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AB-180 Medi-Cal.(2017-2018)

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Date Published: 09/05/2018 09:00 PM
AB180:v95#DOCUMENT

Enrolled  September 05, 2018
Passed  IN  Senate  August 31, 2018
Passed  IN  Assembly  August 31, 2018
Amended  IN  Senate  August 15, 2018
Amended  IN  Senate  May 26, 2017
Amended  IN  Senate  May 18, 2017

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill
No. 180

Introduced by Assembly Member Wood
(Coauthor: Senator McGuire)

January 18, 2017

An act to add Section 14132.103 to the Welfare and Institutions Code, relating to Medi-Cal, and declaring the urgency thereof, to take effect immediately.


LEGISLATIVE COUNSEL'S DIGEST


AB 180, Wood. Medi-Cal.
(1) Existing law establishes 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 provides that federally qualified health center (FQHC) services and rural health clinic (RHC) services are covered benefits under the Medi-Cal program to be reimbursed, to the extent that federal financial participation is obtained, to providers on a per-visit basis.
This bill would, on or before March 1, 2019, require the department to establish a stakeholder process to assist the department in developing guidance for a FQHC or RHC to determine whether a payment would constitute an incentive payment that is prohibited from being reimbursed. The bill would further require the department to issue the guidance developed pursuant to the stakeholder process on or before July 1, 2019, and apply the guidance only to all FQHC and RHC payments starting on and after that issuance date. The bill would authorize the department to seek necessary federal approvals and require the department to promulgate regulations to implement these provisions.
(2) This bill would declare that it is to take effect immediately as an urgency statute.
Vote: 2/3   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 (a) It is the intent of the Legislature that quality incentive payments are excluded from wraparound payment calculation when federally qualified health center (FQHC) or rural health clinic (RHC) services are partially reimbursed by a third-party payer, as consistent with Section 405.2469(a)(2) of Title 42 of the Code of Federal Regulations, Section 14132.100 of the Welfare and Institutions Code, and the federal Centers for Medicare and Medicaid Services (CMS) guidance, and that these payments must meet any other federal prospective payment system requirements.
(b) It is the intent of the Legislature that the State Department of Health Care Services issue guidance on what constitutes an incentive payment by a process that collaborates with stakeholders that include, among others, FQHCs, RHCs, and health plans.
(c) It is the intent of the Legislature that the guidance on incentive payments will drive improvements in quality of care by encouraging FQHCs, RHCs, and health plans to partner on developing incentive programs that further the intent of the Medi-Cal delivery system toward the triple aim of improving health outcomes, improving patient experience, and reducing the per capita cost of care.

SEC. 2.

 Section 14132.103 is added to the Welfare and Institutions Code, to read:

14132.103.
 (a) (1) On or before March 1, 2019, the State Department of Health Care Services shall establish a stakeholder process to assist the department in developing guidance for a federally qualified health center (FQHC) or rural health clinic (RHC) to determine whether a payment would constitute an incentive payment that is prohibited from being included in the calculation of supplemental payments during the reconciliation process.
(2) The stakeholder process shall include, but not be limited to, the department conducting at least two meetings with stakeholders. The stakeholders shall include, but not be limited to, representatives from FQHCs and RHCs, public hospitals, and health plans, including local health plans. The department shall include at least two representatives of FQHCs and RHCs from rural areas in the stakeholder process.
(b) On or before July 1, 2019, the department shall issue the guidance developed pursuant to the stakeholder process set forth in subdivision (a). The department shall publish the guidance on its Internet Web site.
(c) On and after the date the department issued the guidance pursuant to subdivision (b), the department shall use the guidance for FQHC and RHC reconciliation, and shall not apply the guidance to FQHC and RHC reconciliations for any date prior to that issuance date. For any date prior to the date the department issued the guidance pursuant to subdivision (b), FQHC and RHC payments received as part of a quality improvement incentive program, including risk pools, withholds, and bonuses per Section 405.2469(a)(2) of Title 42 of the Code of Federal Regulations, shall not be included in the reconciliation.
(d) The department may seek any necessary federal approvals for the guidance on incentive payments developed pursuant to this section.
(e) Nothing in this bill shall be construed to require an FQHC or RHC to participate in any quality incentive payment arrangement with a third-party payer.
(f) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions without taking regulatory action. The department shall adopt regulations by July 1, 2021, in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code.

SEC. 3.

 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:
To ensure that federally qualified health centers (FQHCs) and rural health clinics (RHCs) are able to timely participate in the pay for performance program consistent with federal authorization, and to provide necessary clarity to FQHCs or RHCs when the State Department of Health Care Services performs audits of FQHCs or RHCs, it is necessary for this act to take effect immediately.