2009 California Welfare and Institutions Code - Section 14167.31-14167.40 :: Article 5.22. Quality Assurance Fee Act

14167.31.  (a) "Aggregate quality assurance fee" means the sum of
all of the following:
   (1) The annual fee-for-service days for an individual hospital
multiplied by the fee-for-service per diem quality assurance fee
rate.
   (2) The annual managed care days for an individual hospital
multiplied by the managed care per diem quality assurance fee rate.
   (3) The annual Medi-Cal days for an individual hospital multiplied
by the Medi-Cal per diem quality assurance fee rate.
   (b) "Annual fee-for-service days" means the number of
fee-for-service days of each hospital subject to the quality
assurance fee in the 2007 calendar year, as reported on the days data
source.
   (c) "Annual managed care days" means the number of managed care
days of each hospital subject to the quality assurance fee in the
2007 calendar year, as reported on the days data source.
   (d) "Annual Medi-Cal days" means the number of Medi-Cal days of
each hospital subject to the quality assurance fee in the 2007
calendar year, as reported on the days data source.
   (e) "Days data source" means the following:
   (1) For a hospital that did not submit an Annual Financial
Disclosure Report to the Office of Statewide Health Planning and
Development for a fiscal year ending during 2007, but submitted that
report for a fiscal period ending in 2008 that includes at least 10
months of 2007, the Annual Financial Disclosure Report submitted by
the hospital to the Office of Statewide Health Planning and
Development for the fiscal period in 2008 that includes at least 10
months of 2007.
   (2) For a hospital owned by Kaiser Foundation Hospitals that
submitted corrections to reported patient days to the Office of
Statewide Health Planning and Development for its fiscal year ending
in 2007 before July 31, 2009, the corrected data.
   (3) For all other hospitals, the hospital's Annual Financial
Disclosure Report in the Office of Statewide Health Planning and
Development files as of October 31, 2008, for its fiscal year ending
during 2007.
   (f) "Designated public hospital" shall have the meaning given in
subdivision (d) of Section 14166.1 as that section may be amended
from time to time.
   (g) "Exempt facility" means any of the following:
   (1) A public hospital as defined in paragraph (25) of subdivision
(a) of Section 14105.98.
   (2) With the exception of a hospital that is in the Charitable
Research Hospital peer group, as set forth in the 1991 Hospital Peer
Grouping Report published by the department, a hospital that is a
hospital designated as a specialty hospital in the hospital's Office
of Statewide Health Planning and Development Hospital Annual
Disclosure Report for the hospital's fiscal year ending in the 2007
calendar year.
   (3) A hospital that satisfies the Medicare criteria to be a
long-term care hospital.
   (4) A small and rural hospital as specified in Section 124840 of
the Health and Safety Code designated as that in the hospital's
Office of Statewide Health Planning and Development Hospital Annual
Disclosure Report for the hospital's fiscal year ending in the 2007
calendar year.
   (h) (1) "Federal approval" means the last approval by the federal
government required for the implementation of this article and
Article 5.21 (commencing with Section 14167.1).
   (2) If federal approval is sought initially for only the 2008-09
federal fiscal year and separately secured for subsequent federal
fiscal years, the implementation date, as defined in subdivision (i)
of Section 14167.1, for the 2008-09 federal fiscal year shall occur
when all necessary federal approvals have been secured for that
federal fiscal year.
   (i) "Fee-for-service per diem quality assurance fee rate" means a
fixed fee on fee-for-service days of two hundred thirty-three dollars
and sixty-six cents ($233.66) per day.
   (j) "Fee-for-service days" means inpatient hospital days where the
service type is reported as "acute care," "psychiatric care," and
"chemical dependency care and rehabilitation care," and the payer
category is reported as "Medicare traditional," "county indigent
programs-traditional," "other third parties-traditional," "other
indigent," and "other payers," for purposes of the Annual Financial
Disclosure Report submitted by hospitals to the Office of Statewide
Health Planning and Development.
   (k) "Fee percentage" means, for a subject federal fiscal year, a
fraction, expressed as a percentage, the numerator of which is the
amount of payments under Sections 14167.2, 14167.3, and 14167.4,
subdivision (b) of Section 14167.5, and Section 14167.6 for which
federal financial participation is available and the denominator of
which is three billion seven hundred eleven million seven hundred
eight thousand seven hundred forty dollars ($3,711,708,740).
   (l) "General acute care hospital" shall mean any hospital licensed
pursuant to subdivision (a) of Section 1250 of the Health and Safety
Code.
   (m) "Hospital community" means any hospital industry organization
or system that represents children's hospitals, nondesignated public
hospitals, designated public hospitals, private safety-net hospitals,
and other public or private hospitals.
   (n) "Managed care days" means inpatient hospital days in the 2007
calendar year as reported on the days data source where the service
type is reported as "acute care," "psychiatric care," and "chemical
dependency care and rehabilitation care," and the payer category is
reported as "Medicare managed care," "county indigent
programs-managed care," and "other third parties-managed care," for
purposes of the Annual Financial Disclosure Report submitted by
hospitals to the Office of Statewide Health Planning and Development.
   (o) "Managed care per diem quality assurance fee rate" means a
fixed fee on managed care days of twenty-seven dollars and
twenty-five cents ($27.25) per day.
   (p) "Medi-Cal days" means inpatient hospital days in the 2007
calendar year as reported on the days data source where the service
type is reported as "acute care," "psychiatric care," and "chemical
dependency care and rehabilitation care," and the payer category is
reported as "Medi-Cal-traditional" and "Medi-Cal-managed care," for
purposes of the Annual Financial Disclosure Report submitted by
hospitals to the Office of Statewide Health Planning and Development.
   (q) "Medi-Cal per diem quality assurance fee rate" means a fixed
fee on Medi-Cal days of two hundred ninety-three dollars ($293) per
day.
   (r) "Nondesignated public hospital" means a public hospital that
is licensed under subdivision (a) of Section 1250 of the Health and
Safety Code and is defined in paragraph (25) of subdivision (a) of
Section 14105.98, excluding designated public hospitals.
   (s) "Prior fiscal year data" means any data taken from sources
that the department determines are the most accurate and reliable at
the time the determination is made, or may be calculated from the
most recent audited data using appropriate update factors. The data
may be from prior fiscal years, current fiscal years, or projections
of future fiscal years.
   (t) "Private hospital" means a hospital licensed under subdivision
(a) of Section 1250 of the Health and Safety Code that is a
nonpublic hospital, nonpublic converted hospital, or converted
hospital as those terms are defined in paragraphs (26) to (28),
inclusive, respectively, of subdivision (a) of Section 14105.98.
   (u) "Subject federal fiscal year" means a federal fiscal year
ending after the implementation date, as defined in Section 14167.1,
and beginning before December 31, 2010.
   (v) "Upper payment limit" means a federal upper payment limit on
the amount of the Medicaid payment for which federal financial
participation is available for a class of service and a class of
health care providers, as specified in Part 447 of Title 42 of the
Code of Federal Regulations.

14167.32.  (a) There shall be imposed on each general acute care
hospital that is not an exempt facility a quality assurance fee, as a
condition of participation in state-funded health insurance
programs, other than the Medi-Cal program.
   (b) The quality assurance fee shall be computed starting on the
effective date of this article and continue through and including
December 31, 2010.
   (c) The department shall calculate the amount of the aggregate
quality assurance fee for each general acute care hospital that is
not an exempt facility within 30 days after the effective date of
this article. Within 20 days of calculating the aggregate quality
assurance fee, the department shall send notice to each general acute
care hospital that is not an exempt facility of the amount of the
hospital's aggregate quality assurance fee.
   (d) For calendar quarters prior to federal approval of the
implementation of this article and the calendar quarter in which the
department receives notice of federal approval of the implementation
of this article, the following provisions shall apply:
   (1) For the partial calendar quarter ending September 30, 2009, 20
days after the effective date of this article, each general acute
care hospital that is not an exempt facility shall certify to the
best of its knowledge, on a form provided by the department, that the
hospital is prepared to pay the aggregate quality assurance fee for
that hospital.
   (2) For each calendar quarter beginning on or after October 1,
2009, and ending on or before September 30, 2010, within 30 days
following the beginning of each calendar quarter, each general acute
care hospital that is not an exempt facility shall certify to the
best of its knowledge, on a form provided by the department, that the
hospital is prepared to pay the aggregate quality assurance fee for
that hospital divided by four.
   (3) For the calendar quarter beginning October 1, 2010, on or
before November 1, 2010, each general acute care hospital that is not
an exempt facility shall certify to the best of its knowledge, on a
form provided by the department, that the hospital is prepared to pay
the aggregate quality assurance fee for that hospital.
   (4) Each certification required by this subdivision shall be
cumulative, and in addition, to any prior certification.
   (e) Upon receipt of federal approval, the following shall become
operative:
   (1) Within 10 days following receipt of the notice of federal
approval from the federal government, the department shall send
notice to each hospital subject to the quality assurance fee, and
publish on its Internet Web site, the following information:
   (A) The date that the state received notice of federal approval.
   (B) The fee percentage for each subject federal fiscal year.
   (2) The notice to each hospital subject to the quality assurance
fee shall also state the following:
   (A) Within 30 days after the date the department received notice
of federal approval, the hospital shall pay the amount of the quality
assurance fee the hospital has certified or will certify for
calendar quarters, up to, and including, the quarter in which the
department receives notice of approval by the federal government of
the implementation of this article, pursuant to subdivision (d),
multiplied by the applicable fee percentage or percentages, except
that, in the event that the director has made modifications to the
fee model to secure federal approval pursuant to subdivision (f) or
(g) of Section 14167.35, the above-described amount, adjusted to
reflect the director's modifications.
   (B) The total amount of the fee that will be payable by the
hospital within 30 days after the date the department received notice
of federal approval.
   (3) Within 30 days after the date the department received notice
of federal approval, each general acute care hospital that is not an
exempt facility shall pay the amounts stated in the department's
notice pursuant to paragraph (2).
   (4) Within 30 days following the beginning of each calendar
quarter, commencing with the quarter following the last quarter
governed by subdivision (d) and ending with, and including, the
calendar quarter ending December 31, 2010, each general acute care
hospital that is not an exempt facility shall pay to the department
the amounts that the hospital would certify to pay for the relevant
quarter pursuant to subdivision (d), multiplied by the applicable fee
percentage, provided that, if modifications were made to the fee
model by the director in order to secure federal approval pursuant to
subdivision (f) or (g) of Section 14167.35, then the hospital shall
pay the amount resulting from the modifications.
   (f) The quality assurance fee, as paid pursuant to this
subdivision, shall be paid by each hospital subject to the fee to the
department for deposit in the Hospital Quality Assurance Revenue
Fund. Deposits may be accepted at any time and will be credited
toward the fiscal year for which they were assessed.
   (g) Subdivisions (d) and (e) shall become inoperative if the
federal Centers for Medicare and Medicaid Services denies approval
for, or does not approve before January 1, 2012, the implementation
of this article or Article 5.21 (commencing with Section 14167.1),
and either or both article cannot be modified by the department
pursuant to subdivision (e) of Section 14167.35 in order to meet the
requirements of federal law or to obtain federal approval. If
subdivisions (d) and (e) become inoperative pursuant to this
subdivision, each hospital subject to the quality assurance fee shall
be released from any certifications made pursuant to subdivision
(d).
   (h) In no case shall the aggregate fees collected in a subject
federal fiscal year pursuant to this section exceed the maximum
percentage of the annual aggregate net patient revenue for hospitals
subject to the fee that is prescribed pursuant to federal law and
regulations as necessary to preclude a finding that an indirect
guarantee has been created.
   (i) (1) Interest shall be assessed on quality assurance fees not
paid on the date due at the greater of 10 percent per annum or the
rate at which the department assesses interest on Medi-Cal program
overpayments to hospitals that are not repaid when due. Interest
shall begin to accrue the day after the date the payment was due and
shall be deposited in the Hospital Quality Assurance Revenue Fund.
   (2) In the event that any fee payment is more than 60 days
overdue, a penalty equal to the interest charge described in
paragraph (1) shall be assessed and due for each month for which the
payment is not received after 60 days.
   (j) When a hospital fails to pay all or part of the quality
assurance fee within 60 days of the date that payment is due, the
department may deduct the unpaid assessment and interest owed from
any Medi-Cal payments or other state payments to the hospital in
accordance with Section 12419.5 of the Government Code until the full
amount is recovered. Any deduction shall be made only after written
notice to the hospital and may be taken over a period of time. All
amounts, except penalties, deducted by the department under this
subdivision shall be deposited in the Hospital Quality Assurance
Revenue Fund. The remedy provided by this section is in addition to
other remedies available under law.
   (k) The payment of the quality assurance fee shall not be
considered as an allowable cost for Medi-Cal cost reporting and
reimbursement purposes.
   (l) The department shall work in consultation with the hospital
community to implement the quality assurance fee.
   (m) This subdivision creates a contractually enforceable promise
on behalf of the state to use the proceeds of the quality assurance
fee, including any federal matching funds, solely and exclusively for
the purposes set forth in this article as they existed on the
effective date of this article, to limit the amount of the proceeds
of the quality assurance fee to be used to pay for the health care
coverage of children to the amounts specified in this article and to
make any payments for the department's costs of administration to the
amounts set forth in this article on the effective date of this
article to maintain and continue prior reimbursement levels as set
forth in Article 5.21 (commencing with Section 14167.1) on the
effective date of that article, and to otherwise comply with all its
obligations set forth in Article 5.21 (commencing with Section
14167.1) and this article.
   (n) For the purpose of this article, references to the receipt of
notice by the state of federal approval of the implementation of this
article shall refer to the last date that the state receives notice
of all federal approval or waivers required for implementation of
this article and Article 5.21 (commencing with Section 14167.1),
subject to Section 14167.14.
   (o) (1) Effective January 1, 2011, the rates payable to hospitals
and managed health care plans under Medi-Cal shall be the rates then
payable without the supplemental and enhanced payments set forth in
Article 5.21 (commencing with Section 14167.1).
   (2) The supplemental payments and other payments under Article
5.21 (commencing with Section 14167.1) shall be regarded as quality
assurance payments, the implementation or suspension of which does
not affect a determination of the adequacy of any rates under federal
law.

14167.35.  (a) The Hospital Quality Assurance Revenue Fund is hereby
created in the State Treasury.
   (b) (1) All fees required to be paid to the state pursuant to this
article shall be paid in the form of remittances payable to the
department.
   (2) The department shall directly transmit the fee payments and
any related federal reimbursement to the Treasurer to be deposited in
the Hospital Quality Assurance Revenue Fund. Notwithstanding Section
16305.7 of the Government Code, any interest and dividends earned on
deposits in the fund shall be retained in the fund for purposes
specified in subdivision (c).
   (c) All funds in the Hospital Quality Assurance Revenue Fund,
together with any interest and dividends earned on money in the fund,
shall, upon appropriation by the Legislature, be used exclusively to
enhance federal financial participation for hospital services under
the Medi-Cal program, to provide additional reimbursement to, and to
support quality improvement efforts of, hospitals, and to minimize
uncompensated care provided by hospitals to uninsured patients, in
the following order of priority:
   (1) To pay for the department's staffing and administrative costs
directly attributable to implementing Article 5.21 (commencing with
Section 14167.1) and this article, including any administrative fees
that the director determines shall be paid to mental health plans
pursuant to subdivision (d) of Section 14167.11 and repayment of the
loan made to the department from the Private Hospital Supplemental
Fund pursuant to the act that added this section.
   (2) To pay for the health care coverage for children in the amount
of eighty million dollars ($80,000,000) for each quarter for which
payments are made under Article 5.21 (commencing with Section
14167.1). In any quarter for which payments reflect room under the
upper payment limit that was available from prior or subsequent
quarters, the prior or subsequent quarters shall constitute quarters
for purposes of the payment for health care coverage for children
required by this paragraph.
   (3) To make increased payments to hospitals pursuant to Article
5.21 (commencing with Section 14167.1).
   (4) To make enhanced payments to managed health care plans
pursuant to Article 5.21 (commencing with Section 14167.1).
   (5) To make increased payments to mental health plans pursuant to
Article 5.21 (commencing with Section 14167.1).
   (d) Any amounts of the quality assurance fee collected in excess
of the funds required to implement subdivision (c), including any
funds recovered under subdivision (d) of Section 14167.14 or
subdivision (e) of Section 14167.36, shall be refunded to general
acute care hospitals, pro rata with the amount of quality assurance
fee paid by the hospital, subject to the limitations of federal law.
If federal rules prohibit the refund described in this subdivision,
the excess funds shall be deposited in the Distressed Hospital Fund
to be used for the purposes described in Section 14166.23, and shall
be supplemental to and not supplant existing funds.
   (e) Any methodology or other provision specified in Article 5.21
(commencing with Section 14167.1) and this article may be modified by
the department, in consultation with the hospital community, to the
extent necessary to meet the requirements of federal law or
regulations to obtain federal approval or to enhance the probability
that federal approval can be obtained, provided the modifications do
not violate the spirit and intent of Article 5.21 (commencing with
Section 14167.1) or this article and are not inconsistent with the
conditions of implementation set forth in Section 14167.36.
   (f) The department, in consultation with the hospital community,
shall make adjustments, as necessary, to the amounts calculated
pursuant to Section 14167.32 in order to ensure compliance with the
federal requirements set forth in Section 433.68 of Title 42 of the
Code of Federal Regulations or elsewhere in federal law.
   (g) The department shall request approval from the federal Centers
for Medicare and Medicaid Services for the implementation of this
article. In making this request, the department shall seek specific
approval from the federal Centers for Medicare and Medicaid Services
to exempt providers identified in this article as exempt from the
fees specified, including the submission, as may be necessary, of a
request for waiver of the broad based requirement, waiver of the
uniform fee requirement, or both, pursuant to paragraphs (1) and (2)
of subdivision (e) of Section 433.68 of Title 42 of the Code of
Federal Regulations.
   (h) (1) For purposes of this section, a modification pursuant to
this section shall be implemented only if the modification, change,
or adjustment does not do either of the following:
   (A) Reduces or increases the supplemental payments or grants made
under Article 5.21 (commencing with Section 14167.1) in the aggregate
for the 2008-09, 2009-10, and 2010-11 federal fiscal years to a
hospital by more than 2 percent of the amount that would be
determined under this article without any change or adjustment.
   (B) Reduces or increases the amount of the fee payable by a
hospital in total under this article for the 2008-09, 2009-10, and
2010-11 federal fiscal years by more than 2 percent of the amount
that would be determined under this article without any change or
adjustment.
   (2) The department shall provide the Joint Legislative Budget
Committee and the fiscal and appropriate policy committees of the
Legislature a status update of the implementation of Article 5.21
(commencing with Section 14167.1) and this article on January 1,
2010, and quarterly thereafter. Information on any adjustments or
modifications to the provisions of this article or Article 5.21
(commencing with Section 14167.1) that may be required for federal
approval shall be provided coincident with the consultation required
under subdivisions (f) and (g).
   (i) Notwithstanding subdivision (h), in consultation with the
hospital community, the department, as necessary to receive federal
approval for the implementation of this article, may do the
following:
   (1) Increase or decrease the managed care per diem quality
assurance fee rate by an amount not to exceed five dollars ($5).
   (2) Decrease the fee-for-service per diem quality assurance fee
rate by an amount not to exceed six dollars ($6).
   (3) Increase the Medi-Cal per diem quality assurance fee rate by
an amount not to exceed two dollars ($2).
   (j) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement this article or Article 5.21 (commencing
with Section 14167.1) by means of provider bulletins, all plan
letters, or other similar instruction, without taking regulatory
action. The department shall also provide notification to the Joint
Legislative Budget Committee and to the appropriate policy and fiscal
committees of the Legislature within five working days when the
above-described action is taken in order to inform the Legislature
that the action is being implemented.

14167.36.  (a) This article shall only be implemented so long as the
following conditions are met:
   (1) Subject to Section 14167.35, the quality assurance fee is
established in a manner that is fundamentally consistent with this
article.
   (2) The quality assurance fee, including any interest on the fee
after collection by the department, is deposited in a segregated fund
apart from the General Fund.
   (3) The proceeds of the quality assurance fee, including any
interest and related federal reimbursement, may only be used for the
purposes set forth in this article.
   (b) No hospital shall be required to pay the quality assurance fee
to the department unless and until the state receives and maintains
federal approval of the quality assurance fee and Article 5.21
(commencing with Section 14167.1) from the federal Centers for
Medicare and Medicaid Services.
   (c) Hospitals shall be required to pay the quality assurance fee
to the department as set forth in this article only as long as all of
the following conditions are met:
   (1) The federal Centers for Medicare and Medicaid Services allows
the use of the quality assurance fee as set forth in this article.
   (2) Article 5.21 (commencing with Section 14167.1) is enacted and
remains in effect and hospitals are reimbursed the increased rates
beginning on the implementation date, as defined in Section 14167.1.
   (3) The full amount of the quality assurance fee assessed and
collected pursuant to this article remains available only for the
purposes specified in this article.
   (d) This article shall become inoperative if either of the
following occur:
   (1) In the event, and on the effective date, of a final judicial
determination made by any court of appellate jurisdiction or a final
determination by the federal Department of Health and Human Services
or the federal Centers for Medicare and Medicaid Services that any
element of this article cannot be implemented.
   (2) In the event both of the following conditions exist:
   (A) The federal Centers for Medicare and Medicaid Services denies
approval for, or does not approve before January 1, 2012, the
implementation of Article 5.21 (commencing with Section 14167.1) or
this article.
   (B) Either or both articles cannot be modified by the department
pursuant to subdivision (e) of Section 14167.35 in order to meet the
requirements of federal law or to obtain federal approval.
   (e) If this article becomes inoperative pursuant to paragraph (1)
of subdivision (d) and the determination applies to any period or
periods of time prior to the effective date of the determination, the
department may recoup all payments made pursuant to Article 5.21
(commencing with Section 14167.1) during that period or those periods
of time.
   (f) This article and Article 5.21 (commencing with Section
14167.1) shall not be implemented with respect to the 2009-10 and
2010-11 federal fiscal years until the earlier of April 30, 2010, or
the date the federal government approves a federal waiver for a
demonstration that will replace the Current Section 1115 Waiver, as
defined in subdivision (c) of Section 14167.1.

14167.37.  Each report or informational submission required from
providers pursuant to this article shall contain a legal verification
to be signed by the provider verifying that the information provided
is true and correct to the best of the provider's knowledge, and
that any information in supporting documents submitted by the
provider is true and correct.

14167.38.  Notwithstanding any other provision of this article or
Article 5.21 (commencing with Section 14167.1), supplemental payments
or other payments under Article 5.21 (commencing with Section
14167.1) shall only be required and payable in any quarter for which
a fee payment obligation exists. In any quarter where payments under
Article 5.21 (commencing with Section 14167.1) are based on upper
payment limit room resulting from other quarters, no payment shall be
made that reflects the room resulting from other quarters unless the
fee payment is similarly increased.

14167.39.  (a) This article and Article 5.21(commencing with Section
14167.1) shall become inoperative and the requirements for
supplemental payments or other payments under Article 5.21
(commencing with Section 14167.1) shall be retroactively invalidated,
on the first day of the first month of the calendar quarter
following notification to the Joint Legislative Budget Committee by
the Department of Finance, that any of the following have occurred:
   (1) A final judicial determination by the California Supreme Court
or any California Court of Appeal that the revenues collected
pursuant to this article that are deposited in the Hospital Quality
Assurance Fund are either of the following:
   (A) "General Fund proceeds of taxes appropriated pursuant to
Article XIII B of the California Constitution," as used in
subdivision (b) of Section 8 of Article XVI of the California
Constitution.
   (B) "Allocated local proceeds of taxes," as used in subdivision
(b) of Section 8 of Article XVI of the California Constitution.
   (2) The department has sought but has not received federal
financial participation for the supplemental payments and other costs
required by this article for which federal financial participation
has been sought.
   (3) A lawsuit related to this article or Article 5.21 (commencing
with Section 14167.1) is filed against the state and a preliminary
injunction or other order has been issued that results in a financial
disadvantage to the state.
   (4) The director, in consultation with the Department of Finance,
determines that the implementation of this article or Article 5.21
(commencing with Section 14167.1) has resulted in a financial
disadvantage to the state.
   (b) For purposes of this section, "financial disadvantage to the
state" means either:
   (1) A loss of federal financial participation.
   (2) A cost to the General Fund, that is equal to or greater than
one-quarter of a percent of the General Fund expenditures authorized
in the most recent annual Budget Act.
   (c) (1) The director shall have the authority to recoup any
payments made under Article 5.21 (commencing with Section 14167.1) if
any of the following apply:
   (A) Recoupment of payments made under Article 5.21 (commencing
with Section 14167.1) is ordered by a court.
   (B) Federal financial participation is not available for payments
made under Article 5.21 (commencing with Section 14167.1) for which
federal financial participation has been sought.
   (C) Recoupment of payments made under Article 5.21 (commencing
with Section 14167.1) is necessary to prevent a General Fund cost
that is estimated to be equal to or greater than one-quarter of a
percent of the General Fund expenditures authorized in the most
recent annual Budget Act and that results from implementation of a
court order or the unavailability of federal financial participation.
   (2) In the event payments are recouped for a particular quarter,
fees paid by a hospital for that quarter pursuant to this article
shall be refunded to the extent that the hospital meets both of the
following conditions:
   (A) The hospital has actually paid the fee for the subject quarter
and for all prior quarters.
   (B) The hospital has returned the payment received pursuant to
Article 5.21 (commencing with Section 14167.1) for that quarter, or
has had that payment recouped through a withholding of funds owed by
Medi-Cal or other state payments, or recouped through other means.
   (d) In the event the department determines that recoupment of
supplemental payments is necessary to implement any provision of this
section, the department may recoup payments made pursuant to Article
5.21 (commencing with Section 14167.1) from fees paid by the
hospital pursuant to this article.
   (e) Concurrent with invoking any provision of this section, the
director shall notify the fiscal and appropriate policy committees of
the Legislature of the intended action and the specific reason or
reasons for the proposed action.

14167.40.  This article shall remain in effect only until January 1,
2013, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2013, deletes or extends
that date.