State Codes and Statutes

Statutes > California > Hsc > 1324.20-1324.30

HEALTH AND SAFETY CODE
SECTION 1324.20-1324.30



1324.20.  For purposes of this article, the following definitions
shall apply:
   (a) (1) "Continuing care retirement community" means a provider of
a continuum of services, including independent living services,
assisted living services as defined in paragraph (5) of subdivision
(a) of Section 1771, and skilled nursing care, on a single campus,
that is subject to Section 1791, or a provider of such a continuum of
services on a single campus that has not received a Letter of
Exemption pursuant to subdivision (d) of Section 1771.3.
   (2) Notwithstanding paragraph (1), beginning with the 2010-11 rate
year and for every rate year thereafter, the term "continuing care
retirement community" shall have the definition contained in
paragraph (11) of subdivision (c) of Section 1771.
   (b) "Department," unless otherwise specified, means the State
Department of Health Care Services.
   (c) (1) "Exempt facility" means a skilled nursing facility that is
part of a continuing care retirement community, a skilled nursing
facility operated by the state or another public entity, a unit that
provides pediatric subacute services in a skilled nursing facility, a
skilled nursing facility that is certified by the State Department
of Mental Health for a special treatment program and is an
institution for mental disease as defined in Section 1396d(i) of
Title 42 of the United States Code, or a skilled nursing facility
that is a distinct part of a facility that is licensed as a general
acute care hospital.
   (2) Notwithstanding paragraph (1), beginning with the 2010-11 rate
year and for every rate year thereafter, the term "exempt facility"
shall mean a skilled nursing facility that is part of a continuing
care retirement community, as defined in paragraph (2) of subdivision
(a), a skilled nursing facility operated by the state or another
public entity, a unit that provides pediatric subacute services in a
skilled nursing facility, a skilled nursing facility that is
certified by the State Department of Mental Health for a special
treatment program and is an institution for mental disease as defined
in Section 1396d(i) of Title 42 of the United States Code, or a
skilled nursing facility that is a distinct part of a facility that
is licensed as a general acute care hospital.
   (3) Notwithstanding paragraph (1), beginning with the 2010-11 rate
year and every rate year thereafter, a multilevel facility, as
described in paragraph (1) of subdivision (a), shall not be exempt
from the quality assurance fee requirements pursuant to this article,
unless it meets the definition of a continuing care retirement
community in paragraph (11) of subdivision (c) of Section 1771.
   (d) (1) "Net revenue" means gross resident revenue for routine
nursing services and ancillary services provided to all residents by
a skilled nursing facility, less Medicare revenue for routine and
ancillary services, including Medicare revenue for services provided
to residents covered under a Medicare managed care plan, less payer
discounts and applicable contractual allowances as permitted under
federal law and regulation.
   (2) Notwithstanding paragraph (1), for the 2009-10 to 2011-12,
inclusive, rate years, "net revenue" means gross resident revenue for
routine nursing services and ancillary services provided to all
residents by a skilled nursing facility, including Medicare revenue
for routine and ancillary services and Medicare revenue for services
provided to residents covered under a Medicare managed care plan,
less payer discounts and applicable contractual allowances as
permitted under federal law and regulation. To implement this
paragraph, the department shall request federal approval pursuant to
Section 1324.27.
   (3) "Net revenue" does not mean charitable contributions and bad
debt.
   (e) "Payer discounts and contractual allowances" means the
difference between the facility's resident charges for routine or
ancillary services and the actual amount paid.
   (f) "Skilled nursing facility" means a licensed facility as
defined in subdivision (c) of Section 1250.



1324.21.  (a) For facilities licensed under subdivision (c) of
Section 1250, there shall be imposed each fiscal year a uniform
quality assurance fee per resident day. The uniform quality assurance
fee shall be based upon the entire net revenue of all skilled
nursing facilities subject to the fee, except an exempt facility, as
defined in Section 1324.20, calculated in accordance with subdivision
(b).
   (b) The amount of the uniform quality assurance fee to be assessed
per resident day shall be determined based on the aggregate net
revenue of skilled nursing facilities subject to the fee, in
accordance with the methodology outlined in the request for federal
approval required by Section 1324.27 and in regulations, provider
bulletins, or other similar instructions. The uniform quality
assurance fee shall be calculated as follows:
   (1) (A) For the rate year 2004-05, the net revenue shall be
projected for all skilled nursing facilities subject to the fee. The
projection of net revenue shall be based on prior rate-year data.
Once determined, the aggregate projected net revenue for all
facilities shall be multiplied by 2.7 percent, as determined under
the approved methodology, and then divided by the projected total
resident days of all providers subject to the fee.
   (B) Notwithstanding subparagraph (A), the Director of Health Care
Services may increase the amount of the fee up to 3 percent of the
aggregate projected net revenue if necessary for the implementation
of Article 3.8 (commencing with Section 14126) of Chapter 7 of Part 3
of Division 9 of the Welfare and Institutions Code.
   (2) (A) For the rate year 2005-06 and subsequent rate years
through and including the 2009-10 rate year, the net revenue shall be
projected for all skilled nursing facilities subject to the uniform
quality assurance fee. The projection of net revenue shall be based
on the prior rate year's data. Once determined, the aggregate
projected net revenue for all facilities shall be multiplied by 6
percent, as determined under the approved methodology, and then
divided by the projected total resident days of all providers subject
to the fee. The amounts so determined shall be subject to the
provisions of subdivision (d).
   (B) For the 2010-11 rate year and subsequent rate years, the net
revenue shall be projected for all skilled nursing facilities subject
to the uniform quality assurance fee. The projection of net revenue
shall be based on the prior year's data trended forward, using
historical increases in net revenues. Once determined, the aggregate
projected net revenue for all facilities shall be multiplied by 6
percent, as determined under the approved methodology, and then
divided by the projected total resident days of all providers subject
to the fee. The amounts so determined shall be subject to
subdivision (d).
   (c) The director may assess and collect a nonuniform fee
consistent with the methodology approved pursuant to Section 1324.27.
   (d) In no case shall the fees collected annually pursuant to this
article, taken together with applicable licensing fees, exceed the
amounts allowable under federal law.
   (e) If there is a delay in the implementation of this article for
any reason, including a delay in the approval of the quality
assurance fee and methodology by the federal Centers for Medicare and
Medicaid Services, in the 2004-05 rate year or in any other rate
year, all of the following shall apply:
   (1) Any facility subject to the fee may be assessed the amount the
facility will be required to pay to the department, but shall not be
required to pay the fee until the methodology is approved and
Medi-Cal rates are increased in accordance with paragraph (2) of
subdivision (a) of Section 1324.28 and the increased rates are paid
to facilities.
   (2) The department may retroactively increase and make payment of
rates to facilities.
   (3) Facilities that have been assessed a fee by the department
shall pay the fee assessed within 60 days of the date rates are
increased in accordance with paragraph (2) of subdivision (a) of
Section 1324.28 and paid to facilities.
   (4) The department shall accept a facility's payment
notwithstanding that the payment is submitted in a subsequent fiscal
year than the fiscal year in which the fee is assessed.



1324.22.  (a) The quality assurance fee, as calculated pursuant to
Section 1324.21, shall be paid by the provider to the department for
deposit in the State Treasury on a monthly basis on or before the
last day of the month following the month for which the fee is
imposed, except as provided in subdivision (e) of Section 1324.21.
   (b) On or before the last day of each calendar quarter, each
skilled nursing facility shall file a report with the department, in
a prescribed form, showing the facility's total resident days for the
preceding quarter and payments made. If it is determined that a
lesser amount was paid to the department, the facility shall pay the
amount owed in the preceding quarter to the department with the
report. Any amount determined to have been paid in excess to the
department during the previous quarter shall be credited to the
amount owed in the following quarter.
   (c) On or before August 31 of each year, each skilled nursing
facility subject to an assessment pursuant to Section 1324.21 shall
report to the department, in a prescribed form, the facility's total
resident days and total payments made for the preceding state fiscal
year. If it is determined that a lesser amount was paid to the
department during the previous year, the facility shall pay the
amount owed to the department with the report.
   (d) (1) A newly licensed skilled nursing facility shall complete
all requirements of subdivision (a) for any portion of the year in
which it commences operations and of subdivision (b) for any portion
of the quarter in which it commences operations.
   (2) For purposes of this subdivision, "newly licensed skilled
nursing facility" means a location that has not been previously
licensed as a skilled nursing facility.
   (e) (1) When a skilled nursing facility fails to pay all or part
of the quality assurance fee within 60 days of the date that payment
is due, the department may deduct the unpaid assessment and interest
owed from any Medi-Cal reimbursement payments to the facility until
the full amount is recovered. Any deduction shall be made only after
written notice to the facility and may be taken over a period of time
taking into account the financial condition of the facility.
   (2) In addition to the provisions of paragraph (1), any unpaid
quality assurance fee assessed by this article shall constitute a
debt due to the state and may be collected pursuant to Section
12419.5 of the Government Code.
   (f) Notwithstanding any other provision of law, the department
shall continue to assess and collect the quality assurance fee,
including any previously unpaid quality assurance fee, from each
skilled nursing facility, irrespective of any changes in ownership or
ownership interest or control or the transfer of any portion of the
assets of the facility to another owner.
   (g) During the time period in which a temporary manager is
appointed to a facility pursuant to Section 1325.5 or during which a
receiver is appointed by a court pursuant to Section 1327, the State
Department of Public Health shall not be responsible for any unpaid
quality assurance fee assessed prior to the time period of the
temporary manager or receiver. Nothing in this subdivision shall
affect the responsibility of the facility to make all payments of
unpaid or current quality assurance fees, as required by this section
and Section 1324.21.
   (h) If all or any part of the quality assurance fee remains
unpaid, the department may take either or both of the following
actions:
   (1) Assess a penalty equal to 50 percent of the unpaid fee amount
for unpaid fees assessed during the 2004-05 to 2009-10, inclusive,
rate years, and up to 50 percent of the unpaid fee amount for unpaid
fees assessed during the 2010-11 rate year and any subsequent rate
year.
   (2) (A) Delay license renewal.
   (B) Beginning with the 2010-11 rate year, the department may
recommend to the State Department of Public Health that license
renewal be delayed until the full amount of the quality assurance
fee, penalties, and interest is recovered.
   (i) In accordance with the provisions of the Medicaid State Plan,
the payment of the quality assurance fee shall be considered as an
allowable cost for Medi-Cal reimbursement purposes.
   (j) The assessment process pursuant to this section shall become
operative not later than 60 days from receipt of federal approval of
the quality assurance fee, unless extended by the department. The
department may assess fees and collect payment in accordance with
subdivision (e) of Section 1324.21 in order to provide retroactive
payments for any rate increase authorized under this article.
   (k) The amendments made to subdivision (d) and the addition of
subdivision (f) by the act that added this subdivision shall not be
construed as substantive changes, but are merely clarifying existing
law.


1324.23.  (a) The Director of Health Care Services, or his or her
designee, shall administer this article.
   (b) The director may adopt regulations as are necessary to
implement this article. These regulations may be adopted as emergency
regulations in accordance with the rulemaking provisions of the
Administrative Procedure Act (Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code).
For purposes of this article, the adoption of regulations shall be
deemed an emergency and necessary for the immediate preservation of
the public peace, health and safety, or general welfare. The
regulations shall include, but need not be limited to, any
regulations necessary for any of the following purposes:
   (1) The administration of this article, including the proper
imposition and collection of the quality assurance fee not to exceed
amounts reasonably necessary for purposes of this article.
   (2) The development of any forms necessary to obtain required
information from facilities subject to the quality assurance fee.
   (3) To provide details, definitions, formulas, and other
requirements.
   (c) As an alternative to subdivision (b), and notwithstanding the
rulemaking provisions of Chapter 3.5 (commencing with Section 11340)
of Part 1 of Division 3 of Title 2 of the Government Code, the
director may implement this article, in whole or in part, by means of
a provider bulletin, or other similar instructions, without taking
regulatory action, provided that no such bulletin or other similar
instructions shall remain in effect after July 31, 2012. It is the
intent of the Legislature that the regulations adopted pursuant to
subdivision (b) shall be adopted on or before July 31, 2012.



1324.24.  The quality assurance fee assessed and collected pursuant
to this article shall be deposited in the State Treasury.



1324.25.  The funds assessed pursuant to this article shall be
available to enhance federal financial participation in the Medi-Cal
program or to provide additional reimbursement to, and to support
facility quality improvement efforts in, licensed skilled nursing
facilities.



1324.26.  In implementing this article, the department may utilize
the services of the Medi-Cal fiscal intermediary through a change
order to the fiscal intermediary contract to administer this program,
consistent with the requirements of Sections 14104.6, 14104.7,
14104.8, and 14104.9 of the Welfare and Institutions Code.




1324.27.  (a) (1) The department shall request approval from the
federal Centers for Medicare and Medicaid Services for the
implementation of this article. In making this request, the
department shall seek specific approval from the federal Centers for
Medicare and Medicaid Services to exempt facilities identified in
subdivision (c) of Section 1324.20, including the submission of a
request for waiver of broad-based requirement, waiver of uniform fee
requirement, or both, pursuant to paragraphs (1) and (2) of
subdivision (e) of Section 433.68 of Title 42 of the Code of Federal
Regulations.
   (2) The director may alter the methodology specified in this
article, to the extent necessary to meet the requirements of federal
law or regulations or to obtain federal approval. The Director of
Health Services may also add new categories of exempt facilities or
apply a nonuniform fee to the skilled nursing facilities subject to
the fee in order to meet requirements of federal law or regulations.
The Director of Health Services may apply a zero fee to one or more
exempt categories of facilities, if necessary to obtain federal
approval.
   (3) If after seeking federal approval, federal approval is not
obtained, this article shall not be implemented.
   (b) The department shall make retrospective adjustments, as
necessary, to the amounts calculated pursuant to Section 1324.21 in
order to assure that the aggregate quality assurance fee for any
particular state fiscal year does not exceed 6 percent of the
aggregate annual net revenue of facilities subject to the fee.



1324.28.  (a) This article shall be implemented as long as both of
the following conditions are met:
   (1) The state receives federal approval of the quality assurance
fee from the federal Centers for Medicare and Medicaid Services.
   (2) Legislation is enacted in the 2004 legislative session making
an appropriation from the General Fund and from the Federal Trust
Fund to fund a rate increase for skilled nursing facilities, as
defined under subdivision (c) of Section 1250, for the 2004-05 rate
year in an amount consistent with the Medi-Cal rates that specific
facilities would have received under the rate methodology in effect
as of July 31, 2004, plus the proportional costs as projected by
Medi-Cal for new state or federal mandates.
   (b) This article shall remain operative only as long as all of the
following conditions are met:
   (1) The federal Centers for Medicare and Medicaid Services
continues to allow the use of the provider assessment provided in
this article.
   (2) The Medi-Cal Long-Term Care Reimbursement Act, Article 3.8
(commencing with Section 14126) of Chapter 7 of Part 3 of Division 9
of the Welfare and Institutions Code, as added during the 2003-04
Regular Session by the act adding this section, is enacted and
implemented on or before July 31, 2005, or as extended as provided in
that article, and remains in effect thereafter.
   (3) The state has continued its maintenance of effort for the
level of state funding of nursing facility reimbursement for the
2005-06 rate year, and for every subsequent rate year continuing
through the 2011-12 rate year, in an amount not less than the amount
that specific facilities would have received under the rate
methodology in effect on July 31, 2004, plus Medi-Cal's projected
proportional costs for new state or federal mandates, not including
the quality assurance fee.
   (4) The full amount of the quality assurance fee assessed and
collected pursuant to this article remains available for the purposes
specified in Section 1324.25 and for related purposes.
   (c) If all of the conditions in subdivision (a) are met, this
article is implemented, and subsequently, any one of the conditions
in subdivision (b) is not met, on and after the date that the
department makes that determination, this article shall not be
implemented, notwithstanding that the condition or conditions
subsequently may be met.
   (d) Notwithstanding subdivisions (a), (b), and (c), in the event
of a final judicial determination made by any state or federal court
that is not appealed, or by a court of appellate jurisdiction that is
not further appealed, in any action by any party, or a final
determination by the administrator of the federal Centers for
Medicare and Medicaid Services, that federal financial participation
is not available with respect to any payment made under the
methodology implemented pursuant to this article because the
methodology is invalid, unlawful, or contrary to any provision of
federal law or regulations, or of state law, this section shall
become inoperative.



1324.29.  (a) The quality assurance fee shall cease to be assessed
after July 31, 2012.
   (b) Notwithstanding subdivision (a) and Section 1324.30, the
department's authority and obligation to collect all quality
assurance fees and penalties, including interest, shall continue in
effect and shall not cease until the date that all amounts are paid
or recovered in full.
   (c) This section shall remain operative until the date that all
fees and penalties, including interest, have been recovered pursuant
to subdivision (b), and as of that date is repealed.




1324.30.  This article shall become inoperative after July 31, 2012,
and, as of January 1, 2013, is repealed, unless a later enacted
statute, that becomes operative on or before January 1, 2013, deletes
or extends the dates on which it becomes inoperative and is
repealed.

State Codes and Statutes

Statutes > California > Hsc > 1324.20-1324.30

HEALTH AND SAFETY CODE
SECTION 1324.20-1324.30



1324.20.  For purposes of this article, the following definitions
shall apply:
   (a) (1) "Continuing care retirement community" means a provider of
a continuum of services, including independent living services,
assisted living services as defined in paragraph (5) of subdivision
(a) of Section 1771, and skilled nursing care, on a single campus,
that is subject to Section 1791, or a provider of such a continuum of
services on a single campus that has not received a Letter of
Exemption pursuant to subdivision (d) of Section 1771.3.
   (2) Notwithstanding paragraph (1), beginning with the 2010-11 rate
year and for every rate year thereafter, the term "continuing care
retirement community" shall have the definition contained in
paragraph (11) of subdivision (c) of Section 1771.
   (b) "Department," unless otherwise specified, means the State
Department of Health Care Services.
   (c) (1) "Exempt facility" means a skilled nursing facility that is
part of a continuing care retirement community, a skilled nursing
facility operated by the state or another public entity, a unit that
provides pediatric subacute services in a skilled nursing facility, a
skilled nursing facility that is certified by the State Department
of Mental Health for a special treatment program and is an
institution for mental disease as defined in Section 1396d(i) of
Title 42 of the United States Code, or a skilled nursing facility
that is a distinct part of a facility that is licensed as a general
acute care hospital.
   (2) Notwithstanding paragraph (1), beginning with the 2010-11 rate
year and for every rate year thereafter, the term "exempt facility"
shall mean a skilled nursing facility that is part of a continuing
care retirement community, as defined in paragraph (2) of subdivision
(a), a skilled nursing facility operated by the state or another
public entity, a unit that provides pediatric subacute services in a
skilled nursing facility, a skilled nursing facility that is
certified by the State Department of Mental Health for a special
treatment program and is an institution for mental disease as defined
in Section 1396d(i) of Title 42 of the United States Code, or a
skilled nursing facility that is a distinct part of a facility that
is licensed as a general acute care hospital.
   (3) Notwithstanding paragraph (1), beginning with the 2010-11 rate
year and every rate year thereafter, a multilevel facility, as
described in paragraph (1) of subdivision (a), shall not be exempt
from the quality assurance fee requirements pursuant to this article,
unless it meets the definition of a continuing care retirement
community in paragraph (11) of subdivision (c) of Section 1771.
   (d) (1) "Net revenue" means gross resident revenue for routine
nursing services and ancillary services provided to all residents by
a skilled nursing facility, less Medicare revenue for routine and
ancillary services, including Medicare revenue for services provided
to residents covered under a Medicare managed care plan, less payer
discounts and applicable contractual allowances as permitted under
federal law and regulation.
   (2) Notwithstanding paragraph (1), for the 2009-10 to 2011-12,
inclusive, rate years, "net revenue" means gross resident revenue for
routine nursing services and ancillary services provided to all
residents by a skilled nursing facility, including Medicare revenue
for routine and ancillary services and Medicare revenue for services
provided to residents covered under a Medicare managed care plan,
less payer discounts and applicable contractual allowances as
permitted under federal law and regulation. To implement this
paragraph, the department shall request federal approval pursuant to
Section 1324.27.
   (3) "Net revenue" does not mean charitable contributions and bad
debt.
   (e) "Payer discounts and contractual allowances" means the
difference between the facility's resident charges for routine or
ancillary services and the actual amount paid.
   (f) "Skilled nursing facility" means a licensed facility as
defined in subdivision (c) of Section 1250.



1324.21.  (a) For facilities licensed under subdivision (c) of
Section 1250, there shall be imposed each fiscal year a uniform
quality assurance fee per resident day. The uniform quality assurance
fee shall be based upon the entire net revenue of all skilled
nursing facilities subject to the fee, except an exempt facility, as
defined in Section 1324.20, calculated in accordance with subdivision
(b).
   (b) The amount of the uniform quality assurance fee to be assessed
per resident day shall be determined based on the aggregate net
revenue of skilled nursing facilities subject to the fee, in
accordance with the methodology outlined in the request for federal
approval required by Section 1324.27 and in regulations, provider
bulletins, or other similar instructions. The uniform quality
assurance fee shall be calculated as follows:
   (1) (A) For the rate year 2004-05, the net revenue shall be
projected for all skilled nursing facilities subject to the fee. The
projection of net revenue shall be based on prior rate-year data.
Once determined, the aggregate projected net revenue for all
facilities shall be multiplied by 2.7 percent, as determined under
the approved methodology, and then divided by the projected total
resident days of all providers subject to the fee.
   (B) Notwithstanding subparagraph (A), the Director of Health Care
Services may increase the amount of the fee up to 3 percent of the
aggregate projected net revenue if necessary for the implementation
of Article 3.8 (commencing with Section 14126) of Chapter 7 of Part 3
of Division 9 of the Welfare and Institutions Code.
   (2) (A) For the rate year 2005-06 and subsequent rate years
through and including the 2009-10 rate year, the net revenue shall be
projected for all skilled nursing facilities subject to the uniform
quality assurance fee. The projection of net revenue shall be based
on the prior rate year's data. Once determined, the aggregate
projected net revenue for all facilities shall be multiplied by 6
percent, as determined under the approved methodology, and then
divided by the projected total resident days of all providers subject
to the fee. The amounts so determined shall be subject to the
provisions of subdivision (d).
   (B) For the 2010-11 rate year and subsequent rate years, the net
revenue shall be projected for all skilled nursing facilities subject
to the uniform quality assurance fee. The projection of net revenue
shall be based on the prior year's data trended forward, using
historical increases in net revenues. Once determined, the aggregate
projected net revenue for all facilities shall be multiplied by 6
percent, as determined under the approved methodology, and then
divided by the projected total resident days of all providers subject
to the fee. The amounts so determined shall be subject to
subdivision (d).
   (c) The director may assess and collect a nonuniform fee
consistent with the methodology approved pursuant to Section 1324.27.
   (d) In no case shall the fees collected annually pursuant to this
article, taken together with applicable licensing fees, exceed the
amounts allowable under federal law.
   (e) If there is a delay in the implementation of this article for
any reason, including a delay in the approval of the quality
assurance fee and methodology by the federal Centers for Medicare and
Medicaid Services, in the 2004-05 rate year or in any other rate
year, all of the following shall apply:
   (1) Any facility subject to the fee may be assessed the amount the
facility will be required to pay to the department, but shall not be
required to pay the fee until the methodology is approved and
Medi-Cal rates are increased in accordance with paragraph (2) of
subdivision (a) of Section 1324.28 and the increased rates are paid
to facilities.
   (2) The department may retroactively increase and make payment of
rates to facilities.
   (3) Facilities that have been assessed a fee by the department
shall pay the fee assessed within 60 days of the date rates are
increased in accordance with paragraph (2) of subdivision (a) of
Section 1324.28 and paid to facilities.
   (4) The department shall accept a facility's payment
notwithstanding that the payment is submitted in a subsequent fiscal
year than the fiscal year in which the fee is assessed.



1324.22.  (a) The quality assurance fee, as calculated pursuant to
Section 1324.21, shall be paid by the provider to the department for
deposit in the State Treasury on a monthly basis on or before the
last day of the month following the month for which the fee is
imposed, except as provided in subdivision (e) of Section 1324.21.
   (b) On or before the last day of each calendar quarter, each
skilled nursing facility shall file a report with the department, in
a prescribed form, showing the facility's total resident days for the
preceding quarter and payments made. If it is determined that a
lesser amount was paid to the department, the facility shall pay the
amount owed in the preceding quarter to the department with the
report. Any amount determined to have been paid in excess to the
department during the previous quarter shall be credited to the
amount owed in the following quarter.
   (c) On or before August 31 of each year, each skilled nursing
facility subject to an assessment pursuant to Section 1324.21 shall
report to the department, in a prescribed form, the facility's total
resident days and total payments made for the preceding state fiscal
year. If it is determined that a lesser amount was paid to the
department during the previous year, the facility shall pay the
amount owed to the department with the report.
   (d) (1) A newly licensed skilled nursing facility shall complete
all requirements of subdivision (a) for any portion of the year in
which it commences operations and of subdivision (b) for any portion
of the quarter in which it commences operations.
   (2) For purposes of this subdivision, "newly licensed skilled
nursing facility" means a location that has not been previously
licensed as a skilled nursing facility.
   (e) (1) When a skilled nursing facility fails to pay all or part
of the quality assurance fee within 60 days of the date that payment
is due, the department may deduct the unpaid assessment and interest
owed from any Medi-Cal reimbursement payments to the facility until
the full amount is recovered. Any deduction shall be made only after
written notice to the facility and may be taken over a period of time
taking into account the financial condition of the facility.
   (2) In addition to the provisions of paragraph (1), any unpaid
quality assurance fee assessed by this article shall constitute a
debt due to the state and may be collected pursuant to Section
12419.5 of the Government Code.
   (f) Notwithstanding any other provision of law, the department
shall continue to assess and collect the quality assurance fee,
including any previously unpaid quality assurance fee, from each
skilled nursing facility, irrespective of any changes in ownership or
ownership interest or control or the transfer of any portion of the
assets of the facility to another owner.
   (g) During the time period in which a temporary manager is
appointed to a facility pursuant to Section 1325.5 or during which a
receiver is appointed by a court pursuant to Section 1327, the State
Department of Public Health shall not be responsible for any unpaid
quality assurance fee assessed prior to the time period of the
temporary manager or receiver. Nothing in this subdivision shall
affect the responsibility of the facility to make all payments of
unpaid or current quality assurance fees, as required by this section
and Section 1324.21.
   (h) If all or any part of the quality assurance fee remains
unpaid, the department may take either or both of the following
actions:
   (1) Assess a penalty equal to 50 percent of the unpaid fee amount
for unpaid fees assessed during the 2004-05 to 2009-10, inclusive,
rate years, and up to 50 percent of the unpaid fee amount for unpaid
fees assessed during the 2010-11 rate year and any subsequent rate
year.
   (2) (A) Delay license renewal.
   (B) Beginning with the 2010-11 rate year, the department may
recommend to the State Department of Public Health that license
renewal be delayed until the full amount of the quality assurance
fee, penalties, and interest is recovered.
   (i) In accordance with the provisions of the Medicaid State Plan,
the payment of the quality assurance fee shall be considered as an
allowable cost for Medi-Cal reimbursement purposes.
   (j) The assessment process pursuant to this section shall become
operative not later than 60 days from receipt of federal approval of
the quality assurance fee, unless extended by the department. The
department may assess fees and collect payment in accordance with
subdivision (e) of Section 1324.21 in order to provide retroactive
payments for any rate increase authorized under this article.
   (k) The amendments made to subdivision (d) and the addition of
subdivision (f) by the act that added this subdivision shall not be
construed as substantive changes, but are merely clarifying existing
law.


1324.23.  (a) The Director of Health Care Services, or his or her
designee, shall administer this article.
   (b) The director may adopt regulations as are necessary to
implement this article. These regulations may be adopted as emergency
regulations in accordance with the rulemaking provisions of the
Administrative Procedure Act (Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code).
For purposes of this article, the adoption of regulations shall be
deemed an emergency and necessary for the immediate preservation of
the public peace, health and safety, or general welfare. The
regulations shall include, but need not be limited to, any
regulations necessary for any of the following purposes:
   (1) The administration of this article, including the proper
imposition and collection of the quality assurance fee not to exceed
amounts reasonably necessary for purposes of this article.
   (2) The development of any forms necessary to obtain required
information from facilities subject to the quality assurance fee.
   (3) To provide details, definitions, formulas, and other
requirements.
   (c) As an alternative to subdivision (b), and notwithstanding the
rulemaking provisions of Chapter 3.5 (commencing with Section 11340)
of Part 1 of Division 3 of Title 2 of the Government Code, the
director may implement this article, in whole or in part, by means of
a provider bulletin, or other similar instructions, without taking
regulatory action, provided that no such bulletin or other similar
instructions shall remain in effect after July 31, 2012. It is the
intent of the Legislature that the regulations adopted pursuant to
subdivision (b) shall be adopted on or before July 31, 2012.



1324.24.  The quality assurance fee assessed and collected pursuant
to this article shall be deposited in the State Treasury.



1324.25.  The funds assessed pursuant to this article shall be
available to enhance federal financial participation in the Medi-Cal
program or to provide additional reimbursement to, and to support
facility quality improvement efforts in, licensed skilled nursing
facilities.



1324.26.  In implementing this article, the department may utilize
the services of the Medi-Cal fiscal intermediary through a change
order to the fiscal intermediary contract to administer this program,
consistent with the requirements of Sections 14104.6, 14104.7,
14104.8, and 14104.9 of the Welfare and Institutions Code.




1324.27.  (a) (1) The department shall request approval from the
federal Centers for Medicare and Medicaid Services for the
implementation of this article. In making this request, the
department shall seek specific approval from the federal Centers for
Medicare and Medicaid Services to exempt facilities identified in
subdivision (c) of Section 1324.20, including the submission of a
request for waiver of broad-based requirement, waiver of uniform fee
requirement, or both, pursuant to paragraphs (1) and (2) of
subdivision (e) of Section 433.68 of Title 42 of the Code of Federal
Regulations.
   (2) The director may alter the methodology specified in this
article, to the extent necessary to meet the requirements of federal
law or regulations or to obtain federal approval. The Director of
Health Services may also add new categories of exempt facilities or
apply a nonuniform fee to the skilled nursing facilities subject to
the fee in order to meet requirements of federal law or regulations.
The Director of Health Services may apply a zero fee to one or more
exempt categories of facilities, if necessary to obtain federal
approval.
   (3) If after seeking federal approval, federal approval is not
obtained, this article shall not be implemented.
   (b) The department shall make retrospective adjustments, as
necessary, to the amounts calculated pursuant to Section 1324.21 in
order to assure that the aggregate quality assurance fee for any
particular state fiscal year does not exceed 6 percent of the
aggregate annual net revenue of facilities subject to the fee.



1324.28.  (a) This article shall be implemented as long as both of
the following conditions are met:
   (1) The state receives federal approval of the quality assurance
fee from the federal Centers for Medicare and Medicaid Services.
   (2) Legislation is enacted in the 2004 legislative session making
an appropriation from the General Fund and from the Federal Trust
Fund to fund a rate increase for skilled nursing facilities, as
defined under subdivision (c) of Section 1250, for the 2004-05 rate
year in an amount consistent with the Medi-Cal rates that specific
facilities would have received under the rate methodology in effect
as of July 31, 2004, plus the proportional costs as projected by
Medi-Cal for new state or federal mandates.
   (b) This article shall remain operative only as long as all of the
following conditions are met:
   (1) The federal Centers for Medicare and Medicaid Services
continues to allow the use of the provider assessment provided in
this article.
   (2) The Medi-Cal Long-Term Care Reimbursement Act, Article 3.8
(commencing with Section 14126) of Chapter 7 of Part 3 of Division 9
of the Welfare and Institutions Code, as added during the 2003-04
Regular Session by the act adding this section, is enacted and
implemented on or before July 31, 2005, or as extended as provided in
that article, and remains in effect thereafter.
   (3) The state has continued its maintenance of effort for the
level of state funding of nursing facility reimbursement for the
2005-06 rate year, and for every subsequent rate year continuing
through the 2011-12 rate year, in an amount not less than the amount
that specific facilities would have received under the rate
methodology in effect on July 31, 2004, plus Medi-Cal's projected
proportional costs for new state or federal mandates, not including
the quality assurance fee.
   (4) The full amount of the quality assurance fee assessed and
collected pursuant to this article remains available for the purposes
specified in Section 1324.25 and for related purposes.
   (c) If all of the conditions in subdivision (a) are met, this
article is implemented, and subsequently, any one of the conditions
in subdivision (b) is not met, on and after the date that the
department makes that determination, this article shall not be
implemented, notwithstanding that the condition or conditions
subsequently may be met.
   (d) Notwithstanding subdivisions (a), (b), and (c), in the event
of a final judicial determination made by any state or federal court
that is not appealed, or by a court of appellate jurisdiction that is
not further appealed, in any action by any party, or a final
determination by the administrator of the federal Centers for
Medicare and Medicaid Services, that federal financial participation
is not available with respect to any payment made under the
methodology implemented pursuant to this article because the
methodology is invalid, unlawful, or contrary to any provision of
federal law or regulations, or of state law, this section shall
become inoperative.



1324.29.  (a) The quality assurance fee shall cease to be assessed
after July 31, 2012.
   (b) Notwithstanding subdivision (a) and Section 1324.30, the
department's authority and obligation to collect all quality
assurance fees and penalties, including interest, shall continue in
effect and shall not cease until the date that all amounts are paid
or recovered in full.
   (c) This section shall remain operative until the date that all
fees and penalties, including interest, have been recovered pursuant
to subdivision (b), and as of that date is repealed.




1324.30.  This article shall become inoperative after July 31, 2012,
and, as of January 1, 2013, is repealed, unless a later enacted
statute, that becomes operative on or before January 1, 2013, deletes
or extends the dates on which it becomes inoperative and is
repealed.


State Codes and Statutes

State Codes and Statutes

Statutes > California > Hsc > 1324.20-1324.30

HEALTH AND SAFETY CODE
SECTION 1324.20-1324.30



1324.20.  For purposes of this article, the following definitions
shall apply:
   (a) (1) "Continuing care retirement community" means a provider of
a continuum of services, including independent living services,
assisted living services as defined in paragraph (5) of subdivision
(a) of Section 1771, and skilled nursing care, on a single campus,
that is subject to Section 1791, or a provider of such a continuum of
services on a single campus that has not received a Letter of
Exemption pursuant to subdivision (d) of Section 1771.3.
   (2) Notwithstanding paragraph (1), beginning with the 2010-11 rate
year and for every rate year thereafter, the term "continuing care
retirement community" shall have the definition contained in
paragraph (11) of subdivision (c) of Section 1771.
   (b) "Department," unless otherwise specified, means the State
Department of Health Care Services.
   (c) (1) "Exempt facility" means a skilled nursing facility that is
part of a continuing care retirement community, a skilled nursing
facility operated by the state or another public entity, a unit that
provides pediatric subacute services in a skilled nursing facility, a
skilled nursing facility that is certified by the State Department
of Mental Health for a special treatment program and is an
institution for mental disease as defined in Section 1396d(i) of
Title 42 of the United States Code, or a skilled nursing facility
that is a distinct part of a facility that is licensed as a general
acute care hospital.
   (2) Notwithstanding paragraph (1), beginning with the 2010-11 rate
year and for every rate year thereafter, the term "exempt facility"
shall mean a skilled nursing facility that is part of a continuing
care retirement community, as defined in paragraph (2) of subdivision
(a), a skilled nursing facility operated by the state or another
public entity, a unit that provides pediatric subacute services in a
skilled nursing facility, a skilled nursing facility that is
certified by the State Department of Mental Health for a special
treatment program and is an institution for mental disease as defined
in Section 1396d(i) of Title 42 of the United States Code, or a
skilled nursing facility that is a distinct part of a facility that
is licensed as a general acute care hospital.
   (3) Notwithstanding paragraph (1), beginning with the 2010-11 rate
year and every rate year thereafter, a multilevel facility, as
described in paragraph (1) of subdivision (a), shall not be exempt
from the quality assurance fee requirements pursuant to this article,
unless it meets the definition of a continuing care retirement
community in paragraph (11) of subdivision (c) of Section 1771.
   (d) (1) "Net revenue" means gross resident revenue for routine
nursing services and ancillary services provided to all residents by
a skilled nursing facility, less Medicare revenue for routine and
ancillary services, including Medicare revenue for services provided
to residents covered under a Medicare managed care plan, less payer
discounts and applicable contractual allowances as permitted under
federal law and regulation.
   (2) Notwithstanding paragraph (1), for the 2009-10 to 2011-12,
inclusive, rate years, "net revenue" means gross resident revenue for
routine nursing services and ancillary services provided to all
residents by a skilled nursing facility, including Medicare revenue
for routine and ancillary services and Medicare revenue for services
provided to residents covered under a Medicare managed care plan,
less payer discounts and applicable contractual allowances as
permitted under federal law and regulation. To implement this
paragraph, the department shall request federal approval pursuant to
Section 1324.27.
   (3) "Net revenue" does not mean charitable contributions and bad
debt.
   (e) "Payer discounts and contractual allowances" means the
difference between the facility's resident charges for routine or
ancillary services and the actual amount paid.
   (f) "Skilled nursing facility" means a licensed facility as
defined in subdivision (c) of Section 1250.



1324.21.  (a) For facilities licensed under subdivision (c) of
Section 1250, there shall be imposed each fiscal year a uniform
quality assurance fee per resident day. The uniform quality assurance
fee shall be based upon the entire net revenue of all skilled
nursing facilities subject to the fee, except an exempt facility, as
defined in Section 1324.20, calculated in accordance with subdivision
(b).
   (b) The amount of the uniform quality assurance fee to be assessed
per resident day shall be determined based on the aggregate net
revenue of skilled nursing facilities subject to the fee, in
accordance with the methodology outlined in the request for federal
approval required by Section 1324.27 and in regulations, provider
bulletins, or other similar instructions. The uniform quality
assurance fee shall be calculated as follows:
   (1) (A) For the rate year 2004-05, the net revenue shall be
projected for all skilled nursing facilities subject to the fee. The
projection of net revenue shall be based on prior rate-year data.
Once determined, the aggregate projected net revenue for all
facilities shall be multiplied by 2.7 percent, as determined under
the approved methodology, and then divided by the projected total
resident days of all providers subject to the fee.
   (B) Notwithstanding subparagraph (A), the Director of Health Care
Services may increase the amount of the fee up to 3 percent of the
aggregate projected net revenue if necessary for the implementation
of Article 3.8 (commencing with Section 14126) of Chapter 7 of Part 3
of Division 9 of the Welfare and Institutions Code.
   (2) (A) For the rate year 2005-06 and subsequent rate years
through and including the 2009-10 rate year, the net revenue shall be
projected for all skilled nursing facilities subject to the uniform
quality assurance fee. The projection of net revenue shall be based
on the prior rate year's data. Once determined, the aggregate
projected net revenue for all facilities shall be multiplied by 6
percent, as determined under the approved methodology, and then
divided by the projected total resident days of all providers subject
to the fee. The amounts so determined shall be subject to the
provisions of subdivision (d).
   (B) For the 2010-11 rate year and subsequent rate years, the net
revenue shall be projected for all skilled nursing facilities subject
to the uniform quality assurance fee. The projection of net revenue
shall be based on the prior year's data trended forward, using
historical increases in net revenues. Once determined, the aggregate
projected net revenue for all facilities shall be multiplied by 6
percent, as determined under the approved methodology, and then
divided by the projected total resident days of all providers subject
to the fee. The amounts so determined shall be subject to
subdivision (d).
   (c) The director may assess and collect a nonuniform fee
consistent with the methodology approved pursuant to Section 1324.27.
   (d) In no case shall the fees collected annually pursuant to this
article, taken together with applicable licensing fees, exceed the
amounts allowable under federal law.
   (e) If there is a delay in the implementation of this article for
any reason, including a delay in the approval of the quality
assurance fee and methodology by the federal Centers for Medicare and
Medicaid Services, in the 2004-05 rate year or in any other rate
year, all of the following shall apply:
   (1) Any facility subject to the fee may be assessed the amount the
facility will be required to pay to the department, but shall not be
required to pay the fee until the methodology is approved and
Medi-Cal rates are increased in accordance with paragraph (2) of
subdivision (a) of Section 1324.28 and the increased rates are paid
to facilities.
   (2) The department may retroactively increase and make payment of
rates to facilities.
   (3) Facilities that have been assessed a fee by the department
shall pay the fee assessed within 60 days of the date rates are
increased in accordance with paragraph (2) of subdivision (a) of
Section 1324.28 and paid to facilities.
   (4) The department shall accept a facility's payment
notwithstanding that the payment is submitted in a subsequent fiscal
year than the fiscal year in which the fee is assessed.



1324.22.  (a) The quality assurance fee, as calculated pursuant to
Section 1324.21, shall be paid by the provider to the department for
deposit in the State Treasury on a monthly basis on or before the
last day of the month following the month for which the fee is
imposed, except as provided in subdivision (e) of Section 1324.21.
   (b) On or before the last day of each calendar quarter, each
skilled nursing facility shall file a report with the department, in
a prescribed form, showing the facility's total resident days for the
preceding quarter and payments made. If it is determined that a
lesser amount was paid to the department, the facility shall pay the
amount owed in the preceding quarter to the department with the
report. Any amount determined to have been paid in excess to the
department during the previous quarter shall be credited to the
amount owed in the following quarter.
   (c) On or before August 31 of each year, each skilled nursing
facility subject to an assessment pursuant to Section 1324.21 shall
report to the department, in a prescribed form, the facility's total
resident days and total payments made for the preceding state fiscal
year. If it is determined that a lesser amount was paid to the
department during the previous year, the facility shall pay the
amount owed to the department with the report.
   (d) (1) A newly licensed skilled nursing facility shall complete
all requirements of subdivision (a) for any portion of the year in
which it commences operations and of subdivision (b) for any portion
of the quarter in which it commences operations.
   (2) For purposes of this subdivision, "newly licensed skilled
nursing facility" means a location that has not been previously
licensed as a skilled nursing facility.
   (e) (1) When a skilled nursing facility fails to pay all or part
of the quality assurance fee within 60 days of the date that payment
is due, the department may deduct the unpaid assessment and interest
owed from any Medi-Cal reimbursement payments to the facility until
the full amount is recovered. Any deduction shall be made only after
written notice to the facility and may be taken over a period of time
taking into account the financial condition of the facility.
   (2) In addition to the provisions of paragraph (1), any unpaid
quality assurance fee assessed by this article shall constitute a
debt due to the state and may be collected pursuant to Section
12419.5 of the Government Code.
   (f) Notwithstanding any other provision of law, the department
shall continue to assess and collect the quality assurance fee,
including any previously unpaid quality assurance fee, from each
skilled nursing facility, irrespective of any changes in ownership or
ownership interest or control or the transfer of any portion of the
assets of the facility to another owner.
   (g) During the time period in which a temporary manager is
appointed to a facility pursuant to Section 1325.5 or during which a
receiver is appointed by a court pursuant to Section 1327, the State
Department of Public Health shall not be responsible for any unpaid
quality assurance fee assessed prior to the time period of the
temporary manager or receiver. Nothing in this subdivision shall
affect the responsibility of the facility to make all payments of
unpaid or current quality assurance fees, as required by this section
and Section 1324.21.
   (h) If all or any part of the quality assurance fee remains
unpaid, the department may take either or both of the following
actions:
   (1) Assess a penalty equal to 50 percent of the unpaid fee amount
for unpaid fees assessed during the 2004-05 to 2009-10, inclusive,
rate years, and up to 50 percent of the unpaid fee amount for unpaid
fees assessed during the 2010-11 rate year and any subsequent rate
year.
   (2) (A) Delay license renewal.
   (B) Beginning with the 2010-11 rate year, the department may
recommend to the State Department of Public Health that license
renewal be delayed until the full amount of the quality assurance
fee, penalties, and interest is recovered.
   (i) In accordance with the provisions of the Medicaid State Plan,
the payment of the quality assurance fee shall be considered as an
allowable cost for Medi-Cal reimbursement purposes.
   (j) The assessment process pursuant to this section shall become
operative not later than 60 days from receipt of federal approval of
the quality assurance fee, unless extended by the department. The
department may assess fees and collect payment in accordance with
subdivision (e) of Section 1324.21 in order to provide retroactive
payments for any rate increase authorized under this article.
   (k) The amendments made to subdivision (d) and the addition of
subdivision (f) by the act that added this subdivision shall not be
construed as substantive changes, but are merely clarifying existing
law.


1324.23.  (a) The Director of Health Care Services, or his or her
designee, shall administer this article.
   (b) The director may adopt regulations as are necessary to
implement this article. These regulations may be adopted as emergency
regulations in accordance with the rulemaking provisions of the
Administrative Procedure Act (Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code).
For purposes of this article, the adoption of regulations shall be
deemed an emergency and necessary for the immediate preservation of
the public peace, health and safety, or general welfare. The
regulations shall include, but need not be limited to, any
regulations necessary for any of the following purposes:
   (1) The administration of this article, including the proper
imposition and collection of the quality assurance fee not to exceed
amounts reasonably necessary for purposes of this article.
   (2) The development of any forms necessary to obtain required
information from facilities subject to the quality assurance fee.
   (3) To provide details, definitions, formulas, and other
requirements.
   (c) As an alternative to subdivision (b), and notwithstanding the
rulemaking provisions of Chapter 3.5 (commencing with Section 11340)
of Part 1 of Division 3 of Title 2 of the Government Code, the
director may implement this article, in whole or in part, by means of
a provider bulletin, or other similar instructions, without taking
regulatory action, provided that no such bulletin or other similar
instructions shall remain in effect after July 31, 2012. It is the
intent of the Legislature that the regulations adopted pursuant to
subdivision (b) shall be adopted on or before July 31, 2012.



1324.24.  The quality assurance fee assessed and collected pursuant
to this article shall be deposited in the State Treasury.



1324.25.  The funds assessed pursuant to this article shall be
available to enhance federal financial participation in the Medi-Cal
program or to provide additional reimbursement to, and to support
facility quality improvement efforts in, licensed skilled nursing
facilities.



1324.26.  In implementing this article, the department may utilize
the services of the Medi-Cal fiscal intermediary through a change
order to the fiscal intermediary contract to administer this program,
consistent with the requirements of Sections 14104.6, 14104.7,
14104.8, and 14104.9 of the Welfare and Institutions Code.




1324.27.  (a) (1) The department shall request approval from the
federal Centers for Medicare and Medicaid Services for the
implementation of this article. In making this request, the
department shall seek specific approval from the federal Centers for
Medicare and Medicaid Services to exempt facilities identified in
subdivision (c) of Section 1324.20, including the submission of a
request for waiver of broad-based requirement, waiver of uniform fee
requirement, or both, pursuant to paragraphs (1) and (2) of
subdivision (e) of Section 433.68 of Title 42 of the Code of Federal
Regulations.
   (2) The director may alter the methodology specified in this
article, to the extent necessary to meet the requirements of federal
law or regulations or to obtain federal approval. The Director of
Health Services may also add new categories of exempt facilities or
apply a nonuniform fee to the skilled nursing facilities subject to
the fee in order to meet requirements of federal law or regulations.
The Director of Health Services may apply a zero fee to one or more
exempt categories of facilities, if necessary to obtain federal
approval.
   (3) If after seeking federal approval, federal approval is not
obtained, this article shall not be implemented.
   (b) The department shall make retrospective adjustments, as
necessary, to the amounts calculated pursuant to Section 1324.21 in
order to assure that the aggregate quality assurance fee for any
particular state fiscal year does not exceed 6 percent of the
aggregate annual net revenue of facilities subject to the fee.



1324.28.  (a) This article shall be implemented as long as both of
the following conditions are met:
   (1) The state receives federal approval of the quality assurance
fee from the federal Centers for Medicare and Medicaid Services.
   (2) Legislation is enacted in the 2004 legislative session making
an appropriation from the General Fund and from the Federal Trust
Fund to fund a rate increase for skilled nursing facilities, as
defined under subdivision (c) of Section 1250, for the 2004-05 rate
year in an amount consistent with the Medi-Cal rates that specific
facilities would have received under the rate methodology in effect
as of July 31, 2004, plus the proportional costs as projected by
Medi-Cal for new state or federal mandates.
   (b) This article shall remain operative only as long as all of the
following conditions are met:
   (1) The federal Centers for Medicare and Medicaid Services
continues to allow the use of the provider assessment provided in
this article.
   (2) The Medi-Cal Long-Term Care Reimbursement Act, Article 3.8
(commencing with Section 14126) of Chapter 7 of Part 3 of Division 9
of the Welfare and Institutions Code, as added during the 2003-04
Regular Session by the act adding this section, is enacted and
implemented on or before July 31, 2005, or as extended as provided in
that article, and remains in effect thereafter.
   (3) The state has continued its maintenance of effort for the
level of state funding of nursing facility reimbursement for the
2005-06 rate year, and for every subsequent rate year continuing
through the 2011-12 rate year, in an amount not less than the amount
that specific facilities would have received under the rate
methodology in effect on July 31, 2004, plus Medi-Cal's projected
proportional costs for new state or federal mandates, not including
the quality assurance fee.
   (4) The full amount of the quality assurance fee assessed and
collected pursuant to this article remains available for the purposes
specified in Section 1324.25 and for related purposes.
   (c) If all of the conditions in subdivision (a) are met, this
article is implemented, and subsequently, any one of the conditions
in subdivision (b) is not met, on and after the date that the
department makes that determination, this article shall not be
implemented, notwithstanding that the condition or conditions
subsequently may be met.
   (d) Notwithstanding subdivisions (a), (b), and (c), in the event
of a final judicial determination made by any state or federal court
that is not appealed, or by a court of appellate jurisdiction that is
not further appealed, in any action by any party, or a final
determination by the administrator of the federal Centers for
Medicare and Medicaid Services, that federal financial participation
is not available with respect to any payment made under the
methodology implemented pursuant to this article because the
methodology is invalid, unlawful, or contrary to any provision of
federal law or regulations, or of state law, this section shall
become inoperative.



1324.29.  (a) The quality assurance fee shall cease to be assessed
after July 31, 2012.
   (b) Notwithstanding subdivision (a) and Section 1324.30, the
department's authority and obligation to collect all quality
assurance fees and penalties, including interest, shall continue in
effect and shall not cease until the date that all amounts are paid
or recovered in full.
   (c) This section shall remain operative until the date that all
fees and penalties, including interest, have been recovered pursuant
to subdivision (b), and as of that date is repealed.




1324.30.  This article shall become inoperative after July 31, 2012,
and, as of January 1, 2013, is repealed, unless a later enacted
statute, that becomes operative on or before January 1, 2013, deletes
or extends the dates on which it becomes inoperative and is
repealed.