BILL NUMBER: AB 939 CHAPTERED 09/24/04 CHAPTER 748 FILED WITH SECRETARY OF STATE SEPTEMBER 24, 2004 APPROVED BY GOVERNOR SEPTEMBER 24, 2004 PASSED THE ASSEMBLY AUGUST 24, 2004 PASSED THE SENATE AUGUST 18, 2004 AMENDED IN SENATE APRIL 28, 2004 AMENDED IN SENATE MARCH 15, 2004 AMENDED IN ASSEMBLY JUNE 2, 2003 AMENDED IN ASSEMBLY APRIL 24, 2003 INTRODUCED BY Assembly Member Yee FEBRUARY 20, 2003 An act to add Section 5781 to the Welfare and Institutions Code, relating to Medi-Cal. LEGISLATIVE COUNSEL'S DIGEST AB 939, Yee. Psychiatric inpatient hospital services: reimbursement. Existing law provides for the Medi-Cal program, administered by the State Department of Health Services, under which qualified low-income persons are provided with health care services, including mental health services. Existing law requires the State Department of Mental Health to implement managed mental health care for Medi-Cal beneficiaries through fee-for-service or capitated rate contracts with mental health plans, including individual counties, counties acting jointly, any qualified individual or organization, or a nongovernmental entity. Existing law authorizes counties to contract with mental health providers to provide mental health services to Medi-Cal beneficiaries. Existing regulations establish reimbursement procedures for the reimbursement of acute psychiatric inpatient hospital services for each fee-for-service Medi-Cal hospital with a contract with a mental health provider, and for the reimbursement of those services for each of these hospitals without one of these contracts. This bill would authorize a mental health plan to enter into a contract for the provision of mental health services for Medi-Cal beneficiaries with a hospital that is reimbursed through the fee-for-service payment system, using the Medi-Cal fiscal intermediary, and that provides for a per diem reimbursement rate that includes room and board, routine hospital services, and all hospital-based ancillary services and that provides separately for the attending mental health professional's daily visit fee. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. The Legislature finds and declares that allowing hospitals to contract on behalf of health professionals providing mental health services to Medi-Cal beneficiaries helps increase access to an already strained Medi-Cal program and assists those health professionals in obtaining timely reimbursement for services provided to Medi-Cal beneficiaries. It is the intent of the Legislature, in enacting this act, to reaffirm the importance of Section 2400 of the Business and Professions Code. SEC. 2. Section 5781 is added to the Welfare and Institutions Code, to read: 5781. (a) Notwithstanding any other provision of law, a mental health plan may enter into a contract for the provision of mental health services for Medi-Cal beneficiaries with a hospital that provides for a per diem reimbursement rate for services that include room and board, routine hospital services, and all hospital-based ancillary services and that provides separately for the attending mental health professional's daily visit fee. The payment of these negotiated reimbursement rates to the hospital by the mental health plan shall be considered payment in full for each day of inpatient psychiatric and hospital care rendered to a Medi-Cal beneficiary, subject to third-party liability and patient share of costs, if any. (b) This section shall not be construed to allow a hospital to interfere with, control, or otherwise direct the professional judgment of a physician and surgeon in a manner prohibited by Section 2400 of the Business and Professions Code or any other provision of law. (c) For purposes of this section, "hospital" means a hospital that submits reimbursement claims for Medi-Cal psychiatric inpatient hospital services through the Medi-Cal fiscal intermediary as permitted by subdivision (g) of Section 5778.