BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 1783
A
AUTHOR: Hayashi
B
AMENDED: June 14, 2010
HEARING DATE: June 16, 2010
1
CONSULTANT:
7
Dunstan
8
3
SUBJECT
Medi-Cal: licensed dentist enrollment: change of location
SUMMARY
This bill requires the California Department of Health Care
Services (DHCS) to allow dentists who are providers under
the Medi-Cal program to file a change of location form,
rather than requiring these providers to complete a full
Medi-Cal provider application, when moving within a county.
CHANGES TO EXISTING LAW
Existing federal law:
Establishes the Medicaid program to provide comprehensive
health benefits to specified groups of low-income persons.
Existing state law:
Establishes the Medi-Cal program, California's Medicaid
program, administered by the Department of Health Care
Services (DHCS), which provides comprehensive health care
coverage for low-income individuals and their families;
pregnant women; elderly, blind, or disabled persons;
nursing home residents; and refugees who meet specified
eligibility criteria.
Continued---
STAFF ANALYSIS OF ASSEMBLY BILL 1783 (Hayashi) Page
2
Requires a provider to be enrolled in Medi-Cal in order to
receive reimbursement for the provision of covered
services, goods, supplies or merchandise to a Medi-Cal
beneficiary.
Establishes the Denti-Cal program as a part of Medi-Cal and
specifies covered services and limits for services.
Requires DHCS, within 15 days after receiving the change of
location form from a physician or group of physicians, to
provide notice that the form has been received. Mandates
DHCS to develop the change of location form and requires
that it comply with all applicable federal Medicaid
requirements. Establishes that filing this form shall be
in lieu of submitting a complete application package.
Requires a dentist who wants to enroll in the Denti-Cal
program to submit a complete application package for
enrollment, continuing enrollment, enrollment at a new
location, or a change in location.
This bill:
Permits a dentist licensed by the Dental Board of
California, practicing in an individual dental practice,
who is enrolled and in good standing in the Medi-Cal
program, and who is changing locations of that individual
dental practice within the same county, to be eligible to
continue enrollment at the new location by filing a change
of location form to be developed by DHCS. Requires that
the form developed by DHCS complies with all minimum
federal requirements related to Medicaid provider
enrollment. Defines individual dental practice for the
purposes of this bill.
FISCAL IMPACT
According to the Assembly Appropriations Committee, there
would be a minor absorbable workload to DHCS to continue
oversight of Denti-Cal providers. According to statewide
data, this bill may benefit about 200 Denti-Cal providers
each year who move within the county in which they are
already authorized to provide services.
BACKGROUND AND DISCUSSION
STAFF ANALYSIS OF ASSEMBLY BILL 1783 (Hayashi) Page
3
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 thirty
pages long compared to the simplified "Change of Location
Form" for a physician, which is five pages.
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 to 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 beneficiaries
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.
Medi-Cal dental program
Medi-Cal currently covers a comprehensive package of dental
benefits for children and some adults. Covered services
include diagnostic and preventive services, restorative
services such as fillings, and oral surgery services.
Access to dental services for children under age 21 is
required by federal law, whereas adult dental services are
an optional benefit.
ABX3 5 (Evans), Chapter 20, Statutes of 2009-10 Third
Extraordinary Session, eliminated selected optional
benefits under the Medi-Cal Program, including most adult
dental services, effective July 1, 2009. This action does
not affect services provided to beneficiaries under age 21.
According to DHCS, 1,730 dental provider applications were
STAFF ANALYSIS OF ASSEMBLY BILL 1783 (Hayashi) Page
4
processed in 2009, including new applications, change of
address and new offices. The average processing time is 55
days. Of these, 264 were for a change of address with an
average processing time of 51 days. The number of
Denti-Cal providers in the current year may decrease
substantially due to the elimination of adult dental
services in the Medi-Cal program.
State Audits
The Bureau of State Audits conducted audits of Medi-Cal
provider enrollment in May 2002 and April 2007. The 2002
audit found that DHCS' Provider Enrollment Branch was not
effectively using its resources to process provider
applications, nor was it effectively coordinating its
efforts with the DHCS Audit & Investigations Branch. The
2007 audit found that, despite the department's effort to
shorten the average time to process applications, the
department does not process some applications within the
specified time frame under current law. As a result, the
enrollment branch continues to review the applications
after the statutorily required times, and is forced to
enroll these applicants into Medi-Cal on a provisional
status, because it cannot make a timely determination on
the applications.
Prior legislation
AB 1226 (Hayashi) of 2007 Chapter 693, Statutes of 2007,
makes specified physicians eligible for expedited
enrollment as Medi-Cal physicians and 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.
SB 770 (Romero) and SB 1353 (Romero), 2005-2006 session,
would have permitted physicians and osteopaths, who are
Medi-Cal providers in good standing, to change practice
location within the same county and continue enrollment at
the new location by filing a change of location form. The
bill would have also granted provisional provider status to
applicants whose forms have not been processed within 90
days. It would have also reduced the maximum time for DHCS
to process provider enrollment applications from 180 days
to 90 days. SB 770 was held on the Assembly Appropriations
suspense file. The governor vetoed SB 1353 on the grounds
that it would unintentionally result in tens of millions of
STAFF ANALYSIS OF ASSEMBLY BILL 1783 (Hayashi) Page
5
fraudulent claims by interfering with Medi-Cal fraud
activities designed to protect program integrity.
AB 119 (Cohn ) of 2005-2006, would have permitted specified
medical providers in good standing to be eligible for
automatic enrollment in the Medi-Cal program, and would
have permitted providers to file a change of location form
in lieu of a complete application package. This bill was
amended in the Senate to address a different subject.
SB 857 (Speier), Chapter 601, Statutes of 2003, made
several changes to the Medi-Cal program enrollment process
for providers to reduce fraud. Defined Medi-Cal
application requirements for new providers, existing
providers that change their locations, providers applying
for continued enrollment, and created rules for obtaining
provisional provider status.
SB 643 (Chesbro), Chapter 551, Statutes of 2005, reduced
the time DHCS may take to process Medi-Cal provider
applications from 180 days to 30 days for specified
independent nurse providers.
Arguments in support
The sponsors, the California Dental Association, states
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 the
change of address. The sponsor argues that, to information
that the provider had already provided, for an existing
provider, the information on the form is redundant and
irrelevant.
The California Society of Pediatric Dentistry adds in
support that, when the change of address is within the same
county, the dentist has the ability, and usually the
intent, to provide a continuum of service to existing
patients. They point out that interruptions in Denti-Cal
enrollment that occur as the result of the new enrollment
application process can disrupt existing treatment plans,
suspend or delay needed services and, if prolonged, disturb
or even sever the dentist-patient relationship.
STAFF ANALYSIS OF ASSEMBLY BILL 1783 (Hayashi) Page
6
PRIOR ACTIONS
Assembly Health: 18-0
Assembly Appropriations: 15-0
Assembly Floor: 74-0
POSITIONS
Support: California Dental Association (sponsor)
California Society of Pediatric Dentistry
Oppose: None received
-- END --