BILL NUMBER: AB 839	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Emmerson

                        FEBRUARY 26, 2009

   An act to amend Section 14104.5 of the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 839, as introduced, Emmerson. Medi-Cal service providers:
judicial remedies.
   Existing law establishes the Medi-Cal program, administered by the
State Department of Health Care Services, under which basic health
care services are provided to qualified low-income persons.
   Existing law requires the Director of Health Care Services to
adopt procedures for the review of grievances or complaints filed by
Medi-Cal service providers concerning the processing or payment of
money that the provider alleges is payable under the Medi-Cal
program. A provider that complies with these procedures and is not
satisfied with the director's decision regarding that claim may seek
appropriate judicial remedies within a specified time period.
   This bill would, instead, specify that the provider who has
complied with these procedures may, within the time period prescribed
in existing law, seek either a writ of mandate or, if the claim
meets the jurisdictional requirements, file a claim in small claims
court.
   Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.


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

  SECTION 1.  Section 14104.5 of the Welfare and Institutions Code is
amended to read:
   14104.5.  Notwithstanding any other provision of law, the director
shall by regulation adopt such procedures as are necessary for the
review of a grievance or complaint concerning the processing or
payment of money alleged by a provider of services to be payable by
reason of any of the provisions of this chapter. After complying with
these procedures, if the provider is not satisfied with the director'
s decision on his or her claim, he or she may not later than one year
after receiving notice of the decision,  seek appropriate
judicial remedies   file a petition for writ of mandate
pursuant to Section 1085 of the Code of Civil Procedure in the
superior   court or file a claim in small claims court if
the claim meets the jurisdictional requirements  . This section
shall be the exclusive remedy available to the provider of services
for moneys alleged to be payable by reason of this chapter.
   This section shall not apply to those grievances or complaints
arising from the findings of an audit or examination made by or on
behalf of the director pursuant to Sections 10722 and 14170. Article
5.3 (commencing with Section 14170) shall govern the grievances or
complaints.