BILL NUMBER: AB 969	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  MARCH 25, 2011

INTRODUCED BY   Assembly Member Atkins

                        FEBRUARY 18, 2011

   An act to  amend Section 14105.22 of   add
Section 14105.221 to  the Welfare and Institutions Code,
relating to Medi-Cal.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 969, as amended, Atkins. Medi-Cal: clinical laboratory and
laboratory services.
   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.
The Medi-Cal program is, in part, governed and funded by federal
Medicaid Program provisions. Existing law provides that reimbursement
for clinical laboratory or laboratory services, as defined, may not
exceed 80% of the lowest maximum allowance established by the federal
Medicare program for the same or similar services. 
   This bill would make a technical, nonsubstantive change to this
provision.  
   This bill would require commercial clinical reference laboratory
providers, as defined, to submit their usual and customary charges,
as defined, when billing the Medi-Cal program for clinical laboratory
tests or examinations or laboratory services. This bill would
provide that payment to commercial clinical reference laboratory
providers shall be the lower of the usual and customary charge or the
reimbursement rate specified for clinical laboratory or laboratory
services. This bill would require commercial clinical reference
laboratory providers to keep and maintain records of their usual and
customary charges for a period of 3 years from the date the clinical
laboratory test or examination or laboratory service is rendered.

   Vote: majority. Appropriation: no. Fiscal committee:  no
  yes  . State-mandated local program: no.


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

   SECTION 1.    Section 14105.221 is added to the 
 Welfare and Institutions Code   , to read:  
   14105.221.  (a) For the purposes of this section, "commercial
clinical reference laboratory provider" means a clinical laboratory
that provides clinical laboratory tests or examinations or laboratory
services to the general public for profit. For the purposes of this
section, "commercial clinical reference laboratory provider" does not
include a physician office laboratory, as defined in paragraph (10)
of subdivision (a) of Section 1206 of the Business and Professions
Code, or a not-for-profit, federal, state, or local government
laboratory.
   (b) (1) For the purposes of this section, "usual and customary
charge" for a clinical laboratory test or examination or laboratory
service means the lower of either of the following:
   (A) The lowest price reimbursed to the commercial  clinical
reference laboratory by third-party payers in the state, excluding
Medi-Cal managed care plans, as defined in subdivision (a) of Section
14456.5.
   (B) The lowest price routinely offered by the commercial clinical
reference laboratory to any segment of the general public.
   (2) Donation of, or discounts for, clinical laboratory tests or
examinations or laboratory services by a commercial clinical
reference laboratory to a federal qualified health center, as defined
in Section 1396d(l)(2)(B) of Title 42 of the United States Code,
shall not be considered to be a usual and customary charge.
   (c) Commercial clinical reference laboratory providers shall
submit their usual and customary charges when billing the Medi-Cal
program for clinical laboratory tests or examinations or laboratory
services.
   (d) Commercial clinical reference laboratory providers shall keep
and maintain records of their usual and customary charges for a
period of three years from the date the clinical laboratory test or
examination or laboratory service is rendered.
   (e) Payment to commercial clinical reference laboratory providers
shall be the lower of the usual and customary charge or the
reimbursement rate established pursuant to Section 14105.22.
   (f) (1) Notwithstanding any other provision of law, the department
may, without taking regulatory action pursuant to Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code, implement, interpret, or make specific this
section by means of a provider bulletin or notice, policy letter, or
other similar instructions.
   (2) The department shall notify and consult with interested
parties and appropriate stakeholders in implementing, interpreting,
or making specific the provisions of this section, and shall do all
of the following:
   (A) Notify provider representatives of the proposed action or
change. The notice shall occur at least 10 business days prior to a
meeting described in subparagraph (B).
   (B) Schedule at least one meeting with interested parties and
appropriate stakeholders to discuss the proposed action or change.
   (C) Allow for written input regarding the proposed action or
change.
   (D) Provide at least 30 days advance notice of the effective date
of the action or change. 
  SECTION 1.    Section 14105.22 of the Welfare and
Institutions Code is amended to read:
   14105.22.  Reimbursement for clinical laboratory or laboratory
services, as defined in Section 51137.2 of Title 22 of the California
Code of Regulations, may not surpass 80 percent of the lowest
maximum allowance established by the federal Medicare program for the
same or similar services.