Medi-Cal.

(1) Existing law authorizes the board of supervisors in each county to designate an entity or entities to assist county jail inmates with applying for a health insurance affordability program, as defined, consistent with federal requirements. Commencing January 1, 2023, this bill would instead require the board of supervisors, in consultation with the county sheriff, to designate an entity or entities to assist both county jail inmates and juvenile inmates with the application process, and would make conforming changes to provisions relating to the coordination duties of jail administrators. By creating new duties for local officials, including boards of supervisors and jail administrators, the bill would impose a state-mandated local program. No sooner than January 1, 2023, the bill would require the department to develop and implement a mandatory process for county jails and county juvenile facilities to coordinate with Medi-Cal managed care plans and Medi-Cal behavioral health delivery systems to facilitate continued behavioral health treatment in the community for inmates, as specified, and would authorize the sharing of prescribed data with and among counties and other specified entities, as determined necessary by the department. (2) 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, including mental health and substance use disorder 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 federal law provides for the federal Medicare program, which is a public health insurance program for persons who are 65 years of age or older and specified persons with disabilities who are under 65 years of age. Under existing law, a demonstration project known as the Coordinated Care Initiative (CCI) enables beneficiaries who are 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 these programs. Existing law, the Medi-Cal 2020 Demonstration Project Act, requires the department to implement specified components of a Medi-Cal demonstration project, including the Global Payment Program (GPP) , the Public Hospital Redesign and Incentives in Medi-Cal (PRIME) program, and the Whole Person Care pilot program, 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 (CalAIM) 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 make specified portions of the CCI operative only through December 31, 2022, as specified, and would repeal its provisions on January 1, 2025. The bill would also require Medi-Cal managed care plans to operate, or continue to operate, a Medicare Advantage Dual Special Needs Plan, commencing January 1, 2023, in CCI counties, and, commencing January 1, 2025, in all other counties. The bill would make various changes to the CCI component of the CalAIM initiative, including requiring the department to convene, in collaboration with the State Department of Social Services, a workgroup to address specified matters relating to the transition of beneficiaries residing in certain facilities from the Medi-Cal fee-for-service delivery system to the Medi-Cal managed care delivery system. Under the Medi-Cal program, behavioral health services, including specialty mental health services and substance use disorder treatment, are provided under the Medi-Cal Specialty Mental Health Services Program, the Drug Medi-Cal Treatment Program, and the Drug Medi-Cal organized delivery system, respectively. Under existing law, specialty mental health services and substance use disorder treatment are funded through certified public expenditures. Existing law requires the department to implement managed mental health care by delivering specialty mental health services to Medi-Cal beneficiaries through contracts with county mental health plans. Under existing law, for individuals 21 years of age and older, a service is "medically necessary" if it is reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain. Existing law provides that for individuals under 21 years of age, "medically necessary" or "medical necessity" standards are governed by the definition in federal law. This bill would provide that these medical necessity standards do not preclude coverage for, and reimbursement of, a clinically appropriate and covered mental health or substance use disorder assessment, screening, or treatment service under certain circumstances. The bill would provide that the above-described medical necessity criteria for a Medi-Cal beneficiary under 21 years of age is applicable to the Drug Medi-Cal Treatment Program and the Drug Medi-Cal organized delivery system. For the 2022–23 and 2023–24 fiscal years, the bill would require the department to include certain information on Medi-Cal specialty mental health services in the Medi-Cal program assumptions and estimates. The bill would require the department to develop standardized screening tools and statewide transition tools, and to require the use of these tools after those tools have been field tested. This bill would require the department to establish, implement, and administer the Behavioral Health Quality Improvement Program to assist county mental health plans and counties that administer the Drug Medi-Cal Treatment Program or the Drug Medi-Cal organized delivery system to prepare those entities for implementation of the behavioral health components included in CalAIM, and would establish in the State Treasury the Behavioral Health Quality Improvement Account to fund those efforts. For purposes of the CalAIM initiative, commencing January 1, 2022, this bill would require the department to continue to implement the Medi-Cal Specialty Mental Health Services Program and the Drug Medi-Cal organized delivery system, as a component of CalAIM and consistent with the Special Terms and Conditions approved by the federal Centers for Medicare and Medicaid Services. Commencing no sooner than July 1, 2022, the bill would require each Medi-Cal behavioral health delivery system to comply with the behavioral health payment reform provisions approved in the CalAIM Terms and Conditions. Commencing no sooner than July 1, 2022, the bill would require the nonfederal share of any payments associated with Medi-Cal behavioral health systems to consist of voluntary intergovernmental transfers of funds provided by eligible governmental agencies or public entities associated with those systems. The bill would require the department to establish and implement prospective reimbursement rate methodologies utilizing past county cost experience for specified services provided through Medi-Cal behavioral health delivery systems. Commencing January 1, 2027, the bill would require a county, or counties acting jointly, to provide and administer covered behavioral health Medi-Cal benefits under a single Medi-Cal behavioral health delivery system contract pursuant to the CalAIM Terms and Conditions. Under the GPP, existing law makes designated public hospitals, and any successor or differently named hospital, eligible to receive global payments that are calculated using a value-based point methodology based on the health care that they provide to the uninsured. This bill would authorize those designated hospitals, if restructured or reorganized, to continue to participate in the GPP, and, commencing January 1, 2021, would authorize the continuation of the GPP, as modified, and as a component of the CalAIM initiative. Existing law establishes the Medi-Cal Hospital/Uninsured Care Demonstration Project Act, which revises hospital reimbursement methodologies to maximize the use of federal funds consistent with federal Medicaid law and stabilize the distribution of funding for hospitals that provide care to Medi-Cal beneficiaries and uninsured patients. Under the Medi-Cal 2020 demonstration project, existing law establishes prescribed payment methodologies and requirements relating to the Medi-Cal Hospital/Uninsured Care Demonstration Project Act. This bill would generally extend the specified payment methodologies set forth under the Medi-Cal 2020 demonstration project as part of the CalAIM initiative, and would make technical and conforming changes. For the 2020–21 state fiscal year, and subsequent state fiscal years, the bill would modify reimbursement methodologies for designated public hospitals. Existing law requires the department to establish and maintain the County Administrative Cost Control Plan, whereby costs for county administration of the determination of eligibility for benefits under the Medi-Cal program are controlled within the amounts annually appropriated for that administration. Existing law requires this plan to establish standards and performance criteria, including workload standards, and requires counties to adhere to these requirements. Existing law imposes various duties on counties relating to Medi-Cal eligibility, such as requiring counties to submit reconciliation files of its Medi-Cal eligible population, as specified. No later than July 1, 2022, this bill would require the department to issue guidance, in consultation with specified individuals and entities, to restart county performance reporting and monitoring processes, and, during the consultation process, would require the department to perform prescribed duties. Commencing with the 2017–18 state fiscal year, existing law requires the department to establish a program under which a designated public hospital system may earn performance-based quality incentive payments from Medi-Cal managed care plans, and requires payments to be earned by each designated public hospital system based on its performance in achieving identified targets for quality of care. Under existing law, these payments are federally and nonfederally funded, and the nonfederal share may consist of voluntary intergovernmental transfers of funds that the department may deposit the transfer in the Medi-Cal Inpatient Payment Adjustment Fund, a continuously appropriated fund. Existing law requires the department to establish uniform performance measures and parameters for the designated public hospital systems to select the applicable measures and requires these performance measures to advance at least one goal identified in the state's Medicaid quality strategy. Commencing with the 2020–21 state fiscal year, this bill would require the department to consult with district and municipal hospitals, would expand the performance-based quality incentive payments to those hospitals, and would make various conforming changes relating to this expansion. By increasing the intergovernmental transfers of funds that the department may deposit in the Medi-Cal Inpatient Payment Adjustment Fund, a continuously appropriated fund, the bill would make an appropriation. Through and until June 30, 2020, the bill would provide that specified performance measures shall not duplicate measures utilized in the PRIME program. Commencing with the 2020–21 state fiscal year, the bill would impose specified requirements relating to the implementation of these payments on those hospitals and the department. The bill would cease the implementation of the expanded quality incentive payments if the implementation is no longer financially and programmatically supportive of the Medi-Cal program, as determined pursuant to prescribed factors. (3) This bill would make its provisions severable and would make other legislative findings and declarations. (4) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.