SB 819: Medi-Cal: certification.
- Session Year: 2023-2024
- House: Senate
- Latest Version Date: 2024-09-22
Current Status:
Passed
(2024-09-22: Chaptered by Secretary of State. Chapter 448, Statutes of 2024.)
Introduced
In Committee
First Chamber
In Committee
Second Chamber
Enacted
Existing law requires the State Department of Public Health to license and regulate clinics. Existing law exempts from those licensing provisions certain clinics that are directly conducted, maintained, or operated by federal, state, or local governmental entities, as specified. Existing law also exempts from those licensing provisions a clinic that is operated by a primary care community or free clinic, that is operated on separate premises from the licensed clinic, and that is only open for limited services of no more than 40 hours per week.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services (department) and 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 sets forth various procedures, including the submission of an application package, for providers to enroll in the Medi-Cal program. Under existing law, an applicant or provider that is a government-run license-exempt clinic as described above is required to comply with those Medi-Cal enrollment procedures.
Under existing law, an applicant or provider that is operated on separate premises and is license exempt, including an intermittent site or mobile health care unit that is operated by a licensed primary care clinic that provides all staffing, protocols, equipment, supplies, and billing services, is not required to enroll in the Medi-Cal program as a separate provider or comply with the above-described enrollment procedures, if the licensed primary care clinic has notified the department of its separate locations, premises, intermittent sites, or mobile health care units.
This bill would additionally exempt from the Medi-Cal enrollment procedures an intermittent site or mobile health care unit that is operated by the above-described government-run license-exempt clinic if that clinic has notified the department of its separate locations, premises, sites, or units.
The bill would make legislative findings stating that this bill is declaratory of existing law, as specified.
Existing law requires the State Department of Public Health to license and regulate clinics. Existing law exempts from those licensing provisions certain clinics that are directly conducted, maintained, or operated by federal, state, or local governmental entities, as specified. Existing law also exempts from those licensing provisions a clinic that is operated by a primary care community or free clinic, that is operated on separate premises from the licensed clinic, and that is only open for limited services of no more than 40 hours per week.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services (department) and 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 sets forth various procedures, including the submission of an application package, for providers to enroll in the Medi-Cal program. Under existing law, an applicant or provider that is a government-run license-exempt clinic as described above is required to comply with those Medi-Cal enrollment procedures.
Under existing law, an applicant or provider that is operated on separate premises and is license exempt, including an intermittent site or mobile health care unit that is operated by a licensed primary care clinic that provides all staffing, protocols, equipment, supplies, and billing services, is not required to enroll in the Medi-Cal program as a separate provider or comply with the above-described enrollment procedures, if the licensed primary care clinic has notified the department of its separate locations, premises, intermittent sites, or mobile health care units.
This bill would additionally exempt from the Medi-Cal enrollment procedures an intermittent site or mobile health care unit that is operated by the above-described government-run license-exempt clinic if that clinic has notified the department of its separate locations, premises, sites, or units.
The bill would make legislative findings stating that this bill is declaratory of existing law, as specified.
Existing law requires the State Department of Public Health to license and regulate clinics. Existing law exempts from those licensing provisions certain clinics that are directly conducted, maintained, or operated by federal, state, or local governmental entities, as specified. Existing law also exempts from those licensing provisions a clinic that is operated by a primary care community or free clinic, that is operated on separate premises from the licensed clinic, and that is only open for limited services of no more than 40 hours per week.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services (department) and 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 sets forth various procedures, including the submission of an application package, for providers to enroll in the Medi-Cal program. Under existing law, an applicant or provider that is a government-run license-exempt clinic as described above is required to comply with those Medi-Cal enrollment procedures.
Under existing law, an applicant or provider that is operated on separate premises and is license exempt, including an intermittent site or mobile health care unit that is operated by a licensed primary care clinic that provides all staffing, protocols, equipment, supplies, and billing services, is not required to enroll in the Medi-Cal program as a separate provider or comply with the above-described enrollment procedures, if the licensed primary care clinic has notified the department of its separate locations, premises, intermittent sites, or mobile health care units.
This bill would additionally exempt from the Medi-Cal enrollment procedures an intermittent site or mobile health care unit that is operated by the above-described government-run license-exempt clinic if that clinic has notified the department of its separate locations, premises, sites, or units.
The bill would make legislative findings stating that this bill is declaratory of existing law, as specified.
Existing law requires the State Department of Public Health to license and regulate clinics. Existing law exempts from those licensing provisions certain clinics that are directly conducted, maintained, or operated by federal, state, or local governmental entities, as specified. Existing law also exempts from those licensing provisions a clinic that is operated by a primary care community or free clinic, that is operated on separate premises from the licensed clinic, and that is only open for limited services of no more than 40 hours per week.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services (department) and 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 sets forth various procedures, including the submission of an application package, for providers to enroll in the Medi-Cal program. Under existing law, an applicant or provider that is a government-run license-exempt clinic as described above is required to comply with those Medi-Cal enrollment procedures.
Under existing law, an applicant or provider that is operated on separate premises and is license exempt, including an intermittent site or mobile health care unit that is operated by a licensed primary care clinic that provides all staffing, protocols, equipment, supplies, and billing services, is not required to enroll in the Medi-Cal program as a separate provider or comply with the above-described enrollment procedures, if the licensed primary care clinic has notified the department of its separate locations, premises, intermittent sites, or mobile health care units.
This bill would additionally exempt from the Medi-Cal enrollment procedures an intermittent site or mobile health care unit that is operated by the above-described government-run license-exempt clinic if that clinic has notified the department of its separate locations, premises, sites, or units.
The bill would make legislative findings stating that this bill is declaratory of existing law, as specified.
Existing law requires the State Department of Public Health to license and regulate clinics. Existing law exempts from those licensing provisions certain clinics that are directly conducted, maintained, or operated by federal, state, or local governmental entities, as specified. Existing law also exempts from those licensing provisions a clinic that is operated by a primary care community or free clinic, that is operated on separate premises from the licensed clinic, and that is only open for limited services of no more than 40 hours per week.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services (department) and 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 sets forth various procedures, including the submission of an application package, for providers to enroll in the Medi-Cal program. Under existing law, an applicant or provider that is a government-run license-exempt clinic as described above is required to comply with those Medi-Cal enrollment procedures.
Under existing law, an applicant or provider that is operated on separate premises and is license exempt, including an intermittent site or mobile health care unit that is operated by a licensed primary care clinic that provides all staffing, protocols, equipment, supplies, and billing services, is not required to enroll in the Medi-Cal program as a separate provider or comply with the above-described enrollment procedures, if the licensed primary care clinic has notified the department of its separate locations, premises, intermittent sites, or mobile health care units.
This bill would additionally exempt from the Medi-Cal enrollment procedures an intermittent site or mobile health care unit that is operated by the above-described government-run license-exempt clinic if that clinic has notified the department of its separate locations, premises, sites, or units.
The bill would make legislative findings stating that this bill is declaratory of existing law, as specified.
Existing law requires the State Department of Public Health to license and regulate clinics. Existing law exempts from those licensing provisions certain clinics that are directly conducted, maintained, or operated by federal, state, or local governmental entities, as specified. Existing law also exempts from those licensing provisions a clinic that is operated by a primary care community or free clinic, that is operated on separate premises from the licensed clinic, and that is only open for limited services of no more than 40 hours per week.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services (department) and 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 sets forth various procedures, including the submission of an application package, for providers to enroll in the Medi-Cal program. Under existing law, an applicant or provider that is a government-run license-exempt clinic as described above is required to comply with those Medi-Cal enrollment procedures.
Under existing law, an applicant or provider that is operated on separate premises and is license exempt, including an intermittent site or mobile health care unit that is operated by a licensed primary care clinic that provides all staffing, protocols, equipment, supplies, and billing services, is not required to enroll in the Medi-Cal program as a separate provider or comply with the above-described enrollment procedures, if the licensed primary care clinic has notified the department of its separate locations, premises, intermittent sites, or mobile health care units.
This bill would additionally exempt from the Medi-Cal enrollment procedures an intermittent site or mobile health care unit that is operated by the above-described government-run license-exempt clinic if that clinic has notified the department of its separate locations, premises, sites, or units.
The bill would make legislative findings stating that this bill is declaratory of existing law, as specified.
Existing law requires the State Department of Public Health to license and regulate clinics. Existing law exempts from those licensing provisions certain clinics that are directly conducted, maintained, or operated by federal, state, or local governmental entities, as specified. Existing law also exempts from those licensing provisions a clinic that is operated by a primary care community or free clinic, that is operated on separate premises from the licensed clinic, and that is only open for limited services of no more than 40 hours per week.
Existing law provides for establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, Services (department) and 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 change in location. Existing law exempts an applicant, a provider operated by a licensed primary care clinic, or 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 a licensed primary care clinic operating the applicant, provider clinic, or mobile health care unit notifies the department of its separate locations.This bill would make a technical, nonsubstantive change to that provision.Existing law sets forth various procedures, including the submission of an application package, for providers to enroll in the Medi-Cal program. Under existing law, an applicant or provider that is a government-run license-exempt clinic as described above is required to comply with those Medi-Cal enrollment procedures.
Under existing law, an applicant or provider that is operated on separate premises and is license exempt, including an intermittent site or mobile health care unit that is operated by a licensed primary care clinic that provides all staffing, protocols, equipment, supplies, and billing services, is not required to enroll in the Medi-Cal program as a separate provider or comply with the above-described enrollment procedures, if the licensed primary care clinic has notified the department of its separate locations, premises, intermittent sites, or mobile health care units.
This bill would additionally exempt from the Medi-Cal enrollment procedures an intermittent site or mobile health care unit that is operated by the above-described government-run license-exempt clinic if that clinic has notified the department of its separate locations, premises, sites, or units.
Existing law provides for 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 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 change in location. Existing law exempts an applicant, a provider operated by a licensed primary care clinic, or 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 a licensed primary care clinic operating the applicant, provider clinic, or mobile health care unit notifies the department of its separate locations.
This bill would make a technical, nonsubstantive change to that provision.
The Legislature finds and declares that under existing law, intermittent sites and mobile health care units operated by licensed primary care clinics are exempt from the enrollment procedures under the Medi-Cal program, if the operating clinic has made a related notification to the State Department of Health Care Services. This act clarifies the intent of existing law to express the same exemption from the Medi-Cal enrollment procedures for intermittent sites and mobile health care units operated by clinics exempt from licensure by the State Department of Public Health pursuant to subdivision (b) of Section 1206 of the Health and Safety Code. This bill does not contemplate or affect existing law that allows mobile health care units to be operated as a service of a licensed clinic or a licensed health facility, pursuant to subdivision (b) of Section 1765.105 of the Health and Safety Code.
SEC. 2.Section 14043.15 of the Welfare and Institutions Code is amended to read:14043.15.(a)The department may adopt regulations for certification of each applicant and each provider in the Medi-Cal program. No certification shall be required for natural persons licensed or certificated under Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act.
(b)(1)An applicant or provider who is a natural person, and is licensed or certificated pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act, or is a professional corporation, as defined in subdivision (b) of Section 13401 of the Corporations Code, shall comply with Section 14043.26 and shall be enrolled in the Medi-Cal program as either an individual provider or as a rendering provider in a provider group for each application package submitted and approved pursuant to Section 14043.26, notwithstanding that the applicant or provider meets the requirements to qualify as exempt from clinic licensure under subdivision (a) or (m) of Section 1206 of the Health and Safety Code.
(2)A provider enrolled in the Medi-Cal program pursuant to paragraph (1), who has disclosed in the application package for enrollment that the providers practice includes the rendering of services, goods, supplies, or merchandise solely at one, or at more than one, health facility, as defined in Section 1250 of the Health and Safety Code, or clinic, as defined in Section 1204 of the Health and Safety Code, or medical therapy unit, for purposes of Section 123950 of the Health and Safety Code, or residence of the providers patient, or office of a physician and surgeon involved in the care and treatment of the providers patients, shall not be required to enroll at each such health facility, clinic, medical therapy unit, patients residence, or physician and surgeons office location and may utilize the business addresses listed on the application for enrollment pursuant to paragraph (1) to claim reimbursement from the Medi-Cal program for services rendered by the provider to Medi-Cal beneficiaries at all of those health facilities, clinics, medical therapy units, residences, or physician offices.
(3)This subdivision shall not be interpreted to allow the violation of any state or federal law governing fiscal intermediaries or Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act. This subdivision does not remove the requirement that each claim for reimbursement from the Medi-Cal program identify the place of service and the rendering, ordering, referring, and prescribing provider, where applicable.
(c)An applicant or provider licensed as a clinic pursuant to Chapter 1 (commencing with Section 1200) of, or a health facility licensed pursuant to Chapter 2 (commencing with Section 1250) of, Division 2 of the Health and Safety Code may be enrolled in the Medi-Cal program as a clinic or a health facility and need not comply with Section 14043.26 if the clinic or health facility is certified by the department to participate in the Medi-Cal program.
(d)An applicant or provider that meets the requirements to qualify as exempt from clinic licensure under subdivisions (b) to (l), inclusive, or subdivisions (n) to (p), inclusive, of Section 1206 of the Health and Safety Code shall comply with Section 14043.26 and may be enrolled in the Medi-Cal program as either a clinic or within any other provider category for which the applicant or provider qualifies. An applicant or provider to which any of the clinic licensure exemptions specified in this subdivision apply shall identify the licensure exemption category and document in its application package the legal and factual basis for the clinic license exemption claimed.
(e)Notwithstanding subdivisions (a), (b), (c), and (d), an applicant or provider need not enroll in the Medi-Cal program as a separate provider and need not comply with Section 14043.26 if all of the following conditions are met:
(1)The applicant or provider is one of the following:
(A)An intermittent site that qualifies as exempt from clinic licensure under subdivision (h) of Section 1206 of the Health and Safety Code.
(B)An affiliated mobile health care unit licensed or approved under Chapter 9 (commencing with Section 1765.101) of Division 2 of the Health and Safety Code, and qualifies as exempt from clinic licensure under subdivision (h) of Section 1206 of the Health and Safety Code.
(2)The applicant or provider is operated by, and all staffing, protocols, equipment, supplies, and billing services are provided, directly or indirectly, by, one of the following:
(A)A licensed primary care clinic.
(B)A clinic exempt from licensure pursuant to subdivision (b) of Section 1206 of the Health and Safety Code.
(3)The licensed primary care clinic or clinic exempt from licensure under subdivision (b) of Section 1206 of the Health and Safety Code operating the applicant, provider clinic, or mobile health care unit has notified the department of its separate locations, premises, intermittent sites, or mobile health care units.
(f)A primary care clinic with (1) an additional physical plant added to its primary care clinic license under a consolidated license pursuant to subdivision (d) of Section 1212 of the Health and Safety Code, or (2) a physical plant that was added to an existing primary care clinic license by the State Department of Public Health, prior to January 1, 2017, whether by a regional district office or the centralized application unit, need not separately enroll the additional physical plant as a separate provider, and need not comply with Section 14043.26 if the primary care clinic has notified the department of its additional physical plant.
(g)Notwithstanding any other law and to the extent permitted by federal law, an applicant or provider that meets the requirements to qualify as a mobile optometric office pursuant to Section 3070.2 of the Business and Professions Code and Section 14043.26 may be enrolled in the Medi-Cal program as either a mobile optometric office or within any other provider category for which the applicant or provider qualifies.
(1)An applicant or provider to which Section 3070.2 of the Business and Professions Code applies shall demonstrate its compliance by providing proof of its nonprofit or charitable organization status pursuant to Section 501(c)(3) or 501(c)(4) of the Internal Revenue Code and a statement that it shall not accept payment for services other than those provided to Medi-Cal beneficiaries, even if the State Board of Optometry has not yet issued final regulations as required by Section 3070.2 of the Business and Professions Code or issued any registrations at the time of enrollment.
(2)A mobile optometric office shall use the address of the owner and operator of the mobile optometric office as registered with the State Board of Optometry for its place of business address and shall not be required to comply with Section 51000.60 of Title 22 of the California Code of Regulations.
(3)To the extent federal financial participation is available, a mobile optometric office shall be permitted to bill the Medi-Cal program for the professional optometry services provided by licensed optometrists. The licensed optometrists providing service at a mobile optometric office shall use the address of the owner and operator of the mobile optometric office as registered with the State Board of Optometry for its place of business address and shall not be required to comply with Section 51000.60 of Title 22 of the California Code of Regulations.
The Legislature finds and declares that under existing law, intermittent sites and mobile health care units operated by licensed primary care clinics are exempt from the enrollment procedures under the Medi-Cal program, if the operating clinic has made a related notification to the State Department of Health Care Services. This act clarifies the intent of existing law to express the same exemption from the Medi-Cal enrollment procedures for intermittent sites and mobile health care units operated by clinics exempt from licensure by the State Department of Public Health pursuant to subdivision (b) of Section 1206 of the Health and Safety Code. This bill does not contemplate or affect existing law that allows mobile health care units to be operated as a service of a licensed clinic or a licensed health facility, pursuant to subdivision (b) of Section 1765.105 of the Health and Safety Code.
SEC. 2.Section 14043.15 of the Welfare and Institutions Code is amended to read:14043.15.(a)The department may adopt regulations for certification of each applicant and each provider in the Medi-Cal program. No certification shall be required for natural persons licensed or certificated under Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act.
(b)(1)An applicant or provider who is a natural person, and is licensed or certificated pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act, or is a professional corporation, as defined in subdivision (b) of Section 13401 of the Corporations Code, shall comply with Section 14043.26 and shall be enrolled in the Medi-Cal program as either an individual provider or as a rendering provider in a provider group for each application package submitted and approved pursuant to Section 14043.26, notwithstanding that the applicant or provider meets the requirements to qualify as exempt from clinic licensure under subdivision (a) or (m) of Section 1206 of the Health and Safety Code.
(2)A provider enrolled in the Medi-Cal program pursuant to paragraph (1), who has disclosed in the application package for enrollment that the providers practice includes the rendering of services, goods, supplies, or merchandise solely at one, or at more than one, health facility, as defined in Section 1250 of the Health and Safety Code, or clinic, as defined in Section 1204 of the Health and Safety Code, or medical therapy unit, for purposes of Section 123950 of the Health and Safety Code, or residence of the providers patient, or office of a physician and surgeon involved in the care and treatment of the providers patients, shall not be required to enroll at each such health facility, clinic, medical therapy unit, patients residence, or physician and surgeons office location and may utilize the business addresses listed on the application for enrollment pursuant to paragraph (1) to claim reimbursement from the Medi-Cal program for services rendered by the provider to Medi-Cal beneficiaries at all of those health facilities, clinics, medical therapy units, residences, or physician offices.
(3)This subdivision shall not be interpreted to allow the violation of any state or federal law governing fiscal intermediaries or Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act. This subdivision does not remove the requirement that each claim for reimbursement from the Medi-Cal program identify the place of service and the rendering, ordering, referring, and prescribing provider, where applicable.
(c)An applicant or provider licensed as a clinic pursuant to Chapter 1 (commencing with Section 1200) of, or a health facility licensed pursuant to Chapter 2 (commencing with Section 1250) of, Division 2 of the Health and Safety Code may be enrolled in the Medi-Cal program as a clinic or a health facility and need not comply with Section 14043.26 if the clinic or health facility is certified by the department to participate in the Medi-Cal program.
(d)An applicant or provider that meets the requirements to qualify as exempt from clinic licensure under subdivisions (b) to (l), inclusive, or subdivisions (n) to (p), inclusive, of Section 1206 of the Health and Safety Code shall comply with Section 14043.26 and may be enrolled in the Medi-Cal program as either a clinic or within any other provider category for which the applicant or provider qualifies. An applicant or provider to which any of the clinic licensure exemptions specified in this subdivision apply shall identify the licensure exemption category and document in its application package the legal and factual basis for the clinic license exemption claimed.
(e)Notwithstanding subdivisions (a), (b), (c), and (d), an applicant or provider need not enroll in the Medi-Cal program as a separate provider and need not comply with Section 14043.26 if all of the following conditions are met:
(1)The applicant or provider is one of the following:
(A)An intermittent site that qualifies as exempt from clinic licensure under subdivision (h) of Section 1206 of the Health and Safety Code.
(B)An affiliated mobile health care unit licensed or approved under Chapter 9 (commencing with Section 1765.101) of Division 2 of the Health and Safety Code, and qualifies as exempt from clinic licensure under subdivision (h) of Section 1206 of the Health and Safety Code.
(2)The applicant or provider is operated by, and all staffing, protocols, equipment, supplies, and billing services are provided, directly or indirectly, by, one of the following:
(A)A licensed primary care clinic.
(B)A clinic exempt from licensure pursuant to subdivision (b) of Section 1206 of the Health and Safety Code.
(3)The licensed primary care clinic or clinic exempt from licensure under subdivision (b) of Section 1206 of the Health and Safety Code operating the applicant, provider clinic, or mobile health care unit has notified the department of its separate locations, premises, intermittent sites, or mobile health care units.
(f)A primary care clinic with (1) an additional physical plant added to its primary care clinic license under a consolidated license pursuant to subdivision (d) of Section 1212 of the Health and Safety Code, or (2) a physical plant that was added to an existing primary care clinic license by the State Department of Public Health, prior to January 1, 2017, whether by a regional district office or the centralized application unit, need not separately enroll the additional physical plant as a separate provider, and need not comply with Section 14043.26 if the primary care clinic has notified the department of its additional physical plant.
(g)Notwithstanding any other law and to the extent permitted by federal law, an applicant or provider that meets the requirements to qualify as a mobile optometric office pursuant to Section 3070.2 of the Business and Professions Code and Section 14043.26 may be enrolled in the Medi-Cal program as either a mobile optometric office or within any other provider category for which the applicant or provider qualifies.
(1)An applicant or provider to which Section 3070.2 of the Business and Professions Code applies shall demonstrate its compliance by providing proof of its nonprofit or charitable organization status pursuant to Section 501(c)(3) or 501(c)(4) of the Internal Revenue Code and a statement that it shall not accept payment for services other than those provided to Medi-Cal beneficiaries, even if the State Board of Optometry has not yet issued final regulations as required by Section 3070.2 of the Business and Professions Code or issued any registrations at the time of enrollment.
(2)A mobile optometric office shall use the address of the owner and operator of the mobile optometric office as registered with the State Board of Optometry for its place of business address and shall not be required to comply with Section 51000.60 of Title 22 of the California Code of Regulations.
(3)To the extent federal financial participation is available, a mobile optometric office shall be permitted to bill the Medi-Cal program for the professional optometry services provided by licensed optometrists. The licensed optometrists providing service at a mobile optometric office shall use the address of the owner and operator of the mobile optometric office as registered with the State Board of Optometry for its place of business address and shall not be required to comply with Section 51000.60 of Title 22 of the California Code of Regulations.
The Legislature finds and declares that this act is declaratory of existing law, and that intermittent sites or mobile health care units operated by clinics exempt from licensure by the State Department of Public Health pursuant to subdivision (b) of Section 1206 of the Health and Safety Code are exempt under the law, as it existed prior to the enactment of this act, from the enrollment procedures under the Medi-Cal program, if the operating clinic has made a related notification to the State Department of Health Care Services. under existing law, intermittent sites and mobile health care units operated by licensed primary care clinics are exempt from the enrollment procedures under the Medi-Cal program, if the operating clinic has made a related notification to the State Department of Health Care Services. This act clarifies the intent of existing law to express the same exemption from the Medi-Cal enrollment procedures for intermittent sites and mobile health care units operated by clinics exempt from licensure by the State Department of Public Health pursuant to subdivision (b) of Section 1206 of the Health and Safety Code. This bill does not contemplate or affect existing law that allows mobile health care units to be operated as a service of a licensed clinic or a licensed health facility, pursuant to subdivision (b) of Section 1765.105 of the Health and Safety Code.
SEC. 2.Section 14043.15 of the Welfare and Institutions Code is amended to read:14043.15.(a)The department may adopt regulations for certification of each applicant and each provider in the Medi-Cal program. No certification shall be required for natural persons licensed or certificated under Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act.
(b)(1)An applicant or provider who is a natural person, and is licensed or certificated pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act, or is a professional corporation, as defined in subdivision (b) of Section 13401 of the Corporations Code, shall comply with Section 14043.26 and shall be enrolled in the Medi-Cal program as either an individual provider or as a rendering provider in a provider group for each application package submitted and approved pursuant to Section 14043.26, notwithstanding that the applicant or provider meets the requirements to qualify as exempt from clinic licensure under subdivision (a) or (m) of Section 1206 of the Health and Safety Code.
(2)A provider enrolled in the Medi-Cal program pursuant to paragraph (1), who has disclosed in the application package for enrollment that the providers practice includes the rendering of services, goods, supplies, or merchandise solely at one, or at more than one, health facility, as defined in Section 1250 of the Health and Safety Code, or clinic, as defined in Section 1204 of the Health and Safety Code, or medical therapy unit, for purposes of Section 123950 of the Health and Safety Code, or residence of the providers patient, or office of a physician and surgeon involved in the care and treatment of the providers patients, shall not be required to enroll at each such health facility, clinic, medical therapy unit, patients residence, or physician and surgeons office location and may utilize the business addresses listed on the application for enrollment pursuant to paragraph (1) to claim reimbursement from the Medi-Cal program for services rendered by the provider to Medi-Cal beneficiaries at all of those health facilities, clinics, medical therapy units, residences, or physician offices.
(3)This subdivision shall not be interpreted to allow the violation of any state or federal law governing fiscal intermediaries or Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act. This subdivision does not remove the requirement that each claim for reimbursement from the Medi-Cal program identify the place of service and the rendering, ordering, referring, and prescribing provider, where applicable.
(c)An applicant or provider licensed as a clinic pursuant to Chapter 1 (commencing with Section 1200) of, or a health facility licensed pursuant to Chapter 2 (commencing with Section 1250) of, Division 2 of the Health and Safety Code may be enrolled in the Medi-Cal program as a clinic or a health facility and need not comply with Section 14043.26 if the clinic or health facility is certified by the department to participate in the Medi-Cal program.
(d)An applicant or provider that meets the requirements to qualify as exempt from clinic licensure under subdivisions (b) to (l), inclusive, or subdivisions (n) to (p), inclusive, of Section 1206 of the Health and Safety Code shall comply with Section 14043.26 and may be enrolled in the Medi-Cal program as either a clinic or within any other provider category for which the applicant or provider qualifies. An applicant or provider to which any of the clinic licensure exemptions specified in this subdivision apply shall identify the licensure exemption category and document in its application package the legal and factual basis for the clinic license exemption claimed.
(e)Notwithstanding subdivisions (a), (b), (c), and (d), an applicant or provider that meets the requirements to qualify as exempt from clinic licensure pursuant to subdivision (h) of Section 1206 of the Health and Safety Code, including an intermittent site or an affiliated mobile health care unit exempted from licensure, licensed, or approved under Chapter 9 (commencing with Section 1765.101) of Division 2 of the Health and Safety Code, and that is operated by a licensed primary care clinic or a clinic exempt from licensure pursuant to subdivision (b) of Section 1206 of the Health and Safety Code, and for which intermittent site or mobile health care unit the licensed primary care clinic or license-exempt clinic directly or indirectly provides all staffing, protocols, equipment, supplies, and billing services, need not enroll in the Medi-Cal program as a separate provider and need not comply with Section 14043.26 if the licensed primary care clinic or license-exempt clinic operating the applicant, provider clinic, or mobile health care unit has notified the department of its separate locations, premises, intermittent sites, or mobile health care units.(e)Notwithstanding subdivisions (a), (b), (c), and (d), an applicant or provider need not enroll in the Medi-Cal program as a separate provider and need not comply with Section 14043.26 if all of the following conditions are met:
(1)The applicant or provider is one of the following:
(A)An intermittent site that qualifies as exempt from clinic licensure under subdivision (h) of Section 1206 of the Health and Safety Code.
(B)An affiliated mobile health care unit licensed or approved under Chapter 9 (commencing with Section 1765.101) of Division 2 of the Health and Safety Code, and qualifies as exempt from clinic licensure under subdivision (h) of Section 1206 of the Health and Safety Code.
(2)The applicant or provider is operated by, and all staffing, protocols, equipment, supplies, and billing services are provided, directly or indirectly, by, one of the following:
(A)A licensed primary care clinic.
(B)A clinic exempt from licensure pursuant to subdivision (b) of Section 1206 of the Health and Safety Code.
(3)The licensed primary care clinic or clinic exempt from licensure under subdivision (b) of Section 1206 of the Health and Safety Code operating the applicant, provider clinic, or mobile health care unit has notified the department of its separate locations, premises, intermittent sites, or mobile health care units.
(f)A primary care clinic with (1) an additional physical plant added to its primary care clinic license under a consolidated license pursuant to subdivision (d) of Section 1212 of the Health and Safety Code, or (2) a physical plant that was added to an existing primary care clinic license by the State Department of Public Health, prior to January 1, 2017, whether by a regional district office or the centralized application unit, need not separately enroll the additional physical plant as a separate provider, and need not comply with Section 14043.26 if the primary care clinic has notified the department of its additional physical plant.
(g)Notwithstanding any other law and to the extent permitted by federal law, an applicant or provider that meets the requirements to qualify as a mobile optometric office pursuant to Section 3070.2 of the Business and Professions Code and Section 14043.26 may be enrolled in the Medi-Cal program as either a mobile optometric office or within any other provider category for which the applicant or provider qualifies.
(1)An applicant or provider to which Section 3070.2 of the Business and Professions Code applies shall demonstrate its compliance by providing proof of its nonprofit or charitable organization status pursuant to Section 501(c)(3) or 501(c)(4) of the Internal Revenue Code and a statement that it shall not accept payment for services other than those provided to Medi-Cal beneficiaries, even if the State Board of Optometry has not yet issued final regulations as required by Section 3070.2 of the Business and Professions Code or issued any registrations at the time of enrollment.
(2)A mobile optometric office shall use the address of the owner and operator of the mobile optometric office as registered with the State Board of Optometry for its place of business address and shall not be required to comply with Section 51000.60 of Title 22 of the California Code of Regulations.
(3)To the extent federal financial participation is available, a mobile optometric office shall be permitted to bill the Medi-Cal program for the professional optometry services provided by licensed optometrists. The licensed optometrists providing service at a mobile optometric office shall use the address of the owner and operator of the mobile optometric office as registered with the State Board of Optometry for its place of business address and shall not be required to comply with Section 51000.60 of Title 22 of the California Code of Regulations.
The Legislature finds and declares that this act is declaratory of existing law, and that intermittent sites or mobile health care units operated by clinics exempt from licensure by the State Department of Public Health pursuant to subdivision (b) of Section 1206 of the Health and Safety Code are exempt under the law, as it existed prior to the enactment of this act, from the enrollment procedures under the Medi-Cal program, if the operating clinic has made a related notification to the State Department of Health Care Services.
SEC. 2.Section 14043.15 of the Welfare and Institutions Code is amended to read:14043.15.(a)The department may adopt regulations for certification of each applicant and each provider in the Medi-Cal program. No certification shall be required for natural persons licensed or certificated under Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act.
(b)(1)An applicant or provider who is a natural person, and is licensed or certificated pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act, or is a professional corporation, as defined in subdivision (b) of Section 13401 of the Corporations Code, shall comply with Section 14043.26 and shall be enrolled in the Medi-Cal program as either an individual provider or as a rendering provider in a provider group for each application package submitted and approved pursuant to Section 14043.26, notwithstanding that the applicant or provider meets the requirements to qualify as exempt from clinic licensure under subdivision (a) or (m) of Section 1206 of the Health and Safety Code.
(2)A provider enrolled in the Medi-Cal program pursuant to paragraph (1), who has disclosed in the application package for enrollment that the providers practice includes the rendering of services, goods, supplies, or merchandise solely at one, or at more than one, health facility, as defined in Section 1250 of the Health and Safety Code, or clinic, as defined in Section 1204 of the Health and Safety Code, or medical therapy unit, for purposes of Section 123950 of the Health and Safety Code, or residence of the providers patient, or office of a physician and surgeon involved in the care and treatment of the providers patients, shall not be required to enroll at each such health facility, clinic, medical therapy unit, patients residence, or physician and surgeons office location and may utilize the business addresses listed on the application for enrollment pursuant to paragraph (1) to claim reimbursement from the Medi-Cal program for services rendered by the provider to Medi-Cal beneficiaries at all of those health facilities, clinics, medical therapy units, residences, or physician offices.
(3)This subdivision shall not be interpreted to allow the violation of any state or federal law governing fiscal intermediaries or Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act. This subdivision does not remove the requirement that each claim for reimbursement from the Medi-Cal program identify the place of service and the rendering, ordering, referring, and prescribing provider, where applicable.
(c)An applicant or provider licensed as a clinic pursuant to Chapter 1 (commencing with Section 1200) of, or a health facility licensed pursuant to Chapter 2 (commencing with Section 1250) of, Division 2 of the Health and Safety Code may be enrolled in the Medi-Cal program as a clinic or a health facility and need not comply with Section 14043.26 if the clinic or health facility is certified by the department to participate in the Medi-Cal program.
(d)An applicant or provider that meets the requirements to qualify as exempt from clinic licensure under subdivisions (b) to (l), inclusive, or subdivisions (n) to (p), inclusive, of Section 1206 of the Health and Safety Code shall comply with Section 14043.26 and may be enrolled in the Medi-Cal program as either a clinic or within any other provider category for which the applicant or provider qualifies. An applicant or provider to which any of the clinic licensure exemptions specified in this subdivision apply shall identify the licensure exemption category and document in its application package the legal and factual basis for the clinic license exemption claimed.
(e)Notwithstanding subdivisions (a), (b), (c), and (d), an applicant or provider that meets the requirements to qualify as exempt from clinic licensure pursuant to subdivision (h) of Section 1206 of the Health and Safety Code, including an intermittent site or an affiliated mobile health care unit exempted from licensure, or licensed or approved under, licensed, or approved under Chapter 9 (commencing with Section 1765.101) of Division 2 of the Health and Safety Code, and that is operated by a licensed primary care clinic or a clinic exempt from licensure pursuant to subdivision (b) of Section 1206 of the Health and Safety Code, and for which intermittent site or mobile health care unit the licensed primary care clinic or license-exempt clinic directly or indirectly provides all staffing, protocols, equipment, supplies, and billing services, need not enroll in the Medi-Cal program as a separate provider and need not comply with Section 14043.26 if the licensed primary care clinic or license-exempt clinic operating the applicant, provider clinic, or mobile health care unit has notified the department of its separate locations, premises, intermittent sites, or mobile health care units.
(f)A primary care clinic with (1) an additional physical plant added to its primary care clinic license under a consolidated license pursuant to subdivision (d) of Section 1212 of the Health and Safety Code, or (2) a physical plant that was added to an existing primary care clinic license by the State Department of Public Health, prior to January 1, 2017, whether by a regional district office or the centralized application unit, need not separately enroll the additional physical plant as a separate provider, and need not comply with Section 14043.26 if the primary care clinic has notified the department of its additional physical plant.
(g)Notwithstanding any other law and to the extent permitted by federal law, an applicant or provider that meets the requirements to qualify as a mobile optometric office pursuant to Section 3070.2 of the Business and Professions Code and Section 14043.26 may be enrolled in the Medi-Cal program as either a mobile optometric office or within any other provider category for which the applicant or provider qualifies.
(1)An applicant or provider to which Section 3070.2 of the Business and Professions Code applies shall demonstrate its compliance by providing proof of its nonprofit or charitable organization status pursuant to Section 501(c)(3) or 501(c)(4) of the Internal Revenue Code and a statement that it shall not accept payment for services other than those provided to Medi-Cal beneficiaries, even if the State Board of Optometry has not yet issued final regulations as required by Section 3070.2 of the Business and Professions Code or issued any registrations at the time of enrollment.
(2)A mobile optometric office shall use the address of the owner and operator of the mobile optometric office as registered with the State Board of Optometry for its place of business address and shall not be required to comply with Section 51000.60 of Title 22 of the California Code of Regulations.
(3)To the extent federal financial participation is available, a mobile optometric office shall be permitted to bill the Medi-Cal program for the professional optometry services provided by licensed optometrists. The licensed optometrists providing service at a mobile optometric office shall use the address of the owner and operator of the mobile optometric office as registered with the State Board of Optometry for its place of business address and shall not be required to comply with Section 51000.60 of Title 22 of the California Code of Regulations.
The Legislature finds and declares that this act is declaratory of existing law, and that intermittent sites or mobile health care units operated by clinics exempt from licensure by the State Department of Public Health pursuant to subdivision (b) of Section 1206 of the Health and Safety Code are exempt under the law, as it existed prior to the enactment of this act, from the enrollment procedures under the Medi-Cal program, if the operating clinic has made a related notification to the State Department of Health Care Services.
SEC. 2.Section 14043.15 of the Welfare and Institutions Code is amended to read:14043.15.(a)The department may adopt regulations for certification of each applicant and each provider in the Medi-Cal program. No certification shall be required for natural persons licensed or certificated under Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act.
(b)(1)An applicant or provider who is a natural person, and is licensed or certificated pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act, or is a professional corporation, as defined in subdivision (b) of Section 13401 of the Corporations Code, shall comply with Section 14043.26 and shall be enrolled in the Medi-Cal program as either an individual provider or as a rendering provider in a provider group for each application package submitted and approved pursuant to Section 14043.26, notwithstanding that the applicant or provider meets the requirements to qualify as exempt from clinic licensure under subdivision (a) or (m) of Section 1206 of the Health and Safety Code.
(2)A provider enrolled in the Medi-Cal program pursuant to paragraph (1), who has disclosed in the application package for enrollment that the providers practice includes the rendering of services, goods, supplies, or merchandise solely at one, or at more than one, health facility, as defined in Section 1250 of the Health and Safety Code, or clinic, as defined in Section 1204 of the Health and Safety Code, or medical therapy unit, for purposes of Section 123950 of the Health and Safety Code, or residence of the providers patient, or office of a physician and surgeon involved in the care and treatment of the providers patients, shall not be required to enroll at each such health facility, clinic, medical therapy unit, patients residence, or physician and surgeons office location and may utilize the business addresses listed on the application for enrollment pursuant to paragraph (1) to claim reimbursement from the Medi-Cal program for services rendered by the provider to Medi-Cal beneficiaries at all of those health facilities, clinics, medical therapy units, residences, or physician offices.
(3)This subdivision shall not be interpreted to allow the violation of any state or federal law governing fiscal intermediaries or Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act. This subdivision does not remove the requirement that each claim for reimbursement from the Medi-Cal program identify the place of service and the rendering, ordering, referring, and prescribing provider, where applicable.
(c)An applicant or provider licensed as a clinic pursuant to Chapter 1 (commencing with Section 1200) of, or a health facility licensed pursuant to Chapter 2 (commencing with Section 1250) of, Division 2 of the Health and Safety Code may be enrolled in the Medi-Cal program as a clinic or a health facility and need not comply with Section 14043.26 if the clinic or health facility is certified by the department to participate in the Medi-Cal program.
(d)An applicant or provider that meets the requirements to qualify as exempt from clinic licensure under subdivisions (b) to (l), inclusive, or subdivisions (n) to (p), inclusive, of Section 1206 of the Health and Safety Code shall comply with Section 14043.26 and may be enrolled in the Medi-Cal program as either a clinic or within any other provider category for which the applicant or provider qualifies. An applicant or provider to which any of the clinic licensure exemptions specified in this subdivision apply shall identify the licensure exemption category and document in its application package the legal and factual basis for the clinic license exemption claimed.
(e)Notwithstanding subdivisions (a), (b), (c), and (d), an applicant or provider that meets the requirements to qualify as exempt from clinic licensure pursuant to subdivision (h) of Section 1206 of the Health and Safety Code, including an intermittent site or an affiliated mobile health care unit licensed or approved under exempted from licensure, or licensed or approved under, Chapter 9 (commencing with Section 1765.101) of Division 2 of the Health and Safety Code, and that is operated by a licensed primary care clinic or a clinic exempt from licensure pursuant to subdivision (b) of Section 1206 of the Health and Safety Code, and for which intermittent site or mobile health care unit the licensed primary care clinic or license-exempt clinic directly or indirectly provides all staffing, protocols, equipment, supplies, and billing services, need not enroll in the Medi-Cal program as a separate provider and need not comply with Section 14043.26 if the licensed primary care clinic or license-exempt clinic operating the applicant, provider clinic, or mobile health care unit has notified the department of its separate locations, premises, intermittent sites, or mobile health care units.
(f)A primary care clinic with (1) an additional physical plant added to its primary care clinic license under a consolidated license pursuant to subdivision (d) of Section 1212 of the Health and Safety Code, or (2) a physical plant that was added to an existing primary care clinic license by the State Department of Public Health, prior to January 1, 2017, whether by a regional district office or the centralized application unit, need not separately enroll the additional physical plant as a separate provider, and need not comply with Section 14043.26 if the primary care clinic has notified the department of its additional physical plant.
(g)Notwithstanding any other law and to the extent permitted by federal law, an applicant or provider that meets the requirements to qualify as a mobile optometric office pursuant to Section 3070.2 of the Business and Professions Code and Section 14043.26 may be enrolled in the Medi-Cal program as either a mobile optometric office or within any other provider category for which the applicant or provider qualifies.
(1)An applicant or provider to which Section 3070.2 of the Business and Professions Code applies shall demonstrate its compliance by providing proof of its nonprofit or charitable organization status pursuant to Section 501(c)(3) or 501(c)(4) of the Internal Revenue Code and a statement that it shall not accept payment for services other than those provided to Medi-Cal beneficiaries, even if the State Board of Optometry has not yet issued final regulations as required by Section 3070.2 of the Business and Professions Code or issued any registrations at the time of enrollment.
(2)A mobile optometric office shall use the address of the owner and operator of the mobile optometric office as registered with the State Board of Optometry for its place of business address and shall not be required to comply with Section 51000.60 of Title 22 of the California Code of Regulations.
(3)To the extent federal financial participation is available, a mobile optometric office shall be permitted to bill the Medi-Cal program for the professional optometry services provided by licensed optometrists. The licensed optometrists providing service at a mobile optometric office shall use the address of the owner and operator of the mobile optometric office as registered with the State Board of Optometry for its place of business address and shall not be required to comply with Section 51000.60 of Title 22 of the California Code of Regulations.
The Legislature finds and declares that this act is declaratory of existing law, and that intermittent sites or mobile health care units operated by clinics exempt from licensure by the State Department of Public Health pursuant to subdivision (b) of Section 1206 of the Health and Safety Code are exempt under the law, as it existed prior to the enactment of this act, from the enrollment procedures under the Medi-Cal program, if the operating clinic has made a related notification to the State Department of Health Care Services.
SECTION 1.SEC. 2.Section 14043.15 of the Welfare and Institutions Code is amended to read:14043.15.(a)The department may adopt regulations for certification of each applicant and each provider in the Medi-Cal program. No certification shall be required for natural persons licensed or certificated under Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act.
(b)(1)An applicant or provider who is a natural person, and is licensed or certificated pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act, or is a professional corporation, as defined in subdivision (b) of Section 13401 of the Corporations Code, shall comply with Section 14043.26 and shall be enrolled in the Medi-Cal program as either an individual provider or as a rendering provider in a provider group for each application package submitted and approved pursuant to Section 14043.26, notwithstanding that the applicant or provider meets the requirements to qualify as exempt from clinic licensure under subdivision (a) or (m) of Section 1206 of the Health and Safety Code.
(2)A provider enrolled in the Medi-Cal program pursuant to paragraph (1), who has disclosed in the application package for enrollment that the providers practice includes the rendering of services, goods, supplies, or merchandise solely at one, or at more than one, health facility, as defined in Section 1250 of the Health and Safety Code, or clinic, as defined in Section 1204 of the Health and Safety Code, or medical therapy unit, for purposes of Section 123950 of the Health and Safety Code, or residence of the providers patient, or office of a physician and surgeon involved in the care and treatment of the providers patients, shall not be required to enroll at each such health facility, clinic, medical therapy unit, patients residence, or physician and surgeons office location and may utilize the business addresses listed on the application for enrollment pursuant to paragraph (1) to claim reimbursement from the Medi-Cal program for services rendered by the provider to Medi-Cal beneficiaries at all of those health facilities, clinics, medical therapy units, residences, or physician offices.
(3)This subdivision shall not be interpreted to allow the violation of any state or federal law governing fiscal intermediaries or Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act. This subdivision does not remove the requirement that each claim for reimbursement from the Medi-Cal program identify the place of service and the rendering, ordering, referring, and prescribing provider, where applicable.
(c)An applicant or provider licensed as a clinic pursuant to Chapter 1 (commencing with Section 1200) of, or a health facility licensed pursuant to Chapter 2 (commencing with Section 1250) of, Division 2 of the Health and Safety Code may be enrolled in the Medi-Cal program as a clinic or a health facility and need not comply with Section 14043.26 if the clinic or health facility is certified by the department to participate in the Medi-Cal program.
(d)An applicant or provider that meets the requirements to qualify as exempt from clinic licensure under subdivisions (b) to (l), inclusive, or subdivisions (n) to (p), inclusive, of Section 1206 of the Health and Safety Code shall comply with Section 14043.26 and may be enrolled in the Medi-Cal program as either a clinic or within any other provider category for which the applicant or provider qualifies. An applicant or provider to which any of the clinic licensure exemptions specified in this subdivision apply shall identify the licensure exemption category and document in its application package the legal and factual basis for the clinic license exemption claimed.
(e)Notwithstanding subdivisions (a), (b), (c), and (d), an applicant or provider that meets the requirements to qualify as exempt from clinic licensure pursuant to subdivision (h) of Section 1206 of the Health and Safety Code, including an intermittent site or an affiliated mobile health care unit licensed or approved under Chapter 9 (commencing with Section 1765.101) of Division 2 of the Health and Safety Code, and that is operated by a licensed primary care clinic or a clinic exempt from licensure pursuant to subdivision (b) of Section 1206 of the Health and Safety Code, and for which intermittent site or mobile health care unit the licensed primary care clinic or license-exempt clinic directly or indirectly provides all staffing, protocols, equipment, supplies, and billing services, need not enroll in the Medi-Cal program as a separate provider and need not comply with Section 14043.26 if the licensed primary care clinic or license-exempt clinic operating the applicant, provider clinic, or mobile health care unit has notified the department of its separate locations, premises, intermittent sites, or mobile health care units.
(f)A primary care clinic with (1) an additional physical plant added to its primary care clinic license under a consolidated license pursuant to subdivision (d) of Section 1212 of the Health and Safety Code, or (2) a physical plant that was added to an existing primary care clinic license by the State Department of Public Health, prior to January 1, 2017, whether by a regional district office or the centralized application unit, need not separately enroll the additional physical plant as a separate provider, and need not comply with Section 14043.26 if the primary care clinic has notified the department of its additional physical plant.
(g)Notwithstanding any other law and to the extent permitted by federal law, an applicant or provider that meets the requirements to qualify as a mobile optometric office pursuant to Section 3070.2 of the Business and Professions Code and Section 14043.26 may be enrolled in the Medi-Cal program as either a mobile optometric office or within any other provider category for which the applicant or provider qualifies.
(1)An applicant or provider to which Section 3070.2 of the Business and Professions Code applies shall demonstrate its compliance by providing proof of its nonprofit or charitable organization status pursuant to Section 501(c)(3) or 501(c)(4) of the Internal Revenue Code and a statement that it shall not accept payment for services other than those provided to Medi-Cal beneficiaries, even if the State Board of Optometry has not yet issued final regulations as required by Section 3070.2 of the Business and Professions Code or issued any registrations at the time of enrollment.
(2)A mobile optometric office shall use the address of the owner and operator of the mobile optometric office as registered with the State Board of Optometry for its place of business address and shall not be required to comply with Section 51000.60 of Title 22 of the California Code of Regulations.
(3)To the extent federal financial participation is available, a mobile optometric office shall be permitted to bill the Medi-Cal program for the professional optometry services provided by licensed optometrists. The licensed optometrists providing service at a mobile optometric office shall use the address of the owner and operator of the mobile optometric office as registered with the State Board of Optometry for its place of business address and shall not be required to comply with Section 51000.60 of Title 22 of the California Code of Regulations.
(a)The department may adopt regulations for certification of each applicant and each provider in the Medi-Cal program. No certification shall be required for natural persons licensed or certificated under Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act.
(b)(1)An applicant or provider who is a natural person, and is licensed or certificated pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act, or is a professional corporation, as defined in subdivision (b) of Section 13401 of the Corporations Code, shall comply with Section 14043.26 and shall be enrolled in the Medi-Cal program as either an individual provider or as a rendering provider in a provider group for each application package submitted and approved pursuant to Section 14043.26, notwithstanding that the applicant or provider meets the requirements to qualify as exempt from clinic licensure under subdivision (a) or (m) of Section 1206 of the Health and Safety Code.
(2)A provider enrolled in the Medi-Cal program pursuant to paragraph (1), who has disclosed in the application package for enrollment that the providers practice includes the rendering of services, goods, supplies, or merchandise solely at one, or at more than one, health facility, as defined in Section 1250 of the Health and Safety Code, or clinic, as defined in Section 1204 of the Health and Safety Code, or medical therapy unit, for purposes of Section 123950 of the Health and Safety Code, or residence of the providers patient, or office of a physician and surgeon involved in the care and treatment of the providers patients, shall not be required to enroll at each such health facility, clinic, medical therapy unit, patients residence, or physician and surgeons office location and may utilize the business addresses listed on the application for enrollment pursuant to paragraph (1) to claim reimbursement from the Medi-Cal program for services rendered by the provider to Medi-Cal beneficiaries at all of those health facilities, clinics, medical therapy units, residences, or physician offices.
(3)This subdivision shall not be interpreted to allow the violation of any state or federal law governing fiscal intermediaries or Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act. This subdivision does not remove the requirement that each claim for reimbursement from the Medi-Cal program identify the place of service and the rendering, ordering, referring, and prescribing provider, where applicable.
(c)An applicant or provider licensed as a clinic pursuant to Chapter 1 (commencing with Section 1200) of, or a health facility licensed pursuant to Chapter 2 (commencing with Section 1250) of, Division 2 of the Health and Safety Code may be enrolled in the Medi-Cal program as a clinic or a health facility and need not comply with Section 14043.26 if the clinic or health facility is certified by the department to participate in the Medi-Cal program.
(d)An applicant or provider that meets the requirements to qualify as exempt from clinic licensure under subdivisions (b) to (l), inclusive, or subdivisions (n) to (p), inclusive, of Section 1206 of the Health and Safety Code shall comply with Section 14043.26 and may be enrolled in the Medi-Cal program as either a clinic or within any other provider category for which the applicant or provider qualifies. An applicant or provider to which any of the clinic licensure exemptions specified in this subdivision apply shall identify the licensure exemption category and document in its application package the legal and factual basis for the clinic license exemption claimed.
(e)Notwithstanding subdivisions (a), (b), (c), and (d), an applicant or provider that meets the requirements to qualify as exempt from clinic licensure pursuant to subdivision (h) of Section 1206 of the Health and Safety Code, including an intermittent site operated by a licensed primary care clinic or an affiliated mobile health care unit licensed or approved under Chapter 9 (commencing with Section 1765.101) of Division 2 of the Health and Safety Code, and that is operated by a licensed primary care clinic, clinic or a clinic exempt from licensure pursuant to subdivision (b) of Section 1206 of the Health and Safety Code, and for which intermittent site or mobile health care unit the licensed primary care clinic or license-exempt clinic directly or indirectly provides all staffing, protocols, equipment, supplies, and billing services, need not enroll in the Medi-Cal program as a separate provider and need not comply with Section 14043.26 if the licensed primary care clinic or license-exempt clinic operating the applicant, provider clinic, or mobile health care unit has notified the department of its separate locations, premises, intermittent sites, or mobile health care units.
(f)A primary care clinic with (1) an additional physical plant added to its primary care clinic license under a consolidated license pursuant to subdivision (d) of Section 1212 of the Health and Safety Code, or (2) a physical plant that was added to an existing primary care clinic license by the State Department of Public Health, prior to January 1, 2017, whether by a regional district office or the centralized application unit, need not separately enroll the additional physical plant as a separate provider, and need not comply with Section 14043.26 if the primary care clinic has notified the department of its additional physical plant.
(g)Notwithstanding any other law and to the extent permitted by federal law, an applicant or provider that meets the requirements to qualify as a mobile optometric office pursuant to Section 3070.2 of the Business and Professions Code and Section 14043.26 may be enrolled in the Medi-Cal program as either a mobile optometric office or within any other provider category for which the applicant or provider qualifies.
(1)An applicant or provider to which Section 3070.2 of the Business and Professions Code applies shall demonstrate its compliance by providing proof of its nonprofit or charitable organization status pursuant to Section 501(c)(3) or 501(c)(4) of the Internal Revenue Code and a statement that it shall not accept payment for services other than those provided to Medi-Cal beneficiaries, even if the State Board of Optometry has not yet issued final regulations as required by Section 3070.2 of the Business and Professions Code or issued any registrations at the time of enrollment.
(2)A mobile optometric office shall use the address of the owner and operator of the mobile optometric office as registered with the State Board of Optometry for its place of business address and shall not be required to comply with Section 51000.60 of Title 22 of the California Code of Regulations.
(3)To the extent federal financial participation is available, a mobile optometric office shall be permitted to bill the Medi-Cal program for the professional optometry services provided by licensed optometrists. The licensed optometrists providing service at a mobile optometric office shall use the address of the owner and operator of the mobile optometric office as registered with the State Board of Optometry for its place of business address and shall not be required to comply with Section 51000.60 of Title 22 of the California Code of Regulations.
(a)The department may adopt regulations for certification of each applicant and each provider in the Medi-Cal program. No certification shall be required for natural persons licensed or certificated under Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act.
(b)(1)An applicant or provider who is a natural person, and is licensed or certificated pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act, or is a professional corporation, as defined in subdivision (b) of Section 13401 of the Corporations Code, shall comply with Section 14043.26 and shall be enrolled in the Medi-Cal program as either an individual provider or as a rendering provider in a provider group for each application package submitted and approved pursuant to Section 14043.26, notwithstanding that the applicant or provider meets the requirements to qualify as exempt from clinic licensure under subdivision (a) or (m) of Section 1206 of the Health and Safety Code.
(2)A provider enrolled in the Medi-Cal program pursuant to paragraph (1), who has disclosed in the application package for enrollment that the providers practice includes the rendering of services, goods, supplies, or merchandise solely at one, or at more than one, health facility, as defined in Section 1250 of the Health and Safety Code, or clinic, as defined in Section 1204 of the Health and Safety Code, or medical therapy unit, for purposes of Section 123950 of the Health and Safety Code, or residence of the providers patient, or office of a physician and surgeon involved in the care and treatment of the providers patients, shall not be required to enroll at each such health facility, clinic, medical therapy unit, patients residence, or physician and surgeons office location and may utilize the business addresses listed on the application for enrollment pursuant to paragraph (1) to claim reimbursement from the Medi-Cal program for services rendered by the provider to Medi-Cal beneficiaries at all of those health facilities, clinics, medical therapy units, residences, or physician offices.
(3)This subdivision shall not be interpreted to allow the violation of any state or federal law governing fiscal intermediaries or Division 2 (commencing with Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act. This subdivision does not remove the requirement that each claim for reimbursement from the Medi-Cal program identify the place of service and the rendering, ordering, referring, and prescribing provider, where applicable.
(c)An applicant or provider licensed as a clinic pursuant to Chapter 1 (commencing with Section 1200) of, or a health facility licensed pursuant to Chapter 2 (commencing with Section 1250) of, Division 2 of the Health and Safety Code may be enrolled in the Medi-Cal program as a clinic or a health facility and need not comply with Section 14043.26 if the clinic or health facility is certified by the department to participate in the Medi-Cal program.
(d)An applicant or provider that meets the requirements to qualify as exempt from clinic licensure under subdivisions (b) to (l), inclusive, or subdivisions (n) to (p), inclusive, of Section 1206 of the Health and Safety Code shall comply with Section 14043.26 and may be enrolled in the Medi-Cal program as either a clinic or within any other provider category for which the applicant or provider qualifies. An applicant or provider to which any of the clinic licensure exemptions specified in this subdivision apply shall identify the licensure exemption category and document in its application package the legal and factual basis for the clinic license exemption claimed.
(e)Notwithstanding subdivisions (a), (b), (c), and (d), an applicant or provider that meets the requirements to qualify as exempt from clinic licensure pursuant to subdivision (h) of Section 1206 of the Health and Safety Code, including an intermittent site that is operated by a licensed primary care clinic or an affiliated mobile health care unit licensed or approved under Chapter 9 (commencing with Section 1765.101) of Division 2 of the Health and Safety Code, and that is operated by a licensed primary care clinic, and for which intermittent site or mobile health unit the licensed primary care clinic directly or indirectly provides all staffing, protocols, equipment, supplies, and billing services, need not enroll in the Medi-Cal program as a separate provider and need not comply with Section 14043.26 if the licensed primary care clinic operating the applicant, provider clinic, or mobile health care unit has notified the department of its separate locations, premises, intermittent sites, or mobile health care units.
(f)A primary care clinic with (1) an additional physical plant added to its primary care clinic license under a consolidated license pursuant to subdivision (d) of Section 1212 of the Health and Safety Code, or (2) a physical plant that was added to an existing primary care clinic license by the State Department of Public Health, prior to January 1, 2017, whether by a regional district office or the centralized application unit, need not separately enroll the additional physical plant as a separate provider, and need not comply with Section 14043.26 if the primary care clinic has notified the department of its additional physical plant.
(g)Notwithstanding any other law and to the extent permitted by federal law, an applicant or provider that meets the requirements to qualify as a mobile optometric office pursuant to Section 3070.2 of the Business and Professions Code and Section 14043.26 may be enrolled in the Medi-Cal program as either a mobile optometric office or within any other provider category for which the applicant or provider qualifies.
(1)An applicant or provider to which Section 3070.2 of the Business and Professions Code applies shall demonstrate its compliance by providing proof of its nonprofit or charitable organization status pursuant to Section 501(c)(3) or 501(c)(4) of the Internal Revenue Code and a statement that it shall not accept payment for services other than those provided to Medi-Cal beneficiaries, even if the State Board of Optometry has not yet issued final regulations as required by Section 3070.2 of the Business and Professions Code or issued any registrations at the time of enrollment.
(2)A mobile optometric office shall use the address of the owner and operator of the mobile optometric office as registered with the State Board of Optometry for its place of business address and shall not be required to comply with Section 51000.60 of Title 22 of the California Code of Regulations.
(3)To the extent federal financial participation is available, a mobile optometric office shall be permitted to bill the Medi-Cal program for the professional optometry services provided by licensed optometrists. The licensed optometrists providing service at a mobile optometric office shall use the address of the owner and operator of the mobile optometric office as registered with the State Board of Optometry for its place of business address and shall not be required to comply with Section 51000.60 of Title 22 of the California Code of Regulations.
|
Date
|
Status
|
|---|---|
| Sep 22, 2024 | Chaptered by Secretary of State. Chapter 448, Statutes of 2024. |
| Sep 22, 2024 | Approved by the Governor. |
| Sep 11, 2024 | Enrolled and presented to the Governor at 3 p.m. |
| Aug 31, 2024 | Assembly amendments concurred in. (Ayes 40. Noes 0. Page 5769.) Ordered to engrossing and enrolling. |
| Aug 30, 2024 | In Senate. Concurrence in Assembly amendments pending. |
| Aug 30, 2024 | Read third time. Passed. (Ayes 77. Noes 0. Page 7003.) Ordered to the Senate. |
| Aug 29, 2024 | Assembly Rule 96 suspended. |
| Aug 29, 2024 | Ordered to third reading. |
| Aug 29, 2024 | Withdrawn from committee. |
| Aug 27, 2024 | Re-referred to Com. on RLS. pursuant to Assembly Rule 97. |
| Aug 20, 2024 | Read third time and amended. |
| Aug 20, 2024 | Ordered to third reading. |
| Aug 19, 2024 | Ordered to third reading. |
| Aug 19, 2024 | From inactive file. |
| Aug 15, 2024 | Notice of intention to remove from inactive file given by Assembly Member Flora. |
| Aug 28, 2023 | Ordered to inactive file on request of Assembly Member Bryan. |
| Aug 24, 2023 | Ordered to third reading. |
| Aug 24, 2023 | From consent calendar on motion of Assembly Member Bryan. |
| Aug 17, 2023 | Read second time. Ordered to consent calendar. |
| Aug 16, 2023 | From committee: Do pass. Ordered to consent calendar. (Ayes 15. Noes 0.) (August 16). |
| Jul 12, 2023 | From committee: Do pass and re-refer to Com. on APPR. with recommendation: To consent calendar. (Ayes 15. Noes 0.) (July 11). Re-referred to Com. on APPR. |
| Jun 26, 2023 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH. |
| May 11, 2023 | Referred to Com. on HEALTH. |
| May 4, 2023 | In Assembly. Read first time. Held at Desk. |
| May 4, 2023 | Read third time. Passed. (Ayes 37. Noes 0. Page 1004.) Ordered to the Assembly. |
| May 2, 2023 | Read second time. Ordered to consent calendar. |
| May 1, 2023 | From committee: Be ordered to second reading pursuant to Senate Rule 28.8 and ordered to consent calendar. |
| Apr 25, 2023 | Set for hearing May 1. |
| Apr 24, 2023 | Read second time and amended. Re-referred to Com. on APPR. |
| Apr 20, 2023 | From committee: Do pass as amended and re-refer to Com. on APPR with recommendation: To consent calendar. (Ayes 11. Noes 0. Page 832.) (April 19). |
| Apr 13, 2023 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH. |
| Apr 12, 2023 | Set for hearing April 19. |
| Mar 29, 2023 | Re-referred to Com. on HEALTH. |
| Mar 20, 2023 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on RLS. |
| Mar 1, 2023 | Referred to Com. on RLS. |
| Feb 21, 2023 | From printer. May be acted upon on or after March 20. |
| Feb 17, 2023 | Introduced. Read first time. To Com. on RLS. for assignment. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Aug 31, 2024 | Unfinished Business SB819 Eggman Concurrence | Senate Floor |
Passed |
|
| Aug 30, 2024 | SB 819 Eggman Senate Third Reading By Flora | Assembly Floor |
Passed |
|
| Aug 16, 2023 | Do pass. To Consent Calendar. | Assembly Standing Committee on Appropriations |
Passed |
|
| Jul 11, 2023 | Do pass and be re-referred to the Committee on [Appropriations] with recommendation: To Consent Calendar | Assembly Standing Committee on Health |
Passed |
|
| May 4, 2023 | Consent Calendar SB819 Eggman | Senate Floor |
Passed |
|
| Apr 19, 2023 | Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations] with the recommendation: To Consent Calendar | Senate Standing Committee on Health |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| California Association Of Public Hospitals And Health Systems | ** Support | |
| County Health Executives Association Of California | ** Support | |
| San Joaquin County | ** Support |
SENATE THIRD READING
STR Bill Id:SB 819
Author:(Eggman)
As Amended Ver:August 20, 2024
Majority vote
SUMMARY
Clarifies that existing law exempts intermittent clinic sites and mobile health care units operated by clinics exempt from licensure by the Department of Public Health (DPH) from duplicative Medi-Cal enrollment procedures.
Major Provisions
COMMENTS
- San Joaquin County (SJC) mobile health clinic. The author states that this issue was brought to her office's attention by SJC, which acquired a one-exam-room mobile clinic with federal America Rescue Plan funding in 2019. SJC operates San Joaquin Health Centers primary care clinics in two locations, and planned to use the mobile clinic as an extension of its French Camp clinic location in order to access high-risk, low access communities. SJC passed Facility Site Review, which was required and facilitated by Health Plan of San Joaquin and Health Net, and in April of 2022, submitted an application to the Department of Health Care Services (DHCS) to have the mobile clinic enrolled into Medi-Cal. SJC also applied to the Centers for Medicare and Medicaid Services for Medicare enrollment, which it received, but the Medi-Cal license was denied. According to SJC, San Joaquin Health Centers is exempt from licensure as a county agency, and "a non-licensed clinic cannot enroll intermittent or mobile clinics into Medi-Cal." However, on appeal, a hearing officer overruled DHCS' grounds for denying SJC's application to enroll their mobile clinic in Medi-Cal, and DHCS ended up enrolling the mobile clinic with an effective date retroactive to the application submission date of April 28, 2022.
- Intermittent clinics. Under existing law, a licensed primary care clinic is permitted to operate an off-site clinic for up to 40 hours per week, without obtaining a separate license for these offsite locations. Licensed primary care clinics include community clinics and free clinics, but do not include a number of clinic settings that are exempt from licensure, such as county-operated clinics or tribal clinics.
Under the Mobile Health Care Services Act (MHCSA), a mobile unit is a special purpose commercial coach, as specified, that is one of the following: a) it is approved by DPH as a service of a licensed health facility, as defined; b) it is approved by DPH as a service of a licensed clinic, as defined; c) it is licensed by DPH as a clinic, as defined; or, d) it is licensed as an "other" type of approved mobile unit by DPH, with "other" types limited to mobile units performing services within new health facility or clinic licensure categories created after the effective date of the MHCSA (which became effective in 1994). A mobile unit is permitted to be operated as an adjunct to a licensed health facility or to a licensed clinic, or as an independent-freestanding clinic. However, the MHCSA also states that "no person, political subdivision of the state, or governmental agency shall operate a mobile service unit without first obtaining a license or an addition to existing licensure unless exempt from licensure under Section 1206 (of existing law)." Because county-operated clinics are exempt from licensure under Health and Safety Code Section 1206(b), counties are permitted to operate mobile units as additional services to their license-exempt clinics.
According to the Author
This bill will clarify the law to ensure that county-operated primary care clinics can operate mobile health care units as extensions of their primary care clinics without needing to separately enroll into Medi-Cal. While the longstanding practice and understanding of the law is that county clinics, which are not required to be licensed by DPH, are treated equally under the law to primary care clinics that are licensed by DPH, this understanding was recently brought into question when DHCS denied a Medi-Cal enrollment application to a mobile clinic operated by SJC on the basis that SJC's parent clinic was exempt from licensure. While that issue was resolved in favor of SJC, this bill will prevent this problem from happening to other counties.
Arguments in Support
The County Health Executives Association of California (CHEAC), supports this bill and states that, under current statute, in order for intermittent sites and mobile clinics to bill for Medi-Cal services, they must fall under a licensed parent clinic. However, county clinics are exempt from licensure and because of this, mobile clinics operated by a county would be required to apply as separate Medi-Cal provider to bill for services. CHEAC notes that this bill is intended to clarify that counties may operate mobile clinics and intermittent sites without requiring enrollment as a separate Medi-Cal provider. The ability to bill for these services supports the county's ability to offer services in vulnerable communities. CHEAC concludes that local health departments support efforts to enhance the ability for counties to deliver services through their clinics to the community.
The California Association of Public Hospitals and Health Systems (CAHP) supports this bill and notes that in order to help increase access to care, current law allows federal qualified health centers to operate intermittent and mobile clinics without needing to separately enroll them into the Medi-Cal program. CAPH states that this bill would clarify existing law that clinics exempt from licensure are authorized to operate intermittent clinic sites or mobile health care units without enrolling them in the Medi-Cal program as a separate provider if they have notified DHCS of the separate locations, premises, intermittent sites, or mobile health care units. CAHP concludes that this will ensure that public health care systems can continue to provide much needed health care services to underserved communities.
Arguments in Opposition
There is no known opposition to this bill.
FISCAL COMMENTS
According to the Assembly Appropriations Committee, there are no state costs associated with this bill.
VOTES
SENATE FLOOR: 37-0-3
YES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Grove, Hurtado, Jones, Laird, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk
ABS, ABST OR NV: Blakespear, Gonzalez, Limón
ASM HEALTH: 15-0-0
YES: Wood, Waldron, Aguiar-Curry, Arambula, Boerner, Wendy Carrillo, Flora, Vince Fong, Maienschein, McCarty, Joe Patterson, Rodriguez, Santiago, Villapudua, Weber
ASM APPROPRIATIONS: 15-0-1
YES: Holden, Megan Dahle, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Hart, Lowenthal, Mathis, Papan, Sanchez, Soria, Weber, Wilson
ABS, ABST OR NV: Pellerin
UPDATED
VERSION: August 20, 2024
CONSULTANT: Lara Flynn / HEALTH / (916) 319-2097 FN: 0003882
SENATE RULES COMMITTEE Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB 819 |
UNFINISHED BUSINESS
Bill No: SB 819
Author: Eggman (D)
Amended: 8/20/24
Vote: 21
SENATE HEALTH COMMITTEE: 11-0, 4/19/23
AYES: Eggman, Nguyen, Dahle, Glazer, Gonzalez, Limón, Menjivar, Roth, Rubio, Wahab, Wiener
NO VOTE RECORDED: Hurtado
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
SENATE FLOOR: 37-0, 5/4/23 (Consent)
AYES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Grove, Hurtado, Jones, Laird, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk
NO VOTE RECORDED: Blakespear, Gonzalez, Limón
ASSEMBLY FLOOR: 51-0, 8/30/24 – Roll call not available
SUBJECT: Medi-Cal: certification
SOURCE: Author
DIGEST:
This bill clarifies existing Medi-Cal provider enrollment requirements so that a clinic operated by a county, which is exempt from licensure, is treated the same as a licensed clinic in being able to add an intermittent clinic site or an affiliated mobile health care unit operating as an intermittent clinic without needing to separately enroll the intermittent clinic or mobile health care unit as a separate provider.
Assembly Amendments
recast and revise the provisions of this bill to incorporate technical assistance provided by the Department of Health Care Services.
ANALYSIS:
Existing law:
- Licenses and regulates clinics, including primary care clinics and specialty clinics, by the California Department of Public Health (CDPH). [HSC §1200, et seq.]
- Defines a primary care clinic as either a “community clinic,” which is required to be operated by a non-profit corporation and to use a sliding fee scale to charge patients based on their ability to pay, or a “free clinic,” which is also required to be operated by a non-profit but is not allowed to directly charge patients for services rendered or for any drugs, medicines, or apparatuses furnished. [HSC §1204]
- Exempts various types of clinics from licensure and regulation by CDPH, including clinics operated by the federal government and any primary care clinic operated by the state, counties, or cities. [HSC §1206 et seq., §1206(b)]
- Exempts from licensure by CDPH an intermittent clinic that is operated by a licensed primary care community clinic on separate premises from the licensed clinic and is only open for limited services of no more than 40 hours each week. However, an intermittent clinic operated under this exemption is still required to meet all other requirements of law, including administrative regulations and requirements, pertaining to fire and life safety. [HSC §1206(h)]
- Enacts the Mobile Health Care Services Act, which permits a mobile health unit, as defined, to operate as an adjunct to a licensed health facility or to a licensed clinic, or as an independent-freestanding clinic, as specified. Prohibits any person, political subdivision of the state, or governmental agency from operating a mobile service unit without first obtaining a license or an addition to existing licensure unless exempt from licensure. [HSC §1765.101 et seq., §1765.125]
- Establishes the Medi-Cal program as California’s Medicaid program, administered by the Department of Health Care Services (DHCS), which provides comprehensive health care coverage for low-income individuals. [WIC §14000, et seq.]
- Requires specified health care providers seeking to be a Medi-Cal provider to submit a complete application package for enrollment, continuing enrollment, or enrollment at a new location or a change in location (referred to as Medi-Cal Provider Enrollment):
- A provider that currently is not enrolled in the Medi-Cal program;
- A provider applying for continued enrollment, upon written notification from DHCS that enrollment for continued participation of all providers in a specific provider of service category or subgroup of that category to which the provider belongs will occur; and,
- A provider not currently enrolled at a location where the provider intends to provide services, goods, supplies, or merchandise to a Medi-Cal beneficiary. [WIC §14043.26].
- Exempts an applicant or provider from needing to enroll in the Medi-Cal program as a separate provider if the applicant is an intermittent clinic that is exempt from licensure, or is an affiliated mobile health care unit that is licensed or approved by CDPH, as specified, and is operated by a licensed primary care clinic and for which the intermittent site or mobile health unit the licensed primary care clinic directly or indirectly provides all staff, protocols, equipment, supplies, and billing services. Requires the licensed primary care clinic operating the applicant to notify the department of its separate locations, premises, intermittent sites, or mobile health care units. [WIC §14043.15(e)]
This bill:
- Revises a provision of law exempting intermittent clinic sites and affiliated mobile health care units from needing to enroll in the Medi-Cal program as a separate provider if it is operated by a licensed primary care clinic that directly or indirectly provides all staffing, protocols, equipment, supplies, and billing services, so that this provision of law now exempts applicants from needing to enroll in Medi-Cal as a separate provider if all of the following conditions are met:
- The applicant or provider is one of the following:
- An intermittent that is exempt from clinic licensure under existing law, as specified; or
- An affiliated mobile health care unit that is licensed or approved by CDPH, as specified, and qualifies as exempt from licensure under the intermittent clinic provision of existing law; and,
- The applicant or provider is operated by, and all staffing, protocols, equipment, supplies, and billing services are provided, directly or indirectly, by one of the following:
- A licensed primary care clinic;
- A clinic exempt from licensure because it is operated by a county or other governmental agency, as specified.
- The applicant or provider is one of the following:
- Makes legislative findings and declarations that this bill clarifies the intent of existing law to express the same exemption from the Medi-Cal enrollment procedures for intermittent sites and mobile health care units operated by county clinics exempt from licensure.
Comments
- Author’s statement. According to the author, “this bill clarifies the law to ensure that county-operated primary care clinics can operate mobile health care units as extensions of their primary care clinics without needing to separately enroll into Medi-Cal. While the longstanding practice and understanding of the law is that county clinics, which are not required to be licensed by CDPH, are treated equally under the law to primary care clinics that are licensed by CDPH, this understanding was recently brought into question when DHCS denied a Medi-Cal enrollment application to a mobile clinic operated by San Joaquin County (SJC) on the basis that SJC’s parent clinic was exempt from licensure. While that issue was resolved in favor of SJC, this bill will prevent this problem from happening to other counties.”
- Background on problem addressed by this bill. The author states that this issue was brought to her office’s attention by SJC, which acquired a one-exam-room mobile clinic with federal America Rescue Plan funding in 2019. SJC operates San Joaquin Health Centers primary care clinics in two locations, and planned to use the mobile clinic as an extension of its French Camp clinic location in order to access high-risk, low access communities. SJC passed Facility Site Review, which was required and facilitated by Health Plan of San Joaquin and Health Net, and in April of 2022, submitted an application to DHCS to have the mobile clinic enrolled into Medi-Cal. SJC also applied to the Centers for Medicare and Medicaid Services for Medicare enrollment, which it received, but the Medi-Cal license was denied. According to SJC, San Joaquin Health Centers is exempt from licensure as a county agency, and “a non-licensed clinic cannot enroll intermittent or mobile clinics into Medi-Cal.” However, on appeal, a hearing officer overruled DHCS’ grounds for denying SJC’s application to enroll their mobile clinic in Medi-Cal, and DHCS ended up enrolling the mobile clinic with an effective date retroactive to the application submission date of April 28, 2022.
- Background on intermittent clinics. Under existing law, a licensed primary care clinic is permitted to operate an off-site clinic for up to 40 hours per week, without obtaining a separate license for these offsite locations. Licensed primary care clinics include community clinics and free clinics, but do not include a number of clinic settings that are exempt from licensure, such as county-operate clinics or tribal clinics. According to CDPH, only clinics licensed by CDPH are captured by the Electronic Licensing Management System, so intermittent clinics are not tracked by CDPH. There are currently 1,388 licensed primary care clinics (1,339 community clinics and 49 free clinics). However, intermittent clinics report to the Provider Enrollment Division at DHCS, which reports that there are currently 795 listed intermittent clinics.
Under the Mobile Health Care Services Act (MHCSA), a mobile unit is a special purpose commercial coach, as specified, that is one of the following: (a) it is approved by CDPH as a service of a licensed health facility, as defined; (b) it is approved by CDPH as a service of a licensed clinic, as defined; (c) it is licensed by CDPH as a clinic, as defined; or, (d) it is licensed as an “other” type of approved mobile unit by CDPH, with “other” types limited to mobile units performing services within new health facility or clinic licensure categories created after the effective date of the MHCSA (which became effective in 1994). A mobile unit is permitted to be operated as an adjunct to a licensed health facility or to a licensed clinic, or as an independent-freestanding clinic. However, the MHCSA also states that “no person, political subdivision of the state, or governmental agency shall operate a mobile service unit without first obtaining a license or an addition to existing licensure unless exempt from licensure under Section 1206.” Because county-operated clinics are exempt from licensure under HSC §1206(b), counties are permitted to operate mobile units as additional services to their license-exempt clinics.
Related/Prior Legislation
SB 779 (Stern, Chapter 505, Statutes of 2023) added intermittent clinics that are exempt from licensure to an existing requirement that licensed clinics file an annual report to the Department of Health Care Access and Information (HCAI) with certain specified information for the previous calendar year. SB 779 also creates new reporting requirements for all primary care clinics, including intermittent clinics, to report various types of data to HCAI, including all mergers and acquisitions, a labor report, a workforce development report, and a report of quality and equity measures.
AB 2204 (Gray, Chapter 279, Statutes of 2018) extended the limit on the number of hours an intermittent primary care clinic can operate, from 30 to 40 hours per week, and still be exempt from licensure.
AB 2428 (Gonzalez Fletcher, Chapter 762, Statutes of 2018) allowed a federally qualified health center (FQHC) or rural health clinic (RHC) that adds an additional physical plant to its primary care license to elect to have the Medi-Cal reimbursement rate for each new plant be billed at and reimbursed at the same rate as the FQHC or RHC. Exempted from the Medi-Cal provider enrollment process a primary care clinic with additional locations added to its clinic license from the requirement to separately enroll the additional locations as separate providers, if the primary care clinic has notified the DHCS of its additional locations.
AB 2053 (Gonzalez, Chapter 639, Statutes of 2016) required CDPH, upon written notification by a licensed primary care clinic or an affiliate clinic that it is adding an additional physical plant maintained and operated on separate premises, to issue a single consolidated license to the clinic.
AB 1130 (Gray, Chapter 412, Statutes of 2015) expanded the licensure exemption for intermittent clinics that are operated by licensed clinics on separate premises by permitting these intermittent clinics to be open for up to 30 hours per week, instead of only 20 hours per week.
AB 941 (Wood, Chapter 502, Statutes of 2015) expanded a licensure exemption for tribal clinics, which were previously exempted if located on tribal land, by exempting tribal clinics regardless of the location of the clinic, if the clinic is operated under a contract with the United States pursuant to the Indian Self-Determination and Education Assistance Act.
SB 442 (Ducheny, Chapter 502, Statutes of 2010) streamlined the administrative requirements for a clinic corporation to apply for licensure for an affiliate primary care clinic.
SB 937 (Ducheny, Chapter 602, Statutes of 2003) revised provisions relating to the licensure and operation of primary care clinics. Permitted a primary care clinic to add a service or remodel a site without first having to apply for a new license from CDPH and required CDPH to issue an affiliate license to a primary care clinic to allow it to open a clinic at an additional site, under specified conditions.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No
According to the Assembly Appropriations Committee, there are no state costs associated with this bill.
SUPPORT: (Verified 8/28/24)
California Association of Public Hospitals and Health Systems
County Health Executives Association of California
San Joaquin County
OPPOSITION: (Verified 8/28/24)
None received
ARGUMENTS IN SUPPORT: The California Association of Public Hospitals and Health Systems (CAPH) states in support that many public health care systems operate an extensive network of Federally Qualified Health Centers to meet the ambulatory care needs of their patients. As public entities, public health care system clinics are exempt from CDPH licensing requirements that apply to private community clinics. To help increase access to care, current law allows FQHCs to operate intermittent and mobile clinics without needing to separately enroll them into Medi-Cal. This bill clarifies existing law that clinics exempt from licensure are authorized to operate intermittent sites or mobile health care units. San Joaquin County also supports, stating that this bill seeks to clarify the historical understanding that license-exempt clinics operated by counties should be treated the same as other primary care clinics.
Prepared by: Vincent D. Marchand / HEALTH / (916) 651-4111
8/30/24 17:27:06
**** END ****
SENATE THIRD READING
STR Bill Id:SB 819
Author:(Eggman)
As Amended Ver:August 20, 2024
Majority vote
SUMMARY
Clarifies that existing law exempts intermittent clinic sites and mobile health care units operated by clinics exempt from licensure by the Department of Public Health (DPH) from duplicative Medi-Cal enrollment procedures.
Major Provisions
COMMENTS
- San Joaquin County (SJC) mobile health clinic. The author states that this issue was brought to her office's attention by SJC, which acquired a one-exam-room mobile clinic with federal America Rescue Plan funding in 2019. SJC operates San Joaquin Health Centers primary care clinics in two locations, and planned to use the mobile clinic as an extension of its French Camp clinic location in order to access high-risk, low access communities. SJC passed Facility Site Review, which was required and facilitated by Health Plan of San Joaquin and Health Net, and in April of 2022, submitted an application to the Department of Health Care Services (DHCS) to have the mobile clinic enrolled into Medi-Cal. SJC also applied to the Centers for Medicare and Medicaid Services for Medicare enrollment, which it received, but the Medi-Cal license was denied. According to SJC, San Joaquin Health Centers is exempt from licensure as a county agency, and "a non-licensed clinic cannot enroll intermittent or mobile clinics into Medi-Cal." However, on appeal, a hearing officer overruled DHCS' grounds for denying SJC's application to enroll their mobile clinic in Medi-Cal, and DHCS ended up enrolling the mobile clinic with an effective date retroactive to the application submission date of April 28, 2022.
- Intermittent clinics. Under existing law, a licensed primary care clinic is permitted to operate an off-site clinic for up to 40 hours per week, without obtaining a separate license for these offsite locations. Licensed primary care clinics include community clinics and free clinics, but do not include a number of clinic settings that are exempt from licensure, such as county-operated clinics or tribal clinics.
Under the Mobile Health Care Services Act (MHCSA), a mobile unit is a special purpose commercial coach, as specified, that is one of the following: a) it is approved by DPH as a service of a licensed health facility, as defined; b) it is approved by DPH as a service of a licensed clinic, as defined; c) it is licensed by DPH as a clinic, as defined; or, d) it is licensed as an "other" type of approved mobile unit by DPH, with "other" types limited to mobile units performing services within new health facility or clinic licensure categories created after the effective date of the MHCSA (which became effective in 1994). A mobile unit is permitted to be operated as an adjunct to a licensed health facility or to a licensed clinic, or as an independent-freestanding clinic. However, the MHCSA also states that "no person, political subdivision of the state, or governmental agency shall operate a mobile service unit without first obtaining a license or an addition to existing licensure unless exempt from licensure under Section 1206 (of existing law)." Because county-operated clinics are exempt from licensure under Health and Safety Code Section 1206(b), counties are permitted to operate mobile units as additional services to their license-exempt clinics.
According to the Author
This bill will clarify the law to ensure that county-operated primary care clinics can operate mobile health care units as extensions of their primary care clinics without needing to separately enroll into Medi-Cal. While the longstanding practice and understanding of the law is that county clinics, which are not required to be licensed by DPH, are treated equally under the law to primary care clinics that are licensed by DPH, this understanding was recently brought into question when DHCS denied a Medi-Cal enrollment application to a mobile clinic operated by SJC on the basis that SJC's parent clinic was exempt from licensure. While that issue was resolved in favor of SJC, this bill will prevent this problem from happening to other counties.
Arguments in Support
The County Health Executives Association of California (CHEAC), supports this bill and states that, under current statute, in order for intermittent sites and mobile clinics to bill for Medi-Cal services, they must fall under a licensed parent clinic. However, county clinics are exempt from licensure and because of this, mobile clinics operated by a county would be required to apply as separate Medi-Cal provider to bill for services. CHEAC notes that this bill is intended to clarify that counties may operate mobile clinics and intermittent sites without requiring enrollment as a separate Medi-Cal provider. The ability to bill for these services supports the county's ability to offer services in vulnerable communities. CHEAC concludes that local health departments support efforts to enhance the ability for counties to deliver services through their clinics to the community.
The California Association of Public Hospitals and Health Systems (CAHP) supports this bill and notes that in order to help increase access to care, current law allows federal qualified health centers to operate intermittent and mobile clinics without needing to separately enroll them into the Medi-Cal program. CAPH states that this bill would clarify existing law that clinics exempt from licensure are authorized to operate intermittent clinic sites or mobile health care units without enrolling them in the Medi-Cal program as a separate provider if they have notified DHCS of the separate locations, premises, intermittent sites, or mobile health care units. CAHP concludes that this will ensure that public health care systems can continue to provide much needed health care services to underserved communities.
Arguments in Opposition
There is no known opposition to this bill.
FISCAL COMMENTS
According to the Assembly Appropriations Committee, there are no state costs associated with this bill.
VOTES
SENATE FLOOR: 37-0-3
YES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Grove, Hurtado, Jones, Laird, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk
ABS, ABST OR NV: Blakespear, Gonzalez, Limón
ASM HEALTH: 15-0-0
YES: Wood, Waldron, Aguiar-Curry, Arambula, Boerner, Wendy Carrillo, Flora, Vince Fong, Maienschein, McCarty, Joe Patterson, Rodriguez, Santiago, Villapudua, Weber
ASM APPROPRIATIONS: 15-0-1
YES: Holden, Megan Dahle, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Hart, Lowenthal, Mathis, Papan, Sanchez, Soria, Weber, Wilson
ABS, ABST OR NV: Pellerin
UPDATED
VERSION: August 20, 2024
CONSULTANT: Lara Flynn / HEALTH / (916) 319-2097 FN: 0003882
SENATE THIRD READING
STR Bill Id:SB 819
Author:(Eggman)
As Amended Ver:June 26, 2023
Majority vote
SUMMARY
Clarifies that existing law exempts intermittent clinic sites and affiliated mobile health care units that are operated by a license-exempt clinic operated by a governmental entity, including a county, from the requirement to enroll in the Medi-Cal program as a separate provider.
Major Provisions
COMMENTS
- San Joaquin County (SJC) mobile health clinic. The author states that this issue was brought to her office's attention by SJC, which acquired a one-exam-room mobile clinic with federal America Rescue Plan funding in 2019. SJC operates San Joaquin Health Centers primary care clinics in two locations, and planned to use the mobile clinic as an extension of its French Camp clinic location in order to access high-risk, low access communities. SJC passed Facility Site Review, which was required and facilitated by Health Plan of San Joaquin and Health Net, and in April of 2022, submitted an application to the Department of Health Care Services (DHCS) to have the mobile clinic enrolled into Medi-Cal. SJC also applied to the Centers for Medicare and Medicaid Services for Medicare enrollment, which it received, but the Medi-Cal license was denied. According to SJC, San Joaquin Health Centers is exempt from licensure as a county agency, and "a non-licensed clinic cannot enroll intermittent or mobile clinics into Medi-Cal." However, on appeal, a hearing officer overruled DHCS' grounds for denying SJC's application to enroll their mobile clinic in Medi-Cal, and DHCS ended up enrolling the mobile clinic with an effective date retroactive to the application submission date of April 28, 2022.
- Intermittent clinics. Under existing law, a licensed primary care clinic is permitted to operate an off-site clinic for up to 40 hours per week, without obtaining a separate license for these offsite locations. Licensed primary care clinics include community clinics and free clinics, but do not include a number of clinic settings that are exempt from licensure, such as county-operated clinics or tribal clinics.
According to the California Health and Human Services Agency's Open Data Portal, there were 2,052 licensed clinics (these include primary care clinics, surgical clinics, chronic dialysis clinics, rehabilitation clinics, psychology clinics, and alternative birth centers) as of May 15, 2023. Of these, 1,325 were licensed primary care clinics (these do not include intermittent clinics). According to the Open Data Portal, there were 1,218 intermittent clinics as of May 15, 2023. According to DHCS, based on Medi-Cal provider enrollment data, there are 818 intermittent clinics.
Under the Mobile Health Care Services Act (MHCSA), a mobile unit is a special purpose commercial coach, as specified, that is one of the following: a) it is approved by the Department of Public Health (DPH) as a service of a licensed health facility, as defined; b) it is approved by DPH as a service of a licensed clinic, as defined; c) it is licensed by DPH as a clinic, as defined; or, d) it is licensed as an "other" type of approved mobile unit by DPH, with "other" types limited to mobile units performing services within new health facility or clinic licensure categories created after the effective date of the MHCSA (which became effective in 1994). A mobile unit is permitted to be operated as an adjunct to a licensed health facility or to a licensed clinic, or as an independent-freestanding clinic. However, the MHCSA also states that "no person, political subdivision of the state, or governmental agency shall operate a mobile service unit without first obtaining a license or an addition to existing licensure unless exempt from licensure under Section 1206." Because county-operated clinics are exempt from licensure under Health and Safety Code Section 1206(b), counties are permitted to operate mobile units as additional services to their license-exempt clinics.
According to the Author
This bill will clarify the law to ensure that county-operated primary care clinics can operate mobile health care units as extensions of their primary care clinics without needing to separately enroll into Medi-Cal. While the longstanding practice and understanding of the law is that county clinics, which are not required to be licensed by DPH, are treated equally under the law to primary care clinics that are licensed by DPH, this understanding was recently brought into question when DHCS denied a Medi-Cal enrollment application to a mobile clinic operated by SJC on the basis that SJC's parent clinic was exempt from licensure. While that issue was resolved in favor of SJC, this bill will prevent this problem from happening to other counties.
Arguments in Support
The County Health Executives Association of California (CHEAC), supports this bill and states that, under current statute, in order for intermittent sites and mobile clinics to bill for Medi-Cal services, they must fall under a licensed parent clinic. However, county clinics are exempt from licensure and because of this, mobile clinics operated by a county would be required to apply as separate Medi-Cal provider to bill for services. CHEAC notes that this bill is intended to clarify that counties may operate mobile clinics and intermittent sites without requiring enrollment as a separate Medi-Cal provider. The ability to bill for these services supports the county's ability to offer services in vulnerable communities. CHEAC concludes that local health departments support efforts to enhance the ability for counties to deliver services through their clinics to the community.
The California Association of Public Hospitals and Health Systems (CAHP) supports this bill and notes that in order to help increase access to care, current law allows federal qualified health centers to operate intermittent and mobile clinics without needing to separately enroll them into the Medi-Cal program. CAPH states that this bill would clarify existing law that clinics exempt from licensure are authorized to operate intermittent clinic sites or mobile health care units without enrolling them in the Medi-Cal program as a separate provider if they have notified DHCS of the separate locations, premises, intermittent sites, or mobile health care units. CAHP concludes that this will ensure that public health care systems can continue to provide much needed health care services to underserved communities.
Arguments in Opposition
There is no known opposition to this bill.
FISCAL COMMENTS
According to the Assembly Appropriations Committee, there are no state costs associated with this bill.
VOTES
SENATE FLOOR: 37-0-3
YES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Grove, Hurtado, Jones, Laird, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk
ABS, ABST OR NV: Blakespear, Gonzalez, Limón
ASM HEALTH: 15-0-0
YES: Wood, Waldron, Aguiar-Curry, Arambula, Boerner, Wendy Carrillo, Flora, Vince Fong, Maienschein, McCarty, Joe Patterson, Rodriguez, Santiago, Villapudua, Weber
ASM APPROPRIATIONS: 15-0-1
YES: Holden, Megan Dahle, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Hart, Lowenthal, Mathis, Papan, Sanchez, Soria, Weber, Wilson
ABS, ABST OR NV: Pellerin
UPDATED
VERSION: June 26, 2023
CONSULTANT: Lara Flynn / HEALTH / (916) 319-2097 FN: 0001317
Date of Hearing: August 16, 2023
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Chris Holden, Chair
SBPCA Bill Id:SB 819
Author:(Eggman) – As Amended Ver:June 26, 2023
Policy Committee: | Health | Vote: | 15 - 0 |
|
| ||
|
|
Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill clarifies that an intermittent clinic site or a mobile health care unit operated by a license-exempt clinic operated by a government entity is not required to enroll in the Medi-Cal program as a separate provider.
FISCAL EFFECT:
No state costs.
COMMENTS:
- Purpose. According to the author:
This bill would clarify the law to ensure that county-operated primary care clinics can operate mobile health care units as extensions of their primary care clinics without needing to separately enroll into Medi-Cal. While the longstanding practice and understanding of the law is that county clinics, which are not required to be licensed by [the California Department of Public Health (CDPH)], are treated equally under the law to primary care clinics that are licensed by CDPH, this understanding was recently brought into question when DHCS denied a Medi-Cal enrollment application to a mobile clinic operated by San Joaquin County (SJC) on the basis that SJC’s parent clinic was exempt from licensure. While that issue was resolved in favor of SJC, this bill will prevent this problem from happening to other counties.
- Background. According to information provided by the author, San Joaquin County (SJC) operates primary care clinics in two locations. In 2019, SJC used federal American Rescue Plan Act funding to acquire a mobile clinic to use as an extension of its French Camp clinic location to provide health care to high-risk, low access communities. SJC passed Facility Site Review, which was required and facilitated by Health Plan of San Joaquin and Health Net, and in April of 2022, submitted an application to the Department of Health Care Services (DHCS) to enroll the mobile clinic into Medi-Cal. SJC successfully applied to the Centers for Medicare and Medicaid Services for Medicare enrollment. However, DHCS determined that “a non-licensed clinic cannot enroll intermittent or mobile clinics into Medi-Cal,” and denied the license. SJC argued San Joaquin Health Centers is exempt from licensure as a county agency. On appeal, a hearing officer overruled DHCS’ grounds for denying SJC’s application to enroll their mobile clinic in Medi-Cal, and DHCS enrolled the mobile clinic.
- Prior Legislation.
- AB 2204 (Gray), Chapter 279, Statutes of 2018, extended, from 30 hours to 40 hours per week, the limit on the number of hours an intermittent primary care clinic may operate and remain exempt from licensure.
- AB 2428 (Gonzalez Fletcher), Chapter 762, Statutes of 2018, exempted a primary care clinic with additional locations on its clinic license from the requirement to enroll the additional locations as separate Medi-Cal providers if the primary care clinic had notified DHCS of its additional locations.
- AB 2053 (Gonzalez), Chapter 639, Statutes of 2016, required CDPH to issue a single consolidated license to a licensed primary care clinic or an affiliate clinic with a physical plant maintained and operated on separate premises, as specified.
- AB 941 (Wood), Chapter 502, Statutes of 2015, expanded a licensure exemption for tribal clinics, which were previously exempted if located on tribal land, by exempting tribal clinics regardless of the location of the clinic, if the clinic is operated under a contract with the U.S. pursuant to the Indian Self-Determination and Education Assistance Act.
- AB 1130 (Gray), Chapter 412, Statutes of 2015, extended, from 20 hours per week to 30 hours per week, the limit on hours of operation for an intermittent primary care clinic.
Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081
Date of Hearing: July 11, 2023
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
SBPCA Bill Id:SB 819
Author:(Eggman) – As Amended Ver:June 26, 2023
SENATE VOTE: 37-0
SUBJECT: Medi-Cal: certification.
SUMMARY: Clarifies that existing law exempts intermittent clinic sites and affiliated mobile health care units that are operated by a license-exempt clinic operated by a governmental entity, including a county, from the requirement to enroll in the Medi-Cal program as a separate provider.
EXISTING LAW:
- Licenses and regulates clinics, including primary care clinics and specialty clinics, by the Department of Public Health (DPH). [Health and Safety Code (HSC) §1200, et seq.]
- Defines a primary care clinic as either a “community clinic,” which is required to be operated by a non-profit corporation and to use a sliding fee scale to charge patients based on their ability to pay, or a “free clinic,” which is also required to be operated by a non-profit but is not allowed to directly charge patients for services rendered or for any drugs, medicines, or apparatuses furnished. [HSC §1204]
- Exempts various types of clinics from licensure and regulation by DPH, including clinics operated by the federal government and any primary care clinic operated by the state, counties, or cities. [HSC §1206 et seq., §1206(b)]
- Exempts an intermittent clinic that is operated by a licensed primary care community clinic on separate premises from the licensed clinic and is only open for limited services of no more than 40 hours each week from licensure by DPH. Requires intermittent clinics operated under this exemption to meet all other requirements of law, including administrative regulations and requirements, pertaining to fire and life safety. [HSC §1206 (h)]
- Enacts the Mobile Health Care Services Act, which permits a mobile health unit, as defined, to operate as an adjunct to a licensed health facility or to a licensed clinic, or as an independent-freestanding clinic, as specified. Prohibits any person, political subdivision of the state, or governmental agency from operating a mobile service unit without first obtaining a license or an addition to existing licensure, unless exempt from licensure. [HSC §1765.101 et seq., §1765.125]
- Establishes the Medi-Cal program as California’s Medicaid program, administered by the Department of Health Care Services (DHCS), which provides comprehensive health care coverage for low-income individuals. [Welfare and Institutions Code (WIC) §14000, et seq.]
- Requires specified health care providers seeking to be a Medi-Cal provider to submit a complete application package for enrollment, continuing enrollment, or enrollment at a new location or a change in location (this is referred to as Medi-Cal Provider Enrollment):
- A provider that currently is not enrolled in the Medi-Cal program;
- A provider applying for continued enrollment, upon written notification from DHCS that enrollment for continued participation of all providers in a specific provider of service category or subgroup of that category to which the provider belongs will occur; and,
- A provider not currently enrolled at a location where the provider intends to provide services, goods, supplies, or merchandise to a Medi-Cal beneficiary. [WIC §14043.26].
- Exempts an applicant or provider from needing to enroll in the Medi-Cal program as a separate provider if the applicant is an intermittent clinic that is exempt from licensure, or is an affiliated mobile health care unit that is licensed or approved by DPH, as specified, and is operated by a licensed primary care clinic and for which the intermittent site or mobile health unit the licensed primary care clinic directly or indirectly provides all staff, protocols, equipment, supplies, and billing services. Requires the licensed primary care clinic operating the applicant to notify DHCS of its separate locations, premises, intermittent sites, or mobile health care units. [WIC §14043.15(e)]
FISCAL EFFECT: According to the Senate Appropriation Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, this bill will clarify the law to ensure that county-operated primary care clinics can operate mobile health care units as extensions of their primary care clinics without needing to separately enroll into Medi-Cal. While the longstanding practice and understanding of the law is that county clinics, which are not required to be licensed by DPH, are treated equally under the law to primary care clinics that are licensed by DPH, this understanding was recently brought into question when DHCS denied a Medi-Cal enrollment application to a mobile clinic operated by San Joaquin County (SJC) on the basis that SJC’s parent clinic was exempt from licensure. While that issue was resolved in favor of SJC, this bill will prevent this problem from happening to other counties.
- BACKGROUND.
- SJC mobile health clinic. The author states that this issue was brought to her office’s attention by SJC, which acquired a one-exam-room mobile clinic with federal America Rescue Plan funding in 2019. SJC operates San Joaquin Health Centers primary care clinics in two locations, and planned to use the mobile clinic as an extension of its French Camp clinic location in order to access high-risk, low access communities. SJC passed Facility Site Review, which was required and facilitated by Health Plan of San Joaquin and Health Net, and in April of 2022, submitted an application to DHCS to have the mobile clinic enrolled into Medi-Cal. SJC also applied to the Centers for Medicare and Medicaid Services for Medicare enrollment, which it received, but the Medi-Cal license was denied. According to SJC, San Joaquin Health Centers is exempt from licensure as a county agency, and “a non-licensed clinic cannot enroll intermittent or mobile clinics into Medi-Cal.” However, on appeal, a hearing officer overruled DHCS’ grounds for denying SJC’s application to enroll their mobile clinic in Medi-Cal, and DHCS ended up enrolling the mobile clinic with an effective date retroactive to the application submission date of April 28, 2022.
- Intermittent clinics. Under existing law, a licensed primary care clinic is permitted to operate an off-site clinic for up to 40 hours per week, without obtaining a separate license for these offsite locations. Licensed primary care clinics include community clinics and free clinics, but do not include a number of clinic settings that are exempt from licensure, such as county-operated clinics or tribal clinics.
According to the California Health and Human Services Agency’s Open Data Portal, there were 2,052 licensed clinics (these include primary care clinics, surgical clinics, chronic dialysis clinics, rehabilitation clinics, psychology clinics, and alternative birth centers) as of May 15, 2023. Of these, 1,325 were licensed primary care clinics (these do not include intermittent clinics). According to the Open Data Portal, there were 1,218 intermittent clinics as of May 15, 2023. According to DHCS, based on Medi-Cal provider enrollment data, there are 818 intermittent clinics.
Under the Mobile Health Care Services Act (MHCSA), a mobile unit is a special purpose commercial coach, as specified, that is one of the following: i) it is approved by DPH as a service of a licensed health facility, as defined; ii) it is approved by DPH as a service of a licensed clinic, as defined; iii) it is licensed by DPH as a clinic, as defined; or, iv) it is licensed as an “other” type of approved mobile unit by DPH, with “other” types limited to mobile units performing services within new health facility or clinic licensure categories created after the effective date of the MHCSA (which became effective in 1994). A mobile unit is permitted to be operated as an adjunct to a licensed health facility or to a licensed clinic, or as an independent-freestanding clinic. However, the MHCSA also states that “no person, political subdivision of the state, or governmental agency shall operate a mobile service unit without first obtaining a license or an addition to existing licensure unless exempt from licensure under Section 1206.” Because county-operated clinics are exempt from licensure under HSC §1206 (b), counties are permitted to operate mobile units as additional services to their license-exempt clinics.
- SUPPORT. The County Health Executives Association of California (CHEAC), supports this bill and states that, under current statute, in order for intermittent sites and mobile clinics to bill for Medi-Cal services, they must fall under a licensed parent clinic. However, county clinics are exempt from licensure and because of this, mobile clinics operated by a county would be required to apply as separate Medi-Cal provider to bill for services. CHEAC notes that this bill is intended to clarify that counties may operate mobile clinics and intermittent sites without requiring enrollment as a separate Medi-Cal provider. The ability to bill for these services supports the county’s ability to offer services in vulnerable communities. CHEAC concludes that local health departments support efforts to enhance the ability for counties to deliver services through their clinics to the community.
The California Association of Public Hospitals and Health Systems (CAHP) supports this bill and notes that in order to help increase access to care, current law allows federal qualified health centers to operate intermittent and mobile clinics without needing to separately enroll them into the Medi-Cal program. CAPH states that this bill would clarify existing law that clinics exempt from licensure are authorized to operate intermittent clinic sites or mobile health care units without enrolling them in the Medi-Cal program as a separate provider if they have notified DHCS of the separate locations, premises, intermittent sites, or mobile health care units. CAHP concludes that this will ensure that public health care systems can continue to provide much needed health care services to underserved communities. - RELATED LEGISLATION. SB 779 (Stern) adds intermittent clinics that are exempt from licensure to an existing requirement that licensed clinics file an annual report to the Department of Health Care Access and Information (HCAI) with specified information for the previous calendar year. SB 779 also creates new reporting requirements for all primary care clinics, including intermittent clinics, to report various types of data to HCAI, including all mergers and acquisitions, a labor report, a workforce development report, and a report of quality and equity measures. SB 779 is pending in the Assembly Health Committee.
- PREVIOUS LEGISLATION.
- AB 2204 (Gray), Chapter 279, Statutes of 2018, extends the limit on the number of hours an intermittent primary care clinic can operate, from 30 to 40 hours per week, and still be exempt from licensure.
- AB 2428 (Gonzalez Fletcher), Chapter 762, Statutes of 2018, allows a federally qualified health center (FQHC) or rural health clinic (RHC) that adds an additional physical plant to its primary care license to elect to have the Medi-Cal reimbursement rate for each new plant be billed at and reimbursed at the same rate as the FQHC or RHC. Exempts from the Medi-Cal provider enrollment process a primary care clinic with additional locations added to its clinic license from the requirement to separately enroll the additional locations as separate providers, if the primary care clinic has notified the DHCS of its additional locations.
- AB 2053 (Gonzalez), Chapter 639, Statutes of 2016, requires DPH, upon written notification by a licensed primary care clinic or an affiliate clinic that it is adding an additional physical plant maintained and operated on separate premises, to issue a single consolidated license to the clinic.
- AB 1130 (Gray), Chapter 412, Statutes of 2015, expanded the licensure exemption for intermittent clinics that are operated by licensed clinics on separate premises by permitting an intermittent clinics to be open for up to 30 hours per week, instead of only 20 hours per week.
- AB 941 (Wood), Chapter 502, Statutes of 2015, expanded a licensure exemption for tribal clinics, which were previously exempted if located on tribal land, by exempting tribal clinics regardless of the location of the clinic, if the clinic is operated under a contract with the United States pursuant to the Indian Self-Determination and Education Assistance Act.
- SB 442 (Ducheny), Chapter 502, Statutes of 2010, streamlined the administrative requirements for a clinic corporation to apply for licensure for an affiliate primary care clinic.
- SB 937 (Ducheny), Chapter 602, Statutes of 2003, revised provisions relating to the licensure and operation of primary care clinics. Permitted a primary care clinic to add a service or remodel a site without first having to apply for a new license from DPH and required DPH to issue an affiliate license to a primary care clinic to allow it to open a clinic at an additional site, under specified conditions.
REGISTERED SUPPORT / OPPOSITION:
Support
California Association of Public Hospitals & Health Systems
County Health Executives Association of California
San Joaquin County
Opposition
None on file.
Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097
SENATE HEALTH COMMITTEE Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB 819 |
CONSENT
Bill No: SB 819
Author: Eggman (D)
Amended: 4/24/23
Vote: 21
SENATE HEALTH COMMITTEE: 11-0, 4/19/23
AYES: Eggman, Nguyen, Dahle, Glazer, Gonzalez, Limón, Menjivar, Roth, Rubio, Wahab, Wiener
NO VOTE RECORDED: Hurtado
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
SUBJECT: Medi-Cal: certification
SOURCE: Author
DIGEST:
This bill clarifies existing Medi-Cal provider enrollment requirements so that a clinic operated by a county, which is exempt from licensure, is treated the same as a licensed clinic in being able to add an intermittent clinic site or an affiliated mobile health care unit without needing to separately enroll the intermittent clinic or mobile health care unit as a separate provider.
ANALYSIS:
Existing law:
- Licenses and regulates clinics, including primary care clinics and specialty clinics, by the California Department of Public Health (CDPH). [HSC §1200, et seq.]
- Defines a primary care clinic as either a “community clinic,” which is required to be operated by a non-profit corporation and to use a sliding fee scale to charge patients based on their ability to pay, or a “free clinic,” which is also required to be operated by a non-profit but is not allowed to directly charge patients for services rendered or for any drugs, medicines, or apparatuses furnished. [HSC §1204]
- Exempts various types of clinics from licensure and regulation by CDPH, including clinics operated by the federal government and any primary care clinic operated by the state, counties, or cities. [HSC §1206 et seq., §1206(b)]
- Exempts from licensure by CDPH an intermittent clinic that is operated by a licensed primary care community clinic on separate premises from the licensed clinic and is only open for limited services of no more than 40 hours each week. However, an intermittent clinic operated under this exemption is still required to meet all other requirements of law, including administrative regulations and requirements, pertaining to fire and life safety. [HSC §1206(h)]
- Enacts the Mobile Health Care Services Act, which permits a mobile health unit, as defined, to operate as an adjunct to a licensed health facility or to a licensed clinic, or as an independent-freestanding clinic, as specified. Prohibits any person, political subdivision of the state, or governmental agency from operating a mobile service unit without first obtaining a license or an addition to existing licensure unless exempt from licensure. [HSC §1765.101 et seq., §1765.125]
- Establishes the Medi-Cal program as California’s Medicaid program, administered by the Department of Health Care Services (DHCS), which provides comprehensive health care coverage for low-income individuals. [WIC §14000, et seq.]
- Requires specified health care providers seeking to be a Medi-Cal provider to submit a complete application package for enrollment, continuing enrollment, or enrollment at a new location or a change in location (referred to as Medi-Cal Provider Enrollment):
- A provider that currently is not enrolled in the Medi-Cal program;
- A provider applying for continued enrollment, upon written notification from DHCS that enrollment for continued participation of all providers in a specific provider of service category or subgroup of that category to which the provider belongs will occur; and,
- A provider not currently enrolled at a location where the provider intends to provide services, goods, supplies, or merchandise to a Medi-Cal beneficiary. [WIC §14043.26].
- Exempts an applicant or provider from needing to enroll in the Medi-Cal program as a separate provider if the applicant is an intermittent clinic that is exempt from licensure, or is an affiliated mobile health care unit that is licensed or approved by CDPH, as specified, and is operated by a licensed primary care clinic and for which the intermittent site or mobile health unit the licensed primary care clinic directly or indirectly provides all staff, protocols, equipment, supplies, and billing services. Requires the licensed primary care clinic operating the applicant to notify the department of its separate locations, premises, intermittent sites, or mobile health care units. [WIC §14043.15(e)]
This bill:
- Revises a provision of law exempting intermittent clinic sites and affiliated mobile health care units from needing to enroll in the Medi-Cal program as a separate provider if it is operated by a licensed primary care clinic that directly or indirectly provides all staffing, protocols, equipment, supplies, and billing services, so that this provision of law also applies to intermittent clinic sites and affiliated mobile health care units that are operated by a license-exempt clinic operated by a governmental entity, including a county.
- Makes legislative findings and declarations that this bill is declaratory of existing law, and that intermittent sites or mobile health care units operated by clinics exempt from licensure by CDPH, as specified, are exempt under the law, as it existed prior to the enactment of this bill, from the enrollment procedures under the Medi-Cal program, if the operating clinic has made a related notification to DHCS.
Comments
- Author’s statement. According to the author, this bill clarifies the law to ensure that county-operated primary care clinics can operate mobile health care units as extensions of their primary care clinics without needing to separately enroll into Medi-Cal. While the longstanding practice and understanding of the law is that county clinics, which are not required to be licensed by CDPH, are treated equally under the law to primary care clinics that are licensed by CDPH, this understanding was recently brought into question when DHCS denied a Medi-Cal enrollment application to a mobile clinic operated by San Joaquin County (SJC) on the basis that SJC’s parent clinic was exempt from licensure. While that issue was resolved in favor of SJC, this bill will prevent this problem from happening to other counties.
- Background on problem addressed by this bill. The author states that this issue was brought to her office’s attention by SJC, which acquired a one-exam-room mobile clinic with federal America Rescue Plan funding in 2019. SJC operates San Joaquin Health Centers primary care clinics in two locations, and planned to use the mobile clinic as an extension of its French Camp clinic location in order to access high-risk, low access communities. SJC passed Facility Site Review, which was required and facilitated by Health Plan of San Joaquin and Health Net, and in April of 2022, submitted an application to DHCS to have the mobile clinic enrolled into Medi-Cal. SJC also applied to the Centers for Medicare and Medicaid Services for Medicare enrollment, which it received, but the Medi-Cal license was denied. According to SJC, San Joaquin Health Centers is exempt from licensure as a county agency, and “a non-licensed clinic cannot enroll intermittent or mobile clinics into Medi-Cal.” However, on appeal, a hearing officer overruled DHCS’ grounds for denying SJC’s application to enroll their mobile clinic in Medi-Cal, and DHCS ended up enrolling the mobile clinic with an effective date retroactive to the application submission date of April 28, 2022.
- Background on intermittent clinics. Under existing law, a licensed primary care clinic is permitted to operate an off-site clinic for up to 40 hours per week, without obtaining a separate license for these offsite locations. Licensed primary care clinics include community clinics and free clinics, but do not include a number of clinic settings that are exempt from licensure, such as county-operate clinics or tribal clinics. According to CDPH, only clinics licensed by CDPH are captured by the Electronic Licensing Management System, so intermittent clinics are not tracked by CDPH. There are currently 1,388 licensed primary care clinics (1,339 community clinics and 49 free clinics). However, intermittent clinics report to the Provider Enrollment Division at DHCS, which reports that there are currently 795 listed intermittent clinics.
Under the Mobile Health Care Services Act (MHCSA), a mobile unit is a special purpose commercial coach, as specified, that is one of the following: (a) it is approved by CDPH as a service of a licensed health facility, as defined; (b) it is approved by CDPH as a service of a licensed clinic, as defined; (c) it is licensed by CDPH as a clinic, as defined; or, (d) it is licensed as an “other” type of approved mobile unit by CDPH, with “other” types limited to mobile units performing services within new health facility or clinic licensure categories created after the effective date of the MHCSA (which became effective in 1994). A mobile unit is permitted to be operated as an adjunct to a licensed health facility or to a licensed clinic, or as an independent-freestanding clinic. However, the MHCSA also states that “no person, political subdivision of the state, or governmental agency shall operate a mobile service unit without first obtaining a license or an addition to existing licensure unless exempt from licensure under Section 1206.” Because county-operated clinics are exempt from licensure under HSC §1206(b), counties are permitted to operate mobile units as additional services to their license-exempt clinics.
Related/Prior Legislation
SB 779 (Stern, 2023) adds intermittent clinics that are exempt from licensure to an existing requirement that licensed clinics file an annual report to the Department of Health Care Access and Information (HCAI) with certain specified information for the previous calendar year. SB 779 also creates new reporting requirements for all primary care clinics, including intermittent clinics, to report various types of data to HCAI, including all mergers and acquisitions, a labor report, a workforce development report, and a report of quality and equity measures. SB 779 passed the Senate Health Committee by a vote of 9-2 on April 12, 2023.
AB 2204 (Gray, Chapter 279, Statutes of 2018) extended the limit on the number of hours an intermittent primary care clinic can operate, from 30 to 40 hours per week, and still be exempt from licensure.
AB 2428 (Gonzalez Fletcher, Chapter 762, Statutes of 2018) allowed a federally qualified health center (FQHC) or rural health clinic (RHC) that adds an additional physical plant to its primary care license to elect to have the Medi-Cal reimbursement rate for each new plant be billed at and reimbursed at the same rate as the FQHC or RHC. Exempted from the Medi-Cal provider enrollment process a primary care clinic with additional locations added to its clinic license from the requirement to separately enroll the additional locations as separate providers, if the primary care clinic has notified the DHCS of its additional locations.
AB 2053 (Gonzalez, Chapter 639, Statutes of 2016) required CDPH, upon written notification by a licensed primary care clinic or an affiliate clinic that it is adding an additional physical plant maintained and operated on separate premises, to issue a single consolidated license to the clinic.
AB 1130 (Gray, Chapter 412, Statutes of 2015) expanded the licensure exemption for intermittent clinics that are operated by licensed clinics on separate premises by permitting these intermittent clinics to be open for up to 30 hours per week, instead of only 20 hours per week.
AB 941 (Wood, Chapter 502, Statutes of 2015) expanded a licensure exemption for tribal clinics, which were previously exempted if located on tribal land, by exempting tribal clinics regardless of the location of the clinic, if the clinic is operated under a contract with the United States pursuant to the Indian Self-Determination and Education Assistance Act.
SB 442 (Ducheny, Chapter 502, Statutes of 2010) streamlined the administrative requirements for a clinic corporation to apply for licensure for an affiliate primary care clinic.
SB 937 (Ducheny, Chapter 602, Statutes of 2003) revised provisions relating to the licensure and operation of primary care clinics. Permitted a primary care clinic to add a service or remodel a site without first having to apply for a new license from CDPH and required CDPH to issue an affiliate license to a primary care clinic to allow it to open a clinic at an additional site, under specified conditions.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No
SUPPORT: (Verified 5/1/23)
California Association of Public Hospitals and Health Systems
County Health Executives Association of California
San Joaquin County
OPPOSITION: (Verified 5/1/23)
None received
ARGUMENTS IN SUPPORT: The California Association of Public Hospitals and Health Systems (CAPH) states in support that many public health care systems operate an extensive network of Federally Qualified Health Centers to meet the ambulatory care needs of their patients. As public entities, public health care system clinics are exempt from CDPH licensing requirements that apply to private community clinics. To help increase access to care, current law allows FQHCs to operate intermittent and mobile clinics without needing to separately enroll them into Medi-Cal. This bill clarifies existing law that clinics exempt from licensure are authorized to operate intermittent sites or mobile health care units. San Joaquin County also supports, stating that this bill seeks to clarify the historical understanding that license-exempt clinics operated by counties should be treated
the same as other primary care clinics.
Prepared by: Vincent D. Marchand / HEALTH / (916) 651-4111
5/3/23 15:07:44
**** END ****
SENATE COMMITTEE ON HEALTH
Senator Dr. Susan Talamantes Eggman, Chair
BILL NO: SB 819
AUTHOR: | Eggman | ||
VERSION: | April 13, 2023 | ||
HEARING DATE: | April 19, 2023 | ||
CONSULTANT: | Vincent D. Marchand | ||
SUBJECT: Medi-Cal: certification
SUMMARY:
Clarifies existing Medi-Cal provider enrollment requirements so that a clinic operated by a county, which is exempt from licensure, is treated the same as a licensed clinic in being able to add an intermittent clinic site or an affiliated mobile health care unit without needing to separately enroll the intermittent clinic or mobile health care unit as a separate provider.
Existing law:
- Licenses and regulates clinics, including primary care clinics and specialty clinics, by the California Department of Public Health (CDPH). [HSC §1200, et seq.]
- Defines a primary care clinic as either a “community clinic,” which is required to be operated by a non-profit corporation and to use a sliding fee scale to charge patients based on their ability to pay, or a “free clinic,” which is also required to be operated by a non-profit but is not allowed to directly charge patients for services rendered or for any drugs, medicines, or apparatuses furnished. [HSC §1204]
- Exempts various types of clinics from licensure and regulation by CDPH, including clinics operated by the federal government and any primary care clinic operated by the state, counties, or cities. [HSC §1206 et seq., §1206(b)]
- Exempts from licensure by CDPH an intermittent clinic that is operated by a licensed primary care community clinic on separate premises from the licensed clinic and is only open for limited services of no more than 40 hours each week. However, an intermittent clinic operated under this exemption is still required to meet all other requirements of law, including administrative regulations and requirements, pertaining to fire and life safety. [HSC §1206(h)]
- Enacts the Mobile Health Care Services Act, which permits a mobile health unit, as defined, to operate as an adjunct to a licensed health facility or to a licensed clinic, or as an independent-freestanding clinic, as specified. Prohibits any person, political subdivision of the state, or governmental agency from operating a mobile service unit without first obtaining a license or an addition to existing licensure unless exempt from licensure. [HSC §1765.101 et seq., §1765.125]
- Establishes the Medi-Cal program as California’s Medicaid program, administered by the Department of Health Care Services (DHCS), which provides comprehensive health care coverage for low-income individuals. [WIC §14000, et seq.]
- Requires specified health care providers seeking to be a Medi-Cal provider to submit a complete application package for enrollment, continuing enrollment, or enrollment at a new location or a change in location (referred to as Medi-Cal Provider Enrollment):
- A provider that currently is not enrolled in the Medi-Cal program;
- A provider applying for continued enrollment, upon written notification from DHCS that enrollment for continued participation of all providers in a specific provider of service category or subgroup of that category to which the provider belongs will occur; and,
- A provider not currently enrolled at a location where the provider intends to provide services, goods, supplies, or merchandise to a Medi-Cal beneficiary. [WIC §14043.26].
- Exempts an applicant or provider from needing to enroll in the Medi-Cal program as a separate provider if the applicant is an intermittent clinic that is exempt from licensure, or is an affiliated mobile health care unit that is licensed or approved by CDPH, as specified, and is operated by a licensed primary care clinic and for which the intermittent site or mobile health unit the licensed primary care clinic directly or indirectly provides all staff, protocols, equipment, supplies, and billing services. Requires the licensed primary care clinic operating the applicant to notify the department of its separate locations, premises, intermittent sites, or mobile health care units. [WIC §14043.15(e)]
This bill:
- Revises a provision of law exempting intermittent clinic sites and affiliated mobile health care units from needing to enroll in the Medi-Cal program as a separate provider if it is operated by a licensed primary care clinic that directly or indirectly provides all staffing, protocols, equipment, supplies, and billing services, so that this provision of law also applies to intermittent clinic sites and affiliated mobile health care units that are operated by a license-exempt clinic operated by a governmental entity, including a county.
- Makes legislative findings and declarations that this bill is declaratory of existing law, and that intermittent sites or mobile health care units operated by clinics exempt from licensure by CDPH, as specified, are exempt under the law, as it existed prior to the enactment of this bill, from the enrollment procedures under the Medi-Cal program, if the operating clinic has made a related notification to DHCS.
FISCAL EFFECT:
This bill has not been analyzed by a fiscal committee.
COMMENTS:
- Author’s statement. According to the author, this bill would clarify the law to ensure that county-operated primary care clinics can operate mobile health care units as extensions of their primary care clinics without needing to separately enroll into Medi-Cal. While the longstanding practice and understanding of the law is that county clinics, which are not required to be licensed by CDPH, are treated equally under the law to primary care clinics that are licensed by CDPH, this understanding was recently brought into question when DHCS denied a Medi-Cal enrollment application to a mobile clinic operated by San Joaquin County (SJC) on the basis that SJC’s parent clinic was exempt from licensure. While that issue was resolved in favor of SJC, this bill will prevent this problem from happening to other counties.
- Background on problem addressed by this bill. The author states that this issue was brought to her office’s attention by SJC, which acquired a one-exam-room mobile clinic with federal America Rescue Plan funding in 2019. SJC operates San Joaquin Health Centers primary care clinics in two locations, and planned to use the mobile clinic as an extension of its French Camp clinic location in order to access high-risk, low access communities. SJC passed Facility Site Review, which was required and facilitated by Health Plan of San Joaquin and Health Net, and in April of 2022, submitted an application to DHCS to have the mobile clinic enrolled into Medi-Cal. SJC also applied to the Centers for Medicare and Medicaid Services for Medicare enrollment, which it received, but the Medi-Cal license was denied. According to SJC, San Joaquin Health Centers is exempt from licensure as a county agency, and “a non-licensed clinic cannot enroll intermittent or mobile clinics into Medi-Cal.” However, on appeal, a hearing officer overruled DHCS’ grounds for denying SJC’s application to enroll their mobile clinic in Medi-Cal, and DHCS ended up enrolling the mobile clinic with an effective date retroactive to the application submission date of April 28, 2022.
- Background on intermittent clinics. Under existing law, a licensed primary care clinic is permitted to operate an off-site clinic for up to 40 hours per week, without obtaining a separate license for these offsite locations. Licensed primary care clinics include community clinics and free clinics, but do not include a number of clinic settings that are exempt from licensure, such as county-operate clinics or tribal clinics. According to CDPH, only clinics licensed by CDPH are captured by the Electronic Licensing Management System, so intermittent clinics are not tracked by CDPH. There are currently 1,388 licensed primary care clinics (1,339 community clinics and 49 free clinics). However, intermittent clinics report to the Provider Enrollment Division at DHCS, which reports that there are currently 795 listed intermittent clinics.
Under the Mobile Health Care Services Act (MHCSA), a mobile unit is a special purpose commercial coach, as specified, that is one of the following: a) it is approved by CDPH as a service of a licensed health facility, as defined; b) it is approved by CDPH as a service of a licensed clinic, as defined; c) it is licensed by CDPH as a clinic, as defined; or, d) it is licensed as an “other” type of approved mobile unit by CDPH, with “other” types limited to mobile units performing services within new health facility or clinic licensure categories created after the effective date of the MHCSA (which became effective in 1994). A mobile unit is permitted to be operated as an adjunct to a licensed health facility or to a licensed clinic, or as an independent-freestanding clinic. However, the MHCSA also states that “no person, political subdivision of the state, or governmental agency shall operate a mobile service unit without first obtaining a license or an addition to existing licensure unless exempt from licensure under Section 1206.” Because county-operated clinics are exempt from licensure under HSC §1206(b), counties are permitted to operate mobile units as additional services to their license-exempt clinics. - Related legislation. SB 779 (Stern) adds intermittent clinics that are exempt from licensure to an existing requirement that licensed clinics file an annual report to the Department of Health Care Access and Information (HCAI) with certain specified information for the previous calendar year. SB 779 also creates new reporting requirements for all primary care clinics, including intermittent clinics, to report various types of data to HCAI, including all mergers and acquisitions, a labor report, a workforce development report, and a report of quality and equity measures. SB 779 passed the Senate Health Committee by a vote of 9-2 on April 12, 2023.
- Prior legislation. AB 2204 (Gray, Chapter 279, Statutes of 2018) extends the limit on the number of hours an intermittent primary care clinic can operate, from 30 to 40 hours per week, and still be exempt from licensure.
AB 2428 (Gonzalez Fletcher, Chapter 762, Statutes of 2018) allows a federally qualified health center (FQHC) or rural health clinic (RHC) that adds an additional physical plant to its primary care license to elect to have the Medi-Cal reimbursement rate for each new plant be billed at and reimbursed at the same rate as the FQHC or RHC. Exempts from the Medi-Cal provider enrollment process a primary care clinic with additional locations added to its clinic license from the requirement to separately enroll the additional locations as separate providers, if the primary care clinic has notified the DHCS of its additional locations.
AB 2053 (Gonzalez, Chapter 639, Statutes of 2016) requires CDPH, upon written notification by a licensed primary care clinic or an affiliate clinic that it is adding an additional physical plant maintained and operated on separate premises, to issue a single consolidated license to the clinic.
AB 1130 (Gray, Chapter 412, Statutes of 2015) expanded the licensure exemption for intermittent clinics that are operated by licensed clinics on separate premises by permitting these intermittent clinics to be open for up to 30 hours per week, instead of only 20 hours per week.
AB 941 (Wood, Chapter 502, Statutes of 2015) expanded a licensure exemption for tribal clinics, which were previously exempted if located on tribal land, by exempting tribal clinics regardless of the location of the clinic, if the clinic is operated under a contract with the United States pursuant to the Indian Self-Determination and Education Assistance Act.
SB 442 (Ducheny, Chapter 502, Statutes of 2010) streamlined the administrative requirements for a clinic corporation to apply for licensure for an affiliate primary care clinic.
SB 937 (Ducheny, Chapter 602, Statutes of 2003) revised provisions relating to the licensure and operation of primary care clinics. Permitted a primary care clinic to add a service or remodel a site without first having to apply for a new license from CDPH and required CDPH to issue an affiliate license to a primary care clinic to allow it to open a clinic at an additional site, under specified conditions.
- Support. The California Association of Public Hospitals and Health Systems (CAPH) states in support that many public health care systems operate an extensive network of Federally Qualified Health Centers to meet the ambulatory care needs of their patients. As public entities, public health care system clinics are exempt from CDPH licensing requirements that apply to private community clinics. To help increase access to care, current law allows FQHCs to operate intermittent and mobile clinics without needing to separately enroll them into Medi-Cal. This bill would clarify existing law that clinics exempt from licensure are authorized to operate intermittent sites or mobile health care units. San Joaquin County also supports, stating that this bill seeks to clarify the historical understanding that license-exempt clinics operated by counties should be treated the same as other primary care clinics.
- Technical amendment. While supporting this bill, CAPH identified an additional point of ambiguity, where it should also be made clear that exempt clinics may operate intermittent sites or mobile health care units. On Page 4, line 23, CAPH suggests adding the word “exempt,” so that the sentence would read, in part, “…including an intermittent site or an affiliated mobile health care unit licensed, exempt, or approved under Chapter 9…”
SUPPORT AND OPPOSITION:
Support: California Association of Public Hospitals and Health Systems
San Joaquin County
Oppose: None received
-- END --
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