BILL NUMBER: AB 366	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  JUNE 2, 2009
	AMENDED IN ASSEMBLY  APRIL 2, 2009

INTRODUCED BY   Assembly Member Ruskin
    (   Coauthors:  
Assembly Members   Adams  
  and Portantino   ) 

                        FEBRUARY 23, 2009

   An act to  add Section 14083.7 to   amend
Section 14083 of  the Welfare and Institutions Code, relating to
Medi-Cal.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 366, as amended, Ruskin. Medi-Cal: inpatient hospital services
 contracts.   contracts: orthopedic
implantation. 
   Existing law provides for the Medi-Cal program, administered by
the State Department of Health Care Services, under which qualified
low-income persons are provided with health care services.
   Under existing law, the California Medical Assistance Commission
is authorized to negotiate inpatient hospital services contracts that
are binding upon the department. Existing law requires the
commission to consider certain factors in negotiating inpatient
hospital services contracts  or in drawing specifications for
competitive bidding  .
   This bill would  additionally require the California
Medical Assistance Commission, in negotiating contracts or in drawing
specifications for competitive bidding, to provide for separate
reimbursement for hospitals for the full cost of orthopedic implants
for cancers of the bone   add specialization in
orthopedic implantation related to cancers of the bone to the list of
factors the commission is required to consider  .
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


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

   SECTION 1.    Section 14083 of the   Welfare
and Institutions Code   is amended to read: 
   14083.  The factors to be considered by the negotiator in
negotiating contracts under this article, or in drawing
specifications for competitive bidding, include, but are not limited
to, all of the following:
   (a) Beneficiary access.
   (b) Utilization controls.
   (c) Ability to render quality services efficiently and
economically.
   (d) Demonstrated ability to provide or arrange needed specialized
services.
   (e) Protection against fraud and abuse.
   (f) Any other factor  which   that 
would reduce costs, promote access, or enhance the quality of care.
   (g) The capacity to provide a given tertiary service, such as
specialized children's services, on a regional basis. 
   (h) Specialization in orthopedic implantation related to cancers
of the bone.  
   (h) 
    (i)  Recognition of the variations in severity of
illness and complexity of care. 
   (i) 
    (j)  Existing labor-management collective bargaining
agreements. 
   (j) 
    (k)  The situation of county hospitals and university
medical centers contracting with counties for provision of health
care to indigent persons entitled to care under Section 17000, which
are burdened to a greater extent than private hospitals with bad
debts, indirect costs, medical education programs, and capital needs.

   (k) 
    (l) The special circumstances of hospitals serving a
disproportionate number of Medi-Cal beneficiaries and patients who
are not covered by other third-party payers, including the costs
associated with assuring an adequate supply of registered nurses.

   (l) 
    (m)  The costs of providing complex emergency services,
including the costs of meeting and maintaining state and local
requirements for trauma center designation. 
   (m) 
    (n)  The hospital does any of the following:
   (1) Provides additional obstetrical beds.
   (2) Contracts with one or more comprehensive perinatal providers.
   (3) Permits certified nurse midwives, subject to hospital rules,
and consistent with existing laws and regulations, to admit patients
to the health facility.
   (4) Expands overall obstetrical services in the hospital. 

   (n) 
    (o)  The special circumstances of hospitals whose
Medi-Cal inpatient utilization rate exceeds the mean Medicaid
inpatient utilization rate by at least one-half of one standard
deviation. 
   (o) 
    (p)  The ability and capacity of the contracting
hospital in a closed health facility planning area to provide health
care services to beneficiaries who are in life threatening or
emergency situations, but have been sufficiently stabilized at
another noncontracting facility in order to facilitate transportation
to the contracting hospital. 
   (p) 
    (q)  The ability of the contracting hospital to provide
a secure environment for the provision of health care services. In
this regard, the negotiator shall consider additional security
measures that the contracting hospital may have taken to provide a
secure environment, including, but not limited to, the use of
detection equipment or procedures to detect lethal weapons, the
appropriate use of surveillance cameras, limiting access of
unauthorized personnel to the emergency department, installation of
bullet proof glass as appropriate in designated areas, the use of
emergency "panic" buttons to alert local law enforcement agencies,
and assigning full-time security personnel to the emergency
department. 
  SECTION 1.    Section 14083.7 is added to the
Welfare and Institutions Code, to read:
   14083.7.  In addition to considering the factors specified in
Sections 14083 and 14083.5, the California Medical Assistance
Commission, in negotiating contracts under this article, or in
drawing specifications for competitive bidding, shall provide for
separate reimbursement for hospitals for the full cost of orthopedic
implants for cancers of the bone.