SB 640, as amended, Lara. 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 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 thatbegin insert, to the extent permitted by federal law,end insert 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.begin insert The bill would also provide that this payment reduction shall not apply to managed health care plans for dates of service after the effective date of the bill.end insert
This bill would declare that it is to take effect immediately as an urgency statute.
Vote: 2⁄3. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 14105.194 is added to the Welfare and
2Institutions Code, to read:
(a) Notwithstanding Section 14105.192, except
4as otherwise provided in this section, payments for fee-for-service
5benefits for dates of service on or after June 1, 2011, shall be
6determined without application of the reductions in Section
714105.192.
8(b) Notwithstanding Sections 14105.191 and 14105.192, except
9as otherwise provided in this section, payments for the classes of
10providers specified in subparagraphs (B) and (D) of paragraph (2)
11and paragraph (3) of subdivision (b) of Section 14105.191 for dates
12of service on or after June 1, 2011, shall be determined without
13application of the reductions set forth in Sections 14105.191 and
1414105.192.
15(c) Notwithstanding subdivisions (a) and (b), for dates of service
16prior to the effective date of the act adding this section, in no event
17shall the payments exceed the reimbursement rate at which
18payment has been made by the department prior to the effective
19date of the act adding this section.
20(d) Notwithstanding Section 14105.192, except as otherwise
21provided in this section, for managed care health plans that
22contract with the department pursuant to this chapter or Chapter
238 (commencing with Section 14200), payments for dates of service
24following the effective date of the act adding this section shall be
25determined without application of the reductions in Section
2614105.192.
27(d)
end delete
28begin insert(end insertbegin inserte)end insert The director shall implement subdivisionsbegin delete (a)end deletebegin insert (a), (b),end insert and
29begin delete (b)end deletebegin insert (d)end insert to the maximum extent permitted by law and for the
30maximum time period for which the director obtains federal
P3 1approval for federal financial participation for the increase provided
2for in this section.
3(e)
end delete
4begin insert(end insertbegin insertf)end insert The director shall promptly seek all necessary federal
5approvals to implement this section.
6(f)
end delete
7begin insert(end insertbegin insertg)end insert Notwithstanding Chapter 3.5 (commencing with Section
811340) of Part 1 of Division 3 of Title 2 of the Government Code,
9the department may implement this
section by means of provider
10bulletins or notices, policy letters, or other similar instructions,
11without taking regulatory action.
This act is an urgency statute necessary for the
13immediate preservation of the public peace, health, or safety within
14the meaning of Article IV of the Constitution and shall go into
15immediate effect. The facts constituting the necessity are:
16In order to ensure and maintain access to medically necessary
17care for the patients and residents needing skilled nursing services,
18it is necessary that this act take effect immediately.
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