BILL NUMBER: SB 239 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 17, 2013
INTRODUCED BY Senators Hernandez and Steinberg
FEBRUARY 12, 2013
An act to amend Section 14167.35 of, and to add Article 5.230
(commencing with Section 14169.51) and Article 5.231 (commencing
with Section 14169.71) to Chapter 7 of Part 3 of Division 9 of, the
Welfare an d Institutions Code, relating to
Medi-Cal , and declaring the urgency thereof, to take effect
immediately .
LEGISLATIVE COUNSEL'S DIGEST
SB 239, as amended, Hernandez. Medi-Cal: hospital quality
assurance fee.
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, subject to federal
approval, imposes a quality assurance fee, as specified, on certain
general acute care hospitals from July 1, 2011, through December 31,
2013. Existing law, subject to federal approval, requires the fee to
be deposited into the Hospital Quality Assurance Revenue Fund, and
requires that the moneys in the fund be used, upon appropriation by
the Legislature, only for certain purposes, including, among other
things, paying for health care coverage for children and making
supplemental payments for certain services to private hospitals,
increased capitation payments to Medi-Cal managed care plans, and
increased payments to mental health plans.
This bill would state the intent of the Legislature to impose a
quality assurance fee to be paid by hospitals, which would be used to
increase federal financial participation in order to make
supplemental Medi-Cal payments to hospitals for the period of January
1, 2014, through December 31, 2015, and to help pay for health care
coverage for low-income children. This bill would require the
department to make every effort to obtain the necessary federal
approvals to implement the quality assurance fee as described.
This bill would, subject to federal approval, impose a hospital
quality assurance fee, as specified, on certain general acute care
hospitals from January 1, 2014, through December 30, 2015, to be
deposited into the Hospital Quality Assurance Revenue Fund. This bill
would, subject to federal approval, impose a hospital quality
assurance fee, as specified, on certain general acute care hospitals
from January 1, 2014, through December 30, 2015, to be deposited into
the Hospital Quality Assurance Revenue Fund. The bill would, subject
to federal approval, require supplemental payments to be made to
private hospitals for certain services and increased capitation
payments to be made to Medi-Cal managed care plans, as specified. The
bill would also make conforming changes.
This bill would declare that it is to take effect immediately as
an urgency statute.
Vote: majority 2/3 . Appropriation:
no. Fiscal committee: no yes .
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares both of the
following:
(a) The Legislature continues to recognize the essential role that
hospitals play in serving the state's Medi-Cal beneficiaries. To
that end, it has been, and remains, the intent of the Legislature to
improve funding for hospitals and obtain all available federal funds
to make supplemental Medi-Cal payments to hospitals.
(b) It is the intent of the Legislature that funding provided to
hospitals through a hospital quality assurance fee be explored with
the goal of increasing access to care and improving hospital
reimbursement through supplemental Medi-Cal payments to hospitals.
SEC. 2. (a) It is the intent of the Legislature to impose a
quality assurance fee to be paid by hospitals, which would be used to
increase federal financial participation in order to make
supplemental Medi-Cal payments to hospitals for the period of January
1, 2014, through December 31, 2015, and to help pay for health care
coverage for low-income children.
(b) The State Department of Health Care Services shall make every
effort to obtain the necessary federal approvals to implement the
quality assurance fee described in subdivision (a) in order to make
supplemental Medi-Cal payments to hospitals for the period of January
1, 2014, through December 31, 2015.
(c) It is the intent of the Legislature that the quality assurance
fee be implemented only if all of the following conditions are met:
(1) The quality assurance fee is established in consultation with
the hospital community.
(2) The quality assurance fee, including any interest earned after
collection by the department, is deposited into segregated funds
apart from the General Fund and used exclusively for supplemental
Medi-Cal payments to hospitals, health care coverage for low-income
children, and for the direct costs of administering the program by
the department.
(3) No hospital shall be required to pay the quality assurance fee
to the department unless and until the state receives and maintains
federal approval of the quality assurance fee and related
supplemental payments to hospitals.
(4) The full amount of the quality assurance fee assessed and
collected remains available only for the purposes specified by the
Legislature in this act.
SEC. 3. Section 14167.35 of the Welfare
and Institutions Code is amended to read:
14167.35. (a) The Hospital Quality Assurance Revenue Fund is
hereby created in the State Treasury.
(b) (1) All fees required to be paid to the state pursuant to this
article shall be paid in the form of remittances payable to the
department.
(2) The department shall directly transmit the fee payments to the
Treasurer to be deposited in the Hospital Quality Assurance Revenue
Fund. Notwithstanding Section 16305.7 of the Government Code, any
interest and dividends earned on deposits in the fund shall be
retained in the fund for purposes specified in subdivision (c).
(c) All funds in the Hospital Quality Assurance Revenue Fund,
together with any interest and dividends earned on money in the fund,
shall, upon appropriation by the Legislature, be used exclusively to
enhance federal financial participation for hospital services under
the Medi-Cal program, to provide additional reimbursement to, and to
support quality improvement efforts of, hospitals, and to minimize
uncompensated care provided by hospitals to uninsured patients, in
the following order of priority:
(1) To pay for the department's staffing and administrative costs
directly attributable to implementing Article 5.21 (commencing with
Section 14167.1) and this article, including any administrative fees
that the director determines shall be paid to mental health plans
pursuant to subdivision (d) of Section 14167.11 and repayment of the
loan made to the department from the Private Hospital Supplemental
Fund pursuant to the act that added this section.
(2) To pay for the health care coverage for children in the amount
of eighty million dollars ($80,000,000) for each subject fiscal
quarter for which payments are made under Article 5.21 (commencing
with Section 14167.1).
(3) To make increased capitation payments to managed health care
plans pursuant to Article 5.21 (commencing with Section 14167.1).
(4) To pay funds from the Hospital Quality Assurance Revenue Fund
pursuant to Section 14167.5 that would have been used for grant
payments and that are retained by the state, and to make increased
payments to hospitals, including grants, pursuant to Article 5.21
(commencing with Section 14167.1), both of which shall be of equal
priority.
(5) To make increased payments to mental health plans pursuant to
Article 5.21 (commencing with Section 14167.1).
(d) Any amounts of the quality assurance fee collected in excess
of the funds required to implement subdivision (c), including any
funds recovered under subdivision (d) of Section 14167.14 or
subdivision (e) of Section 14167.36, shall be refunded to general
acute care hospitals, pro rata with the amount of quality assurance
fee paid by the hospital, subject to the limitations of federal law.
If federal rules prohibit the refund described in this subdivision,
the excess funds shall be deposited in the Distressed Hospital Fund
to be used for the purposes described in Section 14166.23, and shall
be supplemental to and not supplant existing funds.
(e) Any methodology or other provision specified in Article 5.21
(commencing with Section 14167.1) and this article may be modified by
the department, in consultation with the hospital community, to the
extent necessary to meet the requirements of federal law or
regulations to obtain federal approval or to enhance the probability
that federal approval can be obtained, provided the modifications do
not violate the spirit and intent of Article 5.21 (commencing with
Section 14167.1) or this article and are not inconsistent with the
conditions of implementation set forth in Section 14167.36.
(f) The department, in consultation with the hospital community,
shall make adjustments, as necessary, to the amounts calculated
pursuant to Section 14167.32 in order to ensure compliance with the
federal requirements set forth in Section 433.68 of Title 42 of the
Code of Federal Regulations or elsewhere in federal law.
(g) The department shall request approval from the federal Centers
for Medicare and Medicaid Services for the implementation of this
article. In making this request, the department shall seek specific
approval from the federal Centers for Medicare and Medicaid Services
to exempt providers identified in this article as exempt from the
fees specified, including the submission, as may be necessary, of a
request for waiver of the broad based requirement, waiver of the
uniform fee requirement, or both, pursuant to paragraphs (e)(1) and
(e)(2) of Section 433.68 of Title 42 of the Code of Federal
Regulations.
(h) (1) For purposes of this section, a modification pursuant to
this section shall be implemented only if the modification, change,
or adjustment does not do either of the following:
(A) Reduces or increases the supplemental payments or grants made
under Article 5.21 (commencing with Section 14167.1) in the aggregate
for the 2008-09, 2009-10, and 2010-11 federal fiscal years to a
hospital by more than 2 percent of the amount that would be
determined under this article without any change or adjustment.
(B) Reduces or increases the amount of the fee payable by a
hospital in total under this article for the 2008-09, 2009-10, and
2010-11 federal fiscal years by more than 2 percent of the amount
that would be determined under this article without any change or
adjustment.
(2) The department shall provide the Joint Legislative Budget
Committee and the fiscal and appropriate policy committees of the
Legislature a status update of the implementation of Article 5.21
(commencing with Section 14167.1) and this article on January 1,
2010, and quarterly thereafter. Information on any adjustments or
modifications to the provisions of this article or Article 5.21
(commencing with Section 14167.1) that may be required for federal
approval shall be provided coincident with the consultation required
under subdivisions (f) and (g).
(i) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement this article or Article 5.21 (commencing
with Section 14167.1) by means of provider bulletins, all plan
letters, or other similar instruction, without taking regulatory
action. The department shall also provide notification to the Joint
Legislative Budget Committee and to the appropriate policy and fiscal
committees of the Legislature within five working days when the
above-described action is taken in order to inform the Legislature
that the action is being implemented.
(j) Notwithstanding any law, the Controller may use the funds in
the Hospital Quality Assurance Revenue Fund for cashflow loans to the
General Fund as provided in Sections 16310 and 16381 of the
Government Code.
(k) Notwithstanding Sections 14167.17 and 14167.40, subdivisions
(b) to (h), inclusive, shall become inoperative on January 1, 2013,
subdivisions (a), (i), and (j) shall remain operative until January
1, 2015, 2017, and as of January 1,
2015, 2017, this section is repealed.
SEC. 4. Article 5.230 (commencing with Section
14169.51) is added to Chapter 7 of Part 3 of Division 9 of the
Welfare and Institutions Code , to read:
Article 5.230. Medi-Cal Hospital Reimbursement Improvement Act
of 2014
14169.51. For the purposes of this article, the following
definitions shall apply:
(a) "General acute care days" means the total number of Medi-Cal
general acute care days paid by the department to a hospital for
services in the __ calendar year, as reflected in the state paid
claims file on ___.
(b) "Hospital inpatient services" means all services covered under
Medi-Cal and furnished by hospitals to patients who are admitted as
hospital inpatients and reimbursed on a fee-for-service basis by the
department directly or through its fiscal intermediary. Hospital
inpatient services include outpatient services furnished by a
hospital to a patient who is admitted to that hospital within 24
hours of the provision of the outpatient services that are related to
the condition for which the patient is admitted. Hospital inpatient
services do not include services for which a managed health care plan
is financially responsible.
(c) "Hospital outpatient services" means all services covered
under Medi-Cal furnished by hospitals to patients who are registered
as hospital outpatients and reimbursed by the department on a
fee-for-service basis directly or through its fiscal intermediary.
Hospital outpatient services do not include services for which a
managed health care plan is financially responsible, or services
rendered by a hospital-based federally qualified health center for
which reimbursement is received pursuant to Section 14132.100.
(d) (1) "Managed health care plan" means a health care delivery
system that manages the provision of health care and receives prepaid
capitated payments from the state in return for providing services
to Medi-Cal beneficiaries.
(2) (A) Managed health care plans include county organized health
systems and entities contracting with the department to provide
services pursuant to two-plan models and geographic managed care.
Entities providing these services contract with the department
pursuant to any of the following:
(i) Article 2.7 (commencing with Section 14087.3).
(ii) Article 2.8 (commencing with Section 14087.5).
(iii) Article 2.81 (commencing with Section 14087.96).
(iv) Article 2.91 (commencing with Section 14089).
(B) Managed health care plans do not include any of the following:
(i) Mental health plans contracting to provide mental health care
for Medi-Cal beneficiaries pursuant to Chapter 8.9 (commencing with
Section 14700).
(ii) Health plans not covering inpatient services such as primary
care case management plans operating pursuant to Section 14088.85.
(iii) Program for All-Inclusive Care for the Elderly organizations
operating pursuant to Chapter 8.75 (commencing with Section 14591).
(e) "New hospital" means a hospital operation, business, or
facility functioning under current or prior ownership as a private
hospital that does not have a days data source or a hospital that has
a days data source in whole, or in part, from a previous operator
where there is an outstanding monetary liability owed to the state in
connection with the Medi-Cal program and the new operator did not
assume liability for the outstanding monetary obligation.
(f) "Private hospital" means a hospital that meets all of the
following conditions:
(1) Is licensed pursuant to subdivision (a) of Section 1250 of the
Health and Safety Code.
(2) Is in the Charitable Research Hospital peer group, as set
forth in the 1991 Hospital Peer Grouping Report published by the
department, or is not designated as a specialty hospital in the
hospital's Office of Statewide Health Planning and Development Annual
Financial Disclosure Report for the hospital's latest fiscal year
ending in __.
(3) Does not satisfy the Medicare criteria to be classified as a
long-term care hospital.
(4) Is a nonpublic hospital, nonpublic converted hospital, or
converted hospital as those terms are defined in paragraphs (26) to
(28), inclusive, respectively, of subdivision (a) of Section
14105.98.
(g) "Program period" means the period from January 1, 2014, to
December 31, 2015, inclusive.
(h) "Upper payment limit" means a federal upper payment limit on
the amount of the Medicaid payment for which federal financial
participation is available for a class of service and a class of
health care providers, as specified in Part 447 of Title 42 of the
Code of Federal Regulations. The applicable upper payment limit shall
be separately calculated for inpatient and outpatient hospital
services.
14169.52. Private hospitals shall be paid supplemental amounts
for the provision of hospital outpatient services as set forth in
this section. The supplemental amounts shall be in addition to any
other amounts payable to hospitals with respect to those services and
shall not affect any other payments to hospitals. The supplemental
amounts shall result in payments equal to the statewide aggregate
upper payment limit for private hospitals for each subject fiscal
year.
14169.53. Private hospitals shall be paid supplemental amounts
for the provision of hospital inpatient services for the program
period as set forth in this section. The supplemental amounts shall
be in addition to any other amounts payable to hospitals with respect
to those services and shall not affect any other payments to
hospitals. The supplemental amounts shall result in payments equal to
the statewide aggregate upper payment limit for private hospitals
for each subject fiscal year.
14169.54. (a) The department shall increase capitation payments
to Medi-Cal managed health care plans for each subject fiscal year as
set forth in this section.
(b) The increased capitation payments shall be made as part of the
monthly capitated payments made by the department to managed health
care plans.
(c) The aggregate amount of increased capitation payments to all
Medi-Cal managed health care plans for each subject fiscal year shall
be the maximum amount for which federal financial participation is
available on an aggregate statewide basis for the applicable subject
fiscal year.
(d) The department shall determine the amount of the increased
capitation payments for each managed health care plan. The department
shall consider the composition of Medi-Cal enrollees in the plan,
the anticipated utilization of hospital services by the plan's
Medi-Cal enrollees, and other factors that the department determines
are reasonable and appropriate to ensure access to high-quality
hospital services by the plan's enrollees.
(e) The amount of increased capitation payments to each Medi-Cal
managed health care plan shall not exceed an amount that results in
capitation payments that are certified by the state's actuary as
meeting federal requirements, taking into account the requirement
that all of the increased capitation payments under this section
shall be paid by the Medi-Cal managed health care plans to hospitals
for hospital services to Medi-Cal enrollees of the plan.
(f) (1) The increased capitation payments to managed health care
plans under this section shall be made to support the availability of
hospital services and ensure access to hospital services for
Medi-Cal beneficiaries. The increased capitation payments to managed
health care plans shall commence within 90 days of the date on which
all necessary federal approvals have been received, and shall
include, but not be limited to, the sum of the increased payments for
all prior months for which payments are due.
(2) To secure the necessary funding for the payment or payments
made pursuant to paragraph (1), the department may accumulate funds
in the Hospital Quality Assurance Revenue Fund, established pursuant
to Section 14167.35, for the purpose of funding managed health care
capitation payments under this article regardless of the date on
which capitation payments are scheduled to be paid in order to secure
the necessary total funding for managed health care payments by
December 31, 2015.
(g) Payments to managed health care plans that would be paid
consistent with actuarial certification and enrollment in the absence
of the payments made pursuant to this section, including, but not
limited to, payments described in Section 14182.15, shall not be
reduced as a consequence of payments under this section.
(h) (1) Each managed health care plan shall expend 100 percent of
any increased capitation payments it receives under this section on
hospital services.
(2) The department may issue change orders to amend contracts with
managed health care plans as needed to adjust monthly capitation
payments in order to implement this section.
(3) For entities contracting with the department pursuant to
Article 2.91 (commencing with Section 14089), any incremental
increase in capitation rates pursuant to this section shall not be
subject to negotiation and approval by the California Medical
Assistance Commission.
(i) In the event federal financial participation is not available
for all of the increased capitation payments determined for a month
pursuant to this section for any reason, the increased capitation
payments mandated by this section for that month shall be reduced
proportionately to the amount for which federal financial
participation is available.
14169.55. (a) Each managed health care plan receiving increased
capitation payments under Section 14169.54 shall expend the
capitation rate increases in a manner consistent with actuarial
certification, enrollment, and utilization on hospital services. Each
managed health care plan shall expend increased capitation payments
on hospital services within 30 days of receiving the increased
capitation payments to the extent they are made for a subject month
that is prior to the date on which the payments are received by the
managed health care plan.
(b) The sum of all expenditures made by a managed health care plan
for hospital services pursuant to this section shall equal, or
approximately equal, all increased capitation payments received by
the managed health care plan, consistent with actuarial
certification, enrollment, and utilization, from the department
pursuant to Section 14169.54.
(c) Any delegation or attempted delegation by a managed health
care plan of its obligation to expend the capitation rate increases
under this section shall not relieve the plan from its obligation to
expend those capitation rate increases. Managed health care plans
shall submit the documentation that the department may require to
demonstrate compliance with this subdivision. The documentation shall
demonstrate actual expenditure of the capitation rate increases for
hospital services, and not assignment to subcontractors of the
managed health care plan's obligation of the duty to expend the
capitation rate increases.
(d) The supplemental hospital payments made by managed health care
plans pursuant to this section shall reflect the overall purpose of
this article and Article 5.231 (commencing with Section 14169.71).
(e) This article is not intended to create a private right of
action by a hospital against a managed care plan provided that the
managed health care plan expends all increased capitation payments
for hospital services.
14169.56. (a) Exclusive of payments made under Article ____
(commencing with Section ____) and Article ____ (commencing with
Section ____), payment rates for hospital outpatient services,
furnished by private hospitals, nondesignated public hospitals, and
designated public hospitals before December 31, 2015, exclusive of
amounts payable under this article, shall not be reduced below the
rates in effect on January 1, 2014.
(b) Rates payable to hospitals for hospital inpatient services
furnished before December 31, 2015, under contracts negotiated
pursuant to the selective provider contracting program under Article
2.6 (commencing with Section 14081), shall not be reduced below the
contract rates in effect on January 1, 2014. This subdivision shall
not prohibit changes to the supplemental payments paid to individual
hospitals under Sections 14166.12, 14166.17, and 14166.23, provided
that the aggregate amount of the payments for each subject fiscal
year is not less than the minimum amount permitted under former
Section 14167.13.
(c) Notwithstanding Section 14105.281, exclusive of payments made
under former Article 5.21 (commencing with Section 14167.1) and
Article 5.226 (commencing with Section 14168.1), payments to private
hospitals for hospital inpatient services furnished before January 1,
2014, that are not reimbursed under a contract negotiated pursuant
to the selective provider contracting program under Article 2.6
(commencing with Section 14081), exclusive of amounts payable under
this article, shall not be less than the amount of payments that
would have been made under the payment methodology in effect on the
effective date of this article.
(d) Upon the implementation of the new Medi-Cal inpatient hospital
reimbursement methodology based on diagnosis-related groups pursuant
to Section 14105.28, the requirements in subdivisions (b) and (c)
shall be met if the rates paid under the new Medi-Cal inpatient
hospital reimbursement methodology based on diagnosis-related groups
result in an average payment per discharge to all hospitals subject
to the new reimbursement methodology, calculated on an aggregate
basis per subject fiscal year, exclusive of amounts payable under
this article, amounts payable under Sections 14166.11 and 14166.23,
and if amounts payable under Sections 14166.12 and 14166.17 are not
included in the payments under the diagnosis-related group
methodology and continue to be paid separately to hospitals,
exclusive of those amounts, that is not less than the average payment
per discharge to the hospitals, exclusive of amounts payable under
this article, amounts payable under Sections 14166.11 and 14166.23,
and if amounts payable under Sections 14166.12 and 14166.17 are not
included in the payments under the diagnosis-related group
methodology and continue to be paid separately to hospitals,
exclusive of those amounts, calculated on an aggregate basis for the
fiscal year ending June 30, 2012, adjusted, in consultation with the
hospital community, to reflect the movement of populations into
managed care under Article 5.4 (commencing with Section 14180).
(e) Solely for purposes of this article, a rate reduction or a
change in a rate methodology that is enjoined by a court shall be
included in the determination of a rate or a rate methodology until
all appeals or judicial reviews have been exhausted and the rate
reduction or change in rate methodology has been permanently
enjoined, denied by the federal government, or otherwise permanently
prevented from being implemented.
(f) Disproportionate share replacement payments to private
hospitals shall be not less than the amount determined pursuant to
Section 14166.11. For purposes
of this subdivision, references to Section 14166.11 are to the
version of Section 14166.11 in effect on the effective date of the
act that added this subdivision.
SEC. 5. Article 5.231 (commencing with Section
14169.71) is added to Chapter 3 of Part 7 of Division 9 of the
Welfare and Institutions Code , to read:
Article 5.231. Private Hospital Quality Assurance Fee Act of
2014
14169.71. (a) There shall be imposed on each general acute care
hospital that is not an exempt facility a quality assurance fee,
provided that a quality assurance fee under this article shall not be
imposed on a converted hospital.
(b) The quality assurance fee shall be computed starting on
January 1, 2014, and continue through and including December 31,
2015.
(c) The quality assurance fee, as paid pursuant to this section,
shall be paid by each hospital subject to the fee to the department
for deposit in the Hospital Quality Assurance Revenue Fund. Deposits
may be accepted at any time and will be credited toward the program
period.
(d) This section shall become inoperative if the federal Centers
for Medicare and Medicaid Services denies approval for, or does not
approve before July 1, 2015, the implementation of the quality
assurance fee pursuant to this article or the supplemental payments
to private hospitals described in Sections 14169.52 and 14169.53.
(e) In no case shall the aggregate fees collected in a federal
fiscal year pursuant to this section, former Section 14167.32,
Section 14168.32, and Section 14169.32 exceed the maximum percentage
of the annual aggregate net patient revenue for hospitals subject to
the fee that is prescribed pursuant to federal law and regulations as
necessary to preclude a finding that an indirect guarantee has been
created.
(f) The department shall work in consultation with the hospital
community to implement this article and Article 5.230 (commencing
with Section 14169.51).
(g) This subdivision creates a contractually enforceable promise
on behalf of the state to use the proceeds of the quality assurance
fee, including any federal matching funds, solely and exclusively for
the purposes set forth in this article as they existed on the
effective date of this article, to limit the amount of the proceeds
of the quality assurance fee to be used to pay for the health care
coverage of children to the amounts specified in this article, to
limit any payments for the department's costs of administration to
the amounts set forth in this article on the effective date of this
article, to maintain and continue prior reimbursement levels as set
forth in Section ____ on the effective date of that article, and to
otherwise comply with all its obligations set forth in Article 5.230
(commencing with Section 14169.51) and this article provided that
amendments that arise from, or have as a basis for, a decision,
advice, or determination by the federal Centers for Medicare and
Medicaid Services relating to federal approval of the quality
assurance fee or the payments set forth in this article or Article
5.230 (commencing with Section 14169.51) shall control for the
purposes of this subdivision.
(h) (1) Effective January 1, 2014, the rates payable to hospitals
and managed health care plans under Medi-Cal shall be the rates then
payable without the supplemental and increased capitation payments
set forth in Article 5.230 (commencing with Section 14169.51).
(2) The supplemental payments and other payments under Article
5.230 (commencing with Section 14169.51) shall be regarded as quality
assurance payments, the implementation or suspension of which does
not affect a determination of the adequacy of any rates under federal
law.
14169.72. (a) (1) All fees required to be paid to the state
pursuant to this article shall be paid in the form of remittances
payable to the department.
(2) The department shall directly transmit the fee payments to the
Treasurer to be deposited in the Hospital Quality Assurance Revenue
Fund, created pursuant to Section 14167.35. Notwithstanding Section
16305.7 of the Government Code, any interest and dividends earned on
deposits in the fund from the proceeds of the fee assessed pursuant
to this article shall be retained in the fund for purposes specified
in subdivision (b).
(b) Notwithstanding subdivision (c) of Section 14167.35,
subdivision (b) of Section 14168.33, and subdivision (b) of Section
14169.33, all funds from the proceeds of the fee assessed pursuant to
this article in the Hospital Quality Assurance Revenue Fund,
together with any interest and dividends earned on money in the fund,
shall, upon appropriation by the Legislature, continue to be used
exclusively to enhance federal financial participation for hospital
services under the Medi-Cal program, to provide additional
reimbursement to, and to support quality improvement efforts of,
hospitals, and to minimize uncompensated care provided by hospitals
to uninsured patients.
14169.73. (a) This article shall be implemented only as long as
all of the following conditions are met:
(1) Subject to Section ____, the quality assurance fee is
established in a manner that is fundamentally consistent with this
article.
(2) The quality assurance fee, including any interest on the fee
after collection by the department, is deposited in a segregated fund
apart from the General Fund.
(3) The proceeds of the quality assurance fee, including any
interest and related federal reimbursement, may only be used for the
purposes set forth in this article.
(b) No hospital shall be required to pay the quality assurance fee
to the department unless and until the state receives and maintains
federal approval.
(c) Hospitals shall be required to pay the quality assurance fee
to the department as set forth in this article only as long as all of
the following conditions are met:
(1) The federal Centers for Medicare and Medicaid Services allows
the use of the quality assurance fee as set forth in this article in
accordance with federal approval.
(2) Article 5.230 (commencing with Section 14169.51) is enacted
and remains in effect and hospitals are reimbursed the increased
rates for services during the program period, as defined in Section
14169.51.
(3) The full amount of the quality assurance fee assessed and
collected pursuant to this article remains available only for the
purposes specified in this article.
SEC. 6. This act is an urgency statute necessary
for the immediate preservation of the public peace, health, or safety
within the meaning of Article IV of the Constitution and shall go
into immediate effect. The facts constituting the necessity are:
In order to make the necessary changes to increase medi-cal
payments to hospitals and improve access at the earliest time, so as
to allow this act to be operative as soon as approval from the
federal centers for Medicare and Medicaid Services is obtained by the
State Department of Health Care Services, it is necessary that this
act takes effect immediately.