Bill Text


Bill PDF |Add To My Favorites | print page

AB-2458 California Children’s Services: reimbursement rates.(2021-2022)

SHARE THIS: share this bill in Facebook share this bill in Twitter
Date Published: 02/17/2022 09:00 PM
AB2458:v99#DOCUMENT


CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Assembly Bill
No. 2458

Introduced by Assembly Member Akilah Weber

February 17, 2022

An act to amend Section 14105.18 of the Welfare and Institutions Code, relating to child health.


LEGISLATIVE COUNSEL'S DIGEST


AB 2458, as introduced, Akilah Weber. California Children’s Services: reimbursement rates.
Existing law establishes the California Children’s Services (CCS) Program, administered by the State Department of Health Care Services and a designated agency of each county, to provide medically necessary services for persons under 21 years of age who have any of specified medical conditions and who meet certain financial eligibility requirements.
Existing law establishes the Medi-Cal program, which is administered by the department and under which qualified low-income individuals receive health care services. Existing law requires that provider rates of payment for services rendered in the CCS Program be identical to the rates of payment for the same service performed by the same provider type pursuant to the Medi-Cal program. Notwithstanding that requirement, existing law authorizes the reimbursement of services provided under the CCS Program at rates greater than the Medi-Cal rate that would otherwise be applicable if those rates are adopted by the Director of Health Care Services in regulations.
Existing law establishes a Whole Child Model program for Medi-Cal eligible CCS children and youth enrolled in a Medi-Cal managed care plan served by a county organized health system or Regional Health Authority in specified counties. Existing law requires the department to pay a participating managed care plan a certain rate, and requires the plan to pay physician and surgeon provider services at rates that are equal to or exceed the applicable CCS fee-for-service rates, except as specified.
Physician services provided under the CCS Program are currently reimbursed at rates that are 39.7% greater than the applicable Medi-Cal rates.
This bill would make legislative findings relating to the need for an increase in the reimbursement rates for physician services provided under the CCS Program. Under the bill, subject to an appropriation, and commencing January 1, 2023, those reimbursement rates would be increased by adding at least 25% to the above-described augmentation percentage relative to the applicable Medi-Cal rates. The bill would make the rate increase applicable only if the services are provided by a physician in a practice in which at least 30% of the practice’s pediatric patients are Medi-Cal beneficiaries.
The bill would, no later than January 1, 2026, and every 3 years thereafter, require the department to complete a review of those reimbursement rates, including whether the department recommends an increase in the rates, as specified. The bill would require that the reviews contain data disaggregated by rural or urban area, ZIP Code, and satellite clinic providing CCS services. The bill would require the department to submit reports of the reviews and any recommendations to the legislative health committees.
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 finds and declares all of the following:
(a) The California Children’s Services (CCS) Program is one of the oldest Title V Maternal and Child Health Services Block Grant Programs in the nation.
(b) The CCS Program has provided critical access to specialized medical care for California’s most complex and fragile pediatric patients since 1927.
(c) The strong standards and credentialing created under the CCS Program ensure that eligible children obtain care from experienced providers with appropriate pediatric-specific expertise.
(d) CCS has a specified list of conditions that make a child or youth under 21 years of age eligible, such as diabetes, cystic fibrosis, epilepsy, or congenital heart disease, and financial eligibility requirements must be met, making CCS a critical safety net program for low-income families.
(e) To address a crisis in access to pediatric specialty care, in 2001, a rate augmentation for CCS-paneled providers was instituted to stabilize the critical network of physicians at that time.
(f) The rate has not been adjusted since it was implemented over 20 years ago, and the chronic underfunding has caused disruption to the system of care and is having a consequential impact on access for children and families.
(g) Pediatric specialty medical groups are facing multiyear challenges to recruit and retain physicians, resulting in appointment wait times that are unacceptably long for numerous vital pediatric subspecialties. The COVID-19 pandemic has further destabilized the network with decreased patient volume and increased infection control costs.
(h) The CCS rate increase proposed in this act would result in rates that are comparable, in the aggregate, to the rates under the federal Medicare Program for similar services, and would allow medical groups to hire more physicians for specialties that are in short supply.
(i) A more robust physician network would improve access to care, including in rural regions of the state, and would reduce health care disparities related to access, as pediatric subspecialists disproportionately provide care to children of color and Medi-Cal patients.

SEC. 2.

 Section 14105.18 of the Welfare and Institutions Code is amended to read:

14105.18.
 (a) Notwithstanding any other law, provider rates of payment for services rendered in all of the following programs shall be identical to the rates of payment for the same service performed by the same provider type pursuant to the Medi-Cal program:
(1) The California Children’s Services Program established pursuant to Article 5 (commencing with Section 123800) of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code.
(2) The Genetically Handicapped Persons Program established pursuant to Article 1 (commencing with Section 125125) of Chapter 2 of Part 5 of Division 106 of the Health and Safety Code.
(3) The Breast and Cervical Cancer Early Detection Program established pursuant to Article 1.3 (commencing with Section 104150) of Chapter 2 of Part 1 of Division 103 of the Health and Safety Code and the breast cancer programs specified in Section 30461.6 of the Revenue and Taxation Code.
(4) The State-Only Family Planning Program established pursuant to Division 24 (commencing with Section 24000).
(5) The Family Planning, Access, Care, and Treatment (Family PACT) Program established pursuant to subdivision (aa) of Section 14132.
(6) The Healthy Families Program established pursuant to Part 6.2 (commencing with Section 12693) of Division 2 of the Insurance Code if the health care services are provided by a Medi-Cal provider pursuant to subdivision (b) of Section 12693.26 of the Insurance Code.
(7) The Access for Infants and Mothers Program established pursuant to former Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code if the health care services are provided by a Medi-Cal provider.
(b) The director may identify in regulations other programs not listed in subdivision (a) in which providers shall be paid rates of payment that are identical to the rates of payments in the Medi-Cal program pursuant to subdivision (a).
(c) Notwithstanding subdivision (a), services provided under any of the programs described in subdivisions (a) and (b) may be reimbursed at rates greater than the Medi-Cal rate that would otherwise be applicable if those rates are adopted by the director in regulations.
(d) Payment increases made pursuant to former Section 14105.196 shall not apply to provider rates of payment described in this section for services provided to individuals not eligible for Medi-Cal or Family PACT.

(e)This section shall become operative on January 1, 2011.

(e) (1) Notwithstanding subdivision (a), and subject to an appropriation by the Legislature for purposes of this paragraph, commencing January 1, 2023, the reimbursement rates for physician services provided under the California Children’s Services (CCS) Program and that meet the condition described in paragraph (2) shall be increased by adding at least 25 percent to the augmentation percentage that was in effect for CCS physician services on December 31, 2022, relative to the applicable Medi-Cal rates.
(2) The rate increase described in paragraph (1) shall apply only if the services are provided by a physician in a practice in which at least 30 percent of the practice’s pediatric patients are Medi-Cal beneficiaries.
(3) No later than January 1, 2026, and every three years thereafter, the department shall complete a review of the reimbursement rates for physician services provided under the CCS Program, including whether the department recommends an increase in the rates so that they are comparable, in the aggregate, to the rates under the federal Medicare Program for similar services. The reviews shall contain data disaggregated by rural or urban area, ZIP Code, and satellite clinic providing CCS services. The department shall submit reports of the reviews and any recommendations to the Assembly Committee on Health and the Senate Committee on Health.