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AB-1004 Developmental screening services.(2019-2020)

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Date Published: 10/01/2019 02:00 PM
AB1004:v94#DOCUMENT

Assembly Bill No. 1004
CHAPTER 387

An act to add Sections 14132.195 and 14301.3 to, and to add and repeal Section 14197.07 of, the Welfare and Institutions Code, relating to Medi-Cal.

[ Approved by Governor  September 30, 2019. Filed with Secretary of State  September 30, 2019. ]

LEGISLATIVE COUNSEL'S DIGEST


AB 1004, 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, Diagnostic, 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, and existing law requires the department to pay capitation rates to the 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, and would require Medi-Cal managed care plans to ensure that providers who contract with these plans render those services in conformity with specified standards. 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 to adjust a Medi-Cal managed care plan’s capitation rate. Until July 1, 2023, the bill would require an external quality review organization (EQRO) entity to review and report annually on Medi-Cal managed care plan metrics for developmental screenings, and would require the department to use the EQRO’s technical report to monitor Medi-Cal managed care plans’ compliance with providing enrollees access to developmental screenings. The bill would also make legislative findings and declarations relating to child development.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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 14132.195 is added to the Welfare and Institutions Code, immediately following Section 14132.19, to read:

14132.195.
 (a) Consistent with federal law, screening services provided as an Early and Periodic Screening, Diagnostic, 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.
(b) Medi-Cal managed care plans shall ensure, and monitor compliance with, both of the following:
(1) Developmental screening services provided by providers who contract with Medi-Cal managed care plans 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.
(2) Developmental screening tools administered by providers who contract with Medi-Cal managed care plans are administered in their entirety, and in adherence to, the specific tools’ recommended guidelines.
(c) This section does not limit or restrict the scope of the EPSDT benefit, as required to be provided to eligible Medi-Cal beneficiaries under 21 years of age pursuant to Section 1396d(r) of Title 42 of the United States Code.
(d) This section does not limit or restrict blood lead screenings required under Chapter 5 (commencing with Section 105275) of Part 5 of Division 103 of the Health and Safety Code.

SEC. 3.

 Section 14197.07 is added to the Welfare and Institutions Code, to read:

14197.07.
 (a) (1) 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 review and report annually on Medi-Cal managed care plan metrics for developmental screenings included in the federal Centers for Medicare and Medicaid Services’ Core Set of Children’s Health Care Quality Measures for Medicaid and Children’s Health Insurance Program (CHIP).
(2) The department shall use the EQRO’s technical report to monitor Medi-Cal managed care plans’ compliance with providing enrollees access to developmental screenings pursuant to subdivision (v) of Section 14132.
(b) This section shall remain in effect only until July 1, 2023, and as of that date is repealed.

SEC. 4.

 Section 14301.3 is added to the Welfare and Institutions Code, to read:

14301.3.
 The department shall ensure that Medi-Cal managed care plans demonstrate 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 the capitation rate of a Medi-Cal managed care plan to promote improved outcomes through value-based purchasing payment protocols to create improved incentives for outcomes.