BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 1465
AUTHOR: Committee on Health
AMENDED: August 4, 2014
HEARING DATE: August 20, 2014
CONSULTANT: Norring
PURSUANT TO SENATE RULE 29.10.
SUBJECT : Health.
SUMMARY : This bill 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. Extends the sunset date for the California Health
Benefit Review Program to December 31, 2015. Extends immunity to
cover minors participating in STAKE Act scientific surveys.
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.
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.
Continued---
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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
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.
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California Health Benefits Review Program
Existing law:
1.Requests the University of California (UC) to establish the
California Health Benefit Review Program (CHBRP) to assess, as
specified and not later than 60 days of receiving a request by
the Legislature, legislation proposing to mandate or repeal a
health plan or health insurance benefit or service for public
health, medical, and financial impacts.
2.Requires health plans, except specialized health plans, and
health insurers, for fiscal years 2010-11 to 2014-15, to be
assessed an annual fee to fund CHBRP, as specified, not to
exceed $2 million.
3.Sunsets CHBRP on June 30, 2015.
This bill:
1.Extends CHBRP from June 30, 2015, to December 31, 2015.
Home Health Accreditation
Existing law:
1.Requires DHCS to license a home health agency that applies for
a Home Health Agency License, is accredited by Joint
Commission on Accreditation of Healthcare Organizations
(JCAHO) or Community Health Accreditation Program (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.
This bill:
1.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 JCAHO or CHAP.
STAKE Act
Existing law:
1.Exempts a minor from prosecution for purchase, receipt, or
possession of tobacco products or paraphernalia while the
minor is participating in a random, onsite sting inspection
conducted by the State Department of Public Health.
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This bill:
1.Extends this exemption from prosecution under the act while
participating in an activity conducted by the State Department
of Public Health, a local health department, or a law
enforcement agency.
Song-Brown Act
Existing law:
1.Provides funding for grants in the Song Brown Program for new
primary care physician residency slots.
This bill:
1.Adds those residency programs accredited by the American
Osteopathic Association.
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
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.
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Other
This bill:
2.Renames the San Francisco Health Plan beneficiary committee to
member advisory committee and requires the persons nominated
for the committee to be enrolled in the health program.
3.Replaces references in existing law to the now-defunct
Department of Mental Health with Department of State
Hospitals.
4.Deletes obsolete references to nonprofit hospital service
plans in two provisions of Medi-Cal law.
5.Makes other various technical, clarifying changes.
6.Contains an urgency clause that will make this bill effective
upon enactment.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1. Costs to DHCS and EMSA to incorporate changes from this bill
into current practice are negligible.
2. Extending the sunset on the CHBRP program will result in
state costs for an additional six months. The program is
currently budgeted at $2 million annually.
COMMENTS :
1.Author's statement. According to the author, 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. Requiring counties to report to 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
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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.
Makes additional technical, non-substantive changes.
Reorganizes the Quality Assurance Fee provisions to
distinguish between supplemental payment rates and fee rates.
Moves the bridge plan provisions in existing law to a
different chapter and provides various clarifying clean-up.
Provides clean up to the Song-Brown Act. Renames the San
Francisco Health Plan beneficiary committee to health advisory
committee and stipulates who may be nominated for the
committee. Extends immunity to cover minors participating in
STAKE Act scientific surveys. Replaces references in existing
law to the now-defunct Department of Mental Health with
Department of State Hospitals.
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
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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.
4.CHBRP. AB 1996 (Thomson), Chapter 795, Statutes of 2002,
requests UC to assess legislation proposing a mandated benefit
or service (referred to as "mandate bills") and prepare a
written analysis with relevant data on the medical, economic,
and public health impacts of proposed health plan and health
insurance benefit mandate legislation. CHBRP was created in
response to AB 1996. Since 2004, CHBRP has analyzed 103
mandate bills, 45 of which were passed by the Legislature and
enrolled to the Governor. Thirty-three of those bills
analyzed were vetoed, and 11 were signed into law.
5.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.
6.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.
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SB 476 (Florez), Chapter 707, Statutes of 2003, authorized
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, created 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
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.
SB 870 (Committee on Budget), was the Omnibus Health Trailer
Bill for the 2014-15 Budget Act. It contained necessary
changes related to the Budget Act of 2014-15.
7.Support. The Osteopathic Physicians and Surgeons of
California write in support that SB 1465 would correct an
oversight in the California Budget Act of 2014 that failed to
appropriate funding for prospective new residency programs
approved by the American Osteopathic Association. The American
College of Emergency Physicians, California Chapter writes
that this bill will afford the public better access to the
Maddy Fund reports.
SUPPORT AND OPPOSITION :
Support: American College of Emergency Physicians, California
Chapter
Osteopathic Physicians and Surgeons of California
Oppose: None received
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