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AB-990 Medi-Cal managed care plans: financial incentives.(2019-2020)

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Date Published: 03/28/2019 09:00 PM
AB990:v98#DOCUMENT

Amended  IN  Assembly  March 28, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 990


Introduced by Assembly Member Gallagher

February 21, 2019


An act to add Section 14197.25 to and repeal Section 14197.25 of the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 990, as amended, Gallagher. Medi-Cal: Medi-Cal managed care plans: financial incentives.
Existing law provides for establishes 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 services are provided is pursuant to contracts with various types of managed care health plans. Existing law authorizes a Medi-cal Medi-Cal managed care contractor to offer nonmonetary incentives to promote good health practices by its Medi-cal Medi-Cal enrollees.

This bill would express the intent of the Legislature to enact legislation that would require Medi-Cal managed care plans to offer financial incentives to enrollees for their improved wellness activities, as specified.

This bill would require a Medi-Cal managed care plan contract entered into, or amended, on or after January 1, 2021, to require the contracting Medi-Cal managed care plan to offer financial incentives to its existing enrollees for the purpose of promoting participation in preventive health or wellness activities, as specified, for a value of at least $100 annually per participating enrollee.
The bill would require the Medi-Cal managed care plan to annually evaluate its financial incentive programs and to submit an annual report to the department. The bill would require the department to submit a report to the Legislature detailing those financial incentive programs, as specified.
The bill would require that its provisions be implemented only if all necessary federal approvals have been obtained, and only to the extent permitted by federal law.
The bill would repeal these provisions on January 1, 2026.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: NOYES   Local Program: NO  

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


SECTION 1.

 Section 14197.25 is added to the Welfare and Institutions Code, immediately following Section 14197.2, to read:

14197.25.
 (a) A Medi-Cal managed care plan contract entered into, or amended, on or after January 1, 2021, shall require the contracting Medi-Cal managed care plan to offer financial incentives to its existing enrollees for the purpose of promoting participation in preventive health or wellness activities.
(b) The Medi-Cal managed care plan may link the financial incentives to either of the following activities, or any other preventive health or wellness activities:
(1) Participating in a health promotion program, including, but not limited to, a diabetes prevention program or a tobacco cessation program.
(2) Receiving a preventive health service, including, but not limited to, an annual physical examination or recommended screenings.
(c) The financial incentive offered to an enrollee may be in any form, but shall have a value of at least one hundred dollars ($100) annually per participating enrollee. The Medi-Cal managed care plan shall offer the financial incentive at regular intervals.
(d) The Medi-Cal managed care plan shall annually evaluate its financial incentive programs developed pursuant to this section. The evaluation may include, but is not limited to, either of the following:
(1) For enrollees who participated in the financial incentive program, surveys on how much the reward influenced their behavior.
(2) For enrollees who did not participate in the financial incentive program, surveys on those enrollees’ reasons for not participating.
(e) The Medi-Cal managed care plan shall submit an annual report to the department on its financial incentive programs, the programs’ utilization, and the evaluation prepared under this section.
(f) Before January 1, 2026, the department, in consultation with the Department of Managed Health Care, shall submit a report to the Legislature, in compliance with Section 9795 of the Government Code, detailing the financial incentive programs and their utilization and evaluation data, based on the information received pursuant to subdivision (e).
(g) This section shall be implemented only if all necessary federal approvals have been obtained, and only to the extent permitted by federal law.
(h) This section shall remain in effect only until January 1, 2026, and as of that date is repealed.

SECTION 1.Section 14197.25 is added to the Welfare and Institutions Code, to read:
14197.25.

(a)It is the intent of the Legislature to enact legislation that would require Medi-Cal managed care plans, subject to federal approval, to offer financial incentives to enrollees for their improved wellness activities.

(b)The purpose of subdivision (a) is to achieve cost containment in the Medi-Cal managed care delivery system, due to an increase in wellness and a decrease in medical interventions, while improving the lives of Medi-Cal beneficiaries through preventative care and disease management.