Bill Text: CA SB456 | 2017-2018 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: California Consumer Privacy Act of 2018.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Engrossed - Dead) 2018-08-24 - Re-referred to Com. on RLS. pursuant to Assembly Rule 77.2. [SB456 Detail]

Download: California-2017-SB456-Amended.html

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Amended  IN  Assembly  August 20, 2018

Amended  IN  Assembly  June 19, 2017

Amended  IN  Senate  April 26, 2017

Amended  IN  Senate  March 23, 2017

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Senate Bill

No. 456

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Introduced by Senator Pan
(Coauthor: Assembly Member Gonzalez Fletcher)

February 16, 2017

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An act to add Section 14087.326 to the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL'S DIGEST

SB 456, as amended, Pan. Medi-Cal managed care: federally qualified health centers and rural health clinics: services that follow the patient.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. Existing law provides that federally qualified health center (FQHC) services and rural health clinic (RHC) services, as defined, are covered benefits under the Medi-Cal program, to be reimbursed, to the extent that federal financial participation is obtained, to providers on a per-visit basis. “Visit” is defined as a face-to-face encounter between a patient of an FQHC or RHC and specified health care professionals. Existing law requires a managed care entity to offer subcontracts to FQHCs and RHCs in the relevant service area, as a condition of obtaining a contract with the department.

This bill would authorize an a willing and qualified FQHC or RHC to enter into an agreement with a public or private entity willing and qualified to provide services that follow the patient. patient and to receive reimbursement from the public or private entity for the services rendered under the agreement. The bill would prohibit the department from recouping payment authorized under this agreement from the FQHC or RHC, as specified. The bill would describe those entities eligible to contract with an FQHC or RHC under the bill, and would define “services that follow the patient” as services that are not reimbursable on a per-visit basis pursuant to a specified provision, that promote continuity of care and contribute to overall patient wellness, as specified. The bill would specify that compensation paid to a federally qualified health center or rural health clinic pursuant to the agreement would be supplemental to, and separate from, the federally qualified health center’s or rural health clinic’s prospective payment rate, and not subject to reconciliation or reduction, as specified. The bill would prohibit an FQHC or RHC that bills an entity for services that follow the patient from seeking reimbursement or attempting to obtain payment for a service billed pursuant to the specified per-visit billing provision, but would not preclude the FQHC or RHC from billing a visit under that provision and a service provided pursuant to the bill on the same day. The bill would make legislative findings and declarations related to this measure.

Digest Key

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

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Bill Text

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

SECTION 1.

 The Legislature finds and declares all of the following:

(a) Improved patient outcomes and lower costs in the Medi-Cal program can be achieved through providing “services that follow the patient” which refers to services rendered outside the face-to-face visit between a patient and a provider, and the purpose of these services is to support access to and coordination with other medical and non-medical care entities.

(b) There are many state and local initiatives currently underway to expand opportunities for “services that follow the patient” and improve the Medi-Cal delivery system. Examples include the Whole Person Care pilot program, which is a component of the Medi-Cal 2020 Demonstration Project Act, the Diabetes Prevention Program, the California Medication Assisted Treatment (MAT) Expansion Project, and an array of programs developed and supported by Medi-Cal managed care plans and counties.

(c) Many of these programs seek to leverage the primary care provider to coordinate and provide “services that follow the patient”.

(d) Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) provide medically necessary services to a large population of Medi-Cal beneficiaries in California that participate in state and local initiatives that are rooted in the spirit of programs supporting “services that follow the patient”.

(e) Currently, FQHCs and RHCs face administrative barriers that limit their ability to access opportunities to actively serve patients and provide “services that follow the patient” due to the prospective payment system (PPS) reconciliation process.

(f) Under existing federal law, FQHCs and RHCs are not prohibited from entering into agreements with other service providers and entities to render services that are of the nature of “services that follow the patient”. Nevertheless, due to unclear state guidance and policy regarding the treatment of payments for these services outside of the PPS rate, clinics experience barriers that hinder or limit their ability to receive payment for certain services rendered under agreements with other entities.

(g) The State Department of Health Care Services has not provided guidance to FQHCs and RHCs regarding reimbursement policies related to “services that follow the patient.” Therefore, for patients who utilize FQHCs or RHCs as their primary care providers, “services that follow the patient” may not be readily accessible to them.

SECTION 1. SEC. 2.

 Section 14087.326 is added to the Welfare and Institutions Code, to read:

14087.326.

 (a) A willing and qualified federally qualified health center (FQHC) or rural health clinic (RHC) may enter into an agreement with a public or private entity willing and qualified to provide services that follow the patient, as described in this section. section, and the FQHC and RHC may receive reimbursement from the public or private entity for the services rendered under the agreement. To the extent authorized under federal law, the department shall not recoup payment issued under this agreement from the FQHC or RHC. A public or private entity eligible to contract with a federally qualified health center or rural health clinic an FQHC or RHC pursuant to an agreement described in this section shall include, but not be limited to, any of the following:

(1) A managed care health plan.

(2) A county.

(3) A health care district.

(4) A community-based organization.

(5) An individual health care or social services provider whose activities under this section comply with the individual’s scope of practice or certification.

(b) As used in this section, “services that follow the patient” means services that are not reimbursable pursuant to Section 14132.100, that promote continuity of care and contribute to overall patient wellness. These services include, but are not limited to, all of the following: include an array of services provided to eligible Medi-Cal beneficiaries under the following programs:

(1)Comprehensive care management.

(2)Care coordination.

(3)Health and wellness initiatives.

(4)Comprehensive transitional care.

(5)Individual and family support services.

(6)Referral to community and social supports.

(1) The Medi-Cal 2020 Waiver Whole Person Care pilot program, as authorized under Section 14184.60 and pursuant to the Medi-Cal 2020 Demonstration Project Act, as described in Article 5.5 (commencing with Section 14184).

(2) The Diabetes Prevention Program, as authorized under Article 4.11 (commencing with Section 14149.9).

(3) The California Medication Assisted Treatment (MAT) Expansion Project.

(4) The Chronic Care Management program, which was established by the Centers for Medicare and Medicaid Services.

(5) Any other programs that provide services to Medi-Cal enrollees that are otherwise non-reimbursable under the Medi-Cal program, and are approved by the department.

(c) Compensation paid to a federally qualified health center or rural health clinic an FQHC or RHC pursuant to an agreement described in this section shall be supplemental to, and separate from, the federally qualified health center’s or rural health clinic’s its prospective payment rate and shall not be subject to a reconciliation pursuant to Section 14087.325, or to any reduction.

(d) A federally qualified health center or rural health clinic An FQHC or RHC that bills an entity in subdivision (a) for services that follow the patient may not seek reimbursement or attempt to obtain payment from the department or an entity for a service billed pursuant to Section 14132.100.

(e) This section does not preclude a federally qualified health center or rural health clinic an FQHC or RHC from billing a visit under Section 14132.100 and a service under this section on the same day.