Medi-Cal.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. Under existing law, the department is authorized to contract for the provision of Medi-Cal services through certain managed care options, including the geographic managed care model. Under existing law, Sacramento County provides, in part, Medi-Cal services through a geographic managed care health plan. This bill would permit the Sacramento County Department of Health and Human Services to establish a stakeholder advisory committee to provide input to the department on the delivery of health care services provided in the county, as specified. This bill would, except under specified circumstances, permit the advisory committee to request in writing and receive final reports submitted to the department by any managed care health plan operating in Sacramento County. Existing law provides that clinics and hospital outpatient departments, except for emergency rooms, that are owned and operated by Los Angeles County and participated in a specified Medicaid demonstration project for Los Angeles County, shall be reimbursed under a cost-based methodology, as specified, on and after July 1, 2005. This bill would provide that, to the extent permitted by federal law and that federal financial participation is available, if the department implements a Medi-Cal managed care expansion program that includes beneficiaries who are seniors or persons with disabilities, payments received by the clinics and outpatient departments described above shall be equivalent to what otherwise would have been received on a fee-for-service basis. Existing federal law provides for the federal Medicare Program, which is a public health insurance program for persons 65 years of age and older and specified persons with disabilities who are under 65 years of age. This bill would, to the extent that federal financial participation is available, and pursuant to a demonstration project or waiver of federal law, require the department to establish pilot projects in up to 4 counties, as specified, to develop effective health care models to provide services to persons who are dually eligible under both the Medi-Cal and Medicare programs. This bill would require the department to, not sooner than March 1, 2011, identify health care models that may be included in a pilot project, to develop a timeline and process for selecting, financing, monitoring, and evaluating the pilot projects, and to provide this timeline and process to certain committees of the Legislature. Existing law establishes the Medi-Cal Hospital/Uninsured Care Demonstration Project Act, which revises hospital supplemental payment methodologies under the Medi-Cal program in order to maximize the use of federal funds consistent with federal Medicaid law and to stabilize the distribution of funding for hospitals that provide care to Medi-Cal beneficiaries and uninsured patients. This demonstration project provides for funding, in supplementation of Medi-Cal reimbursement, to various hospitals, including designated public hospitals, nondesignated public hospitals, and private hospitals, as defined, in accordance with certain provisions relating to disproportionate share hospitals. This bill would provide that, in the event of a partial-year extension of the demonstration project, the director shall have discretion to determine allocations for the extension period, as specified. Existing law, subject to federal approval, requires the department to make supplemental payments for certain services, as specified, to private hospitals, nondesignated public hospitals, and designated public hospitals, as defined, for subject federal fiscal years, as defined. This bill would, instead, require that the department make the supplemental payments described above for subject fiscal years, as defined. This bill would make various changes to the formulas used to determine the amount of the supplemental payments to the hospitals. Existing law provides that no payments shall be made to a converted, private or nondesignated hospital, for the subject federal fiscal year in which the hospital becomes a converted hospital or for subsequent federal fiscal years. This bill would, instead, provide that no payments shall be made to a converted hospital, as described above, for the portion of the subject fiscal year that begins October 1 and ends June 30, for the subject fiscal year that includes the first day of the subject federal fiscal year in which the hospital becomes a converted hospital, and for all subsequent subject fiscal years. Existing law requires the director to seek federal approval to allow payments to specified converted, nondesignated public hospitals for the period beginning July 1, 2010, and ending December 31, 2010. This bill would, instead, require the director to seek federal approval to allow these payments for the period beginning July 1, 2010, and ending June 30, 2011. Existing law requires that designated public hospitals be paid direct grants in support of health care expenditures, as specified. Under existing law, the aggregate amount of these grants for each subject federal fiscal year shall be $295,000,000. This bill would, instead, provide that the aggregate amount of the grants shall be $73,750,000 for each subject fiscal quarter, as defined. Existing law requires the department to increase capitation payments to Medi-Cal managed health care plans and to increase payments to mental health plans, for specified subject federal fiscal years. Under existing law, the aggregate amount of increased capitation payments for a federal fiscal year shall be $729,829,205 multiplied by the percentage of the subject federal fiscal year for which federal approval is obtained, as specified. This bill would, instead, provide that the increased capitation payments to Medi-Cal managed health care plans shall be made for subject fiscal years, as defined, and that the aggregate amount for all subject fiscal years shall be $1,277,201,209, or the maximum amount for which federal financial participation is available, whichever is lower. This bill would also provide that the aggregate amount of the increased payments to mental health plans for a subject fiscal quarter shall be the total of the individual hospital acute psychiatric supplemental payment amounts for all hospitals for which federal financial participation is available. Existing law, subject to federal approval, also imposes, as a condition of participation in state-funded health insurance programs other than the Medi-Cal program, a quality assurance fee, as specified, on certain general acute care hospitals through and including December 31, 2010. Existing law creates the Hospital Quality Assurance Revenue Fund in the State Treasury and requires that the money collected from the quality assurance fee be deposited into the fund. Existing law provides that the moneys in the fund shall, upon appropriation by the Legislature, be available only for certain purposes, in a specified order of priority. This bill would delete the provision that specifies that the fee shall be imposed only as a condition of participation in state-funded health insurance programs. This bill would also modify the order of priority of the purposes for which the money in the Hospital Quality Assurance Revenue Fund shall be appropriated. Existing law requires the department to seek a demonstration project or federal waiver of Medicaid law to implement specified objectives, which may include better care coordination for seniors and persons with disabilities and children with special health care needs. This bill would, in this regard, provide that to the extent the provisions under the Medi-Cal Hospital/Uninsured Care Demonstration Project Act do not conflict with the provisions of, or the terms and conditions of, the above-described demonstration project, the provisions of the Medi-Cal Hospital/Uninsured Care Demonstration Project Act shall apply. This bill would, in furtherance of the waiver or demonstration project and to the extent that federal financial participation is available, permit the department to require seniors and persons with disabilities who do not have other health coverage to be assigned as mandatory enrollees into new and existing managed care health plans, as specified. This bill would provide that enrollment of seniors and persons with disabilities shall be accomplished using a phased-in process and shall not commence until necessary federal approvals have been acquired, or until June 1, 2011, whichever is later. The bill would impose various requirements upon managed care health plans participating in the demonstration project. This bill would, beginning January 1, 2012, require managed care health plans to comply with quality submission standards developed by the department as prescribed. This bill would provide that, in implementing the provision described above that would require seniors and persons with disabilities who do not have other health coverage to be assigned as mandatory enrollees into new or existing managed care health plans, a public entity, as defined, may, if specified requirements are met, elect to, on a voluntary basis, participate in intergovernmental transfers to be used solely as the nonfederal share of Medi-Cal payments to managed care health plans for the provision of services to Medi-Cal beneficiaries. This bill would require, to the extent authorized under a federal waiver or demonstration project described above, the department to develop a program of investment, improvement, and incentive payments for designated public hospitals to encourage and incentivize delivery system transformation and innovation in preparation for the implementation of federal health care reform. This bill would establish the Public Hospital Investment, Improvement, and Incentive Fund in the State Treasury, which shall consist of any moneys transferred by a county, other political subdivision of the state, or other governmental entity in the state for deposit in the fund. The bill would provide that the fund shall be continuously appropriated to the department to be used as the source for the nonfederal share of investment, improvement, and incentive payments to participating designated public hospitals, as specified. Existing law, the Robert W. Crown California Children's Services Act, requires the department and each county to administer the California Children Services (CCS) program for treatment services for persons under 21 years of age diagnosed with severe chronic disease or severe physical limitations, as specified. This bill also would, in furtherance of the waiver or demonstration project, require the Director of Health Care Services to establish, by January 1, 2012, models of organized health care delivery systems, as specified, for children eligible for services under the CCS program. This bill would provide that, to the extent permitted by federal law, the department may require eligible individuals to enroll in these models. This bill would also permit the Managed Risk Medical Insurance Board to elect, with the consent of the director, to permit children enrolled in the Healthy Families Program who are eligible for CCS services to enroll in these organized health care delivery models. This bill would become operative only if AB 342 of the 2009–10 Regular Session of the Legislature is enacted. This bill would declare that it is to take effect immediately as an urgency statute.