AB 5

Bill Subjects

Abstract

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 1½% 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.