- Bill Information >>
- Bill Search >>
Text
Bill Text
Bill Information
Bill Start
CALIFORNIA LEGISLATURE—
2019–2020 REGULAR SESSION
| Assembly Bill | No. 1004 |
| Introduced by Assembly Member McCarty |
February 21, 2019 |
An act to amend Section 14087.48 of, to add Section 14132.195 to, and to add and repeal Section 14197.07 of, the Welfare and Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 1004, as introduced, McCarty.
Developmental screening services.
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, including Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services for any individual under 21 years of age who is covered under Medi-Cal consistent with the requirements under federal law. 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 services are provided is pursuant to contracts with various types of managed care plans.
Existing federal law provides that EPSDT services include periodic screening services, vision services, dental services, hearing services, and other necessary services to correct or ameliorate defects and physical and
mental illnesses and conditions discovered by the screening services, whether or not the services are covered under the state plan.
This bill would require, consistent with federal law, that screening services provided as an EPSDT benefit include developmental screening services for individuals zero to 3 years of age, inclusive. The bill would require the department to ensure a Medi-Cal managed care plan’s ability and readiness to perform these developmental screening services, and would require the department to adjust a Medi-Cal managed care plan’s capitation rate, as specified. Until July 1, 2023, the bill would require an external quality review organization entity to annually review, survey, and report on managed care plan reporting and compliance with specified developmental screening tools and schedules. The bill would also make legislative findings and declarations relating to child development.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NOBill Text
The people of the State of California do enact as follows:
SECTION 1.
The Legislature hereby finds and declares all of the following:(a) California is committed to the ongoing support of early childhood development as evidenced by the state’s promotion through initiatives and projects consistent with the California Children and Families Act of 1998. For the past 20 years, California’s state and county First 5 Commissions have been responsible for the implementation of comprehensive and integrated services, systems, and solutions designed to provide information and services promoting, supporting, and improving the early childhood development of children through the age of five years. These initiatives and projects address recognized needs related to children’s school readiness, including community
awareness, education, nurturing, childcare, social services, health care, and research.
(b) Despite gains in the past 20 years, not all children experience a clear path toward healthy development, making early identification of developmental concerns and timely connection to appropriate intervention essential to a child’s well-being.
(c) California’s overall rate of developmental screening remains low. The use of validated screening tools is inconsistent. The state’s oversight over the Medi-Cal managed care plans regarding effective screening is ineffective. As a result, many children are at risk for developmental delays or disabilities because these health issues are not identified in a timely fashion, thereby greatly reducing the effectiveness of applied interventions.
(d) California now aims to reinforce a
comprehensive, integrated, and coordinated health care system for California’s children, ranging from prenatal through five years of age, to improve the Medi-Cal fee-for-service and managed care delivery systems, and to enhance the Medi-Cal managed care plans’ obligations to advance a coordinated delivery system through diligent plan oversight and the targeted use of value-based purchasing by California through the plans.
(e) The Bright Futures Guidelines by the American Academy of Pediatrics provide evidence-driven guidance for all preventive care screenings and well-child visits, recommending that developmental surveillance include the periodic administration of a standardized developmental screening test.
(f) Developmental screenings assess a child’s educational, social, and emotional development and are recommended for children at nine months, 18 months, and 30 months of
age.
SEC. 2.
Section 14087.48 of the Welfare and Institutions Code is amended to read:14087.48.
(a) For purposes of this section, “Medi-Cal managed care plan” means any individual, organization, or entity that enters into a contract with the department pursuant to Article 2.7 (commencing with Section 14087.3), Article 2.8 (commencing with Section 14087.5), Article 2.81 (commencing with Section 14087.96), Article 2.9 (commencing with Section 14088), or Article 2.91 (commencing with Section 14089), or pursuant to Article 1 (commencing with Section 14200), or Article 7 (commencing with Section 14490) of Chapter 8.(b) Before a Medi-Cal managed care plan commences operations based upon an action of the director that expands the geographic area of Medi-Cal managed care, the department shall perform an evaluation to determine the readiness of any affected
Medi-Cal managed care plan to commence operations. The evaluation shall include, at a minimum, all of the following:
(1) The extent to which the Medi-Cal managed care plan demonstrates the ability to provide reliable service utilization and cost data, including, but not limited to, quarterly financial reports, audited annual reports, utilization reports of medical services, and encounter data.
(2) The extent to which the Medi-Cal managed care plan has an adequate provider network, including, but not limited to, the location, office hours, and language capabilities of primary care physicians and, if applicable, nonphysician medical practitioners, specialists, pharmacies, and hospitals, that the types of specialists in the provider network are based on the population makeup and particular geographic needs, and that whether requirements will be met for availability of services and
travel distance standards, as set forth in Sections 53852 and 53885, respectively, of Title 22 of the California Code of Regulations.
(3) The extent to which the Medi-Cal managed care plan has developed procedures for the monitoring and improvement of quality of care, including, but not limited to, procedures for retrospective reviews which that include patterns of practice reviews and drug prescribing practice reviews, utilization management mechanisms to detect both under- and over-utilization of health care services, mechanisms for ensuring timely and consistent developmental screenings of children in accordance with its contract with the department and Section 14132.195,
and procedures that specify timeframes for medical authorization.
(4) The extent to which the Medi-Cal managed care plan has demonstrated the ability to meet accessibility standards in accordance with Section 1300.67.2 of Title 28 of the California Code of Regulations, including, but not limited to, procedures for appointments, waiting times, telephone procedures, after hours calls, urgent care, and arrangement for the provision of unusual specialty services.
(5) The extent to which the Medi-Cal managed care plan has met all standards and guidelines established by the department that demonstrate readiness to provide services to enrollees.
(6) The extent to which the Medi-Cal managed care plan has submitted all required contract deliverables to the department, including, but not limited to, quality
improvement systems, utilization management, access and availability, member services, member grievance systems, and enrollments and disenrollments.
(7) The extent to which the Medi-Cal managed care plan’s Evidence of Coverage, Member Services Guide, or both, conforms to federal and state statutes and regulations, is accurate, and is easily understood.
(8) The extent to which the Medi-Cal managed care plan’s primary care and facility sites have been reviewed and evaluated by the department.
(c) The department shall ensure the Medi-Cal managed care plan’s ongoing ability and readiness to perform the obligations set forth in Section 14132.195. The department shall, as may be appropriate and in its discretion, adjust a Medi-Cal managed
care plan’s capitation rate to promote improved outcomes through value-based purchasing payment protocols to create improved incentives for outcomes.
SEC. 3.
Section 14132.195 is added to the Welfare and Institutions Code, immediately following Section 14132.19, to read:14132.195.
Consistent with federal law, screening services provided as an Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit pursuant to subdivision (v) of Section 14132 shall include developmental screening services for individuals zero to three years of age, inclusive. Developmental screening services shall comply with the periodicity schedule and the standardized and validated developmental screening tools that are established by the Bright Futures Guidelines and Recommendations for Preventive Pediatric Health Care, as established by the American Academy of Pediatrics, and by any future updates to this material. Developmental screening tools shall be administered in their entirety, and in adherence to, the specific tools’ recommended guidelines.SEC. 4.
Section 14197.07 is added to the Welfare and Institutions Code, to read:14197.07.
(a) As part of the federally required external quality review organization (EQRO) review of Medi-Cal managed care plans in the annual detailed technical report, as required by Section 438.364 of Title 42 of the Code of Federal Regulations, effective for contract periods commencing on or after July 1, 2020, the EQRO entity shall annually review, survey, and report on managed care plan reporting and compliance with the use of the validated developmental screening tools and periodicity schedule recommended by the American Academy of Pediatrics for children zero to three years of age, inclusive.(b) This section shall remain in effect only until July 1, 2023, and as of that date is repealed.