BILL ANALYSIS �
AB 1785
Page 1
Date of Hearing: April 18, 2012
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
AB 1785 (Bonnie Lowenthal) - As Introduced: February 21, 2012
Policy Committee: HealthVote:17-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill adds marriage and family therapists (MFTs) to the list
of health care professionals whose services are reimbursed
through Medi-Cal on a per-visit basis to federally qualified
health centers (FQHC) or rural health clinics (RHCs).
FISCAL EFFECT
Assuming a 10% increase in the number of mental health visits
reimbursed by Medi-Cal for those currently eligible, costs would
be in the range of $3 million (50% GF, 50% federal funds). The
impact of this bill is somewhat blunted by another provision of
law that prevents clinics from receiving reimbursement for both
a mental health visit and a physical health visit in the same
day.
COMMENTS
1)Rationale . According to the author, Medi-Cal reimbursement for
MFTs will allow clinics to see more low-income patients in
need of mental health services. The author states that under
existing law, psychologists and licensed clinical social
workers (LCSWs) are employed by RHCs and FQHCs to provide
mental health services, and receive reimbursement through
Medi-Cal for that care. However, the author points out that
while a RHC or FQHC can employ an MFT, the lack of
reimbursement for the care provided to Medi-Cal patients acts
as a disincentive for hiring.
2)Clinic Reimbursement . Because of their unique role in
providing health care to underserved communities and the
uninsured, policymakers have historically attempted to ensure
AB 1785
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that community clinics remain financially viable. Federal law
requires federally funded health programs, including Medicaid
and Children's Health Insurance Program (CHIP), to pay clinics
using a special reimbursement structure commonly called a
prospective payment system (PPS). The PPS rate is a
calculated per-visit payment for FQHC/RHC services that is
equal to the reasonable cost of such services documented for a
baseline period, with certain adjustments. The PPS rate is
determined separately for each individual FQHC or RHC, and is
adjusted by a growth rate to account for inflation. In
addition, clinics can request a recalculation of their PPS
rates based on a change in their scope of services. All
clinics must provide at least a defined scope of primary care
and mental health services, but may provide additional
services as well.
3)Costs for MFT Services May Already Be Reflected in Base PPS
Rate . Under current state law, an FQHC or RHC "visit" means a
face-to-face encounter between a patient and certain type of
health care provider defined in state law. A visit must be
documented in order for a clinic to be reimbursed. According
to DHCS, for clinics that provide MFTs within their approved
scope of service, MFT services are included in the
all-inclusive calculation of the PPS rate, but are not
separately billable.
For example, a patient could visit a clinic to receive a
medical check-up and be referred directly to an MFT employed
by the clinic for mental health services. According to DHCS,
MFT services rendered are reflected in the baseline PPS
cost-based rate as long as they are within the approved clinic
scope of service. At this time, however, a facility could not
receive reimbursement for an MFT visit without receiving other
services. This bill would allow such reimbursement.
4)One-Visit Rule . Under current law, clinics are limited to
reimbursement for one visit per day unless the second visit is
dental-related. This so-called "one-visit rule" has caused
difficulty in integrating behavioral with physical health
services at clinics, since clinics are either forced to absorb
the cost of a mental health visit or direct a patient to
return the next day, which often results in missed
appointments and lack of care. The one-visit rule is often
cited as the most significant reason that clinics have
difficulty increasing access to mental health services.
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5)Related Budget Proposal . DHCS has proposed to seek federal
approval for a different payment methodology for clinics
beginning in 2012-13. Instead of paying clinics per-visit PPS
rates, the department proposes to integrate all FQHC/RHC costs
into managed care capitated rates. Under this proposal,
payments made to FQHCs and RHCs would be in the form of a
capitated payment to provide a broad range of services for
Medi-Cal managed care beneficiaries who have selected or been
assigned to their clinic. The department maintains that the
increased flexibility gained by this new methodology will
incentivize quality health care rather than volume, and also
proposes to reduce FQHC/RHC payments by 10% based on
projections of improved efficiency. The Senate Budget
Subcommittee #3 heard and rejected this proposal on March 22,
2012; the Assembly Budget Subcommittee #1 has not yet
considered this issue.
6)Previous Legislation . AB 1445 (Chesbro) of 2009 would have
allowed FQHCs and RHCs to be reimbursed by Medi-Cal for
multiple visits by a patient with a single or different health
care professional on the same day at a single location, when a
patient has an appointment with a mental health professional
or has contracted an illness or been injured and requires
additional treatment. AB 1445 was held on the Suspense file
in the Senate Appropriations Committee.
SB 260 (Steinberg) of 2007 was similar to AB 1445 and was
vetoed by Governor Schwarzenegger on budgetary concerns.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081