SB 586 — Children's services.

Summary

The California Children's Services (CCS) program is a statewide program providing medically necessary services required by physically handicapped children whose parents are unable to pay for those services. The State Department of Health Care Services administers the CCS program. Counties, based on population size, are also charged with administering the program, either independently or jointly with the department. The services covered by the CCS program include expert diagnosis, medical treatment, surgical treatment, hospital care, physical therapy, occupational therapy, special treatment, materials, and the supply of appliances and their upkeep, maintenance, and transportation. Funding for the program comes from county, state, and federal sources. In order to be eligible for the CCS program, an applicant must be under 21 years of age, have or be suspected of having a condition covered by the program, and meet certain financial eligibility standards established by the department. Existing law prohibits services covered by the CCS program from being incorporated into a Medi-Cal managed care contract entered into after August 1, 1994, until January 1, 2017, except with respect to contracts entered into for county organized health systems or Regional Health Authority in specified counties. This bill would exempt contracts entered into under the Whole Child Model program, described below, from that prohibition and would extend to January 1, 2022, and until the evaluation required under the Whole Child Model program has been completed, the termination of the prohibition against CCS-covered services being incorporated in a Medi-Cal managed care contract entered into after August 1, 1994. The bill would authorize the department, no sooner than July 1, 2017, to establish a Whole Child Model program, under which managed care plans served by a county organized health system or Regional Health Authority in designated counties would provide CCS services to Medi-Cal eligible CCS children and youth. The bill would limit the number of managed care plans under a county organized health system or Regional Health Authority that are eligible to participate in the program. The bill would require the department to implement the program, as specified, and would require a managed care plan to obtain written approval from the department and establish a local stakeholder process, as prescribed. The bill would prohibit the department from approving the application of a managed care plan until the Director of Health Care Services has verified the readiness of the managed care plan to address the unique needs of CCS-eligible beneficiaries, including, among other things, that the managed care contractor demonstrates the availability of an appropriate provider network to serve the needs of children and youth with CCS conditions and complies with all CCS program guidelines. The bill would prohibit the department from implementing the program in any county until it has developed specific CCS monitoring and oversight standards for managed care plans. The bill would require the department to establish, through December 31, 2021, a statewide Whole Child Model program stakeholder advisory group comprised of specified stakeholders, including representatives from health plans and family resource centers, or modify an existing stakeholder advisory group and would require the department to consult with the Whole Child Model program stakeholder advisory group on the implementation of the program, as specified. The bill would impose various requirements on a Medi-Cal managed care plan serving children and youth with CCS-eligible conditions under the CCS program, including, but not limited to, coordinating services, as specified; providing appropriate access to care, services, and information, including continuity of care requirements; and providing for case management, care coordination, provider referral, and service authorization services. The bill would require a Medi-Cal managed care plan participating in the Whole Child Model program to ensure provision of case management, care coordination, provider referral, and service authorization services to children and youth, as prescribed, but would authorize the department to waive this requirement if the plan demonstrates that it cannot meet the requirement because it would result in substantially increased program costs, as specified. This bill would require a managed care plan to provide a timely process for accepting and acting upon complaints and grievances of CCS-eligible children and youth. The bill would require a specified stakeholder process to address proposed changes to CCS medical eligibility requirements. The bill would require the department to contract with an independent entity to conduct an evaluation to assess health plan performance and the outcomes and the experience of CCS-eligible children and youth participating in the program, and would require the department to provide a report on the results of this evaluation to the Legislature no later than January 1, 2021. This bill would provide that its provisions are not intended to permit any reduction in benefits or eligibility levels under the existing CCS program. The bill would require the department, by July 1, 2020, to adopt regulations and, commencing July 1, 2018, would require the department to provide a status report to the Legislature until regulations have been adopted. The bill would authorize the Director of Health Care Services to enter into exclusive or nonexclusive contracts on a bid, nonbid, or negotiated basis and amend existing managed care contracts to provide or arrange for services provided under the bill. By imposing new duties on counties with respect to the transition and implementation of CCS program services, this bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.

Bill Text

• Chaptered 09/25/16 - Chaptered Current pdf September 25, 2016
• Enrolled 09/02/16 - Enrolled pdf September 02, 2016
• Amended 08/19/16 - Amended Assembly pdf August 19, 2016
• Amended 08/02/16 - Amended Assembly pdf August 02, 2016
• Amended 06/30/16 - Amended Assembly pdf June 30, 2016
• Amended 06/08/16 - Amended Assembly pdf June 08, 2016
• Amended 05/04/16 - Amended Assembly pdf May 04, 2016
• Amended 04/28/15 - Amended Senate pdf April 28, 2015
• Introduced 02/26/15 - Introduced pdf February 26, 2015
• SB586 View text html

Action History

1. September 25, 2016

   Chaptered by Secretary of State. Chapter 625, Statutes of 2016.

2. September 25, 2016

   Approved by the Governor.

3. September 08, 2016

   Enrolled and presented to the Governor at 5 p.m.

4. August 29, 2016

   Assembly amendments concurred in. (Ayes 39. Noes 0. Page 5474.) Ordered to engrossing and enrolling.

5. August 25, 2016

   From committee: That the Assembly amendments be concurred in. (Ayes 9. Noes 0. Page 5437.)

6. August 25, 2016

   Set for hearing August 25.

7. August 24, 2016

   From committee: Be re-referred to Com. on HEALTH pursuant to Senate Rule 29.10(d). (Ayes 5. Noes 0. Page 5326.) Re-referred to Com. on HEALTH.

8. August 24, 2016

   Re-referred to Com. on RLS. pursuant to Senate Rule 29.10(d).

9. August 23, 2016

   In Senate. Concurrence in Assembly amendments pending.

10. August 23, 2016

    Read third time. Passed. (Ayes 80. Noes 0. Page 6079.) Ordered to the Senate.

11. August 19, 2016

    Ordered to third reading.

12. August 19, 2016

    Read third time and amended. (Ayes 73. Noes 0. Page 5956.)

13. August 15, 2016

    Read second time. Ordered to third reading.

14. August 12, 2016

    From committee: Do pass. (Ayes 20. Noes 0.) (August 11).

15. August 11, 2016

    Joint Rule 62(a) suspended.

16. August 10, 2016

    August 10 set for second hearing. Placed on APPR. suspense file.

17. August 03, 2016

    August 3 set for first hearing canceled at the request of author.

18. August 02, 2016

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

19. June 30, 2016

    Read second time and amended. Re-referred to Com. on APPR.

20. June 29, 2016

    From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 18. Noes 0.) (June 28).

21. June 21, 2016

    June 21 set for second hearing canceled at the request of author.

22. June 08, 2016

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

23. May 04, 2016

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

24. July 14, 2015

    July 14 set for first hearing canceled at the request of author.

25. June 18, 2015

    Referred to Com. on HEALTH.

26. June 02, 2015

    In Assembly. Read first time. Held at Desk.

27. June 01, 2015

    Read third time. Passed. (Ayes 40. Noes 0. Page 1207.) Ordered to the Assembly.

28. May 28, 2015

    Read second time. Ordered to third reading.

29. May 28, 2015

    From committee: Do pass. (Ayes 7. Noes 0. Page 1156.) (May 28).

30. May 23, 2015

    Set for hearing May 28.

31. May 11, 2015

    May 11 hearing: Placed on APPR. suspense file.

32. May 01, 2015

    Set for hearing May 11.

33. April 28, 2015

    Read second time and amended. Re-referred to Com. on APPR.

34. April 27, 2015

    From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 8. Noes 0. Page 758.) (April 22).

35. March 25, 2015

    Set for hearing April 22.

36. March 12, 2015

    Referred to Com. on HEALTH.

37. February 27, 2015

    From printer. May be acted upon on or after March 29.

38. February 26, 2015

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

Sponsors

• Alejo · Cosponsor
• Bonta · Cosponsor
• Chávez · Cosponsor
• Hernandez · Primary
• Wood · Cosponsor

Votes

Subjects