(1) Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which health care services are provided to qualified, low-income persons. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Under existing law, one of the methods by which Medi-Cal services are provided is pursuant to contracts with various types of managed care plans. Existing federal regulations, published on May 6, 2016, revise regulations governing Medicaid managed care plans to, among other things, align, where feasible, those rules with those of other major sources of coverage, including coverage through qualified health plans offered through an American Health Benefit Exchange, such as the California Health Benefit Exchange, and promote quality of care and strengthen efforts to reform delivery systems that serve Medicaid and CHIP beneficiaries. These federal regulations, among other things, authorize an enrollee to request a state fair hearing only after receiving notice that the Medicaid managed care plan is upholding an adverse benefit determination, and requires the enrollee to request a state fair hearing no later than 120 calendar days from the date of the Medicaid managed care plans notice of resolution. These federal regulations require, with regards to a state fair hearing request filed by an enrollee entitled to an expedited resolution of an appeal by a managed care plan, an agency to take final administrative action as expeditiously as the enrollee's health condition requires, but not later than 3 working days after the agency receives, from the managed care plan, the case file and information for any appeal of a denial or a service that, as indicated by the managed care plan meets the criteria for expedited resolution of an appeal, but was not resolved within the timeframe for expedited resolution, or was resolved within the timeframe for expedited resolution of an appeal, but the managed care plan reached a decision wholly or partially adverse to the enrollee.
California AB 205 (20172018) — Medi-Cal: Medi-Cal managed care plans.
(1) Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which health care services are provided to qualified, low-income persons. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Under existing law, one of the methods by which Medi-Cal services are provided is pursuant to contracts with various types of managed care plans. Existing federal regulations, published on May 6, 2016, revise regulations governing Medicaid managed care plans to, among other things, align, where feasible, those rules with those of other major sources of coverage, including coverage through qualified health plans offered through an American Health Benefit Exchange, such as the California Health Benefit Exchange, and promote quality of care and strengthen efforts to reform delivery systems that serve Medicaid and CHIP beneficiaries. These federal regulations, among other things, authorize an enrollee to request a state fair hearing only after receiving notice that the Medicaid managed care plan is upholding an adverse benefit determination, and requires the enrollee to request a state fair hearing no later than 120 calendar days from the date of the Medicaid managed care plans notice of resolution. These federal regulations require, with regards to a state fair hearing request filed by an enrollee entitled to an expedited resolution of an appeal by a managed care plan, an agency to take final administrative action as expeditiously as the enrollee's health condition requires, but not later than 3 working days after the agency receives, from the managed care plan, the case file and information for any appeal of a denial or a service that, as indicated by the managed care plan meets the criteria for expedited resolution of an appeal, but was not resolved within the timeframe for expedited resolution, or was resolved within the timeframe for expedited resolution of an appeal, but the managed care plan reached a decision wholly or partially adverse to the enrollee.
Version chain
The bill's text revisions, in order — the diff chain from filing to enrollment.
With recommendation: That Senate amendments be concurred in. — 11–0 (pass) · lower
Do pass, but first be re-referred to the Committee on [Appropriations] — 8–0 (pass) · upper
That the measure be returned to Senate Floor for consideration. Ordered to third reading. — 9–0 (pass) · upper
Placed on suspense file — 7–0 (pass) · upper
Do pass as amended and be re-referred to the Committee on [Appropriations] — 14–0 (pass) · lower
AB 205 WOOD Assembly Third Reading — 76–0 (pass) · lower
3rd Reading AB205 Wood et al. By Hernandez — 40–0 (pass) · upper
AB 205 WOOD Concurrence in Senate Amendments — 78–0 (pass) · lower
Sponsors
Wood — primary (person)
Hernandez — coauthor (person)
Timeline
The legislative action history — every referral, reading, and vote.
2017-01-23 Read first time. To print. reading-1
2017-01-24 From printer. May be heard in committee February 23.
2017-02-06 Referred to Com. on HEALTH. referral-committee
2017-04-19 From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended. amendment-introduction, amendment-passage, reading-2, reading-1
2017-04-20 Re-referred to Com. on HEALTH. referral-committee
2017-05-01 From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 15. Noes 0.) (April 25). amendment-passage, committee-passage, amendment-introduction
2017-05-02 Read second time and amended. reading-1, amendment-passage, reading-2
2017-05-03 Re-referred to Com. on APPR. referral-committee
2017-05-17 In committee: Set, first hearing. Referred to APPR. suspense file. referral-committee
2017-05-26 From committee: Do pass. (Ayes 17. Noes 0.) (May 26). committee-passage-favorable, committee-passage
2017-05-26 Read second time. Ordered to third reading. reading-2, reading-1
2017-05-30 Read third time. Passed. Ordered to the Senate. (Ayes 76. Noes 0. Page 1809.) reading-3, passage, reading-1
2017-05-30 In Senate. Read first time. To Com. on RLS. for assignment. reading-1
2017-06-08 Referred to Com. on HEALTH. referral-committee
2017-07-05 From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH. amendment-passage, referral-committee, reading-2, reading-1, amendment-introduction
2017-07-13 From committee: Do pass and re-refer to Com. on APPR. (Ayes 8. Noes 0.) (July 12). Re-referred to Com. on APPR. committee-passage-favorable, committee-passage, referral-committee
2017-08-21 In committee: Referred to APPR. suspense file. referral-committee
2017-09-01 From committee: Do pass. (Ayes 7. Noes 0.) (September 1). committee-passage-favorable, committee-passage
2017-09-05 Read second time. Ordered to third reading. reading-2, reading-1
2017-09-08 Read third time and amended. Ordered to second reading. amendment-passage, reading-3, reading-1
2017-09-11 Read second time. Ordered to third reading. reading-2, reading-1
2017-09-11 Re-referred to Com. on RLS. pursuant to Senate Rule 29.10(b). referral-committee
2017-09-11 From committee: Be re-referred to Com. on HEALTH pursuant to Senate Rule 29.10(b). (Ayes 5. Noes 0.) Re-referred to Com. on HEALTH. committee-passage, referral-committee
2017-09-12 From committee: That the measure be returned to Senate Floor for consideration. (Ayes 9. Noes 0.) (September 12) committee-passage
2017-09-13 Read third time. Passed. Ordered to the Assembly. (Ayes 40. Noes 0. Page 2858.). reading-3, passage, reading-1
2017-09-14 In Assembly. Concurrence in Senate amendments pending.
2017-09-14 Re-referred to Com. on HEALTH. pursuant to Assembly Rule 77.2. referral-committee
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