(a)Consistent with federal law, the department shall seek federal approval for, and implement PPI, including, but not limited to, all of the following components:
(1)Reimbursement increases for professional services described in Section 14124.163.
(2)Reimbursement increases for ground emergency medical transport services described in Section 14124.164.
(3)Reimbursement increases for abortion services described in Section 14124.165.
(4)Reimbursement increases for family planning services described in Section 14124.166.
(5)Reimbursement increases for services described in Section 14124.167.
(6)Updating the reimbursement methodology for optional hearing aid benefits, as described in Section 14131.05.
(7)Elimination of certain rate reductions as described in paragraph (16) of subdivisi
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(a)
Consistent with federal law, the department shall seek federal approval for, and implement PPI, including, but not limited to, all of the following components:
(1)
Reimbursement increases for professional services described in Section 14124.163.
(2)
Reimbursement increases for ground emergency medical transport services described in Section 14124.164.
(3)
Reimbursement increases for abortion services described in Section 14124.165.
(4)
Reimbursement increases for family planning services described in Section 14124.166.
(5)
Reimbursement increases for services described in Section 14124.167.
(6)
Updating the reimbursement methodology for optional hearing aid benefits, as described in Section 14131.05.
(7)
Elimination of certain rate reductions as described in paragraph (16) of subdivision (h) of Section 14105.192.
(8)
Implementation of increases to the amount of directed payments for qualifying nonhospital 340B community clinics pursuant to paragraph (2) of subdivision (a) of Section 14105.468.
(b)
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, interpret, or make specific this article, other sections of law
amended by the act that added this subdivision, the PPI Terms and Conditions, or any appertaining Medi-Cal reimbursement methodologies in whole or in part, by means of all-county letters, plan letters, provider bulletins, information notices, or other similar instructions, without taking any further regulatory action.
(c)
For purposes of implementing this article, other sections of law amended by the act that added this subdivision, or the PPI Terms and Conditions, the department may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis, and may implement changes to existing information technology systems. Notwithstanding any other law, contracts entered into or amended, or changes to existing information technology systems, pursuant to this subdivision shall be exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, Section 19130 of
the Government Code, and Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, and shall be exempt from the review or approval of any division of the Department of General Services.
(d)
The department shall seek any federal approvals it deems necessary to implement PPI under this article and other provisions of law amended by the act that added this subdivision. This shall include, but need not be limited to, approval of any amendment, addition, or technical correction to the PPI Terms and Conditions, as the department deems necessary. Except those portions of this article related to abortion services, this article shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.
(e)
To the extent that there is a later enacted statute that
restricts the availability of the moneys in, restricts transfers of moneys into, or transfers moneys out of the Medi-Cal Provider Payment Reserve Fund, or restricts the availability or use of managed care organization provider tax revenues derived from the taxes imposed pursuant to Article 7.1 (commencing with Section 14199.80) or any subsequent continuation of the managed care organization provider tax, the department shall only implement this article or other sections of law amended by the act that added this section to the extent that the department determines the provisions of this article remain feasible with or without making modifications pursuant to subdivision (f).
(f)
(1)
Consistent with subdivisions (d) and (e), the director may modify any methodology or parameter specified in this article or other sections of law amended by the act that added this subdivision, to the extent necessary to do any of the
following:
(A)
To comply with federal law or the PPI Terms and Conditions, to obtain or maintain federal approval, or to ensure federal financial participation is available and not otherwise jeopardized.
(B)
To conform with any later enacted statute that restricts the availability of the moneys in, restricts transfers of moneys into, or transfers moneys out of the Medi-Cal Provider Payment Reserve Fund, or restricts the availability or use of managed care organization provider tax revenues derived from the taxes imposed pursuant to Article 7.1 (commencing with Section 14199.80) or any subsequent continuation of the managed care organization provider tax.
(2)
Any modification must be consistent with the goals set forth in this article and its individual components. Modifications may include, but are not limited to,
implementing PPI components on a time-limited basis or modifying the targeted funding amounts or applicable percentages without exceeding amounts appropriated in the state budget for these purposes.
(3)
Prior to proposing a modification pursuant to this subdivision, the director shall consult with affected stakeholders. Upon approval by the Department of Finance, any modification made pursuant to this subdivision shall take effect no sooner than 30 days after the director provides public notice of the proposed modification and provides notification to the chairpersons of the committees in each house of the Legislature that consider health policy, chairpersons of the committees in each house of the Legislature that consider appropriations, the chairpersons of the committees and appropriate subcommittees that consider the State Budget, and the Chairperson of the Joint Legislative Budget Committee, or not sooner than whatever lesser time the
chairperson of the joint committee, or the chairperson’s designee, may determine. The public notice shall include a description of the projected fiscal impact of the proposed modification on each PPI component. Submission of the semiannual Medi-Cal estimate provided to the Legislature in January and May shall be considered meeting the notification requirement of this provision if the required information is included in the estimate.
(g)
The payment methodologies, investments, and parameters developed and implemented pursuant to this article, the PPI Terms and Conditions, or other sections of law amended by the act that added this subdivision shall supersede any conflicting law or regulation, shall, as applicable, supersede and replace any other applicable payment methodology, and shall be implemented notwithstanding any other law.
(h)
(1)
The payments
implemented pursuant to this article, other sections of law amended by the act that added this subdivision, or the PPI Terms and Conditions shall be supported by managed care organization provider tax revenue, either pursuant to Article 7.1 (commencing with Section 14199.80) or any subsequent continuation of the managed care organization provider tax, or other state funds appropriated by the Legislature to the department as the state’s share for this purpose, including, but not limited to, funds transferred to the Medi-Cal Provider Payment Reserve Fund in accordance with Sections 14105.200 and 14199.82, and to the Healthcare Treatment Fund in accordance with subdivision (a) of Section 30130.55 of the Revenue and Taxation Code.
(2)
Notwithstanding any other law, the Legislature finds and declares increases to fee-for-service reimbursement rates and managed care capitation payments that are made pursuant to this article, other sections of law
amended by the act that added this subdivision, or the PPI Terms and Conditions constitute increases in accordance with subdivision (a) of Section 30130.55 of the Revenue and Taxation Code.
(3)
Notwithstanding any other law, increases to fee-for-service reimbursement rates, managed care capitation payments, or other investments that are made pursuant to this article, other sections of law amended by the act that added this section, or the PPI Terms and Conditions constitute increased reimbursement rates in accordance with statutory requirements imposed on the use of funds generated by the managed care organization provider tax, pursuant to Article 7.1 (commencing with Section 14199.80) or any subsequent statute that continues the managed care organization provider tax.
(i)
The department may require Medi-Cal providers, Medi-Cal managed care plans, and other persons or entities
pertaining to the Medi-Cal delivery system to submit information the department deems necessary to implement and monitor compliance with this article, other sections of law amended by the act that added this section, or the PPI Terms and Conditions, at the times and in the form and manner specified by the department.
(j)
(1)
The department may direct Medi-Cal managed care plans to reimburse eligible providers furnishing the services subject to PPI in accordance with one or more directed payment methodologies pursuant to subsection (c) of Section 438.6 of Title 42 of the Code of Federal Regulations, and as set forth by other sections of law amended by the act that added this section and by the department in guidance issued pursuant to subdivision (b).
(2)
Commencing with the first managed care rating period for which the department documents in the annual rate
certification that the base period data submitted and attested to by Medi-Cal managed care plans that is used by the department for the development of capitation rates for the Medi-Cal managed care delivery system reflects the increased reimbursement levels for a service subject to PPI, the department may, following consultation with affected stakeholders, elect to discontinue any directed payment methodologies implemented for that service.
(k)
The department, as appropriate and to the extent practicable, shall consult with interested stakeholders regarding implementation of applicable components of PPI in which they will participate.