(1) The California Health Facilities Financing Authority Act authorizes the California Health Facilities Financing Authority to make grants from the continuously appropriated California Health Facilities Financing Authority Fund to participating health institutions for financing or refinancing the acquisition, construction, or remodeling of health facilities. Existing law authorizes the authority to award grants to any eligible health facility, as defined, for purposes of financing defined projects.
This bill would require the authority to award grants, not to exceed $250,000 each, to eligible health facilities that meet at least one of 3 specified requirements, including that the health facility is operated by a tax-exempt nonprofit corporation that is licensed to operate the health facility by the State of California, and
the annual gross revenue of the health facility does not exceed $10,000,000. The bill would create the Lifeline Grant Program Subfund in the California Health Facilities Financing Authority Fund and would transfer and appropriate $20,000,000 that is not otherwise obligated or impressed with a trust for other purposes from a specified subfund within the California Health Facilities Financing Authority Fund to the Lifeline Grant Program Subfund for the authority to use for the grant program. The bill would make the moneys available for encumbrance or expenditure until June 30, 2020, and would revert any remaining moneys in the subfund to the originating subfund as of June 30, 2022. The bill would repeal the grant program as of January 1, 2023.
(2) Existing law provides for the licensure and regulation of health facilities, including skilled nursing facilities, by the State Department of Public Health. Among other
requirements, these provisions require the department to develop regulations that establish staff-to-patient ratios for direct caregivers, as specified. These provisions define a direct caregiver to include, among other persons, a registered nurse and a certified nurse assistant. A violation of those provisions is a crime.
This bill would require, effective July 1, 2018, skilled nursing facilities, except those skilled nursing facilities that are a distinct part of a general acute care facility or a state-owned hospital or developmental center, to have a minimum number of direct care service hours, as defined, of 3.5 per patient day, except as specified. The bill would revise the definition of a direct caregiver to include a nursing assistant participating in an approved training program, as specified. The bill would also require the department to adopt regulations to create a waiver of the direct care service hour requirements and to
evaluate the impact of these requirements, as specified. By changing the definition of crimes, the bill would impose a state-mandated local program.
Existing law requires the State Department of Public Health to develop the Skilled Nursing Facility Quality and Accountability Supplemental Payment System to provide supplemental payments to skilled nursing facilities that improve the quality and accountability of care rendered to residents in skilled nursing facilities. Existing law establishes the Skilled Nursing Facility Quality and Accountability Special Fund in the State Treasury, which is a continuously appropriated fund that contains moneys from the assessment of specified administrative penalties and set asides of General Fund moneys, for the purposes of making quality and accountability payments. Existing law requires the State Department of Public Health to assess a skilled nursing facility an administrative penalty if the department determines that the
skilled nursing facility fails to meet specified nursing hours per patient per day requirements.
This bill would additionally require, beginning in the 2019–20 fiscal year, as specified, the department to assess a skilled nursing facility an administrative penalty if the department determines that the skilled nursing facility fails to meet the direct care service hours per patient per day requirements. By providing a new source of funds for a continuously appropriated fund, the bill would make an appropriation.
(3) Existing law, until January 1, 2018, authorizes the Director of the Department of Managed Health Care to establish, by regulation, the Consumer Participation Program, which allows the director to award reasonable advocacy and witness fees to any person or organization that represents consumers and has made a substantial contribution on behalf of consumers to the adoption of a regulation or
with regard to an order or decision impacting a significant number of enrollees.
This bill would extend the sunset date for the Consumer Participation Program until January 1, 2024.
(4) Existing law establishes procedures and requirements to govern the allocation to, and expenditure by, local health jurisdictions, hospitals, long-term health care facilities, clinics, emergency medical systems, and poison control centers of federal funding received for the prevention of, and response to, bioterrorist attacks and other public health emergencies. Existing law requires, of the $16,000,000 appropriated in the Budget Act of 2006 for local health jurisdictions for the purpose of preparing California for public health emergencies, a baseline allocation of $125,000 to be provided to each local health jurisdiction first. Existing law requires a local health jurisdiction that receives funds pursuant to these
provisions to deposit them in a special local public health preparedness trust fund, and requires the interest earned on moneys in the fund to accrue to the benefit of the fund and to be expended for the same purposes as other moneys in the fund.
This bill would instead require, of the funds appropriated in the annual Budget Act for local health jurisdictions for the purpose of preparing California for public health emergencies, a baseline allocation of $60,000 to be provided to each local jurisdiction first, subject to the availability of funds appropriated in the annual Budget Act or another statute. The bill would require the local health jurisdiction to deposit the funds received pursuant to these provisions in a specified account and would require these funds to be tracked and managed according to the specified account name. The bill would prohibit local health jurisdictions from retaining more than $500 in interest earned on moneys in the account and would
require that interest to be returned to the department on an annual basis.
(5) Existing law, until January 1, 2021, requires the State Department of Health Care Services to annually reimburse the Robert F. Kennedy Farm Workers Medical Plan up to $3,000,000 per year for claim payments that exceed $70,000 made by the plan on behalf of an eligible employee or dependent for a single episode of care on or after September 1, 2016. The Robert F. Kennedy Farm Workers Medical Plan is a nonprofit voluntary employees beneficiary association, organized under federal law, that provides payments for health care and other benefits to its members.
This bill would extend that annual reimbursement requirement for an additional 5 years until January 1, 2026.
(6) Existing law requires the State
Department of Public Health to conduct a program of epidemiological assessments of the incidence of Parkinson’s disease, as specified. Under existing law, these provisions may be implemented only to the extent funds from federal or private sources are made available for this purpose. Existing law requires the director of the department to establish a statewide system for the collection of data regarding Parkinson’s disease.
This bill additionally would establish the Richard Paul Hemann Parkinson’s Disease Program, which, among other things, would require the department to collect data on the incidence of Parkinson’s disease in California, as specified. Beginning July 1, 2018, the bill would require a hospital, facility, physician and surgeon, or other health care provider diagnosing or providing treatment to Parkinson’s disease patients to report each case of Parkinson’s disease to the department, as prescribed.
The bill would be implemented only to the extent funds are made available for its purposes. The bill would repeal these provisions on January 1, 2020.
(7) Existing law requires, under the Every Woman Counts Program, the State Department of Health Care Services to provide breast cancer and cervical cancer screening services for qualified low-income individuals. Existing law requires the department to provide the fiscal and appropriate policy committees of the Legislature with quarterly updates on caseload, estimated expenditures, and related program monitoring data for the program, as specified.
This bill would instead require the department to provide biannual updates, as specified, and would require, commencing with the 2017–18 fiscal year, expenditures for the program included in the department’s budget for services provided on or after July 1, 2017, to be
charged against the appropriation for the fiscal year in which the billing is paid.
(8) Existing law requires the State Department of Public Health, to the extent funding is appropriated in the annual Budget Act, to establish a program to provide drug treatments to persons infected with human immunodeficiency virus (HIV) and to persons who are HIV-negative who have been prescribed preexposure prophylaxis included on the AIDS Drug Assistance Program (ADAP) formulary for the prevention of HIV infection, as provided. Existing law also makes, if the department uses a contractor or subcontractor to administer any aspect of the program, all types of information, whether written or oral, concerning a client, made or kept in connection with the administration of the program confidential, and not subject to disclosure except for purposes directly connected with the administration of the program.
This bill would, among other things, also allow those contractors and subcontractors to disclose information for the purposes of coordinating client eligibility with programs funded by the federal Ryan White HIV/AIDS Program, if disclosure is otherwise authorized by law, and pursuant to written authorization by the person who is the subject of the record or by his or her guardian or conservator.
Existing law requires public health records related to HIV or acquired immunodeficiency syndrome (AIDS), containing personally identifying information, that were developed or acquired by a state or local public health agency, or an agent of that agency, to be confidential and not disclosed, except as otherwise provided by law for public health purposes or pursuant to a written authorization by the person who is the subject of the record or by his or her guardian or conservator. Existing law authorizes certain state public health
officials to disclose those records for the purpose of facilitating appropriate HIV/AIDS medical care and treatment, as specified.
This bill would include HIV prevention staff and HIV surveillance staff, as provided, among those state public health officials authorized to disclose those records for the purpose of facilitating appropriate HIV/AIDS medical care and treatment.
Existing law requires the State Public Health Officer, to the extent that state and federal funds are appropriated, to establish, and authorizes him or her to administer, a program to provide drug treatments to persons who are HIV-negative who have been prescribed pre-exposure prophylaxis (PrEP) included on the AIDS Drug Assistance Program (ADAP) formulary for the prevention of HIV infection. Existing law authorizes the State Public Health Officer, to the extent allowable under federal law, and as appropriated in the annual Budget
Act, to expend money from the AIDS Drug Assistance Program Rebate Fund, a continuously appropriated fund, for this HIV infection prevention program to cover the costs of prescribed ADAP formulary medications for the prevention of HIV infection and other specified costs.
This bill would revise and recast the above provisions regarding the HIV infection prevention program by deleting the above provisions and instead authorizing the State Public Health Officer, to the extent that funds are available for these purposes, to establish and administer a program within the State Department of Public Health’s Office of AIDS to subsidize certain costs of medications on the ADAP formulary for the prevention of HIV infection and other related medical services, as provided. The bill would require all types of information concerning a client of the program to be kept confidential and not disclosed, except as provided. The bill would authorize the State Public
Health Officer, to the extent allowable under federal law, and upon the availability of funds, to expend money from the AIDS Drug Assistance Program Rebate Fund for this HIV infection prevention program to cover the costs of prescribed ADAP formulary medications for the prevention of HIV infection and other specified costs. Because the bill would authorize a new purpose for a continuously appropriated fund, the bill would create an appropriation.
(9) 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. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
This bill, until January 1, 2021, or as otherwise specified, would require the State Department of Health Care Services to establish a 3-year pilot
program in specified counties to provide medically tailored meals, as defined, to Medi-Cal participants with specified health conditions.
Comprehensive perinatal services are a covered benefit under the Medi-Cal program. Existing law requires the department to provide Medi-Cal reimbursements to alternative birth centers for facility-related delivery costs at a statewide all-inclusive rate per delivery that does not exceed 80% of the average Medi-Cal reimbursement received by general acute care hospitals with Medi-Cal contracts.
This bill would require the department, no earlier than July 1, 2017, to reimburse facility-related Medi-Cal delivery costs of eligible alternative birth centers based on a statewide all-inclusive rate per delivery that does not exceed 80% of the average diagnosis-related groups Level 1 rates received by general acute care hospitals pursuant to a specified provision and the
applicable provisions of the Medi-Cal State Plan, as specified. The bill would revise eligibility requirements for reimbursements to alternative birth centers, including applicable certification requirements.
Existing law requires the State Department of Health Care Services to provide the Legislature an annual report summarizing data reported by alternative birth centers, as specified.
This bill would delete those reporting requirements.
Existing law excludes certain optional Medi-Cal benefits, including, among others, adult dental services and optometric and optician services from coverage under the Medi-Cal program, except for specified beneficiaries.
This bill would make the exclusion of adult dental services effective only through December 31, 2017, as specified. The bill would make optometric and optician
services a covered benefit under the Medi-Cal program, contingent upon the Legislature including funding for these services in the state budget process, as specified.
Existing federal law prohibits federal financial participation for full-scope Medi-Cal services provided to qualified, nonexempt immigrants who have resided in the United States for less than 5 years. These individuals are known as New Qualified Immigrants (NQI). Existing state law grants full-scope Medi-Cal coverage for these NQI individuals, and requires these services to be provided with state-only funds if federal financial participation is not available.
Existing law provides that an NQI individual who is 21 years of age or older, who does not have minor children, and who is enrolled in coverage through the California Health Benefit Exchange (Exchange) with an advanced premium tax credit shall be eligible for certain Medi-Cal benefits
only to the extent those benefits are not available through his or her individual health plan offered through the Exchange, instead of full-scope, state-funded Medi-Cal benefits. Existing law requires the department to pay on behalf of the beneficiary his or her insurance premium costs and cost-sharing payments for an individual health plan offered through the Exchange, as specified.
This bill would repeal those provisions that provide for the transition of NQI individuals over 21 years of age without children into an individual health plan offered through the Exchange.
Existing law requires the department to implement a specified option for women eligible for Medi-Cal pregnancy-related and postpartum services who are enrolled or will be enrolled in individual health care coverage through the Exchange and who also opt to enroll in Medi-Cal, and requires the department to provide
beneficiaries who are receiving benefits under this provision with only those Medi-Cal benefits for pregnancy-related and postpartum services that are covered under the Medi-Cal program and that are not available through the beneficiary’s qualified health plan offered though the Exchange. Existing law, except as provided, requires the department to pay the beneficiary’s insurance premium costs and the beneficiary’s cost sharing for benefits and services during the beneficiary’s period of eligibility for pregnancy-related and postpartum services under the Medi-Cal program.
This bill would repeal those provisions.
Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA), enacts various health care coverage market reforms that took effect January 1, 2014. Among other things, PPACA requires applicable individuals to maintain minimum essential coverage, and
imposes a shared responsibility penalty on any applicable individual, as defined, who does not maintain minimum essential coverage. Existing federal law defines “minimum essential coverage” to include the coverage under the Medicaid program, however certain health care coverage options under Medicaid, such as coverage limited to treatment of emergency medical conditions, do not qualify as minimum essential coverage. Existing federal regulations authorize the United States Secretary of Health and Human Services to recognize “other coverage” as minimum essential coverage provided that the United States Department of Health and Human Services determines that the coverage meets specified substantive and procedural requirements.
This bill would require the State Department of Health Care Services to apply to the United States Secretary of Health and Human Services for any program under the Medi-Cal program that provides full-scope Medi-Cal benefits
to an applicable individual, as defined, and that otherwise does not qualify as minimum essential coverage, as specified, to be recognized as minimum essential coverage. The bill would make this provision inoperative, and on the following January 1 would repeal it, if the requirement to maintain minimum essential coverage under the PPACA is repealed and no similar provision that would subject Medi-Cal beneficiaries to a tax penalty for the failure to maintain minimum essential coverage is implemented.
Existing law expands eligibility for health care services under Medi-Cal to individuals eligible for aid under the California Work Opportunity and Responsibility to Kids (CalWORKs) program with family incomes that do not exceed 109% of the federal poverty level. When determining eligibility under this provision, existing law requires an applicant’s or beneficiary’s income and resources to be determined based on modified adjusted gross income, as
specified.
This bill would require the State Department of Health Care Services to seek federal approval to use the determination of eligibility for the CalWORKs program as a determination of eligibility for Medi-Cal benefits under the provision described above, and would require, thereafter, the department’s use of the CalWORKs eligibility determination to determine eligibility for Medi-Cal benefits under this provision to be consistent, and in conformity, with the terms of the federal approval.
Because counties are required to make eligibility determinations under the Medi-Cal program, and because this bill would affect Medi-Cal eligibility determinations under that program, this bill would impose a state-mandated local program.
Existing law requires the department to establish and maintain a plan, known as the County
Administrative Cost Control Plan, for the purpose of effectively controlling costs relating to the county administration of the determination of eligibility for benefits under the Medi-Cal program within the amounts annually appropriated for that administration.
Existing law authorizes the Director of Health Care Services, as well as the Attorney General, and other specified officials, to bring an action to recover the reasonable value of benefits provided or that will be provided to a Medi-Cal recipient against a 3rd party, including an insurance carrier, because of any injury for which the 3rd party is liable. Existing law contains procedures for the recovery of these amounts, some of which were originally exercised under a specified pilot project.
This bill would delete references to the pilot project and would revise the department’s procedures, including authorizing the
department to execute one or more at-risk performance contracts to identify, quantify, and recover Medi-Cal payments from responsible 3rd parties and carriers that may be subject to a claim for reimbursement.
Under the Nursing Facility/Acute Hospital Transition and Diversion Waiver (NF/AH waiver), a home- and community-based services waiver authorized under federal law until March 31, 2017, home- and community-based services, such as case management and coordination, habilitation services, and community transition services, are provided to eligible Medi-Cal beneficiaries with long-term medical conditions who would otherwise receive care in a skilled nursing facility.
This bill would authorize the Director of Health Care Services, when renewing the NF/AH waiver, to seek additional increases in the scope of the home- and community-based NF/AH waiver.
Existing law requires the department to develop and implement a program to provide a community-living support benefit to eligible Medi-Cal beneficiaries, to submit any federal documentation that is necessary to provide this benefit, and to implement the benefit only to the extent that federal financial participation is available. Existing law requires the program to include reimbursement for an array of health-related and psychosocial services provided or coordinated at community-based housing sites, and access to certain community-living support services provided or coordinated at those sites, as specified.
This bill would discontinue the community-living support benefit program, effective July 1, 2017, and would require the department to assist participants in transitioning to other services, including, but not limited to, other ongoing waiver programs.
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.
This bill, to the extent that any necessary federal approvals are obtained and federal financial participation is available, would require the State Department of Health Care Services to make graduate medical education (GME) payments, in recognition of the Medi-Cal managed care share of direct and indirect GME costs, to designated public hospital systems and their affiliated government entities, as defined, in accordance with a methodology developed in consultation with the designated public hospitals, as specified. The bill would require any intergovernmental funds that a designated public hospital or affiliated government entity or other public entity elects to transfer to the department to be deposited into the Designated Public Hospital Graduate Medical
Education Special Fund, which the bill would establish in the State Treasury, to be continuously appropriated, thereby making an appropriation, to the department to be used as the nonfederal share of graduate medical education payments, to reimburse the department’s administrative costs in implementing this program, and to otherwise support the Medi-Cal program.
Existing law establishes a demonstration project under the Medi-Cal program that maximizes the use of federal funds consistent with federal Medicaid law for distribution to specified hospitals that provide care to Medi-Cal beneficiaries and uninsured patients, in supplementation of Medi-Cal reimbursements. Under existing law, for the period of November 1, 2010, through October 31, 2015, a designated public hospital, as defined, receives federal disproportionate share hospital funds under this project, subject to interim reconciliation of payments, adjustments, and
final audits, as specified.
This bill would require the department to follow specified calculations if the determinations pursuant to the interim reconciliation of payments, adjustments, and final audits result in total federal disproportionate share hospital funds claimable for distribution that, in combination with the payment adjustments made to nondesignated public hospitals, as defined, for the same year, are less than the applicable federal disproportionate share hospital allotment. The bill would also require the department to perform specified revised distribution calculations under designated circumstances. This bill would require the department, if the affiliated governmental entity for the designated public hospital is a county subject to specified provisions relating to redirection of funds for services to indigent persons, to determine how to account for whether any additional payment amount distributed to the
hospital would otherwise have affected, if at all, the county’s redirection obligation for the 2014–15 fiscal year, as specified, and to determine any necessary adjustments. The bill would require the department to consult with the affected designated public hospitals for these purposes, as specified. By creating new duties for county officials for purposes of consulting the department, the bill would impose a state-mandated local program.
Existing law prohibits the reimbursement to Medi-Cal pharmacy providers for legend and nonlegend drugs, as defined, from exceeding the lowest of either the estimated acquisition cost of the drug plus a professional dispensing fee or the pharmacy’s usual and customary charge, as defined. Existing law, commencing April 1, 2017, requires the department to implement a new professional dispensing fee or fees consistent with a specified provision of federal law. Existing law requires the
department to establish a list of maximum allowable ingredient costs (MAIC), as defined, for generically equivalent drugs, and requires these MAICs to be updated at least every 3 months.
This bill, among other things, would modify the way in which reimbursement to Medi-Cal pharmacy providers is calculated by, in part, requiring the department to implement a drug ingredient cost reimbursement methodology based on actual acquisition cost, as defined, and, effective for dates of service on or after April 1, 2017, a dispensing fee that is based upon a pharmacy’s total annual claim volume of the previous year, as specified, and would require the department to reimburse physician-administered drugs that are blood factors, as defined, at an amount that does not exceed 120% of the average sales prices of the last quarter reported.
Existing federal law, the 21st Century
Cures Act, authorizes the United States Secretary of Health and Human Services to award grants to states for the purpose of addressing the opioid abuse crisis, as specified, and requires grants awarded to a state under this program, the Opioid Grant Program, to be used for carrying out activities that supplement activities pertaining to opioids undertaken by the state agency responsible for administering the substance abuse prevention and treatment block grant.
This bill would authorize the State Department of Health Care Services to enter into exclusive or nonexclusive contracts, or to amend existing contracts, on a bid or negotiated basis for the purpose of administering or implementing any federal grant awarded pursuant to the federal 21st Century Cures Act, such as the Opioid Grant Program, as specified.
Existing law authorizes the department to create a program to provide
health home services to Medi-Cal beneficiaries with chronic conditions, and provides that diabetic testing supplies are a covered benefit.
This bill would, to the extent federal financial participation is available and any necessary federal approvals have been obtained, require the department to establish the Diabetes Prevention Program, an evidence-based, lifestyle change program designed to prevent or delay the onset of type 2 diabetes within the Medi-Cal fee-for-service and managed care delivery systems.
Existing law authorizes the State Department of Health Care Services to enter into nonexclusive contracts with entities to provide fiscal intermediary services in order to administer and disburse funds available for Medi-Cal services to health care providers in accordance with the provisions of the contract and any schedule of charges or formula for determining payments
established pursuant to the contract.
Existing law requires the department to provide the appropriate fiscal and policy committees of the Legislature, the Legislative Analyst’s Office, the Department of Technology, and the California State Auditor’s Office with quarterly reports on the transition and takeover process efforts of the Medi-Cal fiscal intermediary contract, as specified, including copies of any oversight reports developed by contractors of the department for the California Medicaid Management Information System (CA-MMIS) project. Existing law requires the California State Auditor’s Office to review the appropriate project documents and quarterly reports and make specified recommendations.
This bill would repeal those provisions.
Existing regulations authorize the department to designate a Medi-Cal Managed
Care Ombudsman to provide Medi-Cal beneficiaries access to services that investigate and resolve complaints about managed care plans by, or on behalf of, Medi-Cal beneficiaries.
This bill would require the department to prepare and post on its Internet Web site quarterly reports on calls received by the Medi-Cal Managed Care Ombudsman, as specified.
(10) Existing federal law provides for the federal Medicare program, which is a public health insurance program for persons who are 65 years of age or older and specified persons with disabilities who are under 65 years of age.
Existing law requires the department to seek federal approval pursuant to a Medicare or Medicaid demonstration project or waiver, or a combination thereof, to establish a demonstration project, known as the Coordinated Care Initiative (CCI), that enables beneficiaries
who are dually eligible for the Medi-Cal program and the Medicare program to receive a continuum of services that maximizes access to, and coordination of, benefits between these programs. Existing law conditions the implementation of the CCI on whether the Director of Finance estimates that the CCI will generate net General Fund savings, as specified. Existing law requires that Medi-Cal beneficiaries who have dual eligibility in the Medi-Cal and Medicare programs to be assigned as mandatory enrollees into managed care health plans in counties participating in the CCI, and requires that no later than December 31, 2017, or the date the managed care health plans and MSSP providers jointly satisfy certain readiness criteria, whichever is earlier, Multipurpose Senior Services Program (MSSP) services to be covered under managed care health contracts and only available through managed care health plans in counties participating in the CCI.
This bill
would provide that the provision conditioning implementation of the CCI on the above-described estimation by the Director of Finance is inoperative on January 2, 2018, and, as of July 1, 2018, is repealed. The bill would make conforming changes in various provisions relating to the CCI to provide that those provisions continue to be operative.
Existing law provides that a person meeting participation requirements for the Program of All-Inclusive Care for the Elderly (PACE) may select a PACE plan if one is available in that person’s county. Existing law as part of the CCI also requires specified Medi-Cal long-term services to be covered under managed health care plan contracts and to be available only though managed care health plans to beneficiaries residing in counties participating in the CCI.
This bill would provide that, except in counties with county
organized health systems, a beneficiary who has dual eligibility in the Medi-Cal program and the Medicare Program or who is required to receive long-term services and supports through a managed care plan under the CCI, and who is also potentially eligible for PACE shall be informed by the department or its enrollment contractor that the beneficiary may request to be assessed for eligibility for PACE, and, if eligible, may enroll in PACE. The bill would prohibit enrollment of that beneficiary into a managed care plan until the earlier of 60 days or the time that he or she is assessed and determined to be ineligible for a PACE plan, unless the beneficiary subsequently chooses to enroll in a managed care plan. The bill would provide that while a beneficiary required to receive long-term services and supports is being assessed he or she shall remain in fee-for-service Medi-Cal, or, if applicable, the managed care plan in which he or she is enrolled.
(11) Existing law establishes the county-administered In-Home Supportive Services (IHSS) program, under which qualified aged, blind, and disabled persons are provided with services in order to permit them to remain in their own homes and avoid institutionalization. Existing law requires Medi-Cal long-term services and supports, including IHSS, Community-Based Adult Services (CBAS), Multipurpose Senior Services Program (MSSP) services, and certain skilled nursing facility and subacute care services, to be covered services under managed care health plan contracts and to be available only through managed care health plans to beneficiaries residing in the CCI counties, except as specified.
This bill would provide that the above-described long-term services and supports continue to be covered services, as specified above, and would provide that IHSS are part of the covered long-term services
and supports only through December 31, 2017. The bill would repeal, as of January 1, 2018, other provisions relating to IHSS as a Medi-Cal benefit available through managed care health plans in participating counties. The bill would make conforming changes in related provisions.
(12) Existing law requires, no later than December 31, 2017, or on the date the managed care health plans and MSSP providers jointly satisfy specified readiness criteria, whichever is earlier, MSSP services to transition from a federal waiver, as specified, to a benefit administered and allocated by managed care health plans in CCI counties.
This bill would instead require the above transition of MSSP services to take place no sooner than December 31, 2019, or as specified or on the date the above entities jointly satisfy the readiness criteria, whichever is earlier.
(13) Existing law establishes the Major Risk Medical Insurance Fund in the State Treasury and continuously appropriates moneys in the fund, except as specified, to the State Department of Health Care Services for purposes of the California Major Risk Medical Insurance Program. Existing law also establishes the Managed Care Administrative Fines and Penalties Fund, from which certain amounts are transferred into the Major Risk Medical Insurance Fund and, upon appropriation by the Legislature, used for the program, including to cover expenses of providing major risk medical coverage to eligible persons.
This bill would repeal the Major Risk Medical Insurance Fund, effective July 1, 2017, and replace it with the Health Care Services Plan Fines and Penalties Fund. The bill would require the moneys previously transferred to the Major Risk Medical Insurance Fund to instead be transferred to the Health Care
Services Plan Fines and Penalties Fund, effective January 1, 2017. The bill would require those moneys to be continuously appropriated to the department, to be used, in addition to the purposes described above, to cover expenses of providing health care services for eligible individuals in the Medi-Cal program, subject to specified criteria.
This bill would authorize the Controller to use the funds in the Health Care Services Plan Fines and Penalties Fund for cashflow loans to the General Fund as authorized in specified provisions of the Government Code.
(14) Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.
This bill would make legislative findings to that effect.
(15) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that with regard to certain mandates no reimbursement is required by this act for a specified reason.
With regard to any other mandates, this bill would provide that, if the Commission on State Mandates determines that the bill contains costs so mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
(16) This bill would declare that it is to take
effect immediately as a bill providing for appropriations related to the Budget Bill.