AB 1114, as amended, Eggman. Medi-Cal: pharmacist services.
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.
This
bill would add to the schedule of benefits pharmacist services,begin insert as specified,end insert subject to department protocols and utilization controls.begin delete 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.end delete 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.
This bill would declare that it is to take effect immediately as an urgency statute.
Vote: 2⁄3. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 14132.968 is added to the Welfare and
2Institutions Code, immediately following Section 14132.966, to
3read:
(a) begin insert(1)end insertbegin insert end insert Pharmacist services are a benefit under
5the Medi-Cal program, subject to approval by the federal Centers
6for Medicare and Medicaid Services.
7(b) The department shall develop a list of pharmacist services
8that are reimbursable to an enrolled Medi-Cal pharmacy provider.
9 9(1)
end delete
10begin insert(2)end insert The department shall establish a fee schedule for the list of
11pharmacist services.
11 12(2)
end delete
P3 1begin insert(3)end insert The rate of reimbursement for pharmacist services shall be
2at 85 percent of the fee schedule for physician services under the
3Medi-Cal program.
4(c) Covered pharmacist services provided to a
Medi-Cal
5beneficiary shall include only those services provided by a
6pharmacist consistent with the laws governing his or her scope of
7practice. Covered pharmacist services shall be subject to
8department protocols and utilization controls.
9
(b) (1) The following services are covered pharmacist services
10that may be provided to a Medi-Cal beneficiary:
11
(A) Furnishing travel medications as authorized in clause (3)
12of subparagraph (A) of paragraph (10) of subdivision (a) of Section
134052 of the Business and Professions Code.
14
(B) Furnishing naloxone hydrochloride as authorized in Section
154052.01 of the Business and Professions Code.
16
(C) Furnishing self-administered hormonal contraception, as
17authorized in Section 4052.3 of the Business and Professions Code.
18
(D) Initiating and administering immunizations as authorized
19in Section 4052.8 of the Business and Professions Code.
20
(E) Providing tobacco cessation counseling and furnishing
21nicotine replacement therapy as
authorized in Section 4052.9 of
22the Business and Professions Code.
23
(2) Covered pharmacist services shall be subject to department
24protocols and utilization controls.
19 25(d)
end delete
26begin insert(c)end insert A pharmacist shall be enrolled as an ordering, referring, and
27prescribing provider under the Medi-Cal program prior to rendering
28a pharmacist service that is submitted by a Medi-Cal pharmacy
29provider for reimbursement pursuant to this section.
23 30(e)
end delete
31begin insert(d)end insertbegin insert end insertbegin insert(1)end insert The director shall seek any necessary federal approvals
32to implement this section. This section shall not be implemented
33until the necessary federal approvals are obtained and shall be
34implemented only to the extent that federal financial participation
35is available.
36
(2) This section does not restrict or prohibit any services
37currently provided by pharmacists as authorized by law, including,
38but not limited to, this chapter, or the Medicaid state plan.
28 39(f)
end delete
P4 1begin insert(e)end insert Notwithstanding Chapter 3.5 (commencing with Section
211340) of Part 1 of Division 3 of Title 2 of the Government Code,
3the department may implement, interpret, or make specific this
4section, and any applicable federal waivers and state plan
5amendments, by means of all-county letters, plan letters, plan or
6provider bulletins, or similar instructions, without taking regulatory
7action. By July 1, 2021, the department shall adopt regulations in
8accordance with the requirements of Chapter 3.5 (commencing
9with Section 11340) of Part 1 of Division 3 of Title 2 of the
10Government Code. Commencing July 1, 2017, the department
11shall provide a status report to the Legislature on a semiannual
12basis, in compliance with Section 9795 of the Government Code,
13
until regulations have been adopted.
This act is an urgency statute necessary for the
15immediate preservation of the public peace, health, or safety within
16the meaning of Article IV of the Constitution and shall go into
17immediate effect. The facts constituting the necessity are:
18In order to make pharmacist services available as a benefit under
19the Medi-Cal program at the earliest possible time, it is necessary
20that this act take effect immediately.
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