BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 299
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|AUTHOR: |Monning |
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|VERSION: |February 23, 2015 |
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|HEARING DATE: |April 8, 2015 | | |
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|CONSULTANT: |Scott Bain |
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SUBJECT : Medi-Cal: provider enrollment
SUMMARY: Exempts health care providers submitting a Medi-Cal provider
application package to the Department of Health Care Services'
(DHCS) Medi-Cal provider enrollment division process from the
current notarization requirements if the provider enrolls
electronically. Conforms state law to federal regulation by
requiring DHCS to designate a provider or applicant as a "high"
categorical risk if DHCS lifted a temporary moratorium within
the previous 6 months for the particular provider type
submitting the application.
Existing law:
1.Establishes the Medi-Cal program, which is administered by
DHCS, under which qualified low-income individuals receive
health care services.
2.Requires an applicant or provider to submit a complete
application package for enrollment as a Medi-Cal provider, and
generally requires the application package for enrollment, the
provider agreement, and all attachments or changes that are
submitted by specified applicants or providers to be
notarized.
3.Designates Medi-Cal provider types as "limited," "moderate,"
or "high" categorical risk by the federal government, and
requires DHCS, at minimum, to utilize the federal regulations
in determining a provider's or applicant's categorical risk.
4.Requires DHCS, in accordance with federal regulation, to
designate a provider or applicant as a "high" categorical risk
if specified conditions are met, including if the federal
Centers for Medicare and Medicaid Services (CMS) lifted a
SB 299 (Monning) Page 2 of ?
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.
This bill:
1.Exempts, from the current DHCS notarization requirements, any
provider that chooses to enroll electronically.
2.Conforms state law to federal regulation by requiring DHCS to
designate a provider or applicant as a "high" categorical risk
if DHCS (in addition to CMS) lifted a temporary moratorium
within the previous six months for the particular provider
type submitting the application.
3.Delete various obsolete provisions of law.
FISCAL
EFFECT: This bill has not been analyzed by a fiscal committee.
COMMENTS:
1.Author's statement. According to the author, this bill
removes the obsolete statutory notarization requirement for
Medi-Cal provider applicants when applying online in an effort
to simplify and improve the Medi-Cal enrollment process.
Because DHCS is developing an online enrollment system that is
scheduled for a September 2015 rollout, the urgency clause
included in this bill is necessary to avoid duplicative
identity verification.
2.Medi-Cal provider enrollment and electronic applications.
State law governing Medi-Cal and federal Medicaid law and
regulations contain provisions to prevent and address fraud
and abuse in the Medicaid program. DHCS' Provider Enrollment
Division (PED) is responsible for the enrollment and
re-enrollment of 40 fee-for-service health care provider types
into the Medi-Cal program. Later this year, DHCS' PED is
proposing to implement the Provider Application and Validation
for Enrollment (PAVE) system. PAVE is intended to transform
DHCS' provider enrollment activities from a manual process to
a web-based portal that providers can use to complete and
submit their applications, verifications and report changes.
SB 299 (Monning) Page 3 of ?
The urgency clause in this bill would permit provider
applications to be submitted electronically without the
current notarization requirement in anticipation of PAVE
implementation.
3.Categorical risk of fraud and provider moratorium. Federal
regulations require State Medicaid agencies to screen all
initial applications, including applications for a new
practice location, and any applications received in response
to a re-enrollment or revalidation of enrollment request based
on a categorical risk level of "limited," "moderate," or
"high." Federal regulations require, when a State Medicaid
agency designates a provider as a "high" categorical risk, the
agency to conduct a criminal background check and require the
submission of fingerprints. Under federal regulations, state
Medicaid agencies must adjust the categorical risk level from
"limited" or "moderate" to "high" when the State Medicaid
agency or CMS in the previous six months lifted a temporary
moratorium.
This bill would conform state law to this federal regulation if
DHCS were to lift a temporary moratorium. DHCS has three
enrollment moratoriums currently in effect: (a) clinical
laboratories (statewide); (b) durable medical equipment
providers located in Los Angeles, Orange, Riverside, and San
Bernardino Counties, and out-of-state; and, (c) non-chain,
non-pharmacist owned pharmacies in Los Angeles County.
4.Prior legislation. SB 1212 (Walters), of 2014, would have
exempted a clinical laboratory from the Medi-Cal provider
moratorium if the lab had an existing relationship with the
Medi-Cal program as a provider of benefits through a contract
with a Medi-Cal managed care plan. That bill was held in the
Senate Health Committee with a commitment to hold an oversight
hearing on the Medi-Cal provider moratoriums.
SB 1529 (Alquist), Chapter 797, Statutes of 2012, revises
screening, enrollment, disenrollment, suspensions, and other
sanctions for fee-for service Medi-Cal providers and suppliers
to conform to the federal Affordable Care Act. The changes
made by SB 1529 became operative on the effective date of
federal approval of a State Plan Amendment (SPA) necessary to
implement the change and the DHCS director executing a
declaration. The SPA was approved by CMS on November 2012 and
DHCS issued a directive in December 2012. SB 299 would delete
SB 299 (Monning) Page 4 of ?
obsolete references to the operative and effective dates in SB
1529 because federal approval was obtained.
5.Related legislation. AB 1388 (Obernolte), is a reintroduction
of SB 1212 that would exempt a clinical laboratory from the
Medi-Cal provider moratorium if the lab had an existing
relationship with the Medi-Cal program as a provider of
benefits through a contract with a Medi-Cal managed care plan.
6.Support. The California Chapter of the American College of
Emergency Physicians (Cal-ACEP) writes in support that
emergency physicians have reported problems with enrolling in
Medi-Cal program, and delays can be more than one year before
the emergency physician is approved. Cal-ACEP states any
effort to lessen the administrative burden on Medi-Cal
providers is a welcome relief, and by exempting providers who
choose to enroll electronically from the notarization
requirements, this bill would do just that.
SUPPORT AND OPPOSITION :
Support: California Association of Physician Groups
California Chapter of the American College of
Emergency Physicians
California Pharmacists Association
Oppose: None received.
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