BILL NUMBER: SB 147	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Hernandez

                        JANUARY 28, 2015

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


	LEGISLATIVE COUNSEL'S DIGEST


   SB 147, 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.
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.
   This bill would require the department to authorize a 3-year 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 in
relation to both rates and number of enrollees assigned.
   (e) (1) 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.
   (2) A report submitted pursuant to this subdivision shall be
submitted in compliance with Section 9795 of the Government Code.
   (f) The department shall seek any federal approvals necessary for
the implementation of this section.