SB 1423

  • California Senate Bill
  • 2023-2024 Regular Session
  • Introduced in Senate Feb 16, 2024
  • Passed Senate May 22, 2024
  • Assembly
  • Governor

Medi-Cal: critical access hospitals.

Abstract

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Under existing law, each hospital designated by the department as a critical access hospital, and certified as such by the Secretary of the United States Department of Health and Human Services under the federal Medicare rural hospital flexibility program, is eligible for supplemental payments for Medi-Cal covered outpatient services rendered to Medi-Cal eligible persons. Existing law conditions those payments on receipt of federal financial participation and an appropriation in the annual Budget Act for the nonfederal share of those payments, with supplemental payments being apportioned among critical access hospitals based on their number of Medi-Cal outpatient visits. This bill would require that each critical access hospital that elects to participate receive a base reimbursement at 100% of the hospital's projected reasonable and allowable costs for covered Medi-Cal services, as defined, furnished in the Medi-Cal fee-for-service and managed care delivery systems for each subject calendar year, effective for dates of service on or after January 1, 2026. The bill would require the department to develop and maintain one or more reimbursement methodologies, or revise one or more existing reimbursement methodologies applicable to participating critical access hospitals, or both, to implement the cost-based payment levels. The bill would set forth a timeline and a procedure for the department to notify each critical access hospital of the ability to elect to participate in those methodologies, and for a critical access hospital to inform the department of its election to participate, its discontinuance, or its later participation. The bill would require a critical access hospital that elects to participate to make available to the department relevant financial information upon request by the department. Under the bill, these provisions would not be construed to preclude a participating critical access hospital from receiving any other Medi-Cal payment for which it is eligible, including, but not limited to, supplemental payments, with specified exceptions. The bill would require the department to determine the projected reasonable and allowable Medi-Cal costs prior to each applicable calendar year, as specified. The bill would require the department to require each applicable Medi-Cal managed care plan to reimburse a participating hospital for covered services, and would require the department to develop and pay actuarially sound capitation rates to each applicable managed care plan, as specified. The bill would require the department to promptly seek any federal approvals that it deems necessary to implement these provisions, as specified. The bill would condition implementation of these provisions on receipt of any necessary federal approvals, the availability of federal financial participation, and an appropriation. The bill would authorize the department to modify the requirements described in these provisions under certain conditions for federal purposes.

Bill Sponsors (10)

Votes


Actions


Jun 03, 2024

Assembly

Referred to Com. on HEALTH.

  • Referral-Committee
Com. on HEALTH.

May 23, 2024

Assembly

In Assembly. Read first time. Held at Desk.

May 22, 2024

Senate

Read third time. Passed. (Ayes 38. Noes 0.) Ordered to the Assembly.

May 20, 2024

Senate

Read second time. Ordered to third reading.

May 16, 2024

Senate

Read second time and amended. Ordered to second reading.

Senate

From committee: Do pass as amended. (Ayes 7. Noes 0. Page 3983.) (May 16).

May 10, 2024

Senate

Set for hearing May 16.

May 06, 2024

Senate

May 6 hearing: Placed on APPR suspense file.

Apr 30, 2024

Senate

Set for hearing May 6.

Apr 29, 2024

Senate

Read second time and amended. Re-referred to Com. on APPR.

  • Amendment-Passage
  • Reading-1
  • Reading-2
  • Referral-Committee
Com. on APPR.

Apr 25, 2024

Senate

From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 11. Noes 0. Page 3756.) (April 24).

Apr 08, 2024

Senate

From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.

  • Amendment-Passage
  • Committee-Passage
  • Reading-1
  • Reading-2
  • Referral-Committee
Com. on HEALTH.

Apr 03, 2024

Senate

Set for hearing April 24.

Feb 29, 2024

Senate

Referred to Com. on HEALTH.

  • Referral-Committee
Com. on HEALTH.

Feb 20, 2024

Senate

From printer. May be acted upon on or after March 18.

Feb 16, 2024

Senate

Introduced. Read first time. To Com. on RLS. for assignment. To print.

Bill Text

Bill Text Versions Format
SB1423 HTML
02/16/24 - Introduced PDF
04/08/24 - Amended Senate PDF
04/29/24 - Amended Senate PDF
05/16/24 - Amended Senate PDF

Related Documents

Document Format
04/22/24- Senate Health PDF
05/03/24- Senate Appropriations PDF
05/16/24- Senate Appropriations PDF
05/21/24- Sen. Floor Analyses PDF

Sources

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