BILL NUMBER: AB 62 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 28, 2011
INTRODUCED BY Assembly Member Monning
DECEMBER 7, 2010
An act to add Article 5.227 (commencing with Section
14168) to Chapter 7 of Part 3 of Division 9 amend
Section 14132.275 of the Welfare and Institutions Code,
relating to Medi-Cal , making an appropriation therefor, and
declaring the urgency thereof, to take effect immediately.
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LEGISLATIVE COUNSEL'S DIGEST
AB 62, as amended, Monning. Medi-Cal: hospitals: quality
assurance fee. dual eligibles: pilot projects.
Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services and
under which qualified low-income persons receive health care
benefits. The Medi-Cal program is, in part, governed and funded by
federal Medicaid provisions. Existing federal law provides for
the federal Medicare Program, which is a public health insurance
program for persons 65 years of age and older and specified persons
with disabilities who are under 65 years of age. Existing law, to the
extent that federal financial participation is available, and
pursuant to a demonstration project or waiver of federal law,
requires the department to establish pilot projects in up to 4
counties, to develop effective health care models to provide services
to persons who are dually eligible under both the Medi-Cal and
Medicare programs. Existing law requires the department
to, not sooner than March 1, 2011, identify health care models that
may be included in a pilot project, develop a timeline and
process for selecting, financing, monitoring, and evaluating the
pilot projects, and provide this timeline and process to
certain committees of the Legislature.
This bill would provide that, in relation to the requirement that
the department seek federal approval to establish the pilot projects,
the department may seek federal approval pursuant to a response to a
request for proposal from the federal Centers for Medicare and
Medicaid Services. This bill would require the department to consult
with stakeholders, including, among others, representatives of
advocacy organizations, persons with disabilities, seniors, and
representatives of legal services agencies that serve dual eligibles
on a regular basis throughout the development and implementation of
the pilot projects.
Existing law, subject to federal approval, requires the department
to make supplemental payments for certain services, as specified, to
private hospitals, nondesignated public hospitals, and designated
public hospitals, as defined, for subject federal fiscal years.
Existing law, subject to federal approval, also imposes a quality
assurance fee, as specified, on certain general acute care hospitals
through and including December 31, 2010. Existing law creates the
Hospital Quality Assurance Revenue Fund in the State Treasury and
requires that the money collected from the quality assurance fee be
deposited into the fund. Existing law provides that the moneys in the
fund shall, upon appropriation by the Legislature, be available only
for certain purposes, including providing the above-described
supplemental payments to hospitals and health care coverage for
children.
Existing law, effective January 1, 2011, and subject to subsequent
statutory authorization that meets certain conditions, imposes a
quality assurance fee in a manner necessary to obtain federal
Medicaid matching funds that shall be due and payable to the
department by each general acute care hospital at specified rates for
the purpose of making Medi-Cal payments to hospitals.
This bill would, effective July 1, 2011, impose on each general
acute care hospital that is not an exempt facility, as defined, a
quality assurance fee. This bill would require the quality assurance
fee to be computed starting on the effective date of the bill and
continue through and including October 31, 2015. The bill would
require the proceeds from the fee to be used for the same purposes as
the above-described quality assurance fee that is imposed on
hospitals through and including December 31, 2010. The bill would
provide that the method of calculation and collection of the quality
assurance fee is to be determined in an unspecified manner.
This bill would require the director to seek federal approvals or
waivers as may be necessary to implement the above-described
provisions and to obtain federal financial participation to the
maximum extent possible with the proceeds from the quality assurance
fee paid pursuant to those provisions.
This bill would require the fee payments and any related federal
reimbursement to be deposited in the Hospital Quality Assurance
Revenue Fund. The bill would continuously appropriate these moneys in
an unspecified manner.
This bill would declare that it is to take effect immediately as
an urgency statute.
Vote: 2/3 majority . Appropriation:
yes no . Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14132.275 of the
Welfare and Institutions Code is amended to read:
14132.275. (a) The department shall seek federal approval to
establish pilot projects described in this section pursuant to a
Medicare or a Medicaid demonstration project or waiver, or
a combination thereof , or in response to a request
for proposal from the federal Centers for Medicare and
Medicaid Services . Under a Medicare demonstration, the
department may operate the Medicare component of a pilot project as a
delegated Medicare benefit administrator, and may enter into
financing arrangements with the federal Centers for Medicare and
Medicaid Services to share in any Medicare program savings generated
by the operation of any pilot project.
(b) After federal approval is obtained, the department shall
establish pilot projects that enable dual eligibles to receive a
continuum of services, and that maximize the coordination of benefits
between the Medi-Cal and Medicare programs and access to the
continuum of services needed. The purpose of the pilot projects is to
develop effective health care models that integrate services
authorized under the federal Medicaid Program (Title XIX of the
federal Social Security Act (42 U.S.C. Sec. 1396 et seq.)) and the
federal Medicare Program (Title XVIII of the federal Social Security
Act (42 U.S.C. Sec. 1395 et seq.)). These pilot projects may also
include additional services as approved through a demonstration
project or waiver, or a combination thereof.
(c) Not sooner than March 1, 2011, the department shall identify
health care models that may be included in a pilot project, shall
develop a timeline and process for selecting, financing, monitoring,
and evaluating these pilot projects, and shall provide this timeline
and process to the appropriate fiscal and policy committees of the
Legislature. The department may implement these pilot projects in
phases.
(d) Goals for the pilot projects shall include all of the
following:
(1) Coordinating Medi-Cal benefits, Medicare benefits, or both,
across health care settings and improving continuity of acute care,
long-term care, and home- and community-based services.
(2) Coordinating access to acute and long-term care services for
dual eligibles.
(3) Maximizing the ability of dual eligibles to remain in their
homes and communities with appropriate services and supports in lieu
of institutional care.
(4) Increasing the availability of and access to home- and
community-based alternatives.
(e) Pilot projects shall be established in up to four counties,
and shall include at least one county that provides Medi-Cal services
via a two-plan model pursuant to Article 2.7 (commencing with
Section 14087.3) and at least one county that provides Medi-Cal
services under a county organized health system pursuant to Article
2.8 (commencing with Section 14087.5). In determining the counties in
which to establish a pilot project, the director shall consider the
following:
(1) Local support for integrating medical care, long-term care,
and home- and community-based services networks.
(2) A local stakeholder process that includes health plans,
providers, community programs, consumers, and other interested
stakeholders in the development, implementation, and continued
operation of the pilot project.
(f) The director may enter into exclusive or nonexclusive
contracts on a bid or negotiated basis and may amend existing managed
care contracts to provide or arrange for services provided under
this section. Contracts entered into or amended pursuant to this
section shall be exempt from the provisions of Chapter 2 (commencing
with Section 10290) of Part 2 of Division 2 of the Public Contract
Code and Chapter 6 (commencing with Section 14825) of Part 5.5 of
Division 3 of Title 2 of the Government Code.
(g) Services under Section 14132.95 , or
14132.952, or Article 7 (commencing with Section 12300) of
Chapter 3 that are provided under the pilot projects established by
this section shall be provided through direct hiring of personnel,
contract, or establishment of a public authority or nonprofit
consortium, in accordance with, and subject to, the requirements of
Section 12302 or 12301.6, as applicable.
(h) Notwithstanding any other provision of state law, the
department may require that dual eligibles be assigned as mandatory
enrollees into managed care plans established or expanded as part of
a pilot project established under this section. Mandatory enrollment
in managed care for dual eligibles shall be applicable to the
beneficiary's Medi-Cal benefits only. Dual eligibles shall have the
option to enroll in a Medicare Advantage special needs plan (SNP)
offered by the managed care plan established or expanded as part of a
pilot project established pursuant to subdivision (e). To
the extent that mandatory enrollment is required, any requirement of
the department and the health plans, and any requirement of
continuity of care protections for enrollees, as specified in Section
14182, shall be applicable to this section. Dual eligibles shall
have the option to forgo receiving Medicare benefits under a pilot
project. Nothing in this section shall be interpreted to reduce
benefits otherwise available under the Medi-Cal program or the
Medicare Program.
(i) For purposes of this section, a "dual eligible" means an
individual who is simultaneously eligible for full scope benefits
under Medi-Cal and the federal Medicare Program.
(j) Persons meeting requirements for the Program of
All-Inclusive Care for the Elderly (PACE) pursuant to Chapter 8.75
(commencing with Section 14590), may select a PACE plan if one is
available in that county.
(k) Notwithstanding Section 10231.5 of the Government Code, the
department shall conduct an evaluation to assess outcomes and the
experience of dual eligibles in these pilot projects and shall
provide a report to the Legislature after the first full year of
pilot operation, and annually thereafter. A report submitted to the
Legislature pursuant to this subdivision shall be submitted in
compliance with Section 9795 of the Government Code. The department
shall consult with stakeholders regarding the scope and structure of
the evaluation.
(l) This section shall be implemented only if and to the extent
that federal financial participation or funding is available to
establish these pilot projects.
(m) The department shall consult with stakeholders, including, but
not limited to, representatives of advocacy organizations, persons
with disabilities, seniors, representatives of legal services
agencies that serve dual eligibles, specialty care providers,
provider associations, labor, health plans, county government, and
the Legislature, on a regular basis throughout the development and
implementation of the pilot projects.
(m)
( n) Notwithstanding Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code, the department may implement, interpret, or make
specific this section and any applicable federal waivers and state
plan amendments by means of all-county letters, plan letters, plan or
provider bulletins, or similar instructions, without taking
regulatory action. Prior to issuing any letter or similar instrument
authorized pursuant to this section, the department shall notify and
consult with stakeholders, including advocates, providers, and
beneficiaries. The department shall notify the appropriate policy and
fiscal committees of the Legislature of its intent to issue
instructions under this section at least five days in advance of the
issuance.
SECTION 1. Article 5.227 (commencing with
Section 14168) is added to Chapter 7 of Part 3 of Division 9 of the
Welfare and Institutions Code, to read:
Article 5.227. Quality Assurance Fee Act
14168. (a) (1) "Exempt facility" means any of the following:
(A) A public hospital, which shall include either of the
following:
(i) A hospital, as defined in paragraph (25) of subdivision (a) of
Section 14105.98.
(ii) A tax-exempt nonprofit hospital that is licensed under
subdivision (a) of Section 1250 of the Health and Safety Code and
operating a hospital owned by a local health care district, and is
affiliated with the health care district hospital owner by means of
the district's status as the nonprofit corporation's sole corporate
member.
(B) With the exception of a hospital that is in the Charitable
Research Hospital peer group, as set forth in the 1991 Hospital Peer
Grouping Report published by the department, a hospital that is a
hospital designated as a specialty hospital in the hospital's Office
of Statewide Health Planning and Development Hospital Annual
Disclosure Report for the hospital's fiscal year ending in the 2007
calendar year.
(C) A hospital that satisfies the Medicare criteria to be a
long-term care hospital.
(D) A small and rural hospital as specified in Section 124840 of
the Health and Safety Code designated as that in the hospital's
Office of Statewide Health Planning and Development Hospital Annual
Disclosure Report for the hospital's fiscal year ending in the 2007
calendar year.
(2) "General acute care hospital" means any hospital licensed
pursuant to subdivision (a) of Section 1250 of the Health and Safety
Code.
(b) Effective July 1, 2011, there shall be imposed on each general
acute care hospital that is not an exempt facility a quality
assurance fee.
(c) (1) The quality assurance fee shall be computed starting on
the effective date of this article and continue through and including
October 31, 2015.
(2) The method of calculation and collection of the quality
assurance fee shall be determined pursuant to ____.
(3) The quality assurance fee shall be used solely for the
purposes specified in Article 5.21 (commencing with Section 14167.1)
and Article 5.22 (commencing with Section 14167.31).
(d) The director shall do all of the following:
(1) Seek federal approvals or waivers as may be necessary to
implement this article.
(2) Obtain federal financial participation to the maximum extent
possible with the proceeds from the quality assurance fee paid
pursuant to this article.
(e) (1) The fee payments and any related federal reimbursement
shall be deposited in the Hospital Quality Assurance Revenue Fund.
(2) Notwithstanding Section 13340 of the Government Code, any
moneys deposited in the Hospital Quality Assurance Revenue Fund
pursuant to paragraph (1) shall be continuously appropriated, without
regard to fiscal year, as follows:____.
SEC. 2. This act is an urgency statute
necessary for the immediate preservation of the public peace, health,
or safety within the meaning of Article IV of the Constitution and
shall go into immediate effect. The facts constituting the necessity
are:
In order to make the necessary statutory changes to increase
Medi-Cal payments to health care providers and improve access, at the
earliest possible time, it is necessary that this act take effect
immediately.