BILL ANALYSIS �
AB 62
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 62 (Monning)
As Amended June 27, 2011
Majority vote
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|ASSEMBLY: |78-0 |(May 19, 2011) |SENATE: |39-0 |(August 18, |
| | | | | |2011) |
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Original Committee Reference: HEALTH
SUMMARY : Requires the Department of Health Care Services (DHCS)
to consult with specified stakeholders in developing and
implementing a pilot project for a Medicaid or Medicare
demonstration project or waiver and authorizes DHCS to respond
to a request for proposal from the federal Centers for Medicare
and Medicaid Services (CMS).
The Senate amendments are technical and clarifying.
AS PASSED BY THE ASSEMBLY , this bill was substantially similar
to the bill as passed by the Senate.
FISCAL EFFECT : According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS : According to the author, this bill provides
technical changes to existing law relating to the Section
1115(a) Medi-Cal Demonstration "Bridge to Reform" Waiver. SB
208 (Steinberg), Chapter 714, Statutes of 2010, included
provisions authorizing the establishment of pilot projects in up
to four counties with the purpose of developing effective health
care models that integrate Medi-Cal and Medicare services. The
author states that at the time the authorization was included as
part of the Section 1115 Medi-Cal waiver legislation. However,
the author states, CMS requested the state not include the dual
eligibles (persons eligible for both Medi-Cal and Medicare) as
part of that waiver. The author explains that the federal
Patient Protections and Affordable Care Act created the Center
for Medicare and Medicaid Innovation (CMMI). The CMMI and
Office of Duals are working on a new initiative "State
Demonstrations to Integrate Care for Dual Eligible Individuals."
According to the author, DHCS submitted a response to the CMS
Request for Proposal (RFP) for this new initiative on January
AB 62
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28, 2011. The author states that this bill clarifies that the
dual eligible project is not a part of the Medi-Cal
Demonstration Waiver. The author 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.
Under the current system Medicare is administered and funded by
the federal government and generally covers primary and acute
care and pharmacy. Medi-Cal is the secondary payer for
low-income beneficiaries and covers primary and acute care,
medical equipment, and LTC. Medi-Cal also pays for home and
community-based services but these may be administered
separately such as In Home Support Services.
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 opportunity for up to 15
states with up to $1 million per state for 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.
DHCS has convened a Stakeholder Advisory Committee to advise on
preparation of the Section 1115(a) waiver as required by AB 6 X4
(Evans), Chapter 6, Statutes of 2009 of the Fourth Extraordinary
Session. The Stakeholder Advisory Committee will also advise on
the implementation of the waiver until its expiration. As
specified, the Stakeholder Advisory Committee includes persons
with disabilities, seniors, representatives of legal services
agencies that serve clients in the affected populations, health
plans, specialty care providers, physicians, hospitals, county
government, labor, and others as appropriate. A Stakeholder
Advisory Committee was appointed in December 31, 2009, and met
on January 7, March 10, May 13, June 10, September 29, and,
December 8 in 2010 and February 10 in 2011. The Stakeholder
Advisory Committee has been sub-divided into five Technical
Workgroups which each have held public meetings to provide
technical support to DHCS on a variety of subjects including
Implementation plan to pilot and test different strategies to
integrate primary care and behavioral health services, including
implementation of a plan for enrollment of Dual Eligible
AB 62
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individuals (those eligible for both Medicare and Medi-Cal) in
an organized system of care that more fully integrates Medicare
and Medi-Cal to provide more effective delivery of Home and
Community Based Services. This bill clarifies that a
stakeholder consultation process should also continue to include
the dual eligible project even though it is not part of the
Medi-Cal waiver.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
FN:
0002024