BILL NUMBER: AB 1750	INTRODUCED
	BILL TEXT


INTRODUCED BY   Committee on Health (Dymally (Chair), Bass, Berg, De
Leon, Gaines, Hancock, Hayashi, Hernandez, Huff, Lieber, Ma, and
Salas)

                        APRIL 10, 2007

   An act to amend and renumber Section 11834 of the Health and
Safety Code, and to amend Sections 14495.10, 16915, 16932, 16933,
16934.5, 16935, 16935.5, and 16952 of the Welfare and Institutions
Code, relating to health, and declaring the urgency thereof, to take
effect immediately.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 1750, as introduced, Committee on Health. Health.
   Existing law provides for the Medi-Cal program, administered by
the State Department of Health Care Services, under which basic
health care services are provided to qualified low-income persons.
Existing law requires the department to establish a pilot program to
provide continuous skilled nursing care as a benefit under the
Medi-Cal program when those services are provided pursuant to a
federal waiver and in accordance with prescribed requirements. This
provision is repealed as of January 1, 2008.
   This bill would extend the repeal date to January 1, 2011.
   Existing law provides that the board of supervisors of a county
that contracted with the State Department of Health Care Services
pursuant to a specified provision of law during the 1990-91 fiscal
year and any county with a population under 300,000, as determined in
accordance with the 1990 decennial census, by adopting a resolution
to that effect, may elect to participate in the County Medical
Services Program (CMSP) for state administration of health care
services to eligible persons in the county. Existing law requires the
department to allocate funds from various sources to CMSP counties.
   This bill would make technical, nonsubstantive changes to these
provisions.
   This bill would declare that it is to take effect immediately as
an urgency statute.
   Vote: 2/3. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 11834 of the Health and Safety Code is amended
and renumbered to read:
    11834.   11832.1.   The department
shall encourage the development of educational courses that provide
core knowledge concerning alcohol and drug abuse problems and
programs to personnel working within alcohol and drug abuse programs.

  SEC. 2.  Section 14495.10 of the Welfare and Institutions Code is
amended to read:
   14495.10.  (a) The department shall establish a pilot program to
provide continuous skilled nursing care as a benefit of the Medi-Cal
program, when those services are provided in accordance with an
approved federal waiver meeting the requirements of subdivision (b).
"Continuous skilled nursing care" means medically necessary care
provided by, or under the supervision of, a registered nurse within
his or her scope of practice, seven days a week, 24 hours per day, in
a health facility participating in the pilot program. This care
shall include a minimum of eight hours per day provided by or under
the direct supervision of a registered nurse. Each health facility
providing continuous skilled nursing care in the pilot program shall
have a minimum of one registered nurse or one licensed vocational
nurse awake and in the facility at all times.
   (b) The department shall submit to the federal Centers for
Medicare and Medicaid Services, no later than April 1, 2000, a
federal waiver request developed in consultation with the State
Department of Developmental Services and the Association of Regional
Center Agencies, pursuant to Section 1915(b) of the federal Social
Security Act to provide continuous skilled nursing care services
under the pilot program.
   (c) (1) The pilot program shall be conducted to explore more
flexible models of health facility licensure to provide continuous
skilled nursing care to developmentally disabled individuals in the
least restrictive health facility setting, and to evaluate the effect
of the pilot program on the health, safety, and quality of life of
individuals, and the cost-effectiveness of this care. The evaluation
shall include a review of the pilot program by an independent agency.

   (2) Participation in the pilot program shall include 10 health
facilities provided that the facilities meet all eligibility
requirements. The facilities shall be approved by the department, in
consultation with the State Department of Developmental Services and
the appropriate regional center agencies, and shall meet the
requirements of subdivision (e). Priority shall be given to
facilities with four to six beds, to the extent those facilities meet
all other eligibility requirements.
   (d) Under the pilot program established in this section, a
developmentally disabled individual is eligible to receive continuous
skilled nursing care if all of the following conditions are met:
   (1) The developmentally disabled individual meets the criteria as
specified in the federal waiver.
   (2) The developmentally disabled individual resides in a health
facility that meets the provider participation criteria as specified
in the federal waiver.
   (3) The continuous skilled nursing care services are provided in
accordance with the federal waiver.
   (4) The continuous skilled nursing care services provided to the
developmentally disabled individual do not result in costs that
exceed the fiscal limit established in the federal waiver.
   (e) A health facility seeking to participate in the pilot program
shall provide care for developmentally disabled individuals who
require the availability of continuous skilled nursing care, in
accordance with the terms of the pilot program. During participation
in the pilot program, the health facility shall comply with all the
terms and conditions of the federal waiver described in subdivision
(b), and shall not be subject to licensure or inspection under
Chapter 2 (commencing with Section 1250) of Division 2 of the Health
and Safety Code. Upon termination of the pilot program and
verification of compliance with Section 1265 of the Health and Safety
Code, the department shall immediately reinstate the participating
health facility's previous license for the balance of time remaining
on the license when the health facility began participation in the
pilot program.
   (f) The department shall implement this pilot program only to the
extent it can demonstrate fiscal neutrality, as required under the
terms of the federal waiver, and only if the department has obtained
the necessary approvals to implement the pilot program and receives
federal financial participation from the federal Centers for Medicare
and Medicaid Services.
   (g) In implementing this article, the department may enter into
contracts for the provision of essential administration and other
services. Contracts entered into under this section may be on a
noncompetitive bid basis and shall be exempt from the requirements of
Chapter 2 (commencing with Section 10290) of Part 2 of Division 2 of
the Public Contract Code.
   (h) This section shall remain in effect only until January 1,
 2008   2011  , and as of that date is
repealed, unless a later enacted statute that becomes effective on or
before January 1,  2008   2011  , deletes
or extends that date.
  SEC. 3.  Section 16915 of the Welfare and Institutions Code is
amended to read:
   16915.  (a) Any county receiving an allocation pursuant to this
part shall, at a minimum, report to the department all indigent
health care program demographic, expenditure, and utilization data,
in a manner that will provide an unduplicated count of users, as
follows:
   (1) The following patient demographic data:
   (A) Age.
   (B) Sex.
   (C) Ethnicity.
   (D) Family size.
   (E) Monthly income.
   (F) Source of income, according to the following categories:
   (i) Disability income.
   (ii) Employment.
   (iii) Retirement.
   (iv) General assistance.
   (v) Other.
   (G) Type of employment, according to the following categories:
   (i) Agriculture.
   (ii) Labor and production.
   (iii) Professional and technical.
   (iv) Service.
   (v) Nonemployed.
   (H) Payer source, according to the following categories:
   (i) Private insurance.
   (ii) County program.
   (iii) Self-pay.
   (iv) Other.
   (I) ZIP Code of residence.
   (2) Indigent health care expenditure data, including all of the
following:
   (A) Inpatient hospital services, according to the following
categories:
   (i) County hospital.
   (ii) Contract hospital.
   (iii) University teaching hospital.
   (iv) Other, noncontract hospital.
   (v) Diagnostic category, as defined by the International
Classification of Diseases, 9th Revision, Clinical Modification
(ICD-9-CM).
   (B) Outpatient services, according to the following categories:
   (i) Hospital outpatient.
   (ii) Freestanding community clinic.
   (iii) Primary care physician.
   (iv) Nonemergency services rendered in an emergency room
environment.
   (v) Type of service.
   (C) Emergency room services, according to the following
categories:
   (i) Emergency services.
   (ii) Emergency services which result in a hospital admission.
   (iii) Emergency services, which are rendered in a noncounty,
noncontract hospital and result in a transfer of the patient to a
county or contract hospital.
   (3) Indigent health care utilization data.
   (A) Inpatient hospital services, according to the following
categories:
   (i) County hospital days and discharges.
   (ii) Contract hospital days and discharges.
   (iii) University teaching hospital days and discharges.
   (iv) Other, noncontract hospital days and discharges.
   (B) Outpatient services, according to the following categories:
   (i) Hospital outpatient visits.
   (ii) Freestanding community clinic visits.
   (iii) Primary care physician visits.
   (iv) Visits to a hospital emergency room for nonemergency
services.
   (C) Emergency room services, according to the following
categories:
   (i) Visits for emergency services in a county hospital.
   (ii) Visits for emergency services in a contract hospital.
   (iii) Visits for emergency services in a noncounty, noncontract
hospital.
   (iv) Visits for emergency services which result in an admission in
a county hospital.
   (v) Visits for emergency services which result in an admission to
a contract hospital.
   (vi) Visits for emergency services which result in an admission to
a noncounty, noncontract hospital.
   (D) Visits for emergency services which are rendered in a
noncounty, noncontract hospital and result in a transfer of the
patient to a county or contract hospital.
   (4) Geographic location of rendered services.
   (A) Inpatient hospital services, according to the following
categories:
   (i) County hospital.
   (ii) Contract hospital.
   (iii) University teaching hospital.
   (iv) Other, noncontract hospital.
   (B) Outpatient services, according to the following categories:
   (i) Hospital outpatient.
   (ii) Freestanding community clinic.
   (iii) Primary care physician.
   (iv) Nonemergency services rendered in an emergency room
environment.
   (C) Emergency room services.
   (5) Expenditure and utilization data for persons with acquired
 immune deficiency   immunodeficiency 
syndrome (AIDS) and AIDS-related complex.
   (A) Total number of patients.
   (B) Number of inpatient users.
   (C) Number of discharges.
   (D) Total inpatient days.
   (E) Total inpatient expenditures.
   (F) Number of outpatient users.
   (G) Number of outpatient visits.
   (H) Total outpatient expenditures.
   (I) Number of emergency room users.
   (J) Number of emergency room visits.
   (K) Total emergency room expenditures.
   (b) Counties shall report demographic, cost and utilization data
on indigent health care to the department as follows:
   (1) An actual annual report no later than 360 days after the last
day of the year to be reported.
   (2) Counties shall maintain all patient-specific data collected
through the medically indigent care reporting system for a period of
24 months after the last day of the fiscal year for which the data
was collected.
   (3) Reports shall be submitted on machine readable media, on 51/4
inch or 31/2 inch diskette, in the format specified by the
department.
   (c) Counties  which enter into a contract with the
department   that   elect to participate in the
CMSP  pursuant to Section 16809  and which 
 that  do not operate a county hospital and  which
  that  also elect to enter into a contract with
the department to administer the noncounty hospital portion of the
Hospital Services Account, pursuant to Section 16934.7, and the
Physician Services Account, pursuant to subdivision (c) of Section
16952  ,  are not required to report indigent health care
program demographic, cost, and utilization data pursuant to this
section.
   (d) The department shall collect the data specified in subdivision
(a) for services paid for through the hospital contract-back and
physician services contract-back programs specified in Section
16934.7 and subdivision (c) of Section 16952.
   (e) The data specified in subparagraphs (D), (E), (F), and (G) of
paragraph (1) of subdivision (a) for services paid for with funds
specified under subparagraph (A) of paragraph (1) of subdivision (b)
of Section 16946 and funds administered pursuant to Article 3.5
(commencing with Section 16951) of Chapter 5 are not required to be
reported to the department pursuant to this section.
  SEC. 4.  Section 16932 of the Welfare and Institutions Code is
amended to read:
   16932.  The department shall allocate money derived from the
Hospital Services Account in the fund to each  CMSP 
county  that elects to participate in the CMSP p  
ursuant to Section 16809  in the following manner:
   (a) The combined total of hospital uncompensated care costs for
all county and noncounty hospitals in each  CMSP 
county  that elects to participate in the CMSP pursuant to
Section 16809  shall be calculated by using the definitions,
procedures, and data elements specified in Section 16945.
   (b) (1) The office shall determine each county's 1989-90 fiscal
year share by using the 1988 calendar year data, as adjusted by the
office, existing on the statewide file on September 1, 1989.
   (2) The office shall determine each county's share for the fiscal
years after the 1989-90 fiscal year by using the data from the
quarterly reports for the calendar year preceding the fiscal year, as
adjusted by the office and existing on the statewide file on April
15 immediately preceding the fiscal year.
   (3) The office shall determine each county's share based on that
county's total hospital uncompensated care costs, divided by the
total hospital uncompensated care costs for all  CMSP
 counties  that elect to participate in the CMSP
pursuant to Section 16809  , and by multiplying that product by
the amount appropriated from the Hospital Services Account in the
fund for purposes of this chapter.
   (4) The amounts calculated pursuant to paragraphs (2) and (3)
shall be each county's allocation from the total amount available for
allocation to the counties under this chapter.
   (c) The amounts calculated pursuant to paragraph (4) of
subdivision (b) shall be divided and allocated in accordance with
Section 16946. Sections 16946, 16947, 16948, and 16949 shall be
applicable to counties and hospitals receiving these funds.
  SEC. 5.  Section 16933 of the Welfare and Institutions Code is
amended to read:
   16933.  (a) The department shall distribute those moneys
appropriated from the Physician Services Account and the Unallocated
Account in the fund to  CMSP  counties  that
elect to participate in the CMSP pursuant to Section 16809  on
the basis of the percentages obtained by dividing  each
  the population of each county that elects to
participate in the  CMSP  county's population 
 pursuant to Section 16809  by the total population of all
 CMSP  counties  that elect to participate in
the CMSP pursuant to Section 16809  , as reported in the most
recent annual Department of Finance Research Unit report E-1.
   (b) Each county shall use moneys allocated from the Unallocated
Account in the fund pursuant to, and for the purposes specified in,
Article 4 (commencing with Section 16960) of Chapter 5, and to expand
emergency medical transportation services.
   (c) Counties shall use moneys allocated from the Physician
Services Account in the fund the following ways to provide medically
necessary emergency, obstetric, or pediatric services, or all of
them, to patients who cannot afford to pay for those services, and
for whom payment will not be made through any private coverage or by
any program funded in whole or in part by the federal government:
   (1) Establishment and administration of a Physician Services
Account in the county emergency medical services fund in accordance
with Article 3.5 (commencing with Section 16951) of Chapter 5.
   (2) Contracting with the department for the administration of all
Physician Services Account moneys specified in this subdivision
pursuant to subdivision (c) of Section 16952.
   (3) The reimbursement or support of services, either directly or
by contract, which are provided by physicians or groups of
physicians.
   (d) Moneys allocated from the Physician Services Account in the
fund shall be used to provide reimbursement for services provided on
or after July 1, 1989.
  SEC. 6.  Section 16934.5 of the Welfare and Institutions Code is
amended to read:
   16934.5.  (a) For the 1990-91 fiscal year and subsequent fiscal
years, each county  that elects to participate in the CMSP
pursuant to Section 16809  may enter into a contract with the
department in which the department agrees to assume the
responsibility to pay for the cost of treatment service provided on
or after July 1, 1990, to children pursuant to Section 16934. If a
county  contracting with the department   that
elects to participate in the CMSP  pursuant to Section 16809
does not apply for or rescinds its application for funds under this
chapter, the department may use all or part of that county's
allocation, as calculated pursuant to paragraph (3), to pay for the
costs of treatment services to children pursuant to Section 16934.
   (1) Each county intending to contract with the department shall
submit to the department a notice of intent to contract adopted by
the board of supervisors no later than June 1, 1990. For each fiscal
year thereafter a notice adopted by the board of supervisors shall be
submitted no later than April 1 of the fiscal year preceding the
fiscal year for which the agreement will be in effect, in accordance
with procedures established by the department. As a condition of
contracting with the department, the department may establish uniform
standards, forms, and procedures for the processing and payment of
claims for treatment services.
   (2) (A) Each county contracting with the department pursuant to
this subdivision for the 1991-92 fiscal year that has previously
contracted with the department pursuant to this section shall agree
that the department shall retain 10 percent of the allocation it
would otherwise have received under this chapter. The department
shall transfer amounts retained on a monthly basis to the CHDP
Treatment Account established in subdivision (b).
   (B) Any county that contracts with the department pursuant to this
subdivision during the 1991-92 fiscal year that has not previously
contracted with the department pursuant to this section shall agree
that the department shall retain 20 percent of the allocation the
county would otherwise have received under this chapter for that
portion of the year for which it contracts under this section.
   (3) In future fiscal years the percentage retained by the
department may be adjusted to reflect actual payments, projected
expenditures, funds appropriated by the Legislature for treatment
services, and the overall status of the account established in
subdivision (b).
   (b) Beginning with the 1990-91 fiscal year, the department shall
establish a separate Child Health and Disability Prevention Treatment
Account. For purposes of this chapter "CHDP Treatment Account" means
the account established pursuant to this subdivision.
   (1) The following funds shall be deposited into the CHDP Treatment
Account:
   (A) Funds appropriated by the Legislature to fund the reinsurance
account established in subdivision (b) of Section 16934.2 which are
not expended or encumbered for that purpose.
   (B) Any funds recouped from those counties electing to establish a
15 percent reserve pursuant to subdivision (a) of Section 16934.2.
   (C) Funds retained by the department pursuant to subdivision (a).
   (D) Interest earnings on funds.
   (E) Any additional funds appropriated by the Legislature.
   (2) Funds deposited in the CHDP Treatment Account shall be
administered on an accrual basis and notwithstanding any other
provision of law, except as provided in this chapter, shall not be
transferred to any other fund or account except for purposes of
investment as provided in Article 4 (commencing with Section 16470)
of Chapter 3 of Part 2 of Division 4 of Title 2 of the Government
Code.
   (3) Moneys deposited into the account shall constitute a risk pool
which shall be used for any or all of the following purposes:
   (A) Payment for services provided pursuant to Section 16934 in
counties which have contracted with the department pursuant to
subdivision (a).
   (B) State administrative costs, including any costs associated
with a contract for processing claims.
   (C) If the projected expenditure of funds from the CHDP Treatment
Account for any fiscal year exceeds available revenues, the
department may adjust payments for the remainder of the fiscal year
to providers on a pro rata basis in order to ensure that expenditures
do not exceed available revenues.
  SEC. 7.  Section 16935 of the Welfare and Institutions Code is
amended to read:
   16935.  (a) A  count   y that elects to participate
in the  CMSP  county electing to have the state
administer its medically indigent adult program as authorized by
  pursuant to  Section 16809 may also elect to have
the state administer its physician services account. Each 
CMSP  county  that elects to participate in the CMSP
pursuant to Section   16809 and  electing to have the
state administer its physician services account shall do all of the
following:
   (1) Enter into a contract with the department to administer its
county physician services account.
   (2) Authorize the department to act on its behalf and to assume
all responsibilities for the distribution and monitoring of funds in
its physician services account pursuant to subdivision (c) of Section
16952.
   (3) Agree to comply with uniform policies, procedures, and program
standards, including, but not limited to, eligibility levels
established mutually by the department and the participating
counties.
   (4) Transfer funds allocated to the county for purposes of the
county physician services account, less any funds retained pursuant
to subdivision (a) of Section 16934.5 to the department under such
conditions as the department may require.
   (b) The department may use funds retained or transferred to it by
the county pursuant to this subdivision for purposes of administering
the county's physician services account in accordance with Sections
16952 to 16958, inclusive.
   (c) For the 1989-90 fiscal year, any county which intends to
contract with the department for the administration of moneys
allocated from the Physician Services Account in the fund pursuant to
subdivision (c) of Section 16952 shall submit, to the department, a
notice of intent to contract which has been adopted by the county
board of supervisors, not later than November 15, 1989.
   (d) For the 1990-91 fiscal year and subsequent fiscal years, any
county which intends to contract with the department for the
administration of moneys allocated from the Physician Services
Account in the fund shall submit to the department a notice of intent
to contract, which has been adopted by the county board of
supervisors, not later than April 1 of the fiscal year preceding the
fiscal year for which the contract will be in effect and in
accordance with procedures established by the department.
  SEC. 8.  Section 16935.5 of the Welfare and Institutions Code is
amended to read:
   16935.5.  The department may administer the distribution and
monitoring of funds allocated from the Hospital Services Account
pursuant to subdivision (b) of Section 16946 and from the Physician
Services Account pursuant to subdivision (c) of Section 16952, less
funds retained by the department for the administration of the
children's treatment program pursuant to Section 16934, for any
county  contracting with the department   that
elects to participate in the CMSP  pursuant to Section 16809
that does not apply for, or rescinds its application for, funds under
this chapter. Allocations for a particular county shall generally be
utilized for payments to eligible providers in that county.
  SEC. 9.  Section 16952 of the Welfare and Institutions Code is
amended to read:
   16952.  (a) (1) Each county shall establish within its emergency
medical services fund a Physician Services Account. Each county shall
deposit in the Physician Services Account those funds appropriated
by the Legislature for the purposes of the Physician Services Account
of the fund.
   (2) (A) Each county may encumber sufficient funds to reimburse
physician losses incurred during the fiscal year for which bills will
not be received until after the fiscal year.
   (B) Each county shall provide a reasonable basis for its estimate
of the necessary amount encumbered.
   (C) All funds that are encumbered for a fiscal year shall be
expended or disencumbered prior to the submission of the report of
actual expenditures required by Sections 16938 and 16980.
   (b) (1) Funds deposited in the Physician Services Account in the
county emergency medical services fund shall be exempt from the
percentage allocations set forth in subdivision (a) of Section
1797.98. However, funds in the county Physician Services Account
shall not be used to reimburse for physician services provided by
physicians employed by county hospitals.
   (2) No physician who provides physician services in a primary care
clinic which receives funds from this act shall be eligible for
reimbursement from the Physician Services Account for any losses
incurred in the provision of those services.
   (c) The county physician services account shall be administered by
each county, except that a county  electing to have the
state administer its medically indigent adult program as authorized
by   that elects to participate in the CMSP pursuant to
 Section 16809, may also elect to have its county physician
services account administered by the state  in accordance
with Section 16954  .
   (d) Costs of administering the account, whether by the county or
by the department through the emergency medical services
contract-back program, shall be reimbursed by the account based on
actual administrative costs, not to exceed 10 percent of the amount
of the account.
   (e) For purposes of this article "administering agency" means the
agency designated by the board of supervisors to administer this
article, or the department, in the case of those  CMSP
counties electing   counties that elect to participate
in the CMSP pursuant to Section 16809, and  to have the state
administer this article on their behalf.
   (f) The county Physician Services Account shall be used to
reimburse physicians for losses incurred for services provided during
the fiscal year of allocation due to patients who do not have health
insurance coverage for emergency services and care, who cannot
afford to pay for those services, and for whom payment will not be
made through any private coverage or by any program funded in whole
or in part by the federal government with the exception of claims
submitted for reimbursement through Section 1011 of the federal
Medicare Prescription Drug, Improvement and Modernization Act of
2003.
   (g) Physicians shall be eligible to receive payment for patient
care services provided by, or in conjunction with, a properly
credentialed nurse practitioner or physician's assistant for care
rendered under the direct supervision of a physician and surgeon who
is present in the facility where the patient is being treated and who
is available for immediate consultation. Payment shall be limited to
those claims that are substantiated by
               a medical record and that have been reviewed and
countersigned by the supervising physician and surgeon in accordance
with regulations established for the supervision of nurse
practitioners and physician assistants in California.
   (h) (1) Reimbursement for losses shall be limited to emergency
services as defined in Section 16953, obstetric, and pediatric
services as defined in Sections 16905.5 and 16907.5, respectively.
   (2) It is the intent of this subdivision to allow reimbursement
for all of the following:
   (A) All inpatient and outpatient obstetric services which are
medically necessary, as determined by the attending physician.
   (B) All inpatient and outpatient pediatric services which are
medically necessary, as determined by the attending physician.
   (i) Any physician may be reimbursed for up to 50 percent of the
amount claimed pursuant to Section 16955 for the initial cycle of
reimbursements made by the administering agency in a given year. All
funds remaining at the end of the fiscal year shall be distributed
proportionally, based on the dollar amount of claims submitted and
paid to all physicians who submitted qualifying claims during that
year. The administering agency shall not disburse funds in excess of
the total amount of a qualified claim.
  SEC. 10.  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 adequately protect the public health and safety, its
necessary that this act take effect immediately.