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HomeMy WebLinkAboutMINUTES - 09211999 - U1 r To: BOARD OF SUPERVISORS UPERS ISORS Contra J ti^ SUPERVISOR DONNA GERBER , Costa FROM: _. SUPERVISOR MARK DeSAULNIER `s ����• "_� ��°� County DATE: September 20, 1999 SUBJECT: LEGISLATION - AB 469 (PAPAN) SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: ADOPT a position in opposition to AB 469 by Assemblyman Lou Papan and AUTHORIZE the Chair, Board of Supervisors,to sign a letter to the Governor asking him to veto the bill. BACKGROUND: Currently the State Department of Health Services determines which Medi-Cal beneficiaries will be mandatorily enrolled in a health plan and which have the option of remaining in the fee-for-service program. AB 469 (which is sponsored by the Western Center on Law and Poverty) would provide that enrollment in a Medi-Cal managed care plan shall be voluntary for beneficiaries who are eligible for benefits under the Federal SSI (Supplemental Security Income) Program. It also provides that enrollment of certain infants and children in a managed care plan would be voluntary. It also provides that children eligible for the California Children's Service (CCS) Program who are enrolled in a Medi-Cal managed care program could disenroll under specified circumstances. CONTINUED ON ATTACHMENT: YES SIGNATURE: RECOMMENDA OF COUNTY INISTRATOR --.-RECOMMENDATION OF BOARD COMMITTEE APPROVE O HER SIGNATUREM: DONNA RBER MARK DeSAULNIER ACTION OF BOARD oC�pptember 21, 1999 APPROVED AS RECOMMENDED OTHER IT IS BY THE BOARD ORDERED, by unanimous vote, that this matter is added to the agenda as an urgency item; a position in opposition to AB 469 is ADOPTED; and the Chair, Board of Supervisors, is AUTHORIZED to sign a letter to the Governor asking him to veto AB 469. VOTE OF SUPERVISORS I HEREBY CERTIFY THAT"THIS IS A TRUE UNANIMOUS(ABSENT n ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS THE DATE SHOWN. County Administrator ATTESTED Contact: Health Services Director PHIL 14ATCHELOR,CLERK OF THE BOARD OF cc: Executive Director, CCHP SUPERVISORS AND COUNTY ADMINISTRATOR Les Spahnn; Heim, Noack, Kelly&Spahnn 51, 994r�� ,DEPUTY BYY The fee-for-service is typically more expensive than the care provided by a managed care plan. Enactment of AB 469 would also permit some enrollees in the Contra Costa Health Plan to disenroll and would impact the level of future enrollment. The CCHP Joint Conference Committee, of which we are both members, discussed this bill on September 17, 1999, and voted to authorize Supervisor Gerber, as its Chair, to write to the Governor asking for a veto of AB 469. We are bringing this matter to the attention of the Board of Supervisors as an urgency matter, asking that the Board authorize its Chair to likewise write to the Governor asking for a veto. -2- Assembly Bill No.469 Passed the Assembly September 9, 1999 Chief Clerk of the Assembly Passed the Senate September 8, 1999 Secretary of the Senate This bill was received by the Governor this day Of 1999, at O'clock----m. Private Secretary of the Governor AB 469 2— CHAPTER An act to amend Section 14089 of, and to add Sections 14087.11 and 14094.4 to, the Welfare and Institutions Code, relating to health. LEGISLATIVE COUNSEL'S DIGEST AB 469, Papan. Medi-Cal: managed care plans. Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Services, pursuant to which medical benefits are provided to public assistance recipients and certain other low-income persons. This bill would provide that enrollment in a Medi-Cal managed care plan shall be voluntary for beneficiaries who are eligible for benefits under the federal Supplemental Security Income for the Aged, Blind and Disabled Program and eligible low-income infants and children, in areas specified by the Director of Health Services for expansion of the Medi-Cal managed care program and where the department is contracting with various entities for those benefits. The bill would, with the exception of contracts entered into for county organized health systems, authorize any child who is eligible for California Children Services Program benefits who is enrolled in a Medi-Cal managed care plan to be disenrolled in specified conditions, and would specify that their enrollment in managed care plans is voluntary. The people of the State of California do enact as follows: SECTION 1. Section 14087.11 is added to the Welfare and Institutions Code, to read: 14087.11. (a) Enrollment in a Medi-Cal managed health care plan under this article shall be voluntary for all of the following: (1) Beneficiaries who are eligible for the federal Supplemental Security Income for the Aged, Blind, and 95 -3 AB 469 Disabled Program (Subchapter 16 (commencing with Section 1381) of Chapter 7 of Title 42 of the United States Code). (2) Low-income infants and children described in subsection (1) of Section 1396a of Title 42 of the United States Code. (b) Subdivision (a) shall apply only in areas specified by the director for expansion of the Medi-Cal managed care program, as provided for pursuant to Section 14087.3, and where the department is contracting with prepaid health plans or with prepaid health plans that are contracting with, or governed, owned, or operated by, either a county board of supervisors, a county special commission, or a county health authority authorized by Section 14018.7, 14087.31, 14087.35, 14087.36, 14087.38, 14087.96, or 14089.05. SEC. 2. Section 14089 of the Welfare and Institutions Code is amended to read: 14089. (a) The purpose of this article is to provide a comprehensive program of managed health care plan services to Medi-Cal recipients residing in clearly defined geographical areas. It is, further, the purpose of this article to create maximum accessibility to health care services by permitting Medi-Cal recipients the option of choosing from among two or more managed health care plans or fee-for-service managed case arrangements, including, but not limited to, health maintenance organizations, prepaid health plans, primary care case management plans. Independent practice associations, health insurance carriers, private foundations, and university medical centers systems, not-for-profit clinics, and other primary care providers, may be offered as choices to Medi-Cal recipients under this article if they are organized and operated as managed care plans, for the provision of preventive managed health care plan services. (b) The negotiator may seek proposals and then shall contract based on relative costs, extent of coverage offered, quality of health services to be provided, financial stability of the health care plan or carrier, 95 AB 469 4— recipient access to services, cost-containment strategies, peer and community participation in quality control, emphasis on preventive and managed health care services and the ability of the health plan to meet all requirements for both of the following: (1) Certification, where legally required, by the Commissioner of Corporations and the Insurance Commissioner. (2) Compliance with all of the following: (A) The health plan shall satisfy all applicable state and federal legal requirements for participation as a Medi-Cal managed care contractor. (B) The health plan shall meet any standards established by the department for the implementation of this article. (C) The health plan receives the approval of the department to participate in the pilot project under this article. (c) (1) (A) The proposals shall be for the provision of preventive and managed health care services to specified eligible populations on a capitated, prepaid or postpayment basis. (B) Enrollment in a Medi-Cal managed health care plan under this article shall be voluntary for all of the following: (i) Beneficiaries who are eligible for the federal Supplemental Security Income for the Aged, Blind, and Disabled Program (Subchapter 16 (commencing with Section 1381) of Chapter 7 of Title 42 of the United States Code). (ii) Low-income infants and children described in subsection (1) of Section 1396a of Title 42 of the United States Code. (2) The cost of each program established under this section shall not exceed the total amount which the department estimates it would pay for all services and requirements within the same geographic area under the fee-for-service Medi-Cal program. 95 -5 AB 469 (d) The department shall enter into contracts pursuant to this article, and shall be bound by the rates, terms, and conditions negotiated by the negotiator. (e) (1) An eligible beneficiary shall be entitled to enroll in any health care plan contracted for pursuant to this article that is in effect for the geographic area in which he or she resides. Enrollment shall be for a minimum of six months. Contracts entered into pursuant to this article shall be for at least one but no more than three years. The director shall make available to recipients information summarizing the benefits and limitations of each health care plan available pursuant to this section in the geographic area in which the recipient resides. (2) No later than 30 days following the date a Medi-Cal or AFDC recipient is informed of the health care options described in paragraph (1) of subdivision (e), the recipient shall indicate his or her choice in writing of one of the available health care plans and his or her choice of primary care provider or clinic contracting with the selected health care plan. (3) The health care options information described in paragraph (1) of subdivision (e) shall include the following elements: (A) Each beneficiary or eligible applicant shall be provided with the name, address, telephone number, and specialty, if any, of each primary care provider, and each clinic participating in each health care plan. This information shall be presented under geographic area designations in alphabetical order by the name of the primary care provider and clinic. The name, address, and telephone number of each specialist participating in each health care plan shall be made available by contacting the health care options contractor or the health care plan. (B) Each beneficiary or eligible applicant shall be informed that he or she may choose to continue an established patient-provider relationship in a managed care option, if his or her treating provider is a primary care provider or clinic contracting with any of the health 95 AB 469 —6— plans available and has the available capacity and agrees to continue to treat that beneficiary or eligible applicant. (C) Each beneficiary or eligible applicant shall be informed that if he or she fails to make a choice, he or she shall be assigned to, and enrolled in, a health care plan. (4) At the time the beneficiary or eligible applicant selects a health care plan, the department shall, when applicable, encourage the beneficiary or eligible applicant to also indicate, in writing, his or her choice of primary care provider or clinic contracting with the selected health care plan. (5) Commencing with the implementation of a geographic managed care project in a designated county, a Medi-Cal or AFDC beneficiary who does not make a choice of health care plans in accordance with paragraph (2), shall be assigned to and enrolled in an appropriate health care plan providing service within the area in which the beneficiary resides. (6) If a beneficiary or eligible applicant does not choose a primary care provider or clinic, or does not select any primary care provider who is available, the health care plan selected by or assigned to the beneficiary shall ensure that the beneficiary selects a primary care provider or clinic within 30 days after enrollment or is assigned to a primary care provider within 40 days after enrollment. (7) Any Medi-Cal or AFDC beneficiary dissatisfied with the primary care provider or health care plan shall be allowed to select or be assigned to another primary care provider within the same health care plan. In addition, the beneficiary shall be allowed to select or be assigned to another health care plan contracted for pursuant to this article that is in effect for the geographic area in which he or she resides in accordance with Section 1903(m)(2)(F)(ii) of the Social Security Act. (8) The department or its contractor shall notify a health care plan when it has been selected by or assigned to a beneficiary. The health care plan that has been selected or assigned by a beneficiary shall notify the primary care provider that has been selected or assigned. 95 -7 AB 469 The health care plan shall also notify the beneficiary of the health care plan and primary care provider selected or assigned. (9) This section shall be implemented in a manner consistent with any federal waiver that is required to be obtained by the department to implement this section. (f) A participating county may include within the plan or plans providing coverage pursuant to this section, employees of county government, and others who reside in the geographic area and who depend upon county funds for all or part of their health care costs. (g) The negotiator and the department shall establish pilot projects to test the cost-effectiveness of delivering benefits as defined in subdivisions (a) to (f), inclusive. (h) The California Medical Assistance Commission shall evaluate the cost effectiveness of these pilot projects after one year of implementation. Pursuant to this evaluation the commission may either terminate or retain the existing pilot projects. (i) Funds may be provided to prospective contractors to assist in the design, development, and installation of appropriate programs. The award of these funds shall be based on criteria established by the department. 0) In implementing this article, the department may enter into contracts for the provision of essential administrative and other services. Contracts entered into under this subdivision may be on a noncompetitive bid basis and shall be exempt from Chapter 2 (commencing with Section 10290) of Part 2 of Division 2 of the Public Contract Code. SEC. 3. Section 14094.4 is added to the Welfare and Institutions Code, to read: 14094.4. (a) Except for the contracts entered into for county organized health systems, including the Santa Barbara Regional Health Authority, any child who is eligible for benefits under the California Children's Services Program provided for pursuant to Article 5 (commencing with Section 123800) of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code who is enrolled in a Medi-Cal managed care plan shall be 95 AB 469 8— disenrolled upon request of a parent or guardian of that child if all of the following conditions are met: (1) A specialist approved under the California Children's Services Program who is providing care to the child has indicated in writing that the child should be disenrolled. (2) A primary care physician or the specialist approved under the California Children's Services Program who is providing care to the child has indicated in writing a willingness to accept the child for primary and preventive care under the fee-for-service Medi-Cal program. The local children's medical services office, which includes any office under the California Children's Services Program or the Child Health and Disability Prevention Program, may assist the child's family with locating an appropriate primary care physician if the child does not have a primary care physician. (b) The disenrollment of a child from a managed care plan shall take effect as follows: (1) Within two working days after the request under this section if the specialist or primary care physician indicates the existence of a medical emergency. (2) In any case to which paragraph (1) does not apply, the disenrollment shall take effect not later than the next Medi-Cal eligibility redetermination. 95 Approved ' 1999 Governor