BILL ANALYSIS                                                                                                                                                                                                    



                                                                       



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                                 THIRD READING


          Bill No:  AB 839
          Author:   Emmerson (R)
          Amended:  8/18/09 in Senate
          Vote:     21

           
           SENATE HEALTH COMMITTEE  :  6-0, 6/17/09
          AYES:  Alquist, DeSaulnier, Leno, Maldonado, Pavley, Wolk
          NO VOTE RECORDED:  Strickland, Aanestad, Cedillo, Cox,  
            Negrete McLeod

           SENATE JUDICIARY COMMITTEE  :  5-0, 7/7/09
          AYES: Corbett, Harman, Florez, Leno, Walters

           SENATE APPROPRIATIONS COMMITTEE  :  Senate Rule 28.8

           ASSEMBLY FLOOR  :  77-0, 5/21/09 - See last page for vote


           SUBJECT  :    Medi-Cal:  providers:  remedies

           SOURCE  :     Deaprtment of Health Care Services


           DIGEST  :    This bill changes Medi-Cal provider remedies,  
          including specifying the judicial remedy when there is a  
          dispute over processing or payment of money and modifies  
          the date for the beginning of a period when a health care  
          provider is barred from enrollment in Medi-Cal as specified  
          in law.

           Senate Floor Amendments  of 8/18/09 are to avoid chaptering  
          out problems with AB 1540 (Committee on Health).
                                                           CONTINUED





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           ANALYSIS  :   

           Existing Law

           1.Establishes the Medi-Cal program, administered by the  
            Department of Health Care Services (DHCS), which provides  
            comprehensive health care coverage for low-income  
            individuals and their families; pregnant women; elderly,  
            blind, or disabled persons; nursing home residents; and  
            refugees who meet specified eligibility criteria.

          2.Requires the Director of DHCS, by regulation, to adopt  
            procedures for the review of a grievance or complaint  
            concerning the process or payment of money alleged by a  
            provider of services to be payable under the Medi-Cal  
            program.

          3.Permits a provider who complies with these procedures and  
            is not satisfied with the director's decision regarding  
            that claim to seek appropriate judicial remedies within a  
            specified time period.

          4.Requires the preceding two provisions to be the exclusive  
            remedy available to the health care provider for monies  
            alleged to be payable by the Medi-Cal program.

          5.Requires that health care providers apply to, and be  
            certified to, DHCS prior to their participation in the  
            Medi-Cal program.

          6.Prohibits an applicant or provider from reapplying for  
            enrollment or continued enrollment in the Medi-Cal  
            program or for participation in any health care program  
            administered by DHCS for a period of three years based  
            from the date the application package is denied or the  
            provisional provider status is terminated, unless there  
            is an appeal from that denial or termination, then the  
            three-year period begins from the date of the final  
            decision following an appeal.

          7.Provides for a ten-year ban on reapplying, if the denial  
            or termination is based on the applicant's conviction of  
            specified offenses.







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          This bill:
           
           1.Clarifies that a health care provider who files a  
            grievance or complaint regarding the processing or  
            payment of money by the Medi-Cal program, and who filed a  
            complaint with DHCS may appeal the DHCS decision by  
            filing a petition for writ of mandate in superior court.

          2.Modifies the three-year and ten-year prohibition on  
            enrollment as a health care provider in any DHCS program  
            to begin from the date the provider's application package  
            is denied or provisional provider status is terminated.

          This bill is double-jointed to AB 1540 (Assembly Health  
            Committee).
           
          Comments

           To address provider fraud in the Medi-Cal program, SB 857  
          (Speier), Chapter 601, Statutes of 2005, established new  
          requirements for health care providers seeking to bill the  
          Medi-Cal program.  Health care providers must apply to, and  
          be certified by, DHCS's Medi-Cal Provider Enrollment Branch  
          prior to their participation in the Medi-Cal program.

          Existing law allows DHCS, if specified conditions are met,  
          to grant provisional provider status or preferred  
          provisional provider status to an applicant or provider,  
          and requires DHCS to terminate that status if any of the  
          specified grounds exist.  If an application for provisional  
          provider status or preferred provisional provider status is  
          denied, or that status is terminated, the applicant or  
          provider is prohibited from reapplying for enrollment, or  
          continued enrollment, in the Medi-Cal program or for  
          participation in any health care program administered by  
          DHCS.

          Existing law allows DHCS, if specified conditions are met,  
          to grant provisional provider status or preferred  
          provisional provider status to an applicant or provider,  
          and requires DHCS to terminate that status if any of the  
          specified grounds exist.  If an application for provisional  
          provider status or preferred provisional provider status is  







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          denied, or that status is terminated, the applicant or  
          provider is prohibited from reapplying for enrollment, or  
          continued enrollment, in the Medi-Cal program or for  
          participation in any health care program administered by  
          DHCS.

          This prohibition from reapplication to the Medi-Cal program  
          is for a period of three years from the date the  
          application package is denied or the provisional provider  
          status is terminated, or from the date of the final  
          decision following an appeal from that denial or  
          termination, except as specified.  If a application for  
          provisional provider status or preferred provisional  
          provider status is denied based upon a criminal conviction  
          for specified offenses or acts, the applicant or provider  
          is prohibited from reapplying for enrollment or continued  
          enrollment in the Medi-Cal program or for participation in  
          any health cared program administered by DHCS.  This  
          prohibition is for a period of ten y ears from the date the  
          application package is denied or the provisional provider  
          status or preferred provisional provider status is  
          terminated, or from the date of the final decision  
          following an appeal from that denial or termination.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  No

           SUPPORT  :   (Verified  8/19/09)

          Department of Health Care Services (source)
          California Association of Health Facilities
          California Medical Association
          Judicial Council of California

           ARGUMENTS IN SUPPORT  :    According to DHCS, the bill's  
          sponsor, this bill will benefit the state and Medi-Cal  
          providers who sue the state by creating a speedy and  
          equitable remedy for claims.  The sponsor also points out  
          that the bill will also benefit Medi-Cal providers who  
          choose to appeal their denied application for enrollment  
          because current law allowing for appropriate judicial  
          remedies is vague, and fails to outline a specific legal  
          remedy for Medi-Cal providers seeking to appeal the denial  
          of a claim for reimbursement.  The result is that providers  







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          file a variety of actions for reimbursement, including  
          money damages or breach of contract actions where it is  
          unclear what contract or statute they are suing to enforce.  
           The sponsor notes that this confusing situation contrasts  
          with the traditional remedy for individuals seeking relief  
          from a denial by a state agency, which is pursuing a writ  
          of mandate under Code of Civil Procedure Section 1085 to  
          overturn the denial.


           ASSEMBLY FLOOR  : 
          AYES:  Adams, Ammiano, Anderson, Arambula, Beall, Bill  
            Berryhill, Tom Berryhill, Blakeslee, Block, Blumenfield,  
            Brownley, Buchanan, Caballero, Charles Calderon, Carter,  
            Chesbro, Conway, Cook, Coto, Davis, De La Torre, De Leon,  
            DeVore, Duvall, Emmerson, Eng, Evans, Feuer, Fletcher,  
            Fong, Fuller, Furutani, Gaines, Galgiani, Garrick,  
            Gilmore, Hagman, Hall, Harkey, Hayashi, Hernandez, Hill,  
            Huber, Huffman, Jeffries, Jones, Knight, Krekorian, Lieu,  
            Logue, Bonnie Lowenthal, Ma, Mendoza, Miller, Monning,  
            Nestande, Niello, Nielsen, John A. Perez, V. Manuel  
            Perez, Portantino, Price, Ruskin, Salas, Silva, Skinner,  
            Smyth, Solorio, Audra Strickland, Swanson, Torlakson,  
            Torres, Torrico, Tran, Villines, Yamada, Bass
          NO VOTE RECORDED:  Fuentes, Nava, Saldana


          CTW:cm  8/19/09   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE

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