BILL ANALYSIS Ó
AB 2051
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 2051 (Gonzalez and Bocanegra)
As Amended August 14, 2014
Majority vote
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|ASSEMBLY: |78-0 |(May 15, 2014) |SENATE: |26-8 |(August 19, |
| | | | | |2014) |
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Original Committee Reference: HEALTH
SUMMARY : Streamlines the enrollment process into Medi-Cal and
the Family Planning, Access, Care, and Treatment (Family PACT)
for affiliate primary care clinics.
The Senate amendments delete provisions requiring the Department
of Health Care Services (DHCS) to approve, or provide written
notice on the status of, an affiliate primary care clinic's
Medi-Cal provider application, as well as provisions requiring
DHCS to approve the affiliate primary care clinic's
participation in specified public health programs, and instead:
1)Require DHCS, within 30 calendar days, rather than 15 calendar
days, of receipt of confirmation from the Department of Public
Health (DPH) of the affiliate primary care clinic's
certification as a Medi-Cal provider to provide written notice
to the applicant that its Medi-Cal enrollment is approved.
2)Require DHCS to make the affiliate primary care clinic's
enrollment effective on the date the clinic was certified to
participate in the Medi-Cal program.
3)Require DHCS, within 30 calendar days of receipt of a complete
application from an affiliate primary care clinic for
enrollment into the Family PACT program, to:
a) Approve the application provided the applicant meets
Family PACT program enrollment requirements; or,
b) Notify the applicant, if the applicant is an enrolled
Medi-Cal provider in good standing, of any discrepancies in
the Family PACT program enrollment application, grant the
applicant 30 days from the date of written notice to
correct any identified discrepancies, and approve the
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application within 30 calendar days of receipt of all
requested corrections.
4)Prohibit DHCS from proceeding with the streamlined application
process for Family PACT applicants if the applicant is not an
enrolled Medi-Cal provider in good standing.
5)Establish the effective date of enrollment into the Family
PACT program as the later of the date DHCS receives
confirmation of enrollment as a Medi-Cal provider, or the date
the application meets all Family PACT program provider
enrollment requirements.
EXISTING LAW :
1)Establishes the Medi-Cal program, administered by DHCS, under
which qualified low-income individuals receive health care
services, and requires a provider to apply to DHCS to obtain
approval for enrollment as a Medi-Cal provider.
2)Establishes the Family PACT program to provide comprehensive
clinical family planning services to individuals who meet
specified income requirements.
3)Requires primary care clinics to be licensed by DPH and approved
for operation by DPH prior to obtaining a Medi-Cal provider
number or providing services, and clarifies that a clinic
corporation can apply to establish affiliate clinics on behalf
of a primary care clinic, as specified.
4)Requires the affiliate clinic licensure application to consist
solely of a simple form and supporting documents containing:
the names, addresses and contact information of the clinic
corporation and affiliate clinic's administrative officers;
the affiliate clinic location and hours of operation; evidence
of compliance with minimum safety standards related to the
affiliate clinic's physical plant; and, other pertinent
information, as specified.
5)Requires DPH to issue a license to an affiliate clinic within 30
days of receiving a completed application.
FISCAL EFFECT : According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS : According to the author, certain non-profit
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corporations that operate multiple primary care clinics are
entitled to use a streamlined application process that allows
affiliated primary care clinics to receive a license from DPH
within 30 days of submitting a completed application.
Unfortunately, this streamlined licensure process does not
specifically address the timelines by which the DHCS must
complete the affiliate clinic's enrollment as a Medi-Cal
provider. The author notes as a consequence, 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, but often cannot get paid for providing
certain services until their enrollment in Medi-Cal is complete,
which can take three to four months. The author states,
existing law allows DHCS to take as long as 180 days to even
begin to review an affiliate clinic's Medi-Cal application, and
DHCS is backlogged with applications, resulting in a very slow
turnaround time that is very close to the statutory limit. The
author argues the significant interruption in revenue increases
the cost and complexities of opening a new affiliated primary
care clinic and is at odds with the intent behind the current
expedited licensure process.
There are approximately 1,000 primary care clinics currently
licensed in California. Certain non-profit corporations that
operate multiple primary care clinics are entitled to use a
streamlined application process that allows qualifying primary
care clinics, known as affiliated primary care clinics, to
receive a DPH license within 30 days of submitting a completed
application. This streamlined licensure process, in place since
2011, has eliminated unnecessary paperwork, eased administrative
burdens, and significantly sped up the licensing process for
these affiliated clinics.
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. Because
affiliate clinics have already been certified by DPH to
participate in Medi-Cal, PED's review of the affiliate clinic is
limited to checking federal and state databases to ensure the
provider has not been excluded from participation in Medi-Cal
federal database and reviewing the affiliate clinic's provider
agreement form. Once PED's review is complete, a record for the
provider is built into the claims processing system and the
provider's enrollment is effective the date they are certified
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in the Medi-Cal program by DPH.
The Family PACT program provides family planning services to
individuals with incomes under 200% of the federal poverty
level. Providers already enrolled in the Medi-Cal program may
apply for enrollment as a Family PACT provider. Once the Family
PACT program approves the provider's application, the Family
PACT program submits a transmittal to PED processes the provider
application in a similar process to that described above for
Medi-Cal providers.
Supporters, including the California Primary Care Association
and the Planned Parenthood Affiliates of California (PPAC),
state that the clinic licensure process under existing law does
not address the timelines under which affiliated primary care
clinics are enrolled as Medi-Cal providers, delaying the ability
of affiliate clinics to provide and receive reimbursement for
Medi-Cal services. PPAC also indicates that the vast majority
of its patients are eligible for Family PACT, so a delay in
enrollment for this program results in clinics having to operate
without a revenue stream for these patients. PPAC notes that a
clinic can be licensed, but it can take up to three to four
months to be approved as a Medi-Cal provider and receive
reimbursements, making opening a health center an even more
challenging and expensive undertaking. Supporters argue this
bill will streamline the Medi-Cal and Family PACT enrollment
processes for affiliated primary care clinics which will allow
clinics to open their doors more quickly and begin providing
needed health care services to the individuals and families in
their communities.
The California Chapter of American College of Physicians and the
California Medical Association maintain a support if amended
position on this bill. These organizations state that they
support creating a faster Medi-Cal provider enrollment process
Medi-Cal to increase access to care, and would support this bill
if it were amended to include an expedited provider enrollment
standard for emergency physicians.
The California Right to Life Committee, Inc. (CRLC) opposes this
bill and states 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 care family planning agencies by requiring
the authorizing agency to work with and coach the petitioning
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clinic on how to properly complete the state's form and comply
with state requirements, and retroactively rewarding the clinic
for its inability to comply with application requirements.
Analysis Prepared by : Kelly Green / HEALTH / (916) 319-2097
FN:
0004802