Amended in Senate September 1, 2015

Amended in Senate June 19, 2015

Amended in Assembly May 28, 2015

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 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, subject to utilization controls, 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. The bill would require the department to adopt regulations by July 1, 2017. Commencing 6 months after the effective date of this act, the bill would require the department to provide a status report to the Legislature on a semiannual basis until regulations have been adopted.

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

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

P2    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:

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
14controls.

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
P3    1and any category of intermediate care facility for the
2developmentally disabled are covered subject to utilization controls.

3(d) (1) Purchase of prescribed drugs is covered subject to the
4Medi-Cal List of Contract Drugs and utilization controls.

5(2) Purchase of drugs used to treat erectile dysfunction or any
6off-label uses of those drugs are covered only to the extent that
7federal financial participation is available.

8(3) (A) To the extent required by federal law, the purchase of
9outpatient prescribed drugs, for which the prescription is executed
10by a prescriber in written, nonelectronic form on or after April 1,
112008, is covered only when executed on a tamper resistant
12prescription form. The implementation of this paragraph shall
13conform to the guidance issued by the federal Centers for Medicare
14and Medicaid Services but shall not conflict with state statutes on
15the characteristics of tamper resistant prescriptions for controlled
16substances, including Section 11162.1 of the Health and Safety
17Code. The department shall provide providers and beneficiaries
18with as much flexibility in implementing these rules as allowed
19by the federal government. The department shall notify and consult
20with appropriate stakeholders in implementing, interpreting, or
21making specific this paragraph.

22(B) Notwithstanding Chapter 3.5 (commencing with Section
2311340) of Part 1 of Division 3 of Title 2 of the Government Code,
24the department may take the actions specified in subparagraph (A)
25by means of a provider bulletin or notice, policy letter, or other
26similar instructions without taking regulatory action.

27(4) (A) (i) For the purposes of this paragraph, nonlegend has
28the same meaning as defined in subdivision (a) of Section
2914105.45.

30(ii) Nonlegend acetaminophen-containing products, with the
31exception of children’s acetaminophen-containing products,
32selected by the department are not covered benefits.

33(iii) Nonlegend cough and cold products selected by the
34department are not covered benefits. This clause shall be
35implemented on the first day of the first calendar month following
3690 days after the effective date of the act that added this clause,
37or on the first day of the first calendar month following 60 days
38after the date the department secures all necessary federal approvals
39to implement this section, whichever is later.

P4    1(iv) Beneficiaries under the Early and Periodic Screening,
2Diagnosis, and Treatment Program shall be exempt from clauses
3(ii) and (iii).

4(B) Notwithstanding Chapter 3.5 (commencing with Section
511340) of Part 1 of Division 3 of Title 2 of the Government Code,
6the department may take the actions specified in subparagraph (A)
7by means of a provider bulletin or notice, policy letter, or other
8similar instruction without taking regulatory action.

9(e) Outpatient dialysis services and home hemodialysis services,
10including physician services, medical supplies, drugs and
11equipment required for dialysis, are covered, subject to utilization
12controls.

13(f) Anesthesiologist services when provided as part of an
14outpatient medical procedure, nurse anesthetist services when
15rendered in an inpatient or outpatient setting under conditions set
16forth by the director, outpatient laboratory services, and X-ray
17services are covered, subject to utilization controls. Nothing in
18this subdivision shall be construed to require prior authorization
19for anesthesiologist services provided as part of an outpatient
20medical procedure or for portable X-ray services in a nursing
21facility or any category of intermediate care facility for the
22developmentally disabled.

23(g) Blood and blood derivatives are covered.

24(h) (1) Emergency and essential diagnostic and restorative
25dental services, except for orthodontic, fixed bridgework, and
26partial dentures that are not necessary for balance of a complete
27artificial denture, are covered, subject to utilization controls. The
28utilization controls shall allow emergency and essential diagnostic
29and restorative dental services and prostheses that are necessary
30to prevent a significant disability or to replace previously furnished
31prostheses that are lost or destroyed due to circumstances beyond
32the beneficiary’s control. Notwithstanding the foregoing, the
33director may by regulation provide for certain fixed artificial
34dentures necessary for obtaining employment or for medical
35conditions that preclude the use of removable dental prostheses,
36and for orthodontic services in cleft palate deformities administered
37by the department’s California Children Services Program.

38(2) For persons 21 years of age or older, the services specified
39in paragraph (1) shall be provided subject to the following
40conditions:

P5    1(A) Periodontal treatment is not a benefit.

2(B) Endodontic therapy is not a benefit except for vital
3pulpotomy.

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

5(D) Removable prosthetics shall be a benefit only for patients
6as a requirement for employment.

7(E) The director may, by regulation, provide for the provision
8of fixed artificial dentures that are necessary for medical conditions
9that preclude the use of removable dental prostheses.

10(F) Notwithstanding the conditions specified in subparagraphs
11(A) to (E), inclusive, the department may approve services for
12persons with special medical disorders subject to utilization review.

13(3) Paragraph (2) shall become inoperative July 1, 1995.

14(i) Medical transportation is covered, subject to utilization
15controls.

16(j) Home health care services are covered, subject to utilization
17controls.

18(k) Prosthetic and orthotic devices and eyeglasses are covered,
19subject to utilization controls. Utilization controls shall allow
20replacement of prosthetic and orthotic devices and eyeglasses
21necessary because of loss or destruction due to circumstances
22beyond the beneficiary’s control. Frame styles for eyeglasses
23replaced pursuant to this subdivision shall not change more than
24once every two years, unless the department so directs.

25Orthopedic and conventional shoes are covered when provided
26by a prosthetic and orthotic supplier on the prescription of a
27physician and when at least one of the shoes will be attached to a
28prosthesis or brace, subject to utilization controls. Modification
29of stock conventional or orthopedic shoes when medically
30indicated, is covered subject to utilization controls. When there is
31a clearly established medical need that cannot be satisfied by the
32modification of stock conventional or orthopedic shoes,
33custom-made orthopedic shoes are covered, subject to utilization
34controls.

35Therapeutic shoes and inserts are covered when provided to
36beneficiaries with a diagnosis of diabetes, subject to utilization
37controls, to the extent that federal financial participation is
38available.

39(l) Hearing aids are covered, subject to utilization controls.
40Utilization controls shall allow replacement of hearing aids
P6    1necessary because of loss or destruction due to circumstances
2beyond the beneficiary’s control.

3(m) Durable medical equipment and medical supplies are
4covered, subject to utilization controls. The utilization controls
5shall allow the replacement of durable medical equipment and
6medical supplies when necessary because of loss or destruction
7due to circumstances beyond the beneficiary’s control. The
8utilization controls shall allow authorization of durable medical
9equipment needed to assist a disabled beneficiary in caring for a
10child for whom the disabled beneficiary is a parent, stepparent,
11foster parent, or legal guardian, subject to the availability of federal
12financial participation. The department shall adopt emergency
13regulations to define and establish criteria for assistive durable
14medical equipment in accordance with the rulemaking provisions
15of the Administrative Procedure Act (Chapter 3.5 (commencing
16with Section 11340) of Part 1 of Division 3 of Title 2 of the
17Government Code).

18(n) Family planning services are covered, subject to utilization
19 controls. However, for Medi-Cal managed care plans, any
20utilization controls shall be subject to Section 1367.25 of the Health
21and Safety Code.

22(o) Inpatient intensive rehabilitation hospital services, including
23respiratory rehabilitation services, in a general acute care hospital
24are covered, subject to utilization controls, when either of the
25following criteria are met:

26(1) A patient with a permanent disability or severe impairment
27requires an inpatient intensive rehabilitation hospital program as
28described in Section 14064 to develop function beyond the limited
29amount that would occur in the normal course of recovery.

30(2) A patient with a chronic or progressive disease requires an
31inpatient intensive rehabilitation hospital program as described in
32Section 14064 to maintain the patient’s present functional level as
33 long as possible.

34(p) (1) Adult day health care is covered in accordance with
35Chapter 8.7 (commencing with Section 14520).

36(2) Commencing 30 days after the effective date of the act that
37added this paragraph, and notwithstanding the number of days
38previously approved through a treatment authorization request,
39adult day health care is covered for a maximum of three days per
40week.

P7    1(3) As provided in accordance with paragraph (4), adult day
2health care is covered for a maximum of five days per week.

3(4) As of the date that the director makes the declaration
4described in subdivision (g) of Section 14525.1, paragraph (2)
5shall become inoperative and paragraph (3) shall become operative.

6(q) (1) Application of fluoride, or other appropriate fluoride
7treatment as defined by the department, and other prophylaxis
8treatment for children 17 years of age and under are covered.

9(2) All dental hygiene services provided by a registered dental
10hygienist, registered dental hygienist in extended functions, and
11registered dental hygienist in alternative practice licensed pursuant
12to Sections 1753, 1917, 1918, and 1922 of the Business and
13Professions Code may be covered as long as they are within the
14scope of Denti-Cal benefits and they are necessary services
15provided by a registered dental hygienist, registered dental
16hygienist in extended functions, or registered dental hygienist in
17alternative practice.

18(r) (1) Paramedic services performed by a city, county, or
19special district, or pursuant to a contract with a city, county, or
20special district, and pursuant to a program established under former
21Article 3 (commencing with Section 1480) of Chapter 2.5 of
22Division 2 of the Health and Safety Code by a paramedic certified
23pursuant to that article, and consisting of defibrillation and those
24services specified in subdivision (3) of former Section 1482 of the
25article.

26(2) All providers enrolled under this subdivision shall satisfy
27all applicable statutory and regulatory requirements for becoming
28a Medi-Cal provider.

29(3) This subdivision shall be implemented only to the extent
30funding is available under Section 14106.6.

31(s) In-home medical care services are covered when medically
32appropriate and subject to utilization controls, for beneficiaries
33who would otherwise require care for an extended period of time
34in an acute care hospital at a cost higher than in-home medical
35care services. The director shall have the authority under this
36section to contract with organizations qualified to provide in-home
37medical care services to those persons. These services may be
38provided to patients placed in shared or congregate living
39arrangements, if a home setting is not medically appropriate or
40available to the beneficiary. As used in this section, “in-home
P8    1medical care service” includes utility bills directly attributable to
2continuous, 24-hour operation of life-sustaining medical equipment,
3to the extent that federal financial participation is available.

4As used in this subdivision, in-home medical care services
5include, but are not limited to:

6(1) Level-of-care and cost-of-care evaluations.

7(2) Expenses, directly attributable to home care activities, for
8materials.

9(3) Physician fees for home visits.

10(4) Expenses directly attributable to home care activities for
11shelter and modification to shelter.

12(5) Expenses directly attributable to additional costs of special
13diets, including tube feeding.

14(6) Medically related personal services.

15(7) Home nursing education.

16(8) Emergency maintenance repair.

17(9) Home health agency personnel benefits that permit coverage
18of care during periods when regular personnel are on vacation or
19using sick leave.

20(10) All services needed to maintain antiseptic conditions at
21stoma or shunt sites on the body.

22(11) Emergency and nonemergency medical transportation.

23(12) Medical supplies.

24(13) Medical equipment, including, but not limited to, scales,
25gurneys, and equipment racks suitable for paralyzed patients.

26(14) Utility use directly attributable to the requirements of home
27care activities that are in addition to normal utility use.

28(15) Special drugs and medications.

29(16) Home health agency supervision of visiting staff that is
30medically necessary, but not included in the home health agency
31rate.

32(17) Therapy services.

33(18) Household appliances and household utensil costs directly
34attributable to home care activities.

35(19) Modification of medical equipment for home use.

36(20) Training and orientation for use of life-support systems,
37including, but not limited to, support of respiratory functions.

38(21) Respiratory care practitioner services as defined in Sections
393702 and 3703 of the Business and Professions Code, subject to
40prescription 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
40are incurred.

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 organizations
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
28(s).

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
10adopted.

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.

29(ii) Sexuality.

30(iii) Fertility.

31(iv) Pregnancy.

32(v) Parenthood.

33(vi) Infertility.

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
39supplies.

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
9conditions.

10(E) A complete physical examination on initial and subsequent
11periodic visits.

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
40regulatory action.

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, subject to
9utilization controls, 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) begin insert(A)end insertbegin insertend insert “Nonmedical transportation” includes, but is not limited
13to, roundtrip 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
19licensed, operated, and equipped in accordance with state and local
20statutes, ordinances, or regulations. Nonmedical transportation
21includes, but is not limited to, mileage reimbursement for
22conveyance by private vehicle, bus passes, taxi vouchers, or train
23tickets.

begin insert

24(B) The cost of nonmedical transportation shall be paid for a
25beneficiary who can attest in a manner to be specified by the
26department that other available resources have been reasonably
27exhausted.

end insert

28(3) Nonmedical transportation shall be provided in a form and
29manner that is accessible, in terms of physical and geographic
30accessibility, for the beneficiary, and consistent with policies and
31procedures established for a beneficiary with a disability.

32(4) It is the intent of the Legislature in enacting this subdivision
33to affirm the requirement under Section 431.53 of Title 42 of the
34Code of Federal Regulations, in which the department is required
35to ensure necessary transportation for recipients to and from
36providers. This subdivision shall not be interpreted to add a new
37benefit to the Medi-Cal program.

38(5) begin deleteThe end deletebegin insert(A)end insertbegin insertend insertbegin insertUpon enactment of this subdivision, the end insertdepartment
39begin delete may seek approval of any necessary state plan amendments to
40implement this subdivision.end delete
begin insert shall seek any federal approvals
P16   1necessary to implement end insert
begin insertthis subdivisionend insertbegin insert that the department
2determines are necessary to implementend insert
begin insert this subdivision. This
3subdivision shall not be implemented until all necessary federal
4approvals are obtained.end insert

begin delete

5(6)

end delete

6begin insert(B)end insert This subdivision shall be implemented only to the extent
7that federal financial participation is availablebegin insert and not otherwise
8jeopardized,end insert
and any necessary federal approvals have been
9obtained.

begin delete

10(7)

end delete

11begin insert(6)end insert Notwithstanding Chapter 3.5 (commencing with Section
1211340) of Part 1 of Division 3 of Title 2 of the Government Code,
13the department, without taking any further regulatory action, shall
14implement, interpret, or make specific this subdivision by means
15of all-county letters, plan letters, plan or provider bulletins, or
16similar instructions until the time regulations are adopted. By July
171, 2017, the department shall adopt regulations in accordance with
18the requirements of Chapter 3.5 (commencing with Section 11340)
19of Part 1 of Division 3 of Title 2 of the Government Code.
20Commencing six months after the effective date of the act that
21added this subdivision, and notwithstanding Section 10231.5 of
22the Government Code, the department shall provide a status report
23to the Legislature on a semiannual basis, in compliance with
24Section 9795 of the Government Code, until regulations have been
25adopted.



O

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