Bill Text: CA SB1511 | 2023-2024 | Regular Session | Amended
Bill Title: Health omnibus.
Spectrum: Committee Bill
Status: (Introduced) 2024-04-23 - From committee: Do pass and re-refer to Com. on APPR with recommendation: To consent calendar. (Ayes 11. Noes 0.) (April 22). Re-referred to Com. on APPR. [SB1511 Detail]
Download: California-2023-SB1511-Amended.html
|
Amended
IN
Senate
April 09, 2024 |
CALIFORNIA LEGISLATURE—
2023–2024 REGULAR SESSION
Senate Bill
No. 1511
| Introduced by Committee on Health (Senators Roth (Chair), Glazer, Gonzalez, Grove, Hurtado, Limón, Menjivar, Nguyen, Rubio, Smallwood-Cuevas, and Wiener) |
February 21, 2024 |
An act to amend Sections 1345, 1649.2, and 129385 of, and to amend and renumber Section 1367.34 of, and to add Section 102970 to, the Health and Safety Code, and to amend Sections 5150.05, 5250, 5350, 5350.5, 10022, and 14115.8 of the Welfare and Institutions Code, relating to health, and making an appropriation therefor.
LEGISLATIVE COUNSEL'S DIGEST
SB 1511, as amended, Committee on Health.
Health omnibus.
(1) Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. Existing law defines a “group contract,” for purposes of the act, as a contract that by its terms limits the eligibility of subscribers and enrollees to a specified group.
This bill would clarify that reference to a “group” in the act does not include a Medi-Cal managed care contract between a health care service plan and the State Department of Health Care Services to provide benefits to beneficiaries of the Medi-Cal program.
(2) Existing law, the Compassionate Access to Medical Cannabis Act or Ryan’s Law, requires specified health care facilities to allow
a terminally ill patient’s use of medicinal cannabis within the health care facility, as defined, subject to certain restrictions. Existing law requires the State Department of Public Health to enforce the act. Existing law prohibits a general acute care hospital, as specified, from permitting a patient with a chronic disease to use medicinal cannabis.
This bill would authorize a general acute care hospital to allow a terminally ill patient, as defined, to use medicinal cannabis.
(3) Existing law establishes the Distressed Hospital Loan Program, administered by the Department of Health Care Access and Information, in order to provide interest-free cashflow loans to not-for-profit hospitals and public hospitals in significant financial distress or to governmental entities representing a closed hospital, except as otherwise provided, to prevent the closure of, or facilitate the reopening of, those
hospitals. Existing law establishes the Distressed Hospital Loan Program Fund, with moneys in the fund being continuously appropriated for the department. Existing law authorizes the Department of Finance to transfer up to $150,000,000 from the General Fund and $150,000,000 from the Medi-Cal Provider Payment Reserve Fund to the Distressed Hospital Loan Program Fund in state fiscal year 2023–24 to implement the program. Existing law requires any funds transferred to be available for encumbrance or expenditure until June 30, 2026.
This bill would instead require any funds transferred to be available for encumbrance or expenditure until December 31, 2031. By extending the amount of time continuously appropriated funds are available for encumbrance and expenditure, this bill would make an appropriation.
(4) Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Existing law establishes the Administrative Claiming process under which the department is authorized to contract with local governmental agencies and local educational consortia for the purpose of obtaining federal matching funds to assist with the performance of administrative activities relating to the Medi-Cal program that are provided by a local governmental agency or local educational agency (LEA).
Existing law requires the department to engage in specified activities relating to the LEA Medi-Cal Billing Option, including amending the Medicaid state plan to ensure that schools are reimbursed for all eligible services, consulting with specified
entities in formulating state plan amendments, examining methodologies for increasing school participation in the LEA Medi-Cal Billing Option, and conducting an audit of a Medi-Cal Billing Option claim consistent with prescribed requirements, such as generally accepted accounting principles. Existing law requires the department to issue and regularly maintain a program guide for the LEA Medi-Cal Billing Option program. Existing law requires the department to file an annual report with the Legislature that includes, among other things, a summary of department activities.
Existing law requires these activities to be funded and staffed by proportionately reducing federal Medicaid payments allocable to LEAs for the provision of benefits funded by the federal Medicaid program under the billing option for services by LEAs. Existing law directs moneys collected as a result of the reduction in federal Medicaid payments allocable to LEAs to be deposited into the Local
Educational Agency Medi-Cal Recovery Fund to be used, upon appropriation by the Legislature, only to support the department to meet all the requirements of the activities described above.
This bill would instead require that the department’s administration of the LEA Medi-Cal Billing Option program be funded and staffed by these funds and would require moneys in the Local Educational Agency Medi-Cal Recovery Fund to be used, upon appropriation, only to support the department to meet all the requirements of administering the program.
(5) Existing law, the Lanterman-Petris-Short Act, provides for the involuntary commitment and treatment of a person who is a danger to others or to themselves, or who is gravely disabled. Existing law, commencing January 1, 2024, defines “gravely disabled,” for purposes of involuntary commitment, as either a condition in which a person, as a result of a
mental health disorder, severe substance use disorder, or a cooccurring mental health disorder and a severe substance use disorder, is unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care or who has been found mentally incompetent, as specified.
This bill would make conforming changes to related provisions for consistency with that definition of gravely disabled. The bill would also make technical changes.
(6) Existing law establishes the State Department of Public Health under the direction of the State Public Health Officer. Existing law requires a funeral director, or a person acting in lieu of a funeral director if there is no funeral director, to prepare a certificate of fetal death and register it with the local registrar. Existing law requires the funeral director to prepare and register a fetal death within
8 calendar days. Existing law requires an attending physician in attendance on the delivery of a fetus to state specified information on the certificate of fetal death concerning the time of fetal death or delivery. Existing law requires the attending physician to deposit the fetal death certificate within 15 hours after the fetal death. Existing law requires a coroner to state specified information on the certificate of fetal death concerning the time of fetal death. Existing law requires the coroner to deliver the death certificate to the attending funeral director within 3 days after examining the body.
This bill would require the department to regularly, but no less than annually, review fetal death registrations to determine compliance with existing timeframe requirements for fetal death registrations. The bill would require the department to notify the relevant licensing entity of an individual’s or entity’s repeated failures to timely comply with fetal death
registration requirements, as specified.
(7) Existing law provides that a person with private health care coverage is not entitled to receive health care items or services furnished or paid for by a publicly funded health care program if those health care items or services are covered by that private health care coverage. Existing law entitles a publicly funded health care program that furnishes or pays for designated health care items or services to be subrogated to the rights that person has against the carrier of the coverage to the extent of the health care items provided or services rendered. Under existing law, an entity providing private health care coverage is required to, among other things, respond to inquiries of, and agree not to deny claims submitted by, the state or a provider, as defined, in connection with the provision of a health care item or service, as specified.
This bill would also require the entity providing private health care coverage to respond to, and agree not to deny claims submitted by, Medi-Cal managed care plans, as defined. The bill would also require, among other things, entities providing private health care coverage to request a refund of a claim paid in error from the State Department of Health Care Services within 3 years from the date of payment.
(4)
(8) This bill would make an additional technical, nonsubstantive change by renumbering a related provision.
Digest Key
Vote: 2/3 Appropriation: YES Fiscal Committee: YES Local Program: NOBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 1345 of the Health and Safety Code is amended to read:1345.
As used in this chapter:(a) “Advertisement” means any written or printed communication or any communication by means of recorded telephone messages or by radio, television, or similar communications media, published in connection with the offer or sale of plan contracts.
(b) “Basic health care services” means all of the following:
(1) Physician services, including consultation and referral.
(2) Hospital inpatient services and ambulatory care services.
(3) Diagnostic laboratory and diagnostic and therapeutic radiologic services.
(4) Home health services.
(5) Preventive health services.
(6) Emergency health care services, including ambulance and ambulance transport services and out-of-area coverage. “Basic health care services” includes ambulance and ambulance transport services provided through the “911” emergency response system.
(7) Hospice care pursuant to Section 1368.2.
(c) “Enrollee” means a person who is enrolled in a plan and who is a recipient of services from the plan.
(d) “Evidence of coverage” means any certificate, agreement, contract, brochure, or letter of entitlement issued to a subscriber or enrollee setting forth the coverage to which the subscriber or enrollee is entitled.
(e) “Group contract” means a contract that by its terms limits the eligibility of subscribers and enrollees to a specified group. Reference to a “group” does not include a Medi-Cal managed care contract between a health care service plan and the State Department of Health Care Services to provide benefits to beneficiaries of the Medi-Cal program.
(f) “Health care service plan” or “specialized health care service plan” means either of the following:
(1) Any person who undertakes to arrange for the
provision of health care services to subscribers or enrollees, or to pay for or to reimburse any part of the cost for those services, in return for a prepaid or periodic charge paid by or on behalf of the subscribers or enrollees.
(2) Any person, whether located within or outside of this state, who solicits or contracts with a subscriber or enrollee in this state to pay for or reimburse any part of the cost of, or who undertakes to arrange or arranges for, the provision of health care services that are to be provided wholly or in part in a foreign country in return for a prepaid or periodic charge paid by or on behalf of the subscriber or enrollee.
(g) “License” means, and “licensed” refers to, a license as a plan pursuant to Section 1353.
(h) “Out-of-area coverage,” for purposes of paragraph (6) of subdivision (b), means coverage while an enrollee is anywhere outside the service area of the plan, and shall also include coverage for urgently needed services to prevent serious deterioration of an enrollee’s health resulting from unforeseen illness or injury for which treatment cannot be delayed until the enrollee returns to the plan’s service area.
(i) “Provider” means any professional person, organization, health facility, or other person or institution licensed by the state to deliver or furnish health care services.
(j) “Person” means any person, individual, firm, association, organization, partnership, business trust, foundation, labor organization,
corporation, limited liability company, public agency, or political subdivision of the state.
(k) “Service area” means a geographical area designated by the plan within which a plan shall provide health care services.
(l) “Solicitation” means any presentation or advertising conducted by, or on behalf of, a plan, where information regarding the plan, or services offered and charges therefor, is disseminated for the purpose of inducing persons to subscribe to, or enroll in, the plan.
(m) “Solicitor” means any person who engages in the acts defined in subdivision (l).
(n) “Solicitor firm” means any person, other than a plan, who through one or more
solicitors engages in the acts defined in subdivision (l).
(o) “Specialized health care service plan contract” means a contract for health care services in a single specialized area of health care, including dental care, for subscribers or enrollees, or which pays for or which reimburses any part of the cost for those services, in return for a prepaid or periodic charge paid by or on behalf of the subscribers or enrollees.
(p) “Subscriber” means the person who is responsible for payment to a plan or whose employment or other status, except for family dependency, is the basis for eligibility for membership in the plan.
(q) Unless the context indicates otherwise, “plan” refers to health care service plans and
specialized health care service plans.
(r) “Plan contract” means a contract between a plan and its subscribers or enrollees or a person contracting on their behalf pursuant to which health care services, including basic health care services, are furnished; and unless the context otherwise indicates it includes specialized health care service plan contracts; and unless the context otherwise indicates it includes group contracts.
(s) All references in this chapter to financial statements, assets, liabilities, and other accounting items mean those financial statements and accounting items prepared or determined in accordance with generally accepted accounting principles, and fairly presenting the matters they purport to present, subject to any specific requirement imposed by this
chapter or by the director.
SEC. 2.
Section 1367.34 of the Health and Safety Code, as added by Section 1 of Chapter 641 of the Statutes of 2021, is amended and renumbered to read:1367.37.
(a) A health care service plan contract issued, amended, or renewed on or after January 1, 2022, that provides coverage for pediatric services and preventive care, as required by this chapter, including Sections 1367.002 and 1367.005, shall additionally include coverage for adverse childhood experiences screenings. This section does not prohibit a health care service plan from applying cost-sharing requirements as authorized by law.(b) For purposes of this section, “adverse childhood experiences,” or “ACEs,” means an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting
adverse effects on the individual’s functioning and physical, social, emotional, or spiritual well-being.
(c) The department may adopt guidance to health care service plans to implement this section. The guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). The departmental guidance shall apply the rules and regulations for screening for trauma as set forth in the Medi-Cal program as the minimum ACEs coverage requirements for health care service plans. This section does not prohibit a health care service plan from exceeding the Medi-Cal program’s rules and regulations for trauma screening.
SEC. 3.
Section 1649.2 of the Health and Safety Code is amended to read:1649.2.
(a) Except as provided in subdivision (b), a health care facility shall permit patient use of medicinal cannabis, as indicated by the attending physician, as defined by Section 11362.7, in the patient’s medical record and shall do all of the following:(1) (A) A home health agency shall prohibit smoking or vaping immediately before or while home health agency staff are present in the residence.
(B) All other health facilities shall prohibit smoking or vaping as methods to use medicinal cannabis.
(2) Include the use of medicinal cannabis within
the patient’s medical records.
(3) Require a patient to provide a copy of the patient’s valid identification card, as described in Section 11362.715, or a copy of that patient’s written documentation as defined in Section 11362.7.
(4) Require a patient or a primary caregiver, as defined in Section 11362.7, to be responsible for acquiring, retrieving, administering, and removing medicinal cannabis.
(5) Require medicinal cannabis to be stored securely at all times in a locked container in the patient’s room, other designated area, or with the patient’s primary caregiver. This requirement does not apply to a home health agency.
(6) Prohibit health care
professionals, health care facility staff, and home health agency staff, including, but not limited to, physicians, nurses, and pharmacists, from administering medicinal cannabis or retrieving medicinal cannabis from storage.
(7) Develop, disseminate, and train health facility staff on the written guidelines developed by the facility for the use and disposal of medicinal cannabis within the health care facility pursuant to this chapter. This requirement does not apply to a home health agency.
(8) Ensure that a patient is not denied admission to the health care facility in whole or in part because of the patient’s use of medicinal cannabis.
(b) Notwithstanding subdivision (a), a general acute care hospital specified
in subdivision (a) of Section 1250 shall not permit a patient with a chronic disease to use medicinal cannabis unless the patient meets the definition of “terminally ill” in subdivision (f) of Section 1649.1.
SEC. 4.
Section 102970 is added to the Health and Safety Code, to read:102970.
(a) The department shall regularly, but no less than annually, review fetal death registrations completed pursuant to this chapter to determine whether there is a failure to comply with the required timeframes for fetal death registration pursuant to Section 102950. The department shall review data completed by individuals or entities required to complete portions of the fetal death certificate and individuals or entities required to register the fetal death in order to evaluate and identify steps necessary to ensure compliance with this chapter.(b) If the department identifies repeated failures to comply with the timeframe required by Section 102950, the department shall electronically notify the Medical Board of California, the Cemetery
and Funeral Bureau, or other relevant licensing entity of an individual’s or entity’s failure to timely comply with fetal death registration requirements. The department’s electronic notification shall include the information necessary for the relevant licensing entity to adequately investigate the identified untimely fetal death registration.
SEC. 4.SEC. 5.
Section 129385 of the Health and Safety Code is amended to read:129385.
(a) The Distressed Hospital Loan Program Fund is hereby established in the State Treasury. The fund shall be administered by the department consistent with this chapter.(b) Notwithstanding Section 13340 of the Government Code, all moneys in the fund are continuously appropriated, without regard to fiscal years, for the department and the authority to implement this chapter.
(c) The authority shall make secured loans from the Distressed Hospital Loan Program Fund to a hospital or to a governmental entity representing a closed hospital, for purposes of preventing the closure, or facilitating the reopening, of the hospital.
(d) The department may allocate an amount not to exceed 5 percent of total program funds to administer the program, including, but not limited to, administrative costs to the authority. Any funds transferred shall be available for encumbrance or expenditure until December 31, 2031.
(e) (1) The Department of Finance may transfer up to one hundred fifty million dollars ($150,000,000) from the General Fund to the Distressed Hospital Loan Program Fund between state fiscal years 2022–23 and 2023–24 to implement this chapter.
(2) The Department of Finance may transfer, subject to Section 14105.200 of the Welfare and Institutions Code, up to one hundred fifty million dollars ($150,000,000) from the Medi-Cal
Provider Payment Reserve Fund to the Distressed Hospital Loan Program Fund in state fiscal year 2023–24 to implement this chapter.
(f) All moneys accruing to the authority and the department under this chapter from any source shall be deposited into the fund.
(g) The Treasurer may invest moneys in the fund that are not required for its current needs in eligible securities specified in Section 16430 of the Government Code and may transfer moneys in the fund to the Surplus Money Investment Fund for investment pursuant to Article 4 (commencing with Section 16470) of Chapter 3 of Part 2 of Division 4 of Title 2 of the Government Code.
(h) Notwithstanding Section 16305.7 of the Government Code, all interest or other increment
resulting from the investment or deposit of moneys from the fund shall be deposited in the fund.
(i) Moneys in the fund shall not be subject to transfer to any other funds pursuant to any provision of Part 2 (commencing with Section 16300) of Division 4 of Title 2 of the Government Code, except to the Surplus Money Investment Fund.
(j) Effective December 31, 2031, the Distressed Hospital Loan Program Fund in the State Treasury, created pursuant to this chapter, is hereby abolished. After accounting for all final program transactions, any remaining Distressed Hospital Loan Program Fund reserves shall be returned to the source of origin, in the amounts of up to one hundred fifty million dollars ($150,000,000) to the General Fund, and up to one hundred fifty million dollars ($150,000,000)
to the Medi-Cal Provider Payment Reserve Fund. Any other remaining balance, assets, liabilities, and encumbrances of the Distressed Hospital Loan Program Fund shall revert to the General Fund. The department shall deposit all subsequent loan repayments or Medi-Cal reimbursements withheld for due cause pursuant to subdivision (b) of Section 129384 to the Treasurer, to the credit of the General Fund.
(k) The department and the authority may require any hospital receiving a loan under this chapter to provide the department and the authority with an independent financial audit of the hospital’s operations for any fiscal year in which a loan is outstanding.
SEC. 6.
Section 5150.05 of the Welfare and Institutions Code is amended to read:5150.05.
(a) When determining if probable cause exists to take a person into custody, or cause a person to be taken into custody, pursuant to Section 5150,(b) For purposes of this section, “information about the historical course of the person’s mental disorder” includes evidence presented by the person who has provided or is providing mental health or related support services to the person subject to a determination described in subdivision (a), evidence presented by one or more members of the family of that person, and evidence presented by the person subject to a determination described in subdivision (a) or anyone designated by that person.
(c) If the probable cause in subdivision (a) is based on the statement of a person other than the one authorized to take the person into custody pursuant to Section 5150, a member of the attending staff, or a professional person, the person making the statement shall be liable in a civil action for intentionally giving any a
statement that he or she knows they know to be false.
(d) This section shall not be applied to does not limit the application of Section 5328.
SEC. 7.
Section 5250 of the Welfare and Institutions Code is amended to read:5250.
If a person is detained for 72 hours under the provisions of Article 1 (commencing with Section 5150), or under court order for evaluation pursuant to Article 2 (commencing with Section 5200) or Article 3 (commencing with Section 5225) and has received an evaluation,(a) The professional staff of the agency or facility providing evaluation services has analyzed the person’s condition and has found the person
is, as a result of a mental health disorder or impairment by chronic alcoholism, a danger to others, or to himself or herself, or others or to themselves, or is gravely disabled.
(b) The facility providing intensive treatment is designated by the county to provide intensive treatment, treatment and agrees to admit the person. No A facility shall
not be designated to provide intensive treatment unless it complies with the certification review hearing required by this article. The procedures shall be described in the county Short-Doyle plan as required by Section 5651.3. plan.
(c) The person has been advised of the need for, but has not been willing or able to accept, treatment on a voluntary basis.
(d) (1) Notwithstanding paragraph (1) of subdivision (h) of Section 5008, a person is not “gravely disabled” if that person can survive safely without involuntary detention with the help of responsible family, friends, or others who are both willing and able to help provide for
the person’s basic personal needs for food, clothing, or shelter.
(2) However, unless they specifically indicate in writing their willingness and ability to help, family, friends, or others shall not be considered willing or able to provide this help.
(3) The purpose of this subdivision is to avoid the necessity for, and the harmful effects of, requiring family, friends, and others to publicly state, and requiring the certification review officer to publicly find, that no one is willing or able to assist a person with a mental health disorder in providing for the person’s basic needs for food, clothing, or shelter. grave disability.
SEC. 8.
Section 5350 of the Welfare and Institutions Code is amended to read:5350.
A conservator of the person, of the estate, or of the person and the estate may be appointed for a person who is gravely disabledThe procedure for establishing, administering, and terminating a conservatorship under this chapter shall be the same as that provided in Division 4 (commencing with Section 1400) of the Probate Code, except as follows:
(a) A conservator may be appointed for a gravely disabled minor.
(b) (1) Appointment of a conservator under this part, including the appointment of a conservator for a person who is gravely disabled, as defined in subparagraph (A) of paragraph (1) of subdivision (h) of Section 5008, shall be subject to the list of priorities in Section 1812 of the Probate Code unless the officer providing conservatorship investigation recommends otherwise to the superior court.
(2) In appointing a conservator for a person who is gravely disabled, as defined in subparagraph (B) of paragraph (1) of subdivision (h) of Section 5008, the court shall consider the purposes of protection of the public and the treatment of the conservatee. Notwithstanding any other provision of this section, the court shall not appoint the proposed conservator if the court
it determines that appointment of the proposed conservator will not result in adequate protection of the public.
(c) A conservatorship of the estate pursuant to this chapter shall not be established if a conservatorship or guardianship of the estate exists under the Probate Code. When a gravely disabled person already has a guardian or conservator of the person appointed under the Probate Code, the proceedings under this chapter shall not terminate the prior proceedings but shall be concurrent with and superior thereto. The superior court may appoint the existing guardian or conservator of the person or another person as conservator of the person under this chapter.
(d) (1) The person for whom conservatorship is sought shall have the right to demand a court or jury trial on the issue of whether the person is gravely
disabled. Demand for court or jury trial shall be made within five days following the hearing on the conservatorship petition. If the proposed conservatee demands a court or jury trial before the date of the hearing as provided for in Section 5365, the demand shall constitute a waiver of the hearing.
(2) Court The court or jury trial shall commence within 10 days of the date of the demand, except that the court shall continue the trial date for a period not to exceed 15 days upon the request of counsel for the proposed conservatee. Failure to commence the trial within that period of time is grounds for dismissal of the conservatorship proceedings.
(3) This right shall also apply in subsequent
proceedings to reestablish conservatorship.
(e) (1) Notwithstanding subparagraph (A) of paragraph (1) of subdivision (h) of Section 5008, a person is not “gravely disabled” if that person can survive safely without involuntary detention with the help of responsible family, friends, or others who are both willing and able to help provide for the person’s basic personal needs.
(2) However, unless they specifically indicate in writing their willingness and ability to help, family, friends, or others shall not be considered willing or able to provide this help.
(3) The purpose of this subdivision is to avoid the necessity for, and the harmful effects of, requiring family, friends, and others to publicly state, and requiring the court to publicly find, that no one is willing or able to assist a
person with a mental health disorder in providing for the person’s basic needs for food, clothing, or shelter.
grave disability.
(4) This subdivision does not apply to a person who is gravely disabled, disabled as defined in subparagraph (B) of paragraph (1) of subdivision (h) of Section 5008.
(f) Conservatorship investigation shall be conducted pursuant to this part and shall not be is not subject to Section 1826 of the Probate Code or Chapter 2 (commencing with
Section 1850) of Part 3 of Division 4 of the Probate Code.
(g) Notice of proceedings under this chapter shall be given to a guardian or conservator of the person or estate of the proposed conservatee appointed under the Probate Code.
(h) As otherwise provided in this chapter.
SEC. 9.
Section 5350.5 of the Welfare and Institutions Code is amended to read:5350.5.
(a) If a conservatorship has already been established under the Probate Code, the court, in a proceeding under the Probate Code, after an evidentiary hearing attended by the conservatee, unless the conservatee waives presence, and the conservatee’s counsel, may refer the conservatee, in consultation with a licensed physician or licensed psychologist satisfying the conditions of subdivision (c) of Section 2032.020 of the Code of Civil Procedure providing assessment or treatment to the conservatee, for an assessment by the local mental health system or plan to determine if the conservatee has a treatable mental illness, including whether the conservatee is gravely disabled(b) The local mental health system or plan shall file a copy of the assessment with the court that made the referral for assessment in a proceeding under the Probate Code.
SEC. 10.
Section 10022 of the Welfare and Institutions Code is amended to read:10022.
(a) Each publicly funded health care program, as defined in paragraph (1) of subdivision (b) of Section 10020, that furnishes or pays for health care items or services under this division to a person having private health care coverage shall be entitled to be subrogated to the rights that person has against the carrier of the coverage to the extent of the health care items provided or services rendered.(b) An entity providing private health care coverage, as defined in paragraph (2) of subdivision (b) of Section 10020, shall do all of the following:
(1) Accept the state’s right of recovery and the assignment to the state of any right of an individual or other entity to payment from the party for
an item or service for which payment has been made under the state plan.
plan, waivers granted in accordance with Section 1315 or 1396n of Title 42 of the United States Code, or through a Medi-Cal managed care plan, as defined in subdivision (j) of Section 14184.101.
(2) Respond to any an inquiry by the state or a provider, as defined in subdivision (o) of Section 14043.1, including a billing agent or a billing agent of the provider, as defined in subdivision (a) of Section 14040.1, or a Medi-Cal managed care plan, as defined in subdivision (j) of Section 14184.101, regarding a claim for payment for any
a health care item or service that is submitted not later than three years after the date of the provision of that health care item or service.
(3) Agree not to deny a claim submitted by the state or a provider, state, a provider as defined in paragraph (2), or a Medi-Cal managed care plan, as defined in subdivision (j) of Section 14184.101, solely on the basis of the date of submission of the claim, the type or format of the claim form, or a failure to present proper documentation at the point-of-sale that is the basis of the claim
claim, or in the case of a responsible third party, a failure to obtain a prior authorization for the item or service for which the claim is being submitted if both of the following occur:
(A) The claim is submitted by the state or a provider, state, a provider as defined in paragraph (2), or a Medi-Cal managed care plan, as defined in subdivision (j) of Section 14184.101, within the three-year period beginning on the date on which the item or service was furnished.
(B) Any An
action by the state or a provider, state, a provider as defined in paragraph (2), or a Medi-Cal managed care plan, as defined in subdivision (j) of Section 14184.101, to enforce its rights with respect to that claim is commenced within six years of the state’s or provider’s submission of the claim.
(4) Request a refund of a claim paid in error no later than three years from the date the payment was made to the State Department of Health Care Services. The State Department of Health Care Services shall not refund a claim paid in error if the
request for a refund is more than three years from the date the payment was made to the State Department of Health Care Services.
(5) Respond to a request for payment by the state, a provider as defined in paragraph (2), or a Medi-Cal managed care plan, as defined in paragraph (2), within 60 days by providing one of the following:
(A) Payment on the claim.
(B) A written request for additional information necessary to process the claim.
(C) A written explanation for the denial of the claim.
SEC. 11.
Section 14115.8 of the Welfare and Institutions Code is amended to read:14115.8.
(a) (1) The department shall amend the Medicaid state plan with respect to the billing option for services by local educational agencies (LEAs), to ensure that schools shall be reimbursed for all eligible services that they provide that are not precluded by federal requirements.(2) The department shall examine methodologies for increasing school participation in the Medi-Cal Billing Option for LEAs so that schools can meet the health care needs of their students.
(3) The department, to the extent possible, shall simplify claiming processes for LEA billing.
(4) The department shall eliminate and modify state
plan and regulatory requirements that exceed federal requirements when they are unnecessary.
(5) (A) The department shall, in consultation with the LEA Ad Hoc Workgroup established pursuant to subdivision (c), and consistent with any applicable federal requirements, issue and regularly maintain a program guide for the LEA Medi-Cal Billing Option program. The program guide shall contain a billing manual that includes, but is not limited to, an explanation of billing, auditing, costs reporting, time studies, federal and state compliance rules, fiscal and programmatic compliance information regarding processes, documentation, and guidance necessary for the proper submission of claims, and auditing of LEAs, charter schools, and community colleges, as required under the LEA Medi-Cal Billing Option program.
(B) The program guide described in subparagraph (A) shall
include, but not be limited to, state plan amendments, Frequently Asked Questions, policy and procedure letters, a plain language explanation of the certified public expenditure processes used to report and reconcile program costs from interim reimbursement to final cost settlement, trainings, provider manuals, and all other types of instructional materials relevant to the LEA Medi-Cal Billing Option program.
(C) (i) The department shall distribute the program guide to all participating LEAs, charter schools, and community colleges by January 1, 2020. Distribution of the program guide may occur by electronic mail or by notification by electronic mail of the posting of the guide on the department’s internet website.
(ii) The department shall distribute an updated program guide to all participating LEAs, including charter schools and community colleges, by July
1, 2024, that includes the requirements described in subparagraphs (A) and (B). The department may distribute the program guide by electronic mail or by notification by electronic mail of the posting of the guide on the department’s internet website.
(D) The department shall only adopt a revision of the program guide after providing 30 calendar days’ written notification of the revision, including a statement of justification, to the LEA Ad Hoc Workgroup and all other participating LEAs, charter schools, and community colleges. The department may provide written notice by electronic mail. Under extraordinary circumstances, when revisions are necessary to reflect changes required by state or federal law or otherwise mandated by the federal Centers for Medicare and Medicaid Services and those changes require immediate action, the department may provide less than 30 calendar days’ written notice.
(b) The department shall conduct an audit of a Medi-Cal Billing Option claim consistent with, but not limited to, all of the following:
(1) (A) The program guide and any revisions made pursuant to paragraph (5) of subdivision (a), including any revisions that are necessary to reflect changes required by state or federal law or otherwise mandated by the federal Centers for Medicare and Medicaid Services, that are in effect at the time the service was provided.
(B) Generally accepted accounting principles.
(C) Federal audit regulations, as set forth in Part 200 (commencing with Section 200.0) of Title 2 of the Code of Federal Regulations (Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards), or its successor.
(D) Reasonable cost principles under the federal Medicare Program, as set forth in Part 413 (commencing with Section 413.1) of Title 42 of the Code of Federal Regulations, or its successor.
(E) The federal Centers for Medicare and Medicaid Services Provider Reimbursement Manual Part 1 (CMS Publication 15-1).
(F) Any and all applicable federal or state statutes and regulations.
(2) (A) The department shall complete an audit and notify an LEA of the audit findings within 18 months of the date that the Cost and Reimbursement Comparison Schedule (CRCS) is submitted. This timeline may be extended by no more than three months upon a determination that the LEA has not provided sufficient documentation as requested by the auditor.
(B) The department shall provide an interim settlement or final settlement of the Medi-Cal share of each LEA’s costs within 12 months of the March 1 due date of the CRCS.
(C) When a final settlement is not issued within 12 months of the March 1 due date, the department shall complete final settlement no later than 18 months after the date that the CRCS is submitted.
(D) LEAs shall be reimbursed for all eligible services that meet federal requirements.
(3) For purposes of this subdivision, an audit shall refer to the audit and cost recovery process described in Section 14170.
(c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code, the department may issue and regularly maintain the program guide described in this section without taking regulatory action.
(d) If a rate study for the LEA Medi-Cal Billing Option is completed pursuant to Section 52 of Chapter 171 of the Statutes of 2001, the department, in consultation with the entities named in paragraph (1) of subdivision (e), shall implement the recommendations from the study, to the extent feasible and appropriate.
(e) (1) In order to assist the department in formulating the state plan amendments required to implement this section, the department shall regularly consult with the LEA Ad Hoc Workgroup, consisting of, but not limited to, representatives of the State Department of Education, LEAs, including urban, rural, large and small school districts, and county offices of education, and local education consortia. It is the intent
of the Legislature that the department also consult with staff from Region IX of the federal Centers for Medicare and Medicaid Services, experts from the fields of both health and education, and state legislative staff.
(2) The department shall ensure that any LEA participating in the Medi-Cal Billing Option program may participate virtually in any trainings or stakeholder meetings, including those meetings conducted pursuant to paragraph (1).
(f) Notwithstanding any other law, or any other contrary state requirement, the department shall take whatever action is necessary to ensure that, to the extent there is capacity in its certified match, an LEA shall be reimbursed retroactively for the maximum period allowed by the federal government for any department change that results in an increase in reimbursement to LEA providers.
(g) The department may undertake all necessary activities to recoup matching funds from the federal government for reimbursable services that have already been provided in the state’s public schools. The department shall prepare and take whatever action is necessary to implement all regulations, policies, state plan amendments, and other requirements necessary to achieve this purpose.
(h) The department shall, on or before December 31 of each year, file with the Legislature, and publish on its internet website, an annual report that shall include at least all of the following:
(1) A copy of the annual comparison required by subdivision (m).
(2) A state-by-state comparison of school-based Medicaid total and per eligible child claims and federal revenues. The comparison shall include a review of the most
recent two years for which completed data is available.
(3) A summary of department activities, including training for LEAs, and an explanation of how each activity contributed toward narrowing the gap between California’s per eligible student federal fund recovery and the per student recovery of the top three states.
(4) A listing of all school-based services, activities, and providers approved for reimbursement by the federal Centers for Medicare and Medicaid Services in other state plans that are not yet approved for reimbursement in California’s state plan and the service unit rates approved for reimbursement.
(5) The official recommendations made to the department by the entities named in subdivision (e) and the action taken by the department regarding each recommendation.
(6) A one-year timetable for state plan amendments and other actions necessary to obtain reimbursement for those items listed in paragraph (4).
(7) Identification of any barriers to LEA reimbursement, including those specified by the entities named in subdivision (e), that are not imposed by federal requirements, and a description of the actions that have been, and will be, taken to eliminate them.
(8) (A) A statewide summary of financial findings related to the process identified in the program guide for the most recently completed audited state fiscal year. The summary of findings shall be updated in subsequent years until all filed CRCS reports have been audited.
(B) For purposes of subparagraph (A), the “most recently completed
audited state fiscal year” means the most recent state fiscal year where 70 percent or more of the filed CRCSs have been audited.
(C) A description of changes to the cost settlement process that shall include all of the following:
(i) A summary of the number of audits conducted of Medi-Cal Billing Option program CRCSs.
(ii) A summary of the difference between interim reimbursement and the CRCSs.
(iii) A summary related to audit findings of noncompliance.
(i) The department shall provide semiannual Medi-Cal Billing Option billing forums to LEAs to provide guidance on appropriate billing practices.
(j) The department shall make
targeted technical assistance available to LEAs that experience a 25 percent or greater difference between their submitted cost report and the final audited settlement, including assisting LEAs to understand the actions needed to reduce differences between submitted cost reports and the final audited settlement.
(k) (1) These activities The department’s administration of the LEA Medi-Cal Billing Option program shall be funded and staffed by proportionately reducing federal Medicaid payments allocable to LEAs for the provision of benefits funded by the federal Medicaid program under the billing option for services by LEAs specified in this section.
LEAs.
Moneys collected as a result of the reduction in federal Medicaid payments allocable to LEAs shall be deposited into the Local Educational Agency Medi-Cal Recovery Fund, which is hereby established in the Special Deposit Fund established pursuant to Section 16370 of the Government Code. These funds shall be used, upon appropriation by the Legislature, only to support the department to meet all the requirements of this section. administering the LEA Medi-Cal Billing Option program. If at any time this section is repealed, it is the intent of the Legislature that all funds in the Local Educational Agency Medi-Cal Recovery Fund be returned proportionally to all LEAs whose federal Medicaid funds were used to create this fund. The annual amount withheld pursuant to this paragraph shall not exceed 5 percent
of total Medicaid payments allocable to LEAs for the provision of benefits funded by the federal Medicaid program under the billing option for services by LEAs.
(2) Moneys collected under paragraph (1) shall be proportionately reduced from federal Medicaid payments to all participating LEAs so that no one LEA loses a disproportionate share of its federal Medicaid payments.
(l) (1) The department may enter into a sole source contract to comply with the requirements of this section.
(2) The level of additional staff to comply with the requirements of this section, including, but not limited to, staff for which the department has contracted for pursuant to paragraph (1), shall be limited to that level that can be funded with revenues derived pursuant to subdivision (i).
(m) The activities of the department shall include all of the following:
(1) An annual comparison of the school-based Medicaid systems in comparable states.
(2) Efforts to improve communications with the federal government, the State Department of Education, and LEAs.
(3) The development and updating of written guidelines to LEAs regarding best practices to avoid audit exceptions, as needed.
(4) The establishment and maintenance of an LEA user-friendly, interactive internet website.
(5) Collaboration with the State Department of Education to help ensure LEA compliance with state and federal Medicaid requirements and to help
improve LEA participation in the Medi-Cal Billing Option for LEAs.
