BILL NUMBER: AB 1327	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  MAY 10, 2011
	AMENDED IN ASSEMBLY  APRIL 7, 2011

INTRODUCED BY   Assembly Member Portantino

                        FEBRUARY 18, 2011

   An act to add Section 14087.309 to the Welfare and Institutions
Code, relating to health care.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1327, as amended, Portantino. Medi-Cal services.
   Existing law establishes the Medi-Cal program to provide
qualifying individuals with health care services. Under existing law,
the director of the State Department of Health Care Services is
authorized to contract with any qualified individual, organization,
or entity to provide services to Medi-Cal beneficiaries.
   This bill would require the State Department of Health Care
Services  , as a pilot project that is to remain operative for 3
years,  to determine  and provide reimbursement at  a
per capita payment rate  to a Medi-Cal primary care case
management plan or a successor plan, as specified,  for services
provided to Medi-Cal beneficiaries with HIV or AIDS  and
would specify its calculation method  .
   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 14087.309 is added to the Welfare and
Institutions Code, to read:
   14087.309.   (a)    The department shall  ,
as a pilot project,  determine a per capita rate of payment to a
 managed care plan for services provided to Medi-Cal
beneficiaries with HIV or AIDS. In developing the rate, the
department shall use   Medi-Cal primary care case
management (PCCM) plan or a successor health care plan that is
licensed pursuant to the Knox-Keene Health Care Service Plan Act of
1975 (Chapter 2.2 (commencing with Section 1340) of Division 2 of the
Health and Safety Code) for services provided to Medi-Cal
beneficiaries with HIV or AIDS who are enrolled pursuant to
subdivision (j) of Section 14182 and reimburse the plan based upon
this rate. The rate shall be an average of medical treatment costs
for the Medi-Cal beneficiary population with HIV and the Medi-Cal
beneficiary population with AIDS. In developing the per capita rate,
the department shall do both of the following: 
    (1)     Use  all of the coding
elements of the definition of AIDS issued by the United States
Centers for Disease Prevention and Control and by the National Drug
Code for antiretroviral medications.  The rate shall be an
average of medical treatment costs for the Medi-Cal beneficiary
population with HIV and the Medi-Cal beneficiary population with
AIDS. A managed care plan shall be reimbursed at this rate for a
Medi-Cal beneficiary with HIV or AIDS. 
    (2) Develop the rate in accordance with rate-setting
guidelines established by the Centers for Medicare and Medicaid
Services. 
    (b) The department shall operate the pilot project for a
three-year period. At the end of this period, the department shall
evaluate the feasibility of developing the rate specified in
subdivision (a) and provide a comparison to the rate that would have
otherwise been paid. 
    (c) Nothing in this section shall be construed to authorize
the release of confidential health records or the results of an HIV
test not otherwise authorized for release by law.