SB 804 Senate Bill - INTRODUCED

BILL NUMBER: SB 804	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Corbett

                        FEBRUARY 18, 2011

   An act to amend Section 14132.25 of the Welfare and Institutions
Code, relating to Medi-Cal, and declaring the urgency thereof, to
take effect immediately.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 804, as introduced, Corbett. Medi-Cal: subacute care program:
congregate living health facilities.
   Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which qualified low-income individuals receive health care services.
The Medi-Cal program is, in part, governed and funded by federal
Medicaid Program provisions. Existing law requires the department to
establish a subacute care program in health facilities in order to
more effectively use limited Medi-Cal dollars while ensuring needed
services for patients who meet subacute care criteria, as established
by the department. Existing law provides that, for the purposes of
this program, subacute care may be provided by any facility
designated by the Director of Health Care Services as meeting
subacute care criteria and that has an approved provider
participation agreement with the department.
   This bill would require the department to allow congregate living
health facilities, as defined, that solely provide pediatric subacute
care services and do not provide Medicare services to participate in
the subacute care program. This bill would provide that these type
of facilities shall not be required to be Medicare certified to
participate in the subacute care program. The bill would require the
department to seek all necessary federal approvals for the
implementation of these provisions.
   This bill would declare that it is to take effect immediately as
an urgency statute.
   Vote: 2/3. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


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

  SECTION 1.  The Legislature finds and declares all of the
following:
   (a) George Mark Children's House is the only comprehensive
pediatric palliative care organization in California licensed as a
congregate living health facility (CLHF). As allowed by its CLHF
license, George Mark Children's House provides a broad scope of
pediatric palliative care services to children enrolled in the
Medi-Cal program, including pediatric subacute care services. The
cost of its services is substantially less than the cost of providing
pediatric subacute care in a hospital setting.
   (b) Under federal law, pediatric patients are not Medicare
eligible and given that George Mark Children's House exclusively
serves pediatric patients, the facility does not serve Medicare
beneficiaries. Existing regulations of the State Department of Health
Care Services require a CLHF, in order to be reimbursed for
providing pediatric subacute services to Medi-Cal beneficiaries, to
be Medicare certified.
   (c) There is no mechanism under current law by which a CLHF can
become Medicare certified because Medicare does not currently
recognize the CLHF designation. Even so, the state allows CLHFs to
provide pediatric subacute care services within the scope of their
license with the state's full knowledge that these barriers to
Medi-Cal reimbursement exist.
   (d) Because palliative care services for children provided in a
CLHF setting are important to children, their families, and the
state, it is necessary to amend existing law to allow CLHFs that
exclusively serve a pediatric patient population to be reimbursed for
providing pediatric subacute care services to Medi-Cal beneficiaries
without requiring those CLHFs to be Medicare certified.
  SEC. 2.  Section 14132.25 of the Welfare and Institutions Code is
amended to read:
   14132.25.   (a)    On or before July 1, 1983,
the  State Department of Health Services  
department  shall establish a subacute care program in health
facilities in order to more effectively use the limited Medi-Cal
dollars available while, at the same time, ensuring needed services
for these patients. The subacute care program shall be available to
patients in facilities who meet subacute care criteria. Subacute care
may be provided by any facility designated by the director as
meeting the subacute care criteria  , and which 
 and that  has an approved provider participation agreement
with the  State Department of Health Services  
department  . 
   The State Department of Health Services 
    (b)     The department  shall develop
a rate of reimbursement for this subacute care program. Reimbursement
rates  will   shall  be determined in
accordance with methodology developed by the  State
Department of Health Services   department  ,
specified in regulation, and may include the following:
   (1)  All inclusive   All-inclusive  per
diem rates.
   (2) Individual  patient specific  
patient-specific  rates according to the needs of the individual
subacute care patient.
   (3) Other rates subject to negotiation with the health facility.
   However, reimbursement at subacute care rates shall only be
implemented  when   if  funds are available
for this purpose pursuant to the annual Budget Act. 
   The 
    (c)     The  department may negotiate
and execute an agreement with any health facility  which
  that  meets the standards for providing subacute
care. An agreement may be negotiated or established between the
health facility and the department for subacute care based on
individual patient assessment. The department shall establish level
of care criteria and appropriate utilization controls for patients
eligible for the subacute care program. 
   For 
    (d)     For  the purposes of this
section, subacute patient care shall be defined by the  state
 department based on the results of its study pursuant to
Chapter 1211 of the Statutes of 1980. 
   (e) (1) Notwithstanding any other provision of state law, and to
the extent permitted by federal law, the department shall allow
congregate living health facilities, as defined in subdivision (i) of
Section 1250 of the Health and Safety Code, that solely provide
pediatric subacute care services and do not provide Medicare services
to participate in the subacute care program. 
   (2) Congregate living health facilities described in paragraph (1)
shall not be required to be Medicare certified to participate in the
subacute care program.  
   (f) The department shall seek all necessary federal approvals for
the implementation of this section. 
  SEC. 3.  This act is an urgency statute necessary for the immediate
preservation of the public peace, health, or safety within the
meaning of Article IV of the Constitution and shall go into immediate
effect. The facts constituting the necessity are:
   In order to enable statutory changes to be made to the Medi-Cal
program at the earliest possible time, it is necessary that this act
take effect immediately.