LEGISLATIVE COUNSEL'S DIGEST


AB 839, as amended, Emmerson. Medi-Cal service providers:
judicial : providers: remedies.
Existing
(1) Existing law establishes the
Medi-Cal program, administered by the State Department of Health Care
Services, under which basic health care services are provided to
qualified low-income persons.
Existing law requires that health care providers apply to, and be
certified by, the department prior to their participation in the
Medi-Cal program.
Existing law allows the department, if specified conditions are
met, to grant provisional provider status or preferred provisional
provider status to an applicant or provider, and requires the
department to terminate that status if any of specified grounds
exist.
Existing law provides that, if an application for provisional
provider status or preferred provisional provider status is denied
under specified provisions, or that status is terminated under the
provisions described above, the applicant or provider is prohibited
from reapplying for enrollment or continued enrollment in the
Medi-Cal program or for participation in any health care program
administered by the department for a period of 3 years from the date
the application package is denied or the provisional provider status
is terminated, or from the date of the final decision following an
appeal from that denial or termination, except as specified.

Existing law provides that, if an application for provisional
provider status or preferred provisional provider status is denied
based upon a conviction for specified offenses or acts, the applicant
or provider is prohibited from reapplying for enrollment or
continued enrollment in the Medi-Cal program or for participation in
any health care program administered by the department for a period
of 10 years from the date the application package is denied or the
provisional provider status or preferred provisional provider status
is terminated, or from the date of the final decision following an
appeal from that denial or termination.
This bill would delete the provisions that provide that the 3-year
and 10-year prohibitions may begin from the date of the final
decision following an appeal from that denial or termination.

Existing
(2) Existing law requires the
Director of Health Care Services to adopt procedures for the review
of grievances or complaints filed by Medi-Cal service providers
concerning the processing or payment of money that the provider
alleges is payable under the Medi-Cal program. A provider
that who complies with these procedures and is
not satisfied with the director's decision regarding that claim may
seek appropriate judicial remedies within a specified time period.
This bill would, instead, specify that the provider who has
complied with these procedures may, within the time period prescribed
in existing law, seek either a writ of mandate
or, if the claim meets the jurisdictional requirements, file
a claim in small claims court .