BILL NUMBER: AB 1114 AMENDED
BILL TEXT
AMENDED IN SENATE AUGUST 24, 2016
AMENDED IN SENATE AUGUST 15, 2016
AMENDED IN SENATE SEPTEMBER 1, 2015
AMENDED IN SENATE JUNE 15, 2015
AMENDED IN ASSEMBLY APRIL 16, 2015
INTRODUCED BY Assembly Member Eggman
FEBRUARY 27, 2015
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.
LEGISLATIVE COUNSEL'S DIGEST
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, as specified, 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.
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 1. Section 14132.968 is added to the Welfare and
Institutions Code, immediately following Section 14132.966, to read:
14132.968. (a) (1) 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)
(2) The department shall establish a fee schedule for
the list of pharmacist services.
(2)
(3) 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.
(b) (1) The following services are covered pharmacist services
that may be provided to a Medi-Cal beneficiary:
(A) Furnishing travel medications as authorized in clause (3) of
subparagraph (A) of paragraph (10) of subdivision (a) of Section 4052
of the Business and Professions Code.
(B) Furnishing naloxone hydrochloride as authorized in Section
4052.01 of the Business and Professions Code.
(C) Furnishing self-administered hormonal contraception, as
authorized in Section 4052.3 of the Business and Professions Code.
(D) Initiating and administering immunizations as authorized in
Section 4052.8 of the Business and Professions Code.
(E) Providing tobacco cessation counseling and furnishing nicotine
replacement therapy as authorized in Section 4052.9 of the Business
and Professions Code.
(2) Covered pharmacist services shall be subject to department
protocols and utilization controls.
(d)
(c) 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)
(d) (1) 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.
(2) This section does not restrict or prohibit any services
currently provided by pharmacists as authorized by law, including,
but not limited to, this chapter, or the Medicaid state plan.
(f)
(e) 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.
SEC. 2. 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:
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.