BILL NUMBER: SBX2 4 INTRODUCED
BILL TEXT
INTRODUCED BY Senators Nielsen and Stone
(Coauthors: Senators Anderson, Bates, Berryhill, Fuller, Gaines,
Huff, Moorlach, Morrell, Nguyen, Runner, and Vidak)
(Coauthors: Assembly Members Maienschein, Mayes, and Steinorth)
JULY 16, 2015
An act to amend Sections 4681.6, 4689.8, 4691.9, and 4860, and to
add Sections 4681.2, 4690.7, 4793, 4794, and 14105.194 to, the
Welfare and Institutions Code, relating to human services financing,
and making an appropriation therefor.
LEGISLATIVE COUNSEL'S DIGEST
SB 4, as introduced, Nielsen. Developmental services: Medi-Cal:
rate increases.
The Lanterman Developmental Disabilities Services Act requires the
State Department of Developmental Services to contract with regional
centers to provide services and supports to individuals with
developmental disabilities. Under existing law, the regional centers
purchase needed services for individuals with developmental
disabilities through approved service providers or arrange for those
services through other publicly funded agencies. Existing law
establishes specified rates to be paid to certain service providers
and the rates to be paid for certain developmental services. Existing
law requires that rates to be paid to other developmental service
providers either be set by the department or negotiated between the
regional center and the service provider. Existing law prohibits
certain provider rate increases, but authorizes increases to those
rates as necessary to adjust employee wages to meet the state minimum
wage law and to provide paid sick leave.
Existing law establishes the Medi-Cal program, administered by the
State Department of Health Care Services, under which basic health
care services are provided to qualified low-income persons. 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, as specified.
This bill would, to the extent that General Fund revenues for the
2014-15 fiscal year exceed the revenues estimated for that fiscal
year in the Budget Act of 2015 and that General Fund revenues for the
2015-16 fiscal year are expected to exceed the revenues estimated
for that fiscal year in the Budget Act of 2015, appropriate certain
sums to the State Department of Developmental Services to increase
rates for certain developmental service providers and to increase
regional center operating budgets, and appropriate certain sums to
the State Department of Health Care Services for the purpose of
increasing Medi-Cal provider rates for providers whose rates were
reduced. The bill would require the Director of Finance to determine
the percentage increases to be provided to developmental service
providers, regional center operating budgets, and Medi-Cal providers
based on the amount by which General Fund revenues exceed, or are
expected to exceed, the revenues budgeted for the 2014-15 and 2015-16
fiscal years. The bill would make the rate increases, if any,
retroactive to July 1, 2015.
Vote: 2/3. Appropriation: yes. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. (a) The Legislature finds and declares that the Budget
Act of 2015 did not prioritize community services for Californians
with intellectual or developmental disabilities or better access to
care for Medi-Cal recipients.
(b) Therefore, it is the intent of the Legislature that
unanticipated General Fund revenues received by the state be used to
increase funding for community services provided to individuals with
intellectual or developmental disabilities and to increase
reimbursement rates for Medi-Cal providers.
SEC. 2. Section 4681.2 is added to the Welfare and Institutions
Code, to read:
4681.2. Notwithstanding any other law, the department shall
increase the rates set for community care facilities serving persons
with developmental disabilities to implement the rate increase or
increases, if any, required by Section 4793.
SEC. 3. Section 4681.6 of the Welfare and Institutions Code is
amended to read:
4681.6. (a) Notwithstanding any other law or regulation,
commencing July 1, 2008:
(1) A regional center shall not pay an existing residential
service provider, for services where rates are determined through a
negotiation between the regional center and the provider, a rate
higher than the rate in effect on June 30, 2008, unless the increase
is required by a contract between the regional center and the vendor
that is in effect on June 30, 2008, or the regional center
demonstrates that the approval is necessary to protect the consumer's
health or safety and the department has granted prior written
authorization.
(2) A regional center shall not negotiate a rate with a new
residential service provider, for services where rates are determined
through a negotiation between the regional center and the provider,
that is higher than the regional center's median rate for the same
service code and unit of service, or the statewide median rate for
the same service code and unit of service, whichever is lower. The
unit of service designation shall conform with an existing regional
center designation or, if none exists, a designation used to
calculate the statewide median rate for the same service. The
regional center shall annually certify to the department its median
rate for each negotiated rate service code, by designated unit of
service. This certification shall be subject to verification through
the department's biennial fiscal audit of the regional center.
(b) Notwithstanding subdivision (a), commencing July 1, 2014,
regional centers may negotiate a rate adjustment with residential
service providers regarding rates that are otherwise restricted
pursuant to subdivision (a), if the adjustment is necessary in order
to pay employees no less than the minimum wage as established by
Section 1182.12 of the Labor Code, as amended by Chapter 351 of the
Statutes of 2013, and only for the purpose of adjusting payroll costs
associated with the minimum wage increase. The rate adjustment shall
be specific to the unit of service designation that is affected by
the increased minimum wage, shall be specific to payroll costs
associated with any increase necessary to adjust employee pay only to
the extent necessary to bring pay into compliance with the increased
state minimum wage, and shall not be used as a general wage
enhancement for employees paid above the minimum wage. Regional
centers shall maintain documentation on the process to determine, and
the rationale for granting, any rate adjustment associated with the
minimum wage increase.
(c) Notwithstanding subdivision (a), commencing July 1, 2015,
regional centers may negotiate a rate adjustment with residential
service providers regarding rates that are otherwise restricted
pursuant to subdivision (a), if the adjustment is necessary to
implement Article 1.5 (commencing with Section 245) of Chapter 1 of
Part 1 of Division 2 of the Labor Code, as added by Chapter 317 of
the Statutes of 2014. The rate adjustment may be applied only if a
minimum of 24 hours or three days of paid sick leave per year was not
a benefit provided to employees as of June 30, 2015, and shall be
specific to payroll costs associated with any increase necessary to
compensate an employee up to a maximum of 24 hours or three days of
paid sick leave in each year of employment.
(d) Notwithstanding subdivision (a), regional centers shall
increase the rates paid to residential service providers, for
services where rates are determined through a negotiation between the
regional center and the provider, to implement the rate increase or
increases, if any, required by Section 4793.
(d)
( e) For purposes of this section,
"residential service provider" includes Adult Residential Facilities
for Persons with Special Health Care Needs, as described in Section
4684.50.
(e)
(f) This section shall not apply to those services for
which rates are determined by the State Department of Health Care
Services, or the State Department of Developmental Services, or are
usual and customary.
SEC. 4. Section 4689.8 of the Welfare and Institutions Code is
amended to read:
4689.8. (a) Notwithstanding any other
provision of law or regulation, commencing July 1,
2008:
(a) No
(1) A regional center
may shall not pay an existing supported living
service provider, for services where rates are determined through a
negotiation between the regional center and the provider, a rate
higher than the rate in effect on June 30, 2008, unless the increase
is required by a contract between the regional center and the vendor
that is in effect on June 30, 2008, or the regional center
demonstrates that the approval is necessary to protect the consumer's
health or safety and the department has granted prior written
authorization.
(b) No
(2) A regional center
may shall not negotiate a rate with a new
supported living service provider, for services where rates are
determined through a negotiation between the regional center and the
provider, that is higher than the regional center's median rate for
the same service code and unit of service, or the statewide median
rate for the same service code and unit of service, whichever is
lower. The unit of service designation shall conform with an existing
regional center designation or, if none exists, a designation used
to calculate the statewide median rate for the same service. The
regional center shall annually certify to the State Department of
Developmental Services its median rate for each negotiated rate
service code, by designated unit of service. This certification shall
be subject to verification through the department's biennial fiscal
audit of the regional center.
(b) Notwithstanding subdivision (a), regional centers shall
increase the rates paid to supported living service providers, for
services where rates are determined through a negotiation between the
regional center and the provider, to implement the rate increase or
increases, if any, required by Section 4793.
SEC. 5. Section 4690.7 is added to the Welfare and Institutions
Code, to read:
4690.7. Notwithstanding any other law, the department shall
increase the rates set for nonresidential service providers to
implement the rate increase or increases, if any, required by Section
4793.
SEC. 6. Section 4691.9 of the Welfare and Institutions Code is
amended to read:
4691.9. (a) Notwithstanding any other law or regulation,
commencing July 1, 2008:
(1) A regional center shall not pay an existing service provider,
for services where rates are determined through a negotiation between
the regional center and the provider, a rate higher than the rate in
effect on June 30, 2008, unless the increase is required by a
contract between the regional center and the vendor that is in effect
on June 30, 2008, or the regional center demonstrates that the
approval is necessary to protect the consumer's health or safety and
the department has granted prior written authorization.
(2) A regional center shall not negotiate a rate with a new
service provider, for services where rates are determined through a
negotiation between the regional center and the provider, that is
higher than the regional center's median rate for the same service
code and unit of service, or the statewide median rate for the same
service code and unit of service, whichever is lower. The unit of
service designation shall conform with an existing regional center
designation or, if none exists, a designation used to calculate the
statewide median rate for the same service. The regional center shall
annually certify to the State Department of Developmental Services
its median rate for each negotiated rate service code, by designated
unit of service. This certification shall be subject to verification
through the department's biennial fiscal audit of the regional
center.
(b) Notwithstanding subdivision (a), commencing July 1, 2014,
regional centers may negotiate a rate adjustment with providers
regarding rates if the adjustment is necessary in order to pay
employees no less than the minimum wage as established by Section
1182.12 of the Labor Code, as amended by Chapter 351 of the Statutes
of 2013, and only for the purpose of adjusting payroll costs
associated with the minimum wage increase. The rate adjustment shall
be specific to the unit of service designation that is affected by
the increased minimum wage, shall be specific to payroll costs
associated with any increase necessary to adjust employee pay only to
the extent necessary to bring pay into compliance with the increased
state minimum wage, and shall not be used as a general wage
enhancement for employees paid above the increased minimum wage.
Regional centers shall maintain documentation on the process to
determine, and the rationale for granting, any rate adjustment
associated with the minimum wage increase.
(c) Notwithstanding any other law or regulation, commencing
January 1, 2015, rates for personal assistance and supported living
services in effect on December 31, 2014, shall be increased by 5.82
percent, subject to funds specifically appropriated for this increase
for costs due to changes in federal regulations implementing the
federal Fair Labor Standards Act of 1938 (29 U.S.C. Sec. 201 et
seq.). The increase shall be applied as a percentage, and the
percentage shall be the same for all applicable providers. As used in
this subdivision, both of the following definitions shall apply:
(1) "Personal assistance" is limited only to those services
provided by vendors classified by the regional center as personal
assistance providers, pursuant to the miscellaneous services
provisions contained in Title 17 of the California Code of
Regulations.
(2) "Supported living services" are limited only to those services
defined as supported living services in Title 17 of the California
Code of Regulations.
(d) Notwithstanding subdivision (a), commencing July 1, 2015,
regional centers may negotiate a rate adjustment with existing
service providers for services for which rates are determined through
negotiation between the regional center and the provider, if the
adjustment is necessary to implement Article 1.5 (commencing with
Section 245) of Chapter 1 of Part 1 of Division 2 of the Labor Code,
as added by Chapter 317 of the Statutes of 2014. The rate adjustment
may be applied only if a minimum of 24 hours or three days of paid
sick leave per year was not a benefit provided to employees as of
June 30, 2015, and shall be specific to payroll costs associated with
any increase necessary to compensate an employee up to a maximum of
24 hours or three days of paid sick leave in each year of employment.
(e) Notwithstanding subdivision (a), regional centers shall
increase the rates paid to service providers, for services where
rates are determined through a negotiation between the regional
center and the provider, to implement the rate increase, if any,
required by Section 4793.
(e)
(f ) This section shall not apply to those
services for which rates are determined by the State Department of
Health Care Services, or the State Department of Developmental
Services, or are usual and customary.
SEC. 7. Section 4793 is added to the Welfare and Institutions
Code, immediately following Section 4792, to read:
4793. (a) (1) On or before January 10, 2016, the Director of
Finance shall calculate the sum of the amount by which General Fund
revenues for the 2014-15 fiscal year exceed the revenue estimated for
that fiscal year calculated at the time of the Budget Act of 2015
and the amount by which General Fund revenues for the 2015-16 fiscal
year are expected to exceed the revenue estimated for that fiscal
year in the Budget Act of 2015.
(2) (A) If the amount calculated pursuant to paragraph (1), after
subtracting the amounts required to satisfy the obligations arising
from Sections 8 and 20 of Article XVI of the California Constitution,
is less than or equal to the amount necessary to provide a 10
percent rate increase to the developmental services providers
identified in subparagraph (B), the entire amount is appropriated to
the State Department of Developmental Services for the purpose of
providing rate increases to service providers and increasing regional
center operating budgets, the amount of which shall be calculated
pursuant to subparagraph (B).
(B) The Director of Finance shall, in consultation with the State
Department of Developmental Services, calculate the percentage rate
increase to be provided to community care facilities serving persons
with developmental disabilities, residential service providers,
supported living service providers, nonresidential service providers,
other service providers, and supported employment services
providers, and the increase to regional center operating budgets. In
calculating the percentage increase, the director shall ensure that
the total cost of the rate increases for all service providers and
the increase in regional center operating budgets equals the amount
calculated pursuant to paragraph (1) and that the percentage increase
for each provider type and regional center operating budget is the
same.
(3) (A) If the amount calculated pursuant to paragraph (1), after
subtracting the amounts required to satisfy the obligations arising
from Sections 8 and 20 of Article XVI of the California Constitution,
is more than the amount necessary to provide a 10 percent rate
increase to the developmental services providers identified in
subparagraph (B) of paragraph (2), then the amount necessary to
provide a 10 percent rate increase to the developmental services
providers identified in subparagraph (B) of paragraph (2) is
appropriated to the State Department of Developmental Services for
the purpose of providing rate increases to service providers and
increasing regional center operating budgets, the amount of which
shall be calculated pursuant to subparagraph (B), and the remainder
of the amount, up to the amount necessary to restore the rates paid
to affected Medi-Cal providers to the levels in effect prior to the
reductions imposed by Sections 14105.07, 14105.191, 14105.192, and
14105.93, is appropriated to the State Department of Health Care
Services for the purpose of increasing Medi-Cal provider rates, the
amount of which shall be calculated pursuant to subparagraph (C).
(B) The Director of Finance shall, in consultation with the State
Department of Developmental Services, calculate the percentage rate
increase to be provided to community care facilities serving persons
with developmental disabilities, residential service providers,
supported living service providers, nonresidential service providers,
other service providers, and supported employment service providers,
and the increase to regional center operating budgets. In
calculating the percentage increase, the director shall ensure that
the total cost of the rate increases for all service providers and
the increase in regional center operating budgets is no greater than
the amount necessary to provide a 10 percent rate increase to the
developmental services providers identified in subparagraph (B) of
paragraph (2) and that the percentage increase for each provider type
and regional center operating budget is the same.
(C) The Director of Finance shall, in consultation with the State
Department of Health Care Services, calculate the percentage rate
increase to be provided to Medi-Cal providers for whom rates were
reduced pursuant to Section 14105.07, 14105.191, 14105.192, or
14105.93. In calculating the percentage rate increase, the director
shall ensure that the total cost of the rate increase for all
providers equals the amount calculated pursuant to paragraph (1)
minus the amount necessary to provide a 10 percent rate increase to
the developmental services providers identified in subparagraph (B)
of paragraph (2), but no more than the amount necessary to restore
the rates paid to affected Medi-Cal providers to the levels in effect
prior to the reductions imposed by Sections 14105.07, 14105.191,
14105.192, and 14105.93, and that the percentage increase is
equitable among eligible Medi-Cal providers and managed care health
plans that contract with the State Department of Health Care Services
pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8
(commencing with Section 14200) of Part 3 of Division 9.
(b) (1) On or before May 14, 2016, the Director of Finance shall
recalculate the sum of the amount by which General Fund revenues for
the 2014-15 fiscal year exceed the revenue estimated for that fiscal
year calculated at the time of the Budget Act of 2015 and the amount
by which General Fund revenues for the 2015-16 fiscal year are
expected to exceed the revenue estimated for that fiscal year in the
Budget Act of 2015.
(2) If the amount calculated pursuant to paragraph (1), after
subtracting the amounts required to satisfy the obligations arising
from Sections 8 and 20 of Article XVI of the California Constitution,
is greater than the amount calculated pursuant to paragraph (1) of
subdivision (a), but is less than or equal to the amount necessary to
provide a 10 percent rate increase to the developmental services
providers identified in subparagraph (B) of paragraph (2) of
subdivision (a), the entire amount, less the amount appropriated
pursuant to subparagraph (A) of paragraph (2) of subdivision (a), is
appropriated to the State Department of Developmental Services for
the purpose of providing rate increases to service providers and
increasing regional center operating budgets, the amount of which
shall be calculated pursuant to subparagraph (B) of paragraph (2) of
subdivision (a), except that the total cost of the rate increases for
all service providers and the increase in regional center operating
budgets shall equal the amount calculated pursuant to this paragraph.
(3) If the amount calculated pursuant to paragraph (1), after
subtracting the amounts required to satisfy the obligations arising
from Sections 8 and 20 of Article XVI of the California Constitution,
is greater than the amount calculated pursuant to paragraph (1) of
subdivision (a), and is more than the amount necessary to provide a
10 percent rate increase to the developmental services providers
identified in subparagraph (B) of paragraph (2) of subdivision (a),
then the amount necessary to provide a 10 percent rate increase to
the developmental services providers identified in subparagraph (B)
of paragraph (2) of subdivision (a), less any amount appropriated
pursuant to subparagraph (A) of paragraph (2) of subdivision (a) or
subparagraph (A) of paragraph (3) of subdivision (a), is appropriated
to the State Department of Developmental Services for the purpose of
providing rate increases to service providers and increasing
regional center operating budgets, the amount of which shall be
calculated pursuant to subparagraph (B) of paragraph (3) of
subdivision (a), except that the total cost of the rate increases for
all service providers and the increase in regional center operating
budgets shall equal the amount appropriated to the State Department
of Developmental Services pursuant to this paragraph. The remainder
of the amount, up to the amount necessary to restore the rates paid
to affected Medi-Cal providers to the levels in effect prior to the
reductions imposed by Sections 14105.07, 14105.191, 14105.192, and
14105.93, less any amount appropriated pursuant to subparagraph (A)
of paragraph (3) of subdivision (a), is appropriated to the State
Department of Health Care Services for the purpose of increasing
Medi-Cal provider rates for providers for whom rates were reduced
pursuant to Sections 14105.07, 14105.191, 14105.192, and 14105.93,
the amount of which shall be calculated pursuant to subparagraph (C)
of paragraph (3) of subdivision (a), except that the total cost of
the rate increase for all providers shall equal the amount
appropriated to the State Department of Health Care Services pursuant
to this paragraph.
(c) The rate increases calculated and provided pursuant to this
section, if any, shall be retroactive to July 1, 2015.
SEC. 8. Section 4794 is added to the Welfare and Institutions
Code, immediately following Section 4793, to read:
4794. Notwithstanding any other law, the department shall
increase funding provided to a regional center for the regional
center's operating budget to implement the rate increase or
increases, if any, required by Section 4793.
SEC. 9. Section 4860 of the Welfare and Institutions Code is
amended to read:
4860. (a) (1) The Except as provided in
subdivision (f), the hourly rate for supported employment
services provided to consumers receiving individualized services
shall be thirty dollars and eighty-two cents ($30.82).
(2) Job coach hours spent in travel to consumer worksites may be
reimbursable for individualized services only when the job coach
travels from the vendor's headquarters to the consumer's worksite or
from one consumer's worksite to another, and only when the travel is
one way.
(b) The Except as provided in
subdivision (f), the hourly rate for group services shall be
thirty dollars and eighty-two cents ($30.82), regardless of the
number of consumers served in the group. Consumers in a group shall
be scheduled to start and end work at the same time, unless an
exception that takes into consideration the consumer's compensated
work schedule is approved in advance by the regional center. The
department, in consultation with stakeholders, shall adopt
regulations to define the appropriate grounds for granting these
exceptions. When the number of consumers in a supported employment
placement group drops to fewer than the minimum required in
subdivision (r) of Section 4851, the regional center may terminate
funding for the group services in that group, unless, within 90 days,
the program provider adds one or more regional centers, or
Department of Rehabilitation-funded supported employment consumers to
the group.
(c) Job coaching hours for group services shall be allocated on a
prorated basis between a regional center and the Department of
Rehabilitation when regional center and Department of Rehabilitation
consumers are served in the same group.
(d) When Section 4855 applies, fees shall be authorized for the
following:
(1) A three-hundred-sixty-dollar ($360) fee shall be paid to the
program provider upon intake of a consumer into a supported
employment program. No fee shall be paid if that consumer completed a
supported employment intake process with that same supported
employment program within the previous 12 months.
(2) A seven-hundred-twenty-dollar ($720) fee shall be paid upon
placement of a consumer in an integrated job, except that no fee
shall be paid if that consumer is placed with another consumer or
consumers assigned to the same job coach during the same hours of
employment.
(3) A seven-hundred-twenty-dollar ($720) fee shall be paid after a
90-day retention of a consumer in a job, except that no fee shall be
paid if that consumer has been placed with another consumer or
consumers, assigned to the same job coach during the same hours of
employment.
(e) Notwithstanding paragraph (4) of subdivision (a) of Section
4648, the regional center shall pay the supported employment program
rates established by this section.
(f) The department shall increase the hourly rates established
pursuant to subdivisions (a) and (b) to implement the rate increase
or increases, if any, required by Section 4793.
SEC. 10. Section 14105.194 is added to the Welfare and
Institutions Code, to read:
14105.194. (a) Notwithstanding Sections 14105.07, 14105.191,
14105.192, and 14105.193, payments to providers and managed care
health plans that contract with the department pursuant to this
chapter or Chapter 8 (commencing with Section 14200) shall be
increased pursuant to the operation of Section 4793.
(b) The director shall implement this section to the maximum
extent permitted by federal law and for the maximum time period for
which the director obtains federal approval for federal financial
participation for the increases provided for in Section 4793 and this
section.
(c) The director shall promptly seek all necessary federal
approvals to implement this section.
SEC. 11. The Legislature declares that the changes made by this
act are not intended to result in the substantial impairment of any
contract. To the extent any contract would be substantially impaired
as a result of the application of any change made by this act, it is
the intent of the Legislature that the change apply only to contracts
renewed or entered into on or after the date this act becomes
effective.