California 2021-2022 Regular Session Status: Passed Senate

SB 256 — California Advancing and Innovating Medi-Cal.

Last action — Referred to Com. on HEALTH.

  1. ✓
    Introduced
  2. ✓
    In Committee
  3. 3
    Passed Senate
  4. 4
    Passed Assembly
  5. 5
    To Executive
  6. 6
    Enacted

This bill died with 2021-2022 Regular Session. It reached “Passed Senate” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.

Summary

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Under existing law, health care services are provided under the Medi-Cal program pursuant to a schedule of benefits, and those benefits are provided to beneficiaries through various health care delivery systems, including fee-for-service and managed care. Existing law authorizes the department to enter into various types of contracts for the provision of services to beneficiaries, including contracts with a Medi-Cal managed care plan. Existing law imposes various requirements on Medi-Cal managed care plan contractors, and requires the department to pay capitations rates to health plans participating in the Medi-Cal managed care program using actuarial methods. Existing law authorizes the department to establish, and requires the department to utilize, health-plan- and county-specific rates for specified Medi-Cal managed care plan contracts, and requires those developed rates to include identified information, such as health-plan-specific encounter and claims data. Existing law, the Medi-Cal 2020 Demonstration Project Act, requires the department to implement specified components of a Medi-Cal demonstration project, including the Global Payment Program, the Whole Person Care pilot program, and the Dental Transformation Initiative, consistent with the Special Terms and Conditions approved by the federal Centers for Medicare and Medicaid Services. Pursuant to existing law, the department has created a multiyear initiative, the California Advancing and Innovating Medi-Cal (CalAIM) initiative, for purposes of building upon the outcomes of various Medi-Cal pilots and demonstration projects, including the Medi-Cal 2020 demonstration project. Existing federal law authorizes specified managed care entities that participate in a state's Medicaid program to cover, for enrollees, services or settings that are in lieu of services and settings otherwise covered under a state plan. This bill would establish the CalAIM initiative, and would require the implementation of CalAIM to support stated goals of identifying and managing the risk and needs of Medi-Cal beneficiaries, transitioning and transforming the Medi-Cal program to a more consistent and seamless system, and improving quality outcomes. The bill would require the department to seek federal approval for the CalAIM initiative, and would condition its implementation on receipt of any necessary federal approvals and availability of federal financial participation. To implement the CalAIM initiative, the bill would authorize the department to enter into exclusive or nonexclusive contracts, or amend existing contracts, and to implement these provisions by various means, including provider bulletins. For purposes of the CalAIM initiative, this bill would additionally authorize the department to standardize those populations that are subject to mandatory enrollment in a Medi-Cal managed care plan across aid code groups and Medi-Cal managed care models. Commencing January 1, 2023, the bill would require the department to implement the Population Health Management Program under the Medi-Cal managed care delivery system to improve health outcomes, care coordination, and efficiency through application of standardized health management requirements. The bill would require the department to require each Medi-Cal managed care plan to develop and maintain a beneficiary-centered population health management program that meets specified standards, including identifying and mitigating social determinants of health and reducing health disparities or inequities. The bill would require the department to consult with specified stakeholders, including the State Department of Public Health, to establish requirements for the population health management program, as specified, and, beginning January 1, 2024, would require the department to annually develop and issue a public report, which includes prescribed information, on this program. Under the CalAIM initiative, this bill would require the department to implement an enhanced care management (ECM) benefit designed to address the clinical and nonclinical needs on a whole-person-care basis for certain target populations of Medi-Cal beneficiaries enrolled in Medi-Cal managed care plans, as specified. The bill would require Medi-Cal managed care plans to consult and collaborate with county mental health plans for the delivery of ECM services for beneficiaries with certain health conditions, including serious mental illness, to maximize federal reimbursement and minimize duplication of services. The bill would require the department to require those plans to report specified information related to the ECM benefit and would require the department to annually publicly report on the utilization of ECM in a manner that allows for an analysis of demographic populations, as specified. As part of the CalAIM initiative, and commencing January 1, 2022, this bill would require the department to authorize Medi-Cal managed care plans to elect to cover those services or settings approved by the department as cost effective and medically appropriate in the comprehensive risk contract that are in lieu of applicable Medi-Cal state plan services. The bill would provide that in lieu of services include specified services, such as housing transition navigation services, recuperative care, and asthma remediation. The bill would require the department to establish metrics for, and conduct an annual evaluation of, the utilization and effectiveness of in lieu of services, and to publicly report, as prescribed, the evaluation and conduct the evaluation in a specified manner. Commencing January 1, 2022, this bill would require the department, subject to appropriation, to make incentive payments available to qualifying Medi-Cal managed care plans that meet predefined milestones and metrics associated with implementation of applicable components of the CalAIM initiative, and to consult with specified entities, including Medi-Cal managed care plans, to establish the methodology pursuant to prescribed standards. This bill would authorize the department to establish capitation rates to contracted health plans on a regional basis in lieu of health plan and county-specific rates, and would require the department to consult with affected entities and individuals, including consumer representatives. Before the implementation of a regional-based capitation rate, the bill would require the department to report to the Legislature on specified matters, including how these rates are to be established. This bill would make its provisions severable and would make other legislative findings and declarations.

Bill Text

Action History

  1. Referred to Com. on HEALTH.

  2. In Assembly. Read first time. Held at Desk.

  3. Read third time. Passed. (Ayes 39. Noes 0. Page 1343.) Ordered to the Assembly.

  4. Ordered to special consent calendar.

  5. Read second time. Ordered to third reading.

  6. From committee: Do pass. (Ayes 7. Noes 0. Page 1185.) (May 20).

  7. Set for hearing May 20.

  8. May 17 hearing: Placed on APPR suspense file.

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

  10. Set for hearing May 17.

  11. May 10 hearing postponed by committee.

  12. Set for hearing May 10.

  13. From committee: Do pass and re-refer to Com. on APPR. (Ayes 11. Noes 0. Page 955.) (April 28). Re-referred to Com. on APPR.

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

  15. Set for hearing April 28.

  16. Joint Rule 55 suspended. (Ayes 32. Noes 4. Page 272.)

  17. (Ayes 32. Noes 4.)

  18. Art. IV. Sec. 8(a) of the Constitution dispensed with.

  19. Referred to Com. on HEALTH.

  20. From printer. May be acted upon on or after February 26.

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

Sponsors

  • Pan · Primary

Sponsorship breakdown

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1 sponsors · 0 co-sponsors · 121 not signed on

Sponsors (1)

  • Pan

Co-sponsors (0)

None.

Not signed on (121)

121 members have not signed on to this bill.

Show all 121 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

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Votes

Special Consent SB256

Passed 39 Yea · 0 Nay · 1 Other
Party YeaNayPresentNot Voting
Democratic 13000
Unaffiliated 22001
Republican 4000
Total 39001
% of votes cast 98%0%0%3%
How each member voted (40)
Member Party Vote
Glazer — Yea
Roth — Yea
Eggman — Yea
Bates — Yea
Gonzalez — Yea
Portantino — Yea
Bradford — Yea
Min — Yea
Hertzberg — Yea
Borgeas — Yea
Skinner — Yea
Wieckowski — Yea
Leyva — Yea
Nielsen — Yea
Wilk — Yea
Atkins — Yea
Newman — Yea
Hueso — Yea
Kamlager — Yea
Pan — Yea
Rubio — Yea
Dodd — Yea
Melendez — Not Voting
Allen, Benjamin Democratic Yea
Archuleta, Bob Democratic Yea
Becker, Josh Democratic Yea
Caballero, Anna M. Democratic Yea
Cortese, Dave Democratic Yea
Durazo, Maria Elena Democratic Yea
Hurtado, Melissa Democratic Yea
Laird, John Democratic Yea
Limón, Monique Democratic Yea
McGuire, Mike Democratic Yea
Stern, Henry I. Democratic Yea
Umberg, Thomas J. Democratic Yea
Wiener, Scott D. Democratic Yea
Dahle, Megan Republican Yea
Grove, Shannon Republican Yea
Jones, Brian W. Republican Yea
Ochoa Bogh, Rosilicie Republican Yea

Official roll call →

Do pass

Passed 7 Yea · 0 Nay
Party YeaNayPresentNot Voting
Unaffiliated 5000
Republican 1000
Democratic 1000
Total 7000
% of votes cast 100%0%0%0%
How each member voted (7)
Member Party Vote
Wieckowski — Yea
Kamlager — Yea
Portantino — Yea
Bradford — Yea
Bates — Yea
Laird, John Democratic Yea
Jones, Brian W. Republican Yea

Official roll call →

Placed on suspense file

Passed 7 Yea · 0 Nay
Party YeaNayPresentNot Voting
Unaffiliated 5000
Republican 1000
Democratic 1000
Total 7000
% of votes cast 100%0%0%0%
How each member voted (7)
Member Party Vote
Bates — Yea
Kamlager — Yea
Portantino — Yea
Wieckowski — Yea
Bradford — Yea
Laird, John Democratic Yea
Jones, Brian W. Republican Yea

Official roll call →

Do pass, but first be re-referred to the Committee on [Appropriations]

Passed 11 Yea · 0 Nay
Party YeaNayPresentNot Voting
Unaffiliated 7000
Republican 1000
Democratic 3000
Total 11000
% of votes cast 100%0%0%0%
How each member voted (11)
Member Party Vote
Eggman — Yea
Gonzalez — Yea
Pan — Yea
Leyva — Yea
Melendez — Yea
Roth — Yea
Rubio — Yea
Hurtado, Melissa Democratic Yea
Limón, Monique Democratic Yea
Wiener, Scott D. Democratic Yea
Grove, Shannon Republican Yea

Official roll call →

Subjects

healthcare health-insurance
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Frequently asked questions

What does SB 256 do?
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Under existing law, health care services are provided under the Medi-Cal program pursuant to a schedule of benefits, and those benefits are provided to beneficiaries through various health care delivery systems, including fee-for-service and managed care. Existing law authorizes the department to enter into various types of contracts for the provision of services to beneficiaries, including contracts with a Medi-Cal managed care plan. Existing law imposes various requirements on Medi-Cal managed care plan contractors, and requires the department to pay capitations rates to health plans participating in the Medi-Cal managed care program using actuarial methods. Existing law authorizes the department to establish, and requires the department to utilize, health-plan- and county-specific rates for specified Medi-Cal managed care plan contracts, and requires those developed rates to include identified information, such as health-plan-specific encounter and claims data. Existing law, the Medi-Cal 2020 Demonstration Project Act, requires the department to implement specified components of a Medi-Cal demonstration project, including the Global Payment Program, the Whole Person Care pilot program, and the Dental Transformation Initiative, consistent with the Special Terms and Conditions approved by the federal Centers for Medicare and Medicaid Services. Pursuant to existing law, the department has created a multiyear initiative, the California Advancing and Innovating Medi-Cal (CalAIM) initiative, for purposes of building upon the outcomes of various Medi-Cal pilots and demonstration projects, including the Medi-Cal 2020 demonstration project. Existing federal law authorizes specified managed care entities that participate in a state's Medicaid program to cover, for enrollees, services or settings that are in lieu of services and settings otherwise covered under a state plan. This bill would establish the CalAIM initiative, and would require the implementation of CalAIM to support stated goals of identifying and managing the risk and needs of Medi-Cal beneficiaries, transitioning and transforming the Medi-Cal program to a more consistent and seamless system, and improving quality outcomes. The bill would require the department to seek federal approval for the CalAIM initiative, and would condition its implementation on receipt of any necessary federal approvals and availability of federal financial participation. To implement the CalAIM initiative, the bill would authorize the department to enter into exclusive or nonexclusive contracts, or amend existing contracts, and to implement these provisions by various means, including provider bulletins. For purposes of the CalAIM initiative, this bill would additionally authorize the department to standardize those populations that are subject to mandatory enrollment in a Medi-Cal managed care plan across aid code groups and Medi-Cal managed care models. Commencing January 1, 2023, the bill would require the department to implement the Population Health Management Program under the Medi-Cal managed care delivery system to improve health outcomes, care coordination, and efficiency through application of standardized health management requirements. The bill would require the department to require each Medi-Cal managed care plan to develop and maintain a beneficiary-centered population health management program that meets specified standards, including identifying and mitigating social determinants of health and reducing health disparities or inequities. The bill would require the department to consult with specified stakeholders, including the State Department of Public Health, to establish requirements for the population health management program, as specified, and, beginning January 1, 2024, would require the department to annually develop and issue a public report, which includes prescribed information, on this program. Under the CalAIM initiative, this bill would require the department to implement an enhanced care management (ECM) benefit designed to address the clinical and nonclinical needs on a whole-person-care basis for certain target populations of Medi-Cal beneficiaries enrolled in Medi-Cal managed care plans, as specified. The bill would require Medi-Cal managed care plans to consult and collaborate with county mental health plans for the delivery of ECM services for beneficiaries with certain health conditions, including serious mental illness, to maximize federal reimbursement and minimize duplication of services. The bill would require the department to require those plans to report specified information related to the ECM benefit and would require the department to annually publicly report on the utilization of ECM in a manner that allows for an analysis of demographic populations, as specified. As part of the CalAIM initiative, and commencing January 1, 2022, this bill would require the department to authorize Medi-Cal managed care plans to elect to cover those services or settings approved by the department as cost effective and medically appropriate in the comprehensive risk contract that are in lieu of applicable Medi-Cal state plan services. The bill would provide that in lieu of services include specified services, such as housing transition navigation services, recuperative care, and asthma remediation. The bill would require the department to establish metrics for, and conduct an annual evaluation of, the utilization and effectiveness of in lieu of services, and to publicly report, as prescribed, the evaluation and conduct the evaluation in a specified manner. Commencing January 1, 2022, this bill would require the department, subject to appropriation, to make incentive payments available to qualifying Medi-Cal managed care plans that meet predefined milestones and metrics associated with implementation of applicable components of the CalAIM initiative, and to consult with specified entities, including Medi-Cal managed care plans, to establish the methodology pursuant to prescribed standards. This bill would authorize the department to establish capitation rates to contracted health plans on a regional basis in lieu of health plan and county-specific rates, and would require the department to consult with affected entities and individuals, including consumer representatives. Before the implementation of a regional-based capitation rate, the bill would require the department to report to the Legislature on specified matters, including how these rates are to be established. This bill would make its provisions severable and would make other legislative findings and declarations.
Who sponsors SB 256?
SB 256 is sponsored by Pan.
What is the current status of SB 256?
This bill died with 2021-2022 Regular Session. It reached “Passed Senate” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track SB 256?
Track SB 256 free on One Click Politics — get push/email alerts when it moves.

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