就本条而言,以下定义适用:
(a)CA 福利和机构 Code § 17613.2(a) “基准年”是指计算重新分配金额的财政年度之前的第三个财政年度。
(b)CA 福利和机构 Code § 17613.2(b) “综合消费者物价指数趋势因子”是指适用于该财政年度的综合百分比变化,该变化来源于美国劳工统计局发布的未经季节性调整的全体城市消费者物价指数 (CPI-U)(美国城市平均),其中医院及相关服务权重为75%,医疗服务权重为25%,计算方法如下:
(1)CA 福利和机构 Code § 17613.2(b)(1) 对于需通过州财政年度进行趋势分析的期间内的每个之前的财政年度,应分别确定医院及相关服务指数和医疗服务指数的月度指数金额的年度平均值。
(2)CA 福利和机构 Code § 17613.2(b)(2) 应确定第 (1) 款中确定的医院及相关服务指数和医疗服务指数各自的年度间百分比变化。
(3)CA 福利和机构 Code § 17613.2(b)(3) 应根据第 (2) 款的确定结果计算每个年度间期间的加权平均年度百分比变化,其中医院及相关服务指数的百分比变化权重为75%,医疗服务指数的百分比变化权重为25%。由此产生的平均年度百分比变化应表示为分数,并增加1.00。
(4)CA 福利和机构 Code § 17613.2(b)(4) 第 (3) 款中确定的连续年度间金额的乘积即为综合消费者物价指数趋势因子。
(c)CA 福利和机构 Code § 17613.2(c) “人均计算成本”是通过将县级贫困人口项目成本除以适用财政年度的贫困人口项目个人数量来确定的。如果一个县扩大了资格,则登记人数仅限于根据2013年7月1日存在的资格要求有资格获得服务的贫困人口项目个人,除非经批准作为根据 (d) 款第 (3) 项允许的例外情况。
(d)CA 福利和机构 Code § 17613.2(d) “成本控制上限”是指为2014-15财政年度及此后的每个财政年度确定的县级贫困人口项目成本,并按以下方式调整:
(1)Copy CA 福利和机构 Code § 17613.2(d)(1)
(A)Copy CA 福利和机构 Code § 17613.2(d)(1)(A) 州财政年度的县级贫困人口项目成本应作为本款目的的相关财政期间的贫困人口项目成本确定。
(B)CA 福利和机构 Code § 17613.2(d)(1)(A)(B) 县级基准年的人均计算成本将乘以综合消费者物价指数趋势因子,然后再乘以县级财政年度贫困人口项目个人数量。所使用的基准年成本不应反映本分项下的任何调整。
(C)CA 福利和机构 Code § 17613.2(d)(1)(A)(C) 应将 (A) 项中确定的财政年度金额与 (B) 项中的趋势金额进行比较。如果 (B) 项中的金额超过 (A) 项中的金额,则该县将被视为已满足成本控制上限。如果 (A) 项中的金额超过 (B) 项中的金额,则应执行第 (2) 款中的计算。
(2)CA 福利和机构 Code § 17613.2(d)(2) 如果县级根据第 (1) 款 (A) 项确定的成本超过第 (1) 款 (B) 项确定的金额,则以下分配给县级贫困人口医疗项目的成本应计入成本并反映在任何控制上限中:
(A)CA 福利和机构 Code § 17613.2(d)(2)(A) 与州或联邦强制性活动、要求或福利变更相关的成本。
(B)CA 福利和机构 Code § 17613.2(d)(2)(B) 因法院命令或和解产生的成本。
(C)CA 福利和机构 Code § 17613.2(d)(2)(C) 因自然灾害或恐怖主义行为而产生的成本。
(3)CA 福利和机构 Code § 17613.2(d)(3) 如果县级根据第 (1) 款 (A) 项确定的成本超过第 (1) 款 (B) 项确定的金额(经第 (2) 款调整后),则该县可以请求部门将其他成本视为对成本控制上限的调整。这些成本需要部门批准。
(e)CA 福利和机构 Code § 17613.2(e) 就本条而言,“县”是指以下县:弗雷斯诺、默塞德、奥兰治、普莱瑟、萨克拉门托、圣迭戈、圣路易斯奥比斯波、圣巴巴拉、圣克鲁斯、斯坦尼斯劳斯、图莱里和约洛。从2019-20财政年度开始及此后的每个财政年度,“县”不包括约洛县。
(f)CA 福利和机构 Code § 17613.2(f) “县级贫困人口医疗健康重组金额”是指健康重组金额乘以健康重组贫困人口医疗百分比的乘积,按县级特定基础计算。
(g)CA 福利和机构 Code § 17613.2(g) “县级节余确定流程”是指根据第 17613.1 条确定应重新分配金额的流程,该金额根据第 17613.3 条 (a) 款计算。
(h)CA 福利和机构 Code § 17613.2(h) “Department” means the State Department of Health Care Services.
(i)CA 福利和机构 Code § 17613.2(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)CA 福利和机构 Code § 17613.2(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)CA 福利和机构 Code § 17613.2(j)(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)CA 福利和机构 Code § 17613.2(j)(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)CA 福利和机构 Code § 17613.2(j)(3) The average of the percentages determined in paragraph (2) shall be the county’s health realignment indigent care percentage.
(4)CA 福利和机构 Code § 17613.2(j)(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)CA 福利和机构 Code § 17613.2(k) All references to “health services” or “health care
services,” unless specified otherwise, shall exclude mental health and substance use disorder services.
(l)CA 福利和机构 Code § 17613.2(l) “Historical fiscal years” means the fiscal years 2008–09 to 2011–12, inclusive.
(m)CA 福利和机构 Code § 17613.2(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)CA 福利和机构 Code § 17613.2(m)(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)CA 福利和机构 Code § 17613.2(m)(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)CA 福利和机构 Code § 17613.2(m)(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)CA 福利和机构 Code § 17613.2(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)CA 福利和机构 Code § 17613.2(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)CA 福利和机构 Code § 17613.2(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)CA 福利和机构 Code § 17613.2(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)CA 福利和机构 Code § 17613.2(r) “特别地方卫生基金”是指县在财政年度内为贫困项目个人提供卫生服务所收到的以下县级资金的金额,并应包括根据州与美国主要烟草产品制造商于1998年11月23日签订的《主和解协议》及相关文件在财政年度内可用的资金。用于此目的的烟草和解资金金额应为(1)款或(2)款中的较大者,减去与本分节所述资金相关的任何债券支付和其他证券化成本。
(1)CA 福利和机构 Code § 17613.2(r)(1) 县在财政年度内为贫困项目个人提供卫生服务所支出的资金金额。
(2)CA 福利和机构 Code § 17613.2(r)(2) 烟草和解资金金额乘以县在历史财政年度内为贫困项目个人提供卫生服务所分配和支出的烟草和解资金金额百分比的平均值。