BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                     AB 858


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          GOVERNOR'S VETO


          AB  
          858 (Wood)


          As Enrolled  September 14, 2015


          2/3 vote


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          |ASSEMBLY:  | 76-0 | (June 2,      |SENATE: |40-0  | (September 9,   |
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          |ASSEMBLY:  |     | (September 10, |        |      |                 |
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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  








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          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.


          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  








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          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.


          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  








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          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.


          GOVERNOR'S VETO MESSAGE:


          I am returning the following six bills without my signature;


          Assembly Bill 50


          Assembly Bill 858


          Assembly Bill 1162


          Assembly Bill 1231


          Assembly Bill 1261








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          Senate Bill 610


          These bills unnecessarily codify certain existing health care  
          benefits or require the expansion or development of new benefits  
          and procedures in the Medi-Cal program.


          Taken together, these bills would require new spending at a time  
          when there is considerable uncertainty in the funding of this  
          program.  Until the fiscal outlook for Medi-Cal is stabilized, I  
          cannot support any of these measures.




          Analysis Prepared by:                                             
                          Roger Dunstan / HEALTH / (916) 319-2097  FN:  
          0002491