BILL NUMBER: SB 645	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Nielsen

                        FEBRUARY 22, 2013

   An act to add Section 14105.282 to the Welfare and Institutions
Code, relating to Medi-Cal, and declaring the urgency thereof, to
take effect immediately.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 645, as introduced, Nielsen. Diagnosis-related group
methodology.
   Existing law provides for 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 the department,
subject to federal approval, to develop and implement a payment
methodology based on diagnosis-related groups that reflects that
costs and staffing levels associated with quality of care for
patients in all general acute care hospitals, as specified. Existing
law requires that the methodology developed pursuant to these
provisions be implemented on July 1, 2012, or on the date upon which
the director executes a declaration certifying that all necessary
federal approvals have been obtained and the methodology is
sufficient for formal implementation, whichever is later.
   This bill would require the department, before the
diagnosis-related group methodology can be implemented, to develop a
methodology, in consultation with the hospital community, for
hospitals to review base payment rates proposed by the department.
The bill would require the department, commencing July 1, 2013, to
begin collecting diagnosis codes and procedure codes to establish a
database from which to develop base payment rates and would require
the department to develop an education and training program for
hospital Medi-Cal billing staff, in consultation with the hospital
community, to be conducted between April 1, 2014, and May 13, 2014.
   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 14105.282 is added to the Welfare and
Institutions Code, to read:
   14105.282.  (a) Notwithstanding Section 14105.28, the methodology
based on diagnosis-related groups shall not be implemented until the
department develops a methodology, in consultation with the hospital
community, for hospitals to review base payment rates for health care
services proposed by the department. The methodology shall include a
process for appealing for changes to a base rate if discrepancies
are identified by the hospitals.
   (b) Commencing on July 1, 2013, the department shall begin to
collect diagnosis codes and procedure codes to establish a database
from which to develop base payment rates as described in subdivision
(a).
   (c) By March 1, 2014, the department shall develop an education
and training program for hospital Medi-Cal billing staff, in
consultation with the hospital community, to be conducted between
April 1, 2014, and May 13, 2014.
   (d) The department shall work in collaboration with the hospital
community and be responsive to solving discrepancies in data, data
collection, calculations, assumptions, base payment rates, and other
issues related to ensuring an accurate and responsible implementation
of the methodology based on diagnosis-related groups pursuant to
Section 14105.28.
  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 an accurate and responsible implementation of
the new Medi-Cal inpatient hospital reimbursement methodology based
on diagnosis-related groups, it is necessary that this act take
effect immediately.