Amended in Senate May 10, 2016

Amended in Assembly January 26, 2016

Amended in Assembly January 4, 2016

California Legislature—2015–16 Regular Session

Assembly Bill No. 1244

Introduced by Assembly Member Gray

February 27, 2015

An act to begin delete amend Section 1229 of the Water Code, relating to water. end delete begin insert add Section 5307.15 to the Labor Code, and to amend Section 14123 of the Welfare and Institutions Code, relating to workers’ compensation. end insert

LEGISLATIVE COUNSEL’S DIGEST

AB 1244, as amended, Gray. begin delete Water rights: small irrigation use. end delete begin insert Workers’ compensation: providers: suspension and revocation. end insert

begin insert

Under existing law, the Director of Health Care Services is authorized, for purposes of administering the Medi-Cal program, to suspend a provider of service from further participation under the program for specified reasons, including conviction of any felony or any misdemeanor involving fraud, abuse of the Medi-Cal program or any patient, or otherwise substantially related to the qualifications, functions, or duties of a provider of service. Existing law requires the director, upon receipt of written notification from the Secretary of the United States Department of Health and Human Services that a physician or other individual practitioner has been suspended from participation in the Medicare or Medicaid programs, to promptly suspend the practitioner from participation in the Medi-Cal program.

end insert begin insert

Existing law establishes a workers’ compensation system, administered by the Administrative Director of the Division of Workers’ Compensation, that generally requires employers to secure the payment of workers’ compensation for injuries incurred by their employees that arise out of, or in the course of, employment. Existing law requires an employer to provide all medical services reasonably required to cure or relieve the injured worker from the effects of the injury.

end insert begin insert

Existing law authorizes an insurer, employer, or entity that provides physician network services to establish or modify a medical provider network for the provision of medical treatment to injured employees and requires the administrative director to contract with individual physicians or an independent medical review organization to perform medical provider network independent medical reviews. Existing law also requires the administrative director to appoint qualified medical evaluators in each of the respective specialties as required for the evaluation of medical-legal issues.

end insert begin insert

This bill would require the Director of Health Care Services to notify the administrative director of a suspension imposed pursuant to the above provisions and would require the administrative director, upon that notification, to promptly suspend the physician or practitioner from participating in the workers’ compensation system in any capacity, including, but not limited to, participation as a qualified medical examiner, a treating provider in a medical provider network, or an independent medical reviewer. The bill would require the administrative director to adopt regulations establishing criteria for revocation of a suspended physician’s or practitioner’s participation in the workers’ compensation system, subject to specified notice and hearing requirements.

end insert begin insert

This bill would require the administrative director to notify the appropriate state licensing entity of a physician’s or practitioner’s suspension or revocation and to update relevant provider databases of qualified medical evaluators and medical provider networks. The bill would prohibit claims for payment for services or supplies provided by a provider whose participation in the workers’ compensation system has been suspended or revoked, except under specified circumstances.

end insert begin delete

Existing law authorizes any person to obtain a right to appropriate water for a small irrigation use upon registering the use with the State Water Resources Control Board and thereafter applying the water to reasonable and beneficial use with due diligence. Existing law provides that the board is not required to adopt general conditions applicable to appropriations for small irrigation use until the board determines that funds are available for that purpose. Existing law provides that the authority to register for small irrigation use is effective only to the extent that the board establishes the general conditions for the applicable category of small irrigation use.

end delete begin delete

This bill would require the board, when adopting general conditions, to consult with the Department of Food and Agriculture and the University of California Cooperative Extension, regarding relevant agricultural information, and with the Department of Fish and Wildlife, regarding potential impacts on fish and wildlife species, for small irrigation use.

end delete

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

begin insert

begin insert SECTION 1 end insert begin insert . end insert   

end insert

begin insert Section 5307.15 is added to the end insert begin insert Labor Code end insert begin insert , to
read: end insert

begin insert

begin insert 5307.15. end insert   

(a) (1) Whenever the administrative director receives
written notification from the Director of Health Care Services
pursuant to Section 14123 of the Welfare and Institutions Code
that a physician or other individual practitioner has been
suspended from participation in the Medi-Cal program, the
administrative director shall promptly suspend the physician or
practitioner from participating in the workers’ compensation
system in any capacity, including, but not limited to, participation
as a qualified medical examiner, a treating provider in a medical
provider network, or a medical provider network independent
medical reviewer.

(2) The administrative director also shall exercise due diligence
to identify physicians and practitioners who have been suspended
as described in subdivision (a) by accessing the quarterly updates
to the list of suspended and ineligible providers maintained by the
State Department of Health Care Services for the Medi-Cal
program at
https://files.medi-cal.ca.gov/pubsdoco/SandILanding.asp.

(b) (1) The administrative director shall adopt regulations
establishing criteria for revocation of a suspended physician’s or
practitioner’s participation in the workers’ compensation system,
subject to the notice and hearing requirements in paragraph (2).

(2) The administrative director shall serve the physician or
practitioner with written notice of the specific basis for revocation
of his or her participation in the workers’ compensation system
and shall set a hearing within 30 days of the date of service on the
physician or practitioner. The hearing proceedings shall be
conducted pursuant to Chapter 4 (commencing with Section 11370)
of Part 1 of Division 3 of Title 2 of the Government Code.

(c) The administrative director shall promptly notify the
physician’s or practitioner’s state licensing, certifying, or
registering authority of a suspension or revocation imposed
pursuant to this section and shall update the department’s qualified
medical evaluator and medical provider network databases, as
appropriate.

(d) A provider of services, whether an individual, clinic, group,
corporation, or other association, may not submit a claim for
payment to a payor for any services or supplies provided by a
physician or practitioner whose participation in the workers’
compensation has been suspended or revoked pursuant to this
section. This subdivision does not apply with respect to services
or supplies provided prior to the date of the suspension or
revocation.

end insert

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 14123 of the end insert begin insert Welfare and Institutions Code end insert begin insert is
amended to read: end insert

14123.  

Participation in the Medi-Cal program by a provider
of service is subject to suspension in order to protect the health of
the recipients and the funds appropriated to carry out this chapter.

(a)  begin insert (1) end insert begin insert   end insert The director may suspend a provider of service from
further participation under the Medi-Cal program for violation of
any provision of this chapter or Chapter 8 (commencing with
Section 14200) or any rule or regulation promulgated by the
director pursuant to those chapters. begin delete Any such end delete begin insert The end insert suspension may
be for an indefinite or specified period of time and with or without
begin delete conditions end delete begin insert conditions, end insert or may be imposed with the operation of
the suspension stayed or probation granted. The director shall
suspend a provider of service for conviction of any felony or any
misdemeanor involving fraud, abuse of the Medi-Cal program or
any patient, or otherwise substantially related to the qualifications,
functions, or duties of a provider of service.

begin delete

If

end delete

begin insert (2) end insert begin insert   end insert begin insert If end insert the provider of service is a clinic, group, corporation, or
other association, conviction of any officer, director, or shareholder
with a 10 percent or greater interest in that organization, of begin delete such end delete
a crime begin insert described in paragraph (1) end insert shall result in the suspension
of that organization and the individual convicted if the director
believes that suspension would be in the best interest of the
Medi-Cal program. If the provider of services is a political
subdivision of the state or other government agency, the conviction
of the person in charge of the facility of begin delete such end delete a crime begin insert described in
paragraph (1) end insert may result in the suspension of that facility. The
record of conviction or a certified copy thereof, certified by the
clerk of the court or by the judge in whose court the conviction is
had, shall be conclusive evidence of the fact that the conviction
occurred. A plea or verdict of guilty, or a conviction following a
plea of nolo contendere is deemed to be a conviction within the
meaning of this section.

begin delete

After

end delete

begin insert (3) end insert begin insert   end insert begin insert After end insert conviction, but before the time for appeal has elapsed
or the judgment of conviction has been affirmed on appeal, the
director, if he or she believes that suspension would be in the best
interests of the Medi-Cal program, may order the suspension of a
provider of service. When the time for appeal has elapsed, or the
judgment of conviction has been affirmed on appeal or when an
order granting probation is made suspending the imposition of
sentence irrespective of any subsequent order under Section 1203.4
of the Penal Code allowing a person to withdraw his or her plea
of guilty and to enter a plea of not guilty, or setting aside the verdict
of guilty, or dismissing the accusation, information, or indictment,
the director shall order the suspension of a provider of service.
The suspension shall not take effect earlier than the date of the
director’s order. Suspension following a conviction is not subject
to the proceedings required in subdivision (c). However, the
director may grant an informal hearing at the request of the provider
of service to determine in the director’s sole discretion if the
circumstances surrounding the conviction justify rescinding or
otherwise modifying the suspension provided for in this
subdivision.

begin delete

If

end delete

begin insert (4) end insert begin insert   end insert begin insert If end insert the provider of service appeals the conviction and the
conviction is reversed, the provider may apply for reinstatement
to the Medi-Cal program after the conviction is reversed.
Notwithstanding Section 14126.6, the application for reinstatement
shall not be subject to the one-year waiting period for the filing of
a reinstatement petition pursuant to Section 11522 of the
Government Code.

(b) Whenever the director receives written notification from the
Secretary of the United States Department of Health and Human
begin delete Services, end delete begin insert Services end insert that a physician or other individual practitioner
has been suspended from participation in the Medicare or medicaid
programs, the director shall promptly suspend the practitioner from
participation in the Medi-Cal begin delete program. end delete begin insert program and notify the
Administrative Director of the Division of Workers’ Compensation
of the suspension, in accordance with paragraph (2) of subdivision
(e). end insert This automatic suspension is not subject to the proceedings
required in subdivision (c). No payment from state or federal funds
may be made for any item or service rendered by the practitioner
during the period of suspension.

(c) The proceedings for suspension shall be conducted pursuant
to Section 100171 of the Health and Safety Code. The director
may temporarily suspend any provider of service prior to any
hearing when in his or her opinion that action is necessary to
protect the public welfare or the interests of the Medi-Cal program.
The director shall notify the provider of service of the temporary
suspension and the effective date thereof and at the same time
serve the provider with an accusation. The accusation and all
proceedings thereafter shall be in accordance with Section 100171
of the Health and Safety Code. Upon receipt of a notice of defense
by the provider, the director shall set the matter for hearing within
30 days after receipt of the notice. The temporary suspension shall
remain in effect until such time as the hearing is completed and
the director has made a final determination on the merits. The
temporary suspension shall, however, be deemed vacated if the
director fails to make a final determination on the merits within
60 days after the original hearing has been completed. This
subdivision does not apply where the suspension of a provider is
based upon the conviction of any crime involving fraud, abuse of
the Medi-Cal program, or suspension from the federal Medicare
program. In those instances, suspension shall be automatic.

(d)  begin insert (1) end insert begin insert   end insert The suspension by the director of any provider of
service shall preclude the provider from submitting claims for
payment, either personally or through claims submitted by any
clinic, group, corporation, or other association to the Medi-Cal
program for any services or supplies the provider has provided
under the program, except for services or supplies provided prior
to the suspension. No clinic, group, corporation, or other
association which is a provider of service shall submit claims for
payment to the Medi-Cal program for any services or supplies
provided by a person within the organization who has been
suspended or revoked by the director, except for services or
supplies provided prior to the suspension.

begin delete

Where

end delete

begin insert (2) end insert begin insert   end insert begin insert If end insert the provisions of this begin delete chapter or end delete begin insert chapter, end insert Chapter 8
(commencing with Section begin delete 14200) end delete begin insert 14200), end insert or the regulations
promulgated by the director are violated by a provider of service
begin delete which end delete begin insert that end insert is a clinic, group, corporation, or other association, the
director may suspend the organization and any individual person
within the organization who is responsible for the violation.

(e)  begin insert (1) end insert begin insert   end insert Notice of the suspension shall be sent by the director
to the provider’s state licensing, certifying, or registering authority,
along with the evidence upon which the suspension was based.

begin insert

(2) At the same time notice is provided pursuant to paragraph
(1), the director shall provide written notification of the suspension
to the Administrative Director of the Division of Workers’
Compensation, for purposes of Section 5307.15 of the Labor Code.

end insert

(f) In addition to the bases for suspension contained in
subdivisions (a) and (b), the director may suspend a provider of
service from further participation under the Medi-Cal dental
program for the provision of services that are below or less than
the standard of acceptable quality, as established by the California
Dental Association Guidelines for the Assessment of Clinical
Quality and Professional Performance, Copyright 1995, Third
Edition, as periodically amended. begin delete Any such end delete begin insert The end insert suspension shall
be subject to the requirements contained in subdivisions (a) to (e),
inclusive.

begin delete

SECTION 1.  

Section 1229 of the Water Code is amended to
read:

1229.  

(a) The board is not required to adopt general conditions
for small irrigation use pursuant to subdivision (a) of Section
1228.6 until the board determines that funds are available for that
purpose.

(b) A registration for small irrigation use pursuant to this article
is not authorized until the board establishes general conditions for
small irrigation use pursuant to subdivision (a) of Section 1228.6
to protect instream beneficial uses.

(c) The board may establish general conditions for some
methods of diversion or categories of small irrigation use before
establishing general conditions for other methods or categories,
in which case a registration for small irrigation use is authorized
only for those methods or categories for which the board has
established the general conditions for the protection of instream
beneficial uses.

(d) The board, when adopting general conditions, shall consult
with the Department of Food and Agriculture and the University
of California Cooperative Extension, regarding relevant agricultural
information, and with the Department of Fish and Wildlife,
regarding potential impacts on fish and wildlife species, for small
irrigation use.

end delete