BILL ANALYSIS
AB 1445
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Date of Hearing: May 6, 2009
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Kevin De Leon, Chair
AB 1445 (Chesbro) - As Amended: April 15, 2009
Policy Committee: Health Vote:17-0
Urgency: No State Mandated Local Program:
No Reimbursable:
SUMMARY
This bill authorizes reimbursement to federally qualified health
centers (FQHCs) and rural health centers (RHCs) for multiple
visits for a single patient, in the same day, under specified
conditions.
FISCAL EFFECT
Annual costs of $1.7 million (50% GF) to provide an additional
11,500 same-day visits. This estimate assumes that less than
half of FQHCs and RHCs provide mental health services, which is
the most likely kind of visit to be added to an existing visit
for patients in need of additional care. In addition, of those
clinics providing mental health services, only a small
proportion provides same day appointments for mental health.
Single patient visits are reimbursed at a rate of $151 each.
COMMENTS
1)Rationale . This bill, sponsored by the California Primary Care
Association (CPCA), authorizes FQHCs and RHCs to provide
medical and mental health services to a patient in a single
day and be reimbursed for each service. Under current state
law, payment may be made for patients seen for more than one
type service. However, the services are reimbursed as a single
visit. Federal law allows for same-day medical and mental
health services to be reimbursed separately. This bill creates
this reimbursement option under state law.
2)Clinic Mental Health Treatment . Mental health diagnoses are
the third most common condition requiring treatment in
community health center settings. Early intervention with
AB 1445
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mental health issues may reduce costly emergency care and
crisis-intervention services. In addition, effective mental
health treatment has been shown to reduce the need for other
medical services. Integration of mental health services in a
primary care setting has been shown to be particularly
effective. However, such integration is difficult to achieve
without financing and infrastructure to support such
integration. This bill increases the ability of clinics to
integrate behavioral health services.
3)Background . FQHCs and RHCs are a type of provider defined by
federal Medicaid and Medicare statutes. These designations
enable qualified providers in medically underserved areas to
receive enhanced reimbursement and allows for the direct
reimbursement of nurse practitioners, physician assistants,
and certified nurse midwives. These clinics provide
comprehensive primary health, dental, and mental health
services to beneficiaries of all ages throughout urban and
rural communities statewide.
There are several hundred community clinic FQHCs statewide that
provide medical care to patients in underserved communities
more than 6 million times each year. About 40 % of the
patients served in these clinics are covered by Medi-Cal while
the remainder are Medicare beneficiaries or uninsured. The
enhanced rates paid to these clinics, above the typical
Medi-Cal rates, accounts for the significant portion of
uncompensated care they provide statewide.
4) Related Legislation . SB 260 (Steinberg) in 2007 was similar
to this bill and vetoed due to concerns about impacts of the
bill on rate calculations. AB 1445 partially addresses this
concern.
SB 238 (Aanestaad), Chapter 638, statutes of 2007 adds dental
hygienist or dental hygienist in alternative practice to the
list of professionals who may provide services that compose a
reimbursable visit to a FQHC or a RHC.
AB 363 (Berg) in 2007 authorized FQHCs to request enhanced
Medi-Cal reimbursement on behalf of patients served at
locations other than the FQHC pursuant to a written
professional services agreement. AB 363 was held on the
Suspense File of the Senate Appropriations Committee.
AB 1445
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Analysis Prepared by : Mary Ader / APPR. / (916) 319-2081