BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 858 (Wood) - Medi-Cal: federally qualified health centers
and rural health clinics
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|Version: July 1, 2015 |Policy Vote: HEALTH 9 - 0 |
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|Urgency: No |Mandate: No |
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|Hearing Date: August 27, 2015 |Consultant: Brendan McCarthy |
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*********** ANALYSIS ADDENDUM - SUSPENSE FILE ***********
The following information is revised to reflect amendments
adopted by the committee on August 27, 2015
Bill
Summary: AB 858 would add marriage and family therapists (MFTs)
to the list of health care providers that qualify for
face-to-face encounter payments from the Medi-Cal program to
federally qualified health centers and rural health clinics.
Fiscal
Impact:
One-time costs, likely in the low millions to recalculate the
prospective payment system (PPS) rate for clinics that are
providing marriage and family therapist services or wish to
add those services (General Fund and federal funds). The bill
requires clinics that are currently including marriage and
family therapist services in the costs used to calculate their
PPS rate to seek a recalculation of the rate to allow the
clinic to bill for face-to-face visits. The process for
AB 858 (Wood) Page 1 of
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recalculating a PPS rate requires a detailed review of
utilization and expenditures by clinics. For example, assuming
that the cost of performing such a review is about $10,000 and
that 500 clinics seek a recalculation, the administrative
costs to the Department of Health Care Services would be about
$5 million.
No significant increase in costs is expected for MFT services
in eligible clinics. Under the current system for calculating
the PPS rate paid by Medi-Cal to federally qualified health
centers and rural health clinics, the total amount of eligible
services (including mental health services) provided to
Medi-Cal beneficiaries is divided by the number of eligible
face-to-face visits (e.g. a visit with a physician or clinical
psychologist). Because the bill requires a recalculation of
the PPS to account for the fact that MFTs would be eligible
for face-to-face billing before a clinic can bill for such an
encounter, the Medi-Cal program is not expected to pay more
for services currently being provided. (In other words, a
clinic employing MFTs would be able to bill for more
face-to-face encounters, but the PPS rate would be lower to
account for those visits.)
Author
Amendments: Would make a technical correction.
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