Release: “Whole Child Model” for CA Children’s Services Program Signed into Law

September 26, 2016

Patient-centered protections will coordinate care for children with special care needs

SACRAMENTO – California Governor Jerry Brown signed into law Senate Bill 586, authored by Senator Ed Hernandez, O.D., (D-West Covina), setting forth a patient-centered framework for our most needy and vulnerable children. SB 586 ensures the expertise and quality of care in the California Children’s Services program (CCS) is preserved as part of the transition to the “Whole Child Model.”

SB 586 would authorize a Whole Child Model for the CCS program, under which four County Organized Health System (COHS) plans would provide both CCS and Medi-Cal services to children enrolled in Medi-Cal and CCS. This transition moves from the existing arrangement in most counties where CCS services are “carved out” from the Medi-Cal managed care plan.

“I authored SB 586 with the intention of ensuring children in the Whole Child Model receive high quality care. These children need specialized medical services and they deserve careful attention to ensure high quality care,” said Senator Ed Hernandez, chair of the Senate Health Committee. “SB 586 includes important consumer protections to ensure CCS standards are maintained, timely access to care is provided, and an evaluation of the Whole Child Model is done. I thank the Administration, advocates, countless families, and staff that helped put these children first. ”

The CCS program provides diagnostic and treatment services, medical case management, and physical and occupational therapy services to children under 21 years of age with CCS-eligible conditions (e.g., severe genetic diseases, chronic and severe medical conditions, and traumatic injuries).

SB 586 is supported by children’s advocates, health care providers for children and advocates for low-income families.

“Life is tough enough for chronically and seriously ill kids and their families,” said Ted Lempert, the President of Children Now. “We are proud to stand with Senator Hernandez, families, advocates, and providers in support of SB 586, which will protect quality health care for kids in the California Children’s Services program.”

"We thank Senator Hernandez for his leadership in crafting legislation that both protects the high quality of care assured by the California Children's Services Program and promotes a careful, phased integration with managed care,” said Ann Kuhns, President and CEO of the California Children’s Hospital Association. “And we appreciate the Governor's support for a transition that includes a rigorous evaluation of patient outcomes under the model as well as opportunities for families and other stakeholders to provide ongoing input as the model is implemented.”

Most Medi-Cal beneficiaries, including children, are required to enroll in Medi-Cal managed care plans. However, for children who are enrolled in both Medi-Cal and CCS, CCS services are “carved-out” of Medi-Cal managed care. Under the carve-out, medical services provided through the CCS program for the child’s CCS condition are reimbursed on a fee-for-service basis by DHCS, rather than through the Medi-Cal managed care plan. At the end of 2016, the existing law requiring CCS services to be provided on a fee-for-service basis will sunset.

Under SB 586, the Whole Child Model would be authorized in 21 counties served by COHS. The counties include, Del Norte, Humboldt, Lake, Lassen, Marin, Mendocino, Merced, Modoc, Monterey, Napa, Orange, San Luis Obispo, San Mateo, Santa Barbara, Santa Cruz, Shasta, Siskiyou, Solano, Sonoma, Trinity, and Yolo.

In the Whole Child Model, children would receive nearly all of their CCS services through the COHS. As of now, there are 27,510 children enrolled in CCS and Medi-Cal who would be affected by this proposal. Under SB 586, the CCS carve out would continue in the remaining 37 counties until January 1, 2022.

SB 586 contains a number of provisions to ensure the expertise and quality of care in CCS is preserved as part of the transition to the Whole Child Model, including continuity of care, ensuring CCS standards are maintained, and requiring independent evaluation.

The Whole Child Model authorized by SB 586 would begin on or after July 1, 2017. The final version of SB 586 passed the Assembly on an 80-0 vote and the Senate on a 39-0 vote, and received support from more than 30 organizations.