BILL NUMBER: AB 396	AMENDED
	BILL TEXT

	AMENDED IN SENATE  SEPTEMBER 2, 2011
	AMENDED IN SENATE  AUGUST 30, 2011
	AMENDED IN SENATE  AUGUST 15, 2011
	AMENDED IN ASSEMBLY  MAY 12, 2011
	AMENDED IN ASSEMBLY  APRIL 25, 2011
	AMENDED IN ASSEMBLY  MARCH 30, 2011

INTRODUCED BY   Assembly Member Mitchell
   (Coauthors: Assembly Members Blumenfield, Dickinson, Jeffries, and
V. Manuel Pérez)

                        FEBRUARY 14, 2011

   An act to add Sections 14053.8 and 14053.9 to the Welfare and
Institutions Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 396, as amended, Mitchell. Medi-Cal: juvenile detention
facilities.
   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.
The Medi-Cal program is, in part, governed and funded by federal
Medicaid provisions. Existing federal law, with certain exceptions,
excludes federal financial participation for medical care provided to
any individual who is an inmate in a public institution, and
existing state law suspends Medi-Cal benefits, for a specified period
of time, to an individual under 21 years of age who is an inmate of
a public institution. Existing state law also provides that no person
shall be denied benefits, for whom and for which federal financial
participation is available, based solely on the individual's
incarcerated status in a county or city jail or juvenile detention
facility.
   Existing law authorizes the Department of Corrections and
Rehabilitation and the State Department of Health Care Services, to
the extent that federal participation is not jeopardized and federal
approval is obtained, to develop a process for the provision of
inpatient hospital services to inmates who would otherwise be
eligible for Medi-Cal, but for their institutional status as inmates.
Existing law also authorizes, to the extent federal financial
participation is available, the State Department of Health Care
Services to provide Medi-Cal eligibility and reimbursement for
inpatient hospital services to inmates, as defined.
   This bill would additionally require the State Department of
Health Care Services to develop processes to allow counties and the
Division of Juvenile Facilities within the Department of Corrections
and Rehabilitation to receive any available federal financial
participation for  health care   acute inpatient
hospital services and inpatient psychiatric  services provided
to juvenile  detainees or detained youth  
inmates  , as  defined and as  applicable, who are
admitted as inpatients in a medical institution. The bill would
require the department to consult with counties and the Division of
Juvenile Facilities in the development of these processes, and would
require the department to seek any federal approvals necessary to
implement these provisions. The bill would provide that these
provisions shall be implemented only to the extent that the Division
of Juvenile Facilities and counties elect to voluntarily provide the
nonfederal share of expenditures for  health care services
  acute inpatient hospital services and inpatient
psychiatric services  , and would require that the federal
financial participation associated with services provided pursuant to
these processes be paid to the participating counties or the
Department of Corrections and Rehabilitation, as applicable. The bill
would provide that these provisions shall be implemented only to the
extent that any necessary federal approval is obtained and existing
levels of federal financial participation are not jeopardized. The
bill would make related findings and declarations.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


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

  SECTION 1.  The Legislature finds and declares all of the
following:
   (a) Federal financial participation may be available for counties
that provide health care services to juvenile  detainees
  inmates  while the juveniles are admitted as
patients in a medical institution.
   (b) Current law provides that an individual under 21 years of age
who is an inmate of a public institution shall have his or her
Medi-Cal services suspended for up to one year.
   (c) The eligibility procedures of the State Department of Health
Care Services currently do not allow counties to obtain available
federal financial participation for health care services provided to
juvenile  detainees   inmates  when they
have been transferred to a medical institution for inpatient
services.
   (d) Pursuant to Section 5072 of the Penal Code and Section 14053.7
of the Welfare and Institutions Code, the department is authorized
to develop a process to maximize federal financial participation for
inpatient hospital services to adult inmates residing in a state
prison facility.
   (e) To reduce the fiscal strain on counties, it is imperative that
the department work with counties to develop and implement a similar
process to allow counties to obtain federal financial participation
based on county expenditures for inpatient hospital services provided
to juveniles in their custody.
   (f) It is not the intent of the Legislature to alter or abrogate
any obligation of the state under federal or state law to cover,
fund, or reimburse under Medi-Cal any medical services provided to a
juvenile detainee.
  SEC. 2.  Section 14053.8 is added to the Welfare and Institutions
Code, to read:
   14053.8.  (a) Notwithstanding any other provision of law, the
department shall develop a process to allow counties to receive any
available federal financial participation for  health care
  acute inpatient hospital services and inpatient
psychiatric  services provided to juvenile  detainees
  inmates  who are admitted as inpatients in a
medical institution  off the grounds of the correctional
facility, and who, but for their institutional status as inmates, are
otherwise eligible for Medi-Cal benefits pursuant to this chapter
 . This process shall be coordinated, to the extent possible,
with the processes and procedures established pursuant to Section
14053.7 of this code and Section 5072 of the Penal Code. This
subdivision shall not be construed to alter or abrogate any
obligation of the state pursuant to an administrative action or a
court order that is final and no longer subject to appeal to fund and
reimburse counties for any medical services provided to a juvenile
 detainee   inmate  .
   (b) A juvenile  detainee   inmate  who
is an inpatient in a medical institution  off the grounds of the
correctional facility  shall not be denied  Medi-Cal
eligibility   eligibility for Medi-Cal benefits under
this section  because of his or her institutional status as
 a detainee   an inmate  of a public
institution.
   (c) The department shall consult with counties in the development
of the process pursuant to this section. 
   (d) This section shall not be construed to limit the department's
authority to suspend or terminate Medi-Cal eligibility pursuant to
Section 14011.10, except during such times that the juvenile inmate
is receiving acute inpatient hospital services or inpatient
psychiatric services pursuant to subdivision (b).  
   (e) This section shall be implemented only if and to the extent
that existing levels of federal financial participation are not
otherwise jeopardized. To the extent that the department determines
that existing levels of federal financial participation are
jeopardized, this section shall no longer be implemented. 

   (d) 
    (f)  The department shall seek any federal approvals
necessary to implement the process developed pursuant to this
section. This section shall be implemented only if and to the extent
that any necessary federal  approval is  
approvals have been  obtained, and only to the extent that
 existing levels of federal financial participation are not
otherwise jeopardized   federal financial participation
is available  . 
   (e) 
    (g)  Notwithstanding any other provision of law, as part
of the process developed pursuant to this section, the department
may exempt  the juvenile detainees   juvenile
inmates  from enrollment into new or existing managed care
health plans. 
   (f) The process developed pursuant to this section shall be
implemented in only those counties that elect to voluntarily provide
the nonfederal share of expenditures for health care services to
juvenile detainees who, but for their inpatient status, would be
ineligible for Medi-Cal as detainees of a public institution. For
counties that elect to participate, the counties shall agree to pay
the nonfederal share of the department's administrative costs in
accordance with this section.  
   (h) The process developed pursuant to this section shall be
implemented in only those counties that elect to provide the
nonfederal share of the state's administrative costs associated with
implementation of this section and the nonfederal share of
expenditures for acute inpatient hospital services and inpatient
psychiatric services provided to eligible juvenile inmates described
in subdivision (a).  
   (g) 
    (i)  The federal financial participation received
pursuant to the process implemented under this section shall be paid
to the participating counties for services rendered to the juvenile
 detainees   inmates  . If a federal audit
disallowance and interest results from claims made under the process
created pursuant to this section, the department shall recoup from
the county that received the disallowed funds the amount of the
disallowance and any applicable interest. 
   (j) (1) If there is a final judicial determination made by any
state or federal court that is not appealed, or by a court of
appellate jurisdiction that is not further appealed, in any action by
any party, or a final determination by the administrator of the
federal Centers for Medicare and Medicaid Services (CMS), that
disallows, defers, or alters the implementation of this section or,
to the extent applicable, Section 14053.7 of this code or Section
5072 of the Penal Code, including the rate methodology or payment
process established by the department that limits or effects the
department's authority to select the facilities used to provide acute
inpatient hospital services and inpatient psychiatric services to
juvenile inmates, then any provision of this section that is
inconsistent with the final judicial or CMS determination shall have
no force or effect.  
   (2) In addition, the department may, at its discretion, cease to
implement any other part of this section that is implicated by the
final judicial or CMS determination.  
   (k) For the purposes of Medi-Cal eligibility pursuant to this
section, "juvenile inmate" means an individual under 21 years of age
who is involuntarily residing in a public institution, including
state and local institutions.  
   (h) 
    (l)  Notwithstanding Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code, the department may, without taking any further regulatory
action, implement this section by means of all-county letters or
similar instructions.
  SEC. 3.  Section 14053.9 is added to the Welfare and Institutions
Code, to read:
   14053.9.  (a) Notwithstanding any other provision of law, the
department shall develop a process to allow the Department of
Corrections and Rehabilitation, Division of Juvenile Facilities, or
any successor, to receive any available federal financial
participation for  health care   acute inpatient
hospital services and inpatient psychiatric  services provided
to any  youth detained   juvenile inmates 
in the Division of Juvenile Facilities who are admitted as inpatients
in a medical institution  off the grounds of the correctional
facility, and who, but for their institutional status as juvenile
inmates, are otherwise eligible for Medi-Cal benefits pursuant to
this chapter  . This process shall be coordinated, to the extent
possible, with the processes and procedures established pursuant to
Section 14053.7 of this code and Section 5072 of the Penal Code.
   (b) Any  youth detained   juvenile inmate
 in the Division of Juvenile Facilities who is an inpatient in a
medical institution  off the grounds of the correctional
facility  shall not be denied  Medi-Cal eligibility
  eligibility for Medi-Cal benefits under this section
 because of his or her institutional status as  a ward
committed to, or a youth housed in,   an inmate in 
the Division of Juvenile Facilities.
   (c) The department shall consult with the Division of Juvenile
Facilities in the development of the process pursuant to this
section.
   (d) The department shall seek any federal approvals necessary to
implement the process developed pursuant to this section. This
section shall be implemented only if and to the extent that any
necessary federal  approval is   approvals have
been  obtained, and only to the extent that  existing
levels of federal financial participation are not otherwise
jeopardized   federal financial participation is
available  .
   (e) Notwithstanding any other provision of law, as part of the
process developed pursuant to this section, the department may exempt
any  youth detained   juvenile inmate  in
a facility operated by the Division of Juvenile Facilities from
enrollment into new or existing managed care health plans.
   (f) The process developed pursuant to this section shall be
implemented only to the extent that the Division of Juvenile
Facilities agrees voluntarily to provide the nonfederal share of
 expenditures for health care services to any youth detained
in the Division of Juvenile Facilities who, but for their inpatient
status, would be ineligible for Medi-Cal as an inmate of a public
institution.   any costs to the department associated
with the administration of this section and the nonfederal share of
expenditures for acute inpatient hospital services and inpatient
psychiatric services provided off the grounds   of the
correctional facility to any juvenile inmate of the Division of
Juvenile Facilities who is eligible for Medi-Cal benefits pursuant to
this section. 
   (g) The federal financial participation received pursuant to
 the process implemented under  this section shall
be paid to the Department of Corrections and Rehabilitation for
services rendered to any  youth detained  
juvenile inmate  in the Division of Juvenile Facilities. 
   (h) Reimbursement pursuant to this section shall be limited to
only those services for which federal financial participation is
available.  
   (i) (1) If there is a final judicial determination made by any
state or federal court that is not appealed, or by a court of
appellate jurisdiction that is not further appealed, in any action by
any party, or a final determination by the administrator of the
federal Centers for Medicare and Medicaid Services (CMS), that
disallows, defers, or alters the implementation of this section or,
to the extent applicable, Section 14053.7 of this code or Section
5072 of the Penal Code, including the rate methodology or payment
process established by the department that limits or effects the
department's authority to select the facilities used to provide acute
inpatient hospital services and inpatient psychiatric services to
juvenile inmates in the Division of Juvenile Facilities, then any
provision of this section that is inconsistent with the final
judicial or CMS determination shall have no force or effect. 

   (2) In addition, the department may, at its discretion, cease to
implement any other part of this section that is implicated by the
final judicial or CMS determination.  
   (k) For the purposes of Medi-Cal eligibility pursuant to this
section, "juvenile inmate" means an individual under 21 years of age
who is involuntarily residing in a public institution, including
state and local institutions.  
   (l) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may, without taking any further regulatory action,
implement this section by means of all-county letters or similar
instructions.