AB 1607: Medi-Cal: hospitals: quality assurance fee.
- Session Year: 2015-2016
- House: Assembly
- Latest Version Date: 2016-06-27
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 and funded by federal Medicaid program provisions. Existing law, subject to federal approval, imposes a hospital quality assurance fee, as specified, on certain general acute care hospitals to be deposited into the Hospital Quality Assurance Revenue Fund. Existing law provides that moneys in the Hospital Quality Assurance Revenue Fund are continuously appropriated during the first program period of January 1, 2014, to December 31, 2016, inclusive, and available only for certain purposes, including paying for health care coverage for children, as specified, and making supplemental payments for certain services to private hospitals and increased capitation payments to Medi-Cal managed care plans. For subsequent program periods, existing law requires that the moneys in the Hospital Quality Assurance Revenue Fund be used for the above-described purposes upon appropriation by the Legislature in the annual Budget Act. Existing law provides that these provisions are inoperative on January 1, 2017, and that a hospital is not required to pay the hospital quality assurance fee after that date, as specified.
This bill would extend the operation of these provisions to January 1, 2018. The bill would instead, for the second program period and subsequent program periods, require moneys in the Hospital Quality Assurance Revenue Fund to be continuously appropriated, thereby making an appropriation, for the above-described purposes.
This bill would declare that it is to take effect immediately as a bill providing for appropriations related to the Budget Bill.
This bill would declare that it is to take effect immediately as an urgency statute.
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 and funded by federal Medicaid program provisions. Existing law, subject to federal approval, imposes a hospital quality assurance fee, as specified, on certain general acute care hospitals to be deposited into the Hospital Quality Assurance Revenue Fund. Existing law provides that moneys in the Hospital Quality Assurance Revenue Fund are continuously appropriated during the first program period of January 1, 2014, to December 31, 2016, inclusive, and available only for certain purposes, including paying for health care coverage for children, as specified, and making supplemental payments for certain services to private hospitals and increased capitation payments to Medi-Cal managed care plans. For subsequent program periods, existing law requires that the moneys in the Hospital Quality Assurance Revenue Fund be used for the above-described purposes upon appropriation by the Legislature in the annual Budget Act. Existing law provides that these provisions are inoperative on January 1, 2017, and that a hospital is not required to pay the hospital quality assurance fee after that date, as specified.
This bill would extend the operation of these provisions to January 1, 2018. The bill would instead, for the second program period and subsequent program periods, require moneys in the Hospital Quality Assurance Revenue Fund to be continuously appropriated, thereby making an appropriation, for the above-described purposes.
This bill would declare that it is to take effect immediately as a bill providing for appropriations related to the Budget Bill.
This bill would declare that it is to take effect immediately as an urgency statute.
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 and funded by federal Medicaid program provisions. Existing law, subject to federal approval, imposes a hospital quality assurance fee, as specified, on certain general acute care hospitals to be deposited into the Hospital Quality Assurance Revenue Fund. Existing law provides that moneys in the Hospital Quality Assurance Revenue Fund are continuously appropriated during the first program period of January 1, 2014, to December 31, 2016, inclusive, and available only for certain purposes, including paying for health care coverage for children, as specified, and making supplemental payments for certain services to private hospitals and increased capitation payments to Medi-Cal managed care plans. For subsequent program periods, existing law requires that the moneys in the Hospital Quality Assurance Revenue Fund be used for the above-described purposes upon appropriation by the Legislature in the annual Budget Act. Existing law provides that these provisions are inoperative on January 1, 2017, and that a hospital is not required to pay the hospital quality assurance fee after that date, as specified.
This bill would extend the operation of these provisions to January 1, 2018. The bill would instead, for the second program period and subsequent program periods, require moneys in the Hospital Quality Assurance Revenue Fund to be continuously appropriated, thereby making an appropriation, for the above-described purposes.
This bill would declare that it is to take effect immediately as a bill providing for appropriations related to the Budget Bill.
This bill would declare that it is to take effect immediately as an urgency statute.
This bill would express the intent of the Legislature to enact statutory changes relating to the Budget Act of 2016.
This bill would express the intent of the Legislature to enact statutory changes relating to the Budget Act of 2016.
This bill would express the intent of the Legislature to enact statutory changes relating to the Budget Act of 2016.
(a)(1)All fees required to be paid to the state pursuant to this article shall be paid in the form of remittances payable to the department.
(2)The department shall directly transmit the fee payments to the Treasurer to be deposited in the fund. Notwithstanding Section 16305.7 of the Government Code, any interest and dividends earned on deposits in the fund from the proceeds of the fee assessed pursuant to this article shall be retained in the fund for purposes specified in subdivision (b).
(b)(1)Notwithstanding subdivision (c) of Section 14167.35, subdivision (b) of Section 14168.33, and subdivision (b) of Section 14169.33, all funds from the proceeds of the fee assessed pursuant to this article in the fund, together with any interest and dividends earned on money in the fund, shall continue to be used exclusively to enhance federal financial participation for hospital services under the Medi-Cal program, to provide additional reimbursement to, and to support quality improvement efforts of, hospitals, and to minimize uncompensated care provided by hospitals to uninsured patients, as well as to pay for the states administrative costs and to provide funding for childrens health coverage, in the following order of priority:
(A)To pay for the departments staffing and administrative costs directly attributable to implementing this article, not to exceed two hundred fifty thousand dollars ($250,000) for each subject fiscal quarter, exclusive of any federal matching funds.
(B)To pay for the health care coverage, as described in subdivision (g), except that for the two subject fiscal quarters in the 201314 fiscal year, the amount for childrens health care coverage shall be one hundred fifty-five million dollars ($155,000,000) for each subject fiscal quarter, exclusive of any federal matching funds.
(C)To make increased capitation payments to managed health care plans pursuant to this article and Section 14169.82, including the nonfederal share of capitation payments to managed health care plans pursuant to this article and Section 14169.82 for services provided to 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)).
(D)To make increased payments and direct grants to hospitals pursuant to this article and Section 14169.83, including the nonfederal share of payments to hospitals under this article and Section 14169.83 for services provided to 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)).
(2)Notwithstanding subdivision (c) of Section 14167.35, subdivision (b) of Section 14168.33, and subdivision (b) of Section 14169.33, and notwithstanding Section 13340 of the Government Code, the moneys in the fund shall be continuously appropriated during the first program period only, without regard to fiscal year, for the purposes of this article, Article 5.229 (commencing with Section 14169.31), Article 5.228 (commencing with Section 14169.1), Article 5.227 (commencing with Section 14168.31), former Article 5.226 (commencing with Section 14168.1), former Article 5.22 (commencing with Section 14167.31), and former Article 5.21 (commencing with Section 14167.1).
(3)Notwithstanding any other law, for the second program period and subsequent program periods, the moneys in the fund shall be continuously appropriated, without regard to fiscal year, for the purposes of this article and Sections 14169.82 and 14169.83.
(c)Any amounts of the quality assurance fee collected in excess of the funds required to implement subdivision (b), including any funds recovered under subdivision (d) of Section 14169.61, shall be refunded to general acute care hospitals, pro rata with the amount of quality assurance fee paid by the hospital, subject to the limitations of federal law. If federal rules prohibit the refund described in this subdivision, the excess funds shall be used as quality assurance fees for the next program period for general acute care hospitals, pro rata with the amount of quality assurance fees paid by the hospital for the program period.
(d)Any methodology or other provision specified in this article may be modified by the department, in consultation with the hospital community, to the extent necessary to meet the requirements of federal law or regulations to obtain federal approval or to enhance the probability that federal approval can be obtained, provided the modifications do not violate the spirit, purposes, and intent of this article and are not inconsistent with the conditions of implementation set forth in Section 14169.72. The department shall notify the Joint Legislative Budget Committee and the fiscal and appropriate policy committees of the Legislature 30 days prior to implementation of a modification pursuant to this subdivision.
(e)The department, in consultation with the hospital community, shall make adjustments, as necessary, to the amounts calculated pursuant to Section 14169.52 in order to ensure compliance with the federal requirements set forth in Section 433.68 of Title 42 of the Code of Federal Regulations or elsewhere in federal law.
(f)The department shall request approval from the federal Centers for Medicare and Medicaid Services for the implementation of this article. In making this request, the department shall seek specific approval from the federal Centers for Medicare and Medicaid Services to exempt providers identified in this article as exempt from the fees specified, including the submission, as may be necessary, of a request for waiver of the broad-based requirement, waiver of the uniform fee requirement, or both, pursuant to paragraphs (1) and (2) of subdivision (e) of Section 433.68 of Title 42 of the Code of Federal Regulations.
(g)(1)For purposes of this subdivision, the following definitions shall apply:
(A)Actual net benefit means the net benefit determined by the department for a net benefit period after the conclusion of the net benefit period using payments and grants actually made, and fees actually collected, for the net benefit period.
(B)Aggregate fees means the aggregate fees collected from hospitals under this article.
(C)Aggregate payments means the aggregate payments and grants made directly or indirectly to hospitals under this article, including payments and grants described in Sections 14169.54, 14169.55, 14169.57, and 14169.58, and subdivision (b) of Section 14169.82.
(D)Net benefit means the aggregate payments for a net benefit period minus the aggregate fees for the net benefit period.
(E)Net benefit period means a subject fiscal year or portion thereof that is in a program period and begins on or after July 1, 2014.
(F)Preliminary net benefit means the net benefit determined by the department for a net benefit period prior to the beginning of that net benefit period using estimated or projected data.
(2)The amount of funding provided for childrens health care coverage under subdivision (b) for a net benefit period shall be equal to 24 percent of the net benefit for that net benefit period.
(3)The department shall determine the preliminary net benefit for all net benefit periods in the first program period before July 1, 2014. The department shall determine the preliminary net benefit for all net benefit periods in a subsequent program period before the beginning of the program period.
(4)The department shall determine the actual net benefit and make the reconciliation described in paragraph (5) for each net benefit period within six months after the date determined by the department pursuant to subdivision (h).
(5)For each net benefit period, the department shall reconcile the amount of moneys in the fund used for childrens health coverage based on the preliminary net benefit with the amount of the fund that may be used for childrens health coverage under this subdivision based on the actual net benefit. For each net benefit period, any amounts that were in the fund and used for childrens health coverage in excess of the 24 percent of the actual net benefit shall be returned to the fund, and the amount, if any, by which 24 percent of the actual net benefit exceeds 24 percent of the preliminary net benefit shall be available from the fund to the department for childrens health coverage. The department shall notify the Joint Legislative Budget Committee and the fiscal and appropriate policy committees of the Legislature of the results of the reconciliation for each net benefit period pursuant to this paragraph within five working days of performing the reconciliation.
(6)The department shall make all calculations and reconciliations required by this subdivision in consultation with the hospital community using data that the department determines is the best data reasonably available.
(h)After consultation with the hospital community, the department shall determine a date upon which substantially all fees have been paid and substantially all supplemental payments, grants, and rate range increases have been made for a program period, which date shall be no later than two years after the end of a program period. After the date determined by the department pursuant to this subdivision, no further supplemental payments shall be made under the program period, and any fees collected with respect to the program period shall be used for a subsequent program period consistent with this section. Nothing in this subdivision shall affect the departments authority to collect quality assurance fees for a program period after the end of the program period or after the date determined by the department pursuant to this subdivision. The department shall notify the Joint Legislative Budget Committee and fiscal and appropriate policy committees of that date within five working days of the determination.
(i)Use of the fee proceeds to enhance federal financial participation pursuant to subdivision (b) shall include use of the proceeds to supply the nonfederal share, if any, of payments to hospitals under this article for services provided to 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.
SEC. 2.Section 14169.75 of the Welfare and Institutions Code is amended to read:14169.75.Notwithstanding Section 14169.72, this article shall become inoperative on January 1, 2018. A hospital shall not be required to pay the fee after that date unless the fee was owed during the period in which the article was operative, and payments authorized under Section 14169.53 shall not be made unless the payments were owed during the period in which the article was operative.
SEC. 3.This act is a bill providing for appropriations related to the Budget Bill within the meaning of subdivision (e) of Section 12 of Article IV of the California Constitution, has been identified as related to the budget in the Budget Bill, and shall take effect immediately.
SEC. 4.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to provide continued health care coverage for Californians at the earliest possible time, it is necessary that this bill take effect immediately.
(a)(1)All fees required to be paid to the state pursuant to this article shall be paid in the form of remittances payable to the department.
(2)The department shall directly transmit the fee payments to the Treasurer to be deposited in the fund. Notwithstanding Section 16305.7 of the Government Code, any interest and dividends earned on deposits in the fund from the proceeds of the fee assessed pursuant to this article shall be retained in the fund for purposes specified in subdivision (b).
(b)(1)Notwithstanding subdivision (c) of Section 14167.35, subdivision (b) of Section 14168.33, and subdivision (b) of Section 14169.33, all funds from the proceeds of the fee assessed pursuant to this article in the fund, together with any interest and dividends earned on money in the fund, shall continue to be used exclusively to enhance federal financial participation for hospital services under the Medi-Cal program, to provide additional reimbursement to, and to support quality improvement efforts of, hospitals, and to minimize uncompensated care provided by hospitals to uninsured patients, as well as to pay for the states administrative costs and to provide funding for childrens health coverage, in the following order of priority:
(A)To pay for the departments staffing and administrative costs directly attributable to implementing this article, not to exceed two hundred fifty thousand dollars ($250,000) for each subject fiscal quarter, exclusive of any federal matching funds.
(B)To pay for the health care coverage, as described in subdivision (g), except that for the two subject fiscal quarters in the 201314 fiscal year, the amount for childrens health care coverage shall be one hundred fifty-five million dollars ($155,000,000) for each subject fiscal quarter, exclusive of any federal matching funds.
(C)To make increased capitation payments to managed health care plans pursuant to this article and Section 14169.82, including the nonfederal share of capitation payments to managed health care plans pursuant to this article and Section 14169.82 for services provided to 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)).
(D)To make increased payments and direct grants to hospitals pursuant to this article and Section 14169.83, including the nonfederal share of payments to hospitals under this article and Section 14169.83 for services provided to 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)).
(2)Notwithstanding subdivision (c) of Section 14167.35, subdivision (b) of Section 14168.33, and subdivision (b) of Section 14169.33, and notwithstanding Section 13340 of the Government Code, the moneys in the fund shall be continuously appropriated during the first program period only, without regard to fiscal year, for the purposes of this article, Article 5.229 (commencing with Section 14169.31), Article 5.228 (commencing with Section 14169.1), Article 5.227 (commencing with Section 14168.31), former Article 5.226 (commencing with Section 14168.1), former Article 5.22 (commencing with Section 14167.31), and former Article 5.21 (commencing with Section 14167.1).
(3)Notwithstanding any other law, for the second program period and subsequent program periods, the moneys in the fund shall be continuously appropriated, without regard to fiscal year, for the purposes of this article and Sections 14169.82 and 14169.83.
(c)Any amounts of the quality assurance fee collected in excess of the funds required to implement subdivision (b), including any funds recovered under subdivision (d) of Section 14169.61, shall be refunded to general acute care hospitals, pro rata with the amount of quality assurance fee paid by the hospital, subject to the limitations of federal law. If federal rules prohibit the refund described in this subdivision, the excess funds shall be used as quality assurance fees for the next program period for general acute care hospitals, pro rata with the amount of quality assurance fees paid by the hospital for the program period.
(d)Any methodology or other provision specified in this article may be modified by the department, in consultation with the hospital community, to the extent necessary to meet the requirements of federal law or regulations to obtain federal approval or to enhance the probability that federal approval can be obtained, provided the modifications do not violate the spirit, purposes, and intent of this article and are not inconsistent with the conditions of implementation set forth in Section 14169.72. The department shall notify the Joint Legislative Budget Committee and the fiscal and appropriate policy committees of the Legislature 30 days prior to implementation of a modification pursuant to this subdivision.
(e)The department, in consultation with the hospital community, shall make adjustments, as necessary, to the amounts calculated pursuant to Section 14169.52 in order to ensure compliance with the federal requirements set forth in Section 433.68 of Title 42 of the Code of Federal Regulations or elsewhere in federal law.
(f)The department shall request approval from the federal Centers for Medicare and Medicaid Services for the implementation of this article. In making this request, the department shall seek specific approval from the federal Centers for Medicare and Medicaid Services to exempt providers identified in this article as exempt from the fees specified, including the submission, as may be necessary, of a request for waiver of the broad-based requirement, waiver of the uniform fee requirement, or both, pursuant to paragraphs (1) and (2) of subdivision (e) of Section 433.68 of Title 42 of the Code of Federal Regulations.
(g)(1)For purposes of this subdivision, the following definitions shall apply:
(A)Actual net benefit means the net benefit determined by the department for a net benefit period after the conclusion of the net benefit period using payments and grants actually made, and fees actually collected, for the net benefit period.
(B)Aggregate fees means the aggregate fees collected from hospitals under this article.
(C)Aggregate payments means the aggregate payments and grants made directly or indirectly to hospitals under this article, including payments and grants described in Sections 14169.54, 14169.55, 14169.57, and 14169.58, and subdivision (b) of Section 14169.82.
(D)Net benefit means the aggregate payments for a net benefit period minus the aggregate fees for the net benefit period.
(E)Net benefit period means a subject fiscal year or portion thereof that is in a program period and begins on or after July 1, 2014.
(F)Preliminary net benefit means the net benefit determined by the department for a net benefit period prior to the beginning of that net benefit period using estimated or projected data.
(2)The amount of funding provided for childrens health care coverage under subdivision (b) for a net benefit period shall be equal to 24 percent of the net benefit for that net benefit period.
(3)The department shall determine the preliminary net benefit for all net benefit periods in the first program period before July 1, 2014. The department shall determine the preliminary net benefit for all net benefit periods in a subsequent program period before the beginning of the program period.
(4)The department shall determine the actual net benefit and make the reconciliation described in paragraph (5) for each net benefit period within six months after the date determined by the department pursuant to subdivision (h).
(5)For each net benefit period, the department shall reconcile the amount of moneys in the fund used for childrens health coverage based on the preliminary net benefit with the amount of the fund that may be used for childrens health coverage under this subdivision based on the actual net benefit. For each net benefit period, any amounts that were in the fund and used for childrens health coverage in excess of the 24 percent of the actual net benefit shall be returned to the fund, and the amount, if any, by which 24 percent of the actual net benefit exceeds 24 percent of the preliminary net benefit shall be available from the fund to the department for childrens health coverage. The department shall notify the Joint Legislative Budget Committee and the fiscal and appropriate policy committees of the Legislature of the results of the reconciliation for each net benefit period pursuant to this paragraph within five working days of performing the reconciliation.
(6)The department shall make all calculations and reconciliations required by this subdivision in consultation with the hospital community using data that the department determines is the best data reasonably available.
(h)After consultation with the hospital community, the department shall determine a date upon which substantially all fees have been paid and substantially all supplemental payments, grants, and rate range increases have been made for a program period, which date shall be no later than two years after the end of a program period. After the date determined by the department pursuant to this subdivision, no further supplemental payments shall be made under the program period, and any fees collected with respect to the program period shall be used for a subsequent program period consistent with this section. Nothing in this subdivision shall affect the departments authority to collect quality assurance fees for a program period after the end of the program period or after the date determined by the department pursuant to this subdivision. The department shall notify the Joint Legislative Budget Committee and fiscal and appropriate policy committees of that date within five working days of the determination.
(i)Use of the fee proceeds to enhance federal financial participation pursuant to subdivision (b) shall include use of the proceeds to supply the nonfederal share, if any, of payments to hospitals under this article for services provided to 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.
SEC. 2.Section 14169.75 of the Welfare and Institutions Code is amended to read:14169.75.Notwithstanding Section 14169.72, this article shall become inoperative on January 1, 2018. A hospital shall not be required to pay the fee after that date unless the fee was owed during the period in which the article was operative, and payments authorized under Section 14169.53 shall not be made unless the payments were owed during the period in which the article was operative.
SEC. 3.This act is a bill providing for appropriations related to the Budget Bill within the meaning of subdivision (e) of Section 12 of Article IV of the California Constitution, has been identified as related to the budget in the Budget Bill, and shall take effect immediately.
SEC. 4.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to provide continued health care coverage for Californians at the earliest possible time, it is necessary that this bill take effect immediately.
(a)(1)All fees required to be paid to the state pursuant to this article shall be paid in the form of remittances payable to the department.
(2)The department shall directly transmit the fee payments to the Treasurer to be deposited in the fund. Notwithstanding Section 16305.7 of the Government Code, any interest and dividends earned on deposits in the fund from the proceeds of the fee assessed pursuant to this article shall be retained in the fund for purposes specified in subdivision (b).
(b)(1)Notwithstanding subdivision (c) of Section 14167.35, subdivision (b) of Section 14168.33, and subdivision (b) of Section 14169.33, all funds from the proceeds of the fee assessed pursuant to this article in the fund, together with any interest and dividends earned on money in the fund, shall continue to be used exclusively to enhance federal financial participation for hospital services under the Medi-Cal program, to provide additional reimbursement to, and to support quality improvement efforts of, hospitals, and to minimize uncompensated care provided by hospitals to uninsured patients, as well as to pay for the states administrative costs and to provide funding for childrens health coverage, in the following order of priority:
(A)To pay for the departments staffing and administrative costs directly attributable to implementing this article, not to exceed two hundred fifty thousand dollars ($250,000) for each subject fiscal quarter, exclusive of any federal matching funds.
(B)To pay for the health care coverage, as described in subdivision (g), except that for the two subject fiscal quarters in the 201314 fiscal year, the amount for childrens health care coverage shall be one hundred fifty-five million dollars ($155,000,000) for each subject fiscal quarter, exclusive of any federal matching funds.
(C)To make increased capitation payments to managed health care plans pursuant to this article and Section 14169.82, including the nonfederal share of capitation payments to managed health care plans pursuant to this article and Section 14169.82 for services provided to 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)).
(D)To make increased payments and direct grants to hospitals pursuant to this article and Section 14169.83, including the nonfederal share of payments to hospitals under this article and Section 14169.83 for services provided to 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)).
(2)Notwithstanding subdivision (c) of Section 14167.35, subdivision (b) of Section 14168.33, and subdivision (b) of Section 14169.33, and notwithstanding Section 13340 of the Government Code, the moneys in the fund shall be continuously appropriated during the first program period only, without regard to fiscal year, for the purposes of this article, Article 5.229 (commencing with Section 14169.31), Article 5.228 (commencing with Section 14169.1), Article 5.227 (commencing with Section 14168.31), former Article 5.226 (commencing with Section 14168.1), former Article 5.22 (commencing with Section 14167.31), and former Article 5.21 (commencing with Section 14167.1).
(3) For Notwithstanding any other law, for the second program period and subsequent program periods, the moneys in the fund shall be used, upon appropriation by the Legislature in the annual Budget Act, continuously appropriated, without regard to fiscal year, for the purposes of this article and Sections 14169.82 and 14169.83.
(c)Any amounts of the quality assurance fee collected in excess of the funds required to implement subdivision (b), including any funds recovered under subdivision (d) of Section 14169.61, shall be refunded to general acute care hospitals, pro rata with the amount of quality assurance fee paid by the hospital, subject to the limitations of federal law. If federal rules prohibit the refund described in this subdivision, the excess funds shall be used as quality assurance fees for the next program period for general acute care hospitals, pro rata with the amount of quality assurance fees paid by the hospital for the program period.
(d)Any methodology or other provision specified in this article may be modified by the department, in consultation with the hospital community, to the extent necessary to meet the requirements of federal law or regulations to obtain federal approval or to enhance the probability that federal approval can be obtained, provided the modifications do not violate the spirit, purposes, and intent of this article and are not inconsistent with the conditions of implementation set forth in Section 14169.72. The department shall notify the Joint Legislative Budget Committee and the fiscal and appropriate policy committees of the Legislature 30 days prior to implementation of a modification pursuant to this subdivision.
(e)The department, in consultation with the hospital community, shall make adjustments, as necessary, to the amounts calculated pursuant to Section 14169.52 in order to ensure compliance with the federal requirements set forth in Section 433.68 of Title 42 of the Code of Federal Regulations or elsewhere in federal law.
(f)The department shall request approval from the federal Centers for Medicare and Medicaid Services for the implementation of this article. In making this request, the department shall seek specific approval from the federal Centers for Medicare and Medicaid Services to exempt providers identified in this article as exempt from the fees specified, including the submission, as may be necessary, of a request for waiver of the broad-based requirement, waiver of the uniform fee requirement, or both, pursuant to paragraphs (1) and (2) of subdivision (e) of Section 433.68 of Title 42 of the Code of Federal Regulations.
(g)(1)For purposes of this subdivision, the following definitions shall apply:
(A)Actual net benefit means the net benefit determined by the department for a net benefit period after the conclusion of the net benefit period using payments and grants actually made, and fees actually collected, for the net benefit period.
(B)Aggregate fees means the aggregate fees collected from hospitals under this article.
(C)Aggregate payments means the aggregate payments and grants made directly or indirectly to hospitals under this article, including payments and grants described in Sections 14169.54, 14169.55, 14169.57, and 14169.58, and subdivision (b) of Section 14169.82.
(D)Net benefit means the aggregate payments for a net benefit period minus the aggregate fees for the net benefit period.
(E)Net benefit period means a subject fiscal year or portion thereof that is in a program period and begins on or after July 1, 2014.
(F)Preliminary net benefit means the net benefit determined by the department for a net benefit period prior to the beginning of that net benefit period using estimated or projected data.
(2)The amount of funding provided for childrens health care coverage under subdivision (b) for a net benefit period shall be equal to 24 percent of the net benefit for that net benefit period.
(3)The department shall determine the preliminary net benefit for all net benefit periods in the first program period before July 1, 2014. The department shall determine the preliminary net benefit for all net benefit periods in a subsequent program period before the beginning of the program period.
(4)The department shall determine the actual net benefit and make the reconciliation described in paragraph (5) for each net benefit period within six months after the date determined by the department pursuant to subdivision (h).
(5)For each net benefit period, the department shall reconcile the amount of moneys in the fund used for childrens health coverage based on the preliminary net benefit with the amount of the fund that may be used for childrens health coverage under this subdivision based on the actual net benefit. For each net benefit period, any amounts that were in the fund and used for childrens health coverage in excess of the 24 percent of the actual net benefit shall be returned to the fund, and the amount, if any, by which 24 percent of the actual net benefit exceeds 24 percent of the preliminary net benefit shall be available from the fund to the department for childrens health coverage. The department shall notify the Joint Legislative Budget Committee and the fiscal and appropriate policy committees of the Legislature of the results of the reconciliation for each net benefit period pursuant to this paragraph within five working days of performing the reconciliation.
(6)The department shall make all calculations and reconciliations required by this subdivision in consultation with the hospital community using data that the department determines is the best data reasonably available.
(h)After consultation with the hospital community, the department shall determine a date upon which substantially all fees have been paid and substantially all supplemental payments, grants, and rate range increases have been made for a program period, which date shall be no later than two years after the end of a program period. After the date determined by the department pursuant to this subdivision, no further supplemental payments shall be made under the program period, and any fees collected with respect to the program period shall be used for a subsequent program period consistent with this section. Nothing in this subdivision shall affect the departments authority to collect quality assurance fees for a program period after the end of the program period or after the date determined by the department pursuant to this subdivision. The department shall notify the Joint Legislative Budget Committee and fiscal and appropriate policy committees of that date within five working days of the determination.
(i)Use of the fee proceeds to enhance federal financial participation pursuant to subdivision (b) shall include use of the proceeds to supply the nonfederal share, if any, of payments to hospitals under this article for services provided to 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.
SEC. 2.Section 14169.75 of the Welfare and Institutions Code is amended to read:14169.75.Notwithstanding Section 14169.72, this article shall become inoperative on January 1, 2017. No 2018. A hospital shall not be required to pay the fee after that date unless the fee was owed during the period in which the article was operative, and no payments authorized under Section 14169.53 shall not be made unless the payments were owed during the period in which the article was operative.
SEC. 3.This act is a bill providing for appropriations related to the Budget Bill within the meaning of subdivision (e) of Section 12 of Article IV of the California Constitution, has been identified as related to the budget in the Budget Bill, and shall take effect immediately.
SEC. 4.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to provide continued health care coverage for Californians at the earliest possible time, it is necessary that this bill take effect immediately.
SECTION 1.It is the intent of the Legislature to enact statutory changes relating to the 2016 Budget Act.
HeadingLines 1, 2, 3, 4, and 5.It is the intent of the Legislature to enact statutory changes relating to the Budget Act of 2016. 2016 Budget Act.
It is the intent of the Legislature to enact statutory changes relating to the Budget Act of 2016.
|
Date
|
Status
|
|---|---|
| Jun 13, 2016 | From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on B. & F.R. |
| Jun 27, 2016 | Chaptered by Secretary of State - Chapter 27, Statutes of 2016. |
| Jun 27, 2016 | Approved by the Governor. |
| Jun 17, 2016 | Enrolled and presented to the Governor at 4 p.m. |
| Jun 16, 2016 | Urgency clause adopted. Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 75. Noes 0.). |
| Jun 16, 2016 | Urgency clause adopted. Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 75. Noes 0. Page 5396.). |
| Jun 16, 2016 | Read third time. Urgency clause adopted. Passed. Ordered to the Assembly. (Ayes 34. Noes 4. Page 4377.). |
| Jun 16, 2016 | Read third time. Urgency clause adopted. Passed. Ordered to the Assembly. |
| Jun 16, 2016 | In Assembly. Concurrence in Senate amendments pending. May be considered on or after June 18 pursuant to Assembly Rule 77. |
| Jun 16, 2016 | Assembly Rule 77 suspended. (Ayes 51. Noes 26.) |
| Jun 16, 2016 | Assembly Rule 77 suspended. (Ayes 51. Noes 26. Page 5392.) |
| Jun 16, 2016 | Assembly Rule 63 suspended. (Ayes 51. Noes 26.) |
| Jun 16, 2016 | Assembly Rule 63 suspended. (Ayes 51. Noes 26. Page 5392.) |
| Jun 14, 2016 | Read second time. Ordered to third reading. |
| Jun 13, 2016 | From committee: Do pass. (Ayes 14. Noes 2.) (June 13). |
| Jan 7, 2016 | Read first time. To print. |
| May 5, 2016 | Referred to Com. on B. & F.R. |
| Apr 28, 2016 | Read third time. Passed. Ordered to the Senate. (Ayes 51. Noes 26.) |
| Apr 28, 2016 | Read third time. Passed. Ordered to the Senate. (Ayes 51. Noes 26. Page 4573.) |
| Apr 28, 2016 | Read third time. Passed. Ordered to the Senate. |
| Apr 28, 2016 | In Senate. Read first time. To Com. on RLS. for assignment. |
| Apr 25, 2016 | Withdrawn from committee. |
| Apr 25, 2016 | Ordered to third reading. |
| Apr 25, 2016 | Assembly Rule 96 suspended. (Ayes 49. Noes 25.) |
| Apr 25, 2016 | Assembly Rule 96 suspended. (Ayes 49. Noes 25. Page 4488.) |
| Apr 18, 2016 | Re-referred to Com. on BUDGET. |
| Apr 14, 2016 | From committee chair, with author's amendments: Amend, and re-refer to Com. on BUDGET. Read second time and amended. |
| Feb 1, 2016 | Referred to Com. on BUDGET. |
| Jan 8, 2016 | From printer. May be heard in committee February 7. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Jun 16, 2016 | AB 1607 BUDGET Concurrence - Urgency Added By TING | Assembly Floor |
Passed |
|
| Jun 16, 2016 | Assembly 3rd Reading AB1607 Committee On BUDGET (Ting) By Leno Urgency Clause | Senate Floor |
Passed |
|
| Jun 13, 2016 | Do pass | Senate Standing Committee on Budget and Fiscal Review |
Passed |
|
| Apr 28, 2016 | AB 1607 BUDGET Assembly Third Reading By TING | Assembly Floor |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| California Hospital Association | * Support | Jun 13, 2016 |
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB |
THIRD READING
Bill No: AB 1607
:
SENATE BUDGET AND FISCAL REVIEW COMMITTEE: 14-2, 6/13/16
AYES: Leno, Nielsen, Allen, Beall, Block, Glazer, Hancock, Mitchell, Monning, Moorlach, Pan, Pavley, Roth, Wolk
NOES: Anderson, Nguyen
NO VOTE RECORDED: Stone
ASSEMBLY FLOOR: Not relevant
DIGEST: This bill extends the hospital quality assurance fee to January 1, 2018 (it currently sunsets on January 1, 2017). This results in estimated $845 million General Fund savings in 2017-18.
ANALYSIS: This bill extends the hospital quality assurance fee to January 1, 2018 (it currently sunsets on January 1, 2017). This results in estimated $845 million General Fund savings in 2017-18.
Related/Prior Legislation
SB 239 (Hernandez, Chapter 657, Statutes of 2013) established the hospital quality assurance fee.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
According to the Senate Budget and Fiscal Review Committee, this bill continuously appropriates the Hospital Quality Assurance Revenue Fund.
SUPPORT: (Verified 6/14/16)
None received
OPPOSITION: (Verified 6/14/16)
None received
6/16/16 8:55:20
**** END ****
(Without Reference to File)
CONCURRENCE IN SENATE AMENDMENTS
CSA1 Bill Id:AB 1607
Author:(Committee on Budget)
As Amended Ver:June 13, 2016
2/3 vote. Budget Bill Appropriation Takes Effect Immediately. Urgency
ASSEMBLY: |
| April 28, 2016 | SENATE: | 34-4 | (June 16, 2016) |
(Vote not relevant)
Original Committee Reference: BUDGET
SUMMARY: This is the Hospital Quality Assurance Fee Extension Trailer Bill for 2016-17. It contains necessary changes related to the Budget Act of 2016.
The Senate amendments delete the Assembly version of this bill, and instead:
- Extends the existing Hospital Quality Assurance Fee by moving the sunset date from January 1, 2017 to January 1, 2018.
- Requires that moneys in the Hospital Quality Assurance Revenue Fund be continuously appropriated for the purposes of the Act that establishes and authorizes the Hospital Quality Assurance Fee.
- Is expected to result in approximately $845 million in General Fund savings in the 2017-18 Fiscal Year.
COMMENTS: This bill is a budget trailer bill within the overall 2016-17 budget package to implement actions taken affecting the Department of Health Care Services.
Analysis Prepared by: Andrea Margolis / Budget / 916-319-2099 FN: 0003440
Senator Mark Leno, Chair
2015 - 2016 Regular
Bill No: Hearing Date: June 13, 2016
Author: | Committee on Budget | ||
Version: | As amended | ||
Urgency: | Yes | Fiscal: | Yes |
Consultant: | |||
Subject: Medi-Cal Hospitals Quality Assurance Fee
Summary:
Medi-Cal: hospital quality assurance fee (Urgency).
Background:
This bill extends the hospital quality assurance fee to January 1, 2018 (it currently sunsets on January 1, 2017). This results in estimated $845 million General Fund savings in 2017-18.
SB 239 (Hernandez), Chapter 657, Statutes of 2013 establishes the hospital quality assurance fee.
Proposed Law:
Fiscal Effect:
This bill continuously appropriates the Hospital Quality Assurance Revenue Fund.
Support:
None on file.
Opposed:
None on file.
-- END --
Discussed in Hearing
1MIN
Assembly Floor
4MIN
Senate Floor
2MIN
Senate Standing Committee on Budget and Fiscal Review
Bill Author
Bill Co-Author(s):