CSAC Bulletin Article

Health and Human Services update 10/3/2014

For a summary chart of the 2014 Legislative Session Health and Human Services bills mentioned below, please click here.

Medi-Cal

SB 508 (Hernandez) – Support
Chapter 831, Statutes of 2014

SB 508, by Senator Ed Hernandez, makes necessary changes to the statutory framework for California’s implementation of the Patient Protection and Affordable Care Act of 2010 (ACA). The measure is a follow-up to SBX1 1 (Hernandez and Steinberg, Chapter 4, Statutes of 2013) and ABX1 1 (Perez, Chapter 3, Statutes of 2013).

Signed into law on September 29, SB 508 codifies the new federal income standards – utilizing modified adjusted gross income (MAGI) rules – established by the Department of Health Care Services (DHCS) for determining Medi-Cal eligibility. SB 508 ensures California statutes accurately reflect how the Administration has defined the MAGI standards for purposes of eligibility of various groups.

Additionally, the measure extends Medi-Cal benefits to independent foster care adolescents. SB 508 ensures that foster youth who lose foster care eligibility due to having reached the maximum age for assistance are still be able to get Medicaid coverage up to age 26 or a higher age the state has elected under federal law. Recent state law changes allow youth to remain in care beyond age 18, up to age 21. As a result, youth are leaving care at various ages. SB 508 ensures that these youth are treated equally for purposes of ongoing eligibility for Medi-Cal benefits. SB 508 also streamlines eligibility by deleting the deprivation requirement for parent or caretaker relatives.

SB 1341 (Mitchell) – Support
Chapter 846, Statutes of 2014

SB 1341, by Senator Holly Mitchell, codifies the existing agreement between the Administration, Covered California, and the counties regarding the respective roles of the State Automated Welfare System (SAWS) and the California Health Eligibility Enrollment and Retention System (CalHEERS).

Specifically, SB 1341:

  • Specifies SAWS as the system of record for Medi-Cal and that SAWS shall contain all Medi-Cal eligibility rules and case management functionality. The bill permits the MAGI rules for Medi-Cal to continue to be housed in CalHEERS as they currently are; and,
  • Requires that Notices of Action (NOAs) for Medi-Cal be programmed into the Medi-Cal system of record: the SAWS systems.

This week, Governor Brown signed SB 1341 into law.

SB 1089 (Mitchell) – Support 

Chapter 836, Statutes of 2014

SB 1089, by Senator Holly Mitchell, was sponsored by Los Angeles County and intended as a technical clean-up measure for AB 396 (Chapter 394, Statutes of 2011). AB 396 created a voluntary program that allows counties to draw down federal matching funds for the medical treatment of minors who are held in a juvenile justice facility and require hospitalization. SB 1089, signed into law on September 29, clarifies the county’s share of the costs and encourages the development of a claiming process.

SB 1124 (Hernandez) – Support 
Vetoed

Governor Brown vetoed SB 1124, by Senator Ed Hernandez, stating that the cost needs to be considered along other worthwhile policy changes in the budget process next year. SB 1124 would have limited estate recovery in California to those age 55 and over to only the health care services required to be recovered under federal law. It would have also eliminated recovery against the estate of a surviving spouse of a deceased Medi-Cal beneficiary. SB 1124 would have required DHCS to provide to Medi-Cal beneficiaries, free-of-charge, the total amount of Medi-Cal expenses paid on behalf of the beneficiary that are subject to estate recovery and would have required DHCS to post information regarding how to request this information.

CSAC supported SB 1124 as it aimed to encourage individuals over the age of 55 to enroll in Medi-Cal by alleviating some key deterrents resulting from to estate recovery. The Governor’s veto message follows:

I am returning Senate Bill 1124 without my signature. The bill would revise Medi-Cal’s policy of recouping monies from some estates of deceased beneficiaries and require certain notices to be made to current and former beneficiaries about estate recovery. Allowing more estate protection for the next generation may be a reasonable policy goal. The cost of this change, however, needs to be considered alongside other worthwhile policy changes in the budget process next year. Sincerely, Edmund G. Brown Jr.

SB 1339 (Canella) – Pending
Chapter 488, Statutes of 2014

SB 1339, by Senator Canella, was signed into law by Governor Brown on September 19. The bill was introduced in response to the fraud cases uncovered in the Drug Medi-Cal program last year. Specifically, the measure requires a county or the Department of Health Care Services (DHCS) to obtain criminal background information from facility owners and key staff of a certified Drug Medi-Cal provider before contracting with that provider. Additionally, the bill authorizes a county or the DHCS to contract with a certified DMC provider irrespective of the contents of the state summary criminal history information.

SB 1150 (Hueso and Correa) – Support 
As Amended on March 26, 2014 

SB 1150 by Senators Ben Hueso and Lou Correa would have allowed Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) to be reimbursed by Medi-Cal for two visits by a patient with a single or different health care professional on the same day at a single location. Specifically, SB 1150 would have allowed for billing for two visits when a patient has a medical visit and an additional visit with a mental health practitioner or a dental professional. SB 1150, sponsored by Orange County, was held by the Senate Appropriations Committee and did not move forward this legislative process. 

SB 1081 (Hernandez) – Support
As Introduced February 19, 2014

SB 1081, by Senator Hernandez, sought to create a three-year Medi-Cal alternative payment methodology pilot project for county and community-based federally qualified health centers (FQHCs). The proposed pilot projects consisted of a rural and an urban pilot, to test a full managed care contracting arrangement and “wrap cap” respectively. CSAC Supported SB 1081 as it offered an exciting opportunity to test innovations in care delivery through payment reform.

SB 1081 was held by the Senate Appropriations Committee and did not move forward this legislative session.

Mental Health

SB 1054 (Steinberg) – Support 
Chapter 436, Statutes of 2014 

SB 1054, by Senate President pro Tempore Darrell Steinberg, extends a working group deadline for improving the collection of juvenile justice data and makes several adjustments to the structure the Mentally Ill Offender Crime Reduction Grants program – such as shortening the grant terms from four to three years — which was renewed in the 2014-15 budget. 

CSAC supports SB 1054, which Governor Brown signed into law on September 18.

AB 1725 (Maienschein) – Oppose 
As Amended on April 30, 2014 

AB 1725, by Assembly Member Brian Maienschein, was concerning for counties as it would have increased costs and workload levels and hasten the erosion of county authority in conservatorship investigations had this measure moved forward.

Counties remained opposed to the remaining provisions in the April 30 amendments, which would have allowed a Probate Court to make a recommendation of conservatorship to the county Conservatorship Officer (CO) and require the CO to conduct the investigation and file a report within 30 days of the probate court recommendation.

While the proposed language did not require the CO to recommend conservatorship to the Superior Court, it did compel the CO to conduct a conservatorship investigation. This was contrary to current law, whereby a CO retains the authority to determine whether an investigation is warranted upon receiving a referral by a medical professional.

Had the mandate in AB 1725 become law, counties anticipated a significant increase in workload and county costs for conservatorship investigations. Further, the measure would have also imposed an arbitrary and frankly unrealistic 30-day mandated timeline for the investigation and submission of a report to the Superior Court.

AB 1725 was held by the Senate Appropriations Committee and did not move forward this legislative session.

Substance Use Disorder Treatment

SB 1161 (Beall) – Support 
Chapter 486, Statutes of 2014

SB 1161, by Senator Jim Beall, requires the Department of Health Care Services to expand substance use disorder (SUD) residential treatment capacity and medical detoxification services in California by pursuing a federal Medicaid waiver with the Center for Medicare and Medicaid Services.

SB 1161 ensures that residential care facilities for substance use disorder and medical detoxification services are available to Medi-Cal beneficiaries. Expansion of provider capacity is a critical component of ensuring that the Medi-Cal expansion meets the needs of those seeking substance use disorder treatment. As California looks to expand treatment capacity, it should partner with the federal government in seeking flexibility in the models for delivering care that will allow for the most cost effective expenditure of public funds.

CSAC is also supportive of DHCS’s pursuit of a broad federal waiver to test a new model for better access and care coordination within the Drug Medi-Cal program and SUD services at the county level. Governor Brown signed SB 1161 on September 19.

Public Health 

AB 467 (Stone) – Support 
Chapter 10, Statutes of 2014 

AB 467, by Assembly Member Mark Stone, allows the California State Board of Pharmacy to license a surplus medication collection and distribution intermediary (SMCDI), with standards and safeguards to ensure the efficiency and safety of county Pharmaceutical Repository and Distribution Programs (SB 1329 by Senator Joe Simitian, Chapter 709, Statutes of 2012).

CSAC supported SB 1329 and supported AB 467 to further clarify technical portions of Pharmaceutical Repository and Distribution Programs. The Governor signed AB 467 into law.

SB 443 (Walters) – Oppose 
As Amended on August 4, 2014

SB 443, by Senator Mimi Walters, would have recast the provisions of and define an organized camp and organized resident camp. It would have also required an organized camp to register annually with the local public health officer and provide the local public health officer with its written plan or written verification that the camp is accredited.

CSAC opposed SB 443, which was held by the Assembly Appropriations Committee.

AB 2731 (Perea) – Support 
Chapter 743, Statutes of 2014

AB 2731, by Assembly Member Perea, defers the Proposition 42 maintenance of effort (MOE) payment for the County of Fresno until June 30, 2020. AB 2731 made the deferral of the MOE contingent upon Fresno County using $5.5 million of funds that would otherwise be used meet the MOE requirement, to provide specialty medical services to medically indigent adults in conjunction with Federally Qualified Health Centers.

CSAC supported AB 2731, which was signed into law on September 28.

Homeless Assistance 

AB 1733 (Quirk-Silva, Maienschein, Atkins) – Support 
Chapter 764, Statutes of 2014 

AB 1733, by Assembly Members Sharon Quirk-Silva, Brian Maienschein and Assembly Speaker Toni Atkins, authorizes a fee waiver for a homeless person to obtain a certified certificate of live birth from the county registrar or recorder or an identification card from the Department of Motor Vehicles (DMV). 
CSAC supported AB 1733. As the service provider of last resort for indigent Californians, counties deal with the effects of homelessness across our systems, including health, human services and public safety. AB 1733 facilitates access for homeless people to services that are critical to helping them move towards self-sufficiency. Government and non-governmental entities fund a variety of services that help ensure the health and safety of homeless and low-income people. However, eligibility must be established in order to access these services, which often requires proof of identity with a birth record or valid identification card. Providing these services to homeless persons reduce costs to government and society overall, but particularly counties.

The Governor signed AB 1733 into law this week.

Public Hospitals and Health Systems 

AB 2546 (Salas) – Support 
Chapter 616, Statutes of 2014

AB 2546, by Assembly Member Rudy Salas, authorizes and provides a statutory framework for Kern County to form the Kern County Hospital Authority. The Hospital Authority positions Kern to evolve with the changing health care landscape and innovate to better serve its low-income residents. CSAC supported AB 2546, which has been signed into law.

AB 39 (Skinner) – Concerns 
As Amended on August 20, 2014

AB 39, by Assembly Member Skinner would have required the Department of Health Care Services to seek federal approval to add Doctors Medical Center to the list of designated public hospitals. CSAC appreciates the important role and unique challenges associated with Doctors Medical Center, which is a district hospital in San Pablo in Contra Costa County. CSAC raised a number of concerns regarding the precedent of expanding the number of designated public hospitals.

AB 39 was held in Senate Rules Committee. However, SB 883 (Committee on Budget and Fiscal Review) was amended on August 30 to provide financial support for Doctors Medical Center. SB 883 appropriates $3 million from the Major Risk Medical Insurance Fund to the West Contra Costa Healthcare District for support of the Doctors Medical Center. The Governor signed SB 883 into law on September 27.

Human Services 

AB 2547 (Gaines) – Support 
Chapter 272, Statutes of 2014 

The Governor signed AB 2547, by Assembly Member Beth Gaines, into law on August 22, 2014. AB 2547 allows Placer County to continue to operate their successful integrated, coordinated, and seamless approach to health and human services delivery in the County.

Sponsored by the Placer County Board of Supervisors, AB 2547 makes the County’s Integrated Health and Human Services Pilot Program permanent. Operated in conjunction with the State, Placer County’s Integrated Health and Human Services Pilot Program serves as a model of family centered and needs-based delivery of services to children and families by providing blended education, mental health, probation, and child welfare services in a seamless team approach. In making this program permanent, obsolete evaluation and reporting requirements used in the prior pilot were removed.

CalWORKs 

SB 1029 (Hancock) – Support 
As Amended on May 27, 2014 

SB 1029, by Senator Loni Hancock, sought to authorize CalFresh benefits for individuals in the community who were convicted of a drug felony after December 31, 1997. CSAC supported the measure, which was amended in Senate Appropriations Committee to remove CalWORKs eligibility for this population. On May 29, SB 1029 was ordered to the inactive file by request of Senator Hancock. Please note that the 2014-15 Budget Act included $9 million to fund CalFresh and CalWORKs benefits for drug felons.

AB 264 (Maienschein) – Support 
As Amended on June 12, 2014

AB 264, as amended, by Assembly Member Brian Maienschein, would have eliminated the current requirement that the 16 days of housing assistance provided to homeless families through the CalWORKs program be used consecutively. AB 264 would have allowed counties to target the intermittent cycle of homelessness by increasing flexibility for the receipt of temporary housing assistance.

The Senate Appropriations Committee held AB 264 on the Suspense File, therefore the measure did not move forward.

AB 1452 (Stone) – Support 
As Amended on June 12, 2014

AB 1452, by Assembly Member Mark Stone, attempted to increase the amount of homeless assistance funding available to a family of four from $65 to $75. It would have also required annual adjustments of the amount based on increases or decreases in cost of living expenses.

The Senate Appropriations Committee held AB 1452 on the Suspense File and the measure did not move forward this legislative session.

AB 1654 (Bonilla) – Support 
As Amended on August 4, 2014

AB 1654, by Assembly Member Susan Bonilla, sought to increase the amount of the child support pass through for those on CalWORKs aid from $50 for one child and $100 for a family with two or more children to $100 and $200 respectively, beginning January 1, 2016.

While CSAC supported AB 1654, the Senate Appropriations Committee held it on the Suspense File. The measure did not move forward this legislative session.

In-Home Supportive Services 

SB 878 (Committee on Budget and Fiscal Review) – No position 
Chapter 689, Statutes of 2014 

SB 878 is a budget trailer bill that made a number of changes to In-Home Supportive Services (IHSS) provider enrollment and orientation. Specific provisions include:

  • Effective immediately, IHSS provider orientation must include additional content on minimum wage and overtime pay, including paid travel time and wait time.
  • Beginning no later than April 1, 2015, provider orientation must be “on-site” and attended in person by prospective IHSS providers. Providers may attend the orientation only after completing the application for the IHSS provider enrollment process. Additionally, any oral presentation and written materials must be translated into all IHSS threshold languages in the county.
  • Effective April 1, 2015, representatives of the recognized employee organization in the county are permitted to make a presentation of up to 30 minutes at the orientation. Prior to this requirement taking effect, recognized employee organizations shall have the ability to make presentations at provider orientations as allowed as of September 1, 2014.

Signed into law, SB 878 included an urgency clause that took effect immediately upon signature by the Governor. Please recall that county costs for IHSS are capped by the IHSS MOE; if SB 878 results in additional costs, the state will bear costs above the MOE.

Emergency Medical Services

AB 1621 (Lowenthal) – Oppose 
As Amended on June 24, 2014

AB 1621, by Assembly Member Bonnie Lowenthal, attempted to create a State Emergency Medical Services Data and Information Systems (SEMSDIS), mandate the use of electronic patient care record systems, and require local EMS agencies to submit patient and system data to the EMS Authority.

CSAC and CHEAC are generally supportive of the concept of expanding the use of electronic emergency medical services data. However, this bill would have created a costly regulatory mandate on counties and EMS providers. The cost of implementing an electronic patient care record system can be measured in the tens of thousands of dollars, and funds for this purpose are virtually nonexistent for most counties, most acutely in our rural counties.

For these reasons, CSAC joined with CHEAC to oppose AB 1621. This measure was held on the Suspense File by the Senate Appropriations Committee.

AB 1975 (Hernández) – Oppose 
As Amended on May 7, 2014 

AB 1975, by Assembly Member Roger Hernández, originally would have required Local Emergency Medical Services Agencies (LEMSAs) which are implementing a trauma care system to commission the American College of Surgeons (ACS) to conduct a comprehensive assessment periodically of equitability and access to its trauma system. 
After the amendments on May 7, AB 1975 would have required local EMS agencies (LEMSAs) to commission regional assessments by an independent entity of their trauma systems. This bill would have also required LEMSAs to incorporate regional trauma coordinating committee (RTCC) recommendations into their local trauma care plans. 
Counties opposed AB 1975. Local EMS agencies, with the oversight of the EMS Authority and the Commission on EMS, currently perform objective and independent trauma planning and system evaluation. While there may be value on a case-by-case basis for a local EMS agency voluntarily choosing to contract with an independent entity, counties opposed the significant increase in authority and roles for RTCC’s in the development of local trauma care plans.

CSAC continued to oppose the measure, which was held by the Assembly Appropriations Committee.

General Assistance

AB 2311 (Bradford) – Oppose 
As Amended on May 23, 2014

AB 2311, by Assembly Member Steven Bradford, sought to alter locally-established General Assistance (GA) eligibility to allow honorably discharged veterans to receive GA benefits for a longer period of time.

Each county establishes GA benefit eligibility and award levels to best serve the needs of their communities. While counties strive to serve veteran populations, AB 2311 would have increased county-funded benefits for a specific population and would have removed local authority to set GA levels that meets the needs of each community.

CSAC, along with The Urban Counties Caucus and the Rural County Representatives of California, remained in opposition of AB 2311. The Senate Appropriations Committee held AB 2311 on the Suspense File and the bill did not proceed through the legislative process.

Child Welfare Services

SB 909 (Pavley) – Support 
As Amended on May 13, 2014 

SB 909, by Senator Fran Pavley, sought to permit a social worker, in the absence of a standing court order, to authorize an initial noninvasive medical, dental, and mental health screening for children in temporary custody after an initial examination without parental consent or a court order, if reasonable attempts to notify the parent are made.

SB 909 was sponsored by Los Angeles County and would have assisted all counties in expediting needed health care for the children in our custody. Further, this measure would not have been a mandate and may have reduced county costs by allowing children to receive basic medical care before mounting a costly effort to gain parental or judicial consent.

CSAC strongly supported SB 909, which was held by the Senate Appropriations Committee on May 23.

Elders/Dependent Adults

AB 2379 (Weber) – Support 
Chapter No. 62, Statutes of 2014 

AB 2379, by Assembly Member Shirley Weber, increases information sharing among county Child Welfare Services (CWS) and Adult Protective Services (APS) systems regarding dependent adults. This measure is not a mandate and has no fiscal impacts. CSAC supported this policy change to help the abovementioned county systems carry out their core mission: prevent the pain, suffering, and costs associated with ongoing dependent adult abuse.

The Governor signed AB 2379 into law on June 25, 2014.

Family Justice Centers

AB 1623 (Atkins) – Support 
Chapter 85, Statutes of 2014 

AB 1623, by Assembly Speaker Atkins, authorizes any city, county, or community-based nonprofit organization to establish a multiagency, multidisciplinary family justice center to assist victims of domestic violence, sexual assault, elder abuse, and human trafficking, as specified beginning January 1st of 2015. The bill also specified additional confidentiality provisions relating to information disclosed by a victim in a family justice center and requires each family justice center to provide mandatory training for all staff members, volunteers, and agency professionals.

CSAC supported SB 1623, which was signed into law on July 7. 

Crisis Nurseries 

AB 2228 (Cooley) – Support 
Chapter 735, Statutes of 2014 

CSAC supported AB 2228, by Assembly Member Ken Cooley, which Governor Brown signed into law on September 28. AB 2228 requires crisis nurseries to be licensed by the State Department of Social Services to operate overnight programs and authorizes crisis nurseries to provide crisis day services. AB 2228 also establishes the maximum licensed capacity for a crisis residential overnight program at 14 children and establishes that the maximum licensed capacity for crisis day services is based on 35 square feet of activity space per child.

Crisis nurseries provide short-term care and supervision for children under six years of age who are voluntarily placed for temporary care by a parent or legal guardian due to a family crisis or stressful situation. This bill ensures the safety and well-being of these young children, who require proper supervision and adequate space in a high-quality supervised environment.

State Hospitals

AB 2186 (Lowenthal) – Watch 
Chapter 733, Statutes of 2014

AB 2186, by Assembly Member Bonnie Lowethal, Requires courts to consider medical opinion when considering involuntary or voluntary administration of antipsychotic meds during commitment proceedings. This measure was sponsored by the Department of State Hospitals and signed into law by Governor Brown on September 28.

AB 1340 (Achadjian) – Watch 
Chapter 718, Statutes of 2014

AB 1340, by Assembly Member Katcho Achadjian, authorizes the Department of State Hospitals to establish Enhanced Treatment Programs for the most dangerous and high risk patients. Governor Brown signed AB 1340 into law on September 28.

AB 2625 (Achadjian) – Watch 
Chapter 742, Statutes of 2014

AB 2625, by Assembly Member Katcho Achadjian, is designed to streamline the process for returning Incompetent to Stand Trial (IST) defendants to their county of commitment after exhausting treatment at a State Hospital.

The bill requires the medical director of the state hospital or other treatment facility to which a defendant is confined for treatment to regain mental competence to do the following if the medical director’s report concerning the defendant’s progress toward mental competency recovery indicates that there is no substantial likelihood that the defendant will regain mental competence in the foreseeable future:

Promptly notify and provide a copy of the report to the defendant’s attorney and the district attorney; and,
Provide a separate notification, in compliance with applicable privacy laws, to the committing county’s sheriff that transportation will be needed for the patient.

The bill also requires that a defendant committed to a state hospital for treatment to regain mental competency, but who has not recovered competence, to be returned to the committing court no later than 90 days before the expiration of the defendant’s term of commitment.

The Department of State Hospitals, which sponsored the bill, believes these changes will increase the number of beds available for waitlisted IST patients and reserve space for those who are most likely to benefit from treatment at a State Hospital. Governor Brown signed AB 2625 into law on September 28.

AB 1960 (Perea) – Watch 
Chapter 730, Statutes of 2014

AB 1960, by Assembly Member Henry Perea, allows the director of a state hospital or a clinician, as defined, to obtain the state summary criminal history information for a patient committed to the State Department of State Hospitals and requires the information to be removed from the patient’s file and destroyed within 30 days of the patient being discharged.

This measure was also sponsored by the Department of State Hospitals, and Governor Brown signed it into law on September 28.

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