BILL ANALYSIS �
AB 301
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Date of Hearing: April 13, 2011
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
AB 301 (Pan) - As Introduced: February 9, 2011
Policy Committee: HealthVote:19-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill would extend, from January 1, 2012 to January 1, 2018,
the sunset date for the prohibition on California Children's
Services (CCS) program from being incorporated into a Medi-Cal
managed care contract. The prohibition exempts contracts
entered into for county organized health systems or a regional
health authority in San Mateo, Santa Barbara, Solano, Yolo,
Marin, and Napa counties.
FISCAL EFFECT
1)DHCS indicates no state fiscal effect, as this continues
current practice.
2)It is possible that removing the prohibition and authorizing
CCS services to be integrated into managed care contracts or
provided through alternate systems of care would provide cost
savings to the state as compared with current practice.
However, at this time there is no evidence as to the fiscal
nor programmatic effects of removing the prohibition.
COMMENTS
1)Rationale . This bill is jointly sponsored by the Children's
Specialty Care Coalition, the California Children's Hospital
Association, and the American Academy of Pediatrics, who argue
that since 1994, there has been a bipartisan effort to protect
children with catastrophic and chronic health conditions in
California. The sponsors state that the carve-out maintains
CCS as a separate organized system that meets the needs of
infants, children, and teens with catastrophic and chronic
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medical conditions.
2)Background . Originally established in 1927, the CCS Program
provides diagnostic and treatment services, medical case
management, and physical and occupational therapy services to
children under age 21 with CCS-eligible medical conditions.
Examples of CCS-eligible conditions include, but are not
limited to, chronic medical conditions such as cystic
fibrosis, hemophilia, cerebral palsy, heart disease, cancer,
traumatic injuries, and certain infectious diseases.
3)CCS Carve-out . Existing law prohibits CCS-covered services
from being incorporated into a Medi-Cal managed care contract
entered into after August 1, 1994, until January 1, 2012,
except with respect to contracts entered into with county
organized health systems in San Mateo, Santa Barbara, Solano,
Yolo, Marin, and Napa counties.
During the 1990s, as California began enrolling increasing
numbers of Medi-Cal
beneficiaries (including children) into managed care plans,
providers and children's advocates became concerned that
CCS-eligible children would fail to receive the same quality
of care as they did through CCS. As a result, in 1994, a
"carve-out" for CCS-eligible children, who are enrolled in
Medi-Cal managed care, became law, requiring these children to
continue receiving highly specialized care for their
CCS-eligible condition through CCS, while receiving preventive
and general care through a managed care plan. The law
contained a sunset that has since been extended several times.
4)CCS Redesign . While the CCS-carve out has been effective in
providing access to high-quality pediatric specialty care for
eligible children, according to DHCS the carve-out has been
identified by an array of stakeholders as a barrier to
effective care coordination. Furthermore, a recent independent
review identified a broad array of other program challenges,
including significant program variation across counties, a
complex and burdensome financial structure, provider access
problems, and an inefficient authorization process for
services.
DHCS states that the recent development of a new Section 1115
Medi-Cal Demonstration Project Waiver offered an opportunity
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to redesign the CCS program and improve care for children with
special health care needs. As part of the waiver development,
a technical work group appointed by DHCS identified four
potential models for pilot projects to test alternate systems
of care for the CCS program: (a) existing Medi-Cal managed
care plans, (b) a specialty health care plan, (c) Enhanced
Primary Care Case Management, and (d) a Provider-based
Accountable Care Organization.
SB 208 (Steinberg), Chapter 714, Statutes of 2010, required
DHCS to seek proposals to test and evaluate these models.
DHCS is currently seeking comments on a draft RFP for pilot
projects, with the intent to begin implementation of the
projects in 2012. The bill's sponsors, as well as DHCS,
indicate that passage of this legislation would allow the CCS
pilot demonstration projects to constructively inform the
redesign of the CCS Program and provide a sound evidence base
for instituting changes to the CCS Program.
5)Related Legislation . AB 2379 (Chan), Chapter 333, Statutes of
2007, extended the sunset date from August 1, 2008, to January
1, 2012 on the CCS carve-out. Several other bills prior to AB
2379 have also extended the sunset.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081