BILL ANALYSIS                                                                                                                                                                                                    




                   Senate Appropriations Committee Fiscal Summary
                           Senator Christine Kehoe, Chair

                                           303 (Beall)
          
          Hearing Date:  8/27/2009        Amended: 6/18/2009
          Consultant: Katie Johnson       Policy Vote: Health 11-0
          _________________________________________________________________ 
          ____
          BILL SUMMARY:  AB 303 would allow designated public hospitals to  
          receive Medi-Cal supplemental reimbursement funds from the  
          Construction and Renovation Reimbursement Program (CRRP) for  
          debt service on new capital projects specifically related to  
          meeting state seismic safety deadlines.
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          ____
                            Fiscal Impact (in thousands)

           Major Provisions         2009-10      2010-11       2011-12     Fund
                                                                  
          Debt service payments                   unknown,  
          potentiallyFederal/
                                   $75 - $150 million annually         
          Local/
                                                                 Special
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          ____

          STAFF COMMENTS:  SUSPENSE FILE.

          Existing law establishes seismic safety requirements under the  
          Alfred E. Alquist Hospital Facilities Seismic Safety Act. The  
          act required the Office of Statewide Health Planning and  
          Development (OSHPD) to classify general acute care hospital  
          buildings in one of 5 Structural Performance Categories-SPC-1  
          meaning the building is at risk of collapse during an  
          earthquake, SPC-2 meaning the building is not at risk of  
          collapse, but may not be functional after an earthquake, and  
          SPC-3 - SPC-5 meaning the building is capable of providing  
          services after an earthquake. SPC-1 buildings must have been  
          removed, replaced, or retrofitted by January 1, 2008, or 2013 or  
          2015 or replaced by 2020 if they received authorized extensions.  
          SPC-2 buildings must be in compliance with seismic safety  
          standards by 2030.

          Existing law, SB 1732 (Presley), Chapter 1635, Statutes of 1988,  










          establishes the Construction and Renovation Reimbursement  
          Program (CRRP), which provides supplemental Medi-Cal  
          reimbursement for a portion of the debt service incurred on  
          revenue bonds that were issued for the construction, renovation,  
          or replacement of eligible hospital facilities, as specified,  
          that had submitted plans for new construction between September  
          1, 1988, and June 30, 1994. SB 1732 expenditures were $132.9  
          million in 2006-2007 for 16 hospitals and $97.9 million in  
          2007-2008 for 20 hospitals. SB 1732's nonfederal share payments  
          are made with General Fund dollars. 

          This bill would permit the designated public hospitals, as  
          specified, to receive supplemental reimbursements from the CRRP  
          for new capital projects for which final plans were submitted to  
          OSHPD between January 1, 2007, and December 31, 2011. At the  
          time of this analysis, it is unknown how many of the 24 eligible  
          hospitals would choose to participate in the program.

          Page 2
          AB 303 (Beall)

          This bill would prohibit the use of General Fund monies for the  
          nonfederal share of the supplemental reimbursement provided  
          under these provisions. Instead, it would allow the use of other  
          state funds, or, in their absence, the use of certified public  
          expenditures (CPEs) or intergovernmental transfers (IGTs), among  
          others, as the nonfederal share. Currently, there are no special  
          funds identified for this purpose. The Department of Health Care  
          Services would need to amend the Medi-Cal state plan in order  
          for hospitals to use CPEs or IGTs to draw down federal funds. 

          Funding through CPEs and IGTs would put pressure on county  
          budgets. This bill would provide that these provisions would  
          only be implemented to the extent that federal approval and  
          federal financial participation is available.

          This bill is similar to AB 1149 (Beall) of 2007, which would  
          have authorized disproportionate share hospitals designated as  
          Level 1 trauma centers located in Seismic Zone 4 as eligible to  
          receive supplemental payments from CRRP. AB 1149 was held on the  
          Assembly Appropriations suspense file.