(a) The department shall determine during each rebase calculation year the number of subject fiscal years in the next program period. (b) During each rebase calculation year, the department shall retrieve the data, including, but not limited to, the days data source, used to determine the following for the subsequent program period: acute psychiatric days, annual fee-for-service days, annual managed care days, annual Medi-Cal days, fee-for-service days, general acute care days, high acuity days, managed care days, Medi-Cal days, Medi-Cal fee-for-service days, Medi-Cal managed care days, Medi-Cal managed care fee days, outpatient base amount, and transplant days. The department shall pull data from the most recent base calendar year for which the department determines reliable data is available for all hospitals. (c) (1) During each rebase calculation year, the department shall determine all of the following supplemental payment rates for the subsequent program period, which supplemental payment rates shall be specified in provisional language in the annual Budget Act: (A) The acute psychiatric per diem supplemental rate for each subject fiscal year during the program period. (B) The general acute care per diem supplemental rate for each subject fiscal year during the program period. (C) The high acuity per diem supplemental rate for each subject fiscal year during the program period. (D) The high acuity trauma per diem supplemental rate for each subject fiscal year during the program period. (E) The outpatient supplemental rate for each subject fiscal year during the program period. (F) The subacute supplemental rate for each subject fiscal year during the program period. (G) The transplant per diem supplemental rate for each subject fiscal year during the program period. (2) During each rebase calculation year, the department shall determine all of the following fee rates for the subsequent program period, which fee rates shall be specified in provisional language in the annual Budget Act: (A) The fee-for-service per diem quality assurance fee rate for each subject fiscal year during the program period. (B) The managed care per diem quality assurance fee rate for each subject fiscal year during the program period. (C) The Medi-Cal per diem quality assurance fee rate for each subject fiscal year during the program period. (D) The prepaid health plan hospital managed care per diem quality assurance fee rate for each subject fiscal year during the program period. (E) The prepaid health plan hospital Medi-Cal managed care per diem quality assurance fee rate for each subject fiscal year during the program period. (d) The department shall determine the rates set forth in subdivision (c) based on the data retrieved pursuant to subdivision (b). Each rate determined by the department shall be the same for all hospitals to which the rate applies. These rates shall be specified in provisional language in the annual Budget Act. The department shall determine the rates in accordance with all of the following: (1) The rates shall meet the requirements of federal law and be established in a manner to obtain federal approval. (2) The department shall consult with the hospital community in determining the rates. (3) The supplemental payments and other Medi-Cal payments for hospital outpatient services furnished by private hospitals for each fiscal year shall equal as close as possible the applicable federal upper payment limit. (4) The supplemental payments and other Medi-Cal payments for hospital inpatient services furnished by private hospitals for each fiscal year shall equal as close as possible the applicable federal upper payment limit. (5) The increased capitation payments to managed health care plans shall result in the maximum payments to the plans permitted by federal law. (6) The quality assurance fee proceeds shall be adequate to make the expenditures described in this article, but shall not be more than necessary to make the expe
‹ Prev All California sections Next ›
Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.