BILL NUMBER: AB 1349 CHAPTERED 10/06/05 CHAPTER 616 FILED WITH SECRETARY OF STATE OCTOBER 6, 2005 APPROVED BY GOVERNOR OCTOBER 6, 2005 PASSED THE ASSEMBLY SEPTEMBER 8, 2005 PASSED THE SENATE SEPTEMBER 7, 2005 AMENDED IN SENATE SEPTEMBER 2, 2005 AMENDED IN SENATE AUGUST 30, 2005 AMENDED IN SENATE JULY 6, 2005 AMENDED IN ASSEMBLY APRIL 4, 2005 INTRODUCED BY Assembly Member Goldberg FEBRUARY 22, 2005 An act to amend Section 11839.20 of, and to add Sections 11758.421 and 11758.425 to, the Health and Safety Code, relating to narcotic treatment programs, and declaring the urgency thereof, to take effect immediately. LEGISLATIVE COUNSEL'S DIGEST AB 1349, Goldberg Narcotic treatment programs. Existing law authorizes the State Department of Alcohol and Drug Programs to enter into a Medi-Cal Drug Treatment Program contract with each county for the provision of services within the county service area. Existing law requires the department to establish fees for controlled substances dispensed to Medi-Cal beneficiaries under this program based on a per capita uniform statewide monthly reimbursement rate. Existing law requires that reimbursement under the program be limited to the lower of that uniform statewide monthly reimbursement rate or the provider's usual and customary charge to the public for the same or similar services. This bill would provide that if a narcotic treatment program provider establishes a sliding indigency scale for low-income persons who are not eligible to participate in the Medi-Cal Drug Treatment Program in accordance with requirements established by the bill, the provider shall be deemed in compliance with federal and state law for purposes of the application of an exception to reimbursement requirements that would prohibit those reduced charges under the sliding indigency scale from lowering the provider's usual and customary charge determination for Medi-Cal reimbursement. The bill would also authorize a narcotic treatment program provider to use an instruction and financial evaluation form that the bill would create to aid in implementing a sliding indigency scale. Existing law establishes that the Legislature's intent in licensing narcotic treatment programs is to provide a means whereby the patient may be rehabilitated and will no longer need to support a dependency on narcotics. Existing law declares that the ultimate goal of all narcotic treatment programs shall be to aid the patient in altering his or her lifestyle and eventually to eliminate all dependency on drugs. This bill would revise the Legislature's intent and declarations so that the Legislature's intent in licensing narcotic treatment programs would be to provide a means whereby the patient may be rehabilitated and will no longer need to support a dependency on opiates, and the ultimate goal of narcotic treatment programs would be to aid the patient in altering his or her lifestyle and eventually to eliminate the improper use of legal drugs and the use of illicit drugs. This bill would declare that it is to take effect immediately as an urgency statute. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 11758.421 is added to the Health and Safety Code, to read: 11758.421. (a) (1) The Legislature finds and declares all of the following: (A) Medical treatment for indigent patients who are not eligible for Medi-Cal is essential to protecting the public health. (B) The Legislature supports the adoption of standardized and simplified forms and procedures in order to promote the drug treatment of indigent patients who are not eligible for Medi-Cal. (C) Providers should not be required by the state to subsidize the medical treatment provided to indigent patients who are not eligible for Medi-Cal. (D) The Legislature supports the therapeutic value of indigent patients who are not eligible for Medi-Cal contributing some level of fees for drug treatment services in order to support the goals of those drug treatment services. (2) It is the intent of the Legislature in enacting this section to encourage narcotic treatment program providers to serve indigent patients who are not eligible for Medi-Cal. It is also the intent of the Legislature that the State Department of Alcohol and Drug Programs allow narcotic treatment program providers to charge therapeutic fees for providing drug treatment to indigent patients who are not eligible for Medi-Cal if the providers establish a fee scale that complies with the documentation requirements established pursuant to this section and federal law. (b) (1) The Legislature recognizes that narcotic treatment program providers are reimbursed for controlled substances provided under the Medi-Cal Drug Treatment Program, also known as Drug Medi-Cal (Chapter 3.4 (commencing with Section 11758.40)), and pursuant to federal law at a rate that is the lower of the per capita uniform statewide monthly reimbursement or Drug Medi-Cal rate, or the provider's usual and customary charge to the general public for the same or similar services. (2) It furthers the intent of the Legislature to ensure that narcotic treatment programs in the state are able to serve indigent clients and that there is an exception to the reimbursement requirements described in paragraph (1), as the federal law has been interpreted by representatives with the Centers for Medicare and Medicaid Services. Pursuant to this exception, if a narcotic treatment program provider who is serving low-income non-Drug Medi-Cal clients complies with a federal requirement for the application of a sliding indigency scale, the reduced charges under the sliding indigency scale shall not lower the provider's usual and customary charge determination for purposes of Medi-Cal reimbursement. (c) A licensed narcotic treatment program provider that serves low-income non-Drug Medi-Cal clients shall be deemed in compliance with federal and state law, for purposes of the application of the exception described in paragraph (2) of subdivision (b), and avoid audit disallowances, if the provider implements a sliding indigency scale that meets all of the following requirements: (1) The maximum fee contained in the scale shall be the provider's full nondiscounted, published charge and shall be at least the rate that Drug Medi-Cal would pay for the same or similar services provided to Drug Medi-Cal clients. (2) The sliding indigency scale shall provide for an array of different charges, based upon a client's ability to pay, as measured by identifiable variables. These variables may include, but need not be limited to, financial information and the number of dependents of the client. (3) Income ranges shall be in increments that result in a reasonable distribution of clients paying differing amounts for services based on differing abilities to pay. (4) A provider shall obtain written documentation that supports an indigency allowance under the sliding indigency scale established pursuant to this section, including a financial determination. In cases where this written documentation cannot be obtained, the provider shall document at least three attempts to obtain this written documentation from a client. (5) The provider shall maintain all written documentation that supports an indigency allowance under this section, including, if used, the financial evaluation form set forth in Section 11758.425. (6) Written policies shall be established and maintained that set forth the basis for determining whether an indigency allowance may be granted under this section and establish what documentation shall be requested from a client. (d) In developing the sliding indigency scale, a narcotic treatment program provider shall consider, but need not include, any or all of the following components: (1) Vertically, the rows would reflect increments of family or household income. There would be a sufficient number of increments to allow for differing charges, such as a six hundred dollar ($600) increase per interval. (2) Horizontally, the columns would provide for some other variable, such as family size, in which case, the columns would reflect the number of people dependent on the income, including the client. (3) Each row, except the first and last rows, would contain at least two different fee amounts and each of the columns, four or more in number, would contain at least six different fee amounts. (4) The cells would contain an array of fees so that no fee would be represented in more than 25 percent of the cells. (e) A narcotic treatment program provider that uses the financial evaluation form instructions and financial form set forth in Section 11758.425 in obtaining written documentation that supports an indigency allowance as required under paragraph (4) of subdivision (c) shall be deemed in compliance with that paragraph. SEC. 2. Section 11758.425 is added to the Health and Safety Code, to read: 11758.425. A narcotic treatment program provider may use the following instructions and financial evaluation form to comply with the requirements of paragraph (4) of subdivision (c) of Section 11758.421: FINANCIAL EVALUATION FORM INSTRUCTIONS MONTHLY INCOME DATA--This data should specify the source and the amount and be supported by sufficient documentation. Income data may include, but are not limited to, income received as a paid employee, unemployment benefits, disability benefits, pension payments, family income, savings income, or other sources. MONTHLY EXPENSES DATA--This data is not required unless there is no evidence or documentation of income data. Expense data may include, but are not limited to, any known expenses related to the following: (1) Court-ordered payments, such as child support, fines, debts, restitution, or other payments. (2) Housing-related expenses, such as rent, mortgage, insurance, utilities, or other obligations. (3) Transportation costs, such as any related expenses, including automobile payments or automobile insurance payments. (4) Insurance coverage should also be noted if it produces either an expense or benefit to the client. CLIENT MONTHLY TREATMENT FEE--The following applies to this data: (1) The amount box indicates the client's fee according to his or her location on the sliding scale. (2) The adjusted client monthly fee box is to be filled only if the fee to be charged differs from the fee indicated by the client's location on the sliding scale. (3) If the fee is adjusted from what the sliding scale would indicate, a reason for the adjustment must be provided. (Valid reasons might include extraordinary medical expenses for a client suffering from HIV/AIDS, etc.) PLEASE NOTE--The documentation for this form requires that the provider make at least three documented attempts to collect documentation from a client. Any questions on this form may be directed to the department at (___). SEC. 3. Section 11839.20 of the Health and Safety Code is amended to read: 11839.20. (a) It is the intent of the Legislature in licensing narcotic treatment programs to provide a means whereby the patient may be rehabilitated and will no longer need to support a dependency on opiates. (b) It is the intent of the Legislature that each narcotic treatment program shall have a strong rehabilitative element, including, but not limited to, individual and group therapy, counseling, vocational guidance, and job and education counseling. (c) The Legislature declares the ultimate goal of all narcotic treatment programs shall be to aid the patient in altering his or her lifestyle and eventually to eliminate the improper use of legal drugs and the use of illicit drugs. (d) The department shall adopt any regulations necessary to ensure that every program is making a sustained effort to end the drug dependency of the patients. SEC. 4. This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are: In order to protect the health and safety of all Californians as soon as possible by ensuring that drug treatment services remain available to indigent patients, it is necessary that this act take effect immediately.