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 pursuant to a schedule of benefits. Under existing law, health care services are provided to Medi-Cal beneficiaries through various health care delivery systems, including fee-for-service and managed care. Existing law authorizes the department to enter into various types of contracts for the provision of services to beneficiaries, such as contracts with a Medi-Cal managed care plan, and imposes requirements on Medi-Cal managed care plan contractors, including appointment time standards and network adequacy standards. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing federal law authorizes specified managed care entities that participate in a state's Medicaid program to cover, for enrollees, services or settings that are in-lieu-of services and settings otherwise covered under a state plan. This bill would require the department to require, by January 1, 2022, each Medi-Cal managed care plan to implement a population health management program (program) to identify, assess, and manage the needs of Medi-Cal beneficiaries who are enrolled in each plan. The bill would require a Medi-Cal managed care plan to describe case management services provided to enrollees and to report to the department on specified information, including the number of enrollees receiving in-lieu-of services. The bill would require the department to establish metrics for, and require the federally required external quality review organization (EQRO) to evaluate the effectiveness of, the enhanced care management and in-lieu-of services provided to enrollees, to establish metrics for evaluating the program, and to require the EQRO to conduct an analysis of each Medi-Cal managed care plan's program.
Sponsored bills
Existing law, known as the Higher Education Employer-Employee Relations Act, provides for negotiations concerning wages, hours, and other terms and conditions of employment between a higher education employer, as defined to mean the Regents of the University of California, the Board of Directors of the Hastings College of the Law, and the Trustees of the California State University, and representatives of recognized employee organizations. The act prohibits higher education employers from, among other things, denying to employee organizations rights that are guaranteed under the act, refusing or failing to engage in meeting and conferring with an exclusive representative of employees, and dominating or interfering with the formation or administration of any employee organization, as specified. A provision of the act applicable only to the University of California sets forth requirements relating to the duty of meeting and conferring in a timely manner. This bill would additionally prohibit the University of California, on and after January 1, 2020, during or in relation to a labor dispute, from canceling an employee's, dependent's, or other person's health insurance coverage, deeming an employee, dependent, or other person ineligible for health insurance coverage, withholding payment of the higher education employer's share of an employee's health insurance premium, or taking any other action that would increase the number of employees who are dependent on Medi-Cal coverage for their health care.
Existing law establishes the Office of Patient Advocate within the California Health and Human Services Agency to provide assistance to, and advocate on behalf of, health care consumers by, among other things, coordinating amongst, providing assistance to, and collecting data from, all of the state agency consumer assistance or patient assistance programs and call centers, to better enable health care consumers to access the health care services to which they are eligible. Existing law requires public health coverage programs to provide the office with call center data, and requires the office to prepare an annual report on the quality of help centers, call centers, and other health care consumer or patient assistance services operated by those programs. Under existing law, "health coverage program" for purposes of those provisions includes the Medi-Cal program, the California Health Benefit Exchange, county health coverage programs, the Healthy Families Program, the Basic Health Program, if enacted, and the Access for Infants and Mothers Program. This bill would remove references to the Healthy Families Program, the Basic Health Program, and the Access for Infants and Mothers Program from the list of "health coverage programs" described above.
Existing law establishes the California State University, administered by the Trustees of the California State University, and the California Community Colleges, administered by the Board of Governors of the California Community Colleges. Existing law provides for community college districts with locally elected governing boards throughout the state, which operate community college campuses. Existing law provides for licensing and regulation of various professions in the healing arts, including physicians and surgeons, psychologists, marriage and family therapists, educational psychologists, clinical social workers, and licensed professional clinical counselors. This bill would express the intent of the Legislature to enact later legislation that would require the Trustees of the California State University and the governing board of each community college district to have one full-time equivalent mental health counselor with an applicable California license per 1,500 students enrolled at each of their respective campuses to the extent consistent with state and federal law.
Existing law, the California Residential Care Facilities for the Elderly Act, provides for the licensure of residential care facilities for the elderly by the State Department of Social Services. Existing law requires the department to impose regulations on residential care facilities for the elderly and requires those regulations to prescribe standards of safety and sanitation for the physical plant and standards for basic care and supervision, personal care, and services to be provided. Existing law makes a violation of those regulations a crime. This bill would require the department's regulations to require a licensed residential care facility for the elderly to immediately telephone 911 if an injury or other circumstance results in an imminent threat to a resident's health. Because a violation of this requirement would be a crime, the bill would impose a state-mandated local program. The bill would prohibit the department from waiving this requirement. 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. The bill would provide that no reimbursement is required by this act for a specified reason.
When a resident of a skilled nursing facility is prescribed or ordered a medical intervention that requires informed consent, the patient lacks capacity, and there is no person with legal authority to consent, existing law requires a skilled nursing facility to conduct an interdisciplinary team review of the prescribed medical intervention prior to the administration of the medical intervention, as specified. Existing case law requires notice and an opportunity to be heard before a patient is determined to lack capacity for this purpose. This bill would state the intent of the Legislature to enact legislation that would appropriately implement the decision in California Advocates for Nursing Home Reform v. Smith (2019) 38 Cal.App.5th 838, which required that nursing homes adopt, and the State Department of Public Health to enforce, notice and hearing requirements when determining medical incompetence for purposes of Section 1418.8 of the Health and Safety Code, as well as establishing requirements for the composition of interdisciplinary teams for incapacitated patients.
Existing law provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or health insurer to establish criteria or guidelines that meet specified requirements to be used to determine whether or not to authorize, modify, or deny health care services. This bill would authorize the Department of Managed Health Care and the Insurance Commissioner, as appropriate, to review a plan's or insurer's clinical criteria, guidelines, and utilization management policies to ensure compliance with existing law. If the criteria and guidelines are not in compliance with existing law, the bill would authorize the Director of the Department of Managed Health Care or the commissioner to issue a corrective action and send the matter to enforcement, if necessary.
This measure would proclaim January 26, 2020, as India Republic Day, and would urge all Californians to join in celebrating India Republic Day.