BILL ANALYSIS �
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|SENATE RULES COMMITTEE | AB 301|
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THIRD READING
Bill No: AB 301
Author: Pan (D), et al.
Amended: 8/30/11 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 6/8/11
AYES: Hernandez, Strickland, Alquist, Anderson, Blakeslee,
De Le�n, DeSaulnier, Rubio, Wolk
SENATE APPROPRIATIONS COMMITTEE : 9-0, 8/25/11
AYES: Kehoe, Walters, Alquist, Emmerson, Lieu, Pavley,
Price, Runner, Steinberg
ASSEMBLY FLOOR : 75-0, 4/25/11 - See last page for vote
SUBJECT : Medi-Cal: managed care
SOURCE : American Academy of Pediatrics
California Childrens Hospital Association
Childrens Specialty Care Coalition
DIGEST : This bill prohibits, until January 1, 2016,
California Childrens Services program covered services from
being incorporated into Medi-Cal managed care contracts,
except for contracts within specified county organized
health systems and regional health authorities.
ANALYSIS : Existing law:
1. Establishes the Medi-Cal Program, administered by
CONTINUED
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Department of Health Care Services (DHCS), which
provides comprehensive health benefits to low-income
children, their parents or caretaker relatives, pregnant
women, elderly, blind or disabled persons, nursing home
residents, and refugees who meet specified eligibility
criteria.
2. Establishes the California Children's Services (CCS)
Program to provide specified medical care and therapy
services to children with eligible conditions.
3. Authorizes the state to contract for comprehensive
managed health care services for Medi-Cal beneficiaries
and requires mandatory enrollment of beneficiaries in
specified eligibility categories.
4. Prohibits, until January 1, 2012, CCS covered services
from being incorporated into Medi-Cal managed care
contracts, except in county organized health systems
plans in the counties of San Mateo, Santa Barbara,
Solano, Yolo, Marin, and Napa.
5. Requires DHCS to seek proposals to establish models of
organized health care delivery for Medi-Cal eligible
children with CCS-eligible conditions and conduct an
evaluation.
This bill prohibits, until January 1, 2016, CCS program
covered services from being incorporated into Medi-Cal
managed care contracts, except for contracts within
specified county organized health systems and regional
health authorities.
This bill adds in a code section reference that would
clarify that the state would pay a Healthy Families
provider no more than the Medi-Cal rate if the health care
services are provided by a Medi-Cal provider.
Background
In 2010, California received federal approval for a new
five-year Waiver. Section 1115 of the Social Security Act
authorizes the federal Secretary of Health and Human
Services to allow states to receive federal Medicaid
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matching funds for coverage expansions without complying
with all of the federal Medicaid rules if they can
demonstrate cost neutrality to the federal government.
According to DHCS, the need to submit a new waiver
application presented an opportunity to transform the
delivery of health care to children with significant health
care needs enrolled in the CCS program, and to provide
services in a manner that improves coordination and quality
of care, better integrates services, uses and supports
medical homes, and provides incentives for specialty and
non-specialty care.
In preparation for the redesign process, the California
Health Care Foundation, engaged Health Management
Associates to provide technical assistance and explore, in
discussion with a large group of stakeholders, the issues
that must be addressed in the process. The discussion was
focused on exploring potential options to redesign the CCS
program and to see if a new service delivery model would
improve the CCS program and meet both stakeholder and the
state's needs. Four potential models for the CCS pilot
projects emerged:
1. Existing Medi-Cal Managed Care Plan;
2. Specialty Health Care Plan;
3. Enhanced Primary Care Case Management, and
4. Provider-based Accountable Care Organization.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13
2013-14 Fund
CCS carve-out Continuation of current
General/** sunset extensionexpenditure levels Federal
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**CCS and Medi-Cal services are shared 50 percent General
Fund, 50 percent federal funds.
SUPPORT : (Verified 8/26/11)
American Academy of Pediatrics (co-source)
California Children's Hospital Association (co-source)
Children's Specialty Care Coalition (co-source)
American Federation of State, County, and Municipal
Employees
California Children's Health Initiative
California Chiropractic Association
California Medical Association
California Primary Care Association
Children Now
Children's Advocacy Institute
Children's Defense Fund California
Hemophilia Council of California
Los Angeles Care Health Plan
Lucile Packard Children's Hospital
Occupational Therapy Association of California
People Improving Communities through Organizing California
The Children's Partnership
United Ways of California
ARGUMENTS IN SUPPORT : Supporters write that extending
the carve-out until January 1, 2018, will allow vulnerable
children with complex medical conditions and their families
to continue to get the care and support they need.
Supporters state that children enrolled in CCS have serious
medical conditions that demand coordinated care, quality
assurance, and case management. This bill preserves a
system of care that protects 185,000 of California's
children. Supporters write that the CCS program is
developing pilot projects to test various models of care
for children with serious and chronic health conditions.
Until these pilot projects are completed and evaluated, to
ensure the effective delivery of medical care for these
severely ill or disabled children, it would be premature to
the end the carve-out for CCS services.
ASSEMBLY FLOOR : 75-0, 4/25/11
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Beall,
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Bill Berryhill, Block, Blumenfield, Bonilla, Bradford,
Brownley, Buchanan, Butler, Campos, Carter, Cedillo,
Chesbro, Conway, Cook, Davis, Dickinson, Donnelly, Eng,
Feuer, Fletcher, Fong, Fuentes, 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, Pan, Perea, V. Manuel P�rez,
Portantino, Silva, Skinner, Smyth, Solorio, Swanson,
Torres, Valadao, Wagner, Wieckowski, Williams, Yamada,
John A. P�rez
NO VOTE RECORDED: Charles Calderon, Furutani, Gorell,
Olsen, Vacancy
CTW:kc 8/29/11 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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