BILL ANALYSIS Ó AB 858 Page 1 GOVERNOR'S VETO AB 858 (Wood) As Enrolled September 14, 2015 2/3 vote -------------------------------------------------------------------- |ASSEMBLY: | 76-0 | (June 2, |SENATE: |40-0 | (September 9, | | | |2015) | | |2015) | | | | | | | | | | | | | | | -------------------------------------------------------------------- -------------------------------------------------------------------- |ASSEMBLY: | | (September 10, | | | | | |80-0 |2015) | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | -------------------------------------------------------------------- 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 AB 858 Page 2 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 AB 858 Page 3 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 AB 858 Page 4 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 AB 858 Page 5 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