HomeMy WebLinkAboutMINUTES - 03161993 - 1.37 �. 37
TO: BOARD OF SUPERVISORS Contra
FROM: Phil Batchelor, County Administrator 3
Costa
dA-doCounty
DATE: March 11, 1993 r"r
r s
SUBJECT: LEGISLATION: AB 476 (Rainey)
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
Acknowledge that the Board of Supervisors is the SPONSOR of AB 476
(Rainey) which, as introduced, is only a technical "spot" bill, but
which can be used if legislation is necessary in order to move
forward with the County' s proposed Managed Care proposal for Medi-
Cal recipients .
BACKGROUND:
As the Board is aware, the State Administration is interested in
implementing "managed care" as a mechanism for saving money for the
Medi-Cal Program. The concept of managed care includes having a
primary care physician who is responsible for a patient' s care and
responsible for ordering tests, laboratory work, prescriptions and
referrals to specialists . In this way, a single physician is aware
of and responsible for all of the care a patient receives, much as
is the case with Kaiser or other HMO' s, including the County' s
Contra Costa Health Plan. Under the current fee-for-service Medi-
Cal system, only the patient is truly in charge of the patient' s
care, since no one else is necessarily aware of or in control of
how many physicians a patient tries to see, how many prescriptions
a patient may be taking or how many tests are ordered. As is often
the case with the private fee-for-service medical care system,
there is little or no incentive for a provider to hold down costs
or reduce the number of visits or tests that are ordered. The
provider is generally paid only when the patient complains about an
illness and often is paid more as more tests are ordered.
CONTINUED ON ATTACHMENT: __)L_YES SIGNATURE.
X RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
L APPROVE OTHER
SIGNATURE S .
ACTION OF BOARD ON marcn 16, 1993 APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
1� I HEREBY CERTIFY THAT THIS IS A TRUE
_UNANIMOUS(ABSENT �� ) AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
ATTESTED MAR 16 1993
Contact' CountyAdministrator PHIL BATCHELOR,CLERK OF THE BOARD OF
CC: . SUPERVISORS AND COUNTY ADMINISTRATOR
Health Services Director
Executive Director, CCHP
County Counsel
BY ,DEPUTY
Contra Costa County is interested in participating in the State's
proposed managed care program by taking over responsibility for
nearly all aspects of the . Medi-Cal Program in the County, with
specific exceptions . The Health Services Department has submitted
a proposal to the State Department of Health Services . However,
the only models of managed care which the State appears to be
pursuing would not appear to fit the proposal the County has
submitted.
If it becomes necessary to pursue legislation in order to move
forward with the type of proposal the County wants to pursue, AB
476 is available as a vehicle. It has been introduced by
Assemblyman Rainey at the request of the Health Services Director,
and is consistent with the Board' s 1993 Legislative Program, which
included:
"Follow development of "managed care" program closely and
support any required legislation which will provide
Contra Costa County with the ability to manage Medi-Cal
Program expenditures in this County. In this regard,
maintain contact with the State Health & Welfare Agency. "
Since this issue is a part of the Board' s 1993 Legislative Program,
and since Assemblyman Rainey has agreed to carry this legislation
for the County, it is appropriate for the Board of Supervisors to
acknowledge that it is the sponsor of AB 476 . If and when
substantive provisions are inserted into the bill, we will report
back to the Board with the specific nature of those amendments .
-2-
1 -37
CALIFORNIA LEGISLATURE--1993-.44 REGULAR SESSION
ASSEMBLY BILL No. 476
Introduced by Assembly Member Rainey
February 11, 1993 .
An-'act to amend Section 14016.5 of the Welfare and.
.Institutions Code, relating to 'Medi-Cal:
LEGISLATIVE COUNSEL`S DIGEST..
j
AB .476, as introduced, Rainey. Medi-Cal.
Existing law provides for the Medi-Cal program,
j administered by the State Department of Health Services, `
under which qualified low-income persons are provided with
health care services. One of the:methods for the provision of
Medi-Cal services is through contracts with managed care a
plans. i
Existing law provides that, commencing January 1, 1993, in
,areas specified by the Director of Health Services, a Medi-Cal .�
-applicant or beneficiary who .does 'not make a choice of a
care plan or the provision of services , on a
managed p
fee-for-service basis or who does not certify that he or she has
an established relationship.with a primary care provider, shall.
S be assigned to and enrolled in an appropriate managed'care
plan, pilot project, or fee-for-service. case management
provider providing services within the area in which the
beneficiary resides.
This bill would remove substantially duplicative language
from that provision.
Vote: majority.'Appropriation no. Fiscal committee: yes.
State-mandated local program: no.
I
99 80
AB 476
The people of the State of California do enact as follows.
`: . .1
SECTION, 1. Section 14016.5 of the Welfare and
2: Institutions Code is amended to read:
3 14016.5. (a) At the time of determining or
4 redetermining the eligibility of a Medi-Cal or aid to
:. : 5 families' with dependent'children (AFDC) applicant or
6 . beneficiary who resides in an area served. by a managed.
7. health care plan or.pilot program in which beneficiaries
:.8.
may enroll, each applicant.or beneficiary shall personally.
9 attend a presentation at which: the applicant or .
10: beneficiary. is informed ofthe .e-managed care and
}- :.11 fee-for-service options available regarding- methods :of
`receiving Medi-Cal benefits.'The.county shall ensure that:
` 13 each beneficiary or,applicant attends this .presentation.
14 (b) No.later than.30 days following the date a Medi-Cal
15 or AFDC beneficiary or apphcarit is referred to the
16 presentation described in subdivision (a), the beneficiary
17 .or applicant shall indicate,his.or her-choice in:writing, as
;18 a condition of coverage for Medi-Cal benefits, of either.of
19 the.following health care- options: t,
20 (1) To . obtain benefits. : by receiving a monthly
r 21 .; Medi-Cal card,whichmay be used to obtain services from
22 individual providers, that .the beneficiary would locate,
. 23 who choose to provide services to Medi-Cal beneficiaries.
24 The department may. .require each beneficiary or
25 eligible applicant, as a condition for electing this option,
26 to sign a statement certifying .that he or she has an
.27 . established patient-provider relationship, or in'the case of
..28 . a dependent, the parent or guardian shall make that
29 certification. This certification. shall not require the
30. acknowledgment or guarantee of acceptance, by any
. 31 indicated Medi-Cal provider orhealth health facility, of any
32 beneficiary making a certification under this section.
. 33 (2) To. obtain benefits by enrolling in .a prepaid
34 managed care health plan, " pilot program, or
.35 fee-for-service case management provider that has
:36 agreed to make Medi-Cal services readily ,available to
37 enrolled Medi-Cal beneficiaries.
38 (c) (1) Commencing January 1, 1993, in areas
ss 110 i
H
k`
-3— AB 476
lows: 0� 1 specified by the director, a Medi-Cal or AFDC
2 beneficiary. or eligible applicant who does not make a
ire and 3 choice, or ;who does not certify that he or she has an
4 established relationship with a primary care provider
ing or. 5 shall'be enrolled in an appropriate managed care plan,
r aid to 6 pilot. project, or fee-for-service case management
Icant or 7 provider,providing service within the area in which the
aanaged, 8 beneficiary,resides s be assigned to and��aft
:ficiar es 9 apprrioe Medi awwwged.ease p prejeet.,
:rsonally 10 erreevrr.:.., ser ee ease faftager to p e .
cant 11 (2) if A isnot possible to enroll the beneficiary under
tre;. ,and ; 12 a -Medi-Cal :managed care 'plan or pilot project or a
thuds :of, 13 fee-for-service�cease management provider because of a
;urea'at. 14 lack � of capacity. or - availability of participating
;ntation: 15 contractors,: tlie beneficiary shall be provided with a
Medi=Ca1 ' 16 monthly.: °:Medi-Cal card and Anformed about
. to' the -'17 fee-for.-service primary care .providers who do all of the
eficiary 18 following:
ruing, as 19 (A): The providers agree to accept Medi-Cal patients.
either,of : 20 (B).1The:,providers provide information about the
21 rounder's villin guess to accept Medi-Cal patients as
P p p .
monthly 22 described in'Section 14016.6.
.ces-from 23 (C) The providers provide services within the area in
I locate, 24 which the beneficiary resides.:
�ficiaries: :25 (d). (1) the: managed care .plan shall have a valid
i � �� e
c ary or 26 Medi-Cal. contract, adequate capacity, and appropriate
S option; . 27 staffing to provide health care services to the beneficiary.
has an . 28 (2) The department shall establish standards for all of
r:.
ie case of 29 the following:
ake that I.. 30 (A) The maximum distances a beneficiary is required
vire the 31 to travel to obtain primary care services from . the
> by any 32 managed care plan, fee-for-service managed care
r, of any 33 provider, ,or pilot .project in which the beneficiary is
lction. ..0 34 enrolled.
prepaid 35 (B) The conditions under which a primary care
or `' 36 service site shall be accessible by public transportation.
that has 37 (C) The conditions under which a managed care plan,
tilable to 38 fee-for-service managed care.provider, or pilot project
z. 39 shall provide nonmedical transportation to a primary
in areas- 0 40 care service site.
99 110 99 130
AB 476 —4-
1
4-
1 3 In de 1 in •
( ) ve op g the standards required by
2 'paragraph (2), the department shall take into account,on
3 a geographic basis, the means of transportation used and
4 distances typically traveled by Medi-Cal beneficiaries to
5. obtain fee-for-service primary 'care services and the
Vex of managed care plans in delivering services.
7 to Medi-Cal enrollees. The department shall also consider
8 the , provider's . ability to render culturally- and .
9., linguistically appropriate services.
10. (e) To the extent possible; . the arrangements for
11. carrying out subdivision. (c) shall provide for the
12 equitable distribution of Medi-Cal beneficiaries among
13. participating managed..care .plans, fee;-for-service case ;
14.;: management providers; and pilot .projects.
15 . (f) If, under the provisions of subdivision (c), a
16 Medi-Cal beneficiary or applicant does not make a choice
17.. or does not certify, that he or she has an established
18 .relationship with a primary care provider, the ,person
19 . may, at the option of the department, be provided with
20 ` a monthly Medi-Cal card or assigned to and enrolled in
21 a managed. care plan.
22 (g) (1) The department shall ensure that Modi-Cal
23: beneficiaries eligible under Title XVI of the Social
24. Security.Act are provided with information about options
25 available regarding: methods ::of receiving Medi-Cal O
26 'bene'fits as described in subdivision (b)..
.27 (2) (A) The director may waivethe requirements of
28 subdivisions (b)l and (c) until a means is established to
29 directly provide the presentation described in
30 subdivision (a) to beneficiaries. who are eligible for the
31 federal Supplemental Security Income for the Aged,
32 Blind, and Disabled . Program (Subchapter 16
33 (commencing with Section 1381) of Chapter 7 of Title 42
34 of the United States Code)
35 (B) The director may : elect not to apply the
36 requirements of subdivisions (b).and (c) to beneficiaries
37 whose eligibility under the Supplemental Security
38 Income program is established before January 1, 1994.
39 (h) In areas where there is no prepaid managed health
40 care plan or pilot program which has contracted with the
99 150
AB 476
1 f
b x P . 1 department to provide services to Medi-Cal
y
it2 beneficiaries, and where no other enrollment
,on
I and
"' 3 requirements have been established by the department,
->�. �:
es to 4 no explicit choice need be made, and the beneficiary or
the` 5 , eligible applicant shall receive"a monthly Medi-Cal card.
6 i The following definitions contained in. this
vices ('} g
oder 7 subdivision shall control the construction of this section,
8 unless the context requires otherwise:
9 (1): Applicant, beneficiary, and eligible
} 10 applicant,,' in the case .of a family group, means any
the' person with legal authority to make a choice on:behalf of
12 dependent, members.
tong:::