AB 1815: Medi-Cal.

(1)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 and funded by federal Medicaid program provisions. Existing law, the California Healthcare, Research and Prevention Tobacco Tax Act of 2016, an initiative measure approved as Proposition 56 at the November 8, 2016, statewide general election, increases taxes imposed on distributors of cigarettes and tobacco products and requires all revenues to be deposited into the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 Fund, a continuously appropriated fund. Proposition 56 requires the Controller to transfer 82% of those revenues to the Healthcare Treatment Fund, to be used by the State Department of Health Care Services to increase funding for Medi-Cal and other specified health care programs and services in a way that, among other things, ensures timely access, limits geographic shortages of services, and ensures quality care. The act authorizes the Legislature to amend the provision relating to the allocation of revenues in the Healthcare Treatment Fund to further the purposes of the act with a ²/₃ vote of the membership of each house of the Legislature.

This bill, until January 1, 2026, would establish the Proposition 56 Medi-Cal Physicians and Dentists Loan Repayment Act Program, which would be developed by the State Department of Health Care Services to provide loan assistance payments to qualifying, recent graduate physicians and dentists that serve beneficiaries of Medi-Cal and other specified health care programs using moneys from the Healthcare Treatment Fund. By allocating revenues in that fund to the new loan repayment program, the bill would amend Proposition 56. The bill would require the department to administer separate payment pools for participating physicians and dentists, and to develop the eligibility criteria to be used to evaluate applicant physicians and dentists, including the minimum number of years a participating physician or dentist shall be a Medi-Cal enrolled provider to be eligible for loan assistance. The bill would provide that a judicial challenge to the bills provisions establishing the Proposition 56 Medi-Cal Physicians and Dentists Loan Repayment Act Program shall be brought only within 45 days of the effective date of the bill. The bill would also provide that both the provisions establishing the program and those governing judicial challenge shall be inoperative if a single provision of either is found to be invalid.

(2)Existing law, the Medi-Cal Hospital Reimbursement Improvement Act of 2013, subject to federal approval, imposes a hospital quality assurance fee, as specified, on certain general acute care hospitals to be deposited into the Hospital Quality Assurance Revenue Fund. Existing law provides that moneys in the Hospital Quality Assurance Revenue Fund are continuously appropriated during the first, 2nd, and subsequent program periods, as specified, and are available only for certain purposes, including, among others, paying the departments staffing and administrative costs directly attributable to implementing the quality assurance fee provisions, not to exceed $250,000, as specified. The California Constitution, pursuant to Proposition 52 as approved by voters at the November 8, 2016, statewide general election, prohibits a statute amending or adding to the provisions of the act from becoming effective unless approved by the electors, as specified, but authorizes the Legislature, by a ²/₃ vote in each house of the Legislature, to amend or add provisions that further the purposes of the act.

This bill would additionally make moneys in the fund available to pay for the departments staffing and administrative costs directly attributable to implementing the quality assurance fee provisions specifically incurred due to the implementation of certain federal Medicaid regulations, not to exceed $500,000, as specified. By expanding the use of moneys in the Hospital Quality Assurance Revenue Fund for additional staffing and administrative costs, this bill would make an appropriation.

This bill would declare that its provisions further the purposes of the Medi-Cal Hospital Reimbursement Improvement Act of 2013 within the meaning of a specified provision of the California Constitution.

(3)Existing law establishes the Medi-Cal 2020 Demonstration Project Act, under which the State Department of Health Care Services is required to implement specified components of a demonstration project, consistent with the Special Terms and Conditions approved by the federal Centers for Medicare and Medicaid Services. Existing law requires the department to implement the Dental Transformation Initiative (DTI), a component of the Medi-Cal 2020 demonstration project, under which DTI incentive payments are available to qualified providers who meet achievements within one or more of the project domains. Existing law authorizes the department to establish Local Dental Pilot Projects under the DTI, under which DTI incentive payments are available to approved Local Dental Pilot Projects that address certain DTI domain categories through alternative projects.

This bill would permit the department to authorize a dental integration pilot program in San Mateo County as a component of the Medi-Cal demonstration project, subject to appropriation by the Legislature and federal approval. The bill would require the department, before the start date of the pilot program, to take specified action, including seeking input from affective stakeholders. The bill would provide that enrollees of the Health Plan of San Mateo would not receive covered Medi-Cal dental care services through the Medi-Cal fee-for-service system during the pilot program, but instead the Health Plan of San Mateo would be responsible for those services. The bill would require the department to contract for an evaluation of the pilot program, using funding provided by the Health Plan of San Mateo, to be completed and published no later than December 31 of the 6th fiscal year the pilot program is in operation.

(4)This bill would declare that it is to take effect immediately as a bill providing for appropriations related to the Budget Bill.