Bill Text: CA AB498 | 2013-2014 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Medi-Cal.

Spectrum: Slight Partisan Bill (Republican 4-2)

Status: (Passed) 2013-10-10 - Chaptered by Secretary of State - Chapter 672, Statutes of 2013. [AB498 Detail]

Download: California-2013-AB498-Amended.html

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BILL NUMBER: AB 498	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  MARCH 19, 2013

INTRODUCED BY   Assembly Member Chávez

                        FEBRUARY 20, 2013

   An act to amend Section  47601 of the Education Code,
relating to pupils   14166.151 of the Welfare and
Institutions Code, relating to Medi-Cal  .


	LEGISLATIVE COUNSEL'S DIGEST


   AB 498, as amended, Chávez.  Charter schools: operation.
  Medi-Cal.  
   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, modifies the inpatient fee-for-service reimbursement
methodology for nondesignated public hospitals, as defined, under a
specified demonstration project for services on or after July 1,
2012.  
   This bill would instead provide that these provisions apply to
services provided on or after July 1, 2013.  
   The Charter Schools Act of 1992 allows one or more persons seeking
to establish a charter school within a school district to circulate
a petition to that effect. The act provides for the establishment and
operation of a charter school as prescribed. Existing law expresses
the Legislature's intent to provide an opportunity for teachers,
parents, pupils, and community members to establish and maintain
schools that operate independently from the existing school district
structure, as a method to accomplish specified goals. 

   This bill would make a nonsubstantive change to the latter
provision. 
   Vote: majority. Appropriation: no. Fiscal committee:  no
  yes  . State-mandated local program: no.


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

   SECTION 1.    Section 14166.151 of the  
Welfare and Institutions Code   is amended to read: 
   14166.151.  (a) It is the intent of the Legislature to reform the
inpatient fee-for-service reimbursement methodology for nondesignated
public hospitals based on their public structure in order to provide
new opportunities for nondesignated public hospitals to receive
reimbursement under the successor demonstration project for care
provided to the uninsured and to receive new incentive payments for
achievement related to delivery system reform.
   (b) Subject to subdivision (c), beginning with services provided
on or after July 1,  2012   2013  ,
fee-for-service payments to nondesignated public hospitals for
inpatient services shall be governed by this subdivision. Each
nondesignated public hospital shall receive as payment for inpatient
hospital services provided to Medi-Cal beneficiaries during any
successor demonstration year, the federal financial participation
claimed by the department based on the hospital's allowable costs
incurred in providing those services, subject to all of the
following:
   (1) Nondesignated public hospitals shall comply with the
requirements of Section 14166.152. The payments authorized in this
section shall be subject to audit and a final reconciliation where an
overpayment to the nondesignated public hospital shall result in a
collection of the overpayment and an underpayment to the
nondesignated public hospital shall result in a corrective payment.
   (2) (A) Nondesignated public hospitals shall be eligible to
receive safety net care pool payments for uncompensated care costs to
the extent that additional federal funding is made available
pursuant to the Special Terms and Conditions for the safety net care
pool uncompensated care limit of the successor demonstration project
and if they comply with the requirements set forth in Section
14166.154.
   (B) The amount of funds that may be claimed pursuant to
subparagraph (A) shall not exceed the additional federal funding made
available under the safety net care pool for nondesignated public
hospital uncompensated care costs, and shall not reduce the amounts
of federal funding for safety net care pool uncompensated care costs
that would otherwise be made available to designated public hospitals
in the absence of this paragraph, including the amounts available
under the Special Terms and Conditions in effect as of April 1, 2012,
and amounts available pursuant to Section 15916.
   (C) (i) Notwithstanding subparagraph (B), if the designated public
hospitals do not have sufficient certified public expenditures to
claim the full amount of federal funding made available to the
designated public hospitals as referenced in subparagraph (B),
including consideration of the potential for the designated public
hospitals to have sufficient certified public expenditures in a
subsequent year, the department may authorize the funding to be
claimed by the nondesignated public hospitals.
   (ii) The department may determine whether designated public
hospitals do not have sufficient certified public expenditures to
claim the full amount of federal funding pursuant to clause (i) no
sooner than after the submission of the cost reporting information
required pursuant to Section 14166.8 for the applicable successor
demonstration year.
   (iii) If the department makes the determination identified in
clause (ii) based on as-filed cost reporting information submitted
prior to a final audit, the department shall make the determination
in consultation with the designated public hospitals and shall apply
an audit cushion of at least 5 percent to the as-filed cost
information. If the department makes the determination identified in
clause (ii) based on audited cost reporting information, no audit
cushion shall be applied.
   (3) (A) 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 paragraph,
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 such unused funding to be made
available to the nondesignated public hospitals.
   (c) (1) (A) The reimbursement methodology developed pursuant to
subdivision (b) shall be effective beginning July 1,  2012
  2013  . If all necessary federal approvals have
not been received by July 1,  2012   2013 
, then the effective date shall be retroactive to July 1, 
2012   2013  . Between July 1,  2012
  2013  , and when all necessary federal approvals
have been received, any payments made pursuant to any methodology
replaced by subdivision (b) shall be deemed as interim payments
subject to offsetting and recoupment against payments made under
subdivision (b) pursuant to Section 51047 of Title 22 of the
California Code of Regulations.
   (B) Subject to paragraph (2), beginning January 1, 2014, the
reimbursement methodology developed pursuant to subdivision (b),
which shall be in effect July 1,  2012   2013
 , through and including December 31, 2013, shall continue for
those nondesignated public hospitals that certify voluntary
participation as described in clause (i), if the director executes a
declaration on or before December 31, 2013, certifying all of the
following:
   (i) The governmental entities that own or operate a nondesignated
public hospital, or hospitals, have provided certifications of
voluntary participation in the reimbursement methodology pursuant to
subdivision (b).
   (ii) Any necessary federal approvals have been obtained.
   (iii) Continuation of the reimbursement methodology for those
nondesignated public hospitals certifying voluntary participation
would be cost beneficial to the state.
   (2) On December 31, 2013, if one or more of the nondesignated
public hospitals subject to the reimbursement methodology described
in subdivision (b) have not provided written certification of
voluntariness described in clause (i) of subparagraph (B) of
paragraph (1), or if the director determines, for any reason, that
the reimbursement methodology described in subdivision (b) cannot be
implemented on or after January 1, 2014, then the director shall
execute a declaration certifying that the reimbursement methodology
described in subdivision (b) cannot continue to be implemented for
all or one or more of the nondesignated public hospitals, in which
case subdivision (e) shall be implemented on January 1, 2014.
   (d) Upon implementation of subparagraph (A) of paragraph (1) of
subdivision (c), implementation of the laws and regulations listed in
paragraphs (1) to (4), inclusive, shall be suspended with respect to
fee-for-service payments to all nondesignated public hospitals for
inpatient services through and including December 31, 2013.
Implementation of the laws and regulations listed in paragraphs (1)
to (4), inclusive, shall also be suspended with respect to
fee-for-service payments to nondesignated public hospitals that
certify voluntary participation if a declaration is executed pursuant
to subparagraph (B) of paragraph (1) of subdivision (c), beginning
on January 1, 2014, and until the expiration of the successor
demonstration project.
   (1) The Nondesignated Public Hospital Medi-Cal Rate Stabilization
Act in Article 5.17 (commencing with Section 14165.55).
   (2) The inpatient fee-for-service per diem rate authorized in
Article 2.6 (commencing with Section 14081).
   (3) The reimbursement methodology for fee-for-service inpatient
services in Sections 14105 and 14105.15, and Article 7.5 (commencing
with Section 51536) of Title 22 of the California Code of
Regulations.
   (4) Section 14166.17.
   (e) Subject to the conditions in paragraph (2) of subdivision (c),
on January 1, 2014, the percentage of each intergovernmental
transfer amount retained pursuant to subdivision (j) of Section
14165.57 shall be increased to 20 percent to reimburse the
department, or transferred to the General Fund, for the
administrative costs of operating the Nondesignated Public Hospital
Intergovernmental Transfer Program and for the benefit of the
Medi-Cal program.
   (f) This section and Sections 14166.152, 14166.153, 14166.154, and
14166.155 shall become operative on the date all necessary federal
approvals have been obtained to implement all of these sections.

  SECTION 1.    Section 47601 of the Education Code
is amended to read:
   47601.  It is the intent of the Legislature, in enacting this
part, to provide an opportunity for teachers, parents, pupils, and
community members to establish and maintain schools that operate
independently from the existing school district structure, as a
method to accomplish all of the following:
   (a) Improve pupil learning.
   (b) Increase learning opportunities for all pupils, with special
emphasis on expanded learning experiences for pupils who are
identified as academically low achieving.
   (c) Encourage the use of different and innovative teaching
methods.
   (d) Create new professional opportunities for teachers, including
the opportunity to be responsible for the learning program at the
schoolsite.
   (e) Provide parents and pupils with expanded choices in the types
of educational opportunities that are available within the public
school system.
   (f) Hold the schools established under this part accountable for
meeting measurable pupil outcomes, and provide the schools with a
method to change from rule-based to performance-based accountability
systems.
   (g) Provide vigorous competition within the public school system
to stimulate continual improvements in all public schools.