Bill Text: CA AB2025 | 2009-2010 | Regular Session | Amended
Bill Title: Medi-Cal: demonstration project.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2010-05-28 - In committee: Set, second hearing. Held under submission. [AB2025 Detail]
Download: California-2009-AB2025-Amended.html
BILL NUMBER: AB 2025 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MAY 11, 2010
INTRODUCED BY Assembly Member De La Torre
FEBRUARY 17, 2010
An act to amend Section 14166.2 of the Welfare and Institutions
Code, relating to Medi-Cal, and declaring the urgency thereof, to
take effect immediately.
LEGISLATIVE COUNSEL'S DIGEST
AB 2025, as amended, De La Torre. Medi-Cal: demonstration project.
Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services and
under which qualified low-income persons receive health care
benefits. The Medi-Cal program is, in part, governed and funded by
federal Medicaid provisions.
Existing law establishes the Medi-Cal Hospital/Uninsured Care
Demonstration Project Act that revises hospital reimbursement
methodologies in order to maximize the use of federal funds
consistent with federal Medicaid law and stabilize the distribution
of funding for hospitals.
Existing law requires the department to submit an application to
the federal Centers for Medicare and Medicaid Services (CMS) for a
waiver or demonstration project that would implement specified
objectives. Existing law requires the department to submit the waiver
or demonstration project application to the CMS by a date that
allows sufficient time for the waiver or demonstration project to be
approved by no later than September 1, 2010, or the conclusion of any
extension period granted in the demonstration project set forth in
the Medi-Cal Hospital/Uninsured Care Demonstration Project Act,
whichever happens last.
This bill would, to the extent necessary to continue the
implementation of the Medi-Cal Hospital/Uninsured Care Demonstration
Project Act, require the department to submit to CMS, by September 1,
2010, proposed amendments to the Medi-Cal state plan
an application for a waiver or a demonstration project
.
This bill would declare that it is to take effect immediately as
an urgency statute.
Vote: 2/3. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14166.2 of the Welfare and Institutions Code is
amended to read:
14166.2. (a) The demonstration project shall be implemented and
administered pursuant to this article.
(b) The director may modify any process or methodology specified
in this article to the extent necessary to comply with federal law or
the terms of the demonstration project, but only if the modification
results in the equitable distribution of funding, consistent with
this article, among the hospitals affected by the modification. If
the director, after consulting with affected hospitals, determines
that an equitable distribution cannot be achieved, the director shall
execute a declaration stating that this determination has been made.
The director shall retain the declaration and provide a copy, within
five working days of the execution of the declaration, to the fiscal
and appropriate policy committees of the Legislature. This article
shall become inoperative on the date that the director executes a
declaration pursuant to this subdivision, and as of January 1 of the
following year shall be repealed.
(c) The director shall administer the demonstration project and
related Medi-Cal payment programs in a manner that attempts to
maximize available payment of federal financial participation,
consistent with federal law, the Special Terms and Conditions for the
demonstration project issued by the federal Centers for Medicare and
Medicaid Services, and this article.
(d) As permitted by the federal Centers for Medicare and Medicaid
Services, this article shall be effective with regard to services
rendered throughout the term of the demonstration project, and
retroactively, with regard to services rendered on or after July 1,
2005, but prior to the implementation of the demonstration project.
(e) In the administration of this article, the state shall
continue to make payments to hospitals that meet the eligibility
requirements for participation in the supplemental reimbursement
program for hospital facility construction, renovation, or
replacement pursuant to Section 14085.5 and shall continue to make
inpatient hospital payments not covered by the contract. These
payments shall not duplicate any other payments made under this
article.
(f) The department shall continue to operate the selective
provider contracting program in accordance with Article 2.6
(commencing with Section 14081) in a manner consistent with this
article. A designated public hospital participating in the certified
public expenditure process shall maintain a selective provider
contracting program contract. These contracts shall continue to be
exempt from Chapter 2 (commencing with Section 10290) of Part 2 of
Division 2 of the Public Contract Code.
(g) In the event of a final judicial determination made by any
state or federal court that is not appealed in any action by any
party or a final determination by the administrator of the Centers
for Medicare and Medicaid Services that federal financial
participation is not available with respect to any payment made under
any of the methodologies implemented pursuant to this article
because the methodology is invalid, unlawful, or is contrary to any
provision of federal law or regulation, the director may modify the
process or methodology to comply with law, but only if the
modification results in the equitable distribution of demonstration
project funding, consistent with this article, among the hospitals
affected by the modification. If the director, after consulting with
affected hospitals, determines that an equitable distribution cannot
be achieved, the director shall execute a declaration stating that
this determination has been made. The director shall retain the
declaration and provide a copy, within five working days of the
execution of the declaration, to the fiscal and appropriate policy
committees of the Legislature. This article shall become inoperative
on the date that the director executes a declaration pursuant to this
subdivision, and as of January 1 of the following year shall be
repealed.
(h) (1) The department may adopt regulations to implement this
article. These regulations may initially be adopted as emergency
regulations in accordance with the rulemaking provisions of the
Administrative Procedure Act (Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code).
For purposes of this article, the adoption of regulations shall be
deemed an emergency and necessary for the immediate preservation of
the public peace, health, and safety or general welfare. Any
emergency regulations adopted pursuant to this section shall not
remain in effect subsequent to 24 months after the effective date of
this article.
(2) As an alternative, and notwithstanding the rulemaking
provisions of Chapter 3.5 (commencing with Section 11340) of Part 1
of Division 3 of Title 2 of the Government Code, or any other
provision of law, the department may implement and administer this
article by means of provider bulletins, manuals, or other similar
instructions, without taking regulatory action. The department shall
notify the fiscal and appropriate policy committees of the
Legislature of its intent to issue a provider bulletin, manual, or
other similar instruction, at least five days prior to issuance. In
addition, the department shall provide a copy of any provider
bulletin, manual, or other similar instruction issued under this
paragraph to the fiscal and appropriate policy committees of the
Legislature. The department shall consult with interested parties and
appropriate stakeholders, regarding the implementation and ongoing
administration of this article.
(i) (1) To the extent necessary to implement this article, the
department shall submit, by September 30, 2005, to the federal
Centers for Medicare and Medicaid Services proposed amendments to the
Medi-Cal state plan, including, but not limited to, proposals to
modify inpatient hospital payments to designated public hospitals,
modify the disproportionate share hospital payment program, and
provide for supplemental Medi-Cal reimbursement for certain physician
and nonphysician professional services. The department shall,
subsequent to September 30, 2005, submit any additional proposed
amendments to the Medi-Cal state plan that may be required by the
federal Centers for Medicare and Medicaid Services, to the extent
necessary to implement this article.
(2) To the extent necessary to continue the implementation of this
article, the department shall submit, by September 1, 2010, to the
federal Centers for Medicare and Medicaid Services proposed
amendments to the Medi-Cal state plan an application
for a waiver or a demonstration project .
(j) Each designated public hospital shall implement a
comprehensive process to offer individuals who receive services at
the hospital the opportunity to apply for the Medi-Cal program, the
Healthy Families Program, or any other public health coverage program
for which the individual may be eligible, and shall refer the
individual to those programs, as appropriate.
(k) In any judicial challenge of the provisions of this article,
nothing shall create an obligation on the part of the state to fund
any payment from state funds due to the absence or shortfall of
federal funding.
(l) Any reference in this article to the "Medicare cost report"
shall be deemed a reference to the Medi-Cal cost report to the extent
that report is approved by the federal Centers for Medicare and
Medicaid Services for any of the uses described in this article.
SEC. 2. This act is an urgency statute necessary for the immediate
preservation of the public peace, health, or safety within the
meaning of Article IV of the Constitution and shall go into immediate
effect. The facts constituting the necessity are:
In order to ensure the renewal of the Medi-Cal Hospital/Uninsured
Care Demonstration Project Act before the current federal waiver
authorizing for the demonstration project expires
in 2010, it is necessary for this act to take effect immediately.
