Bill Text: CA SB1477 | 2015-2016 | Regular Session | Introduced

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

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Bill Title: Health.

Spectrum: Moderate Partisan Bill (Democrat 7-2)

Status: (Passed) 2016-09-27 - Chaptered by Secretary of State. Chapter 733, Statutes of 2016. [SB1477 Detail]

Download: California-2015-SB1477-Introduced.html

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BILL NUMBER: SB 1477	INTRODUCED
	BILL TEXT


INTRODUCED BY   Committee on Health (Senators Hernandez (Chair),
Hall, Mitchell, Monning, Nguyen, Nielsen, Pan, Roth, and Wolk)

                        MARCH 9, 2016

   An act to amend Section 100500 of the Government Code, and to
amend Sections 101319, 123870, 123900, 123929, 123940, and 123955 of
the Health and Safety Code, relating to health.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 1477, as introduced, Committee on Health. Health.
   (1) Existing federal law, the federal Patient Protection and
Affordable Care Act (PPACA), enacts various health care coverage
market reforms that took effect January 1, 2014. Among other things,
PPACA requires each state, by January 1, 2014, to establish an
American Health Benefit Exchange that facilitates the purchase of
qualified health plans by qualified individuals and qualified small
employers. Existing state law establishes the California Health
Benefit Exchange (the Exchange) within state government, specifies
the powers and duties of the board governing the Exchange, and
requires the board to facilitate the purchase of qualified health
plans by qualified individuals and qualified small employers.
   This bill would state that the California Health Benefit Exchange
is also known as Covered California and would deem any reference to
the California Health Benefit Exchange or the Exchange to refer to
Covered California.
   (2) Under existing law, the Robert W. Crown California Children's
Services Act, the State Department of Health Care Services and each
county administers the California Children's Services Program (CCS
program) for treatment services for physically defective or
handicapped persons under 21 years of age, as specified. Existing law
authorizes, if a person is enrolled in the Health Families Program
or the AIM-Linked Infants Program, the financial documentation
required to establish eligibility for those programs to be used to
establish financial eligibility for treatment services under the CCS
program. Existing law transitions enrollees of the Healthy Families
Program to the Medi-Cal program and renamed the AIM-Linked Infants
Program as the Medi-Cal Access Program.
   This bill would change references to the Healthy Families Program
to the Medi-Cal program, and the AIM-Linked Infants Program to the
Medi-Cal Access Program. The bill would also make other technical,
nonsubstantive changes.
   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 100500 of the Government Code is amended to
read:
   100500.  (a) There is in state government the California Health
Benefit Exchange, an independent public entity not affiliated with an
agency or department, which shall  also  be known as
 the Exchange. The Exchange   Covered
California. Covered California  shall be governed by an
executive board consisting of five members who are residents of
California. Of the members of the board, two shall be appointed by
the Governor, one shall be appointed by the Senate Committee on
Rules, and one shall be appointed by the Speaker of the Assembly. The
Secretary of California Health and Human Services or his or her
designee shall serve as a voting, ex officio member of the board.
   (b) Members of the board, other than an ex officio member, shall
be appointed for a term of four years, except that the initial
appointment by the Senate Committee on Rules shall be for a term of
five years, and the initial appointment by the Speaker of the
Assembly shall be for a term of two years. Appointments by the
Governor made after January 2, 2011, shall be subject to confirmation
by the Senate. A member of the board may continue to serve until the
appointment and qualification of his or her successor. Vacancies
shall be filled by appointment for the unexpired term. The board
shall elect a chairperson on an annual basis.
   (c) (1) Each person appointed to the board shall have demonstrated
and acknowledged expertise in at least two of the following areas:
   (A) Individual health care coverage.
   (B) Small employer health care coverage.
   (C) Health benefits plan administration.
   (D) Health care finance.
   (E) Administering a public or private health care delivery system.

   (F) Purchasing health plan coverage.
   (G) Marketing of health insurance products.
   (H) Information technology system management.
   (I) Management information systems.
   (J) Enrollment counseling assistance, with priority to cultural
and linguistic competency.
   (2) Appointing authorities shall consider the expertise of the
other members of the board and attempt to make appointments so that
the board's composition reflects a diversity of expertise.
   (d) Each member of the board shall have the responsibility and
duty to meet the requirements of this title, the federal act, and all
applicable state and federal laws and regulations, to serve the
public interest of the individuals and small businesses seeking
health care coverage through the Exchange, and to ensure the
operational well-being and fiscal solvency of the Exchange.
   (e) In making appointments to the board, the appointing
authorities shall take into consideration the cultural, ethnic, and
geographical diversity of the state so that the board's composition
reflects the communities of California.
   (f) (1) A member of the board or of the staff of the Exchange
shall not be employed by, a consultant to, a member of the board of
directors of, affiliated with, or otherwise a representative of, a
carrier or other insurer, an agent or broker, a health care provider,
or a health care facility or health clinic while serving on the
board or on the staff of the Exchange. A member of the board or of
the staff of the Exchange shall not be a member, a board member, or
an employee of a trade association of carriers, health facilities,
health clinics, or health care providers while serving on the board
or on the staff of the Exchange. A member of the board or of the
staff of the Exchange shall not be a health care provider unless he
or she receives no compensation for rendering services as a health
care provider and does not have an ownership interest in a
professional health care practice.
   (2) A board member shall not receive compensation for his or her
service on the board, but may receive a per diem and reimbursement
for travel and other necessary expenses, as provided in Section 103
of the Business and Professions Code, while engaged in the
performance of official duties of the board.
   (3) For purposes of this subdivision, "health care provider" means
a person licensed or certified pursuant to Division 2 (commencing
with Section 500) of the Business and Professions Code, or licensed
pursuant to the Osteopathic Act or the Chiropractic Act.
   (g)  A member of the board shall not make, participate in making,
or in any way attempt to use his or her official position to
influence the making of a decision that he or she knows or has reason
to know will have a reasonably foreseeable material financial
effect, distinguishable from its effect on the public generally, on
him or her or a member of his or her immediate family, or on either
of the following:
   (1) Any source of income, other than gifts and other than loans by
a commercial lending institution in the regular course of business
on terms available to the public without regard to official status
aggregating two hundred fifty dollars ($250) or more in value
provided to, received by, or promised to the member within 12 months
prior to the time when the decision is made.
   (2) Any business entity in which the member is a director,
officer, partner, trustee, employee, or holds any position of
management.
   (h) There shall not be liability in a private capacity on the part
of the board or a member of the board, or an officer or employee of
the board, for or on account of an act performed or obligation
entered into in an official capacity, when done in good faith,
without intent to defraud, and in connection with the administration,
management, or conduct of this title or affairs related to this
title.
   (i) The board shall hire an executive director to organize,
administer, and manage the operations of the Exchange. The executive
director shall be exempt from civil service and shall serve at the
pleasure of the board.
   (j) The board shall be subject to the Bagley-Keene Open Meeting
Act (Article 9 (commencing with Section 11120) of Chapter 1 of Part 1
of Division 3 of Title 2), except that the board may hold closed
sessions when considering matters related to litigation, personnel,
contracting, and rates.
   (k) (1) The board shall apply for planning and establishment
grants made available to the Exchange pursuant to Section 1311 of the
federal act. If an executive director has not been hired under
subdivision (i) when the United States Secretary of Health and Human
Services makes the planning and establishment grants available, the
California Health and Human Services Agency shall, upon request of
the board, submit the initial application for planning and
establishment grants to the United States Secretary of Health and
Human Services.
   (2) If a majority of the board has not been appointed when the
United States Secretary of Health and Human Services makes the
planning and establishment grants available, the California Health
and Human Services Agency shall submit the initial application for
planning and establishment grants to the United States Secretary of
Health and Human Services. Any subsequent applications shall be made
as described in paragraph (1) once a majority of the members have
been appointed to the board.
   (3) The board shall be responsible for using the funds awarded by
the United States Secretary of Health and Human Services for the
planning and establishment of the Exchange, consistent with
subdivision (b) of Section 1311 of the federal act. 
   (l) Any reference to the California Health Benefit Exchange or the
Exchange is deemed to refer to Covered California. 
  SEC. 2.  Section 101319 of the Health and Safety Code is amended to
read:
   101319.  Due to the need to rapidly implement, and to provide
local health jurisdictions, hospitals, long-term health care
facilities, clinics, emergency medical systems, and poison control
centers  , or their trade associations,  with timely funding
for the purposes of, this article, funds appropriated in the annual
Budget Act or some other act for purposes of this article for the
2002-03 fiscal year and subsequent fiscal years shall be allocated
through the use of agreements, which shall not be subject to Part 2
(commencing with Section 10100) of Division 2 of the Public Contract
Code.
  SEC. 3.  Section 123870 of the Health and Safety Code is amended to
read:
   123870.  (a) The department shall establish standards of financial
eligibility for treatment services under the California Children's
Services Program (CCS program).
   (1) Financial eligibility for treatment services under this
program shall be limited to persons in families with an adjusted
gross income of forty thousand dollars ($40,000) or less in the most
recent tax year, as calculated for California state income tax
purposes.  If a person is enrolled in the Healthy Families
Program (Part 6.2 (commencing with Section 12693) of Division 2 of
the Insurance Code), the financial documentation required for that
program in Section 2699.6600 of Title 10 of the California Code of
Regulations may be used instead of the person's California state
income tax return.  If a person is enrolled in the Medi-Cal
program pursuant to Section 14005.26 of the Welfare and Institutions
Code, or enrolled in the  AIM-Linked Infants  
Medi-Cal Access  Program pursuant to Chapter 2 (commencing with
Section  15850)   15810)  of Part 3.3 of
Division 9 of the Welfare and Institutions Code, the financial
documentation required to establish eligibility for the respective
programs may be used instead of the person's California state income
tax return. However, the director may authorize treatment services
for persons in families with higher incomes if the estimated cost of
care to the family in one year is expected to exceed 20 percent of
the family's adjusted gross income.
   (2) Children enrolled in  the Healthy Families Program,
 the Medi-Cal program pursuant to Section 14005.26 of the
Welfare and Institutions  Code,   Code  or
the  AIM-Linked Infants   Medi-Cal Access 
Program pursuant to Chapter 2 (commencing with Section 
15850)   15810)  of Part 3.3 of Division 9 of the
Welfare and Institutions Code, who have a CCS program eligible
medical condition under Section 123830, and whose families do not
meet the financial eligibility requirements of paragraph (1), shall
be deemed financially eligible for CCS program benefits.
   (b) Necessary medical therapy treatment services under the
California Children's Services Program rendered in the public schools
shall be exempt from financial eligibility standards and enrollment
fee requirements for the services when rendered to any handicapped
child whose educational or physical development would be impeded
without the services.
   (c) All counties shall use the uniform standards for financial
eligibility and enrollment fees established by the department. All
enrollment fees shall be used in support of the California Children's
Services Program.
   (d) Annually, every family with a child eligible to receive
services under this article shall pay a fee of twenty dollars ($20),
that shall be in addition to any other program fees for which the
family is liable. This assessment shall not apply to any child who is
eligible for full scope Medi-Cal benefits without a share of cost,
for children receiving therapy through the California Children's
Services Program as a related service in their individualized
education plans, for children from families having incomes of less
than 100 percent of the federal poverty level, or for children
covered under the  Healthy Families Program  
  Medi-Cal program pursuant to Section 14005.26 of the
Welfare and Institutions Code  or the  AIM-Linked
Infants   Medi-Cal Access  Program.
  SEC. 4.  Section 123900 of the Health and Safety Code is amended to
read:
   123900.  (a)  Beginning September 1, 1991, in addition to any
other standards of eligibility pursuant to this article, each family
with a child otherwise eligible to receive services under this
article shall pay an annual enrollment fee as a requirement for
eligibility for services, except as specified in subdivision (f).
   (b)  The department shall determine the annual enrollment fee,
 that   which  shall be a sliding fee scale
based upon family size and income, and shall be adjusted by the
department to reflect changes in the federal poverty level.
   (c)  "Family size" shall include the child, his or her natural or
adoptive parents, siblings, and other family members who live
together and whose expenses are dependent upon the family income.
   (d)  "Family income" for purposes of this article, shall include
the total gross income, or their equivalents, of the child and his or
her natural or adoptive parents.
   (e)  Payment of the enrollment fee is a condition of program
participation. The enrollment fee is independent of any other
financial obligation to the program.
   (f)  The enrollment fee shall not be charged in any of the
following cases:
   (1)  The only services required are for diagnosis to determine
eligibility for services, or are for medically necessary therapy
pursuant to Section 123875.
   (2)  The child is otherwise eligible to receive services and is
eligible for full Medi-Cal benefits at the time of application or
reapplication.
   (3)  The family of the child otherwise eligible to receive
services under this article has a gross annual income of less than
200 percent of the federal poverty level.
   (4)  The family of a child otherwise eligible to receive services
under this article who is enrolled in the  Healthy Families
Program (Part 6.2 (commencing with Section 12693) of Division 2 of
the Insurance Code).     Medi-Cal  
program pursuant to Section 14005.26 of the Welfare and Institutions
Code. 
   (g)  Failure to pay or to arrange for payment of the enrollment
fee within 60 days of the due date shall result in disenrollment and
ineligibility for coverage of treatment services 60 days after the
due date of the required payment.
   (h)  The county shall apply the enrollment fee scale established
by the department and shall collect the enrollment fee. The county
may arrange with the family for periodic payment during the year if a
lump-sum payment will be a hardship for the family. The agency
director of California Children's Services may, on a case-by-case
basis, waive or reduce the amount of a family's enrollment fee if, in
the director's judgment, payment of the fee will result in undue
hardship.
   (i)  By thirty days after the effective date of this section or
August 1, 1991, whichever is later, the department shall advance to
each county, as a one-time startup amount, five dollars and fifty
cents ($5.50) for each county child who was receiving services under
this article on June 30, 1990, and who was not a Medi-Cal
beneficiary. This one-time payment shall be in addition to the 4.1
percent of the gross total expenditures for diagnoses, treatment, and
therapy by counties allowed under  subdivision (c) of
 Section 123955.
   (j)  Each county shall submit to the state, as part of its
quarterly claim for reimbursement, an accounting of all revenues due
and revenues collected as enrollment fees.
  SEC. 5.  Section 123929 of the Health and Safety Code is amended to
read:
   123929.  (a) Except as otherwise provided in this section and
Section 14133.05 of the Welfare and Institutions Code, California
Children's Services program services provided pursuant to this
article require prior authorization by the department or its
designee. Prior authorization is contingent on determination by the
department or its designee of all of the following:
   (1) The child receiving the services is confirmed to be medically
eligible for the CCS program.
   (2) The provider of the services is approved in accordance with
the standards of the CCS program.
   (3) The services authorized are medically necessary to treat the
child's CCS-eligible medical condition.
   (b) The department or its designee may approve a request for a
treatment authorization that is otherwise in conformance with
subdivision (a) for services for a child participating in the
 Healthy Families Program   Medi-Cal program
pursuant   to Section 14005.26 of the Welfare and
Institutions Code  or the  AIM-Linked Infants 
 Medi-Cal Access  Program pursuant to  clause (ii)
of subparagraph (A) of paragraph (6) of subdivision (a) of Section
12693.70 of the Insurance Code or  Chapter 2 (commencing
with Section 15810) of Part 3.3 of Division 9 of the Welfare and
Institutions Code, received by the department or its designee after
the requested treatment has been provided to the child.
   (c) If a provider of services who meets the requirements of
paragraph (2) of subdivision (a) incurs costs for services described
in paragraph (3) of subdivision (a) to treat a child described in
subdivision (b) who is subsequently determined to be medically
eligible for the CCS  program   program, 
as determined by the department or its designee, the department may
reimburse the provider for those costs. Reimbursement under this
section shall conform to the requirements of Section 14105.18 of the
Welfare and Institutions Code.
   (d) (1) By July 1, 2016, or a subsequent date determined by the
department, requests for authorization of services, excluding
requests for authorization of services submitted by dental providers
enrolled in the Medi-Cal Dental program, shall be submitted in an
electronic format determined by the department and shall be submitted
via the department's Internet Web site or other electronic means
designated by the department. The department may implement this
requirement in phases.
   (2) The department shall designate an alternate format for
submitting requests for authorization of services when the department'
s Internet Web site or other electronic means designated in paragraph
(1) are unavailable due to a system disruption.
   (3) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may, without taking regulatory action, implement,
interpret, or make specific this subdivision and any applicable
waivers and state plan amendments by means of all-county letters,
plan letters, plan or provider bulletins, or similar instructions.
Thereafter, the department shall adopt regulations by July 1, 2017,
in accordance with the requirements of Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code. The department shall consult with interested parties and
appropriate stakeholders in implementing this subdivision.
  SEC. 6.  Section 123940 of the Health and Safety Code is amended to
read:
   123940.  (a) (1) Annually, the board of supervisors shall
appropriate a sum of money for services for handicapped children of
the county, including diagnosis, treatment, and therapy services for
physically handicapped children in public schools, equal to 25
percent of the actual expenditures for the county program under this
article for the 1990-91 fiscal year, except as specified in paragraph
(2).
   (2) If the state certifies that a smaller amount is needed in
order for the county to pay 25 percent of costs of the county's
program from this source. The smaller amount certified by the state
shall be the amount that the county shall appropriate.
   (b) In addition to the amount required by subdivision (a), the
county shall allocate an amount equal to the amount determined
pursuant to subdivision (a) for purposes of this article from
revenues allocated to the county pursuant to Chapter 6 (commencing
with Section 17600)  of Part 5  of Division 9 of the Welfare
and Institutions Code.
   (c) (1) The state shall match county expenditures for this article
from funding provided pursuant to subdivisions (a) and (b).
   (2) County expenditures shall be waived for payment of services
for children who are eligible pursuant to paragraph (2) of
subdivision (a) of Section 123870.
   (d) The county may appropriate and expend moneys in addition to
those set forth in subdivision (a) and (b) and the state shall match
the expenditures, on a dollar-for-dollar basis, to the extent that
state funds are available for this article.
   (e) County appropriations under subdivisions (a) and (b) shall
include county financial participation in the nonfederal share of
expenditures for services for children who are enrolled in the
Medi-Cal program pursuant to Section 14005.26 of the Welfare and
Institutions Code, or the  AIM-Linked Infants  
Medi-Cal Access  Program pursuant to Chapter 2 (commencing with
Section  15850)   15810)  of Part 3.3 of
Division 9 of the Welfare and Institutions Code, and who are eligible
for services under this article pursuant to paragraph (1) of
subdivision (a) of Section 123870, to the extent that federal
financial participation is available at the enhanced federal
reimbursement rate under Title XXI of the federal Social Security Act
(42 U.S.C. Sec. 1397aa et seq.) and funds are appropriated for the
California Children's Services Program in the State Budget.
   (f)  Nothing in this   This  section
shall  not  require the county to expend more than the
amount set forth in subdivision (a) plus the amount set forth in
subdivision  (b)   (b),  nor shall it
require the state to expend more than the amount of the match set
forth in subdivision (c).
   (g) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department, without taking further regulatory action, shall implement
this section by means of California Children's Services numbered
letters.
  SEC. 7.  Section 123955 of the Health and Safety Code is amended to
read:
   123955.  (a) The state and the counties shall share in the cost of
administration of the California Children's Services Program at the
local level.
   (b) (1) The director shall adopt regulations establishing minimum
standards for the administration, staffing, and local implementation
of this article subject to reimbursement by the state.
   (2) The standards shall allow necessary flexibility in the
administration of county programs, taking into account the
variability of county needs and resources, and shall be developed and
revised jointly with state and county representatives.
   (c) The director shall establish minimum standards for
administration, staffing and local operation of the program subject
to reimbursement by the state.
   (d) Until July 1, 1992, reimbursable administrative costs, to be
paid by the state to counties, shall not exceed 4.1 percent of the
gross total expenditures for diagnosis, treatment and therapy by
counties as specified in Section 123940.
   (e) Beginning July 1, 1992, this subdivision shall apply with
respect to all of the following:
   (1) Counties shall be reimbursed by the state for 50 percent of
the amount required to meet state administrative standards for that
portion of the county caseload under this article that is ineligible
for Medi-Cal to the extent funds are available in the State Budget
for the California Children's Services Program.
   (2) Counties shall be reimbursed by the state for 50 percent of
the nonfederal share of the amount required to meet state
administrative standards for that portion of the county caseload
under this article that is enrolled in the Medi-Cal program pursuant
to Section 14005.26 of the Welfare and Institutions Code or the
 AIM-Linked Infants   Medi-Cal Access 
Program pursuant to Chapter 2 (commencing with Section 
15850)   15810)  of Part 3.3 of Division 9 of the
Welfare and Institutions Code, and who are eligible for services
under this article pursuant to subdivision (a) of Section 123870, to
the extent that federal financial participation is available at the
enhanced federal reimbursement rate under Title XXI of the federal
Social Security Act (42 U.S.C. Sec. 1397aa et seq.) and funds are
appropriated for the California Children's Services Program in the
State Budget.
   (3) On or before September 15 of each year, each county program
implementing this article shall submit an application for the
subsequent fiscal year that provides information as required by the
state to determine if the county administrative staff and budget meet
state standards.
   (4) The state shall determine the maximum amount of state funds
available for each county from state funds appropriated for CCS
county administration. If the amount appropriated for any fiscal year
in the Budget Act for county administration under this article
differs from the amounts approved by the department, each county
shall submit a revised application in a form and at the time
specified by the department.
   (f) The department and counties shall maximize the use of federal
funds for administration of the programs implemented pursuant to this
article, including using state and county funds to match funds
claimable under Title XIX or Title XXI of the federal Social Security
Act (42 U.S.C. Sec. 1396 et seq.; 42 U.S.C. Sec. 1397aa et seq.).