BILL ANALYSIS                                                                                                                                                                                                    Ó




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                                       CONSENT


          Bill No:  SB 299
          Author:   Monning (D)
          Introduced:2/23/15  
          Vote:     27  - Urgency

           SENATE HEALTH COMMITTEE:  9-0, 4/8/15
           AYES:  Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,  
            Pan, Roth, Wolk

          SENATE APPROPRIATIONS COMMITTEE:  Senate Rule 28.8

           SUBJECT:   Medi-Cal:  provider enrollment


          SOURCE:    Author


          DIGEST:  This bill exempts health care providers submitting a  
          Medi-Cal provider application package to the Department of  
          Health Care Services' (DHCS) Medi-Cal provider enrollment  
          division from the current notarization requirements if the  
          provider enrolls electronically.  Conforms state law to federal  
          regulation by requiring DHCS to designate a provider or  
          applicant as a "high" categorical risk if DHCS lifted a  
          temporary moratorium within the previous six months for the  
          particular provider type submitting the application.


          ANALYSIS:
          
          Existing law:

          1)Establishes the Medi-Cal program, which is administered by  
            DHCS, under which qualified low-income individuals receive  
            health care services. 








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          2)Requires an applicant or provider to submit a complete  
            application package for enrollment as a Medi-Cal provider, and  
            generally requires the application package for enrollment, the  
            provider agreement, and all attachments or changes that are  
            submitted by specified applicants or providers to be  
            notarized.

          3)Designates Medi-Cal provider types as "limited," "moderate,"  
            or "high" categorical risk by the federal government, and  
            requires DHCS, at minimum, to utilize the federal regulations  
            in determining a provider's or applicant's categorical risk. 

          4)Requires DHCS, in accordance with federal regulation, to  
            designate a provider or applicant as a "high" categorical risk  
            if specified conditions are met, including if the federal  
            Centers for Medicare and Medicaid Services (CMS) lifted a  
            temporary moratorium within the previous six months for the  
            particular provider type submitting the application, the  
            applicant would have been prevented from enrolling based on  
            that previous moratorium, and the applicant applies for  
            enrollment as a provider at any time within six months from  
            the date the moratorium was lifted.
          
          This bill:
          
          1)Exempts, from the current DHCS notarization requirements, any  
            provider that chooses to enroll electronically.

          2)Conforms state law to federal regulation by requiring DHCS to  
            designate a provider or applicant as a "high" categorical risk  
            if DHCS (in addition to CMS) lifted a temporary moratorium  
            within the previous six months for the particular provider  
            type submitting the application.

          3)Deletes various obsolete provisions of law.

          Comments
          
          1)Author's statement.  According to the author, this bill  
            removes the obsolete statutory notarization requirement for  
            Medi-Cal provider applicants when applying online in an effort  








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            to simplify and improve the Medi-Cal enrollment process.  
            Because DHCS is developing an online enrollment system that is  
            scheduled for a September 2015 rollout, the urgency clause  
            included in this bill is necessary to avoid duplicative  
            identity verification.

          2)Medi-Cal provider enrollment and electronic applications.   
            State law governing Medi-Cal and federal Medicaid law and  
            regulations contain provisions to prevent and address fraud  
            and abuse in the Medicaid program. DHCS' Provider Enrollment  
            Division (PED) is responsible for the enrollment and  
            re-enrollment of 40 fee-for-service health care provider types  
            into the Medi-Cal program. Later this year, DHCS' PED is  
            proposing to implement the Provider Application and Validation  
            for Enrollment (PAVE) system. PAVE is intended to transform  
            DHCS' provider enrollment activities from a manual process to  
            a web-based portal that providers can use to complete and  
            submit their applications, verifications and report changes.  
            The urgency clause in this bill would permit provider  
            applications to be submitted electronically without the  
            current notarization requirement in anticipation of PAVE  
            implementation.
          
          3)Categorical risk of fraud and provider moratorium.  Federal  
            regulations require state Medicaid agencies to screen all  
            initial applications, including applications for a new  
            practice location, and any applications received in response  
            to a re-enrollment or revalidation of enrollment request based  
            on a categorical risk level of "limited," "moderate," or  
            "high." Federal regulations require, when a state Medicaid  
            agency designates a provider as a "high" categorical risk, the  
            agency to conduct a criminal background check and require the  
            submission of fingerprints. Under federal regulations, state  
            Medicaid agencies must adjust the categorical risk level from  
            "limited" or "moderate" to "high" when the state Medicaid  
            agency or CMS in the previous six months lifted a temporary  
            moratorium. 

          This bill conforms state law to this federal regulation if DHCS  
            were to lift a temporary moratorium. DHCS has three enrollment  
            moratoriums currently in effect: (a) clinical laboratories  
            (statewide); (b) durable medical equipment providers located  








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            in Los Angeles, Orange, Riverside, and San Bernardino  
            Counties, and out-of-state; and, (c) non-chain, non-pharmacist  
            owned pharmacies in Los Angeles County. 
            
          FISCAL EFFECT:   Appropriation:    No          Fiscal  
          Com.:YesLocal:   No


          SUPPORT:   (Verified4/20/15)


          California Association of Physician Groups
          California Chapter of the American College of Emergency  
          Physicians
          California Pharmacists Association 


          OPPOSITION:   (Verified  4/20/15)


          None received


          ARGUMENTS IN SUPPORT:  The California Chapter of the American  
          College of Emergency Physicians (Cal-ACEP) writes in support  
          that emergency physicians have reported problems with enrolling  
          in the Medi-Cal program, and delays can be more than one year  
          before the emergency physician is approved. Cal-ACEP states any  
          effort to lessen the administrative burden on Medi-Cal providers  
          is a welcome relief, and by exempting providers who choose to  
          enroll electronically from the notarization requirements, this  
          bill would do just that.



          Prepared by:Scott Bain / HEALTH / 
          4/22/15 16:20:15


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