BILL NUMBER: AB 1244 AMENDED
BILL TEXT
AMENDED IN SENATE MAY 10, 2016
AMENDED IN ASSEMBLY JANUARY 26, 2016
AMENDED IN ASSEMBLY JANUARY 4, 2016
INTRODUCED BY Assembly Member Gray
FEBRUARY 27, 2015
An act to amend Section 1229 of the Water Code, relating
to water. add Section 5307.15 to the Labor Code, and
to amend Section 14123 of the Welfare and Institutions Code, relating
to workers' compensation.
LEGISLATIVE COUNSEL'S DIGEST
AB 1244, as amended, Gray. Water rights: small irrigation
use. Workers' compensation: providers: suspension and
revocation.
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.
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.
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.
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.
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.
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.
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.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1 . Section 5307.15 is added to
the Labor Code , to read:
5307.15. (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.
SEC. 2. Section 14123 of the Welfare
and Institutions Code is amended to read:
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) (1) 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. Any such
The suspension may be for an indefinite or specified period of
time and with or without conditions
conditions, 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.
If
(2) If 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 such a crime
described in paragraph (1) 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 such a
crime described in paragraph (1) 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.
After
(3) After 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.
If
(4) If 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
Services, Services 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
program. program and notify the Administrative
Director of the Division of Workers' Compensation of the
suspension, in accordance with paragraph (2) of subdivision (e).
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) (1) 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.
Where
(2) If the provisions of this
chapter or chapter, Chapter 8
(commencing with Section 14200) 14200),
or the regulations promulgated by the director are violated by a
provider of service which that 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) (1) 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.
(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.
(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. Any such The
suspension shall be subject to the requirements contained in
subdivisions (a) to (e), inclusive.
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.