Bill Text: CA SB1268 | 2023-2024 | Regular Session | Amended

California Senate Bill 1268

Bill Title: Medi-Cal managed care plans: contracts with safety net providers.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced) 2024-04-24 - April 24 set for first hearing canceled at the request of author. [SB1268 Detail]

Download: California-2023-SB1268-Amended.html

Amended IN Senate April 15, 2024

Amended IN Senate March 20, 2024

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Senate Bill

No. 1268

Introduced by Senator Nguyen

February 15, 2024

An act to add Section ~~14197.8~~ 14197.13 to the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL'S DIGEST

SB 1268, as amended, Nguyen. Medi-Cal managed care plans: contracts with safety net providers.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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. Under existing law, one of the methods by which Medi-Cal services are provided is pursuant to contracts between the department and various types of managed care plans and between those plans and providers of those services.

In the case of a contract between a Medi-Cal managed care plan and a safety net provider, as defined, that furnishes Medi-Cal services, the bill would, to the extent not in conflict with federal law, prohibit the plan and the provider from terminating the contract during the contract period without first declaring the cause of termination. The bill would prohibit the declared cause of termination from being a material fact or condition that existed at the time that the contract was entered into by those parties, and of which both parties had knowledge at that time.
This bill would require a Medi-Cal managed care plan to offer a network provider contract to, and maintain a network provider contract with, each safety net provider, as defined, operating within the plan’s contracted geographic service areas if the safety net provider agrees to provide its applicable scope of services in accordance with the same terms and conditions that the Medi-Cal managed care plan requires of other similar providers.
The bill would set forth exceptions to that requirement in the case of a safety net provider no longer being willing to accept those terms and conditions, its license being revoked or suspended, or the department determining that the health or welfare of a Medi-Cal enrollee is threatened by the provider. The bill would require the plan to follow certain notification procedures if it terminates the network provider contract.
The bill would condition implementation of these provisions on receipt of any necessary federal approvals and the availability of federal financial participation.

Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO

The people of the State of California do enact as follows:

SECTION 1.

Section 14197.13 is added to the Welfare and Institutions Code, immediately following Section 14197.11, to read:

14197.13.
(a) Except as provided in subdivision (b), and notwithstanding any other law to the contrary, a Medi-Cal managed care plan shall offer a network provider contract to, and maintain a network provider contract with, each safety net provider operating within the plan’s contracted geographic service areas if the safety net provider agrees to provide its applicable scope of services in accordance with the same terms and conditions that the Medi-Cal managed care plan requires of other similar providers.
(b) (1) If a safety net provider is no longer willing to accept a network provider contract on the same terms and conditions required of other similar providers, and the Medi-Cal managed care plan elects to terminate the network provider contract as a result, the Medi-Cal managed care plan shall notify the department of its intent to terminate that network provider contract with the applicable safety net provider at least 60 calendar days prior to the effective date of the intended contract termination.
(2) If the license of the safety net provider is revoked or suspended, or if the department determines that the health or welfare of a Medi-Cal enrollee is threatened by the provider, the Medi-Cal managed care plan may terminate the network provider contract with the applicable safety net provider immediately and without prior approval from the department, but the plan shall notify the department and the provider of the termination concurrently.
(c) This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available and not otherwise jeopardized.
(d) For purposes of this section, the following definitions apply:
(1) “Medi-Cal managed care plan” has the same meaning as set forth in subdivision (j) of Section 14184.101.
(2) “Network provider” has the same meaning as set forth in Section 438.2 of Title 42 of the Code of Federal Regulations.
(3) “Safety net provider” means any provider of comprehensive primary care services or acute inpatient hospital services that serves a significant number of Medi-Cal beneficiaries, patients receiving charity, or patients who are medically underinsured, in relation to the total number of patients served by the provider. For purposes of a safety net provider of acute inpatient hospital services, this term includes, but is not limited to, a Medicaid Disproportionate Share Hospital-eligible hospital as described in Section 14105.98 and the Medi-Cal State Plan.

SECTION 1.Section 14197.8 is added to the Welfare and Institutions Code, to read:
14197.8.
(a)In the case of a contract between a Medi-Cal managed care plan of any type and a safety net provider, as defined in subdivision (e), that furnishes health care services covered under the Medi-Cal program, the plan and the provider shall not terminate the contract during the contract period without first declaring the cause of termination.
(b)The declared cause of termination described in subdivision (a) shall not be a material fact or condition that existed at the time that the contract was entered into by the plan and the provider, and of which both the plan and the provider had knowledge at the time of entering that contract.
~~(c)This section shall not be construed as modifying or otherwise affecting Section 14197.7.~~
~~(d)This section shall be implemented only to the extent not in conflict with federal law.~~
(e)For purposes of this section, “safety net provider” has the same meaning as set forth in Section 53810 of Title 22 of the California Code of Regulations, or its successor, and in which the provider has agreed to provide services under the same terms and conditions that the Medi-Cal managed care plan requires of any other similar provider to be included in the health care delivery system under a contract with the Medi-Cal managed care plan.