BILL ANALYSIS                                                                                                                                                                                                    �




                   Senate Appropriations Committee Fiscal Summary
                           Senator Christine Kehoe, Chair

                                          SB 485 (Hernandez)
          
          Hearing Date: 5/16/2011         Amended: 4/14/2011
          Consultant: Katie Johnson       Policy Vote: Health 7-2
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          ____
          BILL SUMMARY: SB 485 would require the Department of Health Care 
          Services to establish a pilot program to facilitate 
          collaboration between an available and accessible provider of 
          nonemergency medical care and a hospital to provide a Medi-Cal 
          beneficiary or patient who lacks health insurance with an 
          alternative to the use of the emergency department. 
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          ____
                            Fiscal Impact (in thousands)

           Major Provisions         2011-12      2012-13       2013-14     Fund
           
          DHCS start-up and                            low hundreds 
          ofGeneral/*
          and ongoing              administration           thousands of 
          dollars                       Federal                  
          *Medi-Cal costs shared 50 percent General Fund, 50 percent 
          federal funds.
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          ____

          STAFF COMMENTS: This bill meets the criteria for referral to the 
          Suspense File.
          
          SB 485 would require the Department of Health Care Services 
          (DHCS) to establish a pilot program to facilitate collaboration 
          between an available and accessible provider of nonemergency 
          medical care and a hospital to provide a Medi-Cal beneficiary or 
          patient who lacks health insurance with an alternative to the 
          use of the emergency department. of a hospital if the patient, 
          after a medical screening, is determined by a physician and 
          surgeon or other health care provider to not have an emergency 
          medical condition and is provided with the information in 
          writing before discharge from the emergency unit.

          DHCS would need additional staff at a cost of a few hundred 
          thousand dollars to develop a program, apply for federal 








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          approval, produce a request for proposal, review received 
          proposals, and provide ongoing monitoring and evaluation for the 
          program, as specified in this bill. Additionally, DHCS would 
          need to work closely with individual counties' indigent medical 
          services programs in order to ensure that uninsured patients 
          were assigned a medical home with an appropriate provider. If 
          this pilot program were expanded statewide, administrative costs 
          would increase accordingly.

          To the extent that this pilot program, after it is established, 
          succeeds in redirecting patients with non-urgent needs to 
          primary care providers, there could be some cost avoidance in 
          utilization of emergency department and inpatient hospital 
          services.

          Since this would be a pilot program and there is no sunset on 
          the program, staff recommends that this bill be amended to 
          sunset the pilot program January 1, 2017, and that DHCS provide 
          the evaluation of the pilot program to the relevant policy and 
          fiscal committees of the Legislature no later than January 1, 
          2016.