Amended
IN
Assembly
March 23, 2018
CALIFORNIA LEGISLATURE—
2017–2018 REGULAR SESSION
Assembly Bill
No. 2472Introduced by Assembly Member Wood
(Coauthors: Assembly Members Arambula, Chiu, and Friedman)
February 14, 2018
An act to amend Section 1368.03 of add Chapter 2.34 (commencing with Section 1414.10) to Division 2 of the Health and Safety Code, relating to health care service plans. coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 2472, as amended, Wood.
Health care service plans. coverage: Medi-Cal: public purchase option.
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 establishes eligibility criteria for beneficiary enrollment in the Medi-Cal program, and requires counties to make eligibility determinations for those purposes.
This bill would require the State Department of Health Care Services to apply to the United States Department of Health and Human Services for federal waivers to permit individuals whose income is greater than the income eligibility threshold for Medi-Cal benefits to purchase coverage under the Medi-Cal
program through a separate public purchase option. The bill would require the Director of Health Care Services to report to the health and budget committees of the Legislature on its progress in this regard by January 1, 2020. The bill would require the department to prepare an implementation plan for the public purchase option, including specified components, and to submit the plan to the health committees of both houses of the Legislature by March 1, 2020.
Existing law provides for the licensing and regulation of health care service plans by the Department of Managed Health Care. Existing law authorizes the department to require enrollees and subscribers of health care service plans to participate in a plan’s grievance process for up to 30 days before pursuing a grievance through the department or the independent medical review system, and authorizes the department to refer a grievance issue unrelated to compliance with the laws governing health care service plans to the appropriate governmental entity.
This bill would make technical, nonsubstantive changes to that provision.
The people of the State of California do enact as follows:
SECTION 1. Chapter 2.34 (commencing with Section 1414.10) is added to Division 2 of the Health and Safety Code, to read:
CHAPTER
2.34. Public Purchase Option
1414.10. (a) The State Department of Health Care Services shall apply to the United States Department of Health and Human Services for federal waivers to permit individuals whose income is greater than the income eligibility threshold for Medi-Cal benefits to purchase coverage under the Medi-Cal program through a separate public purchase option in accordance with this chapter.
(b) The Director of Health Care Services shall report to the health and budget committees of both houses of the Legislature on the progress in receiving the federal waivers described in subdivision (a) by January 1, 2020.
1414.11. (a) The State Department of Health Care Services shall prepare an implementation plan for the public purchase option described in Section 1414.10. At a minimum, the plan shall include all of the following:
(1) Actuarial and economic analyses.
(2) Eligibility requirements.
(3) Program benefits.
(4) Enrollment process.
(5) Premiums and cost sharing.
(6) Participation of public and private health plans, including county
organized health systems and local health plans.
(7) Relationship of the plan to Covered California and the subsidized individual market.
(8) Administration.
(b) The department shall submit the plan described in subdivision (a) to the health committees of both houses of the Legislature by March 1, 2020. The plan shall be submitted in compliance with Section 9795 of the Government Code.
SECTION 1.Section 1368.03 of the Health and Safety Code is amended to read:1368.03.
(a)The department may require enrollees and subscribers to participate in a plan’s grievance process for up to 30 days before pursuing a grievance through the department or the independent medical review system. However, the department may not impose this waiting period for expedited review cases covered by subdivision (b) of Section 1368.01 or in any other case where the department determines that an earlier review is warranted.
(b)Notwithstanding subdivision (a), the department may refer a grievance issue that does not pertain to compliance with this chapter to the State Department of Health
Care Services, the California Department of Aging, the federal Centers for Medicare and Medicaid Services, or any other appropriate governmental entity for investigation and resolution.