(

a) This

article shall be implemented only as long as all of the following conditions are met:

(1) Subject to

Section 14168.33, the quality assurance fee is established in a manner that is fundamentally consistent with this article.

(2) The quality assurance fee, including any interest on the fee after collection by the department, is deposited in a segregated fund apart from the General Fund.

(3) The proceeds of the quality assurance fee, including any interest and related federal reimbursement, may only be used for the purposes set forth in this article. (

b) No hospital shall be required to pay the quality assurance fee to the department unless and until the state receives and maintains federal approval of the quality assurance fee as set forth in this

article and

Article 5.226 (commencing with

Section 14168.1) from the federal Centers for Medicare and Medicaid Services. (

c) Hospitals shall be required to pay the quality assurance fee to the department as set forth in this

article only as long as all of the following conditions are met:

(1) The federal Centers for Medicare and Medicaid Services allows the use of the quality assurance fee as set forth in this article.

(2) Article 5.226 (commencing with

Section 14168.1) is enacted and remains in effect and hospitals are reimbursed the increased rates for services during the program period, as defined in

Section 14168.1.

(3) The full amount of the quality assurance fee assessed and collected pursuant to this

article remains available only for the purposes specified in this article. (

d) This

article shall become inoperative if either of the following occurs:

(1) In the event, and on the effective date, of a final judicial determination made by any court of appellate jurisdiction or a final determination by the United States Department of Health and Human Services or the federal Centers for Medicare and Medicaid Services that any element of this

article or any provision of

Section 14166.115 cannot be implemented.

(2) In the event both of the following conditions exist: (

A) The federal Centers for Medicare and Medicaid Services denies approval for, or does not approve before January 1, 2012, the implementation of

Article 5.226 (commencing with

Section 14168.1) or this article. (

B) Either or both articles cannot be modified by the department pursuant to subdivision (

d) of

Section 14168.33 in order to meet the requirements of federal law or to obtain federal approval. (

e) If this

article becomes inoperative pursuant to paragraph (1) of subdivision (

d) and the determination applies to any period or periods of time prior to the effective date of the determination, the department may recoup all payments made pursuant to

Article 5.226 (commencing with

Section 14168.1) during that period or those periods of time. (f)

(1) In the event that all necessary final federal approvals are not received as described and anticipated under this

article or

Article 5.226 (commencing with

Section 14168.1), the director shall have the discretion and authority to develop procedures for recoupment from managed health care plans, and from hospitals under contract with managed health care plans, of any amounts received pursuant to this

article or

Article 5.226 (commencing with

Section 14168.1).

(2) Any procedure instituted pursuant to this subdivision shall be developed in consultation with representatives from managed health care plans and representatives of the hospital community.

(3) Any procedure instituted pursuant to this subdivision shall be in addition to all other remedies made available under the law, pursuant to contracts between the department and the managed health care plans, or pursuant to contracts between the managed health care plans and the hospitals.