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

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

---

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

---

BILL NUMBER: AB 498	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JUNE 20, 2013
	AMENDED IN ASSEMBLY  MAY 7, 2013
	AMENDED IN ASSEMBLY  APRIL 23, 2013
	AMENDED IN ASSEMBLY  MARCH 19, 2013

INTRODUCED BY   Assembly Member Chávez

                        FEBRUARY 20, 2013

   An act to  add Section 14166.156 to   amend
Section 14166.151 of  the Welfare and Institutions Code,
relating to Medi-Cal.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 498, as amended, Chávez. 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.  Existing law provides that beginning with the 2012-13
fiscal year, and if specified conditions are met, nondesignated
public hospitals, or governmental entities with which the hospitals
are affiliated, shall be eligible to receive safety net care pool
payments for uncompensated care from the   Health Care
Support Fund. Existing law provides that these provisions shall
become operative on the date that all necessary federal approvals
have been obtained to implement these and other related provisions.
 
   This bill would prohibit a payment made to a nondesignated public
hospital pursuant to these provisions from being subject to a peer
grouping inpatient reimbursement limitation established by the
department, unless otherwise required by federal law. 
   This bill would instead authorize the department to seek necessary
federal approvals or waivers to separately implement the safety net
care pool payments for uncompensated care provisions for the 2013-14
and 2014-15 fiscal years. The bill would require the state, if the
state receives federal safety net care pool funds for uncompensated
care under these provision, to retain 1/2 of the funds for Medi-Cal
related expenditures. 
   Vote: 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 14166.151 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, 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. If all
necessary federal approvals have not been received by July 1, 2012,
then the effective date shall be retroactive to July 1, 2012. Between
July 1, 2012, 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, 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)  (1)    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. 
   (2) Notwithstanding paragraph (1) of this subdivision and Section
14166.154, if the necessary federal approvals are not obtained to
implement all of the sections set forth in paragraph (1), the
department may seek any necessary federal approvals or waivers to
separately implement the safety net care pool payments for
uncompensated care, as described in paragraph (2) of subdivision (b)
of this section and Section 14166.154, for the 2013-14 and 2014-15
fiscal years. If federal safety net care pool funds for uncompensated
care are received by the state for this purpose, the state shall
retain one-half of the funds for Medi-Cal related expenditures. 

  SECTION 1.    Section 14166.156 is added to the
Welfare and Institutions Code, to read:
   14166.156.  If a payment to a nondesignated public hospital is
made pursuant to Section 14166.151, the reimbursement shall not be
subject to a peer grouping inpatient reimbursement limitation
established by the department, unless otherwise required by federal
law.