BILL NUMBER: SB 1322	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Hernandez

                        FEBRUARY 21, 2014

   An act to add Section 14132.04 to the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 1322, as introduced, Hernandez. Medi-Cal: preventive services:
providers.
   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 Program provisions. Existing law provides for a
schedule of benefits under the Medi-Cal program, which includes
specified preventive services.
   This bill would require the department to reimburse Medi-Cal
providers for, and would require Medi-Cal managed care plans to
cover, preventive services provided by a health care practitioner not
subject to professional licensure by the state, that have been
recommended by a physician or other licensed practitioner of healing
arts acting within the scope of that physician's or practitioner's
license. The bill would provide that this coverage is available only
to the extent that federal financial participation in the cost of
providing these services is available. The bill would require the
department to convene a working group, as specified, to determine the
types of health care practitioners eligible to provide preventive
services pursuant to these provisions and to develop a summary of
practitioner qualifications for those practitioners to be included in
any state plan amendment necessary to implement these provisions.
   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.  (a) The Legislature finds and declares both of the
following:
   (1) Research suggests that 50 percent of a physician's time is
spent providing preventive care and screenings, much of which can be
provided by other health care practitioners.
   (2) On July 15, 2013, the Centers for Medicare and Medicaid
Services released an update to federal Medicaid regulations that
permits state Medicaid programs to reimburse for preventive services
recommended by a physician or other licensed health care
practitioner.
   (b) It is the intent of the Legislature in enacting this act to
maximize federal funds to provide critical preventive services to
Medi-Cal beneficiaries by amending state law to reflect the July 15,
2013, update to federal Medicaid regulations.
  SEC. 2.  Section 14132.04 is added to the Welfare and Institutions
Code, to read:
   14132.04.  (a) (1) The department shall reimburse Medi-Cal
providers for preventive services, as defined in Section 440.130(c)
of Title 42 of the Code of Federal Regulations, provided by a health
care practitioner not subject to professional licensure by the state,
including, but not limited to, a community health worker, that have
been recommended by a physician or other licensed practitioner of
healing arts acting within the scope of that physician's or
practitioner's license.
   (2) Medi-Cal managed care plans shall cover preventive services,
as defined in Section 440.130(c) of Title 42 of the Code of Federal
Regulations, provided by a health care practitioner not subject to
professional licensure by the state, including, but not limited to, a
community health worker, that have been recommended by a physician
or other licensed practitioner of healing arts acting within the
scope of that physician's or practitioner's license.
   (3) Coverage for preventive services pursuant to this section
shall be available only to the extent that federal financial
participation in the cost of providing these services is available.
   (b) By June 30, 2015, the department shall convene a working group
to determine the types of health care practitioners eligible to
provide preventive services pursuant to this section and the summary
of qualifications for those practitioners to be included in any state
plan amendment that may be necessary to implement this section. The
working group shall include representatives from consumer advocacy
groups, community health worker organizations, community clinics,
physicians' groups, and health plans. The summary of practitioner
qualifications shall reflect widely supported perspectives.