HomeMy WebLinkAboutMINUTES - 08032004 - SD2 CONTRA
TO: BOARD OF SUPERVISORS k COSTA
COUNTY
FROM: William B. Walker, MD, Health Services Director
DATE: August 3, 2004 �+
SUBJECT: Support SB 1525 (Speier) - Breast and Cervical Cancer Screening Services
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
RECOMMENDATION(S):
1. SUPPORT SB 1525 (Speier) which would consolidate the Family Planning Access Care and Treatment
Program (Family PACT) and the Cancer Detection Programs, Every Woman Counts, to be administered
by the Office of Family Planning.
2. CONTACT the Contra Costa County legislative delegation conceming the Board's support of SB 1525.
BACKGROUND/REASON(S) FOR RECOMMENDATION(S):
Consolidation of family planning services and the breast and cervical cancer screening services at the State
level will create a more efficient and cost-effective means of providing local healthcare services to uninsured
California residents with incomes below 200% of federal poverty level. SB 1525 would provide a more
comprehensive approach to women's health, taking a step toward universal healthcare for women in
California.
Currently, family planning services and breast and cervical cancer screening, diagnostic, and treatment
services are provided through three distinct programs at the State level. Each program has different eligibility
requirements and enrollment processes. This proposed legislation would establish one set of eligibility
requirements and allow all medical providers to conduct screening and diagnosis for women. It would simplify
heath care delivery for the patient, the medical provider, and the State and County systems of care. In Contra
Costa, we have many different programs to provide health care services to women through Family PACT,
Medi-Cal, and the Every Woman Counts Program, each with different eligibility requirements, paperwork, and
record-keeping systems. SB 1525 would improve services for low-income women while saving money for the
State administering agency and the local health care delivery system. This streamlined approach would shift
women into a program that provides a 9:1 federal match for services, generating additional revenues for the
State. The set-up costs for this move can be absorbed over time and would result in longer term cost savings
for the State and for providers.
CONTINUED ON ATTACHMENT: YES XX ,Ift Signature
-.-'-RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
w--`"``APPROVE OTHER
SIGNATURE(S):. - /.,�9 ,
ACTION OF BC�'AgI ON._ ' ,�1` VAPP OVED AS RECOMMENDED -4�
i
APPROVtO above recommendations and REQUESTED this item be presented/forwarded to
the California State Association of Counties (CSAC).
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A
UNANIMOUS {ABSENT �- _ - ) TRUE AND CORRECT COPY OF AN
AYES: NOES: ACTION TAKEN AND ENTERED
ABSENT: ABSTAIN: ON MINUTES OF THE BOARD OF
SUPERVISORS ON THE DATE SHOWN.
i'
ATTESTED !%y-
JOHN SWEET N, RK OF THE BOARD
OF SUPE VISORS AND COUNTY ADMINSTRATOR
Contact: Wendel Brunner, director of Public Health, 313-6712
By: Deputy
cc Public Health Director, 597 Center, #204, Mtz
Health Services Director, 20 Allen, Mtz ;,
BACKGROUNDIREASON(S) FOR RECOMMENDATION (cont'd):
Contra Costa County has one of the highest rates of breast cancer in the country, with higher rates than the
San Francisco Bay Area and California. In Contra Costa, approximately 728 women are diagnosed with
invasive breast cancer, and 135 women die from invasive breast cancer each year. In Contra Costa, invasive
breast cancer is the leading cause of cancer death among Hispanic Women, and the second leading cause of
cancer death among White, African American, and Asian/Pacific Islander women. This figure is particularly
alarming because Hispanic women are one of the fastest growing populations in Contra Costa County. Contra
Costa County also has a higher rate of cervical cancer than the San Francisco Bay Area. The greatest
incidence of cervical cancer in Contra Costa County occurs first among Latinas and secondly among African
Americans.
Breast and cervical cancer screening and diagnosis are conducted at our twelve outpatient health centers.
Additionally: CCHS holds four outpatient Women's Health Clinics a week at sites in Concord and Pittsburg.
We will be expanding to Brentwood, Bay Point and Richmond before the end of 2004. These clinics were
instituted in order to facilitate women's access to basic breast and gynecological care. Only female providers
staff the Women's Health Clinics and bilingual staff are also present at each clinic. Each Clinic promotes a
friendly, warm, and caring environment where client education is a priority. In the Pittsburg Clinic, there is a
specially designed exam table for disabled women. However, because the family planning program and the
breast and cervical cancer screening program have different eligibility requirements and distinct services
based on these requirements, women experience barriers to receiving comprehensive care. There current
system of care is fractured, in that women must sometimes see two or more providers to get their healthcare
services.
SB 1525 would remove barriers and create a more seamless system of care for needed services.
Consolidation of these two programs would result in local cost savings because more Contra Costa residents
would be eligible for state-funded comprehensive cancer screening services. Ultimately, this would result in
fewer women seeking services through Contra Costa County's Basic Health Care program.
Summary of advantages of SB 1525:
a) SB 1525 would reduce the number of women who do not receive necessary healthcare services due to
multiple enrollment processes. Elimination of this burden would make the programs more accessible
to women and reduce costs associated with enrolling patients.
b) SB 1525 will produce long-term cost savings, through consolidation of enrollment procedures and
administrative inconsistencies in the provision of services.
c) SB 1525 would shift women into a program that provides a 9:1 federal match for some services,
generating additional revenues for the State. The set-up costs for this move can be absorbed over
time and would result in longer term cost savings for the State and for providers.
d) SB 1525 would make breast and cervical cancer screening services more accessible to women who
need these services because Family PACT is a more widely accessible program than the current Every
Woman Counts program.
AMENDED IN ASSEMBLY JUNE 23, 2004
AMENDED IN SENATE MAY 24, 2004
AMENDED IN SENATE APRIL 27, 2004
.AMENDED IN SENATE APRIL 14, 2004
AMENDED IN SENATE MARCH 30, 2004
SENATE BILL No. 1525
Introduced by Senator Speier
February 19, 2004
An act to amend Section 104150 of the Health and Safety Code,and
to amend 'Sections 11024.3, 14105.18, 14132, 24001, 24003.2,
24003.5, and 24027 of the Welfare and Institutions Code, relating to
health care.
LEGISLATIVE COUNSEL'S DIGEST
SB 1525, as amended, Speier. Health care. breast cancer and
cervical cancer screening services: family planning services.
Existing lav requires the State Department of Health Services to
provide breast cancer and cervical cancer screening services under a
federal grant made under the federal Centers for Disease Control and
Prevention breast and cervical cancer early detection program to
eligible low-income individuals.
A provider or entity that participates in the grant program may only
render screening services to an individual if the provider or entity
determines that the individual's family income does not exceed 200%
of the federal poverty level.
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SB 1525 —2—
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
other low-income persons. Pursuant to a federal waiver, the Medi-Cal
program administers a program known as the Family Planning,Access,
Care, and Treatment (Family PACT) Waiver Program, under which
comprehensive clinical family planning services are provided to any
person who has a family income at or below 200%of the federal poverty
level and who is eligible to receive those services pursuant to the terms
of the waiver. These services include a comprehensive health history
that is periodically updated and that includes a complete obstetrical
history, gynecological history,contraceptive history,personal medical
history,health risk factors,and family health history, including genetic
or hereditary conditions,and a complete physical examination on initial
and subsequent periodic visits.
Existing law establishes the Office of Family Planning in the State
Department of Health Services.
This bill would
e"aftd the F-411., waiver-aft4 weft14-require the Family PACT
Program i " motet--within,. . --,within th Of
fee of Family Planning to
administer the breast and cervical cancer early detection program.This
bill also would rename the Family Planning, Access, Care, and
Treatment (Family PACT) Waiver Program, as the Family Planning,
Access,Care, and Treatment(Family PACT) Program.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
The people of the State of California do enact asfellows:
I SECTION 1. (a) It is the intent of the Legislature, in enacting
2 this act, that women should have the easiest and most seamless
3 access to health care and to cancer screening and treatment that our
4 current resources can provide and to increase the return to the State
5 of California on its investments in comprehensive clinical family
6 planning services and early detection breast and cervical cancer
7 screening. Consolidation of Family PACT and the breast and
8 cervical cancer screening program—Every Woman
9 Counts—provides an opportunity to create a more efficient means
10 of providing these important health care services to uninsured
11 Californians who have incomes below 200 percent of the federal
94
-3— SB 1525
1 poverty level. The Legislature finds and declares that, at the same
2 time, we can increase the benefit through sharing of best practices,
3 economies of scale in outreach and provider network maintenance,
4 and maximizing local contributions of volunteers, cash, and
5 in-kind resources.
6 (b) The Legislature further finds and declares that, at a time
7 when the state is reducing provider rates,we need to find ways to
8 encourage more providers to serve our low-income communities
9 and provide essential health care services. Through consolidation
10 of Family PACT and Every Woman Counts within the State
1 I Department of Health Services, it is the intent of the Legislature
12 in enacting this act to reduce bureaucracy, simplify paperwork and
13 provider contracts, and work toward developing a seamless
14 mechanism for eligible populations to receive services through
15 these programs.
16 (c) It is the intent of the Legislature that the essential character
1.7 of the Family PACT and the breast and cervical cancer early
18 detection programs not change through consolidation. Through
19 consolidation of these programs, the Legislature intends to utilize
20 all means to draw down more federal dollars for cervical cancer
21 screening services and other areas of service overlap between the
22 two programs. Community engagement, culturally competent
23 outreach and education,and data collection are essential to giving
24 eligible women access to health services, including breast and
25 cervical cancer screening. The Legislature finds and declares that
26 the consolidated program should utilize regional infrastructures to
27 ensure statewide provision of'breast and cervical cancer screening
28 provider network maintenance, outreach to underserved
29 communities, continuing professional education, quality
30 improvement, data collection, and coordination with the State
31 Department of Health Services Cancer Detection Section.
32 (d) The Legislature funds and declares that California has made
33 great strides in cancer screening,treatment, and research,and we
34 need to do more, and do it better and smarter. By maintaining and
35 expanding provider networks and community outreach, we can
36 improve the health outcomes for California's women.
37 SEC. 2. Section 104150 of the Health and Safety Code is
38 amended to read:
94
F
SB 1525 —4-
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22 104150. (a) The breast and cervical cancer early detection
23 program shall be administered by the Family Planning, Access,
24 Care, and Treatment (Family PACT)Program within the Office of.
25 Family Planning that was established within the State Department
26 of Health Services under the authority of Section 24000 of the
27 Welfare and Institutions Code.
28 (b) A provider or entity that participates in the grant made to the
29 department by the federal Centers for Disease Control and
30 Prevention breast and cervical cancer early detection program
31 established under Title XV of the Public Health Service Act (42
32 U.S.C. Sec. 300k et seq.) in accordance with requirements of
33 Section 1504 of that act (42 U.S.C. Sec. 300n) may only render
34 screening services under the grant to an individual if the provider
35 or entity determines that the individual's family income does not
36 exceed 204 percent of the federal poverty level.
37 (c) The department shall provide for breast cancer and cervical
38 cancer screening services under the grant at the level of funding
39 budgeted from state and other resources during the fiscal year in
40 which the Legislature has appropriated funds to the department for
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1 this purpose. These screening services shall not be deemed to be
2 an entitlement.
3 (d) To implement the federal breast and cervical cancer early
4 detection program specified in this section, the department may
5 contract, to the extent permitted by Section 19130 of the
6 Government Code, with public and private entities, or utilize
7 existing health care service provider enrollment and payment
8 mechanisms, including the Medi-Cal program's fiscal
9 intermediary. However, the Medi-Cal program's fiscal
10 intermediary shall only be utilized if services provided under the
1 I program are specifically identified and reimbursed in a manner
12 that does not claim federal financial reimbursement.Any contracts
13 with, and the utilization of, the Medi-Cal program's fiscal
14 intermediary shall not be subject to Chapter 3 (commencing with
15 Section 12 100)of Part 2 of Division 2 of the Public Contract Code.
16 Contracts to implement the federal breast and cervical cancer early
17 detection program entered into by the department with entities
18 other than the Medi-Cal program's fiscal intermediary shall not be
19 subject to Part 2 (commencing with Section 10 100)of Division 2
20 of the Public Contract Code.
21 SEC. 3. Section 11024.3 of the Welfare and Institutions Code
22 is amended to read:
23 11024.3. Commencing March 1,2002,the State Department
24 of Health Services shall post all of the following data on its Internet
25 Web site and in a format that may be easily understood by the
26 general public, in addition to the information required by Section
27 11024:
28 (a) All county letters and county information notices prepared
29 after January 1, 2002.
30 (b) All application forms for the fallowing programs, to the
31 extent they are available in computerized form:
32 (1) The Medi-Cal program.
33 (2) The California Children's Services Program.
34 (3) The Child Health and Disability Prevention Program.
35 (4) The Family Planning,Access, Care, and Treatment(Family
36 PACU') Program under subdivision(aa)of Section 14132.
37 SEC. 4. Section 14105.1.8 of the Welfare and Institutions
38 Code is amended to read:
39 14105.18. (a) Notwithstanding any other provision of law,
40 provider rates of payment for services rendered in all of the
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SB 1525 —6-
1
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1 following programs shall be identical to the rates of payment for
2 the same service performed by the same provider type pursuant to
3 the Medi-Cal program.
4 (1) The California Children's Services Program established
5 pursuant to Article 5 (commencing with Section 123800) of
6 Chapter 3 of Part 2 of Division 106 of the Health and Safety Code.
7 (2) The Genetically Handicapped Person's Program
8 established pursuant to Article 1 (commencing with Section
9 125125)of Chapter 2 of Fart 5 of Division 106 of the Health and
10 Safety Code.
11 (3) The Breast and Cervical Cancer Early Detection Program
12 established pursuant to Article 1.3 (commencing with Section
13 104150)of Chapter 2 of Part 1 of Division 103 of the Health and
14 Safety,Code and the breast cancer programs specified in Section
15 30461.6 of the Revenue and Taxation Code.
16 (4) The State-Only Family Planning Program established
17 pursuant to Division 24 (commencing with Section 24000).
18 (5) The Family Planning,Access,Care,and Treatment(Family
19 PACT) Program established pursuant to subdivision (aa) of
20 Section. 14132.
21 (b) The director may identify in regulations other programs not
22 listed in subdivision(a)in which providers shall be paid rates of
23 payment that are identical to the rates of payments in the Medi-Cal
24 program pursuant to subdivision(a).
25 (e) Notwithstanding subdivision (a), services provided under
26 any of the programs described in subdivisions (a)and(b)may be
27 reimbursed at rates greater than the Medi-Cal rate that would
28 otherwise be applicable if those rates are adopted by the director
29 in regulations.
30 SEC. 5. Section 14132 of the Welfare and Institutions Code
31 is amended to read:
32 1.4132. The following is the schedule of benefits under this
33 chapter:
34 (a) 'Outpatient services are covered as follows:
35 Physician, hospital or clinic outpatient, surgical center,
36 respiratory care, optometric, chiropractic, psychology, podiatric,
37 occupational therapy,physical therapy, speech therapy,audiology,
38 acupuncture to the extent federal matching funds are provided for
39 acupuncture, and services of persons rendering treatment by
40 prayer or healing by spiritual means in the practice of any church
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1 or religious denomination insofar as these can be encompassed by
2 federal participation under an approved plan, subject to utilization
3 controls.
4 (b) Inpatient hospital services, including, but not limited to,
5 physician and podiatric services, physical therapy and
6 occupational therapy, are covered subject to utilization controls.
7 (c) Nursing facility services, subacute care services, and
8 services provided by any category of intermediate care facility for
9 the developmentally disabled,including podiatry,physician,nurse
10 practitioner services, and prescribed drugs, as described in
11 subdivision (d), are covered subject to utilization controls.
1.2 Respiratory care, physical therapy, occupational therapy, speech
13 therapy, and audiology services for patients in nursing facilities
14 and any category of intermediate care facility for the
15 developmentally disabled are covered subject to utilization
16 controls.
17 (d) Purchase of prescribed drugs is covered subject to the
18 Medi-Cal List of Contract Drugs and utilization controls.
19 (e) Outpatient dialysis services and home hemodialysis
20 services, including physician services,medical supplies,drugs and
21 equipment required for dialysis,are covered, subject to utilization
22 controls.
23 (f) Anesthesiologist services when provided as part of an
24 outpatient medical procedure, nurse anesthetist services when
25 rendered in an inpatient or outpatient setting under conditions set
26 forth by the director, outpatient laboratory services, and X-ray
27 services are covered,subject to utilization controls.Nothing in this
28 subdivision shall be construed to require prior authorization for
29 anesthesiologist services provided as part of an outpatient medical
30 procedure or for portable X-ray services in a nursing facility or any
31 category of intermediate care facility for the developmentally
32 disabled.
33 (g) Blood and blood derivatives are covered.
34 (h) (1) Emergency and essential diagnostic and restorative
35 dental services, except for orthodontic, fixed bridgework, and
36 partial dentures that are not necessary for balance of a complete
37 artificial denture, are covered, subject to utilization controls. The
38 utilization controls shall allow emergency and essential diagnostic
39 and restorative dental services and prostheses that are necessary to
40 prevent a significant disability or to replace previously furnished
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SB 1525 —8-
1
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1 prostheses which are lost or destroyed due to circumstances
2 beyond the beneficiary's control.Notwithstanding the foregoing,
3 the director may by regulation provide for certain fixed artificial
4 dentures necessary for obtaining employment or for medical
5 conditions that preclude the use of removable dental prostheses,
6 and for orthodontic services in cleft palate deformities
7 administered by the department's California Children Services
8 Program..
9 (2) For persons 21 years of age or older,the services specified
10 in paragraph (1) shall be provided subject to the following
11 conditions:
12 (A) Periodontal treatment is not a Benefit.
1.3 (B) Endodontic therapy is not a benefit except for vital
14 pulpotomy.
15 (C) Laboratory processed crowns are not a benefit.
16 (D) Removable prosthetics shall be a benefit only for patients
17 as a requirement for employment.
18 (E) The director may, by regulation, provide for the provision
19 of fixed artificial dentures that are necessary for medical
20 conditions that preclude the use of removable dental prostheses.
21 (F) Notwithstanding the conditions specified in subparagraphs
22 (A) to;(E), inclusive, the department may approve services for
23 persons with special medical disorders subject to utilization
24 review.
25 (3) ',Paragraph(2) shall become inoperative July 1, 1995.
26 (i) Medical transportation is covered, subject to utilization
27 controls.
28 0) Home health care services are covered, subject to utilization
29 controls.
30 (k) 'Prosthetic and orthotic devices and eyeglasses are covered,
31 subject to utilization controls. Utilization controls shall allow
32 replacement of prosthetic and orthotic devices and eyeglasses
33 necessary because of loss or destruction due to circumstances
34 beyond the beneficiary's control. Frame styles for eyeglasses
35 replaced pursuant to this subdivision shall not change more than
36 once every two years, unless the department so directs.
37 Orthopedic and conventional shoes are covered when provided
38 by a prosthetic and orthotic supplier on the prescription of a
39 physician and when at least one of the shoes will be attached to a
40 prosthesis or brace, subject to utilization controls.Modification of
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1
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1 stock conventional or orthopedic shoes when medically indicated,
2 is covered subject to utilization controls. When there is a clearly
3 established medical need that cannot be satisfied by the
4 modification of stock conventional or orthopedic shoes,
5 custom-made orthopedic shoes are covered, subject to utilization
6 controls.
7 (0 Hearing aids are covered, subject to utilization controls.
8 utilization controls shall allow replacement of hearing aids
9 necessary because of loss or destruction due to circumstances
10 beyond the beneficiary's control.
II (m) Durable medical equipment and medical supplies are
1.2 covered, subject to utilization controls. The utilization controls
13 shall allow the replacement of durable medical equipment and
14 medical supplies when necessary because of loss or destruction
15 due to circumstances beyond the beneficiary's control. The
16 utilization controls shall allow authorization of durable medical
17 equipment needed to assist a disabled beneficiary in caring for a
18 child for whom the disabled beneficiary is a parent, stepparent,
19 foster parent, or legal guardian, subject to the availability of
20 federal financial participation. The department shall adopt
21 emergency regulations to define and establish criteria for assistive
22 durable medical equipment in accordance with the rulemaking;
23 provisions of the Administrative Procedure Act (Chapter 3.5
24 (commencing with Section 11340)of Part 1 of Division 3 of Title
25 2 of the Government Code).
26 (n) family planning services are covered, subject to utilization
27 controls.
28 (o) Inpatient intensive rehabilitation hospital services,
29 including respiratory rehabilitation services, in a general acute
30 care Hospital are covered, subject to utilization controls, when
31 either of the following criteria are met:
32 (1) A patient with a permanent disability or severe impairment
33 requires an inpatient intensive rehabilitation hospital program.as
34 described in Section 1.4064 to develop function beyond the limited
35 amount that would occur in the normal course of recovery.
36 (2) A patient with a chronic or progressive disease requires an
37 inpatient intensive rehabilitation hospital program as described in
38 Section 14064 to maintain the patient's present functional level as
39 long as possible.
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SB 1525 _ 10—
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10-1 (p) Adult day health care is covered in accordance with Chapter
2 8.7 (commencing with Section 14520).
3 (q) (1) Application of fluoride, or other appropriate fluoride
4 treatment as defined by the department, other prophylaxis
5 treatment for children 17 years of age and under, are covered.
6 (2) All dental hygiene services provided by a registered dental
7 hygienist in alternative practice pursuant to Sections 1768 and
8 1770 of the Business and Professions Code may be covered as long
9 as they are within the scope of Denti-Cal benefits and they are
10 necessary services provided by a registered dental hygienist in
11 alternative practice.
12 (r) (1) Paramedic services performed by a city, county, or
13 special district, or pursuant to a contract with a city, county, or
14 special district.
15 (2) All providers enrolled under this subdivision shall satisfy
16 all applicable statutory and regulatory requirements for becoming
17 a Medi-Cal provider.
18 (3) This subdivision shall be implemented only to the extent
19 funding is available under Section 14106.6.
20 (s) In-home medical care services are covered when medically
21 appropriate and subject to utilization controls, for beneficiaries
22 who would otherwise require care for an extended period of time
23 in an acute care hospital at a cost higher than in-home medical care
24 services.The director shall have the authority under this section to
25 contract with organizations qualified to provide in-home medical
26 care services to those persons. These services may be provided to
27 patients placed in shared or congregate living arrangements, if a
28 home setting is not medically appropriate or available to the
29 beneficiary. As used in this section, "in-home medical care
30 service" includes utility bills directly attributable to continuous,
31 24-hour operation of life-sustaining medical equipment, to the
32 extent that federal financial participation is available.
33 As used in this subdivision, in-home medical care services,
34 include, but are not limited to:
35 (1) 'Level of care and cost of care evaluations.
36 (2) Expenses, directly attributable to home care activities, for
37 materials.
38 (3) Physician fees for home visits.
39 (4) Expenses directly attributable to home care activities for
40 shelter and modification to shelter.
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1 (5) Expenses directly attributable to additional costs of special
2 diets, including tube feeding.
3 (6) Medically related personal services.
4 (7) Horne nursing education.
5 (8) Emergency maintenance repair.
6 (9) Home health agency personnel benefits which permit
7 coverage of care during periods when regular personnel are on
8 vacation or using sick.leave.
9 (10) All services needed to .maintain antiseptic conditions at
10 stoma or shunt sites on the body.
11 (11) Emergency and nonemergency medical transportation.
12 (12)' Medical supplies.
13 (13)' Medical equipment, including,but not limited to, scales,
14 gurneys, and equipment racks suitable for paralyzed patients.
15 (14) Utility use directly attributable to the requirements of
16 home care activities which are in addition to normal utility use.
17 (15), Special drugs and medications.
18 (16)' Home health agency supervision of visiting staff which is
19 medically necessary, but not included in the home health agency
20 rate.
21 (17) Therapy services.
22 (18) Household appliances and household utensil costs directly
23 attributable to home care activities.
24 (19) Modification of medical equipment for home use.
25 (20) Training and orientation for use of life-support systems,
26 including, but not limited to, support of respiratory functions.
27 (21) Respiratory care practitioner services as defined in
28 Sections 3702 and 3703 of the Business and Professions Code,
29 subject to prescription by a physician and surgeon.
30 Beneficiaries receiving in-home medical care services are
31 entitled to the full range of services within the Medi-Cal scope of
32 benefits as defined by this section,subject to;medical necessity and
33 applicable utilization control. Services provided pursuant to this
34 subdivision, which are not otherwise included in the Medi-Cal
35 schedule of benefits, shall be available only to the extent that
36 federal financial participation for these services is available in
37 accordance with a home- and community-based services waiver.
38 (t) Home- and community-based services approved by the
39 United States:Department of Health and Human Services may be
40 covered to the extent that federal financial participation is
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1
--=12--•1 available for those services under waivers granted in accordance
2 with Section 1396n of Title 42 of the United States Code. The
3 director may seek waivers for any or all home- and
4 community-based services approvable under Section 1396n of
5 Title 42 of the United States Code. Coverage for those services
6 shall be limited by the terms, conditions, and duration of the
7 federal waivers.
8 (u) Comprehensive perinatal services, as provided through an
9 agreement with a health care provider designated in Section
10 14134.5 and meeting the standards developed by the department
11 pursuant to Section 14134.5, subject to utilization controls.
12 The department shall seek any federal waivers necessary to
13 implement the provisions of this subdivision. The provisions for
14 which appropriate federal waivers cannot be obtained shall not be
15 implemented. Provisions for which waivers are obtained or for
16 which waivers are not required shall be implemented
17 notwithstanding any inability to obtain federal waivers for the
18 other provisions. No provision of this subdivision shall be
19 implemented unless matching funds from Subchapter XIX
20 (commencing with Section 1396) of Chapter 7 of Title 42 of the
21 United States Code are available.
22 (v) Early and periodic screening, diagnosis, and treatment for
23 any individual under 21 years of age is covered,consistent with the
24 requirements of Subchapter XIX (commencing with Section
5 1396) of Chapter 7 of Title 42 of the United States Code.
26 (w) Hospice service which is Medicare-certified hospice
27 service is covered, subject to utilization controls. Coverage shall
28 be available only to the extent that no additional net program costs
29 are incurred.
30 (x) When a claim for treatment provided to a beneficiary
31 includes both services which are authorized and reimbursable
32 under this chapter,and services which are not reimbursable under
33 this chapter,that portion of the claim for the treatment and services
34 authorized and reimbursable under this chapter shall be payable.
35 (y) ',Home- and community-based services approved by the
36 Ignited States Department of Health and Human Services for
37 beneficiaries with a diagnosis of AIDS or ARC, who require
38 intermediate care or a higher level of care.
39 Services provided pursuant to a waiver obtained from the
40 Secretary of the United States Department of Health and Human
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1 Services pursuant to this subdivision,and which are not otherwise
2 included in the Medi-Cal schedule of benefits, shall be available
3 only to the extent that federal financial participation for these
4 services is available in accordance with the waiver, and subject to
5 the terms, conditions, and duration of the waiver. These services
6 shall be provided to individual beneficiaries in accordance with the
7 client's needs as identified in the plan of care, and subject to
8 medical necessity and applicable utilization control.
9 The director may under this section contract with organizations
10 qualified to provide,directly or by subcontract,services provided
11 for in this subdivision to eligible beneficiaries. Contracts or
12 agreements entered into pursuant to this division shall not be
13 subject to the Public Contract Code.
14 (z) Respiratory care when provided in organized health care
15 systems as defined in Section 3701 of the.Business and Professions
16 Code, and as an in-home medical service as outlined in subdivision
17 (s).
18 (aa) (1) There is hereby established in the department, a
19 program to provide comprehensive clinical family planning
20 services to any person who has a family income at or below 240
21 percent of the federal poverty level, as revised annually,and who
22 is eligible to receive these services pursuant to the waiver
23 identified in paragraph (2). This program shall be known as the
24 Family Planning, Access, Care, and Treatment (Family PACT)
25 Program.
26 (2) The department shall seek a waiver for a program to provide
27 comprehensive clinical family planning services as described in
28 paragraph(8). The program shall be operated only in accordance
29 with the waiver and the statutes and regulations in paragraph(4)
30 and subject to the terms, conditions, and duration of the waiver.
31 The services shall be provided under the program only if the
32 waiver is approved by the federal Centers for Medicare and
33 Medicaid Services in accordance with Section 1396n of Title 42
34 of the United States Code and only to the extent that federal.
35 financial participation is available for the services.
36 (3) Solely for the purposes of the waiver and notwithstanding
37 any other provision of law,the collection and use of an individual's
38 social security number shall be necessary only to the extent
39 required by federal law.
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1
-- 14-1 (4) (A) Sections 14105.3 to 14105.39, inclusive, 14107.11,
2 24005, and 24013, and any regulations adopted under these
3 statutes shall apply to the program provided for under this
4 subdivision. No other provision of law under the Medi-Cal
5 program or the State-Only Family Planning Program shall apply
6 to the program provided for under this subdivision.
7 (B) The breast and cervical cancer early detection program
8 established pursuant to Section 104150 of the health and Safety
9 Code shall be administered by the Family PACT Program within
10 the Office of Family Planning as provided under Section 104150
11 of the.Health and Safety Code.
12 (5) Notwithstanding Chapter 3.5 (commencing with Section
13 11340) of Part 1 of Division 3 of Title 2 of the Government Code,
14 the department may implement,without taking regulatory action,
15 the provisions of the waiver after its approval by the federal health
16 Care Financing Administration and the provisions of this section
17 by means of an all-county letter or similar instruction to providers.
18 Thereafter, the department shall adopt regulations to implement
19 this section and the approved waiver in accordance with the
20 requirements of Chapter 3.5 (commencing with Section 11340)of
21 fart 1 of:Division 3 of Title 2 of the Government Code.Beginning
22 six months after the effective date of the act adding this
23 subdivision, the department shall provide a status report to the
24 Legislature on a semiannual basis until regulations have been
25 adopted.
26 (6) In the event that the Department of Finance determines that
27 the program operated under the authority of the waiver described
28 in paragraph(2)is no longer cost-effective, this subdivision shall
29 become inoperative on the first day of the first month following the
30 issuance of a 30-day notification of that determination in writing
31 by the.Department of Finance to the chairperson in each house that
32 considers appropriations,the chairpersons of the committees, and
33 the appropriate subcommittees in each house that considers the
34 State Budget, and the Chairperson of the Joint Legislative Budget
35 Committee.
36 (7) If this subdivision ceases to be operative, all persons who
37 have received or are eligible to receive comprehensive clinical
38 family,planning services pursuant to the waiver described in
39 paragraph (2) shall receive family planning services under the
40 Medi-Cal program pursuant to subdivision (n) if they are
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1 otherwise eligible for Medi-Cal with no share of cost, or shall
2 receive comprehensive clinical family planning services under the
3 program established in. Division 24 (commencing with Section
4 24000)either if they are eligible for Medi-Cal with a share of cost
5 or if they are otherwise eligible under Section 24003.
6 (8) For purposes of this subdivision, "comprehensive clinical
7 family planning services" means the process of establishing
8 objectives for the number and spacing of children, and selecting
9 the means by which those objectives may be achieved. These
10 means include a broad range of acceptable and effective methods
11 and services to limit or enhance fertility, including contraceptive
12 methods, federal Food and Drug Administration approved
13 contraceptive drugs, devices, and supplies, natural family
14 planning, abstinence methods, and basic, limited fertility
15 management. Comprehensive clinical family planning services
16 include,but are not limited to,preconception counseling,maternal
17 and fetal health counseling, general reproductive health care,
18 including diagnosis and treatment of infections and conditions,
19 including cancer, that threaten reproductive capability, medical
20 family planning treatment and procedures,including supplies and
21 followup, and informational, counseling, and educational
22 services. Comprehensive clinical family planning services shall
23 not include abortion,pregnancy testing solely for the purposes of
24 referral for abortion or services ancillary to abortions, or
25 pregnancy care that is not incident to the diagnosis of pregnancy.
26 Comprehensive clinical family planning services shall be subject
27 to utilization control and include all of the following:
28 (A) Family planning related services and male and female
29 sterilization. Family planning services for men and women shall
30 include emergency services and services for complications
31 directly related to the contraceptive method, federal Food and
32 Drug Administration approved contraceptive drugs, devices, and
33 supplies, and followup, consultation, and referral services, as
34 indicated, which may require treatment authorization requests.
35 (B) All United States Department of Agriculture,federal Food
36 and Drug Administration approved contraceptive drugs, devices,
37 and supplies that are in keeping with current standards of practice
38 and from which the individual may choose.
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SB 1525 — 16-
1 (C) Culturally and linguistically appropriate health education
2 and counseling services, including informed consent,that include
3 all of the following:
4 (i) Psychosocial and medical aspects of contraception.
5 (ii) Sexuality.
6 (iii) Fertility.
7 (iv) Pregnancy.
8 (v) Parenthood.
9 (vi) Infertility.
10 (vii) reproductive health care.
11 (viii) Preconception and nutrition counseling.
12 (ix) Prevention and treatment of sexually transmitted infection.
13 (x) Use of contraceptive methods, federal Food and Drug
14 Administration approved contraceptive drugs, devices, and
15 supplies.
16 (xi) Possible contraceptive consequences and followup.
17 (xii); Interpersonal communication and negotiation of
18 relationships to assist individuals and couples in effective
19 contraceptive method use and planning families.
20 (D) A comprehensive health history, updated at next periodic
21 visit (between 11 and 24 months after initial examination) that
22 includes a complete obstetrical history, gynecological history,
23 contraceptive history,personal medical history,health risk factors,
24 and fancily health history, including genetic or hereditary
25 conditions.
26 (E) A complete physical examination on initial and subsequent
27 periodic visits.
28 (ab) Purchase of prescribed enteral formulae is covered,
29 subject to the Medi-Cal list of enteral formulae and utilization
30 controls.
31 (ac) Diabetic testing supplies are covered when provided by a
32 pharmacy, subject to utilization controls.
33 SEC. 6. Section 24001 of the Welfare and Institutions Code
34 is amended to read:
35 24001. (a) (1) For purposes of this division, "family
36 planning" means the process of establishing objectives for the
37 number and spacing of children, and selecting the means by which
38 those;objectives may be achieved. These means include a broad
39 rangeof acceptable and effective methods and services to limit or
40 enhance fertility, including contraceptive methods,natural family
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1 planning, abstinence methods and basic, limited fertility
2 management. Family planning services include,but are not limited
3 to, preconception counseling, maternal and fetal health
4 counseling,general reproductive health care, including diagnosis
5 and treatment of infections and conditions, including cancer,that
6 threaten reproductive capability, medical family planning
7 treatment and procedures, including supplies and followup, and
8 informational, counseling, and educational services. Family
9 planning shall not include abortion, pregnancy testing solely for
10 the purposes of referral for abortion or services ancillary to
1.1 abortions,not including contraceptives,or pregnancy care that is
12 not incident to the diagnosis of pregnancy.
13 (2) Family planning services for males shall be expanded to
14 include laboratory tests for sexually transmitted infections and
15 comprehensive physical examinations.Within 60 days of approval
16 of the Family Planning, Access, Care, and Treatment (Family
17 PACT) Program, provided for pursuant to subdivision (aa) of
18 Section 14132,the department shall seek to amend the waiver to
19 add this expansion.The implementation of this paragraph shall be
20 dependent upon federal approval and receipt of federal financial
21 participation.
22 (b) :For purposes of this division, "department" means the
23 State Department of Health Services.
24 SFC. 7. Section 24003.2 of the Welfare and Institutions Code
25 is amended to read:
26 24003.2. The basic preventive health services covered under
27 this program shall include measles,mumps,and rubella vaccines
28 for women of reproductive age. Within 60 days of approval of the
29 Family Planning, Access, Care, and Treatment (Family PACT)
30 Program, provided for pursuant to subdivision (aa) of Section
31 14132, the department shall seek to amend the waiver to add this
32 expansion. The implementation of this section shall be dependent
33 upon federal approval and receipt of federal financial
34 participation.
35 SEC. 8. Section 24003.5 of the Welfare and Institutions Code
36 is amended to read:
37 24003.5. Any male or female of reproductive age who is not
38 at risk for pregnancy and is eligible for the program shall have
39 available the scope of benefits provided by the program.Within 60
40 days of approval of the Family Planning, Access, Care, and
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1 Treatment (Family PACT) Program, provided for pursuant to
2 subdivision (aa) of Section 14132, the department shall seek to
3 amend the waiver to add this expansion. The implementation of
4 this section shall be dependent upon federal approval and receipt
5 of federal financial participation.
6 SEC. 9. Section 24027 of the Welfare and Institutions Code
7 is amended to read:
8 24027. The State-Only Family Planning.Program established
9 under this division is hereby reenacted and continued in existence
10 in order to continue to provide comprehensive, clinical family
11 planning services to those persons who are not eligible to receive
12 these services under the Family Planning, Access, Care, and
13 Treatment (Family PACT) Program established pursuant to
14 subdivision(aa) of Section 14132, and to those persons who are
15 not eligible to receive family planning services pursuant to
16 subdivision(n) of Section 14132 without a share of cost.
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