Amended in Senate August 15, 2016

Amended in Senate September 1, 2015

Amended in Senate June 15, 2015

Amended in Assembly April 16, 2015

California Legislature—2015–16 Regular Session

Assembly Bill No. 1114

Introduced by Assembly Member begin delete Bonilla end delete begin insert Eggman end insert

February 27, 2015

begin delete An act to amend Section 15926 of the Welfare and Institutions Code, relating to public health. end delete begin insert An act to add Section 14132.968 to the Welfare and Institutions Code, relating to health care, and declaring the urgency thereof, to take effect immediately. end insert

LEGISLATIVE COUNSEL’S DIGEST

AB 1114, as amended, begin delete Bonilla end delete   begin insert Eggman end insert . begin delete Health care: eligibility and enrollment. end delete begin insert Medi-Cal: pharmacist services. end insert

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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 for a schedule of benefits covered by the Medi-Cal program, including the purchase of prescribed drugs subject to the Medi-Cal list of contract drugs and utilization controls. Existing law requires a pharmacy provider under the Medi-Cal program to submit his or her usual and customary charge, as defined, when billing the Medi-Cal program for prescribed drugs. The Pharmacy Law specifies the functions a pharmacist is authorized to perform, including furnishing nicotine replacement products and administering immunizations, as specified.

end insert begin insert

This bill would add to the schedule of benefits pharmacist services, subject to department protocols and utilization controls. The bill would require pharmacist services to include only those services provided by a pharmacist consistent with the laws governing his or her scope of practice and would require the department to develop a list of pharmacist services. The bill would require the rate of reimbursement for pharmacist services to be at 85% of the fee schedule for physician services under the Medi-Cal program and would require the department to establish a fee schedule. The bill would authorize the department to implement these provisions by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions, without taking regulatory action, until regulations are adopted, and would require the department to adopt those regulations by July 1, 2021. Commencing July 1, 2017, the bill would require the department to provide a status report to the Legislature on a semiannual basis until regulations have been adopted. The bill would require these provisions to be implemented only to the extent that federal financial participation is available and the necessary federal approvals are obtained.

end insert begin insert

This bill would declare that it is to take effect immediately as an urgency statute.

end insert begin delete

Existing law establishes various programs to provide health care coverage to persons with limited financial resources, including the Medi-Cal program and the State’s Children’s Health Insurance Program. Existing law establishes the California Health Benefit Exchange (Exchange), pursuant to the federal Patient Protection and Affordable Care Act (PPACA), and specifies the duties and powers of the board governing the Exchange relative to determining eligibility for enrollment in the Exchange and arranging for coverage under qualified health plans, and facilitating the purchase of qualified health plans through the Exchange. Existing law, the Health Care Reform Eligibility, Enrollment, and Retention Planning Act, operative as provided, requires the California Health and Human Services Agency, in consultation with specified entities, to establish standardized single, accessible, application forms and related renewal procedures for state health subsidy programs, as defined, in accordance with specified requirements relating to the forms and notices developed for these purposes.

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This bill would define the terms “forms” and “notices” for these purposes as application and renewal forms and notices of action needed to obtain or retain eligibility, benefits, or services from an insurance affordability program.

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Vote:  begin delete majority end delete begin insert ²⁄₃ end insert . 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:

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begin insert SECTION 1. end insert   

end insert

begin insert Section 14132.968 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , end insert immediately following Section 14132.966 begin insert , to
read: end insert

begin insert

begin insert 14132.968. end insert   

(a) Pharmacist services are a benefit under the
Medi-Cal program, subject to approval by the federal Centers for
Medicare and Medicaid Services.

(b) The department shall develop a list of pharmacist services
that are reimbursable to an enrolled Medi-Cal pharmacy provider.

(1) The department shall establish a fee schedule for the list of
pharmacist services.

(2) The rate of reimbursement for pharmacist services shall be
at 85 percent of the fee schedule for physician services under the
Medi-Cal program.

(c) Covered pharmacist services provided to a Medi-Cal
beneficiary shall include only those services provided by a
pharmacist consistent with the laws governing his or her scope of
practice. Covered pharmacist services shall be subject to
department protocols and utilization controls.

(d) A pharmacist shall be enrolled as an ordering, referring,
and prescribing provider under the Medi-Cal program prior to
rendering a pharmacist service that is submitted by a Medi-Cal
pharmacy provider for reimbursement pursuant to this section.

(e) The director shall seek any necessary federal approvals to
implement this section. This section shall not be implemented until
the necessary federal approvals are obtained and shall be
implemented only to the extent that federal financial participation
is available.

(f) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department may implement, interpret, or make specific this
section, and any applicable federal waivers and state plan
amendments, by means of all-county letters, plan letters, plan or
provider bulletins, or similar instructions, without taking
regulatory action. By July 1, 2021, the department shall adopt
regulations in accordance with the requirements of Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title
2 of the Government Code. Commencing July 1, 2017, the
department shall provide a status report to the Legislature on a
semiannual basis, in compliance with Section 9795 of the
Government Code, until regulations have been adopted.

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begin insert

begin insert SEC. 2. end insert   

end insert begin insert

This act is an urgency statute necessary for the
immediate preservation of the public peace, health, or safety within
the meaning of Article IV of the Constitution and shall go into
immediate effect. The facts constituting the necessity are:

end insert begin insert

In order to make pharmacist services available as a benefit under
the Medi-Cal program at the earliest possible time, it is necessary
that this act take effect immediately.

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All matter omitted in this version of the bill appears in the bill as amended in the Senate, September 1, 2015. (JR11)