20250AB__235298AMD INTRODUCED 2026-02-19 AMENDED_ASSEMBLY 2026-05-18 2025 AB AMD Introduced by Assembly Member Valencia (Coauthor: Assembly Member Elhawary) LEAD_AUTHOR ASSEMBLY Valencia COAUTHOR ASSEMBLY Elhawary

An act to amend

Section 14043.15 of the Welfare and Institutions Code, relating to Medi-Cal. Medi-Cal Medi-Cal providers: nonprofit public benefit corporations. Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is in part governed by, and funded pursuant to, federal Medicaid program provisions.

Existing law sets forth various procedures, including the submission of an application package, for provider enrollment, continuing enrollment, or enrollment at a new location or a change in location under the Medi-Cal program.

Existing law requires an applicant or provider who is a natural person and is licensed or certificated under provisions relating to healing arts, the Osteopathic Initiative Act, or the Chiropractic Initiative Act, or is a professional corporation, to comply with the above-described procedures and to be enrolled in the Medi-Cal program as either an individual provider or as a rendering provider in a provider group for each application package that is submitted and approved.

This bill would also apply the above-described provision to a nonprofit public benefit corporation that has been granted tax-exempt status and through which licensed providers enumerated in the Medicaid state plan provide nonspecialty mental health services, as specified. MAJORITY NO YES NO NO NO NO NO NO NO NO The people of the State of California do enact as follows:

SECTION

Section 14043.15 of the Welfare and Institutions Code is amended to read: 14043.15. (

a) The department may adopt regulations for certification of each applicant and each provider in the Medi-Cal program. No certification shall be required for natural persons licensed or certificated under Division 2 (commencing with

Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act. (b)

(1) The following applicants or providers shall comply with

Section 14043.26 and shall be enrolled in the Medi-Cal program as either an individual provider or as a rendering provider in a provider group for each application package submitted and approved pursuant to

Section 14043.26, notwithstanding that the applicant or provider meets the requirements to qualify as exempt from clinic licensure under subdivision (

a) or (

m) of

Section of the Health and Safety Code: (

A) A natural person licensed or certificated pursuant to Division 2 (commencing with

Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act. (

B) A professional corporation, as defined in subdivision (

b) of

Section of the Corporations Code. (

C) A nonprofit public benefit corporation, as defined in

Section of the Corporations Code, that has been granted tax-exempt status under

Section 501(c)(3) of the federal Internal Revenue Code, and through which licensed providers enumerated in the Medicaid state plan provide nonspecialty mental health services as described in

Section 14184.402.

(2) A provider enrolled in the Medi-Cal program pursuant to paragraph (1), who has disclosed in the application package for enrollment that the provider’s practice includes the rendering of services, goods, supplies, or merchandise solely at one, or at more than one, health facility, as defined in

Section of the Health and Safety Code, or clinic, as defined in

Section of the Health and Safety Code, or medical therapy unit, for purposes of

Section of the Health and Safety Code, or residence of the provider’s patient, or office of a physician and surgeon involved in the care and treatment of the provider’s patients, shall not be required to enroll at each such health facility, clinic, medical therapy unit, patient’s residence, or physician and surgeon’s office location and may utilize the business addresses listed on the application for enrollment pursuant to paragraph (1) to claim reimbursement from the Medi-Cal program for services rendered by the provider to Medi-Cal beneficiaries at all of those health facilities, clinics, medical therapy units, residences, or physician offices.

(3) This subdivision shall not be interpreted to allow the violation of any state or federal law governing fiscal intermediaries or Division 2 (commencing with

Section 500) of the Business and Professions Code, the Osteopathic Initiative Act, or the Chiropractic Initiative Act. This subdivision does not remove the requirement that each claim for reimbursement from the Medi-Cal program identify the place of service and the rendering, ordering, referring, and prescribing provider, where applicable. (

c) An applicant or provider licensed as a clinic pursuant to

Chapter 1 (commencing with

Section 1200) of, or a health facility licensed pursuant to

Chapter 2 (commencing with

Section 1250) of, Division of the Health and Safety Code may be enrolled in the Medi-Cal program as a clinic or a health facility and need not comply with

Section 14043.26 if the clinic or health facility is certified by the department to participate in the Medi-Cal program. (

d) An applicant or provider that meets the requirements to qualify as exempt from clinic licensure under subdivisions (

b) to (l), inclusive, or subdivisions (

n) to (p), inclusive, of

Section of the Health and Safety Code shall comply with

Section 14043.26 and may be enrolled in the Medi-Cal program as either a clinic or within any other provider category for which the applicant or provider qualifies. An applicant or provider to which any of the clinic licensure exemptions specified in this subdivision apply shall identify the licensure exemption category and document in its application package the legal and factual basis for the clinic license exemption claimed. (

e) Notwithstanding subdivisions (a), (b), (c), and (d), an applicant or provider need not enroll in the Medi-Cal program as a separate provider and need not comply with

Section 14043.26 if all of the following conditions are met:

(1) The applicant or provider is one of the following: (

A) An intermittent site that qualifies as exempt from clinic licensure under subdivision (

h) of

Section of the Health and Safety Code. (

B) An affiliated mobile health care unit licensed or approved under

Chapter 9 (commencing with

Section 1765.101) of Division of the Health and Safety Code, and qualifies as exempt from clinic licensure under subdivision (

h) of

Section of the Health and Safety Code.

(2) The applicant or provider is operated by, and all staffing, protocols, equipment, supplies, and billing services are provided, directly or indirectly, by, one of the following: (

A) A licensed primary care clinic. (

B) A clinic exempt from licensure pursuant to subdivision (

b) of

Section of the Health and Safety Code.

(3) The licensed primary care clinic or clinic exempt from licensure under subdivision (

b) of

Section of the Health and Safety Code operating the applicant, provider clinic, or mobile health care unit has notified the department of its separate locations, premises, intermittent sites, or mobile health care units. (

f) A primary care clinic with (1) an additional physical plant added to its primary care clinic license under a consolidated license pursuant to subdivision (

d) of

Section of the Health and Safety Code, or (2) a physical plant that was added to an existing primary care clinic license by the State Department of Public Health, prior to January 1, 2017, whether by a regional district office or the centralized application unit, need not separately enroll the additional physical plant as a separate provider, and need not comply with

Section 14043.26 if the primary care clinic has notified the department of its additional physical plant. (

g) Notwithstanding any other law and to the extent permitted by federal law, an applicant or provider that meets the requirements to qualify as a mobile optometric office pursuant to

Section 3070.2 of the Business and Professions Code and

Section 14043.26 may be enrolled in the Medi-Cal program as either a mobile optometric office or within any other provider category for which the applicant or provider qualifies.

(1) An applicant or provider to which

Section 3070.2 of the Business and Professions Code applies shall demonstrate its compliance by providing proof of its nonprofit or charitable organization status pursuant to

Section 501(c)(3) or 501(c)(4) of the Internal Revenue Code and a statement that it shall not accept payment for services other than those provided to Medi-Cal beneficiaries, even if the State Board of Optometry has not yet issued final regulations as required by

Section 3070.2 of the Business and Professions Code or issued any registrations at the time of enrollment.

(2) A mobile optometric office shall use the address of the owner and operator of the mobile optometric office as registered with the State Board of Optometry for its place of business address and shall not be required to comply with

Section 51000.60 of Title of the California Code of Regulations.

(3) To the extent federal financial participation is available, a mobile optometric office shall be permitted to bill the Medi-Cal program for the professional optometry services provided by licensed optometrists. The licensed optometrists providing service at a mobile optometric office shall use the address of the owner and operator of the mobile optometric office as registered with the State Board of Optometry for its place of business address and shall not be required to comply with

Section 51000.60 of Title of the California Code of Regulations.