BILL NUMBER: AB 667	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Mitchell

                        FEBRUARY 17, 2011

   An act to amend Section 14132.25 of the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 667, as introduced, Mitchell. Medi-Cal: subacute care 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.
The Medi-Cal program is, in part, governed and funded by federal
Medicaid Program provisions. Existing law requires the department to
establish a subacute care program in health facilities in order to
more effectively use limited Medi-Cal dollars while ensuring needed
services for patients who meet subacute care criteria, as established
by the department. Existing law provides that, for the purposes of
this program, subacute care may be provided by any facility
designated by the Director of Health Care Services as meeting
subacute care criteria and that has an approved provider
participation agreement with the department. Existing law also
provides that subacute patient care shall be defined by the
department based on the results of a specified study.
   This bill would delete the requirement that the department define
subacute patient care based on the results of the study and would
provide that, for the purposes of the subacute care program, medical
necessity for pediatric subacute care services, as defined, shall be
substantiated in one of 4 ways. This bill would also make technical,
nonsubstantive changes to these provisions.
   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.  Section 14132.25 of the Welfare and Institutions Code
is amended to read:
   14132.25.   (a)    On or before July 1, 1983,
the State Department of Health  Care  Services shall
establish a subacute care program in health facilities in order to
more effectively use the limited Medi-Cal dollars available while
 ,  at the same time  ,  ensuring
needed services for these patients. The subacute care program shall
be available to patients in  health  facilities who meet
subacute care criteria. Subacute care may be provided by any facility
designated by the director as meeting the subacute care criteria
 , and which   that  has an approved
provider participation agreement with the  State Department
of Health Services   department  .
    The State Department of Health Services 
    (b)     The   department 
shall develop a rate of reimbursement for this subacute care program.
Reimbursement rates  will   shall  be
determined in accordance with methodology developed by the 
State Department of Health Services   department  ,
specified in regulation, and may include the following:
   (1)  All inclusive   All-inclusive  
 per diem rates.
   (2) Individual  patient specific  
patient-specific  rates according to the needs of the individual
subacute care patient.
   (3) Other rates subject to negotiation with the health facility.

   However, reimbursement 
    (c)     Reimbursement  at subacute
care rates  ,   as specified in subdivision (b), 
shall only be implemented  when   if  funds
are available for this purpose pursuant to the annual Budget Act.

   The 
    (d)     The  department may negotiate
and execute an agreement with any health facility  which
  that  meets the standards for providing subacute
care. An agreement may be negotiated or established between the
health facility and the department for subacute care based on
individual patient assessment. The department shall establish level
of care criteria and appropriate utilization controls for patients
eligible for the subacute care program. 
   For the purposes of this section, subacute patient care shall be
defined by the state department based on the results of its study
pursuant to Chapter 1211 of the Statutes of 1980.  
   (e) For the purposes of this section, pediatric subacute services
are the health care services needed by a person under 21 years of age
who uses a medical technology that compensates for the loss of a
vital bodily function.  
   (f) Medical necessity for pediatric subacute care services shall
be substantiated in any one of the following ways:  
   (1) A tracheostomy with dependence on mechanical ventilation for a
minimum of six hours each day.  
   (2) Dependence on tracheostomy care requiring suctioning at least
every six hours, and room air mist or oxygen as needed, and
dependence on one of the following treatment procedures:  
   (A) Dependence on continuous intravenous therapy, including
administration of a therapeutic agent necessary for hydration or of
intravenous pharmaceuticals, or intravenous pharmaceutical
administration of more than one agent, via a peripheral or central
line, without continuous infusion.  
   (B) Dependence on peritoneal dialysis treatments requiring at
least four exchanges every 24 hours.  
   (C) Dependence on tube feeding by means of a nasogastric or
gastrostomy tube.  
   (D) Dependence on at least one other medical technology required
continuously, which, in the opinion of the attending physician and
the Medi-Cal consultant, requires the services of a professional
nurse, including, but not limited to, the following:  
   (i) Variable/bilevel positive airway pressure (BiPAP) device.
 
   (ii) Wound care.  
   (iii) Glucose stabilization for pediatric diabetic patients. 

   (iv) Breathing treatment at least four times per day.  
   (3) Dependence on total parenteral nutrition or other intravenous
nutritional support, and dependence on one of the following treatment
procedures:  
   (i)  Dependence on intermittent suctioning at least every eight
hours and room air mist or oxygen as needed.  
   (ii) One of the treatment procedures specified in subparagraphs
(A) to (D), inclusive, of paragraph (2).  
   (4) Dependence on skilled nursing care in the administration of
any three of the following treatment procedures:
   (i)  Dependence on intermittent suctioning at least every eight
hours and room air mist or oxygen as needed.
   (ii) Any of the treatment procedures specified in subparagraphs
(A) to (D), inclusive, of paragraph (2).