BILL NUMBER: SB 485	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 14, 2011
	AMENDED IN SENATE  MARCH 24, 2011

INTRODUCED BY   Senator Hernandez

                        FEBRUARY 17, 2011

   An act to add Section 14134.7 to the Welfare and Institutions
Code, relating to  Medi-Cal   health facilities
 .



	LEGISLATIVE COUNSEL'S DIGEST


   SB 485, as amended, Hernandez.  Medi-Cal.  
Health facilities: emergency units. 
   Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services and
under which qualified low-income persons receive health care
services.  Existing law provides for the licensure of health
facilities, including general acute care hospitals. 
   This bill would require the department to establish a pilot
program to facilitate collaboration between  a federally
qualified health clinic   an available and accessible
provider of nonemergency medical care  and a general acute care
hospital to provide a Medi-Cal beneficiary  or patient who lacks
health insurance  with an alternative to the use of the
emergency unit of a general acute care hospital for care and services
if the Medi-Cal beneficiary  or patient  , after a medical
screening, is determined by a physician and surgeon  or other
health care provider, as specified,  to not have an emergency
medical condition and the Medi-Cal beneficiary  or patient 
is provided the specified information, in writing, before 
nonemergency medical care is provided in   discharge
from  the emergency unit.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


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

  SECTION 1.  Section 14134.7 is added to the Welfare and
Institutions Code, to read:
   14134.7.  (a) The department shall establish a pilot program to
facilitate collaboration between  a federally qualified
health clinic   an available and accessible provider of
nonemergency medical care  and a general acute care hospital,
 as a benefit of the Medi-Cal program, to provide a Medi-Cal
beneficiary with an   within two geographic locations,
to provide a Medi-Cal beneficiary, a patient who lacks health
insurance, or   both, with an  alternative to the use
of the emergency unit of a general acute care hospital for care and
services if the Medi-Cal beneficiary  or patient who lacks health
insurance  , after a medical screening, is determined by a
physician and surgeon  or other health care provider who acts
within his or her scope of practice  to not have an emergency
medical condition and the Medi-Cal beneficiary  or patient who
lacks health insurance  is provided the following information,
in writing, before  nonemergency medical care is provided in
the emergency unit:   the patient is discharged from the
emergency unit: 
   (1) The name and address of an available and accessible provider
of nonemergency medical care  who does not charge a copay or
may charge a lower copay than the general acute care hospital.
  . 
   (2) A referral from the general acute care hospital if necessary
to coordinate the scheduling of treatment.
   (b) The department shall submit any necessary application to the
federal Centers for Medicare and Medicaid Services for a waiver to
implement the pilot project described in this section. The department
shall determine the form of waiver most appropriate to achieve the
purposes of this section. The waiver request shall be included in any
waiver application submitted within 12 months after the effective
date of this section, or shall be submitted as an independent
application within that time period. After federal approval is
secured, the department shall implement the waiver within 12 months
of the date of approval.
   (c) The department shall develop  a request for proposal
process for available and accessible providers of nonemergency
medical care and general acute care hospitals that want to
participate in the pilot project. The department also shall develop
 a timeline and process for monitoring and evaluating the pilot
project and provide this timeline and process to the appropriate
fiscal and policy committees of the Legislature.
   (d) For purposes of this section,  an   "an
 available and accessible provider of nonemergency medical
 care   care"  includes the office of a
physician and surgeon, health clinic, community health center, and
hospital outpatient department, provided that the provider of
nonemergency medical care is able to diagnose or treat
contemporaneously within the same amount of time that a physician
within the emergency unit of a general acute care hospital would have
taken to provide the same nonemergency services.