Bill Text: CA SB1081 | 2013-2014 | Regular Session | Introduced

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Bill Title: Federally qualified health centers.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2014-05-23 - Held in committee and under submission. [SB1081 Detail]

Download: California-2013-SB1081-Introduced.html

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BILL NUMBER: SB 1081	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Hernandez

                        FEBRUARY 19, 2014

   An act to add Section 14132.103 to the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 1081, as introduced, Hernandez. Federally qualified health
centers.
   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.
The Medi-Cal program is, in part, governed and funded by federal
Medicaid Program provisions. Existing law provides that federally
qualified health center (FQHC) services, as described, are covered
benefits under the Medi-Cal program, to be reimbursed, to the extent
that federal financial participation is obtained, to providers on a
per-visit basis. "Visit" is defined as a face-to-face encounter
between a patient of an FQHC and specified health care professionals.

   This bill would require the department to authorize a 3-year
alternative payment methodology (APM) pilot project for FQHCs that
would be implemented in any county and FQHC willing to participate.
Under the APM pilot project, participating FQHCs would receive
capitated monthly payments for each Medi-Cal managed care enrollee
assigned to the FQHC in place of the wrap-around, fee-for-service
per-visit payments from the department. The bill would require,
except as specified, that an evaluation of the APM pilot project be
conducted by an independent entity within 6 months after the APM
pilot project is completed, and that the independent entity report
the findings to the department and the Legislature.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 14132.103 is added to the Welfare and
Institutions Code, to read:
   14132.103.  (a) Notwithstanding any other law, the department
shall authorize a three-year alternative payment methodology (APM)
pilot project for federally qualified health centers (FQHCs) in
accordance with this section.
   (b) The APM shall be implemented in any county and FQHC willing to
participate.
   (c) Under the APM pilot project, participating FQHCs shall receive
capitated monthly payments for each Medi-Cal managed care enrollee
assigned to the FQHC in place of the wrap-around, fee-for-service
per-visit payments from the department.
   (d) The APM shall include all necessary protections and safeguards
for both the FQHCs and the health plans to ensure that neither are
financially harmed by the implementation of the APM, which includes
both rates and number of enrollees assigned.
   (e) Within six months after the APM pilot project is completed, an
evaluation of the pilot project shall be conducted by an independent
entity that takes into consideration payment adequacy, delivery
system transformation, and quality measures. The independent entity
shall report its findings to the department and the Legislature. An
evaluation pursuant to this subdivision shall be completed only if
there are nonstate General Fund moneys available for this purpose.
   (f) The department shall seek any federal approvals necessary for
the implementation of this section.