Bill Text: CA SB98 | 2013-2014 | Regular Session | Chaptered
Bill Title: Public health.
Spectrum: Slight Partisan Bill (Democrat 11-4)
Status: (Passed) 2013-09-26 - Chaptered by Secretary of State. Chapter 358, Statutes of 2013. [SB98 Detail]
Download: California-2013-SB98-Chaptered.html
BILL NUMBER: SB 98 CHAPTERED
BILL TEXT
CHAPTER 358
FILED WITH SECRETARY OF STATE SEPTEMBER 26, 2013
APPROVED BY GOVERNOR SEPTEMBER 26, 2013
PASSED THE SENATE SEPTEMBER 10, 2013
PASSED THE ASSEMBLY SEPTEMBER 6, 2013
AMENDED IN ASSEMBLY AUGUST 27, 2013
INTRODUCED BY Committee on Budget and Fiscal Review
JANUARY 10, 2013
An act to amend Sections 11155, 11322.85, 11450.025, 14186.11,
14199.1, 17600.15, 17600.50, 17600.60, 17601.75, 17603, 17604,
17606.10, 17610, 17610.5, 17612.1, 17612.2, 17612.3, 17612.5,
17612.6, 17613.1, 17613.2, 17613.3, 17613.4, and 18901.2 of, and to
repeal Section 17612.21 of, the Welfare and Institutions Code,
relating to public health, and making an appropriation therefor, to
take effect immediately, bill related to the budget.
LEGISLATIVE COUNSEL'S DIGEST
SB 98, Committee on Budget and Fiscal Review. Public health.
Existing law imposes limits on the amount of income and personal
and real property an individual or family may possess in order to be
eligible for public aid, including under the CalFresh program, and
specifies the allowable value of a licensed vehicle retained by an
applicant for, or recipient of, that aid.
This bill would change the term "licensed vehicle" to "motor
vehicle" for these purposes.
Under existing law, every individual, as a condition of
eligibility for aid under the CalWORKs program, is required to
participate in certain welfare-to-work activities for a period of 24
months, except as provided. Existing law provides that any month in
which certain conditions exist shall not be counted as one of the 24
months of participation.
This bill would make a clarifying change to these provisions. This
bill would also make a nonsubstantive technical change to these
provisions.
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, to the extent
that federal financial participation is available, and pursuant to a
demonstration project or waiver of federal law, the department to
establish specified pilot projects in up to 8 counties, known as
Coordinated Care Initiative counties.
This bill would correct an erroneous cross-reference with respect
to a provision of law relating to Coordinated Care Initiative
counties.
Existing law establishes the Local Revenue Fund, a continuously
appropriated fund that allocates Vehicle License Fund moneys and
sales tax moneys. Existing law creates various accounts within the
Local Revenue Fund, including the Sales Tax Account and the Sales Tax
Growth Account, which each contain various subaccounts.
Existing law, for the 2013-14 fiscal year and subsequent fiscal
years, allocates funds to the Social Services Subaccount, Health
Subaccount, and Mental Health Subaccount of the Sales Tax Account
using specified calculations.
This bill would modify the calculations used to allocate moneys to
the above-described subaccounts, and would also require the
Controller to transfer funds between the Social Services Subaccount
and the Health Subaccount in an amount not to exceed $300 million for
the 2013-14 fiscal year, or $1 billion in any subsequent fiscal
year, as specified, thereby making an appropriation.
Existing law requires counties, through a choice of methodologies,
to provide specified health services to eligible county residents
who are indigent. Existing law authorizes counties to receive funding
for this program from the Health Subaccount by either proving actual
costs or by electing to receive 60% of the funds that would
otherwise have been allocated to them, and would establish a default
contribution for counties that fail to make a choice or to inform the
Director of Health Care Services by a specified date. Existing law
places the difference between prior fiscal year contributions to
counties from the Health Subaccount and the new contributions to
counties in the Family Support Subaccount, which is established
within the Sales Tax Account, to be used by counties for the CalWORKs
program, as specified.
With respect to the redirection of funds to the Family Support
Subaccount, existing law requires counties to determine the amount or
percentage of funding to be redirected and to provide that
calculation to the department by a specified date. Existing law
provides a specified process to be used if the department disagrees
with a county's determination. Existing law authorizes the county to
submit a petition to the County Health Care Funding Resolution
Committee if no agreement between the parties is reached by a
specified date. Existing law also establishes an expedited formal
appeal process by which a county may contest the determinations, as
specified.
This bill would make technical changes to these provisions and
revise the deadlines by which counties must comply with the
provisions described above.
Existing law requires the department, in consultation with the
counties, to determine the historical low-income shortfall between
Medi-Cal and uninsured revenues and the costs incurred by county
public hospital health systems for health services to Medi-Cal
beneficiaries and uninsured patients. In determining this shortfall,
the department is required to apply against that shortfall county
indigent realignment amounts, special local health funds specifically
restricted for indigent care, amounts from other specified sources
of funding, including unrestricted health care funds and one-time
funds received or carried forward by a county public hospital health
system, and then gains from all other payers.
This bill would require the department, once the department has
accounted for amounts for county indigent realignment and special
local health funds specifically restricted for indigent care, to
determine and apply against the shortfall amounts for special local
health funds that are not restricted for indigent care, amounts
imputed for county low-income health, and one-time and carry-forward
revenues, as defined. The bill would require the department to
determine these amounts on a historical basis for the 2008-09 to
2011-12 fiscal years, inclusive.
This bill would also make technical, nonsubstantive changes to
these provisions.
Existing law states the Legislature's intent to create a program
in California that provides a Low-Income Home Energy Assistance
Program (LIHEAP) service benefit, through the LIHEAP block grant, to
all recipient households of CalFresh, as specified.
Existing law requires that, if the demand for the nominal LIHEAP
service benefit exceeds allocated funding, the Department of
Community Services and Development and the State Department of Social
Services report that information to the Legislature and develop a
plan to maintain the program as intended.
This bill would delete those provisions. The bill would require
that the nominal LIHEAP services benefit be funded through the LIHEAP
grant allocated for outreach activities in accordance with state and
federal requirements.
This bill would declare that it is to take effect immediately as a
bill providing for appropriations related to the Budget Bill.
Appropriation: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 11155 of the Welfare and Institutions Code, as
added by Section 13 of Chapter 21 of the Statutes of 2013, is amended
to read:
11155. (a) Notwithstanding Section 11257, in addition to the
personal property or resources permitted by other provisions of this
part, and to the extent permitted by federal law, an applicant or
recipient for aid under this chapter including an applicant or
recipient under Chapter 2 (commencing with Section 11200) may retain
countable resources in an amount equal to the amount permitted under
federal law for qualification for the federal Supplemental Nutrition
Assistance Program, administered in California as CalFresh.
(b) The county shall determine the value of exempt personal
property other than motor vehicles in conformance with methods
established under CalFresh.
(c) (1) (A) The value of each motor vehicle that is not exempt
under paragraph (4) shall be the equity value of the vehicle, which
shall be the fair market value less encumbrances.
(B) Any motor vehicle with an equity value of nine thousand five
hundred dollars ($9,500) or less shall not be attributed to the
family's resource level.
(C) For each motor vehicle with an equity value of more than nine
thousand five hundred dollars ($9,500), the equity value that exceeds
nine thousand five hundred dollars ($9,500) shall be attributed to
the family's resource level.
(2) The equity threshold described in paragraph (1) of nine
thousand five hundred dollars ($9,500) shall be adjusted upward
annually by the increase, if any, in the United States Transportation
Consumer Price Index for All Urban Consumers published by the United
States Department of Labor, Bureau of Labor Statistics.
(3) The county shall determine the fair market value of the
vehicle in accordance with a methodology determined by the
department. The applicant or recipient shall self-certify the amount
of encumbrance, if any.
(4) The entire value of any motor vehicle shall be exempt if any
of the following apply:
(A) It is used primarily for income-producing purposes.
(B) It annually produces income that is consistent with its fair
market value, even if used on a seasonal basis.
(C) It is necessary for long distance travel, other than daily
commuting, that is essential for the employment of a family member.
(D) It is used as the family's residence.
(E) It is necessary to transport a physically disabled family
member, including an excluded disabled family member, regardless of
the purpose of the transportation.
(F) It would be exempted under any of subparagraphs (A) to (D),
inclusive, but the vehicle is not in use because of temporary
unemployment.
(G) It is used to carry fuel for heating for home use, when the
transported fuel or water is the primary source of fuel or water for
the family.
(H) Ownership of the vehicle was transferred through a gift,
donation, or family transfer, as defined by the Department of Motor
Vehicles.
(d) This section shall become operative on January 1, 2014.
SEC. 2. Section 11322.85 of the Welfare and Institutions Code, as
amended by Section 26 of Chapter 21 of the Statutes of 2013, is
amended to read:
11322.85. (a) Unless otherwise exempt, an applicant or recipient
shall participate in welfare-to-work activities.
(1) For 24 cumulative months during a recipient's lifetime, these
activities may include the activities listed in Section 11322.6 that
are consistent with the assessment performed in accordance with
Section 11325.4 and that are included in the individual's
welfare-to-work plan, as described in Section 11325.21, to meet the
hours required in Section 11322.8. These 24 months need not be
consecutive.
(2) Any month in which the recipient meets the requirements of
Section 11322.8, through participation in an activity or activities
described in paragraph (3), shall not count as a month of activities
for purposes of the 24-month time limit described in paragraph (1).
(3) After a total of 24 months of participation in welfare-to-work
activities pursuant to paragraph (1), an aided adult shall
participate in one or more of the following welfare-to-work
activities, in accordance with Section 607(c) and (d) of Title 42 of
the United States Code as of the operative date of this section, that
are consistent with the assessment performed in accordance with
Section 11325.4, and included in the individual's welfare-to-work
plan, described in Section 11325.21:
(A) Unsubsidized employment.
(B) Subsidized private sector employment.
(C) Subsidized public sector employment.
(D) Work experience, including work associated with the
refurbishing of publicly assisted housing, if sufficient private
sector employment is not available.
(E) On-the-job training.
(F) Job search and job readiness assistance.
(G) Community service programs.
(H) Vocational educational training (not to exceed 12 months with
respect to any individual).
(I) Job skills training directly related to employment.
(J) Education directly related to employment, in the case of a
recipient who has not received a high school diploma or a certificate
of high school equivalency.
(K) Satisfactory attendance at a secondary school or in a course
of study leading to a certificate of general equivalence, in the case
of a recipient who has not completed secondary school or received
such a certificate.
(L) The provision of child care services to an individual who is
participating in a community service program.
(b) Any month in which any of the following conditions exists
shall not be counted as one of the 24 months of participation allowed
under paragraph (1) of subdivision (a):
(1) The recipient is participating in job search or assessment
pursuant to subdivision (a) or (b) of Section 11320.1, is in the
process of appraisal as described in Section 11325.2, or is
participating in the development of a welfare-to-work plan, as
described in Section 11325.21.
(2) The recipient is no longer receiving aid, pursuant to Sections
11327.4 and 11327.5.
(3) The recipient has been excused from participation for good
cause, pursuant to Section 11320.3.
(4) The recipient is exempt from participation pursuant to
subdivision (b) of Section 11320.3.
(5) The recipient is only required to participate in accordance
with subdivision (d) of Section 11320.3.
(c) County welfare departments shall provide each recipient who is
subject to the requirements of paragraph (3) of subdivision (a)
written notice describing the 24-month time limitation described in
that paragraph and the process by which recipients may claim
exemptions from, and extensions to, those requirements.
(d) The notice described in subdivision (c) shall be provided at
the time the individual applies for aid, during the recipient's
annual redetermination, and at least once after the individual has
participated for a total of 18 months, and prior to the end of the
21st month, that count toward the 24-month time limit.
(e) The notice described in this section shall include, but shall
not be limited to, all of the following:
(1) The number of remaining months the adult recipient may be
eligible to receive aid.
(2) The requirements that the recipient must meet in accordance
with paragraph (3) of subdivision (a) and the action that the county
will take if the adult recipient does not meet those requirements.
(3) The manner in which the recipient may dispute the number of
months counted toward the 24-month time limit.
(4) The opportunity for the recipient to modify his or her
welfare-to-work plan to meet the requirements of paragraph (3) of
subdivision (a).
(5) The opportunity for an exemption to, or extension of, the
24-month time limitation.
(f) For an individual subject to the requirements of paragraph (3)
of subdivision (a), who is not exempt or granted an extension, and
who does not meet those requirements, the provisions of Sections
11327.4, 11327.5, 11327.9, and 11328.2 shall apply to the extent
consistent with the requirements of this section. For purposes of
this section, the procedures referenced in this subdivision shall not
be described as sanctions.
(g) (1) The department, in consultation with stakeholders, shall
convene a workgroup to determine further details of the noticing and
engagement requirements for the 24-month time limit, and shall
instruct counties via an all-county letter, followed by regulations,
no later than 18 months after the effective date of the act that
added this section.
(2) The workgroup described in paragraph (1) may also make
recommendations to refine or differentiate the procedures and due
process requirements applicable to individuals as described in
subdivision (f).
(h) (1) Notwithstanding paragraph (3) of subdivision (a) or any
other law, an assistance unit that contains an eligible adult who has
received assistance under this chapter, or from any state pursuant
to the Temporary Assistance for Needy Families program (Part A
(commencing with Section 401) of Title IV of the federal Social
Security Act (42 U.S.C. Sec. 601 et seq.)) prior to January 1, 2013,
may continue in a welfare-to-work plan that meets the requirements of
Section 11322.6 for a cumulative period of 24 months commencing
January 1, 2013, unless or until he or she exceeds the 48-month time
limitation described in Section 11454.
(2) All months of assistance described in paragraph (1) prior to
January 1, 2013, shall not be applied to the 24-month limitation
described in paragraph (1) of subdivision (a).
(i) This section shall remain in effect only until January 1,
2014, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2014, deletes or extends
that date.
SEC. 3. Section 11322.85 of the Welfare and Institutions Code, as
added by Section 27 of Chapter 21 of the Statutes of 2013, is amended
to read:
11322.85. (a) Unless otherwise exempt, an applicant or recipient
shall participate in welfare-to-work activities.
(1) For 24 cumulative months during a recipient's lifetime, these
activities may include the activities listed in Section 11322.6 that
are consistent with the assessment performed in accordance with
Section 11325.4 and that are included in the individual's
welfare-to-work plan, as described in Section 11325.21, to meet the
hours required in Section 11322.8. These 24 months need not be
consecutive.
(2) Any month in which the recipient meets the requirements of
Section 11322.8, through participation in an activity or activities
described in paragraph (3), shall not count as a month of activities
for purposes of the 24-month time limit described in paragraph (1).
(3) After a total of 24 months of participation in welfare-to-work
activities pursuant to paragraph (1), an aided adult shall
participate in one or more of the following welfare-to-work
activities, in accordance with Section 607(c) and (d) of Title 42 of
the United States Code as of the operative date of this section, that
are consistent with the assessment performed in accordance with
Section 11325.4, and included in the individual's welfare-to-work
plan, described in Section 11325.21:
(A) Unsubsidized employment.
(B) Subsidized private sector employment.
(C) Subsidized public sector employment.
(D) Work experience, including work associated with the
refurbishing of publicly assisted housing, if sufficient private
sector employment is not available.
(E) On-the-job training.
(F) Job search and job readiness assistance.
(G) Community service programs.
(H) Vocational educational training (not to exceed 12 months with
respect to any individual).
(I) Job skills training directly related to employment.
(J) Education directly related to employment, in the case of a
recipient who has not received a high school diploma or a certificate
of high school equivalency.
(K) Satisfactory attendance at a secondary school or in a course
of study leading to a certificate of general equivalence, in the case
of a recipient who has not completed secondary school or received
such a certificate.
(L) The provision of child care services to an individual who is
participating in a community service program.
(b) Any month in which any of the following conditions exists
shall not be counted as one of the 24 months of participation allowed
under paragraph (1) of subdivision (a):
(1) The recipient is participating in job search in accordance
with Section 11325.22, assessment pursuant to Section 11325.4, is in
the process of appraisal as described in Section 11325.2, or is
participating in the development of a welfare-to-work plan as
described in Section 11325.21.
(2) The recipient is no longer receiving aid, pursuant to Sections
11327.4 and 11327.5.
(3) The recipient has been excused from participation for good
cause, pursuant to Section 11320.3.
(4) The recipient is exempt from participation pursuant to
subdivision (b) of Section 11320.3.
(5) The recipient is only required to participate in accordance
with subdivision (d) of Section 11320.3.
(6) The recipient is participating in family stabilization
pursuant to Section 11325.24, and the recipient would meet the
criteria for good cause pursuant to Section 11320.3. This paragraph
may apply to a recipient for no more than six cumulative months.
(c) County welfare departments shall provide each recipient who is
subject to the requirements of paragraph (3) of subdivision (a)
written notice describing the 24-month time limitation described in
that paragraph and the process by which recipients may claim
exemptions from, and extensions to, those requirements.
(d) The notice described in subdivision (c) shall be provided at
the time the individual applies for aid, during the recipient's
annual redetermination, and at least once after the individual has
participated for a total of 18 months, and prior to the end of the
21st month, that count toward the 24-month time limit.
(e) The notice described in this section shall include, but shall
not be limited to, all of the following:
(1) The number of remaining months the adult recipient may be
eligible to receive aid.
(2) The requirements that the recipient must meet in accordance
with paragraph (3) of subdivision (a) and the action that the county
will take if the adult recipient does not meet those requirements.
(3) The manner in which the recipient may dispute the number of
months counted toward the 24-month time limit.
(4) The opportunity for the recipient to modify his or her
welfare-to-work plan to meet the requirements of paragraph (3) of
subdivision (a).
(5) The opportunity for an exemption to, or extension of, the
24-month time limitation.
(f) For an individual subject to the requirements of paragraph (3)
of subdivision (a), who is not exempt or granted an extension, and
who does not meet those requirements, the provisions of Sections
11327.4, 11327.5, 11327.9, and 11328.2 shall apply to the extent
consistent with the requirements of this section. For purposes of
this section, the procedures referenced in this subdivision shall not
be described as sanctions.
(g) (1) The department, in consultation with stakeholders, shall
convene a workgroup to determine further details of the noticing and
engagement requirements for the 24-month time limit, and shall
instruct counties via an all-county letter, followed by regulations,
no later than 18 months after the effective date of the act that
added this section.
(2) The workgroup described in paragraph (1) may also make
recommendations to refine or differentiate the procedures and due
process requirements applicable to individuals as described in
subdivision (f).
(h) (1) Notwithstanding paragraph (3) of subdivision (a) or any
other law, an assistance unit that contains an eligible adult who has
received assistance under this chapter, or from any state pursuant
to the Temporary Assistance for Needy Families program (Part A
(commencing with Section 401) of Title IV of the federal Social
Security Act (42 U.S.C. Sec. 601 et seq.)) prior to January 1, 2013,
may continue in a welfare-to-work plan that meets the requirements of
Section 11322.6 for a cumulative period of 24 months commencing
January 1, 2013, unless or until he or she exceeds the 48-month time
limitation described in Section 11454.
(2) All months of assistance described in paragraph (1) prior to
January 1, 2013, shall not be applied to the 24-month limitation
described in paragraph (1) of subdivision (a).
(i) This section shall become operative on January 1, 2014.
SEC. 4. Section 11450.025 of the Welfare and Institutions Code is
amended to read:
11450.025. (a) Notwithstanding any other law, effective on March
1, 2014, the maximum aid payments in effect on July 1, 2012, as
specified in subdivision (b) of Section 11450.02, shall be increased
by 5 percent.
(b) Commencing in 2014 and annually thereafter, on or before
January 10 and on or before May 14, the Director of Finance shall do
all of the following:
(1) Estimate the amount of growth revenues pursuant to subdivision
(f) of Section 17606.10 that will be deposited in the Child Poverty
and Family Supplemental Support Subaccount of the Local Revenue Fund
for the current fiscal year and the following fiscal year and the
amounts in the subaccount carried over from prior fiscal years.
(2) For the current fiscal year and the following fiscal year,
determine the total cost of providing the increase described in
subdivision (a), as well as any other increase in the maximum aid
payments subsequently provided only under this section, after
adjusting for updated projections of CalWORKs costs associated with
caseload changes, as reflected in the local assistance subvention
estimates prepared by the State Department of Social Services and
released with the annual Governor's Budget and subsequent May
Revision update.
(3) If the amount estimated in paragraph (1) plus the amount
projected to be deposited for the current fiscal year into the Child
Poverty and Family Supplemental Support Subaccount pursuant to
subparagraph (3) of subdivision (e) of Section 17600.15 is greater
than the amount determined in paragraph (2), the difference shall be
used to calculate the percentage increase to the CalWORKs maximum aid
payment standards that could be fully funded on an ongoing basis
beginning the following fiscal year.
(4) If the amount estimated in paragraph (1) plus the amount
projected to be deposited for the current fiscal year into the Child
Poverty and Family Supplemental Support Subaccount pursuant to
subparagraph (3) of subdivision (e) of Section 17600.15 is equal to
or less than the amount determined in paragraph (2), no additional
increase to the CalWORKs maximum aid payment standards shall be
provided in the following fiscal year in accordance with this
section.
(5) (A) Commencing with the 2014-15 fiscal year and for all fiscal
years thereafter, if changes to the estimated amounts determined in
paragraphs (1) or (2), or both, as of the May Revision, are enacted
as part of the final budget, the Director of Finance shall repeat,
using the same methodology used in the May Revision, the calculations
described in paragraphs (3) and (4) using the revenue projections
and grant costs assumed in the enacted budget.
(B) If a calculation is required pursuant to subparagraph (A), the
Department of Finance shall report the result of this calculation to
the appropriate policy and fiscal committees of the Legislature upon
enactment of the Budget Act.
(c) An increase in maximum aid payments calculated pursuant to
paragraph (3) of subdivision (b), or pursuant to paragraph (5) of
subdivision (b) if applicable, shall become effective on October 1 of
the following fiscal year.
(d) (1) An increase in maximum aid payments provided in accordance
with this section shall be funded with growth revenues from the
Child Poverty and Family Supplemental Support Subaccount in
accordance with paragraph (3) of subdivision (e) of Section 17600.15
and subdivision (f) of Section 17606.10, to the extent funds are
available in that subaccount.
(2) If funds received by the Child Poverty and Family Supplemental
Support Subaccount in a particular fiscal year are insufficient to
fully fund any increases to maximum aid payments made pursuant to
this section, the remaining cost for that fiscal year will be
addressed through existing provisional authority included in the
annual Budget Act. Additional grant increases shall not be provided
until and unless the ongoing cumulative costs of all prior grant
increases provided pursuant to this section are fully funded by the
Child Poverty and Family Supplemental Support Subaccount.
(e) Notwithstanding Section 15200, counties shall not be required
to contribute a share of cost to cover the costs of increases to
maximum aid payments made pursuant to this section.
SEC. 5. Section 14186.11 of the Welfare and Institutions Code is
amended to read:
14186.11. Section 14182.17 shall apply to the provision of CBAS,
MSSP, skilled nursing facility, and IHSS services in Coordinated Care
Initiative counties as set forth in this article.
SEC. 6. Section 14199.1 of the Welfare and Institutions Code is
amended to read:
14199.1. (a) The Legislature finds and declares the following:
(1) Beginning January 1, 2014, many low-income individuals will be
eligible for Medi-Cal coverage pursuant to federal law, as part of
health care reform.
(2) In implementing this expansion of Medi-Cal coverage, it is
critical to maintain the role of county public hospital health
systems that have traditionally served Medi-Cal and uninsured
beneficiaries to ensure adequate access to care is available for the
new Medi-Cal members, and to preserve the policy goal to support and
strengthen traditional safety net providers who treat a high volume
of uninsured and Medi-Cal patients.
(b) For purposes of this section, the following definitions shall
apply:
(1) "County public hospital health system" shall have the meaning
provided in subdivision (f) of Section 17612.2.
(2) "Default members" means newly eligible beneficiaries enrolled
in each Medi-Cal managed care plan who do not affirmatively select a
primary care provider as part of the enrollment process.
(3) "Enrollment target" means the number of newly eligible
beneficiaries assigned to primary care providers within a county
public hospital health system, not to exceed the number of
unduplicated Low Income Health Program and uninsured patient count in
the county public hospital health system. The unduplicated patient
count shall be certified by the county public hospital health system
and provided to the department, along with its proposed enrollment
target, by November 30, 2013. The county public hospital health
system may notify the department of a proposed reduction to its
enrollment target based on its capacity to accept new patients. A
standardized protocol for determining the target shall be developed
by the department in consultation with the public hospital health
system counties.
(4) "Low Income Health Program" shall mean the LIHP as defined in
subdivision (c) of Section 15909.1.
(5) "Medi-Cal managed care plan" means an organization or entity
that enters into a contract with the department pursuant to Article
2.7 (commencing with Section 14087.3), Article 2.8 (commencing with
Section 14087.5), Article 2.81 (commencing with Section 14087.96),
Article 2.91 (commencing with Section 14089), or Chapter 8
(commencing with Section 14200).
(6) "Newly eligible beneficiaries" shall have the meaning provided
in subdivision (s) of Section 17612.2.
(7) "Primary care provider" means a primary care physician or
nonphysician medical practitioner, medical group, clinic, or a
medical home.
(8) "Public hospital health system county" shall have the meaning
provided in subdivision (u) of Section 17612.2.
(c) Subject to subdivision (d), default members who reside in a
public hospital health system county shall be assigned by each
Medi-Cal managed care plan in the county to a primary care provider
in accordance with the following:
(1) Throughout the three-year period ending on December 31, 2016,
at least 75 percent of default members shall be assigned by each
Medi-Cal managed care plan to primary care providers within the
county public hospital health system until the county public hospital
health system meets its enrollment target.
(2) Following the expiration of the three-year period set forth in
paragraph (1), at least 50 percent of default members shall be
assigned by each Medi-Cal managed care plan to primary care providers
within the county public hospital health system until the county
public hospital health system meets its applicable enrollment target.
(3) Paragraphs (1) and (2) shall not apply with respect to a
county public hospital health system during any time period in which
the county public hospital health system meets or exceeds its
applicable target. For time periods during which paragraphs (1) and
(2) do not apply, default members shall be assigned to primary care
providers in the same manner as other Medi-Cal members of the
Medi-Cal managed care plan who do not affirmatively select primary
care providers. Medi-Cal managed care plans shall not modify the
assignment procedures due to the default assignment requirements of
this section with respect to primary care providers within the county
public hospital health system.
(4) In implementing the assignment process set forth in paragraphs
(1) and (2), to the extent legally permissible and consistent with
federal and state privacy and patient confidentiality laws, each
Medi-Cal managed care plan shall first assign to a primary care
provider within the county public hospital health system those
default members who have accessed care within the county public
hospital health system two or more times within the past 12 months.
The department and the county public hospital health systems shall
work together to share patient information in order to provide the
Medi-Cal managed care plans with data demonstrating which default
members have accessed the county public hospital health system
providers prior to assignment to a primary care provider.
(5) If at any time a county public hospital health system notifies
a contracted Medi-Cal managed care plan that it has reached its
maximum capacity for the assignment of default members, the
requirements set forth in paragraphs (1) and (2) shall not apply to
the Medi-Cal managed care plan so notified. Once the county public
hospital health system notifies a Medi-Cal managed care plan that it
has capacity to
accept assignment of default members, the requirements set forth in
paragraphs (1) and (2) shall apply effective on the first day of the
month following that notice.
(6) A Medi-Cal managed care plan shall not assign default members
to a primary care provider within the county public hospital health
system if that primary care provider has notified the Medi-Cal
managed care plan that it does not have capacity to accept new
patients.
(d) The default process described in this section shall not apply
to Low Income Health Program enrollees subject to Section 14005.61.
(e) Nothing set forth in this section shall alter, reduce, or
modify in any manner the way in which Medi-Cal managed care plans
assign other Medi-Cal members to the county public hospital health
systems.
(f) (1) The department shall modify its contracts with the
Medi-Cal managed care plans in public hospital health system counties
to include the assignment requirements set forth in this section.
(2) Each Medi-Cal managed care plan shall demonstrate and certify
that it has contracts or other arrangements in place with county
public hospital health systems that provide for implementing the
requirements of this section. To the extent a Medi-Cal managed care
plan is not compliant with any of the requirements of this section,
the department shall reduce by 25 percent the default assignment into
the Medi-Cal managed care plan with respect to all Medi-Cal
beneficiaries, as long as the other Medi-Cal managed care plan or
plans in that county have the capacity to receive the additional
default membership.
(g) Nothing in this section shall modify the ability of newly
eligible beneficiaries to select or change their primary care
providers.
(h) The department shall seek any necessary federal approvals to
implement the provisions of this section.
SEC. 7. Section 17600.15 of the Welfare and Institutions Code is
amended to read:
17600.15. (a) Of the sales tax proceeds from revenues collected
in the 1991-92 fiscal year which are deposited to the credit of the
Local Revenue Fund, 51.91 percent shall be credited to the Mental
Health Subaccount, 36.17 percent shall be credited to the Social
Services Subaccount, and 11.92 percent shall be credited to the
Health Subaccount of the Sales Tax Account.
(b) For the 1992-93 fiscal year to the 2011-12 fiscal year,
inclusive, of the sales tax proceeds from revenues deposited to the
credit of the Local Revenue Fund, the Controller shall make monthly
deposits to the Mental Health Subaccount, the Social Services
Subaccount, and the Health Subaccount of the Sales Tax Account until
the deposits equal the amounts that were allocated to counties,
cities, and cities and counties mental health accounts, social
services accounts, and health accounts, respectively, of the local
health and welfare trust funds in the prior fiscal year pursuant to
this chapter from the Sales Tax Account and the Sales Tax Growth
Account. Any excess sales tax revenues received pursuant to Sections
6051.2 and 6201.2 of the Revenue and Taxation Code shall be deposited
in the Sales Tax Growth Account of the Local Revenue Fund.
(c) (1) For the 2012-13 fiscal year, of the sales tax proceeds
from revenues deposited to the credit of the Local Revenue Fund, the
Controller shall make monthly deposits to the Social Services
Subaccount and the Health Subaccount of the Sales Tax Account until
the deposits equal the amounts that were allocated to counties',
cities', and city and counties social services accounts and health
accounts, respectively, of the local health and welfare trust funds
in the prior fiscal year pursuant to this chapter from the Sales Tax
Account and the Sales Tax Growth Account.
(2) For the 2012-13 fiscal year, of the sales tax proceeds from
revenues deposited to the credit of the Local Revenue Fund, the
Controller shall make monthly deposits to the Mental Health
Subaccount of the Sales Tax Account until the deposits equal the
amounts that were allocated to counties', cities', and city and
counties CalWORKs Maintenance of Effort Subaccounts pursuant to
subdivision (a) of Section 17601.25, and any additional amounts above
the amount specified in subdivision (a) of Section 17601.25, of the
local health and welfare trust funds in the prior fiscal year
pursuant to this chapter from the Sales Tax Account and the Sales Tax
Growth Account. The Controller shall not include in this calculation
any funding deposited in the Mental Health Subaccount from the
Support Services Growth Subaccount pursuant to Section 30027.9 of the
Government Code or funds described in subdivision (c) of Section
17601.25.
(3) Any excess sales tax revenues received pursuant to Sections
6051.2 and 6201.2 of the Revenue and Taxation Code after the
allocations required by paragraphs (1) and (2) are made shall be
deposited in the Sales Tax Growth Account of the Local Revenue Fund.
(d) (1) For the 2013-14 fiscal year, of the sales tax proceeds
from revenues deposited to the credit of the Local Revenue Fund, the
Controller shall make monthly deposits pursuant to a schedule
provided by the Department of Finance, which shall provide deposits
to the Social Services Subaccount and the Health Subaccount of the
Sales Tax Account until the deposits equal the amounts that were
allocated to counties', cities', and city and counties' social
services accounts and health accounts, respectively, of the local
health and welfare trust funds in the prior fiscal year pursuant to
this chapter from the Sales Tax Account and the Sales Tax Growth
Account.
(2) For the 2013-14 fiscal year, of the sales tax proceeds from
revenues deposited to the credit of the Local Revenue Fund, the
Controller shall make monthly deposits to the Mental Health
Subaccount of the Sales Tax Account until the deposits equal the
amounts that were allocated to counties', cities', and cities and
counties' CalWORKs Maintenance of Effort Subaccounts pursuant to
subdivision (a) of Section 17601.25, and any additional amounts above
the amount specified in subdivision (a) of Section 17601.25, of the
local health and welfare trust funds in the prior fiscal year
pursuant to this chapter from the Sales Tax Account and the Sales Tax
Growth Account. The Controller shall not include in this calculation
any funding deposited in the Mental Health Subaccount from the
Support Services Growth Subaccount pursuant to Section 30027.9 of the
Government Code or funds described in subdivision (c) of Section
17601.25.
(3) Any excess sales tax revenues received pursuant to Sections
6051.2 and 6201.2 of the Revenue and Taxation Code after the
allocations required by paragraphs (1) and (2) are made shall be
deposited in the Sales Tax Growth Account of the Local Revenue Fund.
(4) On a monthly basis, pursuant to a schedule provided by the
Department of Finance, the Controller shall transfer funds from the
Social Services Subaccount to the Health Subaccount in an amount that
shall not exceed three hundred million dollars ($300,000,000) for
the 2013-14 fiscal year. The funds so transferred shall not be used
in calculating future year deposits to the Social Services Subaccount
or the Health Subaccount.
(e) For the 2014-15 fiscal year and fiscal years thereafter, of
the sales tax proceeds from revenues deposited to the credit of the
Local Revenue Fund, the Controller shall make the following monthly
deposits:
(1) To the Social Services Subaccount of the Sales Tax Account,
until the deposits equal the total amount that was deposited to the
Social Services Subaccount in the prior fiscal year pursuant to this
section, in addition to the amounts that were allocated to the social
services accounts of the local health and welfare trust funds in the
prior fiscal year pursuant to this chapter from the Sales Tax Growth
Account.
(2) To the Health Subaccount of the Sales Tax Account, until the
deposits equal the total amount that was deposited to the Health
Subaccount in the prior year from the Sales Tax Account in addition
to the amounts that were allocated to the health accounts of the
local health and welfare trust funds in the prior fiscal year
pursuant to this chapter from the Sales Tax Growth Account.
(3) To the Child Poverty and Family Supplemental Support
Subaccount until the deposits equal the amounts that were deposited
in the prior fiscal year from the Sales Tax Account and the Sales Tax
Growth Account.
(4) To the Mental Health Subaccount of the Sales Tax Account until
the deposits equal the amounts that were allocated to counties',
cities', and cities and counties' CalWORKs Maintenance of Effort
Subaccounts pursuant to subdivision (a) of Section 17601.25, and any
additional amounts above the amount specified in subdivision (a) of
Section 17601.25 of the local health and welfare trust funds in the
prior fiscal year pursuant to this chapter from the Sales Tax Account
and the Sales Tax Growth Account. The Controller shall not include
in this calculation any funding deposited in the Mental Health
Subaccount from the Support Services Growth Subaccount pursuant to
Section 30027.9 of the Government Code or funds described in
subdivision (c) of Section 17601.25.
(5) Any excess sales tax revenues received pursuant to Sections
6051.2 and 6201.2 of the Revenue and Taxation Code after the
allocations required by paragraphs (1) to (4), inclusive, are made
shall be deposited in the Sales Tax Growth Account of the Local
Revenue Fund.
(6) On a monthly basis, pursuant to a schedule provided by the
Department of Finance, the Controller shall transfer funds from the
Social Services Subaccount to the Health Subaccount in an amount that
shall not exceed one billion dollars ($1,000,000,000) in any fiscal
year. The transfer schedule shall be based on the amounts that each
county is receiving in vehicle license fees pursuant to this chapter.
The funds so transferred shall not be used in calculating future
year deposits to the Social Services Subaccount or the Health
Subaccount.
SEC. 8. Section 17600.50 of the Welfare and Institutions Code is
amended to read:
17600.50. (a) A county that participated in the County Medical
Services Program in the 2011-12 fiscal year, including the Counties
of Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, El Dorado,
Glenn, Humboldt, Imperial, Inyo, Kings, Lake, Lassen, Madera, Marin,
Mariposa, Mendocino, Modoc, Mono, Napa, Nevada, Plumas, San Benito,
Shasta, Sierra, Siskiyou, Solano, Sonoma, Sutter, Tehama, Trinity,
Tuolumne, and Yuba and the Governing Board of the County Medical
Services Program, shall adopt resolutions by January 22, 2014, that
confirm acceptance for the following approach to determining payments
to the Family Support Subaccount:
(1) The amount of payments to the Family Support Subaccount shall
be equal to 60 percent of the sum of the following:
(A) The 1991 health realignment funds that would have otherwise
been allocated to the counties listed above pursuant to Sections
17603, 17604, and 17606.20 and the maintenance of effort in
subdivision (a) of Section 17608.10 for these counties, as those
sections read on January 1, 2012, and Section 17606.10 as it read on
July 1, 2013.
(B) The 1991 health realignment funds that would have otherwise
been allocated to the County Medical Services Program pursuant to
Sections 17603, 17604, 17605.07, and 17606.20, as those sections read
on January 1, 2012.
(2) The payment computed in paragraph (1) shall be achieved
through the following:
(A) Each county listed in subdivision (a) shall pay the amounts
otherwise payable to the County Medical Services Program pursuant to
subparagraph (B) of paragraph (2) of subdivision (j) of Section 16809
to the Family Support Subaccount.
(B) The County Medical Services Program shall pay the difference
between the total computed in paragraph (1) and the amount calculated
in subparagraph (A) from funds provided pursuant to the Welfare and
Institutions Code.
(b) The Counties of Fresno, Merced, Orange, Placer, Sacramento,
San Diego, San Luis Obispo, Santa Barbara, Santa Cruz, Stanislaus,
Tulare, and Yolo shall each tentatively inform the state by November
1, 2013, which of the following options it selects for determining
its payments to the Family Support Subaccount. On or before January
22, 2014, the board of supervisors of each county and city and county
may adopt a resolution informing the state of the county's or city
and county's final selection of the option for determining its
payments to the Family Support Subaccount:
(1) The formula detailed in Article 13 (commencing with Section
17613.1).
(2) (A) A calculation of 60 percent of the total of 1991 health
realignment funds that would have otherwise been allocated to that
county or city and county pursuant to Sections 17603, 17604, and
17606.20, as those sections read on January 1, 2012, and Section
17606.10, as it read on July 1, 2013, and 60 percent of the
maintenance of effort in subdivision (a) of Section 17608.10, as it
read on January 1, 2012.
(B) If a county's maintenance of effort in subdivision (a) of
Section 17608.10 is greater than 14.6 percent of the total value of
the county's 2010-11 allocation pursuant to Sections 17603, 17604,
17606.10, and 17606.20 and subdivision (a) of Section 17608.10, the
value of the maintenance of effort used in the calculation in
subparagraph (A) shall be limited to 14.6 percent.
(c) The Counties of Alameda, Contra Costa, Kern, Los Angeles,
Monterey, Riverside, San Bernardino, San Francisco, San Joaquin, San
Mateo, Santa Clara, and Ventura shall each tentatively inform the
state by November 1, 2013, which of the following options it selects
for determining its payments to the Family Support Subaccount. On or
before January 22, 2014, the board of supervisors of each county and
city and county may adopt a resolution informing the state of the
county's or city and county's final selection of the option for
determining its payments to the Family Support Subaccount:
(1) The formula detailed in Article 12 (commencing with Section
17612.1).
(2) (A) A calculation of 60 percent of the total of 1991 health
realignment funds that would have otherwise been allocated to that
county or city and county pursuant to Sections 17603, 17604, and
17606.20, as those sections read on January 1, 2012, and Section
17606.10, as it read on July 1, 2013, and 60 percent of the
maintenance of effort in subdivision (a) of Section 17608.10, as it
read on January 1, 2012.
(B) If a county's maintenance of effort in subdivision (a) of
Section 17608.10 is greater than 25.9 percent of the total value of
the county's 2010-11 fiscal year allocation pursuant to Sections
17603, 17604, 17606.10, and 17606.20, and subdivision (a) of Section
17608.10, the value of the maintenance of effort used in the
calculation in subparagraph (A) shall be limited to 25.9 percent.
(d) (1) If the board of supervisors of a county or city and county
fails to adopt a resolution pursuant to subdivision (b) or (c), as
applicable, or fails to inform the Director of Health Care Services
of the city and county or county's final selection, by January 22,
2014, the calculation shall be 62.5 percent of the total of 1991
health realignment funds that would have otherwise been allocated to
that county or city and county pursuant to Sections 17603, 17604, and
17606.20, as those sections read on January 1, 2012, and Section
17606.10, as it read on July 1, 2013, and 62.5 percent of the
maintenance of effort in subdivision (a) of Section 17608.10, as it
read on January 1, 2012.
(2) If the County Medical Services Program governing board or the
board of supervisors of a county that participates in the County
Medical Services Program fails to adopt a resolution pursuant to
subdivision (a), or fails to inform the Director of Health Care
Services of the county's final selection, by January 22, 2014, then
paragraphs (1) and (2) of subdivision (a) apply to the applicable
counties and to the County Medical Services Program.
SEC. 9. Section 17600.60 of the Welfare and Institutions Code is
amended to read:
17600.60. (a) The County Health Care Funding Resolution Committee
is hereby created to do all of the following:
(1) Determine whether the calculation of the historical percentage
or amount to be applied in calculations in Sections 17612.3 and
17613.3 complies with those sections, taking into account the data
and calculations provided by the county and any alternative data and
calculations submitted by the department.
(2) Hear and determine petitions from certain counties, as
defined, to make particularized changes in what provisions of Section
17600.50 are controlling.
(3) Hear and determine petitions for an alternative cost
calculation to the cost per person calculation in subdivision (c) of
Section 17613.2.
(b) The committee shall consist of the following members:
(1) One person selected by the California State Association of
Counties.
(2) One person selected by the State Department of Health Care
Services.
(3) One person selected by the Director of Finance.
(c) (1) The committee is not subject to the Bagley-Keene Open
Meeting Act (Article 9 (commencing with Section 11120) of Chapter 1
of Part 1 of Division 3 of Title 2 of the Government Code) and shall
be exempt from the Administrative Procedure Act (Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code). The Department of Finance shall provide staff
for the committee.
(2) Pursuant to paragraph (2) of subdivision (b) of Section 3 of
Article I of the California Constitution, the Legislature finds and
declares that the public interest in affordable and accessible health
care outweighs the public interest in access to these proceedings.
(d) (1) A county or city and county, that chose to be subject to
paragraph (2) of subdivision (b) or paragraph (2) of subdivision (c)
of Section 17600.50 may submit a petition to the committee to be
subject to paragraph (1) of subdivision (b) or paragraph (1) of
subdivision (c) of Section 17600.50, as applicable, if the county or
city and county demonstrates and provides sufficient evidence of both
of the following criteria:
(A) There have been changes in expenditures related to state and
federal law, regulation and rulemaking, or court decisions that have
a material impact on the provision of health care services to
indigent adults.
(B) All of the data necessary to participate in Article 12
(commencing with Section 17612.1) or Article 13 (commencing with
Section 17613.1), as appropriate.
(2) The form of petition shall be determined by the committee by
January 31, 2014.
(3) If the committee approves the petition the county or city and
county shall be subject to paragraph (1) of subdivision (b) or
paragraph (1) of subdivision (c) of Section 17600.50, as applicable,
at the start of the next fiscal year.
(e) (1) A county that chose to be subject to Article 13
(commencing with Section 17613.1) may submit a petition to the
committee for an alternative cost calculation to the cost per person
calculation in subdivision (c) of Section 17613.2 with the
documentation of extraordinary circumstances, including circumstances
related to the local health care marketplace, provider, and provider
contracts.
(2) The county shall submit all necessary data to support its
submission.
(f) The committee shall make decisions within 45 days of hearing
any petition.
SEC. 10. Section 17601.75 of the Welfare and Institutions Code is
amended to read:
17601.75. (a) On or before the 27th day of the month, the
Controller shall allocate to the family support account in the local
health and welfare trust fund of each county and city and county the
amounts deposited and remaining unexpended and unreserved on the 15th
day of the month in the Family Support Subaccount of the Local
Revenue Fund, pursuant to schedules developed by the Department of
Finance in conjunction with the appropriate state departments and in
consultation with the California State Association of Counties.
(b) All of the funds deposited in the family support account shall
be used by each county and city and county that receives an
allocation of those funds to pay an increased county contribution
toward the costs of CalWORKs grants. Each county's total annual
contribution pursuant to this section shall equal the total amount of
funds deposited in each county's and city and county's family
support account during that fiscal year. The family support account
shall not be subject to the transferability provisions of Section
17600.20. Each county's contribution pursuant to this section and
Section 17601.25 shall be in addition to the shares of cost required
pursuant to Section 15200.
SEC. 11. Section 17603 of the Welfare and Institutions Code is
amended to read:
17603. This paragraph shall only apply until the end of the
2012-13 fiscal year. On or before the 27th day of each month, the
Controller shall allocate to the local health and welfare trust fund
health accounts the amounts deposited and remaining unexpended and
unreserved on the 15th day of the month in the Health Subaccount of
the Sales Tax Account of the Local Revenue Fund, in accordance with
subdivisions (a) and (b):
(a) For the 1991-92 fiscal year, allocations shall be made in
accordance with the following schedule:
Allocation
Jurisdiction Percentage
Alameda .................... 4.5046
Alpine ..................... 0.0137
Amador ..................... 0.1512
Butte ...................... 0.8131
Calaveras .................. 0.1367
Colusa...................... 0.1195
Contra Costa ............... 2.2386
Del Norte .................. 0.1340
El Dorado .................. 0.5228
Fresno ..................... 2.3531
Glenn ...................... 0.1391
Humboldt ................... 0.8929
Imperial ................... 0.8237
Inyo ....................... 0.1869
Kern ....................... 1.6362
Kings ...................... 0.4084
Lake ....................... 0.1752
Lassen ..................... 0.1525
Los Angeles ................ 37.2606
Madera ..................... 0.3656
Marin....................... 1.0785
Mariposa ................... 0.0815
Mendocino .................. 0.2586
Merced ..................... 0.4094
Modoc ...................... 0.0923
Mono ....................... 0.1342
Monterey ................... 0.8975
Napa ....................... 0.4466
Nevada ..................... 0.2734
Orange ..................... 5.4304
Placer ..................... 0.2806
Plumas ..................... 0.1145
Riverside .................. 2.7867
Sacramento ................. 2.7497
San Benito ................. 0.1701
San Bernardino.............. 2.4709
San Diego .................. 4.7771
San Francisco .............. 7.1450
San Joaquin ................ 1.0810
San Luis Obispo ............ 0.4811
San Mateo .................. 1.5937
Santa Barbara .............. 0.9418
Santa Clara ................ 3.6238
Santa Cruz ................. 0.6714
Shasta ..................... 0.6732
Sierra ..................... 0.0340
Siskiyou.................... 0.2246
Solano ..................... 0.9377
Sonoma ..................... 1.6687
Stanislaus ................. 1.0509
Sutter ..................... 0.4460
Tehama ..................... 0.2986
Trinity .................... 0.1388
Tulare ..................... 0.7485
Tuolumne ................... 0.2357
Ventura .................... 1.3658
Yolo ....................... 0.3522
Yuba ....................... 0.3076
Berkeley ................... 0.0692
Long Beach ................. 0.2918
Pasadena ................... 0.1385
(b) For the 1992-93 fiscal year and fiscal years thereafter until
the commencement of the 2013-14 fiscal year, the allocations to each
county and city and county shall equal the amounts received in the
prior fiscal year by each county, city, and city and county from the
Sales Tax Account and the Sales Tax Growth Account of the Local
Revenue Fund into the health and welfare trust fund.
(c) (1) For the 2013-14 fiscal year, on the 27th day of each
month, the Controller shall allocate, in the same proportion as funds
in subdivision (b) were allocated, to each county's and city and
county's local health and welfare trust fund health accounts, the
amounts deposited and remaining unexpended and unreserved on the 15th
day of the month in the Health Subaccount of the Sales Tax Account
of the Local Revenue Fund.
(2) (A) Beginning January 2014 and for the remainder of the
2013-14 fiscal year, on or before the 27th of each month, the
Controller shall transfer to the Family Support Subaccount from the
Health Subaccount amounts determined pursuant to a schedule prepared
by the Department of Finance in consultation with the California
State Association of Counties. Cumulatively, no more than three
hundred million dollars ($300,000,000) shall be transferred.
(B) Every month, after the transfers in subparagraph (A) have
occurred, the remainder shall be allocated to the counties and cities
and counties in the same proportions as funds in subdivision (b)
were allocated.
(C) For counties participating in the County Medical Services
Program, transfers from each county shall not be greater than the
monthly amount the county would otherwise pay pursuant to paragraph
(2) of subdivision (j) of Section 16809 for participation in the
County Medical Services Program. Any difference between the amount
paid by these counties and the proportional share of the three
hundred million dollars ($300,000,000) calculated as payable by these
counties and the County Medical Services Program shall be paid from
the funds available for allocation to the County Medical Services
Program in accordance with the Welfare and Institutions Code.
(3) For the 2013-14 fiscal year, the Controller, using the same
timing and criteria used in paragraph (1), shall allocate to each
city, not to include a city and county, funds that shall equal the
amounts received in the prior fiscal year by each city from the Sales
Tax Account and the Sales Tax Growth Account of the Local Revenue
Fund into the health and welfare trust fund.
(d) (1) (A) For the 2014-15 fiscal year and for every fiscal year
thereafter, the Department of Finance, in consultation with the
California State Association of Counties, shall calculate the amount
each county or city and county shall
contribute to the Family Support Subaccount in accordance
with Section 17600.50.
(B) On or before the 27th of each month, the Controller shall
transfer, based on a schedule prepared the Department of Finance in
consultation with the California State Association of Counties, from
the funds deposited and remaining unexpended and unreserved on the
15th day of the month in the Health Subaccount of the Sales Tax
Account of the Local Revenue Fund to the Family Support Subaccount,
funds that equal, over the course of the year, the amount determined
in subparagraph (A) pursuant to a schedule provided by the Department
of Finance.
(C) After the transfer in subparagraph (B) has occurred, the State
Controller shall allocate on or before the 27th of each month to
health account in the local health and welfare trust fund of every
county and city and county from a schedule prepared by the Department
of Finance, in consultation with the California State Association of
Counties, any funds remaining in the Health Account from the funds
deposited and remaining unexpended and unreserved on the 15th day of
the month in the Health Subaccount of the Sales Tax Account of the
Local Revenue Fund. The schedule shall be prepared as the allocations
would have been distributed pursuant to subdivision (b).
(D) For the 2014-15 fiscal year and for every fiscal year
thereafter, the Controller, using the same timing and criteria as had
been used in subdivision (b), shall allocate to each city, not to
include a city and county, funds that equal the amounts received in
the prior fiscal year by each city from the Sales Tax Account and the
Sales Tax Growth Account of the Local Revenue Fund into the health
and welfare trust fund.
SEC. 12. Section 17604 of the Welfare and Institutions Code is
amended to read:
17604. (a) All motor vehicle license fee revenues collected in
the 1991-92 fiscal year that are deposited to the credit of the Local
Revenue Fund shall be credited to the Vehicle License Fee Account of
that fund.
(b) (1) For the 1992-93 fiscal year and fiscal years thereafter,
from vehicle license fee proceeds from revenues deposited to the
credit of the Local Revenue Fund, the Controller shall make monthly
deposits to the Vehicle License Fee Account of the Local Revenue Fund
until the deposits equal the amounts that were allocated to
counties, cities, and cities and counties as general purpose revenues
in the prior fiscal year pursuant to this chapter from the Vehicle
License Fee Account in the Local Revenue Fund and the Vehicle License
Fee Account and the Vehicle License Fee Growth Account in the Local
Revenue Fund.
(2) Any excess vehicle fee revenues deposited into the Local
Revenue Fund pursuant to Section 11001.5 of the Revenue and Taxation
Code shall be deposited in the Vehicle License Fee Growth Account of
the Local Revenue Fund.
(3) The Controller shall calculate the difference between the
total amount of vehicle license fee proceeds deposited to the credit
of the Local Revenue Fund, pursuant to paragraph (1) of subdivision
(a) of Section 11001.5 of the Revenue and Taxation Code, and
deposited into the Vehicle License Fee Account for the period of July
16, 2009, to July 15, 2010, inclusive, and the amount deposited for
the period of July 16, 2010, to July 15, 2011, inclusive.
(4) Of vehicle license fee proceeds deposited to the Vehicle
License Fee Account after July 15, 2011, an amount equal to the
difference calculated in paragraph (3) shall be deemed to have been
deposited during the period of July 16, 2010, to July 15, 2011,
inclusive, and allocated to cities, counties, and a city and county
as if those proceeds had been received during the 2010-11 fiscal
year.
(c) (1) On or before the 27th day of each month, the Controller
shall allocate to each county, city, or city and county, as general
purpose revenues the amounts deposited and remaining unexpended and
unreserved on the 15th day of the month in the Vehicle License Fee
Account of the Local Revenue Fund, in accordance with paragraphs (2)
and (3).
(2) For the 1991-92 fiscal year, allocations shall be made in
accordance with the following schedule:
Allocation
Jurisdiction Percentage
Alameda .................... 4.5046
Alpine ..................... 0.0137
Amador ..................... 0.1512
Butte ...................... 0.8131
Calaveras .................. 0.1367
Colusa...................... 0.1195
Contra Costa ............... 2.2386
Del Norte .................. 0.1340
El Dorado .................. 0.5228
Fresno ..................... 2.3531
Glenn ...................... 0.1391
Humboldt ................... 0.8929
Imperial ................... 0.8237
Inyo ....................... 0.1869
Kern ....................... 1.6362
Kings ...................... 0.4084
Lake ....................... 0.1752
Lassen ..................... 0.1525
Los Angeles ................ 37.2606
Madera ..................... 0.3656
Marin....................... 1.0785
Mariposa ................... 0.0815
Mendocino .................. 0.2586
Merced ..................... 0.4094
Modoc ...................... 0.0923
Mono ....................... 0.1342
Monterey ................... 0.8975
Napa ....................... 0.4466
Nevada ..................... 0.2734
Orange ..................... 5.4304
Placer ..................... 0.2806
Plumas ..................... 0.1145
Riverside .................. 2.7867
Sacramento ................. 2.7497
San Benito ................. 0.1701
San Bernardino.............. 2.4709
San Diego .................. 4.7771
San Francisco .............. 7.1450
San Joaquin ................ 1.0810
San Luis Obispo ............ 0.4811
San Mateo .................. 1.5937
Santa Barbara .............. 0.9418
Santa Clara ................ 3.6238
Santa Cruz ................. 0.6714
Shasta ..................... 0.6732
Sierra ..................... 0.0340
Siskiyou.................... 0.2246
Solano ..................... 0.9377
Sonoma ..................... 1.6687
Stanislaus ................. 1.0509
Sutter ..................... 0.4460
Tehama ..................... 0.2986
Trinity .................... 0.1388
Tulare ..................... 0.7485
Tuolumne ................... 0.2357
Ventura .................... 1.3658
Yolo ....................... 0.3522
Yuba ....................... 0.3076
Berkeley ................... 0.0692
Long Beach ........... 0.2918
Pasadena ................... 0.1385
(3) For the 1992-93, 1993-94, and 1994-95 fiscal year and fiscal
years thereafter, allocations shall be made in the same amounts as
were distributed from the Vehicle License Fee Account and the Vehicle
License Fee Growth Account in the prior fiscal year.
(4) For the 1995-96 fiscal year, allocations shall be made in the
same amounts as distributed in the 1994-95 fiscal year from the
Vehicle License Fee Account and the Vehicle License Fee Growth
Account after adjusting the allocation amounts by the amounts
specified for the following counties:
Alpine .......................... $(11,296)
Amador .......................... 25,417
Calaveras ....................... 49,892
Del Norte ....................... 39,537
Glenn ........................... (12,238)
Lassen .......................... 17,886
Mariposa ........................ (6,950)
Modoc ........................... (29,182)
Mono ............................ (6,950)
San Benito ...................... 20,710
Sierra .......................... (39,537)
Trinity ......................... (48,009)
(5) For the 1996-97 fiscal year and fiscal years thereafter,
allocations shall be made in the same amounts as were distributed
from the Vehicle License Fee Account and the Vehicle License Fee
Growth Account in the prior fiscal year.
Initial proceeds deposited in the Vehicle License Fee Account in
the 2003-04 fiscal year in the amount that would otherwise have been
transferred pursuant to Section 10754 of the Revenue and Taxation
Code for the period June 20, 2003, to July 15, 2003, inclusive, shall
be deemed to have been deposited during the period June 16, 2003, to
July 15, 2003, inclusive, and allocated to cities, counties, and a
city and county during the 2002-03 fiscal year.
(d) The Controller shall make monthly allocations from the amount
deposited in the Vehicle License Collection Account of the Local
Revenue Fund to each county in accordance with a schedule to be
developed by the State Department of Mental Health in consultation
with the California Mental Health Directors Association, which is
compatible with the intent of the Legislature expressed in the act
adding this subdivision.
(e) Prior to making the monthly allocations in accordance with
paragraph (5) of subdivision (c) and subdivision (d), and pursuant to
a schedule provided by the Department of Finance, the Controller
shall adjust the monthly distributions from the Vehicle License Fee
Account to reflect an equal exchange of sales and use tax funds from
the Social Services Subaccount to the Health Subaccount, as required
by subdivisions (d) and (e) of Section 17600.15, and of Vehicle
License Fee funds from the Health Account to the Social Services
Account. Adjustments made to the Vehicle License Fee distributions
pursuant to this subdivision shall not be used in calculating future
year allocations to the Vehicle License Fee Account.
SEC. 13. Section 17606.10 of the Welfare and Institutions Code is
amended to read:
17606.10. (a) For the 1992-93 fiscal year and subsequent fiscal
years, the Controller shall allocate funds, on a monthly basis from
the General Growth Subaccount in the Sales Tax Growth Account to the
appropriate accounts in the local health and welfare trust fund of
each county, city, and city and county in accordance with a schedule
setting forth the percentage of total state resources received in the
1990-91 fiscal year, including State Legalization Impact Assistance
Grants distributed by the state under Part 4.5 (commencing with
Section 16700), funding provided for purposes of implementation of
Division 5 (commencing with Section 5000), for the organization and
financing of community mental health services, including the
Cigarette and Tobacco Products Surtax proceeds which are allocated to
county mental health programs pursuant to Chapter 1331 of the
Statutes of 1989, Chapter 51 of the Statutes of 1990, and Chapter
1323 of the Statutes of 1990, and state hospital funding and funding
distributed for programs administered under Sections 1794, 10101.1,
and 11322.2, as annually adjusted by the Department of Finance, in
conjunction with the appropriate state department to reflect changes
in equity status from the base percentages. However, for the 1992-93
fiscal year, the allocation for community mental health services
shall be based on the following schedule:
Percentage
of Statewide
Jurisdiction Resource Base
Alameda ....................... 4.3693
Alpine ........................ 0.0128
Amador ........................ 0.0941
Butte ......................... 0.7797
Calaveras ..................... 0.1157
Colusa ........................ 0.0847
Contra Costa .................. 2.3115
Del Norte ..................... 0.1237
El Dorado ..................... 0.3966
Fresno ........................ 3.1419
Glenn ......................... 0.1304
Humboldt ...................... 0.6175
Imperial ...................... 0.5425
Inyo .......................... 0.1217
Kern .......................... 1.8574
Kings ......................... 0.4229
Lake .......................... 0.2362
Lassen ........................ 0.1183
Los Angeles.................... 27.9666
Madera ........................ 0.3552
Marin ......................... 0.9180
Mariposa ...................... 0.0792
Mendocino ..................... 0.4099
Merced ........................ 0.8831
Modoc ......................... 0.0561
Mono .......................... 0.0511
Monterey ...................... 1.1663
Napa .......................... 0.3856
Nevada ........................ 0.2129
Orange ........................ 5.3423
Placer ........................ 0.5034
Plumas ........................ 0.1134
Riverside ..................... 3.6179
Sacramento .................... 4.1872
San Benito .................... 0.1010
San Bernardino ................ 4.5494
San Diego ..................... 7.8773
San Francisco ................. 3.5335
San Joaquin ................... 2.4690
San Luis Obispo ............... 0.6652
San Mateo ..................... 2.5169
Santa Barbara ................. 1.0745
Santa Clara ................... 5.0488
Santa Cruz .................... 0.7960
Shasta ........................ 0.5493
Sierra ........................ 0.0345
Siskiyou ...................... 0.2051
Solano ........................ 0.6694
Sonoma ........................ 1.1486
Stanislaus .................... 1.4701
Sutter/Yuba ................... 0.6294
Tehama ........................ 0.2384
Trinity ....................... 0.0826
Tulare ........................ 1.4704
Tuolumne ...................... 0.1666
Ventura ....................... 1.9311
Yolo .......................... 0.5443
Berkeley ...................... 0.2688
Tri-City ...................... 0.2347
(b) The Department of Finance shall recalculate the resource base
used in determining the General Growth Subaccount allocations to the
Health Account, Mental Health Account, and Social Services Account of
the local health and welfare trust fund of each city, county, and
city and county for the 1994-95 fiscal year general growth
allocations according to subdivisions (c) and (d). For the 1995-96
fiscal year and annually until the end of the 2012-13 fiscal year,
the Department of Finance shall prepare the schedule of allocations
of growth based upon the recalculation of the resource base as
provided by subdivision (c).
(c) For the Mental Health Account, the Department of Finance shall
do all of the following:
(1) Use the following sources as reported by the State Department
of Mental Health:
(A) The final December 1992 distribution of resources associated
with Institutes for Mental Disease.
(B) The 1990-91 fiscal year state hospitals and community mental
health allocations.
(C) Allocations for services provided for under Chapter 1294 of
the Statutes of 1989.
(2) Expand the resource base with the following nonrealigned
funding sources as allocated among the counties:
(A) Tobacco surtax allocations made under Chapter 1331 of the
Statutes of 1989 and Chapter 51 of the Statutes of 1990.
(B) For the 1994-95 allocation year only, Chapter 1323 of the
Statutes of 1990.
(C) 1993-94 fiscal year federal homeless block grant allocation.
(D) 1993-94 fiscal year Mental Health Special Education
allocations.
(E) 1993-94 fiscal year allocations for the system of care for
children, in accordance with Chapter 1229 of the Statutes of 1992.
(F) 1993-94 fiscal year federal Substance Abuse and Mental Health
Services Administration block grant allocations pursuant to
Subchapter 1 (commencing with Section 10801) of Chapter 114 of Title
42 of the United States Code.
(d) Until the end of the 2012-13 fiscal year, for the Health
Account, the Department of Finance shall use the historical resource
base of state funds as allocated among the counties, cities, and city
and county as reported by the State Department of Health Services in
a September 17, 1991, report of Indigent and Community Health
Resources.
(e) The Department of Finance shall use these adjusted resource
bases for the Health Account and Mental Health Account to calculate
what the 1994-95 fiscal year General Growth Subaccount allocations
would have been, and together with 1994-95 fiscal year Base
Restoration Subaccount allocations, CMSP subaccount allocations,
equity allocations to the Health Account and Mental Health Account as
adjusted by subparagraph (E) of paragraph (2) of subdivision (c) of
Section 17606.05, and special equity allocations to the Health
Account and Mental Health Account as adjusted by subdivision (e) of
Section 17606.15 reconstruct the 1994-95 fiscal year General Growth
Subaccount resource base for the 1995-96 allocation year for each
county, city, and city and county. Notwithstanding any other
provision of law, the actual 1994-95 general growth allocations shall
not become part of the realignment base allocations to each county,
city, and city and county. The total amounts distributed by the
Controller for general growth for the 1994-95 allocation year shall
be reallocated among the counties, cities, and city and county in the
1995-96 allocation year according to this paragraph, and shall be
included in the general growth resource base for the 1996-97
allocation year and each fiscal year thereafter. For the 1996-97
allocation year and fiscal years thereafter, the Department of
Finance shall update the base with actual growth allocations to the
Health Account, Mental Health Account, and Social Services Account of
each county, city, and city and county local health and welfare
trust fund in the prior year, and adjust for actual changes in
nonrealigned funds specified in subdivision (c) in the year prior to
the allocation year.
(f) For the 2013-14 fiscal year and every fiscal year thereafter,
the Controller shall do all of the following:
(1) Allocate to the mental health account of each county, city, or
city and county based on a schedule provided by the Department of
Finance. The Department of Finance shall recalculate the resource
base used in determining the General Growth Subaccount allocations to
mental health account in accordance with subdivision (c) and
allocate based on that recalculation.
(2) Allocate 18.4545 percent of the total General Growth
Subaccount to the Health Account.
(3) Allocate to the Child Poverty and Family Supplemental Support
Subaccount in the Sales Tax Account the remainder of the funds in the
General Growth Subaccount.
SEC. 14. Section 17610 of the Welfare and Institutions Code is
amended to read:
17610. (a) In June 2016 and for every fiscal year thereafter, for
every county or city and county that selected the option pursuant to
paragraph (1) of subdivision (b) or paragraph (1) of subdivision (c)
of Section 17600.50, the Director of Finance shall make a final
determination of the amount of the allocation attributable to each
county and city and county should have been pursuant to subdivision
(d) of Section 17603 for the penultimate fiscal year.
(b) The amount of the final determination amount for each county
or city and county shall be subtracted from the amount attributable
to each county or city and county that was actually transferred in
the applicable fiscal year. This calculation shall be made at the
same time as the final determination in subdivision (a).
(c) The Director of Finance shall promptly notify every affected
county or city and county and the Joint Legislative Budget Committee
of the determinations made pursuant to subdivisions (a) and (b).
(d) If the difference calculated in subdivision (b) is negative,
the state shall pay the applicable county or city and county, the
difference and those funds shall be deposited in that county's or
city and county's health account of the local health and welfare
trust fund. Notwithstanding Section 13340 of the Government Code,
there is hereby continuously appropriated to the Director of Finance
the funds necessary to pay any amounts owed pursuant to this
subdivision.
(e) If the difference determined in subdivision (b) is positive,
the applicable county or city and county shall pay the difference to
the family support account within the health and welfare trust fund
of that county or city and county. If within three months of receipt
of the determination made in subdivision (b), the county or city and
county has failed to make the payment, then the Director of Finance
shall provide a supplemental schedule to the Controller to have 1.5
times the amount of the determination transferred from the next
Health Subaccount allocations of the applicable county or city and
county to the Family Support Subaccount until 1.5 times the amount
owed has been deposited in the family support account.
(f) Solely for the June 2016 final determination, the amount
redirected pursuant to this article shall not exceed the amount
determined for the county or city and county for the 2013-14 fiscal
year under subdivision (c) of Section 17603, as that amount may have
been reduced by the application of Section 17610.5.
SEC. 15. Section 17610.5 of the Welfare and Institutions Code is
amended to read:
17610.5. (a) There is hereby created a 2013-14 Special Holding
Account in the Family Support Subaccount. Starting January 1, 2014,
until the end of the 2013-14 fiscal year, funds transferred to the
Family Support Subaccount that are attributable to every county or
city and county that chose to be subject to paragraph (1) of
subdivision (b), or paragraph (1) of subdivision (c), of Section
17600.50 shall be placed in the 2013-14 Special Holding Account.
(b) No later than April 20, 2014, the State Department of Health
Care Services shall provide an updated savings estimate for every
county and city and county that chose to be subject to paragraph (1)
of subdivision (b), or paragraph (1) of subdivision (c) of Section
17600.50 to the Department of Finance. On or before May 14, 2014, the
Department of Finance shall, for each county or city and county
described in subdivision (a), determine whether the actual savings
for each county or city and county is greater or lesser than the
amount of funds deposited into the Special Holding Account.
(c) If the revised estimate of savings is greater than the funds
estimated by the Department of Finance to be deposited in the Special
Holding Account, the funds shall be transferred back to the Family
Support Subaccount by the end of the 2013-14 fiscal year, for
allocation.
(d) If the revised estimate of savings is less than the funds
estimated by the Department of Finance to be deposited in the Special
Holding Account, the difference between the amount estimated to be
transferred and the revised estimated savings amount shall be
transferred to the health account of the local health and welfare
trust fund of every affected county or city and county pursuant to a
schedule prepared by the Director of Finance in consultation with the
California State Association of Counties and provided to the
Controller.
(e) This section shall remain in effect only until January 1,
2015, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2015, deletes or extends
that date.
SEC. 16. Section 17612.1 of the Welfare and Institutions Code is
amended to read:
17612.1. (a) For the 2013-14 fiscal year and each fiscal year
thereafter, for each public hospital health system county that
selected the option in paragraph (1) of subdivision (c) of Section
17600.50, the total amount that would be payable for the fiscal year
from 1991 Health Realignment funds under Sections 17603, 17604, and
17606.20, as those sections read on January 1, 2012, and Section
17606.10, as it read on July 1, 2013, and deposited by the Controller
into the local health and welfare trust fund health account of the
county in the absence of this section shall be determined.
(b) The redirected amount determined for the public hospital
health system county pursuant to Section 17612.3 shall be divided by
the total determined in subdivision (a), except that, with respect to
the County of Los Angeles, the redirected amount shall be determined
by taking into account the adjustments required in Section 17612.5.
(c) The resulting fraction determined in subdivision (b) shall be
the percentage of 1991 Health Realignment funds under Sections 17603,
17604, and 17606.20, as those sections read on January 1, 2012, and
Section 17606.10, as it read on July 1, 2013, to be deposited each
month into the Family Support Subaccount.
(d) The total amount deposited into the Family Support Subaccount
under subdivision (c) with respect to a public hospital health system
county for a fiscal year shall not exceed the redirected amount
determined pursuant to Section 17612.3, and shall be subject to the
appeal processes, and judicial review as described in subdivision (d)
of Section 17612.3.
(e) The Legislature finds and declares that this article is not
intended to change the local obligation pursuant to Section 17000.
SEC. 17. Section 17612.2 of the Welfare and Institutions Code is
amended to read:
17612.2. For purposes of this article, the following definitions
shall apply:
(a) "Adjusted patient day" means a county public hospital health
system's total number of patient census days, as defined by the
Office of Statewide Health Planning and Development, multiplied by
the following fraction: the numerator that is the sum of the county
public hospital health system's total gross revenue for all services
provided to all patients, including nonhospital services, and the
denominator that is the sum of the county public hospital health
system's gross inpatient revenue. The adjusted patient days shall
pertain to those services that are provided by the county public
hospital health system and shall exclude services that are provided
by contract or out-of-network clinics or hospitals.
(b) "Base year" means the fiscal year ending three years prior to
the fiscal year for which the redirected amount is calculated.
(c) "Blended CPI trend factor" means the blended percent change
applicable for the fiscal year that is derived from the nonseasonally
adjusted Consumer Price Index for All Urban Consumers (CPI-U),
United States City Average, for Hospital and Related Services,
weighted at 75 percent, and for Medical Care Services, weighted at 25
percent, all as published by the United States Bureau of Labor
Statistics, computed as follows:
(1) For each prior fiscal year within
the period to be trended through the current fiscal year, the annual
average of the monthly index amounts shall be determined separately
for the Hospital and Related Services Index and the Medical Care
Services Index.
(2) The year-to-year percentage changes in the annual averages
determined in paragraph (1) for each of the Hospital and Related
Services Index and the Medical Care Services Index shall be
calculated.
(3) A weighted average annual percentage change for each
year-to-year period shall be calculated from the determinations made
in paragraph (2), with the percentage changes in the Hospital and
Related Services Index weighted at 75 percent, and the percentage
changes in the Medical Care Services Index weighted at 25 percent.
The resulting average annual percentage changes shall be expressed as
a fraction, and increased by 1.00.
(4) The product of the successive year-to-year amounts determined
in paragraph (3) shall be the blended CPI trend factor.
(d) "Cost containment limit" means the public hospital health
system county's Medi-Cal costs and uninsured costs determined for the
2014-15 fiscal year and each subsequent fiscal year, adjusted as
follows:
(1) Notwithstanding paragraphs (2) to (4), inclusive, at the
public hospital health system county's option it shall be deemed to
comply with the cost containment limit if the county demonstrates
that its total health care costs, including nursing facility, mental
health, and substance use disorder services, that are not limited to
Medi-Cal and uninsured patients, for the fiscal year did not exceed
its total health care costs in the base year, multiplied by the
blended CPI trend factor for the fiscal year. A county electing this
option shall elect by November 1 following the end of the fiscal
year, and submit its supporting reports for meeting this requirement,
including the annual report of financial transactions required to be
submitted to the Controller pursuant to Section 53891 of the
Government Code.
(2) (A) The public hospital health system county's Medi-Cal costs,
uninsured costs, and other entity intergovernmental transfer amounts
for the fiscal year shall be added together. Medi-Cal costs,
uninsured costs, and other entity intergovernmental transfer amounts
for purposes of this paragraph are as defined in subdivisions (q),
(t), and (y) for the relevant fiscal period.
(B) The public hospital health system county's Medi-Cal costs,
uninsured costs, and imputed other entity intergovernmental transfer
amounts for the base year shall be added together and multiplied by
the blended CPI trend factor. The base year costs used shall not
reflect any adjustments under this subdivision.
(C) The fiscal year amount determined in subparagraph (A) shall be
compared to the trended amount in subparagraph (B). If the amount in
subparagraph (B) exceeds the amount in subparagraph (A), the public
hospital health system county shall be deemed to have satisfied the
cost containment limit. If the amount in subparagraph (A) exceeds the
amount in subparagraph (B), the calculation in paragraph (3) shall
be performed.
(3) (A) If the number of adjusted patient days of service provided
by the county public hospital health system for the fiscal year
exceeds its number of adjusted patient days of service rendered in
the base year by at least 10 percent, the excess adjusted patient
days above the base year for the fiscal year shall be multiplied by
the cost per adjusted patient day of the county public hospital
health system for the base year. The result shall be added to the
trended base year amount determined in subparagraph (B) of paragraph
(2), yielding the applicable cost containment limit, subject to
paragraph (4).
(B) If the number of adjusted patient days of service provided by
a county's public hospital health system for the fiscal year does not
exceed its number of adjusted patient days of service rendered in
the base year by 10 percent, the applicable cost containment limit is
the trended base year amount determined in subparagraph (B) of
paragraph (2), subject to paragraph (4).
(4) If a public hospital health system county's costs, as
determined in subparagraph (A) of paragraph (2), exceeds the amount
determined in subparagraph (B) of paragraph (2) as adjusted by
paragraph (3), the portion of the following cost increases incurred
in providing services to Medi-Cal beneficiaries and uninsured
patients shall be added to and reflected in any cost containment
limit:
(A) Electronic Health Records and related implementation and
infrastructure costs.
(B) Costs related to state or federally mandated activities,
requirements, or benefit changes.
(C) Costs resulting from a court order or settlement.
(D) Costs incurred in response to seismic concerns, including
costs necessary to meet facility seismic standards.
(E) Costs incurred as a result of a natural disaster or act of
terrorism.
(5) If a public hospital health system county's costs, as
determined in subparagraph (A) of paragraph (2), exceeds the amount
determined in subparagraph (B) of paragraph (2) as adjusted by
paragraphs (3) and (4), the county may request that the department
consider other costs as adjustments to the cost containment limit,
including, but not limited to, transfer amounts in excess of the
imputed other entity intergovernmental transfer amount trended by the
blended CPI trend factor, costs related to case mix index increases,
pension costs, expanded medical education programs, increased costs
in response to delivery system changes in the local community, and
system expansions, including capital expenditures necessary to ensure
access to and the quality of health care. Costs approved by the
department shall be added to and reflected in any cost containment
limit.
(e) "County indigent care health realignment amount" means the
product of the health realignment amount times the health realignment
indigent care percentage, as computed on a county-specific basis.
(f) "County public hospital health system" means a designated
public hospital identified in paragraphs (6) to (20), inclusive, and
paragraph (22) of subdivision (d) of Section 14166.1, and its
affiliated governmental entity clinics, practices, and other health
care providers that do not provide predominantly public health
services. A county public hospital health system does not include a
health care service plan, as defined in subdivision (f) of Section
1345 of the Health and Safety Code. The Alameda County Medical Center
and County of Alameda shall be considered affiliated governmental
entities.
(g) "Department" means the State Department of Health Care
Services.
(h) "Health realignment amount" means the amount that, in the
absence of this article, would be payable to a public hospital health
system county under Sections 17603, 17604, and 17606.20, as those
sections read on January 1, 2012, and Section 17606.10, as it read on
July 1, 2013, for the fiscal year that is deposited by the
Controller into the local health and welfare trust fund health
account of the public hospital health system county.
(i) "Health realignment indigent care percentage" means the
county-specific percentage determined in accordance with the
following, and established in accordance with the procedures
described in subdivision (c) of Section 17612.3.
(1) Each public hospital health system county shall identify the
portion of that county's health realignment amount that was used to
provide health services to the indigent, including Medi-Cal
beneficiaries and the uninsured, for each of the historical fiscal
years along with verifiable data in support thereof.
(2) The amounts identified in paragraph (1) shall be expressed as
a percentage of the health realignment amount of that county for each
historical fiscal year.
(3) The average of the percentages determined in paragraph (2)
shall be the county's health realignment indigent care percentage.
(4) To the extent a county does not provide the information
required in paragraph (1) or the department determines that the
information provided is insufficient, the amount under this
subdivision shall be 85 percent.
(j) "Historical fiscal years" means the state 2008-09 to 2011-12,
inclusive, fiscal years.
(k) "Hospital fee direct grants" means the direct grants described
in Section 14169.7 that are funded by the Private Hospital Quality
Assurance Fee Act of 2011 (Article 5.229 (commencing with Section
14169.31) of Chapter 7 of Part 3), or direct grants made in support
of health care expenditures funded by a successor statewide hospital
fee program.
( l ) "Imputed county low-income health amount" means
the predetermined, county-specific amount of county general purpose
funds assumed, for purposes of the calculation in Section 17612. 3,
to be available to the county public hospital health system for
services to Medi-Cal and uninsured patients. County general purpose
funds shall not include any other revenues, grants, or funds
otherwise defined in this section. The imputed county low-income
health amount shall be determined as follows and established in
accordance with subdivision (c) of Section 17612.3.
(1) For each of the historical fiscal years, an amount determined
to be the annual amount of county general fund contribution provided
for health services to Medi-Cal beneficiaries and the uninsured,
which does not include funds provided for nursing facility, mental
health, and substance use disorder services, shall be determined
through methodologies described in subdivision (ab).
(2) If a year-to-year percentage increase in the amount determined
in paragraph (1) was present, an average annual percentage trend
factor shall be determined.
(3) The annual amounts determined in paragraph (1) shall be
averaged, and multiplied by the percentage trend factor, if
applicable, determined in paragraph (2), for each fiscal year after
the 2011-12 fiscal year through the applicable fiscal year. However,
if the percentage trend factor determined in paragraph (2) is greater
than the applicable percentage change for any year of the same
period in the blended CPI trend factor, the percentage change in the
blended CPI trend factor for that year shall be used. The resulting
determination is the imputed county low-income health amount for
purposes of Section 17612.3.
(m) "Imputed gains from other payers" means the predetermined,
county-specific amount of revenues in excess of costs generated from
all other payers for health services that is assumed to be available
to the county public hospital health system for services to Medi-Cal
and uninsured patients, which shall be determined as follows and
established in accordance with subdivision (c) of Section 17612.3.
(1) For each of the historical fiscal years, the gains from other
payers shall be determined in accordance with methodologies described
in subdivision (ab).
(2) The amounts determined in paragraph (1) shall be averaged,
yielding the imputed gains from other payers.
(n) "Imputed other entity intergovernmental transfer amount" means
the predetermined average historical amount of the public hospital
health system county's other entity intergovernmental transfer
amount, determined as follows and established in accordance with
subdivision (c) of Section 17612.3.
(1) For each of the historical fiscal years, the other entity
intergovernmental transfer amount shall be determined based on the
records of the public hospital health system county.
(2) The annual amounts in paragraph (1) shall be averaged.
(o) "Medicaid demonstration revenues" means payments paid or
payable to the county public hospital health system for the fiscal
year pursuant to the Special Terms and Conditions of the federal
Medicaid demonstration project authorized under Section 1115 of the
federal Social Security Act entitled the "Bridge to Health Care
Reform" (waiver number 11-W-00193/9), for uninsured care services
from the Safety Net Care Pool or as incentive payments from the
Delivery System Reform Improvement Pool, or pursuant to mechanisms
that provide funding for similar purposes under the subsequent
demonstration project. Medicaid demonstration revenues do not include
the nonfederal share provided by county public hospital health
systems as certified public expenditures, and are reduced by any
intergovernmental transfer by county public hospital health systems
or affiliated governmental entities that is for the nonfederal share
of Medicaid demonstration payments to the county public hospital
health system or payments to a Medi-Cal managed care plan for
services rendered by the county public hospital health system, and
any related fees imposed by the state on those transfers; and by any
reimbursement of costs, or payment of administrative or other
processing fees imposed by the state relating to payments or other
Medicaid demonstration program functions. Medicaid demonstration
revenues shall not include Safety Net Care Pool revenues for nursing
facility, mental health, and substance use disorder services, as
determined from the pro rata share of eligible certified public
expenditures for such services, or revenues that are otherwise
included as Medi-Cal revenues.
(p) "Medi-Cal beneficiaries" means individuals eligible to receive
benefits under Chapter 7 (commencing with Section 14000) of Part 3,
except for: individuals who are dual eligibles, as defined in
paragraph (4) of subdivision (c) of Section 14132.275, and
individuals for whom Medi-Cal benefits are limited to cost sharing or
premium assistance for Medicare or other insurance coverage as
described in Section 1396d(a) of Title 42 of the United States Code.
(q) "Medi-Cal costs" means the costs incurred by the county public
hospital health system for providing Medi-Cal services to Medi-Cal
beneficiaries during the fiscal year, which shall be determined in a
manner consistent with the cost claiming protocols developed for
Medi-Cal cost-based reimbursement for public providers and under
Section 14166.8, and, in consultation with each county, shall be
based on other cost reporting and statistical data necessary for an
accurate determination of actual costs as required in Section
17612.4. Medi-Cal costs shall include all fee-for-service and managed
care hospital and nonhospital components, managed care
out-of-network costs, and related administrative costs. The Medi-Cal
costs determined under this paragraph shall exclude costs incurred
for nursing facility, mental health, and substance use disorder
services.
(r) "Medi-Cal revenues" means total amounts paid or payable to the
county public hospital health system for medical services provided
under the Medi-Cal State Plan that are rendered to Medi-Cal
beneficiaries during the state fiscal year, and shall include
payments from Medi-Cal managed care plans for services rendered to
Medi-Cal managed care plan members, Medi-Cal copayments received from
Medi-Cal beneficiaries, but only to the extent actually received,
supplemental payments for Medi-Cal services, and Medi-Cal
disproportionate share hospital payments for the state fiscal year,
but shall exclude Medi-Cal revenues paid or payable for nursing
facility, mental health, and substance use disorder services.
Medi-Cal revenues do not include the nonfederal share provided by
county public hospital health systems as certified public
expenditures. Medi-Cal revenues shall be reduced by all of the
following:
(1) Intergovernmental transfers by the county public hospital
health system or its affiliated governmental entities that are for
the nonfederal share of Medi-Cal payments to the county public
hospital health system, or Medi-Cal payments to a Medi-Cal managed
care plan for services rendered by the county public hospital health
system for the fiscal year.
(2) Related fees imposed by the state on the transfers specified
in paragraph (1).
(3) Administrative or other fees, payments, or transfers imposed
by the state, or voluntarily provided by the county public hospital
health systems or affiliated governmental entities, relating to
payments or other Medi-Cal program functions for the fiscal year.
(s) "Newly eligible beneficiaries" means 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.
(t) "Other entity intergovernmental transfer amount" means the
amount of intergovernmental transfers by a county public hospital
health system or affiliated governmental entities, and accepted by
the department, that are for the nonfederal share of Medi-Cal
payments or Medicaid demonstration payments for the fiscal year to
any Medi-Cal provider other than the county public hospital health
system, or to a Medi-Cal managed care plan for services rendered by
those other providers, and any related fees imposed by the state on
those transfers.
(u) "Public hospital health system county" means a county in which
a county public hospital health system is located.
(v) "Redirected amount" means the amount to be redirected in
accordance with Section 17612.1, as calculated pursuant to
subdivision (a) of Section 17612.3.
(w) "Special local health funds" means the amount of the following
county funds received by the county public hospital health system
for health services during the fiscal year:
(1) Assessments and fees restricted for health-related purposes.
The amount of the assessment or fee for this purpose shall be the
greater of subparagraph (A) or (B). If, because of restrictions and
limitations applicable to the assessment or fee, the county public
hospital health system cannot expend this amount, this amount shall
be reduced to the amount actually expended.
(A) The amount of the assessment or fee expended by the county
public hospital health system for the provision of health services to
Medi-Cal and uninsured beneficiaries during the fiscal year.
(B) The amount of the assessment or fee multiplied by the average
of the percentages of the amount of assessment or fees that were
allocated to and expended by the county public hospital health system
for health services to Medi-Cal and uninsured beneficiaries during
the historical fiscal years. The percentages for the historical
fiscal years shall be determined by dividing the amount allocated in
each fiscal year as described in subparagraphs (B) and (C) of
paragraph (2) of subdivision (ab) by the actual amount of assessment
or fee expended in the fiscal year.
(2) Funds available pursuant to the Master Settlement Agreement
and related documents entered into on November 23, 1998, by the state
and leading United States tobacco product manufacturers during a
fiscal year. The amount of the tobacco settlement funds that may be
used for this purpose shall be the greater of subparagraph (A) or
(B), less any bond payments and other costs of securitization related
to the funds described in this paragraph.
(A) The amount of the funds expended by the county public hospital
health system for the provision of health services to Medi-Cal and
uninsured beneficiaries during the fiscal year.
(B) The amount of the tobacco settlement funds multiplied by the
average of the percentages of the amount of tobacco settlement funds
that were allocated to and expended by the county public hospital
health system for health services to Medi-Cal and uninsured
beneficiaries during the historical fiscal years. The percentages for
the historical fiscal years shall be determined by dividing the
amount allocated in each fiscal year as described in subparagraphs
(B) and (C) of paragraph (2) of subdivision (ab) by the actual amount
of tobacco settlement funds expended in the fiscal year.
(x) "Subsequent demonstration project" means the federally
approved Medicaid demonstration project implemented after the
termination of the federal Medicaid demonstration project authorized
under Section 1115 of the federal Social Security Act entitled the
"Bridge to Health Care Reform" (waiver number 11-W-00193/9), the
extension of that demonstration project, or the material amendment to
that demonstration project.
(y) "Uninsured costs" means the costs incurred by the public
hospital health system county and its affiliated government entities
for purchasing, providing, or ensuring the availability of services
to uninsured patients during the fiscal year. Uninsured costs shall
be determined in a manner consistent with the cost-claiming protocols
developed for the federal Medicaid demonstration project authorized
under Section 1115 of the federal Social Security Act entitled the
"Bridge to Health Care Reform" (waiver number 11-W-00193/9),
including protocols pending federal approval, and under Section
14166.8, and, in consultation with each county, shall be based on any
other cost reporting and statistical data necessary for an accurate
determination of actual costs incurred. For this purpose, no
reduction factor applicable to otherwise allowable costs under the
demonstration project or the subsequent demonstration project shall
apply. Uninsured costs shall exclude costs for nursing facility,
mental health, and substance use disorder services.
(z) "Uninsured patients" means individuals who have no source of
third-party coverage for the specific service furnished, as further
defined in the reporting requirements established pursuant to Section
17612.4.
(aa) "Uninsured revenues" means self-pay payments made by or on
behalf of uninsured patients to the county public hospital health
system for the services rendered in the fiscal year, but shall
exclude revenues received for nursing facility, mental health, and
substance use disorder services. Uninsured revenues do not include
the health realignment amount or imputed county low-income health
amount and shall not include any other revenues, grants, or funds
otherwise defined in this section.
(ab) "Historical allocation" means the allocation for the amounts
in the historical years described in subdivisions (l), (m), and (w)
for health services to Medi-Cal beneficiaries and uninsured patients.
The allocation of those amounts in the historical years shall be
done in accordance with a process to be developed by the department,
in consultation with the counties, which includes the following
required parameters:
(1) For each of the historical fiscal years, the Medi-Cal costs,
uninsured costs, and costs of other entity intergovernmental transfer
amounts, as defined in subdivisions (q), (t), and (y), and the
Medicaid demonstration, Medi-Cal and uninsured revenues, and hospital
fee direct grants with respect to the services as defined in
subdivisions (k), (o), (r), and (aa), shall be determined. For these
purposes, Medicaid demonstration revenues shall include applicable
payments as described in subdivision (o) paid or payable to the
county public hospital health system under the prior demonstration
project defined in subdivision (c) of Section 14166.1, under the Low
Income Health Program (Part 3.6 (commencing with Section 15909)), and
under the Health Care Coverage Initiative (Part 3.5 (commencing with
Section 15900)), none of which shall include the nonfederal share of
the Medicaid demonstration payments. The revenues shall be
subtracted from the costs, yielding the initial low-income shortfall
for each of the historical fiscal years.
(2) The following shall be applied in sequential order against,
but shall not exceed in the aggregate, the initial low-income
shortfall determined in paragraph (1) for each of the historical
fiscal years:
(A) First, the county indigent care health realignment amount
shall be applied 100 percent against the initial low-income
shortfall.
(B) Second, special local health funds specifically restricted for
indigent care shall be applied 100 percent against the initial
low-income shortfall.
(C) Third, the sum of clauses (iv), (v), and (vi). Clause (iv) is
the special local health funds, as defined in subdivision (w) and not
otherwise identified as restricted special local health funds under
subparagraph (B), clause (v) is the imputed county low-income health
amount defined in subdivision (l), and clause (vi) is the one-time
and carry-forward revenues as defined in subdivision (aj), all
allocated to the historical low-income shortfall. These amounts shall
be calculated as follows:
(i) Determine the sum of the special local health funds, as
defined in subdivision (w) and not otherwise identified as restricted
special local health funds under subparagraph (B), the imputed
county low-income health amount defined in subdivision (l), and
one-time and carry-forward revenues as defined in subdivision (aj).
(ii) Divide the historical total shortfall defined in subdivision
(ah) by the sum in clause (i) to get the historical usage of funds
percentage defined in subdivision (ai). If this calculation produces
a percentage above 100 percent in a given historical fiscal year,
then the historical usage of funds percentage in that historical
fiscal year shall be deemed to be 100 percent.
(iii) Multiply the historical usage of funds percentage defined in
subdivision (ai) and calculated in clause (ii) by each of the
following funds:
(I) Special local health funds, as defined in subdivision (w) and
not otherwise identified as restricted special local health funds
under subparagraph (B).
(II) The imputed county low-income health amount defined in
subdivision (l).
(III) One-time and carry-forward revenues as defined in
subdivision (aj).
(iv) Multiply the product of subclause (I) of clause (iii) by the
historical low-income shortfall percentage defined in subdivision
(af) to determine the amount of special local health funds, as
defined in subdivision (w) and not otherwise identified as restricted
special local health funds under subparagraph (B), allocated to the
historical low-income shortfall.
(v) Multiply the product of subclause (II) of clause (iii) by the
historical low-income shortfall percentage defined in subdivision
(af) to determine the amount of the imputed county low-income health
amount defined in subdivision (l) allocated to the historical
low-income shortfall.
(vi) Multiply the product of subclause (III) of clause (iii) by
the historical low-income shortfall percentage defined in subdivision
(af) to determine the amount of one-time and carry-forward revenues
as defined in subdivision (aj) allocated to the
historical low-income shortfall.
(D) Finally, to the extent that the process above does not result
in completely allocating revenues up to the amount necessary to
address the initial low-income shortfall in the historical years,
gains from other payers shall be allocated to fund those costs only
to the extent that such other payer gains exist.
(ac) "Gains from other payers" means the county-specific amount of
revenues in excess of costs generated from all other payers for
health services. For purposes of this subdivision, patients with
other payer coverage are patients who are identified in all other
financial classes, including, but not limited to, commercial coverage
and dual eligible, other than allowable costs and associated
revenues for Medi-Cal and the uninsured.
(ad) "New mandatory other entity intergovernmental transfer
amounts" means other entity intergovernmental transfer amounts
required by the state after July 1, 2013.
(ae) "Historical low-income shortfall" means, for each of the
historical fiscal years described in subdivision (j), the initial
low-income shortfall for Medi-Cal and uninsured costs determined in
paragraph (1) of subdivision (ab), less amounts identified in
subparagraphs (A) and (B) of paragraph (2) of subdivision (ab).
(af) "Historical low-income shortfall percentage" means, for each
of the historical fiscal years described in subdivision (j), the
historical low-income shortfall described in subdivision (ae) divided
by the historical total shortfall described in subdivision (ah).
(ag) "Historical other shortfall" means, for each of the
historical fiscal years described in subdivision (j), the shortfall
for all other types of costs incurred by the public hospital health
system that are not Medi-Cal or uninsured costs, and is determined as
total costs less total revenues, excluding any costs and revenue
amounts used in the calculation of the historical low-income
shortfall, and also excluding those costs and revenues related to
mental health and substance use disorder services. If the amount of
historical other shortfall in a given historical fiscal year is less
than zero, then the historical other shortfall for that historical
fiscal year shall be deemed to be zero.
(ah) "Historical total shortfall" means, for each of the
historical fiscal years described in subdivision (j), the sum of the
historical low-income shortfall described in subdivision (ae) and the
historical other shortfall described in subdivision (ag).
(ai) "Historical usage of funds percentage" means, for each of the
historical fiscal years described in subdivision (j), the historical
total shortfall described in subdivision (ah) divided by the sum of
special local health funds as defined in subdivision (w) and not
otherwise identified as restricted special local health funds under
subparagraph (B) of paragraph (2) of subdivision (ab), the imputed
county low-income health amount defined in subdivision (l), and
one-time and carry-forward revenues as defined in subdivision (aj).
If this calculation produces a percentage above 100 percent in a
given historical fiscal year, then the historical usage of funds
percentage in that historical fiscal year shall be deemed to be 100
percent.
(aj) "One-time and carry-forward revenues" mean, for each of the
historical fiscal years described in subdivision (j), revenues and
funds that are not attributable to services provided or obligations
in the applicable historical fiscal year, but were available and
utilized during the applicable historical fiscal year by the public
hospital health system.
SEC. 18. Section 17612.21 of the Welfare and Institutions Code is
repealed.
SEC. 19. Section 17612.3 of the Welfare and Institutions Code is
amended to read:
17612.3. (a) For each fiscal year, commencing with the 2013-14
fiscal year, the amount to be redirected in accordance with Section
17612.1 shall be determined for each public hospital health system
county as follows:
(1) The public hospital health system county's revenues and other
funds paid or payable for the state fiscal year shall be comprised of
the total of the following:
(A) Medi-Cal revenues.
(B) Uninsured revenues.
(C) Medicaid demonstration revenues.
(D) Hospital fee direct grants.
(E) Special local health funds.
(F) The county indigent care health realignment amount.
(G) The imputed county low-income health amount.
(H) Imputed gains from other payers.
(I) The amount by which the public hospital health system county's
costs exceeded the cost containment limit for the fiscal year,
expressed as a negative number, multiplied by 0.50.
(2) The following, incurred by the public hospital health system
county for the fiscal year, not to exceed in total the cost
containment limit, shall be subtracted from the sum in paragraph (1):
(A) Medi-Cal costs.
(B) Uninsured costs.
(C) The lesser of the other entity intergovernmental transfer
amount or the imputed other entity intergovernmental transfer
amounts.
(D) New mandatory other entity intergovernmental transfer amounts.
(3) The resulting amount determined in paragraph (2) shall be
multiplied by 0.80, except that for the 2013-14 fiscal year the
resulting amount determined in paragraph (2) shall be multiplied by
0.70.
(4) If the amount in paragraph (3) is a positive number, that
amount, subject to paragraph (5), shall be redirected in accordance
with Section 17612.1, except that for the 2013-14 fiscal year the
amount to be redirected shall not exceed the amount determined for
the county for the 2013-14 fiscal year under subdivision (c) of
Section 17603, as that amount may have been reduced by the
application of Section 17610.5. If the amount determined in paragraph
(3) is a negative number, the redirected amount shall be zero.
(5) Notwithstanding any other law, the amount to be redirected as
determined in paragraph (4) for any fiscal year shall not exceed the
county indigent care health realignment amount for that fiscal year.
(6) (A) The redirected amount shall be applied until the later of
the following:
(i) June 30, 2023.
(ii) The beginning of the fiscal year following a period of two
consecutive fiscal years in which both of the following occur:
(aa) The total interim amount determined under subdivision (b) of
Section 17612.3 in May of the previous fiscal year is within 10
percent of the final, reconciled amount in subdivision (d) of that
section.
(bb) The final, reconciled amounts under subdivision (d) of
Section 17612.3 are within 5 percent of each other.
(B) After the redirected amount ceases as provided in subparagraph
(A), a permanent redirected amount shall be established to be an
amount determined by calculating the percentage that the redirected
amount was in the last fiscal year of the operation of this article
of the county's health realignment amount of that same fiscal year,
multiplied by the county's health realignment amount of all
subsequent years.
(b) Commencing with the 2014-15 fiscal year, the department shall
calculate an interim redirected amount for each public hospital
health system county under subdivision (a) by the January immediately
prior to the starting fiscal year, using the most recent and
accurate data available. For purposes of the interim determinations,
the cost containment limit shall not be applied. The interim
redirected amount shall be updated in the May before the start of the
fiscal year in consultation with each public hospital health system
county and based on any more recent and accurate data available at
that time. During the fiscal year, the interim redirected amount will
be applied pursuant to Section 17612.1.
(c) The predetermined amounts or historical percentages described
in subdivisions (i), (l), (m), (n), and (w) of Section 17612.2 shall
each be established in accordance with the following procedure:
(1) By October 31, 2013, each public hospital health system county
shall determine the amount or percentage described in the applicable
subdivision, and shall provide this calculation to the department,
supported by verifiable data and a description of how the
determination was made.
(2) If the department disagrees with the public hospital health
system county's determination, the department shall confer with the
public hospital health system county by December 15, 2013, and shall
issue its determination by January 31, 2014.
(3) If no agreement between the parties has been reached by
January 31, 2014, the department shall apply the county's
determination when making the interim calculations pursuant to
subdivision (b), until a decision is issued pursuant to paragraph
(6).
(4) If no agreement between the parties has been reached by
January 31, 2014, the public hospital health system county shall
submit a petition by February 28, 2014, to the County Health Care
Funding Resolution Committee, established pursuant to Section
17600.60, to seek a decision regarding the historical percentage or
amount to be applied in calculations under this section.
(5) The County Health Care Funding Resolution Committee shall hear
and make a determination as to whether the county's proposed
percentage or amount complies with the requirements of this section
taking into account the data and calculations of the county and any
alternative data and calculations submitted by the department.
(6) The committee shall issue its final determination within 45
days of the petition. If the county chooses to contest the final
determination, the final determination of the committee will be
applied for purposes of any interim calculation under subdivision (b)
until a final decision is issued pursuant to de novo administrative
review pursuant to paragraph (2) of subdivision (d).
(d) (1) The data for the final calculations under subdivision (a)
for the fiscal year shall be submitted by public hospital health
system counties within 12 months after the conclusion of each fiscal
year as required in Section 17612.4. The data shall be the most
recent and accurate data from the public hospital health system
county's books and records pertaining to the revenues paid or
payable, and the costs incurred, for services provided in the subject
fiscal year. After consulting with the county, the department shall
make final calculations using the data submitted pursuant to this
paragraph by December 15 of the following fiscal year, and shall
provide its final determination to the county. The final
determination will also reflect the application of the cost
containment limit, if any. If the county and the department agree, a
revised recalculation and reconciliation may be completed by the
department within six months thereafter.
(2) The director shall establish an expedited formal appeal
process for a public hospital health system county to contest final
determinations made under this article. No appeal shall be available
for interim determinations made under subdivision (b). The appeals
process shall include all of the following:
(A) The public hospital health system county shall have 30
calendar days, following the issuance of a final determination made
under paragraph (6) of subdivision (c) or paragraph (1) of this
subdivision, to file an appeal with the Director of Health Care
Services. All appeals shall be governed by Section 100171 of the
Health and Safety Code, except for those provisions of paragraph (1)
of subdivision (d) of Section 100171 of the Health and Safety Code
relating to accusations, statements of issues, statement to
respondent, and notice of defense, and except as otherwise set forth
in this section. All appeals shall be in writing and shall be filed
with the State Department of Health Care Service's Office of
Administrative Hearings and Appeals. An appeal shall be deemed filed
on the date it is received by the Office of Administrative Hearings
and Appeals.
(i) An appeal shall specifically set forth each issue in dispute,
which may include any component of the determination, and include the
public hospital health system county's contentions as to those
issues. A formal hearing before an Office of Administrative Hearings
and Appeals Administrative Law Judge shall commence within 60 days of
the filing of the appeal requesting a formal hearing. A final
decision under this paragraph shall be adopted no later than six
months following the filing of the appeal.
(ii) If the public hospital health system county fails to file an
appeal within 30 days of the issuance of a determination made under
this section, the determination of the department shall be deemed
final and not appealable either administratively or to a court of
general jurisdiction, except that a county may elect to appeal a
determination under subdivision (c) within 30 days of the issuance of
the County Health Care Funding Resolution Committee's final
determination under paragraph (6) of subdivision (c) or as a
component of an appeal of the department's final determination under
paragraph (1) of this subdivision for the 2013-14 fiscal year.
(B) If a final decision under this paragraph is not issued by the
department within two years of the last day of the subject fiscal
year, the public hospital health system county shall be deemed to
have exhausted its administrative remedies and shall not be precluded
from pursuing any available judicial review. However, the time
period in this subdivision shall be extended by either of the
following:
(i) Undue delay caused by the public hospital health system
county.
(ii) An extension of time granted to a public hospital health
system county at its sole request, or following the joint request of
the public hospital health system county and the department.
(C) If the final decision issued by the department pursuant to
this paragraph results in a different determination than that
originally determined by the department, then the Department of
Finance shall adjust the original determination by that amount,
pursuant to a process developed by the Department of Finance and in
consultation with the public hospital health system counties.
(e) For purposes of this article, all references to "health
services" or "health care services," unless specified otherwise,
shall exclude nursing facility, mental health, and substance use
disorder services.
SEC. 20. Section 17612.5 of the Welfare and Institutions Code is
amended to read:
17612.5. (a) For the 2013-14 fiscal year and each year
thereafter, the amount to be redirected in accordance with Section
17612.1 for the County of Los Angeles shall be determined in
accordance with Section 17612.3, except that the formula in
subdivision (a) of Section 17612.3 shall be replaced with the
following formula:
(1) The total revenues as defined in paragraph (7) of subdivision
(b) paid or payable to the County of Los Angeles, Department of
Health Services, for the fiscal year, which shall include special
local health funds and as adjusted in accordance with Section
17612.6, shall be added together.
(2) The sum of three hundred twenty-three million dollars
($323,000,000), which represents the imputed county low-income health
amount trended annually by 1 percent from the 2012-13 fiscal year
through the applicable fiscal year, and the county indigent care
health realignment amount, as determined in accordance with
subdivision (e) of Section 17612.2 for the fiscal year.
(3) The amount by which the county's total costs exceeded the cost
containment limit for the fiscal year, expressed as a negative
number, multiplied by 0.50.
(4) (A) The total costs as defined in paragraph (6) of subdivision
(b) incurred by or on behalf of the County of Los Angeles,
Department of Health Services, for the fiscal year shall be added
together, but shall not exceed the cost containment limit determined
in accordance with paragraph (3) of subdivision (b).
(B) The costs in paragraph (A) shall be subtracted from the sum of
paragraphs (1) to (3), inclusive.
(5) The resulting amount determined in subparagraph (B) of
paragraph (4) shall be multiplied by 0.80, except that for the
2013-14 fiscal year, the resulting amount determined in subparagraph
(B) of paragraph (4) shall be multiplied by 0.70.
(6) If the amount in paragraph (5) is a positive number, that
amount, subject to paragraph (7), shall be redirected in accordance
with Section 17612.1 of this article, except that for the 2013-14
fiscal year the amount to be redirected shall not exceed the amount
determined for the County of Los Angeles for the 2013-14 fiscal year
under subdivision (c) of Section 17603, as that amount may have been
reduced by the application of Section 17610.5. If the amount
determined in paragraph (5) is a negative number, the redirected
amount shall be zero.
(7) Notwithstanding any other provision of law, the amount to be
redirected as determined in paragraph (6) for any fiscal year shall
not exceed the county indigent care health realignment amount for
that fiscal year.
(8) (A) The redirected amount shall be applied until the later of:
(i) June 30, 2023.
(ii) The beginning of fiscal year following a period of two
consecutive fiscal years that both of the following occur:
(aa) The total interim amount determined under subdivision (b) of
Section 17612.3 in May of the previous fiscal year is within 10
percent of the final, reconciled amount in subdivision (d) of that
section.
(bb) The final, reconciled amounts under subdivision (d) of
Section 17612.3 are within 5 percent of each other.
(B) After the redirected amount ceases as provided in subparagraph
(A), a permanent redirected amount shall be established to be an
amount determined by calculating the percentage that the redirected
amount was in the last fiscal year of the operation of this article
of the county's health realignment amount of that same fiscal year,
multiplied by the county's health realignment amount of all
subsequent years.
(b) Except as otherwise provided in this section, the definitions
in Section 17612.2 shall apply. For purposes of this section, and for
purposes the calculations in Section 17612.3 that apply to the
County of Los Angeles, the following definitions shall apply:
(1) "Adjusted patient day" means LA County DHS's total number of
patient days multiplied by the following fraction: the numerator that
is the sum of the county public hospital health system's total gross
revenue for all services provided to all patients, including
nonhospital services, and the denominator that is the sum of the
county public hospital health system's gross inpatient revenue. The
adjusted patient days shall pertain to those services that are
provided by the LA County DHS, and shall exclude services that are
provided by contract or out-of-network clinics or hospitals. For
purposes of this paragraph, gross revenue shall be adjusted as
necessary to reflect the relationship between inpatient costs and
charges and outpatient costs and charges.
(2) "Blended CPI trend factor" means the blended percent change
applicable for the state fiscal year that is derived from the
nonseasonally adjusted Consumer Price Index for All Urban Consumers
(CPI-U), United States City Average, for Hospital and Related
Services, weighted at 90 percent, and for Medical Care Services,
weighted at 10 percent, all as published by the United States Bureau
of Labor Statistics, computed as follows:
(A) For each prior fiscal year, within the period to be trended
through the fiscal year, the annual average of the monthly index
amounts shall be determined separately for the Hospital and Related
Services Index and the Medical Care Services Index.
(B) The year-to-year percentage changes in the annual averages
determined in subparagraph (A) for each of the Hospital and Related
Services Index and the Medical Care Services Index shall be
determined.
(C) A weighted average annual percentage change for each
year-to-year period shall be calculated from the determinations made
in subparagraph (B), with the percentage changes in the Hospital and
Related Services Index weighted at 90 percent, and the percentage
changes in the Medical Care Services Index weighted at 10 percent.
The resulting average annual percentage changes shall be expressed as
a fraction, and increased by 1.00.
(D) The product of the successive year-to-year amounts determined
in subparagraph (C) shall be the blended CPI trend factor.
(3) "Cost containment limit" means the LA County DHS's total costs
determined for the 2014-15 fiscal year and each subsequent fiscal
year adjusted as follows:
(A) The County of Los Angeles will be deemed to comply with the
cost containment limit if the county demonstrates that its total
costs for the fiscal year did not exceed its total costs in the base
year, multiplied by the blended CPI trend factor for the fiscal year
as reflected in the annual report of financial transactions required
to be submitted to the Controller pursuant to Section 53891 of the
Government Code. If the total costs for the fiscal year exceeded the
total cost in the base year, multiplied by the blended CPI trend
factor for the fiscal year, the calculation in subparagraph (B) shall
be performed.
(B) (i) If the number of adjusted patient days of service provided
by LA County DHS for the fiscal year exceeds its number of adjusted
patient days of service rendered in the base year by at least 10
percent, the excess adjusted patient days above the base year for the
fiscal year shall be multiplied by the cost per adjusted patient day
of the public hospital health system for the base year. The result
shall be added to the trended base year amount determined in
subparagraph (A), yielding the applicable cost containment limit,
subject to subparagraph (C). Costs per adjusted patient day shall be
based upon only those LA County DHS costs incurred for patient care
services.
(ii) If the number of adjusted patient days of service provided by
LA County DHS for the fiscal year does not exceed its number of
adjusted patient days of service rendered in the base year by at
least 10 percent, the applicable limit is the trended base year
amount determined in subparagraph (A) subject to subparagraph (C).
(C) If LA County DHS's total costs for the fiscal year in as
determined in subparagraph (A) exceeds the trended cost as determined
in subparagraph (A) as adjusted by subparagraph (B), the following
cost increases shall be added to and reflected in any cost
containment limit:
(i) Electronic health records and related implementation and
infrastructure costs.
(ii) Costs related to state or federally mandated activities,
requirements, or benefit changes.
(iii) Costs resulting from a court order or settlement.
(iv) Costs incurred in response to seismic concerns, including
costs necessary to meet facility seismic standards.
(v) Costs incurred as a result of a natural disaster or act of
terrorism.
(vi) The total amount of any intergovernmental transfer for the
nonfederal share of Medi-Cal payments to the hospital facility
described in subdivision (f) of Section 14165.50.
(D) If LA County DHS's total costs for the fiscal year exceed the
trended costs as adjusted by subparagraphs (B) and (C), the county
may request that the department consider other costs as adjustments
to the cost containment limit, including, but not limited to,
transfer amounts in excess of the imputed other entity
intergovernmental transfer amount trended by the blended CPI trend
factor, costs related to case mix index increases, pension costs,
expanded medical education programs, increased costs in response to
delivery system changes in the local community, and system
expansions, including capital expenditures necessary to ensure access
to and the quality of health care. Costs approved by the department
shall be added to and reflected in the cost containment limit.
(4) "Health realignment indigent care percentage" means 83
percent.
(5) "Special local health funds" means both of the following:
(A) The total amount of assessments and fees restricted for
health-related purposes that are received by LA County DHS and
expended for health services during the fiscal year.
(B) Ninety-one percent of the funds actually received by the
County of Los Angeles during the fiscal year pursuant to the Master
Settlement Agreement and related documents entered into on November
23, 1998, by the state and leading United States tobacco product
manufacturers, less any bond payments and other costs of
securitization related to the funds described in this paragraph.
(6) "Total costs" means the actual net expenditures, excluding
encumbrances, for all operating budget units of the LA County DHS.
Operating budget units consist of four Hospital Enterprise Funds plus
the LA County DHS's budget units within the county general fund. Net
expenditures, excluding encumbrances, are those recognized within LA
County DHS, net of intrafund transfers, expenditure distributions,
and all other billable services recorded from and to the LA County
DHS enterprise funds and the LA County DHS general fund budget units,
determined based on its central accounting system known as eCAPS, as
of November 30 of the year following the fiscal year, and shall
include the new mandatory other entity intergovernmental transfer
amounts, as defined in subdivision (ad) of Section 17612.2, and the
lesser of other entity intergovernmental transfer amounts or the
imputed other entity intergovernmental transfer amounts.
(7) "Total revenues" means the sum of the revenue paid or payable
for all operating budget units of the LA County DHS determined based
on its central accounting system known as eCAPS, as of November 30 of
the year following the fiscal year.
(8) "LA County DHS" means operating budget units consisting of
four hospital enterprise funds plus the DHS budget units within the
county's general fund.
SEC. 21. Section 17612.6 of the Welfare and Institutions Code is
amended to read:
17612.6. (a) For purposes of this section, the following
definitions shall apply:
(1) "Type A payers" means the following sources of revenue for
amounts paid to the County of Los Angeles, Department of Health
Services:
(A) Title XVIII of the federal Social Security Act, known as the
Medicare program.
(B) Commercial health insurance.
(C) Health care coverage for providers of in-home supportive
services, consistent with Article 7 (commencing with Section 12300)
of Chapter 3 and Chapter 7 (commencing with Section 14000) of Part 3
of Division 9.
(2) "Type B payers" means the following sources of revenue for
amounts paid to the County of Los Angeles, Department of Health
Services:
(A) Patient care revenues received for
services provided to other county departments.
(B) State payments for patient financial services workers.
(C) Other federal payers, not including federal grants, Medicare,
Medicaid, and payments pursuant to Section 1011 of the federal
Medicare Prescription Drug, Improvement, and Modernization Act of
2003 (Public Law 108-173).
(3) "Historical Base Type A revenues" means revenues from Type A
payers in the historical fiscal years, calculated as follows:
(A) For each historical fiscal year, the actual revenue received
from Type A payers.
(B) Calculate the average of the historical year's amounts in
subparagraph (A). This average shall be considered the historical
Base Type A revenues.
(4) "Historical Base Type B revenues" means revenues from Type B
payers in the historical fiscal years, calculated as follows:
(A) For each historical fiscal year, the actual revenue received
from Type B payers.
(B) Calculate the average of the historical years amounts in
subparagraph (A). This average shall be considered the historical
Base Type B revenues.
(5) "Type A payer revenue" means the amount of revenue that is the
greater of the following:
(A) The amount of the revenue received from Type A payers for
services rendered during the fiscal year.
(B) The historical Base Type A revenues, as adjusted by the Type A
adjustment, defined in paragraph (8).
(6) "Type B payer revenue" means the amount of revenue that is the
greater of the following:
(A) The amount of the revenue received from Type B payers for
services rendered during the fiscal year.
(B) The historical Base Type B revenues.
(7) "Baseline Type A payer costs" means the average of the costs
of services provided to Type A payer patients rendered in each of the
four historical fiscal years to be determined as follows:
(A) For each historical year, the actual costs incurred in
providing services to Type A payer patients.
(B) Calculate the average of the historical fiscal year amounts in
subparagraph (A), this average shall be considered the baseline Type
A payer costs.
(8) "Type A adjustment" means the value of the revenue adjustment
to historical base Type A revenues as defined in paragraph (3).
(A) This adjustment will occur only if the Type A payer revenue
for the fiscal year is less than historical base, otherwise the
adjustment is considered to be zero.
(B) If the requirement in subparagraph (A) is met, then there will
only be an adjustment if one or more of the specified Type A payers'
data meets all of the following conditions:
(i) The Type A payer revenue for the fiscal year is less than the
historical base.
(ii) The Type A payer costs for the fiscal year are less than the
historical base trended by the blended CPI trend factor.
(iii) The Type A payer volume for the fiscal year is less than the
historical base.
(C) For each Type A payer that meets all the conditions in
subparagraph (B) the adjustment to the Type A payer revenue for that
Type A payer will be as follows:
(i) Calculate the percentage decrease in cost from the baseline
Type A payer cost as trended by the blended CPI trend factor as
defined in paragraph (2) of subdivision (b) of Section 17612.5 and
applied from the 2010-11 fiscal year to the subject fiscal year.
(ii) Calculate the percentage decrease in volume, based on the
adjusted patient days, from the baseline Type A payer volume to the
subject fiscal year.
(iii) Calculate the average of the percentages in clauses (i) and
(ii).
(iv) The percentage reduction in clause (iii) shall be applied to
the historical Base Type A payer revenue for the individual Type A
payer.
(b) The Type A payer revenues included in the total revenues in
subdivision (a) of Section 17612.5 shall be the greater of the
adjusted historical Type A baseline or the actual revenues received
from Type A payers for services rendered in the subject fiscal year.
(c) The Type B payer revenues included in the total revenues in
subdivision (a) of Section 17612.5 shall be the greater of the
historical Base Type B revenues or the actual revenues received from
Type B payers for services rendered in the subject fiscal year.
SEC. 22. Section 17613.1 of the Welfare and Institutions Code is
amended to read:
17613.1. (a) For the 2013-14 fiscal year and each fiscal year
thereafter, for each county, the total amount that would be payable
for the fiscal year from 1991 Health Realignment funds under Sections
17603, 17604, and 17606.20, as those sections read on January 1,
2012, and Section 17606.10, as it read on July 1, 2013, and deposited
by the Controller into the local health and welfare trust fund
health account of the county in the absence of this section, shall be
determined.
(b) The redirected amount determined for the county pursuant to
Section 17613.3 shall be divided by the total determined in
subdivision (a).
(c) The resulting fraction determined in subdivision (b) shall be
the percentage of 1991 Health Realignment funds under Sections 17603,
17604, and 17606.20, as those sections read on January 1, 2012, and
Section 17606.10, as it read on July 1, 2013, to be deposited each
month into the Family Support Subaccount.
(d) The total amount deposited pursuant to subdivision (c) with
respect to a county for a fiscal year shall not exceed the redirected
amount determined pursuant to Section 17613.3, and shall be subject
to the appeal processes, and judicial review as described in
subdivision (d) of Section 17613.3.
(e) The Legislature finds and declares that this article is not
intended to change the local obligation pursuant to Section 17000.
SEC. 23. Section 17613.2 of the Welfare and Institutions Code is
amended to read:
17613.2. For purposes of this article, the following definitions
shall apply:
(a) "Base year" means the fiscal year ending three years prior to
the fiscal year for which the redirected amount is calculated.
(b) "Blended CPI trend factor" means the blended percent change
applicable for the fiscal year that is derived from the nonseasonally
adjusted Consumer Price Index for All Urban Consumers (CPI-U),
United States City Average, for Hospital and Related Services,
weighted at 75 percent, and for Medical Care Services, weighted at 25
percent, all as published by the United States Bureau of Labor
Statistics, computed as follows:
(1) For each prior fiscal year within the period to be trended
through the state fiscal year, the annual average of the monthly
index amounts shall be determined separately for the Hospital and
Related Services Index and the Medical Care Services Index.
(2) The year-to-year percentage changes in the annual averages
determined in paragraph (1) for each of the Hospital and Related
Services Index and the Medical Care Services Index shall be
determined.
(3) A weighted average annual percentage change for each
year-to-year period shall be calculated from the determinations made
in paragraph (2), with the percentage changes in the Hospital and
Related Services Index weighted at 75 percent, and the percentage
changes in the Medical Care Services Index weighted at 25 percent.
The resulting average annual percentage changes shall be expressed as
a fraction, and increased by 1.00.
(4) The product of the successive year-to-year amounts determined
in paragraph (3) shall be the blended CPI trend factor.
(c) "Calculated cost per person" is determined by dividing county
indigent program costs by the number of indigent program individuals
for the applicable fiscal year. If a county expands eligibility, the
enrollment count is limited to those indigent program individuals who
would have been eligible for services under the eligibility
requirements in existence on July 1, 2013, except if approved as an
exception allowed pursuant to subparagraph (3) of paragraph (C) of
subdivision (d).
(d) "Cost containment limit" means the county's indigent program
costs determined for the 2014-15 fiscal year and each subsequent
fiscal year, to be adjusted as follows:
(1) (A) The county's indigent program costs for the state fiscal
year shall be determined as indigent program costs for purposes of
this paragraph for the relevant fiscal period.
(B) The county's calculated costs per person for the base year
will be multiplied by the blended CPI trend factor and then
multiplied by the county's fiscal year indigent program individuals.
The base year costs used shall not reflect any adjustments under this
subdivision.
(C) The fiscal year amount determined in subparagraph (A) shall be
compared to the trended amount in subparagraph (B). If the amount in
subparagraph (B) exceeds the amount in subparagraph (A), the county
will be deemed to have satisfied the cost containment limit. If the
amount in subparagraph (A) exceeds the amount in subparagraph (B),
the calculation in paragraph (2) shall be performed.
(2) If a county's costs as determined in subparagraph (A) of
paragraph (1) exceeds the amount determined in subparagraph (B) of
paragraph (1), the following costs, as allocated to the county's
indigent care program, shall be added to the cost and reflected in
any containment limit:
(A) Costs related to state or federally mandated activities,
requirements, or benefit changes.
(B) Costs resulting from a court order or settlement.
(C) Costs incurred as a result of a natural disaster or act of
terrorism.
(3) If a county's costs as determined in subparagraph (A) of
paragraph (1) exceed the amount determined in subparagraph (B) of
paragraph (1), as adjusted by paragraph (2), the county may request
that the department consider other costs as adjustments to the cost
containment limit. These costs would require departmental approval.
(e) "County" for purposes of this article means the following
counties: Fresno, Merced, Orange, Placer, Sacramento, San Diego, San
Luis Obispo, Santa Barbara, Santa Cruz, Stanislaus, Tulare, and Yolo.
(f) "County indigent care health realignment amount" means the
product of the health realignment amount times the health realignment
indigent care percentage, as computed on a county-specific basis.
(g) "County savings determination process" means the process for
determining the amount to be redirected in accordance with Section
17613.1, as calculated pursuant to subdivision (a) of Section
17613.3.
(h) "Department" means the State Department of Health Care
Services.
(i) "Health realignment amount" means the amount that, in the
absence of this article, would be payable to a county under Sections
17603, 17604, and 17606.20, as those sections read on January 1,
2012, and Section 17606.10, as it read on July 1, 2013, for the
fiscal year that is deposited by the Controller into the local health
and welfare trust fund health account of the county.
(j) "Health realignment indigent care percentage" means the
county-specific percentage determined in accordance with the
following, and established in accordance with the procedures
described in subdivision (c) of Section 17613.3:
(1) Each county shall identify the portion of that county's health
realignment amount that was used to provide health services to the
indigent, including the indigent program individuals, for each of the
historical fiscal years, along with verifiable data in support
thereof.
(2) The amounts identified in paragraph (1) shall be expressed as
a percentage of the health realignment amount of that county for each
fiscal year of the historical fiscal years.
(3) The average of the percentages determined in paragraph (2)
shall be the county's health realignment indigent care percentage.
(4) To the extent a county does not provide the information
required in paragraph (1) or the department determines that the
information required is insufficient, the amount under this
subdivision shall be considered to be 85 percent.
(k) All references to "health services" or "health care services,"
unless specified otherwise, shall exclude mental health and
substance use disorder services.
( l ) "Historical fiscal years" means the fiscal years
2008-09 to 2011-12, inclusive.
(m) "Imputed county low-income health amount" means the
predetermined, county-specific amount of county general purpose funds
assumed, for purposes of the calculation in Section 17613.3, to be
available to the county for services to indigent program individuals.
The imputed county low-income health amount shall be determined as
set forth below and established in accordance with subdivision (c) of
Section 17613.3.
(1) For each of the historical fiscal years, an amount shall be
determined as the annual amount of county general fund contribution
provided for health services to the indigent, which does not include
funds provided for mental health and substance use disorder services,
through a methodology to be developed by the department, in
consultation with the California State Association of Counties.
(2) If a year-to-year percentage increase in the amount determined
in paragraph (1) was present, an average annual percentage trend
factor shall be determined.
(3) The annual amounts determined in paragraph (1) shall be
averaged and multiplied by the percentage trend factor, if
applicable, determined in paragraph (2), for each fiscal year after
the 2011-12 fiscal year through the applicable fiscal year.
Notwithstanding the foregoing, if the percentage trend factor
determined in paragraph (2) is greater than the applicable percentage
change for any year of the same period in the blended CPI trend
factor, the percentage change in the blended CPI trend factor for
that year shall be used. The resulting determination is the imputed
county low-income health amount for purposes of Section 17613.3.
(n) "Indigent program costs" means the costs incurred by the
county for purchasing, providing, or ensuring the availability of
services to indigent program individuals during the fiscal year. The
costs for mental health and substance use disorder services shall not
be included in these costs.
(o) "Indigent program individuals" means all individuals enrolled
in a county indigent health care program at any point throughout the
fiscal year. If a county does not enroll individuals into an indigent
health care program, indigent program individuals shall mean all
individuals who used services offered through the county indigent
health care program in the fiscal year.
(p) "Indigent program revenues" means self-pay payments made by or
on behalf of indigent program individuals to the county for the
services rendered in the fiscal year, but shall exclude revenues
received for mental health and substance use disorder services.
(q) "Redirected amount" means the amount to be redirected in
accordance with Section 17613.1, as calculated pursuant to
subdivision (a) of Section 17613.3.
(r) "Special local health funds" means the amount of the following
county funds received by the county for health services to indigent
program individuals during the fiscal year and shall include funds
available pursuant to the Master Settlement Agreement and related
documents entered into on November 23, 1998, by the state and leading
United States tobacco product manufacturers during a fiscal year.
The amount of the tobacco settlement funds to be used for this
purpose shall be the greater of paragraph (1) or (2), less any bond
payments and other costs of securitization related to the funds
described in this subdivision.
(1) The amount of the funds expended by the county for the
provision of health services to indigent program individuals during
the fiscal year.
(2) The amount of the tobacco settlement funds multiplied by the
average of the percentages of the amount of tobacco settlement funds
that were allocated to and expended by the county for health services
to indigent program individuals during the historical fiscal years.
SEC. 24. Section 17613.3 of the Welfare and Institutions Code is
amended to read:
17613.3. (a) For each fiscal year commencing with the 2013-14
fiscal year, the amount to be redirected in accordance with Section
17613.1 shall be determined for each county as set forth in this
section.
(1) The county's revenues and other funds paid or payable for the
fiscal year shall be comprised of the total of the following:
(A) Indigent program revenues.
(B) Special local health funds.
(C) The county indigent care health realignment amount.
(D) The imputed county low-income health amount.
(2) Indigent program costs incurred by the county for the fiscal
year, not to exceed in total the cost containment limit, shall be
subtracted from the sum in paragraph (1).
(3) The resulting amount shall be multiplied by 0.80, except that
for the 2013-14 fiscal year where the resulting amount shall be
multiplied by 0.70.
(4) If the amount in paragraph (3) is a positive number, that
amount, subject to paragraph (5), shall be redirected in accordance
with Section 17613.1, except that for the 2013-14 fiscal year, the
amount to be redirected shall not exceed the amount determined for
the county for the 2013-14 fiscal year under subdivision (c) of
Section 17603, as that amount may have been reduced by the
application of Section 17610.5. If the amount determined in paragraph
(3) is a negative number, the redirected amount shall be zero.
(5) Notwithstanding any other law, the amount to be redirected as
determined in paragraph (4) for a fiscal year shall not exceed the
county indigent care health realignment amount for that fiscal year.
(6) (A) The redirected amount shall be applied until the later of
the following:
(i) June 30, 2023.
(ii) The beginning of the fiscal year following a period of two
consecutive fiscal years in which both of the following occur:
(aa) The total interim amount determined under subdivision (b) in
May of the previous fiscal year is within 10 percent of the final,
reconciled amount in subdivision (d).
(bb) The final, reconciled amounts under subdivision (d) are
within 5 percent of each other.
(B) After the redirected amount ceases as provided in subparagraph
(A), a permanent redirected amount shall be established to be the
amount determined by calculating the percentage that the redirected
amount was in the last fiscal year of the operation of this article
of the county's health realignment amount of that same fiscal year,
multiplied by the county's health realignment amount of all
subsequent years.
(b) Starting with the 2014-15 fiscal year, the department shall
calculate an interim redirected amount for each county under
subdivision (a) by the January immediately prior to the starting
fiscal year, using the most recent and accurate data available. For
purposes of the interim determinations, the cost containment limit
shall not be applied. The interim redirected amount shall be updated
in the May before the start of the fiscal year in consultation with
each county and based on any more recent and accurate data available
at that time. During the fiscal year, the interim redirected amount
will be applied pursuant to Section 17613.1.
(c) The predetermined amounts or historical percentages described
in subdivisions (j), (m), and (r) of Section 17613.2 shall each be
established in accordance with the following procedure:
(1) By October 31, 2013, each county shall determine the amount or
percentage described in the applicable subdivision, and shall
provide this calculation to the department, supported by verifiable
data and a description of how the determination was made.
(2) If the department disagrees with the county's determination,
the department shall confer with the county by December 15, 2013, and
shall issue its determination by January 31, 2014.
(3) If no agreement between the parties has been reached by
January 31, 2014, the department shall apply the county's
determination when making the interim calculations pursuant to
subdivision (b), until a decision is issued pursuant to paragraph
(6).
(4) If no agreement between the parties has been reached by
January 31, 2014, the county shall submit a petition by February 28,
2014, to the County Health Care Funding Resolution Committee,
established pursuant to Section 17600.60, to seek a decision
regarding the historical percentage or amount to be applied in
calculations under this section.
(5) The County Health Care Funding Resolution Committee shall hear
and make a determination as to whether the county's proposed
percentage or amount complies with the requirements of this section
based on the data and calculations of the county and any alternative
data and calculations submitted by the department.
(6) The County Health Care Funding Resolution Committee shall
issue its final determination within 45 days of the petition. If the
county chooses to contest the final determination, the final
determination of the committee will be applied for purposes of any
interim calculation under subdivision (b) until a final decision is
issued pursuant to de novo administrative review under paragraph (2)
of subdivision (d).
(d) (1) The data for the final calculations under subdivision (a)
for the fiscal year shall be submitted by counties within 12 months
after the conclusion of each fiscal year as required in Section
17613.4. The data shall be the most recent and accurate data from the
county's books and records pertaining to the revenues paid or
payable, and the costs incurred, for services provided in the subject
fiscal year. After consulting with the county, the department shall
make final calculations using the data submitted pursuant to this
paragraph by December 15 of the following fiscal year, and shall
provide its final determination to the county. The final
determination will also reflect the application of the cost
containment limit, if any. If the county and the department agree, a
revised recalculation and reconciliation may be completed by the
department within six months thereafter.
(2) The Director of Health Care Services shall establish an
expedited formal appeal process for a county to contest final
determinations made under this article. No appeal shall be available
for interim determinations made under subdivision (b). The appeals
process shall include all of the following:
(A) The county shall have 30 calendar days, following the issuance
of a final determination made under paragraph (6) of subdivision (c)
or paragraph (1) of this subdivision, to file an appeal with the
director. All appeals shall be governed by Section 100171 of the
Health and Safety Code, except for those provisions of paragraph (1)
of subdivision (d) of Section 100171 of the Health and Safety Code
relating to accusations, statements of issues, statement to
respondent, and notice of defense, and except as otherwise set forth
in this section. All appeals shall be in writing and shall be filed
with the State Department of Health Care Service's Office of
Administrative Hearings and Appeals. An appeal shall be deemed filed
on the date it is received by the Office of Administrative Hearings
and Appeals.
(i) An appeal shall specifically set forth each issue in dispute,
including, but not limited to, any component of the determination,
and include the county's contentions as to those issues. A formal
hearing before an Office of Administrative Hearings and Appeals
Administrative Law Judge shall commence within 60 days of the filing
of the appeal requesting a formal hearing. A final decision under
this paragraph shall be adopted no later than six months following
the filing of the appeal.
(ii) If the county fails to file an appeal within 30 days of the
issuance of a determination made under this section, the
determination of the department shall be deemed final and not
appealable either administratively or to a court of general
jurisdiction, except that a county may elect to appeal a
determination under subdivision (c) within 30 days of the issuance of
the County Health Care Funding Resolution Committee's final
determination under paragraph (6) of subdivision (c) or as a
component of an appeal of the department's final determination under
paragraph (1) for the 2013-14 fiscal year.
(B) If a final decision under this paragraph is not issued by the
department within two years of the last day of the subject fiscal
year, the county shall be deemed to have exhausted its administrative
remedies, and shall not be precluded from pursuing any available
judicial review. However, the time period in this subdivision shall
be extended by either of the following:
(i) Undue delay caused by the county.
(ii) An extension of time granted to a county at its sole request,
or following the joint request of the county and the department.
(C) If the final decision issued by the department pursuant to
this paragraph results in a different determination than that
originally made by the department, then the Department of Finance
shall adjust the original determination by that amount, pursuant to a
process developed by the Department of Finance and in consultation
with the California State Association of Counties.
SEC. 25. Section 17613.4 of the Welfare and Institutions Code is
amended to read:
17613.4. (a) Beginning with the 2013-14 fiscal year, each county
that has elected to participate in the County Savings Determination
Process shall, within five months after the end of each fiscal year,
be required to submit initial reports on both of the following:
(1) All revenue data required for the operation of Section
17613.3, including both of the following:
(A) Indigent program revenues.
(B) Special local health funds.
(2) All cost data required for the operation of Section 17613.3,
including indigent program costs.
(b) Counties shall submit final reports of cost and revenue data
identified in subdivision (a) to the department for the each fiscal
year no later than June 30 of the fiscal year ending one year after
the subject fiscal year.
(c) The department shall develop, in consultation with California
State Association of Counties, the methodologies used to determine
the costs and revenues required to be reported and the format of the
submissions.
(d) Reports submitted under this section shall be accompanied by a
certification by an appropriate public official attesting to the
accuracy of the reports.
(e) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department, without taking any further regulatory action, shall
implement, interpret, or make specific this article by means of
all-county letters, plan letters, plan or provider bulletins, or
similar instructions.
SEC. 26. Section 18901.2 of the Welfare and Institutions
Code is amended to read:
18901.2. (a) It is the intent of the Legislature to create a
program in California that provides a nominal Low-Income Home Energy
Assistance Program (LIHEAP) service benefit, through the LIHEAP block
grant, to all recipient households of CalFresh so that they are made
aware of services available under LIHEAP and so that some households
may experience an increase in federal Supplemental Nutrition
Assistance Program benefits, as well as benefit from paperwork
reduction.
(b) To the extent permitted by federal law, the State Department
of Social Services (DSS) shall, in conjunction with the Department of
Community Services and Development (CSD), design, implement, and
maintain a utility assistance initiative: the "Heat and Eat" program.
(1) The nominal LIHEAP service benefit shall be funded through the
LIHEAP block grant allocated for outreach activities in accordance
with state and federal requirements, and shall be provided by the CSD
to the DSS after receipt by the CSD of the LIHEAP block grant funds
from the federal funding authorities.
(2) The total amount transferred shall be the product of the
nominal LIHEAP service benefit established by the CSD in the LIHEAP
state plan multiplied by the number of CalFresh recipient households
as agreed upon annually by the CSD and the DSS.
(3) The total amount transferred shall be reduced by any
unexpended or reinvested amounts remaining from prior transfers for
the nominal LIHEAP service benefits as provided in subparagraph (C)
of paragraph (1) of subdivision (c).
(c) In implementing and maintaining the utility assistance
initiative, the State Department of Social Services shall do all of
the following:
(1) (A) Grant recipient households of CalFresh benefits pursuant
to this chapter a nominal LIHEAP service benefit out of the federal
LIHEAP block grant (42 U.S.C. Sec. 8621 et seq.).
(B) In establishing the nominal LIHEAP service benefit amount, the
department shall take into consideration that the benefit level need
not provide significant utility assistance.
(C) Any funds allocated for this purpose not expended by CalFresh
recipient households shall be recouped through the "Heat and Eat"
program and reinvested into the program on an annual basis as
determined by both departments.
(2) Provide the nominal LIHEAP service benefit without requiring
the applicant or recipient to provide additional paperwork or
verification.
(3) To the extent permitted by federal law and to the extent
federal funds are available, provide the nominal LIHEAP service
benefit annually to each recipient of CalFresh benefits.
(4) (A) Deliver the nominal LIHEAP service benefit using the
Electronic Benefit Transfer (EBT) system or other nonpaper delivery
system.
(B) Notification of a recipient's impending EBT dormant account
status shall not be required when the remaining balance in a
recipient's account at the time the account becomes inactive is
ninety-nine cents ($0.99) or less of LIHEAP service benefits.
(5) Ensure that receipt of the nominal LIHEAP service benefit
pursuant to this section shall not adversely affect a CalFresh
recipient household's eligibility, reduce a household's CalFresh
benefits, or disqualify the applicant or recipient of CalFresh
benefits from receiving other nominal LIHEAP service benefits or
other utility benefits for which they may qualify.
(d) Recipients of the nominal LIHEAP service benefit pursuant to
this section shall remain subject to the additional eligibility
requirements for LIHEAP assistance as outlined in the California
LIHEAP state plan, developed by the CSD.
(e) (1) To the extent permitted by federal law, a CalFresh
household receiving or anticipating receipt of nominal LIHEAP service
benefits pursuant to the utility assistance initiative or any other
law shall be entitled to use the full standard utility allowance
(SUA) for the purposes of calculating CalFresh benefits. A CalFresh
household shall be entitled to use the full SUA regardless of whether
the nominal LIHEAP service benefit is actually redeemed.
(2) If use of the full SUA, instead of the homeless shelter
deduction, results in a lower amount of CalFresh benefits for a
homeless household, the homeless household shall be entitled to use
the homeless shelter deduction instead of the full SUA.
(f) The department shall implement the initiative by January 1,
2013.
SEC. 27. 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.
