BILL NUMBER: AB 1467 ENROLLED
BILL TEXT
PASSED THE SENATE JUNE 15, 2012
PASSED THE ASSEMBLY JUNE 15, 2012
AMENDED IN SENATE JUNE 13, 2012
INTRODUCED BY Committee on Budget (Blumenfield (Chair), Alejo,
Bonilla, Brownley, Buchanan, Butler, Cedillo, Chesbro, Dickinson,
Feuer, Gordon, Huffman, Mitchell, Monning, and Swanson)
JANUARY 10, 2012
An act to amend Sections 7575, 12803.3, and 15438 of, to add
Section 15438.10 to, and to repeal Section 7582 of, the Government
Code, to amend Sections 137, 138.4, 138.6, 152, 1324.8, 1324.24,
100950, 104150, 104160, 104162.1, 104163, 104314, 104315, 104322,
110050, 113717, 116064.2, 123865, 123870, 123875, 124300, 125130,
125205, 125215, 130060, 130316, 130317, 131051, and 131052 of, to add
Sections 1324.9, 131019.5, and 131055.1 to, to repeal Sections 135,
136, 138, 150, 151, 116064.1, and 125145 of, and to repeal and add
Section 113718 of, the Health and Safety Code, and to amend Sections
4362, 4362.5, 4364, 4364.5, 4366, 4367.5, 4368.5, 5820, 5821, 5822,
5830, 5840, 5845, 5846, 5847, 5848, 5878.1, 5878.3, 5890, 5891, 5892,
5897, 5898, 14046.7, 14091.3, 14105.22, 14134, 14134.1, 14154,
14165, 14166.8, 14166.12, 14166.14, 14166.17, 14166.19, 14169.7,
14169.7.5, 14169.13, 14169.31, 14169.32, 14169.33, 14169.34,
14169.36, 14169.38, 14171, 14182.4, 14182.45, 14183.6, 14204,
14301.1, 14500.5, 15911, 15916, 24000, and 24001 of, to amend and
repeal Sections 14085.6, 14085.7, 14085.8, 14085.81, and 14085.9 of,
to add Sections 4024.7, 5899, 14089.08, 14089.09, 14166.151,
14166.152, 14166.153, 14166.154, 14166.155, 14459.6, 14459.8,
15911.1, and 15912.1 to, to add Article 2.82 (commencing with Section
14087.98) to Chapter 7 of Part 3 of Division 9 of, and to add and
repeal Section 14105.196 of, the Welfare and Institutions Code,
relating to health, and making an appropriation therefor, to take
effect immediately, bill related to the budget.
LEGISLATIVE COUNSEL'S DIGEST
AB 1467, Committee on Budget. Health.
(1) Under existing law, the Robert W. Crown California Children's
Services Act, the State Department of Health Care Services and each
county administer the California Children's Services Program (CCS
program) for treatment services for persons under 21 years of age
diagnosed with severe chronic disease or severe physical limitations,
as specified. Existing law generally limits eligibility for CCS
program services to persons in families with an annual adjusted gross
income of $40,000 or less. Under existing law, the department, or
any designated local agency administering the program, is responsible
for providing medically necessary occupational and physical therapy,
to eligible children, as specified.
Existing law requires school districts, county offices of
education, and special education local plan areas to comply with
state laws that conform to the federal Individuals with Disabilities
Education Act (IDEA), in order that the state may qualify for federal
funds available for the education of individuals with exceptional
needs. Existing law requires school districts, county offices of
education, and special education local plan areas to identify,
locate, and assess individuals with exceptional needs and to provide
those pupils with a free appropriate public education in the least
restrictive environment, and with special education and related
services as reflected in an individualized education program (IEP).
Existing law requires the Superintendent of Public Instruction to
administer the special education provisions of the Education Code and
to be responsible for assuring provision of, and supervising,
education and related services to individuals with exceptional needs
as required pursuant to the federal IDEA.
This bill would require, when a child has an IEP, that all
occupational and physical therapy services assessed and determined to
be educationally necessary by the IEP team and included in the IEP
shall be provided in accordance with the federal IDEA, and not paid
for by the CCS program. The bill would require the parents or estate
of a child with an IEP to disclose that IEP to the CCS program at the
time of application and on revision of the child's IEP. This bill
would make conforming changes to procedures applicable to the CCS
program's medical therapy unit conference team, when determining a
child's eligibility for those therapy services.
Existing law requires that specified assessments and therapy
treatment services rendered to a child referred to a local education
agency for an assessment or a disabled child or youth with an IEP be
exempt from financial eligibility standards and family repayment
requirements.
This bill would delete these provisions.
The bill would require the State Department of Education to review
regulations to ensure the appropriate implementation of
educationally necessary occupational and physical therapy services
required by specified provisions of federal law and specified
provisions of the bill. The bill would require that specified
provisions of the bill be implemented no later than October 1, 2012,
and would require the State Department of Health Care Services to
report, as provided, specified data relating to the implementation of
the bill's provisions.
(2) Existing law transfers the Systems Integration Division of the
California Health and Human Services Data Center to the California
Health and Human Services Agency and provides that it shall be known
as the Office of Systems Integration. Existing law prohibits the
California Health and Human Services Agency from placing or
transferring information technology projects in the office without
further legislation authorizing these activities.
This bill would delete this prohibition.
(3) The California Health Facilities Financing Authority Act
authorizes the California Health Facilities Financing Authority to
make loans from the continuously appropriated California Health
Facilities Financing Authority Fund to participating health
institutions for financing or refinancing the acquisition,
construction, or remodeling of health facilities. The act defines a
health facility to include various specified facilities and
facilities operated in conjunction with these facilities. It also
defines a participating health institution to mean specified entities
authorized by state law to provide or operate a health facility and
undertake the financing or refinancing of the construction or
acquisition of a project or of working capital, as defined. Existing
law authorizes the authority to award grants to any eligible health
facility, as defined, for purposes of financing defined projects.
This bill would authorize the authority to award one or more
grants that, in the aggregate, do not exceed $1,500,000 to one or
more projects designed to demonstrate new or enhanced cost-effective
methods of delivering health care services, as specified. This bill
would authorize the authority to implement a 2nd grant program to
award up to $5,000,000 to eligible recipients, if a demonstration
project is successful at developing a new method of delivering
certain services. This bill would create the California Health Access
Model Program Account in the California Health Facilities Financing
Authority Fund, and would transfer up to $6,500,000 from the fund to
the account for the purposes of the bill. The bill would require that
any moneys remaining in the account as of January 1, 2020, revert to
the fund. By expanding the purposes for which a continuously
appropriated fund may be used, this bill would make an appropriation.
(4) Existing law establishes the Office of Women's Health within
the State Department of Health Care Services. Existing law requires
the California Health and Human Services Agency to establish an
interagency task force on women's health, as specified. Existing law
establishes the Office of Multicultural Health within the State
Department of Public Health.
This bill would repeal these provisions and other related
provisions and instead establish the Office of Health Equity within
the State Department of Public Health. The bill would require the
office to perform various duties relating to reducing health and
mental health disparities in vulnerable communities, as defined. The
bill would require that a deputy director be appointed, as specified,
and that an advisory committee be established within the office no
later than October 1, 2013. The bill would require that an
interagency agreement be established between the State Department of
Public Health and the State Department of Health Care Services to
outline the process by which the departments will jointly work to
advance the mission of the office, including responsibilities, scope
of work, and necessary resources. This bill would make conforming and
related changes.
(5) 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 that, as a
condition of participation in the Medi-Cal program, there be imposed
a quality assurance fee on certain intermediate care facilities.
Existing law requires that the fees be deposited into the General
Fund and allocated to intermediate care facilities to support their
quality improvement efforts, and distributed to each facility based
on the number of Medi-Cal patients at the eligible facility. Existing
law requires the department to impose a uniform quality assurance
fee on each skilled nursing facility, with certain exceptions, in
accordance with a prescribed formula and requires that the fees be
deposited in the State Treasury. Existing law, the Medi-Cal Long-Term
Care Reimbursement Act, requires the department to implement a
facility-specific reimbursement ratesetting system for certain
skilled nursing facilities. Reimbursement rates for freestanding
skilled nursing facilities are funded by a combination of federal
funds and moneys collected pursuant to the skilled nursing uniform
quality assurance fee.
This bill would instead, beginning August 1, 2013, require the
quality assurance fees imposed pursuant to these provisions be
deposited into the Long-Term Care Quality Assurance Fund which would
be created by this bill.
(6) The State Department of Public Health is required to perform
various public health functions, including providing breast and
cervical cancer screening and treatment for low-income individuals,
providing prostate cancer screening and treatment for low-income and
uninsured men, and specified family planning services.
This bill would, commencing July 1, 2012, transfer the duties
referenced above to the State Department of Health Care Services.
(7) Existing law, the Sherman Food, Drug, and Cosmetic Law
(Sherman Law), requires the department to regulate activities related
to food, drugs, devices, and cosmetics and establishes the Food
Safety Fund for the deposit of money collected by the department
under specified Sherman Law provisions. Money in the Food Safety Fund
is available to the department, upon appropriation by the
Legislature, to implement specified Sherman Law provisions. The
existing California Retail Food Code regulates the health and
sanitation standards for retail food facilities and establishes the
Retail Food Safety and Defense Fund. Money collected by the
department under specified California Retail Food Code provisions is
deposited in the fund and used by the department, upon appropriation
by the Legislature, to implement the California Retail Food Code.
This bill would eliminate the Retail Food Safety and Defense Fund
and require all money deposited into the fund to be transferred to
the Food Safety Fund. This bill would expand the purpose of the Food
Safety Fund to include carrying out the provisions of the California
Retail Food Code.
(8) Existing law requires public swimming pools to be equipped
with antientrapment devices or systems that meet ASME/ANSI or ASTM
performance standards. Existing law permits the State Department of
Public Health to assess an annual fee on public swimming pool owners,
collected by the local health department, and deposited into the
Recreational Health Fund along with other money collected by the
department through enforcement of these provisions. Money in the fund
is available to the department, upon appropriation by the
Legislature, for the purpose of promoting these public swimming pool
provisions.
This bill would instead require public swimming pools to be
equipped with antientrapment devices or systems that comply with
ANSI/APSP standard 16 and make related changes. This bill would
eliminate the Recreational Health Fund and the department's authority
to administer or enforce specified public swimming pool provisions.
(9) Existing law requires, after January 1, 2008, that any general
acute care hospital building that is determined to be a potential
risk of collapse or pose significant loss of life only be used for
nonacute care hospital purposes, unless granted an extension as
prescribed.
Existing law authorizes, commencing on the date when the State
Department of Health Care Services receives specified federal
approval for a 2011-12 fiscal year hospital quality assurance fee
program that meets a specified condition, the Office of Statewide
Health Planning and Development to grant a hospital an additional
extension of up to 7 years for a hospital building that it owns or
operates if the hospital meets specified milestones. These milestones
include a March 31, 2012, deadline for submitting to the office a
specified letter of intent and schedule.
This bill would extend until September 30, 2012, the deadline for
the above-described milestones for submitting a letter of intent and
a schedule.
(10) Existing law requires the Director of Health Care Services to
appoint an Advisory Committee on Genetically Handicapped Person's
Program. Existing law requires the director to seek advice from the
committee when adopting regulations under the Genetically Handicapped
Person's Program that would expand the list of genetically
handicapping conditions covered by the program and requires approval
from the committee when prioritizing funds and services.
This bill would delete the provisions that establish the Advisory
Committee on Genetically Handicapped Person's Program. This bill
would delete the provisions that authorize the director to expand the
list of genetically handicapping conditions covered by the program
and that require the director to establish priorities for the use of
funds and services. This bill would make conforming changes.
(11) Existing law, the Health Insurance Portability and
Accountability Implementation Act of 2001, requires the Office of
HIPAA Implementation, established by the Governor's office within the
agency, to perform specified activities required for compliance with
the federal Health Insurance Portability and Accountability Act.
Under existing law, the act will become inoperative and be repealed
on January 1, 2013, unless a later enacted statute, that is enacted
before January 1, 2013, deletes or extends that date, and all
unexpended or unencumbered funds under that act will revert to the
General Fund on January 1, 2013.
The bill would extend the act's duration to June 30, 2016, when it
would be inoperative and repealed, and all funds under the act that
are unexpended or unencumbered as of that date would revert to the
General Fund.
(12) Under existing law, the State Department of Mental Health is
authorized and required to perform various functions relating to the
care and treatment of persons with mental disorders. Existing law
requires the Director of Mental Health, with the advice of the
Statewide Resources Consultant, as described, to contract with
nonprofit community resource agencies to establish regionally based
resource centers to provide services for brain-impaired adults.
This bill would transfer the Director of Mental Health's
responsibilities with respect to these resource centers to the
Director of Health Care Services.
(13) Existing law, the Mental Health Services Act, an initiative
measure enacted by the voters as Proposition 63 at the November 2,
2004, statewide general election, establishes the continuously
appropriated Mental Health Services Fund to fund various county
mental health programs. Existing law establishes the Mental Health
Services Oversight and Accountability Commission (commission) to
oversee the administration of various parts of the Mental Health
Services Act. The act provides that it may be amended by the
Legislature by a 2/3 vote of each house as long as the amendment is
consistent with and furthers the intent of the act, and that the
Legislature may also clarify procedures and terms of the act by
majority vote.
This bill would authorize the commission to assist in providing
technical assistance, as specified, and would authorize the
commission to work in collaboration with, and in consultation with,
various entities in designing a comprehensive joint plan for
coordinated evaluation of client outcomes. This bill would require
the California Health and Human Services Agency to lead the
comprehensive joint plan effort. This bill would transfer various
functions of the State Department of Mental Health under the Mental
Health Services Act to the State Department of Health Care Services
and the Office of Statewide Health Planning and Development. This
bill would make various technical and conforming changes to reflect
the transfer of those mental health responsibilities. This bill would
require all projects included in the innovative programs portion of
the county plan to meet specified requirements.
Existing law requires each county mental health program to prepare
and submit a 3-year plan that includes specified components.
This bill, in this regard, would require the plan to be a 3-year
program and expenditure plan adopted by the county board of
supervisors and submitted to the commission, would require annual
updates, and would require plans to be certified by the county mental
health director and the county auditor-controller, as specified.
This bill would require the State Department of Health Care Services
to inform the California Mental Health Directors Association and the
commission of the methodology used for revenue allocation to the
counties. This bill would require the State Department of Health Care
Services, in consultation with the commission and the California
Mental Health Directors Association, to develop and administer
instructions for the Annual Mental Health Services Act Revenue and
Expenditure Report, as prescribed.
This bill would declare that it clarifies procedures and terms of
the Mental Health Services Act.
This bill would require the Governor or the Director of Health
Care Services to appoint, subject to confirmation by the Senate, a
Deputy Director of Mental Health and Substance Use Disorder Services
of the State Department of Health Care Services.
(14) Existing law requires the State Department of Health Care
Services to establish and administer, until July 1, 2021, the
Medi-Cal Electronic Health Records Incentive Program, for the
purposes of providing federal incentive payments to Medi-Cal
providers for the implementation and use of electronic records
systems. Existing law prohibits General Fund moneys from being used
for this purpose.
This bill would instead provide that no more than $200,000 from
the General Fund may be used annually for state administrative costs
associated with implementing these provisions.
(15) Existing law establishes the Emergency Services and
Supplemental Payments Fund, the Medi-Cal Education Supplemental
Payment Fund, the Large Teaching Emphasis Hospital and Children's
Hospital Medi-Cal Medical Education Supplemental Payment Fund, and
the Small and Rural Hospital Supplemental Payments Fund administered
by the department from which the department is required to make
supplemental payments to certain hospitals based on specified
criteria.
This bill would provide that these provisions shall become
inoperative on June 30, 2013, and shall be repealed on January 1,
2014.
(16) Existing law authorizes the department to provide health care
services to Medi-Cal beneficiaries through various models of managed
care, including though a comprehensive program of managed health
care plan services for Medi-Cal recipients residing in clearly
defined geographical areas. Existing law provides for a schedule of
benefits under the Medi-Cal program, which, with some exceptions,
includes certain dental services.
This bill would authorize the Director of Health Care Services to
enter into contracts with one or more managed health care plans to
provide a comprehensive program of managed health care services to
Medi-Cal beneficiaries residing in specified counties. This bill
would also make enrollment in Medi-Cal managed health care plans
mandatory for beneficiaries residing in these counties.
This bill would require the department to establish a list of
performance measures to ensure dental health plans meet quality
criteria required by the department to be included in dental health
contracts entered into between the department and a dental health
plan. This bill would require the department to designate an external
quality review organization to conduct quality reviews for any
dental health plan contracting with the department, as specified.
This bill would require the Director of Health Care Services to
establish a beneficiary dental exception (BDE) process for Medi-Cal
beneficiaries mandatorily enrolled in dental health plans in the
County of Sacramento, and would require the department to amend
contracts with dental health plans that provide dental services to
Medi-Cal beneficiaries who reside in a specified geographic area to
meet these additional requirements.
This bill would require the department, by no later than March 15,
2013, and annually thereafter, to provide designated committees of
the Legislature a report on dental managed care in the Counties of
Sacramento and Los Angeles, and, for reports on the County of
Sacramento, data outcomes and findings from the BDE process. This
bill would require the Department of Managed Health Care, by no later
than January 1, 2013, to provide designated committees of the
Legislature with its final report on specified surveys for the dental
health plans participating in the Sacramento Geographic Managed Care
Program. This bill would authorize the County of Sacramento to
establish a stakeholder advisory committee on the delivery of oral
health and dental care services, and would require the State
Department of Health Care Services to meet periodically with the
committee, as specified.
This bill would also require the department to perform specified
functions in connection with the Medi-Cal managed care plan default
assignment algorithm.
Existing law requires the department to enter into an interagency
agreement with the Department of Managed Health Care to conduct
financial audits, medical surveys, and a review of the provider
networks of the managed care plans participating in a certain
demonstration project.
This bill would additionally require the department to enter into
the interagency agreement with the Department of Managed Health Care
to conduct financial audits, medical surveys, and a review of the
provider networks in connection with the expansion of Medi-Cal
managed care into rural counties, and to provide consumer assistance
to beneficiaries affected by certain provisions.
This bill would make legislative findings and declarations as to
the necessity of a special statute for specified counties.
(17) Existing law requires, until January 1, 2013, a hospital that
does not have in effect a contract with a Medi-Cal managed care
health plan, as defined, that establishes payment amounts for
services furnished to a beneficiary enrolled in that plan to accept
as payment in full, from all Medi-Cal managed care plans, specified
amounts for outpatient services, emergency inpatient services, and
poststabilization services following an emergency admission.
This bill would modify the payment amount a hospital subject to
these provisions is required to accept as payment in full from
Medi-Cal managed care health plans for emergency inpatient services,
and would provide that the payment amounts for both emergency
inpatient services and poststabilization services related to an
emergency medical condition shall remain in effect only until the
department implements a specified payment methodology based on
diagnosis-related groups, at which time, the hospital shall accept
the payment amount established by that methodology for those
services. This bill would extend the operative date of these
provisions to July 1, 2013, and would make related changes.
(18) Existing federal law requires the state to provide payment
for primary care services furnished in the 2013 and 2014 calendar
years by Medi-Cal providers with specified primary specialty
designations at a rate not less than 100% of the payment rate that
applies to those services and physicians under the Medicare Program.
This bill would, only to the extent that the federal medical
assistance percentage is equal to 100% and only until January 1,
2015, implement this requirement for both Medi-Cal fee-for-service
and managed care plans.
(19) Existing law provides that reimbursement for clinical
laboratory or laboratory services under the Medi-Cal program, as
defined, may not exceed 80% of the lowest maximum allowance
established by the federal Medicare Program for the same or similar
services.
This bill would, upon federal approval, change the rate
methodology for clinical laboratory or laboratory services, as
specified. This bill would also require that rates for clinical
laboratory or laboratory services be reduced by 10% until federal
approval is obtained for this new rate methodology.
(20) Existing law requires Medi-Cal beneficiaries to make set
copayments for specified services. Existing law, subject to federal
approval, revises these copayment rates, expands the services for
which copayments are due, and requires the department to reduce the
amount of the payment to the provider by the amount of the copayment.
Existing law provides, upon federal approval and with certain
exceptions, that a provider has no obligation to provide services to
a beneficiary who does not pay the copayment at the point of service.
This bill would modify these provisions as they relate to
emergency and nonemergency services.
(21) Existing law provides that it is the intent of the
Legislature to provide appropriate funding to the counties for the
effective administration of the Medi-Cal program, except for
specified fiscal years in regard to any cost-of-doing-business
adjustment.
This bill would additionally provide that it is the intent of the
Legislature to not appropriate funds for the cost-of-doing-business
adjustment for the 2012-13 fiscal year.
(22) Existing law establishes the continuously appropriated
Private Hospital Supplemental Fund and the continuously appropriated
Nondesignated Public Hospital Supplemental Fund administered by the
California Medical Assistance Commission for the purposes of funding
the nonfederal share of specified payments to private and
nondesignated hospitals. Existing law also provides for stabilization
funding for certain hospitals through October 31, 2010, and requires
specified amounts of that funding to be transferred to the Private
Hospital Supplemental Fund and the Nondesignated Public Hospital
Supplemental Fund. Existing law requires that the California Medical
Assistance Commission be dissolved after June 30, 2012, and requires
the department to develop a staff transition plan, as specified, that
will be included in the 2012-13 Governor's budget. Existing law
requires that, upon dissolution of the commission, all powers,
duties, and responsibilities of the commission be transferred to the
Director of Health Care Services. Existing law provides that upon a
determination by the director that a payment system based on
diagnosis-related groups, as described, has been developed and
implemented, the powers, duties, and responsibilities conferred on
the commission and transferred to the director shall no longer be
exercised.
This bill, instead, would provide that the powers, duties, and
responsibilities conferred on the commission and transferred to the
director shall no longer be exercised upon the director's
determination, except for those
relating to specified stabilization payments and the ability
to negotiate and make payments from the Private Hospital
Supplemental Fund and the Nondesignated Public Hospital Supplemental
Fund. This bill would also modify the criteria a hospital would have
to meet to receive distributions from these funds. This bill would
also require, notwithstanding any other law, that stabilization
funding payable to nondesignated public hospitals and to project year
private DSH hospitals that has not been paid or specifically
committed for payment prior to January 1, 2012, be transferred to the
General Fund, except as specified, and that funds that would
otherwise be drawn from the General Fund for stabilization payments
to these hospitals be retained in the General Fund. This bill would
delete the requirement that the department develop a staff transition
plan and, instead, would implement the transition of staff positions
serving the commission to the department. This bill would provide
that after the diagnosis-related groups payment system is
implemented, the transferred employees will transfer to civil service
classifications within the department, as specified.
(23) Existing law establishes the Medi-Cal Hospital/Uninsured Care
Demonstration Project Act, which revises hospital supplemental
payment methodologies under the Medi-Cal program in order to maximize
the use of federal funds consistent with federal Medicaid law and to
stabilize the distribution of funding for hospitals that provide
care to Medi-Cal beneficiaries and uninsured patients. Existing law
requires the department to seek a successor 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 that to the extent the provisions under the Medi-Cal
Hospital/Uninsured Care Demonstration Project Act do not conflict
with the provisions of, or the Special Terms and Conditions of, this
demonstration project, the provisions of the Medi-Cal
Hospital/Uninsured Care Demonstration Project Act shall apply.
Existing law establishes the continuously appropriated Health Care
Support Fund, which consists of federal safety net care pool funds
claimed and received by the department under the demonstration
project and the successor demonstration project. Existing law also
establishes the continuously appropriated Public Hospital Investment,
Improvement, and Incentive Fund, which consists of moneys that a
county, other political subdivision of the state, or other
governmental entity in the state elects to transfer to the department
for use as the nonfederal share of investment, improvement, and
incentive payments to participating designated hospitals and the
governmental entities with which they are affiliated.
This bill would, subject to federal approval, modify the inpatient
fee-for-service reimbursement methodology for nondesignated public
hospitals under the successor demonstration project. This bill would,
among other things, provide that beginning with the 2012-13 fiscal
year, and if specified conditions are met, nondesignated public
hospitals, or governmental entities with which they are affiliated,
shall be eligible to receive safety net care pool payments for
uncompensated care from the Health Care Support Fund. By revising the
purposes for which moneys in the Health Care Support Fund may be
expended, this bill would make an appropriation. This bill would also
provide that beginning with the 2012-13 fiscal year, subject to
federal approval and if specified conditions are met, nondesignated
public hospitals may receive delivery system reform incentive pool
funding, as specified. This bill would make related changes to the
Public Hospital Investment, Improvement, and Incentive Fund
provisions. By revising the purposes for which moneys in the Public
Hospital Investment, Improvement, and Incentive Fund may be used,
this bill would make an appropriation. This bill would also require
designated public hospitals to report and certify specified
information for each successor demonstration year beginning with the
2012-13 fiscal year.
(24) Existing law, subject to federal approval, imposes a quality
assurance fee, as specified, on certain general acute care hospitals
for the period of July 1, 2011, through December 31, 2013. Existing
law creates the Hospital Quality Assurance Revenue Fund in the State
Treasury and requires that the money collected from the quality
assurance fee be deposited into the fund. Existing law, subject to
federal approval, provides that the moneys in the Hospital Quality
Assurance Revenue Fund shall, upon appropriation by the Legislature,
be available only for certain purposes, including, among other
things, paying for health care coverage for children, as specified,
making supplemental payments to private hospitals, and making direct
grants in support of health care expenditures to designated and
nondesignated public hospitals.
This bill would revise the definition of "federal approval" for
the purposes of those provisions and would make conforming changes.
This bill would increase the amount previously allocated for health
care coverage for children for each subject fiscal quarter during the
2012-13 and 2013-14 fiscal years, and would, for the 2013-14 fiscal
year, additionally require that the amount of $21,500,000 previously
allocated for grants to designated public hospitals be retained by
the state to pay for health care coverage of children, as specified.
(25) Existing law requires the department to audit the amounts
paid for services provided to Medi-Cal beneficiaries. Existing law
requires the Director of Health Care Services to establish
administrative appeal processes to review complaints arising from the
findings of an audit. Existing law provides that a specified
interest rate shall be assessed on amounts when a provider prevails
in an appeal of a disallowed payment that was paid and recovered by
the department or when an unrecovered overpayment is due to the
department, and in other circumstances.
This bill would modify the applicable interest rate.
(26) Existing law requires the department, pursuant to federal
approval of a successor demonstration project, to authorize a local
Low Income Health Program (LIHP) to provide health care services to
eligible low-income individuals under certain circumstances.
This bill would modify the provisions relating to the application
of rates agreed to between the department and the participating
entities with respect to the LIHP year ending June 30, 2012.
(27) Existing law authorizes counties meeting certain criteria to
elect to participate in the County Medical Services Program (CMSP),
for the purpose of providing specified health services to eligible
county residents. Counties that elect to participate in the program
may establish a CMSP governing board, responsible for the oversight
of the participating counties. Existing law permits a CMSP governing
board to apply to operate a local LIHP for the purpose of providing
health care services, as specified.
This bill would authorize the Director of Finance to require the
Controller to draw warrants against General Fund cash to provide
cashflow loans of no more than a total of $100,000,000 in the 2012-13
and 2013-14 fiscal years for CMSP governing board expenses that are
associated with a Low Income Health Program operated by the governing
board, thereby making an appropriation.
(28) Existing law establishes the Office of AIDS in the State
Department of Public Health as the lead agency responsible for
coordinating state programs, services, and activities relating to the
human immunodeficiency virus (HIV), acquired immunodeficiency
syndrome (AIDS), and AIDS-related conditions (ARC). Existing federal
law, under the federal Ryan White HIV/AIDS Treatment Extension Act of
2009 (Ryan White Act), makes financial assistance available to
states and other public and nonprofit entities to provide for the
delivery of services to families with HIV.
This bill would require the State Department of Health Care
Services, in collaboration with the State Department of Public
Health, and in consultation with stakeholders, to develop polices and
guidance on the transition of persons diagnosed with HIV/AIDS from
programs funded under the federal Ryan White Act to the Low Income
Health Program.
(29) 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 requires the department to annually seek authority from
the federal Centers for Medicare and Medicaid Services under the
Special Terms and Conditions of the successor demonstration project
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.
This bill would modify the conditions under which designated
public hospitals may utilize the redirected safety net care pool
funds and would modify the provisions relating to disallowances or
deferrals that relate to certified public expenditures for
uncompensated care incurred by the designated public hospitals under
these provisions.
(30) This bill would incorporate additional changes in Section
123870 of the Health and Safety Code proposed in AB 1494 and SB 1034,
that would become operative only if either AB 1494 or SB 1034 and
this bill are both chaptered and become effective on or before
January 1, 2013, and this bill is chaptered last.
(31) This bill would declare that it is to take effect immediately
as a bill providing for appropriations related to the Budget Bill.
Appropriation: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 7575 of the Government Code is amended to read:
7575. (a) Notwithstanding any other provision of law, all
services assessed and determined as educationally necessary by the
individualized education program (IEP) team contained in the child's
IEP or individualized education plan shall be provided in accordance
with the federal Individuals with Disabilities Education Act (IDEA;
20 U.S.C. Sec. 1400 et seq.).
(b) If a child applies to the California Children's Services
Program pursuant to Section 123865 or 123875 of the Health and Safety
Code, the State Department of Health Care Services shall determine
whether the child needs medically necessary occupational therapy or
physical therapy. A medical referral to the California Children's
Services Program shall be based on a written report from a licensed
physician and surgeon who has examined the pupil. The written report
shall include the following:
(1) The diagnosed neuromuscular, musculoskeletal, or physical
disabling condition prompting the referral.
(2) The referring physician's treatment goals and objectives.
(3) The basis for determining the recommended treatment goals and
objectives, including how these will ameliorate or improve the pupil'
s diagnosed condition.
(4) The relationship of the medical disability to the pupil's need
for special education and related services.
(5) Relevant medical records.
(c) If the child has an IEP pursuant to the federal IDEA, the
parents or the estate of the child shall disclose that IEP to the
California Children's Services Program at the time of application and
on revision of the child's IEP.
(d) The department shall provide the service directly or by
contracting with another public agency, qualified individual, or a
state-certified nonpublic nonsectarian school or agency.
(e) Local education agencies shall provide necessary space and
equipment for the provision of occupational therapy and physical
therapy in the most efficient and effective manner.
(f) The department shall also be responsible for providing the
services of a home health aide when the local education agency
considers a less restrictive placement from home to school for a
pupil for whom both of the following conditions exist:
(1) The California Medical Assistance Program provides a
life-supporting medical service via a home health agency during the
time in which the pupil would be in school or traveling between
school and home.
(2) The medical service provided requires that the pupil receive
the personal assistance or attention of a nurse, home health aide,
parent or guardian, or some other specially trained adult in order to
be effectively delivered.
SEC. 2. Section 7582 of the Government Code is repealed.
SEC. 3. Section 12803.3 of the Government Code is amended to read:
12803.3. (a) For purposes of this section, the following
definitions shall apply:
(1) "Director" means the Director of the Office of Systems
Integration.
(2) "Office" means the Office of Systems Integration.
(3) "Services" means all functions, responsibilities, and services
deemed to be functions, responsibilities, and services of the
Systems Integration Division, also known as Systems Management
Services, of the California Health and Human Services Agency Data
Center, as determined by the Secretary of California Health and Human
Services.
(b) (1) The Systems Integration Division of the California Health
and Human Services Agency Data Center is hereby transferred to the
California Health and Human Services Agency and shall be known as the
Office of Systems Integration. The Office of Systems Integration
shall be the successor to, and is vested with, all of the duties,
powers, purposes, responsibilities, and jurisdiction of the Systems
Integration Division of the California Health and Human Services
Agency Data Center.
(2) Notwithstanding any other law, all services of the Systems
Integration Division of the California Health and Human Services
Agency Data Center shall become the services of the Office of Systems
Integration.
(c) The office shall be under the supervision of a director, known
as the Director of the Office of Systems Integration, who shall be
appointed by, and serve at the pleasure of, the Secretary of
California Health and Human Services.
(d) No contract, lease, license, or any other agreement to which
the California Health and Human Services Data Center is a party on
the date of the transfer as described in paragraph (1) of subdivision
(b) shall be void or voidable by reason of this section, but shall
continue in full force and effect. The office shall assume from the
California Health and Human Services Data Center all of the rights,
obligations, and duties of the Systems Integration Division. This
assumption of rights, obligations, and duties shall not affect the
rights of the parties to the contract, lease, license, or agreement.
(e) All books, documents, records, and property of the Systems
Integration Division shall be in the possession and under the control
of the office.
(f) All officers and employees of the Systems Integration Division
shall be designated as officers and employees of the agency. The
status, position, and rights of any officer or employee shall not be
affected by this designation and all officers and employees shall be
retained by the agency pursuant to the applicable provisions of the
State Civil Service Act (Part 2 (commencing with Section 18500) of
Division 5), except as to any position that is exempt from civil
service.
(g) (1) All contracts, leases, licenses, or any other agreements
to which the California Health and Human Services Data Center is a
party regarding any of the following are hereby assigned from the
California Health and Human Services Data Center to the office:
(A) Statewide Automated Welfare System (SAWS).
(B) Child Welfare Services/Case Management System (CWS/CMS).
(C) Electronic Benefit Transfer (EBT).
(D) Statewide Fingerprinting Imaging System (SFIS).
(E) Case Management Information Payrolling System (CMIPS).
(F) Employment Development Department Unemployment Insurance
Modernization (UIMOD) Project.
(2) All other contracts, leases, or agreements necessary or
related to the operation of the Systems Integration Division of the
California Health and Human Services Data Center are hereby assigned
from the California Health and Human Services Data Center to the
office.
(h) It is the intent of the Legislature that the transfer of the
Systems Integration Division of the California Health and Human
Services Agency Data Center pursuant to this section shall be
retroactive to the passage and enactment of the Budget Act of 2005
and that existing employees of the Systems Integration Division of
the California Health and Human Services Agency Data Center and the
newly established Office of Systems Integration shall not be
negatively impacted by the reorganization and transfer conducted
pursuant to this section.
(i) It is the intent of the Legislature to review fully
implemented information technology projects managed by the office to
assess the viability of placing the management responsibility for
those projects in the respective program department.
(j) On or before April 1, 2006, the Department of Finance shall
report to the Chairperson of the Joint Legislative Budget Committee
the date that the administration shall conduct an assessment for each
of the projects managed by the office. The California Health and
Human Services Agency, the California Health and Human Services
Agency Data Center, or its successor, the State Department of Social
Services, and the office shall provide to the Department of Finance
all information and analysis the Department of Finance deems
necessary to conduct the assessment required by this section. Each
assessment shall consider the costs, benefits, and any associated
risks of maintaining the project management responsibility in the
office and of moving the project management responsibility to its
respective program department.
SEC. 4. Section 15438 of the Government Code is amended to read:
15438. The authority may do any of the following:
(a) Adopt bylaws for the regulation of its affairs and the conduct
of its business.
(b) Adopt an official seal.
(c) Sue and be sued in its own name.
(d) Receive and accept from any agency of the United States, any
agency of the state, or any municipality, county, or other political
subdivision thereof, or from any individual, association, or
corporation gifts, grants, or donations of moneys for achieving any
of the purposes of this chapter.
(e) Engage the services of private consultants to render
professional and technical assistance and advice in carrying out the
purposes of this part.
(f) Determine the location and character of any project to be
financed under this part, and to acquire, construct, enlarge,
remodel, renovate, alter, improve, furnish, equip, fund, finance,
own, maintain, manage, repair, operate, lease as lessee or lessor,
and regulate the same, to enter into contracts for any or all of
those purposes, to enter into contracts for the management and
operation of a project or other health facilities owned by the
authority, and to designate a participating health institution as its
agent to determine the location and character of a project
undertaken by that participating health institution under this
chapter and as the agent of the authority, to acquire, construct,
enlarge, remodel, renovate, alter, improve, furnish, equip, own,
maintain, manage, repair, operate, lease as lessee or lessor, and
regulate the same, and as the agent of the authority, to enter into
contracts for any or all of those purposes, including contracts for
the management and operation of that project or other health
facilities owned by the authority.
(g) Acquire, directly or by and through a participating health
institution as its agent, by purchase solely from funds provided
under the authority of this part, or by gift or devise, and to sell,
by installment sale or otherwise, any lands, structures, real or
personal property, rights, rights-of-way, franchises, easements, and
other interests in lands, including lands lying under water and
riparian rights, that are located within the state that the authority
determines necessary or convenient for the acquisition,
construction, or financing of a health facility or the acquisition,
construction, financing, or operation of a project, upon the terms
and at the prices considered by the authority to be reasonable and
that can be agreed upon between the authority and the owner thereof,
and to take title thereto in the name of the authority or in the name
of a participating health institution as its agent.
(h) Receive and accept from any source loans, contributions, or
grants for, or in aid of, the construction, financing, or refinancing
of a project or any portion of a project in money, property, labor,
or other things of value.
(i) Make secured or unsecured loans to, or purchase secured or
unsecured loans of, any participating health institution in
connection with the financing of a project or working capital in
accordance with an agreement between the authority and the
participating health institution. However, no loan to finance a
project shall exceed the total cost of the project, as determined by
the participating health institution and approved by the authority.
Funds for secured loans may be provided from the California Health
Facilities Financing Authority Fund pursuant to subdivision (b) of
Section 15439 to small or rural health facilities pursuant to
authority guidelines.
(j) (1) Make secured or unsecured loans to, or purchase secured or
unsecured loans of, any participating health institution in
accordance with an agreement between the authority and the
participating health institution to refinance indebtedness incurred
by that participating health institution or a participating health
institution that controls or manages, is controlled or managed by, is
under common control or management with, or is affiliated with that
participating health institution, in connection with projects
undertaken or for health facilities acquired or for working capital.
(2) Make secured or unsecured loans to, or purchase secured or
unsecured loans of, any participating health institution in
accordance with an agreement between the authority and the
participating health institution to refinance indebtedness incurred
by that participating health institution or a participating health
institution that controls or manages, is controlled or managed by, is
under common control or management with, or is affiliated with that
participating health institution, payable to the authority or
assigned or pledged to authority issued bonds.
(3) Funds for secured loans may be provided from the California
Health Facilities Financing Authority Fund pursuant to subdivision
(b) of Section 15439 to small or rural health facilities pursuant to
authority guidelines.
(k) Mortgage all or any portion of interest of the authority in a
project or other health facilities and the property on which that
project or other health facilities are located, whether owned or
thereafter acquired, including the granting of a security interest in
any property, tangible or intangible, and to assign or pledge all or
any portion of the interests of the authority in mortgages, deeds of
trust, indentures of mortgage or trust, or similar instruments,
notes, and security interests in property, tangible or intangible, of
participating health institutions to which the authority has made
loans, and the revenues therefrom, including payments or income from
any thereof owned or held by the authority, for the benefit of the
holders of bonds issued to finance the project or health facilities
or issued to refund or refinance outstanding indebtedness of
participating health institutions as permitted by this part.
(l) Lease to a participating health institution the project being
financed or other health facilities conveyed to the authority in
connection with that financing, upon the terms and conditions the
authority determines proper, charge and collect rents therefor,
terminate the lease upon the failure of the lessee to comply with any
of the obligations of the lease, and include in that lease, if
desired, provisions granting the lessee options to renew the term of
the lease for the period or periods and at the rent, as determined by
the authority, purchase any or all of the health facilities or that
upon payment of all of the indebtedness incurred by the authority for
the financing of that project or health facilities or for refunding
outstanding indebtedness of a participating health institution, then
the authority may convey any or all of the project or the other
health facilities to the lessee or lessees thereof with or without
consideration.
(m) Charge and equitably apportion among participating health
institutions, the administrative costs and expenses incurred by the
authority in the exercise of the powers and duties conferred by this
part.
(n) Obtain, or aid in obtaining, from any department or agency of
the United States or of the state, any private company, or any
insurance or guarantee as to, of, or for the payment or repayment of,
interest or principal, or both, or any part thereof, on any loan,
lease, or obligation, or any instrument evidencing or securing the
loan, lease, or obligation, made or entered into pursuant to this
part; and notwithstanding any other provisions of this part, to enter
into any agreement, contract, or any other instrument whatsoever
with respect to that insurance or guarantee, to accept payment in the
manner and form as provided therein in the event of default by a
participating health institution, and to assign that insurance or
guarantee as security for the authority's bonds.
(o) Enter into any and all agreements or contracts, including
agreements for liquidity or credit enhancement, bond exchange
agreements, interest rate swaps or hedges, execute any and all
instruments, and do and perform any and all acts or things necessary,
convenient, or desirable for the purposes of the authority or to
carry out any power expressly granted by this part.
(p) Invest any moneys held in reserve or sinking funds or any
moneys not required for immediate use or disbursement, at the
discretion of the authority, in any obligations authorized by the
resolution authorizing the issuance of the bonds secured thereof or
authorized by law for the investment of trust funds in the custody of
the Treasurer.
(q) Award grants to any eligible clinic pursuant to Section
15438.6.
(r) Award grants to any eligible health facility pursuant to
Section 15438.7.
(s) (1) Notwithstanding any other provision of law, provide a
working capital loan of up to five million dollars ($5,000,000) to
assist in the establishment and operation of the California Health
Benefit Exchange (Exchange) established under Section 100500. The
authority may require any information it deems necessary and prudent
prior to providing a loan to the Exchange and may require any term,
condition, security, or repayment provision it deems necessary in the
event the authority chooses to provide a loan. Under no
circumstances shall the authority be required to provide a loan to
the Exchange.
(2) Prior to the authority providing a loan to the Exchange, a
majority of the board of the Exchange shall be appointed and shall
demonstrate, to the satisfaction of the authority, that the federal
planning and establishment grants made available to the Exchange by
the United States Secretary of Health and Human Services are
insufficient or will not be released in a timely manner to allow the
Exchange to meet the necessary requirements of the federal Patient
Protection and Affordable Care Act (Public Law 111-148).
(3) The Exchange shall repay a loan made under this subdivision no
later than June 30, 2016, and shall pay interest at the rate paid on
moneys in the Pooled Money Investment Account.
(t) Award grants pursuant to Section 15438.10.
SEC. 5. Section 15438.10 is added to the Government Code, to read:
15438.10. (a) The Legislature finds and declares the following:
(1) Many Californians face serious obstacles in obtaining needed
health care services, including, but not limited to, medical, mental
health, dental, and preventive services. The obstacles faced by
vulnerable populations and communities include existence of complex
medical, physical, or social conditions, disabilities, economic
disadvantage, and living in remote or underserved areas that make it
difficult to access services.
(2) With the recent passage of national health care reform, there
is an increased demand for innovative ways to deliver quality health
care, including preventive services, to individuals in a
cost-effective manner.
(3) There is a need to develop new methods of delivering health
services utilizing innovative models that can be demonstrated to be
effective and then replicated throughout California and that bring
community-based health care preventive services to individuals where
they live or receive education, social, or general health services.
(4) For more than 30 years, the California Health Facilities
Financing Authority has provided financial assistance through
tax-exempt bonds, low-interest loans, and grants to health facilities
in California, assisting in the expansion of the availability of
health services and health care facilities throughout the state.
(b) (1) Following the completion of a competitive selection
process, the authority may award one or more grants that, in the
aggregate, do not exceed one million five hundred thousand dollars
($1,500,000) to one or more projects designed to demonstrate
specified new or enhanced cost-effective methods of delivering
quality health care services to improve access to quality health care
for vulnerable populations or communities, or both, that are
effective at enhancing health outcomes and improving access to
quality health care and preventive services. These health care
services may include, but are not limited to, medical, mental health,
or dental services for the diagnosis, care, prevention, and
treatment of human illness, or individuals with physical, mental, or
developmental disabilities. More than one demonstration project may
receive a grant pursuant to this section. It is the intent of the
Legislature for a demonstration project that receives a grant to
allow patients to receive screenings, diagnosis, or treatment in
community settings, including, but not limited to, school-based
health centers, adult day care centers, and residential care
facilities for the elderly, or for individuals with mental illness or
developmental disabilities.
(2) A grant awarded pursuant to this subdivision may be allocated
in increments to a demonstration project over multiple years to
ensure the demonstration project's ability to complete its work, as
determined by the authority. Prior to the initial allocation of funds
pursuant to this subdivision, the administrators of the
demonstration project shall provide evidence that the demonstration
project has or will have additional funds sufficient to ensure
completion of the demonstration project. If the authority allocates a
grant in increments, each subsequent year's allocation shall be
provided to the demonstration project only upon submission of
research that shows that the project is progressing toward the
identification of a high-quality and cost-effective delivery model
that improves health outcomes and access to quality health care and
preventive services for vulnerable populations or communities, and
can be replicated throughout the state in community settings.
(3) Except for a health facility that qualifies as a "small and
rural hospital" pursuant to Section 124840 of the Health and Safety
Code, a health facility that has received tax-exempt bond financing
from the authority shall not be eligible to receive funds awarded for
a demonstration project. Such a health facility may participate as
an uncompensated partner or member of a collaborative effort that is
awarded a demonstration project grant. A health facility that
participates in a demonstration project that receives funds pursuant
to this section may not claim the funding provided by the authority
toward meeting its community benefit and charity care obligations.
(4) Funds provided to a demonstration project pursuant to this
subdivision may be used to supplement, but not to supplant, existing
financial and resource commitments of the grantee or grantees or any
other member of a collaborative effort that has been awarded a
demonstration project grant.
(c) (1) If a demonstration project that receives a grant pursuant
to subdivision (b) is successful at developing a new method of
delivering high-quality and cost-effective health care services in
community settings that result in increased access to quality health
care and preventive services or improved health care outcomes for
vulnerable populations or communities, or both, then beginning as
early as the second year after the initial allocation of moneys
provided pursuant to subdivision (b), the authority may implement a
second grant program that awards not more than five million dollars
($5,000,000), in the aggregate, to eligible recipients as defined by
the authority, to replicate in additional California communities the
model developed by a demonstration project that received a grant
pursuant to subdivision (b). Prior to the implementation of this
second grant program, the authority shall prepare and provide a
report to the Legislature and the Governor on the outcomes of the
demonstration project. The report shall be made in accordance with
Section 9795.
(2) If the authority implements the second grant program, the
authority shall also report annually, beginning with the first year
of implementation of the second grant program, to the Legislature and
the Governor regarding the program, including, but not limited to,
the total amount of grants issued pursuant to this subdivision, the
amount of each grant issued, and a description of each project
awarded funding for replication of the model.
(3) Grants under this subdivision may be utilized for eligible
costs, as defined in subdivision (c) of Section 15432, including
equipment, information technology, and working capital, as defined in
subdivision (h) of Section 15432.
(4) The authority may adopt regulations relating to the grant
program authorized pursuant to this subdivision, including
regulations that define eligible recipients, eligible costs, and
minimum and maximum grant amounts.
(d) (1) The authority shall prepare and provide a report to the
Legislature and the Governor by January 1, 2014, on the outcomes of
the demonstration grant program, including, but not limited to, the
following:
(A) The total amount of grants issued.
(B) The amount of each grant issued.
(C) A description of other sources of funding for each project.
(D) A description of each project awarded funding.
(E) A description of project outcomes that demonstrate
cost-effective delivery of health care services in community
settings, that result in improved access to quality health care or
improved health care outcomes.
(2) A report submitted pursuant to this subdivision shall be
submitted in compliance with Section 9795.
(e) There is hereby created the California Health Access Model
Program Account in the California Health Facilities Financing
Authority Fund. All moneys in the account are hereby continuously
appropriated to the authority for carrying out the purposes of this
section. An amount of up to six million five hundred thousand dollars
($6,500,000) shall be transferred from funds in the California
Health Facilities Financing Authority Fund that are not impressed
with a trust for other purposes into the California Health Access
Model Program Account for the purpose of issuing grants pursuant to
this section. Any moneys remaining in the California Health Access
Model Program Account on January 1, 2020, shall revert as of that
date to the California Health Facilities Financing Authority Fund.
(f) Any recipient of a grant provided pursuant to subdivision (b)
shall adhere to all applicable laws relating to scope of practice,
licensure, staffing, and building codes.
SEC. 6. Section 135 of the Health and Safety Code is repealed.
SEC. 7. Section 136 of the Health and Safety Code is repealed.
SEC. 8. Section 137 of the Health and Safety Code is amended to
read:
137. (a) The
State Department of Public Health shall develop a coordinated state
strategy for addressing the health-related needs of women, including
implementation of goals and objectives for women's health.
(b) The approved programmatic costs associated with this strategy
shall be the responsibility of the State Department of Public Health
unless otherwise provided by law.
SEC. 9. Section 138 of the Health and Safety Code is repealed.
SEC. 10. Section 138.4 of the Health and Safety Code is amended to
read:
138.4. (a) The State Department of Public Health shall place
priority on providing information to consumers, patients, and health
care providers regarding women's gynecological cancers, including
signs and symptoms, risk factors, the benefits of early detection
through appropriate diagnostic testing, and treatment options.
(b) In exercising the powers under this section, the State
Department of Public Health shall consult with appropriate health
care professionals and providers, consumers, and patients, or
organizations representing them.
(c) The duties of the State Department of Public Health pursuant
to this section are contingent upon the receipt of funds appropriated
for this purpose.
(d) The State Department of Public Health may adopt any
regulations necessary and appropriate for the implementation of this
section.
SEC. 11. Section 138.6 of the Health and Safety Code is amended to
read:
138.6. (a) The State Department of Public Health shall include in
any literature that it produces regarding breast cancer information
that shall include, but not be limited to, all of the following:
(1) Summarized information on risk factors for breast cancer in
younger women, including, but not limited to, information on the
increased risk associated with a family history of the disease.
(2) Summarized information regarding detection alternatives to
mammography that may be available and more effective for at-risk
women between the ages of 25 and 40 years.
(3) Information on Internet Web sites of relevant organizations,
government agencies, and research institutions where information on
mammography alternatives may be obtained.
(b) The information required by subdivision (a) shall be produced
consistent with the department's protocols and procedures regarding
the production and dissemination of information on breast cancer,
including, but not limited to, the following factors:
(1) Restrictions imposed by space limitation on materials
currently produced and distributed by the department.
(2) Future regular production and replacement schedules.
(3) Translation standards governing the number of languages and
literacy levels.
(4) The nature, content, and purpose of the material into which
this new information will be incorporated.
(c) It is the intent of the Legislature that subdivisions (a) and
(b) apply to information that is distributed by any branch of the
department, including, but not limited to, the Cancer Detection
Section and the Office of Health Equity.
SEC. 12. Section 150 of the Health and Safety Code is repealed.
SEC. 13. Section 151 of the Health and Safety Code is repealed.
SEC. 14. Section 152 of the Health and Safety Code is amended to
read:
152. (a) The State Department of Public Health Office of Health
Equity shall do all of the following:
(1) Perform strategic planning to develop departmentwide plans for
implementation of goals and objectives to close the gaps in health
status and access to care among the state's diverse racial and ethnic
communities, women, persons with disabilities, and the lesbian, gay,
bisexual, transgender, queer, and questioning (LGBTQQ) communities.
(2) Conduct departmental policy analysis on specific issues
related to multicultural health.
(3) Coordinate projects funded by the state that are related to
improving the effectiveness of services to ethnic and racial
communities, women, and the LGBTQQ communities.
(4) Identify the unnecessary duplication of services and future
service needs.
(5) Communicate and disseminate information and perform a liaison
function within the department and to providers of health, social,
educational, and support services to racial and ethnic communities,
women, persons with disabilities, and the LGBTQQ communities. The
department shall consult regularly with representatives from diverse
racial and ethnic communities, women, persons with disabilities, and
the LGBTQQ communities, including health providers, advocates, and
consumers.
(6) Perform internal staff training, an internal assessment of
cultural competency, and training of health care professionals to
ensure more linguistically and culturally competent care.
(7) Serve as a resource for ensuring that programs collect and
keep data and information regarding ethnic and racial health
statistics, including those statistics described in reports released
by Healthy People 2020, and information based on sexual orientation,
gender identity, and gender expression, strategies and programs that
address multicultural health issues, including, but not limited to,
infant and maternal mortality, cancer, cardiovascular disease,
diabetes, human immunodeficiency virus (HIV), acquired
immunodeficiency syndrome (AIDS), child and adult immunization,
osteoporosis, menopause, and full reproductive health, asthma,
unintentional and intentional injury, and obesity, as well as issues
that impact the health of racial and ethnic communities, women, and
the LGBTQQ communities, including substance abuse, mental health,
housing, teenage pregnancy, environmental disparities, immigrant and
migrant health, and health insurance and delivery systems.
(8) Encourage innovative responses by public and private entities
that are attempting to address multicultural health issues.
(9) Provide technical assistance to counties, other public
entities, and private entities seeking to obtain funds for
initiatives in multicultural health, including identification of
funding sources and assistance with writing grants.
(b) Notwithstanding Section 10231.5 of the Government Code, the
State Department of Public Health shall biennially prepare and submit
a report to the Legislature on the status of the activities required
by this chapter. This report shall be included in the report
required under paragraph (1) of subdivision (d) of Section 131019.5.
SEC. 15. Section 1324.8 of the Health and Safety Code is amended
to read:
1324.8. (a) The quality assurance fee assessed and collected
pursuant to this article shall be deposited in the General Fund.
(b) Notwithstanding subdivision (a), commencing August 1, 2013,
the quality assurance fee assessed and collected pursuant to this
article shall be deposited in the Long-Term Care Quality Assurance
Fund established pursuant to Section 1324.9.
SEC. 16. Section 1324.9 is added to the Health and Safety Code, to
read:
1324.9. (a) The Long-Term Care Quality Assurance Fund is hereby
created in the State Treasury. Moneys in the fund shall be available,
upon appropriation by the Legislature, for expenditure by the State
Department of Health Care Services for the purposes of this article
and Article 7.6 (commencing with Section 1324.20). Notwithstanding
Section 16305.7 of the Government Code, the fund shall contain all
interest and dividends earned on moneys in the fund.
(b) Notwithstanding any other law, beginning August 1, 2013, all
revenues received by the State Department of Health Care Services
categorized by the State Department of Health Care Services as
long-term care quality assurance fees shall be deposited into the
Long-Term Care Quality Assurance Fund. Revenue that shall be
deposited into this fund shall include quality assurance fees imposed
pursuant to this article and quality assurance fees imposed pursuant
to Article 7.6 (commencing with Section 1324.20).
SEC. 17. Section 1324.24 of the Health and Safety Code is amended
to read:
1324.24. (a) The quality assurance fee assessed and collected
pursuant to this article shall be deposited in the State Treasury.
(b) Notwithstanding subdivision (a), commencing August 1, 2013,
the quality assurance fee assessed and collected pursuant to this
article shall be deposited in the Long-Term Care Quality Assurance
Fund established pursuant to Section 1324.9.
SEC. 18. Section 100950 of the Health and Safety Code is amended
to read:
100950. The department shall administer this part, Section
100295, and Chapter 3 (commencing with Section 101175) of Part 3 and
shall adopt necessary regulations. These regulations shall be adopted
only after consultation with and approval by the California
Conference of Local Health Officers. Approval of these regulations
shall be by majority vote of those present at an official session.
SEC. 19. Section 104150 of the Health and Safety Code is amended
to read:
104150. (a) A provider or entity that participates in the grant
made to the department by the federal Centers for Disease Control and
Prevention breast and cervical cancer early detection program
established under Title XV of the federal Public Health Service Act
(42 U.S.C. Sec. 300k et seq.) in accordance with requirements of
Section 1504 of that act (42 U.S.C. Sec. 300n) may only render
screening services under the grant to an individual if the provider
or entity determines that the individual's family income does not
exceed 200 percent of the federal poverty level.
(b) The department shall provide for breast cancer and cervical
cancer screening services under the grant at the level of funding
budgeted from state and other resources during the fiscal year in
which the Legislature has appropriated funds to the department for
this purpose. These screening services shall not be deemed to be an
entitlement.
(c) To implement the federal breast and cervical cancer early
detection program specified in this section, the department may
contract, to the extent permitted by Section 19130 of the Government
Code, with public and private entities, or utilize existing health
care service provider enrollment and payment mechanisms, including
the Medi-Cal program's fiscal intermediary. However, the Medi-Cal
program's fiscal intermediary shall only be utilized if services
provided under the program are specifically identified and reimbursed
in a manner that does not claim federal financial reimbursement. Any
contracts with, and the utilization of, the Medi-Cal program's
fiscal intermediary shall not be subject to Chapter 3 (commencing
with Section 12100) of Part 2 of Division 2 of the Public Contract
Code. Contracts to implement the federal breast and cervical cancer
early detection program entered into by the department with entities
other than the Medi-Cal program's fiscal intermediary shall not be
subject to Part 2 (commencing with Section 10100) of Division 2 of
the Public Contract Code.
(d) The department shall enter into an interagency agreement with
the State Department of Health Care Services to transfer that portion
of the grant made to the department by the federal Centers for
Disease Control and Prevention breast and cervical cancer early
detection program established under Title XV of the federal Public
Health Service Act (42 U.S.C. Sec. 300k et seq.) to the State
Department of Health Care Services. The department shall have no
other liability to the State Department of Health Care Services under
this article.
SEC. 20. Section 104160 of the Health and Safety Code is amended
to read:
104160. (a) The State Department of Health Care Services shall
develop and maintain the Breast and Cervical Cancer Treatment Program
to expand and ensure quality breast and cervical cancer treatment
for low-income uninsured and underinsured individuals who are
diagnosed with breast or cervical cancer.
(b) To implement the program, the State Department of Health Care
Services may contract with public or private entities, or utilize
existing health care service provider enrollment and payment
mechanisms, including the Medi-Cal program's fiscal intermediary,
only if services provided under the program are specifically
identified and reimbursed in a manner that does not claim federal
financial reimbursement. The utilization of the Medi-Cal program's
fiscal intermediary shall not be subject to Chapter 3 (commencing
with Section 12100) of Part 2 of Division 2 of the Public Contract
Code. Contracts to implement the program entered into by the State
Department of Health Care Services with entities other than the
Medi-Cal program's fiscal intermediary shall not be subject to Part 2
(commencing with Section 10100) of Division 2 of the Public Contract
Code.
SEC. 21. Section 104162.1 of the Health and Safety Code is amended
to read:
104162.1. When an individual is underinsured, as defined in
subdivision (g) of Section 104161, the State Department of Health
Care Services shall be the payer of second resort for treatment
services. To the extent necessary for the individual to obtain
treatment services under any health care insurance listed in
paragraph (2), (3), or (4) of subdivision (f) of Section 104161, the
State Department of Health Care Services may do the following:
(a) Pay for the individual's breast or cervical cancer copayments,
premiums, and deductible.
(b) Provide only treatment services not otherwise covered by any
health care insurance listed in paragraph (2), (3), or (4) of
subdivision (f) of Section 104161.
SEC. 22. Section 104163 of the Health and Safety Code is amended
to read:
104163. The State Department of Health Care Services shall
provide for breast cancer and cervical cancer treatment services
pursuant to this article at the level of funding budgeted from state
and other resources during the fiscal year in which the Legislature
has appropriated funds to the department for this purpose. These
treatment services shall not be deemed to be an entitlement.
SEC. 23. Section 104314 of the Health and Safety Code is amended
to read:
104314. (a) The Prostate Cancer Fund is hereby established in
the State Treasury. It is the intent of the Legislature that the fund
be funded by an annual appropriation, when funds are available, in
the Budget Act.
(b) The moneys in the Prostate Cancer Fund shall be expended by
the State Department of Health Care Services, upon appropriation by
the Legislature, for the purpose of the Prostate Cancer Screening
Program established by Section 104315.
(c) For the purposes of this chapter, "department" means the State
Department of Health Care Services.
SEC. 24. Section 104315 of the Health and Safety Code is amended
to read:
104315. (a) The Prostate Cancer Screening Program shall be
established in the State Department of Health Care Services.
(b) The program shall apply to both of the following:
(1) Uninsured men 50 years of age and older.
(2) Uninsured men between 40 and 50 years of age who are at high
risk for prostate cancer, upon the advice of a physician or upon the
request of the patient.
(c) For purposes of this chapter, "uninsured" means not covered by
any of the following:
(1) Medi-Cal.
(2) Medicare.
(3) A health care service plan contract or policy of disability
insurance that covers screening for prostate cancer for men 50 years
of age and older, and for men between 40 and 50 years of age who are
at high risk for prostate cancer upon the advice of a physician or
upon the request of the patient.
(4) Any other form of health care coverage that covers screening
for prostate cancer for men 50 years of age and older, and for men
between 40 and 50 years of age who are at high risk for prostate
cancer upon the advice of a physician or upon the request of the
patient.
(d) The program shall include all of the following:
(1) Screening of men for prostate cancer as an early detection
health care measure.
(2) After screening, medical referral of screened men and services
necessary for definitive diagnosis.
(3) If a positive diagnosis is made, then assistance and advocacy
shall be provided to help the person obtain necessary treatment.
(4) Outreach and health education activities to ensure that
uninsured men are aware of and appropriately utilize the services
provided by the program.
(e) Any entity funded by the program shall coordinate with other
local providers of prostate cancer screening, diagnostic, followup,
education, and advocacy services to avoid duplication of effort. Any
entity funded by the program shall comply with any applicable state
and federal standards regarding prostate cancer screening.
(f) Administrative costs of the department shall not exceed 10
percent of the funds allocated to the program. Indirect costs of the
entities funded by this program shall not exceed 12 percent. The
department shall define "indirect costs" in accordance with
applicable state and federal law.
(g) Any entity funded by the program shall collect data and
maintain records that are determined by the department to be
necessary to facilitate the state department's ability to monitor and
evaluate the effectiveness of the entities and the program.
Commencing with the program's second year of operation, and
notwithstanding Section 10231.5 of the Government Code, the
department shall submit an annual report to the Legislature and any
other appropriate entity. The report shall describe the activities
and effectiveness of the program and shall include, but not be
limited to, the following types of information regarding those served
by the program:
(1) The number.
(2) The ethnic, geographic, and age breakdown.
(3) The stages of presentation.
(4) The diagnostic and treatment status.
(h) The department or any entity funded by the program shall
collect personal and medical information necessary to administer the
program from any individual applying for services under the program.
The information shall be confidential and shall not be disclosed
other than for purposes directly connected with the administration of
the program or except as otherwise provided by law or pursuant to
prior written consent of the subject of the information.
(i) The department or any entity funded by the program may
disclose the confidential information to medical personnel and fiscal
intermediaries of the state to the extent necessary to administer
the program, and to other state public health agencies or medical
researchers if the confidential information is necessary to carry out
the duties of those agencies or researchers in the investigation,
control, or surveillance of prostate cancer.
(j) The department shall adopt regulations to implement the
Prostate Cancer Screening Program in accordance with Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code.
(k) This section shall not be implemented unless and until funds
are appropriated for this purpose in the annual Budget Act.
( l ) To implement the Prostate Cancer Screening
Program, the department may contract, to the extent permitted by
Section 19130 of the Government Code, with public and private
entities, or utilize existing health care service provider enrollment
and payment mechanisms, including the Medi-Cal program's fiscal
intermediary. However, the Medi-Cal program's fiscal intermediary
shall only be utilized if services provided under the program are
specifically identified and reimbursed in a manner that does not
claim federal financial reimbursement. Any contracts with, and the
utilization of, the Medi-Cal program's fiscal intermediary shall not
be subject to Chapter 3 (commencing with Section 12100) of Part 2 of
Division 2 of the Public Contract Code. Contracts to implement the
Prostate Cancer Screening Program entered into by the department with
entities other than the Medi-Cal program's fiscal intermediary shall
not be subject to Part 2 (commencing with Section 10100) of Division
2 of the Public Contract Code.
SEC. 25. Section 104322 of the Health and Safety Code is amended
to read:
104322. (a) (1) The State Department of Health Care Services
shall develop and implement a program to provide quality prostate
cancer treatment for low-income and uninsured men.
(2) The State Department of Health Care Services shall award one
or more contracts to provide prostate cancer treatment through
private or public nonprofit organizations, including, but not limited
to, community-based organizations, local health care providers, the
University of California medical centers, and the Charles R. Drew
University of Medicine and Science, an affiliate of the David Geffen
School of Medicine at the University of California at Los Angeles.
Contracts awarded, subsequent to the effective date of the amendments
to this section made during the 2005 portion of the 2005-06 Regular
Session, pursuant to this paragraph shall be consistent with both of
the following:
(A) Eighty-seven percent of the total contract funding shall be
used for direct patient care.
(B) No less than 70 percent of the total contract funding shall be
expended on direct patient care treatment costs, which shall be
defined as funding to fee-for-service providers for Medi-Cal eligible
services.
(3) The contracts described in paragraph (2) shall not be subject
to Part 2 (commencing with Section 10100) of Division 2 of the Public
Contract Code. Commencing July 1, 2006, those contracts shall be
entered into on a competitive bid basis.
(4) It is the intent of the Legislature to support the prostate
cancer treatment program provided for pursuant to this section, and
that the program be cost-effective and maximize the number of men
served for the amount of funds appropriated. It is further the intent
of the Legislature to ensure that the program has an adequate health
care provider network to facilitate reasonable access to treatment.
(b) Treatment provided under this chapter shall be provided to
uninsured and underinsured men with incomes at or below 200 percent
of the federal poverty level. Covered services shall be limited to
prostate cancer treatment and prostate cancer-related services.
Eligible men shall be enrolled in a 12-month treatment regimen.
(c) The State Department of Health Care Services shall contract
for prostate cancer treatment services only at the level of funding
budgeted from state and other sources during a fiscal year in which
the Legislature has appropriated funds to the department for this
purpose.
(d) Notwithstanding subdivision (a) of Section 2.00 of the Budget
Act of 2003 and any other provision of law, commencing with the
2003-04 fiscal year and for each fiscal year thereafter, any amount
appropriated to the State Department of Health Care Services for the
prostate cancer treatment program implemented pursuant to this
chapter shall be made available, for purposes of that program, for
encumbrance for one fiscal year beyond the year of appropriation and
for expenditure for two fiscal years beyond the year of encumbrance.
SEC. 26. Section 110050 of the Health and Safety Code is amended
to read:
110050. The Food Safety Fund is hereby created as a special fund
in the State Treasury. All moneys collected by the department under
subdivision (c) of Section 110466 and Sections 110470, 110471,
110485, 111130, and 113717, and under Article 7 (commencing with
Section 110810) of Chapter 5 shall be deposited in the fund, for use
by the department, upon appropriation by the Legislature, for the
purposes of providing funds necessary to carry out and implement the
inspection provisions of this part relating to food, licensing,
inspection, enforcement, and other provisions of Article 12
(commencing with Section 111070) relating to water, the provisions
relating to education and training in the prevention of microbial
contamination pursuant to Section 110485, and the registration
provisions of Article 7 (commencing with Section 110810) of Chapter
5, and to carry out and implement the provisions of the California
Retail Food Code (Part 7 (commencing with Section 113700) of Division
104).
SEC. 27. Section 113717 of the Health and Safety Code is amended
to read:
113717. (a) Any person requesting the department to undertake any
activity pursuant to paragraph (5) of subdivision (c) of Section
113871, Section 114417, paragraph (2) of subdivision (b) of Section
114419, and Section 114419.3 shall pay the department's costs
incurred in undertaking the activity. The department's services shall
be assessed at the current hourly cost-recovery rate, and it shall
be entitled to recover any other costs reasonably and actually
incurred in performing those activities, including, but not limited
to, the costs of additional inspection and laboratory testing. For
purposes of this section, the department's hourly rate shall be
adjusted annually in accordance with Section 100425.
(b) The department shall provide to the person paying the required
fee a statement, invoice, or similar document that describes in
reasonable detail the costs paid.
(c) For purposes of this section only, the term "person" does not
include any city, county, city and county, or other political
subdivision of the state or local government.
SEC. 28. Section 113718 of the Health and Safety Code is repealed.
SEC. 29. Section 113718 is added to the Health and Safety Code, to
read:
113718. Notwithstanding Section 16350 of the Government Code, all
moneys deposited in the Retail Food Safety and Defense Fund shall be
transferred to the Food Safety Fund for appropriation and
expenditure as specified by Section 110050.
SEC. 30. Section 116064.1 of the Health and Safety Code is
repealed.
SEC. 31. Section 116064.2 of the Health and Safety Code is amended
to read:
116064.2. (a) As used in this section, the following words have
the following meanings:
(1) "ASME/ANSI performance standard" means a standard that is
accredited by the American National Standards Institute and published
by the American Society of Mechanical Engineers.
(2) "ASTM performance standard" means a standard that is developed
and published by ASTM International.
(3) "Main drain" means a submerged suction outlet typically
located at the bottom of a swimming pool that conducts water to a
recirculating pump.
(4) "Public swimming pool" means an outdoor or indoor structure,
whether in-ground or above-ground, intended for swimming or
recreational bathing, including a swimming pool, hot tub, spa, or
nonportable wading pool, that is any of the following:
(A) Open to the public generally, whether for a fee or free of
charge.
(B) Open exclusively to members of an organization and their
guests, residents of a multiunit apartment building, apartment
complex, residential
real estate development, or other multifamily residential area, or
patrons of a hotel or other public accommodations facility.
(C) Located on the premises of an athletic club, or public or
private school.
(5) "Qualified individual" means a contractor who holds a current
valid license issued by the State of California or a professional
engineer licensed in the State of California who has experience
working on public swimming pools.
(6) "Safety vacuum release system" means a vacuum release system
that ceases operation of the pump, reverses the circulation flow, or
otherwise provides a vacuum release at a suction outlet when a
blockage is detected.
(7) "Skimmer equalizer line" means a suction outlet located below
the waterline and connected to the body of a skimmer that prevents
air from being drawn into the pump if the water level drops below the
skimmer weir. However, a skimmer equalizer line is not a main drain.
(8) "Unblockable drain" means a drain of any size and shape that a
human body cannot sufficiently block to create a suction entrapment
hazard.
(b) Subject to subdivision (e), every public swimming pool shall
be equipped with antientrapment devices or systems that comply with
the ANSI/APSP-16 2011 standard as in effect on December 31, 2011.
(c) Subject to subdivisions (d) and (e), every public swimming
pool with a single main drain that is not an unblockable drain shall
be equipped with at least one or more of the following devices or
systems that are designed to prevent physical entrapment by pool
drains:
(1) A safety vacuum release system that has been tested by a
nationally recognized testing laboratory and found to conform to
ASME/ANSI performance standard A112.19.17, as in effect on December
31, 2009, or ASTM performance standard F2387, as in effect on
December 31, 2009.
(2) A suction-limiting vent system with a tamper-resistant
atmospheric opening, provided that it conforms to any applicable
ASME/ANSI or ASTM performance standard.
(3) A gravity drainage system that utilizes a collector tank,
provided that it conforms to any applicable ASME/ANSI or ASTM
performance standard.
(4) An automatic pump shut-off system tested by a
department-approved independent third party and found to conform to
any applicable ASME/ANSI or ASTM performance standard.
(5) Any other system that is deemed, in accordance with federal
law, to be equally effective as, or more effective than, the systems
described in paragraph (1) at preventing or eliminating the risk of
injury or death associated with pool drainage systems.
(d) Every public swimming pool constructed on or after January 1,
2010, shall have at least two main drains per pump that are
hydraulically balanced and symmetrically plumbed through one or more
"T" fittings, and that are separated by a distance of at least three
feet in any dimension between the drains. A public swimming pool
constructed on or after January 1, 2010, that meets the requirements
of this subdivision, shall be exempt from the requirements of
subdivision (c).
(e) A public swimming pool constructed prior to January 1, 2010,
shall be retrofitted to comply with subdivisions (b) and (c) by no
later than July 1, 2010, except that no further retrofitting is
required for a public swimming pool that completed a retrofit between
December 19, 2007, and January 1, 2010, that complied with the
Virginia Graeme Baker Pool and Spa Safety Act (15 U.S.C. Sec. 8001 et
seq.) as in effect on the date of issue of the construction permit,
or for a nonportable wading pool that completed a retrofit prior to
January 1, 2010, that complied with state law on the date of issue of
the construction permit. A public swimming pool owner who meets the
exception described in this subdivision shall do one of the following
prior to September 30, 2010:
(1) File the form issued by the department pursuant to subdivision
(f), as otherwise provided in subdivision (h).
(2) (A) File a signed statement attesting that the required work
has been completed.
(B) Provide a document containing the name and license number of
the qualified individual who completed the required work.
(C) Provide either a copy of the final building permit, if
required by the local agency, or a copy of one of the following
documents if no permit was required:
(i) A document that describes the modification in a manner that
provides sufficient information to document the work that was done to
comply with federal law.
(ii) A copy of the final paid invoice. The amount paid for the
services may be omitted or redacted from the final invoice prior to
submission.
(f) Prior to March 31, 2010, the department shall issue a form for
use by an owner of a public swimming pool to indicate compliance
with this section. The department shall consult with county health
officers and directors of departments of environmental health in
developing the form and shall post the form on the department's
Internet Web site. The form shall be completed by the owner of a
public swimming pool prior to filing the form with the appropriate
city, county, or city and county department of environmental health.
The form shall include, but not be limited to, the following
information:
(1) A statement of whether the pool operates with a single or
split main drain.
(2) Identification of the type of antientrapment devices or
systems that have been installed pursuant to subdivision (b) and the
date or dates of installation.
(3) Identification of the type of devices or systems designed to
prevent physical entrapment that have been installed pursuant to
subdivision (c) in a public swimming pool with a single main drain
that is not an unblockable drain and the date or dates of
installation or the reason why the requirement is not applicable.
(4) A signature and license number of a qualified individual who
certifies that the factual information provided on the form in
response to paragraphs (1) to (3), inclusive, is true to the best of
his or her knowledge.
(g) A qualified individual who improperly certifies information
pursuant to paragraph (4) of subdivision (f) shall be subject to
potential disciplinary action at the discretion of the licensing
authority.
(h) Except as provided in subdivision (e), each public swimming
pool owner shall file a completed copy of the form issued by the
department pursuant to this section with the city, county, or city
and county department of environmental health in the city, county, or
city and county in which the swimming pool is located. The form
shall be filed within 30 days following the completion of the
swimming pool construction or installation required pursuant to this
section or, if the construction or installation is completed prior to
the date that the department issues the form pursuant to this
section, within 30 days of the date that the department issues the
form. The public swimming pool owner or operator shall not make a
false statement, representation, certification, record, report, or
otherwise falsify information that he or she is required to file or
maintain pursuant to this section.
(i) In enforcing this section, health officers and directors of
city, county, or city and county departments of environmental health
shall consider documentation filed on or with the form issued
pursuant to this section by the owner of a public swimming pool as
evidence of compliance with this section. A city, county, or city and
county department of environmental health may verify the accuracy of
the information filed on or with the form.
(j) To the extent that the requirements for public wading pools
imposed by Section 116064 conflict with this section, the
requirements of this section shall prevail.
(k) The department shall have no authority to take any
enforcement action against any person for violation of this section
and has no responsibility to administer or enforce the provisions of
this section.
SEC. 32. Section 123865 of the Health and Safety Code is amended
to read:
123865. (a) Whenever the parents or estate of a handicapped child
is wholly or partly unable to furnish for the child necessary
services, the parents or guardian may apply to the agency of the
county that has been designated by the board of supervisors of the
county of residence under the terms of Section 123850 to administer
the provisions for handicapped children. Residence shall be
determined in accordance with Sections 243 and 244 of the Government
Code.
(b) If the child has an individualized education program (IEP)
pursuant to the federal Individuals with Disabilities Education Act
(IDEA; 20 U.S.C. Sec. 1400 et seq.), that IEP shall be disclosed to
the California Children's Services Program by the parents or the
estate of the handicapped child at the time of application provided
for in subdivision (a) and on revision of the child's IEP.
SEC. 33. Section 123870 of the Health and Safety Code is amended
to read:
123870. (a) The State Department of Health Care Services shall
establish standards of financial eligibility for treatment services
under the California Children's Services Program (CCS program).
(1) Financial eligibility for treatment services under this
program shall be limited to persons in families with an adjusted
gross income of forty thousand dollars ($40,000) or less in the most
recent tax year, as calculated for California state income tax
purposes. If a person is enrolled in the Healthy Families Program
(Part 6.2 (commencing with Section 12693) of Division 2 of the
Insurance Code), the financial documentation required for that
program in Section 2699.6600 of Title 10 of the California Code of
Regulations may be used instead of the person's California state
income tax return. However, the director may authorize treatment
services for persons in families with higher incomes if the estimated
cost of care to the family in one year is expected to exceed 20
percent of the family's adjusted gross income.
(2) Children enrolled in the Healthy Families Program who have a
CCS program eligible medical condition under Section 123830, and
whose families do not meet the financial eligibility requirements of
paragraph (1), shall be deemed financially eligible for CCS program
benefits.
(b) Necessary medical therapy treatment services under the CCS
program rendered in the public schools shall be exempt from financial
eligibility standards and enrollment fee requirements for the
services when rendered to any handicapped child whose physical
development would be impeded without the services. All occupational
and physical therapy services assessed and determined to be
educationally necessary by the individualized education program (IEP)
team and included in the child's IEP developed pursuant to the
provisions of the federal Individuals with Disabilities Education Act
(IDEA; 20 U.S.C. Sec. 1400 et seq.), shall be provided in accordance
with the provisions of that federal act and shall not be paid for by
the CCS program.
(c) All counties shall use the uniform standards for financial
eligibility and enrollment fees established by the department. All
enrollment fees shall be used in support of the CCS program.
(d) Annually, every family with a child eligible to receive
services under this article shall pay a fee of twenty dollars ($20),
that shall be in addition to any other program fees for which the
family is liable. This assessment shall not apply to any child who is
eligible for full scope Medi-Cal benefits without a share of cost,
for children receiving therapy in accordance with the federal IDEA as
a related service in their individualized education plans, for
children from families having incomes of less than 100 percent of the
federal poverty level, or for children covered under the Healthy
Families Program.
SEC. 33.5. Section 123870 of the Health and Safety Code is amended
to read:
123870. (a) The State Department of Health Care Services shall
establish standards of financial eligibility for treatment services
under the California Children's Services Program (CCS program).
(1) Financial eligibility for treatment services under this
program shall be limited to persons in families with an adjusted
gross income of forty thousand dollars ($40,000) or less in the most
recent tax year, as calculated for California state income tax
purposes. If a person is enrolled in the Healthy Families Program
(Part 6.2 (commencing with Section 12693) of Division 2 of the
Insurance Code), the financial documentation required for that
program in Section 2699.6600 of Title 10 of the California Code of
Regulations may be used instead of the person's California state
income tax return. If a person is enrolled in the Medi-Cal program
pursuant to Section 14005.26 of the Welfare and Institutions Code,
the financial documentation required to establish eligibility for the
Medi-Cal program may be used instead of the person's California
state income tax return. However, the director may authorize
treatment services for persons in families with higher incomes if the
estimated cost of care to the family in one year is expected to
exceed 20 percent of the family's adjusted gross income.
(2) Children enrolled in the Healthy Families Program, or enrolled
in the Medi-Cal program pursuant to Section 14005.26 of the Welfare
and Institutions Code, who have a CCS program eligible medical
condition under Section 123830, and whose families do not meet the
financial eligibility requirements of paragraph (1), shall be deemed
financially eligible for CCS program benefits.
(b) Necessary medical therapy treatment services under the CCS
program rendered in the public schools shall be exempt from financial
eligibility standards and enrollment fee requirements for the
services when rendered to any handicapped child whose physical
development would be impeded without the services. All occupational
and physical therapy services assessed and determined to be
educationally necessary by the individualized education program (IEP)
team and included in the child's IEP developed pursuant to the
provisions of the federal Individuals with Disabilities Education Act
(IDEA; 20 U.S.C. Sec. 1400 et seq.), shall be provided in accordance
with the provisions of that federal act and shall not be paid for by
the CCS program.
(c) All counties shall use the uniform standards for financial
eligibility and enrollment fees established by the department. All
enrollment fees shall be used in support of the CCS program.
(d) Annually, every family with a child eligible to receive
services under this article shall pay a fee of twenty dollars ($20),
that shall be in addition to any other program fees for which the
family is liable. This assessment shall not apply to any child who is
eligible for full scope Medi-Cal benefits without a share of cost,
for children receiving therapy in accordance with the federal IDEA as
a related service in their individualized education plans, for
children from families having incomes of less than 100 percent of the
federal poverty level, or for children covered under the Healthy
Families Program.
SEC. 34. Section 123875 of the Health and Safety Code is amended
to read:
123875. A handicapped child, as defined in Section 123830, who
applies to the California Children's Services Program in accordance
with Section 123865, shall be determined to be eligible for therapy
services when the California Children's Services Program's medical
therapy unit conference team finds that the child needs medically
necessary occupational or physical therapy. If the California
Children's Services medical consultant disagrees with the
determination of eligibility by the California Children's Services
medical therapy unit conference team, the medical consultant shall
communicate with the conference team to ask for further justification
of its determination, and shall weigh the conference team's
arguments in support of its decision in reaching his or her own
determination.
This section shall not change eligibility criteria for the
California Children's Services programs as described in Sections
123830 and 123860.
This section shall not apply to children diagnosed as specific
learning disabled, unless they otherwise meet the eligibility
criteria of the California Children's Services.
SEC. 35. Section 124300 of the Health and Safety Code is amended
to read:
124300. Within any county where 10 percent or more of the
population, as determined by the Population Research Unit of the
Department of Finance, speaks any one language other than English as
its native language, every local health department shall make copies
of circulars and pamphlets relating to family planning that are made
available to the public also available in the other language.
The State Department of Health Care Services, upon request, shall
make a translation available in other than English those family
planning informational materials normally distributed to the general
public.
SEC. 36. Section 125130 of the Health and Safety Code is amended
to read:
125130. The Director of Health Care Services shall establish and
administer a program for the medical care of persons with genetically
handicapping conditions, including cystic fibrosis, hemophilia,
sickle cell disease, Huntington's disease, Friedreich's Ataxia,
Joseph's disease, Von Hippel-Landau syndrome, and the following
hereditary metabolic disorders: phenylketonuria, homocystinuria,
branched chain amino acidurias, disorders of propionate and
methylmalonate metabolism, urea cycle disorders, hereditary orotic
aciduria, Wilson's Disease, galactosemia, disorders of lactate and
pyruvate metabolism, tyrosinemia, hyperornithinemia, and other
genetic organic acidemias that require specialized treatment or
service available from only a limited number of program-approved
sources.
The program shall also provide access to social support services,
that may help ameliorate the physical, psychological, and economic
problems attendant to genetically handicapping conditions, in order
that the genetically handicapped person may function at an optimal
level commensurate with the degree of impairment.
The medical and social support services may be obtained through
physicians and surgeons, genetically handicapped person's program
specialized centers, and other providers that qualify pursuant to the
regulations of the department to provide the services. "Medical
care," as used in this section, is limited to noncustodial medical
and support services.
The director shall adopt regulations that are necessary for the
implementation of this article.
SEC. 37. Section 125145 of the Health and Safety Code is repealed.
SEC. 38. Section 125205 of the Health and Safety Code is amended
to read:
125205. The department and the State Department of Social
Services shall, after consultation with the Genetically Handicapped
Persons Program of the department and consumer organizations
representing persons with chronic and degenerative conditions, as
defined in Section 125210, compile a list of long-term care resources
that serve adults with chronic and degenerative conditions, as
defined. The list of resources shall include those that have already
been identified by the Genetically Handicapped Persons Program as
serving persons with Huntington's disease, Joseph's disease, and
Friedrich's ataxia, and shall include those that have already been
identified by consumer organizations representing persons with
chronic and degenerative conditions. The list of resources shall
include, but not be limited to, the following:
(a) Public and private skilled nursing facilities and
intermediate care facilities.
(b) Public and private community residential care facilities.
(c) Public and private out-of-home long-term care resources such
as day activity programs, and in-home support service programs.
Nothing in this section shall require the State Department of Health
Care Services to undertake a survey of long-term care facilities or
programs in the state for the purposes of carrying out the
requirements of this section.
The information shall be made available to the public, upon
request, through the Genetically Handicapped Persons Program of the
department.
SEC. 39. Section 125215 of the Health and Safety Code is amended
to read:
125215. The department and the State Department of Social
Services shall review regulations that currently provide
disincentives to providers of in-home and out-of-home long-term care
resources, as defined in Section 125205, to accept and serve persons
with chronic and degenerative disorders. The review shall be
conducted with assistance and input from the Genetically Handicapped
Persons Program of the department. These departments shall provide a
list of those regulations to the Legislature by September 1, 1982.
The regulations subject to review shall be those regulations that do
the following:
(a) Affect the admission of patients to state-licensed skilled
nursing facilities, intermediate care facilities, and community
residential care facilities.
(b) Affect the staffing ratios necessary to care for persons with
chronic and degenerative conditions, as defined, within those
facilities.
(c) Affect the likelihood of facilities, or of day care programs
and in-home support service programs, to refuse the admission of
persons with chronic and degenerative conditions, solely on the basis
of anticipated jeopardy to their licensing, or on the basis of
anticipated liability to the facilities arising from instances where
a person's degenerative condition, by its own clinical merits,
results in medical complications that are, in fact, entirely
unrelated to the quality of care provided by the facility or program.
SEC. 40. Section 130060 of the Health and Safety Code is amended
to read:
130060. (a) (1) After January 1, 2008, any general acute care
hospital building that is determined to be a potential risk of
collapse or pose significant loss of life shall only be used for
nonacute care hospital purposes. A delay in this deadline may be
granted by the office upon a demonstration by the owner that
compliance will result in a loss of health care capacity that may not
be provided by other general acute care hospitals within a
reasonable proximity. In its request for an extension of the
deadline, a hospital shall state why the hospital is unable to comply
with the January 1, 2008, deadline requirement.
(2) Prior to granting an extension of the January 1, 2008,
deadline pursuant to this section, the office shall do all of the
following:
(A) Provide public notice of a hospital's request for an extension
of the deadline. The notice, at a minimum, shall be posted on the
office's Internet Web site, and shall include the facility's name and
identification number, the status of the request, and the beginning
and ending dates of the comment period, and shall advise the public
of the opportunity to submit public comments pursuant to subparagraph
(C). The office shall also provide notice of all requests for the
deadline extension directly to interested parties upon request of the
interested parties.
(B) Provide copies of extension requests to interested parties
within 10 working days to allow interested parties to review and
provide comment within the 45-day comment period. The copies shall
include those records that are available to the public pursuant to
the California Public Records Act (Chapter 3.5 (commencing with
Section 6250) of Division 7 of Title 1 of the Government Code).
(C) Allow the public to submit written comments on the extension
proposal for a period of not less than 45 days from the date of the
public notice.
(b) (1) It is the intent of the Legislature, in enacting this
subdivision, to facilitate the process of having more hospital
buildings in substantial compliance with this chapter and to take
nonconforming general acute care hospital inpatient buildings out of
service more quickly.
(2) The functional contiguous grouping of hospital buildings of a
general acute care hospital, each of which provides, as the primary
source, one or more of the hospital's eight basic services as
specified in subdivision (a) of Section 1250, may receive a five-year
extension of the January 1, 2008, deadline specified in subdivision
(a) of this section pursuant to this subdivision for both structural
and nonstructural requirements. A functional contiguous grouping
refers to buildings containing one or more basic hospital services
that are either attached or connected in a way that is acceptable to
the State Department of Health Care Services. These buildings may be
either on the existing site or a new site.
(3) To receive the five-year extension, a single building
containing all of the basic services or at least one building within
the contiguous grouping of hospital buildings shall have obtained a
building permit prior to 1973 and this building shall be evaluated
and classified as a nonconforming, Structural Performance Category-1
(SPC-1) building. The classification shall be submitted to and
accepted by the Office of Statewide Health Planning and Development.
The identified hospital building shall be exempt from the requirement
in subdivision (a) until January 1, 2013, if the hospital agrees
that the basic service or services that were provided in that
building shall be provided, on or before January 1, 2013, as follows:
(A) Moved into an existing conforming Structural Performance
Category-3 (SPC-3), Structural Performance Category-4 (SPC-4), or
Structural Performance Category-5 (SPC-5) and Non-Structural
Performance Category-4 (NPC-4) or Non-Structural Performance
Category-5 (NPC-5) building.
(B) Relocated to a newly built compliant SPC-5 and NPC-4 or NPC-5
building.
(C) Continued in the building if the building is retrofitted to a
SPC-5 and NPC-4 or NPC-5 building.
(4) A five-year extension is also provided to a post-1973 building
if the hospital owner informs the Office of Statewide Health
Planning and Development that the building is classified as SPC-1,
SPC-3, or SPC-4 and will be closed to general acute care inpatient
service use by January 1, 2013. The basic services in the building
shall be relocated into a SPC-5 and NPC-4 or NPC-5 building by
January 1, 2013.
(5) SPC-1 buildings, other than the building identified in
paragraph (3) or (4), in the contiguous grouping of hospital
buildings shall also be exempt from the requirement in subdivision
(a) until January 1, 2013. However, on or before January 1, 2013, at
a minimum, each of these buildings shall be retrofitted to a SPC-2
and NPC-3 building, or no longer be used for general acute care
hospital inpatient services.
(c) On or before March 1, 2001, the office shall establish
a schedule of interim work progress deadlines that hospitals shall
be required to meet to be eligible for the extension specified in
subdivision (b). To receive this extension, the hospital building or
buildings shall meet the year 2002 nonstructural requirements.
(d) A hospital building that is eligible for an extension pursuant
to this section shall meet the January 1, 2030, nonstructural and
structural deadline requirements if the building is to be used for
general acute care inpatient services after January 1, 2030.
(e) Upon compliance with subdivision (b), the hospital shall be
issued a written notice of compliance by the office. The office shall
send a written notice of violation to hospital owners that fail to
comply with this section. The office shall make copies of these
notices available on its Internet Web site.
(f) (1) A hospital that has received an extension of the January
1, 2008, deadline pursuant to subdivision (a) or (b) may request an
additional extension of up to two years for a hospital building that
it owns or operates and that meets the criteria specified in
paragraph (2), (3), or (5).
(2) The office may grant the additional extension if the hospital
building subject to the extension meets all of the following
criteria:
(A) The hospital building is under construction at the time of the
request for extension under this subdivision and the purpose of the
construction is to meet the requirements of subdivision (a) to allow
the use of the building as a general acute care hospital building
after the extension deadline granted by the office pursuant to
subdivision (a) or (b).
(B) The hospital building plans were submitted to the office and
were deemed ready for review by the office at least four years prior
to the applicable deadline for the building. The hospital shall
indicate, upon submission of its plans, the SPC-1 building or
buildings that will be retrofitted or replaced to meet the
requirements of this section as a result of the project.
(C) The hospital received a building permit for the construction
described in subparagraph (A) at least two years prior to the
applicable deadline for the building.
(D) The hospital submitted a construction timeline at least two
years prior to the applicable deadline for the building demonstrating
the hospital's intent to meet the applicable deadline. The timeline
shall include all of the following:
(i) The projected construction start date.
(ii) The projected construction completion date.
(iii) Identification of the contractor.
(E) The hospital is making reasonable progress toward meeting the
timeline set forth in subparagraph (D), but factors beyond the
hospital's control make it impossible for the hospital to meet the
deadline.
(3) The office may grant the additional extension if the hospital
building subject to the extension meets all of the following
criteria:
(A) The hospital building is owned by a health care district that
has, as owner, received the extension of the January 1, 2008,
deadline, but where the hospital is operated by an unaffiliated
third-party lessee pursuant to a facility lease that extends at least
through December 31, 2009. The district shall file a declaration
with the office with a request for an extension stating that, as of
the date of the filing, the district has lacked, and continues to
lack, unrestricted access to the subject hospital building for
seismic planning purposes during the term of the lease, and that the
district is under contract with the county to maintain hospital
services when the hospital comes under district control. The office
shall not grant the extension if an unaffiliated third-party lessee
will operate the hospital beyond December 31, 2010.
(B) The hospital building plans were submitted to the office and
were deemed ready for review by the office at least four years prior
to the applicable deadline for the building. The hospital shall
indicate, upon submission of its plans, the SPC-1 building or
buildings that will be retrofitted or replaced to meet the
requirements of this section as a result of the project.
(C) The hospital received a building permit for the construction
described in subparagraph (B) by December 31, 2011.
(D) The hospital submitted, by December 31, 2011, a construction
timeline for the building demonstrating the hospital's intent and
ability to meet the deadline of December 31, 2014. The timeline shall
include all of the following:
(i) The projected construction start date.
(ii) The projected construction completion date.
(iii) Identification of the contractor.
(E) The hospital building is under construction at the time of the
request for the extension, the purpose of the construction is to
meet the requirements of subdivision (a) to allow the use of the
building as a general acute care hospital building after the
extension deadline granted by the office pursuant to subdivision (a)
or (b), and the hospital is making reasonable progress toward meeting
the timeline set forth in subparagraph (D).
(F) The hospital granted an extension pursuant to this paragraph
shall submit an additional status report to the office, equivalent to
that required by subdivision (c) of Section 130061, no later than
June 30, 2013.
(4) An extension granted pursuant to paragraph (3) shall be
applicable only to the health care district applicant and its
affiliated hospital while the hospital is operated by the district or
an entity under the control of the district.
(5) The office may grant the additional extension if the hospital
building subject to the extension meets all of the following
criteria:
(A) The hospital owner submitted to the office, prior to June 30,
2009, a request for review using current computer modeling utilized
by the office and based upon software developed by the Federal
Emergency Management Agency, referred to as Hazards US, and the
building was deemed SPC-1 after that review.
(B) The hospital building plans for the building are submitted to
the office and deemed ready for review by the office prior to July 1,
2010. The hospital shall indicate, upon submission of its plans, the
SPC-1 building or buildings that shall be retrofitted or replaced to
meet the requirements of this section as a result of the project.
(C) The hospital receives a building permit from the office for
the construction described in subparagraph (B) prior to January 1,
2012.
(D) The hospital submits, prior to January 1, 2012, a construction
timeline for the building demonstrating the hospital's intent and
ability to meet the applicable deadline. The timeline shall include
all of the following:
(i) The projected construction start date.
(ii) The projected construction completion date.
(iii) Identification of the contractor.
(E) The hospital building is under construction at the time of the
request for the extension, the purpose of the construction is to
meet the requirements of subdivision (a) to allow the use of the
building as a general acute care hospital building after the
extension deadline granted by the office pursuant to subdivision (a)
or (b), and the hospital is making reasonable progress toward meeting
the timeline set forth in subparagraph (D).
(F) The hospital owner completes construction such that the
hospital meets all criteria to enable the office to issue a
certificate of occupancy by the applicable deadline for the building.
(6) A hospital denied an extension pursuant to this subdivision
may appeal the denial to the Hospital Building Safety Board.
(7) The office may revoke an extension granted pursuant to this
subdivision for any hospital building where the work of construction
is abandoned or suspended for a period of at least one year, unless
the hospital demonstrates in a public document that the abandonment
or suspension was caused by factors beyond its control.
(g) (1) Notwithstanding subdivisions (a), (b), (c), and (f), and
Sections 130061.5 and 130064, a hospital that has received an
extension of the January 1, 2008, deadline pursuant to subdivision
(a) or (b) also may request an additional extension of up to seven
years for a hospital building that it owns or operates. The office
may grant the extension subject to the hospital meeting the
milestones set forth in paragraph (2).
(2) The hospital building subject to the extension shall meet all
of the following milestones, unless the hospital building is
reclassified as SPC-2 or higher as a result of its Hazards US score:
(A) The hospital owner submits to the office, no later than
September 30, 2012, a letter of intent stating whether it intends to
rebuild, replace, or retrofit the building, or remove all general
acute care beds and services from the building, and the amount of
time necessary to complete the construction.
(B) The hospital owner submits to the office, no later than
September 30, 2012, a schedule detailing why the requested extension
is necessary, and specifically how the hospital intends to meet the
requested deadline.
(C) The hospital owner submits to the office, no later than
September 30, 2012, an application ready for review seeking
structural reassessment of each of its SPC-1 buildings using current
computer modeling based upon software developed by FEMA, referred to
as Hazards US.
(D) The hospital owner submits to the office, no later than
January 1, 2015, plans ready for review consistent with the letter of
intent submitted pursuant to subparagraph (A) and the schedule
submitted pursuant to subparagraph (B).
(E) The hospital owner submits a financial report to the office at
the time the plans are submitted pursuant to subparagraph (D). The
report shall demonstrate the hospital owner's financial capacity to
implement the construction plans submitted pursuant to subparagraph
(D).
(F) The hospital owner receives a building permit consistent with
the letter of intent submitted pursuant to subparagraph (A) and the
schedule submitted pursuant to subparagraph (B), no later than July
1, 2018.
(3) To evaluate public safety and determine whether to grant an
extension of the deadline, the office shall consider the structural
integrity of the hospital's SPC-1 buildings based on its Hazards US
scores, community access to essential hospital services, and the
hospital owner's financial capacity to meet the deadline as
determined by either a bond rating of BBB or below or the financial
report on the hospital owner's financial capacity submitted pursuant
to subparagraph (E) of paragraph (2). The criteria contained in this
paragraph shall be considered by the office in its determination of
the length of an extension or whether an extension should be granted.
(4) The extension or subsequent adjustments granted pursuant to
this subdivision may not exceed the amount of time that is reasonably
necessary to complete the construction specified in paragraph (2).
(5) If the circumstances underlying the request for extension
submitted to the office pursuant to paragraph (2) change, the
hospital owner shall notify the office as soon as practicable, but in
no event later than six months after the hospital owner discovered
the change of circumstances. The office may adjust the length of the
extension granted pursuant to paragraphs (2) and (3) as necessary,
but in no event longer than the period specified in paragraph (1).
(6) A hospital denied an extension pursuant to this subdivision
may appeal the denial to the Hospital Building Safety Board.
(7) The office may revoke an extension granted pursuant to this
subdivision for any hospital building when it is determined that any
information submitted pursuant to this section was falsified, or if
the hospital failed to meet a milestone set forth in paragraph (2),
or where the work of construction is abandoned or suspended for a
period of at least six months, unless the hospital demonstrates in a
publicly available document that the abandonment or suspension was
caused by factors beyond its control.
(8) Regulatory submissions made by the office to the California
Building Standards Commission to implement this section shall be
deemed to be emergency regulations and shall be adopted as emergency
regulations.
(9) The hospital owner that applies for an extension pursuant to
this subdivision shall pay the office an additional fee, to be
determined by the office, sufficient to cover the additional
reasonable costs incurred by the office for maintaining the
additional reporting requirements established under this section,
including, but not limited to, the costs of reviewing and verifying
the extension documentation submitted pursuant to this subdivision.
This additional fee shall not include any cost for review of the
plans or other duties related to receiving a building or occupancy
permit.
(10) This subdivision shall become operative on the date that the
State Department of Health Care Services receives all necessary
federal approvals for a 2011-12 fiscal year hospital quality
assurance fee program that includes three hundred twenty million
dollars ($320,000,000) in fee revenue to pay for health care coverage
for children, which is made available as a result of the legislative
enactment of a 2011-12 fiscal year hospital quality assurance fee
program.
SEC. 41. Section 130316 of the Health and Safety Code is amended
to read:
130316. Any funds appropriated for the purpose of this division
that remain unexpended or unencumbered on June 30, 2016, shall revert
to the General Fund on that date unless a statute that is enacted
before June 30, 2016, extends the provisions of this division.
SEC. 42. Section 130317 of the Health and Safety Code is amended
to read:
130317. This division shall become inoperative on June 30, 2016,
and as of that date is repealed, unless a later enacted statute, that
is enacted before June 30, 2016, deletes or extends the dates on
which it becomes inoperative and is repealed.
SEC. 43. Section 131019.5 is added to the Health and Safety Code,
to read:
131019.5. (a) For purposes of this section, the following
definitions shall apply:
(1) "Determinants of equity" means social, economic, geographic,
political, and physical environmental conditions that lead to the
creation of a fair and just society.
(2) "Health equity" means efforts to ensure that all people have
full and equal access to opportunities that enable them to lead
healthy lives.
(3) "Health and mental health disparities" means differences in
health and mental health status among distinct segments of the
population, including differences that occur by gender, age, race or
ethnicity, sexual orientation, gender identity, education or income,
disability or functional impairment, or geographic location, or the
combination of any of these factors.
(4) "Health and mental health inequities" means disparities in
health or mental health, or the factors that shape health, that are
systemic and avoidable and, therefore, considered unjust or unfair.
(5) "Vulnerable communities" include, but are not limited to,
women, racial or ethnic groups, low-income individuals and families,
individuals who are incarcerated and those who have been
incarcerated, individuals with disabilities, individuals with mental
health conditions, children, youth and young adults, seniors,
immigrants and refugees, individuals who are limited-English
proficient (LEP), and lesbian, gay, bisexual, transgender, queer, and
questioning (LGBTQQ) communities, or combinations of these
populations.
(6) "Vulnerable places" means places or communities with
inequities in the social, economic, educational, or physical
environment or environmental health and that have insufficient
resources or capacity to protect and promote the health and
well-being of their residents.
(b) The State Department of Public Health shall establish an
Office of Health Equity for the purposes of aligning state resources,
decisionmaking, and programs to accomplish all of the following:
(1) Achieve the highest level of health and mental health for all
people, with special attention focused on those who have experienced
socioeconomic disadvantage and historical injustice, including, but
not limited to, vulnerable communities and culturally,
linguistically, and geographically isolated communities.
(2) Work collaboratively with the Health in All Policies Task
Force to promote work to prevent injury and illness through improved
social and environmental factors that promote health and mental
health.
(3) Advise and assist other state departments in their mission to
increase access to, and the quality of, culturally and linguistically
competent health and mental health care and services.
(4) Improve the health status of all populations and places, with
a priority on eliminating health and mental health disparities and
inequities.
(c) The duties of the Office of Health Equity shall include all of
the following:
(1) Conducting policy analysis and developing strategic policies
and plans regarding specific issues affecting vulnerable communities
and vulnerable places to increase positive health and mental health
outcomes for vulnerable communities and decrease health and mental
health disparities and inequities. The policies and plans shall also
include strategies to address social and environmental inequities and
improve health and mental health. The office shall assist other
departments in their missions to increase access to services and
supports and improve quality of care for vulnerable communities.
(2) Establishing a comprehensive, cross-sectoral strategic plan to
eliminate health and mental health disparities and inequities. The
strategies and recommendations developed shall take into account the
needs of vulnerable communities to ensure strategies are developed
throughout the state to eliminate health and mental health
disparities and inequities. This plan shall be developed in
collaboration with the Health in All Policies Task Force. This plan
shall establish goals and benchmarks for specific strategies in order
to measure and track disparities and the effectiveness of these
strategies. This plan shall be updated periodically, but not less
than every two years, to keep abreast of data trends, best practices,
promising practices, and to more effectively focus and direct
necessary resources to mitigate and eliminate disparities and
inequities. This plan shall be included in the report required under
paragraph (1) of subdivision (d). The Office of Health Equity shall
seek input from the public on the plan through an inclusive public
stakeholder process.
(3) Building upon and informing the work of the Health in All
Policies Task Force in working with state agencies and departments to
consider health in appropriate and relevant aspects of public policy
development to ensure the implementation of goals and objectives
that close the gap in health status. The Office of Health Equity
shall work collaboratively with the Health in All Policies Task Force
to assist state agencies and departments in developing policies,
systems, programs, and environmental change strategies that have
population health impacts in all of the following ways, within the
resources made available:
(A) Develop intervention programs with targeted approaches to
address health and mental health inequities and disparities.
(B) Prioritize building cross-sectoral partnerships within and
across departments and agencies to change policies and practices to
advance health equity.
(C) Work with the advisory committee established pursuant to
subdivision (f) and through stakeholder meetings to provide a forum
to identify and address the complexities of health and mental health
inequities and disparities and the need for multiple, interrelated,
and multisectoral strategies.
(D) Provide technical assistance to state and local agencies and
departments with regard to building organizational capacity, staff
training, and facilitating communication to facilitate strategies to
reduce health and mental health disparities.
(E) Highlight and share evidence-based, evidence-informed, and
community-based practices for reducing health and mental health
disparities and inequities.
(F) Work with local public health departments, county mental
health or behavioral health departments, local social services, and
mental health agencies, and other local agencies that address key
health determinants, including, but not limited to, housing,
transportation, planning, education, parks, and economic development.
The Office of Health Equity shall seek to link local efforts with
statewide efforts.
(4) Consult with community-based organizations and local
governmental agencies to ensure that community perspectives and input
are included in policies and any strategic plans, recommendations,
and implementation activities.
(5) Assist in coordinating projects funded by the state that
pertain to increasing the health and mental health status of
vulnerable communities.
(6) Provide consultation and technical assistance to state
departments and other state and local agencies charged with providing
or purchasing state-funded health and mental health care, in their
respective missions to identify, analyze, and report disparities and
to identify strategies to address health and mental health
disparities.
(7) Provide information and assistance to state and local
departments in coordinating projects within and across state
departments that improve the effectiveness of public health and
mental health services to vulnerable communities and that address
community environments to promote health. This information shall
identify unnecessary duplication of services.
(8) Communicate and disseminate information within the department
and with other state departments to assist in developing strategies
to improve the health and mental health status of persons in
vulnerable communities and to share strategies that address the
social and environmental determinants of health.
(9) Provide consultation and assistance to public and private
entities that are attempting to create innovative responses to
improve the health and mental health status of vulnerable
communities.
(10) Seek additional resources, including in-kind assistance,
federal funding, and foundation support.
(d) In identifying and developing recommendations for strategic
plans, the Office of Health Equity shall, at a minimum, do all of the
following:
(1) Conduct demographic analyses on health and mental health
disparities and inequities. The report shall include, to the extent
feasible, an analysis of the underlying conditions that contribute to
health and well-being. The first report shall be due July 1, 2014.
This information shall be updated periodically, but not less than
every two years, and made available through public dissemination,
including posting on the department's Internet Web site. The report
shall be developed using primary and secondary sources of demographic
information available to the office, including the work and data
collected by the Health in All Policies Task Force. Primary sources
of demographic information shall be collected contingent on the
receipt of state, federal, or private funds for this purpose.
(2) Based on the availability of data, including valid data made
available from secondary sources, the report described in paragraph
(1) shall address the following key factors as they relate to health
and mental health disparities and inequities:
(A) Income security such as living wage, earned income tax credit,
and paid leave.
(B) Food security and nutrition such as food stamp eligibility and
enrollment, assessments of food access, and rates of access to
unhealthy food and beverages.
(C) Child development, education, and literacy rates, including
opportunities for early childhood development and parenting support,
rates of graduation compared to dropout rates, college attainment,
and adult literacy.
(D) Housing, including access to affordable, safe, and healthy
housing, housing near parks and with access to healthy foods, and
housing that incorporates universal design and visitability features.
(E) Environmental quality, including exposure to toxins in the
air, water, and soil.
(F) Accessible built environments that promote health and safety,
including mixed-used land, active transportation such as improved
pedestrian, bicycle, and automobile safety, parks and green space,
and healthy school siting.
(G) Health care, including accessible disease management programs,
access to affordable, quality health and behavioral health care,
assessment of the health care workforce, and workforce diversity.
(H) Prevention efforts, including community-based education and
availability of preventive services.
(I) Assessing ongoing discrimination and minority stressors
against individuals and groups in vulnerable communities based upon
race, gender, gender identity, gender expression, ethnicity, marital
status, language, sexual orientation, disability, and other factors,
such as discrimination that is based upon bias and negative attitudes
of health professionals and providers.
(J) Neighborhood safety and collective efficacy, including rates
of violence, increases or decreases in community cohesion, and
collaborative efforts to improve the health and well-being of the
community.
(K) The efforts of the Health in All Policies Task Force,
including monitoring and identifying efforts to include health and
equity in all sectors.
(L) Culturally appropriate and competent services and training in
all sectors, including training to eliminate bias, discrimination,
and mistreatment of persons in vulnerable communities.
(M) Linguistically appropriate and competent services and training
in all sectors, including the availability of information in
alternative formats such as large font, braille, and American Sign
Language.
(N) Accessible, affordable, and appropriate mental health
services.
(3) Consult regularly with representatives of vulnerable
communities, including diverse racial, ethnic, cultural, and LGBTQQ
communities, women's health advocates, mental health advocates,
health and mental health providers, community-based organizations and
advocates, academic institutions, local public health departments,
local government entities, and low-income and vulnerable consumers.
(4) Consult regularly with the advisory committee established by
subdivision (f) for input and updates on the policy recommendations,
strategic plans, and status of cross-sectoral work.
(e)
The Office of Health Equity shall be organized as follows:
(1) A Deputy Director shall be appointed by the Governor or the
State Public Health Officer, and is subject to confirmation by the
Senate. The salary for the Deputy Director shall be fixed in
accordance with state law.
(2) The Deputy Director of the Office of Health Equity shall
report to the State Public Health Officer and shall work closely with
the Director of Health Care Services to ensure compliance with the
requirements of the office's strategic plans, policies, and
implementation activities.
(f) The Office of Health Equity shall establish an advisory
committee to advance the goals of the office and to actively
participate in decisionmaking. The advisory committee shall be
composed of representatives from applicable state agencies and
departments, local health departments, community-based organizations
working to advance health and mental health equity, vulnerable
communities, and stakeholder communities that represent the diverse
demographics of the state. The chair of the advisory committee shall
be a representative from a nonstate entity. The advisory committee
shall be established by no later than October 1, 2013, and shall
meet, at a minimum, on a quarterly basis. Subcommittees of this
advisory committee may be formed as determined by the chair.
(g) An interagency agreement shall be established between the
State Department of Public Health and the State Department of Health
Care Services to outline the process by which the departments will
jointly work to advance the mission of the Office of Health Equity,
including responsibilities, scope of work, and necessary resources.
SEC. 44. Section 131051 of the Health and Safety Code is amended
to read:
131051. The duties, powers, functions, jurisdiction, and
responsibilities transferred to the State Department of Public Health
shall, pursuant to the act that added this section, include all of
the following previously performed by the former State Department of
Health Services:
(a) Under the jurisdiction of the Deputy Director for Prevention
Services:
(1) The Office of AIDS, including but not limited to:
(A) The AIDS Drug Assistance Program (Chapter 6 (commencing with
Section 120950) of Part 4 of Division 105).
(B) The AIDS Early Intervention Program (Chapter 4 (commencing
with Section 120900) of Part 4 of Division 105).
(C) The CARE Services Program, provided for pursuant to the
federal Ryan White CARE Act, 42 U.S.C. Section 300ff.
(D) The CARE/Health Insurance Premium Payment Program (federal
Ryan White CARE Act, 42 U.S.C. Sec. 300ff).
(E) The Housing Opportunities for Persons with AIDS Program
(Section 100119).
(F) The Residential AIDS Licensed Facilities Program (former
Section 100119; Chapter 2 (commencing with Section 120815) of Part 4
of Division 105).
(G) The AIDS Case Management Program (federal Ryan White CARE Act,
42 U.S.C. Sec. 300ff; Chapter 2 (commencing with Section 120815) of
Part 4 of Division 105).
(H) The AIDS Medi-Cal Waiver Program (former Section 100119; 42
U.S.C. Sec. 1396n(c)).
(I) The Bridge Project (former Section 100119).
(J) The HIV Therapeutic Monitoring Program (Chapter 16 (commencing
with Section 121345) of Part 4 of Division 105).
(K) The Learning Immune Function Enhancement program (former
Section 100119).
(L) The San Ysidro Prevention Project (Section 113019).
(M) The California Statewide Treatment Education Program (former
Section 100119).
(N) The HIV Counseling and Testing Program (Section 113019).
(O) The Neighborhood Intervention Geared Toward High-Risk Testing
program (former Section 100119).
(P) The Perinatal Transmission Prevention Project (Section
113019).
(Q) The California AIDS Clearinghouse (Section 113019).
(R) The California Disclosure Assistance and Partner
Services/Partner Counseling and Referral Services (Section 113019).
(S) The African-American HIV Initiative (Section 113019; Chapter
13.7 (commencing with Section 120290) of Part 4 of Division 105).
(T) The Injection Drug User HIV Testing Utilizing Hepatitis C
Testing High-Risk Initiative (Section 113019).
(U) The Prevention with Positives High-Risk Initiative (Section
113019).
(V) The Statewide Technical Assistance Initiatives (Section
113019).
(W) The HIV/AIDS Case Registry (Sections 113019, 120125, and
120130).
(2) The Office of Binational Border Health, including, but not
limited to, all of the following:
(A) The California-Mexico Health Initiative (Part 3 (commencing
with Section 475) of Division 1).
(B) The Early Warning Infectious Disease Surveillance Program
(Chapter 2 (commencing with Section 1250) of Division 2; Chapter 2
(commencing with Section 120130) of Part 1 of Division 105).
(3) The Division of Communicable Disease Control, including, but
not limited to, all of the following:
(A) The Infant Botulism Treatment and Prevention Program (Article
2.5 (commencing with Section 123700) of Chapter 3 of Part 2 of
Division 106).
(B) The Sexually Transmitted Disease Control Program (Part 3
(commencing with Section 120500) of Division 105).
(C) The Infectious Disease Program (Chapter 2 (commencing with
Section 120130) of Part 1 of Division 105).
(D) The Bioterrorism Epidemiology Program.
(E) The Vector Borne Disease (Part 11 (commencing with Section
116100) of Division 104).
(F) The Tuberculosis Control Program (Part 5 (commencing with
Section 121350) of Division 105).
(G) The Microbial Diseases Laboratory (Chapter 2 (commencing with
Section 100250) of Division 101).
(H) The Viral and Rickettsial Disease Laboratory (Chapter 2
(commencing with Section 100250) of Division 101).
(I) The West Nile Human Surveillance Program (Chapter 2
(commencing with Section 116110) of Part 11 of Division 104).
(J) The Immunization Program (Part 2 (commencing with Section
120325) of Division 105).
(K) The Vaccines for Children Program (Part 2 (commencing with
Section 120325) of Division 105).
(4) The Division of Chronic Disease and Injury Control, including,
but not limited to, all of the following:
(A) The IMPACT Prostate Cancer Treatment Program (Chapter 7
(commencing with Section 104322) of Part 1 of Division 103), until
June 30, 2012. Commencing July 1, 2012, the duties, powers,
functions, jurisdiction, and responsibilities of the State Department
of Public Health regarding this program are hereby with the State
Department of Health Care Services.
(B) The Every Woman Counts program (Breast and Cervical Cancer
Screening Program) (Article 1.3 (commencing with Section 104150) of
Chapter 2 of Part 1 of Division 103; Section 30461.6 of the Revenue
and Taxation Code), until June 30, 2012. Commencing July 1, 2012, the
duties, powers, functions, jurisdiction, and responsibilities of the
State Department of Public Health regarding this program are hereby
with the State Department of Health Care Services.
(C) The Well-Integrated Screening and Evaluation for Women Across
the Nation Demonstration Project (Article 1.3 (commencing with
Section 104150) of Chapter 2 of Part 1 of Division 103).
(D) The California Nutrition Network (Chapter 2 (commencing with
Section 104575) of Part 3 of Division 103).
(E) The Cancer Research Program (Article 2 (commencing with
Section 104175) of Chapter 2 of Part 1 of Division 103).
(F) The Translational Cancer Research and Technology Transfer
Program (Article 2 (commencing with Section 104175) of Chapter 2 of
Part 1 of Division 103).
(G) The Ken Maddy California Cancer Registry (Chapter 2
(commencing with Section 103875) of Part 2 of Division 102).
(H) The California Osteoporosis Prevention and Education Program
(Chapter 1 (commencing with Section 125700) of Part 8 of Division
106).
(I) The Preventive Health Care for the Aging Program (Part 4
(commencing with Section 104900) of Division 103).
(J) The California Arthritis Prevention Program (former Section
100185).
(K) The Office of Oral Health (Chapter 3 (commencing with Section
104750) of Part 3 of Division 103).
(L) The Children's Dental Disease Prevention Program (Article 3
(commencing with Section 104770) of Chapter 3 of Part 3 of Division
103).
(M) The Community Water Fluoridation Program (Article 3.5
(commencing with Section 116409) of Chapter 4 of Part 12 of Division
104).
(N) The California Asthma Public Health Initiative (Chapter 6.5
(commencing with Section 104316) of Part 1 of Division 103).
(O) The California Obesity Prevention Initiative (Chapter 2
(commencing with Section 104575) of Part 3 of Division 103).
(P) The School Health Connections program (Chapter 2 (commencing
with Section 104575) of Part 3 of Division 103).
(Q) The California Project LEAN (Chapter 2 (commencing with
Section 104575) of Part 3 of Division 103).
(R) The California Center for Physical Activity (Section 131085).
(S) The California Diabetes Program (Section 131085).
(T) The Preventive Medicine Residency Program (Section 131090).
(U) The California Epidemiologic Investigation Service (Article 4
(commencing with Section 100325) of Chapter 2 of Part 1 of Division
101).
(V) The Continuing Professional Education Program (Section
131090).
(W) The Injury Surveillance and Epidemiology Program (Part 2
(commencing with Section 104325) of Division 103).
(X) The State and Local Injury Control Program (Chapter 1
(commencing with Section 104325) of Part 2 of Division 103).
(Y) The Office on Disability and Health (former Section 100185).
(Z) The Alzheimer's Disease Program (Article 4 (commencing with
Section 125275) of Chapter 2 of Part 5 of Division 106).
(AA) The California Tobacco Control Program (Chapter 1 (commencing
with Section 104350) of Part 3 of Division 103).
(5) The Division of Drinking Water and Environmental Management,
including, but not limited to, all of the following:
(A) The Medical Waste Management Program (Part 14 (commencing with
Section 117600) of Division 104).
(B) The Department of Defense Oversight Program (Radiologic
Guidance and Approvals) (Part 9 (commencing with Section 114650) of
Division 104).
(C) The Nuclear Emergency Response Program (Part 9 (commencing
with Section 114650) of Division 104).
(D) The Institutions Program (Environmental Surveys) (Article 5
(commencing with Section 116025) of Chapter 5 of Part 10 of Division
104).
(E) The Drinking Water Field Management program (Chapter 4
(commencing with Section 116270) of Part 12 of Division 104).
(F) The Environmental Health Specialist Registration Program
(Article 1 (commencing with Section 106600) of Chapter 4 of Part 1 of
Division 104).
(G) The Sanitation and Radiation Laboratory (Article 2 (commencing
with Section 100250) of Chapter 2 of Part 1 of Division 101);
Chapter 4 (commencing with Section 116270) of Part 12 of Division
104).
(H) The Radon Program (Chapter 7 (commencing with Section 105400)
of Part 5 of Division 103; Chapter 4 (commencing with Section 116270)
of Part 12, and Article 2 (commencing with Section 106750) of
Chapter 4 of Part 1, of Division 104).
(I) The Shellfish Sanitation Program (Chapter 5 (commencing with
Section 112150) of Part 6 of Division 104).
(J) The Ocean Beach Safety Programs (Article 2 (commencing with
Section 115875) of Chapter 5 of Part 10 of Division 104).
(K) The Bioterrorism Planning and Response for Drinking Water,
Medical Waste, and Environmental Health program (Article 6
(commencing with Section 101315) of Chapter 3 of Part 3 of Division
101).
(L) The Safe Drinking Water State Revolving Fund (Chapter 4.5
(commencing with Section 116760) of Part 12 of Division 104).
(M) The Drinking Water Technical Programs (Chapter 4 (commencing
with Section 16270) of Part 12 of Division 104; Chapter 4.5
(commencing with Section 116760) of Part 12 of Division 104; Article
3 (commencing with Section 106875) of Chapter 4 of Part 1 of Division
104; Chapter 5 (commencing with Section 116775) of Part 12 of
Division 104; Chapter 5 (commencing with Section 115825) of Part 10
of Division 104; Chapter 7 (commencing with Section 13500) of
Division 7 of the Water Code; Section 13411 of the Water Code).
(N) The Water Security, Clean Drinking Water, Coastal and Beach
Protection Act of 2002 (Proposition 50) (Division 26.5 (commencing
with Section 79500) of the Water Code).
(6) The Division of Environmental and Occupational Disease
Control, including, but not limited to, all of the following:
(A) The California Birth Defect Monitoring Program (Chapter 1
(commencing with Section 103825) of Part 2 of Division 102).
(B) The Childhood Lead Poisoning Prevention Program (Chapter 5
(commencing with Section 105275) of Part 5 of Division 103; Article 7
(commencing with Section 124125) of Chapter 3 of Part 2 of Division
106).
(C) The Lead Related Construction Program (Chapter 4 (commencing
with Section 105250) of Part 5 of Division 103).
(D) The Epidemiology Studies Laboratory (Sections 25416, former
Section 100170, Section 100325, and Section 104324.25).
(E) The Center for Autism and Developmental Disabilities Research
and Epidemiology (former Section 100170).
(F) The Cancer Cluster/Environmental Investigations (former
Section 100170).
(G) The Toxic Mold Program (Chapter 18 (commencing with Section
26100) of Division 20).
(H) The Federal Agency for Toxic Substances and Disease Registry
Health Assessments, Education and Investigations program (former
Section 100170).
(I) The Fish Contamination Outreach and Education program (former
Section 100170).
(J) The Air Pollution and Cardiovascular Disease in the California
Teachers Study Cohort Project (former Section 100170).
(K) The Delta Watershed Fish Project (outreach, education, and
training to reduce exposures to mercury in fish) (former Section
100170).
(L) The Environmental Health Laboratory (former Section 100170;
Article 2 (commencing with Section 100250) of Chapter 2 of Part 1 of
Division 101).
(M) The Indoor Air Quality program (Chapter 7 (commencing with
Section 105400) of Part 5 of Division 103).
(N) The Outdoor Air Quality program (Section 60.9 of the Labor
Code).
(O) The Laboratory Response Network for Chemical Terrorism program
(former Section 100170; Article 2 (commencing with Section 100250)
of Chapter 2 of Part 1 of Division 101).
(P) The Air Quality and Human Monitoring Support Program (former
Section 100170).
(Q) The Hazard Evaluation System and Information Service Program
(Article 1 (commencing with Section 105175) of Chapter 2 of Part 5 of
Division 103; Section 147.2 of the Labor Code).
(R) The Occupational Health Surveillance and Evaluation Program
(Article 1 (commencing with Section 105175) of Chapter 2 of Part 5 of
Division 103).
(S) The Occupational Lead Poisoning Prevention Program (Article 2
(commencing with Section 105185) of Chapter 2 of Part 5 of Division
103).
(T) The Occupational Blood Lead Registry (Article 2 (commencing
with Section 105185) of Chapter 2 of Part 5 of Division 103).
(7) The Division of Food, Drug and Radiation Safety, including,
but not limited to, all of the following:
(A) The Drug Licensing Program (Article 6 (commencing with Section
111615) of Chapter 6 of Part 5 of Division 104).
(B) The Consumer Product Safety Program (Part 3 (commencing with
Section 108100) of Division 104).
(C) The Export Program (Article 2 (commencing with Section 110190)
of Chapter 2 of Part 5 of Division 104).
(D) The Food Safety Inspection Program (Part 5 (commencing with
Section 109875) and Part 6 (commencing with Section 111940) of
Division 104).
(E) The Foodborne Illness and Tampering Emergency Response Program
(Part 5 (commencing with Section 109875) of Division 104).
(F) The Retail Food Safety Program (Part 7 (commencing with
Section 113700) of Division 104).
(G) The Food Safety Industry Education and Training Program
(pursuant to Section 110485).
(H) The Medical Device Licensing Program (Article 6 (commencing
with Section 111615) of Chapter 6 of Part 5 of Division 104).
(I) The Medical Device Safety Program (Part 5 (commencing with
Section 109875) of Division 104).
(J) The Stop Tobacco Access to Kids Enforcement Program (STAKE)
(Division 8.5 (commencing with Section 22950) of the Business and
Professions Code).
(K) The Food and Drug Laboratory (Chapter 2 (commencing with
Section 100250) of Division 101).
(L) The Drug Safety Program (Part 4 (commencing with Section
109250) and Part 5 (commencing with Section 109875) of Division 104).
(M) The General Food Safety Program (Part 5 (commencing with
Section 109875) and Part 6 (commencing with Section 111940) of
Division 104).
(N) The Food Testing Program (Chapter 2 (commencing with Section
100250) of Division 101).
(O) The Forensic Alcohol Testing Program (Article 2 (commencing
with Section 100700) of Chapter 4 of Part 1 of Division 101).
(P) The Methadone Laboratory Regulating Program (Article 2
(commencing with Section 11839.23) of Chapter 10 of Part 2 of
Division 10.5).
(Q) The Radiologic Health Program (Part 9 (commencing with Section
114650) of Division 104).
(R) The Mammography Program (Chapter 6 (commencing with Section
114840) of Part 9 of Division 104).
(S) The Radioactive Materials Licensing and Inspection Program
(Chapter 8 (commencing with Section 114960) of Part 9 of Division
104).
(T) The Radiological Technologist Certification Program (Article 5
(commencing with Section 106955) of Part 1, and Article 3
(commencing with Section 114855) of Chapter 6 of Part 9 of Division
104).
(U) The Radioactive Waste Tracking Program (Chapter 8 (commencing
with Section 114960) of Part 9 of Division 104).
(V) The Radioactive Waste Minimization Program (Chapter 8
(commencing with Section 114960) of Part 9 of Division 104).
(W) The Low Level Radioactive Waste Management, Treatment and
Disposal Program (Chapter 8 (commencing with Section 114960) of Part
9 of Division 104).
(X) The Statewide Environmental Radiation Monitoring Program
(pursuant to Section 114755).
(Y) The Department of Energy Oversight Program (Part 9 (commencing
with Section 114650) of Division 104).
(Z) The X-Ray Machine Inspection and Registration and Mammography
Quality Standards Act Inspection Program (Article 5 (commencing with
Section 106955) of Part 1, and Article 3 (commencing with Section
114855) of Chapter 6 of Part 9 of Division 104).
(8) The Deputy Director for Laboratory Science, including, but not
limited to, all of the following:
(A) The Environmental Laboratory Accreditation Program (Article 3
(commencing with Section 100825) of Chapter 4 of Part 1 of Division
101).
(B) The Laboratory Central Services Program (Article 2 (commencing
with Section 100250) of Chapter 2 of Part 1 of Division 101).
(C) The National Laboratory Training Network (Section 131085).
(D) The Laboratory Field Services program (Chapter 3 (commencing
with Section 1200) of Division 2 of the Business and Professions
Code).
(b) Under the jurisdiction of the Deputy Director for Licensing
and Certification:
(1) The General Acute Care Hospitals Licensing Program (Chapter 2
(commencing with Section 1250) of Division 2).
(2) The Acute Psychiatric Hospitals Licensing Program (Chapter 2
(commencing with Section 1250) of Division 2).
(3) The Special Hospitals Licensing Program (Chapter 2 (commencing
with Section 1250) of Division 2).
(4) The Chemical Dependency Recovery Hospitals Licensing Program
(Chapter 2 (commencing with Section 1250) of Division 2).
(5) The Skilled Nursing Facilities Licensing Program (Chapter 2
(commencing with Section 1250) of Division 2).
(6) The Intermediate Care Facilities Licensing Program (Chapter 2
(commencing with Section 1250) of Division 2).
(7) The Intermediate Care Facilities-Developmentally Disabled
Licensing Program (Chapter 2 (commencing with Section 1250) of
Division 2).
(8) The Intermediate Care Facilities-Developmentally
Disabled-Habilitative Licensing Program (Chapter 2 (commencing with
Section 1250) of Division 2).
(9) The Intermediate Care Facility-Developmentally
Disabled-Nursing Licensing Program (Chapter 2 (commencing with
Section 1250) of Division 2).
(10) The Home Health Agencies Licensing Program (Chapter 8
(commencing with Section 1725) of Division 2).
(11) The Referral Agencies Licensing Program (Chapter 2.3
(commencing with Section 1400) of Division 2).
(12) The Adult Day Health Centers Licensing Program (Chapter 3.3
(commencing with Section 1570) of Division 2).
(13) The Congregate Living Health Facilities (Chapter 2
(commencing with Section 1250) of Division 2).
(14) The Psychology Clinics Licensing Program (Chapter 1
(commencing with Section 1200) of Division 2).
(15) The Primary Clinics--Community and Free Licensing Program
(Chapter 1 (commencing with Section 1200) of Division 2).
(16) The Specialty Clinics--Rehab Clinics Licensing Program
(Chapter 1 (commencing with Section 1200) of Division 2).
(17) The Dialysis Clinics Licensing Program (Chapter 1 (commencing
with Section 1200) of Division 2).
(18) The Pediatric Day Health/Respite Care Licensing Program
(Chapter 2 (commencing with Section 1250) of Division 2).
(19) The Alternative Birthing Centers Licensing Program (Chapter 1
(commencing with Section 1200) of Division 2).
(20) The Hospice Licensing Program (Chapter 2 (commencing with
Section 1339.30) of Division 2).
(21) The Correctional Treatment Centers Licensing Program (Chapter
2 (commencing with Section 1250) of Division 2).
(22) The Medicare/Medi-Cal Certification Program (Chapter 7
(commencing with Section 14000) of Part 3 of Division 9 of the
Welfare and Institutions Code).
(23) The Nursing Home Administrator Professional Certification
Program (Chapter 2.35 (commencing with Section 1416) of Division 2).
(24) The Certified Nursing Assistants Professional Certification
Program (Chapter 2 (commencing with Section 1337) of Division 2).
(25) The Home Health Aides Professional Certification Program
(Chapter 8 (commencing with Section 1725) of Division 2).
(26) The Hemodialysis Technicians Professional Certification
Program (Chapter 3 (commencing with Section 1247) of Division 2 of
the Business and Professions Code; Chapter 10 (commencing with
Section 1794) of Division 2).
(27) The Criminal Background Clearance Program (Chapter 2
(commencing with Section 1337), Chapter 3 (commencing with Section
1520), Chapter 3.01 (commencing with Section 1569.15), Chapter 3.4
(commencing with Section 1496.80) of Division 2, and Chapter 4
(commencing with Section 11150) of Division 8).
(c) Under the jurisdiction of the Deputy Director for Health
Information and Strategic Planning:
(1) The Refugee Health Program (Subpart G of Part 400 of Title 45
of the Code of Federal Regulations).
(2) The Office of County Health Services (Article 5 (commencing
with Section 101300) of Chapter 3 of Part 3 of Division 101; Part 4.7
(commencing with Section 16900) of Division 9 of the Welfare and
Institutions Code).
(3) The Medically Indigent Services Program (Article 5 (commencing
with Section 101300) of Chapter 3 of Part 3 of Division 101).
(4) The Office of Vital Records (Part 1 (commencing with Section
102100) of Division 102).
(5) The Office of Health Information and Research (Article 1
(commencing with Section 102175) of Chapter 2 of Part 1 of Division
102; Section 128730).
(6) The Local Public Health Services Program (Article 5
(commencing with Section 101300) of Chapter 3 of Part 3 of Division
101).
(7) The Center for Health Statistics (Part 1 (commencing with
Section 102100) of Division 102; Section 128730).
(8) The Medical Marijuana Program (Article 2.5 (commencing with
Section 11362.7) of Chapter 6 of Division 10 of the Health and Safety
Code).
(d) Under the jurisdiction of the Deputy Director for Primary Care
and Family Health:
(1) The Maternal, Child and Adolescent Health program (Part 2
(commencing with Section 123225) of Division 106).
(2) The Adolescent Family Life Program (Article 1 (commencing with
Section 124175) of Chapter 4 of Part 2 of Division 106).
(3) The Advanced Practice Nurse Training program (Part 2
(commencing with Section 123225) of Division 106).
(4) The Black Infant Health Program (Part 2 (commencing with
Section 123225) of Division 106).
(5) The Breastfeeding Program (Article 3 (commencing with Section
123360) of Chapter 1 of Part 2 of Division 6).
(6) The California Diabetes and Pregnancy Program (Part 2
(commencing with Section 123225) of Division 106).
(7) The California Initiative to Improve Adolescent Health (Part 2
(commencing with Section 123225) of Division 106).
(8) The Childhood Injury Prevention Program (Article 4 (commencing
with Section 100325) of Chapter 2 of Division 101).
(9) The Comprehensive Perinatal Services Program (Article 3
(commencing with Section 123475) of Chapter 2 of Part 2; Section
14134.5 of the Welfare and Institutions Code).
(10) The Fetal and Infant Mortality Review Program (Article 1
(commencing with Section 123650) of Chapter 3 of Part 2 of Division
106).
(11) The Human Stem Cell Research Program (Chapter 3 (commencing
with Section 125290.10) of Part 5 of Division 106; Chapter 1
(commencing with Section 125300) of Part 5.5 of Division 106).
(12) The Local Health Department Maternal, Child and Adolescent
Health Program (Section 123255).
(13) The Maternal Mortality Review Program (Article 4 (commencing
with Section 100325) of Chapter 2 of Division 101).
(14) The Oral Health Program (Part 2 (commencing with Section
123225) of Division 106).
(15) The Preconception Health and Health Care Initiative (Part 2
(commencing with Section 123225) of Division 106).
(16) The Regional Perinatal Programs of California (Article 4
(commencing with Section 123550) of Chapter 2 of Part 2 of Division
106).
(17) The Perinatal Dispatch Centers Outreach and Education Program
(Article 4 (commencing with Section 123750) of Chapter 3 of Part 2
of Division 106).
(18) The State Early Childhood Comprehensive Services program
(Part 2 (commencing with Section 123225) of Division 106).
(19) The Sudden Infant Death Syndrome Program (Article 3
(commencing with Section 123725) of Chapter 3 of Part 2 of Division
106).
(20) The Youth Pilot Program (Chapter 12.85 (commencing with
Section 18987) of Part 6 of Division 9 of the Welfare and
Institutions Code).
(21) The Office of Family Planning (Chapter 8.5 (commencing with
Section 14500) of Part 3 of Division 9 of the Welfare and
Institutions Code; Division 24 (commencing with Section 24000) of the
Welfare and
Institutions Code), until June 30, 2012. Commencing July 1, 2012, the
duties, powers, functions, jurisdiction, and responsibilities of the
State Department of Public Health regarding this office are hereby
with the State Department of Health Care Services.
(22) The Community Challenge Grant Program (Section 14504.1 of the
Welfare and Institutions Code, and Chapter 14 (commencing with
Section 18993) of Part 6 of Division 9 of the Welfare and
Institutions Code).
(23) The Information and Education Program (Section 14504.3 of the
Welfare and Institutions Code).
(24) The Family PACT Program (subdivision (aa) of Section 14132
and Section 24005 of the Welfare and Institutions Code), until June
30, 2012. Commencing July 1, 2012, the duties, powers, functions,
jurisdiction, and responsibilities of the State Department of Public
Health regarding this program are hereby with the State Department of
Health Care Services.
(25) The Male Involvement Program (Section 14504 of the Welfare
and Institutions Code).
(26) The TeenSMART Outreach Program (Section 14504.2 of the
Welfare and Institutions Code).
(27) The Battered Women Shelter Program (Chapter 6 (commencing
with Section 124250) of Part 2 of Division 106).
(28) The Women, Infants and Children Program (Article 1
(commencing with Section 123275) of Chapter 1 of Part 2 of Division
106).
(29) The WIC Supplemental Nutrition Program (Article 1 (commencing
with Section 123275) of Chapter 1 of Part 2 of Division 106).
(30) The Farmers Market Nutrition Program (Section 123279).
(31) Genetic Disease Program (Chapter 1 (commencing with Section
124975) of Part 5 of Division 106).
(32) The Newborn Screening Program (Chapter 1 (commencing with
Section 124975) of Part 5 of Division 106).
(33) The Prenatal Screening Program (Chapter 1 (commencing with
Section 124975) of Part 5 of Division 106).
SEC. 45. Section 131052 of the Health and Safety Code is amended
to read:
131052. In implementing the transfer of jurisdiction pursuant to
this article, the State Department of Public Health succeeds to and
is vested with all the statutory duties, powers, purposes,
responsibilities, and jurisdiction of the former State Department of
Health Services as they relate to public health as provided for or
referred to in all of the following provisions of law:
(1) Sections 550, 555, 650, 680, 1241, 1658, 2221.1, 2248.5, 2249,
2259, 2259.5, 2541.3, 2585, 2728, 3527, 4017, 4027, 4037, 4191,
19059.5, 19120, 22950, 22973.2, and 22974.8 of the Business and
Professions Code.
(2) Sections 56.17, 1812.508, and 1812.543 of the Civil Code.
(3) Sections 8286, 8803, 17613, 32064, 32065, 32066, 32241, 49030,
49405, 49414, 49423.5, 49452.6, 49460, 49464, 49565, 49565.8,
49531.1, 56836.165, and 76403 of the Education Code.
(4) Sections 405, 6021, 6026, 18963, 30852, 41302, and 78486 of
the Food and Agricultural Code.
(5) Sections 307, 355, 422, 7572, 7574, 8706, 8817, and 8909 of
the Family Code.
(6) Sections 217.6, 1507, 1786, 4011, 5671, 5674, 5700, 5701,
5701.5, 7715, and 15700 of the Fish and Game Code.
(7) Sections 855, 51010, and 551017.1 of the Government Code. For
purposes of subdivision (s) of Section 6254 of the Government Code,
the term "State Department of Health Services" is hereby deemed to
refer to the State Department of Public Health.
(8) (A) Sections 475, 1180.6, 1418.1, 1422.1, 1428.2, 1457, 1505,
1507.1, 1507.5, 1570.7, 1599.2, 1599.60, 1599.75, 1599.87, 2002,
2804, 11362.7, 11776, 11839.21, 11839.23, 11839.24, 11839.25,
11839.26, 11839.27, 11839.28, 11839.29, 11839.30, 11839.31, 11839.32,
11839.33, 11839.34, 17920.10, 17961, 18897.2, 24185, 24186, 24187,
24275, 26101, 26122, 26134, 26155, 26200, and 26203.
(B) Chapters 1, 2, 2.05, 2.3, 2.35, 2.4, 3.3, 3.9, 3.93, 3.95, 4,
4.1, 4.5, 5, 6, 6.5, 8, 8.3, 8.5, 8.6, 9, and 11 of Division 2.
(C) Articles 2 and 4 of Chapter 2, Chapter 3, and Chapter 4 of
Part 1, Part 2 and Part 3 of Division 101.
(D) Division 102, including Sections 102230 and 102231.
(E) Division 103, including Sections 104145, 104181, 104182,
104182.5, 104187, 104191, 104192, 104193, 104316, 104317, 104318,
104319, 104320, 104321, 104324.2, 104324.25, 104350, 105191, 105251,
105255, 105280, 105340, and 105430.
(F) Division 104, including Sections 106615, 106675, 106770,
108115, 108855, 109282, 109910, 109915, 112155, 112500, 112650,
113355, 114460, 114475, 114650, 114710, 114850, 114855, 114985,
115061, 115261, 115340, 115736, 115880, 115885, 115915, 116064,
116183, 116270, 116365.5, 116366, 116375, 116610, 116751, 116760.20,
116825, 117100, 117924, and 119300.
(G) Division 105, including Sections 120262, 120381, 120395,
120440, 120480, 120956, 120966, 121155, 121285, 121340, 121349.1,
121480, 122410, and 122420.
(H) Part 1, Part 2 excluding Articles 5, 5.5, 6, and 6.5 of
Chapter 3, Part 3 and Part 5 excluding Articles 1 and 2 of Chapter 2,
Part 7, and Part 8 of Division 106.
(9) Sections 799.03, 10123.35, 10123.5, 10123.55, 10123.10,
10123.184, and 11520 of the Insurance Code.
(10) Sections 50.8, 142.3, 144.5, 144.7, 147.2, 4600.6, 6307.1,
6359, 6712, 9009, and 9022 of the Labor Code.
(11) Sections 4018.1, 5008.1, 7501, 7502, 7510, 7511, 7515, 7518,
7530, 7550, 7553, 7575, 7576, 11010, 11174.34, and 13990 of the Penal
Code.
(12) Section 4806 of the Probate Code.
(13) Sections 15027, 25912, 28004, 30950, 41781.1, 42830, 43210,
43308, 44103, and 71081 of the Public Resources Code.
(14) Section 10405 of the Public Contract Code.
(15) Sections 883, 1507, and 7718 of the Public Utilities Code.
(16) Sections 18833, 18838, 18845.2, 18846.2, 18847.2, 18863,
30461.6, 43010.1, and 43011.1 of the Revenue and Taxation Code.
(17) Section 11020 of the Unemployment Insurance Code.
(18) Sections 22511.55, 23158, 27366, and 33000 of the Vehicle
Code.
(19) Sections 5326.9, 5328, 5328.15, 14132, 16902, and 16909, and
Division 24 of the Welfare and Institutions Code. Payment for
services provided under the Family Planning, Access, Care, and
Treatment (Family PACT) Waiver Program pursuant to subdivision (aa)
of Section 14132 and Division 24 shall be made through the State
Department of Health Care Services. The State Department of Public
Health and the State Department of Health Care Services may enter
into an interagency agreement for the administration of those
payments. This paragraph, to the extent that it applies to the Family
PACT Waiver Program, shall become inoperative on June 30, 2012.
(20) Sections 13176, 13177.5, 13178, 13193, 13390, 13392, 13392.5,
13393.5, 13395.5, 13396.7, 13521, 13522, 13523, 13528, 13529,
13529.2, 13550, 13552.4, 13552.8, 13553, 13553.1, 13554, 13554.2,
13816, 13819, 13820, 13823, 13824, 13825, 13827, 13830, 13834, 13835,
13836, 13837, 13858, 13861, 13862, 13864, 13868, 13868.1, 13868.3,
13868.5, 13882, 13885, 13886, 13887, 13891, 13892, 13895.1, 13895.6,
13895.9, 13896, 13896.3, 13896.4, 13896.5, 13897, 13897.4, 13897.5,
13897.6, 13898, 14011, 14012, 14015, 14016, 14017, 14019, 14022,
14025, 14026, 14027, and 14029 of the Water Code.
SEC. 46. Section 131055.1 is added to the Health and Safety Code,
to read:
131055.1. (a) Notwithstanding Section 131050, commencing on July
1, 2012, the State Department of Health Care Services shall succeed
to and be vested with all the duties, powers, purposes, functions,
responsibilities, and jurisdiction of the State Department of Public
Health as they relate to the Breast and Cervical Cancer Screening
Program pursuant to Article 1.3 (commencing with Section 104150) of
Chapter 1, the Breast and Cervical Cancer Treatment Program pursuant
to Article 1.5 (commencing with Section 104160) of Chapter 1, the
Prostate Cancer Screening Program pursuant to Chapter 6 (commencing
with Section 104310), the IMPACT Prostate Cancer Treatment Program
pursuant to Chapter 7 (commencing with Section 104322) of Part 1 of
Division 103, translation services pursuant to Part 3 (commencing
with Section 124300) of Division 106, the Office of Family Planning
pursuant to Chapter 8.5 (commencing with Section 14500) of Part 3 of
Division 9 of the Welfare and Institutions Code, excluding the
Personal Responsibility Education Federal Grant Program, the Family
Planning, Access, Care, and Treatment (Family PACT) Program pursuant
to subdivision (aa) of Section 14132, and the State-Only Family
Planning Program pursuant to Division 24 (commencing with Section
24000) of the Welfare and Institutions Code.
(b) Commencing July 1, 2012, any reference to the State Department
of Public Health with regard to the Breast and Cervical Cancer
Screening Program pursuant to Article 1.3 (commencing with Section
104150) of Chapter 1, the Breast and Cervical Cancer Treatment
Program pursuant to Article 1.5 (commencing with Section 104160) of
Chapter 1, the Prostate Cancer Screening Program pursuant to Chapter
6 (commencing with Section 104310), the IMPACT Prostate Cancer
Treatment Program pursuant to Chapter 7 (commencing with Section
104322) of Part 1 of Division 103, translation services pursuant to
Part 3 (commencing with Section 124300) of Division 106, the Office
of Family Planning pursuant to Chapter 8.5 (commencing with Section
14500) of Part 3 of Division 9 of the Welfare and Institutions Code,
excluding the Personal Responsibility Education Federal Grant
Program, the Family Planning, Access, Care, and Treatment (Family
PACT) Program pursuant to subdivision (aa) of Section 14132, or the
State-Only Family Planning Program pursuant to Division 24
(commencing with Section 24000) of the Welfare and Institutions Code,
shall refer to the State Department of Health Care Services.
(c) All regulations and orders adopted by the State Department of
Public Health and any of its predecessors in effect prior to July 1,
2012, shall remain in effect and shall be fully enforceable unless
and until readopted, amended, or repealed, or until they expire by
their own terms. Any action by or against the State Department of
Public Health and any of its predecessors pertaining to matters
vested in the State Department of Health Care Services by this act
shall not abate but shall continue in the name of the State
Department of Health Care Services, and the State Department of
Health Care Services shall be substituted for the State Department of
Public Health and any of its predecessors by the court wherein the
action is pending. The substitution shall not in any way affect the
rights of the parties to the action.
(d) Commencing July 1, 2012, the unexpended balance of all funds
available for use by the State Department of Public Health or any of
its predecessors in carrying out any functions transferred to the
State Department of Health Care Services shall be available for use
by the State Department of Health Care Services.
(e) Commencing July 1, 2012, all books, documents, records, and
property of the State Department of Public Health pertaining to
functions transferred to the State Department of Health Care Services
shall be transferred to the State Department of Health Care
Services.
(f) Commencing July 1, 2012, positions filled by appointment by
the Governor in the State Department of Public Health whose principal
assignment was to perform functions transferred to the State
Department of Health Care Services shall be transferred to the State
Department of Health Care Services. Individuals in positions
transferred pursuant to this subdivision shall serve at the pleasure
of the Governor. Salaries of positions transferred shall remain at
the level established pursuant to law unless otherwise provided.
(g) Commencing July 1, 2012, every officer and employee of the
State Department of Public Health who is performing a function
transferred to the State Department of Health Care Services and who
is serving in the state civil service, other than as a temporary
employee, shall be transferred to the State Department of Health Care
Services pursuant to the provisions of Section 19050.9 of the
Government Code. The status, position, and rights of any officer or
employee of the State Department of Public Health shall not be
affected by the transfer and shall be retained by the person as an
officer or employee of the State Department of Health Care Services,
as applicable, pursuant to the State Civil Service Act (Part 2
(commencing with Section 18500) of Division 5 of Title 2 of the
Government Code), except for a position that is exempt from civil
service.
(h) No contract, lease, license, or any other agreement to which
the State Department of Public Health is a party shall be void or
voidable by reason of this act, but shall continue in full force and
effect, with State Department of Health Care Services assuming all of
the rights, obligations, liabilities, and duties of the State
Department of Public Health as relates to the duties, powers,
purposes, responsibilities, and jurisdiction vested by this section
in the State Department of Health Care Services. The assumption by
the State Department of Health Care Services shall not in any way
affect the rights of the parties to any contract, lease, license, or
agreement.
SEC. 47. Section 4024.7 is added to the Welfare and Institutions
Code, to read:
4024.7. The Governor or the Director of Health Care Services
shall appoint, subject to confirmation by the Senate, a Deputy
Director of Mental Health and Substance Use Disorder Services of the
State Department of Health Care Services. The salary for the deputy
director shall be fixed in accordance with law.
SEC. 48. Section 4362 of the Welfare and Institutions Code is
amended to read:
4362. The Legislature finds all of the following:
(a) That state public policy discriminates against adults with
brain damage or degenerative brain disease, such as Alzheimer's
disease. This damage or disease is referred to as "brain impairments"
in this chapter.
(b) That the Legislature has declared state public policy and
accepted responsibility to ensure that persons under the age of 18
years who are developmentally disabled pursuant to Division 4.5
(commencing with Section 4500), receive services necessary to meet
their needs, which are often similar to those of persons who suffer
from brain impairments.
(c) That persons over the age of 18 who sustain brain impairment
have a variety of program and service needs for which there is no
clearly defined, ultimate responsibility vested in any single state
agency and for which there are currently a number of different
programs attempting to meet their needs.
(d) That the lack of clearly defined ultimate responsibility has
resulted in severe financial liability and physical and mental strain
on brain-impaired persons, their families, and caregivers.
(e) That terminology and nomenclature used to describe brain
impairments are varied and confusing, in part because of different
medical diagnoses and professional opinions, as well as differences
in terminology used by the various funding sources for programs and
services. Uniformity is required in order to ensure that appropriate
programs and services are available throughout the state to serve
these persons.
(f) That the term "brain damage" covers a wide range of organic
and neurological disorders, and that these disorders, as identified
below, are not necessarily to be construed as mental illnesses. These
disorders include, but are not limited to, all of the following:
(1) Progressive, degenerative, and dementing illnesses, including,
but not limited to, presenile and senile dementias, Alzheimer's
disease, multiinfarct disease, Pick's disease, and Kreutzfeldt-Jakob'
s disease.
(2) Degenerative diseases of the central nervous system that can
lead to dementia or severe brain impairment, including, but not
limited to, epilepsy, multiple sclerosis, Parkinson's disease,
amyotrophic lateral sclerosis (ALS), and hereditary diseases such as
Huntington's disease.
(3) Permanent damage caused by cerebrovascular accidents more
commonly referred to as "strokes," including, but not limited to,
cerebral hemorrhage, aneurysm, and embolism.
(4) Posttraumatic, postanoxic, and postinfectious damage caused by
incidents, including, but not limited to, coma, accidental skull and
closed head injuries, loss of oxygen (anoxia), and infections such
as encephalitis, herpes simplex, and tuberculosis.
(5) Permanent brain damage or temporary or progressive dementia as
a result of tumors (neoplasm), hydrocephalus, abscesses, seizures,
substance toxicity, and other disorders.
(g) That brain damage frequently results in functional impairments
that adversely affect personality, behavior, and ability to perform
daily activities. These impairments cause dependency on others for
care and decisionmaking. The manifestations of brain damage include
impairments of memory, cognitive ability, orientation, judgment,
emotional response, and social inhibition. Brain damage can strike
anyone regardless of age, race, sex, occupation, or economic status.
(h) That Family Survival Project for Brain-Damaged Adults of San
Francisco, a three-year pilot project established pursuant to former
Chapter 4 (commencing with Section 4330), has demonstrated that the
most successful, cost-effective service model is one which allows a
nonprofit community agency to provide a full array of support
services to families that have a member who suffers from a brain
impairment. This agency provides direct services, coordinates
existing resources, and assists in the development of new programs
and services on a regional basis.
(i) That respite care services provide a combination of
time-limited, in-home, and out-of-home services that significantly
decrease the stress of family members and increase their ability to
maintain a brain-impaired person at home at less cost than other
alternatives. This ability is further increased when complemented by
case planning, care training, and other support services for family
members.
(j) That providing services to brain-impaired adults, and to their
families and caregivers, requires the coordinated services of many
state departments and community agencies to ensure that no gaps occur
in communication, in the availability of programs, or in the
provision of services.
SEC. 49. Section 4362.5 of the Welfare and Institutions Code is
amended to read:
4362.5. As used in this chapter:
(a) "Brain damage," "degenerative brain diseases," and "brain
impairment" mean significant destruction of brain tissue with
resultant loss of brain function. Examples of causes of the
impairments are Alzheimer's disease, stroke, traumatic brain injury,
and other impairments described in subdivision (f) of Section 4330.
(b) "Brain-impaired adult" means a person whose brain impairment
has occurred after the age of 18.
(c) "Respite care" means substitute care or supervision in support
of the caregiver for the purposes of providing relief from the
stresses of constant care provision and so as to enable the caregiver
to pursue a normal routine and responsibilities. Respite care may be
provided in the home or in an out-of-home setting, such as day care
centers or short-term placements in inpatient facilities.
(d) "Family member" means any relative or court-appointed guardian
or conservator who is responsible for the care of a brain-impaired
adult.
(e) "Caregiver" means any unpaid family member or individual who
assumes responsibility for the care of a brain-impaired adult.
(f) "Director" means the Director of Health Care Services.
SEC. 50. Section 4364 of the Welfare and Institutions Code is
amended to read:
4364. The Statewide Resources Consultant shall do all of the
following:
(a) Serve as the centralized information and technical assistance
clearinghouse for brain-impaired adults, their families, caregivers,
service professionals and agencies, and volunteer organizations, and
in this capacity may assist organizations that serve families with
adults with Huntington's disease and Alzheimer's disease by reviewing
data collected by those organizations in their efforts to determine
the means of providing high-quality appropriate care in health
facilities and other out-of-home placements; and shall disseminate
information, including, but not limited to, the results of research
and activities conducted pursuant to its responsibilities set forth
in this chapter as determined by the director, and which may include
forwarding quality of care and related information to appropriate
state departments for consideration.
(b) Work closely and coordinate with organizations serving
brain-impaired adults, their families, and caregivers in order to
ensure, consistent with requirements for quality of services as may
be established by the director, that the greatest number of persons
are served and that the optimal number of organizations participate.
(c) Develop and conduct training that is appropriate for a variety
of persons, including, but not limited to, all of the following:
(1) Families.
(2) Caregivers and service professionals involved with
brain-impaired adults.
(3) Advocacy and self-help family and caregiver support
organizations.
(4) Educational institutions.
(d) Provide other training services, including, but not limited
to, reviewing proposed training curricula regarding the health,
psychological, and caregiving aspects of individuals with brain
damage as defined in subdivision (f) of Section 4362. The proposed
curricula may be submitted by providers or statewide associations
representing individuals with brain damage, their families, or
caregivers.
(e) Provide service and program development consultation to
resource centers and to identify funding sources that are available.
(f) Assist the appropriate state agencies in identifying and
securing increased federal financial participation and third-party
reimbursement, including, but not limited to, Title XVIII (42 U.S.C.
Sec. 1395 and following) and Title XIX (42 U.S.C. Sec. 1396 and
following) of the federal Social Security Act.
(g) Conduct public social policy research based upon the
recommendations of the director.
(h) Assist the director, as the director may require, in
conducting directly, or through contract, research in brain damage
epidemiology and data collection, and in developing a uniform
terminology and nomenclature.
(i) Assist the director in establishing criteria for, and in
selecting resource centers and in designing a methodology for, the
consistent assessment of resources and needs within the geographic
areas to be serviced by the resource centers.
(j) Conduct conferences, as required by the director, for
families, caregivers, service providers, advocacy organizations,
educational institutions, business associations, community groups,
and the general public, in order to enhance the quality and
availability of high-quality, low-cost care and treatment of
brain-impaired adults.
(k) Make recommendations, after consultation with appropriate
state department representatives, to the director and the Secretary
of California Health and Human Services for a comprehensive statewide
policy to support and strengthen family caregivers, including the
provision of respite and other support services, in order to
implement more fully this chapter. The Statewide Resources Consultant
shall coordinate its recommendations to assist the California Health
and Human Services Agency to prepare its report on long-term care
programs pursuant to Chapter 1.5 (commencing with Section 100145) of
Part 1 of Division 101 of the Health and Safety Code.
( l ) Conduct an inventory and submit an analysis of
California's publicly funded programs serving family caregivers of
older persons and functionally impaired adults.
SEC. 51. Section 4364.5 of the Welfare and Institutions Code is
amended to read:
4364.5. The Statewide Resources Consultant, pursuant to Section
4364, shall do the following:
(a) Develop respite care training materials, with consultation by
other appropriate organizations including the California Association
of Homes for the Aging, and under the direction of the director, for
distribution to all resource centers established under this chapter.
(b) Provide the respite care training materials described in
subdivision (a) to other appropriate state entities for distribution
to their respective services and programs.
(c) Pursuant to the requirements of Section 4365.5, report on the
utilization of the respite care training materials, developed
pursuant to subdivision (a), by all the resource centers for the
period ending December 31, 1990, only, and make recommendations for
the future use of these materials.
SEC. 52. Section 4366 of the Welfare and Institutions Code is
amended to read:
4366. Resource centers shall serve all of the following
functions:
(a) Provide directly or assist families in securing information,
advice, and referral services, legal services and financial
consultation, planning and problem-solving consultation, family
support services, and respite care services, as specified in Section
4338.
(b) Provide centralized access to information about, and referrals
to, local, state, and federal services and programs in order to
assure a comprehensive approach for brain-impaired adults, their
families, and caregivers. Nothing in this chapter shall prohibit
access to services through other organizations which provide similar
programs and services to brain-impaired adults and their families,
nor shall other organizations be prevented from providing these
programs and services.
(c) Assist in the identification and documentation of service
needs and the development of necessary programs and services to meet
the needs of brain-impaired adults in the geographic area.
(d) Cooperate with the Statewide Resources Consultant and the
director in any activities which they deem necessary for the proper
implementation of this chapter.
(e) Work closely and coordinate with organizations serving
brain-impaired adults, their families, and caregivers in order to
ensure, consistent with requirements for quality of services as may
be established by the director, that the greatest number of persons
are served and that the optimal number of organizations participate.
SEC. 53. Section 4367.5 of the Welfare and Institutions Code is
amended to read:
4367.5. The director shall establish criteria for client
eligibility, including financial liability, pursuant to Section 4368.
However, persons eligible for services provided by regional centers
or the State Department of Developmental Services are not eligible
for services provided under this chapter. Income shall not be the
sole basis for client eligibility. The director
shall assume responsibility for the
coordination of existing funds and services for brain-impaired
adults, and for the purchase of respite care, as defined in
subdivision (c) of Section 4362.5, with other departments that may
serve brain-impaired adults, including the Department of
Rehabilitation, the State Department of Social Services, the State
Department of Developmental Services, the Department of Aging, the
Office of Statewide Health Planning and Development, and the State
Department of Alcohol and Drug Programs.
SEC. 54. Section 4368.5 of the Welfare and Institutions Code is
amended to read:
4368.5. In considering total service funds available for the
project, the director shall utilize funding available from
appropriate state departments, including, but not limited to: the
State Department of Social Services, the Department of
Rehabilitation, the California Department of Aging, and the State
Department of Alcohol and Drug Programs. The director in conjunction
with the Statewide Resources Consultant shall coordinate his or her
activities with the implementation of the Torres-Felando Long-Term
Care Reform Act (Chapter 1453, Statutes of 1982) in order to further
the goal of obtaining comprehensive, coordinated public policy and to
maximize the availability of funding for programs and services for
persons with brain impairments.
SEC. 55. Section 5820 of the Welfare and Institutions Code is
amended to read:
5820. (a) It is the intent of this part to establish a program
with dedicated funding to remedy the shortage of qualified
individuals to provide services to address severe mental illnesses.
(b) Each county mental health program shall submit to the Office
of Statewide Health Planning and Development a needs assessment
identifying its shortages in each professional and other occupational
category in order to increase the supply of professional staff and
other staff that county mental health programs anticipate they will
require in order to provide the increase in services projected to
serve additional individuals and families pursuant to Part 3
(commencing with Section 5800), Part 3.2 (commencing with Section
5830), Part 3.6 (commencing with Section 5840), and Part 4
(commencing with Section 5850) of this division. For purposes of this
part, employment in California's public mental health system
includes employment in private organizations providing publicly
funded mental health services.
(c) The Office of Statewide Health Planning and Development, in
coordination with the California Mental Health Planning Council,
shall identify the total statewide needs for each professional and
other occupational category utilizing county needs assessment
information and develop a five-year education and training
development plan.
(d) Development of the first five-year plan shall commence upon
enactment of the initiative. Subsequent plans shall be adopted every
five years, with the next five-year plan due as of April 1, 2014.
(e) Each five-year plan shall be reviewed and approved by the
California Mental Health Planning Council.
SEC. 56. Section 5821 of the Welfare and Institutions Code is
amended to read:
5821. (a) The California Mental Health Planning Council shall
advise the Office of Statewide Health Planning and Development on
education and training policy development and provide oversight for
education and training plan development.
(b) The Office of Statewide Health Planning and Development shall
work with the California Mental Health Planning Council and the State
Department of Health Care Services so that council staff is
increased appropriately to fulfill its duties required by Sections
5820 and 5821.
SEC. 57. Section 5822 of the Welfare and Institutions Code is
amended to read:
5822. The Office of Statewide Health Planning and Development
shall include in the five-year plan:
(a) Expansion plans for the capacity of postsecondary education to
meet the needs of identified mental health occupational shortages.
(b) Expansion plans for the forgiveness and scholarship programs
offered in return for a commitment to employment in California's
public mental health system and make loan forgiveness programs
available to current employees of the mental health system who want
to obtain Associate of Arts, Bachelor of Arts, master's degrees, or
doctoral degrees.
(c) Creation of a stipend program modeled after the federal Title
IV-E program for persons enrolled in academic institutions who want
to be employed in the mental health system.
(d) Establishment of regional partnerships between the mental
health system and the educational system to expand outreach to
multicultural communities, increase the diversity of the mental
health workforce, to reduce the stigma associated with mental
illness, and to promote the use of web-based technologies, and
distance learning techniques.
(e) Strategies to recruit high school students for mental health
occupations, increasing the prevalence of mental health occupations
in high school career development programs such as health science
academies, adult schools, and regional occupation centers and
programs, and increasing the number of human service academies.
(f) Curriculum to train and retrain staff to provide services in
accordance with the provisions and principles of Part 3 (commencing
with Section 5800), Part 3.2 (commencing with Section 5830), Part 3.6
(commencing with Section 5840), and Part 4 (commencing with Section
5850) of this division.
(g) Promotion of the employment of mental health consumers and
family members in the mental health system.
(h) Promotion of the meaningful inclusion of mental health
consumers and family members and incorporating their viewpoint and
experiences in the training and education programs in subdivisions
(a) through (f).
(i) Promotion of meaningful inclusion of diverse, racial, and
ethnic community members who are underrepresented in the mental
health provider network.
(j) Promotion of the inclusion of cultural competency in the
training and education programs in subdivisions (a) through (f).
SEC. 58. Section 5830 of the Welfare and Institutions Code is
amended to read:
5830. County mental health programs shall develop plans for
innovative programs to be funded pursuant to paragraph (6) of
subdivision (a) of Section 5892.
(a) The innovative programs shall have the following purposes:
(1) To increase access to underserved groups.
(2) To increase the quality of services, including better
outcomes.
(3) To promote interagency collaboration.
(4) To increase access to services.
(b) All projects included in the innovative program portion of the
county plan shall meet the following requirements:
(1) Address one of the following purposes as its primary purpose:
(A) Increase access to underserved groups.
(B) Increase the quality of services, including measurable
outcomes.
(C) Promote interagency and community collaboration.
(D) Increase access to services.
(2) Support innovative approaches by doing one of the following:
(A) Introducing new mental health practices or approaches,
including, but not limited to, prevention and early intervention.
(B) Making a change to an existing mental health practice or
approach, including, but not limited to, adaptation for a new setting
or community.
(C) Introducing a new application to the mental health system of a
promising community-driven practice or an approach that has been
successful in nonmental health contexts or settings.
(c) An innovative project may affect virtually any aspect of
mental health practices or assess a new or changed application of a
promising approach to solving persistent, seemingly intractable
mental health challenges, including, but not limited to, any of the
following:
(1) Administrative, governance, and organizational practices,
processes, or procedures.
(2) Advocacy.
(3) Education and training for service providers, including
nontraditional mental health practitioners.
(4) Outreach, capacity building, and community development.
(5) System development.
(6) Public education efforts.
(7) Research.
(8) Services and interventions, including prevention, early
intervention, and treatment.
(d) If an innovative project has proven to be successful and a
county chooses to continue it, the project workplan shall transition
to another category of funding as appropriate.
(e) County mental health programs shall expend funds for their
innovation programs upon approval by the Mental Health Services
Oversight and Accountability Commission.
SEC. 59. Section 5840 of the Welfare and Institutions Code is
amended to read:
5840. (a) The State Department of Health Care Services, in
coordination with counties, shall establish a program designed to
prevent mental illnesses from becoming severe and disabling. The
program shall emphasize improving timely access to services for
underserved populations.
(b) The program shall include the following components:
(1) Outreach to families, employers, primary care health care
providers, and others to recognize the early signs of potentially
severe and disabling mental illnesses.
(2) Access and linkage to medically necessary care provided by
county mental health programs for children with severe mental
illness, as defined in Section 5600.3, and for adults and seniors
with severe mental illness, as defined in Section 5600.3, as early in
the onset of these conditions as practicable.
(3) Reduction in stigma associated with either being diagnosed
with a mental illness or seeking mental health services.
(4) Reduction in discrimination against people with mental
illness.
(c) The program shall include mental health services similar to
those provided under other programs effective in preventing mental
illnesses from becoming severe, and shall also include components
similar to programs that have been successful in reducing the
duration of untreated severe mental illnesses and assisting people in
quickly regaining productive lives.
(d) The program shall emphasize strategies to reduce the following
negative outcomes that may result from untreated mental illness:
(1) Suicide.
(2) Incarcerations.
(3) School failure or dropout.
(4) Unemployment.
(5) Prolonged suffering.
(6) Homelessness.
(7) Removal of children from their homes.
(e) Prevention and early intervention funds may be used to broaden
the provision of community-based mental health services by adding
prevention and early intervention services or activities to these
services.
(f) In consultation with mental health stakeholders, and
consistent with guidelines from the Mental Health Services Oversight
and Accountability Commission, pursuant to Section 5846, the
department shall revise the program elements in Section 5840
applicable to all county mental health programs in future years to
reflect what is learned about the most effective prevention and
intervention programs for children, adults, and seniors.
SEC. 60. Section 5845 of the Welfare and Institutions Code is
amended to read:
5845. (a) The Mental Health Services Oversight and Accountability
Commission is hereby established to oversee Part 3 (commencing with
Section 5800), the Adult and Older Adult Mental Health System of Care
Act; Part 3.1 (commencing with Section 5820), Human Resources,
Education, and Training Programs; Part 3.2 (commencing with Section
5830), Innovative Programs; Part 3.6 (commencing with Section 5840),
Prevention and Early Intervention Programs; and Part 4 (commencing
with Section 5850), the Children's Mental Health Services Act. The
commission shall replace the advisory committee established pursuant
to Section 5814. The commission shall consist of 16 voting members as
follows:
(1) The Attorney General or his or her designee.
(2) The Superintendent of Public Instruction or his or her
designee.
(3) The Chairperson of the Senate Health and Human Services
Committee or another member of the Senate selected by the President
pro Tempore of the Senate.
(4) The Chairperson of the Assembly Health Committee or another
member of the Assembly selected by the Speaker of the Assembly.
(5) Two persons with a severe mental illness, a family member of
an adult or senior with a severe mental illness, a family member of a
child who has or has had a severe mental illness, a physician
specializing in alcohol and drug treatment, a mental health
professional, a county sheriff, a superintendent of a school
district, a representative of a labor organization, a representative
of an employer with less than 500 employees and a representative of
an employer with more than 500 employees, and a representative of a
health care services plan or insurer, all appointed by the Governor.
In making appointments, the Governor shall seek individuals who have
had personal or family experience with mental illness.
(b) Members shall serve without compensation, but shall be
reimbursed for all actual and necessary expenses incurred in the
performance of their duties.
(c) The term of each member shall be three years, to be staggered
so that approximately one-third of the appointments expire in each
year.
(d) In carrying out its duties and responsibilities, the
commission may do all of the following:
(1) Meet at least once each quarter at any time and location
convenient to the public as it may deem appropriate. All meetings of
the commission shall be open to the public.
(2) Within the limit of funds allocated for these purposes,
pursuant to the laws and regulations governing state civil service,
employ staff, including any clerical, legal, and technical assistance
as may appear necessary. The commission shall administer its
operations separate and apart from the State Department of Health
Care Services.
(3) Establish technical advisory committees such as a committee of
consumers and family members.
(4) Employ all other appropriate strategies necessary or
convenient to enable it to fully and adequately perform its duties
and exercise the powers expressly granted, notwithstanding any
authority expressly granted to any officer or employee of state
government.
(5) Enter into contracts.
(6) Obtain data and information from the State Department of
Health Care Services, the Office of Statewide Health Planning and
Development, or other state or local entities that receive Mental
Health Services Act funds, for the commission to utilize in its
oversight, review, training and technical assistance, accountability,
and evaluation capacity regarding projects and programs supported
with Mental Health Services Act funds.
(7) Participate in the joint state-county decisionmaking process,
as contained in Section 4061, for training, technical assistance, and
regulatory resources to meet the mission and goals of the state's
mental health system.
(8) Develop strategies to overcome stigma and discrimination, and
accomplish all other objectives of Part 3.2 (commencing with Section
5830), 3.6 (commencing with Section 5840), and the other provisions
of the act establishing this commission.
(9) At any time, advise the Governor or the Legislature regarding
actions the state may take to improve care and services for people
with mental illness.
(10) If the commission identifies a critical issue related to the
performance of a county mental health program, it may refer the issue
to the State Department of Health Care Services pursuant to Section
5655.
(11) Assist in providing technical assistance to accomplish the
purposes of the Mental Health Services Act, Part 3 (commencing with
Section 5800), and Part 4 (commencing with Section 5850) in
collaboration with the State Department of Health Care Services and
in consultation with the California Mental Health Directors
Association.
(12) Work in collaboration with the State Department of Health
Care Services and the California Mental Health Planning Council, and
in consultation with the California Mental Health Directors
Association, in designing a comprehensive joint plan for a
coordinated evaluation of client outcomes in the community-based
mental health system, including, but not limited to, parts listed in
subdivision (a). The California Health and Human Services Agency
shall lead this comprehensive joint plan effort.
SEC. 61. Section 5846 of the Welfare and Institutions Code is
amended to read:
5846. (a) The commission shall issue guidelines for expenditures
pursuant to Part 3.2 (commencing with Section 5830), for innovative
programs, and Part 3.6 (commencing with Section 5840), for prevention
and early intervention, no later than 180 days before the fiscal
year for which the funds will apply.
(b) The commission may provide technical assistance to any county
mental health plan as needed to address concerns or recommendations
of the commission or when local programs could benefit from technical
assistance for improvement of their plans.
(c) The commission shall ensure that the perspective and
participation of diverse community members reflective of California
populations and others suffering from severe mental illness and their
family members is a significant factor in all of its decisions and
recommendations.
SEC. 62. Section 5847 of the Welfare and Institutions Code is
amended to read:
5847. Integrated Plans for Prevention, Innovation, and System of
Care Services.
(a) Each county mental health program shall prepare and submit a
three-year program and expenditure plan, and annual updates, adopted
by the county board of supervisors, to the Mental Health Services
Oversight and Accountability Commission within 30 days after
adoption.
(b) The three-year program and expenditure plan shall be based on
available unspent funds and estimated revenue allocations provided
by the state and in accordance with established stakeholder
engagement and planning requirements as required in Section 5848. The
three-year program and expenditure plan and annual updates shall
include all of the following:
(1) A program for prevention and early intervention in accordance
with Part 3.6 (commencing with Section 5840).
(2) A program for services to children in accordance with Part 4
(commencing with Section 5850), to include a program pursuant to
Chapter 4 (commencing with Section 18250) of Part 6 of Division 9 or
provide substantial evidence that it is not feasible to establish a
wraparound program in that county.
(3) A program for services to adults and seniors in accordance
with Part 3 (commencing with Section 5800).
(4) A program for innovations in accordance with Part 3.2
(commencing with Section 5830).
(5) A program for technological needs and capital facilities
needed to provide services pursuant to Part 3 (commencing with
Section 5800), Part 3.6 (commencing with Section 5840), and Part 4
(commencing with Section 5850). All plans for proposed facilities
with restrictive settings shall demonstrate that the needs of the
people to be served cannot be met in a less restrictive or more
integrated setting.
(6) Identification of shortages in personnel to provide services
pursuant to the above programs and the additional assistance needed
from the education and training programs established pursuant to Part
3.1 (commencing with Section 5820).
(7) Establishment and maintenance of a prudent reserve to ensure
the county program will continue to be able to serve children,
adults, and seniors that it is currently serving pursuant to Part 3
(commencing with Section 5800), the Adult and Older Adult Mental
Health System of Care Act, Part 3.6 (commencing with Section 5840),
Prevention and Early Intervention Programs, and Part 4 (commencing
with Section 5850), the Children's Mental Health Services Act, during
years in which revenues for the Mental Health Services Fund are
below recent averages adjusted by changes in the state population and
the California Consumer Price Index.
(8) Certification by the county mental health director, which
ensures that the county has complied with all pertinent regulations,
laws, and statutes of the Mental Health Services Act, including
stakeholder participation and nonsupplantation requirements.
(9) Certification by the county mental health director and by the
county auditor-controller that the county has complied with any
fiscal accountability requirements as directed by the State
Department of Health Care Services, and that all expenditures are
consistent with the requirements of the Mental Health Services Act.
(c) The programs established pursuant to paragraphs (2) and (3) of
subdivision (b) shall include services to address the needs of
transition age youth ages 16 to 25. In implementing this subdivision,
county mental health programs shall consider the needs of transition
age foster youth.
(d) Each year, the State Department of Health Care Services shall
inform the California Mental Health Directors Association and the
Mental Health Services Oversight and Accountability Commission of the
methodology used for revenue allocation to the counties.
(e) Each county mental health program shall prepare expenditure
plans pursuant to Part 3 (commencing with Section 5800) for adults
and seniors, Part 3.2 (commencing with Section 5830) for innovative
programs, Part 3.6 (commencing with Section 5840) for prevention and
early intervention programs, and Part 4 (commencing with Section
5850) for services for children, and updates to the plans developed
pursuant to this section. Each expenditure update shall indicate the
number of children, adults, and seniors to be served pursuant to Part
3 (commencing with Section 5800), and Part 4 (commencing with
Section 5850), and the cost per person. The expenditure update shall
include utilization of unspent funds allocated in the previous year
and the proposed expenditure for the same purpose.
(f) A county mental health program shall include an allocation of
funds from a reserve established pursuant to paragraph (7) of
subdivision (b) for services pursuant to paragraphs (2) and (3) of
subdivision (b) in years in which the allocation of funds for
services pursuant to subdivision (e) are not adequate to continue to
serve the same number of individuals as the county had been serving
in the previous fiscal year.
SEC. 63. Section 5848 of the Welfare and Institutions Code is
amended to read:
5848. (a) Each three-year program and expenditure plan and update
shall be developed with local stakeholders, including adults and
seniors with severe mental illness, families of children, adults, and
seniors with severe mental illness, providers of services, law
enforcement agencies, education, social services agencies, veterans,
representatives from veterans organizations, providers of alcohol and
drug services, health care organizations, and other important
interests. Counties shall demonstrate a partnership with constituents
and stakeholders throughout the process that includes meaningful
stakeholder involvement on mental health policy, program planning,
and implementation, monitoring, quality improvement, evaluation, and
budget allocations. A draft plan and update shall be prepared and
circulated for review and comment for at least 30 days to
representatives of stakeholder interests and any interested party who
has requested a copy of the draft plans.
(b) The mental health board established pursuant to Section 5604
shall conduct a public hearing on the draft three-year program and
expenditure plan and annual updates at the close of the 30-day
comment period required by subdivision (a). Each adopted three-year
program and expenditure plan and update shall include any substantive
written recommendations for revisions. The adopted three-year
program and expenditure plan or update shall summarize and analyze
the recommended revisions. The mental health board shall review the
adopted plan or update and make recommendations to the county mental
health department for revisions.
(c) The plans shall include reports on the achievement of
performance outcomes for services pursuant to Part 3 (commencing with
Section 5800), Part 3.6 (commencing with Section 5840), and Part 4
(commencing with Section 5850) funded by the Mental Health Services
Fund and established jointly by the State Department of Health Care
Services and the Mental Health Services Oversight and Accountability
Commission, in collaboration with the California Mental Health
Directors Association.
(d) Mental health services provided pursuant to Part 3 (commencing
with Section 5800), and Part 4 (commencing with Section 5850), shall
be included in the review of program performance by the California
Mental Health Planning Council required by paragraph (2) of
subdivision (c) of Section 5772 and in the local mental health board'
s review and comment on the performance outcome data required by
paragraph (7) of subdivision (a) of Section 5604.2.
SEC. 64. Section 5878.1 of the Welfare and Institutions Code is
amended to read:
5878.1. (a) It is the intent of this article to establish
programs that ensure services will be provided to severely mentally
ill children as defined in Section 5878.2 and that they be part of
the children's system of care established pursuant to this part. It
is the intent of this act that services provided under this chapter
to severely mentally ill children are accountable, developed in
partnership with youth and their families, culturally competent, and
individualized to the strengths and needs of each child and his or
her family.
(b) Nothing in this act shall be construed to authorize any
services to be provided to a minor without the consent of the child's
parent or legal guardian beyond those already authorized by existing
statute.
SEC. 65. Section 5878.3 of the Welfare and Institutions Code is
amended to read:
5878.3. (a) Subject to the availability of funds as determined
pursuant to Part 4.5 (commencing with Section 5890) of this division,
county mental health programs shall offer services to severely
mentally ill children for whom services under any other public or
private insurance or other mental health or entitlement program is
inadequate or unavailable. Other entitlement programs include but are
not limited to mental health services available pursuant to
Medi-Cal, child welfare, and special education programs. The funding
shall cover only those portions of care that cannot be paid for with
public or private insurance, other mental health funds or other
entitlement programs.
(b) Funding shall be at sufficient levels to ensure that counties
can provide each child served all of the necessary services set forth
in the applicable treatment plan developed in accordance with this
part, including services
where appropriate and necessary to prevent an out of home placement,
such as services pursuant to Chapter 4 (commencing with Section
18250) of Part 6 of Division 9.
(c) The State Department of Health Care Services shall contract
with county mental health programs for the provision of services
under this article in the manner set forth in Section 5897.
SEC. 66. Section 5890 of the Welfare and Institutions Code is
amended to read:
5890. (a) The Mental Health Services Fund is hereby created in
the State Treasury. The fund shall be administered by the state.
Notwithstanding Section 13340 of the Government Code, all moneys in
the fund are, except as provided in subdivision (d) of Section 5892,
continuously appropriated, without regard to fiscal years, for the
purpose of funding the following programs and other related
activities as designated by other provisions of this division:
(1) Part 3 (commencing with Section 5800), the Adult and Older
Adult System of Care Act.
(2) Part 3.2 (commencing with Section 5830), Innovative Programs.
(3) Part 3.6 (commencing with Section 5840), Prevention and Early
Intervention Programs.
(4) Part 4 (commencing with Section 5850), the Children's Mental
Health Services Act.
(b) Nothing in the establishment of this fund, nor any other
provisions of the act establishing it or the programs funded shall be
construed to modify the obligation of health care service plans and
disability insurance policies to provide coverage for mental health
services, including those services required under Section 1374.72 of
the Health and Safety Code and Section 10144.5 of the Insurance Code,
related to mental health parity. Nothing in this act shall be
construed to modify the oversight duties of the Department of Managed
Health Care or the duties of the Department of Insurance with
respect to enforcing these obligations of plans and insurance
policies.
(c) Nothing in this act shall be construed to modify or reduce the
existing authority or responsibility of the State Department of
Health Care Services.
(d) The State Department of Health Care Services shall seek
approval of all applicable federal Medicaid approvals to maximize the
availability of federal funds and eligibility of participating
children, adults, and seniors for medically necessary care.
(e) Share of costs for services pursuant to Part 3 (commencing
with Section 5800), and Part 4 (commencing with Section 5850) of this
division, shall be determined in accordance with the Uniform Method
for Determining Ability to Pay applicable to other publicly funded
mental health services, unless this Uniform Method is replaced by
another method of determining co-payments, in which case the new
method applicable to other mental health services shall be applicable
to services pursuant to Part 3 (commencing with Section 5800), and
Part 4 (commencing with Section 5850) of this division.
SEC. 67. Section 5891 of the Welfare and Institutions Code is
amended to read:
5891. (a) The funding established pursuant to this act shall be
utilized to expand mental health services. Except as provided in
subdivision (j) of Section 5892 due to the state's fiscal crisis,
these funds shall not be used to supplant existing state or county
funds utilized to provide mental health services. The state shall
continue to provide financial support for mental health programs with
not less than the same entitlements, amounts of allocations from the
General Fund or from the Local Revenue Fund 2011 in the State
Treasury, and formula distributions of dedicated funds as provided in
the last fiscal year which ended prior to the effective date of this
act. The state shall not make any change to the structure of
financing mental health services, which increases a county's share of
costs or financial risk for mental health services unless the state
includes adequate funding to fully compensate for such increased
costs or financial risk. These funds shall only be used to pay for
the programs authorized in Section 5892. These funds may not be used
to pay for any other program. These funds may not be loaned to the
state General Fund or any other fund of the state, or a county
general fund or any other county fund for any purpose other than
those authorized by Section 5892.
(b) Notwithstanding subdivision (a), the Controller may use the
funds created pursuant to this part for loans to the General Fund as
provided in Sections 16310 and 16381 of the Government Code. Any such
loan shall be repaid from the General Fund with interest computed at
110 percent of the Pooled Money Investment Account rate, with
interest commencing to accrue on the date the loan is made from the
fund. This subdivision does not authorize any transfer that would
interfere with the carrying out of the object for which these funds
were created.
(c) Commencing July 1, 2012, on or before the 15th day of each
month, pursuant to a methodology provided by the State Department of
Health Care Services, the Controller shall distribute to each Local
Mental Health Service Fund established by counties pursuant to
subdivision (f) of Section 5892, all unexpended and unreserved funds
on deposit as of the last day of the prior month in the Mental Health
Services Fund, established pursuant to Section 5890, for the
provision of programs and other related activities set forth in Part
3 (commencing with Section 5800), Part 3.2 (commencing with Section
5830), Part 3.6 (commencing with Section 5840), and Part 4
(commencing with Section 5850).
(d) Counties shall base their expenditures on the county mental
health program's three-year program and expenditure plan or annual
update, as required by Section 5847. Nothing in this subdivision
shall affect subdivision (a) or (b).
SEC. 68. Section 5892 of the Welfare and Institutions Code is
amended to read:
5892. (a) In order to promote efficient implementation of this
act, the county shall use funds distributed from the Mental Health
Services Fund as follows:
(1) In 2005-06, 2006-07, and in 2007-08 10 percent shall be placed
in a trust fund to be expended for education and training programs
pursuant to Part 3.1.
(2) In 2005-06, 2006-07 and in 2007-08 10 percent for capital
facilities and technological needs distributed to counties in
accordance with a formula developed in consultation with the
California Mental Health Directors Association to implement plans
developed pursuant to Section 5847.
(3) Twenty percent of funds distributed to the counties pursuant
to subdivision (c) of Section 5891 shall be used for prevention and
early intervention programs in accordance with Part 3.6 (commencing
with Section 5840) of this division.
(4) The expenditure for prevention and early intervention may be
increased in any county in which the department determines that the
increase will decrease the need and cost for additional services to
severely mentally ill persons in that county by an amount at least
commensurate with the proposed increase.
(5) The balance of funds shall be distributed to county mental
health programs for services to persons with severe mental illnesses
pursuant to Part 4 (commencing with Section 5850), for the children's
system of care and Part 3 (commencing with Section 5800), for the
adult and older adult system of care.
(6) Five percent of the total funding for each county mental
health program for Part 3 (commencing with Section 5800), Part 3.6
(commencing with Section 5840), and Part 4 (commencing with Section
5850) of this division, shall be utilized for innovative programs in
accordance with Sections 5830, 5847, and 5848.
(b) In any year after 2007-08, programs for services pursuant to
Part 3 (commencing with Section 5800), and Part 4 (commencing with
Section 5850) of this division may include funds for technological
needs and capital facilities, human resource needs, and a prudent
reserve to ensure services do not have to be significantly reduced in
years in which revenues are below the average of previous years. The
total allocation for purposes authorized by this subdivision shall
not exceed 20 percent of the average amount of funds allocated to
that county for the previous five years pursuant to this section.
(c) The allocations pursuant to subdivisions (a) and (b) shall
include funding for annual planning costs pursuant to Section 5848.
The total of these costs shall not exceed 5 percent of the total of
annual revenues received for the fund. The planning costs shall
include funds for county mental health programs to pay for the costs
of consumers, family members, and other stakeholders to participate
in the planning process and for the planning and implementation
required for private provider contracts to be significantly expanded
to provide additional services pursuant to Part 3 (commencing with
Section 5800), and Part 4 (commencing with Section 5850) of this
division.
(d) Prior to making the allocations pursuant to subdivisions (a),
(b), and (c), funds shall be reserved for the costs for the State
Department of Health Care Services, the California Mental Health
Planning Council, the Office of Statewide Health Planning and
Development, the Mental Health Services Oversight and Accountability
Commission, the State Department of Public Health, and any other
state agency to implement all duties pursuant to the programs set
forth in this section. These costs shall not exceed 3.5 percent of
the total of annual revenues received for the fund. The
administrative costs shall include funds to assist consumers and
family members to ensure the appropriate state and county agencies
give full consideration to concerns about quality, structure of
service delivery, or access to services. The amounts allocated for
administration shall include amounts sufficient to ensure adequate
research and evaluation regarding the effectiveness of services being
provided and achievement of the outcome measures set forth in Part 3
(commencing with Section 5800), Part 3.6 (commencing with Section
5840), and Part 4 (commencing with Section 5850) of this division.
The amount of funds available for the purposes of this subdivision in
any fiscal year shall be subject to appropriation in the annual
Budget Act.
(e) In 2004-05 funds shall be allocated as follows:
(1) Forty-five percent for education and training pursuant to
Part 3.1 (commencing with Section 5820) of this division.
(2) Forty-five percent for capital facilities and technology
needs in the manner specified by paragraph (2) of subdivision (a).
(3) Five percent for local planning in the manner specified in
subdivision (c).
(4) Five percent for state implementation in the manner specified
in subdivision (d).
(f) Each county shall place all funds received from the State
Mental Health Services Fund in a local Mental Health Services Fund.
The Local Mental Health Services Fund balance shall be invested
consistent with other county funds and the interest earned on the
investments shall be transferred into the fund. The earnings on
investment of these funds shall be available for distribution from
the fund in future years.
(g) All expenditures for county mental health programs shall be
consistent with a currently approved plan or update pursuant to
Section 5847.
(h) Other than funds placed in a reserve in accordance with an
approved plan, any funds allocated to a county which have not been
spent for their authorized purpose within three years shall revert to
the state to be deposited into the fund and available for other
counties in future years, provided however, that funds for capital
facilities, technological needs, or education and training may be
retained for up to 10 years before reverting to the fund.
(i) If there are still additional revenues available in the fund
after the Mental Health Services Oversight and Accountability
Commission has determined there are prudent reserves and no unmet
needs for any of the programs funded pursuant to this section,
including all purposes of the Prevention and Early Intervention
Program, the commission shall develop a plan for expenditures of
these revenues to further the purposes of this act and the
Legislature may appropriate these funds for any purpose consistent
with the commission's adopted plan which furthers the purposes of
this act.
(j) For the 2011-12 fiscal year, General Fund revenues will be
insufficient to fully fund many existing mental health programs,
including Early and Periodic Screening, Diagnosis, and Treatment
(EPSDT), Medi-Cal Specialty Mental Health Managed Care, and mental
health services provided for special education pupils. In order to
adequately fund those programs for the 2011-12 fiscal year and avoid
deeper reductions in programs that serve individuals with severe
mental illness and the most vulnerable, medically needy citizens of
the state, prior to distribution of funds under paragraphs (1) to
(6), inclusive, of subdivision (a), effective July 1, 2011, moneys
shall be allocated from the Mental Health Services Fund to the
counties as follows:
(1) Commencing July 1, 2011, one hundred eighty-three million six
hundred thousand dollars ($183,600,000) of the funds available as of
July 1, 2011, in the Mental Health Services Fund, shall be allocated
in a manner consistent with subdivision (c) of Section 5778 and based
on a formula determined by the state in consultation with the
California Mental Health Directors Association to meet the fiscal
year 2011-12 General Fund obligation for Medi-Cal Specialty Mental
Health Managed Care.
(2) Upon completion of the allocation in paragraph (1), the
Controller shall distribute to counties ninety-eight million five
hundred eighty-six thousand dollars ($98,586,000) from the Mental
Health Services Fund for mental health services for special education
pupils based on a formula determined by the state in consultation
with the California Mental Health Directors Association.
(3) Upon completion of the allocation in paragraph (2), the
Controller shall distribute to counties 50 percent of their 2011-12
Mental Health Services Act component allocations consistent with
Sections 5847 and 5891, not to exceed four hundred eighty-eight
million dollars ($488,000,000). This allocation shall commence
beginning August 1, 2011.
(4) Upon completion of the allocation in paragraph (3), and as
revenues are deposited into the Mental Health Services Fund, the
Controller shall distribute five hundred seventy-nine million dollars
($579,000,000) from the Mental Health Services Fund to counties to
meet the General Fund obligation for EPSDT for fiscal year 2011-12.
These revenues shall be distributed to counties on a quarterly basis
and based on a formula determined by the state in consultation with
the California Mental Health Directors Association. These funds shall
not be subject to reconciliation or cost settlement.
(5) The Controller shall distribute to counties the remaining
2011-12 Mental Health Services Act component allocations consistent
with Sections 5847 and 5891, beginning no later than April 30, 2012.
These remaining allocations shall be made on a monthly basis.
(6) The total one-time allocation from the Mental Health Services
Fund for EPSDT, Medi-Cal Specialty Mental Health Managed Care, and
mental health services provided to special education pupils as
referenced shall not exceed eight hundred sixty-two million dollars
($862,000,000). Any revenues deposited in the Mental Health Services
Fund in fiscal year 2011-12 that exceed this obligation shall be
distributed to counties for remaining fiscal year 2011-12 Mental
Health Services Act component allocations, consistent with Sections
5847 and 5891.
(k) Subdivision (j) shall not be subject to repayment.
(l) Subdivision (j) shall become inoperative on July 1, 2012.
SEC. 69. Section 5897 of the Welfare and Institutions Code is
amended to read:
5897. (a) Notwithstanding any other provision of state law, the
State Department of Health Care Services shall implement the mental
health services provided by Part 3 (commencing with Section 5800),
Part 3.6 (commencing with Section 5840), and Part 4 (commencing with
Section 5850) of this division through contracts with county mental
health programs or counties acting jointly. A contract may be
exclusive and may be awarded on a geographic basis. As used herein a
county mental health program includes a city receiving funds pursuant
to Section 5701.5.
(b) Two or more counties acting jointly may agree to deliver or
subcontract for the delivery of such mental health services. The
agreement may encompass all or any part of the mental health services
provided pursuant to these parts. Any agreement between counties
shall delineate each county's responsibilities and fiscal liability.
(c) The department shall implement the provisions of Part 3
(commencing with Section 5800), Part 3.2 (commencing with Section
5830), Part 3.6 (commencing with Section 5840), and Part 4
(commencing with Section 5850) of this division through the annual
county mental health services performance contract, as specified in
Chapter 2 (commencing with Section 5650) of Part 2 of Division 5.
(d) When a county mental health program is not in compliance with
its performance contract, the department may request a plan of
correction with a specific timeline to achieve improvements.
(e) Contracts awarded by the State Department of Health Care
Services, the California Mental Health Planning Council, the Office
of Statewide Health Planning and Development, and the Mental Health
Services Oversight and Accountability Commission pursuant to Part 3
(commencing with Section 5800), Part 3.1 (commencing with Section
5820), Part 3.2 (commencing with Section 5830), Part 3.6 (commencing
with Section 5840), Part 3.7 (commencing with Section 5845), Part 4
(commencing with Section 5850), and Part 4.5 (commencing with Section
5890) of this division, may be awarded in the same manner in which
contracts are awarded pursuant to Section 5814 and the provisions of
subdivisions (g) and (h) of Section 5814 shall apply to such
contracts.
(f) For purposes of Section 5775, the allocation of funds pursuant
to Section 5892 which are used to provide services to Medi-Cal
beneficiaries shall be included in calculating anticipated county
matching funds and the transfer to the State Department of Health
Care Services of the anticipated county matching funds needed for
community mental health programs.
SEC. 70. Section 5898 of the Welfare and Institutions Code is
amended to read:
5898. The State Department of Health Care Services, in
consultation with the Mental Health Services Oversight and
Accountability Commission, shall develop regulations, as necessary,
for the State Department of Health Care Services, the Mental Health
Services Oversight and Accountability Commission, or designated state
and local agencies to implement this act. Regulations adopted
pursuant to this section shall be developed with the maximum feasible
opportunity for public participation and comments.
SEC. 71. Section 5899 is added to the Welfare and Institutions
Code, to read:
5899. (a) The State Department of Health Care Services, in
consultation with the Mental Health Services Oversight and
Accountability Commission and the California Mental Health Directors
Association, shall develop and administer instructions for the Annual
Mental Health Services Act Revenue and Expenditure Report. This
report shall be submitted electronically to the department and to the
Mental Health Services Oversight and Accountability Commission.
(b) The purpose of the Annual Mental Health Services Act Revenue
and Expenditure Report is as follows:
(1) Identify the expenditures of Mental Health Services Act (MHSA)
funds that were distributed to each county.
(2) Quantify the amount of additional funds generated for the
mental health system as a result of the MHSA.
(3) Identify unexpended funds, and interest earned on MHSA funds.
(4) Determine reversion amounts, if applicable, from prior fiscal
year distributions.
(c) This report is intended to provide information that allows for
the evaluation of all of the following:
(1) Children's systems of care.
(2) Prevention and early intervention strategies.
(3) Innovative projects.
(4) Workforce education and training.
(5) Adults and older adults systems of care.
(6) Capital facilities and technology needs.
SEC. 72. Section 14046.7 of the Welfare and Institutions Code is
amended to read:
14046.7. (a) General Fund moneys shall not be used for the
purposes of this article.
(b) Notwithstanding subdivision (a), no more than two hundred
thousand dollars ($200,000) from the General Fund may be used
annually for state administrative costs associated with implementing
this article.
SEC. 73. Section 14085.6 of the Welfare and Institutions Code is
amended to read:
14085.6. (a) Except as stated in subdivision (g), each hospital
contracting to provide services under this article that meets the
criteria contained in the state Medicaid plan for disproportionate
share hospital status shall be eligible to negotiate with the
commission for distributions from the Emergency Services and
Supplemental Payments Fund, which is hereby created. All
distributions from the fund shall be pursuant to this section.
(b) (1) To the extent permitted by federal law, the department
shall administer the fund in accordance with this section.
(2) The money in this fund shall be available for expenditure by
the department for the purposes of this section, subject to approval
through the regular budget process.
(c) The fund shall include all of the following:
(1) Subject to subdivision (l), all public funds transferred by
public agencies to the department for deposit in the fund, as
permitted under Section 433.51 of Title 42 of the Code of Federal
Regulations or any other applicable federal Medicaid laws. These
transfers shall constitute local government financial participation
in Medi-Cal as permitted under Section 1902(a)(2) of the federal
Social Security Act (Title 42 U.S.C. Sec. 1396a(a)(2)) and other
applicable federal Medicaid laws.
(2) Subject to subdivision (l), all private donated funds
transferred by private individuals or entities for deposit in the
fund as permitted under applicable federal Medicaid laws.
(3) Any amounts appropriated to the fund by the Legislature.
(4) Interest that accrues on amounts in the fund.
(5) Moneys appropriated to the fund, or appropriated for poison
control center grants and transferred to the fund, pursuant to the
annual Budget Act.
(d) Amounts in the fund shall be used as the source for the
nonfederal share of payments to hospitals under this section. Moneys
shall be allocated from the fund by the department and matched by
federal funds in accordance with customary Medi-Cal accounting
procedures for purposes of payments under this section.
(e) Distributions from the fund shall be supplemental to any and
all other amounts that hospitals would have received under the
contracting program, and under the state Medicaid plan, including
contract rate increases and supplemental payments and payment
adjustments under distribution programs relating to disproportionate
share hospitals.
(f) Distributions from the fund shall not serve as the state's
payment adjustment program under Section 1923 of the federal Social
Security Act (42 U.S.C. Sec. 1396r-4). To the extent permitted by
federal law, and except as otherwise provided in this section,
distributions from the fund shall not be subject to requirements
contained in or related to Section 1923 of the federal Social
Security Act (42 U.S.C. Sec. 1396r-4). Distributions from the fund
shall be supplemental contract payments and may be structured on any
federally permissible basis, as negotiated between the commission and
the hospital.
(g) In order to qualify for distributions from the fund, a
hospital shall meet all of the following criteria:
(1) Be a contracting hospital under this article.
(2) Satisfy the state Medicaid plan criteria referred to in
subdivision (a).
(3) Be one of the following:
(A) A licensed provider of basic emergency services as described
in Sections 70411 and following of Title 22 of the California Code of
Regulations.
(B) A licensed provider of comprehensive emergency medical
services as defined in Sections 70451 and following of Title 22 of
the California Code of Regulations.
(C) A children's hospital as defined in Section 14087.21 that
satisfies subparagraph (A) or (B) or that jointly provides basic or
comprehensive emergency services in conjunction with another licensed
hospital.
(D) A hospital owned and operated by a public agency that operates
two or more hospitals that qualify under subparagraph (A) or (B)
with respect to the particular state fiscal year.
(E) A hospital designated by the National Cancer Institute as a
comprehensive or clinical cancer research center that primarily
treats acutely ill cancer patients and that is exempt from the
federal Medicare prospective payment system pursuant to Section 1886
(d)(1)(B)(v) of the federal Social Security Act (42 U.S.C. Sec.
1395ww(d)(1)(B)(v)).
(4) Be able to demonstrate a purpose for additional funding under
the selective provider contracting program including proposals
relating to emergency services and other health care services,
including infrequent yet high-cost services, such as anti-AB human
antitoxin treatment for infant botulism (human botulinum immune
globulin (HBIG), commonly referred to as "Baby-BIG"), that are made
available, or will be made available, to Medi-Cal beneficiaries.
(h) (1) The department shall seek federal financial participation
for expenditures made from the fund to the full extent permitted by
federal law.
(2) The department shall promptly seek any necessary federal
approvals regarding this section.
(i) Any funds remaining in the fund at the end of a fiscal year
shall be carried forward for use in following fiscal years.
(j) For purposes of this section, "fund" means the Emergency
Services and Supplemental Payments Fund.
(k) (1) Any public agency transferring amounts to the fund, as
specified in paragraph (1) of subdivision (c), may for that purpose,
utilize any revenues, grants, or allocations received from the state
for health care programs or purposes, unless otherwise prohibited by
law. A public agency may also utilize its general funds or any other
public funds or revenues for purposes of transfers to the fund,
unless otherwise prohibited by law.
(2) Notwithstanding paragraph (1), a public agency may transfer to
the fund only those moneys that have a source that will qualify
for federal financial
participation under the provisions of the Medicaid Voluntary
Contribution and Provider-Specific Tax Amendments of 1991 (Public Law
102-234) or other applicable federal Medicaid laws.
(l) Public funds transferred pursuant to paragraph (1) of
subdivision (c), and private donated funds transferred pursuant to
paragraph (2) of subdivision (c), shall be deposited into the fund,
and expended pursuant to this section. The director may accept only
those funds that are certified by the transferring entity as
qualifying for federal financial participation under the terms of the
Medicaid Voluntary Contributions and Provider-Specific Tax
Amendments of 1991 (Public Law 102-234) and may return any funds
transferred in error.
(m) The department may adopt emergency regulations, if necessary,
for the purposes of this section.
(n) The state shall be held harmless from any federal disallowance
resulting from this section. A hospital receiving supplemental
reimbursement pursuant to this section shall be liable for any
reduced federal financial participation resulting from the
implementation of this section with respect to that hospital. The
state may recoup that federal disallowance from the hospital in any
manner authorized by law or contract.
(o) This section shall become inoperative on June 30, 2013, and,
as of January 1, 2014, is repealed, unless a later enacted statute,
that becomes operative on or before January 1, 2014, deletes or
extends the dates on which it becomes inoperative and is repealed.
SEC. 74. Section 14085.7 of the Welfare and Institutions Code is
amended to read:
14085.7. (a) The Medi-Cal Medical Education Supplemental Payment
Fund is hereby created in the State Treasury. Notwithstanding Section
13340 of the Government Code, the fund shall be continuously
appropriated to, and under the administrative control of, the
department for the purposes specified in this section. Except as
otherwise limited by this section, the fund shall consist of all of
the following:
(1) All public moneys transferred by public agencies to the
department for deposit into the fund, as permitted under Section
433.51 of Title 42 of the Code of Federal Regulations or any other
applicable federal Medicaid laws.
(2) All private moneys donated by private individuals or entities
to the department for deposit in the fund as permitted under
applicable federal Medicaid laws.
(3) Any amounts appropriated to the fund by the Legislature.
(4) Any interest that accrues on amounts in the fund.
(b) Any public agency transferring moneys to the fund may, for
that purpose, utilize any revenues, grants, or allocations received
from the state for health care programs or purposes, unless otherwise
prohibited by law. A public agency may also utilize its general
funds or any other public moneys or revenues for purposes of
transfers to the fund, unless otherwise prohibited by law.
(c) The department shall have the discretion to accept or not
accept moneys offered to the department for deposit in the fund. If
the department accepts moneys pursuant to this section, the
department shall obtain federal matching funds to the full extent
permitted by law. The department shall accept only those funds that
are certified by the transferring or donating entity as qualifying
for federal financial participation under the terms of the Medicaid
Voluntary Contribution and Provider-Specific Tax Amendments of 1991
(Public Law 102-234) or Section 433.51 of Title 42 of the Code of
Federal Regulations, as applicable, and may return any funds
transferred or donated in error.
(d) Moneys in the fund shall be used as the source for the
nonfederal share of payments to hospitals under this section. Moneys
shall be allocated from the fund by the department and matched by
federal funds in accordance with customary Medi-Cal accounting
procedures for purposes of payments under subdivision (e).
Distributions from the fund shall be supplemental to any other
amounts that hospitals receive under the contracting program.
(e) For purposes of recognizing medical education costs incurred
for services rendered to Medi-Cal beneficiaries, payments from this
fund shall be negotiated between the California Medical Assistance
Commission and hospitals contracting under this article that meet the
definition of university teaching hospitals or major (nonuniversity)
teaching hospitals as set forth on page 51 and as listed on page 57
of the department's report dated May 1991, entitled "Hospital Peer
Grouping." Payments from the fund shall be used solely for the
purposes identified in the contract between the hospital and the
state.
(f) The state shall be held harmless from any federal disallowance
resulting from this section. A hospital receiving supplemental
reimbursement pursuant to this section shall be liable for any
reduced federal financial participation resulting from the
implementation of this section with respect to that hospital. The
state may recoup any federal disallowance from the hospital.
(g) This section shall become inoperative on June 30, 2013, and,
as of January 1, 2014, is repealed, unless a later enacted statute,
that becomes operative on or before January 1, 2014, deletes or
extends the dates on which it becomes inoperative and is repealed.
SEC. 75. Section 14085.8 of the Welfare and Institutions Code is
amended to read:
14085.8. (a) The Large Teaching Emphasis Hospital and Children's
Hospital Medi-Cal Medical Education Supplemental Payment Fund is
hereby created in the State Treasury.
(b) Notwithstanding Section 13340 of the Government Code, the fund
shall be continuously appropriated to, and under the administrative
control of, the department for the purposes specified in this
section.
(c) Except as otherwise limited by this section, the fund shall
consist of all of the following:
(1) All public moneys transferred by public agencies to the
department for deposit into the fund, as permitted under Section
433.51 of Title 42 of the Code of Federal Regulations or any other
applicable federal Medicaid laws.
(2) All private moneys donated by private individuals or entities
to the department for deposit in the fund as permitted under
applicable federal Medicaid laws.
(3) Any amounts appropriated to the fund by the Legislature.
(4) Any interest that accrues on amounts in the fund.
(d) Any public agency transferring moneys to the fund may, for
that purpose, utilize any revenues, grants, or allocations received
from the state for health care programs or purposes, unless otherwise
prohibited by law. A public agency may also utilize its general
funds or any other public moneys or revenues for purposes of
transfers to the fund, unless otherwise prohibited by law.
(e) The department may accept or not accept moneys offered to the
department for deposit in the fund. If the department accepts moneys
pursuant to this section, the department shall obtain federal
matching funds to the full extent permitted by law. The department
shall accept only those funds that are certified by the transferring
or donating entity as qualifying for federal financial participation
under the terms of the Medicaid Voluntary Contribution and
Provider-Specific Tax Amendments of 1991 (Public Law 102-234) or
Section 433.51 of Title 42 of the Code of Federal Regulations, as
applicable, and may return any funds transferred or donated in error.
(f) Moneys in the fund shall be used as the source for the
nonfederal share of payments to hospitals under this section. Moneys
shall be allocated from the fund by the department and matched by
federal funds in accordance with customary Medi-Cal accounting
procedures for purposes of payments under subdivision (g).
Distributions from the fund shall be supplemental to any other
amounts that hospitals receive under the contracting program.
(g) (1) For purposes of recognizing medical education costs
incurred for services rendered to Medi-Cal beneficiaries, contracts
for payments from the fund may, at the discretion of the California
Medical Assistance Commission, be negotiated between the commission
and hospitals contracting under this article that are defined as
either of the following:
(A) A large teaching emphasis hospital, as set forth on page 51
and listed on page 57 of the department's report dated May 1991,
entitled "Hospital Peer Grouping," and meets the definition of
eligible hospital as defined in paragraph (3) of subdivision (a) of
Section 14105.98.
(B) A children's hospital pursuant to Section 10727 and meets the
definition of eligible hospital as defined in paragraph (3) of
subdivision (a) of Section 14105.98.
(2) Payments from the fund shall be used solely for the purposes
identified in the contract between the hospital and the state.
(h) The state shall be held harmless from any federal disallowance
resulting from this section. A hospital receiving supplemental
reimbursement pursuant to this section shall be liable for any
reduced federal financial participation resulting from the
implementation of this section with respect to that hospital. The
state may recoup any federal disallowance from the hospital.
(i) This section shall become inoperative on June 30, 2013, and,
as of January 1, 2014, is repealed, unless a later enacted statute,
that becomes operative on or before January 1, 2014, deletes or
extends the dates on which it becomes inoperative and is repealed.
SEC. 76. Section 14085.81 of the Welfare and Institutions Code is
amended to read:
14085.81. (a) Notwithstanding the requirement in subparagraph (A)
of paragraph (1) of subdivision (g) of Section 14085.8 that a
hospital must be listed on page 57 of the department's report dated
May 1991, entitled "Hospital Peer Grouping," any hospital whose
license pursuant to Chapter 2 (commencing with Section 1250) of
Division 2 of the Health and Safety Code was consolidated during the
1999 calendar year with a large teaching emphasis hospital that is
listed on page 57 of the above described report shall be eligible to
negotiate payments pursuant to paragraph (1) of subdivision (g) of
Section 14085.8. All other requirements of Section 14085.8 shall
continue to apply.
(b) This section shall become inoperative on June 30, 2013, and,
as of January 1, 2014, is repealed, unless a later enacted statute,
that becomes operative on or before January 1, 2014, deletes or
extends the dates on which it becomes inoperative and is repealed.
SEC. 77. Section 14085.9 of the Welfare and Institutions Code is
amended to read:
14085.9. (a) Except as provided in subdivision (g), each hospital
contracting to provide services under this article that meets the
criteria contained in the state Medicaid plan for disproportionate
share hospital status shall be eligible to negotiate with the
commission for distributions from the Small and Rural Hospital
Supplemental Payments Fund, which is hereby created and,
notwithstanding Section 13340 of the Government Code, is continuously
appropriated for the purposes specified in this section. All
distributions from the fund shall be pursuant to this section.
(b) (1) To the extent permitted by federal law, the department
shall administer the fund in accordance with this section.
(2) The money in this fund shall be available for expenditure by
the department for the purposes of this section, subject to approval
through the regular budget process.
(c) The fund shall include all of the following:
(1) Subject to subdivision ( l ), all public funds
transferred by public agencies to the department for deposit in the
fund, as permitted under Section 433.51 of Title 42 of the Code of
Federal Regulations or any other applicable federal Medicaid laws.
These transfers shall constitute local government financial
participation in Medi-Cal as permitted under Section 1902(a)(2) of
the federal Social Security Act (Title 42 U.S.C. Sec. 1396a(a)(2))
and other applicable federal Medicaid laws.
(2) Subject to subdivision ( l ), all private donated
funds transferred by private individuals or entities for deposit in
the fund as permitted under applicable federal Medicaid laws.
(3) Any amounts appropriated to the fund by the Legislature.
(4) Interest that accrues on amounts in the fund.
(d) Amounts in the fund shall be used as the source for the
nonfederal share of payments to hospitals under this section. Moneys
shall be allocated from the fund by the department and matched by
federal funds in accordance with customary Medi-Cal accounting
procedures for purposes of payments under this section.
(e) Distributions from the fund shall be supplemental to any and
all other amounts that hospitals would have received under the
contracting program, and under the state Medicaid plan, including
contract rate increases and supplemental payments and payment
adjustments under distribution programs relating to disproportionate
share hospitals.
(f) Distributions from the fund shall not serve as the state's
payment adjustment program under Section 1923 of the federal Social
Security Act (42 U.S.C. Sec. 1396r-4). To the extent permitted by
federal law, and except as otherwise provided in this section,
distributions from the fund shall not be subject to requirements
contained in or related to Section 1923 of the federal Social
Security Act (42 U.S.C. Sec. 1396r-4). Distributions from the fund
shall be supplemental contract payments and may be structured on any
federally permissible basis, as negotiated between the commission and
the hospital.
(g) In order to qualify for distributions from the fund, a
hospital shall meet all of the following criteria:
(1) Be a contracting hospital under this article.
(2) Satisfy the state Medicaid plan criteria referred to in
subdivision (a).
(3) Be a small and rural hospital as defined in Section 124840 of
the Health and Safety Code.
(4) Be a licensed provider of standby emergency services as
described in Section 70649 and following of Title 22 of the
California Code of Regulations.
(5) Be able to demonstrate a purpose for additional funding under
the selective provider contracting program with proposals relating to
health care services that are made available, or will be made
available, to Medi-Cal beneficiaries.
(6) Be determined by the California Medical Assistance Commission
to be a hospital that provides an important community service that
otherwise would not be provided in the community.
(h) (1) The department shall seek federal financial participation
for expenditures made from the fund to the full extent permitted by
federal law.
(2) The department shall promptly seek any necessary federal
approvals regarding this section.
(i) Any funds remaining in the fund at the end of a fiscal year
shall be carried forward for use in following fiscal years.
(j) For purposes of this section, "fund" means the Small and Rural
Hospital Supplemental Payments Fund.
(k) (1) Any public agency transferring amounts to the fund, as
specified in paragraph (1) of subdivision (c), may for that purpose,
utilize any revenues, grants, or allocations received from the state
for health care programs or purposes, unless otherwise prohibited by
law. A public agency may also utilize its general funds or any other
public funds or revenues for purposes of transfers to the fund,
unless otherwise prohibited by law.
(2) Notwithstanding paragraph (1), a public agency may transfer to
the fund only those moneys that have a source that will qualify for
federal financial participation under the provisions of the Medicaid
Voluntary Contribution and Provider-Specific Tax Amendments of 1991
(Public Law 102-234) or other applicable federal Medicaid laws.
( l ) Public funds transferred pursuant to paragraph
(1) of subdivision (c), and private donated funds transferred
pursuant to paragraph (2) of subdivision (c), shall be deposited into
the fund, and expended pursuant to this section. The director may
accept only those funds that are certified by the transferring entity
as qualifying for federal financial participation under the terms of
the Medicaid Voluntary Contributions and Provider-Specific Tax
Amendments of 1991 (Public Law 102-234) and may return any funds
transferred in error.
(m) The department may adopt emergency regulations for the
purposes of this section.
(n) The state shall be held harmless from any federal disallowance
resulting from this section. A hospital receiving supplemental
reimbursement pursuant to this section shall be liable for any
reduced federal financial participation resulting from the
implementation of this section with respect to that hospital. The
state may recoup that federal disallowance from the hospital in any
manner authorized by law or contract.
(o) This section shall become inoperative on June 30, 2013, and,
as of January 1, 2014, is repealed, unless a later enacted statute,
that becomes operative on or before January 1, 2014, deletes or
extends the dates on which it becomes inoperative and is repealed.
SEC. 78. Article 2.82 (commencing with Section 14087.98) is added
to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions
Code, to read:
Article 2.82. Managed Health Care Expansion into Rural
Counties
14087.98. (a) The purpose of this article is to provide a
comprehensive program of managed health care plan services to
Medi-Cal recipients residing in the following counties that currently
receive Medi-Cal services on a fee-for-service basis: Alpine,
Amador, Butte, Calaveras, Colusa, Del Norte, El Dorado, Glenn,
Humboldt, Imperial, Inyo, Lake, Lassen, Mariposa, Modoc, Nevada,
Mono, Placer, Plumas, San Benito, Shasta, Sierra, Siskiyou, Sutter,
Tehama, Trinity, Tuolumne, and Yuba.
(b) The director may enter into exclusive or nonexclusive
contracts on a bid or negotiated basis with one or more managed
health care plans to provide a comprehensive program of managed
health care plan services to Medi-Cal recipients residing in the
counties described in subdivision (a). The director shall give
special consideration to managed health care plans that meet all of
the following:
(1) Have demonstrated experience in effectively serving Medi-Cal
beneficiaries, including diverse populations.
(2) Have demonstrated experience in effectively partnering with
public and traditional safety net health care providers.
(3) Have demonstrated experience in working with local
stakeholders, including consumers, providers, advocates, and county
officials, in plan oversight and in delivery of care.
(4) Have the lowest administrative costs.
(5) Show support from local county officials as demonstrated by an
action of the county board of supervisors.
(6) Show recent successful experience with expansion of managed
care to a rural area.
(7) Offer a quality improvement program for primary care
providers.
(c) Contracts entered into or amended pursuant to this section
shall be exempt from the provisions of Chapter 2 (commencing with
Section 10290) of Part 2 of Division 2 of the Public Contract Code
and Chapter 6 (commencing with Section 14825) of Part 5.5 of Division
3 of Title 2 of the Government Code.
(d) The managed health care plans that the department contracts
with under this article shall comply with the requirements of Section
14087.48 and meet all of the following:
(1) Have Medi-Cal managed health care plan contract experience, or
evidence of the ability to meet these contracting requirements.
(2) Be in good financial standing and meet licensure requirements
under the Knox-Keene Health Care Service Plan Act of 1975 (Chapter
2.2 (commencing with Section 1340) of Division 2 of the Health and
Safety Code), if applicable.
(3) Meet quality measures, which may include Medi-Cal and Medicare
Healthcare Effectiveness Data and Information Set measures and other
quality measures determined or developed by the department and the
federal Centers for Medicare and Medicaid Services.
(e) The managed health care plans that the department contracts
with under this article shall provide Medi-Cal beneficiaries with
information about enrollment rights and options, plan benefits and
rules, and care plan elements so that beneficiaries have the ability
to make informed choices. This information shall be delivered in a
format and language accessible to beneficiaries. The managed health
care plans shall provide access to providers in compliance with
applicable state and federal laws, including, but not limited to,
physical accessibility and the provision of health plan information
in alternative formats.
(f) The department shall conduct a stakeholder process including
relevant stakeholders to ensure that beneficiaries, health care
providers, and managed health care plans have an opportunity to
provide input into the delivery model for these counties and to help
ensure smooth care transitions for beneficiaries.
(g) Enrollment in a Medi-Cal managed health care plan or plans
under this article shall be mandatory in order to receive services
under Medi-Cal, except as otherwise provided by law.
(h) Each beneficiary or eligible applicant shall be informed that
he or she may choose to continue an established patient-provider
relationship if his or her treating provider is a primary care
provider or clinic contracting with the managed health care plan, has
the available capacity, and agrees to continue to treat that
beneficiary or eligible applicant. The managed health care plans
shall comply with continuity of care requirements in Section 1373.96
of the Health and Safety Code.
(i) (1) 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, interpret, or make specific this section
and amend regulations and orders adopted by the department by means
of plan letters, plan or provider bulletins, or similar instructions,
without taking regulatory action, until the time regulations are
adopted. It is the intent of the Legislature that the department have
temporary authority as necessary to implement program changes until
completion of the regulatory process.
(2) The department shall adopt emergency regulations no later than
July 1, 2014. The department may readopt any emergency regulation
authorized by this section that is the same as or substantially
equivalent to an emergency regulation previously adopted pursuant to
this section. The initial adoption of emergency regulations
implementing this section shall be deemed an emergency and necessary
for the immediate preservation of the public peace, health, safety,
or general welfare. Initial emergency regulations and the one
readoption of emergency regulations authorized by this section shall
be exempt from review by the Office of Administrative Law.
(3) The initial emergency regulations and the one readoption of
emergency regulations authorized by this section shall be submitted
to the Office of Administrative Law for filing with the Secretary of
State and each shall remain in effect for no more than 180 days, by
which time final regulations may be adopted.
(j) The cost of any program established under this section shall
not exceed the total amount that the department estimates it would
pay for all services and requirements within the same geographic area
under the fee-for-service Medi-Cal program.
(k) The department shall have exclusive authority to set the
rates, terms, and conditions of managed health care plan contracts
and contract amendments under this article. The director may include
in the contract a provision for quality assurance withholding from
the plan payment, to be paid only if quality measures identified in
the plan contract are met.
(l) The department shall provide the fiscal and appropriate policy
committees of the Legislature with quarterly updates, commencing
January 1, 2014, and ending January 1, 2016, regarding the expansion
of Medi-Cal managed care into the new counties authorized pursuant to
this section. These updates shall include, but not be limited to,
continuity of care requests, grievance and appeal rates, and
utilization reports for the new counties.
(m) The department shall seek all necessary federal approvals to
allow for federal financial participation in expenditures under this
article. This article shall not be implemented until all necessary
federal approvals have been obtained.
(n) This section shall be implemented only to the extent federal
financial participation or funding is available.
(o) Notwithstanding subdivision (q) of Section 6254 of the
Government Code, a contract or contract amendments executed by both
parties after the effective date of the act adding this subdivision
shall be considered a public record for purposes of the California
Public Records Act (Chapter 3.5 (commencing with Section 6250) of
Division 7 of Title 1 of the Government Code) and shall be disclosed
upon request. This subdivision applies to contracts that reveal the
department's rates of payment for health care services, the rates
themselves, and rate manuals.
(p) To implement this section, the department may contract with
public or private entities. Contracts or amendments entered into
under this section may be on an exclusive or nonexclusive basis and a
noncompetitive bid basis and shall be exempt from the following:
(1) Part 2 (commencing with Section 10100) of Division 2 of the
Public Contract Code and any policies, procedures, or regulations
authorized by that part.
(2) Article 4 (commencing with Section 19130) of Chapter 5 of Part
2 of Division 5 of Title 2 of the Government Code.
(3) Review or approval of contracts by the Department of General
Services.
SEC. 79. Section 14089.08 is added to the Welfare and Institutions
Code, to read:
14089.08. (a) Sacramento County may establish a stakeholder
advisory committee to provide input on the delivery of oral health
and dental care services, including prevention and education
services, dental managed care, and fee-for-service Denti-Cal. The
advisory committee shall include, but not be limited to, local
nonprofit organizations, representatives from the First Five
Sacramento Commission, representatives and members of the local
dental society, local health and human services representatives,
representatives of Medi-Cal dental managed care plans, Medi-Cal
enrollees, and other interested individuals. The advisory committee
may meet on a monthly basis.
(b) The advisory committee may submit written input to the State
Department of Health Care Services or the Sacramento County Board of
Supervisors, as applicable, regarding policies that improve the
delivery of oral health and dental services in Sacramento under the
Medi- Cal program or
county-administered health care system.
(c) The State Department of Health Care Services shall meet
periodically, but at least on a quarterly basis, with the advisory
committee to facilitate communication, dissemination of information,
and improvements in the provision of oral health and dental care
services under the Medi-Cal program in the County of Sacramento. The
dissemination of information shall include data reported from
performance measures and benchmarks used by the department.
(d) The advisory committee may meet periodically, but at least
twice annually, with the Sacramento County Department of Health and
Human Services advisory committee established pursuant to Section
14089.07.
(e) No state General Fund moneys shall be used to fund advisory
committee costs or to fund any related administrative costs incurred
by the county.
SEC. 80. Section 14089.09 is added to the Welfare and Institutions
Code, to read:
14089.09. (a) It is the intent of the Legislature to improve
access to oral health and dental care services provided to Medi-Cal
beneficiaries enrolled in dental health managed care plans in the
Counties of Sacramento and Los Angeles through implementation of
performance contracting to ensure dental health plans meet quality
criteria and timely access to dental care, as contained in Section
14459.6, and implementation of a beneficiary dental exception process
for Medi-Cal beneficiaries in the County of Sacramento to access
dental care through fee-for-service Denti-Cal when applicable.
(b) (1) The Director of Health Care Services shall exercise his or
her authority under Section 14131.15 to establish a beneficiary
dental exception (BDE) process, as described in paragraph (2), for
Medi-Cal beneficiaries mandatorily enrolled in dental health plans in
the County of Sacramento. The BDE process shall be implemented no
later than July 1, 2012, and shall be in effect for as long as
mandatory enrollment for dental care is in effect in the County of
Sacramento. The department shall consult with the advisory committee
established pursuant to Section 14089.08 regarding potential
modifications to the BDE process. For purposes of emergency access to
dental care issues, the department shall establish specific
processes under the BDE to accommodate for these issues.
(2) The BDE shall be available to Medi-Cal dental managed care
beneficiaries in the County of Sacramento who are unable to secure
access to services through their managed care plan, in accordance
with applicable contractual timeframes and in accordance with the
Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2
(commencing with Section 1340) of Division 2 of the Health and Safety
Code). The BDE shall allow a beneficiary to opt-out of Medi-Cal
dental managed care and move into fee-for-service Denti-Cal where the
beneficiary may select his or her own dental provider on an ongoing
basis. The beneficiary shall remain in fee-for-service Denti-Cal
until the time he or she chooses to opt in to a dental managed care
arrangement.
(3) Beneficiaries shall be notified of the BDE option, which shall
include the process for access to emergency visits, through a letter
from the department detailing the process, directions on how to fill
out the BDE form, and where to access the BDE form. A hard copy of
the BDE form shall accompany the letter from the department. The BDE
form, directions on how to fill out the BDE form, and a description
of the process shall also be posted on the department's Internet Web
site for easy access by beneficiaries and the public. The department
shall also notify and inform dental managed care plans of the BDE
process and its operation.
(4) Upon receipt of the BDE form, the department shall have no
more than three business days to contact the beneficiary. The
department shall, within five business days from the date of contact
with the beneficiary, work with the beneficiary and the dental plan
to schedule an appointment within the applicable contractual
timeframes and in accordance with the Knox-Keene Health Care Service
Plan Act of 1975 (Chapter 2.2 (commencing with Section 1340) of
Division 2 of the Health and Safety Code).
(A) If an appointment is not available, the department shall
approve and process the BDE and move the beneficiary into
fee-for-service Denti-Cal.
(B) If an appointment is available, the beneficiary shall receive
from the department a followup telephone call after the appointment
to assess how the visit went and to determine if there is a need for
any additional followup.
(5) Based on the followup as identified in subparagraph (B) of
paragraph (4), to the extent no additional access issues to
contractually required services are identified, the BDE shall be
closed and the beneficiary shall remain in the selected dental plan.
(c) The department shall take all necessary steps to implement the
BDE process as described in this section and shall, monthly,
publicly report on the department's Internet Web site the number of
individuals requesting the BDE and the specific outcome of each
request, including, but not limited to, summary data on the types of
visits subject to the BDE process, the services provided, description
of timely access to care, the delivery system in which services were
provided, beneficiary satisfaction, and the department's perspective
of the outcome. The information provided on the department's
Internet Web site shall be deidentified in accordance with the Health
Insurance Portability and Availability Act of 1996 (HIPAA),
including Section 164.514 of Title 45 of the Code of Federal
Regulations, and shall not contain any personally indentifiable
information according to the Information Practices Act of 1977
(Chapter 1 (commencing with Section 1798) of Title 1.8 of Part 4 of
Division 3 of the Civil Code).
(d) The department shall consult with stakeholders in the
development of the BDE form and related materials.
SEC. 81. Section 14091.3 of the Welfare and Institutions Code is
amended to read:
14091.3. (a) For purposes of this section, the following
definitions shall apply:
(1) "Medi-Cal managed care plan contracts" means those contracts
entered into with the department by any individual, organization, or
entity pursuant to Article 2.7 (commencing with Section 14087.3),
Article 2.8 (commencing with Section 14087.5), or Article 2.91
(commencing with Section 14089) of this chapter, or Article 1
(commencing with Section 14200) or Article 7 (commencing with Section
14490) of Chapter 8, or Chapter 8.75 (commencing with Section
14591).
(2) "Medi-Cal managed care health plan" means an individual,
organization, or entity operating under a Medi-Cal managed care plan
contract with the department under this chapter, Chapter 8
(commencing with Section 14200), or Chapter 8.75 (commencing with
Section 14591).
(b) The department shall take all appropriate steps to amend the
Medicaid State Plan, if necessary, to carry out this section. This
section shall be implemented only to the extent that federal
financial participation is available.
(c) (1) Any hospital that does not have in effect a contract with
a Medi-Cal managed care health plan, as defined in paragraph (2) of
subdivision (a), that establishes payment amounts for services
furnished to a beneficiary enrolled in that plan shall accept as
payment in full, from all these plans, the following amounts:
(A) For outpatient services, the Medi-Cal fee-for-service (FFS)
payment amounts.
(B) For emergency inpatient services, the average per diem
contract rate specified in paragraph (2) of subdivision (b) of
Section 14166.245, except that the payment amount shall not be
reduced by 5 percent, until July 1, 2013, and thereafter, the average
contract rate specified in Section 1396u-2(b)(2) of Title 42 of the
United States Code. For the purposes of this subparagraph, this
payment amount shall apply to all hospitals, including hospitals that
contract with the department under the Medi-Cal Selective Provider
Contracting Program described in Article 2.6 (commencing with Section
14081), and small and rural hospitals specified in Section 124840 of
the Health and Safety Code.
(C) For poststabilization services following an emergency
admission, payment amounts shall be consistent with Section 438.114
(e) of Title 42 of the Code of Federal Regulations. This paragraph
shall only be implemented to the extent that contract amendment
language providing for these payments is approved by CMS. For
purposes of this subparagraph, this payment amount shall apply to all
hospitals, including hospitals that contract with the department
under the Medi-Cal Selective Provider Contracting Program pursuant to
Article 2.6 (commencing with Section 14081).
(2) The rates established in paragraph (1) for emergency inpatient
services and poststabilization services shall remain in effect only
until the department implements the payment methodology based on
diagnosis-related groups pursuant to Section 14105.28.
(3) Upon implementation of the payment methodology based on
diagnosis-related groups pursuant to Section 14105.28, any hospital
described in paragraph (1) shall accept as payment in full for
inpatient hospital services, including both emergency inpatient
services and poststabilization services related to an emergency
medical condition, the payment amount established pursuant to the
methodology developed under Section 14105.28.
(d) Medi-Cal managed care health plans that, pursuant to the
department's encouragement in All Plan Letter 07003, have been paying
out-of-network hospitals the most recent California Medical
Assistance Commission regional average per diem rate as a temporary
rate for purposes of Section 1932(b)(2)(D) of the federal Social
Security Act (SSA), which became effective January 1, 2007, shall
make reconciliations and adjustments for all hospital payments made
since January 1, 2007, based upon rates published by the department
pursuant to Section 1932(b)(2)(D) of the SSA and effective January 1,
2007, to June 30, 2008, inclusive, and, if applicable, provide
supplemental payments to hospitals as necessary to make payments that
conform with Section 1932(b)(2)(D) of the SSA. In order to provide
managed care health plans with 60 working days to make any necessary
supplemental payments to hospitals prior to these payments becoming
subject to the payment of interest, Section 1300.71 of Title 28 of
the California Code of Regulations shall not apply to these
supplemental payments until 30 working days following the publication
by the department of the rates.
(e) (1) The department shall provide a written report to the
policy and fiscal committees of the Legislature on October 1, 2009,
and May 1, 2010, on the implementation and impact made by this
section, including the impact of these changes on access to hospitals
by managed care enrollees and on contracting between hospitals and
managed care health plans, including the increase or decrease in the
number of these contracts.
(2) Not later than August 1, 2010, the department shall report to
the Legislature on the implementation of this section. The report
shall include, but not be limited to, information and analyses
addressing managed care enrollee access to hospital services, the
impact of this section on managed care health plan capitation rates,
the impact of this section on the extent of contracting between
managed care health plans and hospitals, and fiscal impact on the
state.
(3) For the purposes of preparing the status reports and the final
evaluation report required pursuant to this subdivision, Medi-Cal
managed care health plans shall provide the department with all data
and documentation, including contracts with providers, including
hospitals, as deemed necessary by the department to evaluate the
impact of the implementation of this section. In order to ensure the
confidentiality of managed care health plan proprietary information,
and thereby enable the department to have access to all of the data
necessary to provide the Legislature with accurate and meaningful
information regarding the impact of this section, all information and
documentation provided to the department pursuant to this section
shall be considered proprietary and shall be exempt from disclosure
as official information pursuant to subdivision (k) of Section 6254
of the Government Code as contained in the California Public Records
Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of
Title 1 of the Government Code).
(f) Notwithstanding the 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 department may implement, interpret, or make specific this
section and applicable federal waivers and state plan amendments by
means of all-county letters, plan letters, plan or provider
bulletins, or similar instructions, without taking regulatory action.
Prior to issuing any letter or similar instrument authorized
pursuant to this section, the department shall notify and consult
with stakeholders, including advocates, providers, and beneficiaries.
(g) This section shall become inoperative on July 1, 2013, and, as
of January 1, 2014, is repealed, unless a later enacted statute,
that becomes operative on or before January 1, 2014, deletes or
extends the dates on which it becomes inoperative and is repealed.
SEC. 82. Section 14105.196 is added to the Welfare and
Institutions Code, to read:
14105.196. (a) It is the intent of the Legislature to comply with
the provisions of the federal Health Care and Education
Reconciliation Act of 2010 (Public Law 111-152) and temporarily
increase reimbursement to certain primary care providers at the same
levels as Medicare rates for the 2013 and 2014 calendar years for
specified services.
(b) (1) Notwithstanding any other law, to the extent required by
federal law and regulations, beginning January 1, 2013, through and
including December 31, 2014, payments for primary care services
provided by a physician with a primary specialty designation of
family medicine, general internal medicine, or pediatric medicine
shall not be less than 100 percent of the payment rate that applies
to those services and physicians as established by the Medicare
Program, for both fee-for-service and managed care plans.
(2) Notwithstanding any other law, to the extent required by
federal law and regulations, beginning January 1, 2013, through and
including December 31, 2014, the payments for primary care services
implemented pursuant to this section shall be exempt from the payment
reductions under Sections 14105.191 and 14105.192.
(c) For purposes of this section, "primary care services" and
"primary specialty" means the services and primary specialties
defined in Section 1202 of the federal Health Care and Education
Reconciliation Act of 2010 (Public Law 111-152; 42 U.S.C. Sec. 1396a
(a)(13)(C)) and related federal regulations.
(d) Notwithstanding any other law, effective on or after January
1, 2013, the payment increase implemented pursuant to this section
shall apply to managed care health plans that contract with the
department pursuant to Chapter 8.75 (commencing with Section 14591)
and to contracts with the Senior Care Action Network and the AIDS
Healthcare Foundation, and to the extent that the services are
provided through any of these contracts, payments shall be increased
by the actuarial equivalent amount of the payment increases pursuant
to contract amendments or change orders effective on or after January
1, 2013.
(e) 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, clarify, make specific, and define the
provisions of this section by means of provider bulletins or similar
instructions, without taking regulatory action.
(f) Notwithstanding paragraph (1) of subdivision (b), if a final
judicial determination is made by any state or federal court that is
not appealed, in any action by any party, or a final determination is
made by the administrator of the federal Centers for Medicare and
Medicaid Services, that any payments pursuant to this section are
invalid, unlawful, or contrary to any provision of federal law or
regulations, or of state law, this section shall become inoperative.
(g) (1) The director shall implement the increased payments for
primary care services and primary specialties provided for in this
section only to the extent that the federal medical assistance
percentage is equal to 100 percent.
(2) In assessing 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.
(3) To the extent that the director determines that the payments
do not comply with applicable federal Medicaid requirements, the
director shall retain the discretion not to implement the changes and
may revise the payments as necessary to comply with the federal
Medicaid requirements.
(h) This section shall remain in effect only until January 1,
2015, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2015, deletes or extends
that date.
SEC. 83. Section 14105.22 of the Welfare and Institutions Code is
amended to read:
14105.22. (a) (1) Reimbursement for clinical laboratory or
laboratory services, as defined in Section 51137.2 of Title 22 of the
California Code of Regulations, may not exceed 80 percent of the
lowest maximum allowance established by the federal Medicare Program
for the same or similar services.
(2) This subdivision shall be implemented only until the new rate
methodology under subdivision (b) is approved by the federal Centers
for Medicare and Medicaid Services (CMS).
(b) (1) It is the intent of the Legislature that the department
develop payment rates for clinical laboratory or laboratory services
that are comparable to the payment amounts received from other payers
for laboratory services. Development of these rates will enable the
department to reimburse clinical laboratory or laboratory service
providers in compliance with state and federal law.
(2) (A) The provisions of Section 51501(a) of Title 22 of the
California Code of Regulations shall not apply to the rate
methodology developed for clinical laboratories or laboratory
services pursuant to this subdivision.
(B) In addition to subparagraph (a), any payment reductions
implemented pursuant to this section shall not be subject to the
provisions of Section 51501(a) of Title 22 of the California Code of
Regulations for 12 months following the date of implementation of
this reduction.
(3) Reimbursement to providers for clinical laboratory or
laboratory services shall not exceed the lowest of the following:
(A) The amount billed.
(B) The charge to the general public.
(C) Eighty percent of the lowest maximum allowance established by
the federal Medicare Program for the same or similar services.
(D) A reimbursement rate based on an average of the lowest amount
that other payers and other state Medicaid programs are paying for
similar clinical laboratory services.
(4) In addition to the payment reductions implemented pursuant to
Section 14105.192, payments shall be reduced by up to 10 percent for
clinical laboratory or laboratory services, as defined in Section
51137.2 of Title 22 of the California Code of Regulations, for dates
of service on and after July 1, 2012. The payment reductions pursuant
to this paragraph shall continue until the new rate methodology
under this subdivision has been approved by CMS.
(5) (A) For purposes of establishing reimbursement rates for
clinical laboratory or laboratory services based on the lowest
amounts other payers are paying providers for similar laboratory
services, laboratory service providers shall submit data reports
within six months of the date the act that added this paragraph
becomes effective and annually thereafter. The data provided shall be
based on the previous calendar year and shall specify the provider's
usual and customary payments, reflecting Medi-Cal, other state
Medicaid programs, private insurance, and Medicare payment data,
minus discounts and rebates.
(B) The data submitted pursuant to subparagraph (A) may be used to
determine reimbursement rates by procedure code based on an average
of the lowest amount other payers are paying providers for similar
laboratory services, excluding significant deviations of cost or
volume factors and with consideration to geographical areas.
(C) For purposes of subparagraph (B), the department may contract
with a vendor for the purposes of collecting payment data reports
from clinical laboratories, analyzing payment information, and
calculating a proposed rate.
(D) The proposed rates calculated by the vendor described in
subparagraph (C) may be used in determining the lowest reimbursement
rate for clinical laboratories or laboratory services in accordance
with paragraph (3).
(E) Data reports submitted to the department shall be certified by
the provider's certified financial officer or an authorized
individual.
(F) Clinical laboratory providers that fail to submit data reports
within 30 working days from the time requested by the department
shall be subject to the suspension provisions of subdivisions (a) and
(c) of Section 14123.
(6) Data reports provided to the department 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).
(7) The department shall seek stakeholder input on the rate
setting methodology.
(8) (A) 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 by means of
provider bulletins or similar instructions until regulations are
adopted. It is the intent of the Legislature that the department have
temporary authority as necessary to implement program changes until
completion of the regulatory process.
(B) The department shall adopt emergency regulations no later than
July 1, 2014. The department may readopt any emergency regulation
authorized by this section that is the same as or substantially
equivalent to an emergency regulation previously adopted pursuant to
this section. The initial adoption of emergency regulations
implementing the amendments to this section and the one readoption of
emergency regulations authorized by this section shall be deemed an
emergency and necessary for the immediate preservation of the public
peace, health, safety, or general welfare. Initial emergency
regulations and the one readoption of emergency regulations
authorized by this section shall be exempt from review by the Office
of Administrative Law.
(C) The initial emergency regulations and the one readoption of
emergency regulations authorized by this section shall be submitted
to the Office of Administrative Law for filing with the Secretary of
State and each shall remain in effect for no more than 180 days, by
which time final regulations may be adopted.
(9) To the extent that the director determines that the new
methodology or payment reductions are not consistent with the
requirements of Section 1396a(a)(30)(A) of Title 42 of the United
States Code, the department may revert to the methodology under
subdivision (a) to ensure access to care is not compromised.
(10) (A) The department 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.
(B) In determining whether federal financial participation is
available, the director shall determine whether the rates and
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.
(C) To the extent that the director determines that the rates and
payments do not comply with applicable federal Medicaid requirements
or that federal financial participation is not available with respect
to any reimbursement rate, the director retains the discretion not
to implement that rate or payment and may revise the rate or payment
as necessary to comply with federal Medicaid requirements. The
department shall notify the Joint Legislative Budget Committee 10
days prior to revising the rate or payment to comply with federal
Medicaid requirements.
SEC. 84. Section 14134 of the Welfare and Institutions Code, as
amended by Chapter 3 of the Statutes of 2011, is amended to read:
14134. (a) Except for any prescription, refill, visit, service,
device, or item for which the program's payment is ten dollars ($10)
or less, in which case no copayment shall be required, a recipient of
services under this chapter shall be required to make copayments not
to exceed the maximum permitted under federal regulations or federal
waivers as follows:
(1) Copayment of five dollars ($5) shall be made for nonemergency
services received in an emergency department or emergency room when
the services do not result in the treatment of an emergency medical
condition or inpatient admittance. For the purposes of this section,
"nonemergency services" means services not required to, as
appropriate, medically screen, examine, evaluate, or stabilize an
emergency medical condition that manifests itself by acute symptoms
of sufficient severity, including severe pain, such that the absence
of immediate medical attention could reasonably be expected to result
in any of the following:
(A) Placing the individual's health, or, with respect to a
pregnant woman, the health of the woman or her unborn child, in
serious jeopardy.
(B) Serious impairment to bodily functions.
(C) Serious dysfunction of any bodily organ or part.
(2) Copayment of one dollar ($1) shall be made for each drug
prescription or refill.
(3) Copayment of one dollar ($1) shall be made for each visit for
services under subdivisions (a) and (h) of Section 14132.
(4) The copayment amounts set forth in paragraphs (1), (2), and
(3) may be collected and retained or waived by the provider.
(5) The department shall not reduce the reimbursement
otherwise due to providers as a result of the copayment. The
copayment amounts shall be in addition to any reimbursement otherwise
due the provider for services rendered under this program.
(6) This section does not apply to emergency services, family
planning services, or to any services received by:
(A) Any child in AFDC-Foster Care, as defined in Section 11400.
(B) Any person who is an inpatient in a health facility, as
defined in Section 1250 of the Health and Safety Code.
(C) Any person 18 years of age or under.
(D) Any woman receiving perinatal care.
(7) Paragraph (2) does not apply to any person 65 years of age or
over.
(8) A provider of service shall not deny care or services to an
individual solely because of that person's inability to copay under
this section. An individual shall, however, remain liable to the
provider for any copayment amount owed.
(9) The department shall seek any federal waivers necessary to
implement this section. The provisions for which appropriate federal
waivers cannot be obtained shall not be implemented, but provisions
for which waivers are either obtained or found to be unnecessary
shall be unaffected by the inability to obtain federal waivers for
the other provisions.
(10) The director shall adopt any regulations necessary to
implement this section as emergency regulations in accordance with
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code. The adoption of the regulations
shall be deemed to be an emergency and necessary for the immediate
preservation of the public peace, health and safety, or general
welfare. The director shall transmit these emergency regulations
directly to the Secretary of State for filing and the regulations
shall become effective immediately upon filing. Upon completion of
the formal regulation adoption process and prior to the expiration of
the 120 day duration period of emergency regulations, the director
shall transmit directly to the Secretary of State for filing the
adopted regulations, the rulemaking file, and the certification of
compliance as required by subdivision (e) of Section 11346.1 of the
Government Code.
(b) This section, or subdivisions thereof, if applicable, shall
become inoperative on the implementation date for copayments stated
in the declaration executed by the director pursuant to Section 14134
as added by Section 101.5 of the act that added this subdivision.
SEC. 85. Section 14134 of the Welfare and Institutions Code, as
added by Chapter 3 of the Statutes of 2011, is amended to read:
14134. (a) The Legislature finds and declares all of 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 or imposing further reductions on
Medi-Cal providers during times of economic crisis, it is crucial to
find areas within the program where beneficiaries can share
responsibility for utilization of health care, whether they are
participating in the fee-for-service or the managed care model of
service delivery.
(3) The establishment of cost-sharing obligations within the
Medi-Cal program is complex and is subject to close supervision by
the United States Department of Health and Human Services.
(4) As the single state agency for Medicaid in California, the
State Department of Health Care Services has unique expertise that
can inform decisions that set or adjust cost-sharing responsibilities
for Medi-Cal beneficiaries receiving health care services.
(b) Therefore, it is the intent of the Legislature for the
department to obtain federal approval to implement cost-sharing for
Medi-Cal beneficiaries and permit providers to require that
individuals meet their cost-sharing obligation prior to receiving
care or services.
(c) A Medi-Cal beneficiary shall be required to make copayments as
described in this section. These copayments represent a contribution
toward the rate of payment made to providers of Medi-Cal services
and shall be as follows:
(1) Copayment of up to fifty dollars ($50) shall be made for
nonemergency services received in an emergency department or
emergency room when the services do not result in the treatment of an
emergency condition or inpatient admittance. For the purposes of
this section, "nonemergency services" means services not required to,
as appropriate, medically screen, examine, evaluate, or stabilize an
emergency medical condition that manifests itself by acute symptoms
of sufficient severity, including severe pain, such that the absence
of immediate medical attention could reasonably be expected to result
in any of the following:
(A) Placing the individual's health, or, with respect to a
pregnant woman, the health of the woman or her unborn child, in
serious jeopardy.
(B) Serious impairment to bodily functions.
(C) Serious dysfunction of any bodily organ or part.
(2) Copayment of up to fifty dollars ($50) shall be made for
emergency services received in an emergency department or emergency
room when the services result in the treatment of an emergency
medical condition or inpatient admittance. For purposes of this
section, "emergency services" means services required to, as
appropriate, medically screen, examine, evaluate, or stabilize an
emergency medical condition that manifests itself by acute symptoms
of sufficient severity, including severe pain, such that the absence
of immediate medical attention could reasonably be expected to result
in any of the following:
(A) Placing the individual's health, or, with respect to a
pregnant woman, the health of the woman or her unborn child, in
serious jeopardy.
(B) Serious impairment to bodily functions.
(C) Serious dysfunction of any bodily organ or part.
(3) Copayment of up to one hundred dollars ($100) shall be made
for each hospital inpatient day, up to a maximum of two hundred
dollars ($200) per admission.
(4) Copayment of up to three dollars ($3) shall be made for each
preferred drug prescription or refill. A copayment of up to five
dollars ($5) shall be made for each nonpreferred drug prescription or
refill. Except as provided in subdivision (g), "preferred drug"
shall have the same meaning as in Section 1916A of the Social
Security Act (42 U.S.C. Sec. 1396o-1).
(5) Copayment of up to five dollars ($5) shall be made for each
visit for services under subdivision (a) of Section 14132 and for
dental services received on an outpatient basis provided as a
Medi-Cal benefit pursuant to this chapter or Chapter 8 (commencing
with Section 14200), as applicable.
(6) This section does not apply to services provided pursuant to
subdivision (aa) of Section 14132.
(d) The copayments established pursuant to subdivision (c) shall
be set by the department, at the maximum amount provided for in the
applicable paragraph, except that each copayment amount shall not
exceed the maximum amount allowable pursuant to the state plan
amendments or other federal approvals.
(e) The copayment amounts set forth in subdivision (c) may be
collected and retained or waived by the provider. The department
shall deduct the amount of the copayment from the payment the
department makes to the provider whether retained, waived, or not
collected by the provider.
(f) Notwithstanding any other provision of law, and only to the
extent allowed pursuant to federal law, a provider of service has no
obligation to provide services to a Medi-Cal beneficiary who does
not, at the point of service, pay the copayment assessed pursuant to
this section. If the provider provides services without collecting
the copayment, and has not waived the copayment, the provider may
hold the beneficiary liable for the copayment amount owed.
(g) (1) Notwithstanding any other provision of law, except as
described in paragraph (2), this section shall apply to Medi-Cal
beneficiaries enrolled in a health plan contracting with the
department pursuant to this chapter or Chapter 8 (commencing with
Section 14200), except for the Senior Care Action Network or AIDS
Healthcare Foundation. To the extent permitted by federal law and
pursuant to any federal waivers or state plan adjustments obtained, a
managed care health plan may establish a lower copayment or no
copayment.
(2) For the purpose of paragraph (4) of subdivision (c),
copayments assessed against a beneficiary who receives Medi-Cal
services through a health plan described in paragraph (1) shall be
based on the plan's designation of a drug as preferred or
nonpreferred.
(3) To the extent provided by federal law, capitation payments
shall be calculated on an actuarial basis as if copayments described
in this section were collected.
(h) This section shall be implemented only to the extent that
federal financial participation is available. The department shall
seek and obtain any federal waivers or state plan amendments
necessary to implement this section. The provisions for which
appropriate federal waivers or state plan amendments cannot be
obtained shall not be implemented, but provisions for which waivers
or state plan amendments are either obtained or found to be
unnecessary shall be unaffected by the inability to obtain federal
waivers or state plan amendments for the other provisions.
(i) 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, interpret, or make specific this section by
means of all-county letters, all-plan letters, provider bulletins,
or similar instructions, without taking further regulatory actions.
(j) (1) This section shall become operative on the date that the
act adding this section is effective, but shall not be implemented
until the date in the declaration executed by the director pursuant
to paragraph (2). In no event shall the director set an
implementation date prior to the date federal approval is received.
(2) The director shall execute a declaration that states the date
that implementation of the copayments described in this section or
subdivisions thereof, if applicable, will commence and shall post the
declaration on the department's Internet Web site and provide a copy
of the declaration to the Chair of the Joint Legislative Budget
Committee, the Chief Clerk of the Assembly, the Secretary of the
Senate, the Office of the Legislative Counsel, and the Secretary of
State.
SEC. 86. Section 14134.1 of the Welfare and Institutions Code is
amended to read:
14134.1. (a) Except as provided in paragraph (2) of subdivision
(a) of Section 14134, no provider under this chapter may deny care or
services to an individual eligible for care or services under this
chapter because of the individual's inability to pay a copayment, as
defined in Section 14134. The requirements of this section shall not
extinguish the liability of the individual to whom the care or
services were furnished for payment of the copayment.
(b) 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, interpret, or make specific this section by
means of all-county letters, provider bulletins, or similar
instructions, without taking further regulatory action.
(c) This section shall become inoperative to the extent, and on
the implementation date for, copayments as stated in the declaration
executed by the director pursuant to Section 14134 as added by
Section 101.5 of the act that added this subdivision.
SEC. 87. 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, 2011-12, and 2012-13 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.
(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. 88. 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) (A) On July 1, 2012, notwithstanding any other law, employees
of the California Medical Assistance Commission as of June 30, 2012,
excluding commissioners, shall transfer to the State Department of
Health Care Services.
(B) Employees who transfer pursuant to subparagraph (A) shall be
subject to the same conditions of employment under the department as
they were under the California Medical Assistance Commission,
including retention of their exempt status, until the
diagnosis-related groups payment system described in Section 14105.28
replaces the contract-based payment system described in this
article.
(C) (i) Notwithstanding any other law or rule, persons employed by
the department who transferred to the department pursuant to
subparagraph (A) shall be eligible to apply for civil service
examinations. Persons receiving passing scores shall have their names
placed on lists resulting from these examinations, or otherwise gain
eligibility for appointment. In evaluating minimum qualifications,
related California Medical Assistance Commission experience shall be
considered state civil service experience in a class deemed
comparable by the State Personnel Board, based on the duties and
responsibilities assigned.
(ii) On the date the diagnosis-related groups payment system
described in Section 14105.28 replaces the contract-based system
described in this article, employees who transferred to the
department pursuant to subparagraph (A) shall transfer to civil
service classifications within the department for which they are
eligible.
(3) Upon a determination by the Director of Health Care Services
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 this article has been developed and
implemented, the powers, duties, and responsibilities conferred on
the commission and transferred to the Director of Health Care
Services shall no longer be exercised, excluding both of the
following:
(A) Stabilization payments made or committed from Sections
14166.14 and 14166.19 for services rendered prior to the director's
determination pursuant to this paragraph.
(B) The ability to negotiate and make payments from the Private
Hospital Supplemental Fund, established pursuant to Section 14166.12,
and the Nondesignated Public Hospital Supplemental Fund, established
pursuant to Section 14166.17.
(4) Protections afforded to the negotiations and contracts of the
commission by 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. 89. Section 14166.8 of the Welfare and Institutions Code is
amended to read:
14166.8. (a) Within five months after the end of each project
year or successor demonstration year, each of the designated public
hospitals shall submit to the department all of the following
reports:
(1) The hospital's Medicare cost report for the project year or
successor demonstration year.
(2) Other cost reporting and statistical data necessary for the
determination of amounts due the hospital under the demonstration
project or successor demonstration project, as requested by the
department.
(b) For each project year or successor demonstration year, the
reports shall identify all of the following:
(1) The costs incurred in providing inpatient hospital services to
Medi-Cal beneficiaries on a fee-for-service basis and physician and
nonphysician practitioner services costs, as identified in
subdivision (e) of Section 14166.4.
(2) The amount of uncompensated costs incurred in providing
hospital services to Medi-Cal beneficiaries, including managed care
enrollees.
(3) The costs incurred in providing hospital services to uninsured
individuals.
(4) (A) Discharge data, commencing with successor demonstration
year 6, and retrospectively for prior periods as necessary to
establish interim payment determinations, for the following patient
categories:
(i) Uninsured patients.
(ii) Low Income Health Program patients.
(iii) Medi-Cal patients, excluding discharges for which Medicare
payments were received.
(B) The department shall consult with the designated public
hospitals regarding a methodology for adjusting prior period
discharge data to reflect the projected number of discharges relating
to Low Income Health Program patients for the period at issue.
(c) (1) Each designated public hospital, or governmental entity
with which it is affiliated, that operates nonhospital clinics or
provides physician, nonphysician practitioner, or other health care
services that are not identified as hospital services under the
Special Terms and Conditions for the demonstration project and
successor demonstration project, may report and certify all, or a
portion, of the uncompensated Medi-Cal and uninsured costs of the
services furnished.
(2) Notwithstanding paragraph (1), beginning with the 2012-13
fiscal year, and for each successor demonstration year thereafter,
each designated public hospital, or governmental entity with which it
is affiliated, that operates nonhospital clinics or provides
physician, nonphysician practitioner, or other health care services
that are not identified as hospital services under the Special Terms
and Conditions for the successor demonstration project, shall report
and certify all of the uncompensated uninsured costs of the services
furnished that meet the requirements of subdivisions (d) and (e).
(3) The amount of these uncompensated costs to be claimed by the
department shall be determined by the department in consultation with
the governmental entity so as to optimize the level of claimable
federal Medicaid funding.
(d) Reports submitted under this section shall include all
allowable costs.
(e) The appropriate public official shall certify to all of the
following:
(1) The accuracy of the reports required under this section.
(2) That the expenditures to meet the reported costs comply with
Section 433.51 of Title 42 of the Code of Federal Regulations.
(3) That the sources of funds used to make the expenditures
certified under this section do not include impermissible provider
taxes or donations as defined under Section 1396b(w) of Title 42 of
the United States Code or other federal funds. For this purpose,
federal funds do not include delivery system reform incentive pool
payments, patient care revenue received as payment for services
rendered under programs such as designated state health programs, the
Low Income Health Program, Medicare, or Medicaid.
(f) The certification of public expenditures made pursuant to this
section shall be based on a schedule established by the department.
The director may require the designated public hospitals to submit
quarterly estimates of anticipated expenditures, if these estimates
are necessary to obtain interim payments of federal Medicaid funds.
All reported expenditures shall be subject to reconciliation to
allowable costs, as determined in accordance with applicable
implementing documents for the demonstration project and successor
demonstration project.
(g) Subject to the determination made under paragraph (3) of
subdivision (c), the director shall seek Medicaid federal financial
participation for all certified public expenditures reported by the
designated public hospitals and recognized under the demonstration
project and successor demonstration project, to the extent consistent
with Section 14166.9.
(h) Governmental or public entities other than those that operate
a designated public hospital may, at the request of a governmental or
public entity, certify uncompensated Medi-Cal and uninsured costs in
accordance with this section, subject to the department's discretion
and prior approval of the federal Centers for Medicare and Medicaid
Services.
(i) The timeframes for data submission and reporting periods may
be adjusted as necessary with respect to the 2010-11 project year
through October 31, 2010, and successor demonstration years 6 and 10.
SEC. 90. Section 14166.12 of the Welfare and Institutions Code is
amended to read:
14166.12. (a) The California Medical Assistance Commission shall
negotiate payment amounts, in accordance with the selective provider
contracting program established pursuant to Article 2.6 (commencing
with Section 14081), from the Private Hospital Supplemental Fund
established pursuant to subdivision (b) for distribution to private
hospitals that satisfy the criteria of subdivision (s). Pursuant to
Section 14165, on and after July 1, 2012, the Director of Health Care
Services shall exercise the discretion granted to the California
Medical Assistance Commission.
(b) The Private Hospital Supplemental Fund is hereby established
in the State Treasury. For purposes of this section, "fund" means the
Private Hospital Supplemental Fund.
(c) Notwithstanding Section 13340 of the Government Code, the fund
shall be continuously appropriated to the department for the
purposes specified in this section.
(d) Except as otherwise limited by this section, the fund shall
consist of all of the following:
(1) One hundred eighteen million four hundred thousand dollars
($118,400,000), which shall be transferred annually from General Fund
amounts appropriated in the annual Budget Act for the Medi-Cal
program, except as follows:
(A) For the 2008-09 fiscal year, this amount shall be reduced by
thirteen million six hundred thousand dollars ($13,600,000) and by an
amount equal to one-half of the difference between eighteen million
three hundred thousand dollars ($18,300,000) and the amount of any
reduction in the additional payments for distressed hospitals
calculated pursuant to subparagraph (B) of paragraph (3) of
subdivision (b) of Section 14166.20.
(B) For the 2012-13 fiscal year, this amount shall be reduced by
seventeen million five hundred thousand dollars ($17,500,000).
(C) For the 2013-14 fiscal year, this amount shall be reduced by
eight million seven hundred fifty thousand dollars ($8,750,000).
(2) Any additional moneys appropriated to the fund.
(3) All stabilization funding transferred to the fund pursuant to
paragraph (2) of subdivision (a) of Section 14166.14.
(4) Any moneys that any county, other political subdivision of the
state, or other governmental entity in the state may elect to
transfer to the department for deposit into the fund, as permitted
under Section 433.51 of Title 42 of the Code of Federal Regulations
or any other applicable federal Medicaid laws.
(5) All private moneys donated by private individuals or entities
to the department for deposit in the fund as permitted under
applicable federal Medicaid laws.
(6) Any interest that accrues on amounts in the fund.
(e) Any public agency transferring moneys to the fund may, for
that purpose, utilize any revenues, grants, or allocations received
from the state for health care programs or purposes, unless otherwise
prohibited by law. A public agency may also utilize its general
funds or any other public moneys or revenues for purposes of
transfers to the fund, unless otherwise prohibited by law.
(f) The department may accept or not accept moneys offered to the
department for deposit in the fund. If the department accepts moneys
pursuant to this section, the department shall obtain federal
financial participation to the full extent permitted by law. With
respect to funds transferred or donated from private individuals or
entities, the department shall accept only those funds that are
certified by the transferring or donating entity that qualify for
federal financial participation under the terms of the Medicaid
Voluntary Contribution and Provider-Specific Tax Amendments of 1991
(Public Law 102-234) or Section 433.51 of Title 42 of the Code of
Federal Regulations, as applicable. The department may return any
funds transferred or donated in error.
(g) Moneys in the fund shall be used as the source for the
nonfederal share of payments to hospitals under this section.
(h) Any funds remaining in the fund at the end of a fiscal year
shall be carried forward for use in the following fiscal year.
(i) Moneys shall be allocated from the fund by the department and
shall be applied to obtain federal financial participation in
accordance with customary Medi-Cal accounting procedures for purposes
of payments under this section. Distributions from the fund shall be
supplemental to any other Medi-Cal reimbursement received by the
hospitals, including amounts that hospitals receive under the
selective provider contracting program (Article 2.6 (commencing with
Section 14081)), and shall not affect provider rates paid under the
selective provider contracting program.
(j) Each private hospital that was a private hospital during the
2002-03 fiscal year, received payments for the 2002-03 fiscal year
from any of the prior supplemental funds, and, during the project
year, satisfies the criteria in subdivision (s) to be eligible to
negotiate for distributions under any of those sections, shall
receive no less from the Private Hospital Supplemental Fund for the
project year than 100 percent of the amount the hospital received
from the prior supplemental funds for the 2002-03 fiscal year. Each
private hospital described in this subdivision shall be eligible for
additional payments from the fund pursuant to subdivision (k).
(k) All amounts that are in the fund for a project year in excess
of the amount necessary to make the payments under subdivision (j)
shall be available for negotiation by the California Medical
Assistance Commission, along with corresponding federal financial
participation, for supplemental payments to private hospitals, which
for the project year satisfy the criteria under subdivision (s) to be
eligible to negotiate for distributions under any of those sections,
and paid for services rendered during the project year pursuant to
the selective provider contracting program established under Article
2.6 (commencing with Section 14081).
(l) The amount of any stabilization funding transferred to the
fund, or the amount of intergovernmental transfers deposited to the
fund pursuant to subdivision (o), together with the associated
federal reimbursement, with respect to a particular project year,
may, in the discretion of the California Medical Assistance
Commission, until its dissolution on June 30, 2012, be paid for
services furnished in the same project year regardless of when the
stabilization funds or intergovernmental transfer funds, and the
associated federal reimbursement, become available, provided the
payment is consistent with other applicable federal or state law
requirements and does not result in a hospital exceeding any
applicable reimbursement limitations. On and after July 1, 2012, the
Director of Health Care Services shall exercise the discretion
granted to the California Medical Assistance Commission by this
subdivision.
(m) The department shall pay amounts due to a private hospital
from the fund for a project year, with the exception of stabilization
funding, in up to four installment payments, unless otherwise
provided in the hospital's contract negotiated with the California
Medical Assistance Commission, except that hospitals that are not
described in subdivision (j) shall not receive the first installment
payment. The first payment shall be made as soon as practicable after
the issuance of the tentative disproportionate share hospital list
for the project year, and in no event later than January 1 of the
project year. The second and subsequent payments shall be made after
the issuance of the final disproportionate hospital list for the
project year, and shall be made only to hospitals that are on the
final disproportionate share hospital list for the project year. The
second payment shall be made by February 1 of the project year or as
soon as practicable after the issuance of the final disproportionate
share hospital list for the project year. The third payment, if
scheduled, shall be made by April 1 of the project year. The fourth
payment, if scheduled, shall be made by June 30 of the project year.
This subdivision does not apply to hospitals that are scheduled to
receive payments from the fund because they meet the criteria under
paragraph (2) of subdivision (s) and do not meet the criteria under
paragraph (1), (3), or (4) of subdivision (s), which shall be paid in
accordance with the applicable contract or contract amendment
negotiated by the California Medical Assistance Commission.
(n) The department shall pay stabilization funding transferred to
the fund in amounts negotiated by the California Medical Assistance
Commission and shall pay the scheduled payments in accordance with
the applicable contract or contract amendment.
(o) Payments to private hospitals that are eligible to receive
payments pursuant to subdivision (s) may be made using funds
transferred from governmental entities to the state, at the option of
the governmental entity. Any payments funded by intergovernmental
transfers shall remain with the private hospital and shall not be
transferred back to any unit of government. An amount equal to 25
percent of the amount of any intergovernmental transfer made in the
project year that results in a supplemental payment made for the same
project year to a project year private DSH hospital designated by
the governmental entity that made the intergovernmental transfer
shall be deposited in the fund for distribution as determined by the
California Medical Assistance Commission. An amount equal to 75
percent shall be deposited in the fund and distributed to the private
hospitals designated by the governmental entity.
(p) A private hospital that receives payment pursuant to this
section for a particular project year shall not submit a notice for
the termination of its participation in the selective provider
contracting program established pursuant to Article 2.6 (commencing
with Section 14081) until the later of the following dates:
(1) On or after December 31 of the next project year.
(2) The date specified in the hospital's contract, if applicable.
(q) (1) For the 2007-08, 2008-09, and 2009-10 project years, the
County of Los Angeles shall make intergovernmental transfers to the
state to fund the nonfederal share of increased Medi-Cal payments to
those private hospitals that serve the South Los Angeles population
formerly served by Los Angeles County Martin Luther King, Jr.-Harbor
Hospital. The intergovernmental transfers required under this
subdivision shall be funded by county tax revenues and shall total
five million dollars ($5,000,000) per project year, except that, in
the event that the director determines that any amount is due to the
County of Los Angeles under the demonstration project for services
rendered during the portion of a project year during which Los
Angeles County Martin Luther King, Jr.-Harbor Hospital was
operational, the amount of intergovernmental transfers required under
this subdivision shall be reduced by a percentage determined by
reducing 100 percent by the percentage reduction in Los Angeles
County Martin Luther King, Jr.-Harbor Hospital's baseline, as
determined under subdivision (c) of Section 14166.5 for that project
year.
(2) Notwithstanding subdivision (o), an amount equal to 100
percent of the county's intergovernmental transfers under this
subdivision shall be deposited in the fund and, within 30 days after
receipt of the intergovernmental transfer, shall be distributed,
together with related federal financial participation, to the private
hospitals designated by the county in the amounts designated by the
county. The director shall disregard amounts received pursuant to
this subdivision in calculating the OBRA 1993 payment limitation, as
defined in paragraph (24) of subdivision (a) of Section 14105.98, for
purposes of determining the amount of disproportionate share
hospital replacement payments due a private hospital under Section
14166.11.
(r) (1) The reductions in supplemental payments under this section
that result from the reductions in the amounts transferred from the
General Fund to the Private Hospital Supplemental Fund for the
2012-13 and 2013-14 fiscal years under subparagraphs (B) and (C) of
paragraph (1) of subdivision (d) shall be allocated equally in the
aggregate between children's hospitals eligible for supplemental
payments under this section and other hospitals eligible for
supplemental payments under this section. When negotiating payment
amounts to a hospital under this section for the 2012-13 and 2013-14
fiscal years, the California Medical Assistance Commission, or its
successor agency, shall identify both a payment amount that would
have been made absent the funding reductions in subparagraphs (B) and
(C) of paragraph (1) of subdivision (d) and the payment amount that
will be made taking into account the funding reductions under
subparagraphs (B) and (C) of paragraph (1) of subdivision (d). For
purposes of this subdivision, "children's hospital" shall have the
meaning set forth in paragraph (13) of subdivision (a) of Section
14105.98.
(2) This subdivision shall not preclude the department from
including some or all of the reductions under this section within the
payments made under a new diagnosis-related group payment
methodology for the 2012-13 fiscal year or the 2013-14 fiscal year.
In the event the department includes some or all of the amounts,
including reductions, within the payments made under a new
diagnosis-related group payment methodology for the 2012-13 fiscal
year or the 2013-14 fiscal year, the department, in implementing the
reductions in paragraph (1) of subdivision (d), shall, to the extent
feasible, utilize the allocation specified in paragraph (1).
(s) In order for a hospital to receive distributions pursuant to
this section, the hospital shall satisfy the eligibility criteria in
paragraph (1), (2), (3), or (4) of this subdivision.
(1) The hospital meets all of the following criteria:
(A) The hospital is contracting under this article.
(B) The hospital meets the criteria contained in the Medicaid
State Plan for disproportionate share hospital status.
(C) The hospital is one of the following:
(i) A licensed provider of basic emergency services as described
in Section 70411 of Title 22 of the California Code of Regulations.
(ii) A licensed provider of comprehensive emergency medical
services as defined in Section 70451 of Title 22 of the California
Code of Regulations.
(iii) A children's hospital, as defined in Section 14087.21, that
satisfies clause (i) or (ii), or that jointly provides basic or
comprehensive emergency services in conjunction with another licensed
hospital.
(iv) A hospital owned and operated by a public agency that
operates two or more hospitals that qualify under subparagraph (A) or
(B) with respect to the particular state fiscal year.
(v) A hospital designated by the National Cancer Institute as a
comprehensive or clinical cancer research center that primarily
treats acutely ill cancer patients and that is exempt from the
federal Medicare prospective payment system pursuant to Section 1886
(d)(1)(B)(v) of the federal Social Security Act (42 U.S.C. Sec.
1395ww(d)(1)(B)(v)).
(D) The hospital is able to demonstrate a purpose for additional
funding under the selective provider contracting program including
proposals relating to emergency services and other health care
services, including infrequent yet high-cost services, such as
anti-AB human antitoxin treatment for infant botulism (human
botulinum immune globulin (HBIG), commonly referred to as "Baby-BIG"
), that are made available, or will be made available, to Medi-Cal
beneficiaries.
(2) The hospital is contracting under this article and meets the
definition of a university teaching hospital or major, nonuniversity,
teaching hospital as set forth on page 51 and as listed on page 57
of the department's report dated May 1991, entitled "Hospital Peer
Grouping." Payments from the fund shall be used solely for the
purposes identified in the contract between the hospital and the
state.
(3) The hospital is contracting under this article, and meets the
definition of any of the following:
(A) A large teaching emphasis hospital, as set forth on page 51
and listed on page 57 of the department's report dated May 1991,
entitled "Hospital Peer Grouping," and also meets the definition of
eligible hospital as defined in paragraph (3) of subdivision (a) of
Section 14105.98.
(B) A children's hospital pursuant to Section 10727, and also
meets the definition of eligible hospital as defined in paragraph (3)
of subdivision (a) of Section 14105.98.
(C) Notwithstanding the requirement in subparagraph (A) that a
hospital must be listed on page 57 of the department's report dated
May 1991, entitled "Hospital Peer Grouping," any hospital whose
license pursuant to Chapter 2 (commencing with Section 1250) of
Division 2 of the Health and Safety Code was consolidated during the
1999 calendar year with a large teaching emphasis hospital that is
listed on page 57 of the above-described report shall be eligible.
All other requirements of paragraph
(3) shall continue to apply.
(4) The hospital meets all of the following criteria:
(A) The hospital is contracting under this article.
(B) The hospital satisfies the Medicaid State Plan criteria for
disproportionate share hospital status.
(C) The hospital is a small and rural hospital as defined in
Section 124840 of the Health and Safety Code.
(D) The hospital is a licensed provider of standby emergency
services as described in Section 70649 of Title 22 of the California
Code of Regulations.
(E) The hospital is able to demonstrate a purpose for additional
funding under the selective provider contracting program with
proposals relating to health care services that are made available,
or will be made available, to Medi-Cal beneficiaries.
(F) The hospital is determined by the California Medical
Assistance Commission to be a hospital that provides an important
community service that otherwise would not be provided in the
community.
SEC. 91. Section 14166.14 of the Welfare and Institutions Code is
amended to read:
14166.14. The amount of any stabilization funding payable to the
project year private DSH hospitals under Section 14166.20 for a
project year, which amount shall not include the amount of
stabilization funding paid or payable to hospitals prior to the
computation of the stabilization funding under Section 14166.20, plus
any amount payable to project year private DSH hospitals under
paragraph (1) of subdivision (b) of Section 14166.21, shall be
allocated as follows:
(a) (1) To fund any shortfall due under Section 14166.11.
(2) An amount shall be transferred to the Private Hospital
Supplemental Fund established pursuant to Section 14166.12, as may be
necessary so that the amount for the Private Hospital Supplemental
Fund for the project year, including all funds previously transferred
to, or deposited in, the Private Hospital Supplemental Fund for the
project year, is not less than the Private Hospital Supplemental Fund
base amount determined pursuant to subdivision (j) of Section
14166.12.
(3) The amounts paid or transferred under paragraphs (1) and (2)
shall be reduced pro rata if there is not sufficient funding
described under paragraphs (1) and (2).
(b) Of the stabilization funding remaining, after allocations
pursuant to subdivision (a), that are payable to project year private
DSH hospitals, 66.4 percent shall be allocated and distributed among
those hospitals pro rata based on the amounts determined in
accordance with Section 14166.11, and 33.6 percent shall be
transferred to the Private Hospital Supplemental Fund.
(c) (1) Notwithstanding any other law, the stabilization funding
payable to project year private DSH hospitals under Section 14166.20
for a project year as determined under this section that has not been
paid, or specifically committed for payment, to hospitals prior to
January 1, 2012, may be utilized by the director to make payments to
hospitals that received underpayments pursuant to Section 14166.11
due to improper peer group classifications for the 2005-06 and
2006-07 payment adjustment years.
(2) The balance after payments made pursuant to paragraph (1), if
any, of the stabilization funding payable to project year private DSH
hospitals under Section 14166.20 shall not be paid to the project
year private DSH hospitals pursuant to Section 14166.20. The funds
that would otherwise be paid from the Private Hospital Supplemental
Fund shall be transferred to the General Fund, and funds that would
otherwise be drawn from the General Fund for payments to the private
DSH hospitals pursuant to Section 14166.20 shall be retained in the
General Fund.
SEC. 92. Section 14166.151 is added to the Welfare and
Institutions Code, to read:
14166.151. (a) It is the intent of the Legislature to reform the
inpatient fee-for-service reimbursement methodology for nondesignated
public hospitals based on their public structure in order to provide
new opportunities for nondesignated public hospitals to receive
reimbursement under the successor demonstration project for care
provided to the uninsured and to receive new incentive payments for
achievement related to delivery system reform.
(b) Subject to subdivision (c), beginning with services provided
on or after July 1, 2012, fee-for-service payments to nondesignated
public hospitals for inpatient services shall be governed by this
subdivision. Each nondesignated public hospital shall receive as
payment for inpatient hospital services provided to Medi-Cal
beneficiaries during any successor demonstration year, the federal
financial participation claimed by the department based on the
hospital's allowable costs incurred in providing those services,
subject to all of the following:
(1) Nondesignated public hospitals shall comply with the
requirements of Section 14166.152. The payments authorized in this
section shall be subject to audit and a final reconciliation where an
overpayment to the nondesignated public hospital shall result in a
collection of the overpayment and an underpayment to the
nondesignated public hospital shall result in a corrective payment.
(2) (A) Nondesignated public hospitals shall be eligible to
receive safety net care pool payments for uncompensated care costs to
the extent that additional federal funding is made available
pursuant to the Special Terms and Conditions for the safety net care
pool uncompensated care limit of the successor demonstration project
and if they comply with the requirements set forth in Section
14166.154.
(B) The amount of funds that may be claimed pursuant to
subparagraph (A) shall not exceed the additional federal funding made
available under the safety net care pool for nondesignated public
hospital uncompensated care costs, and shall not reduce the amounts
of federal funding for safety net care pool uncompensated care costs
that would otherwise be made available to designated public hospitals
in the absence of this paragraph, including the amounts available
under the Special Terms and Conditions in effect as of April 1, 2012,
and amounts available pursuant to Section 15916.
(C) (i) Notwithstanding subparagraph (B), if the designated public
hospitals do not have sufficient certified public expenditures to
claim the full amount of federal funding made available to the
designated public hospitals as referenced in subparagraph (B),
including consideration of the potential for the designated public
hospitals to have sufficient certified public expenditures in a
subsequent year, the department may authorize the funding to be
claimed by the nondesignated public hospitals.
(ii) The department may determine whether designated public
hospitals do not have sufficient certified public expenditures to
claim the full amount of federal funding pursuant to clause (i) no
sooner than after the submission of the cost reporting information
required pursuant to Section 14166.8 for the applicable successor
demonstration year.
(iii) If the department makes the determination identified in
clause (ii) based on as-filed cost reporting information submitted
prior to a final audit, the department shall make the determination
in consultation with the designated public hospitals and shall apply
an audit cushion of at least 5 percent to the as-filed cost
information. If the department makes the determination identified in
clause (ii) based on audited cost reporting information, no audit
cushion shall be applied.
(3) (A) Nondesignated public hospitals shall be eligible to
receive delivery system reform incentive pool payments to the extent
additional federal funding is made available for this purpose under
the delivery system reform incentive pool in the successor
demonstration project and if the nondesignated public hospitals
comply with the delivery system reform incentive pool funding
requirements set forth in Section 14166.155.
(B) The amount of funds that may be received shall not exceed the
additional federal funding made available for delivery system reform
incentive pool payments to nondesignated public hospitals, and shall
not reduce the amounts that would otherwise be made available to
designated public hospitals in the absence of this paragraph,
including the amounts that designated public hospitals would be
eligible to receive under their delivery system reform incentive pool
plans approved as of January 1, 2012.
(C) Notwithstanding subparagraph (B), if the designated public
hospitals are unable to claim the full amount of federal funding made
available to the designated public hospitals pursuant to Section
14166.77 and the Special Terms and Conditions, including through
reallocations made pursuant to paragraph (3) of subdivision (a) of
Section 14166.77 as authorized by the Special Terms and Conditions,
and the unused amount of federal funding made available to the
designated public hospitals cannot be used in a later demonstration
year, the department may authorize such unused funding to be made
available to the nondesignated public hospitals.
(c) (1) (A) The reimbursement methodology developed pursuant to
subdivision (b) shall be effective beginning July 1, 2012. If all
necessary federal approvals have not been received by July 1, 2012,
then the effective date shall be retroactive to July 1, 2012. Between
July 1, 2012, and when all necessary federal approvals have been
received, any payments made pursuant to any methodology replaced by
subdivision (b) shall be deemed as interim payments subject to
offsetting and recoupment against payments made under subdivision (b)
pursuant to Section 51047 of Title 22 of the California Code of
Regulations.
(B) Subject to paragraph (2), beginning January 1, 2014, the
reimbursement methodology developed pursuant to subdivision (b),
which shall be in effect July 1, 2012, through and including December
31, 2013, shall continue for those nondesignated public hospitals
that certify voluntary participation as described in clause (i), if
the director executes a declaration on or before December 31, 2013,
certifying all of the following:
(i) The governmental entities that own or operate a nondesignated
public hospital, or hospitals, have provided certifications of
voluntary participation in the reimbursement methodology pursuant to
subdivision (b).
(ii) Any necessary federal approvals have been obtained.
(iii) Continuation of the reimbursement methodology for those
nondesignated public hospitals certifying voluntary participation
would be cost beneficial to the state.
(2) On December 31, 2013, if one or more of the nondesignated
public hospitals subject to the reimbursement methodology described
in subdivision (b) have not provided written certification of
voluntariness described in clause (i) of subparagraph (B) of
paragraph (1), or if the director determines, for any reason, that
the reimbursement methodology described in subdivision (b) cannot be
implemented on or after January 1, 2014, then the director shall
execute a declaration certifying that the reimbursement methodology
described in subdivision (b) cannot continue to be implemented for
all or one or more of the nondesignated public hospitals, in which
case subdivision (e) shall be implemented on January 1, 2014.
(d) Upon implementation of subparagraph (A) of paragraph (1) of
subdivision (c), implementation of the laws and regulations listed in
paragraphs (1) to (4), inclusive, shall be suspended with respect to
fee-for-service payments to all nondesignated public hospitals for
inpatient services through and including December 31, 2013.
Implementation of the laws and regulations listed in paragraphs (1)
to (4), inclusive, shall also be suspended with respect to
fee-for-service payments to nondesignated public hospitals that
certify voluntary participation if a declaration is executed pursuant
to subparagraph (B) of paragraph (1) of subdivision (c), beginning
on January 1, 2014, and until the expiration of the successor
demonstration project.
(1) The Nondesignated Public Hospital Medi-Cal Rate Stabilization
Act in Article 5.17 (commencing with Section 14165.55).
(2) The inpatient fee-for-service per diem rate authorized in
Article 2.6 (commencing with Section 14081).
(3) The reimbursement methodology for fee-for-service inpatient
services in Sections 14105 and 14105.15, and Article 7.5 (commencing
with Section 51536) of Title 22 of the California Code of
Regulations.
(4) Section 14166.17.
(e) Subject to the conditions in paragraph (2) of subdivision (c),
on January 1, 2014, the percentage of each intergovernmental
transfer amount retained pursuant to subdivision (j) of Section
14165.57 shall be increased to 20 percent to reimburse the
department, or transferred to the General Fund, for the
administrative costs of operating the Nondesignated Public Hospital
Intergovernmental Transfer Program and for the benefit of the
Medi-Cal program.
(f) This section and Sections 14166.152, 14166.153, 14166.154, and
14166.155 shall become operative on the date all necessary federal
approvals have been obtained to implement all of these sections.
SEC. 93. Section 14166.152 is added to the Welfare and
Institutions Code, to read:
14166.152. (a) Pursuant to subdivision (b) of Section 14166.151,
and notwithstanding any other law, fee-for-service payments to
nondesignated public hospitals for inpatient services to Medi-Cal
beneficiaries shall be governed by this section. The hospitals'
allowable costs shall be determined, certified, and claimed in
accordance with Section 14166.153. The Medicaid federal financial
participation received by the state for the certified public
expenditures of the hospital, or the governmental entity with which
the hospital is affiliated, for inpatient hospital services rendered
to Medi-Cal beneficiaries shall be paid to the hospital.
(b) With respect to each successor demonstration year, each of the
nondesignated public hospitals shall receive an interim payment for
each day of inpatient hospital services rendered to Medi-Cal
beneficiaries based upon claims filed by the hospital in accordance
with the claiming process set forth in Division 3 (commencing with
Section 50000) of Title 22 of the California Code of Regulations. The
interim per diem payment amount shall be based on estimated costs,
which shall be derived from statistical data from the following
sources and which shall be multiplied by the federal medical
assistance percentage:
(1) For allowable costs reflected in the Medicare cost report, the
cost report most recently audited by the hospital's Medicare fiscal
intermediary adjusted by a trend factor to reflect increased costs,
as approved by the federal Centers for Medicare and Medicaid Services
for the successor demonstration project.
(2) For allowable costs not reflected in the Medicare cost report,
each hospital shall provide hospital-specific cost data requested by
the department. The department shall adjust the data by a trend
factor as necessary to reflect project year allowable costs.
(c) Until the department commences making payments pursuant to
subdivision (b), the department may continue to make fee-for-service
per diem payments to the nondesignated public hospitals pursuant to
the selective provider contracting program in accordance with Article
2.6 (commencing with Section 14081), for services rendered on and
after July 1, 2012. Per diem payments shall be adjusted retroactively
to the amounts determined under the payment methodology prescribed
in this section.
(d) No later than April 1 following the end of the relevant
reporting period for the successor demonstration year, the department
shall undertake an interim reconciliation of payments made pursuant
to subdivisions (a) to (c), inclusive, based on Medicare and other
cost and statistical data submitted by the hospital for the year and
shall adjust payments to the hospital accordingly.
(e) (1) The nondesignated public hospitals shall receive
supplemental reimbursement for the costs incurred for physician and
nonphysician practitioner services provided to Medi-Cal beneficiaries
who are patients of the hospital, to the extent that those services
are not claimed as inpatient hospital services by the hospital and
the costs of those services are not otherwise recognized under
subdivision (a).
(2) Expenditures made by the nondesignated public hospital, or a
governmental entity with which it is affiliated, for the services
identified in paragraph (1) shall be reduced by any payments received
pursuant to Article 7 (commencing with Section 51501) of Title 22 of
the California Code of Regulations. The remainder shall be certified
by the appropriate public official and claimed by the department in
accordance with Section 14166.153. These expenditures may include any
of the following:
(A) Compensation to physicians or nonphysician practitioners
pursuant to contracts with the nondesignated public hospital.
(B) Salaries and related costs for employed physicians and
nonphysician practitioners.
(C) The costs of interns, residents, and related teaching
physician and supervision costs.
(D) Administrative costs associated with the services described in
subparagraphs (A) to (C), inclusive, including billing costs.
(3) Nondesignated public hospitals shall receive federal financial
participation based on the expenditures identified and certified in
paragraph (2).
(4) The federal financial participation received by the department
for the certified public expenditures identified in paragraph (2)
shall be paid to the nondesignated public hospital, or a governmental
entity with which it is affiliated.
(5) Supplemental reimbursement under this subdivision may be
distributed as part of the interim payments under subdivision (b), on
a per-visit basis, on a per-procedure basis, or on any other
federally permissible basis.
(6) The department shall submit for federal approval, by September
30, 2012, a proposed amendment to the Medi-Cal state plan to
implement this subdivision, retroactive to July 1, 2012, to the
extent permitted by the federal Centers for Medicare and Medicaid
Services. If necessary to obtain federal approval, the department may
limit the application of this subdivision to costs determined
allowable by the federal Centers for Medicare and Medicaid Services.
If federal approval is not obtained, this subdivision shall not be
implemented.
(f) This section shall become operative as provided in subdivision
(f) of Section 14166.151.
SEC. 94. Section 14166.153 is added to the Welfare and
Institutions Code, to read:
14166.153. (a) Beginning in the 2012-13 fiscal year, within five
months after the end of a successor demonstration year, each of the
nondesignated public hospitals shall submit to the department all of
the following reports:
(1) The hospital's Medicare cost report for the project year or
successor demonstration year.
(2) Other cost reporting and statistical data necessary for the
determination of amounts due the hospital under the demonstration
project or successor demonstration project, as requested by the
department.
(b) For each project year or successor demonstration year, the
reports shall identify all of the following:
(1) To the extent applicable, the costs incurred in providing
inpatient hospital services to Medi-Cal beneficiaries on a
fee-for-service basis and physician and nonphysician practitioner
services costs, as identified in subdivision (e) of Section
14166.152.
(2) The costs incurred in providing hospital services to uninsured
individuals.
(c) Each nondesignated public hospital, or governmental entity
with which it is affiliated, that operates nonhospital clinics or
provides physician, nonphysician practitioner, or other health care
services that are not identified as hospital services under the
Special Terms and Conditions for the demonstration project and
successor demonstration project, shall report and certify all of the
uncompensated Medi-Cal and uninsured costs of the services furnished.
The amount of these uncompensated costs to be claimed by the
department shall be determined by the department in consultation with
the governmental entity so as to optimize the level of claimable
federal Medicaid reimbursement.
(d) Reports submitted under this section shall include all
allowable costs.
(e) The appropriate public official shall certify to all of the
following:
(1) The accuracy of the reports required under this section.
(2) That the expenditures to meet the reported costs comply with
Section 433.51 of Title 42 of the Code of Federal Regulations.
(3) That the sources of funds used to make the expenditures
certified under this section do not include impermissible provider
taxes or donations as defined under Section 1396b(w) of Title 42 of
the United States Code or other federal funds. For this purpose,
federal funds do not include delivery system reform incentive pool
payments or patient care revenue received as payment for services
rendered under programs such as nondesignated state health programs,
the Low Income Health Program, Medicare, or Medicaid.
(f) The certification of public expenditures made pursuant to this
section shall be based on a schedule established by the department
in accordance with federal requirements.
(1) The director may require the nondesignated public hospitals to
submit quarterly estimates of anticipated expenditures, if these
estimates are necessary to obtain interim payments of federal
Medicaid funds.
(2) All reported expenditures shall be subject to reconciliation
to allowable costs, as determined in accordance with applicable
implementing documents for the demonstration project and successor
demonstration project.
(g) The director shall seek Medicaid federal financial
participation for all certified public expenditures reported by the
nondesignated public hospitals and recognized under the successor
demonstration project.
(h) The timeframes for data submission and reporting periods may
be adjusted as necessary in accordance with federal requirements.
(i) This section shall become operative as provided in subdivision
(f) of Section 14166.151.
SEC. 95. Section 14166.154 is added to the Welfare and
Institutions Code, to read:
14166.154. (a) (1) Beginning in the 2012-13 fiscal year, if the
reimbursement methodology in subdivision (b) of Section 14166.151 is
in effect and federal approval is obtained for an amendment to the
successor demonstration project that was submitted pursuant to
subdivision (d), then, with respect to each successor demonstration
year, nondesignated public hospitals, or governmental entities with
which they are affiliated, shall be eligible to receive safety net
care pool payments for uncompensated care from the Health Care
Support Fund established pursuant to Section 14166.21. Safety net
care pool payments for uncompensated care shall be allocated to
nondesignated public hospitals as follows:
(A) The department shall determine the maximum amount of safety
net care pool payments for uncompensated care that is available to
nondesignated public hospitals for the successor demonstration year
pursuant to paragraph (2) of subdivision (b) of Section 14166.151.
This determination shall be made solely with respect to allowable
uncompensated care costs incurred by nondesignated public hospitals
and reported pursuant to Section 14166.153.
(B) The department shall establish, in consultation with the
nondesignated public hospitals, an allocation methodology to
determine the amount of safety net care pool payments to be made to
each hospital. The allocation methodology shall be implemented when
the director issues a declaration stating that the methodology
complies with all applicable federal requirements for federal
financial participation.
(2) A safety net care pool payment amount may be paid to a
nondesignated public hospital, or governmental entity with which it
is affiliated, pursuant to this section independent of the amount of
uncompensated Medi-Cal and uninsured costs that is certified as
public expenditures pursuant to Section 14166.153, provided that, in
accordance with the Special Terms and Conditions for the successor
demonstration project, the recipient hospital does not return any
portion of the funds received to any unit of government, excluding
amounts recovered by the state or federal government.
(3) In establishing the amount to be paid to each nondesignated
public hospital under this subdivision, the department shall minimize
to the extent possible the redistribution of federal funds that are
based on certified public expenditures as described in paragraph (2).
(b) Each nondesignated public hospital, or governmental entity
with which it is affiliated, shall receive the amount established
pursuant to subdivision (a) in quarterly interim payments during the
successor demonstration year. The determination of the interim
payments shall be made on an interim basis prior to the start of each
successor demonstration year. The department shall use the same cost
and statistical data that is used in determining the interim
payments for Medi-Cal inpatient hospital services under Section
14166.152.
(c) (1) No later than April 1 following the end of the relevant
reporting period for the successor demonstration year, the department
shall undertake an interim reconciliation of the payment amount
established pursuant to subdivision (a) for each nondesignated public
hospital using Medicare and other cost, payment, and statistical
data submitted by the hospital for the successor demonstration year,
and shall adjust payments to the hospital accordingly.
(2) The final payment to a nondesignated public hospital, for
purposes of subdivision (b) and paragraph (1) of this subdivision,
shall be subject to final audits of all applicable Medicare and other
cost, payment, discharge, and statistical data for the successor
demonstration year.
(d) The department shall submit for federal approval a proposed
amendment to the successor demonstration project to implement this
section.
(e) This section shall become operative as provided in subdivision
(f) of Section 14166.151.
SEC. 96. Section 14166.155 is added to the Welfare and
Institutions Code, to read:
14166.155. (a) (1) Beginning in the 2012-13 fiscal year, if the
reimbursement methodology in subdivision (b) of Section 14166.151 is
in effect and federal approval is obtained for an amendment to the
successor demonstration project that was submitted pursuant to
subdivision (c), then nondesignated public hospitals may receive
payments pursuant to this section. The amount of delivery system
reform incentive pool funding, consisting of both the federal and
nonfederal share of payments,
that is made available to each nondesignated public hospital
system in the aggregate for the term of the successor demonstration
project shall be based initially on the delivery system reform
proposals that are submitted by the nondesignated public hospitals to
the department for review and submission to the federal Centers for
Medicare and Medicaid Services for final approval. The initial
percentages of delivery system reform incentive pool funding among
the nondesignated public hospitals for each successor demonstration
year shall be determined based on the annual components as contained
in the approved proposals.
(2) The actual receipt of funds shall be conditioned on the
nondesignated public hospital's progress toward, and achievement of,
the specified milestones and other metrics established in its
approved delivery system reform incentive pool proposal. A
nondesignated public hospital may carry forward available incentive
pool funding associated with milestones and metrics from one year to
a subsequent period as authorized by the Special Terms and Conditions
and the final delivery system reform incentive pool protocol.
(3) The department may reallocate the incentive pool funding
available under this section pursuant to conditions specified, and as
authorized by, the Special Terms and Conditions and the final
delivery system reform incentive pool protocol.
(b) Each nondesignated public hospital shall be individually
responsible for progress toward, and achievement of, milestones and
other metrics in its proposal, as well as other applicable
requirements specified in the Special Terms and Conditions and the
final delivery system reform incentive pool protocol, in order to
receive its specified allocation of incentive pool funding under this
section.
(1) The nondesignated public hospital shall submit semiannual
reports and requests for payment to the department by March 31 and
the September 30 following the end of the second and fourth quarters
of the successor demonstration year, or comply with any other process
as approved by the federal Centers for Medicare and Medicaid
Services.
(2) Within 14 days after the semiannual report due date, the
nondesignated public hospital system or its affiliated governmental
entity shall make an intergovernmental transfer of funds equal to the
nonfederal share that is necessary to claim the federal funding for
the pool payment related to the achievement or progress metric that
is certified. The intergovernmental transfers shall be deposited into
the Public Hospital Investment, Improvement, and Incentive Fund,
established pursuant to Section 14182.4.
(3) The department shall claim the federal funding and pay both
the nonfederal and federal shares of the incentive payment to the
nondesignated public hospital system or other affiliated governmental
provider, as applicable. If the intergovernmental transfer is made
within the appropriate 14-day timeframe, the incentive payment shall
be disbursed within seven days with the expedited payment process as
approved by the federal Centers for Medicare and Medicaid Services,
otherwise the payment shall be disbursed within 20 days of when the
transfer is made.
(4) The nondesignated public hospital system or other affiliated
governmental provider is responsible for any fee or cost required to
implement the expedited payment process in accordance with Section
8422.1 of the State Administrative Manual.
(c) The department shall submit for federal approval an amendment
to the successor demonstration project to implement this section.
(d) In the event of a conflict between any provision of this
section and the Special Terms and Conditions for the successor
demonstration project and the final delivery system reform incentive
pool protocol, the Special Terms and Conditions and the final
delivery system reform incentive pool protocol shall control.
(e) This section shall become operative as provided in subdivision
(f) of Section 14166.151.
SEC. 97. Section 14166.17 of the Welfare and Institutions Code is
amended to read:
14166.17. (a) The California Medical Assistance Commission shall
negotiate payment amounts in accordance with the selective provider
contracting program established pursuant to Article 2.6 (commencing
with Section 14081) from the Nondesignated Public Hospital
Supplemental Fund established pursuant to subdivision (b) for
distribution to nondesignated public hospitals that satisfy the
criteria of subdivision (o). Pursuant to Section 14165, on and after
July 1, 2012, the Director of Health Care Services shall exercise the
discretion granted to the California Medical Assistance Commission.
(b) The Nondesignated Public Hospital Supplemental Fund is hereby
established in the State Treasury. For purposes of this section,
"fund" means the Nondesignated Public Hospital Supplemental Fund.
(c) Notwithstanding Section 13340 of the Government Code, the fund
shall be continuously appropriated to the department for the
purposes specified in this section.
(d) Except as otherwise limited by this section, the fund shall
consist of all of the following:
(1) One million nine hundred thousand dollars ($1,900,000), which
shall be transferred annually from General Fund amounts appropriated
in the annual Budget Act for the fund.
(2) Any additional moneys appropriated to the fund.
(3) All stabilization funding transferred to the fund.
(4) All private moneys donated by private individuals or entities
to the department for deposit in the fund as permitted under
applicable federal Medicaid laws.
(5) Any interest that accrues on amounts in the fund.
(e) The department may accept or not accept moneys offered to the
department for deposit in the fund. If the department accepts moneys
pursuant to this section, the department shall obtain federal
financial participation to the full extent permitted by law. With
respect to funds transferred or donated from private individuals or
entities, the department shall accept only those funds that are
certified by the transferring or donating entity as qualifying for
federal financial participation under the terms of the Medicaid
Voluntary Contribution and Provider-Specific Tax Amendments of 1991
(Public Law 102-234) or Section 433.51 of Title 42 of the Code of
Federal Regulations, as applicable. The department may return any
funds transferred or donated in error.
(f) Moneys in the funds shall be used as the source for the
nonfederal share of payments to hospitals under this section.
(g) Any funds remaining in the fund at the end of a fiscal year
shall be carried forward for use in the following fiscal year.
(h) Moneys shall be allocated from the fund by the department and
shall be applied to obtain federal financial participation in
accordance with customary Medi-Cal accounting procedures for purposes
of payments under this section. Distributions from the fund shall be
supplemental to any other Medi-Cal reimbursement received by the
hospitals, including amounts that hospitals receive under the
selective provider contracts negotiated under Article 2.6 (commencing
with Section 14081), and shall not affect provider rates paid under
the selective provider contracting program.
(i) Each nondesignated public hospital that was a nondesignated
public hospital during the 2002-03 fiscal year, received payments for
the 2002-03 fiscal year from any of the prior supplemental funds,
and, during the project year satisfies the criteria in subdivision
(o) to be eligible to negotiate for distributions under any of those
sections shall receive no less from the Nondesignated Public Hospital
Supplemental Fund for the project year than 100 percent of the
amount the hospital received from the prior supplemental funds for
the 2002-03 fiscal year, minus the total amount of intergovernmental
transfers made by or on behalf of the hospital pursuant to
subdivision (o) for the same fiscal year. Each hospital described in
this subdivision shall be eligible for additional payments from the
fund pursuant to subdivision (j).
(j) All amounts that are in the fund for a project year in excess
of the amount necessary to make the payments under subdivision (i)
shall be available for negotiation by the California Medical
Assistance Commission, along with corresponding federal financial
participation, for supplemental payments to nondesignated public
hospitals that for the project year satisfy the criteria under
subdivision (o) to be eligible to negotiate for distributions under
any of those sections, and paid for services rendered during the
project year pursuant to the selective provider contracting program
under Article 2.6 (commencing with Section 14081).
(k) The amount of any stabilization funding transferred to the
fund with respect to a project year may in the discretion of the
California Medical Assistance Commission, until its dissolution on
June 30, 2012, to be paid for services furnished in the same project
year regardless of when the stabilization funds become available,
provided the payment is consistent with other applicable federal or
state legal requirements and does not result in a hospital exceeding
any applicable reimbursement limitations. On and after July 1, 2012,
the Director of Health Care Services shall exercise the discretion
granted to the California Medical Assistance Commission by this
subdivision.
(l) The department shall pay amounts due to a nondesignated
hospital from the fund for a project year, with the exception of
stabilization funding, in up to four installment payments, unless
otherwise provided in the hospital's contract negotiated with the
California Medical Assistance Commission, except that hospitals that
are not described in subdivision (i) shall not receive the first
installment payment. The first payment shall be made as soon as
practicable after the issuance of the tentative disproportionate
share hospital list for the project year, and in no event later than
January 1 of the project year. The second and subsequent payments
shall be made after the issuance of the final disproportionate
hospital list for the project year, and shall be made only to
hospitals that are on the final disproportionate share hospital list
for the project year. The second payment shall be made by February 1
of the project year or as soon as practicable after the issuance of
the final disproportionate share hospital list for the project year.
The third payment, if scheduled, shall be made by April 1 of the
project year. The fourth payment, if scheduled, shall be made by June
30 of the project year. This subdivision does not apply to hospitals
that are scheduled to receive payments from the fund because they
meet the criteria under paragraph (2) of subdivision (o) but do not
meet the criteria under paragraph (1), (3), or (4) of subdivision
(o).
(m) The department shall pay stabilization funding transferred to
the fund in amounts negotiated by the California Medical Assistance
Commission and paid in accordance with the applicable contract or
contract amendment.
(n) A nondesignated public hospital that receives payment pursuant
to this section for a particular project year shall not submit a
notice for the termination of its participation in the selective
provider contracting program established pursuant to Article 2.6
(commencing with Section 14081) until the later of the following
dates:
(1) On or after December 31 of the next project year.
(2) The date specified in the hospital's contract, if applicable.
(o) In order for a hospital to receive distributions pursuant to
this section, the hospital shall satisfy the eligibility criteria in
paragraph (1), (2), (3), or (4) of this subdivision.
(1) The hospital meets all of the following criteria:
(A) The hospital is contracting under this article.
(B) The hospital meets the criteria contained in the Medicaid
State Plan for disproportionate share hospital status.
(C) The hospital is one of the following:
(i) A licensed provider of basic emergency services as described
in Section 70411 of Title 22 of the California Code of Regulations.
(ii) A licensed provider of comprehensive emergency medical
services as defined in Section 70451 of Title 22 of the California
Code of Regulations.
(iii) A children's hospital, as defined in Section 14087.21, that
satisfies clause (i) or (ii), or that jointly provides basic or
comprehensive emergency services in conjunction with another licensed
hospital.
(iv) A hospital owned and operated by a public agency that
operates two or more hospitals that qualify under subparagraph (A) or
(B) with respect to the particular state fiscal year.
(v) A hospital designated by the National Cancer Institute as a
comprehensive or clinical cancer research center that primarily
treats acutely ill cancer patients and that is exempt from the
federal Medicare prospective payment system pursuant to Section 1886
(d)(1)(B)(v) of the federal Social Security Act (42 U.S.C. Sec.
1395ww(d)(1)(B)(v)).
(D) (1) The hospital is able to demonstrate a purpose for
additional funding under the selective provider contracting program
including proposals relating to emergency services and other health
care services, including infrequent yet high-cost services, such as
anti-AB human antitoxin treatment for infant botulism (human
botulinum immune globulin (HBIG), commonly referred to as "Baby-BIG"
), that are made available, or will be made available, to Medi-Cal
beneficiaries.
(2) The hospital is contracting under this article and meets the
definition of a university teaching hospital or major, nonuniversity,
teaching hospital as set forth on page 51 and as listed on page 57
of the department's report dated May 1991, entitled "Hospital Peer
Grouping." Payments from the fund shall be used solely for the
purposes identified in the contract between the hospital and the
state.
(3) The hospital is contracting under this article and meets the
definition of any of the following:
(A) A large teaching emphasis hospital, as set forth on page 51
and listed on page 57 of the department's report dated May 1991,
entitled "Hospital Peer Grouping," and also meets the definition of
eligible hospital as defined in paragraph (3) of subdivision (a) of
Section 14105.98.
(B) A children's hospital pursuant to Section 10727, and also
meets the definition of eligible hospital as defined in paragraph (3)
of subdivision (a) of Section 14105.98.
(C) Notwithstanding the requirement in subparagraph (A) of
paragraph (3) that a hospital must be listed on page 57 of the
department's report dated May 1991, entitled "Hospital Peer Grouping,"
any hospital whose license pursuant to Chapter 2 (commencing with
Section 1250) of Division 2 of the Health and Safety Code was
consolidated during the 1999 calendar year with a large teaching
emphasis hospital that is listed on page 57 of the above-described
report shall be eligible. All other requirements of paragraph (3)
shall continue to apply.
(4) The hospital meets all of the following criteria:
(A) The hospital is contracting under this article.
(B) The hospital satisfies the Medicaid State Plan criteria for
disproportionate share hospital status.
(C) The hospital is a small and rural hospital as defined in
Section 124840 of the Health and Safety Code.
(D) The hospital is a licensed provider of standby emergency
services as described in Section 70649 of Title 22 of the California
Code of Regulations.
(E) The hospital is able to demonstrate a purpose for additional
funding under the selective provider contracting program with
proposals relating to health care services that are made available,
or will be made available, to Medi-Cal beneficiaries.
(F) The hospital is determined by the California Medical
Assistance Commission to be a hospital that provides an important
community service that otherwise would not be provided in the
community.
SEC. 98. Section 14166.19 of the Welfare and Institutions Code is
amended to read:
14166.19. The amount of any stabilization funding payable to the
nondesignated public hospitals under paragraph (4) of subdivision (b)
of Section 14166.20 for a project year, which amount shall not
include the amount of stabilization funding paid or payable to
hospitals prior to the computation of the stabilization funding under
Section 14166.20, shall be allocated in the following priority:
(a) An amount shall be transferred to the Nondesignated Public
Hospital Supplemental Fund, as may be necessary so that the amount
for the Nondesignated Public Hospital Supplemental Fund for the
project year, including all funds previously transferred to, or
deposited in, the Nondesignated Public Hospital Supplemental Fund for
the project year, is not less than one million nine hundred thousand
dollars ($1,900,000).
(b) Of the remaining stabilization funding payable to
nondesignated public hospitals, 75 percent shall be allocated,
distributed, and paid in accordance with Section 14166.16, and 25
percent shall be transferred to the Nondesignated Public Hospital
Supplemental Fund.
(c) Notwithstanding any other law, the amount of any stabilization
funding payable to nondesignated public hospitals under Section
14166.20 for a project year as determined under this section that has
not been paid, or specifically committed for payment, to
nondesignated public hospitals before January 1, 2012, shall not be
paid pursuant to Section 14166.20. The funds that would otherwise be
paid from the Nondesignated Public Hospital Supplemental Fund shall
be transferred to the General Fund, and funds that would otherwise be
drawn from the General Fund for payments to the nondesignated public
hospitals pursuant to Section 14166.20 shall be retained in the
General Fund.
SEC. 99. Section 14169.7 of the Welfare and Institutions Code is
amended to read:
14169.7. (a) (1) Designated public hospitals shall be paid direct
grants in support of health care expenditures, which shall not
constitute Medi-Cal payments, and which shall be funded by the
quality assurance fee set forth in Article 5.229 (commencing with
Section 14169.31). The aggregate amount of the grants to designated
public hospitals shall be fifty million dollars ($50,000,000) for the
2011-12 fiscal year, forty-three million dollars ($43,000,000) for
the 2012-13 fiscal year, and twenty-one million five hundred thousand
dollars ($21,500,000) for the 2013-14 fiscal year. The director
shall allocate the amounts specified in this paragraph pursuant to
paragraph (2).
(2) For the 2011-12 fiscal year, the director shall allocate the
fifty million dollars ($50,000,000) identified in paragraph (1) among
the designated public hospitals pursuant to a methodology developed
in consultation with the designated public hospitals. For the 2012-13
fiscal year, the director shall allocate the forty-three million
dollars ($43,000,000) identified in paragraph (1) among the
designated public hospitals pursuant to a methodology developed in
consultation with the designated public hospitals. For the 2013-14
fiscal year, the state shall retain the twenty-one million five
hundred thousand dollars ($21,500,000) identified in paragraph (1) to
pay for health care coverage for children in addition to the amounts
identified in Section 14169.33.
(b) Nondesignated public hospitals shall be paid direct grants in
support of health care expenditures, and shall be funded by the
quality assurance fee set forth in Article 5.229 (commencing with
Section 14169.31). The aggregate amount of the grants to
nondesignated public hospitals for each subject fiscal year shall be
ten million dollars ($10,000,000), except that for the 2013-14
subject fiscal year, the aggregate amount of the grants shall be five
million dollars ($5,000,000). The director shall allocate the
amounts specified in this subdivision among the nondesignated public
hospitals pursuant to a methodology developed in consultation with
the nondesignated public hospitals.
SEC. 100. Section 14169.7.5 of the Welfare and Institutions Code
is amended to read:
14169.7.5. (a) The Low Income Health Program MCE Out-of-Network
Emergency Care Services Fund is hereby established in the State
Treasury. The moneys in the fund shall, upon appropriation by the
Legislature to the department, be used solely for the purposes
specified in this section. Notwithstanding Section 16305.7 of the
Government Code, any and all interest and dividends earned on money
in the fund shall be used exclusively for the purposes of this
section.
(b) The fund shall consist of the following:
(1) Funds transferred from governmental entities, at the option of
the governmental entity, to the state for deposit into the fund in
an aggregate amount of twenty million dollars ($20,000,000) per
subject fiscal year, except that for the 2013-14 subject fiscal year,
the aggregate amount of the transfer shall be ten million dollars
($10,000,000).
(2) Proceeds of the quality assurance fee set forth in Article
5.229 (commencing with Section 14169.31) that, subject to paragraph
(1) of subdivision (a) of Section 14169.36, are transferred from the
Hospital Quality Assurance Revenue Fund and deposited into the fund
in an aggregate amount of seventy-five million dollars ($75,000,000)
per subject fiscal year, except that for the 2013-14 subject fiscal
year, the aggregate amount of the proceeds of the quality assurance
fee deposited into the fund shall be thirty-seven million five
hundred thousand dollars ($37,500,000).
(c) Any amounts of the quality assurance fee deposited to the fund
in excess of the funds required to implement this section shall be
returned to the Hospital Quality Assurance Revenue Fund.
(d) Any amounts deposited to the fund as described in paragraph
(1) of subdivision (b) that are in excess of the funds required to
implement this section shall be returned to the transferring entity.
(e) Consistent with the Special Terms and Conditions for the
California's Bridge to Reform Section 1115(a) Medicaid Demonstration
(11-W-00193/9), moneys in the fund shall be used with respect to Low
Income Health Programs (LIHPs) operating pursuant to Part 3.6
(commencing with Section 15909) as the source for the nonfederal
share of expenditures for coverage for the Medi-Cal coverage
expansion (MCE) population of medically necessary hospital emergency
services for emergency medical conditions and required
poststabilization care furnished by private hospitals and
nondesignated public hospitals that are outside the LIHP coverage
network, subject to the following:
(1) Moneys in the fund shall only be used to fund the nonfederal
share of supplemental payments made to private hospital and
nondesignated public hospital out-of-network emergency care services
providers by the LIHP for the MCE population in accordance with this
section.
(2) Supplemental payments under this section shall supplement but
shall not supplant amounts that would have been paid absent the
provisions of this section.
(f) Moneys in the fund shall be allocated with respect to each
subject fiscal year as follows:
(1) Within 60 days after the last day of each subject fiscal year,
each LIHP shall report utilization data to the department on
approved hospital emergency services for emergency medical conditions
and required poststabilization care, in accordance with Paragraph
63.f.ii of the Special Terms and Conditions of California's Bridge to
Reform Section 1115(a) Demonstration (11-W-00193/9), provided to MCE
enrollees by out-of-network private hospitals and nondesignated
public hospitals during that year. The reported data shall be as
specified by the department, and shall include the number of
emergency room encounters and the number of inpatient hospital days.
(2) The department shall, in consultation with the hospital
community, determine the amount of funding for the nonfederal share
of supplemental payments available for each reported emergency room
encounter or inpatient day by dividing the total funds available by
the total number of inpatient days or emergency visits in accordance
with subparagraphs (A) and (B).
(A) Seventy percent of the moneys in the fund shall be allocated
for the nonfederal share of supplemental payments to private
hospitals and nondesignated public hospitals for approved
out-of-network inpatient hospital emergency and poststabilization
care, in accordance with Paragraph 63.f.ii of the Special Terms and
Conditions of California's Bridge to Reform Section 1115(a)
Demonstration (11-W-00193/9).
(B) Thirty percent of the available funds shall be allocated for
the nonfederal share of supplemental payments to private hospitals
and nondesignated public hospitals for approved out-of-network
hospital emergency room services (excluding emergency room visits, in
accordance with Paragraph 63.f.ii of the Special Terms and
Conditions of California's Bridge to Reform Section 1115(a)
Demonstration (11-W-00193/9), that resulted in an approved
out-of-network inpatient hospital stay), provided that for any
emergency room visit that results in a hospital stay for which a
supplemental payment is available under subparagraph (A), no
supplemental payment shall be available under this subparagraph.
(C) The allocations and total available fund amount shall be
adjusted as necessary so as to be consistent with the requirement in
paragraph (1) of subdivision (g).
(g) (1) The department shall obtain federal financial
participation for moneys in the fund to the full extent permitted by
federal law. Moneys shall be allocated from the fund by the
department to be matched by federal funds in accordance with the
Special Terms and Conditions for the Medicaid Demonstration, or
pursuant to other federal approvals or waivers as necessary.
(2) The department shall disburse moneys from the fund to the
LIHPs in accordance with the calculations in subdivision (f) within
60 days after completing the calculations. The moneys shall be
distributed to the LIHPs solely for purposes of funding the
nonfederal portion of the supplemental out-of-network amounts
determined for each service in subdivision (f) to out-of-network
hospital emergency care services providers.
(3) The LIHPs shall make the supplemental payments described in
paragraph (2) within 30 days of receiving the nonfederal share from
the department.
(h) It is the intent of the Legislature that for each subject
fiscal year, the first twenty million dollars ($20,000,000), or, for
subject fiscal year 2013-14, the first ten million dollars
($10,000,000), of the nonfederal share for the emergency hospital
services payments are funded with intergovernmental transfers
described in paragraph (1) of subdivision (b).
(i) This section shall be implemented only if, and to the
extent that, both of the following conditions exist:
(1) All necessary federal approvals have been obtained for the
implementation of this section and federal financial participation is
available.
(2) The ability of the department to maximize federal funding is
not jeopardized.
(j) In designing and implementing the program for supplemental
payments created under this section, the director shall have
discretion, after consultation with the hospital community and the
LIHPs, to modify timelines and to make modifications to the
operational requirements of this section, but only to the extent
necessary to secure federal approval or to ensure successful
operation of the program and to effectuate the intent of this
section.
(k) Notwithstanding any other provision of this article or Article
5.229 (commencing with Section 14169.31), federal disapproval of the
program developed pursuant to the requirements of this section shall
not affect the implementation of the remainder of this article or
Article 5.229 (commencing with Section 14169.31).
SEC. 101. Section 14169.13 of the Welfare and Institutions Code is
amended to read:
14169.13. (a) The director shall do all of the following:
(1) Promptly submit any state plan amendment or waiver request
that may be necessary to implement this article.
(2) Promptly seek federal approvals or waivers as may be necessary
to implement this article and to obtain federal financial
participation to the maximum extent possible for the payments under
this article.
(3) Amend the contracts between the managed health care plans and
the department as necessary to incorporate the provisions of Sections
14169.5 and 14169.6 and promptly seek all necessary federal
approvals of those amendments. The department shall pursue amendments
to the contracts as soon as possible after the effective date of
this article and Article 5.229 (commencing with Section 14169.31),
and shall not wait for federal approval of this article or Article
5.229 (commencing with Section 14169.31) prior to pursuing amendments
to the contracts. The amendments to the contracts shall, among other
provisions, set forth an agreement to increase capitation payments
to managed health care plans under Section 14169.5 and increase
payments to hospitals under Section 14169.6 in a manner that relates
back to July 1, 2011, or as soon thereafter as possible, conditioned
on obtaining all federal approvals necessary for federal financial
participation for the increased capitation payments to the managed
health care plans.
(b) In implementing this article, the department may utilize the
services of the Medi-Cal fiscal intermediary through a change order
to the fiscal intermediary contract to administer this program,
consistent with the requirements of Sections 14104.6, 14104.7,
14104.8, and 14104.9. Contracts entered into for purposes of
implementing this article or Article 5.229 (commencing with Section
14169.31) shall not be subject to Part 2 (commencing with Section
10100) of Division 2 of the Public Contract Code.
(c) This article shall become inoperative if either of the
following occurs:
(1) In the event, and on the effective date, of a final judicial
determination made by any court of appellate jurisdiction or a final
determination by the federal Department of Health and Human Services
or the federal Centers for Medicare and Medicaid Services that
Section 14169.2, Section 14169.3, or any provision of Section
14166.115 cannot be implemented.
(2) In the event both of the following conditions exist:
(A) The federal Centers for Medicare and Medicaid Services denies
approval for, or does not approve before January 1, 2013, the
implementation of Section 14169.2, Section 14169.3, or the quality
assurance fee established pursuant to Article 5.229 (commencing with
Section 14169.31).
(B) Section 14169.2, Section 14169.3, or Article 5.229
(commencing with Section 14169.31) cannot be modified by the
department pursuant to subdivision (e) of Section 14169.33 in order
to meet the requirements of federal law or to obtain federal
approval.
(d) If this article becomes inoperative pursuant to paragraph (1)
of subdivision (c) and the determination applies to any period or
periods of time prior to the effective date of the determination, the
department shall have authority to recoup all payments made pursuant
to this article during that period or those periods of time.
(e) In the event any hospital, or any party on behalf of a
hospital, shall initiate a case or proceeding in any state or federal
court in which the hospital seeks any relief of any sort whatsoever,
including, but not limited to, monetary relief, injunctive relief,
declaratory relief, or a writ, based in whole or in part on a
contention that any or all of this article or Article 5.229
(commencing with Section 14169.31) is unlawful and may not be
lawfully implemented, both of the following shall apply:
(1) Payments shall not be made to the hospital pursuant to this
article until the case or proceeding is finally resolved, including
the final disposition of all appeals.
(2) Any amount computed to be payable to the hospital pursuant to
this section for a project year shall be withheld by the department
and shall be paid to the hospital only after the case or proceeding
is finally resolved, including the final disposition of all appeals.
(f) Subject to Section 14169.34, no payment shall be made under
this article until all necessary federal approvals for the payment
and for the fee provisions in Article 5.229 (commencing with Section
14169.31) have been obtained and the fee has been imposed and
collected. Notwithstanding any other provision of law, payments under
this article shall be made only to the extent that the fee
established in Article 5.229 (commencing with Section 14169.31) is
collected and available to cover the nonfederal share of the
payments.
(g) A hospital's receipt of payments under this article for
services rendered prior to the effective date of this article is
conditioned on the hospital's continued participation in Medi-Cal for
at least 30 days after the effective date of this article.
(h) All payments made by the department to hospitals, managed
health care plans, and mental health plans under this article shall
be made only from the following:
(1) The quality assurance fee set forth in Article 5.229
(commencing with Section 14169.31) and due and payable on or before
December 31, 2013, along with any interest or other investment income
thereon.
(2) Federal reimbursement and any other related federal funds.
SEC. 102. Section 14169.31 of the Welfare and Institutions Code is
amended to read:
14169.31. For the purposes of this article, the following
definitions shall apply:
(a) (1) "Aggregate quality assurance fee" means, with respect to a
hospital that is not a prepaid health plan hospital, the sum of all
of the following:
(A) The annual fee-for-service days for an individual hospital
multiplied by the fee-for-service per diem quality assurance fee
rate.
(B) The annual managed care days for an individual hospital
multiplied by the managed care per diem quality assurance fee rate.
(C) The annual Medi-Cal days for an individual hospital multiplied
by the Medi-Cal per diem quality assurance fee rate.
(2) "Aggregate quality assurance fee" means, with respect to a
hospital that is a prepaid health plan hospital, the sum of all of
the following:
(A) The annual fee-for-service days for an individual hospital
multiplied by the fee-for-service per diem quality assurance fee
rate.
(B) The annual managed care days for an individual hospital
multiplied by the prepaid health plan hospital managed care per diem
quality assurance fee rate.
(C) The annual Medi-Cal managed care days for an individual
hospital multiplied by the prepaid health plan hospital Medi-Cal
managed care per diem quality assurance fee rate.
(D) The annual Medi-Cal fee-for-service days for an individual
hospital multiplied by the Medi-Cal per diem quality assurance fee
rate.
(3) "Aggregate quality assurance fee after the application of the
fee percentage" means the aggregate quality assurance fee multiplied
by the fee percentage for each subject fiscal year.
(b) "Annual fee-for-service days" means the number of
fee-for-service days of each hospital subject to the quality
assurance fee, as reported on the days data source.
(c) "Annual managed care days" means the number of managed care
days of each hospital subject to the quality assurance fee, as
reported on the days data source.
(d) "Annual Medi-Cal days" means the number of Medi-Cal days of
each hospital subject to the quality assurance fee, as reported on
the days data source.
(e) "Converted hospital" shall mean a hospital described in
subdivision (b) of Section 14169.1.
(f) "Days data source" means the hospital's Annual Financial
Disclosure Report filed with the Office of Statewide Health Planning
and Development as of May 5, 2011, for its fiscal year ending during
2009.
(g) "Designated public hospital" shall have the meaning given in
subdivision (d) of Section 14166.1 as of January 1, 2011.
(h) "Exempt facility" means any of the following:
(1) A public hospital, which shall include either of the
following:
(A) A hospital, as defined in paragraph (25) of subdivision (a) of
Section 14105.98.
(B) A tax-exempt nonprofit hospital that is licensed under
subdivision (a) of Section 1250 of the Health and Safety Code and
operating a hospital owned by a local health care district, and is
affiliated with the health care district hospital owner by means of
the district's status as the nonprofit corporation's sole corporate
member.
(2) With the exception of a hospital that is in the Charitable
Research Hospital peer group, as set forth in the 1991 Hospital Peer
Grouping Report published by the department, a hospital that is a
hospital designated as a specialty hospital in the hospital's Office
of Statewide Health Planning and Development Hospital Annual
Financial Disclosure Report for the hospital's fiscal year ending in
the 2009 calendar year.
(3) A hospital that satisfies the Medicare criteria to be a
long-term care hospital.
(4) A small and rural hospital as specified in Section 124840 of
the Health and Safety Code designated as that in the hospital's
Office of Statewide Health Planning and Development Hospital Annual
Financial Disclosure Report for the hospital's fiscal year ending in
the 2009 calendar year.
(i) "Federal approval" means the approval by the federal
government of both the quality assurance fee established pursuant to
this article and the supplemental payments to private hospitals
described in Sections 14169.2 and 14169.3.
(j) (1) "Fee-for-service per diem quality assurance fee rate"
means a fixed daily fee on fee-for-service days.
(2) The fee-for-service per diem quality assurance fee rate shall
be three hundred nine dollars and eighty-six cents ($309.86) per day.
(3) Upon federal approval or conditional federal approval
described in Section 14169.34, the director shall determine the
fee-for-service per diem quality assurance fee rate based on the
funds required to make the payments specified in Article 5.228
(commencing with Section 14169.1), in consultation with the hospital
community.
(k) "Fee-for-service days" means inpatient hospital days where the
service type is reported as "acute care," "psychiatric care," and
"rehabilitation care," and the payer category is reported as
"Medicare traditional," "county indigent programs-traditional,"
"other third parties-traditional," "other indigent," and "other
payers," for purposes of the Annual Financial Disclosure Report
submitted by hospitals to the Office of Statewide Health Planning and
Development.
(l) "Fee percentage" means a fraction, expressed as a percentage,
the numerator of which is the amount of payments for each subject
fiscal year under Sections 14169.2, 14169.3, 14169.5, and 14169.7.5,
for which federal financial participation is available and the
denominator of which is four billion eight hundred ninety-seven
million eight hundred sixty-six thousand nine hundred thirty-seven
dollars ($4,897,866,937).
(m) "General acute care hospital" means any hospital licensed
pursuant to subdivision (a) of Section 1250 of the Health and Safety
Code.
(n) "Hospital community" means any hospital industry organization
or system that represents hospitals.
(o) "Managed care days" means inpatient hospital days where the
service type is reported as "acute care," "psychiatric care," and
"rehabilitation care," and the payer category is reported as
"Medicare managed care," "county indigent programs-managed care," and
"other third parties-managed care," for purposes of the Annual
Financial Disclosure Report submitted by hospitals to the Office of
Statewide Health Planning and Development.
(p) "Managed care per diem quality assurance fee rate" means a
fixed fee on managed care days of eighty-six dollars and forty cents
($86.40) per day.
(q) "Medi-Cal days" means inpatient hospital days where the
service type is reported as "acute care," "psychiatric care," and
"rehabilitation care," and the payer category is reported as
"Medi-Cal traditional" and "Medi-Cal managed care," for purposes of
the Annual Financial Disclosure Report submitted by hospitals to the
Office of Statewide Health Planning and Development.
(r) "Medi-Cal fee-for-service days" means inpatient hospital days
where the service type is reported as "acute care," "psychiatric
care," and "rehabilitation care," and the payer category is reported
as "Medi-Cal traditional" for purposes of the Annual Financial
Disclosure Report submitted by hospitals to the Office of Statewide
Health Planning and Development.
(s) "Medi-Cal managed care days" means inpatient hospital days as
reported on the days data source where the service type is reported
as "acute care," "psychiatric care," and "rehabilitation care," and
the payer category is reported as "Medi-Cal managed care" for
purposes of the Annual Financial Disclosure Report submitted by
hospitals to the Office of Statewide Health Planning and Development.
(t) "Medi-Cal per diem quality assurance fee rate" means a fixed
fee on Medi-Cal days of three hundred eighty-three dollars and twenty
cents ($383.20) per day.
(u) "New hospital" means a hospital operation, business, or
facility functioning under current or prior ownership as a private
hospital that does not have a days data source or a hospital that has
a days data source in whole, or in part, from a previous operator
where there is an outstanding monetary liability owed to the state in
connection with the Medi-Cal program and the new operator did not
assume liability for the outstanding monetary obligation.
(v) "Nondesignated public hospital" means either of the following:
(1) A public hospital that is licensed under subdivision (a) of
Section 1250 of the Health and Safety Code, is not designated as a
specialty hospital in the hospital's Annual Financial Disclosure
Report for the hospital's latest fiscal year ending in 2009, and
satisfies the definition in paragraph (25) of subdivision (a) of
Section 14105.98, excluding designated public hospitals.
(2) A tax-exempt nonprofit hospital that is licensed under
subdivision (a) of Section 1250 of the Health and Safety Code, is not
designated as a specialty hospital in the hospital's Annual
Financial Disclosure Report for the hospital's latest fiscal year
ending in 2009, is operating a hospital owned by a local health care
district, and is affiliated with the health care district hospital
owner by means of the district's status as the nonprofit corporation'
s sole corporate member.
(w) "Prepaid health plan hospital" means a hospital owned by a
nonprofit public benefit corporation that shares a common board of
directors with a nonprofit health care service plan.
(x) "Prepaid health plan hospital managed care per diem quality
assurance fee rate" means a fixed fee on non-Medi-Cal managed care
days for prepaid health plan hospitals of forty-eight dollars and
thirty-eight cents ($48.38) per day.
(y) "Prepaid health plan hospital Medi-Cal managed care per diem
quality assurance fee rate" means a fixed fee on Medi-Cal managed
care days for prepaid health plan hospitals of two hundred fourteen
dollars and fifty-nine cents ($214.59) per day.
(z) "Prior fiscal year data" means any data taken from sources
that the department determines are the most accurate and reliable at
the time the determination is made, or may be calculated from the
most recent audited data using appropriate update factors. The data
may be from prior fiscal years, current fiscal years, or projections
of future fiscal years.
(aa) "Private hospital" means a hospital that meets all of the
following conditions:
(1) Is licensed pursuant to subdivision (a) of Section 1250 of the
Health and Safety Code.
(2) Is in the Charitable Research Hospital peer group, as set
forth in the 1991 Hospital Peer Grouping Report published by the
department, or is not designated as a specialty hospital in the
hospital's Office of Statewide Health Planning and Development Annual
Financial Disclosure Report for the hospital's latest fiscal year
ending in 2009.
(3) Does not satisfy the Medicare criteria to be classified as a
long-term care hospital.
(4) Is a nonpublic hospital, nonpublic converted hospital, or
converted hospital as those terms are defined in paragraphs (26) to
(28), inclusive, respectively, of subdivision (a) of Section
14105.98.
(ab) "Program period" means the period from July 1, 2011, to
December 31, 2013, inclusive.
(ac) "Subject fiscal quarter" means a state fiscal quarter during
the program period.
(ad) "Subject fiscal year" means a state fiscal year that ends
after July 1, 2011, and begins before January 1, 2014.
(ae) "Upper payment limit" means a federal upper payment limit on
the amount of the Medicaid payment for which federal financial
participation is available for a class of service and a class of
health care providers, as specified in Part 447 of Title 42 of the
Code of Federal Regulations. The applicable upper payment limit shall
be separately calculated for inpatient and outpatient hospital
services.
SEC. 103. Section 14169.32 of the Welfare and Institutions Code is
amended to read:
14169.32. (a) There shall be imposed on each general acute care
hospital that is not an exempt facility a quality assurance fee,
provided that a quality assurance fee under this article shall not be
imposed on a converted hospital.
(b) The quality assurance fee shall be computed starting on July
1, 2011, and continue through and including December 31, 2013.
(c) Subject to Section 14169.34, upon receipt of federal approval,
the following shall become operative:
(1) Within 10 business days following receipt of the notice of
federal approval from the federal government, the department shall
send notice to each hospital subject to the quality assurance fee,
and publish on its Internet Web site, the following information:
(A) The date that the state received notice of federal approval.
(B) The fee percentage for each subject fiscal year.
(2) The notice to each hospital subject to the quality assurance
fee shall also state the following:
(A) The aggregate quality assurance fee after the application of
the fee percentage for each subject fiscal year.
(B) The aggregate quality assurance fee.
(C) The amount of each payment due from the hospital with respect
to the aggregate quality assurance fee.
(D) The date on which each payment is due.
(3) The hospitals shall pay the aggregate quality assurance fee in
10 equal installments. The department shall establish the date that
each installment is due, provided that the first installment shall be
due no earlier than 20 days following the department sending the
notice pursuant to paragraph (1), and the installments shall be paid
at least one month apart, but if possible, the installments shall be
paid on a quarterly basis.
(4) Notwithstanding paragraph (3), the amount of each hospital's
aggregate quality assurance fee after the application of the fee
percentage that has not been paid by the hospital before December 15,
2013, pursuant to paragraph (3), shall be paid by the hospital no
later than December 15, 2013.
(d) The quality assurance fee, as paid pursuant to this section,
shall be paid by each hospital subject to the fee to the department
for deposit in the Hospital Quality Assurance Revenue Fund. Deposits
may be accepted at any time and will be credited toward the program
period.
(e) This section shall become inoperative if the federal Centers
for Medicare and Medicaid Services denies approval for, or does not
approve before July 1, 2014, the implementation of the quality
assurance fee pursuant to this article or the supplemental payments
to private hospitals described in Sections 14169.2 and 14169.3, and
either or both provisions cannot be modified by the department
pursuant to subdivision (d) of Section 14169.33 in order to meet the
requirements of federal law or to obtain federal approval.
(f) In no case shall the aggregate fees collected in a federal
fiscal year pursuant to this section, Section 14167.32, and Section
14168.32 exceed the maximum percentage of the annual aggregate net
patient revenue for hospitals subject to the fee that is prescribed
pursuant to federal law and regulations as necessary to preclude a
finding that an indirect guarantee has been created.
(g) (1) Interest shall be assessed on quality assurance fees not
paid on the date due at the greater of 10 percent per annum or the
rate at which the department assesses interest on Medi-Cal program
overpayments to hospitals that are not repaid when due. Interest
shall begin to accrue the day after the date the payment was due and
shall be deposited in the Hospital Quality Assurance Revenue Fund.
(2) In the event that any fee payment is more than 60 days
overdue, a penalty equal to the interest charge described in
paragraph (1) shall be assessed and due for each month for which the
payment is not received after 60 days.
(h) When a hospital fails to pay all or part of the quality
assurance fee on or before the date that payment is due, the
department may immediately begin to deduct the unpaid assessment and
interest from any Medi-Cal payments owed to the hospital, or, in
accordance with Section 12419.5 of the Government Code, from any
other state payments owed to the hospital until the full amount is
recovered. All amounts, except penalties, deducted by the department
under this subdivision shall be deposited in the Hospital Quality
Assurance Revenue Fund. The remedy provided to the department by this
section is in addition to other remedies available under law.
(i) The payment of the quality assurance fee shall not be
considered as an allowable cost for Medi-Cal cost reporting and
reimbursement purposes.
(j) The department shall work in consultation with the hospital
community to implement this article and Article 5.228 (commencing
with Section 14169.1).
(k) This subdivision creates a contractually enforceable promise
on behalf of the state to use the proceeds of the quality assurance
fee, including any federal matching funds, solely and exclusively for
the purposes set forth in this article as they existed on the
effective date of this article, to limit the amount of the proceeds
of the quality assurance fee to be used to pay for the health care
coverage of children to the amounts specified in this article, to
limit any payments for the department's costs of administration to
the amounts set forth in this article on the effective date of this
article, to maintain and continue prior reimbursement levels as set
forth in Section 14169.12 on the effective date of that article, and
to otherwise comply with all its obligations set forth in Article
5.228 (commencing with Section 14169.1) and this article provided
that amendments that arise from, or have as a basis, a decision,
advice, or determination by the federal Centers for Medicare and
Medicaid Services relating to federal approval of the quality
assurance fee or the payments set forth in this article or Article
5.228 (commencing with Section 14169.1) shall control for the
purposes of this subdivision.
(l) (1) Effective January 1, 2014, the rates payable to hospitals
and managed health care plans under Medi-Cal shall be the rates then
payable without the supplemental and increased capitation payments
set forth in Article 5.228 (commencing with Section 14169.1).
(2) The supplemental payments and other payments under Article
5.228 (commencing with Section 14169.1) shall be regarded as quality
assurance payments, the implementation or suspension of which does
not affect a determination of the adequacy of any rates under federal
law.
(m) (1) Subject to paragraph (2), the director may waive any or
all interest and penalties assessed under this article in the event
that the director determines, in his or her sole discretion, that the
hospital has demonstrated that imposition of the full quality
assurance fee on the timelines applicable under this article has a
high likelihood of creating a financial hardship for the hospital or
a significant danger of reducing the provision of needed health care
services.
(2) Waiver of some or all of the interest or penalties under this
subdivision shall be conditioned on the hospital's agreement to make
fee payments, or to have the payments withheld from payments
otherwise due from the Medi-Cal program to the hospital, on a
schedule developed by the department that takes into account the
financial situation of the hospital and the potential impact on
services.
(3) A decision by the director under this subdivision shall not be
subject to judicial review.
(4) If fee payments are remitted to the department after the date
determined by the department to be the final date for calculating the
final supplemental payments under this article and Article 5.228
(commencing with Section 14169.1), the fee payments shall be retained
in the fund for purposes of funding supplemental payments supported
by a hospital quality assurance fee program implemented under
subsequent legislation, provided, however, that if supplemental
payments are not implemented under subsequent legislation, then those
fee payments shall be deposited in the Distressed Hospital Fund.
(5) If during the implementation of this article, fee payments
that were due under Article 5.21 (commencing with Section 14167.1)
and Article 5.22
(commencing with Section 14167.31), or Article 5.226 (commencing with
Section 14168.1) and Article 5.227 (commencing with Section
14168.31), are remitted to the department under a payment plan or for
any other reason, and the final date for calculating the final
supplemental payments under those articles has passed, then those fee
payments shall be deposited in the fund to support the uses
established by this article.
SEC. 104. Section 14169.33 of the Welfare and Institutions Code is
amended to read:
14169.33. (a) (1) All fees required to be paid to the state
pursuant to this article shall be paid in the form of remittances
payable to the department.
(2) The department shall directly transmit the fee payments to the
Treasurer to be deposited in the Hospital Quality Assurance Revenue
Fund, created pursuant to Section 14167.35. Notwithstanding Section
16305.7 of the Government Code, any interest and dividends earned on
deposits in the fund from the proceeds of the fee assessed pursuant
to this article shall be retained in the fund for purposes specified
in subdivision (b).
(b) Notwithstanding subdivision (c) of Section 14167.35 and
subdivision (b) of Section 14168.33, all funds from the proceeds of
the fee assessed pursuant to this article in the Hospital Quality
Assurance Revenue Fund, together with any interest and dividends
earned on money in the fund, shall, upon appropriation by the
Legislature, continue to be used exclusively to enhance federal
financial participation for hospital services under the Medi-Cal
program, to provide additional reimbursement to, and to support
quality improvement efforts of, hospitals, and to minimize
uncompensated care provided by hospitals to uninsured patients, as
well as to pay for the state's administrative costs and to provide
funding for children's health coverage, in the following order of
priority:
(1) To pay for the department's staffing and administrative costs
directly attributable to implementing Article 5.228 (commencing with
Section 14169.1) and this article, not to exceed two million five
hundred thousand dollars ($2,500,000) for the program period.
(2) To pay for the health care coverage for children in the amount
of eighty-five million dollars ($85,000,000) for each subject fiscal
quarter during the 2011-12 subject fiscal year, in the amount of one
hundred thirty-four million two hundred fifty thousand dollars
($134,250,000) for each subject fiscal quarter during the 2012-13
subject fiscal year, and in the amount of one hundred forty-four
million two hundred fifty thousand dollars ($144,250,000) for each
subject fiscal quarter during the 2013-14 subject fiscal year.
(3) To make increased capitation payments to managed health care
plans pursuant to Article 5.228 (commencing with Section 14169.1).
(4) To reimburse the General Fund for the increase in the overall
compensation to a private hospital that is attributable to its change
in status from contract hospital to noncontract hospital, pursuant
to subdivision (a) of Section 14169.10.
(5) To make increased payments or grants to hospitals pursuant to
Article 5.228 (commencing with Section 14169.1).
(6) To make increased payments to mental health plans pursuant to
Article 5.228 (commencing with Section 14169.1).
(7) To make supplemental payments for out-of-network emergency and
poststabilization services provided by private hospitals and
nondesignated public hospitals to Medi-Cal expansion enrollees in the
Low Income Health Program in the amount of thirty-seven million five
hundred thousand dollars ($37,500,000) for each fiscal quarter
pursuant to Section 14169.7.5.
(c) Any amounts of the quality assurance fee collected in excess
of the funds required to implement subdivision (b), including any
funds recovered under subdivision (d) of Section 14169.13 or
subdivision (e) of Section 14169.38, shall be refunded to general
acute care hospitals, pro rata with the amount of quality assurance
fee paid by the hospital, subject to the limitations of federal law.
If federal rules prohibit the refund described in this subdivision,
the excess funds shall be deposited in the Distressed Hospital Fund
to be used for the purposes described in Section 14166.23, and shall
be supplemental to and not supplant existing funds.
(d) Any methodology or other provision specified in Article 5.228
(commencing with Section 14169.1) or this article may be modified by
the department, in consultation with the hospital community, to the
extent necessary to meet the requirements of federal law or
regulations to obtain federal approval or to enhance the probability
that federal approval can be obtained, provided the modifications do
not violate the spirit and intent of Article 5.228 (commencing with
Section 14169.1) or this article and are not inconsistent with the
conditions of implementation set forth in Section 14169.40.
(e) The department, in consultation with the hospital community,
shall make adjustments, as necessary, to the amounts calculated
pursuant to Section 14169.32 in order to ensure compliance with the
federal requirements set forth in Section 433.68 of Title 42 of the
Code of Federal Regulations or elsewhere in federal law.
(f) The department shall request approval from the federal Centers
for Medicare and Medicaid Services for the implementation of this
article. In making this request, the department shall seek specific
approval from the federal Centers for Medicare and Medicaid Services
to exempt providers identified in this article as exempt from the
fees specified, including the submission, as may be necessary, of a
request for waiver of the broad-based requirement, waiver of the
uniform fee requirement, or both, pursuant to paragraphs (1) and (2)
of subdivision (e) of Section 433.68 of Title 42 of the Code of
Federal Regulations.
(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 this article or Article 5.228 (commencing
with Section 14169.1) by means of provider bulletins, all plan
letters, or other similar instruction, without taking regulatory
action. The department shall also provide notification to the Joint
Legislative Budget Committee and to the appropriate policy and fiscal
committees of the Legislature within five working days when the
above-described action is taken in order to inform the Legislature
that the action is being implemented.
SEC. 105. Section 14169.34 of the Welfare and Institutions Code is
amended to read:
14169.34. (a) Notwithstanding any other provision of this article
or Article 5.228 (commencing with Section 14169.1) requiring federal
approvals, the department may impose and collect the quality
assurance fee and may make payments under this article and Article
5.228 (commencing with Section 14169.1), including increased
capitation payments, based upon receiving a letter from the federal
Centers for Medicare and Medicaid Services or the United States
Department of Health and Human Services that indicates likely federal
approval, but only if and to the extent that the letter is
sufficient as set forth in subdivision (b).
(b) In order for the letter to be sufficient under this section,
the director shall find that the letter meets both of the following
requirements:
(1) The letter is in writing and signed by an official of the
federal Centers for Medicare and Medicaid Services or an official of
the United States Department of Health and Human Services.
(2) The director, after consultation with the hospital community,
has determined, in the exercise of his or her sole discretion, that
the letter provides a sufficient level of assurance to justify
advanced implementation of the fee and payment provisions.
(c) Nothing in this section shall be construed as modifying the
requirement under Section 14169.13 that payments shall be made only
to the extent a sufficient amount of funds collected as the quality
assurance fee are available to cover the nonfederal share of those
payments.
(d) Upon notice from the federal government that final federal
approval for the fee model under this article or for the supplemental
payments to private hospitals under Section 14169.2 or 14169.3 has
been denied, any fees collected pursuant to this section shall be
refunded and any payments made pursuant to this article or Article
5.228 (commencing with Section 14169.1) shall be recouped, including,
but not limited to, supplemental payments, increased capitation
payments, payments to hospitals by health care plans resulting from
the increased capitation payments, increased payments to mental
health plans, and payments for the health care coverage of children.
To the extent fees were paid by a hospital that also received
payments under this section, the payments may first be recouped from
fees that would otherwise be refunded to the hospital prior to the
use of any other recoupment method allowed under law.
(e) Any payment made pursuant to this section shall be a
conditional payment until final federal approval has been received.
(f) The director shall have broad authority under this section to
collect the quality assurance fee for an interim period after receipt
of the letter described in subdivision (a) pending receipt of all
necessary federal approvals. This authority shall include discretion
to determine both of the following:
(1) Whether the quality assurance fee should be collected on a
full or pro rata basis during the interim period.
(2) The dates on which payments of the quality assurance fee are
due.
(g) The department may draw against the Hospital Quality Assurance
Revenue Fund for all administrative costs associated with
implementation under this article or Article 5.228 (commencing with
Section 14169.1).
(h) This section shall be implemented only to the extent federal
financial participation is not jeopardized by implementation prior to
the receipt of all necessary final federal approvals.
SEC. 106. Section 14169.36 of the Welfare and Institutions Code is
amended to read:
14169.36. (a) Upon receipt of a letter that indicates likely
federal approval that the director determines is sufficient for
implementation under Section 14169.34, or upon the receipt of federal
approval, the following shall occur:
(1) To the maximum extent possible, and consistent with the
availability of funds in the Hospital Quality Assurance Revenue Fund,
the department shall make all of the payments under Sections
14169.2, 14169.3, 14169.5, 14169.7, and 14169.7.5, including, but not
limited to, supplemental payments and increased capitation payments,
prior to January 1, 2014, except that the increased capitation
payments under Section 14169.5 shall not be made until federal
approval is obtained for these payments.
(2) The department shall make supplemental payments to hospitals
under Article 5.228 (commencing with Section 14169.1) consistent with
the timeframe described in Section 14169.11 or a modified timeline
developed pursuant to Section 14169.35.
(b) Notwithstanding any other provision of this article or Article
5.228 (commencing with Section 14169.1), if the director determines,
on or after December 15, 2013, that there are insufficient funds
available in the Hospital Quality Assurance Revenue Fund to make all
scheduled payments under Article 5.228 (commencing with Section
14169.1) before January 1, 2014, he or she shall consult with
representatives of the hospital community to develop an acceptable
plan for making additional payments to hospitals and managed health
care plans to maximize the use of delinquent fee payments or other
deposits or interest projected to become available in the fund after
December 15, 2013, but before June 15, 2014.
(c) Nothing in this section shall require the department to
continue to make payments under Article 5.228 (commencing with
Section 14169.1) if, after the consultation required under
subdivision (b), the director determines in the exercise of his or
her sole discretion that a workable plan for the continued payments
cannot be developed.
(d) Subdivisions (b) and (c) shall be implemented only if and to
the extent federal financial participation is available for continued
supplemental payments and to providers and continued increased
capitation payments to managed health care plans.
(e) If any payment or payments made pursuant to this section are
found to be inconsistent with federal law, the department shall
recoup the payments by means of withholding or any other available
remedy.
(f) Nothing in this section shall be read as affecting the
department's ongoing authority to continue, after December 31, 2013,
to collect quality assurance fees imposed on or before December 31,
2013.
SEC. 107. Section 14169.38 of the Welfare and Institutions Code is
amended to read:
14169.38. (a) This article shall be implemented only as long as
all of the following conditions are met:
(1) Subject to Section 14169.33, the quality assurance fee is
established in a manner that is fundamentally consistent with this
article.
(2) The quality assurance fee, including any interest on the fee
after collection by the department, is deposited in a segregated fund
apart from the General Fund.
(3) The proceeds of the quality assurance fee, including any
interest and related federal reimbursement, may only be used for the
purposes set forth in this article.
(b) No hospital shall be required to pay the quality assurance fee
to the department unless and until the state receives and maintains
federal approval.
(c) Hospitals shall be required to pay the quality assurance fee
to the department as set forth in this article only as long as all of
the following conditions are met:
(1) The federal Centers for Medicare and Medicaid Services allows
the use of the quality assurance fee as set forth in this article in
accordance with federal approval.
(2) Article 5.228 (commencing with Section 14169.1) is enacted and
remains in effect and hospitals are reimbursed the increased rates
for services during the program period, as defined in Section
14169.1.
(3) The full amount of the quality assurance fee assessed and
collected pursuant to this article remains available only for the
purposes specified in this article.
(d) This article shall become inoperative if either of the
following occurs:
(1) In the event, and on the effective date, of a final judicial
determination made by any court of appellate jurisdiction or a final
determination by the United States Department of Health and Human
Services or the federal Centers for Medicare and Medicaid Services
that the quality assurance fee established pursuant to this article
or any provision of Section 14166.115 cannot be implemented.
(2) In the event both of the following conditions exist:
(A) The federal Centers for Medicare and Medicaid Services denies
approval for, or does not approve before January 1, 2014, the
implementation of Sections 14169.2 and 14169.3 or this article.
(B) Section 14169.2, Section 14169.3, or this article cannot be
modified by the department pursuant to subdivision (d) of Section
14169.33 in order to meet the requirements of federal law or to
obtain federal approval.
(e) If this article becomes inoperative pursuant to paragraph (1)
of subdivision (d) and the determination applies to any period or
periods of time prior to the effective date of the determination, the
department may recoup all payments made pursuant to Article 5.228
(commencing with Section 14169.1) during that period or those periods
of time.
(f) (1) In the event that all necessary final federal approvals
are not received as described and anticipated under this article or
Article 5.228 (commencing with Section 14169.1), the director shall
have the discretion and authority to develop procedures for
recoupment from managed health care plans, and from hospitals under
contract with managed health care plans, of any amounts received
pursuant to this article or Article 5.228 (commencing with Section
14169.1).
(2) Any procedure instituted pursuant to this subdivision shall be
developed in consultation with representatives from managed health
care plans and representatives of the hospital community.
(3) Any procedure instituted pursuant to this subdivision shall be
in addition to all other remedies made available under the law,
pursuant to contracts between the department and the managed health
care plans, or pursuant to contracts between the managed health care
plans and the hospitals.
SEC. 108. Section 14171 of the Welfare and Institutions Code is
amended to read:
14171. (a) The director shall establish administrative appeal
processes to review grievances or complaints arising from the
findings of an audit or examination made pursuant to Sections 10722
and 14170 and for final settlements, including, in the case of
hospitals, the application of Sections 51536, 51537, and 51539 of
Title 22 of the California Code of Regulations. All these processes
shall be established by regulation, pursuant to, and consistent with,
Section 100171 of the Health and Safety Code.
(b) Different administrative appeal processes may be established
by the director for grievances or complaints arising from the
determinations of a tentative or final settlement based on audit or
examination findings made by or on behalf of the department pursuant
to Sections 10722 and 14170. However, consistent with existing
practice, no administrative appeal shall be available for tentative
settlement of cost reports.
(c) The administrative appeal process established by the director
for tentative settlements, including, in the case of hospitals, the
application of Sections 51536, 51537, and 51539 of Title 22 of the
California Code of Regulations shall be an informal process which,
however, guarantees a provider the right to present any grievance or
complaint to the department in writing. Any subsequent hearings shall
be conducted in an informal manner and shall be held at the
discretion of the department.
(d) The time limitations in subdivisions (e) and (f) for the
impartial hearing and the final decisions are mandatory. If the
department fails to conduct the hearing or to adopt a final decision
thereon within the time limitations provided in subdivisions (e) and
(f), the amount of any overpayment which is ultimately determined by
the department to be due shall be reduced by 10 percent for each
30-day period, or portion thereof, that the hearing or the decision,
or both, are delayed beyond the time limitations provided in
subdivisions (e) and (f). However, the time period shall be extended
by either of the following:
(1) Delay caused by a provider.
(2) Extensions of time granted a provider at its sole request or
at the joint request of the provider and the department.
(e) (1) The administrative appeal process established by the
director shall commence with an informal conference with the
provider, a representative of the department, and the administrative
law judge. The informal conference shall be conducted no later than
90 days after the filing of a timely and specific statement of
disputed issues by the provider. The administrative law judge, when
appropriate, may assign the administrative appeal to an informal
level of review where efforts could be made to resolve facts and
issues in dispute in a fair and equitable manner, subject to the
requirements of state and federal law. The review conducted at this
informal level shall be completed no later than 180 days after the
filing of a timely and specific statement of disputed issues by the
provider.
(2) Nothing in this subdivision shall prohibit the provider from
presenting any unresolved grievances or complaints at an impartial
hearing pursuant to subdivision (a). The impartial hearing shall be
conducted no later than 300 days after the filing of a timely and
specific statement of disputed issues by the provider.
(3) (A) Subject to subdivision (f), a final decision in a
noninstitutional provider appeal shall be adopted within 180 days
after the closure of the record of the impartial hearing, and a final
decision in an institutional provider appeal shall be adopted within
300 days after the closure of the record of the impartial hearing.
(B) The department shall mail a copy of the adopted decision to
all parties within 30 days of the date of adoption of the decision.
(f) In the event the director intends to modify a proposed
decision, on or before the 180th day following the closure of the
record of the hearing for noninstitutional providers or the 300th day
following the closure of the record of the hearing for institutional
providers, the director shall provide written notice of his or her
intention to the parties and shall afford the parties an opportunity
to present written argument. Following this notice, on or before the
240th day following the closure of the record of the hearing for
noninstitutional providers or the 420th day following closure of the
record of the hearing for institutional providers, or within that
additional time period as is granted pursuant to the sole request of
a provider or at the joint request of the provider and the
department, the director shall issue a final decision.
(g) In the event recovery of a disallowed payment has been made by
the department, a provider who prevails in an appeal of a disallowed
payment shall be entitled to interest at the rate equal to the
monthly average received on investments in the Surplus Money
Investment Fund, or simple interest at the rate of 7 percent per
annum, whichever is higher, commencing on the date the appeal is
formally accepted by the department or the date payment is received
by the department, whichever is later.
(h) Except as provided in subdivision (i), commencing 60 days
after issuance of the first statement of account status or demand for
repayment resulting from an audit or examination made pursuant to
Sections 10722 and 14170, interest at the rate equal to the monthly
average received on investments in the Surplus Money Investment Fund
during the month the first statement of account status or demand for
repayment was issued, or simple interest at the rate of 7 percent per
annum, whichever is higher, shall be assessed against any
unrecovered overpayment due to the department.
(i) (1) Commencing on the day following the last day of the period
covered by an audit or examination made pursuant to Sections 10722
and 14170, interest at the rate established under Section 19269 of
the Revenue and Taxation Code which is in effect on the date of the
commencement of that interest shall be assessed against any
unrecovered overpayment due to the department by providers of durable
medical equipment or incontinence supplies.
(2) Interest which accrues under this subdivision for recoupment
of an overpayment based on the lack of medical necessity for a
previously approved claim shall commence to accrue on the date of
written demand by the department.
(j) The final decision of the director shall be reviewable in
accordance with Section 1094.5 of the Code of Civil Procedure within
six months of the issuance of the director's final decision.
SEC. 109. Section 14182.4 of the Welfare and Institutions Code is
amended to read:
14182.4. (a) To the extent authorized under a federal waiver or
demonstration project described in Section 14180 that is approved by
the federal Centers for Medicare and Medicaid Services, the
department shall establish a program of investment, improvement, and
incentive payments for designated public hospitals and, to the extent
federal approval is obtained pursuant to subdivision (c) of Section
14166.155, for nondesignated public hospitals to encourage and
incentivize delivery system transformation and innovation in
preparation for the implementation of federal health care reform.
(b) The Public Hospital Investment, Improvement, and Incentive
Fund is hereby established in the State Treasury. Notwithstanding
Section 13340 of the Government Code, moneys in the fund shall be
continuously appropriated, without regard to fiscal years, to the
department for the purposes specified in this section.
(c) The fund shall consist of any moneys that a county, other
political subdivision of the state, or other governmental entity in
the state that may elect to transfer to the department for deposit
into the fund, as permitted under Section 433.51 of Title 42 of the
Code of Federal Regulations or any other applicable federal Medicaid
laws.
(d) Moneys in the fund shall be used as the source for the
nonfederal share of investment, improvement, and incentive payments
as authorized under a federal waiver or demonstration project to
participating designated public hospitals and, to the extent federal
approval is obtained pursuant to subdivision (c) of Section
14166.155, to nondesignated public hospitals, defined in subdivisions
(d) and (f) of Section 14166.1 respectively, and the governmental
entities with which they are affiliated, that provide the
intergovernmental transfers for deposit into the fund.
(e) The department shall obtain federal financial participation
for moneys in the fund to the full extent permitted by law. Moneys
shall be allocated from the fund by the department and used as the
nonfederal share for claiming federal funds in accordance with the
Special Terms and Conditions of the waiver or demonstration project
and Sections 14166.77 and 14166.155, to the extent federal approval
is obtained pursuant to subdivision (c) of Section 14166.151, as
applicable. The moneys disbursed from the fund, and all associated
federal financial participation, shall be distributed only to the
designated public hospitals and the governmental entities with which
they are affiliated, and to the extent federal approval is obtained
pursuant to subdivision (c) of Section 14166.155, to nondesignated
public hospitals as described in subdivision (a) and the governmental
entities with which they are affiliated.
(f) Participation under this section is voluntary on the part of
the county or other political subdivision for purposes of all
applicable federal laws. As part of its voluntary participation in
the nonfederal share of payments under this section, the county or
other political subdivision agrees to reimburse the state for the
nonfederal share of state staffing or administrative costs directly
attributable to implementation of this section. This section shall be
implemented only to the extent federal financial participation is
not jeopardized.
(g) 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, the department may clarify, interpret, or implement the
provisions of this section by means of provider bulletins or similar
instructions. The department shall notify the fiscal and appropriate
policy committees of the Legislature of its intent to issue
instructions under this section at least five days in advance of the
issuance.
SEC. 110. Section 14182.45 of the Welfare and Institutions Code is
amended to read:
14182.45. (a) In consultation with the designated public
hospitals, as defined in subdivision (d) of Section 14166.1, and to
the extent it does not impede the ability of the designated public
hospitals to meet the requirements and conditions for delivery system
reform incentive payments authorized under Sections 14166.77 and
14182.4, the state may provide for milestone incentive payments to
private disproportionate share hospitals and nondesignated public
disproportionate share hospitals to create incentives for improvement
activities towards, and achievement of, delivery system
transformation. The milestone incentive payments to private
disproportionate share hospitals and nondesignated public
disproportionate share hospitals shall be structured in accordance
with the requirements and conditions for delivery system reform
incentive payments set forth in the Special Terms and Conditions and
as approved by the federal Centers for Medicare and Medicaid
Services. Incentive payments may be funded by voluntary
intergovernmental transfers made by the designated public hospitals
and nondesignated public hospitals. All incentive pool funding,
including any potential private and nondesignated public hospital
subpools, shall be limited to the total amount of incentive pool
funding allowed for delivery system reform incentive payments as set
forth in the Special Terms and Conditions.
(b) Upon federal approval of the reimbursement methodology in
subdivision (b) of Section 14166.151, this section shall become
inoperative.
SEC. 111. Section 14183.6 of the Welfare and Institutions Code is
amended to read:
14183.6. The department shall enter into an interagency agreement
with the Department of Managed Health Care to have the Department of
Managed Health Care, on behalf of the department, conduct financial
audits, medical surveys, and a review of the provider networks of the
managed care health plans participating in the demonstration project
and the Medi-Cal managed care expansion into rural counties, and to
provide consumer assistance to beneficiaries affected by Sections
14182.16 and 14182.17. The interagency agreement shall be updated, as
necessary, on an annual basis in order to maintain functional
clarity regarding the roles and responsibilities of these core
activities. The department shall not delegate its authority under
this division to the Department of Managed Health Care.
SEC. 112. Section 14204 of the Welfare and Institutions Code is
amended to read:
14204. (a) Pursuant to the provisions of this chapter, the
department may contract with one or more prepaid health plans in
order to provide the benefits authorized under this chapter and
Chapter 7 (commencing with Section 14000) of this part. The
department may contract with one or more children's hospitals on an
exclusive basis for a specified population in a specified geographic
area. Contracts entered into pursuant to this chapter may be awarded
on a bid or nonbid basis.
(b) In order to achieve maximum cost savings the Legislature
hereby determines that expedited contract process for contracts under
this chapter is necessary. Therefore, contracts under this chapter
shall be exempt from Chapter 2 (commencing with Section 10290) of
Part 2 of Division 2 of the Public Contract Code.
(c) The department shall amend contracts with dental health plans
in effect on the date the act that added this subdivision and Section
14459.6 become effective to provide Medi-Cal dental services
authorized under this chapter and Chapter 7 (commencing with Section
14000) to Medi-Cal beneficiaries who reside in a specified geographic
area to meet the requirements of Sections 14089.09 and 14459.6.
SEC. 113. Section 14301.1 of the Welfare and Institutions Code is
amended to read:
14301.1. (a) For rates established on or after August 1, 2007,
the department shall pay capitation rates to health plans
participating in the Medi-Cal managed care program using actuarial
methods and may establish health-plan- and county-specific rates. The
department shall utilize a county- and model-specific rate
methodology to develop Medi-Cal managed care capitation rates for
contracts entered into between the department and any entity pursuant
to Article 2.7 (commencing with Section 14087.3), Article 2.8
(commencing with Section 14087.5), and Article 2.91 (commencing with
Section 14089) of Chapter 7 that includes, but is not limited to, all
of the following:
(1) Health-plan-specific encounter and claims data.
(2) Supplemental utilization and cost data submitted by the health
plans.
(3) Fee-for-service data for the underlying county of operation or
other appropriate counties as deemed necessary by the department.
(4) Department of Managed Health Care financial statement data
specific to Medi-Cal operations.
(5) Other demographic factors, such as age, gender, or
diagnostic-based risk adjustments, as the department deems
appropriate.
(b) To the extent that the department is unable to obtain
sufficient actual plan data, it may substitute plan model, similar
plan, or county-specific fee-for-service data.
(c) The department shall develop rates that include administrative
costs, and may apply different administrative costs with respect to
separate aid code groups.
(d) The department shall develop rates that shall include, but are
not limited to, assumptions for underwriting, return on investment,
risk, contingencies, changes in policy, and a detailed review of
health plan financial statements to validate and reconcile costs for
use in developing rates.
(e) The department may develop rates that pay plans based on
performance incentives, including quality indicators, access to care,
and data submission.
(f) The department may develop and adopt condition-specific
payment rates for health conditions, including, but not limited to,
childbirth delivery.
(g) (1) Prior to finalizing Medi-Cal managed care capitation
rates, the department shall provide health plans with information on
how the rates were developed, including rate sheets for that specific
health plan, and provide the plans with the opportunity to provide
additional supplemental information.
(2) For contracts entered into between the department and any
entity pursuant to Article 2.8 (commencing with Section 14087.5) of
Chapter 7, the department, by June 30 of each year, or, if the budget
has not passed by that date, no later than five working days after
the budget is signed, shall provide preliminary rates for the
upcoming fiscal year.
(h) For the purposes of developing capitation rates through
implementation of this ratesetting methodology, Medi-Cal managed care
health plans shall provide the department with financial and
utilization data in a form and substance as deemed necessary by the
department to establish rates. This data shall be considered
proprietary and shall be exempt from disclosure as official
information pursuant to subdivision (k) of Section 6254 of the
Government Code as contained in the California Public Records Act
(Division 7 (commencing with Section 6250) of Title 1 of the
Government Code).
(i) The department shall report, upon request, to the fiscal and
policy committees of the respective houses of the Legislature
regarding implementation of this section.
(j) Prior to October 1, 2011, the risk-adjusted countywide
capitation rate shall comprise no more than 20 percent of the total
capitation rate paid to each Medi-Cal managed care plan.
(k) (1) It is the intent of the Legislature to preserve the policy
goal to support and strengthen traditional safety net providers who
treat high volumes of uninsured and Medi-Cal patients when Medi-Cal
enrollees are defaulted into Medi-Cal managed care plans.
(2) As the department adds additional factors, such as managed
care plan costs, to the Medi-Cal managed care plan default assignment
algorithm, it shall consult with the Auto Assignment Performance
Incentive Program stakeholder workgroup to develop cost factor
disregards related to intergovernmental transfers and required
wraparound payments that support safety net providers.
SEC. 114. Section 14459.6 is added to the Welfare and Institutions
Code, to read:
14459.6. (a) The department shall establish a list of performance
measures to ensure dental health plans meet quality criteria
required by the department. The list shall specify the benchmarks
used by the department to determine whether and the extent to which a
dental health plan meets each performance measure. Commencing
January 1, 2013, and quarterly thereafter, the list of performance
measures established by the department along with each plan's
performance shall be posted on the department's Internet Web site.
The Department of Managed Health Care and the advisory committee
established pursuant to Section 14089.08 shall have access to all
performance measures and benchmarks used by the department as
described in this section.
(1) The performance measures established by the department shall
include, but not be limited to, all of the following: provider
network adequacy, overall utilization of dental services, annual
dental visits, use of preventive dental services, use of dental
treatment services, use of examinations and oral health evaluations,
sealant to restoration ratio, filling to preventive services ratio,
treatment to caries prevention ratio, use of dental sealants, use of
diagnostic services, and survey of member satisfaction with plans and
providers.
(2) The survey of member satisfaction with plans and providers
shall be the same dental version of the Consumer Assessment of
Healthcare Providers and Systems (CAHPS) survey as used by the
Healthy Families Program.
(3) The department shall notify dental health plans at least 30
days prior to the implementation date of these performance measures.
(4) The department shall include the initial list of performance
measures and benchmarks in any dental health contracts entered into
between the department and a dental health plan pursuant to Section
14204.
(5) The department shall update performance measures and
benchmarks and establish additional performance measures and
benchmarks in accordance with all of the following:
(A) The department shall consider performance measures and
benchmarks established by other states, the federal government, and
national organizations developing dental program performance and
quality measures.
(B) The department shall notify dental health plans at least 30
days prior to the implementation date of updates or changes to
performance measures and benchmarks. The department shall also post
these updates or changes on its Internet Web site at least 30 days
prior to implementation in order to provide transparency to the
public.
(C) To ensure that the dental health needs of Medi-Cal
beneficiaries are met, the department shall, when evaluating
performance measures and benchmarks for retention on, addition to, or
deletion from the list, consider all of the following criteria:
(i) Monthly, quarterly, annual, and multiyear Medi-Cal dental
managed care trended data.
(ii) County and statewide Medi-Cal dental fee-for-service
performance and quality ratings.
(iii) Other state and national dental program performance and
quality measures.
(iv) Other state and national performance ratings.
(b) In establishing and updating the performance measures and
benchmarks, the department shall consult the advisory committee
established pursuant to Section 14089.08, as well as dental health
plan representatives and other stakeholders, including
representatives from counties, local dental societies, nonprofit
entities, legal aid entities, and other interested parties.
(c) In evaluating a dental health plan's ability to meet the
criteria established through the performance measures and benchmarks,
the department shall select specific performance measures from those
established by the department in subdivision (a) as the basis for
establishing financial or other incentives or disincentives,
including, but not limited to, bonuses, payment withholds, and
adjustments to beneficiary assignment to plan algorithms. These
incentives and disincentives shall be included in the dental health
plan contracts.
(d) (1) The department shall designate an external quality review
organization (EQRO) that shall conduct external quality reviews for
any dental health plan contracting with the department pursuant to
Section 14204.
(2) As determined by the department, but at least annually, dental
health plans shall arrange for an external quality of care review
with the EQRO designated by the department that evaluates the dental
health plan's performance in meeting the performance measures
established in this section. Dental health plans shall cooperate with
and assist the EQRO in this review. The Department of Managed Health
Care shall have direct access to all external quality of care review
information upon request to the department.
(3) An external quality of care review shall include, but not be
limited to, all of the following: performance on the selected
performance measures and benchmarks established and updated by the
department, the CAHPS member or consumer satisfaction survey
referenced in paragraph (2) of subdivision (a), reporting systems,
and methodologies for calculating performance measures. An external
quality of care review that includes all of the above components
shall be paid for by the dental health plan and posted online
annually, or at any other frequency specified by the department, on
the department's Internet Web site.
(e) All marketing methods and activities to be used by dental
plans shall comply with subdivision (b) of Section 10850, Sections
14407.1, 14408, 14409, 14410, and 14411, and Title 22 of the
California Code of Regulations, including Sections 53880 and 53881.
Each dental plan shall submit its marketing plan to the department
for review and approval.
(f) Each dental plan shall submit its member services procedures,
beneficiary informational materials, and any updates to those
procedures or materials to the department for review and approval.
The department shall ensure that member services procedures and
beneficiary informational materials are clear and provide timely and
fair processes for accepting and acting upon complaints, grievances,
and disenrollment requests, including procedures for appealing
decisions regarding coverage or benefits.
(g) Each dental plan shall submit its provider compensation
agreements to the department for review and approval.
(h) The department shall post to its Internet Web site a copy of
all final reports completed by the Department of Managed Health Care
regarding dental managed care plans.
SEC. 115. Section 14459.8 is added to the Welfare and Institutions
Code, to read:
14459.8. (a) By no later than March 15, 2013, with annual updates
thereafter, the department shall provide the fiscal and appropriate
policy committees of the Legislature with either a comprehensive
report or separate reports on dental managed care in the Counties of
Sacramento and Los Angeles. This report shall articulate specific
changes and improvements implemented to increase Medi-Cal beneficiary
access to preventive services and dental treatment, the utilization
of services, and beneficiary satisfaction. Key measures, outcomes,
and department findings pertaining to participating dental managed
care plans and provider networks shall also be included.
(b) Any report provided pursuant to subdivision (a) on the County
of Sacramento shall also provide data regarding the outcomes and
findings from the beneficiary dental exception (BDE) process
implemented by the department pursuant to Section 14089.09, including
the consideration of voluntary enrollment in the County of
Sacramento as compared to the existing mandatory enrollment.
(c) The department may seek foundation funding or federal grant
funding to facilitate data analysis and reporting as applicable for
this purpose.
SEC. 116. Section 14500.5 of the Welfare and Institutions Code is
amended to read:
14500.5. (a) It is the intent of the Legislature that family
planning includes, but is not limited to, an effective means to
improve reproductive health by disease prevention and treatment, to
reduce the incidence of unintended pregnancies, and to reduce the
demand for abortions. It is the intent of the Legislature that no
family planning shall be expended other than for the services
enumerated in this chapter. It is also the intent of the Legislature
that no funds received pursuant to this chapter be used for abortions
or services ancillary to abortions.
(b) For purposes of this chapter, the following definitions shall
apply:
(1) "Family planning" means the process of establishing objectives
for the number and spacing of children, and selecting the means by
which those objectives may be achieved. These means include a broad
range of acceptable and effective methods and services to limit or
enhance fertility, including contraceptive methods, natural family
planning, abstinence methods, and the management of infertility.
Family planning services include preconceptional counseling, maternal
and fetal health counseling, and general reproductive health care,
including diagnosis and treatment of infections and conditions,
including cancer, that threaten reproductive capability, and other
services as described in Section 14503, except for abortions and
services ancillary to abortions as prohibited in Section 14509.
Family planning does not include abortion, pregnancy testing solely
for the purposes of referral for abortion or services ancillary to
abortions, or pregnancy care which is not incident to the diagnosis
of a pregnancy, except as otherwise provided for in this chapter.
(2) "Abortion as a method of family planning" means the deliberate
choice of abortion over other methods to limit the number, gender,
and spacing of children, including, but not limited to,
contraception, abstinence, and natural family planning methods.
(3) "Department" means the State Department of Health Care
Services.
(4) "Director" means the Director of Health Care Services.
(5) "Grantee" means an agency, institution, or organization
approved by the department to provide family planning services
pursuant to this chapter.
SEC. 117. Section 15911 of the Welfare and Institutions Code is
amended to read:
15911. (a) Funding for each LIHP shall be based on all of the
following:
(1) The amount of funding that the participating entity
voluntarily provides for the nonfederal share of LIHP expenditures.
(2) For a LIHP that had in operation a Health Care Coverage
Initiative program under Part 3.5 (commencing with Section 15900) as
of November 1, 2010, and elects to continue funding the program, the
amount of funds requested to ensure that eligible enrollees continue
to receive health care services for persons enrolled in the Health
Care Coverage Initiative program as of November 1, 2010.
(3) Any limitations imposed by the Special Terms and Conditions of
the demonstration project.
(4) The total allocations requested by participating entities for
Health Care Coverage Initiative eligible individuals.
(5) Whether funding under this part would result in the reduction
of other payments under the demonstration project.
(b) Nothing in this part shall be construed to require a political
subdivision of the state to participate in a LIHP as set forth in
this part, and those local funds expended or transferred for the
nonfederal share of LIHP expenditures under this part shall be
considered voluntary contributions for purposes of the federal
Patient Protection and Affordable Care Act (Public Law 111-148), as
amended by the federal Health Care and Education Reconciliation Act
of 2010 (Public Law 111-152), and the federal American Recovery and
Reinvestment Act of 2009 (Public Law 111-5), as amended by the
federal Patient Protection and Affordable Care Act.
(c) No state General Fund moneys shall be used to fund LIHP
services, nor to fund any related administrative costs incurred by
counties or any other political subdivision of the state.
(d) Subject to the Special Terms and Conditions of the
demonstration project, if a participating entity elects to fund the
nonfederal share of a LIHP, the nonfederal funding and payments to
the LIHP shall be provided through one of the following mechanisms,
at the options of the participating entity:
(1) On a quarterly basis, the participating entity shall transfer
to the department for deposit in the LIHP Fund established for the
participating counties and pursuant to subparagraph (A), the amount
necessary to meet the nonfederal share of estimated payments to the
LIHP for the next quarter under subdivision (g) Section 15910.3.
(A) The LIHP Fund is hereby created in the State Treasury.
Notwithstanding Section 13340 of the Government Code, all moneys in
the fund shall be continuously appropriated to the department for the
purposes specified in this part. The fund shall contain all moneys
deposited into the fund in accordance with this paragraph.
(B) The department shall obtain the related federal financial
participation and pay the rates established under Section 15910.3,
provided that the intergovernmental transfer is transferred in
accordance with the deadlines imposed under the Medi-Cal Checkwrite
Schedule, no later than the next available warrant release date. This
payment shall be a nondiscretionary obligation of the department,
enforceable under a writ of mandate pursuant to Section 1085 of the
Code of Civil Procedure. Participating entities may request expedited
processing within seven business days of the transfer as made
available by the Controller's office, provided that the participating
entity prepay the department for the additional administrative costs
associated with the expedited processing.
(C) Total quarterly payment amounts shall be determined in
accordance with estimates of the number of enrollees in each rate
category, subject to annual reconciliation to final enrollment data.
(2) If a participating entity operates its LIHP through a contract
with another entity, the participating entity may pay the operating
entity based on the per enrollee rates established under Section
15910.3 on a quarterly basis in accordance with estimates of the
number of enrollees in each rate category, subject to annual
reconciliation to final enrollment data.
(A) (i) On a quarterly basis, the participating entity shall
certify the expenditures made under this paragraph and submit the
report of certified public expenditures to the department.
(ii) The department shall report the certified public expenditures
of a participating entity under this paragraph on the next available
quarterly report as necessary to obtain federal financial
participation for the expenditures. The total amount of federal
financial participation associated with the participating entity's
expenditures under this paragraph shall be reimbursed to the
participating entity.
(B) At the option of the participating entity, the LIHP may be
reimbursed on a cost basis in accordance with the methodology applied
to Health Care Coverage Initiative programs established under Part
3.5 (commencing with Section 15900) including interim quarterly
payments.
(e) (1) Notwithstanding Section 15910.3 and subdivision (d) of
this section, if the participating entity cannot reach an agreement
with the department as to the appropriate rate to be paid under
Section 15910.3, at the option of the participating entity, the LIHP
shall be reimbursed on a cost basis in accordance with the
methodology applied to Health Care Coverage Initiative programs
established under Part 3.5 (commencing with Section 15900), including
interim quarterly payments. If the participating entity and the
department reach an agreement as to the appropriate rate, the rate
shall be applied no earlier than the first day of the LIHP year in
which the parties agree to the rate, except that for the LIHP year
ending June 30, 2012, the rate may apply as early as July 1, 2011,
without regard to the date of the agreement between the participating
entity and the department.
(2) (A) The department finds and declares all of the following:
(i) The department, in consultation with a number of the LIHPs,
has proposed LIHP capitation rates for federal approval.
(ii) There is some concern that federal approval of the proposed
rates will not be received, and implementing contracts may not be
signed, before June 30, 2012.
(iii) The amendments made to this subdivision by the act that
added this clause would allow the federally approved capitation rates
to apply to the LIHP year, which is July 1, 2011, to June 30, 2012,
inclusive, even if federal approval and the necessary contract
amendments are not finalized until after June 30, 2012.
(B) Therefore, it is the intent of the Legislature in amending
this subdivision to allow the LIHP capitation rates to apply for the
2011-12 fiscal year even if final agreements on the capitation rates
are delayed while awaiting federal approval and are not finalized
until after June 30, 2012.
(f) If authorized under the Special Terms and Conditions of the
demonstration project, pending the department's development of rates
in accordance with Section 15910.3, the department shall make interim
quarterly payments to approved LIHPs for expenditures based on
estimated costs submitted for rate setting.
(g) Participating entities that operate a LIHP directly or through
contract with another entity shall be entitled to any federal
financial participation available for administrative expenditures
incurred in the operation of the Medi-Cal program or the
demonstration project, including, but not limited to, outreach,
screening and enrollment, program development, data collection,
reporting and quality monitoring, and contract administration, but
only to the extent that the expenditures are allowable under federal
law and only to the extent the expenditures are not taken into
account in the determination of the per enrollee rates under Section
15910.3.
(h) On and after January 1, 2014, the state shall
implement comprehensive health care reform for the populations
targeted by the LIHP in compliance with federal health care reform
law, regulation, and policy, including the federal Patient Protection
and Affordable Care Act (Public Law 111-148), as amended by the
federal Health Care and Education Reconciliation Act of 2010 (Public
Law 111-152), and subsequent amendments.
(i) Subject to the Special Terms and Conditions of the
demonstration project, a participating entity may elect to include,
in collaboration with the department, as the nonfederal share of LIHP
expenditures, voluntary intergovernmental transfers or certified
public expenditures of another governmental entity, as long as the
intergovernmental transfer or certified public expenditure is
consistent with federal law.
(j) Participation in the LIHP under this part is voluntary on the
part of the eligible entity for purposes of all applicable federal
laws. As part of its voluntary participation under this article, the
participating entity shall agree to reimburse the state for the
nonfederal share of state staffing and administrative costs directly
attributable to the cost of administering that LIHP, including, but
not limited to, the state administrative costs related to certified
public expenditures and intergovernmental transfers. This section
shall be implemented only to the extent federal financial
participation is not jeopardized.
SEC. 118. Section 15911.1 is added to the Welfare and Institutions
Code, to read:
15911.1. Upon the order of the Director of Finance, the
Controller shall draw warrants against General Fund cash to provide
cashflow loans as follows:
(a) The Director of Finance may approve cashflow loans of no more
than a total of one hundred million dollars ($100,000,000) in the
2012-13 and 2013-14 fiscal years for County Medical Services Program
governing board expenses that are associated with a Low Income Health
Program operated by the governing board pursuant to this part.
(b) The terms and conditions of any cashflow loan provided
pursuant to this section shall be subject to approval by the Director
of Finance. Interest shall be charged at the rate earned by moneys
in the Pooled Money Investment Account.
(c) The Department of Finance shall notify the Legislature within
15 days of authorizing a cashflow loan pursuant to this section,
unless prior notification of the cashflow loan was included when the
Medi-Cal estimates were submitted pursuant to Section 14100.5.
(d) Any cashflow loans made pursuant to this section shall be
short term and shall not constitute General Fund expenditures. These
loans and the repayment of these loans shall not affect the General
Fund reserve.
SEC. 119. Section 15912.1 is added to the Welfare and Institutions
Code, to read:
15912.1. (a) The department, in collaboration with the State
Department of Public Health, shall develop policies and guidance on
the transition of persons diagnosed with HIV/AIDS from federal Ryan
White HIV/AIDS Treatment Extension Act of 2009 (Ryan White Act)
funded programs, pursuant to Section 131019 of the Health and Safety
Code, to the Low Income Health Program (LIHP) pursuant to Part 3.6
(commencing with Section 15909). These policies and guidance shall be
provided to local LIHPs, federal Ryan White Act providers, and to
persons receiving services pursuant to the federal Ryan White Act, as
applicable. Guidance shall include, but not be limited to,
operational processes and procedures supporting the transition of
persons receiving services pursuant to the federal Ryan White Act in
order to minimize disruption of access to and availability of care
and services.
(b) The department, in collaboration with the State Department of
Public Health, shall consult with stakeholders, including
administrators, advocates, providers, and persons receiving services
pursuant to the federal Ryan White Act, to obtain advice in forming
the policy decisions regarding the transition of persons receiving
services pursuant to the federal Ryan White Act to the local LIHPs.
SEC. 120. Section 15916 of the Welfare and Institutions Code is
amended 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. "Demonstration year" may be
denominated in yearly increments, which correspond with the yearly
increments 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 for use in any 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, up to the amount of redirected SNCP funds
available, 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.
(3) As a condition of receiving any of the funding in paragraph
(2), 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 will be used 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).
(e) 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.
(f) The department shall consult with DPH representatives
regarding the availability of excess certified public expenditures,
how to optimize the level of claimable federal Medicaid funding, and
the appropriate allocation of SNCP funds under paragraphs (2) and (3)
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.
(g) 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) 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.
(2) If there are additional disallowances or deferrals beyond
those described in paragraph (1), the department shall be solely
responsible for 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 (3) of
subdivision (d) for that particular year.
(3) 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.
(h) The department shall obtain federal approvals or waivers as
necessary to implement this section and to obtain federal financial
participation to the maximum extent permitted by federal law. This
section shall be implemented only to the extent other federal
financial participation is not jeopardized.
SEC. 121. Section 24000 of the Welfare and Institutions Code is
amended to read:
24000. There is established in the State Department of Health
Care Services the State-Only Family Planning Program to provide
comprehensive clinical family planning services to low-income men and
women. This division shall be known and may be cited as the
State-Only Family Planning Program.
SEC. 122. Section 24001 of the Welfare and Institutions Code is
amended to read:
24001. (a) (1) For purposes of this division, "family planning"
means the process of establishing objectives for the number and
spacing of children, and selecting the means by which those
objectives may be achieved. These means include a broad range of
acceptable and effective methods and services to limit or enhance
fertility, including contraceptive methods, natural family planning,
abstinence methods and basic, limited fertility management. Family
planning services include, but are not limited to, preconception
counseling, maternal and fetal health counseling, general
reproductive health care, including diagnosis and treatment of
infections and conditions, including cancer, that threaten
reproductive capability, medical family planning treatment and
procedures, including supplies and followup, and informational,
counseling, and educational services. Family planning shall not
include abortion, pregnancy testing solely for the purposes of
referral for abortion or services ancillary to abortions, not
including contraceptives, or pregnancy care that is not incident to
the diagnosis of pregnancy.
(2) Family planning services for males shall be expanded to
include laboratory tests for sexually transmitted infections and
comprehensive physical examinations. Within 60 days of approval of
the Family Planning, Access, Care, and Treatment (Family PACT) Waiver
Program, provided for pursuant to subdivision (aa) of Section 14132,
the department shall seek to amend the waiver to add this expansion.
The implementation of this paragraph shall be dependent upon federal
approval and receipt of federal financial participation.
(b) For purposes of this division, "department" means the State
Department of Health Care Services.
SEC. 123. (a) It is the intent of the Legislature that the State
Department of Education and the State Department of Health Care
Services modify or repeal regulations that are no longer supported by
statute due to the amendments in Sections 1, 2, 32, 33, 33.5, and 34
of this act.
(b) The State Department of Education shall review regulations to
ensure the appropriate implementation of educationally necessary
occupational and physical therapy services required by the federal
Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400 et
seq.) and Sections 1, 2, 32, 33, 33.5, and 34 of this act.
(c) The State Department of Education may adopt regulations to
implement Sections 1, 2, 32, 33, 33.5, and 34 of this act. The
adoption, amendment, repeal, or readoption of a regulation authorized
by this section is deemed to address an emergency, for purposes of
Sections 11346.1 and 11349.6 of the Government Code, and the State
Department of Education is hereby exempted, for this purpose, from
the requirements of subdivision (a) of Section 11346.1 of the
Government Code. For purposes of subdivision (e) of Section 11346.1
of the Government Code, the 180-day period, as applicable to the
effective period of an emergency regulatory action and submission of
specified materials to the Office of Administrative Law, is hereby
extended to one year.
(d) Implementation of Sections 1, 2, 32, 33, 33.5, and 34 of this
act shall occur no later than October 1, 2012.
(e) The State Department of Health Care Services shall report in
the November 2012 and May 2013 Family Health Estimate on the status
of the implementation of the provisions of Sections 1, 2, 32, 33,
33.5, and 34 of this act. The report shall include, but not be
limited to, the following:
(1) The number of children enrolled in the California Children's
Services by county known to the county California Children's Services
Programs to be receiving physical and occupational therapy services
from the California Children's Services Medical Therapy Program
assessed and determined to be educationally necessary by the
individualized education program team and included in a child's
individualized education program.
(2) The estimated California Children's Services Program savings
from implementation of Sections 1, 2, 32, 33, 33.5, and 34 of this
act.
(3) An update on the implementation of Sections 1, 2, 32, 33,
33.5, and 34 of this act, including a description of implementation
successes and challenges.
(f) The State Department of Education and the State Department of
Health Care Services shall work together to collect the relevant data
necessary for the report described in subdivision (e).
SEC. 124. By no later than January 1, 2013, the Department of
Managed Health Care shall provide the fiscal and appropriate policy
committees of the Legislature with its final report on surveys
conducted under the requirements of the Knox-Keene Health Care
Service Plan Act of 1975 (Chapter 2.2 (commencing with Section 1340)
of Division 2 of the Health and Safety Code) and the department's
contractual requirements, for the dental plans participating in the
Sacramento Geographic Managed Care Program.
SEC. 125. Given the uncertainty within which persons diagnosed
with HIV/AIDS from federal Ryan White HIV/AIDS Treatment Extension
Act of 2009 funded programs may transition to the Low Income Health
Program pursuant to Part 3.6 (commencing with Section 15909) of the
Welfare and Institutions Code, the State Department of Public Health
shall report to the Joint Legislative Budget Committee by October 1,
2012, on whether any of the projections or assumptions used to
develop the AIDS Drug Assistance Program (ADAP) estimated budget for
the Budget Act of 2012 may result in an inability of ADAP to provide
services to eligible ADAP clients. If this occurs before October 1,
2012, and ADAP is unable to provide services to eligible ADAP
clients, the State Department of Public Health shall provide
notification to the Joint Legislative Budget Committee within 15
calendar days of this determination.
SEC. 126. Notwithstanding the amendments made in Sections 18 to
25, inclusive, and Sections 35, 116, 121, and 122 of this act, if
this act becomes effective before July 1, 2012, it is the intent of
the Legislature that the transfer of duties, powers, functions,
responsibilities, and jurisdiction described in those sections from
the State Department of Public Health to the State Department of
Health Care Services shall occur in accordance with Sections 131051,
131052, and 131055.1 of the Health and Safety Code, as amended or
added by this act.
SEC. 127. The Legislature finds and declares that Sections 55 to
63, inclusive, 66 to 68, inclusive, and 70 and 71 of this act clarify
procedures and terms of the Mental Health Services Act within the
meaning of Section 18 of the Mental Health Services Act.
SEC. 128. The Legislature finds and declares that, for the
purposes of Sections 78 and 111 of this act, a special law is
necessary and that a general law cannot be made applicable within the
meaning of Section 16 of Article IV of the California Constitution
because the counties listed in subdivision (a) of Section 14087.98 of
the Welfare and Institutions Code, as added by this act, are
Medi-Cal fee-for-service counties and this act would provide
expansion of Medi-Cal managed care to these counties.
SEC. 129. The Legislature finds and declares that, for the
purposes of Sections 79, 80, 112, 114, 115, and 124 of this act, a
special law is necessary and that a general law cannot be made
applicable within the meaning of Section 16 of Article IV of the
California Constitution because the Counties of Los Angeles and
Sacramento are the only counties that have Medi-Cal dental managed
care arrangements and the County of Sacramento is the only county
with mandatory dental managed care enrollment.
SEC. 130. Section 33.5 of this bill incorporates amendments to
Section 123870 of the Health and Safety Code proposed by this bill
and Assembly Bill 1494 and Senate Bill 1034. It shall only become
operative if (1) either Assembly Bill 1494 or Senate Bill 1034 and
this bill are enacted and become effective on or before January 1,
2013, (2) each bill amends Section 123870 of the Health and Safety
Code, and (3) this bill is enacted after either Assembly Bill 1494 or
Senate Bill 1034, in which case Section 33 of this bill shall not
become operative.
SEC. 131. 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.