BILL ANALYSIS �
SB 494
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Date of Hearing: August 30, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
SB 494 (Monning) - As Amended: August 19, 2013
Policy Committee: HealthVote:18-0
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill modifies standards related to primary care providers
in managed care plans. Specifically, this bill:
1)Until January 1, 2019, for purposes of health plans, including
Medi-Cal managed care plans, permits assignment of an
additional 1,000 patients to a physician's panel for every
nurse practitioner (NP) or physician assistant (PA) supervised
by the physician.
2)Defines the term "nonphysician medical practitioner" in the
Welfare and Institutions Code, Insurance Code, and Health and
Safety Code.
3)Until January 1, 2019, for purposes of Medi-Cal managed care,
explicitly authorizes assignment of up to 2,000 beneficiaries
for each full-time equivalent primary care physician in
addition to the authorization in (1) above.
FISCAL EFFECT
1)Potentially significant cost pressure to Medi-Cal managed care
(MCMC) rates (GF/federal funds) if plans are forced to change
or expand their networks to accommodate the new requirements
in (3) above. It is difficult to evaluate the cost
implications of compliance with this new standard, as neither
the plan nor the state regulates the number of members an
individual provider is willing to accept into a panel.
2)Unknown, likely minor, one-time administrative costs to the
Department of Health Care Services (DHCS) (GF/federal funds)
and likely some level of expenditure ongoing, to verify
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compliance with the new requirements in (3), above, related to
panel size of physicians who contract with MCMC plans.
3)One-time costs of $600,000 to DMHC (Managed Care Fund) for
review of licensee's documents verifying compliance with these
standards.
4)Minor potential ongoing costs, in the tens of thousands of
dollars annually, to DMHC (Managed Care Fund), for enforcement
of new rules related to the size of physician panels.
5)It is unclear if this bill will trigger a review of network
adequacy requirements in regulation, given the new definitions
and authorizations. If it does, both the California Department
of Insurance and DMHC may incur associated special fund costs.
Costs would depend on the depth of review and revision of
regulations.
COMMENTS
1)Rationale . The author believes this bill will encourage
greater use of NPs and PAs as primary care providers in the
managed care setting. Currently, managed care contracts in the
Medi-Cal program allow assignment of a caseload of up to 1,000
patients to nonphysician medical practitioners. This bill
applies a similar logic to managed care plans broadly.
The sunset was added in Health committee in order to reexamine
the impact of this policy in several years. The bill is
sponsored by California Association of Physician Groups (CAPG)
and the California Academy of Physician Assistants, and has no
registered opposition.
2)Background . In order to maintain a plan license, managed care
plans must meet, among other standards, network adequacy
requirements that establish minimum ratios of enrollees to
physicians. Currently, DMHC regulations require a ratio of
one fulltime equivalent physician to every 2,000 enrollees in
a plan. This bill explicitly permits assignment of an
additional 1,000 patients to a physician's panel for every
nonphysician primary care provider in managed care plans. If
additional patients can be served by NPs and PAs in a group
setting, it may trigger a reevaluation of what constitutes
adequate networks for purposes of primary care. Additionally,
the hire of more nonphysician medical practitioners would
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better allow physician practices to expand capacity and meet
requirements on timely access to care under the Knox-Keene
Act.
3)Medi-Cal Managed Care (MCMC) . Currently MCMC plans are
required to maintain a ratio of one primary care physician
(PCP) for every 2,000 members, but neither the plan nor the
state regulates the number of members an individual provider
is willing to accept into a panel. The plan will, however,
have to meet standards related to timely access to care, which
limits the number of patients a physician or physician group
can manage for purposes of primary care. This bill explicitly
authorizes assignment of "up to" 2,000 patients per physician,
but the number of patients per physician is not directly
capped or limited elsewhere in law or regulation. Thus, the
implication of this change is not clear, as the number of
patients assigned to each physician is not currently centrally
tracked.
4)Related Legislation . SB 491 (Ed Hernandez) permits a NP to
practice independently after a period of physician supervision
if the NP has national certification and liability insurance,
and authorizes the NP to perform various other specified tasks
related to the practice of nursing without protocols.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081