Medi-Cal

This page tracks California legislation relating to Medi-Cal issues that impact Urban Indian individuals, families and clinics. This tracker is updated regularly and provides links to the California Legislative Information website for additional resources.

Click here to view recently chaptered bills.

AB 1863: Assembly member Wood (District 2)

Summary: This bill would include a marriage and family therapist within those health care professionals covered under that definition. The bill would require an FQHC or RHC that currently includes the cost of services of a dental hygenist in alternative practice, or a marriage and family therapist for the purposes of establishing its FQHC or RHC rate to apply to the department for an adjustment to its per-visit rate if the FQHC or RHC chooses to bill these services as a separate visit, and, after the rate adjustment has been approved by the department, would require the FQHC or RHC to bill these services as a separate visit, as specified. The bill would require an FQHC or RHC that does not provide the services of a dental hygienist, dental hygienist in alternative practice, or a marriage and family therapist, and later elects to add these services and bill these services as a separate visit, to process the addition of these services as a change in scope of service.

Last Action: 08/11/2016 From committee: Do pass.

For more information on this bill please check the Official California Legislative Information site here

SB 1335: Senator Mitchell (District 30)

Improving Access to Behavioral Health Services (Drug Medi-Cal)

Summary: This bill will improve Californians’ access to Substance Use Disorder treatment by eliminating a barrier which prevents community health centers from participating in the Drug Medi-Cal. Specifically, it would allow Federally Qualified Health Centers to contract with their counties for these services and be reimbursed on par with other health care providers.

Place holder language in the 1115 Waiver was created for an Indian Organized Delivery System within Drug-Medi-Cal and therefore treat Indian health programs as a “59th county/ county equivalent.” As FQHC’s our UIHO clinics’ participation in Drug Medi-Cal is currently threatened by the barriers to contracting. However, this bill would remove that barrier.

Last Action: 08/29/2016 Ordered to inactive file on request of Assembly member Calderon

For more information on this bill please check the Official California Legislative Information site here

SB 1418: Senator Lara

Summary: This bill would extend eligibility for full-scope Medi-Cal benefits to individuals 19 years of age and older who are otherwise eligible for those benefits but for their immigration status if the department determines that sufficient funding is available, or for limited scope Medi-Cal benefits if funding for full-scope benefits is not available. The bill would require these individuals to enroll into Medi-Cal managed care health plans, and to pay copayments and premium contributions, to the extent required of otherwise eligible Medi-Cal recipients who are similarly situated. The bill would require that benefits for those services to be provided with state-only funds only if federal financial participation is not available. Because counties are required to make Medi-Cal eligibility determinations and this bill would expand Medi-Cal eligibility, the bill would impose a state-mandated local program.

Last Action: 05/04/2016 Re-referred to Committee on Health

For more information on this bill please check the Official California Legislative Information site here

AB 2821: Assembly member Chiu (District 2)

Summary: This bill would requirethe Department of Housing and Community Development to award grants on a competitive basis to eligible grant applicants participating in a Whole Person Care pilot program, a program under the Medi-Cal program that provides specified entities with the option to receive support to integrate care for a particularly vulnerable group of Medi-Cal beneficiaries, including individuals who are experiencing or are at risk of homelessness, that includes eligibility based on homelessness, or with Medi-Cal managed care plans administering the Health Home Program. The bill would provide that an applicant is eligible for a grant under the program if the applicant meets specified requirements, including that the applicant is a lead agency participating in a Whole Person Care pilot or has previously participated in a Whole Person Care pilot designed to provide services to people experiencing homelessness or is located in a county with Medi-Cal managed care plan or plans participating in the Health Home Program.

This bill would require an applicant awarded a grant to use the funds for specified purposes, including long-term rental assistance and interim housing. The bill would provide that a county resident is eligible to receive assistance pursuant to a grant awarded under the Medi-Cal Housing Program if he or she meets specified requirements, including that the person is homeless, is a Medi-Cal beneficiary is eligible for Supplemental Security Income, and is eligible to receive services under the Whole Person Care pilot or the Health Home Program. The bill would provide that the program shall be funded upon appropriation under Legislature.

Last Action: 08/11/2016 From Committee: Do amend and pass.

For more information on this bill please check the Official California Legislative Information site here

AB 2077: Assembly members Burke (District 62) and Bonilla (District 14)

Summary: This bill would establish procedures to ensure that eligible recipients of insurance affordability programs move between the Medi-Cal program and other insurance affordability programs without any breaks in coverage. This bill would require and individual’s case information and eligibility determination to be sent to his or her county of residence within 3 business days if the individual is determined newly eligible for Medi-Cal through the California Health Care Eligibility, Enrollment, and Retention Act (CalHEERS). This bill would require those cases to be processed by the county according to specified timelines. The bill would establish different enrollment procedures to be followed for those counties that provide Medi-Cal services under the two-plan model or the geographic managed care plan model, or a county organized health system, as specified.

Last Action: 06/27/2016  Re-referred to Committee on Appropriations

For more information on this bill please check the Official California Legislative Information site here

AB 2084: Assembly member Wood (District 2)

Summary: This bill would provide that comprehensive medication management (CMM) services, are a covered benefit under the Medi-Cal program, and would require those services to include, among other things, the development and implementation of a written medication treatment plan that is designed to resolve documented medication therapy problems and to prevent future medication therapy problems. The bill would require the department to evaluate the effectiveness of CMM on quality of care, patient outcomes, and total program costs, as specified.

Last Action: 05/27/2016 In committee: held under submission

For more information on this bill please check the Official California Legislative Information site here

SB 1244: Senator Berryhill (District 8)

Summary: The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law provides that it is the intent of the Legislature to provide, to the extent practicable, for health care for those aged and other individuals who lack sufficient annual income to meet the costs of health care, and whose other assets are so limited that their application toward the costs of care would jeopardize the individual’s or family’s future minimum self-maintenance and security. This bill would make technical, non-substantive changes to this statement of legislative intent.

Last Action: 3/3/16 Referred to Committee on Rules.

For more information on this bill please check the Official California Legislative Information site here

SB 1300: Senator Hernandez (District 17)

Summary: This bill, commencing July 1, 2017, and subject to federal approval, would impose a quality assurance fee for each transport provided by an emergency medical transport provider, as defined, subject to the quality assurance fee in accordance with a prescribed methodology. The bill would authorize the director to exempt categories of emergency medical transport providers from the quality assurance fee if necessary to obtain federal approval. The bill would require the Director of Health Care Services to deposit the collected quality assurance fee into the Medi-Cal Emergency Medical Transport Fund, which the bill would create in the State Treasury, to be continuously appropriated, thereby making an appropriation, to the department to be used exclusively in a specified order of priority to enhance federal financial participation for ambulance services under the Medi-Cal program, and to provide additional reimbursement to, and to support quality improvement efforts of, emergency medical transport providers, to pay for state administrative costs, and to provide funding for health care coverage for Californians. The bill, on or before August 15, 2016, would require each emergency medical transport provider to report to the department specified data, including data on gross receipts, as defined, from the provision of emergency medical transports, as specified, in a manner and form prescribed by the department and, commencing on October 1, 2016, and each fiscal quarter thereafter, would require each emergency medical transport provider to report this data to the department. The bill would authorize the department to establish an Internet Web site for the submission of these data reports. The bill would authorize the department to require a certification by each emergency medical transport provider, under penalty of perjury, of the truth of these data reports. By expanding the scope of the crime of perjury, the bill would impose a state-mandated local program. The bill would authorize the department, upon written notice to the emergency medical transport provider, to impose a $100 per day penalty against the provider for each day that the provider fails to make a report within 5 business days of the date upon which the data report was due. The bill would provide that the failure to make a report under these provisions within 90 days of the date upon which the report was due shall be considered a violation that relates to his or her licensed activities for purposes of a specified section of the Vehicle Code, which authorizes the Commissioner of the California Highway Patrol to suspend, revoke, or take other disciplinary action against a license if the licensee violates any section of the Vehicle Code that relates to his or her licensed activities.

Last Action: 06/30/2016 Re-referred to Committee on Appropriations

For more information on this bill please check the Official California Legislative Information site here

SB 1308: Senator Nguyen (District 17)

Summary: This bill would prohibit a county organized health system  from utilizing funds intended for administrative and operational expenses for staff retreats, promotional giveaways, excessive executive compensation, or promotion of federal or state legislative or regulatory modifications. The bill would prohibit a media campaign or paid advertising purchased by the county organized health system from featuring the image or voice of an elected public official or candidate for elected office, or directly represent the views of an official or candidate. The bill would permit the media campaign or paid advertising to reference an official or candidate if the name appears in a roster listing containing the names of all officers of the purchasing agency, as specified. The bill would make related legislative findings and declarations.

Last Action: 4/5/16 Hearing canceled at the request of the author

For more information on this bill please check the Official California Legislative Information site here

SB 815: Senator Ed Hernandez (District 22) and de Leon (District 24)

Medi-Cal: demonstration project

Summary: Existing law provides for a demonstration project under the Medi-Cal program until October 31, 2015, to implement specified objectives, including better care coordination for seniors and persons with disabilities and maximization of opportunities to reduce the number of uninsured individuals. This bill would require the State Department of Health Care Services to implement a waiver or demonstration project authorized under a specified federal waiver that, among other things, includes a delivery system transformation and alignment incentive program for designated public hospital systems and district municipal hospitals.

Last Action: 06/27/2016 Ordered to engrossing and enrolling

For more information on this bill please check the Official California Legislative Information site here

AB 1568: Assembly member Bonta (District 18) and Atkins (District 78)

Medi-Cal: demonstration project

Summary:Existing law provides for a demonstration project under the Medi-Cal program until October 31, 2015, to implement specified objectives, including better care coordination for seniors and persons with disabilities and maximization of opportunities to reduce the number of uninsured individuals. This bill would require the State Department of Health Care Services to implement a waiver or demonstration project authorized under a specified federal waiver that, among other things, includes a delivery system transformation and alignment incentive program for designated public hospital systems and district municipal hospitals.

Last Action: 07/01/2016 Approved by the Governor

For more information on this bill please check the Official California Legislative Information site here

AB 1839: Senator Patterson  (District 23)

California Health Benefit Exchange: enrollment options

Summary:This bill would require the Exchange’s enrollment system to be upgraded so an enrollee whose family income qualifies him or her for subsidized coverage, but only qualifies children in the household 19 years of age or younger for Medi-Cal, would be presented with the option of either enrolling in a plan with subsidized coverage for himself or herself and enrolling the eligible child or children in Medi-Cal, or enrolling in a single plan for the family that preserves the enrollee’s subsidized coverage and purchasing unsubsidized coverage under the same plan for the child or children under

For more information on this bill please check the Official California Legislative Information site here

SBX2-15: Senator Hernandez  (District 22)

Developmental services:Medi-Cal: rate increases

Summary: This bill would establish a new managed care organization provider tax, to be administered by the State Department of Health Care Services. The tax would be assessed by the department on licensed health care service plans, managed care plans contracted with the department to provide Medi-Cal services, and alternate health care service plans (AHCSP), as defined, except as excluded by the bill. The bill would require the department to determine for each health plan using the base data source, as defined, specified enrollment information for the base year.

Last Action: 03/10/2016 From Committee without further action

For more information on this bill please check the Official California Legislative Information site here

SB 818: Senator Nielsen  (District 4)

Developmental services:Medi-Cal: rate increases

Summary:This bill would appropriate certain sums to the State Department of Developmental Services to provide a 10% rate increase for certain developmental service providers and regional center operating budgets, and would appropriate certain sums to the State Department of Health Care Services to restore rates paid to Medi-Cal providers to those levels in effect prior to the implementation of the provider rate reductions. The bill would require the Director of Finance to calculate the amounts necessary to provide

Last Action: 1/28/2016 Referred to Committee on Health and Human Services

For more information on this bill please check the Official California Legislative Information site here

AB 20: Assemblymember Bonta  (District 18)

Medi-Cal: managed care organization tax

Summary: This bill, on July 1, 2016, and until July 1, 2019, would establish a new managed care organization provider tax, to be administered by the State Department of Health Care Services. The tax would be assessed by the department on licensed health care service plans, managed care plans contracted with the department to provide Medi-Cal services, and alternate health care service plans (AHCSP), as defined, except as excluded by the bill. The bill would require the department to determine for each health plan using the base data source, as defined, specified enrollment information for the base year. By October 14, 2016, or within 10 business days following the date upon which the department receives approval for federal financial participation, whichever is later, the bill would require the department to commence notification to the health plans of the assessed tax amount due for each fiscal year and the dates on which the installment tax payments are due for each fiscal year.

Last Action: 3/15/2016 From committee without further action

For more information on this bill please check the Official California Legislative Information site here

AB 2394: Assemblymember Garcia  (District 56)

Medi-Cal: nonmedical transportation

Summary: This bill would add to the schedule of benefits nonmedical transportation, as defined, subject to utilization controls and permissible time and distance standards, for a beneficiary to obtain covered Medi-Cal services. The bill would specify that these provisions shall not be interpreted to add a new benefit to the Medi-Cal program. The bill would require the department to adopt regulations by July 1, 2018. Commencing July 1, 2017, the bill would require the department to provide a status report to the Legislature on a semiannual basis until regulations have been adopted.

Last Action: 06/23/2016 Re-referred to Committee on Appropriations.

For more information on this bill please check the Official California Legislative Information site here

AB 2345: Assemblymember Ridley-Thomas (District 54)

Health care: patient access

Summary:  The goal of the Office of Patient Advocate, within the California Health and Human Services Agency is to coordinate amongst, provide assistance to, and collect data from, all of the state agency consumer assistance or patient assistance programs and call centers, to better enable health care consumers to access the health care services to which they are eligible under the law, including, but not limited to, commercial and exchange coverage, Medi-Cal, Medicare, and federal veterans health benefits. This bill would state the intent of the Legislature to enact legislation to require a study regarding the problems confronted by patients in accessing health care in California.

Last Action: 05/27/2016 In committee: held under submission

For more information on this bill please check the Official California Legislative Information site here

AB 2207: Assemblymember Wood (District 2)

Medi-Cal: Dental program

Summary: Existing law, beginning May 1, 2014, or the effective date of any necessary federal approvals, whichever is later, provides that only specified adult dental services are a covered Medi-Cal benefit for persons 21 years of age or older. This bill would require the department to undertake specified activities for the purpose of improving the Medi-Cal Dental Program, such as expediting provider enrollment and monitoring dental service access and utilization. The bill would require a Medi-Cal managed care health plan to provide dental health screenings for eligible beneficiaries and refer them to appropriate Medi-Cal dental providers. This bill would provide that those provisions shall only be implemented to the extent that the department obtains necessary federal approvals, federal matching funds, and an appropriation in the annual Budget Act for the specific purpose of implementing those provisions.

Last Action: 08/31/2016 Enrolled and presented to the Governor.

For more information on this bill please check the Official California Legislative Information site here

AB 1849: Assemblymember Gipson (District 64)

Foster youth: transition to independent living: health insurance coverage.

Summary:Existing law extends certain foster care benefits to youth up to 21 years of age, known as nonminor dependents if specified conditions are met. This bill would require, for purposes of the 90-day transition plan, options regarding health insurance to include verification that the youth or non-minor is enrolled in Medi-Cal and a description of the steps already taken and that will be taken by the social worker or probation officer upon case closure to ensure that the youth or nonminor is transitioned into the Medi-Cal program, as specified.

Last Action: 08/02/2016 From committe: Do pass.

For more information on this bill please check the Official California Legislative Information site here

AB 1696: Assemblymember Holden (District 41)

Medi-Cal: tobacco cessation services

Summary:This bill would provide that, only to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained, tobacco cessation services are covered benefits, subject to utilization controls, under the Medi-Cal program and would require those services to include all intervention recommendations, as periodically updated, assigned a grade A or B by the United States Preventive Services Task Force, and, at a minimum, 4 quit attempts per year. The bill would also require, only to the extent consistent with the recommendations of the United States Preventive Services Task Force, tobacco cessation services to include at least 4 counseling sessions per quit attempt and a 12-week treatment regimen of any medication approved by the federal Food and Drug Administration for tobacco cessation. The bill would require the department to seek any federal approvals necessary to implement those provisions.

Last Action: 08/30/2016 Enrolled and presented to the Governor

For more information on this bill please check the Official California Legislative Information site here

AB 1655: Assemblymember Dodd (District 4)

Medi-Cal: beneficiary maintenance needs: personal needs allowance.

Summary:This bill would increase the personal needs allowance amount from $35 to $80 per month while a person is a patient as described above, and instead would require the department to annually increase this amount based on the percentage increase in the California Consumer Price Index. Because counties are required to make Medi-Cal eligibility determinations, and this bill would expand eligibility by increasing the personal needs allowance and would increase the responsibility of counties in determining Medi-Cal eligibility, this bill would impose a state-mandated local program

Last Action: 05/27/2016 In committee: held under submission

For more information on this bill please check the Official California Legislative Information site here

AB 1863:  Jim Wood (District 2 ) 

Improving Access to Behavioral Health Services (MFT Bill) 

Summary: This bill will increase Californians’ access to culturally appropriate behavioral health services by permitting Marriage and Family Therapists (MFT) services at an FQHC or RHC to be reimbursed on a per-visit basis, just as services provided by other mental health professionals are reimbursed. Adding MFT’s would require a rate adjustment.

This is the same MFT Bill that was vetoed by the Governor last round because of the MCO tax, a substantial Medi-Cal revenue source, had not been resolved.  With bipartisan support and momentum from the last session, FQHCs are optimistic. It is important to highlight, however, that adding MFT services will require a scope change.

For more information on this bill please check the Official California Legislative Information site here

AB 2589: Assemblymember Gomez (District 51)

Lactation Support for California Moms

Summary: This bill will empower working moms to breastfeed their babies by ensuring that Medi-Cal provides access to modern day breast pumps. In addition, the bill will improve duel enrollment systems for WIC and Medi-Cal, and create standards and quality metrics for lactation support. CPCA is co-sponsoring this legislation with the California Women, Infants, and Children (WIC) Association. Status: Introduced in the Assembly.

Last Action: 06/27/2016 Re-referred to Committee on Appropriations

For more information on this bill please check the Official California Legislative Information site here

SB 33: Senator Hernandez (District 22) 

Medi-Cal Estate Recovery

Summary: This bill would require the State Department of Health Care Services (DHCS) to accept contributions by private foundations in the amount of at least $6 million for the purpose of providing Medi-Cal renewal assistance payments, as specified. The bill would also appropriate $6 million from the Healthcare Outreach and Medi-Cal Enrollment Account and $6 million from the Federal Trust Fund, to be available for encumbrance or expenditure until December 31, 2016, and authorize the use of previously appropriated funds in that account for this purpose. The bill would require the department to seek federal matching funds for the contributions to the extent permissible for training, testing, certifying, supporting, and compensating persons and entities providing renewal assistance and for any other permissible renewal assistance related activities, and to seek all necessary federal approvals for purposes of obtaining federal funding. The bill would also require the department, in collaboration with the County Welfare Directors Association and legal services organizations, to develop renewal assistance training for employees of community-based organizations, as specified.

Last Action: 09/04/2015 Ordered to inactive file on request of Assembly Member Holden.

For more information on this bill please check the Official California Legislative Information site here

AB 366: Assemblymember Bonta (District 18)

Medi-Cal Annual access monitoring report

Summary:  This bill would authorize the City of Alameda to impose a transactions and use tax for general purposes that, in combination with other transactions and use taxes, would not exceed the combined rate limit of 2% by more than 0.5%, if the city adopts an ordinance proposing the tax and the ordinance proposing the tax is approved by the voters, subject to applicable voter approval requirements, as specified. The bill would repeal this authorization on January 1, 2025, if an ordinance proposing the tax has not been approved by that date.

Last Action: 06/14/2016 Read for a second time, amended and re-referred to Committee on Appropriations

For more information on this bill please check the Official California Legislative Information site here

AB 1299: Assemblymember Ridley-Thomas (District 54)

Medi-Cal: Specialty Mental Health Services: Foster Children

Summary: This bill would ensure that foster children who are placed outside of their county of original jurisdiction receive access to mental health care in a timely manner. Their access would take into account individual strengths and needs, and would meet the EPSDT program standards. The department would have to issue a policy to guide and arrange the steps involved in the transferring and arranging of mental health care services in the child’s new county of residence.

The bill would require the Department of Finance to adjust the allocation schedule of its Behavioral Health Sub-account in order to ensure that the counties paying for the transfer of mental health services are reimbursed within that fiscal year. The bill also requires that the Department of Finance determine whether it is necessary to seek approval under the state’s Section 1915(b) Medicaid Waiver from the federal Centers Medicare and Medicaid Services (CMS) before implementation. If necessary, they will seek an expeditious approval.

Last Action: 08/29/2016 Senate amendments concurred in. To Engrossing and Enrolling.

For more information on this bill please check the Official California Legislative Information site here

AB 763: Assemblymembers Burke (District 62) and Bonilla (District 14)

Medi-Cal: Program for aged and disabled people

Summary:Existing law requires the State Department of Health Care Services, which administers Medi-Cal, to implement a program for aged and disabled persons. In order to be eligible for such a program, the individual’s income cannot exceed an income standard equal to 100% of the applicable federal poverty level, plus an income disregard of $230 for an individual, or $310 in the case of a couple.

This bill would increase those income disregard amounts to $369 for an individual, or $498 in the case of a couple, and require that the income disregards be adjusted annually.

Last Action: 02/01/16 From committee: Filed with the Chief Clerk pursuant to Joint Rule 56.

For more information on this bill please check the Official California Legislative Information site here

AB 1117:  Assemblymember Cristina Garcia (District 58)

Medi-Cal Vaccination Rates

Summary:Existing law requires each county to establish a community child health and disability prevention program to provide health screening and evaluation services for all children. In order to carry out these services, immunizations and an assessment of immunization status must be performed.

This bill would require the State Department of Health Care Services (SDHS) to establish the California Childhood Immunization Quality Improvement Fund (CCIQIF) program to improve childhood immunization rates. SDHS would have to apply to the federal Centers for Medicare and Medicaid Services to run a 5-year demonstration trial before permanent implementation. To support the demonstration project, the SDHS would contact researchers to develop and submit an evaluation of the program’s effectiveness to the legislature.

SDHS would have to develop a plan for the collection and expenditure of CCIQIF moneys, taking the use of voluntary contributions from Medi-Cal managed care plans for provider support payments and reward payments to Medi-Cal managed care plans into consideration.

DHCS would incur costs in the low hundreds of thousands of dollars to develop and seek federal approval for a program. Annual costs would be similar.

Last Action: 8/27/15 In committee: Held under submission

For more information on this bill please check the Official California Legislative Information site here

AB 1216: Assemblymember Bonta (District 18)

Plan amendments and waiver applications

Summary: Existing law requires the State Department of Heath Care Services (SDHS) to seek approval from the federal Centers for Medicare and Medicaid Services (CMS) for all waivers and amendments to the state plan. The SDHS is required to post all state plan amendments and federal waiver applications to its website within ten business days of submitting the application to the CMS. The SDHS must also upload all pending state plan amendments and federal waiver applications submitted to the CMS since 2009 to its website.

This bill would require the SDHS to post to its website all state plan amendments, federal waiver applications including requests for new waivers, waiver amendments, waiver renewals and extensions within 7 business days of submission. SDHS remains responsible for uploading all pending applications since 2009 to its website. This bill would require the SDHS to accept public comments on such uploaded documents and to consider the comments in the formation of potential amendments.

Last Action: 08/02/2016 Read a second time and ordered for a third reading.

For more information on this bill please check the Official California Legislative Information site here

AB 1257: Assemblymember Gray (District 21)

Ground Ambulance Rates

Summary: This bill would require the State Department of HealthcareServices to establish payment rates for ambulance services based on changes in the Consumer PriceIndex-Urban (CPI-U) and the Geographic Practice Cost Index. The department would need to engage in a specified ambulance cost study conducted by the federal Government Accountability Office.  As a result of the study, this bill would increase Medi-Cal ambulance rates to better reflect business costs, which can be especially high as ambulance providers are legally obligated to respond to all calls. This bill is supported by ambulance providers and first responders.

Estimated annual cost increases should be in the range of $5-10 million per year (GF federal), depending on changes in the CPI-U.

Last Action: 02/01/16 From committee: Filed with the Chief Clerk pursuant to Joint Rule 56.

For more information on this bill please check the Official California Legislative Information site here

SB 447: Senator Allen

Clinics: drugs and supplies

Summary: This bill revises the Medi-Cal and Family PACT (Planning, Access, Care, and Treatment) reimbursement formula for drugs and supplies dispensed to patients by specified clinics. This bill requires that the reimbursement to specified clinics for drugs and supplies equal the sum of the actual acquisition cost of a drug or supply, which must be calculated at least once a year, plus a clinic dispensing fee. Existing law requires that the clinic dispensing fee not exceed $12 per billing unit. This bill however, requires that the additional clinic dispensing fee be the difference between the actual acquisition cost of a drug or supply and the Medi-Cal reimbursement rate. Thus, this bill removes the cap for clinical dispensing fee reimbursements. According to the author, this bill will encourage clinics to dispense more medicine onsite by making the billing and reimbursement system easier.

Last Action: 08/01/2016 From committee with author’s amendments. Read second time and amended. Re-referred to Committee on Appropriations.

For more information on this bill please check the Official California Legislative Information site here

AB 635: Assemblymember Atkins

Medical interpretation Services

Summary: Existing federal law requires increased funding for the translation and interpretation services that aid in enrollment in, and retention and use of Medicaid services for patients. This bill would require the Department of Health Care Services to acquire federal funding to establish a program that provides and reimburses certified medical interpretation services, excluding sign language. The reimbursements would be received by the Medi-Cal beneficiaries who are limited English proficient. The program would be administered by Medi-Cal providers who serve the beneficiaries on a fee-for-service or managed care basis.

Last Action: 09/04/15 Ordered to inactive file at the request of Senator Lara.

For more information on this bill please check the Official California Legislative Information site here

AB 859: Assemblymember Medina (District 61)

Obesity Treatment Plans

Summary: This bill would require the Department of Health Care Services starting on December 31^st, 2016 and until January 1, 2021 to implement an Obesity Treatment Action Plan to diagnose and treat obesity, with the hopes of decreasing the incidence of obesity in the Medi-Cal program. The department would need to first expose the plan for service to the legislature and incorporate their recommendations. The report would include the provider’s guidelines for obesity treatment, identifying and screening patients, as well as a review of all the coverage services included to treat obesity. The bill requires the department to seek federal approval and financial support.

Fiscal costs are estimated to be in the low hundreds of thousands of dollars to the General Fund to support the review of treatment options and developmental process.

Last Action: 02/01/16 From committee: Filed with the Chief Clerk pursuant to Joint Rule 56.

For more information on this bill please check the Official California Legislative Information site here

AB 1018: Assemblymember Cooper (District 9)

Early and periodic screening, diagnosis, and treatment (EPSDT)

Summary:  Under existing law, EPSDT services for anyone under 21 are covered under Medi-Cal. EPSDT services include screening, vision, dental, hearing and other services that treat detected physical or mental conditions. Patients can receive these covered services regardless of their state’s plan. The existing Individuals and Disabilities Act requires that those with exceptional needs can access free public education that is tailored to their needs.

This bill would require the Department of Health Care Services and the Department of Education to develop a joint task force to discuss the delivery of mental health services for children eligible for EPSDT services and those offered under the Disabilities Education Act. The task force would need to hold at least two public meetings by October 1, 2016 in order to submit a report of key findings and recommendations for action to the legislature.

Last Action: 8/27/15 In committee: Held under submission
For more information on this bill please check the Official California Legislative Information site here

AB 1388: Assemblymember Obernolte (District 33)

Moratoria on enrollment providers

Summary: Existing law authorizes the Department of Health Care Services to implement a moratorium on the enrollment of providers in the Medi-Cal program.

Last Action: 02/01/16 From committee: Filed with the Chief Clerk pursuant to Joint Rule 56.
For more information on this bill please check the Official California Legislative Information site  here

SB 642: Senator Nguyen

Geographic Managed Care: Dental

Summary:  Existing law authorizes the Department of Health Care Services (DHCS) to provide managed health care plan services to Medi-Cal recipients residing in clearly defined geographic areas. Additionally, the Medi-Cal program includes a schedule of benefits which includes certain dental services. Existing law authorizes Sacramento County to establish an advisory committee that meets on its own and is required to periodically convene with DHCS to discuss the delivery of oral health and dental care services. This bill would make technical, nonsubstantive changes to the latter provision.

Last Action: 02/01/16 Returned to Secretary of Senate pursuant to Joint Rule 56.

For more information on this bill please check the Official California Legislative Information site here

SB 243: Senator Hernandez

Medi-Cal: reimbursement: provider rates

Summary: This bill would require the department to increase inpatient hospital reimbursement rates by 16% for the 2015–16 fiscal year, and diagnosis-related group payment claims annually thereafter July 1, 2016, based on the medical portion of the California Consumer Price Index. This bill also requires, commencing with the 2015–16 fiscal year, Medi-Cal managed care rates to be increased by a proportionately equal amount for increased payments for hospital services.

Existing law requires that Medi-Cal provider payments for non-Medi-Cal programs to be reduced by 10% for dates of service on and after June 1, 2011. This bill would prohibit the application of those reductions for payments to providers for dates of service on or after June 1, 2011. The bill would also require payments for managed care health plans for dates of service to be determined without application of some of those reductions.

This bill, commencing January 1, 2016, would require that payments for medical care services be at least 100% of the service payment rate established by the Medicare program for fee-for-service providers. This bill, starting January 1, 2016, would also require rates paid to Denti-Cal adult and children providers to be increased by the percent equivalent to the increase required for other fee-for-service Medi-Cal providers. This bill authorizes the department to implement these provisions through provider bulletins and to adopt those regulations by July 1, 2018.

Last Action: 02/01/16 Returned to Secretary of Senate pursuant to Joint Rule 56.

For more information on this bill please check the Official California Legislative Information site here