SB 610, as amended, Pan. Medi-Cal: federally qualified health centers and rural health clinics: managed care contracts.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. Existing law provides that federally qualified health center (FQHC) services and rural health clinic (RHC) services, as defined, are covered benefits under the Medi-Cal program to be reimbursed, to the extent that federal financial participation is obtained, to providers on a per-visit basis.
Existing law authorizes an FQHC or RHC to apply for an adjustment to its per-visit rate, based on a change in the scope of services provided, as prescribed. Existing law establishes alternative ratesetting procedures with respect to a new entity that first qualifies as an FQHC or RHC in the year 2001 or later, a newly licensed facility at a new location added to an existing FQHC or RHC or an existing FQHC or RHC that is relocated. Two of the procedures are referred to as comparability approaches, based on the rates of 3 similarly situated FQHCs and RHCs. The 3rd procedure requires, at a new entity’s one-time election, that the department establish the reimbursement rate, calculated on a per-visit basis, that equals 100% of the projected allowable costs to the FQHC or RHC of furnishing services during its first 12 months of operation as an FQHC or RHC.
This bill would require the department to finalize a new rate within 90 days after an FQHC’s or RHC’s submission of a scope-of-service rate change. With respect to a new FQHC or RHC that has elected for the department to establish its reimbursement rate based on projected allowable costs as described above, this bill would require the department to finalize that rate within 90 days after the submission of the actual cost report from the first full 12 months of operation, as specified.
This bill would revise the department’s responsibilities with respect to a new entity or a relocated FQHC or RHC that selects either of the comparability approaches. The bill would require the department to review the comparable facilities to determine if any of them do not meet the comparability threshold and, if so, to notify the new entity, and request a supplemental submission, as prescribed. The bill would require the department to finalize
begin delete a new entity’send delete rate within 90 days after receiving a submission the department determines to be begin delete comparable.end delete
This bill would require the department to correct erroneous payments at least quarterly to reprocess past claims and ensure all claims are reimbursed at the appropriate finalized new rate.
Existing law requires the department to administer a program to ensure that total payments to FQHCs and RHCs operating as managed care subcontractors comply with applicable federal law regarding payment for services provided by FQHCs and RHCs. Under the department’s program, existing law requires FQHCs and RHCs subcontracting with specified managed care plans to seek supplemental reimbursement from the department through a per visit fee-for-service billing system. To be reimbursed under these provisions, existing law requires each FQHC and RHC to submit to the department for approval a rate differential based on the FQHC’s or RHC’s reasonable cost or the prospective payment rate. Within 6 months of the end of the FQHC’s or RHC’s fiscal year, existing law requires, to the extent feasible, the department to perform an annual reconciliation to reasonable cost, and make payments to, or obtain recovery from, the FQHC or RHC.
This bill would impose various requirements on the department regarding the reconciliation process described above. The bill would require the department to complete the final reconciliation review and pay to the center or clinic any remaining amount owed within 15 months of the last date of the fiscal year for which the department is conducting the review.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 14087.325 of the Welfare and Institutions
2Code is amended to read:
(a) The department shall require, as a condition
4of obtaining a contract with the department, that any local initiative,
5as defined in Section 53810 of Title 22 of the California Code of
6Regulations, offer a subcontract to any entity defined in Section
71396d(l)(2)(B) of Title 42 of the United States Code providing
8services as defined in Section 1396d(a)(2)(C) of Title 42 of the
9United States Code and operating in the service area covered by
10the local initiative’s contract with the department. These entities
11are also known as federally qualified health centers.
12(b) Except as otherwise provided in this section, managed care
13subcontracts offered to a federally qualified health center or a rural
14health clinic, as defined in Section 1396d(l)(1) of Title 42 of the
15United States Code, by a local initiative, county organized health
16system, as defined in Section 12693.05 of the Insurance Code,
17commercial plan, as defined in Section 53810 of Title 22 of the
18California Code of Regulations, or a health plan contracting with
19a geographic managed care program, as defined in subdivision (g)
20of Section 53902 of Title 22 of the California Code of Regulations,
21shall be on the same terms and conditions offered to other
22subcontractors providing a similar scope of service. Any
23beneficiary, subscriber, or enrollee of a program or plan who
24affirmatively selects, or is assigned by default to, a federally
25qualified health center or rural health clinic under the terms of a
26contract between a plan, government program, or any subcontractor
27of a plan or program, and a federally qualified health center or
P4 1rural health clinic, shall be assigned directly to the federally
2qualified health center or rural health clinic, and not to any
3 individual provider performing services on behalf of the federally
4qualified health center or rural health clinic.
5(c) The department shall provide incentives in the competitive
6application process described in paragraph (1) of subdivision (b)
7of Section 53800 of Title 22 of the California Code of Regulations,
8to encourage potential commercial plans as defined in Section
953810 of Title 22 of the California Code of Regulations to offer
10subcontracts to these federally qualified health centers.
11(d) Reimbursement to federally qualified health centers and
12rural health centers for services provided pursuant to a subcontract
13with a local initiative, a commercial plan, geographic managed
14care program health plan, or a county organized health system,
15shall be paid in a manner that is not less than the level and amount
16of payment that the plan would make for the same scope of services
17if the services were furnished by a provider that is not a federally
18qualified health center or rural health clinic.
19(e) (1) The department shall administer a program to ensure
20that total payments to federally qualified health centers and rural
21health clinics operating as managed care subcontractors pursuant
22to subdivision (d) comply with applicable federal law pursuant to
23Sections 1902(bb) and 1903(m)(2)(A)(ix) of the Social Security
24Act (42 U.S.C. Secs. 1396a(bb) and 1396b(m)(2)(A)(ix)). Under
25the department’s program, federally qualified health centers and
26rural health clinics subcontracting with local initiatives, commercial
27plans, county organized health systems, and geographic managed
28care program health plans shall seek supplemental reimbursement
29from the department through a per visit fee-for-service billing
30system utilizing the state’s Medi-Cal fee-for-service claims
31processing system contractor. To carry out this per visit payment
32process, each federally qualified health system and rural health
33clinic shall submit to the department for approval a rate differential
34calculated to reflect the amount necessary to reimburse the federally
35qualified health center or rural health clinic for the difference
36between the payment the center or clinic received from the
37managed care health plan and either the interim rate established
38by the department based on the center’s or clinic’s reasonable cost
39or the center’s or clinic’s prospective payment rate. The department
40shall adjust the computed rate differential as it deems necessary
P5 1to minimize the difference between the center’s or clinic’s revenue
2from the plan and the center’s or clinic’s cost-based reimbursement
3or the center’s or clinic’s prospective payment rate.
4(2) In addition, to the extent feasible, within six months of the
5end of the center’s or clinic’s fiscal year, the department shall
6perform an annual reconciliation to reasonable cost, and make
7payments to, or obtain a recovery from, the center or clinic.
8Reconciliation shall be based upon the reconciliation filing
9submitted to the department by the center or clinic. The department
10shall perform an initial review of the reconciliation filing within
1130 days of receipt. If the department determines during the initial
12review that a payment is owed to the center or clinic, the
13department shall pay to the center or clinic at least 80 percent of
14the amount owed within 30 days of completion of the initial review
15or in any event within 60 days of receipt of the reconciliation filing.
16The department shall complete the final reconciliation review and
17shall pay to the center or clinic the remaining amount owed within
1815 months of the last date of the fiscal year for which the
19department is conducting the review.
20(f) In calculating the capitation rates to be paid to local
21initiatives, commercial plans, geographic managed care program
22health plans, and county organized health systems, the department
23shall not include the additional dollar amount applicable to
24cost-based reimbursement that would otherwise be paid, absent
25cost-based reimbursement, to federally qualified health centers
26and rural health clinics in the Medi-Cal fee-for-service program.
27(g) On or before September 30, 2002, the director shall conduct
28a study of the actual and projected impact of the transition from a
29cost-based reimbursement system to a prospective payment system
30for federally qualified health centers and rural health clinics. In
31conducting the study, the director shall evaluate the extent to which
32the prospective payment system stimulates expansion of services,
33including new facilities to expand capacity of the centers, and the
34extent to which actual and estimated prospective payment rates of
35federally qualified health centers and rural health clinics for the
36first five years of the prospective payment system are reflective
37of the cost of providing services to Medi-Cal beneficiaries. Clinics
38may submit cost reporting information to the department to provide
39data for the study.
P6 1(h) The department shall approve all contracts between federally
2qualified health centers or rural health clinics and any local
3initiative, commercial plan, geographic managed care program
4health plan, or county organized health system in order to ensure
5compliance with this section.
6(i) This section shall not preclude the department from
7establishing pilot programs pursuant to Section 14087.329.
Section 14132.100 of the Welfare and Institutions
9Code is amended to read:
(a) The federally qualified health center services
11described in Section 1396d(a)(2)(C) of Title 42 of the United States
12Code are covered benefits.
13(b) The rural health clinic services described in Section
141396d(a)(2)(B) of Title 42 of the United States Code are covered
16(c) Federally qualified health center services and rural health
17clinic services shall be reimbursed on a per-visit basis in
18accordance with the definition of “visit” set forth in subdivision
20(d) Effective October 1, 2004, and on each October 1, thereafter,
21until no longer required by federal law, federally qualified health
22center (FQHC) and rural health clinic (RHC) per-visit rates shall
23be increased by the Medicare Economic Index applicable to
24primary care services in the manner provided for in Section
251396a(bb)(3)(A) of Title 42 of the United States Code. Prior to
26January 1, 2004, FQHC and RHC per-visit rates shall be adjusted
27by the Medicare Economic Index in accordance with the
28methodology set forth in the state plan in effect on October 1,
30(e) (1) An FQHC or RHC may apply for an adjustment to its
31per-visit rate based on a change in the scope of services provided
32by the FQHC or RHC. Rate changes based on a change in the
33scope of services provided by an FQHC or RHC shall be evaluated
34in accordance with Medicare reasonable cost principles, as set
35forth in Part 413 (commencing with Section 413.1) of Title 42 of
36the Code of Federal Regulations, or its successor.
37(2) Subject to the conditions set forth
in subparagraphs (A) to
38(D), inclusive, of paragraph (3), a change in scope of service means
39any of the following:
P7 1(A) The addition of a new FQHC or RHC service that is not
2incorporated in the baseline prospective payment system (PPS)
3rate, or a deletion of an FQHC or RHC service that is incorporated
4in the baseline PPS rate.
5(B) A change in service due to amended regulatory requirements
7(C) A change in service resulting from relocating or remodeling
8an FQHC or RHC.
9(D) A change in types of services due to a change in applicable
10technology and medical practice utilized by the center or clinic.
11(E) An increase in service intensity attributable to changes in
12the types of patients served, including, but not limited to,
13populations with HIV or AIDS, or other chronic diseases, or
14homeless, elderly, migrant, or other special populations.
15(F) Any changes in any of the services described in subdivision
16(a) or (b), or in the provider mix of an FQHC or RHC or one of
18(G) Changes in operating costs attributable to capital
19expenditures associated with a modification of the scope of any
20of the services described in subdivision (a) or (b), including new
21or expanded service facilities, regulatory compliance, or changes
22in technology or medical practices at the center or clinic.
23(H) Indirect medical education adjustments and a direct graduate
24medical education payment that reflects the costs of providing
25teaching services to interns and residents.
26(I) Any changes in the scope of a project approved by the federal
27Health Resources and Service Administration (HRSA).
28(3) No change in costs shall, in and of itself, be considered a
29scope-of-service change unless all of the following apply:
30(A) The increase or decrease in cost is attributable to an increase
31or decrease in the scope of services defined in subdivisions (a) and
32(b), as applicable.
33(B) The cost is allowable under Medicare reasonable cost
34principles set forth in Part 413 (commencing with Section 413) of
35Subchapter B of Chapter 4 of Title 42 of the Code of Federal
36Regulations, or its successor.
37(C) The change in the scope of services is a change in the type,
38intensity, duration, or amount of services, or any combination
P8 1(D) The net change in the FQHC’s or RHC’s rate equals or
2exceeds 1.75 percent for the affected FQHC or RHC site. For
3FQHCs and RHCs that filed consolidated cost reports for multiple
4sites to establish the initial prospective payment reimbursement
5rate, the 1.75-percent threshold shall be applied to the average
6per-visit rate of all sites for the purposes of calculating the cost
7associated with a scope-of-service change. “Net change” means
8the per-visit rate change attributable to the cumulative effect of all
9increases and decreases for a particular fiscal year.
10(4) An FQHC or RHC may submit requests for scope-of-service
11changes once per fiscal year, only within 90 days following the
12beginning of the FQHC’s or RHC’s fiscal year. Any approved
13increase or decrease in the provider’s rate shall be retroactive to
14the beginning of the FQHC’s or RHC’s fiscal year in which the
15request is submitted.
16(5) An FQHC or RHC shall submit a scope-of-service rate
17change request within 90 days after the beginning of any FQHC
18or RHC fiscal year occurring after the effective date of this section,
19if, during the FQHC’s or RHC’s prior fiscal year, the FQHC or
20RHC experienced a decrease in the scope of services provided that
21the FQHC or RHC either knew or should have known would have
22resulted in a significantly lower per-visit rate. If an FQHC or RHC
23discontinues providing onsite pharmacy or dental services, it shall
24submit a scope-of-service rate change request within 90 days after
25the beginning of the following fiscal year. The rate change shall
26be effective as provided for in paragraph (4). As used in this
27paragraph, “significantly lower” means an average per-visit rate
28decrease in excess of 2.5 percent.
29(6) The department shall finalize a new rate within 90 days after
30the submission by an FQHC or RHC of a scope-of-service rate
31change request and shall update the provider master file within 10
32business days of finalizing the rate.
7(7) Notwithstanding paragraph (4), if the approved
8 scope-of-service change or changes were initially implemented
9on or after the first day of an FQHC’s or RHC’s fiscal year ending
10in calendar year 2001, but before the adoption and issuance of
11written instructions for applying for a scope-of-service change,
12the adjusted reimbursement rate for that scope-of-service change
13shall be made retroactive to the date the scope-of-service change
14was initially implemented. Scope-of-service changes under this
15paragraph shall be required to be submitted within the later of 150
16days after the adoption and issuance of the written instructions by
17the department, or 150 days after the end of the FQHC’s or RHC’s
18fiscal year ending in 2003.
references in this subdivision to “fiscal year” shall be
20construed to be references to the fiscal year of the individual FQHC
21or RHC, as the case may be.
22(f) (1) An FQHC or RHC may request a supplemental payment
23if extraordinary circumstances beyond the control of the FQHC
24or RHC occur after December 31, 2001, and PPS payments are
25insufficient due to these extraordinary circumstances. Supplemental
26payments arising from extraordinary circumstances under this
27subdivision shall be solely and exclusively within the discretion
28of the department and shall not be subject to subdivision (l). These
29supplemental payments shall be determined separately from the
30scope-of-service adjustments described in subdivision (e).
31Extraordinary circumstances include, but are not limited to, acts
32of nature, changes in applicable requirements in the Health and
33Safety Code, changes in applicable licensure requirements, and
34changes in applicable rules or regulations. Mere inflation of costs
35alone, absent extraordinary circumstances, shall not be grounds
36for supplemental payment. If an FQHC’s or RHC’s PPS rate is
37sufficient to cover its overall costs, including those associated with
38the extraordinary circumstances, then a supplemental payment is
P10 1(2) The department shall accept requests for supplemental
2payment at any time throughout the prospective payment rate year.
3(3) Requests for supplemental payments shall be submitted in
4writing to the department and shall set forth the reasons for the
5request. Each request shall be accompanied by sufficient
6documentation to enable the department to act upon the request.
7Documentation shall include the data necessary to demonstrate
8that the circumstances for which supplemental payment is requested
9meet the requirements set forth in this section. Documentation
10shall include all of the following:
11(A) A presentation of data to demonstrate reasons for the
12FQHC’s or RHC’s request for a supplemental payment.
13(B) Documentation showing the cost implications. The cost
14impact shall be material and significant, two hundred thousand
15dollars ($200,000) or 1 percent of a facility’s total costs, whichever
17(4) A request shall be submitted for each affected year.
18(5) Amounts granted for supplemental payment requests shall
19be paid as lump-sum amounts for those years and not as revised
20PPS rates, and shall be repaid by the FQHC or RHC to the extent
21that it is not expended for the specified purposes.
22(6) The department shall notify the provider of the
23discretionary decision in writing.
24(g) (1) An FQHC or RHC “visit” means a face-to-face
25encounter between an FQHC or RHC patient and a physician,
26physician assistant, nurse practitioner, certified nurse-midwife,
27clinical psychologist, licensed clinical social worker, or a visiting
28nurse. For purposes of this section, “physician” shall be interpreted
29in a manner consistent with the Centers for Medicare and Medicaid
30Services’ Medicare Rural Health Clinic and Federally Qualified
31Health Center Manual (Publication 27), or its successor, only to
32the extent that it defines the professionals whose services are
33reimbursable on a per-visit basis and not as to the types of services
34that these professionals may render during these visits and shall
35include a physician and surgeon, podiatrist, dentist, optometrist,
36and chiropractor. A visit shall also include a face-to-face encounter
37between an FQHC or RHC patient and a comprehensive perinatal
38services practitioner, as defined in Section 51179.1 of Title 22 of
39the California Code of Regulations, providing comprehensive
40perinatal services, a four-hour day of attendance at an adult day
P11 1health care center, and any other provider identified in the state
2plan’s definition of an FQHC or RHC visit.
3(2) (A) A visit shall also include a face-to-face encounter
4between an FQHC or RHC patient and a dental hygienist or a
5dental hygienist in alternative practice.
6(B) Notwithstanding subdivision (e), an FQHC or RHC that
7currently includes the cost of the services of a dental hygienist in
8alternative practice for the purposes of establishing its FQHC or
9RHC rate shall apply for an adjustment to its per-visit rate, and,
10after the rate adjustment has been approved by the department,
11shall bill these services as a separate visit. However, multiple
12encounters with dental professionals that take place on the same
13day shall constitute a single visit. The department shall develop
14the appropriate forms to determine which FQHC’s or RHC rates
15shall be adjusted and to facilitate the calculation of the adjusted
16rates. An FQHC’s or RHC’s application for, or the department’s
17approval of, a rate adjustment pursuant to this subparagraph shall
18not constitute a change in scope of service within the meaning of
19subdivision (e). An FQHC or RHC that applies for an adjustment
20to its rate pursuant to this subparagraph may continue to bill for
21all other FQHC or RHC visits at its existing per-visit rate, subject
22to reconciliation, until the rate adjustment for visits between an
23FQHC or RHC patient and a dental hygienist or a dental hygienist
24in alternative practice has been approved. Any approved increase
25or decrease in the provider’s rate shall be made within six months
26after the date of receipt of the department’s rate adjustment forms
27pursuant to this subparagraph and shall be retroactive to the
28beginning of the fiscal year in which the FQHC or RHC submits
29the request, but in no case shall the effective date be earlier than
30January 1, 2008.
31(C) An FQHC or RHC that does not provide dental hygienist
32or dental hygienist in alternative practice services, and later elects
33to add these services, shall process the addition of these services
34as a change in scope of service pursuant to subdivision (e).
35(h) If FQHC or RHC services are partially reimbursed by a
36third-party payer, such as a managed care entity (as defined in
37Section 1396u-2(a)(1)(B) of Title 42 of the United States Code),
38the Medicare Program, or the Child Health and Disability
39Prevention (CHDP) program, the department shall reimburse an
40FQHC or RHC for the difference between its per-visit PPS rate
P12 1and receipts from other plans or programs on a contract-by-contract
2basis and not in the aggregate, and may not include managed care
3financial incentive payments that are required by federal law to
4be excluded from the calculation.
5(i) (1) An entity that first qualifies as an FQHC or RHC in the
6year 2001 or later, a newly licensed facility at a new location added
7to an existing FQHC or RHC, and any entity that is an existing
8FQHC or RHC that is relocated to a new site shall each have its
9reimbursement rate established in accordance with one of the
10following methods, as selected by the FQHC or RHC:
11(A) The rate may be calculated on a per-visit basis in an amount
12that is equal to the average of the per-visit rates of three comparable
13FQHCs or RHCs located in the same or adjacent area with a similar
15(B) In the absence of three comparable FQHCs or RHCs with
16a similar caseload, the rate may be calculated on a per-visit basis
17in an amount that is equal to the average of the per-visit rates of
18three comparable FQHCs or RHCs located in the same or an
19adjacent service area, or in a reasonably similar geographic area
20with respect to relevant social, health care, and economic
22(C) At a new entity’s one-time election, the department shall
23establish a reimbursement rate, calculated on a per-visit basis, that
24is equal to 100 percent of the projected allowable costs to the
25FQHC or RHC of furnishing FQHC or RHC services during the
26first 12 months of operation as an FQHC or RHC. After the first
2712-month period, the projected per-visit rate shall be increased by
28the Medicare Economic Index then in effect. The projected
29allowable costs for the first 12 months shall be cost settled and the
30prospective payment reimbursement rate shall be adjusted based
31on actual and allowable cost per visit. The department shall finalize
32a new rate within 90 days after the submission of the actual cost
33report from the first full 12 months of operation and shall update
34the department provider master file within 10 business days of
35finalizing the rate.
36(D) The department may adopt any further and additional
37methods of setting reimbursement rates for newly qualified FQHCs
38or RHCs as are consistent with Section 1396a(bb)(4) of Title 42
39of the United States Code.
P13 1(2) (A) In order for an FQHC or RHC to establish the
2comparability of its caseload, the department shall require that the
3FQHC or RHC submit its most recent annual utilization report as
4submitted to the Office of Statewide Health Planning and
5Development, unless the FQHC or RHC was not required to file
6an annual utilization report. FQHCs or RHCs that have experienced
7changes in their services or caseload subsequent to the filing of
8the annual utilization report may submit to the department a
9completed report in the format applicable to the prior calendar
10year. FQHCs or RHCs that have not previously submitted an annual
11utilization report shall submit to the department a completed report
12in the format applicable to the prior calendar year. The FQHC or
13RHC shall not be required to submit the annual utilization report
14for the comparable FQHCs or RHCs to the department, but shall
15be required to identify the comparable FQHCs or RHCs. This
16paragraph shall apply only to a facility that selects the
17comparability approach described in subparagraph (A) or (B) of
19(B) The department shall conduct an initial review of the three
20FQHCs or RHCs for the purpose of determining comparability
21within 30 days of submission by the new entity. If the department
22determines one or more of the submitted centers or clinics do not
23meet the comparability threshold, the department shall notify the
24new entity no later than the 31st day after submission.
25(C) The notification shall state the reason or reasons for the
26finding of noncomparability and shall request a supplemental
27submission from the new entity. The request shall clearly state
28whether the new entity shall submit data from one, two, or three
29FQHCs or RHCs to meet the comparability threshold. Once the
30new entity submits its supplemental information, the initial review
31process described in subparagraph (B) shall apply.
32(D) Within 90 days after receiving a submission determined by
33the department to be comparable, the department shall finalize the
34new entity’s rate and shall update the provider master file within
3510 business days.
36(3) The rate for any newly qualified entity set forth under this
37subdivision shall be effective retroactively to the later of the date
38that the entity was first qualified by the applicable federal agency
39as an FQHC or RHC, the date a new facility at a new location was
40added to an existing FQHC or RHC, or the date on which an
P14 1existing FQHC or RHC was relocated to a new site. The FQHC
2or RHC shall be permitted to continue billing for Medi-Cal covered
3benefits on a fee-for-service basis until it is informed of its
4enrollment as an FQHC or RHC, and the department shall reconcile
5the difference between the fee-for-service payments and the
6FQHC’s or RHC’s prospective payment rate at that time.
7(j) Visits occurring at an intermittent clinic site, as defined in
8subdivision (h) of Section 1206 of the Health and Safety Code, of
9an existing FQHC or RHC, or in a mobile unit as defined by
10paragraph (2) of subdivision (b) of Section 1765.105 of the Health
11and Safety Code, shall be billed by and reimbursed at the same
12rate as the FQHC or RHC establishing the intermittent clinic site
13or the mobile unit, subject to the right of the FQHC or RHC to
14request a scope-of-service adjustment to the rate.
15(k) An FQHC or RHC may elect to have pharmacy or dental
16services reimbursed on a fee-for-service basis, utilizing the current
17fee schedules established for those services. These costs shall be
18adjusted out of the FQHC’s or RHC’s clinic base rate as
19scope-of-service changes. An FQHC or RHC that reverses its
20election under this subdivision shall revert to its prior rate, subject
21to an increase to account for all MEI increases occurring during
22the intervening time period, and subject to any increase or decrease
23associated with applicable scope-of-services adjustments as
24provided in subdivision (e).
25(l) FQHCs and RHCs may appeal a grievance or complaint
26concerning ratesetting, scope-of-service changes, and settlement
27of cost report audits, in the manner prescribed by Section 14171.
28The rights and remedies provided under this subdivision are
29cumulative to the rights and remedies available under all other
30provisions of law of this state.
31(m) The department shall, by no later than March 30, 2008,
32promptly seek all necessary federal approvals in order to implement
33this section, including any amendments to the state plan. To the
34extent that any element or requirement of this section is not
35approved, the department shall submit a request to the federal
36Centers for Medicare and Medicaid Services for any waivers that
37would be necessary to implement this section.
38(n) The department shall implement this section only to the
39extent that federal financial participation is obtained.
P15 1(o) The department shall correct erroneous payments at least
2 quarterly to reprocess past claims and ensure all claims are
3reimbursed at the finalized new rate determined pursuant to either
4subdivision (e) or (i).