BILL NUMBER: AB 1114 CHAPTERED
BILL TEXT
CHAPTER 602
FILED WITH SECRETARY OF STATE SEPTEMBER 25, 2016
APPROVED BY GOVERNOR SEPTEMBER 25, 2016
PASSED THE SENATE AUGUST 25, 2016
PASSED THE ASSEMBLY AUGUST 31, 2016
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, 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 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.
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.
(2) The department shall establish a fee schedule for the list of
pharmacist services.
(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.
(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.
(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.
(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.
(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.