BILL ANALYSIS �
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SENATE THIRD READING
SB 1034 (Budget and Fiscal Review Committee)
As Amended June 25, 2012
Majority vote. Budget Bill Appropriation Takes Effect Immediately
SENATE VOTE :Vote not relevant
SUMMARY : Contains necessary statutory changes to achieve savings
assumed in the 2012 Budget Act related to both the Managed Risk
Medical Insurance Board and the Department of Health Care Services
and implements the transition of all children in the Healthy
Families Program to Medi-Cal. Specifically, this bill :
1)Implements the transition of all children in the Healthy Families
Program to Medi-Cal. Specifically, the bill:
a) Increases eligibility for the Medi-Cal program, for children
ages 6 through 18, to family incomes up to and including 200%
of the federal poverty level (FPL), and exempts all resources
and disregards income at or above 200% and up to and including
250% FPL. Exempts Access for Infants and Mothers-linked
infants, with incomes above 250% FPL, from this transition.
b) Eliminates premiums for children with incomes at or below
150% FPL and requires premiums of all children above 150% FPL
at the Healthy Families category B level.
c) Requires that the Healthy Families Program cease to enroll
new subscribers no sooner than the date that this transition
begins.
d) Requires counties to perform final eligibility
determinations and annual redeterminations, utilizing reporting
and performance standards established in this bill.
e) Provides presumptive eligibility for Medi-Cal for the
children transferring from Healthy Families, which will
continue until final determinations are made within one year of
the children's Healthy Families Program annual review dates.
f) Requires that children transfer from Healthy Families to
Medi-Cal in four phases as follows:
i) Phase 1 - Children enrolled in a Healthy Families
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Program health plan that is also a Medi-Cal managed care plan
shall transfer to the same plan no sooner than January 1,
2013.
ii) Phase 2 - Children enrolled in a Healthy Families
managed care plan that is a subcontractor of a Medi-Cal
managed care plan, will be enrolled into a Medi-Cal managed
care plan that includes the child's current plan, beginning
no earlier than April 1, 2013.
iii) Phase 3 - Children enrolled in a Healthy Families
managed care plan that is not a Medi-Cal managed care plan
and does not contract or subcontract with a Medi-Cal managed
care plan will be enrolled in a Medi-Cal managed care plan in
that county, beginning no earlier than August 1, 2013.
iv) Phase 4 - Children living in a county that is not a
Medi-Cal managed care county will transition into
fee-for-service Medi-Cal, no earlier than September 1, 2013.
Should Medi-Cal managed care be implemented in these
counties, children in Medi-Cal will transition into managed
care.
g) Requires the following to be in place prior to
implementation of all phases of the transition: a) Managed
care plan performance measures must be integrated and
coordinated with the Healthy Families Program performance
standards and in compliance with Medi-Cal managed care
performance measurements, including network adequacy and
linguistic services; and, b) Medi-Cal managed care plans must
allow enrollees to remain with their current primary care
provider, or report to the department on how continuity of care
will be ensured.
h) Requires the California Health and Human Services Agency, in
consultation with the Managed Risk Medical Insurance Board
(MRMIB), the Department of Health Care Services (DHCS), the
Department of Managed Health Care (DMHC), and a stakeholder
group, to provide the Legislature with a strategic plan for
implementing this transition by October 1, 2012. Requires the
strategic plan to address administrative components, methods
for diverse stakeholder engagement throughout the transition,
state monitoring of managed care health plans' performance and
accountability, and health and dental delivery system
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components.
i) Requires implementation plans to be developed prior to each
phase of this transition to ensure continuity of care and to
prevent disruptions in service. Requires the implementation
plans to include information on health and dental plan network
adequacy, continuity of care, eligibility and enrollment
requirements, consumer protections, and family notifications.
Requires DHCS to consult with stakeholders, including
consumers, families, advocates, counties, providers, and health
and dental plans on the development of implementation plans.
j) Requires dental care to be provided through fee-for-service
Medi-Cal for children in all counties except Sacramento and Los
Angeles.
aa) Requires, for children in Sacramento County, dental coverage
to continue to be provided by a child's Healthy Families dental
managed care plan if the plan is also a Medi-Cal dental managed
care plan. If a child's plan is not a Medi-Cal plan, the
family will choose a Medi-Cal dental managed care plan, or be
assigned to a plan with preference for a plan with the child's
current provider. Children in Sacramento County may access the
beneficiary dental exception process adopted through AB 1467
(the 2012 omnibus health trailer bill).
bb) Requires, for children in Los Angeles County, dental
coverage to continue to be provided by the child's Healthy
Families dental managed care plan if that plan is a Medi-Cal
dental plan in Los Angeles. If the child's plan is not a
Medi-Cal plan, the family may select a Medi-Cal plan or choose
fee-for-service.
cc) Requires managed care health and dental plans to report to
DHCS specified information on transition implementation issues,
enrollees, and providers, including grievances related to
access to care, continuity of care requests and outcomes, and
changes to provider networks.
dd) Requires DHCS to consult and collaborate with DMHC in
assessing Medi-Cal managed care health plan network adequacy
for purposes of the required transition plans.
ee) Requires DHCS to provide monthly status reports to the
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Legislature on the transition beginning no later than February.
ff) Requires DHCS to provide written notice regarding this
transition to families at least 60 days prior to the transition
of children in Phase 1, and at least 90 days prior to the
transition of children in Phases 2 and 3. Specifies various
requirements for these notices.
gg) Requires DHCS to provide a process for ongoing stakeholder
consultation and for making information publicly available,
including the achievement of benchmarks, enrollment data,
utilization data and quality measures.
hh) Requires DHCS to designate department liaisons responsible
for the coordination of the Healthy Families Program.
ii) Appropriates $400,000 from the Managed Care Fund to DMHC
for administration of the call center to assist individuals
with the Healthy Families transition and any other aspects of
health plan readiness and coordination with DHCS and MRMIB.
2)Restores current law by overriding provisions contained AB 1467
(the 2012 omnibus health trailer bill) that prohibited the
California Children's Services (CCS) program from covering the
cost of medical therapy services for any child who has an
individualized education program (IEP) and these services are
identified as educationally related within the child's IEP.
3)States the Legislature's intent to develop new payment rates for
clinical laboratory services that are comparable to the payment
amounts received from other payers of services. Provides that
reimbursement for laboratory services shall not exceed the lowest
of the following: a) the amount billed; b) the charge to the
general public; c) 80% of the lowest maximum allowance established
by the federal Medicare Program for the same or similar services;
or, d) a reimbursement rate based on an average of the lowest
amount that other payers and other state Medicaid programs pay for
similar services. Imposes a 10% rate reduction, to achieve $7.7
million in General Fund savings in 2012-13, for laboratory
services beginning July 1, 2012, and continuing until this new
rate methodology has received federal approval. Exempts the
Family Planning, Access, Care and Treatment program from this 10%
rate reduction. Establishes rate data reporting requirements for
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laboratories to the state to be utilized for developing the new
rate methodology. Requires DHCS to seek stakeholder input in the
development of the rate methodology. Replaces similar provisions
contained in AB 1467 (the 2012 omnibus health trailer bill).
4)Contains an appropriation allowing this bill to take effect
immediately upon enactment.
Analysis Prepared by : Andrea Margolis / BUDGET / (916) 319-2099
FN: 0004199