Amended in Senate July 1, 2014

Amended in Assembly May 23, 2014

Amended in Assembly April 21, 2014

Amended in Assembly March 25, 2014

California Legislature—2013–14 Regular Session

Assembly Bill No. 1759

Introduced by Assembly Members Pan and Skinner

(Coauthor: Assembly Member Bonta)

February 14, 2014

An act to add Section 14105.197 to the Welfare and Institutions Code, relating to health care services.

LEGISLATIVE COUNSEL’S DIGEST

AB 1759, as amended, Pan. Medi-Cal: reimbursement rates: care: independent assessment.

Existing law establishes the Medi-Cal program, 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 requires the director of the department to prescribe policies regarding the Medi-Cal program, including polices regarding rates of payment for health care services.

This bill would begin delete request the University of California to annually conduct end delete begin insert require the department to contract with an independent entity for purposes of conducting end insert an independent assessment of Medi-Cal provider reimbursement rates, access to care, and the quality of care received in the Medi-Cal program, reflecting the variety of providers and services offered in the program. begin insert The bill would exempt contracts entered into pursuant to these provisions from generally applicable provisions of law governing contracts for the acquisition of goods and services by state entities. end insert The bill would also require the director to annually review the findings and recommendations of that assessment and suggest adjustments to the reimbursement rates as necessary to ensure that quality and access in the Medi-Cal fee-for-service program and in Medi-Cal managed care plans are adequate to meet applicable state and federal standards. The bill would require that the findings and recommendations of the independent assessment and the director’s suggested adjustments to provider reimbursement rates be submitted to the Legislature annually as part of the Governor’s Budget. The bill would also create an advisory committee composed of 16 members appointed by the Governor and the Legislature, as specified, to begin delete meet periodically with the University of California and end delete provide input on begin insert the selection of the independent entity and the work of the independent entity. The bill would require the advisory committee to meet periodically with the independent entity selected and provide input on end insert the assessment conducted pursuant to the bill’s provisions. begin insert The bill would require meetings of the advisory committee to be open. end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

Section 14105.197 is added to the Welfare and
Institutions Code, to read:

14105.197.  

(a) The begin delete Legislature requests the University of
California to annually conduct an end delete begin insert department shall contract with
an independent entity for purposes of conducting an annual end insert
independent assessment of Medi-Cal provider reimbursement rates,
access to care, and the quality of care received in the Medi-Cal
program begin insert , which shall include the different geographic areas of the
state and the access to care and quality received by different
populations enrolled in the Medi-Cal program. The independent
entity assessment shall include, but not be limited to, the use of
existing quality measures and existing requirements for access to
care and timeliness of care end insert . The assessment should reflect the
variety of providers and services offered in the Medi-Cal program.

(b) (1) An advisory committee is hereby created to be composed
of 16 members representing health care stakeholders, including,
but not limited to, patients, providers, public and private health
delivery systems, payers, and state officials begin insert to provide input on
the selection of the independent entity and the work of the
independent entity end insert . The Governor shall appoint eight members,
the Senate Committee on Rules shall appoint four members, and
the Speaker of the Assembly shall appoint four members.

(2) Except for the initial appointments described in paragraph
(3), members of the committee shall be appointed for a term of
four years, and each member shall hold office until the appointment
and qualification of his or her successor or until one year has
elapsed since the expiration of the term for which he or she was
appointed, whichever occurs first.

(3) (A) Of the initial members appointed by the Governor, two
shall serve a term of one year, two shall serve a term of two years,
two shall serve a term of three years, and two shall serve a term
of four years.

(B) Of the initial members appointed by the Senate Committee
on Rules, one shall serve a term of one year, one shall serve a term
of two years, one shall serve a term of three years, and one shall
serve a term of four years.

(C) Of the initial members appointed by the Speaker of the
Assembly, one shall serve a term of one year, one shall serve a
term of two years, one shall serve a term of three years, and one
shall serve a term of four years.

(4) Members of the committee shall publicly report financial
and other potential conflicts of interest.

(5) The committee shall establish an open process for the
conduct of its affairs that enables all health care stakeholders to
provide feedback on those affairs.

(6) The committee shall meet periodically with the begin delete University
of California end delete begin insert independent entity selected end insert and provide input to the
begin delete University of California end delete begin insert independent entity end insert on the assessment
conducted pursuant to subdivision (a).

(c) The director shall annually review the findings and
recommendations of the assessment conducted under subdivision
(a) and suggest adjustments to the reimbursement rates as necessary
to ensure that quality and access in the Medi-Cal fee-for-service
program and in Medi-Cal managed care plans are adequate to meet
applicable state and federal standards.

begin insert

(d) Meetings of the advisory committee shall be open for
presentation, discussion, and public comment on each agenda
item, and in accordance with the Bagley-Keene Open Meeting Act
(Article 9 (commencing with Section 11120) of Chapter 1 of Part
1 of Division 3 of Title 2 of the Government Code).

end insert begin insert

(e) In order to provide for quicker implementation of the
independent assessment required by this section, contracts made
under this section are exempt from Chapter 2 (commencing with
Section 10290) of Part 2 of Division 2 of the Public Contract Code.

end insert begin delete

(d)

end delete

begin insert (f) end insert  Notwithstanding Section 10231.5 of the Government Code,
the findings and recommendations of the independent assessment
conducted under subdivision (a) and the director’s suggested
adjustments to provider reimbursement rates provided pursuant to
subdivision (c) shall be submitted to the Legislature annually as
part of the Governor’s Budget submitted pursuant to Section 13337
of the Government Code.