BILL ANALYSIS                                                                                                                                                                                                    



                                                                       



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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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                                                                SB 260
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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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