BILL NUMBER: AB 396	CHAPTERED
	BILL TEXT

	CHAPTER  394
	FILED WITH SECRETARY OF STATE  OCTOBER 2, 2011
	APPROVED BY GOVERNOR  OCTOBER 2, 2011
	PASSED THE SENATE  SEPTEMBER 7, 2011
	PASSED THE ASSEMBLY  SEPTEMBER 8, 2011
	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, Mitchell. Medi-Cal: juvenile inmates.
   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 acute inpatient hospital services and inpatient
psychiatric services provided to juvenile 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 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.



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 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 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 acute inpatient
hospital services and inpatient psychiatric services provided to
juvenile 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 inmate.
   (b) A juvenile inmate who is an inpatient in a medical institution
off the grounds of the correctional facility shall not be denied
eligibility for Medi-Cal benefits under this section because of his
or her institutional status as 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.
   (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 approvals have been obtained, and only to the
extent that federal financial participation is available.
   (g) Notwithstanding any other provision of law, as part of the
process developed pursuant to this section, the department may exempt
juvenile inmates from enrollment into new or existing managed care
health plans.
   (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).
   (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 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.
   (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 acute inpatient hospital services and inpatient
psychiatric services provided to any 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 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 eligibility for Medi-Cal
benefits under this section because of his or her institutional
status as 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 approvals have been obtained, and only to the
extent that 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 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 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 this
section shall be paid to the Department of Corrections and
Rehabilitation for services rendered to any 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.