SB 1339, as amended, Cannella. Medi-Cal: Drug Medi-Cal Treatment Program providers.
Existing law provides for the Drug Medi-Cal (DMC) Treatment Program, under which counties enter into contracts with the State Department of Health Care Services for the provision of various drug treatment services to Medi-Cal recipients, or the department directly arranges for the provision of these services if a county elects not to do so.
Existing law requires the State Department of Health Care Services to screen Medi-Cal providers and designate each provider or applicant as “limited,” “moderate,” or “high” categorical risk. Existing law requires a provider or applicant designated as a “high” categorical risk, and a person with a 5% or greater direct or indirect ownership interest in the provider, to submit to the Department of Justice fingerprint images and related information for the purpose of obtaining information as to the existence of past criminal conduct, as specified. Existing law requires the Department of Justice to charge a fee, to be paid by the applicant or provider, sufficient to cover the cost of processing the criminal background check request.
This bill wouldbegin delete require DMC providers to be designated as a “high” categorical risk and be subject to the background checks described above. The bill wouldend delete provide that if thebegin delete provider or applicant isend deletebegin insert department designatesend insert a nonprofit Drug Medi-Cal provider or applicantbegin insert as a “high” categorical riskend insert, the criminal background check and the requirement to submit
fingerprint images and related information would apply to the officers and executive director of thebegin insert nonprofitend insert provider or applicant.begin delete The bill would permit the department to designate a DMC provider as a “limited” or “moderate” categorical risk by executing a declaration stating the reason or reasons that a “high” categorical risk designation is no longer warranted. The bill would provide that it is the responsibility of the DMC provider, or the person with a 5% or greater direct or indirect ownership interest in the provider, to pay the fee imposed for processing the criminal background check request, as applicable. The bill would prohibit, except as provided by federal law, a DMC provider from being excluded from contracting with a county or the department based solely on the existence of a past criminal record of the DMC provider or a person with a 5% or greater direct or indirect ownership interest in the provider. 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:
Section 14043.38 of the Welfare and Institutions
2Code is amended to read:
(a) Provider types are designated as “limited,”
4“moderate,” or “high” categorical risk by the federal government
5in Section 424.518 of Title 42 of the Code of Federal Regulations.
6The department shall, at minimum, utilize the federal regulations
7in determining a provider’s or applicant’s categorical risk.
8(b) In accordance with Section 455.450 of Title 42 of the Code
9of Federal Regulations, the department shall designate a provider
P3 1or applicant as a “high” categorical risk if any of the following
2occur:
3(1) The department imposes a payment suspension based on a
4credible allegation of fraud, waste, or abuse.
5(2) The provider or applicant has an existing Medicaid
6overpayment based on fraud, waste, or abuse.
7(3) The provider or applicant has been excluded by the federal
8Office of the Inspector General or another state’s Medicaid program
9within the previous 10 years.
10(4) The federal Centers for Medicare and Medicaid Services
11lifted a temporary moratorium within the previous six months for
12the particular provider type submitting the application, the applicant
13would have been prevented from enrolling based on that previous
14moratorium, and the applicant applies for enrollment as a provider
15at any time within six months from the date the moratorium was
16lifted.
17(c) If
the department designates a provider or applicant as a
18“high” categorical risk, the department or its designee shall do
19both of the following:
20(1) Conduct a criminal background check of
the following
21persons:
22(A) The provider or applicant. If the provider or applicant is a
23nonprofit Drug Medi-Cal provider or applicant, the officers and
24executive director of the provider or applicant.
25(B) Any person with a 5-percent or greater direct or indirect
26ownership interest in the provider or applicant.
27(2) Require
the following persons to submit a set of fingerprints
28within 30 days of the department’s request, in a manner determined
29by the department:
30(A) The provider or applicant. If the provider or applicant is a
31nonprofit Drug Medi-Cal provider or applicant, the officers and
32executive director of the provider or applicant.
33(B) Any person with a 5-percent or greater direct or indirect
34ownership interest in the provider or applicant.
35(d) (1) The department shall submit to the Department of Justice
36fingerprint images and related information required by the
37Department of Justice of Medi-Cal providers or applicants
38determined to be a “high” categorical risk pursuant to subdivision
39(a), and any
person with a 5-percent or greater direct or indirect
40ownership interest in those providers and applicants, for the
P4 1purposes of obtaining information as to the existence and content
2of a record of state or federal convictions and state or federal arrests
3and also information as to the existence and content of a record of
4state or federal arrests for which the Department of Justice
5establishes that the person is free on bail or on his or her
6recognizance pending trial or appeal.
7(2) When received, the Department of Justice shall forward to
8the Federal Bureau of Investigation requests for federal summary
9criminal history information received pursuant to this section. The
10Department of Justice shall review the information returned from
11the Federal Bureau of Investigation and compile and disseminate
12a response to the department.
13(3) The Department of Justice shall provide a state or federal
14level response to the department pursuant to paragraph (1) of
15subdivision (p) of Section 11105 of the Penal Code.
16(4) The department shall request from the Department of Justice
17subsequent notification service, as provided pursuant to Section
1811105.2 of the Penal Code, for persons described in paragraph (1).
19(5) The Department of Justice shall charge a fee sufficient to
20cover the cost of processing the request described in this section.
21That fee shall be paid by the subject of the criminal background
22check.
23(e) For persons subject to the requirements of subdivision (a)
24of Section 15660, the procedure
for obtaining and submitting
25fingerprints and notification by the Department of Justice of
26criminal record information set forth in subdivision (c) of Section
2715660 shall apply instead of the procedure set forth in subdivision
28(d).
Section 14124.27 is added to the Welfare and
30Institutions Code, to read:
(a) (1) Certified Drug Medi-Cal (DMC) providers
32shall be designated as a “high” categorical risk pursuant to Section
3314043.38 and the provider and any person with a 5 percent or
34greater direct or indirect ownership interest in the provider shall
35be subject to background checks pursuant to the provisions of that
36section.
37(2) The department may designate a DMC provider as a
38“limited” or “moderate” categorical risk for purposes of Section
3914043.38 and federal regulations. To designate a DMC provider
40as a “limited” or “moderate” categorical risk, the department shall
P5 1execute a declaration, to be retained by the director, with a copy
2
to be posted on the department’s Internet Web site and a copy
3transmitted to the Legislature, stating the reason or reasons that a
4“high” categorical risk designation for that provider is no longer
5warranted.
6(b) Payment of the fee imposed pursuant to paragraph (5) of
7subdivision (d) of Section 14043.38 shall be the responsibility of
8the DMC provider or person with a 5 percent or greater direct or
9indirect ownership interest in the provider, as applicable.
10(c) Except as provided by federal law, a DMC provider shall
11not be excluded from contracting with a county or the department
12based solely on the existence of a past criminal record of the DMC
13provider or a person with 5 percent or greater direct or indirect
14ownership interest in the provider.
O
94