BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 299|
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UNFINISHED BUSINESS
Bill No: SB 299
Author: Monning (D)
Amended: 5/18/15
Vote: 27 - Urgency
SENATE HEALTH COMMITTEE: 9-0, 4/8/15
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
SENATE FLOOR: 37-0, 4/23/15 (Consent)
AYES: Allen, Anderson, Bates, Beall, Berryhill, Block, De
León, Fuller, Gaines, Galgiani, Hall, Hancock, Hernandez,
Hertzberg, Hill, Hueso, Huff, Jackson, Lara, Leno, Leyva, Liu,
McGuire, Mendoza, Mitchell, Monning, Moorlach, Morrell,
Nguyen, Nielsen, Pan, Pavley, Roth, Runner, Vidak, Wieckowski,
Wolk
NO VOTE RECORDED: Cannella, Stone
ASSEMBLY FLOOR: 79-0, 7/16/15 (Consent) - See last page for
vote
SUBJECT: Medi-Cal: provider enrollment
SOURCE: Author
DIGEST: This bill exempts health care providers submitting a
Medi-Cal provider application package to the Department of
Health Care Services (DHCS) Medi-Cal provider enrollment
division from the current notarization requirements if the
provider enrolls electronically. This bill conforms state law to
federal regulation by requiring DHCS to designate a provider or
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applicant as a "high" categorical risk if DHCS lifted a
temporary moratorium within the previous six months for the
particular provider type submitting the application.
Assembly Amendments require DHCS to collect an application fee
for continued enrollment as a Medi-Cal provider.
ANALYSIS:
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)Requires DHCS to collect an application fee for enrollment as
a Medi-Cal provider, including enrollment at a new location or
a change in location. Prohibits the application fee from being
collected from individual physicians or non-physician
practitioners, from providers that are enrolled in Medicare or
another state's Medicaid program or Children's Health
Insurance Program (CHIP), 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. Requires
the application fee collected to be in the amount calculated
by the federal Centers for Medicare and Medicaid Services
(CMS) in effect for the calendar year during which the
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application for enrollment is received by DHCS.
4)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.
5)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 CMS 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.
This bill:
1)Exempts, from the current DHCS notarization requirements, any
provider that chooses to enroll electronically.
2)Requires DHCS to collect an application fee for continued
enrollment as a Medi-Cal provider.
3)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.
4)Deletes various obsolete provisions of law.
Comments
1)Author's statement. According to the author, this bill
removes the obsolete statutory notarization requirement for
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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.
The urgency clause in this bill permits provider applications
to be submitted electronically without the current
notarization requirement in anticipation of PAVE
implementation.
3)Provider fee for continued enrollment. The Assembly
amendments require DHCS to collect an application fee for
continued enrollment as a Medi-Cal provider. This change
provides DHCS with the statutory authority to meet a federal
Medicaid regulation requirement that requires states to
collect the applicable application fee prior to executing a
provider agreement from a prospective or re-enrolling provider
other than individual physicians or nonphysician practitioners
and providers that are enrolled in Medicare, another state's
Medicaid or CHIP program or providers who have paid the
applicable application fee to a Medicare contractor or another
state. DHCS estimates that of the 130,000 Medi-Cal-enrolled
providers, 7,200 are provider types that would be subject to
the application fee upon revalidation.
4)Categorical risk of fraud and provider moratorium. Federal
regulations require state Medicaid agencies to screen all
initial applications, including applications for a new
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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 conforms 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.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Assembly Appropriations Committee:
1)Annual costs of $2 million to support the California Health
Benefits Review Program (within the University of California),
supported by an assessment on health plans and health insurers
(Health Care Benefits Fund).
2)Minor administrative costs for the California Health Benefits
Exchange to revise existing regulations to conform to the
updated open enrollment period.
SUPPORT: (Verified8/10/15)
California Association of Physician Groups
California Chapter of the American College of Emergency
Physicians
California Pharmacists Association
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Department of Health Care Services
OPPOSITION: (Verified8/10/15)
None Received
ARGUMENTS IN 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 the 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 will do just that.
ASSEMBLY FLOOR: 79-0, 7/16/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle,
Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina
Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gray,
Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones,
Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low,
Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin,
Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea,
Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,
Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,
Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Gordon
Prepared by:Scott Bain / HEALTH /
8/13/15 13:07:43
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