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 This provision is repealed as of January 1, 2008.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 1,20082011 , and as of that date is repealed, unless a later enacted statute that becomes effective on or before January 1,20082011 , 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 acquiredimmune deficiencyimmunodeficiency 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) Countieswhich enter into a contract with the departmentthat elect to participate in the CMSP pursuant to Section 16809and whichthat do not operate a county hospital andwhichthat 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 eachCMSPcounty 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 eachCMSPcounty 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 allCMSPcounties 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 toCMSPcounties that elect to participate in the CMSP pursuant to Section 16809 on the basis of the percentages obtained by dividingeachthe population of each county that elects to participate in the CMSPcounty's populationpursuant to Section 16809 by the total population of allCMSPcounties 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 countycontracting with the departmentthat 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 CMSPcounty electing to have the state administer its medically indigent adult program as authorized bypursuant to Section 16809 may also elect to have the state administer its physician services account. EachCMSPcounty 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 countycontracting with the departmentthat 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 countyelecting to have the state administer its medically indigent adult program as authorized bythat elects to participate in the CMSP pursuant to Section 16809, may also elect to have its county physician services account administered by the statein 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 thoseCMSP counties electingcounties 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.