SB 1257: Geographic Managed Care Pilot Project: County of San Diego: advisory board.
- Session Year: 2023-2024
- House: Senate
- Latest Version Date: 2024-07-15
Current Status:
Passed
(2024-07-15: Chaptered by Secretary of State. Chapter 134, Statutes of 2024.)
Introduced
In Committee
First Chamber
In Committee
Second Chamber
Enacted
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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 authorizes the department, upon approval by the board of supervisors of the County of San Diego, to implement a multiplan managed care pilot project for the provision of Medi-Cal services. Existing law authorizes the County of San Diego to establish 2 advisory boards, with certain compositions, to advise the Department of Health Services of the County of San Diego and review and comment on the implementation of the multiplan project. Existing law requires that at least one member of each board be appointed by the board of supervisors and requires the board of supervisors to establish the number of members on each board.
This bill would instead authorize the County of San Diego to establish one board, as specified, and would require the board to advise the Health and Human Services Agency of the County of San Diego on the implementation of the state Medi-Cal policy as it pertains to Medi-Cal managed care plans in the county. The bill would require each supervisor of the board to appoint at least one member to the advisory board, with each supervisor appointing an equal number of members.
Existing law prohibits the compensation of the advisory board members for activities relating to their duties, but requires that members who are Medi-Cal recipients be reimbursed an appropriate amount by the county for travel and child care expenses incurred in performing their duties in the pilot project.
This bill would also authorize advisory board members who are Medi-Cal recipients to be reimbursed by the county for their time in performing their duties in the pilot project, at the discretion of the county.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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 authorizes the department, upon approval by the board of supervisors of the County of San Diego, to implement a multiplan managed care pilot project for the provision of Medi-Cal services. Existing law authorizes the County of San Diego to establish 2 advisory boards, with certain compositions, to advise the Department of Health Services of the County of San Diego and review and comment on the implementation of the multiplan project. Existing law requires that at least one member of each board be appointed by the board of supervisors and requires the board of supervisors to establish the number of members on each board.
This bill would instead authorize the County of San Diego to establish one board, as specified, and would require the board to advise the Health and Human Services Agency of the County of San Diego on the implementation of the state Medi-Cal policy as it pertains to Medi-Cal managed care plans in the county. The bill would require each supervisor of the board to appoint at least one member to the advisory board, with each supervisor appointing an equal number of members.
Existing law prohibits the compensation of the advisory board members for activities relating to their duties, but requires that members who are Medi-Cal recipients be reimbursed an appropriate amount by the county for travel and child care expenses incurred in performing their duties in the pilot project.
This bill would also authorize advisory board members who are Medi-Cal recipients to be reimbursed by the county for their time in performing their duties in the pilot project, at the discretion of the county.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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 Advancing and Innovating Medi-Cal (CalAIM) Act, supports the stated goals of identifying and managing the risk and needs of Medi-Cal beneficiaries, transitioning and transforming the Medi-Cal program to a more consistent and seamless system, and improving quality outcomes.
Existing law permits authorizes the department, upon approval by the board of supervisors of the County of San Diego, to establish implement a multiplan managed care pilot project for the provision of Medi-Cal services. Existing law authorizes the County of San Diego to establish 2 advisory boards boards, with certain compositions, to advise the Department of Health Services of the County of San Diego and review and comment on the implementation of the multiplan project. Existing law requires that at least one member of each board be appointed by the board of supervisors and requires the board of supervisors to establish the number of members on each board.
This bill would instead authorize the County of San Diego to establish one board and require it board, as specified, and would require the board to advise the Health and Human Services Agency of the County of San Diego and support the goals of CalAIM. on the implementation of the state Medi-Cal policy as it pertains to Medi-Cal managed care plans in the county. The bill would require each supervisor of the board to appoint at least one member to the advisory board, with each supervisor appointing an equal number of members.
Existing law prohibits the compensation of the advisory board members for activities relating to their duties, but requires that members who are Medi-Cal recipients be reimbursed an appropriate amount by the county for travel and child care expenses incurred in performing their duties in the pilot project.
This bill would also authorize advisory board members who are Medi-Cal recipients to be reimbursed by the county for their time in performing their duties in the pilot project, at the discretion of the county.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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 Advancing and Innovating Medi-Cal (CalAIM) Act, supports the stated goals of identifying and managing the risk and needs of Medi-Cal beneficiaries, transitioning and transforming the Medi-Cal program to a more consistent and seamless system, and improving quality outcomes.
Existing law permits the department, upon approval by the board of supervisors of the County of San Diego, to establish a multiplan managed care pilot project for the provision of Medi-Cal services. Existing law authorizes the County of San Diego to establish 2 advisory boards to advise the Department of Health Services of the County of San Diego and review and comment on the implementation of the multiplan project. Existing law requires that at least one member of each board be appointed by the board of supervisors and requires the board of supervisors to establish the number of members on each board.
This bill would instead authorize the County of San Diego to establish one board and require it to advise the Health and Human Services Agency of the County of San Diego and support the goals of CalAIM. The bill would require each supervisor of the board to appoint at least one member to the advisory board, with each supervisor appointing an equal number of members.
(a)(1)The department may implement a multiplan project in the County of San Diego, upon approval of the Board of Supervisors of the County of San Diego, for the provision of benefits under this chapter to eligible Medi-Cal recipients. The multiplan project implemented in the County of San Diego pursuant to this section shall provide diagnostic, therapeutic, and preventive services provided under the Medi-Cal program, and additional benefits including, but not limited to, medical-related transportation, comprehensive patient management, and referral to other support services.
(2)The County of San Diego shall be eligible to receive funds transferred pursuant to paragraph (1) of subdivision (p) of Section 14163 for the development and implementation of this section. These funds in the amount allocated by the department for the County of San Diego shall be paid by the department upon the enactment of this section to the County of San Diego to reimburse a portion of the costs of the development of the project. To the full extent permitted by state and federal law, these funds shall be distributed by the department for expenditure by the County of San Diego in a manner that qualifies for federal financial participation under the Medicaid program and the department shall expedite the payment of the federal funds to the County of San Diego. The department shall seek additional state, federal, and other funds to pay for costs that are incurred by the County of San Diego to develop the multiplan project in excess of the payment required by this section, and the department shall assist the county in obtaining the additional funds.
(b)(1)The County of San Diego may establish an advisory board composed of consumer representatives and health care professionals representatives. The board shall advise the Health and Human Services Agency of the County of San Diego and review and comment on all aspects of the implementation of the multiplan project. The advisory board shall advise on the implementation of the state Medi-Cal policy as it pertains to Medi-Cal managed care plans in the County of San Diego. Each supervisor of the board of supervisors shall appoint at least one member to the advisory board with each supervisor to appoint an equal number of members from their district. The advisory board shall vote on all pilot project policies and issues that are submitted to the board of supervisors.
(2)Notwithstanding any other law, a member of the advisory board established pursuant to this section shall not be deemed to be interested in a contract entered into by the department within the meaning of Article 4 (commencing with Section 1090) of Chapter 1 of Division 4 of Title 1 of the Government Code if the member is a Medi-Cal recipient or if all of the following apply:
(A)The member was appointed to represent the interests of physicians, health care practitioners, hospitals, pharmacies, or other health care organizations.
(B)The contract authorizes the member or the organization the member represents to provide Medi-Cal services under the multiplan project.
(C)The contract contains substantially the same terms and conditions as contracts entered into with other individuals or organizations the member was appointed to represent.
(D)The member does not influence or attempt to influence the advisory board or another member of the advisory board to recommend that the department enter into the contract in which the member is interested.
(E)The member discloses the interest to the advisory board and abstains from voting on any recommendation on the contract.
(F)The advisory board notes the members disclosure and abstention in its official records.
(3)Members of the advisory board shall not be paid compensation for activities relating to their duties as members, but members who are Medi-Cal recipients shall be reimbursed an appropriate amount by the County of San Diego for their travel and child care expenses incurred in performing their duties under this section. Members of the advisory board who are Medi-Cal recipients may also be reimbursed by the County of San Diego for their time in performing their duties under this section, at the discretion of the county.
(c)At the discretion of the department, the County of San Diego, the department, or other appropriate entities may perform any of the following in a manner that accomplishes the integration of the intake of eligible beneficiaries to the project, the assessment of beneficiary individual and family needs and circumstances, and the timely referral of beneficiaries to health care and other services to respond to their individual and family needs:
(1)Determine the eligibility of Medi-Cal applicants and recipients in a manner and environment that is accessible to the recipients and applicants.
(2)Perform enrollment activities in a manner that ensures that recipients be given the opportunity to select the provider of their choice in a manner and environment that is accessible to the recipients.
(3)The department may negotiate and amend its contract with the county to provide for specified quality improvement activities, and may require each of the health plans to participate in those activities. The department shall also participate in the countys quality improvement activities.
(d)Notwithstanding Section 14089 or any other provision of law, the County of San Diego, when contracting with the department pursuant to this section or Section 14089, shall not be liable for damages for injury to persons or property arising out of the actions or inactions of the department, the departments other contractors, or providers of health care or other services, or Medi-Cal recipients. This section shall not relieve the County of San Diego from liability arising out of its actions or inactions.
(e)The County of San Diego, when contracting with the department pursuant to Section 14089 or this section, shall have no legal duty to provide health care or other services to Medi-Cal recipients, and shall have no financial responsibility for the departments other contractors or providers of health care or other services, except to the extent specifically set forth in contracts between the department and the county.
(f)Notwithstanding Section 14089.6, the department may terminate any existing managed care contract with either a prepaid health plan or a primary care case management plan for services in the County of San Diego in accordance with the terms and conditions set forth in the existing contract, at any time that the department determines that termination is in the best interest of the state. The department shall notify an existing prepaid health plan at least 90 days prior to termination. The department shall notify a primary care case management plan at least 30 days prior to termination.
(g)All contracts entered into by the department and the County of San Diego pursuant to Section 14089 or this section shall not be for the benefit of any third party, and no third-party beneficiary relationship shall be established between the county and any other party, except as may be specifically set forth in contracts between the department and the County of San Diego.
(h)(1)For purposes of this section, multiplan project means a program authorized by this section in which a number of Knox-Keene licensed health plans designated by the county and approved by the department shall be the only Medi-Cal managed care health plans authorized to operate within the County of San Diego, with the exception of special projects approved by the department.
(2)Designated health plans shall include, but not be limited to, health plans sponsored by traditional Medi-Cal physicians, neighborhood health centers, community clinics, health systems, including hospitals and other providers, or a combination thereof.
(3)Participating health plans shall first be designated by the county for approval by the department. Health plans approved by the department shall be eligible to contract with the department. Designation by the county and approval by the department provides the health plan only with the opportunity to compete for a contract and does not guarantee a contract with the state.
(4)Designation requirements imposed by the county shall not conflict with the requirements imposed by the department, the federal Medicaid program, and the Medi-Cal program, and may not impose stricter requirements, without the departments approval, than those imposed by the department, the federal Medicaid program, and the Medi-Cal program.
(5)Designation of health plans by the county will continue for the term of the Medi-Cal contract.
(i)Nothing in this section relieves the county of duties or liabilities imposed by Part 5 (commencing with Section 17000) or that it has assumed through contract with entities other than the department.
(j)Indian health facilities in the County of San Diego may contract directly with the department as Medi-Cal fee-for-service case management providers apart from the geographic managed care program or may participate in the network of one or more of the geographic managed care plans. Indian health service facilities that contract with the department as fee-for-service case management providers may enroll Medi-Cal recipients, including, but not limited to, recipients who are in any of the geographic managed care mandatory enrollment aid codes.
(a)(1)The department may implement a multiplan project in the County of San Diego, upon approval of the Board of Supervisors of the County of San Diego, for the provision of benefits under this chapter to eligible Medi-Cal recipients. The multiplan project implemented in the County of San Diego pursuant to this section shall provide diagnostic, therapeutic, and preventive services provided under the Medi-Cal program, and additional benefits including, but not limited to, medical-related transportation, comprehensive patient management, and referral to other support services.
(2)The County of San Diego shall be eligible to receive funds transferred pursuant to paragraph (1) of subdivision (p) of Section 14163 for the development and implementation of this section. These funds in the amount allocated by the department for the County of San Diego shall be paid by the department upon the enactment of this section to the County of San Diego to reimburse a portion of the costs of the development of the project. To the full extent permitted by state and federal law, these funds shall be distributed by the department for expenditure by the County of San Diego in a manner that qualifies for federal financial participation under the Medicaid program and the department shall expedite the payment of the federal funds to the County of San Diego. The department shall seek additional state, federal, and other funds to pay for costs that are incurred by the County of San Diego to develop the multiplan project in excess of the payment required by this section, and the department shall assist the county in obtaining the additional funds.
(b)(1)The County of San Diego may establish an advisory board composed of consumer representatives and health care professionals representatives. The board shall advise the Health and Human Services Agency of the County of San Diego and review and comment on all aspects of the implementation of the multiplan project. The advisory board shall advise on the implementation of the state Medi-Cal policy as it pertains to Medi-Cal managed care plans in the County of San Diego. Each supervisor of the board of supervisors shall appoint at least one member to the advisory board with each supervisor to appoint an equal number of members from their district. The advisory board shall vote on all pilot project policies and issues that are submitted to the board of supervisors.
(2)Notwithstanding any other law, a member of the advisory board established pursuant to this section shall not be deemed to be interested in a contract entered into by the department within the meaning of Article 4 (commencing with Section 1090) of Chapter 1 of Division 4 of Title 1 of the Government Code if the member is a Medi-Cal recipient or if all of the following apply:
(A)The member was appointed to represent the interests of physicians, health care practitioners, hospitals, pharmacies, or other health care organizations.
(B)The contract authorizes the member or the organization the member represents to provide Medi-Cal services under the multiplan project.
(C)The contract contains substantially the same terms and conditions as contracts entered into with other individuals or organizations the member was appointed to represent.
(D)The member does not influence or attempt to influence the advisory board or another member of the advisory board to recommend that the department enter into the contract in which the member is interested.
(E)The member discloses the interest to the advisory board and abstains from voting on any recommendation on the contract.
(F)The advisory board notes the members disclosure and abstention in its official records.
(3)Members of the advisory board shall not be paid compensation for activities relating to their duties as members, but members who are Medi-Cal recipients shall be reimbursed an appropriate amount by the County of San Diego for their travel and child care expenses incurred in performing their duties under this section. Members of the advisory board who are Medi-Cal recipients may also be reimbursed by the County of San Diego for their time in performing their duties under this section, at the discretion of the county.
(c)At the discretion of the department, the County of San Diego, the department, or other appropriate entities may perform any of the following in a manner that accomplishes the integration of the intake of eligible beneficiaries to the project, the assessment of beneficiary individual and family needs and circumstances, and the timely referral of beneficiaries to health care and other services to respond to their individual and family needs:
(1)Determine the eligibility of Medi-Cal applicants and recipients in a manner and environment that is accessible to the recipients and applicants.
(2)Perform enrollment activities in a manner that ensures that recipients be given the opportunity to select the provider of their choice in a manner and environment that is accessible to the recipients.
(3)The department may negotiate and amend its contract with the county to provide for specified quality improvement activities, and may require each of the health plans to participate in those activities. The department shall also participate in the countys quality improvement activities.
(d)Notwithstanding Section 14089 or any other provision of law, the County of San Diego, when contracting with the department pursuant to this section or Section 14089, shall not be liable for damages for injury to persons or property arising out of the actions or inactions of the department, the departments other contractors, or providers of health care or other services, or Medi-Cal recipients. This section shall not relieve the County of San Diego from liability arising out of its actions or inactions.
(e)The County of San Diego, when contracting with the department pursuant to Section 14089 or this section, shall have no legal duty to provide health care or other services to Medi-Cal recipients, and shall have no financial responsibility for the departments other contractors or providers of health care or other services, except to the extent specifically set forth in contracts between the department and the county.
(f)Notwithstanding Section 14089.6, the department may terminate any existing managed care contract with either a prepaid health plan or a primary care case management plan for services in the County of San Diego in accordance with the terms and conditions set forth in the existing contract, at any time that the department determines that termination is in the best interest of the state. The department shall notify an existing prepaid health plan at least 90 days prior to termination. The department shall notify a primary care case management plan at least 30 days prior to termination.
(g)All contracts entered into by the department and the County of San Diego pursuant to Section 14089 or this section shall not be for the benefit of any third party, and no third-party beneficiary relationship shall be established between the county and any other party, except as may be specifically set forth in contracts between the department and the County of San Diego.
(h)(1)For purposes of this section, multiplan project means a program authorized by this section in which a number of Knox-Keene licensed health plans designated by the county and approved by the department shall be the only Medi-Cal managed care health plans authorized to operate within the County of San Diego, with the exception of special projects approved by the department.
(2)Designated health plans shall include, but not be limited to, health plans sponsored by traditional Medi-Cal physicians, neighborhood health centers, community clinics, health systems, including hospitals and other providers, or a combination thereof.
(3)Participating health plans shall first be designated by the county for approval by the department. Health plans approved by the department shall be eligible to contract with the department. Designation by the county and approval by the department provides the health plan only with the opportunity to compete for a contract and does not guarantee a contract with the state.
(4)Designation requirements imposed by the county shall not conflict with the requirements imposed by the department, the federal Medicaid program, and the Medi-Cal program, and may not impose stricter requirements, without the departments approval, than those imposed by the department, the federal Medicaid program, and the Medi-Cal program.
(5)Designation of health plans by the county will continue for the term of the Medi-Cal contract.
(i)Nothing in this section relieves the county of duties or liabilities imposed by Part 5 (commencing with Section 17000) or that it has assumed through contract with entities other than the department.
(j)Indian health facilities in the County of San Diego may contract directly with the department as Medi-Cal fee-for-service case management providers apart from the geographic managed care program or may participate in the network of one or more of the geographic managed care plans. Indian health service facilities that contract with the department as fee-for-service case management providers may enroll Medi-Cal recipients, including, but not limited to, recipients who are in any of the geographic managed care mandatory enrollment aid codes.
(a)(1)The department may implement a multiplan project in the County of San Diego, upon approval of the Board of Supervisors of the County of San Diego, for the provision of benefits under this chapter to eligible Medi-Cal recipients. The multiplan project implemented in San Diego County the County of San Diego pursuant to this section shall provide diagnostic, therapeutic, and preventive services provided under the Medi-Cal program, and additional benefits including, but not limited to, medical-related transportation, comprehensive patient management, and referral to other support services.
(2)The County of San Diego shall be eligible to receive funds transferred pursuant to paragraph (1) of subdivision (p) of Section 14163 for the development and implementation of this section. These funds in the amount allocated by the department for the County of San Diego shall be paid by the department upon the enactment of this section to the County of San Diego to reimburse a portion of the costs of the development of the project. To the full extent permitted by state and federal law, these funds shall be distributed by the department for expenditure by the County of San Diego in a manner that qualifies for federal financial participation under the Medicaid Program program and the department shall expedite the payment of the federal funds to the County of San Diego. The department shall seek additional state, federal, and other funds to pay for costs that are incurred by the County of San Diego to develop the multiplan project in excess of the payment required by this section, and the department shall assist the county in obtaining the additional funds.
(b)(1)The County of San Diego may establish an advisory board composed of consumer representatives and health care professionals professionals representatives. The board shall advise the Health and Human Services Agency of the County of San Diego and review and comment on all aspects of the implementation of the multiplan project. The advisory board shall support the goals of the California Advancing and Innovating Medi-Cal (CalAIM) Act as set forth in Section 14184.100. advise on the implementation of the state Medi-Cal policy as it pertains to Medi-Cal managed care plans in the County of San Diego. Each supervisor of the board of supervisors shall appoint at least one member to the advisory board with each supervisor to appoint an equal number of members from their district. The advisory board shall vote on all pilot project policies and issues that are submitted to the board of supervisors.
(2)Notwithstanding any other provision of law, a member of the advisory board established pursuant to this section shall not be deemed to be interested in a contract entered into by the department within the meaning of Article 4 (commencing with Section 1090) of Chapter 1 of Division 4 of Title 1 of the Government Code if the member is a Medi-Cal recipient or if all of the following apply:
(A)The member was appointed to represent the interests of physicians, health care practitioners, hospitals, pharmacies, or other health care organizations.
(B)The contract authorizes the member or the organization the member represents to provide Medi-Cal services under the multiplan project.
(C)The contract contains substantially the same terms and conditions as contracts entered into with other individuals or organizations the member was appointed to represent.
(D)The member does not influence or attempt to influence the advisory board or another member of the advisory board to recommend that the department enter into the contract in which the member is interested.
(E)The member discloses the interest to the advisory board and abstains from voting on any recommendation on the contract.
(F)The advisory board notes the members disclosure and abstention in its official records.
(3)Members of the advisory boards board shall not be paid compensation for activities relating to their duties as members, but members who are Medi-Cal recipients may shall be reimbursed an appropriate amount by the County of San Diego for their time, travel, travel and child care expenses incurred in performing their duties under this section. Members of the advisory board who are Medi-Cal recipients may also be reimbursed by the County of San Diego for their time in performing their duties under this section, at the discretion of the county.
(c)At the discretion of the department, the County of San Diego, the department, or other appropriate entities may perform any of the following in a manner that accomplishes the integration of the intake of eligible beneficiaries to the project, the assessment of beneficiary individual and family needs and circumstances, and the timely referral of beneficiaries to health care and other services to respond to their individual and family needs:
(1)Determine the eligibility of Medi-Cal applicants and recipients in a manner and environment that is accessible to the recipients and applicants.
(2)Perform enrollment activities in a manner that ensures that recipients be given the opportunity to select the provider of their choice in a manner and environment that is accessible to the recipients.
(3)The department may negotiate and amend its contract with the county to provide for specified quality improvement activities, and may require each of the health plans to participate in those activities. The department shall also participate in the countys quality improvement activities.
(d)Notwithstanding Section 14089 or any other provision of law, the County of San Diego, when contracting with the department pursuant to this section or Section 14089, shall not be liable for damages for injury to persons or property arising out of the actions or inactions of the department, the departments other contractors, or providers of health care or other services, or Medi-Cal recipients. This section shall not relieve the County of San Diego from liability arising out of its actions or inactions.
(e)The County of San Diego, when contracting with the department pursuant to Section 14089 or this section, shall have no legal duty to provide health care or other services to Medi-Cal recipients, and shall have no financial responsibility for the departments other contractors or providers of health care or other services, except to the extent specifically set forth in contracts between the department and the county.
(f)Notwithstanding Section 14089.6, the department may terminate any existing managed care contract with either a prepaid health plan or a primary care case management plan for services in the County of San Diego in accordance with the terms and conditions set forth in the existing contract, at any time that the department determines that termination is in the best interest of the state. The department shall notify an existing prepaid health plan at least 90 days prior to termination. The department shall notify a primary care case management plan at least 30 days prior to termination.
(g)All contracts entered into by the department and the County of San Diego pursuant to Section 14089 or this section shall not be for the benefit of any third party, and no third-party beneficiary relationship shall be established between the county and any other party, except as may be specifically set forth in contracts between the department and the County of San Diego.
(h)(1)For purposes of this section, multiplan project means a program authorized by this section in which a number of Knox-Keene licensed health plans designated by the county and approved by the department shall be the only Medi-Cal managed care health plans authorized to operate within San Diego County, the County of San Diego, with the exception of special projects approved by the department.
(2)Designated health plans shall include, but not be limited to, health plans sponsored by traditional Medi-Cal physicians, neighborhood health centers, community clinics, health systems, including hospitals and other providers, or a combination thereof.
(3)Participating health plans shall first be designated by the county for approval by the department. Health plans approved by the department shall be eligible to contract with the department. Designation by the county and approval by the department provides the health plan only with the opportunity to compete for a contract and does not guarantee a contract with the state.
(4)Designation requirements imposed by the county shall not conflict with the requirements imposed by the department, the federal Medicaid Program, program, and the Medi-Cal program, and may not impose stricter requirements, without the departments approval, than those imposed by the department, the federal Medicaid Program, program, and the Medi-Cal program.
(5)Designation of health plans by the county will continue for the term of the Medi-Cal contract.
(i)Nothing in this section relieves the county of duties or liabilities imposed by Part 5 (commencing with Section 17000) or which that it has assumed through contract with entities other than the department.
(j)Indian health facilities in San Diego County the County of San Diego may contract directly with the department as Medi-Cal fee-for-service case management providers apart from the geographic managed care program or may participate in the network of one or more of the geographic managed care plans. Indian health service facilities that contract with the department as fee-for-service case management providers may enroll Medi-Cal recipients, including, but not limited to, recipients who are in any of the geographic managed care mandatory enrollment aid codes.
(a)(1)The department may implement a multiplan project in the County of San Diego, upon approval of the Board of Supervisors of the County of San Diego, for the provision of benefits under this chapter to eligible Medi-Cal recipients. The multiplan project implemented in San Diego County pursuant to this section shall provide diagnostic, therapeutic, and preventive services provided under the Medi-Cal program, and additional benefits including, but not limited to, medical-related transportation, comprehensive patient management, and referral to other support services.
(2)The County of San Diego shall be eligible to receive funds transferred pursuant to paragraph (1) of subdivision (p) of Section 14163 for the development and implementation of this section. These funds in the amount allocated by the department for the County of San Diego shall be paid by the department upon the enactment of this section to the County of San Diego to reimburse a portion of the costs of the development of the project. To the full extent permitted by state and federal law, these funds shall be distributed by the department for expenditure by the County of San Diego in a manner that qualifies for federal financial participation under the Medicaid Program and the department shall expedite the payment of the federal funds to the County of San Diego. The department shall seek additional state, federal, and other funds to pay for costs that are incurred by the County of San Diego to develop the multiplan project in excess of the payment required by this section, and the department shall assist the county in obtaining the additional funds.
(b)(1)The County of San Diego may establish two advisory boards, one of which shall be composed of consumer representatives and the other of which shall be composed of health care professionals representatives. Each board shall advise the Department of Health Services an advisory board composed of consumer representatives and health care professionals representatives. The board shall advise the Health and Human Services Agency of the County of San Diego and review and comment on all aspects of the implementation of the multiplan project. At least one of the members of each advisory board shall be appointed by the board of supervisors. The board of supervisors shall establish a number of members to serve on each advisory board, The advisory board shall support the goals of the California Advancing and Innovating Medi-Cal (CalAIM) Act as set forth in Section 14184.100. Each supervisor of the board of supervisors shall appoint at least one member to the advisory board with each supervisor to appoint an equal number of members from his or her district. Each their district. The advisory board shall vote on all pilot project policies and issues that are submitted to the board of supervisors.
(2)Notwithstanding any other provision of law, a member of an the advisory board established pursuant to this section shall not be deemed to be interested in a contract entered into by the department within the meaning of Article 4 (commencing with Section 1090) of Chapter 1 of Division 4 of Title 1 of the Government Code if the member is a Medi-Cal recipient or if all of the following apply:
(A)The member was appointed to represent the interests of physicians, health care practitioners, hospitals, pharmacies, or other health care organizations.
(B)The contract authorizes the member or the organization the member represents to provide Medi-Cal services under the multiplan project.
(C)The contract contains substantially the same terms and conditions as contracts entered into with other individuals or organizations the member was appointed to represent.
(D)The member does not influence or attempt to influence the joint advisory board or another member of the joint advisory board to recommend that the department enter into the contract in which the member is interested.
(E)The member discloses the interest to the joint advisory board and abstains from voting on any recommendation on the contract.
(F)The advisory board notes the members disclosure and abstention in its official records.
(3)Members of the advisory boards shall not be paid compensation for activities relating to their duties as members, but members who are Medi-Cal recipients shall may be reimbursed an appropriate amount by the County of San Diego for travel their time, travel, and child care expenses incurred in performing their duties under this section.
(c)At the discretion of the department, the County of San Diego, the department, or other appropriate entities may perform any of the following in a manner that accomplishes the integration of the intake of eligible beneficiaries to the project, the assessment of beneficiary individual and family needs and circumstances, and the timely referral of beneficiaries to health care and other services to respond to their individual and family needs:
(1)Determine the eligibility of Medi-Cal applicants and recipients in a manner and environment that is accessible to the recipients and applicants.
(2)Perform enrollment activities in a manner that ensures that recipients be given the opportunity to select the provider of their choice in a manner and environment that is accessible to the recipients.
(3)The department may negotiate and amend its contract with the county to provide for specified quality improvement activities, and may require each of the health plans to participate in those activities. The department shall also participate in the countys quality improvement activities.
(d)Notwithstanding Section 14089 or any other provision of law, the County of San Diego, when contracting with the department pursuant to this section or subdivision (d), (i), or (j) of Section 14089, shall not be liable for damages for injury to persons or property arising out of the actions or inactions of the department, the departments other contractors, or providers of health care or other services, or Medi-Cal recipients. This section shall not relieve the County of San Diego from liability arising out of its actions or inactions.
(e)The County of San Diego, when contracting with the department pursuant to Section 14089 or this section, shall have no legal duty to provide health care or other services to Medi-Cal recipients, and shall have no financial responsibility for the departments other contractors or providers of health care or other services, except to the extent specifically set forth in contracts between the department and the county.
(f)Notwithstanding Section 14089.6, the department may terminate any existing managed care contract with either a prepaid health plan or a primary care case management plan for services in the County of San Diego in accordance with the terms and conditions set forth in the existing contract, at any time that the department determines that termination is in the best interest of the state. The department shall notify an existing prepaid health plan at least 90 days prior to termination. The department shall notify a primary care case management plan at least 30 days prior to termination.
(g)All contracts entered into by the department and the County of San Diego pursuant to Section 14089 or this section shall not be for the benefit of any third party, and no third-party beneficiary relationship shall be established between the county and any other party, except as may be specifically set forth in contracts between the department and the County of San Diego.
(h)(1)For purposes of this section, multiplan project means a program authorized by this section in which a number of Knox-Keene licensed health plans designated by the county and approved by the department shall be the only Medi-Cal managed care health plans authorized to operate within San Diego County, with the exception of special projects approved by the department.
(2)Designated health plans shall include, but not be limited to, health plans sponsored by traditional Medi-Cal physicians, neighborhood health centers, community clinics, health systems, including hospitals and other providers, or a combination thereof.
(3)Participating health plans shall first be designated by the county for approval by the department. Health plans approved by the department shall be eligible to contract with the department. Designation by the county and approval by the department provides the health plan only with the opportunity to compete for a contract and does not guarantee a contract with the state.
(4)Designation requirements imposed by the county shall not conflict with the requirements imposed by the department, the federal Medicaid Program, and the Medi-Cal program, and may not impose stricter requirements, without the departments approval, than those imposed by the department, the federal Medicaid Program, and the Medi-Cal program.
(5)Designation of health plans by the county will continue for the term of the Medi-Cal contract.
(i)Nothing in this section relieves the county of duties or liabilities imposed by Part 5 (commencing with Section 17000) or which it has assumed through contract with entities other than the department.
(j)Indian health facilities in San Diego County may contract directly with the department as Medi-Cal fee-for-service case management providers apart from the geographic managed care program or may participate in the network of one or more of the geographic managed care plans. Indian health service facilities that contract with the department as fee-for-service case management providers may enroll Medi-Cal recipients, including, but not limited to, recipients who are in any of the geographic managed care mandatory enrollment aid codes.
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Date
|
Status
|
|---|---|
| Jul 15, 2024 | Chaptered by Secretary of State. Chapter 134, Statutes of 2024. |
| Jul 15, 2024 | Approved by the Governor. |
| Jul 2, 2024 | Enrolled and presented to the Governor at 3 p.m. |
| Jun 27, 2024 | In Senate. Ordered to engrossing and enrolling. |
| Jun 26, 2024 | Read third time. Passed. (Ayes 75. Noes 0. Page 6037.) Ordered to the Senate. |
| Jun 20, 2024 | Read second time. Ordered to consent calendar. |
| Jun 19, 2024 | From committee: Do pass. Ordered to consent calendar. (Ayes 14. Noes 0.) (June 19). |
| Jun 5, 2024 | From committee: Do pass and re-refer to Com. on APPR. with recommendation: To consent calendar. (Ayes 15. Noes 0.) (June 4). Re-referred to Com. on APPR. |
| May 6, 2024 | Referred to Com. on HEALTH. |
| Apr 25, 2024 | In Assembly. Read first time. Held at Desk. |
| Apr 25, 2024 | Read third time. Passed. (Ayes 36. Noes 0. Page 3773.) Ordered to the Assembly. |
| Apr 23, 2024 | Read second time. Ordered to consent calendar. |
| Apr 22, 2024 | From committee: Be ordered to second reading pursuant to Senate Rule 28.8 and ordered to consent calendar. |
| Apr 16, 2024 | Set for hearing April 22. |
| Apr 15, 2024 | Read second time and amended. Re-referred to Com. on APPR. |
| Apr 11, 2024 | From committee: Do pass as amended and re-refer to Com. on APPR with recommendation: To consent calendar. (Ayes 11. Noes 0. Page 3561.) (April 10). |
| Mar 20, 2024 | Set for hearing April 10. |
| Feb 29, 2024 | Referred to Com. on HEALTH. |
| Feb 16, 2024 | From printer. May be acted upon on or after March 17. |
| Feb 15, 2024 | Introduced. Read first time. To Com. on RLS. for assignment. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Jun 26, 2024 | SB 1257 Blakespear Consent Calendar Second Day Regular Session | Assembly Floor |
Passed |
|
| Jun 19, 2024 | Do pass. To Consent Calendar. | Assembly Standing Committee on Appropriations |
Passed |
|
| Jun 4, 2024 | Do pass and be re-referred to the Committee on [Appropriations] with recommendation: To Consent Calendar | Assembly Standing Committee on Health |
Passed |
|
| Apr 25, 2024 | Consent Calendar 2nd SB1257 Blakespear | Senate Floor |
Passed |
|
| Apr 10, 2024 | Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations] with the recommendation: To Consent Calendar | Senate Standing Committee on Health |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
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Position
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Date
|
|---|---|---|
| County Of San Diego | ** Support |
Date of Hearing: June 19, 2024
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Buffy Wicks, Chair
SBPCA Bill Id:SB 1257
Author:(Blakespear) – As Amended Ver:April 15, 2024
Policy Committee: | Health | Vote: | 15 - 0 |
|
| ||
|
|
Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill authorizes the County of San Diego (county) to revise the structure of boards that advise the county on the implementation of Medi-Cal managed care.
Specifically, this bill:
- Authorizes the county to establish a single advisory board that includes representatives of both consumers and health care professionals, rather than separate advisory boards for each group.
- Requires the county to reimburse advisory board members who are Medi-Cal recipients for travel and child care expenses, and authorizes the county to reimburse such members for their service.
- Expands the advisory board’s authority to advise on the implementation of the state Medi-Cal policy as it pertains to Medi-Cal managed care plans in the county.
FISCAL EFFECT:
No state costs.
COMMENTS:
- Purpose. This bill is sponsored by the county. According to the author, the county faces unique barriers to implementing California Advancing and Innovating Medi-Cal (CalAIM) due to the multi-plan geographic managed care (GMC) model in the county. Implementation of Cal-AIM does not fall within the statutory scope of the county’s advisory board, and the author contends this bill, by clarifying the advisory board’s authority to advise more broadly on Medi-Cal managed care implementation, will enhance coordination among stakeholders and success of CalAIM initiatives, and ensure a sound statutory basis for the advisory board’s activities.
- Background.
CalAIM and GMC. In 2022, California embarked on CalAIM, a statewide initiative to modernize the Medi-Cal program. CalAIM involves far-reaching transformations of Medi-Cal managed care. The vast majority of Medi-Cal beneficiaries receive their care through a Medi-Cal managed care plan. Some counties have only one or two plans available, which can enhance efficiency, but also restrict choice. In most counties, a county-administered or county-authorized plan is available. In the two GMC counties – San Diego and Sacramento – multiple commercial plans deliver Medi-Cal managed care, requiring the county to coordinate with multiple plans to implement CalAIM.
Advisory Board Compensation. According to the Center for Health Care Strategies, a nonprofit focused on Medicaid policy, compensating consumer members of an advisory board for their time and expertise is a best practice to support consumer meaningful participation.
Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081
Date of Hearing: June 4, 2024
ASSEMBLY COMMITTEE ON HEALTH
Mia Bonta, Chair
SBPCA Bill Id:SB 1257
Author:(Blakespear) – As Amended Ver:April 15, 2024
SENATE VOTE: 36-0.
SUBJECT: Geographic Managed Care Pilot Project: County of San Diego: advisory board.
SUMMARY: Updates the structure of boards that advise the County of San Diego on the implementation of Medi-Cal managed care in the county, including allowing advisory board members who are Medi-Cal recipients to be reimbursed by the county for their service and, consistent with current practice, combining two advisory boards into a single board.
EXISTING LAW:
- Establishes the Medi-Cal program, administered by the Department of Health Care Services (DHCS), under which health care services are provided to qualified, low-income persons. [Welfare and Institutions Code (WIC) § 14000, et seq.]
- Permits DHCS to implement a Geographic Managed Care (GMC) project in the County of San Diego offering multiple Medi-Cal managed care plans, upon the approval of the county board of supervisors, for the provision of Medi-Cal benefits to eligible Medi-Cal recipients. [WIC § 14089.05 (a)]
- Permits the County of San Diego to establish two advisory boards, one composed of consumer representatives and one composed of health care professional representatives, to advise the county’s Department of Health Services and review and comment on all aspects of the implementation of the GMC project described in 2) above. [WIC § 14089.05 (b)]
- Requires the county board of supervisors to establish the number of members to serve on each advisory board and requires each supervisor to appoint an equal number of members from their district. [Ibid.]
- Prohibits advisory board members from being compensated for activities related to their duties as members, except for members who are Medi-Cal recipients, who are required to be reimbursed for their travel and child care expenses incurred while performing their duties as advisory board members. [WIC § 14089.05]
FISCAL EFFECT: According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, in 2022, California embarked on the statewide initiative to modernize the Medi-Cal program, an initiative known as the California Advancing and Innovating Medi-Cal (CalAIM). The author explains that CalAIM involves far-reaching transformations of Medi-Cal’s managed care program, which is administered at the county level, and that implementation in San Diego County is particularly challenging because the County is one of two counties that contract with multiple commercial Medi-Cal managed care plans under the GMC model. By clarifying the County advisory board’s authority to advise on Medi-Cal managed care implementation more broadly, this bill aims to enhance coordination among stakeholders and success of CalAIM initiatives, as well as to ensure a sound statutory basis for the advisory board activities.
- BACKGROUND. The vast majority of Medi-Cal beneficiaries receive their care through a Medi-Cal managed care plan. Some counties have only one or two plans available, which can restrict choice but enhance efficiency. In most counties, a county-administered or county-authorized plan is available. Sacramento County and San Diego County are unique in that multiple commercial plans deliver Medi-Cal managed care in these two counties.
The GMC program in San Diego is operated under an umbrella within the county Health and Human Services Agency called Healthy San Diego. According to the County of San Diego, the sponsor of this bill, the two statutorily mandated advisory boards have operated as a joint consumer and health professional advisory board to advise the county.
As referenced above, CalAIM is a multipronged and complicated set of initiatives. The need to coordinate with multiple plans to implement these initiatives locally can pose challenges, and the county has found the current advisory board is a successful forum to convene these conversations locally. Current statute authorizes the advisory boards to advise the county on implementation on the GMC model; this bill would provide authority to advise on the local implementation of Medi-Cal policy more broadly. In addition, according to the Center for Health Care Strategies, a nonprofit focused on Medicaid policy, compensating consumer members of an advisory board for their time and expertise is a best practice to support consumer meaningful participation.
- SUPPORT. The County of San Diego writes that this bill would modernize the Healthy San Diego Advisory Board to ensure health care quality for Medi-Cal recipients. This bill establishes a single Healthy San Diego Advisory Board composed of consumers and health care professionals to advise the board on the implementation of state Medi-Cal policy in San Diego County and allows the County to reimburse Medi-Cal recipients for their time performing duties on the advisory board.
REGISTERED SUPPORT / OPPOSITION:
Support
County of San Diego
Opposition
None on file.
Analysis Prepared by: Lisa Murawski / HEALTH / (916) 319-2097
SENATE RULES COMMITTEE Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB 1257 |
CONSENT
Bill No: SB 1257
Author: Blakespear (D)
Amended: 4/15/24
Vote: 21
SENATE HEALTH COMMITTEE: 11-0, 4/10/24
AYES: Roth, Nguyen, Glazer, Gonzalez, Grove, Hurtado, Limón, Menjivar, Rubio, Smallwood-Cuevas, Wiener
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
SUBJECT: Geographic Managed Care Pilot Project: County of San Diego: advisory board
SOURCE: County of San Diego
DIGEST:
This bill authorizes the County of San Diego to establish a single advisory board to advise its Health and Human Services Agency (HHSA) on the implementation of state Medi-Cal policy as it pertains to Medi-Cal managed care plans in the county. Makes additional technical changes to the advisory board.
ANALYSIS:
Existing law:
- Establishes the Medi-Cal program, administered by the Department of Health Care Services (DHCS), under which health care services are provided to qualified, low-income persons. [WIC § 14000, et seq.]
- Permits DHCS to implement a Geographic Managed Care (GMC) project in the County of San Diego offering multiple Medi-Cal managed care plans (MCMC plans), upon the approval of the county board of supervisors, for the provision of Medi-Cal benefits to eligible Medi-Cal recipients. [WIC § 14089.05]
- Permits the County of San Diego to establish two advisory boards, one composed of consumer representatives and one composed of health care professional representatives, to advise the county’s Department of Health Services and review and comment on all aspects of the implementation of the GMC project described in 2). [WIC § 14089.05]
- Requires the county board of supervisors to establish the number of members to serve on each advisory board and requires each supervisor to appoint an equal number of members from their district. [WIC § 14089.05]
- Prohibits advisory board members from being compensated for activities related to their duties as members, except for members who are Medi-Cal recipients, who are required to be reimbursed for their travel and child care expenses incurred while performing their duties as advisory board members. [WIC § 14089.05]
- Establishes the California Advancing and Innovating Medi-Cal (CalAIM) initiative effective from January 1, 2022 until December 31, 2026. The goals of CalAIM are to (a) identify and manage the risk and needs of Medi-Cal recipients through whole-person-care approaches and addressing social determinants of health; (b) transition and transform the Medi-Cal program to a more consistent and seamless system by reducing complexity and increasing flexibility; and (c) improve quality outcomes, reduce health disparities, and drive delivery system transformation and innovation through value-based initiatives, modernization of systems, and payment reform. [WIC §14184.100]
- Establishes, through CalAIM, new requirements on MCMC plans including new Medi-Cal populations subject to mandatory MCMC plan enrollment, new mandatory plan benefits, new optional plan benefits, new requirements to develop a population health management program, and new incentive payments to MCMC plans. [WIC §§ 14184.100-14184.207]
This bill:
- Permits the County of San Diego to establish a single advisory board composed of consumer representatives and health care professional representatives to advise the county HHSA, review, and comment on all aspects of the implementation of the GMC project.
- Requires the advisory board to advise on the implementation of state Medi-Cal policy as it pertains to Medi-Cal managed care plans in the County.
- Permits the County of San Diego to reimburse members of the advisory board who are Medi-Cal recipients for their time in performing their duties as advisory board members.
Comments
- Author’s statement. According to the author, in 2022, California embarked on the statewide initiative to modernize the Medi-Cal program, known as CalAIM. CalAIM involves far-reaching transformations of Medi-Cal’s managed care program, which is administered at the county level. Implementation of CalAIM in San Diego County is particularly challenging because the County is one of two counties that contract with multiple insurance plan providers under the GMC model. The multi-plan model adds substantial complexity and unique challenges to the County’s CalAIM implementation effort. By clarifying the County advisory board’s authority to support CalAIM implementation, this bill will enhance coordination, accountability, and innovation between various stakeholders, including patients, health care providers, insurance plans, and the San Diego County HHSA. Ultimately, this will maximize improvements in health care and social services for the County’s patients and reduce costs for all.
- MCMC plans in San Diego County. Beginning in 1981, the State began licensing different models of managed care delivery for Medi-Cal recipients in different counties. Today, over 14 million Medi-Cal recipients are enrolled in a MCMC plan and receive services through one of five managed care models, each with its own enacting statutes: Two-Plan, County Organized Health System, Regional Model, Single-Plan, and Geographic Managed Care. In 1998, San Diego became a GMC county, a model that allows several commercial plans to operate within the county to provide services to Medi-Cal recipients. As these plans are commercial plans, they are required to be licensed by the Department of Managed Health Care under the Knox-Keene Health Care Service Plan Act of 1975. Sacramento and San Diego are the only two GMC counties in the state, with the other counties all participating in one of the other models with far more restrictive choices, and in many cases, only one choice. As of February 2024, there were just under one million enrollees in San Diego’s four GMC plans.
The GMC program in San Diego is operated under an umbrella within the county HHSA called Healthy San Diego. For many years, the two statutorily mandated advisory boards have operated as a joint consumer and health professional advisory board to advise HHSA well beyond the initial implementation of the GMC program.
Related/Prior Legislation
SB 2139 (Haynes, Chapter 717, Statutes of 1996) added further requirements to the San Diego County GMC statute, including the requirement that there be two advisory boards.
AB 2178 (Peace, Chapter 631, Statutes of 1994) enabled development of the GMC program in San Diego County.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No
SUPPORT: (Verified 4/23/24)
County of San Diego (source)
OPPOSITION: (Verified 4/23/24)
None received
ARGUMENTS IN SUPPORT: The County of San Diego writes that this bill would modernize the County of San Diego’s Healthy San Diego Advisory Board to ensure health care quality for Medi-Cal recipients. Current law permits the board of supervisors of the County of San Diego to establish a multiplan managed care pilot project for the provision of Medi-Cal services. This bill establishes a single Healthy San Diego Advisory Board composed of consumers and health care professionals to advise the board on the implementation of state Medi-Cal policy in San Diego County and allows the County to reimburse Medi-Cal recipients for their time performing duties on the advisory board.
Click here to enter text.
Prepared by: Jen Flory / HEALTH / (916) 651-4111
4/24/24 11:16:23
**** END ****
SENATE COMMITTEE ON HEALTH
Senator Richard Roth, Chair
BILL NO: SB 1257
AUTHOR: | Blakespear | ||
VERSION: | February 15, 2024 | ||
HEARING DATE: | April 10, 2024 | ||
CONSULTANT: | Jen Flory | ||
SUBJECT: Geographic Managed Care Pilot Project: County of San Diego: CalAIM
SUMMARY:
Authorizes the County of San Diego to establish a single advisory board to advise its Health and Human Services Agency on the implementation of its Medi-Cal Geographic Managed Care project and to support the goals of the CalAIM initiative. Makes additional technical changes to the advisory board.
Existing law:
- Establishes the Medi-Cal program, administered by the Department of Health Care Services (DHCS), under which health care services are provided to qualified, low-income persons. [WIC § 14000, et seq.]
- Permits DHCS to implement a Geographic Managed Care (GMC) project in the County of San Diego offering multiple Medi-Cal managed care plans (MCMC plans), upon the approval of the county board of supervisors, for the provision of Medi-Cal benefits to eligible Medi-Cal recipients. [WIC § 14089.05]
- Permits the County of San Diego to establish two advisory boards, one composed of consumer representatives and one composed of health care professional representatives, to advise the county’s Department of Health Services and review and comment on all aspects of the implementation of the GMC project described in 2). [WIC § 14089.05]
- Requires the county board of supervisors to establish the number of members to serve on each advisory board and requires each supervisor to appoint an equal number of members from their district. [WIC § 14089.05]
- Prohibits advisory board members from being compensated for activities related to their duties as members, except for members who are Medi-Cal recipients, who are required to be reimbursed for their travel and child care expenses incurred while performing their duties as advisory board members. [WIC § 14089.05]
- Establishes the California Advancing and Innovating Medi-Cal (CalAIM) initiative effective from January 1, 2022 until December 31, 2026. The goals of CalAIM are to identify and manage the risk and needs of Medi-Cal recipients through whole-person-care approaches and addressing social determinants of health; transition and transform the Medi-Cal program to a more consistent and seamless system by reducing complexity and increasing flexibility; and improve quality outcomes, reduce health disparities, and drive delivery system transformation and innovation through value-based initiatives, modernization of systems, and payment reform. [WIC §14184.100]
- Establishes, through CalAIM, new requirements on MCMC plans including new Medi-Cal populations subject to mandatory MCMC plan enrollment, new mandatory plan benefits, new optional plan benefits, new requirements to develop a population health management program, and new incentive payments to MCMC plans. [WIC §§ 14184.100-14184.207]
This bill:
- Permits the County of San Diego to establish a single advisory board composed of consumer representatives and health care professional representatives to advise the county Health and Human Services Agency (HHSA), review, and comment on all aspects of the implementation of the GMC project.
- Requires the advisory board to support the goals of the CalAIM initiative.
- Permits the county to reimburse members of the advisory board who are Medi-Cal recipients for their time, travel, and childcare expenses incurred while performing their duties as advisory board members.
FISCAL EFFECT:
This bill has not been analyzed by a fiscal committee.
COMMENTS:
- Author’s statement. According to the author, in 2022, California embarked on the statewide initiative to modernize the Medi-Cal program, known as CalAIM. CalAIM involves far-reaching transformations of Medi-Cal’s managed care program, which is administered at the county level. Implementation of CalAIM in San Diego County is particularly challenging because the County is one of two counties that contract with multiple insurance plan providers under the GMC model. The multi-plan model adds substantial complexity and unique challenges to the County’s CalAIM implementation effort. By clarifying the County advisory board’s authority to support CalAIM implementation, this bill will enhance coordination, accountability, and innovation between various stakeholders, including patients, health care providers, insurance plans, and the San Diego County HHSA. Ultimately, this will maximize improvements in health care and social services for the County’s patients and reduce costs for all.
- MCMC plans in San Diego County. Beginning in 1981, the state began licensing different models of managed care delivery for Medi-Cal recipients in different counties. Today, over 14 million Medi-Cal recipients are enrolled in a MCMC plan and receive services through one of five managed care models, each with its own enacting statutes: Two-Plan, County Organized Health System, Regional Model, Single-Plan, and Geographic Managed Care. In 1998, San Diego became a GMC county, a model that allows several commercial plans to operate within the county to provide services to Medi-Cal recipients. As these plans are commercial plans, they are required to be licensed by the Department of Managed Health Care under the Knox-Keene Health Care Service Plan Act of 1975. Sacramento and San Diego are the only two GMC counties in the state, with the other counties all participating in one of the other models with far more restrictive choices, and in many cases, only one choice. As of February 2024, there were just under one million enrollees in San Diego’s four GMC plans.
The GMC program in San Diego is operated under an umbrella within the county HHSA called Healthy San Diego. For many years, the two statutorily mandated advisory boards have operated as a joint consumer and health professional advisory board to advise HHSA well beyond the initial implementation of the GMC program.
- Prior legislation. SB 2139 (Haynes, Chapter 717, Statutes of 1996) added further requirements to the San Diego County GMC statute, including the requirement that there be two advisory boards.
AB 2178 (Peace, Chapter 631, Statutes of 1994) enabled development of the GMC program in San Diego County.
- Support. Sponsor the County of San Diego writes that this bill would modernize the County of San Diego’s Healthy San Diego Advisory Board to ensure health care quality for Medi-Cal recipients. Current law permits the board of supervisors of the County of San Diego to establish a multiplan managed care pilot project for the provision of Medi-Cal services. This bill establishes a single Healthy San Diego Advisory Board composed of consumers and health care professionals to advise the board on the implementation of state Medi-Cal policy in San Diego County and allows the County to reimburse Medi-Cal recipients for their time performing duties on the advisory board.
- Policy comments. The language regarding the advisory board’s role in the implementation of CalAIM may be too specific considering that the CalAIM initiative ends at the end of 2026 and that state efforts to improve the managed care delivery system will likely continue. Additionally, the language allowing for Medi-Cal recipients who are advisory board members to be compensated for their time inadvertently made the mandatory reimbursement for travel and childcare expenses optional.
- Amendments. The author and committee have agreed to the following amendments to address the comments above:
(b)(1) . . . The advisory board shall advise on the implementation of state Medi-Cal policy as it pertains to health plans in San Diego. support the goals of the California Advancing and Innovating Medi-Cal (CalAIM) Act as set forth in Section 14184.100.
. . .
(b)(3) Members of the advisory boards shall not be paid compensation for activities relating to their duties as members, but members who are Medi-Cal recipients may shall be reimbursed an appropriate amount by the County of San Diego for their time, travel, and child care expenses incurred in performing their duties under this section. Members who are Medi-Cal recipients may also be reimbursed by the County of San Diego for their time performing their duties under this section, at the discretion of the county.
SUPPORT AND OPPOSITION:
Support: County of San Diego (sponsor)
Oppose: None received
-- END --
Bill Author
Bill Co-Author(s):