AB 2428: Federally qualified health centers: rural health clinics.

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. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.

Existing law authorizes the department to adopt regulations for the certification of each applicant and each provider in the Medi-Cal program. Existing law requires a provider that is not currently enrolled at a location where the provider intends to provide services, goods, supplies, or merchandise to a Medi-Cal beneficiary, to submit a complete application package for enrollment at a new location or a change in location. Existing law exempts an applicant or a provider that meets specified requirements and is operated by a licensed primary care clinic, including an affiliated mobile health care unit, from this requirement and from a requirement to enroll in the Medi-Cal program as a separate provider, if the licensed primary care clinic operating the applicant, provider clinic, or mobile health care unit notifies the department of its separate locations, premises, or mobile health care units.

This bill would exempt a primary care clinic with an additional physical plant added to its primary care clinic license from the requirement to separately enroll the additional physical plant as a separate provider and from the requirement to submit a complete application package, as described above, if the primary care clinic has notified the department of its additional physical plant.

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 establishes the reimbursement rate for an FQHC or RHC that is a newly licensed facility at a new location added to an existing FQHC or RHC on a per-visit basis in an amount, among other methods, equal to the average of the per-visit rates of 3 comparable FQHCs or RHCs located in the same or adjacent area with a similar caseload.

This bill would authorize an FQHC or RHC that adds a new licensed location to its existing primary care license to elect to have the reimbursement rate for the new location determined in accordance with existing rates or to have one prospective payment system rate, as described, for all locations that appear on the primary care license, as specified. The bill would make conforming and technical changes.

This bill would incorporate additional changes to Section 14132.100 of the Welfare and Institutions Code proposed by SB 1125 to be operative only if this bill and SB 1125 are enacted and this bill is enacted last.