BILL ANALYSIS �
SB 857
Page 1
( Without Reference to File )
SENATE THIRD READING
SB 857 (Budget and Fiscal Review Committee)
As Amended June 12, 2014
Majority vote. Budget Bill Appropriation Takes Effect
Immediately
SENATE VOTE :Vote not relevant
SUMMARY : This is one of two Omnibus Health Trailer Bills for
2014-15. This bill contains necessary changes related to the
Budget Act of 2014. This bill makes various statutory changes
to implement the 2014-15 budget. Specifically, this bill :
1)Provides full scope Medi-Cal for pregnant women with incomes
up to 138% of the federal poverty level (FPL). Establishes a
"wrap program" for women between 139% and 213% FPL which
allows them to opt to have both Covered California coverage
and Medi-Cal as a wrap to pay their premiums and co-pays and
to cover services not covered by their Covered California
plan. Requires a stakeholder process to develop the informing
materials to help women understand their options and to ensure
access to Comprehensive Perinatal Services Program services.
Prohibits plans from billing the consumer directly, and if
they do, requires the consumer to be reimbursed by Medi-Cal.
Authorizes women in the wrap to go out-of-network, if
necessary, for Certified Nurse Midwives, Freestanding Birth
Centers, and family planning.
2)Institutes various requirements regarding contracts and
enrollment limitations on Medicare Advantage plans in the
context of the Coordinated Care Initiative (CCI).
Specifically, requires, for the 2015 calendar year and the
remainder of the CCI, in CCI counties, the Department of
Health Care Services (DHCS) to offer Dual Special Needs Plan
(D-SNP) contracts to D-SNP plans that were approved for the
D-SNP plan's service areas as of January 1, 2013. Requires
DHCS to enter into D-SNP contracts with D-SNP plans only for
excluded beneficiaries. Requires, in non-CCI counties, DHCS
to offer D-SNP contracts to D-SNP plans. Authorizes D-SNP
contracts to include various requirements on D-SNP plans.
Exempts beneficiaries in Fully-Integrated Dual Eligible
Special Needs Plan and Medicare Advantage plans, other than
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D-SNPs, from these enrollment provisions.
3)Provides statutory authority to comply with federal rules that
require states to report Provider Preventable Conditions
(PPCs) and prohibits Medi-Cal payment for costs of services
related to PPCs. 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.
Requires providers to report PPCs to DHCS.
4)Provides DHCS statutory 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. Provides DOJ
with legal authority to charge the providers for the
fingerprinting and background checks.
5)Exempts from Public Contract Code requirements, amendments,
and change orders to the Fiscal Intermediary contract.
6)Authorizes DHCS to increase fees charged for licensure and
certification of all residential alcohol and other drug (AOD)
recovery and treatment facilities and of all outpatient AOD
programs. Requires DHCS to publish the current fee structure
on DHCS's Web site. Requires DHCS to notify and consult with
stakeholders regarding new fees or fee changes.
7)Eliminates the Managed Risk Medical Insurance Board (MRMIB)
and transfers the Major Risk Medical Insurance Program, the
Access for Infants and Mothers (AIM) program, and the County
Children's Health Initiative Matching Fund Program to DHCS.
Renames the AIM-linked infants program to the "Medi-Cal Access
Program." Transitions the responsibilities 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. Transitions 27
positions at MRMIB to DHCS and Covered California.
8)Requires DHCS to establish a list of performance measures to
ensure the dental fee-for-service program meets quality and
access criteria required by DHCS. Requires that the measures
evaluate utilization, access, availability, and effectiveness
of preventive care and treatment. Requires DHCS to post the
performance measures, dental care data, and a summary of
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complaints on the DHCS Web site.
9)Requires DHCS to provide information on opportunities for
comprehensive coverage to enrollees of state-only programs.
10)Establishes a stakeholder workgroup to explore the use of
Proposition 99 (1998) funds for on-going coverage for
remaining uninsured populations.
11)Requires that the Martin Luther King Jr. Community Hospital
continue to receive each fiscal year, the base payment amounts
equal to 100% of its projected Medi-Cal costs; eliminates
references to the prior California Medical Assistance
Commission, contracting and non-contracting methodologies;
requires the two Medi-Cal Managed Care Plans in Los Angeles
County serving Medi-Cal beneficiaries to pay the hospital the
same amount for enrollees in managed care as the hospital
would have received for those in fee-for-service, and ensures
the Medi-Cal capitation rates paid to the plans reflect that
obligation; maximizes federal funding; allows the hospital to
receive supplemental payments from Los Angeles County in order
to reach 100% of its projected Medi-Cal costs; maintains the
hospital's eligibility for disproportionate share hospital
(DSH) status and payments for which it may be entitled to
receive, pursuant to federal law; makes the hospital
in-eligible to receive DSH replacement payments; and provides
that the new hospital's projected Medi-Cal costs shall be
determined prospectively prior to the start of each fiscal
year, using the best available and reasonable current
estimates or projections.
12)Suspends the annual cost of living adjustment for counties
for the administration of Medi-Cal eligibility work for
2014-15.
13)Requires the integration of substance use disorder services
into local behavioral health and mental health activities.
14)Expands the scope of the Song Brown program beyond family
practice to provide financial support to primary care
specialties, including family medicine, internal medicine,
obstetrics and gynecology, and pediatrics. Authorizes the
program to contract with teaching health centers.
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15)Implements the federal mental health parity law by requiring
an individual, small group and large group health care service
plan contract to be in compliance with the federal law by
January 1, 2015. Authorizes the director of the Department of
Managed Health Care (DMHC) to issue guidance to health care
service plans until January 1, 2016.
16)Revises the responsibilities of the Office of Patient
Advocate (OPA) to clarify that it is not the primary source of
direct assistance to consumers; requires the OPA 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; requires OPA to make
recommendations for the standardization of reporting on
complaints, grievances, questions and requests for assistance;
requires the 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; and shifts funding to DMHC to
supplement contracts with community-based organizations to
provide direct consumer assistance.
17)Authorizes the transfer of functions, including three
investigator positions and $251,000, from the California
Office of Health Information Integrity, within the California
Health & Human Services Agency, to the Department of Public
Health (DPH) Licensing and Certification. Authorizes DPH to
conduct joint investigations of individuals and health
facilities for violations of this statute.
18)Authorizes the California Franchise Tax Board to share tax
data with the Office of AIDS (OA) for purposes of verifying
income eligibility for OA programs.
19)Exempts from the Public Contract Code the California Reducing
Disparities Project.
20)Authorizes the OA to pay out-of-pocket medical expenses, in
addition to premiums, for eligible OA Health Insurance Premium
Payment clients who choose to purchase insurance through
Covered California.
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21)Requires DPH to convene stakeholders to solicit input on
nutrition education and obesity prevention programs, as well
as on the transition from contracted to state civil service
staff for the operation of the Supplemental Nutrition
Assistance Program Education program.
22)Requires DPH to report on a quarterly basis to the
Legislature and post on its Web site all workload and
performance metrics and specified information on aspects of
Licensing and Certification. Requires DPH to hold semiannual
stakeholder meetings to improve the Licensing and
Certification Program.
23)Authorizes DPH to investigate, apply for, and enter into
agreements to secure federal or non-governmental funding
opportunities to advance public health.
24)Requires that a local entity that receives state funding for
tuberculosis control shall first allocate the moneys for
specified tuberculosis control activities. Authorizes a local
health department that receives such funding to use the funds
to reimburse for the actual costs of carrying out the
tuberculosis control activities described in this section of
law.
25)Authorizes the Health Benefits Exchange to operate under the
authority of emergency regulations for up to two years after
the initial adoption of the emergency regulation.
26)Reappropriates Mental Health Services Fund moneys to the
Mental Health Services Oversight and Accountability Commission
until June 30, 2015.
COMMENT : This bill is a budget trailer bill within the overall
2014-15 budget package to implement actions taken affecting
DHCS, DMHC, DPH, the MRMIB, the Mental Health Services Oversight
& Accountability Commission, and the Office of Statewide Health
Planning and Development.
Analysis Prepared by : Andrea Margolis / BUDGET / (916)
319-2099
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