Asm. Jim Wood

Existing law provides that the Department of Transportation has full possession and control of state highways and associated property. Existing law requires the department to notify companies and organizations working on broadband deployment on its Internet Web site of specified department-led highway construction projects and authorizes those companies and organizations to collaborate with the department to install broadband conduits as part of those projects. This bill would require the department, as part of those projects that are located in priority areas, as defined, to install broadband conduits capable of supporting fiber optic communication cables.

Under existing law, the Emergency Medical Air Transportation Act, a penalty of $4 is imposed upon every conviction for a violation of the Vehicle Code, or a local ordinance adopted pursuant to the Vehicle Code, other than a parking offense. Existing law requires the county or the court that imposed the fine to transfer the moneys collected pursuant to this act to the Emergency Medical Air Transportation Act Fund. Under existing law, the assessment of these penalties will terminate on January 1, 2018, and any moneys unexpended and unencumbered in the Emergency Medical Air Transportation Act Fund on June 30, 2019, will transfer to the General Fund. Existing law repeals the Emergency Medical Air Transportation Act on January 1, 2020. This bill would extend the dates of the Emergency Medical Air Transportation Act, so that the assessment of the penalties will terminate commencing January 1, 2028, and any moneys unexpended and unencumbered in the Emergency Medical Air Transportation Act Fund on June 30, 2029, will transfer to the General Fund. The bill would extend the operation of the Emergency Medical Air Transportation Act until January 1, 2030.

Existing law provides for the licensure and regulation of home health agencies by the State Department of Public Health. Existing law requires all private or public organizations that provide or arrange for skilled nursing services to patients in the home to obtain a home health agency license. Existing law also 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 provides that home health care services are covered Medi-Cal benefits, subject to utilization controls. This bill would require the department, on or before January 1, 2018, to establish an incentive-based, supplemental payment program, as defined, which would apply to licensed home health agencies that treat children who are receiving continuous nursing care or private duty nursing services through the Medi-Cal program. The purpose of the program would be to increase access to quality in-home nursing services and encouraging additional home health agencies to participate in nursing care for children receiving Medi-Cal services. The bill would require the department to collaborate with designated stakeholders in establishing the payments, and would authorize the department to establish reasonable provider eligibility standards, as specified. The supplemental payment program would be implemented only to the extent that federal financial participation is available and would require the department to submit any necessary applications to the federal Centers for Medicare and Medicaid Services to implement the supplemental payment program. The bill would require the department to submit a report evaluating the effectiveness of the supplemental payment program to specified committees of the Legislature on or before July 1, 2021. The bill would remain in effect until January 1, 2022, and as of that date would be repealed.

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 by, and funded pursuant to, federal Medicaid program provisions. Existing law provides for a schedule of covered benefits under the Medi-Cal program. Existing law also generally requires pharmaceutical manufacturers to provide to the department a state rebate for certain drug products that have been added to the list of Medi-Cal contract drugs, that are approved for the treatment of acquired immunodeficiency syndrome (AIDS) , or an AIDS-related condition, or cancer, and that are reimbursed through the Medi-Cal outpatient fee-for-service drug program, as specified. This bill would, to the extent that federal financial participation is available and any necessary federal approvals have been obtained, add continuous glucose monitors and related supplies required for use with those monitors to the schedule of benefits under the Medi-Cal program for the treatment of diabetes mellitus type 1 and diabetes mellitus type 2 when medically necessary, subject to utilization controls. The bill would also authorize the department to require the manufacturer of a continuous glucose monitor to enter into a rebate agreement with the department.

Existing law creates the State Department of Public Health and vests it with duties, powers, functions, jurisdiction, and responsibilities with regard to the advancement of public health. This bill would require the department to convene a workgroup, comprised of members selected by the department, to review existing prescription guidelines and develop a recommended statewide guideline addressing best practices for prescribing opioid pain relievers. The bill would require the department, on or before March 1, 2019, to report the workgroup's conclusions and recommendations to the Legislature. The bill would repeal its provisions on January 1, 2020.

Under existing law, the Public Utilities Commission has regulatory authority over public utilities, including telephone corporations. Existing law establishes, among other funds related to telecommunications, the California Advanced Services Fund (CASF) in the State Treasury. Existing law requires the commission to develop, implement, and administer the CASF to encourage deployment of high-quality advanced communications services to all Californians that will promote economic growth, job creation, and the substantial social benefits of advanced information and communications technologies, as provided in specified decisions of the commission and in the CASF statute. Existing law requires the commission to give priority to projects that provide last-mile broadband access to households that are unserved by an existing facility-based broadband provider. Existing law establishes that the goal of the program is, no later than December 31, 2015, to approve funding for infrastructure projects that will provide broadband access to no less than 98% of California households. Existing law authorizes the commission to collect a surcharge for deposit into the CASF not to exceed $315,000,000 in total and authorizes the surcharge until 2020. Existing law establishes 4 accounts, the Broadband Infrastructure Grant Account, the Rural and Urban Regional Broadband Consortia Grant Account, the Broadband Infrastructure and Revolving Loan Account, and the Broadband Public Housing Account, within the CASF and specifies the amount of moneys to be deposited into each account. This bill would revise the goal of the program to provide that its goal is to approve funding by December 31, 2022, for infrastructure projects that will provide broadband access to no less than 98% of California households in each consortia region, as identified by the commission on or before January 1, 2017. The bill would eliminate the Broadband Infrastructure and Revolving Loan Account and would require the transfer of the remaining unencumbered moneys in that account as of January 1, 2018, and the deposit of moneys collected that would be owed to that account into the Broadband Infrastructure Grant Account. The bill would establish within the CASF the Broadband Adoption Account and would require specified amounts of moneys to be deposited into this new account, the Broadband Infrastructure Grant Account, and the Rural and Urban Regional Broadband Consortia Grant Account. The bill repeals the current authorization to collect up to $315,000,000 for deposit in the CASF at a rate of up to $25,000,000 per year through the 2020 calendar year, and instead would authorize the commission to collect $330,000,000 for deposit into the CASF beginning January 1, 2018, and continuing through the 2022 calendar year. The bill would revise the eligibility requirements for projects and project applicants for grants funded from the Broadband Infrastructure Grant Account. The bill would make moneys from the Rural and Urban Regional Broadband Consortia Grant Account available to facilitate the deployment of broadband infrastructure by assisting infrastructure grant applicants in the project development or grant application process. The bill would require recipients of those moneys to conduct an annual audit and to submit to the commission an annual report regarding activities funded by those moneys. The bill would make available moneys in the Broadband Adoption Account to specified entities for digital literacy training, public education, and outreach programs to increase broadband adoption by consumers. Existing law requires the commission to conduct and report to the Legislature, by April 1, 2021, a final financial audit and a final performance audit of the CASF. This bill would require the commission to conduct and report to the Legislature, by April 1, 2020, an interim financial audit and an interim performance audit. The bill would delay the date for the submission of the final audits to April 1, 2023. Existing law requires the commission to annually report specified information relative to the CASF to the Legislature. Existing law repeals these reporting requirements on January 1, 2022. This bill would revise the information specified for inclusion in the report. The bill would repeal these reporting requirements on January 1, 2024. The bill would require the commission to identify unserved areas and delineate the areas in the annual reports. The bill would require the commission to consult regional consortia, stakeholders, and consumers regarding priority areas and cost-effective strategies to achieve the broadband access goal through public workshops conducted at least annually no later than April 30 of each year. Under existing law, a violation of the Public Utilities Act or any order, decision, rule, direction, demand, or requirement of the commission is a crime. Because a violation of an order or decision of the commission implementing the bill's requirements would be a crime, this bill would impose a state-mandated local program by creating a new crime. 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. This bill would declare that it is to take effect immediately as an urgency statute.

Existing law requires a pupil, while enrolled in kindergarten in a public school, or while enrolled in first grade in a public school if the pupil was not previously enrolled in kindergarten in a public school, to present proof of having received an oral health assessment by a licensed dentist or other licensed or registered dental health professional operating within his or her scope of practice that was performed no earlier than 12 months prior to the date of the initial enrollment of the pupil. Existing law specifies that a school district or county office of education is not precluded from developing a schoolsite-based oral health assessment to comply with that requirement. Existing law requires a public school, using a standardized notification form developed and posted online by the State Department of Education in consultation with interested persons, to notify parents and legal guardians of the assessment requirement. Existing law requires a school district to send a report by December 31 of each year containing information related to the assessments to the county office of education in the county in which the school district is located. Existing law requires the Office of Oral Health of the Chronic Disease Control Branch of the State Department of Public Health to conduct an evaluation of, and submit a report related to, these requirements by January 1, 2010. This bill would require the State Department of Education to also consult with the state dental director in developing and posting online the standardized notification form and would require the department, in consultation with those entities, to revise the standardized form as necessary. The bill would require the standardized form to also include specified information on parental rights relating to schoolsite oral health assessments. The bill would require a school district to instead submit the report to a system designated by the state dental director for the collection of those reports or to the county office of education, or both, by July 1 of each year and would require a school district to include in the report the total number of pupils required to submit an assessment who are assessed and found to have had caries experience. To the extent these requirements would impose additional duties on public schools and school districts, the bill would impose a state-mandated local program. The bill would encourage all school districts that have fulfilled the annual July 1 report requirement by submitting a report to the county office of education and all county offices of education to submit the report to a system designated by the state dental director for that purpose. The bill would require the Office of Oral Health to conduct or provide for the conducting of periodic evaluations of the pupil oral health assessment requirements. 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.

(1) Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which health care services are provided to qualified, low-income persons. 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 services are provided is pursuant to contracts with various types of managed care plans. Existing federal regulations, published on May 6, 2016, revise regulations governing Medicaid managed care plans to, among other things, align, where feasible, those rules with those of other major sources of coverage, including coverage through qualified health plans offered through an American Health Benefit Exchange, such as the California Health Benefit Exchange, and promote quality of care and strengthen efforts to reform delivery systems that serve Medicaid and CHIP beneficiaries. These federal regulations, among other things, require specified Medicaid managed care plans to calculate and report a medical loss ratio (MLR) for the rating period that begins in 2017. If a state elects to mandate a minimum MLR for its Medicaid managed care plans, these regulations require that minimum MLR to be equal to or higher than 85% and authorizes the state to impose a remittance requirement consistent with the minimum standards established in these federal regulations for the failure to meet the minimum ratio standard imposed by the state. This bill would implement various provisions in regard to those federal regulations, as amended May 6, 2016, governing Medicaid managed care plans. The bill, commencing July 1, 2019, would require a Medi-Cal managed care plan to comply with a minimum 85% MLR and to calculate and report the MLR for each MLR reporting year, as defined, consistent with the MLR calculation and reporting requirements imposed under those federal regulations. The bill would require, effective for contract rating periods commencing on or after July 1, 2023, a Medi-Cal managed care plan to provide a remittance to the state if the ratio does not meet the minimum ratio of 85% for that reporting year consistent with those federal regulations. The bill would require the department to determine the remittance amount on a plan-specific basis for each rating region of the plan and to calculate the federal and nonfederal share amounts associated with each remittance. The bill would require the nonfederal share of amounts remitted by a Medi-Cal managed care plan to be transferred to the Medically Underserved Account for Physicians within the Health Professions Education Fund, and would require these funds, upon appropriation by the Legislature, to be used for purposes of the Steven M. Thompson Physician Corps Loan Repayment Program, as specified. The bill would generally provide that these MLR requirements do not apply to a health care service plan under a subcontract with a Medi-Cal managed care plan to provide covered health care services to Medi-Cal beneficiaries enrolled in the Medi-Cal managed care plan. The bill would require the department to post specified information on its Internet Web site, including any required remittances owed by a Medi-Cal managed care plan. The bill would require the department to seek any federal approvals it deems necessary to implement these MLR provisions. The bill would require these provisions to be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized. The bill would make a conforming change. (2) Existing federal regulations, published on March 30, 2016, revise regulations governing mental health parity requirements to address the application of certain mental health parity requirements under a specified federal law to certain Medicaid managed care plans, Medicaid benchmark and benchmark-equivalent plans, and the Children's Health Insurance Program (CHIP) . This bill would require the State Department of Health Care Services to ensure that all covered mental health benefits and substance use disorder benefits, as defined, are provided in compliance with those revised federal regulations. The bill would authorize the department to implement, interpret, or make specific this provision by means of all-county letters, plan letters, or plan or provider bulletins, or similar instructions until regulations are adopted, and would require the department to adopt regulations, where appropriate, by July 1, 2022. The bill would require the department to make any findings of noncompliance and corrective action plans available on its Internet Web site. (3) Existing law requires specified percentages of newly eligible beneficiaries, such as childless adults under 65 years of age, to be assigned to public hospital health systems in an eligible county, if applicable, until the county public hospital health system meets its enrollment target, as defined. Existing law also requires, subject to specified criteria, Medi-Cal managed care plans serving newly eligible beneficiaries to pay county public hospital health systems for providing and making available services to newly eligible beneficiaries of the Medi-Cal managed care plan in amounts that are no less than the cost of providing those services, and requires the capitation rates paid to Medi-Cal managed care plans for newly eligible beneficiaries to be determined based on its obligations to provide supplemental payments to those county public hospital health systems providing services to newly eligible beneficiaries. Existing law requires the department to pay Medi-Cal managed care plans specified rate range increases, and requires those Medi-Cal managed care plans to pay all of the rate range increases as additional payments to county public hospital health systems, as specified. Existing law authorizes a designated public hospital system or affiliated governmental entity to voluntarily provide intergovernmental transfers to provide support for the nonfederal share of risk-based payments to managed care health plans to enable those plans to compensate designated public hospital systems in an amount to preserve and strengthen the availability and quality of services provided by those hospitals. These federal regulations, published on May 6, 2016, generally prohibit states from directing managed care plans' expenditures under a managed care contract. The federal regulations authorize states to direct managed care plans' expenditures for provider payment through the managed care contracts in a manner based on the delivery of services, utilization, and the outcomes and quality of the delivered services. This bill, commencing with the 2017–18 state fiscal year, would require the department to require each Medi-Cal managed care plan, as defined, to increase contract services payments, as defined, to the designated public hospital systems, as defined, by an amount determined under a prescribed directed payment methodology to be developed by the department, and would authorize these directed payments to separately account for inpatient and noninpatient hospital services and require these directed payments to be developed and applied separately for classes of designated public hospital systems. The bill would require the department, in consultation with the designated public hospital systems, to establish the classes of designated public hospital systems, as specified. The bill would require a Medi-Cal managed care plan to annually provide to the department an accounting of the amount paid or payable to a designated public hospital system to demonstrate its compliance with the directed payment requirements. The bill would authorize the department, after providing notice of its determination to the affected Medi-Cal managed care plan and allowing a reasonable period to cure the deficiencies, to reduce the default assignment into a Medi-Cal managed care plan by up to 25% in the applicable county, as specified, if the Medi-Cal managed care plan is not in compliance with the directed payment requirements. The bill, commencing with the 2017–18 state fiscal year, would require 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 would require payments to be earned by each designated public hospital system based on its performance in achieving identified targets for quality of care. The bill would require the department to establish uniform performance measures and parameters for the designated public hospital systems to select the applicable measures, and would require these performance measures to advance at least one goal identified in the state's Medicaid quality strategy. The bill would authorize a designated public hospital system and their affiliated governmental entities, or other public entities, to voluntarily provide the nonfederal share of the portion of the capitation rates associated with the directed payments and for the quality incentive payments through an intergovernmental transfer. The bill would authorize the department to accept these elective funds and, in its discretion, to deposit the transfer in the Medi-Cal Inpatient Payment Adjustment Fund, a continuously appropriated fund, thereby making an appropriation. The bill would prohibit the department or a Medi-Cal managed care plan from being required to make any payment pursuant to the provisions described in (3) for any state fiscal year in which these provisions are implemented, as specified. The bill would authorize the department to implement, interpret, or make specific these provisions by means of all-county letters, plan letters, provider bulletins, or other similar instructions without taking regulatory action. The bill would require these provisions to be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized, and would require the department to seek any necessary federal approvals. The bill would provide that these provisions shall cease to be operative on the first day of the state fiscal year beginning on or after the date the department determines, after consultation with the designated public hospital systems, that implementation of these provisions is no longer financially and programmatically supportive of the Medi-Cal program, as specified. The bill would require the department to post notice of the determination on its Internet Web site, and to provide written notice of the determination to the Secretary of State, the Secretary of the Senate, the Chief Clerk of the Assembly, and the Legislative Counsel. (4) This bill would become operative only if AB 205 of the 2017–18 Regular Session is enacted and becomes effective on or before January 1, 2018.

(1) Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which health care services are provided to qualified, low-income persons. 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 services are provided is pursuant to contracts with various types of managed care plans. Existing federal regulations, published on May 6, 2016, revise regulations governing Medicaid managed care plans to, among other things, align, where feasible, those rules with those of other major sources of coverage, including coverage through qualified health plans offered through an American Health Benefit Exchange, such as the California Health Benefit Exchange, and promote quality of care and strengthen efforts to reform delivery systems that serve Medicaid and CHIP beneficiaries. These federal regulations, among other things, authorize an enrollee to request a state fair hearing only after receiving notice that the Medicaid managed care plan is upholding an adverse benefit determination, and requires the enrollee to request a state fair hearing no later than 120 calendar days from the date of the Medicaid managed care plans notice of resolution. These federal regulations require, with regards to a state fair hearing request filed by an enrollee entitled to an expedited resolution of an appeal by a managed care plan, an agency to take final administrative action as expeditiously as the enrollee's health condition requires, but not later than 3 working days after the agency receives, from the managed care plan, the case file and information for any appeal of a denial or a service that, as indicated by the managed care plan meets the criteria for expedited resolution of an appeal, but was not resolved within the timeframe for expedited resolution, or was resolved within the timeframe for expedited resolution of an appeal, but the managed care plan reached a decision wholly or partially adverse to the enrollee. Existing state law establishes hearing procedures for an applicant for or beneficiary of Medi-Cal who is dissatisfied with certain actions regarding health care services and medical assistance to request a hearing from the State Department of Social Services under specified circumstances, and requires a request for a hearing to be filed within 90 days after the order or action complained of. This bill would implement various provisions in regard to those federal regulations, as amended May 6, 2016, governing Medicaid managed care plans. The bill would authorize a person, after he or she has exhausted the Medi-Cal managed care plan's appeals process, to request a hearing involving a Medi-Cal managed care plan within 120 calendar days after he or she has either received notice from the Medi-Cal managed care plan that the adverse benefit determination, as defined, is upheld, or the person is deemed to have exhausted the Medi-Cal managed care plans appeals process, as specified, and would exclude a request from the 120-calendar day filing time if there is good cause, as defined, for filing the request beyond the 120-calendar day period. The bill would authorize the State Department of Social Services, until January 1, 2019, to implement these provisions through an all-county information letter or similar instruction. The bill would require the State Department of Social Services, by January 1, 2019, to adopt any necessary rules and regulations to implement these changes. The bill would generally require the State Department of Social Services, for a beneficiary of a Medi-Cal managed care plan who meets the criteria for an expedited resolution of an appeal, to take final administrative action as expeditiously as the individual's health condition requires, but no later than 3 working days after the State Department of Social Services receives certain information from the Medi-Cal managed care plan consistent with the federal regulation described above. The bill would require a Medi-Cal managed care plan, upon notice from the State Department of Social Services that a beneficiary has requested a state fair hearing, to provide to the department a copy of the case file and any information for any appeal of an adverse benefit determination within 3 business days of the Medi-Cal managed care plan's receipt of the department's notice of a request by a beneficiary for a state fair hearing. The bill would make conforming changes. (2) These federal regulations require a state that contracts with specified Medicaid managed care plans to develop and enforce network adequacy standards and requires each state to ensure that all services covered under the Medicaid state plan are available and accessible to enrollees of specified Medicaid managed care plans in a timely manner. This bill would establish, until January 1, 2022, certain time and distance and appointment time standards for specified services consistent with those federal regulations to ensure that all Medi-Cal managed care covered services are available and accessible to enrollees of Medi-Cal managed care plans in a timely manner, as specified. The bill would authorize the State Department of Health Care Services, upon the request of a Medi-Cal managed care plan, to allow alternative access standards for the time and distance standards, if the applying Medi-Cal managed care plan has exhausted all other reasonable options to obtain providers to meet the time and distance standards or if the department determines that the requesting Medi-Cal managed care plan has demonstrated that its delivery structure is capable of delivering the appropriate level of care and access, and would set forth the process for submitting and reviewing a request for alternative access standards. The bill would authorize the use of clinically appropriate telecommunications technology, including telehealth, as a means of determining annual compliance with the time and distance standards established under this provision or the department's approval of a request for alternative access standards. The bill, effective for contract periods commencing on or after July 1, 2018, would require, on an annual basis and when requested by the department, a Medi-Cal managed care plan to demonstrate to the department its compliance with the time and distance and appointment time standards developed under this provision, and, effective for contract periods commencing on or after July 1, 2018, would require the department, on an annual basis, to evaluate a Medi-Cal managed care plan's compliance with the standards developed under this provision. The bill would authorize the department to implement, interpret, or make specific these provisions by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions until the time regulations are adopted. The bill would require the department to seek any federal approvals necessary to implement these provisions, and would require these provisions to be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized. The bill would require, as part of the federally required external quality review organization review of Medi-Cal managed care plans in the annual detailed technical report required under federal regulations, the external quality review organization entity designated by the department to compile specified data by Medi-Cal managed care plan and by county for the purpose of informing the status of the implementation of the time and distance and appointment time standards described above. The bill would require the department to make this information publicly available, as specified. (3) These federal regulations require specified managed care plans to have a grievance and appeal system in place for enrollees, and requires managed care plans to resolve each grievance and appeal, and to provide timely and adequate notice, as expeditiously as the enrollee's health condition requires, within certain state-established timeframes that may not exceed specified timeframes. This bill would require a Medi-Cal managed care plan, as defined, to give a beneficiary timely and adequate notice of an adverse benefit determination, as defined, in writing consistent with those federal regulations. The bill would require a Medi-Cal managed care plan to establish and maintain an expedited review process for a beneficiary or the beneficiary's provider to request an expedited resolution of an appeal based on specified circumstances, including when the beneficiary's condition is such that the beneficiary faces an imminent and serious threat to his or her health, or the standard timeline would be detrimental to the beneficiary's life or health or could jeopardize the beneficiary's ability to regain maximum function. The bill would require a Medi-Cal managed care plan to resolve a standard appeal no more than 30 calendar days from the day the Medi-Cal managed care plan receives the appeal, and would require the Medi-Cal managed care plan to resolve an expedited appeal no longer than 72 hours after the Medi-Cal managed care plan receives the appeal. (4) This bill would become operative only if SB 171 of the 2017–18 Regular Session is enacted and becomes effective on or before January 1, 2018.