BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 1783|
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CONSENT
Bill No: AB 1783
Author: Hayashi (D)
Amended: 6/14/10 in Assembly
Vote: 21
SENATE HEALTH COMMITTEE : 8-0, 6/16/10
AYES: Alquist, Strickland, Aanestad, Cedillo, Leno,
Negrete McLeod, Pavley, Romero
NO VOTE RECORDED: Cox
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 74-0, 4/22/10 (Consent) - See last page
for vote
SUBJECT : Licensed dentist: change of location form
SOURCE : California Dental Association
DIGEST : 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 the
Department of Health Care Services (DHCS), requires that
the form developed by DHCS complies with all minimum
federal requirements related to Medicaid provider
enrollment, and defines individual dental practice for the
CONTINUED
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purposes of this bill.
ANALYSIS :
Existing law:
1. Establishes the Medi-Cal Program, administered by the
Department of Health Care Services (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 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
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conduct background checks, preenrollment inspections,
or unannounced visits.
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.
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 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.
4. Applies these provisions to a dentist practicing as an
individual dentist practice, and defines "individual
dentist practice" as a dentist licensed by the Dental
Board of California enrolled or enrolling in Medi-Cal as
an individual provider who is a sole proprietor of
his/her practice or is a corporation owned solely by the
individual dentist and the only dentist practitioner is
the owner.
Background
In 2003, the Senate Select Committee on Government
Oversight, conducted hearings on Medi-Cal Fraud and over
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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, and
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 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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 6/28/10)
California Dental Association (source)
California Society of Pediatric Dentistry
ARGUMENTS IN SUPPORT : The bill's sponsor, 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
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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. In support, the
California Society of Pediatric Dentistry adds 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.
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Anderson, Arambula, Bass, Beall,
Bill Berryhill, Tom Berryhill, Blakeslee, Block,
Bradford, Brownley, Buchanan, Charles Calderon, Carter,
Chesbro, Conway, Cook, Coto, Davis, De La Torre, De Leon,
DeVore, Emmerson, Eng, Evans, Feuer, Fletcher, Fong,
Fuentes, Fuller, Furutani, Gaines, Galgiani, Garrick,
Gilmore, Hagman, Hall, Harkey, Hayashi, Hernandez, Hill,
Jeffries, Jones, Knight, Lieu, Logue, Bonnie Lowenthal,
Ma, Mendoza, Miller, Monning, Nava, Nestande, Niello,
Nielsen, V. Manuel Perez, Portantino, Ruskin, Salas,
Saldana, Silva, Skinner, Smyth, Solorio, Audra
Strickland, Swanson, Torlakson, Torres, Torrico, Tran,
Villines, Yamada, John A. Perez
NO VOTE RECORDED: Blumenfield, Caballero, Huber, Huffman,
Norby, Vacancy
CTW:mw 6/29/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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