Bill Text: CA SB1352 | 2013-2014 | Regular Session | Chaptered
Bill Title: Alameda Health System.
Spectrum: Partisan Bill (Democrat 5-0)
Status: (Passed) 2014-06-23 - Chaptered by Secretary of State. Chapter 46, Statutes of 2014. [SB1352 Detail]
Download: California-2013-SB1352-Chaptered.html
BILL NUMBER: SB 1352 CHAPTERED
BILL TEXT
CHAPTER 46
FILED WITH SECRETARY OF STATE JUNE 23, 2014
APPROVED BY GOVERNOR JUNE 23, 2014
PASSED THE SENATE MAY 1, 2014
PASSED THE ASSEMBLY JUNE 12, 2014
AMENDED IN SENATE APRIL 21, 2014
AMENDED IN SENATE MARCH 25, 2014
INTRODUCED BY Senator Hancock
(Coauthor: Senator Corbett)
(Coauthors: Assembly Members Bonta, Quirk, and Skinner)
FEBRUARY 21, 2014
An act to amend Section 101850 of, and to amend the heading of
Chapter 5 (commencing with Section 101850) of Part 4 of Division 101
of, the Health and Safety Code, and to amend Sections 14085.53,
14166.1, and 17612.2 of the Welfare and Institutions Code, relating
to the Alameda Health System.
LEGISLATIVE COUNSEL'S DIGEST
SB 1352, Hancock. Alameda Health System.
Existing law authorizes the board of supervisors of Alameda County
to establish an independent hospital authority strictly and
exclusively dedicated to the management, administration, and control
of the group of public hospitals, clinics, and programs that comprise
the Alameda County Medical Center.
This bill would instead authorize the board to establish an
independent hospital authority for the Alameda Health System, which
was formerly known as the Alameda County Medical Center. The bill
would make conforming changes with regard to legislative findings and
declarations and would include additional legislative findings and
declarations relating to the Alameda Health System. The bill would
also make other conforming changes in existing law.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) The Alameda County Medical Center has evolved to include
additional facilities that have expanded services and the quality of
care to the residents of the County of Alameda.
(b) In order to better reflect the regional availability of
services to the residents of the County of Alameda, the Alameda
County Medical Center is doing business as the Alameda Health System
and it is appropriate that the name change be reflected statutorily
to ensure that there is no confusion in the administration of state
programs.
(c) The Alameda Health System is a major public health care
provider and medical training institution recognized for its world
class patient and family-centered system of care.
(d) The Alameda Health System provides comprehensive, high-quality
medical treatment, health promotion, disease prevention, and health
maintenance in an integrated system of hospitals, clinics, and health
services.
(e) As a training institution, the Alameda Health System maintains
an environment that is supportive of a wide range of educational
programs and activities, including the education of medical students,
interns, residents, and continuing education for medical nursing,
and other staff, along with medical research.
(f) The Alameda Health System is a regional provider of health
care services, and includes the following facilities:
(1) Highland Hospital, located in Oakland, is a major regional
trauma center and teaching hospital that delivers primary, specialty,
and multispecialty care. Within the Highland campus are centers of
excellence in maternity services, gastroenterology, surgery,
orthopedics, geriatrics and senior care, and trauma.
(2) John George Psychiatric Hospital, located in San Leandro,
provides psychiatric emergency and acute care services to adults
experiencing severe and disabling mental illnesses.
(3) San Leandro Hospital, located in San Leandro, is a 93-bed
facility in central Alameda County acquired in late 2013 and provides
a wide range of medical services, including 24-hour emergency
services, critical care, a full complement of skilled surgeons,
rehabilitation services, and ancillary services.
(4) Fairmont Hospital, located in San Leandro, is an acute
rehabilitation center that is one of the foremost providers of acute
rehabilitation services in northern California, treating severe
injuries such as stroke, brain, and multiple-trauma injuries.
(5) Wellness Centers, in Oakland, Hayward, and Newark form a
network of community-based wellness centers that expand access to
primary care and Alameda Health System medical specialties. All
primary services are offered at the Wellness Centers to provide
continuity of care for patients. These services include pediatrics,
immunizations, family planning, HIV/AIDS, breast health, dental,
podiatry, tuberculosis, minor surgery, social work, and health
education.
SEC. 2. The heading of Chapter 5 (commencing with Section 101850)
of Part 4 of Division 101 of the Health and Safety Code is amended to
read:
CHAPTER 5. ALAMEDA HEALTH SYSTEM HOSPITAL AUTHORITY
SEC. 3. Section 101850 of the Health and Safety Code is amended to
read:
101850. The Legislature finds and declares the following:
(a) (1) Due to the challenges facing the Alameda Health System
arising from changes in the public and private health industries, the
Alameda County Board of Supervisors has determined that a transfer
of governance of the Alameda Health System to an independent
governing body, a hospital authority, is needed to improve the
efficiency, effectiveness, and economy of the community health
services provided at the medical center. The board of supervisors has
further determined that the creation of an independent hospital
authority strictly and exclusively dedicated to the management,
administration, and control of the medical center, in a manner
consistent with the county's obligations under Section 17000 of the
Welfare and Institutions Code, is the best way to fulfill its
commitment to the medically indigent, special needs, and general
populations of Alameda County. To accomplish this, it is necessary
that the board of supervisors be given authority to create a hospital
authority. Because there is no general law under which this
authority could be formed, the adoption of a special act and the
formation of a special authority is required.
(2) The following definitions shall apply for purposes of this
section:
(A) "The county" means the County of Alameda.
(B) "Governing board" means the governing body of the hospital
authority.
(C) "Hospital authority" means the separate public agency
established by the Board of Supervisors of Alameda County to manage,
administer, and control the Alameda Health System.
(D) "Medical center" means the Alameda Health System, which was
formerly known as the Alameda County Medical Center.
(b) The board of supervisors of the county may, by ordinance,
establish a hospital authority separate and apart from the county for
the purpose of effecting a transfer of the management,
administration, and control of the medical center in accordance with
Section 14000.2 of the Welfare and Institutions Code. A hospital
authority established pursuant to this chapter shall be strictly and
exclusively dedicated to the management, administration, and control
of the medical center within parameters set forth in this chapter,
and in the ordinance, bylaws, and contracts adopted by the board of
supervisors that shall not be in conflict with this chapter, Section
1442.5 of this code, or Section 17000 of the Welfare and Institutions
Code.
(c) A hospital authority established pursuant to this chapter
shall be governed by a board that is appointed, both initially and
continually, by the Board of Supervisors of the County of Alameda.
This hospital authority governing board shall reflect both the
expertise necessary to maximize the quality and scope of care at the
medical center in a fiscally responsible manner and the diverse
interest that the medical center serves. The enabling ordinance shall
specify the membership of the hospital authority governing board,
the qualifications for individual members, the manner of appointment,
selection, or removal of governing board members, their terms of
office, and all other matters that the board of supervisors deems
necessary or convenient for the conduct of the hospital authority's
activities.
(d) The mission of the hospital authority shall be the management,
administration, and other control, as determined by the board of
supervisors, of the group of public hospitals, clinics, and programs
that comprise the medical center, in a manner that ensures
appropriate, quality, and cost-effective medical care as required of
counties by Section 17000 of the Welfare and Institutions Code, and,
to the extent feasible, other populations, including special
populations in the County of Alameda.
(e) The board of supervisors shall adopt bylaws for the medical
center that set forth those matters related to the operation of the
medical center by the hospital authority that the board of
supervisors deems necessary and appropriate. The bylaws shall become
operative upon approval by a majority vote of the board of
supervisors. Any changes or amendments to the bylaws shall be by
majority vote of the board of supervisors.
(f) The hospital authority created and appointed pursuant to this
section is a duly constituted governing body within the meaning of
Section 1250 and Section 70035 of Title 22 of the California Code of
Regulations as currently written or subsequently amended.
(g) Unless otherwise provided by the board of supervisors by way
of resolution, the hospital authority is empowered, or the board of
supervisors is empowered on behalf of the hospital authority, to
apply as a public agency for one or more licenses for the provision
of health care pursuant to statutes and regulations governing
licensing as currently written or subsequently amended.
(h) In the event of a change of license ownership, the governing
body of the hospital authority shall comply with the obligations of
governing bodies of general acute care hospitals generally as set
forth in Section 70701 of Title 22 of the California Code of
Regulations, as currently written or subsequently amended, as well as
the terms and conditions of the license. The hospital authority
shall be the responsible party with respect to compliance with these
obligations, terms, and conditions.
(i) (1) Any transfer by the county to the hospital authority of
the administration, management, and control of the medical center,
whether or not the transfer includes the surrendering by the county
of the existing general acute care hospital license and corresponding
application for a change of ownership of the license, shall not
affect the eligibility of the county, or in the case of a change of
license ownership, the hospital authority, to do any of the
following:
(A) Participate in, and receive allocations pursuant to, the
California Healthcare for the Indigents Program (CHIP).
(B) Receive supplemental reimbursements from the Emergency
Services and Supplemental Payments Fund created pursuant to Section
14085.6 of the Welfare and Institutions Code.
(C) Receive appropriations from the Medi-Cal Inpatient Payment
Adjustment Fund without relieving the county of its obligation to
make intergovernmental transfer payments related to the Medi-Cal
Inpatient Payment Adjustment Fund pursuant to Section 14163 of the
Welfare and Institutions Code.
(D) Receive Medi-Cal capital supplements pursuant to Section
14085.5 of the Welfare and Institutions Code.
(E) Receive any other funds that would otherwise be available to a
county hospital.
(2) Any transfer described in paragraph (1) shall not otherwise
disqualify the county, or in the case of a change in license
ownership, the hospital authority, from participating in any of the
following:
(A) Other funding sources either specific to county hospitals or
county ambulatory care clinics or for which there are special
provisions specific to county hospitals or to county ambulatory care
clinics.
(B) Funding programs in which the county, on behalf of the medical
center and the Alameda County Health Care Services Agency, had
participated prior to the creation of the hospital authority, or
would otherwise be qualified to participate in had the hospital
authority not been created, and administration, management, and
control not been transferred by the county to the hospital authority,
pursuant to this chapter.
(j) A hospital authority created pursuant to this chapter shall be
a legal entity separate and apart from the county and shall file the
statement required by Section 53051 of the Government Code. The
hospital authority shall be a government entity separate and apart
from the county, and shall not be considered to be an agency,
division, or department of the county. The hospital authority shall
not be governed by, nor be subject to, the charter of the county and
shall not be subject to policies or operational rules of the county,
including, but not limited to, those relating to personnel and
procurement.
(k) (1) Any contract executed by and between the county and the
hospital authority shall provide that liabilities or obligations of
the hospital authority with respect to its activities pursuant to the
contract shall be the liabilities or obligations of the hospital
authority, and shall not become the liabilities or obligations of the
county.
(2) Any liabilities or obligations of the hospital authority with
respect to the liquidation or disposition of the hospital authority's
assets upon termination of the hospital authority shall not become
the liabilities or obligations of the county.
(3) Any obligation of the hospital authority, statutory,
contractual, or otherwise, shall be the obligation solely of the
hospital authority and shall not be the obligation of the county or
the state.
( l ) (1) Notwithstanding any other provision of this
section, any transfer of the administration, management, or assets of
the medical center, whether or not accompanied by a change in
licensing, shall not relieve the county of the ultimate
responsibility for indigent care pursuant to Section 17000 of the
Welfare and Institutions Code or any obligation pursuant to Section
1442.5 of this code.
(2) Any contract executed by and between the county and the
hospital authority shall provide for the indemnification of the
county by the hospital authority for liabilities as specifically set
forth in the contract, except that the contract shall include a
provision that the county shall remain liable for its own negligent
acts.
(3) Indemnification by the hospital authority shall not be
construed as divesting the county from its ultimate responsibility
for compliance with Section 17000 of the Welfare and Institutions
Code.
(m) Notwithstanding the provisions of this section relating to the
obligations and liabilities of the hospital authority, a transfer of
control or ownership of the medical center shall confer onto the
hospital authority all the rights and duties set forth in state law
with respect to hospitals owned or operated by a county.
(n) (1) A transfer of the maintenance, operation, and management
or ownership of the medical center to the hospital authority shall
comply with the provisions of Section 14000.2 of the Welfare and
Institutions Code.
(2) A transfer of maintenance, operation, and management or
ownership to the hospital authority may be made with or without the
payment of a purchase price by the hospital authority and otherwise
upon the terms and conditions that the parties may mutually agree,
which terms and conditions shall include those found necessary by the
board of supervisors to ensure that the transfer will constitute an
ongoing material benefit to the county and its residents.
(3) A transfer of the maintenance, operation, and management to
the hospital authority shall not be construed as empowering the
hospital authority to transfer any ownership interest of the county
in the medical center except as otherwise approved by the board of
supervisors.
(o) The board of supervisors shall retain control over the use of
the medical center physical plant and facilities except as otherwise
specifically provided for in lawful agreements entered into by the
board of supervisors. Any lease agreement or other agreement between
the county and the hospital authority shall provide that county
premises shall not be sublet without the approval of the board of
supervisors.
(p) The statutory authority of a board of supervisors to prescribe
rules that authorize a county hospital to integrate its services
with those of other hospitals into a system of community service that
offers free choice of hospitals to those requiring hospital care, as
set forth in Section 14000.2 of the Welfare and Institutions Code,
shall apply to the hospital authority upon a transfer of maintenance,
operation, and management or ownership of the medical center by the
county to the hospital authority.
(q) The hospital authority shall have the power to acquire and
possess real or personal property and may dispose of real or personal
property other than that owned by the county, as may be necessary
for the performance of its functions. The hospital authority shall
have the power to sue or be sued, to employ personnel, and to
contract for services required to meet its obligations. Before
January 1, 2024, the hospital authority shall not enter into a
contract with any private person or entity to replace services being
provided by physicians and surgeons who are employed by the hospital
authority and in a recognized collective bargaining unit as of March
31, 2013, with services provided by a private person or entity
without clear and convincing evidence that the needed medical care
can only be delivered cost effectively by a private contractor. Prior
to entering into a contract for any of those services, the authority
shall negotiate with the representative of the recognized collective
bargaining unit of its physician and surgeon employees over the
decision to privatize and, if unable to resolve any dispute through
negotiations, shall submit the matter to final binding arbitration.
(r) Any agreement between the county and the hospital authority
shall provide that all existing services provided by the medical
center shall continue to be provided to the county through the
medical center subject to the policy of the county and consistent
with the county's obligations under Section 17000 of the Welfare and
Institutions Code.
(s) A hospital authority to which the maintenance, operation, and
management or ownership of the medical center is transferred shall be
a "district" within the meaning set forth in the County Employees
Retirement Law of 1937 (Chapter 3 (commencing with Section 31450) of
Part 3 of Division 4 of Title 3 of the Government Code). Employees of
a hospital authority are eligible to participate in the County
Employees Retirement System to the extent permitted by law, except as
described in Section 101851.
(t) Members of the governing board of the hospital authority shall
not be vicariously liable for injuries caused by the act or omission
of the hospital authority to the extent that protection applies to
members of governing boards of local public entities generally under
Section 820.9 of the Government Code.
(u) The hospital authority shall be a public agency subject to the
Meyers-Milias-Brown Act (Chapter 10 (commencing with Section 3500)
of Division 4 of Title 1 of the Government Code).
(v) Any transfer of functions from county employee classifications
to a hospital authority established pursuant to this section shall
result in the recognition by the hospital authority of the employee
organization that represented the classifications performing those
functions at the time of the transfer.
(w) (1) In exercising its powers to employ personnel, as set forth
in subdivision (p), the hospital authority shall implement, and the
board of supervisors shall adopt, a personnel transition plan. The
personnel transition plan shall require all of the following:
(A) Ongoing communications to employees and recognized employee
organizations regarding the impact of the transition on existing
medical center employees and employee classifications.
(B) Meeting and conferring on all of the following issues:
(i) The timeframe for which the transfer of personnel shall occur.
The timeframe shall be subject to modification by the board of
supervisors as appropriate, but in no event shall it exceed one year
from the effective date of transfer of governance from the board of
supervisors to the hospital authority.
(ii) A specified period of time during which employees of the
county impacted by the transfer of governance may elect to be
appointed to vacant positions with the Alameda County Health Care
Services Agency for which they have tenure.
(iii) A specified period of time during which employees of the
county impacted by the transfer of governance may elect to be
considered for reinstatement into positions with the county for which
they are qualified and eligible.
(iv) Compensation for vacation leave and compensatory leave
accrued while employed with the county in a manner that grants
affected employees the option of either transferring balances or
receiving compensation to the degree permitted employees laid off
from service with the county.
(v) A transfer of sick leave accrued while employed with the
county to hospital authority employment.
(vi) The recognition by the hospital authority of service with the
county in determining the rate at which vacation accrues.
(vii) The possible preservation of seniority, pensions, health
benefits, and other applicable accrued benefits of employees of the
county impacted by the transfer of governance.
(2) Nothing in this subdivision shall be construed as prohibiting
the hospital authority from determining the number of employees, the
number of full-time equivalent positions, the job descriptions, and
the nature and extent of classified employment positions.
(3) Employees of the hospital authority are public employees for
purposes of Division 3.6 (commencing with Section 810) of Title 1 of
the Government Code relating to claims and actions against public
entities and public employees.
(x) Any hospital authority created pursuant to this section shall
be bound by the terms of the memorandum of understanding executed by
and between the county and health care and management employee
organizations that is in effect as of the date this legislation
becomes operative in the county. Upon the expiration of the
memorandum of understanding, the hospital authority shall have sole
authority to negotiate subsequent memorandums of understanding with
appropriate employee organizations. Subsequent memorandums of
understanding shall be approved by the hospital authority.
(y) The hospital authority created pursuant to this section may
borrow from the county and the county may lend the hospital authority
funds or issue revenue anticipation notes to obtain those funds
necessary to operate the medical center and otherwise provide medical
services.
(z) The hospital authority shall be subject to state and federal
taxation laws that are applicable to counties generally.
(aa) The hospital authority, the county, or both, may engage in
marketing, advertising, and promotion of the medical and health care
services made available to the community at the medical center.
(ab) The hospital authority shall not be a "person" subject to
suit under the Cartwright Act (Chapter 2 (commencing with Section
16700) of Part 2 of Division 7 of the Business and Professions Code).
(ac) Notwithstanding Article 4.7 (commencing with Section 1125) of
Chapter 1 of Division 4 of Title 1 of the Government Code related to
incompatible activities, a member of the hospital authority
administrative staff shall not be considered to be engaged in
activities inconsistent and incompatible with his or her duties as a
result of employment or affiliation with the county.
(ad) (1) The hospital authority may use a computerized management
information system in connection with the administration of the
medical center.
(2) Information maintained in the management information system or
in other filing and records maintenance systems that is confidential
and protected by law shall not be disclosed except as provided by
law.
(3) The records of the hospital authority, whether paper records,
records maintained in the management information system, or records
in any other form, that relate to trade secrets or to payment rates
or the determination thereof, or which relate to contract
negotiations with providers of health care, shall not be subject to
disclosure pursuant to the California Public Records Act (Chapter 5
(commencing with Section 6250) of Division 7 of Title 1 of the
Government Code). The transmission of the records, or the information
contained therein in an alternative form, to the board of
supervisors shall not constitute a waiver of exemption from
disclosure, and the records and information once transmitted shall be
subject to this same exemption. The information, if compelled
pursuant to an order of a court of competent jurisdiction or
administrative body in a manner permitted by law, shall be limited to
in-camera review, which, at the discretion of the court, may include
the parties to the proceeding, and shall not be made a part of the
court file unless sealed.
(ae) (1) Notwithstanding any other law, the governing board may
order that a meeting held solely for the purpose of discussion or
taking action on hospital authority trade secrets, as defined in
subdivision (d) of Section 3426.1 of the Civil Code, shall be held in
closed session. The requirements of making a public report of
actions taken in closed session and the vote or abstention of every
member present may be limited to a brief general description devoid
of the information constituting the trade secret.
(2) The governing board may delete the portion or portions
containing trade secrets from any documents that were finally
approved in the closed session that are provided to persons who have
made the timely or standing request.
(3) Nothing in this section shall be construed as preventing the
governing board from meeting in closed session as otherwise provided
by law.
(af) Open sessions of the hospital authority shall constitute
official proceedings authorized by law within the meaning of Section
47 of the Civil Code. The privileges set forth in that section with
respect to official proceedings shall apply to open sessions of the
hospital authority.
(ag) The hospital authority shall be a public agency for purposes
of eligibility with respect to grants and other funding and loan
guarantee programs. Contributions to the hospital authority shall be
tax deductible to the extent permitted by state and federal law.
Nonproprietary income of the hospital authority shall be exempt from
state income taxation.
(ah) Contracts by and between the hospital authority and the state
and contracts by and between the hospital authority and providers of
health care, goods, or services may be let on a nonbid basis and
shall be exempt from Chapter 2 (commencing with Section 10290) of
Part 2 of Division 2 of the Public Contract Code.
(ai) (1) Provisions of the Evidence Code, the Government Code,
including the Public Records Act (Chapter 5 (commencing with Section
6250) of Division 7 of Title 1 of the Government Code), the Civil
Code, the Business and Professions Code, and other applicable law
pertaining to the confidentiality of peer review activities of peer
review bodies shall apply to the peer review activities of the
hospital authority. Peer review proceedings shall constitute an
official proceeding authorized by law within the meaning of Section
47 of the Civil Code and those privileges set forth in that section
with respect to official proceedings shall apply to peer review
proceedings of the hospital authority. If the hospital authority is
required by law or contractual obligation to submit to the state or
federal government peer review information or information relevant to
the credentialing of a participating provider, that submission shall
not constitute a waiver of confidentiality. The laws pertaining to
the confidentiality of peer review activities shall be together
construed as extending, to the extent permitted by law, the maximum
degree of protection of confidentiality.
(2) Notwithstanding any other law, Section 1461 shall
apply to hearings on the reports of hospital medical audit or quality
assurance committees.
(aj) The hospital authority shall carry general liability
insurance to the extent sufficient to cover its activities.
(ak) In the event the board of supervisors determines that the
hospital authority should no longer function for the purposes as set
forth in this chapter, the board of supervisors may, by ordinance,
terminate the activities of the hospital authority and expire the
hospital authority as an entity.
(al) A hospital authority which is created pursuant to this
section but which does not obtain the administration, management, and
control of the medical center or which has those duties and
responsibilities revoked by the board of supervisors shall not be
empowered with the powers enumerated in this section.
(am) (1) The county shall establish baseline data reporting
requirements for the medical center consistent with the Medically
Indigent Health Care Reporting System (MICRS) program established
pursuant to Section 16910 of the Welfare and Institutions Code and
shall collect that data for at least one year prior to the final
transfer of the medical center to the hospital authority established
pursuant to this chapter. The baseline data shall include, but not be
limited to, all of the following:
(A) Inpatient days by facility by quarter.
(B) Outpatient visits by facility by quarter.
(C) Emergency room visits by facility by quarter.
(D) Number of unduplicated users receiving services within the
medical center.
(2) Upon transfer of the medical center, the county shall
establish baseline data reporting requirements for each of the
medical center inpatient facilities consistent with data reporting
requirements of the Office of Statewide Health Planning and
Development, including, but not limited to, monthly average daily
census by facility for all of the following:
(A) Acute care, excluding newborns.
(B) Newborns.
(C) Skilled nursing facility, in a distinct part.
(3) From the date of transfer of the medical center to the
hospital authority, the hospital authority shall provide the county
with quarterly reports specified in paragraphs (1) and (2) and any
other data required by the county. The county, in consultation with
health care consumer groups, shall develop other data requirements
that shall include, at a minimum, reasonable measurements of the
changes in medical care for the indigent population of Alameda County
that result from the transfer of the administration, management, and
control of the medical center from the county to the hospital
authority.
(an) A hospital authority established pursuant to this section
shall comply with the requirements of Sections 53260 and 53261 of the
Government Code.
SEC. 4. Section 14085.53 of the Welfare and Institutions Code is
amended to read:
14085.53. (a) The Alameda Health System may revise plans
submitted in accordance with subparagraph (C) of paragraph (1) of
subdivision (b) of Section 14085.5 for the Alameda Health System
capital project and submit those revised plans pursuant to this
section. The revised capital project plans shall qualify for
supplemental reimbursement under Section 14085.5 for the revised
capital project as described in the revised plans, notwithstanding
the assignment of a different permit number, if all of the following
conditions are met:
(1) The revised capital project continues to meet all other
requirements for eligibility as specified in Section 14085.5.
(2) The revised plans are submitted to the Office of Statewide
Health Planning and Development prior to June 30, 1997.
(3) The modifications do not involve a deviation from the original
capital project plan's stated architectural building footprint.
(b) The revised capital project plan for the Alameda Health System
may provide for any or all or any combination of the following:
(1) A reduction in size and scope of the original project plan.
(2) Tenant interior improvements for the entire building not
specified in the original project plan.
(3) Modifications to the foundation, structural frame, and
building exterior shell, commonly known as the shell and core.
(4) Modifications necessary to comply with current seismic safety
standards.
(c) The revised capital project plans for the Alameda Health
System, as described in this section, shall qualify for supplemental
reimbursement as calculated pursuant to subdivision (c) of Section
14085.5, as limited by this section. The initial Medi-Cal inpatient
utilization rate for the Alameda Health System, for purposes of
calculating the supplemental reimbursement, shall be that which was
established at the point of the original project plan submission. The
supplemental reimbursement shall be based on actual costs of the
revised capital project eligible for reimbursement under Section
14085.5. However, in no event shall the supplemental reimbursement
for the revised capital project exceed 85 percent of the supplemental
reimbursement for that portion of the original Alameda Health System
capital project that qualified for the supplemental reimbursement,
the original qualifying amount that was sixty-two million six hundred
ninety-six thousand three hundred forty dollars ($62,696,340), as
indicated by the budgetary estimate as prepared and submitted by
Alameda County to the department July 11, 1994.
SEC. 5. Section 14166.1 of the Welfare and Institutions Code is
amended to read:
14166.1. For purposes of this article, the following definitions
shall apply:
(a) "Allowable costs" means those costs recognized as allowable
under Medicare reasonable cost principles and additional costs
recognized under the demonstration project and successor
demonstration project, including those expenditures identified in
Appendix D to the Special Terms and Conditions for the demonstration
project and successor demonstration project. Allowable costs under
this subdivision shall be determined in accordance with the Special
Terms and Conditions and implementation documents for the
demonstration project and successor demonstration project approved by
the federal Centers for Medicare and Medicaid Services.
(b) "Base year private DSH hospital" means a nonpublic hospital,
nonpublic-converted hospital, or converted hospital, as those terms
are defined in paragraphs (26), (27), and (28), respectively, of
subdivision (a) of Section 14105.98, that was an eligible hospital
under paragraph (3) of subdivision (a) of Section 14105.98 for the
2004-05 state fiscal year.
(c) "Demonstration project" means the Medi-Cal Hospital/Uninsured
Care Demonstration, Number 11-W-00193/9, as approved by the federal
Centers for Medicare and Medicaid Services, effective for the period
of September 1, 2005, through October 31, 2010.
(d) "Designated public hospital" means any one of the following
hospitals to the extent identified in Attachment C,
"Government-operated Hospitals to be Reimbursed on a Certified Public
Expenditure Basis," to the Special Terms and Conditions for the
demonstration project and successor demonstration project, as
applicable, issued by the federal Centers for Medicare and Medicaid
Services:
(1) UC Davis Medical Center.
(2) UC Irvine Medical Center.
(3) UC San Diego Medical Center.
(4) UC San Francisco Medical Center.
(5) UC Los Angeles Medical Center, including Santa Monica/UCLA
Medical Center.
(6) LA County Harbor/UCLA Medical Center.
(7) LA County Martin Luther King Jr.-Harbor Hospital.
(8) LA County Olive View UCLA Medical Center.
(9) LA County Rancho Los Amigos National Rehabilitation Center.
(10) LA County University of Southern California Medical Center.
(11) Alameda Health System.
(12) Arrowhead Regional Medical Center.
(13) Contra Costa Regional Medical Center.
(14) Kern Medical Center.
(15) Natividad Medical Center.
(16) Riverside County Regional Medical Center.
(17) San Francisco General Hospital.
(18) San Joaquin General Hospital.
(19) San Mateo Medical Center.
(20) Santa Clara Valley Medical Center.
(21) Tuolumne General Hospital.
(22) Ventura County Medical Center.
(e) "Federal medical assistance percentage" means the federal
medical assistance percentage applicable for federal financial
participation purposes for medical services under the Medi-Cal state
plan pursuant to Section 1396b(a) of Title 42 of the United States
Code.
(f) "Nondesignated public hospital" means a public hospital
defined in paragraph (25) of subdivision (a) of Section 14105.98,
excluding designated public hospitals.
(g) "Project year" means the applicable state fiscal year of the
Medi-Cal Hospital/Uninsured Care Demonstration Project through
October 31, 2010.
(h) "Project year private DSH hospital" means a nonpublic
hospital, nonpublic-converted hospital, or converted hospital, as
those terms are defined in paragraphs (26), (27), and (28),
respectively, of subdivision (a) of Section 14105.98, that was an
eligible hospital under paragraph (3) of subdivision (a) of Section
14105.98, for the particular project year.
(i) "Prior supplemental funds" means the Emergency Services and
Supplemental Payments Fund, the Medi-Cal Medical Education
Supplemental Payment Fund, the Large Teaching Emphasis Hospital and
Children's Hospital Medi-Cal Medical Education Supplemental Payment
Fund, and the Small and Rural Hospital Supplemental Payments Fund,
established under Sections 14085.6, 14085.7, 14085.8, and 14085.9,
respectively.
(j) "Private hospital" means a nonpublic hospital,
nonpublic-converted hospital, or converted hospital, as those terms
are defined in paragraphs (26) to (28), inclusive, respectively, of
subdivision (a) of Section 14105.98.
(k) "Safety net care pool" means the federal funds available under
the Medi-Cal Hospital/Uninsured Care Demonstration Project and the
successor demonstration project to ensure continued government
support for the provision of health care services to uninsured
populations.
(l) "Uninsured" shall have the same meaning as that term has in
the Special Terms and Conditions issued by the federal Centers for
Medicare and Medicaid Services for the demonstration project and the
successor demonstration project.
(m) "Successor demonstration project" means the Medicaid
demonstration project entitled "California's Bridge to Reform," No.
11-W-00193/9, as approved by the federal Centers for Medicare and
Medicaid Services, effective for the period of November 1, 2010,
through October 31, 2015.
(n) "Successor demonstration year" means the demonstration year as
identified in the Special Terms and Conditions for the successor
demonstration project that corresponds to a specific period of time
as follows:
(1) Successor demonstration year 6 corresponds to the period of
November 1, 2010, through June 30, 2011.
(2) Successor demonstration year 7 corresponds to the period of
July 1, 2011, through June 30, 2012.
(3) Successor demonstration year 8 corresponds to the period of
July 1, 2012, through June 30, 2013.
(4) Successor demonstration year 9 corresponds to the period of
July 1, 2013, through June 30, 2014.
(5) Successor demonstration year 10 corresponds to July 1, 2014,
through October 31, 2015.
(o) "Low Income Health Program" means the county-based elective
program to provide benefits for low-income individuals that is
authorized by the successor demonstration project and implemented by
Part 3.6 (commencing with Section 15909).
(p) "Delivery system reform incentive pool" means the separate
federal funding pool created within the safety net care pool under
the successor demonstration project that is available to support
programs of activity to enhance the quality of care and health of
patients served by designated public hospitals and nonhospital
clinics and other provider types with which they are affiliated, and,
under specified conditions and approval of the federal Centers for
Medicare and Medicaid Services, to private disproportionate share
hospitals and nondesignated public hospitals.
SEC. 6. Section 17612.2 of the Welfare and Institutions Code is
amended to read:
17612.2. For purposes of this article, the following definitions
shall apply:
(a) "Adjusted patient day" means a county public hospital health
system's total number of patient census days, as defined by the
Office of Statewide Health Planning and Development, multiplied by
the following fraction: the numerator that is the sum of the county
public hospital health system's total gross revenue for all services
provided to all patients, including nonhospital services, and the
denominator that is the sum of the county public hospital health
system's gross inpatient revenue. The adjusted patient days shall
pertain to those services that are provided by the county public
hospital health system and shall exclude services that are provided
by contract or out-of-network clinics or hospitals.
(b) "Base year" means the fiscal year ending three years prior to
the fiscal year for which the redirected amount is calculated.
(c) "Blended CPI trend factor" means the blended percent change
applicable for the fiscal year that is derived from the nonseasonally
adjusted Consumer Price Index for All Urban Consumers (CPI-U),
United States City Average, for Hospital and Related Services,
weighted at 75 percent, and for Medical Care Services, weighted at 25
percent, all as published by the United States Bureau of Labor
Statistics, computed as follows:
(1) For each prior fiscal year within the period to be trended
through the current fiscal year, the annual average of the monthly
index amounts shall be determined separately for the Hospital and
Related Services Index and the Medical Care Services Index.
(2) The year-to-year percentage changes in the annual averages
determined in paragraph (1) for each of the Hospital and Related
Services Index and the Medical Care Services Index shall be
calculated.
(3) A weighted average annual percentage change for each
year-to-year period shall be calculated from the determinations made
in paragraph (2), with the percentage changes in the Hospital and
Related Services Index weighted at 75 percent, and the percentage
changes in the Medical Care Services Index weighted at 25 percent.
The resulting average annual percentage changes shall be expressed as
a fraction, and increased by 1.00.
(4) The product of the successive year-to-year amounts determined
in paragraph (3) shall be the blended CPI trend factor.
(d) "Cost containment limit" means the public hospital health
system county's Medi-Cal costs and uninsured costs determined for the
2014-15 fiscal year and each subsequent fiscal year, adjusted as
follows:
(1) Notwithstanding paragraphs (2) to (4), inclusive, at the
public hospital health system county's option it shall be deemed to
comply with the cost containment limit if the county demonstrates
that its total health care costs, including nursing facility, mental
health, and substance use disorder services, that are not limited to
Medi-Cal and uninsured patients, for the fiscal year did not exceed
its total health care costs in the base year, multiplied by the
blended CPI trend factor for the fiscal year. A county electing this
option shall elect by November 1 following the end of the fiscal
year, and submit its supporting reports for meeting this requirement,
including the annual report of financial transactions required to be
submitted to the Controller pursuant to Section 53891 of the
Government Code.
(2) (A) The public hospital health system county's Medi-Cal costs,
uninsured costs, and other entity intergovernmental transfer amounts
for the fiscal year shall be added together. Medi-Cal costs,
uninsured costs, and other entity intergovernmental transfer amounts
for purposes of this paragraph are as defined in subdivisions (q),
(t), and (y) for the relevant fiscal period.
(B) The public hospital health system county's Medi-Cal costs,
uninsured costs, and imputed other entity intergovernmental transfer
amounts for the base year shall be added together and multiplied by
the blended CPI trend factor. The base year costs used shall not
reflect any adjustments under this subdivision.
(C) The fiscal year amount determined in subparagraph (A) shall be
compared to the trended amount in subparagraph (B). If the amount in
subparagraph (B) exceeds the amount in subparagraph (A), the public
hospital health system county shall be deemed to have satisfied the
cost containment limit. If the amount in subparagraph (A) exceeds the
amount in subparagraph (B), the calculation in paragraph (3) shall
be performed.
(3) (A) If the number of adjusted patient days of service provided
by the county public hospital health system for the fiscal year
exceeds its number of adjusted patient days of service rendered in
the base year by at least 10 percent, the excess adjusted patient
days above the base year for the fiscal year shall be multiplied by
the cost per adjusted patient day of the county public hospital
health system for the base year. The result shall be added to the
trended base year amount determined in subparagraph (B) of paragraph
(2), yielding the applicable cost containment limit, subject to
paragraph (4).
(B) If the number of adjusted patient days of service provided by
a county's public hospital health system for the fiscal year does not
exceed its number of adjusted patient days of service rendered in
the base year by 10 percent, the applicable cost containment limit is
the trended base year amount determined in subparagraph (B) of
paragraph (2), subject to paragraph (4).
(4) If a public hospital health system county's costs, as
determined in subparagraph (A) of paragraph (2), exceeds the amount
determined in subparagraph (B) of paragraph (2) as adjusted by
paragraph (3), the portion of the following cost increases incurred
in providing services to Medi-Cal beneficiaries and uninsured
patients shall be added to and reflected in any cost containment
limit:
(A) Electronic health records and related implementation and
infrastructure costs.
(B) Costs related to state or federally mandated activities,
requirements, or benefit changes.
(C) Costs resulting from a court order or settlement.
(D) Costs incurred in response to seismic concerns, including
costs necessary to meet facility seismic standards.
(E) Costs incurred as a result of a natural disaster or act of
terrorism.
(5) If a public hospital health system county's costs, as
determined in subparagraph (A) of paragraph (2), exceeds the amount
determined in subparagraph (B) of paragraph (2) as adjusted by
paragraphs (3) and (4), the county may request that the department
consider other costs as adjustments to the cost containment limit,
including, but not limited to, transfer amounts in excess of the
imputed other entity intergovernmental transfer amount trended by the
blended CPI trend factor, costs related to case mix index increases,
pension costs, expanded medical education programs, increased costs
in response to delivery system changes in the local community, and
system expansions, including capital expenditures necessary to ensure
access to and the quality of health care. Costs approved by the
department shall be added to and reflected in any cost containment
limit.
(e) "County indigent care health realignment amount" means the
product of the health realignment amount times the health realignment
indigent care percentage, as computed on a county-specific basis.
(f) "County public hospital health system" means a designated
public hospital identified in paragraphs (6) to (20), inclusive, and
paragraph (22) of subdivision (d) of Section 14166.1, and its
affiliated governmental entity clinics, practices, and other health
care providers that do not provide predominantly public health
services. A county public hospital health system does not include a
health care service plan, as defined in subdivision (f) of Section
1345 of the Health and Safety Code. The Alameda Health System and
County of Alameda shall be considered affiliated governmental
entities.
(g) "Department" means the State Department of Health Care
Services.
(h) "Health realignment amount" means the amount that, in the
absence of this article, would be payable to a public hospital health
system county under Sections 17603, 17604, and 17606.20, as those
sections read on January 1, 2012, and Section 17606.10, as it read on
July 1, 2013, for the fiscal year that is deposited by the
Controller into the local health and welfare trust fund health
account of the public hospital health system county.
(i) "Health realignment indigent care percentage" means the
county-specific percentage determined in accordance with the
following, and established in accordance with the procedures
described in subdivision (c) of Section 17612.3.
(1) Each public hospital health system county shall identify the
portion of that county's health realignment amount that was used to
provide health services to the indigent, including Medi-Cal
beneficiaries and the uninsured, for each of the historical fiscal
years along with verifiable data in support thereof.
(2) The amounts identified in paragraph (1) shall be expressed as
a percentage of the health realignment amount of that county for each
historical fiscal year.
(3) The average of the percentages determined in paragraph (2)
shall be the county's health realignment indigent care percentage.
(4) To the extent a county does not provide the information
required in paragraph (1) or the department determines that the
information provided is insufficient, the amount under this
subdivision shall be 85 percent.
(j) "Historical fiscal years" means the state 2008-09 to 2011-12,
inclusive, fiscal years.
(k) "Hospital fee direct grants" means the direct grants described
in Section 14169.7 that are funded by the Private Hospital Quality
Assurance Fee Act of 2011 (Article 5.229 (commencing with Section
14169.31) of Chapter 7 of Part 3), or direct grants made in support
of health care expenditures funded by a successor statewide hospital
fee program.
( l ) "Imputed county low-income health amount" means
the predetermined, county-specific amount of county general purpose
funds assumed, for purposes of the calculation in Section 17612.3, to
be available to the county public hospital health system for
services to Medi-Cal and uninsured patients. County general purpose
funds shall not include any other revenues, grants, or funds
otherwise defined in this section. The imputed county low-income
health amount shall be determined as follows and established in
accordance with subdivision (c) of Section 17612.3.
(1) For each of the historical fiscal years, an amount determined
to be the annual amount of county general fund contribution provided
for health services to Medi-Cal beneficiaries and the uninsured,
which does not include funds provided for nursing facility, mental
health, and substance use disorder services, shall be determined
through methodologies described in subdivision (ab).
(2) If a year-to-year percentage increase in the amount determined
in paragraph (1) was present, an average annual percentage trend
factor shall be determined.
(3) The annual amounts determined in paragraph (1) shall be
averaged, and multiplied by the percentage trend factor, if
applicable, determined in paragraph (2), for each fiscal year after
the 2011-12 fiscal year through the applicable fiscal year. However,
if the percentage trend factor determined in paragraph (2) is greater
than the applicable percentage change for any year of the same
period in the blended CPI trend factor, the percentage change in the
blended CPI trend factor for that year shall be used. The resulting
determination is the imputed county low-income health amount for
purposes of Section 17612.3.
(m) "Imputed gains from other payers" means the predetermined,
county-specific amount of revenues in excess of costs generated from
all other payers for health services that is assumed to be available
to the county public hospital health system for services to Medi-Cal
and uninsured patients, which shall be determined as follows and
established in accordance with subdivision (c) of Section 17612.3.
(1) For each of the historical fiscal years, the gains from other
payers shall be determined in accordance with methodologies described
in subdivision (ab).
(2) The amounts determined in paragraph (1) shall be averaged,
yielding the imputed gains from other payers.
(n) "Imputed other entity intergovernmental transfer amount" means
the predetermined average historical amount of the public hospital
health system county's other entity intergovernmental transfer
amount, determined as follows and established in accordance with
subdivision (c) of Section 17612.3.
(1) For each of the historical fiscal years, the other entity
intergovernmental transfer amount shall be determined based on the
records of the public hospital health system county.
(2) The annual amounts in paragraph (1) shall be averaged.
(o) "Medicaid demonstration revenues" means payments paid or
payable to the county public hospital health system for the fiscal
year pursuant to the Special Terms and Conditions of the federal
Medicaid demonstration project authorized under Section 1115 of the
federal Social Security Act entitled the "Bridge to Health Care
Reform" (waiver number 11-W-00193/9), for uninsured care services
from the safety net care pool or as incentive payments from the
delivery system reform improvement pool, or pursuant to mechanisms
that provide funding for similar purposes under the subsequent
demonstration project. Medicaid demonstration revenues do not include
the nonfederal share provided by county public hospital health
systems as certified public expenditures, and are reduced by any
intergovernmental transfer by county public hospital health systems
or affiliated governmental entities that is for the nonfederal share
of Medicaid demonstration payments to the county public hospital
health system or payments to a Medi-Cal managed care plan for
services rendered by the county public hospital health system, and
any related fees imposed by the state on those transfers; and by any
reimbursement of costs, or payment of administrative or other
processing fees imposed by the state relating to payments or other
Medicaid demonstration program functions. Medicaid demonstration
revenues shall not include safety net care pool revenues for nursing
facility, mental health, and substance use disorder services, as
determined from the pro rata share of eligible certified
public expenditures for such
services, or revenues that are otherwise included as Medi-Cal
revenues.
(p) "Medi-Cal beneficiaries" means individuals eligible to receive
benefits under Chapter 7 (commencing with Section 14000) of Part 3,
except for: individuals who are dual eligibles, as defined in
paragraph (4) of subdivision (c) of Section 14132.275, and
individuals for whom Medi-Cal benefits are limited to cost sharing or
premium assistance for Medicare or other insurance coverage as
described in Section 1396d(a) of Title 42 of the United States Code.
(q) "Medi-Cal costs" means the costs incurred by the county public
hospital health system for providing Medi-Cal services to Medi-Cal
beneficiaries during the fiscal year, which shall be determined in a
manner consistent with the cost claiming protocols developed for
Medi-Cal cost-based reimbursement for public providers and under
Section 14166.8, and, in consultation with each county, shall be
based on other cost reporting and statistical data necessary for an
accurate determination of actual costs as required in Section
17612.4. Medi-Cal costs shall include all fee-for-service and managed
care hospital and nonhospital components, managed care
out-of-network costs, and related administrative costs. The Medi-Cal
costs determined under this paragraph shall exclude costs incurred
for nursing facility, mental health, and substance use disorder
services.
(r) "Medi-Cal revenues" means total amounts paid or payable to the
county public hospital health system for medical services provided
under the Medi-Cal State Plan that are rendered to Medi-Cal
beneficiaries during the state fiscal year, and shall include
payments from Medi-Cal managed care plans for services rendered to
Medi-Cal managed care plan members, Medi-Cal copayments received from
Medi-Cal beneficiaries, but only to the extent actually received,
supplemental payments for Medi-Cal services, and Medi-Cal
disproportionate share hospital payments for the state fiscal year,
but shall exclude Medi-Cal revenues paid or payable for nursing
facility, mental health, and substance use disorder services.
Medi-Cal revenues do not include the nonfederal share provided by
county public hospital health systems as certified public
expenditures. Medi-Cal revenues shall be reduced by all of the
following:
(1) Intergovernmental transfers by the county public hospital
health system or its affiliated governmental entities that are for
the nonfederal share of Medi-Cal payments to the county public
hospital health system, or Medi-Cal payments to a Medi-Cal managed
care plan for services rendered by the county public hospital health
system for the fiscal year.
(2) Related fees imposed by the state on the transfers specified
in paragraph (1).
(3) Administrative or other fees, payments, or transfers imposed
by the state, or voluntarily provided by the county public hospital
health systems or affiliated governmental entities, relating to
payments or other Medi-Cal program functions for the fiscal year.
(s) "Newly eligible beneficiaries" means individuals who meet the
eligibility requirements in Section 1902(a)(10)(A)(i)(VIII) of Title
XIX of the federal Social Security Act (42 U.S.C. Sec. 1396a(a)(10)
(A)(i)(VIII)), and who meet the conditions described in Section 1905
(y) of the federal Social Security Act (42 U.S.C. Sec. 1396d(y)) such
that expenditures for services provided to the individual are
eligible for the enhanced federal medical assistance percentage
described in that section.
(t) "Other entity intergovernmental transfer amount" means the
amount of intergovernmental transfers by a county public hospital
health system or affiliated governmental entities, and accepted by
the department, that are for the nonfederal share of Medi-Cal
payments or Medicaid demonstration payments for the fiscal year to
any Medi-Cal provider other than the county public hospital health
system, or to a Medi-Cal managed care plan for services rendered by
those other providers, and any related fees imposed by the state on
those transfers.
(u) "Public hospital health system county" means a county in which
a county public hospital health system is located.
(v) "Redirected amount" means the amount to be redirected in
accordance with Section 17612.1, as calculated pursuant to
subdivision (a) of Section 17612.3.
(w) "Special local health funds" means the amount of the following
county funds received by the county public hospital health system
for health services during the fiscal year:
(1) Assessments and fees restricted for health-related purposes.
The amount of the assessment or fee for this purpose shall be the
greater of subparagraph (A) or (B). If, because of restrictions and
limitations applicable to the assessment or fee, the county public
hospital health system cannot expend this amount, this amount shall
be reduced to the amount actually expended.
(A) The amount of the assessment or fee expended by the county
public hospital health system for the provision of health services to
Medi-Cal and uninsured beneficiaries during the fiscal year.
(B) The amount of the assessment or fee multiplied by the average
of the percentages of the amount of assessment or fees that were
allocated to and expended by the county public hospital health system
for health services to Medi-Cal and uninsured beneficiaries during
the historical fiscal years. The percentages for the historical
fiscal years shall be determined by dividing the amount allocated in
each fiscal year as described in subparagraphs (B) and (C) of
paragraph (2) of subdivision (ab) by the actual amount of assessment
or fee expended in the fiscal year.
(2) Funds available pursuant to the Master Settlement Agreement
and related documents entered into on November 23, 1998, by the state
and leading United States tobacco product manufacturers during a
fiscal year. The amount of the tobacco settlement funds that may be
used for this purpose shall be the greater of subparagraph (A) or
(B), less any bond payments and other costs of securitization related
to the funds described in this paragraph.
(A) The amount of the funds expended by the county public hospital
health system for the provision of health services to Medi-Cal and
uninsured beneficiaries during the fiscal year.
(B) The amount of the tobacco settlement funds multiplied by the
average of the percentages of the amount of tobacco settlement funds
that were allocated to and expended by the county public hospital
health system for health services to Medi-Cal and uninsured
beneficiaries during the historical fiscal years. The percentages for
the historical fiscal years shall be determined by dividing the
amount allocated in each fiscal year as described in subparagraphs
(B) and (C) of paragraph (2) of subdivision (ab) by the actual amount
of tobacco settlement funds expended in the fiscal year.
(x) "Subsequent demonstration project" means the federally
approved Medicaid demonstration project implemented after the
termination of the federal Medicaid demonstration project authorized
under Section 1115 of the federal Social Security Act entitled the
"Bridge to Health Care Reform" (waiver number 11-W-00193/9), the
extension of that demonstration project, or the material amendment to
that demonstration project.
(y) "Uninsured costs" means the costs incurred by the public
hospital health system county and its affiliated government entities
for purchasing, providing, or ensuring the availability of services
to uninsured patients during the fiscal year. Uninsured costs shall
be determined in a manner consistent with the cost claiming protocols
developed for the federal Medicaid demonstration project authorized
under Section 1115 of the federal Social Security Act entitled the
"Bridge to Health Care Reform" (waiver number 11-W-00193/9),
including protocols pending federal approval, and under Section
14166.8, and, in consultation with each county, shall be based on any
other cost reporting and statistical data necessary for an accurate
determination of actual costs incurred. For this purpose, no
reduction factor applicable to otherwise allowable costs under the
demonstration project or the subsequent demonstration project shall
apply. Uninsured costs shall exclude costs for nursing facility,
mental health, and substance use disorder services.
(z) "Uninsured patients" means individuals who have no source of
third-party coverage for the specific service furnished, as further
defined in the reporting requirements established pursuant to Section
17612.4.
(aa) "Uninsured revenues" means self-pay payments made by or on
behalf of uninsured patients to the county public hospital health
system for the services rendered in the fiscal year, but shall
exclude revenues received for nursing facility, mental health, and
substance use disorder services. Uninsured revenues do not include
the health realignment amount or imputed county low-income health
amount and shall not include any other revenues, grants, or funds
otherwise defined in this section.
(ab) "Historical allocation" means the allocation for the amounts
in the historical years described in subdivisions (l), (m), and (w)
for health services to Medi-Cal beneficiaries and uninsured patients.
The allocation of those amounts in the historical years shall be
done in accordance with a process to be developed by the department,
in consultation with the counties, which includes the following
required parameters:
(1) For each of the historical fiscal years, the Medi-Cal costs,
uninsured costs, and costs of other entity intergovernmental transfer
amounts, as defined in subdivisions (q), (t), and (y), and the
Medicaid demonstration, Medi-Cal and uninsured revenues, and hospital
fee direct grants with respect to the services as defined in
subdivisions (k), (o), (r), and (aa), shall be determined. For these
purposes, Medicaid demonstration revenues shall include applicable
payments as described in subdivision (o) paid or payable to the
county public hospital health system under the prior demonstration
project defined in subdivision (c) of Section 14166.1, under the Low
Income Health Program (Part 3.6 (commencing with Section 15909)), and
under the Health Care Coverage Initiative (Part 3.5 (commencing with
Section 15900)), none of which shall include the nonfederal share of
the Medicaid demonstration payments. The revenues shall be
subtracted from the costs, yielding the initial low-income shortfall
for each of the historical fiscal years.
(2) The following shall be applied in sequential order against,
but shall not exceed in the aggregate, the initial low-income
shortfall determined in paragraph (1) for each of the historical
fiscal years:
(A) First, the county indigent care health realignment amount
shall be applied 100 percent against the initial low-income
shortfall.
(B) Second, special local health funds specifically restricted for
indigent care shall be applied 100 percent against the initial
low-income shortfall.
(C) Third, the sum of clauses (iv), (v), and (vi). Clause (iv) is
the special local health funds, as defined in subdivision (w) and not
otherwise identified as restricted special local health funds under
subparagraph (B), clause (v) is the imputed county low-income health
amount defined in subdivision (l), and clause (vi) is the one-time
and carry-forward revenues as defined in subdivision (aj), all
allocated to the historical low-income shortfall. These amounts shall
be calculated as follows:
(i) Determine the sum of the special local health funds, as
defined in subdivision (w) and not otherwise identified as restricted
special local health funds under subparagraph (B), the imputed
county low-income health amount defined in subdivision (l), and
one-time and carry-forward revenues as defined in subdivision (aj).
(ii) Divide the historical total shortfall defined in subdivision
(ah) by the sum in clause (i) to get the historical usage of funds
percentage defined in subdivision (ai). If this calculation produces
a percentage above 100 percent in a given historical fiscal year,
then the historical usage of funds percentage in that historical
fiscal year shall be deemed to be 100 percent.
(iii) Multiply the historical usage of funds percentage defined in
subdivision (ai) and calculated in clause (ii) by each of the
following funds:
(I) Special local health funds, as defined in subdivision (w) and
not otherwise identified as restricted special local health funds
under subparagraph (B).
(II) The imputed county low-income health amount defined in
subdivision (l).
(III) One-time and carry-forward revenues as defined in
subdivision (aj).
(iv) Multiply the product of subclause (I) of clause (iii) by the
historical low-income shortfall percentage defined in subdivision
(af) to determine the amount of special local health funds, as
defined in subdivision (w) and not otherwise identified as restricted
special local health funds under subparagraph (B), allocated to the
historical low-income shortfall.
(v) Multiply the product of subclause (II) of clause (iii) by the
historical low-income shortfall percentage defined in subdivision
(af) to determine the amount of the imputed county low-income health
amount defined in subdivision (l) allocated to the historical
low-income shortfall.
(vi) Multiply the product of subclause (III) of clause (iii) by
the historical low-income shortfall percentage defined in subdivision
(af) to determine the amount of one-time and carry-forward revenues
as defined in subdivision (aj) allocated to the historical low-income
shortfall.
(D) Finally, to the extent that the process above does not result
in completely allocating revenues up to the amount necessary to
address the initial low-income shortfall in the historical years,
gains from other payers shall be allocated to fund those costs only
to the extent that such other payer gains exist.
(ac) "Gains from other payers" means the county-specific amount of
revenues in excess of costs generated from all other payers for
health services. For purposes of this subdivision, patients with
other payer coverage are patients who are identified in all other
financial classes, including, but not limited to, commercial coverage
and dual eligible, other than allowable costs and associated
revenues for Medi-Cal and the uninsured.
(ad) "New mandatory other entity intergovernmental transfer
amounts" means other entity intergovernmental transfer amounts
required by the state after July 1, 2013.
(ae) "Historical low-income shortfall" means, for each of the
historical fiscal years described in subdivision (j), the initial
low-income shortfall for Medi-Cal and uninsured costs determined in
paragraph (1) of subdivision (ab), less amounts identified in
subparagraphs (A) and (B) of paragraph (2) of subdivision (ab).
(af) "Historical low-income shortfall percentage" means, for each
of the historical fiscal years described in subdivision (j), the
historical low-income shortfall described in subdivision (ae) divided
by the historical total shortfall described in subdivision (ah).
(ag) "Historical other shortfall" means, for each of the
historical fiscal years described in subdivision (j), the shortfall
for all other types of costs incurred by the public hospital health
system that are not Medi-Cal or uninsured costs, and is determined as
total costs less total revenues, excluding any costs and revenue
amounts used in the calculation of the historical low-income
shortfall, and also excluding those costs and revenues related to
mental health and substance use disorder services. If the amount of
historical other shortfall in a given historical fiscal year is less
than zero, then the historical other shortfall for that historical
fiscal year shall be deemed to be zero.
(ah) "Historical total shortfall" means, for each of the
historical fiscal years described in subdivision (j), the sum of the
historical low-income shortfall described in subdivision (ae) and the
historical other shortfall described in subdivision (ag).
(ai) "Historical usage of funds percentage" means, for each of the
historical fiscal years described in subdivision (j), the historical
total shortfall described in subdivision (ah) divided by the sum of
special local health funds as defined in subdivision (w) and not
otherwise identified as restricted special local health funds under
subparagraph (B) of paragraph (2) of subdivision (ab), the imputed
county low-income health amount defined in subdivision (l), and
one-time and carry-forward revenues as defined in subdivision (aj).
If this calculation produces a percentage above 100 percent in a
given historical fiscal year, then the historical usage of funds
percentage in that historical fiscal year shall be deemed to be 100
percent.
(aj) "One-time and carry-forward revenues" mean, for each of the
historical fiscal years described in subdivision (j), revenues and
funds that are not attributable to services provided or obligations
in the applicable historical fiscal year, but were available and
utilized during the applicable historical fiscal year by the public
hospital health system.
