BILL ANALYSIS
AB 2674
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 2674 (Chu)
As Amended August 26, 2002
Majority vote
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|ASSEMBLY: | |(May 28, 2002) |SENATE: |38-0 |(August 28, |
| |79-0 | | | |2002) |
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Original Committee Reference: HEALTH
SUMMARY : Requires any Medi-Cal Managed Care enrollee who
selects, or is assigned to, a federally qualified health center
(FQHC) or rural health clinic (RHC), or to an employee of
either, to be assigned directly to the FQHC or RHC, and not to
any individual provider performing services on behalf of the
FQHC or RHC. Requires reports related to participation of FQHCs
and RHCs in Medi-Cal Managed Care. Specifically, this bill :
1)Requires any Medi-Cal Managed Care enrollee who selects, or is
assigned to, a FQHC or RHC to be assigned directly to the FHQC
or RHC, and not to any individual provider performing services
on behalf of the FQHC or RHC.
2)Requires, notwithstanding any other provision of law, Medi-Cal
beneficiaries to be entitled to affirmatively select, or to be
assigned by default to, any primary care provider as defined.
3)Requires, notwithstanding any other provision of law, when a
Medi-Cal beneficiary is assigned to a primary care physician,
and that primary care physician is an employee of a primary
care provider, as defined, the assignment constitutes an
assignment to the primary care provider.
4)Repeals requirement that FQHCs and RHCs must waive their
rights to cost based reimbursement to participate in Medi-Cal
Managed Care Risk contracts.
5)Contains language from SB 1413 to avoid chaptering out should
both bills be enacted.
The Senate amendments :
1)Delete requirement for reports related to participation of
AB 2674
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FQHCs and RHCs in Medi-Cal Managed Care.
2)Contain language from SB 1413 to avoid chaptering out should
both bills be enacted.
AS PASSED BY THE ASSEMBLY , this bill required any Medi-Cal
Managed Care enrollee who selects, or is assigned to, a FQHC or
RHC, or to an employee of either, to be assigned directly to the
FQHC or RHC, and not to any individual provider performing
services on behalf of the FQHC or RHC. Required reports related
to participation of FQHCs and RHCs in Medi-Cal Managed Care.
FISCAL EFFECT : According to the Assembly Appropriations
Committee Analysis:
1)Costs to Medi-Cal-probably over $300,000 (GF) to the extent
that FQHCs and RHCs participating in managed care contracts
qualify for supplemental payments under a new federally
required FQHC/RHC payment system. However, this provision in
the bill to repeal a disqualification from cost-based
reimbursement is intended to bring California into compliance
with federal requirements.
2)Minor, absorbable costs to DHS to collect the information from
commercial plans on their FQHC and RHC beneficiaries and
update the DHS Web site quarterly.
COMMENTS: According to the author, this bill will clearly
indicate in statute that community clinics are capable and
eligible to receive Medi-Cal enrollee assignments and referrals.
The author states that in the current managed care system of
assignment to physicians, clinics are invisible within both the
referral system of care and the assignment of enrollees.
Without the ability of clinics to receive assignment of managed
care lives, patients coming into Medi-Cal continue to lose out
on being offered the choice of community-based clinics as one of
their choices of providers. The author believes this bill will
result in improved quality of care, increased patient choice,
and increased access to critical enabling services, such as
transportation, translation, childcare, and case management that
community clinics offer. Additionally, community clinics tend
to be more convenient for their patients because they
incorporate a wide range of services, including medical, dental,
and optometry. Community-based clinic patients are
predominantly low-income and uninsured. On average, 44% of
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clinic patients do not speak English as their first language.
Community-based clinics serve California's culturally and
ethnically diverse population that make up the majority of
Medi-Cal enrollees, yet they represent a small percentage of the
managed care providers in these programs. The author believes
that one of the barriers is a system that precludes clinics from
receiving the assignment of managed care enrollees and precludes
patients from choosing a clinic as their primary care provider.
The author states this system creates an unintended barrier to
integrating community clinics into the managed care system of
health care.
By requiring "notwithstanding any other provision of law," if
this bill is adopted, two provisions of this bill will override
any existing state law that is in conflict with those
provisions. Those two provisions are: the requirement that
Medi-Cal beneficiaries are entitled to affirmatively select, or
to be assigned by default to, any primary care provider as
defined; and the requirement that when a Medi-Cal beneficiary is
assigned to a primary care physician, and that primary care
physician is an employee of a primary care provider, as defined,
the assignment constitutes an assignment to the primary care
provider. However, a beneficiary who has established an
on-going professional relationship with a clinic physician may
prefer to be assigned to the physician rather than the clinic in
order to maintain continuity of care with that physician if he
or she leaves the clinic.
Analysis Prepared by : John Gilman / HEALTH / (916) 319-2097
FN: 0007563