BILL NUMBER: SB 92 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 15, 1999
INTRODUCED BY Senator Hayden
DECEMBER 7, 1998
An act to amend Sections 12693.41 and
Section 12693.70 of, and to add Section
Sections 12693.415 and 12693.705 to, the Insurance Code,
relating to health insurance.
LEGISLATIVE COUNSEL'S DIGEST
SB 92, as amended, 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
(3) Existing law continuously appropriates money from the Healthy
Families Fund for purposes of implementation of the Healthy Families
Program.
The bill's provisions expanding coverage and
eligibility 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
SECTION 1. Section 12693.415 is added to the Insurance Code, to
read:
12693.415. (a) (1) Upon the effective date of coverage of a
child eligible for the program, the board shall arrange for payment
of eligible providers an eligible provider
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 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) Eligible providers An eligible
provider 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 An eligible provider
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 An eligible provider
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 An eligible
provider 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 1, 2, and 3 shall
become operative only if funding for the purposes of those sections
is appropriated by the Budget Act.