BILL ANALYSIS
AB 839
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 839 (Emmerson)
As Amended August 18, 2009
Majority vote
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|ASSEMBLY: |77-0 |(May 21, 2009) |SENATE: |32-0 |(September 1, |
| | | | | |2009) |
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Original Committee Reference: HEALTH
SUMMARY : Makes changes related to provider appeals in Medi-Cal.
Specifically, this bill requires:
1)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.
2)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.
The Senate amendments incorporate changes made to the same
statutes by AB 1540 (Health Committee) to prevent chaptering out
should both bills be enacted.
EXISTING LAW :
1)Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), under which basic
health care services are provided to qualified low-income
persons.
2)Requires the Director of DHCS, by regulation, to adopt such
procedures as are necessary for the review of a grievance or
complaint concerning the processing 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
AB 839
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time period.
4)Requires the provisions in 2) and 3) above to be the exclusive
remedy available to the health care provider for moneys
alleged to be payable by the Medi-Cal program.
5)Requires that health care providers apply to, and be certified
by, 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 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.
7)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 ten years 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 if the application is denied based on a
criminal conviction for specified offenses
AS PASSED BY THE ASSEMBLY, this bill was substantially similar
to the version passed by the Senate.
FISCAL EFFECT : According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
FN:
0002503