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Assembly Bill No. 1467 |
CHAPTER 23 |
An
act to amend Sections 7575, 12803.3, and 15438 of, to add Section
15438.10 to, and to repeal Section 7582 of, the Government Code, to
amend Sections 137, 138.4, 138.6, 152, 1324.8, 1324.24, 100950, 104150,
104160, 104162.1, 104163, 104314, 104315, 104322, 110050, 113717,
116064.2, 123865, 123870, 123875, 124300, 125130, 125205, 125215,
130060, 130316, 130317, 131051, and 131052 of, to add Sections 1324.9,
131019.5, and 131055.1 to, to repeal Sections 135, 136, 138, 150, 151,
116064.1, and 125145 of, and to repeal and add Section 113718 of, the
Health and Safety Code, and to amend Sections 4362, 4362.5, 4364,
4364.5, 4366, 4367.5, 4368.5, 5820, 5821, 5822, 5830, 5840, 5845, 5846,
5847, 5848, 5878.1, 5878.3, 5890, 5891, 5892, 5897, 5898, 14046.7,
14091.3, 14105.22, 14134, 14134.1, 14154, 14165, 14166.8, 14166.12,
14166.14, 14166.17, 14166.19, 14169.7, 14169.7.5, 14169.13, 14169.31,
14169.32, 14169.33, 14169.34, 14169.36, 14169.38,
14171, 14182.4, 14182.45, 14183.6, 14204, 14301.1, 14500.5, 15911,
15916, 24000, and 24001 of, to amend and repeal Sections 14085.6,
14085.7, 14085.8, 14085.81, and 14085.9 of, to add Sections 4024.7,
5899, 14089.08, 14089.09, 14166.151, 14166.152, 14166.153, 14166.154,
14166.155, 14459.6, 14459.8, 15911.1, and 15912.1 to, to add Article
2.82 (commencing with Section 14087.98) to Chapter 7 of Part 3 of
Division 9 of, and to add and repeal Section 14105.196 of, the Welfare
and Institutions Code, relating to health, and making an appropriation
therefor, to take effect immediately, bill related to the budget.
[
Approved by
Governor
June 27, 2012.
Filed with
Secretary of State
June 27, 2012.
]
LEGISLATIVE COUNSEL'S DIGEST
AB 1467, Committee on Budget.
Health.
(1) Under
existing law, the Robert W. Crown California Children’s Services Act,
the State Department of Health Care Services and each county administer
the California Children’s Services Program (CCS program) for treatment
services for persons under 21 years of age diagnosed with severe chronic
disease or severe physical limitations, as specified. Existing law
generally limits eligibility for CCS program services to persons in
families with an annual adjusted gross income of $40,000 or less. Under
existing law, the department, or any designated local agency
administering the program, is responsible for providing medically
necessary occupational and physical therapy, to eligible children, as
specified.
Existing law requires
school districts, county offices of education, and special education
local plan
areas to comply with state laws that conform to the federal
Individuals with Disabilities Education Act (IDEA), in order that the
state may qualify for federal funds available for the education of
individuals with exceptional needs. Existing law requires school
districts, county offices of education, and special education local plan
areas to identify, locate, and assess individuals with exceptional
needs and to provide those pupils with a free appropriate public
education in the least restrictive environment, and with special
education and related services as reflected in an individualized
education program (IEP). Existing law requires the Superintendent of
Public Instruction to administer the special education provisions of the
Education Code and to be responsible for assuring provision of, and
supervising, education and related services to individuals with
exceptional needs as required pursuant to the federal IDEA.
This
bill would require,
when a child has an IEP, that all occupational and physical therapy
services assessed and determined to be educationally necessary by the
IEP team and included in the IEP shall be provided in accordance with
the federal IDEA, and not paid for by the CCS program. The bill would
require the parents or estate of a child with an IEP to disclose that
IEP to the CCS program at the time of application and on revision of the
child’s IEP. This bill would make conforming changes to procedures
applicable to the CCS program’s medical therapy unit conference team,
when determining a child’s eligibility for those therapy services.
Existing
law requires that specified assessments and therapy treatment services
rendered to a child referred to a local education agency for an
assessment or a disabled child or youth with an IEP be exempt from
financial eligibility standards and family repayment requirements.
This bill would delete these provisions.
The
bill would require the State Department of Education to review
regulations to ensure the appropriate implementation of educationally
necessary occupational and physical therapy services required by
specified provisions of federal law and specified provisions of the
bill. The bill would require that specified provisions of the bill be
implemented no later than October 1, 2012, and would require the State
Department of Health Care Services to report, as provided, specified
data relating to the implementation of the bill’s provisions.
(2) Existing
law transfers the Systems Integration Division of the California Health
and Human Services Data Center to the California Health and Human
Services Agency and provides that it shall be known as the Office of
Systems Integration.
Existing law prohibits the California Health and Human Services Agency
from placing or transferring information technology projects in the
office without further legislation authorizing these activities.
This bill would delete this prohibition.
(3) The
California Health Facilities Financing Authority Act authorizes the
California Health Facilities Financing Authority to make loans from the
continuously appropriated California Health Facilities Financing
Authority Fund to participating health institutions for financing or
refinancing the acquisition, construction, or remodeling of health
facilities. The act defines a health facility to include various
specified facilities and facilities operated in conjunction with these
facilities. It also defines a participating health institution to mean
specified entities authorized by state law to provide or operate a
health facility and undertake the financing or
refinancing of the construction or acquisition of a project or of
working capital, as defined. Existing law authorizes the authority to
award grants to any eligible health facility, as defined, for purposes
of financing defined projects.
This
bill would authorize the authority to award one or more grants that, in
the aggregate, do not exceed $1,500,000 to one or more projects designed
to demonstrate new or enhanced cost-effective methods of delivering
health care services, as specified. This bill would authorize the
authority to implement a 2nd grant program to award up to $5,000,000 to
eligible recipients, if a demonstration project is successful at
developing a new method of delivering certain services. This bill would
create the California Health Access Model Program Account in the
California Health Facilities Financing Authority Fund, and would
transfer up to $6,500,000 from the fund to the account for the purposes
of the bill. The bill would require that any
moneys remaining in the account as of January 1, 2020, revert to the
fund. By expanding the purposes for which a continuously appropriated
fund may be used, this bill would make an appropriation.
(4) Existing
law establishes the Office of Women’s Health within the State
Department of Health Care Services. Existing law requires the California
Health and Human Services Agency to establish an interagency task force
on women’s health, as specified. Existing law establishes the Office of
Multicultural Health within the State Department of Public Health.
This
bill would repeal these provisions and other related provisions and
instead establish the Office of Health Equity within the State
Department of Public Health. The bill would require the office to
perform various duties relating to reducing health and mental health
disparities in vulnerable communities, as
defined. The bill would require that a deputy director be appointed,
as specified, and that an advisory committee be established within the
office no later than October 1, 2013. The bill would require that an
interagency agreement be established between the State Department of
Public Health and the State Department of Health Care Services to
outline the process by which the departments will jointly work to
advance the mission of the office, including responsibilities, scope of
work, and necessary resources. This bill would make conforming and
related changes.
(5) 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 that, as a condition of participation
in the Medi-Cal
program, there be imposed a quality assurance fee on certain
intermediate care facilities. Existing law requires that the fees be
deposited into the General Fund and allocated to intermediate care
facilities to support their quality improvement efforts, and distributed
to each facility based on the number of Medi-Cal patients at the
eligible facility. Existing law requires the department to impose a
uniform quality assurance fee on each skilled nursing facility, with
certain exceptions, in accordance with a prescribed formula and requires
that the fees be deposited in the State Treasury. Existing law, the
Medi-Cal Long-Term Care Reimbursement Act, requires the department to
implement a facility-specific reimbursement ratesetting system for
certain skilled nursing facilities. Reimbursement rates for freestanding
skilled nursing facilities are funded by a combination of federal funds
and moneys collected pursuant to the skilled nursing uniform quality
assurance fee.
This bill would
instead, beginning August 1, 2013, require the quality assurance fees
imposed pursuant to these provisions be deposited into the Long-Term
Care Quality Assurance Fund which would be created by this bill.
(6) The
State Department of Public Health is required to perform various public
health functions, including providing breast and cervical cancer
screening and treatment for low-income individuals, providing prostate
cancer screening and treatment for low-income and uninsured men, and
specified family planning services.
This bill would, commencing July 1, 2012, transfer the duties referenced above to the State Department of Health Care Services.
(7) Existing
law, the Sherman Food, Drug, and Cosmetic Law (Sherman Law), requires
the department to regulate activities related to food, drugs,
devices, and cosmetics and establishes the Food Safety Fund for the
deposit of money collected by the department under specified Sherman Law
provisions. Money in the Food Safety Fund is available to the
department, upon appropriation by the Legislature, to implement
specified Sherman Law provisions. The existing California Retail Food
Code regulates the health and sanitation standards for retail food
facilities and establishes the Retail Food Safety and Defense Fund.
Money collected by the department under specified California Retail Food
Code provisions is deposited in the fund and used by the department,
upon appropriation by the Legislature, to implement the California
Retail Food Code.
This bill would
eliminate the Retail Food Safety and Defense Fund and require all money
deposited into the fund to be transferred to the Food Safety Fund. This
bill would expand the purpose of the Food Safety Fund to include
carrying out the provisions of the
California Retail Food Code.
(8) Existing
law requires public swimming pools to be equipped with antientrapment
devices or systems that meet ASME/ANSI or ASTM performance standards.
Existing law permits the State Department of Public Health to assess an
annual fee on public swimming pool owners, collected by the local health
department, and deposited into the Recreational Health Fund along with
other money collected by the department through enforcement of these
provisions. Money in the fund is available to the department, upon
appropriation by the Legislature, for the purpose of promoting these
public swimming pool provisions.
This
bill would instead require public swimming pools to be equipped with
antientrapment devices or systems that comply with ANSI/APSP standard 16
and make related changes. This bill would eliminate the Recreational
Health Fund and the department’s authority
to administer or enforce specified public swimming pool provisions.
(9) Existing
law requires, after January 1, 2008, that any general acute care
hospital building that is determined to be a potential risk of collapse
or pose significant loss of life only be used for nonacute care hospital
purposes, unless granted an extension as prescribed.
Existing
law authorizes, commencing on the date when the State Department of
Health Care Services receives specified federal approval for a 2011–12
fiscal year hospital quality assurance fee program that meets a
specified condition, the Office of Statewide Health Planning and
Development to grant a hospital an additional extension of up to 7 years
for a hospital building that it owns or operates if the hospital meets
specified milestones. These milestones include a March 31, 2012,
deadline for submitting to the office a specified letter of
intent and schedule.
This bill
would extend until September 30, 2012, the deadline for the
above-described milestones for submitting a letter of intent and a
schedule.
(10) Existing law
requires the Director of Health Care Services to appoint an Advisory
Committee on Genetically Handicapped Person’s Program. Existing law
requires the director to seek advice from the committee when adopting
regulations under the Genetically Handicapped Person’s Program that
would expand the list of genetically handicapping conditions covered by
the program and requires approval from the committee when prioritizing
funds and services.
This bill would
delete the provisions that establish the Advisory Committee on
Genetically Handicapped Person’s Program. This bill would delete the
provisions that authorize the director to expand the list
of genetically handicapping conditions covered by the program and that
require the director to establish priorities for the use of funds and
services. This bill would make conforming changes.
(11) Existing
law, the Health Insurance Portability and Accountability Implementation
Act of 2001, requires the Office of HIPAA Implementation, established
by the Governor’s office within the agency, to perform specified
activities required for compliance with the federal Health Insurance
Portability and Accountability Act. Under existing law, the act will
become inoperative and be repealed on January 1, 2013, unless a later
enacted statute, that is enacted before January 1, 2013, deletes or
extends that date, and all unexpended or unencumbered funds under that
act will revert to the General Fund on January 1, 2013.
The bill would extend the act’s duration to June 30, 2016, when it would be inoperative and
repealed, and all funds under the act that are unexpended or unencumbered as of that date would revert to the General Fund.
(12) Under
existing law, the State Department of Mental Health is authorized and
required to perform various functions relating to the care and treatment
of persons with mental disorders. Existing law requires the Director of
Mental Health, with the advice of the Statewide Resources Consultant,
as described, to contract with nonprofit community resource agencies to
establish regionally based resource centers to provide services for
brain-impaired adults.
This bill
would transfer the Director of Mental Health’s responsibilities with
respect to these resource centers to the Director of Health Care
Services.
(13) Existing law,
the Mental Health Services Act, an initiative measure enacted by the
voters as Proposition 63
at the November 2, 2004, statewide general election, establishes the
continuously appropriated Mental Health Services Fund to fund various
county mental health programs. Existing law establishes the Mental
Health Services Oversight and Accountability Commission (commission) to
oversee the administration of various parts of the Mental Health
Services Act. The act provides that it may be amended by the Legislature
by a 2/3 vote of each house
as long as the amendment is consistent with and furthers the intent of
the act, and that the Legislature may also clarify procedures and terms
of the act by majority vote.
This
bill would authorize the commission to assist in providing technical
assistance, as specified, and would authorize the commission to work in
collaboration with, and in consultation with, various entities in
designing a comprehensive joint plan for coordinated
evaluation of client outcomes. This bill would require the California
Health and Human Services Agency to lead the comprehensive joint plan
effort. This bill would transfer various functions of the State
Department of Mental Health under the Mental Health Services Act to the
State Department of Health Care Services and the Office of Statewide
Health Planning and Development. This bill would make various technical
and conforming changes to reflect the transfer of those mental health
responsibilities. This bill would require all projects included in the
innovative programs portion of the county plan to meet specified
requirements.
Existing law requires each county mental health program to prepare and submit a 3-year plan that includes specified components.
This
bill, in this regard, would require the plan to be a 3-year program and
expenditure plan adopted by the county board of supervisors and
submitted to the commission,
would require annual updates, and would require plans to be certified
by the county mental health director and the county auditor-controller,
as specified. This bill would require the State Department of Health
Care Services to inform the California Mental Health Directors
Association and the commission of the methodology used for revenue
allocation to the counties. This bill would require the State Department
of Health Care Services, in consultation with the commission and the
California Mental Health Directors Association, to develop and
administer instructions for the Annual Mental Health Services Act
Revenue and Expenditure Report, as prescribed.
This bill would declare that it clarifies procedures and terms of the Mental Health Services Act.
This
bill would require the Governor or the Director of Health Care Services
to appoint, subject to confirmation by the Senate, a Deputy Director of
Mental Health and Substance Use Disorder Services of the State
Department of Health Care Services.
(14) Existing
law requires the State Department of Health Care Services to establish
and administer, until July 1, 2021, the Medi-Cal Electronic Health
Records Incentive Program, for the purposes of providing federal
incentive payments to Medi-Cal providers for the implementation and use
of electronic records systems. Existing law prohibits General Fund
moneys from being used for this purpose.
This
bill would instead provide that no more than $200,000 from the General
Fund may be used annually for state administrative costs associated with
implementing these provisions.
(15) Existing
law establishes the Emergency Services and Supplemental Payments Fund,
the Medi-Cal Education Supplemental Payment Fund, the Large Teaching
Emphasis Hospital
and Children’s Hospital Medi-Cal Medical Education Supplemental
Payment Fund, and the Small and Rural Hospital Supplemental Payments
Fund administered by the department from which the department is
required to make supplemental payments to certain hospitals based on
specified criteria.
This bill would
provide that these provisions shall become inoperative on June 30, 2013,
and shall be repealed on January 1, 2014.
(16) Existing
law authorizes the department to provide health care services to
Medi-Cal beneficiaries through various models of managed care, including
though a comprehensive program of managed health care plan services for
Medi-Cal recipients residing in clearly defined geographical areas.
Existing law provides for a schedule of benefits under the Medi-Cal
program, which, with some exceptions, includes certain dental services.
This
bill would authorize the Director of Health Care Services to enter into
contracts with one or more managed health care plans to provide a
comprehensive program of managed health care services to Medi-Cal
beneficiaries residing in specified counties. This bill would also make
enrollment in Medi-Cal managed health care plans mandatory for
beneficiaries residing in these counties.
This
bill would require the department to establish a list of performance
measures to ensure dental health plans meet quality criteria required by
the department to be included in dental health contracts entered into
between the department and a dental health plan. This bill would require
the department to designate an external quality review organization to
conduct quality reviews for any dental health plan contracting with the
department, as specified. This bill would require the Director of Health
Care Services to establish a
beneficiary dental exception (BDE) process for Medi-Cal beneficiaries
mandatorily enrolled in dental health plans in the County of Sacramento,
and would require the department to amend contracts with dental health
plans that provide dental services to Medi-Cal beneficiaries who reside
in a specified geographic area to meet these additional requirements.
This
bill would require the department, by no later than March 15, 2013, and
annually thereafter, to provide designated committees of the
Legislature a report on dental managed care in the Counties of
Sacramento and Los Angeles, and, for reports on the County of
Sacramento, data outcomes and findings from the BDE process. This bill
would require the Department of Managed Health Care, by no later than
January 1, 2013, to provide designated committees of the Legislature
with its final report on specified surveys for the dental health plans
participating in the Sacramento Geographic Managed Care
Program. This bill would authorize the County of Sacramento to
establish a stakeholder advisory committee on the delivery of oral
health and dental care services, and would require the State Department
of Health Care Services to meet periodically with the committee, as
specified.
This bill would also
require the department to perform specified functions in connection with
the Medi-Cal managed care plan default assignment algorithm.
Existing
law requires the department to enter into an interagency agreement with
the Department of Managed Health Care to conduct financial audits,
medical surveys, and a review of the provider networks of the managed
care plans participating in a certain demonstration project.
This
bill would additionally require the department to enter into the
interagency agreement with the Department of Managed Health Care to
conduct financial audits, medical surveys, and a review of the
provider networks in connection with the expansion of Medi-Cal managed
care into rural counties, and to provide consumer assistance to
beneficiaries affected by certain provisions.
This bill would make legislative findings and declarations as to the necessity of a special statute for specified counties.
(17) Existing
law requires, until January 1, 2013, a hospital that does not have in
effect a contract with a Medi-Cal managed care health plan, as defined,
that establishes payment amounts for services furnished to a beneficiary
enrolled in that plan to accept as payment in full, from all Medi-Cal
managed care plans, specified amounts for outpatient services, emergency
inpatient services, and poststabilization services following an
emergency admission.
This bill would
modify the
payment amount a hospital subject to these provisions is required to
accept as payment in full from Medi-Cal managed care health plans for
emergency inpatient services, and would provide that the payment amounts
for both emergency inpatient services and poststabilization services
related to an emergency medical condition shall remain in effect only
until the department implements a specified payment methodology based on
diagnosis-related groups, at which time, the hospital shall accept the
payment amount established by that methodology for those services. This
bill would extend the operative date of these provisions to July 1,
2013, and would make related changes.
(18) Existing
federal law requires the state to provide payment for primary care
services furnished in the 2013 and 2014 calendar years by Medi-Cal
providers with specified primary specialty designations at a rate not
less than 100% of the payment rate that applies to those services
and physicians under the Medicare Program.
This
bill would, only to the extent that the federal medical assistance
percentage is equal to 100% and only until January 1, 2015, implement
this requirement for both Medi-Cal fee-for-service and managed care
plans.
(19) Existing law
provides that reimbursement for clinical laboratory or laboratory
services under the Medi-Cal program, as defined, may not exceed 80% of
the lowest maximum allowance established by the federal Medicare Program
for the same or similar services.
This
bill would, upon federal approval, change the rate methodology for
clinical laboratory or laboratory services, as specified. This bill
would also require that rates for clinical laboratory or laboratory
services be reduced by 10% until federal approval is obtained for this
new
rate methodology.
(20) Existing
law requires Medi-Cal beneficiaries to make set copayments for
specified services. Existing law, subject to federal approval, revises
these copayment rates, expands the services for which copayments are
due, and requires the department to reduce the amount of the payment to
the provider by the amount of the copayment. Existing law provides, upon
federal approval and with certain exceptions, that a provider has no
obligation to provide services to a beneficiary who does not pay the
copayment at the point of service.
This bill would modify these provisions as they relate to emergency and nonemergency services.
(21) Existing
law provides that it is the intent of the Legislature to provide
appropriate funding to the counties for the effective administration of
the Medi-Cal program, except
for specified fiscal years in regard to any cost-of-doing-business
adjustment.
This bill would
additionally provide that it is the intent of the Legislature to not
appropriate funds for the cost-of-doing-business adjustment for the
2012–13 fiscal year.
(22) Existing
law establishes the continuously appropriated Private Hospital
Supplemental Fund and the continuously appropriated Nondesignated Public
Hospital Supplemental Fund administered by the California Medical
Assistance Commission for the purposes of funding the nonfederal share
of specified payments to private and nondesignated hospitals. Existing
law also provides for stabilization funding for certain hospitals
through October 31, 2010, and requires specified amounts of that funding
to be transferred to the Private Hospital Supplemental Fund and the
Nondesignated Public Hospital Supplemental Fund. Existing law requires
that the California
Medical Assistance Commission be dissolved after June 30, 2012, and
requires the department to develop a staff transition plan, as
specified, that will be included in the 2012–13 Governor’s budget.
Existing law requires that, upon dissolution of the commission, all
powers, duties, and responsibilities of the commission be transferred to
the Director of Health Care Services. Existing law provides that upon a
determination by the director that a payment system based on
diagnosis-related groups, as described, has been developed and
implemented, the powers, duties, and responsibilities conferred on the
commission and transferred to the director shall no longer be exercised.
This
bill, instead, would provide that the powers, duties, and
responsibilities conferred on the commission and transferred to the
director shall no longer be exercised upon the director’s determination,
except for those relating to specified stabilization payments and the
ability to negotiate and
make payments from the Private Hospital Supplemental Fund and the
Nondesignated Public Hospital Supplemental Fund. This bill would also
modify the criteria a hospital would have to meet to receive
distributions from these funds. This bill would also require,
notwithstanding any other law, that stabilization funding payable to
nondesignated public hospitals and to project year private DSH hospitals
that has not been paid or specifically committed for payment prior to
January 1, 2012, be transferred to the General Fund, except as
specified, and that funds that would otherwise be drawn from the General
Fund for stabilization payments to these hospitals be retained in the
General Fund. This bill would delete the requirement that the department
develop a staff transition plan and, instead, would implement the
transition of staff positions serving the commission to the department.
This bill would provide that after the diagnosis-related groups payment
system is implemented, the transferred employees will transfer
to civil service classifications within the department, as specified.
(23) Existing
law establishes the Medi-Cal Hospital/Uninsured Care Demonstration
Project Act, which revises hospital supplemental payment methodologies
under the Medi-Cal program in order to maximize the use of federal funds
consistent with federal Medicaid law and to stabilize the distribution
of funding for hospitals that provide care to Medi-Cal beneficiaries and
uninsured patients. Existing law requires the department to seek a
successor demonstration project or federal waiver of Medicaid law to
implement specified objectives, which may include better care
coordination for seniors, persons with disabilities, and children with
special health care needs. Existing law provides that to the extent the
provisions under the Medi-Cal Hospital/Uninsured Care Demonstration
Project Act do not conflict with the provisions of, or the Special Terms
and Conditions of, this demonstration
project, the provisions of the Medi-Cal Hospital/Uninsured Care
Demonstration Project Act shall apply. Existing law establishes the
continuously appropriated Health Care Support Fund, which consists of
federal safety net care pool funds claimed and received by the
department under the demonstration project and the successor
demonstration project. Existing law also establishes the continuously
appropriated Public Hospital Investment, Improvement, and Incentive
Fund, which consists of moneys that a county, other political
subdivision of the state, or other governmental entity in the state
elects to transfer to the department for use as the nonfederal share of
investment, improvement, and incentive payments to participating
designated hospitals and the governmental entities with which they are
affiliated.
This bill would, subject
to federal approval, modify the inpatient fee-for-service reimbursement
methodology for nondesignated public hospitals
under the successor demonstration project. This bill would, among
other things, provide that beginning with the 2012–13 fiscal year, and
if specified conditions are met, nondesignated public hospitals, or
governmental entities with which they are affiliated, shall be eligible
to receive safety net care pool payments for uncompensated care from the
Health Care Support Fund. By revising the purposes for which moneys in
the Health Care Support Fund may be expended, this bill would make an
appropriation. This bill would also provide that beginning with the
2012–13 fiscal year, subject to federal approval and if specified
conditions are met, nondesignated public hospitals may receive delivery
system reform incentive pool funding, as specified. This bill would make
related changes to the Public Hospital Investment, Improvement, and
Incentive Fund provisions. By revising the purposes for which moneys in
the Public Hospital Investment, Improvement, and Incentive Fund may be
used, this bill would make an
appropriation. This bill would also require designated public
hospitals to report and certify specified information for each successor
demonstration year beginning with the 2012–13 fiscal year.
(24) Existing
law, subject to federal approval, imposes a quality assurance fee, as
specified, on certain general acute care hospitals for the period of
July 1, 2011, through December 31, 2013. Existing law creates the
Hospital Quality Assurance Revenue Fund in the State Treasury and
requires that the money collected from the quality assurance fee be
deposited into the fund. Existing law, subject to federal approval,
provides that the moneys in the Hospital Quality Assurance Revenue Fund
shall, upon appropriation by the Legislature, be available only for
certain purposes, including, among other things, paying for health care
coverage for children, as specified, making supplemental payments to
private hospitals, and making direct
grants in support of health care expenditures to designated and
nondesignated public hospitals.
This
bill would revise the definition of “federal approval” for the purposes
of those provisions and would make conforming changes. This bill would
increase the amount previously allocated for health care coverage for
children for each subject fiscal quarter during the 2012–13 and 2013–14
fiscal years, and would, for the 2013–14 fiscal year, additionally
require that the amount of $21,500,000 previously allocated for grants
to designated public hospitals be retained by the state to pay for
health care coverage of children, as specified.
(25) Existing
law requires the department to audit the amounts paid for services
provided to Medi-Cal beneficiaries. Existing law requires the Director
of Health Care Services to establish administrative appeal processes to
review complaints arising from
the findings of an audit. Existing law provides that a specified
interest rate shall be assessed on amounts when a provider prevails in
an appeal of a disallowed payment that was paid and recovered by the
department or when an unrecovered overpayment is due to the department,
and in other circumstances.
This bill would modify the applicable interest rate.
(26) Existing
law requires the department, pursuant to federal approval of a
successor demonstration project, to authorize a local Low Income Health
Program (LIHP) to provide health care services to eligible low-income
individuals under certain circumstances.
This
bill would modify the provisions relating to the application of rates
agreed to between the department and the participating entities with
respect to the LIHP year ending June 30, 2012.
(27) Existing
law authorizes counties meeting certain criteria to elect to
participate in the County Medical Services Program (CMSP), for the
purpose of providing specified health services to eligible county
residents. Counties that elect to participate in the program may
establish a CMSP governing board, responsible for the oversight of the
participating counties. Existing law permits a CMSP governing board to
apply to operate a local LIHP for the purpose of providing health care
services, as specified.
This bill
would authorize the Director of Finance to require the Controller to
draw warrants against General Fund cash to provide cashflow loans of no
more than a total of $100,000,000 in the 2012–13 and 2013–14 fiscal
years for CMSP governing board expenses that are associated with a Low
Income Health Program operated by the governing board, thereby making an
appropriation.
(28) Existing
law establishes the Office of AIDS in the State Department of Public
Health as the lead agency responsible for coordinating state programs,
services, and activities relating to the human immunodeficiency virus
(HIV), acquired immunodeficiency syndrome (AIDS), and AIDS-related
conditions (ARC). Existing federal law, under the federal Ryan White
HIV/AIDS Treatment Extension Act of 2009 (Ryan White Act), makes
financial assistance available to states and other public and nonprofit
entities to provide for the delivery of services to families with HIV.
This
bill would require the State Department of Health Care Services, in
collaboration with the State Department of Public Health, and in
consultation with stakeholders, to develop polices and guidance on the
transition of persons diagnosed with HIV/AIDS from programs funded under
the federal Ryan White Act to the Low Income Health Program.
(29) Existing
law provides for the Health Care Coverage Initiative (HCCI), which is a
federal waiver demonstration project established to expand health care
coverage to low-income uninsured individuals who are not currently
eligible for the Medi-Cal program, the Healthy Families Program, or the
Access for Infants and Mothers Program. Existing law requires the
department to annually seek authority from the federal Centers for
Medicare and Medicaid Services under the Special Terms and Conditions of
the successor demonstration project to redirect HCCI funds within the
safety net care pool, as defined, that are not fully utilized by the end
of a demonstration year, as defined, to the category of uncompensated
care to be used by designated public hospitals, on a voluntary basis,
for allowable certified public expenditures, as specified.
This
bill would modify the conditions under which
designated public hospitals may utilize the redirected safety net care
pool funds and would modify the provisions relating to disallowances or
deferrals that relate to certified public expenditures for
uncompensated care incurred by the designated public hospitals under
these provisions.
(30) This
bill would incorporate additional changes in Section 123870 of the
Health and Safety Code proposed in AB 1494 and SB 1034, that would
become operative only if either AB 1494 or SB 1034 and this bill are
both chaptered and become effective on or before January 1, 2013, and
this bill is chaptered last.
(31) This
bill would declare that it is to take effect immediately as a bill
providing for appropriations related to the Budget Bill.
Digest Key
Vote: MAJORITY Appropriation: YES Fiscal Committee: YES Local Program: NOBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 7575 of the Government Code is amended to read:7575.
(a) Notwithstanding any other provision of law, all services assessed and determined as educationally necessary by the individualized education program (IEP) team contained in the child’s IEP or individualized education plan shall be provided in accordance with the federal Individuals with Disabilities Education Act (IDEA; 20 U.S.C. Sec. 1400 et seq.).(b) If
a child applies to the California Children’s Services Program pursuant
to Section 123865 or 123875 of the Health and Safety Code, the State
Department of Health Care Services shall determine whether the child
needs medically necessary occupational therapy or physical therapy. A
medical referral to the California Children’s
Services Program shall be based on a written report from a
licensed physician and surgeon who has examined the pupil. The written
report shall include the following:
(1) The diagnosed neuromuscular, musculoskeletal, or physical disabling condition prompting the referral.
(2) The referring physician’s treatment goals and objectives.
(3) The
basis for determining the recommended treatment goals and objectives,
including how these will ameliorate or improve the pupil’s diagnosed
condition.
(4) The relationship of the medical disability to the pupil’s need for special education and related services.
(5) Relevant medical records.
(c) If
the child has an IEP pursuant to the federal IDEA, the parents or the
estate of the child shall disclose that IEP to the California Children’s
Services Program at the time of application and on revision of the
child’s IEP.
(d) The department
shall provide the service directly or by contracting with another
public agency, qualified individual, or a state-certified nonpublic
nonsectarian school or agency.
(e) Local
education agencies shall provide necessary space and equipment for the
provision of occupational therapy and physical therapy in the most
efficient and effective manner.
(f) The
department shall also be responsible for providing the services of a
home health aide when the local education agency considers a less
restrictive placement from home to school for a pupil for whom both of
the
following conditions exist:
(1) The
California Medical Assistance Program provides a life-supporting
medical service via a home health agency during the time in which the
pupil would be in school or traveling between school and home.
(2) The
medical service provided requires that the pupil receive the personal
assistance or attention of a nurse, home health aide, parent or
guardian, or some other specially trained adult in order to be
effectively delivered.
SEC. 2.
Section 7582 of the Government Code is repealed.SEC. 3.
Section 12803.3 of the Government Code is amended to read:12803.3.
(a) For purposes of this section, the following definitions shall apply:(1) “Director” means the Director of the Office of Systems Integration.
(2) “Office” means the Office of Systems Integration.
(3) “Services”
means all functions, responsibilities, and services deemed to be
functions, responsibilities, and services of the Systems Integration
Division, also known as Systems Management Services, of the California
Health and Human Services Agency Data Center, as determined by the
Secretary of California Health and Human Services.
(b) (1) The
Systems Integration Division of the California Health and Human
Services Agency Data Center is hereby transferred to the California
Health and Human Services Agency and shall be known as the Office of
Systems Integration. The Office of Systems Integration shall be the
successor to, and is vested with, all of the duties, powers, purposes,
responsibilities, and jurisdiction of the Systems Integration Division
of the California Health and Human Services Agency Data Center.
(2) Notwithstanding
any other law, all services of the Systems Integration Division of the
California Health and Human Services Agency Data Center shall become the
services of the Office of Systems Integration.
(c) The
office shall be under the supervision of a director, known as the
Director of the Office of Systems
Integration, who shall be appointed by, and serve at the pleasure
of, the Secretary of California Health and Human Services.
(d) No
contract, lease, license, or any other agreement to which the
California Health and Human Services Data Center is a party on the date
of the transfer as described in paragraph (1) of subdivision (b) shall
be void or voidable by reason of this section, but shall continue in
full force and effect. The office shall assume from the California
Health and Human Services Data Center all of the rights, obligations,
and duties of the Systems Integration Division. This assumption of
rights, obligations, and duties shall not affect the rights of the
parties to the contract, lease, license, or agreement.
(e) All
books, documents, records, and property of the Systems Integration
Division shall be in the possession and under the control of the office.
(f) All
officers and employees of the Systems Integration Division shall be
designated as officers and employees of the agency. The status,
position, and rights of any officer or employee shall not be affected by
this designation and all officers and employees shall be retained by
the agency pursuant to the applicable provisions of the State Civil
Service Act (Part 2 (commencing with Section 18500) of Division 5),
except as to any position that is exempt from civil service.
(g) (1) All
contracts, leases, licenses, or any other agreements to which the
California Health and Human Services Data Center is a party regarding
any of the following are hereby assigned from the California Health and
Human Services Data Center to the office:
(A) Statewide Automated Welfare System (SAWS).
(B) Child Welfare Services/Case Management System (CWS/CMS).
(C) Electronic Benefit Transfer (EBT).
(D) Statewide Fingerprinting Imaging System (SFIS).
(E) Case Management Information Payrolling System (CMIPS).
(F) Employment Development Department Unemployment Insurance Modernization (UIMOD) Project.
(2) All
other contracts, leases, or agreements necessary or related to the
operation of the Systems Integration Division of the California Health
and Human Services Data Center are hereby assigned from the California
Health and Human Services Data Center to the office.
(h) It
is the intent of the Legislature that the transfer of the Systems
Integration Division of the California Health and Human Services Agency
Data Center pursuant to this section shall be retroactive to the passage
and enactment of the Budget Act of 2005 and that existing employees of
the Systems Integration Division of the California Health and Human
Services Agency Data Center and the newly established Office of Systems
Integration shall not be negatively impacted by the reorganization and
transfer conducted pursuant to this section.
(i) It
is the intent of the Legislature to review fully implemented
information technology projects managed by the office to assess the
viability of placing the management responsibility for those projects in
the respective program department.
(j) On
or before April 1, 2006, the Department of Finance shall report to the
Chairperson
of the Joint Legislative Budget Committee the date that the
administration shall conduct an assessment for each of the projects
managed by the office. The California Health and Human Services Agency,
the California Health and Human Services Agency Data Center, or its
successor, the State Department of Social Services, and the office shall
provide to the Department of Finance all information and analysis the
Department of Finance deems necessary to conduct the assessment required
by this section. Each assessment shall consider the costs, benefits,
and any associated risks of maintaining the project management
responsibility in the office and of moving the project management
responsibility to its respective program department.
SEC. 4.
Section 15438 of the Government Code is amended to read:15438.
The authority may do any of the following:(a) Adopt bylaws for the regulation of its affairs and the conduct of its business.
(b) Adopt an official seal.
(c) Sue and be sued in its own name.
(d) Receive
and accept from any agency of the United States, any agency of the
state, or any municipality, county, or other political subdivision
thereof, or from any individual, association, or corporation gifts,
grants, or donations of moneys for achieving any of the purposes of this
chapter.
(e) Engage the
services of private consultants to render professional and technical
assistance and advice in carrying out the purposes of this part.
(f) Determine
the location and character of any project to be financed under this
part, and to acquire, construct, enlarge, remodel, renovate, alter,
improve, furnish, equip, fund, finance, own, maintain, manage, repair,
operate, lease as lessee or lessor, and regulate the same, to enter into
contracts for any or all of those purposes, to enter into contracts for
the management and operation of a project or other health facilities
owned by the authority, and to designate a participating health
institution as its agent to determine the location and character of a
project undertaken by that participating health institution under this
chapter and as the agent of the authority, to acquire, construct,
enlarge, remodel, renovate, alter, improve, furnish, equip, own,
maintain, manage, repair,
operate, lease as lessee or lessor, and regulate the same, and as
the agent of the authority, to enter into contracts for any or all of
those purposes, including contracts for the management and operation of
that project or other health facilities owned by the authority.
(g) Acquire,
directly or by and through a participating health institution as its
agent, by purchase solely from funds provided under the authority of
this part, or by gift or devise, and to sell, by installment sale or
otherwise, any lands, structures, real or personal property, rights,
rights-of-way, franchises, easements, and other interests in lands,
including lands lying under water and riparian rights, that are located
within the state that the authority determines necessary or convenient
for the acquisition, construction, or financing of a health facility or
the acquisition, construction, financing, or operation of a project,
upon the terms and at the prices considered
by the authority to be reasonable and that can be agreed upon
between the authority and the owner thereof, and to take title thereto
in the name of the authority or in the name of a participating health
institution as its agent.
(h) Receive
and accept from any source loans, contributions, or grants for, or in
aid of, the construction, financing, or refinancing of a project or any
portion of a project in money, property, labor, or other things of
value.
(i) Make secured or
unsecured loans to, or purchase secured or unsecured loans of, any
participating health institution in connection with the financing of a
project or working capital in accordance with an agreement between the
authority and the participating health institution. However, no loan to
finance a project shall exceed the total cost of the project, as
determined by the participating health institution and approved by the
authority. Funds for secured loans may be provided from the
California Health Facilities Financing Authority Fund pursuant to
subdivision (b) of Section 15439 to small or rural health facilities
pursuant to authority guidelines.
(j) (1) Make
secured or unsecured loans to, or purchase secured or unsecured loans
of, any participating health institution in accordance with an agreement
between the authority and the participating health institution to
refinance indebtedness incurred by that participating health institution
or a participating health institution that controls or manages, is
controlled or managed by, is under common control or management with, or
is affiliated with that participating health institution, in connection
with projects undertaken or for health facilities acquired or for
working capital.
(2) Make
secured or unsecured loans to, or purchase
secured or unsecured loans of, any participating health
institution in accordance with an agreement between the authority and
the participating health institution to refinance indebtedness incurred
by that participating health institution or a participating health
institution that controls or manages, is controlled or managed by, is
under common control or management with, or is affiliated with that
participating health institution, payable to the authority or assigned
or pledged to authority issued bonds.
(3) Funds
for secured loans may be provided from the California Health Facilities
Financing Authority Fund pursuant to subdivision (b) of Section 15439
to small or rural health facilities pursuant to authority guidelines.
(k) Mortgage
all or any portion of interest of the authority in a project or other
health facilities and the property on which that project or other health
facilities are located, whether owned or thereafter acquired,
including the granting of a security interest in any property, tangible
or intangible, and to assign or pledge all or any portion of the
interests of the authority in mortgages, deeds of trust, indentures of
mortgage or trust, or similar instruments, notes, and security interests
in property, tangible or intangible, of participating health
institutions to which the authority has made loans, and the revenues
therefrom, including payments or income from any thereof owned or held
by the authority, for the benefit of the holders of bonds issued to
finance the project or health facilities or issued to refund or
refinance outstanding indebtedness of participating health institutions
as permitted by this part.
(l) Lease
to a participating health institution the project being financed or
other health facilities conveyed to the authority in connection with
that financing, upon the terms and
conditions the authority determines proper, charge and collect
rents therefor, terminate the lease upon the failure of the lessee to
comply with any of the obligations of the lease, and include in that
lease, if desired, provisions granting the lessee options to renew the
term of the lease for the period or periods and at the rent, as
determined by the authority, purchase any or all of the health
facilities or that upon payment of all of the indebtedness incurred by
the authority for the financing of that project or health facilities or
for refunding outstanding indebtedness of a participating health
institution, then the authority may convey any or all of the project or
the other health facilities to the lessee or lessees thereof with or
without consideration.
(m) Charge
and equitably apportion among participating health institutions, the
administrative costs and expenses incurred by the authority in the
exercise of the powers and duties
conferred by this part.
(n) Obtain,
or aid in obtaining, from any department or agency of the United States
or of the state, any private company, or any insurance or guarantee as
to, of, or for the payment or repayment of, interest or principal, or
both, or any part thereof, on any loan, lease, or obligation, or any
instrument evidencing or securing the loan, lease, or obligation, made
or entered into pursuant to this part; and notwithstanding any other
provisions of this part, to enter into any agreement, contract, or any
other instrument whatsoever with respect to that insurance or guarantee,
to accept payment in the manner and form as provided therein in the
event of default by a participating health institution, and to assign
that insurance or guarantee as security for the authority’s bonds.
(o) Enter
into any and all agreements or contracts, including agreements for
liquidity
or credit enhancement, bond exchange agreements, interest rate
swaps or hedges, execute any and all instruments, and do and perform any
and all acts or things necessary, convenient, or desirable for the
purposes of the authority or to carry out any power expressly granted by
this part.
(p) Invest any
moneys held in reserve or sinking funds or any moneys not required for
immediate use or disbursement, at the discretion of the authority, in
any obligations authorized by the resolution authorizing the issuance of
the bonds secured thereof or authorized by law for the investment of
trust funds in the custody of the Treasurer.
(q) Award grants to any eligible clinic pursuant to Section 15438.6.
(r) Award grants to any eligible health facility pursuant to Section 15438.7.
(s) (1) Notwithstanding
any other provision of law, provide a working capital loan of up to
five million dollars ($5,000,000) to assist in the establishment and
operation of the California Health Benefit Exchange (Exchange)
established under Section 100500. The authority may require any
information it deems necessary and prudent prior to providing a loan to
the Exchange and may require any term, condition, security, or repayment
provision it deems necessary in the event the authority chooses to
provide a loan. Under no circumstances shall the authority be required
to provide a loan to the Exchange.
(2) Prior
to the authority providing a loan to the Exchange, a majority of the
board of the Exchange shall be appointed and shall demonstrate, to the
satisfaction of the authority, that the federal planning and
establishment grants made available to the Exchange by the United States
Secretary of Health and Human
Services are insufficient or will not be released in a timely
manner to allow the Exchange to meet the necessary requirements of the
federal Patient Protection and Affordable Care Act (Public Law 111-148).
(3) The
Exchange shall repay a loan made under this subdivision no later than
June 30, 2016, and shall pay interest at the rate paid on moneys in the
Pooled Money Investment Account.
(t) Award grants pursuant to Section 15438.10.
SEC. 5.
Section 15438.10 is added to the Government Code, to read:15438.10.
(a) The Legislature finds and declares the following:(1) Many
Californians face serious obstacles in obtaining needed health care
services, including, but not limited to, medical, mental health, dental,
and preventive services. The obstacles faced by vulnerable populations
and communities include existence of complex medical, physical, or
social conditions, disabilities, economic disadvantage, and living in
remote or underserved areas that make it difficult to access services.
(2) With
the recent passage of national health care reform, there is an
increased demand for innovative ways to deliver quality health care,
including preventive
services, to individuals in a cost-effective manner.
(3) There
is a need to develop new methods of delivering health services
utilizing innovative models that can be demonstrated to be effective and
then replicated throughout California and that bring community-based
health care preventive services to individuals where they live or
receive education, social, or general health services.
(4) For
more than 30 years, the California Health Facilities Financing
Authority has provided financial assistance through tax-exempt bonds,
low-interest loans, and grants to health facilities in California,
assisting in the expansion of the availability of health services and
health care facilities throughout the state.
(b) (1) Following
the completion of a competitive selection process, the authority may
award
one or more grants that, in the aggregate, do not exceed one
million five hundred thousand dollars ($1,500,000) to one or more
projects designed to demonstrate specified new or enhanced
cost-effective methods of delivering quality health care services to
improve access to quality health care for vulnerable populations or
communities, or both, that are effective at enhancing health outcomes
and improving access to quality health care and preventive services.
These health care services may include, but are not limited to, medical,
mental health, or dental services for the diagnosis, care, prevention,
and treatment of human illness, or individuals with physical, mental, or
developmental disabilities. More than one demonstration project may
receive a grant pursuant to this section. It is the intent of the
Legislature for a demonstration project that receives a grant to allow
patients to receive screenings, diagnosis, or treatment in community
settings, including, but not limited to, school-based health centers,
adult day care centers, and residential care facilities for the
elderly, or for individuals with mental illness or developmental
disabilities.
(2) A grant
awarded pursuant to this subdivision may be allocated in increments to a
demonstration project over multiple years to ensure the demonstration
project’s ability to complete its work, as determined by the authority.
Prior to the initial allocation of funds pursuant to this subdivision,
the administrators of the demonstration project shall provide evidence
that the demonstration project has or will have additional funds
sufficient to ensure completion of the demonstration project. If the
authority allocates a grant in increments, each subsequent year’s
allocation shall be provided to the demonstration project only upon
submission of research that shows that the project is progressing toward
the identification of a high-quality and cost-effective delivery model
that improves health outcomes and
access to quality health care and preventive services for
vulnerable populations or communities, and can be replicated throughout
the state in community settings.
(3) Except
for a health facility that qualifies as a “small and rural hospital”
pursuant to Section 124840 of the Health and Safety Code, a health
facility that has received tax-exempt bond financing from the authority
shall not be eligible to receive funds awarded for a demonstration
project. Such a health facility may participate as an uncompensated
partner or member of a collaborative effort that is awarded a
demonstration project grant. A health facility that participates in a
demonstration project that receives funds pursuant to this section may
not claim the funding provided by the authority toward meeting its
community benefit and charity care obligations.
(4) Funds
provided to a demonstration project pursuant to
this subdivision may be used to supplement, but not to supplant,
existing financial and resource commitments of the grantee or grantees
or any other member of a collaborative effort that has been awarded a
demonstration project grant.
(c) (1) If
a demonstration project that receives a grant pursuant to subdivision
(b) is successful at developing a new method of delivering high-quality
and cost-effective health care services in community settings that
result in increased access to quality health care and preventive
services or improved health care outcomes for vulnerable populations or
communities, or both, then beginning as early as the second year after
the initial allocation of moneys provided pursuant to subdivision (b),
the authority may implement a second grant program that awards not more
than five million dollars ($5,000,000), in the aggregate, to eligible
recipients as defined by the authority, to replicate in
additional California communities the model developed by a
demonstration project that received a grant pursuant to subdivision (b).
Prior to the implementation of this second grant program, the authority
shall prepare and provide a report to the Legislature and the Governor
on the outcomes of the demonstration project. The report shall be made
in accordance with Section 9795.
(2) If
the authority implements the second grant program, the authority shall
also report annually, beginning with the first year of implementation of
the second grant program, to the Legislature and the Governor regarding
the program, including, but not limited to, the total amount of grants
issued pursuant to this subdivision, the amount of each grant issued,
and a description of each project awarded funding for replication of the
model.
(3) Grants under this
subdivision may be utilized for eligible costs,
as defined in subdivision (c) of Section 15432, including
equipment, information technology, and working capital, as defined in
subdivision (h) of Section 15432.
(4) The
authority may adopt regulations relating to the grant program
authorized pursuant to this subdivision, including regulations that
define eligible recipients, eligible costs, and minimum and maximum
grant amounts.
(d) (1) The
authority shall prepare and provide a report to the Legislature and the
Governor by January 1, 2014, on the outcomes of the demonstration grant
program, including, but not limited to, the following:
(A) The total amount of grants issued.
(B) The amount of each grant issued.
(C) A
description of other sources of funding for each project.
(D) A description of each project awarded funding.
(E) A
description of project outcomes that demonstrate cost-effective
delivery of health care services in community settings, that result in
improved access to quality health care or improved health care outcomes.
(2) A report submitted pursuant to this subdivision shall be submitted in compliance with Section 9795.
(e) There
is hereby created the California Health Access Model Program Account in
the California Health Facilities Financing Authority Fund. All moneys
in the account are hereby continuously appropriated to the authority for
carrying out the purposes of this section. An amount of up to six
million five hundred thousand dollars
($6,500,000) shall be transferred from funds in the California
Health Facilities Financing Authority Fund that are not impressed with a
trust for other purposes into the California Health Access Model
Program Account for the purpose of issuing grants pursuant to this
section. Any moneys remaining in the California Health Access Model
Program Account on January 1, 2020, shall revert as of that date to the
California Health Facilities Financing Authority Fund.
(f) Any
recipient of a grant provided pursuant to subdivision (b) shall adhere
to all applicable laws relating to scope of practice, licensure,
staffing, and building codes.
SEC. 6.
Section 135 of the Health and Safety Code is repealed.SEC. 7.
Section 136 of the Health and Safety Code is repealed.SEC. 8.
Section 137 of the Health and Safety Code is amended to read:137.
(a) The State Department of Public Health shall develop a coordinated state strategy for addressing the health-related needs of women, including implementation of goals and objectives for women’s health.(b) The
approved programmatic costs associated with this strategy shall be the
responsibility of the State Department of Public Health unless otherwise
provided by law.
SEC. 9.
Section 138 of the Health and Safety Code is repealed.SEC. 10.
Section 138.4 of the Health and Safety Code is amended to read:138.4.
(a) The State Department of Public Health shall place priority on providing information to consumers, patients, and health care providers regarding women’s gynecological cancers, including signs and symptoms, risk factors, the benefits of early detection through appropriate diagnostic testing, and treatment options.(b) In
exercising the powers under this section, the State Department of
Public Health shall consult with appropriate health care professionals
and providers, consumers, and patients, or organizations representing
them.
(c) The duties of the State Department of Public Health pursuant to this section are
contingent upon the receipt of funds appropriated for this purpose.
(d) The
State Department of Public Health may adopt any regulations necessary
and appropriate for the implementation of this section.
SEC. 11.
Section 138.6 of the Health and Safety Code is amended to read:138.6.
(a) The State Department of Public Health shall include in any literature that it produces regarding breast cancer information that shall include, but not be limited to, all of the following:(1) Summarized
information on risk factors for breast cancer in younger women,
including, but not limited to, information on the increased risk
associated with a family history of the disease.
(2) Summarized
information regarding detection alternatives to mammography that may be
available and more effective for at-risk women between the ages of 25
and 40 years.
(3) Information
on Internet Web sites of relevant organizations, government agencies,
and research institutions where information on mammography alternatives
may be obtained.
(b) The
information required by subdivision (a) shall be produced consistent
with the department’s protocols and procedures regarding the production
and dissemination of information on breast cancer, including, but not
limited to, the following factors:
(1) Restrictions imposed by space limitation on materials currently produced and distributed by the department.
(2) Future regular production and replacement schedules.
(3) Translation standards governing the number of languages and literacy levels.
(4) The nature, content, and purpose of the material into which this new information will be incorporated.
(c) It
is the intent of the Legislature that subdivisions (a) and (b) apply to
information that is distributed by any branch of the department,
including, but not limited to, the Cancer Detection Section and the
Office of Health Equity.
SEC. 12.
Section 150 of the Health and Safety Code is repealed.SEC. 13.
Section 151 of the Health and Safety Code is repealed.SEC. 14.
Section 152 of the Health and Safety Code is amended to read:152.
(a) The State Department of Public Health Office of Health Equity shall do all of the following:(1) Perform
strategic planning to develop departmentwide plans for implementation
of goals and objectives to close the gaps in health status and access to
care among the state’s diverse racial and ethnic communities, women,
persons with disabilities, and the lesbian, gay, bisexual, transgender,
queer, and questioning (LGBTQQ) communities.
(2) Conduct departmental policy analysis on specific issues related to multicultural health.
(3) Coordinate projects funded by the state that are related to improving
the effectiveness of services to ethnic and racial communities, women, and the LGBTQQ communities.
(4) Identify the unnecessary duplication of services and future service needs.
(5) Communicate
and disseminate information and perform a liaison function within the
department and to providers of health, social, educational, and support
services to racial and ethnic communities, women, persons with
disabilities, and the LGBTQQ communities. The department shall consult
regularly with representatives from diverse racial and ethnic
communities, women, persons with disabilities, and the LGBTQQ
communities, including health providers, advocates, and consumers.
(6) Perform
internal staff training, an internal assessment of cultural competency,
and training of health care professionals to ensure more linguistically
and
culturally competent care.
(7) Serve
as a resource for ensuring that programs collect and keep data and
information regarding ethnic and racial health statistics, including
those statistics described in reports released by Healthy People 2020,
and information based on sexual orientation, gender identity, and gender
expression, strategies and programs that address multicultural health
issues, including, but not limited to, infant and maternal mortality,
cancer, cardiovascular disease, diabetes, human immunodeficiency virus
(HIV), acquired immunodeficiency syndrome (AIDS), child and adult
immunization, osteoporosis, menopause, and full reproductive health,
asthma, unintentional and intentional injury, and obesity, as well as
issues that impact the health of racial and ethnic communities, women,
and the LGBTQQ communities, including substance abuse, mental health,
housing, teenage pregnancy, environmental disparities, immigrant and
migrant health,
and health insurance and delivery systems.
(8) Encourage
innovative responses by public and private entities that are attempting
to address multicultural health issues.
(9) Provide
technical assistance to counties, other public entities, and private
entities seeking to obtain funds for initiatives in multicultural
health, including identification of funding sources and assistance with
writing grants.
(b) Notwithstanding
Section 10231.5 of the Government Code, the State Department of Public
Health shall biennially prepare and submit a report to the Legislature
on the status of the activities required by this chapter. This report
shall be included in the report required under paragraph (1) of
subdivision (d) of Section 131019.5.
SEC. 15.
Section 1324.8 of the Health and Safety Code is amended to read:1324.8.
(a) The quality assurance fee assessed and collected pursuant to this article shall be deposited in the General Fund.(b) Notwithstanding
subdivision (a), commencing August 1, 2013, the quality assurance fee
assessed and collected pursuant to this article shall be deposited in
the Long-Term Care Quality Assurance Fund established pursuant to
Section 1324.9.
SEC. 16.
Section 1324.9 is added to the Health and Safety Code, to read:1324.9.
(a) The Long-Term Care Quality Assurance Fund is hereby created in the State Treasury. Moneys in the fund shall be available, upon appropriation by the Legislature, for expenditure by the State Department of Health Care Services for the purposes of this article and Article 7.6 (commencing with Section 1324.20). Notwithstanding Section 16305.7 of the Government Code, the fund shall contain all interest and dividends earned on moneys in the fund.(b) Notwithstanding
any other law, beginning August 1, 2013, all revenues received by the
State Department of Health Care Services categorized by the State
Department of Health Care Services as long-term care quality assurance
fees shall be deposited into the
Long-Term Care Quality Assurance Fund. Revenue that shall be
deposited into this fund shall include quality assurance fees imposed
pursuant to this article and quality assurance fees imposed pursuant to
Article 7.6 (commencing with Section 1324.20).
SEC. 17.
Section 1324.24 of the Health and Safety Code is amended to read:1324.24.
(a) The quality assurance fee assessed and collected pursuant to this article shall be deposited in the State Treasury.(b) Notwithstanding
subdivision (a), commencing August 1, 2013, the quality assurance fee
assessed and collected pursuant to this article shall be deposited in
the Long-Term Care Quality Assurance Fund established pursuant to
Section 1324.9.
SEC. 18.
Section 100950 of the Health and Safety Code is amended to read:100950.
The department shall administer this part, Section 100295, and Chapter 3 (commencing with Section 101175) of Part 3 and shall adopt necessary regulations. These regulations shall be adopted only after consultation with and approval by the California Conference of Local Health Officers. Approval of these regulations shall be by majority vote of those present at an official session.SEC. 19.
Section 104150 of the Health and Safety Code is amended to read:104150.
(a) A provider or entity that participates in the grant made to the department by the federal Centers for Disease Control and Prevention breast and cervical cancer early detection program established under Title XV of the federal Public Health Service Act (42 U.S.C. Sec. 300k et seq.) in accordance with requirements of Section 1504 of that act (42 U.S.C. Sec. 300n) may only render screening services under the grant to an individual if the provider or entity determines that the individual’s family income does not exceed 200 percent of the federal poverty level.(b) The
department shall provide for breast cancer and cervical cancer screening
services under the grant at the level of
funding budgeted from state and other resources during the fiscal
year in which the Legislature has appropriated funds to the department
for this purpose. These screening services shall not be deemed to be an
entitlement.
(c) To implement
the federal breast and cervical cancer early detection program specified
in this section, the department may contract, to the extent permitted
by Section 19130 of the Government Code, with public and private
entities, or utilize existing health care service provider enrollment
and payment mechanisms, including the Medi-Cal program’s fiscal
intermediary. However, the Medi-Cal program’s fiscal intermediary shall
only be utilized if services provided under the program are specifically
identified and reimbursed in a manner that does not claim federal
financial reimbursement. Any contracts with, and the utilization of, the
Medi-Cal program’s fiscal intermediary shall not be subject to Chapter 3
(commencing with
Section 12100) of Part 2 of Division 2 of the Public Contract
Code. Contracts to implement the federal breast and cervical cancer
early detection program entered into by the department with entities
other than the Medi-Cal program’s fiscal intermediary shall not be
subject to Part 2 (commencing with Section 10100) of Division 2 of the
Public Contract Code.
(d) The
department shall enter into an interagency agreement with the State
Department of Health Care Services to transfer that portion of the grant
made to the department by the federal Centers for Disease Control and
Prevention breast and cervical cancer early detection program
established under Title XV of the federal Public Health Service Act (42
U.S.C. Sec. 300k et seq.) to the State Department of Health Care
Services. The department shall have no other liability to the State
Department of Health Care Services under this article.
SEC. 20.
Section 104160 of the Health and Safety Code is amended to read:104160.
(a) The State Department of Health Care Services shall develop and maintain the Breast and Cervical Cancer Treatment Program to expand and ensure quality breast and cervical cancer treatment for low-income uninsured and underinsured individuals who are diagnosed with breast or cervical cancer.(b) To implement the
program, the State Department of Health Care Services may contract with
public or private entities, or utilize existing health care service
provider enrollment and payment mechanisms, including the Medi-Cal
program’s fiscal intermediary, only if services provided under the
program are specifically identified and reimbursed in a manner that does
not claim federal financial
reimbursement. The utilization of the Medi-Cal program’s fiscal
intermediary shall not be subject to Chapter 3 (commencing with Section
12100) of Part 2 of Division 2 of the Public Contract Code. Contracts to
implement the program entered into by the State Department of Health
Care Services with entities other than the Medi-Cal program’s fiscal
intermediary shall not be subject to Part 2 (commencing with Section
10100) of Division 2 of the Public Contract Code.
SEC. 21.
Section 104162.1 of the Health and Safety Code is amended to read:104162.1.
When an individual is underinsured, as defined in subdivision (g) of Section 104161, the State Department of Health Care Services shall be the payer of second resort for treatment services. To the extent necessary for the individual to obtain treatment services under any health care insurance listed in paragraph (2), (3), or (4) of subdivision (f) of Section 104161, the State Department of Health Care Services may do the following:(a) Pay for the individual’s breast or cervical cancer copayments, premiums, and deductible.
(b) Provide only treatment services not otherwise covered by any health care insurance listed in paragraph (2), (3),
or (4) of subdivision (f) of Section 104161.
SEC. 22.
Section 104163 of the Health and Safety Code is amended to read:104163.
The State Department of Health Care Services shall provide for breast cancer and cervical cancer treatment services pursuant to this article at the level of funding budgeted from state and other resources during the fiscal year in which the Legislature has appropriated funds to the department for this purpose. These treatment services shall not be deemed to be an entitlement.SEC. 23.
Section 104314 of the Health and Safety Code is amended to read:104314.
(a) The Prostate Cancer Fund is hereby established in the State Treasury. It is the intent of the Legislature that the fund be funded by an annual appropriation, when funds are available, in the Budget Act.(b)
The moneys in the Prostate Cancer Fund shall be expended by the
State Department of Health Care Services, upon appropriation by the
Legislature, for the purpose of the Prostate Cancer Screening Program
established by Section 104315.
(c) For the purposes of this chapter, “department” means the State Department of Health Care Services.
SEC. 24.
Section 104315 of the Health and Safety Code is amended to read:104315.
(a) The Prostate Cancer Screening Program shall be established in the State Department of Health Care Services.(b) The program shall apply to both of the following:
(1) Uninsured men 50 years of age and older.
(2) Uninsured
men between 40 and 50 years of age who are at high risk for prostate
cancer, upon the advice of a physician or upon the request of the
patient.
(c) For purposes of this chapter, “uninsured” means not covered by any of the following:
(1) Medi-Cal.
(2) Medicare.
(3) A
health care service plan contract or policy of disability insurance
that covers screening for prostate cancer for men 50 years of age and
older, and for men between 40 and 50 years of age who are at high risk
for prostate cancer upon the advice of a physician or upon the request
of the patient.
(4) Any other
form of health care coverage that covers screening for prostate cancer
for men 50 years of age and older, and for men between 40 and 50 years
of age who are at high risk for prostate cancer upon the advice of a
physician or upon the request of the patient.
(d) The program shall include all of the following:
(1) Screening of men for prostate cancer as an early detection health care measure.
(2) After screening, medical referral of screened men and services necessary for definitive diagnosis.
(3) If
a positive diagnosis is made, then assistance and advocacy shall be
provided to help the person obtain necessary treatment.
(4) Outreach
and health education activities to ensure that uninsured men are aware
of and appropriately utilize the services provided by the program.
(e) Any
entity funded by the program shall coordinate with other local
providers of prostate cancer screening, diagnostic, followup, education,
and advocacy services to avoid duplication of effort. Any entity funded
by the program
shall comply with any applicable state and federal standards
regarding prostate cancer screening.
(f) Administrative
costs of the department shall not exceed 10 percent of the funds
allocated to the program. Indirect costs of the entities funded by this
program shall not exceed 12 percent. The department shall define
“indirect costs” in accordance with applicable state and federal law.
(g) Any
entity funded by the program shall collect data and maintain records
that are determined by the department to be necessary to facilitate the
state department’s ability to monitor and evaluate the effectiveness of
the entities and the program. Commencing with the program’s second year
of operation, and notwithstanding Section 10231.5 of the Government
Code, the department shall submit an annual report to the Legislature
and any other appropriate entity. The report shall describe the
activities and effectiveness of the program and shall include, but
not be limited to, the following types of information regarding those
served by the program:
(1) The number.
(2) The ethnic, geographic, and age breakdown.
(3) The stages of presentation.
(4) The diagnostic and treatment status.
(h) The
department or any entity funded by the program shall collect personal
and medical information necessary to administer the program from any
individual applying for services under the program. The information
shall be confidential and shall not be disclosed other than for purposes
directly connected with the administration of the program or except as
otherwise provided by law or pursuant to
prior written consent of the subject of the information.
(i) The
department or any entity funded by the program may disclose the
confidential information to medical personnel and fiscal intermediaries
of the state to the extent necessary to administer the program, and to
other state public health agencies or medical researchers if the
confidential information is necessary to carry out the duties of those
agencies or researchers in the investigation, control, or surveillance
of prostate cancer.
(j) The
department shall adopt regulations to implement the Prostate Cancer
Screening Program in accordance with Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code.
(k) This section shall not be implemented unless and until funds are appropriated for this purpose in the annual
Budget Act.
(l) To
implement the Prostate Cancer Screening Program, the department may
contract, to the extent permitted by Section 19130 of the Government
Code, with public and private entities, or utilize existing health care
service provider enrollment and payment mechanisms, including the
Medi-Cal program’s fiscal intermediary. However, the Medi-Cal program’s
fiscal intermediary shall only be utilized if services provided under
the program are specifically identified and reimbursed in a manner that
does not claim federal financial reimbursement. Any contracts with, and
the utilization of, the Medi-Cal program’s fiscal intermediary shall not
be subject to Chapter 3 (commencing with Section 12100) of Part 2 of
Division 2 of the Public Contract Code. Contracts to implement the
Prostate Cancer Screening Program entered into by the department with
entities other than the Medi-Cal program’s fiscal intermediary shall not
be subject to Part
2 (commencing with Section 10100) of Division 2 of the Public
Contract Code.
SEC. 25.
Section 104322 of the Health and Safety Code is amended to read:104322.
(a) (1) The State Department of Health Care Services shall develop and implement a program to provide quality prostate cancer treatment for low-income and uninsured men.(2) The State
Department of Health Care Services shall award one or more contracts to
provide prostate cancer treatment through private or public nonprofit
organizations, including, but not limited to, community-based
organizations, local health care providers, the University of California
medical centers, and the Charles R. Drew University of Medicine and
Science, an affiliate of the David Geffen School of Medicine at the
University of California at Los Angeles. Contracts awarded, subsequent
to the effective date of the amendments to this section made
during the 2005 portion of the 2005–06 Regular Session, pursuant to this
paragraph shall be consistent with both of the following:
(A) Eighty-seven percent of the total contract funding shall be used for direct patient care.
(B) No
less than 70 percent of the total contract funding shall be expended on
direct patient care treatment costs, which shall be defined as funding
to fee-for-service providers for Medi-Cal eligible services.
(3) The
contracts described in paragraph (2) shall not be subject to Part 2
(commencing with Section 10100) of Division 2 of the Public Contract
Code. Commencing July 1, 2006, those contracts shall be entered into on a
competitive bid basis.
(4) It
is the intent of
the Legislature to support the prostate cancer treatment program
provided for pursuant to this section, and that the program be
cost-effective and maximize the number of men served for the amount of
funds appropriated. It is further the intent of the Legislature to
ensure that the program has an adequate health care provider network to
facilitate reasonable access to treatment.
(b) Treatment
provided under this chapter shall be provided to uninsured and
underinsured men with incomes at or below 200 percent of the federal
poverty level. Covered services shall be limited to prostate cancer
treatment and prostate cancer-related services. Eligible men shall be
enrolled in a 12-month treatment regimen.
(c) The
State Department of Health Care Services shall contract for prostate
cancer treatment services only at the level of funding budgeted from
state and other sources during a fiscal
year in which the Legislature has appropriated funds to the
department for this purpose.
(d) Notwithstanding
subdivision (a) of Section 2.00 of the Budget Act of 2003 and any other
provision of law, commencing with the 2003–04 fiscal year and for each
fiscal year thereafter, any amount appropriated to the State Department
of Health Care Services for the prostate cancer treatment program
implemented pursuant to this chapter shall be made available, for
purposes of that program, for encumbrance for one fiscal year beyond the
year of appropriation and for expenditure for two fiscal years beyond
the year of encumbrance.
SEC. 26.
Section 110050 of the Health and Safety Code is amended to read:110050.
The Food Safety Fund is hereby created as a special fund in the State Treasury. All moneys collected by the department under subdivision (c) of Section 110466 and Sections 110470, 110471, 110485, 111130, and 113717, and under Article 7 (commencing with Section 110810) of Chapter 5 shall be deposited in the fund, for use by the department, upon appropriation by the Legislature, for the purposes of providing funds necessary to carry out and implement the inspection provisions of this part relating to food, licensing, inspection, enforcement, and other provisions of Article 12 (commencing with Section 111070) relating to water, the provisions relating to education and training in the prevention of microbial contamination pursuant to Section 110485, and the registration provisions of Article 7 (commencing with Section 110810) of Chapter 5, and to carry out and implement the provisions of the California Retail Food Code (Part 7 (commencing with Section 113700) of Division 104).SEC. 27.
Section 113717 of the Health and Safety Code is amended to read:113717.
(a) Any person requesting the department to undertake any activity pursuant to paragraph (5) of subdivision (c) of Section 113871, Section 114417, paragraph (2) of subdivision (b) of Section 114419, and Section 114419.3 shall pay the department’s costs incurred in undertaking the activity. The department’s services shall be assessed at the current hourly cost-recovery rate, and it shall be entitled to recover any other costs reasonably and actually incurred in performing those activities, including, but not limited to, the costs of additional inspection and laboratory testing. For purposes of this section, the department’s hourly rate shall be adjusted annually in accordance with Section 100425.(b) The department
shall provide to the person paying the required fee a statement,
invoice, or similar document that describes in reasonable detail the
costs paid.
(c) For purposes of
this section only, the term “person” does not include any city, county,
city and county, or other political subdivision of the state or local
government.
SEC. 28.
Section 113718 of the Health and Safety Code is repealed.SEC. 29.
Section 113718 is added to the Health and Safety Code, to read:113718.
Notwithstanding Section 16350 of the Government Code, all moneys deposited in the Retail Food Safety and Defense Fund shall be transferred to the Food Safety Fund for appropriation and expenditure as specified by Section 110050.SEC. 30.
Section 116064.1 of the Health and Safety Code is repealed.SEC. 31.
Section 116064.2 of the Health and Safety Code is amended to read:116064.2.
(a) As used in this section, the following words have the following meanings:(1) “ASME/ANSI
performance standard” means a standard that is accredited by the
American National Standards Institute and published by the American
Society of Mechanical Engineers.
(2) “ASTM performance standard” means a standard that is developed and published by ASTM International.
(3) “Main
drain” means a submerged suction outlet typically located at the bottom
of a swimming pool that conducts water to a recirculating pump.
(4) “Public
swimming pool”
means an outdoor or indoor structure, whether in-ground or
above-ground, intended for swimming or recreational bathing, including a
swimming pool, hot tub, spa, or nonportable wading pool, that is any of
the following:
(A) Open to the public generally, whether for a fee or free of charge.
(B) Open
exclusively to members of an organization and their guests, residents
of a multiunit apartment building, apartment complex, residential real
estate development, or other multifamily residential area, or patrons of
a hotel or other public accommodations facility.
(C) Located on the premises of an athletic club, or public or private school.
(5) “Qualified individual” means a contractor who holds a current valid license issued by the State of California or a
professional engineer licensed in the State of California who has experience working on public swimming pools.
(6) “Safety
vacuum release system” means a vacuum release system that ceases
operation of the pump, reverses the circulation flow, or otherwise
provides a vacuum release at a suction outlet when a blockage is
detected.
(7) “Skimmer
equalizer line” means a suction outlet located below the waterline and
connected to the body of a skimmer that prevents air from being drawn
into the pump if the water level drops below the skimmer weir. However, a
skimmer equalizer line is not a main drain.
(8) “Unblockable
drain” means a drain of any size and shape that a human body cannot
sufficiently block to create a suction entrapment hazard.
(b) Subject
to
subdivision (e), every public swimming pool shall be equipped with
antientrapment devices or systems that comply with the ANSI/APSP-16
2011 standard as in effect on December 31, 2011.
(c) Subject
to subdivisions (d) and (e), every public swimming pool with a single
main drain that is not an unblockable drain shall be equipped with at
least one or more of the following devices or systems that are designed
to prevent physical entrapment by pool drains:
(1) A
safety vacuum release system that has been tested by a nationally
recognized testing laboratory and found to conform to ASME/ANSI
performance standard A112.19.17, as in effect on December 31, 2009, or
ASTM performance standard F2387, as in effect on December 31, 2009.
(2) A suction-limiting vent system with a tamper-resistant atmospheric opening, provided that it
conforms to any applicable ASME/ANSI or ASTM performance standard.
(3) A
gravity drainage system that utilizes a collector tank, provided that
it conforms to any applicable ASME/ANSI or ASTM performance standard.
(4) An
automatic pump shut-off system tested by a department-approved
independent third party and found to conform to any applicable ASME/ANSI
or ASTM performance standard.
(5) Any
other system that is deemed, in accordance with federal law, to be
equally effective as, or more effective than, the systems described in
paragraph (1) at preventing or eliminating the risk of injury or death
associated with pool drainage systems.
(d) Every
public swimming pool constructed on or after January 1, 2010, shall
have at least two main drains per pump that
are hydraulically balanced and symmetrically plumbed through one
or more “T” fittings, and that are separated by a distance of at least
three feet in any dimension between the drains. A public swimming pool
constructed on or after January 1, 2010, that meets the requirements of
this subdivision, shall be exempt from the requirements of subdivision
(c).
(e) A public swimming pool
constructed prior to January 1, 2010, shall be retrofitted to comply
with subdivisions (b) and (c) by no later than July 1, 2010, except that
no further retrofitting is required for a public swimming pool that
completed a retrofit between December 19, 2007, and January 1, 2010,
that complied with the Virginia Graeme Baker Pool and Spa Safety Act (15
U.S.C. Sec. 8001 et seq.) as in effect on the date of issue of the
construction permit, or for a nonportable wading pool that completed a
retrofit prior to January 1, 2010, that complied with state law on the
date of issue
of the construction permit. A public swimming pool owner who meets
the exception described in this subdivision shall do one of the
following prior to September 30, 2010:
(1) File the form issued by the department pursuant to subdivision (f), as otherwise provided in subdivision (h).
(2) (A) File a signed statement attesting that the required work has been completed.
(B) Provide a document containing the name and license number of the qualified individual who completed the required work.
(C) Provide
either a copy of the final building permit, if required by the local
agency, or a copy of one of the following documents if no permit was
required:
(i) A document that
describes the modification in a manner that provides sufficient
information to document the work that was done to comply with federal
law.
(ii) A copy of the final
paid invoice. The amount paid for the services may be omitted or
redacted from the final invoice prior to submission.
(f) Prior
to March 31, 2010, the department shall issue a form for use by an
owner of a public swimming pool to indicate compliance with this
section. The department shall consult with county health officers and
directors of departments of environmental health in developing the form
and shall post the form on the department’s Internet Web site. The form
shall be completed by the owner of a public swimming pool prior to
filing the form with the appropriate city, county, or city and county
department of environmental health. The form shall include, but not be
limited to, the following information:
(1) A statement of whether the pool operates with a single or split main drain.
(2) Identification
of the type of antientrapment devices or systems that have been
installed pursuant to subdivision (b) and the date or dates of
installation.
(3) Identification
of the type of devices or systems designed to prevent physical
entrapment that have been installed pursuant to subdivision (c) in a
public swimming pool with a single main drain that is not an unblockable
drain and the date or dates of installation or the reason why the
requirement is not applicable.
(4) A
signature and license number of a qualified individual who certifies
that the factual information provided on the form in response to
paragraphs (1) to (3), inclusive, is true to the best of his or
her knowledge.
(g) A
qualified individual who improperly certifies information pursuant to
paragraph (4) of subdivision (f) shall be subject to potential
disciplinary action at the discretion of the licensing authority.
(h) Except
as provided in subdivision (e), each public swimming pool owner shall
file a completed copy of the form issued by the department pursuant to
this section with the city, county, or city and county department of
environmental health in the city, county, or city and county in which
the swimming pool is located. The form shall be filed within 30 days
following the completion of the swimming pool construction or
installation required pursuant to this section or, if the construction
or installation is completed prior to the date that the department
issues the form pursuant to this section, within 30 days of the date
that the department issues the form. The
public swimming pool owner or operator shall not make a false
statement, representation, certification, record, report, or otherwise
falsify information that he or she is required to file or maintain
pursuant to this section.
(i) In
enforcing this section, health officers and directors of city, county,
or city and county departments of environmental health shall consider
documentation filed on or with the form issued pursuant to this section
by the owner of a public swimming pool as evidence of compliance with
this section. A city, county, or city and county department of
environmental health may verify the accuracy of the information filed on
or with the form.
(j) To the
extent that the requirements for public wading pools imposed by Section
116064 conflict with this section, the requirements of this section
shall prevail.
(k) The
department shall have no authority to take any enforcement action
against any person for violation of this section and has no
responsibility to administer or enforce the provisions of this section.
SEC. 32.
Section 123865 of the Health and Safety Code is amended to read:123865.
(a) Whenever the parents or estate of a handicapped child is wholly or partly unable to furnish for the child necessary services, the parents or guardian may apply to the agency of the county that has been designated by the board of supervisors of the county of residence under the terms of Section 123850 to administer the provisions for handicapped children. Residence shall be determined in accordance with Sections 243 and 244 of the Government Code.(b) If
the child has an individualized education program (IEP) pursuant to the
federal Individuals with Disabilities Education Act (IDEA; 20 U.S.C.
Sec. 1400 et seq.), that IEP shall be disclosed to the California
Children’s Services
Program by the parents or the estate of the handicapped child at
the time of application provided for in subdivision (a) and on revision
of the child’s IEP.
SEC. 33.
Section 123870 of the Health and Safety Code is amended to read:123870.
(a) The State Department of Health Care Services shall establish standards of financial eligibility for treatment services under the California Children’s Services Program (CCS program).(1)
Financial eligibility for treatment services under this program
shall be limited to persons in families with an adjusted gross income of
forty thousand dollars ($40,000) or less in the most recent tax year,
as calculated for California state income tax purposes. If a person is
enrolled in the Healthy Families Program (Part 6.2 (commencing with
Section 12693) of Division 2 of the Insurance Code), the financial
documentation required for that program in Section 2699.6600 of Title 10
of the
California Code of Regulations may be used instead of the person’s
California state income tax return. However, the director may authorize
treatment services for persons in families with higher incomes if the
estimated cost of care to the family in one year is expected to exceed
20 percent of the family’s adjusted gross income.
(2)
Children enrolled in the Healthy Families Program who have a CCS
program eligible medical condition under Section 123830, and whose
families do not meet the financial eligibility requirements of paragraph
(1), shall be deemed financially eligible for CCS program benefits.
(b)
Necessary medical therapy treatment services under the CCS
program rendered in the public schools shall be exempt from financial
eligibility standards and enrollment fee requirements for the services
when rendered to any handicapped child whose physical development would
be
impeded without the services. All occupational and physical
therapy services assessed and determined to be educationally necessary
by the individualized education program (IEP) team and included in the
child’s IEP developed pursuant to the provisions of the federal
Individuals with Disabilities Education Act (IDEA; 20 U.S.C. Sec. 1400
et seq.), shall be provided in accordance with the provisions of that
federal act and shall not be paid for by the CCS program.
(c)
All counties shall use the uniform standards for financial
eligibility and enrollment fees established by the department. All
enrollment fees shall be used in support of the CCS program.
(d)
Annually, every family with a child eligible to receive services
under this article shall pay a fee of twenty dollars ($20), that shall
be in addition to any other program fees for which the family is liable.
This assessment shall
not apply to any child who is eligible for full scope Medi-Cal
benefits without a share of cost, for children receiving therapy in
accordance with the federal IDEA as a related service in their
individualized education plans, for children from families having
incomes of less than 100 percent of the federal poverty level, or for
children covered under the Healthy Families Program.
SEC. 33.5.
Section 123870 of the Health and Safety Code is amended to read:123870.
(a) The State Department of Health Care Services shall establish standards of financial eligibility for treatment services under the California Children’s Services Program (CCS program).(1) Financial
eligibility for treatment services under this program shall be limited
to persons in families with an adjusted gross income of forty thousand
dollars ($40,000) or less in the most recent tax year, as calculated for
California state income tax purposes. If a person is enrolled in the
Healthy Families Program (Part 6.2 (commencing with Section 12693) of
Division 2 of the Insurance Code), the financial documentation required
for that program in Section 2699.6600 of Title 10 of the
California Code of Regulations may be used instead of the person’s
California state income tax return. If a person is enrolled in the
Medi-Cal program pursuant to Section 14005.26 of the Welfare and
Institutions Code, the financial documentation required to establish
eligibility for the Medi-Cal program may be used instead of the person’s
California state income tax return. However, the director may authorize
treatment services for persons in families with higher incomes if the
estimated cost of care to the family in one year is expected to exceed
20 percent of the family’s adjusted gross income.
(2) Children
enrolled in the Healthy Families Program, or enrolled in the Medi-Cal
program pursuant to Section 14005.26 of the Welfare and Institutions
Code, who have a CCS program eligible medical condition under Section
123830, and whose families do not meet the financial eligibility
requirements of paragraph (1), shall be deemed financially eligible
for CCS program benefits.
(b) Necessary
medical therapy treatment services under the CCS program rendered in
the public schools shall be exempt from financial eligibility standards
and enrollment fee requirements for the services when rendered to any
handicapped child whose physical development would be impeded without
the services. All occupational and physical therapy services assessed
and determined to be educationally necessary by the individualized
education program (IEP) team and included in the child’s IEP developed
pursuant to the provisions of the federal Individuals with Disabilities
Education Act (IDEA; 20 U.S.C. Sec. 1400 et seq.), shall be provided in
accordance with the provisions of that federal act and shall not be paid
for by the CCS program.
(c) All counties shall use the uniform standards for financial eligibility and enrollment fees established by the
department. All enrollment fees shall be used in support of the CCS program.
(d) Annually,
every family with a child eligible to receive services under this
article shall pay a fee of twenty dollars ($20), that shall be in
addition to any other program fees for which the family is liable. This
assessment shall not apply to any child who is eligible for full scope
Medi-Cal benefits without a share of cost, for children receiving
therapy in accordance with the federal IDEA as a related service in
their individualized education plans, for children from families having
incomes of less than 100 percent of the federal poverty level, or for
children covered under the Healthy Families Program.
SEC. 34.
Section 123875 of the Health and Safety Code is amended to read:123875.
A handicapped child, as defined in Section 123830, who applies to the California Children’s Services Program in accordance with Section 123865, shall be determined to be eligible for therapy services when the California Children’s Services Program’s medical therapy unit conference team finds that the child needs medically necessary occupational or physical therapy. If the California Children’s Services medical consultant disagrees with the determination of eligibility by the California Children’s Services medical therapy unit conference team, the medical consultant shall communicate with the conference team to ask for further justification of its determination, and shall weigh the conference team’s arguments in support of its decision in reaching his or her own determination.This section
shall not change eligibility criteria for the California Children’s
Services programs as described in Sections 123830 and 123860.
This
section shall not apply to children diagnosed as specific learning
disabled, unless they otherwise meet the eligibility criteria of the
California Children’s Services.
SEC. 35.
Section 124300 of the Health and Safety Code is amended to read:124300.
Within any county where 10 percent or more of the population, as determined by the Population Research Unit of the Department of Finance, speaks any one language other than English as its native language, every local health department shall make copies of circulars and pamphlets relating to family planning that are made available to the public also available in the other language.The State
Department of Health Care Services, upon request, shall make a
translation available in other than English those family planning
informational materials normally distributed to the general public.
SEC. 36.
Section 125130 of the Health and Safety Code is amended to read:125130.
The Director of Health Care Services shall establish and administer a program for the medical care of persons with genetically handicapping conditions, including cystic fibrosis, hemophilia, sickle cell disease, Huntington’s disease, Friedreich’s Ataxia, Joseph’s disease, Von Hippel-Landau syndrome, and the following hereditary metabolic disorders: phenylketonuria, homocystinuria, branched chain amino acidurias, disorders of propionate and methylmalonate metabolism, urea cycle disorders, hereditary orotic aciduria, Wilson’s Disease, galactosemia, disorders of lactate and pyruvate metabolism, tyrosinemia, hyperornithinemia, and other genetic organic acidemias that require specialized treatment or service available from only a limited number of program-approved sources.The program shall
also provide access to social support services, that may help ameliorate
the physical, psychological, and economic problems attendant to
genetically handicapping conditions, in order that the genetically
handicapped person may function at an optimal level commensurate with
the degree of impairment.
The
medical and social support services may be obtained through physicians
and surgeons, genetically handicapped person’s program specialized
centers, and other providers that qualify pursuant to the regulations of
the department to provide the services. “Medical care,” as used in this
section, is limited to noncustodial medical and support services.
The director shall adopt regulations that are necessary for the implementation of this article.
SEC. 37.
Section 125145 of the Health and Safety Code is repealed.SEC. 38.
Section 125205 of the Health and Safety Code is amended to read:125205.
The department and the State Department of Social Services shall, after consultation with the Genetically Handicapped Persons Program of the department and consumer organizations representing persons with chronic and degenerative conditions, as defined in Section 125210, compile a list of long-term care resources that serve adults with chronic and degenerative conditions, as defined. The list of resources shall include those that have already been identified by the Genetically Handicapped Persons Program as serving persons with Huntington’s disease, Joseph’s disease, and Friedrich’s ataxia, and shall include those that have already been identified by consumer organizations representing persons with chronic and degenerative conditions. The list of resources shall include, but not be limited to, the following:(a) Public and private skilled nursing facilities and intermediate care facilities.
(b) Public and private community residential care facilities.
(c)
Public and private out-of-home long-term care resources such as
day activity programs, and in-home support service programs. Nothing in
this section shall require the State Department of Health Care Services
to undertake a survey of long-term care facilities or programs in the
state for the purposes of carrying out the requirements of this section.
The
information shall be made available to the public, upon request,
through the Genetically Handicapped Persons Program of the department.
SEC. 39.
Section 125215 of the Health and Safety Code is amended to read:125215.
The department and the State Department of Social Services shall review regulations that currently provide disincentives to providers of in-home and out-of-home long-term care resources, as defined in Section 125205, to accept and serve persons with chronic and degenerative disorders. The review shall be conducted with assistance and input from the Genetically Handicapped Persons Program of the department. These departments shall provide a list of those regulations to the Legislature by September 1, 1982. The regulations subject to review shall be those regulations that do the following:(a) Affect the admission of patients to state-licensed skilled nursing facilities, intermediate care facilities, and
community residential care facilities.
(b)
Affect the staffing ratios necessary to care for persons with
chronic and degenerative conditions, as defined, within those
facilities.
(c) Affect the
likelihood of facilities, or of day care programs and in-home support
service programs, to refuse the admission of persons with chronic and
degenerative conditions, solely on the basis of anticipated jeopardy to
their licensing, or on the basis of anticipated liability to the
facilities arising from instances where a person’s degenerative
condition, by its own clinical merits, results in medical complications
that are, in fact, entirely unrelated to the quality of care provided by
the facility or program.
SEC. 40.
Section 130060 of the Health and Safety Code is amended to read:130060.
(a) (1) After January 1, 2008, any general acute care hospital building that is determined to be a potential risk of collapse or pose significant loss of life shall only be used for nonacute care hospital purposes. A delay in this deadline may be granted by the office upon a demonstration by the owner that compliance will result in a loss of health care capacity that may not be provided by other general acute care hospitals within a reasonable proximity. In its request for an extension of the deadline, a hospital shall state why the hospital is unable to comply with the January 1, 2008, deadline requirement.(2) Prior to granting an extension of the January 1, 2008, deadline pursuant to this section,
the office shall do all of the following:
(A) Provide
public notice of a hospital’s request for an extension of the deadline.
The notice, at a minimum, shall be posted on the office’s Internet Web
site, and shall include the facility’s name and identification number,
the status of the request, and the beginning and ending dates of the
comment period, and shall advise the public of the opportunity to submit
public comments pursuant to subparagraph (C). The office shall also
provide notice of all requests for the deadline extension directly to
interested parties upon request of the interested parties.
(B) Provide
copies of extension requests to interested parties within 10 working
days to allow interested parties to review and provide comment within
the 45-day comment period. The copies shall include those records that
are available to the public pursuant to the California Public
Records Act (Chapter 3.5 (commencing with Section 6250) of
Division 7 of Title 1 of the Government Code).
(C) Allow
the public to submit written comments on the extension proposal for a
period of not less than 45 days from the date of the public notice.
(b) (1) It
is the intent of the Legislature, in enacting this subdivision, to
facilitate the process of having more hospital buildings in substantial
compliance with this chapter and to take nonconforming general acute
care hospital inpatient buildings out of service more quickly.
(2) The
functional contiguous grouping of hospital buildings of a general acute
care hospital, each of which provides, as the primary source, one or
more of the hospital’s eight basic services as specified in subdivision
(a) of Section 1250, may receive a five-year
extension of the January 1, 2008, deadline specified in
subdivision (a) of this section pursuant to this subdivision for both
structural and nonstructural requirements. A functional contiguous
grouping refers to buildings containing one or more basic hospital
services that are either attached or connected in a way that is
acceptable to the State Department of Health Care Services. These
buildings may be either on the existing site or a new site.
(3) To
receive the five-year extension, a single building containing all of
the basic services or at least one building within the contiguous
grouping of hospital buildings shall have obtained a building permit
prior to 1973 and this building shall be evaluated and classified as a
nonconforming, Structural Performance Category-1 (SPC-1) building. The
classification shall be submitted to and accepted by the Office of
Statewide Health Planning and Development. The identified hospital
building shall be
exempt from the requirement in subdivision (a) until January 1,
2013, if the hospital agrees that the basic service or services that
were provided in that building shall be provided, on or before January
1, 2013, as follows:
(A) Moved
into an existing conforming Structural Performance Category-3 (SPC-3),
Structural Performance Category-4 (SPC-4), or Structural Performance
Category-5 (SPC-5) and Non-Structural Performance Category-4 (NPC-4) or
Non-Structural Performance Category-5 (NPC-5) building.
(B) Relocated to a newly built compliant SPC-5 and NPC-4 or NPC-5 building.
(C) Continued in the building if the building is retrofitted to a SPC-5 and NPC-4 or NPC-5 building.
(4) A
five-year extension is also provided to a post-1973 building if the
hospital
owner informs the Office of Statewide Health Planning and
Development that the building is classified as SPC-1, SPC-3, or SPC-4
and will be closed to general acute care inpatient service use by
January 1, 2013. The basic services in the building shall be relocated
into a SPC-5 and NPC-4 or NPC-5 building by January 1, 2013.
(5) SPC-1
buildings, other than the building identified in paragraph (3) or (4),
in the contiguous grouping of hospital buildings shall also be exempt
from the requirement in subdivision (a) until January 1, 2013. However,
on or before January 1, 2013, at a minimum, each of these buildings
shall be retrofitted to a SPC-2 and NPC-3 building, or no longer be used
for general acute care hospital inpatient services.
(c) On
or before March 1, 2001, the office shall establish a schedule of
interim work progress deadlines that hospitals shall be required to meet
to be
eligible for the extension specified in subdivision (b). To
receive this extension, the hospital building or buildings shall meet
the year 2002 nonstructural requirements.
(d) A
hospital building that is eligible for an extension pursuant to this
section shall meet the January 1, 2030, nonstructural and structural
deadline requirements if the building is to be used for general acute
care inpatient services after January 1, 2030.
(e) Upon
compliance with subdivision (b), the hospital shall be issued a written
notice of compliance by the office. The office shall send a written
notice of violation to hospital owners that fail to comply with this
section. The office shall make copies of these notices available on its
Internet Web site.
(f) (1) A
hospital that has received an extension of the January
1, 2008, deadline pursuant to subdivision (a) or (b) may request
an additional extension of up to two years for a hospital building that
it owns or operates and that meets the criteria specified in paragraph
(2), (3), or (5).
(2) The
office may grant the additional extension if the hospital building
subject to the extension meets all of the following criteria:
(A) The
hospital building is under construction at the time of the request for
extension under this subdivision and the purpose of the construction is
to meet the requirements of subdivision (a) to allow the use of the
building as a general acute care hospital building after the extension
deadline granted by the office pursuant to subdivision (a) or (b).
(B) The
hospital building plans were submitted to the office and were deemed
ready for review by the office
at least four years prior to the applicable deadline for the
building. The hospital shall indicate, upon submission of its plans, the
SPC-1 building or buildings that will be retrofitted or replaced to
meet the requirements of this section as a result of the project.
(C) The
hospital received a building permit for the construction described in
subparagraph (A) at least two years prior to the applicable deadline for
the building.
(D) The hospital
submitted a construction timeline at least two years prior to the
applicable deadline for the building demonstrating the hospital’s intent
to meet the applicable deadline. The timeline shall include all of the
following:
(i) The projected construction start date.
(ii) The projected construction completion
date.
(iii) Identification of the contractor.
(E) The
hospital is making reasonable progress toward meeting the timeline set
forth in subparagraph (D), but factors beyond the hospital’s control
make it impossible for the hospital to meet the deadline.
(3) The
office may grant the additional extension if the hospital building
subject to the extension meets all of the following criteria:
(A) The
hospital building is owned by a health care district that has, as
owner, received the extension of the January 1, 2008, deadline, but
where the hospital is operated by an unaffiliated third-party lessee
pursuant to a facility lease that extends at least through December 31,
2009. The district shall file a declaration with the office with a
request for an extension
stating that, as of the date of the filing, the district has
lacked, and continues to lack, unrestricted access to the subject
hospital building for seismic planning purposes during the term of the
lease, and that the district is under contract with the county to
maintain hospital services when the hospital comes under district
control. The office shall not grant the extension if an unaffiliated
third-party lessee will operate the hospital beyond December 31, 2010.
(B) The
hospital building plans were submitted to the office and were deemed
ready for review by the office at least four years prior to the
applicable deadline for the building. The hospital shall indicate, upon
submission of its plans, the SPC-1 building or buildings that will be
retrofitted or replaced to meet the requirements of this section as a
result of the project.
(C) The hospital received a building permit for
the construction described in subparagraph (B) by December 31, 2011.
(D) The
hospital submitted, by December 31, 2011, a construction timeline for
the building demonstrating the hospital’s intent and ability to meet the
deadline of December 31, 2014. The timeline shall include all of the
following:
(i) The projected construction start date.
(ii) The projected construction completion date.
(iii) Identification of the contractor.
(E) The
hospital building is under construction at the time of the request for
the extension, the purpose of the construction is to meet the
requirements of subdivision (a) to allow the use of the building as a
general acute care hospital building after the
extension deadline granted by the office pursuant to subdivision
(a) or (b), and the hospital is making reasonable progress toward
meeting the timeline set forth in subparagraph (D).
(F) The
hospital granted an extension pursuant to this paragraph shall submit
an additional status report to the office, equivalent to that required
by subdivision (c) of Section 130061, no later than June 30, 2013.
(4) An
extension granted pursuant to paragraph (3) shall be applicable only to
the health care district applicant and its affiliated hospital while
the hospital is operated by the district or an entity under the control
of the district.
(5) The office
may grant the additional extension if the hospital building subject to
the extension meets all of the following criteria:
(A) The
hospital owner submitted to the office, prior to June 30, 2009, a
request for review using current computer modeling utilized by the
office and based upon software developed by the Federal Emergency
Management Agency, referred to as Hazards US, and the building was
deemed SPC-1 after that review.
(B) The
hospital building plans for the building are submitted to the office
and deemed ready for review by the office prior to July 1, 2010. The
hospital shall indicate, upon submission of its plans, the SPC-1
building or buildings that shall be retrofitted or replaced to meet the
requirements of this section as a result of the project.
(C) The
hospital receives a building permit from the office for the
construction described in subparagraph (B) prior to January 1, 2012.
(D) The
hospital submits, prior
to January 1, 2012, a construction timeline for the building
demonstrating the hospital’s intent and ability to meet the applicable
deadline. The timeline shall include all of the following:
(i) The projected construction start date.
(ii) The projected construction completion date.
(iii) Identification of the contractor.
(E) The
hospital building is under construction at the time of the request for
the extension, the purpose of the construction is to meet the
requirements of subdivision (a) to allow the use of the building as a
general acute care hospital building after the extension deadline
granted by the office pursuant to subdivision (a) or (b), and the
hospital is making reasonable progress toward meeting the timeline set
forth in subparagraph
(D).
(F) The hospital
owner completes construction such that the hospital meets all criteria
to enable the office to issue a certificate of occupancy by the
applicable deadline for the building.
(6) A
hospital denied an extension pursuant to this subdivision may appeal
the denial to the Hospital Building Safety Board.
(7) The
office may revoke an extension granted pursuant to this subdivision for
any hospital building where the work of construction is abandoned or
suspended for a period of at least one year, unless the hospital
demonstrates in a public document that the abandonment or suspension was
caused by factors beyond its control.
(g) (1) Notwithstanding
subdivisions (a), (b), (c), and (f), and Sections 130061.5 and 130064, a
hospital that has received an extension of the January 1, 2008,
deadline pursuant to subdivision (a) or (b) also may request an
additional extension of up to seven years for a hospital building that
it owns or operates. The office may grant the extension subject to the
hospital meeting the milestones set forth in paragraph (2).
(2) The
hospital building subject to the extension shall meet all of the
following milestones, unless the hospital building is reclassified as
SPC-2 or higher as a result of its Hazards US score:
(A) The
hospital owner submits to the office, no later than September 30, 2012,
a letter of intent stating whether it intends to rebuild, replace, or
retrofit the building, or remove all general acute care beds and
services from the building, and the amount of time necessary to complete
the construction.
(B) The
hospital owner submits to the office, no later than September 30, 2012, a
schedule detailing why the requested extension is necessary, and
specifically how the hospital intends to meet the requested deadline.
(C) The
hospital owner submits to the office, no later than September 30, 2012,
an application ready for review seeking structural reassessment of each
of its SPC-1 buildings using current computer modeling based upon
software developed by FEMA, referred to as Hazards US.
(D) The
hospital owner submits to the office, no later than January 1, 2015,
plans ready for review consistent with the letter of intent submitted
pursuant to subparagraph (A) and the schedule submitted pursuant to
subparagraph (B).
(E) The
hospital owner submits a financial report to the office at the time the
plans are
submitted pursuant to subparagraph (D). The report shall
demonstrate the hospital owner’s financial capacity to implement the
construction plans submitted pursuant to subparagraph (D).
(F) The
hospital owner receives a building permit consistent with the letter of
intent submitted pursuant to subparagraph (A) and the schedule
submitted pursuant to subparagraph (B), no later than July 1, 2018.
(3) To
evaluate public safety and determine whether to grant an extension of
the deadline, the office shall consider the structural integrity of the
hospital’s SPC-1 buildings based on its Hazards US scores, community
access to essential hospital services, and the hospital owner’s
financial capacity to meet the deadline as determined by either a bond
rating of BBB or below or the financial report on the hospital owner’s
financial capacity submitted pursuant to subparagraph (E) of paragraph
(2). The criteria contained in this paragraph shall be considered
by the office in its determination of the length of an extension or
whether an extension should be granted.
(4) The
extension or subsequent adjustments granted pursuant to this
subdivision may not exceed the amount of time that is reasonably
necessary to complete the construction specified in paragraph (2).
(5) If
the circumstances underlying the request for extension submitted to the
office pursuant to paragraph (2) change, the hospital owner shall
notify the office as soon as practicable, but in no event later than six
months after the hospital owner discovered the change of circumstances.
The office may adjust the length of the extension granted pursuant to
paragraphs (2) and (3) as necessary, but in no event longer than the
period specified in paragraph (1).
(6) A
hospital denied an extension pursuant to this subdivision may appeal
the denial to the Hospital Building Safety Board.
(7) The
office may revoke an extension granted pursuant to this subdivision for
any hospital building when it is determined that any information
submitted pursuant to this section was falsified, or if the hospital
failed to meet a milestone set forth in paragraph (2), or where the work
of construction is abandoned or suspended for a period of at least six
months, unless the hospital demonstrates in a publicly available
document that the abandonment or suspension was caused by factors beyond
its control.
(8) Regulatory
submissions made by the office to the California Building Standards
Commission to implement this section shall be deemed to be emergency
regulations and shall be adopted as emergency regulations.
(9) The
hospital owner that applies for an extension pursuant to this
subdivision shall pay the office an additional fee, to be determined by
the office, sufficient to cover the additional reasonable costs incurred
by the office for maintaining the additional reporting requirements
established under this section, including, but not limited to, the costs
of reviewing and verifying the extension documentation submitted
pursuant to this subdivision. This additional fee shall not include any
cost for review of the plans or other duties related to receiving a
building or occupancy permit.
(10) This
subdivision shall become operative on the date that the State
Department of Health Care Services receives all necessary federal
approvals for a 2011–12 fiscal year hospital quality assurance fee
program that includes three hundred twenty million dollars
($320,000,000) in fee revenue to pay for
health care coverage for children, which is made available as a
result of the legislative enactment of a 2011–12 fiscal year hospital
quality assurance fee program.
SEC. 41.
Section 130316 of the Health and Safety Code is amended to read:130316.
Any funds appropriated for the purpose of this division that remain unexpended or unencumbered on June 30, 2016, shall revert to the General Fund on that date unless a statute that is enacted before June 30, 2016, extends the provisions of this division.SEC. 42.
Section 130317 of the Health and Safety Code is amended to read:130317.
This division shall become inoperative on June 30, 2016, and as of that date is repealed, unless a later enacted statute, that is enacted before June 30, 2016, deletes or extends the dates on which it becomes inoperative and is repealed.SEC. 43.
Section 131019.5 is added to the Health and Safety Code, to read:131019.5.
(a) For purposes of this section, the following definitions shall apply:(1) “Determinants
of equity” means social, economic, geographic, political, and physical
environmental conditions that lead to the creation of a fair and just
society.
(2) “Health equity”
means efforts to ensure that all people have full and equal access to
opportunities that enable them to lead healthy lives.
(3) “Health
and mental health disparities” means differences in health and mental
health status among distinct segments of the population, including
differences that occur by gender, age, race or
ethnicity, sexual orientation, gender identity, education or
income, disability or functional impairment, or geographic location, or
the combination of any of these factors.
(4) “Health
and mental health inequities” means disparities in health or mental
health, or the factors that shape health, that are systemic and
avoidable and, therefore, considered unjust or unfair.
(5) “Vulnerable
communities” include, but are not limited to, women, racial or ethnic
groups, low-income individuals and families, individuals who are
incarcerated and those who have been incarcerated, individuals with
disabilities, individuals with mental health conditions, children, youth
and young adults, seniors, immigrants and refugees, individuals who are
limited-English proficient (LEP), and lesbian, gay, bisexual,
transgender, queer, and questioning (LGBTQQ) communities, or
combinations of these
populations.
(6) “Vulnerable
places” means places or communities with inequities in the social,
economic, educational, or physical environment or environmental health
and that have insufficient resources or capacity to protect and promote
the health and well-being of their residents.
(b) The
State Department of Public Health shall establish an Office of Health
Equity for the purposes of aligning state resources, decisionmaking, and
programs to accomplish all of the following:
(1) Achieve
the highest level of health and mental health for all people, with
special attention focused on those who have experienced socioeconomic
disadvantage and historical injustice, including, but not limited to,
vulnerable communities and culturally, linguistically, and
geographically isolated communities.
(2) Work
collaboratively with the Health in All Policies Task Force to promote
work to prevent injury and illness through improved social and
environmental factors that promote health and mental health.
(3) Advise
and assist other state departments in their mission to increase access
to, and the quality of, culturally and linguistically competent health
and mental health care and services.
(4) Improve
the health status of all populations and places, with a priority on
eliminating health and mental health disparities and inequities.
(c) The duties of the Office of Health Equity shall include all of the following:
(1) Conducting
policy analysis and developing strategic policies and plans
regarding specific issues affecting vulnerable communities and
vulnerable places to increase positive health and mental health outcomes
for vulnerable communities and decrease health and mental health
disparities and inequities. The policies and plans shall also include
strategies to address social and environmental inequities and improve
health and mental health. The office shall assist other departments in
their missions to increase access to services and supports and improve
quality of care for vulnerable communities.
(2) Establishing
a comprehensive, cross-sectoral strategic plan to eliminate health and
mental health disparities and inequities. The strategies and
recommendations developed shall take into account the needs of
vulnerable communities to ensure strategies are developed throughout the
state to eliminate health and mental health disparities and inequities.
This plan shall be developed in collaboration with the Health in All
Policies Task Force. This plan shall establish goals and
benchmarks for specific strategies in order to measure and track
disparities and the effectiveness of these strategies. This plan shall
be updated periodically, but not less than every two years, to keep
abreast of data trends, best practices, promising practices, and to more
effectively focus and direct necessary resources to mitigate and
eliminate disparities and inequities. This plan shall be included in the
report required under paragraph (1) of subdivision (d). The Office of
Health Equity shall seek input from the public on the plan through an
inclusive public stakeholder process.
(3) Building
upon and informing the work of the Health in All Policies Task Force in
working with state agencies and departments to consider health in
appropriate and relevant aspects of public policy development to ensure
the implementation of goals and objectives that close the gap in health
status. The
Office of Health Equity shall work collaboratively with the Health
in All Policies Task Force to assist state agencies and departments in
developing policies, systems, programs, and environmental change
strategies that have population health impacts in all of the following
ways, within the resources made available:
(A) Develop intervention programs with targeted approaches to address health and mental health inequities and disparities.
(B) Prioritize
building cross-sectoral partnerships within and across departments and
agencies to change policies and practices to advance health equity.
(C) Work
with the advisory committee established pursuant to subdivision (f) and
through stakeholder meetings to provide a forum to identify and address
the complexities of health and mental health inequities and disparities
and the
need for multiple, interrelated, and multisectoral strategies.
(D) Provide
technical assistance to state and local agencies and departments with
regard to building organizational capacity, staff training, and
facilitating communication to facilitate strategies to reduce health and
mental health disparities.
(E) Highlight
and share evidence-based, evidence-informed, and community-based
practices for reducing health and mental health disparities and
inequities.
(F) Work with local
public health departments, county mental health or behavioral health
departments, local social services, and mental health agencies, and
other local agencies that address key health determinants, including,
but not limited to, housing, transportation, planning, education, parks,
and economic development. The Office of Health Equity shall seek
to link local efforts with statewide efforts.
(4) Consult
with community-based organizations and local governmental agencies to
ensure that community perspectives and input are included in policies
and any strategic plans, recommendations, and implementation activities.
(5) Assist
in coordinating projects funded by the state that pertain to increasing
the health and mental health status of vulnerable communities.
(6) Provide
consultation and technical assistance to state departments and other
state and local agencies charged with providing or purchasing
state-funded health and mental health care, in their respective missions
to identify, analyze, and report disparities and to identify strategies
to address health and mental health disparities.
(7) Provide
information and assistance to state and local departments in
coordinating projects within and across state departments that improve
the effectiveness of public health and mental health services to
vulnerable communities and that address community environments to
promote health. This information shall identify unnecessary duplication
of services.
(8) Communicate
and disseminate information within the department and with other state
departments to assist in developing strategies to improve the health and
mental health status of persons in vulnerable communities and to share
strategies that address the social and environmental determinants of
health.
(9) Provide
consultation and assistance to public and private entities that are
attempting to create innovative responses to improve the health and
mental health status of vulnerable communities.
(10) Seek additional resources, including in-kind assistance, federal funding, and foundation support.
(d) In
identifying and developing recommendations for strategic plans, the
Office of Health Equity shall, at a minimum, do all of the following:
(1) Conduct
demographic analyses on health and mental health disparities and
inequities. The report shall include, to the extent feasible, an
analysis of the underlying conditions that contribute to health and
well-being. The first report shall be due July 1, 2014. This information
shall be updated periodically, but not less than every two years, and
made available through public dissemination, including posting on the
department’s Internet Web site. The report shall be developed using
primary and secondary sources of demographic information available to
the office, including
the work and data collected by the Health in All Policies Task
Force. Primary sources of demographic information shall be collected
contingent on the receipt of state, federal, or private funds for this
purpose.
(2) Based on the
availability of data, including valid data made available from secondary
sources, the report described in paragraph (1) shall address the
following key factors as they relate to health and mental health
disparities and inequities:
(A) Income security such as living wage, earned income tax credit, and paid leave.
(B) Food
security and nutrition such as food stamp eligibility and enrollment,
assessments of food access, and rates of access to unhealthy food and
beverages.
(C) Child
development, education, and literacy rates,
including opportunities for early childhood development and
parenting support, rates of graduation compared to dropout rates,
college attainment, and adult literacy.
(D) Housing,
including access to affordable, safe, and healthy housing, housing near
parks and with access to healthy foods, and housing that incorporates
universal design and visitability features.
(E) Environmental quality, including exposure to toxins in the air, water, and soil.
(F) Accessible
built environments that promote health and safety, including mixed-used
land, active transportation such as improved pedestrian, bicycle, and
automobile safety, parks and green space, and healthy school siting.
(G) Health care, including accessible disease management programs, access to
affordable, quality health and behavioral health care, assessment of the health care workforce, and workforce diversity.
(H) Prevention efforts, including community-based education and availability of preventive services.
(I) Assessing
ongoing discrimination and minority stressors against individuals and
groups in vulnerable communities based upon race, gender, gender
identity, gender expression, ethnicity, marital status, language, sexual
orientation, disability, and other factors, such as discrimination that
is based upon bias and negative attitudes of health professionals and
providers.
(J) Neighborhood
safety and collective efficacy, including rates of violence, increases
or decreases in community cohesion, and collaborative efforts to improve
the health and well-being of the community.
(K) The
efforts of the Health in All Policies Task Force, including monitoring
and identifying efforts to include health and equity in all sectors.
(L) Culturally
appropriate and competent services and training in all sectors,
including training to eliminate bias, discrimination, and mistreatment
of persons in vulnerable communities.
(M) Linguistically
appropriate and competent services and training in all sectors,
including the availability of information in alternative formats such as
large font, braille, and American Sign Language.
(N) Accessible, affordable, and appropriate mental health services.
(3) Consult
regularly with representatives of vulnerable communities, including
diverse
racial, ethnic, cultural, and LGBTQQ communities, women’s health
advocates, mental health advocates, health and mental health providers,
community-based organizations and advocates, academic institutions,
local public health departments, local government entities, and
low-income and vulnerable consumers.
(4) Consult
regularly with the advisory committee established by subdivision (f)
for input and updates on the policy recommendations, strategic plans,
and status of cross-sectoral work.
(e) The Office of Health Equity shall be organized as follows:
(1) A
Deputy Director shall be appointed by the Governor or the State Public
Health Officer, and is subject to confirmation by the Senate. The salary
for the Deputy Director shall be fixed in accordance with state law.
(2) The
Deputy Director of the Office of Health Equity shall report to the
State Public Health Officer and shall work closely with the Director of
Health Care Services to ensure compliance with the requirements of the
office’s strategic plans, policies, and implementation activities.
(f) The
Office of Health Equity shall establish an advisory committee to
advance the goals of the office and to actively participate in
decisionmaking. The advisory committee shall be composed of
representatives from applicable state agencies and departments, local
health departments, community-based organizations working to advance
health and mental health equity, vulnerable communities, and stakeholder
communities that represent the diverse demographics of the state. The
chair of the advisory committee shall be a representative from a
nonstate entity. The advisory committee shall be established by no later
than October 1, 2013, and shall meet, at a
minimum, on a quarterly basis. Subcommittees of this advisory
committee may be formed as determined by the chair.
(g) An
interagency agreement shall be established between the State Department
of Public Health and the State Department of Health Care Services to
outline the process by which the departments will jointly work to
advance the mission of the Office of Health Equity, including
responsibilities, scope of work, and necessary resources.
SEC. 44.
Section 131051 of the Health and Safety Code is amended to read:131051.
The duties, powers, functions, jurisdiction, and responsibilities transferred to the State Department of Public Health shall, pursuant to the act that added this section, include all of the following previously performed by the former State Department of Health Services:(a) Under the jurisdiction of the Deputy Director for Prevention Services:
(1) The Office of AIDS, including but not limited to:
(A) The AIDS Drug Assistance Program (Chapter 6 (commencing with Section 120950) of Part 4 of Division 105).
(B) The
AIDS Early Intervention Program (Chapter 4 (commencing with Section 120900) of Part 4 of Division 105).
(C) The CARE Services Program, provided for pursuant to the federal Ryan White CARE Act, 42 U.S.C. Section 300ff.
(D) The CARE/Health Insurance Premium Payment Program (federal Ryan White CARE Act, 42 U.S.C. Sec. 300ff).
(E) The Housing Opportunities for Persons with AIDS Program (Section 100119).
(F) The
Residential AIDS Licensed Facilities Program (former Section 100119;
Chapter 2 (commencing with Section 120815) of Part 4 of Division 105).
(G) The
AIDS Case Management Program (federal Ryan White CARE Act, 42 U.S.C.
Sec. 300ff; Chapter 2 (commencing with Section 120815) of Part 4 of
Division 105).
(H) The AIDS Medi-Cal Waiver Program (former Section 100119; 42 U.S.C. Sec. 1396n(c)).
(I) The Bridge Project (former Section 100119).
(J) The HIV Therapeutic Monitoring Program (Chapter 16 (commencing with Section 121345) of Part 4 of Division 105).
(K) The Learning Immune Function Enhancement program (former Section 100119).
(L) The San Ysidro Prevention Project (Section 113019).
(M) The California Statewide Treatment Education Program (former Section 100119).
(N) The HIV Counseling and Testing Program (Section 113019).
(O) The Neighborhood Intervention Geared Toward High-Risk Testing program (former Section 100119).
(P) The Perinatal Transmission Prevention Project (Section 113019).
(Q) The California AIDS Clearinghouse (Section 113019).
(R) The California Disclosure Assistance and Partner Services/Partner Counseling and Referral Services (Section 113019).
(S) The
African-American HIV Initiative (Section 113019; Chapter 13.7
(commencing with Section 120290) of Part 4 of Division 105).
(T) The Injection Drug User HIV Testing Utilizing Hepatitis C Testing High-Risk Initiative (Section 113019).
(U) The Prevention with Positives High-Risk Initiative (Section 113019).
(V) The Statewide Technical Assistance Initiatives (Section 113019).
(W) The HIV/AIDS Case Registry (Sections 113019, 120125, and 120130).
(2) The Office of Binational Border Health, including, but not limited to, all of the following:
(A) The California-Mexico Health Initiative (Part 3 (commencing with Section 475) of Division 1).
(B) The
Early Warning Infectious Disease Surveillance Program (Chapter 2
(commencing with Section 1250) of Division 2; Chapter 2 (commencing with
Section 120130) of Part 1 of Division 105).
(3) The Division of
Communicable Disease Control, including, but not limited to, all of the following:
(A) The
Infant Botulism Treatment and Prevention Program (Article 2.5
(commencing with Section 123700) of Chapter 3 of Part 2 of Division
106).
(B) The Sexually Transmitted Disease Control Program (Part 3 (commencing with Section 120500) of Division 105).
(C) The Infectious Disease Program (Chapter 2 (commencing with Section 120130) of Part 1 of Division 105).
(D) The Bioterrorism Epidemiology Program.
(E) The Vector Borne Disease (Part 11 (commencing with Section 116100) of Division 104).
(F) The Tuberculosis Control Program (Part 5
(commencing with Section 121350) of Division 105).
(G) The Microbial Diseases Laboratory (Chapter 2 (commencing with Section 100250) of Division 101).
(H) The Viral and Rickettsial Disease Laboratory (Chapter 2 (commencing with Section 100250) of Division 101).
(I) The West Nile Human Surveillance Program (Chapter 2 (commencing with Section 116110) of Part 11 of Division 104).
(J) The Immunization Program (Part 2 (commencing with Section 120325) of Division 105).
(K) The Vaccines for Children Program (Part 2 (commencing with Section 120325) of Division 105).
(4) The Division of Chronic Disease and Injury Control, including,
but not limited to, all of the following:
(A) The
IMPACT Prostate Cancer Treatment Program (Chapter 7 (commencing with
Section 104322) of Part 1 of Division 103), until June 30, 2012.
Commencing July 1, 2012, the duties, powers, functions, jurisdiction,
and responsibilities of the State Department of Public Health regarding
this program are hereby with the State Department of Health Care
Services.
(B) The Every Woman
Counts program (Breast and Cervical Cancer Screening Program) (Article
1.3 (commencing with Section 104150) of Chapter 2 of Part 1 of Division
103; Section 30461.6 of the Revenue and Taxation Code), until June 30,
2012. Commencing July 1, 2012, the duties, powers, functions,
jurisdiction, and responsibilities of the State Department of Public
Health regarding this program are hereby with the State Department of
Health Care Services.
(C) The
Well-Integrated Screening and Evaluation for Women Across the Nation
Demonstration Project (Article 1.3 (commencing with Section 104150) of
Chapter 2 of Part 1 of Division 103).
(D) The California Nutrition Network (Chapter 2 (commencing with Section 104575) of Part 3 of Division 103).
(E) The Cancer Research Program (Article 2 (commencing with Section 104175) of Chapter 2 of Part 1 of Division 103).
(F) The
Translational Cancer Research and Technology Transfer Program (Article 2
(commencing with Section 104175) of Chapter 2 of Part 1 of Division
103).
(G) The Ken Maddy California Cancer Registry (Chapter 2 (commencing with Section 103875) of Part 2 of Division 102).
(H) The
California Osteoporosis Prevention and Education Program (Chapter 1
(commencing with Section 125700) of Part 8 of Division 106).
(I) The Preventive Health Care for the Aging Program (Part 4 (commencing with Section 104900) of Division 103).
(J) The California Arthritis Prevention Program (former Section 100185).
(K) The Office of Oral Health (Chapter 3 (commencing with Section 104750) of Part 3 of Division 103).
(L) The
Children’s Dental Disease Prevention Program (Article 3 (commencing
with Section 104770) of Chapter 3 of Part 3 of Division 103).
(M) The Community Water Fluoridation Program (Article 3.5 (commencing with
Section 116409) of Chapter 4 of Part 12 of Division 104).
(N) The
California Asthma Public Health Initiative (Chapter 6.5 (commencing
with Section 104316) of Part 1 of Division 103).
(O) The California Obesity Prevention Initiative (Chapter 2 (commencing with Section 104575) of Part 3 of Division 103).
(P) The School Health Connections program (Chapter 2 (commencing with Section 104575) of Part 3 of Division 103).
(Q) The California Project LEAN (Chapter 2 (commencing with Section 104575) of Part 3 of Division 103).
(R) The California Center for Physical Activity (Section 131085).
(S) The California Diabetes Program (Section
131085).
(T) The Preventive Medicine Residency Program (Section 131090).
(U) The
California Epidemiologic Investigation Service (Article 4 (commencing
with Section 100325) of Chapter 2 of Part 1 of Division 101).
(V) The Continuing Professional Education Program (Section 131090).
(W) The Injury Surveillance and Epidemiology Program (Part 2 (commencing with Section 104325) of Division 103).
(X) The State and Local Injury Control Program (Chapter 1 (commencing with Section 104325) of Part 2 of Division 103).
(Y) The Office on Disability and Health (former Section 100185).
(Z) The Alzheimer’s Disease Program (Article 4 (commencing with Section 125275) of Chapter 2 of Part 5 of Division 106).
(AA) The California Tobacco Control Program (Chapter 1 (commencing with Section 104350) of Part 3 of Division 103).
(5) The Division of Drinking Water and Environmental Management, including, but not limited to, all of the following:
(A) The Medical Waste Management Program (Part 14 (commencing with Section 117600) of Division 104).
(B) The
Department of Defense Oversight Program (Radiologic Guidance and
Approvals) (Part 9 (commencing with Section 114650) of Division 104).
(C) The Nuclear Emergency Response Program (Part 9 (commencing with Section 114650) of
Division 104).
(D) The
Institutions Program (Environmental Surveys) (Article 5 (commencing with
Section 116025) of Chapter 5 of Part 10 of Division 104).
(E) The Drinking Water Field Management program (Chapter 4 (commencing with Section 116270) of Part 12 of Division 104).
(F) The
Environmental Health Specialist Registration Program (Article 1
(commencing with Section 106600) of Chapter 4 of Part 1 of Division
104).
(G) The Sanitation and
Radiation Laboratory (Article 2 (commencing with Section 100250) of
Chapter 2 of Part 1 of Division 101); Chapter 4 (commencing with Section
116270) of Part 12 of Division 104).
(H) The
Radon Program (Chapter 7 (commencing with Section 105400) of Part 5
of Division 103; Chapter 4 (commencing with Section 116270) of
Part 12, and Article 2 (commencing with Section 106750) of Chapter 4 of
Part 1, of Division 104).
(I) The Shellfish Sanitation Program (Chapter 5 (commencing with Section 112150) of Part 6 of Division 104).
(J) The Ocean Beach Safety Programs (Article 2 (commencing with Section 115875) of Chapter 5 of Part 10 of Division 104).
(K) The
Bioterrorism Planning and Response for Drinking Water, Medical Waste,
and Environmental Health program (Article 6 (commencing with Section
101315) of Chapter 3 of Part 3 of Division 101).
(L) The Safe Drinking Water State Revolving Fund (Chapter 4.5 (commencing with Section 116760) of Part 12 of Division 104).
(M) The
Drinking Water Technical Programs (Chapter 4 (commencing with Section
16270) of Part 12 of Division 104; Chapter 4.5 (commencing with Section
116760) of Part 12 of Division 104; Article 3 (commencing with Section
106875) of Chapter 4 of Part 1 of Division 104; Chapter 5 (commencing
with Section 116775) of Part 12 of Division 104; Chapter 5 (commencing
with Section 115825) of Part 10 of Division 104; Chapter 7 (commencing
with Section 13500) of Division 7 of the Water Code; Section 13411 of
the Water Code).
(N) The Water
Security, Clean Drinking Water, Coastal and Beach Protection Act of 2002
(Proposition 50) (Division 26.5 (commencing with Section 79500) of the
Water Code).
(6) The Division of Environmental and Occupational Disease Control, including, but not limited to, all of the following:
(A) The California Birth Defect Monitoring Program (Chapter 1 (commencing with Section 103825) of Part 2 of Division 102).
(B) The
Childhood Lead Poisoning Prevention Program (Chapter 5 (commencing with
Section 105275) of Part 5 of Division 103; Article 7 (commencing with
Section 124125) of Chapter 3 of Part 2 of Division 106).
(C) The Lead Related Construction Program (Chapter 4 (commencing with Section 105250) of Part 5 of Division 103).
(D) The Epidemiology Studies Laboratory (Sections 25416, former Section 100170, Section 100325, and Section 104324.25).
(E) The Center for Autism and Developmental Disabilities Research and Epidemiology (former Section 100170).
(F) The
Cancer Cluster/Environmental Investigations (former Section 100170).
(G) The Toxic Mold Program (Chapter 18 (commencing with Section 26100) of Division 20).
(H) The
Federal Agency for Toxic Substances and Disease Registry Health
Assessments, Education and Investigations program (former Section
100170).
(I) The Fish Contamination Outreach and Education program (former Section 100170).
(J) The Air Pollution and Cardiovascular Disease in the California Teachers Study Cohort Project (former Section 100170).
(K) The
Delta Watershed Fish Project (outreach, education, and training to
reduce exposures to mercury in fish) (former Section 100170).
(L) The
Environmental Health Laboratory (former Section 100170; Article 2
(commencing with Section 100250) of Chapter 2 of Part 1 of Division
101).
(M) The Indoor Air Quality program (Chapter 7 (commencing with Section 105400) of Part 5 of Division 103).
(N) The Outdoor Air Quality program (Section 60.9 of the Labor Code).
(O) The
Laboratory Response Network for Chemical Terrorism program (former
Section 100170; Article 2 (commencing with Section 100250) of Chapter 2
of Part 1 of Division 101).
(P) The Air Quality and Human Monitoring Support Program (former Section 100170).
(Q) The Hazard Evaluation System and Information Service Program (Article 1 (commencing with Section
105175) of Chapter 2 of Part 5 of Division 103; Section 147.2 of the Labor Code).
(R) The
Occupational Health Surveillance and Evaluation Program (Article 1
(commencing with Section 105175) of Chapter 2 of Part 5 of Division
103).
(S) The Occupational Lead
Poisoning Prevention Program (Article 2 (commencing with Section
105185) of Chapter 2 of Part 5 of Division 103).
(T) The
Occupational Blood Lead Registry (Article 2 (commencing with Section
105185) of Chapter 2 of Part 5 of Division 103).
(7) The Division of Food, Drug and Radiation Safety, including, but not limited to, all of the following:
(A) The Drug Licensing Program (Article 6 (commencing with Section 111615) of Chapter 6 of Part
5 of Division 104).
(B) The Consumer Product Safety Program (Part 3 (commencing with Section 108100) of Division 104).
(C) The Export Program (Article 2 (commencing with Section 110190) of Chapter 2 of Part 5 of Division 104).
(D) The
Food Safety Inspection Program (Part 5 (commencing with Section 109875)
and Part 6 (commencing with Section 111940) of Division 104).
(E) The
Foodborne Illness and Tampering Emergency Response Program (Part 5
(commencing with Section 109875) of Division 104).
(F) The Retail Food Safety Program (Part 7 (commencing with Section 113700) of Division 104).
(G) The Food Safety Industry Education and
Training Program (pursuant to Section 110485).
(H) The
Medical Device Licensing Program (Article 6 (commencing with Section
111615) of Chapter 6 of Part 5 of Division 104).
(I) The Medical Device Safety Program (Part 5 (commencing with Section 109875) of Division 104).
(J) The
Stop Tobacco Access to Kids Enforcement Program (STAKE) (Division 8.5
(commencing with Section 22950) of the Business and Professions Code).
(K) The Food and Drug Laboratory (Chapter 2 (commencing with Section 100250) of Division 101).
(L) The
Drug Safety Program (Part 4 (commencing with Section 109250) and Part 5
(commencing with Section 109875) of Division 104).
(M) The
General Food Safety Program (Part 5 (commencing with Section 109875)
and Part 6 (commencing with Section 111940) of Division 104).
(N) The Food Testing Program (Chapter 2 (commencing with Section 100250) of Division 101).
(O) The
Forensic Alcohol Testing Program (Article 2 (commencing with Section
100700) of Chapter 4 of Part 1 of Division 101).
(P) The
Methadone Laboratory Regulating Program (Article 2 (commencing with
Section 11839.23) of Chapter 10 of Part 2 of Division 10.5).
(Q) The Radiologic Health Program (Part 9 (commencing with Section 114650) of Division 104).
(R) The Mammography Program (Chapter 6 (commencing with Section 114840) of Part 9 of Division
104).
(S) The Radioactive
Materials Licensing and Inspection Program (Chapter 8 (commencing with
Section 114960) of Part 9 of Division 104).
(T) The
Radiological Technologist Certification Program (Article 5 (commencing
with Section 106955) of Part 1, and Article 3 (commencing with Section
114855) of Chapter 6 of Part 9 of Division 104).
(U) The Radioactive Waste Tracking Program (Chapter 8 (commencing with Section 114960) of Part 9 of Division 104).
(V) The Radioactive Waste Minimization Program (Chapter 8 (commencing with Section 114960) of Part 9 of Division 104).
(W) The Low Level Radioactive Waste Management, Treatment and Disposal Program (Chapter 8 (commencing with Section 114960)
of Part 9 of Division 104).
(X) The Statewide Environmental Radiation Monitoring Program (pursuant to Section 114755).
(Y) The Department of Energy Oversight Program (Part 9 (commencing with Section 114650) of Division 104).
(Z) The
X-Ray Machine Inspection and Registration and Mammography Quality
Standards Act Inspection Program (Article 5 (commencing with Section
106955) of Part 1, and Article 3 (commencing with Section 114855) of
Chapter 6 of Part 9 of Division 104).
(8) The Deputy Director for Laboratory Science, including, but not limited to, all of the following:
(A) The Environmental Laboratory Accreditation Program (Article 3 (commencing with Section 100825) of Chapter 4 of Part 1
of Division 101).
(B) The
Laboratory Central Services Program (Article 2 (commencing with Section
100250) of Chapter 2 of Part 1 of Division 101).
(C) The National Laboratory Training Network (Section 131085).
(D) The
Laboratory Field Services program (Chapter 3 (commencing with Section
1200) of Division 2 of the Business and Professions Code).
(b) Under the jurisdiction of the Deputy Director for Licensing and Certification:
(1) The General Acute Care Hospitals Licensing Program (Chapter 2 (commencing with Section 1250) of Division 2).
(2) The Acute Psychiatric Hospitals Licensing Program (Chapter 2 (commencing with Section
1250) of Division 2).
(3) The Special Hospitals Licensing Program (Chapter 2 (commencing with Section 1250) of Division 2).
(4) The Chemical Dependency Recovery Hospitals Licensing Program (Chapter 2 (commencing with Section 1250) of Division 2).
(5) The Skilled Nursing Facilities Licensing Program (Chapter 2 (commencing with Section 1250) of Division 2).
(6) The Intermediate Care Facilities Licensing Program (Chapter 2 (commencing with Section 1250) of Division 2).
(7) The
Intermediate Care Facilities-Developmentally Disabled Licensing Program
(Chapter 2 (commencing with Section 1250) of Division 2).
(8) The
Intermediate
Care Facilities-Developmentally Disabled-Habilitative Licensing
Program (Chapter 2 (commencing with Section 1250) of Division 2).
(9) The
Intermediate Care Facility-Developmentally Disabled-Nursing Licensing
Program (Chapter 2 (commencing with Section 1250) of Division 2).
(10) The Home Health Agencies Licensing Program (Chapter 8 (commencing with Section 1725) of Division 2).
(11) The Referral Agencies Licensing Program (Chapter 2.3 (commencing with Section 1400) of Division 2).
(12) The Adult Day Health Centers Licensing Program (Chapter 3.3 (commencing with Section 1570) of Division 2).
(13) The Congregate Living Health Facilities (Chapter 2 (commencing with Section 1250) of Division
2).
(14) The Psychology Clinics Licensing Program (Chapter 1 (commencing with Section 1200) of Division 2).
(15) The Primary Clinics—Community and Free Licensing Program (Chapter 1 (commencing with Section 1200) of Division 2).
(16) The Specialty Clinics—Rehab Clinics Licensing Program (Chapter 1 (commencing with Section 1200) of Division 2).
(17) The Dialysis Clinics Licensing Program (Chapter 1 (commencing with Section 1200) of Division 2).
(18) The Pediatric Day Health/Respite Care Licensing Program (Chapter 2 (commencing with Section 1250) of Division 2).
(19) The Alternative Birthing Centers Licensing Program (Chapter 1
(commencing with Section 1200) of Division 2).
(20) The Hospice Licensing Program (Chapter 2 (commencing with Section 1339.30) of Division 2).
(21) The Correctional Treatment Centers Licensing Program (Chapter 2 (commencing with Section 1250) of Division 2).
(22) The
Medicare/Medi-Cal Certification Program (Chapter 7 (commencing with
Section 14000) of Part 3 of Division 9 of the Welfare and Institutions
Code).
(23) The Nursing Home
Administrator Professional Certification Program (Chapter 2.35
(commencing with Section 1416) of Division 2).
(24) The
Certified Nursing Assistants Professional Certification Program
(Chapter 2 (commencing with Section 1337) of Division 2).
(25) The Home Health Aides Professional Certification Program (Chapter 8 (commencing with Section 1725) of Division 2).
(26) The
Hemodialysis Technicians Professional Certification Program (Chapter 3
(commencing with Section 1247) of Division 2 of the Business and
Professions Code; Chapter 10 (commencing with Section 1794) of Division
2).
(27) The Criminal
Background Clearance Program (Chapter 2 (commencing with Section 1337),
Chapter 3 (commencing with Section 1520), Chapter 3.01 (commencing with
Section 1569.15), Chapter 3.4 (commencing with Section 1496.80) of
Division 2, and Chapter 4 (commencing with Section 11150) of Division
8).
(c) Under the jurisdiction of the Deputy Director for Health Information and Strategic Planning:
(1) The Refugee Health Program (Subpart G of Part 400 of Title 45 of the Code of Federal Regulations).
(2) The
Office of County Health Services (Article 5 (commencing with Section
101300) of Chapter 3 of Part 3 of Division 101; Part 4.7 (commencing
with Section 16900) of Division 9 of the Welfare and Institutions Code).
(3) The
Medically Indigent Services Program (Article 5 (commencing with Section
101300) of Chapter 3 of Part 3 of Division 101).
(4) The Office of Vital Records (Part 1 (commencing with Section 102100) of Division 102).
(5) The
Office of Health Information and Research (Article 1 (commencing with
Section 102175) of Chapter 2 of Part 1 of Division 102; Section 128730).
(6) The
Local Public Health Services Program (Article 5 (commencing with
Section 101300) of Chapter 3 of Part 3 of Division 101).
(7) The Center for Health Statistics (Part 1 (commencing with Section 102100) of Division 102; Section 128730).
(8) The
Medical Marijuana Program (Article 2.5 (commencing with Section
11362.7) of Chapter 6 of Division 10 of the Health and Safety Code).
(d) Under the jurisdiction of the Deputy Director for Primary Care and Family Health:
(1) The Maternal, Child and Adolescent Health program (Part 2 (commencing with Section 123225) of Division 106).
(2) The Adolescent Family Life Program (Article 1
(commencing with Section 124175) of Chapter 4 of Part 2 of Division 106).
(3) The Advanced Practice Nurse Training program (Part 2 (commencing with Section 123225) of Division 106).
(4) The Black Infant Health Program (Part 2 (commencing with Section 123225) of Division 106).
(5) The Breastfeeding Program (Article 3 (commencing with Section 123360) of Chapter 1 of Part 2 of Division 6).
(6) The California Diabetes and Pregnancy Program (Part 2 (commencing with Section 123225) of Division 106).
(7) The California Initiative to Improve Adolescent Health (Part 2 (commencing with Section 123225) of Division 106).
(8) The
Childhood Injury Prevention Program (Article 4 (commencing with Section 100325) of Chapter 2 of Division 101).
(9) The
Comprehensive Perinatal Services Program (Article 3 (commencing with
Section 123475) of Chapter 2 of Part 2; Section 14134.5 of the Welfare
and Institutions Code).
(10) The
Fetal and Infant Mortality Review Program (Article 1 (commencing with
Section 123650) of Chapter 3 of Part 2 of Division 106).
(11) The
Human Stem Cell Research Program (Chapter 3 (commencing with Section
125290.10) of Part 5 of Division 106; Chapter 1 (commencing with Section
125300) of Part 5.5 of Division 106).
(12) The Local Health Department Maternal, Child and Adolescent Health Program (Section 123255).
(13) The Maternal Mortality Review Program (Article 4 (commencing with Section 100325) of Chapter 2 of Division 101).
(14) The Oral Health Program (Part 2 (commencing with Section 123225) of Division 106).
(15) The Preconception Health and Health Care Initiative (Part 2 (commencing with Section 123225) of Division 106).
(16) The
Regional Perinatal Programs of California (Article 4 (commencing with
Section 123550) of Chapter 2 of Part 2 of Division 106).
(17) The
Perinatal Dispatch Centers Outreach and Education Program (Article 4
(commencing with Section 123750) of Chapter 3 of Part 2 of Division
106).
(18) The State Early
Childhood Comprehensive Services program (Part 2 (commencing with Section 123225) of Division 106).
(19) The
Sudden Infant Death Syndrome Program (Article 3 (commencing with
Section 123725) of Chapter 3 of Part 2 of Division 106).
(20) The
Youth Pilot Program (Chapter 12.85 (commencing with Section 18987) of
Part 6 of Division 9 of the Welfare and Institutions Code).
(21) The
Office of Family Planning (Chapter 8.5 (commencing with Section 14500)
of Part 3 of Division 9 of the Welfare and Institutions Code; Division
24 (commencing with Section 24000) of the Welfare and Institutions
Code), until June 30, 2012. Commencing July 1, 2012, the duties, powers,
functions, jurisdiction, and responsibilities of the State Department
of Public Health regarding this office are hereby with the State
Department of Health Care
Services.
(22) The
Community Challenge Grant Program (Section 14504.1 of the Welfare and
Institutions Code, and Chapter 14 (commencing with Section 18993) of
Part 6 of Division 9 of the Welfare and Institutions Code).
(23) The Information and Education Program (Section 14504.3 of the Welfare and Institutions Code).
(24) The
Family PACT Program (subdivision (aa) of Section 14132 and Section
24005 of the Welfare and Institutions Code), until June 30, 2012.
Commencing July 1, 2012, the duties, powers, functions, jurisdiction,
and responsibilities of the State Department of Public Health regarding
this program are hereby with the State Department of Health Care
Services.
(25) The Male Involvement Program (Section 14504 of the Welfare and Institutions
Code).
(26) The TeenSMART Outreach Program (Section 14504.2 of the Welfare and Institutions Code).
(27) The Battered Women Shelter Program (Chapter 6 (commencing with Section 124250) of Part 2 of Division 106).
(28) The
Women, Infants and Children Program (Article 1 (commencing with Section
123275) of Chapter 1 of Part 2 of Division 106).
(29) The
WIC Supplemental Nutrition Program (Article 1 (commencing with Section
123275) of Chapter 1 of Part 2 of Division 106).
(30) The Farmers Market Nutrition Program (Section 123279).
(31) Genetic Disease Program (Chapter 1 (commencing with Section 124975) of Part 5 of Division
106).
(32) The Newborn Screening Program (Chapter 1 (commencing with Section 124975) of Part 5 of Division 106).
(33) The Prenatal Screening Program (Chapter 1 (commencing with Section 124975) of Part 5 of Division 106).
SEC. 45.
Section 131052 of the Health and Safety Code is amended to read:131052.
In implementing the transfer of jurisdiction pursuant to this article, the State Department of Public Health succeeds to and is vested with all the statutory duties, powers, purposes, responsibilities, and jurisdiction of the former State Department of Health Services as they relate to public health as provided for or referred to in all of the following provisions of law:(1) Sections
550, 555, 650, 680, 1241, 1658, 2221.1, 2248.5, 2249, 2259, 2259.5,
2541.3, 2585, 2728, 3527, 4017, 4027, 4037, 4191, 19059.5, 19120, 22950,
22973.2, and 22974.8 of the Business and Professions Code.
(2) Sections 56.17, 1812.508, and 1812.543 of the Civil
Code.
(3) Sections 8286,
8803, 17613, 32064, 32065, 32066, 32241, 49030, 49405, 49414, 49423.5,
49452.6, 49460, 49464, 49565, 49565.8, 49531.1, 56836.165, and 76403 of
the Education Code.
(4) Sections 405, 6021, 6026, 18963, 30852, 41302, and 78486 of the Food and Agricultural Code.
(5) Sections 307, 355, 422, 7572, 7574, 8706, 8817, and 8909 of the Family Code.
(6) Sections 217.6, 1507, 1786, 4011, 5671, 5674, 5700, 5701, 5701.5, 7715, and 15700 of the Fish and Game Code.
(7) Sections
855, 51010, and 551017.1 of the Government Code. For purposes of
subdivision (s) of Section 6254 of the Government Code, the term “State
Department of Health Services” is hereby deemed to refer to the State
Department of Public Health.
(8) (A) Sections
475, 1180.6, 1418.1, 1422.1, 1428.2, 1457, 1505, 1507.1, 1507.5,
1570.7, 1599.2, 1599.60, 1599.75, 1599.87, 2002, 2804, 11362.7, 11776,
11839.21, 11839.23, 11839.24, 11839.25, 11839.26, 11839.27, 11839.28,
11839.29, 11839.30, 11839.31, 11839.32, 11839.33, 11839.34, 17920.10,
17961, 18897.2, 24185, 24186, 24187, 24275, 26101, 26122, 26134, 26155,
26200, and 26203.
(B) Chapters
1, 2, 2.05, 2.3, 2.35, 2.4, 3.3, 3.9, 3.93, 3.95, 4, 4.1, 4.5, 5, 6,
6.5, 8, 8.3, 8.5, 8.6, 9, and 11 of Division 2.
(C) Articles 2 and 4 of Chapter 2, Chapter 3, and Chapter 4 of Part 1, Part 2 and Part 3 of Division 101.
(D) Division 102, including Sections 102230 and 102231.
(E) Division
103, including Sections 104145, 104181, 104182, 104182.5, 104187,
104191, 104192, 104193, 104316, 104317, 104318, 104319, 104320, 104321,
104324.2, 104324.25, 104350, 105191, 105251, 105255, 105280, 105340, and
105430.
(F) Division 104,
including Sections 106615, 106675, 106770, 108115, 108855, 109282,
109910, 109915, 112155, 112500, 112650, 113355, 114460, 114475, 114650,
114710, 114850, 114855, 114985, 115061, 115261, 115340, 115736, 115880,
115885, 115915, 116064, 116183, 116270, 116365.5, 116366, 116375,
116610, 116751, 116760.20, 116825, 117100, 117924, and 119300.
(G) Division
105, including Sections 120262, 120381, 120395, 120440, 120480, 120956,
120966, 121155, 121285, 121340, 121349.1, 121480, 122410, and 122420.
(H) Part
1, Part 2
excluding Articles 5, 5.5, 6, and 6.5 of Chapter 3, Part 3 and
Part 5 excluding Articles 1 and 2 of Chapter 2, Part 7, and Part 8 of
Division 106.
(9) Sections 799.03, 10123.35, 10123.5, 10123.55, 10123.10, 10123.184, and 11520 of the Insurance Code.
(10) Sections 50.8, 142.3, 144.5, 144.7, 147.2, 4600.6, 6307.1, 6359, 6712, 9009, and 9022 of the Labor Code.
(11) Sections
4018.1, 5008.1, 7501, 7502, 7510, 7511, 7515, 7518, 7530, 7550, 7553,
7575, 7576, 11010, 11174.34, and 13990 of the Penal Code.
(12) Section 4806 of the Probate Code.
(13) Sections 15027, 25912, 28004, 30950, 41781.1, 42830, 43210, 43308, 44103, and 71081 of the Public Resources Code.
(14) Section 10405 of the Public Contract Code.
(15) Sections 883, 1507, and 7718 of the Public Utilities Code.
(16) Sections
18833, 18838, 18845.2, 18846.2, 18847.2, 18863, 30461.6, 43010.1, and
43011.1 of the Revenue and Taxation Code.
(17) Section 11020 of the Unemployment Insurance Code.
(18) Sections 22511.55, 23158, 27366, and 33000 of the Vehicle Code.
(19) Sections
5326.9, 5328, 5328.15, 14132, 16902, and 16909, and Division 24 of the
Welfare and Institutions Code. Payment for services provided under the
Family Planning, Access, Care, and Treatment (Family PACT) Waiver
Program pursuant to subdivision (aa) of Section
14132 and Division 24 shall be made through the State Department
of Health Care Services. The State Department of Public Health and the
State Department of Health Care Services may enter into an interagency
agreement for the administration of those payments. This paragraph, to
the extent that it applies to the Family PACT Waiver Program, shall
become inoperative on June 30, 2012.
(20) Sections
13176, 13177.5, 13178, 13193, 13390, 13392, 13392.5, 13393.5, 13395.5,
13396.7, 13521, 13522, 13523, 13528, 13529, 13529.2, 13550, 13552.4,
13552.8, 13553, 13553.1, 13554, 13554.2, 13816, 13819, 13820, 13823,
13824, 13825, 13827, 13830, 13834, 13835, 13836, 13837, 13858, 13861,
13862, 13864, 13868, 13868.1, 13868.3, 13868.5, 13882, 13885, 13886,
13887, 13891, 13892, 13895.1, 13895.6, 13895.9, 13896, 13896.3, 13896.4,
13896.5, 13897, 13897.4, 13897.5, 13897.6, 13898, 14011, 14012, 14015,
14016, 14017, 14019, 14022, 14025, 14026, 14027, and 14029 of the
Water Code.
SEC. 46.
Section 131055.1 is added to the Health and Safety Code, to read:131055.1.
(a) Notwithstanding Section 131050, commencing on July 1, 2012, the State Department of Health Care Services shall succeed to and be vested with all the duties, powers, purposes, functions, responsibilities, and jurisdiction of the State Department of Public Health as they relate to the Breast and Cervical Cancer Screening Program pursuant to Article 1.3 (commencing with Section 104150) of Chapter 1, the Breast and Cervical Cancer Treatment Program pursuant to Article 1.5 (commencing with Section 104160) of Chapter 1, the Prostate Cancer Screening Program pursuant to Chapter 6 (commencing with Section 104310), the IMPACT Prostate Cancer Treatment Program pursuant to Chapter 7 (commencing with Section 104322) of Part 1 of Division 103, translation services pursuant to Part 3 (commencing with Section 124300) of Division 106, the Office of Family Planning pursuant to Chapter 8.5 (commencing with Section 14500) of Part 3 of Division 9 of the Welfare and Institutions Code, excluding the Personal Responsibility Education Federal Grant Program, the Family Planning, Access, Care, and Treatment (Family PACT) Program pursuant to subdivision (aa) of Section 14132, and the State-Only Family Planning Program pursuant to Division 24 (commencing with Section 24000) of the Welfare and Institutions Code.(b) Commencing
July 1, 2012, any reference to the State Department of Public Health
with regard to the Breast and Cervical Cancer Screening Program pursuant
to Article 1.3 (commencing with Section 104150) of Chapter 1, the
Breast and Cervical Cancer Treatment Program pursuant to Article 1.5
(commencing with Section 104160) of Chapter 1, the Prostate Cancer
Screening Program pursuant to Chapter 6 (commencing with Section
104310), the IMPACT Prostate Cancer Treatment Program pursuant to
Chapter 7 (commencing with Section 104322) of Part 1 of Division 103,
translation services pursuant to Part 3 (commencing with Section 124300)
of Division 106, the Office of Family Planning pursuant to Chapter 8.5
(commencing with Section 14500) of Part 3 of Division 9 of the Welfare
and Institutions Code, excluding the Personal Responsibility Education
Federal Grant Program, the Family Planning, Access, Care, and Treatment
(Family PACT) Program pursuant to subdivision (aa) of Section 14132, or
the State-Only Family Planning Program pursuant to Division 24
(commencing with Section 24000) of the Welfare and Institutions Code,
shall refer to the State Department of Health Care Services.
(c) All
regulations and orders adopted by the State Department of Public Health
and any of its predecessors in effect prior to July 1, 2012, shall
remain in effect and shall be fully enforceable
unless and until readopted, amended, or repealed, or until they
expire by their own terms. Any action by or against the State Department
of Public Health and any of its predecessors pertaining to matters
vested in the State Department of Health Care Services by this act shall
not abate but shall continue in the name of the State Department of
Health Care Services, and the State Department of Health Care Services
shall be substituted for the State Department of Public Health and any
of its predecessors by the court wherein the action is pending. The
substitution shall not in any way affect the rights of the parties to
the action.
(d) Commencing July
1, 2012, the unexpended balance of all funds available for use by the
State Department of Public Health or any of its predecessors in carrying
out any functions transferred to the State Department of Health Care
Services shall be available for use by the State Department of Health
Care Services.
(e) Commencing
July 1, 2012, all books, documents, records, and property of the State
Department of Public Health pertaining to functions transferred to the
State Department of Health Care Services shall be transferred to the
State Department of Health Care Services.
(f) Commencing
July 1, 2012, positions filled by appointment by the Governor in the
State Department of Public Health whose principal assignment was to
perform functions transferred to the State Department of Health Care
Services shall be transferred to the State Department of Health Care
Services. Individuals in positions transferred pursuant to this
subdivision shall serve at the pleasure of the Governor. Salaries of
positions transferred shall remain at the level established pursuant to
law unless otherwise provided.
(g) Commencing
July 1, 2012, every
officer and employee of the State Department of Public Health who
is performing a function transferred to the State Department of Health
Care Services and who is serving in the state civil service, other than
as a temporary employee, shall be transferred to the State Department of
Health Care Services pursuant to the provisions of Section 19050.9 of
the Government Code. The status, position, and rights of any officer or
employee of the State Department of Public Health shall not be affected
by the transfer and shall be retained by the person as an officer or
employee of the State Department of Health Care Services, as applicable,
pursuant to the State Civil Service Act (Part 2 (commencing with
Section 18500) of Division 5 of Title 2 of the Government Code), except
for a position that is exempt from civil service.
(h) No
contract, lease, license, or any other agreement to which the State
Department of Public Health is a party shall be void or
voidable by reason of this act, but shall continue in full force
and effect, with State Department of Health Care Services assuming all
of the rights, obligations, liabilities, and duties of the State
Department of Public Health as relates to the duties, powers, purposes,
responsibilities, and jurisdiction vested by this section in the State
Department of Health Care Services. The assumption by the State
Department of Health Care Services shall not in any way affect the
rights of the parties to any contract, lease, license, or agreement.
SEC. 47.
Section 4024.7 is added to the Welfare and Institutions Code, to read:4024.7.
The Governor or the Director of Health Care Services shall appoint, subject to confirmation by the Senate, a Deputy Director of Mental Health and Substance Use Disorder Services of the State Department of Health Care Services. The salary for the deputy director shall be fixed in accordance with law.SEC. 48.
Section 4362 of the Welfare and Institutions Code is amended to read:4362.
The Legislature finds all of the following:(a) That
state public policy discriminates against adults with brain damage or
degenerative brain disease, such as Alzheimer’s disease. This damage or
disease is referred to as “brain impairments” in this chapter.
(b) That
the Legislature has declared state public policy and accepted
responsibility to ensure that persons under the age of 18 years who are
developmentally disabled pursuant to Division 4.5 (commencing with
Section 4500), receive services necessary to meet their needs, which are
often similar to those of persons who suffer from brain impairments.
(c) That
persons over the age of 18 who sustain brain impairment have a variety
of program and service needs for which there is no clearly defined,
ultimate responsibility vested in any single state agency and for which
there are currently a number of different programs attempting to meet
their needs.
(d) That the lack
of clearly defined ultimate responsibility has resulted in severe
financial liability and physical and mental strain on brain-impaired
persons, their families, and caregivers.
(e) That
terminology and nomenclature used to describe brain impairments are
varied and confusing, in part because of different medical diagnoses and
professional opinions, as well as differences in terminology used by
the various funding sources for programs and services. Uniformity is
required in order to ensure that appropriate
programs and services are available throughout the state to serve
these persons.
(f) That the
term “brain damage” covers a wide range of organic and neurological
disorders, and that these disorders, as identified below, are not
necessarily to be construed as mental illnesses. These disorders
include, but are not limited to, all of the following:
(1) Progressive,
degenerative, and dementing illnesses, including, but not limited to,
presenile and senile dementias, Alzheimer’s disease, multiinfarct
disease, Pick’s disease, and Kreutzfeldt-Jakob’s disease.
(2) Degenerative
diseases of the central nervous system that can lead to dementia or
severe brain impairment, including, but not limited to, epilepsy,
multiple sclerosis, Parkinson’s disease, amyotrophic lateral sclerosis
(ALS), and hereditary diseases such as
Huntington’s disease.
(3) Permanent
damage caused by cerebrovascular accidents more commonly referred to as
“strokes,” including, but not limited to, cerebral hemorrhage,
aneurysm, and embolism.
(4) Posttraumatic,
postanoxic, and postinfectious damage caused by incidents, including,
but not limited to, coma, accidental skull and closed head injuries,
loss of oxygen (anoxia), and infections such as encephalitis, herpes
simplex, and tuberculosis.
(5) Permanent
brain damage or temporary or progressive dementia as a result of tumors
(neoplasm), hydrocephalus, abscesses, seizures, substance toxicity, and
other disorders.
(g) That
brain damage frequently results in functional impairments that adversely
affect personality, behavior, and ability to perform
daily activities. These impairments cause dependency on others for
care and decisionmaking. The manifestations of brain damage include
impairments of memory, cognitive ability, orientation, judgment,
emotional response, and social inhibition. Brain damage can strike
anyone regardless of age, race, sex, occupation, or economic status.
(h) That
Family Survival Project for Brain-Damaged Adults of San Francisco, a
three-year pilot project established pursuant to former Chapter 4
(commencing with Section 4330), has demonstrated that the most
successful, cost-effective service model is one which allows a nonprofit
community agency to provide a full array of support services to
families that have a member who suffers from a brain impairment. This
agency provides direct services, coordinates existing resources, and
assists in the development of new programs and services on a regional
basis.
(i) That respite care
services provide a combination of time-limited, in-home, and out-of-home
services that significantly decrease the stress of family members and
increase their ability to maintain a brain-impaired person at home at
less cost than other alternatives. This ability is further increased
when complemented by case planning, care training, and other support
services for family members.
(j) That
providing services to brain-impaired adults, and to their families and
caregivers, requires the coordinated services of many state departments
and community agencies to ensure that no gaps occur in communication, in
the availability of programs, or in the provision of services.
SEC. 49.
Section 4362.5 of the Welfare and Institutions Code is amended to read:4362.5.
As used in this chapter:(a) “Brain
damage,” “degenerative brain diseases,” and “brain impairment” mean
significant destruction of brain tissue with resultant loss of brain
function. Examples of causes of the impairments are Alzheimer’s disease,
stroke, traumatic brain injury, and other impairments described in
subdivision (f) of Section 4330.
(b) “Brain-impaired adult” means a person whose brain impairment has occurred after the age of 18.
(c) “Respite
care” means substitute care or supervision in support of the caregiver
for the purposes of providing relief from the stresses
of constant care provision and so as to enable the caregiver to
pursue a normal routine and responsibilities. Respite care may be
provided in the home or in an out-of-home setting, such as day care
centers or short-term placements in inpatient facilities.
(d) “Family
member” means any relative or court-appointed guardian or conservator
who is responsible for the care of a brain-impaired adult.
(e) “Caregiver”
means any unpaid family member or individual who assumes responsibility
for the care of a brain-impaired adult.
(f) “Director” means the Director of Health Care Services.
SEC. 50.
Section 4364 of the Welfare and Institutions Code is amended to read:4364.
The Statewide Resources Consultant shall do all of the following:(a) Serve
as the centralized information and technical assistance clearinghouse
for brain-impaired adults, their families, caregivers, service
professionals and agencies, and volunteer organizations, and in this
capacity may assist organizations that serve families with adults with
Huntington’s disease and Alzheimer’s disease by reviewing data collected
by those organizations in their efforts to determine the means of
providing high-quality appropriate care in health facilities and other
out-of-home placements; and shall disseminate information, including,
but not limited to, the results of research and activities conducted
pursuant to its
responsibilities set forth in this chapter as determined by the
director, and which may include forwarding quality of care and related
information to appropriate state departments for consideration.
(b) Work
closely and coordinate with organizations serving brain-impaired
adults, their families, and caregivers in order to ensure, consistent
with requirements for quality of services as may be established by the
director, that the greatest number of persons are served and that the
optimal number of organizations participate.
(c) Develop
and conduct training that is appropriate for a variety of persons,
including, but not limited to, all of the following:
(1) Families.
(2) Caregivers and service professionals involved with brain-impaired adults.
(3) Advocacy and self-help family and caregiver support organizations.
(4) Educational institutions.
(d) Provide
other training services, including, but not limited to, reviewing
proposed training curricula regarding the health, psychological, and
caregiving aspects of individuals with brain damage as defined in
subdivision (f) of Section 4362. The proposed curricula may be submitted
by providers or statewide associations representing individuals with
brain damage, their families, or caregivers.
(e) Provide
service and program development consultation to resource centers and to
identify funding sources that are available.
(f) Assist
the appropriate state agencies in identifying and securing
increased federal financial participation and third-party
reimbursement, including, but not limited to, Title XVIII (42 U.S.C.
Sec. 1395 and following) and Title XIX (42 U.S.C. Sec. 1396 and
following) of the federal Social Security Act.
(g) Conduct public social policy research based upon the recommendations of the director.
(h) Assist
the director, as the director may require, in conducting directly, or
through contract, research in brain damage epidemiology and data
collection, and in developing a uniform terminology and nomenclature.
(i) Assist
the director in establishing criteria for, and in selecting resource
centers and in designing a methodology for, the consistent assessment of
resources and needs within the geographic areas to be serviced by the
resource centers.
(j) Conduct
conferences, as required by the director, for families, caregivers,
service providers, advocacy organizations, educational institutions,
business associations, community groups, and the general public, in
order to enhance the quality and availability of high-quality, low-cost
care and treatment of brain-impaired adults.
(k) Make
recommendations, after consultation with appropriate state department
representatives, to the director and the Secretary of California Health
and Human Services for a comprehensive statewide policy to support and
strengthen family caregivers, including the provision of respite and
other support services, in order to implement more fully this chapter.
The Statewide Resources Consultant shall coordinate its recommendations
to assist the California Health and Human Services Agency to prepare its
report on long-term care programs pursuant to Chapter 1.5
(commencing with Section 100145) of Part 1 of Division 101 of the
Health and Safety Code.
(l) Conduct
an inventory and submit an analysis of California’s publicly funded
programs serving family caregivers of older persons and functionally
impaired adults.
SEC. 51.
Section 4364.5 of the Welfare and Institutions Code is amended to read:4364.5.
The Statewide Resources Consultant, pursuant to Section 4364, shall do the following:(a) Develop
respite care training materials, with consultation by other appropriate
organizations including the California Association of Homes for the
Aging, and under the direction of the director, for distribution to all
resource centers established under this chapter.
(b) Provide
the respite care training materials described in subdivision (a) to
other appropriate state entities for distribution to their respective
services and programs.
(c) Pursuant
to the requirements of Section 4365.5,
report on the utilization of the respite care training materials,
developed pursuant to subdivision (a), by all the resource centers for
the period ending December 31, 1990, only, and make recommendations for
the future use of these materials.
SEC. 52.
Section 4366 of the Welfare and Institutions Code is amended to read:4366.
Resource centers shall serve all of the following functions:(a) Provide
directly or assist families in securing information, advice, and
referral services, legal services and financial consultation, planning
and problem-solving consultation, family support services, and respite
care services, as specified in Section 4338.
(b) Provide
centralized access to information about, and referrals to, local,
state, and federal services and programs in order to assure a
comprehensive approach for brain-impaired adults, their families, and
caregivers. Nothing in this chapter shall prohibit access to services
through other organizations which provide
similar programs and services to brain-impaired adults and their
families, nor shall other organizations be prevented from providing
these programs and services.
(c) Assist
in the identification and documentation of service needs and the
development of necessary programs and services to meet the needs of
brain-impaired adults in the geographic area.
(d) Cooperate
with the Statewide Resources Consultant and the director in any
activities which they deem necessary for the proper implementation of
this chapter.
(e) Work closely
and coordinate with organizations serving brain-impaired adults, their
families, and caregivers in order to ensure, consistent with
requirements for quality of services as may be established by the
director, that the greatest number of persons are served and that the
optimal number of
organizations participate.
SEC. 53.
Section 4367.5 of the Welfare and Institutions Code is amended to read:4367.5.
The director shall establish criteria for client eligibility, including financial liability, pursuant to Section 4368. However, persons eligible for services provided by regional centers or the State Department of Developmental Services are not eligible for services provided under this chapter. Income shall not be the sole basis for client eligibility. The director shall assume responsibility for the coordination of existing funds and services for brain-impaired adults, and for the purchase of respite care, as defined in subdivision (c) of Section 4362.5, with other departments that may serve brain-impaired adults, including the Department of Rehabilitation, the State Department of Social Services, the State Department of Developmental Services, the Department of Aging, the Office of Statewide Health Planning and Development, and the State Department of Alcohol and Drug Programs.SEC. 54.
Section 4368.5 of the Welfare and Institutions Code is amended to read:4368.5.
In considering total service funds available for the project, the director shall utilize funding available from appropriate state departments, including, but not limited to: the State Department of Social Services, the Department of Rehabilitation, the California Department of Aging, and the State Department of Alcohol and Drug Programs. The director in conjunction with the Statewide Resources Consultant shall coordinate his or her activities with the implementation of the Torres-Felando Long-Term Care Reform Act (Chapter 1453, Statutes of 1982) in order to further the goal of obtaining comprehensive, coordinated public policy and to maximize the availability of funding for programs and services for persons with brain impairments.SEC. 55.
Section 5820 of the Welfare and Institutions Code is amended to read:5820.
(a) It is the intent of this part to establish a program with dedicated funding to remedy the shortage of qualified individuals to provide services to address severe mental illnesses.(b) Each
county mental health program shall submit to the Office of Statewide
Health Planning and Development a needs assessment identifying its
shortages in each professional and other occupational category in order
to increase the supply of professional staff and other staff that county
mental health programs anticipate they will require in order to provide
the increase in services projected to serve additional individuals and
families pursuant to Part 3 (commencing with Section 5800), Part 3.2
(commencing with Section 5830), Part 3.6 (commencing with Section
5840), and Part 4 (commencing with Section 5850) of this division. For
purposes of this part, employment in California’s public mental health
system includes employment in private organizations providing publicly
funded mental health services.
(c) The
Office of Statewide Health Planning and Development, in coordination
with the California Mental Health Planning Council, shall identify the
total statewide needs for each professional and other occupational
category utilizing county needs assessment information and develop a
five-year education and training development plan.
(d) Development
of the first five-year plan shall commence upon enactment of the
initiative. Subsequent plans shall be adopted every five years, with the
next five-year plan due as of April 1, 2014.
(e) Each five-year plan shall be reviewed and approved by the California Mental Health Planning Council.
SEC. 56.
Section 5821 of the Welfare and Institutions Code is amended to read:5821.
(a) The California Mental Health Planning Council shall advise the Office of Statewide Health Planning and Development on education and training policy development and provide oversight for education and training plan development.(b) The Office of
Statewide Health Planning and Development shall work with the
California Mental Health Planning Council and the State Department of
Health Care Services so that council staff is increased appropriately to
fulfill its duties required by Sections 5820 and 5821.
SEC. 57.
Section 5822 of the Welfare and Institutions Code is amended to read:5822.
The Office of Statewide Health Planning and Development shall include in the five-year plan:(a) Expansion
plans for the capacity of postsecondary education to meet the needs of
identified mental health occupational shortages.
(b) Expansion
plans for the forgiveness and scholarship programs offered in return
for a commitment to employment in California’s public mental health
system and make loan forgiveness programs available to current employees
of the mental health system who want to obtain Associate of Arts,
Bachelor of Arts, master’s degrees, or doctoral degrees.
(c) Creation
of a stipend program modeled after the federal Title IV-E program for
persons enrolled in academic institutions who want to be employed in the
mental health system.
(d) Establishment
of regional partnerships between the mental health system and the
educational system to expand outreach to multicultural communities,
increase the diversity of the mental health workforce, to reduce the
stigma associated with mental illness, and to promote the use of
web-based technologies, and distance learning techniques.
(e) Strategies
to recruit high school students for mental health occupations,
increasing the prevalence of mental health occupations in high school
career development programs such as health science academies, adult
schools, and regional occupation centers and programs, and increasing
the number of human service academies.
(f) Curriculum
to train and retrain staff to provide services in accordance with the
provisions and principles of Part 3 (commencing with Section 5800), Part
3.2 (commencing with Section 5830), Part 3.6 (commencing with Section
5840), and Part 4 (commencing with Section 5850) of this division.
(g) Promotion of the employment of mental health consumers and family members in the mental health system.
(h) Promotion
of the meaningful inclusion of mental health consumers and family
members and incorporating their viewpoint and experiences in the
training and education programs in subdivisions (a) through (f).
(i) Promotion
of meaningful inclusion of diverse, racial, and ethnic community
members who are underrepresented in the mental health provider network.
(j) Promotion
of the inclusion of cultural competency in the training and education
programs in subdivisions (a) through (f).
SEC. 58.
Section 5830 of the Welfare and Institutions Code is amended to read:5830.
County mental health programs shall develop plans for innovative programs to be funded pursuant to paragraph (6) of subdivision (a) of Section 5892.(a) The innovative programs shall have the following purposes:
(1) To increase access to underserved groups.
(2) To increase the quality of services, including better outcomes.
(3) To promote interagency collaboration.
(4) To increase access to services.
(b) All projects included in the innovative program portion of the county plan shall meet the following requirements:
(1) Address one of the following purposes as its primary purpose:
(A) Increase access to underserved groups.
(B) Increase the quality of services, including measurable outcomes.
(C) Promote interagency and community collaboration.
(D) Increase access to services.
(2) Support innovative approaches by doing one of the following:
(A) Introducing new mental health practices or approaches, including, but not limited to, prevention and
early intervention.
(B) Making
a change to an existing mental health practice or approach, including,
but not limited to, adaptation for a new setting or community.
(C) Introducing
a new application to the mental health system of a promising
community-driven practice or an approach that has been successful in
nonmental health contexts or settings.
(c) An
innovative project may affect virtually any aspect of mental health
practices or assess a new or changed application of a promising approach
to solving persistent, seemingly intractable mental health challenges,
including, but not limited to, any of the following:
(1) Administrative, governance, and organizational practices, processes, or procedures.
(2) Advocacy.
(3) Education and training for service providers, including nontraditional mental health practitioners.
(4) Outreach, capacity building, and community development.
(5) System development.
(6) Public education efforts.
(7) Research.
(8) Services and interventions, including prevention, early intervention, and treatment.
(d) If
an innovative project has proven to be successful and a county chooses
to continue it, the project workplan shall transition to another
category of funding as appropriate.
(e) County
mental health programs shall expend funds for their innovation programs
upon approval by the Mental Health Services Oversight and
Accountability Commission.
SEC. 59.
Section 5840 of the Welfare and Institutions Code is amended to read:5840.
(a) The State Department of Health Care Services, in coordination with counties, shall establish a program designed to prevent mental illnesses from becoming severe and disabling. The program shall emphasize improving timely access to services for underserved populations.(b) The program shall include the following components:
(1) Outreach
to families, employers, primary care health care providers, and others
to recognize the early signs of potentially severe and disabling mental
illnesses.
(2) Access and
linkage to medically necessary care provided by
county mental health programs for children with severe mental
illness, as defined in Section 5600.3, and for adults and seniors with
severe mental illness, as defined in Section 5600.3, as early in the
onset of these conditions as practicable.
(3) Reduction in stigma associated with either being diagnosed with a mental illness or seeking mental health services.
(4) Reduction in discrimination against people with mental illness.
(c) The
program shall include mental health services similar to those provided
under other programs effective in preventing mental illnesses from
becoming severe, and shall also include components similar to programs
that have been successful in reducing the duration of untreated severe
mental illnesses and assisting people in quickly regaining productive
lives.
(d) The program shall
emphasize strategies to reduce the following negative outcomes that may
result from untreated mental illness:
(1) Suicide.
(2) Incarcerations.
(3) School failure or dropout.
(4) Unemployment.
(5) Prolonged suffering.
(6) Homelessness.
(7) Removal of children from their homes.
(e) Prevention
and early intervention funds may be used to broaden the provision of
community-based mental health services by adding
prevention and early intervention services or activities to these
services.
(f) In consultation
with mental health stakeholders, and consistent with guidelines from the
Mental Health Services Oversight and Accountability Commission,
pursuant to Section 5846, the department shall revise the program
elements in Section 5840 applicable to all county mental health programs
in future years to reflect what is learned about the most effective
prevention and intervention programs for children, adults, and seniors.
SEC. 60.
Section 5845 of the Welfare and Institutions Code is amended to read:5845.
(a) The Mental Health Services Oversight and Accountability Commission is hereby established to oversee Part 3 (commencing with Section 5800), the Adult and Older Adult Mental Health System of Care Act; Part 3.1 (commencing with Section 5820), Human Resources, Education, and Training Programs; Part 3.2 (commencing with Section 5830), Innovative Programs; Part 3.6 (commencing with Section 5840), Prevention and Early Intervention Programs; and Part 4 (commencing with Section 5850), the Children’s Mental Health Services Act. The commission shall replace the advisory committee established pursuant to Section 5814. The commission shall consist of 16 voting members as follows:(1) The
Attorney General or his or her designee.
(2) The Superintendent of Public Instruction or his or her designee.
(3) The
Chairperson of the Senate Health and Human Services Committee or
another member of the Senate selected by the President pro Tempore of
the Senate.
(4) The Chairperson
of the Assembly Health Committee or another member of the Assembly
selected by the Speaker of the Assembly.
(5) Two
persons with a severe mental illness, a family member of an adult or
senior with a severe mental illness, a family member of a child who has
or has had a severe mental illness, a physician specializing in alcohol
and drug treatment, a mental health professional, a county sheriff, a
superintendent of a school district, a representative of a labor
organization,
a representative of an employer with less than 500 employees and a
representative of an employer with more than 500 employees, and a
representative of a health care services plan or insurer, all appointed
by the Governor. In making appointments, the Governor shall seek
individuals who have had personal or family experience with mental
illness.
(b) Members shall
serve without compensation, but shall be reimbursed for all actual and
necessary expenses incurred in the performance of their duties.
(c) The
term of each member shall be three years, to be staggered so that
approximately one-third of the appointments expire in each year.
(d) In carrying out its duties and responsibilities, the commission may do all of the following:
(1) Meet
at least once each
quarter at any time and location convenient to the public as it
may deem appropriate. All meetings of the commission shall be open to
the public.
(2) Within the
limit of funds allocated for these purposes, pursuant to the laws and
regulations governing state civil service, employ staff, including any
clerical, legal, and technical assistance as may appear necessary. The
commission shall administer its operations separate and apart from the
State Department of Health Care Services.
(3) Establish technical advisory committees such as a committee of consumers and family members.
(4) Employ
all other appropriate strategies necessary or convenient to enable it
to fully and adequately perform its duties and exercise the powers
expressly granted, notwithstanding any authority expressly granted to
any officer or employee of
state government.
(5) Enter into contracts.
(6) Obtain
data and information from the State Department of Health Care Services,
the Office of Statewide Health Planning and Development, or other state
or local entities that receive Mental Health Services Act funds, for
the commission to utilize in its oversight, review, training and
technical assistance, accountability, and evaluation capacity regarding
projects and programs supported with Mental Health Services Act funds.
(7) Participate
in the joint state-county decisionmaking process, as contained in
Section 4061, for training, technical assistance, and regulatory
resources to meet the mission and goals of the state’s mental health
system.
(8) Develop strategies
to overcome stigma and discrimination,
and accomplish all other objectives of Part 3.2 (commencing with
Section 5830), 3.6 (commencing with Section 5840), and the other
provisions of the act establishing this commission.
(9) At
any time, advise the Governor or the Legislature regarding actions the
state may take to improve care and services for people with mental
illness.
(10) If the commission
identifies a critical issue related to the performance of a county
mental health program, it may refer the issue to the State Department of
Health Care Services pursuant to Section 5655.
(11) Assist
in providing technical assistance to accomplish the purposes of the
Mental Health Services Act, Part 3 (commencing with Section 5800), and
Part 4 (commencing with Section 5850) in collaboration with the State
Department of Health Care Services and in consultation with
the California Mental Health Directors Association.
(12) Work
in collaboration with the State Department of Health Care Services and
the California Mental Health Planning Council, and in consultation with
the California Mental Health Directors Association, in designing a
comprehensive joint plan for a coordinated evaluation of client outcomes
in the community-based mental health system, including, but not limited
to, parts listed in subdivision (a). The California Health and Human
Services Agency shall lead this comprehensive joint plan effort.
SEC. 61.
Section 5846 of the Welfare and Institutions Code is amended to read:5846.
(a) The commission shall issue guidelines for expenditures pursuant to Part 3.2 (commencing with Section 5830), for innovative programs, and Part 3.6 (commencing with Section 5840), for prevention and early intervention, no later than 180 days before the fiscal year for which the funds will apply.(b) The commission may
provide technical assistance to any county mental health plan as needed
to address concerns or recommendations of the commission or when local
programs could benefit from technical assistance for improvement of
their plans.
(c) The commission
shall ensure that the perspective and participation of diverse
community members reflective of
California populations and others suffering from severe mental
illness and their family members is a significant factor in all of its
decisions and recommendations.
SEC. 62.
Section 5847 of the Welfare and Institutions Code is amended to read:5847.
Integrated Plans for Prevention, Innovation, and System of Care Services.(a) Each
county mental health program shall prepare and submit a three-year
program and expenditure plan, and annual updates, adopted by the county
board of supervisors, to the Mental Health Services Oversight and
Accountability Commission within 30 days after adoption.
(b) The three-year program and expenditure plan shall be based on
available unspent funds and estimated revenue allocations provided by
the state and in accordance with established stakeholder engagement and
planning requirements as required in Section 5848. The three-year
program and expenditure plan and annual updates shall include all of
the following:
(1) A program for prevention and early intervention in accordance with Part 3.6 (commencing with Section 5840).
(2) A
program for services to children in accordance with Part 4 (commencing
with Section 5850), to include a program pursuant to Chapter 4
(commencing with Section 18250) of Part 6 of Division 9 or provide
substantial evidence that it is not feasible to establish a wraparound
program in that county.
(3) A program for services to adults and seniors in accordance with Part 3 (commencing with Section 5800).
(4) A program for innovations in accordance with Part 3.2 (commencing with Section 5830).
(5) A
program for technological needs and capital facilities needed to
provide services pursuant to Part 3 (commencing with Section
5800), Part 3.6 (commencing with Section 5840), and Part 4 (commencing
with Section 5850). All plans for proposed facilities with restrictive
settings shall demonstrate that the needs of the people to be served
cannot be met in a less restrictive or more integrated setting.
(6) Identification
of shortages in personnel to provide services pursuant to the above
programs and the additional assistance needed from the education and
training programs established pursuant to Part 3.1 (commencing with
Section 5820).
(7) Establishment
and maintenance of a prudent reserve to ensure the county program will
continue to be able to serve children, adults, and seniors that it is
currently serving pursuant to Part 3 (commencing with Section 5800), the
Adult and Older Adult Mental Health System of Care Act, Part 3.6
(commencing with
Section 5840), Prevention and Early Intervention Programs, and
Part 4 (commencing with Section 5850), the Children’s Mental Health
Services Act, during years in which revenues for the Mental Health
Services Fund are below recent averages adjusted by changes in the state
population and the California Consumer Price Index.
(8) Certification
by the county mental health director, which ensures that the county has
complied with all pertinent regulations, laws, and statutes of the
Mental Health Services Act, including stakeholder participation and
nonsupplantation requirements.
(9) Certification
by the county mental health director and by the county
auditor-controller that the county has complied with any fiscal
accountability requirements as directed by the State Department of
Health Care Services, and that all expenditures are consistent with the
requirements of the Mental Health
Services Act.
(c) The
programs established pursuant to paragraphs (2) and (3) of subdivision
(b) shall include services to address the needs of transition age youth
ages 16 to 25. In implementing this subdivision, county mental health
programs shall consider the needs of transition age foster youth.
(d) Each
year, the State Department of Health Care Services shall inform the
California Mental Health Directors Association and the Mental Health
Services Oversight and Accountability Commission of the methodology used
for revenue allocation to the counties.
(e) Each
county mental health program shall prepare expenditure plans pursuant
to Part 3 (commencing with Section 5800) for adults and seniors, Part
3.2 (commencing with Section 5830) for innovative programs, Part 3.6
(commencing with Section 5840) for prevention and
early intervention programs, and Part 4 (commencing with Section
5850) for services for children, and updates to the plans developed
pursuant to this section. Each expenditure update shall indicate the
number of children, adults, and seniors to be served pursuant to Part 3
(commencing with Section 5800), and Part 4 (commencing with Section
5850), and the cost per person. The expenditure update shall include
utilization of unspent funds allocated in the previous year and the
proposed expenditure for the same purpose.
(f) A
county mental health program shall include an allocation of funds from a
reserve established pursuant to paragraph (7) of subdivision (b) for
services pursuant to paragraphs (2) and (3) of subdivision (b) in years
in which the allocation of funds for services pursuant to subdivision
(e) are not adequate to continue to serve the same number of individuals
as the county had been serving in the previous fiscal
year.
SEC. 63.
Section 5848 of the Welfare and Institutions Code is amended to read:5848.
(a) Each three-year program and expenditure plan and update shall be developed with local stakeholders, including adults and seniors with severe mental illness, families of children, adults, and seniors with severe mental illness, providers of services, law enforcement agencies, education, social services agencies, veterans, representatives from veterans organizations, providers of alcohol and drug services, health care organizations, and other important interests. Counties shall demonstrate a partnership with constituents and stakeholders throughout the process that includes meaningful stakeholder involvement on mental health policy, program planning, and implementation, monitoring, quality improvement, evaluation, and budget allocations. A draft plan and update shall be prepared and circulated for review and comment for at least 30 days to representatives of stakeholder interests and any interested party who has requested a copy of the draft plans.(b) The
mental health board established pursuant to Section 5604 shall conduct a
public hearing on the draft three-year program and expenditure plan and
annual updates at the close of the 30-day comment period required by
subdivision (a). Each adopted three-year program and expenditure plan
and update shall include any substantive written recommendations for
revisions. The adopted three-year program and expenditure plan or update
shall summarize and analyze the recommended revisions. The mental
health board shall review the adopted plan or update and make
recommendations to the county mental health department for revisions.
(c) The
plans shall include reports on the achievement of performance outcomes
for services
pursuant to Part 3 (commencing with Section 5800), Part 3.6
(commencing with Section 5840), and Part 4 (commencing with Section
5850) funded by the Mental Health Services Fund and established jointly
by the State Department of Health Care Services and the Mental Health
Services Oversight and Accountability Commission, in collaboration with
the California Mental Health Directors Association.
(d) Mental
health services provided pursuant to Part 3 (commencing with Section
5800), and Part 4 (commencing with Section 5850), shall be included in
the review of program performance by the California Mental Health
Planning Council required by paragraph (2) of subdivision (c) of Section
5772 and in the local mental health board’s review and comment on the
performance outcome data required by paragraph (7) of subdivision (a) of
Section 5604.2.
SEC. 64.
Section 5878.1 of the Welfare and Institutions Code is amended to read:5878.1.
(a) It is the intent of this article to establish programs that ensure services will be provided to severely mentally ill children as defined in Section 5878.2 and that they be part of the children’s system of care established pursuant to this part. It is the intent of this act that services provided under this chapter to severely mentally ill children are accountable, developed in partnership with youth and their families, culturally competent, and individualized to the strengths and needs of each child and his or her family.(b) Nothing
in this act shall be construed to authorize any services to be provided
to a minor without the consent of the child’s parent or legal guardian
beyond those already authorized by existing statute.
SEC. 65.
Section 5878.3 of the Welfare and Institutions Code is amended to read:5878.3.
(a) Subject to the availability of funds as determined pursuant to Part 4.5 (commencing with Section 5890) of this division, county mental health programs shall offer services to severely mentally ill children for whom services under any other public or private insurance or other mental health or entitlement program is inadequate or unavailable. Other entitlement programs include but are not limited to mental health services available pursuant to Medi-Cal, child welfare, and special education programs. The funding shall cover only those portions of care that cannot be paid for with public or private insurance, other mental health funds or other entitlement programs.(b) Funding
shall be at sufficient levels to ensure that counties can provide
each child served all of the necessary services set forth in the
applicable treatment plan developed in accordance with this part,
including services where appropriate and necessary to prevent an out of
home placement, such as services pursuant to Chapter 4 (commencing with
Section 18250) of Part 6 of Division 9.
(c) The
State Department of Health Care Services shall contract with county
mental health programs for the provision of services under this article
in the manner set forth in Section 5897.
SEC. 66.
Section 5890 of the Welfare and Institutions Code is amended to read:5890.
(a) The Mental Health Services Fund is hereby created in the State Treasury. The fund shall be administered by the state. Notwithstanding Section 13340 of the Government Code, all moneys in the fund are, except as provided in subdivision (d) of Section 5892, continuously appropriated, without regard to fiscal years, for the purpose of funding the following programs and other related activities as designated by other provisions of this division:(1) Part 3 (commencing with Section 5800), the Adult and Older Adult System of Care Act.
(2) Part 3.2 (commencing with Section 5830), Innovative Programs.
(3) Part 3.6 (commencing with Section 5840), Prevention and Early Intervention Programs.
(4) Part 4 (commencing with Section 5850), the Children’s Mental Health Services Act.
(b) Nothing
in the establishment of this fund, nor any other provisions of the act
establishing it or the programs funded shall be construed to modify the
obligation of health care service plans and disability insurance
policies to provide coverage for mental health services, including those
services required under Section 1374.72 of the Health and Safety Code
and Section 10144.5 of the Insurance Code, related to mental health
parity. Nothing in this act shall be construed to modify the oversight
duties of the Department of Managed Health Care or the duties of the
Department of Insurance with respect to enforcing these obligations of
plans and insurance policies.
(c) Nothing
in this act shall be construed to modify or reduce the existing
authority or responsibility of the State Department of Health Care
Services.
(d) The State
Department of Health Care Services shall seek approval of all applicable
federal Medicaid approvals to maximize the availability of federal
funds and eligibility of participating children, adults, and seniors for
medically necessary care.
(e) Share
of costs for services pursuant to Part 3 (commencing with Section
5800), and Part 4 (commencing with Section 5850) of this division, shall
be determined in accordance with the Uniform Method for Determining
Ability to Pay applicable to other publicly funded mental health
services, unless this Uniform Method is replaced by another method of
determining co-payments, in which case the new method applicable to
other
mental health services shall be applicable to services pursuant to
Part 3 (commencing with Section 5800), and Part 4 (commencing with
Section 5850) of this division.
SEC. 67.
Section 5891 of the Welfare and Institutions Code is amended to read:5891.
(a) The funding established pursuant to this act shall be utilized to expand mental health services. Except as provided in subdivision (j) of Section 5892 due to the state’s fiscal crisis, these funds shall not be used to supplant existing state or county funds utilized to provide mental health services. The state shall continue to provide financial support for mental health programs with not less than the same entitlements, amounts of allocations from the General Fund or from the Local Revenue Fund 2011 in the State Treasury, and formula distributions of dedicated funds as provided in the last fiscal year which ended prior to the effective date of this act. The state shall not make any change to the structure of financing mental health services, which increases a county’s share of costs or financial risk for mental health services unless the state includes adequate funding to fully compensate for such increased costs or financial risk. These funds shall only be used to pay for the programs authorized in Section 5892. These funds may not be used to pay for any other program. These funds may not be loaned to the state General Fund or any other fund of the state, or a county general fund or any other county fund for any purpose other than those authorized by Section 5892.(b) Notwithstanding
subdivision (a), the Controller may use the funds created pursuant to
this part for loans to the General Fund as provided in Sections 16310
and 16381 of the Government Code. Any such loan shall be repaid from the
General Fund with interest computed at 110 percent of the Pooled Money
Investment Account rate, with interest commencing to accrue on the date
the loan is made from the fund. This subdivision does not authorize any
transfer that
would interfere with the carrying out of the object for which
these funds were created.
(c) Commencing
July 1, 2012, on or before the 15th day of each month, pursuant to a
methodology provided by the State Department of Health Care Services,
the Controller shall distribute to each Local Mental Health Service Fund
established by counties pursuant to subdivision (f) of Section 5892,
all unexpended and unreserved funds on deposit as of the last day of the
prior month in the Mental Health Services Fund, established pursuant to
Section 5890, for the provision of programs and other related
activities set forth in Part 3 (commencing with Section 5800), Part 3.2
(commencing with Section 5830), Part 3.6 (commencing with Section 5840),
and Part 4 (commencing with Section 5850).
(d) Counties shall base their expenditures on the county mental
health program’s three-year program and
expenditure plan or annual update, as required by Section 5847.
Nothing in this subdivision shall affect subdivision (a) or (b).
SEC. 68.
Section 5892 of the Welfare and Institutions Code is amended to read:5892.
(a) In order to promote efficient implementation of this act, the county shall use funds distributed from the Mental Health Services Fund as follows:(1) In
2005–06, 2006–07, and in 2007–08 10 percent shall be placed in a trust
fund to be expended for education and training programs pursuant to Part
3.1.
(2) In 2005–06, 2006–07
and in 2007–08 10 percent for capital facilities and technological needs
distributed to counties in accordance with a formula developed in
consultation with the California Mental Health Directors Association to
implement plans developed pursuant to Section 5847.
(3) Twenty
percent of funds distributed to the counties pursuant to
subdivision (c) of Section 5891 shall be used for prevention and early
intervention programs in accordance with Part 3.6 (commencing with
Section 5840) of this division.
(4) The
expenditure for prevention and early intervention may be increased in
any county in which the department determines that the increase will
decrease the need and cost for additional services to severely mentally
ill persons in that county by an amount at least commensurate with the
proposed increase.
(5) The
balance of funds shall be distributed to county mental health programs
for services to persons with severe mental illnesses pursuant to Part 4
(commencing with Section 5850), for the children’s system of care and
Part 3 (commencing with Section 5800), for the adult and older adult
system of care.
(6) Five
percent of the total funding for each county mental health program for
Part 3 (commencing with Section 5800), Part 3.6 (commencing with Section
5840), and Part 4 (commencing with Section 5850) of this division,
shall be utilized for innovative programs in accordance with Sections
5830, 5847, and 5848.
(b) In
any year after 2007–08, programs for services pursuant to Part 3
(commencing with Section 5800), and Part 4 (commencing with Section
5850) of this division may include funds for technological needs and
capital facilities, human resource needs, and a prudent reserve to
ensure services do not have to be significantly reduced in years in
which revenues are below the average of previous years. The total
allocation for purposes authorized by this subdivision shall not exceed
20 percent of the average amount of funds allocated to that county for
the previous five years pursuant to this section.
(c) The
allocations pursuant to subdivisions (a) and (b) shall include funding
for annual planning costs pursuant to Section 5848. The total of these
costs shall not exceed 5 percent of the total of annual revenues
received for the fund. The planning costs shall include funds for county
mental health programs to pay for the costs of consumers, family
members, and other stakeholders to participate in the planning process
and for the planning and implementation required for private provider
contracts to be significantly expanded to provide additional services
pursuant to Part 3 (commencing with Section 5800), and Part 4
(commencing with Section 5850) of this division.
(d) Prior
to making the allocations pursuant to subdivisions (a), (b), and (c),
funds shall be reserved for the costs for the State Department of Health
Care Services, the California Mental Health Planning Council, the
Office of Statewide Health Planning and Development, the Mental
Health Services Oversight and Accountability Commission, the State
Department of Public Health, and any other state agency to implement all
duties pursuant to the programs set forth in this section. These costs
shall not exceed 3.5 percent of the total of annual revenues received
for the fund. The administrative costs shall include funds to assist
consumers and family members to ensure the appropriate state and county
agencies give full consideration to concerns about quality, structure of
service delivery, or access to services. The amounts allocated for
administration shall include amounts sufficient to ensure adequate
research and evaluation regarding the effectiveness of services being
provided and achievement of the outcome measures set forth in Part 3
(commencing with Section 5800), Part 3.6 (commencing with Section 5840),
and Part 4 (commencing with Section 5850) of this division. The amount
of funds available for the purposes of this
subdivision in any fiscal year shall be subject to appropriation
in the annual Budget Act.
(e) In 2004–05 funds shall be allocated as follows:
(1) Forty-five percent for education and training pursuant to Part 3.1 (commencing with Section 5820) of this division.
(2)
Forty-five percent for capital facilities and technology needs in the
manner specified by paragraph (2) of subdivision (a).
(3) Five percent for local planning in the manner specified in subdivision (c).
(4) Five percent for state implementation in the manner specified in subdivision (d).
(f) Each
county shall place all funds received from the State Mental
Health Services Fund in a local Mental Health Services Fund. The
Local Mental Health Services Fund balance shall be invested consistent
with other county funds and the interest earned on the investments shall
be transferred into the fund. The earnings on investment of these funds
shall be available for distribution from the fund in future years.
(g) All
expenditures for county mental health programs shall be consistent with
a currently approved plan or update pursuant to Section 5847.
(h) Other
than funds placed in a reserve in accordance with an approved plan, any
funds allocated to a county which have not been spent for their
authorized purpose within three years shall revert to the state to be
deposited into the fund and available for other counties in future
years, provided however, that funds for capital facilities,
technological needs, or education and training may be
retained for up to 10 years before reverting to the fund.
(i) If
there are still additional revenues available in the fund after the
Mental Health Services Oversight and Accountability Commission has
determined there are prudent reserves and no unmet needs for any of the
programs funded pursuant to this section, including all purposes of the
Prevention and Early Intervention Program, the commission shall develop a
plan for expenditures of these revenues to further the purposes of this
act and the Legislature may appropriate these funds for any purpose
consistent with the commission’s adopted plan which furthers the
purposes of this act.
(j) For
the 2011–12 fiscal year, General Fund revenues will be insufficient to
fully fund many existing mental health programs, including Early and
Periodic Screening, Diagnosis, and Treatment (EPSDT), Medi-Cal Specialty
Mental Health Managed Care,
and mental health services provided for special education pupils.
In order to adequately fund those programs for the 2011–12 fiscal year
and avoid deeper reductions in programs that serve individuals with
severe mental illness and the most vulnerable, medically needy citizens
of the state, prior to distribution of funds under paragraphs (1) to
(6), inclusive, of subdivision (a), effective July 1, 2011, moneys shall
be allocated from the Mental Health Services Fund to the counties as
follows:
(1) Commencing July 1,
2011, one hundred eighty-three million six hundred thousand dollars
($183,600,000) of the funds available as of July 1, 2011, in the Mental
Health Services Fund, shall be allocated in a manner consistent with
subdivision (c) of Section 5778 and based on a formula determined by the
state in consultation with the California Mental Health Directors
Association to meet the fiscal year 2011–12 General Fund obligation for
Medi-Cal Specialty
Mental Health Managed Care.
(2) Upon
completion of the allocation in paragraph (1), the Controller shall
distribute to counties ninety-eight million five hundred eighty-six
thousand dollars ($98,586,000) from the Mental Health Services Fund for
mental health services for special education pupils based on a formula
determined by the state in consultation with the California Mental
Health Directors Association.
(3) Upon
completion of the allocation in paragraph (2), the Controller shall
distribute to counties 50 percent of their 2011–12 Mental Health
Services Act component allocations consistent with Sections 5847 and
5891, not to exceed four hundred eighty-eight million dollars
($488,000,000). This allocation shall commence beginning August 1, 2011.
(4) Upon
completion of the allocation in paragraph (3), and as
revenues are deposited into the Mental Health Services Fund, the
Controller shall distribute five hundred seventy-nine million dollars
($579,000,000) from the Mental Health Services Fund to counties to meet
the General Fund obligation for EPSDT for fiscal year 2011–12. These
revenues shall be distributed to counties on a quarterly basis and based
on a formula determined by the state in consultation with the
California Mental Health Directors Association. These funds shall not be
subject to reconciliation or cost settlement.
(5) The
Controller shall distribute to counties the remaining 2011–12 Mental
Health Services Act component allocations consistent with Sections 5847
and 5891, beginning no later than April 30, 2012. These remaining
allocations shall be made on a monthly basis.
(6) The
total one-time allocation from the Mental Health Services Fund for
EPSDT, Medi-Cal Specialty
Mental Health Managed Care, and mental health services provided to
special education pupils as referenced shall not exceed eight hundred
sixty-two million dollars ($862,000,000). Any revenues deposited in the
Mental Health Services Fund in fiscal year 2011–12 that exceed this
obligation shall be distributed to counties for remaining fiscal year
2011–12 Mental Health Services Act component allocations, consistent
with Sections 5847 and 5891.
(k) Subdivision (j) shall not be subject to repayment.
(l) Subdivision (j) shall become inoperative on July 1, 2012.
SEC. 69.
Section 5897 of the Welfare and Institutions Code is amended to read:5897.
(a) Notwithstanding any other provision of state law, the State Department of Health Care Services shall implement the mental health services provided by Part 3 (commencing with Section 5800), Part 3.6 (commencing with Section 5840), and Part 4 (commencing with Section 5850) of this division through contracts with county mental health programs or counties acting jointly. A contract may be exclusive and may be awarded on a geographic basis. As used herein a county mental health program includes a city receiving funds pursuant to Section 5701.5.(b) Two
or more counties acting jointly may agree to deliver or subcontract for
the delivery of such mental health services. The agreement may
encompass all or any part of the mental health services provided
pursuant to these parts. Any agreement between counties shall delineate
each county’s responsibilities and fiscal liability.
(c) The
department shall implement the provisions of Part 3 (commencing with
Section 5800), Part 3.2 (commencing with Section 5830), Part 3.6
(commencing with Section 5840), and Part 4 (commencing with Section
5850) of this division through the annual county mental health services
performance contract, as specified in Chapter 2 (commencing with Section
5650) of Part 2 of Division 5.
(d) When
a county mental health program is not in compliance with its
performance contract, the department may request a plan of correction
with a specific timeline to achieve improvements.
(e) Contracts
awarded by the State Department of Health Care
Services, the California Mental Health Planning Council, the
Office of Statewide Health Planning and Development, and the Mental
Health Services Oversight and Accountability Commission pursuant to Part
3 (commencing with Section 5800), Part 3.1 (commencing with Section
5820), Part 3.2 (commencing with Section 5830), Part 3.6 (commencing
with Section 5840), Part 3.7 (commencing with Section 5845), Part 4
(commencing with Section 5850), and Part 4.5 (commencing with Section
5890) of this division, may be awarded in the same manner in which
contracts are awarded pursuant to Section 5814 and the provisions of
subdivisions (g) and (h) of Section 5814 shall apply to such contracts.
(f) For
purposes of Section 5775, the allocation of funds pursuant to Section
5892 which are used to provide services to Medi-Cal beneficiaries shall
be included in calculating anticipated county matching funds and the
transfer to the State Department of Health Care
Services of the anticipated county matching funds needed for
community mental health programs.
SEC. 70.
Section 5898 of the Welfare and Institutions Code is amended to read:5898.
The State Department of Health Care Services, in consultation with the Mental Health Services Oversight and Accountability Commission, shall develop regulations, as necessary, for the State Department of Health Care Services, the Mental Health Services Oversight and Accountability Commission, or designated state and local agencies to implement this act. Regulations adopted pursuant to this section shall be developed with the maximum feasible opportunity for public participation and comments.SEC. 71.
Section 5899 is added to the Welfare and Institutions Code, to read:5899.
(a) The State Department of Health Care Services, in consultation with the Mental Health Services Oversight and Accountability Commission and the California Mental Health Directors Association, shall develop and administer instructions for the Annual Mental Health Services Act Revenue and Expenditure Report. This report shall be submitted electronically to the department and to the Mental Health Services Oversight and Accountability Commission.(b) The purpose of the Annual Mental Health Services Act Revenue and Expenditure Report is as follows:
(1) Identify the expenditures of Mental Health Services Act (MHSA) funds that were distributed to
each county.
(2) Quantify the amount of additional funds generated for the mental health system as a result of the MHSA.
(3) Identify unexpended funds, and interest earned on MHSA funds.
(4) Determine reversion amounts, if applicable, from prior fiscal year distributions.
(c) This report is intended to provide information that allows for the evaluation of all of the following:
(1) Children’s systems of care.
(2) Prevention and early intervention strategies.
(3) Innovative projects.
(4) Workforce
education and training.
(5) Adults and older adults systems of care.
(6) Capital facilities and technology needs.
SEC. 72.
Section 14046.7 of the Welfare and Institutions Code is amended to read:14046.7.
(a) General Fund moneys shall not be used for the purposes of this article.(b) Notwithstanding
subdivision (a), no more than two hundred thousand dollars ($200,000)
from the General Fund may be used annually for state administrative
costs associated with implementing this article.
SEC. 73.
Section 14085.6 of the Welfare and Institutions Code is amended to read:14085.6.
(a) Except as stated in subdivision (g), each hospital contracting to provide services under this article that meets the criteria contained in the state Medicaid plan for disproportionate share hospital status shall be eligible to negotiate with the commission for distributions from the Emergency Services and Supplemental Payments Fund, which is hereby created. All distributions from the fund shall be pursuant to this section.(b) (1) To the
extent permitted by federal law, the department shall administer the
fund in accordance with this section.
(2) The money in this fund shall be available for
expenditure by the department for the purposes of this section, subject to approval through the regular budget process.
(c) The fund shall include all of the following:
(1) Subject
to subdivision (l), all public funds transferred by public agencies to
the department for deposit in the fund, as permitted under Section
433.51 of Title 42 of the Code of Federal Regulations or any other
applicable federal Medicaid laws. These transfers shall constitute local
government financial participation in Medi-Cal as permitted under
Section 1902(a)(2) of the federal Social Security Act (Title 42 U.S.C.
Sec. 1396a(a)(2)) and other applicable federal Medicaid laws.
(2) Subject
to subdivision (l), all private donated funds transferred by private
individuals or entities for deposit in the fund as permitted under
applicable federal
Medicaid laws.
(3) Any amounts appropriated to the fund by the Legislature.
(4) Interest that accrues on amounts in the fund.
(5) Moneys
appropriated to the fund, or appropriated for poison control center
grants and transferred to the fund, pursuant to the annual Budget Act.
(d) Amounts
in the fund shall be used as the source for the nonfederal share of
payments to hospitals under this section. Moneys shall be allocated from
the fund by the department and matched by federal funds in accordance
with customary Medi-Cal accounting procedures for purposes of payments
under this section.
(e) Distributions
from the fund shall be supplemental to any and all other amounts that
hospitals would have
received under the contracting program, and under the state
Medicaid plan, including contract rate increases and supplemental
payments and payment adjustments under distribution programs relating to
disproportionate share hospitals.
(f) Distributions
from the fund shall not serve as the state’s payment adjustment program
under Section 1923 of the federal Social Security Act (42 U.S.C. Sec.
1396r-4). To the extent permitted by federal law, and except as
otherwise provided in this section, distributions from the fund shall
not be subject to requirements contained in or related to Section 1923
of the federal Social Security Act (42 U.S.C. Sec. 1396r-4).
Distributions from the fund shall be supplemental contract payments and
may be structured on any federally permissible basis, as negotiated
between the commission and the hospital.
(g) In order to qualify for distributions from the
fund, a hospital shall meet all of the following criteria:
(1) Be a contracting hospital under this article.
(2) Satisfy the state Medicaid plan criteria referred to in subdivision (a).
(3) Be one of the following:
(A) A
licensed provider of basic emergency services as described in Sections
70411 and following of Title 22 of the California Code of Regulations.
(B) A
licensed provider of comprehensive emergency medical services as
defined in Sections 70451 and following of Title 22 of the California
Code of Regulations.
(C) A children’s hospital as defined in Section 14087.21 that satisfies subparagraph (A) or (B) or that
jointly provides basic or comprehensive emergency services in conjunction with another licensed hospital.
(D) A
hospital owned and operated by a public agency that operates two or
more hospitals that qualify under subparagraph (A) or (B) with respect
to the particular state fiscal year.
(E) A
hospital designated by the National Cancer Institute as a comprehensive
or clinical cancer research center that primarily treats acutely ill
cancer patients and that is exempt from the federal Medicare prospective
payment system pursuant to Section 1886(d)(1)(B)(v) of the federal
Social Security Act (42 U.S.C. Sec. 1395ww(d)(1)(B)(v)).
(4) Be
able to demonstrate a purpose for additional funding under the
selective provider contracting program including proposals relating to
emergency services and other health care services,
including infrequent yet high-cost services, such as anti-AB human
antitoxin treatment for infant botulism (human botulinum immune
globulin (HBIG), commonly referred to as “Baby-BIG”), that are made
available, or will be made available, to Medi-Cal beneficiaries.
(h) (1) The
department shall seek federal financial participation for expenditures
made from the fund to the full extent permitted by federal law.
(2) The department shall promptly seek any necessary federal approvals regarding this section.
(i) Any funds remaining in the fund at the end of a fiscal year shall be carried forward for use in following fiscal years.
(j) For purposes of this section, “fund” means the Emergency Services and Supplemental Payments Fund.
(k) (1) Any
public agency transferring amounts to the fund, as specified in
paragraph (1) of subdivision (c), may for that purpose, utilize any
revenues, grants, or allocations received from the state for health care
programs or purposes, unless otherwise prohibited by law. A public
agency may also utilize its general funds or any other public funds or
revenues for purposes of transfers to the fund, unless otherwise
prohibited by law.
(2) Notwithstanding
paragraph (1), a public agency may transfer to the fund only those
moneys that have a source that will qualify for federal financial
participation under the provisions of the Medicaid Voluntary
Contribution and Provider-Specific Tax Amendments of 1991 (Public Law
102-234) or other applicable federal Medicaid laws.
(l) Public
funds transferred
pursuant to paragraph (1) of subdivision (c), and private donated
funds transferred pursuant to paragraph (2) of subdivision (c), shall be
deposited into the fund, and expended pursuant to this section. The
director may accept only those funds that are certified by the
transferring entity as qualifying for federal financial participation
under the terms of the Medicaid Voluntary Contributions and
Provider-Specific Tax Amendments of 1991 (Public Law 102-234) and may
return any funds transferred in error.
(m) The department may adopt emergency regulations, if necessary, for the purposes of this section.
(n) The
state shall be held harmless from any federal disallowance resulting
from this section. A hospital receiving supplemental reimbursement
pursuant to this section shall be liable for any reduced federal
financial participation resulting from the implementation of this
section
with respect to that hospital. The state may recoup that federal
disallowance from the hospital in any manner authorized by law or
contract.
(o) This section
shall become inoperative on June 30, 2013, and, as of January 1, 2014,
is repealed, unless a later enacted statute, that becomes operative on
or before January 1, 2014, deletes or extends the dates on which it
becomes inoperative and is repealed.
SEC. 74.
Section 14085.7 of the Welfare and Institutions Code is amended to read:14085.7.
(a) The Medi-Cal Medical Education Supplemental Payment Fund is hereby created in the State Treasury. Notwithstanding Section 13340 of the Government Code, the fund shall be continuously appropriated to, and under the administrative control of, the department for the purposes specified in this section. Except as otherwise limited by this section, the fund shall consist of all of the following:(1) All
public moneys transferred by public agencies to the department for
deposit into the fund, as permitted under Section 433.51 of Title 42 of
the Code of Federal Regulations or any other applicable federal Medicaid
laws.
(2) All private moneys
donated by private individuals or entities to the department for deposit
in the fund as permitted under applicable federal Medicaid laws.
(3) Any amounts appropriated to the fund by the Legislature.
(4) Any interest that accrues on amounts in the fund.
(b) Any
public agency transferring moneys to the fund may, for that purpose,
utilize any revenues, grants, or allocations received from the state for
health care programs or purposes, unless otherwise prohibited by law. A
public agency may also utilize its general funds or any other public
moneys or revenues for purposes of transfers to the fund, unless
otherwise prohibited by law.
(c) The
department shall have the discretion to accept or not accept moneys
offered to
the department for deposit in the fund. If the department accepts
moneys pursuant to this section, the department shall obtain federal
matching funds to the full extent permitted by law. The department shall
accept only those funds that are certified by the transferring or
donating entity as qualifying for federal financial participation under
the terms of the Medicaid Voluntary Contribution and Provider-Specific
Tax Amendments of 1991 (Public Law 102-234) or Section 433.51 of Title
42 of the Code of Federal Regulations, as applicable, and may return any
funds transferred or donated in error.
(d) Moneys
in the fund shall be used as the source for the nonfederal share of
payments to hospitals under this section. Moneys shall be allocated from
the fund by the department and matched by federal funds in accordance
with customary Medi-Cal accounting procedures for purposes of payments
under subdivision (e). Distributions from the fund shall be
supplemental to any other amounts that hospitals receive under the
contracting program.
(e) For
purposes of recognizing medical education costs incurred for services
rendered to Medi-Cal beneficiaries, payments from this fund shall be
negotiated between the California Medical Assistance Commission and
hospitals contracting under this article that meet the definition of
university teaching hospitals or major (nonuniversity) teaching
hospitals as set forth on page 51 and as listed on page 57 of the
department’s report dated May 1991, entitled “Hospital Peer Grouping.”
Payments from the fund shall be used solely for the purposes identified
in the contract between the hospital and the state.
(f) The
state shall be held harmless from any federal disallowance resulting
from this section. A hospital receiving supplemental reimbursement
pursuant to this section shall be liable for any
reduced federal financial participation resulting from the
implementation of this section with respect to that hospital. The state
may recoup any federal disallowance from the hospital.
(g) This
section shall become inoperative on June 30, 2013, and, as of January
1, 2014, is repealed, unless a later enacted statute, that becomes
operative on or before January 1, 2014, deletes or extends the dates on
which it becomes inoperative and is repealed.
SEC. 75.
Section 14085.8 of the Welfare and Institutions Code is amended to read:14085.8.
(a) The Large Teaching Emphasis Hospital and Children’s Hospital Medi-Cal Medical Education Supplemental Payment Fund is hereby created in the State Treasury.(b) Notwithstanding
Section 13340 of the Government Code, the fund shall be continuously
appropriated to, and under the administrative control of, the department
for the purposes specified in this section.
(c) Except as otherwise limited by this section, the fund shall consist of all of the following:
(1) All
public moneys transferred by public agencies to the department for
deposit into the fund,
as permitted under Section 433.51 of Title 42 of the Code of
Federal Regulations or any other applicable federal Medicaid laws.
(2) All
private moneys donated by private individuals or entities to the
department for deposit in the fund as permitted under applicable federal
Medicaid laws.
(3) Any amounts appropriated to the fund by the Legislature.
(4) Any interest that accrues on amounts in the fund.
(d) Any
public agency transferring moneys to the fund may, for that purpose,
utilize any revenues, grants, or allocations received from the state for
health care programs or purposes, unless otherwise prohibited by law. A
public agency may also utilize its general funds or any other public
moneys or revenues for purposes of transfers to the fund, unless
otherwise prohibited by law.
(e) The
department may accept or not accept moneys offered to the department
for deposit in the fund. If the department accepts moneys pursuant to
this section, the department shall obtain federal matching funds to the
full extent permitted by law. The department shall accept only those
funds that are certified by the transferring or donating entity as
qualifying for federal financial participation under the terms of the
Medicaid Voluntary Contribution and Provider-Specific Tax Amendments of
1991 (Public Law 102-234) or Section 433.51 of Title 42 of the Code of
Federal Regulations, as applicable, and may return any funds transferred
or donated in error.
(f) Moneys
in the fund shall be used as the source for the nonfederal share of
payments to hospitals under this section. Moneys shall be allocated from
the fund by the department and matched by federal
funds in accordance with customary Medi-Cal accounting procedures
for purposes of payments under subdivision (g). Distributions from the
fund shall be supplemental to any other amounts that hospitals receive
under the contracting program.
(g) (1) For
purposes of recognizing medical education costs incurred for services
rendered to Medi-Cal beneficiaries, contracts for payments from the fund
may, at the discretion of the California Medical Assistance Commission,
be negotiated between the commission and hospitals contracting under
this article that are defined as either of the following:
(A) A
large teaching emphasis hospital, as set forth on page 51 and listed on
page 57 of the department’s report dated May 1991, entitled “Hospital
Peer Grouping,” and meets the definition of eligible hospital as defined
in paragraph (3) of subdivision (a) of Section
14105.98.
(B) A
children’s hospital pursuant to Section 10727 and meets the definition
of eligible hospital as defined in paragraph (3) of subdivision (a) of
Section 14105.98.
(2) Payments
from the fund shall be used solely for the purposes identified in the
contract between the hospital and the state.
(h) The
state shall be held harmless from any federal disallowance resulting
from this section. A hospital receiving supplemental reimbursement
pursuant to this section shall be liable for any reduced federal
financial participation resulting from the implementation of this
section with respect to that hospital. The state may recoup any federal
disallowance from the hospital.
(i) This
section shall become inoperative on June 30, 2013, and,
as of January 1, 2014, is repealed, unless a later enacted
statute, that becomes operative on or before January 1, 2014, deletes or
extends the dates on which it becomes inoperative and is repealed.
SEC. 76.
Section 14085.81 of the Welfare and Institutions Code is amended to read:14085.81.
(a) Notwithstanding the requirement in subparagraph (A) of paragraph (1) of subdivision (g) of Section 14085.8 that a hospital must be listed on page 57 of the department’s report dated May 1991, entitled “Hospital Peer Grouping,” any hospital whose license pursuant to Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code was consolidated during the 1999 calendar year with a large teaching emphasis hospital that is listed on page 57 of the above described report shall be eligible to negotiate payments pursuant to paragraph (1) of subdivision (g) of Section 14085.8. All other requirements of Section 14085.8 shall continue to apply.(b) This
section shall become inoperative on June 30, 2013, and, as of
January 1, 2014, is repealed, unless a later enacted statute, that
becomes operative on or before January 1, 2014, deletes or extends the
dates on which it becomes inoperative and is repealed.
SEC. 77.
Section 14085.9 of the Welfare and Institutions Code is amended to read:14085.9.
(a) Except as provided in subdivision (g), each hospital contracting to provide services under this article that meets the criteria contained in the state Medicaid plan for disproportionate share hospital status shall be eligible to negotiate with the commission for distributions from the Small and Rural Hospital Supplemental Payments Fund, which is hereby created and, notwithstanding Section 13340 of the Government Code, is continuously appropriated for the purposes specified in this section. All distributions from the fund shall be pursuant to this section.(b) (1) To the extent permitted by federal law, the department shall administer the fund in accordance
with this section.
(2) The
money in this fund shall be available for expenditure by the department
for the purposes of this section, subject to approval through the
regular budget process.
(c) The fund shall include all of the following:
(1) Subject
to subdivision (l), all public funds transferred by public agencies to
the department for deposit in the fund, as permitted under Section
433.51 of Title 42 of the Code of Federal Regulations or any other
applicable federal Medicaid laws. These transfers shall constitute local
government financial participation in Medi-Cal as permitted under
Section 1902(a)(2) of the federal Social Security Act (Title 42 U.S.C.
Sec. 1396a(a)(2)) and other applicable federal Medicaid laws.
(2) Subject
to subdivision
(l), all private donated funds transferred by private individuals
or entities for deposit in the fund as permitted under applicable
federal Medicaid laws.
(3) Any amounts appropriated to the fund by the Legislature.
(4) Interest that accrues on amounts in the fund.
(d) Amounts
in the fund shall be used as the source for the nonfederal share of
payments to hospitals under this section. Moneys shall be allocated from
the fund by the department and matched by federal funds in accordance
with customary Medi-Cal accounting procedures for purposes of payments
under this section.
(e) Distributions
from the fund shall be supplemental to any and all other amounts that
hospitals would have received under the contracting program, and under
the state
Medicaid plan, including contract rate increases and supplemental
payments and payment adjustments under distribution programs relating to
disproportionate share hospitals.
(f) Distributions
from the fund shall not serve as the state’s payment adjustment program
under Section 1923 of the federal Social Security Act (42 U.S.C. Sec.
1396r-4). To the extent permitted by federal law, and except as
otherwise provided in this section, distributions from the fund shall
not be subject to requirements contained in or related to Section 1923
of the federal Social Security Act (42 U.S.C. Sec. 1396r-4).
Distributions from the fund shall be supplemental contract payments and
may be structured on any federally permissible basis, as negotiated
between the commission and the hospital.
(g) In order to qualify for distributions from the fund, a hospital shall meet all of the following criteria:
(1) Be a contracting hospital under this article.
(2) Satisfy the state Medicaid plan criteria referred to in subdivision (a).
(3) Be a small and rural hospital as defined in Section 124840 of the Health and Safety Code.
(4) Be
a licensed provider of standby emergency services as described in
Section 70649 and following of Title 22 of the California Code of
Regulations.
(5) Be able to
demonstrate a purpose for additional funding under the selective
provider contracting program with proposals relating to health care
services that are made available, or will be made available, to Medi-Cal
beneficiaries.
(6) Be
determined by the
California Medical Assistance Commission to be a hospital that
provides an important community service that otherwise would not be
provided in the community.
(h) (1) The
department shall seek federal financial participation for expenditures
made from the fund to the full extent permitted by federal law.
(2) The department shall promptly seek any necessary federal approvals regarding this section.
(i) Any funds remaining in the fund at the end of a fiscal year shall be carried forward for use in following fiscal years.
(j) For purposes of this section, “fund” means the Small and Rural Hospital Supplemental Payments Fund.
(k) (1) Any
public agency
transferring amounts to the fund, as specified in paragraph (1) of
subdivision (c), may for that purpose, utilize any revenues, grants, or
allocations received from the state for health care programs or
purposes, unless otherwise prohibited by law. A public agency may also
utilize its general funds or any other public funds or revenues for
purposes of transfers to the fund, unless otherwise prohibited by law.
(2) Notwithstanding
paragraph (1), a public agency may transfer to the fund only those
moneys that have a source that will qualify for federal financial
participation under the provisions of the Medicaid Voluntary
Contribution and Provider-Specific Tax Amendments of 1991 (Public Law
102-234) or other applicable federal Medicaid laws.
(l) Public
funds transferred pursuant to paragraph (1) of subdivision (c), and
private donated funds transferred pursuant to paragraph
(2) of subdivision (c), shall be deposited into the fund, and
expended pursuant to this section. The director may accept only those
funds that are certified by the transferring entity as qualifying for
federal financial participation under the terms of the Medicaid
Voluntary Contributions and Provider-Specific Tax Amendments of 1991
(Public Law 102-234) and may return any funds transferred in error.
(m) The department may adopt emergency regulations for the purposes of this section.
(n) The
state shall be held harmless from any federal disallowance resulting
from this section. A hospital receiving supplemental reimbursement
pursuant to this section shall be liable for any reduced federal
financial participation resulting from the implementation of this
section with respect to that hospital. The state may recoup that federal
disallowance from the hospital in any manner authorized
by law or contract.
(o) This
section shall become inoperative on June 30, 2013, and, as of January
1, 2014, is repealed, unless a later enacted statute, that becomes
operative on or before January 1, 2014, deletes or extends the dates on
which it becomes inoperative and is repealed.
SEC. 78.
Article 2.82 (commencing with Section 14087.98) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read:Article 2.82. Managed Health Care Expansion into Rural Counties
14087.98.
(a) The purpose of this article is to provide a comprehensive program of managed health care plan services to Medi-Cal recipients residing in the following counties that currently receive Medi-Cal services on a fee-for-service basis: Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Mariposa, Modoc, Nevada, Mono, Placer, Plumas, San Benito, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne, and Yuba.(b) The
director may enter into exclusive or nonexclusive contracts on a bid or
negotiated basis with one or more managed health care plans to provide a
comprehensive program of managed health care plan
services to Medi-Cal recipients residing in the counties described
in subdivision (a). The director shall give special consideration to
managed health care plans that meet all of the following:
(1) Have demonstrated experience in effectively serving Medi-Cal beneficiaries, including diverse populations.
(2) Have demonstrated experience in effectively partnering with public and traditional safety net health care providers.
(3) Have
demonstrated experience in working with local stakeholders, including
consumers, providers, advocates, and county officials, in plan oversight
and in delivery of care.
(4) Have the lowest administrative costs.
(5) Show support from local county officials as
demonstrated by an action of the county board of supervisors.
(6) Show recent successful experience with expansion of managed care to a rural area.
(7) Offer a quality improvement program for primary care providers.
(c) Contracts
entered into or amended pursuant to this section shall be exempt from
the provisions of Chapter 2 (commencing with Section 10290) of Part 2 of
Division 2 of the Public Contract Code and Chapter 6 (commencing with
Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government
Code.
(d) The managed health
care plans that the department contracts with under this article shall
comply with the requirements of Section 14087.48 and meet all of the
following:
(1) Have Medi-Cal
managed health care plan contract experience, or evidence of the ability
to meet these contracting requirements.
(2) Be
in good financial standing and meet licensure requirements under the
Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2 (commencing
with Section 1340) of Division 2 of the Health and Safety Code), if
applicable.
(3) Meet quality
measures, which may include Medi-Cal and Medicare Healthcare
Effectiveness Data and Information Set measures and other quality
measures determined or developed by the department and the federal
Centers for Medicare and Medicaid Services.
(e) The
managed health care plans that the department contracts with under this
article shall provide Medi-Cal beneficiaries with information about
enrollment rights and options, plan benefits and
rules, and care plan elements so that beneficiaries have the
ability to make informed choices. This information shall be delivered in
a format and language accessible to beneficiaries. The managed health
care plans shall provide access to providers in compliance with
applicable state and federal laws, including, but not limited to,
physical accessibility and the provision of health plan information in
alternative formats.
(f) The
department shall conduct a stakeholder process including relevant
stakeholders to ensure that beneficiaries, health care providers, and
managed health care plans have an opportunity to provide input into the
delivery model for these counties and to help ensure smooth care
transitions for beneficiaries.
(g) Enrollment
in a Medi-Cal managed health care plan or plans under this article
shall be mandatory in order to receive services under Medi-Cal, except
as
otherwise provided by law.
(h) Each
beneficiary or eligible applicant shall be informed that he or she may
choose to continue an established patient-provider relationship if his
or her treating provider is a primary care provider or clinic
contracting with the managed health care plan, has the available
capacity, and agrees to continue to treat that beneficiary or eligible
applicant. The managed health care plans shall comply with continuity of
care requirements in Section 1373.96 of the Health and Safety Code.
(i) (1) Notwithstanding
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of
Title 2 of the Government Code, the department may implement, interpret,
or make specific this section and amend regulations and orders adopted
by the department by means of plan letters, plan or provider bulletins,
or similar instructions, without taking
regulatory action, until the time regulations are adopted. It is
the intent of the Legislature that the department have temporary
authority as necessary to implement program changes until completion of
the regulatory process.
(2) The
department shall adopt emergency regulations no later than July 1,
2014. The department may readopt any emergency regulation authorized by
this section that is the same as or substantially equivalent to an
emergency regulation previously adopted pursuant to this section. The
initial adoption of emergency regulations implementing this section
shall be deemed an emergency and necessary for the immediate
preservation of the public peace, health, safety, or general welfare.
Initial emergency regulations and the one readoption of emergency
regulations authorized by this section shall be exempt from review by
the Office of Administrative Law.
(3) The
initial emergency regulations and the one readoption of emergency
regulations authorized by this section shall be submitted to the Office
of Administrative Law for filing with the Secretary of State and each
shall remain in effect for no more than 180 days, by which time final
regulations may be adopted.
(j) The
cost of any program established under this section shall not exceed the
total amount that the department estimates it would pay for all
services and requirements within the same geographic area under the
fee-for-service Medi-Cal program.
(k) The
department shall have exclusive authority to set the rates, terms, and
conditions of managed health care plan contracts and contract amendments
under this article. The director may include in the contract a
provision for quality assurance withholding from the plan payment, to be
paid only if quality measures identified in the plan
contract are met.
(l) The
department shall provide the fiscal and appropriate policy committees
of the Legislature with quarterly updates, commencing January 1, 2014,
and ending January 1, 2016, regarding the expansion of Medi-Cal managed
care into the new counties authorized pursuant to this section. These
updates shall include, but not be limited to, continuity of care
requests, grievance and appeal rates, and utilization reports for the
new counties.
(m) The
department shall seek all necessary federal approvals to allow for
federal financial participation in expenditures under this article. This
article shall not be implemented until all necessary federal approvals
have been obtained.
(n) This section shall be implemented only to the extent federal financial participation or funding is available.
(o) Notwithstanding
subdivision (q) of Section 6254 of the Government Code, a contract or
contract amendments executed by both parties after the effective date of
the act adding this subdivision shall be considered a public record for
purposes of the California Public Records Act (Chapter 3.5 (commencing
with Section 6250) of Division 7 of Title 1 of the Government Code) and
shall be disclosed upon request. This subdivision applies to contracts
that reveal the department’s rates of payment for health care services,
the rates themselves, and rate manuals.
(p) To
implement this section, the department may contract with public or
private entities. Contracts or amendments entered into under this
section may be on an exclusive or nonexclusive basis and a
noncompetitive bid basis and shall be exempt from the following:
(1) Part
2 (commencing with Section 10100) of Division 2 of the Public Contract
Code and any policies, procedures, or regulations authorized by that
part.
(2) Article 4 (commencing with Section 19130) of Chapter 5 of Part 2 of Division 5 of Title 2 of the Government Code.
(3) Review or approval of contracts by the Department of General Services.
SEC. 79.
Section 14089.08 is added to the Welfare and Institutions Code, to read:14089.08.
(a) Sacramento County may establish a stakeholder advisory committee to provide input on the delivery of oral health and dental care services, including prevention and education services, dental managed care, and fee-for-service Denti-Cal. The advisory committee shall include, but not be limited to, local nonprofit organizations, representatives from the First Five Sacramento Commission, representatives and members of the local dental society, local health and human services representatives, representatives of Medi-Cal dental managed care plans, Medi-Cal enrollees, and other interested individuals. The advisory committee may meet on a monthly basis.(b) The
advisory committee may submit written input
to the State Department of Health Care Services or the Sacramento
County Board of Supervisors, as applicable, regarding policies that
improve the delivery of oral health and dental services in Sacramento
under the Medi-Cal program or county-administered health care system.
(c) The
State Department of Health Care Services shall meet periodically, but
at least on a quarterly basis, with the advisory committee to facilitate
communication, dissemination of information, and improvements in the
provision of oral health and dental care services under the Medi-Cal
program in the County of Sacramento. The dissemination of information
shall include data reported from performance measures and benchmarks
used by the department.
(d) The
advisory committee may meet periodically, but at least twice annually,
with the Sacramento County Department of Health and Human Services
advisory committee
established pursuant to Section 14089.07.
(e) No
state General Fund moneys shall be used to fund advisory committee
costs or to fund any related administrative costs incurred by the
county.
SEC. 80.
Section 14089.09 is added to the Welfare and Institutions Code, to read:14089.09.
(a) It is the intent of the Legislature to improve access to oral health and dental care services provided to Medi-Cal beneficiaries enrolled in dental health managed care plans in the Counties of Sacramento and Los Angeles through implementation of performance contracting to ensure dental health plans meet quality criteria and timely access to dental care, as contained in Section 14459.6, and implementation of a beneficiary dental exception process for Medi-Cal beneficiaries in the County of Sacramento to access dental care through fee-for-service Denti-Cal when applicable.(b) (1) The
Director of Health Care Services shall exercise his or her authority
under Section 14131.15 to
establish a beneficiary dental exception (BDE) process, as
described in paragraph (2), for Medi-Cal beneficiaries mandatorily
enrolled in dental health plans in the County of Sacramento. The BDE
process shall be implemented no later than July 1, 2012, and shall be in
effect for as long as mandatory enrollment for dental care is in effect
in the County of Sacramento. The department shall consult with the
advisory committee established pursuant to Section 14089.08 regarding
potential modifications to the BDE process. For purposes of emergency
access to dental care issues, the department shall establish specific
processes under the BDE to accommodate for these issues.
(2) The
BDE shall be available to Medi-Cal dental managed care beneficiaries in
the County of Sacramento who are unable to secure access to services
through their managed care plan, in accordance with applicable
contractual timeframes and in accordance with the Knox-Keene Health Care
Service Plan Act of 1975 (Chapter 2.2 (commencing with Section
1340) of Division 2 of the Health and Safety Code). The BDE shall allow a
beneficiary to opt-out of Medi-Cal dental managed care and move into
fee-for-service Denti-Cal where the beneficiary may select his or her
own dental provider on an ongoing basis. The beneficiary shall remain in
fee-for-service Denti-Cal until the time he or she chooses to opt in to
a dental managed care arrangement.
(3) Beneficiaries
shall be notified of the BDE option, which shall include the process
for access to emergency visits, through a letter from the department
detailing the process, directions on how to fill out the BDE form, and
where to access the BDE form. A hard copy of the BDE form shall
accompany the letter from the department. The BDE form, directions on
how to fill out the BDE form, and a description of the process shall
also be posted on the department’s Internet Web site for easy access by
beneficiaries and the public. The department shall also notify and
inform dental managed care plans of the BDE process and its operation.
(4) Upon
receipt of the BDE form, the department shall have no more than three
business days to contact the beneficiary. The department shall, within
five business days from the date of contact with the beneficiary, work
with the beneficiary and the dental plan to schedule an appointment
within the applicable contractual timeframes and in accordance with the
Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2 (commencing
with Section 1340) of Division 2 of the Health and Safety Code).
(A) If
an appointment is not available, the department shall approve and
process the BDE and move the beneficiary into fee-for-service Denti-Cal.
(B) If
an appointment is available, the
beneficiary shall receive from the department a followup telephone
call after the appointment to assess how the visit went and to
determine if there is a need for any additional followup.
(5) Based
on the followup as identified in subparagraph (B) of paragraph (4), to
the extent no additional access issues to contractually required
services are identified, the BDE shall be closed and the beneficiary
shall remain in the selected dental plan.
(c) The
department shall take all necessary steps to implement the BDE process
as described in this section and shall, monthly, publicly report on the
department’s Internet Web site the number of individuals requesting the
BDE and the specific outcome of each request, including, but not limited
to, summary data on the types of visits subject to the BDE process, the
services provided, description of timely access to care, the delivery
system in
which services were provided, beneficiary satisfaction, and the
department’s perspective of the outcome. The information provided on the
department’s Internet Web site shall be deidentified in accordance with
the Health Insurance Portability and Availability Act of 1996 (HIPAA),
including Section 164.514 of Title 45 of the Code of Federal
Regulations, and shall not contain any personally indentifiable
information according to the Information Practices Act of 1977 (Chapter 1
(commencing with Section 1798) of Title 1.8 of Part 4 of Division 3 of
the Civil Code).
(d) The department shall consult with stakeholders in the development of the BDE form and related materials.
SEC. 81.
Section 14091.3 of the Welfare and Institutions Code is amended to read:14091.3.
(a) For purposes of this section, the following definitions shall apply:(1) “Medi-Cal
managed care plan contracts” means those contracts entered into with
the department by any individual, organization, or entity pursuant to
Article 2.7 (commencing with Section 14087.3), Article 2.8 (commencing
with Section 14087.5), or Article 2.91 (commencing with Section 14089)
of this chapter, or Article 1 (commencing with Section 14200) or Article
7 (commencing with Section 14490) of Chapter 8, or Chapter 8.75
(commencing with Section 14591).
(2) “Medi-Cal
managed care health plan” means an individual, organization, or entity
operating under a Medi-Cal managed care
plan contract with the department under this chapter, Chapter 8
(commencing with Section 14200), or Chapter 8.75 (commencing with
Section 14591).
(b) The
department shall take all appropriate steps to amend the Medicaid State
Plan, if necessary, to carry out this section. This section shall be
implemented only to the extent that federal financial participation is
available.
(c) (1) Any
hospital that does not have in effect a contract with a Medi-Cal managed
care health plan, as defined in paragraph (2) of subdivision (a), that
establishes payment amounts for services furnished to a beneficiary
enrolled in that plan shall accept as payment in full, from all these
plans, the following amounts:
(A) For outpatient services, the Medi-Cal fee-for-service (FFS) payment amounts.
(B) For
emergency inpatient services, the average per diem contract rate
specified in paragraph (2) of subdivision (b) of Section 14166.245,
except that the payment amount shall not be reduced by 5 percent, until
July 1, 2013, and thereafter, the average contract rate specified in
Section 1396u-2(b)(2) of Title 42 of the United States Code. For the
purposes of this subparagraph, this payment amount shall apply to all
hospitals, including hospitals that contract with the department under
the Medi-Cal Selective Provider Contracting Program described in Article
2.6 (commencing with Section 14081), and small and rural hospitals
specified in Section 124840 of the Health and Safety Code.
(C) For
poststabilization services following an emergency admission, payment
amounts shall be consistent with Section 438.114(e) of Title 42 of the
Code of Federal Regulations. This paragraph shall only be
implemented to the extent that contract amendment language
providing for these payments is approved by CMS. For purposes of this
subparagraph, this payment amount shall apply to all hospitals,
including hospitals that contract with the department under the Medi-Cal
Selective Provider Contracting Program pursuant to Article 2.6
(commencing with Section 14081).
(2) The
rates established in paragraph (1) for emergency inpatient services and
poststabilization services shall remain in effect only until the
department implements the payment methodology based on diagnosis-related
groups pursuant to Section 14105.28.
(3) Upon
implementation of the payment methodology based on diagnosis-related
groups pursuant to Section 14105.28, any hospital described in paragraph
(1) shall accept as payment in full for inpatient hospital services,
including both emergency inpatient services and
poststabilization services related to an emergency medical
condition, the payment amount established pursuant to the methodology
developed under Section 14105.28.
(d) Medi-Cal
managed care health plans that, pursuant to the department’s
encouragement in All Plan Letter 07003, have been paying out-of-network
hospitals the most recent California Medical Assistance Commission
regional average per diem rate as a temporary rate for purposes of
Section 1932(b)(2)(D) of the federal Social Security Act (SSA), which
became effective January 1, 2007, shall make reconciliations and
adjustments for all hospital payments made since January 1, 2007, based
upon rates published by the department pursuant to Section 1932(b)(2)(D)
of the SSA and effective January 1, 2007, to June 30, 2008, inclusive,
and, if applicable, provide supplemental payments to hospitals as
necessary to make payments that conform with Section 1932(b)(2)(D) of
the SSA. In order to provide
managed care health plans with 60 working days to make any
necessary supplemental payments to hospitals prior to these payments
becoming subject to the payment of interest, Section 1300.71 of Title 28
of the California Code of Regulations shall not apply to these
supplemental payments until 30 working days following the publication by
the department of the rates.
(e) (1) The
department shall provide a written report to the policy and fiscal
committees of the Legislature on October 1, 2009, and May 1, 2010, on
the implementation and impact made by this section, including the impact
of these changes on access to hospitals by managed care enrollees and
on contracting between hospitals and managed care health plans,
including the increase or decrease in the number of these contracts.
(2) Not
later than August 1, 2010, the department shall report to the
Legislature on the implementation of this section. The report
shall include, but not be limited to, information and analyses
addressing managed care enrollee access to hospital services, the impact
of this section on managed care health plan capitation rates, the
impact of this section on the extent of contracting between managed care
health plans and hospitals, and fiscal impact on the state.
(3) For
the purposes of preparing the status reports and the final evaluation
report required pursuant to this subdivision, Medi-Cal managed care
health plans shall provide the department with all data and
documentation, including contracts with providers, including hospitals,
as deemed necessary by the department to evaluate the impact of the
implementation of this section. In order to ensure the confidentiality
of managed care health plan proprietary information, and thereby enable
the department to have access to all of the data necessary to provide
the Legislature with accurate and meaningful information regarding
the impact of this section, all information and documentation provided
to the department pursuant to this section shall be considered
proprietary and shall be exempt from disclosure as official information
pursuant to subdivision (k) of Section 6254 of the Government Code as
contained in the California Public Records Act (Chapter 3.5 (commencing
with Section 6250) of Division 7 of Title 1 of the Government Code).
(f) Notwithstanding
the rulemaking provisions of 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 may implement, interpret, or
make specific this section and applicable federal waivers and state plan
amendments by means of all-county letters, plan letters, plan or
provider bulletins, or similar instructions, without taking regulatory
action. Prior to issuing any
letter or similar instrument authorized pursuant to this section,
the department shall notify and consult with stakeholders, including
advocates, providers, and beneficiaries.
(g) This
section shall become inoperative on July 1, 2013, and, as of January 1,
2014, is repealed, unless a later enacted statute, that becomes
operative on or before January 1, 2014, deletes or extends the dates on
which it becomes inoperative and is repealed.
SEC. 82.
Section 14105.196 is added to the Welfare and Institutions Code, to read:14105.196.
(a) It is the intent of the Legislature to comply with the provisions of the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152) and temporarily increase reimbursement to certain primary care providers at the same levels as Medicare rates for the 2013 and 2014 calendar years for specified services.(b) (1) Notwithstanding
any other law, to the extent required by federal law and regulations,
beginning January 1, 2013, through and including December 31, 2014,
payments for primary care services provided by a physician with a
primary specialty designation of family medicine, general internal
medicine, or pediatric medicine shall not be less than 100
percent of the payment rate that applies to those services and
physicians as established by the Medicare Program, for both
fee-for-service and managed care plans.
(2) Notwithstanding
any other law, to the extent required by federal law and regulations,
beginning January 1, 2013, through and including December 31, 2014, the
payments for primary care services implemented pursuant to this section
shall be exempt from the payment reductions under Sections 14105.191 and
14105.192.
(c) For purposes of
this section, “primary care services” and “primary specialty” means the
services and primary specialties defined in Section 1202 of the federal
Health Care and Education Reconciliation Act of 2010 (Public Law
111-152; 42 U.S.C. Sec. 1396a(a)(13)(C)) and related federal
regulations.
(d) Notwithstanding
any other law, effective
on or after January 1, 2013, the payment increase implemented
pursuant to this section shall apply to managed care health plans that
contract with the department pursuant to Chapter 8.75 (commencing with
Section 14591) and to contracts with the Senior Care Action Network and
the AIDS Healthcare Foundation, and to the extent that the services are
provided through any of these contracts, payments shall be increased by
the actuarial equivalent amount of the payment increases pursuant to
contract amendments or change orders effective on or after January 1,
2013.
(e) Notwithstanding
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of
Title 2 of the Government Code, the department shall implement, clarify,
make specific, and define the provisions of this section by means of
provider bulletins or similar instructions, without taking regulatory
action.
(f) Notwithstanding
paragraph (1) of subdivision (b), if a final judicial determination is
made by any state or federal court that is not appealed, in any action
by any party, or a final determination is made by the administrator of
the federal Centers for Medicare and Medicaid Services, that any
payments pursuant to this section are invalid, unlawful, or contrary to
any provision of federal law or regulations, or of state law, this
section shall become inoperative.
(g) (1) The
director shall implement the increased payments for primary care
services and primary specialties provided for in this section only to
the extent that the federal medical assistance percentage is equal to
100 percent.
(2) In assessing
whether federal financial participation is available, the director shall
determine whether the payments comply with applicable federal
Medicaid requirements, including those set forth in Section
1396a(a)(30)(A) of Title 42 of the United States Code.
(3) To
the extent that the director determines that the payments do not comply
with applicable federal Medicaid requirements, the director shall
retain the discretion not to implement the changes and may revise the
payments as necessary to comply with the federal Medicaid requirements.
(h) 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. 83.
Section 14105.22 of the Welfare and Institutions Code is amended to read:14105.22.
(a) (1) Reimbursement for clinical laboratory or laboratory services, as defined in Section 51137.2 of Title 22 of the California Code of Regulations, may not exceed 80 percent of the lowest maximum allowance established by the federal Medicare Program for the same or similar services.(2) This
subdivision shall be implemented only until the new rate methodology
under subdivision (b) is approved by the federal Centers for Medicare
and Medicaid Services (CMS).
(b) (1) It
is the intent of the Legislature that the department develop payment
rates for clinical laboratory or
laboratory services that are comparable to the payment amounts
received from other payers for laboratory services. Development of these
rates will enable the department to reimburse clinical laboratory or
laboratory service providers in compliance with state and federal law.
(2) (A) The
provisions of Section 51501(a) of Title 22 of the California Code of
Regulations shall not apply to the rate methodology developed for
clinical laboratories or laboratory services pursuant to this
subdivision.
(B) In addition to
subparagraph (a), any payment reductions implemented pursuant to this
section shall not be subject to the provisions of Section 51501(a) of
Title 22 of the California Code of Regulations for 12 months following
the date of implementation of this reduction.
(3) Reimbursement to providers
for clinical laboratory or laboratory services shall not exceed the lowest of the following:
(A) The amount billed.
(B) The charge to the general public.
(C) Eighty
percent of the lowest maximum allowance established by the federal
Medicare Program for the same or similar services.
(D) A
reimbursement rate based on an average of the lowest amount that other
payers and other state Medicaid programs are paying for similar clinical
laboratory services.
(4) In
addition to the payment reductions implemented pursuant to Section
14105.192, payments shall be reduced by up to 10 percent for clinical
laboratory or laboratory services, as defined in Section 51137.2 of
Title 22 of the California Code
of Regulations, for dates of service on and after July 1, 2012.
The payment reductions pursuant to this paragraph shall continue until
the new rate methodology under this subdivision has been approved by
CMS.
(5) (A) For purposes
of establishing reimbursement rates for clinical laboratory or
laboratory services based on the lowest amounts other payers are paying
providers for similar laboratory services, laboratory service providers
shall submit data reports within six months of the date the act that
added this paragraph becomes effective and annually thereafter. The data
provided shall be based on the previous calendar year and shall specify
the provider’s usual and customary payments, reflecting Medi-Cal, other
state Medicaid programs, private insurance, and Medicare payment data,
minus discounts and rebates.
(B) The
data submitted pursuant to subparagraph
(A) may be used to determine reimbursement rates by procedure code
based on an average of the lowest amount other payers are paying
providers for similar laboratory services, excluding significant
deviations of cost or volume factors and with consideration to
geographical areas.
(C) For
purposes of subparagraph (B), the department may contract with a vendor
for the purposes of collecting payment data reports from clinical
laboratories, analyzing payment information, and calculating a proposed
rate.
(D) The proposed rates
calculated by the vendor described in subparagraph (C) may be used in
determining the lowest reimbursement rate for clinical laboratories or
laboratory services in accordance with paragraph (3).
(E) Data reports submitted to the department shall be certified by the provider’s certified financial
officer or an authorized individual.
(F) Clinical
laboratory providers that fail to submit data reports within 30 working
days from the time requested by the department shall be subject to the
suspension provisions of subdivisions (a) and (c) of Section 14123.
(6) Data
reports provided to the department pursuant to this section shall be
confidential and shall be exempt from disclosure under the California
Public Records Act (Chapter 3.5 (commencing with Section 6250) of
Division 7 of Title 1 of the Government Code).
(7) The department shall seek stakeholder input on the rate setting methodology.
(8) (A) Notwithstanding
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of
Title 2 of the Government Code, the
department shall, without taking any further regulatory action,
implement, interpret, or make specific this section by means of provider
bulletins or similar instructions until regulations are adopted. It is
the intent of the Legislature that the department have temporary
authority as necessary to implement program changes until completion of
the regulatory process.
(B) The
department shall adopt emergency regulations no later than July 1,
2014. The department may readopt any emergency regulation authorized by
this section that is the same as or substantially equivalent to an
emergency regulation previously adopted pursuant to this section. The
initial adoption of emergency regulations implementing the amendments to
this section and the one readoption of emergency regulations authorized
by this section shall be deemed an emergency and necessary for the
immediate preservation of the public peace, health, safety, or general
welfare. Initial
emergency regulations and the one readoption of emergency
regulations authorized by this section shall be exempt from review by
the Office of Administrative Law.
(C) The
initial emergency regulations and the one readoption of emergency
regulations authorized by this section shall be submitted to the Office
of Administrative Law for filing with the Secretary of State and each
shall remain in effect for no more than 180 days, by which time final
regulations may be adopted.
(9) To
the extent that the director determines that the new methodology or
payment reductions are not consistent with the requirements of Section
1396a(a)(30)(A) of Title 42 of the United States Code, the department
may revert to the methodology under subdivision (a) to ensure access to
care is not compromised.
(10) (A) The
department shall implement this section in a manner that is
consistent with federal Medicaid law and regulations. The director shall
seek any necessary federal approvals for the implementation of this
section. This section shall be implemented only to the extent that
federal approval is obtained.
(B) In
determining whether federal financial participation is available, the
director shall determine whether the rates and payments comply with
applicable federal Medicaid requirements, including those set forth in
Section 1396a(a)(30)(A) of Title 42 of the United States Code.
(C) To
the extent that the director determines that the rates and payments do
not comply with applicable federal Medicaid requirements or that federal
financial participation is not available with respect to any
reimbursement rate, the director retains the discretion not to implement
that rate or payment and may
revise the rate or payment as necessary to comply with federal
Medicaid requirements. The department shall notify the Joint Legislative
Budget Committee 10 days prior to revising the rate or payment to
comply with federal Medicaid requirements.
SEC. 84.
Section 14134 of the Welfare and Institutions Code, as amended by Chapter 3 of the Statutes of 2011, is amended to read:14134.
(a) Except for any prescription, refill, visit, service, device, or item for which the program’s payment is ten dollars ($10) or less, in which case no copayment shall be required, a recipient of services under this chapter shall be required to make copayments not to exceed the maximum permitted under federal regulations or federal waivers as follows:(1) Copayment
of five dollars ($5) shall be made for nonemergency services received
in an emergency department or emergency room when the services do not
result in the treatment of an emergency medical condition or inpatient
admittance. For the purposes of this section, “nonemergency services”
means services not required to, as appropriate, medically screen,
examine, evaluate,
or stabilize an emergency medical condition that manifests itself
by acute symptoms of sufficient severity, including severe pain, such
that the absence of immediate medical attention could reasonably be
expected to result in any of the following:
(A) Placing
the individual’s health, or, with respect to a pregnant woman, the
health of the woman or her unborn child, in serious jeopardy.
(B) Serious impairment to bodily functions.
(C) Serious dysfunction of any bodily organ or part.
(2) Copayment of one dollar ($1) shall be made for each drug prescription or refill.
(3) Copayment of one dollar ($1) shall be made for each visit for services under subdivisions (a) and (h) of Section 14132.
(4) The
copayment amounts set forth in paragraphs (1), (2), and (3) may be
collected and retained or waived by the provider.
(5) The
department shall not reduce the reimbursement otherwise due to
providers as a result of the copayment. The copayment amounts shall be
in addition to any reimbursement otherwise due the provider for services
rendered under this program.
(6) This section does not apply to emergency services, family planning services, or to any services received by:
(A) Any child in AFDC-Foster Care, as defined in Section 11400.
(B) Any person who is an inpatient in a health facility, as defined in Section 1250 of the Health and Safety Code.
(C) Any person 18 years of age or under.
(D) Any woman receiving perinatal care.
(7) Paragraph (2) does not apply to any person 65 years of age or over.
(8) A
provider of service shall not deny care or services to an individual
solely because of that person’s inability to copay under this section.
An individual shall, however, remain liable to the provider for any
copayment amount owed.
(9) The
department shall seek any federal waivers necessary to implement this
section. The provisions for which appropriate federal waivers cannot be
obtained shall not be implemented, but provisions for which waivers are
either obtained or found to be unnecessary shall be unaffected by the
inability to obtain
federal waivers for the other provisions.
(10) The
director shall adopt any regulations necessary to implement this
section as emergency regulations in accordance with Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code. The adoption of the regulations shall be deemed to
be an emergency and necessary for the immediate preservation of the
public peace, health and safety, or general welfare. The director shall
transmit these emergency regulations directly to the Secretary of State
for filing and the regulations shall become effective immediately upon
filing. Upon completion of the formal regulation adoption process and
prior to the expiration of the 120 day duration period of emergency
regulations, the director shall transmit directly to the Secretary of
State for filing the adopted regulations, the rulemaking file, and the
certification of compliance as required by subdivision (e) of Section
11346.1 of the Government Code.
(b) This
section, or subdivisions thereof, if applicable, shall become
inoperative on the implementation date for copayments stated in the
declaration executed by the director pursuant to Section 14134 as added
by Section 101.5 of the act that added this subdivision.
SEC. 85.
Section 14134 of the Welfare and Institutions Code, as added by Chapter 3 of the Statutes of 2011, is amended to read:14134.
(a) The Legislature finds and declares all of the following:(1) Costs
within the Medi-Cal program continue to grow due to the rising cost of
providing health care throughout the state and also due to increases in
enrollment, which are more pronounced during difficult economic times.
(2) In
order to minimize the need for drastically cutting enrollment standards
or benefits or imposing further reductions on Medi-Cal providers during
times of economic crisis, it is crucial to find areas within the
program where beneficiaries can share responsibility for utilization of
health care, whether they are participating in the fee-for-service or
the managed care model of
service delivery.
(3) The
establishment of cost-sharing obligations within the Medi-Cal program
is complex and is subject to close supervision by the United States
Department of Health and Human Services.
(4) As
the single state agency for Medicaid in California, the State
Department of Health Care Services has unique expertise that can inform
decisions that set or adjust cost-sharing responsibilities for Medi-Cal
beneficiaries receiving health care services.
(b) Therefore,
it is the intent of the Legislature for the department to obtain
federal approval to implement cost-sharing for Medi-Cal beneficiaries
and permit providers to require that individuals meet their cost-sharing
obligation prior to receiving care or services.
(c) A
Medi-Cal beneficiary
shall be required to make copayments as described in this section.
These copayments represent a contribution toward the rate of payment
made to providers of Medi-Cal services and shall be as follows:
(1) Copayment
of up to fifty dollars ($50) shall be made for nonemergency services
received in an emergency department or emergency room when the services
do not result in the treatment of an emergency condition or inpatient
admittance. For the purposes of this section, “nonemergency services”
means services not required to, as appropriate, medically screen,
examine, evaluate, or stabilize an emergency medical condition that
manifests itself by acute symptoms of sufficient severity, including
severe pain, such that the absence of immediate medical attention could
reasonably be expected to result in any of the following:
(A) Placing the individual’s health, or, with respect to a
pregnant woman, the health of the woman or her unborn child, in serious jeopardy.
(B) Serious impairment to bodily functions.
(C) Serious dysfunction of any bodily organ or part.
(2) Copayment
of up to fifty dollars ($50) shall be made for emergency services
received in an emergency department or emergency room when the services
result in the treatment of an emergency medical condition or inpatient
admittance. For purposes of this section, “emergency services” means
services required to, as appropriate, medically screen, examine,
evaluate, or stabilize an emergency medical condition that manifests
itself by acute symptoms of sufficient severity, including severe pain,
such that the absence of immediate medical attention could reasonably be
expected to result in any of the following:
(A) Placing
the individual’s health, or, with respect to a pregnant woman, the
health of the woman or her unborn child, in serious jeopardy.
(B) Serious impairment to bodily functions.
(C) Serious dysfunction of any bodily organ or part.
(3) Copayment
of up to one hundred dollars ($100) shall be made for each hospital
inpatient day, up to a maximum of two hundred dollars ($200) per
admission.
(4) Copayment of up
to three dollars ($3) shall be made for each preferred drug prescription
or refill. A copayment of up to five dollars ($5) shall be made for
each nonpreferred drug prescription or refill. Except as provided in
subdivision (g), “preferred drug” shall have the same meaning as in
Section
1916A of the Social Security Act (42 U.S.C. Sec. 1396o-1).
(5) Copayment
of up to five dollars ($5) shall be made for each visit for services
under subdivision (a) of Section 14132 and for dental services received
on an outpatient basis provided as a Medi-Cal benefit pursuant to this
chapter or Chapter 8 (commencing with Section 14200), as applicable.
(6) This section does not apply to services provided pursuant to subdivision (aa) of Section 14132.
(d) The
copayments established pursuant to subdivision (c) shall be set by the
department, at the maximum amount provided for in the applicable
paragraph, except that each copayment amount shall not exceed the
maximum amount allowable pursuant to the state plan amendments or other
federal approvals.
(e) The
copayment amounts set forth in subdivision (c) may be collected
and retained or waived by the provider. The department shall deduct the
amount of the copayment from the payment the department makes to the
provider whether retained, waived, or not collected by the provider.
(f) Notwithstanding
any other provision of law, and only to the extent allowed pursuant to
federal law, a provider of service has no obligation to provide services
to a Medi-Cal beneficiary who does not, at the point of service, pay
the copayment assessed pursuant to this section. If the provider
provides services without collecting the copayment, and has not waived
the copayment, the provider may hold the beneficiary liable for the
copayment amount owed.
(g) (1) Notwithstanding
any other provision of law, except as described in paragraph (2), this
section shall apply to Medi-Cal
beneficiaries enrolled in a health plan contracting with the
department pursuant to this chapter or Chapter 8 (commencing with
Section 14200), except for the Senior Care Action Network or AIDS
Healthcare Foundation. To the extent permitted by federal law and
pursuant to any federal waivers or state plan adjustments obtained, a
managed care health plan may establish a lower copayment or no
copayment.
(2) For the purpose
of paragraph (4) of subdivision (c), copayments assessed against a
beneficiary who receives Medi-Cal services through a health plan
described in paragraph (1) shall be based on the plan’s designation of a
drug as preferred or nonpreferred.
(3) To
the extent provided by federal law, capitation payments shall be
calculated on an actuarial basis as if copayments described in this
section were collected.
(h) This
section shall be implemented only to the extent that federal financial
participation is available. The department shall seek and obtain any
federal waivers or state plan amendments necessary to implement this
section. The provisions for which appropriate federal waivers or state
plan amendments cannot be obtained shall not be implemented, but
provisions for which waivers or state plan amendments are either
obtained or found to be unnecessary shall be unaffected by the inability
to obtain federal waivers or state plan amendments for the other
provisions.
(i) Notwithstanding
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of
Title 2 of the Government Code, the department may implement, interpret,
or make specific this section by means of all-county letters, all-plan
letters, provider bulletins, or similar instructions, without taking
further regulatory actions.
(j) (1) This
section shall become operative on the date that the act adding this
section is effective, but shall not be implemented until the date in the
declaration executed by the director pursuant to paragraph (2). In no
event shall the director set an implementation date prior to the date
federal approval is received.
(2) The
director shall execute a declaration that states the date that
implementation of the copayments described in this section or
subdivisions thereof, if applicable, will commence and shall post the
declaration on the department’s Internet Web site and provide a copy of
the declaration to the Chair of the Joint Legislative Budget Committee,
the Chief Clerk of the Assembly, the Secretary of the Senate, the Office
of the Legislative Counsel, and the Secretary of State.
SEC. 86.
Section 14134.1 of the Welfare and Institutions Code is amended to read:14134.1.
(a) Except as provided in paragraph (2) of subdivision (a) of Section 14134, no provider under this chapter may deny care or services to an individual eligible for care or services under this chapter because of the individual’s inability to pay a copayment, as defined in Section 14134. The requirements of this section shall not extinguish the liability of the individual to whom the care or services were furnished for payment of the copayment.(b) Notwithstanding
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of
Title 2 of the Government Code, the department may implement, interpret,
or make specific this section by means of all-county letters, provider
bulletins, or similar instructions, without
taking further regulatory action.
(c) This
section shall become inoperative to the extent, and on the
implementation date for, copayments as stated in the declaration
executed by the director pursuant to Section 14134 as added by Section
101.5 of the act that added this subdivision.
SEC. 87.
Section 14154 of the Welfare and Institutions Code is amended to read:14154.
(a) (1) The department shall establish and maintain a plan whereby costs for county administration of the determination of eligibility for benefits under this chapter will be effectively controlled within the amounts annually appropriated for that administration. The plan, to be known as the County Administrative Cost Control Plan, shall establish standards and performance criteria, including workload, productivity, and support services standards, to which counties shall adhere. The plan shall include standards for controlling eligibility determination costs that are incurred by performing eligibility determinations at county hospitals, or that are incurred due to the outstationing of any other eligibility function. Except as provided in Section 14154.15, reimbursement to a county for outstationed eligibility functions shall be based solely on productivity standards applied to that county’s welfare department office.(2) (A) The plan shall delineate both of the following:
(i) The
process for determining county administration base costs, which include
salaries and benefits, support costs, and staff development.
(ii) The process for determining funding for caseload changes, cost-of-living adjustments, and program and other changes.
(B) The
annual county budget survey document utilized under the plan shall be
constructed to enable the counties to provide sufficient detail to the
department to support their budget requests.
(3) The
plan shall be part of a single state plan, jointly developed by the
department and the State Department of Social Services, in conjunction
with the counties, for administrative cost control for the California
Work Opportunity and Responsibility to Kids (CalWORKs), CalFresh, and
Medical Assistance (Medi-Cal) programs. Allocations shall be made to
each county and shall be limited by and determined based upon the County
Administrative Cost Control Plan. In administering the plan to control
county administrative costs, the department shall not allocate state
funds to cover county cost overruns that result from county failure to
meet requirements of the plan. The department and the State Department
of Social Services shall budget, administer, and allocate state funds
for county administration in a uniform and consistent manner.
(4) The
department and county welfare departments shall develop procedures to
ensure the data clarity,
consistency, and reliability of information contained in the
county budget survey document submitted by counties to the department.
These procedures shall include the format of the county budget survey
document and process, data submittal and its documentation, and the use
of the county budget survey documents for the development of determining
county administration costs. Communication between the department and
the county welfare departments shall be ongoing as needed regarding the
content of the county budget surveys and any potential issues to ensure
the information is complete and well understood by involved parties. Any
changes developed pursuant to this section shall be incorporated within
the state’s annual budget process by no later than the 2011–12 fiscal
year.
(5) The department shall
provide a clear narrative description along with fiscal detail in the
Medi-Cal estimate package, submitted to the Legislature in January and
May of
each year, of each component of the county administrative funding
for the Medi-Cal program. This shall describe how the information
obtained from the county budget survey documents was utilized and, where
applicable, modified and the rationale for the changes.
(6) Notwithstanding
any other provision of law, the department shall develop and implement,
in consultation with county program and fiscal representatives, a new
budgeting methodology for Medi-Cal county administrative costs. The new
budgeting methodology shall be used to reimburse counties for
eligibility determinations for applicants and beneficiaries, including
one-time eligibility processing and ongoing case maintenance.
(A) The
budgeting methodology shall include, but is not limited to,
identification of the costs of eligibility determinations for
applicants, and the costs of eligibility redeterminations and case
maintenance activities for recipients, for different groupings of
cases. The groupings of cases shall be based on variations in time and
resources needed to conduct eligibility determinations. The calculation
of time and resources shall be based on the following factors:
complexity of eligibility rules, ongoing eligibility requirements, and
other factors as determined appropriate by the department.
(B) The
new budgeting methodology shall be clearly described, state the
necessary data elements to be collected from the counties, and establish
the timeframes for counties to provide the data to the state.
(C) The department may develop a process for counties to phase in the requirements of the new budgeting methodology.
(D) To the extent a county does not submit the requested data pursuant to subparagraph (B), the new
budgeting methodology may include a process to use peer-based proxy costs in developing the county budget.
(E) The
department shall provide the new budgeting methodology to the
legislative fiscal committees by March 1, 2012, and may include the
methodology in the May Medi-Cal Local Assistance Estimate, beginning
with the May 2012 estimate, for the 2012–13 fiscal year and each fiscal
year thereafter.
(F) To the
extent that the funding for the county budgets developed pursuant to the
new budget methodology is not fully appropriated in any given fiscal
year, the department, with input from the counties, shall identify and
consider options to align funding and workload responsibilities.
(b) Nothing
in this section, Section 15204.5, or Section 18906 shall be construed
so as to limit the administrative or budgetary
responsibilities of the department in a manner that would violate
Section 14100.1, and thereby jeopardize federal financial participation
under the Medi-Cal program.
(c) (1) The
Legislature finds and declares that in order for counties to do the
work that is expected of them, it is necessary that they receive
adequate funding, including adjustments for reasonable annual
cost-of-doing-business increases. The Legislature further finds and
declares that linking appropriate funding for county Medi-Cal
administrative operations, including annual cost-of-doing-business
adjustments, with performance standards will give counties the incentive
to meet the performance standards and enable them to continue to do the
work they do on behalf of the state. It is therefore the Legislature’s
intent to provide appropriate funding to the counties for the effective
administration of the Medi-Cal program at the local level to ensure that
counties can reasonably meet the purposes of the performance
measures as contained in this section.
(2) It
is the intent of the Legislature to not appropriate funds for the
cost-of-doing-business adjustment for the 2008–09, 2009–10, 2010–11,
2011–12, and 2012–13 fiscal years.
(d) The
department is responsible for the Medi-Cal program in accordance with
state and federal law. A county shall determine Medi-Cal eligibility in
accordance with state and federal law. If in the course of its duties
the department becomes aware of accuracy problems in any county, the
department shall, within available resources, provide training and
technical assistance as appropriate. Nothing in this section shall be
interpreted to eliminate any remedy otherwise available to the
department to enforce accurate county administration of the program. In
administering the Medi-Cal eligibility process, each
county shall meet the following performance standards each fiscal
year:
(1) Complete eligibility determinations as follows:
(A) Ninety percent of the general applications without applicant errors and are complete shall be completed within 45 days.
(B) Ninety
percent of the applications for Medi-Cal based on disability shall be
completed within 90 days, excluding delays by the state.
(2) (A) The
department shall establish best-practice guidelines for expedited
enrollment of newborns into the Medi-Cal program, preferably with the
goal of enrolling newborns within 10 days after the county is informed
of the birth. The department, in consultation with counties and other
stakeholders, shall work to develop a process for expediting
enrollment for all newborns, including those born to mothers
receiving CalWORKs assistance.
(B) Upon
the development and implementation of the best-practice guidelines and
expedited processes, the department and the counties may develop an
expedited enrollment timeframe for newborns that is separate from the
standards for all other applications, to the extent that the timeframe
is consistent with these guidelines and processes.
(3) Perform timely annual redeterminations, as follows:
(A) Ninety percent of the annual redetermination forms shall be mailed to the recipient by the anniversary date.
(B) Ninety
percent of the annual redeterminations shall be completed within 60
days of the recipient’s annual redetermination date for those
redeterminations
based on forms that are complete and have been returned to the
county by the recipient in a timely manner.
(C) Ninety
percent of those annual redeterminations where the redetermination form
has not been returned to the county by the recipient shall be completed
by sending a notice of action to the recipient within 45 days after the
date the form was due to the county.
(D) When
a child is determined by the county to change from no share of cost to a
share of cost and the child meets the eligibility criteria for the
Healthy Families Program established under Section 12693.98 of the
Insurance Code, the child shall be placed in the Medi-Cal-to-Healthy
Families Bridge Benefits Program, and these cases shall be processed as
follows:
(i) Ninety percent of the families of these children shall be sent a notice informing them
of the Healthy Families Program within five working days from the determination of a share of cost.
(ii) Ninety
percent of all annual redetermination forms for these children shall be
sent to the Healthy Families Program within five working days from the
determination of a share of cost if the parent has given consent to send
this information to the Healthy Families Program.
(iii) Ninety
percent of the families of these children placed in the
Medi-Cal-to-Healthy Families Bridge Benefits Program who have not
consented to sending the child’s annual redetermination form to the
Healthy Families Program shall be sent a request, within five working
days of the determination of a share of cost, to consent to send the
information to the Healthy Families Program.
(E) Subparagraph
(D) shall not be implemented until 60 days
after the Medi-Cal and Joint Medi-Cal and Healthy Families
applications and the Medi-Cal redetermination forms are revised to allow
the parent of a child to consent to forward the child’s information to
the Healthy Families Program.
(e) The
department shall develop procedures in collaboration with the counties
and stakeholder groups for determining county review cycles, sampling
methodology and procedures, and data reporting.
(f) On
January 1 of each year, each applicable county, as determined by the
department, shall report to the department on the county’s results in
meeting the performance standards specified in this section. The report
shall be subject to verification by the department. County reports shall
be provided to the public upon written request.
(g) If
the department finds that a county is not in
compliance with one or more of the standards set forth in this
section, the county shall, within 60 days, submit a corrective action
plan to the department for approval. The corrective action plan shall,
at a minimum, include steps that the county shall take to improve its
performance on the standard or standards with which the county is out of
compliance. The plan shall establish interim benchmarks for improvement
that shall be expected to be met by the county in order to avoid a
sanction.
(h) (1) If a
county does not meet the performance standards for completing
eligibility determinations and redeterminations as specified in this
section, the department may, at its sole discretion, reduce the
allocation of funds to that county in the following year by 2 percent.
Any funds so reduced may be restored by the department if, in the
determination of the department, sufficient improvement has been made by
the county in meeting
the performance standards during the year for which the funds were
reduced. If the county continues not to meet the performance standards,
the department may reduce the allocation by an additional 2 percent for
each year thereafter in which sufficient improvement has not been made
to meet the performance standards.
(2) No
reduction of the allocation of funds to a county shall be imposed
pursuant to this subdivision for failure to meet performance standards
during any period of time in which the cost-of-doing-business increase
is suspended.
(i) The
department shall develop procedures, in collaboration with the counties
and stakeholders, for developing instructions for the performance
standards established under subparagraph (D) of paragraph (3) of
subdivision (d), no later than September 1, 2005.
(j) No
later than
September 1, 2005, the department shall issue a revised annual
redetermination form to allow a parent to indicate parental consent to
forward the annual redetermination form to the Healthy Families Program
if the child is determined to have a share of cost.
(k) The
department, in coordination with the Managed Risk Medical Insurance
Board, shall streamline the method of providing the Healthy Families
Program with information necessary to determine Healthy Families
eligibility for a child who is receiving services under the
Medi-Cal-to-Healthy Families Bridge Benefits Program.
(l) Notwithstanding
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of
Title 2 of the Government Code, the department shall, without taking any
further regulatory action, implement, interpret, or make specific this
section and any applicable federal waivers and state plan amendments by
means of all-county letters or similar instructions.
SEC. 88.
Section 14165 of the Welfare and Institutions Code is amended to read:14165.
(a) There is hereby created in the Governor’s office the California Medical Assistance Commission, for the purpose of contracting with health care delivery systems for the provision of health care services to recipients under the California Medical Assistance program.(b) Notwithstanding
any other provision of law, the commission created pursuant to
subdivision (a) shall continue through June 30, 2012, after which, it
shall be dissolved and the term of any commissioner serving at that time
shall end.
(1) Upon
dissolution of the commission, all powers, duties, and responsibilities
of the commission shall be transferred to the Director of Health Care
Services.
These powers, duties, and responsibilities shall include, but are
not limited to, those exercised in the operation of the selective
provider contracting program pursuant to Article 2.6 (commencing with
Section 14081).
(2) (A) On
July 1, 2012, notwithstanding any other law, employees of the
California Medical Assistance Commission as of June 30, 2012, excluding
commissioners, shall transfer to the State Department of Health Care
Services.
(B) Employees who
transfer pursuant to subparagraph (A) shall be subject to the same
conditions of employment under the department as they were under the
California Medical Assistance Commission, including retention of their
exempt status, until the diagnosis-related groups payment system
described in Section 14105.28 replaces the contract-based payment system
described in this article.
(C) (i) Notwithstanding
any other law or rule, persons employed by the department who
transferred to the department pursuant to subparagraph (A) shall be
eligible to apply for civil service examinations. Persons receiving
passing scores shall have their names placed on lists resulting from
these examinations, or otherwise gain eligibility for appointment. In
evaluating minimum qualifications, related California Medical Assistance
Commission experience shall be considered state civil service
experience in a class deemed comparable by the State Personnel Board,
based on the duties and responsibilities assigned.
(ii) On
the date the diagnosis-related groups payment system described in
Section 14105.28 replaces the contract-based system described in this
article, employees who transferred to the department pursuant to
subparagraph (A) shall
transfer to civil service classifications within the department
for which they are eligible.
(3) Upon
a determination by the Director of Health Care Services that a payment
system based on diagnosis-related groups as described in Section
14105.28 that is sufficient to replace the contract-based payment system
described in this article has been developed and implemented, the
powers, duties, and responsibilities conferred on the commission and
transferred to the Director of Health Care Services shall no longer be
exercised, excluding both of the following:
(A) Stabilization
payments made or committed from Sections 14166.14 and 14166.19 for
services rendered prior to the director’s determination pursuant to this
paragraph.
(B) The ability to
negotiate and make payments from the Private Hospital
Supplemental Fund, established pursuant to Section 14166.12, and
the Nondesignated Public Hospital Supplemental Fund, established
pursuant to Section 14166.17.
(4) Protections
afforded to the negotiations and contracts of the commission by the
California Public Records Act (Chapter 3.5 (commencing with Section
6250) of Division 7 of Title 1 of the Government Code) shall be
applicable to the negotiations and contracts conducted or entered into
pursuant to this section by the State Department of Health Care
Services.
(c) Notwithstanding
the rulemaking provisions of Chapter 3.5 (commencing with Section 11340)
of Part 1 of Division 3 of Title 2 of the Government Code, or any other
provision of law, the State Department of Health Care Services may
implement and administer this section by means of provider bulletins or
other similar instructions, without taking regulatory action. The
authority to implement this section as set forth in this
subdivision shall include the authority to give notice by provider
bulletin or other similar instruction of a determination made pursuant
to paragraph (3) of subdivision (b) and to modify or supersede existing
regulations in Title 22 of the California Code of Regulations that
conflict with implementation of this section.
SEC. 89.
Section 14166.8 of the Welfare and Institutions Code is amended to read:14166.8.
(a) Within five months after the end of each project year or successor demonstration year, each of the designated public hospitals shall submit to the department all of the following reports:(1) The hospital’s Medicare cost report for the project year or successor demonstration year.
(2) Other
cost reporting and statistical data necessary for the determination of
amounts due the hospital under the demonstration project or successor
demonstration project, as requested by the department.
(b) For each project year or successor demonstration year, the reports shall identify all of the
following:
(1) The costs
incurred in providing inpatient hospital services to Medi-Cal
beneficiaries on a fee-for-service basis and physician and nonphysician
practitioner services costs, as identified in subdivision (e) of Section
14166.4.
(2) The amount of
uncompensated costs incurred in providing hospital services to Medi-Cal
beneficiaries, including managed care enrollees.
(3) The costs incurred in providing hospital services to uninsured individuals.
(4) (A) Discharge
data, commencing with successor demonstration year 6, and
retrospectively for prior periods as necessary to establish interim
payment determinations, for the following patient categories:
(i) Uninsured patients.
(ii) Low Income Health Program patients.
(iii) Medi-Cal patients, excluding discharges for which Medicare payments were received.
(B) The
department shall consult with the designated public hospitals regarding
a methodology for adjusting prior period discharge data to reflect the
projected number of discharges relating to Low Income Health Program
patients for the period at issue.
(c) (1) Each
designated public hospital, or governmental entity with which it is
affiliated, that operates nonhospital clinics or provides physician,
nonphysician practitioner, or other health care services that are not
identified as hospital services under the Special Terms and Conditions
for the demonstration project
and successor demonstration project, may report and certify all,
or a portion, of the uncompensated Medi-Cal and uninsured costs of the
services furnished.
(2) Notwithstanding
paragraph (1), beginning with the 2012–13 fiscal year, and for each
successor demonstration year thereafter, each designated public
hospital, or governmental entity with which it is affiliated, that
operates nonhospital clinics or provides physician, nonphysician
practitioner, or other health care services that are not identified as
hospital services under the Special Terms and Conditions for the
successor demonstration project, shall report and certify all of the
uncompensated uninsured costs of the services furnished that meet the
requirements of subdivisions (d) and (e).
(3) The amount of these uncompensated costs to be claimed by the
department shall be determined by the department in consultation with
the governmental entity so as to optimize the level of claimable
federal Medicaid funding.
(d) Reports submitted under this section shall include all allowable costs.
(e) The appropriate public official shall certify to all of the following:
(1) The accuracy of the reports required under this section.
(2) That
the expenditures to meet the reported costs comply with Section 433.51
of Title 42 of the Code of Federal Regulations.
(3) That
the sources of funds used to make the expenditures certified under this
section do not include impermissible provider taxes or donations as
defined under Section 1396b(w) of Title 42 of the United States Code or
other federal funds. For this purpose, federal
funds do not include delivery system reform incentive pool
payments, patient care revenue received as payment for services rendered
under programs such as designated state health programs, the Low Income
Health Program, Medicare, or Medicaid.
(f) The
certification of public expenditures made pursuant to this section
shall be based on a schedule established by the department. The director
may require the designated public hospitals to submit quarterly
estimates of anticipated expenditures, if these estimates are necessary
to obtain interim payments of federal Medicaid funds. All reported
expenditures shall be subject to reconciliation to allowable costs, as
determined in accordance with applicable implementing documents for the
demonstration project and successor demonstration project.
(g) Subject
to the determination made under paragraph (3) of subdivision (c), the
director shall
seek Medicaid federal financial participation for all certified
public expenditures reported by the designated public hospitals and
recognized under the demonstration project and successor demonstration
project, to the extent consistent with Section 14166.9.
(h) Governmental
or public entities other than those that operate a designated public
hospital may, at the request of a governmental or public entity, certify
uncompensated Medi-Cal and uninsured costs in accordance with this
section, subject to the department’s discretion and prior approval of
the federal Centers for Medicare and Medicaid Services.
(i) The
timeframes for data submission and reporting periods may be adjusted as
necessary with respect to the 2010–11 project year through October 31,
2010, and successor demonstration years 6 and 10.
SEC. 90.
Section 14166.12 of the Welfare and Institutions Code is amended to read:14166.12.
(a) The California Medical Assistance Commission shall negotiate payment amounts, in accordance with the selective provider contracting program established pursuant to Article 2.6 (commencing with Section 14081), from the Private Hospital Supplemental Fund established pursuant to subdivision (b) for distribution to private hospitals that satisfy the criteria of subdivision (s). Pursuant to Section 14165, on and after July 1, 2012, the Director of Health Care Services shall exercise the discretion granted to the California Medical Assistance Commission.(b) The
Private Hospital Supplemental Fund is hereby established in the State
Treasury. For purposes of this section, “fund” means the Private
Hospital Supplemental
Fund.
(c) Notwithstanding
Section 13340 of the Government Code, the fund shall be continuously
appropriated to the department for the purposes specified in this
section.
(d) Except as otherwise limited by this section, the fund shall consist of all of the following:
(1) One
hundred eighteen million four hundred thousand dollars ($118,400,000),
which shall be transferred annually from General Fund amounts
appropriated in the annual Budget Act for the Medi-Cal program, except
as follows:
(A) For the 2008–09
fiscal year, this amount shall be reduced by thirteen million six
hundred thousand dollars ($13,600,000) and by an amount equal to
one-half of the difference between eighteen million three hundred
thousand dollars ($18,300,000) and the amount of any
reduction in the additional payments for distressed hospitals
calculated pursuant to subparagraph (B) of paragraph (3) of subdivision
(b) of Section 14166.20.
(B) For
the 2012–13 fiscal year, this amount shall be reduced by seventeen
million five hundred thousand dollars ($17,500,000).
(C) For
the 2013–14 fiscal year, this amount shall be reduced by eight million
seven hundred fifty thousand dollars ($8,750,000).
(2) Any additional moneys appropriated to the fund.
(3) All stabilization funding transferred to the fund pursuant to paragraph (2) of subdivision (a) of Section 14166.14.
(4) Any
moneys that any county, other political subdivision of the state, or
other governmental entity in the
state may elect to transfer to the department for deposit into the
fund, as permitted under Section 433.51 of Title 42 of the Code of
Federal Regulations or any other applicable federal Medicaid laws.
(5) All
private moneys donated by private individuals or entities to the
department for deposit in the fund as permitted under applicable federal
Medicaid laws.
(6) Any interest that accrues on amounts in the fund.
(e) Any
public agency transferring moneys to the fund may, for that purpose,
utilize any revenues, grants, or allocations received from the state for
health care programs or purposes, unless otherwise prohibited by law. A
public agency may also utilize its general funds or any other public
moneys or revenues for purposes of transfers to the fund, unless
otherwise prohibited by law.
(f) The
department may accept or not accept moneys offered to the department
for deposit in the fund. If the department accepts moneys pursuant to
this section, the department shall obtain federal financial
participation to the full extent permitted by law. With respect to funds
transferred or donated from private individuals or entities, the
department shall accept only those funds that are certified by the
transferring or donating entity that qualify for federal financial
participation under the terms of the Medicaid Voluntary Contribution and
Provider-Specific Tax Amendments of 1991 (Public Law 102-234) or
Section 433.51 of Title 42 of the Code of Federal Regulations, as
applicable. The department may return any funds transferred or donated
in error.
(g) Moneys in the fund shall be used as the source for the nonfederal share of payments to hospitals under this section.
(h) Any
funds remaining in the fund at the end of a fiscal year shall be
carried forward for use in the following fiscal year.
(i) Moneys
shall be allocated from the fund by the department and shall be applied
to obtain federal financial participation in accordance with customary
Medi-Cal accounting procedures for purposes of payments under this
section. Distributions from the fund shall be supplemental to any other
Medi-Cal reimbursement received by the hospitals, including amounts that
hospitals receive under the selective provider contracting program
(Article 2.6 (commencing with Section 14081)), and shall not affect
provider rates paid under the selective provider contracting program.
(j) Each
private hospital that was a private hospital during the 2002–03 fiscal
year, received payments for the 2002–03 fiscal year
from any of the prior supplemental funds, and, during the project
year, satisfies the criteria in subdivision (s) to be eligible to
negotiate for distributions under any of those sections, shall receive
no less from the Private Hospital Supplemental Fund for the project year
than 100 percent of the amount the hospital received from the prior
supplemental funds for the 2002–03 fiscal year. Each private hospital
described in this subdivision shall be eligible for additional payments
from the fund pursuant to subdivision (k).
(k) All
amounts that are in the fund for a project year in excess of the amount
necessary to make the payments under subdivision (j) shall be available
for negotiation by the California Medical Assistance Commission, along
with corresponding federal financial participation, for supplemental
payments to private hospitals, which for the project year satisfy the
criteria under subdivision (s) to be eligible to negotiate for
distributions under any of those sections, and paid for services
rendered during the project year pursuant to the selective provider
contracting program established under Article 2.6 (commencing with
Section 14081).
(l) The amount
of any stabilization funding transferred to the fund, or the amount of
intergovernmental transfers deposited to the fund pursuant to
subdivision (o), together with the associated federal reimbursement,
with respect to a particular project year, may, in the discretion of the
California Medical Assistance Commission, until its dissolution on June
30, 2012, be paid for services furnished in the same project year
regardless of when the stabilization funds or intergovernmental transfer
funds, and the associated federal reimbursement, become available,
provided the payment is consistent with other applicable federal or
state law requirements and does not result in a hospital exceeding any
applicable reimbursement
limitations. On and after July 1, 2012, the Director of Health
Care Services shall exercise the discretion granted to the California
Medical Assistance Commission by this subdivision.
(m) The
department shall pay amounts due to a private hospital from the fund
for a project year, with the exception of stabilization funding, in up
to four installment payments, unless otherwise provided in the
hospital’s contract negotiated with the California Medical Assistance
Commission, except that hospitals that are not described in subdivision
(j) shall not receive the first installment payment. The first payment
shall be made as soon as practicable after the issuance of the tentative
disproportionate share hospital list for the project year, and in no
event later than January 1 of the project year. The second and
subsequent payments shall be made after the issuance of the final
disproportionate hospital list for the project year, and shall be made
only to
hospitals that are on the final disproportionate share hospital
list for the project year. The second payment shall be made by February 1
of the project year or as soon as practicable after the issuance of the
final disproportionate share hospital list for the project year. The
third payment, if scheduled, shall be made by April 1 of the project
year. The fourth payment, if scheduled, shall be made by June 30 of the
project year. This subdivision does not apply to hospitals that are
scheduled to receive payments from the fund because they meet the
criteria under paragraph (2) of subdivision (s) and do not meet the
criteria under paragraph (1), (3), or (4) of subdivision (s), which
shall be paid in accordance with the applicable contract or contract
amendment negotiated by the California Medical Assistance Commission.
(n) The
department shall pay stabilization funding transferred to the fund in
amounts negotiated by the California Medical
Assistance Commission and shall pay the scheduled payments in
accordance with the applicable contract or contract amendment.
(o) Payments
to private hospitals that are eligible to receive payments pursuant to
subdivision (s) may be made using funds transferred from governmental
entities to the state, at the option of the governmental entity. Any
payments funded by intergovernmental transfers shall remain with the
private hospital and shall not be transferred back to any unit of
government. An amount equal to 25 percent of the amount of any
intergovernmental transfer made in the project year that results in a
supplemental payment made for the same project year to a project year
private DSH hospital designated by the governmental entity that made the
intergovernmental transfer shall be deposited in the fund for
distribution as determined by the California Medical Assistance
Commission. An amount equal to 75 percent shall be deposited in the fund
and distributed to the private hospitals designated by the
governmental entity.
(p) A
private hospital that receives payment pursuant to this section for a
particular project year shall not submit a notice for the termination of
its participation in the selective provider contracting program
established pursuant to Article 2.6 (commencing with Section 14081)
until the later of the following dates:
(1) On or after December 31 of the next project year.
(2) The date specified in the hospital’s contract, if applicable.
(q) (1) For
the 2007–08, 2008–09, and 2009–10 project years, the County of Los
Angeles shall make intergovernmental transfers to the state to fund the
nonfederal share of increased Medi-Cal payments to those private
hospitals that serve the South Los Angeles population formerly
served by Los Angeles County Martin Luther King, Jr.-Harbor Hospital.
The intergovernmental transfers required under this subdivision shall be
funded by county tax revenues and shall total five million dollars
($5,000,000) per project year, except that, in the event that the
director determines that any amount is due to the County of Los Angeles
under the demonstration project for services rendered during the portion
of a project year during which Los Angeles County Martin Luther King,
Jr.-Harbor Hospital was operational, the amount of intergovernmental
transfers required under this subdivision shall be reduced by a
percentage determined by reducing 100 percent by the percentage
reduction in Los Angeles County Martin Luther King, Jr.-Harbor
Hospital’s baseline, as determined under subdivision (c) of Section
14166.5 for that project year.
(2) Notwithstanding
subdivision (o), an
amount equal to 100 percent of the county’s intergovernmental
transfers under this subdivision shall be deposited in the fund and,
within 30 days after receipt of the intergovernmental transfer, shall be
distributed, together with related federal financial participation, to
the private hospitals designated by the county in the amounts designated
by the county. The director shall disregard amounts received pursuant
to this subdivision in calculating the OBRA 1993 payment limitation, as
defined in paragraph (24) of subdivision (a) of Section 14105.98, for
purposes of determining the amount of disproportionate share hospital
replacement payments due a private hospital under Section 14166.11.
(r) (1) The
reductions in supplemental payments under this section that result from
the reductions in the amounts transferred from the General Fund to the
Private Hospital Supplemental Fund for the 2012–13 and 2013–14 fiscal
years under
subparagraphs (B) and (C) of paragraph (1) of subdivision (d)
shall be allocated equally in the aggregate between children’s hospitals
eligible for supplemental payments under this section and other
hospitals eligible for supplemental payments under this section. When
negotiating payment amounts to a hospital under this section for the
2012–13 and 2013–14 fiscal years, the California Medical Assistance
Commission, or its successor agency, shall identify both a payment
amount that would have been made absent the funding reductions in
subparagraphs (B) and (C) of paragraph (1) of subdivision (d) and the
payment amount that will be made taking into account the funding
reductions under subparagraphs (B) and (C) of paragraph (1) of
subdivision (d). For purposes of this subdivision, “children’s hospital”
shall have the meaning set forth in paragraph (13) of subdivision (a)
of Section 14105.98.
(2) This
subdivision shall not preclude the department
from including some or all of the reductions under this section
within the payments made under a new diagnosis-related group payment
methodology for the 2012–13 fiscal year or the 2013–14 fiscal year. In
the event the department includes some or all of the amounts, including
reductions, within the payments made under a new diagnosis-related group
payment methodology for the 2012–13 fiscal year or the 2013–14 fiscal
year, the department, in implementing the reductions in paragraph (1) of
subdivision (d), shall, to the extent feasible, utilize the allocation
specified in paragraph (1).
(s) In
order for a hospital to receive distributions pursuant to this section,
the hospital shall satisfy the eligibility criteria in paragraph (1),
(2), (3), or (4) of this subdivision.
(1) The hospital meets all of the following criteria:
(A) The hospital is contracting under this article.
(B) The hospital meets the criteria contained in the Medicaid State Plan for disproportionate share hospital status.
(C) The hospital is one of the following:
(i) A
licensed provider of basic emergency services as described in Section
70411 of Title 22 of the California Code of Regulations.
(ii) A
licensed provider of comprehensive emergency medical services as
defined in Section 70451 of Title 22 of the California Code of
Regulations.
(iii) A children’s
hospital, as defined in Section 14087.21, that satisfies clause (i) or
(ii), or that jointly provides basic or comprehensive emergency services
in conjunction with another
licensed hospital.
(iv) A
hospital owned and operated by a public agency that operates two or
more hospitals that qualify under subparagraph (A) or (B) with respect
to the particular state fiscal year.
(v) A
hospital designated by the National Cancer Institute as a comprehensive
or clinical cancer research center that primarily treats acutely ill
cancer patients and that is exempt from the federal Medicare prospective
payment system pursuant to Section 1886(d)(1)(B)(v) of the federal
Social Security Act (42 U.S.C. Sec. 1395ww(d)(1)(B)(v)).
(D) The
hospital is able to demonstrate a purpose for additional funding under
the selective provider contracting program including proposals relating
to emergency services and other health care services, including
infrequent yet high-cost services, such as anti-AB human antitoxin
treatment for infant botulism (human botulinum immune globulin
(HBIG), commonly referred to as “Baby-BIG”), that are made available, or
will be made available, to Medi-Cal beneficiaries.
(2) The
hospital is contracting under this article and meets the definition of a
university teaching hospital or major, nonuniversity, teaching hospital
as set forth on page 51 and as listed on page 57 of the department’s
report dated May 1991, entitled “Hospital Peer Grouping.” Payments from
the fund shall be used solely for the purposes identified in the
contract between the hospital and the state.
(3) The hospital is contracting under this article, and meets the definition of any of the following:
(A) A
large teaching emphasis hospital, as set forth on page 51 and listed on
page 57 of the department’s report dated May 1991,
entitled “Hospital Peer Grouping,” and also meets the definition
of eligible hospital as defined in paragraph (3) of subdivision (a) of
Section 14105.98.
(B) A
children’s hospital pursuant to Section 10727, and also meets the
definition of eligible hospital as defined in paragraph (3) of
subdivision (a) of Section 14105.98.
(C) Notwithstanding
the requirement in subparagraph (A) that a hospital must be listed on
page 57 of the department’s report dated May 1991, entitled “Hospital
Peer Grouping,” any hospital whose license pursuant to Chapter 2
(commencing with Section 1250) of Division 2 of the Health and Safety
Code was consolidated during the 1999 calendar year with a large
teaching emphasis hospital that is listed on page 57 of the
above-described report shall be eligible. All other requirements of
paragraph (3) shall continue to apply.
(4) The hospital meets all of the following criteria:
(A) The hospital is contracting under this article.
(B) The hospital satisfies the Medicaid State Plan criteria for disproportionate share hospital status.
(C) The hospital is a small and rural hospital as defined in Section 124840 of the Health and Safety Code.
(D) The
hospital is a licensed provider of standby emergency services as
described in Section 70649 of Title 22 of the California Code of
Regulations.
(E) The hospital
is able to demonstrate a purpose for additional funding under the
selective provider contracting program with proposals relating to health
care
services that are made available, or will be made available, to
Medi-Cal beneficiaries.
(F) The
hospital is determined by the California Medical Assistance Commission
to be a hospital that provides an important community service that
otherwise would not be provided in the community.
SEC. 91.
Section 14166.14 of the Welfare and Institutions Code is amended to read:14166.14.
The amount of any stabilization funding payable to the project year private DSH hospitals under Section 14166.20 for a project year, which amount shall not include the amount of stabilization funding paid or payable to hospitals prior to the computation of the stabilization funding under Section 14166.20, plus any amount payable to project year private DSH hospitals under paragraph (1) of subdivision (b) of Section 14166.21, shall be allocated as follows:(a) (1) To fund any shortfall due under Section 14166.11.
(2) An
amount shall be transferred to the Private Hospital Supplemental Fund
established pursuant to
Section 14166.12, as may be necessary so that the amount for the
Private Hospital Supplemental Fund for the project year, including all
funds previously transferred to, or deposited in, the Private Hospital
Supplemental Fund for the project year, is not less than the Private
Hospital Supplemental Fund base amount determined pursuant to
subdivision (j) of Section 14166.12.
(3) The
amounts paid or transferred under paragraphs (1) and (2) shall be
reduced pro rata if there is not sufficient funding described under
paragraphs (1) and (2).
(b) Of
the stabilization funding remaining, after allocations pursuant to
subdivision (a), that are payable to project year private DSH hospitals,
66.4 percent shall be allocated and distributed among those hospitals
pro rata based on the amounts determined in accordance with Section
14166.11, and 33.6 percent shall be transferred to the Private
Hospital Supplemental Fund.
(c) (1) Notwithstanding
any other law, the stabilization funding payable to project year
private DSH hospitals under Section 14166.20 for a project year as
determined under this section that has not been paid, or specifically
committed for payment, to hospitals prior to January 1, 2012, may be
utilized by the director to make payments to hospitals that received
underpayments pursuant to Section 14166.11 due to improper peer group
classifications for the 2005–06 and 2006–07 payment adjustment years.
(2) The
balance after payments made pursuant to paragraph (1), if any, of the
stabilization funding payable to project year private DSH hospitals
under Section 14166.20 shall not be paid to the project year private DSH
hospitals pursuant to Section 14166.20. The funds that would otherwise
be paid from the Private Hospital Supplemental
Fund shall be transferred to the General Fund, and funds that
would otherwise be drawn from the General Fund for payments to the
private DSH hospitals pursuant to Section 14166.20 shall be retained in
the General Fund.
SEC. 92.
Section 14166.151 is added to the Welfare and Institutions Code, to read:14166.151.
(a) It is the intent of the Legislature to reform the inpatient fee-for-service reimbursement methodology for nondesignated public hospitals based on their public structure in order to provide new opportunities for nondesignated public hospitals to receive reimbursement under the successor demonstration project for care provided to the uninsured and to receive new incentive payments for achievement related to delivery system reform.(b) Subject
to subdivision (c), beginning with services provided on or after July
1, 2012, fee-for-service payments to nondesignated public hospitals for
inpatient services shall be governed by this subdivision. Each
nondesignated public hospital shall receive as payment
for inpatient hospital services provided to Medi-Cal beneficiaries
during any successor demonstration year, the federal financial
participation claimed by the department based on the hospital’s
allowable costs incurred in providing those services, subject to all of
the following:
(1) Nondesignated
public hospitals shall comply with the requirements of Section
14166.152. The payments authorized in this section shall be subject to
audit and a final reconciliation where an overpayment to the
nondesignated public hospital shall result in a collection of the
overpayment and an underpayment to the nondesignated public hospital
shall result in a corrective payment.
(2) (A) Nondesignated
public hospitals shall be eligible to receive safety net care pool
payments for uncompensated care costs to the extent that additional
federal funding is made available pursuant to
the Special Terms and Conditions for the safety net care pool
uncompensated care limit of the successor demonstration project and if
they comply with the requirements set forth in Section 14166.154.
(B) The
amount of funds that may be claimed pursuant to subparagraph (A) shall
not exceed the additional federal funding made available under the
safety net care pool for nondesignated public hospital uncompensated
care costs, and shall not reduce the amounts of federal funding for
safety net care pool uncompensated care costs that would otherwise be
made available to designated public hospitals in the absence of this
paragraph, including the amounts available under the Special Terms and
Conditions in effect as of April 1, 2012, and amounts available pursuant
to Section 15916.
(C) (i) Notwithstanding
subparagraph (B), if the designated public hospitals do not have
sufficient certified public expenditures to claim the full amount
of federal funding made available to the designated public hospitals as
referenced in subparagraph (B), including consideration of the potential
for the designated public hospitals to have sufficient certified public
expenditures in a subsequent year, the department may authorize the
funding to be claimed by the nondesignated public hospitals.
(ii) The
department may determine whether designated public hospitals do not
have sufficient certified public expenditures to claim the full amount
of federal funding pursuant to clause (i) no sooner than after the
submission of the cost reporting information required pursuant to
Section 14166.8 for the applicable successor demonstration year.
(iii) If
the department makes the determination identified in clause (ii) based
on as-filed cost reporting information submitted prior
to a final audit, the department shall make the determination in
consultation with the designated public hospitals and shall apply an
audit cushion of at least 5 percent to the as-filed cost information. If
the department makes the determination identified in clause (ii) based
on audited cost reporting information, no audit cushion shall be
applied.
(3) (A) Nondesignated
public hospitals shall be eligible to receive delivery system reform
incentive pool payments to the extent additional federal funding is made
available for this purpose under the delivery system reform incentive
pool in the successor demonstration project and if the nondesignated
public hospitals comply with the delivery system reform incentive pool
funding requirements set forth in Section 14166.155.
(B) The
amount of funds that may be received shall not exceed the additional
federal funding
made available for delivery system reform incentive pool payments
to nondesignated public hospitals, and shall not reduce the amounts that
would otherwise be made available to designated public hospitals in the
absence of this paragraph, including the amounts that designated public
hospitals would be eligible to receive under their delivery system
reform incentive pool plans approved as of January 1, 2012.
(C) Notwithstanding
subparagraph (B), if the designated public hospitals are unable to
claim the full amount of federal funding made available to the
designated public hospitals pursuant to Section 14166.77 and the Special
Terms and Conditions, including through reallocations made pursuant to
paragraph (3) of subdivision (a) of Section 14166.77 as authorized by
the Special Terms and Conditions, and the unused amount of federal
funding made available to the designated public hospitals cannot be used
in a later demonstration year, the
department may authorize such unused funding to be made available
to the nondesignated public hospitals.
(c) (1) (A) The
reimbursement methodology developed pursuant to subdivision (b) shall
be effective beginning July 1, 2012. If all necessary federal approvals
have not been received by July 1, 2012, then the effective date shall be
retroactive to July 1, 2012. Between July 1, 2012, and when all
necessary federal approvals have been received, any payments made
pursuant to any methodology replaced by subdivision (b) shall be deemed
as interim payments subject to offsetting and recoupment against
payments made under subdivision (b) pursuant to Section 51047 of Title
22 of the California Code of Regulations.
(B) Subject
to paragraph (2), beginning January 1, 2014, the reimbursement
methodology developed pursuant to subdivision (b), which
shall be in effect July 1, 2012, through and including December
31, 2013, shall continue for those nondesignated public hospitals that
certify voluntary participation as described in clause (i), if the
director executes a declaration on or before December 31, 2013,
certifying all of the following:
(i) The
governmental entities that own or operate a nondesignated public
hospital, or hospitals, have provided certifications of voluntary
participation in the reimbursement methodology pursuant to subdivision
(b).
(ii) Any necessary federal approvals have been obtained.
(iii) Continuation
of the reimbursement methodology for those nondesignated public
hospitals certifying voluntary participation would be cost beneficial to
the state.
(2) On December 31,
2013,
if one or more of the nondesignated public hospitals subject to
the reimbursement methodology described in subdivision (b) have not
provided written certification of voluntariness described in clause (i)
of subparagraph (B) of paragraph (1), or if the director determines, for
any reason, that the reimbursement methodology described in subdivision
(b) cannot be implemented on or after January 1, 2014, then the
director shall execute a declaration certifying that the reimbursement
methodology described in subdivision (b) cannot continue to be
implemented for all or one or more of the nondesignated public
hospitals, in which case subdivision (e) shall be implemented on January
1, 2014.
(d) Upon
implementation of subparagraph (A) of paragraph (1) of subdivision (c),
implementation of the laws and regulations listed in paragraphs (1) to
(4), inclusive, shall be suspended with respect to fee-for-service
payments to all nondesignated public hospitals
for inpatient services through and including December 31, 2013.
Implementation of the laws and regulations listed in paragraphs (1) to
(4), inclusive, shall also be suspended with respect to fee-for-service
payments to nondesignated public hospitals that certify voluntary
participation if a declaration is executed pursuant to subparagraph (B)
of paragraph (1) of subdivision (c), beginning on January 1, 2014, and
until the expiration of the successor demonstration project.
(1) The Nondesignated Public Hospital Medi-Cal Rate Stabilization Act in Article 5.17 (commencing with Section 14165.55).
(2) The inpatient fee-for-service per diem rate authorized in Article 2.6 (commencing with Section 14081).
(3) The reimbursement methodology for fee-for-service inpatient services in Sections 14105 and 14105.15, and Article 7.5
(commencing with Section 51536) of Title 22 of the California Code of Regulations.
(4) Section 14166.17.
(e) Subject
to the conditions in paragraph (2) of subdivision (c), on January 1,
2014, the percentage of each intergovernmental transfer amount retained
pursuant to subdivision (j) of Section 14165.57 shall be increased to 20
percent to reimburse the department, or transferred to the General
Fund, for the administrative costs of operating the Nondesignated Public
Hospital Intergovernmental Transfer Program and for the benefit of the
Medi-Cal program.
(f) This
section and Sections 14166.152, 14166.153, 14166.154, and 14166.155
shall become operative on the date all necessary federal approvals have
been obtained to implement all of these sections.
SEC. 93.
Section 14166.152 is added to the Welfare and Institutions Code, to read:14166.152.
(a) Pursuant to subdivision (b) of Section 14166.151, and notwithstanding any other law, fee-for-service payments to nondesignated public hospitals for inpatient services to Medi-Cal beneficiaries shall be governed by this section. The hospitals’ allowable costs shall be determined, certified, and claimed in accordance with Section 14166.153. The Medicaid federal financial participation received by the state for the certified public expenditures of the hospital, or the governmental entity with which the hospital is affiliated, for inpatient hospital services rendered to Medi-Cal beneficiaries shall be paid to the hospital.(b) With
respect to each successor demonstration year, each of the
nondesignated public hospitals shall receive an interim payment
for each day of inpatient hospital services rendered to Medi-Cal
beneficiaries based upon claims filed by the hospital in accordance with
the claiming process set forth in Division 3 (commencing with Section
50000) of Title 22 of the California Code of Regulations. The interim
per diem payment amount shall be based on estimated costs, which shall
be derived from statistical data from the following sources and which
shall be multiplied by the federal medical assistance percentage:
(1) For
allowable costs reflected in the Medicare cost report, the cost report
most recently audited by the hospital’s Medicare fiscal intermediary
adjusted by a trend factor to reflect increased costs, as approved by
the federal Centers for Medicare and Medicaid Services for the successor
demonstration project.
(2) For
allowable costs not
reflected in the Medicare cost report, each hospital shall provide
hospital-specific cost data requested by the department. The department
shall adjust the data by a trend factor as necessary to reflect project
year allowable costs.
(c) Until
the department commences making payments pursuant to subdivision (b),
the department may continue to make fee-for-service per diem payments to
the nondesignated public hospitals pursuant to the selective provider
contracting program in accordance with Article 2.6 (commencing with
Section 14081), for services rendered on and after July 1, 2012. Per
diem payments shall be adjusted retroactively to the amounts determined
under the payment methodology prescribed in this section.
(d) No
later than April 1 following the end of the relevant reporting period
for the successor demonstration year, the department shall undertake an
interim
reconciliation of payments made pursuant to subdivisions (a) to
(c), inclusive, based on Medicare and other cost and statistical data
submitted by the hospital for the year and shall adjust payments to the
hospital accordingly.
(e) (1) The
nondesignated public hospitals shall receive supplemental reimbursement
for the costs incurred for physician and nonphysician practitioner
services provided to Medi-Cal beneficiaries who are patients of the
hospital, to the extent that those services are not claimed as inpatient
hospital services by the hospital and the costs of those services are
not otherwise recognized under subdivision (a).
(2) Expenditures
made by the nondesignated public hospital, or a governmental entity
with which it is affiliated, for the services identified in paragraph
(1) shall be reduced by any payments received pursuant to Article 7
(commencing with Section 51501) of Title 22 of the California Code
of Regulations. The remainder shall be certified by the appropriate
public official and claimed by the department in accordance with Section
14166.153. These expenditures may include any of the following:
(A) Compensation to physicians or nonphysician practitioners pursuant to contracts with the nondesignated public hospital.
(B) Salaries and related costs for employed physicians and nonphysician practitioners.
(C) The costs of interns, residents, and related teaching physician and supervision costs.
(D) Administrative
costs associated with the services described in subparagraphs (A) to
(C), inclusive, including billing costs.
(3) Nondesignated
public hospitals shall receive federal financial participation based on
the expenditures identified and certified in paragraph (2).
(4) The
federal financial participation received by the department for the
certified public expenditures identified in paragraph (2) shall be paid
to the nondesignated public hospital, or a governmental entity with
which it is affiliated.
(5) Supplemental
reimbursement under this subdivision may be distributed as part of the
interim payments under subdivision (b), on a per-visit basis, on a
per-procedure basis, or on any other federally permissible basis.
(6) The
department shall submit for federal approval, by September 30, 2012, a
proposed amendment to the Medi-Cal state plan to implement this
subdivision, retroactive to July 1, 2012, to the extent
permitted by the federal Centers for Medicare and Medicaid
Services. If necessary to obtain federal approval, the department may
limit the application of this subdivision to costs determined allowable
by the federal Centers for Medicare and Medicaid Services. If federal
approval is not obtained, this subdivision shall not be implemented.
(f) This section shall become operative as provided in subdivision (f) of Section 14166.151.
SEC. 94.
Section 14166.153 is added to the Welfare and Institutions Code, to read:14166.153.
(a) Beginning in the 2012–13 fiscal year, within five months after the end of a successor demonstration year, each of the nondesignated public hospitals shall submit to the department all of the following reports:(1) The hospital’s Medicare cost report for the project year or successor demonstration year.
(2) Other
cost reporting and statistical data necessary for the determination of
amounts due the hospital under the demonstration project or successor
demonstration project, as requested by the department.
(b) For each project year or successor demonstration year, the
reports shall identify all of the following:
(1) To
the extent applicable, the costs incurred in providing inpatient
hospital services to Medi-Cal beneficiaries on a fee-for-service basis
and physician and nonphysician practitioner services costs, as
identified in subdivision (e) of Section 14166.152.
(2) The costs incurred in providing hospital services to uninsured individuals.
(c) Each
nondesignated public hospital, or governmental entity with which it is
affiliated, that operates nonhospital clinics or provides physician,
nonphysician practitioner, or other health care services that are not
identified as hospital services under the Special Terms and Conditions
for the demonstration project and successor demonstration project, shall
report and certify all of the uncompensated Medi-Cal and uninsured
costs of the
services furnished. The amount of these uncompensated costs to be
claimed by the department shall be determined by the department in
consultation with the governmental entity so as to optimize the level of
claimable federal Medicaid reimbursement.
(d) Reports submitted under this section shall include all allowable costs.
(e) The appropriate public official shall certify to all of the following:
(1) The accuracy of the reports required under this section.
(2) That
the expenditures to meet the reported costs comply with Section 433.51
of Title 42 of the Code of Federal Regulations.
(3) That
the sources of funds used to make the expenditures certified under this
section do not include
impermissible provider taxes or donations as defined under Section
1396b(w) of Title 42 of the United States Code or other federal funds.
For this purpose, federal funds do not include delivery system reform
incentive pool payments or patient care revenue received as payment for
services rendered under programs such as nondesignated state health
programs, the Low Income Health Program, Medicare, or Medicaid.
(f) The
certification of public expenditures made pursuant to this section
shall be based on a schedule established by the department in accordance
with federal requirements.
(1) The
director may require the nondesignated public hospitals to submit
quarterly estimates of anticipated expenditures, if these estimates are
necessary to obtain interim payments of federal Medicaid funds.
(2) All
reported expenditures
shall be subject to reconciliation to allowable costs, as
determined in accordance with applicable implementing documents for the
demonstration project and successor demonstration project.
(g) The
director shall seek Medicaid federal financial participation for all
certified public expenditures reported by the nondesignated public
hospitals and recognized under the successor demonstration project.
(h) The
timeframes for data submission and reporting periods may be adjusted as
necessary in accordance with federal requirements.
(i) This section shall become operative as provided in subdivision (f) of Section 14166.151.
SEC. 95.
Section 14166.154 is added to the Welfare and Institutions Code, to read:14166.154.
(a) (1) Beginning in the 2012–13 fiscal year, if the reimbursement methodology in subdivision (b) of Section 14166.151 is in effect and federal approval is obtained for an amendment to the successor demonstration project that was submitted pursuant to subdivision (d), then, with respect to each successor demonstration year, nondesignated public hospitals, or governmental entities with which they are affiliated, shall be eligible to receive safety net care pool payments for uncompensated care from the Health Care Support Fund established pursuant to Section 14166.21. Safety net care pool payments for uncompensated care shall be allocated to nondesignated public hospitals as follows:(A) The department
shall determine the maximum amount of safety net care pool payments for
uncompensated care that is available to nondesignated public hospitals
for the successor demonstration year pursuant to paragraph (2) of
subdivision (b) of Section 14166.151. This determination shall be made
solely with respect to allowable uncompensated care costs incurred by
nondesignated public hospitals and reported pursuant to Section
14166.153.
(B) The department
shall establish, in consultation with the nondesignated public
hospitals, an allocation methodology to determine the amount of safety
net care pool payments to be made to each hospital. The allocation
methodology shall be implemented when the director issues a declaration
stating that the methodology complies with all applicable federal
requirements for federal financial participation.
(2) A
safety net care pool
payment amount may be paid to a nondesignated public hospital, or
governmental entity with which it is affiliated, pursuant to this
section independent of the amount of uncompensated Medi-Cal and
uninsured costs that is certified as public expenditures pursuant to
Section 14166.153, provided that, in accordance with the Special Terms
and Conditions for the successor demonstration project, the recipient
hospital does not return any portion of the funds received to any unit
of government, excluding amounts recovered by the state or federal
government.
(3) In establishing
the amount to be paid to each nondesignated public hospital under this
subdivision, the department shall minimize to the extent possible the
redistribution of federal funds that are based on certified public
expenditures as described in paragraph (2).
(b) Each
nondesignated public hospital, or governmental entity
with which it is affiliated, shall receive the amount established
pursuant to subdivision (a) in quarterly interim payments during the
successor demonstration year. The determination of the interim payments
shall be made on an interim basis prior to the start of each successor
demonstration year. The department shall use the same cost and
statistical data that is used in determining the interim payments for
Medi-Cal inpatient hospital services under Section 14166.152.
(c) (1) No
later than April 1 following the end of the relevant reporting period
for the successor demonstration year, the department shall undertake an
interim reconciliation of the payment amount established pursuant to
subdivision (a) for each nondesignated public hospital using Medicare
and other cost, payment, and statistical data submitted by the hospital
for the successor demonstration year, and shall adjust payments to the
hospital accordingly.
(2) The
final payment to a nondesignated public hospital, for purposes of
subdivision (b) and paragraph (1) of this subdivision, shall be subject
to final audits of all applicable Medicare and other cost, payment,
discharge, and statistical data for the successor demonstration year.
(d) The
department shall submit for federal approval a proposed amendment to
the successor demonstration project to implement this section.
(e) This section shall become operative as provided in subdivision (f) of Section 14166.151.
SEC. 96.
Section 14166.155 is added to the Welfare and Institutions Code, to read:14166.155.
(a) (1) Beginning in the 2012–13 fiscal year, if the reimbursement methodology in subdivision (b) of Section 14166.151 is in effect and federal approval is obtained for an amendment to the successor demonstration project that was submitted pursuant to subdivision (c), then nondesignated public hospitals may receive payments pursuant to this section. The amount of delivery system reform incentive pool funding, consisting of both the federal and nonfederal share of payments, that is made available to each nondesignated public hospital system in the aggregate for the term of the successor demonstration project shall be based initially on the delivery system reform proposals that are submitted by the nondesignated public hospitals to the department for review and submission to the federal Centers for Medicare and Medicaid Services for final approval. The initial percentages of delivery system reform incentive pool funding among the nondesignated public hospitals for each successor demonstration year shall be determined based on the annual components as contained in the approved proposals.(2) The
actual receipt of funds shall be conditioned on the nondesignated public
hospital’s progress toward, and achievement of, the specified
milestones and other metrics established in its approved delivery system
reform incentive pool proposal. A nondesignated public hospital may
carry forward available incentive pool funding associated with
milestones and metrics from one year to a subsequent period as
authorized by the Special Terms and Conditions and the final delivery
system reform incentive pool protocol.
(3) The
department may reallocate the incentive pool funding available
under this section pursuant to conditions specified, and as authorized
by, the Special Terms and Conditions and the final delivery system
reform incentive pool protocol.
(b) Each
nondesignated public hospital shall be individually responsible for
progress toward, and achievement of, milestones and other metrics in its
proposal, as well as other applicable requirements specified in the
Special Terms and Conditions and the final delivery system reform
incentive pool protocol, in order to receive its specified allocation of
incentive pool funding under this section.
(1) The
nondesignated public hospital shall submit semiannual reports and
requests for payment to the department by March 31 and the September 30
following the end of the second and fourth quarters of the successor
demonstration year, or comply with any other
process as approved by the federal Centers for Medicare and
Medicaid Services.
(2) Within
14 days after the semiannual report due date, the nondesignated public
hospital system or its affiliated governmental entity shall make an
intergovernmental transfer of funds equal to the nonfederal share that
is necessary to claim the federal funding for the pool payment related
to the achievement or progress metric that is certified. The
intergovernmental transfers shall be deposited into the Public Hospital
Investment, Improvement, and Incentive Fund, established pursuant to
Section 14182.4.
(3) The
department shall claim the federal funding and pay both the nonfederal
and federal shares of the incentive payment to the nondesignated public
hospital system or other affiliated governmental provider, as
applicable. If the intergovernmental transfer is made within the
appropriate 14-day
timeframe, the incentive payment shall be disbursed within seven
days with the expedited payment process as approved by the federal
Centers for Medicare and Medicaid Services, otherwise the payment shall
be disbursed within 20 days of when the transfer is made.
(4) The
nondesignated public hospital system or other affiliated governmental
provider is responsible for any fee or cost required to implement the
expedited payment process in accordance with Section 8422.1 of the State
Administrative Manual.
(c) The
department shall submit for federal approval an amendment to the
successor demonstration project to implement this section.
(d) In
the event of a conflict between any provision of this section and the
Special Terms and Conditions for the successor demonstration project and
the final delivery system reform
incentive pool protocol, the Special Terms and Conditions and the
final delivery system reform incentive pool protocol shall control.
(e) This section shall become operative as provided in subdivision (f) of Section 14166.151.
SEC. 97.
Section 14166.17 of the Welfare and Institutions Code is amended to read:14166.17.
(a) The California Medical Assistance Commission shall negotiate payment amounts in accordance with the selective provider contracting program established pursuant to Article 2.6 (commencing with Section 14081) from the Nondesignated Public Hospital Supplemental Fund established pursuant to subdivision (b) for distribution to nondesignated public hospitals that satisfy the criteria of subdivision (o). Pursuant to Section 14165, on and after July 1, 2012, the Director of Health Care Services shall exercise the discretion granted to the California Medical Assistance Commission.(b) The Nondesignated Public Hospital Supplemental Fund is hereby established in the State Treasury. For
purposes of this section, “fund” means the Nondesignated Public Hospital Supplemental Fund.
(c) Notwithstanding
Section 13340 of the Government Code, the fund shall be continuously
appropriated to the department for the purposes specified in this
section.
(d) Except as otherwise limited by this section, the fund shall consist of all of the following:
(1) One
million nine hundred thousand dollars ($1,900,000), which shall be
transferred annually from General Fund amounts appropriated in the
annual Budget Act for the fund.
(2) Any additional moneys appropriated to the fund.
(3) All stabilization funding transferred to the fund.
(4) All
private moneys donated by private individuals or entities to the
department for deposit in the fund as permitted under applicable federal
Medicaid laws.
(5) Any interest that accrues on amounts in the fund.
(e) The
department may accept or not accept moneys offered to the department
for deposit in the fund. If the department accepts moneys pursuant to
this section, the department shall obtain federal financial
participation to the full extent permitted by law. With respect to funds
transferred or donated from private individuals or entities, the
department shall accept only those funds that are certified by the
transferring or donating entity as qualifying for federal financial
participation under the terms of the Medicaid Voluntary Contribution and
Provider-Specific Tax Amendments of 1991 (Public Law 102-234) or
Section 433.51 of Title 42 of the Code of
Federal Regulations, as applicable. The department may return any
funds transferred or donated in error.
(f) Moneys in the funds shall be used as the source for the nonfederal share of payments to hospitals under this section.
(g) Any
funds remaining in the fund at the end of a fiscal year shall be
carried forward for use in the following fiscal year.
(h) Moneys
shall be allocated from the fund by the department and shall be applied
to obtain federal financial participation in accordance with customary
Medi-Cal accounting procedures for purposes of payments under this
section. Distributions from the fund shall be supplemental to any other
Medi-Cal reimbursement received by the hospitals, including amounts that
hospitals receive under the selective provider contracts negotiated
under Article 2.6 (commencing with
Section 14081), and shall not affect provider rates paid under the
selective provider contracting program.
(i) Each
nondesignated public hospital that was a nondesignated public hospital
during the 2002–03 fiscal year, received payments for the 2002–03 fiscal
year from any of the prior supplemental funds, and, during the project
year satisfies the criteria in subdivision (o) to be eligible to
negotiate for distributions under any of those sections shall receive no
less from the Nondesignated Public Hospital Supplemental Fund for the
project year than 100 percent of the amount the hospital received from
the prior supplemental funds for the 2002–03 fiscal year, minus the
total amount of intergovernmental transfers made by or on behalf of the
hospital pursuant to subdivision (o) for the same fiscal year. Each
hospital described in this subdivision shall be eligible for additional
payments from the fund pursuant to subdivision (j).
(j) All
amounts that are in the fund for a project year in excess of the amount
necessary to make the payments under subdivision (i) shall be available
for negotiation by the California Medical Assistance Commission, along
with corresponding federal financial participation, for supplemental
payments to nondesignated public hospitals that for the project year
satisfy the criteria under subdivision (o) to be eligible to negotiate
for distributions under any of those sections, and paid for services
rendered during the project year pursuant to the selective provider
contracting program under Article 2.6 (commencing with Section 14081).
(k) The
amount of any stabilization funding transferred to the fund with
respect to a project year may in the discretion of the California
Medical Assistance Commission, until its dissolution on June 30, 2012,
to be paid for services furnished in the same
project year regardless of when the stabilization funds become
available, provided the payment is consistent with other applicable
federal or state legal requirements and does not result in a hospital
exceeding any applicable reimbursement limitations. On and after July 1,
2012, the Director of Health Care Services shall exercise the
discretion granted to the California Medical Assistance Commission by
this subdivision.
(l) The
department shall pay amounts due to a nondesignated hospital from the
fund for a project year, with the exception of stabilization funding, in
up to four installment payments, unless otherwise provided in the
hospital’s contract negotiated with the California Medical Assistance
Commission, except that hospitals that are not described in subdivision
(i) shall not receive the first installment payment. The first payment
shall be made as soon as practicable after the issuance of the tentative
disproportionate share hospital
list for the project year, and in no event later than January 1 of
the project year. The second and subsequent payments shall be made
after the issuance of the final disproportionate hospital list for the
project year, and shall be made only to hospitals that are on the final
disproportionate share hospital list for the project year. The second
payment shall be made by February 1 of the project year or as soon as
practicable after the issuance of the final disproportionate share
hospital list for the project year. The third payment, if scheduled,
shall be made by April 1 of the project year. The fourth payment, if
scheduled, shall be made by June 30 of the project year. This
subdivision does not apply to hospitals that are scheduled to receive
payments from the fund because they meet the criteria under paragraph
(2) of subdivision (o) but do not meet the criteria under paragraph (1),
(3), or (4) of subdivision (o).
(m)
The department shall pay
stabilization funding transferred to the fund in amounts
negotiated by the California Medical Assistance Commission and paid in
accordance with the applicable contract or contract amendment.
(n) A
nondesignated public hospital that receives payment pursuant to this
section for a particular project year shall not submit a notice for the
termination of its participation in the selective provider contracting
program established pursuant to Article 2.6 (commencing with Section
14081) until the later of the following dates:
(1) On or after December 31 of the next project year.
(2) The date specified in the hospital’s contract, if applicable.
(o) In order for a hospital to receive distributions pursuant to this section, the hospital shall satisfy the
eligibility criteria in paragraph (1), (2), (3), or (4) of this subdivision.
(1) The hospital meets all of the following criteria:
(A) The hospital is contracting under this article.
(B) The hospital meets the criteria contained in the Medicaid State Plan for disproportionate share hospital status.
(C) The hospital is one of the following:
(i) A
licensed provider of basic emergency services as described in Section
70411 of Title 22 of the California Code of Regulations.
(ii) A
licensed provider of comprehensive emergency medical services as
defined in Section 70451 of Title 22 of the California Code of
Regulations.
(iii) A children’s
hospital, as defined in Section 14087.21, that satisfies clause (i) or
(ii), or that jointly provides basic or comprehensive emergency services
in conjunction with another licensed hospital.
(iv) A
hospital owned and operated by a public agency that operates two or
more hospitals that qualify under subparagraph (A) or (B) with respect
to the particular state fiscal year.
(v) A
hospital designated by the National Cancer Institute as a comprehensive
or clinical cancer research center that primarily treats acutely ill
cancer patients and that is exempt from the federal Medicare prospective
payment system pursuant to Section 1886(d)(1)(B)(v) of the federal
Social Security Act (42 U.S.C. Sec. 1395ww(d)(1)(B)(v)).
(D) (1) The
hospital is able to demonstrate a purpose for additional funding under
the selective provider contracting program including proposals relating
to emergency services and other health care services, including
infrequent yet high-cost services, such as anti-AB human antitoxin
treatment for infant botulism (human botulinum immune globulin (HBIG),
commonly referred to as “Baby-BIG”), that are made available, or will be
made available, to Medi-Cal beneficiaries.
(2) The
hospital is contracting under this article and meets the definition of a
university teaching hospital or major, nonuniversity, teaching hospital
as set forth on page 51 and as listed on page 57 of the department’s
report dated May 1991, entitled “Hospital Peer Grouping.” Payments from
the fund shall be used solely for the purposes identified in the
contract between the hospital and the state.
(3) The
hospital is contracting under this article and meets the definition of any of the following:
(A) A
large teaching emphasis hospital, as set forth on page 51 and listed on
page 57 of the department’s report dated May 1991, entitled “Hospital
Peer Grouping,” and also meets the definition of eligible hospital as
defined in paragraph (3) of subdivision (a) of Section 14105.98.
(B) A
children’s hospital pursuant to Section 10727, and also meets the
definition of eligible hospital as defined in paragraph (3) of
subdivision (a) of Section 14105.98.
(C) Notwithstanding
the requirement in subparagraph (A) of paragraph (3) that a hospital
must be listed on page 57 of the department’s report dated May 1991,
entitled “Hospital Peer Grouping,” any hospital whose license pursuant
to Chapter 2 (commencing with Section 1250) of
Division 2 of the Health and Safety Code was consolidated during
the 1999 calendar year with a large teaching emphasis hospital that is
listed on page 57 of the above-described report shall be eligible. All
other requirements of paragraph (3) shall continue to apply.
(4) The hospital meets all of the following criteria:
(A) The hospital is contracting under this article.
(B) The hospital satisfies the Medicaid State Plan criteria for disproportionate share hospital status.
(C) The hospital is a small and rural hospital as defined in Section 124840 of the Health and Safety Code.
(D) The hospital is a licensed provider of standby emergency services as described in Section 70649 of Title 22
of the California Code of Regulations.
(E) The
hospital is able to demonstrate a purpose for additional funding under
the selective provider contracting program with proposals relating to
health care services that are made available, or will be made available,
to Medi-Cal beneficiaries.
(F) The
hospital is determined by the California Medical Assistance Commission
to be a hospital that provides an important community service that
otherwise would not be provided in the community.
SEC. 98.
Section 14166.19 of the Welfare and Institutions Code is amended to read:14166.19.
The amount of any stabilization funding payable to the nondesignated public hospitals under paragraph (4) of subdivision (b) of Section 14166.20 for a project year, which amount shall not include the amount of stabilization funding paid or payable to hospitals prior to the computation of the stabilization funding under Section 14166.20, shall be allocated in the following priority:(a) An
amount shall be transferred to the Nondesignated Public Hospital
Supplemental Fund, as may be necessary so that the amount for the
Nondesignated Public Hospital Supplemental Fund for the project year,
including all funds previously transferred to, or deposited in, the
Nondesignated Public Hospital Supplemental Fund
for the project year, is not less than one million nine hundred
thousand dollars ($1,900,000).
(b) Of
the remaining stabilization funding payable to nondesignated public
hospitals, 75 percent shall be allocated, distributed, and paid in
accordance with Section 14166.16, and 25 percent shall be transferred to
the Nondesignated Public Hospital Supplemental Fund.
(c) Notwithstanding
any other law, the amount of any stabilization funding payable to
nondesignated public hospitals under Section 14166.20 for a project year
as determined under this section that has not been paid, or
specifically committed for payment, to nondesignated public hospitals
before January 1, 2012, shall not be paid pursuant to Section 14166.20.
The funds that would otherwise be paid from the Nondesignated Public
Hospital Supplemental Fund shall be transferred to the General Fund, and
funds that would otherwise
be drawn from the General Fund for payments to the nondesignated
public hospitals pursuant to Section 14166.20 shall be retained in the
General Fund.
SEC. 99.
Section 14169.7 of the Welfare and Institutions Code is amended to read:14169.7.
(a) (1) Designated public hospitals shall be paid direct grants in support of health care expenditures, which shall not constitute Medi-Cal payments, and which shall be funded by the quality assurance fee set forth in Article 5.229 (commencing with Section 14169.31). The aggregate amount of the grants to designated public hospitals shall be fifty million dollars ($50,000,000) for the 2011–12 fiscal year, forty-three million dollars ($43,000,000) for the 2012–13 fiscal year, and twenty-one million five hundred thousand dollars ($21,500,000) for the 2013–14 fiscal year. The director shall allocate the amounts specified in this paragraph pursuant to paragraph (2).(2) For the
2011–12 fiscal year, the
director shall allocate the fifty million dollars ($50,000,000)
identified in paragraph (1) among the designated public hospitals
pursuant to a methodology developed in consultation with the designated
public hospitals. For the 2012–13 fiscal year, the director shall
allocate the forty-three million dollars ($43,000,000) identified in
paragraph (1) among the designated public hospitals pursuant to a
methodology developed in consultation with the designated public
hospitals. For the 2013–14 fiscal year, the state shall retain the
twenty-one million five hundred thousand dollars ($21,500,000)
identified in paragraph (1) to pay for health care coverage for children
in addition to the amounts identified in Section 14169.33.
(b) Nondesignated
public hospitals shall be paid direct grants in support of health care
expenditures, and shall be funded by the quality assurance fee set forth
in Article 5.229 (commencing with Section 14169.31). The aggregate
amount of the grants to nondesignated public hospitals for each
subject fiscal year shall be ten million dollars ($10,000,000), except
that for the 2013–14 subject fiscal year, the aggregate amount of the
grants shall be five million dollars ($5,000,000). The director shall
allocate the amounts specified in this subdivision among the
nondesignated public hospitals pursuant to a methodology developed in
consultation with the nondesignated public hospitals.
SEC. 100.
Section 14169.7.5 of the Welfare and Institutions Code is amended to read:14169.7.5.
(a) The Low Income Health Program MCE Out-of-Network Emergency Care Services Fund is hereby established in the State Treasury. The moneys in the fund shall, upon appropriation by the Legislature to the department, be used solely for the purposes specified in this section. Notwithstanding Section 16305.7 of the Government Code, any and all interest and dividends earned on money in the fund shall be used exclusively for the purposes of this section.(b) The fund shall consist of the following:
(1) Funds
transferred from governmental entities, at the option of the
governmental entity, to the state for deposit into the fund in an
aggregate amount of twenty
million dollars ($20,000,000) per subject fiscal year, except that
for the 2013–14 subject fiscal year, the aggregate amount of the
transfer shall be ten million dollars ($10,000,000).
(2) Proceeds
of the quality assurance fee set forth in Article 5.229 (commencing
with Section 14169.31) that, subject to paragraph (1) of subdivision (a)
of Section 14169.36, are transferred from the Hospital Quality
Assurance Revenue Fund and deposited into the fund in an aggregate
amount of seventy-five million dollars ($75,000,000) per subject fiscal
year, except that for the 2013–14 subject fiscal year, the aggregate
amount of the proceeds of the quality assurance fee deposited into the
fund shall be thirty-seven million five hundred thousand dollars
($37,500,000).
(c) Any amounts
of the quality assurance fee deposited to the fund in excess of the
funds required to implement this section shall
be returned to the Hospital Quality Assurance Revenue Fund.
(d) Any
amounts deposited to the fund as described in paragraph (1) of
subdivision (b) that are in excess of the funds required to implement
this section shall be returned to the transferring entity.
(e) Consistent
with the Special Terms and Conditions for the California’s Bridge to
Reform Section 1115(a) Medicaid Demonstration (11-W-00193/9), moneys in
the fund shall be used with respect to Low Income Health Programs
(LIHPs) operating pursuant to Part 3.6 (commencing with Section 15909)
as the source for the nonfederal share of expenditures for coverage for
the Medi-Cal coverage expansion (MCE) population of medically necessary
hospital emergency services for emergency medical conditions and
required poststabilization care furnished by private hospitals and
nondesignated public hospitals that are outside the LIHP
coverage network, subject to the following:
(1) Moneys
in the fund shall only be used to fund the nonfederal share of
supplemental payments made to private hospital and nondesignated public
hospital out-of-network emergency care services providers by the LIHP
for the MCE population in accordance with this section.
(2) Supplemental
payments under this section shall supplement but shall not supplant
amounts that would have been paid absent the provisions of this section.
(f) Moneys in the fund shall be allocated with respect to each subject fiscal year as follows:
(1) Within
60 days after the last day of each subject fiscal year, each LIHP shall
report utilization data to the department on approved hospital
emergency services for emergency medical
conditions and required poststabilization care, in accordance with
Paragraph 63.f.ii of the Special Terms and Conditions of California’s
Bridge to Reform Section 1115(a) Demonstration (11-W-00193/9), provided
to MCE enrollees by out-of-network private hospitals and nondesignated
public hospitals during that year. The reported data shall be as
specified by the department, and shall include the number of emergency
room encounters and the number of inpatient hospital days.
(2) The
department shall, in consultation with the hospital community,
determine the amount of funding for the nonfederal share of supplemental
payments available for each reported emergency room encounter or
inpatient day by dividing the total funds available by the total number
of inpatient days or emergency visits in accordance with subparagraphs
(A) and (B).
(A) Seventy
percent of the moneys in the fund shall
be allocated for the nonfederal share of supplemental payments to
private hospitals and nondesignated public hospitals for approved
out-of-network inpatient hospital emergency and poststabilization care,
in accordance with Paragraph 63.f.ii of the Special Terms and Conditions
of California’s Bridge to Reform Section 1115(a) Demonstration
(11-W-00193/9).
(B) Thirty
percent of the available funds shall be allocated for the nonfederal
share of supplemental payments to private hospitals and nondesignated
public hospitals for approved out-of-network hospital emergency room
services (excluding emergency room visits, in accordance with Paragraph
63.f.ii of the Special Terms and Conditions of California’s Bridge to
Reform Section 1115(a) Demonstration (11-W-00193/9), that resulted in an
approved out-of-network inpatient hospital stay), provided that for any
emergency room visit that results in a hospital stay for which a
supplemental payment is
available under subparagraph (A), no supplemental payment shall be
available under this subparagraph.
(C) The
allocations and total available fund amount shall be adjusted as
necessary so as to be consistent with the requirement in paragraph (1)
of subdivision (g).
(g) (1) The
department shall obtain federal financial participation for moneys in
the fund to the full extent permitted by federal law. Moneys shall be
allocated from the fund by the department to be matched by federal funds
in accordance with the Special Terms and Conditions for the Medicaid
Demonstration, or pursuant to other federal approvals or waivers as
necessary.
(2) The department
shall disburse moneys from the fund to the LIHPs in accordance with the
calculations in subdivision (f) within 60 days after completing the
calculations. The moneys shall be distributed to the LIHPs solely
for purposes of funding the nonfederal portion of the supplemental
out-of-network amounts determined for each service in subdivision (f) to
out-of-network hospital emergency care services providers.
(3) The
LIHPs shall make the supplemental payments described in paragraph (2)
within 30 days of receiving the nonfederal share from the department.
(h) It
is the intent of the Legislature that for each subject fiscal year, the
first twenty million dollars ($20,000,000), or, for subject fiscal year
2013–14, the first ten million dollars ($10,000,000), of the nonfederal
share for the emergency hospital services payments are funded with
intergovernmental transfers described in paragraph (1) of subdivision
(b).
(i) This section shall be implemented only if, and
to the extent that, both of the following conditions exist:
(1) All
necessary federal approvals have been obtained for the implementation
of this section and federal financial participation is available.
(2) The ability of the department to maximize federal funding is not jeopardized.
(j) In
designing and implementing the program for supplemental payments
created under this section, the director shall have discretion, after
consultation with the hospital community and the LIHPs, to modify
timelines and to make modifications to the operational requirements of
this section, but only to the extent necessary to secure federal
approval or to ensure successful operation of the program and to
effectuate the intent of this section.
(k) Notwithstanding
any other
provision of this article or Article 5.229 (commencing with
Section 14169.31), federal disapproval of the program developed pursuant
to the requirements of this section shall not affect the implementation
of the remainder of this article or Article 5.229 (commencing with
Section 14169.31).
SEC. 101.
Section 14169.13 of the Welfare and Institutions Code is amended to read:14169.13.
(a) The director shall do all of the following:(1) Promptly submit any state plan amendment or waiver request that may be necessary to implement this article.
(2) Promptly
seek federal approvals or waivers as may be necessary to implement this
article and to obtain federal financial participation to the maximum
extent possible for the payments under this article.
(3) Amend
the contracts between the managed health care plans and the department
as necessary to incorporate the provisions of Sections 14169.5 and
14169.6 and promptly seek all necessary federal approvals of those
amendments. The
department shall pursue amendments to the contracts as soon as
possible after the effective date of this article and Article 5.229
(commencing with Section 14169.31), and shall not wait for federal
approval of this article or Article 5.229 (commencing with Section
14169.31) prior to pursuing amendments to the contracts. The amendments
to the contracts shall, among other provisions, set forth an agreement
to increase capitation payments to managed health care plans under
Section 14169.5 and increase payments to hospitals under Section 14169.6
in a manner that relates back to July 1, 2011, or as soon thereafter as
possible, conditioned on obtaining all federal approvals necessary for
federal financial participation for the increased capitation payments to
the managed health care plans.
(b) In
implementing this article, the department may utilize the services of
the Medi-Cal fiscal intermediary through a change order to the fiscal
intermediary
contract to administer this program, consistent with the
requirements of Sections 14104.6, 14104.7, 14104.8, and 14104.9.
Contracts entered into for purposes of implementing this article or
Article 5.229 (commencing with Section 14169.31) shall not be subject to
Part 2 (commencing with Section 10100) of Division 2 of the Public
Contract Code.
(c) This article shall become inoperative if either of the following occurs:
(1) In
the event, and on the effective date, of a final judicial determination
made by any court of appellate jurisdiction or a final determination by
the federal Department of Health and Human Services or the federal
Centers for Medicare and Medicaid Services that Section 14169.2, Section
14169.3, or any provision of Section 14166.115 cannot be implemented.
(2) In the event both of the following
conditions exist:
(A) The
federal Centers for Medicare and Medicaid Services denies approval for,
or does not approve before January 1, 2013, the implementation of
Section 14169.2, Section 14169.3, or the quality assurance fee
established pursuant to Article 5.229 (commencing with Section
14169.31).
(B) Section
14169.2, Section 14169.3, or Article 5.229 (commencing with Section
14169.31) cannot be modified by the department pursuant to subdivision
(e) of Section 14169.33 in order to meet the requirements of federal law
or to obtain federal approval.
(d) If
this article becomes inoperative pursuant to paragraph (1) of
subdivision (c) and the determination applies to any period or periods
of time prior to the effective date of the determination, the department
shall have authority to recoup all payments made pursuant
to this article during that period or those periods of time.
(e) In
the event any hospital, or any party on behalf of a hospital, shall
initiate a case or proceeding in any state or federal court in which the
hospital seeks any relief of any sort whatsoever, including, but not
limited to, monetary relief, injunctive relief, declaratory relief, or a
writ, based in whole or in part on a contention that any or all of this
article or Article 5.229 (commencing with Section 14169.31) is unlawful
and may not be lawfully implemented, both of the following shall apply:
(1) Payments
shall not be made to the hospital pursuant to this article until the
case or proceeding is finally resolved, including the final disposition
of all appeals.
(2) Any amount
computed to be payable to the hospital pursuant to this section for a
project year shall be withheld by the department and shall be paid
to the hospital only after the case or proceeding is finally resolved,
including the final disposition of all appeals.
(f) Subject
to Section 14169.34, no payment shall be made under this article until
all necessary federal approvals for the payment and for the fee
provisions in Article 5.229 (commencing with Section 14169.31) have been
obtained and the fee has been imposed and collected. Notwithstanding
any other provision of law, payments under this article shall be made
only to the extent that the fee established in Article 5.229 (commencing
with Section 14169.31) is collected and available to cover the
nonfederal share of the payments.
(g) A
hospital’s receipt of payments under this article for services rendered
prior to the effective date of this article is conditioned on the
hospital’s continued participation
in Medi-Cal for at least 30 days after the effective date of this
article.
(h) All payments made
by the department to hospitals, managed health care plans, and mental
health plans under this article shall be made only from the following:
(1) The
quality assurance fee set forth in Article 5.229 (commencing with
Section 14169.31) and due and payable on or before December 31, 2013,
along with any interest or other investment income thereon.
(2) Federal reimbursement and any other related federal funds.
SEC. 102.
Section 14169.31 of the Welfare and Institutions Code is amended to read:14169.31.
For the purposes of this article, the following definitions shall apply:(a) (1) “Aggregate
quality assurance fee” means, with respect to a hospital that is not a
prepaid health plan hospital, the sum of all of the following:
(A) The
annual fee-for-service days for an individual hospital multiplied by
the fee-for-service per diem quality assurance fee rate.
(B) The
annual managed care days for an individual hospital multiplied by the
managed care per diem quality assurance fee rate.
(C) The annual Medi-Cal days for an individual
hospital multiplied by the Medi-Cal per diem quality assurance fee rate.
(2) “Aggregate
quality assurance fee” means, with respect to a hospital that is a
prepaid health plan hospital, the sum of all of the following:
(A) The
annual fee-for-service days for an individual hospital multiplied by
the fee-for-service per diem quality assurance fee rate.
(B) The
annual managed care days for an individual hospital multiplied by the
prepaid health plan hospital managed care per diem quality assurance fee
rate.
(C) The annual Medi-Cal
managed care days for an individual hospital multiplied by the prepaid
health plan hospital Medi-Cal managed care per diem quality assurance
fee rate.
(D) The annual
Medi-Cal fee-for-service days for an individual hospital multiplied by the Medi-Cal per diem quality assurance fee rate.
(3) “Aggregate
quality assurance fee after the application of the fee percentage”
means the aggregate quality assurance fee multiplied by the fee
percentage for each subject fiscal year.
(b) “Annual
fee-for-service days” means the number of fee-for-service days of each
hospital subject to the quality assurance fee, as reported on the days
data source.
(c) “Annual
managed care days” means the number of managed care days of each
hospital subject to the quality assurance fee, as reported on the days
data source.
(d) “Annual
Medi-Cal days” means the number of Medi-Cal days of each hospital
subject to the quality assurance fee, as reported
on the days data source.
(e) “Converted hospital” shall mean a hospital described in subdivision (b) of Section 14169.1.
(f) “Days
data source” means the hospital’s Annual Financial Disclosure Report
filed with the Office of Statewide Health Planning and Development as of
May 5, 2011, for its fiscal year ending during 2009.
(g) “Designated public hospital” shall have the meaning given in subdivision (d) of Section 14166.1 as of January 1, 2011.
(h) “Exempt facility” means any of the following:
(1) A public hospital, which shall include either of the following:
(A) A hospital, as defined in paragraph (25) of subdivision (a) of
Section 14105.98.
(B) A
tax-exempt nonprofit hospital that is licensed under subdivision (a) of
Section 1250 of the Health and Safety Code and operating a hospital
owned by a local health care district, and is affiliated with the health
care district hospital owner by means of the district’s status as the
nonprofit corporation’s sole corporate member.
(2) With
the exception of a hospital that is in the Charitable Research Hospital
peer group, as set forth in the 1991 Hospital Peer Grouping Report
published by the department, a hospital that is a hospital designated as
a specialty hospital in the hospital’s Office of Statewide Health
Planning and Development Hospital Annual Financial Disclosure Report for
the hospital’s fiscal year ending in the 2009 calendar year.
(3) A hospital that satisfies the Medicare criteria
to be a long-term care hospital.
(4) A
small and rural hospital as specified in Section 124840 of the Health
and Safety Code designated as that in the hospital’s Office of Statewide
Health Planning and Development Hospital Annual Financial Disclosure
Report for the hospital’s fiscal year ending in the 2009 calendar year.
(i) “Federal
approval” means the approval by the federal government of both the
quality assurance fee established pursuant to this article and the
supplemental payments to private hospitals described in Sections 14169.2
and 14169.3.
(j) (1) “Fee-for-service per diem quality assurance fee rate” means a fixed daily fee on fee-for-service days.
(2) The fee-for-service per diem quality assurance fee rate shall be three
hundred nine dollars and eighty-six cents ($309.86) per day.
(3) Upon
federal approval or conditional federal approval described in Section
14169.34, the director shall determine the fee-for-service per diem
quality assurance fee rate based on the funds required to make the
payments specified in Article 5.228 (commencing with Section 14169.1),
in consultation with the hospital community.
(k) “Fee-for-service
days” means inpatient hospital days where the service type is reported
as “acute care,” “psychiatric care,” and “rehabilitation care,” and the
payer category is reported as “Medicare traditional,” “county indigent
programs-traditional,” “other third parties-traditional,” “other
indigent,” and “other payers,” for purposes of the Annual Financial
Disclosure Report submitted by hospitals to the Office of Statewide
Health Planning and Development.
(l) “Fee
percentage” means a fraction, expressed as a percentage, the numerator
of which is the amount of payments for each subject fiscal year under
Sections 14169.2, 14169.3, 14169.5, and 14169.7.5, for which federal
financial participation is available and the denominator of which is
four billion eight hundred ninety-seven million eight hundred sixty-six
thousand nine hundred thirty-seven dollars ($4,897,866,937).
(m) “General
acute care hospital” means any hospital licensed pursuant to
subdivision (a) of Section 1250 of the Health and Safety Code.
(n) “Hospital community” means any hospital industry organization or system that represents hospitals.
(o) “Managed
care days” means inpatient hospital days where the service type is
reported as “acute care,”
“psychiatric care,” and “rehabilitation care,” and the payer
category is reported as “Medicare managed care,” “county indigent
programs-managed care,” and “other third parties-managed care,” for
purposes of the Annual Financial Disclosure Report submitted by
hospitals to the Office of Statewide Health Planning and Development.
(p) “Managed
care per diem quality assurance fee rate” means a fixed fee on managed
care days of eighty-six dollars and forty cents ($86.40) per day.
(q) “Medi-Cal
days” means inpatient hospital days where the service type is reported
as “acute care,” “psychiatric care,” and “rehabilitation care,” and the
payer category is reported as “Medi-Cal traditional” and “Medi-Cal
managed care,” for purposes of the Annual Financial Disclosure Report
submitted by hospitals to the Office of Statewide Health Planning and
Development.
(r) “Medi-Cal
fee-for-service days” means inpatient hospital days where the service
type is reported as “acute care,” “psychiatric care,” and
“rehabilitation care,” and the payer category is reported as “Medi-Cal
traditional” for purposes of the Annual Financial Disclosure Report
submitted by hospitals to the Office of Statewide Health Planning and
Development.
(s) “Medi-Cal
managed care days” means inpatient hospital days as reported on the days
data source where the service type is reported as “acute care,”
“psychiatric care,” and “rehabilitation care,” and the payer category is
reported as “Medi-Cal managed care” for purposes of the Annual
Financial Disclosure Report submitted by hospitals to the Office of
Statewide Health Planning and Development.
(t) “Medi-Cal per diem quality assurance fee rate” means a fixed fee
on Medi-Cal days of three hundred eighty-three dollars and twenty cents ($383.20) per day.
(u) “New
hospital” means a hospital operation, business, or facility functioning
under current or prior ownership as a private hospital that does not
have a days data source or a hospital that has a days data source in
whole, or in part, from a previous operator where there is an
outstanding monetary liability owed to the state in connection with the
Medi-Cal program and the new operator did not assume liability for the
outstanding monetary obligation.
(v) “Nondesignated public hospital” means either of the following:
(1) A
public hospital that is licensed under subdivision (a) of Section 1250
of the Health and Safety Code, is not designated as a specialty hospital
in the hospital’s Annual Financial Disclosure Report for the
hospital’s latest fiscal year ending in 2009, and satisfies the
definition in paragraph (25) of subdivision (a) of Section 14105.98,
excluding designated public hospitals.
(2) A
tax-exempt nonprofit hospital that is licensed under subdivision (a) of
Section 1250 of the Health and Safety Code, is not designated as a
specialty hospital in the hospital’s Annual Financial Disclosure Report
for the hospital’s latest fiscal year ending in 2009, is operating a
hospital owned by a local health care district, and is affiliated with
the health care district hospital owner by means of the district’s
status as the nonprofit corporation’s sole corporate member.
(w) “Prepaid
health plan hospital” means a hospital owned by a nonprofit public
benefit corporation that shares a common board of directors with a
nonprofit health care service plan.
(x) “Prepaid
health plan hospital managed care per diem quality assurance fee rate”
means a fixed fee on non-Medi-Cal managed care days for prepaid health
plan hospitals of forty-eight dollars and thirty-eight cents ($48.38)
per day.
(y) “Prepaid health
plan hospital Medi-Cal managed care per diem quality assurance fee rate”
means a fixed fee on Medi-Cal managed care days for prepaid health plan
hospitals of two hundred fourteen dollars and fifty-nine cents
($214.59) per day.
(z) “Prior
fiscal year data” means any data taken from sources that the department
determines are the most accurate and reliable at the time the
determination is made, or may be calculated from the most recent audited
data using appropriate update factors. The data may be from prior
fiscal years, current fiscal years, or projections of future fiscal
years.
(aa) “Private hospital” means a hospital that meets all of the following conditions:
(1) Is licensed pursuant to subdivision (a) of Section 1250 of the Health and Safety Code.
(2) Is
in the Charitable Research Hospital peer group, as set forth in the
1991 Hospital Peer Grouping Report published by the department, or is
not designated as a specialty hospital in the hospital’s Office of
Statewide Health Planning and Development Annual Financial Disclosure
Report for the hospital’s latest fiscal year ending in 2009.
(3) Does not satisfy the Medicare criteria to be classified as a long-term care hospital.
(4) Is a nonpublic hospital, nonpublic converted hospital, or converted hospital as those
terms are defined in paragraphs (26) to (28), inclusive, respectively, of subdivision (a) of Section 14105.98.
(ab) “Program period” means the period from July 1, 2011, to December 31, 2013, inclusive.
(ac) “Subject fiscal quarter” means a state fiscal quarter during the program period.
(ad) “Subject fiscal year” means a state fiscal year that ends after July 1, 2011, and begins before January 1, 2014.
(ae) “Upper
payment limit” means a federal upper payment limit on the amount of the
Medicaid payment for which federal financial participation is available
for a class of service and a class of health care providers, as
specified in Part 447 of Title 42 of the Code of Federal Regulations.
The applicable upper payment limit shall be separately calculated
for inpatient and outpatient hospital services.
SEC. 103.
Section 14169.32 of the Welfare and Institutions Code is amended to read:14169.32.
(a) There shall be imposed on each general acute care hospital that is not an exempt facility a quality assurance fee, provided that a quality assurance fee under this article shall not be imposed on a converted hospital.(b) The quality
assurance fee shall be computed starting on July 1, 2011, and continue
through and including December 31, 2013.
(c) Subject to Section 14169.34, upon receipt of federal approval, the following shall become operative:
(1) Within
10 business days following receipt of the notice of federal approval
from the federal government, the department shall send notice to
each hospital subject to the quality assurance fee, and publish on
its Internet Web site, the following information:
(A) The date that the state received notice of federal approval.
(B) The fee percentage for each subject fiscal year.
(2) The notice to each hospital subject to the quality assurance fee shall also state the following:
(A) The aggregate quality assurance fee after the application of the fee percentage for each subject fiscal year.
(B) The aggregate quality assurance fee.
(C) The amount of each payment due from the hospital with respect to the aggregate quality assurance fee.
(D) The date on which each payment is due.
(3) The
hospitals shall pay the aggregate quality assurance fee in 10 equal
installments. The department shall establish the date that each
installment is due, provided that the first installment shall be due no
earlier than 20 days following the department sending the notice
pursuant to paragraph (1), and the installments shall be paid at least
one month apart, but if possible, the installments shall be paid on a
quarterly basis.
(4) Notwithstanding
paragraph (3), the amount of each hospital’s aggregate quality
assurance fee after the application of the fee percentage that has not
been paid by the hospital before December 15, 2013, pursuant to
paragraph (3), shall be paid by the hospital no later than December 15,
2013.
(d) The quality assurance
fee, as paid pursuant to this section, shall be paid by each hospital
subject to the fee to the department for deposit in the Hospital Quality
Assurance Revenue Fund. Deposits may be accepted at any time and will
be credited toward the program period.
(e) This
section shall become inoperative if the federal Centers for Medicare
and Medicaid Services denies approval for, or does not approve before
July 1, 2014, the implementation of the quality assurance fee pursuant
to this article or the supplemental payments to private hospitals
described in Sections 14169.2 and 14169.3, and either or both provisions
cannot be modified by the department pursuant to subdivision (d) of
Section 14169.33 in order to meet the requirements of federal law or to
obtain federal approval.
(f) In
no case shall the
aggregate fees collected in a federal fiscal year pursuant to this
section, Section 14167.32, and Section 14168.32 exceed the maximum
percentage of the annual aggregate net patient revenue for hospitals
subject to the fee that is prescribed pursuant to federal law and
regulations as necessary to preclude a finding that an indirect
guarantee has been created.
(g) (1) Interest
shall be assessed on quality assurance fees not paid on the date due at
the greater of 10 percent per annum or the rate at which the department
assesses interest on Medi-Cal program overpayments to hospitals that
are not repaid when due. Interest shall begin to accrue the day after
the date the payment was due and shall be deposited in the Hospital
Quality Assurance Revenue Fund.
(2) In the event that any fee payment is more than 60 days overdue, a penalty equal to the interest charge
described in paragraph (1) shall be assessed and due for each month for which the payment is not received after 60 days.
(h) When
a hospital fails to pay all or part of the quality assurance fee on or
before the date that payment is due, the department may immediately
begin to deduct the unpaid assessment and interest from any Medi-Cal
payments owed to the hospital, or, in accordance with Section 12419.5 of
the Government Code, from any other state payments owed to the hospital
until the full amount is recovered. All amounts, except penalties,
deducted by the department under this subdivision shall be deposited in
the Hospital Quality Assurance Revenue Fund. The remedy provided to the
department by this section is in addition to other remedies available
under law.
(i) The payment of the quality assurance fee shall not be considered as an allowable cost for Medi-Cal cost reporting
and reimbursement purposes.
(j) The
department shall work in consultation with the hospital community to
implement this article and Article 5.228 (commencing with Section
14169.1).
(k) This subdivision
creates a contractually enforceable promise on behalf of the state to
use the proceeds of the quality assurance fee, including any federal
matching funds, solely and exclusively for the purposes set forth in
this article as they existed on the effective date of this article, to
limit the amount of the proceeds of the quality assurance fee to be used
to pay for the health care coverage of children to the amounts
specified in this article, to limit any payments for the department’s
costs of administration to the amounts set forth in this article on the
effective date of this article, to maintain and continue prior
reimbursement levels as set forth in Section 14169.12 on the effective
date of that article, and to otherwise comply with all its
obligations set forth in Article 5.228 (commencing with Section 14169.1)
and this article provided that amendments that arise from, or have as a
basis, a decision, advice, or determination by the federal Centers for
Medicare and Medicaid Services relating to federal approval of the
quality assurance fee or the payments set forth in this article or
Article 5.228 (commencing with Section 14169.1) shall control for the
purposes of this subdivision.
(l) (1) Effective
January 1, 2014, the rates payable to hospitals and managed health care
plans under Medi-Cal shall be the rates then payable without the
supplemental and increased capitation payments set forth in Article
5.228 (commencing with Section 14169.1).
(2) The
supplemental payments and other payments under Article 5.228
(commencing with Section
14169.1) shall be regarded as quality assurance payments, the
implementation or suspension of which does not affect a determination of
the adequacy of any rates under federal law.
(m) (1) Subject
to paragraph (2), the director may waive any or all interest and
penalties assessed under this article in the event that the director
determines, in his or her sole discretion, that the hospital has
demonstrated that imposition of the full quality assurance fee on the
timelines applicable under this article has a high likelihood of
creating a financial hardship for the hospital or a significant danger
of reducing the provision of needed health care services.
(2) Waiver
of some or all of the interest or penalties under this subdivision
shall be conditioned on the hospital’s agreement to make fee payments,
or to have the payments withheld from payments otherwise due
from the Medi-Cal program to the hospital, on a schedule developed
by the department that takes into account the financial situation of
the hospital and the potential impact on services.
(3) A decision by the director under this subdivision shall not be subject to judicial review.
(4) If
fee payments are remitted to the department after the date determined
by the department to be the final date for calculating the final
supplemental payments under this article and Article 5.228 (commencing
with Section 14169.1), the fee payments shall be retained in the fund
for purposes of funding supplemental payments supported by a hospital
quality assurance fee program implemented under subsequent legislation,
provided, however, that if supplemental payments are not implemented
under subsequent legislation, then those fee payments shall be deposited
in the Distressed Hospital Fund.
(5) If
during the implementation of this article, fee payments that were due
under Article 5.21 (commencing with Section 14167.1) and Article 5.22
(commencing with Section 14167.31), or Article 5.226 (commencing with
Section 14168.1) and Article 5.227 (commencing with Section 14168.31),
are remitted to the department under a payment plan or for any other
reason, and the final date for calculating the final supplemental
payments under those articles has passed, then those fee payments shall
be deposited in the fund to support the uses established by this
article.
SEC. 104.
Section 14169.33 of the Welfare and Institutions Code is amended to read:14169.33.
(a) (1) All fees required to be paid to the state pursuant to this article shall be paid in the form of remittances payable to the department.(2) The
department shall directly transmit the fee payments to the Treasurer to
be deposited in the Hospital Quality Assurance Revenue Fund, created
pursuant to Section 14167.35. Notwithstanding Section 16305.7 of the
Government Code, any interest and dividends earned on deposits in the
fund from the proceeds of the fee assessed pursuant to this article
shall be retained in the fund for purposes specified in subdivision (b).
(b) Notwithstanding
subdivision (c) of Section 14167.35 and subdivision
(b) of Section 14168.33, all funds from the proceeds of the fee
assessed pursuant to this article in the Hospital Quality Assurance
Revenue Fund, together with any interest and dividends earned on money
in the fund, shall, upon appropriation by the Legislature, continue to
be used exclusively to enhance federal financial participation for
hospital services under the Medi-Cal program, to provide additional
reimbursement to, and to support quality improvement efforts of,
hospitals, and to minimize uncompensated care provided by hospitals to
uninsured patients, as well as to pay for the state’s administrative
costs and to provide funding for children’s health coverage, in the
following order of priority:
(1) To
pay for the department’s staffing and administrative costs directly
attributable to implementing Article 5.228 (commencing with Section
14169.1) and this article, not to exceed two million five hundred
thousand dollars ($2,500,000) for the
program period.
(2) To
pay for the health care coverage for children in the amount of
eighty-five million dollars ($85,000,000) for each subject fiscal
quarter during the 2011–12 subject fiscal year, in the amount of one
hundred thirty-four million two hundred fifty thousand dollars
($134,250,000) for each subject fiscal quarter during the 2012–13
subject fiscal year, and in the amount of one hundred forty-four million
two hundred fifty thousand dollars ($144,250,000) for each subject
fiscal quarter during the 2013–14 subject fiscal year.
(3) To
make increased capitation payments to managed health care plans
pursuant to Article 5.228 (commencing with Section 14169.1).
(4) To
reimburse the General Fund for the increase in the overall compensation
to a private hospital that is attributable to its change in status from
contract hospital to noncontract hospital, pursuant to subdivision
(a) of Section 14169.10.
(5) To make increased payments or grants to hospitals pursuant to Article 5.228 (commencing with Section 14169.1).
(6) To make increased payments to mental health plans pursuant to Article 5.228 (commencing with Section 14169.1).
(7) To
make supplemental payments for out-of-network emergency and
poststabilization services provided by private hospitals and
nondesignated public hospitals to Medi-Cal expansion enrollees in the
Low Income Health Program in the amount of thirty-seven million five
hundred thousand dollars ($37,500,000) for each fiscal quarter pursuant
to Section 14169.7.5.
(c) Any
amounts of the quality assurance fee collected in excess of the funds
required to implement subdivision (b), including any funds
recovered under subdivision (d) of Section 14169.13 or subdivision (e)
of Section 14169.38, shall be refunded to general acute care hospitals,
pro rata with the amount of quality assurance fee paid by the hospital,
subject to the limitations of federal law. If federal rules prohibit the
refund described in this subdivision, the excess funds shall be
deposited in the Distressed Hospital Fund to be used for the purposes
described in Section 14166.23, and shall be supplemental to and not
supplant existing funds.
(d) Any
methodology or other provision specified in Article 5.228 (commencing
with Section 14169.1) or this article may be modified by the department,
in consultation with the hospital community, to the extent necessary to
meet the requirements of federal law or regulations to obtain federal
approval or to enhance the probability that federal approval can be
obtained, provided the
modifications do not violate the spirit and intent of Article
5.228 (commencing with Section 14169.1) or this article and are not
inconsistent with the conditions of implementation set forth in Section
14169.40.
(e) The department,
in consultation with the hospital community, shall make adjustments, as
necessary, to the amounts calculated pursuant to Section 14169.32 in
order to ensure compliance with the federal requirements set forth in
Section 433.68 of Title 42 of the Code of Federal Regulations or
elsewhere in federal law.
(f) The
department shall request approval from the federal Centers for Medicare
and Medicaid Services for the implementation of this article. In making
this request, the department shall seek specific approval from the
federal Centers for Medicare and Medicaid Services to exempt providers
identified in this article as exempt from the fees specified,
including the submission, as may be necessary, of a request for
waiver of the broad-based requirement, waiver of the uniform fee
requirement, or both, pursuant to paragraphs (1) and (2) of subdivision
(e) of Section 433.68 of Title 42 of the Code of Federal Regulations.
(g) Notwithstanding
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of
Title 2 of the Government Code, the department may implement this
article or Article 5.228 (commencing with Section 14169.1) by means of
provider bulletins, all plan letters, or other similar instruction,
without taking regulatory action. The department shall also provide
notification to the Joint Legislative Budget Committee and to the
appropriate policy and fiscal committees of the Legislature within five
working days when the above-described action is taken in order to inform
the Legislature that the action is being implemented.
SEC. 105.
Section 14169.34 of the Welfare and Institutions Code is amended to read:14169.34.
(a) Notwithstanding any other provision of this article or Article 5.228 (commencing with Section 14169.1) requiring federal approvals, the department may impose and collect the quality assurance fee and may make payments under this article and Article 5.228 (commencing with Section 14169.1), including increased capitation payments, based upon receiving a letter from the federal Centers for Medicare and Medicaid Services or the United States Department of Health and Human Services that indicates likely federal approval, but only if and to the extent that the letter is sufficient as set forth in subdivision (b).(b) In order for the letter to be sufficient under this section, the director shall find that the letter meets
both of the following requirements:
(1) The
letter is in writing and signed by an official of the federal Centers
for Medicare and Medicaid Services or an official of the United States
Department of Health and Human Services.
(2) The
director, after consultation with the hospital community, has
determined, in the exercise of his or her sole discretion, that the
letter provides a sufficient level of assurance to justify advanced
implementation of the fee and payment provisions.
(c) Nothing
in this section shall be construed as modifying the requirement under
Section 14169.13 that payments shall be made only to the extent a
sufficient amount of funds collected as the quality assurance fee are
available to cover the nonfederal share of those payments.
(d) Upon
notice from the federal government that final federal approval for the
fee model under this article or for the supplemental payments to private
hospitals under Section 14169.2 or 14169.3 has been denied, any fees
collected pursuant to this section shall be refunded and any payments
made pursuant to this article or Article 5.228 (commencing with Section
14169.1) shall be recouped, including, but not limited to, supplemental
payments, increased capitation payments, payments to hospitals by health
care plans resulting from the increased capitation payments, increased
payments to mental health plans, and payments for the health care
coverage of children. To the extent fees were paid by a hospital that
also received payments under this section, the payments may first be
recouped from fees that would otherwise be refunded to the hospital
prior to the use of any other recoupment method allowed under law.
(e) Any payment made
pursuant to this section shall be a conditional payment until final federal approval has been received.
(f) The
director shall have broad authority under this section to collect the
quality assurance fee for an interim period after receipt of the letter
described in subdivision (a) pending receipt of all necessary federal
approvals. This authority shall include discretion to determine both of
the following:
(1) Whether the quality assurance fee should be collected on a full or pro rata basis during the interim period.
(2) The dates on which payments of the quality assurance fee are due.
(g) The
department may draw against the Hospital Quality Assurance Revenue Fund
for all administrative costs associated with implementation under this
article or Article
5.228 (commencing with Section 14169.1).
(h) This
section shall be implemented only to the extent federal financial
participation is not jeopardized by implementation prior to the receipt
of all necessary final federal approvals.
SEC. 106.
Section 14169.36 of the Welfare and Institutions Code is amended to read:14169.36.
(a) Upon receipt of a letter that indicates likely federal approval that the director determines is sufficient for implementation under Section 14169.34, or upon the receipt of federal approval, the following shall occur:(1) To the maximum
extent possible, and consistent with the availability of funds in the
Hospital Quality Assurance Revenue Fund, the department shall make all
of the payments under Sections 14169.2, 14169.3, 14169.5, 14169.7, and
14169.7.5, including, but not limited to, supplemental payments and
increased capitation payments, prior to January 1, 2014, except that the
increased capitation payments under Section 14169.5 shall not be made
until federal approval is obtained for these payments.
(2) The
department shall make supplemental payments to hospitals under Article
5.228 (commencing with Section 14169.1) consistent with the timeframe
described in Section 14169.11 or a modified timeline developed pursuant
to Section 14169.35.
(b) Notwithstanding
any other provision of this article or Article 5.228 (commencing with
Section 14169.1), if the director determines, on or after December 15,
2013, that there are insufficient funds available in the Hospital
Quality Assurance Revenue Fund to make all scheduled payments under
Article 5.228 (commencing with Section 14169.1) before January 1, 2014,
he or she shall consult with representatives of the hospital community
to develop an acceptable plan for making additional payments to
hospitals and managed health care plans to maximize the use of
delinquent fee payments or other deposits or interest projected to
become available in
the fund after December 15, 2013, but before June 15, 2014.
(c) Nothing
in this section shall require the department to continue to make
payments under Article 5.228 (commencing with Section 14169.1) if, after
the consultation required under subdivision (b), the director
determines in the exercise of his or her sole discretion that a workable
plan for the continued payments cannot be developed.
(d) Subdivisions
(b) and (c) shall be implemented only if and to the extent federal
financial participation is available for continued supplemental payments
and to providers and continued increased capitation payments to managed
health care plans.
(e) If any
payment or payments made pursuant to this section are found to be
inconsistent with federal law, the department shall recoup the payments
by means of withholding or any
other available remedy.
(f) Nothing
in this section shall be read as affecting the department’s ongoing
authority to continue, after December 31, 2013, to collect quality
assurance fees imposed on or before December 31, 2013.
SEC. 107.
Section 14169.38 of the Welfare and Institutions Code is amended to read:14169.38.
(a) This article shall be implemented only as long as all of the following conditions are met:(1) Subject
to Section 14169.33, the quality assurance fee is established in a
manner that is fundamentally consistent with this article.
(2) The
quality assurance fee, including any interest on the fee after
collection by the department, is deposited in a segregated fund apart
from the General Fund.
(3) The
proceeds of the quality assurance fee, including any interest and
related federal reimbursement, may only be used for the purposes set
forth in this article.
(b) No
hospital shall be required to pay the quality assurance fee to the
department unless and until the state receives and maintains federal
approval.
(c) Hospitals shall
be required to pay the quality assurance fee to the department as set
forth in this article only as long as all of the following conditions
are met:
(1) The federal
Centers for Medicare and Medicaid Services allows the use of the quality
assurance fee as set forth in this article in accordance with federal
approval.
(2) Article 5.228
(commencing with Section 14169.1) is enacted and remains in effect and
hospitals are reimbursed the increased rates for services during the
program period, as defined in Section 14169.1.
(3) The
full amount of the quality assurance fee assessed and collected
pursuant to this article remains available only for the purposes
specified in this article.
(d) This article shall become inoperative if either of the following occurs:
(1) In
the event, and on the effective date, of a final judicial determination
made by any court of appellate jurisdiction or a final determination by
the United States Department of Health and Human Services or the
federal Centers for Medicare and Medicaid Services that the quality
assurance fee established pursuant to this article or any provision of
Section 14166.115 cannot be implemented.
(2) In the event both of the following conditions exist:
(A) The
federal Centers for Medicare and Medicaid
Services denies approval for, or does not approve before January
1, 2014, the implementation of Sections 14169.2 and 14169.3 or this
article.
(B) Section 14169.2,
Section 14169.3, or this article cannot be modified by the department
pursuant to subdivision (d) of Section 14169.33 in order to meet the
requirements of federal law or to obtain federal approval.
(e) If
this article becomes inoperative pursuant to paragraph (1) of
subdivision (d) and the determination applies to any period or periods
of time prior to the effective date of the determination, the department
may recoup all payments made pursuant to Article 5.228 (commencing with
Section 14169.1) during that period or those periods of time.
(f) (1) In
the event that all necessary final federal approvals are not received
as described and
anticipated under this article or Article 5.228 (commencing with
Section 14169.1), the director shall have the discretion and authority
to develop procedures for recoupment from managed health care plans, and
from hospitals under contract with managed health care plans, of any
amounts received pursuant to this article or Article 5.228 (commencing
with Section 14169.1).
(2) Any
procedure instituted pursuant to this subdivision shall be developed in
consultation with representatives from managed health care plans and
representatives of the hospital community.
(3) Any
procedure instituted pursuant to this subdivision shall be in addition
to all other remedies made available under the law, pursuant to
contracts between the department and the managed health care plans, or
pursuant to contracts between the managed health care plans and the
hospitals.
SEC. 108.
Section 14171 of the Welfare and Institutions Code is amended to read:14171.
(a) The director shall establish administrative appeal processes to review grievances or complaints arising from the findings of an audit or examination made pursuant to Sections 10722 and 14170 and for final settlements, including, in the case of hospitals, the application of Sections 51536, 51537, and 51539 of Title 22 of the California Code of Regulations. All these processes shall be established by regulation, pursuant to, and consistent with, Section 100171 of the Health and Safety Code.(b) Different
administrative appeal processes may be established by the director for
grievances or complaints arising from the determinations of a tentative
or final settlement based on audit or
examination findings made by or on behalf of the department
pursuant to Sections 10722 and 14170. However, consistent with existing
practice, no administrative appeal shall be available for tentative
settlement of cost reports.
(c) The
administrative appeal process established by the director for tentative
settlements, including, in the case of hospitals, the application of
Sections 51536, 51537, and 51539 of Title 22 of the California Code of
Regulations shall be an informal process which, however, guarantees a
provider the right to present any grievance or complaint to the
department in writing. Any subsequent hearings shall be conducted in an
informal manner and shall be held at the discretion of the department.
(d) The
time limitations in subdivisions (e) and (f) for the impartial hearing
and the final decisions are mandatory. If the department fails to
conduct the hearing or
to adopt a final decision thereon within the time limitations
provided in subdivisions (e) and (f), the amount of any overpayment
which is ultimately determined by the department to be due shall be
reduced by 10 percent for each 30-day period, or portion thereof, that
the hearing or the decision, or both, are delayed beyond the time
limitations provided in subdivisions (e) and (f). However, the time
period shall be extended by either of the following:
(1) Delay caused by a provider.
(2) Extensions of time granted a provider at its sole request or at the joint request of the provider and the department.
(e) (1) The
administrative appeal process established by the director shall
commence with an informal conference with the provider, a representative
of the department, and the administrative law
judge. The informal conference shall be conducted no later than 90
days after the filing of a timely and specific statement of disputed
issues by the provider. The administrative law judge, when appropriate,
may assign the administrative appeal to an informal level of review
where efforts could be made to resolve facts and issues in dispute in a
fair and equitable manner, subject to the requirements of state and
federal law. The review conducted at this informal level shall be
completed no later than 180 days after the filing of a timely and
specific statement of disputed issues by the provider.
(2) Nothing
in this subdivision shall prohibit the provider from presenting any
unresolved grievances or complaints at an impartial hearing pursuant to
subdivision (a). The impartial hearing shall be conducted no later than
300 days after the filing of a timely and specific statement of disputed
issues by the provider.
(3) (A) Subject
to subdivision (f), a final decision in a noninstitutional provider
appeal shall be adopted within 180 days after the closure of the record
of the impartial hearing, and a final decision in an institutional
provider appeal shall be adopted within 300 days after the closure of
the record of the impartial hearing.
(B) The
department shall mail a copy of the adopted decision to all parties
within 30 days of the date of adoption of the decision.
(f) In
the event the director intends to modify a proposed decision, on or
before the 180th day following the closure of the record of the hearing
for noninstitutional providers or the 300th day following the closure of
the record of the hearing for institutional providers, the director
shall provide written notice of his or her intention to the
parties and shall afford the parties an opportunity to present
written argument. Following this notice, on or before the 240th day
following the closure of the record of the hearing for noninstitutional
providers or the 420th day following closure of the record of the
hearing for institutional providers, or within that additional time
period as is granted pursuant to the sole request of a provider or at
the joint request of the provider and the department, the director shall
issue a final decision.
(g) In
the event recovery of a disallowed payment has been made by the
department, a provider who prevails in an appeal of a disallowed payment
shall be entitled to interest at the rate equal to the monthly average
received on investments in the Surplus Money Investment Fund, or simple
interest at the rate of 7 percent per annum, whichever is higher,
commencing on the date the appeal is formally accepted by the department
or the date payment is
received by the department, whichever is later.
(h) Except
as provided in subdivision (i), commencing 60 days after issuance of
the first statement of account status or demand for repayment resulting
from an audit or examination made pursuant to Sections 10722 and 14170,
interest at the rate equal to the monthly average received on
investments in the Surplus Money Investment Fund during the month the
first statement of account status or demand for repayment was issued, or
simple interest at the rate of 7 percent per annum, whichever is
higher, shall be assessed against any unrecovered overpayment due to the
department.
(i) (1) Commencing
on the day following the last day of the period covered by an audit or
examination made pursuant to Sections 10722 and 14170, interest at the
rate established under Section 19269 of the Revenue and Taxation Code
which is in
effect on the date of the commencement of that interest shall be
assessed against any unrecovered overpayment due to the department by
providers of durable medical equipment or incontinence supplies.
(2) Interest
which accrues under this subdivision for recoupment of an overpayment
based on the lack of medical necessity for a previously approved claim
shall commence to accrue on the date of written demand by the
department.
(j) The final
decision of the director shall be reviewable in accordance with Section
1094.5 of the Code of Civil Procedure within six months of the issuance
of the director’s final decision.
SEC. 109.
Section 14182.4 of the Welfare and Institutions Code is amended to read:14182.4.
(a) To the extent authorized under a federal waiver or demonstration project described in Section 14180 that is approved by the federal Centers for Medicare and Medicaid Services, the department shall establish a program of investment, improvement, and incentive payments for designated public hospitals and, to the extent federal approval is obtained pursuant to subdivision (c) of Section 14166.155, for nondesignated public hospitals to encourage and incentivize delivery system transformation and innovation in preparation for the implementation of federal health care reform.(b) The
Public Hospital Investment, Improvement, and Incentive Fund is hereby
established in the State Treasury. Notwithstanding Section 13340 of the
Government Code, moneys in the fund shall be continuously
appropriated, without regard to fiscal years, to the department for the
purposes specified in this section.
(c) The
fund shall consist of any moneys that a county, other political
subdivision of the state, or other governmental entity in the state that
may elect to transfer to the department for deposit into the fund, as
permitted under Section 433.51 of Title 42 of the Code of Federal
Regulations or any other applicable federal Medicaid laws.
(d) Moneys
in the fund shall be used as the source for the nonfederal share of
investment, improvement, and incentive payments as authorized under a
federal waiver or demonstration project to participating designated
public hospitals and, to the extent federal approval is obtained
pursuant to subdivision (c) of Section 14166.155, to nondesignated
public hospitals, defined in
subdivisions (d) and (f) of Section 14166.1 respectively, and the
governmental entities with which they are affiliated, that provide the
intergovernmental transfers for deposit into the fund.
(e) The
department shall obtain federal financial participation for moneys in
the fund to the full extent permitted by law. Moneys shall be allocated
from the fund by the department and used as the nonfederal share for
claiming federal funds in accordance with the Special Terms and
Conditions of the waiver or demonstration project and Sections 14166.77
and 14166.155, to the extent federal approval is obtained pursuant to
subdivision (c) of Section 14166.151, as applicable. The moneys
disbursed from the fund, and all associated federal financial
participation, shall be distributed only to the designated public
hospitals and the governmental entities with which they are affiliated,
and to the extent federal approval is obtained pursuant to subdivision
(c) of
Section 14166.155, to nondesignated public hospitals as described
in subdivision (a) and the governmental entities with which they are
affiliated.
(f) Participation
under this section is voluntary on the part of the county or other
political subdivision for purposes of all applicable federal laws. As
part of its voluntary participation in the nonfederal share of payments
under this section, the county or other political subdivision agrees to
reimburse the state for the nonfederal share of state staffing or
administrative costs directly attributable to implementation of this
section. This section shall be implemented only to the extent federal
financial participation is not jeopardized.
(g) Notwithstanding
the rulemaking provisions of Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code, the
department may clarify, interpret, or
implement the provisions of this section by means of provider
bulletins or similar instructions. The department shall notify the
fiscal and appropriate policy committees of the Legislature of its
intent to issue instructions under this section at least five days in
advance of the issuance.
SEC. 110.
Section 14182.45 of the Welfare and Institutions Code is amended to read:14182.45.
(a) In consultation with the designated public hospitals, as defined in subdivision (d) of Section 14166.1, and to the extent it does not impede the ability of the designated public hospitals to meet the requirements and conditions for delivery system reform incentive payments authorized under Sections 14166.77 and 14182.4, the state may provide for milestone incentive payments to private disproportionate share hospitals and nondesignated public disproportionate share hospitals to create incentives for improvement activities towards, and achievement of, delivery system transformation. The milestone incentive payments to private disproportionate share hospitals and nondesignated public disproportionate share hospitals shall be structured in accordance with the requirements and conditions for delivery system reform incentive payments set forth in the Special Terms and Conditions and as approved by the federal Centers for Medicare and Medicaid Services. Incentive payments may be funded by voluntary intergovernmental transfers made by the designated public hospitals and nondesignated public hospitals. All incentive pool funding, including any potential private and nondesignated public hospital subpools, shall be limited to the total amount of incentive pool funding allowed for delivery system reform incentive payments as set forth in the Special Terms and Conditions.(b) Upon
federal approval of the reimbursement methodology in subdivision (b) of
Section 14166.151, this section shall become inoperative.
SEC. 111.
Section 14183.6 of the Welfare and Institutions Code is amended to read:14183.6.
The department shall enter into an interagency agreement with the Department of Managed Health Care to have the Department of Managed Health Care, on behalf of the department, conduct financial audits, medical surveys, and a review of the provider networks of the managed care health plans participating in the demonstration project and the Medi-Cal managed care expansion into rural counties, and to provide consumer assistance to beneficiaries affected by Sections 14182.16 and 14182.17. The interagency agreement shall be updated, as necessary, on an annual basis in order to maintain functional clarity regarding the roles and responsibilities of these core activities. The department shall not delegate its authority under this division to the Department of Managed Health Care.SEC. 112.
Section 14204 of the Welfare and Institutions Code is amended to read:14204.
(a) Pursuant to the provisions of this chapter, the department may contract with one or more prepaid health plans in order to provide the benefits authorized under this chapter and Chapter 7 (commencing with Section 14000) of this part. The department may contract with one or more children’s hospitals on an exclusive basis for a specified population in a specified geographic area. Contracts entered into pursuant to this chapter may be awarded on a bid or nonbid basis.(b) In
order to achieve maximum cost savings the Legislature hereby determines
that expedited contract process for contracts under this chapter is
necessary. Therefore, contracts under this chapter shall be exempt from
Chapter 2 (commencing with Section 10290) of Part 2 of Division 2
of the Public Contract Code.
(c) The
department shall amend contracts with dental health plans in effect on
the date the act that added this subdivision and Section 14459.6 become
effective to provide Medi-Cal dental services authorized under this
chapter and Chapter 7 (commencing with Section 14000) to Medi-Cal
beneficiaries who reside in a specified geographic area to meet the
requirements of Sections 14089.09 and 14459.6.
SEC. 113.
Section 14301.1 of the Welfare and Institutions Code is amended to read:14301.1.
(a) For rates established on or after August 1, 2007, the department shall pay capitation rates to health plans participating in the Medi-Cal managed care program using actuarial methods and may establish health-plan- and county-specific rates. The department shall utilize a county- and model-specific rate methodology to develop Medi-Cal managed care capitation rates for contracts entered into between the department and any entity pursuant to Article 2.7 (commencing with Section 14087.3), Article 2.8 (commencing with Section 14087.5), and Article 2.91 (commencing with Section 14089) of Chapter 7 that includes, but is not limited to, all of the following:(1) Health-plan-specific encounter and claims data.
(2) Supplemental utilization and cost data submitted by the health plans.
(3) Fee-for-service
data for the underlying county of operation or other appropriate
counties as deemed necessary by the department.
(4) Department of Managed Health Care financial statement data specific to Medi-Cal operations.
(5) Other
demographic factors, such as age, gender, or diagnostic-based risk
adjustments, as the department deems appropriate.
(b) To
the extent that the department is unable to obtain sufficient actual
plan data, it may substitute plan model, similar plan, or
county-specific fee-for-service data.
(c) The
department shall develop
rates that include administrative costs, and may apply different
administrative costs with respect to separate aid code groups.
(d) The
department shall develop rates that shall include, but are not limited
to, assumptions for underwriting, return on investment, risk,
contingencies, changes in policy, and a detailed review of health plan
financial statements to validate and reconcile costs for use in
developing rates.
(e) The
department may develop rates that pay plans based on performance
incentives, including quality indicators, access to care, and data
submission.
(f) The department
may develop and adopt condition-specific payment rates for health
conditions, including, but not limited to, childbirth delivery.
(g) (1) Prior
to
finalizing Medi-Cal managed care capitation rates, the department
shall provide health plans with information on how the rates were
developed, including rate sheets for that specific health plan, and
provide the plans with the opportunity to provide additional
supplemental information.
(2) For
contracts entered into between the department and any entity pursuant
to Article 2.8 (commencing with Section 14087.5) of Chapter 7, the
department, by June 30 of each year, or, if the budget has not passed by
that date, no later than five working days after the budget is signed,
shall provide preliminary rates for the upcoming fiscal year.
(h) For
the purposes of developing capitation rates through implementation of
this ratesetting methodology, Medi-Cal managed care health plans shall
provide the department with financial and utilization data in a form and
substance as deemed necessary by
the department to establish rates. This data shall be considered
proprietary and shall be exempt from disclosure as official information
pursuant to subdivision (k) of Section 6254 of the Government Code as
contained in the California Public Records Act (Division 7 (commencing
with Section 6250) of Title 1 of the Government Code).
(i) The
department shall report, upon request, to the fiscal and policy
committees of the respective houses of the Legislature regarding
implementation of this section.
(j) Prior
to October 1, 2011, the risk-adjusted countywide capitation rate shall
comprise no more than 20 percent of the total capitation rate paid to
each Medi-Cal managed care plan.
(k) (1) It
is the intent of the Legislature to preserve the policy goal to support
and strengthen traditional safety net
providers who treat high volumes of uninsured and Medi-Cal
patients when Medi-Cal enrollees are defaulted into Medi-Cal managed
care plans.
(2) As the
department adds additional factors, such as managed care plan costs, to
the Medi-Cal managed care plan default assignment algorithm, it shall
consult with the Auto Assignment Performance Incentive Program
stakeholder workgroup to develop cost factor disregards related to
intergovernmental transfers and required wraparound payments that
support safety net providers.
SEC. 114.
Section 14459.6 is added to the Welfare and Institutions Code, to read:14459.6.
(a) The department shall establish a list of performance measures to ensure dental health plans meet quality criteria required by the department. The list shall specify the benchmarks used by the department to determine whether and the extent to which a dental health plan meets each performance measure. Commencing January 1, 2013, and quarterly thereafter, the list of performance measures established by the department along with each plan’s performance shall be posted on the department’s Internet Web site. The Department of Managed Health Care and the advisory committee established pursuant to Section 14089.08 shall have access to all performance measures and benchmarks used by the department as described in this section.(1) The
performance measures established by the department shall include, but
not be limited to, all of the following: provider network adequacy,
overall utilization of dental services, annual dental visits, use of
preventive dental services, use of dental treatment services, use of
examinations and oral health evaluations, sealant to restoration ratio,
filling to preventive services ratio, treatment to caries prevention
ratio, use of dental sealants, use of diagnostic services, and survey of
member satisfaction with plans and providers.
(2) The
survey of member satisfaction with plans and providers shall be the
same dental version of the Consumer Assessment of Healthcare Providers
and Systems (CAHPS) survey as used by the Healthy Families Program.
(3) The department shall notify dental health plans at least 30 days prior
to the implementation date of these performance measures.
(4) The
department shall include the initial list of performance measures and
benchmarks in any dental health contracts entered into between the
department and a dental health plan pursuant to Section 14204.
(5) The
department shall update performance measures and benchmarks and
establish additional performance measures and benchmarks in accordance
with all of the following:
(A) The
department shall consider performance measures and benchmarks
established by other states, the federal government, and national
organizations developing dental program performance and quality
measures.
(B) The department
shall notify dental health plans at least 30 days prior to the
implementation date of updates or
changes to performance measures and benchmarks. The department
shall also post these updates or changes on its Internet Web site at
least 30 days prior to implementation in order to provide transparency
to the public.
(C) To ensure
that the dental health needs of Medi-Cal beneficiaries are met, the
department shall, when evaluating performance measures and benchmarks
for retention on, addition to, or deletion from the list, consider all
of the following criteria:
(i) Monthly, quarterly, annual, and multiyear Medi-Cal dental managed care trended data.
(ii) County and statewide Medi-Cal dental fee-for-service performance and quality ratings.
(iii) Other state and national dental program performance and quality measures.
(iv) Other state and national performance ratings.
(b) In
establishing and updating the performance measures and benchmarks, the
department shall consult the advisory committee established pursuant to
Section 14089.08, as well as dental health plan representatives and
other stakeholders, including representatives from counties, local
dental societies, nonprofit entities, legal aid entities, and other
interested parties.
(c) In
evaluating a dental health plan’s ability to meet the criteria
established through the performance measures and benchmarks, the
department shall select specific performance measures from those
established by the department in subdivision (a) as the basis for
establishing financial or other incentives or disincentives, including,
but not limited to, bonuses, payment withholds, and adjustments to
beneficiary assignment to plan algorithms. These incentives and
disincentives shall be included in the dental health plan contracts.
(d) (1) The
department shall designate an external quality review organization
(EQRO) that shall conduct external quality reviews for any dental health
plan contracting with the department pursuant to Section 14204.
(2) As
determined by the department, but at least annually, dental health
plans shall arrange for an external quality of care review with the EQRO
designated by the department that evaluates the dental health plan’s
performance in meeting the performance measures established in this
section. Dental health plans shall cooperate with and assist the EQRO in
this review. The Department of Managed Health Care shall have direct
access to all external quality of care review information upon request
to the department.
(3) An
external quality of care review shall include, but not be limited to,
all of the following: performance on the selected performance measures
and benchmarks established and updated by the department, the CAHPS
member or consumer satisfaction survey referenced in paragraph (2) of
subdivision (a), reporting systems, and methodologies for calculating
performance measures. An external quality of care review that includes
all of the above components shall be paid for by the dental health plan
and posted online annually, or at any other frequency specified by the
department, on the department’s Internet Web site.
(e) All
marketing methods and activities to be used by dental plans shall
comply with subdivision (b) of Section 10850, Sections 14407.1, 14408,
14409, 14410, and 14411, and Title 22 of the California Code of
Regulations, including Sections 53880 and 53881. Each dental plan
shall submit its marketing plan to the department for review and
approval.
(f) Each dental plan
shall submit its member services procedures, beneficiary informational
materials, and any updates to those procedures or materials to the
department for review and approval. The department shall ensure that
member services procedures and beneficiary informational materials are
clear and provide timely and fair processes for accepting and acting
upon complaints, grievances, and disenrollment requests, including
procedures for appealing decisions regarding coverage or benefits.
(g) Each dental plan shall submit its provider compensation agreements to the department for review and approval.
(h) The
department shall post to its Internet Web site a copy of all final
reports completed by the Department of Managed Health Care
regarding dental managed care plans.
SEC. 115.
Section 14459.8 is added to the Welfare and Institutions Code, to read:14459.8.
(a) By no later than March 15, 2013, with annual updates thereafter, the department shall provide the fiscal and appropriate policy committees of the Legislature with either a comprehensive report or separate reports on dental managed care in the Counties of Sacramento and Los Angeles. This report shall articulate specific changes and improvements implemented to increase Medi-Cal beneficiary access to preventive services and dental treatment, the utilization of services, and beneficiary satisfaction. Key measures, outcomes, and department findings pertaining to participating dental managed care plans and provider networks shall also be included.(b) Any
report provided pursuant to subdivision (a) on
the County of Sacramento shall also provide data regarding the
outcomes and findings from the beneficiary dental exception (BDE)
process implemented by the department pursuant to Section 14089.09,
including the consideration of voluntary enrollment in the County of
Sacramento as compared to the existing mandatory enrollment.
(c) The
department may seek foundation funding or federal grant funding to
facilitate data analysis and reporting as applicable for this purpose.
SEC. 116.
Section 14500.5 of the Welfare and Institutions Code is amended to read:14500.5.
(a) It is the intent of the Legislature that family planning includes, but is not limited to, an effective means to improve reproductive health by disease prevention and treatment, to reduce the incidence of unintended pregnancies, and to reduce the demand for abortions. It is the intent of the Legislature that no family planning shall be expended other than for the services enumerated in this chapter. It is also the intent of the Legislature that no funds received pursuant to this chapter be used for abortions or services ancillary to abortions.(b) For purposes of this chapter, the following definitions shall apply:
(1) “Family
planning” means the process of establishing objectives for the number
and spacing of children, and selecting the means by which those
objectives may be achieved. These means include a broad range of
acceptable and effective methods and services to limit or enhance
fertility, including contraceptive methods, natural family planning,
abstinence methods, and the management of infertility. Family planning
services include preconceptional counseling, maternal and fetal health
counseling, and general reproductive health care, including diagnosis
and treatment of infections and conditions, including cancer, that
threaten reproductive capability, and other services as described in
Section 14503, except for abortions and services ancillary to abortions
as prohibited in Section 14509. Family planning does not include
abortion, pregnancy testing solely for the purposes of referral for
abortion or services ancillary to abortions, or pregnancy care which is
not incident to the diagnosis of a
pregnancy, except as otherwise provided for in this chapter.
(2) “Abortion
as a method of family planning” means the deliberate choice of abortion
over other methods to limit the number, gender, and spacing of
children, including, but not limited to, contraception, abstinence, and
natural family planning methods.
(3) “Department” means the State Department of Health Care Services.
(4) “Director” means the Director of Health Care Services.
(5) “Grantee”
means an agency, institution, or organization approved by the
department to provide family planning services pursuant to this chapter.
SEC. 117.
Section 15911 of the Welfare and Institutions Code is amended to read:15911.
(a) Funding for each LIHP shall be based on all of the following:(1) The amount of funding that the participating entity voluntarily provides for the nonfederal share of LIHP expenditures.
(2) For
a LIHP that had in operation a Health Care Coverage Initiative program
under Part 3.5 (commencing with Section 15900) as of November 1, 2010,
and elects to continue funding the program, the amount of funds
requested to ensure that eligible enrollees continue to receive health
care services for persons enrolled in the Health Care Coverage
Initiative program as of November 1, 2010.
(3) Any limitations
imposed by the Special Terms and Conditions of the demonstration project.
(4) The total allocations requested by participating entities for Health Care Coverage Initiative eligible individuals.
(5) Whether funding under this part would result in the reduction of other payments under the demonstration project.
(b) Nothing
in this part shall be construed to require a political subdivision of
the state to participate in a LIHP as set forth in this part, and those
local funds expended or transferred for the nonfederal share of LIHP
expenditures under this part shall be considered voluntary contributions
for purposes of the federal Patient Protection and Affordable Care Act
(Public Law 111-148), as amended by the federal Health Care and
Education Reconciliation Act of 2010 (Public Law 111-152), and the
federal American
Recovery and Reinvestment Act of 2009 (Public Law 111-5), as
amended by the federal Patient Protection and Affordable Care Act.
(c) No
state General Fund moneys shall be used to fund LIHP services, nor to
fund any related administrative costs incurred by counties or any other
political subdivision of the state.
(d) Subject
to the Special Terms and Conditions of the demonstration project, if a
participating entity elects to fund the nonfederal share of a LIHP, the
nonfederal funding and payments to the LIHP shall be provided through
one of the following mechanisms, at the options of the participating
entity:
(1) On a quarterly
basis, the participating entity shall transfer to the department for
deposit in the LIHP Fund established for the participating counties and
pursuant to subparagraph (A), the amount necessary to
meet the nonfederal share of estimated payments to the LIHP for
the next quarter under subdivision (g) Section 15910.3.
(A) The
LIHP Fund is hereby created in the State Treasury. Notwithstanding
Section 13340 of the Government Code, all moneys in the fund shall be
continuously appropriated to the department for the purposes specified
in this part. The fund shall contain all moneys deposited into the fund
in accordance with this paragraph.
(B) The
department shall obtain the related federal financial participation and
pay the rates established under Section 15910.3, provided that the
intergovernmental transfer is transferred in accordance with the
deadlines imposed under the Medi-Cal Checkwrite Schedule, no later than
the next available warrant release date. This payment shall be a
nondiscretionary obligation of the department, enforceable under a writ
of mandate pursuant to
Section 1085 of the Code of Civil Procedure. Participating
entities may request expedited processing within seven business days of
the transfer as made available by the Controller’s office, provided that
the participating entity prepay the department for the additional
administrative costs associated with the expedited processing.
(C) Total
quarterly payment amounts shall be determined in accordance with
estimates of the number of enrollees in each rate category, subject to
annual reconciliation to final enrollment data.
(2) If
a participating entity operates its LIHP through a contract with
another entity, the participating entity may pay the operating entity
based on the per enrollee rates established under Section 15910.3 on a
quarterly basis in accordance with estimates of the number of enrollees
in each rate category, subject to annual reconciliation to final
enrollment
data.
(A) (i) On a
quarterly basis, the participating entity shall certify the expenditures
made under this paragraph and submit the report of certified public
expenditures to the department.
(ii) The
department shall report the certified public expenditures of a
participating entity under this paragraph on the next available
quarterly report as necessary to obtain federal financial participation
for the expenditures. The total amount of federal financial
participation associated with the participating entity’s expenditures
under this paragraph shall be reimbursed to the participating entity.
(B) At
the option of the participating entity, the LIHP may be reimbursed on a
cost basis in accordance with the methodology applied to Health Care
Coverage Initiative programs established under Part 3.5
(commencing with Section 15900) including interim quarterly
payments.
(e) (1) Notwithstanding
Section 15910.3 and subdivision (d) of this section, if the
participating entity cannot reach an agreement with the department as to
the appropriate rate to be paid under Section 15910.3, at the option of
the participating entity, the LIHP shall be reimbursed on a cost basis
in accordance with the methodology applied to Health Care Coverage
Initiative programs established under Part 3.5 (commencing with Section
15900), including interim quarterly payments. If the participating
entity and the department reach an agreement as to the appropriate rate,
the rate shall be applied no earlier than the first day of the LIHP
year in which the parties agree to the rate, except that for the LIHP
year ending June 30, 2012, the rate may apply as early as July 1, 2011,
without regard to the date of the agreement between the participating
entity
and the department.
(2) (A) The department finds and declares all of the following:
(i) The department, in consultation with a number of the LIHPs, has proposed LIHP capitation rates for federal approval.
(ii) There
is some concern that federal approval of the proposed rates will not be
received, and implementing contracts may not be signed, before June 30,
2012.
(iii) The amendments
made to this subdivision by the act that added this clause would allow
the federally approved capitation rates to apply to the LIHP year, which
is July 1, 2011, to June 30, 2012, inclusive, even if federal approval
and the necessary contract amendments are not finalized until after June
30, 2012.
(B) Therefore, it is
the intent of the Legislature in amending this subdivision to allow the
LIHP capitation rates to apply for the 2011–12 fiscal year even if
final agreements on the capitation rates are delayed while awaiting
federal approval and are not finalized until after June 30, 2012.
(f) If
authorized under the Special Terms and Conditions of the demonstration
project, pending the department’s development of rates in accordance
with Section 15910.3, the department shall make interim quarterly
payments to approved LIHPs for expenditures based on estimated costs
submitted for rate setting.
(g) Participating
entities that operate a LIHP directly or through contract with another
entity shall be entitled to any federal financial participation
available for administrative expenditures incurred in the operation of
the Medi-Cal program or the demonstration project,
including, but not limited to, outreach, screening and enrollment,
program development, data collection, reporting and quality monitoring,
and contract administration, but only to the extent that the
expenditures are allowable under federal law and only to the extent the
expenditures are not taken into account in the determination of the per
enrollee rates under Section 15910.3.
(h) On
and after January 1, 2014, the state shall implement comprehensive
health care reform for the populations targeted by the LIHP in
compliance with federal health care reform law, regulation, and policy,
including the federal Patient Protection and Affordable Care Act (Public
Law 111-148), as amended by the federal Health Care and Education
Reconciliation Act of 2010 (Public Law 111-152), and subsequent
amendments.
(i) Subject to the
Special Terms and Conditions of the demonstration project, a
participating entity may elect to include, in collaboration with
the department, as the nonfederal share of LIHP expenditures, voluntary
intergovernmental transfers or certified public expenditures of another
governmental entity, as long as the intergovernmental transfer or
certified public expenditure is consistent with federal law.
(j) Participation
in the LIHP under this part is voluntary on the part of the eligible
entity for purposes of all applicable federal laws. As part of its
voluntary participation under this article, the participating entity
shall agree to reimburse the state for the nonfederal share of state
staffing and administrative costs directly attributable to the cost of
administering that LIHP, including, but not limited to, the state
administrative costs related to certified public expenditures and
intergovernmental transfers. This section shall be implemented only to
the extent federal financial participation is not
jeopardized.
SEC. 118.
Section 15911.1 is added to the Welfare and Institutions Code, to read:15911.1.
Upon the order of the Director of Finance, the Controller shall draw warrants against General Fund cash to provide cashflow loans as follows:(a) The
Director of Finance may approve cashflow loans of no more than a total
of one hundred million dollars ($100,000,000) in the 2012–13 and 2013–14
fiscal years for County Medical Services Program governing board
expenses that are associated with a Low Income Health Program operated
by the governing board pursuant to this part.
(b) The
terms and conditions of any cashflow loan provided pursuant to this
section shall be subject to approval by the Director of Finance.
Interest shall be charged at the rate earned by
moneys in the Pooled Money Investment Account.
(c) The
Department of Finance shall notify the Legislature within 15 days of
authorizing a cashflow loan pursuant to this section, unless prior
notification of the cashflow loan was included when the Medi-Cal
estimates were submitted pursuant to Section 14100.5.
(d) Any
cashflow loans made pursuant to this section shall be short term and
shall not constitute General Fund expenditures. These loans and the
repayment of these loans shall not affect the General Fund reserve.
SEC. 119.
Section 15912.1 is added to the Welfare and Institutions Code, to read:15912.1.
(a) The department, in collaboration with the State Department of Public Health, shall develop policies and guidance on the transition of persons diagnosed with HIV/AIDS from federal Ryan White HIV/AIDS Treatment Extension Act of 2009 (Ryan White Act) funded programs, pursuant to Section 131019 of the Health and Safety Code, to the Low Income Health Program (LIHP) pursuant to Part 3.6 (commencing with Section 15909). These policies and guidance shall be provided to local LIHPs, federal Ryan White Act providers, and to persons receiving services pursuant to the federal Ryan White Act, as applicable. Guidance shall include, but not be limited to, operational processes and procedures supporting the transition of persons receiving services pursuant to the federal Ryan White Act in order to minimize disruption of access to and availability of care and services.(b) The
department, in collaboration with the State Department of Public
Health, shall consult with stakeholders, including administrators,
advocates, providers, and persons receiving services pursuant to the
federal Ryan White Act, to obtain advice in forming the policy decisions
regarding the transition of persons receiving services pursuant to the
federal Ryan White Act to the local LIHPs.
SEC. 120.
Section 15916 of the Welfare and Institutions Code is amended to read:15916.
(a) It is the intent of the Legislature that the State Department of Health Care Services and all other departments take all appropriate steps to fully maximize and claim all available expenditures for Designated State Health Programs listed in the Special Terms and Conditions of California’s Bridge to Reform Section 1115(a) Demonstration under the safety net care pool (SNCP) for an applicable demonstration year.(b) For the purposes of this section, the following definitions apply:
(1) “California’s
Bridge to Reform Section 1115(a) Demonstration” means the Section
1115(a) Medicaid demonstration project, No. 11-W-00193/9, as approved by
the federal Centers for
Medicare and Medicaid Services (CMS), effective for the period of
November 1, 2010, through October 31, 2015.
(2) “Demonstration
year” means a specific period of time during California’s Bridge to
Reform Section 1115(a) Wavier as identified in the Special Terms and
Conditions. “Demonstration year” may be denominated in yearly
increments, which correspond with the yearly increments identified in
the Special Terms and Conditions.
(3) “Designated public hospital” has the meaning given in subdivision (d) of Section 14166.1.
(4) “Excess
certified public expenditures” means the amount of allowable
uncompensated care expenditures reported and certified for the
applicable demonstration year under Section 14166.8 by designated public
hospitals (DPHs), including the governmental entities with which they
are affiliated, that is
in excess of the amount necessary to draw the maximum amount of
federal funding for DPHs for uncompensated care under the safety net
care pool and for disproportionate share hospital payments without
regard to subdivision (c) or to the amount authorized pursuant to
paragraph (5).
(5) “Reserved
SNCP funds for DSHP” means the amount of SNCP uncompensated care funds
used to fund expenditures for the Designated State Health Programs, as
specified in the Special Terms and Conditions of California’s Bridge to
Reform Section 1115(a) Demonstration.
(6) “Redirected
SNCP funds” means the amount of federal funding available for a
specified demonstration year that would otherwise be restricted for
expenditures associated with the Health Care Coverage Initiative (HCCI)
program, for which there are insufficient HCCI expenditures to draw the
federal funds and which CMS has authorized to be
available for uncompensated care expenditures under the safety net
care pool in either the demonstration year for which the funds were
initially reserved or a subsequent demonstration year.
(7) “Safety
net care pool” or “SNCP” means the federal funds available under the
Medi-Cal Hospital/Uninsured Care Demonstration Project and the successor
demonstration project, California’s Bridge to Reform, to ensure
continued government support for the provision of health care services
to uninsured populations.
(c) Notwithstanding
any other provision of law, the state shall annually seek authority
from CMS under the Special Terms and Conditions of California’s Bridge
to Reform Section 1115(a) Demonstration to redirect to the uncompensated
care category within the SNCP the portion of the restricted funds used
to fund expenditures under the HCCI that will not be fully utilized by
the end of the
demonstration year for use in any demonstration year.
(d) Designated public hospitals may utilize the redirected SNCP funds described in subdivision (c) as follows:
(1) Designated public hospitals may opt to utilize excess certified public expenditures to claim the redirected SNCP funds.
(2) As
a condition of exercising the option in paragraph (1), DPHs voluntarily
agree that, up to the amount of redirected SNCP funds available, the
excess certified public expenditures are to be allocated equally between
the state and the DPHs, such that for every dollar of excess certified
public expenditure used by the DPHs, the DPHs will voluntarily allow the
state to use a corresponding excess certified public expenditure amount
for claiming purposes.
(3) As a
condition of receiving any of the funding in paragraph (2), DPHs
voluntarily agree that, to the extent the state is unable to fully claim
the maximum annual amount of reserved SNCP funds for DSHP, the excess
certified public expenditures will be used to enable the state to
receive total SNCP uncompensated care funds, in conjunction with its
claims for expenditures for DSHP, to the maximum amount described in
paragraph (5) of subdivision (b).
(e) Participation
in the utilization of the excess certified public expenditures and
redirected SNCP funds under this section is voluntary on the part of the
DPHs for the purpose of all applicable federal laws.
(f) The
department shall consult with DPH representatives regarding the
availability of excess certified public expenditures, how to optimize
the level of claimable federal Medicaid funding, and the appropriate
allocation of SNCP funds
under paragraphs (2) and (3) of subdivision (d). The department
may make interim determinations and allocations of such SNCP funds,
provided that the interim determinations and allocations take into
account adjustments to reported expenditures for possible audit
disallowances, consistent with the type of adjustments applied in prior
projects years under Article 5.2 (commencing with Section 14166). Any
interim determinations and allocations of redirected SNCP funds based on
excess certified public expenditures shall be subject to interim and
final reconciliations.
(g) Notwithstanding
any other provision of law, upon the receipt of a notice of
disallowance or deferral from the federal government related to any
certified public expenditures for uncompensated care incurred by DPHs
that are used for federal claiming under the SNCP pursuant to
California’s Bridge to Reform Section 1115(a) Demonstration after this
section is implemented, and subject
to the processes described in subdivisions (a) through (d) of
Section 14166.24, the following shall apply with respect to the
disallowance or deferral:
(1) The
department and the DPH shall each be responsible for half of the
repayment of the federal portion of any federal disallowance or deferral
for the applicable demonstration year, up to the amount claimed and
allocated pursuant to paragraph (2) of subdivision (d) for that
particular year.
(2) If there
are additional disallowances or deferrals beyond those described in
paragraph (1), the department shall be solely responsible for the
repayment of the federal portion of any federal disallowance or deferral
for the applicable demonstration year, up to the amount claimed and
allocated pursuant to paragraph (3) of subdivision (d) for that
particular year.
(3) If there
are additional disallowances or deferrals beyond those described
in paragraphs (1) and (2) for the applicable demonstration year, the DPH
shall be solely responsible for the repayment of the federal portion of
all remaining federal disallowances or deferrals for that particular
year.
(h) The department shall
obtain federal approvals or waivers as necessary to implement this
section and to obtain federal financial participation to the maximum
extent permitted by federal law. This section shall be implemented only
to the extent other federal financial participation is not jeopardized.
SEC. 121.
Section 24000 of the Welfare and Institutions Code is amended to read:24000.
There is established in the State Department of Health Care Services the State-Only Family Planning Program to provide comprehensive clinical family planning services to low-income men and women. This division shall be known and may be cited as the State-Only Family Planning Program.SEC. 122.
Section 24001 of the Welfare and Institutions Code is amended to read:24001.
(a) (1) For purposes of this division, “family planning” means the process of establishing objectives for the number and spacing of children, and selecting the means by which those objectives may be achieved. These means include a broad range of acceptable and effective methods and services to limit or enhance fertility, including contraceptive methods, natural family planning, abstinence methods and basic, limited fertility management. Family planning services include, but are not limited to, preconception counseling, maternal and fetal health counseling, general reproductive health care, including diagnosis and treatment of infections and conditions, including cancer, that threaten reproductive capability, medical family planning treatment and procedures, including supplies and followup, and informational, counseling, and educational services. Family planning shall not include abortion, pregnancy testing solely for the purposes of referral for abortion or services ancillary to abortions, not including contraceptives, or pregnancy care that is not incident to the diagnosis of pregnancy.(2) Family
planning services for males shall be expanded to include laboratory
tests for sexually transmitted infections and comprehensive physical
examinations. Within 60 days of approval of the Family Planning, Access,
Care, and Treatment (Family PACT) Waiver Program, provided for pursuant
to subdivision (aa) of Section 14132, the department shall seek to
amend the waiver to add this expansion. The implementation of this
paragraph shall be dependent upon federal approval and receipt of
federal financial participation.
(b) For purposes of this division, “department” means the State Department of Health Care Services.
SEC. 123.
(a) It is the intent of the Legislature that the State Department of Education and the State Department of Health Care Services modify or repeal regulations that are no longer supported by statute due to the amendments in Sections 1, 2, 32, 33, 33.5, and 34 of this act.(b) The
State Department of Education shall review regulations to ensure the
appropriate implementation of educationally necessary occupational and
physical therapy services required by the federal Individuals with
Disabilities Education Act (20 U.S.C. Sec. 1400 et seq.) and Sections 1,
2, 32, 33, 33.5, and 34 of this act.
(c) The
State
Department of Education may adopt regulations to implement Sections
1, 2, 32, 33, 33.5, and 34 of this act. The adoption, amendment, repeal,
or readoption of a regulation authorized by this section is deemed to
address an emergency, for purposes of Sections 11346.1 and 11349.6 of
the Government Code, and the State Department of Education is hereby
exempted, for this purpose, from the requirements of subdivision (a) of
Section 11346.1 of the Government Code. For purposes of subdivision (e)
of Section 11346.1 of the Government Code, the 180-day period, as
applicable to the effective period of an emergency regulatory action and
submission of specified materials to the Office of Administrative Law,
is hereby extended to one year.
(d) Implementation of Sections 1, 2, 32, 33, 33.5, and 34 of this act shall occur no later than October 1, 2012.
(e) The
State Department of Health Care
Services shall report in the November 2012 and May 2013 Family
Health Estimate on the status of the implementation of the provisions of
Sections 1, 2, 32, 33, 33.5, and 34 of this act. The report shall
include, but not be limited to, the following:
(1) The
number of children enrolled in the California Children’s Services by
county known to the county California Children’s Services Programs to be
receiving physical and occupational therapy services from the
California Children’s Services Medical Therapy Program assessed and
determined to be educationally necessary by the individualized education
program team and included in a child’s individualized education
program.
(2) The estimated
California Children’s Services Program savings from implementation of
Sections 1, 2, 32, 33, 33.5, and 34 of this act.
(3) An
update on
the implementation of Sections 1, 2, 32, 33, 33.5, and 34 of this
act, including a description of implementation successes and challenges.
(f) The
State Department of Education and the State Department of Health Care
Services shall work together to collect the relevant data necessary for
the report described in subdivision (e).