Amended in Assembly August 27, 2013

Senate BillNo. 98


Introduced by Committee on Budget and Fiscal Review

January 10, 2013


begin deleteAn act relating to the Budget Act of 2013. end deletebegin insertAn act to amend Sections 11155, 11322.85, 11450.025, 14186.11, 14199.1, 17600.15, 17600.50, 17600.60, 17601.75, 17603, 17604, 17606.10, 17610, 17610.5, 17612.1, 17612.2, 17612.3, 17612.5, 17612.6, 17613.1, 17613.2, 17613.3, 17613.4, and 18901.2 of, and to repeal Section 17612.21 of, the Welfare and Institutions Code, relating to public health, and making an appropriation therefor, to take effect immediately, bill related to the budget.end insert

LEGISLATIVE COUNSEL’S DIGEST

SB 98, as amended, Committee on Budget and Fiscal Review. begin deleteBudget Act of 2013. end deletebegin insertPublic health.end insert

begin insert

Existing law imposes limits on the amount of income and personal and real property an individual or family may possess in order to be eligible for public aid, including under the CalFresh program, including specifying the allowable value of a licensed vehicle retained by an applicant for, or recipient of, that aid.

end insert
begin insert

This bill would change the term “licensed vehicle” to “motor vehicle” for these purposes.

end insert
begin insert

Under existing law, with certain exceptions, every individual, as a condition of eligibility for aid under the CalWORKs program, is required to participate in certain welfare-to-work activities for a period of 24 months. Existing law provides that any month in which certain conditions exist shall not be counted as one of the 24 months of participation.

end insert
begin insert

This bill would make a clarifying change to these provisions. This bill would also make a nonsubstantive technical change to these provisions.

end insert
begin insert

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, to the extent that federal financial participation is available, and pursuant to a demonstration project or waiver of federal law, the department to establish specified pilot projects in up to 8 counties, known as Coordinated Care Initiative counties.

end insert
begin insert

This bill would correct an erroneous cross-reference with respect to a provision of law relating to Coordinated Care Initiative counties.

end insert
begin insert

Existing law establishes the Local Revenue Fund, a continuously appropriated fund that allocates Vehicle License Fund moneys and sales tax moneys. Existing law creates various accounts within the Local Revenue Fund, including the Sales Tax Account and the Sales Tax Growth Account, which each contain various subaccounts.

end insert
begin insert

Existing law, for the 2013-14 fiscal year and subsequent fiscal years, allocates funds to the Social Services Subaccount, Health Subaccount, and Mental Health Subaccount of the Sales Tax Account using specified calculations.

end insert
begin insert

This bill would modify the calculations used to allocate moneys to the above-described subaccounts, and would also require the Controller to transfer funds between the Social Services Subaccount and the Health Subaccount in an amount not to exceed $300 million for the 2013-14 fiscal year, or one billion dollars in any subsequent fiscal year, as specified, thereby making at appropriation.

end insert
begin insert

Existing law requires counties, through a choice of methodologies, to provide specified health services to eligible county residents who are indigent. Existing law authorizes counties to receive funding for this program from the Health Subaccount by either proving actual costs or by electing to receive 60% of the funds that would otherwise have been allocated to them, and would establish a default contribution for counties that fail to make a choice or to inform the Director of Health Care Services by a specified date. Existing law places the difference between prior fiscal year contributions to counties from the Health Subaccount and the new contributions to counties in the Family Support Subaccount, which is established within the Sales Tax Account, to be used by counties for the CalWORKs program, as specified.

end insert
begin insert

With respect to the redirection of funds to the Family Support Subaccount, existing law requires counties to determine the amount or percentage of funding to be redirected and to provide that calculation to the department by a specified date. Existing law provides a specified process to be used if the department disagrees with a county’s determination. Existing law authorizes the county to submit a petition to the County Health Care Funding Resolution Committee if no agreement between the parties is reached by a specified date. Existing law also establishes an expedited formal appeal process by which a county may contest the determinations, as specified.

end insert
begin insert

This bill would make technical changes to these provisions and revise the deadlines by which counties must comply with the provisions described above.

end insert
begin insert

Existing law requires the department, in consultation with the counties, to determine the historical low-income shortfall between Medi-Cal and uninsured revenues and the costs incurred by county public hospital health systems for health services to Medi-Cal beneficiaries and uninsured patients. In determining this shortfall, the department is required to apply against that shortfall county indigent realignment amounts, special local health funds specifically restricted for indigent care, amounts from other specified sources of funding, including unrestricted health care funds and one-time funds received or carried forward by a county public hospital health system, and then gains from all other payers.

end insert
begin insert

This bill would require the department, once the department has accounted for amounts for county indigent realignment and special local health funds specifically restricted for indigent care, to determine and apply against the shortfall amounts for special local health funds that are not restricted for indigent care, amounts imputed for county low-income health, and one-time and carry-forward revenues, as defined. The bill would require the department to determine these amounts on a historical basis for the 2008-09 to 2011-12 fiscal years, inclusive.

end insert
begin insert

This bill would also make technical, nonsubstantive changes to these provisions.

end insert
begin insert

Existing law states the Legislature’s intent to create a program in California that provides a Low-Income Home Energy Assistance Program (LIHEAP) service benefit, through the LIHEAP block grant, to all recipient households of CalFresh, as specified.

end insert
begin insert

Existing law requires that, if the demand for the nominal LIHEAP service benefit exceeds allocated funding, the Department of Community Services and Development and the State Department of Social Services report that information to the Legislature and develop a plan to maintain the program as intended.

end insert
begin insert

This bill would delete those provisions. The bill would require that the nominal LIHEAP services benefit be funded through the LIHEAP grant allocated for outreach activities in accordance with state and federal requirements.

end insert
begin insert

This bill would declare that it is to take effect immediately as a bill providing for appropriations related to the Budget Bill.

end insert
begin delete

This bill would express the intent of the Legislature to enact statutory changes relating to the Budget Act of 2013.

end delete

Vote: majority. Appropriation: begin deleteno end deletebegin insertyesend insert. Fiscal committee: begin deleteno end deletebegin insertyesend insert. State-mandated local program: no.

The people of the State of California do enact as follows:

P4    1begin insert

begin insertSECTION 1.end insert  

end insert

begin insertSection 11155 of the end insertbegin insertWelfare and Institutions
2Code
end insert
begin insert, as added by Section 13 of Chapter 21 of the Statutes of 2013,
3is amended to read:end insert

4

11155.  

(a) Notwithstanding Section 11257, in addition to the
5personal property or resources permitted by other provisions of
6this part, and to the extent permitted by federal law, an applicant
7or recipient for aid under this chapter including an applicant or
8recipient under Chapter 2 (commencing with Section 11200) may
9retain countable resources in an amount equal to the amount
10permitted under federal law for qualification for the federal
11Supplemental Nutrition Assistance Program, administered in
12California as CalFresh.

13(b) The county shall determine the value of exempt personal
14property other than motor vehicles in conformance with methods
15established under CalFresh.

16(c) (1) (A) The value of eachbegin delete licensedend deletebegin insert motorend insert vehicle that is not
17exempt under paragraph (4) shall be the equity value of the vehicle,
18which shall be the fair market value less encumbrances.

P5    1(B) Anybegin insert motorend insert vehicle with an equity value of nine thousand
2five hundred dollars ($9,500) or less shall not be attributed to the
3family’s resource level.

4(C) For eachbegin delete licensedend deletebegin insert motorend insert vehicle with an equity value of
5more than nine thousand five hundred dollars ($9,500), the equity
6value that exceeds nine thousand five hundred dollars ($9,500)
7shall be attributed to the family’s resource level.

8(2) The equity threshold described in paragraph (1) of nine
9thousand five hundred dollars ($9,500) shall be adjusted upward
10annually by the increase, if any, in the United States Transportation
11Consumer Price Index forbegin delete all urban consumersend deletebegin insert All Urban
12Consumersend insert
published by the United States Department of Labor,
13Bureau of Labor Statistics.

14(3) The county shall determine the fair market value of the
15vehicle in accordance with a methodology determined by the
16department. The applicant or recipient shall self-certify the amount
17of encumbrance, if any.

18(4) The entire value of anybegin delete licensedend deletebegin insert motorend insert vehicle shall be
19exempt if any of the following apply:

20(A) It is used primarily for income-producing purposes.

21(B) It annually produces income that is consistent with its fair
22market value, even if used on a seasonal basis.

23(C) It is necessary for long distance travel, other than daily
24commuting, that is essential for the employment of a family
25member.

26(D) It is used as the family’s residence.

27(E) It is necessary to transport a physically disabled family
28member, including an excluded disabled family member, regardless
29of the purpose of the transportation.

30(F) It would be exempted under any of subparagraphs (A) to
31(D), inclusive, but the vehicle is not in use because of temporary
32unemployment.

33(G) It is used to carry fuel for heating for home use, when the
34transported fuel or water is the primary source of fuel or water for
35the family.

36(H) Ownership of the vehicle was transferred through a gift,
37donation, or family transfer, as defined by the Department of Motor
38Vehicles.

39(d) This section shall become operative on January 1, 2014.

P6    1begin insert

begin insertSEC. 2.end insert  

end insert

begin insertSection 11322.85 of the end insertbegin insertWelfare and Institutions Codeend insertbegin insert,
2as amended by Section 26 of Chapter 21 of the Statutes of 2013,
3is amended to read:end insert

4

11322.85.  

(a) Unless otherwise exempt, an applicant or
5recipient shall participate in welfare-to-work activities.

6(1) For 24 cumulative months during a recipient’s lifetime, these
7activities may include the activities listed in Section 11322.6 that
8are consistent with the assessment performed in accordance with
9Section 11325.4 and that are included in the individual’s
10welfare-to-work plan, as described in Section 11325.21, to meet
11the hours required in Section 11322.8. These 24 months need not
12be consecutive.

13(2) Any month in which the recipient meets the requirements
14of Section 11322.8, through participation in an activity or activities
15described in paragraph (3), shall not count as a month of activities
16for purposes of the 24-month time limit described in paragraph
17(1).

18(3) After a total of 24 months of participation in welfare-to-work
19activities pursuant to paragraph (1), an aided adult shall participate
20in one or more of the following welfare-to-work activities, in
21accordance with Section 607(c) and (d) of Title 42 of the United
22States Code as of the operative date of this section, that are
23consistent with the assessment performed in accordance with
24Section 11325.4, and included in the individual’s welfare-to-work
25plan, described in Section 11325.21:

26(A) Unsubsidized employment.

27(B) Subsidized private sector employment.

28(C) Subsidized public sector employment.

29(D) Work experience, including work associated with the
30refurbishing of publicly assisted housing, if sufficient private sector
31employment is not available.

32(E) On-the-job training.

33(F) Job search and job readiness assistance.

34(G) Community service programs.

35(H) Vocational educational training (not to exceed 12 months
36with respect to any individual).

37(I) Job skills training directly related to employment.

38(J) Education directly related to employment, in the case of a
39recipient who has not received a high school diploma or a
40certificate of high school equivalency.

P7    1(K) Satisfactory attendance at a secondary school or in a course
2of study leading to a certificate of general equivalence, in the case
3of a recipient who has not completed secondary school or received
4such a certificate.

5(L) The provision of child care services to an individual who is
6participating in a community service program.

7(b) Any month in whichbegin insert any ofend insert the following conditionsbegin delete existend delete
8begin insert existsend insert shall not be counted as one of the 24 months of participation
9allowed under paragraph (1) of subdivision (a):

10(1) The recipient is participating in job search or assessment
11pursuant to subdivision (a) or (b) of Section 11320.1, is in the
12process of appraisal as described in Section 11325.2, or is
13participating in the development of a welfare-to-work plan, as
14described in Section 11325.21.

15(2) The recipient is no longer receiving aid, pursuant to Sections
1611327.4 and 11327.5.

17(3) The recipient has been excused from participation for good
18cause, pursuant to Section 11320.3.

19(4) The recipient is exempt from participation pursuant to
20subdivision (b) of Section 11320.3.

21(5) The recipient is only required to participate in accordance
22with subdivision (d) of Section 11320.3.

23(c) County welfare departments shall provide each recipient
24who is subject to the requirements of paragraph (3) of subdivision
25(a) written notice describing the 24-month time limitation described
26in that paragraph and the process by which recipients may claim
27exemptions from, and extensions to, those requirements.

28(d) The notice described in subdivision (c) shall be provided at
29the time the individual applies for aid, during the recipient’s annual
30redetermination, and at least once after the individual has
31participated for a total of 18 months, and prior to the end of the
3221st month, that count toward the 24-month time limit.

33(e) The notice described in this section shall include, but shall
34not be limited to, all of the following:

35(1) The number of remaining months the adult recipient may
36be eligible to receive aid.

37(2) The requirements that the recipient must meet in accordance
38with paragraph (3) of subdivision (a) and the action that the county
39will take if the adult recipient does not meet those requirements.

P8    1(3) The manner in which the recipient may dispute the number
2of months counted toward the 24-month time limit.

3(4) The opportunity for the recipient to modify his or her
4welfare-to-work plan to meet the requirements of paragraph (3)
5of subdivision (a).

6(5) The opportunity for an exemption to, or extension of, the
724-month time limitation.

8(f) For an individual subject to the requirements of paragraph
9(3) of subdivision (a), who is not exempt or granted an extension,
10and who does not meet those requirements, the provisions of
11Sections 11327.4, 11327.5, 11327.9, and 11328.2 shall apply to
12the extent consistent with the requirements of this section. For
13purposes of this section, the procedures referenced in this
14subdivision shall not be described as sanctions.

15(g) (1) The department, in consultation with stakeholders, shall
16convene a workgroup to determine further details of the noticing
17and engagement requirements for the 24-month time limit, and
18shall instruct counties via an all-county letter, followed by
19regulations, no later than 18 months after the effective date of the
20act that added this section.

21(2) The workgroup described in paragraph (1) may also make
22recommendations to refine or differentiate the procedures and due
23process requirements applicable to individuals as described in
24subdivision (f).

25(h) (1) Notwithstanding paragraph (3) of subdivision (a) or any
26other law, an assistance unit that contains an eligible adult who
27has received assistance under this chapter, or from any state
28pursuant to the Temporary Assistance for Needy Families program
29(Part A (commencing with Section 401) of Title IV of the federal
30Social Security Act (42 U.S.C. Sec. 601 et seq.)) prior to January
311, 2013, may continue in a welfare-to-work plan that meets the
32requirements of Section 11322.6 for a cumulative period of 24
33months commencing January 1, 2013, unless or until he or she
34exceeds the 48-month time limitation described in Section 11454.

35(2) All months of assistance described in paragraph (1) prior to
36January 1, 2013, shall not be applied to the 24-month limitation
37described in paragraph (1) of subdivision (a).

38(i) This section shall remain in effect only until January 1, 2014,
39and as of that date is repealed, unless a later enacted statute, that
40is enacted before January 1, 2014, deletes or extends that date.

P9    1begin insert

begin insertSEC. 3.end insert  

end insert

begin insertSection 11322.85 of the end insertbegin insertWelfare and Institutions Codeend insertbegin insert,
2as added by Section 27 of Chapter 21 of the Statutes of 2013, is
3amended to read:end insert

4

11322.85.  

(a) Unless otherwise exempt, an applicant or
5recipient shall participate in welfare-to-work activities.

6(1) For 24 cumulative months during a recipient’s lifetime, these
7activities may include the activities listed in Section 11322.6 that
8are consistent with the assessment performed in accordance with
9Section 11325.4 and that are included in the individual’s
10welfare-to-work plan, as described in Section 11325.21, to meet
11the hours required in Section 11322.8. These 24 months need not
12be consecutive.

13(2) Any month in which the recipient meets the requirements
14of Section 11322.8, through participation in an activity or activities
15described in paragraph (3), shall not count as a month of activities
16for purposes of the 24-month time limit described in paragraph
17(1).

18(3) After a total of 24 months of participation in welfare-to-work
19activities pursuant to paragraph (1), an aided adult shall participate
20in one or more of the following welfare-to-work activities, in
21accordance with Section 607(c) and (d) of Title 42 of the United
22States Code as of the operative date of this section, that are
23consistent with the assessment performed in accordance with
24Section 11325.4, and included in the individual’s welfare-to-work
25plan, described in Section 11325.21:

26(A) Unsubsidized employment.

27(B) Subsidized private sector employment.

28(C) Subsidized public sector employment.

29(D) Work experience, including work associated with the
30refurbishing of publicly assisted housing, if sufficient private sector
31employment is not available.

32(E) On-the-job training.

33(F) Job search and job readiness assistance.

34(G) Community service programs.

35(H) Vocational educational training (not to exceed 12 months
36with respect to any individual).

37(I) Job skills training directly related to employment.

38(J) Education directly related to employment, in the case of a
39recipient who has not received a high school diploma or a
40certificate of high school equivalency.

P10   1(K) Satisfactory attendance at a secondary school or in a course
2of study leading to a certificate of general equivalence, in the case
3of a recipient who has not completed secondary school or received
4such a certificate.

5(L) The provision of child care services to an individual who is
6participating in a community service program.

7(b) Any month in whichbegin insert any ofend insert the following conditionsbegin delete existend delete
8begin insert existsend insert shall not be counted as one of the 24 months of participation
9allowed under paragraph (1) of subdivision (a):

10(1) The recipient is participating in job search in accordance
11with Section 11325.22, assessment pursuant to Section 11325.4,
12is in the process of appraisal as described in Section 11325.2, or
13is participating in the development of a welfare-to-work plan as
14described in Section 11325.21.

15(2) The recipient is no longer receiving aid, pursuant to Sections
1611327.4 and 11327.5.

17(3) The recipient has been excused from participation for good
18cause, pursuant to Section 11320.3.

19(4) The recipient is exempt from participation pursuant to
20subdivision (b) of Section 11320.3.

21(5) The recipient is only required to participate in accordance
22with subdivision (d) of Section 11320.3.

23(6) The recipient is participating in family stabilization pursuant
24to Section 11325.24, and the recipient would meet the criteria for
25good cause pursuant to Section 11320.3. This paragraph may apply
26to a recipient for no more than six cumulative months.

27(c) County welfare departments shall provide each recipient
28who is subject to the requirements of paragraph (3) of subdivision
29(a) written notice describing the 24-month time limitation described
30in that paragraph and the process by which recipients may claim
31exemptions from, and extensions to, those requirements.

32(d) The notice described in subdivision (c) shall be provided at
33the time the individual applies for aid, during the recipient’s annual
34redetermination, and at least once after the individual has
35participated for a total of 18 months, and prior to the end of the
3621st month, that count toward the 24-month time limit.

37(e) The notice described in this section shall include, but shall
38not be limited to, all of the following:

39(1) The number of remaining months the adult recipient may
40be eligible to receive aid.

P11   1(2) The requirements that the recipient must meet in accordance
2with paragraph (3) of subdivision (a) and the action that the county
3will take if the adult recipient does not meet those requirements.

4(3) The manner in which the recipient may dispute the number
5of months counted toward the 24-month time limit.

6(4) The opportunity for the recipient to modify his or her
7welfare-to-work plan to meet the requirements of paragraph (3)
8of subdivision (a).

9(5) The opportunity for an exemption to, or extension of, the
1024-month time limitation.

11(f) For an individual subject to the requirements of paragraph
12(3) of subdivision (a), who is not exempt or granted an extension,
13and who does not meet those requirements, the provisions of
14Sections 11327.4, 11327.5, 11327.9, and 11328.2 shall apply to
15the extent consistent with the requirements of this section. For
16purposes of this section, the procedures referenced in this
17subdivision shall not be described as sanctions.

18(g) (1) The department, in consultation with stakeholders, shall
19convene a workgroup to determine further details of the noticing
20and engagement requirements for the 24-month time limit, and
21shall instruct counties via an all-county letter, followed by
22regulations, no later than 18 months after the effective date of the
23act that added this section.

24(2) The workgroup described in paragraph (1) may also make
25recommendations to refine or differentiate the procedures and due
26process requirements applicable to individuals as described in
27subdivision (f).

28(h) (1) Notwithstanding paragraph (3) of subdivision (a) or any
29other law, an assistance unit that contains an eligible adult who
30has received assistance under this chapter, or from any state
31pursuant to the Temporary Assistance for Needy Families program
32(Part A (commencing with Section 401) of Title IV of the federal
33Social Security Act (42 U.S.C. Sec. 601 et seq.)) prior to January
341, 2013, may continue in a welfare-to-work plan that meets the
35requirements of Section 11322.6 for a cumulative period of 24
36months commencing January 1, 2013, unless or until he or she
37exceeds the 48-month time limitation described in Section 11454.

38(2) All months of assistance described in paragraph (1) prior to
39January 1, 2013, shall not be applied to the 24-month limitation
40described in paragraph (1) of subdivision (a).

P12   1(i) This section shall become operative on January 1, 2014.

2begin insert

begin insertSEC. 4.end insert  

end insert

begin insertSection 11450.025 of the end insertbegin insertWelfare and Institutions Codeend insert
3begin insert is amended to read:end insert

4

11450.025.  

(a) Notwithstanding any other law, effective on
5March 1, 2014, the maximum aid payments in effect on July 1,
62012, as specified in subdivision (b) of Section 11450.02, shall be
7increased by 5 percent.

8(b) Commencing in 2014 and annually thereafter, on or before
9January 10 and on or before May 14, the Director of Finance shall
10do all of the following:

11(1) Estimate the amount of growth revenues pursuant to
12subdivision (f) of Section 17606.10 that will be deposited in the
13Child Poverty and Family Supplemental Support Subaccount of
14the Local Revenue Fund for the current fiscal year and the
15following fiscal year and the amounts in the subaccount carried
16over from prior fiscal years.

17(2) For the current fiscal year and the following fiscal year,
18determine the total cost of providing the increase described in
19subdivision (a), as well as any other increase in the maximum aid
20payments subsequently provided only under this section, after
21adjusting for updated projections of CalWORKs costs associated
22with caseload changes, as reflected in the local assistance
23subvention estimates prepared by the State Department of Social
24Services and released with the annual Governor’s Budget and
25subsequent May Revision update.

26(3) If the amount estimated in paragraph (1) plus the amount
27projected to be deposited for the current fiscal year into the Child
28Poverty and Family Supplemental Support Subaccount pursuant
29to subparagraph (3) of subdivision (e) of Section 17600.15 is
30greater than the amount determined in paragraph (2), the difference
31shall be used to calculate the percentage increase to the CalWORKs
32maximum aid payment standards that could be fully funded on an
33ongoing basis beginning the following fiscal year.

34(4) If the amount estimated in paragraph (1) plus the amount
35projected to be deposited for the current fiscal year into the Child
36Poverty and Family Supplemental Support Subaccount pursuant
37to subparagraph (3) of subdivision (e) of Section 17600.15 is equal
38to or less than the amount determined in paragraph (2), no
39additional increase to the CalWORKs maximum aid payment
P13   1standards shall be provided in the following fiscal year in
2accordance with this section.

3(5) (A) Commencing with the 2014-15 fiscal year and for all
4fiscal years thereafter, if changes to the estimated amounts
5determined in paragraphs (1) or (2), or both, as of the May
6Revision, are enacted as part of the final budget, the Director of
7Finance shall repeat, using the same methodology used in the May
8Revision, the calculations described in paragraphs (3) and (4) using
9the revenue projections and grant costs assumed in the enacted
10budget.

11(B) If a calculation is required pursuant to subparagraph (A),
12the Department of Finance shall report the result of this calculation
13to the appropriate policy and fiscal committees of the Legislature
14upon enactment of the Budget Act.

15(c) An increase in maximum aid payments calculated pursuant
16to paragraph (3) of subdivision (b), or pursuant to paragraph (5)
17of subdivision (b) if applicable, shall become effective on October
181 of the following fiscal year.

19(d) (1) An increase in maximum aid payments provided in
20accordance with this section shall be funded with growth revenues
21from the Child Poverty and Family Supplemental Support
22Subaccount in accordance with paragraph (3) of subdivision (e)
23of Section 17600.15 and subdivision (f) of Section 17606.10, to
24the extent funds are available in that subaccount.

25(2) If funds received by the Child Poverty and Family
26Supplemental Support Subaccount in a particular fiscal year are
27insufficient to fully fund any increases to maximum aid payments
28made pursuant to this section, the remaining cost for that fiscal
29year will be addressed through existing provisional authority
30included in the annual Budget Act. Additional grant increases shall
31not be provided until and unless the ongoing cumulative costs of
32all prior grant increases provided pursuantbegin insert toend insert this section are fully
33funded by the Child Poverty and Family Supplemental Support
34Subaccount.

35(e) Notwithstanding Section 15200, counties shall not be
36required to contribute a share of cost to cover the costs of increases
37to maximum aid payments made pursuant to this section.

38begin insert

begin insertSEC. 5.end insert  

end insert

begin insertSection 14186.11 of the end insertbegin insertWelfare and Institutions Codeend insert
39begin insert is amended to read:end insert

P14   1

14186.11.  

Sectionbegin delete 14186.17end deletebegin insert 14182.17end insert shall apply to the
2provision of CBAS, MSSP, skilled nursing facility, and IHSS
3services in Coordinated Care Initiative counties as set forth in this
4article.

5begin insert

begin insertSEC. 6.end insert  

end insert

begin insertSection 14199.1 of the end insertbegin insertWelfare and Institutions Codeend insert
6begin insert is amended to read:end insert

7

14199.1.  

(a) The Legislature finds and declares the following:

8(1) Beginning January 1, 2014, many low-income individuals
9will be eligible for Medi-Cal coverage pursuant to federal law, as
10part of health care reform.

11(2) In implementing this expansion of Medi-Cal coverage, it is
12critical to maintain the role of county public hospital health systems
13that have traditionally served Medi-Cal and uninsured beneficiaries
14to ensure adequate access to care is available for the new Medi-Cal
15members, and to preserve the policy goal to support and strengthen
16traditional safety net providers who treat a high volume of
17uninsured and Medi-Cal patients.

18(b) For purposes of this section, the following definitions shall
19apply:

20(1) “County public hospital health system” shall have the
21meaning provided in subdivision (f) of Section 17612.2.

22(2) “Default members” means newly eligible beneficiaries
23enrolled in each Medi-Cal managed care plan who do not
24affirmatively select a primary care provider as part of the
25enrollment process.

26(3) “Enrollment target” means the number of newly eligible
27beneficiaries assigned to primary care providers within a county
28public hospital health system, not to exceed the number of
29unduplicated Low Income Health Program and uninsured patient
30count in the county public hospital health system. The unduplicated
31patient count shall be certified by the county public hospital health
32system and provided to the department, along with its proposed
33enrollment target, by November 30, 2013. The county public
34hospital health system may notify the department of a proposed
35reduction to its enrollment target based on its capacity to accept
36new patients. A standardized protocol for determining the target
37shall be developed by the department in consultation with the
38public hospital health system counties.

39(4) “Low Income Health Program” shall mean the LIHP as
40defined in subdivision (c) of Section 15909.1.

P15   1(5) “Medi-Cal managed care plan” means an organization or
2entity that enters into a contract with the department pursuant to
3Article 2.7 (commencing with Section 14087.3), Article 2.8
4(commencing with Section 14087.5), Article 2.81 (commencing
5with Section 14087.96), Article 2.91 (commencing with Section
614089), or Chapter 8 (commencing with Section 14200).

7(6) “Newly eligible beneficiaries” shall have the meaning
8provided in subdivision (s) of Section 17612.2.

9(7) “Primary care provider” means a primary care physician or
10nonphysician medical practitioner, medical group, clinic, or a
11medical home.

12(8) “Public hospital health system county” shall have the
13meaning provided in subdivision (u) of Section 17612.2.

14(c) Subject to subdivision (d), default members who reside in
15a public hospital health system county shall be assigned by each
16Medi-Cal managed care plan in the county to a primary care
17provider in accordance with the following:

18(1) Throughout the three-year period ending on December 31,
192016, at least 75 percent of default members shall be assigned by
20each Medi-Cal managed care plan to primary care providers within
21the county public hospital health system until the county public
22hospital health system meets its enrollment target.

23(2) Following the expiration of the three-year period set forth
24in paragraph (1), at least 50 percent of default members shall be
25assigned by each Medi-Cal managed care plan to primary care
26providers within the county public hospital health system until the
27county public hospital health system meets its applicable
28enrollment target.

29(3) Paragraphs (1) and (2) shall not apply with respect to a
30county public hospital health system during any time period in
31which the county public hospital health system meets or exceeds
32its applicable target. For time periods during which paragraphs (1)
33and (2) do not apply, default members shall be assigned to primary
34care providers in the same manner as other Medi-Cal members of
35the Medi-Cal managed care plan who do not affirmatively select
36primary care providers. Medi-Cal managed care plans shall not
37modify the assignment procedures due to the default assignment
38requirements of this section with respect to primary care providers
39within the county public hospital health system.

P16   1(4) In implementing the assignment process set forth in
2paragraphs (1) and (2), to the extent legally permissible and
3consistent with federal and state privacy and patient confidentiality
4laws, each Medi-Cal managed care plan shall first assign to a
5primary care provider within the county public hospital health
6system those default members who have accessed care within the
7county public hospital health system two or more times within the
8past 12 months. The department and the county public hospital
9health systems shall work together to share patient information in
10order to provide the Medi-Cal managed care plans with data
11demonstrating which default members have accessed the county
12public hospital health system providers prior to assignment to a
13primary care provider.

14(5) If at any time a county public hospital health system notifies
15a contracted Medi-Cal managed care plan that it has reached its
16maximum capacity for the assignment of default members, the
17requirements set forth in paragraphs (1) and (2) shall not apply to
18the Medi-Cal managed care plan so notified. Once the county
19public hospital health system notifies a Medi-Cal managed care
20plan that it has capacity to accept assignment of default members,
21the requirements set forth in paragraphs (1) and (2) shall apply
22effective on the first day of the month following that notice.

23(6) A Medi-Cal managed care plan shall not assign default
24members to a primary care provider within the county public
25hospital health system if that primary care provider has notified
26the Medi-Cal managed care plan that it does not have capacity to
27accept new patients.

28(d) The default process described in this section shall not apply
29to Low Income Health Program enrollees subject to Section
30begin delete 14005.60.end deletebegin insert 14005.61.end insert

31(e) Nothing set forth in this section shall alter, reduce, or modify
32in any manner the way in which Medi-Cal managed care plans
33assign other Medi-Cal members to the county public hospital health
34systems.

35(f) (1) The department shall modify its contracts with the
36Medi-Cal managed care plans in public hospital health system
37counties to include the assignment requirements set forth in this
38section.

39(2) Each Medi-Cal managed care plan shall demonstrate and
40certify that it has contracts or other arrangements in place with
P17   1county public hospital health systems that provide for implementing
2the requirements of this section. To the extent a Medi-Cal managed
3care plan is not compliant with any of the requirements of this
4section, the department shall reduce by 25 percent the default
5assignment into the Medi-Cal managed care plan with respect to
6all Medi-Cal beneficiaries, as long as the other Medi-Cal managed
7care plan or plans in that county have the capacity to receive the
8additional default membership.

9(g) Nothing in this section shall modify the ability of newly
10eligible beneficiaries to select or change their primary care
11providers.

12(h) The department shall seek any necessary federal approvals
13to implement the provisions of this section.

14begin insert

begin insertSEC. 7.end insert  

end insert

begin insertSection 17600.15 of the end insertbegin insertWelfare and Institutions Codeend insert
15begin insert is amended to read:end insert

16

17600.15.  

(a) Of the sales tax proceeds from revenues collected
17in the 1991-92 fiscal year which are deposited to the credit of the
18Local Revenue Fund, 51.91 percent shall be credited to the Mental
19Health Subaccount, 36.17 percent shall be credited to the Social
20Services Subaccount, and 11.92 percent shall be credited to the
21Health Subaccount of the Sales Tax Account.

22(b) For the 1992-93 fiscal year to the 2011-12 fiscal year,
23inclusive, of the sales tax proceeds from revenues deposited to the
24credit of the Local Revenue Fund, the Controller shall make
25monthly deposits to the Mental Health Subaccount, the Social
26Services Subaccount, and the Health Subaccount of the Sales Tax
27Account until the deposits equal the amounts that were allocated
28to counties, cities, and cities and counties mental health accounts,
29social services accounts, and health accounts, respectively, of the
30local health and welfare trust funds in the prior fiscal year pursuant
31to this chapter from the Sales Tax Account and the Sales Tax
32Growth Account. Any excess sales tax revenues received pursuant
33to Sections 6051.2 and 6201.2 of the Revenue and Taxation Code
34shall be deposited in the Sales Tax Growth Account of the Local
35Revenue Fund.

36(c) (1) For the 2012-13 fiscal year, of the sales tax proceeds
37from revenues deposited to the credit of the Local Revenue Fund,
38the Controller shall make monthly deposits to the Social Services
39Subaccount and the Health Subaccount of the Sales Tax Account
40until the deposits equal the amounts that were allocated to
P18   1counties’, cities’, and city and counties social services accounts
2and health accounts, respectively, of the local health and welfare
3trust funds in the prior fiscal year pursuant to this chapter from the
4Sales Tax Account and the Sales Tax Growth Account.

5(2) For the 2012-13 fiscal year, of the sales tax proceeds from
6revenues deposited to the credit of the Local Revenue Fund, the
7Controller shall make monthly deposits to the Mental Health
8Subaccount of the Sales Tax Account until the deposits equal the
9amounts that were allocated to counties’, cities’, and city and
10counties CalWORKs Maintenance of Effort Subaccounts pursuant
11to subdivision (a) of Section 17601.25, and any additional amounts
12above the amount specified in subdivision (a) of Section 17601.25,
13of the local health and welfare trust funds in the prior fiscal year
14pursuant to this chapter from the Sales Tax Account and the Sales
15Tax Growth Account. The Controller shall not include in this
16calculation any funding deposited in the Mental Health Subaccount
17from the Support Services Growth Subaccount pursuant to Section
1830027.9 of the Government Code or funds described in subdivision
19(c) of Section 17601.25.

20(3) Any excess sales tax revenues received pursuant to Sections
216051.2 and 6201.2 of the Revenue and Taxation Code after the
22allocations required by paragraphs (1) and (2) are made shall be
23deposited in the Sales Tax Growth Account of the Local Revenue
24Fund.

begin delete end deletebegin delete

25(d) (1) For the 2013-14 fiscal year, of the sales tax proceeds
26from revenues deposited to the credit of the Local Revenue Fund,
27the Controller shall make monthly deposits pursuant to a schedule
28provided by the Department of Finance, which shall provide for
29total allocations as follows:

end delete
begin delete end deletebegin delete

30(A) To

end delete

31begin insert(d)end insertbegin insertend insertbegin insert(1)end insertbegin insertend insertbegin insert Forend insert thebegin insert 2013-14 fiscal year, of the sales tax proceeds
32from revenues deposited to the credit of the Local Revenue Fund,
33the Controller shall make monthly deposits pursuant to a schedule
34provided by the Department of Finance, which shall provide
35deposits to theend insert
Social Services Subaccountbegin insert and the Health
36Subaccountend insert
of the Sales Tax Account until the depositsbegin delete are one
37billion dollars ($1,000,000,000) less thanend delete
begin insert equalend insert thebegin delete total amountend delete
38begin insert amountsend insert thatbegin delete wasend deletebegin insert wereend insert allocated tobegin delete theend deletebegin insert counties’, cities’, and city
39and counties’end insert
social services accountsbegin insert and health accounts,
40respectively,end insert
of the local health and welfare trust funds in the prior
P19   1fiscal year pursuant to this chapter from the Sales Tax Account
2and the Sales Tax Growth Account.

begin delete end deletebegin delete

3(B) To the Health Subaccount of the Sales Tax Account until
4the deposits are one billion dollars ($1,000,000,000) more than
5the total amount that was allocated to the health accounts of the
6local health and welfare trust funds in the prior fiscal year pursuant
7to this chapter from the Sales Tax Account and the Sales Tax
8Growth Account.

end delete
begin delete end deletebegin delete

9(C) To

end delete

10begin insert(2)end insertbegin insertend insertbegin insert Forend insert thebegin insert 2013-14 fiscal year, of the sales tax proceeds from
11revenues deposited to the credit of the Local Revenue Fund, the
12Controller shall make monthly deposits to theend insert
Mental Health
13Subaccount of the Sales Tax Account until the deposits equal the
14amounts that were allocated to counties’, cities’, and cities and
15counties’ CalWORKs Maintenance of Effort Subaccounts pursuant
16to subdivision (a) of Section 17601.25, and any additional amounts
17above the amount specified in subdivision (a) of Section 17601.25,
18of the local health and welfare trust funds in the prior fiscal year
19pursuant to this chapter from the Sales Tax Account and the Sales
20Tax Growth Account. The Controller shall not include in this
21calculation any funding deposited in the Mental Health Subaccount
22from the Support Services Growth Subaccount pursuant to Section
2330027.9 of the Government Code or funds described in subdivision
24(c) of Section 17601.25.

begin delete

25(2)

end delete

26begin insert(3)end insert Any excess sales tax revenues received pursuant to Sections
276051.2 and 6201.2 of the Revenue and Taxation Code after the
28allocations required bybegin delete subparagraphs (A) to (C), inclusive, of
29paragraph (1)end delete
begin insert paragraphs (1) and (2)end insert are made shall be deposited
30in the Sales Tax Growth Account of the Local Revenue Fund.

begin insert

31(4) On a monthly basis, pursuant to a schedule provided by the
32Department of Finance, the Controller shall transfer funds from
33the Social Services Subaccount to the Health Subaccount in an
34amount that shall not exceed three hundred million dollars
35($300,000,000) for the 2013-14 fiscal year. The funds so
36transferred shall not be used in calculating future year deposits
37to the Social Services Subaccount or the Health Subaccount.

end insert

38(e) For the 2014-15 fiscal year and fiscal years thereafter, of
39the sales tax proceeds from revenues deposited to the credit of the
P20   1Local Revenue Fund, the Controller shall make the following
2monthly deposits:

3(1) To the Social Servicesbegin delete Subaccount,end deletebegin insert Subaccountend insert of the Sales
4Taxbegin delete Accountend deletebegin insert Account,end insert until the deposits equal the total amount
5that wasbegin insert deposited to the Social Services Subaccount in the prior
6fiscal year pursuant to this section, in addition to the amounts that
7wereend insert
allocated to the social services accounts of the local health
8and welfare trust funds in the prior fiscal year pursuant to this
9begin delete chapter,end deletebegin insert chapterend insert from the Sales Taxbegin delete Account and the Sales Taxend delete
10 Growth Account.

11(2) To the Health Subaccount of the Sales Tax Account, until
12the deposits equal the total amount that was depositedbegin insert to the Health
13Subaccountend insert
in the prior year from the Sales Tax Account in
14addition to the amounts that were allocated to the health accounts
15of the local health and welfare trust funds in the prior fiscal year
16pursuant to this chapter from the Sales Tax Growth Account.

17(3) To the Child Poverty and Family Supplemental Support
18Subaccount until the deposits equal the amounts that were
19deposited in the prior fiscal year from the Sales Tax Account and
20the Sales Tax Growth Account.

21(4) To the Mental Health Subaccount of the Sales Tax Account
22until the deposits equal the amounts that were allocated to
23counties’, cities’, and cities and counties’ CalWORKs Maintenance
24of Effort Subaccounts pursuant to subdivision (a) of Section
2517601.25, and any additional amounts above the amount specified
26in subdivision (a) of Section 17601.25 of the local health and
27welfare trust funds in the prior fiscal year pursuant to this chapter
28from the Sales Tax Account and the Sales Tax Growth Account.
29The Controller shall not include in this calculation any funding
30deposited in the Mental Health Subaccount from the Support
31Services Growth Subaccount pursuant to Section 30027.9 of the
32Government Code or funds described in subdivision (c) of Section
3317601.25.

34(5) Any excess sales tax revenues received pursuant to Sections
356051.2 and 6201.2 of the Revenue and Taxation Code after the
36allocations required by paragraphs (1) to (4), inclusive, are made
37shall be deposited in the Sales Tax Growth Account of the Local
38Revenue Fund.

begin insert

39(6) On a monthly basis, pursuant to a schedule provided by the
40Department of Finance, the Controller shall transfer funds from
P21   1the Social Services Subaccount to the Health Subaccount in an
2amount that shall not exceed one billion dollars ($1,000,000,000)
3in any fiscal year. The transfer schedule shall be based on the
4amounts that each county is receiving in vehicle license fees
5pursuant to this chapter. The funds so transferred shall not be used
6in calculating future year deposits to the Social Services
7Subaccount or the Health Subaccount.

end insert
8begin insert

begin insertSEC. 8.end insert  

end insert

begin insertSection 17600.50 of the end insertbegin insertWelfare and Institutions Codeend insert
9begin insert is amended to read:end insert

10

17600.50.  

(a) A county that participated in the County Medical
11Services Program in the 2011-12 fiscal year, including the Counties
12of Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, El
13Dorado, Glenn, Humboldt, Imperial, Inyo, Kings, Lake, Lassen,
14Madera, Marin, Mariposa, Mendocino, Modoc, Mono, Napa,
15Nevada, Plumas, San Benito, Shasta, Sierra, Siskiyou, Solano,
16Sonoma, Sutter, Tehama, Trinity, Tuolumne, and Yuba and the
17Governing Board of the County Medical Services Program, shall
18adopt resolutions bybegin delete December 4, 2013,end deletebegin insert January 22, 2014,end insert that
19confirm acceptance for the following approach to determining
20payments to the Family Supportbegin delete Servicesend delete Subaccount:

21(1) The amount of payments to the Family Supportbegin delete Servicesend delete
22 Subaccount shall be equal to 60 percent of the sum of the
23following:

24(A) The 1991 health realignment funds that would have
25otherwise been allocated to the counties listed above pursuant to
26Sections 17603, 17604,begin delete 17606.10,end delete and 17606.20 and the
27maintenance of effort in subdivision (a) of Section 17608.10 for
28these counties, as those sections read on January 1,begin delete 2012.end deletebegin insert 2012,
29and Section 17606.10 as it read on July 1, 2013.end insert

30(B) The 1991 health realignment funds that would have
31otherwise been allocated to the County Medical Services Program
32pursuant to Sections 17603, 17604, 17605.07, and 17606.20, as
33those sections read on January 1, 2012.

34(2) The payment computed in paragraph (1) shall be achieved
35through the following:

36(A) Each county listed in subdivision (a) shall pay the amounts
37otherwise payable to the County Medical Services Program
38pursuant to subparagraph (B) of paragraph (2) of subdivision (j)
39of Section 16809 to the Family Supportbegin delete Servicesend delete Subaccount.

P22   1(B) The County Medical Services Program shall pay the
2difference between the total computed in paragraph (1) and the
3amount calculated in subparagraph (A) from funds provided
4pursuant to the Welfare and Institutions Code.

5(b) The Counties of Fresno, Merced, Orange, Placer,
6Sacramento, San Diego, San Luis Obispo, Santa Barbara, Santa
7Cruz, Stanislaus, Tulare, and Yolo shall each tentatively inform
8the state bybegin delete Octoberend deletebegin insert Novemberend insert 1, 2013, which of the following
9options it selects for determining its payments to the Family
10Supportbegin delete Servicesend delete Subaccount. On or beforebegin delete December 4, 2013,end delete
11begin insert January 22, 2014,end insert the board of supervisors of each county and city
12and county may adopt a resolution informing the state of the
13county’s or city and county’s final selection of the option for
14determining its payments to the Family Supportbegin delete Servicesend delete
15 Subaccount:

16(1) The formula detailed in Article 13 (commencing with Section
1717613.1).

18(2) (A) A calculation of 60 percent of the total of 1991 health
19realignment funds that would have otherwise been allocated to
20that county or city and county pursuant to Sections 17603, 17604,
21andbegin delete 17606.20 andend deletebegin insert 17606.20, as those sections read on January 1,
222012, and Sectionend insert
17606.10,begin insert as it read on July 1, 2013, andend insert 60
23percent of the maintenance of effort in subdivision (a) of Section
2417608.10, asbegin delete those sectionsend deletebegin insert itend insert read on January 1, 2012.

25(B) If a county’s maintenance of effort in subdivision (a) of
26Section 17608.10 is greater than 14.6 percent of the total value of
27the county’s 2010-11 allocation pursuant to Sections 17603, 17604,
2817606.10, and 17606.20 and subdivision (a) of Section 17608.10,
29the value of the maintenance of effort used in the calculation in
30subparagraph (A) shall be limited to 14.6 percent.

31(c) The Counties of Alameda, Contra Costa, Kern, Los Angeles,
32Monterey, Riverside, San Bernardino, San Francisco, San Joaquin,
33San Mateo, Santa Clara, and Ventura shall each tentatively inform
34the state bybegin delete Octoberend deletebegin insert Novemberend insert 1, 2013, which of the following
35options it selects for determining its payments to the Family
36Supportbegin delete Servicesend delete Subaccount. On or beforebegin delete December 4, 2013,end delete
37begin insert January 22, 2014,end insert the board of supervisors of each county and city
38and county may adopt a resolution informing the state of the
39county’s or city and county’s final selection of the option for
P23   1determining its payments to the Family Supportbegin delete Servicesend delete
2 Subaccount:

3(1) The formula detailed in Article 12 (commencing with Section
417612.1).

5(2) (A) A calculation of 60 percent of the total of 1991 health
6realignment funds that would have otherwise been allocated to
7that county or city and county pursuant to Sections 17603, 17604,
8begin insert and 17606.20, as those sections read on January 1, 2012, and
9Sectionend insert
17606.10,begin delete and 17606.20 andend deletebegin insert as it read on July 1, 2013,
10andend insert
60 percent of the maintenance of effort in subdivision (a) of
11Section 17608.10, asbegin delete those sectionsend deletebegin insert itend insert read on January 1, 2012.

12(B) If a county’s maintenance of effort in subdivision (a) of
13Section 17608.10 is greater than 25.9 percent of the total value of
14the county’s 2010-11 fiscal year allocation pursuant to Sections
1517603, 17604, 17606.10, and 17606.20, and subdivision (a) of
16Section 17608.10, the value of the maintenance of effort used in
17the calculation in subparagraph (A) shall be limited to 25.9 percent.

18(d) (1) If the board of supervisors of a county or city and county
19fails to adopt a resolution pursuant to subdivision (b) or (c), as
20applicable, or fails to inform the Director of Health Care Services
21of the city and county or county’s final selection, bybegin delete December 4,
222013,end delete
begin insert January 22, 2014,end insert the calculation shall be 62.5 percent of
23the total of 1991 health realignment funds that would have
24otherwise been allocated to that county or city and county pursuant
25to Sections 17603, 17604,begin delete 17606.10,end delete andbegin delete 17606.20end deletebegin insert 17606.20, as
26those sections read on January 1, 2012,end insert
andbegin insert Section 17606.10, as
27it read on July 1, 2013, andend insert
62.5 percent of the maintenance of
28effort in subdivision (a) of Sectionbegin delete 17608.10.end deletebegin insert 17608.10, as it read
29on January 1, 2012.end insert

30(2) If the County Medical Services Program governing board
31or the board of supervisors of a county that participates in the
32County Medical Services Program fails to adopt a resolution
33pursuant to subdivision (a), or fails to inform the Director of Health
34Care Services of the county’s final selection, bybegin delete December 4, 2013,end delete
35begin insert January 22, 2014,end insert then paragraphs (1) and (2) of subdivision (a)
36begin delete appliesend deletebegin insert applyend insert to the applicable counties and to the County Medical
37Services Program.

38begin insert

begin insertSEC. 9.end insert  

end insert

begin insertSection 17600.60 of the end insertbegin insertWelfare and Institutions Codeend insert
39begin insert is amended to read:end insert

P24   1

17600.60.  

(a) The County Health Care Funding Resolution
2Committee is hereby created to do all of the following:

3(1) Determine whether the calculation of the historical
4percentage or amount to be applied in calculations inbegin delete Sectionend delete
5begin insert Sectionsend insert 17612.3begin insert and 17613.3end insert complies withbegin delete that section,end deletebegin insert those
6sections,end insert
taking into account the data and calculations provided
7by the county and any alternative data and calculations submitted
8by the department.

9(2) Hear and determine petitions from certain counties, as
10defined, to make particularized changes in what provisions of
11Section 17600.50 are controlling.

12(3) Hear and determine petitions for an alternative cost
13calculation to the cost per person calculation in subdivision (c) of
14Section 17613.2.

15(b) The committee shall consist of the following members:

16(1) One person selected by the California State Association of
17 Counties.

18(2) One person selected by the State Department of Health Care
19Services.

20(3) One person selected by the Director of Finance.

21(c) (1) The committee is not subject to the Bagley-Keene Open
22Meeting Act (Article 9 (commencing with Section 11120) of
23Chapter 1 of Part 1 of Division 3 of Title 2 of the Government
24Code) and shall be exempt from the Administrative Procedure Act
25(Chapter 3.5 (commencing with Section 11340) of Part 1 of
26Division 3 of Title 2 of the Government Code). The Department
27of Finance shall provide staff for the committee.

28(2) Pursuant to paragraph (2) of subdivision (b) of Section 3 of
29Article I of the California Constitution, the Legislature finds and
30declares that the public interest in affordable and accessible health
31care outweighs the public interest in access to these proceedings.

32(d) (1) A county or city and county, that chose to be subject to
33paragraph (2) of subdivision (b) or paragraph (2) of subdivision
34(c) of Section 17600.50 may submit a petition to the committee to
35be subject to paragraph (1) of subdivision (b) or paragraph (1) of
36subdivision (c) of Section 17600.50, as applicable, if the county
37or city and county demonstrates and provides sufficient evidence
38of both of the following criteria:

39(A) There have been changes in expenditures related to state
40and federal law, regulation and rulemaking, or court decisions that
P25   1have a material impact on the provision of health care services to
2indigent adults.

3(B) All of the data necessary to participate in Article 12
4(commencing with Section 17612.1) or Article 13 (commencing
5with Section 17613.1), as appropriate.

6(2) The form of petition shall be determined by the committee
7bybegin delete Decemberend deletebegin insert Januaryend insert 31,begin delete 2013.end deletebegin insert 2014.end insert

8(3) If the committee approves the petition the county or city and
9county shall be subject to paragraph (1) of subdivision (b) or
10paragraph (1) of subdivision (c) of Section 17600.50, as applicable,
11at the start of the next fiscal year.

12(e) (1) A county that chose to be subject to Article 13
13(commencing with Section 17613.1) may submit a petition to the
14committee for an alternative cost calculation to the cost per person
15calculation in subdivision (c) of Section 17613.2 with the
16documentation of extraordinary circumstances, including
17circumstances related to the local health care marketplace, provider,
18and provider contracts.

19(2) The county shall submit all necessary data to support its
20submission.

21(f) The committee shall make decisions within 45 days of
22hearing any petition.

23begin insert

begin insertSEC. 10.end insert  

end insert

begin insertSection 17601.75 of the end insertbegin insertWelfare and Institutions Codeend insert
24begin insert is amended to read:end insert

25

17601.75.  

(a) On or before the 27th day of the month, the
26Controller shall allocate to the family support account in the local
27health and welfare trust fund of each county and city and county
28the amounts deposited and remaining unexpended and unreserved
29on the 15th day of the month in the Family Support Subaccount
30of the Local Revenue Fund, pursuant to schedules developed by
31the Department of Finance in conjunction with the appropriate
32state departments and in consultation with the California State
33Association of Counties.

34(b) All of the funds deposited in the family support account
35shall be used by each county and city and county that receives an
36allocation of those funds to pay an increased county contribution
37toward the costs ofbegin delete CalWORKSend deletebegin insert CalWORKsend insert grants. Each county’s
38total annual contribution pursuant to this section shall equal the
39total amount of funds deposited in each county’s and city and
40county’s family support account during that fiscal year. The family
P26   1support account shall not be subject to the transferability provisions
2of Section 17600.20. Each county’s contribution pursuant to this
3section and Section 17601.25 shall be in addition to the shares of
4cost required pursuant to Section 15200.

5begin insert

begin insertSEC. 11.end insert  

end insert

begin insertSection 17603 of the end insertbegin insertWelfare and Institutions Codeend insert
6begin insert is amended to read:end insert

7

17603.  

This paragraph shall only apply until the end of the
8begin delete 2012-12end deletebegin insert 2012-13end insert fiscal year. On or before the 27th day of each
9month, the Controller shall allocate to the local health and welfare
10trust fund health accounts the amounts deposited and remaining
11unexpended and unreserved on the 15th day of the month in the
12Health Subaccount of the Sales Tax Account of the Local Revenue
13Fund, in accordance with subdivisions (a) and (b):

14(a) For the 1991-92 fiscal year, allocations shall be made in
15accordance with the following schedule:


16

 

Jurisdiction

Allocation
Percentage

Alameda   

4.5046

Alpine   

0.0137

Amador   

0.1512

Butte   

0.8131

Calaveras   

0.1367

Colusa   

0.1195

Contra Costa   

2.2386

Del Norte   

0.1340

El Dorado   

0.5228

Fresno   

2.3531

Glenn   

0.1391

Humboldt   

0.8929

Imperial   

0.8237

Inyo   

0.1869

Kern   

1.6362

Kings   

0.4084

Lake   

0.1752

Lassen   

0.1525

Los Angeles   

37.2606 

Madera   

0.3656

Marin   

1.0785

Mariposa   

0.0815

Mendocino   

0.2586

Merced   

0.4094

Modoc   

0.0923

Mono   

0.1342

Monterey   

0.8975

Napa   

0.4466

Nevada   

0.2734

Orange   

5.4304

Placer   

0.2806

Plumas   

0.1145

Riverside   

2.7867

Sacramento   

2.7497

San Benito   

0.1701

San Bernardino   

2.4709

San Diego   

4.7771

San Francisco   

7.1450

San Joaquin   

1.0810

San Luis Obispo   

0.4811

San Mateo   

1.5937

Santa Barbara   

0.9418

Santa Clara   

3.6238

Santa Cruz   

0.6714

Shasta   

0.6732

Sierra   

0.0340

Siskiyou   

0.2246

Solano   

0.9377

Sonoma   

1.6687

Stanislaus   

1.0509

Sutter   

0.4460

Tehama   

0.2986

Trinity   

0.1388

Tulare   

0.7485

Tuolumne   

0.2357

Ventura   

1.3658

Yolo   

0.3522

Yuba   

0.3076

Berkeley   

0.0692

Long Beach   

0.2918

Pasadena   

0.1385

P27  40

 

P28   1(b) For the 1992-93 fiscal year and fiscal years thereafter until
2the commencement of thebegin delete 2012-13end deletebegin insert 2013-14end insert fiscal year, the
3allocations to each county and city and county shall equal the
4amounts received in the prior fiscal year by each county, city, and
5city and county from the Sales Tax Account and the Sales Tax
6Growth Account of the Local Revenue Fund into the health and
7welfare trust fund.

8(c) (1) For the 2013-14 fiscal year, on the 27th day of each
9month, the Controller shall allocate, in the same proportionbegin delete andend delete
10begin insert asend insert funds in subdivision (b) were allocated, to each county’s and
11city and county’s local health and welfare trust fund health
12accounts, the amounts deposited and remaining unexpended and
13unreserved on the 15th day of the month in the Health Subaccount
14of the Sales Tax Account of the Local Revenue Fund.

15(2) (A) Beginning January 2014 and for the remainder of the
162013-14 fiscalbegin delete year ending June 30, 2014,end deletebegin insert year,end insert on or before the
17begin delete 25thend deletebegin insert 27thend insert of each month, the Controller shall transfer to the Family
18Support Subaccount from the Health Subaccount amounts
19determined pursuant to a schedule prepared by the Department of
20Finance in consultation with the California State Association of
21Counties. Cumulatively, no more than three hundred million dollars
22($300,000,000) shall be transferred.

23(B) Every month, after the transfers in subparagraph (A) have
24occurred, the remainder shall be allocated to the counties and cities
25and counties in the same proportions as funds in subdivision (b)
26were allocated.

27(C) For counties participating in the County Medical Services
28Program, transfers from each county shall not be greater than the
29monthly amount the county would otherwise pay pursuant to
30paragraph (2) of subdivision (j) of Section 16809 for participation
31in the County Medical Services Program. Any difference between
32the amount paid by these counties and the proportional share of
33the three hundred million dollars ($300,000,000) calculated as
34payable by these counties and the County Medical Services
35Program shall be paid from the funds available for allocation to
36the County Medical Services Program in accordance with the
37Welfare and Institution Code.

38(3) For the 2013-14 fiscal year, the Controller, using the same
39timing and criteria used in paragraph (1), shall allocate to each
40city, not to include a city and county, funds that shall equal the
P29   1amounts received in the prior fiscal year by each city from the
2Sales Tax Account and the Sales Tax Growth Account of the Local
3Revenue Fund into the health and welfare trust fund.

4(d) (1) (A) For the 2014-15 fiscal year and for every fiscal
5year thereafter, the Department of Finance, in consultation with
6the California State Association of Counties, shall calculate the
7amount each county or city and county shall contribute to the
8Family Support Subaccount in accordance with Section 17600.50.

9(B) On or before thebegin delete 25thend deletebegin insert 27thend insert of each month, the Controller
10shall transfer, based on a schedule prepared the Department of
11Finance in consultation with the California State Association of
12Counties, from the funds deposited and remaining unexpended
13and unreserved on the 15th day of the month in the Health
14Subaccount of the Sales Tax Account of the Local Revenue Fund
15to the Family Support Subaccount, funds that equal, over the course
16of the year, the amount determined in subparagraph (A) pursuant
17to a schedule provided by the Department of Finance.

18(C) After the transfer in subparagraph (B) has occurred, the
19State Controller shall allocate on or before the 27th of each month
20to health account in the local health and welfare trust fund of every
21county and city and county from a schedule prepared by the
22 Department of Finance, in consultation with the California State
23Association of Counties, any funds remaining in the Health
24Account from the funds deposited and remaining unexpended and
25unreserved on the 15th day of the month in the Health Subaccount
26of the Sales Tax Account of the Local Revenue Fund. The schedule
27shall be prepared as the allocations would have been distributed
28pursuant to subdivision (b).

29(D) For the 2014-15 fiscal year and for every fiscal year
30thereafter, the Controller, using the same timing and criteria as
31had been used in subdivision (b), shall allocate to each city, not to
32include a city and county, funds that equal the amounts received
33in the prior fiscal year by each city from the Sales Tax Account
34and the Sales Tax Growth Account of the Local Revenue Fund
35into the health and welfare trust fund.

36begin insert

begin insertSEC. 12.end insert  

end insert

begin insertSection 17604 of the end insertbegin insertWelfare and Institutions Codeend insert
37begin insert is amended to read:end insert

38

17604.  

(a) All motor vehicle license fee revenues collected in
39the 1991-92 fiscal year that are deposited to the credit of the Local
P30   1Revenue Fund shall be credited to the Vehicle License Fee Account
2of that fund.

3(b) (1) For the 1992-93 fiscal year and fiscal years thereafter,
4from vehicle license fee proceeds from revenues deposited to the
5credit of the Local Revenue Fund, the Controller shall make
6monthly deposits to the Vehicle License Fee Account of the Local
7Revenue Fund until the deposits equal the amounts that were
8allocated to counties, cities, and cities and counties as general
9purpose revenues in the prior fiscal year pursuant to this chapter
10from the Vehicle License Fee Account in the Local Revenue Fund
11and the Vehicle License Fee Account and the Vehicle License Fee
12Growth Account in the Local Revenue Fund.

13(2) Any excess vehicle fee revenues deposited into the Local
14Revenue Fund pursuant to Section 11001.5 of the Revenue and
15Taxation Code shall be deposited in the Vehicle License Fee
16Growth Account of the Local Revenue Fund.

17(3) The Controller shall calculate the difference between the
18total amount of vehicle license fee proceeds deposited to the credit
19of the Local Revenue Fund, pursuant to paragraph (1) of
20subdivision (a) of Section 11001.5 of the Revenue and Taxation
21Code, and deposited into the Vehicle License Fee Account for the
22period of July 16, 2009, to July 15, 2010, inclusive, and the amount
23deposited for the period of July 16, 2010, to July 15, 2011,
24inclusive.

25(4) Of vehicle license fee proceeds deposited to the Vehicle
26License Fee Account after July 15, 2011, an amount equal to the
27difference calculated in paragraph (3) shall be deemed to have
28been deposited during the period of July 16, 2010, to July 15, 2011,
29inclusive, and allocated to cities, counties, and a city and county
30as if those proceeds had been received during the 2010-11 fiscal
31year.

32(c) (1) On or before the 27th day of each month, the Controller
33shall allocate to each county, city, or city and county, as general
34purpose revenues the amounts deposited and remaining unexpended
35and unreserved on the 15th day of the month in the Vehicle License
36Fee Account of the Local Revenue Fund, in accordance with
37paragraphs (2) and (3).

38(2) For the 1991-92 fiscal year, allocations shall be made in
39accordance with the following schedule:


P32  24

 

Jurisdiction

Allocation
Percentage

Alameda   

4.5046

Alpine   

0.0137

Amador   

0.1512

Butte   

0.8131

Calaveras   

0.1367

Colusa   

0.1195

Contra Costa   

2.2386

Del Norte   

0.1340

El Dorado   

0.5228

Fresno   

2.3531

Glenn   

0.1391

Humboldt   

0.8929

Imperial   

0.8237

Inyo   

0.1869

Kern   

1.6362

Kings   

0.4084

Lake   

0.1752

Lassen   

0.1525

Los Angeles   

37.2606 

Madera   

0.3656

Marin   

1.0785

Mariposa   

0.0815

Mendocino   

0.2586

Merced   

0.4094

Modoc   

0.0923

Mono   

0.1342

Monterey   

0.8975

Napa   

0.4466

Nevada   

0.2734

Orange   

5.4304

Placer   

0.2806

Plumas   

0.1145

Riverside   

2.7867

Sacramento   

2.7497

San Benito   

0.1701

San Bernardino   

2.4709

San Diego   

4.7771

San Francisco   

7.1450

San Joaquin   

1.0810

San Luis Obispo   

0.4811

San Mateo   

1.5937

Santa Barbara   

0.9418

Santa Clara   

3.6238

Santa Cruz   

0.6714

Shasta   

0.6732

Sierra   

0.0340

Siskiyou   

0.2246

Solano   

0.9377

Sonoma   

1.6687

Stanislaus   

1.0509

Sutter   

0.4460

Tehama   

0.2986

Trinity   

0.1388

Tulare   

0.7485

Tuolumne   

0.2357

Ventura   

1.3658

Yolo   

0.3522

Yuba   

0.3076

Berkeley   

0.0692

Long Beach   

0.2918

Pasadena   

0.1385

35P32   8

 

25(3) For the 1992-93, 1993-94, and 1994-95 fiscal year and
26fiscal years thereafter, allocations shall be made in the same
27amounts as were distributed from the Vehicle License Fee Account
28and the Vehicle License Fee Growth Account in the prior fiscal
29year.

30(4) For the 1995-96 fiscal year, allocations shall be made in the
31same amounts as distributed in the 1994-95 fiscal year from the
32Vehicle License Fee Account and the Vehicle License Fee Growth
33Account after adjusting the allocation amounts by the amounts
34specified for the following counties:

 

Alpine   

  $(11,296)

Amador   

25,417

Calaveras   

49,892

Del Norte   

39,537

Glenn   

 (12,238)

Lassen   

17,886

Mariposa   

  (6,950)

Modoc   

 (29,182)

Mono   

  (6,950)

San Benito   

20,710

Sierra   

 (39,537)

Trinity   

 (48,009)

P32   8

 

9(5) For the 1996-97 fiscal year and fiscal years thereafter,
10allocations shall be made in the same amounts as were distributed
11from the Vehicle License Fee Account and the Vehicle License
12Fee Growth Account in the prior fiscal year.

13Initial proceeds deposited in the Vehicle License Fee Account
14in the 2003-04 fiscal year in the amount that would otherwise have
15been transferred pursuant to Section 10754 of the Revenue and
16Taxation Code for the period June 20, 2003, to July 15, 2003,
17inclusive, shall be deemed to have been deposited during the period
18June 16, 2003, to July 15, 2003, inclusive, and allocated to cities,
19counties, and a city and county during the 2002-03 fiscal year.

20(d) The Controller shall make monthly allocations from the
21amount deposited in the Vehicle License Collection Account of
22the Local Revenue Fund to each county in accordance with a
23schedule to be developed by the State Department of Mental Health
24in consultation with the California Mental Health Directors
25Association, which is compatible with the intent of the Legislature
26expressed in the act adding this subdivision.

27(e) Prior to making thebegin insert monthlyend insert allocations in accordance with
28paragraph (5) of subdivision (c) and subdivision (d),begin insert and pursuant
29to a schedule provided byend insert
thebegin insert Department of Finance, theend insert
30 Controller shall adjust thebegin insert monthlyend insert distributions from the Vehicle
31License Fee Account to reflect an equal exchange of sales and use
32tax funds from the Social Services Subaccount to the Health
33Subaccount, as required bybegin delete subdivisionend deletebegin insert subdivisionsend insert (d)begin insert and (e)end insert
34 of Section 17600.15, and of Vehicle License Fee funds from the
35Health Account to the Social Services Account.begin insert Adjustments made
36to the Vehicle License Fee distributions pursuant to this subdivision
37shall not be used in calculating future year allocations to the
38Vehicle License Fee Account.end insert

39begin insert

begin insertSEC. 13.end insert  

end insert

begin insertSection 17606.10 of the end insertbegin insertWelfare and Institutions Codeend insert
40begin insert is amended to read:end insert

P34   1

17606.10.  

(a) For the 1992-93 fiscal year and subsequent
2fiscal years, the Controller shall allocate funds, on a monthly basis
3from the General Growth Subaccount in the Sales Tax Growth
4Account to the appropriate accounts in the local health and welfare
5trust fund of each county, city, and city and county in accordance
6with a schedule setting forth the percentage of total state resources
7received in the 1990-91 fiscal year, including State Legalization
8Impact Assistance Grants distributed by the state under Part 4.5
9(commencing with Section 16700), funding provided for purposes
10of implementation of Division 5 (commencing with Section 5000),
11for the organization and financing of community mental health
12services, including the Cigarette and Tobacco Products Surtax
13proceeds which are allocated to county mental health programs
14pursuant to Chapter 1331 of the Statutes of 1989, Chapter 51 of
15the Statutes of 1990, and Chapter 1323 of the Statutes of 1990,
16and state hospital funding and funding distributed for programs
17administered under Sections 1794, 10101.1, and 11322.2, as
18annually adjusted by the Department of Finance, in conjunction
19with the appropriate state department to reflect changes in equity
20status from the base percentages. However, for the 1992-93 fiscal
21year, the allocation for community mental health services shall be
22based on the following schedule:


23

 

 

Percentage

 

of Statewide

Jurisdiction

Resource Base

Alameda   

4.3693

Alpine   

0.0128

Amador   

0.0941

Butte   

0.7797

Calaveras   

0.1157

Colusa   

0.0847

Contra Costa   

2.3115

Del Norte   

0.1237

El Dorado   

0.3966

Fresno   

3.1419

Glenn   

0.1304

Humboldt   

0.6175

Imperial   

0.5425

Inyo   

0.1217

Kern   

1.8574

Kings   

0.4229

Lake   

0.2362

Lassen   

0.1183

Los Angeles   

27.9666 

Madera   

0.3552

Marin   

0.9180

Mariposa   

0.0792

Mendocino   

0.4099

Merced   

0.8831

Modoc   

0.0561

Mono   

0.0511

Monterey   

1.1663

Napa   

0.3856

Nevada   

0.2129

Orange   

5.3423

Placer   

0.5034

Plumas   

0.1134

Riverside   

3.6179

Sacramento   

4.1872

San Benito   

0.1010

San Bernardino   

4.5494

San Diego   

7.8773

San Francisco   

3.5335

San Joaquin   

2.4690

San Luis Obispo   

0.6652

San Mateo   

2.5169

Santa Barbara   

1.0745

Santa Clara   

5.0488

Santa Cruz   

0.7960

Shasta   

0.5493

Sierra   

0.0345

Siskiyou   

0.2051

Solano   

0.6694

Sonoma   

1.1486

Stanislaus   

1.4701

Sutter/Yuba   

0.6294

Tehama   

0.2384

Trinity   

0.0826

Tulare   

1.4704

Tuolumne   

0.1666

Ventura   

1.9311

Yolo   

0.5443

Berkeley   

0.2688

Tri-City   

0.2347

P36   6

 

7(b) The Department of Finance shall recalculate the resource
8base used in determining the General Growth Subaccount
9allocations to the Health Account, Mental Health Account, and
10Social Services Account of the local health and welfare trust fund
11of each city, county, and city and county for the 1994-95 fiscal
12year general growth allocations according to subdivisions (c) and
13(d). For the 1995-96 fiscal year and annually until the end of the
142012-13 fiscal year, the Department of Finance shall prepare the
15schedule of allocations of growth based upon the recalculation of
16the resource base as provided by subdivision (c).

17(c) For the Mental Health Account, the Department of Finance
18shall do all of the following:

19(1) Use the following sources as reported by the State
20Department of Mental Health:

21(A) The final December 1992 distribution of resources
22associated with Institutes for Mental Disease.

23(B) The 1990-91 fiscal year state hospitals and community
24mental health allocations.

25(C) Allocations for services provided for under Chapter 1294
26of the Statutes of 1989.

27(2) Expand the resource base with the following nonrealigned
28funding sources as allocated among the counties:

29(A) Tobacco surtax allocations made under Chapter 1331 of the
30Statutes of 1989 and Chapter 51 of the Statutes of 1990.

31(B) For the 1994-95 allocation year only, Chapter 1323 of the
32Statutes of 1990.

33(C) 1993-94 fiscal year federal homeless block grant allocation.

34(D) 1993-94 fiscal year Mental Health Special Education
35allocations.

36(E) 1993-94 fiscal year allocations for the system of care for
37children, in accordance with Chapter 1229 of the Statutes of 1992.

38(F) 1993-94 fiscal year federal Substance Abuse and Mental
39Health Services Administration block grant allocations pursuant
P37   1to Subchapter 1 (commencing with Section 10801) of Chapter 114
2of Title 42 of the United States Code.

3(d) Until the end of the 2012-13 fiscal year, for the Health
4Account, the Department of Finance shall use the historical
5resource base of state funds as allocated among the counties, cities,
6and city and county as reported by the State Department of Health
7Services in a September 17, 1991, report of Indigent and
8Community Health Resources.

9(e) The Department of Finance shall use these adjusted resource
10bases for the Health Account and Mental Health Account to
11calculate what the 1994-95 fiscal year General Growth Subaccount
12allocations would have been, and together with 1994-95 fiscal
13year Base Restoration Subaccount allocations, CMSP subaccount
14allocations, equity allocations to the Health Account and Mental
15Health Account as adjusted by subparagraph (E) of paragraph (2)
16of subdivision (c) of Section 17606.05, and special equity
17allocations to the Health Account and Mental Health Account as
18adjusted by subdivision (e) of Section 17606.15 reconstruct the
191994-95 fiscal year General Growth Subaccount resource base
20for the 1995-96 allocation year for each county, city, and city and
21county. Notwithstanding any other provision of law, the actual
221994-95 general growth allocations shall not become part of the
23realignment base allocations to each county, city, and city and
24county. The total amounts distributed by the Controller for general
25growth for the 1994-95 allocation year shall be reallocated among
26the counties, cities, and city and county in the 1995-96 allocation
27year according to this paragraph, and shall be included in the
28general growth resource base for the 1996-97 allocation year and
29each fiscal year thereafter. For the 1996-97 allocation year and
30fiscal years thereafter, the Department of Finance shall update the
31base with actual growth allocations to the Health Account, Mental
32Health Account, and Social Services Account of each county, city,
33and city and county local health and welfare trust fund in the prior
34year, and adjust for actual changes in nonrealigned funds specified
35in subdivision (c) in the year prior to the allocation year.

36(f) For the 2013-14 fiscal year and every fiscal year thereafter,
37the Controller shall do all of the following:

38(1) Allocate to the mental health account of eachbegin delete countyend deletebegin insert county,
39city,end insert
or city and county based on a schedule provided by the
40Department of Finance. The Department of Finance shall
P38   1recalculate the resource base used in determining the General
2Growth Subaccount allocations to mental health account in
3accordance with subdivision (c) and allocate based on that
4recalculation.

5(2) Allocate 18.4545 percent of the total General Growth
6Subaccount to the Health Account.

7(3) Allocate to the Child Poverty and Family Supplemental
8Support Subaccount in the Sales Tax Account the remainder of
9the funds in the General Growth Subaccount.

10begin insert

begin insertSEC. 14.end insert  

end insert

begin insertSection 17610 of the end insertbegin insertWelfare and Institutions Codeend insert
11begin insert is amended to read:end insert

12

17610.  

(a) In June 2016 and for every fiscal year thereafter,
13for every countybegin insert or city and countyend insert that selected the option
14pursuant to paragraph (1) of subdivision (b) or paragraph (1) of
15subdivision (c) of Section 17600.50, the Director of Finance shall
16make a final determination of the amount of the allocation
17attributable to each county and city and county should have been
18pursuant to subdivision (d) of Section 17603 for the penultimate
19fiscal year.

20(b) The amount of the final determination amount for each
21county or city and county shall be subtracted from the amount
22attributable to each county or city and county that was actually
23transferred in the applicable fiscal year. This calculation shall be
24made at the same time as the final determination in subdivision
25(a).

26(c) The Director of Finance shall promptly notify every affected
27countybegin insert or cityend insert andbegin insert countyend insertbegin insert andend insert the Joint Legislative Budget
28Committee of the determinations made pursuant to subdivisions
29(a) and (b).

30(d) If the difference calculated in subdivision (b) is negative,
31the state shall pay the applicable countybegin insert or city and county,end insert the
32difference and those funds shall be deposited in that county’sbegin insert or
33city and county’send insert
health account of the local health and welfare
34trust fund. Notwithstanding Section 13340 of the Government
35Code, there is hereby continuously appropriated to the Director of
36Finance the funds necessary to pay any amounts owed pursuant
37to this subdivision.

38(e) If the difference determined in subdivision (b) is positive,
39the applicable county or city and county shall pay the difference
40to the family support account within the health and welfare trust
P39   1fund of thatbegin delete cityend deletebegin insert countyend insert or city and county. If within three months
2of receipt of the determination made in subdivision (b), the county
3or city and county has failed to make the payment, then the Director
4of Finance shall provide a supplemental schedule to the Controller
5to have 1.5 times the amount of the determination transferred from
6the next Health Subaccount allocations of the applicable county
7or city and county to the Family Support Subaccount until 1.5
8times the amount owed has been deposited in the family support
9account.

begin insert

10(f) Solely for the June 2016 final determination, the amount
11redirected pursuant to this article shall not exceed the amount
12determined for the county or city and county for the 2013-14 fiscal
13year under subdivision (c) of Section 17603, as that amount may
14have been reduced by the application of Section 17610.5.

end insert
15begin insert

begin insertSEC. 15.end insert  

end insert

begin insertSection 17610.5 of the end insertbegin insertWelfare and Institutions Codeend insert
16begin insert is amended to read:end insert

17

17610.5.  

(a) There is hereby created a 2013-14 Special
18Holding Account in the Family Support Subaccount. Starting
19January 1, 2014,begin delete and ending July 25, 2014,end deletebegin insert until the end of the
202013-14 fiscal year,end insert
funds transferred to the Family Support
21Subaccount that are attributable to every county or city and county
22that chose to be subject to paragraph (1) of subdivision (b), or
23paragraph (1) of subdivision (c), of Section 17600.50 shall be
24placed in the 2013-14 Special Holding Account.

25(b) No later than April 20, 2014, the State Department of Health
26Care Services shall provide an updated savings estimate for every
27county and city and county that chose to be subject to paragraph
28(1) of subdivision (b), or paragraph (1) of subdivision (c) of Section
2917600.50 to the Department of Finance. On or before May 14,
302014, the Department of Finance shall, for each county or city and
31county described in subdivision (a), determine whether the actual
32savings for each county or city and county is greater or lesser than
33the amount of funds deposited into the Special Holding Account.

34(c) If the revised estimate of savings is greater than the funds
35estimated by the Department of Finance to be deposited in the
36Special Holding Account, the funds shall be transferred back to
37the Family Support Subaccount bybegin delete June 30, 2014,end deletebegin insert the end of the
382013-14 fiscal year,end insert
for allocation.

39(d) If the revised estimate of savings is less than the funds
40estimated by the Department of Finance to be deposited in the
P40   1Special Holding Account, the difference between the amount
2estimated to be transferred and the revised estimated savings
3amount shall be transferred to the health account of the local health
4and welfare trust fund of every affected county or city and county
5pursuant to a schedule prepared by the Director of Finance in
6consultation with the California State Association of Counties and
7provided to the Controller.

8(e) This section shall remain in effect only until January 1, 2015,
9and as of that date is repealed, unless a later enacted statute, that
10is enacted before January 1, 2015, deletes or extends that date.

11begin insert

begin insertSEC. 16.end insert  

end insert

begin insertSection 17612.1 of the end insertbegin insertWelfare and Institutions Codeend insert
12begin insert is amended to read:end insert

13

17612.1.  

(a) For the 2013-14 fiscal year and each fiscal year
14thereafter, for each public hospital health system county that
15selected the option in paragraph (1) of subdivision (c) of Section
1617600.50, the total amount that would be payable for the fiscal
17year from 1991 Health Realignment funds under Sections 17603,
1817604,begin delete 17606.10end delete and 17606.20, as those sections read on January
191, 2012, andbegin insert Section 17606.10, as it read on July 1, 2013, andend insert
20 deposited by the Controller into the local health and welfare trust
21fund health account of the county in the absence of this section
22shall be determined.

23(b) The redirected amount determined for the public hospital
24health system county pursuant to Section 17612.3 shall be divided
25by the total determined in subdivision (a), except that, with respect
26to the County of Los Angeles, the redirected amount shall be
27determined by taking into account the adjustments required in
28Section 17612.5.

29(c) The resulting fraction determined in subdivision (b) shall
30be the percentage of 1991 Health Realignment funds under Sections
3117603, 17604,begin delete 17606.10,end delete and 17606.20, as those sections read on
32January 1, 2012,begin insert and Section 17606.10, as it read on July 1, 2013,end insert
33 to be deposited each month into the Family Support Subaccount.

34(d) The total amount deposited into the Family Support
35Subaccount under subdivision (c) with respect to a public hospital
36health system county for a fiscal year shall not exceed the
37redirected amount determined pursuant to Section 17612.3, and
38shall be subject to the appeal processes, and judicial review as
39described in subdivision (d) of Section 17612.3.

P41   1(e) The Legislature finds and declares that this article is not
2intended to change the local obligation pursuant to Section 17000.

3begin insert

begin insertSEC. 17.end insert  

end insert

begin insertSection 17612.2 of the end insertbegin insertWelfare and Institutions Codeend insert
4begin insert is amended to read:end insert

5

17612.2.  

For purposes of this article, the following definitions
6shall apply:

7(a) “Adjusted patient day” means a county public hospital health
8system’s total number of patient census days, as defined by the
9Office of Statewide Health Planning and Development, multiplied
10by the following fraction: the numerator that is the sum of the
11county public hospital health system’s total gross revenue for all
12services provided to all patients, including nonhospital services,
13and the denominator that is the sum of the county public hospital
14health system’s gross inpatient revenue. The adjusted patient days
15shall pertain to those services that are provided by the county public
16hospital health system and shall exclude services that are provided
17by contract or out-of-network clinics or hospitals.

18(b) “Base year” means the fiscal year ending three years prior
19to the fiscal year for which the redirected amount is calculated.

20(c) “Blended CPI trend factor” means the blended percent
21change applicable for the fiscal year that is derived from the
22nonseasonally adjusted Consumer Price Index for All Urban
23Consumers (CPI-U), United States City Average, for Hospital and
24Related Services, weighted at 75 percent, and for Medical Care
25Services, weighted at 25 percent, all as published by the United
26States Bureau of Labor Statistics, computed as follows:

27(1) For each prior fiscal year within the period to be trended
28through the current fiscal year, the annual average of the monthly
29index amounts shall be determined separately for the Hospital and
30Related Services Index and the Medical Care Services Index.

31(2) The year-to-year percentage changes in the annual averages
32determined in paragraph (1) for each of the Hospital and Related
33Services Index and the Medical Care Services Index shall be
34calculated.

35(3) A weighted average annual percentage change for each
36year-to-year period shall be calculated from the determinations
37made in paragraph (2), with the percentage changes in the Hospital
38and Related Services Index weighted at 75 percent, and the
39percentage changes in the Medical Care Services Index weighted
P42   1at 25 percent. The resulting average annual percentage changes
2shall be expressed as a fraction, and increased by 1.00.

3(4) The product of the successive year-to-year amounts
4determined in paragraph (3) shall be the blended CPI trend factor.

5(d) “Cost containment limit” means the public hospital health
6system county’s Medi-Cal costs and uninsured costs determined
7for the 2014-15 fiscal year and each subsequent fiscal year,
8adjusted as follows:

9(1) Notwithstanding paragraphs (2) to (4), inclusive, at the public
10hospital health system county’s option it shall be deemed to comply
11with the cost containment limit if the county demonstrates that its
12total health care costs, including nursing facility, mental health,
13and substance use disorder services, that are not limited to
14Medi-Cal and uninsured patients, for the fiscal year did not exceed
15its total health care costs in the base year, multiplied by the blended
16CPI trend factor for the fiscal year. A county electing this option
17shall elect by November 1 following the end of the fiscal year, and
18submit its supporting reports for meeting this requirement,
19including the annual report of financial transactions required to be
20submitted to the Controller pursuant to Section 53891 of the
21Government Code.

22(2) (A) The public hospital health system county’s Medi-Cal
23costs, uninsured costs, and other entity intergovernmental transfer
24amounts for the fiscal year shall be added together. Medi-Cal costs,
25uninsured costs, and other entity intergovernmental transfer
26amounts for purposes of this paragraph are as defined in
27subdivisions (q), (t), and (y) for the relevant fiscal period.

28(B) The public hospital health system county’s Medi-Cal costs,
29uninsured costs, and imputed other entity intergovernmental
30transfer amounts for the base year shall be added together and
31multiplied by the blended CPI trend factor. The base year costs
32used shall not reflect any adjustments under this subdivision.

33(C) The fiscal year amount determined in subparagraph (A)
34shall be compared to the trended amount in subparagraph (B). If
35the amount in subparagraph (B) exceeds the amount in
36subparagraph (A), the public hospital health system county shall
37be deemed to have satisfied the cost containment limit. If the
38amount in subparagraph (A) exceeds the amount in subparagraph
39(B), the calculation in paragraph (3) shall be performed.

P43   1(3) (A) If the number of adjusted patient days of service
2provided by the county public hospital health system for the fiscal
3year exceeds its number of adjusted patient days of service rendered
4in the base year by at least 10 percent, the excess adjusted patient
5days above the base year for the fiscal year shall be multiplied by
6the cost per adjusted patient day of the county public hospital
7health system for the base year. The result shall be added to the
8trended base year amount determined in subparagraph (B) of
9paragraph (2), yielding the applicable cost containment limit,
10subject to paragraph (4).

11(B) If the number of adjusted patient days of service provided
12by a county’s public hospital health system for the fiscal year does
13not exceed its number of adjusted patient days of service rendered
14in the base year by 10 percent, the applicable cost containment
15limit is the trended base year amount determined in subparagraph
16(B) of paragraph (2), subject to paragraph (4).

17(4) If a public hospital health system county’s costs, as
18determined in subparagraph (A) of paragraph (2), exceeds the
19amount determined in subparagraph (B) of paragraph (2) as
20adjusted by paragraph (3), the portion of the following cost
21increases incurred in providing services to Medi-Cal beneficiaries
22and uninsured patients shall be added to and reflected in any cost
23containment limit:

24(A) Electronic Health Records and related implementation and
25infrastructure costs.

26(B) Costs related to state or federally mandated activities,
27requirements, or benefit changes.

28(C) Costs resulting from a court order or settlement.

29(D) Costs incurred in response to seismic concerns, including
30costs necessary to meet facility seismic standards.

31(E) Costs incurred as a result of a natural disaster or act of
32terrorism.

33(5) If a public hospital health system county’s costs, as
34determined in subparagraph (A) of paragraph (2), exceeds the
35amount determined in subparagraph (B) of paragraph (2) as
36adjusted by paragraphs (3) and (4), the county may request that
37the department consider other costs as adjustments to the cost
38containment limit, including, but not limited to, transfer amounts
39in excess of the imputed other entity intergovernmental transfer
40amount trended by the blended CPI trend factor, costs related to
P44   1case mix index increases, pension costs, expanded medical
2education programs, increased costs in response to delivery system
3changes in the local community, and system expansions, including
4capital expenditures necessary to ensure access to and the quality
5of health care. Costs approved by the department shall be added
6to and reflected in any cost containment limit.

7(e) “County indigent care health realignment amount” means
8the product of the health realignment amount times the health
9realignment indigent care percentage, as computed on a
10county-specific basis.

11(f) “County public hospital health system” means a designated
12public hospital identified in paragraphs (6) to (20), inclusive, and
13paragraph (22) of subdivision (d) of Section 14166.1, and its
14affiliated governmental entity clinics, practices, and other health
15care providers that do not provide predominantly public health
16services. A county public hospital health system does not include
17a health care service plan, as defined in subdivision (f) of Section
181345 of the Health and Safety Code. The Alameda County Medical
19Center and County of Alameda shall be considered affiliated
20governmental entities.

21(g) “Department” means the State Department of Health Care
22Services.

23(h) “Health realignment amount” means the amount that, in the
24absence of this article, would be payable to a public hospital health
25system county under Sections 17603, 17604,begin delete 17606.10,end delete and
2617606.20, as those sections read on January 1, 2012,begin insert and Section
2717606.10, as it read on July 1, 2013,end insert
for the fiscal year that is
28deposited by the Controller into the local health and welfare trust
29fund health account of the public hospital health system county.

30(i) “Health realignment indigent care percentage” means the
31county-specific percentage determined in accordance with the
32following, and established in accordance with the procedures
33described in subdivision (c) of Section 17612.3.

34(1) Each public hospital health system county shall identify the
35portion of that county’s health realignment amount that was used
36to provide health services to the indigent, including Medi-Cal
37beneficiaries and the uninsured, for each of the historical fiscal
38years along with verifiable data in support thereof.

P45   1(2) The amounts identified in paragraph (1) shall be expressed
2as a percentage of the health realignment amount of that county
3for each historical fiscal year.

4(3) The average of the percentages determined in paragraph (2)
5shall be the county’s health realignment indigent care percentage.

6(4) To the extent a county does not provide the information
7required in paragraph (1) or the department determines that the
8information provided is insufficient, the amount under this
9subdivision shall be 85 percent.

10(j) “Historical fiscal years” means the state 2008-09 to 2011-12,
11inclusive, fiscal years.

12(k) “Hospital fee direct grants” means the direct grants described
13in Section 14169.7 that are funded by the Private Hospital Quality
14Assurance Fee Act of 2011 (Article 5.229 (commencing with
15Section 14169.31) of Chapter 7 of Part 3), or direct grants made
16in support of health care expenditures funded by a successor
17statewide hospital fee program.

18(l) “Imputed county low-income health amount” means the
19predetermined, county-specific amount of county general purpose
20funds assumed, for purposes of the calculation in Section 17612.
213, to be available to the county public hospital health system for
22services to Medi-Cal and uninsured patients. County general
23purpose funds shall not include any other revenues, grants, or funds
24otherwise defined in this section. The imputed county low-income
25health amount shall be determined as follows and established in
26accordance with subdivision (c) of Section 17612.3.

27(1) For each of the historical fiscal years, an amount determined
28to be the annual amount of county general fund contribution
29provided for health services to Medi-Cal beneficiaries and the
30uninsured, which does not include funds provided for nursing
31facility, mental health, and substance use disorder services, shall
32be determined through methodologies described in subdivision
33(ab).

34(2) If a year-to-year percentage increase in the amount
35determined in paragraph (1) was present, an average annual
36percentage trend factor shall be determined.

37(3) The annual amounts determined in paragraph (1) shall be
38averaged, and multiplied by the percentage trend factor, if
39applicable, determined in paragraph (2), for each fiscal year after
40the 2011-12 fiscal year through the applicable fiscal year.
P46   1However, if the percentage trend factor determined in paragraph
2(2) is greater than the applicable percentage change for any year
3of the same period in the blended CPI trend factor, the percentage
4change in the blended CPI trend factor for that year shall be used.
5The resulting determination is the imputed county low-income
6health amount for purposes of Section 17612.3.

7(m) “Imputed gains from other payers” means the
8predetermined, county-specific amount of revenues in excess of
9costs generated from all other payers for health services that is
10assumed to be available to the county public hospital health system
11for services to Medi-Cal and uninsured patients, which shall be
12determined as follows and established in accordance with
13subdivision (c) of Section 17612.3.

14(1) For each of the historical fiscal years, the gains from other
15payers shall be determined in accordance with methodologies
16described in subdivision (ab).

17(2) The amounts determined in paragraph (1) shall be averaged,
18yielding the imputed gains from other payers.

19(n) “Imputed other entity intergovernmental transfer amount”
20means the predetermined average historical amount of the public
21hospital health system county’s other entity intergovernmental
22transfer amount, determined as follows and established in
23accordance with subdivision (c) of Section 17612.3.

24(1) For each of the historical fiscal years, the other entity
25intergovernmental transfer amount shall be determined based on
26the records of the public hospital health system county.

27(2) The annual amounts in paragraph (1) shall be averaged.

28(o) “Medicaid demonstration revenues” means payments paid
29or payable to the county public hospital health system for the fiscal
30year pursuant to the Special Terms and Conditions of the federal
31Medicaid demonstration project authorized under Section 1115 of
32the federal Social Security Act entitled the “Bridge to Health Care
33Reform” (waiver number 11-W-00193/9), for uninsured care
34services from the Safety Net Care Pool or as incentive payments
35from the Delivery System Reform Improvement Pool, or pursuant
36to mechanisms that provide funding for similar purposes under
37the subsequent demonstration project. Medicaid demonstration
38revenues do not include the nonfederal share provided by county
39public hospital health systems as certified public expenditures,
40and are reduced by any intergovernmental transfer by county public
P47   1hospital health systems or affiliated governmental entities that is
2for the nonfederal share of Medicaid demonstration payments to
3the county public hospital health system or payments to a Medi-Cal
4managed care plan for services rendered by the county public
5hospital health system, and any related fees imposed by the state
6on those transfers; and by any reimbursement of costs, or payment
7of administrative or other processing fees imposed by the state
8relating to payments or other Medicaid demonstration program
9functions. Medicaid demonstration revenues shall not include
10Safety Net Care Pool revenues for nursing facility, mental health,
11and substance use disorder services, as determined from the pro
12rata share of eligible certified public expenditures for such services,
13or revenues that are otherwise included as Medi-Cal revenues.

14(p) “Medi-Cal beneficiaries” means individuals eligible to
15receive benefits under Chapter 7 (commencing with Section 14000)
16of Part 3, except for: individuals who are dual eligibles, as defined
17in paragraph (4) of subdivision (c) of Section 14132.275, and
18individuals for whom Medi-Cal benefits are limited to cost sharing
19or premium assistance for Medicare or other insurance coverage
20as described in Section 1396d(a) of Title 42 of the United States
21Code.

22(q) “Medi-Cal costs” means the costs incurred by the county
23public hospital health system for providing Medi-Cal services to
24Medi-Cal beneficiaries during the fiscal year, which shall be
25determined in a manner consistent with the cost claiming protocols
26developed for Medi-Cal cost-based reimbursement for public
27providers and under Section 14166.8, and, in consultation with
28each county, shall be based on other cost reporting and statistical
29data necessary for an accurate determination of actual costs as
30required in Section 17612.4. Medi-Cal costs shall include all
31fee-for-service and managed care hospital and nonhospital
32components, managed care out-of-network costs, and related
33administrative costs. The Medi-Cal costs determined under this
34paragraph shall exclude costs incurred for nursing facility, mental
35health, and substance use disorder services.

36(r) “Medi-Cal revenues” means total amounts paid or payable
37to the county public hospital health system for medical services
38provided under the Medi-Cal State Plan that are rendered to
39Medi-Cal beneficiaries during the state fiscal year, and shall include
40payments from Medi-Cal managed care plans for services rendered
P48   1to Medi-Cal managed care plan members, Medi-Cal copayments
2received from Medi-Cal beneficiaries, but only to the extent
3actually received, supplemental payments for Medi-Cal services,
4and Medi-Cal disproportionate share hospital payments for the
5state fiscal year, but shall exclude Medi-Cal revenues paid or
6payable for nursing facility, mental health, and substance use
7disorder services. Medi-Cal revenues do not include the nonfederal
8share provided by county public hospital health systems as certified
9public expenditures. Medi-Cal revenues shall be reduced by all of
10the following:

11(1) Intergovernmental transfers by the county public hospital
12health system or its affiliated governmental entities that are for the
13nonfederal share of Medi-Cal payments to the county public
14hospital health system, or Medi-Cal payments to a Medi-Cal
15managed care plan for services rendered by the county public
16hospital health system for the fiscal year.

17(2) Related fees imposed by the state on the transfers specified
18in paragraph (1).

19(3) Administrative or other fees, payments, or transfers imposed
20by the state, or voluntarily provided by the county public hospital
21health systems or affiliated governmental entities, relating to
22payments or other Medi-Cal program functions for the fiscal year.

23(s) “Newly eligible beneficiaries” means individuals who meet
24 the eligibility requirements in Section 1902(a)(10)(A)(i)(VIII) of
25Title XIX of the federal Social Security Act (42 U.S.C. Sec.
261396a(a)(10)(A)(i)(VIII)), and who meet the conditions described
27in Section 1905(y) of the federal Social Security Act (42 U.S.C.
28Sec. 1396d(y)) such that expenditures for services provided to the
29individual are eligible for the enhanced federal medical assistance
30percentage described in that section.

31(t) “Other entity intergovernmental transfer amount” means the
32amount of intergovernmental transfers by a county public hospital
33health system or affiliated governmental entities, and accepted by
34the department, that are for the nonfederal share of Medi-Cal
35payments or Medicaid demonstration payments for the fiscal year
36to any Medi-Cal provider other than the county public hospital
37health system, or to a Medi-Cal managed care plan for services
38rendered by those other providers, and any related fees imposed
39by the state on those transfers.

P49   1(u) “Public hospital health system county” means a county in
2which a county public hospital health system is located.

3(v) “Redirected amount” means the amount to be redirected in
4accordance with Section 17612.1, as calculated pursuant to
5subdivision (a) of Section 17612.3.

6(w) “Special local health funds” means the amount of the
7following county funds received by the county public hospital
8health system for health services during the fiscal year:

9(1) Assessments and fees restricted for health-related purposes.
10The amount of the assessment or fee for this purpose shall be the
11greater of subparagraph (A) or (B). If, because of restrictions and
12limitations applicable to the assessment or fee, the county public
13hospital health system cannot expend this amount, this amount
14shall be reduced to the amount actually expended.

15(A) The amount of the assessment or fee expended by the county
16public hospital health system for the provision of health services
17to Medi-Cal and uninsured beneficiaries during the fiscal year.

18(B) The amount of the assessment or fee multiplied by the
19average of the percentages of the amount of assessment or fees
20that were allocated to and expended by the county public hospital
21health system for health services to Medi-Cal and uninsured
22beneficiaries during the historical fiscal years. The percentages
23for the historical fiscal years shall be determined by dividing the
24amount allocated in each fiscal year as described in subparagraphs
25(B) and (C) of paragraph (2) of subdivision (ab) by the actual
26amount of assessment or fee expended in the fiscal year.

27(2) Funds available pursuant to the Master Settlement Agreement
28and related documents entered into on November 23, 1998, by the
29state and leading United States tobacco product manufacturers
30during a fiscal year. The amount of the tobacco settlement funds
31that may be used for this purpose shall be the greater of
32subparagraph (A) or (B), less any bond payments and other costs
33ofbegin delete securitization.end deletebegin insert securitization related to the funds described in
34this paragraph.end insert

35(A) The amount of the funds expended by the county public
36hospital health system for the provision of health services to
37Medi-Cal and uninsured beneficiaries during the fiscal year.

38(B) The amount of the tobacco settlement funds multiplied by
39the average of the percentages of the amount of tobacco settlement
40funds that were allocated to and expended by the county public
P50   1hospital health system for health services to Medi-Cal and
2uninsured beneficiaries during the historical fiscal years. The
3percentages for the historical fiscal years shall be determined by
4dividing the amount allocated in each fiscal year as described in
5begin delete subparagraphend deletebegin insert subparagraphs (B) andend insert (C) of paragraph (2) of
6subdivision (ab) by the actual amount of tobacco settlement funds
7expended in the fiscal year.

8(x) “Subsequent demonstration project” means the federally
9approved Medicaid demonstration project implemented after the
10termination of the federal Medicaid demonstration project
11authorized under Section 1115 of the federal Social Security Act
12entitled the “Bridge to Health Care Reform” (waiver number
1311-W-00193/9), the extension of that demonstration project, or
14the material amendment to that demonstration project.

15(y) “Uninsured costs” means the costs incurred by the public
16hospital health system county and its affiliated government entities
17for purchasing, providing, or ensuring the availability of services
18to uninsured patients during the fiscal year. Uninsured costs shall
19be determined in a manner consistent with the cost-claiming
20protocols developed for the federal Medicaid demonstration project
21authorized under Section 1115 of the federal Social Security Act
22entitled the “Bridge to Health Care Reform” (waiver number
2311-W-00193/9), including protocols pending federal approval, and
24under Section 14166.8, and, in consultation with each county, shall
25be based on any other cost reporting and statistical data necessary
26for an accurate determination of actual costs incurred. For this
27purpose, no reduction factor applicable to otherwise allowable
28costs under the demonstration project or the subsequent
29demonstration project shall apply. Uninsured costs shall exclude
30costs for nursing facility, mental health, and substance use disorder
31services.

32(z) “Uninsured patients” means individuals who have no source
33of third-party coverage for the specific service furnished, as further
34defined in the reporting requirements established pursuant to
35Section 17612.4.

36(aa) “Uninsured revenues” means self-pay payments made by
37or on behalf of uninsured patients to the county public hospital
38health system for the services rendered in the fiscal year, but shall
39exclude revenues received for nursing facility, mental health, and
40substance use disorder services. Uninsured revenues do not include
P51   1the health realignment amount or imputed county low-income
2health amount and shall not include any other revenues, grants, or
3funds otherwise defined in this section.

4(ab) “Historical allocation” means the allocation for the amounts
5in the historical years described in subdivisions (l), (m), and (w)
6for health services to Medi-Cal beneficiaries and uninsured
7patients. The allocation of those amounts in the historical years
8shall be done in accordance with a process to be developed by the
9department, in consultation with the counties, which includes the
10following required parameters:

11(1) For each of the historical fiscal years, the Medi-Cal costs,
12uninsured costs, and costs of other entity intergovernmental transfer
13amounts, as defined in subdivisions (q), (t), and (y), and the
14Medicaid demonstration, Medi-Cal and uninsuredbegin delete revenuesend delete
15begin insert revenues, and hospital fee direct grantsend insert with respect to the services
16as defined in subdivisionsbegin insert (k),end insert (o), (r), and (aa), shall be determined.
17For these purposes, Medicaid demonstration revenues shall include
18applicable payments as described in subdivision (o) paid or payable
19to the county public hospital health system under the prior
20demonstration project defined in subdivision (c) of Section
2114166.1, under the Low Income Health Program (Part 3.6
22(commencing with Section 15909)), and under the Health Care
23Coverage Initiative (Part 3.5 (commencing with Section 15900)),
24none of which shall include the nonfederal share of the Medicaid
25demonstration payments. The revenues shall be subtracted from
26the costs, yielding the initial low-income shortfall for each of the
27historical fiscal years.

28(2) The followingbegin delete amountsend delete shall bebegin delete allocated,end deletebegin insert applied in
29sequential order against,end insert
but shall notbegin delete exceed,end deletebegin insert exceed inend insert the
30begin insert aggregate, theend insert initial low-income shortfall determined in paragraph
31(1) for eachbegin delete year:end deletebegin insert of the historical fiscal years:end insert

32(A) First, the county indigent care health realignment amount
33shall be applied 100 percent against the initial low-income shortfall.

34(B) Second, special local health funds specifically restricted for
35indigent care shall be applied 100 percent against the initial
36low-income shortfall.

begin insert

37(C) Third, the sum of clauses (iv), (v), and (vi). Clause (iv) is
38the special local health funds, as defined in subdivision (w) and
39not otherwise identified as restricted special local health funds
40under subparagraph (B), clause (v) is the imputed county
P52   1 low-income health amount defined in subdivision (l), and clause
2(vi) is the one-time and carry-forward revenues as defined in
3subdivision (aj), all allocated to the historical low-income shortfall.
4These amounts shall be calculated as follows:

end insert
begin insert

5(i) Determine the sum of the special local health funds, as
6defined in subdivision (w) and not otherwise identified as restricted
7special local health funds under subparagraph (B), the imputed
8county low-income health amount defined in subdivision (l), and
9one-time and carry-forward revenues as defined in subdivision
10(aj).

end insert
begin insert

11(ii) Divide the historical total shortfall defined in subdivision
12(ah) by the sum in clause (i) to get the historical usage of funds
13percentage defined in subdivision (ai). If this calculation produces
14a percentage above 100 percent in a given historical fiscal year,
15then the historical usage of funds percentage in that historical
16fiscal year shall be deemed to be 100 percent.

end insert
begin insert

17(iii) Multiply the historical usage of funds percentage defined
18in subdivision (ai) and calculated in clause (ii) by each of the
19following funds:

end insert
begin insert

20(I) Special local health funds, as defined in subdivision (w) and
21not otherwise identified as restricted special local health funds
22under subparagraph (B).

end insert
begin insert

23(II) The imputed county low-income health amount defined in
24subdivision (l).

end insert
begin insert

25(III) One-time and carry-forward revenues as defined in
26subdivision (aj).

end insert
begin delete

27(C) Third, all other sources

end delete

28begin insert(iv)end insertbegin insertend insertbegin insertMultiply the productend insert ofbegin delete funding, excluding funds for nursing
29facility, mental health, and substance use disorder services and
30gains from other payers, shall be allocatedend delete
begin insert subclause (I) of clause
31(iii) by the historical low-income shortfall percentage definedend insert
in
32begin delete a fair and reasonable mannerend deletebegin insert subdivision (af)end insert to determine the
33begin delete proportion applied to,end deletebegin insert amount of special local health funds, as
34defined in subdivision (w)end insert
and notbegin delete to exceed, the initial low-income
35shortfall. Other sources of funding shall include any of the
36following:end delete
begin insert otherwise identified as restricted special local health
37funds under subparagraph (B), allocated to the historical
38low-income shortfall.end insert

begin delete end deletebegin delete

39(i) Unrestricted special local health funds.

end delete
begin delete end deletebegin delete

40(ii) One-time funds received

end delete

P53   1begin insert(v)end insertbegin insertend insertbegin insertMultiply the product of subclause (II) of clause (iii)end insert by the
2begin insert historical low-income shortfall percentage defined in subdivision
3(af) to determine the amount of the imputedend insert
countybegin delete public hospitalend delete
4begin insert low-incomeend insert healthbegin delete system for health services for that year or prior
5period carry-forward amounts, or carry-forward amounts.end delete
begin insert amount
6defined in subdivision (l) allocated to the historical low-income
7shortfall.end insert

begin delete

8(iii) County general purpose funds described

end delete

9begin insert(vi)end insertbegin insertend insertbegin insertMultiply the product of subclause (III) of clause (iii) by the
10historical low-income shortfall percentage definedend insert
in subdivision
11begin delete (l).end deletebegin insert (af) to determine the amount of one-time and carry-forward
12revenues as defined in subdivision (aj) allocated to the historical
13low-income shortfall.end insert

14(D) Finally, to the extent that the process above does not result
15in completely allocating revenues up to the amount necessary to
16address the initial low-income shortfall in the historical years,
17gains from other payers shall be allocated to fund those costs only
18to the extent that such other payer gains exist.

19(ac) “Gains from other payers” means the county-specific
20amount of revenues in excess of costs generated from all other
21payers for health services. For purposes of this subdivision, patients
22with other payer coverage are patients who are identified in all
23other financial classes, including, but not limited to, commercial
24coverage and dual eligible, other thanbegin insert allowable costs and
25associated revenues forend insert
Medi-Cal andbegin delete uninsured.end deletebegin insert the uninsured.end insert

26(ad) “New mandatory other entity intergovernmental transfer
27amounts” means other entity intergovernmental transfer amounts
28required by the state after July 1, 2013.

begin insert

29(ae) “Historical low-income shortfall” means, for each of the
30historical fiscal years described in subdivision (j), the initial
31low-income shortfall for Medi-Cal and uninsured costs determined
32in paragraph (1) of subdivision (ab), less amounts identified in
33subparagraphs (A) and (B) of paragraph (2) of subdivision (ab).

end insert
begin insert

34(af) “Historical low-income shortfall percentage” means, for
35each of the historical fiscal years described in subdivision (j), the
36historical low-income shortfall described in subdivision (ae)
37divided by the historical total shortfall described in subdivision
38(ah).

end insert
begin insert

39(ag) “Historical other shortfall” means, for each of the
40historical fiscal years described in subdivision (j), the shortfall
P54   1for all other types of costs incurred by the public hospital health
2system that are not Medi-Cal or uninsured costs, and is determined
3as total costs less total revenues, excluding any costs and revenue
4amounts used in the calculation of the historical low-income
5shortfall, and also excluding those costs and revenues related to
6mental health and substance use disorder services. If the amount
7of historical other shortfall in a given historical fiscal year is less
8than zero, then the historical other shortfall for that historical
9fiscal year shall be deemed to be zero.

end insert
begin insert

10(ah) “Historical total shortfall” means, for each of the historical
11fiscal years described in subdivision (j), the sum of the historical
12low-income shortfall described in subdivision (ae) and the
13historical other shortfall described in subdivision (ag).

end insert
begin insert

14(ai) “Historical usage of funds percentage” means, for each of
15the historical fiscal years described in subdivision (j), the historical
16total shortfall described in subdivision (ah) divided by the sum of
17special local health funds as defined in subdivision (w) and not
18otherwise identified as restricted special local health funds under
19subparagraph (B) of paragraph (2) of subdivision (ab), the imputed
20county low-income health amount defined in subdivision (l), and
21one-time and carry-forward revenues as defined in subdivision
22(aj). If this calculation produces a percentage above 100 percent
23in a given historical fiscal year, then the historical usage of funds
24percentage in that historical fiscal year shall be deemed to be 100
25percent.

end insert
begin insert

26(aj) “One-time and carry-forward revenues” mean, for each of
27the historical fiscal years described in subdivision (j), revenues
28and funds that are not attributable to services provided or
29obligations in the applicable historical fiscal year, but were
30available and utilized during the applicable historical fiscal year
31by the public hospital health system.

end insert
32begin insert

begin insertSEC. 18.end insert  

end insert

begin insertSection 17612.21 of the end insertbegin insertWelfare and Institutions Codeend insert
33begin insert is repealed.end insert

begin delete
34

17612.21.  

For the purposes of determining the fair and
35reasonable manner of allocation described in subparagraph (C) of
36paragraph (2) of subdivision (ab) of Section 17612.2, it is the intent
37of the Legislature to codify an allocation methodology by
38September 13, 2013. Prior to that codification, the following steps
39shall occur:

P55   1(a) The department shall meet with representatives of the county
2public hospital health systems to formulate the fair and reasonable
3allocation methodology.

4(b) No later than August 1, 2013, the department shall submit
5to the Legislature a proposed allocation methodology. If the county
6public hospital health systems and the department fail to agree on
7a proposed allocation methodology, the department shall also be
8required to submit an alternative approach from the county public
9hospital health systems, which the county public hospital health
10systems shall submit to the department prior to July 30, 2013, and
11the department’s analysis of why it chose its recommended
12approach.

13(c) If the Legislature enacts legislation implementing the
14allocation methodology described in subparagraph (C) of paragraph
15(2) of subdivision (ab) of Section 17612.2 by July 1, 2014, then
16notwithstanding Chapter 3.5 (commencing with Section 11340)
17of Part 1 of Division 3 of Title 2 of the Government Code, the
18department, without taking any further regulatory action, may
19implement, interpret, or make specific this section by means of
20all-county letters, plan letters, plan or provider bulletins, or similar
21instructions.

22(d) If the Legislature does not enact legislation implementing
23the allocation methodology described in subparagraph (C) of
24paragraph (2) of subdivision (ab) of Section 17612.2 by July 1,
252014, the department may implement the allocation methodology
26described in subparagraph (C) of paragraph (2) of subdivision (ab)
27of Section 17612.2 only by means that are in conformity with
28Chapter 3.5 (commencing with Section 11340) of Part 1 of Division
293 of Title 2 of the Government Code.

end delete
30begin insert

begin insertSEC. 19.end insert  

end insert

begin insertSection 17612.3 of the end insertbegin insertWelfare and Institutions Codeend insert
31begin insert is amended to read:end insert

32

17612.3.  

(a) For each fiscal year, commencing with the
332013-14 fiscal year, the amount to be redirected in accordance
34with Section 17612.1 shall be determined for each public hospital
35health system county as follows:

36(1) The public hospital health system county’s revenues and
37other funds paid or payable for the state fiscal year shall be
38comprised of the total of the following:

39(A) Medi-Cal revenues.

40(B) Uninsured revenues.

P56   1(C) Medicaid demonstration revenues.

2(D) Hospital fee direct grants.

3(E) Special local health funds.

4(F) The county indigent care health realignment amount.

5(G) The imputed county low-income health amount.

6(H) Imputed gains from other payers.

7(I) The amount by which the public hospital health system
8county’s costs exceeded the cost containment limit for the fiscal
9year, expressed as a negative number, multiplied by 0.50.

10(2) The following, incurred by the public hospital health system
11county for the fiscal year, not to exceed in total the cost
12containment limit, shall be subtracted from the sum in paragraph
13(1):

14(A) Medi-Cal costs.

15(B) Uninsured costs.

16(C) The lesser of the other entity intergovernmental transfer
17amount or the imputed other entity intergovernmental transfer
18amounts.

19(D) New mandatory other entity intergovernmental transfer
20amounts.

21(3) The resulting amount determined in paragraph (2) shall be
22multiplied by 0.80, except that for the 2013-14 fiscal year the
23resulting amount determined in paragraph (2) shall be multiplied
24by 0.70.

25(4) If the amount in paragraph (3) is a positive number, that
26amount, subject to paragraph (5), shall be redirected in accordance
27with Sectionbegin delete 17612.1.end deletebegin insert 17612.1, except that for the 2013-14 fiscal
28year the amount to be redirected shall not exceed the amount
29determined for the county for the 2013-14 fiscal year under
30subdivision (c) of Section 17603, as that amount may have been
31reduced by the application of Section 17610.5.end insert
If the amount
32determined in paragraph (3) is a negative number, the redirected
33amount shall be zero.

34(5) Notwithstanding any other law, the amount to be redirected
35as determined in paragraph (4) for any fiscal year shall not exceed
36the county indigent care health realignment amount for that fiscal
37year.

38(6) (A) The redirected amount shall be applied until the later
39of the following:

40(i) June 30, 2023.

P57   1(ii) The beginning of the fiscal year following a period of two
2consecutive fiscal years in which both of the following occur:

3(aa) The total interim amount determined under subdivision (b)
4of Section 17612.3 in May of the previous fiscal year is within 10
5percent of the final, reconciled amount in subdivision (d) of that
6section.

7(bb) The final, reconciled amounts under subdivision (d) of
8Section 17612.3 are within 5 percent of each other.

9(B) After the redirected amount ceases as provided in
10subparagraph (A), a permanent redirected amount shall be
11established to be an amount determined by calculating the
12percentage that the redirected amount was in the last fiscal year
13of the operation of this article of the county’s health realignment
14amount of that same fiscal year, multiplied by the county’s health
15realignment amount of all subsequent years.

16(b) Commencing with the 2014-15 fiscal year, the department
17shall calculate an interim redirected amount for each public hospital
18health system county under subdivision (a) by the January
19immediately prior to the starting fiscal year, using the most recent
20and accurate data available. For purposes of the interim
21determinations, the cost containment limit shall not be applied.
22The interim redirected amount shall be updated in the May before
23the start of the fiscal year in consultation with each public hospital
24health system county and based on any more recent and accurate
25data available at that time. During the fiscal year, the interim
26redirected amount will be applied pursuant to Section 17612.1.

27(c) The predetermined amounts or historical percentages
28described in subdivisions (i), (l), (m), (n), and (w) of Section
2917612.2 shall each be established in accordance with the following
30procedure:

31(1) Bybegin delete September 30,end deletebegin insert October 31,end insert 2013, each public hospital
32health system county shall determine the amount or percentage
33described in the applicable subdivision, and shall provide this
34calculation to the department, supported by verifiable data and a
35description of how the determination was made.

36(2) If the department disagrees with the public hospital health
37system county’s determination, the department shall confer with
38the public hospital health system county bybegin delete Novemberend deletebegin insert Decemberend insert
39 15,begin delete 2013.end deletebegin insert 2013, and shall issue its determination by January 31,
402014.end insert

P58   1(3) If no agreement between the parties has been reached by
2begin delete Decemberend deletebegin insert Januaryend insert 31,begin delete 2013,end deletebegin insert 2014,end insert the department shall apply the
3county’s determination when making the interim calculations
4pursuant to subdivision (b), until a decision is issued pursuant to
5paragraph (6).

6(4) begin deleteA end deletebegin insertIf no agreement between the parties has been reached by
7January 31, 2014, the end insert
public hospital health system countybegin delete mayend delete
8begin insert shallend insert submit a petitionbegin insert by February 28, 2014,end insert to the County Health
9Care Funding Resolution Committee, established pursuant to
10Section 17600.60, to seek a decision regarding the historical
11percentage or amount to be applied in calculations under this
12section.

13(5) The County Health Care Funding Resolution Committee
14shall hear and make a determination as to whether the county’s
15proposed percentage or amount complies with the requirements
16of this section taking into account the data and calculations of the
17county and any alternative data and calculations submitted by the
18department.

19(6) The committee shall issuebegin delete a decisionend deletebegin insert its final determinationend insert
20 within 45 days of the petition. If the county chooses to contest the
21begin insert finalend insert determination, thebegin delete decisionend deletebegin insert final determinationend insert of the
22committee will be applied for purposes of any interim calculation
23under subdivision (b) until a final decision is issued pursuant to
24de novo administrative review pursuant to paragraph (2) of
25subdivision (d).

26(d) (1) The data for the final calculations under subdivision (a)
27for the fiscal year shall be submitted by public hospital health
28system counties within 12 months after the conclusion of each
29fiscal year as required inbegin delete sectionend deletebegin insert Sectionend insert 17612.4. The data shall
30be the most recent and accurate data from the public hospital health
31system county’s books and records pertaining to the revenues paid
32or payable, and the costs incurred, for services provided in the
33subject fiscal year.begin delete Theend deletebegin insert After consulting with the county, theend insert
34 department shall make final calculations using the data submitted
35pursuant to this paragraph by Decemberbegin delete 31end deletebegin insert 15end insert of the following
36fiscal year, and shall providebegin delete the calculationend deletebegin insert its final determinationend insert
37 to the county. The finalbegin delete calculationsend deletebegin insert determinationend insert will also reflect
38the application of the cost containment limit, if any.begin delete Aend deletebegin insert If the county
39and the department agree, a revisedend insert
recalculation and
P59   1reconciliationbegin delete shallend deletebegin insert mayend insert be completed by the department within
2six months thereafter.

3(2) The director shall establish an expedited formal appeal
4process for a public hospital health system county to contestbegin delete theend delete
5begin insert finalend insert determinations madebegin delete inend deletebegin insert underend insert thisbegin delete article, and only as follows:end delete
6begin insert article. No appeal shall be available for interim determinations
7made under subdivision (b). The appeals process shall include all
8of the following:end insert

9(A) The public hospital health system county shall have 30
10calendar days, following the issuance of abegin insert finalend insert determination made
11underbegin insert paragraph (6) of subdivision (c) or paragraph (1) ofend insert this
12begin delete article,end deletebegin insert subdivision,end insert to file an appeal with the Director of Health
13Care Services. All appeals shall be governed by Section 100171
14of the Health and Safety Code, except for those provisions of
15paragraph (1) of subdivision (d) of Section 100171 of the Health
16and Safety Code relating to accusations, statements of issues,
17statement to respondent, and notice of defense, and except as
18otherwise set forth in this section. All appeals shall be in writing
19and shall be filed with the State Department of Health Care
20Service’s Office of Administrative Hearings and Appeals. An
21appeal shall be deemed filed on the date it is received by the Office
22of Administrative Hearings and Appeals.

23(i) An appeal shall specifically set forth each issue in dispute,
24which may include any component of the determination, and
25include the public hospital health system county’s contentions as
26to those issues. A formal hearing before an Office of
27Administrative Hearings and Appeals Administrative Law Judge
28shall commence withinbegin delete 45end deletebegin insert 60end insert days of the filing of the appeal
29requesting a formal hearing. A final decisionbegin insert under this paragraphend insert
30 shall be adoptedbegin delete within 60 days of the close of the record, butend delete no
31later thanbegin delete fiveend deletebegin insert sixend insert months following thebegin delete issuanceend deletebegin insert filingend insert of the
32appeal.

33(ii) If the public hospital health system county fails to file an
34appeal within 30 days of the issuance of a determination made
35under thisbegin delete article,end deletebegin insert section,end insert the determination of the department
36shall be deemed final and not appealable either administratively
37or to a court of generalbegin delete jurisdiction.end deletebegin insert jurisdiction, except that a
38county may elect to appeal a determination under subdivision (c)
39within 30 days of the issuance of the County Health Care Funding
40Resolution Committee’s final determination under paragraph (6)
P60   1of subdivision (c) or as a component of an appeal of the
2department’s final determination under paragraph (1) of this
3subdivision for the 2013-14 fiscal year.end insert

4(B) If a final decisionbegin insert under this paragraphend insert is not issued by the
5department within two years of thebegin delete issuanceend deletebegin insert last dayend insert ofbegin delete a
6determination made under this article, theend delete
begin insert the subject fiscal year,
7theend insert
public hospital health system county shall be deemed to have
8exhausted its administrative remedies and shall not be precluded
9from pursuing any available judicial review. However, the time
10period in this subdivision shall be extended by either of the
11following:

12(i) Undue delay caused by the public hospital health system
13county.

14(ii) An extension of time granted to a public hospital health
15system county at its sole request, or following the joint request of
16the public hospital health system county and the department.

begin delete

17(D)

end delete

18begin insert(C)end insert If the final decision issued by the department pursuant to
19thisbegin delete sectionend deletebegin insert paragraphend insert results in a different determination than
20that originally determined by the department, then the Department
21of Finance shall adjust the original determination by that amount,
22pursuant to a process developed by the Department of Finance and
23in consultation with the public hospital health system counties.

24(e) For purposes of this article, all references to “health services”
25or “health care services,” unless specified otherwise, shall exclude
26nursing facility, mental health, and substance use disorder services.

27begin insert

begin insertSEC. 20.end insert  

end insert

begin insertSection 17612.5 of the end insertbegin insertWelfare and Institutions Codeend insert
28begin insert is amended to read:end insert

29

17612.5.  

(a) For the 2013-14 fiscal year and each year
30thereafter, the amount to be redirected in accordance with Section
3117612.1 for the County of Los Angeles shall be determined in
32accordance with Section 17612.3, except that the formula in
33subdivision (a) of Section 17612.3 shall be replaced with the
34following formula:

35(1) The total revenues as defined in paragraph (7) of subdivision
36(b) paid or payable to the County of Los Angeles, Department of
37Health Services, for the fiscal year, which shall include special
38local health funds and as adjusted in accordance with Section
3917612.6, shall be added together.

P61   1(2) The sum of three hundred twenty-three million dollars
2($323,000,000), which represents the imputed county low-income
3health amount trended annually by 1 percent from the 2012-13
4fiscal year through the applicable fiscal year, and the county
5indigent care health realignment amount, as determined in
6accordance with subdivision (e) ofbegin delete sectionend deletebegin insert Sectionend insert 17612.2 for the
7fiscal year.

8(3) The amount by which the county’s total costs exceeded the
9cost containment limit for the fiscal year, expressed as a negative
10number, multiplied by 0.50.

11(4) (A) The total costs as defined in paragraph (6) of subdivision
12(b) incurred by or on behalf of the County of Los Angeles,
13Department of Health Services,begin delete duringend deletebegin insert forend insert the fiscal year shall be
14added together, but shall not exceed the cost containment limit
15determined in accordance with paragraph (3) of subdivision (b).

16(B) The costs in paragraph (A) shall be subtracted from the sum
17of paragraphs (1) to (3), inclusive.

18(5) The resulting amount determined in subparagraph (B) of
19paragraph (4) shall be multiplied by 0.80, except that for the
202013-14 fiscal year, the resulting amount determined in
21subparagraph (B) of paragraph (4) shall be multiplied by 0.70.

22(6) If the amount in paragraph (5) is a positive number, that
23amount, subject to paragraph (7), shall be redirected in accordance
24with Section 17612.1 of thisbegin delete article.end deletebegin insert article, except that for the
252013-14 fiscal year the amount to be redirected shall not exceed
26the amount determined for the County of Los Angeles for the
272013-14 fiscal year under subdivision (c) of Section 17603, as
28that amount may have been reduced by the application of Section
2917610.5.end insert
If the amount determined in paragraph (5) is a negative
30number, the redirected amount shall be zero.

31(7) Notwithstanding any other provision of law, the amount to
32be redirected as determined in paragraph (6) for any fiscal year
33shall not exceed the county indigent care health realignment
34amount for that fiscal year.

35(8) (A) The redirected amount shall be applied until the later
36of:

37(i) June 30, 2023.

38(ii) The beginning of fiscal year following a period of two
39consecutive fiscal years that both of the following occur:

P62   1(aa) The total interim amount determined under subdivision (b)
2of Section 17612.3 in May of the previous fiscal year is within 10
3percent of the final, reconciled amount in subdivision (d) of that
4section.

5(bb) The final, reconciled amounts under subdivision (d) of
6Section 17612.3 are within 5 percent of each other.

7(B) After the redirected amount ceases as provided in
8subparagraph (A), a permanent redirected amount shall be
9established to be an amount determined by calculating the
10percentage that the redirected amount was in the last fiscal year
11of the operation of this article of the county’s health realignment
12amount of that same fiscal year, multiplied by the county’s health
13realignment amount of all subsequent years.

14(b) Except as otherwise provided in this section, the definitions
15in Section 17612.2 shall apply. For purposes of this section, and
16for purposes the calculations in Section 17612.3 that apply to the
17County of Los Angeles, the following definitions shall apply:

18(1) “Adjusted patient day” means LA County DHS’s total
19number of patient days multiplied by the following fraction: the
20numerator that is the sum of the county public hospital health
21system’s total gross revenue for all services provided to all patients,
22including nonhospital services, and the denominator that is the
23sum of the county public hospital health system’s gross inpatient
24revenue. The adjusted patient days shall pertain to those services
25that are provided by the LA County DHS, and shall exclude
26services that are provided by contract or out-of-network clinics or
27hospitals. For purposes of this paragraph, gross revenue shall be
28adjusted as necessary to reflect the relationship between inpatient
29costs andbegin delete revenuesend deletebegin insert chargesend insert and outpatient costs and charges.

30(2) “Blended CPI trend factor” means the blended percent
31change applicable for the state fiscal year that is derived from the
32nonseasonally adjusted Consumer Price Index for All Urban
33Consumers (CPI-U), United States City Average, for Hospital and
34Related Services, weighted at 90 percent, and for Medical Care
35Services, weighted at 10 percent, all as published by the United
36States Bureau of Labor Statistics, computed as follows:

37(A) For each prior fiscal year, within the period to be trended
38through the fiscal year, the annual average of the monthly index
39amounts shall be determined separately for the Hospital and
40Related Services Index and the Medical Care Services Index.

P63   1(B) The year-to-year percentage changes in the annual averages
2determined in subparagraph (A) for each of the Hospital and
3Related Services Index and the Medical Care Services Index shall
4be determined.

5(C) A weighted average annual percentage change for each
6year-to-year period shall be calculated from the determinations
7made in subparagraph (B), with the percentage changes in the
8Hospital and Related Services Index weighted at 90 percent, and
9the percentage changes in the Medical Care Services Index
10weighted at 10 percent. The resulting average annual percentage
11changes shall be expressed as a fraction, and increased by 1.00.

12(D) The product of the successive year to year amounts
13determined in subparagraph (C) shall be the blended CPI trend
14factor.

15(3) “Cost containment limit” means the LA County DHS’s total
16costs determined for the 2014-15 fiscal year and each subsequent
17fiscal year adjusted as follows:

18(A) The County of Los Angeles will be deemed to comply with
19the cost containment limit if the county demonstrates that its total
20costs for the fiscal year did not exceed its total costs in the base
21year, multiplied by the blended CPI trend factor for the fiscal year
22as reflected in the annual report of financial transactions required
23to be submitted to the Controller pursuant to Section 53891 of the
24Government Code. If the total costs for the fiscal year exceeded
25the total cost in the base year, multiplied by the blended CPI trend
26factor for the fiscal year, the calculation in subparagraph (B) shall
27be performed.

28(B) (i) If the number of adjusted patient days of service provided
29by LA County DHS for the fiscal year exceeds its number of
30adjusted patient days of service rendered in the base year by at
31least 10 percent, the excess adjusted patient days above the base
32year for the fiscal year shall be multiplied by the cost per adjusted
33patient day of the public hospital health system for the base year.
34The result shall be added to the trended base year amount
35determined in subparagraph (A), yielding the applicable cost
36containment limit, subject to subparagraph (C). Costs per adjusted
37patient day shall be based upon only those LA County DHS costs
38incurred for patient care services.

39(ii) If the number of adjusted patient days of service provided
40by LA County DHS for the fiscal year does not exceed its number
P64   1of adjusted patient days of service rendered in the basebegin delete year,end deletebegin insert year
2by at least 10 percent,end insert
the applicable limit is the trended base year
3amount determined in subparagraph (A) subject to subparagraph
4(C).

5(C) If LA County DHS’s total costs for the fiscal year in as
6determined in subparagraph (A) exceeds the trended cost as
7determined in subparagraph (A) as adjusted by subparagraph (B),
8the following cost increases shall be added to and reflected in any
9cost containment limit:

10(i) Electronic health records and related implementation and
11infrastructure costs.

12(ii) Costs related to state or federally mandated activities,
13requirements, or benefit changes.

14(iii) Costs resulting from a court order or settlement.

15(iv) Costs incurred in response to seismic concerns, including
16costs necessary to meet facility seismic standards.

17(v) Costs incurred as a result of a natural disaster or act of
18terrorism.

19(vi) The total amount of any intergovernmental transfer for the
20nonfederal share of Medi-Cal payments to the hospital facility
21described in subdivision (f) of Section 14165.50.

22(D) If LA County DHS’s totalbegin delete costs,end deletebegin insert costs for the fiscal year
23exceed the trended costsend insert
as adjusted by subparagraphs (B) and
24(C),begin delete exceed total costs forend deletebegin delete the fiscal year,end delete the county may request
25that the department consider other costs as adjustments to the cost
26containment limit, including, but not limited to, transfer amounts
27in excess of the imputed other entity intergovernmental transfer
28amount trended by the blended CPI trend factor, costs related to
29case mix index increases, pension costs, expanded medical
30education programs, increased costs in response to delivery system
31changes in the local community, and system expansions, including
32capital expenditures necessary to ensure access to and the quality
33of health care. Costs approved by the department shall be added
34to and reflected in the cost containment limit.

35(4) “Health realignment indigent care percentage” means 83
36percent.

begin delete

37(5) “Special local health funds” means the

end delete
begin insert

38(5) “Special local health funds” means both of the following:

end insert

39begin insert(A)end insertbegin insertend insertbegin insertTheend insert total amount ofbegin delete the following fundsend deletebegin insert assessments and
40fees restricted for health-related purposes that areend insert
received by
P65   1LA County DHS and expended for health services during the fiscal
2begin delete year:end deletebegin insert year.end insert

begin delete end deletebegin delete

3(A) Assessments and fees restricted for health-related purposes.

end delete
begin delete end delete

4(B) Ninety-one percent of the fundsbegin delete availableend deletebegin insert actually received
5by the County of Los Angeles during the fiscal yearend insert
pursuant to
6the Master Settlement Agreement and related documents entered
7into on November 23, 1998, by the state and leading United States
8tobacco productbegin delete manufacturersend deletebegin insert manufacturers, less any bond
9paymentsend insert
andbegin delete allocatedend deletebegin insert other costs of securitization relatedend insert tobegin delete LA
10County DHS during a fiscal year.end delete
begin insert the funds described in this
11paragraph.end insert

12(6) “Total costs” means the actual net expenditures, excluding
13encumbrances, for all operating budget units of the LA County
14DHS. Operating budget units consist of four Hospital Enterprise
15Funds plus the LA County DHS’s budget units within the county
16general fund. Net expenditures, excluding encumbrances, are those
17recognized within LA County DHS, net of intrafund transfers,
18expenditure distributions, and all other billable services recorded
19from and to the LA County DHS enterprise funds and the LA
20County DHS general fund budget units, determined based on its
21central accounting system known as eCAPS, as of November 30
22of the year following the fiscal year, and shall include the new
23mandatory other entity intergovernmental transfer amounts, as
24defined in subdivision (ad) of Section 17612.2, and the lesser of
25other entity intergovernmental transfer amounts or the imputed
26other entity intergovernmental transfer amounts.

27(7) “Total revenues” means the sum of the revenue paid or
28payable for all operating budget units of the LA County DHS
29determined based on its central accounting system known as
30eCAPS, as of November 30 of the year following the fiscal year.

31(8) “LA County DHS” means operating budget units consisting
32of four hospital enterprise funds plus the DHS budget units within
33the county’s general fund.

34begin insert

begin insertSEC. 21.end insert  

end insert

begin insertSection 17612.6 of the end insertbegin insertWelfare and Institutions Codeend insert
35begin insert is amended to read:end insert

36

17612.6.  

(a) For purposes of this section, the following
37definitions shall apply:

38(1) “Type A payers” means the following sources of revenue
39for amounts paid to the County of Los Angeles, Department of
40Health Services:

P66   1(A) Title XVIII of the federal Social Security Act, known as
2the Medicare program.

3(B) Commercial health insurance.

4(C) begin deleteIn-home end deletebegin insertHealth care coverage for providers of in-home end insert
5supportive services, consistent with Article 7 (commencing with
6Section 12300) of Chapter 3 and Chapter 7 (commencing with
7Section 14000) of Partbegin delete 3end deletebegin insert 3 of Division 9end insert.

8(2) “Type B payers” means the following sources of revenue
9for amounts paid to the County of Los Angeles, Department of
10Health Services:

11(A) Patient care revenues received for services provided to other
12county departments.

13(B) State payments for patient financial services workers.

14(C) Other federal payers, not includingbegin insert federal grants, Medicare,
15Medicaid, and payments pursuant to Section 1011 of the federalend insert

16 Medicarebegin insert Prescription Drug, Improvement,end insert andbegin delete Medicaid.end delete
17begin insert Modernization Act of 2003 (Public Law 108-173).end insert

18(3) “Historical Base Type A revenues” means revenues from
19Type A payers in the historical fiscal years, calculated as follows:

20(A) For each historical fiscal year, the actual revenue received
21from Type A payers.

22(B) Calculate the average of the historical year’s amounts in
23subparagraph (A). This average shall be considered the historical
24Base Type A revenues.

25(4) “Historical Base Type B revenues” means revenues from
26Type B payers in the historical fiscal years, calculated as follows:

27(A) For each historical fiscal year, the actual revenue received
28from Type B payers.

29(B) Calculate the average of the historical years amounts in
30subparagraph (A). This average shall be considered the historical
31Base Type B revenues.

32(5) “Type A payer revenue” means the amount of revenue that
33is the greater of the following:

34(A) The amount of the revenue received from Type A payers
35for services rendered during the fiscal year.

36(B) The historical Base Type A revenues, as adjusted by the
37Type A adjustment, defined in paragraph (8).

38(6) “Type B payer revenue” means the amount of revenue that
39is the greater of the following:

P67   1(A) The amount of the revenue received from Type B payers
2for services rendered during the fiscal year.

3(B) The historical Base Type B revenues.

4(7) “Baseline Type A payer costs” means the average of the
5costs of services provided to Type A payer patients rendered in
6each of the four historical fiscal years to be determined as follows:

7(A) For each historical year, the actual costs incurred in
8providing services to Type A payer patients.

9(B) Calculate the average of the historical fiscal year amounts
10in subparagraph (A), this average shall be considered the baseline
11Type A payer costs.

12(8) “Type A adjustment” means the value of the revenue
13adjustment to historical base Type A revenues as defined in
14paragraph (3).

15(A) This adjustment will occur only if the Type A payer revenue
16for the fiscal year is less than historical base, otherwise the
17adjustment is considered to be zero.

18(B) If the requirement in subparagraph (A) is met, then there
19will only be an adjustment if one or more of the specified Type A
20payers’ data meets all of the following conditions:

21(i) The Type A payer revenue for the fiscal year is less than the
22historical base.

23(ii) The Type A payer costs for the fiscal year are less than the
24historical base trended by the blended CPI trend factor.

25(iii) The Type A payer volume for the fiscal year is less than
26the historical base.

27(C) For each Type A payer that meets all the conditions in
28subparagraph (B) the adjustment to the Type A payer revenue for
29that Type A payer will be as follows:

30(i) Calculate the percentage decrease in cost from the baseline
31Type A payer cost as trended by the blended CPI trend factor as
32defined inbegin insert paragraph (2) ofend insert subdivision (b)begin insert of Section 17612.5end insert and
33applied from the 2010-11 fiscal year to the subject fiscal year.

34(ii) Calculate the percentage decrease in volume, based on the
35adjusted patient days, from the baseline Type A payer volume to
36the subject fiscal year.

37(iii) Calculate the average of the percentages in clauses (i) and
38(ii).

P68   1(iv) The percentagebegin insert reductionend insert in clausebegin delete (ii)end deletebegin insert (iii)end insert shall be applied
2to the historical Base Type A payer revenue for the individual
3Type A payer.

4(b) The Type A payer revenues included in the total revenues
5in subdivision (a) of Section 17612.5 shall be the greater of the
6adjusted historical Type A baseline or the actual revenues received
7from Type A payers for services rendered in the subject fiscal year.

8(c) The Type B payer revenues included in the total revenues
9in subdivision (a) of Section 17612.5 shall be the greater of the
10historical Base Type B revenues or the actual revenues received
11from Type B payers for services rendered in the subject fiscal year.

12begin insert

begin insertSEC. 22.end insert  

end insert

begin insertSection 17613.1 of the end insertbegin insertWelfare and Institutions Codeend insert
13begin insert is amended to read:end insert

14

17613.1.  

(a) For the 2013-14 fiscal year and each fiscal year
15thereafter, for each county, the total amount that would be payable
16for the fiscal year from 1991 Health Realignment funds under
17Sections 17603, 17604,begin delete 17606.10,end delete and 17606.20, as those sections
18read on January 1, 2012, andbegin insert Section 17606.10, as it read on July
191, 2013, andend insert
deposited by the Controller into the local health and
20welfare trust fund health account of the county in the absence of
21this section, shall bebegin delete determined pursuant to paragraph (2) of
22subdivision (b) of Section 17600.50.end delete
begin insert determined.end insert

23(b) The redirected amount determined for the county pursuant
24to Sectionbegin delete 17613.3, or in accordance with subdivision (b) of Section
2517600.50 option-to-forgo formula,end delete
begin insert 17613.3end insert shall be divided by
26the total determined in subdivision (a).

27(c) The resulting fraction determined in subdivision (b) shall
28be the percentage of 1991 Health Realignment funds under Sections
2917603, 17604,begin delete 17606.10,end delete and 17606.20, as those sections read on
30January 1, 2012,begin insert and Section 17606.10, as it read on July 1, 2013,end insert
31 to be deposited each month into the Family Support Subaccount.

32(d) The total amount deposited pursuant to subdivision (c) with
33respect to a county for a fiscal year shall not exceed the redirected
34amount determined pursuant to Section 17613.3, and shall be
35subject to the appeal processes, and judicial review as described
36in subdivision (d) of Section 17613.3.

37(e) The Legislature finds and declares that this article is not
38intended to change the local obligation pursuant to section 17000.

39begin insert

begin insertSEC. 23.end insert  

end insert

begin insertSection 17613.2 of the end insertbegin insertWelfare and Institutions Codeend insert
40begin insert is amended to read:end insert

P69   1

17613.2.  

For purposes of this article, the following definitions
2shall apply:

3(a) “Base year” means the fiscal year ending three years prior
4to the fiscal year for which the redirected amount is calculated.

5(b) “Blended CPI trend factor” means the blended percent
6change applicable for the fiscal year that is derived from the
7nonseasonally adjusted Consumer Price Index for All Urban
8Consumers (CPI-U), United States City Average, for Hospital and
9Related Services, weighted at 75 percent, and for Medical Care
10Services, weighted at 25 percent, all as published by the United
11States Bureau of Labor Statistics, computed as follows:

12(1) For each prior fiscal year within the period to be trended
13through the state fiscal year, the annual average of the monthly
14index amounts shall be determined separately for the Hospital and
15Related Services Index and the Medical Care Services Index.

16(2) The year-to-year percentage changes in the annual averages
17determined in paragraph (1) for each of the Hospital and Related
18Services Index and the Medical Care Services Index shall be
19determined.

20(3) A weighted average annual percentage change for each
21year-to-year period shall be calculated from the determinations
22made in paragraph (2), with the percentage changes in the Hospital
23and Related Services Index weighted at 75 percent, and the
24percentage changes in the Medical Care Services Index weighted
25at 25 percent. The resulting average annual percentage changes
26shall be expressed as a fraction, and increased by 1.00.

27(4) The product of the successive year to year amounts
28determined in paragraph (3) shall be the blended CPI trend factor.

29(c) “Calculated cost per person” is determined by dividing
30county indigent program costs by the number of indigent program
31individuals for the applicable fiscal year. If a county expands
32eligibility, the enrollment count is limited to those indigent program
33individuals who would have been eligible for services under the
34eligibility requirements in existence on July 1, 2013, except if
35approved as an exception allowed pursuant to subparagraph (3) of
36paragraph (C) of subdivision (d).

37(d) “Cost containment limit” means the county’s indigent
38program costs determined for the 2014-15 fiscal year and each
39subsequent fiscal year, to be adjusted as follows:

P70   1(1) (A) The county’s indigent program costs for the state fiscal
2year shall be determined as indigent program costs for purposes
3of this paragraph for the relevant fiscal period.

4(B) The county’s calculated costs per person for the base year
5will be multiplied by the blended CPI trend factor and then
6multiplied by the county’s fiscal year indigent program individuals.
7The base year costs used shall not reflect any adjustments under
8this subdivision.

9(C) The fiscal year amount determined in subparagraph (A)
10shall be compared to the trended amount in subparagraph (B). If
11the amount in subparagraph (B) exceeds the amount in
12subparagraph (A), the county will be deemed to have satisfied the
13cost containment limit. If the amount in subparagraph (A) exceeds
14the amount in subparagraph (B), the calculation in paragraph (2)
15shall be performed.

16(2) If a county’s costs as determined in subparagraph (A) of
17paragraph (1) exceeds the amount determined in subparagraph (B)
18of paragraph (1), the following costs, as allocated to the county’s
19indigent care program, shall be added to the cost and reflected in
20any containment limit:

21(A) Costs related to state or federally mandated activities,
22requirements, or benefit changes.

23(B) Costs resulting from a court order or settlement.

24(C) Costs incurred as a result of a natural disaster or act of
25terrorism.

26(3) If a county’s costs as determined in subparagraph (A) of
27paragraph (1) exceed the amount determined in subparagraph (B)
28of paragraph (1), as adjusted by paragraph (2), the county may
29request that the department consider other costs as adjustments to
30the cost containment limit. These costs would require departmental
31approval.

32(e) “County” for purposes of this article means the following
33counties: Fresno, Merced, Orange, Placer, Sacramento, San Diego,
34San Luis Obispo, Santa Barbara, Santa Cruz, Stanislaus, Tulare,
35and Yolo.

36(f) “County indigent care health realignment amount” means
37the product of the health realignment amount times the health
38realignment indigent care percentage, as computed on a
39county-specific basis.

P71   1(g) “County savings determination process” means the process
2for determining the amount to be redirected in accordance with
3Section 17613.1, as calculated pursuant to subdivision (a) of
4Section 17613.3.

5(h) “Department” means the State Department of Health Care
6 Services.

7(i) “Health realignment amount” means the amount that, in the
8absence of this article, would be payable to a county under Sections
917603, 17604,begin delete 17606.10,end delete and 17606.20, as those sections read on
10January 1, 2012,begin insert and Section 17606.10, as it read on July 1, 2013,end insert
11 for the fiscal year that is deposited by the Controller into the local
12health and welfare trust fund health account of the county.

13(j) “Health realignment indigent care percentage” means the
14county-specific percentage determined in accordance with the
15following, and established in accordance with the procedures
16described in subdivision (c) of Section 17613.3:

17(1) Each county shall identify the portion of that county’s health
18realignment amount that was used to provide health services to
19the indigent, including the indigent program individuals, for each
20of the historical fiscal years, along with verifiable data in support
21thereof.

22(2) The amounts identified in paragraph (1) shall be expressed
23as a percentage of the health realignment amount of that county
24for each fiscal year of the historical fiscal years.

25(3) The average of the percentages determined in paragraph (2)
26shall be the county’s health realignment indigent care percentage.

27(4) To the extent a county does not provide the information
28required in paragraph (1) or the department determines that the
29information required is insufficient, the amount under this
30subdivision shall be considered to be 85 percent.

31(k) All references to “health services” or “health care services,”
32unless specified otherwise, shall exclude mental health and
33substance use disorder services.

34(l) “Historical fiscal years” means the fiscal years 2008-09 to
352011-12, inclusive.

36(m) “Imputed county low-income health amount” means the
37predetermined, county-specific amount of county general purpose
38funds assumed, for purposes of the calculation in Section 17613.3,
39to be available to the county for services to indigent program
40individuals. The imputed county low-income health amount shall
P72   1be determined as set forth below and established in accordance
2with subdivision (c) of Section 17613.3.

3(1) For each of the historical fiscal years, an amount shall be
4determined as the annual amount of county general fund
5contribution provided for health services to the indigent, which
6does not include funds provided for mental health and substance
7use disorder services, through a methodology to be developed by
8the department, in consultation with the California State
9Association of Counties.

10(2) If a year-to-year percentage increase in the amount
11determined in paragraph (1) was present, an average annual
12percentage trend factor shall be determined.

13(3) The annual amounts determined in paragraph (1) shall be
14averaged and multiplied by the percentage trend factor, if
15applicable, determined in paragraph (2), for each fiscal year after
16the 2011-12 fiscal year through the applicable fiscal year.
17Notwithstanding the foregoing, if the percentage trend factor
18determined in paragraph (2) is greater than the applicable
19percentage change for any year of the same period in the blended
20CPI trend factor, the percentage change in the blended CPI trend
21factor for that year shall be used. The resulting determination is
22the imputed county low-income health amount for purposes of
23Section 17613.3.

24(n) “Indigent program costs” means the costs incurred by the
25county for purchasing, providing, or ensuring the availability of
26services to indigent program individuals during the fiscal year.
27The costs for mental health and substance use disorder services
28shall not be included in these costs.

29(o) “Indigent program individuals” means all individuals
30enrolled in a county indigent health care program at any point
31throughout the fiscal year. If a county does not enroll individuals
32into an indigent health care program, indigent program individuals
33shall mean all individuals who used services offered through the
34county indigent health care program in the fiscal year.

35(p) “Indigent program revenues” means self-pay payments made
36by or on behalf of indigent program individuals to the county for
37the services rendered in the fiscal year, but shall exclude revenues
38received for mental health and substance use disorder services.

P73   1(q) “Redirected amount” means the amount to be redirected in
2accordance with Section 17613.1, as calculated pursuant to
3subdivision (a) of Section 17613.3.

4(r) “Special local health funds” means the amount of the
5following county funds received by the county for health services
6to indigent program individuals during the fiscal year and shall
7include funds available pursuant to the Master Settlement
8Agreement and related documents entered into on November 23,
91998, by the state and leading United States tobacco product
10manufacturers during a fiscal year. The amount of the tobacco
11settlement funds to be used for this purpose shall be the greater of
12begin delete subparagraph (A)end deletebegin insert paragraph (1)end insert orbegin delete (B),end deletebegin insert (2),end insert less any bond
13payments and other costs ofbegin delete securitization.end deletebegin insert securitization related
14to the funds described in this subdivision.end insert

begin delete

15(A)

end delete

16begin insert(1)end insert The amount of the funds expended by the county for the
17provision of health services to indigent program individuals during
18the fiscal year.

begin delete

19(B)

end delete

20begin insert(2)end insert The amount of the tobacco settlement funds multiplied by
21the average of the percentages of the amount of tobacco settlement
22funds that were allocated to and expended by thebegin delete noncountyend deletebegin insert countyend insert
23 for health services to indigent program individuals during the
24historical fiscal years.

25begin insert

begin insertSEC. 24.end insert  

end insert

begin insertSection 17613.3 of the end insertbegin insertWelfare and Institutions Codeend insert
26begin insert is amended to read:end insert

27

17613.3.  

(a) For each fiscal year commencing with the
282013-14 fiscal year, the amount to be redirected in accordance
29with Section 17613.1 shall be determined for each county as set
30forth in this section.

31(1) The county’s revenues and other funds paid or payable for
32the fiscal year shall be comprised of the total of the following:

33(A) Indigent program revenues.

34(B) Special local health funds.

35(C) The county indigent care health realignment amount.

36(D) The imputed county low-income health amount.

37(2) Indigent program costs incurred by the county for the fiscal
38year, not to exceed in total the cost containment limit, shall be
39subtracted from the sum in paragraph (1).

P74   1(3) The resulting amount shall be multiplied by 0.80, except
2that for the 2013-14 fiscal year where the resulting amount shall
3be multiplied by 0.70.

4(4) If the amount in paragraph (3) is a positive number, that
5amount, subject to paragraph (5), shall be redirected in accordance
6with Sectionbegin delete 17613.1.end deletebegin insert 17613.1, except that for the 2013-14 fiscal
7year, the amount to be redirected shall not exceed the amount
8determined for the county for the 2013-14 fiscal year under
9subdivision (c) of Section 17603, as that amount may have been
10reduced by the application of Section 17610.5.end insert
If the amount
11determined in paragraph (3) is a negative number, the redirected
12amount shall be zero.

13(5) Notwithstanding any other law, the amount to be redirected
14as determined in paragraph (4) for a fiscal year shall not exceed
15the county indigent care health realignment amount for that fiscal
16year.

17(6) (A) The redirected amount shall be applied until the later
18of the following:

19(i) June 30, 2023.

20(ii) The beginning of the fiscal year following a period of two
21consecutive fiscal years in which both of the following occur:

22(aa) The total interim amount determined under subdivision (b)
23in May of the previous fiscal year is within 10 percent of the final,
24reconciled amount in subdivision (d).

25(bb) The final, reconciled amounts under subdivision (d) are
26within 5 percent of each other.

27(B) After the redirected amount ceases as provided in
28subparagraph (A), a permanent redirected amount shall be
29established to be the amount determined by calculating the
30percentage that the redirected amount was in the last fiscal year
31of the operation of this article of the county’s health realignment
32amount of that same fiscal year, multiplied by the county’s health
33realignment amount of all subsequent years.

34(b) Starting with the 2014-15 fiscal year, the department shall
35calculate an interim redirected amount for each county under
36subdivision (a) by the January immediately prior to the starting
37fiscal year, using the most recent and accurate data available. For
38purposes of the interim determinations, the cost containment limit
39shall not be applied. The interim redirected amount shall be updated
40in the May before the start of the fiscal year in consultation with
P75   1each county and based on any more recent and accurate data
2available at that time. During the fiscal year, the interim redirected
3amount will be applied pursuant to Section 17613.1.

4(c) The predetermined amounts or historical percentages
5described in subdivisionsbegin delete (i),end deletebegin insert (j),end insert (m), andbegin delete (n)end deletebegin insert (r)end insert of Section 17613.2
6shall each be established in accordance with the following
7procedure:

8(1) Bybegin delete September 30,end deletebegin insert October 31,end insert 2013, each county shall
9determine the amount or percentage described in the applicable
10subdivision, and shall provide this calculation to the department,
11supported by verifiable data and a description of how the
12determination was made.

13(2) If the department disagrees with the county’s determination,
14the department shall confer with the county bybegin delete Novemberend delete
15begin insert Decemberend insert 15,begin delete 2013.end deletebegin insert 2013, and shall issue its determination by
16January 31, 2014.end insert

17(3) If no agreement between the parties has been reached by
18begin delete Decemberend deletebegin insert Januaryend insert 31,begin delete 2013,end deletebegin insert 2014,end insert the department shall apply the
19county’s determination when making the interim calculations
20pursuant to subdivision (b), until a decision is issued pursuant to
21paragraph (6).

22(4) begin delete Aend deletebegin insert If no agreement between the parties has been reached
23by January 31, 2014, theend insert
countybegin delete mayend deletebegin insert shallend insert submit a petitionbegin insert by
24February 28, 2014,end insert
to the County Health Care Funding Resolution
25Committee, established pursuant to Section 17600.60, to seek a
26decision regarding the historical percentage or amount to be applied
27in calculations under this section.

28(5) The County Health Care Funding Resolution Committee
29shall hear and make a determination as to whether the county’s
30proposed percentage or amount complies with the requirements
31of this section based on the data and calculations of the county and
32any alternative data and calculations submitted by the department.

33(6) The County Health Care Funding Resolution Committee
34shall issuebegin delete a decisionend deletebegin insert its final determinationend insert within 45 days of the
35petition. If the county chooses to contest thebegin insert finalend insert determination,
36thebegin delete decisionend deletebegin insert final determinationend insert of the committee will be applied
37for purposes of any interim calculation under subdivision (b) until
38a final decision is issued pursuant to de novo administrative review
39under paragraph (2) of subdivision (d).

P76   1(d) (1) The data for the final calculations under subdivision (a)
2for the fiscal year shall be submitted by counties within 12 months
3after the conclusion of each fiscal year as required in Section
417613.4. The data shall be the most recent and accurate data from
5the county’s books and records pertaining to the revenues paid or
6payable, and the costs incurred, for services provided in the subject
7fiscal year.begin delete Theend deletebegin insert After consulting with the county, theend insert department
8shall make final calculations using the data submitted pursuant to
9this paragraph by Decemberbegin delete 31end deletebegin insert 15end insert of the following fiscal year,
10and shall providebegin delete the calculationend deletebegin insert its final determinationend insert to the
11county. The finalbegin delete calculationsend deletebegin insert determinationend insert will also reflect the
12application of the cost containment limit, if any.begin delete Aend deletebegin insert If the county
13and the department agree, a revisedend insert
recalculation and
14reconciliationbegin delete shallend deletebegin insert mayend insert be completed by the department within
15six months thereafter.

16(2) The Director of Health Care Services shall establish an
17expedited formal appeal process for a county to contestbegin delete theend deletebegin insert finalend insert
18 determinations madebegin delete inend deletebegin insert underend insert thisbegin delete article, and only as follows:end delete
19begin insert article. No appeal shall be available for interim determinations
20made under subdivision (b). The appeals process shall include all
21of the following:end insert

22(A) The county shall have 30 calendar days, following the
23issuance of abegin insert finalend insert determination made underbegin insert paragraph (6) of
24subdivision (c) or paragraph (1) ofend insert
thisbegin delete article,end deletebegin insert subdivision,end insert to file
25an appeal with the director. All appeals shall be governed by
26Section 100171 of the Health and Safety Code, except for those
27provisions of paragraph (1) of subdivision (d) of Section 100171
28of the Health and Safety Code relating to accusations, statements
29of issues, statement to respondent, and notice of defense, and
30except as otherwise set forth in this section. All appeals shall be
31in writing and shall be filed with the State Department of Health
32Care Service’s Office of Administrative Hearings and Appeals.
33An appeal shall be deemed filed on the date it is received by the
34Office of Administrative Hearings and Appeals.

35(i) An appeal shall specifically set forth each issue in dispute,
36including, but not limited to, any component of the determination,
37and include the county’s contentions as to those issues. A formal
38hearing before an Office of Administrative Hearings and Appeals
39Administrative Law Judge shall commence withinbegin delete 45end deletebegin insert 60end insert days of
40the filing of the appeal requesting a formal hearing. A final decision
P77   1begin insert under this paragraphend insert shall be adoptedbegin delete within 60 days of the close
2of the record, butend delete
no later thanbegin delete fiveend deletebegin insert sixend insert months following the
3begin delete issuanceend deletebegin insert filingend insert of the appeal.

4(ii) If the county fails to file an appeal within 30 days of the
5issuance of a determination made under thisbegin delete article,end deletebegin insert section,end insert the
6determination of the department shall be deemed final and not
7appealable either administratively or to a court of general
8begin delete jurisdiction.end deletebegin insert jurisdiction, except that a county may elect to appeal
9a determination under subdivision (c) within 30 days of the
10issuance of the County Health Care Funding Resolution
11Committee’s final determination under paragraph (6) of
12subdivision (c) or as a component of an appeal of the department’s
13final determination under paragraph (1) for the 2013-14 fiscal
14year.end insert

15(B) If a final decisionbegin insert under this paragraphend insert is not issued by the
16department within two years of thebegin delete issuanceend deletebegin insert last dayend insert ofbegin delete a
17determination made under this article, theend delete
begin insert the subject fiscal year,
18theend insert
county shall be deemed to have exhausted its administrative
19remedies, and shall not be precluded from pursuing any available
20judicial review. However, the time period in this subdivision shall
21be extended by either of the following:

22(i) Undue delay caused by the county.

23(ii) An extension of time granted to a county at its sole request,
24or following the joint request of the county and the department.

25(C) If the final decision issued by the department pursuant to
26thisbegin delete sectionend deletebegin insert paragraphend insert results in a different determination than
27that originally made by the department, then the Department of
28Finance shall adjust the original determination by that amount,
29pursuant to a process developed by the Department of Finance and
30in consultation with the California State Association of Counties.

31begin insert

begin insertSEC. 25.end insert  

end insert

begin insertSection 17613.4 of the end insertbegin insertWelfare and Institutions Codeend insert
32begin insert is amended to read:end insert

33

17613.4.  

(a) Beginning with the 2013-14 fiscal year, each
34county that has elected to participate in the County Savings
35Determination Process shall, within five months after the end of
36each fiscal year, be required to submit initial reports on both of
37the following:

38(1) All revenue data required for the operation of Section
3917613.3, including both of the following:

40(A) Indigent program revenues.

P78   1(B) Special local health funds.

2(2) All cost data required for the operation of Section 17613.3,
3including indigent program costs.

4(b) Counties shall submit final reports of cost and revenue data
5identified in subdivision (a) to the department for the each fiscal
6year no later than June 30 of the fiscal year ending one year after
7the subject fiscal year.

8(c) The department shall develop, in consultation with California
9State Association of Counties, the methodologies used to determine
10the costs and revenues required to be reported and the format of
11the submissions.

12(d) Reports submitted under this section shall be accompanied
13by a certification by an appropriate public official attesting to the
14accuracy of the reports.

15(e) Notwithstanding Chapter 3.5 (commencing with Section
1611340) of Part 1 of Division 3 of Title 2 of the Government Code,
17the department, without taking any further regulatory action, shall
18implement, interpret, or make specific thisbegin delete sectionend deletebegin insert articleend insert by means
19of all-county letters, plan letters, plan or provider bulletins, or
20similar instructions.

21begin insert

begin insertSEC. 26.end insert  

end insert

begin insertSection 18901.2 of the end insertbegin insertWelfare and Institutions Codeend insert
22begin insert is amended to read:end insert

23

18901.2.  

(a) It is the intent of the Legislature to create a
24program in California that provides a nominal Low-Income Home
25Energy Assistance Program (LIHEAP) service benefit, through
26the LIHEAP block grant, to all recipient households of CalFresh
27so that they are made aware of services available under LIHEAP
28and so that some households may experience an increase in federal
29Supplemental Nutrition Assistance Program benefits, as well as
30benefit from paperwork reduction.

31(b) To the extent permitted by federal law, the State Department
32of Social Services (DSS) shall, in conjunction with the Department
33of Community Services and Development (CSD), design,
34implement, and maintain a utility assistance initiative: the “Heat
35and Eat” program.

36(1) The nominal LIHEAP service benefit shall be funded through
37the LIHEAP block grantbegin insert allocated for outreach activities in
38accordance with state and federal requirements, and shall beend insert

39 provided by the CSD to the DSSbegin delete uponend deletebegin insert afterend insert receipt by the CSD of
40the LIHEAP block grant funds from the federal funding authorities.

P79   1(2) The total amount transferred shall be the product of the
2nominal LIHEAP service benefit established by the CSD in the
3LIHEAP state plan multiplied by the number of CalFresh recipient
4households as agreed upon annually by the CSD and the DSS.

5(3) The total amount transferred shall be reduced by any
6unexpended or reinvested amounts remaining from prior transfers
7for the nominal LIHEAP service benefits as provided in
8subparagraph (C) of paragraph (1) of subdivision (c).

begin delete end deletebegin delete

9(4) Should the demand for the nominal LIHEAP service benefit
10exceed allocated funding, established by the CSD in the LIHEAP
11state plan, the CSD and DSS shall report that information to the
12Legislature and develop a plan to maintain the program as intended.

end delete
begin delete end delete

13(c) In implementing and maintaining the utility assistance
14initiative, the State Department of Social Services shall do all of
15the following:

16(1) (A) Grant recipient households of CalFresh benefits pursuant
17to this chapter a nominal LIHEAP service benefit out of the federal
18LIHEAP block grant (42 U.S.C. Sec. 8621 et seq.).

19(B) In establishing the nominal LIHEAP service benefit amount,
20the department shall take into consideration that the benefit level
21need not provide significant utility assistance.

22(C) Any funds allocated for this purpose not expended by
23CalFresh recipient households shall be recouped through the “Heat
24and Eat” program and reinvested into the program on an annual
25basis as determined by both departments.

26(2) Provide the nominal LIHEAP service benefit without
27requiring the applicant or recipient to provide additional paperwork
28or verification.

29(3) To the extent permitted by federal law and to the extent
30federal funds are available, provide the nominal LIHEAP service
31benefit annually to each recipient of CalFresh benefits.

32(4) (A) Deliver the nominal LIHEAP service benefit using the
33Electronic Benefit Transfer (EBT) system or other nonpaper
34delivery system.

35(B) Notification of a recipient’s impending EBT dormant
36account status shall not be required when the remaining balance
37in a recipient’s account at the time the account becomes inactive
38is ninety-nine cents ($0.99) or less of LIHEAP service benefits.

39(5) Ensure that receipt of the nominal LIHEAP service benefit
40pursuant to this section shall not adversely affect a CalFresh
P80   1recipient household’s eligibility, reduce a household’s CalFresh
2benefits, or disqualify the applicant or recipient of CalFresh
3benefits from receiving other nominal LIHEAP service benefits
4or other utility benefits for which they may qualify.

5(d) Recipients of the nominal LIHEAP service benefit pursuant
6to this section shall remain subject to the additional eligibility
7requirements for LIHEAP assistance as outlined in the California
8LIHEAP state plan, developed by the CSD.

9(e) (1) To the extent permitted by federal law, a CalFresh
10household receiving or anticipating receipt of nominal LIHEAP
11service benefits pursuant to the utility assistance initiative or any
12other law shall be entitled to use the full standard utility allowance
13(SUA) for the purposes of calculating CalFresh benefits. A
14CalFresh household shall be entitled to use the full SUA regardless
15of whether the nominal LIHEAP service benefit is actually
16redeemed.

17(2) If use of the full SUA, instead of the homeless shelter
18deduction, results in a lower amount of CalFresh benefits for a
19homeless household, the homeless household shall be entitled to
20use the homeless shelter deduction instead of the full SUA.

21(f) The department shall implement the initiative by January 1,
222013.

23begin insert

begin insertSEC. 27.end insert  

end insert
begin insert

This act is a bill providing for appropriations related
24to the Budget Bill within the meaning of subdivision (e) of Section
2512 of Article IV of the California Constitution, has been identified
26as related to the budget in the Budget Bill, and shall take effect
27immediately.

end insert
begin delete
28

SECTION 1.  

It is the intent of the Legislature to enact statutory
29changes relating to the Budget Act of 2013.

end delete


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