Bill Text: CA AB2096 | 2011-2012 | Regular Session | Amended
Bill Title: Public health care: Medi-Cal: district hospitals.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2012-04-23 - In committee: Set, first hearing. Hearing canceled at the request of author. [AB2096 Detail]
Download: California-2011-AB2096-Amended.html
BILL NUMBER: AB 2096 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 18, 2012
INTRODUCED BY Assembly Member V. Manuel Pérez
FEBRUARY 23, 2012
An act to amend Section 14182.3 14168.7
of , and to add Section 14165.58 to, the Welfare and
Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 2096, as amended, V. Manuel Pérez. Public health care:
Medi-Cal: demonstration projects. district
hospitals.
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.
The Medi-Cal program is, in part, governed and funded by federal
Medicaid Program provisions. Existing law establishes the Medi-Cal
Hospital/Uninsured Care Demonstration Project Act, which revises
hospital supplemental payment methodologies under the Medi-Cal
program in order to maximize the use of federal funds consistent with
federal Medicaid law and to stabilize the distribution of funding
for hospitals that provide care to Medi-Cal beneficiaries and
uninsured patients. Existing law requires the department to seek
another a successor
demonstration project or federal waiver of Medicaid law to implement
specified objectives, which may include better care coordination for
seniors, persons with disabilities, and children with special health
care needs. Existing law provides that to the extent the provisions
under the Medi-Cal Hospital/Uninsured Care Demonstration Project Act
do not conflict with the provisions of, or the Special Terms and
Conditions of, this demonstration project, the provisions of the
Medi-Cal Hospital/Uninsured Care Demonstration Project Act shall
apply. Under existing law, if the Director of Health Care
Services determines that the amount of base funding available under
the new demonstration project is less than a specified amount
available to public hospitals under the original demonstration
project, the state is authorized to reallocate funding to increase
the amount of base funding for the new demonstration project.
Existing law requires the department, pursuant to
federal approval of the successor demonstration project, to authorize
a local Low Income Health Program (LIHP) to provide health care
services to eligible low-income individuals under certain
circumstances. Under existing law, a county, city and county,
consortium of counties serving a region of more than one county, or a
health authority may be eligible to operate an approved LIHP.
This bill would refer ro designated and nondesignated public
hospitals, in the latter provision described above..
This bill would require the department to request any additional
federal funding identified in the recalculation of the successor
demonstration project and make those funds available to district
hospitals in an amount proportionate to the amount of uncompensated
care provided by those hospitals. This bill would require the
department to encourage LIHP contractors to permit district hospitals
to utilize certified public expenditures or intergovernmental
transfers, or both, to access federal funds to provide reimbursement
for LIHP eligible patients.
Existing law requires the department to design and implement an
intergovernmental transfer program relating to Medi-Cal managed care
services provided by designated and nondesignated public hospitals in
order to increase capitation payments for the purpose of increasing
their reimbursement.
This bill would, with respect to district hospitals, require the
department to implement this program and secure federal funding by
July 1, 2013.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14165.58 is added to the
Welfare and Institutions Code , to read:
14165.58. (a) The Legislature finds and declares all of the
following:
(1) The preservation of the state's district hospitals is of
critical importance to the health and welfare of the people of the
state.
(2) District hospitals are facing unprecedented financial
challenges. Many of these hospitals are facing significant budget
deficits impeding their ability to continue serving their essential
role in the safety net health care delivery system, including
providing care to Medi-Cal beneficiaries and uninsured patients.
(3) Given that the department has limited resources for
implementing new programs, allocating a portion of these limited
resources for purposes of securing new federal dollars to assist
California's district hospitals shall be considered of highest
priority.
(b) Acknowledging that district hospitals are California's
geographic health care safety net, it is the intent of the
Legislature to include district hospitals in all future endeavors
that seek increased federal funding for public hospitals, which may
include compensation for treating California's uninsured and
underinsured population, new programs aimed at improving and
expanding services in communities served by California's district
hospitals, and district hospital technology improvements.
(c) The department shall request any additional federal funding
identified in the recalculation of the demonstration project pursuant
to Article 5.4 (commencing with Section 14180) and make the funding
available to district hospitals in an amount proportionate to the
amount of uncompensated care provided by those hospitals. The funds
shall be accessed utilizing certified public expenditures.
(d) The department shall encourage Low Income Health Program
(LIHP) contractors, pursuant to Part 3.6 (commencing with Section
15909), to allow district hospitals to utilize certified public
expenditures or intergovernmental transfers, or both, to access
federal funds to provide reimbursement for LIHP eligible patients
treated by district hospitals, regardless of whether the patients are
part of the LIHP contractor's network.
SEC. 2. Section 14168.7 of the Welfare
and Institutions Code is amended to read:
14168.7. (a) The department shall design and implement, in
consultation with designated and nondesignated public hospitals, an
IGT program relating to Medi-Cal managed care services provided by
designated and nondesignated public hospitals in order to increase
capitation payments for the purpose of increasing their
reimbursement.
(b) For purposes of this section, the department shall follow the
requirements as specified in subdivision (f) of Section 14165.57.
(c) The increased capitation payments under this section shall be
actuarially sound and, in regard to the payments for nondesignated
public hospitals, shall be in proportion to the intergovernmental
transfers pursuant to Section 14165.57 in order to help maximize
reimbursement for designated and nondesignated public hospitals to
the extent permissible under federal law.
(d) This section shall be implemented on the later of June 30,
2011, or the date on which all necessary federal approvals have been
received.
(e) Participation in the intergovernmental transfers under this
section is voluntary on the part of the transferring entities for the
purposes of all applicable federal laws.
(f) This section shall be implemented only to the extent federal
financial participation is available for the reimbursement specified
in subdivision (a).
(g) This section shall be implemented only to the extent federal
financial participation is not jeopardized.
(h) To the extent that the director determines that the payments
do not comply with the federal Medicaid requirements, the director
retains the discretion not to implement an intergovernmental transfer
and may adjust the payment as necessary to comply with federal
Medicaid requirements.
(i) To the extent federal approval is secured, the increased
capitation payments under this section may cover services for periods
beginning on or after July 1, 2011.
(j) The department shall, with respect to district hospitals,
implement the program established pursuant to this section and secure
federal funding by July 1, 2013. This subdivision shall be
implemented in consultation with district hospital representatives.
(j)
(k) 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 policy
letters or similar instructions, without taking further regulatory
action.
SECTION 1. Section 14182.3 of the Welfare and
Institutions Code is amended to read:
14182.3. (a) To the extent the provisions of Article 5.2
(commencing with Section 14166) do not conflict with the provisions
of this article or the Special Terms and Conditions of the new
demonstration project created under this article, the provisions of
Article 5.2 (commencing with Section 14166) shall continue to apply
to the new demonstration project.
(b) In the event of a conflict between any provision of this
article and the Special Terms and Conditions required by the federal
Centers for Medicare and Medicaid Services for the approval of the
demonstration project described in Section 14180, the Special Terms
and Conditions shall control.
(c) (1) Under the demonstration project described in Section
14180, the state shall have priority to claim against and retain the
first five hundred million dollars ($500,000,000) in federal funds
using expenditures incurred under state-only programs or other
programs for which the state is authorized to claim under the Special
Terms and Conditions of the demonstration project or federal
Medicaid law, including state-only programs that serve special
populations, such as those for which state savings were recognized in
the Budget Act for the 2010-11 fiscal year.
(2) Notwithstanding paragraph (1), if the director determines that
the amount of base funding available under the demonstration project
described in Section 14180 is less than the six hundred eighty-one
million six hundred forty thousand dollars ($681,640,000) available
to designated and nondesignated public hospitals under the original
demonstration project, the state may reallocate an amount from the
five hundred million dollars ($500,000,000) described in paragraph
(1) to increase the amount of base funding under the new
demonstration project to six hundred eighty one million six hundred
forty thousand dollars ($681,640,000).
(3) For purposes of this section, the term "base funding" includes
funding for the safety net care pool or a similar pool or fund for
health coverage expansion, and for an investment, incentive, or
similar pool, but shall not include funds made available to hospitals
or counties for inpatient or outpatient Medi-Cal reimbursements,
expansion of managed care for seniors and persons with disabilities,
or other expansions of systems of care for individuals who are
eligible under the Medi-Cal state plan.
(4) If the state is unable to claim the full amount of the five
hundred million dollars ($500,000,000) described in paragraph (1),
any portion of the amount that remains unclaimed may be reallocated
to be claimed based on the certified public expenditures of the
designated public hospitals.
(d) The director shall have authority to maximize available
federal financial participation under the demonstration project
described in Section 14180, including, but not limited to,
authorizing the use of intergovernmental transfers by district
hospitals that are not reimbursed under a contract negotiated
pursuant to the Selective Provider Contracting Program, to fund the
nonfederal share of expenditures to the extent permitted by the
Special Terms and Conditions of the demonstration project.
(e) Participation in intergovernmental transfers under this
section is voluntary on the part of the transferring entity for
purposes of all applicable federal laws. As part of its voluntary
participation in the nonfederal share of payments under this
subdivision by means of intergovernmental transfers, the transferring
entity agrees to reimburse the state for the nonfederal share of
state staffing or administrative costs directly attributable to the
state's implementation of these voluntary intergovernmental
transfers. This subdivision shall be implemented only to the extent
federal financial participation is not jeopardized.
(f) Notwithstanding the rulemaking provisions of Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code, the department may clarify, interpret, or
implement the provisions of this section by means of provider
bulletins or similar instructions. The department shall notify the
fiscal and appropriate policy committees of the Legislature of its
intent to issue instructions under this section at least five days in
advance of the issuance.
