BILL ANALYSIS Ó
AB 858
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ASSEMBLY THIRD READING
AB
858 (Wood)
As Amended May 28, 2015
Majority vote
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|Committee |Votes |Ayes |Noes |
| | | | |
| | | | |
|----------------+------+--------------------+----------------------|
|Health |16-0 |Bonta, Maienschein, | |
| | |Burke, Chávez, | |
| | |Chiu, Gomez, | |
| | |Gonzalez, Lackey, | |
| | |Nazarian, | |
| | |Patterson, | |
| | |Ridley-Thomas, | |
| | |Rodriguez, | |
| | |Santiago, Thurmond, | |
| | |Waldron, Wood | |
| | | | |
|----------------+------+--------------------+----------------------|
|Appropriations |17-0 |Gomez, Bigelow, | |
| | |Bonta, Calderon, | |
| | |Chang, Daly, | |
| | |Eggman, Gallagher, | |
| | | | |
| | | | |
| | |Eduardo Garcia, | |
| | |Gordon, Holden, | |
| | |Jones, Quirk, | |
AB 858
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| | |Rendon, Wagner, | |
| | |Weber, Wood | |
| | | | |
| | | | |
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SUMMARY: Allows federally qualified health centers (FQHCs) and
Rural Health Center (RHCs) to be reimbursed a per visit Medi-Cal
payment under the prospective payment system (PPS), for multiple
visits by a patient with a single or different health care
professional on the same day at a single location and add marriage
and family therapist (MFT) to the list of health care providers
that qualify for a face-to-face encounter with a patient at a FQHC
or RHC for purposes of a per visit Medi-Cal payment under PPS.
FISCAL EFFECT: According to the Assembly Appropriations
Committee:
1)If this bill increases access to mental health services in
Medi-Cal by incentivizing clinics to provide more mental health
visits, it could result in cost pressure to Medi-Cal to fund
additional visits, potentially in the millions of dollars
(General Fund (GF)/federal funds).
2)If 1,000 clinics submit for a recalculation of their rate, it
would take DHCS about $10 million (GF /federal funds) in staff
time to process the requests, likely over a period exceeding a
year or two. The average cost to do a rate recalculation is
$10,000. Currently, clinics can submit on a voluntary basis if
the cost or scope of services they offer changes significantly.
3)Overall, there should not be a Medi-Cal cost impact to allowing
same-day mental health visits or visits with an MFT to be
separately billed, if rates are recalculated as envisioned in
this bill. However, the recalculation could have unknown overall
cost impacts on Medi-Cal, since additional, unrelated factors
AB 858
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may have changed from the last PPS rate calculation.
COMMENTS: According to the author, one in seven Californians are
served by clinics and with the increased number of Californians
eligible for Medi-Cal, this number is likely to increase. The
author cites research showing that within a primary care setting,
up to 26% of patients have some mental disorder and that adults
with mental health needs are 1.5 times more likely to have a
chronic condition such as high blood pressure, heart disease, or
asthma. Yet currently clinics cannot be reimbursed for a mental
health visit on the same day that they are reimbursed for a
medical visit. The author adds that by adding MFT to the list of
PPS billable providers, this bill brings parity throughout the
delivery system in the ability to utilize all qualified mental
health providers regardless of how or where you are receiving
treatment. The author notes that as of February 2012, there were
19,009 licensed clinical social workers and 16,228 licensed
psychologists; as well as 31,865 MFTs in California. Allowing
full access to the entire population of qualified mental health
providers for all aspects of the health care delivery system will
help to meet the increased demands of the Medi-Cal population.
FQHCs and RHCs serve a significant portion of the uninsured and
underinsured in California. They are open-door providers that
treat patients on a sliding fee scale basis and make their
services available regardless of a patient's ability to pay.
Currently, there are approximately 600 FQHCs and 350 RHCs in
California. All FQHCs, and a majority of the RHCs, either are
non-profit community clinics or government entities. Because
clinics are safety net providers, their continued survival depends
heavily on the stability and adequacy of revenues from the
Medi-Cal program. FQHCs and RHCs are paid by Medi-Cal on a "per
visit" basis in an amount equal to the clinic's cost of delivering
services. Essentially, DHCS calculates the annual cost of care
provided by each clinic and divides the total by the number of
visits to determine a per visit rate.
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Support. The California Primary Care Association (CPCA), the
sponsor, states that clinics have been working to integrate
behavioral health services and were recognized as leaders in this
effort. However, they note the current Medi-Cal rules frustrate
their efforts. Medi-Cal will not reimburse a patient's visit to a
primary care provider and a visit to a mental health provider on
the same day. The rule against reimbursing for two visits in one
day requires many vulnerable patients to navigate the complexities
of two separate systems of care. CPCA states that same day
reimbursement is allowed for medical and dental services, but
mental health services are excluded, as the state has not adopted
this option, even though federal law allows reimbursement for same
day visits. The CPCA sponsored a bill, AB 690 (Wood) of the
current legislative session, that contained the provisions
regarding MFTs that were subsequently amended into this bill. AB
690 was held on the Assembly Appropriations Suspense File. CPCA
argues by adding MFTs to the list of PPS billable providers will
help solve existing gaps in workforce capacity by providing FQHCs
and RHCs with an adequate source of funding for their employment
and will help to meet the demand for mental health services in the
public health setting.
Opposition. The National Association of Social Workers-California
Chapter (NASW-CA) opposes provisions of this bill that were
previously in AB 690. They oppose adding MFTs because they
believe there is a sufficient workforce of social workers and only
social workers have the training and skills necessary to treat
this community. NASW-CA maintains these clinics serve a
population that is very diverse and in poverty and while both
MFT's and social workers have mental health training, only social
workers are properly trained to provide a full range of services
to this community.
Analysis Prepared by:
AB 858
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Roger Dunstan / HEALTH / (916) 319-2097 FN:
0000820