BILL ANALYSIS
AB 366
Page 1
Date of Hearing: May 6, 2009
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Kevin De Leon, Chair
AB 366 (Ruskin) - As Amended: April 2, 2009
Policy Committee: Health Vote:17-0
Urgency: No State Mandated Local Program:
No Reimbursable:
SUMMARY
This bill requires the California Medical Assistance Commission
(CMAC) to provide separate reimbursement for hospitals for the
full cost of orthopedic implants for bone cancer patients. The
separate reimbursement established by this bill will be distinct
from the contracting process CMAC conducts on behalf of the
California Department of Health Care Services (DHCS) for
Medi-Cal hospital in-patient costs.
FISCAL EFFECT
1)Increased annual costs of $1 million (50% GF) to $1.2 million
(50% GF) to provide reimbursement above current CMAC
contracted rates. Annually, 300 Californians are diagnosed
with bone cancer each year. Only some of these individuals
have Medi-Cal and only some of the Medi-Cal beneficiaries will
be clinically eligible for a bone implant. Under current law
hospitals with orthopedic bone specialty care must absorb per
implant costs of $20,000 within CMAC inpatient rates or fail
to recover these costs for Medi-Cal patients.
2)The term "full cost" in this bill is undefined. Pricing in
health care is more variable than in many other sectors. The
author may wish to define this term and tie it to a known
benchmark.
COMMENTS
1)Rationale . This bill is sponsored by City of Hope, one of 40
National Cancer Institute-designated Comprehensive Cancer
Centers, located in Los Angeles. This bill increases
reimbursement paid for bone implants by creating a separate
AB 366
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rate, in addition to CMAC rates which average approximately
$1,300 per day. This bill improves Medi-Cal beneficiary
access to orthopedic services when bone implants are a
component of a treatment plan.
2)Background . The CMAC negotiates contracts with hospitals on
behalf of DHCS for inpatient services under the Medi-Cal
program. The CMAC selectively contracts on a competitive
basis with hospitals for inpatient services provided to
beneficiaries in the fee-for-service Medi-Cal program via the
Selective Provider Contracting Program (SPCP). CMAC contracts
with about 200 general acute care hospitals. Under current
law CMAC includes specialized pricing features in contracts
for bone marrow searches, cord blood transplantation and
factor drugs used to treat hemophilia.
Analysis Prepared by : Mary Ader / APPR. / (916) 319-2081