SB 1316, as introduced, Cannella. Medi-Cal: Disease Management Waiver.
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. Existing law requires the department to apply for a waiver of federal law to test the efficacy of providing a disease management benefit, as described, to specified beneficiaries under the Medi-Cal program.
This bill would make a technical, nonsubstantive change to these provisions.
Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 14132.27 of the Welfare and Institutions
2Code is amended to read:
(a) (1) The department shall apply for a waiver of
4federal law pursuant to Section 1396n of Title 42 of the United
5States Code to test the efficacy of providing a disease management
6benefit to beneficiaries under the Medi-Cal program. A disease
7management benefit shall include, but not be limited to, the use
8of evidence-based practice guidelines, supporting adherence to
P2 1care plans, and providing patient education, monitoring, and
2healthy lifestyle changes.
3(2) The waiver developed pursuant to this section shall be known
4as the Disease Management Waiver. The department shall submit
5any necessary waiver applications or modifications to the Medicaid
6State Plan to the federal Centers for Medicare and
Medicaid
7Services to implement the Disease Management Waiver, and shall
8implement the waiver only to the extent federal financial
9participation is available.
10(b) The Disease Management Waiver shall be designed to
11provide eligible individuals with a range of services that enable
12them to remain in the least restrictive and most homelike
13environment while receiving the medical care necessary to protect
14their health and well-being. Services provided pursuant to this
15waiver program shall include only those not otherwise available
16under the state plan, and may include, but are not limited to,
17medication management, coordination with a primary care
18provider, use of evidence-based practice guidelines, supporting
19adherence to a plan of care, patient education, communication and
20collaboration among providers, and process and outcome measures.
21Coverage for those services shall be limited by the terms,
22conditions, and duration of the federal waiver.
23(c) Eligibility for the Disease Management Waiver shall be
24limited to those persons who are eligible for the Medi-Cal program
25as aged, blind, and disabled persons or those persons over 21 years
26of age who are not enrolled in a Medi-Cal managed care plan, or
27eligible for the federal Medicare program, and who are determined
28by the department to be at risk of, or diagnosed with, select chronic
29diseases, including, but not limited to, advanced atherosclerotic
30disease syndromes, congestive heart failure, and diabetes.
31Eligibility shall be based on the individual’s medical diagnosis
32and prognosis, and other criteria, as specified in the waiver.
33(d) The Disease Management Waiver shall test the effectiveness
34of providing a Medi-Cal disease management benefit. The
35department shall evaluate the effectiveness of the Disease
36Management Waiver.
37(1) The evaluation shall include, but not be limited to, participant
38satisfaction, health and safety, the quality of life of the participant
39receiving the disease management benefit, and demonstration of
P3 1the cost neutrality of the Disease Management Waiver as specified
2in federal guidelines.
3(2) The evaluation shall estimate the projected savings, if any,
4in the budgets of state and local governments if the Disease
5Management Waiver was expanded statewide.
6(3) The evaluation shall be submitted to the appropriate policy
7and fiscal committees of the Legislature on or before January 1,
82008.
9(e) The department shall limit the number of participants in the
10Disease Management Waiver during the initial three years of its
11operation to a number that will be statistically significant for
12purposes of the waiver
evaluation and that meets any requirements
13of the federal government, including a request to waive statewide
14implementation requirements for the waiver during the initial years
15of evaluation.
16(f) In undertakingbegin delete thisend deletebegin insert
theend insert Disease Management Waiver, the
17director may enter into contracts for the purpose of directly
18providing Disease Management Waiver services.
19(g) The department shall seek all federal waivers necessary to
20allow for federal financial participation under this section.
21(h) The Disease Management Waiver shall be developed and
22implemented only to the extent that funds are appropriated or
23otherwise available for that purpose.
24(i) The department shall not implement this section if any of
25the following apply:
26(1) The department’s application for federal funds under the
27Disease Management Waiver is not accepted.
28(2) Federal funding for the waiver ceases to be available.
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