AB 2051, as introduced, Gonzalez. Medi-Cal: providers: affiliate primary care clinics.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.
Existing law authorizes the department to adopt regulations for certification of each applicant and each provider in the Medi-Cal program. Existing law requires certain applicants or providers, as defined, to submit a complete application package for enrollment, continuing enrollment, or enrollment at a new location or a change in location. Existing law generally requires the department to give written notice regarding the status of an application to an applicant or provider within a prescribed period of time, as specified.
This bill would require the department, within 15 days after receiving an application and certification package from an applicant that is an affiliate primary care clinic, to provide specified written notice of the status of the application, or to approve the application on the 16th day after receiving the package, as specified. The bill would also require the department, within 15 days after approving an application, to provide written notice regarding certain conditions imposed on the provider, or, on the 16th day after approving an application, to approve the provider’s participation in specified public health programs.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 14043.17 is added to the Welfare and
2Institutions Code, to read:
(a) Notwithstanding any other law, within 15 days
4of receiving an application and certification package to be certified
5as a Medi-Cal provider from an affiliate primary care clinic that
6is licensed pursuant to Section 1218.1 of the Health and Safety
7Code and that has been certified for enrollment by the State
8Department of Public Health, the department shall do either of the
9following:
10(1) Provide written notice to the applicant that one of the
11following applies:
12(A) The applicant is being granted provisional provider status
13for a period of 12 months, effective from the date on the notice.
14(B) The application
package is incomplete. The notice shall
15identify additional information or documentation that is needed to
16complete the application package.
17(C) The department is exercising its authority under Section
1814043.37, 14043.4, or 14043.7, and is conducting background
19checks, preenrollment inspections, or unannounced visits.
20(D) The application package is denied for any of the following
21reasons:
22(i) Pursuant to Section 14043.2 or 14043.36.
23(ii) For lack of a license necessary to perform the health care
24services or to provide the goods, supplies, or merchandise directly
25or indirectly to a Medi-Cal beneficiary, within the applicable
26provider of service category or subgroup of that category.
27(iii) The period of time during which an applicant or provider
28has been barred from reapplying has not passed.
29(iv) For other stated reasons authorized by law.
30(v) For failing to submit fingerprints as required by federal
31Medicaid regulations.
P3 1(vi) For failing to pay an application fee as required by federal
2Medicaid regulations.
3(2) On the 16th day after receiving the application, approve the
4application and make that approval effective on the date the affiliate
5primary care license was issued by the State Department of Public
6Health.
7(b) Notwithstanding any other law, within 15 days of approving
8an application pursuant to subdivision (a), the department shall do
9either of the following:
10(1) Provide written notice to the provider that one of the
11following applies:
12(A) The provider is being granted provisional provider status
13for a period of 12 months, effective from the date on the notice.
14(B) The department is exercising its authority under Section
1514043.37, 14043.4, or 14043.7, and is conducting background
16checks, preenrollment inspections, or unannounced visits.
17(2) On the 16th day after approving the application, approve
18the provider’s participation in any of the programs described in
19Section 1222 of the Health and Safety Code.
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