Senate BillNo. 1089


Introduced by Senator Mitchell

February 19, 2014


An act to amend Section 14053.8 of the Welfare and Institutions Code, and to amend Section 1 of Chapter 394 of the Statutes of 2011, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

SB 1089, as introduced, Mitchell. Medi-Cal: juvenile inmates.

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 provisions. Existing federal law, with certain exceptions, excludes federal financial participation for medical care provided to any individual who is an inmate in a public institution. Existing law requires the State Department of Health Care Services to develop a process to allow counties to receive any available federal financial participation for acute inpatient hospital services and inpatient psychiatric services provided to juvenile inmates, as defined, who are admitted as inpatients in a medical institution, as prescribed. Existing law requires that the process be implemented in only those counties that elect to provide the nonfederal share of the state’s administrative costs associated with the implementation of the process and the nonfederal share of the expenditures for those services provided.

This bill would instead provide that the process developed be implemented in only those counties that elect to provide the county’s pro rata portion of the nonfederal share of the state’s administrative costs.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

P2    1

SECTION 1.  

Section 14053.8 of the Welfare and Institutions
2Code
is amended to read:

3

14053.8.  

(a) Notwithstanding any otherbegin delete provision ofend delete law, the
4department shall develop a process to allow counties to receive
5any available federal financial participation for acute inpatient
6hospital services and inpatient psychiatric services provided to
7juvenile inmates who are admitted as inpatients in a medical
8institution off the grounds of the correctional facility, and who,
9but for their institutional status as inmates, are otherwise eligible
10for Medi-Cal benefits pursuant to this chapter. This process shall
11be coordinated, to the extent possible, with the processes and
12procedures established pursuant to Section 14053.7 of this code
13and Section 5072 of the Penal Code. Thisbegin delete subdivisionend deletebegin insert sectionend insert shall
14not be construed to alter or abrogate any obligation of the state
15pursuant to an administrative action or a court order that is final
16and no longer subject to appeal tobegin delete fund andend delete reimburse counties for
17anybegin delete medicalend deletebegin insert acute inpatient hospital services or inpatient
18psychiatricend insert
services provided to a juvenile inmate.

19(b) A juvenile inmate who is an inpatient in a medical institution
20off the grounds of the correctional facility shall not be denied
21eligibility for Medi-Cal benefits under this section because of his
22or her institutional status as an inmate of a public institution.

23(c) The department shall consult with counties in the
24development of the process pursuant to this section.

25(d) This section shall not be construed to limit the department’s
26authority to suspend or terminate Medi-Cal eligibility pursuant to
27Section 14011.10, except during such times that the juvenile inmate
28is receiving acute inpatient hospital services or inpatient psychiatric
29services pursuant to subdivision (b).

30(e) This section shall be implemented only if and to the extent
31that existing levels of federal financial participation are not
32otherwise jeopardized. To the extent that the department determines
33that existing levels of federal financial participation are jeopardized,
34this section shall no longer be implemented.

P3    1(f) The department shall seek any federal approvals necessary
2to implement the process developed pursuant to this section. This
3section shall be implemented only if and to the extent that any
4necessary federal approvals have been obtained, and only to the
5extent that federal financial participation is available.

6(g) Notwithstanding any otherbegin delete provision ofend delete law, as part of the
7process developed pursuant to this section, the department may
8exempt juvenile inmates from enrollment into new or existing
9managed care health plans.

10(h) The process developed pursuant to this section shall be
11implemented in only those counties that elect to provide the
12begin insert county’s pro rata portion of theend insert nonfederal share of the state’s
13administrative costs associated with implementation of this section
14and the nonfederal share of expenditures for acute inpatient hospital
15 services and inpatient psychiatric services provided to eligible
16juvenile inmates described in subdivision (a).

17(i) begin insert(1)end insertbegin insertend insert The federal financial participation received pursuant to
18the process implemented under this section shall be paid to the
19participating counties for services rendered to the juvenile inmates.
20If a federal audit disallowance and interest results from claims
21made under the process created pursuant to this section, the
22department shall recoup from the county that received the
23disallowed funds the amount of the disallowance and any
24applicable interest.

begin insert

25(2) It is the intent of the Legislature that implementation of this
26section will result in no increased cost to the state General Fund.

end insert

27(j) (1) If there is a final judicial determination made by any
28state or federal court that is not appealed, or by a court of appellate
29jurisdiction that is not further appealed, in any action by any party,
30or a final determination by the administrator of the federal Centers
31for Medicare and Medicaid Services (CMS), that disallows, defers,
32or alters the implementation of this section or, to the extent
33applicable, Section 14053.7 of this code or Section 5072 of the
34Penal Code, including the rate methodology or payment process
35established by the department that limits or affects the department’s
36authority to select the facilities used to provide acute inpatient
37hospital services and inpatient psychiatric services to juvenile
38inmates, then any provision of this section that is inconsistent with
39the final judicial or CMS determination shall have no force or
40effect.

P4    1(2) In addition, the department may, at its discretion, cease to
2implement any other part of this section that is implicated by the
3final judicial or CMS determination.

4(k) For the purposes of Medi-Cal eligibility pursuant to this
5section, “juvenile inmate” means an individual under 21 years of
6age who is involuntarily residing in a public institution, including
7state and local institutions.

8(l) Notwithstanding Chapter 3.5 (commencing with Section
911340) of Part 1 of Division 3 of Title 2 of the Government Code,
10the department may, without taking any further regulatory action,
11implement this section by means of all-county letters or similar
12instructions.

13

SEC. 2.  

Section 1 of Chapter 394 of the Statutes of 2011 is
14amended to read:

15

Section 1.  

The Legislature finds and declares all of the
16following:

17(a) Federal financial participation may be available for counties
18that provide health care services to juvenile inmates while the
19juveniles are admitted as patients in a medical institution.

20(b) Current law provides that an individual under 21 years of
21age who is an inmate of a public institution shall have his or her
22Medi-Cal services suspended for up to one year.

23(c) The eligibility procedures of the State Department of Health
24Care Services currently do not allow counties to obtain available
25federal financial participation for health care services provided to
26juvenile inmates when they have been transferred to a medical
27institution for inpatient services.

28(d) Pursuant to Section 5072 of the Penal Code and Section
2914053.7 of the Welfare and Institutions Code, the department is
30authorized to develop a process to maximize federal financial
31participation for inpatient hospital services to adult inmates residing
32in a state prison facility.

33(e) To reduce the fiscal strain on counties, it is imperative that
34the department work with counties to develop and implement a
35similar process to allow counties to obtain federal financial
36participation based on county expenditures for inpatient hospital
37services provided to juveniles in their custody.

38(f) It is not the intent of the Legislature to alter or abrogate any
39obligation of the state under federal or state law tobegin delete cover, fund, orend delete
40 reimburse under Medi-Cal anybegin delete medicalend deletebegin insert acute inpatient hospitalend insert
P5    1 servicesbegin insert or inpatient psychiatend insertbegin insertric servicesend insert provided to a juvenile
2begin delete detaineeend deletebegin insert inmateend insert.



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