Bill Text: CA AB2174 | 2009-2010 | Regular Session | Introduced

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Bill Title: Medi-Cal: pediatric subacute care units: respiratory

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2010-04-20 - In committee: Set, second hearing. Hearing canceled at the request of author. [AB2174 Detail]

Download: California-2009-AB2174-Introduced.html

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BILL NUMBER: AB 2174	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Beall

                        FEBRUARY 18, 2010

   An act to amend Section 14132.25 of the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 2174, as introduced, Beall. Medi-Cal: pediatric subacute care
units: respiratory therapy hours
   Existing law provides for the licensure and regulation of health
facilities, including skilled nursing facilities, by the State
Department of Public Health.
   Existing law also provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services,
pursuant to which medical benefits are provided to public assistance
recipients and certain other low-income persons. Existing law
requires the State Department of Health Care Services to establish a
subacute care program in health facilities in order to more
effectively use available Medi-Cal funding while simultaneously
ensuring needed services for subacute care patients.
   Existing regulatory law defines a pediatric subacute care unit as
an identifiable unit of a certified nursing facility licensed as a
skilled nursing facility and meeting the standards for participation
as a provider under the Medi-Cal program. Existing regulatory law
requires pediatric subacute care units to utilize a licensed
respiratory care practitioner to provide a minimum of 3.0 hours per
patient day to each ventilator dependent patient and a minimum of 2.0
hours per patient day to each nonventilator dependent patient of
medically necessary respiratory care services.
   This bill would require the State Department of Health Care
Services to waive the above-described regulatory requirements and
allow a pediatric subacute care unit to reduce its respiratory
therapy hours by one hour per patient day, thereby reducing the
required minimum numbers of hours to 2.0 hours per patient day to
each ventilator dependent patient and 1.0 hour per patient day to
each nonventilator dependent patient, if certain conditions are
satisfied.
   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 14132.25 of the Welfare and Institutions Code
is amended to read:
   14132.25.   (a)    On or before July 1, 1983,
the State Department of Health  Care  Services shall
establish a subacute care program in health facilities in order to
more effectively use the limited Medi-Cal dollars available while, at
the same time, ensuring needed services for these patients. The
subacute care program shall be available to patients in  health
 facilities who meet subacute care criteria. Subacute care may
be provided by any facility designated by the director as meeting the
subacute care  criteria, and which   criteria
that  has an approved provider participation agreement with the
State Department of Health  Care  Services. 
    The 
    (b)     The  State Department of
Health  Care  Services shall develop a rate of reimbursement
for this subacute care program. Reimbursement rates  will
  shall  be determined in accordance with
methodology developed by the State Department of Health  Care
 Services, specified in regulation, and may include the
following:
   (1) All inclusive per diem rates.
   (2) Individual patient specific rates according to the needs of
the individual subacute care patient.
   (3) Other rates subject to negotiation with the health facility.
   However, reimbursement at subacute care rates shall only be
implemented when funds are available for this purpose pursuant to the
annual Budget Act. 
    The 
    (c)     The  department may negotiate
and execute an agreement with any health facility  which
  that  meets the standards for providing subacute
care. An agreement may be negotiated or established between the
health facility and the department for subacute care based on
individual patient assessment. The department shall establish level
of care criteria and appropriate utilization controls for patients
eligible for the subacute care program. 
    For 
    (d)     For  the purposes of this
section, subacute patient care shall be defined by the state
department based on the results of its study pursuant to Chapter 1211
of the Statutes of 1980. 
   (e) The department shall waive the requirements of subdivision (t)
of Section 51215.8 of Title 22 of the California Code of Regulations
pertaining to the required minimum number of hours of respiratory
care services provided to ventilator dependent and nonventilator
dependent patients and allow a pediatric subacute care unit to reduce
its respiratory therapy hours by one hour per patient day, thereby
reducing the required minimum number of hours to 2.0 hours per
patient day to each ventilator dependent patient and a minimum of 1.0
hour per patient day to each nonventilator dependent patient, if
both the following conditions are satisfied:  
   (1) The pediatric subacute care unit concurrently increases its
nursing hours by one hour per patient day.  
   (2) The pediatric subacute care unit can demonstrate that the
reduction in hours is cost neutral and that patient care is not
adversely impacted.