BILL NUMBER: AB 2213 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MARCH 18, 2016
INTRODUCED BY Assembly Member Dahle
FEBRUARY 18, 2016
An act to add Section 14179 to the Welfare and Institutions
Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 2213, as amended, Dahle. Medi-Cal: nondesignated public
hospitals.
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 carriers and
providers of Medi-Cal benefits to utilize uniform accounting and
cost-reporting systems as developed by the department, and requires
these carriers and providers to provide cost information to the
department as is necessary, including copies of any Medicare costs
reports and settlements and any Medicare audit reports. Existing law
requires amounts paid for services provided to Medi-Cal beneficiaries
to be audited by the department in a manner and form prescribed by
the department. Existing law requires the department to implement a
new Medi-Cal inpatient hospital reimbursement methodology based on
diagnosis-related groups that reflects the costs and staffing levels
associated with quality of care for private general acute care
hospitals admissions on or after July 1, 2013, and for nondesignated
public hospitals with admissions on or after January 1, 2014.
Existing law requires a hospital to report specified summary
financial and utilization data to the Office of Statewide Health
Planning and Development (OSHPD), as specified.
This bill would require the department and the OSHPD to administer
and implement a demonstration under which the audits of
nondesignated public hospitals for reporting periods beginning on and
after July 1, 2016, would be evaluated to determine the
reimbursement relevancy of cost report data. The bill would require
the department and the OSHPD to, among other things, evaluate the
data currently being collected through specified data and reports,
including financial and utilization data and Medi-Cal cost reports,
in order to determine its reimbursement relevancy, as specified. The
bill would specify the goals of the demonstration, which includes
designing a combined reporting form to collect relevant and useful
data for policy making purposes.
The bill would authorize nondesignated public hospitals to
participate in a 3-year demonstration project for the purpose of
evaluating whether the goals under the initial demonstration are met.
The bill would require the department and the OSHPD, within one year
of the completion date of the 3-year demonstration project, to
prepare and submit a report to the Legislature that includes an
evaluation regarding the effectiveness of the 3-year demonstration
project and recommendations regarding the continuation and expansion
of the demonstration project to all hospitals.
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 establishes the Medi-Cal
Hospital/Uninsured Care Demonstration Project Act, which revises
hospital supplemental payment methodologies under the Medi-Cal
program in order to maximize the use of federal funds consistent with
federal Medicaid law and to stabilize the distribution of funding
for hospitals that provide care to Medi-Cal beneficiaries and
uninsured patients. Existing law requires the department to seek a
successor demonstration project or federal waiver of Medicaid law to
implement specified objectives, which may include better care
coordination for seniors, persons with disabilities, and children
with special health care needs. Existing law provides that to the
extent the provisions under the Medi-Cal Hospital/Uninsured Care
Demonstration Project Act do not conflict with the provisions of, or
the Special Terms and Conditions of, this demonstration project, the
provisions of the Medi-Cal Hospital/Uninsured Care Demonstration
Project Act shall apply. Existing law also defines nondesignated
public hospitals for purposes of these provisions and requires that
nondesignated public hospitals be eligible for specified payments
under the demonstration project.
This bill would declare the intent of the Legislature to enact
legislation that would ensure that nondesignated public hospitals are
reimbursed adequately and promptly.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14179 is added to the
Welfare and Institutions Code , to read:
14179. (a) The department, in collaboration with the Office of
Statewide Health Planning and Development, shall administer and
implement a demonstration under which the audits of nondesignated
public hospitals for reporting periods beginning on and after July 1,
2016, are evaluated to determine the reimbursement relevancy of cost
report data.
(b) In order to determine the reimbursement relevancy of existing
data collected and what additional data would be useful, the
demonstration under this section shall include an evaluation of all
of the following:
(1) Data currently being collected through the Office of Statewide
Health Planning and Development.
(2) Annual and quarterly financial and utilization data.
(3) Annual report of hospitals and other relevant reports.
(4) Data currently being collected by the department through the
annual Medi-Cal cost report.
(c) Goals for the demonstration shall include all of the
following:
(1) Design a combined reporting form to collect relevant and
useful data for policymaking purposes.
(2) Eliminate the data report audit function, if appropriate, and
utilize desk audits to ensure that reported data is as accurate as
possible.
(3) Determine the appropriate agency to administer the reporting
and data collection function.
(d) Upon the attainment of the goals described in subdivision (c),
nondesignated public hospitals may participate in a three-year
demonstration project for the purpose of evaluating whether the goals
under the initial demonstration are met.
(e) (1) The department, in collaboration with the Office of
Statewide Health Planning and Development, shall, within one year of
the completion date of the three-year demonstration project described
in subdivision (d), prepare and submit a report to the Legislature
that includes an evaluation regarding the effectiveness of the
three-year demonstration project and recommendations regarding the
continuation and expansion of the demonstration project to all
hospitals.
(2) A report submitted pursuant to this subdivision shall be
submitted in compliance with Section 9795 of the Government Code.
SECTION 1. It is the intent of the Legislature
to enact legislation that would ensure that nondesignated public
hospitals are reimbursed adequately and promptly.