Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. Existing law provides for a schedule of benefits and services under the Medi-Cal program, subject to utilization controls. Existing law provides that specified utilization controls may be applied to any specific service or group of services that are subject to utilization controls, including prior authorization requirements. Existing law also requires the department to administer other health programs, including the California Childrens Services Program, the Genetically Handicapped Persons Program, Program and the Child Health and Disability Prevention Program.

This bill would require the department to allow a physician assistant or a nurse practitioner to sign any authorization form required by the department for benefits and services under the Medi-Cal program, the Genetically Handicapped Persons Program, or the Child Health and Disability Prevention Program, and to allow a nurse practitioner to sign any required authorization form, as specified, under the California Childrens Services Program, subject to specified criteria, including, among others, that the physician and the designated physician assistant or nurse practitioner are each enrolled as a Medi-Cal provider.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. Existing law provides for a schedule of benefits and services under the Medi-Cal program, subject to utilization controls. Existing law provides that specified utilization controls may be applied to any specific service or group of services that are subject to utilization controls, including prior authorization requirements. Existing law also requires the department to administer other health programs, including the California Childrens Services Program, the Genetically Handicapped Persons Program, and the Child Health and Disability Prevention Program.

This bill would authorize a physician to designate require the department to allow a physician assistant or a nurse practitioner to sign any authorization form required by the department for benefits and services under the Medi-Cal program, provided that the physician and the designated physician assistant or nurse practitioner are each enrolled as a Medi-Cal provider. program, the Genetically Handicapped Persons Program, or the Child Health and Disability Prevention Program, and to allow a nurse practitioner to sign any required authorization form, as specified, under the California Childrens Services Program, subject to specified criteria, including, among others, that the physician and the designated physician assistant or nurse practitioner are each enrolled as a Medi-Cal provider.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. Existing law provides for a schedule of benefits and services under the Medi-Cal program, subject to utilization controls. Existing law provides that specified utilization controls may be applied to any specific service or group of services that are subject to utilization controls, including prior authorization requirements.

This bill would authorize a physician to designate a physician assistant or nurse practitioner to sign any authorization form required by the department for benefits and services under the Medi-Cal program, provided that the physician and the designated physician assistant or nurse practitioner are each enrolled as a Medi-Cal provider.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. Existing law provides for a schedule of benefits and services under the Medi-Cal program, subject to utilization controls. Existing law provides that specified utilization controls may be applied to any specific service or group of services that are subject to utilization controls, including prior authorization requirements.

This bill would declare the intent of the Legislature to enact legislation to authorize a physician to designate a physician assistant to sign any authorization form required by the State Department of Health Care Services department for benefits and services under the Medi-Cal program, provided that the physician and the designated physician assistant are each enrolled as a Medi-Cal provider.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. Existing law provides for a schedule of benefits and services under the Medi-Cal program, subject to utilization controls. Existing law provides that specified utilization controls may be applied to any specific service or group of services that are subject to utilization controls, including prior authorization requirements.

This bill would declare the intent of the Legislature to enact legislation to authorize a physician to designate a physician assistant to sign any authorization form required by the State Department of Health Care Services for benefits and services under the Medi-Cal program, provided that the physician and the designated physician assistant are each enrolled as a Medi-Cal provider.

 THIRD READING  

Bill No: AB 1368

Author: Calderon (D)

Amended: 6/29/17 in Senate

Vote: 21

SENATE HEALTH COMMITTEE: 9-0, 7/5/17

AYES: Hernandez, Nguyen, Atkins, Leyva, Mitchell, Monning, Newman, Nielsen, Roth

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 75-0, 4/27/17 (Consent) - See last page for vote

SUBJECT: Health professionals: authorization forms

SOURCE: Author

DIGEST:

This bill requires the Department of Health Care Services (DHCS) to allow a nurse practitioner (NP) or physician assistant (PA) to sign any authorization form required by DHCS for benefits and services for the Medi-Cal program, the Genetically Handicapped Persons Program, and the Child Health Disability Prevention Program, if the NP or PA is authorized to provide the service pursuant to their scope of practice and the supervising physician and the NP or PA are enrolled as Medi-Cal providers.

ANALYSIS:

Existing law:

1. Establishes the Medi-Cal program, administered by DHCS, under which health care services are provided to qualified low-income persons.
2. Establishes a schedule of benefits for Medi-Cal beneficiaries, which includes both of the following:
   1. Services provided by a PA are a covered benefit to the extent authorized by federal law and subject to utilization controls; and,
   2. Services provided by a certified NP are covered to the extent authorized by federal law, and subject to utilization controls.
3. Limits the utilization controls that DHCS can apply to Medi-Cal services to the following:
   1. Prior authorization;
   2. Post-service pre-payment audit;
   3. Post-service post-payment audit;
   4. Limitation on number of services; and,
   5. Review of services pursuant to Professional Standards Review Organization agreements entered into in accordance with Section 14104.
4. Establishes the Genetically Handicapped Persons Program (GHPP) and the Child Health Disability Prevention Program (CHDP), which are administered by DHCS.

This bill requires DHCS to allow a PA or NP to sign any authorization form required by DHCS for benefits and services under the Medi-Cal program, the CHDP and the GHPP, subject to both of the following:

1. The PA or NP is authorized by the supervising physician, or the NP’s standardized procedure or protocol, to provide the service pursuant to his or her scope of practice; and,
2. The physician and the designated PA or NP are each enrolled as a Medi-Cal provider

Comments

1. Author’s statement. According to the author, PAs and NPs provide a substantial amount of health care to Medi-Cal beneficiaries throughout the state in nearly every specialty of medicine and every setting. Many Medi-Cal forms require a physician signature (even though a PA or NP has provided the services. Often, these providers are the primary care provider, the usual source of care or the only provider on-site and requiring a physician signature delays care. This bill would authorize PAs and NPs to sign any Medi-Cal authorization form required by DHCS for benefits and services within the Medi-Cal program as long as the physician, PA or NP are enrolled as Medi-Cal providers. This bill is needed to improve practice level efficiency and reduce administrative burdens in team-based care.
   
2. Utilization controls in DHCS-administered programs. DHCS is authorized to use utilization controls to require providers to justify medical necessity and control utilization and spending in the fee-for-service Medi-Cal program. In DHCS-administered programs, providers must fill out a Treatment Authorization request in Medi-Cal, or a Services Authorization Request (SAR) in the GHPP for certain supplies and services, such as incontinence supplies, non-emergency medical transportation, and a treatment plan in GHPP. These forms require a signature by the authorizing physician (or in the case of a GHPP new referral SAR, his or her authorized designee), while other forms (for example, a certificate of medical necessity for sleep apnea monitors) do not require a physician signature.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

SUPPORT: (Verified 8/21/17)

California Academy of Family Physicians

California Academy of Physician Assistants

California Access Coalition

California Association for Nurse Practitioners

California Council of Community Behavioral Health Agencies

CaliforniaHealth +Advocates

OPPOSITION: (Verified 8/21/17)

None received

ARGUMENTS IN SUPPORT: This bill is supported by the California Academy of PAs (CAPA), which writes that this bill recognizes the need to create efficiency in team-based practice by reducing administrative burdens related to specific signature requirements on some Medi-Cal authorization forms. CAPA states that some Medi-Cal authorization forms require a physician signature while others permit signatures from a licensed health care provider or PA. The inconsistency of who may sign which form(s) results in confusion and delays in access to critical needs and services for patients. CAPA states that PAs are recognized as primary care providers and are often a usual source of care for Medi-Cal beneficiaries and as such should be authorized to sign and/or attest to need related to benefits and services within the Medi-Cal program. CAPA concludes that authorizing physicians to designate a PA to sign any Medi-Cal authorization form as long as both the physician and PA are enrolled as Medi-Cal providers would significantly improve practice efficiency and reduce confusion and delays in access to care and services.

ASSEMBLY FLOOR: 75-0, 4/27/17

AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bocanegra, Bonta, Brough, Burke, Caballero, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooper, Cunningham, Dababneh, Dahle, Daly, Eggman, Flora, Fong, Frazier, Friedman, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Ridley-Thomas, Rodriguez, Rubio, Salas, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon

NO VOTE RECORDED: Calderon, Cervantes, Cooley, Gomez, Santiago

Prepared by: Scott Bain / HEALTH / (916) 651-4111

8/23/17 16:25:28

**** END ****

SENATE COMMITTEE ON HEALTH

Senator Ed Hernandez, O.D., Chair

BILL NO: AB 1368

SUBJECT: Health professionals: authorization forms

SUMMARY:

Requires the Department of Health Care Services (DHCS) to allow a nurse

practitioner (NP) or physician assistant (PA) to sign any authorization form required by DHCS for benefits and services for the Medi-Cal program, the Genetically Handicapped Persons Program, and the Child Health Disability Prevention Program, if the NP or PA is authorized to provide the service pursuant to their scope of practice and the supervising physician and the NP or PA are enrolled as Medi-Cal providers.

Existing law:

1. Establishes the Medi-Cal program, administered by DHCS, under which health care services are provided to qualified low-income persons.
2. Establishes a schedule of benefits for Medi-Cal beneficiaries, which includes both of the following:
3. Services provided by a PA are a covered benefit to the extent authorized by federal law and subject to utilization controls; and,
4. Services provided by a certified NP are covered to the extent authorized by federal law, and subject to utilization controls.
5. Limits the utilization controls that DHCS can apply to Medi-Cal services to the following:
6. Prior authorization;
7. Post-service pre-payment audit;
8. Post-service post-payment audit;
9. Limitation on number of services; and,
10. Review of services pursuant to Professional Standards Review Organization agreements entered into in accordance with Section 14104.
11. Establishes the Genetically Handicapped Persons Program (GHPP) and the Child Health Disability Prevention Program (CHDP), which are administered by DHCS.

This bill:

1. Requires DHCS to allow a PA or NP to sign any authorization form required by DHCS for benefits and services under the Medi-Cal program, the Child Health and Disability Prevention Program and the Genetically Handicapped Persons Program, subject to both of the following:
2. The PA or NP is authorized by the supervising physician, or the NP’s standardized procedure or protocol, to provide the service pursuant to his or her scope of practice; and,
3. The physician and the designated PA or NP are each enrolled as a Medi-Cal provider

FISCAL EFFECT:

The current version of this bill has not been analyzed by a fiscal committee.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, PAs and NPs provide a substantial amount of health care to Medi-Cal beneficiaries throughout the state in nearly every specialty of medicine and every setting. Many Medi-Cal forms require a physician signature (even though a PA or NP has provided the services. Often, these providers are the primary care provider, the usual source of care or the only provider on-site and requiring a physician signature delays care. This bill would authorize PAs and NPs to sign any Medi-Cal authorization form required by DHCS for benefits and services within the Medi-Cal program as long as the physician, PA or NP are enrolled as Medi-Cal providers. This bill is needed to improve practice level efficiency and reduce administrative burdens in team-based care.
   
2. Utilization controls in DHCS-administered programs. DHCS is authorized to use utilization controls to require providers to justify medical necessity and control utilization and spending in the fee-for-service Medi-Cal program. In DHCS-administered programs, providers must fill out a Treatment Authorization request (TAR) in Medi-Cal, or a Services Authorization Request (SAR) in the GHPP for certain supplies and services, such as incontinence supplies, non-emergency medical transportation, and a treatment plan in GHPP. These forms require a signature by the authorizing physician (or in the case of a GHPP new referral SAR, his or her authorized designee), while other forms (for example, a certificate of medical necessity for sleep apnea monitors) do not require a physician signature.
   
3. Prior legislation. SB 1457 (Evans, Chapter 849, Statutes of 2014) requires requests for authorization for treatment or services in the Medi-Cal program, California Children’s Services Program, and the GHPP Program, excluding those submitted by dental providers enrolled in the Medi-Cal Dental Program, to be submitted in an electronic format determined by the DHCS via DHCS’ Internet Website or other electronic means designated by DHCS. Requires DHCS to implement an alternate format for submission when DHCS’ Internet Website is unavailable due to a system disruption.
4. Support. This bill is supported by the California Academy of PAs (CAPA), which writes that this bill recognizes the need to create efficiency in team-based practice by reducing administrative burdens related to specific signature requirements on some Medi-Cal authorization forms. CAPA states that some Medi-Cal authorization forms require a physician signature while others permit signatures from a licensed health care provider or PA. The inconsistency of who may sign which form(s) results in confusion and delays in access to critical needs and services for patients. CAPA states that PAs are recognized as primary care providers and are often a usual source of care for Medi-Cal beneficiaries and as such should be authorized to sign and/or attest to need related to benefits and services within the Medi-Cal program. CAPA concludes that authorizing physicians to designate a PA to sign any Medi-Cal authorization form as long as both the physician and PA are enrolled as Medi-Cal providers would significantly improve practice efficiency and reduce confusion and delays in access to care and services.

SUPPORT AND OPPOSITION:

Support: California Academy of Family Physicians

California Academy of Physician Assistants

California Association for Nurse Practitioners

California Council of Community Behavioral Health Agencies

CaliforniaHealth +Advocates

Oppose: None received

-- END --

SENATE COMMITTEE ON HEALTH

Senator Ed Hernandez, O.D., Chair

BILL NO: AB 1368

SUBJECT: Health professionals: authorization forms

SUMMARY:

1. Requires the Department of Health Care Services (DHCS) to allow a nurse

practitioner (NP) or physician assistant (PA) to sign any authorization form required by DHCS for benefits and services for the Medi-Cal program, the Genetically Handicapped Persons Program, and the Child Health Disability Prevention Program, if the NP or PA is authorized to provide the service pursuant to their scope of practice and the supervising physician and the NP or PA are enrolled as Medi-Cal providers. Requires DHCS to allow a NP to sign any authorization form required by DHCS for benefits and services under the California Children’s Services Program (CCS), if the NP is a CCS-paneled provider who is authorized by the supervising physician, or the NP’s standardized procedure or protocol, to provide the service pursuant to his or her scope of practice and the physician and the designated NP are each enrolled as a Medi-Cal provider.

Existing law:

1. Establishes the Medi-Cal program, administered by DHCS, under which health care services are provided to qualified low-income persons.
2. Establishes a schedule of benefits for Medi-Cal beneficiaries, which includes both of the following:
3. Services provided by a PA are a covered benefit to the extent authorized by federal law and subject to utilization controls; and,
4. Services provided by a certified NP are covered to the extent authorized by federal law, and subject to utilization controls.
5. Limits the utilization controls that DHCS can apply to Medi-Cal services to the following:
6. Prior authorization;
7. Post-service pre-payment audit;
8. Post-service post-payment audit;
9. Limitation on number of services; and,
10. Review of services pursuant to Professional Standards Review Organization agreements entered into in accordance with Section 14104.
11. Establishes the California Childrens Services Program (CCS), the Genetically Handicapped Persons Program (GHPP) and the Child Health Disability Prevention Program (CHDP), which are administered by DHCS.

This bill:

1. Requires DHCS to allow a PA or NP to sign any authorization form required by DHCS for benefits and services under the Medi-Cal program, the Child Health and Disability Prevention Program and the Genetically Handicapped Persons Program, subject to both of the following:
2. The PA or NP is authorized by the supervising physician, or the NP’s standardized procedure or protocol, to provide the service pursuant to his or her scope of practice; and,
3. The physician and the designated PA or NP are each enrolled as a Medi-Cal provider
4. Requires DHCS to allow a NP to sign any authorization form required by DHCS for benefits and services under CCS, subject to both of the following:
5. The NP is a CCS-paneled provider who is authorized by the supervising physician, or the NP’s standardized procedure or protocol, to provide the service pursuant to his or her scope of practice; and,
6. The physician and the designated NP are each enrolled as a Medi-Cal provider.

FISCAL EFFECT:

This bill is keyed non-fiscal.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, PAs and NPs provide a substantial amount of health care to Medi-Cal beneficiaries throughout the state in nearly every specialty of medicine and every setting. Many Medi-Cal forms require a physician signature (even though a PA or NP has provided the services. Often, these providers are the primary care provider, the usual source of care or the only provider on-site and requiring a physician signature delays care. This bill would authorize PAs and NPs to sign any Medi-Cal authorization form required by DHCS for benefits and services within the Medi-Cal program as long as the physician, PA or NP are enrolled as Medi-Cal providers. This bill is needed to improve practice level efficiency and reduce administrative burdens in team-based care.
2. Utilization controls in DHCS-administered programs. DHCS is authorized to use utilization controls to require providers to justify medical necessity and control utilization and spending in the fee-for-service Medi-Cal program. In DHCS-administered programs, providers must fill out a Treatment Authorization request (TAR) in Medi-Cal, or a Services Authorization Request (SAR) in the CCS Program and GHPP for certain supplies and services, such as incontinence supplies, non-emergency medical transportation, and a treatment plan in CCS and GHPP. These forms require a signature by the authorizing physician (or in the case of a CCS/GHPP new referral SAR, his or her authorized designee), while other forms (for example, a certificate of medical necessity for sleep apnea monitors) do not require a physician signature.
   
3. Prior legislation. SB 1457 (Evans, Chapter 849, Statutes of 2014) requires requests for authorization for treatment or services in the Medi-Cal program, CCS Program, and the GHPP Program, excluding those submitted by dental providers enrolled in the Medi-Cal Dental Program, to be submitted in an electronic format determined by the DHCS via DHCS’ Internet Website or other electronic means designated by DHCS. Requires DHCS to implement an alternate format for submission when DHCS’ Internet Website is unavailable due to a system disruption.
4. Support. This bill is supported by the California Academy of PAs (CAPA), which writes that this bill recognizes the need to create efficiency in team-based practice by reducing administrative burdens related to specific signature requirements on some Medi-Cal authorization forms. CAPA states that some Medi-Cal authorization forms require a physician signature while others permit signatures from a licensed health care provider or PA. The inconsistency of who may sign which form(s) results in confusion and delays in access to critical needs and services for patients. CAPA states that PAs are recognized as primary care providers and are often a usual source of care for Medi-Cal beneficiaries and as such should be authorized to sign and/or attest to need related to benefits and services within the Medi-Cal program. CAPA concludes that authorizing physicians to designate a PA to sign any Medi-Cal authorization form as long as both the physician and PA are enrolled as Medi-Cal providers would significantly improve practice efficiency and reduce confusion and delays in access to care and services.

SUPPORT AND OPPOSITION:

Support: California Academy of Family Physicians

California Academy of Physician Assistants

California Association for Nurse Practitioners

California Council of Community Behavioral Health Agencies

CaliforniaHealth +Advocates

Oppose: None received

-- END --

Date of Hearing: April 18, 2017

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 1368

Author:(Calderon) – As Amended Ver:March 30, 2017

SUBJECT: Medi-Cal: authorization requests.

SUMMARY: Authorizes a physician to designate a physician assistant (PA) to sign any authorization form required by the Department of Health Care Services (DHCS) for benefits and services under the Medi-Cal program, provided that the physician and the designated PA are each enrolled as Medi-Cal providers.

EXISTING LAW:

1. Establishes the Medi-Cal Program, administered by DHCS, to provide comprehensive health benefits to low-income individuals who meet specified eligibility criteria.
2. Establishes a schedule of benefits under the Medi-Cal program, which includes federally required and optional Medicaid benefits.
3. Requires the Director of DHCS to require fully documented medical justification from Medi-Cal providers that requested services are medically necessary to prevent significant illness, alleviate severe pain, protect life, or prevent significant disability, on all requests for prior authorization.
4. Defines a provider as an individual, partnership, group, association, corporation, institution, or entity, and the officers, directors, owners, managing employees, or agents of a partnership, group association, corporation, institution, or entity, that provides services, goods, supplies, or merchandise, directly or indirectly, including all ordering, referring, and prescribing, to a Medi-Cal beneficiary and who has been enrolled in the Medi-Cal program.
5. Establishes the Physician Assistant Board of California to license and regulate the practice of PAs in California.
6. Authorizes a PA to perform physical examination and provide required attestation for specified services, including examination relating to certification for teacher credentialing, and other specified education related medical services.
7. Establishes the Board of Registered Nursing (BRN) to license and regulate the practice of nursing in California.

FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, this bill is needed to improve access to care and reduce unnecessary administrative burdens in team-based care. PAs provide a substantial amount of care to Medi-Cal beneficiaries throughout the state in nearly every specialty of medicine and every setting. Often, PAs are the primary care provider, the usual source of care, or the only clinician on-site. Requiring a physician signature on an authorization form for a medical service already provided by PAs creates delays in care. PAs are licensed health care providers that work with a physician to deliver a wide range of medical and surgical services and as such should be authorized to sign forms necessary for the care and treatment of their patients.
2. BACKGROUND.
   1. Medi-Cal authorization. Certain procedures and services are subject to authorization (Treatment Authorization Requests (TARs) and Service Authorization Requests (SARs)) by Medi-Cal before reimbursement can be approved. There are various forms that must be filled out by providers (generally physicians) including forms for breast and cervical cancer screening, presumptive eligibility forms, incontinence supplies, and non-urgent medical transport.
      
      TARs or SARs are used to help ensure that necessary medical, pharmacy, dental or other medical services are provided to Medi-Cal recipients and that providers are reimbursed appropriately.  TARs or SARs are confidential documents and the information included on them is protected by state and federal privacy laws.
   2. PAs and Nurse Practitioners (NPs). The Physician Assistant Practice Act authorizes a PA to perform specified medical services when the services are rendered under the supervision of a licensed physician and surgeon. A PA may only provide those medical services which he or she is competent to perform and which are consistent with his or her education, training, and experience. A physician and PA must establish written guidelines or protocols for the adequate supervision of PAs.
      
      Under the Nurse Practice Act, NPs hold a valid and active registered nursing license, possess a master’s degree in a clinical field related to nursing or a graduate degree in nursing and have completed a nurse practitioner program approved by the BRN. Generally, standardized procedures and protocols, developed in collaboration with physicians and surgeons and other health professionals, govern the types of medical services that can be provided by NPs.
      
      PAs and NPs provide a wide breath of health care services in a variety of settings, including hospitals, community clinics, and private practice settings.
   3. Primary Care Workforce in California. A February 2017 report by the Healthforce Center at the University of California San Francisco entitled, “California’s Primary Care Workforce: Current Supply, Characteristics and Pipeline of Trainees” concludes that the supply of primary care physicians in California is insufficient to meet the state’s needs. The report further claims that previously identified shortages in California’s primary care workforce persist and will be exacerbated in the coming decade because large percentages of physicians and NPs are reaching retirement age. Among the findings of the report are as follows:
      1. The growth in the Doctor of Osteopathic Medicine (DO), NP and PA workforces outpaced the rate of growth of the physician (medical doctor (MD)) workforce from 2014-2016. For MDs, the growth rate is 36%, while the rate for DOs is 141%; NPs is 75%; and, PAs is 98%;
      2. While MDs make up the greatest number of licensed clinicians, only a fraction of them provide primary care (36%). The percentage of PAs in California who provide primary care is also small (22%); in contras, approximately 60% of DOs and 50% of NPs provide primary care;
      3. NPs and PAs constitute a larger share of the primary care workforce in rural regions of California than in urban regions; and,
      4. One third of physicians and NPs in California are age 55 or older, raising concerns about reductions in the capacity of the workforce in coming years due to retirement or decreased patient care hours. Nearly half of family physicians (44%) are age 55 or older.
3. SUPPORT. The California Academy of PAs, in support of this bill, states that authorizing physicians to designate a PA to sign any Medi-Cal authorization form as long as both the physician and PA are enrolled as Medi-Cal providers would significantly improve practice efficiency and reduce confusion and delays in access to care and services. Currently, the inconsistency of who may sign which form(s) results in confusion and delays in access to critical needs and services for patients.
4. PREVIOUS LEGISLATION.
   1. SB 1457 (Evans), Chapter 849, Statutes of 2014, effective July 1, 2016, requires requests for authorization for treatment or services in the Medi-Cal program, California Children’s Services Program, and the Genetically Handicapped Persons Program, excluding those submitted by dental providers enrolled in the Medi-Cal Dental Program, to be submitted in an electronic format determined by the DHCS via DHCS’ Internet Website or other electronic means designated by DHCS. Requires DHCS to implement an alternate format for submission when DHCS’ Internet Website is unavailable due to a system disruption.
   2. SB 1083 (Pavley), Chapter 438, Statutes of 2013, authorizes a PA to certify claims for disability insurance, after performance of a physical examination by the PA and under the supervision of a physician and surgeon; expands the definition of “practitioner” to include PAs; and, requires the Employment Development Department to implement these provisions on or before January 1, 2017.
5. SUGGESTED AMENDMENT. The Committee recommends and the author has agreed to amend this bill to also apply to NPs.

REGISTERED SUPPORT / OPPOSITION:

Support

California Academy of Physician Assistants

California Access Coalition

California Council of Community Behavioral Health Agencies

Opposition

None on file.

Analysis Prepared by: Rosielyn Pulmano / HEALTH / (916) 319-2097