Healthy Families Program: Medi-Cal: program transition: expansion.

Under existing law, the Robert W. Crown California Children's Services Act, the State Department of Health Care Services and each county administer the California Children's Services Program (CCS program) for treatment services for persons under 21 years of age diagnosed with severe chronic disease or severe physical limitations, as specified. Existing law generally limits eligibility for CCS program services to persons in families with an annual adjusted gross income of $40,000 or less. Under existing law, the department, or any designated local agency administering the program, is responsible for providing medically necessary occupational and physical therapy to eligible children, as specified. Existing law requires that specified assessments and therapy treatment services rendered to a child referred to a local education agency for an assessment or a disabled child or youth with an IEP be exempt from financial eligibility standards and family repayment requirements. This bill would make technical, nonsubstantive changes to these provisions. Existing law creates the Healthy Families Program, administered by the Managed Risk Medical Insurance Board (MRMIB) , to arrange for the provision of health, vision, and dental benefits to eligible children pursuant to a federal program, the Children's Health Insurance Program. Existing law also provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which basic health care services are provided to qualified low-income persons. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. Under existing law, the Director of Health Care Services may contract with any qualified individual, organization, or entity to provide services to, arrange for, or case manage the care of Medi-Cal beneficiaries, subject to specified requirements. Existing law requires a Medi-Cal applicant or beneficiary to be informed of the managed care and fee-for-service options available regarding methods of receiving Medi-Cal benefits. This bill would provide for the transition of specified enrollees of the Healthy Families Program to the Medi-Cal program, to the extent that those individuals are otherwise eligible, no sooner than January 1, 2013. This bill would provide that the transition would take place in 4 phases, as specified, for individuals enrolled in either a Healthy Families Program plan that is also a Medi-Cal managed care plan (Phase 1) or enrolled in a Healthy Families Program plan that is a subcontractor of a Medi-Cal managed care plan or other specified plans (Phase 2 and Phase 3) , or for individuals residing in a county that is not a Medi-Cal managed care county (Phase 4) . This bill would require the department to exercise certain options under federal law to provide benefits to optional targeted low-income children, as described, and seek appropriate federal approvals and state plan amendments, in order to implement the Healthy Families Program to Medi-Cal program transition and Medi-Cal program expansion provided for in the bill. This bill would require MRMIB to coordinate with the department to implement these provisions, and would make related changes. This bill would make related changes to the California Children's Services Program provisions. By increasing county responsibilities with respect to determining Medi-Cal eligibility, this bill would impose a state-mandated local program. Existing law provides that reimbursement for clinical laboratory or laboratory services under the Medi-Cal program, as defined, may not exceed 80% of the lowest maximum allowance established by the federal Medicare Program for the same or similar services. This bill would, upon federal approval, change the rate methodology for clinical laboratory or laboratory services, as specified. This bill would also require that rates for clinical laboratory or laboratory services be reduced by 10% until federal approval is obtained for this new rate methodology. This bill would appropriate $400,000 from the Managed Care Fund to the Department of Managed Health Care for administration, as specified. This bill would make legislative findings and declarations as to the necessity of a special statute for the Counties of Los Angeles and Sacramento. 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, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions. This bill would declare that it is to take effect immediately as a bill providing for appropriations related to the Budget Bill.