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 tobegin delete specifiedend delete 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 14105.195 is added to the Welfare and
2Institutions Code, to read:
(a) Notwithstanding Sections 14105.191 and
414105.192, reimbursement for services provided by skilled nursing
5facilities that are distinct parts of general acute care hospitals shall
6be determined, for dates of service on or after June 1, 2011, without
7application of the reductions set forth in Sections 14105.191 and
814105.192.
9(b) The director shall do all of the following if he or she is
10prevented from implementing subdivision (a) for any dates of
11service on or after June 1, 2011:
12(1) Implement subdivision (a) to the maximum extent permitted
13by law and for the maximum time period for which the director
14obtains
necessary federal approval.
15(2) Increase payments to facilities described in subdivision (a)
16for services provided on or after June 1, 2011, or on or after the
17first date of service permitted by law and for which federal financial
18participation is available, until the date the total amount of
19Medi-Cal payments to those facilities for services provided on or
20after June 1, 2011, is not less than the payments the facilities would
21have received if the reductions in Sections 14105.191 and
2214105.192 had not been imposed for dates of service on or after
23June 1, 2011. The director shall increase payments under this
24paragraph for the shortest period of time possible.
25(c) The director shall promptly seek all necessary federal
26approvals to implement this section.
27(d) Notwithstanding Chapter 3.5 (commencing with Section
2811340) of Part 1 of Division 3 of Title 2 of the Government Code,
29the department may implement this section by means of provider
P3 1bulletins or notices, policy letters, or other similar instructions,
2without taking regulatory action.
3(e) This section shall only apply to a skilled nursing facility that
4is any of the following:
5(1) A rural community hospital in a health care personnel
6shortage area.
7(2) A rural community hospital that serves a medically
8underserved area or a medically underserved population.
9(3) A designated sole community provider.
end delete
10(f) In addition to the criteria listed in subdivision (e), this section
11shall only apply to a skilled nursing facility that meets both of the
12following requirements:
13(1) Ten percent or more of the facility’s patients are enrolled in
14Medi-Cal.
15(2) The facility is outside a 15-mile radius of any county hospital
16or University of California hospital.
This act is an urgency statute necessary for the
18immediate preservation of the public peace, health, or safety within
19the meaning of Article IV of the Constitution and shall go into
20immediate effect. The facts constituting the necessity are:
21In order to ensure and maintain access to medically necessary
22care for the patients and residents needing skilled nursing services
23at the earliest possible time, it is necessary that this act take effect
24immediately.
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