Amended in Senate April 3, 2014

Senate BillNo. 1315


Introduced by Senator Monning

February 21, 2014


An act tobegin delete add Section 1327.5 to the Unemployment Insurance Code, relating to unemployment insurance.end deletebegin insert amend Section 14043.7 of the Welfare and Institutions Code, relating to Medi-Cal.end insert

LEGISLATIVE COUNSEL’S DIGEST

SB 1315, as amended, Monning. begin deleteUnemployment insurance benefits: overpayment. end deletebegin insertMedi-Cal: providers.end insert

begin insert

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.

end insert
begin insert

Existing law permits the department to make unannounced visits to an applicant or to a provider for the purpose of determining whether enrollment, continued enrollment, or certification as a provider is warranted, or as necessary for the administration of the Medi-Cal program. Existing law further requires that a provider be subject to temporary suspension from the Medi-Cal program, which includes temporary deactivation of the provider’s number, for failure to remediate significant discrepancies in information that he or she provided to the department or for failure to remediate significant discrepancies that are discovered as a result of an announced or unannounced visit to a provider, as specified. Existing law requires the provider to be notified, in writing, of the temporary suspension and deactivation of providers number.

end insert
begin insert

This bill would require that notice of temporary suspension to contain a list of discrepancies to be remediated and the timeframe in which the provider needs to remediate those discrepancies. The bill would require the department to lift a temporary suspension and notify a provider that the temporary suspension has been lifted and that he or she is eligible to receive reimbursement for Medi-Cal services provided after the date the temporary suspension was lifted if the provider has demonstrated that the identified discrepancies have been remediated within the applicable timeframe. A provider who fails to remediate the identified discrepancies would be removed from enrollment as a provider in the Medi-Cal program by operation of law.

end insert
begin delete

Existing law requires the Employment Development Department to pay unemployment compensation benefits to eligible claimants, makes any person who is overpaid any amount as benefits liable for the amount overpaid, and requires the department to issue a notice of overpayment. Existing regulations adopted by the department require the department to notify the claimant when the department determines that an overpayment of benefits is probable, and to assist the claimant in furnishing necessary information to the department regarding the claimant’s eligibility for benefits, as specified.

end delete
begin delete

This bill would place in statute the requirement that the department issue a notice of probable overpayment of benefits and provide related assistance, and would require that the claimant be given a minimum of 20 days in which to respond to the notice.

end delete

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

P2    1begin insert

begin insertSECTION 1.end insert  

end insert

begin insertSection 14043.7 of the end insertbegin insertWelfare and Institutions
2Code
end insert
begin insert is amended to read:end insert

3

14043.7.  

(a) The department may make unannounced visits
4to an applicant or to a provider for the purpose of determining
5whether enrollment, continued enrollment, or certification is
6warranted, or as necessary for the administration of the Medi-Cal
7program. If an unannounced site visit is conducted by the
8department for any enrolled provider, the provider shall permit
9access to any and all of their provider locations. If a provider fails
10to permit access for any site visit, the application shall be denied
11and the provider shall be subject to deactivation. At the time of
P3    1the visit, the applicant or provider shall be required to demonstrate
2an established place of business appropriate and adequate for the
3services billed or claimed to the Medi-Cal program, as relevant to
4his or her scope of practice, as indicated by, but not limited to, the
5following:

6(1) Being open and available to the general public.

7(2) Having regularly established and posted business hours.

8(3) Having adequate supplies in stock on the premises.

9(4) Meeting all local laws and ordinances regarding business
10licensing and operations.

11(5) Having the necessary equipment and facilities to carry out
12day-to-day business for his or her practice.

13(b) An unannounced visit pursuant to subdivision (a) shall be
14prohibited with respect to clinics licensed under Section 1204 of
15the Health and Safety Code, clinics exempt from licensure under
16Section 1206 of the Health and Safety Code, health facilities
17licensed under Chapter 2 (commencing with Section 1250) of
18Division 2 of the Health and Safety Code, and natural persons
19licensed or certified under Division 2 (commencing with Section
20500) of the Business and Professions Code, the Osteopathic
21Initiative Act, or the Chiropractic Initiative Act, unless the
22department has reason to believe that the provider will defraud or
23abuse the Medi-Cal program or lacks the organizational or
24administrative capacity to provide services under the program.

25(c) begin insert(1)end insertbegin insertend insertFailure to remediate significant discrepancies in
26information provided to the department by the provider or
27significant discrepancies that are discovered as a result of an
28announced or unannounced visit to a provider, for purposes of
29enrollment, continued enrollment, or certification pursuant to
30subdivision (a) shall make the provider subject to temporary
31suspension from the Medi-Cal program, which shall include
32temporary deactivation of the provider’s number, including all
33business addresses used by the provider to obtain reimbursement
34from the Medi-Cal program. The director shall notify in writing
35the provider of the temporary suspension and deactivation of
36provider numbers, which shall take effect 15 days from the date
37of the notification. Notwithstanding Section 100171 of the Health
38and Safety Code, proceedings after the imposition of sanctions in
39this subdivision shall be in accordance with Section 14043.65.

begin insert

P4    1(2) A notice of temporary suspension issued pursuant to
2paragraph (1) shall include the following:

end insert
begin insert

3(A) A list of discrepancies required to be remediated.

end insert
begin insert

4(B) The timeframe in which a provider may demonstrate to the
5department that the discrepancies identified pursuant to
6subparagraph (A) have been remediated.

end insert
begin insert

7(3) If a provider who has received a notice of temporary
8suspension pursuant to paragraph (1) demonstrates to the
9department that the discrepancies identified pursuant to
10subparagraph (A) of paragraph (2) have been remediated and
11meets the standards of participation within the timeframe specified
12in subparagraph (B) of paragraph (2), the department shall lift
13the temporary suspension and shall notify the provider that the
14temporary suspension has been lifted and that he or she is eligible
15to receive Medi-Cal reimbursement for services provided after the
16date the temporary suspension was lifted.

end insert
begin insert

17(4) If a provider who has received a notice of temporary
18suspension pursuant to paragraph (1) fails to remediate the
19discrepancies identified pursuant to subparagraph (A) of
20paragraph (2) within the timeframe specified in subparagraph (B)
21of paragraph (2), the provider shall be removed from enrollment
22as a provider in the Medi-Cal program by operation of law.

end insert

23(d) (1) This section shall become operative on the effective
24date of the state plan amendment necessary to implement this
25section, as stated in the declaration executed by the director
26pursuant to paragraph (2).

27(2) Upon approval of the state plan amendment necessary to
28implement this section under Section 455.416 of Title 42 of the
29Code of Federal Regulations, the director shall execute a
30declaration, to be retained by the director and posted on the
31department’s Internet Web site, that states that this approval has
32been obtained and the effective date of the state plan amendment.
33The department shall transmit a copy of the declaration to the
34Legislature.

begin delete35

SECTION 1.  

Section 1327.5 is added to the Unemployment
36Insurance Code
, to read:

37

1327.5.  

(a) Whenever the department determines that an
38overpayment is probable, it shall promptly notify the claimant of
39the probable overpayment, the claimant’s right to request that the
40department waive the overpayment, and the standards to obtain a
P5    1waiver of the overpayment. The claimant shall be provided no
2fewer than 20 days from the mailing or personal service of the
3notice to respond before the department issues a decision of
4overpayment. The department shall assist and advise the claimant
5in meeting his or her obligation to furnish the department with all
6information necessary for the department to determine whether
7there is an overpayment and whether the claimant is entitled to
8waiver of an overpayment, and for establishing a repayment
9schedule.

10(b) This section shall not be interpreted to modify Section 1328
11or Section 1334.

end delete


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