HomeMy WebLinkAboutMINUTES - 04221997 - C40 C.40
TO: BOARD OF SUPERVISORS Contra
FROM: PHIL BATCHELOR, COUNTY ADMINISTRATOR % �► ';< Costa
April 17, 1997 : - County
r•.•
DATE: o,,.rq.coiiN'cy
SUBJECT: LEGISLATION: AB 768 (GALLEGOS AND PERATA)
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
ADOPT a position of SUPPORT for AB 768 by Assemblymen Martin Gallegos and
Don Perata, which would limit the contributions which public hospitals would have
to make in the 1997-98 and future fiscal years to the amount they would have had
to contribute had all hospitals which participated in the 1996-97 fiscal year continued
to contribute in the 1997-98 and future years.
BACKGROUND:
Under current law, public hospitals can contribute to the Medi-Cal Inpatient
Adjustment Fund, from which payments are made to specified hospitals which meet
the criteria for being classified as disproportionate share hospitals, meaning that
they serve a disproportionate share of Medi-Cal and indigent patients. The
contributions made by public hospitals serve as a match for Federal funds which are
then returned to all disproportionate share hospitals in the State, both public and
private. Only public hospitals pay for the match, but both public and private hospitals
receive the benefits of the additional Federal dollars. Some public hospitals have
recently withdrawn from the program. As a result, the remaining public hospitals,
including Merrithew Memorial Hospital, have had to increase their contributions in
order to match the available Federal dollars.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
�
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S): C%/��'�C
ACTION OF BOARD ON April 1991 APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
X 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.
CC See Page 2 ATTESTED April 22, 1997
PHIL BATCHELOR,CLERK OF THE BOARD OF
SUPERVISORS AND COUNTY ADMINISTRATOR
M382 (10/68)
BY ,DEPUTY
Assemblymen Gallegos and Perata have introduced AB 768 which would limit the
contributions which public hospitals would have to make in the 1997-98 and future
fiscal years to the amount they would have had to contribute had all hospitals which
participated in the 1996-97 fiscal year continued to contribute in the 1997-98 and
future years.
The Health Services Director has recommended that the Board of Supervisors
support AB 768 in order to stabilize the amounts the County may pay to receive its
disproportionate share hospital payments. This office concurs with that
recommendation.
cc: County Administrator
Health Services Director
Les Spahnn
Heim, Noack, Kelly & Spahnn
1121 L Street, Suite 100
Sacramento, CA 95814
Casey Sparks Kaneko, Executive Director
Urban Counties Caucus
1100 K Street, Suite 101
Sacramento, CA 95814
Steve Szalay, Executive Director
California State Association of Counties
1100 K Street, Suite 101
Sacramento, CA 95814
-2-
,
i,
CALIFORNIA LEGISLATURE-1997-98 REGULAR SESSION
f ASSEMBLY BILL No. 768
Introduced by Assembly Members Gallegos and' Perata
(Principal coauthor: Assembly Member Villaraigosa)
f
February 26, 1997 .
An, act to amend Section 14163 of the. Welfare and
Institutions' Code, -relating to , health, . and declaring the
r.
urgency thereof, to take effect immediately:
t~ LEGISLATIVE COUNSEL'S DIGEST
AB 768 as introduced Galle os. Medi-Cal:
g
disproportionate share hospitals..
Existing law provides for the ' Me -Cal: ;,di program
administered by the State Department of Health Services;
under which�qualifiedaow-income persons are provided with
health care services. The Medi-Cal program provides for a .
e special methodology .of .reimbursement of .disproportionate
( share hospitals for the.provision of inpatient hospital services.
Existing law generahy, defines a disproportionate share
hospital as a hospital that`has proportionately `high1.er costs,
l volume, or services related to ; he provision of services . to
Me' -Cal: or,.other low-income: patients than the statewide
average
Under the Medi=Cal program; the department:is required
to make supplemental payments .to certain disproportionate,
.: share hospitals based ori;specified criteria.`Payments are made .
from defined`intergovernmental transfers that are paid into .
the Medi-Cal Inpatient Payment Adjustment . Fund, as
re wired, with "this fund be' continuously appropriated-for
q, g Y .
99
f
AB 768 — 2 —
specified
2 —specified purposes that do not include the administration b}
the department of this payment adjustment program.
Existing law provides for the calculation of transfer amounts
for the 1991-92 transfer year and for subsequent transfer
years.
This bill would limit the transfer amounts for the 1997-98
transfer year and for subsequent,transfer years. r
This bill would declare that it is to take effect immediately
as an urgency statute.
Voter _2/3. Appropriation: no. .Fiscal committee: yes.
State-mandated,locale program: no.
The people of the.State of California do enact as follows
1: SECTION . 1. Section 14163 sof the. Welfare and .
2 Institutions Code is amended to read:
3 14163. (a) For purposes of this section, the following
4 definitions.'shall apply:
5. (1) "Public entity" means a.county, a city,.. a city and
6. county, the University of California, :a . local hospital ) .
7 district, a local health authority, .or any other political .
8 subdivision of the state.
9 (2) "Hospital"IAeans a health.facility that is licensed
=10 ,pursuant to Chapter' 2 (commencing with Section 1250)
11 of Division`2 of the Health and Safety Code to provide, i,
12 acute inpatient hospital service"s, and includes all
13 components` of the facility. .:
14 ' (3) "Disproportionate:share hospital"means a"hospital
, , 15 rovidm -acute inpatient services . .to Medi-Cal
P g
16 bene.ficiarres that meets:the criteria.for disproportionate
17 share status'relating to acute inpatient services set forth
18 in Section 14105 98
19 (4) "Disproport�onateshare list means the annual'hs,
20 of disproportionate share: hospitals ,for acute uipa i' tt �<
21 services issued by; the''department pursuant to,:Section
22,: 14.105 98.'
23 (5) "Fund" means the Medi-Cal -Inpatient Payment
24', AdjustmentFund:
25 (6) "Eligible hospital" means; for a particular state
26 ' .fiscal, year,..a hospital on the"disproportionate share list
,f
- lk
99
i
y
- 3 — AB 768
1 that is eligible to receive payment adjustment amounts
on b} g P Y J
2. under. Section 14105.98 with respect to that state fiscal
. 3 . year.. .
Year.
tnsfer :;' . 4 {7) "Transfer year means the particular state fiscal
5 year during which, or with .respect to which, public
,97-98 : 6 :entities are required by this section to make an
7 intergovernmental transfer of funds to:the Controller. . .
iately
,
(8) "Transferor entity" means a public entity ,that,
9 with respect to a particular transfer year; is required'by
yes. 10 this section to make an intergovernmental transfer of
11 funds to the Controller.
12 (9) 4;Transfer.: :amount" means an amount ; -of
lows: .13 intergovernmental; transfer of funds that this section
14. requires for a particular transferor entity with respect to
and 15 a artic
pular transfer.year:
16 (10) .Intergovernmental transfer"means a ransfer: of
,fig 17 funds from a: public entity to: the:: state, .that is local
18 government financial participation in Medi-Cal pursuant
y and 19 to.the terms of this section.
spital 20 (11) "Licensee" means,an entity.that has been issued
litical :. :: 21 a.license to operate a-hospital by the department.
-22 . (12) : "Annuahted Medi-Cal" inpatient :.paid. days"
.need 23 ..means :the tote number of Medi-Cal,, acute inpatient
1250 24 hospital days, regardless of. dates :of service, for which
wde'(. sr 25 payment was made by..or on behalf of'the department to
aall 26 . a. -hospital,.'underpresent or previous ownershi ; durin
g . .
-
27 .the .most recent calendar
year ending. prior to ,the - -
sptal 28 beginning of a particular transfer year, including all
li-Cal 29 Medi-Cal' ,.acute `inpatient covered days .of care for
mate 30 hospitals;.that are ;paid bn a,different basis than per:diem
forth 31 payments .
. _
,32 (13) "Medi-Cal acute: inpatient,hospital day" means .
al list 33 any acute inpatient day of service attributable to patients
tient 34 who, ;for those days, were eligible for medical assistance
`` 35 under .the California atate len includin an da of
ction. P g' Y Y
36 service that_is reimbursed on a basis other than per-diem'
Hent 37 ,payments.
38 (14) "OBRA 1993payment .`limitation" means the
state 39 hospital-specific limitation on the totalannual amount of
e list �-�� 40 : payment adjustments to:each.eligble hospital under ahe
99 99
1 ,
AB 768 — 4 -
1
4 -
1 payment adjustment program that can be made with
2 federal financial participation under Section 1396r-4(g)
3 of Title 42 of the United States Code as implemented
4 pursuant to the Medi-Cal State Plan.
5 (b) The Medi-Cal Inpatient Payment. Adjustment
6 Fund.. is hereby created in the State Treasury.
7 Notwithstanding Section.13340 of the Government Code,
8 the fund shall be continuously appropriated to,and under ?.
9 the administrative control of, the department for the
10 purposes specified in subdivision (d) . The fund shall
11consist of the following;
12 (1) Transfer amounts collected by the Controller
i . . 13 under.-;this section, whether submitted by transferor
14 entities pursuant to applicable. provisions of this section
15 or.obtained by offset pursuant to subdivision. 0) .
16 (2);. Any other:`intergovernmental transfers.-deposited
17 in the fund, as permitted by Section 14164:
18:. ` (3) Any interest..that accrues with respect to. amounts
19 in the fund.
20. c Moneys in the fund which shall not consist of an
21 state.,general funds shall be 'used,:as :the source. for..the
22 nonfederal share of payments to hospitals pursuant .to
23. Section,14105.98. Moneys'shall be allocated from the fund .
24 by the department and :matched by federal funds in
accountir25 accordance :` with customary Medi Ca
g
.26 procedures; and used oto snakepayments pursuant to
27 Section.1,4105.98.
28' (d) . Except as otherwise provided in Section:14105.98
29 or in.any:provision of.law appropriating a specified sum
30 .of:. money. to the:..department for 'administering this
31 section and Section 14105.98, moneys in the fund.shall be
32 used only for-the following;
33 (1)' Payments to hospitals:pursuant to Section 141.05..9.8..
34 (2):...Except Jor, the amount transferred pursuant to.
35 paragraph (3),.transfers to.the Health.Care Deposit Fund
36 . as follows:
{ 37 (A). In the amount.of two hundred thirty-nine million
38 seven: hundred fifty-seven ty-seven thousand.:six .hundred ninety
( - 39 dollars .($239,757;690) , for the. 1994=95 and 1995-96 fiscal.40. years.
99
t
— 5 — AB 768
with ( 1 (B) In the amount of two hundred twenty-nine million
r-4(g) 2 seven. hundred fifty-seven thousand six hundred ninety
ented 3 dollars .($229,757,690) for the 1996-97 fiscal year and each
4 fiscal year thereafter.
Lment 5 (C) Notwithstanding any other provision of law, the
asury. 6 amount specified in this paragraph shall be in addition to
Code, r 7 any amounts transferred to the Health Care Deposit
uxider `:� ''�_: 8 Fund arising from changes of. any kind attributable . to
ar .the 9 : payment adjustment years prior to the 1993-94 payment
shall. 10 adjustment year. These transfers from the fund shall be
11 made in six equal monthly installments to the Medi-Cal
.roller 12 local assistance..appropriation item '(Item 4260-101-001 of
sferor13 the annual Budget Act) in support of Medi-Cal
,ction .14. ,expenditures.: The first. installment shall accrue in
15 October of each transfer,year, and all other installments
osited 16 , shall accrue monthly thereafter from November through
17 March:
.ounts . .18 . ' (3) In the.19.93-94 fiscal year,in addition to the amount
19.' transferred as specified in paragraph. (2),, fifteen million
)f any: 20. dollars ($15,000;000) shall . also be transferred to the
)r the0). 21. Medi-Cal local assistance appropriation item (Item
. 0
tnt .to 22 4260-101-001) of.the :Budget Act of 1993,
fund 23 (e) For the .1991-92 state fiscal year, the department
,.ds- in 24 :: shall determine;no later than 70 days after the.enactment
ntirig ,/ 25 of this section, the transferor entities for the 1991-92
.nt. to . ' 26 . transfer , year. To '.make this determination, the
y
27 department shall utilize the disproportionate share list
.05.98 28 : for the 1991-92 fiscal,year,- which shall be issued by the
I sum 29 ' .department no later .than 65 days after the enactment of
this 30; othis section; pursuant to paragraph (1).of subdivision (f)
all be 3,11 of Section 14105,98.1 The department.shall identify.each
32 eligible hospital on the-list for.which.a'pubhc entity-is the
x.9.8. 33 aicensee :as,.of July L .. 199.1. The public entity that is the.
nt.ao. 34 licensee ::of :each identified: eligible hospital,shall be. a
3 , transferor entit for the 1991-92 transfer year.
Fund 5 . . y y.
36- (f) The:department:shall determine, no later than 70
.illion .:37 . ,days after the. enactment. of this section; the transfer
inety 38 amounts,for:the.1991-92 transfer year.
fiscal 39 ;The'transfer amounts shall be determined as follows:
it
99 99
AB 768 — 6 -
1
6 -
1 (1) The eligible hospitals for 1991-92 shall be
-2 identified. For each hospital, -the. applicable total per
3 diem payment adjustment amount under Section
4-14105.98 for the 1991-92 transfer year shall be computed.
5 This amount shall be multiplied by 80 percent. of the
6 eligible "hospital's annualized Medi Cal inpatient paid
7 days as determinedfrom.all Medi-Cal paid claims records t
8 available ,through April 1, 1991. The products of these '
9 calculations for all eligible hospitals shall be added
10 together to determine an aggregate sum for the 1991-92-
ill transfer year. .
12` (2) ;The eligible: hospitals,. for 1991=92 involving
13 transferor entitieslas licensees shall I be identified. For
14: each hospital, the -applicable totalP e- r diem payment
15 adjustment amount' under Section 14105.98 for the
16 `1991-92 transfer year shall be computed. This amount
17: shall be multiplied by 80 percent of the-eligible hospital's
18 annualized Medi-Cal inpatient paid days as determined
19 , from all Medi-Cal paid claims records available through
20 April 1, 1991. Ther products of these calculations for all '
i 21 eligible hositals with transferor'entities:as licensees shall , �: .
22.. be added together to determine an aggregate sum for the
23." 1991 92 transfer year:
24 3 The:a e ate sum determined under ara a h
O Sg PP
25 (1`) . shah,.be divided:by:the aggregate um determined
26 .. under ` ara a h 2 .yielding a factor to be:utilized m
I
P • P ( )
r 27 . paragraph :,(4)
! 28.: (4.) :The factor determined in:paragraph (3) shall be
29=: multiplied:.by the amount: determined:for.each: hospital
30 ;. underparagraph` (2) The product"of,this calculation for
a 31, each hos ital m; ara a h 2 shall be. divided.b 1771,
P P ' p O y
32 yelchng a transfer amount for;the "particular transferor
33 : entity for the transfer.year
34 (g) For:ahe .1991 92 transfer year, . the departmehi
35 shall notify:::each transferor; entity :.in writing of its:
36 �a hscable:tranfer. amount "or amounts `no'later than 70
I PP
4 37 days.after the.enactment:of.-this section.
38 -';.(h) For the .1992-93 -transfer.'
..year.:.and : subsequent
39 transfer.years; transfer, mounts -shall be. determined. in
99
- 7 — AB 768
l
1 be ,�r`7 ; ry, 1 the same procedural manner as set forth in subdivision
l per 2 (f), except:
ction 3 (1) The department shall use all of the following:
uted. 4 (A) The disproportionate share list applicable .to the
F the 5 particular transfer year to determine the, eligible
paid 6 hospitals.
ords 7 (B) The payment adjustment amounts calculated
nese 8 under Section 14105.98 for the particular transferyear.
3ded 9 These amounts shall take into account any projected .or
4-92 10 actual increases or:decreases in the size of the payment
11 adjustment. program as are required under Section
IVing 12 14105.98 for the particular year in question, including any .
For . 13 , decreases resultingfrom the application of the OBRA
hent 14 1993 payment limitation. Subject- to the installment .
the . 15 schedule in paragraph (5) of subdivision (i) regarding
ount 16 transfer amounts, the department may issue . interim,
ital's 17 revised, and supplemental transfer requests.as necessary
ined 18 and appropriate to address changes in payment
)ugh 19 adjustment levels that occur under Section .14105.98. All
all20 transfer . requests,. or adjustments thereto; issued to
shall.,, ��� 21 transferor, entities by the department shall meet the
the 22 requirements set forth in subparagraph (E) of paragraph
23 (5)` of subdivision (i)
24 (C) Data regarding an, Medi-Cal inpatient
Lned �q` 25 paid days for the most recent calendar year ending prior
� }
d in 26 to.. the -beginning of the particular transfer year, as
27 determined from all Medi-Cal paid claims . records
iJ :be 28 available through April 1` preceding the particular
vital . .
29: transfer year.
i for 30: (D) The status of public entities as licensees of eligible.
.771, 31 hospitals as of July, 1 of the particular transfer year.;
6ror 32 (E) � .(i) Except : as provided. in subparagraph . `(ii),
33 transfer amounts. calculated by the department may.be :
lent 34 increased or decreased b a ercenta a amount
��) y p g. .
its.: 35consistent!with.the Medi-Cal State.-Plan.
i 70 36 (ii) For the 1995:-96 transfer:year, the nonfederal share
37 of the secondary supplemental payment :adjustments
lent 38 ..described in paragraph (9) of subdivision (y) of Section
Jin 39 � 14105:98 shall,be,,funded as follows:
AB 768 — 8 —
1 (I) Ninety-nine percent of the nonfederal share shall
2 be funded by a transfer from the University of California.
3 (II) One-percent of. the nonfederal share shall 'be .
4 funded by transfers from those public entities that are the
I 5 licensees of the hospitals included in the `other public.
6 . hospitals" group referred to in clauses (ii) and (iii) of
7 subparagraph (B) of paragraph (9) of subdivision (y) of
8 Section 14105.98. The transfer responsibilities for this one '
9percent shall be.allocated to the particular public entities
10 on a pro rata basis, based on a formula or formulae 1
11 customarily used by` .the. department for allocating
12 transfer amounts under this section. The formula `or 1
13 formulae shall take into 'account; through'reallocation of 1
14 transfer amounts as.appropriate;_the situation of hospitals. 1
15 whose secondary.supple'mental.payment adjustments. are , ]
16 restricted due to the application of the limitation set_forth 1
17 in clause (°v). of. subparagraph (B) . of paragraph (9) of
18 subdivision (y)`: of Section. 14105.98. 1
19 (III)` `All' transfer amounts under this' subparagraph 1
20 shall be paid.by,the particular transferor, entities within : l 2
21 30 days.after the de artment notifies the transferor emit �� (` 2
y. P; Y
22 in writing of the transfer amount-to be.e.-Paid.
23 (2) For the "1993=94 transfer year and .subsequent 2
24. transfer'years; transfer amounts:.:shall -be increased on a ' 2
25 ro. rata basis for.each transferor enti for. the articular 2
P ty , p ) �f. .
26 transfer�. year .in the amounts .. necessary .to fund the 2
27 nonfederal, share of. the total supplemental ,lump-sum 2
4 ` J28 paymentadjustment :amounts that arise under Section 2
' 29 14105.98: For purposes of this paragraph; the 2'
:; 30supplemental lump-sum payment�.adjustment' amounts 3(
31 shall be deemed io :arise for the particular aransfer year "' 3
32 as :of. the :date specified .:in Section 14105.98 Transfer, 3
33: ;amounts to. fund the nonfederal share.' the payments r 3"
i 34 shall be paid by the transferor entities for the particular ,! 3-
35 . transfer year within-20 days after the departrnerit notifies 3�
36 the -transferor entity in writing of the additional transfer 3(
37 amount to be paid 3'
38 3 The de artment. shall re are reliminar . 3'
,i t ) p P P p Y
j 39 analyses -and calculations: regarding :potential transfer. 3!
I. 40 amounts and potential transferor'` :entities shall be d` 4(
99
=— 9 — AB 768
re shall W1 1 notified by the department of estimated transfer amounts
ifornia. 2 as soon as reasonably feasible regarding, any particular
hall be . 3 transfer year. Written notices of transfer amounts shall be
are the 4 issued by,the department as-soon as possible with respect
public. 5 to .each transfer year.: All state agencies shall take all
(iii) of 6 necessary steps in order to supply applicable data to the
(y) of Ai j 7 department to accomplish these: .tasks. The Office of
his one 8 Statewide Health Plan and d Develo merit shall
P
3ntities 9 ...provide to the department quarterly access to the edited
-mulae 10 and unedited confidential patient discharge data files for
)cating -11 all Medi-Cal. eligible patients.. Thedepartment shall
Lula 'or 12 maintain Ihe confidentiality. of .that' data- to :'the same
tion of 13 ..extent,as is .:required.of the Office 'of Statewide Health
►spitals. 14 Planning and -Development. In addition, the Office of
nts are 15 Statewide- , Health Planning and Development shall
a forth 16 provide to the department,not later than March 1 of each
(9) 'of 17 . year ,the data.specified by the -department, as the data
18 existed,on.the statewide data base file'as of February l of
tgraph t 19 , each year;,from.all of the following:.
within 20 (A) ; Hospital'annuaLdisclosure reports, (filed'with the
entity21 Office .of Statewide Health Planning and Development
22 pursuant'to .Section 443:31 or, 128735 of the Health and
�quent 23 Safety Code,, for hospital. fiscal years.that ended during-
on a.` r 24 the calendar,,,-. ending 13 months :prior: to the
.icular t(a' 25 applicable February.1
.d the 26 (B} Annual reports.of hospitals,filed with the Office of
p=sum '27 Statewide Headh�Planning .and. Developr ent :pursuantt
ection 28 to Section 439.2.or.127285 of the Health,and Safety. Code,
the. 29 for the calendary'
eari, nding 13 months prior . to . the
founts �; .30 applicable February 1
r year 31 (Cj Hospital patient discharge data.reports;filed with.
ansfer 32 the ,O£fiee of:; ..Statewide Health Plarming and
:u.ents ,3 33 Development ,pursuant to subdivision (g) .:of Section
ioular �ti 34 443:31 or 128735 of-the Health and Safety Code, for, the
Lilies '35 :calendar.,year: ending 13;months--prior to, th'e applicable
a s£er 36 . :February l
37 :(D) Any other materials on ;file with the Office of
Binary . 38 : Statewide.IHealth Planning and Development;
rasfer. 39 (4) For .the , 1993-94, transfer year, . and subsequent
.11 be transfer,years, the divisor to be used for purposes of the
99 99
AB 768 _ 10 —
L
10 -1 calculation referred to in paragraph (4) of subdivision (f)
2 shall be determined by the department: The divisor shall
' 3. be calculated to ensure that the appropriate amount of
4 transfers from transferor entities are received into the
5 fund to 'satisfy the requirements .of Section 14105.98 for
6 the particular transfer year.For the 1993-94 transfer year,
7 the divisor shall be 1.742.
8 . (5) . For,,the 1993-94 fiscal year, the transfer amount .tf.' )�
9 that would otherwise be required from the University of
10 California shall be increased by fifteen million dollars
11 .($15 000 000)
12 (6) Notwithstandi ig.,any other provision of law, the
13 total' amount .of transfers required from the transferor
14 :entities for any;,particular transfer year shall not exceed
15 the sum of.the following
16 (A) The amount needed to:fund the no share
17 of all payment .-adjustment amounts applicable . to the
18 particular.payment adjustment year as calculated under
19 Section 14105.98. Included in the calculations .for this
20 purpose shallbe any decreases in the program as a whole,
21 . and for individual` hospitals, that arise due to they (`
22 . 'provisions of Section 1396r-4(f) or .(g) of:Title 42 of the
23 .United States Code..
24 (B) The amount-°needed to fund the transfers to the
25 Health Care Deposit Fund,-,,as referred to in paragraphs ) (((,
26 2 and . 3 of subdivision d
O O O i
27 (7.) (A).'.Except asprovided in subparagraph '(B) and
28 . in paragraph .(2) of- subdivision (j) and- except,, for a
29 prudent reserv& not. to exceed, two million dollars
30.' ($2,000;000) in the Medi-Cal' . Inpatient Payment ,
. 31 Adjustment :Fund an '
y amounts m the fund;.including
32. interest that accrues`wit h respect.to the amounts in the
33 fund, that are,not expended,:or estirriated to .be=required -
34for expenditure; under Section 14105:98 with respect ao a ) y .
35 particular;,transfer year shalf b returned on a pro rata
36. . basis to the transferor:entities for the. particular transfer
37.. year within ,120 -days after the Aepartment determines
38 that the funds are not needed for. an expenditure in
39 connection with the particular. transfer year.
99
- 11 — 'AB 768
►n (f) 4 1 (B) The department shall determine the interest
Shall 2 amounts that have accrued in the fund from its inception
.nt of 3 through June 30, 1995, and, no later than January 1, 1996,
a the 4 shall distribute these interest amounts ' to transferor
S for 5 ' entities, as follows:
year, 6 (i) The total amount transferred to the fund by each
( 7�, transferor. entity for all transfer years from the inception
ount of the fund through gh June 30, 1995, shall be .determined.
ity of .9 (ii) The.total amounts determined for all transferor
>llars 10 entities under clause .(i) shall be added together,yielding
11 . an aggregate ofthe totalamounts'transferred to.t' he fund
the 12 for all transfer.' years from the inception of the fund
ceror 13 through June 30; 1995:
ceed `_ 14 (iii): The total amount determined under clause (i) for
15 each transferor entity shall be divided by the aggregate
hare 16 amount, determined- under clause (ii)) yielding a
the.. 17 percentage for each transferor entity.
rder 18 (iv). The total amount.of,interest earned by the fund
this 19 from its- inception through June 30, 1995, shall be
dOle, 20 determined:
the 21 v The ercenta e determined under clause iii for
� ) p g � . ) .
F the 22.., each transferor entity,shall be:multiplied-by the amount
23 determined under clause .(iv) _yielding, the amount of
} the 24 interest.that shall he distributedunder,this subparagraph
-xphs (('� 25 to each transferor enti
t3'�
. 26 . (C) Regarding any' funds returned to a .transferor
and 27.-:.entity under subparagraph (A); or interest amounts
or .a 28 distributed -to a transferorentity under subparagraph
liars 29 (B), the department.shall-provide to the transferor entity
cent' 30 ..a written -statement .that explains the ' basis for the
ding _ 31-: particular return or distribution of funds and contains.the
the 32 :general calculations used by: he . department in
fired ( 33.; determining the :amount of the particular return or .
to a 34 distribution:of funds:
rata Notw hbstanding any:other provision of la w, .
tsfer 36 ::including, but hot limited to paragraph (4), with respect Ines37� :to.the transferor entities for the 1997--98 transfer year and
e, in ... 38 subsequent. transfer ,years; as identified pursuant to
39 subparagraph :(D) ¶graph (1), transfer amountsfor
<<<1?
I
AB 768 — 12 —
I
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1 the particular transfer year shall be limited as set forth in
2 subparagraph (B).
3 (B) The transfer:amounts payable by each transferor
4 -entity for the 1997.-98 transfer year and subsequent
5 Itransfer,years shall be limited to the amounts that would
6 have been payable by the particular transferor entity for
7 the particular transfer year had all transferor entities for
8 the 1996-97 transfer year con tin ued to be transferor,
9 entities for the particular transferyear, and had each
10 transferor entity for the 1996-97 transfer year con tin ued
.11 to own and operate during the particular transfer year
12 , ea'eh hospital that the transferor entity owned and
13 operated at`any time during the 19997 transfer year.
14 (i) (1) For the 1991-92 transfer year, each transferor
15 . entity shall pay its transfer amount or amounts to the
16 Controller, . for deposit in the fund, in eight' equal
17 installments. Except as . provided below, the first
18 installment shall accrue on. July 25, 1991, and all other
19 installments shall accrue on the fifth day, of each.month
20 thereafter from•August through February.
Iti
21 (2) Notwithstanding paragraph (1), no installment
22 , shall"be payable to the Controller until that date which is
'23 <20'da s after the,de � artinentnotifies the transferor entity .
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!i 24 in writing that the payment adjustment,program set forth -'•�
25 n Section:14105.98 has first: gained :federal approval as..
26part'. of the: Medi-Cal.,.,program. For purposes of this ;
`27 . paragraph,.federal approval'requires both (i) approval by
28 appropriate federal. agencies of an amendment to the
29 Medi-Cal State Plan; as.referred to in subdivision (o). of
30. . Section 14105.98, "and ii . confirmation b appropriate
( ) Y'
31 " federal agencies regarding the availability of. ;federal
32 financial participation for the "payment adjustrnent
33:; program set-forth in Section.14105.98 ata level of at-least
34 40 ercent of the percentage',
of federal ;financial
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1 : `35 participation that .is normally; applicable for Medi-Cal
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36 ;expenditures for acute inpatient hospital services.
37 (3) If any installment that would otherwise be payable
38 . under paragraph (1) is not paid because of the provisions
39. ' of paragraph (2), then subparagraphs (A) .and (B) shall n
40 ..be followed when federal approval is gained. ,
1 99
- 13 — AB 768
,thin .1 (A) All installments that were deferred based on the
2, provisions of.paragraph (2) shall be paid no,later than 20
,feror 3 days after the department notifies the transferor entity in.
uerit 4 writing that federal. approval has been gained; in an
would 5 amount,consistent with subparagraph (B)
'tyfor 6 (B) The, installments paid pursuant to subparagraph
es for �`' 7 (A) shall be paid in full..
,feror 8 (4) All installments for the 1991-92'transfer year that
each 9, arise..in months after federal approval is gained shall be
r'nued 10 paid by- the fifth day of the month or 20 days after _the
year 11 department notifies the transferor entity in writing that
I and 12 federal approval.has-been gained, whichever is later..
ea_r. 13 (5). (A) 'Except as,provided in subparagr'aphs (B) and
;feror 14 (C),for tho.1992-93 transfer year and subsequent transfer
o the 15 years, each.transferor entity shall pay its transfer amount
equal 16. or amounts to the Controller.; for deposit in the fund, in .
first 17, eight equal: installments. The first installment, shall be .
other 18 payable on July 10 -of each ..transfer year. All other
ionth A. installments shall be. :payable on the fifth day of each
CI).
..20. :month thereafter from August through.February.
ment 21 . (B):. .For the, 1994-95 transfer year, each transferor
rich is . 22 entity shall pay .its .transfer amount or amounts to the
entity. . 23 Controller; for deposit in . the fund, in . five equal
forth ;,ry .24 _ installments. The: first -installment.shall be ,payable on, .
ral as ;: .25 October 5, 1994., The next four installments shall be
this ; 26 payable on the fifth, day of each.monththereafter from
,ral by 27 . November through. February
o the 28 . (C) For. the 1995-96 transfer year, each transferor
o) of 29 entity shall'pay its transfer amount or amounts to the
)riate 30 Controller, .for .deposit: in the fund, in five equal.
decal 31 installments:. The first installment shall be payable :on
rneint 32 October., 5 ' .1995: Thenext four installments :shall: be
least ( '33. payable',.on the:fifth day of.,each' month thereafter from .
racial �L 34 November"through February:
li-Cal 35 (D) 'Except. . as otherwise specifically provided,
'36 subparagraphs (A) :to (C); inclusive; shall not apply. to
Viable 37 increases ' f sfer.amounts described in paragraph .(2)�
,ions 38 of subdivision .(h).-or ,to additional transfer amounts
shall . 39 described.in subdivision (o) .
AB 768 — 14 -
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1 (E) All requests for transfer payments, or adjustments 1
2
2 thereto, issued by the department shall be in writing and 3
3 shall include (i) an . explanation of the basis for the
4 particular transfer -request 'or transfer activity; (ii) a 4
5 summary description of program funding status for the 5
6 particular transfer year,and (iii)' the general calculations 6 '
7 used by the department in connection with the.particular 7
8 transfer request or transfer activity. 8
9 6 A transferor entity, may use an of the following. 9
( ). Y Y Y10 �
10 funds for purposes of meeting its transfer obligations
11 under this.section: 11 .
12
-12 (A):,General funds of the:transferor entity
13 (B). Any other funds permitted"'by law to be used for 13
14 these purposes,, except. that �a trransferor;entity.'shaU not
14
15.: submit to -the Controller any federal funds unless.those
16 federal funds are;authorized by.;federal law to be used to 16 i
17 match other federal funds. In addition, norivate 17
p 18
18 donated funds from any.:health care,provider, or from any 19 1
19 -person or. organization affiliated with such'a,:health care -
20 provider,.shall be,channeled through a transferor entity _ �;, 20
er ublic`enti to.ahe fund.`- The transferor 21 t
21 or any oth p ty
22 entity shall be responsible for determining .that funds
23 transferred.meet the requirements of this aubparagraph : 23 c
1 If a `transferor enh does not; submit ,`an 24
24 �j) O t�rne Y25
.periods ecified in .this
25 transfer`amount withui the p
.`26 section, the Controller= shall offset' immediately`,:the . 26 ]
27 amount owed'against:any:funds which otherwise.would 27
28-bei payable by the -state. to :the transferor, entity. The' 28 i
29 `
Controller: however" shall ,not impose an` offset against 30 29 I
30 ari articular funds'- a able to the transferor entit t
Y .P p Y Y 31 c
31 where.the offset would violate state or federal law :
32 (2) -Where A withhold or a' recoupment occurs, 32 ; i
r - (2) 'o , s 33 1subdivisi33pursuant to the xovisionsoaa a hon
34 1.
34 (r). of Section 14105.98; he nonfederal :portion of the: :
35 amount -in question: shall`"remain-in.the fund, or shall be : 35
36 . redeposited'inthe fund by Elie department; as.app licable.`, 36 t
37. The department shall then proceed.as:follows: 37 s
38 (A). If-the withhold'or recoupment.:was imposed with . 38 s
39 respect to a hospital~whose--. 'w
was a transferor' 39
40 'entity for the particular state fiscal -year to which the z` 40 s
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1 withhold or recoupment related, the nonfederal portion
rents
g and, 2 of the amount withheld or recouped shall serve as a credit
r the 3 for the particular transferor entity against an equal
(u) a 4 amount of transfer obligations under this section, to be
)r the 5 applied ,whenever the transfer obligations next arise.
itions 6 Should no such,transfer obligation arise within 180 days,
icular, 7 the department.shall return the funds in question to the
. 4 8 particular. transferor entity within 30 days.thereafter.
swing 9 (B) For other situations, he withheld or recouped
itions 10 nonfederal portion .shall be subject to paragraph (7) of
11 subdivision (h) .
12 . (k) 111. amounts received by the Controller pursuant
,d=for 13 to subdivision M, paragraph (2) of subdivision (h), or
Un 14 subdivision (o), or. offset by.the Controller pursuant ,to
those 15 subdivision 0) , shall_immediately be deposited in the
.ed to 16 fund.
ivate 17 (l). For :purposes of this section, the disproportionate
n any
18: 1 share list utilized by the department for a particular
care 19 transfer year. shall be .identical to the disproportionate
ntit l 20 share list.utilized by.the department for the same state
y 21 fiscal year, for purposes of Section 14105.98. Nothing on a
feror
=ands 22 disproportionate share list, once issued by the
rap . ., .
23 . department, shall be modified for any reason other than
24 mathematical or typographical errors or omissions on the
25 part.of the de artinent or:the Office of Statewide,Health
p -
the ;' 26 Planning and Development in preparation of the list.
could 27 (m) Neither . the intergovernmental transfers
The : required-by:this section, :nor any elective transfer made
;ain't 29 pursuant ao Section 14164, shall create,:lead.to; or expand
30 . 1h e'health care funding or service obligations for current
�ntity _
31 or .future years for any transferor entity, except as
ccurs 32 required of the.state by this section or as may be required
33 by: federal law in which case the state shall be held
sion s i
f the , 34 harmless by' the transferor.entities on a pro.rata basis:
ill_be...
35 (n) ,No amount submitted to the Controller :pursuant
able.. . 36 to subdivision (i), :paragraph (2). of subdivision ,(h)., or
:37 subdivision (o), or offset by the Controller pursuant to
with38 :subdivision:. (j); shall be claimed. or recognized as an
feror' 39. : allowable element. of cost .:in Medi-Cal cost reports
i . e l 40 submitted.t ' the:.department.
AB 768 — 16 —
1 (o) Whenever additional transfer amounts are 1 '
2 required to fund the nonfederal share of payment
3 adjustment amounts- under Section 14105:98 that are
{
4: distributed after , the close of the particular payment
5 adjustment year to which . the payment adjustment �.
6; amounts apply; the additional transfer amounts shall be
7 paid by the parties who-were the. transferor entities for
8 the particular transfer year.that was concurrent with the .
a .
.9 particular payment adjustment year. The additional
10 transfer.;amounts shall be calculated under the formula,
11 that was in effect during the articular transfer ear: For
i g P y
12 . transfer years prior--.to Ahe 1993-94 transfer. year, the' ,
13 :,percentage of the additional ;transfer amounts available
} 14 for transfer' to: the. Health Cane Deposit Fund under
15 subdivision (d) shall be the percentage. that was in effect {
16 during the particular transfer year. nal
These additio
17 transfer :amounts shall be paid. by transferor entities }
1' '''With�ci 20 days after the department notifies the
1.9 transferor. entity, m, writing of the additional 'transfer �
20' amount to be.paid
21 (p) (1) 'Ten million dollars ($10,000;000) of the=
22: amount transferred from the . Medi CaL Inpatient
23 Payment-:Adjustment Fund to the Health Care Deposit
-24;.'., Fund due- to.amounts transferred attributable to years
25 .prior to the 1993-94 cal year is hereby"appropriated ,z3
26 ''-without.regard to fiscal years to the State Department of
27.; Health Services to be.used to.support the-development of
28 managed care,programs,under;the department's plan°to
29 expand Medi=Cal managed care
h; 34 (2) :These, funds.shall.be used by the department for
31 ., both of the following .purposes.: (A) -distributions .to
32 counties..or, other local,entities that contract with the
: 33 department to receive those funds to offset a portion of
} 34 the .casts of forming the Iocal'initiative: entity, and B
{
l 35 .s°distributions;to local initiative entitles that contract with
36 the department to::receive those fdiids to offset a portion
37 of the costs o£ developing. the local initiative health
38 delivery system iri.`accordance with the department's.
f. 39 plan to.expand Medi-Cal managed care
i
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are 1 (3). Entities contracting with the department for any "
Lent 2 portion of the ten million dollars ($10,000,000) shall meet
are 3 the objectives of the' department's plan . to expand
gent 4 Medi-Cal managed care with regard to :traditional and
lent 5 safety net providers.
I. be 6 .(4) Entities contracting with. the department for any
for ,:; 7 portion of the. ten million dollars ($10,000,000) .may be
the 8 authorized under those contracts to utilize their funds to
)nal 9 provide :for reimbursement of. the costs of local
Lula . 10 organizations and entities incurred in participating in"the
For" 11 . development and operation.of"a local.initiative.
the 12.1 (5) To, .the .full extent permitted by state and federal
,.ble 13. law, these funds shall:be distributed.by the "department.
der' 14 for. expenditure at. the. local level .in- a "manner that
ect 15 ..qualifies: for federal financial participation under the
final 16 .medicaid program.
hes 17 ` SEC. 2. This act is an urgency statute necessary for.the
the 18 , immediate :preservation of the publicpeace, health, or
;fer : 19 safety within the meaning of Article . IV of the
20 Constitution and shall go into immediate-effect. The facts..
the 21. constituting the necessity are:
ent 22 In : order to . ,ensure sufficient., funding " for .;
Osit ; 23 disproportionate share providers in the. Medi;.-Cal
'ars 24 program to enable ahem' to "provide sufficient access to
ted " tr;( " 25 Medi`:Cal benefits as soon as possible; it is"necessary that
t of 26 . this act_take effect immediately.
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99 99