BILL NUMBER: SB 623	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 30, 2007
	AMENDED IN SENATE  APRIL 23, 2007

INTRODUCED BY   Senator Wiggins
   (Coauthors: Senators Alquist and Kuehl)

                        FEBRUARY 22, 2007

   An act to add Section 14133.231 to the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 623, as amended, Wiggins. Medi-Cal: drug benefits.
   Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services and
under which qualified low-income persons receive health care
benefits, including, for certain beneficiaries, prescription drug
benefits. The Medi-Cal program is, in part, governed and funded by
federal Medicaid provisions.
   Existing law provides for the federal Medicare Program, which
provides health care benefits, including prescription drug benefits,
to persons 65 years of age and older and other specified persons.
Under the Medicare Program, prescription drug benefits are obtained
through enrollment in a prescription drug plan offered under the
program. Existing law requires Medicare eligible persons who are also
eligible for Medi-Cal prescription drug benefits (known as duel
eligible persons) to obtain those benefits through a prescription
drug plan under the Medicare Program, except as specified.
   This bill would provide that, beginning January 1, 2008, the
department shall pay all copayments required by drug plans under the
Medicare Program for generic or brand name medications for
full-benefit dual eligible beneficiaries under specified conditions.
The bill would require the department to develop a process for the
reimbursement of Medi-Cal enrolled pharmacies for the cost of the
copayments, unless specified conditions are met. 
   The bill would require that a pharmacists's claim for
reimbursement under the bill submitted under penalty of perjury,
thereby expanding the definition of an existing crime, thus creating
a state-mandated local program.  
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.  
   This bill would provide that no reimbursement is required by this
act for a specified reason. 
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program:  yes   no  .



THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 14133.231 is added to the Welfare and
Institutions Code, to read:
   14133.231.  (a) Beginning January 1, 2008, the Department of
Health Care Services shall pay all copayments required by drug plans
under Part D of Title XVIII of the Social Security Act (42 U.S.C.
Sec. 1395w-101 et seq.) or MA-PD plans under Part C of Title XVII of
the Social Security Act (42 U.S.C. Sec. 1395w-21 et seq.) for generic
or brand name medications for full-benefit dual eligible
beneficiaries under all of the following conditions:
   (1) Copayments for prescriptions are no greater than the amounts
permitted under the Medicare Modernization Act of 2003.
   (2) Payments are made on behalf of the full-benefit dual eligible
beneficiary to the pharmacy that dispenses the medication.
   (3) The pharmacy is an enrolled provider in the Medi-Cal program.
   (4) The Part D prescription drug plan in which the full-benefit
dual eligible beneficiary is enrolled, or the pharmacy from which the
beneficiary is receiving medication, has not waived, limited, or
otherwise reduced the required copayments. If the copayment has been
reduced or limited, the department shall pay the lower copayment,
provided that the other conditions in this subdivision are met.
   (5) The full-benefit dual eligible beneficiary for which a claim
is filed shall not have reached the catastrophic coverage threshold
of five thousand one hundred fifty dollars ($5,150) per year as
described in the Medicare Modernization Act of 2003.
   (b) To obtain reimbursement from the department a pharmacy shall
submit a claim  and certify on that claim under penalty of
perjury   stating  that the conditions specified in
subdivision (a) exist.
   (c) The department shall develop a process for the reimbursement
of Medi-Cal enrolled pharmacies for the cost of copayments on behalf
of full-benefit dual eligible beneficiaries.
   (d) Any copayments for prescription drugs made available to
full-benefit dual eligible beneficiaries under this section shall not
be deemed to be an entitlement. 
  SEC. 2.    No reimbursement is required by this
act pursuant to Section 6 of Article XIII B of the California
Constitution because the only costs that may be incurred by a local
agency or school district will be incurred because this act creates a
new crime or infraction, eliminates a crime or infraction, or
changes the penalty for a crime or infraction, within the meaning of
Section 17556 of the Government Code, or changes the definition of a
crime within the meaning of Section 6 of Article XIII B of the
California Constitution.