CA Welf & Inst Code Section 14184.10

For purposes of this article, the following definitions shall apply:

(a)

“Demonstration project” means the California Medi-Cal 2020 Demonstration, Number 11-W-00193/9, as approved by the federal Centers for Medicare and Medicaid Services, effective for the period from December 30, 2015, to December 31, 2020, inclusive, and any applicable extension period.

(b)

“Demonstration term” means the entire period during which the demonstration project is in effect, as approved by the federal Centers for Medicare and Medicaid Services, including any applicable extension period.

(c)

“Demonstration year” means the demonstration year as identified in the Special Terms and Conditions that corresponds to a specific period of time as set forth in paragraphs (1) to (6), inclusive. Individual programs under the demonstration project may be operated on program years that differ from the demonstration years identified in paragraphs (1) to (6), inclusive.

(1)

Demonstration year 11 corresponds to the period of January 1, 2016, to June 30, 2016, inclusive.

(2)

Demonstration year 12 corresponds to the period of July 1, 2016, to June 30, 2017, inclusive.

(3)

Demonstration year 13 corresponds to the period of July 1, 2017, to June 30, 2018, inclusive.

(4)

Demonstration year 14 corresponds to the period of July 1, 2018, to June 30, 2019, inclusive.

(5)

Demonstration year 15 corresponds to the period of July 1, 2019, to June 30, 2020, inclusive.

(6)

Demonstration year 16 corresponds to the period of July 1, 2020, to December 31, 2020, inclusive.

(d)

“Dental Transformation Initiative” or “DTI” means the waiver program intended to improve oral health services for children, as authorized under the Special Terms and Conditions and described in Section 14184.70.

(e)

“Designated state health program” shall have the same meaning as set forth in the Special Terms and Conditions.

(f)

(1)“Designated public hospital” means any one of the following hospitals, and any successor or differently named hospital, which is operated by a county, a city and county, the University of California, or special hospital authority described in Chapter 5 (commencing with Section 101850) or Chapter 5.5 (commencing with Section 101852) of Part 4 of Division 101 of the Health and Safety Code, or any additional public hospital, to the extent identified as a “designated public hospital” in the Special Terms and Conditions. Unless otherwise provided for in law, in the Medi-Cal State Plan, or in the Special Terms and Conditions, all references in law to a designated public hospital as defined in subdivision (d) of Section 14166.1 shall be deemed to refer to a hospital described in this section effective as of January 1, 2016, except as provided in paragraph (2):

(A)

UC Davis Medical Center.

(B)

UC Irvine Medical Center.

(C)

UC San Diego Medical Center.

(D)

UC San Francisco Medical Center.

(E)

UCLA Medical Center.

(F)

Santa Monica/UCLA Medical Center, also known as the Santa Monica-UCLA Medical Center and Orthopaedic Hospital.

(G)

LA County Health System Hospitals:

(i)

LA County Harbor/UCLA Medical Center.

(ii)

LA County Olive View UCLA Medical Center. (iii)LA County Rancho Los Amigos National Rehabilitation Center.

(iv)

LA County University of Southern California Medical Center.

(H)

Alameda Health System Hospitals, including the following:

(i)

Highland Hospital, including the Fairmont and John George Psychiatric facilities.

(ii)

Alameda Hospital. (iii)San Leandro Hospital.

(I)

Arrowhead Regional Medical Center.

(J)

Contra Costa Regional Medical Center.

(K)

Kern Medical Center.

(L)

Natividad Medical Center.

(M)

Riverside University Health System-Medical Center.

(N)

San Francisco General Hospital.

(O)

San Joaquin General Hospital.

(P)

San Mateo Medical Center.

(Q)

Santa Clara Valley Medical Center.

(R)

Ventura County Medical Center.

(2)

For purposes of the following reimbursement methodologies, the hospitals identified in clauses (ii) and (iii) of subparagraph (H) of paragraph (1) shall be deemed to be a designated public hospital as of the following effective dates:

(A)

For purposes of the fee-for-service payment methodologies established and implemented under Section 14166.4, the effective date shall be the date described in paragraph (3) of subdivision (a) of Section 14184.30.

(B)

For purposes of Article 5.230 (commencing with Section 14169.50), the effective date shall be January 1, 2017.

(g)

“Disproportionate share hospital provisions of the Medi-Cal State Plan” means those applicable provisions contained in Attachment 4.19-A of the California Medicaid state plan, approved by the federal Centers for Medicare and Medicaid Services, that implement the payment adjustment program for disproportionate share hospitals.

(h)

“Federal disproportionate share hospital allotment” means the amount specified for California under Section 1396r-4(f) of Title 42 of the United States Code for a federal fiscal year.

(i)

“Federal medical assistance percentage” means the federal medical assistance percentage applicable for federal financial participation purposes for medical services under the Medi-Cal State Plan pursuant to Section 1396b(a)(1) of Title 42 of the United States Code.

(j)

“Global Payment Program” or “GPP” means the payment program authorized under the demonstration project and described in Section 14184.40 that assists participating public health care systems that provide health care for the uninsured and that promotes the delivery of more cost-effective, higher-value health care services and activities.

(k)

“Nondesignated public hospital” means a public hospital as that term is defined in paragraph (25) of subdivision (a) of Section 14105.98, excluding designated public hospitals.

(l)

“Nonfederal share percentage” means the difference between 100 percent and the federal medical assistance percentage.

(m)

“PRIME” means the Public Hospital Redesign and Incentives in Medi-Cal program authorized under the demonstration project and described in Section 14184.50.

(n)

“Total computable disproportionate share hospital allotment” means the federal disproportionate share hospital allotment for a federal fiscal year, divided by the applicable federal medical assistance percentage with respect to that same federal fiscal year.

(o)

“Special Terms and Conditions” means those terms and conditions issued by the federal Centers for Medicare and Medicaid Services, including all attachments to those terms and conditions and any subsequent amendments approved by the federal Centers for Medicare and Medicaid Services, that apply to the demonstration project.

(p)

“Uninsured” means an individual for whom there is no source of third-party coverage for the health care services the individual receives, as determined pursuant to the Special Terms and Conditions.

(q)

“Whole Person Care pilot program” means a local collaboration among local governmental agencies, Medi-Cal managed care plans, health care and behavioral health providers, or other community organizations, as applicable, that are approved by the department to implement strategies to serve one or more identified target populations, pursuant to Section 14184.60 and the Special Terms and Conditions.