Amended in Assembly March 28, 2014

California Legislature—2013–14 Regular Session

Assembly Bill No. 1967

Introduced by Assembly Member Pan

February 19, 2014

An act to amend Section 14124.24 of the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

AB 1967, as amended, Pan. Drug Medi-Cal.

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 establishes the Drug Medi-Cal Treatment Program (Drug Medi-Cal) under which the department is authorized to enter into contracts with counties for various drug treatment services to Medi-Cal recipients, or is required to directly arrange for these services if a county elects not to do so. begin insert Existing law requires a county to end insert begin insert negotiate contracts only with providers certified to provide Drug Medi-Cal services. end insert Existing law defines Drug Medi-Cal reimbursable services for purposes of these provisions.

This bill would begin insert require the department to promptly notify each county that currently contracts with a certified provider for Drug Medi-Cal services if the department has commenced or concluded an investigation of the provider. The bill would also end insert make technical, nonsubstantive changes to begin delete that definition. end delete begin insert the definition of Drug Medi-Cal reimburs end insert begin insert able services. end insert

Vote: majority. Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

Section 14124.24 of the Welfare and Institutions
Code is amended to read:

14124.24.  

(a) For purposes of this section, “Drug Medi-Cal
reimbursable services” means the substance use disorder services
described in the California State Medicaid Plan and includes, but
is not limited to, all of the following services, administered by the
department, and to the extent consistent with state and federal law:

(1) Narcotic treatment program services, as set forth in Section
14021.51.

(2) Day care rehabilitative services.

(3) Perinatal residential services for pregnant women and women
in the postpartum period.

(4) Naltrexone services.

(5) Outpatient drug-free services.

(6) Other services upon approval of a federal Medicaid state
plan amendment or waiver authorizing federal financial
participation.

(b) (1) While seeking federal approval for any federal Medicaid
state plan amendment or waiver associated with Drug Medi-Cal
services, the department shall consult with the counties and
stakeholders in the development of the state plan amendment or
waiver.

(2) Upon federal approval of a federal Medicaid state plan
amendment authorizing federal financial participation in the
following services, and subject to appropriation of funds, “Drug
Medi-Cal reimbursable services” shall also include the following
services, administered by the department, and to the extent
consistent with state and federal law:

(A) Notwithstanding subdivision (a) of Section 14132.90, day
care habilitative services, which, for purposes of this paragraph,
are outpatient counseling and rehabilitation services provided to
persons with substance use disorder diagnoses.

(B) Case management services, including supportive services
to assist persons with substance use disorder diagnoses in gaining
access to medical, social, educational, and other needed services.

(C) Aftercare services.

(c) (1) The nonfederal share for Drug Medi-Cal services shall
be funded through a county’s Behavioral Health Subaccount of
the Support Services Account of the Local Revenue Fund 2011,
and any other available county funds eligible under federal law
for federal Medicaid reimbursement. The funds contained in each
county’s Behavioral Health Subaccount of the Support Services
Account of the Local Revenue Fund 2011 shall be considered state
funds distributed by the principal state agency for the purposes of
receipt of the federal block grant funds for prevention and treatment
of substance abuse found at Subchapter XVII of Chapter 6A of
Title 42 of the United States Code. Pursuant to applicable federal
Medicaid law and regulations including Section 433.51 of Title
42 of the Code of Federal Regulations, counties may claim
allowable Medicaid federal financial participation for Drug
Medi-Cal services based on the counties certifying their actual
total funds expenditures for eligible Drug Medi-Cal services to
the department.

(2) (A) If the director determines that a county’s provision of
Drug Medi-Cal treatment services are disallowed by the federal
government or by state or federal audit or review, the impacted
county shall be responsible for repayment of all disallowed federal
funds. In addition to any other recovery methods available,
including, but not limited to, offset of Medicaid federal financial
participation funds owed to the impacted county, the director may
offset these amounts in accordance with Section 12419.5 of the
Government Code.

(B) A county subject to an action by the director pursuant to
subparagraph (A) may challenge that action by requesting a hearing
in writing no later than 30 days from receipt of notice of the
department’s action. The proceeding shall be conducted in
accordance with Chapter 5 (commencing with Section 11500) of
Part 1 of Division 3 of Title 2 of the Government Code, and the
director has all the powers granted therein. Upon a county’s timely
request for hearing, the county’s obligation to make payment as
determined by the director shall be stayed pending the county’s
exhaustion of administrative remedies provided herein but no
longer than will ensure the department’s compliance with Section
1903(d)(2)(C) of the federal Social Security Act (42 U.S.C. Sec.
1396b).

(d) Drug Medi-Cal services are only reimbursable to Drug
Medi-Cal providers with an approved Drug Medi-Cal contract.

(e) Counties shall negotiate contracts only with providers
certified to provide Drug Medi-Cal services.

(f) The department shall develop methods to ensure timely
payment of Drug Medi-Cal claims.

(g) (1) A county or a contracted provider, except for a provider
to whom subdivision (h) applies, shall submit accurate and
complete cost reports for the previous fiscal year by November 1,
following the end of the fiscal year. The department may settle
Drug Medi-Cal reimbursable services, based on the cost report as
the final amendment to the approved county Drug Medi-Cal
contract.

(2) Amounts paid for services provided to Drug Medi-Cal
beneficiaries shall be audited by the department in the manner and
form described in Section 14170.

(3) Administrative appeals to review grievances or complaints
arising from the findings of an audit or examination made pursuant
to this section shall be subject to Section 14171.

(h) Certified narcotic treatment program providers that are
exclusively billing the state or the county for services rendered to
persons subject to Section 1210.1 or 3063.1 of the Penal Code or
Section 14021.52 of this code shall submit accurate and complete
performance reports for the previous state fiscal year by November
1 following the end of that fiscal year. A provider to which this
subdivision applies shall estimate its budgets using the uniform
state daily reimbursement rate. The format and content of the
performance reports shall be mutually agreed to by the department,
the County Alcohol and Drug Program Administrators’ Association
of California, and representatives of the treatment providers.

(i) Contracts entered into pursuant to this section shall be exempt
from the requirements of Chapter 1 (commencing with Section
10100) and Chapter 2 (commencing with Section 10290) of Part
2 of Division 2 of the Public Contract Code.

(j) Annually, the department shall publish procedures for
contracting for Drug Medi-Cal services with certified providers
and for claiming payments, including procedures and specifications
for electronic data submission for services rendered.

begin insert

(k) If the department commences or concludes an investigation
of a certified provider, the department shall promptly notify each
county that currently contracts with the provider for Drug
Medi-Cal services that an investigation has commenced or
concluded, as applicable.

end insert