Amended  IN  Assembly  April 21, 2021
Amended  IN  Assembly  March 18, 2021

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Assembly Bill
No. 368

Introduced by Assembly Member Bonta
(Coauthors: Assembly Members Arambula, Chiu, Reyes, and Wicks)

February 01, 2021

An act to add and repeal Section 14042.15 of the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 368, as amended, Bonta. Food prescriptions.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services, including enteral nutrition products, pursuant to a schedule of benefits, and subject to utilization controls, such as prior authorization. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law requires the department to establish a Medically Tailored Meals Pilot Program to operate for a period of 4 years from the date the program is established, or until funding is no longer available, whichever date is earlier, in specified counties, including the Counties of Alameda and Sonoma, to provide medically tailored meal intervention services to Medi-Cal participants with specified health conditions, such as diabetes and renal disease.
This bill would require the department to establish, no earlier than January 1, 2022, a pilot program for a 2-year period in 3 counties, including the County of Alameda, the Counties of Alameda, Fresno, and San Bernardino to provide food prescriptions to eligible Medi-Cal beneficiaries, including individuals who have a specified chronic health condition, such as Type 2 diabetes and hypertension, when utilizing evidence-based practices that demonstrate the prevention, treatment, or reversal of those specified diseases. The bill would authorize the department, in consultation with stakeholders, to establish utilization controls, including the limitation on the number of services, food prescriptions, and to enter into contracts for purposes of implementing the pilot program. The bill would require a Medi-Cal managed care plan or their contractor that participates in the pilot program to establish procedures for referring and enrolling eligible Medi-Cal beneficiaries in the pilot program. The bill would require the department to evaluate the pilot program upon its conclusion, to report to the Legislature on those findings, and to implement these provisions by various means, including provider bulletins, without taking regulatory action. The bill would repeal these provisions on January 1, 2027.
This bill would make legislative findings and declarations as to the necessity of a special statute for specified counties, including the County of Alameda. the Counties of Alameda, Fresno, and San Bernardino.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 14042.15 is added to the Welfare and Institutions Code, immediately following Section 14042.1, to read:

14042.15.
 (a) (1) It is the intent of the Legislature to eliminate racial and ethnic health disparities, increase positive health outcomes, and reduce rates of food and nutrition insecurity for Medi-Cal beneficiaries in three counties in California, including the County of Alameda and two large counties, the Counties of Alameda, Fresno, and San Bernardino by establishing a two-year food prescription pilot program. The objective of this pilot program is to build upon Assembly Concurrent Resolution No. 108 (Res. Ch. 166, Stats. 2017), which encourages local jurisdictions across California to create “Food as Medicine” programs to address the obesity and diabetes epidemic. The pilot program shall provide food prescriptions to eligible Medi-Cal beneficiaries who are enrolled in a Medi-Cal managed care plan and are medically considered at rising-risk because they have one or more specified chronic health conditions and are experiencing food insecurity, but they do not require extensive care coordination. A food prescription shall consist of medically supportive food used for the prevention, reversal, or treatment of chronic health conditions, and may be paired with behavioral, cooking, or nutrition education, coaching, and counseling.
(2) The Legislature finds that racial and ethnic health disparities have been exacerbated by the COVID-19 pandemic. This public health emergency, COVID-19, has illuminated the urgent need to build resiliency among medically vulnerable populations, especially those with underlying chronic health conditions. According to the State Department of Public Health, Latinos, African Americans, Pacific Islanders, and Native Hawaiians have a higher death rate from COVID-19 than other populations. The federal Centers for Disease Control and Prevention overwhelmingly reports that most of those hospitalized or who die from COVID-19 have an underlying health condition. Chronic health conditions disproportionately impact communities of color, making them particularly vulnerable for adverse health outcomes from severe COVID-19, including hospitalization and death. African Americans, Latinos, and Filipinos are at higher risk for prediabetes and diabetes than other populations. The Kaiser Family Foundation reports that one in five Latinos say they have fair or poor health, and, according to the March of Dimes, African American women have a higher rate of preterm and low birth weight babies, which is often an indication of subsequent health problems, such as diabetes and high blood pressure. By preventing, treating, and reversing their underlying chronic health conditions, Medi-Cal beneficiaries, and especially members of populations who experience health disparities, may be less vulnerable not only to COVID-19, but other chronic illnesses. Moreover, it is the intent of the Legislature to reduce racial health disparities and generate long-term cost savings to the health care system as a result of the implementation of the two-year food prescription pilot program.
(b) For purposes of this section, the following definitions apply:
(1) “Eligible Medi-Cal beneficiary” means an individual who is eligible to participate in the pilot program and meets all of the following requirements:
(A) (i) Enrolled in a Medi-Cal managed care plan.
(ii) For purposes of clause (i), “Medi-Cal managed care plan” means a Medi-Cal managed care health plan that serves in one or more of the three pilot counties.
(B) Has one or more of the following chronic health conditions:
(i) Depression or anxiety.
(ii) Type 2 diabetes or prediabetes.
(iii) Hypertension, which is also referred to as high blood pressure.
(iv) Nonalcoholic fatty liver disease.
(v) Overweight, obesity, or severe obesity, as measured by a person’s body mass index (BMI). For purposes of this clause, “overweight” means a person’s BMI is between 25 kg/m2 and 30 kg/m2. “Obesity” means a person’s BMI is 30 kg/m2 or higher, but under 40 kg/m2, and “severe obesity” means that a person’s BMI is 40 kg/m2 or higher.
(vi) Dyslipidemia, hypertriglyceridemia, or low high-density lipoprotein cholesterol.
(vii) High-risk pregnancy, including gestational diabetes.
(C) Medically vulnerable, as defined by health conditions with the highest health disparities.
(2) “Food prescription” means a specific dosage of medically supportive food, which is prescribed by a Medi-Cal managed care plan or plan contractor, that is based on evidence-based practices that demonstrate the prevention, treatment, or reversal of specific chronic health conditions.
(3) “Medically supportive food” means any nutrient-rich whole food, including any fruit, vegetable, legume, nut, seed, whole grain, seafood, and lean animal protein, used for the prevention, treatment, or reversal of a specific chronic health condition.
(4) (A)“Pilot program” means the two-year pilot program established in the County of Alameda and two large counties Counties of Alameda, Fresno, and San Bernardino to provide medically supportive food through food prescription programs and services one or more food prescription programs to eligible Medi-Cal beneficiaries with the goal of eliminating health disparities, improving health outcomes, and reducing rates of food and nutrition insecurity.

(B)For purposes of subparagraph (A), “large counties” means counties with a population of greater than 700,000 people.

(c) To the extent funds are made available in the annual Budget Act for this purpose, and no earlier than January 1, 2022, the department shall establish a pilot program for a two-year period in the County of Alameda and two large counties Counties of Alameda, Fresno, and San Bernardino to provide food prescriptions to eligible Medi-Cal beneficiaries, as described in paragraph (1) of subdivision (b), subject to utilization controls, as specified in subdivision (d) and Section 14133.
(d) The department, in consultation with stakeholders, may establish utilization controls, as described in Section 14133, with respect to the limitation on the number of services, including how these services food prescriptions, including how these food prescriptions may be restricted as to a set number within a specified timeframe. In developing these utilization controls under the pilot program, the department and Medi-Cal managed care plans shall consider the nutritional needs, food security, and health status of a recipient. If applicable, the department shall consult with the Medi-Cal managed care plans in each of the pilot program counties to ensure that the pilot program does not duplicate services or funding between pilot program participants and the target population for the California Advancing and Innovating Medi-Cal initiative, including enhanced case management and in lieu of services, and the Medically Tailored Meals Pilot Program, as established under Section 14042.1.
(e) For purposes of implementing the pilot program, the department may enter into exclusive or nonexclusive contracts on a bid or negotiated basis with Medi-Cal managed care plans that may directly implement the food prescription programs and services one or more food prescription programs or contract with vendors to administer these programs and services those food prescription programs on their behalf. Medi-Cal managed care plans shall prioritize public, nonprofit, and community-based organizations, including entities that source California-grown produce and products. Any contract entered into or amended pursuant to this section shall be exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, Section 19130 of the Government Code, and Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, and shall be exempt from the review or approval of any division of the Department of General Services.
(f) A Medi-Cal managed care plan or their contractor that participates in the pilot program shall establish procedures for referring and enrolling eligible Medi-Cal beneficiaries in the pilot program. The department shall direct the Medi-Cal managed plans participating in the pilot program to target eligible Medi-Cal beneficiaries with health conditions as described in subparagraphs (B) and (C), inclusive, of paragraph (1) of subdivision (b).
(g) (1) Upon the completion of the pilot program, and to the extent it can be determined, the department shall evaluate the impact of the pilot program, including, but not limited to, relevant health outcome and health disparities data, and the pilot program’s impact on quality and performance improvement metrics, such as Healthcare Effectiveness Data and Information Set measures, medication adherence, medical appointment attendance, and member satisfaction scores. The department shall prepare these findings, including its recommendation on expanding the pilot program on a statewide-basis or for an extended period of time, into a finalized report, and shall submit this report to the Legislature by January 1, 2025, or within 12 months after the end of the pilot program, whichever is sooner.
(2) A report to be submitted pursuant to paragraph (1) shall be submitted in compliance with Section 9795 of the Government Code.
(h) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department shall implement this section by means of a provider bulletin or similar instruction, without taking regulatory action.
(i) This section shall remain in effect only until January 1, 2027, and as of that date is repealed.

SEC. 2.

 The Legislature finds and declares that a special statute is necessary and that a general statute cannot be made applicable within the meaning of Section 16 of Article IV of the California Constitution because of the unique position of the County of Alameda, and the large counties described in this act, Counties of Alameda, Fresno, and San Bernardino to continue to build upon their efforts to provide medically supportive food to medically vulnerable residents for purposes of developing a model food prescription pilot program to be expanded on a statewide basis.