BILL ANALYSIS �
SB 1081
Page 1
SENATE THIRD READING
SB 1081 (Fuller)
As Amended June 20, 2012
2/3 vote. Urgency
SENATE VOTE :37-0
HEALTH 19-0 APPROPRIATIONS 17-0
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|Ayes:|Monning, Logue, Ammiano, |Ayes:|Fuentes, Harkey, |
| |Atkins, Bonilla, Eng, | |Blumenfield, Bradford, |
| |Garrick, Gordon, Hayashi, | |Charles Calderon, Campos, |
| |Roger Hern�ndez, | |Davis, Donnelly, Gatto, |
| |Bonnie Lowenthal, | |Hall, Hill, Lara, |
| |Mansoor, Mitchell, | |Mitchell, Nielsen, Norby, |
| |Nestande, Pan, | |Solorio, Wagner |
| |V. Manuel P�rez, Silva, | | |
| |Smyth, Williams | | |
| | | | |
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SUMMARY : Authorizes nondesignated public hospitals (NDPH),
which are hospitals owned by a local health care district, to
operate a Low Income Health Program (LIHP) in a county that does
not have a designated public hospital and if the county does not
intend to operate a LIHP. Specifically, this bill :
1)Requires the NDPH to provide the application to the county at
the same time it is provided to the Department of Health Care
Services (DHCS).
2)Requires DHCS to consider the application if the county does
not indicate within 30 days that it will proceed.
3)Requires DHCS to seek any necessary federal approvals.
4)States legislative intent that any NDPH that submits an
application initially establish a local stakeholder advisory
committee as specified.
5)Contains an urgency clause to ensure that the provisions of
this bill go into immediate effect upon enactment.
FISCAL EFFECT : According to the Assembly Appropriations
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Committee,
1)Minor administrative costs to DHCS to seek federal approval
for this change and review applications from hospitals to
operate LIHPs. These administrative costs are funded by 50%
federal funds, 50% local funds from participating entities.
Given the short time frame and unique circumstances, only one
county (Tulare County) is expected to apply pursuant to this
bill.
2)If an NDPH operated a LIHP pursuant to this bill, local funds
for health care services would also be matched by new federal
funds. According to the District Hospital Leadership Forum,
the sponsor of this bill, this could result in an estimated
increase in federal funds in Tulare County of $2.7 million.
COMMENTS : According to the author, this bill is needed in order
to modify the special terms and conditions (STCs) of the 2010
Section 1115 Medi-Cal Demonstration/Pilot Project Waiver,
entitled "A Bridge to Reform" to allow a public district
hospital to become a Medicaid Coverage Expansion (MCE)-LIHP
contractor in counties that are both without a county hospital
or are not interested in becoming a LIHP contractor. The author
argues that expanding coverage to more areas in California will
ensure that the stated goals of the MCE can be achieved
throughout all of California without a cost to the state General
Fund allowing for additional federal dollars to be received in
California. Currently, while an NDPH can negotiate with a
MCE-LIHP contractor to participate in a LIHP network, they
cannot become an MCE-LIHP contractor. The waiver STCs and
implementing legislation specifically limit the LIHP contractor
applicant to either be a county, city and county, health
authority or consortium of counties serving a region. These
restrictions limit California's ability to take full advantage
of these uncapped federal dollars. Public district hospitals
are the only public health care entities that cannot contract
directly, creating a barrier restricting the flow of these
federal dollars to California. There are circumstances where an
NDPH would like to be a LIHP network provider, but the county
chooses not to participate in the program, thus prohibiting the
district's ability to participate without being the contractor.
As of April 2012, LIHP enrollment was 384,000. This includes
the enrollment in the 10 legacy Health Care Coverage Initiative
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(HCCI) counties from the 2005 waiver. Originally voluntary
letters of intent to participate had been received from all 58
counties, the City of Pasadena, and 12 California Rural Indian
Health Board (CRIHB) programs in 11 counties. Thirty-four of
the counties are participating through the County Medical
Services Program (CMSP) which provides medical and dental care
to indigent adults in 34 small and rural counties but is
administered through DHCS. As of April 2012, in addition to the
CMSP counties and the 10 legacy counties, three additional
counties have implemented LIHPs. Seven counties have
implementation dates between June 1, 2012, and August 1, 2012.
Two counties, Fresno and San Luis Obispo, have withdrawn their
applications. Three applications are pending (Tulare, Santa
Barbara and CRIHB).
According to the sponsor, this bill is intended to apply to
Tulare County. Tulare County has engaged a consulting firm to
determine whether a LIHP is viable for the county or not. The
report has not yet been submitted to the county and the Board of
Supervisors has not yet noticed the item for the Board agenda.
If the Board decides not to move forward, the three NDPHs in the
county will submit an application. This bill states legislative
intent that the hospital initially establish a local stakeholder
committee comprised of health plans, community health centers,
consumers and other interested stakeholders to provide input
regarding the development, implementation, and operation of the
LIHP. This was added in response to concerns raised by the
community clinics and others that the hospital district may have
little or no prior experience providing primary care services to
the population that a LIHP would serve.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
FN: 0004905