Bill Text: CA SB610 | 2015-2016 | Regular Session | Amended

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

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Bill Title: Medi-Cal: federally qualified health centers: rural health clinics: managed care contracts.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Vetoed) 2016-04-25 - Last day to consider Governors veto pursuant to Joint Rule 58.5. [SB610 Detail]

Download: California-2015-SB610-Amended.html

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BILL NUMBER: SB 610	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 28, 2015
	AMENDED IN SENATE  APRIL 6, 2015

INTRODUCED BY   Senator Pan

                        FEBRUARY 27, 2015

   An act to amend Sections 14087.325 and 14132.100 of the Welfare
and Institutions Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 610, as amended, Pan. Medi-Cal: federally qualified health
 centers and  centers:  rural health
clinics: managed care contracts.
   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 to be reimbursed, to the extent that federal financial
participation is obtained, to providers on a per-visit basis.
   Existing law authorizes an FQHC or RHC to apply for an adjustment
to its per-visit rate, based on a change in the scope of services
provided, as prescribed. Existing law establishes alternative
ratesetting procedures with respect to a new entity that first
qualifies as an FQHC or RHC in the year 2001 or later, a newly
licensed facility at a new location added to an existing FQHC or RHC
or an existing FQHC or RHC that is relocated. Two of the procedures
are referred to as comparability approaches, based on the rates of 3
similarly situated FQHCs and RHCs. The 3rd procedure requires, at a
new entity's one-time election, that the department establish the
reimbursement rate, calculated on a per-visit basis, that equals 100%
of the projected allowable costs to the FQHC or RHC of furnishing
services during its first 12 months of operation as an FQHC or RHC.
   This bill would require the department to finalize a new rate
within 90 days after an FQHC's or RHC's submission of a
scope-of-service rate change. With respect to a new FQHC or RHC that
has elected for the department to establish its reimbursement rate
based on projected allowable costs as described above, this bill
would require the department to finalize that rate within 90 days
after the submission of the actual cost report from the first full 12
months of operation, as specified.
   This bill would revise the department's responsibilities with
respect to a new entity or a relocated FQHC or RHC that selects
either of the comparability approaches. The bill would require the
department to review the comparable facilities to determine if any of
them do not meet the comparability threshold and, if so, to notify
the new entity, and request a supplemental submission, as prescribed.
The bill would require the department to conduct an initial review
of a scope-of-service rate change request within 30 days after
submission by the FQHC or RHC, and notify the FQHC or RHC by the 31st
day after submission if the department determines that additional
information is necessary, as prescribed. The bill would require the
department to finalize the FQHC's or RHC's rate within 90 days after
receiving a submission the department determines to be complete.
   This bill would require the department to correct erroneous
payments at least quarterly to reprocess past claims and ensure all
claims are reimbursed at the appropriate finalized new rate.
   Existing law requires the department to administer a program to
ensure that total payments to FQHCs and RHCs operating as managed
care subcontractors comply with applicable federal law regarding
payment for services provided by FQHCs and RHCs. Under the department'
s program, existing law requires FQHCs and RHCs subcontracting with
specified managed care plans to seek supplemental reimbursement from
the department through a per visit fee-for-service billing system. To
be reimbursed under these provisions, existing law requires each
FQHC and RHC to submit to the department for approval a rate
differential based on the FQHC's or RHC's reasonable cost or the
prospective payment rate. Within 6 months of the end of the FQHC's or
RHC's fiscal year, existing law requires, to the extent feasible,
the department to perform an annual reconciliation to reasonable
cost, and make payments to, or obtain recovery from, the FQHC or RHC.

   This bill would impose various requirements on the department
regarding the reconciliation process described above. The bill would
require the department to complete the final reconciliation review
and pay to the center or clinic any remaining amount owed within 15
months of the last date of the fiscal year for which the department
is conducting the review.
   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 14087.325 of the Welfare and Institutions Code
is amended to read:
   14087.325.  (a) The department shall require, as a condition of
obtaining a contract with the department, that any local initiative,
as defined in Section 53810 of Title 22 of the California Code of
Regulations, offer a subcontract to any entity 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 and operating in the service area covered
by the local initiative's contract with the department. These
entities are also known as federally qualified health centers.
   (b) Except as otherwise provided in this section, managed care
subcontracts offered to a federally qualified health center or a
rural health clinic, as defined in Section 1396d(  l  )(1)
of Title 42 of the United States Code, by a local initiative, county
organized health system, as defined in Section 12693.05 of the
Insurance Code, commercial plan, as defined in Section 53810 of Title
22 of the California Code of Regulations, or a health plan
contracting with a geographic managed care program, as defined in
subdivision (g) of Section 53902 of Title 22 of the California Code
of Regulations, shall be on the same terms and conditions offered to
other subcontractors providing a similar scope of service. Any
beneficiary, subscriber, or enrollee of a program or plan who
affirmatively selects, or is assigned by default to, a federally
qualified health center or rural health clinic under the terms of a
contract between a plan, government program, or any subcontractor of
a plan or program, and a federally qualified health center or rural
health clinic, shall be assigned directly to the federally qualified
health center or rural health clinic, and not to any individual
provider performing services on behalf of the federally qualified
health center or rural health clinic.
   (c) The department shall provide incentives in the competitive
application process described in paragraph (1) of subdivision (b) of
Section 53800 of Title 22 of the California Code of Regulations, to
encourage potential commercial plans as defined in Section 53810 of
Title 22 of the California Code of Regulations to offer subcontracts
to these federally qualified health centers.
   (d) Reimbursement to federally qualified health centers and rural
health centers for services provided pursuant to a subcontract with a
local initiative, a commercial plan, geographic managed care program
health plan, or a county organized health system, shall be paid in a
manner that is not less than the level and amount of payment that
the plan would make for the same scope of services if the services
were furnished by a provider that is not a federally qualified health
center or rural health clinic.
   (e) (1) The department shall administer a program to ensure that
total payments to federally qualified health centers and rural health
clinics operating as managed care subcontractors pursuant to
subdivision (d) comply with applicable federal law pursuant to
Sections 1902(bb) and 1903(m)(2)(A)(ix) of the Social Security Act
(42 U.S.C. Secs. 1396a(bb) and 1396b(m)(2)(A)(ix)). Under the
department's program, federally qualified health centers and rural
health clinics subcontracting with local initiatives, commercial
plans, county organized health systems, and geographic managed care
program health plans shall seek supplemental reimbursement from the
department through a per visit fee-for-service billing system
utilizing the state's Medi-Cal fee-for-service claims processing
system contractor. To carry out this per visit payment process, each
federally qualified health system and rural health clinic shall
submit to the department for approval a rate differential calculated
to reflect the amount necessary to reimburse the federally qualified
health center or rural health clinic for the difference between the
payment the center or clinic received from the managed care health
plan and either the interim rate established by the department based
on the center's or clinic's reasonable cost or the center's or clinic'
s prospective payment rate. The department shall adjust the computed
rate differential as it deems necessary to minimize the difference
between the center's or clinic's revenue from the plan and the center'
s or clinic's cost-based reimbursement or the center's or clinic's
prospective payment rate. 
   (2) 
    (A)  In addition,  to the extent feasible,
within six months of the end of the center's or clinic's fiscal year,
 the department shall perform an annual reconciliation to
reasonable cost, and make payments to, or obtain a recovery from, the
center or clinic.  Reconciliation shall be based upon the
reconciliation filing submitted to the department by the center or
clinic. The 
    (B)     The  department shall perform
an initial review of the reconciliation filing within 30 days of
receipt. If the department determines during the initial review that
a payment is owed to the center or clinic, the department shall pay
to the center or clinic at least 80 percent of the amount owed within
30 days of completion of the initial review or in any event within
60 days of receipt of the reconciliation filing.  The

    (C)     The  department shall complete
the final reconciliation review and shall pay to the center or
clinic the remaining amount owed within 15 months of the last date of
the fiscal year for which the department is conducting the review.
   (f) In calculating the capitation rates to be paid to local
initiatives, commercial plans, geographic managed care program health
plans, and county organized health systems, the department shall not
include the additional dollar amount applicable to cost-based
reimbursement that would otherwise be paid, absent cost-based
reimbursement, to federally qualified health centers and rural health
clinics in the Medi-Cal fee-for-service program.
   (g) On or before September 30, 2002, the director shall conduct a
study of the actual and projected impact of the transition from a
cost-based reimbursement system to a prospective payment system for
federally qualified health centers and rural health clinics. In
conducting the study, the director shall evaluate the extent to which
the prospective payment system stimulates expansion of services,
including new facilities to expand capacity of the centers, and the
extent to which actual and estimated prospective payment rates of
federally qualified health centers and rural health clinics for the
first five years of the prospective payment system are reflective of
the cost of providing services to Medi-Cal beneficiaries. Clinics may
submit cost reporting information to the department to provide data
for the study.
   (h) The department shall approve all contracts between federally
qualified health centers or rural health clinics and any local
initiative, commercial plan, geographic managed care program health
plan, or county organized health system in order to ensure compliance
with this section.
   (i) This section shall not preclude the department from
establishing pilot programs pursuant to Section 14087.329.
  SEC. 2.  Section 14132.100 of the Welfare and Institutions Code is
amended to read:
   14132.100.  (a) The federally qualified health center services
described in Section 1396d(a)(2)(C) of Title 42 of the United States
Code are covered benefits.
   (b) The rural health clinic services described in Section 1396d(a)
(2)(B) of Title 42 of the United States Code are covered benefits.
   (c) Federally qualified health center services and rural health
clinic services shall be reimbursed on a per-visit basis in
accordance with the definition of "visit" set forth in subdivision
(g).
   (d) Effective October 1, 2004, and on each October 1, thereafter,
until no longer required by federal law, federally qualified health
center (FQHC) and rural health clinic (RHC) per-visit rates shall be
increased by the Medicare Economic Index applicable to primary care
services in the manner provided for in Section 1396a(bb)(3)(A) of
Title 42 of the United States Code. Prior to January 1, 2004, FQHC
and RHC per-visit rates shall be adjusted by the Medicare Economic
Index in accordance with the methodology set forth in the state plan
in effect on October 1, 2001.
   (e) (1) An FQHC or RHC may apply for an adjustment to its
per-visit rate based on a change in the scope of services provided by
the FQHC or RHC. Rate changes based on a change in the scope of
services provided by an FQHC or RHC shall be evaluated in accordance
with Medicare reasonable cost principles, as set forth in Part 413
(commencing with Section 413.1) of Title 42 of the Code of Federal
Regulations, or its successor.
   (2) Subject to the conditions set forth in subparagraphs (A) to
(D), inclusive, of paragraph (3), a change in scope of service means
any of the following:
   (A) The addition of a new FQHC or RHC service that is not
incorporated in the baseline prospective payment system (PPS) rate,
or a deletion of an FQHC or RHC service that is incorporated in the
baseline PPS rate.
   (B) A change in service due to amended regulatory requirements or
rules.
   (C) A change in service resulting from relocating or remodeling an
FQHC or RHC.
   (D) A change in types of services due to a change in applicable
technology and medical practice utilized by the center or clinic.
   (E) An increase in service intensity attributable to changes in
the types of patients served, including, but not limited to,
populations with HIV or AIDS, or other chronic diseases, or homeless,
elderly, migrant, or other special populations.
   (F) Any changes in any of the services described in subdivision
(a) or (b), or in the provider mix of an FQHC or RHC or one of its
sites.
   (G) Changes in operating costs attributable to capital
expenditures associated with a modification of the scope of any of
the services described in subdivision (a) or (b), including new or
expanded service facilities, regulatory compliance, or changes in
technology or medical practices at the center or clinic.
   (H) Indirect medical education adjustments and a direct graduate
medical education payment that reflects the costs of providing
teaching services to interns and residents.
   (I) Any changes in the scope of a project approved by the federal
Health Resources and Service Administration (HRSA).
   (3) No change in costs shall, in and of itself, be considered a
scope-of-service change unless all of the following apply:
   (A) The increase or decrease in cost is attributable to an
increase or decrease in the scope of services defined in subdivisions
(a) and (b), as applicable.
   (B) The cost is allowable under Medicare reasonable cost
principles set forth in Part 413 (commencing with Section 413) of
Subchapter B of Chapter 4 of Title 42 of the Code of Federal
Regulations, or its successor.
   (C) The change in the scope of services is a change in the type,
intensity, duration, or amount of services, or any combination
thereof.
   (D) The net change in the FQHC's or RHC's rate equals or exceeds
1.75 percent for the affected FQHC or RHC site. For FQHCs and RHCs
that filed consolidated cost reports for multiple sites to establish
the initial prospective payment reimbursement rate, the 1.75-percent
threshold shall be applied to the average per-visit rate of all sites
for the purposes of calculating the cost associated with a
scope-of-service change. "Net change" means the per-visit rate change
attributable to the cumulative effect of all increases and decreases
for a particular fiscal year.
   (4) An FQHC or RHC may submit requests for scope-of-service
changes once per fiscal year, only within 90 days following the
beginning of the FQHC's or RHC's fiscal year. Any approved increase
or decrease in the provider's rate shall be retroactive to the
beginning of the FQHC's or RHC's fiscal year in which the request is
submitted.
   (5) An FQHC or RHC shall submit a scope-of-service rate change
request within 90 days after the beginning of any FQHC or RHC fiscal
year occurring after the effective date of this section, if, during
the FQHC's or RHC's prior fiscal year, the FQHC or RHC experienced a
decrease in the scope of services provided that the FQHC or RHC
either knew or should have known would have resulted in a
significantly lower per-visit rate. If an FQHC or RHC discontinues
providing onsite pharmacy or dental services, it shall submit a
scope-of-service rate change request within 90 days after the
beginning of the following fiscal year. The rate change shall be
effective as provided for in paragraph (4). As used in this
paragraph, "significantly lower" means an average per-visit rate
decrease in excess of 2.5 percent.
   (6) (A) The department shall conduct an initial review of a
scope-of-service rate change request within 30 days after submission
by an FQHC or RHC.
   (B)  If the department determines that additional information is
necessary to finalize a new rate, the department shall notify the
FQHC or RHC, no later than the 31st day after submission. The
notification shall state the reason or reasons the submitted
information is insufficient and shall request submission of
supplemental information from the FQHC or RHC.
   (C) Within 90 days after receiving a submission that it determines
to be complete, the department shall finalize the FQHC's or RHC's
rate and shall update the provider master file within 10 business
days.
   (7) Notwithstanding paragraph (4), if the approved
scope-of-service change or changes were initially implemented on or
after the first day of an FQHC's or RHC's fiscal year ending in
calendar year 2001, but before the adoption and issuance of written
instructions for applying for a scope-of-service change, the adjusted
reimbursement rate for that scope-of-service change shall be made
retroactive to the date the scope-of-service change was initially
implemented. Scope-of-service changes under this paragraph shall be
required to be submitted within the later of 150 days after the
adoption and issuance of the written instructions by the department,
or 150 days after the end of the FQHC's or RHC's fiscal year ending
in 2003.
   (8) All references in this subdivision to "fiscal year" shall be
construed to be references to the fiscal year of the individual FQHC
or RHC, as the case may be.
   (f) (1) An FQHC or RHC may request a supplemental payment if
extraordinary circumstances beyond the control of the FQHC or RHC
occur after December 31, 2001, and PPS payments are insufficient due
to these extraordinary circumstances. Supplemental payments arising
from extraordinary circumstances under this subdivision shall be
solely and exclusively within the discretion of the department and
shall not be subject to subdivision (l). These supplemental payments
shall be determined separately from the scope-of-service adjustments
described in subdivision (e). Extraordinary circumstances include,
but are not limited to, acts of nature, changes in applicable
requirements in the Health and Safety Code, changes in applicable
licensure requirements, and changes in applicable rules or
regulations. Mere inflation of costs alone, absent extraordinary
circumstances, shall not be grounds for supplemental payment. If an
FQHC's or RHC's PPS rate is sufficient to cover its overall costs,
including those associated with the extraordinary circumstances, then
a supplemental payment is not warranted.
   (2) The department shall accept requests for supplemental payment
at any time throughout the prospective payment rate year.
   (3) Requests for supplemental payments shall be submitted in
writing to the department and shall set forth the reasons for the
request. Each request shall be accompanied by sufficient
documentation to enable the department to act upon the request.
Documentation shall include the data necessary to demonstrate that
the circumstances for which supplemental payment is requested meet
the requirements set forth in this section. Documentation shall
include all of the following:
   (A) A presentation of data to demonstrate reasons for the FQHC's
or RHC's request for a supplemental payment.
   (B) Documentation showing the cost implications. The cost impact
shall be material and significant, two hundred thousand dollars
($200,000) or 1 percent of a facility's total costs, whichever is
less.
   (4) A request shall be submitted for each affected year.
   (5) Amounts granted for supplemental payment requests shall be
paid as lump-sum amounts for those years and not as revised PPS
rates, and shall be repaid by the FQHC or RHC to the extent that it
is not expended for the specified purposes.
   (6) The department shall notify the provider of the department's
discretionary decision in writing.
   (g) (1) An FQHC or RHC "visit" means a face-to-face encounter
between an FQHC or RHC patient and a physician, physician assistant,
nurse practitioner, certified nurse-midwife, clinical psychologist,
licensed clinical social worker, or a visiting nurse. For purposes of
this section, "physician" shall be interpreted in a manner
consistent with the Centers for Medicare and Medicaid Services'
Medicare Rural Health Clinic and Federally Qualified Health Center
Manual (Publication 27), or its successor, only to the extent that it
defines the professionals whose services are reimbursable on a
per-visit basis and not as to the types of services that these
professionals may render during these visits and shall include a
physician and surgeon, podiatrist, dentist, optometrist, and
chiropractor. A visit shall also include a face-to-face encounter
between an FQHC or RHC patient and a comprehensive perinatal services
practitioner, as defined in Section 51179.1 of Title 22 of the
California Code of Regulations, providing comprehensive perinatal
services, a four-hour day of attendance at an adult day health care
center, and any other provider identified in the state plan's
definition of an FQHC or RHC visit.
   (2) (A) A visit shall also include a face-to-face encounter
between an FQHC or RHC patient and a dental hygienist or a dental
hygienist in alternative practice.
   (B) Notwithstanding subdivision (e), an FQHC or RHC that currently
includes the cost of the services of a dental hygienist in
alternative practice for the purposes of establishing its FQHC or RHC
rate shall apply for an adjustment to its per-visit rate, and, after
the rate adjustment has been approved by the department, shall bill
these services as a separate visit. However, multiple encounters with
dental professionals that take place on the same day shall
constitute a single visit. The department shall develop the
appropriate forms to determine which FQHC's or RHC rates shall be
adjusted and to facilitate the calculation of the adjusted rates. An
FQHC's or RHC's application for, or the department's approval of, a
rate adjustment pursuant to this subparagraph shall not constitute a
change in scope of service within the meaning of subdivision (e). An
FQHC or RHC that applies for an adjustment to its rate pursuant to
this subparagraph may continue to bill for all other FQHC or RHC
visits at its existing per-visit rate, subject to reconciliation,
until the rate adjustment for visits between an FQHC or RHC patient
and a dental hygienist or a dental hygienist in alternative practice
has been approved. Any approved increase or decrease in the provider'
s rate shall be made within six months after the date of receipt of
the department's rate adjustment forms pursuant to this subparagraph
and shall be retroactive to the beginning of the fiscal year in which
the FQHC or RHC submits the request, but in no case shall the
effective date be earlier than January 1, 2008.
   (C) An FQHC or RHC that does not provide dental hygienist or
dental hygienist in alternative practice services, and later elects
to add these services, shall process the addition of these services
as a change in scope of service pursuant to subdivision (e).
   (h) If FQHC or RHC services are partially reimbursed by a
third-party payer, such as a managed care entity (as defined in
Section 1396u-2(a)(1)(B) of Title 42 of the United States Code), the
Medicare Program, or the Child Health and Disability Prevention
(CHDP) program, the department shall reimburse an FQHC or RHC for the
difference between its per-visit PPS rate and receipts from other
plans or programs on a contract-by-contract basis and not in the
aggregate, and may not include managed care financial incentive
payments that are required by federal law to be excluded from the
calculation.
   (i) (1) An entity that first qualifies as an FQHC or RHC in the
year 2001 or later, a newly licensed facility at a new location added
to an existing FQHC or RHC, and any entity that is an existing FQHC
or RHC that is relocated to a new site shall each have its
reimbursement rate established in accordance with one of the
following methods, as selected by the FQHC or RHC:
   (A) The rate may be calculated on a per-visit basis in an amount
that is equal to the average of the per-visit rates of three
comparable FQHCs or RHCs located in the same or adjacent area with a
similar caseload.
   (B) In the absence of three comparable FQHCs or RHCs with a
similar caseload, the rate may be calculated on a per-visit basis in
an amount that is equal to the average of the per-visit rates of
three comparable FQHCs or RHCs located in the same or an adjacent
service area, or in a reasonably similar geographic area with respect
to relevant social, health care, and economic characteristics.
   (C) At a new entity's one-time election, the department shall
establish a reimbursement rate, calculated on a per-visit basis, that
is equal to 100 percent of the projected allowable costs to the FQHC
or RHC of furnishing FQHC or RHC services during the first 12 months
of operation as an FQHC or RHC. After the first 12-month period, the
projected per-visit rate shall be increased by the Medicare Economic
Index then in effect. The projected allowable costs for the first 12
months shall be cost settled and the prospective payment
reimbursement rate shall be adjusted based on actual and allowable
cost per visit. The department shall finalize a new rate within 90
days after the submission of the actual cost report from the first
full 12 months of operation and shall update the department provider
master file within 10 business days of finalizing the rate.
   (D) The department may adopt any further and additional methods of
setting reimbursement rates for newly qualified FQHCs or RHCs as are
consistent with Section 1396a(bb)(4) of Title 42 of the United
States Code.
   (2) (A) In order for an FQHC or RHC to establish the comparability
of its caseload, the department shall require that the FQHC or RHC
submit its most recent annual utilization report as submitted to the
Office of Statewide Health Planning and Development, unless the FQHC
or RHC was not required to file an annual utilization report. FQHCs
or RHCs that have experienced changes in their services or caseload
subsequent to the filing of the annual utilization report may submit
to the department a completed report in the format applicable to the
prior calendar year. FQHCs or RHCs that have not previously submitted
an annual utilization report shall submit to the department a
completed report in the format applicable to the prior calendar year.
The FQHC or RHC shall not be required to submit the annual
utilization report for the comparable FQHCs or RHCs to the
department, but shall be required to identify the comparable FQHCs or
RHCs. This paragraph shall apply only to a facility that selects the
comparability approach described in subparagraph (A) or (B) of
paragraph (1).
   (B) The department shall conduct an initial review of the three
FQHCs or RHCs for the purpose of determining comparability within 30
days of submission by the new entity. If the department determines
one or more of the submitted centers or clinics do not meet the
comparability threshold, the department shall notify the new entity
no later than the 31st day after submission.
   (C) The notification shall state the reason or reasons for the
finding of noncomparability and shall request a supplemental
submission from the new entity. The request shall clearly state
whether the new entity shall submit data from one, two, or three
FQHCs or RHCs to meet the comparability threshold. Once the new
entity submits its supplemental information, the initial review
process described in subparagraph (B) shall apply.
   (D) Within 90 days after receiving a submission determined by the
department to be comparable, the department shall finalize the new
entity's rate and shall update the provider master file within 10
business days.
   (3) The rate for any newly qualified entity set forth under this
subdivision shall be effective retroactively to the later of the date
that the entity was first qualified by the applicable federal agency
as an FQHC or RHC, the date a new facility at a new location was
added to an existing FQHC or RHC, or the date on which an existing
FQHC or RHC was relocated to a new site. The FQHC or RHC shall be
permitted to continue billing for Medi-Cal covered benefits on a
fee-for-service basis until it is informed of its enrollment as an
FQHC or RHC, and the department shall reconcile the difference
between the fee-for-service payments and the FQHC's or RHC's
prospective payment rate at that time.
   (j) Visits occurring at an intermittent clinic site, as defined in
subdivision (h) of Section 1206 of the Health and Safety Code, of an
existing FQHC or RHC, or in a mobile unit as defined by paragraph
(2) of subdivision (b) of Section 1765.105 of the Health and Safety
Code, shall be billed by and reimbursed at the same rate as the FQHC
or RHC establishing the intermittent clinic site or the mobile unit,
subject to the right of the FQHC or RHC to request a scope-of-service
adjustment to the rate.
   (k) An FQHC or RHC may elect to have pharmacy or dental services
reimbursed on a fee-for-service basis, utilizing the current fee
schedules established for those services. These costs shall be
adjusted out of the FQHC's or RHC's clinic base rate as
scope-of-service changes. An FQHC or RHC that reverses its election
under this subdivision shall revert to its prior rate, subject to an
increase to account for all MEI increases occurring during the
intervening time period, and subject to any increase or decrease
associated with applicable scope-of-services adjustments as provided
in subdivision (e).
   (l) FQHCs and RHCs may appeal a grievance or complaint concerning
ratesetting, scope-of-service changes, and settlement of cost report
audits, in the manner
prescribed by Section 14171. The rights and remedies provided under
this subdivision are cumulative to the rights and remedies available
under all other provisions of law of this state.
   (m) The department shall, by no later than March 30, 2008,
promptly seek all necessary federal approvals in order to implement
this section, including any amendments to the state plan. To the
extent that any element or requirement of this section is not
approved, the department shall submit a request to the federal
Centers for Medicare and Medicaid Services for any waivers that would
be necessary to implement this section.
   (n) The department shall implement this section only to the extent
that federal financial participation is obtained.
   (o) The department shall correct erroneous payments at least
quarterly to reprocess past claims and ensure all claims are
reimbursed at the finalized new rate determined pursuant to either
subdivision (e) or (i).