BILL ANALYSIS �
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|SENATE RULES COMMITTEE | SB 1019|
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UNFINISHED BUSINESS
Bill No: SB 1019
Author: Senate Budget and Fiscal Review Committee
Amended: 8/23/12
Vote: 21 - Urgency
PRIOR VOTES NOT RELEVANT
ASSEMBLY FLOOR : Not available
SUBJECT : Budget Trailer Bill
SOURCE : Author
DIGEST : This bill makes technical statutory revisions
affecting health programs necessary to implement the Budget
Act of 2012.
Assembly Amendments delete the Senate version of the bill,
which expressed legislative intent relative to the Budget
Act of 2012, and instead add the current language.
ANALYSIS : Under existing law, the Department of Health
Care Services is authorized and required to perform various
functions relating to the care and treatment of persons
with mental disorders. Under existing law, services for
these individuals may be provided in psychiatric hospitals
or other types of facilities, as well as in community
settings. Under existing law, psychiatric health
facilities are licensed and regulated by the State
Department of Social Services. Existing law provides for
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state hospitals for the care, treatment, and education of
mentally disordered persons, which are under the
jurisdiction of the State Department of State Hospitals.
Existing law creates the Healthy Families Program,
administered by the Managed Risk Medical Insurance Board
(MRMIB), to arrange for the provision of health, vision,
and dental benefits to eligible children pursuant to the
federal Children's Health Insurance Program. Existing law
also provides for the Medi-Cal program, which is
administered by the State Department of Health Care
Services, under which basic health care services are
provided to qualified low-income persons. The Medi-Cal
program is, in part, governed and funded by federal
Medicaid provisions.
Existing law provides for the transition of specified
enrollees of the Healthy Families Program to the Medi-Cal
program, to the extent that those individuals are otherwise
eligible, no sooner than January 1, 2013. Existing law
requires this transition to take place in 4 phases, as
prescribed. Existing law requires the Department of Health
Care Services to exercise the option to provide full-scope
benefits with no share of cost to children who have
attained 6 years of age but have not attained 19 years of
age and who are optional targeted low-income children, as
specified.
Existing law requires, to the extent required by federal
law, and beginning January 1, 2013, through and including
December 31, 2014, that payments for primary care services
provided by specified physicians be no less than 100% of
the payment rate that applies to those services and
physicians as established by the Medicare Program, for both
fee-for-service and managed care plans.
Existing law requires the State Department of Health Care
Services to ensure and improve the care coordination and
integration of health care services for Medi-Cal
beneficiaries residing in counties participating in the
demonstration project.
Existing law requires the department to enter into an
interagency agreement with the Department of Managed Health
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Care to conduct financial audits, medical surveys, and a
review of the provider networks of the managed care plans
participating in a certain demonstration project and
provide consumer assistance to beneficiaries affected by
certain provisions.
Existing law authorizes, to the extent consistent with
federal law, the State Department of Health Care Services
to defer payments to Medi-Cal managed care health plans and
providers, as applicable, contracting with the department,
as specified, which are payable to the plans during the
final month of the 2012-13 state fiscal year, if certain
conditions are satisfied.
This bill:
1. Makes technical corrections and clarifications to the
duals demonstration project that was adopted through SB
1008 (Senate Budget and Fiscal Review Committee),
Chapter 33, Statutes of 2012.
2. Requires persons enrolled in a Medi-Cal home and
community-based waiver program to be mandatorily
enrolled in Medi-Cal managed care (for medical services
and long-term supports and services). This change is
consistent with how Seniors and Persons with
Disabilities, who are enrolled in a Medi-Cal home and
community-based waiver program, are mandatorily enrolled
in Medi-Cal managed care. These individuals would still
receive their home and community-based wavier program
services through the waiver program/provider.
3. Eliminates the requirement that the Department of
Managed Health Care (DMHC) monitor health plans
participating in the duals demonstration project on a
quarterly basis to determine whether the beneficiaries
are able to receive timely access to primary and
specialty care services as federal law (42 Code of
Federal Regulations (C.F.R.) Section 422.402) preempts
DMHC from performing this activity on Medicare plans.
4. Makes technical corrections to the eligibility language
for various hospital supplemental funds, as contained in
AB 1467 (Budget Committee), Chapter 23, Statutes of
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2012, which amended Welfare and Institutions Code
Sections 14166.12 and 14166.17 to include the
eligibility requirements for various hospital
supplemental funds. These sections should reference the
Selective Provider Contract program's statute.
5. Makes technical corrections to ensure that Medi-Cal
primary care provider payment increases (as required by
federal health care reform and implemented by AB 1467)
do not apply to state-only programs. Federal health
care reform requires that specified primary care
services be reimbursed at no less than the Medicare rate
from January 1, 2013, through December 31, 2014. The
marginal rate increase is fully funded by the federal
government for services provided in the Medi-Cal
program. This change is necessary to clarify that no
increases will be provided in state-only programs.
6. Makes various technical corrections to the statute that
transfers the Healthy Families Program to Medi-Cal,
contained in AB 1494 (Budget Committee), Chapter 28,
Statutes of 2012.
7. Exempts the Department of Health Care Services (DHCS)
from competitive bidding rules for the purposes of
contracting with the Healthy Families Program
administrative vendor for implementing and maintaining
the necessary systems and activities for providing
health care coverage to optional targeted low-income
children in the Medi-Cal Program for purposes of
Accelerated Enrollment application processing by Single
Point of Entry, non-eligibility-related case maintenance
and premium collection, maintenance of the Health-E-App
web portal, call center staffing and operations,
Certified Application Assistant services, and reporting
capabilities. This bill also permits DHCS to enter into
a contract with the Health Care Options Broker of the
department for purposes of managed care enrollment
activities. These specified contracts may be initially
completed on a noncompetitive bid basis and are exempt
from the Public Contract Code. Subsequent contracts for
these purposes shall use a competitive bid basis and
shall be subject to the Public Contract Code.
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8. Restores sections of AB 1467, which were inadvertently
chaptered out by subsequent bills. The chaptered out
sections relate to the rural expansion of Medi-Cal
managed care and the consideration of safety net
providers when factoring managed care plan costs in the
default managed care assignment algorithm. This bill
restores the AB 1467 changes.
9. Changes references to the Department of Mental Health
(DMH) to the appropriate state departments, as DMH was
eliminated in the Budget Act of 2012.
10.Contains an appropriation allowing this bill take
effect immediately upon enactment.
FISCAL EFFECT : Appropriation: Yes Fiscal Com.: Yes
Local: No
DLW:JJA:d 8/29/12 Senate Floor Analyses
SUPPORT/OPPOSITION: NONE RECEIVED
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