BILL NUMBER: SB 1316 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 8, 2014
INTRODUCED BY Senator Cannella
FEBRUARY 21, 2014
An act to amend Section 14132.27 of the Welfare and
Institutions Code, relating to Medi-Cal. add and
repeal Article 1.1 (commencing with Section 104260) to Chapter 4 of
Part 1 of Division 103 of the Health and Safety Code, relating to
diabetes.
LEGISLATIVE COUNSEL'S DIGEST
SB 1316, as amended, Cannella. Medi-Cal: Disease
Management Waiver. Diabetes: state programs.
Existing law establishes and sets forth the duties of the State
Department of Health Care Services, the State Department of Public
Health, and the Board of Administration of the Public Employees'
Retirement System (PERS), relating to, among other duties, the
administration of the Medi-Cal program, the administration of the
California Diabetes Program, and the administration of the Public
Employees' Medical and Hospital Care Act, respectively.
This bill would require those agencies to each submit a report to
the Legislature, no later than July 1, 2015, that includes specified
information, including the diabetes-related programs administered by
each agency and the diabetes-related contractual or statutory
requirements placed on a health care service plan contract or a
health insurance policy in the Medi-Cal program or on a health care
benefit plan or contract entered into with the Board of
Administration of PERS. The bill would state the intent of the
Legislature to coordinate a response that assesses the quality of
care of, and manages the costs paid for by, state-financed health
programs relating to the diabetes crisis.
Existing law establishes the Medi-Cal program, administered by the
State Department of Health Care Services, under which basic health
care services are provided to qualified low-income persons. Existing
law requires the department to apply for a waiver of federal law to
test the efficacy of providing a disease management benefit, as
described, to specified beneficiaries under the Medi-Cal program.
This bill would make a technical, nonsubstantive change to these
provisions.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Article 1.1 (commencing with Section
104260) is added to Chapter 4 of Part 1 of Division 103 of the
Health and Safety Code , to read:
Article 1.1. General Provisions
104260. (a) It is the intent of the Legislature to coordinate a
response that assesses the quality of, and manages the costs paid for
by, state-financed health programs relating to the diabetes crisis.
(b) No later than July 1, 2015, the following state agencies shall
submit a report to the Legislature with the following information:
(1) The State Department of Public Health shall submit a report
that includes the diabetes-related programs administered by the
department.
(2) The State Department of Health Care Services shall submit a
report that includes all of the following:
(A) The diabetes-related programs administered by the department.
(B) The diabetes-related contractual or statutory requirements
placed on a health care service plan contract or a health insurance
policy in the Medi-Cal program (Chapter 7 (commencing with Section
14000) of Part 3 of Division 9 of the Welfare and Institutions Code).
(C) The implementation of the requirements specified in
subparagraph (B) for each health care service plan contract or health
insurance policy.
(3) The Board of Administration of the Public Employees'
Retirement System shall submit a report that includes all of the
following:
(A) The diabetes-related programs administered by the board.
(B) The diabetes-related contractual or statutory requirements
placed on a health care benefit plan or contract entered into with
the board pursuant to the Public Employees' Medical and Hospital Care
Act (Part 5 (commencing with Section 22750) of Division 5 of Title 2
of the Government Code).
(C) The implementation of the requirements specified in
subparagraph (B) for each health care benefit plan or contract.
(c) A report submitted pursuant to subdivision (b) shall be
submitted in compliance with Section 9795 of the Government Code.
104261. This article shall remain in effect only until July 1,
2019, and as of that date is repealed, unless a later enacted
statute, that is enacted before July 1, 2019, deletes or extends that
date.
SECTION 1. Section 14132.27 of the Welfare and
Institutions Code is amended to read:
14132.27. (a) (1) The department shall apply for a waiver of
federal law pursuant to Section 1396n of Title 42 of the United
States Code to test the efficacy of providing a disease management
benefit to beneficiaries under the Medi-Cal program. A disease
management benefit shall include, but not be limited to, the use of
evidence-based practice guidelines, supporting adherence to care
plans, and providing patient education, monitoring, and healthy
lifestyle changes.
(2) The waiver developed pursuant to this section shall be known
as the Disease Management Waiver. The department shall submit any
necessary waiver applications or modifications to the Medicaid State
Plan to the federal Centers for Medicare and Medicaid Services to
implement the Disease Management Waiver, and shall implement the
waiver only to the extent federal financial participation is
available.
(b) The Disease Management Waiver shall be designed to provide
eligible individuals with a range of services that enable them to
remain in the least restrictive and most homelike environment while
receiving the medical care necessary to protect their health and
well-being. Services provided pursuant to this waiver program shall
include only those not otherwise available under the state plan, and
may include, but are not limited to, medication management,
coordination with a primary care provider, use of evidence-based
practice guidelines, supporting adherence to a plan of care, patient
education, communication and collaboration among providers, and
process and outcome measures. Coverage for those services shall be
limited by the terms, conditions, and duration of the federal waiver.
(c) Eligibility for the Disease Management Waiver shall be limited
to those persons who are eligible for the Medi-Cal program as aged,
blind, and disabled persons or those persons over 21 years of age who
are not enrolled in a Medi-Cal managed care plan, or eligible for
the federal Medicare program, and who are determined by the
department to be at risk of, or diagnosed with, select chronic
diseases, including, but not limited to, advanced atherosclerotic
disease syndromes, congestive heart failure, and diabetes.
Eligibility shall be based on the individual's medical diagnosis and
prognosis, and other criteria, as specified in the waiver.
(d) The Disease Management Waiver shall test the effectiveness of
providing a Medi-Cal disease management benefit. The department shall
evaluate the effectiveness of the Disease Management Waiver.
(1) The evaluation shall include, but not be limited to,
participant satisfaction, health and safety, the quality of life of
the participant receiving the disease management benefit, and
demonstration of the cost neutrality of the Disease Management Waiver
as specified in federal guidelines.
(2) The evaluation shall estimate the projected savings, if any,
in the budgets of state and local governments if the Disease
Management Waiver was expanded statewide.
(3) The evaluation shall be submitted to the appropriate policy
and fiscal committees of the Legislature on or before January 1,
2008.
(e) The department shall limit the number of participants in the
Disease Management Waiver during the initial three years of its
operation to a number that will be statistically significant for
purposes of the waiver evaluation and that meets any requirements of
the federal government, including a request to waive statewide
implementation requirements for the waiver during the initial years
of evaluation.
(f) In undertaking the Disease Management Waiver, the director may
enter into contracts for the purpose of directly providing Disease
Management Waiver services.
(g) The department shall seek all federal waivers necessary to
allow for federal financial participation under this section.
(h) The Disease Management Waiver shall be developed and
implemented only to the extent that funds are appropriated or
otherwise available for that purpose.
(i) The department shall not implement this section if any of the
following apply:
(1) The department's application for federal funds under the
Disease Management Waiver is not accepted.
(2) Federal funding for the waiver ceases to be available.