LEGISLATIVE COUNSEL'S DIGEST


AB 5, as amended, Evans. Budget Act of 2009.
Health.
Existing law provides for the licensure and regulation of health
facilities by the State Department of Public Health, including an
intermediate care facility/developmentally disabled-nursing.
Violation of these provisions is a misdemeanor.
This bill would create as a new category of health facility for,
and require the department to license and regulate, intermediate care
facility/developmentally disabled-continuous nursing (ICF/DD-CN)
facilities, as defined. This bill would require facilities providing
continuous skilled nursing services to persons with developmental
disabilities pursuant to the above-described provisions to apply for
licensure as an ICF/DD-CN within 90 days after licensing regulations
become effective. This bill would make other conforming changes. By
creating a new crime, this bill would impose a state-mandated local
program.
Existing law, until January 1, 2010, authorizes the State
Department of Social Services and the State Department of
Developmental Services, to jointly establish and administer a pilot
project for licensing and regulating Adult Residential Facilities for
Persons with Special Health Care Needs (ARFPSHN), to the extent that
funds are appropriated for this purpose in the annual Budget Act.
Under existing law, a licensed ARFPSHN may provide 24-hour services
to up to 5 adults with developmental disabilities who have special
health care and intensive support needs.
This bill would extend the pilot project until January 1, 2011,
and would make other conforming changes. This bill would impose a
state-mandated local program by changing the definition of crimes
provided for under the California Community Care Facilities Act.

Existing law authorizes local sponsors, as defined, to offer
community dental disease prevention programs to schoolchildren in
preschool through 6th grade, and in classes for individuals with
exceptional needs. Existing law requires the program to include
educational programs focused on the development of personal practices
by pupils, as specified, and preventative services. Existing law
requires any acts performed or services provided pursuant to the
program that constitute the practice of dentistry to be performed or
provided by a licensed dentist.
Existing law provides that it is the intent of the Legislature
that the above-described program shall be funded according to
customary budget procedures.
This bill would, instead, require that the above-described program
be funded according to customary budget procedures and that it only
be implemented upon appropriation of funds by the Legislature.

Existing law requires the State Department of Public Health to
implement and administer a program to meet the requirements of the
federal Residential Lead-Based Paint Hazard Reduction Act of 1992.
The department is required to establish fees for the accreditation of
training providers, the certification of individuals, and the
licensing of entities engaged in lead-related occupations.
This bill would, effective July 1, 2010, require the collected
fees to be deposited in the Lead-Related Construction Fund, which
would be established by the bill. These moneys would be available to
the department upon appropriation by the Legislature for purposes of
the program, and would be available for borrowing in accordance with
prescribed provisions.
Existing law establishes the Occupational Lead Poisoning
Prevention Account, into which fees are paid by employers in
prescribed industries that have documented evidence of potential
poisoning. Moneys in this account are expended for purposes of the
Lead Poisoning Prevention Program, which is conducted by the State
Department of Public Health in accordance with prescribed
requirements.
This bill would provide that of the funds appropriated from this
account in the Budget Act of 2009, $500,000 would be used for
purposes of administration of the residential lead-based paint
program during the 2009-10 fiscal year. It would express the intent
of the Legislature that funds shall be repaid to the account upon a
determination be the Department of Finance that sufficient moneys are
available in the Lead-Related Construction Fund.
Existing law, the Calderon-Sher Safe Drinking Water Act of 1996,
requires the State Department of Public Health to adopt regulations
covering water testing, the monitoring of contaminants, the frequency
and method of sampling and testing, the reporting of results, and
other matters as may be necessary to determine and ensure the quality
of domestic water supplies. Existing law defines "public water
system" to mean a system for the provision of water for human
consumption through pipes or other constructed conveyances that has
15 or more service connections or regularly serves at least 25
individuals daily at least 60 days out of the year.
Existing law requires public water systems serving 1,000 or more
service connections and public water systems that treat water on
behalf of one or more water systems, as specified, to reimburse the
department for the actual cost incurred by the department in
conducting its required activities relating to public water systems,
as provided. Existing law further requires public water systems
serving less than 1,000 service connections to pay an annual drinking
water operating fee to the department for costs incurred by the
department in conducting its required activities relating to public
water systems, as provided. Existing law contains limitations on
maximum fee amounts that may be imposed on public water systems under
these provisions.
This bill would, instead, require these water systems to pay
specified fees per service connection, subject to prescribed minimum
amounts. This bill would authorize the department to increase the
fees, as specified, subject to approval by the Legislature.

Existing law requires the State Department of Health Care Services
to establish and administer the Genetically Handicapped Persons
Program (GHPP) for the provision of health services to genetically
handicapped persons.
This bill would provide that a person who is found eligible for
GHPP services whose employer-sponsored health coverage is later
terminated or a person who applies for GHPP services whose
employer-sponsored health coverage was terminated during the 6-month
period prior to the date he or she applies for services shall be
ineligible for GHPP services, unless certain exceptions apply. The
bill would require an applicant for GHPP services to certify, at the
time of application, under penalty of perjury, that he or she was not
covered by employer-sponsored health coverage during the 6-month
period prior to the date of his or her application or, if he or she
was covered by employer-sponsored health coverage, attest to why one
of the exceptions to ineligibility applies and provide documentation
from the employer-sponsored health coverage that supports his or her
attestation. Because the bill would require representations in the
statement by the applicant to be made under penalty of perjury, thus
changing the definition of a crime, it would impose a state-mandated
local program by expanding the crime of perjury.
This bill would also provide that persons who have been found
eligible for GHPP services whose employer-sponsored health coverage
is thereafter terminated to notify the GHPP within 45 days of the
effective date of the termination of their employer-sponsored health
coverage and, when applicable, provide the program with the same
certification required of applicants for GHPP services.
This bill would authorize the director, on a case-by-case basis,
to waive determinations of ineligibility made pursuant to the
above-described provisions, or reduce certain time periods as set
forth above, if the director determines that the determination of
ineligibility or the time periods will result in undue hardship.

This bill would authorize the department to require a client under
the GHPP to apply to enroll or otherwise participate in any other
state or federal program or other contractual or legal entitlement
that would provide services to the client that would otherwise be
reimbursed under the GHPP.
This bill would authorize the department, when it determines it to
be cost effective, to pay for 3rd-party health coverage for persons
eligible for GHPP services in certain circumstances.
Existing law requires the department to determine and establish an
enrollment fee for GHPP services that shall be a sliding scale based
upon family size and income.
The bill would, with certain exceptions, commencing July 1, 2009,
instead, base the annual enrollment fee on the client's or, if the
client is a minor, the client's parents' or legal guardians' combined
adjusted gross income as reported on the relevant state or federal
income tax forms for the previous tax year. The bill would require
the enrollment fee to be 11/2% of adjusted gross income when the
reported adjusted gross income was between 200% and 299%, inclusive,
of the federal poverty level and to be 3% of adjusted gross income
when the reported adjusted gross income was equal to or greater than
300% of the federal poverty level.
The bill would also provide that in the event the annual
enrollment fee determined pursuant to the above provisions exceeds
the cost of care incurred during the applicable year, the department
shall reduce the enrollment fee by refund or credit to an amount
equal to the cost of care. The bill would also make conforming
changes.
Existing law establishes the California Discount Prescription Drug
Program, which is administered by the State Department of Health
Care Services. Existing law requires, on August 1, 2010, the
department to determine whether pharmaceutical manufacturer
participation in the program has been sufficient to meet certain
benchmarks. It also requires the department, on and after that date,
to reassess program outcomes, at least once every year, consistent
with the benchmarks.
This bill would provide that the California Discount Prescription
Drug Program become operative on or after July 1, 2010, and would
extend the above-described deadlines to August 1, 2013.
Existing law creates the California Major Risk Medical Insurance
Program (MRMIP), which is administered by the Managed Risk Medical
Insurance Board, to arrange for major risk medical coverage for
eligible residents of the state who are unable to secure adequate
private health care coverage. Existing law creates the continuously
appropriated Major Risk Medical Insurance Fund within the MRMIP where
revenue, including $18,000,000 from the Hospital Services Account in
the Cigarette and Tobacco Products Surtax Fund is deposited annually
for the operation of the program.
This bill would, instead, for the 2009-10 fiscal year, prohibit
the Controller from depositing any amount into the Major Risk Medical
Insurance Fund from the Hospital Services Account in the Cigarette
and Tobacco Products Surtax Fund.
Existing law establishes the State Department of Developmental
Services and sets forth its duties and responsibilities, including,
but not limited to, administration and oversight of the state
developmental centers and programs relating to persons with
developmental disabilities. Existing law, the Lanterman Developmental
Disabilities Services Act, requires the department to allocate funds
to private nonprofit regional centers for the provision of community
services and support for persons with developmental disabilities and
their families.
Existing law provides that the State Department of Mental Health
shall house no more than 1,336 patients at Patton State Hospital.
However, until September 2009, up to 1,530 patients may be housed at
the hospital.
This bill would extend the date that 1,530 patients may be housed
at the hospital to September 2012.
Existing law prohibits the total number of developmental center
residents in the secure treatment facility at Porterville
Developmental Center from exceeding 297.
This bill would include residents receiving services in the center'
s transition treatment program for purposes of this limit.

Existing law establishes the federal Medicaid program,
administered by each state, California's version of which is the
Medi-Cal program. The Medi-Cal program, administered by the State
Department of Health Care Services, provides basic health care
services to qualified low-income persons.
Existing federal and state law contain requirements relating to
the establishment of United States citizenship or national status for
purposes of establishing Medi-Cal eligibility. Existing Medi-Cal
provisions implementing these requirements specify that, except as
prescribed, no Medi-Cal services shall be available to any person who
fails to comply with these documentation requirements.
This bill would, to the extent that federal financial
participation is available and all agreements with the federal
government have been obtained, permit the department to exercise a
prescribed federal option relating to health care benefits for
children.
This bill would require the department, pursuant to, and only to
the extent required by, federal law and subject to the provisions
described below, to implement an asset verification program for the
purpose of determining or redetermining the eligibility of an
applicant for, or recipient of, Medi-Cal benefits on the basis of
being aged, blind, or disabled.
This bill would require any applicant or recipient described
above, and any other person whose resources are required by law to be
disclosed to determine the eligibility of the applicant or
recipient, to provide authorization for the department to obtain from
any financial institution, as defined, any financial record, as
defined, held by the institution with respect to the applicant or
recipient, and any other person, as applicable, whenever the
department determines the record is needed in connection with a
determination with respect to eligibility for, or the amount or
extent of, medical assistance. The bill would provide that the
obtaining of financial records by the department, or it's designee,
shall be at no cost to the applicant, recipient, or any other person
whose resources are required to be disclosed. The bill would
authorize the department to determine that an applicant or recipient
is ineligible for medical assistance if the applicant or recipient,
or any other person, as applicable, refuses to provide, or revokes,
any authorization made pursuant to the above-described provisions.
The bill would require the department to provide the applicant or
recipient with notice of the asset verification requirement prior to
the applicant or recipient being required to provide authorization.

This bill would require an officer of a financial institution, as
defined, to furnish the department or its designee with information
in the possession of the bank or company regarding the assets of any
person who is applying for, or is receiving assistance or benefits
from, the department and has provided authorization pursuant to the
above-described provisions.
Existing law allows the California Medical Assistance Commission
to negotiate exclusive contracts with any county that seeks to
provide, or arrange for the provision of, Medi-Cal health care
services. The system of services provided by or through a county
pursuant to these provisions is known as a county-organized health
system. Existing law permits a combination of counties to contract
with the department pursuant to these provisions for the provision of
services on a regional basis.
This bill would delete the regional basis limitation.
Existing law requires the reimbursement to Medi-Cal pharmacy
providers for legend and nonlegend drugs, as defined, to consist of
the estimated acquisition cost of the drug, as defined, plus a
professional fee for dispensing.
Existing law requires the department to establish a list of
maximum allowable ingredient costs (MAIC) for generically equivalent
drugs for purposes of establishing the acquisition cost for legend
and nonlegend drugs, as provided. Existing law requires the
department to update the list of, and establish new, MAICs, and to
base the MAIC on the mean of the average manufacturer's price of
drugs generically equivalent to the particular innovator drug, plus a
percent markup determined by the department to be necessary for the
MAIC to represent the average purchase price paid by retail
pharmacies in California.
This bill would require the department to establish an MAIC only
when 3 or more generically equivalent drugs are available for
purchase and dispensing by retail pharmacies in California.

This bill would provide that if average manufacturer's prices are
unavailable, the department shall establish the MAIC, either (1)
based on the volume weighted average, as defined, of the wholesaler
acquisition costs, as defined, of drugs generically equivalent to the
particular innovator drug plus a percent markup determined by the
department to be necessary for the MAIC to represent the average
purchase price paid by retail pharmacies in California or (2)
pursuant to a contract with a vendor for the purpose of surveying
drug price information, collecting data, and calculating a proposed
MAIC.
This bill would require the department to establish a process for
providers to seek a change to a specific MAIC when the providers
believe the MAIC does not reflect current available market prices.

Under existing law, the State Department of Mental Health is
required to implement managed mental health care for Medi-Cal
recipients through fee-for-service or capitated contracts with
counties, counties acting jointly, qualified individuals or
organizations, or nongovernmental entities. The State Department of
Mental Health is responsible for assuming specified program oversight
authority formerly provided by the State Department of Health Care
Services, including, but not limited to, oversight of certain
utilization controls.
This bill would, if federal approval is obtained, authorize public
agencies that meet certain conditions to, in addition to
reimbursement or other payments that the agency would otherwise
receive for Medi-Cal specialty mental health services, receive
supplemental Medi-Cal reimbursement equal to the amount of federal
financial participation received as a result of claims submitted by
the State Department of Health Care Services for certain expenditures
related to specialty mental health services that are allowable
expenditures under federal law.
Existing law authorizes the State Department of Social Services to
enter into contracts with manufacturers of single source and
multiple source drugs on a bid or nonbid basis and to maintain a list
of contract drugs for purposes of the Medi-Cal program. Existing law
prescribes conditions under which certain drugs for use in the
treatment of acquired immunodeficiency syndrome (AIDS) or an
AIDS-related condition or cancer are deemed approved for addition to
the Medi-Cal list of contract drugs or considered a Medi-Cal benefit.

Existing law requires, commencing July 1, 2002, all pharmaceutical
manufacturers to provide to the department a state rebate, in
addition to rebates pursuant to other provisions of state or federal
laws, for any drug products that have been added to the Medi-Cal list
of contract drugs pursuant to the above-described provisions related
to drugs used to treat AIDS and cancer and reimbursed through the
Medi-Cal outpatient fee-for-service drug program. Existing law
requires the state rebate to be negotiated as necessary between the
department and pharmaceutical manufacturers.
This bill would, commencing July 1, 2009, and until January 1,
2010, require pharmaceutical manufacturers to provide to the
department a state rebate, in addition to rebates pursuant to other
provisions of state or federal law, for certain drug products used to
treat AIDS and cancer that have been added to the Medi-Cal list of
contract drugs, as specified.
Existing federal law requires the United States Secretary of
Health and Human Services to enter into an agreement with each
manufacturer of covered drugs that are not subject to a rebate under
an agreement between the state Medicaid program and the manufacturer
under which the amount required to be paid to the manufacturer for
covered drugs, with certain exceptions, purchased by a covered
entity, as defined, does not exceed an amount equal to the average
manufacturer price for the drug under the federal Medicaid program in
the preceding calendar quarter, reduced by the rebate received
pursuant to the Medicaid agreement.
This bill would provide that a covered entity shall dispense only
the above-described drugs to Medi-Cal beneficiaries. This bill
provides that if a covered entity is unable to purchase the
above-described drugs, the covered entity may dispense a drug
purchased at regular drug wholesale rates to a Medi-Cal beneficiary,
but that it is required to maintain documentation of their inability
to obtain the drugs.
Existing law requires the reimbursement to Medi-Cal pharmacy
providers for legend and nonlegend drugs, as defined, to consist of
the estimated acquisition cost of the drug, as defined, plus a
professional fee for dispensing.
This bill would require pharmacy providers to submit their usual
and customary charge, as defined, when billing the Medi-Cal program
for prescribed drugs. The bill would require that payment to pharmacy
providers be the lower of the pharmacy's usual and customary charge
or the above-described reimbursement rate for legend and nonlegend
drugs.
Existing law, as long as prescribed conditions are met, provides
for the imposition of a uniform quality assurance fee on skilled
nursing facilities, subject to prescribed exemptions, to be
administered by the Director of Health Care Services and deposited in
the State Treasury to be available to enhance federal financial
participation in the Medi-Cal program or to provide additional
reimbursement to, and support facility quality improvement efforts
in, licensed skilled nursing facilities. Existing law provides that
the quality assurance fee shall be based upon the entire net revenue
of all skilled nursing facilities subject to the fee, except an
exempt facility, as defined. Existing law defines "net revenue" to
mean gross resident revenue for routine nursing services and
ancillary services provided to all residents by a skilled nursing
facility, less Medicare revenue for routine and ancillary services,
including Medicare revenue for services provided to residents covered
under a Medicare managed care plan, less payer discounts and
applicable contractual allowances as permitted under federal law and
regulation.
This bill would, for the 2009-10 and 2010-11 rate years, and
subject to federal approval, also include within the definition of
"net revenue" Medicare revenue for routine and ancillary services and
Medicare revenue for services provided to residents covered under a
Medicare managed care plan.
Existing law, the Medi-Cal
Long-Term Reimbursement Act, requires the department to implement a
cost-based reimbursement rate methodology for freestanding skilled
nursing facilities, excluding skilled nursing facilities that are a
distinct part of a facility that is licensed as a general acute care
hospital. Reimbursement rates for these facilities are funded by a
combination of federal funds and moneys collected pursuant to the
above-described uniform quality assurance fees. Existing law provides
that this rate methodology shall cease to be implemented on July 31,
2011, with these provisions to be repealed on January 1, 2012.
Existing law provides, for the 2009-10 and 2010-11 rate years, that
the maximum annual increase in the weighted average Medi-Cal
reimbursement rate required for purposes of the above-described
provisions shall not exceed 5% of the weighted average Medi-Cal
reimbursement rate for the prior fiscal year.
This bill would, instead, provide that for the 2009-10 and 2010-11
rate years, the weighted average Medi-Cal reimbursement rate
required for purposes of the above-described provisions shall not be
increased with respect to the weighted average Medi-Cal reimbursement
rate for the 2008-09 rate year.
Existing law requires the director to reduce provider payments for
certain classes of health facilities for dates of service on and
after March 1, 2009, by 5% for Medi-Cal fee-for-service benefits.

This bill would prohibit Medi-Cal reimbursement rates applicable
to specified classes of providers for services rendered during the
2009-10 rate year and each rate year thereafter from exceeding the
reimbursement rates that were applicable to those classes of
facilities in the 2008-09 rate year, with certain exceptions.

Existing law requires the department to establish a pilot program
to provide continuous skilled nursing care as a benefit under the
Medi-Cal program when those services are provided pursuant to a
federal waiver. This provision is repealed as of January 1, 2010.

This bill would instead, repeal the pilot program if and when the
federal Centers for Medicare and Medicaid Services approve a federal
waiver or approve a Medicaid State Plan amendment ot make the pilot
program a permanent program. The bill would set forth provisions for
the permanent program that are similar to the provisions of the pilot
program and would make these permanent program provisions operative
upon the date federal approval is obtained. The bill would make other
conforming changes.
Existing law provides for the State Supplementary Program for the
Aged, Blind, and Disabled (SSP), which requires the State Department
of Social Services to contract with the United States Secretary of
Health and Human Services to make payments to SSP recipients to
supplement supplemental security income (SSI) payments made available
pursuant to the federal Social Security Act.
Under existing law, benefit payments under the SSP program are
calculated by establishing the maximum level of nonexempt income and
federal (SSI) and state (SSP) benefits for each category of eligible
recipient. The state SSP payment is the amount, when added to the
nonexempt income and SSI benefits available to the recipient, which
would be required to provide the maximum benefit payment.
Existing law authorizes the State Department of Health Care
Services, to the extent that federal financial participation is
available, to exercise options under federal law to implement a
program to provide Medi-Cal benefits for designated aged, blind, and
disabled persons who meet specified income standards.
This bill would require the State Department of Health Care
Services, to the extent that federal financial participation is
available, to exercise an option under federal law to extend
full-scope Medi-Cal benefits to individuals who are ineligible to
receive those benefits under certain aid programs, including SSI/SSP,
as a result of a specified July 1, 2009, reduction in SSI/SSP
maximum aid payments. This bill would identify the applicable income
and resource standards and methodologies to be utilized for its
purposes, and would require an income disregard to be applied, as
specified, to adjust the applicable income standard to that which was
in place on May 1, 2009.
This bill would authorize the department to implement these
revised Medi-Cal eligibility provisions through all-county letters or
similar instructions, and would cease implementation of these
provisions when SSI/SSP program payment levels increase beyond those
in effect on May 1, 2009. The bill would require the department to
seek any approvals from the federal Centers for Medicare and Medicaid
Services necessary to implement these provisions.
Existing law provides for the county-administered In-Home
Supportive Services (IHSS) program, under which qualified aged,
blind, and disabled persons are provided with services in order to
permit them to remain in their own homes and avoid
institutionalization. Existing law permits services to be provided
under the IHSS program either through the employment of individual
providers, a contract between the county and an entity for the
provision of services, the creation by the county of a public
authority, or a contract between the county and a nonprofit
consortium. Under existing law, personal care services provided to an
individual who is eligible for Medi-Cal benefits as a categorically
needy person are a Medi-Cal covered benefit. Personal care services
are also a covered benefit under the IHSS program.
Existing law provides for the payment of a supplementary benefit
under the IHSS program to any eligible aged, blind, or disabled
person who is receiving Medi-Cal personal care services and who would
otherwise be deemed a categorically needy recipient under the IHSS
program. Existing law extends application of this provision to any
aged, blind, or disabled person who is receiving Medi-Cal benefits
and eligible for services under a federal waiver program known as the
IHSS Plus waiver, and who would otherwise be deemed a categorically
needy recipient under the IHSS program.
This bill would require the State Department of Health Care
Services to seek approval of the IHSS Plus option, an amendment to
the Medicaid state plan to provide self-directed personal assistance
services under the state plan, to the extent that federal financial
participation is available, in order to provide IHSS services as a
Medi-Cal benefit. The bill would require these services to be
rendered under the administrative direction of the State Department
of Social Services, as specified.
This bill would exclude residents of designated health and care
facilities from receiving the services provided pursuant to the bill.
It would authorize the State Department of Heath Care Services to
implement the IHSS Plus option provisions through all-county letters
or similar instructions, and to adopt emergency regulations.

This bill would require the Director of Health Care Services to
notify the Legislature of any modifications to IHSS benefits,
eligibility, and operational requirements necessary for the state
plan amendment to become effective.
Existing law, the Medi-Cal Hospital/Uninsured Care Demonstration
Project Act authorizes the director to, pursuant to a federal waiver,
use modified funding methodologies to maximize the use of federal
funds to resolve Medi-Cal reimbursement inequities experienced by
public and private disproportionate share hospitals. The
demonstration project provides for specified stabilization funding to
be provided for prescribed purposes.
This bill would, notwithstanding those provisions, require that
for each of the 2008-09 and 2009-10 fiscal years, the amount
available for these purposes shall be reduced by prescribed amounts
which sum shall be retained in, or transferred to, the General Fund.
This bill would authorize the department to increase federal claiming
from the safety net care pool for state-funded programs if necessary
to achieve prescribed savings.
It would also, for the 2009-10 fiscal years, make a prescribed
reduction from allocations to distressed hospitals, as defined, and
would transfer the amount of this transfer to the General Fund.

The bill would require a 10% reduction in disproportionate share
hospital replacement payments to private hospitals for the 2009-10
fiscal year and would require the department to seek any necessary
federal approvals to implement this requirement.
Under existing law, the State Department of Mental Health is
required to implement managed mental health care for Medi-Cal
recipients through fee-for-service or capitated contracts with
counties, counties acting jointly, qualified individuals or
organizations, or nongovernmental entities. The State Department of
Mental Health is responsible for assuming specified program oversight
authority, including, but not limited to, oversight of certain
utilization controls.
This bill would, if federal approval is obtained, authorize public
agencies that meet certain conditions to, in addition to
reimbursement or other payments that the agency would otherwise
receive for Medi-Cal specialty mental health services, receive
supplemental Medi-Cal reimbursement equal to the amount of federal
financial participation received as a result of claims submitted by
the State Department of Health Care Services for certain expenditures
related to specialty mental health services that are allowable
expenditures under federal law.
Under existing law, one of the benefits provided for under the
Medi-Cal program is adult day health care services. Existing law
contains eligibility criteria for these services, and requires that
adult day health care center provide core services, as defined.

This bill would provide that, commencing 30 days after the
effective date of the bill, adult day health care is covered for a
maximum of three days per week, until the date that the Director of
Health Care Services executes a declaration specifying that
provisions described below relating to adult day health care
services, are operative, at which time these services are covered for
a maximum of 5 days per week.
Under existing law, treatment authorization requests may be
granted for adult day health care services for up to 6 months.

Under existing law, one of the eligibility criteria applicable to
adult day health care services is that the Medi-Cal beneficiary
requires assistance and supervision in performing prescribed
activities.
This bill, subject to federal approval, would permit treatment
authorization requests for a period of up to 12 months, would modify
eligibility criteria to require, with certain exceptions, that the
beneficiary need substantial human assistance in performing the
prescribed activities, and would modify certain elements of the core
services, with all of these provisions to be operative upon the
execution of a declaration by the director that all necessary methods
and procedures necessary to implement the treatment authorization
request provisions have been met.
This bill would require the State Department of Mental Health, by
no later than March 1, 2011, to provide the legislative budget and
policy committees with an analysis of selected county and
subcontractor costs for the 2009-10 fiscal year that are not wholly
reimbursed by the schedule of maximum allowances rates, as specified.

This bill would require the California Health and Human Services
Agency to develop an action plan regarding coordination of core
programmatic functions between the State Department of Mental Health
and the State Department of Health Care Services.
Under existing law, for certain hospitals that receive Medi-Cal
reimbursement from the State Department of Health Care Services and
that are not under contract with the department pursuant to specified
existing law, interim payments and cost report settlements for
inpatient hospital services provided on and after July 1, 2008, are
reduced by 10%, as specified. Existing law revises the amount of
these payments, beginning on October 1, 2008, pursuant to a specified
formula. Existing law exempts certain small and rural hospitals and
certain open health facility planning areas from this revised
formula. Existing law, for purposes of interim payments, specifically
provides that open health facility planning areas with 3 or more
hospitals with licensed general acute care beds are not exempt from
this revised formula. Existing law, for purposes of the cost report
settlements, specifically provides that open health facility planning
areas with more than 3 hospitals with licensed general acute care
beds are not exempt from this revised formula.
This bill would revise both of the above provisions to prohibit a
state-owned or state-operated hospital from being included in
determining the number of hospitals in an open health facility
planning area.
This bill would revise the cost report settlement provision by
requiring that an open health facility planning area have 3 or more
specified hospitals, instead of more than 3 specified hospitals.

This bill would revise the exemption for small and rural
hospitals, as specified.
The bill would require the state Department of Health Care
Services to provide the Legislature with a quarterly update regarding
the implementation of the federal American Recovery and Reinvestment
Act of 2009, as specified. It would also require the department to
provide, in a timely manner, the applicable fiscal and policy
committees of the Legislature with copies of all federal audits and
their findings that pertain to the Medi-Cal program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
The California Constitution authorizes the Governor to declare a
fiscal emergency and to call the Legislature into special session for
that purpose. The Governor issued a proclamation declaring a fiscal
emergency, and calling a special session for this purpose, on July 1,
2009.
This bill would state that it addresses the fiscal emergency
declared by the Governor by proclamation issued on July 1, 2009,
pursuant to the California Constitution.
This bill would declare that it is to take effect immediately as
an urgency statute.
This bill would express the intent of the Legislature to enact
statutory changes relating to the Budget Act of 2009.

The California Constitution authorizes the Governor to declare a
fiscal emergency and to call the Legislature into special session for
that purpose. The Governor issued a proclamation declaring a fiscal
emergency, and calling a special session for this purpose, on July 1,
2009.
This bill would state that it addresses the fiscal emergency
declared by the Governor by proclamation issued on July 1, 2009,
pursuant to the California Constitution.