BILL ANALYSIS ------------------------------------------------------------ |SENATE RULES COMMITTEE | SB 260| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ------------------------------------------------------------ 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, CONTINUED SB 260 Page 2 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. CONTINUED SB 260 Page 3 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 CONTINUED SB 260 Page 4 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. CONTINUED SB 260 Page 5 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, CONTINUED SB 260 Page 6 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 **** END **** CONTINUED