BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 2051
AUTHOR: Gonzalez and Bocanegra
AMENDED: June 11, 2014
HEARING DATE: June 25, 2015
CONSULTANT: Bain
SUBJECT : Medi-Cal: providers: affiliate primary care clinics.
SUMMARY : Requires the Department of Health Care Services (DHCS),
within 30 calendar days of receiving an application for
enrollment as a Medi-Cal provider from an affiliate primary care
clinic that has been certified for enrollment by the Department
of Public Health, to notify the applicant that its Medi-Cal
enrollment is approved, or to ensure the applicant receives
notification of any deficiencies. Requires DHCS, within 30
calendar days of receiving a complete application for enrollment
into the Family Planning, Access, Care, and Treatment Program
(Family PACT) by a Medi-Cal provider affiliate primary care
clinic, to either approve the provider's Family PACT Program
application or notify the applicant of any deficiencies in
enrollment application.
Existing law:
1.Establishes the Medi-Cal program, administered by DHCS, 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.
2.Establishes the Family PACT Program to provide comprehensive
clinical family planning services to individuals who meet
specified income requirements.
3.Requires an applicant, a health care provider who is licensed
or certificated under state law or who is a professional
corporation seeking to receive reimbursement from
fee-for-service Medi-Cal, to be enrolled in the Medi-Cal
program as either an individual provider, or as a rendering
provider in a provider group.
4.Requires an applicant that is not enrolled in the Medi-Cal
program, or a provider applying for continued enrollment (upon
written notification from DHCS), and a provider not currently
enrolled at a location where the provider intends to provide
Continued---
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services to Medi-Cal beneficiaries, to submit a complete
application package to DHCS for enrollment, continuing
enrollment, or enrollment at a new location or a change in
location.
5.Permits an applicant or provider licensed as a clinic or a
health facility to be enrolled in the Medi-Cal program as a
clinic or a health facility without complying with the
provider enrollment requirements if the clinic or health
facility is certified by the Department of Public Health (DPH)
to participate in the Medi-Cal program.
This bill:
1.Requires DHCS, within 30 calendar days of receiving an
application for enrollment as a Medi-Cal provider from an
affiliate primary care clinic that has been certified for
enrollment by DPH, to provide written notice to the applicant
informing the applicant that its Medi-Cal enrollment is
approved.
2.Requires DHCS, if an affiliate primary care clinic's Medi-Cal
enrollment is not approved, to collaborate with DPH to ensure
that the applicant receives written notification informing the
applicant of any deficiencies and providing the applicant with
an opportunity to cure the deficiencies within 30 days of the
date of the written notice.
3.Requires DHCS to have 30 days from the receipt of information
from the applicant to approve or deny the Medi-Cal enrollment.
4.Requires DHCS to enroll the affiliate primary care clinic
retroactive to the date of certification.
5.Requires DHCS , within 30 calendar days of receiving a
complete application for enrollment into the Family PACT
Program by a Medi-Cal provider affiliate primary care clinic,
to do one of the following:
a. Approve the provider's Family PACT Program
application, provided the applicant meets the Family
PACT Program provider eligibility requirements; or,
b. Notify the applicant in writing of any
deficiencies in the Family PACT Program enrollment
application.
6.Requires the applicant to have 30 days from the date of
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3
written notice to correct any cited deficiencies. Requires
DHCS to approve the application within 30 calendar days upon
receipt of all requested corrections.
7.Requires DHCS, if an affiliate primary care clinic files its
Family PACT Program application either before or on the same
day that it files its affiliate primary care clinic licensure
application with DPH, to concurrently review and approve the
applicant's Family PACT Program application and Medi-Cal
enrollment in accordance with this bill. Requires the
effective date of enrollment into both programs to be
retroactive to the date Medi-Cal certification was approved by
DPH.
FISCAL EFFECT : According to the Assembly Appropriations
Committee analysis of the previous version of this bill, minor
costs for DHCS to identify and expedite affiliate primary care
clinic applications.
PRIOR VOTES :
Assembly Health: 19- 0
Assembly Appropriations:17- 0
Assembly Floor: 78- 0
COMMENTS :
1.Author's statement. According to the author, certain
non-profit corporations that operate multiple primary care
clinics are entitled to use a streamlined application process
that allows affiliated primary care clinics to receive a DPH
license within 30 days of submitting a completed application.
This streamlined process, in place since 2011, has eliminated
unnecessary paperwork, eased administrative burdens, and
significantly sped up the licensing process for these
affiliated clinics. Unfortunately, the streamlined licensure
process did not specifically address the timelines by which
DHCS must complete an affiliate clinic's enrollment into
Medi-Cal. Consequently, while affiliate clinics are entitled
to receive their license, open their doors, and provide
services to patients within 30 days of submitting an
application to DPH, they often cannot get paid for providing
those services until their enrollment in Medi-Cal is complete,
which can take three to four months.
2.Affiliate Primary Care Clinics and Provider Enrollment
Process. There are approximately 1,150 primary care clinics
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currently licensed in California, and 302 affiliate clinics.
SB 442 (Ducheny), Chapter 502, Statutes of 2010, established
an expedited licensure process for an affiliate primary care
clinic or a mobile health care unit operated as a primary care
clinic. Certain non-profit corporations that operate multiple
primary care clinics can use a streamlined application process
that allows affiliated primary care clinics to receive a DPH
license within 30 days of submitting a completed application.
In 2010-11, DPH received 37 applications for affiliate
clinics, in 2011-12, 52 applications, and 2012-13, DPH
received 60 applications.
When DPH certifies affiliate clinics for participation in
Medi-Cal, the affiliate clinic must still be approved by DHCS'
Provider Enrollment Division (PED) in order for the affiliate
clinic to be able to bill fee-for-service Medi-Cal. However,
because affiliate clinics have already been certified by DPH
to participate in Medi-Cal, DHCS' PED's review of the
affiliate clinic is limited to checking the list of providers
who are suspended and ineligible to participate in Medi-Cal,
checking a federal database, and reviewing the affiliate
clinic's provider agreement form.
PED administers statutory enrollment requirements to prevent and
address Medi-Cal fraud. A health care provider seeking to
provide services in the fee-for-service Medi-Cal program must
submit a complete application package for enrollment,
continued enrollment, enrollment at a new location or a change
in location. The application package includes an application
form (which must be signed under penalty of perjury or
notarized), a disclosure statement, and a provider agreement.
DHCS' PED indicates it receives 1,400 applications from
providers each month and are required to process applications
within 90 days for physician providers and 180 days for
non-physician providers. Affiliate clinics are exempt from
this process because they are certified by DPH and there is no
requirement for DHCS to complete the review of affiliate
clinics within a specific time frame. Under this bill, DHCS
will be required to complete its review of an affiliate clinic
that has been certified for enrollment by DPH within 30 days.
3.Family PACT Program. The Family PACT Program provides family
planning services to individuals with incomes under 200
percent of the federal poverty level. The 2014-15 budget for
Family PACT is $440 million ($147 million General Fund). In
order to be a Family PACT provider, the provider must be
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enrolled as a Medi-Cal provider, and must attend specific
orientation approved by DHCS in comprehensive family planning
services. This bill would require DHCS to process a complete
Family PACT application for enrollment by a Medi-Cal provider
affiliate clinic, which has met Family PACT provider
eligibility requirements, and to approve the application or
notify the applicant of any deficiencies.
4.Prior legislation. SB 1529 (Alquist), Chapter 797, Statutes of
2012, revises screening, enrollment, disenrollment,
suspensions, and other sanctions for fee-for-service Medi-Cal
providers and suppliers to conform to the federal Affordable
Care Act.
SB 857 (Speier), Chapter 601, Statutes of 2003, made numerous
changes to the Medi-Cal program intended to address provider
fraud, including establishing new Medi-Cal application
requirements for new providers, existing providers at new
locations, and providers applying for continued enrollment.
5.Support. This bill is supported by clinic providers, including
the California Primary Care Association and Planned Parenthood
Affiliates of California (PPAC), to streamline the Medi-Cal
enrollment process for affiliated primary care clinics. PPAC
states the streamlined licensure process created by SB 442
(Ducheny) did not address the timelines under which these
clinics are enrolled as Medi-Cal providers, so clinics can
receive a license to open and begin providing services to
patients within 30 days, but cannot be reimbursed for Medi-Cal
services until approved as an eligible provider, which can take
up to three or four months. During this time, PPAC indicates
its health centers must operate without a revenue stream,
making it even more challenging and expensive to open a new
health center than it would be otherwise. For Family PACT, PPAC
indicates the vast majority of its patients are Family PACT
eligible, so an enrollment delay for this program results in it
having to operate clinics without this revenue stream for three
to four months. PPAC argues this bill will better align the
licensing and Medi-Cal and Family PACT enrollment processes for
affiliate community clinics by requiring DHCS to approve and
enroll affiliated primary care clinics certified by DPH within
30 days. This will allow them to open their doors more quickly
and begin providing needed health care services to the
individuals and families in their communities.
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6.Opposition. The California Right to Life Committee, Inc. (CRLC)
writes in opposition that this bill offers unequal and
unjustifiable advantage to one organization, Planned
Parenthood. CRLC argues this bill demands exceptional service
from the state in support of affiliate primary family planning
agencies by requiring the authorizing agency to work with and
coach the petitioning clinic on how to properly complete the
state's form and comply with state requirements, and
retroactively awarding the clinic for its inability to comply
with application requirements. CRLC states this is favoritism
and cronyism in its most despicable form for a state agency,
and the state licensing requirements and agency's first
priority should be the protection of the customer to be served
by the petitioning agency. CLRC concludes that this bill places
the state health licensing department at the service of a
single petitioning organization, thereby denigrating the needs
of the customer to the financial benefit of the service
provider.
SUPPORT AND OPPOSITION :
Support: American Federation of State, County and Municipal
Employees, AFL-CIO
California Academy of Family Physicians
California Primary Care Association
Planned Parenthood Advocacy Project Los Angeles County
Planned Parenthood Affiliates of California
Planned Parenthood Mar Monte
Planned Parenthood of Orange and San Bernardino
Counties
Planned Parenthood of Santa Barbara, Ventura and San
Luis Obispo Counties
Planned Parenthood of the Pacific Southwest
Planned Parenthood Pasadena and San Gabriel Valley
Planned Parenthood Shasta Pacific Action Fund
Six Rivers Planned Parenthood
Oppose: California Right to Life Committee, Inc.
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