SECTIONS 16943-16949 - California Statutes

WELFARE AND INSTITUTIONS CODE

SECTION 16943-16949

16943. (a) Of those allocations made pursuant to Section 16941 for
the 1989-90 fiscal year, 59.5 percent shall be used to support
uncompensated services provided by county and noncounty hospitals.
(b) For allocations under Section 16941 for the 1990-91 fiscal
year and each fiscal year thereafter, the department shall establish
that percentage of the total fiscal year appropriation to the CHIP
Account which derives from the Hospital Services Account of the fund.
(c) The percentages established in subdivisions (a) and (b), when
applied to the amount of each MISP county's annual allocation
pursuant to Section 16941, constitute the minimum amount of the
allocation which is reserved for payment or support of uncompensated
services provided by hospitals licensed pursuant to subdivision (a)
of Section 1250 of the Health and Safety Code.
(d) The amount of funds calculated in subdivision (c) shall be
referred to as the hospital services funding portion of each county's
allocation made pursuant to Section 16941.
(e) (1) For purposes of calculating county and noncounty hospital
allocations pursuant to this article for the 1991-92 fiscal year and
each fiscal year thereafter, the sum of eighteen million dollars
($18,000,000) shall be added proportionately to each county's
hospital services funding allocation calculated in subdivision (c).
(2) The amount added pursuant to paragraph (1) shall be
distributed within each county's allocation according to subdivisions
(a), (b), and (c) of Section 16946.
(f) (1) For purposes of calculating county and hospital
allocations pursuant to this article for the 1991-92 fiscal year and
each fiscal year thereafter, the sum of one million six hundred fifty
thousand dollars ($1,650,000) shall be added proportionately to the
allocations calculated in subdivision (c) for each county with no
county hospital.
(2) The share for each county with no county hospital of the
amount specified in paragraph (1) shall be determined by dividing the
county's allocation calculated pursuant to subdivisions (c) and (e)
by the total of all allocations for counties with no county hospital
times the sum of one million six hundred fifty thousand dollars
($1,650,000).
(3) The amounts added pursuant to paragraphs (1) and (2) shall be
divided into two equal amounts.
(A) The first amount shall be allocated to each eligible noncounty
hospital within a county pursuant to paragraph (1) of subdivision
(b) of Section 16946.
(B) The second amount shall be distributed to eligible hospitals
pursuant to paragraph (2) of subdivision (b) of Section 16946.
(4) In future fiscal years, the amount specified in paragraph (1)
shall be adjusted proportionately to reflect any augmentation or
reduction in funding available for this article pursuant to Section
43 of Chapter 278 of the Statutes of 1991.

16945. (a) The department shall annually verify and transmit to
each MISP county and each CMSP county the figures specified in
subdivision (c), using data supplied by the office.
(b) (1) For purposes specified in subdivision (c), the office
shall use data from the quarterly reports required by Section 128740
of the Health and Safety Code.
(2) For the 1989-90 fiscal year computations, the office shall use
the 1988 calendar year data, as adjusted by the office, existing on
the statewide file on September 1, 1989.
(3) For the computations for fiscal years after the 1989-90 fiscal
year, the office shall use the data from the quarterly reports for
the calendar year preceding the computational fiscal year, as
adjusted by the office, existing on the statewide file on April 15
immediately preceding the computational fiscal year.
(4) (A) Except as provided in subparagraphs (B), (C), and (D), the
definitions, procedures, and data elements specified in Chapter 3
(commencing with Section 16920) shall be used in all computations
required in subdivision (c).
(B) For the 1991-92 fiscal year, the following definitions shall
be used in all computations required in subdivision (c):
(i) "Uncompensated care charges" means the sum of the charges
related to patients falling within the charity-other category in the
1990 calendar year and 25 percent of the charges related to patients
falling within the bad debts category in the first two quarters of
the 1990 calendar year, as both categories of charges are reported
quarterly to the office pursuant to Section 128740 of the Health and
Safety Code.
(ii) "Uncompensated care costs" means that amount calculated by
applying an overall hospital cost-to-charge ratio, calculated by
dividing gross operating expenses by gross inpatient and outpatient
revenue, as reported quarterly to the office, to uncompensated care
charges.
(C) For the 1992-93 fiscal year, the following definitions shall
be used in all computations required in subdivision (c):
(i) "Uncompensated care charges" means the charges related to
patients falling within charity-other, as reported quarterly to the
office pursuant to Section 128740 of the Health and Safety Code.
(ii) "Uncompensated care costs" means that amount calculated by
applying an overall hospital cost-to-charge ratio, calculated by
dividing gross operating expenses by gross inpatient and outpatient
revenue, as reported quarterly to the office, to uncompensated care
charges.
(D) For the 1993-94, 1994-95, 1995-96, 1996-97 and subsequent
fiscal years, the following definitions shall be used in all
computations required in subdivision (c):
(i) (I) For county hospitals and for all hospitals operating in
counties with no county hospital, "uncompensated care charges" means
the charges related to patients falling within charity-other, gross
inpatient revenue-county indigent programs and gross outpatient
revenue-county indigent programs, as reported quarterly to the office
pursuant to Section 128740 of the Health and Safety Code.
(II) For noncounty hospitals operating in a county with a county
hospital, "uncompensated care charges" means the charges related to
patients falling within charity-other and county indigent programs
contractual adjustments, as reported quarterly to the office pursuant
to Section 128740 of the Health and Safety Code.
(ii) "Uncompensated care costs" means that amount calculated by
applying an overall hospital cost-to-charge ratio, calculated by
dividing gross operating expenses less other operating revenue by
gross inpatient and outpatient revenue, as reported quarterly to the
office, to uncompensated care charges.
(c) The office shall compute the following data on uncompensated
care costs reported by hospitals located within each MISP county and
each CMSP county:
(1) The sum of uncompensated care costs for all hospitals.
(2) The sum of uncompensated care costs for all noncounty
hospitals.
(3) The sum of uncompensated care costs for all county hospitals.
(4) The uncompensated care costs of each hospital within the
county.
(5) The percentage derived from dividing the result of paragraph
(2) by the result of paragraph (1).
(6) The percentage derived from dividing the result of paragraph
(3) by the result of paragraph (1).
(7) The percentage for each individual hospital derived from
dividing each noncounty hospital's uncompensated care cost in
paragraph (4) by the amount in paragraph (2).
(d) The office shall transmit to the department the data specified
in subdivision (c) within 30 days of the dates specified in
paragraph (2) of subdivision (b) and paragraph (3) of subdivision (b)
of this section.

16946. (a) The Hospital Services Account portion of each county's
allocation pursuant to Sections 16932 and 16941 shall be divided into
two amounts by:
(1) Multiplying the Hospital Services Account funding portion by
the percentage specified in paragraph (5) of subdivision (c) of
Section 16945.
(2) Multiplying the amount of the Hospital Services Account
funding portion by the percentage specified in paragraph (6) of
subdivision (c) of Section 16945.
(b) The amount of each county's Hospital Services Account funding
portion calculated in paragraph (1) of subdivision (a) shall be used
for payment or support of services provided on or after July 1, 1989,
by noncounty hospitals. Beginning in the 1991-92 fiscal year and
annually thereafter, these amounts shall be reduced by dividing each
county's amount by the total amount for all counties, multiplied by
the sum of twelve million dollars ($12,000,000). This amount for each
county shall be further divided into two equal parts, as follows:
(1) (A) The first part shall be allocated to each noncounty
hospital within a county in amounts determined by multiplying the
percentages specified in paragraph (7) of subdivision (c) of Section
16945 by the amount of the first part, and may be used for payment or
support of services provided by noncounty hospitals to any eligible
patient treated at any time during the fiscal year of the allocation.
(B) Funds distributed during fiscal years subsequent to the
1989-90 fiscal year shall be accounted for on a quarterly basis.
(C) For the 1989-90 fiscal year, noncounty hospitals shall provide
the demographic data specified in paragraph (2) of subdivision (b)
of Section 16918 on a minimum of 5 percent of patients for whom
services are paid for in whole or in part by funds allocated pursuant
to this paragraph, in addition to any other requirements specified
in Section 16918.
(D) For the 1990-91 fiscal year and fiscal years thereafter,
noncounty hospitals shall provide data pursuant to the reporting
requirements specified in Section 16918 and shall provide posted and
individual notices pursuant to Section 16818 for the duration of any
quarter during which funds allocated pursuant to this paragraph are
used.
(E) Amounts calculated pursuant to this paragraph shall not be
reduced or utilized to offset the costs of administering the Hospital
Services Account.
(2) (A) (i) The remaining 50 percent of the funds from the
Hospital Services Account shall be distributed by the county to
hospitals, including those under contract with the county, to
maintain access to emergency care and to purchase other necessary
hospital services provided during the fiscal year of the allocation.
(ii) In contracting for emergency care with hospitals in
neighboring counties, the county shall not impose conditions to
accept transfers that it does not impose on hospitals within its own
boundaries.
(B) (i) Prior to distributing funds to hospitals, each county
shall consult with the hospitals and consider the historic and
projected patterns of care provided by hospitals, by geographic
catchment areas within both urban and nonurban areas, unique costs
associated with treating disproportionate numbers of severely ill
indigent patients, and disproportionate losses sustained by hospitals
in the provision of care.
(ii) The county shall also consider the patterns of care of its
residents provided by Level I trauma care hospitals in contiguous
counties and may make proportionate allocations to those trauma
centers.
(c) (1) The amount of each county's Hospital Services Account
funding portion calculated in paragraph (2) of subdivision (a) may be
used for the payment or support of services provided in county
hospitals or noncounty hospitals as determined by each county during
the fiscal year of the allocation.
(2) Beginning in the 1991-92 fiscal year and annually thereafter,
the amount of each county's funding portion calculated pursuant to
paragraph (2) of subdivision (a) shall be reduced by an amount that
shall be calculated as follows:
(A) Divide each county's amount of funding under paragraph (2) of
subdivision (a) by the total amount of funding under that paragraph
for all counties.
(B) Multiply the quotient calculated pursuant to subparagraph (A)
by the sum of six million dollars ($6,000,000).
(d) As a condition of receiving funds under this section and
Section 16932, each county shall require each county and noncounty
hospital to do all of the following:
(1) (A) Maintain the same number and classification of emergency
room permits and trauma facility designations as existed on January
1, 1990.
(B) (i) Any hospital that maintained two special permits for basic
emergency service on the effective date of this part shall be deemed
to have met the requirements of paragraph (1) of subdivision (d), if
each of the emergency rooms was located on separate campuses of the
hospital and was located not more than two miles from the other
emergency room.
(ii) Clause (i) shall apply even if one of the emergency room
permits is surrendered after the effective date of this part.
(2) Provide data and reports on the use and expenditure of all
funds received. This information shall be in a form and according to
procedures specified by the county and the department.
(3) Assure that funds received pursuant to this section are used
only for services for persons who cannot afford to pay for those
services, and for whom payment will not be made through any private
coverage or by any program funded in whole or in part by the federal
government.
(e) (1) If a county or noncounty hospital does not comply with
this section, the county shall recover funds received by the hospital
as follows:
(A) For any violation of paragraph (1) of subdivision (d), the
county shall recover that portion of the funds received which equal
the ratio of the number of months not in compliance to 12 months.
(B) For any violation of paragraph (2) of subdivision (d), the
county shall recover all funds received.
(C) For any violation of paragraph (3) of subdivision (d), the
county shall recover the difference between the amount received and
the amount for which the hospital can document that the funds were
used only for services for persons who cannot afford to pay for those
services and for whom payment will not be made through any private
coverage or by any program funded in whole or in part by the federal
government.
(2) The county may deny further payments required by this section
until the hospital demonstrates compliance.
(f) Funds withheld or recovered pursuant to this section may be
reallocated and distributed by the county pursuant to paragraph (2)
of subdivision (b).
(g) (1) Except as provided in paragraph (2), funds allocated
pursuant to paragraph (1) or (2) of subdivision (b) which are not
expended because a hospital does not participate shall be
redistributed pursuant to paragraph (2) of subdivision (b).
(2) If no noncounty hospitals remain to participate, the county
may distribute those unexpended funds pursuant to subdivision (c).
(h) (1) In any county that comprises not more than one-half
percent of the total state population and in which there are a county
hospital and a noncounty hospital with emergency room permits
located within two miles of each other, the county hospital may
surrender its emergency room permit without any penalty for violation
of paragraph (1) of subdivision (d) if, in the alternative, all of
the following occur:
(A) The county shall enter into a contractual arrangement with the
noncounty hospital.
(B) The county and noncounty hospital shall provide for the
availability of at least the same level of emergency services and
specialty backup which the county hospital and noncounty hospital
provided prior to the surrendering of the emergency room permit.
(C) The county shall establish sufficient capacity, including
evening and weekend coverage, in its urgent care clinic and other
outpatient clinics to provide for the same or greater level of urgent
care and nonemergency visits that were provided in the county
hospital emergency department in the calendar year prior to the
surrendering of the emergency room permit.
(D) The county shall provide for adequate initial public hearings
and ongoing public notification and information, in Spanish and
English, on the availability of emergency, urgent care, and nonurgent
clinic services and how to obtain those services. The county shall
provide for, as part of the ongoing public notification, an outreach
program to ensure that the medically indigent community, particularly
migrant and seasonal farmworkers, and cultural and linguistic
minority patients, are effectively made aware of the alternative
system of care and the ways to access it.
(E) The county ensures that there are adequate Spanish translation
services and referral services on a 24-hour basis at the noncounty
hospital emergency department, and at the county hospital clinics,
during their hours of operation.
(F) The county shall ensure, in planning for an alternative
delivery system as provided for in paragraph (C), participation of
those existing agencies providing health care services to the
uninsured and working poor medically indigent, including federally
qualified health centers and nonprofit community-based rural health
clinics.
(G) The county shall ensure that its alternative delivery system
includes medical providers who are culturally and linguistically
competent to service the diverse medically indigent populations and
have been serving uninsured persons seeking care at the county
hospital prior to closing. These providers shall include, among
others, nonprofit community-based safety net and traditional
providers currently serving both the uninsured and medically indigent
populations.
(H) The county shall ensure that its alternative delivery system
does not provide less health care services and resources than that
being made available to the medically indigent and uninsured prior to
the closing of the county hospital.
(2) The department shall annually review the county's compliance
with this subdivision. If the department determines that the county
is not in compliance with this subdivision, it shall require the
county to recover funds and deny further payments pursuant to
subdivision (e) until compliance is resumed.
(3) Any county that is permitted under paragraph (1) to surrender
its emergency room permit shall continue to fulfill its duties and
obligations to provide indigent care according to Section 17000.
(i) Any county of the 20th class or the 24th class that
discontinues the provision of acute inpatient care services may
surrender its emergency room permit without any penalty for violation
of paragraph (1) of subdivision (d), provided that the county shall
enter into a contractual arrangement with at least one noncounty
hospital meeting the requirements of subdivision (d) and all of the
requirements of subparagraphs (A) to (H), inclusive, of paragraph (1)
of subdivision (h) are met by the county and the contracting
noncounty hospital, in which case paragraphs (2) and (3) of
subdivision (h) shall apply to that county.
(j) Notwithstanding any other provision of law, any county of the
20th class or the 24th class that meets the requirements and
conditions of subdivision (i) shall be eligible to receive funds
distributed pursuant to any provision of this section equal to that
amount received by the county for the fiscal year immediately
preceding the year in which it discontinues the provision of acute
inpatient care services. The amount calculated pursuant to this
subdivision shall be adjusted annually based upon the funding
available from the Hospital Services Account in the Cigarette and
Tobacco Products Surtax Fund.

16947. (a) Any hospital which receives funds pursuant to this
chapter or Chapter 4 (commencing with Section 16930) shall, within 90
days of the receipt of those funds, cease all current and waive all
future collection efforts, by itself and by its agents, to obtain any
payment from the patient with respect to whom the services funded
under this chapter were rendered.
(b) This section shall not be interpreted or applied so as to
prevent the hospital from doing either of the following:
(1) Seeking demographic, financial, or other information necessary
for the patient to qualify for Medi-Cal program benefits under
Chapter 14 (commencing with Section 14000) of Part 3 or for the
reimbursement for services through any other third-party payer.
(2) (A) Seeking payment from a responsible third-party payer or,
subject to subparagraph (B), continuing collection on a repayment
schedule for the cost of services rendered.
(B) Collection on a repayment schedule shall be based on the
patient's ability to pay.
(c) If a hospital receives payment from a patient or responsible
third-party payer, the hospital shall notify the county and reimburse
the county in an amount equal to the amount collected from the
patient or third-party payer, but not more than the amount of the
payment received from the county for the patient's care.

16948. (a) Commencing with the 1990-91 fiscal year, within 10
working days of receipt of funds allocated pursuant to Section 16941
and Section 16932, the county shall distribute to each noncounty
hospital that hospital's share of the funds pursuant to paragraph (1)
of subdivision (b) of Section 16946.
(b) Each noncounty hospital which receives funds pursuant to
paragraph (1) of subdivision (b) of Section 16946 shall report to the
county within 30 days after the receipt of the funds, information on
patients for whom the distributions were used, pursuant to Section
16918.
(c) The county shall suspend distribution of funds to any
noncounty hospital which fails to provide the information required
pursuant to subdivision (b) until the hospital provides the required
information.

16949. (a) The Legislature recognizes that in the context of
hospital services rendered as a result of emergency medical
conditions, the application of the supplemental services requirement
of Section 30125 of the Revenue and Taxation Code and Section 13 of
Chapter 1331 of the Statutes of 1989 includes certain unique
considerations, including, but not limited to, all of the following:
(1) Hospital emergency room patient loads generally are not
controlled by the facility.
(2) The facility is obligated, as a condition of licensure, to
take all patients in need of emergency treatment, if it is within the
capacity of the facility to do so.
(3) It is the policy of the Legislature to provide less expensive
alternative methods of care, rather than continue present patterns of
overutilization of emergency facilities.
(b) Hospitals which provide appropriate treatment to patients who
present in the emergency department and which do not impose any
barriers to patients' receipt of that treatment shall be deemed to
satisfy the requirements of Section 30125 of the Revenue and Taxation
Code and Section 13 of Chapter 1331 of the Statutes of 1989.
(c) Each county, as part of its plan for distribution of funds
under paragraph (2) of subdivision (b) of Section 16946, shall
consider the use of those funds to meet emergency room patient needs
and followup treatment, including the need for special hospital
services.
(d) Any hospital which contracts with a county under paragraph (2)
of subdivision (b) of Section 16946 shall report to the county and
to the office on any reduction in hospital emergency room specialist
capability below the level which was provided at that facility on
October 2, 1989.
(e) This section shall not be construed to alter or amend any
hospital's obligation under Sections 1317 to 1317.9a, inclusive, of
the Health and Safety Code.