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AB-1117 Medi-Cal: vaccination rates.(2015-2016)

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AB1117:v97#DOCUMENT

Amended  IN  Assembly  June 01, 2015
Amended  IN  Assembly  March 26, 2015

CALIFORNIA LEGISLATURE— 2015–2016 REGULAR SESSION

Assembly Bill No. 1117


Introduced by Assembly Member Cristina Garcia

February 27, 2015


An act to add Article 6.3 (commencing with Section 14197) to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, relating to vaccinations.


LEGISLATIVE COUNSEL'S DIGEST


AB 1117, as amended, Cristina Garcia. Medi-Cal: vaccination rates.
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. Existing law requires each county to establish a community child health and disability prevention program to include, among other things, health screening and evaluation services for all children that include immunizations and an assessment of immunization status.
This bill would require the State Department of Health Care Services to establish and administer the California Childhood Immunization Quality Improvement Fund (CCIQIF) program to improve childhood immunization rates, and would require the department to submit an application to the federal Centers for Medicare and Medicaid Services for a waiver to implement a 5-year demonstration project to implement the program. The bill would require the department to develop a plan for the collection and expenditure of CCIQIF moneys according to specified guidelines, including voluntary contributions from Medi-Cal managed care plans to be used for provider support payments and reward payments to Medi-Cal managed care plans, as specified. The bill would require the department to contract with specified researchers to develop and submit to the Legislature an evaluation of the effectiveness of the demonstration project. This bill would make these provisions inoperative on a specified date.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 Article 6.3 (commencing with Section 14197) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read:
Article  6.3. California Childhood Immunization Quality Improvement Fund (CCIQIF) Program

14197.
 (a) The Legislature finds and declares all of the following:
(1) The 2014—15 2014–15 outbreaks of vaccine-preventable diseases threaten the health and safety of the California public.
(2) Only 71 percent of young children in California between the ages of 19 to 35 months are immunized, which is below the national average of 75 percent, according to 2010 data reported by the Kaiser Family Foundation.
(3) In 2013, 39,000 two year olds two-year-olds lacked one or more recommended immunizations, according to the State Department of Health Care Services.
(4) The social and direct economic costs of ensuring each child receives the Centers for Disease Control and Prevention Advisory Committee for Immunization Practices recommended schedule for vaccines far outweighs outweigh the costs of not providing routine immunizations. It is estimated that for every $1 one dollar ($1) spent on vaccinations, as many as $29 twenty-nine dollars ($29) can be saved in direct and indirect costs.
(5) California children are required to be fully vaccinated before they enter kindergarten, with some exceptions. However, there are no fewer official requirements for younger children who are often more susceptible to dire consequences from vaccine-preventable diseases.
(b) It is the intent of the Legislature, by enacting this chapter, to ensure that all possible steps are taken to ensure that two year old two-year-old children who are enrolled in Medi-Cal managed care receive all recommended immunizations.

14197.1.
 For purposes of this article, “Medi-Cal managed care plan” means any prepaid health plan or Medi-Cal managed care plan contracting with the department to provide services to enrolled Medi-Cal beneficiaries under this chapter or Chapter 8 (commencing with Section 14200).

14197.2.
 (a) The department shall establish and administer the California Childhood Immunization Quality Improvement Fund (CCIQIF) program to improve childhood immunization rates.
(b) (1) The department shall submit an application to the federal Centers for Medicare and Medicaid Services for a waiver or demonstration project to implement the CCIQIF program no later than 120 270 days after the operative date of this article. The department shall determine the form of waiver most appropriate to achieve the purposes of this article.
(2) The demonstration project shall operate for a period of five years.
(c) In developing the waiver or demonstration project application, the department shall consult with interested stakeholders, including the Medi-Cal Children’s Health Advisory Panel and the Managed Care Advisory Workgroup. The department shall work with stakeholders to incorporate public comment into the waiver or demonstration project application.

14197.3.
 The department shall develop a plan for the collection and expenditure of CCIQIF moneys according to all of the following guidelines:
(a) The CCIQIF program may be financed through voluntary contributions from Medi-Cal managed care plans that shall be used to draw down federal financial participation consistent with federal law.
(b) The department shall allocate 33.3 percent of CCIQIF expenditures for provider support payments for use by the department for administrative staff, training, and other resources to support providers in employing strategies to improve immunization rates in their practices, which may include patient reminders, promotion of colocation vaccination delivery with other services, and other strategies as specified by the department after consideration of public comment. The funds shall also be used to pay for the department’s staffing and administrative costs directly attributable to implementing this article, including costs related to developing and seeking federal approval for the CCIQIF and administering the fund.
(c) (1) The department shall allocate 66.7 percent of CCIQIF expenditures for reward payments to Medi-Cal managed care plans. The rate of the reward shall be $125 one hundred twenty-five dollars ($125) for each enrollee who receives all recommended vaccinations by the time he or she reaches two years of age, as determined by the Childhood Immunization Status measure of the Healthcare Effectiveness Data and Information Set (HEDIS).
(2) Any unearned reward payment expenditures shall roll over to the subsequent demonstration project year. If all reward payment expenditures are earned within a demonstration project year, no additional reward payments shall be distributed until the next demonstration project year begins.
(d) At least 20 percent of the CCIQIF expenditures used for reward payments pursuant to subdivision (c) shall be passed through to contracted providers based on the number of Medi-Cal enrollees who are under two years of age in each provider’s respective panel.

14197.4.
 (a) The department shall contract with the University of California or any other researchers to develop and submit, in compliance with Section 9795 of the Government Code, to the Legislature an evaluation of the effectiveness of the demonstration project using data collected from the first three years of the waiver period or demonstration project. That evaluation shall be submitted within the fourth year of the waiver period or demonstration project.
(b) The evaluation shall, at a minimum, include an assessment of the most effective administrative support strategies.
(c) The evaluation shall be financed with no more than five percent of the total annual CCIQIF program expenditure dollars. During the waiver or demonstration project year that the evaluation is commissioned, CCIQIF provider support expenditures shall be reduced, commensurate with available funds, to offset the cost of the evaluation contract.

14197.5.
 This chapter article shall be implemented only if and to the extent that federal financial participation is available and any necessary federal approvals have been obtained.

14197.6.
 (a) This chapter article shall become inoperative on the date that the Director of Health Care Services executes a declaration, which shall be retained by the director, stating that the demonstration project has concluded, and shall, six months after the date the declaration is executed, be repealed.
(b) In addition to the requirements specified in subdivision (a), the director shall post the declaration on the department’s Internet Web site and the director shall send the declaration to the appropriate policy committees of the Legislature and to the Legislative Counsel.