Medi-Cal Program
Position: No formal position; offering technical assistance
Location: Senate Appropriations Suspense File
Summary: This bill would provide foster children who are wards of the court or victims of abuse annual health assessments, immunizations and preventive care through the Child Health and Disability Prevention program and give these minors limited dental services. The bill would also extend Medi-Cal benefits to former/independent foster youth and those in guardianships under Probate Court until they turn 21. The extension of Medi-Cal benefits to recently mandated foster youth is authorized under federal law and is currently provided to other foster youth. The bill further requires counties to maintain specified health records for foster youth in the court's jurisdiction.
Assigned: Elizabeth Landsberg
Position: Support
Location: Senate Health Committee
Summary: The 250% Working Disabled Program is slated to sunset on January 1, 2009. This bill would eliminate this sunset date and would make some changes in how income and resources are calculated for the program. It would allow people in the program to save some money by exempting resources accumulated while someone is working and in the program. If someone on the program lost their job they could keep their Medi-Cal, paying premiums for up to 52 weeks. Resources exempt under the Working Disabled Program continue to be exempt in other Medi-Cal ABD programs.
Assigned: Elizabeth Landsberg
AB 2117(Evans) Dependent children: psychotropic medications.
Position: Support
Location: Assembly Appropriations Suspense File
Summary: This bill provides important protections for youth in foster care with psychiatric disabilities when they are prescribed psychotropic medications. This bill both provides the checks and balances needed to ensure that foster youth are not given these medications without extensive oversight from the court and also ensures that the youth have a right to participate in the decision making and informed-consent process. Assigned: Elizabeth Landsberg
AB 2229 (Huffman) Medi-Cal: Benefits, Dental Examinations
Position: Priority – No Position Yet
Location: Assembly Appropriations Suspense
Summary: Hearing Provides Medi-Cal coverage for one dental examination per year for beneficiaries 21 years of age and older living in long-term care facilities.
Assigned: Angela Gilliard
AB 2620 (Carter) Medi-Cal Program: Prescription Drug Transparency Board
Position: Support
Location: Did not Advance this Session
Summary: Requires the Secretary of the California Health and Human Services Agency (CHHSA), in collaboration with other relevant state agencies, to establish the Medi-Cal Drug Program Advisory Board (board) to provide transparency with regard to Medi-Cal formulary additions, deletions, and modifications. Assigned: Angela Gilliard
AB 2875(Lieber) Food stamp recipients: presumptive eligibility for health care services.
Position: Priority – No Position Yet
Location: Assembly Appropriations
Summary: This bill would require the State Department of Health Care Services, in conjunction with designated entities, to conduct a study to determine how to implement a pilot program to allow a parent applying for or initial or continued eligibility for Food Stamps for his or her child or children to consent to allow that eligibility information to be forwarded to county health agencies, for the purpose of receiving presumptive eligibility for the Medi-Cal or Healthy Families programs, or other available public health programs. The bill would require the study to include, among other components, a blueprint for implementation of the pilot project, on or before January 1, 2010. This bill would require the department to present the study to the Legislature on or before September 1, 2009. Assigned: Angela Gilliard
Location: Assembly Appropriations Suspense File
Summary: This bill would provide that pursuant to specified federal law, the state elects to provide for Medi-Cal eligibility for nursing facilities or other long-term care services for individuals with an equity interest in their home of $750,000 or less. Western Center supports. Assigned: Elizabeth Landsberg
Position: Western Center Co- Sponsor/Support
Location: Senate Appropriations Suspense File
Summary: This bill, co-sponsored by Western Center, would eliminate the annual redetermination requirement in the Former Foster Care Child Medi-Cal Program to ensure they stay enrolled in the program until the age of 21.
Assigned: Elizabeth Landsberg
SB 1136(Alquist) Public social services: unreasonable fees.
Position: Support
Location: Senate Judiciary.
Summary: This bill would make it a misdemeanor for any person to charge a fee to represent or aid an applicant or recipient in the procurement of public social services. Assigned: Elizabeth Landsberg
SB 1147(Calderon) Medi-Cal: eligibility: juvenile offenders.
Position: Support
Location: Senate Appropriations Suspense File
Summary: This bill would specify that inmate status shall not be used to terminate the eligibility of a child under the Medi-Cal program, and would require the department to establish the protocols and procedures necessary to ensure that Medi-Cal eligibility is not terminated in violation of that requirement. Assigned: Elizabeth Landsberg
SB 1332 (Negrete-McLeod) Medi-Cal Managed Care
Position: Opposed Unless Amended
Location: Senate Appropriations
Summary:Establishes a mandatory enrollment Medi-Cal managed care pilot program, and authorizes the Department of Health Care Services (DHCS) to require that in the San Bernardino and Riverside counties, seniors and persons with disabilities (SPDs) be assigned as mandatory enrollees to new or existing managed care plans, as specified.
Assigned: Angela Gilliard
SB 1369(Cedillo) Pupil nutrition: free and reduced price meals: application.
Position: Support
Location: Senate Health Committee
Summary: School districts can include information about Medi-Cal and Healthy Families into their school lunch program applications. Parents can consent to allow the school district to share information from the school lunch application with the county to make an accelerated Medi-Cal eligibility determination. This bill would prohibit a school district from sharing the information on the school lunch program application if the district determines that the child already has an active Medi-Cal or Healthy Families case. The bill would require that the parent be given a notice explaining that the children already has Medi-Cal or Healthy Families, and who to contact to learn how to access their benefits. Western Center requested and the author took amendments about the notice to parents. Western Center now supports. Assigned: Elizabeth Landsberg
SB 1459(Yee) Health care coverage: Cal-Health Act.
Position: Concerns
Location: Senate Appropriations.
Summary: This bill would create an umbrella "Cal-Health" entity comprised of the Medi-Cal program for children and the Healthy Families Program. It would allow providers to presumptively enroll individuals into the Medi-Cal and Healthy Families programs and require a simplified joint application for the programs. The bill envisions a statewide eligibility determination process. It would eliminate the assets test in the 1931(b) Medi-Cal program and seek a waiver to expand Medi-Cal for childless adults up to 250% FPL. Western Center has a "concerns" position - supporting simplification and expansion of Medi-Cal but having concerns about privatizing Medi-Cal eligibility and the outdated enrollment mechanisms that don't account for current procedures such as the CHDP-Gateway, the joint application, and Accelerated Enrollment.
Assigned: Elizabeth Landsberg
SB 1738 (Steinberg) Medi-Cal: Frequent Users of Health Care Pilot Program
Position: Priority – No Position Yet
Location: Senate Appropriations Committee
Summary: This bill would require DHCS to design a pilot program for providing Medi-Cal services to frequent users of health care services. The bill would define frequent users as individuals who have undergone emergency department treatment on 5 or more occasions in the past 12 months, or 8 or more occasions in the past 24 months, and who have two or more of the following risk factors: chronic disease diagnosis, mental illness diagnosis, homelessness, substance abuse, and a history of not adhering to prescribed treatments. This bill would require the program to provide various supportive services to Medi-Cal beneficiaries, which may include, but need not be limited to, care coordination, medication and money management, transportation and other services, in addition to the individual's existing Medi-Cal benefits. The bill would specify that the purpose of the additional primary, specialty and social services would be to reduce a participating individual's use of hospital emergency departments. Western Center is actively discussing the provisions of this bill with the author.
Assigned: Angela Gilliard
DRA
SB 1398(Margett) Birth and death records: certified copies: identification.
Position: Opposed
Location: Did not get sufficient votes in Senate Health
Summary: This bill would require that any person who has been the victim of identity theft who requests, in person, a certified copy of a birth or death certificate, submit a statement sworn under penalty of perjury that he or she is an authorized person and provide evidence, as prescribed, that he or she has been the victim of identify theft. Western Center opposed because of concerns this would make it more difficult for Medi-Cal beneficiaries and applicants to comply with the DRA citizenship documentation requirements. Assigned: Elizabeth Landsberg
Medical Debt
AB 1203(Salas) Health care service plans: poststabilization care.
Position: Support
Location: Senate Health Committee
Summary: This bill would prohibit a noncontracting hospital that fails to contact a health care service plan to provide poststabilization care from billing the enrollee for poststabilization care. Assigned: Elizabeth Landsberg
AB 2292(Garrick) Income tax: health savings accounts.
Position: Opposed
Location: Assembly Revenue & Tax
Summary: This bill would allow a deduction in connection with health savings accounts in conformity with federal law.
Assigned: Elizabeth Landsberg
Position: Support
Location: Assembly Health
Summary: This bill would require any health care provider that directly bills a patient for health care services, including hospital services, to provide in plain English a description of the medical procedure or services for which a patient is billed.
Assigned: Elizabeth Landsberg
SB 697(Yee) Health care coverage: provider charges.
Position: Support
Location: Assembly Health
Summary: This bill would prohibit a health provider from seeking reimbursement for covered services furnished to a person enrolled in the Healthy Families Program or AIM from other than the plan covering that person. Assigned: Elizabeth Landsberg
SB 981(Perata) Health care coverage: noncontracting hospital-based physician claims.
Position: Support
Location: Assembly Appropriations
Summary: This bill would prohibit balance billing by non-contracting hospital-based providers and would establish a system, including enforcement mechanisms, for resolving payment disputes between non-contracting hospital-based providers and health plans or medical groups. Western Center supports the prohibition against balance billing as long as language does not limit consumers’ remedies.
Assigned: Elizabeth Landsberg
SB 1633(Kuehl) Dental services: credit.
Position: Western Center Sponsored Bill
Location: Senate Appropriations.
Summary: This bill, sponsored by Western Center, would prohibit dentists from arranging credit cards or loans for services that the consumer has not yet received or when the consumer is under anesthesia. It would require dentists to provide consumers with a simple, clear notice about credit cards and loans as well as a proposed treatment plan. For consumers who do not speak English whom the dental office is serving in the consumer’s language, the notice must be provided in that language. For consumers with dental insurance the bill would require that the dentist seek an authorization and state what services are not covered as well as what the consumer is responsible for paying before arranging a credit card or loan. Any loan or credit card entered into in violation of the above requirements would be void. The bill would prohibit a dentist in the Medi-Cal program from charging a Medi-Cal beneficiary until the dentist has tried to get the service covered and has stated what portion of the service is not covered by Medi-Cal. Assigned: Elizabeth Landsberg
Language Access
AB 3027(De Leon) Health care coverage: disclosures: foreign languages.
Position: Support
Location: Assembly Appropriations
Summary: This bill would require DMHC and DOI to jointly develop a uniform document in all Medi-Cal threshold languages to be distributed by every health plan and health insurer to their enrollees annually and with specified correspondence to inform them of their right to interpreter services and how to arrange it.
Assigned: Elizabeth Landsberg
Coverage Expansion
Location: Inactive File
Summary: This bill would provide health coverage for all children up to 300% of FPL regardless of immigration status, through the Medi-Cal and Healthy Families programs if funds are appropriated. It would increase the income level for the 6-18 FPL Program to 133% FPL. It would allow self-verification of income in Healthy Families. It would create the Healthy Families Buy-In Program for children with family incomes above 300% FPL. It would establish a process to transition children from local children's health initiatives into Medi-Cal and Healthy Families. It would replace the Healthy Families-to-Medi-Cal Bridge Benefits Program with the Healthy Families Presumptive Eligibility Program to provide a child Medi-Cal benefits until a Medi-Cal eligibility determination is made and would require public reporting of data regarding HF Presumptive Eligibility. It would provide presumptive eligibility in Medi-Cal for children who apply for coverage at the county (as is done for those applying with a mail-in application currently). It would make a variety of technical changes in MC and HF including allowing children to apply for multiple programs from one location, support digital and electronic signatures, eliminate documentation requirements except those required by federal law. It would change the income guidelines for CCS to conform to Healthy Families levels.
Assigned: Elizabeth Landsberg
SB 840(Kuehl) Single-payer health care coverage.
Position: Support
Location: Assembly Appropriations
Summary: This bill would establish the California Universal Healthcare System (CUHS) under which all California residents would be eligible for specified health care benefits. The CUHS would, on a single payer basis, negotiate for or set fees for comprehensive health care services provided through the system, and pay claims for those services. The bill would also establish various boards and offices, with duties related to the administration of the system. All persons with incomes up to 200% FPL would be guaranteed full-scope no-cost Medi-Cal. All children would be eligible for EPSDT benefits. Assigned: Elizabeth Landsberg
Lead
AB 2115 (Mullin) Childhood Lead Screening
Position: No Position Yet
Location: Assembly Appropriations Committee Suspense File
Summary: This bill requires all schools and child care centers (public and private), beginning July 1, 2010, to not admit any child who is six years of age or younger, unless he or she provides a certificate demonstrating that he or she has undergone an evaluation for lead poisoning, as specified.
Assigned: Angela Gilliard
SB 775 (Ridley-Thomas) Childhood Lead Poisoning
Position: Support – Sponsored By National Health Law Program
Location: Assembly Health Committee
Summary: Requires the Department of Public Health (DPH) to make informational materials on health risks associated with lead available to all health care providers who administer perinatal care services. Requires all children six years of age or younger to have a lead risk assessment and, if necessary, a lead blood test before enrolling in school and for this to be documented on the child's immunization record. Requires laboratories to report additional information to DPH associated with tests for lead exposure. Assigned: Angela Gilliard
Managed Care / Market Reforms
Location: Assembly Appropriations
Summary: This bill, sponsored by the CMA would originally have created a presumption of medical necessity in the IMR process unless the plan proves otherwise and would have allowed a provider to file for an IMR directly. Western Center took an oppose unless amended position, urging that providers getting consumer consent before filing for IMR and that consumers' appeal rights not be adversely affected. Western Center also expressed concerns about introducing a litigation standard into the IMR process. Some amendments have been taken and additional amendments are being discussed. Assigned: Elizabeth Landsberg
SB 1522(Steinberg) Health care coverage: coverage choice categories.
Position: Support
Location: Senate Appropriations.
Summary: This bill would require the DMHC and DOI to jointly, by regulation, develop a system to categorize all health plan contracts and health insurance policies in the individual market into five coverage choice categories that meet specified requirements. The bill would require health plans and insurers that offer coverage on an individual basis to offer at least one contract or policy in each coverage choice category. The bill is also a vehicle to set some minimum standards for health coverage.
Assigned: Elizabeth Landsberg
SB 1525(Kuehl) Health care coverage: medical necessity determinations.
Position: Support
Location: Senate Appropriations.
Summary: This bill would require onsite medical surveys of health plans include a review of procedures for making medical necessity determinations. It requires health plans and insurers to report the rates at which requests for health care services or payments result in initial delays, denials or modification of services, or payment. It would require health insurers and plans to provide information about the medical expertise and training of the medical director and other personnel involved in determining medical necessity when an enrollee applies for an independent medical review. It would require the Department of Insurance and the Department of Managed Health Care to report a medical director to the appropriate licensing entity, if it appears that standards of professional conduct have been violated in making determinations of medical necessity. Assigned: Elizabeth Landsberg
Summary: This bill would require health plans to establish Web sites, updated at least every 2 months, and would require plans to issue a benefits card to enrollees. The bill would delete the ability of a plan to retrospectively modify, delay, or deny health care services to an enrollee, and would modify provisions relating to disclosure by health plans of the process used to authorize, modify, or deny health care services. The bill would expand the grievance system, departmental review, and independent medical review systems to allow health care providers to participate in addition to enrollees. The bill would revise provisions governing timeliness of payment of claims made for health care services. The bill would extend certain requirements now only applicable to full service plans to also apply to specialized plans, including certain mental health plans. The bill would revise provisions relating to imposition of civil penalties by the department. Western Center raised concerns about providers being able to file appeals and IMR without consumer consent and about the timely access standards. The latter were amended out. Assigned: Elizabeth Landsberg
Location: Did not get sufficient votes in Senate Health
Summary: This bill would allow and set standards for the licensure of discount health cards by the Department of Managed Health Care. Assigned: Elizabeth Landsberg