CSAC Bulletin Article

Health and Human Services 12/5/2014

2015 Legislative Session Begins

On December 1, the California Senate and Assembly convened their organizing sessions for the 2015 Legislative year. The desks remain open for both houses, allowing new bills to be introduced, but the full Senate and Assembly will not reconvene until January 5.

Introduced bills include:

  • Assembly Bill 11, by Assemblymember Lorena Gonzalez, to add in-home support services worker to the definition of employee under the Healthy Workplaces, Healthy Families Act of 2014 beginning July 1, 2016, thereby entitling IHSS workers to accrue one hour of sick leave for every 30 hours worked.
  • Senate Bill 4, by Senator Ricardo Lara, to declare it the Legislature’s intent that all Californians, regardless of immigration status, have access to affordable health coverage and care.
  • Senate Bill 11, by Senator Jim Beall, to express the intent of the Legislature to enact legislation to increase the minimum mental health training standard for California Peace Officers.
  • Senate Bill 23, by Senator Holly Mitchell, to allow the birth of a new child to a family that has received aid under the CalWORKs program continuously for the prior 10 months, to be considered for purposes of determining a family’s maximum aid payment.
  • Senate Bill 36, by Senator Ed Hernandez, to require the Department of Health Care Services to submit an application to the federal Centers for Medicare and Medicaid Services for a waiver to implement a successor 1115 Medicaid Waiver demonstration project.

Assemblymember Tony Thurmond Chair, Budget Subcommittee No. 1 on Health and Human Services

Newly elected Assemblymember Tony Thurmond, representing the California State Assembly’s 15th district, was appointed by Speaker Atkins as chair of the Budget Subcommittee No. 1 on Health and Human Services.

During his campaign, Assemblymember Thurmond, a former city councilmember and former school board member, stated he would focus on:

  • Supporting youth and families
  • Improving schools and increasing access to higher education
  • Cleaning up and protecting our environment
  • Creating good jobs and increasing the minimum wage
  • Saving Doctors Medical Center, improving access to quality health care and mental health care; and
  • Combatting crime and violence in our communities.

Assemblymember Rob Bonta Chair, Assembly Committee on Health

Speaker Atkins appointed Assemblymember Rob Bonta as Chair of the Assembly Committee on Health. The Committee’s primary jurisdictions are health care, health insurance, Medi-Cal and other public health care programs, mental health licensing of health and health-related professionals and long-term health care facilities.

Elected to the California State Assembly’s 18th district in 2012, Assemblymember Bonta has previously served as a member of the Health Committee.

Prior to serving in the Assembly, he served as the Vice Mayor of the City of Alameda and prior to that, as an elected member of the Alameda Health Care District Board of Directors.

Assemblymember Bonta will also chair continue to chair the Assembly Committee on Public Employees, Retirement and Social Security.

Assemblymember Kansen Chu Chair, Assembly Committee on Human Services

Assemblymember Kansen Chu, was appointed by Speaker Atkins to chair the Assembly Committee on Human Services. The Committee’s jurisdiction includes child welfare services, foster care, child care, adoption assistance, CalWORKs, CalFresh, developmental disability services, In-home Supportive Services, community care licensing, adult protective services and Supplemental Security Income/State Supplementary Payment.

Assembly Member Chu, newly elected to the California State Assembly represents the 25thdistrict. He is a former city councilmember, whose top priorities included public health and environment. As a long-time advocate for education, Assemblymember Chu also previously served as a school board member.

CDPH Director Ron Chapman Stepping Down from Office

On Wednesday, Ron Chapman, Director of the California Department of Public Health, announced that he will be leaving CDPH at the end of January 2015. Director Chapman, a board-certified family physician, was appointed Director in June 2011. Prior to becoming Director, he served as the Chief Medical Officer of Partnership Health Plan of California and the Public Health Officer and Deputy Director of Public Health in Solano County. From 1998 to 2004, Director Chapman served as the founding chief of the Medicine and Public Health Section in the California Department of Public Health.

Although he has not yet announced his next venture, Director Chapman did share that his work in public health will continue.

DHCS Stakeholder Advisor Committee Meeting

The Department of Health Care Services (DHCS) convened a Stakeholder Advisory Committee meeting on December 3 at the Sacramento Convention Center. DHCS provided updates on the Substance Use Disorder Services Waiver, the Rural Managed Care Expansion and the 1115 Waiver Renewal Process, in addition to other key topics.

DHCS Chief Deputy Director Mari Cantwell announced Wendy Soe as the new Senior Advisor for Policy. Ms. Soe has worked closely with Chief Deputy Director Cantwell over the past few years on waiver implementation and other pressing issues. Ms. Soe will lead the 1115 Waiver Renewal efforts for DHCS.

Additional information and meeting materials are posted on the DHCS webpage.

State Formally Submits Drug Medi-Cal Waiver to Federal Government

The Department of Health Care Services (DHCS) submitted its Drug Medi-Cal Organized Delivery System Waiver to the Centers for Medicare and Medicaid Services (CMS) on November 21, 2014. The terms and conditions document can be found here.

Under federal rules, CMS has 120 days to review the waiver proposal. DHCS is continuing to solicit feedback on the waiver and will be hosting a stakeholder meeting in January to discuss the development of the implementation plan that interested counties will be required to submit.

Please recall that the waiver would be an opt-in – counties would have the option of participating. For counties that do not participate, the existing Drug Medi-Cal delivery system and responsibilities would remain unchanged. DHCS will be asking counties interested in participating in the waiver to submit letters of intent. Once details about the implementation plan are available, counties will be required to submit implementation plans to DHCS. The implementation plans will not require Board of Supervisor approval. Once the implementation plans are reviewed, the interested county would submit a rate package to DHCS. At that point, DHCS and the interested county would negotiate on state/county cost sharing.

Financial Details

Additionally, there is more information available from DHCS about the financing components of the DMC waiver. DHCS presented to stakeholders on November 3, 2014. To view the DHCS power point presentation, click here.

DHCS recognizes the need to address the following financing components:

  • Switching from the current allocation of DMC based on county of service to a county of residence model. DHCS recognizes the need to consider how that will impact funding for individual counties.
  • Variability among counties in historical expenditures and service levels.
  • Variability among counties in population and number of users vs. number of DMC beneficiaries overall.
  • Need to develop a methodology that would account for new services and new populations.
  • Need to develop a methodology that would maintain state and county funding responsibilities but also provides flexibility for counties to develop rates to ensure provider participation AND ensure that neither the state nor counties had financial incentives to influence service use or type.

DHCS is utilizing a per user per month methodology (which they are referring to as PUPM) as the basis for developing a financing model. DHCS looked at five years of historic cost data and trended it forwarded for two years for each of the 58 counties. The department is willing to work with any county that is interested in looking at the specific per user per month data. The historic data would be used in conjunction with a model to forecast utilization and costs of the new services.

An interested county and DHCS would work together to develop a state/county sharing ratio for non-federal costs that takes into account historic expenditures and projections of future utilization and costs. The sharing ratio would be based on what percentage of non-federal funding would have been either the state’s or the county’s absent the waiver. For example, if a county’s historic costs trended forwarded would have been $25 million absent the waiver, but with the addition of new services and populations costs are projected to be $50 million; the state and county would share in DMC waiver costs at a rate of 50/50.

A county that opts to participate in the waiver would have the ability to set provider rates. The rates would be subject to DHCS approval. DHCS believes the per user per month provides a target for counties to consider in developing rates, and service and utilization projections.

The per user per month model is also being used to develop the budget neutrality component of the waiver.


Key elements of the DMC Organized Delivery System (ODS) Waiver include:

  • Creates a continuum of care for substance use disorder treatment services, including early intervention, physician consultation, outpatient treatment, case management, medication assisted treatment, recovery services, recovery residence, withdrawal management and residential treatment.
  • Directs the use of an assessment tool (the American Society of Addiction Medicine, ASAM) to determine the most appropriate level of care.
  • Provides for case management services to ensure that the client is moving through the continuum of care and that counties coordinate care for those residing in the county.
  • Gives counties more authority to select providers, through selective provider contracting.
  • Establishment of relationships between county substance use programs and managed care plans and criminal justice partners. The draft requires counties to enter into MOUs with managed care health plans for referrals and coordination, and also includes language that county substance abuse programs coordinate with criminal justice partners.

DHCS is proposing that counties operate pre-paid ambulatory plans under Medicaid law. Essentially counties would act as specialty health plans for the delivery of substance use disorder treatment. This would be a parallel to the existing arrangement where counties operate pre-paid inpatient plans for the delivery of specialty mental health services.

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