Bill Text: CA AB1087 | 2013-2014 | Regular Session | Introduced
Bill Title: Medi-Cal: California's Bridge to Reform Demonstration.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2014-02-03 - Died at Desk. [AB1087 Detail]
Download: California-2013-AB1087-Introduced.html
BILL NUMBER: AB 1087 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Members Torres and Mitchell
FEBRUARY 22, 2013
An act to amend Section 14180 of the Welfare and Institutions
Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 1087, as introduced, Torres. Medi-Cal: California's Bridge to
Reform Demonstration.
Existing law provides for 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 and funded by federal
Medicaid Program provisions. Existing law requires the department to
seek a demonstration project or federal waiver of Medicaid law to
implement specified objectives, which may include better care
coordination for seniors, persons with disabilities, and children
with special health care needs.
This bill would make a technical, nonsubstantive change to these
provisions.
Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14180 of the Welfare and Institutions Code is
amended to read:
14180. (a) The department shall submit an application to the
federal Centers for Medicare and Medicaid Services for a waiver or a
demonstration project to implement all of the following:
(1) Strengthen California's health care safety net, which includes
disproportionate share hospitals, for low-income and vulnerable
Californians.
(2) Maximize opportunities to reduce the number of uninsured
individuals.
(3) Optimize opportunities to increase federal financial
participation and maximize financial resources to address
uncompensated care.
(4) Promote long-term, efficient, and effective use of state and
local funds.
(5) Improve health care quality and outcomes.
(6) Promote home-and community-based care.
(b) The waiver or demonstration project shall include proposals to
restructure the organization and delivery of services to be more
responsive to the health care needs of Medi-Cal enrollees for the
purpose of providing the most vulnerable Medi-Cal beneficiaries with
access to better coordinated and integrated care that will improve
their health outcomes, slow the long-term growth of the Medi-Cal
program, and continue support for the safety net care system and the
persons who rely on that system for needed care. These restructuring
proposals may include, but are not limited to, the following:
(1) Better care coordination for seniors and persons with
disabilities, dual eligibles, children with special health care
needs, and persons with behavioral health conditions, which shall
include the establishment of organized delivery systems that
incorporate a medical home system and care and disease management, as
well as incentives that reward providers and beneficiaries for
achieving the desired clinical, utilization, and cost-specific
outcomes.
(2) Improved coordination between Medicare and Medi-Cal coverage.
(3) Improved coordination of care for children with significant
medical needs through improved integration of delivery systems and
use of medical homes and specialty centers, and providing incentives
for specialty and nonspecialty care.
(4) Improved integration of physical and behavioral health care.
(c) In developing the waiver or demonstration project application,
the department shall consult on a regular basis with interested
stakeholders and the Legislature.
(d) The department shall determine the form of waiver most
appropriate to achieve the purposes listed in subdivision (a).
(e) The department shall submit the waiver or demonstration
project application to the federal Centers for Medicare and Medicaid
Services by a date that allows sufficient time for the waiver or
demonstration project to be approved by no later than September 1,
2010, or the conclusion of any extension period granted in California'
s Medi-Cal Hospital/Uninsured Care Section 1115(a) Medicaid
Demonstration (No. 11-W-00193/9), whichever happens last.
(f) In order to restructure the Medi-Cal program to improve the
delivery of care for specified populations and secure the maximum
amount of federal financial participation allowable, any waiver or
demonstration project application submitted pursuant to subdivision
(a) may specify and seek authority to enroll beneficiaries into
specified organized delivery systems. Subject to federal approval,
the specified organized delivery systems may include the utilization
of an enhanced primary care case management model, a medical home
model, or managed care model. The department is authorized to enroll
beneficiaries in an organized system of care subject to the
conditions in Section 14181. Subject to federal approval, any waiver
or demonstration project application submitted pursuant to
subdivision (a) shall include processes, and accompanying criteria,
by which the department will evaluate and grant exemption, on an
individual basis, from this section's requirements pertaining to the
mandatory enrollment of beneficiaries in specified organized delivery
systems.
(g) (1) The department shall only implement the waiver or
demonstration project upon submittal of an implementation plan,
pursuant to Section 14181, to the appropriate policy and fiscal
committees of the Legislature at least 60 days prior to any
appropriation.
(2) Pursuant to paragraph (1), mandatory enrollment in any
organized delivery system authorized pursuant to a waiver or
demonstration project authorized pursuant to this article shall
only occur when occur only after funds
necessary to support that effort have been appropriated.
(3) It is the intent of the Legislature to neither impede nor
limit the department's existing statutory authority regarding the
operation of the Medi-Cal program and its health care delivery
systems by the enactment of this article.
(h) The director shall have the discretion to utilize state plan
amendments, in whole or in part, to accomplish any or all purposes of
this article. In the event the director proceeds with state plan
amendments as specified, the department shall provide notification in
writing to the chairperson of the Joint Legislative Budget Committee
within 15 working days of that action and a brief description and
purpose of the amendment. This amendment shall be made available to
the Joint Legislative Budget Committee upon the request of the
chairperson.
