Title

Health.

Summary

(1) Existing law establishes the Office of Statewide Health Planning and Development (OSHPD) , under the control of an executive officer known as the Director of Statewide Health Planning and Development. The office is vested with all the duties, powers, purposes, and responsibilities of the State Department of Public Health relating to health planning and research development. Existing law creates the health care workforce clearinghouse to serve as the central source of health care workforce and education data in the state to collect data regarding health care workers, including the supply of health care workers and current and forecasted demand for health care workers. This bill would rename the Office of Statewide Health Planning and Development as the Department of Health Care Access and Information. The bill would repeal numerous duties and programs currently carried out by the OSHPD, including, among others, rural health care transition oversight, the Steven M. Thompson Medical School Scholarship Program, and the Postsurgical Care Demonstration Project. This bill would eliminate the health care workforce clearinghouse and establish the California Health Workforce Research and Data Center to serve as the state's central source of health care workforce and education data and to inform state policy regarding health care workforce issues. The bill would establish uniform requirements for the reporting and collection of workforce data from health care-related licensing boards to the data center and make related conforming changes. The bill would require the department to maintain the confidentiality of licensee information collected pursuant to these provisions and would only authorize the department to release the information in aggregate form. Existing law makes the office responsible for administering various programs with respect to the health care professions. Existing law establishes various programs to facilitate the expansion of the health care workforce in rural and underserved communities, including, but not limited to, the Health Professions Career Opportunity Program and the California Registered Nurse Education Program. Existing law requires the office to establish a nonprofit public benefit corporation known as the Health Professions Education Foundation to perform various duties with respect to implementing health professions scholarship and loan programs. Existing law also establishes the California Healthcare Workforce Policy Commission to, among other things, identify specific areas of the state where unmet priority needs for primary care family physicians and registered nurses exist and to make recommendations to the Director of Statewide Health Planning and Development with regard to the funding of specific programs. This bill would dissolve the Health Professions Education Foundation, but would authorize the department to continue various foundation programs, such as the California Registered Nurse Education Program. The bill would also eliminate the California Healthcare Workforce Policy Commission and replace it with the California Health Workforce Education and Training Council to plan and coordinate California's approach to health workforce education and training in order to develop a health workforce to meet statewide health care needs. The bill would change the composition of the membership of the council and would authorize the council, among other things, to make recommendations to the department regarding the use of health care education and training funds and advocate for additional funds and additional sources of funds to stimulate graduate medical education expansion in California. The bill would make related conforming changes to existing provisions. This bill would require the Health Professions Career Opportunity Program to be implemented at colleges and universities, as specified, with priority given to campuses in medically underserved areas or with students from groups underrepresented in medicine, demonstrated commitment to diversity and associated institutional change, a track record of providing tailored student support, and strong health professions school partnerships, as specified. Existing law authorizes the office to oversee various aspects of the health care market, including oversight of hospital facilities and community benefit plans. Existing law also requires the office to adopt and enforce regulations prescribing building standards for the adequacy and safety of health facility physical plants. This bill would make necessary conforming changes to these provisions to reflect the reorganization of the office to the Department of Health Care Access and Information. (2) Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. This bill would require the department, on or before March 1, 2022, to convene a Health Equity and Quality Committee to make recommendations to the department for standard health equity and quality measures, including annual benchmark standards for assessing equity and quality in health care delivery. The bill would require the department to consider the committee's recommendations and to establish standard measures and annual benchmarks for equity and quality in health care delivery. The bill would require a health care service plan, including a Medi-Cal managed care plan not licensed by the department, to annually submit to the department a report containing equity and quality data and information. The bill would require the department to review a health care service plan's equity and quality report to determine the plan's compliance with the health equity and quality standard measures and annual benchmarks established by the department. The bill would authorize the department to take certain actions against a health care service plan that does not demonstrate compliance with the requirements of the bill, including requiring a health care service plan to implement corrective action to achieve and demonstrate compliance with the standard measures and annual benchmarks, monitoring a corrective action plan, and assessing administrative penalties, as provided. The bill would require the department, commencing in 2025, and annually thereafter, to publish on its internet website a Health Equity and Quality Compliance Report. The bill would authorize the department to implement the bill by means of all-plan letters or similar instructions, without taking regulatory action until January 1, 2027. The bill would require a health care service plan, but not a Medi-Cal managed care plan, to be accredited by the National Committee for Quality Assurance on or before January 1, 2026. Because a willful violation of the bill's provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program. (3) Existing law establishes 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 pursuant to a schedule of benefits. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Under existing law, the schedule of benefits includes the purchase of prescribed drugs, subject to the Medi-Cal List of Contract Drugs and utilization controls. Existing law excludes nonlegend cough, cold, and acetaminophen-containing products from the schedule of benefits, with prescribed exceptions, such as children's acetaminophen-containing products. This bill would expand, on July 1, 2021, the Medi-Cal schedule of benefits to include nonlegend cough, cold, and acetaminophen-containing products. (4) Existing law establishes that the Medi-Cal program covers specified health care services, including substance use disorder treatment, pursuant to a state plan. Under existing law, the Director of Health Care Services has those powers and duties to conform to requirements for securing approval of a state plan under federal law, and, pursuant to this authority, the director secured approval for the state plan to include clinical preventive services that are assigned a grade of A or B by the United States Preventive Services Task Force, including adult Alcohol Misuse Screening and Behavioral Counseling Interventions in Primary Care, such as screening for misuse of opioids and other illicit drugs. Existing law requires the department to seek federal approval to expand the Medi-Cal benefit for adult Alcohol Misuse Screening and Behavioral Counseling Interventions in Primary Care to include screening for misuse of opioids and other illicit drugs, and suspends the implementation of these provisions on December 31, 2021, unless specified circumstances apply. This bill would repeal obsolete law on the department's obligation to seek federal approval to expand the above-specified benefit and the suspension of the implementation of those provisions. (5) Under existing law governing the Medi-Cal program, health care services are rendered by enrolled Medi-Cal providers, who are subject to specified requirements relating to provider enrollment. Existing federal law requires a state Medicaid program to implement electronic visit verification for prescribed Medicaid services, including personal care services and home health services that require an in-home visit by a provider. This bill would authorize the department to undertake action to implement an electronic visit verification system for purposes of obtaining and maintaining federal approval or ensuring federal financial participation is available or not otherwise jeopardized, and to partner and contract with specified governmental entities, including the State Department of Social Services, to comply with federal requirements on electronic visit verification. If a provider renders Medi-Cal services that are subject to electronic visit verification, the bill would require the provider to comply with requirements on electronic visit verification, as established by the department and its partners, and would authorize the department and its partners to take prescribed action, such as requiring an approved correction action plan, to address a provider's noncompliance of those requirements. The bill would authorize the department and its partners to enter into contracts to implement these provisions, and to implement these provisions by various means, including provider bulletins. (6) Under existing federal and state law, Medi-Cal is required to be the payer of last resort if a Medi-Cal beneficiary has other health coverage in addition to Medi-Cal. To assess overlapping or duplicate health coverage, existing law requires specified other health coverage entities to maintain a centralized file with specified information about their subscribers, enrollees, or policyholders, and to make this information available to the department upon reasonable request by the department. Under existing law, other health coverage entities that are legally responsible for payment of a claim for a health care item or service are required to provide specified information to the department, at the department's request, upon certification by the department that the information requested is pertaining to an individual that is an applicant for, recipient of, or legally responsible person for an applicant for, or recipient of, Medi-Cal services. Existing law requires the department to enter into cooperative agreements with other health coverage entities to establish mutually agreeable procedures for requesting and furnishing specified information to the department about a beneficiary's other health coverage and provides for the reimbursement, as specified, of other health coverage entities for complying with these provisions. This bill would add to the list of other health coverage entities subject to these provisions all health entities licensed by the Department of Insurance, third-party administrators, and union trusts. The bill would also add new categories of information that the other health coverage entities are required to maintain about a subscriber, policyholder, enrollee, or insured. The bill would require other health coverage entities to enter into a cooperative agreement with the department for the provision of specified information, rather than placing this requirement on the department. The bill would require that the information provided pursuant to these cooperative agreements be provided to the department within 90 days of the department's request for the information, at no cost to the department, eliminating the existing reimbursement provisions. The bill would require that the subscriber, policyholder, enrollee, or insured information required to be maintained in the centralized file be provided to the department, at least once a month, in a format specified by the department. The bill would also require this information be provided to the department's agents and Medi-Cal managed care plans upon reasonable request. The bill would require the specified entities to provide the department with real-time, electronic eligibility verification, at no cost, and in a form and manner specified by the department. The bill would also authorize the department to implement these requirements by means of policy letter, information notice, or other similar instruction, without taking any further regulatory action. (7) Existing law excludes specified optional services from coverage in the Medi-Cal program, including audiology services, optometric services, podiatric services, and incontinence creams and washes, among others. Notwithstanding this exclusion, existing law restores coverage for specified optional benefits, including audiology services, optometric services, podiatric services, and incontinence creams and washes. Existing law suspends these optional benefits on December 31, 2021, unless specified conditions occur. This bill would delete the provisions suspending these optional benefits. (8) Under existing law, an individual is eligible for Medi-Cal benefits, to the extent required by federal law, as though the individual was pregnant, for all pregnancy-related and postpartum services for a 60-day period beginning on the last day of pregnancy. Existing law, subject to an appropriation in the annual Budget Act, extends Medi-Cal eligibility for a pregnant individual who receives health care coverage under the Medi-Cal program, or another related program, and who has been diagnosed with a maternal mental health condition, for a period of one year following the last day of the individual's pregnancy if the individual complies with certain requirements. Existing law suspends implementation of these provisions on December 31, 2021, unless specified circumstances apply. This bill would remove the conditional suspension of the above Medi-Cal eligibility extension. The bill would make those provisions on eligibility extension inoperative upon implementation of the extended eligibility provisions described below, and would restore their operation if the provisions below are no longer implemented. The bill would require the department to determine the implementation status of the provisions below and to post, on its internet website, notice of its determination. The bill would instead extend eligibility for full-scope Medi-Cal benefits for a pregnant individual or targeted low-income child who is eligible for and is receiving health care coverage under the Medi-Cal program, or another related program, for the duration of the pregnancy and for a period of one year following the last day of the individual's pregnancy, without conditioning the extended eligibility to a diagnosis of a maternal mental health condition. The bill would require the department to seek any necessary federal approvals for these purposes. Coverage under these provisions would commence on April 1, 2022, or the effective date or dates reflected in any necessary federal approvals obtained by the department, whichever is later. The bill would make implementation of these provisions subject to an appropriation, receipt of any necessary federal approvals, except as specified, and the availability of federal financial participation. The bill would make conforming changes to related provisions. Because counties are required to make eligibility determinations, and this bill would expand Medi-Cal eligibility, the bill would impose a state-mandated local program. (9) The California Healthcare, Research and Prevention Tobacco Tax Act of 2016, an initiative measure approved as Proposition 56 at the November 8, 2016, statewide general election, increases taxes imposed on distributors of cigarettes and tobacco products and requires all revenues to be deposited into the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 Fund, a continuously appropriated fund. That act allocates those revenues for specified purposes, including $30,000,000 to provide funding to the State Department of Public Health state dental program for the purpose and goal of educating about, preventing, and treating dental disease, including dental disease caused by the use of cigarettes and other tobacco products. Under existing law, if there is a reduction in revenues resulting from a reduction in the consumption of cigarettes and tobacco products due to the additional taxes imposed on cigarettes, the amount of funds allocated to specified programs, including the state dental program, is required to be reduced proportionally. This bill would, contingent upon a reduction in allocations to the state dental program, backfill the reduced amount by continuously appropriating moneys from the General Fund in an amount equivalent to the required reduction, so that the total funding for the state dental program remains at $30,000,000 annually. By continuously appropriating moneys from the General Fund, this bill would make an appropriation. (10) Existing law allocates a specified percentage of those revenues to the department to increase funding for the Medi-Cal program, in a manner that, among other things, ensures timely access, limits specific geographic shortages of services, or ensures quality care. Existing law establishes the Healthcare Treatment Fund for this purpose. Existing law authorizes the department to use those funds to make supplemental payments or rate increases for specified service categories, including physician services, dental services, and home health providers, and programs, including value-based payment (VBP) programs. Existing law suspends the department's ability to make those supplemental payments and rate increases after July 1, 2021, unless specified conditions apply, including that the estimates of General Fund revenue and expenditures for the 2021–22 and 2022–23 fiscal years contain estimated annual General Fund revenues that exceed estimated annual General Fund expenditures for those fiscal years by an amount equal to or greater than the sum total of all General Fund appropriations for other specified programs subject to suspension. This bill would repeal these provisions imposing the suspension. Existing law requires the department to develop, using moneys appropriated in the Budget Act for this purpose from the Healthcare Treatment Fund, VBP programs that require designated Medi-Cal managed care plans to make incentive payments to qualified network providers in behavioral health integration (BHI) , prenatal and postpartum care, and chronic disease management for prescribed purposes. Existing law makes the VBP programs inoperative on July 1, 2021, if the department's ability to make those supplemental payments and rate increases is suspended, as specified above. With respect to VBP programs aimed at improving BHI in Medi-Cal managed care, existing law requires designated Medi-Cal managed care plans to make incentive payments to qualified network providers, as prescribed, and authorizes qualified network providers to be eligible for different levels of incentive payments depending on the level of integration. For VBP programs aimed at improving BHI in Medi-Cal managed care, this bill would instead authorize designated Medi-Cal managed care plans to earn incentive payments for achieving milestones and measures through partnerships with qualified network providers, and would provide that different levels of incentive payments may be available depending on the level of integration. For VBP programs, the bill would delete the provisions making those programs inoperative on July 1, 2021, and would require the department to implement payments under VBP programs for a service period during a state fiscal year subject to appropriation by the Legislature for that state fiscal year. (11) Existing law, the Medi-Cal 2020 Demonstration Project Act, requires the department to implement specified components of a Medi-Cal demonstration project, including the Global Payment Program (GPP) , the Dental Transformation Initiative, and the Whole Person Care pilot program, consistent with the Special Terms and Conditions approved by the federal Centers for Medicare and Medicaid Services. Pursuant to existing law, the department has created a multiyear initiative, the California Advancing and Innovating Medi-Cal (CalAIM) initiative, to build upon the outcomes of various Medi-Cal pilots and demonstration projects, including the Medi-Cal 2020 Demonstration Project Act. This bill would establish the CalAIM initiative in statute to support the stated goals of identifying and managing the risk and needs of Medi-Cal beneficiaries, transitioning and transforming the Medi-Cal program to a more consistent and seamless system, and improving quality outcomes. The bill would require the department to seek federal approval for the CalAIM initiative, and would condition its implementation on receipt of federal approvals and availability of federal financial participation. For implementation purposes, the bill would authorize the department to enter into exclusive or nonexclusive contracts, or amend existing contracts. The bill would require the department to issue guidance identifying permissible data-sharing arrangements to implement CalAIM. To the extent authorized by the CalAIM Terms and Conditions, the bill would authorize the department to claim federal financial participation for expenditures associated with the designated state health care programs identified in the CalAIM Terms and Conditions for use solely by the department, and would appropriate both federal and General Fund moneys to the Health Care Deposit Fund in an amount equal to the federal financial participation that may be claimed under these provisions. This bill would authorize the department to make incentive payments, grants, or other financial support available to qualified entities or providers, as specified, under the Providing Access and Transforming Health (PATH) program to support services, infrastructure, and capacity building in advancing and complimenting select goals and components of CalAIM. The bill would require the department to establish the methodologies, parameters, and eligibility criteria for PATH payments. This bill would require the department to standardize those applicable covered Medi-Cal benefits provided by Medi-Cal managed care plans under comprehensive risk contracts with the department on a statewide basis and across all models of Medi-Cal managed care in accordance with specified requirements and the CalAIM Terms and Conditions. This bill would authorize the department to standardize those populations that are subject to mandatory enrollment in a Medi-Cal managed care plan across all aid code groups and Medi-Cal managed care models statewide, subject to a Medi-Cal managed care plan readiness, continuity of care transition plan, and disenrollment process developed in consultation with stakeholders, in accordance with specified requirements and the CalAIM Terms and Conditions. Under the CalAIM initiative, this bill would require the department to implement an enhanced care management (ECM) benefit designed to address the clinical and nonclinical needs on a whole-person-care basis for certain target populations of Medi-Cal beneficiaries enrolled in Medi-Cal managed care plans, as specified. The bill would require Medi-Cal managed care plans to consult and collaborate with county mental health plans for the delivery of ECM services for beneficiaries with certain health conditions, including serious mental illness, to maximize federal reimbursement and minimize duplication of services. The bill would require the department to require those plans to report specified information related to the ECM benefit and would require the department to annually publicly report on the utilization of ECM in a manner that allows for an analysis of demographic populations, as specified. As part of the CalAIM initiative, and commencing January 1, 2022, this bill would require the department to authorize Medi-Cal managed care plans to elect to cover those services or settings approved by the department as cost effective and medically appropriate in the comprehensive risk contract that are in lieu of applicable Medi-Cal state plan services. The bill would provide that in lieu of services include specified services, such as housing transition navigation services, recuperative care, and asthma remediation. The bill would require the department to establish metrics for, and conduct an annual evaluation of, the utilization and effectiveness of in lieu of services, and to publicly report the evaluation, as specified. This bill would reorganize or repeal some of those provisions relating to the Medi-Cal 2020 Demonstration Project Act under the CalAIM initiative, and would continue other components of the Medi-Cal 2020 Demonstration Project Act, including the GPP, Medi-Cal dental efforts, such as the state plan dental improvement program, and enhancement of county oversight and monitoring, as components of the CalAIM initiative. Under the CalAIM initiative, the bill would make various changes to the Medi-Cal managed care system, including requiring prescribed accreditation by the National Committee for Quality Assurance or an alternative entity and providing incentive payments to plans. As part of the CalAIM initiative, this bill would make various changes to the Medi-Cal behavioral health delivery system. The bill would set forth requirements for coverage of certain nonspecialty mental health services by a Medi-Cal managed care plan or the Medi-Cal fee-for-service delivery system, and coverage of specialty mental health services by a county mental health plan, as specified. The bill would prohibit a dispute between a county mental health plan and a Medi-Cal managed care plan from delaying the provision of medically necessary services by either of those plans. The bill would also set forth requirements for covered services provided under a Drug Medi-Cal Treatment Program or a Drug Medi-Cal organized delivery system, including the use of certain professional criteria and coverage of all medically necessary substance use disorder services for an individual under 21 years of age, as specified. The bill would require the department to develop standardized screening tools, statewide transition tools, and documentation standards related to care transitions in the behavioral health delivery system, as specified. The bill would also require the design of an intergovernmental transfer-based reimbursement methodology. The bill would require the department to establish, implement, and administer the Behavioral Health Quality Improvement Program to provide grants to qualified Medi-Cal behavioral health delivery systems to prepare those entities and their contracting health care providers for implementation of CalAIM behavioral health components, and would impose requirements on the department relating to the behavioral health delivery system, such as determining the eligibility criteria. Commencing January 1, 2027, the bill would require an individual county, or counties acting jointly, to provide and administer covered behavioral health Medi-Cal benefits under a single Medi-Cal behavioral health delivery system contract. Subject to federal approval, and under the CalAIM initiative, this bill would require the department to implement the State Plan Dental Improvement Program to further improving accessibility of Medi-Cal dental services and oral health outcomes for targeted populations, as specified. As a component of the CalAIM initiative, on and after July 1, 2022, this bill would require the department, in consultation with representatives of county welfare departments and other affected stakeholders, to develop and make publicly available a dashboard that reflects each county's performance in meeting existing County Administrative Cost Control Plan measures. During the CalAIM term, the bill would require the department to develop and implement specified initiatives to enhance oversight and monitoring of county administration of the California Children's Services (CCS) program and would require the department to convene a workgroup consisting of counties and other stakeholders to develop and implement one or more initiatives designed to improve the collection and use of beneficiary demographic and contact information in administering the Medi-Cal program and other public assistance programs. Commencing January 1, 2023, the bill would require the department to implement the Population Health Management Program under the Medi-Cal managed care delivery system to improve health outcomes, care coordination, and efficiency through application of standardized health management requirements. The bill would require the department to require each Medi-Cal managed care plan to develop and maintain a beneficiary-centered population health management program that meets specified standards, including identifying and mitigating social determinants of health and reducing health disparities or inequities. The bill would require the department to consult with specified stakeholders, including the State Department of Public Health, to establish requirements for the population health management program, as specified, and, beginning January 1, 2024, would require the department to annually post an analysis of the Population Health Management Program on its internet website. As part of the CalAIM initiative, this bill would authorize the department to establish capitation rates to contracted health plans on a regional basis in lieu of health plan and county-specific rates, and would require the department to consult with and provide a briefing to affected entities and individuals, as specified. Before the implementation of a regional-based capitation rate, the bill would require the department to report to the Legislature on specified matters, including how these rates are to be established. The bill would require the department to publish on its public internet website a description of the rate methodology, data used for rate development, and core actuarial assumptions and adjustments in each year that the department develops these rates. The bill would authorize the department to develop and implement appropriate actuarial methods to prevent significant overpayments or significant underpayments, as specified. (12) 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. Under existing law, a demonstration project known as the Coordinated Care Initiative (CCI) 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. As a component of the CalAIM initiative, this bill would make CCI operative only through December 31, 2022, as specified, and would repeal its provisions on January 1, 2025. The bill would require Medi-Cal managed care plans to operate, or continue to operate, a Medicare Advantage Dual Special Needs Plan, commencing January 1, 2023, in CCI counties, and, commencing January 1, 2026, in all other counties. (13) Existing law authorizes the department to create the Health Home Program for Medi-Cal enrollees with chronic conditions, subject to federal approval and the availability of federal financial participation. Existing law generally conditions the implementation of the program on no additional General Fund moneys being used to fund the administration and costs of services. Commencing with the 2021–22 state fiscal year, this bill would authorize program implementation using General Funds moneys upon appropriation by the Legislature. The bill would require the department to cease implementing the program on January 1, 2022, or as specified, and would repeal the program's provisions on January 1, 2023. (14) Existing law authorizes the board of supervisors in each county to designate an entity or entities to assist county jail inmates to apply for a health insurance affordability program, as defined, consistent with federal requirements. Commencing January 1, 2023, this bill would instead require the board of supervisors, in consultation with the county sheriff, to designate an entity or entities to assist both county jail inmates and juvenile inmates with the application process. The bill would make conforming changes to provisions relating to the coordination duties of jail administrators. By creating new duties for local officials, including boards of supervisors and jail administrators, the bill would impose a state-mandated local program. No sooner than January 1, 2023, the bill would require the department to develop and implement a mandatory process for county jails and county juvenile facilities to coordinate with Medi-Cal managed care plans and Medi-Cal behavioral health delivery systems to facilitate continued behavioral health treatment in the community for inmates. The bill would authorize the sharing of certain information, including health records, with and among counties and other specified entities, as determined necessary by the department. (15) Existing law provides for the suspension of Medi-Cal benefits to an inmate of a public institution, and requires county welfare departments to notify the department within 10 days of receiving information that an individual who is receiving Medi-Cal is or will be an inmate of a public institution. Existing law generally requires a county to redetermine a Medi-Cal beneficiary's eligibility to receive Medi-Cal benefits every 12 months and whenever the county receives information about changes in a beneficiary's circumstances that may affect their eligibility for Medi-Cal benefits. This bill would, beginning no sooner than January 1, 2023, require that a qualifying inmate of a public institution be eligible to receive targeted Medi-Cal services approved in the CalAIM Terms and Conditions for 90 days, or the number of days approved in the CalAIM Terms and Conditions if fewer than 90 days, prior to the date they are released from a public institution, if otherwise eligible for the services. The bill would, to the extent federal approval is obtained for this purpose, require the department to arrange for an independent, third-party evaluation of the hypotheses and outcomes associated with providing targeted Medi-Cal services to qualifying inmates as described in the CalAIM Terms and Conditions. The bill would require the department to post the evaluation report on its internet website following submission to the federal Centers for Medicare and Medicaid Services. The bill would also, commencing no sooner than July 1, 2021, require the department, in consultation with specified stakeholders, to initiate the planning process to prioritize the automation of Medi-Cal suspensions for incarcerated individuals into the California Healthcare Eligibility, Enrollment, and Retention System, as specified. (16) For purposes of the programs and services described in paragraphs (11) to (15) , inclusive, this bill would make conforming changes to provisions relating to the adoption of regulations or issuance of all-county letters by the department. (17) Existing law includes coverage for specified pharmacist services under the Medi-Cal program, subject to federal approval, the availability of federal financial participation, department protocols, and utilization controls. This bill would add medication therapy management (MTM) pharmacist services, provided in conjunction with the dispensing of qualified specialty drugs, to the list of covered pharmacist services under the Medi-Cal program, subject to the above conditions. The bill would define MTM and specialty drugs for purposes of these provisions. Existing law requires that the rate of reimbursement for pharmacist services be at 85% of the fee schedule for physician services under the Medi-Cal program. This bill would make an exception for the above MTM pharmacist services and would, subject to an annual appropriation, require the department to implement an MTM reimbursement methodology for covered pharmacist services related to the dispensing of qualified specialty drugs by an eligible pharmacy contracted with the department. The bill would require the department to establish and maintain protocols and utilization controls, a list of covered specialty drug therapy categories, rates of reimbursement, and eligibility criteria and conditions for receipt of MTM pharmacist services reimbursement, as specified. (18) Existing federal law establishes the Money Follows the Person Rebalancing Demonstration, which is designed to achieve various objectives with respect to institutional and home- and community-based long-term care services provided under state Medicaid programs. Under the Money Follows the Person Rebalancing Demonstration, an eligible individual is required to meet prescribed qualifications, including that they have resided in an inpatient facility for a period of not less than 60 consecutive days. Existing law requires the department to provide services consistent with the Money Follows the Person Rebalancing Demonstration for transitioning eligible individuals out of an inpatient facility. Existing law defines "eligible individual" for these purposes as a person who meets certain requirements, including the prescribed qualifications set forth under federal law, except that the person is not required to have resided for at least 90 consecutive days in an inpatient facility. Existing law requires the department to cease providing those services on January 1, 2024, and repeals these provisions on January 1, 2025. This bill would delete the 90 consecutive day residence period, and would instead provide that the eligible individual is not required to have resided for at least 60 consecutive days in an inpatient facility. The bill would make other conforming changes. (19) Existing law requires, for the duration of the COVID-19 emergency period, the State Department of Health Care Services to implement any federal Medicaid program waiver or flexibility approved by the federal Centers for Medicare and Medicaid Services related to that emergency. This bill would require the department to seek any federal approvals it deems necessary to extend the approved waiver or flexibility implemented pursuant to those provisions as of July 1, 2021, that are related to the delivery and reimbursement of services via telehealth modalities in the Medi-Cal program, and, subject to approval by the Department of Finance, would require the department to implement those extended waivers or flexibilities for which federal approval is obtained for a specified period of time ending December 31, 2022. The bill would also require the department to convene an advisory group to provide recommendations to inform the department in establishing and adopting billing and utilization management protocols for telehealth modalities to increase access and equity and reduce disparities in the Medi-Cal program. The bill would authorize the department to enter into contracts, or amend existing contracts, for the purposes of implementing these provisions and would exempt those contracts or amendments from specified provisions of law. (20) The Long-Term Care, Health, Safety, and Security Act of 1973 generally requires the State Department of Public Health to license and regulate long-term health care facilities and to establish an inspection and reporting system to ensure that long-term health care facilities are in compliance with state statutes and regulations. The term "long-term health care facility" includes, among other types of facilities, a skilled nursing facility and intermediate care facility. Existing law provides that it is the intent of the Legislature to expressly set forth fundamental human rights which patients are entitled to in a skilled nursing facility, intermediate care facility, or hospice facility, and to ensure that patients in those facilities are advised of their fundamental human rights, including rights relating to transfers and discharges, and the obligations of the facilities. Existing law, the Medi-Cal Long-Term Care Reimbursement Act, requires, among other things, the State Department of Health Care Services to implement a facility-specific reimbursement ratesetting system for certain skilled nursing facilities. Under the act, existing law requires nursing facilities to meet the residents' discharge planning and referral needs, or make referrals to a designated local contact agency, as determined by the department. This bill would require a long-term health care facility, as defined, to timely comply with a hearing decision, as issued by the department's Office of Administrative Hearings and Appeals, that finds that the facility improperly transferred, discharged, or refused to readmit a resident. If a facility fails to timely comply with a hearing decision, the bill would authorize the department to assess penalties of $750 for each calendar day the facility fails to comply with the hearing decision. To demonstrate compliance with a hearing decision, the bill would require a facility to file a specified certification of compliance with the department, would require the department to make a certificate of compliance available on its internet website, and would provide that the facility's failure to provide the certification of compliance would subject the facility to the prescribed penalties, except as specified. The bill would authorize the department to deduct the penalties from Medi-Cal payments to the facility if the department provides prior written notice to the facility and takes into account the financial condition of the facility. If there is a merger, acquisition, or change of ownership involving a facility that has outstanding penalties, the bill would require the successor long-term health care facility to be responsible for paying to the department the amount of outstanding penalties attributable to the facility for which it was assessed. The bill would authorize the department to waive assessed penalties if that facility petitions for a waiver and the department makes a determination that the facility meets certain requirements, including that the facility has taken corrective action to remediate its improper conduct. The bill would provide that the assessed penalties are appealable only to the superior court of the county where the facility is located and would require the department to refund any penalties paid by a long-term health care facility if the hearing decision is reversed on appeal. The bill would require collected penalties to be deposited into the General Fund, and, upon appropriation by the Legislature, to be used for particular purposes, including to improve the quality of long-term care services under the Medi-Cal program, would authorize the department to implement these provisions by various means, including provider bulletins, and would require the department to seek federal approvals, as necessary, to implement these provisions. The bill would condition the implementation of these provisions to the extent that necessary federal approvals are obtained and federal financial participation is not jeopardized. (21) Existing law requires the State Department of Health Care Services to establish a Medically Tailored Meals Pilot Program in specified counties to provide medically tailored meals, as defined, to Medi-Cal participants with specified health conditions, such as cancer and renal disease. Existing law requires the department to evaluate, at the conclusion of the program, the impact of the pilot program on specified matters related to participants, including hospital readmission and emergency room utilization rates, and to send a report on the evaluation to the Legislature. For the 2021–22 fiscal year, this bill would require the department to implement the Short-Term Medically Tailored Meals Intervention Services Program to award funds to qualified entities providing medically tailored meals intervention services to eligible Medi-Cal beneficiaries with certain health conditions, such as cancer and congestive heart failure, who reside in specified counties. To the extent funding is available, the bill would require an eligible Medi-Cal beneficiary to receive medically tailored meals intervention services, as prescribed, for a period of 12 to 52 weeks, depending on the medical diagnosis and need. The bill would authorize the department to implement additional eligibility requirements for individuals to receive these services, and to use data from the Medi-Cal program to identify eligible Medi-Cal beneficiaries who may receive services under the Short-Term Medically Tailored Meals Intervention Services Program. The bill would require providers that are awarded funding to monitor and document the impacts of this program, including health outcomes, and to provide that information to the department. The bill would require the department to develop a methodology for reimbursing contractors or other entities for services and would require the department to allocate 5% of the funds allocated for purposes of the program to a nonprofit organization fiscal sponsor to coordinate the program, as specified. Existing law makes the provisions of the Medically Tailored Meals Pilot Program inoperative on the earlier of the date the department submits its report to the Legislature or 12 months after the end of that program. This bill would instead make these provisions inoperative on the date the department submits its report to the Legislature or 12 months after the end of the Medically Tailored Meals Pilot Program or the Short-Term Medically Tailored Meals Intervention Services Program, whichever occurs last. (22) The federal Medicaid program provisions prohibit payment to a state for medical assistance furnished to an alien who is not lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law. Existing law requires individuals under 19 years of age enrolled in restricted-scope Medi-Cal benefits at the time the Director of Health Care Services makes a determination that systems have been programmed for implementation of these provisions to be enrolled in the full scope of Medi-Cal benefits, if otherwise eligible, pursuant to an eligibility and enrollment plan, and extends eligibility for full-scope Medi-Cal benefits to individuals who are under 25 years of age, and who are otherwise eligible for those benefits but for their immigration status. Existing law makes the effective date of enrollment for those individuals the same day that systems are operational to begin processing new applications pursuant to the director's determination. Existing law requires an individual eligible for Medi-Cal under these provisions to enroll in a Medi-Cal managed care health plan. Existing law provides that Medi-Cal benefits for individuals who are 65 years of age or older, and who do not have satisfactory immigration status or are unable to establish satisfactory immigration status, as specified, are to be prioritized in the annual Budget Act for the upcoming fiscal year if the Department of Finance projects a positive ending balance in the Special Fund for Economic Uncertainties for the upcoming fiscal year and each of the ensuing 3 fiscal years that exceeds the cost of providing those individuals with full-scope Medi-Cal benefits. The bill would delete the above-specified provisions regarding individuals who are under 19 or 25 years of age, or 65 years of age or older, and delay implementation until the director makes the determination described above. The bill would instead make an individual who is 25 years of age or younger, and who does not have satisfactory immigration status or is unable to establish satisfactory immigration status, as specified, eligible for the full scope of Medi-Cal benefits if they are otherwise eligible for those benefits, would delete obsolete provisions, and would make conforming changes. After the director determines, and communicates that determination in writing to the Department of Finance, that systems have been programmed for implementation of these purposes, but no sooner than May 1, 2022, this bill would extend Medi-Cal eligibility for the full scope of Medi-Cal benefits to an individual who is 50 years of age or older, and who does not have satisfactory immigrant status or is unable to establish satisfactory immigration status, as specified, if they are otherwise eligible for those benefits. The bill would make the effective date of enrollment for those individuals the same day that systems are operational to begin processing new applications pursuant to the director's determination. The bill would provide that a person enrolled in the Medi-Cal program under these provisions is not required to file a new application for the Medi-Cal program, would require the enrollment to be conducted pursuant to a prescribed eligibility and enrollment plan, and would require the department to provide monthly updates to the Legislature, as specified. Because counties are required to make Medi-Cal eligibility determinations and this bill would expand Medi-Cal eligibility to specified individuals who are 50 years of age and older, the bill would impose a state-mandated local program. (23) Existing law authorizes the department to provide health care services to beneficiaries through models of managed care, including geographic managed care and prepaid health plans, and requires the department to implement a dental managed care program. Dental services are provided under geographic managed care in the County of Sacramento and prepaid health plans in the County of Los Angeles. This bill would require the department to extend dental managed care contracts to December 31, 2022, and to secure the extensions on a sole source basis, as specified. The bill would authorize the department to implement provisions on the Medi-Cal dental managed care program by prescribed means, including information notices, without taking any further regulatory action. (24) 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. Under existing law, a demonstration project known as the Coordinated Care Initiative (CCI) 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. This bill would establish the Office of Medi-Cal Innovation and Integration in the department. The duties of the department would include, among others, to provide focused leadership and expertise on innovative models for Medicare beneficiaries in California, as specified, and to develop innovative approaches to integrated models of care and coordinated access to long-term services and supports for Medicare-only beneficiaries and dually eligible beneficiaries. (25) Existing law requires Medi-Cal benefits to be provided to individuals eligible for services pursuant to prescribed standards, including a modified adjusted gross income (MAGI) eligibility standard. Existing law prohibits the use of an asset or resources test for individuals whose financial eligibility for Medi-Cal is determined based on the application of MAGI. Existing federal law authorizes a state to establish a non-MAGI standard for determining the eligibility of specified individuals, and existing law imposes the use of a resources test for establishing Medi-Cal eligibility for prescribed populations. This bill would require the department to seek federal approval to implement specified disregards in nonexempt property for applicants or beneficiaries whose eligibility is not determined using the MAGI-based financial methods, and would condition the implementation of this provision on the Director of Health Care Services determining that systems have been programmed and they communicate that determination in writing to the Department of Finance, and no sooner than July 1, 2022. This bill would prohibit the use of resources, including property or other assets, to determine Medi-Cal eligibility for applicants or beneficiaries whose eligibility is not determined using the MAGI-based financial methods, and would require the department to seek federal authority to disregard all resources as authorized by the flexibilities provided pursuant to federal law. The bill would authorize the department to implement these provisions by various means, including provider bulletins, without taking regulatory authority. The bill would require the department to adopt, amend, or repeal regulations on the prohibition, and to update its notices and forms to delete any reference to limitations on resources or assets, as specified. The bill would condition the implementation of the bill's provisions to the extent consistent with federal law, upon the department obtaining any necessary federal approvals, and to the extent federal financial participation under the Medi-Cal program is available and not otherwise jeopardized. Because counties are required to make Medi-Cal eligibility determinations, and this bill would expand Medi-Cal eligibility, the bill would impose a state-mandated local program. (26) The Budget Act of 2018 appropriates $2,000,000 for the Whole Genome Sequencing Pilot Project, and requires the department to provide a grant to a state nonprofit organization for the execution of a one-time pilot project to investigate the potential clinical and programmatic value of utilizing clinical Whole Genome Sequencing in the Medi-Cal program. This bill would, no sooner than January 1, 2022, expand the Medi-Cal schedule of benefits to include rapid Whole Genome Sequencing, as specified, for any Medi-Cal beneficiary who is one year of age or younger and is receiving inpatient hospital services in an intensive care unit. The bill would authorize the department to implement this provision by various means without taking regulatory action. (27) Existing law requires the department to develop, subject to federal approval, reimbursement rates for clinical or laboratory services according to specified standards, including requiring that reimbursement to providers for those services not exceed the lowest of enumerated criteria, including 80% of the lowest maximum allowance established by the federal Medicare program for the same or similar services. For dates of service on or after July 1, 2022, this bill would raise the above-described standard to 100% of the lowest maximum allowance established by the federal Medicare program for the same or similar services. For dates of service from July 1, 2021, to June 30, 2022, inclusive, the bill would require the department to establish the reimbursement rates for clinical laboratory or laboratory services at the rates in effect and approved in the Medi-Cal State Plan as of December 31, 2019. The bill would prohibit the department from retroactively implementing reimbursement reductions and from recouping overpayments for clinical laboratory or laboratory services, as specified. (28) Existing law authorizes the department to adopt regulations for the certification of each applicant and each provider in the Medi-Cal program. Existing law requires a provider that is not currently enrolled at a location where the provider intends to provide services, goods, supplies, or merchandise to a Medi-Cal beneficiary to submit a complete application package for enrollment at a new location or a change in location. Existing law exempts an applicant, a provider operated by a licensed primary care clinic, or an affiliated mobile health care unit from this requirement and from a requirement to enroll in the Medi-Cal program as a separate provider, if a licensed primary care clinic operating the applicant, provider clinic, or mobile health care unit notifies the department of its separate locations. This bill would, to the extent permissible under federal law, authorize a mobile optometric office that meets certain requirements to be enrolled in the Medi-Cal program as either a mobile optometric office or within any other provider category for which the applicant or provider qualifies. (29) Under existing law, durable medical equipment, which includes custom rehabilitation equipment and custom rehabilitation technology services, is a covered Medi-Cal benefit, subject to utilization controls. Existing law requires a provider of custom rehabilitation equipment and custom rehabilitation technology services to have a qualified rehabilitation professional on staff, as specified, and requires a medical provider to conduct a physical examination of an individual before prescribing a motorized wheelchair or scooter for a Medi-Cal beneficiary. This bill would repeal and recast those provisions to apply to complex rehabilitation technology (CRT) , defined as items classified within the federal Medicare Program as of January 1, 2021, as durable medical equipment that are individually configured for individuals to meet their specific and unique medical, physical, and functional needs and capacities for basic activities of daily living and instrumental activities of daily living identified as medically necessary. The bill would impose certain accreditation, staffing, supply, and other types of requirements for CRT providers. The bill would maintain the above-described requirement concerning physical examinations by medical providers. The bill would recast qualified rehabilitation professionals as qualified health care professionals and qualified rehabilitation technology professionals, as defined, with certain changes to certification requirements. The bill would make a conforming change to a related provision. The bill would require both types of professionals to be involved in the evaluation of complex needs patients, as defined, who receive a complex rehabilitation manual wheelchair, power wheelchair, or seating component. The bill would authorize the department to adopt utilization controls, including a specialty evaluation by a qualified health care professional. The bill would require the department to seek any necessary federal approvals for the implementation of these provisions, and would condition their implementation to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized. Existing law requires, except as otherwise provided, Medi-Cal provider payments and payments for specified non-Medi-Cal programs to be reduced by 10% for dates of service on and after June 1, 2011, and conditions the implementation of these provisions on the department securing federal approval. For dates of service on and after January 1, 2022, or the effective date of any necessary federal approvals, whichever is later, this bill would exempt providers of CRT and CRT services from the above-described provider payment reduction. (30) Existing law authorizes the State Department of Public Health to establish the Office of Suicide Prevention within the department, and requires the office to perform specified duties, including providing information and technical assistance to statewide and regional partners regarding best practices on suicide prevention policies and programs and reporting on progress to reduce rates of suicide, and to authorize the office to apply for and use federal, state, and foundation grants. This bill would remove the limitation that, should the office be established, all duties and responsibilities of the office be carried out using existing staff and resources. (31) Existing law authorizes the Director of Public Health to establish and administer a program within the State Department of Public Health's Office of AIDS to subsidize certain costs of medications for the prevention of human immunodeficiency virus (HIV) infection and other related medical services to residents of California who are at least 18 years of age, who are HIV negative, have been prescribed medications listed on the AIDS Drug Assistance Program (ADAP) formula, and meet specified financial eligibility requirements. Existing law also authorizes the program to subsidize, without regard to eligibility and for the prevention of HIV infection, up to 30 days of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) medications. This bill would expand eligibility for subsidized medications under this program to include individuals who have the specified medication dispensed or otherwise furnished. (32) Existing law authorizes 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 the 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, to the extent that funds are available for these purposes, authorize the office to allocate funds to local health departments and community-based organizations to support PrEP and PEP navigation and retention coordinators and related services for the purpose of increasing PrEP and PEP initiation and retention among individuals most vulnerable to HIV. The bill would require the office to establish a simple application process for funding to support these PrEP and PEP navigation and retention services. The bill would establish eligibility criteria for applicants to receive these funds. The bill would require funded local health departments and community-based organizations to collaborate with the office to conduct outcome and process evaluation of PrEP and PEP navigation and retention services, and would require the office to establish performance metrics to ensure that funding is used efficiently and to measure program success. The bill would authorize the office to use a portion of funds to contract with a third-party entity to provide training, program technical assistance, and capacity building to funded local health departments and community-based organizations. The bill would, to the extent allowable under federal law, and upon availability of funds, authorize the office to expend funding from the AIDS Drug Assistance Program Rebate Fund, a continuously appropriated fund, for these activities. Because the bill would authorize a new purpose for a continuously appropriated fund, the bill would create an appropriation. (33) Existing law requires a licensed physician and surgeon or other person attending a newborn infant diagnosed as having had rhesus (Rh) isoimmunization hemolytic disease to report the condition to the State Department of Public Health on report forms prescribed by the department. This bill would repeal that reporting requirement. (34) Existing law authorizes the State Department of State Hospitals, subject to appropriation by the Legislature, to solicit proposals from, and to contract with, a county to help fund the development or expansion of pretrial diversion for individuals with serious mental disorders who may otherwise be found incompetent to stand trial and committed to the department for restoration of competency. Existing law requires participants to meet specified criteria, including, among others, that they suffer from certain mental disorders and have felony charges, and that there is a significant relationship between the serious mental disorders and the charged offense or between the individual's conditions of homelessness and the charged offense. This bill would, beginning July 1, 2021, and upon appropriation from the Legislature, permit the department to amend a contract with a county

Bill Text

Bill Activity

  • Chaptered by Secretary of State - Chapter 143, Statutes of 2021.

  • Signed Approved by the Governor.

  • Enrolled and presented to the Governor at 3:30 p.m.

  • Senate amendments concurred in. To Engrossing and Enrolling.

  • Assembly Rule 63 suspended.

  • Assembly Rule 77 suspended.

  • In Assembly. Concurrence in Senate amendments pending. May be considered on or after July 17 pursuant to Assembly Rule 77.

  • Passed Read third time. Passed. Ordered to the Assembly. (Ayes 31. Noes 8.).

  • Senate Rule 29 suspended. (Ayes 28. Noes 7.)

  • Read second time. Ordered to third reading.

  • From committee: Do pass. (Ayes 13. Noes 4.) (July 14).

  • From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on B. & F.R.

  • In committee: Hearing postponed by committee.

  • In committee: Hearing postponed by committee.

  • Joint Rule 62(a), file notice suspended. (Ayes 31. Noes 9.)

  • From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on B. & F.R.

  • Joint Rule 62(a), file notice suspended. (Ayes 29. Noes 9.)

  • Referred to Com. on B. & F.R.

  • Passed Read third time. Passed. Ordered to the Senate. (Ayes 56. Noes 18. Page 478.)

  • In Senate. Read first time. To Com. on RLS. for assignment.

  • Passed Read third time. Passed. Ordered to the Senate.

  • Read second time. Ordered to third reading.

  • Assembly Rule 96 suspended. (Ayes 53. Noes 17. Page 432.)

  • Ordered to second reading.

  • Withdrawn from committee.

  • Assembly Rule 96 suspended.

  • Re-referred to Com. on BUDGET.

  • From committee chair, with author's amendments: Amend, and re-refer to Com. on BUDGET. Read second time and amended.

  • Referred to Com. on BUDGET.

  • Read first time.

  • From printer. May be heard in committee February 9.

  • Introduced. To print.

Hearings on this Bill

  • Committee Meeting: Senate Budget and Fiscal Review
  • Committee Meeting: Senate Budget and Fiscal Review
  • Committee Meeting: Senate Budget and Fiscal Review

Votes

lower chamber:
AB 133 BUDGET Assembly Third Reading By TING
upper chamber:
Do pass
lower chamber:
AB 133 BUDGET Concurrence in Senate Amendments By TING