BILL ANALYSIS                                                                                                                                                                                                    �



                                                                  SB 1315
                                                                  Page  1

          Date of Hearing:   August 6, 2014

                        ASSEMBLY COMMITTEE ON APPROPRIATIONS
                                  Mike Gatto, Chair

                   SB 1315 (Monning) - As Amended:  June 30, 2014 

          Policy Committee:                             HealthVote:17-0

          Urgency:     No                   State Mandated Local Program:  
          No     Reimbursable:              No

           SUMMARY  

          This bill modifies rules related to temporary suspensions of  
          providers from the fee-for-service Medi-Cal program.   
          Specifically, this bill:

          1)Requires a list of discrepancies and the time frame to  
            remediate discrepancies.

          2)Requires the Department of Health Care Services to lift a  
            temporary suspension upon demonstration that deficiencies have  
            been remediated and standards have been met within the  
            specified time frame.

          3)Requires DHCS to notify a provider he/she is removed from  
            enrollment in Medi-Cal based on failure to remediate the  
            discrepancies identified in the notice of temporary  
            suspension.

           FISCAL EFFECT  

          Minor costs to DHCS to revise regulations (GF/federal). 

           COMMENTS  

           1)Purpose  . This bill is supported by DHCS, in order to further  
            clarify the temporary suspension process and to allow the  
            department to enforce corrective actions against suspended  
            providers who fail to remediate deficiencies. The author  
            contends current law fails to require any final action  
            pertaining to temporarily suspended providers and that  
            requiring a time frame for compliance, as well as authorizing  
            the additional action to deactivate, could reduce the  








                                                                  SB 1315
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            prevalence of fraud and increase program integrity.  

           2)Background  .  The Medi-Cal program consists of two delivery  
            systems: fee-for-service and managed care.  Within the  
            fee-for-service system, DHCS centrally enrolls providers and  
            verifies compliance with program standards.  If the DHCS  
            provider enrollment division identifies significant  
            discrepancies in information provided to the department, or  
            discrepancies are discovered as a result of a visit to a  
            provider, a provider must remediate the discrepancies to avoid  
            suspension. Current law does not specify what occurs when a  
            provider fails to correct the identified issues.
           
           Analysis Prepared by  :    Lisa Murawski / APPR. / (916) 319-2081