BILL NUMBER: SB 640	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 15, 2013
	AMENDED IN SENATE  APRIL 3, 2013

INTRODUCED BY   Senator Lara
    (   Principal coauthor:   Assembly Member
  Mitchell   ) 

                        FEBRUARY 22, 2013

   An act to add Section 14105.194 to the Welfare and Institutions
Code, relating to Medi-Cal, and declaring the urgency thereof, to
take effect immediately.



	LEGISLATIVE COUNSEL'S DIGEST


   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 that  ,   to the
extent permitted by federal law,  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.  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. 
   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 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) Notwithstanding Section 14105.192, except as otherwise
provided in this section, for managed care health plans that contract
with the department pursuant to this chapter or Chapter 8
(commencing with Section 14200), payments for dates of service
following the effective date of the act adding this section shall be
determined without application of the reductions in Section
14105.192.  
   (d) 
    (   e)  The director shall implement
subdivisions  (a)   (a), (b),  and 
(b)   (d)  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) 
    (   f)  The director shall promptly seek all
necessary federal approvals to implement this section. 
   (f) 
    (   g)  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.