BILL NUMBER: AB 1967 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MARCH 28, 2014
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.
Existing law requires a county to negotiate contracts
only with providers certified to provide Drug Medi-Cal
services. Existing law defines Drug Medi-Cal reimbursable
services for purposes of these provisions.
This bill would 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 make
technical, nonsubstantive changes to that definition.
the definition of Drug Medi-Cal reimburs
able services.
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 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.
(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.