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AB-2439 Medi-Cal: disproportionate share hospital replacement payment adjustments.(2019-2020)

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Date Published: 02/19/2020 09:00 PM
AB2439:v99#DOCUMENT


CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 2439


Introduced by Assembly Members Megan Dahle and Mathis
(Coauthors: Assembly Members Flora and Obernolte)

February 19, 2020


An act to amend Section 14166.3 of the Welfare and Institutions Code, relating to Medi-Cal, making an appropriation therefor, and declaring the urgency thereof, to take effect immediately.


LEGISLATIVE COUNSEL'S DIGEST


AB 2439, as introduced, Megan Dahle. Medi-Cal: disproportionate share hospital replacement payment adjustments.
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 services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law establishes the Medi-Cal Hospital/Uninsured Care Demonstration Project Act. The act revises hospital supplemental payment methodologies in the Medi-Cal program to maximize the use of federal funds consistent with federal Medicaid law and to stabilize the distribution of funding for hospitals that provide care to Medi-Cal beneficiaries and uninsured patients. This demonstration project provides funding, in supplementation of Medi-Cal reimbursement, to various hospitals, such as designated public hospitals, specified nondesignated public hospitals, and private hospitals, in accordance with certain provisions relating to disproportionate share hospitals. Existing law establishes several continuously appropriated funds, including the Demonstration Disproportionate Share Hospital Fund, the Private Hospital Supplemental Fund, the Nondesignated Public Hospital Supplemental Fund, and the Distressed Hospital Fund, to be expended by the department for purposes of the act.
This bill would require the payment of Medi-Cal disproportionate share hospital replacement payment adjustments to any eligible hospital that is a nondesignated public hospital. By expanding the purposes of continuously appropriated funds by authorizing payment of appropriated funds to additional hospital facilities, this bill would make an appropriation.
This bill would declare that it is to take effect immediately as an urgency statute.
Vote: 2/3   Appropriation: YES   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 Section 14166.3 of the Welfare and Institutions Code is amended to read:

14166.3.
 (a) During the demonstration project and successor demonstration project terms, payment adjustments to a payment adjustment to a disproportionate share hospitals hospital shall not be made pursuant to Section 14105.98. Payment adjustments to A payment adjustment to a disproportionate share hospitals hospital shall be made solely in accordance with this article.
(b) Except as otherwise provided in this article, the department shall continue to make all eligibility determinations and perform all payment adjustment amount computations under the disproportionate share hospital payment adjustment program pursuant to Section 14105.98 and pursuant to the disproportionate share hospital provisions of the Medicaid state plan in effect as of the 2004–05 state fiscal year. For purposes of these determinations and computations, services that are any service rendered under the Health Care Coverage Initiative authorized pursuant to Part 3.5 (commencing with Section 15900) or the Low Income Health Program authorized pursuant to Part 3.6 (commencing with Section 15909) shall be included.
(c) (1) Notwithstanding Section 14105.98, the federal disproportionate share hospital allotment specified for California under Section 1396r-4(f) of Title 42 of the United States Code for each of federal fiscal years 2006 to 2015, inclusive, and federal fiscal year 2016 with respect to the pro rata portion of the allotment that will apply during successor demonstration year 10 pursuant to paragraph (2), shall be distributed solely among the following hospitals:
(A) Eligible hospitals, An eligible hospital, as determined pursuant to Section 14105.98 for each project year and successor demonstration year in which the particular federal fiscal year commences, which meet that meets the definition of a public hospital as specified in paragraph (25) of subdivision (a) of Section 14105.98.
(B) Hospitals that are A hospital that is licensed to the University of California, which meet California and meets the requirements set forth in Section 1396r-4(d) of Title 42 of the United States Code.
(2) The federal disproportionate share hospital allotment for each of the federal fiscal years 2006 to 2015, inclusive, shall be aligned with the project year or successor demonstration year in which the applicable federal fiscal year commences. The payment adjustment year, as used within the meaning of defined in paragraph (6) of subdivision (a) of Section 14105.98, shall be the corresponding project year or successor demonstration year. With respect to successor demonstration year 10, the period of July 1, 2015, through October 31, 2015, shall be aligned with a pro rata portion of the federal disproportionate share hospital allotment for federal fiscal year 2016.
(3) Uncompensated Medi-Cal and uninsured costs costs, as reported pursuant to Section 14166.8, shall be used by the department as the basis for determining the hospital-specific disproportionate share hospital payment limits required by Section 1396r-4(g) of Title 42 of the United States Code for the hospitals described in paragraph (1).
(4) The distribution of the federal disproportionate share hospital allotment to hospitals described in paragraph (1) shall satisfy the state’s payment obligations, if any, with respect to those hospitals under Section 1396r-4 of Title 42 of the United States Code.
(d) Eligible hospitals, as determined pursuant to Section 14105.98 An eligible hospital, as described in paragraph (3) of subdivision (a) of Section 14105.98 for each project year and each successor demonstration year, which are that is a nonpublic hospitals, hospital, nonpublic-converted hospitals, and hospital, or converted hospitals, hospital, as those terms are defined in paragraphs (26), (27), and (28), respectively, of subdivision (a) of Section 14105.98, shall receive Medi-Cal disproportionate share hospital replacement payment adjustments pursuant to Section 14166.11 and other provisions of this chapter. The payment adjustments so provided shall satisfy the state’s payment obligations, if any, with respect to those hospitals to that hospital under Section 1396r-4 of Title 42 of the United States Code. The federal share of these payments shall not be claimed from the federal disproportionate share hospital allotment described in subdivision (c).
(e) If an eligible hospital, as described in paragraph (3) of subdivision (a) of Section 14105.98, is a nondesignated public hospital, the eligible hospital shall receive Medi-Cal disproportionate share hospital replacement payment adjustments pursuant to Section 14166.11 and this chapter.

(e)

(f) The nonfederal share of payments described in subdivisions (c) and (d) shall be derived from the following sources:
(1) With respect to the payments a payment described in paragraph (1) of subdivision (c) that are is made to a designated public hospitals, hospital, the nonfederal share shall consist of certified public expenditures described in subparagraphs (A) and (C) of paragraph (2) (1) of subdivision (a) of Section 14166.9, and intergovernmental transfer amounts described in paragraph (2) of subdivision (d) of Section 14166.6.
(2) With respect to the payments a payment described in paragraph (1) of subdivision (c) that are is made to a nondesignated public hospitals, hospital, the nonfederal share shall consist solely of state General Fund appropriations.
(3) With respect to the payments a payment described in subdivision (d), the nonfederal share shall consist of state General Fund appropriations.

(f)

(g) (1)  During the terms of the demonstration project and successor demonstration project, for the 2005–06 state fiscal year and any subsequent state fiscal years, no a public entity shall not be obligated to make any intergovernmental transfer pursuant to Section 14163, and all transfer amount determinations for those state fiscal years shall be suspended. However, during the demonstration project and successor demonstration project terms, intergovernmental transfers shall be made with respect to the disproportionate share hospital payment adjustments made in accordance with paragraph (2) of subdivision (d) of Section 14166.6, or paragraph (2) of subdivision (d) of Section 14166.61, as applicable.
(2) During the terms of the demonstration project and successor demonstration project, for the 2005–06 state fiscal year and any subsequent state fiscal years, transfer amounts from the Medi-Cal Inpatient Payment Adjustment Fund to the Health Care Deposit Fund, as provided for pursuant to paragraph (2) of subdivision (d) of Section 14163, are hereby reduced to zero. Unless otherwise specified in this article, this paragraph shall be disregarded for purposes of the calculations made under Section 14105.98 during the demonstration project and successor demonstration project.

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 California Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to maximize innovative health care and hospital financing within the Medi-Cal program, it is necessary that this act take effect immediately.