California Legislature—2015–16 Regular Session

Assembly BillNo. 1231


Introduced by Assembly Member Wood

February 27, 2015


An act to amend Section 14132 of the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

AB 1231, as introduced, Wood. Medi-Cal: nonmedical transportation.

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 under the Medi-Cal program, which includes medical transportation services, subject to utilization controls.

This bill would add to the schedule of benefits nonmedical transportation, as defined, for a beneficiary to obtain covered specialty care Medi-Cal services, if those services are more than 60 minutes or 30 miles from the beneficiary’s place of residence.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

P1    1

SECTION 1.  

Section 14132 of the Welfare and Institutions
2Code
is amended to read:

3

14132.  

The following is the schedule of benefits under this
4chapter:

P2    1(a) Outpatient services are covered as follows:

2Physician, hospital or clinic outpatient, surgical center,
3respiratory care, optometric, chiropractic, psychology, podiatric,
4occupational therapy, physical therapy, speech therapy, audiology,
5acupuncture to the extent federal matching funds are provided for
6acupuncture, and services of persons rendering treatment by prayer
7or healing by spiritual means in the practice of any church or
8religious denomination insofar as these can be encompassed by
9federal participation under an approved plan, subject to utilization
10controls.

11(b) (1) Inpatient hospital services, including, but not limited
12to, physician and podiatric services, physical therapy and
13occupational therapy, are covered subject to utilization controls.

14(2) For Medi-Cal fee-for-service beneficiaries, emergency
15services and care that are necessary for the treatment of an
16emergency medical condition and medical care directly related to
17the emergency medical condition. This paragraph shall not be
18construed to change the obligation of Medi-Cal managed care
19plans to provide emergency services and care. For the purposes of
20this paragraph, “emergency services and care” and “emergency
21medical condition” shall have the same meanings as those terms
22are defined in Section 1317.1 of the Health and Safety Code.

23(c) Nursing facility services, subacute care services, and services
24provided by any category of intermediate care facility for the
25developmentally disabled, including podiatry, physician, nurse
26practitioner services, and prescribed drugs, as described in
27subdivision (d), are covered subject to utilization controls.
28Respiratory care, physical therapy, occupational therapy, speech
29therapy, and audiology services for patients in nursing facilities
30and any category of intermediate care facility for the
31developmentally disabled are covered subject to utilization controls.

32(d) (1) Purchase of prescribed drugs is covered subject to the
33Medi-Cal List of Contract Drugs and utilization controls.

34(2) Purchase of drugs used to treat erectile dysfunction or any
35off-label uses of those drugs are covered only to the extent that
36federal financial participation is available.

37(3) (A) To the extent required by federal law, the purchase of
38outpatient prescribed drugs, for which the prescription is executed
39by a prescriber in written, nonelectronic form on or after April 1,
402008, is covered only when executed on a tamper resistant
P3    1prescription form. The implementation of this paragraph shall
2conform to the guidance issued by the federal Centers for Medicare
3and Medicaid Services but shall not conflict with state statutes on
4the characteristics of tamper resistant prescriptions for controlled
5substances, including Section 11162.1 of the Health and Safety
6Code. The department shall provide providers and beneficiaries
7with as much flexibility in implementing these rules as allowed
8by the federal government. The department shall notify and consult
9with appropriate stakeholders in implementing, interpreting, or
10making specific this paragraph.

11(B) Notwithstanding Chapter 3.5 (commencing with Section
1211340) of Part 1 of Division 3 of Title 2 of the Government Code,
13the department may take the actions specified in subparagraph (A)
14by means of a provider bulletin or notice, policy letter, or other
15similar instructions without taking regulatory action.

16(4) (A) (i) For the purposes of this paragraph, nonlegend has
17the same meaning as defined in subdivision (a) of Section
1814105.45.

19(ii) Nonlegend acetaminophen-containing products, with the
20exception of children’s acetaminophen-containing products,
21selected by the department are not covered benefits.

22(iii) Nonlegend cough and cold products selected by the
23department are not covered benefits. This clause shall be
24implemented on the first day of the first calendar month following
2590 days after the effective date of the act that added this clause,
26or on the first day of the first calendar month following 60 days
27after the date the department secures all necessary federal approvals
28to implement this section, whichever is later.

29(iv) Beneficiaries under the Early and Periodic Screening,
30Diagnosis, and Treatment Program shall be exempt from clauses
31(ii) and (iii).

32(B) Notwithstanding Chapter 3.5 (commencing with Section
3311340) of Part 1 of Division 3 of Title 2 of the Government Code,
34the department may take the actions specified in subparagraph (A)
35by means of a provider bulletin or notice, policy letter, or other
36similar instruction without taking regulatory action.

37(e) Outpatient dialysis services and home hemodialysis services,
38including physician services, medical supplies, drugs and
39equipment required for dialysis, are covered, subject to utilization
40controls.

P4    1(f) Anesthesiologist services when provided as part of an
2outpatient medical procedure, nurse anesthetist services when
3rendered in an inpatient or outpatient setting under conditions set
4forth by the director, outpatient laboratory services, and X-ray
5services are covered, subject to utilization controls. Nothing in
6this subdivision shall be construed to require prior authorization
7for anesthesiologist services provided as part of an outpatient
8medical procedure or for portable X-ray services in a nursing
9facility or any category of intermediate care facility for the
10developmentally disabled.

11(g) Blood and blood derivatives are covered.

12(h) (1) Emergency and essential diagnostic and restorative
13dental services, except for orthodontic, fixed bridgework, and
14partial dentures that are not necessary for balance of a complete
15artificial denture, are covered, subject to utilization controls. The
16utilization controls shall allow emergency and essential diagnostic
17and restorative dental services and prostheses that are necessary
18to prevent a significant disability or to replace previously furnished
19prostheses which are lost or destroyed due to circumstances beyond
20the beneficiary’s control. Notwithstanding the foregoing, the
21director may by regulation provide for certain fixed artificial
22dentures necessary for obtaining employment or for medical
23conditions that preclude the use of removable dental prostheses,
24and for orthodontic services in cleft palate deformities administered
25by the department’s California Children Services Program.

26(2) For persons 21 years of age or older, the services specified
27in paragraph (1) shall be provided subject to the following
28conditions:

29(A) Periodontal treatment is not a benefit.

30(B) Endodontic therapy is not a benefit except for vital
31pulpotomy.

32(C) Laboratory processed crowns are not a benefit.

33(D) Removable prosthetics shall be a benefit only for patients
34as a requirement for employment.

35(E) The director may, by regulation, provide for the provision
36of fixed artificial dentures that are necessary for medical conditions
37that preclude the use of removable dental prostheses.

38(F) Notwithstanding the conditions specified in subparagraphs
39(A) to (E), inclusive, the department may approve services for
40persons with special medical disorders subject to utilization review.

P5    1(3) Paragraph (2) shall become inoperative July 1, 1995.

2(i) Medical transportation is covered, subject to utilization
3controls.

4(j) Home health care services are covered, subject to utilization
5controls.

6(k) Prosthetic and orthotic devices and eyeglasses are covered,
7subject to utilization controls. Utilization controls shall allow
8replacement of prosthetic and orthotic devices and eyeglasses
9necessary because of loss or destruction due to circumstances
10beyond the beneficiary’s control. Frame styles for eyeglasses
11replaced pursuant to this subdivision shall not change more than
12once every two years, unless the department so directs.

13Orthopedic and conventional shoes are covered when provided
14by a prosthetic and orthotic supplier on the prescription of a
15physician and when at least one of the shoes will be attached to a
16prosthesis or brace, subject to utilization controls. Modification
17of stock conventional or orthopedic shoes when medically
18indicated, is covered subject to utilization controls. When there is
19a clearly established medical need that cannot be satisfied by the
20modification of stock conventional or orthopedic shoes,
21custom-made orthopedic shoes are covered, subject to utilization
22controls.

23Therapeutic shoes and inserts are covered when provided to
24beneficiaries with a diagnosis of diabetes, subject to utilization
25controls, to the extent that federal financial participation is
26available.

27(l) Hearing aids are covered, subject to utilization controls.
28Utilization controls shall allow replacement of hearing aids
29necessary because of loss or destruction due to circumstances
30beyond the beneficiary’s control.

31(m) Durable medical equipment and medical supplies are
32covered, subject to utilization controls. The utilization controls
33shall allow the replacement of durable medical equipment and
34medical supplies when necessary because of loss or destruction
35due to circumstances beyond the beneficiary’s control. The
36utilization controls shall allow authorization of durable medical
37equipment needed to assist a disabled beneficiary in caring for a
38child for whom the disabled beneficiary is a parent, stepparent,
39foster parent, or legal guardian, subject to the availability of federal
40financial participation. The department shall adopt emergency
P6    1regulations to define and establish criteria for assistive durable
2medical equipment in accordance with the rulemaking provisions
3of the Administrative Procedure Act (Chapter 3.5 (commencing
4with Section 11340) of Part 1 of Division 3 of Title 2 of the
5Government Code).

6(n) Family planning services are covered, subject to utilization
7 controls. However, for Medi-Cal managed care plans, any
8utilization controls shall be subject to Section 1367.25 of the Health
9and Safety Code.

10(o) Inpatient intensive rehabilitation hospital services, including
11respiratory rehabilitation services, in a general acute care hospital
12are covered, subject to utilization controls, when either of the
13following criteria are met:

14(1) A patient with a permanent disability or severe impairment
15requires an inpatient intensive rehabilitation hospital program as
16described in Section 14064 to develop function beyond the limited
17amount that would occur in the normal course of recovery.

18(2) A patient with a chronic or progressive disease requires an
19inpatient intensive rehabilitation hospital program as described in
20Section 14064 to maintain the patient’s present functional level as
21 long as possible.

22(p) (1) Adult day health care is covered in accordance with
23Chapter 8.7 (commencing with Section 14520).

24(2) Commencing 30 days after the effective date of the act that
25added this paragraph, and notwithstanding the number of days
26previously approved through a treatment authorization request,
27adult day health care is covered for a maximum of three days per
28week.

29(3) As provided in accordance with paragraph (4), adult day
30health care is covered for a maximum of five days per week.

31(4) As of the date that the director makes the declaration
32described in subdivision (g) of Section 14525.1, paragraph (2)
33shall become inoperative and paragraph (3) shall become operative.

34(q) (1) Application of fluoride, or other appropriate fluoride
35treatment as defined by the department, and other prophylaxis
36treatment for children 17 years of age and under are covered.

37(2) All dental hygiene services provided by a registered dental
38hygienist, registered dental hygienist in extended functions, and
39registered dental hygienist in alternative practice licensed pursuant
40to Sections 1753, 1917, 1918, and 1922 of the Business and
P7    1Professions Code may be covered as long as they are within the
2scope of Denti-Cal benefits and they are necessary services
3provided by a registered dental hygienist, registered dental
4hygienist in extended functions, or registered dental hygienist in
5alternative practice.

6(r) (1) Paramedic services performed by a city, county, or
7special district, or pursuant to a contract with a city, county, or
8special district, and pursuant to a program established under Article
93 (commencing with Section 1480) of Chapter 2.5 of Division 2
10of the Health and Safety Code by a paramedic certified pursuant
11to that article, and consisting of defibrillation and those services
12specified in subdivision (3) of Section 1482 of the article.

13(2) All providers enrolled under this subdivision shall satisfy
14all applicable statutory and regulatory requirements for becoming
15a Medi-Cal provider.

16(3) This subdivision shall be implemented only to the extent
17funding is available under Section 14106.6.

18(s) In-home medical care services are covered when medically
19appropriate and subject to utilization controls, for beneficiaries
20who would otherwise require care for an extended period of time
21in an acute care hospital at a cost higher than in-home medical
22care services. The director shall have the authority under this
23section to contract with organizations qualified to provide in-home
24medical care services to those persons. These services may be
25provided to patients placed in shared or congregate living
26arrangements, if a home setting is not medically appropriate or
27available to the beneficiary. As used in this section, “in-home
28medical care service” includes utility bills directly attributable to
29continuous, 24-hour operation of life-sustaining medical equipment,
30to the extent that federal financial participation is available.

31As used in this subdivision, in-home medical care services
32include, but are not limited to:

33(1) Level-of-care and cost-of-care evaluations.

34(2) Expenses, directly attributable to home care activities, for
35materials.

36(3) Physician fees for home visits.

37(4) Expenses directly attributable to home care activities for
38shelter and modification to shelter.

39(5) Expenses directly attributable to additional costs of special
40diets, including tube feeding.

P8    1(6) Medically related personal services.

2(7) Home nursing education.

3(8) Emergency maintenance repair.

4(9) Home health agency personnel benefits which permit
5coverage of care during periods when regular personnel are on
6vacation or using sick leave.

7(10) All services needed to maintain antiseptic conditions at
8stoma or shunt sites on the body.

9(11) Emergency and nonemergency medical transportation.

10(12) Medical supplies.

11(13) Medical equipment, including, but not limited to, scales,
12gurneys, and equipment racks suitable for paralyzed patients.

13(14) Utility use directly attributable to the requirements of home
14care activities which are in addition to normal utility use.

15(15) Special drugs and medications.

16(16) Home health agency supervision of visiting staff which is
17medically necessary, but not included in the home health agency
18rate.

19(17) Therapy services.

20(18) Household appliances and household utensil costs directly
21attributable to home care activities.

22(19) Modification of medical equipment for home use.

23(20) Training and orientation for use of life-support systems,
24including, but not limited to, support of respiratory functions.

25(21) Respiratory care practitioner services as defined in Sections
263702 and 3703 of the Business and Professions Code, subject to
27prescription by a physician and surgeon.

28Beneficiaries receiving in-home medical care services are entitled
29to the full range of services within the Medi-Cal scope of benefits
30as defined by this section, subject to medical necessity and
31applicable utilization control. Services provided pursuant to this
32subdivision, which are not otherwise included in the Medi-Cal
33schedule of benefits, shall be available only to the extent that
34federal financial participation for these services is available in
35accordance with a home- and community-based services waiver.

36(t) Home- and community-based services approved by the
37United States Department of Health and Human Services are
38covered to the extent that federal financial participation is available
39for those services under the state plan or waivers granted in
40accordance with Section 1315 or 1396n of Title 42 of the United
P9    1States Code. The director may seek waivers for any or all home-
2and community-based services approvable under Section 1315 or
31396n of Title 42 of the United States Code. Coverage for those
4services shall be limited by the terms, conditions, and duration of
5the federal waivers.

6(u) Comprehensive perinatal services, as provided through an
7agreement with a health care provider designated in Section
814134.5 and meeting the standards developed by the department
9pursuant to Section 14134.5, subject to utilization controls.

10The department shall seek any federal waivers necessary to
11implement the provisions of this subdivision. The provisions for
12which appropriate federal waivers cannot be obtained shall not be
13implemented. Provisions for which waivers are obtained or for
14which waivers are not required shall be implemented
15notwithstanding any inability to obtain federal waivers for the
16other provisions. No provision of this subdivision shall be
17implemented unless matching funds from Subchapter XIX
18(commencing with Section 1396) of Chapter 7 of Title 42 of the
19United States Code are available.

20(v) Early and periodic screening, diagnosis, and treatment for
21any individual under 21 years of age is covered, consistent with
22the requirements of Subchapter XIX (commencing with Section
231396) of Chapter 7 of Title 42 of the United States Code.

24(w) Hospice service which is Medicare-certified hospice service
25is covered, subject to utilization controls. Coverage shall be
26available only to the extent that no additional net program costs
27are incurred.

28(x) When a claim for treatment provided to a beneficiary
29includes both services which are authorized and reimbursable
30under this chapter, and services which are not reimbursable under
31this chapter, that portion of the claim for the treatment and services
32authorized and reimbursable under this chapter shall be payable.

33(y) Home- and community-based services approved by the
34United States Department of Health and Human Services for
35beneficiaries with a diagnosis of AIDS or ARC, who require
36intermediate care or a higher level of care.

37Services provided pursuant to a waiver obtained from the
38Secretary of the United States Department of Health and Human
39Services pursuant to this subdivision, and which are not otherwise
40included in the Medi-Cal schedule of benefits, shall be available
P10   1only to the extent that federal financial participation for these
2services is available in accordance with the waiver, and subject to
3the terms, conditions, and duration of the waiver. These services
4shall be provided to individual beneficiaries in accordance with
5the client’s needs as identified in the plan of care, and subject to
6medical necessity and applicable utilization control.

7The director may under this section contract with organizations
8qualified to provide, directly or by subcontract, services provided
9for in this subdivision to eligible beneficiaries. Contracts or
10agreements entered into pursuant to this division shall not be
11subject to the Public Contract Code.

12(z) Respiratory care when provided in organized health care
13systems as defined in Section 3701 of the Business and Professions
14Code, and as an in-home medical service as outlined in subdivision
15(s).

16(aa) (1) There is hereby established in the department, a
17program to provide comprehensive clinical family planning
18services to any person who has a family income at or below 200
19percent of the federal poverty level, as revised annually, and who
20is eligible to receive these services pursuant to the waiver identified
21in paragraph (2). This program shall be known as the Family
22Planning, Access, Care, and Treatment (Family PACT) Program.

23(2) The department shall seek a waiver in accordance with
24Section 1315 of Title 42 of the United States Code, or a state plan
25amendment adopted in accordance with Section
261396a(a)(10)(A)(ii)(XXI) of Title 42 of the United States Code,
27which was added to Section 1396a of Title 42 of the United States
28Code by Section 2303(a)(2) of the federal Patient Protection and
29Affordable Care Act (PPACA) (Public Law 111-148), for a
30program to provide comprehensive clinical family planning
31services as described in paragraph (8). Under the waiver, the
32program shall be operated only in accordance with the waiver and
33the statutes and regulations in paragraph (4) and subject to the
34terms, conditions, and duration of the waiver. Under the state plan
35amendment, which shall replace the waiver and shall be known as
36the Family PACT successor state plan amendment, the program
37shall be operated only in accordance with this subdivision and the
38statutes and regulations in paragraph (4). The state shall use the
39standards and processes imposed by the state on January 1, 2007,
40including the application of an eligibility discount factor to the
P11   1extent required by the federal Centers for Medicare and Medicaid
2Services, for purposes of determining eligibility as permitted under
3Section 1396a(a)(10)(A)(ii)(XXI) of Title 42 of the United States
4Code. To the extent that federal financial participation is available,
5the program shall continue to conduct education, outreach,
6enrollment, service delivery, and evaluation services as specified
7under the waiver. The services shall be provided under the program
8only if the waiver and, when applicable, the successor state plan
9amendment are approved by the federal Centers for Medicare and
10Medicaid Services and only to the extent that federal financial
11participation is available for the services. Nothing in this section
12shall prohibit the department from seeking the Family PACT
13successor state plan amendment during the operation of the waiver.

14(3) Solely for the purposes of the waiver or Family PACT
15successor state plan amendment and notwithstanding any other
16provision of law, the collection and use of an individual’s social
17security number shall be necessary only to the extent required by
18federal law.

19(4) Sections 14105.3 to 14105.39, inclusive, 14107.11, 24005,
20and 24013, and any regulations adopted under these statutes shall
21apply to the program provided for under this subdivision. No other
22provision of law under the Medi-Cal program or the State-Only
23Family Planning Program shall apply to the program provided for
24under this subdivision.

25(5) Notwithstanding Chapter 3.5 (commencing with Section
2611340) of Part 1 of Division 3 of Title 2 of the Government Code,
27the department may implement, without taking regulatory action,
28the provisions of the waiver after its approval by the federal Health
29Care Financing Administration and the provisions of this section
30by means of an all-county letter or similar instruction to providers.
31Thereafter, the department shall adopt regulations to implement
32this section and the approved waiver in accordance with the
33requirements of Chapter 3.5 (commencing with Section 11340) of
34Part 1 of Division 3 of Title 2 of the Government Code. Beginning
35six months after the effective date of the act adding this
36subdivision, the department shall provide a status report to the
37Legislature on a semiannual basis until regulations have been
38adopted.

39(6) In the event that the Department of Finance determines that
40the program operated under the authority of the waiver described
P12   1in paragraph (2) or the Family PACT successor state plan
2amendment is no longer cost effective, this subdivision shall
3become inoperative on the first day of the first month following
4the issuance of a 30-day notification of that determination in
5writing by the Department of Finance to the chairperson in each
6house that considers appropriations, the chairpersons of the
7committees, and the appropriate subcommittees in each house that
8considers the State Budget, and the Chairperson of the Joint
9Legislative Budget Committee.

10(7) If this subdivision ceases to be operative, all persons who
11have received or are eligible to receive comprehensive clinical
12family planning services pursuant to the waiver described in
13paragraph (2) shall receive family planning services under the
14Medi-Cal program pursuant to subdivision (n) if they are otherwise
15eligible for Medi-Cal with no share of cost, or shall receive
16comprehensive clinical family planning services under the program
17established in Division 24 (commencing with Section 24000) either
18if they are eligible for Medi-Cal with a share of cost or if they are
19otherwise eligible under Section 24003.

20(8) For purposes of this subdivision, “comprehensive clinical
21family planning services” means the process of establishing
22objectives for the number and spacing of children, and selecting
23the means by which those objectives may be achieved. These
24means include a broad range of acceptable and effective methods
25and services to limit or enhance fertility, including contraceptive
26methods, federal Food and Drug Administration approved
27contraceptive drugs, devices, and supplies, natural family planning,
28abstinence methods, and basic, limited fertility management.
29Comprehensive clinical family planning services include, but are
30not limited to, preconception counseling, maternal and fetal health
31counseling, general reproductive health care, including diagnosis
32and treatment of infections and conditions, including cancer, that
33threaten reproductive capability, medical family planning treatment
34and procedures, including supplies and followup, and
35informational, counseling, and educational services.
36 Comprehensive clinical family planning services shall not include
37abortion, pregnancy testing solely for the purposes of referral for
38abortion or services ancillary to abortions, or pregnancy care that
39is not incident to the diagnosis of pregnancy. Comprehensive
P13   1clinical family planning services shall be subject to utilization
2control and include all of the following:

3(A) Family planning related services and male and female
4sterilization. Family planning services for men and women shall
5include emergency services and services for complications directly
6related to the contraceptive method, federal Food and Drug
7Administration approved contraceptive drugs, devices, and
8supplies, and followup, consultation, and referral services, as
9indicated, which may require treatment authorization requests.

10(B) All United States Department of Agriculture, federal Food
11and Drug Administration approved contraceptive drugs, devices,
12and supplies that are in keeping with current standards of practice
13and from which the individual may choose.

14(C) Culturally and linguistically appropriate health education
15and counseling services, including informed consent, that include
16all of the following:

17(i) Psychosocial and medical aspects of contraception.

18(ii) Sexuality.

19(iii) Fertility.

20(iv) Pregnancy.

21(v) Parenthood.

22(vi) Infertility.

23(vii) Reproductive health care.

24(viii) Preconception and nutrition counseling.

25(ix) Prevention and treatment of sexually transmitted infection.

26(x) Use of contraceptive methods, federal Food and Drug
27Administration approved contraceptive drugs, devices, and
28supplies.

29(xi) Possible contraceptive consequences and followup.

30(xii) Interpersonal communication and negotiation of
31relationships to assist individuals and couples in effective
32contraceptive method use and planning families.

33(D) A comprehensive health history, updated at the next periodic
34visit (between 11 and 24 months after initial examination) that
35includes a complete obstetrical history, gynecological history,
36contraceptive history, personal medical history, health risk factors,
37and family health history, including genetic or hereditary
38conditions.

39(E) A complete physical examination on initial and subsequent
40periodic visits.

P14   1(F) Services, drugs, devices, and supplies deemed by the federal
2Centers for Medicare and Medicaid Services to be appropriate for
3inclusion in the program.

4(9) In order to maximize the availability of federal financial
5participation under this subdivision, the director shall have the
6discretion to implement the Family PACT successor state plan
7amendment retroactively to July 1, 2010.

8(ab) (1) Purchase of prescribed enteral nutrition products is
9covered, subject to the Medi-Cal list of enteral nutrition products
10and utilization controls.

11(2) Purchase of enteral nutrition products is limited to those
12products to be administered through a feeding tube, including, but
13not limited to, a gastric, nasogastric, or jejunostomy tube.
14Beneficiaries under the Early and Periodic Screening, Diagnosis,
15and Treatment Program shall be exempt from this paragraph.

16(3) Notwithstanding paragraph (2), the department may deem
17an enteral nutrition product, not administered through a feeding
18tube, including, but not limited to, a gastric, nasogastric, or
19jejunostomy tube, a benefit for patients with diagnoses, including,
20but not limited to, malabsorption and inborn errors of metabolism,
21if the product has been shown to be neither investigational nor
22experimental when used as part of a therapeutic regimen to prevent
23serious disability or death.

24(4) Notwithstanding Chapter 3.5 (commencing with Section
2511340) of Part 1 of Division 3 of Title 2 of the Government Code,
26the department may implement the amendments to this subdivision
27made by the act that added this paragraph by means of all-county
28letters, provider bulletins, or similar instructions, without taking
29regulatory action.

30(5) The amendments made to this subdivision by the act that
31added this paragraph shall be implemented June 1, 2011, or on the
32first day of the first calendar month following 60 days after the
33date the department secures all necessary federal approvals to
34implement this section, whichever is later.

35(ac) Diabetic testing supplies are covered when provided by a
36pharmacy, subject to utilization controls.

begin insert

37(ad) (1) Nonmedical transportation is covered for a beneficiary
38to obtain covered specialty care Medi-Cal services, if those services
39are more than 60 minutes or 30 miles from the beneficiary’s place
40of residence.

end insert
begin insert

P15   1(2) “Nonmedical transportation” means roundtrip
2transportation for a beneficiary to obtain covered specialty care
3Medi-Cal services by passenger car, taxicab, or any other form
4of public or private conveyance. Nonmedical transportation does
5not include the transportation of sick, injured, invalid,
6convalescent, infirm, or otherwise incapacitated beneficiaries by
7ambulances, litter vans, or wheelchair vans licensed, operated
8and equipped in accordance with state and local statutes,
9ordinances or regulations. Nonmedical transportation includes,
10but is not limited to, mileage reimbursement for conveyance by
11private vehicle, bus passes, taxi vouchers, or train tickets.

end insert
begin insert

12(3) Nonmedical transportation shall be provided in a form and
13manner that is the most beneficial and accessible, in terms of
14physical and geographic accessibility, for the beneficiary.

end insert
begin insert

15(4) The department may seek approval of any necessary state
16plan amendments to implement this subdivision.

end insert
begin insert

17(5) This subdivision shall be implemented only to the extent that
18federal financial participation is available and any necessary
19federal approvals have been obtained.

end insert


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