Medi-Cal: demonstration project.

(1) 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, this 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, as specified. The bill would authorize the sharing of health information, records, and other data with and among counties and other specified entities to the extent the department determines necessary to implement these provisions. (2) 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, either through a fee-for-service or managed care delivery system. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. 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 Whole Person Care pilot program, and the Public Hospital Redesign and Incentives in Medi-Cal (PRIME) 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, for purposes of building upon the outcomes of various Medi-Cal pilots and demonstration projects, including the Medi-Cal 2020 demonstration project. Under the GPP, existing law makes designated public hospitals, and any successor or differently named hospital, eligible to receive global payments that are calculated using a value-based point methodology based on the health care that they provide to the uninsured. This bill would allow those designated hospitals, if restructured or reorganized, to continue to participate in the GPP. Commencing January 1, 2021, the bill would authorize the continuation of the GPP, as modified, and as a component of the CalAIM initiative. Existing law establishes the Medi-Cal Hospital/Uninsured Care Demonstration Project Act, which revises hospital reimbursement methodologies in order to maximize the use of federal funds consistent with federal Medicaid law and stabilize the distribution of funding for hospitals that provide care to Medi-Cal beneficiaries and uninsured patients. Under the Medi-Cal 2020 demonstration project, existing law establishes prescribed payment methodologies and requirements relating to the Medi-Cal Hospital/Uninsured Care Demonstration Project Act. This bill would generally extend the specified payment methodologies set forth under the Medi-Cal 2020 demonstration project as part of the CalAIM initiative, and would make technical and conforming changes. For the 2020–21 state fiscal year, and subsequent state fiscal years, the bill would modify reimbursement methodologies for designated public hospitals, as prescribed. Existing law requires the department to establish and maintain a County Administrative Cost Control Plan whereby costs for county administration of the determination of eligibility for benefits under the Medi-Cal program are effectively controlled within the amounts annually appropriated for that administration. Existing law requires this plan to establish standards and performance criteria, including workload, productivity, and support services standards, and requires counties to adhere to these requirements. Existing law imposes various duties on counties relating to Medi-Cal eligibility, such as requiring counties to submit reconciliation files of its Medi-Cal eligible population to the department every 3 months. No later than July 1, 2022, this bill would require the department to issue guidance, in consultation with specified individuals and entities, including the exclusive representative of county eligibility workers, to restart county performance reporting and monitoring processes. During the consultation process, the bill would require the department to perform specified duties, such as reviewing the corrective action processes relating to prescribed provisions, including those on the County Administrative Cost Control Plan. Commencing with the 2017–18 state fiscal year, existing law requires the department, in consultation with the designated public hospital systems and applicable Medi-Cal managed care plans, to establish a program under which a designated public hospital system may earn performance-based quality incentive payments from Medi-Cal managed care plans, as specified, and requires payments to be earned by each designated public hospital system based on its performance in achieving identified targets for quality of care. Under existing law, these payments are federally and nonfederally funded, and the nonfederal share may consist of voluntary intergovernmental transfers of funds that the department, in its discretion, may deposit the transfer in the Medi-Cal Inpatient Payment Adjustment Fund, a continuously appropriated fund. Existing law requires the department to establish uniform performance measures and parameters for the designated public hospital systems to select the applicable measures, and requires these performance measures to advance at least one goal identified in the state's Medicaid quality strategy. Commencing with the 2020–21 state fiscal year, this bill would additionally require the department to consult with district and municipal hospitals, would expand the performance-based quality incentive payments to district and municipal hospitals, and would make various conforming changes relating to this expansion. By increasing the intergovernmental transfers of funds that the department may deposit in the Medi-Cal Inpatient Payment Adjustment Fund, a continuously appropriated fund, the bill would make an appropriation. Through and until June 30, 2020, the bill would provide that specified performance measures shall not duplicate measures utilized in the PRIME program. Commencing with the 2020–21 state fiscal year, this bill would require specified payments to be earned by a district and municipal public hospital based on its performance in achieving identified targets for quality of care, would require the department to establish a class of district or municipal public hospitals, and would impose specified requirements relating to the implementation of these payments to district and municipal public hospitals. The bill would cease the implementation of the expanded quality incentive payments if the implementation is no longer financially and programmatically supportive of the Medi-Cal program, as determined pursuant to prescribed factors. (3) This bill would make its provisions severable and would make other legislative findings and declarations. (4) 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 the statutory provisions noted above.