BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 357
AUTHOR: Pan
AMENDED: June 16, 2014
HEARING DATE: June 25, 2014
CONSULTANT: Bain
SUBJECT : Medi-Cal Children's Health Advisory Panel.
SUMMARY : Renames the Healthy Families Advisory Board as the
Medi-Cal Children's Health Advisory Panel, transfers the new
entity to the Department of Health Care Services (DHCS), expands
the membership from 15 to 19 members, requires the Panel to be
an independent statewide advisory board that advises DHCS on
matters relevant to children enrolled in Medi-Cal and their
families, and requires DHCS to provide general support and staff
assistance to the Panel.
Existing law:
1.Establishes, under federal law, the Medicaid Program (Medi-Cal
in California), administered by DHCS, to provide comprehensive
health care services to low income individuals, including
children.
2.Establishes the Healthy Families Program (HFP) Advisory Board,
a 15-member advisory panel appointed by the Managed Risk
Medical Insurance Board (MRMIB).
3.Requires the transition of children from HFP to the Medi-Cal
Program.
This bill:
1.Renames the HFP Advisory Board as the Medi-Cal Children's
Health Advisory Panel (Panel), transfers the new entity to
DHCS, and requires the Panel to be an independent statewide
advisory board that advises DHCS on matters relevant to
children enrolled in Medi-Cal and their families, including,
but not limited to, emerging trends in the care of children,
quality measurements, communications between DHCS and Medi-Cal
families, provider network issues, and Medi-Cal enrollment
issues.
2.Requires the Panel's powers and duties to include, but not be
limited to, all of the following:
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a. To advise the DHCS Director on all policies,
regulations, and operations of the Medi-Cal program
related to providing health care services to children;
and,
b. To meet at least quarterly, unless deemed
unnecessary by the chair.
3.Requires DHCS' powers and duties to include, but not be
limited to, all of the following:
a. To provide general support and staff
assistance to the advisory panel;
b. To convene and attend meetings of the advisory
panel quarterly, unless deemed unnecessary by the
chair, at locations that are easily accessible to the
public and Panel members, are of sufficient duration
for presentation, discussion, and public comment on
each agenda item, and are open in accordance with the
Bagley-Keene Open Meeting Act;
c. To consider all written recommendations of the
Panel and to respond in writing to each written
recommendation;
d. To reimburse the members of the Panel for all
necessary travel expenses associated with the
activities of the Panel, and to provide a stipend of
$100 per meeting attended to each panel member who is
a Medi-Cal enrollee or a parent of a Medi-Cal
enrollee;
e. To maintain an Internet Web page on DHCS'
Internet Web site dedicated to the Panel that
includes, but is not limited to, all of the following:
i. The purpose and scope of the
advisory panel.
ii. The current membership of the
advisory panel.
iii. A list of past and future meetings.
iv. Agendas and other materials made
available for past and future meetings.
v. Recommendations submitted to DHCS
by the advisory panel.
vi. DHCS' responses to recommendations
submitted by the advisory panel.
vii. Contact information for DHCS staff
assisting the advisory panel.
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f. To inform Panel members when new information
is posted to the Internet Web page dedicated to the
Panel; and,
g. To report to the Legislature, by January 1,
2018, and every five years thereafter, on the Panel's
accomplishments, effectiveness, efficiency, and any
recommendations for improving the ability of the Panel
to fulfill its purpose.
4.Requires the membership of the Panel to be expanded from 15 to
19 members. The four additional members are two legislative
appointments, an in-person assister certified for Medi-Cal
enrollment, and an additional Medi-Cal enrollee
representative. The Panel under this bill would be composed of
the following members:
a. Three providers who currently participate in
Medi-Cal, including each of the following: one member
who is a licensed, practicing dentist, one physician
who is board certified in the area of family practice
medicine, and one physician who is board certified in
pediatrics;
b. Five representatives of provider organizations
that currently participate in Medi-Cal, including each
of the following:
i. One representative from a licensed
nonprofit primary care clinic;
ii. One representative from the mental
health provider community;
iii. One representative of the substance
abuse provider community;
iv. One representative of the county
public health provider community; and,
v. One representative from a licensed
hospital that is on the disproportionate share
list maintained by DHCS.
c. Five representatives of the Medi-Cal
population, one of each of the following:
i. A current or former foster youth;
an attorney, social worker, probation officer, or
court appointed special advocate who currently
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represents one or more foster youth, a foster
care service provider, or a child welfare
advocate;
ii. A parent of a Medi-Cal enrollee who
has received treatment services under the
California Children's Services Program within the
past six months;
iii. A Medi-Cal enrollee who has
received services under the Access for Infants
and Mothers Program within the past six months;
iv. A parent or legal guardian of a
Medi-Cal enrollee under 21 years of age who has
received mental health services under the Early
and Periodic Screening, Diagnostic, and Treatment
Program (EPSDT) within the past six months; and,
v. A parent or legal guardian of a
Medi-Cal enrollee who has received services from
the enrollee's Medi-Cal dental managed care plan
within the past year.
5.Permits, if a Panel representative cannot be identified to
meet the requirements of 4c) above, a parent or legal guardian
of any Medi-Cal enrollee can be appointed to participate in
lieu of the individual specified.
6.Two representatives from the Legislature, including one
representative appointed by the Senate Committee on Rules and
one representative appointed by the Speaker of the Assembly.
7.Four additional representatives, including each of the
following:
a. One representative from the health plan
community;
b. One representative from the business
community;
c. One representative from the education
community; and,
d. One in-person assister currently certified to
enroll individuals in Medi-Cal.
FISCAL EFFECT : Minor and absorbable costs to DHCS to continue
providing staff support to the advisory board
(GF/federal funds).
PRIOR VOTES :
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5
Assembly Health: 17- 0
Assembly Appropriations:16- 0
Assembly Floor: 78- 0
COMMENTS :
1.Author's statement. According to the author, as
implementation of the Patient Protection and Affordable Care
Act (ACA) moves forward, HFP participants transition to
Medi-Cal, and Medi-Cal enrollment increases, it is critical
that we have a process for providing stakeholder feedback
regarding Medi-Cal services provided to California's children.
Following the transition of all children in the HFP, nearly
five million children are expected to be enrolled in Medi-Cal.
Additionally, many of the approximately 460,000 children who
are currently eligible but not enrolled in Medi-Cal are
expected to enroll as outreach efforts associated with ACA
implementation increase. Once the transition of children from
HFP into Medi-Cal is complete, close to 50 percent of all
children under the age of 18 in California will be enrolled in
Medi-Cal. Given the unique health needs of children and in
light of recent and impending changes to the Medi-Cal program,
the need is greater than ever for children in Medi-Cal to
benefit from an effective and efficient stakeholder advisory
process so that California can ensure that they are receiving
the best possible care.
2.Background. The HFP Advisory Board was established statutorily
to advise MRMIB on HFP policies, regulations, operation, and
implementation. It is comprised of 15 members, appointed by
MRMIB, who serve three year terms, and consists of subject
matter experts such as providers, health care delivery
organizations, medical and dental providers, a business
representative, and subscriber parents. AB 1494 (Committee on
Budget), Chapter 28, Statutes of 2012, required the Health and
Human Services Agency to provide the legislative fiscal and
policy committees with a strategic plan for the transition for
the HFP no later than October 1, 2012. This strategic plan is
required to include a time certain for the transfer of the HFP
Advisory Board to DHCS.
Effective January 1, 2014, HFP Advisory Board transitioned to
DHCS along with the rest of HFP. Stakeholders and members of
the Advisory Board itself have made suggestions regarding its
future role. These suggestions include monthly meetings,
direct reporting to the Director of DHCS, advising on both
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children and families covered by Medi-Cal, that the Advisory
Board be provided designated DHCS staff, to require written
responses to recommendations of the Advisory Board if its
recommendations are not implemented by DHCS, and advising on
all policies, regulations and operations relating to the
administration and provision of health care services in the
Medi-Cal program.
3.Related legislation. SB 857 (Committee on Budget and Fiscal
Review), one of the two health budget trailer bills,
eliminates MRMIB, which previously administered HFP. Pending
on the Governor's desk.
4.Prior legislation. AB 1494 (Committee on Budget), Chapter 28,
Statutes of 2012, provides for the transition of children from
HFP to Medi-Cal in four phases, starting no earlier than
January 1, 2013.
5.Support. This bill is supported by the children's advocacy
groups, including the Children's Partnership, Children Now,
Children's Defense Fund-California, PICO California, the
California Coverage and Health Initiatives, and United Ways of
California to rename the HFP Advisory Board as the Medi-Cal
Children's Health Advisory Panel, keep its composition intact,
move the body's advisory capacity from MRMIB to DHCS, and
require DHCS to provide staff assistance to the Advisory
Panel. Supporters argue that, in the 15 years the HFP Advisory
Board has been operating, it has made recommendations that
have helped to improve the quality of care for children in
HFP, and has been an important space for parents of enrollees
and other experts to discuss ways to improve the program. The
transition from HFP to Medi-Cal coverage requires an update to
the Advisory Board in its current statutorily-defined
capacity, and supporters argue the ongoing need for and
recognized value of the Advisory Panel role is more important
than ever as DHCS is responsible for providing health coverage
to nearly half of California's children through Medi-Cal.
6.Oppose. The California Right to Life Committee writes in
opposition that it has grave concerns that the membership of
the Panel will include agencies with a vested interest in
promoting "reproductive health care," which would include
abortifacients and abortion services for minors and without
parental notification or consent.
7.Recommended amendment. Staff recommends clarifying language be
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added that the two legislative appointments can be individuals
in addition to current legislators, and that vacant
legislative appointments are filled by their respective
legislative appointing authority.
SUPPORT AND OPPOSITION :
Support: American Academy of Pediatrics, California
California Academy of Child and Adolescent Psychiatry
California Academy of family Physicians
California Academy of Physician Assistants
California Children's Hospital Association
California Coverage and Health Initiatives
California Federation of Teachers
California Hospital Association
California Medical Association
California Optometric Association
California Primary Care Association
California Psychological Association
California Teachers Association
Child Abuse Prevention Center
Children Now
Children's Defense Fund-California
Children's Partnership
Community Clinic Association of Los Angeles County
PICO California
United Ways of California
Oppose: California Right to Life Committee, Inc.
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