Bill Text: CA AB301 | 2011-2012 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

---

Bill Title: Medi-Cal: managed care.

Spectrum: Moderate Partisan Bill (Democrat 5-1)

Status: (Passed) 2011-10-04 - Chaptered by Secretary of State - Chapter 460, Statutes of 2011. [AB301 Detail]

Download: California-2011-AB301-Amended.html

---

BILL NUMBER: AB 301	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JUNE 14, 2011

INTRODUCED BY   Assembly Member Pan
    (   Coauthors:   Assembly Members 
 Beall,   Carter,   Dickinson,  
Logue,   and Solorio   ) 

                        FEBRUARY 9, 2011

   An act to amend Section 14094.3 of the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 301, as amended, Pan. Medi-Cal: managed care.
   Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services,
pursuant to which medical benefits are provided to public assistance
recipients and other low-income persons. Existing law provides for
the department to enter into contracts with managed care systems,
hospitals, and prepaid health plans for the provision of various
Medi-Cal benefits. Existing law prohibits services covered by the
California Children's Services program (CCS) from being incorporated
into a Medi-Cal managed care contract entered into after August 1,
1994, until January 1, 2012, except with respect to contracts entered
into for county organized health systems in specified counties.
   This bill would extend to  January 1, 2018  
July 1, 2016  , the termination of the prohibition against CCS
covered services being incorporated into a Medi-Cal managed care
contract entered into after August 1, 1994.
   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 14094.3 of the Welfare and Institutions Code is
amended to read:
   14094.3.  (a) Notwithstanding this article or Section 14093.05 or
14094.1, CCS covered services shall not be incorporated into any
Medi-Cal managed care contract entered into after August 1, 1994,
pursuant to Article 2.7 (commencing with Section 14087.3), Article
2.8 (commencing with Section 14087.5), Article 2.9 (commencing with
Section 14088), Article 2.91 (commencing with Section 14089), Article
2.95 (commencing with Section 14092); or either Article 2
(commencing with Section 14200), or Article 7 (commencing with
Section 14490) of Chapter 8, until  January 1, 2018 
 July 1, 2016  , except for contracts entered into for
county organized health systems or Regional Health Authority in the
Counties of San Mateo, Santa Barbara, Solano, Yolo, Marin, and Napa.
   (b) Notwithstanding any other provision of this chapter, providers
serving children under the CCS program who are enrolled with a
Medi-Cal managed care contractor but who are not enrolled in a pilot
project pursuant to subdivision (c) shall continue to submit billing
for CCS covered services on a fee-for-service basis until CCS covered
services are incorporated into the Medi-Cal managed care contracts
described in subdivision (a).
   (c) (1) The department may authorize a pilot project in Solano
County in which reimbursement for conditions eligible under the CCS
program may be reimbursed on a capitated basis pursuant to Section
14093.05, and provided all CCS program's guidelines, standards, and
regulations are adhered to, and CCS program's case management is
utilized.
   (2) During the time period described in subdivision (a), the
department may approve, implement, and evaluate limited pilot
projects under the CCS program to test alternative managed care
models tailored to the special health care needs of children under
the CCS program. The pilot projects may include, but need not be
limited to, coverage of different geographic areas, focusing on
certain subpopulations, and the employment of different payment and
incentive models. Pilot project proposals from CCS program-approved
providers shall be given preference. All pilot projects shall utilize
CCS program-approved standards and providers pursuant to Section
14094.1.
   (d) (1) The department shall submit to the appropriate committees
of the Legislature an evaluation of pilot projects established
pursuant to subdivision (c) based on at least one full year of
operation.
   (2) The evaluation required by paragraph (1) shall address the
impact of the pilot projects on outcomes as set forth in paragraph
(4) and, in addition, shall do both of the following:
   (A) Examine the barriers, if any, to incorporating CCS covered
services into the Medi-Cal managed care contracts described in
subdivision (a).
   (B) Compare different pilot project models with the
fee-for-service system. The evaluation shall identify, to the extent
possible, those factors that make pilot projects most effective in
meeting the special needs of children with CCS eligible conditions.
   (3) CCS covered services shall not be incorporated into the
Medi-Cal managed care contracts described in subdivision (a) before
the evaluation process has been completed.
   (4) The pilot projects shall be evaluated to determine whether:
   (A) All children enrolled with a Medi-Cal managed care contractor
described in subdivision (a) identified as having a CCS eligible
condition are referred in a timely fashion for appropriate health
care.
   (B) All children in the CCS program have access to coordinated
care that includes primary care services in their own community.
   (C) CCS program standards are adhered to.
   (e) For purposes of this section, CCS covered services include all
program benefits administered by the program specified in Section
123840 of the Health and Safety Code regardless of the funding
source.
   (f) Nothing in this section shall be construed to exclude or
restrict CCS eligible children from enrollment with a managed care
contractor, or from receiving from the managed care contractor with
which they are enrolled primary and other health care unrelated to
the treatment of the CCS eligible condition.