Proposition 86			00.00 10/05
	Full Extract
	Submitted as: "The Tobacco Tax Act Of 2006"
	Type:  Amendments, to the California Constitution, Revenue and Taxation Code, Health and Safety Code, Insurance Code, and Welfare and Institutions Code
	Subject:  Special tax on cigarettes to support various medical projects.
	Submitters:  Paul Knepprath, for the Coalition for a Healthy California
	Supporting Organization:
		Name:	Coalition For A Healthy California 555 Capitol Mall #1425 Sacramento, CA 95814
		Email: info at healthycalifornia.com
		Web Site: www.yesonprop86.com
		Phone: 916.448.2720
	Opposing Organization:
		Name:	Californians Against Unaccountable Taxes 1415 L Street, Suite 1250 Sacramento, CA 95814
		Email: info at noprop86.org
		Web Site:  www.noprop86.org
		Phone: 916.708.6811
	Section 1 Statement of Findings
	[Discussion of the problem.]
	Section 2 Statement of Purpose
	[What this tax will do to fix the problem.]
	Section 3 Tobacco Tax
	Adds a new Article 4, under Chapter 2 of Part 13 of Division 2 of the Revenue and Taxation Code
	30132 Creates The Tobacco Tax of 2006 Trust Fund ("Tobacco Trust Fund") in the State Treasury, to receive all revenue generated under this article.  The money in the Fund is "continuously appropriated" and allocated as described in 30132.3 below.
	30132.1 (a) Declares that, in addition to existing taxes on cigarettes, a new one shall be imposed, at the rate of 13 cents for each cigarette distributed.  [Per Section 30123 (b) of this Code, the tax on other tobacco products is also raised proportionately.]
	30132.1 (b) Defines cigarette as it was defined in Section 30003 of this Code on 1/1/05.  [Cigarette means "any  roll for smoking, made wholly or in part of tobacco, irrespective of size or shape and irrespective of whether the tobacco is flavored, adulterated or mixed with any other ingredient, where such roll has a wrapper or cover made of paper or any other material, except where such wrapper is wholly or in the greater part made of tobacco and such roll weighs over three pounds per thousand."]
	30132.1 (c) Declares that the new tax will be imposed starting January 1, 2007.
	30132.2 The State Board of Equalization is assigned the task of determining the annual effect that this new tax has on the consumption of cigarettes and tobacco products.  The Board will determine the extent to which this new tax reductes that consumption and thereby reduces the tax revenue that would otherwise go to the California Children and Families First Trust Fund that was created by Proposition 10 in 1998.  That revenue will be made up by transfers from the Tobacco Trust Fund.
	30132.3 Specifies that all money raised by this new tax is to be deposited in the Tobacco Trust Fund, with the exception of some listed reimbursements.  Money is to be allocated and appropriated from the Tobacco Trust Fund as follows:  [NOTE that, since the actual amount that the tax will raise is not known, these allocations are provided as percents of the total amount available.]
	30132.3 (a)  5% to the Health and Disease Research Account, which is hereby created.  This amount is allocated to sub-accounts as follows:
	30132.3 (a) (1) 34% to a Tobacco Control Research Sub-account, which is hereby created, to be continuously appropriated to the University of California to be used solely to supplement the Tobacco Related Disease Research Program.  Specific purposes are:
		(A) Research to improve the effectiveness of tobacco control efforts in California.
		(B) Research on the prevention, causes, and treatment of tobacco-related diseases.
	30132.3 (a) ( 2) 14.50% to a Cancer Registry Sub-account, which is hereby created, to be continuously appropriated to the Department of Health Services to be used solely for a statewide population-based cancer surveillance system.
	30132.3 (a) (3)  25.75% to a Breast Cancer Research Sub-account, which is hereby created, to be continuously appropriated to the University of California to be used solely for the Breast Cancer Research Program.
	30132.3 (a) (4)  14.75% to a Cancer Research Sub-account, which is hereby created, to be continuously appropriated to the Department of Health Services to be used solely for the Cancer Research Program.
	30132.3 (a) (5)  11% to a Lung Cancer and Lung Disease Research Sub-Account, which is hereby created to be continuously appropriated to the University of California to be used solely to provide research grants to develop and advance the understanding of lung disease.
	30132.3 (b)  42.25% to the Health Maintenance and Disease Prevention Account, which is hereby created,  This amount is allocated to sub-accounts as follows:
	30132.3 (b) (1) 6.75% to a Tobacco Control Media Campaign Sub-account, which is hereby created, to be continuously appropriated to the Department of Health Services to be used solely for media advertisements and public relations programs to prevent and reduce the use of tobacco products.
	30132.3 (b) (2)  4.50% to a Tobacco Control Competitive Grants Sub-account, which is hereby created, be continuously appropriated to the Department of Health Services to be used solely for the competitive grants program directed at the prevention of tobacco-related diseases.
	30132.3 (b) (3)  4.25% to a Local Health Department Tobacco Prevention Sub-account, which is hereby created, to be continuously appropriated to the Department of Health Services to be used solely for local-health-department-based programs to prevent tobacco use.
	30132.3 (b) (4)  0.50% to a Tobacco Control Evaluation Sub-account, which is hereby created, to be continuously appropriated to the Department of Health Services to be used solely for evaluation of tobacco control programs.
	30132.3 (b) (5)  3.50% to a Tobacco Education Sub-account, which is hereby created, to be continuously appropriated to the Department of Education to be used solely for programs to prevent or reduce the use of tobacco products.  At least [sic] 2% of the money in the Tobacco Education Sub-Account shall be used solely for administration of the Department's tobacco prevention education program.
	30132.3 (b) (6)  2.25% to a Tobacco Control Enforcement Sub-Account, which is hereby created, to be used solely for programs to enforce tobacco-related statutes and policies, to enforce legal settlement provisions, and to conduct law enforcement training and technical assistance activities, and must be appropriated as follows:
		(A) 50% to be continuously appropriated to the Department of Health Services for grants to law enforcement for training to enforce tobacco laws..
		(B)  25% to be continuously appropriated to the California Office of the Attorney General to be used to support enforcement of tobacco laws at the wholesale level.
		(C)   25%) to be continuously appropriated to the State Board of Equalization to be used to enforce laws that regulate the distribution and sale of cigarettes and other tobacco products.
	30132.3 (b) (7)  8% to a Breast and Cervical Cancer Early Detection Sub-Account, which is hereby created, to be continuously appropriated to the Department of Health Services to be used solely for breast and cervical cancer prevention and early detection services that result in the reduction of breast and cervical cancer morbidity and mortality in California.
	30132.3 (b) (8)  8.50% to a Heart Disease and Stroke Prevention Sub-Account, which is hereby created, to be continuously appropriated to the Department of Health Services to be used solely for the California Heart Disease and Stroke Prevention Program.  [The California Heart Disease and Stroke Prevention Program is created by Section 5 of this Initiative.]
	30132.3 (b) (9)  7.75% to an Obesity Prevention, Nutrition and Physical Activity Promotion Sub-account, which is hereby created, to be further allocated as follows:
		(A) 70% to be continuously appropriated to the Department of Health Services to support programs and activities to be used solely to prevent obesity, diabetes and chronic diseases through the promotion of community norm change, healthy eating and physical activity.
		(B) 30% to be continuously appropriated to the Department of Education to be used solely to design, develop and support programs and activities to prevent obesity, diabetes and chronic diseases through the promotion of, and access to, healthy eating and physical activity for children and their families within the context of coordinated school health.
		(C) The Department of Health Services, in consultation with the Department of Education, shall establish a 13 member Oversight Committee, with expertise pertinent to the purposes of this Sub-Account.  The Committee will advise the Department of Health Services and the State Department of Education with regard to the programs funded by this Sub-account.
	30132.3 (b) (10)  4.25% to an Asthma Prevention and Control Sub-account, which is hereby created, to be used solely to provide support for asthma suffers, allocated as follows:
		(A)  60% to be continuously appropriated to the Department of Health Services to fund programs and services to guide the development of public health programs and asthma policy.
		(B)  40% to be continuously appropriated to the Department of Education to improve the management of asthma within the school setting.
	30132.3 (b) (11)  4.25% to a Colorectal Cancer Sub-account, which is hereby created, to be continuously appropriated to the Department of Health Services to be used solely for the Colorectal Cancer Prevention, Detection and Treatment Program.  At least 40% shall be used for non-clinical public health components.  [The Colorectal Cancer Prevention, Detection and Treatment Program is created in Section 4 of this Initiative.]
	30132.3 (b) (12)  45.50% to a California Healthy Kids Sub-account, which is hereby created "to ensure that every child in California is eligible for comprehensive, affordable health insurance and has access to needed health care."   No less than 90% shall be used to implement Section 12693.99 of the Insurance Code; no more than 10% shall be used to implement Section 12693.991 of the Insurance Code.  [12693.99 and 12693.991 are added by this Initiative; see below.]
	30132.3 (c)  52.75% to the Health Treatment and Services Account, which is hereby created.  This amount is allocated to sub-accounts as follows:
	30132.3 (c) (1) 1.75% to a Tobacco Cessation Services Sub-Account, which is hereby created, to be continuously appropriated to the Department of Health Services to be used solely to provide tobacco cessation programs and services to assist adult and minor tobacco users to quit tobacco.
	30132.3 (c) (2) 1.75% to a Prostate Cancer Treatment Sub-Account, which is hereby created, to be continuously appropriated to the Department of Health Services to be used solely to provide for prostate cancer prevention and treatment for low income and uninsured men.
	30132.3 (c) (3)  5.75% to a Community Clinics Uninsured Sub-Account, which is hereby created, to be continuously appropriated to the Department of Health Services to fund nonprofit clinic corporations providing vital health care service to the uninsured.
	30132.3 (c) (4) (i)  5.75% to an Emergency Care Physician Services Sub-account, which is hereby created, be continuously appropriated to the Department of Health Services to be administered and allocated for distribution through the California Healthcare for Indigents Program (CHIP).
	30132.3 (c) (4) (ii)  0.75% to the Rural Emergency Care Physician Services Sub-account, which is hereby created, to be continuously appropriated to the Department of Health Services to be administered and allocated for distribution through the Rural Health Services Program (RHSP).
	30132.3 (c) (4) (iii)   The funds allocated in (i) and (ii) above shall be used only for reimbursement of doctors for losses incurred in providing uncompensated emergency services in general acute care hospitals providing basic, comprehensive or standby emergency services.  Payment to these doctors is strictly regulated under other Sections of the Welfare and Institutions Code.
	30132.3 (c) (5)  0.75% to a Medically Underserved Account, as created by Business and Professions Code section 2154.4, to be continuously appropriated to the Medical Board of California to promote medical care to low-income patients in areas of the state underserved by physicians, pursuant to the Steven M. Thompson Physician Corps Loan Repayment Program.
	30132.3 (c) (6) 9% to a Nursing Workforce Education Sub-Account, which is hereby created, to be continuously appropriated to the Office of Statewide Health Planning and Development to be used solely to expand nursing education opportunities and capabilities to meet nursing workforce demands, to be further allocated as follows:
		(A)  86% shall be used to support the expansion of California Board of Registered Nursing ("BRN") -approved registered nurse education pre-licensure programs, and to support the expansion of graduate nursing education programs (MSN, DNSc/PhD), and to support California Advanced Practice Registered Nurse Programs at the California State University and the University of California.
		(B) 14% shall be used to support the expansion of BRN-approved privately operated registered nurse education pre-licensure programs, the expansion of privately operated graduate nursing education programs (MSN, DNSc/Ph.D.), and to support the expansion of privately operated California Advanced Practice Registered Nurse Programs.
	30132.3 (c) (7)  74.50% to an Emergency and Trauma Hospital Services Sub-Account, which is hereby created, to be continuously appropriated to the Department of Health Services to further the provision of hospital and medical services to emergency patients in California, as described starting in Section 1797.300 of this Code.  {1797.300 is added by this Initiative.]
	30132.4  All the money allocated and deposited to the accounts and sub-accounts specified in 30132.3 must be spent as specified for each one.  Contrary to Government Code section 13340, money not spent in a fiscal period specified by law will remain in the same account or sub-account to be available for use in the next fiscal period.  [13340 says "on and after July 1, 2007, no moneys in any fund that, by any statute other than a Budget Act, are continuously appropriated without regard to fiscal years, may be encumbered unless the Legislature, by statute, specifies that the moneys in the fund are appropriated for encumbrance."]
	30132.5 (a) Money raised by this tax is to be used in addition to existing expenditures, not to replace them.
	30132.5 (b) Adding detail to (a), money raised by this tax may specifically not be used to replace:
	30132.5 (b) (1) Local funds used to secure state or federal matching funds for any children's health services, children's health, or medical assistance programs.
	30132.5 (b) (2) State funds used to secure federal matching funds for any children's health services, children's health, or medical assistance programs, specifically mentioning:
		(A)  Healthy Families
		(B)  Medi-Cal
		(C)  The Child Health and Disability Prevention Program
	30132.5 (b) (3) State or federal funds to continue or maintain benefits that existed as of September 30, 2005 for any children's health services, children's health, or medical assistance programs, specifically mentioning:
		(A)  Healthy Families
		(B)  Medi-Cal
		(C)  The Child Health and Disability Prevention Program
	30132.5 (c) States "the intent of the people of the State of California" that this initiative shall maximize, and not reduce, federal matching funds made available to the State for children's health coverage under Title XIX and/or Title XXI of the Social Security Act.
	30132.5 (d) State and local government agencies are forbidden to include the payments for emergency services provided for by this initiative as payment on behalf of patients who are government-sponsored or the responsibility of a governmental agency or body.
	30132.6 Contrary to any other provision of law, money in the money deposited in the Tobacco Tax of 2006 Trust Fund cannot be borrowed by any other fund to be used for purposes other than those authorized by the Initiative.
	30132.7 Because of the urgency in adopting this Initiative, contracts fulfilling conditions of paragraphs 30132.3 (b) (7 to 11), and paragraph 30132.3 (c) (2) need not satisfy the requirements of the Public Contract Code, Part 2, "for the first five full years after enactment" of the Initiative.  [Part 2 is the State Contract Act, and sets standards for Plans and Specifications, Bids and Bidders, Award of Contracts, and Payment.]
	30132.8 No less than 2% of the money appropriated to the Department of Health Services, in accord with paragraphs 30132.3 (b) (1 to 4 and also 6), and 30132.3 (c) (1) must be used solely for administration of the Department's tobacco control programs.
	30132.9 Money raised under this Initiative may be used to may be used to maximize federal matching funds that are used for the purposes of the Initiative.
	30132.10 Full public accountability will be accomplished by:
	30132.10 (a) Having the Department of Health Services prepare a report of expenditures to be available on its website, by March 31 of each year.
	30132.10 (b) Having all programs and departments receiving money be audited by the Bureau of State Audits.
	30132.10 (c) Restricting the administrative costs for any Account or sub-account to 5% or less.
	Section 4 Colorectal Cancer Prevention, Detection, and Treatment
	Adds a new Article 2.7, under Chapter 2 of Part 1 of Division 103 of the Health and Safety Code
	104195 The Colorectal Cancer Prevention, Detection, and Treatment Program shall be established within the State Department of Health Services.
	104915.1 The Program shall apply to both of these groups:
	104915.1 (a) Uninsured and underinsured persons 50 years of age and older with incomes at or below 200% of the federal poverty level.
	104915.1 (B) Uninsured and underinsured persons below 50 years of age at high risk for colorectal cancer and who have incomes at or below two hundred percent (200%) of the federal poverty level.
	104915.2 Services provided will be at least:
	104915.2 (a) Screening of men and women for colorectal cancer as an early detection health care measure.
	104915.2 (b) After screening, medical referral of the screened person, and services necessary for a definitive diagnosis.
	104915.2 (c) If a positive diagnosis is made, then provision of assistance and advocacy to help the person obtain necessary treatment.
	104915.2 (d) Necessary treatment.
	104915.2 (e) Outreach and health education activities to ensure that uninsured and underinsured persons are aware of, and appropriately utilize, the services provided by the program.
	104915.3 The Department shall award one or more contracts to provide colorectal cancer screening and treatment through private or public nonprofit organizations,
	Section 5 Heart Disease and Stroke Prevention Program
	Adds a new Section 104142 under Chapter 1 of Part 1 of Division 103 of the Health and Safety Code
	104142 The California Heart Disease and Stroke Prevention Program (CHDSP) is hereby created in the State Department of Health Services.
	104142 (a) The Program will do at least the following:
	104142 (a) (1) Conduct programs to prevent and reduce risk factors for cardio vascular disease.
	104142 (a) (2) Design, implement, and support programs to improve disease treatment and management.
	104142 (a) (3) Promote and support medical professional development for the prevention and treatment of cardio vascular disease.
	104142 (a) (4) Collect, analyze, and publish data on cardio vascular disease.
	104142 (a) (5) Guide the development of public health policies to improve health outcomes from cardio vascular disease.
	104142 (a) (6) Conduct a statewide public education campaign that focuses on the incidence, signs, symptoms, and risk factor reduction strategies for cardio vascular disease.
	104142 (b) The Department shall give priority consideration to the recommendations of the Heart Disease and Stroke Prevention and Treatment Task Force.
	104142 (c) The Department may authorize cardio vascular disease research.
	104142 (d) Nothing in this section shall duplicate other programs in the department.
	Section 6 Children's Health
	Adds a new Chapter 17 under Part 6.2 of Division 2 of the Insurance Code
	12693.99 (a) Indicates that all children in California, as described in (b) will be eligible for the California Healthy Families Program.
	12693.99 (b) All children under 19 years of age shall be eligible  under this Chapter, contrary to the current limits made by paragraph 12693.70 (a) (4) and Section 12693.73, if they meet all of the following: [12693.70(a)(4) and 12693.73 require the child to meet citizenship and immigration status requirements; this Initiative removes that requirement.]
	12693.99 (b) (1) Are in families with household income up to and including 300 percent of the federal poverty level.
	12693.99 (b) (2) Meet the state residency requirements of Healthy Families in place as of September 30, 2005.
	12693.99 (b) (3) Are in compliance with Sections 12693.71 and 12693.72 [These sections require that the child not be covered by other insurance coverage.]
	12693.99 (b) (4) Are not eligible for Healthy Families, or for full-scope Medi-Cal
	12693.99 (c) The confidentiality and privacy protections set forth in Sections 10500 and 14100.2 of the Welfare and Institutions Code shall apply to all children seeking, applying for or enrolled in Healthy Families.[10500 requires courtesy toward patients; 14100.2 requires information to kept confidential.]
	12693.99 (d) Families of children enrolled in Healthy Families through this Chapter shall be required to contribute premiums equal to those required of families of children enrolled in Healthy Families not through this Chapter, with the following exceptions:
	12693.99 (d) (1) Families not required to contribute premiums are: Families of children 18 years of age or less who apply for or are enrolled in Healthy Families and whose household incomes are 100 percent or less of the federal poverty level (FPL); families of children one year of age or less who apply for or are enrolled in Healthy Families and whose countable household incomes are 200 percent or less of the federal poverty level; and families of children six years of age or less who apply for or are enrolled in Healthy Families and whose countable household incomes are 133 percent or less of the federal poverty level.
	12693.99 (d) (2) Families of children enrolled in Healthy Families whose household incomes are between 250 and 300 percent of the federal poverty level shall contribute premiums at 150 percent of the premium rate required for children whose household incomes are between 200 and 250 percent of the federal poverty level.  The discounts that apply to the latter shall also apply to the former.
	12693.99 (e) The Legislature may enact less restrictive eligibility requirements than those specified in (b).
	12693.991 (a) The Managed Risk Medical Insurance Board and the State Department of Health Services ("administering agencies") shall continue to administer the Healthy Families and Medi-Cal programs, respectively, for all eligible children.
	12693.991 (b) The administering agencies, in consultation with the Healthy Kids Oversight and Accountability Commission, shall design and implement streamlined application, enrollment and retention procedures and mechanisms for all benefits available under Healthy FamiIies and Medi-Cal.  From the child's perspective there shall appear to be a single program.  To ensure that all children who are eligible receive health insurance the administering agencies will do at least the following:
	12693.991 (b) (1) Simplify paperwork requirements for families to enroll their children and retain coverage.
	12693.991 (b) (2) Speed up enrollment by offering enrollment through existing entry points and by implementing an electronic gateway system to process that enrollment.
	12693.991 (b) (3) Develop a plan to ensure that eligible, enrolled children do not experience a gap in benefits and to ensure continuity of medical care for children when renewing or transferring between Medi-Cal and Healthy Families, or from a local children's health insurance program ("local CHI").
	12693.991 (b) (4) "Facilitate outreach and education to current and potential beneficiaries, applicants, health care providers, and insurers."
	12693.991 (b) (5) In coordination with the Healthy Kids Oversight and Accountability Commission, do a pilot research demonstration project to test effective strategies, and gather data about the impact of specific efforts, to increase coverage for uninsured children in families with incomes above 300 percent of the federal poverty level; and recommend to the Legislature strategies for increasing coverage for this population based upon the pilot research demonstration project results.
	12693.991 (b) (6) In coordination with the Healthy Kids Oversight and Accountability Commission, create a process for ensuring a smooth transition for local CHI enrollees to Healthy Families. The process should ensure that children who apply for and are determined to be eligible for Healthy Families, and who are enrolled in a local CHI both as of enactment of this Chapter and as of the child's Healthy Families eligibility determination, shall be automatically entered into the child's existing local CHI health plan under Healthy Families, if the health plan is a participating plan in Healthy Families.  For good cause or upon the child's next annual renewal, a child may switch plans or otherwise remain in his/her existing plan.
	12693.991 (b) (7) Maximize federal matching funds available for eligible children's health insurance under Medi-Cal and Healthy Families and implement strategies to do the same.
	12693.991 (b) (8) Take any additional steps necessary to ensure that from a child's perspective, Medi- cal and Healthy Families operate as a single program.
	12693.991 (c) The Healthy Kids Oversight and Accountability Commission is established, which shall: guide the implementation and administration of this Chapter; advise the administering agencies on how best to provide affordable health insurance for all children; review financial audits of the children's Medi-Cal and Healthy Families programs by the Bureau of State Audits; and identify inefficient practices or waste in the administration or operation of Healthy Families and Medi- cal and direct any savings back into providing health insurance for more children.
	12693.991 (c) (1) The Commission shall consist of 15 members with specific expertise and shall include representatives from the following categories:
		(A)  Consumers.
		(B)  Consumer Advocates
		(C)  Health care providers
		(D)  Health plans, and
		(E)  Other stakeholders
	12693.991 (c) (2) The Speaker of the Assembly, the Senate President Pro Tempore, and the Governor shall each appoint five commissioners, one commissioner from each of the five categories.
	12693.991 (c) (3) Members shall serve without compensation, except for reimbursement of expenses incurred in the performance of their duties.
	12693.991 (c) (4) Terms shall be three years, staggered so that approximately one-third of the appointments expire in each year.
	12693.991 (c) (5) In carrying out its duties and responsibilities, the Commission may do all of the following:
		(A)  Meet publicly at least once each quarter at any time and location convenient to the public as it may deem appropriate.
		(B)  Establish technical advisory committees
		(C)  Advise the Governor and the Legislature regarding improved access to, enrollment in, retention of, and use of health coverage for children and their families.
		(D)  Recommend strategies to increase the efficiency of Medi-Cal and Healthy Families, reduce paperwork requirements for benefit administration, and implement electronic gateways and other "express lanes" for increasing enrollment..
		(E)  Recommend strategies to move children among and between local CHIs, Medi-Cal and Healthy Families.
		(F)  Recommend voluntary strategies for employers to maintain or increase employer-sponsored health coverage for employees' dependents under the age of 19 years.
		(G)  Provide guidance in the development of the pilot research demonstration project described above in 12693.991 (b) (5).
		(H)  Study the adequacy of the provider network and seek broad participation from traditional and safety-net providers by recommending strategies to ensure adequate provider reimbursement rates.
		(I)  Employ all other appropriate strategies necessary or convenient to enable it to fully and adequately perform its duties and exercise the powers expressly granted.
	12693.992 (a) Funds appropriated from the California Healthy Kids Sub-account shall be used only:
	12693.992 (a) (1) To provide children's health insurance, through Healthy Families as defined in subdivision 12693.99 (b); and
	12693.992 (a) (2) To support those measures contained in Section 12693.991.
	12693.992 (b) Money from the California Healthy Kids Sub-Account shall be added to but must not replace the following:
	12693.992 (b) (1) Local funds used to secure state or federal matching funds for any children's health services, children's health, or medical assistance programs.
	12693.992 (b) (2) State funds used to secure federal matching funds for any children's health services, children's health, or medical assistance programs, specifically not the following:.
		(A)  Healthy Families
		(B)  Medi-Cal
		(C)  The Child Health and Disability Prevention Program.
	12693.992 (b) (3) State or federal funds to continue or maintain the amount, duration, scope and structure of benefits that existed as of September 30, 2005 for any children's health services, children's health, or medical assistance programs, specifically not the following:.
		(A)  Healthy Families
		(B)  Medi-Cal
		(C)  The Child Health and Disability Prevention Program.
	12693.992 (c) The state may not increase a county's share of costs for children's health services unless the state includes adequate funding to fully compensate for such increased costs.
	12693.993 (a)  Nothing in this Chapter is intended to:
	12693.992 (a) (1) Reduce or restrict any existing entitlement under Medi-Cal;
	12693.992 (a) (2) Reduce or restrict eligibility levels or the amount, duration, scope or structure of benefits under either Healthy Families or Medi-cal;
	12693.992 (a) (3) Create a new entitlement for children enrolled in Healthy Families;
	12693.992 (a) (4) Preclude a child from eligibility for any other children's health insurance, medical service or medical assistance program.
	12693.992 (a) (5) Preclude a child from eligibility for Healthy Families or Medi-Cal if less restrictive eligibility criteria are enacted;
	12693.992 (a) (6) Reduce or erode children's existing employer-sponsored health insurance coverage;
	12693.992 (a) (7) Restrict any public appropriations or private contributions for the provision of children's health insurance through Medi-Cal or Healthy Families,
	12693.992 (a) (8) Prohibit eligibility for Medi-Cal or Healthy Families based on concurrent eligibility for a local CHI;
	12693.992 (a) (9) Create or require creation of a new state department or agency.
	12693.993 (b)  The State Department of Health Services and the Managed Risk Medical Insurance Board may use of charitable or other funding by private and public not-for-profit organizations as a match for federal funds.
	Section 7 Community Clinics
	Adds a new Article 6 under Chapter 1 of Division 2 of the Health and Safety Code
	1246 (a) Funds in the Community Clinics Uninsured Sub-Account established by paragraph  30132.3 (c) (3) of the Revenue and Taxation Code [as created by this initiative] shall be administered by the Department of Health Services solely for the purposes of this Section. The department shall allocate the funds for eligible non-profit clinic corporations providing vital health care services the uninsured, related to smoking. The funds shall be allocated by the Department according to this Section.
	1246 (b) Beginning August 1,2007, each year the Department shall allocate to each eligible non-profit clinic corporation a percentage of the balance present in the Community Clinics Uninsured Sub-Account as of July 1 of the year the allocations are made based on the formula provided in subdivision (c) and subject to subdivision (d).
	1246 (c) Funds in the Community Clinics Uninsured Sub-Account shall be allocated only to eligible non-profit clinic corporations. Funds in the Community Clinics Uninsured Sub-Account shall be allocated to eligible non-profit clinic corporations on a percentage basis based on the total number of uninsured patient encounters.
	1246 (c) (1) For purposes of this Section, an "eligible non-profit clinic corporation" shall meet both of the following requirements:
		(A)  The corporation shall consist of licensed non-profit free and community clinics or of clinics operated by a federally recognized Indian tribe or tribal organization and exempt from licensure.
		(B)  The corporation must provide at least 1,000 uninsured patient encounters based on data submitted to the Office of Statewide Health Planning and Development for the year the allocations are made.
	1246 (c) (2) The total number of uninsured patient encounters shall be based on the data submitted to the Office of Statewide Health Planning and Development pursuant to the reporting procedures established under Section 1216.  Beginning August 1, 2007 and every year thereafter, the allocations shall be made by the Department of Health Services based on the data submitted to the Office of Statewide Health Planning and Development by February 15 of the year the allocations are made.
	1246 (c) (3) Other than the exceptions covered in paragraph (4) below, an uninsured patient encounter is defined as an encounter for which the patient has no public or private third party coverage.  An uninsured patient encounter shall also include encounters involving patients in programs operated by counties pursuant to Part 4.7, starting with Section 16900 and Part 5, starting with Section 17000, of Division 9 of the Welfare and Institutions Code.  An uninsured patient encounter must consist of a primary and preventive health care service, including tobacco cessation and prevention services, and specialty care services traditionally provided by comprehensive primary care providers.  [Part 4.7 covers health care for indigents, Part 5 covers county aid and relief to indigents.]
	1246 (c) (4) Each uninsured patient encounter shall count as one encounter, except that the encounters involving patients in programs operated under paragraph 14132 (a) (1) and Division 24 starting with Section 24000 of the Welfare and Institutions Code, and also operated under Article 6, starting with Section 124025, of the Health and Safety Code, shall count as 0.15 encounter.  [14132(a)(1) is outpatient services; 24000 is Family Planning;  124025 covers early identification and treatment of handicapping conditions.]
	1246 (c) (5) The Department of Health Services shall compute each eligible non-profit clinic corporation's numbers as a percentage of total uninsured patient encounters for all eligible non-profit clinic corporations.  The Department shall then apply these percentages to the available funds in the Subaccount to compute a preliminary allocation amount for each eligible non-profit clinic corporation.  Final allocation amounts will be determined as specified in paragraph (6).
	1246 (c) (6) Final allocation amounts shall be determined as follows:
		(A)  If the preliminary allocation for an eligible non-profit clinic corporation is equal to or less than $25,000, the allocation for that eligible non-profit corporation shall be $25,000.
		(B)  For all eligible non-profit clinic corporations with preliminary allocations of more than $25,000, the Department shall compute the corporation's percentage of the total uninsured patient encounters and apply the percentage to the remaining funds available to determine the final allocation amount for the corporation, limited by subparagraph (C).
		(C)  No eligible non-profit clinic corporation shall receive an allocation in excess of 2% of the total monies distributed to all such corporations in that year.  Allocations that would have been in excess of the limit shall be reallocated to those other eligible non-profit clinic corporations receiving allocations under subparagraph (B) utilizing the methodology in paragraphs (3) and (4).  Reallocations shall not make any final allocation surpass the  2% limit.
	1246 (d) The Department of Health Services shall be reimbursed from the Community Clinics Uninsured Sub-Account for the Department's actual cost of administration. The total amount paid for reimbursement shall not exceed 1% of the monies credited to the Sub-Account during the fiscal year.
	Section 8 Nursing Workforce Education Investment
	Adds a new Section 128224.5 to the Health and Safety Code
	128224.5 (a)  The California Healthcare Workforce Policy Commission shall oversee the plan for and distribution of funds in the Nursing Workforce Education Sub-account covered by paragraph 30132.3 (c) (6) of the Revenue and Taxation Code above.  [This initiative created that Sub-account.]  A state nursing contract program with accredited schools and programs that educate students seeking degrees in nursing, shall be developed to create, expand and improve programs to educate students to become practicing registered nurses, nurses with advanced clinical skills, nurse managers, and faculty for schools of nursing.
	128224.5 (b) The California Healthcare Workforce Policy Commission shall recommend to the director the programs that shall be funded.
	Adds a new Section 128225.5 to the Health and Safety Code
	128225.5  The director shall utilize the funds appropriated to implement the recommendations of the California Healthcare Workforce Policy Commission pursuant to Section 128224.5 [created by this Initiative] and to reimburse  the Commission for all administrative costs incurred to implement this Section, up to one percent (1%) of the amount deposited into the Nursing Workforce Education Sub-Account for the same period.  Appropriated funds that are not utilized, or are returned or remain unspent after being committed, shall remain in or shall be re-deposited into the Nursing Workforce Education Sub-Account for appropriation and use for the same purpose as provided in paragraphs 30132.3(c)(6)(A) or 30132.3(c)(6)(B) of the Revenue and Taxation Code.  [Which are added by this Initiative.]
	Section 9 Emergency and Trauma Hospital Services
	Adds a new Chapter 4.5 to Division 2.5 of the Health and Safety Code
	Adds Article 1  "The Emergency and Trauma Hospital Services Sub-Account", to say:
	1797.300 The Department of Health shall administer funds made available to hospitals for such services as provided by this Chapter.
	1797.301 (a)  The Department shall calculate next calendar year's funding percentage to be used based for each eligible hospital, based upon the information required by Section 1797.302. Each hospital shall be notified of its proposed funding percentage no later than June 15 of each calendar year.
	1797.301 (b)  The Department shall receive the data required by 1797.302 and review it for accuracy and completeness. The department shall develop a standard form that may be used for reporting, though data is not required to be reported on this form.  A method of reporting electronically will be available no later than April 30, 2008.
	1797.301 (c)  The Department shall advise each hospital, no later than April 30 of each year, by written notice, of any discrepancies in the data received.  If no such notice is delivered, the data will be considered to be complete and accurate, though still subject to audit, in accord with (f) below.
	1797.301 (d)  If the hospital is advised that there was a discrepancy in its data, it has 30 days from the receipt of the notice to correct the data.  Hospitals that do not provide sufficient information will not qualify as a hospital eligible for consideration under (a).
	1797.301 (e)  The Department may enter into an agreement with another state agency or private party to assist it in analyzing information reported by eligible hospitals and making the hospital funding allocation computations as provided under this Chapter.
	1797.301 (f)  The Department shall audit the data received per this Section and the funds dispersed in accord with 1797.304.  The Department shall randomly select 20% of all eligible hospitals each year for audit of the information they submit, and may conduct a field audit of the use of funds or information submitted by any hospital.  If the department determines that funds were improperly used, or reporting inaccurate data resulted in an allocation of excess funds, the department shall recover any such excess amounts.  The department may impose a fine of not more than 25% of any funds that were improperly used.  If the improper use was the result of gross negligence or intentional misconduct in reporting data, the department may impose a fine of not more than two times any amounts improperly used or received by the hospital.  Any fines imposed by the department shall be stayed if appealed by the hospital per subdivision (g) until judgment by a court of final jurisdiction.  In no event shall a hospital be subject to multiple penalties for both improperly using and receiving the same funds.
	1797.301 (g) (1) Hospitals shall have the right to appeal: the imposition of any fine by the Department, or a determination by the department that its hospital is not an eligible hospital, for any reason, or an alleged error by the department resulting in an incorrect allocation of funds to the hospital. A hospital shall not be entitled to be reclassified as eligible or to have an increase in funds received under this Chapter based upon subsequent corrections to its own final reporting of incorrect data used to determine funding allocations under this Article.
	1797.301 (g) (2) Any such appeal shall be heard before an administrative law judge employed by the Office of Administrative Hearings.  The decision of the administrative law judge shall be in writing; shall include findings of fact and conclusions of law; shall be final; and shall be subject to appeal.  The decision of the administrative law judge shall be made within 60 days after the conclusion of the hearing and shall be effective upon filing and service upon the petitioner.
	1797.301 (g) (3) The right to appeal  in this way shall not be interpreted to preclude other relief that may be available.
	1797.301 (h) Any fines or other recoveries shall be deposited in the Emergency and Trauma Hospital Services Sub-account within the Tobacco Tax Fund for allocation to eligible hospitals. Such funds shall not be used for administrative costs, and shall be supplemental to, and shall not supplant, any other funds available to be allocated from such Sub-Account to eligible hospitals.
	1797.301 (i) If it is found, past the point of appeal, that a hospital was incorrectly determined to not qualify as eligible, or was allocated an amount less than the amount to which it was entitled, from the next allocation of funds the Department shall allocate  the additional amount to which the hospital was entitled, and reduce the allocation to all other eligible hospitals pro rata..
	1797.302 (a) Hospitals wishing to be designated eligible shall submit the following information to the Department no later than February 15 of each year, starting the first year following the operative date of this Act:
	1797.302 (a) (1) The number of emergency department encounters that took place during the preceding calendar year;
	1797.302 (a) (2) The total amount of charity care costs of the hospital for the preceding calendar year;
	1797.302 (a) (3) The total amount of bad-debt costs of the hospital for the preceding calendar year;
	1797.302 (a) (4) The total amount of county indigent program effort costs of the hospital for the preceding calendar year;
	1797.302 (a) (5) If requested, a photocopy of the hospital's operating license from the State Department of Health Services or equivalent documentation establishing that it operates a licensed emergency department;
	1797.302 (a) (6) A declaration of commitment to provide emergency services and training as required by 1797.303 (a).
	1797.302 (b) Both child and adult patients shall be included in the data submitted. The accuracy of the data shall be attested to in writing by an authorized senior hospital official.  No other data or information shall be required by the Department.
	1797.302 (c) The data provided must cover all patients, including those covered by a single associated comprehensive group practice prepayment health care service plan.
	1797.303 (a) Hospitals receiving allocations have the following duties:
	1797.303 (a) (1) To maintain an operational emergency department to provide emergency care and treatment, as required by law, to any pediatric or adult member of the public who has an emergency medical condition.
	1797.303 (a) (2) To also do all of the following:
		(A)  Participate in a minimum of two disaster-training exercises annually;.
		(B)  Provide training and information as appropriate regarding the identification, management, and reporting of emergency medical conditions and communicable diseases, as well as triage procedures in cases of mass casualties;
		(C)  Collaborate with state and local emergency medical services agencies and public health authorities in establishing communications procedures in preparation for and during a disaster situation; and
		(D)  Establish and maintain an emergency and disaster management plan, available for public inspection.
	1797.303 (b) It is the policy of the state to encourage hospitals to work cooperatively to develop regional plans for assuring maximum availability of emergency services to all patients, and to share equitably in the provision of emergency services to uninsured and low income underinsured patients in achieving such maximum availability of emergency services.  For that reason:
	1797.303 (b) (1) Each hospital receiving funds under this Chapter that operates a basic or comprehensive licensed emergency department may participate in the development of a regional or other local plan for equitably sharing responsibility for providing emergency services to uninsured and low-income underinsured patients arriving at the hospital via ambulance.  Any such plan may be developed under the auspices of a hospital association or through other cooperative arrangements, and shall be submitted to the county or other local emergency services authority for approval and continuing oversight of implementation.
	1797.303 (b) (2) Each hospital receiving funds under this Chapter may work cooperatively with one or more other hospitals to develop a plan for providing maximum coverage of specialty medical services.  Any such plan shall be submitted to and approved by the county or other local emergency services authority for approval and continuing oversight of implementation.
	1797.303 (b) (3) The above cooperative efforts shall incur no liability under federal or state antitrust or other anti-competition laws prohibiting combinations in restraint of trade.
	1797.303 (c) Money received under this Act may not be used in the determination of uncompensated costs for the purpose of the limitation on payment adjustments described in Section 1923(g) of the Social Security Act.
	1797.304 (a) Funds in the Emergency and Trauma Hospital Services Sub-account shall be continuously appropriated without regard to fiscal years, and will be administered by the state Department of Health Services. The department shall allocate the funds solely to eligible hospitals as provided by this Article.
	1797.304 (b) Each quarter, starting with June 30 following the operative date of this Chapter, the department shall allocate to each eligible hospital a percentage of the balance of the Hospital Sub-account equal to such hospital's funding percentage, as determined by the department per Section 1797.301, except as follows:
	1797.304 (b) (1) Hospitals "that receive a preponderance of their revenue from the same associated comprehensive group practice prepayment health care service plan" shall have their annual total allocation limited to a total of $40 million.  The department shall reduce the quarterly allocation to each such hospital pro rata, if necessary, to contain the total allocation to this amount.  The allocation shall be applied by the department in increments of no more than $10 million for each of the first three quarterly distributions of each calendar year.
	1797.304 (b) (2) The maximum specified in (1) may be adjusted up or down annually, after January 1, 2009.  The adjustment will be done on a percentage basis, matching the percentage change in the amount paid into the Hospital Sub-account for the immediate prior year, versus the amount paid in 2007.
	1797.304 (b) (3) After making the adjustment of (2), the Department may make a further adjustment up or down.  The adjustment will be done on a percentage basis, matching the percentage change in the payments received by the hospitals under their group plans, versus the payments received in 2007.
	1797.304 (b) (4) After making the adjustments [and corresponding payments] of paragraphs (1) through (3) above, the department shall allocate any funds remaining in the Hospital Sub-account to hospitals that do not receive a preponderance of their revenue from such group plans, based upon their respective funding percentages.
	1797.304 (c) The actual costs to the department for administering the provisions of this Chapter shall be reimbursed from the Hospital Sub-Account, before the allocations per (b).  The funds withdrawn for all administrative costs under this subdivision shall not exceed 0.5% of the total amounts deposited in the Hospital Sub-account, not including any fines.
	1797.304 (d) Hospitals shall use the funds received under this Section only to further the provision of emergency services by such means as payment for the unreimbursed cost of providing emergency services and improving or expanding emergency services, facilities, or equipment. Such funds may not be used: to pay for more than the hospital's unreimbursed costs of providing emergency services, or to pay the hospital for providing emergency services where it receives payment for providing such services and has agreed to accept such payment as payment in full, or for the compensation of hospital management executives, except for personnel who work full time in hospital emergency departments or for equipment or capital improvements not directly related to the improvement of hospital emergency department facilities or critical care unit. An eligible hospital owned by a public entity may use funds it receives under this Chapter to secure federal matching funds under the Medi-Cal program, or any other federal or state health program that includes coverage of emergency services and reduces the burden of providing uncompensated emergency services by hospitals and physicians.
	1797.304 (e) (1) A hospital may not utilize funds received under this Article to supplement payments to physicians for services to patients enrolled in the Medicare or Medi-Cal programs.  The hospital may use such funds to provide payments to physicians for on-call coverage of emergency services to all patients, including those enrolled in the Medicare or Medi-Cal programs, as provided by subparagraph (2) below. Such payments to physicians for on-call coverage shall not be considered payments for services.
	1797.304 (e) (2) A hospital may utilize funds it receives under this Chapter to provide compensation to a physician for providing on-call coverage of emergency services only if the governing board of the hospital makes the following findings:
		(A) The amount or rate of payment is reasonable and necessary.
		(B)  The method and amount of compensation to any physician or physicians is in compliance with applicable law.
	1797.304 (e) (3)  Prior to entering into an agreement to compensate physicians for on-call coverage of emergency services, the hospital may obtain the opinion of an independent financial analyst as to whether the proposed payment is fair and reasonable under the circumstances.  If the hospital chooses to obtain such an opinion, it shall notify the department in writing.  Within ten days of receiving the request, the Department shall provide the names of three such analysts from a list it establishes and maintains. The hospital's medical staff shall have 15 days to review the list and make a peremptory challenge of one of the analysts by notifying the hospital's governing board in writing. The governing board may also make its own peremptory challenge to one of the analysts.  If two of the analysts are challenged, the hospital may retain only the remaining analyst.  If two analysts remain unchallenged the hospital shall so notify the department, and the department shall select one of the remaining analysts by lottery, in which case the hospital may retain that analyst.  If none of the analysts is challenged, the hospital and its medical staff may agree upon one of the three.  The selected analyst may charge the hospital a reasonable fee for a written opinion as to whether the proposed payment is fair and reasonable.  If the analyst declares that the payment is not fair and reasonable, the analyst may describe a range of payment amounts and rates that are fair and reasonable for the hospital to pay various types of physicians for on-call coverage.  The hospital may not pay an amount or rate for on-call coverage of emergency services that is higher than any amount or rate determined to be fair and reasonable by the opinion of such independent financial analyst, nor shall the hospital pay less than its highest written fair and reasonable offer.
	1797.304 (e) (4) A hospital may compensate a physician for providing on-call emergency services coverage only through a written agreement.
	1797.304 (e) (5) The requirements of this subdivision relate only to the use of funds eligible hospitals received under this Article, and do not apply to the use of other funds by hospitals to pay for on-call coverage of emergency services by physicians..
	1797.305  [Provides definitions of terms.]
	1797.306  Hospitals receiving these funds shall maintain a written record of the use of all such funds, available to the Department upon request, and available for inspection by the public upon written request.  Money not used for the purposes specified within one year of receipt shall be returned to the Department.  In the case of a capital project, money not committed for a specific use within two years of receipt shall be returned to the Department. Funds returned to the department shall be deposited in the Emergency and Trauma Hospital Services Sub-account per Section 1797.304.
	1797.307  The Department may adopt regulations to implement, interpret and make specific the provisions of this Article pursuant to the Administrative Procedures Act
	1797.308  No hospital may receive funds under this Chapter unless it complies with the provisions of Article 2 (commencing with Section 1797.309), relating to financial assistance to certain low-income patients, as provided in Article 2 below.
	Adds Article 2  "Hospital Charity Care and Financial Assistance Policies"
	1797.309 [Provides definitions of terms.].
	1797.309.5  Each hospital shall comply with the provisions of this Article throughout each calendar year in which it receives an allocation.  The requirements of this Article are applicable only to hospitals receiving an allocation, and shall not be construed to limit the ability of the legislature to enact charity care or discount payment policies applicable to all acute hospitals as a condition of licensure or participation in any other state program.
	1797.310 (a)  Each hospital shall maintain an understandable, written charity care policy and discount payment policy for low-income patients with no or inadequate insurance.
	1797.310 (b)  Each hospital's policies shall clearly state eligibility criteria based upon the income and monetary assets of the patient or the patient's family (consistent with the application of the federal poverty level.)  The policy shall also state the process used by the hospital to determine whether a patient is eligible for charity care or discounted payment.  As part of this process, a hospital may consider income and monetary assets of the patient, or the family of the patient.  However, monetary assets shall not include qualified retirement or deferred- compensation plans, or non-qualified deferred compensation plans.  Furthermore, the first $10,000 of a patient's or a patient's family's monetary assets shall not be counted; nor shall 50% of such assets over the first ten thousand dollars be counted in determining eligibility.
	1797.310 (c)  Patients who are at or below 350% of the federal poverty level shall be eligible to apply for participation under each hospital's policies.  However, rural hospitals, as defined by Section 124840 [of this Code], may establish eligibility levels for financial assistance and charity care at a lesser level as appropriate to maintain their financial and operational integrity.
	1797.310 (d) If there is no regulatory prohibition, each hospital shall limit expected payment for services it provides per (c) to the amount of payment the hospital would receive for providing such services from Medicare or any other government-sponsored health program of health benefits in which the hospital participates, whichever is the greater.  If the hospital provides a service for which there is no established payment, the hospital shall establish an appropriate discounted payment.
	1797.310 (e) A hospital shall use its best efforts to ensure all financial assistance policies are applied consistently.
	1797.310 (f) Patients seeking either charity care or discounted payment shall provide the hospital with information concerning health benefits coverage, financial status and other information that is reasonable and necessary for the hospital to make a determination regarding the patient's status relative to the hospital's policies.  Such patients must provide verification of income.  Reasonable and necessary information on monetary assets may include account numbers for all monetary assets, but shall not include statements on retirement or deferred compensation plans.  Hospitals may require waivers or releases from the patient, or the patient's family, authorizing the hospital to obtain account information from the financial or commercial institutions, or other entities that hold or maintain the monetary assets to verify their value.
	1797.310 (g) Eligibility for charity care and discounted payments may be determined at any time the hospital is in receipt of all the information needed to determine the patient's eligibility under its applicable policies.
	1797.310 (h) In determining a patient's eligibility for financial assistance, a hospital shall assist the patient in determining the patient's eligibility for government-sponsored programs.
	1797.311 (a) Each hospital shall post notices regarding the availability of its discount payment policy and charity care policy.
	1797.311 (b) Every posted notice regarding the policies shall contain brief instructions on how to apply for charity care or a discounted payment.  Each notice shall include a contact telephone number that can be called to obtain more information.
	1797.311 (c) Hospitals shall train appropriate staff members about the hospital's discount payment policy.  Training shall be provided to all staff members who directly interact with patients regarding their hospital bills.
	1797.311 (d) Each hospital shall make its policies available to appropriate community health and human services agencies and other organizations that assist low-income patients.
	1797.312 (a) Each hospital shall have a written policy about when and under whose authority patient debt is advanced for collection, and shall use its best efforts to ensure that patient accounts are processed fairly and consistently.
	1797.312 (b) Each hospital shall establish a written policy defining standards and practices for the collection of debt, and shall obtain a written agreement from any agency that collects hospital receivables that it will adhere to the hospital's standards and scope of practices.  In determining the amount of a debt a hospital may seek to recover from patients eligible under its policies, the hospital may consider only income and monetary assets as limited by 1797.310 (b).
	1797.312 (c) At time of billing, each hospital shall provide to all low-income and uninsured patients the same information concerning services and charges provided to all other patients who receive care at the hospital.
	1797.312 (d) When sending a bill to a patient, each hospital shall include:  (1) a statement that indicates that if the patient meets certain low-income requirements the patient may be eligible for a government-sponsored program or for financial assistance from the hospital; and (2) a statement that provides the patient with the name and telephone number of a hospital employee or office from whom or which the patient may obtain information about the hospital's financial assistance policies for patients and how to apply for such assistance.
	1797.312 (e) If patients have a completed application pending, for either government-sponsored coverage or for eligibility under the hospital's own policies, the hospital shall not send that patient's bill to a collection agency prior to 120 days from time of initial billing, without first having made more than one attempt to collect the bill.  Nor may the bill be sent while the completed application is being processed by a governmental agency or the hospital.
	1797.312 (f) If a patient qualifies for eligibility under the hospital's policies and is attempting in good faith to settle an outstanding bill by negotiating a reasonable payment plan or by making regular partial payments of a reasonable amount, the hospital shall not send the unpaid bill to any collection agency "if the hospital knows that doing so may negatively impact a patient's credit".
	1797.312 (g) The hospital, or a collection agency operating on behalf of the hospital, shall not, for patients eligible under the hospital's policies, use wage garnishments or liens on primary residences as a means of collecting unpaid hospital bills. This requirement does not preclude hospitals from pursuing reimbursement from third-party liability settlements or "tortfeasors" or other legally responsible parties.
	1797.312 (h) Any extended payment plans offered by a hospital to assist patients eligible under the hospital's policies, or any other policy adopted by the hospital for assisting low-income patients with no or inadequate insurance in settling past due outstanding hospital bills, shall be interest free.
	1797.313 (a) Contrary to any other provision of law, the amounts paid by parties for services resulting from reduced or waived charges under a hospital's discount payment or charity care policy shall not constitute the hospital's uniform, published, prevailing, or customary charges, its usual fees to the general public, or its charges to non-Medi-Cal purchasers under comparable circumstances, and shall not be used to calculate a hospital's median non-Medicare or Medi-Cal charges, for purposes of any payment limit under the federal Medicare program, the Medi-Cal program or any other federal or state-financed health care program.
	1797.313 (b) Nothing in this Article shall be construed to prohibit a hospital from uniformly imposing charges from its established charge schedule or published rates, nor shall this Article preclude the recognition of a hospital's established charge schedule or published rates for purposes of applying any payment limit, interim payment amount, or other payment calculation based upon a hospital's rates or charges under the Medi-Cal, Medicare, worker's compensation, or other federal, state or local public program of health benefits.
	1797.313 (c) To the extent that any requirement of this Article results in a federal determination that a hospital's established charge schedule or published rates are not the hospital's customary or prevailing charges for services, the requirement in question shall be inoperative.  The Department shall seek federal guidance regarding modification to the requirement in question. All other requirements in this Article shall remain operative.
	Section 10 Preservation of Existing Funding
	Adds a new Section 16950.2 under Article 3 of Chapter 5 of Part 4.7 of Division 9 of the Welfare and Institutions Code
	16950.2 (a) $24.803 million shall be transferred and allocated pursuant to (b) below from accounts within the Cigarette and Tobacco Products Surtax Fund as follows:
	16950.2 (a) (1)  $20.227 million from the Hospital Services Account.
	16950.2 (a) (2)  $4.576 million from the Physician Services Account.
	16950.2 (b)  The money obtained under (a) shall be allocated as follows:
	16950.2 (b) (1)  $22.324 million for distribution through the California Healthcare for Indigents Program (CHIP)
	16950.2 (b) (2)  $2.479 million for distribution through the Rural Health Services Program.
	16950.2 (c)  This transfer shall be made on June 30 of the first fiscal year following adoption of this Act, and on June 30 of each fiscal year thereafter.  Funds transferred are continuously appropriated without regard to fiscal years for the purposes so stated for each such account.
	16950.2 (d) (1) Funds allocated per this Section shall be used only to reimburse physicians for losses incurred in providing uncompensated emergency services in general acute-care hospitals providing emergency services.  Funds shall be transferred to the Physician Services Account in the county Emergency Medical Services Fund, and shall be paid only to physicians who directly provide emergency medical services to patients, based on claims submitted or a subsequent reconciliation of claims.  Payments shall be made as provided in Sections 16951 to 16959, inclusive, of the Welfare and Institutions Code, and payments shall be made on an equitable basis, without preference to any particular physician or group of physicians.
	16950.2 (d) (2) If a county has an EMS Fund Advisory Committee that includes both emergency physicians and emergency department on-call back-up panel physicians, and if the committee unanimously approves, the administrator of the EMS Fund may create a special fee schedule and claims submission criteria for reimbursement for services rendered to uninsured trauma patients.  If this is done, no more than 15% of the tobacco tax revenues allocated to the county's EMS Fund may be distributed through this special fee schedule, all physicians who render trauma services must be entitled to submit claims for reimbursement under this special fee schedule, and no physician's claim may be reimbursed at greater than fifty percent (50%) of losses under this special fee schedule.
	Section 11 Amendment
	(a) This Act may only be amended by the people.
	(b) Except the Legislature may amend Sections 8 and 9 of this Act to further its purposes by a statute passed in each house by roll-call vote entered in the journal, four-fifths of the membership concurring.
	(c) Except the Legislature may amend Article 2, starting with Section 1797.309, of Chapter 4.5 of the Health and Safety Code to further its purposes by a statute passed in each house by roll-call vote entered in the journal, two-thirds of the membership concurring.
	(d) Except the Legislature may amend Sections 6 and 7 of this Act to further its purposes by a statute passed in each house by roll-call vote entered in the journal, a majority of the membership concurring.  Within those sections the Legislature may not amend 12693.992 (b) of the Insurance Code as added by this Act or Sections 1246 (a) or 1246 (c) (1)  of the Health and Safety Code as added by this Act.
	Section 12 Statutory References
	Unless otherwise stated, all references in this Act to existing statutes are to statutes as they existed on December 3 1,2005.
	Section 13 Severability
	[If a provision or part of this Initiative is held invalid or unconstitutional, the rest shall continue in full force.]
	Section 14 Conflicting Measures
	[If this measure conflicts with another measure, the measure receiving the greater number of votes shall prevail.  IF the other measure prevails, but is later found to be invalid, this measure will prevail.]
	Section 15 Conformitv with State Constitution
	Adds Section 14 to Article XIIB of the State Constitution, to say:
	SEC. 14 (a) "Appropriations subject to limitation" of each entity of government shall not include appropriations of revenue from the Tobacco Tax Act of 2006.  No adjustment in the appropriations limit of any entity of government shall be required pursuant to Section 3 as a result of revenue being deposited in or appropriated from the Tobacco Tax of 2006 Trust Fund.
	SEC. 14 (b) The tax created by the Tobacco Tax Act of 2006 and the revenue derived from it shall not be considered General Fund revenues for the purposes of Section 8 of Article XVI.
	SEC. 14 (c) Distribution of moneys in the Tobacco Tax of 2006 Trust Fund or any of the Accounts or Sub-accounts created therein, shall be made pursuant to the Tobacco Tax Act of 2006 notwithstanding any other provision of this Constitution.
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