Amended in Senate April 3, 2013

Senate Bill No. 640

Introduced by Senator Lara

February 22, 2013

An act to begin delete amend end delete begin insert add end insert Section begin delete 14000 of end delete begin insert 14105.194 to end insert the Welfare and Institutions Code, relating to begin delete Medi-Cal end delete begin insert Medi-Cal, and declaring the urgency thereof, to take effect immediately end insert .

LEGISLATIVE COUNSEL’S DIGEST

SB 640, as amended, Lara. begin delete Medi-Cal. end delete begin insert Medi-Cal: reimbursement: provider payments. end insert

The Med-Cal Act establishes 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. begin delete Existing law provides that the purpose of the Medi-Cal Act is to afford to qualifying individuals health care and related remedial or preventive services, including related social services that are necessary for those receiving health care. end delete begin insert end insert begin insert Existing law requires, except as otherwise provided, Medi-Cal provider payments to be reduced by 1% or 5%, and provider payments for specified non-Medi-Cal programs to be reduced by 1%, for dates of service on and after March 1, 2009, and until June 1, 2011. Existing law requires, except as otherwise provided, Medi-Cal provider payments and payments for specified non-Medi-Cal programs to be reduced by 10% for dates of service on and after June 1, 2011. end insert

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This bill would instead require that this payment reduction not apply to skilled nursing facilities or subacute care units that are a distinct part of a general acute care hospital, or to specified Medi-Cal provider payments for fee-for-service benefits, including payments to pharmacies, for dates of service on or after June 1, 2011.

end insert begin insert

This bill would declare that it is to take effect immediately as an urgency statute.

end insert begin delete

This bill would make a technical, nonsubstantive change to those provisions.

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Vote:  begin delete majority end delete begin insert ²⁄₃ end insert . Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program: no.

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

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begin insert SECTION 1. end insert   

end insert

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

begin insert

begin insert 14105.194. end insert   

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

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

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

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

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

(f) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department may implement this section by means of provider
bulletins or notices, policy letters, or other similar instructions,
without taking regulatory action.

end insert

begin insert

begin insert SEC. 2. end insert   

end insert begin insert

This act is an urgency statute necessary for the
immediate preservation of the public peace, health, or safety within
the meaning of Article IV of the Constitution and shall go into
immediate effect. The facts constituting the necessity are:

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

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begin delete

SECTION 1.  

Section 14000 of the Welfare and Institutions
Code is amended to read:

14000.  

The purpose of this chapter is to afford to qualifying
individuals health care and related remedial or preventive services,
including related social services that are necessary for those
receiving health care under this chapter.

The intent of the Legislature is to provide, to the extent
practicable, through the provisions of this chapter, for health care
for those aged and other persons, including family persons who
lack sufficient annual income to meet the costs of health care, and
whose other assets are so limited that their application toward the
costs of such care would jeopardize the person or family’s future
minimum self-maintenance and security. It is intended that
whenever possible and feasible:

(a) The means employed shall allow, to the extent practicable,
eligible persons to secure health care in the same manner employed
by the public generally, and without discrimination or segregation
based purely on their economic disability. The means employed
shall include an emphasis on efforts to arrange and encourage
access to health care through enrollment in organized, managed
care plans of the type available to the general public.

(b) The benefits available under this chapter shall not duplicate
those provided under other federal or state laws or under other
contractual or legal entitlements of the person or persons receiving
them.

(c) In the administration of this chapter and in establishing the
means to be used to provide access to health care to persons eligible
under this chapter, the department shall emphasize and take
advantage of both the efficient organization and ready accessibility
and availability of health care facilities and resources through
enrollment in managed health care plans and new and innovative
fee-for-service managed health care plan approaches to the delivery
of health care services.

end delete