Bill Text: CA AB85 | 2013-2014 | Regular Session | Enrolled

NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Health and human services.

Status: (Passed) 2013-06-27 - Chaptered by Secretary of State - Chapter 24, Statutes of 2013. [AB85 Detail]

Download: California-2013-AB85-Enrolled.html
BILL NUMBER: AB 85	ENROLLED
	BILL TEXT

	PASSED THE SENATE  JUNE 15, 2013
	PASSED THE ASSEMBLY  JUNE 15, 2013
	AMENDED IN SENATE  JUNE 13, 2013

INTRODUCED BY   Committee on Budget (Blumenfield (Chair), Bloom,
Bonilla, Campos, Chesbro, Daly, Dickinson, Gordon, Jones-Sawyer,
Mitchell, Mullin, Muratsuchi, Nazarian, Skinner, Stone, and Ting)

                        JANUARY 10, 2013

   An act to amend Sections 17600.10, 17600.15, 17600.20, 17601.25,
17603, 17604, and 17606.10, to amend, repeal, and add Section 17600
of, to add Sections 11450.025, 14301.5, 17600.50, 17600.60, 17601.50,
17601.75, and 17609.02 to, to add a heading to Article 2.5
(commencing with Section 17601.25) of Chapter 6 of Part 5 of Division
9 of, and to add Article 6.6 (commencing with Section 14199.1) to
Chapter 7 of Part 3 of Division 9 of, and Article 11 (commencing with
Section 17610), Article 12 (commencing with Section 17612.1), and
Article 13 (commencing with Section 17613.1) to Chapter 6 of Part 5
of Division 9 of, the Welfare and Institutions Code, relating to
health and human services, and making an appropriation therefor, to
take effect immediately, bill related to the budget.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 85, Committee on Budget. Health and human services.
   (1) Existing federal law provides for allocation of federal funds
through the federal Temporary Assistance for Needy Families (TANF)
block grant program to eligible states, with California's version of
this program being known as the California Work Opportunity and
Responsibility to Kids (CalWORKs) program. Under the CalWORKs
program, each county provides cash assistance and other benefits to
qualified low-income families and individuals who meet specified
eligibility criteria, including participating in specified
welfare-to-work activities.
   This bill would increase aid payments by 5% as of March 1, 2014,
and would specify a process by which additional grant increases could
be made depending on projected revenue and costs.
   (2) Existing law establishes the Local Revenue Fund, a
continuously appropriated fund, that allocates Vehicle License Fund
moneys and sales tax moneys. Existing law creates various accounts
and subaccounts within that fund, including the Health Subaccount and
the Social Services Subaccount, each of which get funding from the
Local Revenue Fund.
   This bill would make an appropriation by reallocating funds in the
2012-13 fiscal year and subsequent fiscal years to change the
relative percentages of funds from those 2 sources that are allocated
to the Health Subaccount and the Social Services Subaccount.
   (3) Existing law provides for the establishment of the Sales Tax
Growth Account in the continuously appropriated Local Revenue Fund
for the allocation of sales and use tax growth revenues to local
government.
   This bill would delete specified subaccounts in the Sales Tax
Growth Account and would add a Family Support Subaccount and a Child
Poverty and Family Supplemental Support Subaccount to the Sales Tax
Account. The bill would provide funding for the Child Poverty and
Family Supplemental Support Subaccount from the Sales Tax Growth
Account in the 2013-14 fiscal year and from sales tax in later fiscal
years. The bill would require the transfer of funds from the Child
Poverty and Family Services Supplemental Support Subaccount to the
counties for use to support the CalWORKs program, as specified.
   This bill would establish funding for the Family Support
Subaccount from the Health Subaccount. The bill would require the
transfer of funds from the Family Services Support Subaccount to the
counties for use to support the CalWORKs program, as specified.
    Under existing law, cities and counties that receive funds from
the Local Revenue Fund are required to establish and maintain a local
health and welfare trust fund comprised of specified accounts.
   This bill would also require counties to establish a family
support account in their local health and welfare trust accounts. By
requiring additional duties from the counties, this bill would impose
a state-mandated local program.
   (4) Existing law requires counties, through a choice of
methodologies, including County Medical Services Programs, nonpublic
hospitals, and public hospitals, to provide specified health services
eligible county residents who are indigent. Funding for this
program, under existing law, has come from the Health Subaccount.
   This bill would allow counties to receive funding from the Health
Subaccount by either proving actual costs or by electing to receive
60% of the funds that would otherwise have been allocated to them,
and would establish a default contribution for counties that fail to
make a choice or to inform the Director of Health Care Services by
December 4, 2013. The bill would place the difference between prior
fiscal year contributions to counties from the Health Subaccount and
the new contributions to counties in the Family Support Subaccount,
to be used by counties for CalWORKs, as specified.
   This bill would establish processes by which the counties prove
actual costs to the Department of Health Care Services, as specified.

   (5) 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. Under existing law, eligibility for the
Medi-Cal program is expanding.
   This bill would require specified percentages of newly eligible
beneficiaries to be assigned to public hospital health systems in an
eligible county, if applicable, until the county public hospital
health system meets its enrollment target, as defined. The bill would
also require, subject to specified criteria, Medi-Cal managed care
plans serving newly eligible beneficiaries to pay county public
hospital health systems for services provided to newly eligible
beneficiaries in amounts that are no less than the cost of providing
those services, as specified.
   (6) The California Constitution requires the state to reimburse
local agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to these
statutory provisions.
   (7) This bill would declare that it is to take effect immediately
as a bill providing for appropriations related to the Budget Bill.
   Appropriation: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 11450.025 is added to the Welfare and
Institutions Code, to read:
   11450.025.  (a) Notwithstanding any other law, effective on March
1, 2014, the maximum aid payments in effect on July 1, 2012, as
specified in subdivision (b) of Section 11450.02, shall be increased
by 5 percent.
   (b) Commencing in 2014 and annually thereafter, on or before
January 10 and on or before May 14, the Director of Finance shall do
all of the following:
   (1) Estimate the amount of growth revenues pursuant to subdivision
(f) of Section 17606.10 that will be deposited in the Child Poverty
and Family Supplemental Support Subaccount of the Local Revenue Fund
for the current fiscal year and the following fiscal year and the
amounts in the subaccount carried over from prior fiscal years.
   (2) For the current fiscal year and the following fiscal year,
determine the total cost of providing the increase described in
subdivision (a), as well as any other increase in the maximum aid
payments subsequently provided only under this section, after
adjusting for updated projections of CalWORKs costs associated with
caseload changes, as reflected in the local assistance subvention
estimates prepared by the State Department of Social Services and
released with the annual Governor's Budget and subsequent May
Revision update.
   (3) If the amount estimated in paragraph (1) plus the amount
projected to be deposited for the current fiscal year into the Child
Poverty and Family Supplemental Support Subaccount pursuant to
subparagraph (3) of subdivision (e) of Section 17600.15 is greater
than the amount determined in paragraph (2), the difference shall be
used to calculate the percentage increase to the CalWORKs maximum aid
payment standards that could be fully funded on an ongoing basis
beginning the following fiscal year.
   (4) If the amount estimated in paragraph (1) plus the amount
projected to be deposited for the current fiscal year into the Child
Poverty and Family Supplemental Support Subaccount pursuant to
subparagraph (3) of subdivision (e) of Section 17600.15 is equal to
or less than the amount determined in paragraph (2), no additional
increase to the CalWORKs maximum aid payment standards shall be
provided in the following fiscal year in accordance with this
section.
   (5) (A) Commencing with the 2014-15 fiscal year and for all fiscal
years thereafter, if changes to the estimated amounts determined in
paragraphs (1) or (2), or both, as of the May Revision, are enacted
as part of the final budget, the Director of Finance shall repeat,
using the same methodology used in the May Revision, the calculations
described in paragraphs (3) and (4) using the revenue projections
and grant costs assumed in the enacted budget.
   (B) If a calculation is required pursuant to subparagraph (A), the
Department of Finance shall report the result of this calculation to
the appropriate policy and fiscal committees of the Legislature upon
enactment of the Budget Act.
   (c) An increase in maximum aid payments calculated pursuant to
paragraph (3) of subdivision (b), or pursuant to paragraph (5) of
subdivision (b) if applicable, shall become effective on October 1 of
the following fiscal year.
   (d) (1) An increase in maximum aid payments provided in accordance
with this section shall be funded with growth revenues from the
Child Poverty and Family Supplemental Support Subaccount in
accordance with paragraph (3) of subdivision (e) of Section 17600.15
and subdivision (f) of Section 17606.10, to the extent funds are
available in that subaccount.
   (2) If funds received by the Child Poverty and Family Supplemental
Support Subaccount in a particular fiscal year are insufficient to
fully fund any increases to maximum aid payments made pursuant to
this section, the remaining cost for that fiscal year will be
addressed through existing provisional authority included in the
annual Budget Act. Additional grant increases shall not be provided
until and unless the ongoing cumulative costs of all prior grant
increases provided pursuant this section are fully funded by the
Child Poverty and Family Supplemental Support Subaccount.
   (e) Notwithstanding Section 15200, counties shall not be required
to contribute a share of cost to cover the costs of increases to
maximum aid payments made pursuant to this section.
  SEC. 2.  Article 6.6 (commencing with Section 14199.1) is added to
Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions
Code, to read:

      Article 6.6.  Medicaid Expansion Under The Federal Affordable
Care Act


   14199.1.  (a) The Legislature finds and declares the following:
   (1) Beginning January 1, 2014, many low-income individuals will be
eligible for Medi-Cal coverage pursuant to federal law, as part of
health care reform.
   (2) In implementing this expansion of Medi-Cal coverage, it is
critical to maintain the role of county public hospital health
systems that have traditionally served Medi-Cal and uninsured
beneficiaries to ensure adequate access to care is available for the
new Medi-Cal members, and to preserve the policy goal to support and
strengthen traditional safety net providers who treat a high volume
of uninsured and Medi-Cal patients.
   (b) For purposes of this section, the following definitions shall
apply:
   (1) "County public hospital health system" shall have the meaning
provided in subdivision (f) of Section 17612.2.
   (2) "Default members" means newly eligible beneficiaries enrolled
in each Medi-Cal managed care plan who do not affirmatively select a
primary care provider as part of the enrollment process.
   (3) "Enrollment target" means the number of newly eligible
beneficiaries assigned to primary care providers within a county
public hospital health system, not to exceed the number of
unduplicated Low Income Health Program and uninsured patient count in
the county public hospital health system. The unduplicated patient
count shall be certified by the county public hospital health system
and provided to the department, along with its proposed enrollment
target, by November 30, 2013. The county public hospital health
system may notify the department of a proposed reduction to its
enrollment target based on its capacity to accept new patients. A
standardized protocol for determining the target shall be developed
by the department in consultation with the public hospital health
system counties.
   (4) "Low Income Health Program" shall mean the LIHP as defined in
subdivision (c) of Section 15909.1.
   (5) "Medi-Cal managed care plan" means an organization or entity
that enters into a contract with the department pursuant to Article
2.7 (commencing with Section 14087.3), Article 2.8 (commencing with
Section 14087.5), Article 2.81 (commencing with Section 14087.96),
Article 2.91 (commencing with Section 14089), or Chapter 8
(commencing with Section 14200).
   (6) "Newly eligible beneficiaries" shall have the meaning provided
in subdivision (s) of Section 17612.2.
   (7) "Primary care provider" means a primary care physician or
nonphysician medical practitioner, medical group, clinic, or a
medical home.
   (8) "Public hospital health system county" shall have the meaning
provided in subdivision (u) of Section 17612.2.
   (c) Subject to subdivision (d), default members who reside in a
public hospital health system county shall be assigned by each
Medi-Cal managed care plan in the county to a primary care provider
in accordance with the following:
   (1) Throughout the three-year period ending on December 31, 2016,
at least 75 percent of default members shall be assigned by each
Medi-Cal managed care plan to primary care providers within the
county public hospital health system until the county public hospital
health system meets its enrollment target.
   (2) Following the expiration of the three-year period set forth in
paragraph (1), at least 50 percent of default members shall be
assigned by each Medi-Cal managed care plan to primary care providers
within the county public hospital health system until the county
public hospital health system meets its applicable enrollment target.

   (3) Paragraphs (1) and (2) shall not apply with respect to a
county public hospital health system during any time period in which
the county public hospital health system meets or exceeds its
applicable target. For time periods during which paragraphs (1) and
(2) do not apply, default members shall be assigned to primary care
providers in the same manner as other Medi-Cal members of the
Medi-Cal managed care plan who do not affirmatively select primary
care providers. Medi-Cal managed care plans shall not modify the
assignment procedures due to the default assignment requirements of
this section with respect to primary care providers within the county
public hospital health system.
   (4) In implementing the assignment process set forth in paragraphs
(1) and (2), to the extent legally permissible and consistent with
federal and state privacy and patient confidentiality laws, each
Medi-Cal managed care plan shall first assign to a primary care
provider within the county public hospital health system those
default members who have accessed care within the county public
hospital health system two or more times within the past 12 months.
The department and the county public hospital health systems shall
work together to share patient information in order to provide the
Medi-Cal managed care plans with data demonstrating which default
members have accessed the county public hospital health system
providers prior to assignment to a primary care provider.
   (5) If at any time a county public hospital health system notifies
a contracted Medi-Cal managed care plan that it has reached its
maximum capacity for the assignment of default members, the
requirements set forth in paragraphs (1) and (2) shall not apply to
the Medi-Cal managed care plan so notified. Once the county public
hospital health system notifies a Medi-Cal managed care plan that it
has capacity to accept assignment of default members, the
requirements set forth in paragraphs (1) and (2) shall apply
effective on the first day of the month following that notice.
   (6) A Medi-Cal managed care plan shall not assign default members
to a primary care provider within the county public hospital health
system if that primary care provider has notified the Medi-Cal
managed care plan that it does not have capacity to accept new
patients.
   (d) The default process described in this section shall not apply
to Low Income Health Program enrollees subject to Section 14005.60.
   (e) Nothing set forth in this section shall alter, reduce, or
modify in any manner the way in which Medi-Cal managed care plans
assign other Medi-Cal members to the county public hospital health
systems.
   (f) (1) The department shall modify its contracts with the
Medi-Cal managed care plans in public hospital health system counties
to include the assignment requirements set forth in this section.
   (2) Each Medi-Cal managed care plan shall demonstrate and certify
that it has contracts or other arrangements in place with county
public hospital health systems that provide for implementing the
requirements of this section. To the extent a Medi-Cal managed care
plan is not compliant with any of the requirements of this section,
the department shall reduce by 25 percent the default assignment into
the Medi-Cal managed care plan with respect to all Medi-Cal
beneficiaries, as long as the other Medi-Cal managed care plan or
plans in that county have the capacity to receive the additional
default membership.
   (g) Nothing in this section shall modify the ability of newly
eligible beneficiaries to select or change their primary care
providers.
   (h) The department shall seek any necessary federal approvals to
implement the provisions of this section.
   14199.2.  (a) Subject to subdivision (e), Medi-Cal managed care
plans serving newly eligible beneficiaries, as defined in subdivision
(s) of Section 17612.2, shall pay county public hospital health
systems, as defined in subdivision (f) of Section 17612.2, for
services provided to newly eligible beneficiaries in amounts that are
no less than the cost of providing those services, including the
cost of network and out-of-network services that are charged to or
paid for by county public hospital health systems. For purposes of
this requirement, the cost of providing services shall mean the
amounts, including the federal and nonfederal share of all allowable
costs, determined in a manner consistent with the cost claiming
protocols developed for the federal Medicaid demonstration project
authorized under Section 1115 of the Social Security Act entitled the
"Bridge to Health Care Reform" (waiver number 11-W-00193/9),
including protocols pending federal approval, and under Section
14166.8.
   (b) Consistent with federal law, the capitation rates paid to
Medi-Cal managed care plans for newly eligible beneficiaries shall be
determined to reflect the obligations imposed by subdivision (a).
   (c) (1) Prior to the execution of a change order or contract
amendment between the department and a Medi-Cal managed care plan
providing for coverage of newly eligible beneficiaries, the Medi-Cal
managed care plan shall demonstrate and certify that it has contracts
or other arrangements in place with county public hospital health
systems that provide for payments for services meeting the
requirements of subdivision (a).
   (2) Each year, each Medi-Cal managed care plan shall provide to
the department an accounting of the payments made to demonstrate
compliance with subdivision (a). To the extent a Medi-Cal managed
care plan is not compliant with any of the requirements of this
section, the department shall reduce the default assignment into the
Medi-Cal managed care plan with respect to all Medi-Cal beneficiaries
by 25 percent, as long as the other Medi-Cal managed care plan or
plans in the county have the capacity to receive the additional
default membership.
   (d) A Medi-Cal managed care plan shall not impose a fee or
retention amount, or reduce other payments to a county public
hospital health system, that would result in a direct or indirect
reduction to the amounts required to be paid under subdivision (a).
   (e) (1) If a nonfederal share is necessary with respect to the
capitation rates described in subdivision (b), a county public
hospital health system or affiliated governmental entity shall have
the right to voluntarily provide intergovernmental transfers for the
nonfederal share of expenditures for the capitation rates described
in subdivision (b) with respect to the requirements in subdivision
(a). Only if the county public hospital health system or affiliated
governmental entity so chooses, the requirements in this section
shall apply. Notwithstanding any other law, the state shall not
assess the fee described in subdivision (d) of Section 14301.4, or
any other similar fee. Nothing in this section shall be construed to
require a county public hospital health system to provide the
nonfederal share for expenditures for purposes other than those
described in subdivision (a), or for expenditures that are otherwise
for Medi-Cal managed care beneficiaries who do not receive services
in the county public hospital health system.
   (2) Within 12 months following the end of each fiscal year, a
county public hospital system shall submit data to the department
demonstrating the payments received from Medi-Cal managed care plans
as required under subdivision (a). If the amount of the applicable
intergovernmental transfer provided by a county public hospital
system does not equal the nonfederal share of those payments, the
county hospital system and the department shall adjust the amount of
the intergovernmental transfer accordingly.
  SEC. 3.  Section 14301.5 is added to the Welfare and Institutions
Code, to read:
   14301.5.  (a) (1) To the extent federal financial participation is
not jeopardized and consistent with federal law, and subject to the
conditions set forth in subdivision (b), the department shall pay
Medi-Cal managed care plans rate range increases, as defined by
paragraph (4) of subdivision (b) of Section 14301.4, at a minimum
level of 75 percent of the rate range available with respect to all
enrollees who are newly eligible beneficiaries for purposes of this
section. If a nonfederal share is necessary to fund the rate range
increases, a county public hospital health system as defined in
subdivision (f) of Section 17612.2 or affiliated governmental entity
may voluntarily provide intergovernmental transfers for the
nonfederal share.
   (2) The increased payments to Medi-Cal managed care plans that
would be paid consistent with actuarial certification and enrollment
in the absence of this section, including, but not limited to,
payments described in Section 14182.15, shall not be reduced as a
consequence of payment under this section.
   (b) Payments to Medi-Cal managed care plans pursuant to
subdivision (a) are conditioned on all of the following:
   (1) The Medi-Cal managed care plan shall pay all of the rate range
increases provided under this section as additional payments to
county public hospital health systems for providing and making
available services to Medi-Cal enrollees of the plan.
   (2) The Medi-Cal managed care plan shall demonstrate that it has a
contract or other arrangement in place with county public hospital
health systems to provide additional payments to county public
hospital health systems for services rendered to Medi-Cal
beneficiaries that meet the requirements of paragraph (1). The
existence of those agreements or arrangements shall be reported to
the department by the county public hospital health system.
   (3) Additional payments described in paragraph (1) shall not
supplant amounts that would otherwise be payable by Medi-Cal managed
care plans to county public hospital health systems. A Medi-Cal
managed care plan shall not impose a fee or retention amount, or
reduce other payments to a county public hospital health system, that
would result in a direct or indirect reduction to these payments.
   (4) The county public hospital health system or affiliated
governmental entity voluntarily provides an intergovernmental
transfer of public funds to the state for use as the nonfederal
share, if any, of the increased capitation rates. Notwithstanding any
other provision of law, the department shall not assess the fee
described in subdivision (d) of Section 14301.4, or any other similar
fee.
   (c) To the extent a Medi-Cal managed care plan is not compliant
with any of the requirements imposed upon it pursuant to this
section, the department shall reduce by 25 percent the default
assignment into the Medi-Cal managed care plan with respect to all
Medi-Cal beneficiaries, as long as the other Medi-Cal managed care
plan or plans in that county have the capacity to receive the
additional default membership.
  SEC. 4.  Section 17600 of the Welfare and Institutions Code is
amended to read:
   17600.  (a) There is hereby created the Local Revenue Fund, which
shall have all of the following accounts:
   (1) The Sales Tax Account.
   (2) The Vehicle License Fee Account.
   (3) The Vehicle License Collection Account.
   (4) The Sales Tax Growth Account.
   (5) The Vehicle License Fee Growth Account.
   (b) The Sales Tax Account shall have all of the following
subaccounts:
   (1) The Mental Health Subaccount.
   (2) The Social Services Subaccount.
   (3) The Health Subaccount.
   (4) The CalWORKs Maintenance of Effort Subaccount.
   (c) The Sales Tax Growth Account shall have all of the following
subaccounts:
   (1) The Caseload Subaccount.
   (2) The Base Restoration Subaccount.
   (3) The Indigent Health Equity Subaccount.
   (4) The Community Health Equity Subaccount.
   (5) The Mental Health Equity Subaccount.
   (6) The State Hospital Mental Health Equity Subaccount.
   (7) The County Medical Services Subaccount.
   (8) The General Growth Subaccount.
   (9) The Special Equity Subaccount.
   (d) Notwithstanding Section 13340 of the Government Code, the
Local Revenue Fund is hereby continuously appropriated, without
regard to fiscal years, for the purpose of this chapter.
   (e) The Local Revenue Fund shall be invested in the Surplus Money
Investment Fund and all interest earned shall be distributed in
January and July among the accounts and subaccounts in proportion to
the amounts deposited into each subaccount, except as provided in
subdivision (f).
   (f) If a distribution required by subdivision (e) would cause a
subaccount to exceed its limitations imposed pursuant to any of the
following, the distribution shall be made among the remaining
subaccounts in proportion to the amounts deposited into each
subaccount in the six prior months:
   (1) Subdivision (a) of Section 17605.
   (2) Subdivision (a) of Section 17605.05.
   (3) Subdivision (b) of Section 17605.10.
   (4) Subdivision (c) of Section 17605.10.
   (g) This section shall remain in effect only until July 1, 2013,
and as of that date is repealed, unless a later enacted statute, that
is enacted before July 1, 2013, deletes or extends that date.
  SEC. 5.  Section 17600 is added to the Welfare and Institutions
Code, to read:
   17600.  (a) There is hereby created the Local Revenue Fund, which
shall consist of the following accounts:
   (1) The Sales Tax Account.
   (2) The Vehicle License Fee Account.
   (3) The Vehicle License Collection Account.
   (4) The Sales Tax Growth Account.
   (5) The Vehicle License Fee Growth Account.
   (b) The Sales Tax Account shall have all of the following
subaccounts:
   (1) The Mental Health Subaccount.
   (2) The Social Services Subaccount.
   (3) The Health Subaccount.
   (4) The CalWORKs Maintenance of Effort Subaccount.
   (5) The Family Support Subaccount.
   (6) The Child Poverty and Family Supplemental Support Subaccount.
   (c) The Sales Tax Growth Account shall have all of the following
subaccounts:
   (1) The Caseload Subaccount.
   (2) The County Medical Services Subaccount.
   (3) The General Growth Subaccount.
   (d) Notwithstanding Section 13340 of the Government Code, the
Local Revenue Fund is hereby continuously appropriated, without
regard to fiscal years, for the purpose of this chapter.
   (e) Moneys in the Local Revenue Fund shall be invested in the
Surplus Money Investment Fund and all interest earned shall be
distributed in January and July among the accounts and subaccounts in
proportion to the amounts deposited into each subaccount.
   (f) This section shall be operative on July 1, 2013.
  SEC. 6.  Section 17600.10 of the Welfare and Institutions Code is
amended to read:
   17600.10.  (a) Each county and city and county receiving funds in
accordance with this chapter shall establish and maintain a local
health and welfare trust fund comprised of the following accounts:
   (1) The mental health account.
   (2) The social services account.
   (3) The health account.
   (4) The CalWORKs Maintenance of Effort Subaccount.
   (5) The family support account.
   (b) Each city receiving funds in accordance with this chapter
shall establish and maintain a local health and welfare trust fund
comprised of a health account and a mental health account.
  SEC. 7.  Section 17600.15 of the Welfare and Institutions Code is
amended to read:
   17600.15.  (a) Of the sales tax proceeds from revenues collected
in the 1991-92 fiscal year which are deposited to the credit of the
Local Revenue Fund, 51.91 percent shall be credited to the Mental
Health Subaccount, 36.17 percent shall be credited to the Social
Services Subaccount, and 11.92 percent shall be credited to the
Health Subaccount of the Sales Tax Account.
   (b) For the 1992-93 fiscal year to the 2011-12 fiscal year,
inclusive, of the sales tax proceeds from revenues deposited to the
credit of the Local Revenue Fund, the Controller shall make monthly
deposits to the Mental Health Subaccount, the Social Services
Subaccount, and the Health Subaccount of the Sales Tax Account until
the deposits equal the amounts that were allocated to counties,
cities, and cities and counties mental health accounts, social
services accounts, and health accounts, respectively, of the local
health and welfare trust funds in the prior fiscal year pursuant to
this chapter from the Sales Tax Account and the Sales Tax Growth
Account. Any excess sales tax revenues received pursuant to Sections
6051.2 and 6201.2 of the Revenue and Taxation Code shall be deposited
in the Sales Tax Growth Account of the Local Revenue Fund.
   (c) (1) For the 2012-13 fiscal year, of the sales tax proceeds
from revenues deposited to the credit of the Local Revenue Fund, the
Controller shall make monthly deposits to the Social Services
Subaccount and the Health Subaccount of the Sales Tax Account until
the deposits equal the amounts that were allocated to counties',
cities', and city and counties social services accounts and health
accounts, respectively, of the local health and welfare trust funds
in the prior fiscal year pursuant to this chapter from the Sales Tax
Account and the Sales Tax Growth Account.
   (2) For the 2012-13 fiscal year, of the sales tax proceeds from
revenues deposited to the credit of the Local Revenue Fund, the
Controller shall make monthly deposits to the Mental Health
Subaccount of the Sales Tax Account until the deposits equal the
amounts that were allocated to counties', cities', and city and
counties CalWORKs Maintenance of Effort Subaccounts pursuant to
subdivision (a) of Section 17601.25, and any additional amounts above
the amount specified in subdivision (a) of Section 17601.25, of the
local health and welfare trust funds in the prior fiscal year
pursuant to this chapter from the Sales Tax Account and the Sales Tax
Growth Account. The Controller shall not include in this calculation
any funding deposited in the Mental Health Subaccount from the
Support Services Growth Subaccount pursuant to Section 30027.9 of the
Government Code or funds described in subdivision (c) of Section
17601.25.
   (3) Any excess sales tax revenues received pursuant to Sections
6051.2 and 6201.2 of the Revenue and Taxation Code after the
allocations required by paragraphs (1) and (2) are made shall be
deposited in the Sales Tax Growth Account of the Local Revenue Fund.
   (d) (1) For the 2013-14 fiscal year, of the sales tax proceeds
from revenues deposited to the credit of the Local Revenue Fund, the
Controller shall make monthly deposits pursuant to a schedule
provided by the Department of Finance, which shall provide for total
allocations as follows:
         (A) To the Social Services Subaccount of the Sales Tax
Account until the deposits are one billion dollars ($1,000,000,000)
less than the total amount that was allocated to the social services
accounts of the local health and welfare trust funds in the prior
fiscal year pursuant to this chapter from the Sales Tax Account and
the Sales Tax Growth Account.
   (B) To the Health Subaccount of the Sales Tax Account until the
deposits are one billion dollars ($1,000,000,000) more than the total
amount that was allocated to the health accounts of the local health
and welfare trust funds in the prior fiscal year pursuant to this
chapter from the Sales Tax Account and the Sales Tax Growth Account.
   (C) To the Mental Health Subaccount of the Sales Tax Account until
the deposits equal the amounts that were allocated to counties',
cities', and cities and counties' CalWORKs Maintenance of Effort
Subaccounts pursuant to subdivision (a) of Section 17601.25, and any
additional amounts above the amount specified in subdivision (a) of
Section 17601.25, of the local health and welfare trust funds in the
prior fiscal year pursuant to this chapter from the Sales Tax Account
and the Sales Tax Growth Account. The Controller shall not include
in this calculation any funding deposited in the Mental Health
Subaccount from the Support Services Growth Subaccount pursuant to
Section 30027.9 of the Government Code or funds described in
subdivision (c) of Section 17601.25.
   (2) Any excess sales tax revenues received pursuant to Sections
6051.2 and 6201.2 of the Revenue and Taxation Code after the
allocations required by subparagraphs (A) to (C), inclusive, of
paragraph (1) are made shall be deposited in the Sales Tax Growth
Account of the Local Revenue Fund.
   (e) For the 2014-15 fiscal year and fiscal years thereafter, of
the sales tax proceeds from revenues deposited to the credit of the
Local Revenue Fund, the Controller shall make the following monthly
deposits:
   (1) To the Social Services Subaccount, of the Sales Tax Account
until the deposits equal the total amount that was allocated to the
social services accounts of the local health and welfare trust funds
in the prior fiscal year pursuant to this chapter, from the Sales Tax
Account and the Sales Tax Growth Account.
   (2) To the Health Subaccount of the Sales Tax Account, until the
deposits equal the total amount that was deposited in the prior year
from the Sales Tax Account in addition to the amounts that were
allocated to the health accounts of the local health and welfare
trust funds in the prior fiscal year pursuant to this chapter from
the Sales Tax Growth Account.
   (3) To the Child Poverty and Family Supplemental Support
Subaccount until the deposits equal the amounts that were deposited
in the prior fiscal year from the Sales Tax Account and the Sales Tax
Growth Account.
   (4) To the Mental Health Subaccount of the Sales Tax Account until
the deposits equal the amounts that were allocated to counties',
cities', and cities and counties' CalWORKs Maintenance of Effort
Subaccounts pursuant to subdivision (a) of Section 17601.25, and any
additional amounts above the amount specified in subdivision (a) of
Section 17601.25 of the local health and welfare trust funds in the
prior fiscal year pursuant to this chapter from the Sales Tax Account
and the Sales Tax Growth Account. The Controller shall not include
in this calculation any funding deposited in the Mental Health
Subaccount from the Support Services Growth Subaccount pursuant to
Section 30027.9 of the Government Code or funds described in
subdivision (c) of Section 17601.25.
   (5) Any excess sales tax revenues received pursuant to Sections
6051.2 and 6201.2 of the Revenue and Taxation Code after the
allocations required by paragraphs (1) to (4), inclusive, are made
shall be deposited in the Sales Tax Growth Account of the Local
Revenue Fund.
  SEC. 8.  Section 17600.20 of the Welfare and Institutions Code is
amended to read:
   17600.20.  (a) Excluding funds allocated to the CalWORKs
Maintenance of Effort Subaccount and the family support account, any
county, city, or city and county may reallocate money among accounts
in the local health and welfare trust fund, not to exceed 10 percent
of the amount deposited in the account from which the funds are
reallocated for that fiscal year.
   (b) After depositing funds to the social services account
allocated to a county or city and county pursuant to Section 17605
and after reallocating funds from both the health account and mental
health account of the local health and welfare trust fund under
subdivision (a), a county may reallocate up to an additional 10
percent of the money from the health account to the social services
account in the 1992-93 fiscal year and fiscal years thereafter, for
caseload increases for mandated social services programs listed in
paragraph (2) of subdivision (b) of Section 17605 in excess of
revenue growth in the social services account.
   (c) (1) A county, city, or city and county shall, at a regularly
scheduled public hearing of its governing body, document that any
decision to make any substantial change in its allocation of mental
health, social services, or health trust fund moneys among services,
facilities, programs, or providers as a result of reallocating funds
pursuant to subdivision (a), (b), or (d) was based on the most
cost-effective use of available resources to maximize client
outcomes.
   (2) Any county or city and county that reallocates funds pursuant
to subdivision (b) shall document, at a regularly scheduled public
hearing of the board of supervisors, that the net social services
caseload has increased beyond the revenue growth in the social
services account.
   (3) Any county, city, or city and county that is required to
document any reallocation of funds pursuant to paragraphs (1) and (2)
shall forward a copy of the documentation to the Controller. The
Controller shall make copies of the documentation available to the
Legislature and to other interested parties, upon request.
   (d) In addition to subdivision (a), a county or city and county
may reallocate up to an additional 10 percent of the money from the
social services account to the mental health account or the health
account in the 1993-94 fiscal year and fiscal years thereafter when
there exist in the social services account revenues in excess of the
amount necessary to fund mandated caseload costs, pursuant to
paragraph (2) of subdivision (b) of Section 17605, as determined by
the county board of supervisors, as a result of implementation of
personal care services or other program changes.
  SEC. 9.  Section 17600.50 is added to the Welfare and Institutions
Code, to read:
   17600.50.  (a) A county that participated in the County Medical
Services Program in the 2011-12 fiscal year, including the Counties
of Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, El Dorado,
Glenn, Humboldt, Imperial, Inyo, Kings, Lake, Lassen, Madera, Marin,
Mariposa, Mendocino, Modoc, Mono, Napa, Nevada, Plumas, San Benito,
Shasta, Sierra, Siskiyou, Solano, Sonoma, Sutter, Tehama, Trinity,
Tuolumne, and Yuba and the Governing Board of the County Medical
Services Program, shall adopt resolutions by December 4, 2013, that
confirm acceptance for the following approach to determining payments
to the Family Support Services Subaccount:
   (1) The amount of payments to the Family Support Services
Subaccount shall be equal to 60 percent of the sum of the following:
   (A) The 1991 health realignment funds that would have otherwise
been allocated to the counties listed above pursuant to Sections
17603, 17604, 17606.10, and 17606.20 and the maintenance of effort in
subdivision (a) of Section 17608.10 for these counties, as those
sections read on January 1, 2012.
   (B) The 1991 health realignment funds that would have otherwise
been allocated to the County Medical Services Program pursuant to
Sections 17603, 17604, 17605.07, and 17606.20, as those sections read
on January 1, 2012.
   (2) The payment computed in paragraph (1) shall be achieved
through the following:
   (A) Each county listed in subdivision (a) shall pay the amounts
otherwise payable to the County Medical Services Program pursuant to
subparagraph (B) of paragraph (2) of subdivision (j) of Section 16809
to the Family Support Services Subaccount.
   (B) The County Medical Services Program shall pay the difference
between the total computed in paragraph (1) and the amount calculated
in subparagraph (A) from funds provided pursuant to the Welfare and
Institutions Code.
   (b) The Counties of Fresno, Merced, Orange, Placer, Sacramento,
San Diego, San Luis Obispo, Santa Barbara, Santa Cruz, Stanislaus,
Tulare, and Yolo shall each tentatively inform the state by October
1, 2013, which of the following options it selects for determining
its payments to the Family Support Services Subaccount. On or before
December 4, 2013, the board of supervisors of each county and city
and county may adopt a resolution informing the state of the county's
or city and county's final selection of the option for determining
its payments to the Family Support Services Subaccount:
   (1) The formula detailed in Article 13 (commencing with Section
17613.1).
   (2) (A) A calculation of 60 percent of the total of 1991 health
realignment funds that would have otherwise been allocated to that
county or city and county pursuant to Sections 17603, 17604,
17606.10, and 17606.20 and 60 percent of the maintenance of effort in
subdivision (a) of Section 17608.10, as those sections read on
January 1, 2012.
   (B) If a county's maintenance of effort in subdivision (a) of
Section 17608.10 is greater than 14.6 percent of the total value of
the county's 2010-11 allocation pursuant to Sections 17603, 17604,
17606.10, and 17606.20 and subdivision (a) of Section 17608.10, the
value of the maintenance of effort used in the calculation in
subparagraph (A) shall be limited to 14.6 percent.
   (c) The Counties of Alameda, Contra Costa, Kern, Los Angeles,
Monterey, Riverside, San Bernardino, San Francisco, San Joaquin, San
Mateo, Santa Clara, and Ventura shall each tentatively inform the
state by October 1, 2013, which of the following options it selects
for determining its payments to the Family Support Services
Subaccount. On or before December 4, 2013, the board of supervisors
of each county and city and county may adopt a resolution informing
the state of the county's or city and county's final selection of the
option for determining its payments to the Family Support Services
Subaccount:
   (1) The formula detailed in Article 12 (commencing with Section
17612.1).
   (2) (A) A calculation of 60 percent of the total of 1991 health
realignment funds that would have otherwise been allocated to that
county or city and county pursuant to Sections 17603, 17604,
17606.10, and 17606.20 and 60 percent of the maintenance of effort in
subdivision (a) of Section 17608.10, as those sections read on
January 1, 2012.
   (B) If a county's maintenance of effort in subdivision (a) of
Section 17608.10 is greater than 25.9 percent of the total value of
the county's 2010-11 fiscal year allocation pursuant to Sections
17603, 17604, 17606.10, and 17606.20, and subdivision (a) of Section
17608.10, the value of the maintenance of effort used in the
calculation in subparagraph (A) shall be limited to 25.9 percent.
   (d) (1) If the board of supervisors of a county or city and county
fails to adopt a resolution pursuant to subdivision (b) or (c), as
applicable, or fails to inform the Director of Health Care Services
of the city and county or county's final selection, by December 4,
2013, the calculation shall be 62.5 percent of the total of 1991
health realignment funds that would have otherwise been allocated to
that county or city and county pursuant to Sections 17603, 17604,
17606.10, and 17606.20 and 62.5 percent of the maintenance of effort
in subdivision (a) of Section 17608.10.
   (2) If the County Medical Services Program governing board or the
board of supervisors of a county that participates in the County
Medical Services Program fails to adopt a resolution pursuant to
subdivision (a), or fails to inform the Director of Health Care
Services of the county's final selection, by December 4, 2013, then
paragraphs (1) and (2) of subdivision (a) applies to the applicable
counties and to the County Medical Services Program.
  SEC. 10.  Section 17600.60 is added to the Welfare and Institutions
Code, to read:
   17600.60.  (a) The County Health Care Funding Resolution Committee
is hereby created to do all of the following:
   (1) Determine whether the calculation of the historical percentage
or amount to be applied in calculations in Section 17612.3 complies
with that section, taking into account the data and calculations
provided by the county and any alternative data and calculations
submitted by the department.
   (2) Hear and determine petitions from certain counties, as
defined, to make particularized changes in what provisions of Section
17600.50 are controlling.
   (3) Hear and determine petitions for an alternative cost
calculation to the cost per person calculation in subdivision (c) of
Section 17613.2.
   (b) The committee shall consist of the following members:
   (1) One person selected by the California State Association of
Counties.
   (2) One person selected by the State Department of Health Care
Services.
   (3) One person selected by the Director of Finance.
   (c) (1) The committee is not subject to the Bagley-Keene Open
Meeting Act (Article 9 (commencing with Section 11120) of Chapter 1
of Part 1 of Division 3 of Title 2 of the Government Code) and shall
be exempt from the Administrative Procedure Act (Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code). The Department of Finance shall provide staff
for the committee.
   (2) Pursuant to paragraph (2) of subdivision (b) of Section 3 of
Article I of the California Constitution, the Legislature finds and
declares that the public interest in affordable and accessible health
care outweighs the public interest in access to these proceedings.
   (d) (1) A county or city and county, that chose to be subject to
paragraph (2) of subdivision (b) or paragraph (2) of subdivision (c)
of Section 17600.50 may submit a petition to the committee to be
subject to paragraph (1) of subdivision (b) or paragraph (1) of
subdivision (c) of Section 17600.50, as applicable, if the county or
city and county demonstrates and provides sufficient evidence of both
of the following criteria:
   (A) There have been changes in expenditures related to state and
federal law, regulation and rulemaking, or court decisions that have
a material impact on the provision of health care services to
indigent adults.
   (B) All of the data necessary to participate in Article 12
(commencing with Section 17612.1) or Article 13 (commencing with
Section 17613.1), as appropriate.
   (2) The form of petition shall be determined by the committee by
December 31, 2013.
   (3) If the committee approves the petition the county or city and
county shall be subject to paragraph (1) of subdivision (b) or
paragraph (1) of subdivision (c) of Section 17600.50, as applicable,
at the start of the next fiscal year.
   (e) (1) A county that chose to be subject to Article 13
(commencing with Section 17613.1) may submit a petition to the
committee for an alternative cost calculation to the cost per person
calculation in subdivision (c) of Section 17613.2 with the
documentation of extraordinary circumstances, including circumstances
related to the local health care marketplace, provider, and provider
contracts.
   (2) The county shall submit all necessary data to support its
submission.
   (f) The committee shall make decisions within 45 days of hearing
any petition.
  SEC. 11.  The heading of Article 2.5 (commencing with Section
17601.25) is added to Chapter 6 of Part 5 of Division 9 of the
Welfare and Institutions Code, to read:

      Article 2.5.  Family Support Allocations


  SEC. 12.  Section 17601.25 of the Welfare and Institutions Code is
amended to read:
   17601.25.  (a) Notwithstanding any other law, beginning in the
2012-13 fiscal year, except for funds deposited in the Mental Health
Subaccount from the Support Services Growth Subaccount pursuant to
Section 30027.9 of the Government Code and the funds described in
subdivision (c), any funds under this chapter or any other provision
of Chapter 89 of the Statutes of 1991 that would otherwise have been
deposited into each county's or city and county's mental health
account subsequent to July 15 shall instead be deposited in the
CalWORKs Maintenance of Effort Subaccount. However, in each fiscal
year, the amount deposited in the CalWORKs Maintenance of Effort
Subaccount shall not exceed one billion one hundred twenty million
five hundred fifty-one thousand dollars ($1,120,551,000).
   (b) All of the funds deposited in the CalWORKs Maintenance of
Effort Subaccount pursuant to subdivision (a) shall be used by each
county or city and county that receives an allocation of those funds
to pay an increased county contribution toward the costs of CalWORKs
grants. Each county's total annual contribution pursuant to this
section shall equal the total amount of funds deposited in the county'
s CalWORKs Maintenance of Effort Subaccount during that fiscal year.
The CalWORKs Maintenance of Effort Subaccount shall not be subject to
the transferability provisions of Section 17600.20 and shall not be
factored into the calculation of growth allocations pursuant to
Article 7 (commencing with Section 17606.05). Each county's
contribution pursuant to this section and Section 17601.75 shall be
in addition to the share of cost required pursuant to Section 15200.
   (c) There shall be a monthly allocation of ninety-three million
three hundred seventy-nine thousand two hundred fifty-two dollars
($93,379,252) from the Mental Health Account in the Local Revenue
Fund 2011 to the Mental Health Subaccount pursuant to subdivision (a)
of Sections 30027.5, 30027.6, 30027.7, and 30027.8 of the Government
Code.
  SEC. 13.  Section 17601.50 is added to the Welfare and Institutions
Code, to read:
   17601.50.  The moneys in the Child Poverty and Family Supplemental
Support Subaccount shall be allocated to the family support account
in the local health and welfare trust fund in each county and city
and county by the Controller pursuant to a schedule prepared by the
Department of Finance. All funds allocated shall be attributable to
the payment of grant increases as authorized by Section 11450.025.
Funds that are not allocated in a fiscal year, shall be available for
allocation in the following fiscal year.
  SEC. 14.  Section 17601.75 is added to the Welfare and Institutions
Code, to read:
   17601.75.  (a) On or before the 27th day of the month, the
Controller shall allocate to the family support account in the local
health and welfare trust fund of each county and city and county the
amounts deposited and remaining unexpended and unreserved on the 15th
day of the month in the Family Support Subaccount of the Local
Revenue Fund, pursuant to schedules developed by the Department of
Finance in conjunction with the appropriate state departments and in
consultation with the California State Association of Counties.
   (b) All of the funds deposited in the family support account shall
be used by each county and city and county that receives an
allocation of those funds to pay an increased county contribution
toward the costs of CalWORKS grants. Each county's total annual
contribution pursuant to this section shall equal the total amount of
funds deposited in each county's and city and county's family
support account during that fiscal year. The family support account
shall not be subject to the transferability provisions of Section
17600.20. Each county's contribution pursuant to this section and
Section 17601.25 shall be in addition to the shares of cost required
pursuant to Section 15200.
  SEC. 15.  Section 17603 of the Welfare and Institutions Code is
amended to read:
   17603.  This paragraph shall only apply until the end of the
2012-12 fiscal year. On or before the 27th day of each month, the
Controller shall allocate to the local health and welfare trust fund
health accounts the amounts deposited and remaining unexpended and
unreserved on the 15th day of the month in the Health Subaccount of
the Sales Tax Account of the Local Revenue Fund, in accordance with
subdivisions (a) and (b):
   (a) For the 1991-92 fiscal year, allocations shall be made in
accordance with the following schedule:
                                 Allocation
Jurisdiction                    Percentage
Alameda ....................      4.5046
Alpine .....................      0.0137
Amador .....................      0.1512
Butte ......................      0.8131
Calaveras ..................      0.1367
Colusa......................      0.1195
Contra Costa ...............      2.2386
Del Norte ..................      0.1340
El Dorado ..................      0.5228
Fresno .....................      2.3531
Glenn ......................      0.1391
Humboldt ...................      0.8929
Imperial ...................      0.8237
Inyo .......................      0.1869
Kern .......................      1.6362
Kings ......................      0.4084
Lake .......................      0.1752
Lassen .....................      0.1525
Los Angeles ................     37.2606
Madera .....................      0.3656
Marin.......................      1.0785
Mariposa ...................      0.0815
Mendocino ..................      0.2586
Merced .....................      0.4094
Modoc ......................      0.0923
Mono .......................      0.1342
Monterey ...................      0.8975
Napa .......................      0.4466
Nevada .....................      0.2734
Orange .....................      5.4304
Placer .....................      0.2806
Plumas .....................      0.1145
Riverside ..................      2.7867
Sacramento .................      2.7497
San Benito .................      0.1701
San Bernardino..............      2.4709
San Diego ..................      4.7771
San Francisco ..............      7.1450
San Joaquin ................      1.0810
San Luis Obispo ............      0.4811
San Mateo ..................      1.5937
Santa Barbara ..............      0.9418
Santa Clara ................      3.6238
Santa Cruz .................      0.6714
Shasta .....................      0.6732
Sierra .....................      0.0340
Siskiyou....................      0.2246
Solano .....................      0.9377
Sonoma .....................      1.6687
Stanislaus .................      1.0509
Sutter .....................      0.4460
Tehama .....................      0.2986
Trinity ....................      0.1388
Tulare .....................      0.7485
Tuolumne ...................      0.2357
Ventura ....................      1.3658
Yolo .......................      0.3522
Yuba .......................      0.3076
Berkeley ...................      0.0692
Long Beach .................      0.2918
Pasadena ...................      0.1385


   (b) For the 1992-93 fiscal year and fiscal years thereafter until
the commencement of the 2012-13 fiscal year, the allocations to each
county and city and county shall equal the amounts received in the
prior fiscal year by each county, city, and city and county from the
Sales Tax Account and the Sales Tax Growth Account of the Local
Revenue Fund into the health and welfare trust fund.
   (c) (1) For the 2013-14 fiscal year, on the 27th day of each
month, the Controller shall allocate, in the same proportion and
funds in subdivision (b) were allocated, to each county's and city
and county's local health and welfare trust fund health accounts, the
amounts deposited and remaining unexpended and unreserved on the
15th day of the month in the Health Subaccount of the Sales Tax
Account of the Local Revenue Fund.
   (2) (A) Beginning January 2014 and for the remainder of the
2013-14 fiscal year ending June 30, 2014, on or before the 25th of
each month, the Controller shall transfer to the Family Support
Subaccount from the Health Subaccount amounts determined pursuant to
a schedule prepared by the Department of Finance in consultation with
the California State Association of Counties. Cumulatively, no more
than three hundred million dollars ($300,000,000) shall be
transferred.
   (B) Every month, after the transfers in subparagraph (A) have
occurred, the remainder shall be allocated to the counties and cities
and counties in the same proportions as funds in subdivision (b)
were allocated.
   (C) For counties participating in the County Medical Services
Program, transfers from each county shall not be greater than the
monthly amount the county would otherwise pay pursuant to paragraph
(2) of subdivision (j) of Section 16809 for participation in the
County Medical Services Program. Any difference between the amount
paid by these counties and the proportional share of the three
hundred million dollars ($300,000,000) calculated as payable by these
counties and the County Medical Services Program shall be paid from
the funds available for allocation to the County Medical Services
Program in accordance with the Welfare and Institution Code.
   (3) For the 2013-14 fiscal year, the Controller, using the same
timing and criteria used in paragraph (1), shall allocate to each
city, not to include a city and county, funds that shall equal the
amounts received in the prior fiscal year by each city from the Sales
Tax Account and the Sales Tax Growth Account of the Local Revenue
Fund into the health and welfare trust fund.
   (d) (1) (A) For the 2014-15 fiscal year and for every fiscal year
thereafter, the Department of Finance, in consultation with the
California State Association of Counties, shall calculate the amount
each county or city and county shall contribute to the Family Support
Subaccount in accordance with Section 17600.50.
   (B) On or before the 25th of each month, the Controller shall
transfer, based on a schedule prepared the Department of Finance in
consultation with the California State Association of Counties, from
the funds deposited and remaining unexpended and unreserved on the
15th day of the month in the Health Subaccount of the Sales Tax
Account of the Local Revenue Fund to the Family Support Subaccount,
funds that equal, over the course of the year, the amount determined
in subparagraph (A) pursuant to a schedule provided by the Department
of Finance.
                                      (C) After the transfer in
subparagraph (B) has occurred, the State Controller shall allocate on
or before the 27th of each month to health account in the local
health and welfare trust fund of every county and city and county
from a schedule prepared by the Department of Finance, in
consultation with the California State Association of Counties, any
funds remaining in the Health Account from the funds deposited and
remaining unexpended and unreserved on the 15th day of the month in
the Health Subaccount of the Sales Tax Account of the Local Revenue
Fund. The schedule shall be prepared as the allocations would have
been distributed pursuant to subdivision (b).
   (D) For the 2014-15 fiscal year and for every fiscal year
thereafter, the Controller, using the same timing and criteria as had
been used in subdivision (b), shall allocate to each city, not to
include a city and county, funds that equal the amounts received in
the prior fiscal year by each city from the Sales Tax Account and the
Sales Tax Growth Account of the Local Revenue Fund into the health
and welfare trust fund.
  SEC. 16.  Section 17604 of the Welfare and Institutions Code is
amended to read:
   17604.  (a) All motor vehicle license fee revenues collected in
the 1991-92 fiscal year that are deposited to the credit of the Local
Revenue Fund shall be credited to the Vehicle License Fee Account of
that fund.
   (b) (1) For the 1992-93 fiscal year and fiscal years thereafter,
from vehicle license fee proceeds from revenues deposited to the
credit of the Local Revenue Fund, the Controller shall make monthly
deposits to the Vehicle License Fee Account of the Local Revenue Fund
until the deposits equal the amounts that were allocated to
counties, cities, and cities and counties as general purpose revenues
in the prior fiscal year pursuant to this chapter from the Vehicle
License Fee Account in the Local Revenue Fund and the Vehicle License
Fee Account and the Vehicle License Fee Growth Account in the Local
Revenue Fund.
   (2) Any excess vehicle fee revenues deposited into the Local
Revenue Fund pursuant to Section 11001.5 of the Revenue and Taxation
Code shall be deposited in the Vehicle License Fee Growth Account of
the Local Revenue Fund.
   (3) The Controller shall calculate the difference between the
total amount of vehicle license fee proceeds deposited to the credit
of the Local Revenue Fund, pursuant to paragraph (1) of subdivision
(a) of Section 11001.5 of the Revenue and Taxation Code, and
deposited into the Vehicle License Fee Account for the period of July
16, 2009, to July 15, 2010, inclusive, and the amount deposited for
the period of July 16, 2010, to July 15, 2011, inclusive.
   (4) Of vehicle license fee proceeds deposited to the Vehicle
License Fee Account after July 15, 2011, an amount equal to the
difference calculated in paragraph (3) shall be deemed to have been
deposited during the period of July 16, 2010, to July 15, 2011,
inclusive, and allocated to cities, counties, and a city and county
as if those proceeds had been received during the 2010-11 fiscal
year.
   (c) (1) On or before the 27th day of each month, the Controller
shall allocate to each county, city, or city and county, as general
purpose revenues the amounts deposited and remaining unexpended and
unreserved on the 15th day of the month in the Vehicle License Fee
Account of the Local Revenue Fund, in accordance with paragraphs (2)
and (3).
   (2) For the 1991-92 fiscal year, allocations shall be made in
accordance with the following schedule:
                                 Allocation
Jurisdiction                    Percentage
Alameda ....................      4.5046
Alpine .....................      0.0137
Amador .....................      0.1512
Butte ......................      0.8131
Calaveras ..................      0.1367
Colusa......................      0.1195
Contra Costa ...............      2.2386
Del Norte ..................      0.1340
El Dorado ..................      0.5228
Fresno .....................      2.3531
Glenn ......................      0.1391
Humboldt ...................      0.8929
Imperial ...................      0.8237
Inyo .......................      0.1869
Kern .......................      1.6362
Kings ......................      0.4084
Lake .......................      0.1752
Lassen .....................      0.1525
Los Angeles ................     37.2606
Madera .....................      0.3656
Marin.......................      1.0785
Mariposa ...................      0.0815
Mendocino ..................      0.2586
Merced .....................      0.4094
Modoc ......................      0.0923
Mono .......................      0.1342
Monterey ...................      0.8975
Napa .......................      0.4466
Nevada .....................      0.2734
Orange .....................      5.4304
Placer .....................      0.2806
Plumas .....................      0.1145
Riverside ..................      2.7867
Sacramento .................      2.7497
San Benito .................      0.1701
San Bernardino..............      2.4709
San Diego ..................      4.7771
San Francisco ..............      7.1450
San Joaquin ................      1.0810
San Luis Obispo ............      0.4811
San Mateo ..................      1.5937
Santa Barbara ..............      0.9418
Santa Clara ................      3.6238
Santa Cruz .................      0.6714
Shasta .....................      0.6732
Sierra .....................      0.0340
Siskiyou....................      0.2246
Solano .....................      0.9377
Sonoma .....................      1.6687
Stanislaus .................      1.0509
Sutter .....................      0.4460
Tehama .....................      0.2986
Trinity ....................      0.1388
Tulare .....................      0.7485
Tuolumne ...................      0.2357
Ventura ....................      1.3658
Yolo .......................      0.3522
Yuba .......................      0.3076
Berkeley ...................      0.0692
Long       Beach ...........      0.2918
Pasadena ...................      0.1385


   (3) For the 1992-93, 1993-94, and 1994-95 fiscal year and fiscal
years thereafter, allocations shall be made in the same amounts as
were distributed from the Vehicle License Fee Account and the Vehicle
License Fee Growth Account in the prior fiscal year.
   (4) For the 1995-96 fiscal year, allocations shall be made in the
same amounts as distributed in the 1994-95 fiscal year from the
Vehicle License Fee Account and the Vehicle License Fee Growth
Account after adjusting the allocation amounts by the amounts
specified for the following counties:
Alpine ..........................     $(11,296)
Amador ..........................      25,417
Calaveras .......................      49,892
Del Norte .......................      39,537
Glenn ...........................      (12,238)
Lassen ..........................      17,886
Mariposa ........................       (6,950)
Modoc ...........................      (29,182)
Mono ............................       (6,950)
San Benito ......................      20,710
Sierra ..........................      (39,537)
Trinity .........................      (48,009)


   (5) For the 1996-97 fiscal year and fiscal years thereafter,
allocations shall be made in the same amounts as were distributed
from the Vehicle License Fee Account and the Vehicle License Fee
Growth Account in the prior fiscal year.
   Initial proceeds deposited in the Vehicle License Fee Account in
the 2003-04 fiscal year in the amount that would otherwise have been
transferred pursuant to Section 10754 of the Revenue and Taxation
Code for the period June 20, 2003, to July 15, 2003, inclusive, shall
be deemed to have been deposited during the period June 16, 2003, to
July 15, 2003, inclusive, and allocated to cities, counties, and a
city and county during the 2002-03 fiscal year.
   (d) The Controller shall make monthly allocations from the amount
deposited in the Vehicle License Collection Account of the Local
Revenue Fund to each county in accordance with a schedule to be
developed by the State Department of Mental Health in consultation
with the California Mental Health Directors Association, which is
compatible with the intent of the Legislature expressed in the act
adding this subdivision.
   (e) Prior to making the allocations in accordance with paragraph
(5) of subdivision (c) and subdivision (d), the Controller shall
adjust the distributions from the Vehicle License Fee Account to
reflect an equal exchange of sales and use tax funds from the Social
Services Subaccount to the Health Subaccount, as required by
subdivision (d) of Section 17600.15, and of Vehicle License Fee funds
from the Health Account to the Social Services Account.
  SEC. 17.  Section 17606.10 of the Welfare and Institutions Code is
amended to read:
   17606.10.  (a) For the 1992-93 fiscal year and subsequent fiscal
years, the Controller shall allocate funds, on a monthly basis from
the General Growth Subaccount in the Sales Tax Growth Account to the
appropriate accounts in the local health and welfare trust fund of
each county, city, and city and county in accordance with a schedule
setting forth the percentage of total state resources received in the
1990-91 fiscal year, including State Legalization Impact Assistance
Grants distributed by the state under Part 4.5 (commencing with
Section 16700), funding provided for purposes of implementation of
Division 5 (commencing with Section 5000), for the organization and
financing of community mental health services, including the
Cigarette and Tobacco Products Surtax proceeds which are allocated to
county mental health programs pursuant to Chapter 1331 of the
Statutes of 1989, Chapter 51 of the Statutes of 1990, and Chapter
1323 of the Statutes of 1990, and state hospital funding and funding
distributed for programs administered under Sections 1794, 10101.1,
and 11322.2, as annually adjusted by the Department of Finance, in
conjunction with the appropriate state department to reflect changes
in equity status from the base percentages. However, for the 1992-93
fiscal year, the allocation for community mental health services
shall be based on the following schedule:
                                    Percentage
                                   of Statewide
Jurisdiction                      Resource Base
Alameda .......................      4.3693
Alpine ........................      0.0128
Amador ........................      0.0941
Butte .........................      0.7797
Calaveras .....................      0.1157
Colusa ........................      0.0847
Contra Costa ..................      2.3115
Del Norte .....................      0.1237
El Dorado .....................      0.3966
Fresno ........................      3.1419
Glenn .........................      0.1304
Humboldt ......................      0.6175
Imperial ......................      0.5425
Inyo ..........................      0.1217
Kern ..........................      1.8574
Kings .........................      0.4229
Lake ..........................      0.2362
Lassen ........................      0.1183
Los Angeles....................     27.9666
Madera ........................      0.3552
Marin .........................      0.9180
Mariposa ......................      0.0792
Mendocino .....................      0.4099
Merced ........................      0.8831
Modoc .........................      0.0561
Mono ..........................      0.0511
Monterey ......................      1.1663
Napa ..........................      0.3856
Nevada ........................      0.2129
Orange ........................      5.3423
Placer ........................      0.5034
Plumas ........................      0.1134
Riverside .....................      3.6179
Sacramento ....................      4.1872
San Benito ....................      0.1010
San Bernardino ................      4.5494
San Diego .....................      7.8773
San Francisco .................      3.5335
San Joaquin ...................      2.4690
San Luis Obispo ...............      0.6652
San Mateo .....................      2.5169
Santa Barbara .................      1.0745
Santa Clara ...................      5.0488
Santa Cruz ....................      0.7960
Shasta ........................      0.5493
Sierra ........................      0.0345
Siskiyou ......................      0.2051
Solano ........................      0.6694
Sonoma ........................      1.1486
Stanislaus ....................      1.4701
Sutter/Yuba ...................      0.6294
Tehama ........................      0.2384
Trinity .......................      0.0826
Tulare ........................      1.4704
Tuolumne ......................      0.1666
Ventura .......................      1.9311
Yolo ..........................      0.5443
Berkeley ......................      0.2688
Tri-City ......................      0.2347


   (b) The Department of Finance shall recalculate the resource base
used in determining the General Growth Subaccount allocations to the
Health Account, Mental Health Account, and Social Services Account of
the local health and welfare trust fund of each city, county, and
city and county for the 1994-95 fiscal year general growth
allocations according to subdivisions (c) and (d). For the 1995-96
fiscal year and annually until the end of the 2012-13 fiscal year,
the Department of Finance shall prepare the schedule of allocations
of growth based upon the recalculation of the resource base as
provided by subdivision (c).
   (c) For the Mental Health Account, the Department of Finance shall
do all of the following:
   (1) Use the following sources as reported by the State Department
of Mental Health:
   (A) The final December 1992 distribution of resources associated
with Institutes for Mental Disease.
   (B) The 1990-91 fiscal year state hospitals and community mental
health allocations.
   (C) Allocations for services provided for under Chapter 1294 of
the Statutes of 1989.
   (2) Expand the resource base with the following nonrealigned
funding sources as allocated among the counties:
   (A) Tobacco surtax allocations made under Chapter 1331 of the
Statutes of 1989 and Chapter 51 of the Statutes of 1990.
   (B) For the 1994-95 allocation year only, Chapter 1323 of the
Statutes of 1990.
   (C) 1993-94 fiscal year federal homeless block grant allocation.
   (D) 1993-94 fiscal year Mental Health Special Education
allocations.
   (E) 1993-94 fiscal year allocations for the system of care for
children, in accordance with Chapter 1229 of the Statutes of 1992.
   (F) 1993-94 fiscal year federal Substance Abuse and Mental Health
Services Administration block grant allocations pursuant to
Subchapter 1 (commencing with Section 10801) of Chapter 114 of Title
42 of the United States Code.
   (d) Until the end of the 2012-13 fiscal year, for the Health
Account, the Department of Finance shall use the historical resource
base of state funds as allocated among the counties, cities, and city
and county as reported by the State Department of Health Services in
a September 17, 1991, report of Indigent and Community Health
Resources.
   (e) The Department of Finance shall use these adjusted resource
bases for the Health Account and Mental Health Account to calculate
what the 1994-95 fiscal year General Growth Subaccount allocations
would have been, and together with 1994-95 fiscal year Base
Restoration Subaccount allocations, CMSP subaccount allocations,
equity allocations to the Health Account and Mental Health Account as
adjusted by subparagraph (E) of paragraph (2) of subdivision (c) of
Section 17606.05, and special equity allocations to the Health
Account and Mental Health Account as adjusted by subdivision (e) of
Section 17606.15 reconstruct the 1994-95 fiscal year General Growth
Subaccount resource base for the 1995-96 allocation year for each
county, city, and city and county. Notwithstanding any other
provision of law, the actual 1994-95 general growth allocations shall
not become part of the realignment base allocations to each county,
city, and city and county. The total amounts distributed by the
Controller for general growth for the 1994-95 allocation year shall
be reallocated among the counties, cities, and city and county in the
1995-96 allocation year according to this paragraph, and shall be
included in the general growth resource base for the 1996-97
allocation year and each fiscal year thereafter. For the 1996-97
allocation year and fiscal years thereafter, the Department of
Finance shall update the base with actual growth allocations to the
Health Account, Mental Health Account, and Social Services Account of
each county, city, and city and county local health and welfare
trust fund in the prior year, and adjust for actual changes in
nonrealigned funds specified in subdivision (c) in the year prior to
the allocation year.
   (f) For the 2013-14 fiscal year and every fiscal year thereafter,
the Controller shall do all of the following:
   (1) Allocate to the mental health account of each county or city
and county based on a schedule provided by the Department of Finance.
The Department of Finance shall recalculate the resource base used
in determining the General Growth Subaccount allocations to mental
health account in accordance with subdivision (c) and allocate based
on that recalculation.
   (2) Allocate 18.4545 percent of the total General Growth
Subaccount to the Health Account.
   (3) Allocate to the Child Poverty and Family Supplemental Support
Subaccount in the Sales Tax Account the remainder of the funds in the
General Growth Subaccount.
  SEC. 18.  Section 17609.02 is added to the Welfare and Institutions
Code, to read:
   17609.02.  Except as provided in Section 17600.20, funds deposited
in the family support account may be expended only to pay for an
increased county contribution toward the costs of CalWORKs as those
funds were allocated by the Department of Finance.
  SEC. 19.  Article 11 (commencing with Section 17610) is added to
Chapter 6 of Part 5 of Division 9 of the Welfare and Institutions
Code, to read:

      Article 11.  Family Support Subaccount True-Up Process


   17610.  (a) In June 2016 and for every fiscal year thereafter, for
every county that selected the option pursuant to paragraph (1) of
subdivision (b) or paragraph (1) of subdivision (c) of Section
17600.50, the Director of Finance shall make a final determination of
the amount of the allocation attributable to each county and city
and county should have been pursuant to subdivision (d) of Section
17603 for the penultimate fiscal year.
   (b) The amount of the final determination amount for each county
or city and county shall be subtracted from the amount attributable
to each county or city and county that was actually transferred in
the applicable fiscal year. This calculation shall be made at the
same time as the final determination in subdivision (a).
   (c) The Director of Finance shall promptly notify every affected
county and the Joint Legislative Budget Committee of the
determinations made pursuant to subdivisions (a) and (b).
   (d) If the difference calculated in subdivision (b) is negative,
the state shall pay the applicable county the difference and those
funds shall be deposited in that county's health account of the local
health and welfare trust fund. Notwithstanding Section 13340 of the
Government Code, there is hereby continuously appropriated to the
Director of Finance the funds necessary to pay any amounts owed
pursuant to this subdivision.
   (e) If the difference determined in subdivision (b) is positive,
the applicable county or city and county shall pay the difference to
the family support account within the health and welfare trust fund
of that city or city and county. If within three months of receipt of
the determination made in subdivision (b), the county or city and
county has failed to make the payment, then the Director of Finance
shall provide a supplemental schedule to the Controller to have 1.5
times the amount of the determination transferred from the next
Health Subaccount allocations of the applicable county or city and
county to the Family Support Subaccount until 1.5 times the amount
owed has been deposited in the family support account.
   17610.5.  (a) There is hereby created a 2013-14 Special Holding
Account in the Family Support Subaccount. Starting January 1, 2014,
and ending July 25, 2014, funds transferred to the Family Support
Subaccount that are attributable to every county or city and county
that chose to be subject to paragraph (1) of subdivision (b), or
paragraph (1) of subdivision (c), of Section 17600.50 shall be placed
in the 2013-14 Special Holding Account.
   (b) No later than April 20, 2014, the State Department of Health
Care Services shall provide an updated savings estimate for every
county and city and county that chose to be subject to paragraph (1)
of subdivision (b), or paragraph (1) of subdivision (c) of Section
17600.50 to the Department of Finance. On or before May 14, 2014, the
Department of Finance shall, for each county or city and county
described in subdivision (a), determine whether the actual savings
for each county or city and county is greater or lesser than the
amount of funds deposited into the Special Holding Account.
   (c) If the revised estimate of savings is greater than the funds
estimated by the Department of Finance to be deposited in the Special
Holding Account, the funds shall be transferred back to the Family
Support Subaccount by June 30, 2014, for allocation.
   (d) If the revised estimate of savings is less than the funds
estimated by the Department of Finance to be deposited in the Special
Holding Account, the difference between the amount estimated to be
transferred and the revised estimated savings amount shall be
transferred to the health account of the local health and welfare
trust fund of every affected county or city and county pursuant to a
schedule prepared by the Director of Finance in consultation with the
California State Association of Counties and provided to the
Controller.
   (e) This section shall remain in effect only until January 1,
2015, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2015, deletes or extends
that date.
   17611.  (a) On or before January 10 following the end of each
fiscal year, for every county subject to subdivision (a) or (d) or
that selected the option pursuant to paragraph (2) of subdivision
(b), or paragraph (2) of subdivision (c), of Section 17600.50, the
Director of Finance shall make a final determination of how much the
allocation attributable to each county and city and county should
have been pursuant to subdivision (d) of Section 17603 for the prior
fiscal year. This determination shall be based on the sharing ratios
provided in Section 17600.50.
   (b) The amount of the final determination amount for each county
or city and county shall be subtracted from the amount attributable
to each county or city and county that was actually transferred in
the applicable fiscal year.
   (c) At the same time the Director of Finance makes the
determination in subdivision (a), the director shall adjust the
schedules provided to the Controller pursuant to subdivision (d) of
Section 17603. Notwithstanding Section 17603, the Controller shall
only adjust amounts payable by the County Medical Services Program in
order to reconcile underpayment or overpayment made to the Family
Support Subaccount by the County Medical Services Program and
counties participating in the County Medical Services Program in the
preceding fiscal year.
   (d) The Director of Finance shall notify every affected county and
the Joint Legislative Budget Committee of the determinations made
pursuant to subdivisions (a) and (b).
  SEC. 20.  Article 12 (commencing with Section 17612.1) is added to
Chapter 6 of Part 5 of Division 9 of the Welfare and Institutions
Code, to read:

      Article 12.  Redirection of Realignment


   17612.1.  (a) For the 2013-14 fiscal year and each fiscal year
thereafter, for each public hospital health system county that
selected the option in paragraph (1) of subdivision (c) of Section
17600.50, the total amount that would be payable for the fiscal year
from 1991 Health Realignment funds under Sections 17603, 17604,
17606.10 and 17606.20, as those sections read on January 1, 2012, and
deposited by the Controller into the local health and welfare trust
fund health account of the county in the absence of this section
shall be determined.
   (b) The redirected amount determined for the public hospital
health system county pursuant to Section 17612.3 shall be divided by
the total determined in subdivision (a), except that, with respect to
the County of Los Angeles, the redirected amount shall be determined
by taking into account the adjustments required in Section 17612.5.
   (c) The resulting fraction determined in subdivision (b) shall be
the percentage of 1991 Health Realignment funds under Sections 17603,
17604, 17606.10, and 17606.20, as those sections read on January 1,
2012, to be deposited each month into the Family Support Subaccount.
   (d) The total amount deposited into the Family Support Subaccount
under subdivision (c) with respect to a public hospital health system
county for a fiscal year shall not exceed the redirected amount
determined pursuant to Section 17612.3, and shall be subject to the
appeal processes, and judicial review as described in subdivision (d)
of Section 17612.3.
   (e) The Legislature finds and declares that this article is not
intended to change the local obligation pursuant to Section 17000.
   17612.2.  For purposes of this article, the following definitions
shall apply:
   (a) "Adjusted patient day" means a county public hospital health
system's total number of patient census days, as defined by the
Office of Statewide Health Planning and Development, multiplied by
the following fraction: the numerator that is the sum of the county
public hospital health system's total gross revenue for all services
provided to all patients, including nonhospital services, and the
denominator that is the sum of the county public hospital health
system's gross inpatient revenue. The adjusted patient days shall
pertain to those services that are provided by the county public
hospital health system and shall exclude services that are provided
by contract or out-of-network clinics or hospitals.
        (b) "Base year" means the fiscal year ending three years
prior to the fiscal year for which the redirected amount is
calculated.
   (c) "Blended CPI trend factor" means the blended percent change
applicable for the fiscal year that is derived from the nonseasonally
adjusted Consumer Price Index for All Urban Consumers (CPI-U),
United States City Average, for Hospital and Related Services,
weighted at 75 percent, and for Medical Care Services, weighted at 25
percent, all as published by the United States Bureau of Labor
Statistics, computed as follows:
   (1) For each prior fiscal year within the period to be trended
through the current fiscal year, the annual average of the monthly
index amounts shall be determined separately for the Hospital and
Related Services Index and the Medical Care Services Index.
   (2) The year-to-year percentage changes in the annual averages
determined in paragraph (1) for each of the Hospital and Related
Services Index and the Medical Care Services Index shall be
calculated.
   (3) A weighted average annual percentage change for each
year-to-year period shall be calculated from the determinations made
in paragraph (2), with the percentage changes in the Hospital and
Related Services Index weighted at 75 percent, and the percentage
changes in the Medical Care Services Index weighted at 25 percent.
The resulting average annual percentage changes shall be expressed as
a fraction, and increased by 1.00.
   (4) The product of the successive year-to-year amounts determined
in paragraph (3) shall be the blended CPI trend factor.
   (d) "Cost containment limit" means the public hospital health
system county's Medi-Cal costs and uninsured costs determined for the
2014-15 fiscal year and each subsequent fiscal year, adjusted as
follows:
   (1) Notwithstanding paragraphs (2) to (4), inclusive, at the
public hospital health system county's option it shall be deemed to
comply with the cost containment limit if the county demonstrates
that its total health care costs, including nursing facility, mental
health, and substance use disorder services, that are not limited to
Medi-Cal and uninsured patients, for the fiscal year did not exceed
its total health care costs in the base year, multiplied by the
blended CPI trend factor for the fiscal year. A county electing this
option shall elect by November 1 following the end of the fiscal
year, and submit its supporting reports for meeting this requirement,
including the annual report of financial transactions required to be
submitted to the Controller pursuant to Section 53891 of the
Government Code.
   (2) (A) The public hospital health system county's Medi-Cal costs,
uninsured costs, and other entity intergovernmental transfer amounts
for the fiscal year shall be added together. Medi-Cal costs,
uninsured costs, and other entity intergovernmental transfer amounts
for purposes of this paragraph are as defined in subdivisions (q),
(t), and (y) for the relevant fiscal period.
   (B) The public hospital health system county's Medi-Cal costs,
uninsured costs, and imputed other entity intergovernmental transfer
amounts for the base year shall be added together and multiplied by
the blended CPI trend factor. The base year costs used shall not
reflect any adjustments under this subdivision.
   (C) The fiscal year amount determined in subparagraph (A) shall be
compared to the trended amount in subparagraph (B). If the amount in
subparagraph (B) exceeds the amount in subparagraph (A), the public
hospital health system county shall be deemed to have satisfied the
cost containment limit. If the amount in subparagraph (A) exceeds the
amount in subparagraph (B), the calculation in paragraph (3) shall
be performed.
   (3) (A) If the number of adjusted patient days of service provided
by the county public hospital health system for the fiscal year
exceeds its number of adjusted patient days of service rendered in
the base year by at least 10 percent, the excess adjusted patient
days above the base year for the fiscal year shall be multiplied by
the cost per adjusted patient day of the county public hospital
health system for the base year. The result shall be added to the
trended base year amount determined in subparagraph (B) of paragraph
(2), yielding the applicable cost containment limit, subject to
paragraph (4).
   (B) If the number of adjusted patient days of service provided by
a county's public hospital health system for the fiscal year does not
exceed its number of adjusted patient days of service rendered in
the base year by 10 percent, the applicable cost containment limit is
the trended base year amount determined in subparagraph (B) of
paragraph (2), subject to paragraph (4).
   (4) If a public hospital health system county's costs, as
determined in subparagraph (A) of paragraph (2), exceeds the amount
determined in subparagraph (B) of paragraph (2) as adjusted by
paragraph (3), the portion of the following cost increases incurred
in providing services to Medi-Cal beneficiaries and uninsured
patients shall be added to and reflected in any cost containment
limit:
   (A) Electronic Health Records and related implementation and
infrastructure costs.
   (B) Costs related to state or federally mandated activities,
requirements, or benefit changes.
   (C) Costs resulting from a court order or settlement.
   (D) Costs incurred in response to seismic concerns, including
costs necessary to meet facility seismic standards.
   (E) Costs incurred as a result of a natural disaster or act of
terrorism.
   (5) If a public hospital health system county's costs, as
determined in subparagraph (A) of paragraph (2), exceeds the amount
determined in subparagraph (B) of paragraph (2) as adjusted by
paragraphs (3) and (4), the county may request that the department
consider other costs as adjustments to the cost containment limit,
including, but not limited to, transfer amounts in excess of the
imputed other entity intergovernmental transfer amount trended by the
blended CPI trend factor, costs related to case mix index increases,
pension costs, expanded medical education programs, increased costs
in response to delivery system changes in the local community, and
system expansions, including capital expenditures necessary to ensure
access to and the quality of health care. Costs approved by the
department shall be added to and reflected in any cost containment
limit.
   (e) "County indigent care health realignment amount" means the
product of the health realignment amount times the health realignment
indigent care percentage, as computed on a county-specific basis.
   (f) "County public hospital health system" means a designated
public hospital identified in paragraphs (6) to (20), inclusive, and
paragraph (22) of subdivision (d) of Section 14166.1, and its
affiliated governmental entity clinics, practices, and other health
care providers that do not provide predominantly public health
services. A county public hospital health system does not include a
health care service plan, as defined in subdivision (f) of Section
1345 of the Health and Safety Code. The Alameda County Medical Center
and County of Alameda shall be considered affiliated governmental
entities.
   (g) "Department" means the State Department of Health Care
Services.
   (h) "Health realignment amount" means the amount that, in the
absence of this article, would be payable to a public hospital health
system county under Sections 17603, 17604, 17606.10, and 17606.20,
as those sections read on January 1, 2012, for the fiscal year that
is deposited by the Controller into the local health and welfare
trust fund health account of the public hospital health system
county.
   (i) "Health realignment indigent care percentage" means the
county-specific percentage determined in accordance with the
following, and established in accordance with the procedures
described in subdivision (c) of Section 17612.3.
   (1) Each public hospital health system county shall identify the
portion of that county's health realignment amount that was used to
provide health services to the indigent, including Medi-Cal
beneficiaries and the uninsured, for each of the historical fiscal
years along with verifiable data in support thereof.
   (2) The amounts identified in paragraph (1) shall be expressed as
a percentage of the health realignment amount of that county for each
historical fiscal year.
   (3) The average of the percentages determined in paragraph (2)
shall be the county's health realignment indigent care percentage.
   (4) To the extent a county does not provide the information
required in paragraph (1) or the department determines that the
information provided is insufficient, the amount under this
subdivision shall be 85 percent.
   (j) "Historical fiscal years" means the state 2008-09 to 2011-12,
inclusive, fiscal years.
   (k) "Hospital fee direct grants" means the direct grants described
in Section 14169.7 that are funded by the Private Hospital Quality
Assurance Fee Act of 2011 (Article 5.229 (commencing with Section
14169.31) of Chapter 7 of Part 3), or direct grants made in support
of health care expenditures funded by a successor statewide hospital
fee program.
   (l) "Imputed county low-income health amount" means the
predetermined, county-specific amount of county general purpose funds
assumed, for purposes of the calculation in Section 17612. 3, to be
available to the county public hospital health system for services to
Medi-Cal and uninsured patients. County general purpose funds shall
not include any other revenues, grants, or funds otherwise defined in
this section. The imputed county low-income health amount shall be
determined as follows and established in accordance with subdivision
(c) of Section 17612.3.
   (1) For each of the historical fiscal years, an amount determined
to be the annual amount of county general fund contribution provided
for health services to Medi-Cal beneficiaries and the uninsured,
which does not include funds provided for nursing facility, mental
health, and substance use disorder services, shall be determined
through methodologies described in subdivision (ab).
   (2) If a year-to-year percentage increase in the amount determined
in paragraph (1) was present, an average annual percentage trend
factor shall be determined.
   (3) The annual amounts determined in paragraph (1) shall be
averaged, and multiplied by the percentage trend factor, if
applicable, determined in paragraph (2), for each fiscal year after
the 2011-12 fiscal year through the applicable fiscal year. However,
if the percentage trend factor determined in paragraph (2) is greater
than the applicable percentage change for any year of the same
period in the blended CPI trend factor, the percentage change in the
blended CPI trend factor for that year shall be used. The resulting
determination is the imputed county low-income health amount for
purposes of Section 17612.3.
   (m) "Imputed gains from other payers" means the predetermined,
county-specific amount of revenues in excess of costs generated from
all other payers for health services that is assumed to be available
to the county public hospital health system for services to Medi-Cal
and uninsured patients, which shall be determined as follows and
established in accordance with subdivision (c) of Section 17612.3.
   (1) For each of the historical fiscal years, the gains from other
payers shall be determined in accordance with methodologies described
in subdivision (ab).
   (2) The amounts determined in paragraph (1) shall be averaged,
yielding the imputed gains from other payers.
   (n) "Imputed other entity intergovernmental transfer amount" means
the predetermined average historical amount of the public hospital
health system county's other entity intergovernmental transfer
amount, determined as follows and established in accordance with
subdivision (c) of Section 17612.3.
   (1) For each of the historical fiscal years, the other entity
intergovernmental transfer amount shall be determined based on the
records of the public hospital health system county.
   (2) The annual amounts in paragraph (1) shall be averaged.
   (o) "Medicaid demonstration revenues" means payments paid or
payable to the county public hospital health system for the fiscal
year pursuant to the Special Terms and Conditions of the federal
Medicaid demonstration project authorized under Section 1115 of the
federal Social Security Act entitled the "Bridge to Health Care
Reform" (waiver number 11-W-00193/9), for uninsured care services
from the Safety Net Care Pool or as incentive payments from the
Delivery System Reform Improvement Pool, or pursuant to mechanisms
that provide funding for similar purposes under the subsequent
demonstration project. Medicaid demonstration revenues do not include
the nonfederal share provided by county public hospital health
systems as certified public expenditures, and are reduced by any
intergovernmental transfer by county public hospital health systems
or affiliated governmental entities that is for the nonfederal share
of Medicaid demonstration payments to the county public hospital
health system or payments to a Medi-Cal managed care plan for
services rendered by the county public hospital health system, and
any related fees imposed by the state on those transfers; and by any
reimbursement of costs, or payment of administrative or other
processing fees imposed by the state relating to payments or other
Medicaid demonstration program functions. Medicaid demonstration
revenues shall not include Safety Net Care Pool revenues for nursing
facility, mental health, and substance use disorder services, as
determined from the pro rata share of eligible certified public
expenditures for such services, or revenues that are otherwise
included as Medi-Cal revenues.
   (p) "Medi-Cal beneficiaries" means individuals eligible to receive
benefits under Chapter 7 (commencing with Section 14000) of Part 3,
except for: individuals who are dual eligibles, as defined in
paragraph (4) of subdivision (c) of Section 14132.275, and
individuals for whom Medi-Cal benefits are limited to cost sharing or
premium assistance for Medicare or other insurance coverage as
described in Section 1396d(a) of Title 42 of the United States Code.
   (q) "Medi-Cal costs" means the costs incurred by the county public
hospital health system for providing Medi-Cal services to Medi-Cal
beneficiaries during the fiscal year, which shall be determined in a
manner consistent with the cost claiming protocols developed for
Medi-Cal cost-based reimbursement for public providers and under
Section 14166.8, and, in consultation with each county, shall be
based on other cost reporting and statistical data necessary for an
accurate determination of actual costs as required in Section
17612.4. Medi-Cal costs shall include all fee-for-service and managed
care hospital and nonhospital components, managed care
out-of-network costs, and related administrative costs. The Medi-Cal
costs determined under this paragraph shall exclude costs incurred
for nursing facility, mental health, and substance use disorder
services.
   (r) "Medi-Cal revenues" means total amounts paid or payable to the
county public hospital health system for medical services provided
under the Medi-Cal State Plan that are rendered to Medi-Cal
beneficiaries during the state fiscal year, and shall include
payments from Medi-Cal managed care plans for services rendered to
Medi-Cal managed care plan members, Medi-Cal copayments received from
Medi-Cal beneficiaries, but only to the extent actually received,
supplemental payments for Medi-Cal services, and Medi-Cal
disproportionate share hospital payments for the state fiscal year,
but shall exclude Medi-Cal revenues paid or payable for nursing
facility, mental health, and substance use disorder services.
Medi-Cal revenues do not include the nonfederal share provided by
county public hospital health systems as certified public
expenditures. Medi-Cal revenues shall be reduced by all of the
following:
   (1) Intergovernmental transfers by the county public hospital
health system or its affiliated governmental entities that are for
the nonfederal share of Medi-Cal payments to the county public
hospital health system, or Medi-Cal payments to a Medi-Cal managed
care plan for services rendered by the county public hospital health
system for the fiscal year.
   (2) Related fees imposed by the state on the transfers specified
in paragraph (1).
   (3) Administrative or other fees, payments, or transfers imposed
by the state, or voluntarily provided by the county public hospital
health systems or affiliated governmental entities, relating to
payments or other Medi-Cal program functions for the fiscal year.
   (s) "Newly eligible beneficiaries" means individuals who meet the
eligibility requirements in Section 1902(a)(10)(A)(i)(VIII) of Title
XIX of the federal Social Security Act (42 U.S.C. Sec. 1396a(a)(10)
(A)(i)(VIII)), and who meet the conditions described in Section 1905
(y) of the federal Social Security Act (42 U.S.C. Sec. 1396d(y)) such
that expenditures for services provided to the individual are
eligible for the enhanced federal medical assistance percentage
described in that section.
   (t) "Other entity intergovernmental transfer amount" means the
amount of intergovernmental transfers by a county public hospital
health system or affiliated governmental entities, and accepted by
the department, that are for the nonfederal share of Medi-Cal
payments or Medicaid demonstration payments for the fiscal year to
any Medi-Cal provider other than the county public hospital health
system, or to a Medi-Cal managed care plan for services rendered by
those other providers, and any related fees imposed by the state on
those transfers.
   (u) "Public hospital health system county" means a county in which
a county public hospital health system is located.
   (v) "Redirected amount" means the amount to be redirected in
accordance with Section 17612.1, as calculated pursuant to
subdivision (a) of Section 17612.3.
   (w) "Special local health funds" means the amount of the following
county funds received by the county public hospital health system
for health services during the fiscal year:
   (1) Assessments and fees restricted for health-related purposes.
The amount of the assessment or fee for this purpose shall be the
greater of subparagraph (A) or (B). If, because of restrictions and
limitations applicable to the assessment or fee, the county public
hospital health system cannot expend this amount, this amount shall
be reduced to the amount actually expended.
   (A) The amount of the assessment or fee expended by the county
public hospital health system for the provision of health services to
Medi-Cal and uninsured beneficiaries during the fiscal year.
   (B) The amount of the assessment or fee multiplied by the average
of the percentages of the amount of assessment or fees that were
allocated to and expended by the county public hospital health system
for health services to Medi-Cal and uninsured beneficiaries during
the historical fiscal years. The percentages for the historical
fiscal years shall be determined by dividing the amount allocated in
each fiscal year as described in subparagraphs (B) and (C) of
paragraph (2) of subdivision (ab) by the actual amount of assessment
or fee expended in the fiscal year.
   (2) Funds available pursuant to the Master Settlement Agreement
and related documents entered into on November 23, 1998, by the state
and leading United States tobacco product manufacturers during a
fiscal year. The amount of the tobacco settlement funds that may be
used for this purpose shall be the greater of subparagraph (A) or
(B), less any bond payments and other costs of securitization.
   (A) The amount of the funds expended by the county public hospital
health system for the provision of health services to Medi-Cal and
uninsured beneficiaries during the fiscal year.
   (B) The amount of the tobacco settlement funds multiplied by the
average of the percentages of the amount of tobacco settlement funds
that were allocated to and expended by the county public hospital
health system for health services to Medi-Cal and uninsured
beneficiaries during the historical fiscal years. The percentages for
the historical fiscal years shall be determined by dividing the
amount allocated in each fiscal year as described in subparagraph (C)
of paragraph (2) of subdivision (ab) by the actual amount of tobacco
settlement funds expended in the fiscal year.
   (x) "Subsequent demonstration project" means the federally
approved Medicaid demonstration project implemented after the
termination of the federal Medicaid demonstration project authorized
under Section 1115 of the federal Social Security Act entitled the
"Bridge to Health Care Reform" (waiver number 11-W-00193/9), the
extension of that demonstration project, or the material amendment to
that demonstration project.
   (y) "Uninsured costs" means the costs incurred by the public
hospital health system county and its affiliated government entities
for purchasing, providing, or ensuring the availability of services
to uninsured patients during the fiscal year. Uninsured costs shall
be determined in a manner consistent with the cost-claiming protocols
developed for the federal Medicaid demonstration project authorized
under Section 1115 of the federal Social Security Act entitled the
"Bridge to Health Care Reform" (waiver number 11-W-00193/9),
including protocols pending federal approval, and under Section
14166.8, and, in consultation with each county, shall be based on any
other cost reporting and statistical data necessary for an accurate
determination of actual costs incurred. For this purpose, no
reduction factor applicable to otherwise allowable costs under the
demonstration project or the subsequent demonstration project shall
apply. Uninsured costs shall exclude costs for nursing facility,
mental health, and substance use disorder services.
   (z) "Uninsured patients" means individuals who have no source of
third-party coverage for the specific service furnished, as further
defined in the reporting requirements established pursuant to Section
17612.4.
   (aa) "Uninsured revenues" means self-pay payments made by or on
behalf of uninsured patients to the county public hospital health
system for the services rendered in the fiscal year, but shall
exclude revenues received for nursing facility, mental health, and
substance use disorder services. Uninsured revenues do not include
the health realignment amount or imputed county low-income health
amount and shall not include any other revenues, grants, or funds
otherwise defined in this section.
   (ab) "Historical allocation" means the allocation for the amounts
in the historical years described in subdivisions (l), (m), and (w)
for health services to Medi-Cal beneficiaries and uninsured patients.
The allocation of those amounts in the historical years shall be
done in accordance with a process to be developed by the department,
in consultation with the counties, which includes the following
required parameters:
   (1) For each of the historical fiscal years, the Medi-Cal costs,
uninsured costs, and costs of other entity intergovernmental transfer
amounts, as defined in subdivisions (q), (t), and (y), and the
Medicaid demonstration, Medi-Cal and uninsured revenues with respect
to the services as defined in subdivisions (o), (r), and (aa), shall
be determined. For these purposes, Medicaid demonstration revenues
shall include applicable payments as described in subdivision (o)
paid or payable to the county public hospital health system under the
prior demonstration project defined in subdivision (c) of Section
14166.1, under the Low Income Health Program (Part 3.6 (commencing
with Section 15909)), and under the Health Care Coverage Initiative
(Part 3.5 (commencing with Section 15900)), none of which shall
include the nonfederal share of the Medicaid demonstration payments.
The revenues shall be subtracted from the costs, yielding the initial
low-income shortfall for each of the historical fiscal years.
   (2) The following amounts shall be allocated, but shall not
exceed, the initial low-income shortfall determined in paragraph (1)
for each year:
   (A) First, the county indigent care health realignment amount
shall be applied 100 percent against the initial low-income
shortfall.
   (B) Second, special local health funds specifically restricted for
indigent care shall be applied 100 percent against the initial
low-income shortfall.
   (C) Third, all other sources of funding, excluding funds for
nursing facility, mental health, and substance use disorder services
and gains from other payers, shall be allocated in a fair and
reasonable manner to determine the proportion applied to, and not to
exceed, the initial low-income shortfall. Other sources of funding
shall include any of the following:
   (i) Unrestricted special local health funds.
   (ii) One-time funds received by the county public hospital health
system for health services for that year or prior period
carry-forward amounts, or carry-forward amounts.
   (iii) County general purpose funds described in subdivision (l).
   (D) Finally, to the extent that the process above does not result
in completely allocating revenues up to the amount necessary to
address the initial low-income shortfall in the historical years,
gains from other payers shall be allocated to fund those costs only
to the extent that such other payer gains exist.
   (ac) "Gains from other payers" means the county-specific amount of
revenues in excess of costs generated from all other payers for
health services. For purposes of this subdivision, patients with
other payer coverage are patients who are identified in all other
financial classes, including, but not limited to, commercial coverage
and dual eligible, other than Medi-Cal and uninsured.
   (ad) "New mandatory other entity intergovernmental transfer
amounts" means other entity intergovernmental transfer amounts
required by the state after July 1, 2013.
   17612.21.  For the purposes of determining the fair and reasonable
manner of allocation described in subparagraph (C) of paragraph (2)
of subdivision (ab) of Section 17612.2, it is the intent of the
Legislature to codify an allocation methodology by September 13,
2013. Prior to that codification, the following steps shall occur:
   (a) The department shall meet with representatives of the county
public hospital health systems to formulate the fair and reasonable
allocation methodology.
   (b) No later than August 1, 2013, the department shall submit to
the Legislature a proposed allocation methodology. If the county
public hospital health systems and the department fail to agree on a
                                               proposed allocation
methodology, the department shall also be required to submit an
alternative approach from the county public hospital health systems,
which the county public hospital health systems shall submit to the
department prior to July 30, 2013, and the department's analysis of
why it chose its recommended approach.
   (c) If the Legislature enacts legislation implementing the
allocation methodology described in subparagraph (C) of paragraph (2)
of subdivision (ab) of Section 17612.2 by July 1, 2014, then
notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1
of Division 3 of Title 2 of the Government Code, the department,
without taking any further regulatory action, may implement,
interpret, or make specific this section by means of all-county
letters, plan letters, plan or provider bulletins, or similar
instructions.
   (d) If the Legislature does not enact legislation implementing the
allocation methodology described in subparagraph (C) of paragraph
(2) of subdivision (ab) of Section 17612.2 by July 1, 2014, the
department may implement the allocation methodology described in
subparagraph (C) of paragraph (2) of subdivision (ab) of Section
17612.2 only by means that are in conformity with Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code.
   17612.3.  (a) For each fiscal year, commencing with the 2013-14
fiscal year, the amount to be redirected in accordance with Section
17612.1 shall be determined for each public hospital health system
county as follows:
   (1) The public hospital health system county's revenues and other
funds paid or payable for the state fiscal year shall be comprised of
the total of the following:
   (A) Medi-Cal revenues.
   (B) Uninsured revenues.
   (C) Medicaid demonstration revenues.
   (D) Hospital fee direct grants.
   (E) Special local health funds.
   (F) The county indigent care health realignment amount.
   (G) The imputed county low-income health amount.
   (H) Imputed gains from other payers.
   (I) The amount by which the public hospital health system county's
costs exceeded the cost containment limit for the fiscal year,
expressed as a negative number, multiplied by 0.50.
   (2) The following, incurred by the public hospital health system
county for the fiscal year, not to exceed in total the cost
containment limit, shall be subtracted from the sum in paragraph (1):

   (A) Medi-Cal costs.
   (B) Uninsured costs.
   (C) The lesser of the other entity intergovernmental transfer
amount or the imputed other entity intergovernmental transfer
amounts.
   (D) New mandatory other entity intergovernmental transfer amounts.

   (3) The resulting amount determined in paragraph (2) shall be
multiplied by 0.80, except that for the 2013-14 fiscal year the
resulting amount determined in paragraph (2) shall be multiplied by
0.70.
   (4) If the amount in paragraph (3) is a positive number, that
amount, subject to paragraph (5), shall be redirected in accordance
with Section 17612.1. If the amount determined in paragraph (3) is a
negative number, the redirected amount shall be zero.
   (5) Notwithstanding any other law, the amount to be redirected as
determined in paragraph (4) for any fiscal year shall not exceed the
county indigent care health realignment amount for that fiscal year.
   (6) (A) The redirected amount shall be applied until the later of
the following:
   (i) June 30, 2023.
   (ii) The beginning of the fiscal year following a period of two
consecutive fiscal years in which both of the following occur:
   (aa) The total interim amount determined under subdivision (b) of
Section 17612.3 in May of the previous fiscal year is within 10
percent of the final, reconciled amount in subdivision (d) of that
section.
   (bb) The final, reconciled amounts under subdivision (d) of
Section 17612.3 are within 5 percent of each other.
   (B) After the redirected amount ceases as provided in subparagraph
(A), a permanent redirected amount shall be established to be an
amount determined by calculating the percentage that the redirected
amount was in the last fiscal year of the operation of this article
of the county's health realignment amount of that same fiscal year,
multiplied by the county's health realignment amount of all
subsequent years.
   (b) Commencing with the 2014-15 fiscal year, the department shall
calculate an interim redirected amount for each public hospital
health system county under subdivision (a) by the January immediately
prior to the starting fiscal year, using the most recent and
accurate data available. For purposes of the interim determinations,
the cost containment limit shall not be applied. The interim
redirected amount shall be updated in the May before the start of the
fiscal year in consultation with each public hospital health system
county and based on any more recent and accurate data available at
that time. During the fiscal year, the interim redirected amount will
be applied pursuant to Section 17612.1.
   (c) The predetermined amounts or historical percentages described
in subdivisions (i), (l), (m), (n), and (w) of Section 17612.2 shall
each be established in accordance with the following procedure:
   (1) By September 30, 2013, each public hospital health system
county shall determine the amount or percentage described in the
applicable subdivision, and shall provide this calculation to the
department, supported by verifiable data and a description of how the
determination was made.
   (2) If the department disagrees with the public hospital health
system county's determination, the department shall confer with the
public hospital health system county by November 15, 2013.
   (3) If no agreement between the parties has been reached by
December 31, 2013, the department shall apply the county's
determination when making the interim calculations pursuant to
subdivision (b), until a decision is issued pursuant to paragraph
(6).
   (4) A public hospital health system county may submit a petition
to the County Health Care Funding Resolution Committee, established
pursuant to Section 17600.60, to seek a decision regarding the
historical percentage or amount to be applied in calculations under
this section.
   (5) The County Health Care Funding Resolution Committee shall hear
and make a determination as to whether the county's proposed
percentage or amount complies with the requirements of this section
taking into account the data and calculations of the county and any
alternative data and calculations submitted by the department.
   (6) The committee shall issue a decision within 45 days of the
petition. If the county chooses to contest the determination, the
decision of the committee will be applied for purposes of any interim
calculation under subdivision (b) until a final decision is issued
pursuant to de novo administrative review pursuant to paragraph (2)
of subdivision (d).
   (d) (1) The data for the final calculations under subdivision (a)
for the fiscal year shall be submitted by public hospital health
system counties within 12 months after the conclusion of each fiscal
year as required in section 17612.4. The data shall be the most
recent and accurate data from the public hospital health system
county's books and records pertaining to the revenues paid or
payable, and the costs incurred, for services provided in the subject
fiscal year. The department shall make final calculations using the
data submitted pursuant to this paragraph by December 31 of the
following fiscal year, and shall provide the calculation to the
county. The final calculations will also reflect the application of
the cost containment limit, if any. A recalculation and
reconciliation shall be completed by the department within six months
thereafter.
   (2) The director shall establish an expedited formal appeal
process for a public hospital health system county to contest the
determinations made in this article, and only as follows:
   (A) The public hospital health system county shall have 30
calendar days, following the issuance of a determination made under
this article, to file an appeal with the Director of Health Care
Services. All appeals shall be governed by Section 100171 of the
Health and Safety Code, except for those provisions of paragraph (1)
of subdivision (d) of Section 100171 of the Health and Safety Code
relating to accusations, statements of issues, statement to
respondent, and notice of defense, and except as otherwise set forth
in this section. All appeals shall be in writing and shall be filed
with the State Department of Health Care Service's Office of
Administrative Hearings and Appeals. An appeal shall be deemed filed
on the date it is received by the Office of Administrative Hearings
and Appeals.
   (i) An appeal shall specifically set forth each issue in dispute,
which may include any component of the determination, and include the
public hospital health system county's contentions as to those
issues. A formal hearing before an Office of Administrative Hearings
and Appeals Administrative Law Judge shall commence within 45 days of
the filing of the appeal requesting a formal hearing. A final
decision shall be adopted within 60 days of the close of the record,
but no later than five months following the issuance of the appeal.
   (ii) If the public hospital health system county fails to file an
appeal within 30 days of the issuance of a determination made under
this article, the determination of the department shall be deemed
final and not appealable either administratively or to a court of
general jurisdiction.
   (B) If a final decision is not issued by the department within two
years of the issuance of a determination made under this article,
the public hospital health system county shall be deemed to have
exhausted its administrative remedies and shall not be precluded from
pursuing any available judicial review. However, the time period in
this subdivision shall be extended by either of the following:
   (i) Undue delay caused by the public hospital health system
county.
   (ii) An extension of time granted to a public hospital health
system county at its sole request, or following the joint request of
the public hospital health system county and the department.
   (D) If the final decision issued by the department pursuant to
this section results in a different determination than that
originally determined by the department, then the Department of
Finance shall adjust the original determination by that amount,
pursuant to a process developed by the Department of Finance and in
consultation with the public hospital health system counties.
   (e) For purposes of this article, all references to "health
services" or "health care services," unless specified otherwise,
shall exclude nursing facility, mental health, and substance use
disorder services.
   17612.4.  (a) Beginning with the 2013-14 state fiscal year, each
county that has elected to participate in the County Savings
Determination Process shall, within five months after the end of each
fiscal year, submit initial reports including all of the following:
   (1) All revenue data required for the operation of Section
17612.3, including all of the following:
   (A) Medi-Cal revenues.
   (B) Uninsured revenues.
   (C) Medicaid demonstration revenues.
   (D) Hospital fee direct grants.
   (E) Special local health funds.
   (2) All cost data required for the operation of Section 17612.3,
including all of the following:
   (A) Medi-Cal costs.
   (B) Uninsured costs.
   (C) Other entity intergovernmental transfer amounts.
   (D) New mandatory other entity intergovernmental transfer amounts.

   (b) Notwithstanding paragraph (2) of subdivision (a), a county
that reports data to the department pursuant to Section 14166.8 is
only required to report cost data under this section to the extent
not already reported to the department pursuant to Section 14166.8
for a given fiscal year.
   (c) Counties shall submit final reports of cost and revenue data
identified in paragraphs (1) and (2) of subdivision (a) to the
department for each fiscal year no later than June 30 of the fiscal
year ending one year after the subject fiscal year.
   (d) The department shall develop, in consultation with counties,
the methodologies used to determine the costs and revenues required
to be reported and the format of those submissions.
   (e) Reports submitted under this section shall be accompanied by a
certification by an appropriate local public official attesting to
the accuracy of the reports.
   17612.5.  (a) For the 2013-14 fiscal year and each year
thereafter, the amount to be redirected in accordance with Section
17612.1 for the County of Los Angeles shall be determined in
accordance with Section 17612.3, except that the formula in
subdivision (a) of Section 17612.3 shall be replaced with the
following formula:
   (1) The total revenues as defined in paragraph (7) of subdivision
(b) paid or payable to the County of Los Angeles, Department of
Health Services, for the fiscal year, which shall include special
local health funds and as adjusted in accordance with Section
17612.6, shall be added together.
   (2) The sum of three hundred twenty-three million dollars
($323,000,000), which represents the imputed county low-income health
amount trended annually by 1 percent from the 2012-13 fiscal year
through the applicable fiscal year, and the county indigent care
health realignment amount, as determined in accordance with
subdivision (e) of section 17612.2 for the fiscal year.
   (3) The amount by which the county's total costs exceeded the cost
containment limit for the fiscal year, expressed as a negative
number, multiplied by 0.50.
   (4) (A) The total costs as defined in paragraph (6) of subdivision
(b) incurred by or on behalf of the County of Los Angeles,
Department of Health Services, during the fiscal year shall be added
together, but shall not exceed the cost containment limit determined
in accordance with paragraph (3) of subdivision (b).
   (B) The costs in paragraph (A) shall be subtracted from the sum of
paragraphs (1) to (3), inclusive.
   (5) The resulting amount determined in subparagraph (B) of
paragraph (4) shall be multiplied by 0.80, except that for the
2013-14 fiscal year, the resulting amount determined in subparagraph
(B) of paragraph (4) shall be multiplied by 0.70.
   (6) If the amount in paragraph (5) is a positive number, that
amount, subject to paragraph (7), shall be redirected in accordance
with Section 17612.1 of this article. If the amount determined in
paragraph (5) is a negative number, the redirected amount shall be
zero.
   (7) Notwithstanding any other provision of law, the amount to be
redirected as determined in paragraph (6) for any fiscal year shall
not exceed the county indigent care health realignment amount for
that fiscal year.
   (8) (A) The redirected amount shall be applied until the later of:

   (i) June 30, 2023.
   (ii) The beginning of fiscal year following a period of two
consecutive fiscal years that both of the following occur:
   (aa) The total interim amount determined under subdivision (b) of
Section 17612.3 in May of the previous fiscal year is within 10
percent of the final, reconciled amount in subdivision (d) of that
section.
   (bb) The final, reconciled amounts under subdivision (d) of
Section 17612.3 are within 5 percent of each other.
   (B) After the redirected amount ceases as provided in subparagraph
(A), a permanent redirected amount shall be established to be an
amount determined by calculating the percentage that the redirected
amount was in the last fiscal year of the operation of this article
of the county's health realignment amount of that same fiscal year,
multiplied by the county's health realignment amount of all
subsequent years.
   (b) Except as otherwise provided in this section, the definitions
in Section 17612.2 shall apply. For purposes of this section, and for
purposes the calculations in Section 17612.3 that apply to the
County of Los Angeles, the following definitions shall apply:
   (1) "Adjusted patient day" means LA County DHS's total number of
patient days multiplied by the following fraction: the numerator that
is the sum of the county public hospital health system's total gross
revenue for all services provided to all patients, including
nonhospital services, and the denominator that is the sum of the
county public hospital health system's gross inpatient revenue. The
adjusted patient days shall pertain to those services that are
provided by the LA County DHS, and shall exclude services that are
provided by contract or out-of-network clinics or hospitals. For
purposes of this paragraph, gross revenue shall be adjusted as
necessary to reflect the relationship between inpatient costs and
revenues and outpatient costs and charges.
   (2) "Blended CPI trend factor" means the blended percent change
applicable for the state fiscal year that is derived from the
nonseasonally adjusted Consumer Price Index for All Urban Consumers
(CPI-U), United States City Average, for Hospital and Related
Services, weighted at 90 percent, and for Medical Care Services,
weighted at 10 percent, all as published by the United States Bureau
of Labor Statistics, computed as follows:
   (A) For each prior fiscal year, within the period to be trended
through the fiscal year, the annual average of the monthly index
amounts shall be determined separately for the Hospital and Related
Services Index and the Medical Care Services Index.
   (B) The year-to-year percentage changes in the annual averages
determined in subparagraph (A) for each of the Hospital and Related
Services Index and the Medical Care Services Index shall be
determined.
   (C) A weighted average annual percentage change for each
year-to-year period shall be calculated from the determinations made
in subparagraph (B), with the percentage changes in the Hospital and
Related Services Index weighted at 90 percent, and the percentage
changes in the Medical Care Services Index weighted at 10 percent.
The resulting average annual percentage changes shall be expressed as
a fraction, and increased by 1.00.
   (D) The product of the successive year to year amounts determined
in subparagraph (C) shall be the blended CPI trend factor.
   (3) "Cost containment limit" means the LA County DHS's total costs
determined for the 2014-15 fiscal year and each subsequent fiscal
year adjusted as follows:
   (A) The County of Los Angeles will be deemed to comply with the
cost containment limit if the county demonstrates that its total
costs for the fiscal year did not exceed its total costs in the base
year, multiplied by the blended CPI trend factor for the fiscal year
as reflected in the annual report of financial transactions required
to be submitted to the Controller pursuant to Section 53891 of the
Government Code. If the total costs for the fiscal year exceeded the
total cost in the base year, multiplied by the blended CPI trend
factor for the fiscal year, the calculation in subparagraph (B) shall
be performed.
   (B) (i) If the number of adjusted patient days of service provided
by LA County DHS for the fiscal year exceeds its number of adjusted
patient days of service rendered in the base year by at least 10
percent, the excess adjusted patient days above the base year for the
fiscal year shall be multiplied by the cost per adjusted patient day
of the public hospital health system for the base year. The result
shall be added to the trended base year amount determined in
subparagraph (A), yielding the applicable cost containment limit,
subject to subparagraph (C). Costs per adjusted patient day shall be
based upon only those LA County DHS costs incurred for patient care
services.
   (ii) If the number of adjusted patient days of service provided by
LA County DHS for the fiscal year does not exceed its number of
adjusted patient days of service rendered in the base year, the
applicable limit is the trended base year amount determined in
subparagraph (A) subject to subparagraph (C).
   (C) If LA County DHS's total costs for the fiscal year in as
determined in subparagraph (A) exceeds the trended cost as determined
in subparagraph (A) as adjusted by subparagraph (B), the following
cost increases shall be added to and reflected in any cost
containment limit:
   (i) Electronic health records and related implementation and
infrastructure costs.
   (ii) Costs related to state or federally mandated activities,
requirements, or benefit changes.
   (iii) Costs resulting from a court order or settlement.
   (iv) Costs incurred in response to seismic concerns, including
costs necessary to meet facility seismic standards.
   (v) Costs incurred as a result of a natural disaster or act of
terrorism.
   (vi) The total amount of any intergovernmental transfer for the
nonfederal share of Medi-Cal payments to the hospital facility
described in subdivision (f) of Section 14165.50.
   (D) If LA County DHS's total costs, as adjusted by subparagraphs
(B) and (C), exceed total costs for the fiscal year, the county may
request that the department consider other costs as adjustments to
the cost containment limit, including, but not limited to, transfer
amounts in excess of the imputed other entity intergovernmental
transfer amount trended by the blended CPI trend factor, costs
related to case mix index increases, pension costs, expanded medical
education programs, increased costs in response to delivery system
changes in the local community, and system expansions, including
capital expenditures necessary to ensure access to and the quality of
health care. Costs approved by the department shall be added to and
reflected in the cost containment limit.
   (4) "Health realignment indigent care percentage" means 83
percent.
   (5) "Special local health funds" means the total amount of the
following funds received by LA County DHS and expended for health
services during the fiscal year:
   (A) Assessments and fees restricted for health-related purposes.
   (B) Ninety-one percent of the funds available pursuant to the
Master Settlement Agreement and related documents entered into on
November 23, 1998, by the state and leading United States tobacco
product manufacturers and allocated to LA County DHS during a fiscal
year.
   (6) "Total costs" means the actual net expenditures, excluding
encumbrances, for all operating budget units of the LA County DHS.
Operating budget units consist of four Hospital Enterprise Funds plus
the LA County DHS's budget units within the county general fund. Net
expenditures, excluding encumbrances, are those recognized within LA
County DHS, net of intrafund transfers, expenditure distributions,
and all other billable services recorded from and to the LA County
DHS enterprise funds and the LA County DHS general fund budget units,
determined based on its central accounting system known as eCAPS, as
of November 30 of the year following the fiscal year, and shall
include the new mandatory other entity intergovernmental transfer
amounts, as defined in subdivision (ad) of Section 17612.2, and the
lesser of other entity intergovernmental transfer amounts or the
imputed other entity intergovernmental transfer amounts.
   (7) "Total revenues" means the sum of the revenue paid or payable
for all operating budget units of the LA County DHS determined based
on its central accounting system known as eCAPS, as of November 30 of
the year following the fiscal year.
   (8) "LA County DHS" means operating budget units consisting of
four hospital enterprise funds plus the DHS budget units within the
county's general fund.
   17612.6.  (a) For purposes of this section, the following
definitions shall apply:
   (1) "Type A payers" means the following sources of revenue for
amounts paid to the County of Los Angeles, Department of Health
Services:
   (A) Title XVIII of the federal Social Security Act, known as the
Medicare program.
   (B) Commercial health insurance.
   (C) In-home supportive services, consistent with Article 7
(commencing with Section 12300) of Chapter 3 and Chapter 7
(commencing with Section 14000) of Part 3.
   (2) "Type B payers" means the following sources of revenue for
amounts paid to the County of Los Angeles, Department of Health
Services:
   (A) Patient care revenues received for services provided to other
county departments.
   (B) State payments for patient financial services workers.
   (C) Other federal payers, not including Medicare and Medicaid.
   (3) "Historical Base Type A revenues" means revenues from Type A
payers in the historical fiscal years, calculated as follows:
   (A) For each historical fiscal year, the actual revenue received
from Type A payers.
   (B) Calculate the average of the historical year's amounts in
subparagraph (A). This average shall be considered the historical
Base Type A revenues.
   (4) "Historical Base Type B revenues" means revenues from Type B
payers in the historical fiscal years, calculated as follows:
   (A) For each historical fiscal year, the actual revenue received
from Type B payers.
   (B) Calculate the average of the historical years amounts in
subparagraph (A). This average shall be considered the historical
Base Type B revenues.
   (5) "Type A payer revenue" means the amount of revenue that is the
greater of the following:
   (A) The amount of the revenue received from Type A payers for
services rendered during the fiscal year.
   (B) The historical Base Type A revenues, as adjusted by the Type A
adjustment, defined in paragraph (8).
   (6) "Type B payer revenue" means the amount of revenue that is the
greater of the following:
   (A) The amount of the revenue received from Type B payers for
services rendered during the fiscal year.
   (B) The historical Base Type B revenues.
   (7) "Baseline Type A payer costs" means the average of the costs
of services provided to Type A payer patients rendered in each of the
four historical fiscal years to be determined as follows:
   (A) For each historical year, the actual costs incurred in
providing services to Type A payer patients.
   (B) Calculate the average of the historical fiscal year amounts in
subparagraph (A), this average shall be considered the baseline Type
A payer costs.
   (8) "Type A adjustment" means the value of the revenue adjustment
to historical base Type A revenues as defined in paragraph (3).
   (A) This adjustment will occur only if the Type A payer revenue
for the fiscal year is less than historical base, otherwise the
adjustment is considered to be zero.
   (B) If the requirement in subparagraph (A) is met, then there will
only be an adjustment if one or more of the specified Type A payers'
data meets all of the following conditions:

           (i) The Type A payer revenue for the fiscal year is less
than the historical base.
   (ii) The Type A payer costs for the fiscal year are less than the
historical base trended by the blended CPI trend factor.
   (iii) The Type A payer volume for the fiscal year is less than the
historical base.
   (C) For each Type A payer that meets all the conditions in
subparagraph (B) the adjustment to the Type A payer revenue for that
Type A payer will be as follows:
   (i) Calculate the percentage decrease in cost from the baseline
Type A payer cost as trended by the blended CPI trend factor as
defined in subdivision (b) and applied from the 2010-11 fiscal year
to the subject fiscal year.
   (ii) Calculate the percentage decrease in volume, based on the
adjusted patient days, from the baseline Type A payer volume to the
subject fiscal year.
   (iii) Calculate the average of the percentages in clauses (i) and
(ii).
   (iv) The percentage in clause (ii) shall be applied to the
historical Base Type A payer revenue for the individual Type A payer.

   (b) The Type A payer revenues included in the total revenues in
subdivision (a) of Section 17612.5 shall be the greater of the
adjusted historical Type A baseline or the actual revenues received
from Type A payers for services rendered in the subject fiscal year.
   (c) The Type B payer revenues included in the total revenues in
subdivision (a) of Section 17612.5 shall be the greater of the
historical Base Type B revenues or the actual revenues received from
Type B payers for services rendered in the subject fiscal year.
   17612.65.  Notwithstanding the provisions of subdivision (d) of
Section 17612.3 that require final reconciliation to occur within two
years after the close of the fiscal year, if, subsequent to final
reconciliation, payments to a county public hospital health system
under the federal Medicaid demonstration project authorized by
Section 1115 of the federal Social Security Act entitled the "Bridge
to Health Care Reform" (waiver number 11-W-00193/9) or subsequent
demonstration project are reduced or recouped based on the department'
s failure to meet the applicable budget neutrality limit on Medicaid
funding or similar requirements contained in the applicable
demonstration project Special Terms and Conditions, the redirected
amount for the affected fiscal years shall be recalculated under
subdivision (a) of Section 17612.3 to reflect the reduction in
Medicaid demonstration revenues. The resulting reduction in the
redirected amount for each affected year shall be refunded to the
affected public hospital health system county in a manner to be
agreed upon by the county and the Department of Finance.
   17612.7.  Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code, the
department, without taking any further regulatory action, shall
implement, interpret, or make specific this article by means of
all-county letters, plan letters, plan or provider bulletins, or
similar instructions.
   17612.8.  The department shall submit an application to the
federal Centers for Medicare and Medicaid Services for a subsequent
demonstration project, as defined in subdivision (x) of Section
17612.2. The subsequent demonstration project shall seek to maximize
federal Medicaid funding for county public hospital health systems
and shall include components that maintain a comparable level of
support for delivery system reform in the county public hospital
health systems as was provided under the federal Medicaid
demonstration project authorized under Section 1115 of the federal
Social Security Act entitled the "Bridge to Health Care Reform"
(waiver number 11-W-00193/9).
  SEC. 21.  Article 13 (commencing with Section 17613.1) is added to
Chapter 6 of Part 5 of Division 9 of the Welfare and Institutions
Code, to read:

      Article 13.  Redirection of Realignment for Counties


   17613.1.  (a) For the 2013-14 fiscal year and each fiscal year
thereafter, for each county, the total amount that would be payable
for the fiscal year from 1991 Health Realignment funds under Sections
17603, 17604, 17606.10, and 17606.20, as those sections read on
January 1, 2012, and deposited by the Controller into the local
health and welfare trust fund health account of the county in the
absence of this section, shall be determined pursuant to paragraph
(2) of subdivision (b) of Section 17600.50.
   (b) The redirected amount determined for the county pursuant to
Section 17613.3, or in accordance with subdivision (b) of Section
17600.50 option-to-forgo formula, shall be divided by the total
determined in subdivision (a).
   (c) The resulting fraction determined in subdivision (b) shall be
the percentage of 1991 Health Realignment funds under Sections 17603,
17604, 17606.10, and 17606.20, as those sections read on January 1,
2012, to be deposited each month into the Family Support Subaccount.
   (d) The total amount deposited pursuant to subdivision (c) with
respect to a county for a fiscal year shall not exceed the redirected
amount determined pursuant to Section 17613.3, and shall be subject
to the appeal processes, and judicial review as described in
subdivision (d) of Section 17613.3.
   (e) The Legislature finds and declares that this article is not
intended to change the local obligation pursuant to section 17000.
   17613.2.  For purposes of this article, the following definitions
shall apply:
   (a) "Base year" means the fiscal year ending three years prior to
the fiscal year for which the redirected amount is calculated.
   (b) "Blended CPI trend factor" means the blended percent change
applicable for the fiscal year that is derived from the nonseasonally
adjusted Consumer Price Index for All Urban Consumers (CPI-U),
United States City Average, for Hospital and Related Services,
weighted at 75 percent, and for Medical Care Services, weighted at 25
percent, all as published by the United States Bureau of Labor
Statistics, computed as follows:
   (1) For each prior fiscal year within the period to be trended
through the state fiscal year, the annual average of the monthly
index amounts shall be determined separately for the Hospital and
Related Services Index and the Medical Care Services Index.
   (2) The year-to-year percentage changes in the annual averages
determined in paragraph (1) for each of the Hospital and Related
Services Index and the Medical Care Services Index shall be
determined.
   (3) A weighted average annual percentage change for each
year-to-year period shall be calculated from the determinations made
in paragraph (2), with the percentage changes in the Hospital and
Related Services Index weighted at 75 percent, and the percentage
changes in the Medical Care Services Index weighted at 25 percent.
The resulting average annual percentage changes shall be expressed as
a fraction, and increased by 1.00.
   (4) The product of the successive year to year amounts determined
in paragraph (3) shall be the blended CPI trend factor.
   (c) "Calculated cost per person" is determined by dividing county
indigent program costs by the number of indigent program individuals
for the applicable fiscal year. If a county expands eligibility, the
enrollment count is limited to those indigent program individuals who
would have been eligible for services under the eligibility
requirements in existence on July 1, 2013, except if approved as an
exception allowed pursuant to subparagraph (3) of paragraph (C) of
subdivision (d).
   (d) "Cost containment limit" means the county's indigent program
costs determined for the 2014-15 fiscal year and each subsequent
fiscal year, to be adjusted as follows:
   (1) (A) The county's indigent program costs for the state fiscal
year shall be determined as indigent program costs for purposes of
this paragraph for the relevant fiscal period.
   (B) The county's calculated costs per person for the base year
will be multiplied by the blended CPI trend factor and then
multiplied by the county's fiscal year indigent program individuals.
The base year costs used shall not reflect any adjustments under this
subdivision.
   (C) The fiscal year amount determined in subparagraph (A) shall be
compared to the trended amount in subparagraph (B). If the amount in
subparagraph (B) exceeds the amount in subparagraph (A), the county
will be deemed to have satisfied the cost containment limit. If the
amount in subparagraph (A) exceeds the amount in subparagraph (B),
the calculation in paragraph (2) shall be performed.
   (2) If a county's costs as determined in subparagraph (A) of
paragraph (1) exceeds the amount determined in subparagraph (B) of
paragraph (1), the following costs, as allocated to the county's
indigent care program, shall be added to the cost and reflected in
any containment limit:
   (A) Costs related to state or federally mandated activities,
requirements, or benefit changes.
   (B) Costs resulting from a court order or settlement.
   (C) Costs incurred as a result of a natural disaster or act of
terrorism.
   (3) If a county's costs as determined in subparagraph (A) of
paragraph (1) exceed the amount determined in subparagraph (B) of
paragraph (1), as adjusted by paragraph (2), the county may request
that the department consider other costs as adjustments to the cost
containment limit. These costs would require departmental approval.
   (e) "County" for purposes of this article means the following
counties: Fresno, Merced, Orange, Placer, Sacramento, San Diego, San
Luis Obispo, Santa Barbara, Santa Cruz, Stanislaus, Tulare, and Yolo.

   (f) "County indigent care health realignment amount" means the
product of the health realignment amount times the health realignment
indigent care percentage, as computed on a county-specific basis.
   (g) "County savings determination process" means the process for
determining the amount to be redirected in accordance with Section
17613.1, as calculated pursuant to subdivision (a) of Section
17613.3.
   (h) "Department" means the State Department of Health Care
Services.
   (i) "Health realignment amount" means the amount that, in the
absence of this article, would be payable to a county under Sections
17603, 17604, 17606.10, and 17606.20, as those sections read on
January 1, 2012, for the fiscal year that is deposited by the
Controller into the local health and welfare trust fund health
account of the county.
   (j) "Health realignment indigent care percentage" means the
county-specific percentage determined in accordance with the
following, and established in accordance with the procedures
described in subdivision (c) of Section 17613.3:
   (1) Each county shall identify the portion of that county's health
realignment amount that was used to provide health services to the
indigent, including the indigent program individuals, for each of the
historical fiscal years, along with verifiable data in support
thereof.
   (2) The amounts identified in paragraph (1) shall be expressed as
a percentage of the health realignment amount of that county for each
fiscal year of the historical fiscal years.
   (3) The average of the percentages determined in paragraph (2)
shall be the county's health realignment indigent care percentage.
   (4) To the extent a county does not provide the information
required in paragraph (1) or the department determines that the
information required is insufficient, the amount under this
subdivision shall be considered to be 85 percent.
   (k) All references to "health services" or "health care services,"
unless specified otherwise, shall exclude mental health and
substance use disorder services.
   (l) "Historical fiscal years" means the fiscal years 2008-09 to
2011-12, inclusive.
   (m) "Imputed county low-income health amount" means the
predetermined, county-specific amount of county general purpose funds
assumed, for purposes of the calculation in Section 17613.3, to be
available to the county for services to indigent program individuals.
The imputed county low-income health amount shall be determined as
set forth below and established in accordance with subdivision (c) of
Section 17613.3.
   (1) For each of the historical fiscal years, an amount shall be
determined as the annual amount of county general fund contribution
provided for health services to the indigent, which does not include
funds provided for mental health and substance use disorder services,
through a methodology to be developed by the department, in
consultation with the California State Association of Counties.
   (2) If a year-to-year percentage increase in the amount determined
in paragraph (1) was present, an average annual percentage trend
factor shall be determined.
   (3) The annual amounts determined in paragraph (1) shall be
averaged and multiplied by the percentage trend factor, if
applicable, determined in paragraph (2), for each fiscal year after
the 2011-12 fiscal year through the applicable fiscal year.
Notwithstanding the foregoing, if the percentage trend factor
determined in paragraph (2) is greater than the applicable percentage
change for any year of the same period in the blended CPI trend
factor, the percentage change in the blended CPI trend factor for
that year shall be used. The resulting determination is the imputed
county low-income health amount for purposes of Section 17613.3.
   (n) "Indigent program costs" means the costs incurred by the
county for purchasing, providing, or ensuring the availability of
services to indigent program individuals during the fiscal year. The
costs for mental health and substance use disorder services shall not
be included in these costs.
   (o) "Indigent program individuals" means all individuals enrolled
in a county indigent health care program at any point throughout the
fiscal year. If a county does not enroll individuals into an indigent
health care program, indigent program individuals shall mean all
individuals who used services offered through the county indigent
health care program in the fiscal year.
   (p) "Indigent program revenues" means self-pay payments made by or
on behalf of indigent program individuals to the county for the
services rendered in the fiscal year, but shall exclude revenues
received for mental health and substance use disorder services.
   (q) "Redirected amount" means the amount to be redirected in
accordance with Section 17613.1, as calculated pursuant to
subdivision (a) of Section 17613.3.
   (r) "Special local health funds" means the amount of the following
county funds received by the county for health services to indigent
program individuals during the fiscal year and shall include funds
available pursuant to the Master Settlement Agreement and related
documents entered into on November 23, 1998, by the state and leading
United States tobacco product manufacturers during a fiscal year.
The amount of the tobacco settlement funds to be used for this
purpose shall be the greater of subparagraph (A) or (B), less any
bond payments and other costs of securitization.
   (A) The amount of the funds expended by the county for the
provision of health services to indigent program individuals during
the fiscal year.
   (B) The amount of the tobacco settlement funds multiplied by the
average of the percentages of the amount of tobacco settlement funds
that were allocated to and expended by the noncounty for health
services to indigent program individuals during the historical fiscal
years.
   17613.3.  (a) For each fiscal year commencing with the 2013-14
fiscal year, the amount to be redirected in accordance with Section
17613.1 shall be determined for each county as set forth in this
section.
   (1) The county's revenues and other funds paid or payable for the
fiscal year shall be comprised of the total of the following:
   (A) Indigent program revenues.
   (B) Special local health funds.
   (C) The county indigent care health realignment amount.
   (D) The imputed county low-income health amount.
   (2) Indigent program costs incurred by the county for the fiscal
year, not to exceed in total the cost containment limit, shall be
subtracted from the sum in paragraph (1).
   (3) The resulting amount shall be multiplied by 0.80, except that
for the 2013-14 fiscal year where the resulting amount shall be
multiplied by 0.70.
   (4) If the amount in paragraph (3) is a positive number, that
amount, subject to paragraph (5), shall be redirected in accordance
with Section 17613.1. If the amount determined in paragraph (3) is a
negative number, the redirected amount shall be zero.
   (5) Notwithstanding any other law, the amount to be redirected as
determined in paragraph (4) for a fiscal year shall not exceed the
county indigent care health realignment amount for that fiscal year.
   (6) (A) The redirected amount shall be applied until the later of
the following:
   (i) June 30, 2023.
   (ii) The beginning of the fiscal year following a period of two
consecutive fiscal years in which both of the following occur:
   (aa) The total interim amount determined under subdivision (b) in
May of the previous fiscal year is within 10 percent of the final,
reconciled amount in subdivision (d).
   (bb) The final, reconciled amounts under subdivision (d) are
within 5 percent of each other.
   (B) After the redirected amount ceases as provided in subparagraph
(A), a permanent redirected amount shall be established to be the
amount determined by calculating the percentage that the redirected
amount was in the last fiscal year of the operation of this article
of the county's health realignment amount of that same fiscal year,
multiplied by the county's health realignment amount of all
subsequent years.
   (b) Starting with the 2014-15 fiscal year, the department shall
calculate an interim redirected amount for each county under
subdivision (a) by the January immediately prior to the starting
fiscal year, using the most recent and accurate data available. For
purposes of the interim determinations, the cost containment limit
shall not be applied. The interim redirected amount shall be updated
in the May before the start of the fiscal year in consultation with
each county and based on any more recent and accurate data available
at that time. During the fiscal year, the interim redirected amount
will be applied pursuant to Section 17613.1.
   (c) The predetermined amounts or historical percentages described
in subdivisions (i), (m), and (n) of Section 17613.2 shall each be
established in accordance with the following procedure:
   (1) By September 30, 2013, each county shall determine the amount
or percentage described in the applicable subdivision, and shall
provide this calculation to the department, supported by verifiable
data and a description of how the determination was made.
   (2) If the department disagrees with the county's determination,
the department shall confer with the county by November 15, 2013.
   (3) If no agreement between the parties has been reached by
December 31, 2013, the department shall apply the county's
determination when making the interim calculations pursuant to
subdivision (b), until a decision is issued pursuant to paragraph
(6).
   (4) A county may submit a petition to the County Health Care
Funding Resolution Committee, established pursuant to Section
17600.60, to seek a decision regarding the historical percentage or
amount to be applied in calculations under this section.
   (5) The County Health Care Funding Resolution Committee shall hear
and make a determination as to whether the county's proposed
percentage or amount complies with the requirements of this section
based on the data and calculations of the county and any alternative
data and calculations submitted by the department.
   (6) The County Health Care Funding Resolution Committee shall
issue a decision within 45 days of the petition. If the county
chooses to contest the determination, the decision of the committee
will be applied for purposes of any interim calculation under
subdivision (b) until a final decision is issued pursuant to de novo
administrative review under paragraph (2) of subdivision (d).
   (d) (1) The data for the final calculations under subdivision (a)
for the fiscal year shall be submitted by counties within 12 months
after the conclusion of each fiscal year as required in Section
17613.4. The data shall be the most recent and accurate data from the
county's books and records pertaining to the revenues paid or
payable, and the costs incurred, for services provided in the subject
fiscal year. The department shall make final calculations using the
data submitted pursuant to this paragraph by December 31 of the
following fiscal year, and shall provide the calculation to the
county. The final calculations will also reflect the application of
the cost containment limit, if any. A recalculation and
reconciliation shall be completed by the department within six months
thereafter.
   (2) The Director of Health Care Services shall establish an
expedited formal appeal process for a county to contest the
determinations made in this article, and only as follows:
   (A) The county shall have 30 calendar days, following the issuance
of a determination made under this article, to file an appeal with
the director. All appeals shall be governed by Section 100171 of the
Health and Safety Code, except for those provisions of paragraph (1)
of subdivision (d) of Section 100171 of the Health and Safety Code
relating to accusations, statements of issues, statement to
respondent, and notice of defense, and except as otherwise set forth
in this section. All appeals shall be in writing and shall be filed
with the State Department of Health Care Service's Office of
Administrative Hearings and Appeals. An appeal shall be deemed filed
on the date it is received by the Office of Administrative Hearings
and Appeals.
   (i) An appeal shall specifically set forth each issue in dispute,
including, but not limited to, any component of the determination,
and include the county's contentions as to those issues. A formal
hearing before an Office of Administrative Hearings and Appeals
Administrative Law Judge shall commence within 45 days of the filing
of the appeal requesting a formal hearing. A final decision shall be
adopted within 60 days of the close of the record, but no later than
five months following the issuance of the appeal.
   (ii) If the county fails to file an appeal within 30 days of the
issuance of a determination made under this article, the
determination of the department shall be deemed final and not
appealable either administratively or to a court of general
jurisdiction.
   (B) If a final decision is not issued by the department within two
years of the issuance of a determination made under this article,
the county shall be deemed to have exhausted its administrative
remedies, and shall not be precluded from pursuing any available
judicial review. However, the time period in this subdivision shall
be extended by either of the following:
   (i) Undue delay caused by the county.
   (ii) An extension of time granted to a county at its sole request,
or following the joint request of the county and the department.
   (C) If the final decision issued by the department pursuant to
this section results in a different determination than that
originally made by the department, then the Department of Finance
shall adjust the original determination by that amount, pursuant to a
process developed by the Department of Finance and in consultation
with the California State Association of Counties.
   17613.4.  (a) Beginning with the 2013-14 fiscal year, each county
that has elected to participate in the County Savings Determination
Process shall, within five months after the end of each fiscal year,
be required to submit initial reports on both of the following:
   (1) All revenue data required for the operation of Section
17613.3, including both of the following:
   (A) Indigent program revenues.
   (B) Special local health funds.
   (2) All cost data required for the operation of Section 17613.3,
including indigent program costs.
   (b) Counties shall submit final reports of cost and revenue data
identified in subdivision (a) to the department for the each fiscal
year no later than June 30 of the fiscal year ending one year after
the subject fiscal year.
   (c) The department shall develop, in consultation with California
State Association of Counties, the methodologies used to determine
the costs and revenues required to be reported and the format of the
submissions.
   (d) Reports submitted under this section shall be accompanied by a
certification by an appropriate public official attesting to the
accuracy of the reports.
   (e) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department, without taking any further regulatory action, shall
implement, interpret, or make specific this section by means of
all-county letters, plan letters, plan or provider bulletins, or
similar instructions.
  SEC. 22.  (a) The Department of Finance, the State Department of
Health Care Services, the State Department of Social Services, and
the Controller, in consultation with the California State Association
of Counties, shall collaborate to implement Sections 17600.15,
17600.50, 17601.75, 17603, 17604, 17606.10, 17610, and 17611 of the
Welfare and Institutions Code, as added and amended by this act, to
further the intent of the Legislature.
   (b) If a county or city and county is unable to meet its immediate
fiscal obligations for health programs due to cashflow issues
stemming from changes in allocations from the Health Subaccount, the
Department of Finance shall work with the California State
Association of Counties and the affected county or city and county to
implement procedures regarding the allocations to address those
cashflow issues.
  SEC. 23.  (a) It is the intent of the Legislature that if the
federal government enacts a reform to federal immigration laws that
results in the provision of a pathway to citizenship for otherwise
undocumented persons, and the federal law does not provide for
federal financial participation for nonemergency Medi-Cal services to
those persons or federal funding for advanced premium tax credits
through the California Health Benefit Exchange, the formulas in
Section 17600.50 of the Welfare and Institutions Code shall be
reviewed.
   (b) In order to assist the Legislature in carrying out its intent,
if the federal government enacts a reform to federal immigration
laws that results in the provision of a pathway to citizenship for
otherwise undocumented persons, and the federal law does not provide
for federal financial participation for nonemergency Medi-Cal
services to those persons or federal funding
                      for advanced premium tax credits through the
California Health Benefit Exchange, the State Department of Health
Care Services shall analyze the potential impacts on county health
care expenditures related to this population and report to the
applicable fiscal and policy committees within 90 days of the federal
enactment, or by March 1 of the following year, whichever date is
later.
  SEC. 24.  If the Commission on State Mandates determines that this
act contains costs mandated by the state, reimbursement to local
agencies and school districts for those costs shall be made pursuant
to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of
the Government Code.
  SEC. 25.  This act is a bill providing for appropriations related
to the Budget Bill within the meaning of subdivision (e) of Section
12 of Article IV of the California Constitution, has been identified
as related to the budget in the Budget Bill, and shall take effect
immediately.
                 
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