BILL ANALYSIS Ó
AB 396
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 396 (Mitchell)
As Amended September 2, 2011
Majority vote
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|ASSEMBLY: |75-0 |(May 26, 2011) |SENATE: |35-0 |(September 7, |
| | | | | |2011) |
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Original Committee Reference: PUB. S.
SUMMARY : Requires the Department of Health Care Services
(DHCS) to develop a process to allow counties and the Division
of Juvenile Facilities (DJF) of the Department of Corrections
and Rehabilitation (CDCR) to obtain federal funds for inpatient
hospital and psychiatric services provided to juvenile.
The Senate amendments :
1)Narrow the scope of the bill to allow counties and DJF to seek
federal funds for reimbursement of inpatient hospitals
services and psychiatric services, as opposed to all health
care services.
2)Clarify that the bill does not limit the authority of DHCS to
suspend or terminate Medi-Cal eligibility except during such
times that the juvenile inmate is receiving acute inpatient
hospitals or psychiatric services.
3)Limit implementation of the provisions only to the extent that
existing levels of federal financial participation are not
otherwise jeopardized.
4)Provide that counties electing to participate in the process
shall agree to pay the nonfederal share of the administrative
costs incurred by DHCS as well as the nonfederal share of
expenditures for acute inpatient hospital and psychiatric
services provides to eligible juvenile inmates.
5)Provide that if any final judicial decision or a determination
by the administrator of the federal Centers of Medicare and
Medicaid Services (CMS) deems any part of these provisions to
be invalid, then those provisions shall have no force or
effect.
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6)Change references to "detainees" to "inmates" for purposes of
conformance with federal law, and defines a "juvenile inmate"
as "an individual under 21 years of age who is involuntarily
residing in a public institution."
EXISTING LAW :
1) States that Medi-Cal benefits provided to an individual
under 21 years of age who is an inmate of a public
institution shall be suspended in accordance federal law.
2) Declares that if an individual under 21 years of age is
a Medi-Cal beneficiary on the date he or she becomes an
inmate of a public institution, his or her benefits shall
be suspended effective the date he or she becomes an inmate
of a public institution. Provides that the suspension will
end on the date he or she is no longer an inmate of a
public institution or one year from the date he or she
becomes an inmate of a public institution, whichever is
sooner.
3) Provides that, notwithstanding any other provision of
law, the CDCR and DHCS may develop a process to maximize
federal financial participation for the provision of
inpatient hospital services rendered to individuals who,
but for their institutional status as inmates, are
otherwise eligible for Medi-Cal.
4) States that notwithstanding any other provision of law,
and only to the extent that federal financial participation
is available, DHCS may provide Medi-Cal eligibility and
reimbursement for inpatient hospital services, as
specified.
AS PASSED BY THE ASSEMBLY , this bill enabled counties and the
Division of Juvenile Facilities (DJF) of the Department of
Corrections and Rehabilitation (CDCR) to receive federal funds
through Medi-Cal for reimbursement of inpatient health care
services provided to juvenile detainees. Specifically, this
bill :
1) Declared that a juvenile detainee who is an inpatient in
a medical institution shall not be denied Medi-Cal
eligibility because of his or her status as a detainee of a
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public institution, or incarcerated status as a juvenile
court ward committed to, or housed in, the DJF.
2) Required the DHCS to develop processes to allow counties
and the DJF to receive any available federal financial
participation for health care services provided to juvenile
detainees who are admitted as inpatients in a medical
institution.
3) Mandated DHCS to consult with counties and the DJF in
the development of these processes.
4) Required DHCS to seek any federal approval necessary to
implement the processes.
5) Limited implementation of these provisions only to the
extent that any necessary federal approval is obtained, and
that existing levels of federal financial participation are
not jeopardized.
6) Provided that as a part of the processes, DHCS may
exempt juvenile detainees from enrollment into new or
existing managed care health plans.
7) Limited implementation of these processes to counties
electing to voluntarily provide the nonfederal share of
expenditures for health care services, and to DJF only to
the extent it also voluntarily agrees to provide the
nonfederal share of expenditures for health care services.
8) Required that the federal financial participation
associated with services provided pursuant to the processes
be paid to the participating counties and the CDCR.
9) Allowed DHCS to recoup funds from a county in the event
a federal audit subsequently determines the money received
was disallowed. The amount to be recouped includes the
amount of the disallowance and any applicable interest.
10) Permitted DHCS to implement and administer these
provisions by means of all-county letters or similar
instructions without taking regulatory action.
11) Found and declared the following:
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a) Federal financial participation may be available for
counties that provide health care services to juvenile
detainees 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 DHCS currently do not
allow counties to obtain available federal financial
participation for health care services provided to juvenile
detainees when they have been transferred to a medical
institution for inpatient services;
d) Pursuant to Penal Code Section 5072 and Welfare and
Institutions Code (WIC) Section 14053.7, DHCS 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 DHCS 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; and,
f) The Legislature does not intend to alter or to abrogate
any obligation of the State arising under federal or state
law to cover, fund, or reimburse under Medi-Cal any medical
services provided to a juvenile detainee.
FISCAL EFFECT : According to the Senate Appropriations
Committee:
Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13 2013-14 Fund
DHCS start-up and ongoing $50 $100
$100General/*
administrative costs County/
Federal
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Increased federal likely significant, in the millions
ofFederal
matching funds for dollars annually, upon federal approval
counties and CDCR and implementation
Cost avoidance for DJF unknown, likely in the hundreds of
General/
and county inpatient thousands to millions of dollars, County
upon federal approval and implementation
*50% federal funds, 50% county funds and possibly General Funds
if county funds are insufficient to cover the full non-federal
share of administrative costs.
COMMENTS : According to the author, "ŬThis bill] would require
ŬDHCS] to develop a process to maximize federal financial
participation for the health care services provided by counties
to juveniles in custody who would otherwise be eligible for
Medi-Cal.
"Many minors who are detained in local detention facilities
require medical care that requires hospitalization. ŬThis bill]
would allow counties to draw down federal matching funds to
reimburse them for medical treatment of minors who are outside
of the County detention facility for more than 24-hours and
placed in inpatient facilities for treatment of their medical
condition."
Please see the policy committee analysis for a full discussion
of this bill.
Analysis Prepared by : Sandy Uribe / PUB. S. / (916) 319-3744
FN: 0002759