SB 1131

Bill Subjects

Abstract

Existing law establishes 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 establishes, under the Medi-Cal program, the Family Planning, Access, Care, and Treatment (Family PACT) Program, administered by the Office of Family Planning within the department. Under Family PACT, comprehensive clinical family planning services are provided to a person who has a family income at or below 200% of the federal poverty level and who meets other eligibility criteria to receive those services. Existing law makes the Family PACT Program inoperative if the program is determined to no longer be cost effective, as specified. If the program becomes inoperative, existing law requires all persons who have received, or are eligible to receive, comprehensive clinical family planning services pursuant to Family PACT to receive family planning services under other specified provisions of the Medi-Cal program or under the State-Only Family Planning Program, which is also established within the department. Existing law requires enrolled providers in the Family PACT Program or the State-Only Family Planning Program to attend a specific orientation approved by the department and requires providers who conduct certain services to have prior training in those services. This bill would, for the Family PACT Program, require a site certifier of a primary care clinic or affiliate primary care clinic, as those terms are defined, to be a clinician who oversees the provision of Family PACT services and would authorize certain clinic corporations to enroll multiple, but no more than 10, service addresses under one site certifier. The bill would require any orientation or training that the department requires of a site certifier to comply with specified requirements, including, among others, being offered through a virtual platform and being offered at least once every other month. For purposes of both of the above-described programs, existing law requires the program to disenroll as a program provider any individual who, or any entity that, has a license, certificate, or other approval to provide health care that is revoked or suspended by a federal, California, or other state's licensing, certification, or other approval authority, that is otherwise lost, or that is surrendered while a disciplinary hearing is pending, as specified. This bill would authorize the department to elect to not disenroll an individual or entity as a program provider if the revocation, suspension, loss, or disciplinary hearing in another state is based solely on conduct that is not deemed to be unprofessional conduct under California law. Under existing law, a provider is subject to disenrollment if the provider submits claims for payment for the services, goods, supplies, or merchandise provided to a program beneficiary, by an individual or entity that has been previously suspended, excluded, or otherwise made ineligible to receive reimbursement from one of the above-described programs or from the Medi-Cal program and the individual has previously been on one of certain lists, as specified. Under this bill, a provider would not be subject to disenrollment under that provision if the sole basis for an individual's listing is conduct that is not deemed to be unprofessional conduct under California law. The bill would condition implementation of the disenrollment exceptions described in the 2 provisions above on receipt of any necessary federal approvals and the availability of federal financial participation.