BILL ANALYSIS �
AB 2206
Page 1
GOVERNOR'S VETO
AB 2206 (Atkins)
As Amended August 24, 2012
2/3 vote
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|ASSEMBLY: |73-0 |(May 10, 2012) |SENATE: |38-0 |(August 28, |
| | | | | |2012) |
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|ASSEMBLY: |79-0 |(August 29, | | | |
| | |2012) | | | |
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Original Committee Reference: HEALTH
SUMMARY : Authorizes disenrollment, regardless of any lock-in,
of a person who in any demonstration project established by the
Department of Health Care Services (DHCS) for persons who are
dually eligible for Medi-Cal and Medicare, becomes eligible for
the Program for the All-Inclusive Care for the Elderly (PACE)
while enrolled in a managed care plan participating in the
demonstration project and allows the person to enroll in a PACE
plan. Requires managed care plans to identify, through required
assessments, enrollees who are 55 years of age and older who are
at risk of being placed in a nursing home and further requires
the plan to notify the person of their potential eligibility for
PACE.
The Senate amendments :
1)Authorize individuals eligible for the PACE program to
disenroll from a managed care health plan and enroll in a PACE
plan at any time.
2)Require the Medi-Cal pilot program managed care health plans
to identify and notify certain beneficiaries of their
potential eligibility for the PACE program.
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3)Make other technical amendments to prevent chaptering out
provisions of SB 1008 (Budget and Fiscal Review Committee),
Chapter 33, Statutes of 2012.
AS PASSED BY THE ASSEMBLY , this bill required DHCS to include
PACE, if available, as an option for enrollment in all
enrollment materials, enrollment assistance programs, and
outreach programs related to the state's demonstration project
to integrate care for individuals who are eligible for Medi-Cal
and Medicare (dual-eligible). Required the PACE plan to be made
available to potential enrollees whenever enrollment choices and
options are presented.
FISCAL EFFECT : According to the Senate Appropriations
Committee, according to DHCS, as part of its implementation of
the Coordinated Care Initiative (CCI), it will be setting
capitation rates for PACE that are similar to those paid to
managed care plans for the provision of similar services to a
similar population. Therefore DHCS indicates that additional
use of PACE by dual-eligibles should not increase overall
Medi-Cal costs.
COMMENTS: SB 208 (Steinberg), Chapter 714, Statutes of 2010,
established demonstration projects in up to four counties under
which dual eligible beneficiaries would be enrolled into
coordinated systems responsible for all Medicare and Medi-Cal
benefits, as well as long-term support services (LTSS) and
behavioral health services. In January, the Governor's proposed
2012-13 Budget increased the number of demonstration sites to
10. The proposal also would have allowed DHCS to expand the
demonstration by an additional 20 counties in 2014 and statewide
in 2015. This CCI proposal would have required all full-benefit
dual eligible beneficiaries residing in a demonstration county
to enroll in the demonstration. DHCS would have the authority
to require a beneficiary, upon enrollment into a demonstration
site, to remain in the plan for a period of six months from the
time of initial enrollment (lock-in). After the six month
period, beneficiaries would have an opportunity to opt out of
enrollment in the demonstration for their Medicare benefits
only. They would remain mandatorily enrolled in a Medi-Cal
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Managed Care (MCMC) plan for their Medi-Cal benefits including
in-home supportive services (IHSS). In the May Revision, the
Administration revised in response to stakeholder feedback that
more time is needed to prepare for enrollment, to move the
implementation date from January 1, 2013, to March 1, 2013, with
enrollment phased in throughout the rest of 2013; reduced the
number of counties from 10 to eight; limited dual eligible
mandatory enrollment in MCMC in 2013 to only the eight counties
where the duals demonstration is implemented. (Previously, the
CCI proposed mandatory MCMC for wrap-around Medi-Cal services in
all managed care counties in 2013.); indicated the
Administration's intention to eventually transition IHSS
collective bargaining from the local government level to the
state.
The 2012-13 Budget, as passed by the Legislature and signed by
the Governor included a modified version of the Administration's
CCI proposal to expand the dual demonstration projects and to
coordinate and integrate LTSS, including IHSS. The provisions
as modified by the Legislature are contained in SB 1008 (Budget
and Fiscal Review Committee), Chapter 33, Statutes of 2012, and
SB 1036 (Budget and Fiscal Review Committee), Chapter 45,
Statutes of 2012, both of which passed the Legislature and were
signed by the Governor on June 27, 2012. SB 1008 included the
provisions of this bill relating to enrollment materials as it
passed the Assembly and therefore were deleted from this bill.
In addition SB 1008:
1)Authorizes implementation of the demonstration project in up
to eight counties, not to begin sooner than March 1, 2013, and
requires DHCS consult with the Legislature, federal
government, and stakeholders when determining the
implementation date.
2)Includes legislative intent for the demonstration project to
expand statewide within three years of the start of the
demonstration project and requires that expansion beyond the
initial eight counties is contingent upon statutory
authorization and a subsequent budget appropriation.
3)Requires dual beneficiaries be enrolled into a demonstration
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site unless the beneficiary makes an affirmative choice to opt
out of enrollment or is enrolled in the PACE Program or an
AIDS Healthcare Foundation plan as specified, or is otherwise
exempt.
4)Allows dual beneficiaries who opt out of enrollment in a
demonstration site to choose to remain enrolled in fee for
service Medicare or a Medicare Advantage plan for their
Medicare benefits, but shall be mandatorily enrolled into a
MCMC health plan, with exceptions.
5)Allows, to the extent federal approval is obtained, DHCS to
require that any beneficiary, to remain enrolled in the
Medicare portion of the demonstration project on a mandatory
basis for six months from the date of initial enrollment.
Includes continuity of care provisions.
6)Allows beneficiaries who have been diagnosed with HIV/AIDS to
opt out of the demonstration project at the beginning of any
month.
7)Requires that in the 2013 calendar year, beneficiaries in
Medicare Advantage and Medicare Advantage Special Needs Plans
be exempt from mandatory enrollment in the demonstration
project, but may voluntarily choose to enroll in the
demonstration project.
8)Requires that Medi-Cal beneficiaries who have dual eligibility
in Medi-Cal and Medicare Programs be assigned as mandatory
enrollees into new or existing MCMC health plans for their
Medi-Cal benefits in counties participating in the dual
demonstration projects only, with specified exemptions.
9)Requires that, no sooner than March 1, 2013, all Medi-Cal LTSS
services, as defined, shall be services that are covered under
managed care plan contracts and shall be available only
through managed care plans to beneficiaries residing in
counties participating in the dual demonstration counties
only.
GOVERNOR'S VETO MESSAGE :
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The Program of All-Inclusive Care for the Elderly
(PACE) provides fully integrated care to people age 55
and older who need skilled nursing home type care, but
can live in a community setting. California was the
pioneer for PACE programs in the nation, having
started the first one of its kind in the early 1970's.
Last year, I signed AB 574 to expand PACE, so that
more providers could use this model and give aging
Californians the benefits of fully integrated care.
Since that time, my administration has embarked on a
large scale effort to coordinate care for people who
qualify for both the Medi-Cal and Medicare programs.
The Coordinated Care Initiative, enacted through SB
1008 of 2012, will similarly build on the integrated
care concept, using managed care plans to break down
the silos that currently exist between medical and
long-term care.
Within this effort, there will be ample opportunity
for PACE to continue its mission and thrive as a model
of care. I will direct my administration to involve
PACE providers as the initiative rolls out. Enacting
special provisions for PACE eligibility and referral
is not necessary at this time.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
FN: 0005932