BILL NUMBER: SB 732 AMENDED
BILL TEXT
AMENDED IN SENATE DECEMBER 17, 2009
AMENDED IN SENATE MARCH 31, 2009
INTRODUCED BY Senator Alquist
FEBRUARY 27, 2009
An act to add Section 14126.024 to amend
Section 1324.23 of the Health and Safety Code, and to
amend Section 14126.027 of the Welfare and Institutions Code,
relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
SB 732, as amended, Alquist. Medi-Cal: long-term care
reimbursement: cost reporting methodology. skilled
nursing facilities: quality assurance fees.
Existing law provides for the licensure and regulation by the
State Department of Public Health of long-term health care
facilities, including skilled nursing facilities. Existing law
requires the department to impose a uniform quality assurance fee on
each skilled nursing facility, with certain exceptions, in accordance
with a prescribed formula. The formula is based on the determination
of the projected net revenues of skilled nursing facilities. The fee
will cease to be assessed and collected on and after July 31, 2011.
Existing law provides for the Medi-Cal program,
administered by the State Department of Health Care Services, under
which health care services, including nursing facility services, are
provided to qualified low-income persons. Existing law prescribes
procedures for Medi-Cal reimbursement at these facilities.
The Medi-Cal Long-Term Care Reimbursement Act requires the
department to implement a facility-specific ratesetting system,
subject to federal approval and the availability of federal funds,
that uses a cost-based reimbursement rate methodology that reflects
the costs and staffing levels associated with quality of care for
residents in skilled nursing facilities, except as specified. Under
existing law, the methodology is required to reflect the sum of the
projected cost of specified cost categories and passthrough costs.
Under existing law, the rate methodology shall cease to be
implemented on and after July 31, 2011.
This bill would require the department, in consultation with the
Office of Statewide Health Planning and Development, by July 1, 2010,
to establish a cost reporting methodology that allows the department
to adjust rates in a manner that is expedient and achieves the
intent of the Medi-Cal Long-Term Care Reimbursement Act. This bill
would require the cost reporting methodology to itemize costs,
including passthrough costs, within each of the specified cost
categories. This bill would authorize the department, in establishing
the cost reporting methodology, to update and modify existing cost
reporting mechanisms, as specified.
Existing law, the Medi-Cal Long-Term Care Reimbursement Act,
requires the department, subject to federal approval and the
availability of federal funds, to implement a facility-specific
reimbursement ratesetting system for certain freestanding skilled
nursing facilities. Reimbursement rates for these facilities are
funded by a combination of federal funds and moneys collected
pursuant to the above-described uniform quality assurance fee.
Existing law provides that this rate methodology shall cease to be
implemented on July 31, 2011, with these provisions to be repealed on
January 1, 2012.
Existing law authorizes the director to adopt regulations as are
necessary to implement the above-described provisions. Existing law
authorizes the director, as an alternative to adopting regulations,
to implement the above-described provisions, in whole or in part, by
means of a provider bulletin, or other similar instructions, without
taking regulatory action, provided that neither the bulletin nor the
other similar instructions remain in effect after July 31, 2010.
This bill would, instead, prohibit the provider bulletins or other
similar instructions from remaining in effect after July 31, 2011.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1324.23 of the
Health and Safety Code is amended to read:
1324.23. (a) The Director of Health Care Services, or his or her
designee, shall administer this article.
(b) The director may adopt regulations as are necessary to
implement this article. These regulations may be adopted as emergency
regulations in accordance with the rulemaking provisions of the
Administrative Procedure Act (Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code).
For purposes of this article, the adoption of regulations shall be
deemed an emergency and necessary for the immediate preservation of
the public peace, health and safety, or general welfare. The
regulations shall include, but need not be limited to, any
regulations necessary for any of the following purposes:
(1) The administration of this article, including the proper
imposition and collection of the quality assurance fee not to exceed
amounts reasonably necessary for purposes of this article.
(2) The development of any forms necessary to obtain required
information from facilities subject to the quality assurance fee.
(3) To provide details, definitions, formulas, and other
requirements.
(c) As an alternative to subdivision (b), and notwithstanding the
rulemaking provisions of Chapter 3.5 (commencing with Section 11340)
of Part 1 of Division 3 of Title 2 of the Government Code, the
director may implement this article, in whole or in part, by means of
a provider bulletin, or other similar instructions, without taking
regulatory action, provided that no such bulletin or other similar
instructions shall remain in effect after July 31, 2010
2011 . It is the intent of the Legislature that
the regulations adopted pursuant to subdivision (b) shall be adopted
on or before July 31, 2010 2011 .
SEC. 2. Section 14126.027 of the
Welfare and Institutions Code is amended to read:
14126.027. (a) (1) The Director of Health Care Services, or his
or her designee, shall administer this article.
(2) The regulations and other similar instructions adopted
pursuant to this article shall be developed in consultation with
representatives of the long-term care industry, organized labor,
seniors, and consumers.
(b) (1) The director may adopt regulations as are necessary to
implement this article. The adoption, amendment, repeal, or
readoption of a regulation authorized by this section is deemed to be
necessary for the immediate preservation of the public peace, health
and safety, or general welfare, for purposes of Sections 11346.1 and
11349.6 of the Government Code, and the department is hereby
exempted from the requirement that it describe specific facts showing
the need for immediate action.
(2) The regulations adopted pursuant to this section may include,
but need not be limited to, any regulations necessary for any of the
following purposes:
(A) The administration of this article, including the specific
analytical process for the proper determination of long-term care
rates.
(B) The development of any forms necessary to obtain required cost
data and other information from facilities subject to the
ratesetting methodology.
(C) To provide details, definitions, formulas, and other
requirements.
(c) As an alternative to the adoption of regulations pursuant to
subdivision (b), and notwithstanding Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code, the director may implement this article, in whole or in part,
by means of a provider bulletin or other similar instructions,
without taking regulatory action, provided that no such bulletin or
other similar instructions shall remain in effect after July 31,
2010 2011 . It is the intent that
regulations adopted pursuant to subdivision (b) shall be in place on
or before July 31, 2010 2011 .
SECTION 1. Section 14126.024 is added to the
Welfare and Institutions Code, to read:
14126.024. (a) The department, in consultation with the Office of
Statewide Health Planning and Development, shall, by July 1, 2010,
establish a cost reporting methodology that allows the department to
adjust rates in a manner that is expedient and achieves the intent of
this article.
(b) The cost reporting methodology shall itemize costs, including
passthrough costs, within each cost category specified in Section
14126.023. The department shall consult with representatives of
skilled nursing facilities, labor, and consumers when it determines
what costs shall be itemized.
(c) The department shall continue to collect the cost data
reported prior to July 1, 2010, in the new cost reporting
methodology.
(d) In establishing the cost reporting methodology, the department
may update and modify existing cost reporting mechanisms, including
the integrated long-term care disclosure, the Medi-Cal cost report
required by Section 128730 of the Health and Safety Code, and any
facility financial disclosure reports or supplemental information
provided to the department for the purposes of rate adjustment.