Health.

(1) Existing law creates the Healthy Families Program and the Access for Infants and Mothers Program, which are administered by the Managed Risk Medical Insurance Board, to provide specified health care coverage to individuals that meet prescribed eligibility requirements. Existing law requires a person to be a resident of the state for at least 6 continuous months prior to application to the Access for Infants and Mothers Program. Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. Existing law authorizes the board to negotiate contracts or enter interagency agreements with entities that are not participating plans, such as the department, to provide or pay for benefits to subscribers of the Healthy Families Program or the Access for Infants and Mothers Program. This bill would delete the 6-month residency requirement. This bill would authorize the department to contract with public or private entities, or utilize existing health care service provider payment mechanisms, in order to implement these provisions, and would make conforming changes. (2) Existing law requires the Managed Risk Medical Insurance Board to appoint a 7-member Access for Infants and Mothers Advisory Panel. Existing law requires the board to provide for the transfer of coverage of a subscriber of the Access for Infants and Mothers Program to another participating health plan if a subscriber's coverage under his or her plan is canceled or not renewed. This bill would delete this requirement and would repeal the provisions establishing the Access for Infants and Mothers Advisory Board. (3) Existing law requires the department, no later than June 30, 2014, and subject to federal approval, to develop and implement a Medi-Cal payment methodology based on diagnosis-related groups that reflects the costs and staffing levels associated with quality of care for patients in all general acute care hospitals, as specified. Existing law also establishes the California Medical Assistance Commission in the Governor's office for the purpose of contracting with health care delivery systems for the provision of health care services to recipients under the Medi-Cal program. This bill would require that the payment methodology be implemented on July 1, 2012, or upon the date the Director of Health Care Services executes a specified declaration, whichever is later. This bill would also require the California Medical Assistance Commission to be dissolved after June 30, 2012, that all powers, duties, and responsibilities of the commission be transferred to the director, and that on or before July 1, 2012, staff positions serving the commission, including the executive director, be transferred to the department. This bill would further provide that upon a finding by the director that the payment methodology has been designed and implemented and is sufficient to replace the contract-based payment system, as performed by the commission, the powers, duties, and responsibilities transferred to the director shall no longer be exercised. (4) Existing law requires, except as otherwise provided, Medi-Cal provider payments to be reduced by 1% or 5%, and provider payments for specified non-Medi-Cal programs to be reduced by 1% for dates of service on and after March 1, 2009, and until June 1, 2011. For dates of service on and after June 1, 2011, existing law requires, except as provided, that these provider payments be reduced by 10%. This bill would, instead, require that the 1% and 5% reductions cease to be implemented when and to the extent that federal approval is obtained for one or more specified payment reductions and adjustments, including, but not limited to, the 10% provider payment reductions. (5) Existing law requires the reimbursement to Medi-Cal pharmacy providers for legend and nonlegend drugs, as defined, to consist of the estimated acquisition cost of the drug, as defined, plus a professional fee for dispensing. Existing law requires the estimated acquisition cost for specified legend and nonlegend drugs to be equal to the lowest of the average wholesale price minus 17%, the selling price, the federal upper limit, or the maximum allowable ingredient cost. This bill would, instead, require that reimbursement to Medi-Cal pharmacy providers for legend and nonlegend drugs shall not exceed the lowest of the estimated acquisition cost of the drug plus a professional fee for dispensing or the pharmacy's usual and customary charge, as defined. This bill would also modify the way in which reimbursement is calculated by permitting the estimated acquisition cost to be equal to the average acquisition cost, as defined. (6) Existing law requires the department to establish and maintain the County Administrative Cost Control Plan to control costs for county administration of the determination of eligibility for benefits under the Medi-Cal program. This bill would, instead, require the department to develop and implement, in consultation with county program and fiscal representatives, a new budgeting methodology to reimburse counties for eligibility determinations for applicants for and beneficiaries of the Medi-Cal program. (7) Under existing law, one of the methods by which Medi-Cal services are provided is pursuant to contracts with various types of managed care plans. This bill would, to the extent permitted by federal law, authorize a transferring entity, as defined, to make an intergovernmental transfer (IGT) to the state, and would authorize the department to accept all IGTs from a transferring entity, for the purposes of providing support for the nonfederal share of risk-based payments to managed care health plans, as defined, to compensate providers designated by the transferring entity for Medi-Cal health care services and for the support of the Medi-Cal program. This bill would require the state to assess a fee of 20% on each IGT the state accepts pursuant to these provisions to reimburse the department for the administrative costs associated with implementing these provisions and for the support of the Medi-Cal program. This bill would require that these provisions be implemented on July 1, 2011, or the date on which all necessary federal approvals have been received, whichever is later. (8) Under existing law, the State Department of Mental Health is required to implement mental health care services, as specified, for Medi-Cal recipients. This bill would, effective July 1, 2012, require that the state administrative functions for the operation of Medi-Cal specialty mental health managed care and the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program, and applicable functions related to federal Medicaid requirements that were performed by the State Department of Mental Health be transferred to the department. This bill would require the department, in collaboration with the State Department of Mental Health and the California Health and Human Services Agency, to create a transition plan to be provided, as prescribed, to the fiscal and appropriate policy committees of the Legislature no later than October 1, 2011, or May 15, 2012, as applicable. (9) Existing law requires the department to seek a demonstration project or federal waiver of Medicaid law to implement specified objectives, which may include better care coordination for seniors, persons with disabilities, and children with special health care needs. Existing law provides for the Health Care Coverage Initiative (HCCI) , which is a federal waiver demonstration project established to expand health care coverage to low-income uninsured individuals who are not currently eligible for the Medi-Cal program, the Healthy Families Program, or the Access for Infants and Mothers Program. Existing law also requires the department, on or after November 1, 2010, but no later than March 1, 2011, or 180 days after federal approval of the demonstration project, to authorize the provision of scheduled health care benefits for uninsured adults, as specified. This bill would require the department to annually seek authority from the federal Centers for Medicare and Medicaid Services under the Special Terms and Conditions of California's Bridge to Reform Section 1115(a) Demonstration to redirect HCCI funds within the safety net care pool, as defined, that are not fully utilized by the end of a demonstration year, as defined, to the category of uncompensated care to be used by designated public hospitals, on a voluntary basis, for allowable certified public expenditures, as specified. (10) This bill would appropriate $1,000 from the General Fund to the State Department of Health Care Services for administration. (11) This bill would declare that it is to take effect immediately as a bill providing for appropriations related to the Budget Bill.