Bill Text: CA AB910 | 2019-2020 | Regular Session | Amended
Bill Title: Medi-Cal: dispute resolution.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Engrossed - Dead) 2020-08-05 - In committee: Set, first hearing. Hearing canceled at the request of author. [AB910 Detail]
Download: California-2019-AB910-Amended.html
|
Amended
IN
Assembly
January 06, 2020 |
| Introduced by Assembly Member Wood |
February 20, 2019 |
LEGISLATIVE COUNSEL'S DIGEST
Existing law requires the State Department of Public Health to license and regulate general acute care hospitals. Existing law generally requires the department to issue a single consolidated license to a general acute care hospital that meets the requirements for licensure and includes more than one physical plant maintained and operated on separate premises located not more than 15 miles apart. If an applicant provides evidence satisfactory to the department that it can comply with all the requirements for licensure and provide quality care and adequate supervision, existing law authorizes the Director of Public Health, also known as the State Public Health Officer, to issue a single consolidated license to a general acute care hospital that operates 2 or more physical plants located more than 15 miles apart under specified circumstances, including that one or more of the physical plants
is located in a rural area or provides only outpatient services.
This bill would require the department, on or before January 1, 2021, to report to the Legislature the name, location, and license identification of every general acute care hospital operating under a single consolidated license that operates 2 or more physical plants located more than 15 miles apart. The bill would further require the department, on or before January 1, 2022, and annually thereafter, to update the report, as specified. The bill would also make technical changes to these provisions.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NOBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 14715.5 is added to the Welfare and Institutions Code, immediately following Section 14715, to read:14715.5.
(a) (1) If a county mental health plan and a Medi-Cal managed care plan have a dispute, as described in Section 1850.505 of Title 9 of the California Code of Regulations, and are unable to reach a resolution within 15 business days from the initiation of the dispute resolution process, both the county mental health plan and the Medi-Cal managed care plan shall submit a request for resolution to the department.(a)Notwithstanding subdivision (a) of Section 127170, the department, upon application of a general acute care hospital that meets all the criteria of subdivision (b), and other applicable requirements of licensure, shall issue a single consolidated license to a general acute care hospital that includes more than one physical plant maintained and operated on separate premises or that has multiple licenses for a single health facility on the same premises. A single consolidated license shall not be issued where the separate freestanding physical plant is a skilled nursing facility or an intermediate care facility, whether or not the location of the skilled nursing facility or intermediate care facility is contiguous to the general acute care hospital unless the hospital is exempt from the
requirements of subdivision (b) of Section 1254, or the facility is part of the physical structure licensed to provide acute care.
(b)The issuance of a single consolidated license shall be based on the following criteria:
(1)There is a single governing body for all the facilities maintained and operated by the licensee.
(2)There is a single administration for all the facilities maintained and operated by the licensee.
(3)There is a single medical staff for all the facilities maintained and operated by the licensee, with a single set of bylaws, rules, and regulations, which prescribe a single committee structure.
(4)Except as provided otherwise in this paragraph, the physical plants
maintained and operated by the licensee that are to be covered by the single consolidated license are located not more than 15 miles apart. If an applicant provides evidence satisfactory to the department that it can comply with all requirements of licensure and provide quality care and adequate administrative and professional supervision, the director may issue a single consolidated license to a general acute care hospital that operates two or more physical plants located more than 15 miles apart under any of the following circumstances:
(A)One or more of the physical plants is located in a rural area, as defined by regulations of the director.
(B)One or more of the physical plants
provides only outpatient services, as defined by the department.
(C)If Section 14105.986 of the Welfare and Institutions Code is implemented and the applicant meets all of the following criteria:
(i)The applicant is a nonprofit corporation.
(ii)The applicant is a children’s hospital listed in Section 10727 of the Welfare and Institutions Code.
(iii)The applicant is affiliated with a major university medical school and located adjacent thereto.
(iv)The applicant operates a regional tertiary care facility.
(v)One of the physical plants is located in a county that has a consolidated and county government structure.
(vi)One of the physical plants is located in a county having a population between 1,000,000 and 2,000,000.
(vii)The applicant is located in a city with a population between 50,000 and 100,000.
(c)In issuing the single consolidated license, the
department shall specify the location of each supplemental service and the location of the number and category of beds provided by the licensee. The single consolidated license shall be renewed annually.
(d)To the extent required by Chapter 1 (commencing with Section 127125) of Part 2 of Division 107, a general acute care hospital that has been issued a single consolidated license:
(1)Shall not transfer from one facility to another a special service described in Section 1255 without first obtaining a certificate of need.
(2)Shall not transfer, in whole or in part, from one facility to another, a
supplemental service, as defined in regulations of the director pursuant to this chapter, without first obtaining a certificate of need, unless the licensee, 30 days prior to the relocation, notifies the Office of Statewide Health Planning and Development, the applicable health systems agency, and the department of the licensee’s intent to relocate the supplemental service, and includes with this notice a cost estimate, certified by a person qualified by experience or training to render the estimates, which estimates that the cost of the transfer will not exceed the capital expenditure threshold established by the Office of Statewide Health Planning and Development pursuant to Section 127170.
(3)Shall not transfer beds from one facility to another facility, without first obtaining a certificate of need unless, 30 days prior to the relocation, the licensee
notifies the Office of Statewide Health Planning and Development, the applicable health systems agency, and the
department of the licensee’s intent to relocate health facility beds, and includes with this notice both of the following:
(A)A cost estimate, certified by a person qualified by experience or training to render the estimates, that estimates that the cost of the relocation will not exceed the capital expenditure threshold established by the Office of Statewide Health Planning and Development pursuant to Section 127170.
(B)The identification of the number, classification, and location of the health facility beds in the transferor facility and the proposed number, classification, and location of the health facility beds in the transferee facility.
Except as otherwise permitted in Chapter 1 (commencing with Section 127125) of Part 2 of Division 107, or as authorized in an approved certificate of need pursuant to that chapter, health facility beds transferred pursuant to this section shall be used in the transferee facility in the same bed classification as defined in Section 1250.1, as the beds were classified in the transferor facility.
Health facility beds transferred pursuant to this section shall not be transferred back to the transferor facility for two years from the date of the transfer, regardless of cost, without first obtaining a certificate of need pursuant to Chapter 1 (commencing with Section 127125) of Part 2 of Division 107.
(e)Transfers pursuant to subdivision (d) shall satisfy all applicable requirements of licensure and shall be subject to the written approval, if required, of the
department. The department may adopt regulations necessary to implement this section. These regulations may include a requirement that each facility of a health facility subject to a single consolidated license have an onsite full-time or part-time administrator.
(f)As used in this section, “facility” means a physical plant operated or maintained by a health facility subject to a single, consolidated license issued pursuant to this section.
(g)For purposes of selective provider contracts negotiated under the Medi-Cal program, the treatment of a health facility with a single consolidated license issued pursuant to this section shall be subject to negotiation between the health facility
and the California Medical Assistance Commission. A general acute care hospital that is issued a single consolidated license pursuant to this section may, at its option, be enrolled in the Medi-Cal program as a single business address or as separate business addresses for one or more of the facilities subject to the single consolidated license. Irrespective of whether the general acute care hospital is enrolled at one or more business addresses, the department may require the hospital to file separate cost reports for each facility pursuant to Section 14170 of the Welfare and Institutions Code.
(h)For purposes of the Annual Report of Hospitals required by regulations adopted by the department pursuant to this part, the department and the Office of Statewide
Health Planning and Development may require reporting of bed and service utilization data separately by each facility of a general acute care hospital issued a single consolidated license pursuant to this section.
(i)The amendments made to this section during the 1985–86 Regular Session of the Legislature pertaining to the issuance of a single consolidated license to a general acute care hospital in the case where the separate physical plant is a skilled nursing facility or intermediate care facility do not apply to the following facilities:
(1)A facility that obtained a certificate of need after August 1, 1984, and prior to February 14, 1985, as described in this subdivision. The
certificate of need shall be for the construction of a skilled nursing facility or intermediate care facility that is the same facility for which the hospital applies for a single consolidated license, pursuant to subdivision (a).
(2)A facility for which a single consolidated license has been issued pursuant to subdivision (a), as described in this subdivision, prior to the effective date of the amendments made to this section during the 1985–86 Regular Session of the Legislature.
A facility that has been issued a single consolidated license pursuant to subdivision (a), as described in this subdivision, shall be granted renewal licenses based upon the same criteria used for the initial consolidated license.
(j)If the
department issues a single consolidated license pursuant to this section, the department may take any action authorized by this chapter, including, but not limited to, any action specified in Article 5 (commencing with Section 1294), with respect to a facility, or a service provided in a facility, that is included in the consolidated license.
(k)The eligibility for participation in the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code) of a facility that is included in a consolidated license issued pursuant to this section, provides outpatient services, and is located more than miles from the health facility issued the consolidated license shall be subject to a determination of eligibility by the
department. This subdivision shall not apply to a facility that is located in a rural area and is included in a consolidated license issued pursuant to subparagraphs (A), (B), and (C) of paragraph (4) of subdivision (b). Regardless of whether a facility has received or not received a determination of eligibility pursuant to this subdivision, this subdivision shall not affect the ability of a licensed professional, providing services covered by the Medi-Cal program to a person eligible for Medi-Cal in a facility subject to a determination of eligibility pursuant to this subdivision, to bill the Medi-Cal program for those services provided in accordance with applicable regulations.
(l)Notwithstanding any other
law, the director may issue a single consolidated license for a general acute care hospital to Children’s Hospital Oakland and San Ramon Regional Medical Center.
(m)Notwithstanding any other law, the director may issue a single consolidated license for a general acute care hospital to Children’s Hospital Oakland and the John Muir Medical Center, Concord Campus.
(n)(1)To the extent permitted by federal law, payments made to Children’s Hospital Oakland pursuant to Section 14166.11 of the Welfare and Institutions Code shall be adjusted as follows:
(A)The number of Medi-Cal payment days and net revenues calculated for the John Muir Medical Center, Concord Campus under the consolidated
license shall not be used for eligibility purposes for the private hospital disproportionate share hospital replacement funds for Children’s Hospital Oakland.
(B)The number of Medi-Cal payment days calculated for hospital beds located at John Muir Medical Center, Concord Campus that are included in the consolidated license beginning in the 2007–08 fiscal year shall only be used for purposes of calculating disproportionate share hospital payments authorized under Section 14166.11 of the Welfare and Institutions Code at Children’s Hospital Oakland to the extent that the inclusion of those days does not exceed the total Medi-Cal payment days used to calculate Children’s Hospital Oakland payments for the 2006–07 fiscal year disproportionate share replacement.
(2)This subdivision shall become inoperative in the event that the two facilities covered under the consolidated license
described in subdivision (a) are located within a 15-mile radius of each other.
(o)(1)On or before January 1, 2021, the department shall report to the Legislature the name, location, and license identification of every general acute care hospital operating under a single consolidated license issued pursuant to paragraph (4) of subdivision (b).
(2)On or before January 1, 2022, and annually thereafter, the department shall update the report submitted pursuant to subdivision (a) by reporting the name, location, and license identification of every general acute care hospital operating under a single consolidated license issued pursuant to paragraph (4) of subdivision (b)
in the 12 months prior to the date of the report.
(3)The department shall submit the reports in compliance with Section 9795 of the Government Code.
