Bill Text: CA AB468 | 2013-2014 | Regular Session | Amended
Bill Title: Medi-Cal: nondesignated public hospitals.
Spectrum: Slight Partisan Bill (Republican 2-1)
Status: (Engrossed - Dead) 2014-08-04 - From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on APPR. Withdrawn from committee. Re-referred to Com. on RLS. [AB468 Detail]
Download: California-2013-AB468-Amended.html
BILL NUMBER: AB 468 AMENDED
BILL TEXT
AMENDED IN SENATE AUGUST 4, 2014
AMENDED IN SENATE JUNE 16, 2014
AMENDED IN ASSEMBLY JANUARY 6, 2014
AMENDED IN ASSEMBLY MAY 1, 2013
AMENDED IN ASSEMBLY APRIL 8, 2013
INTRODUCED BY Assembly Member Chávez
(Principal coauthors: Assembly Members Chesbro and Dahle)
FEBRUARY 19, 2013
An act to add Sections 14166.152, 14166.153, and
14166.155 to, amend Section 14301.4 of, and to add
Sections 14166.153 and 14301.56 to, the Welfare and
Institutions Code, relating to Medi-Cal, and declaring the
urgency thereof, to take effect immediately. Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 468, as amended, Chávez. Medi-Cal: delivery system
reform incentive pool payments. nondesignated public
hospitals.
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 the department to
seek a successor demonstration project or federal waiver of Medicaid
law to implement specified objectives, which may include better care
coordination for seniors, persons with disabilities, and children
with special health care needs. Existing law provides that beginning
with services provided on or after July 1, 2013, to the extent that
additional federal funding is made available pursuant to the Special
Terms and Conditions of the demonstration project or waiver,
nondesignated public hospitals shall be eligible to receive safety
net care pool payments for uncompensated care costs.
This bill would, beginning with the 2014-15 fiscal year,
subject to federal approval and if specified conditions are met,
require that nondesignated public hospitals receive delivery system
reform incentive pool funding, as specified. The bill would also
would require nondesignated public hospitals to
report and certify specified information for each successor
demonstration year. the 2012-13 fiscal year and each
fiscal year thereafter.
This bill would declare that it is to take effect immediately as
an urgency statute.
Existing law authorizes a transferring entity, as defined, to make
an intergovernmental transfer (IGT) to the state, and authorizes the
department to accept all IGTs from a transferring entity for the
purpose of providing support for the nonfederal share of risk-based
payments to managed care health plans to enable those plans to
compensate providers designated by the transferring entity for
Medi-Cal health care services and support of the Medi-Cal program.
Existing law, with some exceptions, authorizes the state to assess a
fee of 20% on each IGT to reimburse the department for the
administrative costs of operating the IGT program and for the support
of the Medi-Cal program.
This bill would provide that the 20% assessment shall not apply to
nondesignated public hospitals. The bill would also require the
department to pay rate range increases, as defined, to Medi-Cal
managed care plans that contract with the department to provide
Medi-Cal services in specified counties for the purpose of providing
additional payments to nondesignated public hospitals for purposes of
equaling the amount of reimbursement the nondesignated public
hospital would have received through certified public expenditures
under the fee-for-service payment methodology.
Vote: 2/3 majority . Appropriation:
no. Fiscal committee: yes. State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14166.152 is added to the
Welfare and Institutions Code, to read:
14166.152. (a) For dates of service on and after July 1, 2014,
nondesignated public hospitals shall be eligible to receive delivery
system reform incentive pool payments to the extent additional
federal funding is made available for this purpose under the delivery
system reform incentive pool in the successor demonstration project
and if the nondesignated public hospitals comply with the delivery
system reform incentive pool funding requirements set forth in
Section 14166.155.
(b) The amount of funds that may be received shall not exceed the
additional federal funding made available for delivery system reform
incentive pool payments to nondesignated public hospitals, and shall
not reduce the amounts that would otherwise be made available to
designated public hospitals in the absence of this section, including
the amounts that designated public hospitals would be eligible to
receive under their delivery system reform incentive pool plans
approved as of January 1, 2012.
(c) Notwithstanding subparagraph (B), if the designated public
hospitals are unable to claim the full amount of federal funding made
available to the designated public hospitals pursuant to Section
14166.77 and the Special Terms and Conditions, including through
reallocations made pursuant to paragraph (3) of subdivision (a) of
Section 14166.77 as authorized by the Special Terms and Conditions,
and the unused amount of federal funding made available to the
designated public hospitals cannot be used in a later demonstration
year, the department may authorize the unused funding to be made
available to the nondesignated public hospitals.
SEC. 2. SECTION 1. Section 14166.153
is added to the Welfare and Institutions Code, to read:
14166.153. (a) Beginning in the 2012-13 fiscal year,
within five months after the end of a successor demonstration year,
each For the 2012-13 fiscal year and each fiscal year
thereafter, each of the nondesignated public hospitals shall
submit to the department all of the following reports:
(1) The hospital's Medicare cost report for the project year or
successor demonstration year.
(2) Other cost reporting and statistical data necessary for the
determination of amounts due the hospital under the demonstration
project or successor demonstration project, as requested by the
department.
(b) For each project year or successor demonstration year, the
reports shall identify all of the following:
(1) To the extent applicable, the costs incurred in providing
inpatient hospital services to Medi-Cal beneficiaries on a
fee-for-service basis and physician and nonphysician practitioner
services costs.
(2) The costs incurred in providing hospital services to uninsured
individuals.
(c) Each nondesignated public hospital, or governmental entity
with which it is affiliated, that operates nonhospital clinics or
provides physician, nonphysician practitioner, or other health care
services that are not identified as hospital services under the
Special Terms and Conditions for the demonstration project and
successor demonstration project, shall report and certify all of the
uncompensated Medi-Cal and uninsured costs of the services furnished.
The amount of these uncompensated costs to be claimed by the
department shall be determined by the department in consultation with
the governmental entity so as to optimize the level of claimable
federal Medicaid reimbursement.
(d) Reports submitted under this section shall include all
allowable costs.
(e) The appropriate public official shall certify to all of the
following:
(1) The accuracy of the reports required under this section.
(2) That the expenditures to meet the reported costs comply with
Section 433.51 of Title 42 of the Code of Federal Regulations.
(3) That the sources of funds used to make the expenditures
certified under this section do not include impermissible provider
taxes or donations as defined under Section 1396b(w) of Title 42 of
the United States Code or other federal funds. For this purpose,
federal funds do not include delivery system reform incentive pool
payments or patient care revenue received as payment for services
rendered under programs such as nondesignated state health programs,
the Low Income Health Program, Medicare, or Medicaid.
(f) The certification of public expenditures made pursuant to this
section shall be based on a schedule established by the department
in accordance with federal requirements.
(1) The director may require the nondesignated public hospitals to
submit quarterly estimates of anticipated expenditures, if these
estimates are necessary to obtain interim payments of federal
Medicaid funds.
(2) All reported expenditures shall be subject to reconciliation
to allowable costs, as determined in accordance with applicable
implementing documents for the demonstration project and successor
demonstration project.
(g) The director shall seek Medicaid federal financial
participation for all certified public expenditures reported by the
nondesignated public hospitals and recognized under the successor
demonstration project.
(h) The timeframes for data submission and reporting periods may
be adjusted as necessary in accordance with federal requirements.
SEC. 3. Section 14166.155 is added to the
Welfare and Institutions Code, to read:
14166.155. (a) (1) Beginning in the 2014-15 fiscal year, if
federal approval is obtained for an amendment to the successor
demonstration project, nondesignated public hospitals shall receive
payments pursuant to this section. The amount of delivery system
reform incentive pool funding, consisting of both the federal and
nonfederal share of payments, that is made available to each
nondesignated public hospital system in the aggregate for the term of
the successor demonstration project shall be based initially on the
delivery system reform proposals that are submitted by the
nondesignated public hospitals to the department for review and
submission to the federal Centers for Medicare and Medicaid Services
for final approval. The initial percentages of delivery system reform
incentive pool funding among the nondesignated public hospitals for
each successor demonstration year shall be determined based on the
annual components as contained in the approved proposals.
(2) The actual receipt of funds shall be conditioned on the
nondesignated public hospital's progress toward, and achievement of,
the specified milestones and other metrics established in its
approved delivery system reform incentive pool proposal. A
nondesignated public hospital may carry forward available incentive
pool funding associated with milestones and metrics from one year to
a subsequent period as authorized by the Special Terms and Conditions
and the final delivery system reform incentive pool protocol.
(3) The department may reallocate the incentive pool funding
available under this section pursuant to conditions specified, and as
authorized by, the Special Terms and Conditions and the final
delivery system reform incentive pool protocol.
(b) Each nondesignated public hospital shall be individually
responsible for progress toward, and achievement of, milestones and
other metrics in its proposal, as well as other applicable
requirements specified in the Special Terms and Conditions and the
final delivery system reform incentive pool protocol, in order to
receive its specified allocation of incentive pool funding under this
section.
(1) The nondesignated public hospital shall submit semiannual
reports and requests for payment to the department by March 31 and
the September 30 following the end of the second and fourth quarters
of the successor demonstration year, or comply with any other process
as approved by the federal Centers for Medicare and Medicaid
Services.
(2) Within 14 days after the semiannual report due date, the
nondesignated public hospital system or its affiliated governmental
entity shall make an intergovernmental transfer of funds equal to the
nonfederal share that is necessary to claim the federal funding for
the pool payment related to the achievement or progress metric that
is certified. The intergovernmental transfers shall be deposited into
the Public Hospital Investment, Improvement, and Incentive Fund,
established pursuant to Section 14182.4.
(3) The department shall claim the federal funding and pay both
the nonfederal and federal shares of the incentive payment to the
nondesignated public hospital system or other affiliated governmental
provider, as applicable. If the intergovernmental transfer is made
within the appropriate 14-day timeframe, the incentive payment shall
be disbursed within seven days with the expedited payment process as
approved by the federal Centers for Medicare and Medicaid Services,
otherwise the payment shall be disbursed within 20 days of when the
transfer is made.
(4) The nondesignated public hospital system or other affiliated
governmental provider is responsible for any fee or cost required to
implement the expedited payment process in accordance with Section
8422.1 of the State Administrative Manual.
(c) The department shall submit for federal approval an amendment
to the successor demonstration project to implement this section.
(d) In the event of a conflict between any provision of this
section and the Special Terms and Conditions for the successor
demonstration project and the final delivery system reform incentive
pool protocol, the Special Terms and Conditions and the final
delivery system reform incentive pool protocol shall control.
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 improve access to health care services for patients in
underserved areas at the earliest possible time, it is necessary
that this act take effect immediately.
SEC. 2. Section 14301.4 of the Welfare
and Institutions Code is amended to read:
14301.4. (a) It is the intent of the Legislature, to the extent
federal financial participation is not jeopardized and consistent
with federal law, that the intergovernmental transfers described in
this section provide support for the nonfederal share of risk-based
payments to managed care health plans to enable those plans to
compensate providers designated by the transferring entity for
Medi-Cal health care services and for support of the Medi-Cal
program.
(b) For the purposes of this section, the following definitions
apply:
(1) "Intergovernmental transfer" or "IGT" means the transfer of
public funds by the transferring entity to the state in accordance
with the requirements of this section.
(2) "Managed care health plan" means a Medi-Cal managed care plan
contracting with the department under this chapter or Article 2.7
(commencing with Section 14087.3), Article 2.8 (commencing with
Section 14087.5), Article 2.81 (commencing with Section 14087.96), or
Article 2.91 (commencing with Section 14089) of Chapter 7.
(3) "Public provider" means any provider that is able to certify
public expenditures under state and federal Medicaid law.
(4) "Rate range increases" means increases to risk-based payments
to managed care health plans to increase the payments from the lower
bound of the range determined to be actuarially sound to the upper
bound of that range, as determined by the department's actuaries to
take into account the variations in underwriting, risk, return on
investment, and contingencies.
(5) "Transferring entity" means a public entity, which may be a
city, county, special purpose district, or other governmental unit in
the state, regardless of whether the unit of government is also a
health care provider, except as prohibited by federal law.
(c) To the extent permitted by federal law, a transferring entity
may elect to make an intergovernmental transfer to the state, and the
department may accept all intergovernmental transfers from a
transferring entity, for the purposes of providing support for the
nonfederal share of risk-based payments to managed care health plans
to enable those plans to compensate providers designated by the
transferring entity for Medi-Cal health care services and for the
support of the Medi-Cal program. The transferring entity shall
certify to the department that the funds it proposes to transfer
satisfy the requirements of this section and are in compliance with
all federal rules and regulations.
(d) (1) Pursuant to paragraphs (2), (3), and (4), the state shall,
upon acceptance of the IGT described in subdivision (c), assess a
fee of 20 percent on each IGT subject to this section to reimburse
the department for the administrative costs of operating the IGT
program pursuant to this section and for the support of the Medi-Cal
program.
(2) The IGTs subject to the fee shall be limited to those made by
a transferring entity to provide the nonfederal share of rate range
increases.
(3) The 20-percent assessment shall not apply to IGTs designated
for increases to risk-based payments to managed care health plans
intended to increase reimbursement for designated public providers
and nondesignated public hospitals for purposes of
equaling the amount of reimbursement the public provider would have
received through certified public expenditures under the
fee-for-service payment methodology.
(4) The 20-percent assessment shall not apply to IGTs authorized
pursuant to Sections 14168.7 and 14182.15.
(e) Participation in the intergovernmental transfers pursuant to
this section is voluntary on the part of the transferring entities
for the purposes of all applicable federal laws.
(f) The director shall seek any necessary federal approvals for
the implementation of this section.
(g) To the extent that the director determines that the payments
made pursuant to this section do not comply with the federal Medicaid
requirements, the director retains the discretion to return the IGTs
or not accept the IGTs.
(h) This section shall be implemented only to the extent that
federal financial participation is not jeopardized.
(i) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall implement this section by means of policy letters or
similar instructions, without taking further regulatory action.
(j) This section shall be implemented on July 1, 2011, or the date
on which all necessary federal approvals have been received,
whichever is later.
SEC. 3. Section 14301.56 is added to the
Welfare and Institutions Code , to read:
14301.56. (a) (1) To the extent federal financial participation
is not jeopardized and consistent with federal law, the department
shall pay rate range increases, as defined in paragraph (4) of
subdivision (b) of Section 14301.4, to Medi-Cal managed care plans
that have a contract with the department under Section 14087.98, for
the purposes specified in paragraph (2). If a nonfederal share is
necessary to fund the rate range increases, an affiliated
governmental entity may voluntarily provide intergovernmental
transfers as the nonfederal share. The department shall not be
required to pay rate range increases pursuant to this section if
intergovernmental transfers are not received as the nonfederal share.
(2) The Medi-Cal managed care plans shall pay the rate range
increases provided under this section as additional payments to
nondesignated public hospitals for providing and making available
services to Medi-Cal enrollees of the plan for purposes of equaling
the amount of reimbursement the nondesignated public hospital would
have received through certified public expenditures under the
fee-for-service payment methodology.
(b) The increased payments to Medi-Cal managed care plans that
would be paid consistent with actuarial certification and enrollment
in the absence of this section, including, but not limited to,
payments described in Section 14182.15, shall not be reduced as a
consequence of payment under this section.
