For purposes of this article, the following definitions apply:
(a)
“Base year” means the fiscal year ending three years prior to the fiscal year for which the redirected amount is calculated.
(b)
“Blended CPI trend factor” means the blended percent change applicable for the fiscal year that is derived from the nonseasonally adjusted Consumer Price Index for All Urban Consumers (CPI-U), United States City Average, for Hospital and Related Services, weighted at 75 percent, and for Medical Care Services, weighted at 25 percent, all as published by the United States Bureau of Labor Statistics, computed as follows:
(1)
For each prior fiscal year within the
period to be trended through the state fiscal year, the annual average of the monthly index amounts shall be determined separately for the Hospital and Related Services Index and the Medical Care Services Index.
(2)
The year-to-year percentage changes in the annual averages determined in paragraph (1) for each of the Hospital and Related Services Index and the Medical Care Services Index shall be determined.
(3)
A weighted average annual percentage change for each year-to-year period shall be calculated from the determinations made in paragraph (2), with the percentage changes in the Hospital and Related Services Index weighted at 75 percent, and the percentage changes in the Medical Care Services Index weighted at 25 percent. The resulting average annual percentage changes shall be expressed as a fraction, and increased by 1.00.
(4)
The product of the successive year-to-year amounts determined in paragraph (3) shall be the blended CPI trend factor.
(c)
“Calculated cost per person” is determined by dividing county indigent program costs by the number of indigent program individuals for the applicable fiscal year. If a county expands eligibility, the enrollment count is limited to those indigent program individuals who would have been eligible for services under the eligibility requirements in existence on July 1, 2013, except if approved as an exception allowed pursuant to paragraph (3) of subdivision (d).
(d)
“Cost containment limit” means the county’s indigent program costs determined for the 2014–15 fiscal year and each subsequent fiscal year, to be adjusted as follows:
(1)
(A)
The county’s indigent
program costs for the state fiscal year shall be determined as indigent program costs for purposes of this paragraph for the relevant fiscal period.
(B)
The county’s calculated costs per person for the base year will be multiplied by the blended CPI trend factor and then multiplied by the county’s fiscal year indigent program individuals. The base year costs used shall not reflect any adjustments under this subdivision.
(C)
The fiscal year amount determined in subparagraph (A) shall be compared to the trended amount in subparagraph (B). If the amount in subparagraph (B) exceeds the amount in subparagraph (A), the county will be deemed to have satisfied the cost containment limit. If the amount in subparagraph (A) exceeds the amount in subparagraph (B), the calculation in paragraph (2) shall be performed.
(2)
If a
county’s costs as determined in subparagraph (A) of paragraph (1) exceed the amount determined in subparagraph (B) of paragraph (1), the following costs, as allocated to the county’s indigent care program, shall be added to the cost and reflected in any containment limit:
(A)
Costs related to state or federally mandated activities, requirements, or benefit changes.
(B)
Costs resulting from a court order or settlement.
(C)
Costs incurred as a result of a natural disaster or act of terrorism.
(3)
If a county’s costs as determined in subparagraph (A) of paragraph (1) exceed the amount determined in subparagraph (B) of paragraph (1), as adjusted by
paragraph (2), the county may request that the department consider other costs as adjustments to the cost containment limit. These costs would require departmental approval.
(e)
“County” for purposes of this article means the following counties: Fresno, Merced, Orange, Placer, Sacramento, San Diego, San Luis Obispo, Santa Barbara, Santa Cruz, Stanislaus, Tulare, and Yolo. Beginning in the 2019–20 fiscal year and for each fiscal year thereafter, “county” does not include the County of Yolo.
(f)
“County indigent care health realignment amount” means the product of the health realignment amount times the health realignment indigent care percentage, as computed on a county-specific basis.
(g)
“County savings
determination process” means the process for determining the amount to be redirected in accordance with Section 17613.1, as calculated pursuant to subdivision (a) of Section 17613.3.
(h)
“Department” means the State Department of Health Care Services.
(i)
“Health realignment amount” means the amount that, in the absence of this article, would be payable to a county under Section 17603, as it read on January 1, 2012, Section 17604, as it read on August 1, 2017, Section 17606.20, as it read on August 1, 2019, and Section 17606.10, as it read on July 1, 2013, for the fiscal year that is deposited by the Controller into the local health and welfare trust fund health account of the county.
(j)
“Health realignment indigent care percentage” means the county-specific percentage determined in accordance with the following, and established in accordance with the procedures described in subdivision (c) of Section 17613.3:
(1)
Each county shall identify the portion of that county’s health realignment amount that was used to provide health
services to the indigent, including the indigent program individuals, for each of the historical fiscal years, along with verifiable data in support thereof.
(2)
The amounts identified in paragraph (1) shall be expressed as a percentage of the health realignment amount of that county for each fiscal year of the historical fiscal years.
(3)
The average of the percentages determined in paragraph (2) shall be the county’s health realignment indigent care percentage.
(4)
To the extent a county does not provide the information required in paragraph (1) or the department determines that the information required is insufficient, the amount under this subdivision shall be considered to be 85 percent.
(k)
All references to “health services” or “health care
services,” unless specified otherwise, shall exclude mental health and substance use disorder services.
(
l
)
“Historical fiscal years” means the fiscal years 2008–09 to 2011–12, inclusive.
(m)
“Imputed county low-income health amount” means the predetermined, county-specific amount of county general purpose funds assumed, for purposes of the calculation in Section 17613.3, to be available to the county for services to indigent program individuals. The imputed county low-income health amount shall be determined as set forth below and established in accordance with subdivision (c) of Section 17613.3:
(1)
For each of the historical fiscal years, an amount shall be determined as the annual amount of county general fund contribution provided for health services to the indigent, which does not include funds provided for mental health and substance use disorder services, through a methodology to be developed by the department, in consultation with the California State Association of Counties.
(2)
If a year-to-year percentage increase in the amount determined in paragraph (1) was present, an average annual percentage trend factor shall be determined.
(3)
The annual amounts determined in paragraph (1) shall be averaged and multiplied by the
percentage trend factor, if applicable, determined in paragraph (2), for each fiscal year after the 2011–12 fiscal year through the applicable fiscal year. Notwithstanding the foregoing, if the percentage trend factor determined in paragraph (2) is greater than the applicable percentage change for any year of the same period in the blended CPI trend factor, the percentage change in the blended CPI trend factor for that year shall be used. The resulting determination is the imputed county low-income health amount for purposes of Section 17613.3.
(n)
“Indigent program costs” means the costs incurred by the county for purchasing, providing, or ensuring the availability of services to indigent program individuals during the fiscal year. The costs for mental health and substance use disorder services shall not be included in these costs.
(o)
“Indigent program individuals” means all
individuals enrolled in a county indigent health care program at any point throughout the fiscal year. If a county does not enroll individuals into an indigent health care program, indigent program individuals shall mean all individuals who used services offered through the county indigent health care program in the fiscal year.
(p)
“Indigent program revenues” means self-pay payments made by or on behalf of indigent program individuals to the county for the services rendered in the fiscal year, but shall exclude revenues received for mental health and substance use disorder services.
(q)
“Redirected amount” means the amount to be redirected in accordance with Section 17613.1, as calculated pursuant to subdivision (a) of Section 17613.3.
(r)
“Special local health funds” means the amount of the following county funds
received by the county for health services to indigent program individuals during the fiscal year and shall include funds available pursuant to the Master Settlement Agreement and related documents entered into on November 23, 1998, by the state and leading United States tobacco product manufacturers during a fiscal year. The amount of the tobacco settlement funds to be used for this purpose shall be the greater of paragraph (1) or (2), less any bond payments and other costs of securitization related to the funds described in this subdivision.
(1)
The amount of the funds expended by the county for the provision of health services to indigent program individuals during the fiscal year.
(2)
The amount of the tobacco settlement funds multiplied by the average of the percentages of the amount of tobacco settlement funds that were allocated to and expended by the county for health
services to indigent program individuals during the historical fiscal years.
