SB 1019 — Health.

Summary

(1) Under existing law, the State Department of Health Care Services is authorized and required to perform various functions relating to the care and treatment of persons with mental disorders. Under existing law, services for these individuals may be provided in psychiatric hospitals or other types of facilities, as well as in community settings. Under existing law, psychiatric health facilities are licensed and regulated by the State Department of Social Services. Existing law provides for state hospitals for the care, treatment, and education of mentally disordered persons, which are under the jurisdiction of the State Department of State Hospitals. This bill would make technical, nonsubstantive changes to various provisions of law to, in part, delete obsolete references to the State Department of Mental Health. (2) Existing law creates the Healthy Families Program, administered by the Managed Risk Medical Insurance Board (MRMIB) , to arrange for the provision of health, vision, and dental benefits to eligible children pursuant to the federal Children's Health Insurance Program. Existing law also provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which basic health care services are provided to qualified low-income persons. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. Existing law provides for the transition of specified enrollees of the Healthy Families Program to the Medi-Cal program, to the extent that those individuals are otherwise eligible, no sooner than January 1, 2013. Existing law requires this transition to take place in 4 phases, as prescribed. Existing law requires the Department of Health Care Services to exercise the option to provide full-scope benefits with no share of cost to children who have attained 6 years of age but have not attained 19 years of age and who are optional targeted low-income children, as specified. This bill would delete the age restriction on the option to provide full-scope benefits to optional targeted low-income children. The bill would modify the monthly premiums imposed under these provisions, and would authorize the State Department of Health Care Services to enter into and continue contracts with the Health Families Program administrative vendor for the purposes of implementing and maintaining the necessary systems and activities for providing health care coverage to these children. This bill would authorize the State Department of Health Care Services to enter into a contract with the Health Care Options Broker of the department for purposes of managed care enrollment activities and would make other changes related to the implementation of these provisions. (3) Existing law requires, to the extent required by federal law, and beginning January 1, 2013, through and including December 31, 2014, that payments for primary care services provided by specified physicians be no less than 100% of the payment rate that applies to those services and physicians as established by the Medicare Program, for both fee-for-service and managed care plans. This bill would provide that payment increases made pursuant to these provisions shall not apply to certain provider rates of payment. (4) One of the methods by which Medi-Cal services are provided is pursuant to contracts with various types of managed care health plans. Existing law, to the extent that federal financial participation is available, and pursuant to a demonstration project or waiver of federal law, requires the State Department of Health Care Services to establish demonstration sites, as defined, in up to 8 counties no sooner than March 1, 2013, to enable beneficiaries eligible under both the Medi-Cal and Medicare programs to receive a continuum of services that maximizes access to the continuum of long-term services and supports and behavioral health services. Existing law requires the department, with exceptions, to enroll dual eligible beneficiaries into a demonstration site unless the dual eligible beneficiary makes an affirmative choice to opt out of enrollment or is already enrolled in specific entities, as specified. This bill would modify the criteria that must be met to be excluded from enrollment in the demonstration project and would modify the provisions relating to the disclosure of information relating to beneficiaries who have been diagnosed with HIV/AIDS. Existing law requires the State Department of Health Care Services to ensure and improve the care coordination and integration of health care services for Medi-Cal beneficiaries residing in counties participating in the demonstration project. This bill would delete the requirement under these provisions that the Department of Managed Health Care monitor whether beneficiaries are able to receive timely access to primary and specialty care services as prescribed. (5) Existing law requires the department to enter into an interagency agreement with the Department of Managed Health Care to conduct financial audits, medical surveys, and a review of the provider networks of the managed care plans participating in a certain demonstration project and provide consumer assistance to beneficiaries affected by certain provisions. This bill would additionally require the department to enter into an interagency agreement with the Department of Managed Health Care to conduct financial audits, medical surveys, and a review of the provider networks in connection with the expansion of Medi-Cal managed care into rural counties. (6) Existing law requires the department to pay capitation rates to health plans participating in the Medi-Cal managed care program using actuarial methods and authorizes the department to establish health-plan- and county-specific rates, as specified. This bill would provide that as the department adds additional factors, such as managed care plan costs, to the Medi-Cal managed care plan default assignment algorithm, it shall consult with the Auto Assignment Performance Incentive Program stakeholder workgroup, as specified. (7) Existing law authorizes, to the extent consistent with federal law, the State Department of Health Care Services to defer payments to Medi-Cal managed care health plans and providers, as applicable, contracting with the department, as specified, which are payable to the plans during the final month of the 2012–13 state fiscal year, if certain conditions are satisfied. This bill would modify these provisions to eliminate the limitation of the deferral to the 2012–13 state fiscal year and would additionally authorize the State Department of Health Care Services to defer fee-for-service payments under these provisions. (8) Existing law requires the State Department of Health Care Services, in collaboration with the State Department of Public Health, and in consultation with stakeholders, to develop polices and guidance on the transition of persons diagnosed with HIV/AIDS from programs funded under the federal Ryan White Act to the Low Income Health Program (LIHP) . This bill would, for purposes of implementing LIHP, authorize the State Department of Public Health to share relevant data related to a beneficiary's enrollment in federal Ryan White Act funded programs who may be eligible for LIHP services, and would authorize a participating entity, as defined, to share relevant data relating to persons diagnosed with HIV/AIDS with the State Department of Public Health, as prescribed. (9) This bill would appropriate $1,000 to the State Department of Health Care Services for administration. (10) This bill would declare that it is to take effect immediately as a bill providing for appropriations related to the Budget Bill.

Bill Text

• Amended 08/23/12 - Amended Assembly Current pdf August 23, 2012
• Introduced 02/06/12 - Introduced pdf February 06, 2012
• SB1019 View text html

Action History

1. August 29, 2012

   In Senate. Concurrence in Assembly amendments pending.

2. August 29, 2012

   Read third time. Passed. (Ayes 50. Noes 26. Page 6550.) Ordered to the Senate.

3. August 28, 2012

   Ordered to third reading.

4. August 28, 2012

   Withdrawn from committee. (Ayes 50. Noes 27. Page 6439.)

5. August 23, 2012

   From committee with author's amendments. Read second time and amended. Re-referred to Com. on BUDGET.

6. March 26, 2012

   Referred to Com. on BUDGET.

7. March 22, 2012

   In Assembly. Read first time. Held at Desk.

8. March 22, 2012

   Read third time. Passed. (Ayes 23. Noes 10. Page 2979.) Ordered to the Assembly.

9. March 12, 2012

   Read second time. Ordered to third reading.

10. March 08, 2012

    Ordered to second reading.

11. March 08, 2012

    Withdrawn from committee. (Ayes 24. Noes 14. Page 2916.)

12. February 16, 2012

    Referred to Com. on RLS.

13. February 07, 2012

    From printer. May be acted upon on or after March 8.

14. February 06, 2012

    Introduced. Read first time. To Com. on RLS. for assignment. To print.

Sponsors

• Committee on Budget and Fiscal Review · Primary

Votes

Subjects