BILL NUMBER: AB 1233	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JULY 2, 2013
	AMENDED IN SENATE  JUNE 11, 2013
	AMENDED IN ASSEMBLY  MAY 23, 2013
	AMENDED IN ASSEMBLY  APRIL 23, 2013

INTRODUCED BY   Assembly Member Chesbro

                        FEBRUARY 22, 2013

   An act to amend Section 14132.47 of the Welfare and Institutions
Code, relating to Medi-Cal, and declaring the urgency thereof, to
take effect immediately.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 1233, as amended, Chesbro. Medi-Cal: Administrative Claiming
process.
   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 establishes an
Administrative Claiming process under which local governmental
agencies and local educational consortia contract with the department
for the purpose of obtaining federal matching funds to assist with
the performance of administrative activities relating to the Medi-Cal
program. Under existing law, a participating local governmental
agency may include a Native American Indian tribe, a tribal
organization, or a subgroup of a Native American Indian tribe or
tribal organization.
   This bill would authorize a Native American Indian tribe, a tribal
organization, or a subgroup of a Native American Indian tribe or
tribal organization to claim, as a Medi-Cal Administrative Activity,
facilitating Medi-Cal applications  , which includes, but is not
limited to,  using the California Healthcare Eligibility,
Enrollment, and Retention System.
   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.  Section 14132.47 of the Welfare and Institutions Code
is amended to read:
   14132.47.  (a) It is the intent of the Legislature to provide
local governmental agencies the choice of participating in either or
both of the Targeted Case Management (TCM) and Administrative
Claiming process programs at their option, subject to the
requirements of this section and Section 14132.44.
   (b) The department may contract with each participating local
governmental agency or each local educational consortium to assist
with the performance of administrative activities necessary for the
proper and efficient administration of the Medi-Cal program, pursuant
to Section 1903a of the federal Social Security Act (42 U.S.C. Sec.
1396b(a)), and this activity shall be known as the Administrative
Claiming process.
   (c) (1) Subject to the requirements of paragraph (2) of
subdivision (f), as a condition for participation in the
Administrative Claiming process, each participating local
governmental agency or each local educational consortium shall, for
the purpose of claiming federal Medicaid reimbursement, enter into a
contract with the department and shall certify to the department the
total amount the local governmental agency or each local educational
consortium expended on the allowable administrative activities.
   (2) The department shall deny the claim if it determines that the
certification is not adequately supported, or does not otherwise
comply with federal requirements, for purposes of claiming federal
financial participation.
   (d) Each participating local governmental agency or local
educational consortium may subcontract with private or public
entities to assist with the performance of administrative activities
necessary for the proper and efficient administration of the Medi-Cal
program under the conditions specified by the department in
regulations.
   (e) Each Administrative Claiming process contract shall include a
requirement that each participating local governmental agency or each
local educational consortium submit a claiming plan in a manner that
shall be prescribed by the department in regulations, developed in
consultation with local governmental agencies.
   (f) (1) The department shall require that each participating local
governmental agency or each local educational consortium certify to
the department both of the following:
   (A)  The expenditure of 100 percent of the cost of performing
Administrative Claiming process activities. The funds expended for
this purpose shall be from the local governmental agency's general
fund or the general funds of local educational agencies or from any
other funds allowed under federal law and regulation.
   (B) In each fiscal year that its expenditures represent costs that
are eligible for federal financial participation for that fiscal
year. The department shall deny the claim if it determines that the
certification is not adequately supported for purposes of federal
financial participation.
   (2) (A) (i) A city that is not a participating local governmental
agency, or any other local public entity, that contracts with a local
governmental agency pursuant to subdivision (d) and that is located
within a county that is a participating local governmental agency
pursuant to this section, may submit certification to the local
governmental agency of amounts expended for Administrative Claiming
services in accordance with Section 433.51 of Title 42 of the Code of
Federal Regulations.
   (ii) A city or other local public entity that submits
certification pursuant to this paragraph shall comply with the
requirements of paragraph (1), with other requirements applicable to
local governmental agencies that the department determines, in
regulations, to be applicable, and with all applicable federal
requirements.
   (iii) The local governmental agency shall forward the city's or
local public entity's certification to the department for the
purposes of claiming federal financial participation.
   (iv) As applicable, the local governmental agency shall obtain and
retain appropriate certifications from the expending city or local
public entity, together with documentation of the underlying
expenditures, as required by the department.
   (B) A tribe or tribal organization, as defined in subdivision (n),
that is not participating in Administrative Claiming process
activities as a local governmental agency, may contract with, and
submit to a tribe or tribal organization that is contracting with,
the department pursuant to subdivision (b) amounts expended for
Administrative Claiming process activities that it is certifying in
accordance with Section 433.51 of Title 42 of the Code of Federal
Regulations and other applicable federal law and regulations. The
tribe or tribal organization receiving the certification shall
forward it to the department for purposes of claiming federal
financial participation. The certification shall comply with all of
the requirements for certification set forth in subparagraph (A).
   (g) (1) Notwithstanding any other provision of this section, the
state shall be held harmless, in accordance with paragraphs (2) and
(3), from any federal audit disallowance and interest resulting from
payments made to a participating local governmental agency or local
educational consortium pursuant to this section, for the disallowed
claim.
   (2) To the extent that a federal audit disallowance and interest
results from a claim or claims for which any participating local
governmental agency or local educational consortium has received
reimbursement for Administrative Claiming process activities, the
department shall recoup from the local governmental agency or local
educational consortium that submitted the disallowed claim, through
offsets or by a direct billing, amounts equal to the amount of the
disallowance and interest, in that fiscal year, for the disallowed
claim. All subsequent claims submitted to the department applicable
to any previously disallowed administrative activity or claim, may be
held in abeyance, with no payment made, until the federal
disallowance issue is resolved.
   (3) Notwithstanding paragraph (2), to the extent that a federal
audit disallowance and interest results from a claim or claims for
which the participating local governmental agency or local
educational consortium has received reimbursement for Administrative
Claiming process activities performed by an entity under contract
with, and on behalf of, the participating local governmental agency
or local educational consortium, the department shall be held
harmless by that particular participating local governmental agency
or local educational consortium for 100 percent of the amount of the
federal audit disallowance and interest, for the disallowed claim.
   (h) The use of local funds required by this section shall not
create, lead to, or expand the health care funding obligations or
service obligations for current or future years for any participating
local governmental agency or local educational consortium, except as
required by this section or as may be required by federal law.
   (i) The department shall deny any claim from a participating local
governmental agency or local educational consortium if the
department determines that the claim is not adequately supported in
accordance with criteria established pursuant to this subdivision and
implementing regulations before it forwards the claim for
reimbursement to the federal Medicaid Program. In consultation with
local governmental agencies and local educational consortia, the
department shall adopt regulations that prescribe the requirements
for the submission and payment of claims for administrative
activities performed by each participating local governmental agency
and local educational consortium.
   (j) Administrative activities shall be those determined by the
department to be necessary for the proper and efficient
administration of the state's Medicaid plan and shall be defined in
regulation.
   (k) If the department denies any claim submitted under this
section, the affected participating local governmental agency or
local educational consortium may, within 30 days after receipt of
written notice of the denial, request that the department reconsider
its action. The participating local governmental agency or local
educational consortium may request a meeting with the director or his
or her designee within 30 days to present its concerns to the
department after the request is filed. If the director or his or her
designee cannot meet, the department shall respond in writing
indicating the specific reasons for which the claim is out of
compliance to the participating local governmental agency or local
educational consortium in response to its appeal. Thereafter, the
decision of the director shall be final.
   (l) To the extent consistent with federal law and regulations,
participating local governmental agencies or local educational
consortium may claim the actual costs of nonemergency, nonmedical
transportation of Medi-Cal eligibles to Medi-Cal covered services,
under guidelines established by the department, to the extent that
these costs are actually borne by the participating local
governmental agency or local educational consortium. A local
educational consortium may only claim for nonemergency, nonmedical
transportation of Medi-Cal eligibles for Medi-Cal covered services,
through the Medi-Cal administrative activities program. Medi-Cal
medical transportation services shall be claimed under the local
educational agency Medi-Cal billing option, pursuant to Section
14132.06.
   (m) As a condition of participation in the Administrative Claiming
process and in recognition of revenue generated to each
participating local governmental agency and each local educational
consortium in the Administrative Claiming process, each participating
local governmental agency and each local educational consortium
shall pay an annual participation fee through a mechanism agreed to
by the state and local governmental agencies and local educational
consortia, or, if no agreement is reached by August 1 of each year,
directly to the state. The participation fee shall be used to cover
the cost of administering the Administrative Claiming process,
including, but not limited to, claims processing, technical
assistance, and monitoring. The department shall determine and report
staffing requirements upon which projected costs will be based. The
amount of the participation fee shall be based upon the anticipated
salaries, benefits, and operating expenses, to administer the
Administrative Claiming process and other costs related to that
process.
   (n) (1) For the purposes of this section, "participating local
governmental agency" means a county, chartered city, Native American
Indian tribe, tribal organization, or subgroup of a Native American
Indian tribe or tribal organization, under contract with the
department pursuant to subdivision (b).
   (2) Each participating Native American Indian tribe, tribal
organization, or subgroup of a Native American Indian tribe or tribal
organization may claim, as a Medi-Cal Administrative Activity,
facilitating Medi-Cal applications  , which includes, but is not
limited to,  using the California Healthcare Eligibility,
Enrollment, and Retention System.
   (o) For purposes of this section, "local educational agency" means
a local educational agency, as defined in subdivision (h) of Section
14132.06, that participates under the Administrative Claiming
process as a subcontractor to the local educational consortium in its
service region.
   (p) (1) For purposes of this section, "local educational
consortium" means a local agency that is one of the service regions
of the California County Superintendent Educational Services
Association.
   (2) Each local educational consortium shall contract with the
department pursuant to paragraph (1) of subdivision (c).
   (q) (1) Each participating local educational consortium shall be
responsible for the local educational agencies in its service region
that participate in the Administrative Claiming process. This
responsibility includes, but is not limited to, the preparation and
submission of all administrative claiming plans, training of local
educational agency staff, overseeing the local educational agency
time survey process, and the submission of detailed quarterly
invoices on behalf of any participating local educational agency.
   (2) Each participating local educational consortium shall ensure
local educational agency compliance with all requirements of the
Administrative Claiming process established for local governmental
agencies.
   (3) Ninety days prior to the initial participation in the
Administrative Claiming process, each local educational consortium
shall notify the department of its intent to participate in the
process, and shall identify each local educational agency that will
be participating as its subcontractor.
   (r) (1) Each local educational agency that elects to participate
in the Administrative Claiming process shall submit claims through
its local educational consortium or through the local governmental
agency, but not both.
   (2) Each local educational agency participating as a subcontractor
to a local educational consortium shall comply with all requirements
of the Administrative Claiming process established for local
governmental agencies.
   (s) A participating local governmental agency or a local
educational consortium may charge an administrative fee to any entity
claiming Administrative Claiming through that agency.
   (t) The department shall continue to administer the Administrative
Claiming process in conformity with federal requirements.
   (u) The department shall provide technical assistance to all
participating local governmental agencies and local educational
consortia in order to maximize federal financial participation in the
Administrative Claiming process.
   (v) This section shall be applicable to Administrative Claiming
process activities performed, and to moneys paid to participating
local governmental agencies for those activities in the 1994-95
fiscal year and thereafter, and to local educational consortia in the
1998-99 fiscal year and thereafter.
   (w) Nothing in this section or Section 14132.44 shall be construed
to prevent any state agency from participating in the Administrative
Claiming process or from contracting with others to engage in these
activities.
  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 facilitate implementation of the federal Patient
Protection and Affordable Care Act (Public Law 111-148), as amended
by the federal Health Care and Education Reconciliation Act of 2010
(Public Law 111-152) at the earliest possible time, it is necessary
that this act take effect immediately.