BILL NUMBER: AB 102 AMENDED
BILL TEXT
AMENDED IN SENATE JUNE 8, 2011
AMENDED IN SENATE MARCH 14, 2011
INTRODUCED BY Committee on Budget (Blumenfield (Chair), Alejo,
Allen, Brownley, Buchanan, Butler, Cedillo, Chesbro, Dickinson,
Feuer, Gordon, Huffman, Mitchell, Monning, and Swanson)
JANUARY 10, 2011
An act to amend Sections 11044, 20398, 68511.8, and 77206
of the Government Code, to amend Sections 830.2, 830.5, and 6126.1
of, and to amend and repeal Section 1465.8 of, the Penal Code, to
amend Sections 1051, 1826, 1850, 1850.5, 1851, 2250, 2250.4, 2250.6,
2253, and 2620 of the Probate Code, and to add Part 2.5 (commencing
with Section 19201) to Division 2 of the Public Contract Code,
relating to the administration of justice, making
12693.55, 12696.05, 12697.10, 12698, and 12698.26 of, and to repeal
Sections 12695.04 and 12696.5 of, the Insurance Code, to amend
Sections 14017.7, 14105.18, 14105.28, 14105.191, 14105.192, 14105.45,
14105.451, 14105.455, 14154, and 14165 of, to add Sections 14011.78,
14301.4, and 15916 to, and to add Chapter 8.9 (commencing with
Section 14700) to Part 3 of Division 9 of, the Welfare and
Institutions Code, relating to health, and making an
appropriation therefor , and declaring the urgency thereof
, to take effect immediately, bill related to the budget.
LEGISLATIVE COUNSEL'S DIGEST
AB 102, as amended, Committee on Budget. Administration
of justice. Health.
(1) Existing law creates the Healthy Families Program and the
Access for Infants and Mothers Program, which are administered by the
Managed Risk Medical Insurance Board, to provide specified health
care coverage to individuals that meet prescribed eligibility
requirements. Existing law requires a person to be a resident of the
state for at least six continuous months prior to application to the
Access for Infants and Mothers Program. Existing law provides for the
Medi-Cal program, which is administered by the State Department of
Health Care Services, under which qualified low-income individuals
receive health care services. Existing law authorizes the board to
negotiate contracts or enter interagency agreements with entities
that are not participating plans, such as the department, to provide
or pay for benefits to subscribers of the Healthy Families Program or
the Access for Infants and Mothers Program.
This bill would delete the six-month residency requirement. This
bill would authorize the department to contract with public or
private entities, or utilize existing health care service provider
payment mechanisms, in order to implement these provisions, and would
make conforming changes.
(2) Existing law requires the Managed Risk Medical Insurance Board
to appoint a seven-member Access for Infants and Mothers Advisory
Panel. Existing law requires the board to provide for the transfer of
coverage of a subscriber of the Access for Infants and Mothers
Program to another participating health plan if a subscriber's
coverage under his or her plan is canceled or not renewed.
This bill would delete this requirement and would repeal the
provisions establishing the Access for Infants and Mothers Advisory
Board.
(3) Existing law requires the department, no later than June 30,
2014, and subject to federal approval, to develop and implement a
Medi-Cal payment methodology based on diagnosis-related groups that
reflects the costs and staffing levels associated with quality of
care for patients in all general acute care hospitals, as specified.
Existing law also establishes the California Medical Assistance
Commission in the Governor's office for the purpose of contracting
with health care delivery systems for the provision of health care
services to recipients under the Medi-Cal program.
This bill would require that the payment methodology be
implemented on July 1, 2012, or upon the date the Director of Health
Care Services executes a specified declaration, whichever is later.
This bill would also require the California Medical Assistance
Commission to be dissolved after June 30, 2012, that all powers,
duties, and responsibilities of the commission be transferred to the
director, and that on or before July 1, 2012, that staff positions
serving the commission, including the executive director, be
transferred to the department. This bill would further provide that
upon a finding by the director that the payment methodology has been
designed and implemented and is sufficient to replace the
contract-based payment system, as performed by the commission, the
powers, duties, and responsibilities transferred to the director
shall no longer be exercised.
(4) Existing law requires, except as otherwise provided, Medi-Cal
provider payments to be reduced by 1% or 5%, and provider payments
for specified non-Medi-Cal programs to be reduced by 1% for dates of
service on and after March 1, 2009, and until June 1, 2011. For dates
of services on and after June 1, 2011, existing law requires, except
as provided, that these provider payments be reduced by 10%.
This bill would, instead, require that the 1% and 5% reductions
cease to be implemented when and to the extent that federal approval
is obtained for one or more specified payment reductions and
adjustments, including, but not limited to, the 10% provider payment
reductions.
(5) Existing law requires the reimbursement to Medi-Cal pharmacy
providers for legend and nonlegend drugs, as defined, to consist of
the estimated acquisition cost of the drug, as defined, plus a
professional fee for dispensing. Existing law requires the estimated
acquisition cost for specified legend and nonlegend drugs to be equal
to the lowest of the average wholesale price minus 17%, the selling
price, the federal upper limit, or the maximum allowable ingredient
cost.
This bill would, instead, require that reimbursement to Medi-Cal
pharmacy providers for legend and nonlegend drugs shall not exceed
the lowest of the estimated acquisition cost of the drug plus a
professional fee for dispensing or the pharmacy's usual and customary
charge, as defined. This bill would also modify the way in which
reimbursement is calculated by permitting the estimated acquisition
cost to be equal to the average acquisition cost, as defined.
(6) Existing law requires the department to establish and maintain
the County Administrative Cost Control Plan to control costs for
county administration of the determination of eligibility for
benefits under the Medi-Cal program.
This bill would, instead, require the department to develop and
implement, in consultation with county program and fiscal
representatives, a new budgeting methodology to reimburse counties
for eligibility determinations for applicants for and beneficiaries
of the Medi-Cal program.
(7) Under existing law, one of the methods by which Medi-Cal
services are provided is pursuant to contracts with various types of
managed care plans.
This bill would, to the extent permitted by federal law, authorize
a transferring entity, as defined, to make an intergovernmental
transfer (IGT) to the state, and would authorize the department to
accept all IGTs from a transferring entity, for the purposes of
providing support for the nonfederal share of risk-based payments to
managed care health plans, as defined, to compensate providers
designated by the transferring entity for Medi-Cal health care
services and for the support of the Medi-Cal program. This bill would
require the state to assess a fee of 20% on each IGT the state
accepts pursuant to these provisions to reimburse the department for
the administrative costs associated with implementing these
provisions and for the support of the Medi-Cal program. This bill
would require that these provisions be implemented on July 1, 2011,
or the date on which all necessary federal approvals have been
received, whichever is later.
(8) Under existing law, the State Department of Mental Health is
required to implement mental health care services, as specified, for
Medi-Cal recipients.
This bill would, effective July 1, 2012, require that the state
administrative functions for the operation of Medi-Cal specialty
mental health managed care and the Early and Periodic Screening,
Diagnosis, and Treatment (EPSDT) Program, and applicable functions
related to federal Medicaid requirements that were performed by the
State Department of Mental Health be transferred to the department.
This bill would require the department, in collaboration with the
State Department of Mental Health and the California Health and Human
Services Agency, to create a transition plan to be provided, as
prescribed, to the fiscal and appropriate policy committees of the
Legislature no later than October 1, 2011, or May 15, 2012, as
applicable.
(9) Existing law requires the department to seek a demonstration
project or federal waiver of Medicaid law to implement specified
objectives, which may include better care coordination for seniors,
persons with disabilities, and children with special health care
needs. Existing law provides for the Health Care Coverage Initiative
(HCCI), which is a federal waiver demonstration project established
to expand health care coverage to low-income uninsured individuals
who are not currently eligible for the Medi-Cal program, the Healthy
Families Program, or the Access for Infants and Mothers program.
Existing law also requires the department, on or after November 1,
2010, but no later than March 1, 2011, or 180 days after federal
approval of the demonstration project, to authorize the provision of
scheduled health care benefits for uninsured adults, as specified.
This bill would require the department to annually seek authority
from the federal Centers for Medicare and Medicaid Services under the
Special Terms and Conditions of California's Bridge to Reform
Section 1115(a) Demonstration to redirect HCCI funds within the
safety net care pool, as defined, that are not fully utilized by the
end of a demonstration year, as defined, to the category of
uncompensated care to be used by designated public hospitals, on a
voluntary basis, for allowable certified public expenditures, as
specified.
(10) This bill would appropriate $1,000 from the General Fund to
the State Department of Health Care Services for administration.
(11) This bill would declare that it is to take effect immediately
as a bill providing for appropriations related to the Budget Bill.
(1) Existing law created the Legal Services Revolving Fund in the
State Treasury. Existing law requires the Attorney General to charge
the costs incurred in providing legal services. Existing law
prohibits charges, except as approved by the Department of Finance,
for legal services to be against the General Fund. Existing law
requires the Controller to transfer the amount of the charges for
services rendered from the agency's appropriation to the
appropriation for the support of the Attorney General's Office;
however, the Attorney General is prohibited from requesting an amount
that exceeds the amount budgeted by the state agency for the
Attorney General's legal services.
This bill would delete the prohibition that charges for legal
services cannot be made against the General Fund. This bill would
require the Controller to transfer the amount of the charges for
services rendered from the agency's appropriation to the
appropriation for the support of the Attorney General's office using
the Controller's direct transfer process. This bill would require all
disputes to be resolved in accordance with a specified provision of
the State Administrative Manual.
(2) Existing law classifies certain police officers, sheriff
deputies, and firefighters who have responsibility for the direct
supervision of state peace officer/firefighter personnel as state
peace officer/firefighter members under the Public Employees'
Retirement System (PERS). Employees classified as safety members
under PERS, including state peace officer/firefighter members, are
generally entitled to higher benefits and subject to higher
contribution rates than employees classified as miscellaneous or
general members. Certain employees of the Office of the Inspector
General are peace officers and entitled to state peace
officer/firefighter benefits under PERS.
This bill would include in the state peace officer/firefighter
classification employees of the Office of the Inspector General who
are no longer peace officers after the effective date of this act but
who were hired as peace officers prior to April 1, 2011, or prior to
the first day of the first pay period following the enactment of
this act if this act is enacted after April 1, 2011.
(3) Existing law requires the Judicial Council to provide an
annual status report to the chairpersons of the budget committee in
each house of the Legislature and the Joint Legislative Budget
Committee regarding the California Case Management System and Court
Accounting and Reporting System on or before December 1 of each year
until project completion. Existing law requires the Administrative
Office of the Courts (AOC) to annually provide to those chairpersons
copies of any independent project oversight report for the California
Case Management System.
(4) Existing law also provides that the California Case Management
System, and all other administrative and infrastructure information
technology projects of the Judicial Council or the courts with total
costs estimated at more than $5,000,000, shall be subject to the
review and recommendations of the office of the State Chief
Information Officer, as specified. Existing law requires the State
Chief Information Officer to submit a copy of those reviews and
recommendations to the Joint Legislative Budget Committee.
This bill would instead require the Judicial Council to provide
the above-described status report on or before December 1 of each
year until the completion and full implementation of the project. The
bill would also require the AOC to retain an independent consultant
to review the California Case Management System and produce a written
independent assessment of the system, as specified. The bill would,
prior to the acceptance and deployment of the system, require the
independent consultant to provide the written assessment to the AOC,
require the AOC to provide a copy of the written assessment to
legislative budget committees, as specified, and require the AOC to
work with the development vendor to ensure that any flaws, defects,
or risks identified in the assessment are remedied during the
warranty period.
(5) Existing law provides that the Judicial Council may regulate
the budget and fiscal management of the trial courts. Existing law
requires the Administrative Office of the Courts to contract with the
Controller to perform specified audits, except as specified.
This bill would require that the audits referenced above
additionally determine compliance with the California Judicial Branch
Contract Law, as described in (9) below.
(6) Existing law creates the independent Office of the Inspector
General and provides that it is not a subdivision of any other
government entity. The Inspector General and certain other employees
of the office are peace officers provided that the primary duty of
these peace officers is conducting audits of investigatory practices
and other audits, as well as conducting investigations, of the
Department of Corrections and Rehabilitation, Division of Juvenile
Justice, and the Board of Parole Hearings.
This bill would remove the Inspector General and other employees
of his or her office as peace officers, except for those employees
whose primary duties are conducting investigations of the Department
of Corrections and Rehabilitation, Division of Juvenile Justice, and
the Board of Parole Hearings. The bill would make conforming changes.
The bill would further make nonsubstantive, technical changes to
these provisions.
(7) Existing law requires that $40 be imposed on every conviction
for a criminal offense, including traffic offenses, to ensure and
maintain adequate funding for court security. Existing law requires
that amount to be reduced to $30 on July 1, 2011, and reduced to $20
on July 1, 2013.
This bill would instead keep in effect the charge of $40 until
July 1, 2013, at which time the charge would be reduced to $30. The
bill would delete the provision reducing the charge to $20.
(8) Existing law regulates the terms and conditions of
conservatorships. Existing law authorizes a court to refer certain
issues relating to a conservatorship to a court investigator and
prescribes the duties of a investigator in this regard which include
interviewing specified relatives of a proposed conservatee,
conducting investigations of, and reporting to a court about, the
appropriateness of a conservatorship, and, to the extent practicable,
reviewing accountings with a conservatee. Existing law requires a
court to review each limited conservatorship one year after the
appointment of the conservator and biennially thereafter. Existing
law permits specified parties to file a petition for an appointment
of a temporary guardian or a temporary conservator and establishes
requirements for the petition and for notice of the hearing on the
petition. Existing law also creates various requirements for a court
in this regard, and for a court investigator, including interviewing
a proposed conservatee and informing him or her of the nature,
purpose, and effect of a temporary conservatorship.
This bill would provide that a superior court is not required to
perform certain duties enacted by specified statutes in relation to
conservatorships, described above, until an appropriation is made
that is identified for this purpose.
(9) The Public Contract Code generally governs contracts entered
into by a state agency, including contracts for the erection,
construction, alteration, repair, or improvement of any state
structure, building, road, or other state improvement of any kind, as
prescribed, and the acquisition of goods and services, by the state
agency, and also sets forth the requirements for the solicitation and
evaluation of bids and the awarding of those contracts. For purposes
of those laws, "state agency" does not include the courts, or any
agency in the judicial branch of government.
This bill would create the California Judicial Branch Contract
Law, which would apply specified provisions of the Public Contract
Code applicable to state agencies and departments to specified
contracts initially entered into or amended by judicial branch
entities, as defined, on or after October 1, 2011, as provided. The
bill would require contracts to be subject to review by the Bureau of
State Audits and all administrative and infrastructure information
technology projects of the Judicial Council to be subject to review
by the California Technology Agency, as specified.
This bill would provide that the California Judicial Branch
Contract Law does not apply to procurement and contracting by
judicial branch entities that are related to trial court
construction, including, but not limited to, the planning, design,
construction, rehabilitation, renovation, replacement, lease, or
acquisition of trial court facilities.
This bill would also require the Judicial Council to provide a
report containing certain information relating to procurement to the
Joint Legislative Budget Committee twice a year beginning in 2002, as
specified, and, by January 15, 2013, to provide a report to the
Joint Legislative Budget Committee on the process, transparency,
costs, and timeliness of its construction procurement practices. The
bill would also require the Legislative Analyst's Office to conduct
an analysis of the findings. The Legislative Analyst's Office may
request that the Department of General Services provide comparable
information, as specified. The bill would require the audits
referenced in (5) above to include an audit and report by the State
Auditor on his or her assessment of the implementation of the
California Judicial Branch Contract Law by the judicial branch. The
bill would provide that the State Auditor shall be reimbursed by the
judicial branch entity that is the subject of the audit for all
reasonable costs associated with conducting that audit.
(10) The DNA Fingerprint, Unresolved Crime and Innocence
Protection Act, an initiative measure, requires an additional penalty
of one dollar for every $10 or part thereof to be levied in each
county upon every fine, penalty, or forfeiture imposed and collected
by the courts for all criminal offenses, as specified. The act
requires 25% of those moneys to be transferred to the state's DNA
Identification Fund and specifies the purposes for which those funds
may be used.
This bill would appropriate $1,000 from the DNA Identification
Fund to the Department of Justice for state operations, consistent
with those purposes in the 2011-12 fiscal year.
(11) The California Constitution authorizes the Governor to
declare a fiscal emergency and to call the Legislature into special
session for that purpose. Governor Schwarzenegger issued a
proclamation declaring a fiscal emergency, and calling a special
session for this purpose, on December 6, 2010. Governor Brown issued
a proclamation on January 20, 2011, declaring and reaffirming that a
fiscal emergency exists and stating that his proclamation supersedes
the earlier proclamation for purposes of that constitutional
provision.
This bill would state that it addresses the fiscal emergency
declared and reaffirmed by the Governor by proclamation issued on
January 20, 2011, pursuant to the California Constitution.
(12) This bill would declare that it is to take immediate effect
as an urgency statute and a bill providing for appropriations related
to the Budget Bill.
Vote: 2/3 majority . Appropriation:
yes. Fiscal committee: yes. State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 12693.55 of the
Insurance Code is amended to read:
12693.55. (a) A health care provider who is furnished
documentation of a person's enrollment in the program shall not seek
reimbursement nor attempt to obtain payment for any covered services
provided to that person other than from the participating health plan
covering that person or from other entities that the board
enters into contracts or interagency agreements with to provide or
pay for benefits under this part pursuant to Section 12693.
26 .
(b) The provisions of subdivision (a) do not apply to any
copayments required under this part for the covered
services provided to the person under his or her
participating health plan .
(c) For purposes of this section, "health care provider" means any
professional person, organization, health facility, or other person
or institution licensed by the state to deliver or furnish health
care services.
SEC. 2. Section 12695.04 of the
Insurance Code is repealed.
12695.04. "Advisory panel" means the Managed Risk Medical
Insurance Board Access for Infants and Mothers Advisory Panel created
pursuant to Section 12696.5.
SEC. 3. Section 12696.05 of the
Insurance Code is amended to read:
12696.05. The board may do all of the following:
(a) Determine eligibility criteria for the program. These criteria
shall include the requirements set forth in Section 12698.
(b) Determine the eligibility of applicants.
(c) Determine when subscribers are covered and the extent and
scope of coverage.
(d) Determine subscriber contribution amounts schedules.
(1) Subscriber contribution amounts for care provided to the
subscriber shall be indexed to the federal poverty level and shall
not exceed 2 percent of a subscriber's annual gross family income.
(2) In addition to any other subscriber contribution specified in
this subdivision, for subscribers enrolled on or after July 1, 2007,
the board may also assess an additional subscriber contribution to
cover the AIM-linked infant enrolled in the Healthy Families Program
pursuant to clause (ii) of subparagraph (A) of paragraph (6) of
subdivision (a) of Section 12693.70 for two months, using all
applicable discounts pursuant to Section 12693.43.
(3) The board shall determine the manner in which the subscriber
contributions are to be applied, including the order in which they
are applied.
(e) Provide coverage through participating health plans or through
coordination with other state programs, including, but not
limited to, through interagency agreements with the State Department
of Health Care Services to provide or pay for benefits to subscribers
under this part, and contract for the processing of
applications and the enrollment of subscribers. Any contract entered
into pursuant to this part shall be exempt from any provision of law
relating to competitive bidding, and shall be exempt from the review
or approval of any division of the Department of General Services.
The board shall not be required to specify the amounts encumbered for
each contract, but may allocate funds to each contract based on
projected and actual subscriber enrollments in a total amount not to
exceed the amount appropriated for the program.
(f) Authorize expenditures from the fund to pay program expenses
which exceed subscriber contributions, and to administer the program
as necessary.
(g) Develop a promotional component of the program to make
Californians aware of the program and the opportunity that it
presents.
(h) Issue rules and regulations as necessary to administer the
program. All
(1) All rules and regulations
issued pursuant to this subdivision that manage program integrity,
revise the benefit package, or reduce the eligibility criteria below
300 percent of the federal poverty level may be adopted as emergency
regulations in accordance with the Administrative Procedure Act
(Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code). The adoption of these regulations
shall be deemed an emergency and necessary for the immediate
preservation of the public peace, health, and safety, or general
welfare. The regulations shall become effective immediately upon
filing with the Secretary of State.
(2) During the 2011-12, 2012-13, and 2013-14 fiscal years, the
adoption and readoption of regulations pursuant to this part shall be
deemed to be an emergency that calls for immediate action to avoid
serious harm to the public peace, health, safety, or general welfare
for purposes of Sections 11346.1 and 11349.6 of the Government Code,
and the board is hereby exempted from the requirement that the board
describe facts showing the need for immediate action and from review
by the Office of Administrative Law.
(i) Exercise all powers reasonably necessary to carry out the
powers and responsibilities expressly granted or imposed by this
part.
SEC. 4. Section 12696.5 of the
Insurance Code is repealed.
12696.5. (a) The board shall appoint a seven-member advisory
panel to advise the board, the chairman of which shall serve as an ex
officio, nonvoting, member of the board. The panel shall be
appointed and ready to perform its duties by September 1, 1991.
(b) The membership of the advisory panel shall be composed of all
of the following:
(1) One physician and surgeon who is board certified in the area
of gynecology and obstetrics.
(2) One physician and surgeon who is board certified in
pediatrics.
(3) One physician and surgeon who is board certified in the area
of family practice.
(4) One representative from the beneficiary population.
(5) One representative from a general acute care hospital with a
full complement of obstetrical services.
(6) One advanced practice nurse serving in a maternal and child
health capacity.
(7) One representative from a licensed nonprofit primary care
clinic or from a county clinic.
(c) The panel shall elect, from among its members, its chairman.
(d) The panel shall have all of the following powers and duties:
(1) To advise the board on all policies, regulations, operations,
and implementation of the Access for Infants and Mothers Program.
(2) To consider all written recommendations of the panel and
respond in writing when the board rejects the advice of the panel.
(3) To meet at least quarterly, unless deemed unnecessary by the
chair.
(e) The members of the panel shall be reimbursed for all necessary
travel expenses associated with the activities of the panel.
(f) Those members of the panel who are economically unable to meet
panel responsibilities shall be provided a per diem compensation.
SEC. 5. Section 12697.10 of the
Insurance Code is amended to read:
12697.10. (a) The board
shall include, within contracts negotiated pursuant to this part,
terms regarding the cancellation of the contracts, and may cancel any
contract negotiated pursuant to this part with any participating
health plan as provided for in the contract.
(b) The board shall provide for the transfer of coverage of any
subscriber to another participating health plan if a contract with
any participating health plan under which the subscriber receives
coverage is canceled or not renewed.
SEC. 6. Section 12698 of the Insurance
Code is amended to read:
12698. To be eligible to participate in the program, a person
shall meet all of the following requirements:
(a) Be a resident of the state for at least six
continuous months prior to application . A person who is a
member of a federally recognized California Indian tribe is a
resident of the state for these purposes.
(b) (1) Until the first day of the second month following the
effective date of the amendment made to this subdivision in 1994,
have a household income that does not exceed 250 percent of the
official federal poverty level unless the board determines that the
program funds are adequate to serve households above that level.
(2) Upon the first day of the second month following the effective
date of the amendment made to this subdivision in 1994, have a
household income that is above 200 percent of the official federal
poverty level but does not exceed 250 percent of the official federal
poverty level unless the board determines that the program funds are
adequate to serve households above the 250 percent of the official
federal poverty level.
(c) Pay an initial subscriber contribution of not more than fifty
dollars ($50), and agree to the payment of the complete subscriber
contribution. A federally recognized California Indian tribal
government may make the initial and complete subscriber contributions
on behalf of a member of the tribe only if a contribution on behalf
of members of federally recognized California Indian tribes does not
limit or preclude federal financial participation under Title XXI of
the Social Security Act. If a federally recognized California Indian
tribal government makes a contribution on behalf of a member of the
tribe, the tribal government shall ensure that the subscriber is made
aware of all the health plan options available in the county where
the member resides.
SEC. 7. Section 12698.26 of the
Insurance Code is amended to read:
12698.26. (a) A health care provider who is furnished
documentation of a subscriber's enrollment in the program shall not
seek reimbursement nor attempt to obtain payment for any covered
services provided to that subscriber other than from the
participating health plan covering the subscriber or from other
entities that the board enters into contracts or interagency
agreements with to provide or pay for benefits under this part
pursuant to subdivision (e) of Section 12696.05 .
(b) The provisions of subdivision (a) do not apply to any
copayments required under this part for the covered
services provided to the subscriber under his or her
participating health plan .
(c) For purposes of this section, "health care provider" means any
professional person, organization, health facility, or other person
or institution licensed by the state to deliver or furnish health
care services.
SEC. 8. Section 14011.78 is added to the
Welfare and Institutions Code , to read:
14011.78. (a) The department may contract with public or private
entities, or utilize existing health care service provider payment
mechanisms, including the Medi-Cal program's fiscal intermediary, in
order to implement subdivision (b) of Section 12693.26 and
subdivision (e) of Section 12696.05 of the Insurance Code, only if
services provided under those sections are specifically identified
and reimbursed in a manner that appropriately claims federal
financial reimbursement.
(b) Contracts under this section, including the Medi-Cal fiscal
intermediary contract, and including any contract amendment, any
system change pursuant to a change order, and any project or systems
development notice, shall be exempt from Part 2 (commencing with
Section 10100) of Division 2 of the Public Contract Code, Section
19130 of the Government Code, and any policies, procedures, or
regulations authorized by these laws.
SEC. 9. Section 14017.7 of the Welfare
and Institutions Code is amended to read:
14017.7. (a) In addition to the issuance of Medi-Cal cards,
pursuant to Section 14017.8, the department may issue a benefits
identification card for the purpose of identifying an individual who
has been determined eligible for health care benefits under this
chapter or health care benefits under another health care program
administered by the department, or both.
(b) The department may also issue a benefits identification card
for the purpose of identifying an individual who has been determined
eligible to receive health care services from a Medi-Cal provider
under one of the following programs:
(1) The Healthy Families Program under Part 6.2 (commencing with
Section 12693) of Division 2 of the Insurance Code.
(2) The Access for Infants and Mothers Program under Part 6.3
(commencing with Section 12695) of Division 2 of the Insurance Code.
(b)
(c) In no event shall a benefits identification card be
issued to an individual described in subdivision (a) or (b)
unless appropriate and adequate safeguards have been
implemented to ensure all of the following:
(1) If the individual has been determined eligible for health care
benefits under another health care program administered by the
department or a program identified in subdivision (b) ,
that health care program pays for any and all health care benefits
delivered to the individual by that health care program.
(2) State funds appropriated to or federal medicaid financial
participation claimed by the Medi-Cal program shall only be used for
the delivery of health care benefits authorized pursuant to this
chapter.
(c)
(d) The individual described in subdivision (a) or
(b) may present the benefits identification card to obtain
health care benefits for which that individual has been determined
eligible under this chapter, or health care benefits under another
health care program administered by the department or a program
identified in subdivision (b) , or both
all of them .
(d)
(e) Where applicable, all laws, regulations,
restrictions, conditions, and terms of participation regarding the
possession, billing, and use of Medi-Cal cards shall also apply to a
benefits identification card.
(e)
(f) For the purposes of this section, "benefits"
includes medically necessary services, goods, supplies, or
merchandise.
SEC. 10. Section 14105.18 of the
Welfare and Institutions Code is amended to read:
14105.18. (a) Notwithstanding any other provision of law,
provider rates of payment for services rendered in all of the
following programs shall be identical to the rates of payment for the
same service performed by the same provider type pursuant to the
Medi-Cal program.
(1) The California Children's Services Program established
pursuant to Article 5 (commencing with Section 123800) of Chapter 3
of Part 2 of Division 106 of the Health and Safety Code.
(2) The Genetically Handicapped Person's Program established
pursuant to Article 1 (commencing with Section 125125) of Chapter 2
of Part 5 of Division 106 of the Health and Safety Code.
(3) The Breast and Cervical Cancer Early Detection Program
established pursuant to Article 1.5 1.3
(commencing with Section 104150) of Chapter 2 of Part 1 of Division
103 of the Health and Safety Code and the breast cancer programs
specified in Section 30461.6 of the Revenue and Taxation Code.
(4) The State-Only Family Planning Program established pursuant to
Division 24 (commencing with Section 24000).
(5) The Family Planning, Access, Care, and Treatment (Family PACT)
Waiver Program established pursuant to
subdivision (aa) of Section 14132.
(6) The Healthy Families Program established pursuant to Part 6.2
(commencing with Section 12693) of Division 2 of the Insurance Code
if the health care services are provided by a Medi-Cal provider.
(7) The Access for Infants and Mothers Program established
pursuant to Part 6.3 (commencing with Section 12695) of Division 2 of
the Insurance Code if the health care services are provided by a
Medi-Cal provider.
(b) The director may identify in regulations other programs not
listed in subdivision (a) in which providers shall be paid rates of
payment that are identical to the rates of payments in the Medi-Cal
program pursuant to subdivision (a).
(c) Notwithstanding subdivision (a), services provided under any
of the programs described in subdivisions (a) and (b) may be
reimbursed at rates greater than the Medi-Cal rate that would
otherwise be applicable if those rates are adopted by the director in
regulations.
(d) This section shall become operative on January 1, 2011.
SEC. 11. Section 14105.28 of the
Welfare and Institutions Code is amended to read:
14105.28. (a) It is the intent of the Legislature to design a new
Medi-Cal inpatient hospital reimbursement methodology based on
diagnosis-related groups that more effectively ensures all of the
following:
(1) Encouragement of access by setting higher payments for
patients with more serious conditions.
(2) Rewards for efficiency by allowing hospitals to retain savings
from decreased length of stays and decreased cost
costs per day.
(3) Improvement of transparency and understanding by defining the
"product" of a hospital in a way that is understandable to both
clinical and financial managers.
(4) Improvement of fairness so that different hospitals receive
similar payment for similar care and payments to hospitals are
adjusted for significant cost factors that are outside the hospital's
control.
(5) Encouragement of administrative efficiency and minimizing
administrative burdens on hospitals and the Medi-Cal program.
(6) That payments depend on data that has high consistency and
credibility.
(7) Simplification of the process for determining and making
payments to the hospitals.
(8) Facilitation of improvement of quality and outcomes.
(9) Facilitation of implementation of state and federal provisions
related to hospital acquired conditions.
(10) Support of provider compliance with all applicable state and
federal requirements.
(b) (1) (A) (i) The department shall develop and implement a
payment methodology based on diagnosis-related groups, subject to
federal approval, that reflects the costs and staffing levels
associated with quality of care for patients in all general acute
care hospitals in state and out of state, including Medicare critical
access hospitals, but excluding public hospitals, psychiatric
hospitals, and rehabilitation hospitals, which include alcohol and
drug rehabilitation hospitals.
(ii) This section shall be implemented on the date that the
replacement Medicaid Management Information System, described in
subparagraph (C), becomes fully operational, but no later than June
30, 2014. The director shall execute a declaration stating the date
on which the replacement system has become fully operational.
(ii) The payment methodology developed pursuant to this section
shall be implemented on July 1, 2012, or on the date upon which the
director executes a declaration certifying that all necessary federal
approvals have been obtained and the methodology is sufficient for
formal implementation, whichever is later.
(B) The diagnosis-related group-based payments shall apply to all
claims, except claims for psychiatric inpatient days, rehabilitation
inpatient days, managed care inpatient days, and swing bed stays for
long-term care services, provided, however, that psychiatric and
rehabilitation inpatient days shall be excluded regardless of whether
the stay was in a distinct-part unit. The department may exclude or
include other claims and services as may be determined during the
development of the payment methodology.
(C) Implementation of the new payment methodology shall be
coordinated with the development and implementation of the
replacement Medicaid Management Information System pursuant to the
contract entered into pursuant to Section 14104.3, effective on May
3, 2010.
(2) The department shall evaluate alternative diagnosis-related
group algorithms for the new Medi-Cal reimbursement system for the
hospitals to which paragraph (1) applies. The evaluation shall
include, but not be limited to, consideration of all of the following
factors:
(A) The basis for determining diagnosis-related group base price,
and whether different base prices should be used taking into account
factors such as geographic location, hospital size, teaching status,
the local hospital wage area index, and any other variables that may
be relevant.
(B) Classification of patients based on appropriate acuity
classification systems.
(C) Hospital case mix factors.
(D) Geographic or regional differences in the cost of operating
facilities and providing care.
(E) Payment models based on diagnosis-related groups used in other
states.
(F) Frequency of grouper updates for the diagnosis-related groups.
(G) The extent to which the particular grouping algorithm for the
diagnosis-related groups accommodates ICD-10 diagnosis and procedure
codes, and applicable requirements of the federal Health Insurance
Portability and Accountability Act of 1996.
(H) The basis for calculating relative weights for the various
diagnosis-related groups.
(I) Whether policy adjusters should be used, for which care
categories they should be used, and the frequency of updates to the
policy adjusters.
(J) The extent to which the payment system is budget neutral and
can be expected to result in state budget savings in future years.
(K) Other factors that may be relevant to determining payments,
including, but not limited to, add-on payments, outlier payments,
capital payments, payments for medical education, payments in the
case of early transfers of patients, and payments based on
performance and quality of care.
(c) The department shall submit to the Legislature a status report
on the implementation of this section on April 1, 2011, April 1,
2012, April 1, 2013, and April 1, 2014.
(d) The alternatives for a new system described in paragraph (2)
of subdivision (b) shall be developed in consultation with recognized
experts with experience in hospital reimbursement, economists, the
federal Centers for Medicare and Medicaid Services, and other
interested parties.
(e) In implementing this section, the department may contract, as
necessary, on a bid or nonbid basis, for professional consulting
services from nationally recognized higher education and research
institutions, or other qualified individuals and entities not
associated with a particular hospital or hospital group, with
demonstrated expertise in hospital reimbursement systems. The rate
setting system described in subdivision (b) shall be developed with
all possible expediency. This subdivision establishes an accelerated
process for issuing contracts pursuant to this section and contracts
entered into pursuant to this subdivision shall be exempt from the
requirements of Chapter 1 (commencing with Section 10100) and Chapter
2 (commencing with Section 10290) of Part 2 of Division 2 of the
Public Contract Code.
(f) (1) The department may adopt emergency regulations to
implement the provisions of this section in accordance with
rulemaking provisions of the Administrative Procedure Act (Chapter
3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title
2 of the Government Code). The initial adoption of emergency
regulations and one readoption of the initial regulations shall be
deemed to be an emergency and necessary for the immediate
preservation of the public peace, health , and
safety , or general welfare. Initial emergency regulations
and the one readoption of those regulations shall be exempt from
review by the Office of Administrative Law. The initial emergency
regulations and the one readoption of those regulations authorized by
this section shall be submitted to the Office of Administrative Law
for filing with the Secretary of State and publication in the
California Code of Regulations.
(2) As an alternative to paragraph (1), and notwithstanding the
rulemaking provisions of Chapter 3.5 (commencing with Section 11340)
of Part 1 of Division 3 of Title 2 of the Government Code, or any
other provision of law, the department may implement and administer
this section by means of provider bulletins, all-county letters,
manuals, or other similar instructions, without taking regulatory
action. The department shall notify the fiscal and appropriate policy
committees of the Legislature of its intent to issue a provider
bulletin, all-county letter, manual, or other similar instruction, at
least five days prior to issuance. In addition, the department shall
provide a copy of any provider bulletin, all-county letter, manual,
or other similar instruction issued under this paragraph to the
fiscal and appropriate policy committees of the Legislature.
SEC. 12. Section 14105.191 of the
Welfare and Institutions Code is amended to read:
14105.191. (a) Notwithstanding any other provision of law, in
order to implement changes in the level of funding for health care
services, the director shall reduce provider payments, as specified
in this section.
(b) (1) Except as otherwise provided in this section, payments
shall be reduced by 1 percent for Medi-Cal fee-for-service benefits
for dates of service on and after March 1, 2009.
(2) Except as provided in subdivision (d), for dates of service on
and after March 1, 2009, payments to the following classes of
providers shall be reduced by 5 percent for Medi-Cal fee-for-service
benefits:
(A) Intermediate care facilities, excluding those facilities
identified in paragraph (5) of subdivision (d). For purposes of this
section, "intermediate care facility" has the same meaning as defined
in Section 51118 of Title 22 of the California Code of Regulations.
(B) Skilled nursing facilities that are distinct parts of general
acute care hospitals. For purposes of this section, "distinct part"
has the same meaning as defined in Section 72041 of Title 22 of the
California Code of Regulations.
(C) Rural swing-bed facilities.
(D) Subacute care units that are, or are parts of, distinct parts
of general acute care hospitals. For purposes of this subparagraph,
"subacute care unit" has the same meaning as defined in Section
51215.5 of Title 22 of the California
Code of Regulations.
(E) Pediatric subacute care units that are, or are parts of,
distinct parts of general acute care hospitals. For purposes of this
subparagraph, "pediatric subacute care unit" has the same meaning as
defined in Section 51215.8 of Title 22 of the California Code of
Regulations.
(F) Adult day health care centers.
(3) Except as provided in subdivision (d), for dates of service on
and after March 1, 2009, Medi-Cal fee-for-service payments to
pharmacies shall be reduced by 5 percent.
(4) Except as provided in subdivision (d), payments shall be
reduced by 1 percent for non-Medi-Cal programs described in Article 6
(commencing with Section 124025) of Chapter 3 of Part 2 of Division
106 of the Health and Safety Code, and Section 14105.18, for dates of
service on and after March 1, 2009.
(5) For managed health care plans that contract with the
department pursuant to this chapter, Chapter 8 (commencing with
Section 14200), and Chapter 8.75 (commencing with Section 14590),
payments shall be reduced by the actuarial equivalent amount of the
payment reductions specified in this subdivision pursuant to contract
amendments or change orders effective on July 1, 2008, or
thereafter.
(c) Notwithstanding any other provision of this section, payments
to hospitals that are not under contract with the State Department of
Health Care Services pursuant to Article 2.6 (commencing with
Section 14081) for inpatient hospital services provided to Medi-Cal
beneficiaries and that are subject to Section 14166.245 shall be
governed by that section.
(d) To the extent applicable, the services, facilities, and
payments listed in this subdivision shall be exempt from the payment
reductions specified in subdivision (b):
(1) Acute hospital inpatient services that are paid under
contracts pursuant to Article 2.6 (commencing with Section 14081).
(2) Federally qualified health center services, including those
facilities deemed to have federally qualified health center status
pursuant to a waiver pursuant to subsection (a) of Section 1115 of
the federal Social Security Act (42 U.S.C. Sec. 1315(a)).
(3) Rural health clinic services.
(4) Skilled nursing facilities licensed pursuant to subdivision
(c) of Section 1250 of the Health and Safety Code other than those
specified in paragraph (2) of subdivision (b).
(5) Intermediate care facilities for the developmentally disabled
licensed pursuant to subdivision (e), (g), or (h) of Section 1250 of
the Health and Safety Code, or facilities providing continuous
skilled nursing care to developmentally disabled individuals pursuant
to the pilot project established by Section 14495.10.
(6) Payments to facilities owned or operated by the State
Department of Mental Health or the State Department of Developmental
Services.
(7) Hospice services.
(8) Contract services, as designated by the director pursuant to
subdivision (g).
(9) Payments to providers to the extent that the payments are
funded by means of a certified public expenditure or an
intergovernmental transfer pursuant to Section 433.51 of Title 42 of
the Code of Federal Regulations.
(10) Services pursuant to local assistance contracts and
interagency agreements to the extent the funding is not included in
the funds appropriated to the department in the annual Budget Act.
(11) Payments to Medi-Cal managed care plans pursuant to Section
4474.5 for services to consumers transitioning from Agnews
Developmental Center into the Counties of Alameda, San Mateo, and
Santa Clara pursuant to the Plan for the Closure of Agnews
Developmental Center.
(12) Breast and cervical cancer treatment provided pursuant to
Section 14007.71 and as described in paragraph (3) of subdivision (a)
of Section 14105.18 or Article 1.5 (commencing with Section 104160)
of Chapter 2 of Part 1 of Division 103 of the Health and Safety Code.
(13) The Family Planning, Access, Care, and Treatment (Family
PACT) Waiver Program pursuant to subdivision (aa)
of Section 14132.
(14) Small and rural hospitals, as defined in Section 124840 of
the Health and Safety Code.
(e) Subject to the exemptions listed in subdivision (d), the
payment reductions required by paragraph (1) of subdivision (b) shall
apply to the benefits rendered by any provider who may be authorized
to bill for provision of the benefit, including, but not limited to,
physicians, podiatrists, nurse practitioners, certified nurse
midwives, nurse anesthetists, and organized outpatient clinics.
(f) (1) Notwithstanding any other provision of law, Medi-Cal
reimbursement rates applicable to the classes of providers identified
in paragraph (2) of subdivision (b), for services rendered during
the 2009-10 rate year and each rate year thereafter, shall not exceed
the reimbursement rates that were applicable to those classes of
providers in the 2008-09 rate year.
(2) In addition to the classes of providers described in paragraph
(1), Medi-Cal reimbursement rates applicable to the following
classes of facilities for services rendered during the 2009-10 rate
year, and each rate year thereafter, shall not exceed the
reimbursement rates that were applicable to those facilities and
services in the 2008-09 rate year:
(A) Facilities identified in paragraph (5) of subdivision (d).
(B) Freestanding pediatric subacute care units, as defined in
Section 51215.8 of Title 22 of the California Code of Regulations.
(3) Paragraphs (1) and (2) shall not apply to providers that are
paid pursuant to Article 3.8 (commencing with Section 14126), or to
services, facilities, and payments specified in subdivision (d), with
the exception of facilities described in paragraph (5) of
subdivision (d).
(4) The limitation set forth in this subdivision shall be applied
only after the reductions in paragraph (2) of subdivision (b) have
been made.
(g) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement and administer this section by means of
provider bulletins, or similar instructions, without taking
regulatory action.
(h) The reductions and limitations described in this section shall
apply only to payments for benefits when the General Fund share of
the payment is paid with funds directly appropriated to the
department in the annual Budget Act, and shall not apply to payments
for benefits paid with funds appropriated to other departments or
agencies.
(i) The department shall promptly seek any necessary federal
approvals for the implementation of this section. To the extent that
federal financial participation is not available with respect to any
payment that is reduced or limited pursuant to this section, the
director may elect not to implement that reduction or limitation.
(j) This section shall become inoperative for dates of service on
and after June 1, 2011, and shall, on July 1, 2014, be repealed.
SEC. 13. Section 14105.192 of the
Welfare and Institutions Code is amended to read:
14105.192. (a) The Legislature finds and declares the following:
(1) Costs within the Medi-Cal program continue to grow due to the
rising cost of providing health care throughout the state and also
due to increases in enrollment, which are more pronounced during
difficult economic times.
(2) In order to minimize the need for drastically cutting
enrollment standards or benefits during times of economic crisis, it
is crucial to find areas within the program where reimbursement
levels are higher than required under the standard provided in
Section 1902(a)(30)(A) of the federal Social Security Act and can be
reduced in accordance with federal law.
(3) The Medi-Cal program delivers its services and benefits to
Medi-Cal beneficiaries through a wide variety of health care
providers, some of which deliver care via managed care or other
contract models while others do so through fee-for-service
arrangements.
(4) The setting of rates within the Medi-Cal program is complex
and is subject to close supervision by the United States Department
of Health and Human Services.
(5) As the single state agency for Medicaid in California, the
department has unique expertise that can inform decisions that set or
adjust reimbursement methodologies and levels consistent with the
requirements of federal law.
(b) Therefore, it is the intent of the Legislature for the
department to analyze and identify where reimbursement levels can be
reduced consistent with the standard provided in Section 1902(a)(30)
(A) of the federal Social Security Act and consistent with federal
and state law and policies, including any exemptions contained in the
provisions of the act that added this section, provided that the
reductions in reimbursement shall not exceed 10 percent on an
aggregate basis for all providers, services and products.
(c) Notwithstanding any other provision of law, the director shall
adjust provider payments, as specified in this section.
(d) (1) Except as otherwise provided in this section, payments
shall be reduced by 10 percent for Medi-Cal fee-for-service benefits
for dates of service on and after June 1, 2011.
(2) For managed health care plans that contract with the
department pursuant to this chapter or Chapter 8 (commencing with
Section 14200), except contracts with Senior Care Action Network and
AIDS Healthcare Foundation, payments shall be reduced by the
actuarial equivalent amount of the payment reductions specified in
this section pursuant to contract amendments or change orders
effective on July 1, 2011, or thereafter.
(3) Payments shall be reduced by 10 percent for non-Medi-Cal
programs described in Article 6 (commencing with Section 124025) of
Chapter 3 of Part 2 of Division 106 of the Health and Safety Code,
and Section 14105.18, for dates of service on and after June 1, 2011.
This paragraph shall not apply to inpatient hospital services
provided in a hospital that is paid under contract pursuant to
Article 2.6 (commencing with Section 14081).
(4) (A) Notwithstanding any other provision of law, the director
may adjust the payments specified in paragraphs (1) and (3) of this
subdivision with respect to one or more categories of Medi-Cal
providers, or for one or more products or services rendered, or any
combination thereof, so long as the resulting reductions to any
category of Medi-Cal providers, in the aggregate, total no more than
10 percent.
(B) The adjustments authorized in subparagraph (A) shall be
implemented only if the director determines that, for each affected
product, service or provider category, the payments resulting from
the adjustment comply with subdivision (m).
(e) Notwithstanding any other provision of this section, payments
to hospitals that are not under contract with the State Department of
Health Care Services pursuant to Article 2.6 (commencing with
Section 14081) for inpatient hospital services provided to Medi-Cal
beneficiaries and that are subject to Section 14166.245 shall be
governed by that section.
(f) Notwithstanding any other provision of this section, the
following shall apply:
(1) Payments to providers that are paid pursuant to Article 3.8
(commencing with Section 14126) shall be governed by that article.
(2) (A) Subject to subparagraph (B), for dates of service on and
after June 1, 2011, Medi-Cal reimbursement rates for intermediate
care facilities for the developmentally disabled licensed pursuant to
subdivision (e), (g), or (h) of Section 1250 of the Health and
Safety Code, and facilities providing continuous skilled nursing care
to developmentally disabled individuals pursuant to the pilot
project established by Section 14132.20, as determined by the
applicable methodology for setting reimbursement rates for these
facilities, shall not exceed the reimbursement rates that were
applicable to providers in the 2008-09 rate year.
(B) (i) If Section 14105.07 is added to the Welfare and
Institutions Code during the 2011-12 Regular Session of the
Legislature, subparagraph (A) shall become inoperative.
(ii) If Section 14105.07 is added to the Welfare and Institutions
Code during the 2011-12 Regular Session of the Legislature, then for
dates of service on and after June 1, 2011, payments to intermediate
care facilities for the developmentally disabled licensed pursuant to
subdivision (e), (g), or (h) of Section 1250 of the Health and
Safety Code, and facilities providing continuous skilled nursing care
to developmentally disabled individuals pursuant to the pilot
project established by Section 14132.20, shall be governed by the
applicable methodology for setting reimbursement rates for these
facilities and by Section 14105.07.
(g) The department may enter into contracts with a vendor for the
purposes of implementing this section on a bid or nonbid basis. In
order to achieve maximum cost savings, the Legislature declares that
an expedited process for contracts under this subdivision is
necessary. Therefore, contracts entered into to implement this
section and all contract amendments and change orders shall be exempt
from Chapter 2 (commencing with Section 10290) of Part 2 Division 2
of the Public Contract Code.
(h) To the extent applicable, the services, facilities, and
payments listed in this subdivision shall be exempt from the payment
reductions specified in subdivision (d) as follows:
(1) Acute hospital inpatient services that are paid under
contracts pursuant to Article 2.6 (commencing with Section 14081).
(2) Federally qualified health center services, including those
facilities deemed to have federally qualified health center status
pursuant to a waiver pursuant to subsection (a) of Section 1115 of
the federal Social Security Act (42 U.S.C. Sec. 1315(a)).
(3) Rural health clinic services.
(4) Payments to facilities owned or operated by the State
Department of Mental Health or the State Department of Developmental
Services.
(5) Hospice services.
(6) Contract services, as designated by the director pursuant to
subdivision (k).
(7) Payments to providers to the extent that the payments are
funded by means of a certified public expenditure or an
intergovernmental transfer pursuant to Section 433.51 of Title 42 of
the Code of Federal Regulations. This paragraph shall apply to
payments described in paragraph (3) of subdivision (d) only to the
extent that they are also exempt from reduction pursuant to
subdivision (l).
(8) Services pursuant to local assistance contracts and
interagency agreements to the extent the funding is not included in
the funds appropriated to the department in the annual Budget Act.
(9) Breast and cervical cancer treatment provided pursuant to
Section 14007.71 and as described in paragraph (3) of subdivision (a)
of Section 14105.18 or Article 1.5 (commencing with Section 104160)
of Chapter 2 of Part 1 of Division 103 of the Health and Safety Code.
(10) The Family Planning, Access, Care, and Treatment (Family
PACT) Program pursuant to subdivision (aa) of Section 14132.
(i) Subject to the exception for services listed in subdivision
(h), the payment reductions required by subdivision (d) shall apply
to the benefits rendered by any provider who may be authorized to
bill for the service, including, but not limited to, physicians,
podiatrists, nurse practitioners, certified nurse-midwives, nurse
anesthetists, and organized outpatient clinics.
(j) Notwithstanding any other provision of law, for dates of
service on and after June 1, 2011, Medi-Cal reimbursement rates
applicable to the following classes of providers shall not exceed the
reimbursement rates that were applicable to those classes of
providers in the 2008-09 rate year, as described in subdivision (f)
of Section 14105.91 14105.191 , reduced
by 10 percent:
(1) Intermediate care facilities, excluding those facilities
identified in paragraph (2) of subdivision (f). For purposes of this
section, "intermediate care facility" has the same meaning as defined
in Section 51118 of Title 22 of the California Code of Regulations.
(2) Skilled nursing facilities that are distinct parts of general
acute care hospitals. For purposes of this section, "distinct part"
has the same meaning as defined in Section 72041 of Title 22 of the
California Code of Regulations.
(3) Rural swing-bed facilities.
(4) Subacute care units that are, or are parts of, distinct parts
of general acute care hospitals. For purposes of this subparagraph,
"subacute care unit" has the same meaning as defined in Section
51215.5 of Title 22 of the California Code of Regulations.
(5) Pediatric subacute care units that are, or are parts of,
distinct parts of general acute care hospitals. For purposes of this
subparagraph, "pediatric subacute care unit" has the same meaning as
defined in Section 51215.8 of Title 22 of the California Code of
Regulations.
(6) Adult day health care centers.
(7) Freestanding pediatric subacute care units, as defined in
Section 51215.8 of Title 22 of the California Code of Regulations.
(k) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement and administer this section by means of
provider bulletins , or similar instructions,
without taking regulatory action.
(l) The reductions described in this section shall apply only to
payments for services when the General Fund share of the payment is
paid with funds directly appropriated to the department in the annual
Budget Act and shall not apply to payments for services paid with
funds appropriated to other departments or agencies.
(m) Notwithstanding any other provision of this section, the
payment reductions and adjustments provided for in subdivision (d)
shall be implemented only if the director determines that the
payments that result from the application of this section will comply
with applicable federal Medicaid requirements and that federal
financial participation will be available.
(1) In determining whether federal financial participation is
available, the director shall determine whether the payments comply
with applicable federal Medicaid requirements, including those set
forth in Section 1396a(a)(30)(A) of Title 42 of the United States
Code.
(2) To the extent that the director determines that the payments
do not comply with the federal Medicaid requirements or that federal
financial participation is not available with respect to any payment
that is reduced pursuant to this section, the director retains the
discretion to not implement the particular payment reduction or
adjustment and may adjust the payment as necessary to comply with
federal Medicaid requirements.
(n) The department shall seek any necessary federal approvals for
the implementation of this section.
(o) This section shall not be implemented until federal approval
is obtained. When federal approval is obtained, the payments
resulting from the application of subdivision (d) shall be
implemented retroactively to June 1, 2011, or on such other date or
dates as may be applicable.
(o) (1) The payment reductions and adjustments set forth in this
section shall not be implemented until federal approval is obtained.
(2) To the extent that federal approval is obtained for one or
more of the payment reductions and adjustments in this section and
Section 14105.07, the payment reductions and adjustments set forth in
Section 14105.191 shall cease to be implemented for the same
services provided by the same class of providers. In the event of a
conflict between this section and Section 14105.191, other than the
provisions setting forth a payment reduction or adjustment, this
section shall govern.
(3) When federal approval is obtained, the payments resulting from
the application of this section shall be implemented retroactively
to June 1, 2011, or on any other date or dates as may be applicable.
(4) The director may clarify the application of this subdivision
by means of provider bulletins or similar instructions, pursuant to
subdivision (k).
(p) Adjustments to pharmacy drug product payment pursuant to this
section shall no longer apply when the department determines that the
average acquisition cost methodology pursuant to Section 14105.45
has been fully implemented and the department's pharmacy budget
reduction targets, consistent with payment reduction levels pursuant
to this section, have been met.
SEC. 14. Section 14105.45 of the
Welfare and Institutions Code is amended to read:
14105.45. (a) For purposes of this section, the following
definitions shall apply:
(1) "Average acquisition cost" means the average weighted cost
determined by the department to represent the actual acquisition cost
paid for drugs by Medi-Cal pharmacy providers, including those that
provide specialty drugs. The average acquisition cost shall not be
considered confidential and shall be subject to disclosure pursuant
to the California Public Records Act (Chapter 3.5 (commencing with
Section 6250) of Division 7 of Title 1 of the Government Code).
(1)
(2) "Average manufacturers price" means the price
reported to the department by the federal Centers for
Medicare and Medicaid Services pursuant to Section 1927 of the Social
Security Act (42 U.S.C. Sec. 1396r-8). In the event an
average manufacturer's price is not available, the department shall
use the direct price as the average manufacturer's price.
(2)
(3) "Average wholesale price" means the price for a
drug product listed as the average wholesale price in the department'
s primary price reference source.
(3) "Direct price" means the price for a drug product purchased by
a pharmacy directly from a drug manufacturer listed in the
department's primary reference source.
(4) "Estimated acquisition cost" means the department's best
estimate of the price generally and currently paid by providers for a
drug product sold by a particular manufacturer or principal labeler
in a standard package.
(5) "Federal upper limit" means the maximum per unit reimbursement
when established by the federal Centers for Medicare and
Medicaid Services and published by the department in Medi-Cal
pharmacy provider bulletins and manuals.
(6) "Generically equivalent drugs" means drug products with the
same active chemical ingredients of the same strength ,
quantity, and dosage form, and of the same generic drug
name, as determined by the United States Adopted Names (USAN) and
accepted by the federal Food and Drug Administration (FDA), as those
drug products having the same chemical ingredients.
(7) "Legend drug" means any drug whose labeling states "Caution:
Federal law prohibits dispensing without prescription," "Rx only," or
words of similar import.
(8) "Maximum allowable ingredient cost" (MAIC) means the maximum
amount the department will reimburse Medi-Cal pharmacy providers for
generically equivalent drugs.
(9) "Innovator multiple source drug," "noninnovator multiple
source drug," and "single source drug" have the same meaning as those
terms are defined in Section 1396r-8(k)(7) of Title 42 of the United
States Code.
(10) "Nonlegend drug" means any drug whose labeling does not
contain the statement referenced in paragraph (7).
(11) "Selling price" means the price used in the establishment of
the estimated acquisition cost. The department shall base the selling
price on the average manufacturer's price plus a percent markup
determined by the department to be necessary for the selling price to
represent the average purchase price paid by retail pharmacies in
California. The selling price shall not be considered confidential
and shall be subject to disclosure under the California Public
Records Act (Chapter 3.5 (commencing with Section 6250) of Division 7
of Title 1 of the Government Code).
(11) "Pharmacy warehouse," as defined in Section 4163 of the
Business and Professions Code, means a physical location licensed as
a wholesaler for prescription drugs that acts as a central warehouse
and performs intracompany sales or transfers of those drugs to a
group of pharmacies under common ownership and control.
(12) "Specialty drugs" means drugs determined by the department
pursuant to subdivision (f) of Section 14105.3 to generally require
special handling, complex dosing regimens, specialized
self-administration at home by a beneficiary or caregiver, or
specialized nursing facility services, or may include extended
patient education, counseling, monitoring, or clinical support.
(12)
(13) "Volume weighted average" means the aggregated
average volume for generically equivalent a
group of legend or nonlegend drugs, weighted by each drug's
percentage of the group's total volume in the Medi-Cal
fee-for-service program during the previous six months. For purposes
of this paragraph, volume is based on the standard billing unit used
for the generically equivalent legend or
nonlegend drugs.
(14) "Wholesaler" means a drug wholesaler that is engaged in
wholesale distribution of prescription drugs to retail pharmacies in
California.
(13)
(15) "Wholesaler acquisition cost" means the price for
a drug product listed as the wholesaler acquisition cost in the
department's primary price reference source.
(b) (1) Reimbursement to Medi-Cal pharmacy providers for legend
and nonlegend drugs shall consist of the estimated acquisition cost
of the drug plus a professional fee for dispensing. The
(b) (1) Reimbursement to Medi-Cal pharmacy providers for legend
and nonlegend drugs shall not exceed the lowest of either of the
following:
(A) The estimated acquisition cost of the drug plus a professional
fee for dispensing.
(B) The pharmacy's usual and customary charge as defined in
Section 14105.455.
(2) The professional fee shall be
seven dollars and twenty-five cents ($7.25) per dispensed
prescription. The professional fee for legend drugs dispensed to a
beneficiary residing in a
skilled nursing facility or intermediate care facility shall be eight
dollars ($8) per dispensed prescription. For purposes of this
paragraph "skilled nursing facility" and "intermediate care facility"
shall have the same meaning as defined in Division 5 (commencing
with Section 70001) of Title 22 of the California Code of
Regulations. If the department determines that a change in
dispensing fee is necessary pursuant to this section, the department
shall establish the new dispensing fee through the budget process and
implement the new dispensing fee pursuant to subdivision (d).
(2)
(3) The department shall establish the estimated
acquisition cost of legend and nonlegend drugs as follows:
(A) For single source and innovator multiple source drugs, the
estimated acquisition cost shall be equal to the lowest of the
average wholesale price minus 17 percent, the selling price,
the average acquisition cost, the federal upper
limit, or the MAIC.
(B) For noninnovator multiple source drugs, the estimated
acquisition cost shall be equal to the lowest of the average
wholesale price minus 17 percent, the selling price,
the average acquisition cost, the federal upper
limit, or the MAIC.
(C) Average wholesale price shall not be used to establish the
estimated acquisition cost once the department has determined that
the average acquisition cost methodology has been fully implemented.
(3)
(4) For purposes of paragraph (2)
(3) , the department shall establish a list of MAICs for
generically equivalent drugs, which shall be published in pharmacy
provider bulletins and manuals. The department shall establish a MAIC
only when three or more generically equivalent drugs are available
for purchase and dispensing by retail pharmacies in California. The
department shall update the list of MAICs and establish additional
MAICs in accordance with all of the following:
(A) The department shall base the MAIC on the mean of the average
manufacturer's price of drugs generically equivalent to the
particular innovator drug plus a percent markup determined by the
department to be necessary for the MAIC to represent the average
purchase price paid by retail pharmacies in California.
(B) If average manufacturer prices are unavailable, the department
shall establish the MAIC in either one
of the following ways:
(i) Based on the volume weighted average of wholesaler acquisition
costs of drugs generically equivalent to the particular innovator
drug plus a percent markup determined by the department to be
necessary for the MAIC to represent the average purchase price paid
by retail pharmacies in California.
(ii) Pursuant to a contract with a vendor for the purpose of
surveying drug price information, collecting data, and calculating a
proposed MAIC.
(iii) Based on the volume weighted average acquisition cost of
drugs generically equivalent to the particular innovator drug
adjusted by the department to represent the average purchase price
paid by Medi-Cal pharmacy providers.
(C) The department may enter into contracts with a vendor for the
purpose of this section on a bid or nonbid basis. In order to achieve
maximum cost savings, the Legislature declares that an expedited
process for contracts under this section is necessary. Therefore,
contracts entered into on a nonbid basis shall be exempt from Chapter
2 (commencing with Section 10290) of Part 2 of Division 2 of the
Public Contract Code.
(D)
(C) The department shall update MAICs at least every
three months and notify Medi-Cal providers at least 30 days prior to
the effective date of a MAIC.
(E)
(D) The department shall establish a process for
providers to seek a change to a specific MAIC when the providers
believe the MAIC does not reflect current available market prices. If
the department determines a MAIC change is warranted, the department
may update a specific MAIC prior to notifying providers.
(F)
(E) In determining the average purchase price, the
department shall consider the provider-related costs of the products
that include, but are not limited to, shipping, handling, storage,
and delivery. Costs of the provider that are included in the costs of
the dispensing shall not be used to determine the average purchase
price.
(5) (A) The department may establish the average acquisition cost
in one of the following ways:
(i) Based on the volume weighted average acquisition cost adjusted
by the department to ensure that the average acquisition cost
represents the average purchase price paid by retail pharmacies in
California.
(ii) Based on the proposed average acquisition cost as calculated
by the vendor pursuant to subparagraph (B).
(iii) Based on a national pricing benchmark obtained from the
federal Centers for Medicare and Medicaid Services or on a similar
benchmark listed in the department's primary price reference source
adjusted by the department to ensure that the average acquisition
cost represents the average purchase price paid by retail pharmacies
in California.
(B) For the purposes of paragraph (3), the department may contract
with a vendor for the purposes of surveying drug price information,
collecting data from providers, wholesalers, or drug manufacturers,
and calculating a proposed average acquisition cost.
(C) (i) Medi-Cal pharmacy providers shall submit drug price
information to the department or a vendor designated by the
department for the purposes of establishing the average acquisition
cost. The information submitted by pharmacy providers shall include,
but not be limited to, invoice prices and all discounts, rebates, and
refunds known to the provider that would apply to the acquisition
cost of the drug products purchased during the calendar quarter.
Pharmacy warehouses shall be exempt from the survey process, but
shall provide drug cost information upon audit by the department for
the purposes of validating individual pharmacy provider acquisition
costs.
(ii) Pharmacy providers that fail to submit drug price information
to the department or the vendor as required by this subparagraph
shall receive notice that if they do not provide the required
information within five working days, they shall be subject to
suspension under subdivisions (a) and (c) of Section 14123.
(D) (i) For new drugs or new formulations of existing drugs, where
drug price information is unavailable pursuant to clause (i) of
subparagraph (C), drug manufacturers and wholesalers shall submit
drug price information to the department or a vendor designated by
the department for the purposes of establishing the average
acquisition cost. Drug price information shall include, but not be
limited to, net unit sales of a drug product sold to retail
pharmacies in California divided by the total number of units of the
drug sold by the manufacturer or wholesaler in a specified period of
time determined by the department.
(ii) Drug products from manufacturers and wholesalers that fail to
submit drug price information to the department or the vendor as
required by this subparagraph may not be a reimbursable benefit of
the Medi-Cal program for those manufacturers and wholesalers until
the department has established the average acquisition cost for those
drug products.
(E) Drug pricing information provided to the department or a
vendor designated by the department for the purposes of establishing
the average acquisition cost pursuant to this section shall be
confidential and shall be exempt from disclosure under the California
Public Records Act (Chapter 3.5 (commencing with Section 6250) of
Division 7 of Title 1 of the Government Code).
(F) Prior to the implementation of an average acquisition cost
methodology, the department shall collect data through a survey of
pharmacy providers for purposes of establishing a professional fee
for dispensing in compliance with federal Medicaid requirements.
(i) The department shall seek stakeholder input on the retail
pharmacy factors and elements used for the pharmacy survey relative
to both average acquisition costs and dispensing costs. Any
adjustment to the dispensing fee shall not exceed the aggregate
savings associated with the implementation of the average acquisition
cost methodology.
(ii) For drug products provided by pharmacy providers pursuant to
subdivision (f) of Section 14105.3, a differential professional fee
or payment for services to provide specialized care may be considered
as part of the contracts established pursuant to that section.
(G) When the department implements the average acquisition cost
methodology, the department shall update the Medi-Cal claims
processing system to reflect the average acquisition cost of drugs
not later than 30 days after the department has established average
acquisition cost pursuant to subparagraph (A).
(H) Notwithstanding any other provision of law, if the department
implements average acquisition cost pursuant to clause (i) or (ii) of
subparagraph (A), the department shall update actual acquisition
costs at least every three months and notify Medi-Cal providers at
least 30 days prior to the effective date of any change in an actual
acquisition cost.
(I) The department shall establish a process for providers to seek
a change to a specific average acquisition cost when the providers
believe the average acquisition cost does not reflect current
available market prices. If the department determines an average
acquisition cost change is warranted, the department may update a
specific average acquisition cost prior to notifying providers.
(c) The department shall update the Medi-Cal claims processing
system to reflect the selling price of drugs not later than 30 days
after receiving the average manufacturer's price.
(d) In order to maintain beneficiary access to prescription drug
services, no later than 30 days after the department initially
implements selling price as a component of estimated acquisition
cost, pursuant to paragraph (2) of subdivision (b), the department
shall make a one-time adjustment to the dispensing fees paid to
pharmacy providers in accordance with paragraph (1) of subdivision
(b). This change shall only be made if selling price results in a
lower aggregate drug reimbursement. Any increase in dispensing fee
made pursuant to this subdivision shall not exceed the aggregate
savings associated with the implementation of selling price. At least
30-days prior to implementing the dispensing fee increase, the
department shall issue a copy of the department's request for federal
approval pursuant to subdivision (e), to the chairperson in each
house that considers appropriations and the Chairperson of the Joint
Legislative Budget Committee, or whatever lesser time the Chairperson
of the Joint Legislative Budget Committee or his or her designee may
determine.
(e)
(c) The director shall implement this section in a
manner that is consistent with federal Medicaid law and regulations.
The director shall seek any necessary federal approvals for the
implementation of this section. This section shall be implemented
only to the extent that federal approval is obtained.
(f)
(d) Notwithstanding Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code, the department may take the actions specified in
implement, interpret, or make specific this
section by means of a provider bulletin or notice, policy letter, or
other similar instructions, without taking regulatory action.
(g) The department shall issue a Medi-Cal pharmacy reimbursement
fact sheet to the chairperson of the committee in each house of the
Legislature that considers appropriations no later than March 1,
2008. The reimbursement fact sheet shall contain, but not be limited
to, available data and information regarding the change in
reimbursement due to the federal Deficit Reduction Act of 2005
implementation of average manufacturer's price based federal upper
limits, the implementation of selling price, change in the average
wholesale price reported to the department by the primary price
reference source, change in pharmacy dispensing fees, prescription
drug volume trends, and the number of active Medi-Cal pharmacy
providers. The fact sheet shall also contain general information and
definitions regarding drug pricing terminology and a description of
pharmacy claims processing in Medi-Cal.
(e) The department may enter into contracts with a vendor for the
purposes of implementing this section on a bid or nonbid basis. In
order to achieve maximum cost savings, the Legislature declares that
an expedited process for contracts under this section is necessary.
Therefore, contracts entered into to implement this section, and all
contract amendments and change orders, shall be exempt from Chapter 2
(commencing with Section 10290) of Part 2 of Division 2 of the
Public Contract Code.
(f) (1) The rates provided for in this section shall be
implemented only if the director determines that the rates will
comply with applicable federal Medicaid requirements and that federal
financial participation will be available.
(2) In determining whether federal financial participation is
available, the director shall determine whether the rates comply with
applicable federal Medicaid requirements, including those set forth
in Section 1396a(a)(30)(A) of Title 42 of the United States Code.
(3) To the extent that the director determines that the rates do
not comply with applicable federal Medicaid requirements or that
federal financial participation is not available with respect to any
rate of reimbursement described in this section, the director retains
the discretion not to implement that rate and may revise the rate as
necessary to comply with federal Medicaid requirements.
(g) The director shall seek any necessary federal approvals for
the implementation of this section.
(h) This section shall not be construed to require the department
to collect cost data, to conduct cost studies, or to set or adjust a
rate of reimbursement based on cost data that has been collected.
(i) Adjustments to pharmacy drug product payment pursuant to
Section 14105.192 shall no longer apply when the department
determines that the average acquisition cost methodology has been
fully implemented and the department's pharmacy budget reduction
targets, consistent with payment reduction levels pursuant to Section
14105.192, have been met.
(j) Prior to implementation of this section, the department shall
provide the appropriate fiscal and policy committees of the
Legislature with information on the department's plan for
implementation of the average acquisition cost methodology pursuant
to this section.
SEC. 15. Section 14105.451 of the
Welfare and Institutions Code is amended to read:
14105.451. (a) (1) The Legislature finds and declares all of the
following:
(A) The United States Department of Health and Human Services has
identified the critical need for state Medicaid agencies to establish
pharmacy reimbursement rates based on a pricing benchmark that
reflects actual acquisition costs.
(B) The Medi-Cal program currently uses a methodology based on
average wholesale price (AWP) .
(C) Investigations by the federal Office of Inspector General have
found that average wholesale price is inflated relative to average
acquisition cost.
(2) Therefore, it is the intent of the Legislature to enact
legislation by August 1, 2011, that provides for development of a new
reimbursement methodology that will enable the department to achieve
savings while continuing to reimburse pharmacy providers in
compliance with federal law.
(b) The Subject to Section 14105.45, the
department may require providers, manufacturers, and
wholesalers to submit any data the director determines necessary or
useful in preparing for the transition from a methodology based on
average wholesale price to a methodology based on actual acquisition
cost.
(c) If the AWP ceases to be listed by the department's primary
price reference source vendor, the department may direct the fiscal
intermediary to establish a process with the primary price reference
source vendor to temporarily report the AWP consistent with the
definition of AWP in Section 14105.45. If this process is
established, it shall be limited in scope and duration, and shall
cease when the department has fully implemented the average
acquisition cost methodology pursuant to Section 14105.45.
SEC. 16. Section 14105.455 of the
Welfare and Institutions Code is amended to read:
14105.455. (a) Pharmacy providers shall submit their usual and
customary charge when billing the Medi-Cal program for prescribed
drugs.
(b) "Usual and customary charge" means the lower of the following:
(1) The lowest price reimbursed to the pharmacy by other
third-party payers in California, excluding Medi-Cal managed care
plans and Medicare Part D prescription drug plans.
(2) The lowest price routinely offered to any segment of the
general public.
(c) Donations or discounts provided to a charitable organization
are not considered usual and customary charges.
(d) Pharmacy providers shall keep and maintain records of their
usual and customary charges for a period of three years from the date
the service was rendered.
(e) Payment to pharmacy providers shall be the lower of the
pharmacy's usual and customary charge or the reimbursement rate
pursuant to subdivision (b) of Section 14105.45.
(f) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may take the actions specified in
implement, interpret, or make specific this section by means of
a provider bulletin or notice, policy letter, or other similar
instructions, without taking regulatory action.
SEC. 17. Section 14154 of the Welfare
and Institutions Code is amended to read:
14154. (a) (1) The department shall establish and maintain a plan
whereby costs for county administration of the determination of
eligibility for benefits under this chapter will be effectively
controlled within the amounts annually appropriated for that
administration. The plan, to be known as the County Administrative
Cost Control Plan, shall establish standards and performance
criteria, including workload, productivity, and support services
standards, to which counties shall adhere. The plan shall include
standards for controlling eligibility determination costs that are
incurred by performing eligibility determinations at county
hospitals, or that are incurred due to the outstationing of any other
eligibility function. Except as provided in Section 14154.15,
reimbursement to a county for outstationed eligibility functions
shall be based solely on productivity standards applied to that
county's welfare department office.
(2) (A) The plan shall delineate both of the following:
(i) The process for determining county administration base costs,
which include salaries and benefits, support costs, and staff
development.
(ii) The process for determining funding for caseload changes,
cost-of-living adjustments, and program and other changes.
(B) The annual county budget survey document utilized under the
plan shall be constructed to enable the counties to provide
sufficient detail to the department to support their budget requests.
(3) The plan shall be part of a single state plan, jointly
developed by the department and the State Department of Social
Services, in conjunction with the counties, for administrative cost
control for the California Work Opportunity and Responsibility to
Kids (CalWORKs), CalFresh, and Medical Assistance (Medi-Cal)
programs. Allocations shall be made to each county and shall be
limited by and determined based upon the County Administrative Cost
Control Plan. In administering the plan to control county
administrative costs, the department shall not allocate state funds
to cover county cost overruns that result from county failure to meet
requirements of the plan. The department and the State Department of
Social Services shall budget, administer, and allocate state funds
for county administration in a uniform and consistent manner.
(4) The department and county welfare departments shall develop
procedures to ensure the data clarity, consistency, and reliability
of information contained in the county budget survey document
submitted by counties to the department. These procedures shall
include the format of the county budget survey document and process,
data submittal and its documentation, and the use of the county
budget survey documents for the development of determining county
administration costs. Communication between the department and the
county welfare departments shall be ongoing as needed regarding the
content of the county budget surveys and any potential issues to
ensure the information is complete and well understood by involved
parties. Any changes developed pursuant to this section shall be
incorporated within the state's annual budget process by no later
than the 2011-12 fiscal year.
(5) The department shall provide a clear narrative description
along with fiscal detail in the Medi-Cal estimate package, submitted
to the Legislature in January and May of each year, of each component
of the county administrative funding for the Medi-Cal program. This
shall describe how the information obtained from the county budget
survey documents was utilized and, where applicable, modified and the
rationale for the changes.
(6) Notwithstanding any other provision of law, the department
shall develop and implement, in consultation with county program and
fiscal representatives, a new budgeting methodology for Medi-Cal
county administrative costs. The new budgeting methodology shall be
used to reimburse counties for eligibility determinations for
applicants and beneficiaries, including one-time eligibility
processing and ongoing case maintenance.
(A) The budgeting methodology shall include, but is not limited
to, identification of the costs of eligibility determinations for
applicants, and the costs of eligibility redeterminations and case
maintenance activities for recipients, for different groupings of
cases. The groupings of cases shall be based on variations in time
and resources needed to conduct eligibility determinations. The
calculation of time and resources shall be based on the following
factors: complexity of eligibility rules, ongoing eligibility
requirements, and other factors as determined appropriate by the
department.
(B) The new budgeting methodology shall be clearly described,
state the necessary data elements to be collected from the counties,
and establish the timeframes for counties to provide the data to the
state.
(C) The department may develop a process for counties to phase in
the requirements of the new budgeting methodology.
(D) To the extent a county does not submit the requested data
pursuant to subparagraph (B), the new budgeting methodology may
include a process to use peer-based proxy costs in developing the
county budget.
(E) The department shall provide the new budgeting methodology to
the legislative fiscal committees by March 1, 2012, and may include
the methodology in the May Medi-Cal Local Assistance Estimate,
beginning with the May 2012 estimate, for the 2012-13 fiscal year and
each fiscal year thereafter.
(F) To the extent that the funding for the county budgets
developed pursuant to the new budget methodology is not fully
appropriated in any given fiscal year, the department, with input
from the counties, shall identify and consider options to align
funding and workload responsibilities.
(b) Nothing in this section, Section 15204.5, or Section 18906
shall be construed so as to limit the administrative or budgetary
responsibilities of the department in a manner that would violate
Section 14100.1, and thereby jeopardize federal financial
participation under the Medi-Cal program.
(c) (1) The Legislature finds and declares that in order for
counties to do the work that is expected of them, it is necessary
that they receive adequate funding, including adjustments for
reasonable annual cost-of-doing-business increases. The Legislature
further finds and declares that linking appropriate funding for
county Medi-Cal administrative operations, including annual
cost-of-doing-business adjustments, with performance standards will
give counties the incentive to meet the performance standards and
enable them to continue to do the work
they do on behalf of the state. It is therefore the
Legislature's intent to provide appropriate funding to the counties
for the effective administration of the Medi-Cal program at the local
level to ensure that counties can reasonably meet the purposes of
the performance measures as contained in this section.
(2) It is the intent of the Legislature to not appropriate funds
for the cost-of-doing-business adjustment for the 2008-09, 2009-10,
2010-11, and 2011-12 fiscal years.
(d) The department is responsible for the Medi-Cal program in
accordance with state and federal law. A county shall determine
Medi-Cal eligibility in accordance with state and federal law. If in
the course of its duties the department becomes aware of accuracy
problems in any county, the department shall, within available
resources, provide training and technical assistance as appropriate.
Nothing in this section shall be interpreted to eliminate any remedy
otherwise available to the department to enforce accurate county
administration of the program. In administering the Medi-Cal
eligibility process, each county shall meet the following performance
standards each fiscal year:
(1) Complete eligibility determinations as follows:
(A) Ninety percent of the general applications without applicant
errors and are complete shall be completed within 45 days.
(B) Ninety percent of the applications for Medi-Cal based on
disability shall be completed within 90 days, excluding delays by the
state.
(2) (A) The department shall establish best-practice guidelines
for expedited enrollment of newborns into the Medi-Cal program,
preferably with the goal of enrolling newborns within 10 days after
the county is informed of the birth. The department, in consultation
with counties and other stakeholders, shall work to develop a process
for expediting enrollment for all newborns, including those born to
mothers receiving CalWORKs assistance.
(B) Upon the development and implementation of the best-practice
guidelines and expedited processes, the department and the counties
may develop an expedited enrollment timeframe for newborns that is
separate from the standards for all other applications, to the extent
that the timeframe is consistent with these guidelines and
processes.
(C) Notwithstanding the rulemaking procedures of Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code, the department may implement this section by
means of all-county letters or similar instructions, without further
regulatory action.
(3) Perform timely annual redeterminations, as follows:
(A) Ninety percent of the annual redetermination forms shall be
mailed to the recipient by the anniversary date.
(B) Ninety percent of the annual redeterminations shall be
completed within 60 days of the recipient's annual redetermination
date for those redeterminations based on forms that are complete and
have been returned to the county by the recipient in a timely manner.
(C) Ninety percent of those annual redeterminations where the
redetermination form has not been returned to the county by the
recipient shall be completed by sending a notice of action to the
recipient within 45 days after the date the form was due to the
county.
(D) When a child is determined by the county to change from no
share of cost to a share of cost and the child meets the eligibility
criteria for the Healthy Families Program established under Section
12693.98 of the Insurance Code, the child shall be placed in the
Medi-Cal-to-Healthy Families Bridge Benefits Program, and these cases
shall be processed as follows:
(i) Ninety percent of the families of these children shall be sent
a notice informing them of the Healthy Families Program within five
working days from the determination of a share of cost.
(ii) Ninety percent of all annual redetermination forms for these
children shall be sent to the Healthy Families Program within five
working days from the determination of a share of cost if the parent
has given consent to send this information to the Healthy Families
Program.
(iii) Ninety percent of the families of these children placed in
the Medi-Cal-to-Healthy Families Bridge Benefits Program who have not
consented to sending the child's annual redetermination form to the
Healthy Families Program shall be sent a request, within five working
days of the determination of a share of cost, to consent to send the
information to the Healthy Families Program.
(E) Subparagraph (D) shall not be implemented until 60 days after
the Medi-Cal and Joint Medi-Cal and Healthy Families applications and
the Medi-Cal redetermination forms are revised to allow the parent
of a child to consent to forward the child's information to the
Healthy Families Program.
(e) The department shall develop procedures in collaboration with
the counties and stakeholder groups for determining county review
cycles, sampling methodology and procedures, and data reporting.
(f) On January 1 of each year, each applicable county, as
determined by the department, shall report to the department on the
county's results in meeting the performance standards specified in
this section. The report shall be subject to verification by the
department. County reports shall be provided to the public upon
written request.
(g) If the department finds that a county is not in compliance
with one or more of the standards set forth in this section, the
county shall, within 60 days, submit a corrective action plan to the
department for approval. The corrective action plan shall, at a
minimum, include steps that the county shall take to improve its
performance on the standard or standards with which the county is out
of compliance. The plan shall establish interim benchmarks for
improvement that shall be expected to be met by the county in order
to avoid a sanction.
(h) (1) If a county does not meet the performance standards for
completing eligibility determinations and redeterminations as
specified in this section, the department may, at its sole
discretion, reduce the allocation of funds to that county in the
following year by 2 percent. Any funds so reduced may be restored by
the department if, in the determination of the department, sufficient
improvement has been made by the county in meeting the performance
standards during the year for which the funds were reduced. If the
county continues not to meet the performance standards, the
department may reduce the allocation by an additional 2 percent for
each year thereafter in which sufficient improvement has not been
made to meet the performance standards.
(2) No reduction of the allocation of funds to a county shall be
imposed pursuant to this subdivision for failure to meet performance
standards during any period of time in which the
cost-of-doing-business increase is suspended.
(i) The department shall develop procedures, in collaboration with
the counties and stakeholders, for developing instructions for the
performance standards established under subparagraph (D) of paragraph
(3) of subdivision (d), no later than September 1, 2005.
(j) No later than September 1, 2005, the department shall issue a
revised annual redetermination form to allow a parent to indicate
parental consent to forward the annual redetermination form to the
Healthy Families Program if the child is determined to have a share
of cost.
(k) The department, in coordination with the Managed Risk Medical
Insurance Board, shall streamline the method of providing the Healthy
Families Program with information necessary to determine Healthy
Families eligibility for a child who is receiving services under the
Medi-Cal-to-Healthy Families Bridge Benefits Program.
(l) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking any further regulatory action,
implement, interpret, or make specific this section and any
applicable federal waivers and state plan amendments by means of
all-county letters or similar instructions.
SEC. 18. Section 14165 of the Welfare
and Institutions Code is amended to read:
14165. (a) There is hereby created in the
Governor's Office the California Medical Assistance Commission, for
the purpose of contracting with health care delivery systems for
the provision of health care services to recipients under the
California Medical Assistance program.
(b) Notwithstanding any other provision of law, the commission
created pursuant to subdivision (a) shall continue through June 30,
2012, after which, it shall be dissolved and the term of any
commissioner serving at that time shall end.
(1) Upon dissolution of the commission, all powers, duties, and
responsibilities of the commission shall be transferred to the
Director of Health Care Services. These powers, duties, and
responsibilities shall include, but are not limited to, those
exercised in the operation of the selective provider contracting
program pursuant to Article 2.6 (commencing with Section 14081).
(2) On or before July 1, 2012, the position of executive director
described in Section 14165.5 and all other staff positions serving
the commission shall be transferred to the State Department of Health
Care Services. The Department of Health Care Services shall consult
with the commission, the Department of Finance, and the Department of
Personnel Administration to develop a staff transition plan that
will be included in the 2012-13 Governor's Budget. The transition
plan shall outline the transition of staff positions serving the
commission to the State Department of Health Care Services.
(3) Upon a determination by the director that a payment system
based on diagnosis-related groups as described in Section 14105.28
that is sufficient to replace the contract-based payment system
described in subdivision (a) has been developed and implemented, the
powers, duties, and responsibilities conferred on the commission and
transferred to the director shall no longer be exercised.
(4) Protections afforded to the negotiations and contracts of the
commission of the California Public Records Act (Chapter 3.5
(commencing with Section 6250) of Division 7 of Title 1 of the
Government Code) shall be applicable to the negotiations and
contracts conducted or entered into pursuant to this section by the
State Department of Health Care Services.
(c) Notwithstanding the rulemaking provisions of Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code, or any other provision of law, the State
Department of Health Care Services may implement and administer this
section by means of provider bulletins or other similar instructions,
without taking regulatory action. The authority to implement this
section as set forth in this subdivision shall include the authority
to give notice by provider bulletin or other similar instruction of a
determination made pursuant to paragraph (3) of subdivision (b) and
to modify or supersede existing regulations in Title 22 of the
California Code of Regulations that conflict with implementation of
this section.
SEC. 19. Section 14301.4 is added to the
Welfare and Institutions Code , to read:
14301.4. (a) It is the intent of the Legislature, to the extent
federal financial participation is not jeopardized and consistent
with federal law, that the intergovernmental transfers described in
this section provide support for the nonfederal share of risk-based
payments to managed care health plans to enable those plans to
compensate providers designated by the transferring entity for
Medi-Cal health care services and for support of the Medi-Cal
program.
(b) For the purposes of this section, the following definitions
apply:
(1) "Intergovernmental transfer" or "IGT" means the transfer of
public funds by the transferring entity to the state in accordance
with the requirements of this section.
(2) "Managed care health plan" means a Medi-Cal managed care plan
contracting with the department under this chapter or Article 2.7
(commencing with Section 14087.3), Article 2.8 (commencing with
Section 14087.5), Article 2.81 (commencing with Section 14087.96), or
Article 2.91 (commencing with Section 14089) of Chapter 7.
(3) "Public provider" means any provider that is able to certify
public expenditures under state and federal Medicaid law.
(4) "Rate range increases" means increases to risk-based payments
to managed care health plans to increase the payments from the lower
bound of the range determined to be actuarially sound to the upper
bound of that range, as determined by the department's actuaries to
take into account the variations in underwriting, risk, return on
investment, and contingencies.
(5) "Transferring entity" means a public entity, which may be a
city, county, special purpose district, or other governmental unit in
the state, regardless of whether the unit of government is also a
health care provider, except as prohibited by federal law.
(c) To the extent permitted by federal law, a transferring entity
may elect to make an intergovernmental transfer to the state, and the
department may accept all intergovernmental transfers from a
transferring entity, for the purposes of providing support for the
nonfederal share of risk-based payments to managed care health plans
to enable those plans to compensate providers designated by the
transferring entity for Medi-Cal health care services and for the
support of the Medi-Cal program. The transferring entity shall
certify to the department that the funds it proposes to transfer
satisfy the requirements of this section and are in compliance with
all federal rules and regulations.
(d) (1) Pursuant to paragraphs (2), (3), and (4), the state shall,
upon acceptance of the IGT described in subdivision (c), assess a
fee of 20 percent on each IGT subject to this section to reimburse
the department for the administrative costs of operating the IGT
program pursuant to this section and for the support of the Medi-Cal
program.
(2) The IGTs subject to the fee shall be limited to those made by
a transferring entity to provide the nonfederal share of rate range
increases.
(3) The 20-percent assessment shall not apply to IGTs designated
for increases to risk-based payments to managed care health plans
intended to increase reimbursement for designated public providers
for purposes of equaling the amount of reimbursement the public
provider would have received through certified public expenditures
under the fee-for-service payment methodology.
(4) The 20-percent assessment shall not apply to IGTs authorized
pursuant to Sections 14168.7 and 14182.15.
(e) Participation in the intergovernmental transfers pursuant to
this section is voluntary on the part of the transferring entities
for the purposes of all applicable federal laws.
(f) The director shall seek any necessary federal approvals for
the implementation of this section.
(g) To the extent that the director determines that the payments
made pursuant to this section do not comply with the federal Medicaid
requirements, the director retains the discretion to return the IGTs
or not accept the IGTs.
(h) This section shall be implemented only to the extent that
federal financial participation is not jeopardized.
(i) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall implement this section by means of policy letters or
similar instructions, without taking further regulatory action.
(j) This section shall be implemented on July 1, 2011, or the date
on which all necessary federal approvals have been received,
whichever is later.
SEC. 20. Chapter 8.9 (commencing with Section
14700) is added to Part 3 of Division 9 of the Welfare and
Institutions Code , to read:
CHAPTER 8.9. TRANSITION OF COMMUNITY-BASED MEDI-CAL MENTAL
HEALTH
14700. (a) (1) It is the intent of the Legislature to transfer to
the State Department of Health Care Services, no later than July 1,
2012, the state administration of Medi-Cal specialty mental health
managed care, the Early and Periodic Screening, Diagnosis, and
Treatment (EPSDT) Program, and applicable functions related to
federal Medicaid requirements, from the State Department of Mental
Health.
(2) It is further the intent of the Legislature for this transfer
to occur in an efficient and effective manner, with no unintended
interruptions in service delivery to clients and families. This
transfer is intended to do all of the following:
(A) Improve access to culturally appropriate community-based
mental health services, including a focus on client recovery, social
rehabilitation services, and peer support.
(B) Effectively integrate the financing of services, including the
receipt of federal funds, to more effectively provide services.
(C) Improve state accountabilities and outcomes.
(D) Provide focused, high-level leadership for behavioral health
services within the state administrative structure.
(b) Effective July 1, 2012, the state administrative functions for
the operation of Medi-Cal specialty mental health managed care, the
EPSDT Program, and applicable functions related to federal Medicaid
requirements, that were performed by the State Department of Mental
Health shall be transferred to the State Department of Health Care
Services. This state administrative transfer shall conform to a state
administrative transition plan provided to the fiscal and applicable
policy committees of the Legislature as soon as feasible, but no
later than October 1, 2011. This state administrative transition plan
may also be updated by the Governor and provided to all fiscal and
applicable policy committees of the Legislature upon its completion,
but no later than May 15, 2012.
(c) All regulations and orders concerning Medi-Cal specialty
mental health managed care and the EPSDT Program shall remain in
effect and shall be fully enforceable unless and until readopted,
amended, or repealed by the State Department of Health Care Services,
or until they expire by their own terms.
14701. (a) The State Department of Health Care Services, in
collaboration with the State Department of Mental Health and the
California Health and Human Services Agency, shall create a state
administrative and programmatic transition plan, either as one
comprehensive transition plan or separately, to guide the transfer of
the Medi-Cal specialty mental health managed care and the EPSDT
Program to the State Department of Health Care Services effective
July 1, 2012.
(1) Commencing no later than July 15, 2011, the State Department
of Health Care Services, together with the State Department of Mental
Health, shall convene a series of stakeholder meetings and forums to
receive input from clients, family members, providers, counties, and
representatives of the Legislature concerning the transition and
transfer of Medi-Cal specialty mental health managed care and the
EPSDT Program. This consultation shall inform the creation of a state
administrative transition plan and a programmatic transition plan
that shall include, but is not limited to, the following components:
(A) Plan shall ensure it is developed in a way that continues
access and quality of service during and immediately after the
transition, preventing any disruption of services to clients and
family members, providers and counties and others affected by this
transition.
(B) A detailed description of the state administrative functions
currently performed by the State Department of Mental Health
regarding Medi-Cal specialty mental health managed care and the EPSDT
Program.
(C) Explanations of the operational steps, timelines, and key
milestones for determining when and how each function or program will
be transferred. These explanations shall also be developed for the
transition of positions and staff serving Medi-Cal specialty mental
health managed care and the EPSDT Program, and how these will relate
to, and align with, positions at the State Department of Health Care
Services. The State Department of Health Care Services and the
California Health and Human Services Agency shall consult with the
Department of Personnel Administration in developing this aspect of
the transition plan.
(D) A list of any planned or proposed changes or efficiencies in
how the functions will be performed, including the anticipated fiscal
and programmatic impacts of the changes.
(E) A detailed organization chart that reflects the planned
staffing at the State Department of Health Care Services in light of
the requirements of subparagraphs (A) through (C) and includes
focused, high-level leadership for behavioral health issues.
(F) A description of how stakeholders were included in the various
phases of the planning process to formulate the transition plans and
a description of how their feedback will be taken into consideration
after transition activities are underway.
(2) The State Department of Health Care Services, together with
the State Department of Mental Health and the California Health and
Human Services Agency, shall convene and consult with stakeholders at
least twice following production of a draft of the transition plans
and before submission of transition plans to the Legislature.
Continued consultation with stakeholders shall occur in accordance
with the requirement in subparagraph (F) of paragraph (1).
(3) The State Department of Health Care Services shall provide the
transition plans described in paragraph (1) to all fiscal committees
and appropriate policy committees of the Legislature no later than
October 1, 2011. The transition plans may also be updated by the
Governor and provided to all fiscal and applicable policy committees
of the Legislature upon its completion, but no later than May 15,
2012.
SEC. 21. Section 15916 is added to the
Welfare and Institutions Code , to read:
15916. (a) It is the intent of the Legislature that the State
Department of Health Care Services and all other departments take all
appropriate steps to fully maximize and claim all available
expenditures for Designated State Health Programs listed in the
Special Terms and Conditions of California's Bridge to Reform Section
1115(a) Demonstration under the safety net care pool (SNCP) for an
applicable demonstration year.
(b) For the purposes of this section, the following definitions
apply:
(1) "California's Bridge to Reform Section 1115(a) Demonstration"
means the Section 1115(a) Medicaid demonstration project, No.
11-W-00193/9, as approved by the federal Centers for Medicare and
Medicaid Services (CMS), effective for the period of November 1,
2010, through October 31, 2015.
(2) "Demonstration year" means a specific period of time during
California's Bridge to Reform Section 1115(a) Wavier as identified in
the Special Terms and Conditions.
(3) "Designated public hospital" has the meaning given in
subdivision (d) of Section 14166.1.
(4) "Excess certified public expenditures" means the amount of
allowable uncompensated care expenditures reported and certified for
the applicable demonstration year under Section 14166.8 by designated
public hospitals (DPHs), including the governmental entities with
which they are affiliated, that is in excess of the amount necessary
to draw the maximum amount of federal funding for DPHs for
uncompensated care under the safety net care pool and for
disproportionate share hospital payments without regard to
subdivision (c) or to the amount authorized pursuant to paragraph
(5).
(5) "Reserved SNCP funds for DSHP" means the amount of SNCP
uncompensated care funds used to fund expenditures for the Designated
State Health Programs, as specified in the Special Terms and
Conditions of California's Bridge to Reform Section 1115(a)
Demonstration.
(6) "Redirected SNCP funds" means the amount of federal funding
available for a specified demonstration year that would otherwise be
restricted for expenditures associated with the Health Care Coverage
Initiative (HCCI) program, for which there are insufficient HCCI
expenditures to draw the federal funds and which CMS has authorized
to be available for
uncompensated care expenditures under the safety net care pool in
either the demonstration year for which the funds were initially
reserved or a subsequent demonstration year.
(7) "Safety net care pool" or "SNCP" means the federal funds
available under the Medi-Cal Hospital/Uninsured Care Demonstration
Project and the successor demonstration project, California's Bridge
to Reform, to ensure continued government support for the provision
of health care services to uninsured populations.
(c) Notwithstanding any other provision of law, the state shall
annually seek authority from CMS under the Special Terms and
Conditions of California's Bridge to Reform Section 1115(a)
Demonstration to redirect to the uncompensated care category within
the SNCP the portion of the restricted funds used to fund
expenditures under the HCCI that will not be fully utilized by the
end of the demonstration year.
(d) Designated public hospitals may utilize the redirected SNCP
funds described in subdivision (c) as follows:
(1) Designated public hospitals may opt to utilize excess
certified public expenditures to claim the redirected SNCP funds.
(2) As a condition of exercising the option in paragraph (1), DPHs
voluntarily agree that to the extent the state is unable to fully
claim the maximum annual amount of reserved SNCP funds for DSHP, the
excess certified public expenditures are to be allocated equally
between the state and the DPHs, such that for every dollar of excess
certified public expenditure used by the DPHs, the DPHs will
voluntarily allow the state to use a corresponding excess certified
public expenditure amount for claiming purposes. The amount in excess
certified public expenditures that may be used by the state shall be
limited to that amount necessary to enable the state to receive
total SNCP uncompensated care funds, in conjunction with its claims
for expenditures for DSHP, to the maximum amount described in
paragraph (5) of subdivision (b).
(3) After the state achieves its maximum claiming amount described
in paragraph (5) of subdivision (b), or to the extent the condition
in subdivision (e) is not satisfied, the DPHs may use any remaining
excess certified public expenditures to claim SNCP uncompensated care
funds as authorized by the Special Terms and Conditions of
California's Bridge to Reform Section 1115(a) Demonstration.
(e) As a condition for the state's use of the excess certified
public expenditures pursuant to paragraph (2) of subdivision (d), the
department shall seek any necessary authorization from the federal
Centers for Medicare and Medicaid Services.
(f) Participation in the utilization of the excess certified
public expenditures and redirected SNCP funds under this section is
voluntary on the part of the DPHs for the purpose of all applicable
federal laws.
(g) The department shall consult with DPH representatives
regarding the availability of excess certified public expenditures
and the appropriate allocation of SNCP funds under paragraph (2) of
subdivision (d). The department may make interim determinations and
allocations of such SNCP funds, provided that the interim
determinations and allocations take into account adjustments to
reported expenditures for possible audit disallowances, consistent
with the type of adjustments applied in prior projects years under
Article 5.2 (commencing with Section 14166). Any interim
determinations and allocations of redirected SNCP funds based on
excess certified public expenditures shall be subject to interim and
final reconciliations.
(h) Notwithstanding any other provision of law, upon the receipt
of a notice of disallowance or deferral from the federal government
related to any certified public expenditures for uncompensated care
incurred by DPHs that are used for federal claiming under the SNCP
pursuant to California's Bridge to Reform Section 1115(a)
Demonstration after this section is implemented, and subject to the
processes described in subdivisions (a) through (d) of Section
14166.24, the following shall apply with respect to the disallowance
or deferral:
(1) First, the DPH shall be solely responsible for the repayment
of the federal portion of any federal disallowance or deferral
related to the claiming of a certified public expenditure in a
particular year up to the amount claimed pursuant to paragraph (3) of
subdivision (d), after paragraph (2) of subdivision (d) was
satisfied for that particular year.
(2) Second, if there are additional disallowances or deferrals
beyond those described in paragraph (1), the department and the DPH
shall each be responsible for half of the repayment of the federal
portion of any federal disallowance or deferral for the applicable
demonstration year, up to the amount claimed and allocated pursuant
to paragraph (2) of subdivision (d) for that particular year.
(3) Third, if there are additional disallowances or deferrals
beyond those described in paragraphs (1) and (2) for the applicable
demonstration year, the DPH shall be solely responsible for the
repayment of the federal portion of all remaining federal
disallowances or deferrals for that particular year.
(i) The department shall obtain federal approvals or waivers as
necessary to implement this section and to obtain federal matching
funds to the maximum extent permitted by federal law. This section
shall be implemented only to the extent federal financial
participation is not jeopardized.
SEC. 22. The sum of one thousand dollars ($1,000)
is hereby appropriated from the General Fund to the State Department
of Health Care Services for administration.
SEC. 23. This act is a bill providing for
appropriations related to the Budget Bill within the meaning of
subdivision (e) of Section 12 of Article IV of the California
Constitution, has been identified as related to the budget in the
Budget Bill, and shall take effect immediately. All matter
omitted in this version of the bill appears in the bill as amended in
the Senate, March 14, 2011. (JR11)