BILL NUMBER: SB 920 AMENDED
BILL TEXT
AMENDED IN SENATE JANUARY 4, 2012
INTRODUCED BY Senator Hernandez
FEBRUARY 18, 2011
An act to amend Section 3040 of the Business and
Professions Code, relating to optometry. An act to
amend Sections 14166.12, 14169.5, 14169.16, 14169.17, 14169.18,
14169.41, and 14169.42 of the Welfare and Institutions Code, relating
to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
SB 920, as amended, Hernandez. Optometry.
Medi-Cal: hospitals.
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. The Medi-Cal program is, in part, governed and funded by
federal Medicaid Program provisions.
Existing law establishes the continuously appropriated Private
Hospital Supplemental Fund, which consists of moneys from various
sources used to fund the nonfederal share of supplemental payments to
private hospitals. Existing law requires that the money annually
transferred to this fund from the General Fund be reduced by
specified amounts for the 2012-13 and 2013-14 fiscal years, and that
the reductions in supplemental payments to private hospitals that
result from the reductions in the amounts transferred from the
General Fund be allocated equally, as specified.
This bill would make a technical, nonsubstantive change to those
provisions.
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 requires that the moneys collected from the quality assurance fee
be deposited into the Hospital Quality Assurance Revenue Fund.
Existing law, subject to federal approval, requires that the moneys
in the fund be available, upon appropriation by the Legislature, only
for certain purposes, including, among other things, making
supplemental payments for certain services to private hospitals,
increased capitation payments to Medi-Cal managed care plans, and
increased payments to mental health plans. Existing law provides that
the provisions governing the various payments shall become
inoperative on September 1, 2013, if the department has not received
federal approval or a specified letter that indicates likely federal
approval on or before September 1, 2013. Existing law also provides
that the provisions governing the various payments shall remain in
effect only until July 1, 2014, the date of the last payment of
quality assurance fee payments, or the date of the last payment of
specified payments from the department, whichever is later.
This bill would instead provide that the provisions governing the
various payments shall become inoperative on December 1, 2013, if the
department has not received federal approval or the specified letter
indicating likely federal approval. This bill would extend the
operative date of the provisions governing the various payments to
January 1, 2015, and make related changes. This bill would make other
technical, nonsubstantive changes to these provisions.
Existing law, the Optometry Practice Act, provides for the
licensure and regulation of optometrists by the State Board of
Optometry. Existing law prohibits a person from engaging in the
practice of optometry, or taking other specified actions, without
obtaining a certificate of registration from the board, and provides
that the use of certain items is prima facie evidence of the practice
of optometry.
This bill would make nonsubstantive, technical changes to those
provisions.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. 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 Section 14085.6, 14085.7,
14085.8, or 14085.9.
(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 Section 14085.6, 14085.7, 14085.8, or
14085.9 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 Section 14085.6,
14085.7, 14085.8, or 14085.9 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, 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.
(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
Section 14085.7 and do not meet the criteria under Section 14085.6,
14085.8, or 14085.9, 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 Section 14085.6, 14085.7, 14085.8, or 14085.9
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 2012-12
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).
SEC. 2. Section 14169.5 of the Welfare
and Institutions Code is amended to read:
14169.5. (a) The department shall increase capitation payments to
Medi-Cal managed health care plans for each subject fiscal year as
set forth in this section.
(b) The increased capitation payments shall be made as part of the
monthly capitated payments made by the department to managed health
care plans.
(c) The aggregate amount of increased capitation payments to all
Medi-Cal managed health care plans for each subject fiscal year shall
be the maximum amount for which federal financial participation is
available on an aggregate statewide basis for the applicable subject
fiscal year as it may be adjusted pursuant to Section 14169.19.
(d) The department shall determine the amount of the increased
capitation payments for each managed health care plan. The department
shall consider the composition of Medi-Cal enrollees in the plan,
the anticipated utilization of hospital services by the plan's
Medi-Cal enrollees, and other factors that the department determines
are reasonable and appropriate to ensuring access to high-quality
hospital services by the plan's enrollees.
(e) The amount of increased capitation payments to each Medi-Cal
managed care health care plan shall not
exceed an amount that results in capitation payments that are
certified by the state's actuary as meeting federal requirements,
taking into account the requirement that all of the increased
capitation payments under this section shall be paid by the Medi-Cal
managed health care plans to hospitals for hospital services to
Medi-Cal enrollees of the plan.
(f) (1) The increased capitation payments to managed health care
plans under this section shall be made to support the availability of
hospital services and ensure access to hospital services for
Medi-Cal beneficiaries. The increased capitation payments to managed
health care plans shall commence no later than the later of December
31, 2011, or within 90 days of the date on which all necessary
federal approvals have been received, and shall include, but not be
limited to, the sum of the increased payments for all prior months
for which payments are due.
(2) (A) To secure the necessary funding for the payment or
payments made pursuant to paragraph (1), the department may
accumulate funds in the Hospital Quality Assurance Revenue Fund for
the purpose of funding managed health care capitation
payments under this article regardless of the date on which
capitation payments are scheduled to be paid in order to secure the
necessary total funding for managed health care payments
by December 31, 2013.
(B) To the extent feasible, the department shall accumulate funds
under subparagraph (A) by retaining 10 percent of the total necessary
funding from each of the 10 installments of the quality assurance
fee received from hospitals under Article 5.229 (commencing with
Section 14169.31), provided that the department may adjust the
applicable dates and amounts as necessary to accumulate sufficient
funding by December 31, 2013.
(g) Payments to managed health care plans that would be paid
consistent with actuarial certification and enrollment in the absence
of the payments made pursuant to this section, including, but not
limited to, payments described in Section 14182.15, shall not be
reduced as a consequence of payment under this section.
(h) (1) Each managed health care plan shall expend 100 percent of
any increased capitation payments it receives under this section on
hospital services.
(2) The department may issue change orders to amend contracts with
managed health care plans as needed to adjust monthly capitation
payments in order to implement this section.
(3) For entities contracting with the department pursuant to
Article 2.91 (commencing with Section 14089), any incremental
increase in capitation rates pursuant to this section shall not be
subject to negotiation and approval by the California Medical
Assistance Commission.
(i) (1) In the event federal financial participation is not
available for all of the increased capitation payments determined for
a month pursuant to this section for any reason, the increased
capitation payments mandated by this section for that month shall be
reduced proportionately to the amount for which federal financial
participation is available.
(2) The determination under this subdivision for any month in the
program period shall be made after accounting for all federal
financial participation necessary for full implementation of Section
14182.15 for that month.
(j) It is the intent of the Legislature that payments made
available to designated public hospitals under this section shall
replace, to the extent feasible, increased revenues that could be
available to the hospitals under Section 14168.7 in the absence of
this section and assuming other federal funds to the hospitals would
not be reduced as a result of the payments. If this intent cannot be
effectuated under this act, it is the intent of the Legislature to
enact subsequent legislation to accomplish this purpose through other
means.
(k) 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 this section by means of policy letters or
similar instructions, without taking further regulatory action.
SEC. 3. Section 14169.16 of the Welfare
and Institutions Code is amended to read:
14169.16. (a) This article shall remain
in effect only until July 1, 2014, the date the last payment
of quality assurance fee payments pursuant to Article 5.229
(commencing with Section 14169.31), or the date of the last payment
from the department pursuant to this article, whichever is later, and
as of that date is repealed, unless a later enacted statute, that is
enacted before January 1, 2015, deletes or extends that date.
operative only until the later of the following:
(1) January 1, 2015.
(2) The date of the last payment of the quality assurance fee
payments pursuant to Article 5.229 (commencing Section 14169.31).
(3) The date of the last payment from the department pursuant to
this article.
(b) If this article becomes inoperative under paragraph (1) of
subdivision (a), this article shall be repealed on January 1, 2015,
unless a later enacted statute enacted before that date, deletes or
extends that date.
(c) If this article becomes inoperative under paragraph (2) or (3)
of subdivision (a), this article shall be repealed on January 1 of
the year following the date this article becomes inoperative, unless
a later enacted statute enacted before that date, deletes or extends
that date.
SEC. 4. Section 14169.17 of the Welfare
and Institutions Code is amended to read:
14169.17. Notwithstanding any other provision of law, if federal
approval or a letter that indicates likely federal approval in
accordance with Section 14169.34 has not been received on or before
September December 1, 2013, then this
article shall become inoperative, and as of September
December 1, 2013, is repealed, unless a later
enacted statute, that is enacted before September
December 1, 2013, deletes or extends that date.
SEC. 5. Section 14169.18 of the Welfare
and Institutions Code is amended to read:
14169.18. (a) If the
director determines that this article has become inoperative pursuant
to Section 14169.13, 14169.16, 14169.17, or 14169.40, the
director shall execute a declaration stating that this determination
has been made and stating the basis for this determination
. The director shall retain the declaration and provide a copy,
within five working days of the execution of the declaration, to the
fiscal and appropriate policy committees of the
Legislature.
(b) In
Legislature. In addition to the requirements
specified in subdivision (a) , the director shall post the
declaration on the department's Internet Web site and the director
shall send the declaration to the Secretary of State, the Secretary
of the Senate, the Chief Clerk of the Assembly, and the Legislative
Counsel.
SEC. 6. Section 14169.41 of the Welfare
and Institutions Code is amended to read:
14169.41. (a) This article shall remain
in effect only until January 1, 2015, the date of the last
payment of quality assurance fee payments pursuant to this article,
or the date of the last payment from the department pursuant to
Article 5.228 (commencing with Section 14169.1), whichever is later,
and as of that date is repealed, unless a later enacted statute, that
is enacted before that date, deletes or extends that date.
operative only until the later of the following:
(1) January 1, 2015.
(2) The date of the last payment of the quality assurance fee
payments pursuant to this article.
(3) The date of the last payment from the department pursuant to
Article 5.228 (commencing with Section 14169.1).
(b) If this article becomes inoperative under paragraph (1) of
subdivision (a), this article shall be repealed on January 1, 2015,
unless a later enacted statute enacted before that date, deletes or
extends that date.
(c) If this article becomes inoperative under paragraph (2) or (3)
of subdivision (a), this article shall be repealed on January 1 of
the year following the date this article becomes inoperative, unless
a later enacted statute enacted before that date, deletes or extends
that date.
SEC. 7. Section 14169.42 of the Welfare
and Institutions Code is amended to read:
14169.42. (a) If the
director determines that this article has become inoperative pursuant
to Section 14169.37, 14169.38, or 14169.40,
or 14169.41, the director shall execute a declaration stating
that this determination has been made and stating the basis for
this determination . The director shall retain the declaration
and provide a copy, within five working days of the execution of the
declaration, to the fiscal and appropriate policy committees of the
Legislature.
(b) In
Legislature. In addition to the requirements
specified in subdivision (a) , the director shall post the
declaration on the department's Internet Web site and the director
shall send the declaration to the Secretary of State, the Secretary
of the Senate, the Chief Clerk of the Assembly, and the Legislative
Counsel.
SECTION 1. Section 3040 of the Business and
Professions Code is amended to read:
3040. (a) It is unlawful for a person to engage in the practice
of optometry or to display a sign or in any other way to advertise or
hold himself or herself out as an optometrist without having first
obtained a certificate of registration from the board under the
provisions of this chapter or under the provisions of any former act
relating to the practice of optometry. The practice of optometry
includes the performing or controlling of any acts set forth in
Section 3041.
(b) In any prosecution for a violation of subdivision (a), the use
of test cards, test lenses, or of trial frames is prima facie
evidence of the practice of optometry.