Bill Text: CA AB652 | 2011-2012 | Regular Session | Amended

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

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Bill Title: Child health.

Spectrum: Bipartisan Bill

Status: (Introduced - Dead) 2012-02-01 - Died pursuant to Art. IV, Sec. 10(c) of the Constitution. From committee: Filed with the Chief Clerk pursuant to Joint Rule 56. [AB652 Detail]

Download: California-2011-AB652-Amended.html

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BILL NUMBER: AB 652	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  APRIL 25, 2011

INTRODUCED BY   Assembly Member Mitchell
    (   Coauthor:   Assembly Member  
Jeffries   ) 

                        FEBRUARY 16, 2011

   An act to add Section 1367.17 to the Health and Safety Code, to
add Section 12693.625 to the Insurance Code, and to add Section
 14132.19   14087.306  to the Welfare and
Institutions Code, relating to child health.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 652, as amended, Mitchell. Child health.
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975
(Knox-Keene Act), provides for the licensure and regulation of health
care service plans by the Department of Managed Health Care and
makes a willful violation of the act a crime. Existing law creates
the Healthy Families Program, administered by the Managed Risk
Medical Insurance Board, to arrange for the provision of health,
dental, and vision benefits to eligible children pursuant to a
federal program, the State Children's Health Insurance Program.
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.  Under existing law, one of the methods by
which Medi-Cal is provided is pursuant to   contracts with
various types of managed care plans. Existing law provides for a
schedule of benefits under the Medi-Cal program and provides for
various services provided to children, including, among others, early
and periodic screening, diagnosis, and treatment for any individual
under 21 years of age.  
   This bill would provide that an initial health assessment, as
defined, and a forensic medical evaluation, as defined, shall be
covered benefits under the Healthy Families Program, the Medi-Cal
program, and under health care service plans licensed pursuant to the
Knox-Keene Health Care Service Plan Act of 1973, as prescribed.
Because a willful violation of the bill's provisions relative to
health care service plans would be a crime, the bill would impose a
state-mandated local program.  
   This bill would provide that an initial health assessment, as
defined, and a forensic medical evaluation, as defined, shall be
covered benefits under health care service plans licensed pursuant to
the Knox-Keene Health Care Service Plan Act of 1973, and would
require these health care service plans, plans providing services
under the Healthy Families Program, and Medi-Cal managed care plans,
as defined, to make payments to providers for these services, as
specified. This bill would authorize a county board of supervisors
to, upon a motion made at the request of a local child welfare
agency, excuse the plans specified above from the obligation to
provide coverage of, or payment for, initial health assessments or
forensic medical evaluations provided to children who are residents
of that county if the county welfare agency has made sufficient
alternative arrangements to ensure that the services are provided and
that payment is made to providers for these services. Because a
willful violation of the bill's provisions relative to health care
service plans would be a crime, the 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 no reimbursement is required by this
act for a specified reason.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 1367.17 is added to the Health and Safety Code,
to read:
   1367.17.  (a) For the purposes of this section, the following
definitions shall apply:
   (1) "Initial health assessment" means a medical or dental
examination, or both, performed on a child for whom a case plan must
be prepared pursuant to Section 16501.1 of the Welfare and
Institutions Code and who has been placed in an out-of-home placement
within the last 30 days, and that is designed to determine the child'
s medical and dental status and further health care needs. An initial
health assessment shall meet, and may exceed, the guidelines
established by the Child Health and Disability Prevention Program for
well child exams and includes, but is not limited to, diagnostic
testing to the extent necessary to provide a complete assessment.
   (2) "Forensic medical evaluation" means an examination performed
by a qualified medical professional at the request of a local child
welfare agency  or local law enforcement agency 
pursuant to Section 324.5 of the Welfare and Institutions Code. A
forensic medical  examination   evaluation 
includes, but is not limited to, diagnostic testing to the extent
necessary to provide a complete evaluation.
   (b)  (1)    An individual or group health care
service plan contract issued, amended, or renewed on or after January
1, 2012, shall cover an initial health assessment or forensic
medical evaluation provided for any child who is an enrollee at the
time the assessment or evaluation is performed. Notwithstanding any
other provision of law, prior authorization shall not be required for
the provision of an initial health assessment or forensic medical
evaluation pursuant to this section. 
   (2) This section shall not be construed to apply to specialized
health care service plans as described in subdivision (o) of Section
1345.  
   (c) In the event that a local child welfare agency elects to limit
the health care providers that are eligible to receive payment
pursuant to this section, the obligation to pay providers shall only
apply to initial health assessments and forensic medical evaluations
performed by providers designated by the local child welfare agency.
 
   (d) Payments made to providers pursuant to this section shall be
equal to the reasonable value of the service, which shall in no event
be less than the amount the Medi-Cal program would pay for the same
service when rendered by the same provider to a Medi-Cal beneficiary
on a fee-for-service basis. A contract between a provider and a plan
obligated to make payment pursuant to this section may provide for a
different amount as long as the amount is not less than the amount
the Medi-Cal program would pay for the same service when rendered by
the same provider to a Medi-Cal beneficiary on a fee-for-service
basis.  
   (c) Payments made to providers pursuant to this section shall be
equal to the reasonable value of the service, which shall not, during
the 2012 calendar year, be less than two hundred fifty dollars
($250) for an initial health assessment, and seven hundred fifty
dollars($750) for a forensic medical evaluation. These minimum
payment amounts shall be increased each year by the Medicare Economic
Index. A contract between a provider and a plan obligated to make
payment pursuant to this section may provide for a different payment
amount.  
   (d) In the event that a local child welfare agency elects to limit
the health care providers that are eligible to receive payment
pursuant to this section, the obligation to pay providers shall only
apply to initial health assessments and forensic medical evaluations
performed by providers designated by the local child welfare agency.

   (e) The obligation to pay a provider pursuant to this section
exists irrespective of whether the provider has a contract with the
plan obligated to make the payment and irrespective of whether the
provider is part of the plan's network. 
   (f) A county board of supervisors may, upon a motion made at the
request of a local child welfare agency, excuse all individual and
group health care service plans from the obligation to provide
coverage of, or payment for, initial health assessments or forensic
medical evaluations provided to children who are residents of that
county if the county welfare agency has made sufficient alternative
arrangements to ensure that the services are provided and that
payment is made to providers for these services.  
   (f) 
    (g)  A court, local law enforcement agency, or local
child welfare agency may consider or rely on a report by any
qualified medical professional regarding the health care status,
needs, or findings of a forensic medical evaluation concerning a
child examined or evaluated by the qualified medical professional,
irrespective of whether the medical professional may receive payment
under this section.
  SEC. 2.  Section 12693.625 is added to the Insurance Code, to read:

   12693.625.  (a) For the purposes of this section, the following
definitions shall apply:
   (1) "Initial health assessment" means a medical or dental
examination, or both, performed on a child for whom a case plan must
be prepared pursuant to Section 16501.1 of the Welfare and
Institutions Code and who has been placed in an out-of-home placement
within the last 30 days, and that is designed to determine the child'
s medical and dental status and further health care needs. An initial
health assessment shall meet, and may exceed, the guidelines
established by the Child Health and Disability Prevention Program for
well child exams and includes, but is not limited to, diagnostic
testing to the extent necessary to provide a complete assessment.
   (2) "Forensic medical evaluation" means an examination performed
by a qualified medical professional at the request of a local child
welfare agency  or local law enforcement agency 
pursuant to Section 324.5 of the Welfare and Institutions Code. A
forensic medical  examination   evaluation 
includes, but is not limited to, diagnostic testing to the extent
necessary to provide a complete evaluation. 
   (b) Coverage provided to subscribers under this part shall include
an initial health assessment or forensic medical evaluation provided
for any child who is a subscriber at the time the assessment or
evaluation is performed. Notwithstanding any other 
    (b)     Notwithstanding any other 
provision of law, prior authorization shall not be required for the
provision of an initial health assessment or forensic medical
evaluation pursuant to this section. 
   (c) In the event that a local child welfare agency elects to limit
the health care providers that are eligible to receive payment
pursuant to this section, the obligation to pay providers shall only
apply to initial health assessments and forensic medical evaluations
performed by providers designated by the local child welfare agency.
 
   (d) Payments made to providers pursuant to this section shall be
equal to the reasonable value of the service, which shall in no event
be less than the amount the Medi-Cal program would pay for the same
service when rendered by the same provider to a Medi-Cal beneficiary
on a fee-for-service basis. A contract between a provider and a plan
obligated to make payment pursuant to this section may provide for a
different amount as long as the amount is not less than the amount
the Medi-Cal program would pay for the same service when rendered by
the same provider to a Medi-Cal beneficiary on a fee-for-service
basis.  
   (c) Plans providing coverage under this part, except for
specialized health care service plans as described in subdivision (o)
of Section 1345 of the Health and Safety Code, shall make payment to
providers for initial health assessments and forensic medical
evaluations of amounts at least equal to the reasonable value of the
service, which shall not, during the 2012 calendar year, be less than
two hundred fifty dollars ($250) for an initial health assessment,
and seven hundred fifty dollars ($750) for a forensic medical
evaluation. These minimum payment amounts shall be increased each
year by the Medicare Economic Index. A contract between a provider
and a plan obligated to make payment pursuant to this section may
provide for a different payment amount.  
   (d) In the event that a local child welfare agency elects to limit
the health care providers that are eligible to receive payment
pursuant to this section, the obligation to pay providers shall only
apply to initial health assessments and forensic medical evaluations
performed by providers designated by the local child welfare agency.

   (e) The obligation to pay a provider pursuant to this section
exists irrespective of whether the provider has a contract with the
plan obligated to make the payment and irrespective of whether the
provider is part of the plan's network. 
   (f) To the extent permitted by federal law, a county board of
supervisors may, upon a motion made at the request of a local child
welfare agency, excuse all plans providing coverage pursuant to this
part from the obligation to provide coverage of, or payment for,
initial health assessments or forensic medical evaluations provided
to children who are residents of that county if the county welfare
agency has made sufficient alternative arrangements to ensure that
the services are provided and that payment is made to providers for
these services.  
   (f) 
    (g)  A court, local law enforcement agency, or local
child welfare agency may consider or rely on a report by any
qualified medical professional regarding the health care status,
needs, or findings of a forensic medical evaluation concerning a
child examined or evaluated by the qualified medical professional,
irrespective of whether the medical professional may receive payment
under this section.
  SEC. 3.  Section  14132.19   14087.306 
is added to the Welfare and Institutions Code, to read:
    14132.19.   14087.306.   (a) For the
purposes of this section, the following definitions shall apply:
   (1) "Initial health assessment" means a medical or dental
examination, or both, performed on a child for whom a case plan must
be prepared pursuant to Section 16501.1 and who has been placed in an
out-of-home placement within the last 30 days, and that is designed
to determine the child's medical and dental status and further health
care needs. An initial health assessment shall meet, and may exceed,
the guidelines established by the Child Health and Disability
Prevention Program for well child exams and includes, but is not
limited to, diagnostic testing to the extent necessary to provide a
complete assessment.
   (2) "Forensic medical evaluation" means an examination performed
by a qualified medical professional at the request of a local child
welfare agency  or local law enforcement agency 
pursuant to Section 324.5. A forensic medical  examination
  evaluation  includes, but is not limited to,
diagnostic testing to the extent necessary to provide a complete
evaluation. 
   (b) To the extent permitted by federal law, an initial health
assessment or forensic medical evaluation provided by a Medi-Cal
provider, including a provider under a Medi-Cal managed care plan, as
defined in Section 14093.07, shall be a covered benefit under this
chapter for any child who is a Medi-Cal beneficiary at the time the
assessment or evaluation is performed. Notwithstanding any other
provision of law, prior authorization shall not be required for the
provision of an initial health assessment or forensic medical
evaluation pursuant to this section.  
   (c) In the event that a local child welfare agency elects to limit
health care providers that are eligible to receive reimbursement
under this section, the obligation to reimburse providers shall only
apply to initial health assessments and forensic medical evaluations
performed by providers designated by the local child welfare agency.
 
   (d) Reimbursement paid to providers pursuant to this section shall
be equal to the reasonable value of the service, which shall in no
event be less than the amount the Medi-Cal program would pay for the
same service when rendered by the same provider to a Medi-Cal
beneficiary on a fee-for-service basis. A contract between a provider
and a plan obligated to reimburse the provider pursuant to this
section may provide for a different amount as long as the amount is
not less than amount the Medi-Cal program would pay for the same
service when rendered by the same provider to a Medi-Cal beneficiary
on a fee-for-service basis.  
   (3) "Medi-Cal managed care plan" means a health plan that is
subject to the requirements contained in Article 2.7 (commencing with
Section 14087.3), Article 2.81 (commencing with Section 14087.96),
and Article 2.91 (commencing with Section 14089), or a prepaid health
plan with an agreement under Chapter 8 (commencing with Section
14200). "Medi-Cal managed care plan" shall not include a managed care
plan that contracts to provide health services in a single
specialized area of health care.  
   (b) Notwithstanding any other provision of state law, and to the
extent permitted by federal law, no Medi-Cal managed care plan shall
require prior authorization for the provision of an initial health
assessment or forensic medical evaluation pursuant to this section.
 
   (c) All Medi-Cal managed care plans shall make payment to
providers for the initial health assessments and forensic medical
evaluations at a rate equal to the reasonable value of the service,
which shall not, during the 2012 calendar year, be less than two
hundred fifty dollars ($250) for an initial health assessment, and
seven hundred fifty dollars ($750) for a forensic medical evaluation.
These minimum payment amounts shall be increased each year by the
Medicare Economic Index. A contract between a provider and a plan
obligated to make payment pursuant to this section may provide for a
different payment amount.  
   (d) In the event that a local child welfare agency elects to limit
health care providers that are eligible to receive reimbursement
under this section, the obligation to reimburse providers shall only
apply to initial health assessments and forensic medical evaluations
performed by providers designated by the local child welfare agency.

   (e)  If applicable, the   The 
obligation to reimburse a provider pursuant to this section exists
irrespective of whether the provider has a contract with the 
Medi-Cal managed care  plan obligated to make the payment and
irrespective of whether the provider is part of the plan's network.

   (f) To the extent permitted by federal law, a county board of
supervisors may, upon a motion made at the request of a local child
welfare agency, excuse all Medi-Cal managed care plans from the
obligation to provide coverage of, or make payment for, initial
health assessments or forensic medical evaluations provided to
children who are residents of that county if the county welfare
agency has made sufficient alternative arrangements to ensure that
the services are provided and that payment is made to providers for
these services.  
   (f) 
    (g)  A court, local law enforcement agency, or local
child welfare agency may consider or rely on a report by any
qualified medical professional regarding the health care status,
needs, or findings of a forensic medical evaluation concerning a
child examined or evaluated by the qualified medical professional,
irrespective of whether the medical professional may receive payment
under this section.
  SEC. 4.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.