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SB-361 Medi-Cal: Health Home Program.(2019-2020)



Current Version: 05/17/19 - Amended Senate        


SB361:v97#DOCUMENT

Amended  IN  Senate  May 17, 2019
Amended  IN  Senate  April 08, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Senate Bill No. 361


Introduced by Senator Mitchell

February 20, 2019


An act to amend Sections 14127.3, 14127.4, and 14127.6 of the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


SB 361, as amended, Mitchell. Medi-Cal: Health Home Program.
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 authorizes the department to create the Health Home Program (program) for enrollees with chronic conditions, as authorized under federal law. Existing law conditions the implementation of the program on federal approval and the availability of federal financial participation.
Existing law prohibits the implementation of the program if additional General Fund moneys are used to fund the administration and costs of services, unless the department projects that the implementation of the program would not result in any net increase in ongoing General Fund costs for the Medi-Cal program. Existing law requires the nonfederal share for the program to be provided by funds from specified entities, including local governments.
This bill would remove the prohibition on the use of General Fund moneys for the implementation of the program. The bill would limit the above restriction on sources for the nonfederal share only to the first 8 quarters of implementation of each phase of the program.
Existing law authorizes the department to revise or terminate the program any time after the first 8 quarters of implementation if the department finds that the program fails to demonstrate certain results.
This bill would remove the department’s authority to revise or terminate the program as described above.
Existing law requires the department to select providers with a viable plan to reach out to and engage frequent hospital or emergency department users and chronically homeless eligible individuals.
This bill would require the outreach and engagement to be in person.
The bill would would, subject to an appropriation, require the department to require administering Medi-Cal managed care plans to take specified actions, relating to provider rates, partnerships, and reports, for purposes of adult beneficiaries who have a level of severity in certain conditions based on chronic homelessness, to increase program participation from that population.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 Section 14127.3 of the Welfare and Institutions Code is amended to read:

14127.3.
 (a) If the department creates a Health Home Program pursuant to this article, the department shall determine whether a health home state plan amendment that targets adults is operationally viable.
(b) (1) In determining whether a health home state plan amendment that targets adults is operationally viable, the department shall consider whether a state plan amendment and any necessary Section 1115 waiver amendments could be designed in a manner that minimizes the impact on the General Fund, whether the department has the capacity to administer the health home state plan amendment through the state, a contracting entity, a county, or regional approach, and whether a sufficient provider network exists for providing health home services to populations the department intends to target, including the populations described in subdivision (c).
(2) If the department determines that a health home state plan amendment that targets adults is operationally viable pursuant to paragraph (1), then the department shall design a state plan amendment and any necessary Section 1115 waiver amendments to target and provide health home services to beneficiaries who meet the criteria specified in subdivision (c).
(3) (A) If the department determines a health home state plan amendment that targets adults is not operationally viable, then the department shall inform the appropriate policy and fiscal committees of the Legislature, within 120 days of that determination, of the reasons the program is not operationally viable as described in paragraph (1), and about current efforts underway by the department that help to address health care issues experienced by homeless Medi-Cal beneficiaries.
(B) The requirement for informing the appropriate policy and fiscal committees of the Legislature under subparagraph (A) is inoperative four years after the date the report is due, pursuant to Section 10231.5 of the Government Code.
(c) A state plan amendment and any necessary Section 1115 waiver amendments submitted pursuant to this section shall target adult beneficiaries who meet both of the following criteria:
(1) Have current diagnoses of chronic, physical health, mental health, or substance use disorders prevalent among frequent hospital users.
(2) Have a level of severity in conditions established by the department, based on one or more of the following factors:
(A) Frequent inpatient hospital admissions, including hospitalization for medical, psychiatric, or substance use related conditions.
(B) Excessive use of crisis or emergency services.
(C) Chronic homelessness.
(d) (1) For the purposes of providing health home services to the population identified in subdivision (c), the department shall select health home providers or providers who plan to subcontract with health home team members with all of the following:
(A) Demonstrated experience working with frequent hospital or emergency department users.
(B) Demonstrated experience working with people who are chronically homeless.
(C) The capacity and administrative infrastructure to participate in the Health Home Program, including the ability to meet requirements of federal guidelines.
(D) A viable plan, with roles identified among providers of the health home, to do all of the following:
(i) Reach out to and engage frequent hospital or emergency department users and chronically homeless eligible individuals in person.
(ii) Link eligible individuals who are homeless or experiencing housing instability to permanent housing, such as supportive housing.
(iii) Ensure coordination and linkages to services needed to access and maintain health stability, including medical, mental health, and substance use care, as well as social services and supports to address social determinants of health.
(2) The department may design additional provider criteria to those identified in paragraph (1) after consultation with stakeholder groups who have expertise in engagement and services for the population identified in subdivision (c).
(3) The department may authorize health home providers eligible under this subdivision to serve Medi-Cal enrollees through a fee-for-service or managed care delivery system that may include supplemental payments, and may allow for county-operated and other public and private providers to participate in this program.
(4) If the department designs a state plan amendment designed to serve the population identified in subdivision (c), the department shall design strategies to outreach to, engage, and provide health home services to the population identified in subdivision (c), based on consultation with stakeholders who have expertise in engaging, providing services to, and designing programs addressing the needs of, the population.
(5) If the department creates a health home program that targets adults described in subdivision (c), the department may also submit state plan amendments and any necessary waiver amendments targeting other adult populations.
(6) The Subject to an express appropriation in the annual Budget Act or another statute for purposes of this paragraph, the department shall require administering Medi-Cal managed care plans to do all of the following for purposes of the population identified in subdivision (c) that meets subparagraph (C) of paragraph (2) of subdivision (c), to increase program participation from that population:
(A) Provide tiered payment rates to health home providers, using the highest rate to serve that population.
(B) Partner with local homeless Continuums of Care or agencies to identify members experiencing homelessness, and design a process for referring homeless members to assess for Health Home Program eligibility.
(C) Offer health home providers an outreach rate that requires providers to engage that population in person.
(D) Report to the department member-level data on that population.

SEC. 2.

 Section 14127.4 of the Welfare and Institutions Code is amended to read:

14127.4.
 (a) The department shall administer this article in a manner that attempts to maximize federal financial participation, consistent with federal law.
(b) Except as provided in Section 14127.6, during the first eight quarters of implementation of each phase of the Health Home Program, the nonfederal share shall be provided by funds from local governments, private foundations, or any other source permitted under state and federal law, including Section 1903(a) of the federal Social Security Act (42 U.S.C. Sec. 1396b(a)) and Section 433.51 of Title 42 of the Code of Federal Regulations, and may be used for administration, service delivery, evaluation, and design of the Health Home Program. The department, or counties contracting with the department, may also enter into risk-sharing and social impact bond program agreements to fund services under this article.

SEC. 3.

 Section 14127.6 of the Welfare and Institutions Code is amended to read:

14127.6.
 (a) The Health Home Program shall be implemented only if and to the extent federal financial participation is available and the federal Centers for Medicare and Medicaid Services approves any state plan amendments and any necessary waivers sought pursuant to this article.
(b) The department may use new funding in the form of enhanced federal financial participation for health home services that are currently provided to fund additional costs for new Health Home Program services.
(c) The department shall seek to fund the creation, implementation, and administration of the program with funding other than state general funds.