Amended in Assembly May 18, 2015

Senate BillNo. 299


Introduced by Senator Monning

February 23, 2015


An act to amend Sections 14043.1, 14043.15, 14043.25, 14043.28, 14043.36, 14043.38, 14043.4, and 14043.55 of the Welfare and Institutions Code, relating to Medi-Cal, and declaring the urgency thereof, to take effect immediately.

LEGISLATIVE COUNSEL’S DIGEST

SB 299, as amended, Monning. Medi-Cal: provider enrollment.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law requires an applicant or provider, as defined, to submit a complete application package for enrollment,begin delete continuingend deletebegin insert continuedend insert enrollment, or enrollment at a new location or a change in location, and generally requires the application package for enrollment, the provider agreement, and all attachments or changes to either that are submitted by specified applicants or providers to be notarized.begin insert Existing law requires the department to collect an application fee for enrollment, including enrollment at a new location or a change in location.end insert

This bill would exempt from these notarization requirements any provider that chooses to enroll electronically.begin insert The bill would clarify that the department is also required to collect an application fee for continued enrollment.end insert

Existing law authorizes the department to implement a 180-day moratorium on the enrollment of providers in a specified provider of services category, as specified. Existing law requires the State Department of Health Care Services to screen Medi-Cal providers and designate each provider or applicant as “limited,” “moderate,” or “high” categorical risk. Existing law requires the department to designate a provider or applicant as a “high” categorical risk if specified circumstances occur, including if the federal Centers for Medicare and Medicaid Services lifted a temporary moratorium within the previous 6 months for the particular provider type submitting the application, as specified.

This bill would also require the department to designate a provider or applicant as a “high” categorical risk if the department lifted a temporary moratorium within the previous 6 months for the particular provider type submitting the application.

This bill would also delete various obsolete provisions of law.

This bill would declare that it is to take effect immediately as an urgency statute.

Vote: 23. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

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

P2    1

SECTION 1.  

Section 14043.1 of the Welfare and Institutions
2Code
is amended to read:

3

14043.1.  

As used in this article:

4(a) “Abuse” means either of the following:

5(1) Practices that are inconsistent with sound fiscal or business
6practices and result in unnecessary cost to the federal Medicaid
7and Medicare programs, the Medi-Cal program, another state’s
8Medicaid program, or other health care programs operated, or
9financed in whole or in part, by the federal government or a state
10or local agency in this state or another state.

11(2) Practices that are inconsistent with sound medical practices
12and result in reimbursement by the federal Medicaid and Medicare
13programs, the Medi-Cal program or other health care programs
14operated, or financed in whole or in part, by the federal government
15or a state or local agency in this state or another state, for services
16that are unnecessary or for substandard items or services that fail
17to meet professionally recognized standards for health care.

P3    1(b) “Applicant” means an individual, including an ordering,
2referring, or prescribing individual, partnership, group, association,
3corporation, institution, or entity, and the officers, directors,
4owners, managing employees, or agents thereof, that apply to the
5department for enrollment as a provider in the Medi-Cal program.

6(c) “Application or application package” means a completed
7and signed application form, signed under penalty of perjury or
8notarized pursuant to Section 14043.25, a disclosure statement, a
9provider agreement, and all attachments or changes in the form,
10statement, or agreement.

11(d) “Appropriate volume of business” means a volume that is
12consistent with the information provided in the application and
13any supplemental information provided by the applicant or
14provider, and is of a quality and type that would reasonably be
15expected based upon the size and type of business operated by the
16applicant or provider.

17(e) “Business address” means the location where an applicant
18or provider provides services, goods, supplies, or merchandise,
19directly or indirectly, to a Medi-Cal beneficiary. A post office box
20or commercial box is not a business address. The business address
21for the location of a vehicle or vessel owned and operated by an
22applicant or provider enrolled in the Medi-Cal program and used
23to provide services, goods, supplies, or merchandise, directly or
24indirectly, to a Medi-Cal beneficiary shall either be the business
25address location listed on the provider’s application as the location
26where similar services, goods, supplies, or merchandise would be
27provided or the applicant’s or provider’s pay to address.

28(f) “Convicted” means any of the following:

29(1) A judgment of conviction has been entered against an
30individual or entity by a federal, state, or local court, regardless
31of whether there is a posttrial motion, an appeal pending, or the
32judgment of conviction or other record relating to the criminal
33conduct has been expunged or otherwise removed.

34(2) A federal, state, or local court has made a finding of guilt
35against an individual or entity.

36(3) A federal, state, or local court has accepted a plea of guilty
37or nolo contendere by an individual or entity.

38(4) An individual or entity has entered into participation in a
39first offender, deferred adjudication, or other program or
40arrangement where judgment of conviction has been withheld.

P4    1(g) “Debt due and owing” means 60 days have passed since a
2notice or demand for repayment of an overpayment or another
3amount resulting from an audit or examination, for a penalty
4assessment, or for another amount due to the department was sent
5to the provider, regardless of whether the provider is an institutional
6provider or a noninstitutional provider and regardless of whether
7an appeal is pending.

8(h) “Enrolled or enrollment in the Medi-Cal program” means
9authorized under any processes by the department or its agents or
10contractors to receive, directly or indirectly, reimbursement for
11the provision of services, goods, supplies, or merchandise to a
12Medi-Cal beneficiary.

13(i) “Fraud” means an intentional deception or misrepresentation
14made by a person with the knowledge that the deception could
15result in some unauthorized benefit to himself or herself or some
16other person. It includes any act that constitutes fraud under
17applicable federal or state law.

18(j) “Location” means a street, city, or rural route address or a
19site or place within a street, city, or rural route address, and the
20city, county, state, and nine-digit ZIP Code.

21(k) “Not currently enrolled at the location for which the
22application is submitted” means either of the following:

23(1) The provider is changing location and moving to a different
24location than that for which the provider was issued a provider
25number.

26(2) The provider is adding a business address.

27(l) (1) “Individual dentist practice” means a dentist licensed by
28the Dental Board of California enrolled or enrolling in Medi-Cal
29as an individual provider who is a sole proprietor of his or her
30practice or is a corporation owned solely by the individual dentist
31and the only dentist practitioner is the owner. An individual dentist
32practice may include nondentist allied dental health professionals
33employed and supervised by the dentist.

34(2) “Individual physician practice” means a physician and
35surgeon licensed by the Medical Board of California or the
36Osteopathic Medical Board of California enrolled or enrolling in
37Medi-Cal as an individual provider who is sole proprietor of his
38or her practice or is a corporation owned solely by the individual
39physician and the only physician practitioner is the owner. An
P5    1individual physician practice may include nonphysician medical
2practitioners employed and supervised by the physician.

3(m) “Preenrollment period” or “preenrollment” includes the
4period of time during which an application package for enrollment,
5continued enrollment, or for the addition of or change in a location
6is pending.

7(n) “Professionally recognized standards of health care” means
8statewide or national standards of care, whether in writing or not,
9that professional peers of the individual or entity whose provision
10of care is an issue recognize as applying to those peers practicing
11or providing care within a state. When the United States
12Department of Health and Human Services has declared a treatment
13modality not to be safe and effective, practitioners that employ
14that treatment modality shall be deemed not to meet professionally
15recognized standards of health care. This subdivision shall not be
16construed to mean that all other treatments meet professionally
17recognized standards of care.

18(o) “Provider” means an individual, partnership, group,
19association, corporation, institution, or entity, and the officers,
20directors, owners, managing employees, or agents of a partnership,
21group association, corporation, institution, or entity, that provides
22services, goods, supplies, or merchandise, directly or indirectly,
23including all ordering, referring, and prescribing, to a Medi-Cal
24beneficiary and that has been enrolled in the Medi-Cal program.

25(p) “Resolution of an investigation for fraud or abuse” means
26there is no documentation to indicate either that a charge or
27accusation has been filed against the provider and either (1) the
28investigation has not been active at any time during the previous
2912 months or (2) the department has made a documented good
30faith effort and has been unable, for a period of 12 months, to
31contact an investigator or responsible representative of any agency
32investigating the provider.

33(q) “Unnecessary or substandard items or services” means those
34that are either of the following:

35(1) Substantially in excess of the provider’s usual charges or
36costs for the items or services.

37(2) Furnished, or caused to be furnished, to patients, whether
38or not covered by Medicare, Medicaid, or any of the state health
39care programs to which the definitions of applicant and provider
40apply, and which are substantially in excess of the patient’s needs,
P6    1or of a quality that fails to meet professionally recognized standards
2of health care. The department’s determination that the items or
3services furnished were excessive or of unacceptable quality shall
4be made on the basis of information, including sanction reports,
5from the following sources:

6(A) The professional review organization for the area served
7by the individual or entity.

8(B) State or local licensing or certification authorities.

9(C) Fiscal agents or contractors or private insurance companies.

10(D) State or local professional societies.

11(E) Any other sources deemed appropriate by the department.

12

SEC. 2.  

Section 14043.15 of the Welfare and Institutions Code
13 is amended to read:

14

14043.15.  

(a) The department may adopt regulations for
15certification of each applicant and each provider in the Medi-Cal
16program. No certification shall be required for natural persons
17licensed or certificated under Division 2 (commencing with Section
18500) of the Business and Professions Code, the Osteopathic
19Initiative Act, or the Chiropractic Initiative Act.

20(b) (1) An applicant or provider who is a natural person, and
21is licensed or certificated pursuant to Division 2 (commencing
22with Section 500) of the Business and Professions Code, the
23Osteopathic Initiative Act, or the Chiropractic Initiative Act, or is
24a professional corporation, as defined in subdivision (b) of Section
2513401 of the Corporations Code, shall comply with Section
2614043.26 and shall be enrolled in the Medi-Cal program as either
27an individual provider or as a rendering provider in a provider
28group for each application package submitted and approved
29pursuant to Section 14043.26, notwithstanding that the applicant
30or provider meets the requirements to qualify as exempt from clinic
31licensure under subdivision (a) or (m) of Section 1206 of the Health
32and Safety Code.

33(2) A provider enrolled in the Medi-Cal program pursuant to
34paragraph (1), who has disclosed in the application package for
35enrollment that the provider’s practice includes the rendering of
36services, goods, supplies, or merchandise solely at one, or at more
37than one, health facility, as defined in Section 1250 of the Health
38and Safety Code, or clinic, as defined in Section 1204 of the Health
39and Safety Code, or medical therapy unit, for purposes of Section
40123950 of the Health and Safety Code, or residence of the
P7    1provider’s patient, or office of a physician and surgeon involved
2in the care and treatment of the provider’s patients, shall not be
3required to enroll at each such health facility, clinic, medical
4therapy unit, patient’s residence, or physician and surgeon’s office
5location and may utilize the business addresses listed on the
6application for enrollment pursuant to paragraph (1) to claim
7reimbursement from the Medi-Cal program for services rendered
8by the provider to Medi-Cal beneficiaries at all of those health
9facilities, clinics, medical therapy units, residences, or physician
10offices.

11(3) This subdivision shall not be interpreted to allow the
12violation of any state or federal law governing fiscal intermediaries
13or Division 2 (commencing with Section 500) of the Business and
14Professions Code, the Osteopathic Initiative Act, or the
15Chiropractic Initiative Act. This subdivision does not remove the
16requirement that each claim for reimbursement from the Medi-Cal
17program identify the place of service and the rendering, ordering,
18referring, and prescribing provider, where applicable.

19(c) An applicant or provider licensed as a clinic pursuant to
20Chapter 1 (commencing with Section 1200) of, or a health facility
21licensed pursuant to Chapter 2 (commencing with Section 1250)
22of, Division 2 of the Health and Safety Code may be enrolled in
23the Medi-Cal program as a clinic or a health facility and need not
24comply with Section 14043.26 if the clinic or health facility is
25certified by the department to participate in the Medi-Cal program.

26(d) An applicant or provider that meets the requirements to
27qualify as exempt from clinic licensure under subdivisions (b) to
28(l), inclusive, or subdivisions (n) to (p), inclusive, of Section 1206
29of the Health and Safety Code shall comply with Section 14043.26
30and may be enrolled in the Medi-Cal program as either a clinic or
31within any other provider category for which the applicant or
32provider qualifies. An applicant or provider to which any of the
33clinic licensure exemptions specified in this subdivision apply
34shall identify the licensure exemption category and document in
35its application package the legal and factual basis for the clinic
36license exemption claimed.

37(e) Notwithstanding subdivisions (a), (b), (c), and (d), an
38applicant or provider that meets the requirements to qualify as
39exempt from clinic licensure pursuant to subdivision (h) of Section
401206 of the Health and Safety Code, including an intermittent site
P8    1that is operated by a licensed primary care clinic or an affiliated
2mobile health care unit licensed or approved under Chapter 9
3(commencing with Section 1765.101) of Division 2 of the Health
4and Safety Code, and that is operated by a licensed primary care
5clinic, and for which intermittent site or mobile health unit the
6licensed primary care clinic directly or indirectly provides all
7staffing, protocols, equipment, supplies, and billing services, need
8not enroll in the Medi-Cal program as a separate provider and need
9not comply with Section 14043.26 if the licensed primary care
10clinic operating the applicant, provider clinic, or mobile health
11care unit has notified the department of its separate locations,
12premises, intermittent sites, or mobile health care units.

13

SEC. 3.  

Section 14043.25 of the Welfare and Institutions Code
14 is amended to read:

15

14043.25.  

(a) The application form for enrollment, the provider
16agreement, and all attachments or changes to either, shall be signed
17under penalty of perjury.

18(b) The department may require that the application form for
19enrollment, the provider agreement, and all attachments or changes
20to either, submitted by an applicant or provider licensed pursuant
21to Division 2 (commencing with Section 500) of the Business and
22Professions Code, the Osteopathic Initiative Act, or the
23Chiropractic Initiative Act, be notarized.

24(c) Application forms for enrollment, provider agreements, and
25all attachments or changes to either, submitted by an applicant or
26provider not subject to subdivision (b) shall be notarized. This
27 subdivision shall not apply with respect to providers under the
28In-Home Supportive Services program or any providers that choose
29to enroll electronically.

30(d) The department shall collect an application fee for
31enrollment, includingbegin insert continued enrollment orend insert enrollment at a new
32location or a change in location. The application fee shall not be
33collected from individual physicians or nonphysician practitioners,
34from providers that are enrolled in Medicare or another state’s
35Medicaid program or Children’s Health Insurance Program, from
36providers that submit proof that they have paid the applicable fee
37to a Medicare contractor or to another state’s Medicaid program,
38or pursuant to an exemption or waiver pursuant to federal law. The
39application fee collected shall be in the amount calculated by the
40federal Centers for Medicare and Medicaid Services in effect for
P9    1the calendar year during which the application for enrollment is
2received by the department.

3

SEC. 4.  

Section 14043.28 of the Welfare and Institutions Code
4 is amended to read:

5

14043.28.  

(a) (1) If an application package is denied under
6Section 14043.26 or provisional provider status or preferred
7provisional provider status is terminated under Section 14043.27,
8the applicant or provider shall be prohibited from reapplying for
9enrollment or continued enrollment in the Medi-Cal program or
10for participation in any health care program administered by the
11department or its agents or contractors for a period of three years
12from the date the application package is denied or the provisional
13provider status is terminated, except as provided otherwise in
14paragraph (2) of subdivision (h), or paragraph (2) of subdivision
15(i), of Section 14043.26 and as set forth in this section.

16(2) If the application is denied under paragraph (2) of
17 subdivision (h) of Section 14043.26 because the applicant failed
18to resubmit an incomplete application package or is denied under
19paragraph (2) of subdivision (i) of Section 14043.26 because the
20applicant failed to remediate discrepancies, the applicant may
21resubmit an application in accordance with paragraph (2) of
22subdivision (h) or paragraph (2) of subdivision (i), respectively.

23(3) If the denial of the application package is based upon a
24conviction for any offense or for any act included in Section
2514043.36 or termination of the provisional provider status or
26preferred provisional provider status is based upon a conviction
27for any offense or for any act included in paragraph (1) of
28subdivision (c) of Section 14043.27, the applicant or provider shall
29be prohibited from reapplying for enrollment or continued
30enrollment in the Medi-Cal program or for participation in any
31health care program administered by the department or its agents
32or contractors for a period of 10 years from the date the application
33package is denied or the provisional provider status or preferred
34provisional provider status is terminated.

35(4) If the denial of the application package is based upon two
36or more convictions for any offense or for any two or more acts
37included in Section 14043.36 or termination of the provisional
38provider status or preferred provisional provider status is based
39upon two or more convictions for any offense or for any two acts
40included in paragraph (1) of subdivision (c) of Section 14043.27,
P10   1the applicant or provider shall be permanently barred from
2enrollment or continued enrollment in the Medi-Cal program or
3for participation in any health care program administered by the
4department or its agents or contractors.

5(5) The prohibition in paragraph (1) against reapplying for three
6years shall not apply if the denial of the application or termination
7of provisional provider status or preferred provisional provider
8status is based upon any of the following:

9(A) The grounds provided for in paragraph (4), or subparagraph
10(B) of paragraph (7), of subdivision (c) of Section 14043.27.

11(B) The grounds provided for in subdivision (d) of Section
1214043.27, if the investigation is closed without any adverse action
13being taken.

14(C) The grounds provided for in paragraph (6) of subdivision
15(c) of Section 14043.27. However, the department may deny
16reimbursement for claims submitted while the provider was
17noncompliant with the federal Clinical Laboratory Improvement
18Amendments of 1988 (CLIA) (42 U.S.C. Sec. 263a et seq.).

19(D) The grounds provided for in subdivision (b) of Section
20 14043.36 for being terminated or excluded under Medicare or
21under the Medicaid Program or Children’s Health Insurance
22Program of any other state.

23(b) (1) If an application package is denied under subparagraph
24(A), (B), (D), or (E) of paragraph (4) of subdivision (f) of Section
2514043.26, or with respect to a provider described in subparagraph
26(B) of paragraph (2) of subdivision (h), or subparagraph (B) of
27paragraph (2) of subdivision (i), of Section 14043.26, or provisional
28provider status or preferred provisional provider status is terminated
29based upon any of the grounds stated in subparagraph (A) of
30paragraph (7), or paragraphs (1), (2), (3), (5), and (8) to (12),
31inclusive, of subdivision (c) of Section 14043.27, all business
32addresses of the applicant or provider shall be deactivated and the
33applicant or provider shall be removed from enrollment in the
34Medi-Cal program by operation of law.

35(2) If the termination of provisional provider status is based
36upon the grounds stated in subdivision (d) of Section 14043.27
37and the investigation is closed without any adverse action being
38taken, or is based upon the grounds in subparagraph (B) of
39paragraph (7) of subdivision (c) of Section 14043.27 and the
40applicant or provider obtains the appropriate license, permits, or
P11   1approvals covering the period of provisional provider status, the
2termination taken pursuant to subdivision (c) of Section 14043.27
3shall be rescinded, the previously deactivated provider numbers
4shall be reactivated, and the provider shall be reenrolled in the
5Medi-Cal program, unless there are other grounds for taking these
6actions.

7(c) Claims that are submitted or caused to be submitted by an
8applicant or provider who has been suspended from the Medi-Cal
9program for any reason or who has had its provisional provider
10status terminated or had its application package for enrollment or
11continued enrollment denied and all business addresses deactivated
12may not be paid for services, goods, merchandise, or supplies
13rendered to Medi-Cal beneficiaries during the period of suspension
14or termination or after the date all business addresses are
15deactivated.

16

SEC. 5.  

Section 14043.36 of the Welfare and Institutions Code
17 is amended to read:

18

14043.36.  

(a) The department shall not enroll any applicant
19that has been convicted of any felony or misdemeanor involving
20fraud or abuse in any government program, or related to neglect
21or abuse of a patient in connection with the delivery of a health
22care item or service, or in connection with the interference with
23or obstruction of any investigation into health care related fraud
24or abuse or that has been found liable for fraud or abuse in any
25civil proceeding, or that has entered into a settlement in lieu of
26conviction for fraud or abuse in any government program, within
27the previous 10 years. In addition, the department may deny
28enrollment to any applicant that, at the time of application, is under
29investigation by the department or any state, local, or federal
30government law enforcement agency for fraud or abuse pursuant
31to Subpart A (commencing with Section 455.12) of Part 455 of
32Title 42 of the Code of Federal Regulations. The department shall
33not deny enrollment to an otherwise qualified applicant whose
34felony or misdemeanor charges did not result in a conviction solely
35on the basis of the prior charges. If it is discovered that a provider
36is under investigation by the department or any state, local, or
37federal government law enforcement agency for fraud or abuse,
38that provider shall be subject to temporary suspension from the
39Medi-Cal program, which shall include temporary deactivation of
P12   1the provider’s number, including all business addresses used by
2the provider to obtain reimbursement from the Medi-Cal program.

3(b) If it is discovered that a provider has been terminated under
4Medicare or under the Medicaid Program or Children’s Health
5Insurance Program in any other state, the provider shall not be
6enrolled in, or shall be subject to termination from, the Medi-Cal
7program, which shall include deactivation of the provider’s enrolled
8numbers and all business addresses used to obtain reimbursement
9from the Medi-Cal program.

10(c) The director shall notify in writing the provider of the
11temporary suspension and deactivation of the provider’s number,
12which shall take effect 15 days from the date of the notification.
13Notwithstanding Section 100171 of the Health and Safety Code,
14proceedings after the imposition of sanctions provided for in
15subdivision (a) shall be in accordance with Section 14043.65.

16(d) A temporary suspension may be lifted when a resolution of
17an investigation for fraud or abuse occurs.

18

SEC. 6.  

Section 14043.38 of the Welfare and Institutions Code
19 is amended to read:

20

14043.38.  

(a) Provider types are designated as “limited,”
21“moderate,” or “high” categorical risk by the federal government
22in Section 424.518 of Title 42 of the Code of Federal Regulations.
23The department shall, at minimum, utilize the federal regulations
24in determining a provider’s or applicant’s categorical risk.

25(b) In accordance with Section 455.450 of Title 42 of the Code
26of Federal Regulations, the department shall designate a provider
27or applicant as a “high” categorical risk if any of the following
28occur:

29(1) The department imposes a payment suspension based on a
30credible allegation of fraud, waste, or abuse.

31(2) The provider or applicant has an existing Medicaid
32overpayment based on fraud, waste, or abuse.

33(3) The provider or applicant has been excluded by the federal
34Office of the Inspector General or another state’s Medicaid program
35within the previous 10 years.

36(4) The department or the federal Centers for Medicare and
37Medicaid Services lifted a temporary moratorium within the
38previous six months for the particular provider type submitting
39the application, the applicant would have been prevented from
40enrolling based on that previous moratorium, and the applicant
P13   1applies for enrollment as a provider at any time within six months
2from the date the moratorium was lifted.

3(c) If the department designates a provider or applicant as a
4 “high” categorical risk, the department or its designee shall do
5both of the following:

6(1) Conduct a criminal background check of the following
7persons:

8(A) The provider or applicant. If the provider or applicant is a
9nonprofit Drug Medi-Cal provider or applicant, the officers and
10executive director of the provider or applicant.

11(B) Any person with a 5-percent or greater direct or indirect
12ownership interest in the provider or applicant.

13(2) Require the following persons to submit a set of fingerprints
14within 30 days of the department’s request, in a manner determined
15by the department:

16(A) The provider or applicant. If the provider or applicant is a
17nonprofit Drug Medi-Cal provider or applicant, the officers and
18executive director of the provider or applicant.

19(B) Any person with a 5-percent or greater direct or indirect
20ownership interest in the provider or applicant.

21(d) (1) The department shall submit to the Department of Justice
22fingerprint images and related information required by the
23Department of Justice of Medi-Cal providers or applicants
24determined to be a “high” categorical risk pursuant to subdivision
25(a), and any person with a 5-percent or greater direct or indirect
26ownership interest in those providers and applicants, for the
27purposes of obtaining information as to the existence and content
28of a record of state or federal convictions and state or federal arrests
29and also information as to the existence and content of a record of
30state or federal arrests for which the Department of Justice
31establishes that the person is free on bail or on his or her
32recognizance pending trial or appeal.

33(2) When received, the Department of Justice shall forward to
34the Federal Bureau of Investigation requests for federal summary
35criminal history information received pursuant to this section. The
36Department of Justice shall review the information returned from
37the Federal Bureau of Investigation and compile and disseminate
38a response to the department.

P14   1(3) The Department of Justice shall provide a state or federal
2level response to the department pursuant to paragraph (1) of
3subdivision (p) of Section 11105 of the Penal Code.

4(4) The department shall request from the Department of Justice
5subsequent notification service, as provided pursuant to Section
611105.2 of the Penal Code, for persons described in paragraph (1).

7(5) The Department of Justice shall charge a fee sufficient to
8cover the cost of processing the request described in this section.
9That fee shall be paid by the subject of the criminal background
10check.

11(e) For persons subject to the requirements of subdivision (a)
12of Section 15660, the procedure for obtaining and submitting
13fingerprints and notification by the Department of Justice of
14criminal record information set forth in subdivision (c) of Section
1515660 shall apply instead of the procedure set forth in subdivision
16(d).

17

SEC. 7.  

Section 14043.4 of the Welfare and Institutions Code
18 is amended to read:

19

14043.4.  

If discrepancies are found to exist during the
20preenrollment period, the department may conduct additional
21inspections prior to enrollment. Failure of a provider to remediate
22discrepancies as prescribed by the director may result in denial of
23the application for enrollment. The department may deactivate all
24of the provider’s business addresses if the department determines
25that the discrepancies are material to the provider’s continued
26enrollment and the provider’s compliance with program
27requirements at the additional business addresses.

28

SEC. 8.  

Section 14043.55 of the Welfare and Institutions Code
29 is amended to read:

30

14043.55.  

(a)  The department may implement a 180-day
31moratorium on the enrollment of providers in a specific provider
32of service category, on a statewide basis or within a geographic
33area, except that no moratorium shall be implemented on the
34enrollment of providers who are licensed as clinics under Section
351204 of the Health and Safety Code, health facilities under Chapter
362 (commencing with Section 1250) of the Health and Safety Code,
37clinics exempt from licensure under Section 1206 of the Health
38and Safety Code, or natural persons licensed or certified under
39Division 2 (commencing with Section 500) of the Business and
40Professions Code, the Osteopathic Initiative Act, or the
P15   1Chiropractic Initiative Act, when the director determines this action
2is necessary to safeguard public funds or to maintain the fiscal
3integrity of the program. This moratorium may be extended or
4repeated when the director determines this action is necessary to
5safeguard public funds or to maintain the fiscal integrity of the
6program. The authority granted in this section shall not be
7interpreted as a limitation on the authority granted to the
8department in Section 14105.3.

9(b) If the Secretary of the United States Department of Health
10and Human Services establishes a temporary moratorium on
11enrollment as described in federal regulations, the department shall
12establish a corresponding moratorium covering the same period
13and provider types, even if those provider types would not
14ordinarily be subject to a moratorium under this section, unless
15the department determines that the imposition of the moratorium
16will adversely impact beneficiaries access to medical assistance.
17A federal moratorium adopted under this subdivision shall not be
18subject to the director’s determinations regarding safeguards of
19 public funds and program integrity or other prerequisites that are
20necessary to implement a state-initiated moratorium.

21

SEC. 9.  

This act is an urgency statute necessary for the
22immediate preservation of the public peace, health, or safety within
23the meaning of Article IV of the Constitution and shall go into
24immediate effect. The facts constituting the necessity are:

25To ensure the state’s compliance with the federal Patient
26Protection and Affordable Care Act (Public Law 111-148) as
27originally enacted and as amended by the federal Health Care and
28Education Reconciliation Act of 2010 (Public Law 111-152) and
29to maintain services for health care providers, it is necessary that
30this act take effect immediately.



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