BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 260|
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VETO
Bill No: SB 260
Author: Steinberg (D)
Amended: 8/31/07
Vote: 21
SENATE HEALTH COMMITTEE : 10-0, 4/11/07
AYES: Kuehl, Aanestad, Alquist, Cedillo, Cox, Maldonado,
Ridley-Thomas, Steinberg, Wyland, Yee
NO VOTE RECORDED: Negrete McLeod
SENATE APPROPRIATIONS COMMITTEE : 16-0, 5/31/07
AYES: Torlakson, Cox, Aanestad, Ashburn, Cedillo, Corbett,
Dutton, Florez, Kuehl, Oropeza, Ridley-Thomas, Runner,
Simitian, Steinberg, Wyland, Yee
NO VOTE RECORDED: Battin
SENATE FLOOR : 36-2, 6/4/07
AYES: Aanestad, Alquist, Ashburn, Calderon, Cedillo,
Cogdill, Corbett, Correa, Cox, Denham, Ducheny, Florez,
Harman, Hollingsworth, Kehoe, Kuehl, Lowenthal, Machado,
Maldonado, Margett, Migden, Negrete McLeod, Oropeza,
Padilla, Perata, Ridley-Thomas, Romero, Runner, Scott,
Simitian, Steinberg, Torlakson, Vincent, Wiggins, Wyland,
Yee
NOES: Ackerman, McClintock
NO VOTE RECORDED: Battin, Dutton
SENATE FLOOR : 35-2, 9/6/07
AYES: Aanestad, Alquist, Ashburn, Battin, Calderon,
Cedillo, Cogdill, Corbett, Correa, Cox, Denham, Ducheny,
Dutton, Florez, Harman, Hollingsworth, Kuehl, Lowenthal,
Machado, Maldonado, Margett, Migden, Negrete McLeod,
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Oropeza, Padilla, Perata, Ridley-Thomas, Romero, Scott,
Simitian, Steinberg, Torlakson, Wiggins, Wyland, Yee
NOES: Ackerman, McClintock
NO VOTE RECORDED: Kehoe, Runner, Vincent
ASSEMBLY FLOOR : 76-0, 9/5/07 - See last page for vote
SUBJECT : Medi-Cal
SOURCE : California Primary Care Association
DIGEST : This bill allows federally qualified health
centers to be reimbursed by Medi-Cal for multiple visits by
a patient with a single or different health care
professional on the same day at a single location, and
specifically allows for billing for two visits when a
patient has a medical visit and an additional visit with a
mental health practitioner or a dental professional.
Assembly Amendments are technical and clarifying.
ANALYSIS :
Existing Law
1.Establishes a statutory structure for Medi-Cal payments
for services provided by federally qualified health
centers (FQHCs) on a per-visit basis.
2.Identifies those services that may be reimbursed as
services identified in federal law as covered benefits
for FQHCs and requires FQHCs to be reimbursed on a
per-visit basis with rates determined prospectively.
3.Places the obligation for administering these provisions
of the Medi-Cal program with the Department of Health
Services (DHS).
4.Provides that the Medi-Cal responsibilities of DHS will
be taken over by the new Department of Health Care
Services (DHCS) on July 1, 2007.
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This bill:
1.Allows clinics to receive reimbursement for multiple
visits by a patient on the same day, where provided the
visits are at a single location and the patient suffers
illness or injury requiring additional diagnosis or
treatment.
2.Specifically allows multiple visits when a patient has
made a medical visit and, additionally, sees either a
dental professional or a mental health provider.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee analysis:
Fiscal Impact (in thousands)
Major Provisions 2007-08 2008-09
2009-10 Fund
Medi-Cal benefits $250 $500 $500 GF
$250 $500 $500 FF
State admin/SPA amend $ 60 $-0- $-0- GF
SUPPORT : (Verified 9/5/07)
California Primary Care Association (source)
Alameda Health Consortium
Alliance for Rural Community Health
Anderson Valley Health Center
Asian Pacific Healthcare Venture
California Academy of Family Physicians
California Alliance for Retired Americans
California Council of Community Mental Health Agencies
California Hospital Association
California Medical Association
California Mental Health Directors Association
California Mental Health Planning Council
California Nurses Association
California Psychiatric Association
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California Psychological Association
CommuniCare Health Centers
California Society of Addiction Medicine
California State Association of Counties
County of Monterey
County of San Bernardino
County of Santa Clara
County Health Executives Association of California
Gray Panthers
Latino Coalition for a Healthy California
Mental Health Association of California
National Alliance on Mental Illness California
North Coast Clinics Network
Open Door Community Health Centers
Potter Valley Community Health Center
Protection and Advocacy Inc.
Santa Clara County Board of Supervisors
Six Rivers Planned Parenthood
Southern Trinity Area Rescue
United Advocates for Children and Families
OPPOSITION : (Verified 9/5/07)
Department of Health Care Services
ARGUMENTS IN SUPPORT : Supporters argue that, in order to
best provide integrated behavioral health services to
patients, many clinics provide medical and mental health
services on the same day, reflecting the tenets of the
Integrated Primary Behavioral Health Care Model. Currently
Medi-Cal does not reimburse a patient's visit to a primary
care provider and a visit to a mental health provider on
the same day. In these instances, only one visit is
reimbursed. Same day reimbursement is allowed for medical
and dental services, but mental health services are
excluded, as the state has not adopted this option, even
though federal law allows reimbursement for same day
visits. Supporters also argue that there is a high
correlation between serious mental illness and high rates
of physical health problems. Supporters state that this
bill will help deal with this serious problem and allow the
primary care physician and mental health professional to
work together for the benefit of the patient.
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ARGUMENTS IN OPPOSITION : The California Department of
Health Care Services opposes the bill and writes, "it would
expand the definition of a billable visit for federally
qualified health centers (FQHCs) and rural health clinics
(RHCs). It would allow these clinics to be reimbursed by
Medi-Cal for multiple visits on the same day at a single
location, when a patient receives health services from more
than one professional, if the services or diagnosis are
unrelated. The bill also specifies that a mental health
service visit could be reimbursed as a second visit on the
same day as a medical visit.
"SB 26 would result in an indeterminate but potentially
significant increase in costs to the Medi-Cal program. The
current prospective payment system (PPS) reimbursement rate
paid to FQHCs and RHCs is based on the clinic's actual
costs and therefore assumes and provides reimbursement for
multiple visits by a single patient for medical and mental
health professionals on the same day. To rectify the
over-payment that would result from the bill, the PPS rate
would need to be recalculated for all 511 FQHCs and 265
RHCs. This would require significant staff resources."
GOVERNOR'S VETO MESSAGE:
"I am returning Senate Bill 260 without my signature.
"While I support improving access to health care
services, including mental health services, I cannot
support this bill as it would increase General Fund
pressure at a time of continuing budget challenges.
Mental health services are already included in the
Medi-Cal rates for federally qualified health centers
and rural health clinics. Allowing separate billing for
mental health services would lead to increased costs
that our state cannot afford.
"For this reason, I am returning this bill."
ASSEMBLY FLOOR :
AYES: Adams, Aghazarian, Anderson, Arambula, Bass, Beall,
Benoit, Berg, Berryhill, Blakeslee, Brownley, Caballero,
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Charles Calderon, Carter, Cook, Coto, Davis, De Leon,
DeSaulnier, DeVore, Duvall, Dymally, Emmerson, Eng,
Evans, Feuer, Fuentes, Fuller, Gaines, Galgiani, Garcia,
Garrick, Hancock, Hayashi, Hernandez, Horton, Houston,
Huff, Huffman, Jeffries, Jones, Karnette, Keene, La
Malfa, Laird, Leno, Levine, Lieber, Lieu, Ma, Maze,
Mendoza, Mullin, Nakanishi, Nava, Niello, Parra, Plescia,
Portantino, Price, Sharon Runner, Ruskin, Salas, Saldana,
Silva, Smyth, Solorio, Soto, Spitzer, Swanson, Torrico,
Tran, Villines, Walters, Wolk, Nunez
NO VOTE RECORDED: De La Torre, Krekorian, Strickland,
Vacancy
CTW:do 2/8/08 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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