AB 1231, as amended, 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. The bill would specify that these provisions shall not be interpreted to add a new benefit to the Medi-Cal program.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 14132 of the Welfare and Institutions
2Code is amended to read:
The following is the schedule of benefits under this
5(a) Outpatient services are covered as follows:
6Physician, hospital or clinic outpatient, surgical center,
7respiratory care, optometric, chiropractic, psychology, podiatric,
8occupational therapy, physical therapy, speech therapy, audiology,
9acupuncture to the extent federal matching funds are provided for
10acupuncture, and services of persons rendering treatment by prayer
11or healing by spiritual means in the practice of any church or
12religious denomination insofar as these can be encompassed by
13federal participation under an approved plan, subject to utilization
15(b) (1) Inpatient hospital services, including, but not limited
16to, physician and podiatric services, physical therapy and
17occupational therapy, are covered subject to utilization controls.
18(2) For Medi-Cal fee-for-service beneficiaries, emergency
19services and care that are necessary for the treatment of an
20emergency medical condition and medical care directly related to
21the emergency medical condition. This paragraph shall not be
22construed to change the obligation of Medi-Cal managed care
23plans to provide emergency services and care. For the purposes of
24this paragraph, “emergency services and care” and “emergency
25medical condition” shall have the same meanings as those terms
26are defined in Section 1317.1 of the Health and Safety Code.
27(c) Nursing facility services, subacute care services, and services
28provided by any category of intermediate care facility for the
29developmentally disabled, including podiatry, physician, nurse
30practitioner services, and prescribed drugs, as described in
31subdivision (d), are covered subject to utilization controls.
32Respiratory care, physical therapy, occupational therapy, speech
33therapy, and audiology services for patients in nursing facilities
34and any category of intermediate care facility for the
35developmentally disabled are covered subject to utilization controls.
P3 1(d) (1) Purchase of prescribed drugs is covered subject to the
2Medi-Cal List of Contract Drugs and utilization controls.
of drugs used to treat erectile dysfunction or any
4off-label uses of those drugs are covered only to the extent that
5federal financial participation is available.
6(3) (A) To the extent required by federal law, the purchase of
7outpatient prescribed drugs, for which the prescription is executed
8by a prescriber in written, nonelectronic form on or after April 1,
92008, is covered only when executed on a tamper resistant
10prescription form. The implementation of this paragraph shall
11conform to the guidance issued by the federal Centers for Medicare
12and Medicaid Services but shall not conflict with state statutes on
13the characteristics of tamper resistant prescriptions for controlled
14substances, including Section 11162.1 of the Health and Safety
15Code. The department shall provide providers and beneficiaries
16with as much flexibility in implementing these rules as allowed
17by the federal government. The department shall notify and consult
18with appropriate stakeholders in implementing, interpreting, or
19making specific this paragraph.
20(B) Notwithstanding Chapter 3.5 (commencing with Section
2111340) of Part 1 of Division 3 of Title 2 of the Government Code,
22the department may take the actions specified in subparagraph (A)
23by means of a provider bulletin or notice, policy letter, or other
24similar instructions without taking regulatory action.
25(4) (A) (i) For the purposes of this paragraph, nonlegend has
26the same meaning as defined in subdivision (a) of Section
28(ii) Nonlegend acetaminophen-containing
products, with the
29exception of children’s acetaminophen-containing products,
30selected by the department are not covered benefits.
31(iii) Nonlegend cough and cold products selected by the
32department are not covered benefits. This clause shall be
33implemented on the first day of the first calendar month following
3490 days after the effective date of the act that added this clause,
35or on the first day of the first calendar month following 60 days
36after the date the department secures all necessary federal approvals
37to implement this section, whichever is later.
38(iv) Beneficiaries under the Early and Periodic Screening,
39Diagnosis, and Treatment Program shall be exempt from clauses
40(ii) and (iii).
P4 1(B) Notwithstanding
Chapter 3.5 (commencing with Section
211340) of Part 1 of Division 3 of Title 2 of the Government Code,
3the department may take the actions specified in subparagraph (A)
4by means of a provider bulletin or notice, policy letter, or other
5similar instruction without taking regulatory action.
6(e) Outpatient dialysis services and home hemodialysis services,
7including physician services, medical supplies, drugs and
8equipment required for dialysis, are covered, subject to utilization
10(f) Anesthesiologist services when provided as part of an
11outpatient medical procedure, nurse anesthetist services when
12rendered in an inpatient or outpatient setting under conditions set
13forth by the director, outpatient laboratory services, and X-ray
14services are covered, subject to utilization controls. Nothing in
15this subdivision shall be construed to require prior authorization
16for anesthesiologist services provided as part of an outpatient
17medical procedure or for portable X-ray services in a nursing
18facility or any category of intermediate care facility for the
20(g) Blood and blood derivatives are covered.
21(h) (1) Emergency and essential diagnostic and restorative
22dental services, except for orthodontic, fixed bridgework, and
23partial dentures that are not necessary for balance of a complete
24artificial denture, are covered, subject to utilization controls. The
25utilization controls shall allow emergency and essential diagnostic
26and restorative dental services and prostheses that are necessary
27to prevent a significant disability or to replace previously furnished
28prostheses that are lost or destroyed due to circumstances beyond
29the beneficiary’s control. Notwithstanding the foregoing, the
30director may by regulation provide for certain fixed artificial
31dentures necessary for obtaining employment or for medical
32conditions that preclude the use of removable dental prostheses,
33and for orthodontic services in cleft palate deformities administered
34by the department’s California Children Services Program.
35(2) For persons 21 years of age or older, the services specified
36in paragraph (1) shall be provided subject to the following
38(A) Periodontal treatment is not a benefit.
39(B) Endodontic therapy is not a benefit except for vital
P5 1(C) Laboratory processed crowns are not a benefit.
2(D) Removable prosthetics shall be a benefit only for patients
3as a requirement for employment.
4(E) The director may, by regulation, provide for the provision
5of fixed artificial dentures that are necessary for medical conditions
6that preclude the use of removable dental prostheses.
7(F) Notwithstanding the conditions specified in subparagraphs
8(A) to (E), inclusive, the department may approve services for
9persons with special medical disorders subject to utilization review.
10(3) Paragraph (2) shall become inoperative July 1, 1995.
11(i) Medical transportation is covered, subject to utilization
13(j) Home health care services are covered, subject to utilization
15(k) Prosthetic and orthotic devices and eyeglasses are covered,
16subject to utilization controls. Utilization controls shall allow
17replacement of prosthetic and orthotic devices and eyeglasses
18necessary because of loss or destruction due to circumstances
19beyond the beneficiary’s control. Frame styles for eyeglasses
20replaced pursuant to this subdivision shall not change more than
21once every two years, unless the department so directs.
22Orthopedic and conventional shoes are covered when provided
23by a prosthetic and orthotic supplier on the prescription of a
24physician and when at least one of the shoes will be attached to a
25prosthesis or brace, subject to utilization controls. Modification
26of stock conventional or orthopedic shoes when medically
27indicated, is covered subject to utilization controls. When there is
28a clearly established medical need that cannot be satisfied by the
29modification of stock conventional or orthopedic shoes,
30custom-made orthopedic shoes are covered, subject to utilization
32Therapeutic shoes and inserts are covered when provided to
33beneficiaries with a diagnosis of diabetes, subject to utilization
34controls, to the extent that federal financial participation is
36(l) Hearing aids are covered, subject to utilization controls.
37Utilization controls shall allow replacement of hearing aids
38necessary because of loss or destruction due to circumstances
39beyond the beneficiary’s control.
P6 1(m) Durable medical equipment and medical supplies are
2covered, subject to utilization controls. The utilization controls
3shall allow the replacement of durable medical equipment and
4medical supplies when necessary because of loss or destruction
5due to circumstances beyond the beneficiary’s control. The
6utilization controls shall allow authorization of durable medical
7equipment needed to assist a disabled beneficiary in caring for a
8child for whom the disabled beneficiary is a parent, stepparent,
9foster parent, or legal guardian, subject to the availability of federal
10financial participation. The department shall adopt emergency
11regulations to define and establish criteria for assistive durable
12medical equipment in accordance with the rulemaking provisions
13of the Administrative Procedure Act (Chapter 3.5 (commencing
14with Section 11340) of Part 1 of Division 3 of Title 2 of the
16(n) Family planning services are covered, subject to utilization
17 controls. However, for Medi-Cal managed care plans, any
18utilization controls shall be subject to Section 1367.25 of the Health
19and Safety Code.
20(o) Inpatient intensive rehabilitation hospital services, including
21respiratory rehabilitation services, in a general acute care hospital
22are covered, subject to utilization controls, when either of the
23following criteria are met:
24(1) A patient with a permanent disability or severe impairment
25requires an inpatient intensive rehabilitation hospital program as
26described in Section 14064 to develop function beyond the limited
27amount that would occur in the normal course of recovery.
28(2) A patient with a chronic or progressive disease requires an
29inpatient intensive rehabilitation hospital program as described in
30Section 14064 to maintain the patient’s present functional level as
31 long as possible.
32(p) (1) Adult day health care is covered in accordance with
33Chapter 8.7 (commencing with Section 14520).
34(2) Commencing 30 days after the effective date of the act that
35added this paragraph, and notwithstanding the number of days
36previously approved through a treatment authorization request,
37adult day health care is covered for a maximum of three days per
39(3) As provided in accordance with paragraph (4), adult day
40health care is covered for a maximum of five days per week.
P7 1(4) As of the date that the director makes the declaration
2described in subdivision (g) of Section 14525.1, paragraph (2)
3shall become inoperative and paragraph (3) shall become operative.
4(q) (1) Application of fluoride, or other appropriate fluoride
5treatment as defined by the department, and other prophylaxis
6treatment for children 17 years of age and under are covered.
7(2) All dental hygiene services provided by a registered dental
8hygienist, registered dental hygienist in extended functions, and
9registered dental hygienist in alternative practice licensed pursuant
10to Sections 1753, 1917, 1918, and 1922 of the Business and
11Professions Code may be covered as long as they are within the
12scope of Denti-Cal benefits and they are necessary services
13provided by a registered dental hygienist, registered dental
14hygienist in extended functions, or registered dental hygienist in
16(r) (1) Paramedic services performed by a city, county, or
17special district, or pursuant to a contract with a city, county, or
18special district, and pursuant to a program established under former
19Article 3 (commencing with Section 1480) of Chapter 2.5 of
20Division 2 of the Health and Safety Code by a paramedic certified
21pursuant to that article, and consisting of defibrillation and those
22services specified in subdivision (3) of former Section 1482 of the
24(2) All providers enrolled under this subdivision shall satisfy
25all applicable statutory and regulatory requirements for becoming
26a Medi-Cal provider.
27(3) This subdivision shall be implemented only to the extent
28funding is available under Section 14106.6.
29(s) In-home medical care services are covered when medically
30appropriate and subject to utilization controls, for beneficiaries
31who would otherwise require care for an extended period of time
32in an acute care hospital at a cost higher than in-home medical
33care services. The director shall have the authority under this
34section to contract with organizations qualified to provide in-home
35medical care services to those persons. These services may be
36provided to patients placed in shared or congregate living
37arrangements, if a home setting is not medically appropriate or
38available to the beneficiary. As used in this section, “in-home
39medical care service” includes utility bills directly attributable to
P8 1continuous, 24-hour operation of life-sustaining medical equipment,
2to the extent that federal financial participation is available.
3As used in this subdivision, in-home medical care services
4include, but are not limited to:
5(1) Level-of-care and cost-of-care evaluations.
6(2) Expenses, directly attributable to home care activities, for
8(3) Physician fees for home visits.
9(4) Expenses directly attributable to home care activities for
10shelter and modification to shelter.
11(5) Expenses directly attributable to additional costs of special
12diets, including tube feeding.
13(6) Medically related personal services.
14(7) Home nursing education.
15(8) Emergency maintenance repair.
16(9) Home health agency personnel benefits that permit coverage
17of care during periods when regular personnel are on vacation or
18using sick leave.
19(10) All services needed to maintain antiseptic conditions at
20stoma or shunt sites on the body.
21(11) Emergency and nonemergency medical transportation.
22(12) Medical supplies.
23(13) Medical equipment, including, but not limited to, scales,
24gurneys, and equipment racks suitable for paralyzed patients.
25(14) Utility use directly attributable to the requirements of home
26care activities that are in addition to normal utility use.
27(15) Special drugs and medications.
28(16) Home health agency supervision of visiting staff that is
29medically necessary, but not included in the home health agency
31(17) Therapy services.
32(18) Household appliances and household utensil costs directly
33attributable to home care activities.
34(19) Modification of medical equipment for home use.
35(20) Training and orientation for use of life-support systems,
36including, but not limited to, support of respiratory functions.
37(21) Respiratory care practitioner services as defined in Sections
383702 and 3703 of the Business and Professions Code, subject to
39prescription by a physician and surgeon.
P9 1Beneficiaries receiving in-home medical care services are entitled
2to the full range of services within the Medi-Cal scope of benefits
3as defined by this section, subject to medical necessity and
4applicable utilization control. Services provided pursuant to this
5subdivision, which are not otherwise included in the Medi-Cal
6schedule of benefits, shall be available only to the extent that
7federal financial participation for these services is available in
8accordance with a home- and community-based services waiver.
9(t) Home- and community-based services approved by the
10United States Department of Health and Human Services are
11covered to the extent that federal financial participation is available
12for those services under the state plan or waivers granted in
13accordance with Section 1315 or 1396n of Title 42 of the United
14States Code. The director may seek waivers for any or all home-
15and community-based services approvable under Section 1315 or
161396n of Title 42 of the United States Code. Coverage for those
17services shall be limited by the terms, conditions, and duration of
18the federal waivers.
19(u) Comprehensive perinatal services, as provided through an
20agreement with a health care provider designated in Section
2114134.5 and meeting the standards developed by the department
22pursuant to Section 14134.5, subject to utilization controls.
23The department shall seek any federal waivers necessary to
24implement the provisions of this subdivision. The provisions for
25which appropriate federal waivers cannot be obtained shall not be
26implemented. Provisions for which waivers are obtained or for
27which waivers are not required shall be implemented
28notwithstanding any inability to obtain federal waivers for the
29other provisions. No provision of this subdivision shall be
30implemented unless matching funds from Subchapter XIX
31(commencing with Section 1396) of Chapter 7 of Title 42 of the
32United States Code are available.
33(v) Early and periodic screening, diagnosis, and treatment for
34any individual under 21 years of age is covered, consistent with
35the requirements of Subchapter XIX (commencing with Section
361396) of Chapter 7 of Title 42 of the United States Code.
37(w) Hospice service that is Medicare-certified hospice service
38is covered, subject to utilization controls. Coverage shall be
39available only to the extent that no additional net program costs
P10 1(x) When a claim for treatment provided to a beneficiary
2includes both services that are authorized and reimbursable under
3this chapter, and services that are not reimbursable under this
4chapter, that portion of the claim for the treatment and services
5authorized and reimbursable under this chapter shall be payable.
6(y) Home- and community-based services approved by the
7United States Department of Health and Human Services for
8beneficiaries with a diagnosis of AIDS or ARC, who require
9intermediate care or a higher level of care.
10Services provided pursuant to a waiver obtained from the
11Secretary of the United States Department of Health and Human
12Services pursuant to this subdivision, and which are not otherwise
13included in the Medi-Cal schedule of benefits, shall be available
14only to the extent that federal financial participation for these
15services is available in accordance with the waiver, and subject to
16the terms, conditions, and duration of the waiver. These services
17shall be provided to individual beneficiaries in accordance with
18the client’s needs as identified in the plan of care, and subject to
19medical necessity and applicable utilization control.
20The director may under this section contract with
21qualified to provide, directly or by subcontract, services provided
22for in this subdivision to eligible beneficiaries. Contracts or
23agreements entered into pursuant to this division shall not be
24subject to the Public Contract Code.
25(z) Respiratory care when provided in organized health care
26systems as defined in Section 3701 of the Business and Professions
27Code, and as an in-home medical service as outlined in subdivision
29(aa) (1) There is hereby established in the department, a
30program to provide comprehensive clinical family planning
31services to any person who has a family income at or below 200
32percent of the federal poverty level, as revised annually, and who
33is eligible to receive these services pursuant to the waiver identified
34in paragraph (2). This program shall be known as the Family
35Planning, Access, Care, and Treatment (Family PACT) Program.
36(2) The department shall seek a waiver in accordance with
37Section 1315 of Title 42 of the United States Code, or a state plan
38amendment adopted in accordance with Section
391396a(a)(10)(A)(ii)(XXI) of Title 42 of the United States Code,
40which was added to Section 1396a of Title 42 of the United States
P11 1Code by Section 2303(a)(2) of the federal Patient Protection and
2Affordable Care Act (PPACA) (Public Law 111-148), for a
3program to provide comprehensive clinical family planning
4services as described in paragraph (8). Under the waiver, the
5program shall be operated only in accordance with the waiver and
6the statutes and regulations in paragraph (4) and subject to the
7terms, conditions, and duration of the waiver. Under the state plan
8amendment, which shall replace the waiver and shall be known as
9the Family PACT successor state plan amendment, the program
10shall be operated only in accordance with this subdivision and the
11statutes and regulations in paragraph (4). The state shall use the
12standards and processes imposed by the state on January 1, 2007,
13including the application of an eligibility discount factor to the
14extent required by the federal Centers for Medicare and Medicaid
15Services, for purposes of determining eligibility as permitted under
16Section 1396a(a)(10)(A)(ii)(XXI) of Title 42 of the United States
17Code. To the extent that federal financial participation is available,
18the program shall continue to conduct education, outreach,
19enrollment, service delivery, and evaluation services as specified
20under the waiver. The services shall be provided under the program
21only if the waiver and, when applicable, the successor state plan
22amendment are approved by the federal Centers for Medicare and
23Medicaid Services and only to the extent that federal financial
24participation is available for the services. Nothing in this section
25shall prohibit the department from seeking the Family PACT
26successor state plan amendment during the operation of the waiver.
27(3) Solely for the purposes of the waiver or Family PACT
28successor state plan amendment and notwithstanding any other
29law, the collection and use of an individual’s social security number
30shall be necessary only to the extent required by federal law.
31(4) Sections 14105.3 to 14105.39, inclusive, 14107.11, 24005,
32and 24013, and any regulations adopted under these statutes shall
33apply to the program provided for under this subdivision. No other
34provision of law under the Medi-Cal program or the State-Only
35Family Planning Program shall apply to the program provided for
36under this subdivision.
37(5) Notwithstanding Chapter 3.5 (commencing with Section
3811340) of Part 1 of Division 3 of Title 2 of the Government Code,
39the department may implement, without taking regulatory action,
40the provisions of the waiver after its approval by the federal Centers
P12 1for Medicare and Medicaid Services and the provisions of this
2section by means of an all-county letter or similar instruction to
3providers. Thereafter, the department shall adopt regulations to
4implement this section and the approved waiver in accordance
5with the requirements of Chapter 3.5 (commencing with Section
611340) of Part 1 of Division 3 of Title 2 of the Government Code.
7Beginning six months after the effective date of the act adding this
8subdivision, the department shall provide a status report to the
9Legislature on a semiannual basis until regulations have been
11(6) In the event that the Department of Finance determines that
12the program operated under the authority of the waiver described
13in paragraph (2) or the Family PACT successor state plan
14amendment is no longer cost effective, this subdivision shall
15become inoperative on the first day of the first month following
16the issuance of a 30-day notification of that determination in
17writing by the Department of Finance to the chairperson in each
18house that considers appropriations, the chairpersons of the
19committees, and the appropriate subcommittees in each house that
20considers the State Budget, and the Chairperson of the Joint
21Legislative Budget Committee.
22(7) If this subdivision ceases to be operative, all persons who
23have received or are eligible to receive comprehensive clinical
24family planning services pursuant to the waiver described in
25paragraph (2) shall receive family planning services under the
26Medi-Cal program pursuant to subdivision (n) if they are otherwise
27eligible for Medi-Cal with no share of cost, or shall receive
28comprehensive clinical family planning services under the program
29established in Division 24 (commencing with Section 24000) either
30if they are eligible for Medi-Cal with a share of cost or if they are
31otherwise eligible under Section 24003.
32(8) For purposes of this subdivision, “comprehensive clinical
33family planning services” means the process of establishing
34objectives for the number and spacing of children, and selecting
35the means by which those objectives may be achieved. These
36means include a broad range of acceptable and effective methods
37and services to limit or enhance fertility, including contraceptive
38methods, federal Food and Drug Administration approved
39contraceptive drugs, devices, and supplies, natural family planning,
40abstinence methods, and basic, limited fertility management.
P13 1Comprehensive clinical family planning services include, but are
2not limited to, preconception counseling, maternal and fetal health
3counseling, general reproductive health care, including diagnosis
4and treatment of infections and conditions, including cancer, that
5threaten reproductive capability, medical family planning treatment
6and procedures, including supplies and followup, and
7informational, counseling, and educational services.
8 Comprehensive clinical family planning services shall not include
9abortion, pregnancy testing solely for the purposes of referral for
10abortion or services ancillary to abortions, or pregnancy care that
11is not incident to the diagnosis of pregnancy. Comprehensive
12clinical family planning services shall be subject to utilization
13control and include all of the following:
14(A) Family planning related services and male and female
15sterilization. Family planning services for men and women shall
16include emergency services and services for complications directly
17related to the contraceptive method, federal Food and Drug
18Administration approved contraceptive drugs, devices, and
19supplies, and followup, consultation, and referral services, as
20indicated, which may require treatment authorization requests.
21(B) All United States Department of Agriculture, federal Food
22and Drug Administration approved contraceptive drugs, devices,
23and supplies that are in keeping with current standards of practice
24and from which the individual may choose.
25(C) Culturally and linguistically appropriate health education
26and counseling services, including informed consent, that include
27all of the following:
28(i) Psychosocial and medical aspects of contraception.
34(vii) Reproductive health care.
35(viii) Preconception and nutrition counseling.
36(ix) Prevention and treatment of sexually transmitted infection.
37(x) Use of contraceptive methods, federal Food and Drug
38Administration approved contraceptive drugs, devices, and
40(xi) Possible contraceptive consequences and followup.
P14 1(xii) Interpersonal communication and negotiation of
2relationships to assist individuals and couples in effective
3contraceptive method use and planning families.
4(D) A comprehensive health history, updated at the next periodic
5visit (between 11 and 24 months after initial examination) that
6includes a complete obstetrical history, gynecological history,
7contraceptive history, personal medical history, health risk factors,
8and family health history, including genetic or hereditary
10(E) A complete physical examination on initial and subsequent
12(F) Services, drugs, devices, and supplies deemed by the federal
13Centers for Medicare and Medicaid Services to be appropriate for
14inclusion in the program.
15(9) In order to maximize the availability of federal financial
16participation under this subdivision, the director shall have the
17discretion to implement the Family PACT successor state plan
18amendment retroactively to July 1, 2010.
19(ab) (1) Purchase of prescribed enteral nutrition products is
20covered, subject to the Medi-Cal list of enteral nutrition products
21and utilization controls.
22(2) Purchase of enteral nutrition products is limited to those
23products to be administered through a feeding tube, including, but
24not limited to, a gastric, nasogastric, or jejunostomy tube.
25Beneficiaries under the Early and Periodic Screening, Diagnosis,
26and Treatment Program shall be exempt from this paragraph.
27(3) Notwithstanding paragraph (2), the department may deem
28an enteral nutrition product, not administered through a feeding
29tube, including, but not limited to, a gastric, nasogastric, or
30jejunostomy tube, a benefit for patients with diagnoses, including,
31but not limited to, malabsorption and inborn errors of metabolism,
32if the product has been shown to be neither investigational nor
33experimental when used as part of a therapeutic regimen to prevent
34serious disability or death.
35(4) Notwithstanding Chapter 3.5 (commencing with Section
3611340) of Part 1 of Division 3 of Title 2 of the Government Code,
37the department may implement the amendments to this subdivision
38made by the act that added this paragraph by means of all-county
39letters, provider bulletins, or similar instructions, without taking
P15 1(5) The amendments made to this subdivision
by the act that
2added this paragraph shall be implemented June 1, 2011, or on the
3first day of the first calendar month following 60 days after the
4date the department secures all necessary federal approvals to
5implement this section, whichever is later.
6(ac) Diabetic testing supplies are covered when provided by a
7pharmacy, subject to utilization controls.
8(ad) (1) Nonmedical transportation is covered for a beneficiary to obtain covered specialty
10care Medi-Cal services, if those services are more than 60 minutes
11or 30 miles from the beneficiary’s place of residence.
12(2) “Nonmedical transportation” includes, but is not limited to,
13roundtrip transportation for a beneficiary to obtain covered
14specialty care Medi-Cal services by passenger car, taxicab, or any
15other form of public or private conveyance. Nonmedical
16transportation does not include the transportation of sick, injured,
17invalid, convalescent, infirm, or otherwise incapacitated
18beneficiaries by ambulances, litter vans, or wheelchair vans
begin delete operatedend delete and equipped in accordance with state
20and local statutes,
begin delete ordinancesend delete or regulations.
21 Nonmedical transportation includes, but is not limited to, mileage
22reimbursement for conveyance by private vehicle, bus passes, taxi
23vouchers, or train tickets.
24(3) Nonmedical transportation shall be provided in a form and
25manner that is accessible, in terms of physical and geographic
26accessibility, for the beneficiary, and consistent with policies and
27procedures established for a beneficiary with a disability.
28(4) It is the intent of the Legislature in enacting this subdivision
29to affirm the requirement under Section 431.53 of Title 42 of the
30Code of Federal Regulations, in which the department is required
31to ensure necessary transportation for recipients to and from
32providers. This subdivision shall not be interpreted to add a new
33benefit to the Medi-Cal program.
34(5) The department may seek approval of any necessary state
35plan amendments to implement this subdivision.
36(6) This subdivision shall be implemented only to the extent
37that federal financial participation is available and any necessary
38federal approvals have been obtained.