BILL ANALYSIS Ó
AB 858
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB
858 (Wood)
As Amended September 4, 2015
Majority vote
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|ASSEMBLY: | 76-0 | (June 2, |SENATE: |40-0 | (September 9, |
| | |2015) | | |2015) |
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Original Committee Reference: HEALTH
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.
The Senate amendments clarify reimbursements for marriage and
family therapist services and include chaptering-out amendments,
to ensure that the provisions of this bill, and the provisions
of SB 610 (Pan) of the current legislative session, in the case
that both bills are signed into law, do not chapter each other
out.
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FISCAL EFFECT: According to the Senate Appropriations
Committee, one-time costs, likely in the low millions to
recalculate the PPS rate for clinics that are providing marriage
and family therapist services or wish to add those services.
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
AB 858
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"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.
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. This year, 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.
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.
AB 858
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Analysis Prepared by: Roger Dunstan / HEALTH
/ (916) 319-2097 FN: 0002304