Bill Text: CA SB1315 | 2013-2014 | Regular Session | Chaptered
Bill Title: Medi-Cal: providers.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Passed) 2014-09-29 - Chaptered by Secretary of State. Chapter 844, Statutes of 2014. [SB1315 Detail]
Download: California-2013-SB1315-Chaptered.html
BILL NUMBER: SB 1315 CHAPTERED
BILL TEXT
CHAPTER 844
FILED WITH SECRETARY OF STATE SEPTEMBER 29, 2014
APPROVED BY GOVERNOR SEPTEMBER 29, 2014
PASSED THE SENATE AUGUST 18, 2014
PASSED THE ASSEMBLY AUGUST 14, 2014
AMENDED IN ASSEMBLY JUNE 30, 2014
AMENDED IN ASSEMBLY JUNE 10, 2014
AMENDED IN SENATE MAY 23, 2014
AMENDED IN SENATE APRIL 29, 2014
AMENDED IN SENATE APRIL 3, 2014
INTRODUCED BY Senator Monning
FEBRUARY 21, 2014
An act to amend Section 14043.7 of the Welfare and Institutions
Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
SB 1315, Monning. Medi-Cal: providers.
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 permits the department to make unannounced visits to
an applicant or to a provider for the purpose of determining whether
enrollment, continued enrollment, or certification as a provider is
warranted, or as necessary for the administration of the Medi-Cal
program. Existing law further requires that a provider be subject to
temporary suspension from the Medi-Cal program, which includes
temporary deactivation of the provider's number, for failure to
remediate significant discrepancies in information that he or she
provided to the department or for failure to remediate significant
discrepancies that are discovered as a result of an announced or
unannounced visit to the provider, as specified. Existing law
requires the provider to be notified, in writing, of the temporary
suspension and deactivation of provider numbers.
This bill would require that notice of temporary suspension to
contain a list of discrepancies to be remediated and the timeframe in
which the provider needs to remediate those discrepancies, which
must be at least 60 days from the date the notice of temporary
suspension is issued. The bill would require the department to lift a
temporary suspension and notify a provider that the temporary
suspension has been lifted and that he or she is eligible to receive
reimbursement for Medi-Cal services provided after the date the
temporary suspension was lifted if the provider has demonstrated that
the identified discrepancies have been remediated within the
applicable timeframe. The bill would require the department to send a
notice to a provider who fails to remediate the identified
discrepancies in the applicable timeframe stating that he or she will
be removed from enrollment as a provider in the Medi-Cal program by
operation of law based on failure to remediate the identified
discrepancies.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14043.7 of the Welfare and Institutions Code is
amended to read:
14043.7. (a) The department may make unannounced visits to an
applicant or to a provider for the purpose of determining whether
enrollment, continued enrollment, or certification is warranted, or
as necessary for the administration of the Medi-Cal program. If an
unannounced site visit is conducted by the department for any
enrolled provider, the provider shall permit access to any and all of
their provider locations. If a provider fails to permit access for
any site visit, the application shall be denied and the provider
shall be subject to deactivation. At the time of the visit, the
applicant or provider shall be required to demonstrate an established
place of business appropriate and adequate for the services billed
or claimed to the Medi-Cal program, as relevant to his or her scope
of practice, as indicated by, but not limited to, the following:
(1) Being open and available to the general public.
(2) Having regularly established and posted business hours.
(3) Having adequate supplies in stock on the premises.
(4) Meeting all local laws and ordinances regarding business
licensing and operations.
(5) Having the necessary equipment and facilities to carry out
day-to-day business for his or her practice.
(b) An unannounced visit pursuant to subdivision (a) shall be
prohibited with respect to clinics licensed under Section 1204 of the
Health and Safety Code, clinics exempt from licensure under Section
1206 of the Health and Safety Code, health facilities licensed under
Chapter 2 (commencing with Section 1250) of Division 2 of the Health
and Safety Code, and natural persons licensed or certified under
Division 2 (commencing with Section 500) of the Business and
Professions Code, the Osteopathic Initiative Act, or the Chiropractic
Initiative Act, unless the department has reason to believe that the
provider will defraud or abuse the Medi-Cal program or lacks the
organizational or administrative capacity to provide services under
the program.
(c) (1) Failure to remediate significant discrepancies in
information provided to the department by the provider or significant
discrepancies that are discovered as a result of an announced or
unannounced visit to a provider, for purposes of enrollment,
continued enrollment, or certification pursuant to subdivision (a)
shall make the provider subject to temporary suspension from the
Medi-Cal program, which shall include temporary deactivation of the
provider's number, including all business addresses used by the
provider to obtain reimbursement from the Medi-Cal program. The
director shall notify in writing the provider of the temporary
suspension and deactivation of provider numbers, which shall take
effect 15 days from the date of the notification. Notwithstanding
Section 100171 of the Health and Safety Code, proceedings after the
imposition of sanctions in this subdivision shall be in accordance
with Section 14043.65.
(2) A notice of temporary suspension issued pursuant to paragraph
(1) shall include the following:
(A) A list of discrepancies required to be remediated.
(B) The timeframe in which a provider may demonstrate to the
department that the discrepancies identified pursuant to subparagraph
(A) have been remediated. The timeframe in which a provider may
remediate discrepancies shall not be less than 60 days from the date
the notice of temporary suspension is issued.
(3) If a provider who has received a notice of temporary
suspension pursuant to paragraph (1) demonstrates to the department
that the discrepancies identified pursuant to subparagraph (A) of
paragraph (2) have been remediated and meets the standards of
participation within the timeframe specified in subparagraph (B) of
paragraph (2), the department shall lift the temporary suspension and
shall notify the provider that the temporary suspension has been
lifted and that he or she is eligible to receive Medi-Cal
reimbursement for services provided after the date the temporary
suspension was lifted.
(4) If a provider has received a site visit pursuant to this
section that results in a notice of temporary suspension pursuant to
paragraph (1), and the provider fails to remediate the discrepancies
identified pursuant to subparagraph (A) of paragraph (2) within the
timeframe specified in subparagraph (B) of paragraph (2), the
department shall send the provider a notice stating that the provider
will be removed from enrollment as a provider in the Medi-Cal
program by operation of law based on failure to remediate the
discrepancies identified in the notice of temporary suspension.
