BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Kevin de Le�n, Chair
SB 1150 (Hueso and Correa) - Medi-Cal: federally qualified
health centers and rural health clinics.
Amended: March 26, 2014 Policy Vote: Health 9-0
Urgency: No Mandate: No
Hearing Date: May 5, 2014 Consultant: Brendan McCarthy
This bill meets the criteria for referral to the Suspense File.
Bill Summary: SB 1150 would require the Medi-Cal program to
reimburse federally qualified health centers and rural health
clinics for two visits by a Medi-Cal beneficiary taking place on
the same day, under certain circumstances.
Fiscal Impact:
One-time administrative costs up to $150,000 to develop a
state plan amendment by the Department of Health Care
Services (General Fund and federal funds).
Likely annual costs in the millions to low tens of millions
per year due to increased utilization of services at clinics
(General Fund and federal funds). Under the current
limitation on reimbursing for two visits on the same day,
clinics typically direct a patient needing an additional
services to return on another day. In practice, this reduces
the utilization of services because patients often are not
willing or able to make another appointment or do not return
for the subsequent appointment. By reimbursing clinics for a
second visit on the same day, patients are more likely to
make use of those services, increasing utilization.
Background: Under current law, the Medi-Cal program provides
health care coverage for certain low income and disabled
individuals.
Under current law, when care is provided to a Medi-Cal
beneficiary at a federally qualified health center or a rural
health clinic, the Department only reimburses for a single visit
per day (except if the patient subsequently suffers an injury or
illness or for a subsequent dental visit). If the patient needs
follow up care or different services (such as a mental health
SB 1150 (Hueso and Correa)
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visit) those services must be provided on a different day. In
practice, this requirement limits the use of services by
Medi-Cal beneficiaries, as logistical issues often make it
difficult for beneficiaries to return to a clinic on another
day.
The federal Affordable Care Act allows states to expand Medicaid
(Medi-Cal in California) eligibility to persons under 65 years
of age, who are not pregnant, not entitled to Medicare Part A or
enrolled in Medicare Part B, and whose income does not exceed
133 percent of the federal poverty level (effectively 138
percent of the federal poverty level as calculated under the
Affordable Care Act). California has opted to expand eligibility
for Medi-Cal up to 138 percent of the federal poverty level.
The Affordable Care Act provides a significantly enhanced
federal match for the Medicaid expansion. Under the law, the
federal government will pay for 100 percent of the cost of the
Medicaid expansion in 2013-14 declining to a 90 percent federal
match in the 2020 federal fiscal year and thereafter.
Proposed Law: SB 1150 would require the Medi-Cal program to
reimburse federally qualified health centers and rural health
clinics for two visits by a Medi-Cal beneficiary taking place on
the same day, under certain circumstances.
Specific provisions of the bill would:
Authorize a second visit to be billed if the patient
suffers an illness or injury after the first visit or the
patient has a medical visit and a second visit with a dental
or mental health provider;
Specify the types of additional visits that would be
allowed (with a dental or mental health provider);
Require a federally qualified health center or a rural
health clinic that currently includes the cost for multiple
visits on the same day as constituting a single visit when
billing the Medi-Cal program to apply for a rate adjustment;
Require the Department of Health Care Services to
facilitate the adjustment of rates as needed;
Require the Department to apply to the federal government
for a state plan amendment to implement the changes
authorized in the bill.
Related Legislation:
SB 1150 (Hueso and Correa)
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AB 1445 (Chesbro, 2010) was substantially similar to this
bill. That bill was held on this committee's Suspense File.
SB 260 (Steinberg, 2007) was substantially similar to this
bill. That bill was vetoed by Governor Schwarzenegger.
Staff Comments: The increased costs that the state would incur
under the bill would be split between the state and the federal
government. Traditionally, the federal government has paid 50
percent of the costs for most Medi-Cal beneficiaries (children
formerly eligible for the Healthy Families Program and now
enrolled in Medi-Cal are eligible for an increased federal cost
share). Under the Medi-Cal expansion, the federal government
will pay for 100 percent of the Medi-Cal costs initially,
declining to 90 percent by 2020. The share of additional costs
incurred by the state under the bill that would be paid by the
federal government will vary depending on the individual
patient's specific Medi-Cal eligibility (i.e. whether he or she
would have previously been eligible for Medi-Cal, or whether he
or she is newly eligible).