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 14167.4

(a) Nondesignated public hospitals shall be paid supplemental amounts for the provision of hospital inpatient 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 (f) and (g), each nondesignated public hospital shall be paid the following amounts for each subject fiscal year:

(1) Two hundred eighteen dollars and eighty-two cents ($218.82) 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.

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

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

(2) The amount payable under subdivision (b) to each nondesignated public 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).

(d) 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 federal fiscal year shall be reduced to the amount for which federal financial participation is available.

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

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

(g) (1) 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.

(2) Notwithstanding paragraph (1), the director shall seek federal approval to allow payments to be made under this section for the period beginning July 1, 2010, and ending June 30, 2011, to a converted hospital which is a hospital described in paragraph (2) of subdivision (p) of Section 14167.1, and shall make payments under this section consistent with any approvals, subject to all of the following:

(A) Federal approval shall be sought after all final federal approvals necessary to implement this article and Article 5.22 (commencing with Section 14167.31) are received by the department.

(B) The director shall have determined prior to seeking federal approval that obtaining federal approval and implementing the payments described in this paragraph will not jeopardize the implementation of this article or Article 5.22 (commencing with Section 14167.31), or delay any payments to hospitals and managed health care plans under this article or Article 5.22 (commencing with Section 14167.31), or the collection of the quality assurance fee from hospitals under Article 5.22 (commencing with Section 14167.31), beyond December 31, 2010.

(C) The director shall withdraw any request for federal approval made under this paragraph if, after submitting the request, the director has determined that obtaining federal approval and implementing the payments described in this paragraph will jeopardize the implementation of this article or Article 5.22 (commencing with Section 14167.31) or delay any payments to hospitals and managed health care plans under this article or Article 5.22, (commencing with Section 14167.31) or the collection of the quality assurance fee from hospitals under Article 5.22, (commencing with Section 14167.31) beyond December 31, 2010.

(h) 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 (c) and the ratio for the 2008 09 subject fiscal year described in paragraph (2) of subdivision (c) 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 (c) shall be added to the supplemental payments for each nondesignated public hospital calculated under subdivision (b) for the 2009 10 subject fiscal year.

(i) 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 (h), are reduced by the operation of subdivision (c), the difference between the amounts payable as calculated under subdivision (b), including any carryover amounts, and the amounts payable after the application of subdivision (c) shall be added to the supplemental payments for each nondesignated public hospital calculated under subdivision (b) for the 2010 11 subject fiscal year.

(Amended by Stats. 2010, Ch. 714, Sec. 8. 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.)