Bill Text: CA AB1124 | 2013-2014 | Regular Session | Chaptered
Bill Title: Medi-Cal: reimbursement rates.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Passed) 2014-03-28 - Chaptered by Secretary of State - Chapter 8, Statutes of 2014. [AB1124 Detail]
Download: California-2013-AB1124-Chaptered.html
BILL NUMBER: AB 1124 CHAPTERED
BILL TEXT
CHAPTER 8
FILED WITH SECRETARY OF STATE MARCH 28, 2014
APPROVED BY GOVERNOR MARCH 28, 2014
PASSED THE SENATE MARCH 3, 2014
PASSED THE ASSEMBLY MARCH 20, 2014
AMENDED IN SENATE FEBRUARY 14, 2014
AMENDED IN SENATE JANUARY 17, 2014
AMENDED IN SENATE JULY 2, 2013
AMENDED IN ASSEMBLY MAY 24, 2013
INTRODUCED BY Assembly Member Muratsuchi
FEBRUARY 22, 2013
An act to amend Section 14105.22 of the Welfare and Institutions
Code, relating to Medi-Cal, and declaring the urgency thereof, to
take effect immediately.
LEGISLATIVE COUNSEL'S DIGEST
AB 1124, Muratsuchi. Medi-Cal: reimbursement rates.
Existing law states the intent of the Legislature that the State
Department of Health Care Services develop Medi-Cal reimbursement
rates for clinical laboratory or laboratory services in accordance
with specified criteria. Existing law exempts from compliance with a
specified regulation laboratory providers reimbursed pursuant to any
payment reductions implemented pursuant to these provisions for 21
months following the date of implementation of this reduction, and
requires the department to adopt emergency regulations by July 1,
2014.
This bill would instead exempt these laboratory providers from
compliance with the specified regulation until July 1, 2015, and
would require the department to adopt emergency regulations by June
30, 2016.
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 14105.22 of the Welfare and Institutions Code
is amended to read:
14105.22. (a) (1) Reimbursement for clinical laboratory or
laboratory services, as defined in Section 51137.2 of Title 22 of the
California Code of Regulations, shall not exceed 80 percent of the
lowest maximum allowance established by the federal Medicare Program
for the same or similar services.
(2) This subdivision shall be implemented only until the new rate
methodology under subdivision (b) is approved by the federal Centers
for Medicare and Medicaid Services (CMS).
(b) (1) It is the intent of the Legislature that the department
develop reimbursement rates for clinical laboratory or laboratory
services that are comparable to the payment amounts received from
other payers for clinical laboratory or laboratory services.
Development of these rates will enable the department to reimburse
clinical laboratory or laboratory service providers in compliance
with state and federal law.
(2) (A) The provisions of Section 51501(a) of Title 22 of the
California Code of Regulations shall not apply to laboratory
providers reimbursed under the new rate methodology developed for
clinical laboratories or laboratory services pursuant to this
subdivision.
(B) In addition to subparagraph (A), laboratory providers
reimbursed under any payment reductions implemented pursuant to this
section shall not be subject to the provisions of Section 51501(a) of
Title 22 of the California Code of Regulations until July 1, 2015.
(3) Reimbursement to providers for clinical laboratory or
laboratory services shall not exceed the lowest of the following:
(A) The amount billed.
(B) The charge to the general public.
(C) Eighty percent of the lowest maximum allowance established by
the federal Medicare Program for the same or similar services.
(D) A reimbursement rate based on an average of the lowest amount
that other payers and other state Medicaid programs are paying for
similar clinical laboratory or laboratory services.
(4) (A) In addition to the payment reductions implemented pursuant
to Section 14105.192, payments shall be reduced by up to 10 percent
for clinical laboratory or laboratory services, as defined in Section
51137.2 of Title 22 of the California Code of Regulations, for dates
of service on and after July 1, 2012. The payment reductions
pursuant to this paragraph shall continue until the new rate
methodology under this subdivision has been approved by CMS.
(B) Notwithstanding subparagraph (A), the Family Planning, Access,
Care, and Treatment (Family PACT) Program pursuant to subdivision
(aa) of Section 14132 shall be exempt from the payment reduction
specified in this section.
(5) (A) For purposes of establishing reimbursement rates for
clinical laboratory or laboratory services based on the lowest
amounts other payers are paying providers for similar clinical
laboratory or laboratory services, laboratory service providers shall
submit data reports within 11 months of the date the act that added
this paragraph becomes effective and annually thereafter. The data
initially provided shall be for the 2011 calendar year, and for each
subsequent year, shall be based on the previous calendar year and
shall specify the provider's lowest amounts other payers are paying,
including other state Medicaid programs and private insurance, minus
discounts and rebates. The specific data required for submission
under this subparagraph and the format for the data submission shall
be determined and specified by the department after receiving
stakeholder input pursuant to paragraph (7).
(B) The data submitted pursuant to subparagraph (A) may be used to
determine reimbursement rates by procedure code based on an average
of the lowest amount other payers are paying providers for similar
clinical laboratory or laboratory services, excluding significant
deviations of cost or volume factors and with consideration to
geographical areas. The department shall have the discretion to
determine the specific methodology and factors used in the
development of the lowest average amount under this subparagraph to
ensure compliance with federal Medicaid law and regulations as
specified in paragraph (10).
(C) For purposes of subparagraph (B), the department may contract
with a vendor for the purposes of collecting payment data reports
from clinical laboratories, analyzing payment information, and
calculating a proposed rate.
(D) The proposed rates calculated by the vendor described in
subparagraph (C) may be used in determining the lowest reimbursement
rate for clinical laboratories or laboratory services in accordance
with paragraph (3).
(E) Data reports submitted to the department shall be certified by
the provider's certified financial officer or an authorized
individual.
(F) Clinical laboratory providers that fail to submit data reports
within 30 working days from the time requested by the department
shall be subject to the suspension provisions of subdivisions (a) and
(c) of Section 14123.
(6) Data reports provided to the department pursuant to this
section shall be confidential and shall be exempt from disclosure
under the California Public Records Act (Chapter 3.5 (commencing with
Section 6250) of Division 7 of Title 1 of the Government Code).
(7) The department shall seek stakeholder input on the ratesetting
methodology.
(8) (A) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking any further regulatory action,
implement, interpret, or make specific this section by means of
provider bulletins or similar instructions until regulations are
adopted. It is the intent of the Legislature that the department have
temporary authority as necessary to implement program changes until
completion of the regulatory process.
(B) The department shall adopt emergency regulations no later than
June 30, 2016. The department may readopt any emergency regulation
authorized by this section that is the same as or substantially
equivalent to an emergency regulation previously adopted pursuant to
this section. The initial adoption of emergency regulations
implementing the amendments to this section and the one readoption of
emergency regulations authorized by this section shall be deemed an
emergency and necessary for the immediate preservation of the public
peace, health, safety, or general welfare. Initial emergency
regulations and the one readoption of emergency regulations
authorized by this section shall be exempt from review by the Office
of Administrative Law.
(C) The initial emergency regulations and the one readoption of
emergency regulations authorized by this section shall be submitted
to the Office of Administrative Law for filing with the Secretary of
State and each shall remain in effect for no more than 180 days, by
which time final regulations may be adopted.
(9) To the extent that the director determines that the new
methodology or payment reductions are not consistent with the
requirements of Section 1396a(a)(30)(A) of Title 42 of the United
States Code, the department may revert to the methodology under
subdivision (a) to ensure access to care is not compromised.
(10) (A) The department shall implement this section in a manner
that is consistent with federal Medicaid law and regulations. The
director shall seek any necessary federal approvals for the
implementation of this section. This section shall be implemented
only to the extent that federal approval is obtained.
(B) In determining whether federal financial participation is
available, the director shall determine whether the rates and
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.
(C) To the extent that the director determines that the rates and
payments do not comply with applicable federal Medicaid requirements
or that federal financial participation is not available with respect
to any reimbursement rate, the director retains the discretion not
to implement that rate or payment and may revise the rate or payment
as necessary to comply with federal Medicaid requirements. The
department shall notify the Joint Legislative Budget Committee 10
days prior to revising the rate or payment to comply with federal
Medicaid requirements.
SEC. 2. 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 that the State Department of Health Care
Services can establish a new pricing methodology by the statutory
deadline, it is necessary that this act take effect immediately.
