HomeMy WebLinkAboutMINUTES - 06111996 - C44 '. . . ,y
TO: BOARD OF SUPERVISORS �"SE. L Contra
FROM: PHIL BATCHELOR, COUNTY ADMINISTRATOR a 's Costa
June 5, 1996 x�•- :. ;.: : .. _;¢
DATE: LEGISLATION: AB 1184 (Friedman) REDUCING THE y'4o 0�ounLY
DISPROPORTIONATE SHARE HOSPITAL FUNDING THE STATE CAN
SUBJECT: RETAIN BEFORE ALLOCATING FUNDS TO PUBLIC AND PRIVATE
HOSPITALS
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
ADOPT a position in SUPPORT of AB 1184 by Assemblywoman Barbara Friedman
which would reduce from $239.5 million to $1 million the amount of disproportionate
share hospital funding the State could retain to balance its budget before allocating
the funds to public and private hospitals in California.
BACKGROUND:
Under current law, counties contribute funds to match Federal disproportionate share
funding which is then returned to various public and private hospitals which qualify
as disproportionate share hospitals because of the percentage of low-income,
indigent and Medi-Cal patients they serve. However, the State takes $239.5 million
of the funds which are contributed by public hospitals to assist the State in balancing
its budget. This results in a direct reduction in available funds to county, private and
university hospitals; $4.4 million in the case of Contra Costa County.
With the State's budget improving, it does not appear necessary or appropriate for
counties to continue this subsidy to the State. Assemblywoman Barbara Friedman
has introduced AB 1184 which would reduce this subsidy to $1 million to be used for
administration of the disproportionate share program, thereby returning the balance
of the funds to those hospitals which should be receiving the funds.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
_yy• RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
LL APPROVE OTHER
SIGNATURE(S): �
ACTION OF BOARD ON_ AunP 11 1 199E APPROVED AS RECOMMENDED X OTHER
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
------------
UNANIMOUS(ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
ATTESTED June 11, 1996
Contact: PHIL BATCHELOR,CLERK OF THE BOARD OF
cc: See Page 2 RS AND COUNTY AD BATOR
9-1/7v&_--f
B
The Health Services Director and the California Association of Public Hospitals and
Health Systems recommend that the Board of Supervisors indicate its support for AB
1184 and this office concurs with that recommendation.
cc: County Administrator
Health Services Director
The Honorable Barbara Friedman
Assemblywoman, 40th District
Room 4162, State Capitol
Sacramento, CA 95814
Les Spahnn
Heim, Noack, Kelly & Spahnn
1121 L Street, Suite 100
Sacramento, CA 95814
-2-
11HT-.51-1 y'Jb 12:61 HEALTH SERO I CES ADMIN. 510 370 5098 P.03/06
C.'44callfornia Association of
Public Hospitals and Health Systems
2000 Center Street, Suite 308, Berkeley, CA 94704 Phone 510/649-7650 Fax 5101 B49-1533
TO: CAPH Board M=bers
FROM: Deny Manin
DATE: 5128196
SUBJECT: AR 1184(Flreidtr>an) ..Reduction or SB 855 DSH"Atingnistrative Fee"
Setts Health an4 Hun=Serrrmets Cwnirttiittele flearing--June Stb
URGENT
ACTION REQUESTED
AB 1184(Freidman)sponsored by CAPH to meal=the$239.5 Mil0001 C24ministrative fee')
subsidy to the stag within ttte 0 855 MpropartSonate Sham Hospital(DSH)Payment
Program do$1 Million is now set for hearing. This measure will be heard in the Senate
Health and Human Services Committee an'iWedneWay,June 5th. Given the critical
importance of this measure.we are mquestixig the followitw From tine BoaW:
1)For all members,please send a leacr of support on AB 1184 to the Senate Health and
Human Services Committee as soon as possible. A copy of the CAPH letter which arlividaws
our podflon is attached. Please pude me with a copy of your letter.
2)For members with Senator(s)on the Senate Health and Human Services Committee we arc
requesting that a.pt rsonal lobbying contact be made between your c oumy ad rbe Senalor(s).
CAPH member r ounces mpmsetttead tett this Committee are the roltowir :
Sea".Mt'= Gbutu (s)
Diane Watson ,Chair lix Angeles
Ray Hrtynes,Vice chair Riverside
Teresa Hughes Los Angeles
Ken Maddy Foam and Kern
Henry Mello Mant�emy and Santa Clara
Riclu nd.Pulanco Los Angcks
Hilda Solis I=Angeles
As always,Terri Ttxotnw is cxxilidb sting this effort in Sacramento wd is c:urrendy setting
meetings with these Senators. As such,please advise me or Terri(916-441-2741)of the
outcome of any personal lobbying ettdit by your gouty to help buttress our torts.
3)For county lobbyists to bo present at tote Tube Gtr hearing to offer support for AB 1181.
Ala 1184 is a crentr*ecc or CAPH's advocacy effort this year. If you have any questions or
comet,please contact me dimly at 510449-7650 "t`hu*you for ywr continued
cowratiort and asdslat m
MAY-31-1996 12:31 FEALTH SERVICES ADMIN. 510 370 5098 P.04f06 .
California Association of
Public Hospitals and Health Systema
2000 Censer Streat, Suite 30% Berl misy, CA 94704 Phone 5141 Bag-7554 Fax 5101649-1533
May 28, 1996 -
The honorable Matto Watson,Chair
Senate Cvmmiuce on Health and Human Services
Slate Capitol.Roam 2191
Sams ento.CA 95814
S'UB1ECr: Assembly 18111 i184(Wedtrtan)-SUPPORT
Dear Senator Watson:
One behalf oUhe rnombers of the California Association of Public 11mpatals and Health Syxwms
(CAPD,we wspeafully urge your support of Assembly Hill 1184 by Assembly Member Friodmam
Sponsored by CAPH,this measure is desiped to restore fiscal stability to the Medi-Cal
Mproportionate Sha=Hospital(DSH)Payment Program by reducing the$239.5 Million sttbs€dy to
the stale to$1 Milli m
1n 1991.StW leb6slt tkm(SII 855)enabllished the Medi-Cal DSH Program w pruvide supplerrrantal
funding to a limited number of haispitals that that large volumes of low-income patients. The program
is funded solely by local public entides—select Calatics,bwpital districts,and the UC--dumgh
irrtergaver nmenWl umnsfers(16M)matte to the state,which then uses We funds w obtain 1'&A4 match.
The Federally matched dollars are distributed to bath public and private DASjj alter hoq&jls. In
actditaon to ftwiding the intim DSH program,public anities arc required to prvyride the state with a
subsidy of$239 S Million--$220 Million of which carnes from counties operatutg DSH hospitals.
Imposed to help alleviate the state's Fiscal difficulties during the recent ar+eccssion,rile subsidy to the
State has totalled over$850M shite the inception of ft DsH Program, Svery DSH hospital--private
and pubt#s-- 9s reliant on the financial stability of the small number of counties wXcb pride over
90%of the IG Ts. 'Ilse cuitinued subaidy to the aceta directly a lecets the,ability of low governments to
fund the endm DSH Ptogram. Although the subsidy to the State was imposed to help alleviaw its fiscal
crisis,the economys rebound presents a calque opportunity w restore Meal stability to the DSD
Pwgtata. Beacuse of a variety or factors,the 10S14 Program needs a short team stability plan to assure
it will continue to be funded by local goverrmenm
nic DSH P%gram is vital to preserving health care services to both Medi-Cal bereficiaries and the
unimur+ed in both the public and private sector: The subsidy to the snate destabil5zu the anile DSH
t'rtygram. AB 1184 would help wwe aha:Program continues to be funded by ttte selected Local
govemu'mts. Thank you fyr your consideration, if there are any quediMs,phase contact me at 510-
649-7650 or our Sacramento repmlepotative TerruTbomas at 916-441-2741.
Sincerely,
1DenLw 1C ardn,,MPH
Presidmit&CPC
MAY-31-1996 12:32 HEALTH SEkVICES ADMIN. 510 370 5095 P.05f06
May 28, 19%
Page Z
C Thu Honorable Subara Dedman
I lm those We Members,Senate Health and i-lumM1 ScrviM
Jahn Miller,Senate CummiUm on Y7eahh and Human Scnic%
CAPH Board of Dimet,ors
ririr-]1-1�7b 1Z=13e HLHLIH btKVll.Lb HUMIN. t>lu JIM 5098 P.OE/0 i
SIJ 855 Disproportionate Share Hospital (DSH) Payment Program
Local Government's$239,757,690 Subsidy to State
Cali Fomia Association of Public Hospitals and Health Systems
County Impact
Portion of
Cain_ Subsidy to State.T
Alameda $16,506,071
Contra Costa 4,443,049
Fresno 9,541,511
Humboldt 18,962
Kem 8,752,339
Los Angeles 114,659,904
Merced 959,420
Modoc 251,775
Monterey 11176,203
Riverside 8,032,643
San Bernardino 11,439,548
San Diego 204,313
San Francisco 12,641,552
San Joaquin 3,532,549
San Luis Obispo 614,81:5
San Mateo 2,108,690
Santa Clara, 15,399,621
Shasta 9,093
Svnomt4-1 1,259,957
Stanislaus 2,10$,27,
Trinity 33,811
Tuolumne 70,796
Ventura 3,686,076
Total County Impact: 217,254,977
Total Non County bnpact: 22,502,713
Total Subsidy:.- 239,757,6,90
'Portion d svibsidy to the sWIe bused on pmjwted 1"5-96 SB 855 0310 raymmat amounts.
TOTAL P.06
AMENDED IN SENATE MARCH 20, 1996
i CALIFORNIA LEGISLATURE-1995-96 REGULAR SESSION
ASSEMBLY BILL. No. 1184
Introduced by Assembly Member Friedman
F�
t
February 23, 1995
An act to amend Section 4-444a.4-714163 of the Welfare and
Institutions Code, relating to public social services,making an
appropriation therefor, and declaring the urgency thereof, to
'[ take effect immediately.
LEGISLATIVE COUNSEL'S DIGEST
'AB 1184, as amended, Friedman. P4bhe seeW ser-view
`,,. Med- Pfagr-affi Medi-Cal. disproportionate share
hospitals.
+I+ 4.;ftder.- emistiftg ei=2t' 3 in t4�te
F � ire �es�,� of �' � p��r�r.
. par-pipet � to in cess Te
4
a &2 3e i pay
fry" . ,fe a., �., �s rto yield a
ee nni1��n ^fin nl n r of $200-,000,98p9 � ane« smote in
p p 'tttC�7 JZT'✓G��Ci�GZ41 �k �L�.�Cil J� T4T.�4 ..epesit !
i# 414he Adfftinistrrettive GlEtiffiiftg Fttfid, fey to the i
JaW eeikhFt
e
pewtieipetting leeal fr-ef the !
e of fer-efiiite .ire i
the r-equirred affteunt of & fly bis;
begi"fting yrs after the petrtieip .101
F i !
I
i ,
98
AB 1184 — 2
3%lk V s
Tris bill watild speei€y -+ch4 0re AE14.4fl.i i-i 84ettive Glaiffiitt
pf eee v4ees t�e which this is ftpplieftble awe
0%-Lper dtrri rg a (),f
sttbseejtze + fiseal yeafs.
f 2+ T44-s b4l would deelarre �h4 A- is 1e take effeet �.
diettely fts f ft ;efte'y
Existing law provides for the Medi-Cal program,
administered by the State Department. of Health Services,
' under which qualified 16w-income persons are provided with
health care services. Zander the Medi-Cal program, the
department is required to make :supplemental payments to
certain disproportionate share hospitals based on specified
criteria. Payments are made from moneys paid by hospitals
into the Medi-Cal Inpatient Payment Adjustment Fund, as
5 required, with this fund being continuously appropriated for
sped ed purposes, including, commencing with the 1994-95
' fiscal year, an annual transfer of$239,757,690 to the.Health
Care Deposit Fund.
..This bill would, instead, provide that the amount to be
transferred each fiscal year subsequent to the 1995=96'fiscal
year to the Health Care Deposit Fund would be x'1,000,000
By increasing ,the amount available in the fund for
#` appropriation to disproportionate share hospitals, this bill
iry
Would constitute an appropriation.
This bill. would declare that It is to take effect immediately
as an urgency statute..
. .Vote- , ../ Appropriation: ft yes. Fiscal committee: yes.
State-mandated local program: no.
The.people, of the State of California do enact as follows:
l . N -1- Seetiee 4413"-74 the Welfaie
2 SECTION 1. Section 14163 of the Welfare and
3 Institutions Code is amended to read.
, 4 14163: (a) ,For purposes.of this section, the following
5 definitions shall apply:
6 (1) "Public entity" means a county,,a city, a city and
7 county, the University of California, a local hospital
• r f
98
,} i -
=--- 3 — AB 1184
z 1 district, a local health authority, or any other political
2 subdivision of the state.
3 (2) "Hospital" means a health facility that is licensed
4 pursuant to Chapter 2 (commencing with Section 1250)
5 of Division 2 of the Health and Safety Code to provide
6 acute inpatient hospital services, and . includes all
7 components of the facility.
8 (3) "Disproportionate share hospital"means a Hospital
9 providing acute inpatient _ services to Medi-Cal
10 beneficiaries that meets the criteria for disproportionate
11 share status relating to acute inpatient services set.forth
12 in Section 14105.98.
13 _(4) "Disproportionate share list means the annual list
14 of. disproportionate share hospitals .for acute inpatient
15 services issued by the department pursuant- to Section
16 14105.98.
17 (5) ":Fund" means the Medi-Cal Inpatient Payment
18 Adjustment Fund.
19 '(6) "Eligible hospital" means, for a particular state
' ( 20 fiscal year, a hospital on the disproportionate share list
21 _ that is eligible to receive payment adjustment amounts
22 under Section 14105.98 with respect to that state fiscal
23 year.
24 (7) "Transfer year" means the particular state fiscal
25. year during which, or with respect to which, public
26 entities are required by this section to make an
27 intergovernmental transfer of funds to the Controller.
s 28 (8) "Transferor entity" means a publicenfity that;
29 with respect to a particular transfer year, is required by
30 this section to make an intergovernmental transfer of
31 funds to the Controller.
r 32 (9) "Transfer amount" means an Iamount of
'( 33 intergovernmental transfer - of funds that this section
34 requires for a particular transferor entity with respect to �.
35 a particular.transfer year:
36 (10) "intergovernmental transfer"meansa transfer of
37 funds from a public entity to the state, that is local
.,F
38 government financial participation in Medi=Cal pursuant
39 to the terms of this section.
98
AB 1184 — 4 —
(11) "Licensee" means an entity that has been issued
2 a license to operate a hospital by the department.
3 (12) "Annualized Medi-Cal inpatient paid days"
4 means the total number of Medi-Cal acute inpatient
5 hospital days, regardless of dates of service, for which
6 payment.was made by or on behalf of the department to h
7 a hospital; under present or previous ownership, during
8 the most recent calendaryear ending prior to the
beginning of a particular transfer year, including all
g g
14 : Medi-Cal acute inpatient covered days of .care for
` 11 hospitals that are paid on a different basis than per diem
.12 payments.
s 13 (13) "Medi=Cal acute inpatient: hospital day" means
14 any acute inpatient day of service attributable to patients
15 who, for those days; were eligible for medical assistance
16 under the California state plan; including .any day of
17 service that is reimbursed on a basis other than per diem
18 . payments.
{ 19 . (b) The Medi-Cal Inpatient Payment Adjustment
24 Fund is hereby created in the State Treasury. )
21 Notwithstanding Section 13340 of the Government Code,
5 22 the fund shall be continuously appropriated a ro riated to, and under
23 the administrative control of, the department for the
24 purposes specified in subdivision (d) The fund shall
25 consist of the following:
26 (1) Transfer amounts collected by the Controller
27 under this section, whether submitted by transferor
28 entities pursuant to subdivision (i) or obtained by offset
,._.. ,. , 29 pursuant to subdivision (j) .
{ 30 (2) Any other intergovernmental transfers deposited
31 in the fund, as permitted by Section 14164.
{ .32 (3) Any interest that accruesmith respect to amounts
1 33 in the fund. �' )
}
34 (c) Moneys in the fund, which shall not consist%of any ,
f}
35 state general funds, shall be used. as the source for the
' 36 nonfederal share of payments to hospitals pursuant to
}
37 Section 14105.98, Moneys shall be allocated,from the fund
38 by the .department and matched, by federal funds in
39 accordance with customary Medi-Cal --accounting
31
t. ,
k ( 98
h - 5 — AB 1184
z.
1 procedures, and used to make payments pursuant to
2 Section 14105.98.
3. (d) Except as otherwise provided in Section 14105.98
4 or in any provision of law appropriating a specified sum
} 5 of money to the department for administering this
6 section and Section 14105.98, moneys in the fund shall be
7 used only for the following:
8 (1) Payments to.hospitals pursuant to Section 141.05.98.
9 (2) Except for the amount transferred pursuant to
10 paragraph (3) , transfers to the Health Care Deposit Fund
111 in the amount of two hundred thirty-nine million seven
12 hundred fifty-seven thousand six hundred ninety dollars
13 ($239,757,690); for the 1994-95 and 1,995-96 fiscal yew
14 years, and the.sum of one million dollars ($1,000,000) for
15 each fiscal year thereafter. Notwithstanding any other
16 provision of law, the amount specified in this paragraph
' 17 shall be in addition to any amounts transferred to the
18 Health Care Deposit Fund arising from changes of any
19 kind attributable to payment adjustment years prior to
` r ; 20 the `1993-94.payment adjustment year. These transfers
21 from . the fund shall be made in six equal. monthly
22 installments to the Medi-Cal local assistance
23 appropriation item (Item 4260-101-001 of the annual
24 Budget. Act) in support of Medi-Cal expenditures. The
25 first installment shall accrue in October of each transfer
26 year,. and all other installments shall accrue monthly
27 thereafter from November. through March.
28 (3) In the 1993-94 fiscal year,in addition to the amount
"...y 29 transferred as specified in paragraph (2), fifteen million
30 dollars ($15,000,000) shall also be transferred to the
31 Medi-Cal local assistance appropriation item (Item
32 4260-1,01-001) of the Budget Act of 1993.
33 (e) For the 1991-92 state fiscal year, the department
34 shall determine,no later than 70 days after the enactment
35of this section, -the transferor entities for the, 1991-92
36 transfer year. To make this determination, the
37 department =shall utilize the disproportionate share list
38 ;for,'.the ;1991-92' fiscal year,.which shall be issued by the
39 department no`later than 65 days after the enactment of
40 this section; pursuant to paragraph (1) 0f subdivision (f)
98
ti
AB 1184 — 6 -
1 of Section 14105.98. The department shall identify each
2 eligible_hospital on the list for which a public entity is the
3 licensee as of July 1, 1991. The public entity that is the
4 licensee of each identified eligible hospital shall be a
5 transferor entity for the 1991--92 transfer year.
6 (f) The department shall determine, no later than 70
7 days after the enactment of this section, the transfer
8 amounts for the 1991-92 transfer year.
9 The transfer amounts shall be determined as follows:
10 (1) The eligible hospitals', for 1991-92 shall be
4
11 ' identified. For each hospital, the applicable total per
i 12 diem_: payment adjustment amount under Section
13 14105.98 for the 1991-92 transfer year shall be computed.
14 This 'amount shall be multiplied by 80 percent of the
15 eligible hospital's annualized Medi-Cal inpatient paid
16 days as determined from all Medi-Cal paid claims records
17 available through April 1, 1991. The products of these
18 calculations for all e eli iblhospitals shall be added
g� p'
19 together to determine an aggregate sum for the 1991-92
` 20 transfer year.
21 (2) The eligible hospitals for 1991-92 involving
} 22 transferor entities as licensees shall be identified. For
23 each hospital, the applicable total per diem payment
24 adjustment amount under Section 14105.98 for the
25 .1991-92 transfer year shall be computed. This amount
26 shall be multiplied b 80.percent of the eligible hospital's
I p Y p g� p
27 annualized Medi-Cal inpatient paid days as determined
28 from all Medi-Cal paid claims records available through
R 29 April -1; 1991. The products of these calculations for .all
' 30 eligible hospitals with transferor entities as licensees shall
4 31 be added together to determine-an aggregate sum for the
32 1991-92 transfer. year.
i$ 33 (3) The aggregate sum determined under paragraph ;
r:
34 (1) shall be divided by the aggregate sum determined
35 under paragraph (2), yielding a factor to,+be .utilized in
36 paragraph (4) .
37 (4) The factor determined in,paragraph
(3) shall be
38 multiplied by the amount determined for each hospital
39 under paragraph (2) The product of this calculation for
r i 40 each hospital in paragraph (2) shall be divided by 1.771, ty j
98
s j is
7 — AB 1184
1 yielding a transfer amount for the particular transferor
2 entity for the transfer year, except as provided by
3 paragraph (5) .
` 4 (5) Only for the transfer year with respect to which
' 5 the payment adjustment program set forth in Section
6 14105.98 first gains federal approval, a reduction in the
7 transfer amount determined pursuantto paragraph (4)
8 shall be applicable under the following circumstances:
9 (A) To determine any such, reduction, the transfer.
10 amount determined pursuant to paragraph (4) shall first
I l. be multiplied by a fraction, the numerator of which is the
12 number of days of the transfer year. for which federal
13, approval is effective and the denominator of which is 365.
14 (B) If the product of the calculation under
15 , subparagraph (A) is 80 percent or, more of the transfer
16 amount determined under paragraph (4) , no reduction
s 17 of the.transfer amount determined under paragraph (4)
18 shall apply.
19 (C) If the product of the 'calculation under
20 subparagraph (A) is less than 80 percent of the transfer
21 amount determined under paragraph . (4) , a reducj.ion
22 shall apply to the. transfer amount determined I under
23 . paragraph (4) .. The reduction shall be that particular
24 amount which is equal to the difference between (i) the
$ i 25 transfer amount determined under paragraph 4 and
26 (ii)• the amount calculated under subparagraph (A).
Y.
27 divided by 80 percent.
28 (D) Any reduction of a transfer amount applicable
29 under subparagraph (C) .shall be spread equally among
30' . the installments referred-to in subdivision (i)
31 (g).. For the 1991--92 transfer year, the -department
32 shall notify each transferor entity -in, writing of its
(;( 33 applicable transfer amount or amounts :no later than 70
34 daysafter the enactment of this section, which amount or
35 amounts shall be subject to adjustment pursuant to
36 subdivisions (f) and (i) .
37. (h) For , the . 1.992=93 transfer year and. subsequent
.38 :transfer years;: transfer amounts.,shall be determined in
39: the same procedural manner as set forth. in subdivision
40 (f), except:
' 98
AB 1184 — 8 —
1 (1) The department shall use all of the following:
2 (A) The disproportionate 'share list applicable to the
3 particular transfer, year to determine the eligible
4 hospitals.
5 (B) The payment adjustment ` amounts calculated
6 under Section 14105.98 for the particular transfer year.
7 These amounts sany.projected hall take into account an ected or
8 actual increases or decreases in the size of the payment
9 adjustment program as . are required under Section
10 14105.98 for the particular year in question. Subject to the
11 installment schedule in paragraph; (5) of subdivision (i)
12 regarding transfer amounts, the department may issue
13 interim, revised,. and supplemental transfer requests as
14 necessary and appropriate to address changes inpayment
15 adjustment levels that occur under Section 14105.98. All
16 transfer requests; or adjustments thereto, issued to
17 transferor entities by the department shall .meet the
18 requirements set forth in subparagraph (E) of paragraph
19 (5) of subdivision (i) .
20 (C) .Data regarding annualized Medi-Cal inpatient
2 paid days for the most recent calendar year,ending prior
22 to the beginning of the particular transfer year, as
r -23 determined from all Medi-Cal paid claims records
24 available through,, April 1 preceding the particular
d .25 transfer year.
26 (D) I The status of public entities as licensees of eligible
27 hospitals, as of July.1. of the particular transfer, year.
ft
28 (E) The . transfer amounts calculated by the
29 department may be increased . or decreased by a
30 percentage .amount consistent with the Medi-Cal State
31 . Plan.'
>: 32 (2). For the.: 19,93-94 transfer year and. subsequent
r
33 transfer years, transfer amounts-shall. be increased on a
34 pro rata basis for each transferor entity for the particular
<5 35 : transfer Year in the amounts necessary to fund the
36 nonfederal share of the total supplemental lump-sum
payment adjustment amounts that _arise under Section
38 14198, For� purposes of this. paragraph
05. , the
`
39 supplemental lump-sum payment adjustment amounts
,
40 shall be deemed to arise for the particular transfer year
1 Ii 98
. — 9 — AB 1184
1 as of the date specified in Section 14105.98. Transfer
2 amounts to fund the nonfederal share of the payments
3 shall be paid by the transferor entities for the particular
4 transfer year within 20 days after the department notifies
5 the transferor entity in writing of the additional transfer
6 amount to be paid.
7 (3) The department shall prepare preliminary
8 analyses and calculations regarding potential transfer
9 amounts, and potential transferor entities shall be
k: 10 notified by the department of estimated transfer amounts
11 as soon as reasonably feasible regarding any particular
12 transfer year. Written notices of transfer amounts shall be.
13 issued by the department as soon as possible with respect
14 to each transfer year: All state agencies shall take, all
15 necessary steps in order to supply applicable data to the
16 department to, accomplish these tasks. The Office of
s 17 Statewide Health Planning and Development shall
18 provide to the,department quarterly access to the edited
19 and unedited confidential patient discharge data files for
20 all Medi-Cal eligible patients. The department shall
21 maintain the confidentiality of that data to the same
22 extent as is required of the Office of Statewide Health
23 Planning and Development. In addition, the Office of
24 Statewide Health Planning and Development shall
25 provide to the department, not later than March 1 of each
26 year, the data specified by the department, as the data
27 existed on the statewide-data base file as of February 1 .0f
28 each year, from all of the following:
29 (A) Hospital annual disclosure reports, filed with the
30 Office of Statewide Health Planning and Development
31 pursuant to Section 443.31 of the Health and Safety-Code,
32 -for hospital fiscal years that ended during the calendar
#�( 4 33 year ending 13 months prior to the applicable February
34 1.
35 (B) Annual reports of hospitals, filedwith the Office of
36 Statewide Health Planning arid, Development pursuant
37 to Section 439:2 of the 'Health and Safety Code; for the
38 calendar year ending 13 months prior to the applicable
39 February l.:
4
1
�s�' 98
i
AB 1184 _ 10 -
1
10 --
1 (C) Hospital patient discharge data reports, filed with
2 the Office of Statewide Health Planning and
3 Development pursuant to subdivision (g) of. Section
4 443.31 of the Health and Safety Code, for the calendar
5 ' year ending 13 months prior to the applicable February
6 1:
=7 (D) Any other materials on °'file with the Office of
8Statewide Health Planning and Development.
9 (4) For the 1993-94 transfer year and subsequent
10 transfer years, the divisor to be used for purposes of the
'
. 11 calculation referred to in paragraph (4) of subdivision (f)
12 shall be determined by the department. The divisor shall
13 be calculated to ensure that the appropriate amount of
14 transfers from transferor entities are 'received into the
15 fund to satisfy the requirements. of Section 14105:98 for
16 ` the particular transfer year. For the 1993=94 transfer year,
17 the divisor shall be 1.742.
18 (5} For the 1993-94 fiscal year; the transfer amount
z
19 that would otherwise be required`from the University of
20:. California .shall be increased by fifteen million dollars
21 ($15;000;000)
:22 (6) Notwithstanding any other 'provision of law, the
r 23 total amount of transfers required from the transferor
24 entities for any particular transfer year shall not exceed
25: the sum of the following:
s 26 (A) The'amount needed to fund the nonfederal share
27 'of all payment ,adjustment amounts applicable to the
28 particular payment'adjustment year as-calculated under
29 Section 14105:98. Included in the calculations "for this
30 purpose shall be any decreases in the program as a whole,
t 31 and for individual hospitals that arise due to the
32 provisions of Section 1396r-4(f)° of Title 42 of the United
33 iStates,Code:
34 (B): The amount needed 'to fund the transfers to the
35 Health Care Deposit Fund, as referred to:in paragraphs
36 (2) and (3} of subdivision (d) .
I !; 37- = (7) (A) Except.as provided in subparagraph (B)` and
`! 38 in subparagraph, A of ara ra h 2 _of subdivision
( ) P gp " O (j)
'39' and except for a prudent reserve not:`to exceed two`
40 ; milliondollars ($2;000,000) in the Medi-Cal Inpatient
9s 98 .
- 11 — AB 1184
1 Payment Adjustment Fund, any amounts in the fund,
2 including interest that accrues with respect to the
? 3 amounts in the fund, that are not expended, or estimated
4 to be required for expenditure, under Section 14105.98
5 with respect to a particular transfer year shall be returned
6 on a pro rata basis to the transferor entities for the
7 particular transfer year within 120 days after the
8 department determines that the funds are not needed for
9 an expenditure in connection with the particular transfer
10 year.
11 (B) The .department . shall determine the interest
12 amounts that have accrued in the fund from its inception
13 through June 30, 1995, and, no later than January 1, 1996,
14 shall distribute these interest amounts to transferor
15 entities, as follows:
16 (i) The total amount transferred to the fund by each
17 transferor entity for all transfer years from the inception
18 'of the fund through June'30, 1995, shall be determined.
19 (ii) The total- amounts determined for all transferor
( } 20 entities under clause (i) shall be added together, yielding
21 an aggregate of the total amounts transferred to the fund
22 for all transfer years from the inception of the fund
23 through June 30, 1995.
24 (iii) The total amount determined under clause (i) for
i 25 each transferor entity shall be divided by the aggregate
26 amount determined under clause (ii), yielding a
27 percentage for each transferor entity.
28 (iv) The total amount of interest earned by the fund
29 from its inception through June. 30,. 1995, shall. be
#^ 30 determined.
31 (v) The percentage determined under clause (iii) for
} 32 each transferor,entity shall be multiplied by the amount
0 33 determined .under clause (iv), yielding the amount of
34 interest that shall be distributed under this subparagraph
35 to each transferor entity.
t 36 (C) Regarding any funds returned to a transferor
37 entity::under subparagraph (A), or interest amounts
38 distributed to a transferor entity, under subparagraph
39 (B) , the department shall provide to the transferor entity
40 a written statement that explains the basis for the
98
AB 1184 — 12 —
particular
12 --
particular return or distribution of funds and contains the
2 general calculations. used by the department in
3 . determining the amount of the particular return or
4 distribution of funds.
5 (i) (1) For the 1991-92 transfer year, each transferor
6 entity shall pay its transfer amount or amounts to the
7 Controller; for deposit in the fund, in eight equal
8 installments. Except as provided below, the first
9 installment shall accrue on July 25, 1991, and all other
10' installments shall accrue on the 5th day of each month
11 thereafter from-.August through February.
12 2 N.otwithstandin ara ra h� 1 'no installmen t
( } Notwithstanding . para p O
13 shall be payable to.the Controller until that date which is
4 14 20 days after the department notifies the transferor entity
. s
15 in writing that the payment adjustment program set forth
16 in Section 14105.98 has first. gained federal approval as
17 part of the Medi-Cal programa For I purposes of this
18 paragraph, federal approval requires both (�) approval.b
Y
19 appropriate federal agencies of an amendment -to the
20 Medi-Cal State Plan, as referred to in subdivision (o) of
21 Section 14105.98, and (ii) confirmation by appropriate
22 federal agencies regarding the availability of federal
23 financial participation for the payment adjustment
24 program set forth in Section 141.05.98 at a level of at least
25 _40 percent of the percentage of federal financial
} 26 participation that is normally applicable for Medi-Cal
j: 27 expenditures for acute inpatient hospital services.
28 (3)__ If any installment that would otherwise be payable
29 under paragraph (1) is not paid because of the provisions
r 30, of paragraph (2); then subparagraphs (A) and (B) shall
31 -be followed when federal approval is gained.
32 (A) All installments that were deferred based on the
33 provisions of paragraph (2) shall be paid no later than 20
34 days after the department notifies th
Y p e transferor,entity in
y 35 writing that federal approval, has been gained, in an
36 amount consistent with subparagraph ;(B) .
37 (B) The installments paid pursuant to ,subparagraph
38 '(A) shall be paid. in full, subject to .an adjustment in
j 39 amount pursuant to paragraph (5) of subdivision (f) .
98
k
— 13 — AB 1184
} 1 (4) All installments for the 1991-92 transfer year that
2 arise in months after federal approval is gained shall be
3 paid by the 5th day of the month or 20 days after the
4 department notifies the transferor entity in writing that
5 federal approval has been gained, whichever is later.
6 These installments shall be subject to an adjustment in
7 amount.pursuant to paragraph (5) of subdivision (f) .
8 (5) (A) Except as provided in subparagraphs
. (B) and
9 (C) , for the 1992-93 transfer year and subsequent transfer
10 years, each transferor entity shall pay its transfer amount
11 or amounts to the Controller, for deposit in the fund, in
12 eight. equal installments. The first installment shall be
13 payable on July 10 of each. transfer year. All other
14 installments shall be payable on the 5th day of each month
15 thereafter from August through February.
x 16 (B) For the 1994-95 transfer. year, each transferor
17 entity shall pay its transfer amount or amounts to the
18 Controller, for deposit in the . fund, in five equal
' .19 installments. The first installment shall be payable on
20 October 5, 1994. The next four installments shall be
L .21 payable on the fifth da of each month thereafter P Y Y a ter from22 November through February.
23 (C) For the 1995-96 transfer year, each transferor
24 entity shallpay its transfer amount or amounts to the
n „ 25. Controller, for deposit in the fund, in five equal
26 installments. The first installment h
Al shall be payable on
27 October 5, 1995. The next four installments shall be
28 payable on the fifth day of each month thereafter from
r 29 November through February.
,f
. 30 (D) Except as otherwise specifically provided,
31 subparagraphs (A) to (C) , inclusive, shall not apply to
32 increases in transfer amounts described in paragraph (2)
S 33 of subdivision (h) or to additional. transfer amounts
34.,: described in subdivision o
35 (E) All requests for transfer payments, or adjustments
36 thereto, issued by the department shall be in writing and
3T , shall include (i) . an .explanation of the basis for the
38 ;particular transfer...request or transfer activity, (ii) a
39 summary. description of.program funding status for the
40 .particular transfer year, and (iii) the general calculations
t 98
AB 1184 — 14 -
1
14 -
1 used by the department in connection with the particular
2 transfer request or transfer activity.
3 (6) A transferor entity may use any of the following
4 funds for purposes of meeting its transfer obligations
5 under this section:
6 (A) General funds of the transferor entity.
7 (B) Any other funds permitted by law to be used for
8 these purposes, except that a transferor entity shall not
9 submit to the Controller any federal funds. unless those
10 federal funds are authorized by federal law to be used to
X11. match other federal funds. In addition; no private
12 donated funds from any health care provider, or from any
�' 13 person or organization affiliated with such a health care
E' 14 provider, shall be channeled through a transferor entity
15 or any other public entity to the fund.: The transferor
16 entity shall be responsible for determining that funds
17 transferred meet the requirements of this subparagraph.
18 (j) (1) If a transferor, entity does not submit any
19 transfer amount within the time period specified in this
20 section; the Controller shall offset immediately the `
21 amount owed against any funds which otherwise would
' 22 be payable by the state to the transferor entity. The
23 Controller, however, shall not impose an offset,against
24 any particular funds payable to the transferor entity
25 where the offset would violate state or federal law.
'' 26 (2) Where a withhold or a recoupment occurs
27 pursuant to the provisions of paragraph (2) of subdivision
28 (r) ,of Section 14105.98, the nonfederal portion of the
, 29 amount in question shall remain in the fund, or shall be
30 redeposited in the fund by the department, as applicable.
.31 The department shall_then proceed as follows: ,
32 (A) If the withhold or recoupment was imposed with
33 respect.. to a hospital whose licensee was a transferor
j 34 entity for the particular state fiscal year to which the.
35- withhold:or recoupment related, the nonfederal portion
36 of the amount.withheld or recouped shall serve as a credit
37 for the particular transferor entity against an equal
38 amount: of transfer,,:obligations under this section, to be
9
applied whenever the transfer obligations next arise.
i 3 p� g
40 Should.no such transfer obligation arise within 180 days,
98
- 15 — AB 1184
i
:ular = I the department shall return the funds in question to the
2 particular transferor entity within 30 days thereafter.
wing 3 (B) For other situations, the withheld or recouped
`ions 4 nonfederal portion shall be subject to paragraph (7) of
5 subdivision (h) .
6 (k) All amounts received by the Controllerpursuant
I for 7- to subdivision (i) , paragraph (2) of subdivision (h) , or
t not 8 subdivision (o) , or offset by the Controller pursuant to
hose 9 subdivision (j) , shall immediately be deposited in the
�d to 10 . fund.
,vate 1.1 (l) For purposes of this section:, the disproportionate
i any 12 share list utilized by the department 'for` a particular
care 13 transfer year shall be °ideritical to the disproportionate
ntity 14 share list utilized by the department for the same state
.'eror 15 fiscal year for purposes of Section 14105.98. Nothing on a
unds 16 disproportionate share list, once issued bye the
-aph. 17 department, shall be modified for any reason other than
any 18 mathematical or typographical errors or omissions on the
this I9 part of the department-or the. Office of Statewide Health
the Y ;` 20 Planning and Development in preparation of the-list.
'ould 21 (m) Neither the intergovernmental transfers
The 22 required by this section, nor any elective transfer made
ainst 23 - pursuant to Section 14164, shall create, lead to, or expand
ntity 24 the health care funding or'service obligations for current
. 25 or fixture years for any transferor entity, except as
;curs 26 required of the state by this section or as may be required
ision 27 by federal laws in which case the state shall- be held
Ic the 28 harmless by the transferor entities on a pro rata basis.
.11 be 29 (n) No amount submitted to the Controller pursuant
able. 30 to subdivision (i) paragraph (2) of subdivision (h), or
31 'subdivision- (o) , or offset.by the Controller pursuant to
with 32 subdivision 0) , 2shall be claimed or recognized as an
Feror 33 allowable element. ,of cost in Medi-Cat cost.' reports
i the 34 submitted: to the department.
rtion 35 (o} Whenever additional transfer amounts are
redit 36 required to fund the nonfederal ` share "'of payment
equal 37. adjustment amounts under Section 14105.98 that are
:o be 38 distributed after the close of the particular. payment
:,trise. 39 adjustment year to which the payment 'adjustment
days, apply,:40 amounts a 1 ; .the additional transfer amounts shall be
;,.,: �� ( �� �
98
98
AB 1184 — 16 —
I
16 -1 paid by the parties who were the transferor entities for
2 the particular transfer year that was concurrent with the
3. particular payment adjustment year. The additional
4 transfer amounts shall be calculated under the formula
5 that was in effect during the particular transfer year. For
6 transferyears prior to the 1993-94 transfer °year,' the
7 percentage of the additional transfer amounts available
8 for transfer . to the Health Care Deposit Fund under
9 subdivision (d) shall be the percentage that was in effect
10 during the particular transfer. year: These additional
11 transfer, amounts shall' be paid by transferor entities
12 within 20 days after` the ` department` notifies' the
13 transferor entity, iri='writing of the `additional transfer
14 amount to be paid.:'
15` (p) .. (l) . Ten million dollars
($10,000,000) OE,:
16 amount transferred from the Medi=Cal ' Inpatient
17 Payment Adjustment Fund to the Health Care Deposit
18': Fund due to amounts transferred `attributable to years
heraeteb
riated19 prior to the 1993-94 fiscal year is y aP ro
Department of
20 without regard to fiscal years totheSt
`
21 Health Services to be used to supportthe development of
22 managed care programs under the department's plan to
23 expand Medi-Cal`mariaged care.
24 (2) These funds shallbe used by the:department for
25 both of the following purposes: (A) distributions to
26 counties or other local entities that contract .with the
27 department to receive those funds to offset a portion of
28 `the costs of forming the local initiative entity; and A
29- ` distributions to local initiative entities that coritract with
x
30 the department to receive those funds to I offset a portion
31 ., of the costs of developing the local initiative health
32 delivery system :in accordance' with' the `department's _
33 plan to expand Medi 'Cal managed carer '
34 (3) ' Entities contracting with°the department'for any
35 'portion; of the ten'million dollars'($10,000;000)' shall meet
36 the objectives' of the department's plan to z expand
t."
>Y 37 Medi Cal managed care with regard to !traditional and
38 safety net providers.
89 :- : ' '(4) Entities-contracting:withthe Ab]aartmoftt for any
40 portion of the ten million dollars ($10,000;000) may be
98
-- 17 -- AB 1184
or
1 authorized under those contracts to utilize their funds to
-ie 2 provide for reimbursement of the costs of local
La l 3 organizations and entities incurred in participating in the
ila .4 development and.operation of a local initiative.
or 5 , (5) To the,full extent permitted by state and federal
ne 6 law,,these funds shall be distributed by the department
)le107 for,, expenditure at the local level in =a manner that
er 8 qualifies for. federal financial participation under the
.ct 9 medicaid program. -
tal l0 Tr :�„�;..Y, . Cedeis aielend,edto rete
ies 11 4- 4 : -�a�- { } ; eke l e rt of t4e� Y �;
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421 O}atlfitl:patpiee ift bei state Rftd leeel
ter. 13 .Pr-E)gFfkbe -�'. J.i R i�sA Iter,the iittent of the
14 b egis tef , ifte retia-gig aet; to: e fef leeal
:he . 15 geye ...,...,..,,fttet. -ar-60pati ift the p iece of tetr-geted
grit 16 ease ��g � v �� t-e ieft 1396n(g).
)Sit 17 e . Title 4-2 of the . : Uit-ed t-c e aftd i-ft
ars 18 �f� #tet e i�� „ with pessible fede�a
:ed 19 : finftfkeW ptt #ieipt�
of ?: ; 20 4 i�s ftif ther the ip.#ent of 4=egislatttrre to pr-evide
t of 21 aee�l - r��� g #fie,eh.eiee of
to 22 iii either e-.beth of the= ;et base �4a e Q n ffie .(TGN4)-
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23 a� ���_ - : e�ess prc -ams at their
kn,for 24 eptief; mtents of this .,et;
on aftd
to, 25 -Seefielft x :44.
the' 26 -( -}- The eeft raet. with eaeh
27 tie tg ge er-ftr,..,.t tn� a;geney � the
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(B) 28ie�ar of "a.,, n� ; peeess fef the
Frith 29 p - . �,.C�rseien t of the Medi l
:ion 30 p egr-afe pt��3t to.seetieft 94F (ft} of Title 42 of the
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j — 25 — AB 1184
i 2 leeet! txntil #4e
3 eritepur-sttEtnt to subdivisi {lam} at:e in
4 ef€eet.
5 {-t+ The depff tffi &kftR pr-evide teen „i assistan
& 6 to ill leeal ge-9,er-tiffiental ia.ewer- t-e -zin e
:a} 7 fede� final #fie aid
t7't
9 +tt* This seetierr shetil be appheab4e to AElffiinistrative
-ie10 � g ► eeess n , to n�eeeys
et 11 pa4d to pa'-tie a pg leek gover-ta ,.,enta ageneies fed
Id 12 Wiese etet ,:t es- ift the 4%4#A fiseftl year afrd -h,.:.,. rIF-
3e 13
14 SEC. 2. This act is an urgency statute necessary for the
15 immediate preservation of the public peace; health, or
16 safety within the meaning of Article. IV of the
,al 17 . Constitution and shall go into immediate effect. The facts
18 constituting the necessity are:
j 19 R is leg t-i�ve intent be elay-}fied with
20 respeet. to whieh Medit l Adffiiftistrrettive
21 preeess - - ------ afe sttbjeet toe
. 22 fequir-ed t-e Seetiett 4-44&2-47 e€the W -e aid
al 23 Instituti Gede. This ffitist be e e plish epr-tier-to eke
24 eleslxg. of leeal -' heels fe toe
25 4-994A fiseal yeaf. R is therefere this aet-
26 take effeet
e+ 27 It is essential to require the state and counties to.bear
28 the appropriate share of administrative costs for the
29 state's disproportionate share hospital program,
30 reflecting the costs borne by each, as soon as possible. It
fts
31 is therefore necessary that this act take effect
32 immediately,
le
to
® O
98 98