BILL ANALYSIS �
SB 1465
Page 1
Date of Hearing: June 17, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
SB 1465 (Committee on Health) - As Amended: June 11, 2014
SENATE VOTE : 35-0
SUBJECT : Health.
SUMMARY : Requires local emergency medical services agencies
(LEMSAs) to send Emergency Medical Services (EMS) Fund reports
to the Emergency Medical Services Authority (EMSA), rather than
to the Legislature. Allows the Department of Health Care
Services (DHCS) to develop a Medi-Cal provider enrollment
application withdrawal process. Requires DHCS to license a home
health agency that applies for a Home Health Agency License and
is accredited by an entity approved by the federal Centers for
Medicare and Medicaid Services (CMS) as a national accreditation
organization. Makes numerous technical, clarifying changes to
existing law. Contains an urgency clause to ensure that the
provisions of this bill go into immediate effect upon enactment.
Specifically, this bill :
1)Requires LEMSAs to report on the implementation and status of
their EMS Fund, commonly referred to as Maddy Funds, to be
sent to EMSA annually.
2)Requires EMSA to compile and send a summary of the reports to
the appropriate policy and fiscal committee in the
Legislature.
3)Permits DHCS to cancel a provider application review process
if an application package is withdrawn at the request of the
applicant or provider.
4)Requires DHCS to license a home health agency that applies for
a Home Health Agency License and is accredited by an entity
approved by CMS as a national accreditation organization,
instead of the requirement that the home health agency be
accredited by the Joint Commission on Accreditation of
Healthcare Organizations (JCAHO) or the Community Health
Accreditation Program (CHAP).
5)Changes references of JCAHO and CHAP to a CMS approved
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national accreditation organization.
6)Reorganizes the quality assurance fee (QAF) provisions to
distinguish between supplemental payment rates (amounts that
hospitals are paid) and fee rates (amount that hospitals pay).
7)For purposes of the Quality Assurance Fee Act, defines "Fund"
in the Welfare and Institutions Code as the Hospital Quality
Assurance Revenue Fund.
8)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.
9)Replaces references in existing law to the Department of
Mental Health with Department of State Hospitals.
10)Deletes obsolete references to nonprofit hospital service
plans in two provisions of Medi-Cal law.
11)Makes other various technical, clarifying changes.
EXISTING LAW :
1)Permits each county to establish an EMS Fund, known as the
Maddy Fund, and specifies how these funds are to be used,
including limiting administrative costs to no more than 10% of
the amount in the Fund, with 58% of the balance of the Fund
distributed to physicians for emergency services in hospitals,
25% distributed to hospitals providing disproportionate trauma
and emergency medical care services, and 17% 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
their Maddy Fund.
3)Establishes the Medi-Cal program, administered by the 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.
4)Requires a provider to be enrolled in Medi-Cal in order to
receive fee-for-service reimbursement for the provision of
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services, goods, supplies, or merchandise to a Medi-Cal
beneficiary.
5)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.
6)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.
7)Enacts the Medi-Cal Hospital Reimbursement Improvement Act of
2013, which imposes a hospital 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 hospital services and children's health
coverage and DHCS administration. Sunsets the Medi-Cal
Hospital Reimbursement Improvement Act on January 1, 2017.
8)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.
9)Requires DHCS to license a home health agency that applies for
a Home Health Agency License, is accredited by JCAHO or CHAP,
files an application with fees, and meets any additional
licensing requirements more stringent than those of the
private accrediting agencies as identified by DHCS in
consultation with those agencies.
FISCAL EFFECT : According to the Senate Appropriations
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Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill
makes a number of technical and clarifying changes to existing
law and two substantive changes. The author explains that
each county establishing a Maddy Fund is required to compile
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 along with a request in accordance
with the Legislative Open Records Act. 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 the information.
The author further writes, the other major change this bill
makes is that currently, 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. The
author argues that by permitting DHCS to implement a
withdrawal policy it will lift an unnecessary burden on
Medi-Cal Provider Enrollment Division staff to follow through
on applications that will never be completed.
2)BACKGROUND .
a) Maddy EMS Fund. In 1987, the Legislature approved the
establishment of the Maddy EMS Fund, and although counties
are not required to establish EMS Funds, there are
currently 50 counties that have done so. The Legislature
intended the EMS Funds to reimburse physicians, hospitals,
and other providers of emergency services, specifically to
patients who do not have health insurance coverage for
emergency services and care, 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, as specified.
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;
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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.
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 EMS Fund.
Courts collect the penalty assessments and forward them to
counties.
In 1988, voters passed the Tobacco Tax and Health Protection
Act of 1988 (Proposition 99) through the initiative
process. Proposition 99 imposes taxes on the distribution
of cigarettes and other tobacco products. The state
collects these taxes for deposit in the State's Cigarette
and Tobacco Products Surtax Fund to fund a variety of
programs, including the California Healthcare for Indigents
Program (CHIP) and Rural Health Services (RHS) program,
which allocate funds to counties for indigent care. Since
2000, the Legislature has appropriated money from CHIP and
RHS funds to provide counties with revenues which are
restricted to reimbursement of uncompensated emergency room
care by private physicians. This annual appropriation is
referred to as the EMS Appropriation.
b) 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 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.
3)SUPPORT . The California Chapter of the American College of
Emergency Physicians (California ACEP) writes in support that
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this bill would make Maddy reports, that are already required
of counties that have created a Maddy Fund, easily available
to the public through EMSA. California ACEP states that
currently these reports are required to be submitted to the
Assembly and Senate Health Committees, making the sole means
of access an in-person visit to their State Capitol offices.
Requiring EMSA to both collect the reports and issue annual
reports to the Legislature will afford the public better
access to these reports.
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. SB 1315 is
currently pending in this Committee.
5)PREVIOUS LEGISLATION .
a) SB 191 (Padilla), Chapter 600, Statutes of 2013, extends
to January 1, 2017, existing law authorizing county Boards
of Supervisors to elect to levy an additional $2 for every
$10 fine, penalty, or forfeiture imposed or collected by
the courts for all criminal offenses, including violations
of the Alcoholic Beverage Control Act and Vehicle Code for
purposes of the Maddy Fund. Requires 15% of the collected
assessments to be utilized for pediatric trauma centers and
limits costs of administering the Fund to the actual
administrative costs or 10% of the money collected,
whichever amount is lower.
b) SB 3 X1 (Ed Hernandez), Chapter 5, Statutes of 2013-14
First Extraordinary Session, requires Covered California
(the California Health Benefit Exchange) to establish a
"bridge" plan 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.
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c) SB 239 (Ed Hernandez), Chapter 657, Statutes of 2013,
enacted the Medi-Cal Hospital Reimbursement Improvement
Act, which imposes a hospital quality assurance fee, as
specified, on certain general acute care hospitals from
January 1, 2014, through December 30, 2016.
d) SB 1368 (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.
e) AB 2248 (Ed 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.
f) 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.
g) SB 1892 (Maddy), Chapter 514, Statutes of 1992, requires
DHCS to license a home health agency that applies for a
Home Health Agency License and is accredited by JCAHO or
CHAP.
h) SB 12 (Maddy), Chapter 1240, Statutes of 1987, creates
the Maddy Fund to provide supplemental financing for local
emergency services.
REGISTERED SUPPORT / OPPOSITION :
Support
California Chapter of the American College of Emergency
Physicians
Opposition
SB 1465
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None on file.
Analysis Prepared by : Patty Rodgers / HEALTH / (916) 319-2097