BILL NUMBER: SB 299 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MAY 18, 2015
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, continuing continued
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.
Existing law requires the department to collect an application fee
for enrollment, including enrollment at a new location or a change in
location.
This bill would exempt from these notarization requirements any
provider that chooses to enroll electronically. The bill would
clarify that the department is also required to collect an
application fee for continued enrollment.
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: 2/3. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14043.1 of the Welfare and Institutions Code is
amended to read:
14043.1. As used in this article:
(a) "Abuse" means either of the following:
(1) Practices that are inconsistent with sound fiscal or business
practices and result in unnecessary cost to the federal Medicaid and
Medicare programs, the Medi-Cal program, another state's Medicaid
program, or other health care programs operated, or financed in whole
or in part, by the federal government or a state or local agency in
this state or another state.
(2) Practices that are inconsistent with sound medical practices
and result in reimbursement by the federal Medicaid and Medicare
programs, the Medi-Cal program or other health care programs
operated, or financed in whole or in part, by the federal government
or a state or local agency in this state or another state, for
services that are unnecessary or for substandard items or services
that fail to meet professionally recognized standards for health
care.
(b) "Applicant" means an individual, including an ordering,
referring, or prescribing individual, partnership, group,
association, corporation, institution, or entity, and the officers,
directors, owners, managing employees, or agents thereof, that apply
to the department for enrollment as a provider in the Medi-Cal
program.
(c) "Application or application package" means a completed and
signed application form, signed under penalty of perjury or notarized
pursuant to Section 14043.25, a disclosure statement, a provider
agreement, and all attachments or changes in the form, statement, or
agreement.
(d) "Appropriate volume of business" means a volume that is
consistent with the information provided in the application and any
supplemental information provided by the applicant or provider, and
is of a quality and type that would reasonably be expected based upon
the size and type of business operated by the applicant or provider.
(e) "Business address" means the location where an applicant or
provider provides services, goods, supplies, or merchandise, directly
or indirectly, to a Medi-Cal beneficiary. A post office box or
commercial box is not a business address. The business address for
the location of a vehicle or vessel owned and operated by an
applicant or provider enrolled in the Medi-Cal program and used to
provide services, goods, supplies, or merchandise, directly or
indirectly, to a Medi-Cal beneficiary shall either be the business
address location listed on the provider's application as the location
where similar services, goods, supplies, or merchandise would be
provided or the applicant's or provider's pay to address.
(f) "Convicted" means any of the following:
(1) A judgment of conviction has been entered against an
individual or entity by a federal, state, or local court, regardless
of whether there is a posttrial motion, an appeal pending, or the
judgment of conviction or other record relating to the criminal
conduct has been expunged or otherwise removed.
(2) A federal, state, or local court has made a finding of guilt
against an individual or entity.
(3) A federal, state, or local court has accepted a plea of guilty
or nolo contendere by an individual or entity.
(4) An individual or entity has entered into participation in a
first offender, deferred adjudication, or other program or
arrangement where judgment of conviction has been withheld.
(g) "Debt due and owing" means 60 days have passed since a notice
or demand for repayment of an overpayment or another amount resulting
from an audit or examination, for a penalty assessment, or for
another amount due to the department was sent to the provider,
regardless of whether the provider is an institutional provider or a
noninstitutional provider and regardless of whether an appeal is
pending.
(h) "Enrolled or enrollment in the Medi-Cal program" means
authorized under any processes by the department or its agents or
contractors to receive, directly or indirectly, reimbursement for the
provision of services, goods, supplies, or merchandise to a Medi-Cal
beneficiary.
(i) "Fraud" means an intentional deception or misrepresentation
made by a person with the knowledge that the deception could result
in some unauthorized benefit to himself or herself or some other
person. It includes any act that constitutes fraud under applicable
federal or state law.
(j) "Location" means a street, city, or rural route address or a
site or place within a street, city, or rural route address, and the
city, county, state, and nine-digit ZIP Code.
(k) "Not currently enrolled at the location for which the
application is submitted" means either of the following:
(1) The provider is changing location and moving to a different
location than that for which the provider was issued a provider
number.
(2) The provider is adding a business address.
(l) (1) "Individual dentist practice" means a dentist licensed by
the Dental Board of California enrolled or enrolling in Medi-Cal as
an individual provider who is a sole proprietor of his or her
practice or is a corporation owned solely by the individual dentist
and the only dentist practitioner is the owner. An individual dentist
practice may include nondentist allied dental health professionals
employed and supervised by the dentist.
(2) "Individual physician practice" means a physician and surgeon
licensed by the Medical Board of California or the Osteopathic
Medical Board of California enrolled or enrolling in Medi-Cal as an
individual provider who is sole proprietor of his or her practice or
is a corporation owned solely by the individual physician and the
only physician practitioner is the owner. An individual physician
practice may include nonphysician medical practitioners employed and
supervised by the physician.
(m) "Preenrollment period" or "preenrollment" includes the period
of time during which an application package for enrollment, continued
enrollment, or for the addition of or change in a location is
pending.
(n) "Professionally recognized standards of health care" means
statewide or national standards of care, whether in writing or not,
that professional peers of the individual or entity whose provision
of care is an issue recognize as applying to those peers practicing
or providing care within a state. When the United States Department
of Health and Human Services has declared a treatment modality not to
be safe and effective, practitioners that employ that treatment
modality shall be deemed not to meet professionally recognized
standards of health care. This subdivision shall not be construed to
mean that all other treatments meet professionally recognized
standards of care.
(o) "Provider" means an individual, partnership, group,
association, corporation, institution, or entity, and the officers,
directors, owners, managing employees, or agents of a partnership,
group association, corporation, institution, or entity, that provides
services, goods, supplies, or merchandise, directly or indirectly,
including all ordering, referring, and prescribing, to a Medi-Cal
beneficiary and that has been enrolled in the Medi-Cal program.
(p) "Resolution of an investigation for fraud or abuse" means
there is no documentation to indicate either that a charge or
accusation has been filed against the provider and either (1) the
investigation has not been active at any time during the previous 12
months or (2) the department has made a documented good faith effort
and has been unable, for a period of 12 months, to contact an
investigator or responsible representative of any agency
investigating the provider.
(q) "Unnecessary or substandard items or services" means those
that are either of the following:
(1) Substantially in excess of the provider's usual charges or
costs for the items or services.
(2) Furnished, or caused to be furnished, to patients, whether or
not covered by Medicare, Medicaid, or any of the state health care
programs to which the definitions of applicant and provider apply,
and which are substantially in excess of the patient's needs, or of a
quality that fails to meet professionally recognized standards of
health care. The department's determination that the items or
services furnished were excessive or of unacceptable quality shall be
made on the basis of information, including sanction reports, from
the following sources:
(A) The professional review organization for the area served by
the individual or entity.
(B) State or local licensing or certification authorities.
(C) Fiscal agents or contractors or private insurance companies.
(D) State or local professional societies.
(E) Any other sources deemed appropriate by the department.
SEC. 2. Section 14043.15 of the Welfare and Institutions Code is
amended to read:
14043.15. (a) The department may adopt regulations for
certification of each applicant and each provider in the Medi-Cal
program. No certification shall be required for natural persons
licensed or certificated under Division 2 (commencing with Section
500) of the Business and Professions Code, the Osteopathic Initiative
Act, or the Chiropractic Initiative Act.
(b) (1) An applicant or provider who is a natural person, and is
licensed or certificated pursuant to Division 2 (commencing with
Section 500) of the Business and Professions Code, the Osteopathic
Initiative Act, or the Chiropractic Initiative Act, or is a
professional corporation, as defined in subdivision (b) of Section
13401 of the Corporations Code, shall comply with Section 14043.26
and shall be enrolled in the Medi-Cal program as either an individual
provider or as a rendering provider in a provider group for each
application package submitted and approved pursuant to Section
14043.26, notwithstanding that the applicant or provider meets the
requirements to qualify as exempt from clinic licensure under
subdivision (a) or (m) of Section 1206 of the Health and Safety Code.
(2) A provider enrolled in the Medi-Cal program pursuant to
paragraph (1), who has disclosed in the application package for
enrollment that the provider's practice includes the rendering of
services, goods, supplies, or merchandise solely at one, or at more
than one, health facility, as defined in Section 1250 of the Health
and Safety Code, or clinic, as defined in Section 1204 of the Health
and Safety Code, or medical therapy unit, for purposes of Section
123950 of the Health and Safety Code, or residence of the provider's
patient, or office of a physician and surgeon involved in the care
and treatment of the provider's patients, shall not be required to
enroll at each such health facility, clinic, medical therapy unit,
patient's residence, or physician and surgeon's office location and
may utilize the business addresses listed on the application for
enrollment pursuant to paragraph (1) to claim reimbursement from the
Medi-Cal program for services rendered by the provider to Medi-Cal
beneficiaries at all of those health facilities, clinics, medical
therapy units, residences, or physician offices.
(3) This subdivision shall not be interpreted to allow the
violation of any state or federal law governing fiscal intermediaries
or Division 2 (commencing with Section 500) of the Business and
Professions Code, the Osteopathic Initiative Act, or the Chiropractic
Initiative Act. This subdivision does not remove the requirement
that each claim for reimbursement from the Medi-Cal program identify
the place of service and the rendering, ordering, referring, and
prescribing provider, where applicable.
(c) An applicant or provider licensed as a clinic pursuant to
Chapter 1 (commencing with Section 1200) of, or a health facility
licensed pursuant to Chapter 2 (commencing with Section 1250) of,
Division 2 of the Health and Safety Code may be enrolled in the
Medi-Cal program as a clinic or a health facility and need not comply
with Section 14043.26 if the clinic or health facility is certified
by the department to participate in the Medi-Cal program.
(d) An applicant or provider that meets the requirements to
qualify as exempt from clinic licensure under subdivisions (b) to
(l), inclusive, or subdivisions (n) to (p), inclusive, of Section
1206 of the Health and Safety Code shall comply with Section 14043.26
and may be enrolled in the Medi-Cal program as either a clinic or
within any other provider category for which the applicant or
provider qualifies. An applicant or provider to which any of the
clinic licensure exemptions specified in this subdivision apply shall
identify the licensure exemption category and document in its
application package the legal and factual basis for the clinic
license exemption claimed.
(e) Notwithstanding subdivisions (a), (b), (c), and (d), an
applicant or provider that meets the requirements to qualify as
exempt from clinic licensure pursuant to subdivision (h) of Section
1206 of the Health and Safety Code, including an intermittent site
that is operated by a licensed primary care clinic or an affiliated
mobile health care unit licensed or approved under Chapter 9
(commencing with Section 1765.101) of Division 2 of the Health and
Safety Code, and that is operated by a licensed primary care clinic,
and for which intermittent site or mobile health unit the licensed
primary care clinic directly or indirectly provides all staffing,
protocols, equipment, supplies, and billing services, need not enroll
in the Medi-Cal program as a separate provider and need not comply
with Section 14043.26 if the licensed primary care clinic operating
the applicant, provider clinic, or mobile health care unit has
notified the department of its separate locations, premises,
intermittent sites, or mobile health care units.
SEC. 3. Section 14043.25 of the Welfare and Institutions Code is
amended to read:
14043.25. (a) The application form for enrollment, the provider
agreement, and all attachments or changes to either, shall be signed
under penalty of perjury.
(b) The department may require that the application form for
enrollment, the provider agreement, and all attachments or changes to
either, submitted by an applicant or provider licensed pursuant to
Division 2 (commencing with Section 500) of the Business and
Professions Code, the Osteopathic Initiative Act, or the Chiropractic
Initiative Act, be notarized.
(c) Application forms for enrollment, provider agreements, and all
attachments or changes to either, submitted by an applicant or
provider not subject to subdivision (b) shall be notarized. This
subdivision shall not apply with respect to providers under the
In-Home Supportive Services program or any providers that choose to
enroll electronically.
(d) The department shall collect an application fee for
enrollment, including continued enrollment or enrollment
at a new location or a change in location. The application fee shall
not be collected from individual physicians or nonphysician
practitioners, from providers that are enrolled in Medicare or
another state's Medicaid program or Children's Health Insurance
Program, from providers that submit proof that they have paid the
applicable fee to a Medicare contractor or to another state's
Medicaid program, or pursuant to an exemption or waiver pursuant to
federal law. The application fee collected shall be in the amount
calculated by the federal Centers for Medicare and Medicaid Services
in effect for the calendar year during which the application for
enrollment is received by the department.
SEC. 4. Section 14043.28 of the Welfare and Institutions Code is
amended to read:
14043.28. (a) (1) If an application package is denied under
Section 14043.26 or provisional provider status or preferred
provisional provider status is terminated under Section 14043.27, the
applicant or provider shall be prohibited from reapplying for
enrollment or continued enrollment in the Medi-Cal program or for
participation in any health care program administered by the
department or its agents or contractors for a period of three years
from the date the application package is denied or the provisional
provider status is terminated, except as provided otherwise in
paragraph (2) of subdivision (h), or paragraph (2) of subdivision
(i), of Section 14043.26 and as set forth in this section.
(2) If the application is denied under paragraph (2) of
subdivision (h) of Section 14043.26 because the applicant failed to
resubmit an incomplete application package or is denied under
paragraph (2) of subdivision (i) of Section 14043.26 because the
applicant failed to remediate discrepancies, the applicant may
resubmit an application in accordance with paragraph (2) of
subdivision (h) or paragraph (2) of subdivision (i), respectively.
(3) If the denial of the application package is based upon a
conviction for any offense or for any act included in Section
14043.36 or termination of the provisional provider status or
preferred provisional provider status is based upon a conviction for
any offense or for any act included in paragraph (1) of subdivision
(c) of Section 14043.27, the applicant or provider shall be
prohibited from reapplying for enrollment or continued enrollment in
the Medi-Cal program or for participation in any health care program
administered by the department or its agents or contractors for a
period of 10 years from the date the application package is denied or
the provisional provider status or preferred provisional provider
status is terminated.
(4) If the denial of the application package is based upon two or
more convictions for any offense or for any two or more acts included
in Section 14043.36 or termination of the provisional provider
status or preferred provisional provider status is based upon two or
more convictions for any offense or for any two acts included in
paragraph (1) of subdivision (c) of Section 14043.27, the applicant
or provider shall be permanently barred from enrollment or continued
enrollment in the Medi-Cal program or for participation in any health
care program administered by the department or its agents or
contractors.
(5) The prohibition in paragraph (1) against reapplying for three
years shall not apply if the denial of the application or termination
of provisional provider status or preferred provisional provider
status is based upon any of the following:
(A) The grounds provided for in paragraph (4), or subparagraph (B)
of paragraph (7), of subdivision (c) of Section 14043.27.
(B) The grounds provided for in subdivision (d) of Section
14043.27, if the investigation is closed without any adverse action
being taken.
(C) The grounds provided for in paragraph (6) of subdivision (c)
of Section 14043.27. However, the department may deny reimbursement
for claims submitted while the provider was noncompliant with the
federal Clinical Laboratory Improvement Amendments of 1988 (CLIA) (42
U.S.C. Sec. 263a et seq.).
(D) The grounds provided for in subdivision (b) of Section
14043.36 for being terminated or excluded under Medicare or under the
Medicaid Program or Children's Health Insurance Program of any other
state.
(b) (1) If an application package is denied under subparagraph
(A), (B), (D), or (E) of paragraph (4) of subdivision (f) of Section
14043.26, or with respect to a provider described in subparagraph (B)
of paragraph (2) of subdivision (h), or subparagraph (B) of
paragraph (2) of subdivision (i), of Section 14043.26, or provisional
provider status or preferred provisional provider status is
terminated based upon any of the grounds stated in subparagraph (A)
of paragraph (7), or paragraphs (1), (2), (3), (5), and (8) to (12),
inclusive, of subdivision (c) of Section 14043.27, all business
addresses of the applicant or provider shall be deactivated and the
applicant or provider shall be removed from enrollment in the
Medi-Cal program by operation of law.
(2) If the termination of provisional provider status is based
upon the grounds stated in subdivision (d) of Section 14043.27 and
the investigation is closed without any adverse action being taken,
or is based upon the grounds in subparagraph (B) of paragraph (7) of
subdivision (c) of Section 14043.27 and the applicant or provider
obtains the appropriate license, permits, or approvals covering the
period of provisional provider status, the termination taken pursuant
to subdivision (c) of Section 14043.27 shall be rescinded, the
previously deactivated provider numbers shall be reactivated, and the
provider shall be reenrolled in the Medi-Cal program, unless there
are other grounds for taking these actions.
(c) Claims that are submitted or caused to be submitted by an
applicant or provider who has been suspended from the Medi-Cal
program for any reason or who has had its provisional provider status
terminated or had its application package for enrollment or
continued enrollment denied and all business addresses deactivated
may not be paid for services, goods, merchandise, or supplies
rendered to Medi-Cal beneficiaries during the period of suspension or
termination or after the date all business addresses are
deactivated.
SEC. 5. Section 14043.36 of the Welfare and Institutions Code is
amended to read:
14043.36. (a) The department shall not enroll any applicant that
has been convicted of any felony or misdemeanor involving fraud or
abuse in any government program, or related to neglect or abuse of a
patient in connection with the delivery of a health care item or
service, or in connection with the interference with or obstruction
of any investigation into health care related fraud or abuse or that
has been found liable for fraud or abuse in any civil proceeding, or
that has entered into a settlement in lieu of conviction for fraud or
abuse in any government program, within the previous 10 years. In
addition, the department may deny enrollment to any applicant that,
at the time of application, is under investigation by the department
or any state, local, or federal government law enforcement agency for
fraud or abuse pursuant to Subpart A (commencing with Section
455.12) of Part 455 of Title 42 of the Code of Federal Regulations.
The department shall not deny enrollment to an otherwise qualified
applicant whose felony or misdemeanor charges did not result in a
conviction solely on the basis of the prior charges. If it is
discovered that a provider is under investigation by the department
or any state, local, or federal government law enforcement agency for
fraud or abuse, that provider shall be subject to temporary
suspension from the Medi-Cal program, which shall include temporary
deactivation of the provider's number, including all business
addresses used by the provider to obtain reimbursement from the
Medi-Cal program.
(b) If it is discovered that a provider has been terminated under
Medicare or under the Medicaid Program or Children's Health Insurance
Program in any other state, the provider shall not be enrolled in,
or shall be subject to termination from, the Medi-Cal program, which
shall include deactivation of the provider's enrolled numbers and all
business addresses used to obtain reimbursement from the Medi-Cal
program.
(c) The director shall notify in writing the provider of the
temporary suspension and deactivation of the provider's number, which
shall take effect 15 days from the date of the notification.
Notwithstanding Section 100171 of the Health and Safety Code,
proceedings after the imposition of sanctions provided for in
subdivision (a) shall be in accordance with Section 14043.65.
(d) A temporary suspension may be lifted when a resolution of an
investigation for fraud or abuse occurs.
SEC. 6. Section 14043.38 of the Welfare and Institutions Code is
amended to read:
14043.38. (a) Provider types are designated as "limited,"
"moderate," or "high" categorical risk by the federal government in
Section 424.518 of Title 42 of the Code of Federal Regulations. The
department shall, at minimum, utilize the federal regulations in
determining a provider's or applicant's categorical risk.
(b) In accordance with Section 455.450 of Title 42 of the Code of
Federal Regulations, the department shall designate a provider or
applicant as a "high" categorical risk if any of the following occur:
(1) The department imposes a payment suspension based on a
credible allegation of fraud, waste, or abuse.
(2) The provider or applicant has an existing Medicaid overpayment
based on fraud, waste, or abuse.
(3) The provider or applicant has been excluded by the federal
Office of the Inspector General or another state's Medicaid program
within the previous 10 years.
(4) The department or the federal Centers for Medicare and
Medicaid Services lifted a temporary moratorium within the previous
six months for the particular provider type submitting the
application, the applicant would have been prevented from enrolling
based on that previous moratorium, and the applicant applies for
enrollment as a provider at any time within six months from the date
the moratorium was lifted.
(c) If the department designates a provider or applicant as a
"high" categorical risk, the department or its designee shall do both
of the following:
(1) Conduct a criminal background check of the following persons:
(A) The provider or applicant. If the provider or applicant is a
nonprofit Drug Medi-Cal provider or applicant, the officers and
executive director of the provider or applicant.
(B) Any person with a 5-percent or greater direct or indirect
ownership interest in the provider or applicant.
(2) Require the following persons to submit a set of fingerprints
within 30 days of the department's request, in a manner determined by
the department:
(A) The provider or applicant. If the provider or applicant is a
nonprofit Drug Medi-Cal provider or applicant, the officers and
executive director of the provider or applicant.
(B) Any person with a 5-percent or greater direct or indirect
ownership interest in the provider or applicant.
(d) (1) The department shall submit to the Department of Justice
fingerprint images and related information required by the Department
of Justice of Medi-Cal providers or applicants determined to be a
"high" categorical risk pursuant to subdivision (a), and any person
with a 5-percent or greater direct or indirect ownership interest in
those providers and applicants, for the purposes of obtaining
information as to the existence and content of a record of state or
federal convictions and state or federal arrests and also information
as to the existence and content of a record of state or federal
arrests for which the Department of Justice establishes that the
person is free on bail or on his or her recognizance pending trial or
appeal.
(2) When received, the Department of Justice shall forward to the
Federal Bureau of Investigation requests for federal summary criminal
history information received pursuant to this section. The
Department of Justice shall review the information returned from the
Federal Bureau of Investigation and compile and disseminate a
response to the department.
(3) The Department of Justice shall provide a state or federal
level response to the department pursuant to paragraph (1) of
subdivision (p) of Section 11105 of the Penal Code.
(4) The department shall request from the Department of Justice
subsequent notification service, as provided pursuant to Section
11105.2 of the Penal Code, for persons described in paragraph (1).
(5) The Department of Justice shall charge a fee sufficient to
cover the cost of processing the request described in this section.
That fee shall be paid by the subject of the criminal background
check.
(e) For persons subject to the requirements of subdivision (a) of
Section 15660, the procedure for obtaining and submitting
fingerprints and notification by the Department of Justice of
criminal record information set forth in subdivision (c) of Section
15660 shall apply instead of the procedure set forth in subdivision
(d).
SEC. 7. Section 14043.4 of the Welfare and Institutions Code is
amended to read:
14043.4. If discrepancies are found to exist during the
preenrollment period, the department may conduct additional
inspections prior to enrollment. Failure of a provider to remediate
discrepancies as prescribed by the director may result in denial of
the application for enrollment. The department may deactivate all of
the provider's business addresses if the department determines that
the discrepancies are material to the provider's continued enrollment
and the provider's compliance with program requirements at the
additional business addresses.
SEC. 8. Section 14043.55 of the Welfare and Institutions Code is
amended to read:
14043.55. (a) The department may implement a 180-day moratorium
on the enrollment of providers in a specific provider of service
category, on a statewide basis or within a geographic area, except
that no moratorium shall be implemented on the enrollment of
providers who are licensed as clinics under Section 1204 of the
Health and Safety Code, health facilities under Chapter 2 (commencing
with Section 1250) of the Health and Safety Code, clinics exempt
from licensure under Section 1206 of the Health and Safety Code, or
natural persons licensed or certified under Division 2 (commencing
with Section 500) of the Business and Professions Code, the
Osteopathic Initiative Act, or the Chiropractic Initiative Act, when
the director determines this action is necessary to safeguard public
funds or to maintain the fiscal integrity of the program. This
moratorium may be extended or repeated when the director determines
this action is necessary to safeguard public funds or to maintain the
fiscal integrity of the program. The authority granted in this
section shall not be interpreted as a limitation on the authority
granted to the department in Section 14105.3.
(b) If the Secretary of the United States Department of Health and
Human Services establishes a temporary moratorium on enrollment as
described in federal regulations, the department shall establish a
corresponding moratorium covering the same period and provider types,
even if those provider types would not ordinarily be subject to a
moratorium under this section, unless the department determines that
the imposition of the moratorium will adversely impact beneficiaries
access to medical assistance. A federal moratorium adopted under this
subdivision shall not be subject to the director's determinations
regarding safeguards of public funds and program integrity or other
prerequisites that are necessary to implement a state-initiated
moratorium.
SEC. 9. This act is an urgency statute necessary for the immediate
preservation of the public peace, health, or safety within the
meaning of Article IV of the Constitution and shall go into immediate
effect. The facts constituting the necessity are:
To ensure the state's compliance with the federal Patient
Protection and Affordable Care Act (Public Law 111-148) as originally
enacted and as amended by the federal Health Care and Education
Reconciliation Act of 2010 (Public Law 111-152) and to maintain
services for health care providers, it is necessary that this act
take effect immediately.