BILL ANALYSIS �
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UNFINISHED BUSINESS
Bill No: SB 1465
Author: Senate Health Committee
Amended: 8/4/14
Vote: 27 - Urgency
SENATE HEALTH COMMITTEE : 8-0, 4/24/14
AYES: Hernandez, Morrell, Beall, DeSaulnier, Evans, Monning,
Nielsen, Wolk
NO VOTE RECORDED: De Le�n
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
SENATE FLOOR : 35-0, 5/8/14 (Consent)
AYES: Anderson, Beall, Berryhill, Block, Cannella, Corbett,
Correa, De Le�n, DeSaulnier, Evans, Fuller, Galgiani, Hancock,
Hernandez, Hill, Hueso, Huff, Jackson, Lara, Leno, Lieu, Liu,
Mitchell, Monning, Morrell, Nielsen, Padilla, Pavley, Roth,
Steinberg, Torres, Vidak, Walters, Wolk, Wyland
NO VOTE RECORDED: Calderon, Gaines, Knight, Wright, Yee
SENATE HEALTH COMMITTEE : 9-0, 8/20/14 (Pursuant to Senate Rule
29.10)
AYES: Hernandez, Morrell, Beall, De Le�n, DeSaulnier, Evans,
Monning, Nielsen, Wolk
ASSEMBLY FLOOR : 78-0, 8/19/14 - See last page for vote
SUBJECT : Health
SOURCE : Author
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DIGEST : This bill requires local emergency medical services
agencies 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; and makes numerous technical,
clarifying changes to existing law.
Assembly Amendments add several more technical clarifying
changes to this omnibus bill.
ANALYSIS :
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
the 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
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
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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 (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.
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.
This bill:
1. Requires county reports on the implementation and status of
the 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.
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4. Extends the California Health Benefit Review Program from
June 30, 2015, to December 31, 2015.
5. 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 as a national accreditation organization,
instead of the requirement that the home health agency be
accredited by the Joint Commission on Accreditation of
Healthcare Organization or the Community Health Accreditation
Program.
6. Extends this exemption from prosecution under the act while
participating in an activity conducted by the Department of
Public Health, a local health department, or a law
enforcement agency.
7. Adds those residency programs accredited by the American
Osteopathic Association.
8. Reorganizes the QAF provisions to distinguish between
supplemental payment rates (amounts that hospitals are paid)
and fee rates (amount that hospitals pay).
9. Defines "fund" as the Hospital Quality Assurance Revenue
Fund.
10.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.
11.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.
12.Replaces references in existing law to the now-defunct
Department of Mental Health with Department of State
Hospitals.
13.Deletes obsolete references to nonprofit hospital service
plans in two provisions of Medi-Cal law.
Background
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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.
Existing 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. 50 counties have established Maddy
Funds.
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.
Prior Legislation
SB 1368 (Senate Health Committee, 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.
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AB 2248 (Hernandez, 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. The bill 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 3X1 (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% 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 QAF, as specified, on certain
general acute care hospitals from January 1, 2014, through
December 30, 2016.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 8/20/14)
California Chapter of the American College of Emergency
Physicians
Osteopathic Physicians and Surgeons of California
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ARGUMENTS IN SUPPORT : The California Chapter of the American
College of Emergency Physicians states that while the Maddy EMS
funds only reimburse a small portion of the cost of care, they
are nevertheless a critical source of funding helping to
preserve the emergency care safety net.
ASSEMBLY FLOOR : 78-0, 8/19/14
AYES: Achadjian, Alejo, Allen, Ammiano, Bigelow, Bloom,
Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian
Calderon, Campos, Chau, Ch�vez, Chesbro, Conway, Cooley,
Dababneh, Dahle, Daly, Dickinson, Donnelly, Eggman, Fong, Fox,
Frazier, Beth Gaines, Garcia, Gatto, Gonzalez, Gordon, Gorell,
Gray, Grove, Hagman, Hall, Harkey, Roger Hern�ndez, Holden,
Jones, Jones-Sawyer, Levine, Linder, Logue, Lowenthal,
Maienschein, Mansoor, Medina, Melendez, Mullin, Muratsuchi,
Nazarian, Nestande, Olsen, Pan, Patterson, Perea, John A.
P�rez, V. Manuel P�rez, Quirk, Quirk-Silva, Rendon,
Ridley-Thomas, Rodriguez, Salas, Skinner, Stone, Ting, Wagner,
Waldron, Weber, Wieckowski, Wilk, Williams, Yamada, Atkins
NO VOTE RECORDED: Gomez, Vacancy
JL:k 8/20/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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