SB 1045, as introduced, Beall. Medi-Cal Drug Treatment Program: group outpatient drug free services.
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. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions.
Existing law also provides for the Medi-Cal Drug Treatment Program (Drug Medi-Cal), under which each county enters into contracts with the State Department of Health Care Services to provide various drug treatment services to Medi-Cal recipients, or the department directly arranges to provide these services if a county elects not to do so. For purposes of Drug Medi-Cal, existing law requires that the maximum allowable rate for group outpatient drug free services be set on a per person basis and requires that a group consist of a minimum of 4, and a maximum of 10, individuals, at least one of which must be a Medi-Cal eligible beneficiary.
This bill would require a group to consist of a minimum of 2 individuals, at least one of which is a Medi-Cal eligible beneficiary.
Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 14021.6 of the Welfare and Institutions
2Code is amended to read:
(a) For the fiscal years prior to fiscal year 2004-05,
4and subject to the requirements of federal law, the maximum
5allowable rates for the Medi-Cal Drug Treatment Program shall
6be determined by computing the median rate from available cost
7data by modality from the fiscal year that is two years prior to the
8year for which the rate is being established.
9(b) (1) For the fiscal year 2007-08, and subsequent fiscal years,
10and subject to the requirements of federal law, the maximum
11allowable rates for the Medi-Cal Drug Treatment Program shall
12be determined by computing the median rate from the most recently
13completed cost reports, by specific service codes that are consistent
14with the federal Health
Insurance Portability and Accountability
15Act of 1996 (42 U.S.C. Sec. 300gg).
16(2) For the fiscal years 2005-06 and 2006-07, if the State
17Department of Health Care Services and the State Department of
18Alcohol and Drug Programs determine that reasonably reliable
19and complete cost report data are available, the methodology
20specified in this subdivision shall be applied to either or both of
21those years. If reasonably reliable and complete cost report data
22are not available, the State Department of Health Care Services
23and the State Department of Alcohol and Drug Programs shall
24establish rates for either or both of those years based upon the
25usual, customary, and reasonable charge for the services to be
26provided, as these two departments may determine in their
27discretion. This subdivision is not intended to modify subdivision
28begin delete (k) of Section 11758.46 of the Health and Safety Code,end deletebegin insert
(h) of
29Section 14124.24 of the Welfare and Institutions Code,end insert that requires
30certain providers to submit performance reports.
31(c) Notwithstanding subdivision (a), for the 1996-97 fiscal year,
32the rates for nonperinatal outpatient methadone maintenance
33services shall be set at the rate established for the 1995-96 fiscal
34year.
35(d) Notwithstanding subdivision (a), the maximum allowable
36rate for group outpatient drug free services shall be set on a per
37person basis. A group shall consist of a minimum ofbegin delete four and a begin insert twoend insert individuals, at least one of which shall be a
P3 1maximum of 10end delete
2Medi-Cal eligible beneficiary.
3(e) The department shall develop individual and group rates for
4extensive counseling for outpatient drug free treatment, based on
5a 50-minute individual or a 90-minute group hour, not to exceed
6the total rate established for subdivision (d).
7(f) The department may adopt regulations as necessary to
8implement subdivisions (a), (b), and (c), or to implement cost
9containment procedures. These regulations may be adopted as
10emergency regulations in accordance with Chapter 3.5
11(commencing with Section 11340) of Part 1 of Division 3 of Title
122 of the Government Code. The adoption of these emergency
13regulations shall be deemed an emergency necessary for the
14immediate preservation of the public peace, health and safety, or
15general welfare.
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