BILL NUMBER: SB 640	AMENDED
	BILL TEXT

	AMENDED IN SENATE  MAY 1, 2013
	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   Medi-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,  intermediate care or other
specified facilities serving developmentally disabled individuals,
 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  
Sections 14105.07 and  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  
Sections 14105.07 and  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   Sections
14105.07 and  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  
Sections 14105.07 and  14105.192.
   (e) The director shall implement subdivisions (a), (b), and (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.
   (f) The director shall promptly seek all necessary federal
approvals to implement this section.
   (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   Medi-Cal beneficiaries  , it is
necessary that this act take effect immediately.