Existing law establishes the California Health and Human Services Agency, and includes within that agency, the State Department of Social Services, the Department of Public Health, and the Department of Health Care Services, among other departments.

This bill would require a department within the agency that has received approval of an operational state plan by a federal agency, or that has applied and has been approved for a waiver from a federal law or federal regulation, to make any and all approved plans and waivers available to the public by publishing a hyperlink to that information on the homepage of the departments Internet Web site.

Existing law establishes the California Health and Human Services Agency, and includes within that agency, the State Department of Social Services, the Department of Public Health, and the Department of Health Care Services, among other departments.

This bill would require a department within the agency that has received approval of an operational state plan by a federal agency, or that has applied and has been approved for a waiver from a federal law or federal regulation, to make any and all approved plans and waivers available to the public by publishing a hyperlink to that information on the homepage of the departments Internet Web site.

Existing law establishes the California Health and Human Services Agency, and includes within that agency, the State Department of Social Services, the Department of Public Health, and the Department of Health Care Services, among other departments.

This bill would require a department within the agency that has received approval of an operational state plan by a federal agency, or that has applied and has been approved for a waiver from a federal law or federal regulation, to make any and all approved plans or waiver applications and waivers available to the public by publishing a hyperlink to that information on the homepage of the departments Internet Web site.

Existing law establishes the California Health and Human Services Agency, and includes within that agency, the State Department of Social Services, the Department of Public Health, and the Department of Health Care Services, among other departments.

This bill would require a department within the agency that has received approval of an operational state plan by a federal agency, or that has applied and has been approved for a waiver from a federal law or federal regulation, to make any and all approved plans or waiver applications available to the public by publishing a hyperlink to that information on the homepage of the departments Internet Web site.

Existing law establishes the California Health and Human Services Agency, and includes within that agency, the State Department of Social Services, the Department of Public Health, and the Department of Health Care Services, among other departments.

This bill would require a department within the agency that has received approval of an operational state plan by a federal agency, or that has applied and has been approved for a waiver from a federal law or regulation, to make the approved plan or waiver application any and all approved plans or waiver applications available to the public by publishing a hyperlink to that information on the first page homepage of the departments Internet Web site.

Existing law establishes the California Health and Human Services Agency, and includes within that agency, the State Department of Social Services, the Department of Public Health, and the Department of Health Care Services, among other departments.

This bill would require a department within the agency that has submitted received approval of an operational state plan to by a federal agency, or that has applied and has been approved for a waiver from a federal law or regulation, to make the approved plan or approved waiver application available to the public by publishing a hyperlink to that information on the first page of the departments Internet Web site that relates to the same subject matter as the plan or approved waiver application. site.

Existing law establishes the California Health and Human Services Agency, and includes within that agency, the State Department of Social Services, the Department of Public Health, and the Department of Health Care Services, among other departments.

This bill would require a department within the agency that has submitted an operational state plan to a federal agency, or that has applied and has been approved for a waiver from a federal law or regulation, to make the plan or approved waiver application available to the public by publishing that information on the first page of the departments Internet Web site that relates to the same subject matter as the plan or approved waiver application.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 294

Author:(Lackey and Steinorth)

As Amended Ver:June 15, 2015

Majority vote

Original Committee Reference: HEALTH

SUMMARY: Requires any department within the California Health and Human Services Agency (CHHSA) to post on the first page of its Web site information about any federally approved state plan or waiver of federal laws or regulations.

The Senate amendments add coauthors and make technical, non-substantive changes.

EXISTING LAW:

1. Creates the CHHSA with its 10 constituent departments and a number of other offices and entities.

2. Requires or authorizes state agencies to develop state plans and waiver proposals for submission to the federal government, consistent with federal law. Existing federal law provides for required state plans to implement federal programs and grants federal agencies authority in specified circumstances to waive applicable portions of federal law. In particular, states may be granted waivers of federal law to implement demonstration projects in their Medicaid programs.

FISCAL EFFECT: According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, negligible state costs.

COMMENTS: According to the author, this bill will increase transparency for programs administered within CHHSA. Many of these programs are federal programs partially or fully funded with federal funds and operating under federal requirements. According to the author, frequently the federal government will require the designated state agency to submit a state plan for the operation of the program. In addition, states often obtain federal waivers as they test more innovative approaches to implementing federal law. The author argues this bill would increase transparency and government accountability for these programs by requiring that the administering departments within CHHSA place a copy of the approved state plans and waivers on the front page of the department's Web site. The author concludes that this will allow the public to gain knowledge of the programs and improve CHHSA's abilities to provide critical services to Californians.

According to the Coalition of California Welfare Rights Organizations, this bill's sponsor, is needed because in certain cases the only way for the public to access the details of a federal waiver is through a public information request. The supporters note that this bill would not only improve transparency to the public, but also save valuable resources for departments by taking away the need for public information requests. Supporters also note that some departments within CHHSA already post approved waivers on their Web sites, such as Department of Health Care Services (DHCS) which posts Medi-Cal waivers, however, other departments such as Department of Social Services do not post waivers.

The Western Center on Law and Poverty (WCLP) supports this bill, noting that the plans and waivers are available through public records act requests but are not readily accessible to the public. WCLP argues that this bill will make these documents more accessible to the public and make these government programs more transparent and work better for the people they serve.

Of particular importance for health policy, is the proposed Medicaid waiver request for the Medi-Cal program. Medicaid (known as Medi-Cal in California) is a joint federal-state program to provide health coverage to low-income individuals. Section 1115 of the federal Social Security Act (Act) gives the Secretary of the federal Department of Health and Human Services (HHS) authority to waive provisions of major health and welfare programs authorized under the Act. This includes certain federal Medicaid requirements in any experimental pilot or demonstration project which, in the judgment of the HHS Secretary, is likely to assist in promoting the objectives of Medicaid. In addition, Section 1115 also allows states to use federal Medicaid funds to reimburse for costs in ways that are not otherwise allowed under federal Medicaid law. DHCS has submitted a waiver application to the federal government for consideration.

There is no opposition on file.

Analysis Prepared by: Roger Dunstan / HEALTH / (916) 319-2097 FN: 0001202

 THIRD READING  

Bill No: AB 294

Author: Lackey (R) and Steinorth (R), et al.

Amended: 6/15/15 in Senate

Vote: 21

SENATE HUMAN SERVICES COMMITTEE: 5-0, 6/9/15

AYES: McGuire, Berryhill, Hancock, Liu, Nguyen

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 77-0, 4/30/15 - See last page for vote

SUBJECT: Health and human services: state plans: federal waivers: public notice

SOURCE: Coalition of California Welfare Rights Organizations

DIGEST: This bill requires any department within the California Health and Human Services Agency (CHHSA) to post on the homepage of its Web site information about any federally approved state plan or waiver of federal laws or regulations.

ANALYSIS:

Existing law:

1. Creates the CHHSA with its 10 constituent departments and a number of other boards and entities. (GOV 12803)

2. Requires the state Department of Health Care Services (DHCS) to post the following on its Internet Web site. (WIC 14100.3)

   1. All submitted state plan amendments and all federal waiver applications and requests for new waivers, waiver amendments, and waiver renewals and extensions within 10 business days from the date the department submits these documents for approval to the federal Centers for Medicare and Medicaid Services (CMS).

   2. All final approval or denial letters and accompanying documents for all submitted state plan amendments and federal waiver applications and requests within 10 business days from the date the department receives notification of final approval or denial from CMS.

   3. Notice from DHCS to CMS that it is withdrawing a submitted state plan amendment or federal waiver application or request, as defined, within 10 business days from the date the department notifies CMS of the withdrawal.

   4. All pending submitted state plan amendments and federal waiver applications and requests, which the department submitted to CMS in 2009 and every year thereafter.

This bill adds a new Part 0.5 to the Health and Safety Code, commencing with HSC 135, and a new Division 3.5 to the Welfare and Institutions Code, commencing with a new Section 3500, both requiring that a department within the CHHSA that has received approval of an operational state plan by a federal agency, or has applied and has been approved for a waiver from a federal law or federal regulation, to make any and all approved plans or waivers available to the public by publishing a hyperlink to that information on the homepage of the department’s Internet Web site.

Background

Federal waivers

State agencies are required to develop state plans and permitted to submit waiver proposals to the federal government, as instructed by the relevant federal agencies, to waive requirements of specific programs. An example would be the substantial Home and Community-Based Services waiver, which permits California to receive federally matched Medicaid funding for services outside of a health care institution.

California has several Medicaid waivers, including the Section 1115 Research & Demonstration Projects, which allow states program flexibility to test new or existing approaches to financing and delivering services. Section 1915(b) Managed Care Waivers allow states to provide services through managed care delivery systems or otherwise limit people's choice of providers. Section 1915(c) Home and Community-Based Services Waivers allow states to provide long-term care services in home and community settings rather than institutional settings.

These and other waivers enable California to receive federal funding for a number of programs through Medicaid waivers or state plan language including In-Home Supportive Services, services for individuals with developmental disabilities, those with AIDS or HIV, assisted living services, in home operations or pediatric palliative care, services for individuals with serious mental illness and others.

Additionally, California has federal waivers within its CalFresh food benefit program to maintain nutrition benefits to individuals who are unable to find employment during a recession, waivers to fund various innovations in the foster care program, and others.

Comments

Currently, state departments post waivers and state plans to varying degrees and in various places. The DHCS, which is responsible for managing all Medi-Cal waivers, regardless of the department that is applying them to the provision of services, has a Web site page devoted to the waivers. A link to the waiver page is on the right side of the DHCS homepage. The Department of Developmental Services also has a webpage for its waivers and a link from its home page to the waiver page, however the link is identified as a home and community-based services site, rather than a waiver site.

The CHHSA also has a waiver page, but does not have a link from the homepage. The Department of Aging does not appear to have a waiver page specifically, although some information about relevant waivers is on its home page. The Department of Social Services (CDSS) does not have a waiver link on its home page, although it receives waivers from the U.S. Department of Agriculture for its CalFresh program and from the Administration for Children and Families for its child welfare programs. Much of the waiver information released from CDSS about waivers and plans is in the form of instruction letters to counties or other, similar, directives.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

SUPPORT: (Verified 6/23/15)

Coalition of California Welfare Rights Organizations (source)

AFSCME

Alliance

California Alternative Payment Program Association

California Association of Public Authorities for IHSS

California Hunger Action Coalition

Western Center on Law and Poverty

OPPOSITION: (Verified 6/23/15)

Department of Finance

ARGUMENTS IN SUPPORT: According to the author, this bill will increase transparency for state-run and federally funded programs within the CHHSA by requiring that the state departments place a copy of any approved state plans or waivers on the front page of the administering department’s Web site. This will allow the public to gain knowledge of the programs and improve departments’ abilities to provide critical services to Californians, the author states. The author also states that some federally required plans and federal waivers are not readily accessible to the public because they are not placed on the web page of the single state agency responsible for the administration of the program.

ARGUMENTS IN OPPOSITION: The Department of Finance (DOF) writes in opposition to this bill that it is unnecessary. “If there are gaps in what is being posted, Agency can direct the affected departments to publish the remaining documents. It is our understanding that departments under Agency already publish most of their federally approved operational state plans or federal waiver applications on their respective websites.” DOF also stated that this bill should not result in fiscal impacts to any departments under the CHHSA as the costs to publish the necessary documents are likely to be minor and absorbable.

ASSEMBLY FLOOR: 77-0, 4/30/15

AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Chang, Chau, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins

NO VOTE RECORDED: Campos, Chávez, Gomez

Prepared by: Mareva Brown / HUMAN S. / (916) 651-1524

6/24/15 16:23:23

**** END ****

SENATE COMMITTEE ON HUMAN SERVICES

Senator McGuire, Chair

2015 - 2016 Regular

Bill No: AB 294

Subject: Health and human services: state plans: federal waivers: public notice

SUMMARY

This bill requires any department within the California Health and Human Services Agency (CHHSA) to post on the home page of its website information about any federally approved state plan or waiver of federal laws or regulations.

ABSTRACT

Existing law:

1. Creates the CHHSA with its 10 constituent departments and a number of other boards and entities. (GOV 12803)

2. Requires the state Department of Health Care Services (DHCS) to post the following on its Internet Web site. (WIC 14100.3.)

   1. All submitted state plan amendments and all federal waiver applications and requests for new waivers, waiver amendments, and waiver renewals and extensions within 10 business days from the date the department submits these documents for approval to the federal Centers for Medicare and Medicaid Services (CMS).

   2. All final approval or denial letters and accompanying documents for all submitted state plan amendments and federal waiver applications and requests within 10 business days from the date the department receives notification of final approval or denial from CMS.

   3. Notice from DHCS to CMS that it is withdrawing a submitted state plan amendment or federal waiver application or request, as defined, within 10 business days from the date the department notifies CMS of the withdrawal.

   4. All pending submitted state plan amendments and federal waiver applications and requests, which the department submitted to CMS in 2009 and every year thereafter.

This bill:

1. Adds a new Part 0.5 to Health and Safety code commencing with HSC 135 and a new Division 3.5 to Welfare and Institutions code, commencing with a new Section 3500, both requiring that a department within the California Health and Human Services Agency that has received approval of an operational state plan by a federal agency, or has applied and has been approved for a waiver from a federal law or federal regulation, to make any and all approved plans or waiver applications available to the public by publishing a hyperlink to that information on the homepage of the department’s Internet Web site.

FISCAL IMPACT

An Assembly Appropriations Committee analysis projected negligible state fiscal effect and noted that the bill will apply to ten departments under CHHSA, some of which already are likely compliant.

BACKGROUND AND DISCUSSION

Purpose of the bill:

According to the author, this bill will increase transparency for state-run and federally funded programs within the Health and Human Services Agency by requiring that the state departments place a copy of any approved state plans or waivers on the front page of the administering department’s web site. This will allow the public to gain knowledge of the programs and improve departments’ abilities to provide critical services to Californians, the author states. The author also states that some federally required plans and federal waivers are not readily accessible to the public because they are not placed on the web page of the single state agency responsible for the administration of the program.

Federal waivers

State agencies are required to develop state plans and permitted to submit waiver proposals to the federal government, as instructed by the relevant federal agencies, to waive requirements of specific programs. An example would be the substantial Home and Community-Based Services waiver, which permits California to receive federally matched Medicaid funding for services outside of a health care institution.

California has several Medicaid waivers, including the Section 1115 Research & Demonstration Projects, which allow states program flexibility to test new or existing approaches to financing and delivering services. Section 1915(b) Managed Care Waivers allow states to provide services through managed care delivery systems or otherwise limit people's choice of providers. Section 1915(c) Home and Community-Based Services Waivers allow states to provide long-term care services in home and community settings rather than institutional settings.

These and other waivers enable California to receive federal funding for a number of programs through Medicaid waivers or state plan language including In-Home Supportive Services, services for individuals with developmental disabilities, those with AIDS or HIV, assisted living services, in home operations or pediatric palliative care, services for individuals with serious mental illness and others.

Additionally, California has federal waivers within its CalFresh food benefit program to maintain nutrition benefits to individuals who are unable to find employment during a recession, waivers to fund various innovations in the foster care program, and others.

Posting practices

Currently, state departments post waivers and state plans to varying degrees and in various places. The Department of Health Care Services, which is responsible for managing for all Medi-Cal waivers, regardless of the department that is applying them to the provision of services, has a website page devoted to the waivers. A link to the waiver page is on the right side of the DHCS home page. The Department of Developmental Services also has a webpage for its waivers and a link from its home page to the waiver page, however the link is identified as a home and community based services site, rather than a waiver site.

The Health and Human Services Agency also has a waiver page, but does not have a link from the homepage. The Department of Aging does not appear to have a waiver page specifically, although some information about relevant waivers is on its home page. The Department of Social Services (CDSS) does not have a waiver link on its home page, although it receives waivers from the USDA for its CalFresh program and from the Administration on Families and Children for its child welfare programs. Much of the waiver information released from CDSS about waivers and plans is in the form of instruction letters to counties or other, similar, directives.

Related legislation:

AB 82 (Committee on Budget, Chapter 23, Statutes of 2013) added the requirement for DHCS to post all waiver and state plan information submitted to the federal CMS on its Internet website within 10 days.

AB 1216 (Bonta, 2015) modifies the requirement for DHCS to post all state plan amendments and waiver information submitted to CMS from 10 days to within 7 business days from the date of submission, and requires DHCS to accept public comment on all state plan amendments and waivers, as specified.

PRIOR VOTES

POSITIONS

Support:

Coalition of California Welfare Rights Organizations (Sponsor)

AFSCME

Alliance

California Alternative Payment Program Association

California Hunger Action Coalition

Western Center on Law and Poverty

Oppose:

California Department of Finance

ARGUMENTS IN SUPPORT

The bill’s sponsor, California Coalition of Welfare Rights Organizations, writes that California’s numerous plans and waivers are not readily accessible to the public, although some specific plans are required to be posted. “This bill would make California’s state plans and waivers readily accessible to the public to enhance government transparency.”

ARGUMENTS IN OPPOSITION

The Department of Finance writes in opposition to this bill that SB 294 is unnecessary. “If there are any gaps in what is being posted, Agency can direct the affected departments to publish the remaining documents. It is our understanding that departments under Agency already publish most of their federally approved operational state plans or federal waiver applications on their respective websites.”

-- END --

Date of Hearing: April 22, 2015

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Jimmy Gomez, Chair

ABPCA Bill Id:AB 294

Author:(Lackey) – As Amended Ver:April 9, 2015

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill requires any department within the California Health and Human Services Agency (CHHSA) to post on the homepage of its website information about any federally approved state plan or waiver of federal laws or regulations.

FISCAL EFFECT:

Negligible state fiscal effect. This bill will apply to ten departments under CHHSA, some of which are already likely compliant.

COMMENTS:

Purpose. According to the author, this bill will increase transparency for programs administered within CHHSA, which include many programs partially or fully funded with federal funds and operating under federal requirements. These programs include Medi-Cal, CalFresh, CalWORKs, Women, Infants, and Children (WIC), and others. According to the author, frequently the federal government will require the designated state agency to submit a state plan for the operation of the program. In addition, states often obtain federal waivers as they test more innovative approaches to implementing federal law. It is sometimes difficult to ascertain what is included in state plans, or what waivers of federal law or regulation are operative, if the plans and waivers are not publicly accessible.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: April 7, 2015

ASSEMBLY COMMITTEE ON HEALTH

Rob Bonta, Chair

ABPCA Bill Id:AB 294

Author:(Lackey and Steinorth) – As Amended Ver:March 23, 2015

SUBJECT: Health and human services: state plans: federal waivers: public notice.

SUMMARY: Requires any department within the California Health and Human Services Agency (CHHSA) to post on the first page of its website information about any federally approved state plan or waiver of federal laws or regulations.

EXISTING LAW:

1. Creates the CHHSA with its 10 constituent departments and a number of other offices and entities.

2. Requires or authorizes state agencies to develop state plans and waiver proposals for submission to the federal government, consistent with federal law. Existing federal law provides for required state plans to implement federal programs and grants federal agencies authority in specified circumstances to waive applicable portions of federal law. In particular, states may be granted waivers of federal law to implement demonstration projects in their Medicaid programs.

FISCAL EFFECT: This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, this bill will increase transparency for programs administered within CHHSA. Many of these programs are federal programs partially or fully funded with federal funds and operating under federal requirements. According to the author, frequently the federal government will require the designated state agency to submit a state plan for the operation of the program. In addition, states often obtain federal waivers as they test more innovative approaches to implementing federal law. The author argues this bill would increase transparency and government accountability for these programs by requiring that the administering departments within CHHSA place a copy of the approved state plans and waivers on the front page of the department’s Website. The author concludes that this will allow the public to gain knowledge of the programs and improve CHHSA’s abilities to provide critical services to Californians.

2. SUPPORT. According to the Coalition of California Welfare Rights Organizations, this bill’s sponsor, is needed because in certain cases the only way for the public to access the details of a federal waiver is through a public information request. The supporters note that this bill would not only improve transparency to the public, but also save valuable resources for departments by taking away the need for public information requests. Supporters also note that some departments within CHHSA already post approved waivers on their Websites, such as Department of Health Care Services (DHCS) which posts Medi-Cal waivers, however, other departments such as Department of Social Services do not post waivers.

The Western Center on Law and Poverty (WCLP) supports this bill, noting that the plans and waivers are available through public records act requests but are not readily accessible to the public. WCLP argues that this bill will make these documents more accessible to the public and make these government programs more transparent and work better for the people they serve.

3. BACKGROUND. Of particular importance for health policy, is the proposed Medicaid waiver request for the Medi-Cal program. Medicaid (known as Medi-Cal in California) is a joint federal-state program to provide health coverage to low-income individuals. Section 1115 of the federal Social Security Act (Act) gives the Secretary of the federal Department of Health and Human Services (HHS) authority to waive provisions of major health and welfare programs authorized under the Act. This includes certain federal Medicaid requirements in any experimental pilot or demonstration project which, in the judgment of the HHS Secretary, is likely to assist in promoting the objectives of Medicaid. In addition, Section 1115 also allows states to use federal Medicaid funds to reimburse for costs in ways that are not otherwise allowed under federal Medicaid law. DHCS has submitted a waiver application to the federal government for consideration.
   
   
   

4. Suggested Technical Amendment. The proposed technical amendment would clarify that all plans and waivers could be accessed by one link and change "first" page to "home" page.

Section 135: If a department within the California Health and Human Services Agency has received approval of an operational state plan by a federal agency, or has applied and has been approved for a waiver from a federal law or regulation, the department shall make any and all approved plans or waiver applications the approved plan or waiver application available to the public by publishing a hyperlink to that information on the first home page of the department’s Internet Web site at the time the department is otherwise updating its Internet Web site.

Section 3500: If a department within the California Health and Human Services Agency has received approval of an operational state plan by a federal agency, or has applied and has been approved for a waiver from a federal law or regulation, the department shall make any and all approved plans or waiver applications the approved plan or waiver application available to the public by publishing a hyperlink to that information on the first home page of the department’s Internet Web site at the time the department is otherwise updating its Internet Web site.

5. RELATED LEGISLATION.

1. AB 72 (Bonta), requires DHCS to submit an application to the federal Centers for Medicare and Medicaid Services for a waiver to implement a demonstration project that furthers the delivery of high-quality and cost-efficient care for Medi-Cal beneficiaries. AB 72 is pending in this Committee.

2. SB 36 (Ed Hernandez) is substantially similar to AB 72 and is pending in the Senate Committee on Health.

REGISTERED SUPPORT / OPPOSITION:

Support

Coalition of California Welfare Rights Organizations (sponsor)

California Alternative Payment Program Association

The Alliance

Western Center on Law and Poverty

Opposition

None on file.

Analysis Prepared by: Roger Dunstan / HEALTH / (916) 319-2097