SB 640, as amended, Lara. Medi-Cal: reimbursement: provider payments.
Thebegin delete Med-Calend deletebegin insert Medi-Calend insert 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,begin insert intermediate care or other specified facilities serving developmentally disabled individuals,end insert orbegin delete toend delete 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 14105.194 is added to the Welfare and
2Institutions Code, to read:
(a) Notwithstandingbegin delete Sectionend deletebegin insert Sections 14105.07
4andend insert 14105.192, except as otherwise provided in this section,
5payments for fee-for-service benefits for dates of service on or
6after June 1, 2011, shall be determined without application of the
7reductions inbegin delete Sectionend deletebegin insert Sections 14105.07 and end insert 14105.192.
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) Notwithstandingbegin delete Sectionend deletebegin insert
Sections 14105.07 andend insert
14105.192,
21except as otherwise provided in this section, for managed care
22health plans that contract with the department pursuant to this
23chapter or Chapter 8 (commencing with Section 14200), payments
24for dates of service following the effective date of the act adding
25this section shall be determined without application of the
26reductions inbegin delete Section end deletebegin insert Sections 14105.07 and end insert14105.192.
P3 1(e) The director shall implement subdivisions (a), (b), and (d)
2to the maximum extent permitted by law and for the maximum
3time period for which the director obtains federal approval for
4federal financial participation for the increase provided for in this
5section.
6(f) The director shall promptly seek all necessary federal
7approvals to implement this section.
8(g) Notwithstanding Chapter 3.5 (commencing with Section
911340) of Part 1 of Division 3 of Title 2 of the Government Code,
10the department may implement this section by means of provider
11bulletins or notices, policy letters, or other similar instructions,
12without taking regulatory action.
This act is an urgency statute necessary for the
14immediate preservation of the public peace, health, or safety within
15the meaning of Article IV of the Constitution and shall go into
16immediate effect. The facts constituting the necessity are:
17In order to ensure and maintain access to medically necessary
18care forbegin delete the patients and residents needing skilled nursing servicesend delete
19begin insert Medi-Cal beneficiariesend insert, it is necessary that this act take effect
20immediately.
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