BILL NUMBER: AB 1383 AMENDED
BILL TEXT
AMENDED IN SENATE JULY 9, 2009
AMENDED IN SENATE JULY 1, 2009
AMENDED IN SENATE JUNE 25, 2009
AMENDED IN SENATE JUNE 17, 2009
AMENDED IN SENATE JUNE 11, 2009
AMENDED IN ASSEMBLY JUNE 1, 2009
AMENDED IN ASSEMBLY MAY 14, 2009
AMENDED IN ASSEMBLY APRIL 30, 2009
INTRODUCED BY Assembly Member Jones
(Principal coauthor: Senator Alquist)
(Coauthor: Assembly Member De Leon)
FEBRUARY 27, 2009
An act to add and repeal Articles 5.21 (commencing with Section
14167.2) and 5.22 (commencing with Section 14167.32) of, Chapter 7 of
Part 3 of Division 9 of the Welfare and Institutions Code, relating
to Medi-Cal, and declaring the urgency thereof, to take effect
immediately.
LEGISLATIVE COUNSEL'S DIGEST
AB 1383, as amended, Jones. Medi-Cal: hospitals: supplemental
payments: coverage dividend fee.
Existing law establishes 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. Under
existing law, the Medi-Cal Hospital/Uninsured Care Demonstration
Project Act, specified hospital reimbursement methodologies are
applied in order to maximize the use of federal funds consistent with
federal Medicaid law and stabilize the distribution of funding for
hospitals that provide care to Medi-Cal beneficiaries and uninsured
patients.
This bill would require the department , pursuant to
additional legislation described below, to pay specified
hospitals and Medi-Cal managed health care plans supplemental amounts
for certain hospital services.
This bill would require the Director of Health Care Services to
promptly seek the federal approvals that may be necessary to
implement the above-described supplemental payment provisions.
This bill would prohibit supplemental payments for some or all of
the 2008-09 federal fiscal year until the director executes a
declaration, which shall be submitted to the Legislature, containing
statements relating to the impact this bill's provisions will have on
other Medi-Cal reimbursement methodologies.
This bill would impose provide for the
imposition, pursuant to additional legislation described below, and
as a condition of receiving state funds, a coverage dividend
fee on certain hospitals starting on the date that the bill
becomes effective and continue through and, through,
and including , December 31, 2010, as specified.
This bill would require the director to seek federal approval of the
fee. The bill would provide that no hospital shall be required to pay
the coverage dividend fee to the department until the state receives
and maintains federal approval of the fee and the above-described
supplemental payments from the federal Centers for Medicare and
Medicaid Services.
This bill would provide that the funds collected from the coverage
dividend fee, and any matching federal funds, shall only be used for
certain purposes, including providing the above-described
supplemental payments and health care coverage for children.
This bill would require the director to negotiate the federal
approvals required to implement the bill's provisions for the 2009-10
and 2010-11 federal fiscal years concurrently with the negotiation
of a federal waiver that will replace the current Medi-Cal
Hospital/Uninsured Care Demonstration Project. The bill would provide
that its provisions shall not be implemented until the federal
government approves a federal waiver for a demonstration that will
replace the current Medi-Cal Hospital/Uninsured Care Demonstration
Project and is not adversely impacted by the bill's provisions.
This bill would provide that its provisions shall become
inoperative if the federal Centers for Medicare and Medicaid Services
deny approval for, or do not approve before January 1, 2012, the
implementation of the supplemental payment or the coverage dividend
fee.
This bill provides that it is the intent of the Legislature to
enact additional legislation that will specify more precisely the
calculation of the supplemental payment to individual hospitals and
the amount of the coverage dividend fee due from individual
hospitals. The bill would provide that the additional
legislation shall provide for imposition and for the calculations in
a manner in accordance with a fee assessment. The bill provides
that no supplemental payment shall be paid or coverage dividend fee
made due or payable until the additional legislation has been
enacted. If the additional legislation is not enacted, and does not
become effective, by October 1, 2009, the bill would provide that its
provisions shall be repealed on October 1, 2009, but if the
additional legislation is enacted, and becomes effective, by October
1, 2009, the bill would provide that its provisions shall be repealed
on January 1, 2013.
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. Article 5.21 (commencing with Section 14167.2) is added
to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions
Code, to read:
Article 5.21. Medi-Cal Hospital Provider Rate Stabilization
Act
14167.2. (a) Medi-Cal payments plus supplemental payments made
pursuant to this article for hospital outpatient services furnished
by private hospitals and hospital inpatient services furnished by
private hospitals and nondesignated public hospitals shall equal the
federal upper payment limit for that portion of the 2008-09, 2009-10,
and 2010-11 federal fiscal years for which federal approval of the
supplemental payments described in this article is obtained.
Hospitals shall , pursuant to additional legislation described
in Sections 14167.4 and 14167.38, receive supplemental payments
funded by the coverage dividend fee set forth in Article 5.22
(commencing with Section 14167.32) and available matching federal
funds to comply with this subdivision.
(b) Designated public hospitals shall , pursuant to
additional legislation described in Sections 14167.4 and 14167.38,
be paid direct grants in support of health care expenditures,
which shall be funded by the coverage dividend fee set forth in
Article 5.22 (commencing with Section 14167.32). The aggregate amount
of the grants shall be the total amount of payments that would be
made to designated public hospitals if the nonfederal component of
payments up to the applicable federal upper payment limit and the
payments received by those hospitals under subdivision (c) was funded
by the coverage dividend fee set forth in Article 5.22 (commencing
with Section 14167.32), less the amount of those fees that would have
been paid by the designated public hospitals if the hospitals were
required to pay the fee.
(c) Medi-Cal managed care health plans shall , pursuant to
additional legislation described in Sections 14167.4 and 14167.38,
receive supplemental payments to the extent available from the
funds generated by the coverage dividend fee, including matching
federal funds. The Medi-Cal managed care health plans shall pay all
of the supplemental payments to hospitals in the form of increased
payments for hospital services.
14167.3. (a) The director shall do all of the following:
(1) Submit any Medicaid state plan amendment that may be necessary
to implement this article.
(2) Seek federal approval for the use of the entire federal upper
payment limit.
(3) Seek all federal approvals, waivers, waiver modifications, and
any other federal action as may be necessary to implement and obtain
federal financial participation to the maximum extent possible.
(b) Supplemental payments for some or all of the 2008-09 federal
fiscal year shall not be made until the director executes a
declaration, which shall be submitted to the Legislature, that
contains the following statements:
(1) Based on assurances from the Secretary of the United States
Department of Health and Human Services, the maximum federal funds
available annually pursuant to the Special Terms and Conditions, as
amended October 5, 2007, of California's Medi-Cal Hospital/Uninsured
Care Section 1115 Waiver Demonstration, shall not be reduced.
(2) Taking into account all relevant information available from
the federal government, there is no reasonable basis on which to
conclude that implementation of this article will adversely impact
funding that otherwise would be available for Medi-Cal and uninsured
services pursuant to the Medicaid state plan or waiver that will
replace California's Medi-Cal Hospital/Uninsured Care Section 1115
Waiver Demonstration in effect on the effective date of this article.
(c) (1) The director shall negotiate the federal approvals
required to implement this article and Article 5.22 (commencing with
Section 14167.32) for the 2009-10 and 2010-11 federal fiscal years
concurrently with the negotiation of a federal waiver that will
replace California's Medi-Cal Hospital/Uninsured Care Section 1115
Waiver Demonstration in effect on the effective date of this article.
(2) This article and Article 5.22 (commencing with Section
14167.32) shall not be implemented until the federal government
approves a federal waiver for a demonstration that will replace
California's Medi-Cal Hospital/Uninsured Care Section 1115 Waiver
Demonstration in effect on the effective date of this article.
(d) This article shall become inoperative if the federal Centers
for Medicare and Medicaid Services denies approval for, or does not
approve before January 1, 2012, the implementation of this article or
Article 5.22 (commencing with Section 14167.32).
14167.4. (a) It is the intent of the Legislature to enact
additional legislation that will specify more precisely the
calculation of the supplemental payments to hospitals and to Medi-Cal
managed care health plans under this article. The additional
legislation shall provide for the calculation of the amount of the
supplemental payment to hospitals and Medi-Cal managed care health
plans in a manner that is consistent with the coverage dividend fee
described in Article 5.22 (commencing with Section 14167.32) being a
fee assessment.
(b) No supplemental payments shall be made pursuant to this
article until the legislation described in subdivision (a) has been
enacted.
14167.5. (a) If the legislation described in subdivision (a) of
Section 14167.4 is not enacted, and does not become effective, by
October 1, 2009, this article shall remain in effect only until
October 1, 2009, and as of that date is repealed.
(b) If the legislation described in subdivision (a) of Section
14167.4 is enacted, and becomes effective, by October 1, 2009, this
article shall remain in effect only until January 1, 2013, and as of
that date is repealed.
SEC. 2. Article 5.22 (commencing with Section 14167.32) is added
to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions
Code, to read:
Article 5.22. Hospital Coverage Dividend Fee Act
14167.32. (a) There shall be imposed , pursuant to
additional legislation described in Sections 14167.4 and 14167.38,
a coverage dividend fee that is consistent with the principle
of shared benefit and shared responsibility.
(b) The coverage dividend fee shall , as a condition of
receipt of state funds, be assessed , pursuant to
additional legislation described in Sections 14167.4 and 14167.38,
on hospitals licensed pursuant to subdivision (a) of Section
1250 of the Health and Safety Code, except for public hospitals, as
defined in paragraph (25) of subdivision (a) of Section 14105.98, and
hospitals that are designated as specialty hospitals in the hospital'
s annual financial disclosure reports for the hospital's latest
fiscal year ending in 2008, commencing on the effective date
of this article and shall continue through, and, including,
through, and including, December 31, 2010.
(c) The director shall seek, in a timely manner, any and all
federal approvals that may be necessary for the implementation of
each element of this article.
(d) This article shall become inoperative if the federal Centers
for Medicare and Medicaid Services denies approval for, or does not
approve before January 1, 2012, the implementation of Article 5.21
(commencing with Section 14167.2) or this article.
(e) No hospital shall be required to pay the coverage dividend fee
to the department until the state receives and maintains federal
approval of the coverage dividend fee and Article 5.21 (commencing
with Section 14167.2) from the federal Centers for Medicare and
Medicaid Services for the period for which the coverage dividend fee
is assessed.
14167.35. (a) The funds collected from the fees assessed pursuant
to this article, and any matching federal funds, shall be available
only for the following purposes:
(1) To provide supplemental payments and grants to hospitals under
subdivisions (a) and (b) of Section 14167.2.
(2) To provide supplemental payments to Medi-Cal managed care
health plans under subdivision (c) of Section 14167.2.
(3) To pay for health care coverage for children.
(4) To pay for the department's staffing costs directly
attributable to implementing Article 5.21 (commencing with Section
14167.2) or this article.
(b) The amount of the coverage dividend fee that shall be used for
health care coverage for children shall be eighty million dollars
($80,000,000) for each quarter during the federal fiscal year that
begins after the actual date on which all federal approvals are
obtained that are necessary to implement Article 5.21 (commencing
with Section 14167.2) and this article.
14167.38. (a) It is the intent of the Legislature to enact
additional legislation that will specify more precisely the
calculation of the amount of the coverage dividend fee due from
individual hospitals under this article. The additional
legislation shall provide for the imposition, after the coverage
dividend fee, and for the calculation of the amount of the coverage
dividend fee assessed on each hospital, in a manner in accordance
with a fee assessment.
(b) No coverage dividend fee shall be made due or payable pursuant
to this article until the legislation described in subdivision (a)
has been enacted.
14167.39. (a) If the legislation described in subdivision (a) of
Section 14167.38 is not enacted, and does not become effective, by
October 1, 2009, this article shall remain in effect only until
October 1, 2009, and as of that date is repealed.
(b) If the legislation described in subdivision (a) of Section
14167.38 is enacted, and becomes effective, by October 1, 2009, this
article shall remain in effect only until January 1, 2013, and as of
that date is repealed.
SEC. 3. 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 make the necessary statutory changes to increase
Medi-Cal payments to hospitals and improve access, at the earliest
possible time, so as to allow this act to be operative as soon as
approval from the federal Centers for Medicare and Medicaid Services
is obtained by the State Department of Health Care Services, it is
necessary that this act take effect immediately.