Amended in Senate April 15, 2013

Amended in Senate April 1, 2013

Senate Bill No. 646

Introduced by Senator Nielsen

begin insert

(Principal coauthor: Assembly Member Chesbro)

end insert begin insert

(Coauthor: Senator Fuller)

end insert begin insert

(Coauthors: Assembly Members Achadjian, Bigelow, Conway, Dahle, Donnelly, and Beth Gaines)

end insert

February 22, 2013

An act to add Section 14105.195 to the Welfare and Institutions Code, relating to Medi-Cal, and declaring the urgency thereof, to take effect immediately.

LEGISLATIVE COUNSEL’S DIGEST

SB 646, as amended, Nielsen. Medi-Cal: reimbursement: distinct part nursing facilities.

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, 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 begin insert , subject to federal approval, end insert require that this payment reduction not apply to specified skilled nursing facilities that are a distinct part of a general acute care hospital for dates of service on or after June 1, 2011.

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 14105.195 is added to the Welfare and
Institutions Code, to read:

14105.195.  

(a) Notwithstanding Sections 14105.191 and
14105.192, reimbursement for services provided by skilled nursing
facilities that are distinct parts of general acute care hospitals shall
be determined, for dates of service on or after June 1, 2011, without
application of the reductions set forth in Sections 14105.191 and
14105.192.

(b) The director shall do all of the following begin delete in the event that end delete begin insert if end insert
he or she is prevented from implementing subdivision (a) for any
dates of service on or after June 1, 2011:

(1) Implement subdivision (a) to the maximum extent permitted
by law and for the maximum time period for which the director
obtains necessary federal approval.

(2) Increase payments to facilities described in subdivision (a)
for services provided on or after June 1, 2011, or on or after the
first date of service permitted by law and for which federal financial
participation is available, until the date the total amount of
Medi-Cal payments to those facilities for services provided on or
after June 1, 2011, is not less than the payments the facilities would
have received if the reductions in Sections 14105.191 and
14105.192 had not been imposed for dates of service on or after
June 1, 2011. The director shall increase payments under this
paragraph for the shortest period of time possible.

(c) The director shall promptly seek all necessary federal
approvals to implement this section.

(d) 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.

begin delete

(e) This section shall only apply to a skilled nursing facility at
a rural community hospital in a health care personnel shortage
area, or in an area that serves medically underserved areas or
populations, and the facility is a sole community provider. To
qualify for this section, the skilled nursing facility shall have 10
percent or more of its patients enrolled in Medi-Cal and not have
a county or University of California hospital within a 15 mile
radius.

end delete begin insert

(e) This section shall only apply to a skilled nursing facility that
is any of the following:

end insert begin insert

(1) A rural community hospital in a health care personnel
shortage area.

end insert begin insert

(2) A rural community hospital that serves a medically
underserved area or a medically underserved population.

end insert begin insert

(3) A designated sole community provider.

end insert begin insert

(f) In addition to the criteria listed in subdivision (e), this section
shall only apply to a skilled nursing facility that meets both of the
following requirements:

end insert begin insert

(1) Ten percent or more of the facility’s patients are enrolled
in Medi-Cal.

end insert begin insert

(2) The facility is outside a 15-mile radius of any county hospital
or University of California hospital.

end insert

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
at the earliest possible time, it is necessary that this act take effect
immediately.