BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 1465
AUTHOR: Committee on Health
INTRODUCED: March 20, 2014
HEARING DATE: April 24, 2014
CONSULTANT: Norring
SUBJECT : Health.
SUMMARY : Requires local emergency medical services agencies to
send Emergency Medical Services Fund reports to the Emergency
Medical Services Authority, rather than to the Legislature.
Allows the Department of Health Care Services to develop a
Medi-Cal provider enrollment application withdrawal process.
Makes numerous technical, clarifying changes to existing law.
Takes effect immediately as an urgency statute.
Emergency Medical Services Fund Reporting
Existing law:
1.Permits each county to establish an emergency medical services
(EMS) fund, known as the Maddy Fund, and specifies how these
funds are to be used, including limiting administrative costs
to no more than ten percent of the amount in the fund, with 58
percent of the balance of the fund distributed to physicians
for emergency services in hospitals, 25 percent distributed to
hospitals providing disproportionate trauma and emergency
medical care services, and 17 percent distributed for other
EMS as determined by each county, including funding regional
poison control centers.
2.Requires each county establishing a Maddy Fund to report to
the Legislature annually on the implementation and status of
the fund.
This bill:
1.Requires county reports on the implementation and status of
the Maddy Funds to be sent to the Emergency Medical Services
Authority (EMSA) annually.
2.Requires EMSA to compile and send a summary of the reports to
the appropriate policy and fiscal committee in the
Legislature.
Medi-Cal provider application withdrawal request
Continued---
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Existing law:
1.Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), which provides
comprehensive health care coverage for low-income individuals
and their families; pregnant women; elderly, blind, or
disabled persons; nursing home residents; and, refugees who
meet specified eligibility criteria.
2.Requires a provider to be enrolled in Medi-Cal in order to
receive fee-for-service reimbursement for the provision of
services, goods, supplies, or merchandise to a Medi-Cal
beneficiary.
3.Requires an applicant seeking to obtain Medi-Cal provider
status to submit a complete application package for
enrollment, continuing enrollment, enrollment at a new
location, or a change in location. Requires DHCS to provide
notice to an applicant within 30 days after receiving an
application package that it has been received.
4.Requires DHCS to provide notice to any applicant, except as
specified, after 180 days from receiving an application
package that the applicant does not meet the criteria for
preferred provider status, the application package is
incomplete, DHCS is exercising its authority as specified to
conduct background checks, pre-enrollment inspections, or
unannounced visits, or the application is denied for other
specified reasons. Requires DHCS to grant provisional
provider status for a period of no longer than 12 months,
effective from the 181st day of receiving an application
package or from the date on the notice to the applicant.
This bill:
1.Permits DHCS to cancel a provider application review process
if an application package is withdrawn at the request of the
applicant or provider.
Hospital Quality Assurance Revenue Fund
Existing law:
1.Enacts the Medi-Cal Hospital Reimbursement Improvement Act of
2013 (the Act), which imposes a hospital quality assurance fee
(QAF), as specified, on certain general acute care hospitals
from January 1, 2014, through December 30, 2016. Requires
supplemental payments to be made to private hospitals for
certain services, direct grants to public hospitals, increased
capitation payments to Medi-Cal managed care plans for
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hospital services and children's health coverage and DHCS
administration. Sunsets the Act on January 1, 2017.
This bill:
1.Reorganizes the QAF provisions to distinguish between
supplemental payment rates (amounts that hospitals are paid)
and fee rates (amount that hospitals pay).
2.Defines "fund" as the Hospital Quality Assurance Revenue Fund.
Bridge Plan
Existing law:
1.Requires Covered California, to the extent approved by the
appropriate federal agency, to contract with, and certify as a
qualified health plan, a bridge plan product that it
certifies.
This bill:
1.Moves the bridge plan provisions in existing law to a
different chapter of law and provides various clarifying
clean-up to the bridge plan provisions.
Other
This bill:
2.Replaces references in existing law to the now-defunct
Department of Mental Health with Department of State
Hospitals.
3.Deletes obsolete references to nonprofit hospital service
plans in two provisions of Medi-Cal law.
4.Makes other various technical, clarifying changes.
5.Contains an urgency clause that will make this bill effective
upon enactment.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1.Author's statement. According to the author, this bill makes
a number of technical and clarifying changes to existing law
and two other substantive changes:
Each county establishing a Maddy Fund is required to compile
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and send a report to the Legislature each year on the
implementation and status of its Maddy Fund. The only way to
access these reports is an in-person visit to the Assembly or
Senate Health Committee. Requiring counties to report to the
EMSA, and requiring EMSA to compile a summary of these
reports, will provide more useful information to the
Legislature and improve public access to information.
Currently, the DHCS is required to see any application
submitted for Medi-Cal provider enrollment through the entire
review process. There is no process for an applicant to
withdraw an application, or for DHCS to cancel its review
process upon the request of an applicant. Permitting DHCS to
implement a withdrawal policy will lift an unnecessary burden
on Medi-Cal Provider Enrollment Division staff to follow
through on applications that will never be completed.
2.EMS Funds. Counties have several sources of revenue for their
EMS Funds: Maddy revenues, derived from county penalty
assessments on various criminal offenses and motor vehicle
violations; traffic violator school fees; and, revenues from
taxes on tobacco products deposited in the State's Cigarette
and Tobacco Products Surtax Fund, including the EMS
Appropriation.
The Legislature intended that the EMS Funds be used to
reimburse physicians, hospitals, and other providers of
emergency services, for providing emergency services to
patients who do not have health insurance coverage, cannot
afford to pay for those services, and for whom payment will
not be made through any private coverage or by any program
funded in whole or in part by the federal government.
Current law requires courts to collect the fines, penalties,
and forfeitures for various criminal offenses, motor vehicle
and traffic violations. Currently, the total penalty
assessment is $7 for every $10 of fines and forfeitures, a
portion of which goes to the Maddy Fund. Fifty counties have
established Maddy Funds.
3.QAF. Federal Medicaid law authorizes states to levy fees on
health care providers if the fees meet certain requirements.
Many states (including California) fund a portion of their
share of Medicaid program costs through a fee on health care
providers. Under these funding methods, states collect funds
(through fees, taxes, or other means) from providers, which
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are then matched to allow increased Medicaid reimbursement to
providers. The Legislature enacted a series of bills
establishing a time-limited hospital QAF in 2009, and an
additional six-month QAF for the first six months of 2011. The
current QAF sunsets at the end of this calendar year. In
addition to the hospital QAF, California currently has a QAF
for intermediate care facilities for the developmentally
disabled, and a separate QAF for skilled nursing facilities.
4.Related legislation. SB 1315 (Monning) requires a notice of
temporary suspension issued to a health care provider by the
DHCS Medi-Cal Provider Enrollment Division to include a list
of discrepancies required to be remediated and the timeframe
in which a provider can demonstrate that the discrepancies
identified have been remediated. Requires the provider to be
removed from enrollment as a Medi-Cal provider if a provider
fails to remediate the discrepancies identified.
5.Prior legislation. SB 1368 (Senate Committee on Health),
Chapter 526, Statutes of 2010, contained language
substantially similar to the Maddy Fund reporting requirement
language in this bill. This language was amended out prior to
SB 1368 being chaptered into law.
AB 2248 (Hernandez) of 2010 would have required each county
establishing a Maddy Fund to include in its annual report to
the Legislature a description of each disbursement for other
emergency medical services if funds were disbursed for this
purpose. AB 2248 was vetoed by Governor Schwarzenegger, who
stated that it would create a reimbursable state mandate and
would put a cost pressure on the state's General Fund.
SB 476 (Florez), Chapter 707, Statutes of 2003, authorizes
each administering agency of an EMS fund to maintain a reserve
in specified portions of its Maddy Fund. Changes the county
reporting requirements and the date at which these are due
annually to the Legislature.
SB 12 (Maddy), Chapter 1240, Statutes of 1987, creates the
Maddy Fund to provide supplemental financing for local
emergency services.
SB X1 3 (Hernandez), Chapter 5, Statutes of 2013-14 First
Extraordinary Session, requires Covered California (the
state's Health Benefit Exchange) to establish a "bridge" plan
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product by contracting with Medi-Cal managed care plans for
individuals losing Medi-Cal coverage, the parents of Medi-Cal
or Healthy Families Program children, and individuals with
incomes below 200 percent of the federal poverty level. Limits
enrollment in bridge plan products only to eligible
individuals, and exempts these products from specified
provisions of existing law, including a requirement that
Covered California products be sold in the outside market.
SB 239 (Hernandez), Chapter 657, Statutes of 2013, enacted the
Act, which imposes a hospital quality assurance fee, as
specified, on certain general acute care hospitals from
January 1, 2014, through December 30, 2016.
SUPPORT AND OPPOSITION :
Support: None received
Oppose: None received
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