Amended in Senate April 1, 2014

Senate Bill No. 1322

Introduced by Senator Hernandez

February 21, 2014

An act to add begin delete Section 14132.04 to the Welfare and Institutions Code, relating to Medi-Cal. end delete begin insert Sections 127670 and 127671 to the Health and Safety Code, relating to health care. end insert

LEGISLATIVE COUNSEL’S DIGEST

SB 1322, as amended, Hernandez. begin delete Medi-Cal: preventive services: providers. end delete begin insert California Health Care Quality Improvement and Cost Containment Commission. end insert

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Existing law establishes health care coverage programs to provide health care to segments of the population meeting specified criteria who are otherwise unable to afford health care coverage and provides for the licensure and regulation of health insurers and health care service plans.

end insert begin insert

This bill would state the intent of the Legislature to make available valid performance information to encourage health care providers and facilities to provide care that is safe, medically effective, patient-centered, timely, efficient, and equitable. The bill would require the Governor to convene the California Health Care Quality Improvement and Cost Containment Commission and would specify the composition of the commission. The bill would require the commission to examine and address specified health care issues. The bill would require the commission to issue a report to the Legislature and the Governor, on or before July 1, 2015, or within 6 months of the commission being convened, whichever occurs later, making recommendations for health care quality improvement and cost containment. The bill would provide that the commission not be convened until sufficient private or federal funds have been received and appropriated for that purpose.

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Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law provides for a schedule of benefits under the Medi-Cal program, which includes specified preventive services.

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This bill would require the department to reimburse Medi-Cal providers for, and would require Medi-Cal managed care plans to cover, preventive services provided by a health care practitioner not subject to professional licensure by the state, that have been recommended by a physician or other licensed practitioner of healing arts acting within the scope of that physician’s or practitioner’s license. The bill would provide that this coverage is available only to the extent that federal financial participation in the cost of providing these services is available. The bill would require the department to convene a working group, as specified, to determine the types of health care practitioners eligible to provide preventive services pursuant to these provisions and to develop a summary of practitioner qualifications for those practitioners to be included in any state plan amendment necessary to implement these provisions.

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Vote: majority. Appropriation: no. Fiscal committee: yes. 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   

end insert

begin insert Section 127670 is added to the end insert begin insert Health and Safety
Code end insert begin insert , end insert to be added to Chapter 8 (formerly commencing with Section
127670) of Part 2 of Division 107 begin insert , to read: end insert

begin insert

begin insert 127670. end insert   

(a) It is the intent of the Legislature to make available
valid performance information to encourage health care providers
and facilities to provide care that is safe, medically effective,
patient-centered, timely, efficient, and equitable. It is also the intent
of the Legislature to put provider performance information into
the hands of consumers and purchasers so that they are able to
understand their financial liability and find the best quality and
value.

(b) It is the intent of the Legislature to encourage health care
service plans, health insurers, and providers to develop innovative
approaches, services, and programs that may have the potential
to deliver health care that is both cost effective and responsive to
the needs of enrollees.

end insert

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 127671 is added to the end insert begin insert Health and Safety Code end insert begin insert , end insert to be added to Chapter 8 (formerly commencing with Section
127670) of Part 2 of Division 107 begin insert , to read: end insert

begin insert

begin insert 127671. end insert   

(a) The Governor shall convene the California Health
Care Quality Improvement and Cost Containment Commission to
research and recommend appropriate and timely strategies for
promoting high-quality care and containing health care costs.

(b) The commission shall be composed of 13 members who are
knowledgeable about the health care system and health care
spending.

(c) The Governor shall appoint five members of the commission,
the Senate Committee on Rules shall appoint three members, and
the Speaker of the Assembly shall appoint three members. The
membership shall be comprised of at least one of each of the
following:

(1) A representative of California’s business community.

(2) A representative from organized labor.

(3) A representative of consumers.

(4) A health care practitioner.

(5) A hospital industry representative.

(6) A representative of the health insurance industry.

(7) A representative of the legal community with expertise in
health and ethics.

(8) A representative of persons with disabilities.

(9) A health care economist.

(d) The Secretary of the California Health and Human Services
Agency and the Executive Director of Covered California shall
serve as members of the commission.

(e) The Governor shall appoint the chairperson of the
commission.

(f) The commission shall, on or before July 1, 2015, or within
six months of the convening of the commission, whichever occurs
later, issue a report to the Legislature and the Governor making
recommendations for health care quality improvement and cost
containment. The commission shall, at a minimum, examine and
address the following issues:

(1) Assessing California health care needs and available
resources.

(2) Containing the cost of health care services and coverage.

(3) Improving the quality of health care.

(4) Increasing the transparency of health care costs and the
relative efficiency with which care is delivered.

(5) Use of disease management, wellness, prevention, and other
innovative programs to keep people healthy while reducing costs
and improving health outcomes.

(6) Consolidation of existing state programs to achieve
efficiencies where possible.

(7) Efficient utilization of prescription drugs and technology.

(g) The commission established pursuant to this section shall
not be convened until sufficient private or federal funds have been
received and appropriated for that purpose.

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SECTION 1.  

(a) The Legislature finds and declares both of
the following:

(1) Research suggests that 50 percent of a physician’s time is
spent providing preventive care and screenings, much of which
can be provided by other health care practitioners.

(2) On July 15, 2013, the Centers for Medicare and Medicaid
Services released an update to federal Medicaid regulations that
permits state Medicaid programs to reimburse for preventive
services recommended by a physician or other licensed health care
practitioner.

(b) It is the intent of the Legislature in enacting this act to
maximize federal funds to provide critical preventive services to
Medi-Cal beneficiaries by amending state law to reflect the July
15, 2013, update to federal Medicaid regulations.

SEC. 2.  

Section 14132.04 is added to the Welfare and
Institutions Code, to read:

14132.04.  

(a) (1) The department shall reimburse Medi-Cal
providers for preventive services, as defined in Section 440.130(c)
of Title 42 of the Code of Federal Regulations, provided by a health
care practitioner not subject to professional licensure by the state,
including, but not limited to, a community health worker, that have
been recommended by a physician or other licensed practitioner
of healing arts acting within the scope of that physician’s or
practitioner’s license.

(2) Medi-Cal managed care plans shall cover preventive
services, as defined in Section 440.130(c) of Title 42 of the Code
of Federal Regulations, provided by a health care practitioner not
subject to professional licensure by the state, including, but not
limited to, a community health worker, that have been
recommended by a physician or other licensed practitioner of
healing arts acting within the scope of that physician’s or
practitioner’s license.

(3) Coverage for preventive services pursuant to this section
shall be available only to the extent that federal financial
participation in the cost of providing these services is available.

(b) By June 30, 2015, the department shall convene a working
group to determine the types of health care practitioners eligible
to provide preventive services pursuant to this section and the
summary of qualifications for those practitioners to be included
in any state plan amendment that may be necessary to implement
this section. The working group shall include representatives from
consumer advocacy groups, community health worker
organizations, community clinics, physicians’ groups, and health
plans. The summary of practitioner qualifications shall reflect
widely supported perspectives.

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