BILL NUMBER: AB 2440	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  APRIL 3, 2008

INTRODUCED BY   Assembly Member Laird

                        FEBRUARY 21, 2008

   An act to add Section 14105.76 to the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 2440, as amended, Laird. Medi-Cal: reimbursement codes.
   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.
   Existing law provides for various requirements and procedures
relating to the coding and reimbursement procedures under the
Medi-Cal program. Existing law allows the department to enter into
contracts for fiscal intermediary services in connection with
processing the payment of claims submitted by Medi-Cal providers.
   This bill would require the department to update specified
diagnostic and reimbursement codes within 60 days of their
publication by the federal Centers for Medicare and Medicaid Services
and the American Medical Association, and publish the updated codes
in the Medi-Cal provider bulletin immediately following that 60-day
period. The bill would  provide that, if the department is
unable to complete and publish the updated codes within that period,
the department shall, until completion of the updates and
publication, allow providers to use the current year codes published
by the above-described entities, and would require the department to
allow providers to bill using a miscellaneous billing code until the
permanent code is updated and published   also prohibit
the department from denying a reimbursement claim based on a provider
using the above-described current year codes  . It would
further require the department to ensure that the fiscal intermediary
enters into the Medi-Cal database the updated code within a
specified time period.
   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 14105.76 is added to the Welfare and
Institutions Code, to read:
   14105.76.  (a) In order to ensure that Medi-Cal diagnostic
nomenclature and reimbursement codes are consistent with those used
by the Medicare and private sector payers, the department shall
annually adopt, within 60 days of publication, the following codes:

   (1) The most current International Statistical Classification of
Diseases and Related Health Problems (ICD-9) codes published

    (1)     The most current International
Classification of Diseases, Ninth Revision (ICD-9) codes published
 by the federal Centers for Medicare and Medicaid Services.
   (2)  The most current Current Procedural Terminology (CPT) codes
 published by the American Medical Association,  and the
most current Healthcare Common Procedure Coding System (HCPCS) ,
Level II  codes published by the  American Medical
Association   federal Centers for Medicare and Medicaid
Services  .
   (b) The updates described in subdivision (a) shall be published in
the Medi-Cal provider bulletin that immediately follows the 60-day
period.
   (c) The effective date of the updates described in subdivision (a)
shall be no later than the publication date of the bulletin.

   (d) If the department is unable to complete and publish the
updates within the period specified in subdivision (a), the
department shall do both of the following:  
   (1) Until completion of the updates required by this section,
allow providers to use the current year ICD-9, CPT, and HCPCS codes.
The department shall, until completion of the updates required by
this section, allow providers to bill using a miscellaneous billing
code until the permanent code is updated.  
   (2) Accept, without delay, a provider reimbursement claim if the
provider utilizes the current year codes or miscellaneous codes, as
authorized pursuant to paragraph (1).  
   (d) The department shall not deny a reimbursement claim based on a
provider using a current year code, as described in paragraphs (1)
and (2) of subdivision (a). 
   (e) The department shall ensure that the fiscal intermediary
enters into the Medi-Cal database the code assigned to the product
within the 60-day period described in subdivision (a).