BILL NUMBER: AB 359 AMENDED
BILL TEXT
AMENDED IN SENATE JULY 15, 2009
AMENDED IN ASSEMBLY JUNE 2, 2009
AMENDED IN ASSEMBLY APRIL 15, 2009
INTRODUCED BY Assembly Member Nava
(Coauthor: Assembly Member Blakeslee)
(Coauthors: Senators Maldonado and Strickland)
FEBRUARY 23, 2009
An act to amend Section 104150 of the Health and Safety Code, and
to amend Section 14105.18 of , and to add Section 14132.165
to, the Welfare and Institutions Code, relating to cancer.
LEGISLATIVE COUNSEL'S DIGEST
AB 359, as amended, Nava. Breast and cervical cancer: early
detection screening: digital mammography: reimbursement rates.
Existing law provides for the Medi-Cal program, administered by
the State Department of Health Care Services, under which qualified
low-income persons are provided with health care services, including
breast and cervical cancer services.
Under existing law, the State Department of Public Health
participates in a grant program through the federal Centers for
Disease Control and Prevention to provide breast and cervical cancer
early detection screening. Providers participating in the grant
program may only provide screening services to individuals whose
family income does not exceed 200% of the federal poverty level
, and provider rates are required to be identical to the rates under
the Medi-Cal program .
This bill would, until January 1, 2014, require digital
mammography screening to be covered when analog mammography services
are not available from the provider, to be reimbursed at the Medi-Cal
analog rate , and would make conforming changes
.
Existing law provides for the Medi-Cal program, administered by
the State Department of Health Care Services, under which qualified
low-income persons are provided with health care services, including
breast and cervical cancer services.
This bill would authorize digital screening eligibility and
reimbursement under these programs only for those screenings where
the provider agrees to receive reimbursement in full at the analog
rate.
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 104150 of the Health and Safety Code is amended
to read:
104150. (a) A provider or entity that participates in the grant
made to the department by the federal Centers for Disease Control and
Prevention breast and cervical cancer early detection program
established under Title XV of the Public Health Service Act (42
U.S.C. Sec. 300k et seq.) in accordance with requirements of Section
1504 of that act (42 U.S.C. Sec. 300n) may only render screening
services under the grant to an individual if the provider or entity
determines that the individual's family income does not exceed 200
percent of the federal poverty level.
(b) (1) The department shall provide for breast cancer and
cervical cancer screening services under the grant at the level of
funding budgeted from state and other resources during the fiscal
year in which the Legislature has appropriated funds to the
department for this purpose. These screening services shall not be
deemed to be an entitlement.
(2) For all mammography screening procedures conducted prior to
January 1, 2014, the following provisions apply:
(A) A provider may employ digital mammography technology for the
purposes of this section when analog mammography technology is not
available.
(B) The mammography screening reimbursement rate under this
section shall be limited to the Medi-Cal reimbursement rate for
analog mammography screening.
(C) For purposes of this section, digital mammography screening
may be reimbursed, pursuant to Section 14132.16, only at the analog
rate and only if the provider agrees to receive reimbursement in full
at the analog rate.
(c) To implement the federal breast and cervical cancer early
detection program specified in this section, the department may
contract, to the extent permitted by Section 19130 of the Government
Code, with public and private entities, or utilize existing health
care service provider enrollment and payment mechanisms, including
the Medi-Cal program's fiscal intermediary. However, the Medi-Cal
program's fiscal intermediary shall only be used if services provided
under the program are specifically identified and reimbursed in a
manner that does not claim federal financial reimbursement. Any
contracts with, and the utilization of, the Medi-Cal program's fiscal
intermediary shall not be subject to Chapter 3 (commencing with
Section 12100) of Part 2 of Division 2 of the Public Contract Code.
Contracts to implement the federal breast and cervical cancer early
detection program entered into by the department with entities other
than the Medi-Cal program's fiscal intermediary shall not be subject
to Part 2 (commencing with Section 10100) of Division 2 of the Public
Contract Code.
SEC. 2. Section 14105.18 of the Welfare and Institutions Code, as
added by Section 2 of Chapter 496 of the Statutes of 2008, is amended
to read:
14105.18. (a) Notwithstanding any other provision of law,
provider rates of payment for services rendered in all of the
following programs shall be identical to the rates of payment for the
same service performed by the same provider type pursuant to the
Medi-Cal program.
(1) The California Children's Services Program established
pursuant to Article 5 (commencing with Section 123800) of Chapter 3
of Part 2 of Division 106 of the Health and Safety Code.
(2) The Genetically Handicapped Person's Program established
pursuant to Article 1 (commencing with Section 125125) of Chapter 2
of Part 5 of Division 106 of the Health and Safety Code.
(3) Except as specified in Section 14132.165
subdivision (b) of Section 104150 of the Health and Safety Code
, the Breast and Cervical Cancer Early Detection Program
established pursuant to Article 1.5 (commencing with Section 104150)
of Chapter 2 of Part 1 of Division 103 of the Health and Safety Code
and the breast cancer programs specified in Section 30461.6 of the
Revenue and Taxation Code.
(4) The State-Only Family Planning Program established pursuant to
Division 24 (commencing with Section 24000).
(5) The Family Planning, Access, Care, and Treatment (Family PACT)
Waiver Program established pursuant to subdivision (aa) of Section
14132.
(b) The director may identify in regulations other programs not
listed in subdivision (a) in which providers shall be paid rates of
payment that are identical to the rates of payments in the Medi-Cal
program pursuant to subdivision (a).
(c) Notwithstanding subdivision (a), services provided under the
programs described in subdivisions (a) and (b) may be reimbursed at
rates greater than the Medi-Cal rate that would otherwise be
applicable if those rates are adopted by the director in regulations.
(d) This section shall become operative on January 1, 2010.
SEC. 3. Section 14132.165 is added to the
Welfare and Institutions Code, immediately following Section
14132.16, to read:
14132.165. Digital mammography screening may be reimbursed
pursuant to Section 14132.16, but only at the analog rate and only if
the provider agrees to receive reimbursement in full at the analog
rate.