BILL ANALYSIS �
AB 2051
Page 1
Date of Hearing: April 22, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 2051 (Gonzalez and Bocanegra) - As Introduced: February 20,
2014
SUBJECT : Medi-Cal: providers: affiliate primary care clinics.
SUMMARY : Streamlines the enrollment process into Medi-Cal for
affiliate primary care clinics. Specifically, this bill :
1)Requires the Department of Health Care Services (DHCS) within
15 days of receiving an application and certification package
from a licensed affiliate primary care clinic to take one of
the following actions:
a) Enroll the provider as a provisional provider for a
period of 12 months;
b) Inform the applicant that DHCS is opting to conduct
background checks, preenrollment inspections or unannounced
inspections;
c) Advise the applicant the package is incomplete;
d) Deny the application for specified reasons; or,
e) Approve the application.
2)Requires DHCS within 15 days of approving an application to
take one of the following actions:
a) Enroll the provider as a provisional provider for a
period of 12 months;
b) Inform the applicant that DHCS is opting to conduct
background checks, preenrollment inspections or unannounced
inspections; or,
c) Approve the applicant for participating in the Medi-Cal
Presumptive Eligibility, Child Health and Disability
Prevention, Perinatal Services, and Family Planning,
Access, Care, and Treatment Waiver Programs.
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EXISTING LAW :
1)Defines a primary care clinic as an outpatient health facility,
operated by a nonprofit corporation, which provides direct
medical, surgical, dental, optometric, or podiatric advice,
services, or treatment to patients who remain less than 24
hours.
2)Requires that primary care clinics be licensed by the California
Department of Public Health (DPH) and approved for operation
by DPH prior to obtaining a Medi-Cal provider number or
providing services.
3)Authorizes DPH to take various types of enforcement actions
against a primary care clinic that has violated state law or
regulation, including imposing fines, sanctions, civil or
criminal penalties, and suspension or revocation of the
clinic's license.
4)Requires a provider to apply to DHCS to obtain approval for
participating in the Medi-Cal program and to apply and obtain
DHCS approval for enrollment.
5)Requires the affiliate clinic licensure application to consist
solely of a simple form and supporting documents containing:
the names, addresses, and contact information of the clinic
corporation and affiliate clinic's administrative officers;
the affiliate clinic location and hours of operation; evidence
of compliance with minimum safety standards related to the
affiliate clinic's physical plant; and, other pertinent
information, as specified.
6)Clarifies that a clinic corporation can apply to establish
affiliate clinics on behalf of a primary care clinic, as
specified.
7)Requires DPH to issue a license to an affiliate clinic within 30
days of receiving a completed application.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, legislation
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enacted several years ago provides DPH must approve a clinic
license within 30 days. Unfortunately, the streamlined
licensure process did not specifically address the timelines
by which the DHCS must complete the affiliate clinic's
enrollment into Medi-Cal. The author notes as a consequence,
affiliate clinics are entitled to receive their license, open
their doors, and provide services to patients within 30 days
of submitting an application to DPH, however, they often
cannot get paid for providing those services until their
enrollment in Medi-Cal is complete, which can take three to
four months. Existing law allows DHCS to take as long as 180
days to even begin to review an affiliate clinic's Medi-Cal
application. The author states, due to new requirements under
the Patient Protection and Affordable Care Act, the Provider
Enrollment Division at DHCS is backlogged with applications,
resulting in a very slow turnaround time that is very close to
the statutory limit. The author argues the significant
interruption in revenue increases the cost and complexities of
opening a new affiliated primary care clinic and is at odds
with the intent behind 2010's streamlined and expedited
licensure process. This bill will allow affiliate clinics to
more quickly open their doors and meet the health care needs
of individuals and families in their communities by requiring
DHCS to expedite enrollment into Medi-Cal and other health
care programs.
2)BACKGROUND . There are approximately 1,000 primary care
clinics currently licensed in California. In order to obtain
a license, a primary care clinic must submit an application
and fee to DPH, and pass an initial licensure survey conducted
by DPH. Upon receipt of a completed application for a clinic
license, DPH has up to 100 days to either grant or deny the
license. Existing law requires DPH to issue a provisional
license, good for six months from the date of issuance, to a
clinic that has not been previously licensed. DPH is required
to inspect the clinic within 30 days prior to the termination
of the provisional license, and, if the clinic meets all
licensure requirements, issue a regular license. Clinics that
do not meet the requirements for licensure, but make progress
toward meeting the requirements, may have their provisional
license renewed by DPH for another six months.
Certain non-profit corporations that operate multiple primary
care clinics are entitled to use a streamlined application
process that allows qualifying primary care clinics, known as
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affiliated primary care clinics, to receive a DPH license
within 30 days of submitting a completed application. This
streamlined licensure process, in place since 2011, has
eliminated unnecessary paperwork, eased administrative
burdens, and significantly sped up the licensing process for
these affiliated clinics.
3)SUPPORT . Supporters argue this bill will better align the
licensing and Medi-Cal enrollment process for community
clinics by requiring DHCS to approve and enroll affiliated
primary care clinics certified by DPH within 15 days.
According to supporters, this expedited process will allow
clinics to open their doors more quickly and begin providing
needed health care services to the individuals and families in
their communities. They note the clinic can be licensed
within 15 days but it can take up to four months to be
approved as a Medi-Cal provider and receive reimbursements,
making opening a health center an even more challenging and
expensive undertaking.
The California Medical Association (CMA) and the California
Chapter of the American College of Emergency Physicians
(Cal/ACEP) have a position of support if amended. They agree
with the goals of this bill and agree that more can be done to
streamline the approval process for Medi-Cal providers. The
amendment sought by CMA and Cal/ACEP would include emergency
physicians. They both report that some providers have
experienced delays of more than one year before being approved
for Medi-Cal. They argue this is a special hardship on
emergency physicians who are required under federal law to
treat all patients that come through the door regardless of
their ability to pay.
4)PREVIOUS LEGISLATION . SB 442 (Ducheny), Chapter 502, Statutes
of 2010, streamlines the administrative requirements for a
clinic corporation to apply for licensure for an affiliate
primary care clinic or a mobile health care unit operated as a
primary care clinic.
5)POSSIBLE AMENDMENTS .
a) The timeline requiring DHCS action is very short and may
not be practical for DHCS without additional resources.
The author may want to consider if a slightly longer time
frame, say 30 days, would be more realistic for DHCS to
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accomplish.
b) The intent of the author is for an application to be
deemed approved after the 15-day review period and for the
applicant to be allowed to participate in other health
programs 15 days after approval of the application for
Medi-Cal. The author may want to consider an amendment to
clarify the approval timing and allow DHCS to approve an
application sooner than 15 days.
REGISTERED SUPPORT / OPPOSITION :
Support
American Federation of State, County and Municipal Employees,
AFL-CIO
California Academy of Family Physicians
California Primary Care Association
Planned Parenthood Advocacy Project Los Angeles
Planned Parenthood Affiliates of California
Planned Parenthood Mar Monte
Planned Parenthood of Orange and San Bernardino Counties
Planned Parenthood of Santa Barbara
Planned Parenthood of the Pacific Southwest
Planned Parenthood Pasadena and San Gabriel Valley
Planned Parenthood Shasta Pacific Action Fund
Six Rivers Planned Parenthood
Opposition
None on file.
Analysis Prepared by : Roger Dunstan / HEALTH / (916) 319-2097