BILL ANALYSIS �
AB 301
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 301 (Pan)
As Amended August 30, 2011
Majority vote
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|ASSEMBLY: |75-0 |(April 25, |SENATE: |40-0 |(September 6, |
| | |2011) | | |2011) |
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Original Committee Reference: HEALTH
SUMMARY : Extends the sunset date, from January 1, 2012, to
January 1, 2016, on the prohibition on incorporating California
Children's Services (CCS) covered services in a Medi-Cal managed
care (MCMC) contract. The existing prohibition and the
extension exempts the county organized health systems (COHS)
plans in the counties of San Mateo, Santa Barbara, Solano, Yolo,
Marin, and Napa.
The Senate amendments :
1)Change the sunset date extension from January 1, 2018, to
January 1, 2016;
2)Add legislative findings and specify legislative intent to
continue the prohibition of services covered by the CCS
Program from being incorporated solely into MCMC until the
pilot evaluations can be considered and demonstrate the most
appropriate organized health care delivery models for children
eligible for CCS Program services, which may include
continuation of the current system of care; and,
3)Add provisions to clarify that the state will pay a provider
of health care services for a child enrolled in the Healthy
Families Program (HFP) no more than the Medi-Cal rate if the
family chooses the Medi-Cal fee for service option and the
health care services are provided by a Medi-Cal provider.
AS PASSED BY THE ASSEMBLY , this bill extended the existing
sunset date on the CCS contract prohibition from January 1,
2012, to January 1, 2018.
FISCAL EFFECT : According to the Senate Appropriations
Committee, there could be no new cost above current expenditure
AB 301
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levels, since Department of Health Care Services (DHCS) intends
to continue the existing carve-out/carve-in system and would
likely choose to do so until the CCS pilot projects evaluation
is complete.
COMMENTS : Since the implementation of mandatory enrollment in
MCMC plans, CCS-eligible services have been provided and paid
for on a fee-for-service (FFS) basis through the CCS Program or
"carved-out." The "carve-out" has been extended repeatedly,
usually for three or four year periods and is due to expire
January 1, 2012. The first extension allowed the COHS in the
counties of San Mateo, Santa Barbara, Solano, and Napa to
include CCS services ("carve-in").
SB 208 (Steinberg), Chapter 714, Statutes of 2010, the
legislation that implemented the new 2010 Medi-Cal Section 1115
Waiver, requires DHCS to establish a pilot project and seek
proposals to test four models exploring potential options to
redesign the CCS Program. These delivery models may include an
enhanced primary care case management program, a provider-based
accountable care organization, a specialty health care plan, and
a MCMC plan. DHCS is in the process of soliciting proposals.
SB 208 of 2010 also requires DHCS to conduct a simultaneous
evaluation, to assess the effectiveness of each model in
improving the delivery of health care services for these
children and specifies the measures for the evaluation. This
bill clarifies that it is legislative intent to continue the
"carve-out" until the pilots are evaluated and stakeholders are
consulted.
The federal Children's Health Program Reauthorization Act of
2009 now requires states to provide health plan choice to
children enrolled in Children's Health Insurance Programs (HFP
in California). According to the Administration, there are
presently eight counties where children enrolled in HFP only
have one plan option available. AB 102 (Budget Committee),
Chapter 29 , Statutes of 2011, a health budget trailer bill
enacted the Administration's proposal to provide the Managed
Risk Medical Insurance Board the flexibility to provide health
care coverage through existing participating health plans, as
well as through an interagency agreement with DHCS through the
Medi-Cal FFS Program. This bill makes technical and clarifying
amendments to these provisions.
AB 301
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Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
FN:
0002381