Bill Text: CA SB910 | 2019-2020 | Regular Session | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Population health management program.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2020-03-16 - Re-referred to Com. on HEALTH. [SB910 Detail]
Download: California-2019-SB910-Introduced.html
of of, Medi-Cal beneficiaries. At the director’s discretion, the contract may be exclusive or nonexclusive, statewide or on a more limited geographic basis, and include provisions to do
for the following:
Bill Title: Population health management program.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2020-03-16 - Re-referred to Com. on HEALTH. [SB910 Detail]
Download: California-2019-SB910-Introduced.html
CALIFORNIA LEGISLATURE—
2019–2020 REGULAR SESSION
Senate Bill
No. 910
| Introduced by Senator Pan |
February 03, 2020 |
An act to amend Section 14087.3 of the Welfare and Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
SB 910, as introduced, Pan.
Medi-Cal: managed care.
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 authorizes the Director of Health Care Services to contract, on a bid or nonbid basis, with any qualified individual, organization, or entity to provide services to, arrange for, or case manage the care of, Medi-Cal beneficiaries pursuant to specified provisions.
This bill would make technical, nonsubstantive changes to that provision.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: NO Local Program: NOBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 14087.3 of the Welfare and Institutions Code is amended to read:14087.3.
(a) The director may contract, on a bid or nonbid basis, with any qualified individual, organization, or entity to provide services to, or arrange for or case manage the care(1) Perform To perform targeted case management of selected services or beneficiary populations where it is expected that case management will reduce program expenditures.
(2) Provide To provide for delivery of services in a manner consistent with managed care principles, techniques, and practices directed at ensuring the most cost-effective and appropriate scope, duration, and level of care.
(3) Provide To provide for alternate methods of payment, including, but not limited to, a prospectively negotiated reimbursement rate, fee-for-service, retainer, capitation, shared savings, volume discounts, lowest bid price, negotiated price, rebates, or other basis.
(4) Secure To secure services directed at any or all of the following:
(A) Recruiting and organizing providers to care for Medi-Cal beneficiaries.
(B) Designing
and implementing fiscal or other incentives for providers to participate in the Medi-Cal program in cost-effective ways.
(C) Linking beneficiaries with cost-effective providers.
(5) Provide To provide for:
(A) Medi-Cal managed care plans contracting under this chapter or Chapter 8 (commencing with Section 14200) to share in the efficiencies and economies realized by those contracts.
(B) Effective coordination between contractors operating under this article and Medi-Cal managed care plans in the management of health care provided to Medi-Cal beneficiaries.
(6) Permit To permit individual physicians, groups of physicians, or other providers to participate in a manner that supports the organized system mode of operation.
(7) Encourage To encourage group practices with relationships with hospitals having low unit costs.
(b) (1) The director may require individual
physicians, groups of physicians, or other providers as a condition of participation under the Medi-Cal program, to enter into capitated contracts pursuant to this section in order to correct or prevent irregular or abusive billing practices. No
(2) Neither physician, groups of physicians, or nor other providers shall be reimbursed for services rendered to Medi-Cal beneficiaries if the physician, group of
physicians, or other providers has
have declined to enter into a contract required by the director pursuant to this section.
(c) The department shall seek federal waivers necessary to allow for federal financial participation under this section.
(d) (1) Notwithstanding the provisions of this chapter, the department shall determine preliminary per capita rates of payment for services provided to Medi-Cal beneficiaries enrolled in a managed care program contracting in areas specified by the director for expansion of the Medi-Cal managed care program under this section, or Sections 14018.7, 14087.31, 14087.35, 14087.36, 14087.38, or 14087.96. The department shall provide to each managed care plan the preliminary contract rates and source documents at least 60 days prior to
the effective date of each new rate period.
(2) On or before June 1, 1999, the department shall enter into a memorandum of understanding with the managed care plans subject to paragraph (1) regarding on the development of capitation rates. This memorandum of understanding, which is intended to ensure that capitation rates become effective in a timely manner and remain stable throughout the rate year, shall establish all of the following:
(A) A process and timetable for the managed care plans to review and comment on any modifications in the rate development methodology.
(B) A process and timetable for
the managed care plans to provide comments on the draft rates.
(C) A process and timetable for the department to respond to the managed care plan comments on the draft rates.
(D) A process and timetable to managed care finalize managed care capitation rates.
