HomeMy WebLinkAboutMINUTES - 03122002 - C17 !f Q j,sras�t
TO: BOARD OF SUPERVISORS CONTRA
FROM John Sweeten, County Administrator CQ►�'''►TA
R COUNTY
DATE: March 12, 2002 _.
SUBJECT: AB 2510 (Canciamil'la) - Sponsor
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & 'BACKGROUND AND JUSTIFICATION
RECOMMENDATION(S):
SPONSOR AB 2510 (Canciamilla), which would regulate reimbursement rates for emergency
hospital services provided to specified Medi-Cal beneficiaries.
BACKGROUNDIi EASONfSI:FOR RECOMMENDATION(S):
The 2002 County Legislative Program includes the following platform position:
SPONSOR legislation to clarify that County payments to private, non-contracting hospitals
for inpatient services shall be based on a percentage of actual hospital'charges that are
derived from either the lower of the "audited" or "as filed" cost reports submitted to the
State of California.
Current law requires the County Health Plan to pay private non-contracting:hospitals a percent of
the actual charges incurred by the hospital for services for its heap plan enrollees. The
percentage of actual charges is determined by the state based on the hospital's audited cost
report, done by the state. Unfortunately the state is normally two to three years behind' in auditing
hospital cost reports. As a result, the County Health Plan is paying for services based on old and
outdated information. The net result, according to the Health Services Department, is additional
costs to the County Health Plan.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
7-
-=RECOMMENDATION OF COUNTY ADMINISTRATOR____RECOMMENDATION of ITTEE
APIRO1t1 OTHER
SIGNATURE(S): '
ACTION of BOAR arc APPROVED AS RECOMMENDED X OTHER
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A
X UNANMMOUS[ABSENT NanP ! TRUE AND CORRECT COPY OF AN
AYES: NOES: ACTION TAKEN AND ENTERED'.,
ABSENT: ABSTAIN: ON MINUTES.Of THE BOARD OF
SUPERVISORS ON THE DATE SHOWN.
Contact: Sara Hoffman,835-101
ATTESTED Magh.:12. 20
JOHN SWEETEN,CLERK OF,
THE BOARD OF SUPERVISORS
AND COUNTY ADMINISTRATOR
cc: CAO
William Walker,Health Services `
Pat Godley.Health Services BY, DEPUTY
County Lobbyist
SACNROUNDIREASt) S� Ft�R ItECQ�i MENDATION fcont'd1
AB 2510 would charge the payment requirements for two plan model managed care programs, such
as Contra Costa County, to the actual billed charges, the amount due to the hospital under contract
with the prepaid health plan or the average CaliforniaMedical Assistance Commission rate for the
geographical region, whichever is the least amount.
CALIFORNIA LEGISLATURE-200142 REGULAR SESSIOhI
ASSEMBLY BILL No. 25111'
Introduced by Assembly.Member Canciamiiia
February 21, 2002
An act to amend Section 14105.15 of the Welfare and Institutions
Code,relating to Medi-Cal
LEGISLATIVE COUNSEL'S DIGEST
AB 2510,as introduced, Canciamilla. Medi-Cal: reimbursement
Existing;' law ;provides for the Medi-Cal program, which is
administered by the State Department of Health Services,pursuant to
which medical benefits are provided to public assistance recipients and
certain other low-income persons.
Existing;,law mandates a procedure for the reimbursement of hospital
inpatient hospital services under the Medi-Cal program
This bill would limit Medi-Cal ,reimbursement for emergency
hospital services provided within the state to Medi-Cal beneficiaries
who are enrolled in a prepaid health plan to the amount due to the
hospital under a contract with the prepaid health plan or a specified rate
for the geographic region,or the actual bill charges,whichever is least.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program:no.
The people of'the,Shite of California do enact as,follows;
1 SECTION 1. Section 14105.15 of the Welfare and
2 Institutions Code is amended to read:
3 14105.15." (a) (1) In determining rates of reimbursement for
4 impatient hospital services the department shall use the
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AB2510 —2-
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--Z-1 reimbursement policy existing on June 29, 1982.The director shalt
2 have authority to modify this reimbursement policy. The director
3 shall implement a new reimbursement policy of peer grouping of
4 hospitals through the promulgation of emergency regulations after
5'" required federal approvals are obtained. The department may
6 adjust interim payment percentages to hospitals in order to
7 approximate final settlement and may control or freeze charges in
8 order to carry out this section.
9 (2) This section shall cease to apply to a hospital when the
10 department enters<into a contract, pursuant to .Article 2.6'
11; (commencing with Section 14081), either with that hospital or
12 with other hospitals to the exclusion of that hospital for services
13 'covered under the contracts.
14 (b)'Notwithstanding any other provision of law,the;department
15 may make interim rate adjustments and also implement collection
16 procedures to recover overpayments to hospitals,at tentative and
17 final settlement. These recoveries shall be based on audits or
18 examinations made by or on behalf of the department pursuant to
19 Sections 10722 and 14170,including the application of Sections
20 51536, 51537, and 51539 of Title 22 of the California
21 Administrative Code at tentative and final settlement. Recovery
22 may be made whether or not appeals by the hospitals are pending,
23 Collection of overpayments shall be made in accordance with
24 Section 14172.5.
25 (c) The amendment of this section made at the 1985 portion of
26 the 1985-86 regular Session of the Legislature does not constitute
27 a change in,but is declaratory of,the existing law.This declaration
28 shall not apply to any lawsuits filed on or before July 9, 1985.
29 (d) 1t is the intent of the Legislature to evaluate;alternative
30 payment systems for hospitals in health facility planning areas
31 which are not closed for contracting purposes and noncontracting
32 'hospitals in closed areas.The alternatives shall include,but are not
33 limited to,selective contracting,prospective payment systems,or
34 other feasible options.Any alternative payment system presented
35 to the Legislature shall include at least all of the following.
36 (1) :,Payment adjustments which recognize the situation of
37 hospitals serving a disproportionate share of low-income patients
38 with special needs.
39 (2) The potential'need for payment differentials between urban'
40 and rural hospitals:
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1 (3) Alternative data bases, base years, and payment code
2 weighting considerations.
3 (4) Potential outliers or exemptions,or bath;from prospective
4 payment regarding patient cost,length of stay,or type of service:
5` (5) Facility-specific considerations,
6 (6) Appeals processes and updating mechanisms.
7' (e) 1n order to evaluate the alternatives, the department may
8 select a contractor to conduct a study and prepare a report which
9 shall include preparation of a general systems design of the
10 alternatives and estimate costs of developing a detailed system
11 design of the recommended alternative. The alternatives shall
12 include,but not be limited to,the reduction of administrative costs
13 'to the department and hospitals,incentives for hospitals to contain
14 their costs,and the provision of appropriate and timely payments
15 to hospitals.
16 (f) The contractor and department shall solicit the cooperation
17 and assistance of the hospital industry and shall consider its
18 recommendations throughout the course of the study.
19 (g) The department may submit a report to the Legislature by
20 ; January 31, 1989.The report shall include the contractor's report
21 prepared pursuant to subdivision(c).The department's report shall
22 contain, but shall not be limited to, information on hospital
23 structures and costs on file with the State Department of Health
24 Services,and financial and patient discharge data on file with the
25 Office of Statewide Health'Planning and Development.The report
26 shall include the comments and recommendations of the hospital
27 industry.
28 (h) No new payment system`may be implemented without
29 >specific authorization from the Legislature.
30 (i) Notwithstanding any other provision of law,reimbursement
31 for out-of-state acute inpatient <hospital services provided to
32 Medi-Cal beneficiaries shall not exceed the current statewide
33 ;average of contract rates'for acute inpatient hospital services
34 negotiated by the California Medical Assistance Commission or
35 the actual billed charges,whichever is less,
36 Oji Notwithstanding any other provision of law, reimbursement
37 for emergency hospital services provided within the state to
38 'Medi-Cal beneficiaries who are enrolled in a prepaid health plan
39 <under the two-plan model managed care program pursuant to
40 Section 53800 of Iftle 22 of the California Code of Regulations,
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AB 2510' —4-
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•-41 as defined in subdivision (Il) of Section 53810 of Tftle 22 of the
2 California Cade of Regulations,shall not exceed the amount due
3 to the hospital under a contract with the prepaid health plan,or the
4 average California Medical Assistance Commission rate for the
5 'geographic region, referred to as Standard Consolidated
6 Statistical Area, or the actual billed charges, whichever is least.
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