Bill Text: CA SB1465 | 2013-2014 | Regular Session | Chaptered
Bill Title: Health.
Spectrum: Moderate Partisan Bill (Democrat 7-2)
Status: (Passed) 2014-09-18 - Chaptered by Secretary of State. Chapter 442, Statutes of 2014. [SB1465 Detail]
Download: California-2013-SB1465-Chaptered.html
BILL NUMBER: SB 1465 CHAPTERED
BILL TEXT
CHAPTER 442
FILED WITH SECRETARY OF STATE SEPTEMBER 18, 2014
APPROVED BY GOVERNOR SEPTEMBER 18, 2014
PASSED THE SENATE AUGUST 21, 2014
PASSED THE ASSEMBLY AUGUST 19, 2014
AMENDED IN ASSEMBLY AUGUST 4, 2014
AMENDED IN ASSEMBLY JUNE 11, 2014
INTRODUCED BY Committee on Health (Senators Hernandez (Chair),
Beall, De León, DeSaulnier, Evans, Monning, Morrell, Nielsen, and
Wolk)
MARCH 20, 2014
An act to amend Sections 8880.5, 14670.3, and 14670.5 of the
Government Code, to amend Sections 1728.7, 1797.98b, 127665, and
128225.5 of the Health and Safety Code, to amend and renumber Section
10961 of the Insurance Code, to amend Sections 308, 667.5, and 3000
of the Penal Code, to amend Section 2356 of the Probate Code, and to
amend Sections 736, 5328.15, 6600, 6601, 6608.7, 6609, 9717, 10600.1,
10725, 14043.26, 14087.36, 14105.192, 14124.5, 14169.51, 14169.52,
14169.53, 14169.55, 14169.56, 14169.58, 14169.59, 14169.61, 14169.63,
14169.65, 14169.66, 14169.72, 14312, 14451, 15657.8, and 16541 of
the Welfare and Institutions Code, relating to health, and declaring
the urgency thereof, to take effect immediately.
LEGISLATIVE COUNSEL'S DIGEST
SB 1465, Committee on Health. Health.
(1) Existing law prohibits any private or public organization,
political subdivision of the state, or other government agency within
the state from providing or arranging for skilled nursing services
to patients in the home without first obtaining a home health agency
license, as defined, from the State Department of Public Health.
Existing law establishes the requirements for licensure as a home
health agency. Existing law requires the department to license a home
health agency that, among other things, is accredited by the Joint
Commission on Accreditation of Healthcare Organizations or the
Community Health Accreditation Program and the accrediting
organization forwards to the department certain information.
For purposes of licensure, the bill would instead require a home
health agency to be accredited by an entity approved by the federal
Centers for Medicare and Medicaid Services as a national
accreditation organization.
(2) Existing law authorizes each county to establish an Emergency
Medical Services Fund for reimbursement of costs related to emergency
medical services. Existing law requires each county establishing a
fund to, on January 1, 1989, and each April 15 thereafter, report to
the Legislature on the implementation and status of the Emergency
Medical Services Fund, as specified.
This bill would instead require each county to submit its reports
to the Emergency Medical Services Authority. The bill would require
the authority to compile and forward a summary of each county's
report to the appropriate policy and fiscal committees of the
Legislature.
(3) Existing law, until June 30, 2015, requests the University of
California to establish the California Health Benefit Review Program
to assess legislation proposing to mandate a benefit or service or to
repeal a mandated benefit or service, and to prepare a written
analysis with relevant data on specified areas, including public
health impacts, medical impacts, and financial impacts.
This bill would extend the repeal date of the above provisions to
December 31, 2015.
(4) Existing law requires, until January 1, 2018, and subject to
the appropriation of funds in the Budget Act of 2014, the Director of
Statewide Health Planning and Development to select and contract on
behalf of the state with accredited primary care or family medicine
residency programs for the purpose of providing grants to support
newly created residency positions, and requires the California
Healthcare Workforce Policy Commission to review and make
recommendations to the director concerning the provision of those
grants. Existing law requires the commission, in making these
recommendations, to give priority to residency programs that
demonstrate, among other things, that the new primary care physician
residency positions have been, or will be, approved by the
Accreditation Council for Graduate Medical Education prior to the
first distribution of grant funds.
This bill would include primary care physician residency positions
that have been, or will be, approved by the American Osteopathic
Association in the above-described prioritization provision.
(5) Existing law creates the California Health Benefit Exchange
for the purpose of facilitating the enrollment of qualified
individuals and small employers in qualified health plans. Existing
law requires the Exchange to enter into contracts with and certify as
a qualified health plan bridge plan products that meet specified
requirements. Existing law provides for the regulation of health
insurers by the Department of Insurance and defines a bridge plan
product to include an individual health benefit plan offered by a
health insurer. Existing law requires, until 5 years after federal
approval of bridge plan products, a health insurer selling a bridge
plan product to provide specified enrollment periods and to maintain
a medical loss ratio of 85% for the product. Existing law specifies
that the remaining provisions of the chapter of law to which these
requirements regarding bridge plan products were added became
inoperative on January 1, 2014.
This bill would relocate those requirements regarding bridge plan
products to a different chapter of law and make other technical,
nonsubstantive changes.
(6) Existing law, the Stop Tobacco Access to Kids Enforcement
(STAKE) Act, prohibits a minor from purchasing, receiving, or
possessing tobacco products or paraphernalia. Existing law prohibits
a retailer from knowingly or under circumstances in which it has
knowledge, or should otherwise have grounds for knowledge, selling,
giving, or in any way furnishing a minor with tobacco products or
paraphernalia. Existing law exempts a minor from prosecution for that
purchase, receipt, or possession while the minor is participating in
a random, onsite sting inspection conducted by the State Department
of Public Health as part of its enforcement responsibilities.
This bill would also exempt a minor from prosecution under that
act while the minor is participating in an activity conducted by the
State Department of Public Health, a local health department, or a
law enforcement agency for the purpose of determining or evaluating
youth tobacco purchase rates.
(7) Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which qualified low-income individuals receive health care services.
The Medi-Cal program is, in part, governed and funded by federal
Medicaid Program provisions. Existing law requires an applicant or
provider, as defined, to submit a complete application package for
enrollment, continuing enrollment, or enrollment at a new location or
a change in location. Existing law generally requires the department
to give written notice as to the status of an application to an
applicant or provider within 180 days after receiving an application
package, or from the date of notifying an applicant or provider that
he or she does not qualify as a preferred provider, notifying the
applicant or provider if specified circumstances apply, or, on the
181st day, to grant provisional provider status to the applicant or
provider. Existing law requires the department to send a notice as to
the status of an application to an applicant or provider within 60
days after receiving an application package that was noticed as
incomplete, was resubmitted with all requested information and
documentation, and was received by the department within 60 days of
the date on the notice, notifying the applicant or provider if
specified circumstances apply.
This bill would, except as specified, authorize an applicant or
provider to request to withdraw an application package submitted
pursuant to these provisions, and would require the department to
notify the applicant or provider, in both above-described notices, if
the application package is withdrawn by request of the applicant or
provider and the department's review is canceled.
(8) Under existing law, one of the methods by which Medi-Cal
services are provided is pursuant to various models of managed care.
In this regard, existing law authorizes the City and County of San
Francisco to establish a health authority to be the local initiative
component of the managed care model in that city and county. Existing
law requires that the governing board of the health authority
consist of 18 voting members, 2 of which are required to be nominated
by the beneficiary committee established by the health authority to
advise the authority on issues of concern to the recipients of
services. Existing law requires that at least one of the 2 persons
nominated by the beneficiary committee be a Medi-Cal beneficiary.
This bill would instead require the health authority to establish
a member advisory committee to advise the authority on issues of
concern to the recipients of services and would delete the
requirement that one of the 2 persons nominated by the committee be a
Medi-Cal beneficiary. The bill would instead require the 2 persons
nominated by the committee to be enrolled in a health care program
operated by the health authority, as specified, or be the parent or
legal guardian of an enrollee.
(9) Existing law authorizes the Director of Health Care Services
to administer laws pertaining to the administration of health care
services and medical assistance throughout the state by, among other
things, adopting regulations pursuant to the provisions of the
Administrative Procedure Act to enable the department to carry out
the purposes and intent of the Medi-Cal Act.
This bill would correct obsolete cross-references to the
Administrative Procedure Act in these provisions, and would make
other technical, nonsubstantive changes.
(10) Existing law, subject to federal approval, imposes a hospital
quality assurance fee, as specified, on certain general acute care
hospitals, to be deposited into the Hospital Quality Assurance
Revenue Fund. Existing law, subject to federal approval, requires
that moneys in the Hospital Quality Assurance Revenue Fund be
continuously appropriated during the first program period of January
1, 2014, to December 31, 2016, inclusive, and available only for
certain purposes, including paying for health care coverage for
children, as specified, and making supplemental payments for certain
services to private hospitals and increased capitation payments to
Medi-Cal managed care plans. Existing law also requires the payment
of direct grants to designated and nondesignated public hospitals in
support of health care expenditures funded by the quality assurance
fee for the first program period. For subsequent program periods,
existing law authorizes the payment of direct grants for designated
and nondesignated public hospitals and requires that the moneys in
the Hospital Quality Assurance Revenue Fund be used for the
above-described purposes upon appropriation by the Legislature in the
annual Budget Act.
This bill would define the term "fund" to mean the Hospital
Quality Assurance Revenue Fund for the purposes of these provisions
and would make other technical, conforming changes to these
provisions.
(11) Existing law provides for state hospitals for the care,
treatment, and education of mentally disordered persons, which are
under the jurisdiction of the State Department of State Hospitals.
This bill would make technical, nonsubstantive changes to various
provisions of law to, in part, delete obsolete references to the
State Department of Mental Health. The bill would also make other
technical, nonsubstantive changes.
(12) This bill would declare that it is to take effect immediately
as an urgency statute.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 8880.5 of the Government Code is amended to
read:
8880.5. Allocations for education:
The California State Lottery Education Fund is created within the
State Treasury, and is continuously appropriated for carrying out the
purposes of this chapter. The Controller shall draw warrants on this
fund and distribute them quarterly in the following manner, provided
that the payments specified in subdivisions (a) to (g), inclusive,
shall be equal per capita amounts.
(a) (1) Payments shall be made directly to public school
districts, including county superintendents of schools, serving
kindergarten and grades 1 to 12, inclusive, or any part thereof, on
the basis of an equal amount for each unit of average daily
attendance, as defined by law and adjusted pursuant to subdivision (
l ).
(2) For purposes of this paragraph, in each of the 2008-09,
2009-10, 2010-11, 2011-12, 2012-13, 2013-14, and 2014-15 fiscal
years, the number of units of average daily attendance in each of
those fiscal years for programs for public school districts,
including county superintendents of schools, serving kindergarten and
grades 1 to 12, inclusive, shall include the same amount of average
daily attendance for classes for adults and regional occupational
centers and programs used in the calculation made pursuant to this
subdivision for the 2007-08 fiscal year.
(b) Payments shall also be made directly to public school
districts serving community colleges, on the basis of an equal amount
for each unit of average daily attendance, as defined by law.
(c) Payments shall also be made directly to the Board of Trustees
of the California State University on the basis of an amount for each
unit of equivalent full-time enrollment. Funds received by the
trustees shall be deposited in and expended from the California State
University Lottery Education Fund, which is hereby created or, at
the discretion of the trustees, deposited in local trust accounts in
accordance with subdivision (j) of Section 89721 of the Education
Code.
(d) Payments shall also be made directly to the Regents of the
University of California on the basis of an amount for each unit of
equivalent full-time enrollment.
(e) Payments shall also be made directly to the Board of Directors
of the Hastings College of the Law on the basis of an amount for
each unit of equivalent full-time enrollment.
(f) Payments shall also be made directly to the Department of the
Youth Authority for educational programs serving kindergarten and
grades 1 to 12, inclusive, or any part thereof, on the basis of an
equal amount for each unit of average daily attendance, as defined by
law.
(g) Payments shall also be made directly to the two California
Schools for the Deaf, the California School for the Blind, and the
three Diagnostic Schools for Neurologically Handicapped Children, on
the basis of an amount for each unit of equivalent full-time
enrollment.
(h) Payments shall also be made directly to the State Department
of Developmental Services and the State Department of State Hospitals
for clients with developmental or mental disabilities who are
enrolled in state hospital education programs, including
developmental centers, on the basis of an equal amount for each unit
of average daily attendance, as defined by law.
(i) No Budget Act or other statutory provision shall direct that
payments for public education made pursuant to this chapter be used
for purposes and programs (including workload adjustments and
maintenance of the level of service) authorized by Chapters 498, 565,
and 1302 of the Statutes of 1983, Chapter 97 or 258 of the Statutes
of 1984, or Chapter 1 of the Statutes of the 1983-84 Second
Extraordinary Session.
(j) School districts and other agencies receiving funds
distributed pursuant to this chapter may at their option utilize
funds allocated by this chapter to provide additional funds for those
purposes and programs prescribed by subdivision (i) for the purpose
of enrichment or expansion.
(k) As a condition of receiving any moneys pursuant to subdivision
(a) or (b), each school district and county superintendent of
schools shall establish a separate account for the receipt and
expenditure of those moneys, which account shall be clearly
identified as a lottery education account.
( l ) Commencing with the 1998-99 fiscal year, and each
year thereafter, for purposes of subdivision (a), average daily
attendance shall be increased by the statewide average rate of
excused absences for the 1996-97 fiscal year as determined pursuant
to the provisions of Chapter 855 of the Statutes of 1997. The
statewide average excused absence rate, and the corresponding
adjustment factor required for the operation of this subdivision,
shall be certified to the Controller by the Superintendent of Public
Instruction.
(m) It is the intent of this chapter that all funds allocated from
the California State Lottery Education Fund shall be used
exclusively for the education of pupils and students and no funds
shall be spent for acquisition of real property, construction of
facilities, financing of research, or any other noninstructional
purpose.
SEC. 2. Section 14670.3 of the Government Code is amended to read:
14670.3. Notwithstanding Section 14670, the Director of General
Services, with the consent of the State Department of Developmental
Services, may let to a nonprofit corporation, for the purpose of
conducting an educational and work program for persons with
intellectual disabilities, and for a period not to exceed 55 years,
real property not exceeding five acres located within the grounds of
the Fairview State Hospital.
The lease authorized by this section shall be nonassignable and
shall be subject to periodic review every five years. The review
shall be made by the Director of General Services, who shall do both
of the following:
(a) Ensure the state that the original purposes of the lease are
being carried out.
(b) Determine what, if any, adjustment should be made in the terms
of the lease.
The lease shall also provide for an initial capital outlay by the
lessee of thirty thousand dollars ($30,000) prior to January 1, 1976.
The capital outlay may be, or may have been, contributed before or
after the effective date of the act adding this section.
SEC. 3. Section 14670.5 of the Government Code is amended to read:
14670.5. Notwithstanding Section 14670, the Director of General
Services, with the consent of the State Department of Developmental
Services may let to a nonprofit corporation, for the purpose of
establishing and maintaining a rehabilitation center for persons with
intellectual disabilities, for a period not exceeding 20 years, real
property, not exceeding five acres, located within the grounds of
the Fairview State Hospital in Orange County, and that is retained by
the state primarily to provide a peripheral buffer area, or zone,
between real property that the state hospital is located on and
adjacent real property, if the director deems the letting is in the
best interests of the state.
SEC. 4. Section 1728.7 of the Health and Safety Code is amended to
read:
1728.7. (a) Notwithstanding any other provision of this chapter,
the department shall issue a license to a home health agency that
applies to the department for a home health agency license and meets
all of the following requirements:
(1) Is accredited as a home health agency by an entity approved
by the federal Centers for Medicare and Medicaid Services as a
national accreditation organization, and the national accreditation
organization forwards to the department copies of all initial and
subsequent survey and other accreditation reports or findings.
(2) Files an application with fees pursuant to this chapter.
(3) Meets any other additional licensure requirements of, or
regulations adopted pursuant to, this chapter that the department
identifies, after consulting with the national accreditation
organizations, as more stringent than the accreditation requirements
of the national accreditation organizations.
(b) The department may require a survey of an accredited home
health agency to ensure the accreditation requirements are met. These
surveys shall be conducted using a selective sample basis.
(c) The department may require a survey of an accredited home
health agency to investigate complaints against an accredited home
health agency for substantial noncompliance, as determined by the
department, with these accreditation standards.
(d) Notwithstanding subdivisions (a), (b), and (c), the
department shall retain its full range of authority over accredited
home health agencies to ensure the licensure and accreditation
requirements are met. This authority shall include the entire scope
of enforcement sanctions and options available for unaccredited home
health agencies.
SEC. 5. Section 1797.98b of the Health and Safety Code is amended
to read:
1797.98b. (a) Each county establishing a fund, on January 1,
1989, and on each April 15 thereafter, shall report to the authority
on the implementation and status of the Emergency Medical Services
Fund. Notwithstanding Section 10231.5 of the Government Code, the
authority shall compile and forward a summary of each county's report
to the appropriate policy and fiscal committees of the Legislature.
Each county report, and the summary compiled by the authority, shall
cover the immediately preceding fiscal year, and shall include, but
not be limited to, all of the following:
(1) The total amount of fines and forfeitures collected, the
total amount of penalty assessments collected, and the total amount
of penalty assessments deposited into the Emergency Medical Services
Fund, or, if no moneys were deposited into the fund, the reason or
reasons for the lack of deposits. The total amounts of penalty
assessments shall be listed on the basis of each statute that
provides the authority for the penalty assessment, including Sections
76000, 76000.5, and 76104 of the Government Code, and Section 42007
of the Vehicle Code.
(2) The amount of penalty assessment funds collected under Section
76000.5 of the Government Code that are used for the purposes of
subdivision (e) of Section 1797.98a.
(3) The fund balance and the amount of moneys disbursed under the
program to physicians and surgeons, for hospitals, and for other
emergency medical services purposes, and the amount of money
disbursed for actual administrative costs. If funds were disbursed
for other emergency medical services, the report shall provide a
description of each of those services.
(4) The number of claims paid to physicians and surgeons, and the
percentage of claims paid, based on the uniform fee schedule, as
adopted by the county.
(5) The amount of moneys available to be disbursed to physicians
and surgeons, descriptions of the physician and surgeon claims
payment methodologies, the dollar amount of the total allowable
claims submitted, and the percentage at which those claims were
reimbursed.
(6) A statement of the policies, procedures, and regulatory action
taken to implement and run the program under this chapter.
(7) The name of the physician and surgeon and hospital
administrator organization, or names of specific physicians and
surgeons and hospital administrators, contacted to review claims
payment methodologies.
(8) A description of the process used to solicit input from
physicians and surgeons and hospitals to review payment distribution
methodology as described in subdivision (a) of Section 1797.98e.
(9) An identification of the fee schedule used by the county
pursuant to subdivision (e) of Section 1797.98c.
(10) (A) A description of the methodology used to disburse moneys
to hospitals pursuant to subparagraph (B) of paragraph (5) of
subdivision (b) of Section 1797.98a.
(B) The amount of moneys available to be disbursed to hospitals.
(C) If moneys are disbursed to hospitals on a claims basis, the
dollar amount of the total allowable claims submitted and the
percentage at which those claims were reimbursed to hospitals.
(11) The name and contact information of the entity responsible
for each of the following:
(A) Collection of fines, forfeitures, and penalties.
(B) Distribution of penalty assessments into the Emergency Medical
Services Fund.
(C) Distribution of moneys to physicians and surgeons.
(b) (1) Each county, upon request, shall make available to any
member of the public the report provided to the authority under
subdivision (a).
(2) Each county, upon request, shall make available to any member
of the public a listing of physicians and surgeons and hospitals that
have received reimbursement from the Emergency Medical Services Fund
and the amount of the reimbursement they have received. This listing
shall be compiled on a semiannual basis.
SEC. 6. Section 127665 of the Health and Safety Code is amended to
read:
127665. This chapter shall remain in effect until December 31,
2015, and shall be repealed as of that date, unless a later enacted
statute that becomes operative on or before December 31, 2015,
deletes or extends that date.
SEC. 7. Section 128225.5 of the Health and Safety Code is amended
to read:
128225.5. (a) The commission shall review and make
recommendations to the Director of the Office of Statewide Health
Planning and Development concerning the provision of grants pursuant
to this section. In making recommendations, the commission shall give
priority to residency programs that demonstrate all of the
following:
(1) That the grant will be used to support new primary care
physician slots.
(2) That priority in filling the position shall be given to
physicians who have graduated from a California-based medical school.
(3) That the new primary care physician residency positions have
been, or will be, approved by the Accreditation Council for Graduate
Medical Education or the American Osteopathic Association prior to
the first distribution of grant funds.
(b) The director shall do both of the following:
(1) Determine whether the residency programs recommended by the
commission meet the standards established by this section.
(2) Select and contract on behalf of the state with accredited
primary care or family medicine residency programs for the purpose of
providing grants for the support of newly created residency
positions.
(c) This section does not apply to funding appropriated in the
annual Budget Act for the Song-Brown Health Care Workforce Training
Act (Article 1 (commencing with Section 128200)).
(d) This section shall be operative only if funds are appropriated
in the Budget Act of 2014 for the purposes described in this
section.
(e) This section shall remain in effect only until January 1,
2018, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2018, deletes or extends
that date.
SEC. 8. Section 10961 of the Insurance Code is amended and
renumbered to read:
10965.18. (a) For purposes of this chapter, a bridge plan product
shall mean an individual health benefit plan that is offered by a
health insurer licensed under this part that contracts with the
Exchange pursuant to Title 22 (commencing with Section 100500) of the
Government Code.
(b) On and after September 30, 2013, if a health insurance policy
has not been filed with the commissioner, a health insurer that
contracts with the Exchange to offer a qualified bridge plan product
pursuant to Section 100504.5 of the Government Code shall file the
policy form with the commissioner pursuant to Section 10290.
(c) (1) Notwithstanding subdivision (a) of Section 10965.3, a
health insurer selling a bridge plan product shall not be required to
fairly and affirmatively offer, market, and sell the health insurer'
s bridge plan product except to individuals eligible for the bridge
plan product pursuant to the State Department of Health Care Services
and the Medi-Cal managed care plan's contract entered into pursuant
to Section 14005.70 of the Welfare and Institutions Code, provided
the health care service plan meets the requirements of subdivision
(b) of Section 14005.70 of the Welfare and Institutions Code.
(2) Notwithstanding subdivision (c) of Section 10965.3, a health
insurer selling a bridge plan product shall provide an initial open
enrollment period of six months, and an annual enrollment period and
a special enrollment period consistent with the annual enrollment and
special enrollment periods of the Exchange.
(d) A health insurer that contracts with the Exchange to offer a
qualified bridge plan product pursuant to Section 100504.5 of the
Government Code shall maintain a medical loss ratio of 85 percent for
the bridge plan product. A health insurer shall utilize, to the
extent possible, the same methodology for calculating the medical
loss ratio for the bridge plan product that is used for calculating
the health insurer's medical loss ratio pursuant to Section 10112.25
and shall report its medical loss ratio for the bridge plan product
to the department as provided in Section 10112.25.
(e) This section shall become inoperative on the October 1 that is
five years after the date that federal approval of the bridge plan
option occurs, and, as of the second January 1 thereafter, is
repealed, unless a later enacted statute that is enacted before that
date deletes or extends the dates on which it becomes inoperative and
is repealed.
SEC. 9. Section 308 of the Penal Code is amended to read:
308. (a) (1) Every person, firm, or corporation that knowingly or
under circumstances in which it has knowledge, or should otherwise
have grounds for knowledge, sells, gives, or in any way furnishes to
another person who is under the age of 18 years any tobacco,
cigarette, or cigarette papers, or blunts wraps, or any other
preparation of tobacco, or any other instrument or paraphernalia that
is designed for the smoking or ingestion of tobacco, products
prepared from tobacco, or any controlled substance, is subject to
either a criminal action for a misdemeanor or to a civil action
brought by a city attorney, a county counsel, or a district attorney,
punishable by a fine of two hundred dollars ($200) for the first
offense, five hundred dollars ($500) for the second offense, and one
thousand dollars ($1,000) for the third offense.
Notwithstanding Section 1464 or any other law, 25 percent of each
civil and criminal penalty collected pursuant to this subdivision
shall be paid to the office of the city attorney, county counsel, or
district attorney, whoever is responsible for bringing the successful
action, and 25 percent of each civil and criminal penalty collected
pursuant to this subdivision shall be paid to the city or county for
the administration and cost of the community service work component
provided in subdivision (b).
Proof that a defendant, or his or her employee or agent, demanded,
was shown, and reasonably relied upon evidence of majority shall be
defense to any action brought pursuant to this subdivision. Evidence
of majority of a person is a facsimile of or a reasonable likeness of
a document issued by a federal, state, county, or municipal
government, or subdivision or agency thereof, including, but not
limited to, a motor vehicle operator's license, a registration
certificate issued under the federal Selective Service Act, or an
identification card issued to a member of the Armed Forces.
For purposes of this section, the person liable for selling or
furnishing tobacco products to minors by a tobacco vending machine
shall be the person authorizing the installation or placement of the
tobacco vending machine upon premises he or she manages or otherwise
controls and under circumstances in which he or she has knowledge, or
should otherwise have grounds for knowledge, that the tobacco
vending machine will be utilized by minors.
(2) For purposes of this section, "blunt wraps" means cigar papers
or cigar wrappers of all types that are designed for smoking or
ingestion of tobacco products and contain less than 50 percent
tobacco.
(b) Every person under the age of 18 years who purchases,
receives, or possesses any tobacco, cigarette, or cigarette papers,
or any other preparation of tobacco, or any other instrument or
paraphernalia that is designed for the smoking of tobacco, products
prepared from tobacco, or any controlled substance shall, upon
conviction, be punished by a fine of seventy-five dollars ($75) or 30
hours of community service work.
(c) Every person, firm, or corporation that sells, or deals in
tobacco or any preparation thereof, shall post conspicuously and keep
so posted in his, her, or their place of business at each point of
purchase the notice required pursuant to subdivision (b) of Section
22952 of the Business and Professions Code, and any person failing to
do so shall, upon conviction, be punished by a fine of fifty dollars
($50) for the first offense, one hundred dollars ($100) for the
second offense, two hundred fifty dollars ($250) for the third
offense, and five hundred dollars ($500) for the fourth offense and
each subsequent violation of this provision, or by imprisonment in a
county jail not exceeding 30 days.
(d) For purposes of determining the liability of persons, firms,
or corporations controlling franchises or business operations in
multiple locations for the second and subsequent violations of this
section, each individual franchise or business location shall be
deemed a separate entity.
(e) Notwithstanding subdivision (b), any person under 18 years of
age who purchases, receives, or possesses any tobacco, cigarette, or
cigarette papers, or any other preparation of tobacco, any other
instrument or paraphernalia that is designed for the smoking of
tobacco, or products prepared from tobacco is immune from prosecution
for that purchase, receipt, or possession while participating in
either of the following:
(1) An enforcement activity that complies with the guidelines
adopted pursuant to subdivisions (c) and (d) of Section 22952 of the
Business and Professions Code.
(2) An activity conducted by the State Department of Public
Health, a local health department, or a law enforcement agency for
the purpose of determining or evaluating youth tobacco purchase
rates.
(f) It is the Legislature's intent to regulate the subject matter
of this section. As a result, a city, county, or city and county
shall not adopt any ordinance or regulation inconsistent with this
section.
SEC. 10. Section 667.5 of the Penal Code is amended to read:
667.5. Enhancement of prison terms for new offenses because of
prior prison terms shall be imposed as follows:
(a) Where one of the new offenses is one of the violent felonies
specified in subdivision (c), in addition to and consecutive to any
other prison terms therefor, the court shall impose a three-year term
for each prior separate prison term served by the defendant where
the prior offense was one of the violent felonies specified in
subdivision (c). However, no additional term shall be imposed under
this subdivision for any prison term served prior to a period of 10
years in which the defendant remained free of both prison custody and
the commission of an offense which results in a felony conviction.
(b) Except where subdivision (a) applies, where the new offense is
any felony for which a prison sentence or a sentence of imprisonment
in a county jail under subdivision (h) of Section 1170 is imposed or
is not suspended, in addition and consecutive to any other sentence
therefor, the court shall impose a one-year term for each prior
separate prison term or county jail term imposed under subdivision
(h) of Section 1170 or when sentence is not suspended for any felony;
provided that no additional term shall be imposed under this
subdivision for any prison term or county jail term imposed under
subdivision (h) of Section 1170 or when sentence is not suspended
prior to a period of five years in which the defendant remained free
of both the commission of an offense which results in a felony
conviction, and prison custody or the imposition of a term of jail
custody imposed under subdivision (h) of Section 1170 or any felony
sentence that is not suspended. A term imposed under the provisions
of paragraph (5) of subdivision (h) of Section 1170, wherein a
portion of the term is suspended by the court to allow mandatory
supervision, shall qualify as a prior county jail term for the
purposes of the one-year enhancement.
(c) For the purpose of this section, "violent felony" shall mean
any of the following:
(1) Murder or voluntary manslaughter.
(2) Mayhem.
(3) Rape as defined in paragraph (2) or (6) of subdivision (a) of
Section 261 or paragraph (1) or (4) of subdivision (a) of Section
262.
(4) Sodomy as defined in subdivision (c) or (d) of Section 286.
(5) Oral copulation as defined in subdivision (c) or (d) of
Section 288a.
(6) Lewd or lascivious act as defined in subdivision (a) or (b) of
Section 288.
(7) Any felony punishable by death or imprisonment in the state
prison for life.
(8) Any felony in which the defendant inflicts great bodily injury
on any person other than an accomplice which has been charged and
proved as provided for in Section 12022.7, 12022.8, or 12022.9 on or
after July 1, 1977, or as specified prior to July 1, 1977, in
Sections 213, 264, and 461, or any felony in which the defendant uses
a firearm which use has been charged and proved as provided in
subdivision (a) of Section 12022.3, or Section 12022.5 or 12022.55.
(9) Any robbery.
(10) Arson, in violation of subdivision (a) or (b) of Section 451.
(11) Sexual penetration as defined in subdivision (a) or (j) of
Section 289.
(12) Attempted murder.
(13) A violation of Section 18745, 18750, or 18755.
(14) Kidnapping.
(15) Assault with the intent to commit a specified felony, in
violation of Section 220.
(16) Continuous sexual abuse of a child, in violation of Section
288.5.
(17) Carjacking, as defined in subdivision (a) of Section 215.
(18) Rape, spousal rape, or sexual penetration, in concert, in
violation of Section 264.1.
(19) Extortion, as defined in Section 518, which would constitute
a felony violation of Section 186.22.
(20) Threats to victims or witnesses, as defined in Section 136.1,
which would constitute a felony violation of Section 186.22.
(21) Any burglary of the first degree, as defined in subdivision
(a) of Section 460, wherein it is charged and proved that another
person, other than an accomplice, was present in the residence during
the commission of the burglary.
(22) Any violation of Section 12022.53.
(23) A violation of subdivision (b) or (c) of Section 11418. The
Legislature finds and declares that these specified crimes merit
special consideration when imposing a sentence to display society's
condemnation for these extraordinary crimes of violence against the
person.
(d) For the purposes of this section, the defendant shall be
deemed to remain in prison custody for an offense until the official
discharge from custody, including any period of mandatory
supervision, or until release on parole or postrelease community
supervision, whichever first occurs, including any time during which
the defendant remains subject to reimprisonment or custody in county
jail for escape from custody or is reimprisoned on revocation of
parole or postrelease community supervision. The additional penalties
provided for prior prison terms shall not be imposed unless they are
charged and admitted or found true in the action for the new
offense.
(e) The additional penalties provided for prior prison terms shall
not be imposed for any felony for which the defendant did not serve
a prior separate term in state prison or in county jail under
subdivision (h) of Section 1170.
(f) A prior conviction of a felony shall include a conviction in
another jurisdiction for an offense which, if committed in
California, is punishable by imprisonment in the state prison or in
county jail under subdivision (h) of Section 1170 if the defendant
served one year or more in prison for the offense in the other
jurisdiction. A prior conviction of a particular felony shall include
a conviction in another jurisdiction for an offense which includes
all of the elements of the particular felony as defined under
California law if the defendant served one year or more in prison for
the offense in the other jurisdiction.
(g) A prior separate prison term for the purposes of this section
shall mean a continuous completed period of prison incarceration
imposed for the particular offense alone or in combination with
concurrent or consecutive sentences for other crimes, including any
reimprisonment on revocation of parole which is not accompanied by a
new commitment to prison, and including any reimprisonment after an
escape from incarceration.
(h) Serving a prison term includes any confinement time in any
state prison or federal penal institution as punishment for
commission of an offense, including confinement in a hospital or
other institution or facility credited as service of prison time in
the jurisdiction of the confinement.
(i) For the purposes of this section, a commitment to the State
Department of Mental Health, or its successor the State Department of
State Hospitals, as a mentally disordered sex offender following a
conviction of a felony, which commitment exceeds one year in
duration, shall be deemed a prior prison term.
(j) For the purposes of this section, when a person subject to the
custody, control, and discipline of the Secretary of the Department
of Corrections and Rehabilitation is incarcerated at a facility
operated by the Division of Juvenile Justice, that incarceration
shall be deemed to be a term served in state prison.
(k) (1) Notwithstanding subdivisions (d) and (g) or any other
provision of law, where one of the new offenses is committed while
the defendant is temporarily removed from prison pursuant to Section
2690 or while the defendant is transferred to a community facility
pursuant to Section 3416, 6253, or 6263, or while the defendant is on
furlough pursuant to Section 6254, the defendant shall be subject to
the full enhancements provided for in this section.
(2) This subdivision shall not apply when a full, separate, and
consecutive term is imposed pursuant to any other provision of law.
SEC. 11. Section 3000 of the Penal Code is amended to read:
3000. (a) (1) The Legislature finds and declares that the period
immediately following incarceration is critical to successful
reintegration of the offender into society and to positive
citizenship. It is in the interest of public safety for the state to
provide for the effective supervision of and surveillance of
parolees, including the judicious use of revocation actions, and to
provide educational, vocational, family, and personal counseling
necessary to assist parolees in the transition between imprisonment
and discharge. A sentence resulting in imprisonment in the state
prison pursuant to Section 1168 or 1170 shall include a period of
parole supervision or postrelease community supervision, unless
waived, or as otherwise provided in this article.
(2) The Legislature finds and declares that it is not the intent
of this section to diminish resources allocated to the Department of
Corrections and Rehabilitation for parole functions for which the
department is responsible. It is also not the intent of this section
to diminish the resources allocated to the Board of Parole Hearings
to execute its duties with respect to parole functions for which the
board is responsible.
(3) The Legislature finds and declares that diligent effort must
be made to ensure that parolees are held accountable for their
criminal behavior, including, but not limited to, the satisfaction of
restitution fines and orders.
(4) For any person subject to a sexually violent predator
proceeding pursuant to Article 4 (commencing with Section 6600) of
Chapter 2 of Part 2 of Division 6 of the Welfare and Institutions
Code, an order issued by a judge pursuant to Section 6601.5 of the
Welfare and Institutions Code, finding that the petition, on its
face, supports a finding of probable cause to believe that the
individual named in the petition is likely to engage in sexually
violent predatory criminal behavior upon his or her release, shall
toll the period of parole of that person, from the date that person
is released by the Department of Corrections and Rehabilitation as
follows:
(A) If the person is committed to the State Department of State
Hospitals as a sexually violent predator and subsequently a court
orders that the person be unconditionally discharged, the parole
period shall be tolled until the date the judge enters the order
unconditionally discharging that person.
(B) If the person is not committed to the State Department of
State Hospitals as a sexually violent predator, the tolling of the
parole period shall be abrogated and the parole period shall be
deemed to have commenced on the date of release from the Department
of Corrections and Rehabilitation.
(5) Paragraph (4) applies to persons released by the Department of
Corrections and Rehabilitation on or after January 1, 2012. Persons
released by the Department of Corrections and Rehabilitation prior to
January 1, 2012, shall continue to be subject to the law governing
the tolling of parole in effect on December 31, 2011.
(b) Notwithstanding any provision to the contrary in Article 3
(commencing with Section 3040) of this chapter, the following shall
apply to any inmate subject to Section 3000.08:
(1) In the case of any inmate sentenced under Section 1168 for a
crime committed prior to July 1, 2013, the period of parole shall not
exceed five years in the case of an inmate imprisoned for any
offense other than first or second degree murder for which the inmate
has received a life sentence, and shall not exceed three years in
the case of any other inmate, unless in either case the Board of
Parole Hearings for good cause waives parole and discharges the
inmate from custody of the department. This subdivision shall also be
applicable to inmates who committed crimes prior to July 1, 1977, to
the extent specified in Section 1170.2. In the case of any inmate
sentenced under Section 1168 for a crime committed on or after July
1, 2013, the period of parole shall not exceed five years in the case
of an inmate imprisoned for any offense other than first or second
degree murder for which the inmate has received a life sentence, and
shall not exceed three years in the case of any other inmate, unless
in either case the department for good cause waives parole and
discharges the inmate from custody of the department.
(2) (A) For a crime committed prior to July 1, 2013, at the
expiration of a term of imprisonment of one year and one day, or a
term of imprisonment imposed pursuant to Section 1170 or at the
expiration of a term reduced pursuant to Section 2931 or 2933, if
applicable, the inmate shall be released on parole for a period not
exceeding three years, except that any inmate sentenced for an
offense specified in paragraph (3), (4), (5), (6), (11), or (18) of
subdivision (c) of Section 667.5 shall be released on parole for a
period not exceeding 10 years, unless a longer period of parole is
specified in Section 3000.1.
(B) For a crime committed on or after July 1, 2013, at the
expiration of a term of imprisonment of one year and one day, or a
term of imprisonment imposed pursuant to Section 1170 or at the
expiration of a term reduced pursuant to Section 2931 or 2933, if
applicable, the inmate shall be released on parole for a period of
three years, except that any inmate sentenced for an offense
specified in paragraph (3), (4), (5), (6), (11), or (18) of
subdivision (c) of Section 667.5 shall be released on parole for a
period of 10 years, unless a longer period of parole is specified in
Section 3000.1.
(3) Notwithstanding paragraphs (1) and (2), in the case of any
offense for which the inmate has received a life sentence pursuant to
subdivision (b) of Section 209, with the intent to commit a
specified sex offense, or Section 667.51, 667.61, or 667.71, the
period of parole shall be 10 years, unless a longer period of parole
is specified in Section 3000.1.
(4) (A) Notwithstanding paragraphs (1) to (3), inclusive, in the
case of a person convicted of and required to register as a sex
offender for the commission of an offense specified in Section 261,
262, 264.1, 286, 288a, paragraph (1) of subdivision (b) of Section
288, Section 288.5, or 289, in which one or more of the victims of
the offense was a child under 14 years of age, the period of parole
shall be 20 years and six months unless the board, for good cause,
determines that the person will be retained on parole. The board
shall make a written record of this determination and transmit a copy
of it to the parolee.
(B) In the event of a retention on parole, the parolee shall be
entitled to a review by the board each year thereafter.
(C) There shall be a board hearing consistent with the procedures
set forth in Sections 3041.5 and 3041.7 within 12 months of the date
of any revocation of parole to consider the release of the inmate on
parole, and notwithstanding the provisions of paragraph (3) of
subdivision (b) of Section 3041.5, there shall be annual parole
consideration hearings thereafter, unless the person is released or
otherwise ineligible for parole release. The panel or board shall
release the person within one year of the date of the revocation
unless it determines that the circumstances and gravity of the parole
violation are such that consideration of the public safety requires
a more lengthy period of incarceration or unless there is a new
prison commitment following a conviction.
(D) The provisions of Section 3042 shall not apply to any hearing
held pursuant to this subdivision.
(5) (A) The Board of Parole Hearings shall consider the request of
any inmate whose commitment offense occurred prior to July 1, 2013,
regarding the length of his or her parole and the conditions thereof.
(B) For an inmate whose commitment offense occurred on or after
July 1, 2013, except for those inmates described in Section 3000.1,
the department shall consider the request of the inmate regarding the
length of his or her parole and the conditions thereof. For those
inmates described in Section 3000.1, the Board of Parole Hearings
shall consider the request of the inmate regarding the length of his
or her parole and the conditions thereof.
(6) Upon successful completion of parole, or at the end of the
maximum statutory period of parole specified for the inmate under
paragraph (1), (2), (3), or (4), as the case may be, whichever is
earlier, the inmate shall be discharged from custody. The date of the
maximum statutory period of parole under this subdivision and
paragraphs (1), (2), (3), and (4) shall be computed from the date of
initial parole and shall be a period chronologically determined. Time
during which parole is suspended because the prisoner has absconded
or has been returned to custody as a parole violator shall not be
credited toward any period of parole unless the prisoner is found not
guilty of the parole violation. However, the period of parole is
subject to the following:
(A) Except as provided in Section 3064, in no case may a prisoner
subject to three years on parole be retained under parole supervision
or in custody for a period longer than four years from the date of
his or her initial parole.
(B) Except as provided in Section 3064, in no case may a prisoner
subject to five years on parole be retained under parole supervision
or in custody for a period longer than seven years from the date of
his or her initial parole.
(C) Except as provided in Section 3064, in no case may a prisoner
subject to 10 years on parole be retained under parole supervision or
in custody for a period longer than 15 years from the date of his or
her initial parole.
(7) The Department of Corrections and Rehabilitation shall meet
with each inmate at least 30 days prior to his or her good time
release date and shall provide, under guidelines specified by the
parole authority or the department, whichever is applicable, the
conditions of parole and the length of parole up to the maximum
period of time provided by law. The inmate has the right to
reconsideration of the length of parole and conditions thereof by the
department or the parole authority, whichever is applicable. The
Department of Corrections and Rehabilitation or the board may impose
as a condition of parole that a prisoner make payments on the
prisoner's outstanding restitution fines or orders imposed pursuant
to subdivision (a) or (c) of Section 13967 of the Government Code, as
operative prior to September 28, 1994, or subdivision (b) or (f) of
Section 1202.4.
(8) For purposes of this chapter, and except as otherwise
described in this section, the board shall be considered the parole
authority.
(9) (A) On and after July 1, 2013, the sole authority to issue
warrants for the return to actual custody of any state prisoner
released on parole rests with the court pursuant to Section 1203.2,
except for any escaped state prisoner or any state prisoner released
prior to his or her scheduled release date who should be returned to
custody, and Section 5054.1 shall apply.
(B) Notwithstanding subparagraph (A), any warrant issued by the
Board of Parole Hearings prior to July 1, 2013, shall remain in full
force and effect until the warrant is served or it is recalled by the
board. All prisoners on parole arrested pursuant to a warrant issued
by the board shall be subject to a review by the board prior to the
department filing a petition with the court to revoke the parole of
the petitioner.
(10) It is the intent of the Legislature that efforts be made with
respect to persons who are subject to Section 290.011 who are on
parole to engage them in treatment.
SEC. 12. Section 2356 of the Probate Code is amended to read:
2356. (a) No ward or conservatee may be placed in a mental health
treatment facility under this division against the will of the ward
or conservatee. Involuntary civil placement of a ward or conservatee
in a mental health treatment facility may be obtained only pursuant
to Chapter 2 (commencing with Section 5150) or Chapter 3 (commencing
with Section 5350) of Part 1 of Division 5 of the Welfare and
Institutions Code. Nothing in this subdivision precludes the placing
of a ward in a state hospital under Section 6000 of the Welfare and
Institutions Code upon application of the guardian as provided in
that section. The Director of State Hospitals shall adopt and issue
regulations defining "mental health treatment facility" for the
purposes of this subdivision.
(b) No experimental drug as defined in Section 111515 of the
Health and Safety Code may be prescribed for or administered to a
ward or conservatee under this division. Such an experimental drug
may be prescribed for or administered to a ward or conservatee only
as provided in Article 4 (commencing with Section 111515) of Chapter
6 of Part 5 of Division 104 of the Health and Safety Code.
(c) No convulsive treatment as defined in Section 5325 of the
Welfare and Institutions Code may be performed on a ward or
conservatee under this division. Convulsive treatment may be
performed on a ward or conservatee only as provided in Article 7
(commencing with Section 5325) of Chapter 2 of Part 1 of Division 5
of the Welfare and Institutions Code.
(d) No minor may be sterilized under this division.
(e) This chapter is subject to a valid and effective advance
health care directive under the Health Care Decisions Law (Division
4.7 (commencing with Section 4600)).
SEC. 13. Section 736 of the Welfare and Institutions Code is
amended to read:
736. (a) Except as provided in Section 733, the Department of
Corrections and Rehabilitation, Division of Juvenile Facilities,
shall accept a ward committed to it pursuant to this article if the
Director of the Division of Juvenile Justice believes that the ward
can be materially benefited by the division's reformatory and
educational discipline, and if the division has adequate facilities,
staff, and programs to provide that care. A ward subject to this
section shall not be transported to any facility under the
jurisdiction of the division until the superintendent of the facility
has notified the committing court of the place to which that ward is
to be transported and the time at which he or she can be received.
(b) To determine who is best served by the Division of Juvenile
Facilities, and who would be better served by the State Department of
State Hospitals, the Director of the Division of Juvenile Justice
and the Director of State Hospitals shall, at least annually, confer
and establish policy with respect to the types of cases that should
be the responsibility of each department.
SEC. 14. Section 5328.15 of the Welfare and Institutions Code is
amended to read:
5328.15. All information and records obtained in the course of
providing services under Division 5 (commencing with Section 5000),
Division 6 (commencing with Section 6000), or Division 7 (commencing
with Section 7000), to either voluntary or involuntary recipients of
services shall be confidential. Information and records may be
disclosed, however, notwithstanding any other provision of law, as
follows:
(a) To authorized licensing personnel who are employed by, or who
are authorized representatives of, the State Department of Public
Health, and who are licensed or registered health professionals, and
to authorized legal staff or special investigators who are peace
officers who are employed by, or who are authorized representatives
of the State Department of Social Services, as necessary to the
performance of their duties to inspect, license, and investigate
health facilities and community care facilities and to ensure that
the standards of care and services provided in such facilities are
adequate and appropriate and to ascertain compliance with the rules
and regulations to which the facility is subject. The confidential
information shall remain confidential except for purposes of
inspection, licensing, or investigation pursuant to Chapter 2
(commencing with Section 1250) of, and Chapter 3 (commencing with
Section 1500) of, Division 2 of the Health and Safety Code, or a
criminal, civil, or administrative proceeding in relation thereto.
The confidential information may be used by the State Department of
Public Health or the State Department of Social Services in a
criminal, civil, or administrative proceeding. The confidential
information shall be available only to the judge or hearing officer
and to the parties to the case. Names which are confidential shall be
listed in attachments separate to the general pleadings. The
confidential information shall be sealed after the conclusion of the
criminal, civil, or administrative hearings, and shall not
subsequently be released except in accordance with this subdivision.
If the confidential information does not result in a criminal, civil,
or administrative proceeding, it shall be sealed after the State
Department of Public Health or the State Department of Social
Services decides that no further action will be taken in the matter
of suspected licensing violations. Except as otherwise provided in
this subdivision, confidential information in the possession of the
State Department of Public Health or the State Department of Social
Services shall not contain the name of the patient.
(b) To any board which licenses and certifies professionals in the
fields of mental health pursuant to state law, when the Director of
State Hospitals has reasonable cause to believe that there has
occurred a violation of any provision of law subject to the
jurisdiction of that board and the records are relevant to the
violation. This information shall be sealed after a decision is
reached in the matter of the suspected violation, and shall not
subsequently be released except in accordance with this subdivision.
Confidential information in the possession of the board shall not
contain the name of the patient.
(c) To a protection and advocacy agency established pursuant to
Section 4901, to the extent that the information is incorporated
within any of the following:
(1) An unredacted facility evaluation report form or an unredacted
complaint investigation report form of the State Department of
Social Services. This information shall remain confidential and
subject to the confidentiality requirements of subdivision (f) of
Section 4903.
(2) An unredacted citation report, unredacted licensing report,
unredacted survey report, unredacted plan of correction, or
unredacted statement of deficiency of the State Department of Public
Health, prepared by authorized licensing personnel or authorized
representatives described in subdivision (n). This information shall
remain confidential and subject to the confidentiality requirements
of subdivision (f) of Section 4903.
SEC. 15. Section 6600 of the Welfare and Institutions Code is
amended to read:
6600. As used in this article, the following terms have the
following meanings:
(a) (1) "Sexually violent predator" means a person who has been
convicted of a sexually violent offense against one or more victims
and who has a diagnosed mental disorder that makes the person a
danger to the health and safety of others in that it is likely that
he or she will engage in sexually violent criminal behavior.
(2) For purposes of this subdivision any of the following shall be
considered a conviction for a sexually violent offense:
(A) A prior or current conviction that resulted in a determinate
prison sentence for an offense described in subdivision (b).
(B) A conviction for an offense described in subdivision (b) that
was committed prior to July 1, 1977, and that resulted in an
indeterminate prison sentence.
(C) A prior conviction in another jurisdiction for an offense that
includes all of the elements of an offense described in subdivision
(b).
(D) A conviction for an offense under a predecessor statute that
includes all of the elements of an offense described in subdivision
(b).
(E) A prior conviction for which the inmate received a grant of
probation for an offense described in subdivision (b).
(F) A prior finding of not guilty by reason of insanity for an
offense described in subdivision (b).
(G) A conviction resulting in a finding that the person was a
mentally disordered sex offender.
(H) A prior conviction for an offense described in subdivision (b)
for which the person was committed to the Division of Juvenile
Facilities, Department of Corrections and Rehabilitation pursuant to
Section 1731.5.
(I) A prior conviction for an offense described in subdivision (b)
that resulted in an indeterminate prison sentence.
(3) Conviction of one or more of the crimes enumerated in this
section shall constitute evidence that may support a court or jury
determination that a person is a sexually violent predator, but shall
not be the sole basis for the determination. The existence of any
prior convictions may be shown with documentary evidence. The details
underlying the commission of an offense that led to a prior
conviction, including a predatory relationship with the victim, may
be shown by documentary evidence, including, but not limited to,
preliminary hearing transcripts, trial transcripts, probation and
sentencing reports, and evaluations by the State Department of State
Hospitals. Jurors shall be admonished that they may not find a person
a sexually violent predator based on prior offenses absent relevant
evidence of a currently diagnosed mental disorder that makes the
person a danger to the health and safety of others in that it is
likely that he or she will engage in sexually violent criminal
behavior.
(4) The provisions of this section shall apply to any person
against whom proceedings were initiated for commitment as a sexually
violent predator on or after January 1, 1996.
(b) "Sexually violent offense" means the following acts when
committed by force, violence, duress, menace, fear of immediate and
unlawful bodily injury on the victim or another person, or
threatening to retaliate in the future against the victim or any
other person, and that are committed on, before, or after the
effective date of this article and result in a conviction or a
finding of not guilty by reason of insanity, as defined in
subdivision (a): a felony violation of Section 261, 262, 264.1, 269,
286, 288, 288a, 288.5, or 289 of the Penal Code, or any felony
violation of Section 207, 209, or 220 of the Penal Code, committed
with the intent to commit a violation of Section 261, 262, 264.1,
286, 288, 288a, or 289 of the Penal Code.
(c) "Diagnosed mental disorder" includes a congenital or acquired
condition affecting the emotional or volitional capacity that
predisposes the person to the commission of criminal sexual acts in a
degree constituting the person a menace to the health and safety of
others.
(d) "Danger to the health and safety of others" does not require
proof of a recent overt act while the offender is in custody.
(e) "Predatory" means an act is directed toward a
stranger, a person of casual acquaintance with whom no substantial
relationship exists, or an individual with whom a relationship has
been established or promoted for the primary purpose of
victimization.
(f) "Recent overt act" means any criminal act that manifests a
likelihood that the actor may engage in sexually violent predatory
criminal behavior.
(g) Notwithstanding any other provision of law and for purposes of
this section, a prior juvenile adjudication of a sexually violent
offense may constitute a prior conviction for which the person
received a determinate term if all of the following apply:
(1) The juvenile was 16 years of age or older at the time he or
she committed the prior offense.
(2) The prior offense is a sexually violent offense as specified
in subdivision (b).
(3) The juvenile was adjudged a ward of the juvenile court within
the meaning of Section 602 because of the person's commission of the
offense giving rise to the juvenile court adjudication.
(4) The juvenile was committed to the Division of Juvenile
Facilities, Department of Corrections and Rehabilitation for the
sexually violent offense.
(h) A minor adjudged a ward of the court for commission of an
offense that is defined as a sexually violent offense shall be
entitled to specific treatment as a sexual offender. The failure of a
minor to receive that treatment shall not constitute a defense or
bar to a determination that any person is a sexually violent predator
within the meaning of this article.
SEC. 16. Section 6601 of the Welfare and Institutions Code is
amended to read:
6601. (a) (1) Whenever the Secretary of the Department of
Corrections and Rehabilitation determines that an individual who is
in custody under the jurisdiction of the Department of Corrections
and Rehabilitation, and who is either serving a determinate prison
sentence or whose parole has been revoked, may be a sexually violent
predator, the secretary shall, at least six months prior to that
individual's scheduled date for release from prison, refer the person
for evaluation in accordance with this section. However, if the
inmate was received by the department with less than nine months of
his or her sentence to serve, or if the inmate's release date is
modified by judicial or administrative action, the secretary may
refer the person for evaluation in accordance with this section at a
date that is less than six months prior to the inmate's scheduled
release date.
(2) A petition may be filed under this section if the individual
was in custody pursuant to his or her determinate prison term, parole
revocation term, or a hold placed pursuant to Section 6601.3, at the
time the petition is filed. A petition shall not be dismissed on the
basis of a later judicial or administrative determination that the
individual's custody was unlawful, if the unlawful custody was the
result of a good faith mistake of fact or law. This paragraph shall
apply to any petition filed on or after January 1, 1996.
(b) The person shall be screened by the Department of Corrections
and Rehabilitation and the Board of Parole Hearings based on whether
the person has committed a sexually violent predatory offense and on
a review of the person's social, criminal, and institutional history.
This screening shall be conducted in accordance with a structured
screening instrument developed and updated by the State Department of
State Hospitals in consultation with the Department of Corrections
and Rehabilitation. If as a result of this screening it is determined
that the person is likely to be a sexually violent predator, the
Department of Corrections and Rehabilitation shall refer the person
to the State Department of State Hospitals for a full evaluation of
whether the person meets the criteria in Section 6600.
(c) The State Department of State Hospitals shall evaluate the
person in accordance with a standardized assessment protocol,
developed and updated by the State Department of State Hospitals, to
determine whether the person is a sexually violent predator as
defined in this article. The standardized assessment protocol shall
require assessment of diagnosable mental disorders, as well as
various factors known to be associated with the risk of reoffense
among sex offenders. Risk factors to be considered shall include
criminal and psychosexual history, type, degree, and duration of
sexual deviance, and severity of mental disorder.
(d) Pursuant to subdivision (c), the person shall be evaluated by
two practicing psychiatrists or psychologists, or one practicing
psychiatrist and one practicing psychologist, designated by the
Director of State Hospitals. If both evaluators concur that the
person has a diagnosed mental disorder so that he or she is likely to
engage in acts of sexual violence without appropriate treatment and
custody, the Director of State Hospitals shall forward a request for
a petition for commitment under Section 6602 to the county designated
in subdivision (i). Copies of the evaluation reports and any other
supporting documents shall be made available to the attorney
designated by the county pursuant to subdivision (i) who may file a
petition for commitment.
(e) If one of the professionals performing the evaluation pursuant
to subdivision (d) does not concur that the person meets the
criteria specified in subdivision (d), but the other professional
concludes that the person meets those criteria, the Director of State
Hospitals shall arrange for further examination of the person by two
independent professionals selected in accordance with subdivision
(g).
(f) If an examination by independent professionals pursuant to
subdivision (e) is conducted, a petition to request commitment under
this article shall only be filed if both independent professionals
who evaluate the person pursuant to subdivision (e) concur that the
person meets the criteria for commitment specified in subdivision
(d). The professionals selected to evaluate the person pursuant to
subdivision (g) shall inform the person that the purpose of their
examination is not treatment but to determine if the person meets
certain criteria to be involuntarily committed pursuant to this
article. It is not required that the person appreciate or understand
that information.
(g) Any independent professional who is designated by the
Secretary of the Department of Corrections and Rehabilitation or the
Director of State Hospitals for purposes of this section shall not be
a state government employee, shall have at least five years of
experience in the diagnosis and treatment of mental disorders, and
shall include psychiatrists and licensed psychologists who have a
doctoral degree in psychology. The requirements set forth in this
section also shall apply to any professionals appointed by the court
to evaluate the person for purposes of any other proceedings under
this article.
(h) If the State Department of State Hospitals determines that the
person is a sexually violent predator as defined in this article,
the Director of State Hospitals shall forward a request for a
petition to be filed for commitment under this article to the county
designated in subdivision (i). Copies of the evaluation reports and
any other supporting documents shall be made available to the
attorney designated by the county pursuant to subdivision (i) who may
file a petition for commitment in the superior court.
(i) If the county's designated counsel concurs with the
recommendation, a petition for commitment shall be filed in the
superior court of the county in which the person was convicted of the
offense for which he or she was committed to the jurisdiction of the
Department of Corrections and Rehabilitation. The petition shall be
filed, and the proceedings shall be handled, by either the district
attorney or the county counsel of that county. The county board of
supervisors shall designate either the district attorney or the
county counsel to assume responsibility for proceedings under this
article.
(j) The time limits set forth in this section shall not apply
during the first year that this article is operative.
(k) An order issued by a judge pursuant to Section 6601.5, finding
that the petition, on its face, supports a finding of probable cause
to believe that the individual named in the petition is likely to
engage in sexually violent predatory criminal behavior upon his or
her release, shall toll that person's parole pursuant to paragraph
(4) of subdivision (a) of Section 3000 of the Penal Code, if that
individual is determined to be a sexually violent predator.
(l) Pursuant to subdivision (d), the attorney designated by the
county pursuant to subdivision (i) shall notify the State Department
of State Hospitals of its decision regarding the filing of a petition
for commitment within 15 days of making that decision.
(m) This section shall become operative on the date that the
director executes a declaration, which shall be provided to the
fiscal and policy committees of the Legislature, including the
Chairperson of the Joint Legislative Budget Committee, and the
Department of Finance, specifying that sufficient qualified state
employees have been hired to conduct the evaluations required
pursuant to subdivision (d), or January 1, 2013, whichever occurs
first.
SEC. 17. Section 6608.7 of the Welfare and Institutions Code is
amended to read:
6608.7. The State Department of State Hospitals may enter into an
interagency agreement or contract with the Department of Corrections
and Rehabilitation or with local law enforcement agencies for
services related to supervision or monitoring of sexually violent
predators who have been conditionally released into the community
under the forensic conditional release program pursuant to this
article.
SEC. 18. Section 6609 of the Welfare and Institutions Code is
amended to read:
6609. Within 10 days of a request made by the chief of police of
a city or the sheriff of a county, the State Department of State
Hospitals shall provide the following information concerning each
person committed as a sexually violent predator who is receiving
outpatient care in a conditional release program in that city or
county: name, address, date of commitment, county from which
committed, date of placement in the conditional release program,
fingerprints, and a glossy photograph no smaller than 31/8 × 31/8
inches in size, or clear copies of the fingerprints and photograph.
SEC. 19. Section 9717 of the Welfare and Institutions Code is
amended to read:
9717. (a) All advocacy programs and any programs similar in
nature to the Long-Term Care Ombudsman Program that receive funding
or official designation from the state shall cooperate with the
office, where appropriate. These programs include, but are not
limited to, the Office of Human Rights within the State Department of
State Hospitals, the Office of Patients' Rights, Disability Rights
California, and the Department of Rehabilitation's Client Assistance
Program.
(b) The office shall maintain a close working relationship with
the Legal Services Development Program for the Elderly within the
department.
(c) In order to ensure the provision of counsel for patients and
residents of long-term care facilities, the office shall seek to
establish effective coordination with programs that provide legal
services for the elderly, including, but not limited to, programs
that are funded by the federal Legal Services Corporation or under
the federal Older Americans Act (42 U.S.C. Sec. 3001 et seq.), as
amended.
(d) The department and other state departments and programs that
have roles in funding, regulating, monitoring, or serving long-term
care facility residents, including law enforcement agencies, shall
cooperate with and meet with the office periodically and as needed to
address concerns or questions involving the care, quality of life,
safety, rights, health, and well-being of long-term care facility
residents.
SEC. 20. Section 10600.1 of the Welfare and Institutions Code is
amended to read:
10600.1. (a) The State Department of Social Services succeeds to
and is vested with the duties, purposes, responsibilities, and
jurisdiction exercised by the State Department of Health or the State
Department of Benefit Payments pursuant to the provisions of this
division, except those contained in Chapter 7 (commencing with
Section 14000), Chapter 8 (commencing with Section 14200), Chapter
8.5 (commencing with Section 14500), and Chapter 8.7 (commencing with
Section 14520) of Part 3, on the date immediately prior to the date
this section becomes operative.
(b) The State Department of Social Services also succeeds to and
is vested with the duties, purposes, responsibilities, and
jurisdiction heretofore exercised by the State Department of Health
with respect to its disability determination function performed
pursuant to Titles II and XVI of the federal Social Security Act;
provided, however, that this paragraph shall not vest in the State
Department of Social Services any power or authority over programs
for aid or rehabilitation of mentally disordered or developmentally
disabled persons administered by the State Department of State
Hospitals or the State Department of Developmental Services.
SEC. 21. Section 10725 of the Welfare and Institutions Code is
amended to read:
10725. The director may adopt regulations, orders, or standards
of general application to implement, interpret, or make specific the
law enforced by the department, and those regulations, orders, and
standards shall be adopted, amended, or repealed by the director only
in accordance with Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code. Regulations
relating to services need not be printed in the California Code of
Regulations or the California Regulatory Notice Register if they are
included in the publications of the department. This authority also
may be exercised by the director's designee.
In adopting regulations the director shall strive for clarity of
language that may be readily understood by those administering
services or subject to those regulations.
The rules of the department need not specify or include the detail
of forms, reports, or records, but shall include the essential
authority by which any person, agency, organization, association, or
institution subject to the supervision or investigation of the
department is required to use, submit, or maintain those forms,
reports, or records.
SEC. 22. Section 14043.26 of the Welfare and Institutions Code is
amended to read:
14043.26. (a) (1) On and after January 1, 2004, an applicant that
currently is not enrolled in the Medi-Cal program, or a provider
applying for continued enrollment, upon written notification from the
department that enrollment for continued participation of all
providers in a specific provider of service category or subgroup of
that category to which the provider belongs will occur, or, except as
provided in subdivisions (b) and (e), a provider not currently
enrolled at a location where the provider intends to provide
services, goods, supplies, or merchandise to a Medi-Cal beneficiary,
shall submit a complete application package for enrollment,
continuing enrollment, or enrollment at a new location or a change in
location.
(2) Clinics licensed by the department pursuant to Chapter 1
(commencing with Section 1200) of Division 2 of the Health and Safety
Code and certified by the department to participate in the Medi-Cal
program shall not be subject to this section.
(3) Health facilities licensed by the department pursuant to
Chapter 2 (commencing with Section 1250) of Division 2 of the Health
and Safety Code and certified by the department to participate in the
Medi-Cal program shall not be subject to this section.
(4) Adult day health care providers licensed pursuant to Chapter
3.3 (commencing with Section 1570) of Division 2 of the Health and
Safety Code and certified by the department to participate in the
Medi-Cal program shall not be subject to this section.
(5) Home health agencies licensed pursuant to Chapter 8
(commencing with Section 1725) of Division 2 of the Health and Safety
Code and certified by the department to participate in the Medi-Cal
program shall not be subject to this section.
(6) Hospices licensed pursuant to Chapter 8.5 (commencing with
Section 1745) of Division 2 of the Health and Safety Code and
certified by the department to participate in the Medi-Cal program
shall not be subject to this section.
(b) A physician and surgeon licensed by the Medical Board of
California or the Osteopathic Medical Board of California, or a
dentist licensed by the Dental Board of California, practicing as an
individual physician practice or as an individual dentist practice,
as defined in Section 14043.1, who is enrolled and in good standing
in the Medi-Cal program, and who is changing locations of that
individual physician practice or individual dentist practice within
the same county, shall be eligible to continue enrollment at the new
location by filing a change of location form to be developed by the
department. The form shall comply with all minimum federal
requirements related to Medicaid provider enrollment. Filing this
form shall be in lieu of submitting a complete application package
pursuant to subdivision (a).
(c) (1) Except as provided in paragraph (2), within 30 days after
receiving an application package submitted pursuant to subdivision
(a), the department shall provide written notice that the application
package has been received and, if applicable, that there is a
moratorium on the enrollment of providers in the specific provider of
service category or subgroup of the category to which the applicant
or provider belongs. This moratorium shall bar further processing of
the application package.
(2) Within 15 days after receiving an application package from a
physician, or a group of physicians, licensed by the Medical Board of
California or the Osteopathic Medical Board of California, or a
change of location form pursuant to subdivision (b), the department
shall provide written notice that the application package or the
change of location form has been received.
(d) (1) If the application package submitted pursuant to
subdivision (a) is from an applicant or provider who meets the
criteria listed in paragraph (2), the applicant or provider shall be
considered a preferred provider and shall be granted preferred
provisional provider status pursuant to this section and for a period
of no longer than 18 months, effective from the date on the notice
from the department. The ability to request consideration as a
preferred provider and the criteria necessary for the consideration
shall be publicized to all applicants and providers. An applicant or
provider who desires consideration as a preferred provider pursuant
to this subdivision shall request consideration from the department
by making a notation to that effect on the application package, by
cover letter, or by other means identified by the department in a
provider bulletin. Request for consideration as a preferred provider
shall be made with each application package submitted in order for
the department to grant the consideration. An applicant or provider
who requests consideration as a preferred provider shall be notified
within 60 days whether the applicant or provider meets or does not
meet the criteria listed in paragraph (2). If an applicant or
provider is notified that the applicant or provider does not meet the
criteria for a preferred provider, the application package submitted
shall be processed in accordance with the remainder of this section.
(2) To be considered a preferred provider, the applicant or
provider shall meet all of the following criteria:
(A) Hold a current license as a physician and surgeon issued by
the Medical Board of California or the Osteopathic Medical Board of
California, which license shall not have been revoked, whether stayed
or not, suspended, placed on probation, or subject to other
limitation.
(B) Be a current faculty member of a teaching hospital or a
children's hospital, as defined in Section 10727, accredited by the
Joint Commission or the American Osteopathic Association, or be
credentialed by a health care service plan that is licensed under the
Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2
(commencing with Section 1340) of Division 2 of the Health and Safety
Code) or county organized health system, or be a current member in
good standing of a group that is credentialed by a health care
service plan that is licensed under the Knox-Keene Act.
(C) Have full, current, unrevoked, and unsuspended privileges at a
Joint Commission or American Osteopathic Association accredited
general acute care hospital.
(D) Not have any adverse entries in the federal Healthcare
Integrity and Protection Data Bank.
(3) The department may recognize other providers as qualifying as
preferred providers if criteria similar to those set forth in
paragraph (2) are identified for the other providers. The department
shall consult with interested parties and appropriate stakeholders to
identify similar criteria for other providers so that they may be
considered as preferred providers.
(e) (1) If a Medi-Cal applicant meets the criteria listed in
paragraph (2), the applicant shall be enrolled in the Medi-Cal
program after submission and review of a short form application to be
developed by the department. The form shall comply with all minimum
federal requirements related to Medicaid provider enrollment. The
department shall notify the applicant that the department has
received the application within 15 days of receipt of the
application. The department shall enroll the applicant or notify the
applicant that the applicant does not meet the criteria listed in
paragraph (2) within 90 days of receipt of the application.
(2) Notwithstanding any other provision of law, an applicant or
provider who meets all of the following criteria shall be eligible
for enrollment in the Medi-Cal program pursuant to this subdivision,
after submission and review of a short form application:
(A) The applicant's or provider's practice is based in one or more
of the following: a general acute care hospital, a rural general
acute care hospital, or an acute psychiatric hospital, as defined in
subdivisions (a) and (b) of Section 1250 of the Health and Safety
Code.
(B) The applicant or provider holds a current, unrevoked, or
unsuspended license as a physician and surgeon issued by the Medical
Board of California or the Osteopathic Medical Board of California.
An applicant or provider shall not be in compliance with this
subparagraph if a license revocation has been stayed, the licensee
has been placed on probation, or the license is subject to any other
limitation.
(C) The applicant or provider does not have an adverse entry in
the federal Healthcare Integrity and Protection Data Bank.
(3) An applicant shall be granted provisional provider status
under this subdivision for a period of 12 months.
(f) Except as provided in subdivision (g), within 180 days after
receiving an application package submitted pursuant to subdivision
(a), or from the date of the notice to an applicant or provider that
the applicant or provider does not qualify as a preferred provider
under subdivision (d), the department shall give written notice to
the applicant or provider that any of the following applies, or shall
on the 181st day grant the applicant or provider provisional
provider status pursuant to this section for a period no longer than
12 months, effective from the 181st day:
(1) The applicant or provider is being granted provisional
provider status for a period of 12 months, effective from the date on
the notice.
(2) The application package is incomplete. The notice shall
identify additional information or documentation that is needed to
complete the application package.
(3) The department is exercising its authority under Section
14043.37, 14043.4, or 14043.7, and is conducting background checks,
preenrollment inspections, or unannounced visits.
(4) The application package is denied for any of the following
reasons:
(A) Pursuant to Section 14043.2 or 14043.36.
(B) For lack of a license necessary to perform the health care
services or to provide the goods, supplies, or merchandise directly
or indirectly to a Medi-Cal beneficiary, within the applicable
provider of service category or subgroup of that category.
(C) The period of time during which an applicant or provider has
been barred from reapplying has not passed.
(D) For other stated reasons authorized by law.
(E) For failing to submit fingerprints as required by federal
Medicaid regulations.
(F) For failing to pay an application fee as required by federal
Medicaid regulations.
(5) The application package is withdrawn by request of the
applicant or provider and the department's review is canceled
pursuant to subdivision (n).
(g) Notwithstanding subdivision (f), within 90 days after
receiving an application package submitted pursuant to subdivision
(a) from a physician or physician group licensed by the Medical Board
of California or the Osteopathic Medical Board of California, or
from the date of the notice to that physician or physician group that
does not qualify as a preferred provider under subdivision (d), or
within 90 days after receiving a change of location form submitted
pursuant to subdivision (b), the department shall give written notice
to the applicant or provider that either paragraph (1), (2), (3),
(4), or (5) of subdivision (f) applies, or shall on the 91st day
grant the applicant or provider provisional provider status pursuant
to this section for a period no longer than 12 months, effective from
the 91st day.
(h) (1) If the application package that was noticed as incomplete
under paragraph (2) of subdivision (f) is resubmitted with all
requested information and documentation, and received by the
department within 60 days of the date on the notice, the department
shall, within 60 days of the resubmission, send a notice that any of
the following applies:
(A) The applicant or provider is being granted provisional
provider status for a period of 12 months, effective from the date on
the notice.
(B) The application package is denied for any other reasons
provided for in paragraph (4) of subdivision (f).
(C) The department is exercising its authority under Section
14043.37, 14043.4, or 14043.7 to conduct background checks,
preenrollment inspections, or unannounced visits.
(D) The application package is withdrawn by request of the
applicant or provider and the department's review is canceled
pursuant to subdivision (n).
(2) (A) If the application package that was noticed as incomplete
under paragraph (2) of subdivision (f) is not resubmitted with all
requested information and documentation and received by the
department within 60 days of the date on the notice, the application
package shall be denied by operation of law. The applicant or
provider may reapply by submitting a new application package that
shall be reviewed de novo.
(B) If the failure to resubmit is by a currently enrolled provider
as defined in Section 14043.1, including providers applying for
continued enrollment, the failure may make the provider also subject
to deactivation of the provider's number and all of the business
addresses used by the provider to provide services, goods, supplies,
or merchandise to Medi-Cal beneficiaries.
(C) Notwithstanding subparagraph (A), if the notice of an
incomplete application package included a request for information or
documentation related to grounds for denial under Section 14043.2 or
14043.36, the applicant or provider shall not reapply for enrollment
or continued enrollment in the Medi-Cal program or for participation
in any health care program administered by the department or its
agents or contractors for a period of three years.
(i) (1) If the department exercises its authority under Section
14043.37, 14043.4, or 14043.7 to conduct background checks,
preenrollment inspections, or unannounced visits, the applicant or
provider shall receive notice, from the department, after the
conclusion of the background check, preenrollment inspection, or
unannounced visit of either of the following:
(A) The applicant or provider is granted provisional provider
status for a period of 12 months, effective from the date on the
notice.
(B) Discrepancies or failure to meet program requirements, as
prescribed by the department, have been found to exist during the
preenrollment period.
(2) (A) The notice shall identify the discrepancies or failures,
and whether remediation can be made or not, and if so, the time
period within which remediation must be accomplished. Failure to
remediate discrepancies and failures as prescribed by the department,
or notification that remediation is not available, shall result in
denial of the application by operation of law. The applicant or
provider may reapply by submitting a new application package that
shall be reviewed de novo.
(B) If the failure to remediate is by a currently enrolled
provider as defined in Section 14043.1, including providers applying
for continued enrollment, the failure may make the provider also
subject to deactivation of the provider's number and all of the
business addresses used by the provider to provide services, goods,
supplies, or merchandise to Medi-Cal beneficiaries.
(C) Notwithstanding subparagraph (A), if the discrepancies or
failure to meet program requirements, as prescribed by the director,
included in the notice were related to grounds for denial under
Section 14043.2 or 14043.36, the applicant or provider shall not
reapply for three years.
(j) If provisional provider status or preferred provisional
provider status is granted pursuant to this section, a provider
number shall be used by the provider for each business address for
which an application package has been approved. This provider number
shall be used exclusively for the locations for which it was
approved, unless the practice of the provider's profession or
delivery of services, goods, supplies, or merchandise is such that
services, goods, supplies, or merchandise are rendered or delivered
at locations other than the provider's business address and this
practice or delivery of services, goods, supplies, or merchandise has
been disclosed in the application package approved by the department
when the provisional provider status or preferred provisional
provider status was granted.
(k) Except for providers subject to subdivision (c) of Section
14043.47, a provider currently enrolled in the Medi-Cal program at
one or more locations who has submitted an application package for
enrollment at a new location or a change in location pursuant to
subdivision (a), or filed a change of location form pursuant to
subdivision (b), may submit claims for services, goods, supplies, or
merchandise rendered at the new location until the application
package or change of location form is approved or denied under this
section, and shall not be subject, during that period, to
deactivation, or be subject to any delay or nonpayment of claims as a
result of billing for services rendered at the new location as
herein authorized. However, the provider shall be considered during
that period to have been granted provisional provider status or
preferred provisional provider status and be subject to termination
of that status pursuant to Section 14043.27. A provider that is
subject to subdivision (c) of Section 14043.47 may come within the
scope of this subdivision upon submitting documentation in the
application package that identifies the physician providing
supervision for every three locations. If a provider submits claims
for services rendered at a new location before the application for
that location is received by the department, the department may deny
the claim.
(l) An applicant or a provider whose application for enrollment,
continued enrollment, or a new location or change in location has
been denied pursuant to this section, may appeal the denial in
accordance with Section 14043.65.
(m) (1) Upon receipt of a complete and accurate claim for an
individual nurse provider, the department shall adjudicate the claim
within an average of 30 days.
(2) During the budget proceedings of the 2006-07 fiscal year, and
each fiscal year thereafter, the department shall provide data to the
Legislature specifying the timeframe under which it has processed
and approved the provider applications submitted by individual nurse
providers.
(3) For purposes of this subdivision, "individual nurse providers"
are providers authorized under certain home- and community-based
waivers and under the state plan to provide nursing services to
Medi-Cal recipients in the recipients' own homes rather than in
institutional settings.
(n) (1) Except as provided in paragraph (2), an applicant or
provider may request to withdraw an application package submitted
pursuant to this section at any time, at which point the department's
review shall be canceled.
(2) The department's review shall not be canceled if, at the time
the applicant or provider requests to withdraw the application
package, the department has already initiated its review under
Section 14043.37, 14043.4, or 14043.7.
SEC. 23. Section 14087.36 of the Welfare and Institutions Code is
amended to read:
14087.36. (a) The following definitions shall apply for purposes
of this section:
(1) "County" means the City and County of San Francisco.
(2) "Board" means the Board of Supervisors of the City and County
of San Francisco.
(3) "Department" means the State Department of Health Care
Services.
(4) "Governing body" means the governing body of the health
authority.
(5) "Health authority" means the separate public agency
established by the board of supervisors to operate a health care
system in the county and to engage in the other activities authorized
by this section.
(b) The Legislature finds and declares that it is necessary that a
health authority be established in the county to arrange for the
provision of health care services in order to meet the problems of
the delivery of publicly assisted medical care in the county, to
enter into a contract with the department under Article 2.97
(commencing with Section 14093), or to contract with a health care
service plan on terms and conditions acceptable to the department,
and to demonstrate ways of promoting quality care and cost
efficiency.
(c) The county may, by resolution or ordinance, establish a health
authority to act as and be the local initiative component of the
Medi-Cal state plan pursuant to regulations adopted by the
department. If the board elects to establish a health authority, all
rights, powers, duties, privileges, and immunities vested in a county
under Article 2.8 (commencing with Section 14087.5) and Article 2.97
(commencing with Section 14093) shall be vested in the health
authority. The health authority shall have all power necessary and
appropriate to operate programs involving health care services,
including, but not limited to, the power to acquire, possess, and
dispose of real or personal property, to employ personnel and
contract for services required to meet its obligations, to sue or be
sued, to take all actions and engage in all public and private
business activities, subject to any applicable licensure, as
permitted a health care service plan pursuant to Chapter 2.2
(commencing with Section 1340) of Division 2 of the Health and Safety
Code, and to enter into agreements under Chapter 5 (commencing with
Section 6500) of Division 7 of Title 1 of the Government Code.
(d) (1) (A) The health authority shall be considered a public
entity for purposes of Division 3.6 (commencing with Section 810) of
Title 1 of the Government Code, separate and distinct from the
county, and shall file the statement required by Section 53051 of the
Government Code. The health authority shall have primary
responsibility to provide the defense and indemnification required
under Division 3.6 (commencing with Section 810) of Title 1 of the
Government Code for employees of the health authority who are
employees of the county. The health authority shall provide insurance
under terms and conditions required by the county in order to
satisfy its obligations under this section.
(B) For purposes of this paragraph, "employee" shall have the same
meaning as set forth in Section 810.2 of the Government Code.
(2) The health authority shall not be considered to be an agency,
division, department, or instrumentality of the county and shall not
be subject to the personnel, procurement, or other operational rules
of the county.
(3) Notwithstanding any other provision of law, any obligations of
the health authority, statutory, contractual, or otherwise, shall be
the obligations solely of the health authority and shall not be the
obligations of the county, unless expressly provided for in a
contract between the authority and the county, nor of the state.
(4) Except as agreed to by contract with the county, no liability
of the health authority shall become an obligation of the county upon
either termination of the health authority or the liquidation or
disposition of the health authority's remaining assets.
(e) (1) To the full extent permitted by federal law, the
department and the health authority may enter into contracts to
provide or arrange for health care services for any or all persons
who are eligible to receive benefits under the Medi-Cal program. The
contracts may be on an exclusive or nonexclusive basis, and shall
include payment provisions on any basis negotiated between the
department and the health authority. The health authority may also
enter into contracts for the provision of health care services to
individuals including, but not limited to, those covered under
Subchapter XVIII (commencing with Section 1395) of Chapter 7 of Title
42 of the United States Code, individuals employed by public
agencies and private businesses, and uninsured or indigent
individuals.
(2) Notwithstanding paragraph (1), or subdivision (f), the health
authority may not operate health plans or programs for individuals
covered under Subchapter XVIII (commencing with Section 1395) of
Chapter 7 of Title 42 of the United States Code, or for private
businesses, until the health authority is in full compliance with all
of the requirements of the Knox-Keene Health Care Service Plan Act
of 1975 under Chapter 2.2 (commencing with Section 1340) of Division
2 of the Health and Safety Code, including tangible net equity
requirements applicable to a licensed health care service plan. This
limitation shall not preclude the health authority from enrolling
persons pursuant to the county's obligations under Section 17000, or
from enrolling county employees.
(f) The board of supervisors may transfer responsibility for
administration of county-provided health care services to the health
authority for the purpose of service of populations including
uninsured and indigent persons, subject to the provisions of any
ordinances or resolutions passed by the county board of supervisors.
The transfer of administrative responsibility for those health care
services shall not relieve the county of its responsibility for
indigent care pursuant to Section 17000. The health authority may
also enter into contracts for the provision of health care services
to individuals including, but not limited to, those covered under
Subchapter XVIII (commencing with Section 1395) of Chapter 7 of Title
42 of the United States Code, and individuals employed by public
agencies and private businesses.
(g) Upon creation, the health authority may borrow from the county
and the county may lend the authority funds, or issue revenue
anticipation notes to obtain those funds necessary to commence
operations or perform the activities of the health authority.
Notwithstanding any other provision of law, both the county and the
health authority shall be eligible to receive funding under
subdivision (p) of Section 14163.
(h) The county may terminate the health authority, but only by an
ordinance approved by a two-thirds affirmative vote of the full
board.
(i) Prior to the termination of the health authority, the county
shall notify the department of its intent to terminate the health
authority. The department shall conduct an audit of the health
authority's records within 30 days of notification to determine the
liabilities and assets of the health authority. The department shall
report its findings to the county and to the Department of Managed
Health Care within 10 days of completion of the audit. The county
shall prepare a plan to liquidate or otherwise dispose of the assets
of the health authority and to pay the liabilities of the health
authority to the extent of the health authority's assets, and present
the plan to the department and the Department of Managed Health Care
within 30 days upon receipt of these findings.
(j) Any assets of the health authority derived from the contract
entered into between the state and the authority pursuant to Article
2.97 (commencing with Section 14093), after payment of the
liabilities of the health authority, shall be disposed of pursuant to
the contract.
(k) (1) The governing body shall consist of 18 voting members, 14
of whom shall be appointed by resolution or ordinance of the board as
follows:
(A) One member shall be a member of the board or any other person
designated by the board.
(B) One member shall be a person who is employed in the senior
management of a hospital not operated by the county or the University
of California and who is nominated by the San Francisco Section of
the West Bay Hospital Conference or any successor organization, or if
there is no successor organization, a person who shall be nominated
by the Hospital Council of Northern and Central California.
(C) Two members, one of whom shall be a person employed in the
senior management of San Francisco General Hospital and one of whom
shall be a person employed in the senior management of St. Luke's
Hospital (San Francisco). If San Francisco General Hospital or St.
Luke's Hospital, at the end of the term of the person appointed from
its senior management, is not designated as a disproportionate share
hospital, and if the governing body, after providing an opportunity
for comment by the West Bay Hospital Conference, or any successor
organization, determines that the hospital no longer serves an
equivalent patient population, the governing body may, by a
two-thirds vote of the full governing body, select an alternative
hospital to nominate a person employed in its senior management to
serve on the governing body. Alternatively, the governing body may
approve a reduction in the number of positions on the governing body
as set forth in subdivision (p).
(D) Two members shall be employees in the senior management of
either private nonprofit community clinics or a community clinic
consortium, nominated by the San Francisco Community Clinic
Consortium, or any successor organization.
(E) Two members shall be physicians, nominated by the San
Francisco Medical Society, or any successor organization.
(F) One member shall be nominated by the San Francisco Labor
Council, or any successor organization.
(G) Two members shall be persons nominated by the member advisory
committee of the health authority. Nominees of the member advisory
committee shall be enrolled in any of the health insurance or health
care coverage programs operated by the health authority or be the
parent or legal guardian of an enrollee in any of the health
insurance or health care coverage programs operated by the health
authority.
(H) Two members shall be persons knowledgeable in matters relating
to either traditional safety net providers, health care
organizations, the Medi-Cal program, or the activities of the health
authority, nominated by the program committee of the health
authority.
(I) One member shall be a person nominated by the San Francisco
Pharmacy Leadership Group, or any successor organization.
(2) One member, selected to fulfill the appointments specified in
subparagraph (A), (G), or (H) shall, in addition to representing his
or her specified organization or employer, represent the discipline
of nursing, and shall possess or be qualified to possess a registered
nursing license.
(3) The initial members appointed by the board under the
subdivision shall be, to the extent those individuals meet the
qualifications set forth in this subdivision and are willing to
serve, those persons who are members of the steering committee
created by the county to develop the local initiative component of
the Medi-Cal state plan in San Francisco. Following the initial
staggering of terms, each of those members shall be appointed to a
term of three years, except the member appointed pursuant to
subparagraph (A) of paragraph (1), who shall serve at the pleasure of
the board. At the first meeting of the governing body, the members
appointed pursuant to this subdivision shall draw lots to determine
seven members whose initial terms shall be for two years. Each member
shall remain in office at the conclusion of that member's term until
a successor member has been nominated and appointed.
( l ) In addition to the requirements of subdivision
(k), one member of the governing body shall be appointed by the Mayor
of the City of San Francisco to serve at the pleasure of the mayor,
one member shall be the county's director of public health or
designee, who shall serve at the pleasure of that director, one
member shall be the Chancellor of the University of California at San
Francisco or his or her designee, who shall serve at the pleasure of
the chancellor, and one member shall be the county director of
mental health or his or her designee, who shall serve at the pleasure
of that director.
(m) There shall be one nonvoting member of the governing body who
shall be appointed by, and serve at the pleasure of, the health
commission of the county.
(n) Each person appointed to the governing body shall, throughout
the member's term, either be a resident of the county or be employed
within the geographic boundaries of the county.
(o) (1) The composition of the governing body and nomination
process for appointment of its members shall be subject to alteration
upon a two-thirds vote of the full membership of the governing body.
This action shall be concurred in by a resolution or ordinance of
the county.
(2) Notwithstanding paragraph (1), no alteration described in that
paragraph shall cause the removal of a member prior to the
expiration of that member's term.
(p) A majority of the members of the governing body shall
constitute a quorum for the transaction of business, and all official
acts of the governing body shall require the affirmative vote of a
majority of the members present and voting. However, no official
shall be approved with less than the affirmative vote of six members
of the governing body, unless the number of members prohibited from
voting because of conflicts of interest precludes adequate
participation in the vote. The governing body may, by a two-thirds
vote adopt, amend, or repeal rules and procedures for the governing
body. Those rules and procedures may require that certain decisions
be made by a vote that is greater than a majority vote.
(q) For purposes of Section 87103 of the Government Code, members
appointed pursuant to subparagraphs (B) to (E), inclusive, of
paragraph (1) of subdivision (k) represent, and are appointed to
represent, respectively, the hospitals, private nonprofit community
clinics, and physicians that contract with the health authority, or
the health care service plan with which the health authority
contracts, to provide health care services to the enrollees of the
health authority or the health care service plan. Members appointed
pursuant to subparagraphs (F) and (G) of paragraph (1) of subdivision
(k) represent, and are appointed to represent, respectively, the
health care workers and enrollees served by the health authority or
its contracted health care service plan, and traditional safety net
and ancillary providers and other organizations concerned with the
activities of the health authority.
(r) A member of the governing body may be removed from office by
the board by resolution or ordinance, only upon the recommendation of
the health authority, and for any of the following reasons:
(1) Failure to retain the qualifications for appointment specified
in subdivisions (k) and (n).
(2) Death or a disability that substantially interferes with the
member's ability to carry out the duties of office.
(3) Conviction of any felony or a crime involving corruption.
(4) Failure of the member to discharge legal obligations as a
member of a public agency.
(5) Substantial failure to perform the duties of office,
including, but not limited to, unreasonable absence from meetings.
The failure to attend three meetings in a row of the governing body,
or a majority of the meetings in the most recent calendar year, may
be deemed to be unreasonable absence.
(s) Any vacancy on the governing body, however created, shall be
filled for the unexpired term by the board by resolution or
ordinance. Each vacancy shall be filled by an individual having the
qualifications of his or her predecessor, nominated as set forth in
subdivision (k).
(t) The chair of the authority shall be selected by, and serve at
the pleasure of, the governing body.
(u) The health authority shall establish all of the following:
(1) A member advisory committee to advise the health authority on
issues of concern to the recipients of services.
(2) A program committee to advise the health authority on matters
relating to traditional safety net providers, ancillary providers,
and other organizations concerned with the activities of the health
authority.
(3) Any other committees determined to be advisable by the health
authority.
(v) (1) Notwithstanding any provision of state or local law,
including, but not limited to, the county charter, a member of the
health authority shall not be deemed to be interested in a contract
entered into by the authority within the meaning of Article 4
(commencing with Section 1090) of Chapter 1 of Division 4 of Title 1
of the Government Code, or within the meaning of conflict-of-interest
restrictions in the county charter, if all of the following apply:
(A) The member does not influence or attempt to influence the
health authority or another member of the health authority to enter
into the contract in which the member is interested.
(B) The member discloses the interest to the health authority and
abstains from voting on the contract.
(C) The health authority notes the member's disclosure and
abstention in its official records and authorizes the contract in
good faith by a vote of its membership sufficient for the purpose
without counting the vote of the interested member.
(D) The member has an interest in or was appointed to represent
the interests of physicians, health care practitioners, hospitals,
pharmacies, or other health care organizations.
(E) The contract authorizes the member or the organization the
member has an interest in or represents to provide services to
beneficiaries under the authority's program or administrative
services to the authority.
(2) In addition, no person serving as a member of the governing
body shall, by virtue of that membership, be deemed to be engaged in
activities that are inconsistent, incompatible, or in conflict with
their duties as an officer or employee of the county or the
University of California, or as an officer or an employee of any
private hospital, clinic, or other health care organization. The
membership shall not be deemed to be in violation of Section 1126 of
the Government Code.
(w) Notwithstanding any other provision of law, those records of
the health authority and of the county that reveal the authority's
rates of payment for health care services or the health authority's
deliberative processes, discussions, communications, or any other
portion of the negotiations with providers of health care services
for rates of payment, or the health authority's peer review
proceedings shall not be required to be disclosed pursuant to the
California Public Records Act (Chapter 3.5 (commencing with Section
6250) of Division 7 of Title 1 of the Government Code), or any
similar local law requiring the disclosure of public records.
However, three years after a contract or amendment to a contract is
fully executed, the portion of the contract or amendment containing
the rates of payment shall be open to inspection.
(x) Notwithstanding any other provision of law, the health
authority may meet in closed session to consider and take action on
peer review proceedings and on matters pertaining to contracts and
contract negotiations by the health authority's staff with providers
of health care services concerning all matters relating to rates of
payment. However, a decision as to whether to enter into, amend the
services provisions of, or terminate, other than for reasons based
upon peer review, a contract
with a provider of health care services, shall be made in open
session.
(y) (1) (A) Notwithstanding the Ralph M. Brown Act (Chapter 9
(commencing with Section 54950) of Part 1 of Division 2 of Title 5 of
the Government Code), the governing board of the health authority
may meet in closed session for the purpose of discussion of, or
taking action on matters involving, health authority trade secrets.
(B) The requirement that the authority make a public report of
actions taken in closed session and the vote or abstention of every
member present may be limited to a brief general description of the
action taken and the vote so as to prevent the disclosure of a trade
secret.
(C) For purposes of this subdivision, "health authority trade
secret" means a trade secret, as defined in subdivision (d) of
Section 3426.1 of the Civil Code, that also meets both of the
following criteria:
(i) The secrecy of the information is necessary for the health
authority to initiate a new service, program, marketing strategy,
business plan, or technology, or to add a benefit or product.
(ii) Premature disclosure of the trade secret would create a
substantial probability of depriving the health authority of a
substantial economic benefit or opportunity.
(2) Those records of the health authority that reveal the health
authority's trade secrets are exempt from disclosure pursuant to the
California Public Records Act (Chapter 3.5 (commencing with Section
6250) of Division 7 of Title 1 of the Government Code), or any
similar local law requiring the disclosure of public records. This
exemption shall apply for a period of two years after the service,
program, marketing strategy, business plan, technology, benefit, or
product that is the subject of the trade secret is formally adopted
by the governing body of the health authority, provided that the
service, program, marketing strategy, business plan, technology,
benefit, or product continues to be a trade secret. The governing
board may delete the portion or portions containing trade secrets
from any documents that were finally approved in the closed session
held pursuant to this subdivision that are provided to persons who
have made the timely or standing request.
(z) The health authority shall be deemed to be a public agency for
purposes of all grant programs and other funding and loan guarantee
programs.
(aa) Contracts under this article between the State Department of
Health Services and the health authority shall be on a nonbid basis
and shall be exempt from Chapter 2 (commencing with Section 10290) of
Part 2 of Division 2 of the Public Contract Code.
(ab) (1) The county controller or his or her designee, at
intervals the county controller deems appropriate, shall conduct a
review of the fiscal condition of the health authority, shall report
the findings to the health authority and the board, and shall provide
a copy of the findings to any public agency upon request.
(2) Upon the written request of the county controller, the health
authority shall provide full access to the county controller all
health authority records and documents as necessary to allow the
county controller or his or her designee to perform the activities
authorized by this subdivision.
(ac) A Medi-Cal recipient receiving services through the health
authority shall be deemed to be a subscriber or enrollee for purposes
of Section 1379 of the Health and Safety Code.
SEC. 24. Section 14105.192 of the Welfare and Institutions Code is
amended to read:
14105.192. (a) The Legislature finds and declares the following:
(1) Costs within the Medi-Cal program continue to grow due to the
rising cost of providing health care throughout the state and also
due to increases in enrollment, which are more pronounced during
difficult economic times.
(2) In order to minimize the need for drastically cutting
enrollment standards or benefits during times of economic crisis, it
is crucial to find areas within the program where reimbursement
levels are higher than required under the standard provided in
Section 1902(a)(30)(A) of the federal Social Security Act and can be
reduced in accordance with federal law.
(3) The Medi-Cal program delivers its services and benefits to
Medi-Cal beneficiaries through a wide variety of health care
providers, some of which deliver care via managed care or other
contract models while others do so through fee-for-service
arrangements.
(4) The setting of rates within the Medi-Cal program is complex
and is subject to close supervision by the United States Department
of Health and Human Services.
(5) As the single state agency for Medicaid in California, the
department has unique expertise that can inform decisions that set or
adjust reimbursement methodologies and levels consistent with the
requirements of federal law.
(b) Therefore, it is the intent of the Legislature for the
department to analyze and identify where reimbursement levels can be
reduced consistent with the standard provided in Section 1902(a)(30)
(A) of the federal Social Security Act and consistent with federal
and state law and policies, including any exemptions contained in the
provisions of the act that added this section, provided that the
reductions in reimbursement shall not exceed 10 percent on an
aggregate basis for all providers, services and products.
(c) Notwithstanding any other provision of law, the director shall
adjust provider payments, as specified in this section.
(d) (1) Except as otherwise provided in this section, payments
shall be reduced by 10 percent for Medi-Cal fee-for-service benefits
for dates of service on and after June 1, 2011.
(2) For managed health care plans that contract with the
department pursuant to this chapter or Chapter 8 (commencing with
Section 14200), except contracts with Senior Care Action Network and
AIDS Healthcare Foundation, payments shall be reduced by the
actuarial equivalent amount of the payment reductions specified in
this section pursuant to contract amendments or change orders
effective on July 1, 2011, or thereafter.
(3) Payments shall be reduced by 10 percent for non-Medi-Cal
programs described in Article 6 (commencing with Section 124025) of
Chapter 3 of Part 2 of Division 106 of the Health and Safety Code,
and Section 14105.18, for dates of service on and after June 1, 2011.
This paragraph shall not apply to inpatient hospital services
provided in a hospital that is paid under contract pursuant to
Article 2.6 (commencing with Section 14081).
(4) (A) Notwithstanding any other provision of law, the director
may adjust the payments specified in paragraphs (1) and (3) of this
subdivision with respect to one or more categories of Medi-Cal
providers, or for one or more products or services rendered, or any
combination thereof, so long as the resulting reductions to any
category of Medi-Cal providers, in the aggregate, total no more than
10 percent.
(B) The adjustments authorized in subparagraph (A) shall be
implemented only if the director determines that, for each affected
product, service, or provider category, the payments resulting from
the adjustment comply with subdivision (m).
(e) Notwithstanding any other provision of this section, payments
to hospitals that are not under contract with the State Department of
Health Care Services pursuant to Article 2.6 (commencing with
Section 14081) for inpatient hospital services provided to Medi-Cal
beneficiaries and that are subject to Section 14166.245 shall be
governed by that section.
(f) Notwithstanding any other provision of this section, the
following shall apply:
(1) Payments to providers that are paid pursuant to Article 3.8
(commencing with Section 14126) shall be governed by that article.
(2) (A) Subject to subparagraph (B), for dates of service on and
after June 1, 2011, Medi-Cal reimbursement rates for intermediate
care facilities for the developmentally disabled licensed pursuant to
subdivision (e), (g), or (h) of Section 1250 of the Health and
Safety Code, and facilities providing continuous skilled nursing care
to developmentally disabled individuals pursuant to the pilot
project established by Section 14132.20, as determined by the
applicable methodology for setting reimbursement rates for these
facilities, shall not exceed the reimbursement rates that were
applicable to providers in the 2008-09 rate year.
(B) (i) If Section 14105.07 is added to the Welfare and
Institutions Code during the 2011-12 Regular Session of the
Legislature, subparagraph (A) shall become inoperative.
(ii) If Section 14105.07 is added to the Welfare and Institutions
Code during the 2011-12 Regular Session of the Legislature, then for
dates of service on and after June 1, 2011, payments to intermediate
care facilities for the developmentally disabled licensed pursuant to
subdivision (e), (g), or (h) of Section 1250 of the Health and
Safety Code, and facilities providing continuous skilled nursing care
to developmentally disabled individuals pursuant to the pilot
project established by Section 14132.20, shall be governed by the
applicable methodology for setting reimbursement rates for these
facilities and by Section 14105.07.
(g) The department may enter into contracts with a vendor for the
purposes of implementing this section on a bid or nonbid basis. In
order to achieve maximum cost savings, the Legislature declares that
an expedited process for contracts under this subdivision is
necessary. Therefore, contracts entered into to implement this
section and all contract amendments and change orders shall be exempt
from Chapter 2 (commencing with Section 10290) of Part 2 Division 2
of the Public Contract Code.
(h) To the extent applicable, the services, facilities, and
payments listed in this subdivision shall be exempt from the payment
reductions specified in subdivision (d) as follows:
(1) Acute hospital inpatient services that are paid under
contracts pursuant to Article 2.6 (commencing with Section 14081).
(2) Federally qualified health center services, including those
facilities deemed to have federally qualified health center status
pursuant to a waiver pursuant to subsection (a) of Section 1115 of
the federal Social Security Act (42 U.S.C. Sec. 1315(a)).
(3) Rural health clinic services.
(4) Payments to facilities owned or operated by the State
Department of State Hospitals or the State Department of
Developmental Services.
(5) Hospice services.
(6) Contract services, as designated by the director pursuant to
subdivision (k).
(7) Payments to providers to the extent that the payments are
funded by means of a certified public expenditure or an
intergovernmental transfer pursuant to Section 433.51 of Title 42 of
the Code of Federal Regulations. This paragraph shall apply to
payments described in paragraph (3) of subdivision (d) only to the
extent that they are also exempt from reduction pursuant to
subdivision (l).
(8) Services pursuant to local assistance contracts and
interagency agreements to the extent the funding is not included in
the funds appropriated to the department in the annual Budget Act.
(9) Breast and cervical cancer treatment provided pursuant to
Section 14007.71 and as described in paragraph (3) of subdivision (a)
of Section 14105.18 or Article 1.5 (commencing with Section 104160)
of Chapter 2 of Part 1 of Division 103 of the Health and Safety Code.
(10) The Family Planning, Access, Care, and Treatment (Family
PACT) Program pursuant to subdivision (aa) of Section 14132.
(i) Subject to the exception for services listed in subdivision
(h), the payment reductions required by subdivision (d) shall apply
to the benefits rendered by any provider who may be authorized to
bill for the service, including, but not limited to, physicians,
podiatrists, nurse practitioners, certified nurse-midwives, nurse
anesthetists, and organized outpatient clinics.
(j) Notwithstanding any other provision of law, for dates of
service on and after June 1, 2011, Medi-Cal reimbursement rates
applicable to the following classes of providers shall not exceed the
reimbursement rates that were applicable to those classes of
providers in the 2008-09 rate year, as described in subdivision (f)
of Section 14105.191, reduced by 10 percent:
(1) Intermediate care facilities, excluding those facilities
identified in paragraph (2) of subdivision (f). For purposes of this
section, "intermediate care facility" has the same meaning as defined
in Section 51118 of Title 22 of the California Code of Regulations.
(2) Skilled nursing facilities that are distinct parts of general
acute care hospitals. For purposes of this section, "distinct part"
has the same meaning as defined in Section 72041 of Title 22 of the
California Code of Regulations.
(3) Rural swing-bed facilities.
(4) Subacute care units that are, or are parts of, distinct parts
of general acute care hospitals. For purposes of this subparagraph,
"subacute care unit" has the same meaning as defined in Section
51215.5 of Title 22 of the California Code of Regulations.
(5) Pediatric subacute care units that are, or are parts of,
distinct parts of general acute care hospitals. For purposes of this
subparagraph, "pediatric subacute care unit" has the same meaning as
defined in Section 51215.8 of Title 22 of the California Code of
Regulations.
(6) Adult day health care centers.
(7) Freestanding pediatric subacute care units, as defined in
Section 51215.8 of Title 22 of the California Code of Regulations.
(k) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement and administer this section by means of
provider bulletins or similar instructions, without taking regulatory
action.
(l) The reductions described in this section shall apply only to
payments for services when the General Fund share of the payment is
paid with funds directly appropriated to the department in the annual
Budget Act and shall not apply to payments for services paid with
funds appropriated to other departments or agencies.
(m) Notwithstanding any other provision of this section, the
payment reductions and adjustments provided for in subdivision (d)
shall be implemented only if the director determines that the
payments that result from the application of this section will comply
with applicable federal Medicaid requirements and that federal
financial participation will be available.
(1) In determining whether federal financial participation is
available, the director shall determine whether the payments comply
with applicable federal Medicaid requirements, including those set
forth in Section 1396a(a)(30)(A) of Title 42 of the United States
Code.
(2) To the extent that the director determines that the payments
do not comply with the federal Medicaid requirements or that federal
financial participation is not available with respect to any payment
that is reduced pursuant to this section, the director retains the
discretion to not implement the particular payment reduction or
adjustment and may adjust the payment as necessary to comply with
federal Medicaid requirements.
(n) The department shall seek any necessary federal approvals for
the implementation of this section.
(o) (1) The payment reductions and adjustments set forth in this
section shall not be implemented until federal approval is obtained.
(2) To the extent that federal approval is obtained for one or
more of the payment reductions and adjustments in this section and
Section 14105.07, the payment reductions and adjustments set forth in
Section 14105.191 shall cease to be implemented for the same
services provided by the same class of providers. In the event of a
conflict between this section and Section 14105.191, other than the
provisions setting forth a payment reduction or adjustment, this
section shall govern.
(3) When federal approval is obtained, the payments resulting from
the application of this section shall be implemented retroactively
to June 1, 2011, or on any other date or dates as may be applicable.
(4) The director may clarify the application of this subdivision
by means of provider bulletins or similar instructions, pursuant to
subdivision (k).
(p) Adjustments to pharmacy drug product payment pursuant to this
section shall no longer apply when the department determines that the
average acquisition cost methodology pursuant to Section 14105.45
has been fully implemented and the department's pharmacy budget
reduction targets, consistent with payment reduction levels pursuant
to this section, have been met.
SEC. 25. Section 14124.5 of the Welfare and Institutions Code is
amended to read:
14124.5. (a) The director may, in accordance with Section 10725,
adopt, amend, or repeal, in accordance with Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code, reasonable rules and regulations as may be necessary
or proper to carry out the purposes and intent of this chapter, and
to enable the department to exercise the powers and perform the
duties conferred upon it by this chapter, not inconsistent with any
statute of this state.
(b) All regulations previously adopted by the State Department of
Health Care Services or any predecessor department pursuant to this
chapter and in effect immediately preceding the operative date of
this section, shall remain in effect and shall be fully enforceable
unless and until readopted, amended, or repealed by the director in
accordance with Section 10725.
SEC. 26. Section 14169.51 of the Welfare and Institutions Code is
amended to read:
14169.51. For purposes of this article, the following definitions
shall apply:
(a) "Acute psychiatric days" means the total number of Medi-Cal
specialty mental health service administrative days, Medi-Cal
specialty mental health service acute care days, acute psychiatric
administrative days, and acute psychiatric acute days identified in
the Final Medi-Cal Utilization Statistics for the state fiscal year
preceding the rebase calculation year as calculated by the department
as of the retrieval date.
(b) "Acute psychiatric per diem supplemental rate" means a fixed
per diem supplemental payment for acute psychiatric days.
(c) "Annual fee-for-service days" means the number of
fee-for-service days of each hospital subject to the quality
assurance fee, as reported on the days data source.
(d) "Annual managed care days" means the number of managed care
days of each hospital subject to the quality assurance fee, as
reported on the days data source.
(e) "Annual Medi-Cal days" means the number of Medi-Cal days of
each hospital subject to the quality assurance fee, as reported on
the days data source.
(f) "Base calendar year" means a calendar year that ends before a
subject fiscal year begins, but no more than six years before a
subject fiscal year begins. Beginning with the third program period,
the department shall establish the base calendar year during the
rebase calculation year as the calendar year for which the most
recent data is available that the department determines is reliable.
(g) "Converted hospital" means a private hospital that becomes a
designated public hospital or a nondesignated public hospital on or
after the first day of a program period.
(h) "Days data source" means either: (1) if a hospital's Annual
Financial Disclosure Report for its fiscal year ending in the base
calendar year includes data for a full fiscal year of operation, the
hospital's Annual Financial Disclosure Report retrieved from the
Office of Statewide Health Planning and Development as retrieved by
the department on the retrieval date pursuant to Section 14169.59,
for its fiscal year ending in the base calendar year; or (2) if a
hospital's Annual Financial Disclosure Report for its fiscal year
ending in the base calendar year includes data for more than one day,
but less than a full year of operation, the department's best and
reasonable estimates of the hospital's Annual Financial Disclosure
Report if the hospital had operated for a full year.
(i) "Department" means the State Department of Health Care
Services.
(j) "Designated public hospital" shall have the meaning given in
subdivision (d) of Section 14166.1.
(k) "Director" means the Director of Health Care Services.
(l) "Exempt facility" means any of the following:
(1) A public hospital, which shall include either of the
following:
(A) A hospital, as defined in paragraph (25) of subdivision (a) of
Section 14105.98.
(B) A tax-exempt nonprofit hospital that is licensed under
subdivision (a) of Section 1250 of the Health and Safety Code and
operating a hospital owned by a local health care district, and is
affiliated with the health care district hospital owner by means of
the district's status as the nonprofit corporation's sole corporate
member.
(2) With the exception of a hospital that is in the Charitable
Research Hospital peer group, as set forth in the 1991 Hospital Peer
Grouping Report published by the department, a hospital that is
designated as a specialty hospital in the hospital's most recently
filed Office of Statewide Health Planning and Development Hospital
Annual Financial Disclosure Report, as of the first day of a program
period.
(3) A hospital that satisfies the Medicare criteria to be a
long-term care hospital.
(4) A small and rural hospital as specified in Section 124840 of
the Health and Safety Code designated as that in the hospital's most
recently filed Office of Statewide Health Planning and Development
Hospital Annual Financial Disclosure Report, as of the first day of a
program period.
(m) "Federal approval" means the approval by the federal
government of both the quality assurance fee established pursuant to
this article and the supplemental payments to private hospitals
described pursuant to this article.
(n) "Fee-for-service per diem quality assurance fee rate" means a
fixed fee on fee-for-service days.
(o) "Fee-for-service days" means inpatient hospital days as
reported on the days data source where the service type is reported
as "acute care," "psychiatric care," or "rehabilitation care," and
the payer category is reported as "Medicare traditional," "county
indigent programs-traditional," "other third parties-traditional,"
"other indigent," or "other payers," for purposes of the Annual
Financial Disclosure Report submitted by hospitals to the Office of
Statewide Health Planning and Development.
(p) "Fund" means the Hospital Quality Assurance Revenue Fund
established by Section 14167.35.
(q) "General acute care days" means the total number of Medi-Cal
general acute care days, including well baby days, less any acute
psychiatric inpatient days, paid by the department to a hospital for
services in the base calendar year, as reflected in the state paid
claims file on the retrieval date.
(r) "General acute care hospital" means any hospital licensed
pursuant to subdivision (a) of Section 1250 of the Health and Safety
Code.
(s) "General acute care per diem supplemental rate" means a fixed
per diem supplemental payment for general acute care days.
(t) "High acuity days" means Medi-Cal coronary care unit days,
pediatric intensive care unit days, intensive care unit days,
neonatal intensive care unit days, and burn unit days paid by the
department to a hospital for services in the base calendar year, as
reflected in the state paid claims file prepared by the department on
the retrieval date.
(u) "High acuity per diem supplemental rate" means a fixed per
diem supplemental payment for high acuity days for specified
hospitals in Section 14169.55.
(v) "High acuity trauma per diem supplemental rate" means a fixed
per diem supplemental payment for high acuity days for specified
hospitals in Section 14169.55 that have been designated as specified
types of trauma hospitals.
(w) "Hospital community" includes, but is not limited to, the
statewide hospital industry organization and systems representing
general acute care hospitals.
(x) "Hospital inpatient services" means all services covered under
Medi-Cal and furnished by hospitals to patients who are admitted as
hospital inpatients and reimbursed on a fee-for-service basis by the
department directly or through its fiscal intermediary. Hospital
inpatient services include outpatient services furnished by a
hospital to a patient who is admitted to that hospital within 24
hours of the provision of the outpatient services that are related to
the condition for which the patient is admitted. Hospital inpatient
services do not include services for which a managed health care plan
is financially responsible.
(y) "Hospital outpatient services" means all services covered
under Medi-Cal furnished by hospitals to patients who are registered
as hospital outpatients and reimbursed by the department on a
fee-for-service basis directly or through its fiscal intermediary.
Hospital outpatient services do not include services for which a
managed health care plan is financially responsible, or services
rendered by a hospital-based federally qualified health center for
which reimbursement is received pursuant to Section 14132.100.
(z) "Managed care days" means inpatient hospital days as reported
on the days data source where the service type is reported as "acute
care," "psychiatric care," or "rehabilitation care," and the payer
category is reported as "Medicare managed care," "county indigent
programs-managed care," or "other third parties-managed care," for
purposes of the Annual Financial Disclosure Report submitted by
hospitals to the Office of Statewide Health Planning and Development.
(aa) "Managed care per diem quality assurance fee rate" means a
fixed fee on managed care days.
(ab) (1) "Managed health care plan" means a health care delivery
system that manages the provision of health care and receives prepaid
capitated payments from the state in return for providing services
to Medi-Cal beneficiaries.
(2) (A) Managed health care plans include county organized health
systems and entities contracting with the department to provide or
arrange services for Medi-Cal beneficiaries pursuant to the two-plan
model, geographic managed care, or regional managed care for the
rural expansion. Entities providing these services contract with the
department pursuant to any of the following:
(i) Article 2.7 (commencing with Section 14087.3).
(ii) Article 2.8 (commencing with Section 14087.5).
(iii) Article 2.81 (commencing with Section 14087.96).
(iv) Article 2.82 (commencing with Section 14087.98).
(v) Article 2.91 (commencing with Section 14089).
(B) Managed health care plans do not include any of the following:
(i) Mental health plans contracting to provide mental health care
for Medi-Cal beneficiaries pursuant to Chapter 8.9 (commencing with
Section 14700).
(ii) Health plans not covering inpatient services such as primary
care case management plans operating pursuant to Section 14088.85.
(iii) Program of All-Inclusive Care for the Elderly organizations
operating pursuant to Chapter 8.75 (commencing with Section 14591).
(ac) "Medi-Cal days" means inpatient hospital days as reported on
the days data source where the service type is reported as "acute
care," "psychiatric care," or "rehabilitation care," and the payer
category is reported as "Medi-Cal traditional" or "Medi-Cal managed
care," for purposes of the Annual Financial Disclosure Report
submitted by hospitals to the Office of Statewide Health Planning and
Development.
(ad) "Medi-Cal fee-for-service days" means inpatient hospital days
as reported on the days data source where the service type is
reported as "acute care," "psychiatric care," or "rehabilitation
care," and the payer category is reported as "Medi-Cal traditional"
for purposes of the Annual Financial Disclosure Report submitted by
hospitals to the Office of Statewide Health Planning and Development.
(ae) "Medi-Cal managed care days" means the total number of
general acute care days, including well baby days, listed for the
county organized health system and prepaid health plans identified in
the Final Medi-Cal Utilization Statistics for the state fiscal year
preceding the rebase calculation year, as calculated by the
department as of the retrieval date.
(af) "Medi-Cal managed care fee days" means inpatient hospital
days as reported on the days data source where the service type is
reported as "acute care," "psychiatric care," or "rehabilitation
care," and the payer category is reported as "Medi-Cal managed care"
for purposes of the Annual Financial Disclosure Report submitted by
hospitals to the Office of Statewide Health Planning and Development.
(ag) "Medi-Cal per diem quality assurance fee rate" means a fixed
fee on Medi-Cal days.
(ah) "Medicaid inpatient utilization rate" means Medicaid
inpatient utilization rate as defined in Section 1396r-4 of Title 42
of the United States Code and as set forth in the Final Medi-Cal
Utilization Statistics for the state fiscal year preceding the rebase
calculation year, as calculated by the department as of the
retrieval date.
(ai) "New hospital" means a hospital operation, business, or
facility functioning under current or prior ownership as a private
hospital that does not have a days data source or a hospital that has
a days data source in whole, or in part, from a previous operator
where there is an outstanding monetary obligation owed to the state
in connection with the Medi-Cal program and the hospital is not, or
does not agree to become, financially responsible to the department
for the outstanding monetary obligation in accordance with
subdivision (d) of Section 14169.61.
(aj) "Nondesignated public hospital" means either of the
following:
(1) A public hospital that is licensed under subdivision (a) of
Section 1250 of the Health and Safety Code, is not designated as a
specialty hospital in the hospital's most recently filed Annual
Financial Disclosure Report, as of the first day of a program period,
and satisfies the definition in paragraph (25) of subdivision (a) of
Section 14105.98, excluding designated public hospitals.
(2) A tax-exempt nonprofit hospital that is licensed under
subdivision (a) of Section 1250 of the Health and Safety Code, is not
designated as a specialty hospital in the hospital's most recently
filed Annual Financial Disclosure Report, as of the first day of a
program period, is operating a hospital owned by a local health care
district, and is affiliated with the health care district hospital
owner by means of the district's status as the nonprofit corporation'
s sole corporate member.
(ak) "Outpatient base amount" means the total amount of payments
for hospital outpatient services made to a hospital in the base
calendar year, as reflected in the state paid claims files prepared
by the department as of the retrieval date.
(al) "Outpatient supplemental rate" means a fixed proportional
supplemental payment for Medi-Cal outpatient services.
(am) "Prepaid health plan hospital" means a hospital owned by a
nonprofit public benefit corporation that shares a common board of
directors with a nonprofit health care service plan, which
exclusively contracts with no more than two medical groups in the
state to provide or arrange for professional medical services for the
enrollees of the plan, as of the effective date of this article.
(an) "Prepaid health plan hospital managed care per diem quality
assurance fee rate" means a fixed fee on non-Medi-Cal managed care
fee days for prepaid health plan hospitals.
(ao) "Prepaid health plan hospital Medi-Cal managed care per diem
quality assurance fee rate" means a fixed fee on Medi-Cal managed
care fee days for prepaid health plan hospitals.
(ap) "Private hospital" means a hospital that meets all of the
following conditions:
(1) Is licensed pursuant to subdivision (a) of Section 1250 of the
Health and Safety Code.
(2) Is in the Charitable Research Hospital peer group, as set
forth in the 1991 Hospital Peer Grouping Report published by the
department, or is not designated as a specialty hospital in the
hospital's most recently filed Office of Statewide Health Planning
and Development Annual Financial Disclosure Report, as of the first
day of a program period.
(3) Does not satisfy the Medicare criteria to be classified as a
long-term care hospital.
(4) Is a nonpublic hospital, nonpublic converted hospital, or
converted hospital as those terms are defined in paragraphs (26) to
(28), inclusive, respectively, of subdivision (a) of Section
14105.98.
(5) Is not a nondesignated public hospital or a designated public
hospital.
(aq) "Program period" means a period not to exceed three years
during which a fee model and a supplemental payment model developed
under this article shall be effective. The first program period shall
be the period beginning January 1, 2014, and ending December 31,
2016, inclusive. The second program period shall be the period
beginning on January 1, 2017, and ending June 30, 2019. Each
subsequent program period shall begin on the day immediately
following the last day of the immediately preceding program period
and shall end on the last day of a state fiscal year, as determined
by the department.
(ar) "Quality assurance fee" means the quality assurance fee
assessed pursuant to Section 14169.52 and collected on the basis of
the quarterly quality assurance fee.
(as) (1) "Quarterly quality assurance fee" means, with respect to
a hospital that is not a prepaid health plan hospital, the sum of all
of the following:
(A) The annual fee-for-service days for an individual hospital
multiplied by the fee-for-service per diem quality assurance fee
rate, divided by four.
(B) The annual managed care days for an individual hospital
multiplied by the managed care per diem quality assurance fee rate,
divided by four.
(C) The annual Medi-Cal days for an individual hospital multiplied
by the Medi-Cal per diem quality assurance fee rate, divided by
four.
(2) "Quarterly quality assurance fee" means, with respect to a
hospital that is a prepaid health plan hospital, the sum of all of
the following:
(A) The annual fee-for-service days for an individual hospital
multiplied by the fee-for-service per diem quality assurance fee
rate, divided by four.
(B) The annual managed care days for an individual hospital
multiplied by the prepaid health plan hospital managed care per diem
quality assurance fee rate, divided by four.
(C) The annual Medi-Cal managed care fee days for an individual
hospital multiplied by the prepaid health plan hospital Medi-Cal
managed care per diem quality assurance fee rate, divided by four.
(D) The annual Medi-Cal fee-for-service days for an individual
hospital multiplied by the Medi-Cal per diem quality assurance fee
rate, divided by four.
(at) "Rebase calculation year" means a state fiscal year during
which the department shall rebase the data, including, but not
limited to, the days data source, used for the following: acute
psychiatric days, annual fee-for-service days, annual managed care
days, annual Medi-Cal days, fee-for-service days, general acute care
days, high acuity days, managed care days, Medi-Cal days, Medi-Cal
fee-for-service days, Medi-Cal managed care days, Medi-Cal managed
care fee days, outpatient base amount, and transplant days, pursuant
to Section 14169.59. Beginning with the third program period, the
rebase calculation year for a program period shall be the last
subject fiscal year of the immediately preceding program period.
(au) "Rebase year" means the first state fiscal year of a program
period and shall immediately follow a rebase calculation year.
(av) "Retrieval date" means a day for each data element during the
last quarter of the rebase calculation year upon which the
department retrieves the data, including, but not limited to, the
days data source, used for the following: acute psychiatric days,
annual fee-for-service days, annual managed care days, annual
Medi-Cal days, fee-for-service days, general acute care days, high
acuity days, managed care days, Medi-Cal days, Medi-Cal
fee-for-service days, Medi-Cal managed care days, Medi-Cal managed
care fee days, outpatient base amount, and transplant days, pursuant
to Section 14169.59. The retrieval date for each data element may be
a different date within the quarter as determined to be necessary and
appropriate by the department.
(aw) "Subacute supplemental rate" means a fixed proportional
supplemental payment for acute inpatient services based on a hospital'
s prior provision of Medi-Cal subacute services.
(ax) "Subject fiscal quarter" means a state fiscal quarter
beginning on or after the first day of a program period and ending on
or before the last day of a program period.
(ay) "Subject fiscal year" means a state fiscal year beginning on
or after the first day of a program period and ending on or before
the last day of a program period.
(az) "Subject month" means a calendar month beginning on or after
the first day of a program period and ending on or before the last
day of a program period.
(ba) "Transplant days" means the number of Medi-Cal days for
Medicare Severity-Diagnosis Related Groups (MS-DRGs) 1, 2, 5 to 10,
inclusive, 14, 15, or 652, according to the Patient Discharge Data
File Documentation from the Office of Statewide Health Planning and
Development for the base calendar year accessed on the retrieval
date.
(bb) "Transplant per diem supplemental rate" means a fixed per
diem supplemental payment for transplant days.
(bc) "Upper payment limit" means a federal upper payment limit on
the amount of the Medicaid payment for which federal financial
participation is available for a class of service and a class of
health care providers, as specified in Part 447 of Title 42 of the
Code of Federal Regulations. The applicable upper payment limit shall
be separately calculated for inpatient and outpatient hospital
services.
SEC. 27. Section 14169.52 of the Welfare and Institutions Code is
amended to read:
14169.52. (a) There shall be imposed on each general acute care
hospital that is not an exempt facility a quality assurance fee,
except that a quality assurance fee under this article shall not be
imposed on a converted hospital for the periods when the hospital is
a public hospital or a new hospital with respect to a program period.
(b) The department shall compute the quarterly quality assurance
fee for each subject fiscal year during a program period pursuant to
Section 14169.59.
(c) Subject to Section 14169.63, on the later of the date of the
department's receipt of federal approval or the first day of each
program period, the following shall commence:
(1) Within 10 business days following receipt of the notice of
federal approval, the department shall send notice to each hospital
subject to the quality assurance fee, which shall contain the
following information:
(A) The date that the state received notice of federal approval.
(B) The quarterly quality assurance fee for each subject fiscal
year.
(C) The date on which each payment is due.
(2) The hospitals shall pay the quarterly quality assurance fee,
based on a schedule developed by the department. The department shall
establish the date that each payment is due, provided that the first
payment shall be due no earlier than 20 days following the
department sending the notice pursuant to paragraph (1), and the
payments shall be paid at least one month apart, but if possible, the
payments shall be paid on a quarterly basis.
(3) Notwithstanding any other provision of this section, the
amount of each hospital's quarterly quality assurance fee for a
program period that has not been paid by the hospital before 15 days
prior to the end of a program period shall be paid by the hospital no
later than 15 days prior to the end of a program period.
(4) Each hospital described in subdivision (a) shall pay the
quarterly quality assurance fees that are due, if any, in the amounts
and at the times set forth in the notice unless superseded by a
subsequent notice from the department.
(d) The quality assurance fee, as assessed pursuant to this
section, shall be paid by each hospital subject to the fee to the
department for deposit in the fund. Deposits may be accepted at any
time and shall be credited toward the program period for which the
fees were assessed. This article shall not affect the ability of a
hospital to pay fees assessed for a program period after the end of
that program period.
(e) This section shall become inoperative if the federal Centers
for Medicare and Medicaid Services denies approval for, or does not
approve before December 1, 2016, the implementation of the quality
assurance fee pursuant to this article or the supplemental payments
to private hospitals pursuant to this article for the first program
period.
(f) In no case shall the aggregate fees collected in a federal
fiscal year pursuant to this section, former Section 14167.32,
Section 14168.32, and Section 14169.32 exceed the maximum percentage
of the annual aggregate net patient revenue for hospitals subject to
the fee that is prescribed pursuant to federal law and regulations as
necessary to preclude a finding that an indirect guarantee has been
created.
(g) (1) Interest shall be assessed on quality assurance fees not
paid on the date due at the greater of 10 percent per annum or the
rate at which the department assesses interest on Medi-Cal program
overpayments to hospitals that are not repaid when due. Interest
shall begin to accrue the day after the date the payment was due and
shall be deposited in the fund.
(2) In the event that any fee payment is more than 60 days
overdue, a penalty equal to the interest charge described in
paragraph (1) shall be assessed and due for each month for which the
payment is not received after 60 days.
(h) When a hospital fails to pay all or part of the quality
assurance fee on or before the date that payment is due, the
department may immediately begin to deduct the unpaid assessment and
interest from any Medi-Cal payments owed to the hospital, or, in
accordance with Section 12419.5 of the Government Code, from any
other state payments owed to the hospital until the full amount is
recovered. All amounts, except penalties, deducted by the department
under this subdivision shall be deposited in the fund. The remedy
provided to the department by this section is in addition to other
remedies available under law.
(i) The payment of the quality assurance fee shall not be
considered as an allowable cost for Medi-Cal cost reporting and
reimbursement purposes.
(j) The department shall work in consultation with the hospital
community to implement this article.
(k) This subdivision creates a contractually enforceable promise
on behalf of the state to use the proceeds of the quality assurance
fee, including any federal matching funds, solely and exclusively for
the purposes set forth in this article, to limit the amount of the
proceeds of the quality assurance fee to be used to pay for the
health care coverage of children as provided in Section 14169.53, to
limit any payments for the department's costs of administration to
the amounts set forth in this article, to maintain and continue prior
reimbursement levels as set forth in Section 14169.68 on the
effective date of that section, and to otherwise comply with all its
obligations set forth in this article, provided that amendments that
arise from, or have as a basis for, a decision, advice, or
determination by the federal Centers for Medicare and Medicaid
Services relating to federal approval of the quality assurance fee or
the payments set forth in this article shall control for the
purposes of this subdivision.
(l) (1) Subject to paragraph (2), the director may waive any or
all interest and penalties assessed under this article in the event
that the director determines, in his or her sole discretion, that the
hospital has demonstrated that imposition of the full quality
assurance fee on the timelines applicable under this article has a
high likelihood of creating a financial hardship for the hospital or
a significant danger of reducing the provision of needed health care
services.
(2) Waiver of some or all of the interest or penalties under this
subdivision shall be conditioned on the hospital's agreement to make
fee payments, or to have the payments withheld from payments
otherwise due from the Medi-Cal program to the hospital, on a
schedule developed by the department that takes into account the
financial situation of the hospital and the potential impact on
services.
(3) A decision by the director under this subdivision shall not be
subject to judicial review.
(4) If fee payments are remitted to the department after the date
determined by the department to be the final date for calculating the
final supplemental payments for a program period under this article,
the fee payments shall be refunded to general acute care hospitals,
pro rata with the amount of quality assurance fee paid by the
hospital in the program period, subject to the limitations of federal
law. If federal rules prohibit the refund described in this
paragraph, the excess funds shall be used as quality assurance fees
for the next program period for general acute care hospitals, pro
rata with the quality assurance fees paid by the hospital for the
program period.
(5) If during the implementation of this article, fee payments
that were due under former Article 5.21 (commencing with Section
14167.1) and former Article 5.22 (commencing with Section 14167.31),
or former Article 5.226 (commencing with Section 14168.1) and Article
5.227 (commencing with Section 14168.31), or Article 5.228
(commencing with Section 14169.1) and Article 5.229 (commencing with
Section 14169.31) are remitted to the department under a payment plan
or for any other reason, and the final date for calculating the
final supplemental payments under those articles has passed, then
those fee payments shall be deposited in the fund to support the uses
established by this article.
SEC. 28. Section 14169.53 of the Welfare and Institutions Code is
amended to read:
14169.53. (a) (1) All fees required to be paid to the state
pursuant to this article shall be paid in the form of remittances
payable to the department.
(2) The department shall directly transmit the fee payments to the
Treasurer to be deposited in the fund. Notwithstanding Section
16305.7 of the Government Code, any interest and dividends earned on
deposits in the fund from the proceeds of the fee assessed pursuant
to this article shall be retained in the fund for purposes specified
in subdivision (b).
(b) (1) Notwithstanding subdivision (c) of Section 14167.35,
subdivision (b) of Section 14168.33, and subdivision (b) of Section
14169.33, all funds from the proceeds of the fee assessed pursuant to
this article in the fund, together with any interest and dividends
earned on money in the fund, shall continue to be used exclusively to
enhance federal financial participation for hospital services under
the Medi-Cal program, to provide additional reimbursement to, and to
support quality improvement efforts of, hospitals, and to minimize
uncompensated care provided by hospitals to uninsured patients, as
well as to pay for the state's administrative costs and to provide
funding for children's health coverage, in the following order of
priority:
(A) To pay for the department's staffing and administrative costs
directly attributable to implementing this article, not to exceed two
hundred fifty thousand dollars ($250,000) for each subject fiscal
quarter, exclusive of any federal matching funds.
(B) To pay for the health care coverage, as described in
subdivision (g), except that for the two subject fiscal quarters in
the 2013-14 fiscal year, the amount for children's health care
coverage shall be one hundred fifty-five million dollars
($155,000,000) for each subject fiscal quarter, exclusive of any
federal matching funds.
(C) To make increased capitation payments to managed health care
plans pursuant to this article and Section 14169.82, including the
nonfederal share of capitation payments to managed health care plans
pursuant to this article and Section 14169.82 for services provided
to 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)).
(D) To make increased payments and direct grants to hospitals
pursuant to this article and Section 14169.83, including the
nonfederal share of payments to hospitals under this article and
Section 14169.83 for services provided to 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)).
(2) Notwithstanding subdivision (c) of Section 14167.35,
subdivision (b) of Section 14168.33, and subdivision (b) of Section
14169.33, and notwithstanding Section 13340 of the Government Code,
the moneys in the fund shall be continuously appropriated during the
first program period only, without regard to fiscal year, for the
purposes of this article, Article 5.229 (commencing with Section
14169.31), Article 5.228 (commencing with Section 14169.1), Article
5.227 (commencing with Section 14168.31), former Article 5.226
(commencing with Section 14168.1), former Article 5.22 (commencing
with Section 14167.31), and former Article 5.21 (commencing with
Section 14167.1).
(3) For subsequent program periods, the moneys in the fund shall
be used, upon appropriation by the Legislature in the annual Budget
Act, for the purposes of this article and Sections 14169.82 and
14169.83.
(c) Any amounts of the quality assurance fee collected in excess
of the funds required to implement subdivision (b), including any
funds recovered under subdivision (d) of Section 14169.61, shall be
refunded to general acute care hospitals, pro rata with the amount of
quality assurance fee paid by the hospital, subject to the
limitations of federal law. If federal rules prohibit the refund
described in this subdivision, the excess funds shall be used as
quality assurance fees for the next program period for general acute
care hospitals, pro rata with the amount of quality assurance fees
paid by the hospital for the program period.
(d) Any methodology or other provision specified in this article
may be modified by the department, in consultation with the hospital
community, to the extent necessary to meet the requirements of
federal law or regulations to obtain federal approval or to enhance
the probability that federal approval can be obtained, provided the
modifications do not violate the spirit, purposes, and intent of this
article and are not inconsistent with the conditions of
implementation set forth in Section 14169.72. The department shall
notify the Joint Legislative Budget Committee and the fiscal and
appropriate policy committees of the Legislature 30 days prior to
implementation of a modification pursuant to this subdivision.
(e) The department, in consultation with the hospital community,
shall make adjustments, as necessary, to the amounts calculated
pursuant to Section 14169.52 in order to ensure compliance with the
federal requirements set forth in Section 433.68 of Title 42 of the
Code of Federal Regulations or elsewhere in federal law.
(f) The department shall request approval from the federal Centers
for Medicare and Medicaid Services for the implementation of this
article. In making this request, the department shall seek specific
approval from the federal Centers for Medicare and Medicaid Services
to exempt providers identified in this article as exempt from the
fees specified, including the submission, as may be necessary, of a
request for waiver of the broad-based requirement, waiver of the
uniform fee requirement, or both, pursuant to paragraphs (1) and (2)
of subdivision (e) of Section 433.68 of Title 42 of the Code of
Federal Regulations.
(g) (1) For purposes of this subdivision, the following
definitions shall apply:
(A) "Actual net benefit" means the net benefit determined by the
department for a net benefit period after the conclusion of the net
benefit period using payments and grants actually made, and fees
actually collected, for the net benefit period.
(B) "Aggregate fees" means the aggregate fees collected from
hospitals under this article.
(C) "Aggregate payments" means the aggregate payments and grants
made directly or indirectly to hospitals under this article,
including payments and grants described in Sections 14169.54,
14169.55, 14169.57, and 14169.58, and subdivision (b) of Section
14169.82.
(D) "Net benefit" means the aggregate payments for a net benefit
period minus the aggregate fees for the net benefit period.
(E) "Net benefit period" means a
subject fiscal year or portion thereof that is in a program period
and begins on or after July 1, 2014.
(F) "Preliminary net benefit" means the net benefit determined by
the department for a net benefit period prior to the beginning of
that net benefit period using estimated or projected data.
(2) The amount of funding provided for children's health care
coverage under subdivision (b) for a net benefit period shall be
equal to 24 percent of the net benefit for that net benefit period.
(3) The department shall determine the preliminary net benefit for
all net benefit periods in the first program period before July 1,
2014. The department shall determine the preliminary net benefit for
all net benefit periods in a subsequent program period before the
beginning of the program period.
(4) The department shall determine the actual net benefit and make
the reconciliation described in paragraph (5) for each net benefit
period within six months after the date determined by the department
pursuant to subdivision (h).
(5) For each net benefit period, the department shall reconcile
the amount of moneys in the fund used for children's health coverage
based on the preliminary net benefit with the amount of the fund that
may be used for children's health coverage under this subdivision
based on the actual net benefit. For each net benefit period, any
amounts that were in the fund and used for children's health coverage
in excess of the 24 percent of the actual net benefit shall be
returned to the fund, and the amount, if any, by which 24 percent of
the actual net benefit exceeds 24 percent of the preliminary net
benefit shall be available from the fund to the department for
children's health coverage. The department shall notify the Joint
Legislative Budget Committee and the fiscal and appropriate policy
committees of the Legislature of the results of the reconciliation
for each net benefit period pursuant to this paragraph within five
working days of performing the reconciliation.
(6) The department shall make all calculations and reconciliations
required by this subdivision in consultation with the hospital
community using data that the department determines is the best data
reasonably available.
(h) After consultation with the hospital community, the department
shall determine a date upon which substantially all fees have been
paid and substantially all supplemental payments, grants, and rate
range increases have been made for a program period, which date shall
be no later than two years after the end of a program period. After
the date determined by the department pursuant to this subdivision,
no further supplemental payments shall be made under the program
period, and any fees collected with respect to the program period
shall be used for a subsequent program period consistent with this
section. Nothing in this subdivision shall affect the department's
authority to collect quality assurance fees for a program period
after the end of the program period or after the date determined by
the department pursuant to this subdivision. The department shall
notify the Joint Legislative Budget Committee and fiscal and
appropriate policy committees of that date within five working days
of the determination.
(i) Use of the fee proceeds to enhance federal financial
participation pursuant to subdivision (b) shall include use of the
proceeds to supply the nonfederal share, if any, of payments to
hospitals under this article for services provided to 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.
SEC. 29. Section 14169.55 of the Welfare and Institutions Code is
amended to read:
14169.55. (a) Private hospitals shall be paid supplemental
amounts for the provision of hospital inpatient services for each
subject fiscal quarter in a program period as set forth in this
section. The supplemental amounts shall be in addition to any other
amounts payable to hospitals with respect to those services and shall
not affect any other payments to hospitals. The inpatient
supplemental amounts shall result in payments to hospitals that equal
the applicable federal upper payment limit for the subject fiscal
year, except that with respect to a subject fiscal year that begins
before the start of a program period or that ends after the end of
the program period for which the payments are made, the inpatient
supplemental amounts shall result in payments to hospitals that equal
a percentage of the applicable upper payment limit where the
percentage equals the percentage of the subject fiscal year that
occurs during the program period.
(b) Except as set forth in subdivisions (e) and (f), each private
hospital shall be paid the sum of the following amounts as applicable
for the provision of hospital inpatient services for each subject
fiscal quarter:
(1) A general acute care per diem supplemental rate multiplied by
the hospital's general acute care days.
(2) An acute psychiatric per diem supplemental rate multiplied by
the hospital's acute psychiatric days.
(3) A high acuity per diem supplemental rate multiplied by the
number of the hospital's high acuity days if the hospital's Medicaid
inpatient utilization rate is less than the percent required to be
eligible to receive disproportionate share replacement funds for the
state fiscal year ending in the base calendar year and greater than 5
percent and at least 5 percent of the hospital's general acute care
days are high acuity days.
(4) A high acuity trauma per diem supplemental rate multiplied by
the number of the hospital's high acuity days if the hospital
qualifies to receive the amount set forth in paragraph (3) and has
been designated as a Level I, Level II, Adult/Ped Level I, or
Adult/Ped Level II trauma center by the Emergency Medical Services
Authority established pursuant to Section 1797.1 of the Health and
Safety Code.
(5) A transplant per diem supplemental rate multiplied by the
number of the hospital's transplant days if the hospital's Medicaid
inpatient utilization rate is less than the percent required to be
eligible to receive disproportionate share replacement funds for the
state fiscal year ending in the base calendar year and greater than 5
percent.
(6) A payment for hospital inpatient services equal to the
subacute supplemental rate multiplied by the Medi-Cal subacute
payments as reflected in the state paid claims file prepared by the
department as of the retrieval date for the base calendar year if the
private hospital provided Medi-Cal subacute services during the base
calendar year.
(c) In the event federal financial participation for a subject
fiscal year is not available for all of the supplemental amounts
payable to private hospitals under subdivision (b) due to the
application of an upper payment limit or for any other reason, both
of the following shall apply:
(1) The total amount payable to private hospitals under
subdivision (b) for the subject fiscal year shall be reduced to
reflect the amount for which federal financial participation is
available.
(2) The amount payable under subdivision (b) to each private
hospital for the subject fiscal year shall be equal to the amount
computed under subdivision (b) multiplied by the ratio of the total
amount for which federal financial participation is available to the
total amount computed under subdivision (b).
(d) If the amount otherwise payable to a hospital under this
section for a subject fiscal year exceeds the amount for which
federal financial participation is available for that hospital, the
amount due to the hospital for that subject fiscal year shall be
reduced to the amount for which federal financial participation is
available.
(e) Payments shall not be made under this section for the periods
when a hospital is a new hospital during a program period.
(f) Payments shall be made to a converted hospital that converts
during a subject fiscal quarter by multiplying the hospital's
supplemental payment as calculated in subdivision (b) by the number
of days that the hospital was a private hospital in the subject
fiscal quarter, divided by the number of days in the subject fiscal
quarter. Payments shall not be made to a converted hospital in any
subsequent subject fiscal quarter.
SEC. 30. Section 14169.56 of the Welfare and Institutions Code is
amended to read:
14169.56. (a) The department shall increase capitation payments
to Medi-Cal managed health care plans for each subject fiscal year as
set forth in this section.
(b) (1) Subject to the limitation in paragraph (2), the increased
capitation payments shall be made as part of the monthly capitated
payments made by the department to managed health care plans. The
aggregate amount of increased capitation payments to all Medi-Cal
managed health care plans for each subject fiscal year, or portion
thereof, shall be the maximum amount for which federal financial
participation is available on an aggregate statewide basis for the
applicable subject fiscal year within a program period, or portion
thereof.
(2) (A) The limitation in subparagraph (B) shall be applied with
respect to a subject fiscal year or portion thereof for which the
federal matching assistance percentage is less than 90 percent for
expenditures for services furnished to 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)).
(B) During a subject fiscal year or portion thereof described in
subparagraph (A), the aggregate amount of the increased capitation
payments under this section shall not exceed the aggregate amount of
the increased capitation payments that would be made if the
nonfederal share of the increased capitation payments were the amount
that the nonfederal share would have been if the federal matching
assistance percentage were 90 percent for expenditures for services
furnished to 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)).
(c) The department shall determine the amount of the increased
capitation payments for each managed health care plan for each
subject fiscal year or portion thereof during a program period. The
department shall consider the composition of Medi-Cal enrollees in
the plan, the anticipated utilization of hospital services by the
plan's Medi-Cal enrollees, and other factors that the department
determines are reasonable and appropriate to ensure access to
high-quality hospital services by the plan's enrollees.
(d) The amount of increased capitation payments to each Medi-Cal
managed health care plan shall not exceed an amount that results in
capitation payments that are certified by the state's actuary as
meeting federal requirements, taking into account the requirement
that all of the increased capitation payments under this section
shall be paid by the Medi-Cal managed health care plans to hospitals
for hospital services to Medi-Cal enrollees of the plan.
(e) (1) The increased capitation payments to managed health care
plans under this section shall be made to support the availability of
hospital services and ensure access to hospital services for
Medi-Cal beneficiaries. The increased capitation payments to managed
health care plans shall commence within 90 days after the date on
which all necessary federal approvals have been received, and shall
include, but not be limited to, the sum of the increased payments for
all prior months for which payments are due.
(2) To secure the necessary funding for the payment or payments
made pursuant to paragraph (1), the department may accumulate funds
in the fund, for the purpose of funding managed health care
capitation payments under this article regardless of the date on
which capitation payments are scheduled to be paid in order to secure
the necessary total funding for managed health care payments by the
end of a program period.
(f) Payments to managed health care plans that would be paid
consistent with actuarial certification and enrollment in the absence
of the payments made pursuant to this section, including, but not
limited to, payments described in Section 14182.15, shall not be
reduced as a consequence of payments under this section.
(g) (1) Each managed health care plan shall expend 100 percent of
any increased capitation payments it receives under this section on
hospital services as provided in Section 14169.57.
(2) The department may issue change orders to amend contracts with
managed health care plans as needed to adjust monthly capitation
payments in order to implement this section.
(3) For entities contracting with the department pursuant to
Article 2.91 (commencing with Section 14089), any incremental
increase in capitation rates pursuant to this section shall not be
subject to negotiation and approval by the department.
(h) (1) In the event federal financial participation is not
available for all of the increased capitation payments determined for
a month pursuant to this section for any reason, the increased
capitation payments mandated by this section for that month shall be
reduced proportionately to the amount for which federal financial
participation is available.
(2) The determination under this subdivision for any month in a
program period shall be made after accounting for all federal
financial participation necessary for full implementation of Section
14182.15 for that month.
SEC. 31. Section 14169.58 of the Welfare and Institutions Code is
amended to read:
14169.58. (a) (1) For the first program period, designated public
hospitals shall be paid direct grants in support of health care
expenditures, which shall not constitute Medi-Cal payments, and which
shall be funded by the quality assurance fee set forth in this
article. For the first program period, the aggregate amount of the
grants to designated public hospitals funded by the quality assurance
fee set forth in this article shall be forty-five million dollars
($45,000,000) in the aggregate for the two subject fiscal quarters in
the 2013-14 subject fiscal year, ninety-three million dollars
($93,000,000) for the 2014-15 subject fiscal year, one hundred ten
million five hundred thousand dollars ($110,500,000) for the 2015-16
subject fiscal year, and sixty-two million five hundred thousand
dollars ($62,500,000) in the aggregate for the two subject fiscal
quarters in the 2016-17 subject fiscal year.
(2) (A) Of the direct grant amounts set forth in paragraph (1),
the director shall allocate twenty-four million five hundred thousand
dollars ($24,500,000) in the aggregate for the two subject fiscal
quarters in the 2013-14 subject fiscal year, fifty million five
hundred thousand dollars ($50,500,000) for the 2014-15 subject fiscal
year, sixty million five hundred thousand dollars ($60,500,000) for
the 2015-16 subject fiscal year, and thirty-four million five hundred
thousand dollars ($34,500,000) in the aggregate for the two subject
fiscal quarters in the 2016-17 subject fiscal year among the
designated public hospitals pursuant to a methodology developed in
consultation with the designated public hospitals.
(B) Of the direct grant amounts set forth in subparagraph (A), the
director shall distribute six million one hundred twenty-five
thousand dollars ($6,125,000) for each subject fiscal quarter in the
2013-14 subject fiscal year, six million three hundred twelve
thousand five hundred dollars ($6,312,500) for each subject fiscal
quarter in the 2014-15 subject fiscal year, seven million five
hundred sixty-two thousand five hundred dollars ($7,562,500) for each
subject fiscal quarter in the 2015-16 subject fiscal year, and eight
million six hundred twenty-five thousand dollars ($8,625,000) for
each subject fiscal quarter in the 2016-17 subject fiscal year in
accordance with the timeframes specified in subdivision (a) of
Section 14169.66.
(C) Of the direct grant amounts set forth in subparagraph (A), the
director shall distribute six million one hundred twenty-five
thousand dollars ($6,125,000) for each subject fiscal quarter in the
2013-14 subject fiscal year, six million three hundred twelve
thousand five hundred dollars ($6,312,500) for each subject fiscal
quarter in the 2014-15 subject fiscal year, seven million five
hundred sixty-two thousand five hundred dollars ($7,562,500) for each
subject fiscal quarter in the 2015-16 subject fiscal year, and eight
million six hundred twenty-five thousand dollars ($8,625,000) for
each subject fiscal quarter in the 2016-17 subject fiscal year only
upon 100 percent of the rate range increases being distributed to
managed health care plans pursuant to subparagraph (D) for the
respective subject fiscal quarter. If the rate range increases
pursuant to subparagraph (D) are distributed to managed health care
plans, the direct grant amounts described in this subparagraph shall
be distributed to designated public hospitals no later than 30 days
after the rate range increases have been distributed to managed
health care plans pursuant to subparagraph (D).
(D) Of the direct grant amounts set forth in paragraph (1), twenty
million five hundred thousand dollars ($20,500,000) in the aggregate
for the two subject fiscal quarters in the 2013-14 subject fiscal
year, forty-two million five hundred thousand dollars ($42,500,000)
for the 2014-15 subject fiscal year, fifty million dollars
($50,000,000) for the 2015-16 subject fiscal year, and twenty-eight
million dollars ($28,000,000) in the aggregate for the two subject
fiscal quarters in the 2016-17 subject fiscal year shall be withheld
from payment to the designated public hospitals by the director, and
shall be used as the nonfederal share for rate range increases, as
defined in paragraph (4) of subdivision (b) of Section 14301.4, to
risk-based payments to managed care health plans that contract with
the department to serve counties where a designated public hospital
is located. The rate range increases shall apply to managed care
rates for beneficiaries other than newly eligible beneficiaries, as
defined in subdivision (s) of Section 17612.2, and shall enable plans
to compensate hospitals for Medi-Cal health services and to support
the Medi-Cal program. Each managed health care plan shall expend 100
percent of the rate range increases on hospital services within 30
days of receiving the increased payments. Rate range increases funded
under this subparagraph shall be allocated among plans pursuant to a
methodology developed in consultation with the hospital community.
(3) Notwithstanding any other provision of law, any amounts
withheld from payment to the designated public hospitals by the
director as the nonfederal share for rate range increases, including
those described in subparagraph (D) of paragraph (2), shall not be
considered hospital fee direct grants as defined under subdivision
(k) of Section 17612.2 and shall not be included in the determination
under paragraph (1) of subdivision (a) of Section 17612.3.
(b) (1) For the first program period, nondesignated public
hospitals shall be paid direct grants in support of health care
expenditures, which shall not constitute Medi-Cal payments, and which
shall be funded by the quality assurance fee set forth in this
article. For the first program period, the aggregate amount of the
grants funded by the quality assurance fee set forth in this article
to nondesignated public hospitals shall be twelve million five
hundred thousand dollars ($12,500,000) in the aggregate for two
subject fiscal quarters in the 2013-14 subject fiscal year,
twenty-five million dollars ($25,000,000) for the 2014-15 subject
fiscal year, thirty million dollars ($30,000,000) for the 2015-16
subject fiscal year, and seventeen million five hundred thousand
dollars ($17,500,000) in the aggregate for the two subject fiscal
quarters in the 2016-17 subject fiscal year.
(2) (A) Of the direct grant amounts set forth in paragraph (1),
the director shall allocate two million five hundred thousand dollars
($2,500,000) in the aggregate for the two subject fiscal quarters in
the 2013-14 subject fiscal year, five million dollars ($5,000,000)
for the 2014-15 subject fiscal year, six million dollars ($6,000,000)
for the 2015-16 subject fiscal year, and three million five hundred
thousand dollars ($3,500,000) in the aggregate for the two subject
fiscal quarters in the 2016-17 subject fiscal year among the
nondesignated public hospitals pursuant to a methodology developed in
consultation with the nondesignated public hospitals.
(B) Of the direct grant amounts set forth in paragraph (1), ten
million dollars ($10,000,000) in the aggregate for the two subject
fiscal quarters in the 2013-14 subject fiscal year, twenty million
dollars ($20,000,000) for the 2014-15 subject fiscal year,
twenty-four million dollars ($24,000,000) for the 2015-16 subject
fiscal year, and fourteen million dollars ($14,000,000) in the
aggregate for the two subject fiscal quarters in the 2016-17 subject
fiscal year shall be withheld from payment to the nondesignated
public hospitals by the director, and shall be used as the nonfederal
share for rate range increases, as defined in paragraph (4) of
subdivision (b) of Section 14301.4, to risk-based payments to managed
care health plans that contract with the department. The rate range
increases shall enable plans to compensate hospitals for Medi-Cal
health services and to support the Medi-Cal program. Each managed
health care plan shall expend 100 percent of the rate range increases
on hospital services within 30 days of receiving the increased
payments. Rate range increases funded under this subparagraph shall
be allocated among plans pursuant to a methodology developed in
consultation with the hospital community.
(c) If the amounts set forth in this section for rate range
increases are not actually used for rate range increases as described
in this section, the direct grant amounts set forth in this section
that are withheld pursuant to subparagraph (D) of paragraph (2) of
subdivision (a) and subparagraph (B) of paragraph (2) of subdivision
(b) shall be returned to the fund subject to paragraph (4) of
subdivision (l) of Section 14169.52.
(d) For subsequent program periods, designated public hospitals
and nondesignated public hospitals may be paid direct grants pursuant
to subdivision (e) of Section 14169.59 upon appropriation in the
annual Budget Act.
SEC. 32. Section 14169.59 of the Welfare and Institutions Code is
amended to read:
14169.59. (a) The department shall determine during each rebase
calculation year the number of subject fiscal years in the next
program period.
(b) During each rebase calculation year, the department shall
retrieve the data, including, but not limited to, the days data
source, used to determine the following for the subsequent program
period: acute psychiatric days, annual fee-for-service days, annual
managed care days, annual Medi-Cal days, fee-for-service days,
general acute care days, high acuity days, managed care days,
Medi-Cal days, Medi-Cal fee-for-service days, Medi-Cal managed care
days, Medi-Cal managed care fee days, outpatient base amount, and
transplant days. The department shall pull data from the most recent
base calendar year for which the department determines reliable data
is available for all hospitals.
(c) (1) During each rebase calculation year, the department shall
determine all of the following supplemental payment rates for the
subsequent program period, which supplemental payment rates shall be
specified in provisional language in the annual Budget Act:
(A) The acute psychiatric per diem supplemental rate for each
subject fiscal year during the program period.
(B) The general acute care per diem supplemental rate for each
subject fiscal year during the program period.
(C) The high acuity per diem supplemental rate for each subject
fiscal year during the program period.
(D) The high acuity trauma per diem supplemental rate for each
subject fiscal year during the program period.
(E) The outpatient supplemental rate for each subject fiscal year
during the program period.
(F) The subacute supplemental rate for each subject fiscal year
during the program period.
(G) The transplant per diem supplemental rate for each subject
fiscal year during the program period.
(2) During each rebase calculation year, the department shall
determine all of the following fee rates for the subsequent program
period, which fee rates shall be specified in provisional language in
the annual Budget Act:
(A) The fee-for-service per diem quality assurance fee rate for
each subject fiscal year during the program period.
(B) The managed care per diem quality assurance fee rate for each
subject fiscal year during the program period.
(C) The Medi-Cal per diem quality assurance fee rate for each
subject fiscal year during the program period.
(D) The prepaid health plan hospital managed care per diem quality
assurance fee rate for each subject fiscal year during the program
period.
(E) The prepaid health plan hospital Medi-Cal managed care per
diem quality assurance fee rate for each subject fiscal year during
the program period.
(d) The department shall determine the rates set forth in
subdivision (c) based on the data retrieved pursuant to subdivision
(b). Each rate determined by the department shall be the same for all
hospitals to which the rate applies. These rates shall be specified
in provisional language in the annual Budget Act. The department
shall determine the rates in accordance with all of the following:
(1) The rates shall meet the requirements of federal law and be
established in a manner to obtain federal approval.
(2) The department shall consult with the hospital community in
determining the rates.
(3) The supplemental payments and other Medi-Cal payments for
hospital outpatient services furnished by private hospitals for each
fiscal year shall equal as close as possible the applicable federal
upper payment limit.
(4) The
supplemental payments and other Medi-Cal payments for hospital
inpatient services furnished by private hospitals for each fiscal
year shall equal as close as possible the applicable federal upper
payment limit.
(5) The increased capitation payments to managed health care plans
shall result in the maximum payments to the plans permitted by
federal law.
(6) The quality assurance fee proceeds shall be adequate to make
the expenditures described in this article, but shall not be more
than necessary to make the expenditures.
(7) The relative values of per diem supplemental payment rates to
one another for the various categories of patient days shall be
generally consistent with the relative values during the first
program period under this article.
(8) The relative values of per diem fee rates to one another for
the various categories of patient days shall be generally consistent
with the relative values during the first program period under this
article.
(9) The rates shall result in supplemental payments and quality
assurance fees that are consistent with the purposes of this article.
(e) During each rebase calculation year, the director shall
determine the amounts and allocation methodology, if any, of direct
grants to designated public hospitals and nondesignated public
hospitals for each subject fiscal year in a program period, in
consultation with the hospital community. The amounts and allocation
methodology may include a withholding of direct grants to be used as
the nonfederal share for rate range increases. These amounts shall be
specified in provisional language in the annual Budget Act.
(f) (1) Notwithstanding any other provision in this article, the
following shall apply to the first program period under this article:
(A) The first program period under this article shall be the
period from January 1, 2014, to December 31, 2016, inclusive.
(B) The acute psychiatric days shall be those identified in the
Final Medi-Cal Utilization Statistics for the 2012-13 state fiscal
year as calculated by the department as of December 17, 2012.
(C) The days data source shall be the hospital's Annual Financial
Disclosure Report filed with the Office of Statewide Health Planning
and Development as of June 6, 2013, for its fiscal year ending during
the 2010 calendar year.
(D) The general acute care days shall be those identified in the
2010 calendar year, as reflected in the state paid claims file on
April 26, 2013.
(E) The high acuity days shall be those paid during the 2010
calendar year, as reflected in the state paid claims file prepared by
the department on April 26, 2013.
(F) The Medi-Cal managed care days shall be those identified in
the Final Medi-Cal Utilization Statistics for the 2012-13 fiscal
year, as calculated by the department as of December 17, 2012.
(G) The outpatient base amount shall be those payments for
outpatient services made to a hospital in the 2010 calendar year, as
reflected in the state paid claims files prepared by the department
on April 26, 2013.
(H) The transplant days shall be those identified in the 2010
Patient Discharge Data File Documentation from the Office of
Statewide Health Planning and Development accessed on June 28, 2011.
(I) With respect to a hospital described in subdivision (f) of
Section 14165.50, both of the following shall apply:
(i) The hospital shall not be considered a new hospital as defined
in Section 14169.51 for the purposes of this article.
(ii) To the extent permitted by federal law and other federal
requirements, the department shall use the best available and
reasonable current estimates or projections made with respect to the
hospital for an annual period as the data, including, but not limited
to, the days data source and data described as being derived from a
state paid claims file, used for all purposes, including, but not
limited to, the calculation of supplemental payments and the quality
assurance fee. The estimates and projections shall be deemed to
reflect paid claims and shall be used for each data element
regardless of the time period otherwise applicable to the data
element. The data elements include, but are not limited to, acute
psychiatric days, annual fee-for-service days, annual managed care
days, annual Medi-Cal days, fee-for-service days, general acute care
days, high acuity days, managed care days, Medi-Cal days, Medi-Cal
fee-for-service days, Medi-Cal managed care days, Medi-Cal managed
care fee days, outpatient base amount, and transplant days.
(2) Notwithstanding any other provision in this article, the
following shall apply to determine the supplemental payment rates for
the first program period:
(A) The acute psychiatric per diem supplemental rate shall be nine
hundred sixty-five dollars ($965) for the two remaining subject
fiscal quarters in the 2013-14 subject fiscal year, nine hundred
seventy dollars ($970) for the subject fiscal quarters in the 2014-15
subject fiscal year, nine hundred seventy-five dollars ($975) for
the subject fiscal quarters in the 2015-16 subject fiscal year and
nine hundred seventy-five dollars ($975) for the first two subject
fiscal quarters in the 2016-17 subject fiscal year.
(B) The general acute care per diem supplemental rate shall be
eight hundred twenty-four dollars and forty cents ($824.40) for the
two remaining subject fiscal quarters in the 2013-14 subject fiscal
year, one thousand one hundred ten dollars and sixty-seven cents
($1,110.67) for the subject fiscal quarters in the 2014-15 subject
fiscal year, one thousand three hundred thirty-five dollars and
forty-two cents ($1,335.42) for the subject fiscal quarters in the
2015-16 subject fiscal year, and one thousand four hundred forty-one
dollars and twenty cents ($1,441.20) for the first two subject fiscal
quarters in the 2016-17 subject fiscal year.
(C) The high acuity per diem supplemental rate shall be two
thousand five hundred dollars ($2,500) for the two remaining subject
fiscal quarters in the 2013-14 subject fiscal year, two thousand five
hundred dollars ($2,500) for the subject fiscal quarters in the
2014-15 subject fiscal year, two thousand five hundred dollars
($2,500) for the subject fiscal quarters in the 2015-16 subject
fiscal year, and two thousand five hundred dollars ($2,500) for the
first two subject fiscal quarters in the 2016-17 subject fiscal year.
(D) The high acuity trauma per diem supplemental rate shall be two
thousand five hundred dollars ($2,500) for the two remaining subject
fiscal quarters in the 2013-14 subject fiscal year, two thousand
five hundred dollars ($2,500) for the subject fiscal quarters in the
2014-15 subject fiscal year, two thousand five hundred dollars
($2,500) for the subject fiscal quarters in the 2015-16 subject
fiscal year, and two thousand five hundred dollars ($2,500) for the
first two subject fiscal quarters in the 2016-17 subject fiscal year.
(E) The outpatient supplemental rate shall be 119 percent of the
outpatient base amount for the two remaining subject fiscal quarters
in the 2013-14 subject fiscal year, 268 percent of the outpatient
base amount for the subject fiscal quarters in the 2014-15 subject
fiscal year, 292 percent of the outpatient base amount for the
subject fiscal quarters in the 2015-16 subject fiscal year, and 151
percent of the outpatient base amount for the first two subject
fiscal quarters in the 2016-17 subject fiscal year.
(F) The subacute supplemental rate shall be 50 percent for the two
remaining subject fiscal quarters in the 2013-14 subject fiscal
year, 55 percent for the subject fiscal quarters in the 2014-15
subject fiscal year, 60 percent for the subject fiscal quarters in
the 2015-16 subject fiscal year, and 60 percent for the first two
subject fiscal quarters in the 2016-17 subject fiscal year of the
Medi-Cal subacute payments paid by the department to the hospital
during the 2010 calendar year, as reflected in the state paid claims
file prepared by the department on April 26, 2013.
(G) The transplant per diem supplemental rate shall be two
thousand five hundred dollars ($2,500) for the two remaining subject
fiscal quarters in the 2013-14 subject fiscal year, two thousand five
hundred dollars ($2,500) for the subject fiscal quarters in the
2014-15 subject fiscal year, two thousand five hundred dollars
($2,500) for the subject fiscal quarters in the 2015-16 subject
fiscal year, and two thousand five hundred dollars ($2,500) for the
first two subject fiscal quarters in the 2016-17 subject fiscal year.
(3) Notwithstanding any other provision in this article, the
following shall apply to determine the fee rates for the first
program period:
(A) The fee-for-service per diem quality assurance fee rate shall
be three hundred seventy-four dollars and ninety-one cents ($374.91)
for the two remaining subject fiscal quarters in the 2013-14 subject
fiscal year, four hundred twenty-five dollars and twenty-two cents
($425.22) for the subject fiscal quarters in the 2014-15 subject
fiscal year, four hundred eighty dollars and eleven cents ($480.11)
for the subject fiscal quarters in the 2015-16 subject fiscal year,
and five hundred forty-two dollars and ten cents ($542.10) for the
first two subject fiscal quarters in the 2016-17 subject fiscal year.
(B) The managed care per diem quality assurance fee rate shall be
one hundred forty-five dollars ($145) for the two remaining subject
fiscal quarters in the 2013-14 subject fiscal year, one hundred
forty-five dollars ($145) for the subject fiscal quarters in the
2014-15 subject fiscal year, one hundred seventy dollars ($170) for
the subject fiscal quarters in the 2015-16 subject fiscal year, and
one hundred seventy dollars ($170) for the first two subject fiscal
quarters in the 2016-17 subject fiscal year.
(C) The Medi-Cal per diem quality assurance fee rate shall be four
hundred fifty-seven dollars and ten cents ($457.10) for the two
remaining subject fiscal quarters in the 2013-14 subject fiscal year,
four hundred ninety-seven dollars and eight cents ($497.08) for the
subject fiscal quarters in the 2014-15 subject fiscal year, five
hundred sixty-eight dollars and fifteen cents ($568.15) for the
subject fiscal quarters in the 2015-16 subject fiscal year, and six
hundred eighteen dollars and fourteen cents ($618.14) for the first
two subject fiscal quarters in the 2016-17 subject fiscal year.
(D) The prepaid health plan hospital managed care per diem quality
assurance fee rate shall be eighty-one dollars and twenty cents
($81.20) for the two remaining subject fiscal quarters in the 2013-14
subject fiscal year, eighty-one dollars and twenty cents ($81.20)
for the subject fiscal quarters in the 2014-15 subject fiscal year,
ninety-five dollars and twenty cents ($95.20) for the subject fiscal
quarters in the 2015-16 subject fiscal year, and ninety-five dollars
and twenty cents ($95.20) for the first two subject fiscal quarters
in the 2016-17 subject fiscal year.
(E) The prepaid health plan hospital Medi-Cal managed care per
diem quality assurance fee rate shall be two hundred fifty-five
dollars and ninety-seven cents ($255.97) for the two remaining
subject fiscal quarters in the 2013-14 subject fiscal year, two
hundred seventy-eight dollars and thirty-seven cents ($278.37) for
the subject fiscal quarters in the 2014-15 subject fiscal year, three
hundred eighteen dollars and sixteen cents ($318.16) for the subject
fiscal quarters in the 2015-16 subject fiscal year, and three
hundred forty-six dollars and sixteen cents ($346.16) for the first
two subject fiscal quarters in the 2016-17 subject fiscal year.
(F) Upon federal approval or conditional federal approval
described in Section 14169.63, the director shall have the discretion
to revise the fee-for-service per diem quality assurance fee rate,
the managed care per diem quality assurance fee rate, the Medi-Cal
per diem quality assurance fee rate, the prepaid health plan hospital
managed care per diem quality assurance fee rate, or the prepaid
health plan hospital Medi-Cal managed care per diem quality assurance
fee rate, based on the funds required to make the payments specified
in this article, in consultation with the hospital community.
(g) Notwithstanding any other provision in this article, the
following shall apply to the second program period under this
article:
(1) The second program period under this article shall begin on
January 1, 2017, and shall end on June 30, 2019.
(2) The retrieval date shall occur between October 1, 2016, and
December 31, 2016.
(3) The base calendar year shall be the 2013 calendar year, or a
more recent calendar year for which the department determines
reliable data is available.
(4) The rebase calculation year shall be the 2015-16 state fiscal
year.
(5) With respect to a hospital described in subdivision (f) of
Section 14165.50, both of the following shall apply:
(A) The hospital shall not be considered a new hospital as defined
in subdivision (ai) of Section 14169.51 for the purposes of this
article.
(B) To the extent permitted by federal law or other federal
requirements, the department shall use the best available and
reasonable current estimates or projections made with respect to the
hospital for an annual period as to the data, including, but not
limited to, the days data source and data described as being derived
from a state paid claims file, used for all purposes, including, but
not limited to, the calculation of supplemental payments and the
quality assurance fee. The estimates and projections shall be deemed
to reflect paid claims and shall be used for each data element
regardless of the time period otherwise applicable to the data
element. The data elements include, but are not limited to, acute
psychiatric days, annual fee-for-service days, annual managed care
days, annual Medi-Cal days, fee-for-service days, general acute care
days, high acuity days, managed care days, Medi-Cal days, Medi-Cal
fee-for-service days, Medi-Cal managed care days, Medi-Cal managed
care fee days, outpatient base amount, and transplant days.
(h) Commencing January 2016, the department shall provide a clear
narrative description along with fiscal detail in the Medi-Cal
estimate package, submitted to the Legislature in January and May of
each year, of all of the calculations made by the department pursuant
to this section for the second program period and every program
period thereafter.
SEC. 33. Section 14169.61 of the Welfare and Institutions Code is
amended to read:
14169.61. (a) (1) Except as provided in this section, all data
and other information relating to a hospital that are used for the
purposes of this article, including, without limitation, the days
data source, shall continue to be used to determine the payments to
that hospital, regardless of whether the hospital has undergone one
or more changes of ownership.
(2) All supplemental payments to a hospital under this article
shall be made to the licensee of a hospital on the date the
supplemental payment is made. All quality assurance fee payments
under this article shall be paid by the licensee of a hospital on the
date the quarterly quality assurance fee payment is due.
(b) The data of separate facilities prior to a consolidation shall
be aggregated for the purposes of this article if: (1) a private
hospital consolidates with another private hospital, (2) the
facilities operate under a consolidated hospital license, (3) data
for a period prior to the consolidation is used for purposes of this
article, and (4) neither hospital has had a change of ownership on or
after the effective date of this article unless paragraph (2) of
subdivision (d) has been satisfied by the new owner. Data of a
facility that was a separately licensed hospital prior to the
consolidation shall not be included in the data, including the days
data source, for the purpose of determining payments to the facility
or the quality assurance fees due from the facility under the article
for any time period during which the facility is closed. A facility
shall be deemed to be closed for purposes of this subdivision on the
first day of any period during which the facility has no general
acute, psychiatric, or rehabilitation inpatients for at least 30
consecutive days. A facility that has been deemed to be closed under
this subdivision shall no longer be deemed to be closed on the first
subsequent day on which it has general acute, psychiatric, or
rehabilitation inpatients.
(c) The payments to a hospital under this article shall not be
made, and the quality assurance fees shall not be due, for any period
during which the hospital is closed. A hospital shall be deemed to
be closed on the first day of any period during which the hospital
has no general acute, psychiatric, or rehabilitation inpatients for
at least 30 consecutive days. A hospital that has been deemed to be
closed under this subdivision shall no longer be deemed to be closed
on the first subsequent day on which it has general acute,
psychiatric, or rehabilitation inpatients. Payments under this
article to a hospital and installment payments of the aggregate
quality assurance fee due from a hospital that is closed during any
portion of a subject fiscal quarter shall be reduced by applying a
fraction, expressed as a percentage, the numerator of which shall be
the number of days during the applicable subject fiscal quarter that
the hospital is closed during the subject fiscal year and the
denominator of which shall be the number of days in the subject
fiscal quarter.
(d) The following provisions shall apply only for purposes of this
article, and shall have no application outside of this article nor
shall they affect the assumption of any outstanding monetary
obligation to the Medi-Cal program:
(1) The director shall develop and describe in provider bulletins
and on the department's Internet Web site a process by which the new
operator of a hospital that has a days data source in whole or in
part from a previous operator may enter into an agreement with the
department to confirm that it is financially responsible or to become
financially responsible to the department for the outstanding
monetary obligation to the Medi-Cal program of the previous operator
in order to avoid being classified as a new hospital for purposes of
this article. This process shall be available for changes of
ownership that occur before, on, or after January 1, 2014, but only
in regard to payments under this article and otherwise shall have no
retroactive effect.
(2) The outstanding monetary obligation referred to in subdivision
(ai) of Section 14169.51 shall include responsibility for all of the
following:
(A) Payment of the quality assurance fee established pursuant to
this article.
(B) Known overpayments that have been asserted by the department
or its fiscal intermediary by sending a written communication that is
received by the hospital prior to the date that the new operator
becomes the licensee of the hospital.
(C) Overpayments that are asserted after such date and arise from
customary reconciliations of payments, such as cost report
settlements, and, with the exception of overpayments described in
subparagraph (B), shall exclude liabilities arising from the
fraudulent or intentionally criminal act of a prior operator if the
new operator did not knowingly participate in or continue the
fraudulent or criminal act after becoming the licensee.
(3) The department shall have the discretion to determine whether
the new owner properly and fully agreed to be financially responsible
for the outstanding monetary obligation in connection with the
Medi-Cal program and seek additional assurances as the department
deems necessary, except that a new owner that executes an agreement
with the department to be financially responsible for the monetary
obligations as described in paragraph (1) shall be conclusively
deemed to have agreed to be financially responsible for the
outstanding monetary obligation in connection with the Medi-Cal
program. The department shall have the discretion to establish the
terms for satisfying the outstanding monetary obligation in
connection with the Medi-Cal program, including, but not limited to,
recoupment from amounts payable to the hospital under this section.
SEC. 34. Section 14169.63 of the Welfare and Institutions Code is
amended to read:
14169.63. (a) Notwithstanding any other provision of this article
requiring federal approvals, the department may impose and collect
the quality assurance fee and may make payments under this article,
including increased capitation payments, based upon receiving a
letter from the federal Centers for Medicare and Medicaid Services or
the United States Department of Health and Human Services that
indicates likely federal approval, but only if and to the extent that
the letter is sufficient as set forth in subdivision (b).
(b) In order for the letter to be sufficient under this section,
the director shall find that the letter meets both of the following
requirements:
(1) The letter is in writing and signed by an official of the
federal Centers for Medicare and Medicaid Services or an official of
the United States Department of Health and Human Services.
(2) The director, after consultation with the hospital community,
has determined, in the exercise of his or her sole discretion, that
the letter provides a sufficient level of assurance to justify
advanced implementation of the fee and payment provisions.
(c) Nothing in this section shall be construed as modifying the
requirement under Section 14169.69 that payments shall be made only
to the extent a sufficient amount of funds collected as the quality
assurance fee are available to cover the nonfederal share of those
payments.
(d) Upon notice from the federal government that final federal
approval for the fee model under this article or for the supplemental
payments to private hospitals under Section 14169.54 or 14169.55 has
been denied, any fees collected pursuant to this section shall be
refunded and any payments made pursuant to this article shall be
recouped, including, but not limited to, supplemental payments and
grants, increased capitation payments, payments to hospitals by
health care plans resulting from the increased capitation payments,
and payments for the health care coverage of children. To the extent
fees were paid by a hospital that also received payments under this
section, the payments may first be recouped from fees that would
otherwise be refunded to the hospital prior to the use of any other
recoupment method allowed under law.
(e) Any payment made pursuant to this section shall be a
conditional payment until final federal approval has been received.
(f) The director shall have broad authority under this section to
collect the quality assurance fee for an interim period after receipt
of the letter described in subdivision (a) pending receipt of all
necessary federal approvals. This authority shall include discretion
to determine both of the following:
(1) Whether the quality assurance fee should be collected on a
full or pro rata basis during the interim period.
(2) The dates on which payments of the quality assurance fee are
due.
(g) The department may draw against the fund for all
administrative costs associated with implementation under this
article, consistent with subdivision (b) of Section 14169.53.
(h) This section shall be implemented only to the extent federal
financial participation is not jeopardized by implementation prior to
the receipt of all necessary final federal approvals.
SEC. 35. Section 14169.65 of the Welfare and Institutions Code is
amended to read:
14169.65. (a) Upon receipt of a letter that indicates likely
federal approval that the director determines is sufficient for
implementation under Section 14169.63, or upon the receipt of federal
approval, the following shall occur:
(1) To the maximum extent possible, and consistent with the
availability of funds in the fund, the department shall make all of
the payments under Sections 14169.54, 14169.55, and 14169.56,
including, but not limited to, supplemental payments and increased
capitation payments, prior to the end of a program period, except
that the increased capitation payments under Section 14169.56 shall
not be made until federal approval is obtained for these payments.
(2) The department shall make supplemental payments to hospitals
under this article consistent with the timeframe described in Section
14169.66 or a modified timeline developed pursuant to Section
14169.64.
(b) If any payment or payments made pursuant to this section are
found to be inconsistent with federal law, the department shall
recoup the payments by means of withholding or any other available
remedy.
(c) This section shall not affect the department's ongoing
authority to continue, after the end of a program period, to collect
quality assurance fees imposed on or before the end of the program
period.
SEC. 36. Section 14169.66 of the Welfare and Institutions Code is
amended to read:
14169.66. The department shall make disbursements from the fund
consistent with the following:
(a) Fund disbursements shall be made periodically within 15 days
of each date on which quality assurance fees are due from hospitals.
(b) The funds shall be disbursed in accordance with the order of
priority set forth in subdivision (b) of Section 14169.53, except
that funds may be set aside for increased capitation payments to
managed care health plans pursuant to subdivision (e) of Section
14169.56.
(c) The funds shall be disbursed in each payment cycle in
accordance with the order of priority set forth in subdivision (b) of
Section 14169.53 as modified by subdivision (b), and so that the
supplemental payments and direct grants to hospitals and the
increased capitation payments to managed health care plans are made
to the maximum extent for which funds are available.
(d) To the maximum extent possible, consistent with the
availability of funds in the fund and the timing of federal
approvals, the supplemental payments and direct grants to hospitals
and increased capitation payments to managed health care plans under
this article shall be made before the last day of a program period.
(e) The aggregate amount of funds to be disbursed to private
hospitals shall be determined under Sections 14169.54 and 14169.55.
The aggregate amount of funds to be disbursed to managed health care
plans shall be determined under Section 14169.56. The aggregate
amount of direct grants to designated and nondesignated public
hospitals shall be determined under Section 14169.58.
SEC. 37. Section 14169.72 of the Welfare and
Institutions Code is amended to read:
14169.72. This article shall become inoperative if any of the
following occurs:
(a) The effective date of a final judicial determination made by
any court of appellate jurisdiction or a final determination by the
United States Department of Health and Human Services or the federal
Centers for Medicare and Medicaid Services that the quality assurance
fee established pursuant to this article, or Section 14169.54 or
14169.55, cannot be implemented. This subdivision shall not apply to
any final judicial determination made by any court of appellate
jurisdiction in a case brought by hospitals located outside the
state.
(b) The federal Centers for Medicare and Medicaid Services denies
approval for, or does not approve on or before the last day of a
program period, the implementation of Sections 14169.52, 14169.53,
14169.54, and 14169.55, and the department fails to modify Section
14169.52, 14169.53, 14169.54, or 14169.55 pursuant to subdivision (d)
of Section 14169.53 in order to meet the requirements of federal law
or to obtain federal approval.
(c) A final judicial determination by the California Supreme Court
or any California Court of Appeal that the revenues collected
pursuant to this article that are deposited in the fund are either of
the following:
(1) "General Fund proceeds of taxes appropriated pursuant to
Article XIII B of the California Constitution," as used in
subdivision (b) of Section 8 of Article XVI of the California
Constitution.
(2) "Allocated local proceeds of taxes," as used in subdivision
(b) of Section 8 of Article XVI of the California Constitution.
(d) The department has sought but has not received federal
financial participation for the supplemental payments and other costs
required by this article for which federal financial participation
has been sought.
(e) A lawsuit related to this article is filed against the state
and a preliminary injunction or other order has been issued that
results in a financial disadvantage to the state. For purposes of
this subdivision, "financial disadvantage to the state" means either
of the following:
(1) A loss of federal financial participation.
(2) A cost to the General Fund that is equal to or greater than
one-quarter of 1 percent of the General Fund expenditures authorized
in the most recent annual Budget Act.
(f) The proceeds of the fee and any interest and dividends earned
on deposits are not deposited into the fund or are not used as
provided in Section 14169.53.
(g) The proceeds of the fee, the matching amount provided by the
federal government, and interest and dividends earned on deposits in
the fund are not used as provided in Section 14169.68.
SEC. 38. Section 14312 of the Welfare and Institutions Code is
amended to read:
14312. The director shall adopt all necessary rules and
regulations to carry out the provisions of this chapter. In adopting
such rules and regulations, the director shall be guided by the needs
of eligible persons as well as prevailing practices in the delivery
of health care on a prepaid basis. Except where otherwise required by
federal law or by this part, the rules and regulations shall be
consistent with the requirements of the Knox-Keene Health Care
Service Plan Act of 1975.
SEC. 39. Section 14451 of the Welfare and Institutions Code is
amended to read:
14451. Services under a prepaid health plan contract shall be
provided in accordance with the requirements of the Knox-Keene Health
Care Service Plan Act of 1975.
SEC. 40. Section 15657.8 of the Welfare and Institutions Code is
amended to read:
15657.8. (a) An agreement to settle a civil action for physical
abuse, as defined in Section 15610.63, neglect, as defined in Section
15610.57, or financial abuse, as defined in Section 15610.30, of an
elder or dependent adult shall not include any of the following
provisions, whether the agreement is made before or after filing the
action:
(1) A provision that prohibits any party to the dispute from
contacting or cooperating with the county adult protective services
agency, the local law enforcement agency, the long-term care
ombudsman, the California Department of Aging, the Department of
Justice, the Licensing and Certification Division of the State
Department of Public Health, the State Department of Developmental
Services, the State Department of State Hospitals, a licensing or
regulatory agency that has jurisdiction over the license or
certification of the defendant, any other governmental entity, a
protection and advocacy agency, as defined in Section 4900, or the
defendant's current employer if the defendant's job responsibilities
include contact with elders, dependent adults, or children, provided
that the party contacting or cooperating with one of these entities
had a good faith belief that the information he or she provided is
relevant to the concerns, duties, or obligations of that entity.
(2) A provision that prohibits any party to the dispute from
filing a complaint with, or reporting any violation of law to, the
county adult protective services agency, the local law enforcement
agency, the long-term care ombudsman, the California Department of
Aging, the Department of Justice, the Licensing and Certification
Division of the State Department of Public Health, the State
Department of Developmental Services, the State Department of State
Hospitals, a licensing or regulatory agency that has jurisdiction
over the license or certification of the defendant, any other
governmental entity, a protection and advocacy agency, as defined in
Section 4900, or the defendant's current employer if the defendant's
job responsibilities include contact with elders, dependent adults,
or children.
(3) A provision that requires any party to the dispute to withdraw
a complaint he or she has filed with, or a violation he or she has
reported to, the county adult protective services agency, the local
law enforcement agency, the long-term care ombudsman, the California
Department of Aging, the Department of Justice, the Licensing and
Certification Division of the State Department of Public Health, the
State Department of Developmental Services, the State Department of
State Hospitals, a licensing or regulatory agency that has
jurisdiction over the license or certification of the defendant, any
other governmental entity, a protection and advocacy agency, as
defined in Section 4900, or the defendant's current employer if the
defendant's job responsibilities include contact with elders,
dependent adults, or children.
(b) A provision described in subdivision (a) is void as against
public policy.
(c) This section shall apply only to an agreement entered on or
after January 1, 2013.
SEC. 41. Section 16541 of the Welfare and Institutions Code is
amended to read:
16541. The council shall be comprised of the following members:
(a) The Secretary of California Health and Human Services, who
shall serve as cochair.
(b) The Chief Justice of the California Supreme Court, or his or
her designee, who shall serve as cochair.
(c) The Superintendent of Public Instruction, or his or her
designee.
(d) The Chancellor of the California Community Colleges, or his or
her designee.
(e) The executive director of the State Board of Education.
(f) The Director of Social Services.
(g) The Director of Health Care Services.
(h) The Director of State Hospitals.
(i) The Director of Developmental Services.
(j) The Director of the Youth Authority.
(k) The Administrative Director of the Courts.
(l) The State Foster Care Ombudsperson.
(m) Four foster youth or former foster youth.
(n) The chairpersons of the Assembly Human Services Committee and
the Assembly Judiciary Committee, or two other Members of the
Assembly as appointed by the Speaker of the Assembly.
(o) The chairpersons of the Senate Human Services Committee and
the Senate Judiciary Committee, or two other members appointed by the
President pro Tempore of the Senate.
(p) Leaders and representatives of county child welfare, foster
care, health, education, probation, and mental health agencies and
departments, child advocacy organizations; labor organizations,
recognized professional associations that represent child welfare and
foster care social workers, tribal representatives, and other groups
and stakeholders that provide benefits, services, and advocacy to
families and children in the child welfare and foster care systems,
as recommended by representatives of these groups and as designated
by the cochairs.
SEC. 42. This act is an urgency statute necessary for the
immediate preservation of the public peace, health, or safety within
the meaning of Article IV of the Constitution and shall go into
immediate effect. The facts constituting the necessity are:
In order to ensure the health and safety of Californians by
updating existing law consistent with current practices at the
earliest possible time, it is necessary that this act take effect
immediately.
