SB 243 is sponsored by Achadjian, Block, Bonta, Burke, Campos, Bonilla, Gray, Lopez, Cannella, Chiu, Chu, Cooley, Dababneh, Cooper, Frazier, Dodd, Galgiani, Gatto, Gordon, Hall, Hernandez, Hertzberg, Hill, Jackson, Jones-Sawyer, Levine, Low, Maienschein, McCarty, Nazarian, O'Donnell, Pavley, Pan, Quirk, Rendon, Ridley-Thomas, Rodriguez, Roth, Santiago, Steinorth, Thurmond, Ting, Waldron, Wieckowski, Wolk, Wood, Gonzalez, Lena A. (Democratic), Mark Stone, and Roger Hernández.

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California 2015-2016 Regular Session Status: In Committee 1 D cosponsors

SB 243 — Medi-Cal: reimbursement: provider rates.

Last action February 01, 2016 — Returned to Secretary of Senate pursuant to Joint Rule 56.

✓
Introduced
2
In Committee
3
Passed Senate
4
Passed Assembly
5
To Executive
6
Enacted

This bill died with 2015-2016 Regular Session. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.

Summary

(1) Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which health care services are provided to qualified, low-income persons. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. Existing law requires the department to develop and implement a Medi-Cal inpatient hospital reimbursement payment methodology based on diagnosis-related groups, subject to federal approval, that reflects the costs and staffing levels associated with quality of care for patients in all general acute care hospitals, as specified. Existing law generally requires the diagnosis-related group-based payments to apply to all claims. This bill would require claims for payments pursuant to the inpatient hospital reimbursement methodology described above to be increased by 16% for the 2015â€“16 fiscal year, and would require, commencing July 1, 2016, and annually thereafter, the department to increase each diagnosis-related group payment claim amount based, at a minimum, on increases in the medical component of the California Consumer Price Index. Commencing with the 2015â€“16 fiscal year, and annually thereafter, the bill would require managed care rates for Medi-Cal managed care health plans to be increased by a proportionately equal amount for increased payments for hospital services. (2) Existing law requires, except as otherwise provided, Medi-Cal provider payments to be reduced by 1% or 5%, and provider payments for specified non-Medi-Cal programs to be reduced by 1%, for dates of service on and after March 1, 2009, and until June 1, 2011. Existing law requires, except as otherwise provided, Medi-Cal provider payments and payments for specified non-Medi-Cal programs to be reduced by 10% for dates of service on and after June 1, 2011. This bill would, instead, prohibit the application of those reductions for payments to providers for dates of service on or after June 1, 2011. The bill would also require payments for managed care health plans for dates of service following the effective date of the bill to be determined without application of some of those reductions. The bill would require the Director of Health Care Services to implement this provision to the maximum extent permitted by federal law and for the maximum time period for which the director obtains federal approval for federal financial participation for those payments. (3) Prior law required, beginning January 1, 2013, through and including December 31, 2014, that payments for primary care services provided by specified physicians be no less than 100% of the payment rate that applies to those services and physicians as established by the Medicare program, for both fee-for-service and managed care plans. This bill, commencing January 1, 2016, would require payments for specified medical care services to not be less than 100% of the payment rate that applies to those services as established by the Medicare program for services rendered by fee-for-service providers, and would require rates paid to Medi-Cal managed care plans to be actuarially equivalent to payment rates established by the Medicare program. The bill, commencing January 1, 2016, would require rates paid to Denti-Cal providers for dental services provided to adults and children to be increased by the equivalent percentage as the percentage increase required for other fee-for-service Medi-Cal providers. The bill would require those provisions to be implemented only to the extent permitted by federal law and that federal financial participation is available. The bill would authorize the department to implement those provisions through provider bulletins without taking regulatory action until regulations are adopted, and would require the department to adopt those regulations by July 1, 2018. The bill would require, commencing July 1, 2016, the department to provide a status report to the Legislature on a semiannual basis until regulations have been adopted. (4) This bill would declare that it is to take effect immediately as an urgency statute.

Bill Text

Amended 05/12/15 - Amended Senate Current pdf May 12, 2015
Amended 04/13/15 - Amended Senate pdf April 13, 2015
Introduced 02/17/15 - Introduced pdf February 17, 2015
SB243 View text html

Action History

February 01, 2016
Returned to Secretary of Senate pursuant to Joint Rule 56.
May 28, 2015
May 28 hearing: Held in committee and under submission.
May 23, 2015
Set for hearing May 28.
May 18, 2015
May 18 hearing: Placed on APPR. suspense file.
May 12, 2015
From committee with author's amendments. Read second time and amended. Re-referred to Com. on APPR.
May 08, 2015
Set for hearing May 18.
May 04, 2015
May 11 hearing postponed by committee.
May 01, 2015
Set for hearing May 11.
April 23, 2015
From committee: Do pass and re-refer to Com. on APPR. (Ayes 8. Noes 0. Page 757.) (April 22). Re-referred to Com. on APPR.
April 13, 2015
From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.
March 18, 2015
Set for hearing April 22.
February 26, 2015
Referred to Com. on HEALTH.
February 18, 2015
From printer. May be acted upon on or after March 20.
February 17, 2015
Introduced. Read first time. To Com. on RLS. for assignment. To print.

Sponsorship breakdown

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1 sponsors · 49 co-sponsors · 72 not signed on

Sponsors (1)

Hernandez

Not signed on (72)

72 members have not signed on to this bill.

Show all 72 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Votes

Placed on suspense file

May 18, 2015

Passed 7 Yea · 0 Nay

Party	Yea	Nay	Present	Not Voting
Unaffiliated	7	0	0	0
Total	7	0	0	0
% of votes cast	100%	0%	0%	0%

How each member voted (7)

Member	Party	Vote
Bates	—	Yea
Beall	—	Yea
Hill	—	Yea
Lara	—	Yea
Mendoza	—	Yea
Nielsen	—	Yea
Leyva	—	Yea

Official roll call →

Do pass, but first be re-referred to the Committee on [Appropriations]

April 22, 2015

Passed 8 Yea · 0 Nay · 1 Other

Party	Yea	Nay	Present	Not Voting
Unaffiliated	7	0	0	1
Democratic	1	0	0	0
Total	8	0	0	1
% of votes cast	89%	0%	0%	11%

How each member voted (9)

Member	Party	Vote
Hernandez	—	Yea
Monning	—	Yea
Wolk	—	Yea
Mitchell	—	Yea
Nielsen	—	Yea
Pan	—	Yea
Roth	—	Yea
Hall	—	Not Voting
Nguyen, Stephanie	Democratic	Yea

Official roll call →

Subjects

healthcare health-insurance

Cross-referencing the record. Reading this bill against every other bill in the corpus by meaning, not keywords. Only the first open is slow. It’s instant for you after this. Matching · Ranking · Engrossing

Frequently asked questions

What does SB 243 do?: (1) Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which health care services are provided to qualified, low-income persons. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. Existing law requires the department to develop and implement a Medi-Cal inpatient hospital reimbursement payment methodology based on diagnosis-related groups, subject to federal approval, that reflects the costs and staffing levels associated with quality of care for patients in all general acute care hospitals, as specified. Existing law generally requires the diagnosis-related group-based payments to apply to all claims. This bill would require claims for payments pursuant to the inpatient hospital reimbursement methodology described above to be increased by 16% for the 2015â€“16 fiscal year, and would require, commencing July 1, 2016, and annually thereafter, the department to increase each diagnosis-related group payment claim amount based, at a minimum, on increases in the medical component of the California Consumer Price Index. Commencing with the 2015â€“16 fiscal year, and annually thereafter, the bill would require managed care rates for Medi-Cal managed care health plans to be increased by a proportionately equal amount for increased payments for hospital services. (2) Existing law requires, except as otherwise provided, Medi-Cal provider payments to be reduced by 1% or 5%, and provider payments for specified non-Medi-Cal programs to be reduced by 1%, for dates of service on and after March 1, 2009, and until June 1, 2011. Existing law requires, except as otherwise provided, Medi-Cal provider payments and payments for specified non-Medi-Cal programs to be reduced by 10% for dates of service on and after June 1, 2011. This bill would, instead, prohibit the application of those reductions for payments to providers for dates of service on or after June 1, 2011. The bill would also require payments for managed care health plans for dates of service following the effective date of the bill to be determined without application of some of those reductions. The bill would require the Director of Health Care Services to implement this provision to the maximum extent permitted by federal law and for the maximum time period for which the director obtains federal approval for federal financial participation for those payments. (3) Prior law required, beginning January 1, 2013, through and including December 31, 2014, that payments for primary care services provided by specified physicians be no less than 100% of the payment rate that applies to those services and physicians as established by the Medicare program, for both fee-for-service and managed care plans. This bill, commencing January 1, 2016, would require payments for specified medical care services to not be less than 100% of the payment rate that applies to those services as established by the Medicare program for services rendered by fee-for-service providers, and would require rates paid to Medi-Cal managed care plans to be actuarially equivalent to payment rates established by the Medicare program. The bill, commencing January 1, 2016, would require rates paid to Denti-Cal providers for dental services provided to adults and children to be increased by the equivalent percentage as the percentage increase required for other fee-for-service Medi-Cal providers. The bill would require those provisions to be implemented only to the extent permitted by federal law and that federal financial participation is available. The bill would authorize the department to implement those provisions through provider bulletins without taking regulatory action until regulations are adopted, and would require the department to adopt those regulations by July 1, 2018. The bill would require, commencing July 1, 2016, the department to provide a status report to the Legislature on a semiannual basis until regulations have been adopted. (4) This bill would declare that it is to take effect immediately as an urgency statute.
Who sponsors SB 243?: SB 243 is sponsored by Achadjian, Block, Bonta, Burke, Campos, Bonilla, Gray, Lopez, Cannella, Chiu, Chu, Cooley, Dababneh, Cooper, Frazier, Dodd, Galgiani, Gatto, Gordon, Hall, Hernandez, Hertzberg, Hill, Jackson, Jones-Sawyer, Levine, Low, Maienschein, McCarty, Nazarian, O'Donnell, Pavley, Pan, Quirk, Rendon, Ridley-Thomas, Rodriguez, Roth, Santiago, Steinorth, Thurmond, Ting, Waldron, Wieckowski, Wolk, Wood, Gonzalez, Lena A. (Democratic), Mark Stone, and Roger Hernández.
What is the current status of SB 243?: This bill died with 2015-2016 Regular Session. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track SB 243?: Track SB 243 free on One Click Politics — get push/email alerts when it moves.

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At a glance

Identifier: SB 243
Jurisdiction: California
Session: 2015-2016 Regular Session
Type: Bill
Introduced: February 17, 2015
Status: In Committee
Prime sponsor: Hernandez

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