SB 279

Bill Subjects

Abstract

(1) Existing law establishes 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, either through a fee-for-service or managed care delivery system. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law authorizes the department to create the Health Home Program for Medi-Cal enrollees with chronic conditions, subject to federal approval and the availability of federal financial participation. Existing law generally conditions the implementation of the program on no additional General Fund moneys being used to fund the administration and costs of services. This bill would authorize, commencing with the 2021–22 state fiscal year, the Health Home Program to be implemented using General Fund moneys upon appropriation by the Legislature. The bill would require the department to cease implementing the Health Home Program on January 1, 2022, or as specified, and would repeal the Health Home Program's provisions on January 1, 2023. (2) Existing law authorizes the department to enter into various types of contracts for the provision of services to beneficiaries, including contracts with a Medi-Cal managed care plan. Existing law imposes various requirements on managed care plan contractors, including network adequacy standards relating to time and distance. For contract periods commencing on or after January 1, 2026, the bill would authorize the department to require each Medi-Cal managed care plan and each health plan subcontractor of a Medi-Cal managed care plan to be accredited by the National Committee for Quality Assurance, or an alternative entity, as specified. (3) Existing law, the Medi-Cal 2020 Demonstration Project Act, requires the department to implement specified components of a Medi-Cal demonstration project, including the Dental Transformation Initiative, consistent with the Special Terms and Conditions approved by the federal Centers for Medicare and Medicaid Services. Pursuant to existing law, the department has created a multiyear initiative, the California Advancing and Innovating Medi-Cal initiative, for purposes of building upon the outcomes of various Medi-Cal pilots and demonstration projects, including the Medi-Cal 2020 demonstration project. This bill would require, subject to federal approval, the department to implement the State Plan Dental Improvement Program, with the goal of further improving accessibility of Medi-Cal dental services and oral health outcomes for targeted populations, as a successor program to the Dental Transformation Initiative. Commencing no sooner than January 1, 2021, the bill would expand the Medi-Cal schedule of benefits for certain populations, such as Caries Risk Assessment bundle for eligible children who are 0 to 6 years of age, and would require the department to make supplemental payments to qualified dental providers for increased utilization of certain preventive dental services and for the establishment or maintenance of beneficiary continuity of care through a dental home. The bill would require the department to develop the methodology for making these supplemental payments to qualified dental providers, including safety net clinics.