BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 1465| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- UNFINISHED BUSINESS Bill No: SB 1465 Author: Senate Health Committee Amended: 8/4/14 Vote: 27 - Urgency SENATE HEALTH COMMITTEE : 8-0, 4/24/14 AYES: Hernandez, Morrell, Beall, DeSaulnier, Evans, Monning, Nielsen, Wolk NO VOTE RECORDED: De León SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8 SENATE FLOOR : 35-0, 5/8/14 (Consent) AYES: Anderson, Beall, Berryhill, Block, Cannella, Corbett, Correa, De León, DeSaulnier, Evans, Fuller, Galgiani, Hancock, Hernandez, Hill, Hueso, Huff, Jackson, Lara, Leno, Lieu, Liu, Mitchell, Monning, Morrell, Nielsen, Padilla, Pavley, Roth, Steinberg, Torres, Vidak, Walters, Wolk, Wyland NO VOTE RECORDED: Calderon, Gaines, Knight, Wright, Yee ASSEMBLY FLOOR : 78-0, 8/19/14 - See last page for vote SUBJECT : Health SOURCE : Author DIGEST : This bill requires local emergency medical services agencies to send Emergency Medical Services (EMS) Fund reports to the Emergency Medical Services Authority (EMSA), rather than to the Legislature; allows the Department of Health Care CONTINUED SB 1465 Page 2 Services (DHCS) to develop a Medi-Cal provider enrollment application withdrawal process; and makes numerous technical, clarifying changes to existing law. Assembly Amendments add several more technical clarifying changes to this omnibus bill. ANALYSIS : Existing law: 1.Permits each county to establish an EMS Fund, known as the Maddy Fund, and specifies how these funds are to be used, including limiting administrative costs to no more than 10% of the amount in the Fund, with 58% of the balance of the Fund distributed to physicians for emergency services in hospitals, 25% distributed to hospitals providing disproportionate trauma and emergency medical care services, and 17% distributed for other EMS as determined by each county, including funding regional poison control centers. 2.Requires each county establishing a Maddy Fund to report to the Legislature annually on the implementation and status of the Fund. 3.Establishes the Medi-Cal program, administered by the DHCS, which provides comprehensive health care coverage for low-income individuals and their families; pregnant women; elderly, blind, or disabled persons; nursing home residents; and, refugees who meet specified eligibility criteria. 4.Requires a provider to be enrolled in Medi-Cal in order to receive fee-for-service reimbursement for the provision of services, goods, supplies, or merchandise to a Medi-Cal beneficiary. 5.Requires an applicant seeking to obtain Medi-Cal provider status to submit a complete application package for enrollment, continuing enrollment, enrollment at a new location, or a change in location. Requires DHCS to provide notice to an applicant within 30 days after receiving an application package that it has been received. 6.Requires DHCS to provide notice to any applicant, except as CONTINUED SB 1465 Page 3 specified, after 180 days from receiving an application package that the applicant does not meet the criteria for preferred provider status, the application package is incomplete, DHCS is exercising its authority as specified to conduct background checks, pre-enrollment inspections, or unannounced visits, or the application is denied for other specified reasons. Requires DHCS to grant provisional provider status for a period of no longer than 12 months, effective from the 181st day of receiving an application package or from the date on the notice to the applicant. 7.Enacts the Medi-Cal Hospital Reimbursement Improvement Act of 2013 (Act), which imposes a hospital quality assurance fee (QAF), as specified, on certain general acute care hospitals from January 1, 2014, through December 30, 2016. Requires supplemental payments to be made to private hospitals for certain services, direct grants to public hospitals, increased capitation payments to Medi-Cal managed care plans for hospital services and children's health coverage and DHCS administration. Sunsets the Act on January 1, 2017. 8.Requires Covered California, to the extent approved by the appropriate federal agency, to contract with, and certify as a qualified health plan, a bridge plan product that it certifies. This bill: This omnibus bill makes numerous technical, clarifying, and minor changes to existing law. Specifically, key provisions of this bill: 1.Require local emergency medical services agencies to send EMS Fund reports to EMSA, rather than to the Legislature, and require EMSA to compile and summarize these reports. 2.Permit DHCS to cancel a provider application review process if an application package is withdrawn at the request of the applicant or provider. 3.For purposes of the existing hospital QAF program, reorganize provisions to distinguish between supplemental payment rates (amounts that hospitals are paid) and fee rates (amount that hospitals pay), define "Fund" as the Hospital Quality CONTINUED SB 1465 Page 4 Assurance Revenue Fund, specify data sources to be used for calculations, and modify certain payment rates and fee rates. 4.Extends the sunset on the California Health Benefits Review program from June 30, 2015 to December 1, 2015. Background EMS Funds . Counties have several sources of revenue for their EMS Funds: Maddy revenues, derived from county penalty assessments on various criminal offenses and motor vehicle violations; traffic violator school fees; and, revenues from taxes on tobacco products deposited in the state's Cigarette and Tobacco Products Surtax Fund, including the EMS Appropriation. The Legislature intended that the EMS Funds be used to reimburse physicians, hospitals, and other providers of emergency services, for providing emergency services to patients who do not have health insurance coverage, cannot afford to pay for those services, and for whom payment will not be made through any private coverage or by any program funded in whole or in part by the federal government. Existing law requires courts to collect the fines, penalties, and forfeitures for various criminal offenses, motor vehicle and traffic violations. Currently, the total penalty assessment is $7 for every $10 of fines and forfeitures, a portion of which goes to the Maddy Fund. 50 counties have established Maddy Funds. QAF . Federal Medicaid law authorizes states to levy fees on health care providers if the fees meet certain requirements. Many states (including California) fund a portion of their share of Medicaid program costs through a fee on health care providers. Under these funding methods, states collect funds (through fees, taxes, or other means) from providers, which are then matched to allow increased Medicaid reimbursement to providers. The Legislature enacted a series of bills establishing a time-limited hospital QAF in 2009, and an additional six-month QAF for the first six months of 2011. The current QAF sunsets at the end of this calendar year. In addition to the hospital QAF, California currently has a QAF for intermediate care facilities for the developmentally disabled, and a separate QAF for skilled nursing facilities. CONTINUED SB 1465 Page 5 Prior Legislation SB 1368 (Senate Health Committee, Chapter 526, Statutes of 2010) contained language substantially similar to the Maddy Fund reporting requirement language in this bill. This language was amended out prior to SB 1368 being chaptered into law. AB 2248 (Hernandez, 2010) would have required each county establishing a Maddy Fund to include in its annual report to the Legislature a description of each disbursement for other emergency medical services if funds were disbursed for this purpose. The bill was vetoed by Governor Schwarzenegger, who stated that it would create a reimbursable state mandate and would put a cost pressure on the state's General Fund. SB 476 (Florez, Chapter 707, Statutes of 2003) authorizes each administering agency of an EMS Fund to maintain a reserve in specified portions of its Maddy Fund. Changes the county reporting requirements and the date at which these are due annually to the Legislature. SB 12 (Maddy, Chapter 1240, Statutes of 1987) creates the Maddy Fund to provide supplemental financing for local emergency services. SB 3X1 (Hernandez, Chapter 5, Statutes of 2013-14, First Extraordinary Session) requires Covered California (the state's Health Benefit Exchange) to establish a "bridge" plan product by contracting with Medi-Cal managed care plans for individuals losing Medi-Cal coverage, the parents of Medi-Cal or Healthy Families Program children, and individuals with incomes below 200% of the federal poverty level. Limits enrollment in bridge plan products only to eligible individuals, and exempts these products from specified provisions of existing law, including a requirement that Covered California products be sold in the outside market. SB 239 (Hernandez, Chapter 657, Statutes of 2013) enacted the Act, which imposes a hospital QAF, as specified, on certain general acute care hospitals from January 1, 2014, through December 30, 2016. FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes CONTINUED SB 1465 Page 6 Local: No SUPPORT : (Verified 8/19/14) California Chapter of the American College of Emergency Physicians Osteopathic Physicians and Surgeons of California ARGUMENTS IN SUPPORT : The California Chapter of the American College of Emergency Physicians states that while the Maddy EMS funds only reimburse a small portion of the cost of care, they are nevertheless a critical source of funding helping to preserve the emergency care safety net. ASSEMBLY FLOOR : 78-0, 8/19/14 AYES: Achadjian, Alejo, Allen, Ammiano, Bigelow, Bloom, Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian Calderon, Campos, Chau, Chávez, Chesbro, Conway, Cooley, Dababneh, Dahle, Daly, Dickinson, Donnelly, Eggman, Fong, Fox, Frazier, Beth Gaines, Garcia, Gatto, Gonzalez, Gordon, Gorell, Gray, Grove, Hagman, Hall, Harkey, Roger Hernández, Holden, Jones, Jones-Sawyer, Levine, Linder, Logue, Lowenthal, Maienschein, Mansoor, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Nestande, Olsen, Pan, Patterson, Perea, John A. Pérez, V. Manuel Pérez, Quirk, Quirk-Silva, Rendon, Ridley-Thomas, Rodriguez, Salas, Skinner, Stone, Ting, Wagner, Waldron, Weber, Wieckowski, Wilk, Williams, Yamada, Atkins NO VOTE RECORDED: Gomez, Vacancy JL:k 8/19/14 Senate Floor Analyses SUPPORT/OPPOSITION: SEE ABOVE **** END **** CONTINUED