California Children’s Services Program.
Under existing law, CCS-eligible medical conditions include, among others, cystic fibrosis and hemophilia, and other conditions set forth by the Director of Health Care Services.
This bill would statutorily expand the list of CCS-eligible medical conditions to include those conditions that are specified in existing CCS-related regulations. The bill would, commencing no later than January 1, 2026, and every 5 years thereafter, require the department to consult with, at a minimum, CCS medical directors and experts from the department’s CCS technical advisory committees, to consider the addition of other medical conditions to the list, by regulation. The bill would make conforming changes to related provisions.
(2) This bill would, commencing on January 1, 2025, and subject to an appropriation, for a child who has an eligible medical condition, but who is not financially eligible for the CCS Program, require the department to provide financial assistance for out-of-pocket costs not covered by the child’s health care coverage, as specified, if those costs are for medically necessary services to treat a CCS-eligible medical condition. The bill would require the department to establish a procedure for providing that financial assistance.
(3) This bill would, commencing on January 1, 2025, require the department to provide a sustainability and access payment of $500 to a hospital or CCS special care center for every CCS-enrolled child seen in the hospital or center, with annual adjustments for inflation, as specified.
The bill would, for medically necessary treatments provided during the 2025 calendar year, require the department to adjust CCS payment rates for physician services, reflecting the cumulative effect of inflation, as specified. Under the bill, commencing on January 1, 2026, those payments would be updated annually to reflect the effect of inflation.
The bill would require the department to provide reimbursements for lifesaving specialty drugs prescribed and administered to a CCS-enrolled child for a CCS-eligible medical condition, as specified.
The bill would condition implementation of the provisions in this paragraph on receipt of any necessary federal approval and, for purposes of the physician-related payment rate increases and drug-related reimbursements, on the availability of federal financial participation.
The bill would also condition implementation of the provisions in this paragraph on an appropriation. The bill would state the intent of the Legislature that any consideration of a future appropriation for these provisions be made in accordance with legislative findings concerning subsequent deficits.
(4) By increasing the duties of counties relating to the administration of the CCS Program through the above-described provisions, the bill would impose a state-mandated local program.
(5) Existing law establishes the Medi-Cal program, which is administered by the department 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 Whole Child Model program for Medi-Cal eligible CCS children and youth enrolled in a Medi-Cal managed care plan served by a county organized health system or Regional Health Authority, or, commencing no sooner than January 1, 2024, an alternate health care service plan, in certain listed counties.
This bill would specify that only those listed counties are authorized for the Whole Child Model program.
Existing law prohibits the incorporation of CCS-covered services into a Medi-Cal managed care contract entered into after August 1, 1994, pursuant to specified provisions, until January 1, 2022, and until a certain related evaluation has been completed, except for contracts entered into under the Whole Child Model program or for county organized health systems or Regional Health Authority, as specified.
This bill would extend that prohibition indefinitely by removing the expiration set for January 1, 2022, and for completion of the evaluation.
(6) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.