BILL ANALYSIS Ó
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THIRD READING
Bill No: AB 2051
Author: Gonzalez (D)
Amended: 8/5/14 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 6-2, 6/25/14
AYES: Hernandez, Beall, De León, DeSaulnier, Evans, Monning
NOES: Morrell, Nielsen
NO VOTE RECORDED: Wolk
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 78-0, 5/15/14 - See last page for vote
SUBJECT : Medi-Cal: providers: affiliate primary care
clinics
SOURCE : Author
DIGEST : This bill requires the Department of Health Care
Services (DHCS), except as specified, within 30 calendar days of
receiving an application for enrollment as a Medi-Cal provider
from an applicant that is an affiliate primary care clinic, to
provide specified written notice to the applicant informing the
applicant that its Medi-Cal enrollment is approved. The bill
requires DHCS, if an affiliate primary care clinic's Medi-Cal
enrollment is not approved, to collaborate with the Department
of Public Health (DPH) to ensure that the applicant receives
written notification and providing the applicant with an
opportunity to cure the deficiencies, as specified. The bill
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imposes similar requirements upon DHCS with respect to an
application for enrollment into the Family Planning, Access,
Care, and Treatment (Family PACT) Program. The bill also makes
the effective date of enrollment into the Family PACT Program
the later of the date DHCS receives confirmation of enrollment
as a Medi-Cal provider, or the date the applicant meets all
Family PACT provider enrollment requirements.
ANALYSIS : 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
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 DPH to participate in the Medi-Cal
program.
This bill:
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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 from 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 enrollment requirements; or
B. Notify the applicant in writing of any deficiencies in
the Family PACT Program enrollment application if the
provider is an enrolled Medi-Cal provider in good standing.
Specifies the applicant has 30 days from the date of
written notice to correct any identified deficiencies.
Requires DHCS, upon receipt of all requested corrections,
to approve the application within 30 calendar days.
1.Prohibits DHCS from proceeding with the above actions if the
provider is not an enrolled Medi-Cal provider in good standing
until DHCS receives confirmation of good standing and
enrollment as a Medi-Cal provider.
2.Requires the effective date of enrollment into the Family PACT
Program to be the later of the date DHCS receives confirmation
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of enrollment as a Medi-Cal provider, or the date the
applicant meets all Family PACT Program provider enrollment
requirements.
Comments
According to the author's office, 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.
Affiliate Primary Care Clinics and Provider Enrollment Process.
There are approximately 1,150 primary care clinics 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
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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.
Family PACT Program . The Family PACT Program provides family
planning services to individuals with incomes under 200% 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 enrolled as a
Medi-Cal provider, and must attend specific orientation approved
by DHCS in comprehensive family planning services. This bill
requires 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.
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
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fraud, including establishing new Medi-Cal application
requirements for new providers, existing providers at new
locations, and providers applying for continued enrollment.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (per Senate Health Committee analysis 6/25/14 -
unable to reverify at time of writing)
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
OPPOSITION : (per Senate Health Committee analysis 6/25/14 -
unable to reverify at time of writing)
California Right to Life Committee, Inc.
ARGUMENTS IN 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
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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.
ARGUMENTS IN 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.
ASSEMBLY FLOOR : 78-0, 5/15/14
AYES: Achadjian, Alejo, Allen, Ammiano, Bigelow, Bloom,
Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian
Calderon, Campos, Chau, Chávez, Chesbro, Conway, Cooley,
Dababneh, Dahle, Daly, Dickinson, Donnelly, Eggman, Fong, Fox,
Frazier, Beth Gaines, Garcia, Gatto, Gomez, Gonzalez, Gordon,
Gorell, Gray, Grove, Hagman, Hall, Harkey, Roger Hernández,
Holden, Jones, Jones-Sawyer, Levine, Linder, Logue, Lowenthal,
Maienschein, Medina, Melendez, Mullin, Muratsuchi, Nazarian,
Nestande, Olsen, Pan, Patterson, Perea, John A. Pérez, V.
Manuel Pérez, Quirk, Quirk-Silva, Rendon, Ridley-Thomas,
Rodriguez, Salas, Skinner, Stone, Ting, Wagner, Waldron,
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Weber, Wieckowski, Wilk, Williams, Yamada, Atkins
NO VOTE RECORDED: Mansoor, Vacancy
JL:nl 8/6/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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