BILL NUMBER: SB 1517 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 9, 2012
INTRODUCED BY Senator Wolk
FEBRUARY 24, 2012
An act to amend Section Sections 15911,
16809, and 16809.3 of the Welfare and Institutions Code,
relating to county health services.
LEGISLATIVE COUNSEL'S DIGEST
SB 1517, as amended, Wolk. County medical service program: fees.
Existing law authorizes counties meeting certain criteria to elect
to participate in the County Medical Services Program (CMSP)
, for the purpose of providing specified health services to
eligible county residents. Counties that elect to participate in the
program may establish a County Medical Services Program
CMSP Governing Board , responsible for the
oversight of the participating counties . Existing law requires
fees to be paid each fiscal year, as a condition of participating in
the program, to the governing board in 12 equal monthly payments or
as otherwise specified by the governing board.
This bill would instead require the payments to the CMSP
governing board be made in 10 equal payments during the fiscal
year or as otherwise specified by the governing board.
Existing law establishes the County Medical Services Program
Account in the County Health Services Fund. Existing law requires the
moneys in the program account be used by the CMSP governing board to
pay for health care services of eligible county residents and to pay
the CMSP governing board expenses and program administrative costs.
Existing law permits the Department of Finance to authorize a loan of
up to $30,000,000 for deposit into the program account to ensure
there are sufficient funds available to reimburse providers and
counties pursuant to the CMSP. Existing law authorizes the CMSP
governing board to establish and maintain pilot projects for
providing benefits under the CMSP and to develop and implement
alternative products outside of the CMSP. Existing law permits a CMSP
to apply to operate a local Low Income Health Program for the
purpose of providing health care services, as specified.
This bill would authorize the loan to be used for CMSP governing
board expenses that are associated with the governing board's Low
Income Health Program.
Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 15911 of the Welfare
and Institutions Code is amended to read:
15911. (a) Funding for each LIHP shall be based on all of the
following:
(1) The amount of funding that the participating entity
voluntarily provides for the nonfederal share of LIHP expenditures.
(2) For a LIHP that had in operation a Health Care Coverage
Initiative program under Part 3.5 (commencing with Section 15900) as
of November 1, 2010, and elects to continue funding the program, the
amount of funds requested to ensure that eligible enrollees continue
to receive health care services for persons enrolled in the Health
Care Coverage Initiative program as of November 1, 2010.
(3) Any limitations imposed by the Special Terms and Conditions of
the demonstration project.
(4) The total allocations requested by participating entities for
Health Care Coverage Initiative eligible individuals.
(5) Whether funding under this part would result in the reduction
of other payments under the demonstration project.
(b) Nothing in this part shall be construed to require a political
subdivision of the state to participate in a LIHP as set forth in
this part, and those local funds expended or transferred for the
nonfederal share of LIHP expenditures under this part shall be
considered voluntary contributions for purposes of the federal
Patient Protection and Affordable Care Act (Public Law 111-148), as
amended by the federal Health Care and Education Reconciliation Act
of 2010 (Public Law 111-152), and the federal American Recovery and
Reinvestment Act of 2009 (Public Law 111-5), as amended by the
federal Patient Protection and Affordable Care Act.
(c) No Except as provided for in
subdivision (n) of Section 16809, state General Fund moneys
shall not be used to fund LIHP services, nor to fund any
related administrative costs incurred by counties or any other
political subdivision of the state.
(d) Subject to the Special Terms and Conditions of the
demonstration project, if a participating entity elects to fund the
nonfederal share of a LIHP, the nonfederal funding and payments to
the LIHP shall be provided through one of the following mechanisms,
at the options of the participating entity:
(1) On a quarterly basis, the participating entity shall transfer
to the department for deposit in the LIHP Fund established for the
participating counties and pursuant to subparagraph (A), the amount
necessary to meet the nonfederal share of estimated payments to the
LIHP for the next quarter under subdivision (g) Section 15910.3.
(A) The LIHP Fund is hereby created in the State Treasury.
Notwithstanding Section 13340 of the Government Code, all moneys in
the fund shall be continuously appropriated to the department for the
purposes specified in this part. The fund shall contain all moneys
deposited into the fund in accordance with this paragraph.
(B) The department shall obtain the related federal financial
participation and pay the rates established under Section 15910.3,
provided that the intergovernmental transfer is transferred in
accordance with the deadlines imposed under the Medi-Cal Checkwrite
Schedule, no later than the next available warrant release date. This
payment shall be a nondiscretionary obligation of the department,
enforceable under a writ of mandate pursuant to Section 1085 of the
Code of Civil Procedure. Participating entities may request expedited
processing within seven business days of the transfer as made
available by the State Controllers office, provided that the
participating entity prepay the department for the additional
administrative costs associated with the expedited processing.
(C) Total quarterly payment amounts shall be determined in
accordance with estimates of the number of enrollees in each rate
category, subject to annual reconciliation to final enrollment data.
(2) If a participating entity operates its LIHP through a contract
with another entity, the participating entity may pay the operating
entity based on the per enrollee rates established under Section
15910.3 on a quarterly basis in accordance with estimates of the
number of enrollees in each rate category, subject to annual
reconciliation to final enrollment data.
(A) (i) On a quarterly basis, the participating entity shall
certify the expenditures made under this paragraph and submit the
report of certified public expenditures to the department.
(ii) The department shall report the certified public expenditures
of a participating entity under this paragraph on the next available
quarterly report as necessary to obtain federal financial
participation for the expenditures. The total amount of federal
financial participation associated with the participating entity's
expenditures under this paragraph shall be reimbursed to the
participating entity.
(B) At the option of the participating entity, the LIHP may be
reimbursed on a cost basis in accordance with the methodology applied
to Health Care Coverage Initiative programs established under Part
3.5 (commencing with Section 15900) including interim quarterly
payments.
(e) Notwithstanding Section 15910.3 and subdivision (d) of this
section, if the participating entity cannot reach an agreement with
the department as to the appropriate rate to be paid under Section
15910.3, at the option of the participating entity, the LIHP shall be
reimbursed on a cost basis in accordance with the methodology
applied to Health Care Coverage Initiative programs established under
Part 3.5 (commencing with Section 15900), including interim
quarterly payments. If the participating entity and the department
reach an agreement as to the appropriate rate, the rate shall be
applied no earlier than the first day of the LIHP year in which the
parties agree to the rate.
(f) If authorized under the Special Terms and Conditions of the
demonstration project, pending the department's development of rates
in accordance with Section 15910.3, the department shall make interim
quarterly payments to approved LIHPs for expenditures based on
estimated costs submitted for rate setting.
(g) Participating entities that operate a LIHP directly or through
contract with another entity shall be entitled to any federal
financial participation available for administrative expenditures
incurred in the operation of the Medi-Cal program or the
demonstration project, including, but not limited to, outreach,
screening and enrollment, program development, data collection,
reporting and quality monitoring, and contract administration, but
only to the extent that the expenditures are allowable under federal
law and only to the extent the expenditures are not taken into
account in the determination of the per enrollee rates under Section
15910.3.
(h) On and after January 1, 2014, the state shall implement
comprehensive health care reform for the populations targeted by the
LIHP in compliance with federal health care reform law, regulation,
and policy, including the federal Patient Protection and Affordable
Care Act (Public Law 111-148), as amended by the federal Health Care
and Education Reconciliation Act of 2010 (Public Law 111-152), and
subsequent amendments.
(i) Subject to the Special Terms and Conditions of the
demonstration project, a participating entity may elect to include,
in collaboration with the department, as the nonfederal share of LIHP
expenditures, voluntary intergovernmental transfers or certified
public expenditures of another governmental entity, as long as the
intergovernmental transfer or certified public expenditure is
consistent with federal law.
(j) Participation in the LIHP under this part is voluntary on the
part of the eligible entity for purposes of all applicable federal
laws. As part of its voluntary participation under this article, the
participating entity shall agree to reimburse the state for the
nonfederal share of state staffing and administrative costs directly
attributable to the cost of administering that LIHP, including, but
not limited to, the state administrative costs related to certified
public expenditures and intergovernmental transfers. This section
shall be implemented only to the extent federal financial
participation is not jeopardized.
SEC. 2. Section 16809 of the Welfare
and Institutions Code is amended to read:
16809. (a) (1) The board of supervisors of a county that
contracted with the department pursuant to former Section 16709
during the 1990-91 fiscal year and any county with a population under
300,000, as determined in accordance with the 1990 decennial census,
by adopting a resolution to that effect, may elect to participate in
the County Medical Services Program. The governing board shall have
responsibilities for specified health services to county residents
certified eligible for those services by the county.
(2) The board of supervisors of a county that has contracted with
the governing board pursuant to paragraph (1) may also contract with
the governing board for the delivery of health care and
health-related services to county residents other than under the
County Medical Services Program by adopting a resolution to that
effect. The governing board shall have responsibilities for the
delivery of specified health services to county residents as agreed
upon by the governing board and the county. Participation by a county
pursuant to this paragraph shall be voluntary, and funds shall be
provided solely by the county.
(b) The governing board may contract with the department or any
other person or entity to administer the County Medical Services
Program.
(1) If the governing board contracts with the department to
administer the County Medical Services Program, that contract shall
include, but need not be limited to, all of the following:
(A) Provisions for the payment to participating counties for
making eligibility determinations as determined by the governing
board.
(B) Provisions for payment of expenses of the governing board.
(C) Provisions relating to the flow of funds from counties'
vehicle license fees, sales taxes, and participation fees and the
procedures to be followed if a county does not pay those funds to the
program.
(D) Those provisions, as applicable, contained in the 1993-94
fiscal year contract with counties under the County Medical Services
Program.
(E) Provisions for the department to administer the County Medical
Services Program pursuant to regulations adopted by the governing
board or as otherwise determined by the governing board.
(F) Provisions requiring that the governing board reimburse the
state costs of providing administrative support to the County Medical
Services Program in accordance with amounts determined between the
governing board and the department.
(2) If the governing board does not contract with the department
for administration of the County Medical Services Program, the
governing board may contract with the department for specified
services to assist in the administration of that program. Any
contract with the department under this paragraph shall require that
the governing board reimburse the state costs of providing
administrative support.
(3) The department shall not be liable for any costs related to
decisions of the governing board that are in excess of those set
forth in the contract between the department and the governing board.
(c) Each county intending to participate in the County Medical
Services Program pursuant to this section shall submit to the
governing board a notice of intent to contract adopted by the board
of supervisors no later than April 1 of the fiscal year preceding the
fiscal year in which the county will participate in the County
Medical Services Program.
(d) A county participating in the County Medical Services Program
pursuant to this section, or a county contracting with the governing
board pursuant to paragraph (2) or (3) of subdivision (a), or
participating in a pilot project or contracting with the governing
board for an alternative product pursuant to Section 16809.4, shall
not be relieved of its indigent health care obligation under Section
17000.
(e) (1) The County Medical Services Program Account is established
in the County Health Services Fund. The County Medical Services
Program Account is continuously appropriated, notwithstanding Section
13340 of the Government Code, without regard to fiscal years. The
following amounts may be deposited in the account:
(A) Any interest earned upon moneys deposited in the account.
(B) Moneys provided by participating counties or appropriated by
the Legislature to the account.
(C) Moneys loaned pursuant to subdivision (n).
(2) The methods and procedures used to deposit funds into the
account shall be consistent with the methods used by the program
during the 1993-94 fiscal year, unless otherwise determined by the
governing board.
(f) Moneys in the program account shall be used by the governing
board, or by the department if the department contracts with the
governing board for this purpose, to pay for health care services
provided to the persons meeting the eligibility criteria established
pursuant to subdivision (j) and to pay the governing board expenses
and program administrative costs. In addition, moneys in this account
may be used to reimburse the department for state costs pursuant to
subparagraph (F) of paragraph (1) of subdivision (b).
(g) (1) Moneys in this account shall be administered on an accrual
basis and notwithstanding any other law, except as provided in this
section and Section 17605.051, shall not be transferred to any other
fund or account in the State Treasury except for purposes of
investment as provided in Article 4 (commencing with Section 16470)
of Chapter 3 of Part 2 of Division 4 of Title 2 of the Government
Code.
(2) (A) All interest or other increment resulting from the
investment shall be deposited in the program account, notwithstanding
Section 16305.7 of the Government Code.
(B) All interest deposited pursuant to subparagraph (A) shall be
available to reimburse program-covered services, governing board
expenses, and program administrative costs.
(h) The governing board shall establish a reserve account for the
purpose of depositing funds for the payment of claims and unexpected
contingencies. Funds in the reserve account in excess of the amounts
the governing board determines necessary for these purposes shall be
available for expenditures in years when program expenditures exceed
program funds, and to augment the rates, benefits, or eligibility
criteria under the program.
(i) (1) Counties shall pay participation fees as established by
the governing board and their jurisdictional risk amount in a method
that is consistent with that established in the 1993-94 fiscal year.
(2) A county may request, due to financial hardship, the payments
under paragraph (1) be delayed. The request shall be subject to
approval by the governing board.
(3) Payments made pursuant to this subdivision shall be deposited
in the program account, unless otherwise directed by the governing
board.
(4) Payments may be made as part of the deposits authorized by the
county pursuant to Sections 17603.05 and 17604.05.
(j) (1) (A) Beginning in the 1992-93 fiscal year and for each
fiscal year thereafter, counties and the state shall share the risk
for cost increases of the County Medical Services Program not funded
through other sources. The state shall be at risk for any cost that
exceeds the cumulative annual growth in dedicated sales tax and
vehicle license fee revenue, up to the amount of twenty million two
hundred thirty-seven thousand four hundred sixty dollars
($20,237,460) per fiscal year, except for the 1999-2000, 2000-01,
2001-02, 2002-03, 2003-04, 2004-05, 2005-06, 2006-07, and 2007-08
fiscal years, and all fiscal years thereafter. Counties shall be at
risk up to the cumulative annual growth in the Local Revenue Fund
created by Section 17600, according to the table specified in
paragraph (2), to the County Medical Services Program, plus the
additional cost increases in excess of twenty million two hundred
thirty-seven thousand four hundred sixty dollars ($20,237,460) per
fiscal year, except for the 1999-2000, 2000-01, 2001-02, 2002-03,
2003-04, 2004-05, 2005-06, 2006-07, and 2007-08 fiscal years, and all
fiscal years thereafter.
(B) For the 1999-2000, 2000-01, 2001-02, 2002-03, 2003-04,
2004-05, 2005-06, 2006-07, and 2007-08 fiscal years, and all fiscal
years thereafter, the state shall not be at risk for any cost that
exceeds the cumulative annual growth in dedicated sales tax and
vehicle license fee revenue. Counties shall be at risk up to the
cumulative annual growth in the Local Revenue Fund created by Section
17600, according to the table specified in paragraph (2), to the
County Medical Services Program, plus any additional cost increases
for the 1999-2000, 2000-01, 2001-02, 2002-03, 2003-04, 2004-05,
2005-06, 2006-07, and 2007-08 fiscal years, and all fiscal years
thereafter.
(C) (i) The governing board shall establish uniform eligibility
criteria and benefits among all counties participating in the County
Medical Services Program listed in paragraph (2). For counties that
are not listed in paragraph (2) and that elect to participate
pursuant to paragraph (1) of subdivision (a), the eligibility
criteria and benefit structure may vary from those of counties
participating pursuant to paragraph (2) of subdivision (a).
(ii) Notwithstanding clause (i), the governing board may establish
and maintain pilot projects to identify or test alternative
approaches for determining eligibility or for providing or paying for
benefits under the County Medical Services Program, and may develop
and implement alternative products with varying levels of eligibility
criteria and benefits outside of the County Medical Services
Program.
(2) For the 1991-92 fiscal year, and each fiscal year thereafter,
jurisdictional risk limitations shall be as follows:
Jurisdiction Amount
Alpine.......................... $ 13,150
Amador.......................... 620,264
Butte........................... 5,950,593
Calaveras....................... 913,959
Colusa.......................... 799,988
Del Norte....................... 781,358
El Dorado....................... 3,535,288
Glenn........................... 787,933
Humboldt........................ 6,883,182
Imperial........................ 6,394,422
Inyo............................ 1,100,257
Kings........................... 2,832,833
Lake............................ 1,022,963
Lassen.......................... 687,113
Madera.......................... 2,882,147
Marin........................... 7,725,909
Mariposa........................ 435,062
Mendocino....................... 1,654,999
Modoc........................... 469,034
Mono............................ 369,309
Napa............................ 3,062,967
Nevada.......................... 1,860,793
Plumas.......................... 905,192
San Benito...................... 1,086,011
Shasta.......................... 5,361,013
Sierra.......................... 135,888
Siskiyou........................ 1,372,034
Solano.......................... 6,871,127
Sonoma.......................... 13,183,359
Sutter.......................... 2,996,118
Tehama.......................... 1,912,299
Trinity......................... 611,497
Tuolumne........................ 1,455,320
Yuba............................ 2,395,580
(3) Beginning in the 1991-92 fiscal year and in subsequent fiscal
years, the jurisdictional risk limitation for the counties that did
not contract with the department pursuant to former Section 16709
during the 1990-91 fiscal year shall be the amount specified in
subparagraph (A) plus the amount determined pursuant to subparagraph
(B), minus the amount specified by the governing board as
participation fees.
(A)
Jurisdiction Amount
Merced........................... 2,033,729
Placer........................... 1,338,330
San Luis Obispo.................. 2,000,491
Santa Cruz....................... 3,037,783
Yolo............................. 1,475,620
(B) The amount of funds necessary to fully fund the anticipated
costs for the county shall be determined by the governing board
before a county is permitted to participate in the County Medical
Services Program.
(4) The specific amounts and method of apportioning risk to each
participating county may be adjusted by the governing board.
(k) The Legislature hereby determines that an expedited contract
process for contracts under this section is necessary. Contracts
under this section shall be exempt from Part 2 (commencing with
Section 10100) of Division 2 of the Public Contract Code. Contracts
of the department pursuant to this section shall have no force or
effect unless they are approved by the Department of Finance.
(l) The state shall not incur any liability except as specified in
this section.
(m) Third-party recoveries for services provided under this
section may be pursued.
(n) The Department of Finance may authorize a loan of up to thirty
million dollars ($30,000,000) for deposit into the program account
to ensure that there are sufficient funds available to reimburse
providers and counties pursuant to this section and for
governing board expenses described in subdivision (f) that are
associated with a Low Income Health Program, operated by the
governing board pursuant to Part 3.6 (commencing with Section 15909)
.
(o) Moneys appropriated from the General Fund to meet the state
risk, as set forth in subparagraph (A) of paragraph (1) of
subdivision (j), shall not be available for those counties electing
to disenroll from the County Medical Services Program.
(p) Notwithstanding any other law, the Controller may use the
moneys in the County Medical Services Program Account for loans to
the General Fund as provided in Sections 16310 and 16381 of the
Government Code. However, interest shall be paid on all moneys loaned
to the General Fund from the County Medical Services Program
Account. Interest payable shall be computed at a rate determined by
the Pooled Money Investment Board to be the current earning rate of
the fund from which loaned. This subdivision does not authorize any
transfer that will interfere with the carrying out of the object for
which the County Medical Services Program Account was created.
SECTION 1. SEC. 3. Section 16809.3
of the Welfare and Institutions Code is amended to read:
16809.3. (a) Beginning in the 1991-92 fiscal year, and in
subsequent fiscal years, a county shall pay the amount listed below
or as established by the governing board pursuant to subparagraph (B)
of paragraph (1) of subdivision (e) of Section 16809.4, to the
governing board as a condition of participation in the County Medical
Services Program administered pursuant to Section 16809:
Jurisdiction Amount
Alpine............................. $ 661
Amador............................. 17,107
Butte.............................. 459,610
Calaveras.......................... 30,401
Colusa............................. 28,997
Del Norte.......................... 39,424
El Dorado.......................... 233,492
Glenn.............................. 33,989
Humboldt........................... 430,851
Imperial........................... 249,786
Inyo............................... 18,950
Kings.............................. 195,053
Lake............................... 150,278
Lassen............................. 17,206
Madera............................. 151,434
Marin.............................. 576,233
Mariposa........................... 5,649
Mendocino.......................... 247,578
Modoc.............................. 9,688
Mono............................... 25,469
Napa............................... 142,767
Nevada............................. 42,051
Plumas............................. 23,796
San Benito................... 37,018
Shasta............................. 294,369
Sierra............................. 6,183
Siskiyou........................... 48,956
Solano............................. 809,548
Sonoma............................. 718,947
Sutter............................. 188,781
Tehama............................. 79,950
Trinity............................ 8,319
Tuolumne........................... 34,947
Yuba............................... 101,907
(b) Beginning in the 1991-92 fiscal year and in subsequent fiscal
years, counties that did not contract with the department pursuant to
Section 16709 during the 1990-91 fiscal year shall pay the following
amount listed below or as established by the governing board
pursuant to subparagraph (B) of paragraph (1) of subdivision (e) of
Section 16809.4, to the governing board as a condition of
participation in the County Medical Services Program, administered
pursuant to Section 16809:
Jurisdiction Amount
Merced............................ $488,954
Placer............................ 247,193
San Luis Obispo................... 358,571
Santa Cruz........................ 678,868
Yolo.............................. 532,510
(c) (1) County amounts specified in subdivisions (a) and (b) shall
be paid to the governing board in 10 equal payments during the
fiscal year or as otherwise specified by the governing board. Subject
to paragraphs (2) and (3), a county that does not pay the amounts
specified in subdivision (a) or (b) may be terminated from
participation in the program.
(2) A county may request, due to financial hardship, that payments
specified under subdivisions (a) and (b) be delayed. The request
shall be subject to the approval of the governing board.
(3) For the 1991-92 fiscal year and subsequent fiscal years,
counties that enter the County Medical Services Program shall pay the
amount specified in subdivision (a) or (b), as applicable, on a
prorated basis, for the number of contracted months of participation
in the County Medical Services Program.
(d) The payments required by subdivision (c) shall not be paid
for with funds from the health account of the local health and
welfare trust fund established pursuant to Section 17600.10.