BILL ANALYSIS
AB 1783
Page 1
Date of Hearing: March 23, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 1783 (Hayashi) - As Introduced: February 10, 2010
SUBJECT : Licensed dentist: change of location form.
SUMMARY : Permits a Medi-Cal dental provider to change locations
within the same county by filing a change of location form in
lieu of submitting a complete application package.
Specifically, this bill :
1)Permits a dentist licensed by the Dental Board of California
practicing in a dental practice and who is enrolled in good
standing in the Medi-Cal Program to continue enrollment at the
new location by filing a change of location form to be
developed by the Department of Health Care Services (DHCS).
Requires the form to comply with all minimum federal
requirements related to Medicaid provider enrollment.
2)Requires DHCS, within 15 days after receiving the change of
location form, to provide notice that the form has been
received.
3)Reduces the time, from 180 days to 90 days, DHCS has to notify
a dentist who files a change of location form: if the provider
is granted provisional provider status; if the application
package is incomplete; if DHCS is conducting additional
background investigation; or, if the application is being
denied for specified reasons.
EXISTING LAW :
1)Establishes the Medi-Cal Program, administered by DHCS, which
provides comprehensive health benefits to low-income children,
their parents or caretaker relatives, pregnant women, elderly,
blind or disabled persons, nursing home residents, and
refugees who meet specified eligibility criteria.
2)Requires new Medi-Cal provider applicants, applicants for
continued provider participation, and providers moving to a
new address to submit a complete application package to DHCS.
3)Provides an exemption from 2) above for a Medi-Cal physician
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provider in good standing in the Medi-Cal program who changes
locations within the same county by allowing the provider to
continue enrollment at the new location by filing a change of
location form.
4)Requires DHCS, within 180 days of receiving an application
package, or from the date of notice to an applicant that the
applicant does not qualify as a preferred provider to give
written notice to the applicant that any of the following
applies, or on the 181st day grant the applicant provisional
provider status for a period no longer than 12 months,
effective from the 181st day:
a) The applicant is being granted provisional provider
status for a period of 12 months, effective from the date
on the notice;
b) The application package is incomplete. Requires the
notice to identify any additional information or
documentation that is needed to complete the application
package;
c) DHCS is exercising its authority as specified to conduct
background checks, preenrollment inspections, or
unannounced visits; or,
d) The application package is denied for other specified
reasons.
5)Reduces the time period in 4) above to 90 days for an
individual physician who files a change of location form.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill is
intended to allow licensed dentists who are enrolled and in
good standing in the Medi-Cal Program to use a streamlined
process to register a new address that was established to
enroll individual physicians in good standing. The sponsors
additionally have pointed to the "Application for
Participation in the Denti-Cal Form" that must be filled out
to become a Medi-Cal provider which is over 30 pages and by
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comparison the simplified "Change of Location Form" for a
physician which is five pages.
2)BACKGROUND . AB 1226 (Hayashi), Chapter 693, Statutes of
2007, enacted an expedited process for a Medi-Cal physician
provider who was in good standing and who changes office
location. It was intended to eliminate disincentives for
physicians to enroll or re-enroll in the Medi-Cal Program by
creating a more efficient provider enrollment process. The
author also desired to make sure that physicians willing to
take Medi-Cal patients would be enrolled as providers as
quickly as possible to help ensure that low-income families
enrolled in Medi-Cal are receiving timely access to physician
services. In addition, AB 1226 was intended to help prevent
fraud by freeing up DHCS staff time to concentrate on a more
thorough review of higher-risk applications.
According to DHCS, 1,730 dental provider applications were
processed in 2009, including new applications, change of
address and new offices. The average processing time is 55
days. Of theses, 264 were for change of address with an
average processing time of 51.
3)MEDI-CAL PROVIDER FRAUD . In 2003, the Senate Select Committee
on Government Oversight, conducted hearings on Medi-Cal Fraud
and over utilization. The Committee received testimony that
the vast majority of monetary losses from health care fraud
are due to provider fraud, rather than beneficiary fraud. The
2003 May Revision to the Governor's budget included a major
DHCS (previously the Department of Health Services) proposal
that addressed these issues such as new staff and a number of
statutory changes. SB 857 (Speier), Chapter 601, Statutes of
2003, included the statutory changes such as provisional
provider status intended to more easily remove problem
providers from the Medi-Cal Program; timelines for DHCS to
respond to applications and for providers to answer any
questions raised by DHCS. Until the implementation of AB 1107
(Cedillo), Chapter 146, Statutes of 1999, DHCS issued Medi-Cal
provider numbers to essentially any provider requesting one.
As proposed in the Governor's 2000, May Revision, AB 1107
authorizes DHCS, upon reliable evidence of fraud or willful
misrepresentation by a provider, to collect any overpayments
identified through an audit or examination from any provider
or withhold payment for any goods or services owing to the
provider. AB 1107 also provides for disenrollment, in
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accordance with specified limitations, for providers and
prohibited enrollment for provider applicants found to have
committed fraud or abuse. As a result there were
approximately 70,000 Medi-Cal providers for whom a systematic
review had never been conducted. In 2000, DHCS began
reenrolling providers. These efforts to reduce provider fraud
have resulted in more cumbersome enrollment and reenrollment
procedures.
4) ELIMINATION OF ADULT DENTAL . Assembly Bill 5 X3 (Evans),
Chapter 20, Statutes of 2009-10 Third Extraordinary Session,
contained a provision for elimination of selected optional
benefits under the Medi-Cal Program, including most adult
dental services, effective July 1, 2009. This state law
change will not affect services provided to beneficiaries
under age 21. As a result of the change in patient load,
dentists who rely primarily on Medi-Cal adult patients may be
changing addresses as they move to adjust. This budget change
should also result in fewer providers.
5)PIOR LEGISLATION.
a) AB 1226 (Hayashi) of 2007 makes specified physicians
eligible for expedited enrollment as Medi-Cal physicians.
Permits a Medi-Cal physician provider in an individual
physician practice to change locations within the same
county by filing a change of location form. Extends the
time for a Medi-Cal provider or provider applicant to
resubmit an incomplete application package
b) SB 857 (Speier) of 2003 made numerous changes to the
Medi-Cal Program intended to address provider fraud,
including establishing new Medi-Cal application
requirements for new providers, existing providers at new
locations, and providers applying for continued enrollment.
c) SB 770 (Romero) of 2005 would have required specified
physicians to be eligible for expedited enrollment in the
Medi-Cal Program. Permits a Medi-Cal physician provider to
change locations within the same county by filing a change
of location form. .SB 770 died on the Assembly
Appropriations suspense file.
d) SB 1353 (Romero) of 2006 would have required specified
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physicians to be eligible for expedited enrollment in the
Medi-Cal program. Permits a Medi-Cal physician provider to
change locations within the same county by filing a change
of location form. AB 1353 was vetoed by the Governor. In
his veto message, he expressed concerned that it may
unintentionally result in fraudulent claims. He also
stated that the shared interest in getting Medi-Cal
providers enrolled faster to provide greater access to care
has been largely addressed administratively by improvements
in the provider enrollment process and allowing providers
moving to a new location to continue to bill Medi-Cal while
their application is being processed. Finally, he stated
that DHCS will continue to improve the provider enrollment
system, while balancing the need to retain key tools to
fight fraud and abuse.
6)SUPPORT . The sponsors, the California Dental Association,
state in support, that when a dentist who is participating as
a provider within Denti-Cal changes the location of their
practice they must fill out and submit an entire provider
application form, rather than simply notify DHCS of change of
address. The sponsor goes on to argue that for an existing
provider, the information on the form is redundant and
irrelevant in regard to the need to inform the department of
an address change. The California Society of Pediatric
Dentistry adds in support that when the change is within the
same county, the dentist has the ability, and usually the
intent, to provide a continuum of service to existing
patients. Any interruption in Denti-Cal enrollment that
occurs as the result of the new enrollment application process
can disrupt the existing treatment plans, suspend or delay
needed services and, if prolonged, disturb or even sever the
dentist-patient relationship.
REGISTERED SUPPORT / OPPOSITION :
Support
California Dental Association (sponsor)
California Society of Pediatric Dentistry
Opposition
None on file.
AB 1783
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Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097