BILL NUMBER: SB 29 AMENDED
BILL TEXT
AMENDED IN SENATE JANUARY 22, 2004
AMENDED IN SENATE JANUARY 5, 2004
INTRODUCED BY Senator Figueroa
DECEMBER 2, 2002
An act to amend Sections 14148.03 and 14148.04 of the Welfare and
Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
SB 29, as amended, Figueroa. Medi-Cal: accelerated enrollment.
Existing law provides for the federal medicaid program,
administered by each state, California's version of which is the
Medi-Cal program. The Medi-Cal program, which is administered by the
State Department of Health Services, provides qualified low-income
persons with health care services.
Existing law requires the department, if sufficient funding is
obtained and sufficient new staff is available, to adopt 2 electronic
enrollment processes for the Medi-Cal program, one known as the
Prenatal Gateway, which is for pregnant women to use when applying
for Medi-Cal from a provider's office, and the other known as the
Newborn Hospital Gateway, which is for families to enroll a deemed
eligible newborn in the Medi-Cal program from hospitals that have
elected to participate in the process.
This bill would require the department to implement each
electronic enrollment process within 12 months after the date upon
which the conditions with respect to funding and sufficient staff
have occurred.
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 14148.03 of the Welfare and Institutions Code
is amended to read:
14148.03. (a) Pursuant to options provided in federal law and
notwithstanding any other provision of law, the form used by a
provider to collect information about a pregnant woman pursuant to
the Medi-Cal temporary benefits program under Section 14148.7 as that
program is implemented on January 1, 2003, shall itself qualify as a
simplified application for the Medi-Cal program for pregnant women,
or, if necessary to ensure federal financial participation, the form
shall be modified to add only those elements required for federal
financial participation and be as simple as the department considers
practicable.
(b) For purposes of this section, the department shall determine
whether to grant eligibility for temporary benefits under Section
14148.7 and the county shall make the final eligibility determination
for the Medi-Cal program. The department shall develop and adopt a
process for transferring the application to the county and a followup
process that is as simple as the department considers practicable to
be used by the county if followup is necessary. Based on the
department's instructions, the county shall make a determination
whether followup is necessary to determine the woman's final
eligibility for the Medi-Cal program or to refer the woman to the
Access for Infants and Mothers (AIM) program.
(c) The department shall adopt an electronic enrollment process
for pregnant women to use when applying for the Medi-Cal program from
a provider's office. The application form for this electronic
enrollment shall use the elements of the application form described
in subdivision (a) and the procedures specified in subdivision (b).
This electronic enrollment process shall be known as the Prenatal
Gateway. In developing the Prenatal Gateway required by this
subdivision, the department shall consult with consumer, provider,
county, and health plan representatives.
(d) The purpose of this section is to begin eligibility and
benefits at the time of an eligible pregnant woman's visit to a
provider and to continue eligibility and benefits until a final
eligibility determination is made without the submission of any other
application form to the department, the county, or a single point of
entry and to make the followup process as simple as the department
considers practicable.
(e) The Prenatal Gateway may not be adopted until both of the
following occur:
(1) Sufficient moneys have been deposited in the Special Funds
Account of the Gateway Fund to defray the costs of developing the
Prenatal Gateway.
(2) Sufficient new staff, not to exceed a total of three personnel
years, is available at the department for the purposes of this
section and Section 14148.04 and is funded through nonstate General
Fund sources. Notwithstanding any other provision of law, the
department may hire staff necessary to implement this section.
(f) The department shall implement the Prenatal Gateway within 12
months after the date upon which both of the conditions required
under subdivision (e) have occurred.
(g) To implement this section, the department may contract with
public or private entities, or utilize existing health care service
provider enrollment and payment mechanisms, including the Medi-Cal
program's fiscal intermediary, only if services provided under the
program are specifically identified and reimbursed in a manner that
appropriately claims federal financial reimbursement. Contracts,
including the Medi-Cal fiscal intermediary contract for the Child
Health and Disability Prevention Program, and including any contract
amendment, any system change pursuant to a change order, and any
project or systems development notice shall be exempt from Part 2
(commencing with Section 10100) of Division 2 of the Public Contract
Code, Chapter 7 (commencing with Section 11700) of Part 1 of Division
3 of Title 2 of the Government Code, Section 19130 of the Government
Code, and any policies, procedures, or regulations authorized by
these laws.
SEC. 2. Section 14148.04 of the Welfare and Institutions Code is
amended to read:
14148.04. (a) The department shall adopt, as specified in this
section, an electronic process for families to enroll a deemed
eligible newborn in the Medi-Cal program from hospitals that have
elected to participate in the process. The electronic enrollment
process adopted pursuant to this section shall be known as the
Newborn Hospital Gateway.
(b) With respect to the enrollment of a child under the age of one
year who is deemed to have applied and is deemed eligible for
Medi-Cal benefits under Section 1396a(e)(4) of Title 42 of the United
States Code, the enrollment procedures of the Newborn Hospital
Gateway shall specifically include procedures for confirming the
eligibility of, and issuing a Medi-Cal card to, that child.
(c) In developing the Newborn Hospital Gateway required by this
section, the department shall consult with consumer, provider,
county, and health plan representatives.
(d) The Newborn Hospital Gateway may not be adopted until both of
the following occur:
(1) Sufficient moneys have been deposited in the Special Funds
Account of the Gateway Fund to defray the costs of developing the
Newborn Hospital Gateway.
(2) Sufficient new staff, not to exceed a total of three personnel
years, is available at the department for the purposes of this
section and Section 14148.03 and is funded through nonstate General
Fund sources. Notwithstanding any other provision of law, the
department may hire staff necessary to implement this section.
(e) The department shall implement the Newborn Hospital Gateway
within 12 months after the date upon which both of the conditions
required under subdivision (d) have occurred. To
(f) To implement this section, the department may contract
with public or private entities, or utilize existing health care
service provider enrollment and payment mechanisms, including the
Medi-Cal program's fiscal intermediary, only if services provided
under the program are specifically identified and reimbursed in a
manner that appropriately claims federal financial reimbursement.
Contracts, including the Medi-Cal fiscal intermediary contract for
the Child Health and Disability Prevention Program and including any
contract amendment, any system change pursuant to a change order, and
any project or systems development notice shall be exempt from Part
2 (commencing with Section 10100) of Division 2 of the Public
Contract Code, Chapter 7 (commencing with Section 11700) of Part 1 of
Division 3 of Title 2 of the Government Code, Section 19130 of the
Government Code, and any policies, procedures, or regulations
authorized by these laws.
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