Amended in Senate April 8, 2014

Senate Bill No. 1316

Introduced by Senator Cannella

February 21, 2014

An act to begin delete amend Section 14132.27 of the Welfare and Institutions Code, relating to Medi-Cal. end delete begin insert add and repeal Article 1.1 (commencing with Section 104260) to Chapter 4 of Part 1 of Division 103 of the Health and Safety Code, relating to diabetes. end insert

LEGISLATIVE COUNSEL’S DIGEST

SB 1316, as amended, Cannella. begin delete Medi-Cal: Disease Management Waiver. end delete begin insert Diabetes: state programs. end insert

begin insert

Existing law establishes and sets forth the duties of the State Department of Health Care Services, the State Department of Public Health, and the Board of Administration of the Public Employees’ Retirement System (PERS), relating to, among other duties, the administration of the Medi-Cal program, the administration of the California Diabetes Program, and the administration of the Public Employees’ Medical and Hospital Care Act, respectively.

end insert begin insert

This bill would require those agencies to each submit a report to the Legislature, no later than July 1, 2015, that includes specified information, including the diabetes-related programs administered by each agency and the diabetes-related contractual or statutory requirements placed on a health care service plan contract or a health insurance policy in the Medi-Cal program or on a health care benefit plan or contract entered into with the Board of Administration of PERS. The bill would state the intent of the Legislature to coordinate a response that assesses the quality of care of, and manages the costs paid for by, state-financed health programs relating to the diabetes crisis.

end insert begin delete

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.

end delete begin delete

This bill would make a technical, nonsubstantive change to these provisions.

end delete

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

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

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert Article 1.1 (commencing with Section 104260) is
added to Chapter 4 of Part 1 of Division 103 of the end insert begin insert Health and
Safety Code end insert begin insert , to read: end insert

begin insert

 

Article begin insert 1.1. end insert   General Provisions

 

begin insert 104260. end insert   

(a) It is the intent of the Legislature to coordinate a
response that assesses the quality of, and manages the costs paid
for by, state-financed health programs relating to the diabetes
crisis.

(b) No later than July 1, 2015, the following state agencies shall
submit a report to the Legislature with the following information:

(1) The State Department of Public Health shall submit a report
that includes the diabetes-related programs administered by the
department.

(2) The State Department of Health Care Services shall submit
a report that includes all of the following:

(A) The diabetes-related programs administered by the
department.

(B) The diabetes-related contractual or statutory requirements
placed on a health care service plan contract or a health insurance
policy in the Medi-Cal program (Chapter 7 (commencing with
Section 14000) of Part 3 of Division 9 of the Welfare and
Institutions Code).

(C) The implementation of the requirements specified in
subparagraph (B) for each health care service plan contract or
health insurance policy.

(3) The Board of Administration of the Public Employees’
Retirement System shall submit a report that includes all of the
following:

(A) The diabetes-related programs administered by the board.

(B) The diabetes-related contractual or statutory requirements
placed on a health care benefit plan or contract entered into with
the board pursuant to the Public Employees’ Medical and Hospital
Care Act (Part 5 (commencing with Section 22750) of Division 5
of Title 2 of the Government Code).

(C) The implementation of the requirements specified in
subparagraph (B) for each health care benefit plan or contract.

(c) A report submitted pursuant to subdivision (b) shall be
submitted in compliance with Section 9795 of the Government
Code.

begin insert 104261. end insert   

This article shall remain in effect only until July 1,
2019, and as of that date is repealed, unless a later enacted statute,
that is enacted before July 1, 2019, deletes or extends that date.

end insert

begin delete

SECTION 1.  

Section 14132.27 of the Welfare and Institutions
Code is amended to read:

14132.27.  

(a) (1) The department shall apply for a waiver of
federal law pursuant to Section 1396n of Title 42 of the United
States Code to test the efficacy of providing a disease management
benefit to beneficiaries under the Medi-Cal program. A disease
management benefit shall include, but not be limited to, the use
of evidence-based practice guidelines, supporting adherence to
care plans, and providing patient education, monitoring, and
healthy lifestyle changes.

(2) The waiver developed pursuant to this section shall be known
as the Disease Management Waiver. The department shall submit
any necessary waiver applications or modifications to the Medicaid
State Plan to the federal Centers for Medicare and Medicaid
Services to implement the Disease Management Waiver, and shall
implement the waiver only to the extent federal financial
participation is available.

(b) The Disease Management Waiver shall be designed to
provide eligible individuals with a range of services that enable
them to remain in the least restrictive and most homelike
environment while receiving the medical care necessary to protect
their health and well-being. Services provided pursuant to this
waiver program shall include only those not otherwise available
under the state plan, and may include, but are not limited to,
medication management, coordination with a primary care
provider, use of evidence-based practice guidelines, supporting
adherence to a plan of care, patient education, communication and
collaboration among providers, and process and outcome measures.
Coverage for those services shall be limited by the terms,
conditions, and duration of the federal waiver.

(c) Eligibility for the Disease Management Waiver shall be
limited to those persons who are eligible for the Medi-Cal program
as aged, blind, and disabled persons or those persons over 21 years
of age who are not enrolled in a Medi-Cal managed care plan, or
eligible for the federal Medicare program, and who are determined
by the department to be at risk of, or diagnosed with, select chronic
diseases, including, but not limited to, advanced atherosclerotic
disease syndromes, congestive heart failure, and diabetes.
Eligibility shall be based on the individual’s medical diagnosis
and prognosis, and other criteria, as specified in the waiver.

(d) The Disease Management Waiver shall test the effectiveness
of providing a Medi-Cal disease management benefit. The
department shall evaluate the effectiveness of the Disease
Management Waiver.

(1) The evaluation shall include, but not be limited to, participant
satisfaction, health and safety, the quality of life of the participant
receiving the disease management benefit, and demonstration of
the cost neutrality of the Disease Management Waiver as specified
in federal guidelines.

(2) The evaluation shall estimate the projected savings, if any,
in the budgets of state and local governments if the Disease
Management Waiver was expanded statewide.

(3) The evaluation shall be submitted to the appropriate policy
and fiscal committees of the Legislature on or before January 1,
2008.

(e) The department shall limit the number of participants in the
Disease Management Waiver during the initial three years of its
operation to a number that will be statistically significant for
purposes of the waiver evaluation and that meets any requirements
of the federal government, including a request to waive statewide
implementation requirements for the waiver during the initial years
of evaluation.

(f) In undertaking the Disease Management Waiver, the director
may enter into contracts for the purpose of directly providing
Disease Management Waiver services.

(g) The department shall seek all federal waivers necessary to
allow for federal financial participation under this section.

(h) The Disease Management Waiver shall be developed and
implemented only to the extent that funds are appropriated or
otherwise available for that purpose.

(i) The department shall not implement this section if any of
the following apply:

(1) The department’s application for federal funds under the
Disease Management Waiver is not accepted.

(2) Federal funding for the waiver ceases to be available.

end delete