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SB-1492 Medi-Cal reimbursement rates: private duty nursing. (2023-2024)

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Date Published: 04/15/2024 09:00 PM
SB1492:v98#DOCUMENT

Amended  IN  Senate  April 15, 2024

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Senate Bill
No. 1492

Introduced by Senator Menjivar

February 16, 2024

An act to amend Section 14105.200 of, and to add Section 14105.205 to to, the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


SB 1492, as amended, Menjivar. Medi-Cal reimbursement rates: private duty nursing.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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. Under existing law, one of the methods by which Medi-Cal services are provided is pursuant to contracts with various types of managed care plans. Existing law sets forth requirements for private duty nursing and home health care under the Medi-Cal program.
Existing law imposes a managed care organization (MCO) provider tax, administered and assessed by the department, on licensed health care service plans and managed care plans contracted with the department to provide full-scope Medi-Cal services. Under existing law, proceeds from the MCO provider tax may be used, upon appropriation by the Legislature, for the increased costs incurred as a result of reimbursement requirements, among other things.
This bill would provide that, for the above-described reimbursement purposes, that private duty nursing services provided to a child under 21 years of age by a home health agency are considered specialty care services. included as an eligible category for Medi-Cal reimbursement through the above-described scheme.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 Section 14105.200 of the Welfare and Institutions Code is amended to read:

14105.200.
 (a) The Medi-Cal Provider Payment Reserve Fund is hereby created in the State Treasury.
(b) Notwithstanding Section 16305.7 of the Government Code, any interest and dividends earned on moneys in the Medi-Cal Provider Payment Reserve Fund shall be retained in the fund and used solely for the purposes specified in this section.
(c) (1) Subject to an appropriation made by the Legislature, the department shall use the funds transferred to the Medi-Cal Provider Payment Reserve Fund pursuant to paragraph (3) of subdivision (d) of Section 14199.82 for purposes of funding targeted increases to Medi-Cal payments or other investments that advance access, quality, and equity for Medi-Cal beneficiaries and promote provider participation in the Medi-Cal program.
(2) The expenditures of funds appropriated pursuant to paragraph (1) shall include, but not be limited to, all of the following:
(A) Increased costs incurred as a result of the reimbursement requirements established in Section 14105.201.
(B) Transfers authorized in paragraph (2) of subdivision (e) of Section 129385 of the Health and Safety Code.
(C) Transfers, or an appropriation in the annual Budget Act, to the University of California in the amount of seventy-five million dollars ($75,000,000) each calendar year to expand graduate medical education programs, in order to achieve the goal of increasing the number of primary care and specialty care physicians in the state based on demonstrated workforce needs and priorities.
(D) Transfers, or an appropriation in the annual Budget Act, to the Small and Rural Hospital Relief Fund, as established in Section 130077 of the Health and Safety Code, in the amount of fifty million dollars ($50,000,000) in state fiscal year 2023–24 to support the Small and Rural Hospital Relief Program for seismic assessment and construction.
(E) Effective no sooner than January 1, 2025, increased costs for targeted increases to Medi-Cal payments or other investments pursuant to the plan described in Section 14105.202.
(F) Effective no sooner than January 1, 2025, increased costs incurred as a result of reimbursement pursuant to Section 14105.205 for private duty nursing services.
(d) The department shall provide an annual report to all health plans accounting for the funds deposited in, and expended from, the Medi-Cal Provider Payment Reserve Fund, in a time and manner as deemed appropriate by the director.
(e) Notwithstanding any other law, the Controller may use the funds in the Medi-Cal Provider Payment Reserve Fund for cashflow loans to the General Fund as provided in Sections 16310 and 16381 of the Government Code.

SECTION 1.SEC. 2.

 Section 14105.205 is added to the Welfare and Institutions Code, to read:

14105.205.
 Notwithstanding any other law, private duty nursing services, as defined in Section 1743.2 of Health and Safety Code, provided to a child under 21 years of age by a home health agency, as defined in Section 1725 of the Health and Safety Code, shall be considered specialty care for purposes of included as an eligible category for Medi-Cal reimbursement under Sections 14105.200, 14105.201, 14105.202, pursuant to Sections 14105.200 and 14199.82.