BILL ANALYSIS
AB 1445
Page 1
ASSEMBLY THIRD READING
AB 1445 (Chesbro)
As Amended June 1, 2009
Majority vote
HEALTH 17-0 APPROPRIATIONS 17-0
-----------------------------------------------------------------
|Ayes:|Jones, Fletcher, Adams, |Ayes:|De Leon, Nielsen, |
| |Ammiano, Block, Carter, | |Ammiano, |
| |Conway, De Leon, | |Charles Calderon, Davis, |
| |Emmerson, Hall, Hayashi, | |Duvall, Fuentes, Hall, |
| |Hernandez, Bonnie | |Harkey, Miller, |
| |Lowenthal, Nava, V. | |John A. Perez, Price, |
| |Manuel Perez, Salas, | |Skinner, Solorio, Audra |
| |Audra Strickland | |Strickland, Torlakson, |
| | | |Krekorian |
-----------------------------------------------------------------
SUMMARY : Requires Medi-Cal reimbursement to federally qualified
health centers (FQHCs) and rural health clinics (RHCs) for a
maximum of two visits for one patient on the same day, as
specified. Specifically, this bill :
1)Requires reimbursement for a maximum of two visits, as
specified, on the same day at a single location when one or
more of the following conditions are met:
a) After the first visit the patient suffers an illness or
injury requiring additional diagnosis or treatment; or,
b) The patient has a medical visit and another health
visit, as defined, such as a mental health or dental visit.
2)Requires an FQHC or RHC that currently reports costs for
patient encounters with more than one professional on the same
day, for purposes of establishing the FQHC or RHC's Medi-Cal
visit rate, by January 1, 2011, to apply for a per-visit rate
adjustment and, after approval Department of Health Care
Services (DHCS), to bill same day visits to a medical provider
and a mental health or dental provider as separate visits.
3)Requires DHCS to develop a process and to determine which FQHC
rates to adjust, as specified, and, by January 15, 2010, to
submit a state plan amendment reflecting the changes
AB 1445
Page 2
implemented pursuant to this bill. Provides that rate changes
pursuant to this bill will not constitute a change in the FQHC
or RHCs' scope of service for purposes of the Medi-Cal rate.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, unknown, likely minor cost pressures to some FQHC
rates (50% General Fund, 50% federal) depending on the outcomes
of recalculated clinic-specific rates in 2011 for a small number
of clinics taking advantage of the authorization established in
this bill. Recent amendments require clinics pursing
reimbursement for multiple visits for a single patient in the
same day to apply to the Department of Health Care Services
(DHCS) for a rate readjustment. This amendment is intended to
establish cost-neutrality and address the veto concerns of a
similar bill, SB 260 (Steinberg) in 2007.
COMMENTS : This bill authorizes FQHCs and RHCs to provide
medical and mental health services to a Medi-Cal patient in a
single day and be reimbursed for each service. According to the
author, this bill is necessary to take advantage of federal
funds for Medi-Cal mental health services and will allow FQHCs
to better integrate behavioral health services with medical care
services. The author notes that numerous studies over the last
30 years have found high rates of physical health problems among
individuals with serious mental illness, and that less than half
of patients with mental illnesses actually seek help for their
mental health condition even when being provided medical care
for another condition in a primary care setting. The author
argues that this bill will allow clinic primary care providers
to make same day referrals for mental health treatments, thus
increasing the chances that patients will keep appointments and
get the care they need.
FQHCs are federally funded public or nonprofit community clinics
that serve a high number of Medi-Cal, Medicare and uninsured
patients. FQHCs are "open door" providers that treat patients
on a sliding fee scale basis for comprehensive health and social
services regardless of the patient's ability to pay. Under
federal law, FQHCs and RHCs are eligible for enhanced Medicare
and Medi-Cal reimbursement. FQHC services are reimbursed in
Medi-Cal on a fixed "per visit" rate rather than by individual
services. FQHC provider types are specified in existing statue
as those for which a visit can be billed in a single day:
physician, physician assistant, nurse practitioner, certified
AB 1445
Page 3
nurse midwife, clinical psychologist, licensed clinical social
worker, or a visiting nurse. Current law only allows multiple
billable visits in a single day if they are for medical and
dental services. Mental health visits provided by a clinical
psychologist are separately billable FQHC visits, but not for
services on the same day as a medical visit. California FQHCs
provide more than 6 million visits per year. Approximately 40%
of FQHC patients are Medi-Cal eligible, the remaining patients
are either Medicare beneficiaries or uninsured.
The sponsor of this bill, the California Primary Care
Association, writes in support that this bill will allow FQHC
clinics to more effectively develop and implement integrated
primary and behavioral health services, placing the mental
health professional into the primary care setting as a team
member allowing the mental health practitioner to promptly
assess and treat the patient. The California Mental Health
Directors' Association (CMHDA) supports this bill and believes
that allowing billing for same day medical and mental health
visits will maximize federal Medicaid funds and improve
continuity of care for clinic patients. CMHDA points out that
same day services are the hallmark of a fully integrated primary
behavioral health care model. The California Medical
Association writes that medical and mental health services are
important components of an integrated strategy for maintaining
and improving health for Medi-Cal beneficiaries and points out
that mental health treatment can improve patient compliance with
chronic disease management and treatment.
Analysis Prepared by : John Miller / HEALTH / (916) 319-2097
FN: 0001361 0001341