California Senate Bill SB804 Introduced / Bill

 BILL NUMBER: SB 804INTRODUCED BILL TEXT INTRODUCED BY Senator Corbett FEBRUARY 18, 2011 An act to amend Section 14132.25 of the Welfare and Institutions Code, relating to Medi-Cal, and declaring the urgency thereof, to take effect immediately. LEGISLATIVE COUNSEL'S DIGEST SB 804, as introduced, Corbett. Medi-Cal: subacute care program: congregate living health facilities. 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 requires the department to establish a subacute care program in health facilities in order to more effectively use limited Medi-Cal dollars while ensuring needed services for patients who meet subacute care criteria, as established by the department. Existing law provides that, for the purposes of this program, subacute care may be provided by any facility designated by the Director of Health Care Services as meeting subacute care criteria and that has an approved provider participation agreement with the department. This bill would require the department to allow congregate living health facilities, as defined, that solely provide pediatric subacute care services and do not provide Medicare services to participate in the subacute care program. This bill would provide that these type of facilities shall not be required to be Medicare certified to participate in the subacute care program. The bill would require the department to seek all necessary federal approvals for the implementation of these provisions. This bill would declare that it is to take effect immediately as an urgency statute. Vote: 2/3. Appropriation: no. Fiscal committee: yes. State-mandated local program: no. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. The Legislature finds and declares all of the following: (a) George Mark Children's House is the only comprehensive pediatric palliative care organization in California licensed as a congregate living health facility (CLHF). As allowed by its CLHF license, George Mark Children's House provides a broad scope of pediatric palliative care services to children enrolled in the Medi-Cal program, including pediatric subacute care services. The cost of its services is substantially less than the cost of providing pediatric subacute care in a hospital setting. (b) Under federal law, pediatric patients are not Medicare eligible and given that George Mark Children's House exclusively serves pediatric patients, the facility does not serve Medicare beneficiaries. Existing regulations of the State Department of Health Care Services require a CLHF, in order to be reimbursed for providing pediatric subacute services to Medi-Cal beneficiaries, to be Medicare certified. (c) There is no mechanism under current law by which a CLHF can become Medicare certified because Medicare does not currently recognize the CLHF designation. Even so, the state allows CLHFs to provide pediatric subacute care services within the scope of their license with the state's full knowledge that these barriers to Medi-Cal reimbursement exist. (d) Because palliative care services for children provided in a CLHF setting are important to children, their families, and the state, it is necessary to amend existing law to allow CLHFs that exclusively serve a pediatric patient population to be reimbursed for providing pediatric subacute care services to Medi-Cal beneficiaries without requiring those CLHFs to be Medicare certified. SEC. 2. Section 14132.25 of the Welfare and Institutions Code is amended to read: 14132.25.  (a)    On or before July 1, 1983, the  State Department of Health Services   department  shall establish a subacute care program in health facilities in order to more effectively use the limited Medi-Cal dollars available while, at the same time, ensuring needed services for these patients. The subacute care program shall be available to patients in facilities who meet subacute care criteria. Subacute care may be provided by any facility designated by the director as meeting the subacute care criteria  , and which   and that  has an approved provider participation agreement with the  State Department of Health Services   department  .  The State Department of Health Services   (b)     The department  shall develop a rate of reimbursement for this subacute care program. Reimbursement rates  will   shall  be determined in accordance with methodology developed by the  State Department of Health Services   department  , specified in regulation, and may include the following: (1)  All inclusive   All-inclusive  per diem rates. (2) Individual  patient specific   patient-specific  rates according to the needs of the individual subacute care patient. (3) Other rates subject to negotiation with the health facility. However, reimbursement at subacute care rates shall only be implemented  when   if  funds are available for this purpose pursuant to the annual Budget Act.  The   (c)     The  department may negotiate and execute an agreement with any health facility  which   that  meets the standards for providing subacute care. An agreement may be negotiated or established between the health facility and the department for subacute care based on individual patient assessment. The department shall establish level of care criteria and appropriate utilization controls for patients eligible for the subacute care program.  For   (d)     For  the purposes of this section, subacute patient care shall be defined by the  state  department based on the results of its study pursuant to Chapter 1211 of the Statutes of 1980.  (e) (1) Notwithstanding any other provision of state law, and to the extent permitted by federal law, the department shall allow congregate living health facilities, as defined in subdivision (i) of Section 1250 of the Health and Safety Code, that solely provide pediatric subacute care services and do not provide Medicare services to participate in the subacute care program.  (2) Congregate living health facilities described in paragraph (1) shall not be required to be Medicare certified to participate in the subacute care program.   (f) The department shall seek all necessary federal approvals for the implementation of this section.  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 Constitution and shall go into immediate effect. The facts constituting the necessity are: In order to enable statutory changes to be made to the Medi-Cal program at the earliest possible time, it is necessary that this act take effect immediately.