BILL NUMBER: AB 272 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Member Monning
FEBRUARY 7, 2011
An act to amend Section 12923.5 of, and to repeal Sections
12693.925 and 12693.95 of, the Insurance Code, and to amend Section
14148.8 of the Welfare and Institutions Code, relating to health care
coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 272, as introduced, Monning. Health care coverage: agency:
reports.
Existing law requires the Managed Risk Medical Insurance Board to,
by January 20, 2004, report to the Legislature specified information
with regard to the State Children's Health Insurance Program.
Existing law requires the board to provide, by April 15, 1998, a
proposal relating to drug and alcohol treatment programs for
children.
This bill would delete those obsolete provisions.
Existing law requires the Department of Managed Health Care and
the Department of Insurance to maintain a joint senior level working
group to ensure clarity for health care consumers about who enforces
their patient rights and consistency in the regulations of these
departments. Existing law requires the working group to report its
findings for review by the Insurance Commissioner and the Director of
the Department of Managed Health Care for review and approval and
submission every 5 years to the Legislature.
This bill would delete those reporting requirements.
Existing law requires the State Department of Health Care Services
to provide the Legislature an annual report summarizing data
reported by alternative birth centers, as specified.
This bill would delete that reporting requirement.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 12693.925 of the Insurance Code is repealed.
12693.925. (a) The Managed Risk Medical Insurance Board shall
report to the Legislature on or before January 30, 2004, the
following information with respect to the State Children's Health
Insurance Program:
(1) A list of the categories of vulnerable children who should be
the targets of public health initiatives, including, but not limited
to, immigrant children, homeless children, and other children that
face health disparities.
(2) Recommendations on innovative methods available under the
federal program for addressing health needs and barriers to care for
the identified groups of vulnerable children. The board shall report
as many recommendations as possible that are available under the
federal program and the expected impact of each recommendation.
(3) Recommendations on innovative methods available under the
federal program for developing in urban areas initiatives similar to
the rural demonstration projects. The board shall report as many
recommendations as possible that are available under the federal
program and the expected impact of each recommendation.
(b) The board shall seek input, at regularly scheduled meetings of
the board, from the Healthy Families Advisory Panel and stakeholder
organizations, including, but not limited to, organizations that
represent immigrant and homeless populations, other communities that
experience health disparities, and traditional providers of care to
low-income populations.
(c) This section shall be implemented only to the extent that
federal financial participation is obtained.
SEC. 2. Section 12693.95 of the Insurance Code is repealed.
12693.95. (a) The board in consultation with the Department of
Alcohol and Drug Programs shall provide the Legislature by April 15,
1998, a proposal assessing the viability of providing additional drug
and alcohol treatment services for children enrolled in the program.
If the board determines that it is feasible to provide additional
federal funds received pursuant to Title XXI (commencing with Section
2101) of the Social Security Act to counties to finance drug and
alcohol services and required federal approval is obtained, the board
shall negotiate with participating health plans to establish
memoranda of understanding between plans and counties to facilitate
referral of children in need of these services.
(b) Based on the April 15, 1998, report by the board to the
Legislature, the Legislature finds and declares that there is a
statewide gap in publicly funded alcohol and other drug treatment for
adolescents which is significant and systemic.
(1) Therefore, the Department of Alcohol and Drug Programs, in
cooperation with the board, shall do the following:
(A) Review capacity needs for the Healthy Families Program target
group after year one data has been collected and an assessment of the
adequacy of the benefit can be made.
(B) Request that counties provide data on the number of
adolescents requesting alcohol and other drug treatment and whether
they are participating in the Healthy Families Program.
(2) The board shall do the following:
(A) Request the participating health plans to voluntarily collect
data, as prescribed by the board, on the number of children needing
services that exceed the substance abuse benefit in their plan.
(B) Upon contract renewal, require participating health plans to
collect and report the data.
(C) By September 1, 1999, provide the policy and fiscal committees
of the Legislature with an analysis of the data obtained by the
Department of Alcohol and Drug Programs and from the participating
health plans.
SEC. 3. Section 12923.5 of the Insurance Code is amended to read:
12923.5. (a) The Department of Managed Health Care and the
Department of Insurance shall maintain a joint senior level working
group to ensure clarity for health care consumers about who enforces
their patient rights and consistency in the regulations of these
departments.
(b) The joint working group shall undertake a review and
examination of the Health and Safety Code, the Insurance Code, and
the Welfare and Institutions Code as they apply to the Department of
Managed Health Care and the Department of Insurance to ensure
consistency in consumer protection.
(c) The joint working group shall review and examine all of the
following processes in each department:
(1) Grievance and consumer complaint processes, including, but not
limited to, outreach, standard complaints, including coverage and
medical necessity complaints, independent medical review, and
information developed for consumer use.
(2) The processes used to ensure enforcement of the law,
including, but not limited to, the medical survey and audit process
in the Health and Safety Code and market conduct exams in the
Insurance Code.
(3) The processes for regulating the timely payment of claims.
(d) The joint working group shall report its findings to the
Insurance Commissioner and the Director of the Department of Managed
Health Care for review and approval. The commissioner and the
director shall submit the approved final report under signature to
the Legislature by January 1 of every year for five years.
SEC. 4. Section 14148.8 of the Welfare and Institutions Code is
amended to read:
14148.8. (a) The State Department of Health Care
Services shall provide Medi-Cal reimbursements to alternative birth
centers for facility-related delivery costs at a statewide
all-inclusive rate per delivery that shall not exceed 80 percent of
the average Medi-Cal reimbursement received by general acute care
hospitals with Medi-Cal contracts and shall be based on an average
hospital length of stay of 1.7 days. The reimbursement rate shall be
updated annually and shall be based on the California Medical
Assistance Commission's annually published legislative report of
average contract rates for general acute care hospitals with Medi-Cal
contracts. However, the reimbursement shall not exceed the
alternative birth center's charges to any non-Medi-Cal patient for
similar services.
(b) In order to be eligible for reimbursement pursuant to this
section, an alternative birth center shall satisfy the following
criteria as determined by the state department:
(1) At least 150 patients or 50 percent of the patient caseload
served at the center each year, whichever is less, shall be Medi-Cal
patients and low-income patients.
(2) The facility shall be currently certified as a comprehensive
perinatal services provider. If not currently certified, the facility
shall be certified with the first year of operation.
(3) The facilities may utilize certified nurse midwives, certified
nurse practitioners, and clinical nurse specialists where
appropriate.
(4) The facility shall meet the standards for certification
established by the National Association of Childbearing Centers,
including those relating to the proximity and involvement of
hospitals, obstetricians, and pediatricians.
(5) The facility shall establish and maintain a quality assurance
program.
(6) The facility shall maintain newborn followup care for at least
one year.
(7) The gathering of data and preparing reports as required in
subdivision (c).
(c) (1) Each alternative birth center awarded reimbursement
pursuant to this section shall gather data and annually report
outcome measures relating to the safety, cost-effectiveness, and
patient acceptance of the center to the department to be made
available upon request.
(2) The report shall include data on the incidence of maternal and
infant death, preterm newborns, low birth weight newborns, maternal
complications, newborn complications, cesarean sections,
forcep-assisted deliveries, deliveries involving use of anesthesia,
months of prenatal care, family involvement in childbirth,
breast-feeding, infant immunizations, well baby care, adjusted cost
per case for deliveries performed at the center, and cost per case
for women transferred to hospitals for delivery.
(3) The department shall provide the Legislature with an annual
report summarizing the data reported by the centers.
(4)
(3) The department shall, to the extent
information and resources are available, as determined by the
department, compare the data provided by the centers with information
furnished by other providers of prenatal and delivery services. The
department shall use the comparative data to determine for the
Medi-Cal program whether alternative birth centers are
cost-effective, improve access to prenatal care, reduce the
anticipated incidence of maternal and newborn complications, and have
a high degree of patient acceptance.
(d) The director shall administer this section and establish
standards, procedures, and reimbursement rates, as the director deems
necessary in carrying out this section. The establishment of the
reimbursement rates is not required to be adopted as regulations
pursuant to the Administrative Procedure Act (Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code).
(e) Nothing in this act shall alter the scope of practice for any
health care professional or authorize the delivery of health care
services in a setting or in a manner not authorized by the Health and
Safety Code or the Business and Professions Code.