Amended in Assembly May 24, 2013

Amended in Assembly April 19, 2013

California Legislature—2013–14 Regular Session

Assembly Bill No. 900

Introduced by Assembly Member Alejo

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

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 provider payments. end delete begin insert distinct part nursing facilities. end insert

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The Medi-Cal Act establishes

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begin insert Existing law provides for end insert 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, 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 that begin delete , to the extent permitted by federal law, end delete this payment reduction not apply to skilled nursing facilities begin delete or subacute care units end delete that are a distinct part of a general acute care hospital, begin delete or to specified Medi-Cal provider payments for fee-for-service benefits, including payments to pharmacies, end delete for dates of service on or after begin delete June 1, 2011 end delete begin insert July 1, 2013 end insert . begin delete 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 delete

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:

begin insert

begin insert SECTION 1. end insert   

end insert

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

begin insert

begin insert 14105.194. end insert   

(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 July 1, 2013,
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 July 1, 2013:

(1) Implement subdivision (a) to the maximum extent permitted
by law.

(2) Increase payments to facilities described in subdivision (a)
for services provided on or after July 1, 2013, or on or after the
first date of service permitted by law and for which federal
financial participation is available.

(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.

end insert

begin insert

begin insert SEC. 2. end insert   

end insert begin insert

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:

end insert begin insert

In order to ensure and maintain access to medically necessary
care for the patients and residents needing skilled nursing services,
it is necessary that this act take effect immediately.

end insert

begin delete

SECTION 1.  

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

14105.194.  

(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.

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
or subacute care, it is necessary that this act take effect
immediately.

end delete