AB 2051, as amended, Gonzalez. Medi-Cal: providers: affiliate primary care clinics.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.
Existing law authorizes the department to adopt regulations for certification of each applicant and each provider in the Medi-Cal program. Existing law requires certain applicants or providers, as defined, to submit a complete application package for enrollment, continuing enrollment, or enrollment at a new location or a change in location. Existing law generally requires the department to give written notice regarding the status of an application to an applicant or provider within a prescribed period of time, as specified.
This bill would require the department, within 15 days after receiving an application and certification package from an applicant that is an affiliate primary care clinic, to provide specified written notice of the status of the application, or to approve the applicationbegin delete on the 16th day after receiving the package,end deletebegin insert effective on the date the affiliate primary care clinic license was issued,end insert as specified. The bill would also require the department, within 15 days afterbegin delete approvingend deletebegin insert the approval ofend insert an application,begin delete to provide written notice regarding certain conditions imposed on the provider, or, on the 16th day after approving an application,end delete
to approve the provider’s participation in specified public health programs.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 14043.17 is added to the Welfare and
2Institutions Code, to read:
(a) Notwithstanding any other law, within 15 days
4of receiving an application and certification package to be certified
5as a Medi-Cal provider from an affiliate primary care clinic that
6is licensed pursuant to Section 1218.1 of the Health and Safety
7Code and that has been certified for enrollment by the State
8Department of Public Health, the department shall do either of the
9following:
10(1) Provide written notice to the applicant that one of the
11following applies:
12(A) The applicant is being granted provisional provider status
13for a period of 12 months, effective from the date on the notice.
14(B) The application package is incomplete. The notice shall
15identify additional information or documentation that is needed to
16complete the application package.
17(C) The department is exercising its authority under Section
1814043.37, 14043.4, or 14043.7, and is conducting background
19checks, preenrollment inspections, or unannounced visits.
20(D)
end delete
21begin insert(C)end insert The application package is denied for any of the following
22reasons:
23(i) Pursuant to Section 14043.2 or 14043.36.
24(ii) For lack of abegin delete license necessary to perform the health care
25services or to provide the goods, supplies, or merchandise directly
26or indirectly to
a Medi-Cal beneficiary, within the applicable
27provider of service category or subgroup of that category.end delete
28care clinic license.end insert
P3 1(iii) The period of time during which an applicant or provider
2has been barred from reapplying has not passed.
3(iv) For other stated reasons authorized by law.
4(v) For failing to submit fingerprints as required by federal
5Medicaid regulations.
6(vi) For failing to pay an application fee as required by federal
7Medicaid regulations.
8(2) Approve the application effective on the date the affiliate
9primary care clinic license was issued by the State Department of
10Public Health.
11(2)
end delete
12begin insert(b)end insert On the 16th day after receiving the application,begin delete approve the begin insert if action is not taken pursuant to paragraph
13application and make end delete
14(1) or (2) of subdivision (a), then the application is deemed
15approved and end insertthat approvalbegin insert
isend insert effective on the date the affiliate
16primary carebegin insert clinicend insert license was issued by the State Department of
17Public Health.
18(b)
end delete
19begin insert(c)end insert Notwithstanding any other law, within 15 days ofbegin delete approvingend delete
20begin insert the approval ofend insert an application pursuant to subdivision (a)begin insert
or (b)end insert,
21the department shallbegin delete do either of the following:end deletebegin insert
approve the
22provider’s requested participation in any of the programs described
23in Section 1222 of the Health and Safety Code. On the 16th day
24after approving the application, if action is not taken, the
25provider’s requested participation in any of those programs is
26deemed approved.end insert
27(1) Provide written notice to the provider that one of the
28following applies:
29(A) The provider is being granted provisional provider status
30for a period of 12 months, effective from the date on the notice.
31(B) The department is exercising its authority under Section
3214043.37, 14043.4, or 14043.7, and is conducting background
33checks, preenrollment inspections, or unannounced visits.
34(2) On the 16th day after
approving the application, approve
35the provider’s participation in any of the programs described in
36Section 1222 of the Health and Safety Code.
37(d) This section shall not be construed to limit the department’s
38authority pursuant to Section 14043.37, 14043.4, or 14043.7 to
39conduct background checks, preenrollment inspections, or
40unannounced visits.
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