BILL NUMBER: AB 381	CHAPTERED  10/05/07

	CHAPTER  265
	FILED WITH SECRETARY OF STATE  OCTOBER 5, 2007
	APPROVED BY GOVERNOR  OCTOBER 5, 2007
	PASSED THE SENATE  SEPTEMBER 5, 2007
	PASSED THE ASSEMBLY  SEPTEMBER 5, 2007
	AMENDED IN SENATE  AUGUST 30, 2007
	AMENDED IN SENATE  JUNE 6, 2007
	AMENDED IN ASSEMBLY  APRIL 23, 2007
	AMENDED IN ASSEMBLY  APRIL 10, 2007
	AMENDED IN ASSEMBLY  MARCH 19, 2007

INTRODUCED BY   Assembly Member Galgiani
   (Coauthor: Assembly Member Fuentes)

                        FEBRUARY 15, 2007

   An act to amend Section 14045 of the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 381, Galgiani. Medi-Cal: provider reimbursement.
   Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services and
under which qualified low-income persons receive health care
benefits.
   Existing law, subject to certain exceptions, prohibits a provider
under the Medi-Cal program from submitting a reimbursement request to
the Medi-Cal program that contains a beneficiary's social security
number in order to receive payment if the department has issued that
beneficiary a Medi-Cal beneficiary identification card containing a
beneficiary number that includes the issuance date.
   This bill would delete the limitation on this prohibition to those
instances in which the request is submitted in order to receive
payment, but would exempt the submission of a request by a provider
for beneficiary eligibility from the prohibition.
   Existing law provides that the above prohibition does not apply to
a licensed hospital, long-term health care facility, a primary care
clinic, or emergency medical transportation services.
   This bill would, instead, exempt from this prohibition a licensed
hospital, long-term health care facility, a primary care clinic,
emergency medical transportation services, or a hospital-based
physician, only if the providers of these services have made a good
faith effort to obtain a recipient's beneficiary identification card
number. It would, however, terminate this exemption when the
department establishes an automated system whereby a provider can
access a beneficiary identification card number for submitting
reimbursement requests.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 14045 of the Welfare and Institutions Code is
amended to read:
   14045.  (a) A provider shall not submit a reimbursement request to
the Medi-Cal program containing a beneficiary's social security
number if the department has issued that beneficiary a Medi-Cal
beneficiary identification card containing a beneficiary number with
the issuance date included in that number.
   (b) This section shall not apply to the submission of a request by
a provider for beneficiary eligibility.
   (c) In order to reduce medical fraud and the black market for
stolen social security cards, the State Department of Health Care
Services may establish an automated HIPAA-compliant system using
HIPAA transactions whereby all providers can access a beneficiary's
identification card number for submitting reimbursement requests.
   (d) When the provider makes a good faith effort to obtain a
recipient's beneficiary identification card number, this section
shall not apply tothe following, or services provided by the
following provider types, until the time that the department is able
to establish a system described in subdivision (c):
   (1) A hospital licensed pursuant to Chapter 2 (commencing with
Section 1250) of Division 2 of the Health and Safety Code.
   (2) A long-term health care facility, as defined in Section 1418
of the Health and Safety Code.
   (3) A primary care clinic that is licensed pursuant to subdivision
(a) of Section 1204 of the Health and Safety Code.
   (4) Emergency medical transportation services.
   (5) A hospital-based physician.