BILL NUMBER: SB 1236	AMENDED
	BILL TEXT

	AMENDED IN SENATE  MAY 20, 2010
	AMENDED IN SENATE  APRIL 21, 2010

INTRODUCED BY   Senator Alquist
    (   Coauthor:   Assembly Member  
Beall   ) 

                        FEBRUARY 19, 2010

   An act to add and repeal Section 14133.55 of the Welfare and
Institutions Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 1236, as amended, Alquist. Medi-Cal: utilization controls.
   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
provisions.
   Existing law establishes a program in Alameda County in which
utilization controls shall not be required when, pursuant to federal
law under the Medicare Program, a county hospital based utilization
review committee has been established to determine the level of
authorization for payment under Medi-Cal and a utilization plan has
been filed with  , and approved by,  the department 
and approved by it  .
   This bill would establish a program, whereby state utilization
controls shall not be required for inpatient hospitalization at
designated public hospitals, as defined  , with participation
being optional for each hospital. The bill would require the
department to consult with designated public hospitals in the
development of the program  . The bill would require the
nonfederal share of expenditures for inpatient hospitalization at
designated public hospitals submitted to the federal Centers for
Medicare and Medicaid Services for purposes of claiming federal
financial participation  pursuant to the above-described
provisions  to be comprised of only those funds that are paid
 and certified  by designated public hospitals  and
certified by counties  in accordance with applicable state
and federal requirements.  The bill would, to the extent the
program increases the net costs to the state, require the
participating designated public hospitals to agree to pay the state's
additional administrative costs through an intergovernmental
transfer of funds. 
   This bill would provide that the above-described provisions shall
become inoperative on the date the Director of Health Care Services
executes a declaration specifying that the nonfederal share of
expenditures for inpatient hospitalization at designated public
hospitals used for purposes of claiming federal financial
participation is not comprised of funds that are paid  and
certified  by designated public hospitals  and certified
by counties  in accordance with applicable state and
federal requirements. 
   This bill would require the department to seek any necessary
federal approvals, including waivers and state plan amendments, for
implementing the above-described program, as specified. 
   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 14133.55 is added to the Welfare and
Institutions Code, to read:
   14133.55.  (a) There shall be established a program whereby state
utilization controls shall not be required for inpatient
hospitalization at designated public hospitals, as defined in
subdivision (d) of Section 14166.1. 
   The department shall consult with designated public hospitals in
the development of the program established pursuant to this
subdivision. Each designated public hospital shall have the option to
participate in the program established pursuant to this subdivision.
 
   (b) The department shall seek any necessary federal approvals,
including waivers and state plan amendments, for implementing the
program established pursuant to subdivision (a) in a manner that will
comply with applicable federal Medicaid requirements and allow
designated public hospitals to obtain federal financial participation
for inpatient hospitalization at designated public hospitals. 

   (b) 
    (c)  The nonfederal share of expenditures for inpatient
hospitalization at designated public hospitals submitted to the
federal Centers for Medicare and Medicaid Services for purposes of
claiming federal financial participation  pursuant to this
section  shall be comprised of only those funds that are paid
 and certified  by designated public hospitals  and
certified by counties  in accordance with applicable state
and federal requirements. 
   (c) 
    (d)  This section shall become inoperative on the date
the Director of Health Care Services executes a declaration
specifying that the nonfederal share of expenditures for inpatient
hospitalization at designated public hospitals used for purposes of
claiming federal financial participation is not comprised of funds
that are paid  and certified  by designated public hospitals
 and certified by counties  in accordance with
applicable state and federal requirements, and as of that date is
repealed. 
   (d)
    (e)  Notwithstanding Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code, the department shall implement this section by means of policy
letters or similar instructions, without taking further regulatory
action. 
   (f) To the extent that the program established pursuant to
subdivision (a) increases the net costs to the state, the
participating designated public hospitals shall agree to pay the
state's additional administrative costs through an intergovernmental
transfer of funds.  
   (g) This section shall be implemented only to the extent federal
financial participation is available.