Bill Text: CA SB424 | 2023-2024 | Regular Session | Introduced

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

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Bill Title: The Broadband Infrastructure Grant Account and Federal Funding Account.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Engrossed - Dead) 2024-08-15 - August 15 hearing: Held in committee and under submission. [SB424 Detail]

Download: California-2023-SB424-Introduced.html

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CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Senate Bill

No. 424

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Introduced by Senator Durazo

February 13, 2023

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An act to amend Sections 123860, 123870, and 123875 of, and to add Sections 123831, 123832, and 123833 to, the Health and Safety Code, and to amend Sections 14094.3 and 14094.5 of the Welfare and Institutions Code, relating to children’s health.

LEGISLATIVE COUNSEL'S DIGEST

SB 424, as introduced, Durazo. California Children’s Services Program.

(1) Existing law establishes the California Children’s Services (CCS) Program, administered by the State Department of Health Care Services and a designated agency of each county, to provide medically necessary services for persons under 21 years of age who have any of specified medical conditions and who meet certain financial eligibility requirements.

Under existing law, CCS-eligible medical conditions include, among others, cystic fibrosis and hemophilia, and other conditions set forth by the Director of Health Care Services.

This bill would statutorily expand the list of CCS-eligible medical conditions to include those conditions that are specified in existing CCS-related regulations. The bill would, commencing no later than January 1, 2026, and every 5 years thereafter, require the department to consult with, at a minimum, CCS medical directors and experts from the department’s CCS technical advisory committees, to consider the addition of other medical conditions to the list, by regulation. The bill would make conforming changes to related provisions.

(2) This bill would, commencing on January 1, 2025, and subject to an appropriation, for a child who has an eligible medical condition, but who is not financially eligible for the CCS Program, require the department to provide financial assistance for out-of-pocket costs not covered by the child’s health care coverage, as specified, if those costs are for medically necessary services to treat a CCS-eligible medical condition. The bill would require the department to establish a procedure for providing that financial assistance.

(3) This bill would, commencing on January 1, 2025, require the department to provide a sustainability and access payment of $500 to a hospital or CCS special care center for every CCS-enrolled child seen in the hospital or center, with annual adjustments for inflation, as specified.

The bill would, for medically necessary treatments provided during the 2025 calendar year, require the department to adjust CCS payment rates for physician services, reflecting the cumulative effect of inflation, as specified. Under the bill, commencing on January 1, 2026, those payments would be updated annually to reflect the effect of inflation.

The bill would require the department to provide reimbursements for lifesaving specialty drugs prescribed and administered to a CCS-enrolled child for a CCS-eligible medical condition, as specified.

The bill would condition implementation of the provisions in this paragraph on receipt of any necessary federal approval and, for purposes of the physician-related payment rate increases and drug-related reimbursements, on the availability of federal financial participation.

The bill would also condition implementation of the provisions in this paragraph on an appropriation. The bill would state the intent of the Legislature that any consideration of a future appropriation for these provisions be made in accordance with legislative findings concerning subsequent deficits.

(4) By increasing the duties of counties relating to the administration of the CCS Program through the above-described provisions, the bill would impose a state-mandated local program.

(5) Existing law establishes the Medi-Cal program, which is administered by the department and 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. Existing law establishes a Whole Child Model program for Medi-Cal eligible CCS children and youth enrolled in a Medi-Cal managed care plan served by a county organized health system or Regional Health Authority, or, commencing no sooner than January 1, 2024, an alternate health care service plan, in certain listed counties.

This bill would specify that only those listed counties are authorized for the Whole Child Model program.

Existing law prohibits the incorporation of CCS-covered services into a Medi-Cal managed care contract entered into after August 1, 1994, pursuant to specified provisions, until January 1, 2022, and until a certain related evaluation has been completed, except for contracts entered into under the Whole Child Model program or for county organized health systems or Regional Health Authority, as specified.

This bill would extend that prohibition indefinitely by removing the expiration set for January 1, 2022, and for completion of the evaluation.

(6) 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, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

Digest Key

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

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Bill Text

The people of the State of California do enact as follows:

SECTION 1.

 The Legislature finds and declares all of the following:

(a) The California Children’s Services (CCS) Program was established in 1927 and has provided lifesaving health care to millions of critically ill children.

(b) The CCS Program targets aid to children with eligible medical conditions, including cystic fibrosis, hemophilia, cerebral palsy, congenital heart disease, certain cancers, and traumatic debilitating injuries, among other serious medical conditions.

(c) Nearly 200,000 children receive world-class specialized medical care by the CCS Program each year.

(d) The success of the CCS Program is directly related to its focused approach through both of the following:

(1) Identifying very sick children eligible for the program as early as possible to provide lifesaving medical care, to prevent long-term disability, and to provide both immediate and long-term specialized care to those children.

(2) Serving as the payor of last resort, and providing financial assistance to families who are unable to pay for all of the specialized medical care needed for their child.

(e) To improve access to, and the quality of, health care for these children, the Legislature hereby intends to amend the CCS Program in order to accomplish all of the following:

(1) Alignment of the financial eligibility for the CCS Program with eligibility for subsidized coverage under the California Health Benefit Exchange, also known as Covered California, which was established pursuant to the federal Patient Protection and Affordable Care Act.

(2) Right-sized investments in CCS services and providers, to ensure the program is sustainable and accessible to children with life-threatening health conditions.

(3) Coverage of the costs of lifesaving specialty drugs.

SEC. 2.

 Section 123831 is added to the Health and Safety Code, to read:

123831.

 (a) In addition to the medical conditions listed in Section 123830, the California Children’s Services (CCS) Program shall provide services to children under 21 years of age with the medical conditions listed in Sections 41515.1 to 41518.9, inclusive, of Title 22 of the California Code of Regulations, as those sections were in effect on January 1, 2022.

(b) Commencing no later than January 1, 2026, and every five years thereafter, the department shall consult with, at a minimum, CCS medical directors and experts from the department’s CCS technical advisory committees, to consider the addition of other medical conditions to the list, by regulation.

SEC. 3.

 Section 123832 is added to the Health and Safety Code, to read:

123832.

 (a) (1) Commencing on January 1, 2025, for a child who has an eligible medical condition under Section 123830 or 123831, but who is not financially eligible for the CCS Program pursuant to subdivision (a) of Section 123870, the department shall provide financial assistance for out-of-pocket costs not covered by the child’s health care coverage, if those costs are for medically necessary services to treat a CCS-eligible medical condition.

(2) For purposes of paragraph (1), “out-of-pocket costs not covered by the child’s health care coverage” shall be limited to any costs for medically necessary services to treat a CCS-eligible medical condition that would have been covered had the child been enrolled in a silver plan under the California Health Benefit Exchange, also known as Covered California, established pursuant to Section 100500 of the Government Code.

(b) The department shall establish a procedure for providing the financial assistance described in subdivision (a).

(c) Implementation of this section shall be subject to an appropriation made by the Legislature for the purpose of this section.

SEC. 4.

 Section 123833 is added to the Health and Safety Code, to read:

123833.

 (a) In order to ensure that children served by the California Children’s Services (CCS) Program continue to have access to lifesaving care, the department shall do all of the following:

(1) (A) Commencing on January 1, 2025, provide a sustainability and access payment of five hundred dollars ($500) to a hospital or CCS special care center for every CCS-enrolled child seen in the hospital or CCS special care center.

(B) For purposes of subparagraph (A), “child seen” means a CCS special care center outpatient visit or a hospital inpatient day for a CCS-eligible condition.

(C) The payments described in subparagraph (A) shall be adjusted annually for inflation and shall not do any of the following:

(i) Constitute Medi-Cal payments or patient care payments.

(ii) Supplant or reduce any other financial obligations of the state for services provided by those facilities.

(iii) Be offset by the state for any other purpose.

(iv) Be included in the calculation of low-income percent or the OBRA 1993 payment limitation, as defined in paragraph (24) of subdivision (a) of Section 14105.98 of the Welfare and Institutions Code, for purposes of determining payments to private hospitals.

(D) The department shall establish a procedure for reporting hospital inpatient days and CCS special care center outpatient visits and shall provide for payment pursuant to this paragraph to hospitals and CCS special care centers on an annual basis.

(2) (A) For medically necessary treatments provided during the 2025 calendar year, adjust CCS payment rates for physician services provided to children under the CCS Program, established pursuant to subdivision (l) of Section 51503 of Title 22 of the California Code of Regulations, as that subdivision was in effect on January 1, 2022, to reflect the cumulative effect of inflation for the period between January 1, 2002, and January 1, 2025, inclusive.

(B) Commencing on January 1, 2026, CCS payments for physician services provided to children under the CCS Program shall be updated annually to reflect the effect of inflation.

(3) (A) Notwithstanding any other law, provide reimbursements, in a site-neutral manner, for lifesaving specialty drugs prescribed and administered to a CCS-enrolled child for a CCS-eligible medical condition.

(B) For lifesaving specialty drugs that are provided on an inpatient basis, the department shall reimburse a hospital for the cost to acquire and administer the drug. The reimbursement shall not be included as part of any payment made pursuant to Section 14105.28 of the Welfare and Institutions Code.

(C) For purposes of this paragraph, “lifesaving specialty drug” means a drug described in paragraph (3) of subdivision (b) of Section 127681.

(D) The department shall establish a procedure for reimbursements under this paragraph.

(b) (1) This section shall be implemented only to the extent that any necessary federal approvals are obtained and, for purposes of paragraphs (2) and (3) of subdivision (a), only to the extent that federal financial participation is available.

(2) The Director of Health Care Services shall seek all necessary federal approvals to obtain federal financial participation for payment adjustments and reimbursements described in paragraphs (2) and (3) of subdivision (a).

(c) (1) Implementation of this section shall be subject to an appropriation made by the Legislature for the purpose of this section.

(2) It is the intent of the Legislature that any consideration of a future appropriation for the purpose of this section be made in accordance with Section 11 of the act that added this section.

SEC. 5.

 Section 123860 of the Health and Safety Code is amended to read:

123860.

 In accordance with applicable regulations of the United States Children’s Bureau, the department and designated county agencies shall provide a diagnosis for handicapped children. Within the limits of available funds, the department and designated local agencies may accept for diagnosis a handicapped child believed to have a severe chronic disease or severe physical handicap, as determined by the director, irrespective of whether the child actually has an eligible medical condition specified in Section 123830. 123830 or 123831. The department shall cause a record to be kept listing all conditions diagnosed by the program and shall publish the information annually, including data on the number and kinds of diagnosed medical conditions that do not come within the definition of “handicapped child” as specified in Section 123830. 123830 or within the scope of Section 123831.

SEC. 6.

 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 Medi-Cal program pursuant to Section 14005.26 of the Welfare and Institutions Code, or enrolled in the Medi-Cal Access Program pursuant to Chapter 2 (commencing with Section 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 Medi-Cal program pursuant to Section 14005.26 of the Welfare and Institutions Code or the Medi-Cal Access Program pursuant to Chapter 2 (commencing with Section 15810) of Part 3.3 of Division 9 of the Welfare and Institutions Code, who have a CCS program eligible CCS-eligible medical condition under Section 123830, 123830 or 123831, 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 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 Medi-Cal program pursuant to Section 14005.26 of the Welfare and Institutions Code or the Medi-Cal Access Program.

SEC. 7.

 Section 123875 of the Health and Safety Code is amended to read:

123875.

 If the California Children’s Service medical therapy unit conference team, based on a medical referral recommending medically necessary occupational or physical therapy in accordance with subdivision (b) of Section 7575 of the Government Code, finds that a handicapped child, as defined in Section 123830, 123830 or who has another eligible medical condition pursuant to Section 123831, needs medically necessary occupational or physical therapy, that child shall be determined to be eligible for therapy services. If the California Children’s Services medical consultant disagrees with the determination of eligibility by the California Children’s Services medical therapy unit conference team, the medical consultant shall communicate with the conference team to ask for further justification of its determination, and shall weigh the conference team’s arguments in support of its decision in reaching his or her their own determination.

This section shall not change eligibility criteria for the California Children’s Services programs as described in Sections 123830 123830, 123831, and 123860.

This section shall not apply to children diagnosed as specific learning disabled, unless they otherwise meet the eligibility criteria of the California Children’s Services.

SEC. 8.

 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 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 1 (commencing with Section 14200), or Article 7 (commencing with Section 14490) of Chapter 8, until January 1, 2022, and until the evaluation required pursuant to Section 14094.18 has been completed, or any other law, except for contracts entered into pursuant to the Whole Child Model program, as described in Article 2.985 (commencing with Section 14094.4), or 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 CCS-covered services on a fee-for-service basis until CCS covered 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 the 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) For purposes of this section, CCS covered 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.

(e) This section shall not 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.

SEC. 9.

 Section 14094.5 of the Welfare and Institutions Code is amended to read:

14094.5.

 No sooner than July 1, 2017, the department may establish a Whole Child Model program for Medi-Cal eligible CCS children and youth enrolled in a managed care plan served by a county organized health system or Regional Health Authority, or commencing no sooner than January 1, 2024, an alternate health care service plan contracted with the department pursuant to Section 14197.11, only in the following counties: Del Norte, Humboldt, Lake, Lassen, Marin, Mendocino, Merced, Modoc, Monterey, Napa, Orange, San Luis Obispo, San Mateo, Santa Barbara, Santa Cruz, Shasta, Siskiyou, Solano, Sonoma, Trinity, and Yolo.

SEC. 10.

 If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.

SEC. 11.

 (a) It is the intent of the Legislature that this section be considered for the purpose of any appropriation made to implement Section 123833 of the Health and Safety Code, as added by the act that added this section.

(b) If the Director of Finance certifies that the state General Fund would be in a deficit in the following fiscal year, the Governor may, on or before July 1 of that fiscal year, notify the Legislature of the Governor’s recommendation that an appropriation not be made for any sustainability and access payments, inflation-based increases to payment rates for physician services, or reimbursements for lifesaving specialty drugs, as related to the California Children’s Services (CCS) Program, as described in Section 123833 of the Health and Safety Code, for the following fiscal year. It is the intent of the Legislature that any temporary suspension of those payments, rate increases, or reimbursements not exceed two consecutive fiscal years.