2011 California Code
Welfare and Institutions Code
DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18996]
ARTICLE 5.21. Medi-Cal Hospital Provider Rate Stabilization Act
Section 14167.3

(a) Private hospitals shall be paid supplemental amounts for the provision of hospital inpatient services and subacute services as set forth in this section. The supplemental amounts shall be in addition to any other amounts payable to hospitals with respect to those services and shall not affect any other payments to hospitals.

(b) Except as set forth in subdivisions (g) and (h), each private hospital shall be paid the following amounts as applicable for the provision of hospital inpatient services for each subject fiscal year:

(1) Six hundred forty dollars and forty-six cents ($640.46) multiplied by the hospital s general acute care days.

(2) Four hundred eighty-five dollars ($485) multiplied by the hospital s acute psychiatric days that were paid directly by the department and were not the financial responsibility of a mental health plan.

(3) One thousand three hundred fifty dollars ($1,350) multiplied by the number of the hospital s high acuity days if the hospital s Medicaid inpatient utilization rate is less than 41.1 percent and greater than 5 percent and at least 5 percent of the hospital s general acute care days are high acuity days. This amount shall be in addition to the amounts specified in paragraphs (1) and (2).

(4) One thousand three hundred fifty dollars ($1,350) multiplied by the number of the hospital s high acuity days if the hospital qualifies to receive the amount set forth in paragraph (3) and has been designated as a Level I, Level II, Adult/Ped Level I, or Adult/Ped Level II trauma center by the emergency medical services authority established pursuant to Section 1797.1 of the Health and Safety Code. This amount shall be in addition to the amounts specified in paragraphs (1), (2), and (3).

(c) A private hospital that provides Medi-Cal subacute services during a subject fiscal year and has a Medicaid inpatient utilization rate that is greater than 5.0 percent and less than 41.1 percent shall be paid for the provision of subacute services during each subject fiscal year a supplemental amount equal to 40 percent of the Medi-Cal subacute payments made to the hospital during the 2008 calendar year.

(d) (1) In the event federal financial participation for a subject fiscal year is not available for all of the supplemental amounts payable to private hospitals under subdivision (b) due to the application of a federal limit or for any other reason, both of the following shall apply:

(A) The total amount payable to private hospitals under subdivision (b) for the subject fiscal year shall be reduced to reflect the amount for which federal financial participation is available.

(B) The amount payable under subdivision (b) to each private hospital for the subject fiscal year shall be equal to the amount computed under subdivision (b) multiplied by the ratio of the total amount for which federal financial participation is available to the total amount computed under subdivision (b).

(2) In the event federal financial participation for a subject fiscal year is not available for all of the supplemental amounts payable to private hospitals under subdivision (c) due to the application of a federal upper limit or for any other reason, both of the following shall apply:

(A) The total amount payable to private hospitals under subdivision (c) for the subject fiscal year shall be reduced to reflect the amount for which federal financial participation is available.

(B) The amount payable under subdivision (c) to each private hospital for the subject fiscal year shall be equal to the amount computed under subdivision (c) multiplied by the ratio of the total amount for which federal financial participation is available to the total amount computed under subdivision (c).

(e) In the event the amount otherwise payable to a hospital under this section for a subject fiscal year exceeds the amount for which federal financial participation is available for that hospital, the amount due to the hospital for that fiscal year shall be reduced to the amount for which federal financial participation is available.

(f) The amounts set forth in this section are inclusive of federal financial participation.

(g) No payments shall be made under this section to a new hospital.

(h) No payments shall be made under this section to a converted hospital for the portion of the subject fiscal year that begins on October 1 and ends on June 30 for the subject fiscal year that includes the first day of the subject federal fiscal year in which the hospital becomes a converted hospital, and for all subsequent subject fiscal years. In the event of a conflict between the provisions of this subdivision and the terms of a state plan amendment required for receipt of approval by the federal Centers for Medicare and Medicaid Services, the state plan amendment shall control.

(i) In the event that the amounts payable as calculated under subdivision (b) for the 2008 09 subject fiscal year are reduced by the operation of subdivision (d) and the ratio for the 2008 09 subject fiscal year described in subparagraph (B) of paragraph (1) of subdivision (d) is less than 0.25, the difference between 25 percent of the amounts payable as calculated under subdivision (b) and the amounts payable after the application of subdivision (d) shall be added to the supplemental payments for each private hospital calculated under subdivision (b) for the 2009 10 subject fiscal year.

(j) In the event that the amounts payable as calculated under subdivision (b) for the 2009 10 subject fiscal year, including any carryover amounts determined under subdivision (i), are reduced by the operation of subdivision (d), the difference between the amounts payable as calculated under subdivision (b), including any carryover amounts, and the amounts payable after the application of subdivision (d) shall be added to the supplemental payments for each private hospital calculated under subdivision (b) for the 2010 11 subject fiscal year.

(k) In the event that the amounts payable as calculated under subdivision (c) for the 2008 09 subject fiscal year are reduced by the operation of subdivision (d) and the ratio for the 2008 09 subject fiscal year described in subparagraph (B) of paragraph (2) of subdivision (d) is less than 0.25, the difference between 25 percent of the amounts payable as calculated under subdivision (c) and the amounts payable after the application of subdivision (d) shall be added to the supplemental payments for each private hospital calculated under subdivision (c) for the 2009 10 subject fiscal year.

(l) In the event that the amounts payable as calculated under subdivision (c) for the 2009 10 subject fiscal year, including any carryover amounts determined under subdivision (k), are reduced by the operation of subdivision (d), the difference between the amounts payable as calculated under subdivision (c), including any carryover amounts, and the amounts payable after the application of subdivision (d) shall be added to the supplemental payments for each private hospital calculated under subdivision (c) for the 2010 11 subject fiscal year.

(Amended by Stats. 2010, Ch. 714, Sec. 7. Effective October 19, 2010. Conditionally inoperative as provided in Sections 14167.14 (subd. (c)) and 14167.39 (subd. (a)). Conditionally repealed on December 1, 2010, pursuant to Section 14167.18. Repealed as of January 1, 2013, pursuant to Section 14167.17, if not repealed earlier.)