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SB-456 Medi-Cal managed care: federally qualified health centers and rural health clinics: services that follow the patient.(2017-2018)

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Date Published: 04/26/2017 09:00 PM
SB456:v97#DOCUMENT

Amended  IN  Senate  April 26, 2017
Amended  IN  Senate  March 23, 2017

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Senate Bill No. 456


Introduced by Senator Pan

February 16, 2017


An act to add Section 14087.326 to the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


SB 456, as amended, Pan. Medi-Cal managed care: federally qualified health centers and rural health clinics: services that follow the patient.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. Existing law provides that federally qualified health center (FQHC) services and rural health clinic (RHC) services, as defined, are covered benefits under the Medi-Cal program. program, to be reimbursed, to the extent that federal financial participation is obtained, to providers on a per-visit basis. “Visit” is defined as a face-to-face encounter between a patient of an FQHC or RHC and specified health care professionals. Existing law requires a managed care entity to offer subcontracts to FQHCs and RHCs in the relevant service area, as a condition of obtaining a contract with the department.
This bill would authorize a federally qualified health center or rural health clinic an FQHC or RHC to enter into an agreement with a public or private entity willing and qualified to provide services that follow the patient. The bill would describe those entities eligible to contract with an FQHC or RHC under the bill, and would define “services that follow the patient” as services that are not reimbursable on a per-visit basis pursuant to a specified provision, that promote continuity of care and contribute to overall patient wellness, as specified. The bill would specify that compensation paid to a federally qualified health center or rural health clinic pursuant to the agreement would be supplemental to, and separate from, the federally qualified health center’s or rural health clinic’s prospective payment rate, and not subject to reconciliation or reduction, as specified. The bill would prohibit an FQHC or RHC that bills an entity for services that follow the patient from seeking reimbursement or attempting to obtain payment for a service billed pursuant to the specified per-visit billing provision, but would not preclude the FQHC or RHC from billing a visit under that provision and a service provided pursuant to the bill on the same day.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 14087.326 is added to the Welfare and Institutions Code, to read:

14087.326.
 (a) A federally qualified health center or rural health clinic may enter into an agreement with a public or private entity willing and qualified to provide services that follow the patient, as described in this section. A public or private entity eligible to contract with a federally qualified health center or rural health clinic pursuant to an agreement described in this section shall include, but not be limited to, any of the following:
(1) A managed care health plan.
(2) A county.
(3) A health care district.
(4) A community-based organization.
(5) An individual health care or social services provider whose activities under this section comply with the individual’s scope of practice or certification.
(b) As used in this section, “services that follow the patient” means services that are not reimbursable pursuant to Section 14132.100, that promote continuity of care and contribute to overall patient wellness. These services include, but are not limited to, all of the following:
(1) Comprehensive care management.
(2) Care coordination.
(3) Health and wellness initiatives.
(4) Comprehensive transitional care.
(5) Individual and family support services.
(6) Referral to community and social supports.
(c) Compensation paid to a federally qualified health center or rural health clinic pursuant to an agreement described in this section shall be supplemental to, and separate from, the federally qualified health center’s or rural health clinic’s prospective payment rate and shall not be subject to a reconciliation pursuant to Section 14087.325, or to any reduction.
(d) A federally qualified health center or rural health clinic that bills an entity in subdivision (a) for services that follow the patient may not seek reimbursement or attempt to obtain payment from the department or an entity for a service billed pursuant to Section 14132.100.
(e) This section does not preclude a clinic from billing a visit under Section 14132.100 and a service under this section on the same day.