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AB-733 Medi-Cal: overpayment forgiveness.(2003-2004)

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AB733:v98#DOCUMENT

Amended  IN  Assembly  April 30, 2003

CALIFORNIA LEGISLATURE— 2003–2004 REGULAR SESSION

Assembly Bill
No. 733


Introduced  by  Assembly Member Longville
(Coauthor(s): Assembly Member Runner)
(Coauthor(s): Senator Knight)

February 19, 2003


An act to amend Section 14176.5 of, and to add Section 14176.7 to, the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 733, as amended, Longville. Medi-Cal: overpayment forgiveness.
Existing law provides for the Medi-Cal program, administered by the State Department of Health Services, under which qualified low-income persons are provided with health care services.
Under existing law, the department audits providers to determine whether any overpayments have been made for Medi-Cal services and, subject to an appeals process, the department is empowered to collect overpayments determined to have been made pursuant to these audits. Existing law also provides that whenever, pursuant to an audit conducted by the department, an overpayment for Medi-Cal services has been made to certain categories of hospitals located in Kern or Monterey Counties for services rendered from January 1, 1992, to December 31, 1997, the department may forgive a hospital the debt arising from the overpayment and interest.
This bill would expand the application of this provision to hospitals otherwise meeting the requirements of this provision, but which are located in San Bernardino County.
This bill would provide that when the department determines pursuant to an audit that a hospital owes a debt arising from an overpayment for Medi-Cal services, and the hospital seeks relief from the debt by the introduction of a bill in the Legislature to authorize the department to forgive the debt, the appropriate policy committee chairperson or fiscal committee chairperson may request an assessment of the legislation from the department, as specified.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 14176.5 of the Welfare and Institutions Code is amended to read:

14176.5.
 Whenever it has been determined, pursuant to an audit conducted by the department, that an overpayment for Medi-Cal services has been made to a hospital for services rendered from January 1, 1992, to December 31, 1997, the department may forgive all or part of the debt arising from the overpayment, and interest, if the hospital is all of the following:
(a) A disproportionate share hospital, as defined in Section 14105.98.
(b) Located in Kern County, San Bernardino County, or Monterey County.
(c) A nonprofit hospital, as defined in Section 127050 of the Health and Safety Code, or not affiliated with a hospital system.

SEC. 2.

 Section 14176.7 is added to the Welfare and Institutions Code, to read:

14176.7.
 (a) When the department determines pursuant to an audit that a hospital owes a debt arising from overpayment for Medi-Cal services, and the hospital seeks relief from the debt by the introduction in the Legislature of a bill to authorize the department to forgive the debt, the appropriate policy or fiscal committee chairperson may request an assessment of the legislation from the department. The department shall provide this assessment within 45 days of the chairperson’s request.
(b) The assessment performed by the department shall evaluate the following:
(1) The cause of the overpayment.
(2) The ability of the hospital to repay the debt.
(3) The fiscal solvency of the hospital.
(4) The impact that repayment of the debt would have on services provided by the hospital.
(5) Whether the hospital is a disproportionate share hospital.
(6) The impact of failure to forgive all or part of the debt on patients’ access to health care services.