Cal. WIC § 14199.95 — California Code / Code wic / Division 9 / Part 3 / Chapter 7 / Article 7.2 / Section 14199.95
Section 14199.95
Status: in_force

(a) (1) For each calendar year in which the managed care organization provider tax authorized by this article is in effect, the tax amount for each health plan shall be eight dollars and eighty-five cents ($8.85) per countable enrollee per month, unless modified in accordance with paragraph (2) or (3) or with subdivision (b).

(2) (A) The department may calculate and impose an alternative tax amount upon a determination by the department, in its sole discretion, that the tax amount in paragraph (1) is projected to generate revenues that are lower or materially higher than are needed to meet the goal described in paragraph (1) of subdivision (i) of Section 14199.90.

(B) The alternative tax amount pursuant to subparagraph (A) shall not be higher or lower than the tax amount in paragraph (1) by more than 10 percent for the 2027 calendar year tax period and by more than 25 percent for subsequent tax periods.

(3) (A) The department may establish taxing tiers consisting of discrete ranges of countable enrollees and may calculate and impose alternative tax amounts for these taxing tiers, but only to the extent consistent with the purposes of this article and necessary to achieve legitimate public policy goals.

(B) (i) The average of the alternative tax amounts pursuant to subparagraph (A), weighted according to the applicable number of countable enrollees, shall not exceed the limits specified in subparagraph (B) of paragraph (2).

(ii) The alternative tax amounts pursuant to subparagraph (A) shall not result in an increase in the aggregate tax amounts projected to be collected from any health plan under this article that the department, in its sole discretion, determines is significant.

(b) The department may modify or make adjustments to any methodology, tax amount, taxing tier, or other provision specified in this article to the extent that it deems necessary to meet the requirements of federal law or regulations, to obtain or maintain federal approval, or to ensure that federal financial participation is available or is not otherwise jeopardized, provided the modification or adjustment does not otherwise conflict with the purposes of this article, or result in an increase in the aggregate tax amounts projected to be collected under this article that the department, in its sole discretion, determines is significant.

(c) (1) If the department calculates and imposes an alternative tax amount or amounts in accordance with paragraph (2) or (3) of subdivision (a) or identifies that modification or adjustment is necessary in accordance with subdivision (b), the department shall consult with affected health plans, to the extent practicable, to implement that alternative tax amount or amounts or modification or adjustment, as applicable.

(2) In the event of imposition of an alternative tax amount or amounts in accordance with paragraph (2) or (3) of subdivision (a) or a modification or adjustment made pursuant to subdivision (b), the department shall notify affected health plans, the Department of Finance, the Joint Legislative Budget Committee, the Senate Committees on Appropriations, Budget and Fiscal Review, and Health, and the Assembly Committees on Appropriations, Budget, and Health within 10 business days of taking the applicable action.

(d) The department shall request approval from the federal Centers for Medicare and Medicaid Services as is necessary to implement this article. In making that request, the department may seek, as it deems necessary, a request for waiver of the broad-based requirement, waiver of the uniformity requirement, or both, pursuant to Section 433.68(e) of Title 42 of the Code of Federal Regulations, or a request for waiver of any other federal law or regulation necessary to implement this article.

(e) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement this article by means of provider bulletins, all-plan letters, or other similar instructions, without taking any further regulatory action.