Amended IN Assembly March 25, 2019 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 1131Introduced by Assembly Member GloriaFebruary 21, 2019 An act to amend Section 120190 of the Health and Safety Code, relating to public health. add Section 14132.04 to the Welfare and Institutions Code, relating to Medi-Cal.LEGISLATIVE COUNSEL'S DIGESTAB 1131, as amended, Gloria. Communicable diseases reporting. Medi-Cal: comprehensive medication management.Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law establishes a schedule of benefits under the Medi-Cal program, which includes outpatient prescription drugs, subject to utilization controls and the Medi-Cal list of contract drugs.This bill would provide that comprehensive medication management (CMM) services, as defined, are covered under the Medi-Cal program, and would require CMM services to include, among other specified functions, the development of a care plan in collaboration with the beneficiary and the beneficiarys health care providers to address identified medication therapy problems. The bill would require CMM services to be offered to a beneficiary who meets one or more of specified criteria, including being prescribed 8 or more prescription drugs or biologics to treat or prevent 2 or more chronic medical conditions.Existing law establishes the State Department of Public Health and sets forth its powers and duties, including the administration of provisions relating to the prevention and control of communicable diseases. Existing law requires a health officer of specified local jurisdictions to immediately report to the department by telegraph or telephone every discovered or known case or suspect case of those diseases designated for immediate reporting by the department. Existing law further requires a health officer, within 24 hours, to make reports as the department may require. This bill would delete the option for a health officer to report cases by telegraph and instead authorize a health officer to comply with the reporting requirement by telephone or electronic communication. The bill would make technical, nonsubstantive changes to these provisions.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: NO(3) Medication means prescription medications, biologics, over-the-counter medications, or nutritional or herbal supplements.(4) Medication therapy problems means the use of unnecessary medication, the need for additional medication, ineffective medication, subtherapeutic dosage, inadequate monitoring, adverse event, medication interaction, excessive dosage, inadequate adherence, availability of more cost-effective medication, or inability of the beneficiary to afford the medication.(c) CMM services shall be offered to a beneficiary who meets one or more of the following criteria:(1) Is prescribed eight or more prescription drugs or biologics to treat or prevent two or more chronic medical conditions.(2) Is identified by a physician and surgeon as at high risk for medication therapy problems.(3) Is referred by a physician and surgeon as having a medical condition that could benefit from the provision of CMM services, such as providing CMM services to address poor control of a chronic medical condition.(4) Has been discharged from a hospital, rehabilitation facility, or long-term care health care facility with one or more chronic medical conditions, with a need for a plan to enhance care coordination efforts, including those related to comprehensive transitional care services under the Health Home Program consistent with paragraph (3) of subdivision (b) of Section 14127.2.(d) CMM services may be offered to a beneficiary who has a medication therapy problem if a physician and surgeon refers the beneficiary to CMM services based on medical criteria not described in subdivision (c).(e) CMM services provided pursuant to this section shall do all of the following:(1) Collect and analyze information, addressing both of the following:(A) Review of the beneficiarys medical record to gather relevant information, including medication lists, laboratory values, diagnostic tests, and a medical problem list.(B) Comprehensive review of medications and associated health and social history of the beneficiary in consultation with the beneficiary.(i) For purposes of this subparagraph, health and social history includes, but is not limited to, social determinants of health relevant to medications, such as the ability of the beneficiary to afford the medication, the potential impact of education level, housing, or means of transportation on the beneficiarys ability to use medications as intended, and health literacy level.(ii) For purposes of this subparagraph, review of medications includes, but is not limited to, review of indication, effectiveness, safety, medication adverse effects, medication list reconciliation, adherence, experience, the beneficiarys personal goals of therapy, and how the beneficiary manages their medications at home.(2) Assess the information and formulate a medication therapy problem list.(3) Develop a care plan in collaboration with the beneficiary and the beneficiarys health care providers to address the identified medication therapy problems.(4) Implement the care plan in collaboration with the beneficiarys health care providers, the beneficiary, and the beneficiarys caregivers.(5) Provide followup and monitoring to optimize the care plan, and identify and resolve medication therapy problems, with the goal of optimizing medication use and improving care. Followup and monitoring shall be coordinated with the physician and surgeon and any other health care providers of the beneficiary.
Amended IN Assembly March 25, 2019 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 1131Introduced by Assembly Member GloriaFebruary 21, 2019 An act to amend Section 120190 of the Health and Safety Code, relating to public health. add Section 14132.04 to the Welfare and Institutions Code, relating to Medi-Cal.LEGISLATIVE COUNSEL'S DIGESTAB 1131, as amended, Gloria. Communicable diseases reporting. Medi-Cal: comprehensive medication management.Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law establishes a schedule of benefits under the Medi-Cal program, which includes outpatient prescription drugs, subject to utilization controls and the Medi-Cal list of contract drugs.This bill would provide that comprehensive medication management (CMM) services, as defined, are covered under the Medi-Cal program, and would require CMM services to include, among other specified functions, the development of a care plan in collaboration with the beneficiary and the beneficiarys health care providers to address identified medication therapy problems. The bill would require CMM services to be offered to a beneficiary who meets one or more of specified criteria, including being prescribed 8 or more prescription drugs or biologics to treat or prevent 2 or more chronic medical conditions.Existing law establishes the State Department of Public Health and sets forth its powers and duties, including the administration of provisions relating to the prevention and control of communicable diseases. Existing law requires a health officer of specified local jurisdictions to immediately report to the department by telegraph or telephone every discovered or known case or suspect case of those diseases designated for immediate reporting by the department. Existing law further requires a health officer, within 24 hours, to make reports as the department may require. This bill would delete the option for a health officer to report cases by telegraph and instead authorize a health officer to comply with the reporting requirement by telephone or electronic communication. The bill would make technical, nonsubstantive changes to these provisions.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: NO(3) Medication means prescription medications, biologics, over-the-counter medications, or nutritional or herbal supplements.
Amended IN Assembly March 25, 2019
Amended IN Assembly March 25, 2019
CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION
Assembly Bill No. 1131
Introduced by Assembly Member GloriaFebruary 21, 2019
Introduced by Assembly Member Gloria
February 21, 2019
An act to amend Section 120190 of the Health and Safety Code, relating to public health. add Section 14132.04 to the Welfare and Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
AB 1131, as amended, Gloria. Communicable diseases reporting. Medi-Cal: comprehensive medication management.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law establishes a schedule of benefits under the Medi-Cal program, which includes outpatient prescription drugs, subject to utilization controls and the Medi-Cal list of contract drugs.This bill would provide that comprehensive medication management (CMM) services, as defined, are covered under the Medi-Cal program, and would require CMM services to include, among other specified functions, the development of a care plan in collaboration with the beneficiary and the beneficiarys health care providers to address identified medication therapy problems. The bill would require CMM services to be offered to a beneficiary who meets one or more of specified criteria, including being prescribed 8 or more prescription drugs or biologics to treat or prevent 2 or more chronic medical conditions.Existing law establishes the State Department of Public Health and sets forth its powers and duties, including the administration of provisions relating to the prevention and control of communicable diseases. Existing law requires a health officer of specified local jurisdictions to immediately report to the department by telegraph or telephone every discovered or known case or suspect case of those diseases designated for immediate reporting by the department. Existing law further requires a health officer, within 24 hours, to make reports as the department may require. This bill would delete the option for a health officer to report cases by telegraph and instead authorize a health officer to comply with the reporting requirement by telephone or electronic communication. The bill would make technical, nonsubstantive changes to these provisions.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law establishes a schedule of benefits under the Medi-Cal program, which includes outpatient prescription drugs, subject to utilization controls and the Medi-Cal list of contract drugs.
This bill would provide that comprehensive medication management (CMM) services, as defined, are covered under the Medi-Cal program, and would require CMM services to include, among other specified functions, the development of a care plan in collaboration with the beneficiary and the beneficiarys health care providers to address identified medication therapy problems. The bill would require CMM services to be offered to a beneficiary who meets one or more of specified criteria, including being prescribed 8 or more prescription drugs or biologics to treat or prevent 2 or more chronic medical conditions.
Existing law establishes the State Department of Public Health and sets forth its powers and duties, including the administration of provisions relating to the prevention and control of communicable diseases. Existing law requires a health officer of specified local jurisdictions to immediately report to the department by telegraph or telephone every discovered or known case or suspect case of those diseases designated for immediate reporting by the department. Existing law further requires a health officer, within 24 hours, to make reports as the department may require.
This bill would delete the option for a health officer to report cases by telegraph and instead authorize a health officer to comply with the reporting requirement by telephone or electronic communication. The bill would make technical, nonsubstantive changes to these provisions.
## Digest Key
(4) Medication therapy problems means the use of unnecessary medication, the need for additional medication, ineffective medication, subtherapeutic dosage, inadequate monitoring, adverse event, medication interaction, excessive dosage, inadequate adherence, availability of more cost-effective medication, or inability of the beneficiary to afford the medication.
(c) CMM services shall be offered to a beneficiary who meets one or more of the following criteria:
(1) Is prescribed eight or more prescription drugs or biologics to treat or prevent two or more chronic medical conditions.
(2) Is identified by a physician and surgeon as at high risk for medication therapy problems.
(3) Is referred by a physician and surgeon as having a medical condition that could benefit from the provision of CMM services, such as providing CMM services to address poor control of a chronic medical condition.
(4) Has been discharged from a hospital, rehabilitation facility, or long-term care health care facility with one or more chronic medical conditions, with a need for a plan to enhance care coordination efforts, including those related to comprehensive transitional care services under the Health Home Program consistent with paragraph (3) of subdivision (b) of Section 14127.2.
(d) CMM services may be offered to a beneficiary who has a medication therapy problem if a physician and surgeon refers the beneficiary to CMM services based on medical criteria not described in subdivision (c).
(e) CMM services provided pursuant to this section shall do all of the following:
(1) Collect and analyze information, addressing both of the following:
(A) Review of the beneficiarys medical record to gather relevant information, including medication lists, laboratory values, diagnostic tests, and a medical problem list.
(B) Comprehensive review of medications and associated health and social history of the beneficiary in consultation with the beneficiary.
(i) For purposes of this subparagraph, health and social history includes, but is not limited to, social determinants of health relevant to medications, such as the ability of the beneficiary to afford the medication, the potential impact of education level, housing, or means of transportation on the beneficiarys ability to use medications as intended, and health literacy level.
(ii) For purposes of this subparagraph, review of medications includes, but is not limited to, review of indication, effectiveness, safety, medication adverse effects, medication list reconciliation, adherence, experience, the beneficiarys personal goals of therapy, and how the beneficiary manages their medications at home.
(2) Assess the information and formulate a medication therapy problem list.
(3) Develop a care plan in collaboration with the beneficiary and the beneficiarys health care providers to address the identified medication therapy problems.
(4) Implement the care plan in collaboration with the beneficiarys health care providers, the beneficiary, and the beneficiarys caregivers.
(5) Provide followup and monitoring to optimize the care plan, and identify and resolve medication therapy problems, with the goal of optimizing medication use and improving care. Followup and monitoring shall be coordinated with the physician and surgeon and any other health care providers of the beneficiary.
A health officer shall immediately report by telephone or electronic communication to the department every discovered or known case or suspect case of those diseases designated for immediate reporting by the department. Within 24 hours after investigation, a health officer shall make reports as the department may require.