Amended in Assembly April 19, 2013

California Legislature—2013–14 Regular Session

Assembly Bill No. 900

Introduced by Assembly Member Alejo

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(Coauthors: Assembly Members Ammiano, Chesbro, and Perea)

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February 22, 2013

An act to add Section 14105.194 to the Welfare and Institutions Code, relating to Medi-Cal, and declaring the urgency thereof, to take effect immediately.

LEGISLATIVE COUNSEL’S DIGEST

AB 900, as amended, Alejo. Medi-Cal: reimbursement: begin delete distinct part nursing facilities. end delete begin insert provider payments. end insert

begin delete Existing law provides for the Medi-Cal program, end delete begin insert The Medi-Cal Act establishes the Medi-Cal program, end insert 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, except as otherwise provided, Medi-Cal provider payments to be reduced by 1% or 5%, and provider payments for specified non-Medi-Cal programs to be reduced by 1%, for dates of service on and after March 1, 2009, and until June 1, 2011. Existing law requires, except as otherwise provided, Medi-Cal provider payments and payments for specified non-Medi-Cal programs to be reduced by 10% for dates of service on and after June 1, 2011.

This bill would instead require begin delete that end delete begin insert that, to the extent permitted by federal law, end insert this payment reduction not apply to skilled nursing facilities begin insert or subacute care units end insert that are a distinct part of a general acute care begin delete hospital end delete begin insert hospital, or to specified Medi-Cal provider payments for fee-for-service benefits, including payments to pharmacies, end insert for dates of service on or after June 1, 2011. begin insert The bill would also provide that this payment reduction shall not apply to managed health care plans for dates of service after the effective date of the bill. end insert

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:

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begin insert SECTION 1. end insert   

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begin insert Section 14105.194 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , to read: end insert

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begin insert 14105.194. end insert   

(a) Notwithstanding Section 14105.192, except as
otherwise provided in this section, payments for fee-for-service
benefits for dates of service on or after June 1, 2011, shall be
determined without application of the reductions in Section
14105.192.

(b) Notwithstanding Sections 14105.191 and 14105.192, except
as otherwise provided in this section, payments for the classes of
providers specified in subparagraphs (B) and (D) of paragraph
(2) and paragraph (3) of subdivision (b) of Section 14105.191 for
dates of service on or after June 1, 2011, shall be determined
without application of the reductions set forth in Sections
14105.191 and 14105.192.

(c) Notwithstanding subdivisions (a) and (b), for dates of service
prior to the effective date of the act adding this section, in no event
shall the payments exceed the reimbursement rate at which
payment has been made by the department prior to the effective
date of the act adding this section.

(d) Notwithstanding Section 14105.192, except as otherwise
provided in this section, for managed care health plans that
contract with the department pursuant to this chapter or Chapter
8 (commencing with Section 14200), payments for dates of service
following the effective date of the act adding this section shall be
determined without application of the reductions in Section
14105.192.

(e) The director shall implement subdivisions (a), (b), and (d)
to the maximum extent permitted by law and for the maximum time
period for which the director obtains federal approval for federal
financial participation for the increase provided for in this section.

(f) The director shall promptly seek all necessary federal
approvals to implement this section.

(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 section by means of provider
bulletins or notices, policy letters, or other similar instructions,
without taking regulatory action.

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SECTION 1.  

Section 14105.194 is added to the Welfare and
Institutions Code, to read:

14105.194.  

(a) Notwithstanding Sections 14105.191 and
14105.192, reimbursement for services provided by skilled nursing
facilities that are distinct parts of general acute care hospitals shall
be determined, for dates of service on or after June 1, 2011, without
application of the reductions set forth in Sections 14105.191 and
14105.192.

(b) The director shall do all of the following in the event that
he or she is prevented from implementing subdivision (a) for any
dates of service on or after June 1, 2011:

(1) Implement subdivision (a) to the maximum extent permitted
by law and for the maximum time period for which the director
obtains necessary federal approval.

(2) Increase payments to facilities described in subdivision (a)
for services provided on or after June 1, 2011, or on or after the
first date of service permitted by law and for which federal financial
participation is available, until the date the total amount of
Medi-Cal payments to those facilities for services provided on or
after June 1, 2011, is not less than the payments the facilities would
have received if the reductions in Sections 14105.191 and
14105.192 had not been imposed for dates of service on or after
June 1, 2011. The director shall increase payments under this
paragraph for the shortest period of time possible.

(c) The director shall promptly seek all necessary federal
approvals to implement this section.

(d) 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 section by means of provider
bulletins or notices, policy letters, or other similar instructions,
without taking regulatory action.

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SEC. 2.  

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 ensure and maintain access to medically necessary
care for the patients and residents needing skilled nursing services
begin insert or subacute care end insert , it is necessary that this act take effect
immediately.