SB 810THE CALIFORNIA UNIVERSAL CARE ACT

Introduced February 18, 2011 Author: State Senator Mark Leno Similar legislation has been passed twice before Both times vetoed by former Governor

March 26, 2011Physicians for a National Health Program - California

SB 810LEGISLATIVE DIGEST

Establishes California Healthcare System Creates California Healthcare Agency Healthcare Commissioner (appointed by Gov) Receives all healthcare payments Is the sole payer of healthcare costs Duplication of coverage for benefits provided

by CHS is prohibited

SB 810LEGISLATIVE DIGEST

Establishes Healthcare Policy Board Establishes Office of Patient Advocacy Creates Office of Health Planning Creates Office of Health Care Quality New Office of Inspector General for the CA

Healthcare System in the Atty General’s office

SB 810LEGISLATIVE DIGEST

Creates Healthcare Fund and the Payments Board to administer the finances of CHS

Creates CA Healthcare Premium Commission to determine cost of system

Only the Premium Commission would become operative on Jan 1 after passage

Remaining provisions operative when sufficient funds available to operate the system, or the date CA receives a waiver under PPACA, whichever is later

SB 810Chapters

Chapter 1 – General Provisions Chapter 2 – Governance Chapter 3 – Funding Chapter 4 – Eligibility Chapter 5 – Benefits Chapter 6 – Delivery of Care Chapter 7 – Other Provisions

SB 810 –Chapter 1 HighlightsPurposes

Provide affordable, comprehensive care with a single standard for all CA residents

Control costs Improve quality of care Prevent disease and disability, improve health and

functionality Increase provider satisfaction with the health system Provide culturally and linguistically appropriate

services Develop population based database for planning Provide information and care in an appropriate and

accessible format

SB 810 –Chapter 2 HighlightsThe Commissioner shall (partial list):

Establish health planning regions Oversee establishment of locally based IDS networks Establish an electronic claims and payments system Establish secure electronic medical records, compatible

across the system Establish standards of care based on clinical efficacy Negotiate for or set rates, fees and prices Establish a formulary Use the power of the state to negotiate discounts for

drugs and durable med equip, without adversely affecting needed pharm research

Create job training for displaced workers

SB 810 –Chapter 3 HighlightsFunding

Describes requirements for establishing co-pays, if any Establishes procedures to implement cost controls Explains the payments board, payments to providers Providers can provide and charge for services not

covered by CHS Fees for service providers paid within 30 days Describes procedures governing capital investments Premium structure maintains current ratio for health

care contributions between employers, individuals, government and other sources

SB 810 –Chapter 4 HighlightsEligibility

All California residents shall be eligible for the system.

Residency standards will be established. Includes coverage when Californians are

temporarily out of state. Visitors will be billed.

SB 810 –Chapter 5 HighlightsBenefits

Includes outpatient, inpatient, emergency, diagnostics Includes dental, vision, mental health Includes adult day care, substance abuse, 100 days

SNIF, dialysis, family planning, preventive services Includes podiatry, acupuncture, chiropractic Includes home health, hospice, rehab, durable goods Excludes: cosmetic, private rooms unless needed No copayments or deductibles for preventive care, or

Medi-Cal eligible Copayments possible in 3rd year of program up to $250

per person per year

SB 810 –Chapter 6 HighlightsDelivery of Care

May choose a primary care provider and OBGYN, change any time

Have to stay with an IDS for one year after 3 month trial Need referral to specialist, or may have to pay co-pay Will develop process for providers to request authorizations

for services and treatments, including experimental treatments not included in the benefits package.

No standard or criteria shall impose an undue administrative burden on a health care provider or a patient and none shall delay the care a patient needs.

Office of Patient Advocacy shall establish a program in each region called the Partnerships for Health

Establishes a patient grievance system

SB 810 –Chapter 7 Highlights

The division becomes operative when the Secretary of CA HHS notifies the Secretary of the Senate and Chief Clerk of the Assembly that the Healthcare Fund will have sufficient revenues, or receives the federal waiver, whichever date is later.

Except the Premium Commission which goes into effect on Jan 1, 2012 if passed.