Section 5023.5 Of Chapter 1. The Department Of Corrections And Rehabilitation From California Penal Code >> Title 7. >> Part 3. >> Chapter 1.
5023.5
. (a) Notwithstanding any other law, the Department of
Corrections and Rehabilitation may contract with providers of health
care services and health care network providers, including, but not
limited to, health plans, preferred provider organizations, and other
health care network managers. Hospitals that do not contract with
the department for emergency health care services shall provide these
services to the department on the same basis as they are required to
provide these services pursuant to Section 489.24 of Title 42 of the
Code of Federal Regulations. The department may only reimburse a
noncontract provider of hospital or physician services at a rate
equal to or less than the amount payable under the Medicare Fee
Schedule, regardless of whether the hospital is located within or
outside of California.
(b) An entity that provides ambulance or any other emergency or
nonemergency response service to the department, and that does not
contract with the department for that service, shall be reimbursed
for the service at the rate payable under the Medicare Fee Schedule,
regardless of whether the provider is located within or outside of
California.
(c) Until regulations or emergency regulations are adopted in
accordance with subdivision (g), the department shall not reimburse a
contract provider of hospital services at a rate that exceeds 130
percent of the amount payable under the Medicare Fee Schedule, a
contract provider of physician services at a rate that exceeds 110
percent of the amount payable under the Medicare Fee Schedule, or a
contract provider of ambulance services at a rate that exceeds 120
percent of the amount payable under the Medicare Fee Schedule. The
maximum rates established by this subdivision shall not apply to
reimbursement for administrative days, transplant services, services
provided pursuant to competitively bid contracts, or services
provided pursuant to a contract executed prior to September 1, 2009.
(d) The maximum rates set forth in this section shall not apply to
contracts entered into through the department's designated health
care network provider, if any. The rates for those contracts shall be
negotiated at the lowest rate possible under the circumstances.
(e) The department and its designated health care network provider
may enter into exclusive or nonexclusive contracts on a bid or
negotiated basis for hospital, physician, and ambulance services
contracts.
(f) The Secretary of the Department of Corrections and
Rehabilitation may adopt regulations to implement this section.
During the existence of the receivership established in United States
District Court for the Northern District of California, Case No.
C01-1351 TEH, Plata v. Schwarzenegger, the adoption, amendment, or
repeal of a regulation authorized by this section is hereby exempted
from the rulemaking provisions of the Administrative Procedure Act
(Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code).
(g) The secretary may change the maximum rates set forth in this
section by regulation or emergency regulation, adopted in accordance
with the Administrative Procedure Act, but no sooner than 30 days
after notification to the Joint Legislative Budget Committee. Those
changes may include, but are not limited to, increasing or decreasing
rates, or adding location-based differentials such as those provided
to small and rural hospitals as defined in Section 124840 of the
Health and Safety Code. The adoption, amendment, repeal, or
readoption of a regulation authorized by this section is deemed to
address an emergency, for purposes of Sections 11346.1 and 11349.6 of
the Government Code, and the secretary is hereby exempted for this
purpose from the requirements of subdivision (b) of Section 11346.1
of the Government Code.
(h) During the existence of the receivership established in United
States District Court for the Northern District of California, Case
No. C01-1351 TEH, Plata v. Schwarzenegger, references in this section
to the "secretary" shall mean the receiver appointed in that action.