Twin Waiver Bills Move Forward

The state’s effort to negotiate a new Section 1115 Medicaid hospital waiver with the Centers for Medicare and Medicaid Services (CMS) was the topic of two hearings for identical bills in the Capitol last week. 

Assembly Bill 342, by Assembly Speaker John A. Pérez, and Senate Bill 208, by Senate President pro Tempore Darrell Steinberg, are the two legislative vehicles for the state’s Section 1115 Waiver proposal. Although the bills are both going through the policy committee process, they cannot be finalized until the state and CMS agree on Terms and Conditions for the waiver. The state’s goal of finishing the waiver by August 31 is one that counties strongly support.

Counties play a key role in the waiver proposal, both as essential providers of care to the Medi-Cal population and as a funding source, since the proposal assumes that county funds can be used as a match for drawing down federal reimbursement. Other key issues include the structure and financing for county coverage initiatives and the potential interplay between serving seniors and those with disabilities and the In-Home Supportive Services program. 

AB 342 was approved by the Senate Health Committee on June 30, and SB 208 was approved by the Assembly Health Committee on June 29. It is not yet clear which bill will be designated as the sole legislative vehicle. 
AB 2456 (Torrico) – Oppose
As Amended on June 23, 2010

Assembly Bill 2456, by Assembly Member Albert Torrico, would modify the Emergency Medical Services (EMS) Act to specify that guidelines issued by the California Emergency Medical Services Authority (EMSA), including those dealing with medical control, will require mandatory compliance by local EMS agencies when establishing local policies and procedures.

Also, the May 28 amendments would allow EMSA to adopt a fee schedule to offset the costs of promulgating such regulations. The fees would be based on the number of EM-I, EMT-II, and EMT-P’s licensed or certified by each local authority. The June 23 amendments add an appeals process for decisions to the Emergency Medical Services Commission (Commission), but action on an appeal by the Commission would be final. 

CSAC, along with the County Health Executives Association of California (CHEAC), has argued that these changes are unnecessary because the EMS Act already provides EMSA the necessary statutory oversight responsibilities. In addition, adopting standardized medical guidelines on behalf of all of California’s 58 counties is inherently problematic due to the diversity of their settings – such as urban and rural – and available resources. Furthermore, AB 2456 may also result in unfunded mandates if guidelines are imposed as envisioned by the bill, and the possibility of a fee schedule to be imposed by EMSA is cause for concern. For these reasons, CSAC, along with CHEAC, strongly oppose the bill. 

Despite opposition by CSAC, CHEAC, RCRC, and numerous individual counties, the Senate Health Committee passed the bill on June 30. It now goes to the Senate Appropriations Committee