Bill Text: CA SB1014 | 2021-2022 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Enhanced Clinically Integrated Program for Federally Qualified Health Centers.

Spectrum: Partisan Bill (Democrat 6-0)

Status: (Engrossed - Dead) 2022-08-30 - Ordered to inactive file on request of Assembly Member Boerner Horvath. [SB1014 Detail]

Download: California-2021-SB1014-Amended.html

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Amended  IN  Senate  April 07, 2022

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Senate Bill

No. 1014

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Introduced by Senator Hertzberg
(Principal coauthors: Assembly Members Carrillo and Kalra)
(Coauthor: Senator Wiener)
(Coauthor: Assembly Member Robert Rivas)

February 14, 2022

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An act to add Article 7 (commencing with Section 14199.70) to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL'S DIGEST

SB 1014, as amended, Hertzberg. Enhanced Clinically Integrated Program for Federally Qualified Health Centers.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services 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. Under existing law, federally qualified health center (FQHC) services are covered benefits under the Medi-Cal program, to be reimbursed on a per-visit basis, as specified, to the extent that federal financial participation is obtained.

Existing federal law authorizes a state plan to provide for payment in any fiscal year to an FQHC for specified services in an amount that is determined under an alternative payment methodology (APM) if it is agreed to by the state and the FQHC and results in a payment to the FQHC of an amount that is at least equal to the amount otherwise required to be paid to the FQHC. Existing state law requires the department to authorize an APM pilot project for FQHCs that agree to participate, for implementation with respect to a county for a period of up to 3 years.

This bill would require the department to authorize a new supplemental payment program for FQHCs pursuant to federal law, or as specified, to be named the Enhanced Clinically Integrated Program (ECIP). The bill would, subject to an appropriation, require Under the bill, the nonfederal share of ECIP funding be used to support the ability of FQHCs to pay wages, conduct workforce training, and improve delivery of care. would be subject to an appropriation. The bill would require the department to request at least this amount to fund the program on an ongoing basis in future fiscal years.

Under the bill, participation in ECIP would be optional for FQHCs, and participating FQHCs would not receive payment rates lower than available through their standard prospective payment system (PPS) rate. The bill would also set forth a funding stream for FQHCs participating in labor-management cooperation committees, as specified. supplemental funding under ECIP would be provided in addition to all other funding received by FQHCs, as specified, and participation in ECIP would result in total payments to participating FQHCs that are greater than the prospective payment system (PPS) rate otherwise required to be paid to the FQHC. The bill would, subject to an appropriation, require the department, no later than July 1, 2023, to make funding available for the purpose of direct compensation of health center workers.

The bill would require ECIP to improve quality and access to care by allocating funds, if appropriated, to FQHCs that meet certain standards relating to wage thresholds and participation in bona fide labor-management cooperation committees, as specified. The bill would set forth various requirements for funding allocations to, and uses by, participating FQHCs.

The bill would require the department to establish a statewide 15-member board, as specified, with the responsibility of developing eligibility criteria, an application process, a fund distribution process, and reporting requirements. reporting requirements, and a methodology for adjusting funding allocations based on health care inflation.

The bill would require the department, no later than February 1, 2023, to seek any necessary federal approvals. The bill would condition implementation of these provisions on receipt of those federal approvals and the availability of federal financial participation (FFP). (FFP), with certain exceptions. The bill would require the department to seek to maximize FFP for ECIP funding streams, as specified. The bill would require the department to adopt regulations to implement these provisions.

The bill would make these provisions severable.

Digest Key

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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Bill Text

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

SECTION 1.

 Article 7 (commencing with Section 14199.70) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read:

Article  7. Enhanced Clinically Integrated Program for Federally Qualified Health Centers

14199.70.

 For purposes of this article, the following definitions apply:

(a) “Enhanced Clinically Integrated Program” or “ECIP” means the supplemental payment program set forth in Section 14199.72.

(b) “Federally qualified health center” or “FQHC” means any community or public federally qualified health center, as defined in Section 1396d(l)(2)(B) of Title 42 of the United States Code, providing services as defined in Section 1396d(a)(2)(C) of Title 42 of the United States Code. including FQHC look-alikes.

(c) “Labor-management “Bona fide labor-management cooperation committee” or “LMCC” “bona fide LMCC” means a joint labor-management committee established pursuant to the federal Labor Management Cooperation Act of 1978 (29 U.S.C. Sec. 175a). 175a) and that has the following composition:

(1) Fifty percent of the committee consists of representatives of organized labor unions that represent health center workers in the state.

(2) The other 50 percent of the committee consists of representatives of FQHCs located in the state.

(d) “Participating FQHC” means an FQHC participating in ECIP at one or more of the FQHC’s sites.

(e) “Health center worker” means an employee of an FQHC who provides direct patient care and services directly supporting patient care, including clinicians, clinical support staff, custodial workers, and nonmanagerial administrative staff.

14199.71.

 The Legislature finds and declares all of the following:

(a) California has successfully expanded Medi-Cal to cover approximately 14 million residents, roughly one-third of the state’s population. However, for the state to fully deliver on its promise of universal access to quality care, the health care safety net must be fully funded. Access to quality care requires building provider capacity through investment in both the clinical and nonclinical workforce.

(b) With approximately one-third of the state’s population receiving health care services through Medi-Cal, it is imperative that patient-centered innovations drive Medi-Cal reforms.

(c) The federal Patient Protection and Affordable Care Act (Public Law 111-148) made a significant investment in federally qualified health centers (FQHCs) to incentivize upfront health care services that prevent longer term avoidable high-cost services.

(d) FQHCs are fundamental to the California health care safety net, as their mission is to provide primary and preventive care to low-income and underserved populations.

(e) However, hiring and retaining staff remain a couple of among the largest challenges for FQHCs due to a variety of factors, including low wages, difficult working conditions, and high workloads.

(f) FQHCs are underresourced under-resourced compared to providers that operate outside of the safety net due to FQHCs’ lower reimbursements and per-visit payments, as well as the fact that FQHCs provide more unreimbursed services than other health care providers. FQHCs are further weakened postpandemic due to the uneven distribution of bailout funds, which favored large health care systems and providers that served fewer Medi-Cal patients.

(g) A well-resourced clinically enhanced clinical model can increase patient access to quality care by expanding access to specialists, investing in workforce training and support, and improving capital funding to help clinics grow and meet community needs.

(h) This article would create a supplemental payment program for private and public FQHCs, including FQHC look-alikes, for the specific purpose of alleviating workforce shortages in both the short term and the long term, including investing in training the future workforce.

(h)

(i) Increasing wages and salaries will also help to attract and retain much-needed qualified health care workers, in particular registered nurses, licensed vocational nurses, licensed clinical social workers, licensed mental health workers, medical assistants, and advanced practice professionals, while opening new positions will lower caseloads that contribute to turnover and burnout and allow clinics to see more patients.

(i)

(j) It is the intent of the Legislature that this article also dedicate a portion of funds to clinic support the creation of FQHC labor-management cooperation committees (LMCCs) to help meet staffing needs. LMCCs can engage in activities to grow the workforce, including training, upgrading skills, and educational activities.

14199.72.

 (a) The department shall authorize a new supplemental payment program for FQHCs pursuant to Section 1396a(bb)(6) of Title 42 of the United States Code. Code, or, pursuant to the department’s discretion, another type of supplemental payment program that the department determines will best meet the clinical and financial goals of ECIP and is permissible under federal law.

(b) The new funding model supplemental payment program shall be known, and may be cited, as the Enhanced Clinically Integrated Program (ECIP).

(c) Subject The nonfederal share of ECIP funding shall be subject to an appropriation by the Legislature through the annual Budget Act or any other legislation for purposes of this article, the nonfederal share of ECIP funding described in this section shall be used to support the ability of FQHCs to pay wages, conduct workforce training, and improve delivery of care. article. The department shall request at least this amount to fund the program on an ongoing basis in future fiscal years.

(d)Consistent with Section 1396a(bb)(6) of Title 42 of the United States Code, participation in ECIP shall be fully optional for FQHCs, and participating FQHCs shall not receive payment rates lower than available through their standard prospective payment system (PPS) rate.

(d) Participation in ECIP shall be optional for FQHCs.

(e) Supplemental funding provided pursuant to ECIP shall be provided in addition to all other funding received by FQHCs, including through the prospective payment system (PPS), any other payment methodology adopted pursuant to Section 1396a(bb)(6) of Title 42 of the United States Code, or any other supplemental payment program. Regardless of whether participating FQHCs receive payments through PPS or any other payment methodology, participation in ECIP shall result in total payments to participating FQHCs that are greater than the PPS rate otherwise required to be paid to the FQHC.

(e)

(f) No later than February 1, 2023, the department shall seek any necessary federal approvals for purposes of implementing this article. This If federal approval of ECIP is necessary, this article shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available. available, except that the department shall make available funding for direct compensation of health center workers pursuant to subdivision (h) regardless of whether federal approvals are obtained or federal financial participation is made available.

(g) Supplemental payments received by participating FQHCs pursuant to this section shall be considered separate and apart from the prospective payment system (PPS) methodology set forth in Section 14132.100 and Section 1396a(bb) of Title 42 of the United States Code and shall not be subject to adjustment during annual reconciliation of the PPS rate.

(h) Subject to an appropriation as described in subdivision (c), no later than July 1, 2023, the department shall make funding available for the purpose of direct compensation of health center workers.

(f)

(i) ECIP shall improve quality and access to care by allocating funds, if appropriated, to FQHCs that meet one or both of the following conditions: both of the following standards for program participation:

(1)Meeting the standards for program participation as described in Section 14199.74, and seeking to participate in ECIP for the purpose of improving patient access primarily by strengthening the workforce, through improved wages, benefits, and salaries, and by addressing specialist physician reimbursement and investing in clinic infrastructure and capacity.

(2)Participating in an LMCC, meeting the standards for program participation as described in Section 14199.74, and seeking to participate in ECIP for the purpose of training workers and financially supporting workers as they train.

(1) Commitment to ensuring that all health center workers are paid a minimum wage equivalent to twenty-five dollars ($25) per hour within three months of receiving supplemental funding, whether the worker is compensated by a fixed amount, such as a salary, or receives wages based on a standard of time, task, piece, commission basis, or another method of calculation.

(2) Participation in a bona fide LMCC. FQHCs that participate in a bona fide LMCC and receive supplemental payments pursuant to ECIP shall enter into memoranda of understanding with the department requiring FQHCs to fund the bona fide LMCC for the purposes described in paragraph (2) of subdivision (j).

(j) Funds, if appropriated, shall be distributed to participating FQHCs as follows:

(1) Seventy percent shall be allocated to FQHCs that seek to participate in ECIP for the purpose of improving patient access primarily by strengthening the workforce, through improved wages, benefits, and salaries, addressing specialist physician reimbursement, and investing in clinic infrastructure and capacity. These funds shall be further broken down as follows:

(A) Fifteen percent of the amount allocated pursuant to this paragraph may be used for the purposes of investing in capital needs, specialists or other contractor payments, information technology, or other physical infrastructure and capacity improvements.

(B) The balance of the amount allocated pursuant to this paragraph shall be used as follows:

(i) First, to ensure that all health center workers are paid the minimum wage required pursuant to subdivision (i).

(ii) Subsequently, to increase wages, salaries, or benefits for all other FQHC workers.

(C) FQHCs that access funding pursuant to this paragraph may use the funds to deliver services suited to their individual site needs, subject to the requirements of this paragraph.

(2) Thirty percent shall be allocated to FQHCs that participate in ECIP for purposes of training workers and financially supporting workers as they train.

(k) Annual funding allocations for each part of ECIP shall be adjusted for health care inflation using an appropriate measure developed by the statewide board established pursuant to Section 14199.74.

(g)

(l) The department shall seek to maximize federal financial participation for both funding streams described in paragraphs (1) and (2) of subdivision (f), (j), and shall account for any enhanced federal funds, including, but not limited to, higher federal matching funds for specific populations, when developing estimates in collaboration with the Department of Finance.

(h)

(m) Nothing in this article shall be construed to limit or eliminate services provided by FQHCs as covered benefits in the Medi-Cal program.

14199.73.

 The department shall notify each FQHC in the state about ECIP and shall invite each FQHC in the state to apply for participation in ECIP with respect to one or more of the FQHC’s sites.

14199.74.

 (a) A statewide board shall be established by the department with the responsibility of developing all of the following, consistent with federal law:

(1) The eligibility criteria to be used in evaluating applications from interested FQHCs that voluntarily elect to participate in the pilot project. The criteria shall include, but not be limited to, be designed to ensure that participating FQHCs meet all of the following:

(A)Quality metrics.

(B)Process metrics.

(C)Workforce investment.

(D)Ability to meet ECIP goals.

(E)Compliance with local, state, and federal workplace health and safety rules and regulations.

(2)A process for applying for, and distributing, funds. Potential methods for distribution of funds include, but are not limited to, supplemental payments for services and risk-based payments.

(A) Demonstrate that funds are used for training, retention, and growth of the clinic workforce using appropriate measures.

(B) Demonstrate improvements in quality and access to care using department-approved metrics.

(C) Demonstrate ability to collect and submit patient encounter data in a form and manner that satisfies department requirements, including utilizing the most recent current procedural terminology (CPT) codes.

(D) Demonstrate compliance with local, state, and federal workplace health and safety rules and regulations.

(E) Accomplish the purposes of ECIP through such other appropriate means as the board determines.

(2) A process for applying for, and distributing, supplemental funds.

(3) Reporting requirements for use of funds.

(4) A methodology for adjusting funding allocations based on health care inflation.

(b) The board shall be composed of 15 voting members, as follows:

(1) Five members who are patients of FQHCs or are Medi-Cal beneficiaries.

(2) Five members who are FQHC employees or who are members or representatives of organized labor unions that represent health care workers. health center worker labor organizations.

(3) Five members who represent FQHCs.

(c) The board may consult with experts, other FQHC patients, health care center workers, and community members, as appropriate, in fulfilling its responsibilities pursuant to subdivision (a).

14199.75.

 The department shall adopt regulations to implement this article.

14199.75. 14199.76.

 The provisions of this article are severable. If any provision of this article or its application is held invalid, that invalidity shall not affect other provisions or applications that can be given effect without the invalid provision or application.