14150. Within 60 calendar days of the date that the annual Budget
Act is chaptered, the department shall notify the chairpersons of the
fiscal committees of each house of the Legislature, the Chairperson
and the Vice Chairperson of the Joint Legislative Budget Committee,
and appropriate county representatives if the department plans to
withhold and not allocate any of the baseline allocation for county
Medi-Cal eligibility activities that are appropriated for Medi-Cal
administration.
14151. Bills for services rendered during the 1970-71 fiscal year
to persons other than the beneficiaries under the California Medical
Assistance Program submitted to the state by any county which has
elected to come within the provisions of Section 14150.1 of the
Welfare and Institutions Code are bills against the appropriation for
the fiscal year during which the bills are submitted, and shall be
submitted not later than 60 days following the start of the 1971-72
fiscal year. The director may, when he finds that delay in the
submission of bills was caused by circumstances beyond the control of
the county, extend the period of submissions of bills for a period
not to extend beyond the end of the 1971-72 fiscal year. State
general funds of $27,661,452 are made available from the 1971-72
appropriation to cover the state cost of such bills received. In the
event such bills received are less than $27,661,452, the balance
remaining may be used for the basic or supplemental schedules of
benefits.
14152. Bills for services rendered during the 1970-71 fiscal year
to beneficiaries under the California Medical Assistance Program are
bills against the appropriation for the fiscal year during which the
bills are submitted, and shall be submitted not more than two months
after the month in which the service is rendered, and shall be in the
form prescribed by the director, except that in the event the
patient does not identify himself to the provider as a Medi-Cal
beneficiary, the provider shall be entitled to submit his statement
at any time within 60 days after that date certified by the provider
as the date said patient was first identified as a Medi-Cal
beneficiary, provided, however, that such date certified by the
provider as the date the patient was first so identified shall not be
later than one year after the month in which the service was
rendered. Further, the director may, where he finds that delay in the
submission of bills was caused by circumstances beyond the control
of the provider, extend the period for submission of bills for a
period not to exceed one year. Funds in the amount of $106,269,000
are hereby made available from the 1971-72 appropriation to cover the
cost of such 1970-71 services billed during the 1971-72 fiscal year.
In the event such bills are less than $106,269,000 the balance
remaining may be used for the basic or supplemental schedules of
benefits.
14153. Funds shall be advanced monthly to the respective counties
for costs of administration of the Medi-Cal program in the manner
prescribed in Chapter 9 (commencing with Section 15000).
Funds may be advanced monthly to the respective counties for the
costs of care under the provisions of this chapter upon the order of
the Director of Finance and the State Director of Health Services
utilizing resources made available through the Health Care Deposit
Fund.
County welfare departments shall submit administrative claims for
the Medi-Cal program in accordance with procedures described in
Section 10604.5.
14154. (a) (1) The department shall establish and maintain a plan
whereby costs for county administration of the determination of
eligibility for benefits under this chapter will be effectively
controlled within the amounts annually appropriated for that
administration. The plan, to be known as the County Administrative
Cost Control Plan, shall establish standards and performance
criteria, including workload, productivity, and support services
standards, to which counties shall adhere. The plan shall include
standards for controlling eligibility determination costs that are
incurred by performing eligibility determinations at county
hospitals, or that are incurred due to the outstationing of any other
eligibility function. Except as provided in Section 14154.15,
reimbursement to a county for outstationed eligibility functions
shall be based solely on productivity standards applied to that
county's welfare department office.
(2) (A) The plan shall delineate both of the following:
(i) The process for determining county administration base costs,
which include salaries and benefits, support costs, and staff
development.
(ii) The process for determining funding for caseload changes,
cost-of-living adjustments, and program and other changes.
(B) The annual county budget survey document utilized under the
plan shall be constructed to enable the counties to provide
sufficient detail to the department to support their budget requests.
(3) The plan shall be part of a single state plan, jointly
developed by the department and the State Department of Social
Services, in conjunction with the counties, for administrative cost
control for the California Work Opportunity and Responsibility to
Kids (CalWORKs), Food Stamp, and Medical Assistance (Medi-Cal)
programs. Allocations shall be made to each county and shall be
limited by and determined based upon the County Administrative Cost
Control Plan. In administering the plan to control county
administrative costs, the department shall not allocate state funds
to cover county cost overruns that result from county failure to meet
requirements of the plan. The department and the State Department of
Social Services shall budget, administer, and allocate state funds
for county administration in a uniform and consistent manner.
(4) The department and county welfare departments shall develop
procedures to ensure the data clarity, consistency, and reliability
of information contained in the county budget survey document
submitted by counties to the department. These procedures shall
include the format of the county budget survey document and process,
data submittal and its documentation, and the use of the county
budget survey documents for the development of determining county
administration costs. Communication between the department and the
county welfare departments shall be ongoing as needed regarding the
content of the county budget surveys and any potential issues to
ensure the information is complete and well understood by involved
parties. Any changes developed pursuant to this section shall be
incorporated within the state's annual budget process by no later
than the 2011-12 fiscal year.
(5) The department shall provide a clear narrative description
along with fiscal detail in the Medi-Cal estimate package, submitted
to the Legislature in January and May of each year, of each component
of the county administrative funding for the Medi-Cal program. This
shall describe how the information obtained from the county budget
survey documents was utilized and, where applicable, modified and the
rationale for the changes.
(b) Nothing in this section, Section 15204.5, or Section 18906
shall be construed so as to limit the administrative or budgetary
responsibilities of the department in a manner that would violate
Section 14100.1, and thereby jeopardize federal financial
participation under the Medi-Cal program.
(c) (1) The Legislature finds and declares that in order for
counties to do the work that is expected of them, it is necessary
that they receive adequate funding, including adjustments for
reasonable annual cost-of-doing-business increases. The Legislature
further finds and declares that linking appropriate funding for
county Medi-Cal administrative operations, including annual
cost-of-doing-business adjustments, with performance standards will
give counties the incentive to meet the performance standards and
enable them to continue to do the work they do on behalf of the
state. It is therefore the Legislature's intent to provide
appropriate funding to the counties for the effective administration
of the Medi-Cal program at the local level to ensure that counties
can reasonably meet the purposes of the performance measures as
contained in this section.
(2) It is the intent of the Legislature to not appropriate funds
for the cost-of-doing-business adjustment for the 2008-09, 2009-10,
and 2010-11 fiscal years.
(d) The department is responsible for the Medi-Cal program in
accordance with state and federal law. A county shall determine
Medi-Cal eligibility in accordance with state and federal law. If in
the course of its duties the department becomes aware of accuracy
problems in any county, the department shall, within available
resources, provide training and technical assistance as appropriate.
Nothing in this section shall be interpreted to eliminate any remedy
otherwise available to the department to enforce accurate county
administration of the program. In administering the Medi-Cal
eligibility process, each county shall meet the following performance
standards each fiscal year:
(1) Complete eligibility determinations as follows:
(A) Ninety percent of the general applications without applicant
errors and are complete shall be completed within 45 days.
(B) Ninety percent of the applications for Medi-Cal based on
disability shall be completed within 90 days, excluding delays by the
state.
(2) (A) The department shall establish best-practice guidelines
for expedited enrollment of newborns into the Medi-Cal program,
preferably with the goal of enrolling newborns within 10 days after
the county is informed of the birth. The department, in consultation
with counties and other stakeholders, shall work to develop a process
for expediting enrollment for all newborns, including those born to
mothers receiving CalWORKs assistance.
(B) Upon the development and implementation of the best-practice
guidelines and expedited processes, the department and the counties
may develop an expedited enrollment timeframe for newborns that is
separate from the standards for all other applications, to the extent
that the timeframe is consistent with these guidelines and
processes.
(C) Notwithstanding the rulemaking procedures of 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 section by
means of all-county letters or similar instructions, without further
regulatory action.
(3) Perform timely annual redeterminations, as follows:
(A) Ninety percent of the annual redetermination forms shall be
mailed to the recipient by the anniversary date.
(B) Ninety percent of the annual redeterminations shall be
completed within 60 days of the recipient's annual redetermination
date for those redeterminations based on forms that are complete and
have been returned to the county by the recipient in a timely manner.
(C) Ninety percent of those annual redeterminations where the
redetermination form has not been returned to the county by the
recipient shall be completed by sending a notice of action to the
recipient within 45 days after the date the form was due to the
county.
(D) When a child is determined by the county to change from no
share of cost to a share of cost and the child meets the eligibility
criteria for the Healthy Families Program established under Section
12693.98 of the Insurance Code, the child shall be placed in the
Medi-Cal-to-Healthy Families Bridge Benefits Program, and these cases
shall be processed as follows:
(i) Ninety percent of the families of these children shall be sent
a notice informing them of the Healthy Families Program within five
working days from the determination of a share of cost.
(ii) Ninety percent of all annual redetermination forms for these
children shall be sent to the Healthy Families Program within five
working days from the determination of a share of cost if the parent
has given consent to send this information to the Healthy Families
Program.
(iii) Ninety percent of the families of these children placed in
the Medi-Cal-to-Healthy Families Bridge Benefits Program who have not
consented to sending the child's annual redetermination form to the
Healthy Families Program shall be sent a request, within five working
days of the determination of a share of cost, to consent to send the
information to the Healthy Families Program.
(E) Subparagraph (D) shall not be implemented until 60 days after
the Medi-Cal and Joint Medi-Cal and Healthy Families applications and
the Medi-Cal redetermination forms are revised to allow the parent
of a child to consent to forward the child's information to the
Healthy Families Program.
(e) The department shall develop procedures in collaboration with
the counties and stakeholder groups for determining county review
cycles, sampling methodology and procedures, and data reporting.
(f) On January 1 of each year, each applicable county, as
determined by the department, shall report to the department on the
county's results in meeting the performance standards specified in
this section. The report shall be subject to verification by the
department. County reports shall be provided to the public upon
written request.
(g) If the department finds that a county is not in compliance
with one or more of the standards set forth in this section, the
county shall, within 60 days, submit a corrective action plan to the
department for approval. The corrective action plan shall, at a
minimum, include steps that the county shall take to improve its
performance on the standard or standards with which the county is out
of compliance. The plan shall establish interim benchmarks for
improvement that shall be expected to be met by the county in order
to avoid a sanction.
(h) (1) If a county does not meet the performance standards for
completing eligibility determinations and redeterminations as
specified in this section, the department may, at its sole
discretion, reduce the allocation of funds to that county in the
following year by 2 percent. Any funds so reduced may be restored by
the department if, in the determination of the department, sufficient
improvement has been made by the county in meeting the performance
standards during the year for which the funds were reduced. If the
county continues not to meet the performance standards, the
department may reduce the allocation by an additional 2 percent for
each year thereafter in which sufficient improvement has not been
made to meet the performance standards.
(2) No reduction of the allocation of funds to a county shall be
imposed pursuant to this subdivision for failure to meet performance
standards during any period of time in which the
cost-of-doing-business increase is suspended.
(i) The department shall develop procedures, in collaboration with
the counties and stakeholders, for developing instructions for the
performance standards established under subparagraph (D) of paragraph
(3) of subdivision (d), no later than September 1, 2005.
(j) No later than September 1, 2005, the department shall issue a
revised annual redetermination form to allow a parent to indicate
parental consent to forward the annual redetermination form to the
Healthy Families Program if the child is determined to have a share
of cost.
(k) The department, in coordination with the Managed Risk Medical
Insurance Board, shall streamline the method of providing the Healthy
Families Program with information necessary to determine Healthy
Families eligibility for a child who is receiving services under the
Medi-Cal-to-Healthy Families Bridge Benefits Program.
14154.1. Reimbursement for any Medi-Cal county administrative costs
shall be made subject to the requirements specified in the County
Administrative Cost Control Plan, established pursuant to Section
14154. However, notwithstanding any other provision of law, for
applications taken on or after July 1, 1987, and thereafter, the
department shall make allocations for Medi-Cal county administrative
expenses taking into consideration all Medi-Cal applications.
However, if the department determines that a county is
inappropriately processing non-Medi-Cal applications through the
Medi-Cal process, then the department shall not allocate state
general funds for nonapproved Medi-Cal applications which exceed a
specified level. That level shall be determined by multiplying the
county's number of approved applications by the ratio of nonapproved
applications to approved applications processed by the county during
the base period used in the cost control plan which is in effect for
the fiscal year the inappropriate processing of non-Medi-Cal
applications occurred. Reimbursement to Los Angeles County hospitals
shall be limited on the same basis.
14154.15. (a) Any county may petition the department for an
augmentation of its County Administrative Cost Control Plan in order
to implement a plan, as provided for in Section 1105 of the federal
Social Security Act (42 U.S.C. Sec. 1305), for the outstationing of
one or more eligibility workers at all types of outstation locations,
as defined in Section 435.904(c)(3) of Title 42 of the Code of
Federal Regulations in order to facilitate receipt and processing of
applications for Medi-Cal eligibility for pregnant women, infants and
children as specified by Title XIX of the Social Security Act (42
U.S.C. Sec. 1396 and following). In order to participate pursuant to
this section, a county welfare department shall petition under this
section in accordance with guidelines established by the department.
The petition shall include, but not be limited to, information about
the need for outstation workers at alternative sites and the language
skills needed by the outstation workers.
(b) In reviewing a petition from a county for an augmentation of
its County Administrative Cost Control Plan for outstationing
purposes, the department shall take into account the likely success
rate of applications processed by the proposed outstationed
eligibility workers, the amount of travel and training time required
to implement and continue the outstationing plan, and other
productivity factors associated with the outstationing plan.
(c) The department may approve those proposed augmentations which,
based on its review of the outstationing plan, offer potential to
increase eligibility determinations and access to Medi-Cal perinatal
services by pregnant women and Medi-Cal services by infants and
children specified by Title XIX of the Social Security Act (42
U.S.C., Sec. 1396 and following). The department shall review the
approved plan annually to determine if the plan shall be renewed,
altered, discontinued, or incorporated into the county administrative
funding base.
(d) In addition to any augmentations authorized by this section,
the department may, at its discretion, advance administrative funding
to a county welfare department for which it approves an augmentation
of its County Administrative Cost Control Plan, to cover the initial
incremental costs of outstationed eligibility workers under this
section.
(e) The department shall conduct a one-time outreach plan to
educate county welfare directors, county health officers, and county
elected officials on the opportunities and advantages of
outstationing Medi-Cal eligibility workers to facilitate access by
pregnant women to Medi-Cal perinatal services and Medi-Cal
eligibility for infants and children.
14154.2. (a) The Legislature finds that ambiguities have arisen
regarding payment provisions relating to certain costs incurred in
processing Medi-Cal eligibility applications for various fiscal
years, and believes the ambiguities should be alleviated by means of
legislation clarifying the Legislature's intent regarding such
provisions.
(b) The Legislature recognizes that federal financial
participation in the costs of administering the Medi-Cal program is
an important element in funding such costs, and desires that federal
financial participation be pursued and obtained whenever possible.
With respect to Medi-Cal administration costs, for eligibility
determinations, it is not and has not been the Legislature's intent
to preclude federal financial participation which would otherwise be
available from the Health Care Financing Administration.
14154.3. (a) A provision of a Budget Act or other statute shall not
be interpreted or applied to limit the amount of federal financial
participation, otherwise available under federal law, which may be
reimbursable to counties in support of Medi-Cal administration costs
for eligibility determinations. A provision of a Budget Act or
another statute shall not be interpreted or applied to restrict the
amount of federal financial participation for Medi-Cal administration
costs, for eligibility determinations, otherwise available under
federal law, which may be claimed by the department, and, upon
receipt from the federal government, transferred by the department to
a county.
(b) The Budget Acts referred to in subdivision (a) include, but
are not limited to:
(1) Chapter 510 of the Statutes of 1980, including Item 288 of
Section 2 thereof.
(2) Chapter 99 of the Statutes of 1981, including Items
426-101-001 and 426-101-890 of Section 2.00 thereof.
(3) Chapter 326 of the Statutes of 1982, including Items
4260-101-001 and 4260-101-890 of Section 2.00 thereof.
(4) Chapter 324 of the Statutes of 1983, including Items
4260-101-001 and 4260-101-890 of Section 2.00 thereof.
(5) Chapter 258 of the Statutes of 1984, including Items
4260-101-001 and 4260-101-890 of Section 2.00 thereof.
(6) Chapter 111 of the Statutes of 1985, including Items
4260-101-001 and 4260-101-890 of Section 2.00 thereof.
(7) Chapter 186 of the Statutes of 1986, including Items
4260-101-001 and 4260-101-890 of Section 2.00 thereof.
Provisions of the Budget Acts listed in paragraphs (1) to (7),
inclusive, shall not be interpreted or applied as a prohibition
regarding the amount of costs counties may incur for Medi-Cal
eligibility administration activities. The provisions of those Budget
Acts shall be interpreted and applied as a means of limiting the
allocation of state general funds to be paid in support of Medi-Cal
eligibility determination activities.
(c) To the extent necessary to effectuate the intent of
subdivisions (a) and (b), the following Budget Act provisions shall
be inoperative:
(1) Provision 17.5 of Item 426-101-890 of Section 2.00 of Chapter
99 of the Statutes of 1981.
(2) The incorporation by reference of Provision 16 of Item
4260-101-001 of Section 2.00 of Chapter 326 of the Statutes of 1982
into Provision 1 of Item 4260-101-890 of that chapter.
(3) The incorporation by reference of Provision 15 of Item
4260-101-001 of Section 2.00 of Chapter 324 of the Statutes of 1983
into Provision 1 of Item 4260-101-890 of Section 2.00 of that
chapter.
(d) Sections 14154 and 14154.1 shall not be interpreted or applied
to restrict the amount of federal financial participation, not
deferred or disallowed by federal law or regulation which may be
reimbursable to any county for Medi-Cal administration costs for
eligibility determinations. The County Administrative Cost Control
Plan established pursuant to Section 14154 shall not be interpreted
or applied as a prohibition regarding the amount of costs counties
may incur for Medi-Cal county administration costs. That plan shall
be interpreted and applied only as a means of limiting the allocation
of state general funds to be paid in support of those county costs.
(e) Should federal financial participation be deferred or
disallowed regarding funds transferred by the department to a county
for costs incurred for Medi-Cal eligibility determinations, and that
federal financial participation was matched by county expenditures,
the county which received those federal funds shall repay the funds
in question at such time as the federal deferral or disallowance has
been issued. If the federal deferral or disallowance is noticed or
issued prior to the transfer of the federal funds from the department
to a county, the department shall not be responsible for
transferring the federal funds to the county until the deferral or
disallowance issue regarding these funds has been resolved.
(f) The department shall timely appeal from the federal deferrals
or disallowances and the affected county may assist the department in
preparing and presenting a pending appeal regarding a federal
deferral or disallowance.
(g) Medi-Cal eligibility determination activities are undertaken
by counties on behalf of the department. Reasonable and necessary
costs incurred by counties relating to the eligibility determination
activities shall be recognized as costs incurred by the state for
purposes of inclusion in the nonfederal share of Medi-Cal eligibility
determination expenditures for claiming federal financial
participation.
(h) Subdivision (e) shall not apply to agreements between the
department and a county executed prior to September 27, 1987.
14154.5. (a) Each county shall work, on a routine basis, any error
alert from the department's Medi-Cal Eligibility Data System (MEDS).
Any alert that affects eligibility or the share of cost that is
received by the 10th working day of the month shall be processed in
time for the change to be effective the beginning of the following
month. Any alert that affects eligibility or the share of cost that
is received after the 10th working day of the month shall be
processed in time for the change to be effective the beginning of the
month after the following month. The department shall consult with
the County Welfare Directors Association to define those alerts that
affect eligibility or the share of cost.
(b) The county shall submit reconciliation files of its Medi-Cal
eligible population to the department every three months, based upon
a schedule determined by the department and in a format prescribed by
the department, to identify any discrepancies between eligibility
files in the county records and eligibility as reflected in MEDS.
Counties shall be notified of any changes to the standard format for
submitting reconciliation files sufficiently in advance to allow for
budgeting, scheduling, development, testing, and implementation of
any required change in county automated eligibility systems.
(c) For those records that are on the county's files, but not on
MEDS, the county shall receive worker alerts from the department that
identify these cases, and the county shall fix any data
discrepancies. Any worker alert received by the 10th working day of
the month shall be processed in time for the change to be effective
the beginning of the following month. Any worker alert received after
the 10th working day of the month shall be processed in time for the
change to be effective the beginning of the month after the
following month.
(d) In regard to any record that is on MEDS but not on the county'
s file, the county shall either correct the county record or MEDS,
whichever is appropriate, within the same timeframes specified in
subdivision (c).
(e) The department shall terminate a MEDS-eligible record if the
person is not eligible on the county's file when there has been no
eligibility update on the MEDS record for six months.
(f) (1) If the department finds that a county is not performing
all of the following activities, the county shall, within 60 days,
submit a corrective action plan to the department for approval:
(A) Conducting reconciliations as required in subdivision (b).
(B) Processing 95 percent of worker alerts referred to in
subdivisions (c) and (d), within the timeframes specified.
(C) Processing 90 percent of the error alerts referred to in
subdivision (a) that affect eligibility or the share of cost, within
the timeframes specified.
(2) The corrective action plan shall, at a minimum, include steps
that the county shall take to improve its performance on the
requirements with which the county is out of compliance. The plan
shall establish interim benchmarks for improvement that shall be
expected to be met by the county in order to avoid sanctions.
(g) (1) If the county does not meet the interim benchmarks for
improvement standards, the department may, in its sole discretion,
reduce the allocation of funds to that county in the following year
by 2 percent. Any funds so reduced may be restored by the department
if, in the determination of the department, sufficient improvement
has been made by the county in meeting the performance standards
during the year for which the funds were reduced.
(2) No reduction of the allocation of funds to a county shall be
imposed pursuant to this subdivision for failure to meet performance
standards during any period of time in which the
cost-of-doing-business increase is suspended.
(h) The department, in consultation with the County Welfare
Directors Association, shall investigate features that could be
installed in MEDS to reduce the number of alerts and streamline the
reconciliation process.
(i) 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 department may implement, interpret, or
make specific this section by means of all-county letters, provider
bulletins, or similar instructions. Thereafter, the department may
adopt regulations 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.
14157. There is hereby established a Health Care Deposit Fund from
which expenditures of state, county and federal funds for health care
and administration under this chapter and Chapter 8 (commencing with
Section 14200) shall be made upon order of the Controller in
accordance with certifications made by the director.
The Controller shall deposit in this fund all federal funds as
received under the provisions of Title XIX of the Social Security Act
and all county funds received under this chapter.
All money in the Health Care Deposit Fund is hereby appropriated,
for expenditure for the purposes specified in this chapter and
Chapter 8 (commencing with Section 14200).
14157.6. Notwithstanding any other provision of law, any federal
and county funds, excluding county funds used for the purposes of
Section 4011.1 of the Penal Code, received under the provisions of
Section 14157 during each fiscal year, as reimbursement for
expenditures for health care services authorized under this chapter
made from funds transferred to the Health Care Deposit Fund from the
General Fund in prior years, shall be transferred from the Health
Care Deposit Fund to the General Fund. When a projected deficiency
exists in the Medical Assistance Program, these federal and county
funds are hereby appropriated from the General Fund to the Health
Care Deposit Fund and shall be expended as soon as practicable, but
not sooner than 30 days after notification in writing of the
necessity therefor, to the chairperson of the committee in each house
which considers appropriations, and the Joint Legislative Budget
Committee, for the state's share of payments for medical care and
services, county administration, and fiscal intermediary services.
14158. Funds for the medical assistance program shall be provided
annually by appropriation in the Budget Act. The amount of state
funds appropriated shall be transferred in such sums as are needed by
the Controller from the General Fund to the Health Care Deposit
Fund.
14158.1. Effective for expenditures incurred after enactment of any
new demonstration project under Article 5.4 (commencing with Section
14180), any federal financial participation that is available under
the federal Medicaid Program, or any related waiver or demonstration
project, based on the certified public expenditures of designated
public hospitals, as defined in subdivision (d) of Section 14166.1,
or the governmental entities with which they are affiliated, shall be
paid to designated public hospitals or the governmental entities
with which they are affiliated.
14158.5. Funds appropriated for purposes of this chapter and
Chapter 8 (commencing with Section 14200), shall fully cover and
shall not exceed the state's share of payments under this chapter and
Chapter 8 (commencing with Section 14200), for the costs of medical
care and services, county administration, and fiscal intermediary
services. The state's share of the costs of medical care and
services, county administration, and fiscal intermediary services
shall be determined pursuant to a plan approved by the Director of
Finance and certified to by the director.
14159. Commencing with the 2004-05 fiscal year, expenditures for
Medi-Cal services and fiscal intermediary and county administration
costs included in the department's budget shall be charged against
the appropriation for the fiscal year in which the billing is paid.
Commencing July 1, 2004, all 2002-03 fiscal year and prior accrued
obligations of the Health Care Deposit Fund shall become obligations
of the 2004-05 fiscal year and all moneys available from the 2002-03
fiscal year and prior appropriations shall be reappropriated to the
2004-05 fiscal year for that purpose.
14159.1. The provisions of Chapter 577 of the Statutes of 1971 in
no way eliminate fiscal obligation incurred prior to July 1, 1971, by
any county or the state under Article 5 (commencing with Section
14150) of Chapter 7 of Part 3 of Division 9 of the Welfare and
Institutions Code. After June 30, 1971, all uncollected county share
amounts under said Article 5 due the state for prior periods remain
an obligation of the county to the state.
14160. Whenever an amount is or was prior to the effective date of
this section, erroneously deposited in the Health Care Deposit Fund,
including, but not limited to, duplicate payments and payments in
excess of the correct amount, the erroneous amount shall be refunded
to the depositor. There is hereby appropriated out of the Health Care
Deposit Fund amounts sufficient to pay such refunds.
14161. Carriers and providers of Medi-Cal benefits shall be
required to utilize uniform accounting and cost-reporting systems as
shall be developed and adopted by the department. If any other
provision of law provides for uniform accounting and cost-reporting
systems for hospitals, the department shall adopt these systems.
Carriers and providers of Medi-Cal benefits shall provide cost
information to the department as is necessary in order to conduct
studies to determine payment for services provided under this
chapter, including but not limited to copies of any Medicare cost
reports and settlements, and any Medicare audit reports.
Failure to comply with the provisions of this section shall be
cause for suspension from participation under this chapter.
The department shall conduct such studies as necessary to
determine payments for services provided under this chapter. The
results of or progress reports concerning such studies shall be
submitted to the Legislature by January 31 of each year.
The department shall submit an annual report to the Governor and
the Legislature by January 31 of each year setting forth a
comprehensive description of its activities and the operation and
administration of the Medi-Cal program including, but not limited to,
a fiscal accounting of expenditures, an evaluation of the relative
cost and effectiveness of the various plans in accomplishing the
desired goals, results of demonstration or pilot programs, and its
recommendations as to legislation and other action as is necessary
for carrying out the purposes of this chapter.
14162. (a) Beginning in 1991, the State Department of Health
Services shall include in the November estimate of Medi-Cal
expenditures and the Governor's Budget an estimate of savings from
the prior year which resulted from implementation of Senate Bill 2174
of the 1987-88 Regular Session of the Legislature.
(b) Beginning in 1992, the Department of Finance shall, by
February 1, deposit an amount equal to the savings level identified
in the November estimate of Medi-Cal expenditures into the Critical
Needs Health Care Fund, which is hereby created. Funds deposited in
the Critical Needs Health Care Fund shall be appropriated by the
Legislature for high-priority health expenditures.
14163. (a) For purposes of this section, the following definitions
shall apply:
(1) "Public entity" means a county, a city, a city and county, the
State of California, the University of California, a local health
care district, a local health authority, or any other political
subdivision of the state.
(2) "Hospital" means a health facility that is licensed pursuant
to Chapter 2 (commencing with Section 1250) of Division 2 of the
Health and Safety Code to provide acute inpatient hospital services,
and includes all components of the facility.
(3) "Disproportionate share hospital" means a hospital providing
acute inpatient services to Medi-Cal beneficiaries that meets the
criteria for disproportionate share status relating to acute
inpatient services set forth in Section 14105.98.
(4) "Disproportionate share list" means the annual list of
disproportionate share hospitals for acute inpatient services issued
by the department pursuant to Section 14105.98.
(5) "Fund" means the Medi-Cal Inpatient Payment Adjustment Fund.
(6) "Eligible hospital" means, for a particular state fiscal year,
a hospital on the disproportionate share list that is eligible to
receive payment adjustment amounts under Section 14105.98 with
respect to that state fiscal year.
(7) "Transfer year" means the particular state fiscal year during
which, or with respect to which, public entities are required by this
section to make an intergovernmental transfer of funds to the
Controller.
(8) "Transferor entity" means a public entity that, with respect
to a particular transfer year, is required by this section to make an
intergovernmental transfer of funds to the Controller.
(9) "Transfer amount" means an amount of intergovernmental
transfer of funds that this section requires for a particular
transferor entity with respect to a particular transfer year.
(10) "Intergovernmental transfer" means a transfer of funds from a
public entity to the state that is local government financial
participation in Medi-Cal pursuant to the terms of this section.
(11) "Licensee" means an entity that has been issued a license to
operate a hospital by the department.
(12) "Annualized Medi-Cal inpatient paid days" means the total
number of Medi-Cal acute inpatient hospital days, regardless of dates
of service, for which payment was made by or on behalf of the
department to a hospital, under present or previous ownership, during
the most recent calendar year ending prior to the beginning of a
particular transfer year, including all Medi-Cal acute inpatient
covered days of care for hospitals that are paid on a different basis
than per diem payments.
(13) "Medi-Cal acute inpatient hospital day" means any acute
inpatient day of service attributable to patients who, for those
days, were eligible for medical assistance under the California state
plan, including any day of service that is reimbursed on a basis
other than per diem payments.
(14) "OBRA 1993 payment limitation" means the hospital-specific
limitation on the total annual amount of payment adjustments to each
eligible hospital under the payment adjustment program that can be
made with federal financial participation under Section 1396r-4(g) of
Title 42 of the United States Code as implemented pursuant to the
Medi-Cal State Plan.
(b) The Medi-Cal Inpatient Payment Adjustment Fund is hereby
created in the State Treasury. Notwithstanding Section 13340 of the
Government Code, the fund shall be continuously appropriated to, and
under the administrative control of, the department for the purposes
specified in subdivision (d). The fund shall consist of the
following:
(1) Transfer amounts collected by the Controller under this
section, whether submitted by transferor entities pursuant to
applicable provisions of this section or obtained by offset pursuant
to subdivision (j).
(2) Any other intergovernmental transfers deposited in the fund,
as permitted by Section 14164.
(3) Any interest that accrues with respect to amounts in the fund.
(c) Moneys in the fund, which shall not consist of any state
general funds, shall be used as the source for the nonfederal share
of payments to hospitals pursuant to Section 14105.98. Moneys shall
be allocated from the fund by the department and matched by federal
funds in accordance with customary Medi-Cal accounting procedures,
and used to make payments pursuant to Section 14105.98.
(d) Except as otherwise provided in Section 14105.98 or in any law
appropriating a specified sum of money to the department for
administering this section and Section 14105.98, moneys in the fund
shall be used only for the following:
(1) Payments to hospitals pursuant to Section 14105.98.
(2) Transfers to the Health Care Deposit Fund as follows:
(A) In the amount of two hundred thirty-nine million seven hundred
fifty-seven thousand six hundred ninety dollars ($239,757,690) for
the 1994-95 and 1995-96 fiscal years.
(B) In the amount of two hundred twenty-nine million seven hundred
fifty-seven thousand six hundred ninety dollars ($229,757,690) for
the 1996-97 fiscal year.
(C) In the amount of one hundred fifty-four million seven hundred
fifty-seven thousand six hundred ninety dollars ($154,757,690) for
the 1997-98 fiscal year.
(D) In the amount of one hundred fourteen million seven hundred
fifty-seven thousand six hundred ninety dollars ($114,757,690) for
the 1998-99 fiscal year.
(E) (i) In the amount of eighty-four million seven hundred
fifty-seven thousand six hundred ninety dollars ($84,757,690) for the
1999-2000 fiscal year.
(ii) It is the intent of the Legislature that the economic benefit
of any reduction in the amount transferred, or to be transferred, to
the Health Care Deposit Fund pursuant to this subdivision for the
1999-2000 fiscal year, as compared to the amount so transferred for
the 1998-99 fiscal year, be allocated equally between public and
nonpublic disproportionate share hospitals. To implement the
reduction in clause (i) the department shall, by June 30, 2000,
adjust the calculations in Section 14105.98 in order to allocate the
funds in accordance with this clause.
(F) In the amount of twenty-nine million seven hundred fifty-seven
thousand six hundred ninety dollars ($29,757,690) for the 2000-01
fiscal year and the 2001-02 fiscal year.
(G) In the amount of eighty-five million dollars ($85,000,000) for
the 2002-03 fiscal year and each fiscal year thereafter.
(H) The transfers from the fund shall be made in six equal monthly
installments to the Medi-Cal local assistance appropriation item
(Item 4260-101-0001 of Section 2.00 of the annual Budget Act) in
support of Medi-Cal expenditures. The first installment shall accrue
in October of each transfer year, and all other installments shall
accrue monthly thereafter from November through March.
(e) For the 1991-92 state fiscal year, the department shall
determine, no later than 70 days after the enactment of this section,
the transferor entities for the 1991-92 transfer year. To make this
determination, the department shall utilize the disproportionate
share list for the 1991-92 fiscal year issued by the department
pursuant to paragraph (1) of subdivision (f) of Section 14105.98. The
department shall identify each eligible hospital on the list for
which a public entity is the licensee as of July 1, 1991. The public
entity that is the licensee of each identified eligible hospital
shall be a transferor entity for the 1991-92 transfer year.
(f) The department shall determine, no later than 70 days after
the enactment of this section, the transfer amounts for the 1991-92
transfer year.
The transfer amounts shall be determined as follows:
(1) The eligible hospitals for 1991-92 shall be identified. For
each hospital, the applicable total per diem payment adjustment
amount under Section 14105.98 for the 1991-92 transfer year shall be
computed. This amount shall be multiplied by 80 percent of the
eligible hospital's annualized Medi-Cal inpatient paid days as
determined from all Medi-Cal paid claims records available through
April 1, 1991. The products of these calculations for all eligible
hospitals shall be added together to determine an aggregate sum for
the 1991-92 transfer year.
(2) The eligible hospitals for 1991-92 involving transferor
entities as licensees shall be identified. For each hospital, the
applicable total per diem payment adjustment amount under Section
14105.98 for the 1991-92 transfer year shall be computed. This amount
shall be multiplied by 80 percent of the eligible hospital's
annualized Medi-Cal inpatient paid days as determined from all
Medi-Cal paid claims records available through April 1, 1991. The
products of these calculations for all eligible hospitals with
transferor entities as licensees shall be added together to determine
an aggregate sum for the 1991-92 transfer year.
(3) The aggregate sum determined under paragraph (1) shall be
divided by the aggregate sum determined under paragraph (2), yielding
a factor to be utilized in paragraph (4).
(4) The factor determined in paragraph (3) shall be multiplied by
the amount determined for each hospital under paragraph (2). The
product of this calculation for each hospital in paragraph (2) shall
be divided by 1.771, yielding a transfer amount for the particular
transferor entity for the transfer year.
(g) For the 1991-92 transfer year, the department shall notify
each transferor entity in writing of its applicable transfer amount
or amounts.
(h) For the 1992-93 transfer year and subsequent transfer years,
transfer amounts shall be determined in the same procedural manner as
set forth in subdivision (f), except:
(1) The department shall use all of the following:
(A) The disproportionate share list applicable to the particular
transfer year to determine the eligible hospitals.
(B) The payment adjustment amounts calculated under Section
14105.98 for the particular transfer year. These amounts shall take
into account any projected or actual increases or decreases in the
size of the payment adjustment program as are required under Section
14105.98 for the particular year in question, including any decreases
resulting from the application of the OBRA 1993 payment limitation.
The department may issue interim, revised, and supplemental transfer
requests as necessary and appropriate to address changes in payment
adjustment levels that occur under Section 14105.98. All transfer
requests, or adjustments thereto, issued to transferor entities by
the department shall meet the requirements set forth in subdivision
(i).
(C) Data regarding annualized Medi-Cal inpatient paid days for the
most recent calendar year ending prior to the beginning of the
particular transfer year, as determined from all Medi-Cal paid claims
records available through April 1 preceding the particular transfer
year.
(D) The status of public entities as licensees of eligible
hospitals as of July 1 of the particular transfer year.
(E) For the 1993-94 transfer year and subsequent transfer years,
the divisor to be used for purposes of the calculation referred to in
paragraph (4) of subdivision (f) shall be determined by the
department. The divisor shall be calculated to ensure that the
appropriate amount of transfers from transferor entities are received
into the fund to satisfy the requirements of Section 14105.98,
exclusive of the amounts described in paragraph (2) of this
subdivision, and to satisfy the requirements of paragraph (2) of
subdivision (d), for the particular transfer year. For the 1993-94
transfer year, the divisor shall be 1.742.
(F) The following provisions shall apply for certain transfer
amounts relating to nonsupplemental payments under Section 14105.98:
(i) For the 1998-99 transfer year, transfer amounts shall be
determined as though the payment adjustment amounts arising pursuant
to subdivision (ag) of Section 14105.98 were increased by the amounts
paid or payable pursuant to subdivision (af) of Section 14105.98.
(ii) Any transfer amounts paid by a transferor entity pursuant to
subparagraph (C) of paragraph (2) shall serve as credit for the
particular transferor entity against an equal amount of its transfer
obligation for the 1998-99 transfer year.
(iii) For the 1999-2000 transfer year, transfer amounts shall be
determined as though the amount to be transferred to the Health Care
Deposit Fund, as referred to in paragraph (2) of subdivision (d),
were reduced by 28 percent.
(2) (A) Except as provided in subparagraphs (B), (C), and (D), for
the 1993-94 transfer year and subsequent transfer years, transfer
amounts shall be increased for the particular transfer year in the
amounts necessary to fund the nonfederal share of the total
supplemental payment adjustment amounts of all types that arise under
Section 14105.98. These increases shall be paid only by those
transferor entities that are licensees of hospitals that are
projected to receive some or all of the particular supplemental
payments, and the increases shall be paid by the transferor entities
on a pro rata basis in connection with the particular supplemental
payments. For purposes of this paragraph, supplemental payment
adjustment amounts shall be deemed to arise for the particular
transfer year as of the date specified in Section 14105.98. Transfer
amounts to fund the nonfederal share of the payments shall be paid
for the particular transfer year within 20 days after the department
notifies the transferor entity in writing of the additional transfer
amount to be paid.
(B) For the 1995-96 transfer year, the nonfederal share of the
secondary supplemental payment adjustments described in paragraph (9)
of subdivision (y) of Section 14105.98 shall be funded as follows:
(i) Ninety-nine percent of the nonfederal share shall be funded by
a transfer from the University of California.
(ii) One percent of the nonfederal share shall be funded by
transfers from those public entities that are the licensees of the
hospitals included in the "other public hospitals" group referred to
in clauses (ii) and (iii) of subparagraph (B) of paragraph (9) of
subdivision (y) of Section 14105.98. The transfer responsibilities
for this 1 percent shall be allocated to the particular public
entities on a pro rata basis, based on a formula or formulae
customarily used by the department for allocating transfer amounts
under this section. The formula or formulae shall take into account,
through reallocation of transfer amounts as appropriate, the
situation of hospitals whose secondary supplemental payment
adjustments are restricted due to the application of the limitation
set forth in clause (v) of subparagraph (B) of paragraph (9) of
subdivision (y) of Section 14105.98.
(iii) All transfer amounts under this subparagraph shall be paid
by the particular transferor entities within 30 days after the
department notifies the transferor entity in writing of the transfer
amount to be paid.
(C) For the 1997-98 transfer year, transfer amounts to fund the
nonfederal share of the supplemental payment adjustments described in
subdivision (af) of Section 14105.98 shall be funded by a transfer
from the County of Los Angeles.
(D) (i) For the 1998-99 transfer year, transfer amounts to fund
the nonfederal share of the supplemental payment adjustment amounts
arising under subdivision (ah) of Section 14105.98 shall be increased
as set forth in clause (ii).
(ii) The transfer amounts otherwise calculated to fund the
supplemental payment adjustments referred to in clause (i) shall be
increased on a pro rata basis by an amount equal to 28 percent of the
amount to be transferred to the Health Care Deposit Fund for the
1999-2000 fiscal year, as referred to in paragraph (2) of subdivision
(d).
(3) The department shall prepare preliminary analyses and
calculations regarding potential transfer amounts, and potential
transferor entities shall be notified by the department of estimated
transfer amounts as soon as reasonably feasible regarding any
particular transfer year. Written notices of transfer amounts shall
be issued by the department as soon as possible with respect to each
transfer year. All state agencies shall take all necessary steps in
order to supply applicable data to the department to accomplish these
tasks. The Office of Statewide Health Planning and Development shall
provide to the department quarterly access to the edited and
unedited confidential patient discharge data files for all Medi-Cal
eligible patients. The department shall maintain the confidentiality
of that data to the same extent as is required of the Office of
Statewide Health Planning and Development. In addition, the Office of
Statewide Health Planning and Development shall provide to the
department, not later than March 1 of each year, the data specified
by the department, as the data existed on the statewide database file
as of February 1 of each year, from all of the following:
(A) Hospital annual disclosure reports, filed with the Office of
Statewide Health Planning and Development pursuant to former Section
443.31 of, or Section 128735 of, the Health and Safety Code, for
hospital fiscal years that ended during the calendar year ending 13
months prior to the applicable February 1.
(B) Annual reports of hospitals, filed with the Office of
Statewide Health Planning and Development pursuant to former Section
439.2 of, or Section 127285 of, the Health and Safety Code, for the
calendar year ending 13 months prior to the applicable February 1.
(C) Hospital patient discharge data reports, filed with the Office
of Statewide Health Planning and Development pursuant to former
subdivision (g) of Section 443.31 of, or Section 128735 of, the
Health and Safety Code, for the calendar year ending 13 months prior
to the applicable February 1.
(D) Any other materials on file with the Office of Statewide
Health Planning and Development.
(4) Transfer amounts calculated by the department may be increased
or decreased by a percentage amount consistent with the Medi-Cal
state plan.
(5) For the 1993-94 fiscal year, the transfer amount that would
otherwise be required from the University of California shall be
increased by fifteen million dollars ($15,000,000).
(6) Notwithstanding any other law, except for subparagraph (D) of
paragraph (2), the total amount of transfers required from the
transferor entities for any particular transfer year shall not exceed
the sum of the following:
(A) The amount needed to fund the nonfederal share of all payment
adjustment amounts applicable to the particular payment adjustment
year as calculated under Section 14105.98. Included in the
calculations for this purpose shall be any decreases in the program
as a whole, and for individual hospitals, that arise due to the
provisions of Section 1396r-4(f) or (g) of Title 42 of the United
States Code.
(B) The amount needed to fund the transfers to the Health Care
Deposit Fund, as referred to in subdivision (d).
(7) (A) Except as provided in subparagraphs (B) and (C) and in
paragraph (2) of subdivision (j), and except for a prudent reserve
not to exceed two million dollars ($2,000,000) in the Medi-Cal
Inpatient Payment Adjustment Fund, any amounts in the fund, including
interest that accrues with respect to the amounts in the fund, that
are not expended, or estimated to be required for expenditure, under
Section 14105.98 with respect to a particular transfer year shall be
returned on a pro rata basis to the transferor entities for the
particular transfer year within 120 days after the department
determines that the funds are not needed for an expenditure in
connection with the particular transfer year.
(B) The department shall determine the interest amounts that have
accrued in the fund from its inception through June 30, 1995, and, no
later than January 1, 1996, shall distribute these interest amounts
to transferor entities:
(C) With respect to those particular amounts in the fund resulting
solely from the provisions of subparagraph (D) of paragraph (2), the
department shall determine by September 30, 1999, whether these
particular amounts exceed 28 percent of the amount to be transferred
to the Health Care Deposit Fund for the 1999-2000 fiscal year, as
referred to in paragraph (2) of subdivision (d). Any excess amount so
determined shall be returned to the particular transferor entities
on a pro rata basis no later than October 31, 1999.
(D) Regarding any funds returned to a transferor entity under
subparagraph (A) or (C), or interest amounts distributed to a
transferor entity under subparagraph (B), the department shall
provide to the transferor entity a written statement that explains
the basis for the particular return or distribution of funds and
contains the general calculations used by the department in
determining the amount of the particular return or distribution of
funds.
(i) (1) For the 1991-92 transfer year, each transferor entity
shall pay its transfer amount or amounts to the Controller, for
deposit in the fund, in eight equal installments.
(2) (A) Except as provided in subparagraphs (B) and (C), for the
1992-93 transfer year and subsequent transfer years, each transferor
entity shall pay its transfer amount or amounts to the Controller,
for deposit in the fund, in eight equal installments. However, for
the 1997-98 and subsequent transfer years, each transferor entity
shall pay its transfer amount or amounts to the Controller, for
deposit in the fund, in the form of periodic installments according
to a timetable established by the department. The timetable shall be
structured to effectuate, on a reasonable basis, the prompt
distribution of all nonsupplemental payment adjustments under Section
14105.98, and transfers to the Health Care Deposit Fund under
subdivision (d).
(B) For the 1994-95 transfer year, each transferor entity shall
pay its transfer amount or amounts to the Controller, for deposit in
the fund, in five equal installments.
(C) For the 1995-96 transfer year, each transferor entity shall
pay its transfer amount or amounts to the Controller, for deposit in
the fund, in five equal installments.
(D) Except as otherwise specifically provided, subparagraphs (A)
to (C), inclusive, shall not apply to increases in transfer amounts
described in paragraph (2) of subdivision (h) or to additional
transfer amounts described in subdivision (o).
(E) All requests for transfer payments, or adjustments thereto,
issued by the department shall be in writing and shall include (i) an
explanation of the basis for the particular transfer request or
transfer activity, (ii) a summary description of program funding
status for the particular transfer year, and (iii) the general
calculations used by the department in connection with the particular
transfer request or transfer activity.
(3) A transferor entity may use any of the following funds for
purposes of meeting its transfer obligations under this section:
(A) General funds of the transferor entity.
(B) Any other funds permitted by law to be used for these
purposes, except that a transferor entity shall not submit to the
Controller any federal funds unless those federal funds are
authorized by federal law to be used to match other federal funds. In
addition, no private donated funds from any health care provider, or
from any person or organization affiliated with the health care
provider, shall be channeled through a transferor entity or any other
public entity to the fund, unless the donated funds will qualify
under federal rules as a valid component of the nonfederal share of
the Medi-Cal program and will be matched by federal funds. The
transferor entity shall be responsible for determining that funds
transferred meet the requirements of this subparagraph.
(j) (1) If a transferor entity does not submit any transfer amount
within the time period specified in this section, the Controller
shall offset immediately the amount owed against any funds which
otherwise would be payable by the state to the transferor entity. The
Controller, however, shall not impose an offset against any
particular funds payable to the transferor entity where the offset
would violate state or federal law.
(2) Where a withhold or a recoupment occurs pursuant to the
provisions of paragraph (2) of subdivision (r) of Section 14105.98,
the nonfederal portion of the amount in question shall remain in the
fund, or shall be redeposited in the fund by the department, as
applicable. The department shall then proceed as follows:
(A) If the withhold or recoupment was imposed with respect to a
hospital whose licensee was a transferor entity for the particular
state fiscal year to which the withhold or recoupment related, the
nonfederal portion of the amount withheld or recouped shall serve as
a credit for the particular transferor entity against an equal amount
of transfer obligations under this section, to be applied whenever
the transfer obligations next arise. Should no such transfer
obligation arise within 180 days, the department shall return the
funds in question to the particular transferor entity within 30 days
thereafter.
(B) For other situations, the withheld or recouped nonfederal
portion shall be subject to paragraph (7) of subdivision (h).
(k) All transfer amounts received by the Controller or amounts
offset by the Controller shall immediately be deposited in the fund.
(l) For purposes of this section, the disproportionate share list
utilized by the department for a particular transfer year shall be
identical to the disproportionate share list utilized by the
department for the same state fiscal year for purposes of Section
14105.98. Nothing on a disproportionate share list, once issued by
the department, shall be modified for any reason other than
mathematical or typographical errors or omissions on the part of the
department or the Office of Statewide Health Planning and Development
in preparation of the list.
(m) Neither the intergovernmental transfers required by this
section, nor any elective transfer made pursuant to Section 14164,
shall create, lead to, or expand the health care funding or service
obligations for current or future years for any transferor entity,
except as required of the state by this section or as may be required
by federal law, in which case the state shall be held harmless by
the transferor entities on a pro rata basis.
(n) Except as otherwise permitted by state and federal law, no
transfer amount submitted to the Controller under this section, and
no offset by the Controller pursuant to subdivision (j), shall be
claimed or recognized as an allowable element of cost in Medi-Cal
cost reports submitted to the department.
(o) Whenever additional transfer amounts are required
to fund the nonfederal share of payment adjustment amounts under
Section 14105.98 that are distributed after the close of the
particular payment adjustment year to which the payment adjustment
amounts apply, the additional transfer amounts shall be paid by the
parties who were the transferor entities for the particular transfer
year that was concurrent with the particular payment adjustment year.
The additional transfer amounts shall be calculated under the
formula that was in effect during the particular transfer year. For
transfer years prior to the 1993-94 transfer year, the percentage of
the additional transfer amounts available for transfer to the Health
Care Deposit Fund under subdivision (d) shall be the percentage that
was in effect during the particular transfer year. These additional
transfer amounts shall be paid by transferor entities within 20 days
after the department notifies the transferor entity in writing of the
additional transfer amount to be paid.
(p) (1) Ten million dollars ($10,000,000) of the amount
transferred from the Medi-Cal Inpatient Payment Adjustment Fund to
the Health Care Deposit Fund due to amounts transferred attributable
to years prior to the 1993-94 fiscal year is hereby appropriated
without regard to fiscal years to the State Department of Health Care
Services to be used to support the development of managed care
programs under the department's plan to expand Medi-Cal managed care.
(2) These funds shall be used by the department for both of the
following purposes: (A) distributions to counties or other local
entities that contract with the department to receive those funds
14150. Within 60 calendar days of the date that the annual Budget
Act is chaptered, the department shall notify the chairpersons of the
fiscal committees of each house of the Legislature, the Chairperson
and the Vice Chairperson of the Joint Legislative Budget Committee,
and appropriate county representatives if the department plans to
withhold and not allocate any of the baseline allocation for county
Medi-Cal eligibility activities that are appropriated for Medi-Cal
administration.
14151. Bills for services rendered during the 1970-71 fiscal year
to persons other than the beneficiaries under the California Medical
Assistance Program submitted to the state by any county which has
elected to come within the provisions of Section 14150.1 of the
Welfare and Institutions Code are bills against the appropriation for
the fiscal year during which the bills are submitted, and shall be
submitted not later than 60 days following the start of the 1971-72
fiscal year. The director may, when he finds that delay in the
submission of bills was caused by circumstances beyond the control of
the county, extend the period of submissions of bills for a period
not to extend beyond the end of the 1971-72 fiscal year. State
general funds of $27,661,452 are made available from the 1971-72
appropriation to cover the state cost of such bills received. In the
event such bills received are less than $27,661,452, the balance
remaining may be used for the basic or supplemental schedules of
benefits.
14152. Bills for services rendered during the 1970-71 fiscal year
to beneficiaries under the California Medical Assistance Program are
bills against the appropriation for the fiscal year during which the
bills are submitted, and shall be submitted not more than two months
after the month in which the service is rendered, and shall be in the
form prescribed by the director, except that in the event the
patient does not identify himself to the provider as a Medi-Cal
beneficiary, the provider shall be entitled to submit his statement
at any time within 60 days after that date certified by the provider
as the date said patient was first identified as a Medi-Cal
beneficiary, provided, however, that such date certified by the
provider as the date the patient was first so identified shall not be
later than one year after the month in which the service was
rendered. Further, the director may, where he finds that delay in the
submission of bills was caused by circumstances beyond the control
of the provider, extend the period for submission of bills for a
period not to exceed one year. Funds in the amount of $106,269,000
are hereby made available from the 1971-72 appropriation to cover the
cost of such 1970-71 services billed during the 1971-72 fiscal year.
In the event such bills are less than $106,269,000 the balance
remaining may be used for the basic or supplemental schedules of
benefits.
14153. Funds shall be advanced monthly to the respective counties
for costs of administration of the Medi-Cal program in the manner
prescribed in Chapter 9 (commencing with Section 15000).
Funds may be advanced monthly to the respective counties for the
costs of care under the provisions of this chapter upon the order of
the Director of Finance and the State Director of Health Services
utilizing resources made available through the Health Care Deposit
Fund.
County welfare departments shall submit administrative claims for
the Medi-Cal program in accordance with procedures described in
Section 10604.5.
14154. (a) (1) The department shall establish and maintain a plan
whereby costs for county administration of the determination of
eligibility for benefits under this chapter will be effectively
controlled within the amounts annually appropriated for that
administration. The plan, to be known as the County Administrative
Cost Control Plan, shall establish standards and performance
criteria, including workload, productivity, and support services
standards, to which counties shall adhere. The plan shall include
standards for controlling eligibility determination costs that are
incurred by performing eligibility determinations at county
hospitals, or that are incurred due to the outstationing of any other
eligibility function. Except as provided in Section 14154.15,
reimbursement to a county for outstationed eligibility functions
shall be based solely on productivity standards applied to that
county's welfare department office.
(2) (A) The plan shall delineate both of the following:
(i) The process for determining county administration base costs,
which include salaries and benefits, support costs, and staff
development.
(ii) The process for determining funding for caseload changes,
cost-of-living adjustments, and program and other changes.
(B) The annual county budget survey document utilized under the
plan shall be constructed to enable the counties to provide
sufficient detail to the department to support their budget requests.
(3) The plan shall be part of a single state plan, jointly
developed by the department and the State Department of Social
Services, in conjunction with the counties, for administrative cost
control for the California Work Opportunity and Responsibility to
Kids (CalWORKs), Food Stamp, and Medical Assistance (Medi-Cal)
programs. Allocations shall be made to each county and shall be
limited by and determined based upon the County Administrative Cost
Control Plan. In administering the plan to control county
administrative costs, the department shall not allocate state funds
to cover county cost overruns that result from county failure to meet
requirements of the plan. The department and the State Department of
Social Services shall budget, administer, and allocate state funds
for county administration in a uniform and consistent manner.
(4) The department and county welfare departments shall develop
procedures to ensure the data clarity, consistency, and reliability
of information contained in the county budget survey document
submitted by counties to the department. These procedures shall
include the format of the county budget survey document and process,
data submittal and its documentation, and the use of the county
budget survey documents for the development of determining county
administration costs. Communication between the department and the
county welfare departments shall be ongoing as needed regarding the
content of the county budget surveys and any potential issues to
ensure the information is complete and well understood by involved
parties. Any changes developed pursuant to this section shall be
incorporated within the state's annual budget process by no later
than the 2011-12 fiscal year.
(5) The department shall provide a clear narrative description
along with fiscal detail in the Medi-Cal estimate package, submitted
to the Legislature in January and May of each year, of each component
of the county administrative funding for the Medi-Cal program. This
shall describe how the information obtained from the county budget
survey documents was utilized and, where applicable, modified and the
rationale for the changes.
(b) Nothing in this section, Section 15204.5, or Section 18906
shall be construed so as to limit the administrative or budgetary
responsibilities of the department in a manner that would violate
Section 14100.1, and thereby jeopardize federal financial
participation under the Medi-Cal program.
(c) (1) The Legislature finds and declares that in order for
counties to do the work that is expected of them, it is necessary
that they receive adequate funding, including adjustments for
reasonable annual cost-of-doing-business increases. The Legislature
further finds and declares that linking appropriate funding for
county Medi-Cal administrative operations, including annual
cost-of-doing-business adjustments, with performance standards will
give counties the incentive to meet the performance standards and
enable them to continue to do the work they do on behalf of the
state. It is therefore the Legislature's intent to provide
appropriate funding to the counties for the effective administration
of the Medi-Cal program at the local level to ensure that counties
can reasonably meet the purposes of the performance measures as
contained in this section.
(2) It is the intent of the Legislature to not appropriate funds
for the cost-of-doing-business adjustment for the 2008-09, 2009-10,
and 2010-11 fiscal years.
(d) The department is responsible for the Medi-Cal program in
accordance with state and federal law. A county shall determine
Medi-Cal eligibility in accordance with state and federal law. If in
the course of its duties the department becomes aware of accuracy
problems in any county, the department shall, within available
resources, provide training and technical assistance as appropriate.
Nothing in this section shall be interpreted to eliminate any remedy
otherwise available to the department to enforce accurate county
administration of the program. In administering the Medi-Cal
eligibility process, each county shall meet the following performance
standards each fiscal year:
(1) Complete eligibility determinations as follows:
(A) Ninety percent of the general applications without applicant
errors and are complete shall be completed within 45 days.
(B) Ninety percent of the applications for Medi-Cal based on
disability shall be completed within 90 days, excluding delays by the
state.
(2) (A) The department shall establish best-practice guidelines
for expedited enrollment of newborns into the Medi-Cal program,
preferably with the goal of enrolling newborns within 10 days after
the county is informed of the birth. The department, in consultation
with counties and other stakeholders, shall work to develop a process
for expediting enrollment for all newborns, including those born to
mothers receiving CalWORKs assistance.
(B) Upon the development and implementation of the best-practice
guidelines and expedited processes, the department and the counties
may develop an expedited enrollment timeframe for newborns that is
separate from the standards for all other applications, to the extent
that the timeframe is consistent with these guidelines and
processes.
(C) Notwithstanding the rulemaking procedures of 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 section by
means of all-county letters or similar instructions, without further
regulatory action.
(3) Perform timely annual redeterminations, as follows:
(A) Ninety percent of the annual redetermination forms shall be
mailed to the recipient by the anniversary date.
(B) Ninety percent of the annual redeterminations shall be
completed within 60 days of the recipient's annual redetermination
date for those redeterminations based on forms that are complete and
have been returned to the county by the recipient in a timely manner.
(C) Ninety percent of those annual redeterminations where the
redetermination form has not been returned to the county by the
recipient shall be completed by sending a notice of action to the
recipient within 45 days after the date the form was due to the
county.
(D) When a child is determined by the county to change from no
share of cost to a share of cost and the child meets the eligibility
criteria for the Healthy Families Program established under Section
12693.98 of the Insurance Code, the child shall be placed in the
Medi-Cal-to-Healthy Families Bridge Benefits Program, and these cases
shall be processed as follows:
(i) Ninety percent of the families of these children shall be sent
a notice informing them of the Healthy Families Program within five
working days from the determination of a share of cost.
(ii) Ninety percent of all annual redetermination forms for these
children shall be sent to the Healthy Families Program within five
working days from the determination of a share of cost if the parent
has given consent to send this information to the Healthy Families
Program.
(iii) Ninety percent of the families of these children placed in
the Medi-Cal-to-Healthy Families Bridge Benefits Program who have not
consented to sending the child's annual redetermination form to the
Healthy Families Program shall be sent a request, within five working
days of the determination of a share of cost, to consent to send the
information to the Healthy Families Program.
(E) Subparagraph (D) shall not be implemented until 60 days after
the Medi-Cal and Joint Medi-Cal and Healthy Families applications and
the Medi-Cal redetermination forms are revised to allow the parent
of a child to consent to forward the child's information to the
Healthy Families Program.
(e) The department shall develop procedures in collaboration with
the counties and stakeholder groups for determining county review
cycles, sampling methodology and procedures, and data reporting.
(f) On January 1 of each year, each applicable county, as
determined by the department, shall report to the department on the
county's results in meeting the performance standards specified in
this section. The report shall be subject to verification by the
department. County reports shall be provided to the public upon
written request.
(g) If the department finds that a county is not in compliance
with one or more of the standards set forth in this section, the
county shall, within 60 days, submit a corrective action plan to the
department for approval. The corrective action plan shall, at a
minimum, include steps that the county shall take to improve its
performance on the standard or standards with which the county is out
of compliance. The plan shall establish interim benchmarks for
improvement that shall be expected to be met by the county in order
to avoid a sanction.
(h) (1) If a county does not meet the performance standards for
completing eligibility determinations and redeterminations as
specified in this section, the department may, at its sole
discretion, reduce the allocation of funds to that county in the
following year by 2 percent. Any funds so reduced may be restored by
the department if, in the determination of the department, sufficient
improvement has been made by the county in meeting the performance
standards during the year for which the funds were reduced. If the
county continues not to meet the performance standards, the
department may reduce the allocation by an additional 2 percent for
each year thereafter in which sufficient improvement has not been
made to meet the performance standards.
(2) No reduction of the allocation of funds to a county shall be
imposed pursuant to this subdivision for failure to meet performance
standards during any period of time in which the
cost-of-doing-business increase is suspended.
(i) The department shall develop procedures, in collaboration with
the counties and stakeholders, for developing instructions for the
performance standards established under subparagraph (D) of paragraph
(3) of subdivision (d), no later than September 1, 2005.
(j) No later than September 1, 2005, the department shall issue a
revised annual redetermination form to allow a parent to indicate
parental consent to forward the annual redetermination form to the
Healthy Families Program if the child is determined to have a share
of cost.
(k) The department, in coordination with the Managed Risk Medical
Insurance Board, shall streamline the method of providing the Healthy
Families Program with information necessary to determine Healthy
Families eligibility for a child who is receiving services under the
Medi-Cal-to-Healthy Families Bridge Benefits Program.
14154.1. Reimbursement for any Medi-Cal county administrative costs
shall be made subject to the requirements specified in the County
Administrative Cost Control Plan, established pursuant to Section
14154. However, notwithstanding any other provision of law, for
applications taken on or after July 1, 1987, and thereafter, the
department shall make allocations for Medi-Cal county administrative
expenses taking into consideration all Medi-Cal applications.
However, if the department determines that a county is
inappropriately processing non-Medi-Cal applications through the
Medi-Cal process, then the department shall not allocate state
general funds for nonapproved Medi-Cal applications which exceed a
specified level. That level shall be determined by multiplying the
county's number of approved applications by the ratio of nonapproved
applications to approved applications processed by the county during
the base period used in the cost control plan which is in effect for
the fiscal year the inappropriate processing of non-Medi-Cal
applications occurred. Reimbursement to Los Angeles County hospitals
shall be limited on the same basis.
14154.15. (a) Any county may petition the department for an
augmentation of its County Administrative Cost Control Plan in order
to implement a plan, as provided for in Section 1105 of the federal
Social Security Act (42 U.S.C. Sec. 1305), for the outstationing of
one or more eligibility workers at all types of outstation locations,
as defined in Section 435.904(c)(3) of Title 42 of the Code of
Federal Regulations in order to facilitate receipt and processing of
applications for Medi-Cal eligibility for pregnant women, infants and
children as specified by Title XIX of the Social Security Act (42
U.S.C. Sec. 1396 and following). In order to participate pursuant to
this section, a county welfare department shall petition under this
section in accordance with guidelines established by the department.
The petition shall include, but not be limited to, information about
the need for outstation workers at alternative sites and the language
skills needed by the outstation workers.
(b) In reviewing a petition from a county for an augmentation of
its County Administrative Cost Control Plan for outstationing
purposes, the department shall take into account the likely success
rate of applications processed by the proposed outstationed
eligibility workers, the amount of travel and training time required
to implement and continue the outstationing plan, and other
productivity factors associated with the outstationing plan.
(c) The department may approve those proposed augmentations which,
based on its review of the outstationing plan, offer potential to
increase eligibility determinations and access to Medi-Cal perinatal
services by pregnant women and Medi-Cal services by infants and
children specified by Title XIX of the Social Security Act (42
U.S.C., Sec. 1396 and following). The department shall review the
approved plan annually to determine if the plan shall be renewed,
altered, discontinued, or incorporated into the county administrative
funding base.
(d) In addition to any augmentations authorized by this section,
the department may, at its discretion, advance administrative funding
to a county welfare department for which it approves an augmentation
of its County Administrative Cost Control Plan, to cover the initial
incremental costs of outstationed eligibility workers under this
section.
(e) The department shall conduct a one-time outreach plan to
educate county welfare directors, county health officers, and county
elected officials on the opportunities and advantages of
outstationing Medi-Cal eligibility workers to facilitate access by
pregnant women to Medi-Cal perinatal services and Medi-Cal
eligibility for infants and children.
14154.2. (a) The Legislature finds that ambiguities have arisen
regarding payment provisions relating to certain costs incurred in
processing Medi-Cal eligibility applications for various fiscal
years, and believes the ambiguities should be alleviated by means of
legislation clarifying the Legislature's intent regarding such
provisions.
(b) The Legislature recognizes that federal financial
participation in the costs of administering the Medi-Cal program is
an important element in funding such costs, and desires that federal
financial participation be pursued and obtained whenever possible.
With respect to Medi-Cal administration costs, for eligibility
determinations, it is not and has not been the Legislature's intent
to preclude federal financial participation which would otherwise be
available from the Health Care Financing Administration.
14154.3. (a) A provision of a Budget Act or other statute shall not
be interpreted or applied to limit the amount of federal financial
participation, otherwise available under federal law, which may be
reimbursable to counties in support of Medi-Cal administration costs
for eligibility determinations. A provision of a Budget Act or
another statute shall not be interpreted or applied to restrict the
amount of federal financial participation for Medi-Cal administration
costs, for eligibility determinations, otherwise available under
federal law, which may be claimed by the department, and, upon
receipt from the federal government, transferred by the department to
a county.
(b) The Budget Acts referred to in subdivision (a) include, but
are not limited to:
(1) Chapter 510 of the Statutes of 1980, including Item 288 of
Section 2 thereof.
(2) Chapter 99 of the Statutes of 1981, including Items
426-101-001 and 426-101-890 of Section 2.00 thereof.
(3) Chapter 326 of the Statutes of 1982, including Items
4260-101-001 and 4260-101-890 of Section 2.00 thereof.
(4) Chapter 324 of the Statutes of 1983, including Items
4260-101-001 and 4260-101-890 of Section 2.00 thereof.
(5) Chapter 258 of the Statutes of 1984, including Items
4260-101-001 and 4260-101-890 of Section 2.00 thereof.
(6) Chapter 111 of the Statutes of 1985, including Items
4260-101-001 and 4260-101-890 of Section 2.00 thereof.
(7) Chapter 186 of the Statutes of 1986, including Items
4260-101-001 and 4260-101-890 of Section 2.00 thereof.
Provisions of the Budget Acts listed in paragraphs (1) to (7),
inclusive, shall not be interpreted or applied as a prohibition
regarding the amount of costs counties may incur for Medi-Cal
eligibility administration activities. The provisions of those Budget
Acts shall be interpreted and applied as a means of limiting the
allocation of state general funds to be paid in support of Medi-Cal
eligibility determination activities.
(c) To the extent necessary to effectuate the intent of
subdivisions (a) and (b), the following Budget Act provisions shall
be inoperative:
(1) Provision 17.5 of Item 426-101-890 of Section 2.00 of Chapter
99 of the Statutes of 1981.
(2) The incorporation by reference of Provision 16 of Item
4260-101-001 of Section 2.00 of Chapter 326 of the Statutes of 1982
into Provision 1 of Item 4260-101-890 of that chapter.
(3) The incorporation by reference of Provision 15 of Item
4260-101-001 of Section 2.00 of Chapter 324 of the Statutes of 1983
into Provision 1 of Item 4260-101-890 of Section 2.00 of that
chapter.
(d) Sections 14154 and 14154.1 shall not be interpreted or applied
to restrict the amount of federal financial participation, not
deferred or disallowed by federal law or regulation which may be
reimbursable to any county for Medi-Cal administration costs for
eligibility determinations. The County Administrative Cost Control
Plan established pursuant to Section 14154 shall not be interpreted
or applied as a prohibition regarding the amount of costs counties
may incur for Medi-Cal county administration costs. That plan shall
be interpreted and applied only as a means of limiting the allocation
of state general funds to be paid in support of those county costs.
(e) Should federal financial participation be deferred or
disallowed regarding funds transferred by the department to a county
for costs incurred for Medi-Cal eligibility determinations, and that
federal financial participation was matched by county expenditures,
the county which received those federal funds shall repay the funds
in question at such time as the federal deferral or disallowance has
been issued. If the federal deferral or disallowance is noticed or
issued prior to the transfer of the federal funds from the department
to a county, the department shall not be responsible for
transferring the federal funds to the county until the deferral or
disallowance issue regarding these funds has been resolved.
(f) The department shall timely appeal from the federal deferrals
or disallowances and the affected county may assist the department in
preparing and presenting a pending appeal regarding a federal
deferral or disallowance.
(g) Medi-Cal eligibility determination activities are undertaken
by counties on behalf of the department. Reasonable and necessary
costs incurred by counties relating to the eligibility determination
activities shall be recognized as costs incurred by the state for
purposes of inclusion in the nonfederal share of Medi-Cal eligibility
determination expenditures for claiming federal financial
participation.
(h) Subdivision (e) shall not apply to agreements between the
department and a county executed prior to September 27, 1987.
14154.5. (a) Each county shall work, on a routine basis, any error
alert from the department's Medi-Cal Eligibility Data System (MEDS).
Any alert that affects eligibility or the share of cost that is
received by the 10th working day of the month shall be processed in
time for the change to be effective the beginning of the following
month. Any alert that affects eligibility or the share of cost that
is received after the 10th working day of the month shall be
processed in time for the change to be effective the beginning of the
month after the following month. The department shall consult with
the County Welfare Directors Association to define those alerts that
affect eligibility or the share of cost.
(b) The county shall submit reconciliation files of its Medi-Cal
eligible population to the department every three months, based upon
a schedule determined by the department and in a format prescribed by
the department, to identify any discrepancies between eligibility
files in the county records and eligibility as reflected in MEDS.
Counties shall be notified of any changes to the standard format for
submitting reconciliation files sufficiently in advance to allow for
budgeting, scheduling, development, testing, and implementation of
any required change in county automated eligibility systems.
(c) For those records that are on the county's files, but not on
MEDS, the county shall receive worker alerts from the department that
identify these cases, and the county shall fix any data
discrepancies. Any worker alert received by the 10th working day of
the month shall be processed in time for the change to be effective
the beginning of the following month. Any worker alert received after
the 10th working day of the month shall be processed in time for the
change to be effective the beginning of the month after the
following month.
(d) In regard to any record that is on MEDS but not on the county'
s file, the county shall either correct the county record or MEDS,
whichever is appropriate, within the same timeframes specified in
subdivision (c).
(e) The department shall terminate a MEDS-eligible record if the
person is not eligible on the county's file when there has been no
eligibility update on the MEDS record for six months.
(f) (1) If the department finds that a county is not performing
all of the following activities, the county shall, within 60 days,
submit a corrective action plan to the department for approval:
(A) Conducting reconciliations as required in subdivision (b).
(B) Processing 95 percent of worker alerts referred to in
subdivisions (c) and (d), within the timeframes specified.
(C) Processing 90 percent of the error alerts referred to in
subdivision (a) that affect eligibility or the share of cost, within
the timeframes specified.
(2) The corrective action plan shall, at a minimum, include steps
that the county shall take to improve its performance on the
requirements with which the county is out of compliance. The plan
shall establish interim benchmarks for improvement that shall be
expected to be met by the county in order to avoid sanctions.
(g) (1) If the county does not meet the interim benchmarks for
improvement standards, the department may, in its sole discretion,
reduce the allocation of funds to that county in the following year
by 2 percent. Any funds so reduced may be restored by the department
if, in the determination of the department, sufficient improvement
has been made by the county in meeting the performance standards
during the year for which the funds were reduced.
(2) No reduction of the allocation of funds to a county shall be
imposed pursuant to this subdivision for failure to meet performance
standards during any period of time in which the
cost-of-doing-business increase is suspended.
(h) The department, in consultation with the County Welfare
Directors Association, shall investigate features that could be
installed in MEDS to reduce the number of alerts and streamline the
reconciliation process.
(i) 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 department may implement, interpret, or
make specific this section by means of all-county letters, provider
bulletins, or similar instructions. Thereafter, the department may
adopt regulations 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.
14157. There is hereby established a Health Care Deposit Fund from
which expenditures of state, county and federal funds for health care
and administration under this chapter and Chapter 8 (commencing with
Section 14200) shall be made upon order of the Controller in
accordance with certifications made by the director.
The Controller shall deposit in this fund all federal funds as
received under the provisions of Title XIX of the Social Security Act
and all county funds received under this chapter.
All money in the Health Care Deposit Fund is hereby appropriated,
for expenditure for the purposes specified in this chapter and
Chapter 8 (commencing with Section 14200).
14157.6. Notwithstanding any other provision of law, any federal
and county funds, excluding county funds used for the purposes of
Section 4011.1 of the Penal Code, received under the provisions of
Section 14157 during each fiscal year, as reimbursement for
expenditures for health care services authorized under this chapter
made from funds transferred to the Health Care Deposit Fund from the
General Fund in prior years, shall be transferred from the Health
Care Deposit Fund to the General Fund. When a projected deficiency
exists in the Medical Assistance Program, these federal and county
funds are hereby appropriated from the General Fund to the Health
Care Deposit Fund and shall be expended as soon as practicable, but
not sooner than 30 days after notification in writing of the
necessity therefor, to the chairperson of the committee in each house
which considers appropriations, and the Joint Legislative Budget
Committee, for the state's share of payments for medical care and
services, county administration, and fiscal intermediary services.
14158. Funds for the medical assistance program shall be provided
annually by appropriation in the Budget Act. The amount of state
funds appropriated shall be transferred in such sums as are needed by
the Controller from the General Fund to the Health Care Deposit
Fund.
14158.1. Effective for expenditures incurred after enactment of any
new demonstration project under Article 5.4 (commencing with Section
14180), any federal financial participation that is available under
the federal Medicaid Program, or any related waiver or demonstration
project, based on the certified public expenditures of designated
public hospitals, as defined in subdivision (d) of Section 14166.1,
or the governmental entities with which they are affiliated, shall be
paid to designated public hospitals or the governmental entities
with which they are affiliated.
14158.5. Funds appropriated for purposes of this chapter and
Chapter 8 (commencing with Section 14200), shall fully cover and
shall not exceed the state's share of payments under this chapter and
Chapter 8 (commencing with Section 14200), for the costs of medical
care and services, county administration, and fiscal intermediary
services. The state's share of the costs of medical care and
services, county administration, and fiscal intermediary services
shall be determined pursuant to a plan approved by the Director of
Finance and certified to by the director.
14159. Commencing with the 2004-05 fiscal year, expenditures for
Medi-Cal services and fiscal intermediary and county administration
costs included in the department's budget shall be charged against
the appropriation for the fiscal year in which the billing is paid.
Commencing July 1, 2004, all 2002-03 fiscal year and prior accrued
obligations of the Health Care Deposit Fund shall become obligations
of the 2004-05 fiscal year and all moneys available from the 2002-03
fiscal year and prior appropriations shall be reappropriated to the
2004-05 fiscal year for that purpose.
14159.1. The provisions of Chapter 577 of the Statutes of 1971 in
no way eliminate fiscal obligation incurred prior to July 1, 1971, by
any county or the state under Article 5 (commencing with Section
14150) of Chapter 7 of Part 3 of Division 9 of the Welfare and
Institutions Code. After June 30, 1971, all uncollected county share
amounts under said Article 5 due the state for prior periods remain
an obligation of the county to the state.
14160. Whenever an amount is or was prior to the effective date of
this section, erroneously deposited in the Health Care Deposit Fund,
including, but not limited to, duplicate payments and payments in
excess of the correct amount, the erroneous amount shall be refunded
to the depositor. There is hereby appropriated out of the Health Care
Deposit Fund amounts sufficient to pay such refunds.
14161. Carriers and providers of Medi-Cal benefits shall be
required to utilize uniform accounting and cost-reporting systems as
shall be developed and adopted by the department. If any other
provision of law provides for uniform accounting and cost-reporting
systems for hospitals, the department shall adopt these systems.
Carriers and providers of Medi-Cal benefits shall provide cost
information to the department as is necessary in order to conduct
studies to determine payment for services provided under this
chapter, including but not limited to copies of any Medicare cost
reports and settlements, and any Medicare audit reports.
Failure to comply with the provisions of this section shall be
cause for suspension from participation under this chapter.
The department shall conduct such studies as necessary to
determine payments for services provided under this chapter. The
results of or progress reports concerning such studies shall be
submitted to the Legislature by January 31 of each year.
The department shall submit an annual report to the Governor and
the Legislature by January 31 of each year setting forth a
comprehensive description of its activities and the operation and
administration of the Medi-Cal program including, but not limited to,
a fiscal accounting of expenditures, an evaluation of the relative
cost and effectiveness of the various plans in accomplishing the
desired goals, results of demonstration or pilot programs, and its
recommendations as to legislation and other action as is necessary
for carrying out the purposes of this chapter.
14162. (a) Beginning in 1991, the State Department of Health
Services shall include in the November estimate of Medi-Cal
expenditures and the Governor's Budget an estimate of savings from
the prior year which resulted from implementation of Senate Bill 2174
of the 1987-88 Regular Session of the Legislature.
(b) Beginning in 1992, the Department of Finance shall, by
February 1, deposit an amount equal to the savings level identified
in the November estimate of Medi-Cal expenditures into the Critical
Needs Health Care Fund, which is hereby created. Funds deposited in
the Critical Needs Health Care Fund shall be appropriated by the
Legislature for high-priority health expenditures.
14163. (a) For purposes of this section, the following definitions
shall apply:
(1) "Public entity" means a county, a city, a city and county, the
State of California, the University of California, a local health
care district, a local health authority, or any other political
subdivision of the state.
(2) "Hospital" means a health facility that is licensed pursuant
to Chapter 2 (commencing with Section 1250) of Division 2 of the
Health and Safety Code to provide acute inpatient hospital services,
and includes all components of the facility.
(3) "Disproportionate share hospital" means a hospital providing
acute inpatient services to Medi-Cal beneficiaries that meets the
criteria for disproportionate share status relating to acute
inpatient services set forth in Section 14105.98.
(4) "Disproportionate share list" means the annual list of
disproportionate share hospitals for acute inpatient services issued
by the department pursuant to Section 14105.98.
(5) "Fund" means the Medi-Cal Inpatient Payment Adjustment Fund.
(6) "Eligible hospital" means, for a particular state fiscal year,
a hospital on the disproportionate share list that is eligible to
receive payment adjustment amounts under Section 14105.98 with
respect to that state fiscal year.
(7) "Transfer year" means the particular state fiscal year during
which, or with respect to which, public entities are required by this
section to make an intergovernmental transfer of funds to the
Controller.
(8) "Transferor entity" means a public entity that, with respect
to a particular transfer year, is required by this section to make an
intergovernmental transfer of funds to the Controller.
(9) "Transfer amount" means an amount of intergovernmental
transfer of funds that this section requires for a particular
transferor entity with respect to a particular transfer year.
(10) "Intergovernmental transfer" means a transfer of funds from a
public entity to the state that is local government financial
participation in Medi-Cal pursuant to the terms of this section.
(11) "Licensee" means an entity that has been issued a license to
operate a hospital by the department.
(12) "Annualized Medi-Cal inpatient paid days" means the total
number of Medi-Cal acute inpatient hospital days, regardless of dates
of service, for which payment was made by or on behalf of the
department to a hospital, under present or previous ownership, during
the most recent calendar year ending prior to the beginning of a
particular transfer year, including all Medi-Cal acute inpatient
covered days of care for hospitals that are paid on a different basis
than per diem payments.
(13) "Medi-Cal acute inpatient hospital day" means any acute
inpatient day of service attributable to patients who, for those
days, were eligible for medical assistance under the California state
plan, including any day of service that is reimbursed on a basis
other than per diem payments.
(14) "OBRA 1993 payment limitation" means the hospital-specific
limitation on the total annual amount of payment adjustments to each
eligible hospital under the payment adjustment program that can be
made with federal financial participation under Section 1396r-4(g) of
Title 42 of the United States Code as implemented pursuant to the
Medi-Cal State Plan.
(b) The Medi-Cal Inpatient Payment Adjustment Fund is hereby
created in the State Treasury. Notwithstanding Section 13340 of the
Government Code, the fund shall be continuously appropriated to, and
under the administrative control of, the department for the purposes
specified in subdivision (d). The fund shall consist of the
following:
(1) Transfer amounts collected by the Controller under this
section, whether submitted by transferor entities pursuant to
applicable provisions of this section or obtained by offset pursuant
to subdivision (j).
(2) Any other intergovernmental transfers deposited in the fund,
as permitted by Section 14164.
(3) Any interest that accrues with respect to amounts in the fund.
(c) Moneys in the fund, which shall not consist of any state
general funds, shall be used as the source for the nonfederal share
of payments to hospitals pursuant to Section 14105.98. Moneys shall
be allocated from the fund by the department and matched by federal
funds in accordance with customary Medi-Cal accounting procedures,
and used to make payments pursuant to Section 14105.98.
(d) Except as otherwise provided in Section 14105.98 or in any law
appropriating a specified sum of money to the department for
administering this section and Section 14105.98, moneys in the fund
shall be used only for the following:
(1) Payments to hospitals pursuant to Section 14105.98.
(2) Transfers to the Health Care Deposit Fund as follows:
(A) In the amount of two hundred thirty-nine million seven hundred
fifty-seven thousand six hundred ninety dollars ($239,757,690) for
the 1994-95 and 1995-96 fiscal years.
(B) In the amount of two hundred twenty-nine million seven hundred
fifty-seven thousand six hundred ninety dollars ($229,757,690) for
the 1996-97 fiscal year.
(C) In the amount of one hundred fifty-four million seven hundred
fifty-seven thousand six hundred ninety dollars ($154,757,690) for
the 1997-98 fiscal year.
(D) In the amount of one hundred fourteen million seven hundred
fifty-seven thousand six hundred ninety dollars ($114,757,690) for
the 1998-99 fiscal year.
(E) (i) In the amount of eighty-four million seven hundred
fifty-seven thousand six hundred ninety dollars ($84,757,690) for the
1999-2000 fiscal year.
(ii) It is the intent of the Legislature that the economic benefit
of any reduction in the amount transferred, or to be transferred, to
the Health Care Deposit Fund pursuant to this subdivision for the
1999-2000 fiscal year, as compared to the amount so transferred for
the 1998-99 fiscal year, be allocated equally between public and
nonpublic disproportionate share hospitals. To implement the
reduction in clause (i) the department shall, by June 30, 2000,
adjust the calculations in Section 14105.98 in order to allocate the
funds in accordance with this clause.
(F) In the amount of twenty-nine million seven hundred fifty-seven
thousand six hundred ninety dollars ($29,757,690) for the 2000-01
fiscal year and the 2001-02 fiscal year.
(G) In the amount of eighty-five million dollars ($85,000,000) for
the 2002-03 fiscal year and each fiscal year thereafter.
(H) The transfers from the fund shall be made in six equal monthly
installments to the Medi-Cal local assistance appropriation item
(Item 4260-101-0001 of Section 2.00 of the annual Budget Act) in
support of Medi-Cal expenditures. The first installment shall accrue
in October of each transfer year, and all other installments shall
accrue monthly thereafter from November through March.
(e) For the 1991-92 state fiscal year, the department shall
determine, no later than 70 days after the enactment of this section,
the transferor entities for the 1991-92 transfer year. To make this
determination, the department shall utilize the disproportionate
share list for the 1991-92 fiscal year issued by the department
pursuant to paragraph (1) of subdivision (f) of Section 14105.98. The
department shall identify each eligible hospital on the list for
which a public entity is the licensee as of July 1, 1991. The public
entity that is the licensee of each identified eligible hospital
shall be a transferor entity for the 1991-92 transfer year.
(f) The department shall determine, no later than 70 days after
the enactment of this section, the transfer amounts for the 1991-92
transfer year.
The transfer amounts shall be determined as follows:
(1) The eligible hospitals for 1991-92 shall be identified. For
each hospital, the applicable total per diem payment adjustment
amount under Section 14105.98 for the 1991-92 transfer year shall be
computed. This amount shall be multiplied by 80 percent of the
eligible hospital's annualized Medi-Cal inpatient paid days as
determined from all Medi-Cal paid claims records available through
April 1, 1991. The products of these calculations for all eligible
hospitals shall be added together to determine an aggregate sum for
the 1991-92 transfer year.
(2) The eligible hospitals for 1991-92 involving transferor
entities as licensees shall be identified. For each hospital, the
applicable total per diem payment adjustment amount under Section
14105.98 for the 1991-92 transfer year shall be computed. This amount
shall be multiplied by 80 percent of the eligible hospital's
annualized Medi-Cal inpatient paid days as determined from all
Medi-Cal paid claims records available through April 1, 1991. The
products of these calculations for all eligible hospitals with
transferor entities as licensees shall be added together to determine
an aggregate sum for the 1991-92 transfer year.
(3) The aggregate sum determined under paragraph (1) shall be
divided by the aggregate sum determined under paragraph (2), yielding
a factor to be utilized in paragraph (4).
(4) The factor determined in paragraph (3) shall be multiplied by
the amount determined for each hospital under paragraph (2). The
product of this calculation for each hospital in paragraph (2) shall
be divided by 1.771, yielding a transfer amount for the particular
transferor entity for the transfer year.
(g) For the 1991-92 transfer year, the department shall notify
each transferor entity in writing of its applicable transfer amount
or amounts.
(h) For the 1992-93 transfer year and subsequent transfer years,
transfer amounts shall be determined in the same procedural manner as
set forth in subdivision (f), except:
(1) The department shall use all of the following:
(A) The disproportionate share list applicable to the particular
transfer year to determine the eligible hospitals.
(B) The payment adjustment amounts calculated under Section
14105.98 for the particular transfer year. These amounts shall take
into account any projected or actual increases or decreases in the
size of the payment adjustment program as are required under Section
14105.98 for the particular year in question, including any decreases
resulting from the application of the OBRA 1993 payment limitation.
The department may issue interim, revised, and supplemental transfer
requests as necessary and appropriate to address changes in payment
adjustment levels that occur under Section 14105.98. All transfer
requests, or adjustments thereto, issued to transferor entities by
the department shall meet the requirements set forth in subdivision
(i).
(C) Data regarding annualized Medi-Cal inpatient paid days for the
most recent calendar year ending prior to the beginning of the
particular transfer year, as determined from all Medi-Cal paid claims
records available through April 1 preceding the particular transfer
year.
(D) The status of public entities as licensees of eligible
hospitals as of July 1 of the particular transfer year.
(E) For the 1993-94 transfer year and subsequent transfer years,
the divisor to be used for purposes of the calculation referred to in
paragraph (4) of subdivision (f) shall be determined by the
department. The divisor shall be calculated to ensure that the
appropriate amount of transfers from transferor entities are received
into the fund to satisfy the requirements of Section 14105.98,
exclusive of the amounts described in paragraph (2) of this
subdivision, and to satisfy the requirements of paragraph (2) of
subdivision (d), for the particular transfer year. For the 1993-94
transfer year, the divisor shall be 1.742.
(F) The following provisions shall apply for certain transfer
amounts relating to nonsupplemental payments under Section 14105.98:
(i) For the 1998-99 transfer year, transfer amounts shall be
determined as though the payment adjustment amounts arising pursuant
to subdivision (ag) of Section 14105.98 were increased by the amounts
paid or payable pursuant to subdivision (af) of Section 14105.98.
(ii) Any transfer amounts paid by a transferor entity pursuant to
subparagraph (C) of paragraph (2) shall serve as credit for the
particular transferor entity against an equal amount of its transfer
obligation for the 1998-99 transfer year.
(iii) For the 1999-2000 transfer year, transfer amounts shall be
determined as though the amount to be transferred to the Health Care
Deposit Fund, as referred to in paragraph (2) of subdivision (d),
were reduced by 28 percent.
(2) (A) Except as provided in subparagraphs (B), (C), and (D), for
the 1993-94 transfer year and subsequent transfer years, transfer
amounts shall be increased for the particular transfer year in the
amounts necessary to fund the nonfederal share of the total
supplemental payment adjustment amounts of all types that arise under
Section 14105.98. These increases shall be paid only by those
transferor entities that are licensees of hospitals that are
projected to receive some or all of the particular supplemental
payments, and the increases shall be paid by the transferor entities
on a pro rata basis in connection with the particular supplemental
payments. For purposes of this paragraph, supplemental payment
adjustment amounts shall be deemed to arise for the particular
transfer year as of the date specified in Section 14105.98. Transfer
amounts to fund the nonfederal share of the payments shall be paid
for the particular transfer year within 20 days after the department
notifies the transferor entity in writing of the additional transfer
amount to be paid.
(B) For the 1995-96 transfer year, the nonfederal share of the
secondary supplemental payment adjustments described in paragraph (9)
of subdivision (y) of Section 14105.98 shall be funded as follows:
(i) Ninety-nine percent of the nonfederal share shall be funded by
a transfer from the University of California.
(ii) One percent of the nonfederal share shall be funded by
transfers from those public entities that are the licensees of the
hospitals included in the "other public hospitals" group referred to
in clauses (ii) and (iii) of subparagraph (B) of paragraph (9) of
subdivision (y) of Section 14105.98. The transfer responsibilities
for this 1 percent shall be allocated to the particular public
entities on a pro rata basis, based on a formula or formulae
customarily used by the department for allocating transfer amounts
under this section. The formula or formulae shall take into account,
through reallocation of transfer amounts as appropriate, the
situation of hospitals whose secondary supplemental payment
adjustments are restricted due to the application of the limitation
set forth in clause (v) of subparagraph (B) of paragraph (9) of
subdivision (y) of Section 14105.98.
(iii) All transfer amounts under this subparagraph shall be paid
by the particular transferor entities within 30 days after the
department notifies the transferor entity in writing of the transfer
amount to be paid.
(C) For the 1997-98 transfer year, transfer amounts to fund the
nonfederal share of the supplemental payment adjustments described in
subdivision (af) of Section 14105.98 shall be funded by a transfer
from the County of Los Angeles.
(D) (i) For the 1998-99 transfer year, transfer amounts to fund
the nonfederal share of the supplemental payment adjustment amounts
arising under subdivision (ah) of Section 14105.98 shall be increased
as set forth in clause (ii).
(ii) The transfer amounts otherwise calculated to fund the
supplemental payment adjustments referred to in clause (i) shall be
increased on a pro rata basis by an amount equal to 28 percent of the
amount to be transferred to the Health Care Deposit Fund for the
1999-2000 fiscal year, as referred to in paragraph (2) of subdivision
(d).
(3) The department shall prepare preliminary analyses and
calculations regarding potential transfer amounts, and potential
transferor entities shall be notified by the department of estimated
transfer amounts as soon as reasonably feasible regarding any
particular transfer year. Written notices of transfer amounts shall
be issued by the department as soon as possible with respect to each
transfer year. All state agencies shall take all necessary steps in
order to supply applicable data to the department to accomplish these
tasks. The Office of Statewide Health Planning and Development shall
provide to the department quarterly access to the edited and
unedited confidential patient discharge data files for all Medi-Cal
eligible patients. The department shall maintain the confidentiality
of that data to the same extent as is required of the Office of
Statewide Health Planning and Development. In addition, the Office of
Statewide Health Planning and Development shall provide to the
department, not later than March 1 of each year, the data specified
by the department, as the data existed on the statewide database file
as of February 1 of each year, from all of the following:
(A) Hospital annual disclosure reports, filed with the Office of
Statewide Health Planning and Development pursuant to former Section
443.31 of, or Section 128735 of, the Health and Safety Code, for
hospital fiscal years that ended during the calendar year ending 13
months prior to the applicable February 1.
(B) Annual reports of hospitals, filed with the Office of
Statewide Health Planning and Development pursuant to former Section
439.2 of, or Section 127285 of, the Health and Safety Code, for the
calendar year ending 13 months prior to the applicable February 1.
(C) Hospital patient discharge data reports, filed with the Office
of Statewide Health Planning and Development pursuant to former
subdivision (g) of Section 443.31 of, or Section 128735 of, the
Health and Safety Code, for the calendar year ending 13 months prior
to the applicable February 1.
(D) Any other materials on file with the Office of Statewide
Health Planning and Development.
(4) Transfer amounts calculated by the department may be increased
or decreased by a percentage amount consistent with the Medi-Cal
state plan.
(5) For the 1993-94 fiscal year, the transfer amount that would
otherwise be required from the University of California shall be
increased by fifteen million dollars ($15,000,000).
(6) Notwithstanding any other law, except for subparagraph (D) of
paragraph (2), the total amount of transfers required from the
transferor entities for any particular transfer year shall not exceed
the sum of the following:
(A) The amount needed to fund the nonfederal share of all payment
adjustment amounts applicable to the particular payment adjustment
year as calculated under Section 14105.98. Included in the
calculations for this purpose shall be any decreases in the program
as a whole, and for individual hospitals, that arise due to the
provisions of Section 1396r-4(f) or (g) of Title 42 of the United
States Code.
(B) The amount needed to fund the transfers to the Health Care
Deposit Fund, as referred to in subdivision (d).
(7) (A) Except as provided in subparagraphs (B) and (C) and in
paragraph (2) of subdivision (j), and except for a prudent reserve
not to exceed two million dollars ($2,000,000) in the Medi-Cal
Inpatient Payment Adjustment Fund, any amounts in the fund, including
interest that accrues with respect to the amounts in the fund, that
are not expended, or estimated to be required for expenditure, under
Section 14105.98 with respect to a particular transfer year shall be
returned on a pro rata basis to the transferor entities for the
particular transfer year within 120 days after the department
determines that the funds are not needed for an expenditure in
connection with the particular transfer year.
(B) The department shall determine the interest amounts that have
accrued in the fund from its inception through June 30, 1995, and, no
later than January 1, 1996, shall distribute these interest amounts
to transferor entities:
(C) With respect to those particular amounts in the fund resulting
solely from the provisions of subparagraph (D) of paragraph (2), the
department shall determine by September 30, 1999, whether these
particular amounts exceed 28 percent of the amount to be transferred
to the Health Care Deposit Fund for the 1999-2000 fiscal year, as
referred to in paragraph (2) of subdivision (d). Any excess amount so
determined shall be returned to the particular transferor entities
on a pro rata basis no later than October 31, 1999.
(D) Regarding any funds returned to a transferor entity under
subparagraph (A) or (C), or interest amounts distributed to a
transferor entity under subparagraph (B), the department shall
provide to the transferor entity a written statement that explains
the basis for the particular return or distribution of funds and
contains the general calculations used by the department in
determining the amount of the particular return or distribution of
funds.
(i) (1) For the 1991-92 transfer year, each transferor entity
shall pay its transfer amount or amounts to the Controller, for
deposit in the fund, in eight equal installments.
(2) (A) Except as provided in subparagraphs (B) and (C), for the
1992-93 transfer year and subsequent transfer years, each transferor
entity shall pay its transfer amount or amounts to the Controller,
for deposit in the fund, in eight equal installments. However, for
the 1997-98 and subsequent transfer years, each transferor entity
shall pay its transfer amount or amounts to the Controller, for
deposit in the fund, in the form of periodic installments according
to a timetable established by the department. The timetable shall be
structured to effectuate, on a reasonable basis, the prompt
distribution of all nonsupplemental payment adjustments under Section
14105.98, and transfers to the Health Care Deposit Fund under
subdivision (d).
(B) For the 1994-95 transfer year, each transferor entity shall
pay its transfer amount or amounts to the Controller, for deposit in
the fund, in five equal installments.
(C) For the 1995-96 transfer year, each transferor entity shall
pay its transfer amount or amounts to the Controller, for deposit in
the fund, in five equal installments.
(D) Except as otherwise specifically provided, subparagraphs (A)
to (C), inclusive, shall not apply to increases in transfer amounts
described in paragraph (2) of subdivision (h) or to additional
transfer amounts described in subdivision (o).
(E) All requests for transfer payments, or adjustments thereto,
issued by the department shall be in writing and shall include (i) an
explanation of the basis for the particular transfer request or
transfer activity, (ii) a summary description of program funding
status for the particular transfer year, and (iii) the general
calculations used by the department in connection with the particular
transfer request or transfer activity.
(3) A transferor entity may use any of the following funds for
purposes of meeting its transfer obligations under this section:
(A) General funds of the transferor entity.
(B) Any other funds permitted by law to be used for these
purposes, except that a transferor entity shall not submit to the
Controller any federal funds unless those federal funds are
authorized by federal law to be used to match other federal funds. In
addition, no private donated funds from any health care provider, or
from any person or organization affiliated with the health care
provider, shall be channeled through a transferor entity or any other
public entity to the fund, unless the donated funds will qualify
under federal rules as a valid component of the nonfederal share of
the Medi-Cal program and will be matched by federal funds. The
transferor entity shall be responsible for determining that funds
transferred meet the requirements of this subparagraph.
(j) (1) If a transferor entity does not submit any transfer amount
within the time period specified in this section, the Controller
shall offset immediately the amount owed against any funds which
otherwise would be payable by the state to the transferor entity. The
Controller, however, shall not impose an offset against any
particular funds payable to the transferor entity where the offset
would violate state or federal law.
(2) Where a withhold or a recoupment occurs pursuant to the
provisions of paragraph (2) of subdivision (r) of Section 14105.98,
the nonfederal portion of the amount in question shall remain in the
fund, or shall be redeposited in the fund by the department, as
applicable. The department shall then proceed as follows:
(A) If the withhold or recoupment was imposed with respect to a
hospital whose licensee was a transferor entity for the particular
state fiscal year to which the withhold or recoupment related, the
nonfederal portion of the amount withheld or recouped shall serve as
a credit for the particular transferor entity against an equal amount
of transfer obligations under this section, to be applied whenever
the transfer obligations next arise. Should no such transfer
obligation arise within 180 days, the department shall return the
funds in question to the particular transferor entity within 30 days
thereafter.
(B) For other situations, the withheld or recouped nonfederal
portion shall be subject to paragraph (7) of subdivision (h).
(k) All transfer amounts received by the Controller or amounts
offset by the Controller shall immediately be deposited in the fund.
(l) For purposes of this section, the disproportionate share list
utilized by the department for a particular transfer year shall be
identical to the disproportionate share list utilized by the
department for the same state fiscal year for purposes of Section
14105.98. Nothing on a disproportionate share list, once issued by
the department, shall be modified for any reason other than
mathematical or typographical errors or omissions on the part of the
department or the Office of Statewide Health Planning and Development
in preparation of the list.
(m) Neither the intergovernmental transfers required by this
section, nor any elective transfer made pursuant to Section 14164,
shall create, lead to, or expand the health care funding or service
obligations for current or future years for any transferor entity,
except as required of the state by this section or as may be required
by federal law, in which case the state shall be held harmless by
the transferor entities on a pro rata basis.
(n) Except as otherwise permitted by state and federal law, no
transfer amount submitted to the Controller under this section, and
no offset by the Controller pursuant to subdivision (j), shall be
claimed or recognized as an allowable element of cost in Medi-Cal
cost reports submitted to the department.
(o) Whenever additional transfer amounts are required
to fund the nonfederal share of payment adjustment amounts under
Section 14105.98 that are distributed after the close of the
particular payment adjustment year to which the payment adjustment
amounts apply, the additional transfer amounts shall be paid by the
parties who were the transferor entities for the particular transfer
year that was concurrent with the particular payment adjustment year.
The additional transfer amounts shall be calculated under the
formula that was in effect during the particular transfer year. For
transfer years prior to the 1993-94 transfer year, the percentage of
the additional transfer amounts available for transfer to the Health
Care Deposit Fund under subdivision (d) shall be the percentage that
was in effect during the particular transfer year. These additional
transfer amounts shall be paid by transferor entities within 20 days
after the department notifies the transferor entity in writing of the
additional transfer amount to be paid.
(p) (1) Ten million dollars ($10,000,000) of the amount
transferred from the Medi-Cal Inpatient Payment Adjustment Fund to
the Health Care Deposit Fund due to amounts transferred attributable
to years prior to the 1993-94 fiscal year is hereby appropriated
without regard to fiscal years to the State Department of Health Care
Services to be used to support the development of managed care
programs under the department's plan to expand Medi-Cal managed care.
(2) These funds shall be used by the department for both of the
following purposes: (A) distributions to counties or other local
entities that contract with the department to receive those funds
14150. Within 60 calendar days of the date that the annual Budget
Act is chaptered, the department shall notify the chairpersons of the
fiscal committees of each house of the Legislature, the Chairperson
and the Vice Chairperson of the Joint Legislative Budget Committee,
and appropriate county representatives if the department plans to
withhold and not allocate any of the baseline allocation for county
Medi-Cal eligibility activities that are appropriated for Medi-Cal
administration.
14151. Bills for services rendered during the 1970-71 fiscal year
to persons other than the beneficiaries under the California Medical
Assistance Program submitted to the state by any county which has
elected to come within the provisions of Section 14150.1 of the
Welfare and Institutions Code are bills against the appropriation for
the fiscal year during which the bills are submitted, and shall be
submitted not later than 60 days following the start of the 1971-72
fiscal year. The director may, when he finds that delay in the
submission of bills was caused by circumstances beyond the control of
the county, extend the period of submissions of bills for a period
not to extend beyond the end of the 1971-72 fiscal year. State
general funds of $27,661,452 are made available from the 1971-72
appropriation to cover the state cost of such bills received. In the
event such bills received are less than $27,661,452, the balance
remaining may be used for the basic or supplemental schedules of
benefits.
14152. Bills for services rendered during the 1970-71 fiscal year
to beneficiaries under the California Medical Assistance Program are
bills against the appropriation for the fiscal year during which the
bills are submitted, and shall be submitted not more than two months
after the month in which the service is rendered, and shall be in the
form prescribed by the director, except that in the event the
patient does not identify himself to the provider as a Medi-Cal
beneficiary, the provider shall be entitled to submit his statement
at any time within 60 days after that date certified by the provider
as the date said patient was first identified as a Medi-Cal
beneficiary, provided, however, that such date certified by the
provider as the date the patient was first so identified shall not be
later than one year after the month in which the service was
rendered. Further, the director may, where he finds that delay in the
submission of bills was caused by circumstances beyond the control
of the provider, extend the period for submission of bills for a
period not to exceed one year. Funds in the amount of $106,269,000
are hereby made available from the 1971-72 appropriation to cover the
cost of such 1970-71 services billed during the 1971-72 fiscal year.
In the event such bills are less than $106,269,000 the balance
remaining may be used for the basic or supplemental schedules of
benefits.
14153. Funds shall be advanced monthly to the respective counties
for costs of administration of the Medi-Cal program in the manner
prescribed in Chapter 9 (commencing with Section 15000).
Funds may be advanced monthly to the respective counties for the
costs of care under the provisions of this chapter upon the order of
the Director of Finance and the State Director of Health Services
utilizing resources made available through the Health Care Deposit
Fund.
County welfare departments shall submit administrative claims for
the Medi-Cal program in accordance with procedures described in
Section 10604.5.
14154. (a) (1) The department shall establish and maintain a plan
whereby costs for county administration of the determination of
eligibility for benefits under this chapter will be effectively
controlled within the amounts annually appropriated for that
administration. The plan, to be known as the County Administrative
Cost Control Plan, shall establish standards and performance
criteria, including workload, productivity, and support services
standards, to which counties shall adhere. The plan shall include
standards for controlling eligibility determination costs that are
incurred by performing eligibility determinations at county
hospitals, or that are incurred due to the outstationing of any other
eligibility function. Except as provided in Section 14154.15,
reimbursement to a county for outstationed eligibility functions
shall be based solely on productivity standards applied to that
county's welfare department office.
(2) (A) The plan shall delineate both of the following:
(i) The process for determining county administration base costs,
which include salaries and benefits, support costs, and staff
development.
(ii) The process for determining funding for caseload changes,
cost-of-living adjustments, and program and other changes.
(B) The annual county budget survey document utilized under the
plan shall be constructed to enable the counties to provide
sufficient detail to the department to support their budget requests.
(3) The plan shall be part of a single state plan, jointly
developed by the department and the State Department of Social
Services, in conjunction with the counties, for administrative cost
control for the California Work Opportunity and Responsibility to
Kids (CalWORKs), Food Stamp, and Medical Assistance (Medi-Cal)
programs. Allocations shall be made to each county and shall be
limited by and determined based upon the County Administrative Cost
Control Plan. In administering the plan to control county
administrative costs, the department shall not allocate state funds
to cover county cost overruns that result from county failure to meet
requirements of the plan. The department and the State Department of
Social Services shall budget, administer, and allocate state funds
for county administration in a uniform and consistent manner.
(4) The department and county welfare departments shall develop
procedures to ensure the data clarity, consistency, and reliability
of information contained in the county budget survey document
submitted by counties to the department. These procedures shall
include the format of the county budget survey document and process,
data submittal and its documentation, and the use of the county
budget survey documents for the development of determining county
administration costs. Communication between the department and the
county welfare departments shall be ongoing as needed regarding the
content of the county budget surveys and any potential issues to
ensure the information is complete and well understood by involved
parties. Any changes developed pursuant to this section shall be
incorporated within the state's annual budget process by no later
than the 2011-12 fiscal year.
(5) The department shall provide a clear narrative description
along with fiscal detail in the Medi-Cal estimate package, submitted
to the Legislature in January and May of each year, of each component
of the county administrative funding for the Medi-Cal program. This
shall describe how the information obtained from the county budget
survey documents was utilized and, where applicable, modified and the
rationale for the changes.
(b) Nothing in this section, Section 15204.5, or Section 18906
shall be construed so as to limit the administrative or budgetary
responsibilities of the department in a manner that would violate
Section 14100.1, and thereby jeopardize federal financial
participation under the Medi-Cal program.
(c) (1) The Legislature finds and declares that in order for
counties to do the work that is expected of them, it is necessary
that they receive adequate funding, including adjustments for
reasonable annual cost-of-doing-business increases. The Legislature
further finds and declares that linking appropriate funding for
county Medi-Cal administrative operations, including annual
cost-of-doing-business adjustments, with performance standards will
give counties the incentive to meet the performance standards and
enable them to continue to do the work they do on behalf of the
state. It is therefore the Legislature's intent to provide
appropriate funding to the counties for the effective administration
of the Medi-Cal program at the local level to ensure that counties
can reasonably meet the purposes of the performance measures as
contained in this section.
(2) It is the intent of the Legislature to not appropriate funds
for the cost-of-doing-business adjustment for the 2008-09, 2009-10,
and 2010-11 fiscal years.
(d) The department is responsible for the Medi-Cal program in
accordance with state and federal law. A county shall determine
Medi-Cal eligibility in accordance with state and federal law. If in
the course of its duties the department becomes aware of accuracy
problems in any county, the department shall, within available
resources, provide training and technical assistance as appropriate.
Nothing in this section shall be interpreted to eliminate any remedy
otherwise available to the department to enforce accurate county
administration of the program. In administering the Medi-Cal
eligibility process, each county shall meet the following performance
standards each fiscal year:
(1) Complete eligibility determinations as follows:
(A) Ninety percent of the general applications without applicant
errors and are complete shall be completed within 45 days.
(B) Ninety percent of the applications for Medi-Cal based on
disability shall be completed within 90 days, excluding delays by the
state.
(2) (A) The department shall establish best-practice guidelines
for expedited enrollment of newborns into the Medi-Cal program,
preferably with the goal of enrolling newborns within 10 days after
the county is informed of the birth. The department, in consultation
with counties and other stakeholders, shall work to develop a process
for expediting enrollment for all newborns, including those born to
mothers receiving CalWORKs assistance.
(B) Upon the development and implementation of the best-practice
guidelines and expedited processes, the department and the counties
may develop an expedited enrollment timeframe for newborns that is
separate from the standards for all other applications, to the extent
that the timeframe is consistent with these guidelines and
processes.
(C) Notwithstanding the rulemaking procedures of 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 section by
means of all-county letters or similar instructions, without further
regulatory action.
(3) Perform timely annual redeterminations, as follows:
(A) Ninety percent of the annual redetermination forms shall be
mailed to the recipient by the anniversary date.
(B) Ninety percent of the annual redeterminations shall be
completed within 60 days of the recipient's annual redetermination
date for those redeterminations based on forms that are complete and
have been returned to the county by the recipient in a timely manner.
(C) Ninety percent of those annual redeterminations where the
redetermination form has not been returned to the county by the
recipient shall be completed by sending a notice of action to the
recipient within 45 days after the date the form was due to the
county.
(D) When a child is determined by the county to change from no
share of cost to a share of cost and the child meets the eligibility
criteria for the Healthy Families Program established under Section
12693.98 of the Insurance Code, the child shall be placed in the
Medi-Cal-to-Healthy Families Bridge Benefits Program, and these cases
shall be processed as follows:
(i) Ninety percent of the families of these children shall be sent
a notice informing them of the Healthy Families Program within five
working days from the determination of a share of cost.
(ii) Ninety percent of all annual redetermination forms for these
children shall be sent to the Healthy Families Program within five
working days from the determination of a share of cost if the parent
has given consent to send this information to the Healthy Families
Program.
(iii) Ninety percent of the families of these children placed in
the Medi-Cal-to-Healthy Families Bridge Benefits Program who have not
consented to sending the child's annual redetermination form to the
Healthy Families Program shall be sent a request, within five working
days of the determination of a share of cost, to consent to send the
information to the Healthy Families Program.
(E) Subparagraph (D) shall not be implemented until 60 days after
the Medi-Cal and Joint Medi-Cal and Healthy Families applications and
the Medi-Cal redetermination forms are revised to allow the parent
of a child to consent to forward the child's information to the
Healthy Families Program.
(e) The department shall develop procedures in collaboration with
the counties and stakeholder groups for determining county review
cycles, sampling methodology and procedures, and data reporting.
(f) On January 1 of each year, each applicable county, as
determined by the department, shall report to the department on the
county's results in meeting the performance standards specified in
this section. The report shall be subject to verification by the
department. County reports shall be provided to the public upon
written request.
(g) If the department finds that a county is not in compliance
with one or more of the standards set forth in this section, the
county shall, within 60 days, submit a corrective action plan to the
department for approval. The corrective action plan shall, at a
minimum, include steps that the county shall take to improve its
performance on the standard or standards with which the county is out
of compliance. The plan shall establish interim benchmarks for
improvement that shall be expected to be met by the county in order
to avoid a sanction.
(h) (1) If a county does not meet the performance standards for
completing eligibility determinations and redeterminations as
specified in this section, the department may, at its sole
discretion, reduce the allocation of funds to that county in the
following year by 2 percent. Any funds so reduced may be restored by
the department if, in the determination of the department, sufficient
improvement has been made by the county in meeting the performance
standards during the year for which the funds were reduced. If the
county continues not to meet the performance standards, the
department may reduce the allocation by an additional 2 percent for
each year thereafter in which sufficient improvement has not been
made to meet the performance standards.
(2) No reduction of the allocation of funds to a county shall be
imposed pursuant to this subdivision for failure to meet performance
standards during any period of time in which the
cost-of-doing-business increase is suspended.
(i) The department shall develop procedures, in collaboration with
the counties and stakeholders, for developing instructions for the
performance standards established under subparagraph (D) of paragraph
(3) of subdivision (d), no later than September 1, 2005.
(j) No later than September 1, 2005, the department shall issue a
revised annual redetermination form to allow a parent to indicate
parental consent to forward the annual redetermination form to the
Healthy Families Program if the child is determined to have a share
of cost.
(k) The department, in coordination with the Managed Risk Medical
Insurance Board, shall streamline the method of providing the Healthy
Families Program with information necessary to determine Healthy
Families eligibility for a child who is receiving services under the
Medi-Cal-to-Healthy Families Bridge Benefits Program.
14154.1. Reimbursement for any Medi-Cal county administrative costs
shall be made subject to the requirements specified in the County
Administrative Cost Control Plan, established pursuant to Section
14154. However, notwithstanding any other provision of law, for
applications taken on or after July 1, 1987, and thereafter, the
department shall make allocations for Medi-Cal county administrative
expenses taking into consideration all Medi-Cal applications.
However, if the department determines that a county is
inappropriately processing non-Medi-Cal applications through the
Medi-Cal process, then the department shall not allocate state
general funds for nonapproved Medi-Cal applications which exceed a
specified level. That level shall be determined by multiplying the
county's number of approved applications by the ratio of nonapproved
applications to approved applications processed by the county during
the base period used in the cost control plan which is in effect for
the fiscal year the inappropriate processing of non-Medi-Cal
applications occurred. Reimbursement to Los Angeles County hospitals
shall be limited on the same basis.
14154.15. (a) Any county may petition the department for an
augmentation of its County Administrative Cost Control Plan in order
to implement a plan, as provided for in Section 1105 of the federal
Social Security Act (42 U.S.C. Sec. 1305), for the outstationing of
one or more eligibility workers at all types of outstation locations,
as defined in Section 435.904(c)(3) of Title 42 of the Code of
Federal Regulations in order to facilitate receipt and processing of
applications for Medi-Cal eligibility for pregnant women, infants and
children as specified by Title XIX of the Social Security Act (42
U.S.C. Sec. 1396 and following). In order to participate pursuant to
this section, a county welfare department shall petition under this
section in accordance with guidelines established by the department.
The petition shall include, but not be limited to, information about
the need for outstation workers at alternative sites and the language
skills needed by the outstation workers.
(b) In reviewing a petition from a county for an augmentation of
its County Administrative Cost Control Plan for outstationing
purposes, the department shall take into account the likely success
rate of applications processed by the proposed outstationed
eligibility workers, the amount of travel and training time required
to implement and continue the outstationing plan, and other
productivity factors associated with the outstationing plan.
(c) The department may approve those proposed augmentations which,
based on its review of the outstationing plan, offer potential to
increase eligibility determinations and access to Medi-Cal perinatal
services by pregnant women and Medi-Cal services by infants and
children specified by Title XIX of the Social Security Act (42
U.S.C., Sec. 1396 and following). The department shall review the
approved plan annually to determine if the plan shall be renewed,
altered, discontinued, or incorporated into the county administrative
funding base.
(d) In addition to any augmentations authorized by this section,
the department may, at its discretion, advance administrative funding
to a county welfare department for which it approves an augmentation
of its County Administrative Cost Control Plan, to cover the initial
incremental costs of outstationed eligibility workers under this
section.
(e) The department shall conduct a one-time outreach plan to
educate county welfare directors, county health officers, and county
elected officials on the opportunities and advantages of
outstationing Medi-Cal eligibility workers to facilitate access by
pregnant women to Medi-Cal perinatal services and Medi-Cal
eligibility for infants and children.
14154.2. (a) The Legislature finds that ambiguities have arisen
regarding payment provisions relating to certain costs incurred in
processing Medi-Cal eligibility applications for various fiscal
years, and believes the ambiguities should be alleviated by means of
legislation clarifying the Legislature's intent regarding such
provisions.
(b) The Legislature recognizes that federal financial
participation in the costs of administering the Medi-Cal program is
an important element in funding such costs, and desires that federal
financial participation be pursued and obtained whenever possible.
With respect to Medi-Cal administration costs, for eligibility
determinations, it is not and has not been the Legislature's intent
to preclude federal financial participation which would otherwise be
available from the Health Care Financing Administration.
14154.3. (a) A provision of a Budget Act or other statute shall not
be interpreted or applied to limit the amount of federal financial
participation, otherwise available under federal law, which may be
reimbursable to counties in support of Medi-Cal administration costs
for eligibility determinations. A provision of a Budget Act or
another statute shall not be interpreted or applied to restrict the
amount of federal financial participation for Medi-Cal administration
costs, for eligibility determinations, otherwise available under
federal law, which may be claimed by the department, and, upon
receipt from the federal government, transferred by the department to
a county.
(b) The Budget Acts referred to in subdivision (a) include, but
are not limited to:
(1) Chapter 510 of the Statutes of 1980, including Item 288 of
Section 2 thereof.
(2) Chapter 99 of the Statutes of 1981, including Items
426-101-001 and 426-101-890 of Section 2.00 thereof.
(3) Chapter 326 of the Statutes of 1982, including Items
4260-101-001 and 4260-101-890 of Section 2.00 thereof.
(4) Chapter 324 of the Statutes of 1983, including Items
4260-101-001 and 4260-101-890 of Section 2.00 thereof.
(5) Chapter 258 of the Statutes of 1984, including Items
4260-101-001 and 4260-101-890 of Section 2.00 thereof.
(6) Chapter 111 of the Statutes of 1985, including Items
4260-101-001 and 4260-101-890 of Section 2.00 thereof.
(7) Chapter 186 of the Statutes of 1986, including Items
4260-101-001 and 4260-101-890 of Section 2.00 thereof.
Provisions of the Budget Acts listed in paragraphs (1) to (7),
inclusive, shall not be interpreted or applied as a prohibition
regarding the amount of costs counties may incur for Medi-Cal
eligibility administration activities. The provisions of those Budget
Acts shall be interpreted and applied as a means of limiting the
allocation of state general funds to be paid in support of Medi-Cal
eligibility determination activities.
(c) To the extent necessary to effectuate the intent of
subdivisions (a) and (b), the following Budget Act provisions shall
be inoperative:
(1) Provision 17.5 of Item 426-101-890 of Section 2.00 of Chapter
99 of the Statutes of 1981.
(2) The incorporation by reference of Provision 16 of Item
4260-101-001 of Section 2.00 of Chapter 326 of the Statutes of 1982
into Provision 1 of Item 4260-101-890 of that chapter.
(3) The incorporation by reference of Provision 15 of Item
4260-101-001 of Section 2.00 of Chapter 324 of the Statutes of 1983
into Provision 1 of Item 4260-101-890 of Section 2.00 of that
chapter.
(d) Sections 14154 and 14154.1 shall not be interpreted or applied
to restrict the amount of federal financial participation, not
deferred or disallowed by federal law or regulation which may be
reimbursable to any county for Medi-Cal administration costs for
eligibility determinations. The County Administrative Cost Control
Plan established pursuant to Section 14154 shall not be interpreted
or applied as a prohibition regarding the amount of costs counties
may incur for Medi-Cal county administration costs. That plan shall
be interpreted and applied only as a means of limiting the allocation
of state general funds to be paid in support of those county costs.
(e) Should federal financial participation be deferred or
disallowed regarding funds transferred by the department to a county
for costs incurred for Medi-Cal eligibility determinations, and that
federal financial participation was matched by county expenditures,
the county which received those federal funds shall repay the funds
in question at such time as the federal deferral or disallowance has
been issued. If the federal deferral or disallowance is noticed or
issued prior to the transfer of the federal funds from the department
to a county, the department shall not be responsible for
transferring the federal funds to the county until the deferral or
disallowance issue regarding these funds has been resolved.
(f) The department shall timely appeal from the federal deferrals
or disallowances and the affected county may assist the department in
preparing and presenting a pending appeal regarding a federal
deferral or disallowance.
(g) Medi-Cal eligibility determination activities are undertaken
by counties on behalf of the department. Reasonable and necessary
costs incurred by counties relating to the eligibility determination
activities shall be recognized as costs incurred by the state for
purposes of inclusion in the nonfederal share of Medi-Cal eligibility
determination expenditures for claiming federal financial
participation.
(h) Subdivision (e) shall not apply to agreements between the
department and a county executed prior to September 27, 1987.
14154.5. (a) Each county shall work, on a routine basis, any error
alert from the department's Medi-Cal Eligibility Data System (MEDS).
Any alert that affects eligibility or the share of cost that is
received by the 10th working day of the month shall be processed in
time for the change to be effective the beginning of the following
month. Any alert that affects eligibility or the share of cost that
is received after the 10th working day of the month shall be
processed in time for the change to be effective the beginning of the
month after the following month. The department shall consult with
the County Welfare Directors Association to define those alerts that
affect eligibility or the share of cost.
(b) The county shall submit reconciliation files of its Medi-Cal
eligible population to the department every three months, based upon
a schedule determined by the department and in a format prescribed by
the department, to identify any discrepancies between eligibility
files in the county records and eligibility as reflected in MEDS.
Counties shall be notified of any changes to the standard format for
submitting reconciliation files sufficiently in advance to allow for
budgeting, scheduling, development, testing, and implementation of
any required change in county automated eligibility systems.
(c) For those records that are on the county's files, but not on
MEDS, the county shall receive worker alerts from the department that
identify these cases, and the county shall fix any data
discrepancies. Any worker alert received by the 10th working day of
the month shall be processed in time for the change to be effective
the beginning of the following month. Any worker alert received after
the 10th working day of the month shall be processed in time for the
change to be effective the beginning of the month after the
following month.
(d) In regard to any record that is on MEDS but not on the county'
s file, the county shall either correct the county record or MEDS,
whichever is appropriate, within the same timeframes specified in
subdivision (c).
(e) The department shall terminate a MEDS-eligible record if the
person is not eligible on the county's file when there has been no
eligibility update on the MEDS record for six months.
(f) (1) If the department finds that a county is not performing
all of the following activities, the county shall, within 60 days,
submit a corrective action plan to the department for approval:
(A) Conducting reconciliations as required in subdivision (b).
(B) Processing 95 percent of worker alerts referred to in
subdivisions (c) and (d), within the timeframes specified.
(C) Processing 90 percent of the error alerts referred to in
subdivision (a) that affect eligibility or the share of cost, within
the timeframes specified.
(2) The corrective action plan shall, at a minimum, include steps
that the county shall take to improve its performance on the
requirements with which the county is out of compliance. The plan
shall establish interim benchmarks for improvement that shall be
expected to be met by the county in order to avoid sanctions.
(g) (1) If the county does not meet the interim benchmarks for
improvement standards, the department may, in its sole discretion,
reduce the allocation of funds to that county in the following year
by 2 percent. Any funds so reduced may be restored by the department
if, in the determination of the department, sufficient improvement
has been made by the county in meeting the performance standards
during the year for which the funds were reduced.
(2) No reduction of the allocation of funds to a county shall be
imposed pursuant to this subdivision for failure to meet performance
standards during any period of time in which the
cost-of-doing-business increase is suspended.
(h) The department, in consultation with the County Welfare
Directors Association, shall investigate features that could be
installed in MEDS to reduce the number of alerts and streamline the
reconciliation process.
(i) 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 department may implement, interpret, or
make specific this section by means of all-county letters, provider
bulletins, or similar instructions. Thereafter, the department may
adopt regulations 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.
14157. There is hereby established a Health Care Deposit Fund from
which expenditures of state, county and federal funds for health care
and administration under this chapter and Chapter 8 (commencing with
Section 14200) shall be made upon order of the Controller in
accordance with certifications made by the director.
The Controller shall deposit in this fund all federal funds as
received under the provisions of Title XIX of the Social Security Act
and all county funds received under this chapter.
All money in the Health Care Deposit Fund is hereby appropriated,
for expenditure for the purposes specified in this chapter and
Chapter 8 (commencing with Section 14200).
14157.6. Notwithstanding any other provision of law, any federal
and county funds, excluding county funds used for the purposes of
Section 4011.1 of the Penal Code, received under the provisions of
Section 14157 during each fiscal year, as reimbursement for
expenditures for health care services authorized under this chapter
made from funds transferred to the Health Care Deposit Fund from the
General Fund in prior years, shall be transferred from the Health
Care Deposit Fund to the General Fund. When a projected deficiency
exists in the Medical Assistance Program, these federal and county
funds are hereby appropriated from the General Fund to the Health
Care Deposit Fund and shall be expended as soon as practicable, but
not sooner than 30 days after notification in writing of the
necessity therefor, to the chairperson of the committee in each house
which considers appropriations, and the Joint Legislative Budget
Committee, for the state's share of payments for medical care and
services, county administration, and fiscal intermediary services.
14158. Funds for the medical assistance program shall be provided
annually by appropriation in the Budget Act. The amount of state
funds appropriated shall be transferred in such sums as are needed by
the Controller from the General Fund to the Health Care Deposit
Fund.
14158.1. Effective for expenditures incurred after enactment of any
new demonstration project under Article 5.4 (commencing with Section
14180), any federal financial participation that is available under
the federal Medicaid Program, or any related waiver or demonstration
project, based on the certified public expenditures of designated
public hospitals, as defined in subdivision (d) of Section 14166.1,
or the governmental entities with which they are affiliated, shall be
paid to designated public hospitals or the governmental entities
with which they are affiliated.
14158.5. Funds appropriated for purposes of this chapter and
Chapter 8 (commencing with Section 14200), shall fully cover and
shall not exceed the state's share of payments under this chapter and
Chapter 8 (commencing with Section 14200), for the costs of medical
care and services, county administration, and fiscal intermediary
services. The state's share of the costs of medical care and
services, county administration, and fiscal intermediary services
shall be determined pursuant to a plan approved by the Director of
Finance and certified to by the director.
14159. Commencing with the 2004-05 fiscal year, expenditures for
Medi-Cal services and fiscal intermediary and county administration
costs included in the department's budget shall be charged against
the appropriation for the fiscal year in which the billing is paid.
Commencing July 1, 2004, all 2002-03 fiscal year and prior accrued
obligations of the Health Care Deposit Fund shall become obligations
of the 2004-05 fiscal year and all moneys available from the 2002-03
fiscal year and prior appropriations shall be reappropriated to the
2004-05 fiscal year for that purpose.
14159.1. The provisions of Chapter 577 of the Statutes of 1971 in
no way eliminate fiscal obligation incurred prior to July 1, 1971, by
any county or the state under Article 5 (commencing with Section
14150) of Chapter 7 of Part 3 of Division 9 of the Welfare and
Institutions Code. After June 30, 1971, all uncollected county share
amounts under said Article 5 due the state for prior periods remain
an obligation of the county to the state.
14160. Whenever an amount is or was prior to the effective date of
this section, erroneously deposited in the Health Care Deposit Fund,
including, but not limited to, duplicate payments and payments in
excess of the correct amount, the erroneous amount shall be refunded
to the depositor. There is hereby appropriated out of the Health Care
Deposit Fund amounts sufficient to pay such refunds.
14161. Carriers and providers of Medi-Cal benefits shall be
required to utilize uniform accounting and cost-reporting systems as
shall be developed and adopted by the department. If any other
provision of law provides for uniform accounting and cost-reporting
systems for hospitals, the department shall adopt these systems.
Carriers and providers of Medi-Cal benefits shall provide cost
information to the department as is necessary in order to conduct
studies to determine payment for services provided under this
chapter, including but not limited to copies of any Medicare cost
reports and settlements, and any Medicare audit reports.
Failure to comply with the provisions of this section shall be
cause for suspension from participation under this chapter.
The department shall conduct such studies as necessary to
determine payments for services provided under this chapter. The
results of or progress reports concerning such studies shall be
submitted to the Legislature by January 31 of each year.
The department shall submit an annual report to the Governor and
the Legislature by January 31 of each year setting forth a
comprehensive description of its activities and the operation and
administration of the Medi-Cal program including, but not limited to,
a fiscal accounting of expenditures, an evaluation of the relative
cost and effectiveness of the various plans in accomplishing the
desired goals, results of demonstration or pilot programs, and its
recommendations as to legislation and other action as is necessary
for carrying out the purposes of this chapter.
14162. (a) Beginning in 1991, the State Department of Health
Services shall include in the November estimate of Medi-Cal
expenditures and the Governor's Budget an estimate of savings from
the prior year which resulted from implementation of Senate Bill 2174
of the 1987-88 Regular Session of the Legislature.
(b) Beginning in 1992, the Department of Finance shall, by
February 1, deposit an amount equal to the savings level identified
in the November estimate of Medi-Cal expenditures into the Critical
Needs Health Care Fund, which is hereby created. Funds deposited in
the Critical Needs Health Care Fund shall be appropriated by the
Legislature for high-priority health expenditures.
14163. (a) For purposes of this section, the following definitions
shall apply:
(1) "Public entity" means a county, a city, a city and county, the
State of California, the University of California, a local health
care district, a local health authority, or any other political
subdivision of the state.
(2) "Hospital" means a health facility that is licensed pursuant
to Chapter 2 (commencing with Section 1250) of Division 2 of the
Health and Safety Code to provide acute inpatient hospital services,
and includes all components of the facility.
(3) "Disproportionate share hospital" means a hospital providing
acute inpatient services to Medi-Cal beneficiaries that meets the
criteria for disproportionate share status relating to acute
inpatient services set forth in Section 14105.98.
(4) "Disproportionate share list" means the annual list of
disproportionate share hospitals for acute inpatient services issued
by the department pursuant to Section 14105.98.
(5) "Fund" means the Medi-Cal Inpatient Payment Adjustment Fund.
(6) "Eligible hospital" means, for a particular state fiscal year,
a hospital on the disproportionate share list that is eligible to
receive payment adjustment amounts under Section 14105.98 with
respect to that state fiscal year.
(7) "Transfer year" means the particular state fiscal year during
which, or with respect to which, public entities are required by this
section to make an intergovernmental transfer of funds to the
Controller.
(8) "Transferor entity" means a public entity that, with respect
to a particular transfer year, is required by this section to make an
intergovernmental transfer of funds to the Controller.
(9) "Transfer amount" means an amount of intergovernmental
transfer of funds that this section requires for a particular
transferor entity with respect to a particular transfer year.
(10) "Intergovernmental transfer" means a transfer of funds from a
public entity to the state that is local government financial
participation in Medi-Cal pursuant to the terms of this section.
(11) "Licensee" means an entity that has been issued a license to
operate a hospital by the department.
(12) "Annualized Medi-Cal inpatient paid days" means the total
number of Medi-Cal acute inpatient hospital days, regardless of dates
of service, for which payment was made by or on behalf of the
department to a hospital, under present or previous ownership, during
the most recent calendar year ending prior to the beginning of a
particular transfer year, including all Medi-Cal acute inpatient
covered days of care for hospitals that are paid on a different basis
than per diem payments.
(13) "Medi-Cal acute inpatient hospital day" means any acute
inpatient day of service attributable to patients who, for those
days, were eligible for medical assistance under the California state
plan, including any day of service that is reimbursed on a basis
other than per diem payments.
(14) "OBRA 1993 payment limitation" means the hospital-specific
limitation on the total annual amount of payment adjustments to each
eligible hospital under the payment adjustment program that can be
made with federal financial participation under Section 1396r-4(g) of
Title 42 of the United States Code as implemented pursuant to the
Medi-Cal State Plan.
(b) The Medi-Cal Inpatient Payment Adjustment Fund is hereby
created in the State Treasury. Notwithstanding Section 13340 of the
Government Code, the fund shall be continuously appropriated to, and
under the administrative control of, the department for the purposes
specified in subdivision (d). The fund shall consist of the
following:
(1) Transfer amounts collected by the Controller under this
section, whether submitted by transferor entities pursuant to
applicable provisions of this section or obtained by offset pursuant
to subdivision (j).
(2) Any other intergovernmental transfers deposited in the fund,
as permitted by Section 14164.
(3) Any interest that accrues with respect to amounts in the fund.
(c) Moneys in the fund, which shall not consist of any state
general funds, shall be used as the source for the nonfederal share
of payments to hospitals pursuant to Section 14105.98. Moneys shall
be allocated from the fund by the department and matched by federal
funds in accordance with customary Medi-Cal accounting procedures,
and used to make payments pursuant to Section 14105.98.
(d) Except as otherwise provided in Section 14105.98 or in any law
appropriating a specified sum of money to the department for
administering this section and Section 14105.98, moneys in the fund
shall be used only for the following:
(1) Payments to hospitals pursuant to Section 14105.98.
(2) Transfers to the Health Care Deposit Fund as follows:
(A) In the amount of two hundred thirty-nine million seven hundred
fifty-seven thousand six hundred ninety dollars ($239,757,690) for
the 1994-95 and 1995-96 fiscal years.
(B) In the amount of two hundred twenty-nine million seven hundred
fifty-seven thousand six hundred ninety dollars ($229,757,690) for
the 1996-97 fiscal year.
(C) In the amount of one hundred fifty-four million seven hundred
fifty-seven thousand six hundred ninety dollars ($154,757,690) for
the 1997-98 fiscal year.
(D) In the amount of one hundred fourteen million seven hundred
fifty-seven thousand six hundred ninety dollars ($114,757,690) for
the 1998-99 fiscal year.
(E) (i) In the amount of eighty-four million seven hundred
fifty-seven thousand six hundred ninety dollars ($84,757,690) for the
1999-2000 fiscal year.
(ii) It is the intent of the Legislature that the economic benefit
of any reduction in the amount transferred, or to be transferred, to
the Health Care Deposit Fund pursuant to this subdivision for the
1999-2000 fiscal year, as compared to the amount so transferred for
the 1998-99 fiscal year, be allocated equally between public and
nonpublic disproportionate share hospitals. To implement the
reduction in clause (i) the department shall, by June 30, 2000,
adjust the calculations in Section 14105.98 in order to allocate the
funds in accordance with this clause.
(F) In the amount of twenty-nine million seven hundred fifty-seven
thousand six hundred ninety dollars ($29,757,690) for the 2000-01
fiscal year and the 2001-02 fiscal year.
(G) In the amount of eighty-five million dollars ($85,000,000) for
the 2002-03 fiscal year and each fiscal year thereafter.
(H) The transfers from the fund shall be made in six equal monthly
installments to the Medi-Cal local assistance appropriation item
(Item 4260-101-0001 of Section 2.00 of the annual Budget Act) in
support of Medi-Cal expenditures. The first installment shall accrue
in October of each transfer year, and all other installments shall
accrue monthly thereafter from November through March.
(e) For the 1991-92 state fiscal year, the department shall
determine, no later than 70 days after the enactment of this section,
the transferor entities for the 1991-92 transfer year. To make this
determination, the department shall utilize the disproportionate
share list for the 1991-92 fiscal year issued by the department
pursuant to paragraph (1) of subdivision (f) of Section 14105.98. The
department shall identify each eligible hospital on the list for
which a public entity is the licensee as of July 1, 1991. The public
entity that is the licensee of each identified eligible hospital
shall be a transferor entity for the 1991-92 transfer year.
(f) The department shall determine, no later than 70 days after
the enactment of this section, the transfer amounts for the 1991-92
transfer year.
The transfer amounts shall be determined as follows:
(1) The eligible hospitals for 1991-92 shall be identified. For
each hospital, the applicable total per diem payment adjustment
amount under Section 14105.98 for the 1991-92 transfer year shall be
computed. This amount shall be multiplied by 80 percent of the
eligible hospital's annualized Medi-Cal inpatient paid days as
determined from all Medi-Cal paid claims records available through
April 1, 1991. The products of these calculations for all eligible
hospitals shall be added together to determine an aggregate sum for
the 1991-92 transfer year.
(2) The eligible hospitals for 1991-92 involving transferor
entities as licensees shall be identified. For each hospital, the
applicable total per diem payment adjustment amount under Section
14105.98 for the 1991-92 transfer year shall be computed. This amount
shall be multiplied by 80 percent of the eligible hospital's
annualized Medi-Cal inpatient paid days as determined from all
Medi-Cal paid claims records available through April 1, 1991. The
products of these calculations for all eligible hospitals with
transferor entities as licensees shall be added together to determine
an aggregate sum for the 1991-92 transfer year.
(3) The aggregate sum determined under paragraph (1) shall be
divided by the aggregate sum determined under paragraph (2), yielding
a factor to be utilized in paragraph (4).
(4) The factor determined in paragraph (3) shall be multiplied by
the amount determined for each hospital under paragraph (2). The
product of this calculation for each hospital in paragraph (2) shall
be divided by 1.771, yielding a transfer amount for the particular
transferor entity for the transfer year.
(g) For the 1991-92 transfer year, the department shall notify
each transferor entity in writing of its applicable transfer amount
or amounts.
(h) For the 1992-93 transfer year and subsequent transfer years,
transfer amounts shall be determined in the same procedural manner as
set forth in subdivision (f), except:
(1) The department shall use all of the following:
(A) The disproportionate share list applicable to the particular
transfer year to determine the eligible hospitals.
(B) The payment adjustment amounts calculated under Section
14105.98 for the particular transfer year. These amounts shall take
into account any projected or actual increases or decreases in the
size of the payment adjustment program as are required under Section
14105.98 for the particular year in question, including any decreases
resulting from the application of the OBRA 1993 payment limitation.
The department may issue interim, revised, and supplemental transfer
requests as necessary and appropriate to address changes in payment
adjustment levels that occur under Section 14105.98. All transfer
requests, or adjustments thereto, issued to transferor entities by
the department shall meet the requirements set forth in subdivision
(i).
(C) Data regarding annualized Medi-Cal inpatient paid days for the
most recent calendar year ending prior to the beginning of the
particular transfer year, as determined from all Medi-Cal paid claims
records available through April 1 preceding the particular transfer
year.
(D) The status of public entities as licensees of eligible
hospitals as of July 1 of the particular transfer year.
(E) For the 1993-94 transfer year and subsequent transfer years,
the divisor to be used for purposes of the calculation referred to in
paragraph (4) of subdivision (f) shall be determined by the
department. The divisor shall be calculated to ensure that the
appropriate amount of transfers from transferor entities are received
into the fund to satisfy the requirements of Section 14105.98,
exclusive of the amounts described in paragraph (2) of this
subdivision, and to satisfy the requirements of paragraph (2) of
subdivision (d), for the particular transfer year. For the 1993-94
transfer year, the divisor shall be 1.742.
(F) The following provisions shall apply for certain transfer
amounts relating to nonsupplemental payments under Section 14105.98:
(i) For the 1998-99 transfer year, transfer amounts shall be
determined as though the payment adjustment amounts arising pursuant
to subdivision (ag) of Section 14105.98 were increased by the amounts
paid or payable pursuant to subdivision (af) of Section 14105.98.
(ii) Any transfer amounts paid by a transferor entity pursuant to
subparagraph (C) of paragraph (2) shall serve as credit for the
particular transferor entity against an equal amount of its transfer
obligation for the 1998-99 transfer year.
(iii) For the 1999-2000 transfer year, transfer amounts shall be
determined as though the amount to be transferred to the Health Care
Deposit Fund, as referred to in paragraph (2) of subdivision (d),
were reduced by 28 percent.
(2) (A) Except as provided in subparagraphs (B), (C), and (D), for
the 1993-94 transfer year and subsequent transfer years, transfer
amounts shall be increased for the particular transfer year in the
amounts necessary to fund the nonfederal share of the total
supplemental payment adjustment amounts of all types that arise under
Section 14105.98. These increases shall be paid only by those
transferor entities that are licensees of hospitals that are
projected to receive some or all of the particular supplemental
payments, and the increases shall be paid by the transferor entities
on a pro rata basis in connection with the particular supplemental
payments. For purposes of this paragraph, supplemental payment
adjustment amounts shall be deemed to arise for the particular
transfer year as of the date specified in Section 14105.98. Transfer
amounts to fund the nonfederal share of the payments shall be paid
for the particular transfer year within 20 days after the department
notifies the transferor entity in writing of the additional transfer
amount to be paid.
(B) For the 1995-96 transfer year, the nonfederal share of the
secondary supplemental payment adjustments described in paragraph (9)
of subdivision (y) of Section 14105.98 shall be funded as follows:
(i) Ninety-nine percent of the nonfederal share shall be funded by
a transfer from the University of California.
(ii) One percent of the nonfederal share shall be funded by
transfers from those public entities that are the licensees of the
hospitals included in the "other public hospitals" group referred to
in clauses (ii) and (iii) of subparagraph (B) of paragraph (9) of
subdivision (y) of Section 14105.98. The transfer responsibilities
for this 1 percent shall be allocated to the particular public
entities on a pro rata basis, based on a formula or formulae
customarily used by the department for allocating transfer amounts
under this section. The formula or formulae shall take into account,
through reallocation of transfer amounts as appropriate, the
situation of hospitals whose secondary supplemental payment
adjustments are restricted due to the application of the limitation
set forth in clause (v) of subparagraph (B) of paragraph (9) of
subdivision (y) of Section 14105.98.
(iii) All transfer amounts under this subparagraph shall be paid
by the particular transferor entities within 30 days after the
department notifies the transferor entity in writing of the transfer
amount to be paid.
(C) For the 1997-98 transfer year, transfer amounts to fund the
nonfederal share of the supplemental payment adjustments described in
subdivision (af) of Section 14105.98 shall be funded by a transfer
from the County of Los Angeles.
(D) (i) For the 1998-99 transfer year, transfer amounts to fund
the nonfederal share of the supplemental payment adjustment amounts
arising under subdivision (ah) of Section 14105.98 shall be increased
as set forth in clause (ii).
(ii) The transfer amounts otherwise calculated to fund the
supplemental payment adjustments referred to in clause (i) shall be
increased on a pro rata basis by an amount equal to 28 percent of the
amount to be transferred to the Health Care Deposit Fund for the
1999-2000 fiscal year, as referred to in paragraph (2) of subdivision
(d).
(3) The department shall prepare preliminary analyses and
calculations regarding potential transfer amounts, and potential
transferor entities shall be notified by the department of estimated
transfer amounts as soon as reasonably feasible regarding any
particular transfer year. Written notices of transfer amounts shall
be issued by the department as soon as possible with respect to each
transfer year. All state agencies shall take all necessary steps in
order to supply applicable data to the department to accomplish these
tasks. The Office of Statewide Health Planning and Development shall
provide to the department quarterly access to the edited and
unedited confidential patient discharge data files for all Medi-Cal
eligible patients. The department shall maintain the confidentiality
of that data to the same extent as is required of the Office of
Statewide Health Planning and Development. In addition, the Office of
Statewide Health Planning and Development shall provide to the
department, not later than March 1 of each year, the data specified
by the department, as the data existed on the statewide database file
as of February 1 of each year, from all of the following:
(A) Hospital annual disclosure reports, filed with the Office of
Statewide Health Planning and Development pursuant to former Section
443.31 of, or Section 128735 of, the Health and Safety Code, for
hospital fiscal years that ended during the calendar year ending 13
months prior to the applicable February 1.
(B) Annual reports of hospitals, filed with the Office of
Statewide Health Planning and Development pursuant to former Section
439.2 of, or Section 127285 of, the Health and Safety Code, for the
calendar year ending 13 months prior to the applicable February 1.
(C) Hospital patient discharge data reports, filed with the Office
of Statewide Health Planning and Development pursuant to former
subdivision (g) of Section 443.31 of, or Section 128735 of, the
Health and Safety Code, for the calendar year ending 13 months prior
to the applicable February 1.
(D) Any other materials on file with the Office of Statewide
Health Planning and Development.
(4) Transfer amounts calculated by the department may be increased
or decreased by a percentage amount consistent with the Medi-Cal
state plan.
(5) For the 1993-94 fiscal year, the transfer amount that would
otherwise be required from the University of California shall be
increased by fifteen million dollars ($15,000,000).
(6) Notwithstanding any other law, except for subparagraph (D) of
paragraph (2), the total amount of transfers required from the
transferor entities for any particular transfer year shall not exceed
the sum of the following:
(A) The amount needed to fund the nonfederal share of all payment
adjustment amounts applicable to the particular payment adjustment
year as calculated under Section 14105.98. Included in the
calculations for this purpose shall be any decreases in the program
as a whole, and for individual hospitals, that arise due to the
provisions of Section 1396r-4(f) or (g) of Title 42 of the United
States Code.
(B) The amount needed to fund the transfers to the Health Care
Deposit Fund, as referred to in subdivision (d).
(7) (A) Except as provided in subparagraphs (B) and (C) and in
paragraph (2) of subdivision (j), and except for a prudent reserve
not to exceed two million dollars ($2,000,000) in the Medi-Cal
Inpatient Payment Adjustment Fund, any amounts in the fund, including
interest that accrues with respect to the amounts in the fund, that
are not expended, or estimated to be required for expenditure, under
Section 14105.98 with respect to a particular transfer year shall be
returned on a pro rata basis to the transferor entities for the
particular transfer year within 120 days after the department
determines that the funds are not needed for an expenditure in
connection with the particular transfer year.
(B) The department shall determine the interest amounts that have
accrued in the fund from its inception through June 30, 1995, and, no
later than January 1, 1996, shall distribute these interest amounts
to transferor entities:
(C) With respect to those particular amounts in the fund resulting
solely from the provisions of subparagraph (D) of paragraph (2), the
department shall determine by September 30, 1999, whether these
particular amounts exceed 28 percent of the amount to be transferred
to the Health Care Deposit Fund for the 1999-2000 fiscal year, as
referred to in paragraph (2) of subdivision (d). Any excess amount so
determined shall be returned to the particular transferor entities
on a pro rata basis no later than October 31, 1999.
(D) Regarding any funds returned to a transferor entity under
subparagraph (A) or (C), or interest amounts distributed to a
transferor entity under subparagraph (B), the department shall
provide to the transferor entity a written statement that explains
the basis for the particular return or distribution of funds and
contains the general calculations used by the department in
determining the amount of the particular return or distribution of
funds.
(i) (1) For the 1991-92 transfer year, each transferor entity
shall pay its transfer amount or amounts to the Controller, for
deposit in the fund, in eight equal installments.
(2) (A) Except as provided in subparagraphs (B) and (C), for the
1992-93 transfer year and subsequent transfer years, each transferor
entity shall pay its transfer amount or amounts to the Controller,
for deposit in the fund, in eight equal installments. However, for
the 1997-98 and subsequent transfer years, each transferor entity
shall pay its transfer amount or amounts to the Controller, for
deposit in the fund, in the form of periodic installments according
to a timetable established by the department. The timetable shall be
structured to effectuate, on a reasonable basis, the prompt
distribution of all nonsupplemental payment adjustments under Section
14105.98, and transfers to the Health Care Deposit Fund under
subdivision (d).
(B) For the 1994-95 transfer year, each transferor entity shall
pay its transfer amount or amounts to the Controller, for deposit in
the fund, in five equal installments.
(C) For the 1995-96 transfer year, each transferor entity shall
pay its transfer amount or amounts to the Controller, for deposit in
the fund, in five equal installments.
(D) Except as otherwise specifically provided, subparagraphs (A)
to (C), inclusive, shall not apply to increases in transfer amounts
described in paragraph (2) of subdivision (h) or to additional
transfer amounts described in subdivision (o).
(E) All requests for transfer payments, or adjustments thereto,
issued by the department shall be in writing and shall include (i) an
explanation of the basis for the particular transfer request or
transfer activity, (ii) a summary description of program funding
status for the particular transfer year, and (iii) the general
calculations used by the department in connection with the particular
transfer request or transfer activity.
(3) A transferor entity may use any of the following funds for
purposes of meeting its transfer obligations under this section:
(A) General funds of the transferor entity.
(B) Any other funds permitted by law to be used for these
purposes, except that a transferor entity shall not submit to the
Controller any federal funds unless those federal funds are
authorized by federal law to be used to match other federal funds. In
addition, no private donated funds from any health care provider, or
from any person or organization affiliated with the health care
provider, shall be channeled through a transferor entity or any other
public entity to the fund, unless the donated funds will qualify
under federal rules as a valid component of the nonfederal share of
the Medi-Cal program and will be matched by federal funds. The
transferor entity shall be responsible for determining that funds
transferred meet the requirements of this subparagraph.
(j) (1) If a transferor entity does not submit any transfer amount
within the time period specified in this section, the Controller
shall offset immediately the amount owed against any funds which
otherwise would be payable by the state to the transferor entity. The
Controller, however, shall not impose an offset against any
particular funds payable to the transferor entity where the offset
would violate state or federal law.
(2) Where a withhold or a recoupment occurs pursuant to the
provisions of paragraph (2) of subdivision (r) of Section 14105.98,
the nonfederal portion of the amount in question shall remain in the
fund, or shall be redeposited in the fund by the department, as
applicable. The department shall then proceed as follows:
(A) If the withhold or recoupment was imposed with respect to a
hospital whose licensee was a transferor entity for the particular
state fiscal year to which the withhold or recoupment related, the
nonfederal portion of the amount withheld or recouped shall serve as
a credit for the particular transferor entity against an equal amount
of transfer obligations under this section, to be applied whenever
the transfer obligations next arise. Should no such transfer
obligation arise within 180 days, the department shall return the
funds in question to the particular transferor entity within 30 days
thereafter.
(B) For other situations, the withheld or recouped nonfederal
portion shall be subject to paragraph (7) of subdivision (h).
(k) All transfer amounts received by the Controller or amounts
offset by the Controller shall immediately be deposited in the fund.
(l) For purposes of this section, the disproportionate share list
utilized by the department for a particular transfer year shall be
identical to the disproportionate share list utilized by the
department for the same state fiscal year for purposes of Section
14105.98. Nothing on a disproportionate share list, once issued by
the department, shall be modified for any reason other than
mathematical or typographical errors or omissions on the part of the
department or the Office of Statewide Health Planning and Development
in preparation of the list.
(m) Neither the intergovernmental transfers required by this
section, nor any elective transfer made pursuant to Section 14164,
shall create, lead to, or expand the health care funding or service
obligations for current or future years for any transferor entity,
except as required of the state by this section or as may be required
by federal law, in which case the state shall be held harmless by
the transferor entities on a pro rata basis.
(n) Except as otherwise permitted by state and federal law, no
transfer amount submitted to the Controller under this section, and
no offset by the Controller pursuant to subdivision (j), shall be
claimed or recognized as an allowable element of cost in Medi-Cal
cost reports submitted to the department.
(o) Whenever additional transfer amounts are required
to fund the nonfederal share of payment adjustment amounts under
Section 14105.98 that are distributed after the close of the
particular payment adjustment year to which the payment adjustment
amounts apply, the additional transfer amounts shall be paid by the
parties who were the transferor entities for the particular transfer
year that was concurrent with the particular payment adjustment year.
The additional transfer amounts shall be calculated under the
formula that was in effect during the particular transfer year. For
transfer years prior to the 1993-94 transfer year, the percentage of
the additional transfer amounts available for transfer to the Health
Care Deposit Fund under subdivision (d) shall be the percentage that
was in effect during the particular transfer year. These additional
transfer amounts shall be paid by transferor entities within 20 days
after the department notifies the transferor entity in writing of the
additional transfer amount to be paid.
(p) (1) Ten million dollars ($10,000,000) of the amount
transferred from the Medi-Cal Inpatient Payment Adjustment Fund to
the Health Care Deposit Fund due to amounts transferred attributable
to years prior to the 1993-94 fiscal year is hereby appropriated
without regard to fiscal years to the State Department of Health Care
Services to be used to support the development of managed care
programs under the department's plan to expand Medi-Cal managed care.
(2) These funds shall be used by the department for both of the
following purposes: (A) distributions to counties or other local
entities that contract with the department to receive those funds
