Child health.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act) , 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. Existing law creates the Healthy Families Program, administered by the Managed Risk Medical Insurance Board, to arrange for the provision of health, dental, and vision benefits to eligible children pursuant to a federal program, the State Children's Health Insurance 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. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Under existing law, one of the methods by which Medi-Cal is provided is pursuant to contracts with various types of managed care plans. Existing law provides for a schedule of benefits under the Medi-Cal program and provides for various services provided to children, including, among others, early and periodic screening, diagnosis, and treatment for any individual under 21 years of age. This bill would provide that an initial health assessment, as defined, and a forensic medical evaluation, as defined, shall be covered benefits under health care service plans licensed pursuant to the Knox-Keene Act, and would require these health care service plans, plans providing services under the Healthy Families Program, and Medi-Cal managed care plans, as defined, to make payments to providers for these services, as specified. This bill would authorize a county board of supervisors to, upon a motion made at the request of a local child welfare agency, excuse the plans specified above from the obligation to provide coverage of, or payment for, initial health assessments or forensic medical evaluations provided to children who are residents of that county if the county welfare agency has made sufficient alternative arrangements to ensure that the services are provided and that payment is made to providers for these services. Because a willful violation of the bill's provisions relative to health care service plans would be a crime, the bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason.