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 applicationbegin delete and certification packageend deletebegin insert for enrollment as a Medi-Cal providerend insert 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 application effective on the date the affiliate primary care clinic license was issued, as specified. The bill would also require the department, within 15 days after the approval of an application, to approve the provider’sbegin insert requestedend insert 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 applicationbegin delete and certification package to be certifiedend delete
5begin insert for enrollmentend insert as a Medi-Cal provider from an affiliate primary
6care clinic that is licensed pursuant to Section 1218.1 of the Health
7and Safety Code and that has been certified for enrollment by the
8State Department of Public Health, the department shall do either
9of the following:
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 application package is denied for any of the following
18reasons:
19(i) Pursuant to Section 14043.2 or 14043.36.
20(ii) For lack of a primary care clinic license.
21(iii) The period of time during which an applicant or provider
22has been
barred from reapplying has not passed.
23(iv) For other stated reasons authorized by law.
24(v) For failing to submit fingerprints as required by federal
25Medicaid regulations.
26(vi) For failing to pay an application fee as required by federal
27Medicaid regulations.
P3 1(2) Approve the application effective on the date the affiliate
2primary care clinic license was issued by the State Department of
3Public Health.
4(b) On the 16th day after receiving the application, if action is
5not taken pursuant to paragraph (1) or (2) of subdivision (a), then
6the application is deemed approved and that approval is effective
7on
the date the affiliate primary care clinic license was issued by
8the State Department of Public Health.
9(c) Notwithstanding any other law, within 15 days of the
10approval of an application pursuant to subdivision (a) or (b), the
11department shall approve the provider’s requested participation in
12any of the programs described in Section 1222 of the Health and
13Safety Code. On the 16th day after approving the application, if
14action is not taken, the provider’s requested participation in any
15of those programs is deemed approved.
16(d) This section shall not be construed to limit the department’s
17authority pursuant to Section 14043.37, 14043.4, or 14043.7 to
18conduct background checks, preenrollment inspections, or
19unannounced visits.
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