BILL NUMBER: SB 1516 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 9, 2012
INTRODUCED BY Senator Leno
FEBRUARY 24, 2012
An act to amend Section 14131.07 of the Welfare and
Institutions Code, relating to Medi-Cal. 3400 of the
Public Contract Code, relating to public contracts.
LEGISLATIVE COUNSEL'S DIGEST
SB 1516, as amended, Leno. Medi-Cal: physician office and
clinic visits. Public contracts: bids: "or equal"
materials or service.
Existing law prohibits, except in specified circumstances, a state
agency, political subdivision, municipal corporation, district, or
public officer responsible for letting a public works contract from
drafting bid specifications for that contract in a manner that limits
the bidding to any one concern or product, unless the specification
is followed by the words "or equal." Existing law requires that these
bid specifications provide a period of time prior to or after, or
prior to and after, the award of the contract to allow the contractor
to submit data that demonstrates that a concern or product to be
provided under the contract is equal to the concern or product
identified in the bid specification.
This bill would prohibit these bid specifications from requiring a
bidder to provide submission of data substantiating a request for a
substitution of "an equal" item prior to the bid or proposal
submission deadline.
Existing law establishes the Medi-Cal program, administered by the
State Department of Health Care Services, under which basic health
care services are provided to qualified low-income individuals.
Existing law states that there is a limit on the total number of
physician office and clinic visits for physician services provided by
a physician, or under the direction of a physician, that are a
covered benefit under the Medi-Cal program of 7 visits per
beneficiary per fiscal year, except as specified.
This bill would make a technical, nonsubstantive change to these
provisions.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 3400 of the Public
Contract Code is amended to read:
3400. (a) The Legislature finds and declares that it is the
intent of this section to encourage contractors and manufacturers to
develop and implement new and ingenious materials, products, and
services that function as well, in all essential respects, as
materials, products, and services that are required by a contract,
but at a lower cost to taxpayers.
(b) (1) No agency of the state, nor any
political subdivision, municipal corporation, or district, nor any
public officer or person charged with the letting of contracts for
the construction, alteration, or repair of public works, shall draft
or cause to be drafted specifications for bids, in connection with
the construction, alteration, or repair of public works, (1) in a
manner that limits the bidding, directly or indirectly, to any one
specific concern, or (2) calling for a designated material, product,
thing, or service by specific brand or trade name unless the
specification is followed by the words "or equal" so that bidders may
furnish any equal material, product, thing, or service. In applying
this section, the specifying agency shall, if aware of an equal
product manufactured in this state, name that product in the
specification. Specifications shall provide a period of time prior to
or after, or prior to and after, the award of the contract for
submission of data substantiating a request for a substitution of "an
equal" item. If no time period is specified, data may be submitted
any time within 35 days after the award of the contract.
(2) Notwithstanding paragraph (1), specifications shall not
require a bidder to provide submission of data substantiating a
request for a substitution of "an equal" item prior to the bid or
proposal submission deadline.
(c) Subdivision (b) is not applicable if the awarding authority,
or its designee, makes a finding that is described in the invitation
for bids or request for proposals that a particular material,
product, thing, or service is designated by specific brand or trade
name for any of the following purposes:
(1) In order that a field test or experiment may be made to
determine the product's suitability for future use.
(2) In order to match other products in use on a particular public
improvement either completed or in the course of completion.
(3) In order to obtain a necessary item that is only available
from one source.
(4) (A) In order to respond to an emergency declared by a local
agency, but only if the declaration is approved by a four-fifths vote
of the governing board of the local agency issuing the invitation
for bid or request for proposals.
(B) In order to respond to an emergency declared by the state, a
state agency, or political subdivision of the state, but only if the
facts setting forth the reasons for the finding of the emergency are
contained in the public records of the authority issuing the
invitation for bid or request for proposals.
SECTION 1. Section 14131.07 of the Welfare and
Institutions Code is amended to read:
14131.07. (a) Notwithstanding any other provision of this chapter
or Chapter 8 (commencing with Section 14200), the total number of
physician office and clinic visits for physician services provided by
a physician, or under the direction of a physician, that are a
covered benefit under the Medi-Cal program shall be limited to seven
visits per beneficiary per fiscal year, excepting visits that meet
the conditions described in subdivision (b). For purposes of this
limit, a visit shall include physician services provided at any
federally qualified health center, rural health clinic, community
clinic, outpatient clinic, and hospital outpatient department. The
department may seek input from consumer organizations and the
provider community, as applicable, prior to implementation.
(b) (1) Visits exceeding seven per beneficiary per fiscal year
shall be required to be certified by the physician, or other medical
professional under the supervision of a physician, attesting that one
or more of the following circumstances is applicable:
(A) The services will prevent deterioration in a beneficiary's
condition that would otherwise foreseeably result in admission to the
emergency department.
(B) The services will prevent deterioration in the beneficiary's
condition that would otherwise result in inpatient admission.
(C) The services will prevent disruption in ongoing medical
therapy or surgical therapy, or both, including, but not limited to,
medications, radiation, or wound management.
(D) The services constitute diagnostic workup in progress that
would otherwise foreseeably result in inpatient or emergency
department admission.
(E) The services are for the purpose of assessment and form
completion for Medi-Cal recipients seeking or receiving in-home
supportive services.
(2) The certification shall consist of a written declaration by
the physician, or other medical professional under the supervision of
the physician, that the visit meets the requirements of any one or
more of the circumstances set forth in paragraph (1), and shall
include a description of the services provided.
(3) The certification shall be maintained onsite at the physician'
s office or clinic location at which the medical records for the
beneficiary are maintained and shall be subject to audit and
inspection by the department.
(4) This subdivision does not authorize or direct a beneficiary to
obtain services at a physician office or clinic visit for an
emergency medical condition or that should properly be provided in
the emergency department or as hospital inpatient services.
(c) Specialty mental health services furnished or arranged for the
provision of mental health services to Medi-Cal beneficiaries
pursuant to Part 2.5 (commencing with Section 5775) of Division 5,
shall not be subject to the limit provided in subdivision (a).
(d) Any pregnancy-related visit, or any visit for the treatment of
any other condition that might complicate a pregnancy, shall not be
subject to the limit provided in subdivision (a).
(e) The limit on physician office and clinic visits provided in
subdivision (a) shall not apply to any of the following:
(1) A beneficiary under the Early and Periodic Screening,
Diagnosis, and Treatment (EPSDT) Program.
(2) A beneficiary receiving long-term care in a nursing facility
that is both of the following:
(A) A skilled nursing facility or intermediate care facility as
defined in subdivisions (c), (d), (e), (g), and (h), respectively, of
Section 1250 of the Health and Safety Code, and facilities providing
continuous skilled nursing care to persons with developmental
disabilities under the pilot project established pursuant to Section
14132.20.
(B) Licensed pursuant to subdivision (k) of Section 1250 of the
Health and Safety Code.
(f) For managed health care plans that contract with the
department pursuant to this chapter or Chapter 8 (commencing with
Section 14200), except for Senior Care Action Network or AIDS
Healthcare Foundation, payments shall be reduced by the actuarial
equivalent amount of the benefit reductions resulting from the
implementation of the benefit cap amounts specified in this section
pursuant to contract amendments or change orders effective on July 1,
2011, or thereafter.
(g) This section shall be implemented only to the extent permitted
by federal law.
(h) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement this section by means of all-county letters,
provider bulletins, or similar instructions, without taking
regulatory action.
(i) This section shall be implemented on the first day of the
first calendar month following 180 days after the effective date of
the act that added this section, or on the first day of the calendar
month following 60 days after the date the department secures all
necessary federal approvals to implement this section, whichever is
later. If the implementation date occurs after July 1, 2011, then the
benefit caps described in subdivision (a) for the first year of
implementation shall be applied from the implementation date to June
30 of the state fiscal year in which implementation begins.
Thereafter, the benefit caps shall apply on a state fiscal year
basis.