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AB-652 Child health.(2011-2012)

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Amended  IN  Assembly  May 10, 2011
Amended  IN  Assembly  April 25, 2011

CALIFORNIA LEGISLATURE— 2011–2012 REGULAR SESSION

Assembly Bill
No. 652


Introduced  by  Assembly Member Mitchell
(Coauthor(s): 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 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 health care service plans licensed pursuant to the Knox-Keene Health Care Service Plan Act of 1973 Act, 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   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 pursuant to Section 324.5 of the Welfare and Institutions Code. A forensic medical evaluation includes, but is not limited to, diagnostic testing to the extent necessary to provide a complete evaluation.
(3) “Qualified medical professional” means a medical practitioner who has specialized training in detecting and treating child abuse injuries and neglect pursuant to Section 324.5 of the Welfare and Institutions Code.
(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) 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) 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.
(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 pursuant to Section 324.5 of the Welfare and Institutions Code. A forensic medical evaluation includes, but is not limited to, diagnostic testing to the extent necessary to provide a complete evaluation.
(3) “Qualified medical professional” means a medical practitioner who has specialized training in detecting and treating child abuse injuries and neglect pursuant to Section 324.5 of the Welfare and Institutions Code.
(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) 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.
(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 14087.306 is added to the Welfare and Institutions Code, to read:

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 pursuant to Section 324.5. A forensic medical evaluation includes, but is not limited to, diagnostic testing to the extent necessary to provide a complete evaluation.
(3) “Qualified medical professional” means a medical practitioner who has specialized training in detecting and treating child abuse injuries and neglect pursuant to Section 324.5.
(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) 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.
(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.