California Assembly Bill AB1606 Latest Draft

 BILL NUMBER: AB 1606AMENDED BILL TEXT AMENDED IN ASSEMBLY APRIL 22, 2010 AMENDED IN ASSEMBLY MARCH 23, 2010 INTRODUCED BY Assembly Member Coto JANUARY 6, 2010 An act to add Section 14132.07 to the Welfare and Institutions Code, relating to Medi-Cal. LEGISLATIVE COUNSEL'S DIGEST AB 1606, as amended, Coto. Medi-Cal: department-approved chronic disease self-management programs. Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which basic health care services are provided to qualified low-income persons. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions.  Existing law requires the department to submit an application to the federal Centers for Medicare and Medicaid Services (CMS) for a waiver or demonstration project that would implement specified objectives. Existing law requires the waiver or demonstration project to include designated restructuring proposals for the organization and delivery of services under the Medi-Cal program. Existing law provides that the restructuring proposals may include, but are not limited to, better care coordination for, among other persons, seniors and persons with disabilities, and requires better care coordination to include the establishment of organized delivery systems that incorporate a medical home system of care and disease management.  This bill would require the department  to seek, and if obtained, to implement, all federal waivers necessary to allow for the services provided through a department-approved chronic disease self-management program, as defined, to be reimbursable under the Medi-Cal program   to include reimbursement under the Medi-Cal program for services provided through a department-approved chronic disease self-management program, as defined, as part of the above-described restructuring proposals. The bill would provide that if the department includes better care coordination as part of the above-described restructuring proposals, reimbursement for services provided through a department-approv   ed chronic disease self-management program be implemented as part of the department's implementation of better care coordination  . Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 14132.07 is added to the Welfare and Institutions Code, to read: 14132.07. (a)  (1)    For purposes of this section, a "department-approved chronic disease self-management program" means a chronic disease self-management program approved by the department that has been tested through randomized controlled trials and satisfies the following conditions:  (1)   (A)  Has been shown to be effective at improving or maintaining the health status of people  who are over 18 years of age  with chronic disease.  (2)   (B)  Has been shown to be suitable for implementation, including implementation through community-based services organizations, and is ready for broad national distribution through those organizations.  (3) Nonclinical workers or volunteers are utilized in the delivery of the services provided by the chronic disease self-management program.   (4)   (C)  Any results from the randomized controlled trials done on the chronic disease self-management program have been published in a peer-reviewed scientific journal.  (b) (1) The department shall seek approval for, and if obtained, implement, all federal waivers necessary to allow the services provided to Medi-Cal beneficiaries through a department-approved chronic disease self-management program to be reimbursable under the Medi-Cal program.   (2) In implementing paragraph (1), the department shall consider including reimbursement for services provided through department-approved chronic disease self-management programs as part of the waiver under Section 1115 of the federal Social Security Act (42 U.S.C. Sec. 1315) to replace the current Medi-Cal Hospital/Uninsured Care Demonstration Project or as part of the waiver for the Multipurpose Senior Services Program, or both.   (D) Courses provided through the chronic disease self-management program are affiliated with a licensed Medi-Cal provider that will assume responsibility for billing, monitoring quality of service, and ensuring cultural competency.   (2) Nonclinical workers or volunteers may be used in the delivery of services provided under a department-approved chronic disease self-management program.   (3) Services provided by a department-approved chronic disease self-management program may be provided through the Internet. Internet delivery of department-approved chronic disease self-management program services is particularly appropriate for homebound and disabled individuals.   (b) (1) The department shall include reimbursement under the Medi-Cal program for services provided through a department-approved chronic disease self-management program as part of the restructuring proposal described in subdivision (b) of Section 14180.   (2) If the department includes better care coordination, as described in paragraph (1) of subdivision (b) of Section 14180, as part of the restructuring proposal required by subdivision (b) of Section 14180, the department shall implement paragraph (1) as part of its implementation of paragraph (1) of subdivision (b) of Section 14180.