BILL ANALYSIS Ó
AB 2747
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Date of Hearing: April 20, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
AB
2747 (Hadley) - As Amended March 17, 2016
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill requires the California Department of Public Health
(CDPH) to complete both initial licensure and certification
surveys, within 90 calendar days of receiving a complete chronic
dialysis clinic (CDC) application.
FISCAL EFFECT:
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Cost pressure under $75,000 annually to CDPH to expedite
licensure and certification for specified facilities (GF or
Licensing and Certification (L&C) Fund).
COMMENTS:
1)Purpose. The author cites long wait times for certification of
dialysis centers to participate in Medicare and Medi-Cal. This
bill intends to remedy the problem by giving dialysis centers
a reasonable wait time for certification.
2)Background. CDPH L&C functions as the enforcement and
regulatory agency for approximately 30 different types of
health care facilities, including CDCs. As indicated in their
name, CDPH L&C performs two different, related functions:
ensuring compliance with state licensing laws, and certifying
facilities for participation in Medicare and Medi-Cal. With
respect to dialysis, licensed CDCs are also certified as end
stage renal disease facilities (ESRDs). Certification is
performed under contract with CMS, and L&C receives a federal
grant for the purpose. The federal grant specifies workload
priorities, creating a tiered system under which higher-tier
activities, the most urgent and important, must be completed
before lower-tier activities.
In 2007, CMS issued Survey and Certification (S&C) Letter
08-03, which made certification of ESRDs a "Tier 3" workload
priority, meaning that initial ESRD certification surveys can
only be conducted when higher-priority Tier 1 and 2 workload,
and Tier 3 recertification of ESRDs are completed, providing
federal budgetary funds were still available. CMS also has a
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priority exception process, which allows health facilities to
apply for an exception from the priority process if they can
provide data and other evidence that the lack of CMS
certification would cause significant access to care problems
for beneficiaries. Per CMS policy, the burden is on the
applicant to provide data and other evidence that effectively
establishes the probability of serious, adverse beneficiary
health care access consequences if the provider is not
enrolled to participate in Medicare. According to CMS, they
will not endorse any request that fails to provide such
evidence and that fails to establish the special circumstances
surround the request. Accordingly, CMS expects that such
exceptions will be infrequent.
Under current CMS policy and guidance, the CDPH is not allowed
to conduct a certification survey for a new ESRD unless CMS
has granted the applicant an exception.
3)Staff Comments. The existing federal workload priority
designation appears to create a bottleneck for certifying new
facilities for participation in Medi-Cal and Medicare. If it
is desirable to allow timely certification of new facilities,
and if federally allowable, the author should consider
allowing cost recovery through fees for certification workload
that is otherwise not reimbursed pursuant to rules governing
CDPH's federal grant for certification activities. Otherwise,
this activity would have to be funded with GF or subsidized
through other facility fees paid into the L&C fund.
Facilities pay licensing fees to the L&C Fund based on
licensure workload associated with each facility type, which
is tracked by actual hours spent on activities related to each
type of facility. If the fund paid for additional workload
for certifying facilities as ESRDs, using the current fee
methodology fees would not accurately reflect this additional,
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albeit small, increase in workload attributable to
certification surveys for ESRDs.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081