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AB-1728 Health care programs: provider reimbursement rates.(2011-2012)

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AB1728:v97#DOCUMENT

Amended  IN  Assembly  April 16, 2012
Amended  IN  Assembly  March 27, 2012

CALIFORNIA LEGISLATURE— 2011–2012 REGULAR SESSION

Assembly Bill
No. 1728


Introduced  by  Assembly Member Galgiani

February 16, 2012


An act to amend Section 14105.18 of the Welfare and Institutions Code, relating to health care, and declaring the urgency thereof, to take effect immediately.


LEGISLATIVE COUNSEL'S DIGEST


AB 1728, as amended, Galgiani. Health care programs: provider reimbursement rates.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law requires the department and other state agencies to administer various health programs, including the California Children’s Services Program, Genetically Handicapped Person’s Program, Breast and Cervical Cancer Early Detection Program, State-Only Family Planning Program, Family Planning, Access, Care, and Treatment (Family PACT) Program, Healthy Families Program, and Access for Infants and Mothers Program. Existing law requires provider rates of payment for services under these programs to be identical to the rates of payment for the same service performed by the same provider type pursuant to the Medi-Cal program.
This bill would provide an exception to this latter provision and require hospital inpatient rates of payment for specified programs for dates of service on or after January 1, 2011, through December 31, 2016, to be 90% of the Medi-Cal hospital interim rates of payment, as developed by the department.
This bill would declare that it is to take effect immediately as an urgency statute.
Vote: MAJORITY2/3   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 Section 14105.18 of the Welfare and Institutions Code is amended to read:

14105.18.
 (a) Notwithstanding any other law, and except as provided in subdivision (d), provider rates of payment for services rendered in all of the following programs shall be identical to the rates of payment for the same service performed by the same provider type pursuant to the Medi-Cal program.
(1) The California Children’s Services Program established pursuant to Article 5 (commencing with Section 123800) of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code.
(2) The Genetically Handicapped Person’s Program established pursuant to Article 1 (commencing with Section 125125) of Chapter 2 of Part 5 of Division 106 of the Health and Safety Code.
(3) The Breast and Cervical Cancer Early Detection Program established pursuant to Article 1.3 (commencing with Section 104150) of Chapter 2 of Part 1 of Division 103 of the Health and Safety Code and the breast cancer programs specified in Section 30461.6 of the Revenue and Taxation Code.
(4) The State-Only Family Planning Program established pursuant to Division 24 (commencing with Section 24000).
(5) The Family Planning, Access, Care, and Treatment (Family PACT) Program established pursuant to subdivision (aa) of Section 14132.
(6) The Healthy Families Program established pursuant to Part 6.2 (commencing with Section 12693) of Division 2 of the Insurance Code if the health care services are provided by a Medi-Cal provider pursuant to subdivision (b) of Section 12693.26 of the Insurance Code.
(7) The Access for Infants and Mothers Program established pursuant to Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code if the health care services are provided by a Medi-Cal provider.
(b) The director may identify in regulations other programs not listed in subdivision (a) in which providers shall be paid rates of payment that are identical to the rates of payments in the Medi-Cal program pursuant to subdivision (a).
(c) Notwithstanding subdivision (a), services provided under any of the programs described in subdivisions (a) and (b) may be reimbursed at rates greater than the Medi-Cal rate that would otherwise be applicable if those rates are adopted by the director in regulations.
(d) Hospital inpatient rates of payment for services rendered in the programs described in paragraphs (1) to (5), inclusive, of subdivision (a) for dates of service on or after January 1, 2011, through December 31, 2016, shall be 90 percent of the Medi-Cal hospital interim rates of payment, as developed by the department.

SEC. 2.

 This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to make changes to state-funded health programs to prevent the retroactive recoupment of funds paid to hospitals for inpatient services, it is necessary that this act take effect immediately.