BILL ANALYSIS                                                                                                                                                                                                    



                                                                  AB 839
                                                                  Page  1

          Date of Hearing:   May 13, 2009 

                        ASSEMBLY COMMITTEE ON APPROPRIATIONS
                                Kevin De Leon, Chair

                  AB 839 (Emmerson) - As Amended:  March 26, 2009  

          Policy Committee:                              Health Vote:19-0
                       Judiciary                                 10-0 

          Urgency:     No                   State Mandated Local Program:  
          No     Reimbursable:              

           SUMMARY  

          This bill clarifies Medi-Cal provider appeals processes.  
          Specifically, this bill: 

          1)Authorizes a provider to file a writ of mandate in Superior  
            Court if the provider is not satisfied with a determination of  
            the California Department of Health Care Services (DHCS)  
            regarding payment for Medi-Cal claims. 

          2)Prohibits providers whose applications have been denied from  
            reapplying for three years or ten years, respectively,  
            depending on the circumstance of the application denial. 

           FISCAL EFFECT  

          No direct fiscal impact to DHCS to continue oversight of  
          provider appeals in the Medi-Cal program. 

           COMMENTS  

          This bill is sponsored by DHCS to make two changes related to  
          provider appeals in Medi-Cal.  Specifically, this bill would  
          require that the judicial remedy for Medi-Cal providers seeking  
          to appeal the denial of a grievance or complaint related to  
          Medi-Cal reimbursement is to file a petition for a writ of  
          mandate in superior court.  Additionally, this bill would  
          require the prohibition on enrollment as a Medi-Cal provider to  
          begin on the date of the providers' denial or termination of  
          enrollment, rather than the date when the provider appeals.   
          DHCS argues the current process penalizes providers when they  
          exercise their right to appeal their denial and/or termination  








                                                                  AB 839
                                                                  Page  2

          of enrollment in Medi-Cal.


           Analysis Prepared by  :    Mary Ader / APPR. / (916) 319-2081