Bill Text: CA SB1316 | 2013-2014 | Regular Session | Introduced

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

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Bill Title: Diabetes: state programs.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2014-04-22 - Re-referred to Com. on RLS. [SB1316 Detail]

Download: California-2013-SB1316-Introduced.html

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BILL NUMBER: SB 1316	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Cannella

                        FEBRUARY 21, 2014

   An act to amend Section 14132.27 of the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 1316, as introduced, Cannella. Medi-Cal: Disease Management
Waiver.
   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.
State-mandated local program: no.


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

  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  this   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.