BILL NUMBER: SB 92 INTRODUCED
BILL TEXT
INTRODUCED BY Senator Hayden
DECEMBER 7, 1998
An act to amend Sections 12693.41 and 12693.70 of, and to add
Section 12693.705 to, the Insurance Code, relating to health
insurance.
LEGISLATIVE COUNSEL'S DIGEST
SB 92, as introduced, Hayden. Healthy Families Program.
(1) Existing law provides for the creation of the Healthy Families
Program administered by the Managed Risk Medical Insurance Board.
Existing law provides that when a child becomes eligible for the
program, the board shall arrange for payment of providers that
participate in the Child Health and Disability Prevention Program for
certain services provided up to 30 days prior to the effective date
of coverage.
This bill would extend those provisions to provide for payment of
providers providing services in an emergency room or outpatient
clinic or department located in a licensed acute care hospital, a
community clinic, a free clinic, a rural health clinic, and a
federally qualified health center.
(2) Under existing provisions governing the Healthy Families
Program, in order to be eligible, an applicant must be applying on
behalf of a child who meets certain requirements, including a
requirement that the child be a resident, and including the
citizenship and immigration status requirements established by
federal law. Existing law continuously appropriates money from the
Healthy Families Fund for purposes of implementation of the Healthy
Families Program.
This bill would modify the definition of "resident" by including
an applicant who is physically present and living in California and
who entered the state with a job commitment or to seek employment,
whether or not currently employed. It would also provide that a
child who is otherwise eligible for participation shall not be denied
eligibility based on the child's date of entry into the United
States. These provisions would become operative only if funding for
these purposes is appropriated by the Budget Act.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 12693.41 of the Insurance Code is amended to
read:
12693.41. (a) (1) Upon the effective date of coverage
of a child eligible for the program, the board shall arrange for
payment of eligible providers who participate in
the Child Health and Disability Prevention Program pursuant to
Article 6 (commencing with Section 124025) of Chapter 3 of Part 2 of
Division 106 of the Health and Safety Code, for well-child
health assessments, immunizations, and initial treatment provided up
to 30 days prior to the effective date of coverage.
(2) As used in this section, "eligible provider" means providers
that participate in the Child Health and Disability Prevention
Program pursuant to Article 6 (commencing with Section 124025) of
Chapter 3 of Part 2 of Division 106 of the Health and Safety Code,
and any provider providing services in an emergency room or
outpatient clinic or department located in a licensed acute care
hospital, a community clinic, a free clinic, a rural health clinic,
any clinic owned and operated by a county, including a county
outpatient clinic, and any federally qualified health center as
defined in Section 14087.325 of the Welfare and Institutions Code.
(b) The board shall pay only for those services that are eligible
for federal financial participation under Section 2105 of Title XXI
of the Social Security Act and that are approved in the required
state plan under that title.
(c) (1) Child Health and Disability Prevention Program
Eligible providers shall submit charges for the
services under subdivision (a) on the form or in the format specified
by the department for the Child Health and Disability Prevention
Program. Those providers shall be reimbursed at the rates
established for these services by the Child Health and Disability
Prevention Program once coverage under the program is established.
However, if rates have not been established under that program,
the rates shall be those established for Medi-Cal.
(2) Those providers shall submit charges for services reimbursable
under Medi-Cal on the form or in the format specified by the
department for Medi-Cal. Those providers shall be reimbursed at the
rates established for these services by Medi-Cal once coverage under
Medi-Cal is established.
(d) (1) The board may use the state fiscal intermediary for
medicaid to process the payments authorized in subdivision (a).
(2) The board shall be exempt from the requirements of Chapter 7
(commencing with Section 11700) of Division 3 of Title 2 of the
Government Code and Chapter 3 (commencing with Section 12100) of Part
2 of Division 2 of the Public Contract Code as those requirements
apply to the use of contractual claims processing services by the
state fiscal intermediary.
SEC. 2. Section 12693.70 of the Insurance Code is amended to read:
12693.70. To be eligible to participate in the program, an
applicant shall meet all of the following requirements:
(a) Be an applicant applying on behalf of an eligible child, which
means a child who is all of the following:
(1) Greater than 12 months of age and less than 19 years of age.
An application may be made on behalf of a child less than 12 months
of age for coverage to begin as early as the child's first birthday.
(2) Not eligible for no-cost full-scope Medi-Cal or Medicare at
the time of application.
(3) In compliance with Sections 12693.71 and 12693.72.
(4) A child who meets citizenship and immigration status
requirements that are applicable to persons participating in the
program established by Title XXI of the Social Security Act.
(5) A resident of the State of California pursuant to Section 244
of the Government Code or because the applicant is physically
present and living in California and entered the state with a job
commitment or to seek employment, whether or not currently employed
.
(6) In a family with a gross annual household income equal to or
less than 200 percent of the federal poverty level.
(b) If the applicant is applying for the purchasing pool, the
applicant shall pay the first month's family contribution and agree
to remain in the program for six months, unless other coverage is
obtained and proof of the coverage is provided to the program.
(c) An applicant shall enroll all of the applicant's eligible
children in the program.
SEC. 3. Section 12693.705 is added to the Insurance Code, to read:
12693.705. A child who is otherwise eligible for participation
shall not be denied eligibility based on his or her date of entry
into the United States.
This section does not constitute a change in, but is declaratory
of, existing law.
SEC. 4. Sections 2 and 3 shall become operative only if funding
for the purposes of those sections is appropriated by the Budget Act.