BILL NUMBER: SB 36 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY SEPTEMBER 4, 2015
INTRODUCED BY Senators Hernandez and De León
( Principal coauthor: Assembly Member
Bonta )
DECEMBER 1, 2014
An act to add Article 5.5 (commencing with Section 14184)
to Chapter 7 of Part 3 of Division 9 of Section
14166.253 to the Welfare and Institutions Code, relating to
Medi-Cal, and declaring the urgency thereof, to take effect
immediately.
LEGISLATIVE COUNSEL'S DIGEST
SB 36, as amended, Hernandez. Medi-Cal: demonstration project.
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 provisions. Existing law provides for a
demonstration project under the Medi-Cal program until October 31,
2015, to implement specified objectives, including better care
coordination for seniors and persons with disabilities and
maximization of opportunities to reduce the number of uninsured
individuals.
This bill would require the State Department of Health Care
Services to submit an application to the federal Centers for Medicare
and Medicaid Services for a waiver to implement a demonstration
project that, among other things, continues the state's momentum and
successes in innovation achieved under the demonstration project
described above. The bill would require the department to consult
with interested stakeholders and the Legislature in developing the
waiver application.
This bill would authorize the Director of Health Care Services, if
the State Department of Health Care Services has not received
adequate assurances from the federal Centers for Medicare and
Medicaid Services before November 1, 2015, that the department's
application for a subsequent demonstration project, as specified, is
likely to be approved with an effective date of November 1, 2015, to
request one or more temporary extensions until the approved effective
date of the subsequent demonstration project. The bill would require
the department, under an approved temporary extension, subsequent
demonstration project, or as otherwise permitted under existing
federal Medicaid law, to extend and apply existing payment
methodologies and allocations, as prescribed. Requirements of the
bill would be implemented only to the extent that any necessary
federal approvals are obtained and federal financial participation is
available and is not jeopardized. The bill would authorize the
department, until July 1, 2016, to implement, interpret, or make
specific this section by means of all-county letters, plan letters,
plan or provider bulletins, or similar instructions without taking
regulatory action.
This bill would declare that it is to take effect immediately as
an urgency statute.
Vote: 2/3. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Article 5.5 (commencing with Section
14184) is added to Chapter 7 of Part 3 of Division 9 of the Welfare
and Institutions Code, to read:
Article 5.5. Renewal of Health Care Coordination, Improvement,
and Long-Term Cost Containment Waiver or Demonstration Project
14184. (a) The department shall submit an application to the
federal Centers for Medicare and Medicaid Services for a waiver to
implement a demonstration project that does all of the following:
(1) Furthers the delivery of high-quality and cost-efficient care
for Medi-Cal beneficiaries.
(2) Ensures the long-term viability of the delivery system
following the expansion of Medi-Cal eligibility under the federal
Patient Protection and Affordable Care Act.
(3) Continues California's momentum and successes in innovation
achieved under the 2010 "Bridge to Reform" Waiver.
(b) In developing the waiver application, the department shall
consult with interested stakeholders and the Legislature.
SECTION 1. Section 14166.253 is added to the
Welfare and Institutions Code , to read:
14166.253. (a) If the department has not received adequate
assurances from the federal Centers for Medicare and Medicaid
Services (CMS) before November 1, 2015, that the department's
application for a subsequent demonstration project, as defined in
subdivision (x) of Section 17612.2 and as submitted pursuant to
Section 17612.8, is likely to be approved with an effective date of
November 1, 2015, the director may request one or more temporary
extensions, as necessary to continue the operation of, and the
authorities provided under, the federal Medicaid demonstration
project titled "California Bridge to Reform Demonstration" (waiver
number 11-W-00193/9), until the approved effective date of the
subsequent demonstration project.
(b) To the extent permitted under the terms of any approved
temporary extension obtained by the department pursuant to
subdivision (a), an approved subsequent demonstration project, or as
otherwise permitted under federal Medicaid law, the department shall,
after consulting with the affected designated public hospitals,
extend and apply the payment methodologies and allocations described
in this article and in effect during the successor demonstration
project, on a state fiscal year, annual, partial year, or other
basis, consistent with any applicable implementing provisions of the
Medi-Cal state plan and requirements imposed by the CMS. The
department may make payments on an interim basis and subject to
reconciliation to amounts payable under the payment and allocation
methodologies applicable to any approved temporary extension obtained
by the department pursuant to subdivision (a) or approved subsequent
demonstration project.
(c) This section shall be implemented only to the extent that any
necessary federal approvals are obtained and federal financial
participation is available and is not jeopardized.
(d) Until July 1, 2016, in the event of a conflict between the
terms of any federally approved extension obtained by the department
pursuant to subdivision (a) and this article, the terms of the
federally approved temporary extension shall control, and the
department shall provide notice of the conflict to the appropriate
policy and fiscal committees of the Legislature.
(e) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement, interpret, or make specific this section by
means of all-county letters, plan letters, plan or provider
bulletins, or similar instructions without taking regulatory action
until July 1, 2016.
SEC. 2. This act is an urgency statute necessary for the immediate
preservation of the public peace, health, or safety within the
meaning of Article IV of the Constitution and shall go into immediate
effect. The facts constituting the necessity are:
In order to make changes to state-funded health care programs at
the earliest possible time, it is necessary that this act take effect
immediately.