Bill Text: CA AB1607 | 2015-2016 | Regular Session | Chaptered
Bill Title: Medi-Cal: hospitals: quality assurance fee.
Spectrum: Partisan Bill (Democrat 16-0)
Status: (Passed) 2016-06-27 - Chaptered by Secretary of State - Chapter 27, Statutes of 2016. [AB1607 Detail]
Download: California-2015-AB1607-Chaptered.html
BILL NUMBER: AB 1607 CHAPTERED
BILL TEXT
CHAPTER 27
FILED WITH SECRETARY OF STATE JUNE 27, 2016
PASSED THE SENATE JUNE 16, 2016
PASSED THE ASSEMBLY JUNE 16, 2016
AMENDED IN SENATE JUNE 13, 2016
AMENDED IN ASSEMBLY APRIL 14, 2016
INTRODUCED BY Committee on Budget (Assembly Members Ting (Chair),
Bloom, Bonta, Campos, Chiu, Cooper, Gordon, Holden, Irwin, McCarty,
Mullin, Nazarian, O'Donnell, Rodriguez, Thurmond, and Williams)
JANUARY 7, 2016
An act to amend Sections 14169.53 and 14169.75 of the Welfare and
Institutions Code, relating to Medi-Cal, making an appropriation
therefor, and declaring the urgency thereof, to take effect
immediately, bill related to the budget.
LEGISLATIVE COUNSEL'S DIGEST
AB 1607, Committee on Budget. Medi-Cal: hospitals: quality
assurance fee.
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, 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 provides that
moneys in the Hospital Quality Assurance Revenue Fund are
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. For subsequent program periods, existing
law 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. Existing
law provides that these provisions are inoperative on January 1,
2017, and that a hospital is not required to pay the hospital quality
assurance fee after that date, as specified.
This bill would extend the operation of these provisions to
January 1, 2018. The bill would instead, for the second program
period and subsequent program periods, require moneys in the Hospital
Quality Assurance Revenue Fund to be continuously appropriated,
thereby making an appropriation, for the above-described purposes.
This bill would declare that it is to take effect immediately as a
bill providing for appropriations related to the Budget Bill.
This bill would declare that it is to take effect immediately as
an urgency statute.
Appropriation: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. 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) Notwithstanding any other law, for the second program period
and subsequent program periods, the moneys in the fund shall be
continuously appropriated, without regard to fiscal year, 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. 2. Section 14169.75 of the Welfare and Institutions Code is
amended to read:
14169.75. Notwithstanding Section 14169.72, this article shall
become inoperative on January 1, 2018. A hospital shall not be
required to pay the fee after that date unless the fee was owed
during the period in which the article was operative, and payments
authorized under Section 14169.53 shall not be made unless the
payments were owed during the period in which the article was
operative.
SEC. 3. This act is a bill providing for appropriations related to
the Budget Bill within the meaning of subdivision (e) of Section 12
of Article IV of the California Constitution, has been identified as
related to the budget in the Budget Bill, and shall take effect
immediately.
SEC. 4. 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 provide continued health care coverage for
Californians at the earliest possible time, it is necessary that this
bill take effect immediately.
