Amended in Senate August 18, 2014

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 begin delete Members Pan and Skinner end delete begin insert Member Rendon end insert

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(Coauthor: Assembly Member Bonta)

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February 14, 2014

An act to begin delete add Section 14105.197 to the Welfare and Institutions end delete begin insert amend Section 30301.2 of the Public Resources end insert Code, relating to begin delete health care services end delete begin insert coastal resources end insert .

LEGISLATIVE COUNSEL’S DIGEST

AB 1759, as amended, begin delete Pan end delete   begin insert Rendon end insert . begin delete Medi-Cal: reimbursement rates: care: independent assessment. end delete begin insert California Coastal Commission: appointments. end insert

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Existing law, the California Coastal Act of 1976, prescribes the membership and functions and duties of the California Coastal Commission, and prescribes procedures for the appointment of members to the commission. The act requires that the board of supervisors and the city selection committee in each county within specified regions each nominate one or more supervisors and one or more city council members for appointment, as specified.

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This bill would, for purposes of the above provisions governing commission appointments, specify that a “city council member” may also include a locally elected mayor of a charter city.

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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.

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This bill would require the department to contract with an independent entity for purposes of conducting 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. 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. 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 provide input on 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 the assessment conducted pursuant to the bill’s provisions. The bill would require meetings of the advisory committee to be open.

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Vote: majority. Appropriation: no. Fiscal committee:  begin delete yes end delete begin insert no end insert . State-mandated local program: no.

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

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begin insert SECTION 1. end insert   

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begin insert Section 30301.2 of the end insert begin insert Public Resources Code end insert begin insert is
amended to read: end insert

30301.2.  

(a) begin insert   end insert begin insert (1) end insert  The appointments of the Governor, the Senate
Committee on Rules, and the Speaker of the Assembly, pursuant
to subdivision (e) of Section 30301, shall be made as prescribed
in this section. Within 45 days from the date of receipt of a request
for nominations by the appointing authority, the board of
supervisors and city selection committee of each county within
the region shall nominate supervisors or city council members who
reside in the region from which the Governor, the Senate
Committee on Rules, or the Speaker of the Assembly shall appoint
a replacement. In regions composed of three counties, the board
of supervisors and the city selection committee in each county
within the region shall each nominate one or more supervisors and
one or more city council members. In regions composed of two
counties, the board of supervisors and the city selection committee
in each county within the region shall each nominate not less than
two supervisors and not less than two city council members. In
regions composed of one county, the board of supervisors and the
city selection committee in the county shall each nominate not less
than three supervisors and not less than three city council members.
Immediately upon selecting the nominees, the board of supervisors
and the city selection committee shall send the names of the
nominees to either the Governor, the Senate Committee on Rules,
or the Speaker of the Assembly, whoever will appoint the
replacement.

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(2) For purposes of this subdivision, a “city council member”
may also include a locally elected mayor of a charter city.

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(b) Within 30 days from the date of receipt of the names of the
nominees pursuant to subdivision (a), the Governor, the Speaker
of the Assembly, or the Senate Committee on Rules, whoever will
appoint the replacement, shall either appoint one of the nominees
or notify the boards of supervisors and city selection committees
within the region that none of the nominees are acceptable and
request the boards of supervisors and city selection committees to
make additional nominations. Within 45 days from the date of
receipt of a notice rejecting all of the nominees, the boards of
supervisors and city selection committees within the region shall
nominate and send to the appointing authority the names of
additional nominees in accordance with subdivision (a). Upon
receipt of the names of those additional nominees, the appointing
authority shall appoint one of the nominees.

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SECTION 1.  

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

14105.197.  

(a) The department shall contract with an
independent entity for purposes of conducting an annual
independent assessment of Medi-Cal provider reimbursement rates,
access to care, and the quality of care received in the Medi-Cal
program, 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. 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 to provide input on
the selection of the independent entity and the work of the
independent entity. 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 independent
entity selected and provide input to the independent entity 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.

(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).

(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.

(f) 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.

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