dually
eligible under both the Medi-Cal and Medicare programs.
2. Requires DHCS to consult with stakeholders, including,
but not limited to, representatives of advocacy
organizations, persons with disabilities, seniors,
representatives of legal services agencies that serve
dual eligibles, specialty care providers, provider
associations, labor, health plans, county government,
and the Legislature, on a regular basis throughout the
development and implementation of the pilot projects.
Background
Dual eligible enrollees . For dual eligibles, Medicaid
fills in the gaps in Medicare coverage. For those who
qualify, Medicaid pays the Medicare Part B premium
(Medicare part B premiums are $96.40 per month for most
beneficiaries in 2010), pays the cost sharing charged for
many Medicare services, and covers a range of benefits not
covered by Medicare such as long-term care. According to
DHCS, there are 1.1 million dually eligible Medi-Cal
enrollees. Although they constitute roughly 10 percent of
the Medi-Cal population, they account for nearly 25 percent
of annual Medi-Cal costs. Dual eligibles also account for
75 percent of the total Medi-Cal costs for long-term care.
DHCS states that dual eligible enrollees are the most
chronically ill individuals within both Medicare and
Medicaid, requiring a complex range of services from
multiple providers. According to DHCS, despite the
complexity of their needs, the vast majority of
California's dual eligibles remain in the fragmented
fee-for-service delivery system. SB 208 (Steinberg),
Chapter 714, Statutes of 2010, directs DHCS to develop a
program to provide more streamlined and effective care for
CONTINUED
AB 62
Page
4
California's dual eligibles. At the same time, one of the
purposes of the new CMS CMMI and Office of Duals is the
improvement of coordination and addressing cost shifting
between Medicare and Medicaid.
State demonstration . SB 208 requires DHCS to include at
least one two-plan Medi-Cal managed care county and one
Medi-Cal county organized health system plan county. DHCS
is required to identify the models by January 1, 2012 and
develop a timeline and process for selecting, monitoring
and evaluating these pilot projects. The goals for the
pilot project are as follows:
1. Coordinating Medi-Cal benefits, Medicare benefits, or
both, across health care settings and improving
continuity of acute care, long-term care, and home- and
community-based services.
2. Coordinating access to acute and long-term care services
for dual eligibles.
3. Maximizing the ability of dual eligibles to remain in
their homes and communities with appropriate services
and supports in lieu of institutional care.
4. Increasing the availability of and access to home- and
community-based alternatives.
According to the response submitted to CMS, DHCS is
planning to implement an integrated care pilot program in
four counties in 2012 with a goal that all dual eligibles
will have an option to enroll in a fully integrated system
of care by 2015. The federal RFP provided for contract
opportunities for up to 15 states with up to $1 million per
state for the design phase. An implementation phase may be
offered in 2012. CMS is looking for person-centered models
that integrate the full range of acute, behavioral health,
and long-term supports and services for dual eligible
individuals.
Comments
According to the author's office, this bill provides
technical changes to existing law relating to the
CONTINUED
AB 62
Page
5
"California Bridge to Reform" waiver approved in 2010. SB
208 includes provisions requiring the establishment of dual
eligible pilot projects in up to four counties for the
purpose of developing effective health care models that
integrate Medi-Cal and Medicare services. The author's
office states that at that time the authorization was
included as part of the waiver legislation. However, the
author's office states that CMS requested that the state
not include the dual eligible pilot programs as part of
that waiver. The author's office explains that the federal
Patient Protection and Affordable Care Act created the
Center for Medicare and Medicaid Innovation (CMMI). The
CMMI and the federal Office are working on a new initiative
"State Demonstrations to Integrate Care for Dual Eligible
Individuals" to provide funding for states to support the
design of innovative service delivery and payment models
for dual eligible individuals.
According to the author's office, DHCS submitted a response
to the CMS RFP under this new initiative on January 28,
2011. The author's office states that this bill clarifies
that the dual eligible project in response to the RFP is
not a part of the California Bridge to Reform federal
waiver approved last year. The author's office also states
that this bill requires consultation with stakeholders to
ensure that DHCS continues to be informed by interested and
affected members of the stakeholder community.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
ASSEMBLY FLOOR : 78-0, 5/19/11
AYES: Achadjian, Allen, Ammiano, Atkins, Beall, Bill
Berryhill, Block, Blumenfield, Bonilla, Bradford,
Brownley, Buchanan, Butler, Charles Calderon, Campos,
Carter, Cedillo, Chesbro, Conway, Cook, Davis, Dickinson,
Donnelly, Eng, Feuer, Fletcher, Fong, Fuentes, Furutani,
Beth Gaines, Galgiani, Garrick, Gatto, Gordon, Grove,
Hagman, Halderman, Hall, Harkey, Hayashi, Roger
Hern�ndez, Hill, Huber, Hueso, Huffman, Jeffries, Jones,
Knight, Lara, Logue, Bonnie Lowenthal, Ma, Mansoor,
Mendoza, Miller, Mitchell, Monning, Morrell, Nestande,
Nielsen, Norby, Olsen, Pan, Perea, V. Manuel P�rez,
CONTINUED
AB 62
Page
6
Portantino, Silva, Skinner, Smyth, Solorio, Swanson,
Torres, Valadao, Wagner, Wieckowski, Williams, Yamada,
John A. P�rez
NO VOTE RECORDED: Alejo, Gorell
CTW:kc 8/16/11 Senate Floor Analyses
SUPPORT/OPPOSITION: NONE RECEIVED
**** END ****
CONTINUED