Bill Text: CA SB492 | 2015-2016 | Regular Session | Enrolled
Bill Title: Coordinated Care Initiative: consumer educational and informational guide.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Failed) 2016-11-30 - Died at Desk. [SB492 Detail]
Download: California-2015-SB492-Enrolled.html
BILL NUMBER: SB 492 ENROLLED
BILL TEXT
PASSED THE SENATE AUGUST 24, 2015
PASSED THE ASSEMBLY AUGUST 17, 2015
AMENDED IN ASSEMBLY JUNE 25, 2015
AMENDED IN SENATE MAY 5, 2015
AMENDED IN SENATE APRIL 20, 2015
INTRODUCED BY Senator Liu
(Principal coauthor: Senator Wolk)
(Principal coauthor: Assembly Member Brown)
FEBRUARY 26, 2015
An act to add Section 14132.279 to the Welfare and Institutions
Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
SB 492, Liu. Coordinated Care Initiative: consumer educational and
informational guide.
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. One of the methods by which these
services are provided is pursuant to contracts with various types of
managed care health plans. Existing federal law provides for the
federal Medicare Program, which is a public health insurance program
for persons 65 years of age and older and specified persons with
disabilities who are under 65 years of age.
Existing law, the Coordinated Care Initiative (CCI), requires the
department to seek federal approval pursuant to a Medicare or a
Medicaid demonstration project or waiver, or a combination thereof,
to establish a demonstration project that enables beneficiaries
dually eligible for the Medi-Cal program and the Medicare Program to
receive a continuum of services that maximizes access to, and
coordination of, benefits between the programs.
This bill would make legislative findings and declarations
relating to the CCI and the availability of consumer protections for
beneficiaries. The bill would require, no later than July 1, 2016,
the department to develop and post on the department's Internet Web
site, an educational and informational guide to assist consumers and
patients in understanding the rights afforded to them under the CCI
and how to effectively exercise those rights, as specified. The bill
would require the department to distribute the educational and
informational guide to specified consumer advocacy groups and
programs and, upon request, to all other interested persons. The bill
would require the department to update the educational and
informational guide annually, or as necessary, to keep the
information contained in the guide up to date regarding changes to
the CCI.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) The Coordinated Care Initiative is an innovative health care
service delivery model for Californians who are eligible for services
under both the Medi-Cal and Medicare programs.
(b) Individuals eligible for services under the Coordinated Care
Initiative represent a diverse group of older adults and persons with
disabilities, and include some of the most vulnerable members of our
population.
(c) Incorporation of services from two programs required a variety
of changes in federal and state law, and complex contractual
agreements between the state and the federal Centers for Medicare and
Medicaid Services and between health plans and the various
administering state agencies.
(d) A key component of the Coordinated Care Initiative is the
inclusion of comprehensive beneficiary protections to ensure that
eligible individuals receive appropriate, safe, and high-quality
care. However, these protections are provided for throughout the
various statutes and contractual documents that govern the
establishment and operation of the Coordinated Care Initiative.
(e) It is the intent of the Legislature in enacting this act to
recognize the diversity of individuals receiving services under the
Coordinated Care Initiative, and encourage implementation of an
individualized, person-centered service delivery model. The
Coordinated Care Initiative Consumer and Patient Educational and
Informational Guide is intended to empower beneficiaries to
effectively participate in decisions affecting their health care, by
providing information regarding the protections afforded to them
under the initiative.
SEC. 2. Section 14132.279 is added to the Welfare and Institutions
Code, to read:
14132.279. (a) This section shall be known, and may be cited, as
the Coordinated Care Initiative Consumer and Patient Educational and
Informational Guide.
(b) By July 1, 2016, the department shall develop and post on the
department's Internet Web site, an educational and informational
guide for consumers and patients about the Coordinated Care
Initiative (CCI). In developing the educational and informational
guide, the department shall consult with stakeholders. The guide
shall describe consumer and patient rights under the CCI, and inform
consumers and patients of effective ways to exercise their rights and
who to contact for assistance in securing those rights. The guide
shall include, but not be limited to, all of the following
information:
(1) How to determine whether a health care provider participates
in the CCI.
(2) How to file a grievance and appeal.
(3) How to change health plans.
(4) How to switch from Cal MediConnect to original Medicare and a
Medi-Cal managed care plan.
(5) How to obtain assistance in alternative languages.
(6) The toll-free telephone numbers for the following programs to
assist in problem solving:
(A) Cal MediConnect's Ombudsperson Program.
(B) Medi-Cal Managed Care Office of the Ombudsperson.
(C) HMO Help Center, operated by the Department of Managed Health
Care.
(D) Medicare.
(E) Health Care Options.
(c) (1) The educational and informational guide shall include
information for each of the following groups of individuals:
(A) Dual eligibles: those individuals who are dually eligible for
Medicare and Medi-Cal.
(B) Seniors and persons with disabilities who are required to
receive long-term services and supports through a Medi-Cal managed
care plan.
(2) The department may develop a separate educational and
informational guide for each of the groups identified in paragraph
(1).
(d) (1) Upon publication, the department shall distribute the
educational and informational guide developed pursuant to this
section to all of the following organizations:
(A) Statewide senior advocacy groups.
(B) Statewide consumer advocacy groups.
(C) State and local ombudspersons.
(D) Health consumer centers.
(E) Health insurance counseling and advocacy programs.
(2) The educational and informational guide shall be made
available upon request to all other interested persons.
(e) The department shall make the educational and informational
guide easy to read and understand and available in all Medi-Cal
threshold languages, using an appropriate literacy level and in a
culturally competent manner.
(f) The department shall update the educational and informational
guide developed pursuant to this section annually, or as necessary,
to keep the information contained in the guide up to date regarding
changes to the CCI.
