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AB-368 Medically supportive food.(2021-2022)

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Date Published: 02/01/2021 09:00 PM


Assembly Bill
No. 368

Introduced by Assembly Member Bonta
(Coauthors: Assembly Members Chiu and Wicks)

February 01, 2021

An act to add and repeal Section 14042.15 of the Welfare and Institutions Code, relating to Medi-Cal.


AB 368, as introduced, Bonta. Medically supportive food.
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 enteral nutrition products, pursuant to a schedule of benefits, and subject to utilization controls, such as prior authorization. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law requires the department to establish a Medically Tailored Meals Pilot Program to operate for a period of 4 years from the date the program is established, or until funding is no longer available, whichever date is earlier, in specified counties, including the Counties of Alameda and Sonoma, to provide medically tailored meal intervention services to Medi-Cal participants with specified health conditions, such as diabetes and renal disease.
This bill would require the department to establish, no earlier than January 1, 2022, a pilot program for a 2-year period in 3 counties, including the County of Alameda, to provide food prescriptions for medically supportive food, such as healthy food vouchers or renewable food prescriptions, to eligible Medi-Cal beneficiaries, including individuals who have a specified chronic health condition, such as diabetes and hypertension, when utilizing evidence-based practices that demonstrate the prevention, reduction, or reversal of those specified diseases. The bill would authorize the department, in consultation with stakeholders, to establish utilization controls, including the limitation on the number of services, and to enter into contracts for purposes of implementing the pilot program. The bill would require the department to evaluate the pilot program upon its conclusion, to report to the Legislature on those findings, and to implement these provisions by various means, including provider bulletins, without taking regulatory action. The bill would repeal these provisions on January 1, 2027.
This bill would make legislative findings and declarations as to the necessity of a special statute for the County of Alameda, County of XXX, and County of XXX.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


 Section 14042.15 is added to the Welfare and Institutions Code, immediately following Section 14042.1, to read:

 (a) (1) It is the intent of the Legislature to increase positive health outcomes for Medi-Cal beneficiaries in three counties, the Counties of Alameda, _______, and _______, by establishing a two-year food prescription pilot program. The pilot program shall provide food prescriptions to eligible Medi-Cal beneficiaries who are enrolled in Medi-Cal managed care plans, have one or more specified chronic health condition, and are experiencing food insecurity. A food prescription shall consist of medically supportive food used for the prevention, reversal, or management of chronic health conditions and may be paired with behavioral, cooking, nutrition education, coaching, and counseling.
(2) Racial and ethnic health disparities have been exacerbated by the COVID-19 pandemic. This public health emergency, COVID-19, has illuminated the urgent need to build resiliency among vulnerable populations, especially those with underlying chronic health conditions. Chronic health conditions disproportionately impact communities of color, making them particularly vulnerable for adverse health outcomes from severe COVID-19, including hospitalization and death. By managing, treating, and reversing their underlying chronic health conditions, Medi-Cal beneficiaries, and especially members of communities who experience health disparities, shall be less vulnerable not only to COVID-19, but other chronic illnesses. Moreover, it is the intent of the Legislature to reduce racial health disparities and generate long-term cost savings to the health care system as a result of the implementation of the two-year prescription pilot program.
(b) For purposes of this section, the following definitions apply:
(1) “Eligible Medi-Cal beneficiary” means an individual who is eligible to participate in the pilot program and meets all of the following requirements:
(A) Enrolled in a Medi-Cal managed care plan.
(B) Have one or more of the following chronic health conditions:
(i) Depression.
(ii) Diabetes, including prediabetes and type 1 diabetes mellitus.
(iii) Hypertension or high blood pressure.
(iv) Liver disease.
(v) Obesity or severe obesity, as measured by a person’s body mass index (BMI). For purposes of this clause, “obesity” means a person’s BMI is 25 kg/m2 or higher, but under 40 kg/m2, and “severe obesity” means that a person’s BMI is 40 kg/m2 or higher.
(vi) Pregnancy.
(C) Experience food or nutrition insecurity.
(D) Self-identify as a member of a community that experiences health disparities.
(2) “Food prescription” means a specific dosage of medically supportive food, which is prescribed by a Medi-Cal provider, that is based on evidence-based practices that demonstrate the prevention, reduction, or reversal of specific chronic health conditions. A food prescription includes, but is not limited to, medically supportive food administered through any of the following programs and services:
(A) Healthy food boxes, groceries, or meals.
(B) Healthy food vouchers for food, including produce, whole grains, seafood, and lean animal protein.
(C) Renewable food prescriptions for food, including produce, whole grains, seafood, and lean animal protein.
(D) Renewable produce prescriptions, including produce that has no added fat, sugar, or salt.
(3) “Healthy food voucher” means a coupon for free or discounted medically supportive food.
(4) “Medically supportive food” means any nutrient-rich whole food, including any fruit, vegetable, legume, nut, seed, whole grain, seafood, and lean animal protein, used for the prevention, reversal, or management of a specific chronic health condition.
(5) “Pilot program” means the two-year pilot program established in the Counties of Alameda, _______, and _______, to provide food prescriptions to eligible Medi-Cal beneficiaries.
(c) To the extent funds are made available in the annual Budget Act for this purpose, and no earlier than January 1, 2022, the department shall establish a pilot program for a two-year period in the Counties of Alameda, _______, and _______, to provide food prescriptions to eligible Medi-Cal beneficiaries, as described in paragraph (1) of subdivision (b), subject to utilization controls, as specified in subdivision (d) and Section 14133.
(d) The department, in consultation with stakeholders, may establish utilization controls, as described in Section 14133, with respect to the limitation on the number of services, including how these services may be restricted as to a set number within a specified timeframe. In developing these utilization controls under the pilot program, the department shall consider the nutritional needs of a recipient to prevent, reverse, or manage specified chronic health conditions disproportionately represented in communities of color, their acuity, and other selection criteria.
(e) For purposes of implementing the pilot program, the department may enter into exclusive or nonexclusive contracts on a bid or negotiated basis, and shall prioritize public, nonprofit, and community-based organizations or entities that provide California-grown produce and products. Any contract entered into or amended pursuant to this section shall be exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, Section 19130 of the Government Code, and Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, and shall be exempt from the review or approval of any division of the Department of General Services.
(f) (1) Upon the completion of the pilot program, and to the extent it can be determined, the department shall evaluate the impact of the pilot program, including, but not limited to, relevant health outcome data collected under the Medi-Cal program, and the pilot program’s impact on Healthcare Effectiveness Data and Information Set measures, medication utilization, hospital readmissions, admissions into long-term care facilities, and emergency room utilization rates. The department shall prepare these findings, including its recommendation on expanding the pilot program on a statewide-basis or for an extended period of time, into a finalized report, and shall submit this report to the Legislature by January 1, 2024, or within 12 months after the end of the pilot program, whichever is sooner.
(2) A report submitted pursuant to this subdivision shall be submitted in compliance with Section 9795 of the Government Code.
(g) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department shall implement this section by means of a provider bulletin or similar instruction, without taking regulatory action.
(h) This section shall remain in effect only until January 1, 2027, and as of that date is repealed.

SEC. 2.

 The Legislature finds and declares that a special statute is necessary and that a general statute cannot be made applicable within the meaning of Section 16 of Article IV of the California Constitution because of the unique position of the Counties of Alameda, _______, and _______, to continue to build upon their efforts to provide medically supportive food to medically needy residents for purposes of developing a model pilot program to be expanded on a statewide basis.