BILL NUMBER: SB 640 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 3, 2013
INTRODUCED BY Senator Lara
FEBRUARY 22, 2013
An act to amend add Section
14000 of 14105.194 to the Welfare and
Institutions Code, relating to Medi-Cal
Medi-Cal, and declaring the urgency thereof, to take effect
immediately .
LEGISLATIVE COUNSEL'S DIGEST
SB 640, as amended, Lara. Medi-Cal.
Medi-Cal: reimbursement: provider payments.
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. 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. Existing law requires, except as
otherwise provided, Medi-Cal provider payments to be
reduced by 1% or 5%, and provider payments for specified non-Medi-Cal
programs to be reduced by 1%, for dates of service on and after
March 1, 2009, and until June 1, 2011. Existing law requires, except
as otherwise provided, Medi-Cal provider payments and payments for
specified non-Medi-Cal programs to be reduced by 10% for dates of
service on and after June 1, 2011.
This bill would instead require that 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.
This bill would declare that it is to take effect immediately as
an urgency statute.
This bill would make a technical, nonsubstantive change to those
provisions.
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. Section 14105.194 is added to the
Welfare and Institutions Code , to read:
14105.194. (a) Notwithstanding Section 14105.192, except as
otherwise provided in this section, payments for fee-for-service
benefits for dates of service on or after June 1, 2011, shall be
determined without application of the reductions in Section
14105.192.
(b) Notwithstanding Sections 14105.191 and 14105.192, except as
otherwise provided in this section, payments for the classes of
providers specified in subparagraphs (B) and (D) of paragraph (2) and
paragraph (3) of subdivision (b) of Section 14105.191 for dates of
service on or after June 1, 2011, shall be determined without
application of the reductions set forth in Sections 14105.191 and
14105.192.
(c) Notwithstanding subdivisions (a) and (b), for dates of service
prior to the effective date of the act adding this section, in no
event shall the payments exceed the reimbursement rate at which
payment has been made by the department prior to the effective date
of the act adding this section.
(d) 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.
SEC. 2. This act is an urgency statute necessary
for the immediate preservation of the public peace, health, or safety
within the meaning of Article IV of the Constitution and shall go
into immediate effect. The facts constituting the necessity are:
In order to ensure and maintain access to medically necessary care
for the patients and residents needing skilled nursing services, it
is necessary that this act take effect immediately.
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.