BILL NUMBER: SB 646	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 15, 2013
	AMENDED IN SENATE  APRIL 1, 2013

INTRODUCED BY   Senator Nielsen
    (   Principal coauthor:   Assembly Member
  Chesbro   ) 
    (   Coauthor:   Senator   Fuller
  ) 
    (   Coauthors:   Assembly Members 
 Achadjian,   Bigelow,   Conway,  
Dahle,   Donnelly,   and Beth Gaines   )


                        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  ,   subject to federal
approval,  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  in the
event that   if  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. 
   (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.
 
   (e) This section shall only apply to a skilled nursing facility
that is any of the following:  
   (1) A rural community hospital in a health care personnel shortage
area.  
   (2) A rural community hospital that serves a medically underserved
area or a medically underserved population.  
   (3) A designated sole community provider.  
   (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:  
   (1) Ten percent or more of the facility's patients are enrolled in
Medi-Cal.  
   (2) The facility is outside a 15-mile radius of any county
hospital or University of California hospital. 
  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.