SB 1339, as amended, Cannella. Medi-Cal: Drug Medi-Cal Treatment Program providers.
Existing law provides for the Drug Medi-Cal (DMC) Treatment Program, under which counties enter into contracts with the State Department of Health Care Servicesbegin delete (DHCS)end delete for the provision of various drug treatment services to Medi-Cal recipients, or the department directly arranges for the provision of these services if a county elects not to do so.
Existing law requires thebegin delete DHCSend deletebegin insert State Department of Health Care Servicesend insert to screen Medi-Cal providers and designate each providerbegin insert or applicantend insert
as “limited,” “moderate,” or “high” categorical risk. Existing law requires a provider or applicant designated as a “high” categorical risk, and a person with a 5% or greater direct or indirect ownership interest in the provider, to submit to the Department of Justice fingerprint images and related information for the purpose of obtaining information as to the existence of past criminal conduct, as specified. Existing law requires the Department of Justice to charge a fee, to be paid by the applicant or provider, sufficient to cover the cost of processing the criminal background check request.
This bill would require DMC providers to be designated as a “high” categorical risk and be subject to the background checks described above.begin insert The bill would provide that if the provider or applicant is a nonprofit Drug Medi-Cal provider or applicant, the criminal background check and the requirement to submit fingerprint images and related information would apply to the officers and executive director of the provider or applicant.end insert The bill would permit the department to designate a DMC provider as a “limited” or “moderate” categorical risk by executing a declaration stating the reason or reasons that a “high” categorical risk designation is no longer warranted. The bill would provide that it is the responsibility of the DMC provider, or the person with a 5% or greater direct or indirect ownership interest in the provider, to pay the fee imposed for processing the criminal background check request, as applicable. The bill would prohibit, except as provided by federal law, a DMC provider from being excluded from contracting with a county or the department based solely on the existence of a past criminal record of the DMC provider or a person with a 5% or greater direct or indirect ownership interest in the provider.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
begin insertSection 14043.38 of the end insertbegin insertWelfare and Institutions
2Codeend insertbegin insert is amended to read:end insert
(a) Provider types are designated as “limited,”
4“moderate,” or “high” categorical risk by the federal government
5in Section 424.518 of Title 42 of the Code of Federal Regulations.
6The department shall, at minimum, utilize the federal regulations
7in determining a provider’s or applicant’s categorical risk.
8(b) In accordance with Section 455.450 of Title 42 of the Code
9of Federal Regulations, the department shall designate a provider
10or applicant as a “high” categorical risk if any of the following
11occur:
12(1) The department imposes a payment suspension based on a
13credible allegation of fraud, waste, or abuse.
P3 1(2) The provider or
applicant has an existing Medicaid
2overpayment based on fraud, waste, or abuse.
3(3) The provider or applicant has been excluded by the federal
4Office of the Inspector General or another state’s Medicaid program
5within the previous 10 years.
6(4) The federal Centers for Medicare and Medicaid Services
7lifted a temporary moratorium within the previous six months for
8the particular provider type submitting the application, the applicant
9would have been prevented from enrolling based on that previous
10moratorium, and the applicant applies for enrollment as a provider
11at any time within six months from the date the moratorium was
12lifted.
13(c) If the department designates a provider or applicant as a
14“high” categorical risk, the department or its designee shall do
15both of the following:
16(1) Conduct a criminal background check ofbegin delete the provider or begin insert
the
17applicant, and any person with a 5-percent or greater direct or
18indirect ownership interest in the provider or applicant.end delete
19following persons:end insert
20(A) The provider or applicant. If the provider or applicant is a
21nonprofit Drug Medi-Cal provider or applicant, the officers and
22executive director of the provider or applicant.
23(B) Any person with a 5-percent or greater direct or indirect
24ownership interest in the provider or applicant.
25(2) Requirebegin delete the provider or applicant, and any person with a begin insert
the following personsend insert to submit a set of
265-percent or greater direct or indirect ownership interest in the
27provider or applicant,end delete
28fingerprints within 30 days of the department’s request, in a manner
29determined by thebegin delete department.end deletebegin insert department:end insert
30(A) The provider or applicant. If the provider or applicant is a
31nonprofit Drug Medi-Cal provider or applicant, the officers and
32executive director of the provider or applicant.
33(B) Any person with a 5-percent or greater direct or indirect
34ownership interest in the provider or applicant.
35(d) (1) The department
shall submit to the Department of Justice
36fingerprint images and related information required by the
37Department of Justice of Medi-Cal providers or applicants
38determined to be a “high” categorical risk pursuant to subdivision
39(a), and any person with a 5-percent or greater direct or indirect
40ownership interest in those providers and applicants, for the
P4 1purposes of obtaining information as to the existence and content
2of a record of state or federal convictions and state or federal arrests
3and also information as to the existence and content of a record of
4state or federal arrests for which the Department of Justice
5establishes that the person is free on bail or on his or her
6recognizance pending trial or appeal.
7(2) When received, the Department of Justice shall forward to
8the Federal Bureau of Investigation requests for federal summary
9criminal history information received pursuant to this section. The
10Department of Justice shall review the
information returned from
11the Federal Bureau of Investigation and compile and disseminate
12a response to the department.
13(3) The Department of Justice shall provide a state or federal
14level response to the department pursuant to paragraph (1) of
15subdivision (p) of Section 11105 of the Penal Code.
16(4) The department shall request from the Department of Justice
17subsequent notification service, as provided pursuant to Section
1811105.2 of the Penal Code, for persons described in paragraph (1).
19(5) The Department of Justice shall charge a fee sufficient to
20cover the cost of processing the request described in this section.
21That fee shall be paid by the subject of the criminal background
22check.
23(e) For persons subject to the requirements of subdivision (a)
24of
Section 15660, the procedure for obtaining and submitting
25fingerprints and notification by the Department of Justice of
26criminal record information set forth in subdivision (c) of Section
2715660 shall apply instead of the procedure set forth in subdivision
28(d).
Section 14124.27 is added to the Welfare and
31Institutions Code, to read:
(a) (1) Certified Drug Medi-Cal (DMC) providers
33shall be designated as a “high” categorical risk pursuant to Section
3414043.38 and the provider and any person with a 5 percent or
35greater direct or indirect ownership interest in the provider shall
36be subject to background checks pursuant to the provisions of that
37section.
38(2) The department may designate a DMC provider as a
39“limited” or “moderate” categorical risk for purposes of Section
4014043.38 and federal regulations. To designate a DMC provider
P5 1as a “limited” or “moderate” categorical risk, the department shall
2execute a declaration, to be retained by the director, with a copy
3
to be posted on the department’s Internet Web site and a copy
4transmitted to the Legislature, stating the reason or reasons that a
5“high” categorical risk designation for that provider is no longer
6warranted.
7(b) Payment of the fee imposed pursuant to paragraph (5) of
8subdivision (d) of Section 14043.38 shall be the responsibility of
9the DMC provider or person with a 5 percent or greater direct or
10indirect ownership interest in the provider, as applicable.
11(c) Except as provided by federal law, a DMC provider shall
12not be excluded from contracting with a county or the department
13based solely on the existence of a past criminal record of the DMC
14provider or a person with 5 percent or greater direct or indirect
15ownership interest in the provider.
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