BILL ANALYSIS �
SENATE COMMITTEE ON BUDGET AND FISCAL REVIEW
Mark Leno, Chair
Bill No: AB 1462
Author: Committee on Budget
As Amended: June 12, 2014
Consultant: Michelle Baass
Fiscal: Yes
Hearing Date: June 15, 2014
Subject: Budget Act of 2014 - Health
Summary: This is the Omnibus Health Trailer Bill for
2014-15. It contains necessary changes related to the
Budget Act of 2014.
Background: This bill makes the following statutory
changes to implement the 2014-15 budget:
1.Medi-Cal: Pregnancy. This bill provides full-scope
Medi-Cal coverage to pregnant women with incomes at or
below 138 percent of the federal poverty level (FPL) and
creates an affordability and benefit program for pregnant
women with incomes above 138 percent and up to 208
percent of the FPL who enroll in a Qualified Health Plan
(QHP) through Covered California. This bill requires the
Department of Health Care Services (DHCS) to cover the
out-of-pocket expenditures of the women enrolled in a QHP
through Covered California. These out-of-pocket
expenditures include the premium amounts owed after
premium tax credits have been applied, applicable
cost-sharing, copayments, or any other covered costs that
are required during their pregnancy and postpartum
coverage. The woman shall receive all of her covered
benefits via her QHP and may access additional medically
necessary pregnancy-related Medi-Cal services outside of
the QHP, under Medi-Cal fee-for-service (referred to as
Pregnancy Benefit Wrap) to the extent they are not
otherwise provided by the QHP. The affordability and
benefit program shall be made available January 1, 2015,
or when DHCS determines that the California Healthcare
Eligibility, Enrollment and Retention System (CalHEERS)
is operational to effectuate this policy. This bill also
requires DHCS to consult with stakeholders on the
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processes and procedures to inform affected applicants
and beneficiaries of their enrollment options under the
Medi-Cal program and Covered California and the manner in
which they may receive benefits and services. This bill
also requires DHCS to monitor birth outcomes of women who
are receiving full-scope and limited-scope Medi-Cal and
women who are receiving services through the QHP with
Medi-Cal as the benefit wrap.
2.Medi-Cal: Cal MediConnect (CMC) and Medicare Advantage
and D-SNP Plans. This bill authorizes: (1) the Department
of Health Care Services (DHCS) to offer Medicare
Improvements for Patients and Providers Act of 2008
(MIPPA) to Dual-Eligible Special Needs Plans (D-SNPs) for
2015 and the duration of Cal MediConnect, with certain
limitations, (2) gives DHCS the authority to place an
enrollment cap on Fully Integrated Dual-Eligible (FIDE)
SNPs operating in Los Angeles, Riverside, and San
Bernardino Counties, and (3) allows beneficiaries who are
enrolled in an Alternative Health Care Service Plan
(AHCSP), who age into Medicare while enrolled in the
AHCSP, to elect to enroll in the AHCSP's D-SNP. The
AHCSP would be required, upon mutual agreement between
the CMC plan operated by a health authority or
commission, to take full financial and programmatic
responsibility for the Long-Term Supports and Services,
and services of the D-SNP enrollee. Lastly, this bill
would require DHCS to take into account certain
considerations when assigning Medi-Cal managed care
beneficiaries to a Medi-Cal managed care health plan
(MCP) subcontracting with an AHCSP.
3.Medi-Cal: County Eligibility Administration
Cost-of-Living Adjustment (COLA). This bill suspends the
COLA for county eligibility administration for 2014-15.
4.Medi-Cal: Denti-Cal Metrics and Monitoring. This bill
requires DHCS to monitor dental fee-for-service
utilization in the Denti-Cal program using identified
program metrics and to post this information on the
department's website at least on an annual basis.
5.Medi-Cal: CA-MMIS Contract Modifications. This bill
exempts contract amendments, modifications, and change
orders for the California Medicaid Management Information
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System (CA-MMIS) Fiscal Intermediary (FI) contract from
Public Code requirements.
6.Medi-Cal: Provider Preventable Conditions. This bill
makes statutory changes to comply with federal rules that
require states to report provider preventable conditions
(PPCs) and prohibit Medicaid (Medi-Cal) payment for costs
of services related to PPCs. Specifically, this bill
authorizes DHCS to exclude from Medi-Cal coverage certain
increases in charges billed to the Medi-Cal program that
are directly related to the treatment of PPCs, and to
recoup any payments made for those excluded charges.
Additionally, this bill requires providers to report PPCs
to the department as specified by the department and
prohibits the Medi-Cal enrollee from being billed for
these procedures.
7.Medi-Cal: Fingerprinting and Background Checks. This
bill provides DHCS with the authority to receive the
results of criminal background checks of applicants and
providers from the Department of Justice (DOJ) in order
to screen or enroll the Medi-Cal provider applicants and
providers. This bill also clarifies that applicants and
providers are responsible for reimbursing DOJ for the
costs to complete the expanded background checks and
fingerprinting, and that In-Home Supportive Services
providers will follow the current fingerprinting and
background check process required in Welfare and
Institutions Code Section 15660.
8.Eliminate Managed Risk Medical Insurance Board (MRMIB) -
This bill eliminates MRMIB and transfers its programs,
the Major Risk Medical Insurance Program (MRMIP), the
Access for Infants and Mothers (AIM) program, and the
County Children's Health Initiative Matching (CHIM) Fund
Program, to the Department of Health Care Services
(DHCS). This bill proposes no changes to these programs,
other than their transfer to DHCS. This bill also (1)
renames the AIM program to the Medi-Cal Access Program,
(2) transitions the responsibility for the close-out
activities related to the Healthy Families Program
transition to Medi-Cal and the Pre-Existing Conditions
Insurance Program transition to the federal government to
DHCS, (3) deletes reference to adults from the CHIM
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Program provisions as the program was never expanded to
cover parents, and (4) changes the allocation of
Cigarette and Tobacco Products Surtax Fund (Proposition
99) to MRMIP to be contingent on what is included in the
budget act.
9.Future of Major Risk Medical Insurance Program (MRMIP).
This bill requires DHCS to convene a stakeholder
workgroup by August 1, 2014 composed of stakeholders,
including health care providers, county representatives,
labor, consumer advocates, immigrant policy advocates,
and employers of low-wage workers to develop a plan to
utilize available Major Risk Medical Insurance Funds,
including Managed Care Administrative Fines Penalties
Funds, and the Cigarette and Tobacco Products Surtax
Fund to continue to provide health coverage to
individuals that are not eligible for other full-scope
programs or subsidies.
10.Notification to Enrollees in State Health Programs. This
bill requires DHCS by August 1, 2014 to work with
stakeholders to develop a notification to be sent to
enrollees in the state-only and non-comprehensive health
programs to inform them that they may qualify for
comprehensive coverage through Covered California or
Medi-Cal. This notification would be sent annually prior
to the open enrollment period for Covered California.
11.Substance Use Disorder Residential and Outpatient
License Fee Increase. This bill allows DHCS to increase
licensure, application, and certification fees for
non-medical residential and outpatient alcohol and other
drug detoxification, treatment, or recovery services
facilities upon approval of the Legislature through a
provider bulletin.
12.California Institute for Mental Health (CiMH) and
Substance Use Disorder Services . This bill expands CiMH's
responsibilities to include the ability to provide
technical assistance and training on substance use
disorder services given its merger with the Alcohol and
Drug Policy Institute on July 1, 2014.
13.Martin Luther King (MLK) Jr. Community Hospital. This
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bill ensures that the new MLK, Jr. Community Hospital
receives at a minimum the financing committed to it in
2010 in a manner that continues to guarantee a cap on the
state's contribution.
14.Cross Match of ADAP Data with Franchise Tax Board. This
bill provides the State Franchise Tax Board (FTB) with
authority to share state tax data with the Office of AIDS
at the Department of Public Health (DPH) for verifying
applicant/client income eligibility for the federally
funded Ryan White HIV/AIDS Program AIDS Drug Assistance
Program (ADAP).
15.California Reducing Disparities Project (CRDP). This
bill provides DPH with a statutory exemption from the
Public Contract Code for CRDP that would allow DPH to
complete the Strategic Plan (Phase I) and commence Phase
II of the CRDP, a $60 million (Mental Health Services Act
Funds) endeavor to implement and evaluate
community-defined mental health practices.
16.Federal Fund Authority. This bill clarifies DPH's
authority to apply for federal grants within the purview
of public health.
17.Office of AIDS-Health Insurance Premium Assistance
Payment Program (OA-HIPP) Medical Cost Sharing Wrap. This
bill provides the authority to develop the capacity to
pay out-of-pocket medical expenses, in addition to
premiums for eligible OA-HIPP clients, for clients who
choose to purchase insurance through Covered California.
This would encourage more ADAP clients to enroll in
comprehensive coverage and would result in a reduction in
ADAP costs of $9.9 million in 2014-15.
18.Licensing and Certification (L&C). This bill would
require DPH, beginning October 2014 and on a quarterly
basis, to report metrics on (1) investigations of
complaints related to paraprofessionals certified by DPH,
(2) long-term care health facility complaints,
investigations, state relicensing, and federal
recertification surveys, and (3) vacancy rates and hiring
within L&C. This bill requires DPH by October 2016, to
report the previously specified information for all
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facility types.
This bill also requires DPH to report by October 2014 on
the status of the $1.4 million appropriated in fiscal
year 2014-15 from the Internal Departmental Quality
Improvement Account for the "Licensing and Certification
Program Evaluation," and the outcomes from this effort,
the department's efforts to evaluate and reform the L&C
timekeeping systems and estimate methodology, and an
update on the Los Angeles County contract and Licensing
and Certification's oversight of this contract.
This bill requires DPH by December 1, 2014, to assess the
possibilities of using professional position
classifications other than Health Facility Evaluator
Nurses to perform licensing and certification survey or
complaint workload.
This bill requires DPH beginning August 2014, to hold
semiannual meetings for all interested stakeholders to
provide feedback on improving the L&C program to ensure
that Californians receive the highest quality of medical
care in health facilities. Once they are available, the
department will present the quarterly workload and
performance metrics at these meetings.
19.SNAP-Ed Stakeholder Workgroup. This bill requires the
Department of Public Health to convene a quarterly
meeting of stakeholders, between July 1, 2014 and October
31, 2015, to solicit input and receive feedback on
nutrition education and obesity prevention programs and
to help minimize any disruption of services in the
Supplemental Nutrition and Education Assistance Program
during the transition of work from contracted vendors to
civil service.
20.Tuberculosis Control Mandate. This bill specifies that
funds allocated as part of the Department of Public
Health's tuberculosis control subvention grant to local
jurisdictions shall be used to support certain
tuberculosis control activities.
21.Federal Mental Health Parity. This bill provides the
Department of Managed Health Care with the authority to
enforce federal mental health parity rules and conforms
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to federal rules to impose these requirements on large
group products.
22.Office of Patient Advocate (OPA). This bill revises the
responsibilities of the OPA to (1) clarify that OPA is
not the primary source of direct assistance to consumers,
(2) clarify OPA's responsibilities to track, analyze, and
produce reports with data collected from calls, on
problems and complaints by, and questions from, consumers
about health care coverage received by health consumer
call centers and helplines operated by other departments,
regulators or governmental entities, (3) require OPA to
make recommendations for the standardization of reporting
on complaints, grievances, questions, and requests for
assistance, and (4) requires OPA to develop model
protocols, in consultation with each call center,
consumer advocates and other stakeholders that may be
used by call centers for responding to and referring
calls that are outside the jurisdiction of the call
center or regulator.
23.Song-Program Residency Program. This bill expands the
eligibility for Song-Brown residency program funding to
teaching health centers and increases the number of
primary care residents specializing in internal medicine,
pediatrics, and obstetrics and gynecology.
24.Medical Privacy Breach Enforcement. This bill combines
the authority of two existing programs (at the California
Health and Human Services Agency and DPH) charged with
enforcing medical privacy violations. To do this, the
authority of the California Health and Human Services
Agency's California Office of Health Information
Integrity (CalOHII) over medical privacy breaches by
individuals is combined with DPH's authority over medical
privacy breaches at health facilities.
25.Health Benefit Exchange Emergency Regulation Authority.
This bill would allow emergency regulations adopted by
the Health Benefit Exchange to be readopted for one more
year (no further readoptions would be allowed after
January 1, 2017).
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Fiscal Effect: The funding related to the changes in this
bill is contained in the 2014-15 budget. This bill
reappropriates Mental Health Services Oversight and
Accountability Commission funds for a contract to support
the Commission's evaluation efforts.
Support: NA
Opposed: NA
Comments: This bill provides the necessary statutory
references to enact the 2014-15 budget related to health.
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