BILL ANALYSIS Ó
AB 2053
Page 1
Date of Hearing: April 13, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
AB
2053 (Gonzalez) - As Amended March 31, 2016
-----------------------------------------------------------------
|Policy |Health |Vote:|18 - 0 |
|Committee: | | | |
| | | | |
| | | | |
|-------------+-------------------------------+-----+-------------|
| | | | |
| | | | |
| | | | |
-----------------------------------------------------------------
Urgency: No State Mandated Local Program: YesReimbursable:
No
SUMMARY:
This bill requires the California Department of Public Health
(CDPH), upon written notification by a licensed primary care
clinic (clinic) that it is adding an additional physical plant
maintained and operated on separate premises, to issue a single
consolidated license to the clinic if certain criteria are met.
AB 2053
Page 2
It also specifies a clinic issued a single consolidated license
may, at its option, operate under a single National Provider
Identification (NPI) number or separate number for one or more
of the facilities subject to the single consolidated license.
FISCAL EFFECT:
1)Any costs to CDPH to issue consolidated licenses are expected
to be minor and absorbable (Licensing and Certification Fund).
2)This bill is also expected to be cost-neutral to Medi-Cal,
based on the assumption that if clinics who pursue a
consolidated license experience an associated significant
change in costs or service mix, the clinic seeks a
recalculation of their facility-specific Medi-Cal prospective
payment (PPS) rate pursuant to existing law.
COMMENTS:
1)Purpose. According to the author, this bill offers health
centers a streamlined option to consolidate multiple
facilities or open new space near an existing facility, under
one license. Examples have been cited whereby flexibility was
granted for clinics to append additional nearby care sites
under a clinic's license, but other similar requests were
denied. This bill is intended to explicitly describe the
circumstances in which consolidated licenses are allowed, as
well as the process for requesting such a license.
AB 2053
Page 3
2)Background. Community clinics, which are licensed by CDPH,
have traditionally been the only places to receive primary
care services for high numbers of uninsured before the
coverage expansions of the federal Affordable Care Act (ACA).
In California, they have also grown in number and expanded
capacity as a result of funding available through the ACA and
state/federal reimbursement standards that recognize and
compensate for their Medi-Cal costs. Allowing these clinics
to expand capacity and consolidate operations offers the
opportunity for economies of scale and administrative
simplification.
Clinics are paid by Medi-Cal using a distinct,
facility-specific prospective payment system (PPS) rate. Each
clinic location applies for a NPI, which is used for enrolling
the facility into Medi-Cal and Medicare, billing Medi-Cal and
Medicare and for establishing the location's PPS rate. This
bill does not specifically address Medi-Cal payment, but
certain changes a facility's costs or services could require a
clinic with a consolidated license to apply for an updated
PPS rate.
3)Staff Comments. This bill accomplishes its main intent to
allow clinics to append small additional service locations.
It also appears to allow a group of several clinics to merge
under a consolidated license, provided they meet the standards
of a single governing body, administration, and medical
director. Merging existing licensed, full-scale clinics into
a group under a single license appears substantively different
from making a small expansion to an existing clinic. If the
bill's intent is indeed to allow both, the author may later
wish to consider whether it is clearer to separately describe
the process of expanding existing licensed clinics by
AB 2053
Page 4
appending additional, unlicensed space, versus consolidating
one or more existing clinics under a single license.
Based on preliminary information from the Department of Health
Care Services, it appears a facility attempting to append
additional space may have to apply for a recalculation to its
PPS rate in order to bill for services provided in the new
space. Further clarification on this issue could help ensure
the bill accomplishes its intent.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081