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SB-160 Medi-Cal managed care organization provider tax.(2023-2024)

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Date Published: 06/22/2024 12:18 PM
SB160:v98#DOCUMENT

Amended  IN  Assembly  June 22, 2024

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Senate Bill
No. 160

Introduced by Committee on Budget and Fiscal Review

January 18, 2023

An act relating to the Budget Act of 2023. to amend Section 14199.85 of the Welfare and Institutions Code, relating to Medi-Cal, and making an appropriation therefor, to take effect immediately, bill related to the budget.


LEGISLATIVE COUNSEL'S DIGEST


SB 160, as amended, Committee on Budget and Fiscal Review. Budget Act of 2023. Medi-Cal managed care organization provider tax.
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 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. Under existing law, all revenues, less refunds, derived from the MCO provider tax are available to the department, upon appropriation, for the purpose of funding specified subcomponents to support the Medi-Cal program. Existing law sets forth certain taxing tiers and tax amounts, and sets the Medi-Cal per enrollee tax amount for Medi-Cal taxing tier II, as defined, at $205 for the 2024, 2025, and 2026 calendar years.
This bill would raise the MCO provider tax amount for that tier to $274 for all 3 of those calendar years.
The bill would also reappropriate specified funds from the Budget Act of 2023 related to the State Department of Health Care Services.
This bill would include a change in state statute that would result in a taxpayer paying a higher tax within the meaning of Section 3 of Article XIII A of the California Constitution, and thus would require for passage the approval of 2/3 of the membership of each house of the Legislature.
This bill would declare that it is to take effect immediately as a bill providing for appropriations related to the Budget Bill.

This bill would express the intent of the Legislature to enact statutory changes relating to the Budget Act of 2023.

Vote: MAJORITY2/3   Appropriation: NOYES   Fiscal Committee: NOYES   Local Program: NO  

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


SECTION 1.

 Section 14199.85 of the Welfare and Institutions Code is amended to read:

14199.85.
 (a) For each tax period, the Medi-Cal taxing tiers shall be as follows:
(1) Medi-Cal taxing tier I shall consist of all countable Medi-Cal enrollees in a health plan from zero to 1,250,000, inclusive.
(2) Medi-Cal taxing tier II shall consist of all countable Medi-Cal enrollees in a health plan from 1,250,001 to 4,000,000, inclusive.
(3) Medi-Cal taxing tier III shall consist of all countable Medi-Cal enrollees in a health plan greater than 4,000,000.
(b) For each tax period, the other taxing tiers shall be as follows:
(1) Other taxing tier I shall consist of all countable other enrollees in a health plan from zero to 1,250,000, inclusive.
(2) Other taxing tier II shall consist of all countable other enrollees in a health plan from 1,250,001 to 4,000,000, inclusive.
(3) Other taxing tier III shall consist of all countable other enrollees in a health plan greater than 4,000,000.
(c) For the period of April 1, 2023, through December 31, 2023, the Medi-Cal per enrollee tax amount for each Medi-Cal taxing tier shall be as follows:
(1) The Medi-Cal per enrollee tax for Medi-Cal taxing tier I shall be zero dollars ($0).
(2) The Medi-Cal per enrollee tax for Medi-Cal taxing tier II shall be one hundred eighty-two dollars and fifty cents ($182.50).
(3) The Medi-Cal per enrollee tax for Medi-Cal taxing tier III shall be zero dollars ($0).
(d) For the period of April 1, 2023, through December 31, 2023, the other per enrollee tax amount for each other taxing tier shall be as follows:
(1) The other per enrollee tax for the other taxing tier I shall be zero dollars ($0).
(2) The other per enrollee tax for the other taxing tier II shall be one dollar and seventy-five cents ($1.75).
(3) The other per enrollee tax for the other taxing tier III shall be zero dollars ($0).
(e) For the 2024 calendar year, the Medi-Cal per enrollee tax amount for each Medi-Cal taxing tier shall be as follows:
(1) The Medi-Cal per enrollee tax for Medi-Cal taxing tier I shall be zero dollars ($0).
(2) The Medi-Cal per enrollee tax for Medi-Cal taxing tier II shall be two hundred five dollars ($205). seventy-four dollars ($274).
(3) The Medi-Cal per enrollee tax for Medi-Cal taxing tier III shall be zero dollars ($0).
(f) For the 2024 calendar year, the other per enrollee tax amount for each other taxing tier shall be as follows:
(1) The other per enrollee tax for the other taxing tier I shall be zero dollars ($0).
(2) The other per enrollee tax for the other taxing tier II shall be one dollar and seventy-five cents ($1.75).
(3) The other per enrollee tax for the other taxing tier III shall be zero dollars ($0).
(g) For the 2025 calendar year, the Medi-Cal per enrollee tax amount for each Medi-Cal taxing tier shall be as follows:
(1) The Medi-Cal per enrollee tax for Medi-Cal taxing tier I shall be zero dollars ($0).
(2) The Medi-Cal per enrollee tax for Medi-Cal taxing tier II shall be two hundred five dollars ($205). seventy-four dollars ($274).
(3) The Medi-Cal per enrollee tax for Medi-Cal taxing tier III shall be zero dollars ($0).
(h) For the 2025 calendar year, the other per enrollee tax amount for each other taxing tier shall be as follows:
(1) The other per enrollee tax for the other taxing tier I shall be zero dollars ($0).
(2) The other per enrollee tax for the other taxing tier II shall be two dollars ($2).
(3) The other per enrollee tax for the other taxing tier III shall be zero dollars ($0).
(i) For the 2026 calendar year, the Medi-Cal per enrollee tax amount for each Medi-Cal taxing tier shall be as follows:
(1) The Medi-Cal per enrollee tax for Medi-Cal taxing tier I shall be zero dollars ($0).
(2) The Medi-Cal per enrollee tax for Medi-Cal taxing tier II shall be two hundred five dollars ($205). seventy-four dollars ($274).
(3) The Medi-Cal per enrollee tax for Medi-Cal taxing tier III shall be zero dollars ($0).
(j) For the 2026 calendar year, the other per enrollee tax amount for each other taxing tier shall be as follows:
(1) The other per enrollee tax for the other taxing tier I shall be zero dollars ($0).
(2) The other per enrollee tax for the other taxing tier II shall be two dollars and twenty-five cents ($2.25).
(3) The other per enrollee tax for the other taxing tier III shall be zero dollars ($0).
(k) (1) The department may modify or make adjustments to any methodology, tax amount, taxing tier, or other provision specified in this article to the extent that it deems necessary to meet the requirements of federal law or regulations, to obtain or maintain federal approval, or to ensure federal financial participation is available or is not otherwise jeopardized, provided the modification or adjustment does not otherwise conflict with the purposes of this article, or result in an increase in the aggregate tax amounts projected to be collected under this article that the department, in its sole discretion, determines is significant.
(2) If the department identifies that modification or adjustment is necessary in accordance with paragraph (1), the department shall consult with affected health plans, to the extent practicable, to implement that modification or adjustment.
(3) In the event of a modification or adjustment made pursuant to this subdivision, the department shall notify affected health plans, the Department of Finance, the Joint Legislative Budget Committee, the Senate Committees on Appropriations, Budget and Fiscal Review, and Health, and the Assembly Committees on Appropriations, Budget, and Health within 10 business days of that modification or adjustment.
(l) The department shall request approval from the federal Centers for Medicare and Medicaid Services as is necessary to implement this article. In making that request, the department may seek, as it deems necessary, a request for waiver of the broad-based requirement, waiver of the uniformity requirement, or both, pursuant to Section 433.68(e)(1) and (2) of Title 42 of the Code of Federal Regulations, or a request for waiver of any other federal law or regulation necessary to implement this article.
(m) 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 this article by means of provider bulletins, all-plan letters, or other similar instructions, without taking any further regulatory action. The department shall provide notification to the Department of Finance, the Joint Legislative Budget Committee, the Senate Committees on Appropriations, Budget and Fiscal Review, and Health, and the Assembly Committees on Appropriations, Budget, and Health within 10 business days after the above-described action is taken.

SEC. 2.

 Notwithstanding any other provision of law, the balances as of June 30, 2023, of the appropriations made by Item 4260-101-0001 of the Budget Act of 2023 (Chs. 12, 38, and 189, Stats. 2023) related to Provision 26 of that item are reappropriated and shall be available for encumbrance or expenditure until June 30, 2025, for the same programs and purposes.

SEC. 3.

 This act is a bill providing for appropriations related to the Budget Bill within the meaning of subdivision (e) of Section 12 of Article IV of the California Constitution, has been identified as related to the budget in the Budget Bill, and shall take effect immediately.
SECTION 1.

It is the intent of the Legislature to enact statutory changes relating to the Budget Act of 2023.