1. SB 810 THE 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

2. SB 810 LEGISLATIVE 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

3. SB 810 LEGISLATIVE 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

4. SB 810 LEGISLATIVE 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

5. SB 810 Chapters  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

6. SB 810 –Chapter 1 Highlights Purposes  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

7. SB 810 –Chapter 2 Highlights The 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

8. SB 810 –Chapter 3 Highlights Funding  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

9. SB 810 –Chapter 4 Highlights Eligibility  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.

10. SB 810 –Chapter 5 Highlights Benefits  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 3 rd year of program up to $250 per person per year

11. SB 810 –Chapter 6 Highlights Delivery 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

12. 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.