BILL ANALYSIS
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THIRD READING
Bill No: AB 896
Author: Galgiani (D)
Amended: 9/10/09 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 9-1, 6/17/09
AYES: Alquist, Strickland, Cedillo, Cox, DeSaulnier, Leno,
Maldonado, Pavley, Wolk
NOES: Aanestad
NO VOTE RECORDED: Negrete McLeod
ASSEMBLY FLOOR : 78-0, 6/1/09 - See last page for vote
SUBJECT : Health care programs: provider reimbursement
rates
SOURCE : Author
DIGEST : This bill extends the current requirement that
inpatient payment rates for the California Childrens
Services Program (CCS Program) and the Genetically
Handicapped Persons Program be 90 percent of the Medi-Cal
hospital interim rate until January 1, 2011, after which
provider payment rates for services rendered in those
programs must be identical to the Medi-Cal rates of payment
for the same service performed by the same provider type.
ANALYSIS : Existing law:
1.Requires provider payment rates for services rendered in
CONTINUED
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the CCS Program, the Genetically Handicapped Persons
Program (GHPP), the Breast and Cervical Cancer Early
Detection Program (BCCEDP), the State-Only Family
Planning Program and the Family Planning, Access, Care,
and Treatment (Family PACT) Waiver Program be identical
to the rates of payment for the same service performed by
the same provider type pursuant to the Medi-Cal program,
except that hospital inpatient rates of payment are
required to be 90 percent of the Medi-Cal hospital
interim rates of payment, as developed by the Department
of Health Care Services. The requirement that inpatient
rates of payment be 90 percent of the Medi-Cal hospital
interim rate sunsets January 1, 2010, after which
provider payment rates for services rendered in those
programs must be identical to the Medi-Cal rates of
payment for the same service performed by the same
provider type.
2.Authorizes services provided under the programs above to
be reimbursed at rates greater than the Medi-Cal rate
that would otherwise be applicable if those rates are
increased by the Department of Health Care Services
director in regulations.
The bill extends the current requirement that inpatient
rates of payment be 90 percent of the Medi-Cal hospital
interim rate until January 1, 2011, after which provider
payment rates for services rendered in those programs must
be identical to the Medi-Cal rates of payment for the same
service performed by the same provider type.
Comments
This bill only affects inpatient reimbursement in the CCS
Program and GHPP for non-Medi-Cal individuals enrolled in
those programs because the other programs (BCCEDP, the
State-Only Family Planning Program, Family PACT) do not
reimburse for inpatient services.
The CCS Program provides diagnostic and treatment services,
medical case management, and medical and occupational
therapy services to eligible children and young adults less
than 21 years of age. Eligibility includes diagnosis of
specified medical conditions such as cancer, congenital
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heart disease, and sickle cell anemia. Children receive
services in one of three enrollment pathways: (1)
CCS-Medi-Cal, in which 128,559 children are estimated to be
enrolled in 2009-10; (2) CCS-Healthy Families program, in
which 26,414 children are estimated to be enrolled in
2009-10; and, (3) CCS-only, in which 19,260 children are
estimated to be enrolled in 2009-10. This bill affects
inpatient reimbursement rates for CCS-Healthy Families
program and CCS-only children.
GHPP provides medical care to individuals with genetically
handicapping conditions, including cystic fibrosis,
hemophilia, sickle cell disease, Huntington's disease,
Friedreich's Ataxia, and certain hereditary metabolic
disorders. Individuals receive services in one of two
enrollment pathways: (1) GHPP-Medi-Cal, in which 334
individuals are estimated to be enrolled in 2009-10; and,
(2) GHPP-only, in which 1,426 individuals are estimated to
be enrolled in 2009-10. This bill affects inpatient
reimbursement rates for GHPP-only individuals.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 9/10/09)
California Children's Hospital Association (source)
Children's Specialty Care Coalition
California Hospital Association
ARGUMENTS IN SUPPORT : California Children's Hospital
Association (CCHA) writes that this bill would ensure
hospitals receive adequate reimbursement for providing
high-cost services to seriously ill children in CCS. CCHA
argues that hospitals such as children's hospitals that
treat a disproportionate number of low-income patients
cannot absorb any additional reimbursement reductions
without seriously compromising patient access. CCHA argues
that childrens' hospitals are currently operating with a
-1.4 percent operating margin, and this is prior to
experiencing the full impact of the economic downturn,
which is resulting in both increased Medi-Cal enrollment
and decreased non-operating revenues. The impact of
reducing hospital reimbursement for non-Medi-Cal CCS
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patients to the individual hospital CMAC rate would be
significant for California's Children's Hospitals -
approximately $1 million up to $1.8 million per facility
annually.
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Anderson, Arambula, Beall, Tom
Berryhill, Blakeslee, Blumenfield, Brownley, Buchanan,
Caballero, Charles Calderon, Carter, Chesbro, Conway,
Cook, Coto, Davis, De La Torre, De Leon, DeVore, Duvall,
Emmerson, Eng, Evans, Feuer, Fletcher, Fong, Fuentes,
Fuller, Furutani, Gaines, Galgiani, Garrick, Gilmore,
Hagman, Hall, Harkey, Hayashi, Hernandez, Hill, Huber,
Huffman, Jeffries, Jones, Knight, Krekorian, Lieu, Logue,
Bonnie Lowenthal, Ma, Mendoza, Miller, Monning, Nava,
Nestande, Niello, Nielsen, John A. Perez, V. Manuel
Perez, Portantino, Price, Ruskin, Salas, Saldana, Silva,
Skinner, Smyth, Solorio, Audra Strickland, Swanson,
Torlakson, Torres, Torrico, Tran, Villines, Yamada, Bass
NO VOTE RECORDED: Bill Berryhill, Block
CTW:RJG:JA:nl 9/11/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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