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AB-2579 Medi-Cal: California Special Supplemental Nutrition Program for Women, Infants, and Children.(2017-2018)

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Date Published: 03/24/2018 04:00 AM
AB2579:v98#DOCUMENT

Revised  May 25, 2018
Amended  IN  Assembly  March 23, 2018

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 2579


Introduced by Assembly Member Burke
(Coauthors: Assembly Members Arambula, Wood, Chiu, Friedman, and Gonzalez Fletcher)

February 15, 2018


An act to amend Section 14087.3 of add Section 14124.14 to the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 2579, as amended, Burke. Medi-Cal: managed care contracts. California Special Supplemental Nutrition Program for Women, Infants, and Children.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services 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 the Medi-Cal Access Program, which provides health care services to a woman who is pregnant or in her postpartum period and whose household income is within specified thresholds of the federal poverty level, and to a child under 2 years of age who is delivered by a mother enrolled in the program, as specified.
Existing federal law authorizes a state to provide in its Medicaid state plan that in determining eligibility under the federal Medicaid Program for a child, the state is authorized to rely on a finding made within a reasonable period from an Express Lane agency, as defined, when it determines whether a child satisfies one or more components of eligibility for medical assistance under the federal Medicaid Program.
Existing law establishes the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program), which is administered by the State Department of Public Health and counties and under which nutrition and other assistance are provided to eligible low-income postpartum and lactating women, infants, and children under 5 years of age, who have been determined to be at nutritional risk.
Existing law requires the former Managed Risk Medical Insurance Board and former State Department of Health Services, in collaboration with program offices for the WIC Program and other designated entities, to design, promulgate, and implement policies and procedures for an automated enrollment gateway system, subject to appropriation, allowing children applying to the WIC Program to obtain presumptive eligibility for, and to facilitate application for enrollment in, the Medi-Cal program or the former Healthy Families Program, to the extent federal financial participation is available, as specified.
This bill would require the State Department of Health Care Services, in collaboration with the same designated entities, to design, promulgate, and implement policies and procedures for an automated enrollment gateway system, operational no later than January 1, 2019, allowing children applying to the WIC Program to obtain express lane eligibility for, and to facilitate application for enrollment in, the Medi-Cal program, and allowing pregnant women applying to the WIC Program to obtain presumptive eligibility for the Medi-Cal program or the Medi-Cal Access Program, to the extent federal financial participation is available. The bill would also require the system to perform specified functions relating to the eligibility of those persons under the programs. The bill would require the department to seek approval of any amendments to the state plan necessary to implement these provisions, and would condition the implementation of the provisions on the department obtaining all necessary federal approvals. Because counties are responsible for making eligibility determinations under the Medi-Cal program, by revising eligibility requirements, this 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, 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.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, pursuant to which medical benefits are provided to qualified low-income persons. Existing law authorizes the department to contract with various types of health care providers and entities in order to obtain Medi-Cal services through managed care arrangements.

This bill would make technical, nonsubstantive changes to those provisions.

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

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


SECTION 1.

 Section 14124.14 is added to the Welfare and Institutions Code, to read:

14124.14.
 (a) The department, in collaboration with program offices for the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC or the WIC Program), local WIC agencies, counties in their capacity of making Medi-Cal eligibility determinations, advocates, information technology specialists, and other stakeholders, shall design, promulgate, and implement policies and procedures for an automated enrollment gateway system developed by the department that performs, but is not limited to performing, all of the following functions:
(1) To the extent that federal financial participation is available, allowing children applying to the WIC Program to submit a simple electronic application to simultaneously obtain express lane eligibility for the Medi-Cal program under Title XIX (42 U.S.C. Sec. 1396 et seq.) and Title XXI (42 U.S.C. Sec. 1397aa et seq.) of the federal Social Security Act and, for children, apply for enrollment into the Medi-Cal program with the consent of their parent or guardian, and allowing pregnant women applying to the WIC Program to submit a simple electronic application to simultaneously obtain presumptive eligibility for the Medi-Cal program or the Medi-Cal Access Program (MCAP).
(2) Modifying the existing WIC enrollment system to obtain the minimum required data for enrollment in the Medi-Cal program in order to provide an electronic transactional platform that is connected to the simple electronic application referenced in paragraph (1) and allowing for an interface between that WIC application, the Medi-Cal Eligibility Data System (MEDS), and the Medi-Cal program.
(3) Providing an automated real-time connection with MEDS for the purpose of checking an applicant’s enrollment status and registering express lane eligibility or presumptive eligibility status.
(4) Allowing for the electronic transfer of information to the Medi-Cal program for the purpose of completing the application and making the final eligibility determination.
(5) Checking, as relevant, available government databases for the purpose of electronically receiving information that is necessary to allow the Medi-Cal program to complete the eligibility determination. The department shall comply with all applicable privacy and confidentiality provisions under federal and state law.
(b) The automated enrollment gateway system shall be constructed with the capacity to be used by entities operating the WIC Program and entities operating the Medi-Cal program.
(c) The WIC application process shall be modified to provide an electronic application described in subdivision (a), which shall contain the information necessary to apply for automated Medi-Cal enrollment, and supplemented by the Medi-Cal program with any additional information required to apply for enrollment into the Medi-Cal program.
(d) Benefits for applicants opting to simultaneously obtain express lane eligibility or presumptive eligibility for enrollment under this section shall continue until a final eligibility determination is made for the Medi-Cal program pursuant to Section 14011.8.
(e) Operation of the automated enrollment gateway system by the WIC Program, the Medi-Cal program, and MCAP shall occur within a timely and appropriate period as determined by the department, in consultation with the stakeholders as provided in subdivision (a), but no later than January 1, 2019. The automated enrollment gateway system shall comply with all applicable confidentiality and privacy protection in federal and state law and regulation.
(f) The WIC Program shall collect income and residency information necessary for the Medi-Cal program documentation requirements for applications submitted through the automated enrollment gateway system. To the extent allowed by the federal government, the Medi-Cal program shall rely on income and residency information obtained by the WIC Program and upon the income verification process performed by the WIC Program. The Medi-Cal program shall collect and verify citizenship and immigration information as required under that program.
(g) Consistent with this section, the Medi-Cal program may collect additional information needed to verify eligibility in that program.
(h) Counties shall accept and process applications provided by the WIC gateway system for Medi-Cal eligibility determination and ensure timely processing of these applications and a timely eligibility determination and, for pregnant women, ending of presumptive eligibility.
(i) The express lane eligibility benefits provided under this section shall be identical to the benefits provided to children who receive full-scope Medi-Cal benefits without a share of cost, and shall only be made available through a Medi-Cal provider.
(j) The confidentiality and privacy protections set forth in Sections 10850 and 14100.2 and all other confidentiality and privacy protections in federal and state law and regulation shall apply to all children and families using the automated enrollment gateway system as described in this section.
(k) The state shall promote and offer support to the WIC Program for the use of the simple electronic application and the automated enrollment gateway system.
(l) The department shall seek approval of any amendments to the state plan necessary to implement this section, in accordance with Title XIX (42 U.S.C. Sec. 1396 et seq.) of the federal Social Security Act. Notwithstanding any other law, this section shall be implemented only if all necessary federal approvals have been obtained.

SEC. 2.

 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.
SECTION 1.Section 14087.3 of the Welfare and Institutions Code is amended to read:
14087.3.

(a)The director may contract, on a bid or nonbid basis, with a qualified individual, organization, or entity to provide services to, arrange for, or case manage the care of Medi-Cal beneficiaries. At the director’s discretion, the contract may be exclusive or nonexclusive, statewide, or on a more limited geographic basis, and include provisions to do the following:

(1)Perform targeted case management of selected services or beneficiary populations where it is expected that case management will reduce program expenditures.

(2)Provide for delivery of services in a manner consistent with managed care principles, techniques, and practices directed at ensuring the most cost-effective and appropriate scope, duration, and level of care.

(3)Provide for alternate methods of payment, including, but not limited to, a prospectively negotiated reimbursement rate, fee-for-service, retainer, capitation, shared savings, volume discounts, lowest bid price, negotiated price, rebates, or other basis.

(4)Secure services directed at any or all of the following:

(A)Recruiting and organizing providers to care for Medi-Cal beneficiaries.

(B)Designing and implementing fiscal or other incentives for providers to participate in the Medi-Cal program in cost-effective ways.

(C)Linking beneficiaries with cost-effective providers.

(5)Provide for:

(A)Medi-Cal managed care plans contracting under this chapter or Chapter 8 (commencing with Section 14200) to share in the efficiencies and economies realized by those contracts.

(B)Effective coordination between contractors operating under this article and Medi-Cal managed care plans in the management of health care provided to Medi-Cal beneficiaries.

(6)Permit individual physicians, groups of physicians, or other providers to participate in a manner that supports the organized system mode of operation.

(7)Encourage group practices with relationships with hospitals having low unit costs.

(b)The director may require individual physicians, groups of physicians, or other providers as a condition of participation under the Medi-Cal program, to enter into capitated contracts pursuant to this section in order to correct or prevent irregular or abusive billing practices. No physician, groups of physicians, or other providers shall be reimbursed for services rendered to Medi-Cal beneficiaries if the physician, group of physicians, or other providers has declined to enter into a contract required by the director pursuant to this section.

(c)The department shall seek federal waivers necessary to allow for federal financial participation under this section.

(d)(1)Notwithstanding the provisions of this chapter, the department shall determine preliminary per capita rates of payment for services provided to Medi-Cal beneficiaries enrolled in a managed care program contracting in areas specified by the director for expansion of the Medi-Cal managed care program under this section, or Section 14018.7, 14087.31, 14087.35, 14087.36, 14087.38, or 14087.96. The department shall provide to each managed care plan the preliminary contract rates and source documents at least 60 days prior to the effective date of each new rate period.

(2)On or before June 1, 1999, the department shall enter into a memorandum of understanding with the managed care plans subject to paragraph (1) regarding the development of capitation rates. This memorandum of understanding, which is intended to ensure that capitation rates become effective in a timely manner and remain stable throughout the rate year, shall establish all of the following:

(A)A process and timetable for the managed care plans to review and comment on any modifications in the rate development methodology.

(B)A process and timetable for managed care plans to provide comments on the draft rates.

(C)A process and timetable for the department to respond to managed care plan comments on the draft rates.

(D)A process and timetable to managed care finalize capitation rates.

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REVISIONS:
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