BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
1445 (Chesbro)
Hearing Date: 8/9/2010 Amended: 6/1/2009
Consultant: Katie Johnson Policy Vote: Health 10-0
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BILL SUMMARY: AB 1445 would permit federally qualified health
centers and rural health centers to claim reimbursement for
multiple visits for a single patient on the same day at the same
location, as specified.
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Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12 2012-13 Fund
DHCS implementation up to $200 up to $300
$1,000General/*
and increased Medi-Cal Federal
payments to FQHC/RHCs
*50 percent General Funds, 50 percent federal funds
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STAFF COMMENTS: This bill meets the criteria for referral to the
Suspense File.
Federal law allows for the separate reimbursement of same-day
medical and mental health visits. However, current state law
permits only one visit per day to be reimbursed by Medi-Cal,
except for a subsequent visit by a patient to a dental
professional with rates determined prospectively. This bill
would permit FQHC/RHCs to be reimbursed for medical and mental
health visits as two separate visits and would require clinics
that currently include the cost of encounters with more than one
health professional that take place on the same day at a single
location as constituting a single visit to apply to the
department for an adjustment of their per-visit rate. This rate
redetermination provision is meant to imply that the department
would adjust the per-visit rate to make this bill cost neutral.
There are 907 FQHC/RHCs in the state and they are reimbursed
$160.60 per visit per day under the current reimbursement
system. If half of the clinics were to have two additional
Medi-Cal visits each month as a result of being able to serve
the same person on the same day and bill separately for the two
visits, annual costs would be $1.7 million in total funds,
commencing January 1, 2012, and thereafter. Since Medi-Cal costs
are typically shared 50 percent General Funds and 50 percent,
costs would be $850,000 General Fund and $850,000 federal funds.
If the redetermination provision were to result in a new per
visit rate that would render these additional visits closer to
or cost neutral, costs could be considerably less.
DHCS would also be required to apply for federal approval and
would need to amend its state plan in order to draw down federal
funds to implement these provisions. DHCS could need up to .5 PY
to achieve this in FY 2010-2011 at a cost of approximately
$50,000 total funds. Additionally, DHCS could need up to 3
limited-term auditors at a
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AB 1445 (Chesbro)
cost of $300,000 in total funds for two years commencing in FY
2010-2011, in order to adjust FQHC/RHC rates as provided for in
the bill depending on the number of clinics that apply for a
rate redetermination. These departmental staffing costs would be
shared 50 percent General Fund and 50 percent federal funds.
Additionally, staff recommends that the implementation dates in
the bill be pushed forward 1 year so they reflect this bill as
it would take effect January 1, 2011, instead of assuming a
January 1, 2010, effective date, as it currently does.
In 2007, the Governor vetoed a similar bill, SB 260 (Steinberg),
saying, "While I support improving access to health care
services, including mental health services, I cannot support
this bill as it would increase General Fund pressure at a time
of continuing budget challenges. Mental health services are
already included in the Medi-Cal rates for federally qualified
health centers and rural health clinics. Allowing separate
billing for mental health services would lead to increased costs
that our state cannot afford."