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
begin delete controls,end delete for a beneficiary to obtain
covered begin delete specialty careend delete
Medi-Cal begin delete services, if those services are more than 60 minutes or 30 miles from the beneficiary’s place of residence.end delete 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:
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.
P3 1Respiratory care, physical therapy, occupational therapy, speech
2therapy, and audiology services for patients in nursing facilities
3and any category of intermediate care facility for the
4developmentally disabled are covered subject to utilization controls.
5(d) (1) Purchase of prescribed drugs is covered subject to the
6Medi-Cal List of Contract Drugs and utilization controls.
7(2) Purchase of
drugs used to treat erectile dysfunction or any
8off-label uses of those drugs are covered only to the extent that
9federal financial participation is available.
10(3) (A) To the extent required by federal law, the purchase of
11outpatient prescribed drugs, for which the prescription is executed
12by a prescriber in written, nonelectronic form on or after April 1,
132008, is covered only when executed on a tamper resistant
14prescription form. The implementation of this paragraph shall
15conform to the guidance issued by the federal Centers for Medicare
16and Medicaid Services but shall not conflict with state statutes on
17the characteristics of tamper resistant prescriptions for controlled
18substances, including Section 11162.1 of the Health and Safety
19Code. The department shall provide providers and beneficiaries
20with as much flexibility in implementing these rules as allowed
21by the federal government. The department shall notify and consult
22with appropriate stakeholders in implementing, interpreting, or
23making specific this paragraph.
24(B) Notwithstanding Chapter 3.5 (commencing with Section
2511340) of Part 1 of Division 3 of Title 2 of the Government Code,
26the department may take the actions specified in subparagraph (A)
27by means of a provider bulletin or notice, policy letter, or other
28similar instructions without taking regulatory action.
29(4) (A) (i) For the purposes of this paragraph, nonlegend has
30the same meaning as defined in subdivision (a) of Section
32(ii) Nonlegend acetaminophen-containing
products, with the
33exception of children’s acetaminophen-containing products,
34selected by the department are not covered benefits.
35(iii) Nonlegend cough and cold products selected by the
36department are not covered benefits. This clause shall be
37implemented on the first day of the first calendar month following
3890 days after the effective date of the act that added this clause,
39or on the first day of the first calendar month following 60 days
P4 1after the date the department secures all necessary federal approvals
2to implement this section, whichever is later.
3(iv) Beneficiaries under the Early and Periodic Screening,
4Diagnosis, and Treatment Program shall be exempt from clauses
5(ii) and (iii).
Chapter 3.5 (commencing with Section
711340) of Part 1 of Division 3 of Title 2 of the Government Code,
8the department may take the actions specified in subparagraph (A)
9by means of a provider bulletin or notice, policy letter, or other
10similar instruction without taking regulatory action.
11(e) Outpatient dialysis services and home hemodialysis services,
12including physician services, medical supplies, drugs and
13equipment required for dialysis, are covered, subject to utilization
15(f) Anesthesiologist services when provided as part of an
16outpatient medical procedure, nurse anesthetist services when
17rendered in an inpatient or outpatient setting under conditions set
18forth by the director, outpatient laboratory services, and X-ray
19services are covered, subject to utilization controls. Nothing in
20this subdivision shall be construed to require prior authorization
21for anesthesiologist services provided as part of an outpatient
22medical procedure or for portable X-ray services in a nursing
23facility or any category of intermediate care facility for the
25(g) Blood and blood derivatives are covered.
26(h) (1) Emergency and essential diagnostic and restorative
27dental services, except for orthodontic, fixed bridgework, and
28partial dentures that are not necessary for balance of a complete
29artificial denture, are covered, subject to utilization controls. The
30utilization controls shall allow emergency and essential diagnostic
31and restorative dental services and prostheses that are necessary
32to prevent a significant disability or to replace previously furnished
33prostheses that are lost or destroyed due to circumstances beyond
34the beneficiary’s control. Notwithstanding the foregoing, the
35director may by regulation provide for certain fixed artificial
36dentures necessary for obtaining employment or for medical
37conditions that preclude the use of removable dental prostheses,
38and for orthodontic services in cleft palate deformities administered
39by the department’s California Children Services Program.
P5 1(2) For persons 21 years of age or older, the services specified
2in paragraph (1) shall be provided subject to the following
4(A) Periodontal treatment is not a benefit.
5(B) Endodontic therapy is not a benefit except for vital
7(C) Laboratory processed crowns are not a benefit.
8(D) Removable prosthetics shall be a benefit only for patients
9as a requirement for employment.
10(E) The director may, by regulation, provide for the provision
11of fixed artificial dentures that are necessary for medical conditions
12that preclude the use of removable dental prostheses.
13(F) Notwithstanding the conditions specified in subparagraphs
14(A) to (E), inclusive, the department may approve services for
15persons with special medical disorders subject to utilization review.
16(3) Paragraph (2) shall become inoperative July 1, 1995.
17(i) Medical transportation is covered, subject to utilization
19(j) Home health care services are covered, subject to utilization
21(k) Prosthetic and orthotic devices and eyeglasses are covered,
22subject to utilization controls. Utilization controls shall allow
23replacement of prosthetic and orthotic devices and eyeglasses
24necessary because of loss or destruction due to circumstances
25beyond the beneficiary’s control. Frame styles for eyeglasses
26replaced pursuant to this subdivision shall not change more than
27once every two years, unless the department so directs.
28Orthopedic and conventional shoes are covered when provided
29by a prosthetic and orthotic supplier on the prescription of a
30physician and when at least one of the shoes will be attached to a
31prosthesis or brace, subject to utilization controls. Modification
32of stock conventional or orthopedic shoes when medically
33indicated, is covered subject to utilization controls. When there is
34a clearly established medical need that cannot be satisfied by the
35modification of stock conventional or orthopedic shoes,
36custom-made orthopedic shoes are covered, subject to utilization
38Therapeutic shoes and inserts are covered when provided to
39beneficiaries with a diagnosis of diabetes, subject to utilization
P6 1controls, to the extent that federal financial participation is
3(l) Hearing aids are covered, subject to utilization controls.
4Utilization controls shall allow replacement of hearing aids
5necessary because of loss or destruction due to circumstances
6beyond the beneficiary’s control.
7(m) Durable medical equipment and medical supplies are
8covered, subject to utilization controls. The utilization controls
9shall allow the replacement of durable medical equipment and
10medical supplies when necessary because of loss or destruction
11due to circumstances beyond the beneficiary’s control. The
12utilization controls shall allow authorization of durable medical
13equipment needed to assist a disabled beneficiary in caring for a
14child for whom the disabled beneficiary is a parent, stepparent,
15foster parent, or legal guardian, subject to the availability of federal
16financial participation. The department shall adopt emergency
17regulations to define and establish criteria for assistive durable
18medical equipment in accordance with the rulemaking provisions
19of the Administrative Procedure Act (Chapter 3.5 (commencing
20with Section 11340) of Part 1 of Division 3 of Title 2 of the
22(n) Family planning services are covered, subject to utilization
23 controls. However, for Medi-Cal managed care plans, any
24utilization controls shall be subject to Section 1367.25 of the Health
25and Safety Code.
26(o) Inpatient intensive rehabilitation hospital services, including
27respiratory rehabilitation services, in a general acute care hospital
28are covered, subject to utilization controls, when either of the
29following criteria are met:
30(1) A patient with a permanent disability or severe impairment
31requires an inpatient intensive rehabilitation hospital program as
32described in Section 14064 to develop function beyond the limited
33amount that would occur in the normal course of recovery.
34(2) A patient with a chronic or progressive disease requires an
35inpatient intensive rehabilitation hospital program as described in
36Section 14064 to maintain the patient’s present functional level as
37 long as possible.
38(p) (1) Adult day health care is covered in accordance with
39Chapter 8.7 (commencing with Section 14520).
P7 1(2) Commencing 30 days after the effective date of the act that
2added this paragraph, and notwithstanding the number of days
3previously approved through a treatment authorization request,
4adult day health care is covered for a maximum of three days per
6(3) As provided in accordance with paragraph (4), adult day
7health care is covered for a maximum of five days per week.
8(4) As of the date that the director makes the declaration
9described in subdivision (g) of Section 14525.1, paragraph (2)
10shall become inoperative and paragraph (3) shall become operative.
11(q) (1) Application of fluoride, or other appropriate fluoride
12treatment as defined by the department, and other prophylaxis
13treatment for children 17 years of age and under are covered.
14(2) All dental hygiene services provided by a registered dental
15hygienist, registered dental hygienist in extended functions, and
16registered dental hygienist in alternative practice licensed pursuant
17to Sections 1753, 1917, 1918, and 1922 of the Business and
18Professions Code may be covered as long as they are within the
19scope of Denti-Cal benefits and they are necessary services
20provided by a registered dental hygienist, registered dental
21hygienist in extended functions, or registered dental hygienist in
23(r) (1) Paramedic services performed by a city, county, or
24special district, or pursuant to a contract with a city, county, or
25special district, and pursuant to a program established under former
26Article 3 (commencing with Section 1480) of Chapter 2.5 of
27Division 2 of the Health and Safety Code by a paramedic certified
28pursuant to that article, and consisting of defibrillation and those
29services specified in subdivision (3) of former Section 1482 of the
31(2) All providers enrolled under this subdivision shall satisfy
32all applicable statutory and regulatory requirements for becoming
33a Medi-Cal provider.
34(3) This subdivision shall be implemented only to the extent
35funding is available under Section 14106.6.
36(s) In-home medical care services are covered when medically
37appropriate and subject to utilization controls, for beneficiaries
38who would otherwise require care for an extended period of time
39in an acute care hospital at a cost higher than in-home medical
40care services. The director shall have the authority under this
P8 1section to contract with organizations qualified to provide in-home
2medical care services to those persons. These services may be
3provided to patients placed in shared or congregate living
4arrangements, if a home setting is not medically appropriate or
5available to the beneficiary. As used in this section, “in-home
6medical care service” includes utility bills directly attributable to
7continuous, 24-hour operation of life-sustaining medical equipment,
8to the extent that federal financial participation is available.
9As used in this subdivision, in-home medical care services
10include, but are not limited to:
11(1) Level-of-care and cost-of-care evaluations.
12(2) Expenses, directly attributable to home care activities, for
14(3) Physician fees for home visits.
15(4) Expenses directly attributable to home care activities for
16shelter and modification to shelter.
17(5) Expenses directly attributable to additional costs of special
18diets, including tube feeding.
19(6) Medically related personal services.
20(7) Home nursing education.
21(8) Emergency maintenance repair.
22(9) Home health agency personnel benefits that permit coverage
23of care during periods when regular personnel are on vacation or
24using sick leave.
25(10) All services needed to maintain antiseptic conditions at
26stoma or shunt sites on the body.
27(11) Emergency and nonemergency medical transportation.
28(12) Medical supplies.
29(13) Medical equipment, including, but not limited to, scales,
30gurneys, and equipment racks suitable for paralyzed patients.
31(14) Utility use directly attributable to the requirements of home
32care activities that are in addition to normal utility use.
33(15) Special drugs and medications.
34(16) Home health agency supervision of visiting staff that is
35medically necessary, but not included in the home health agency
37(17) Therapy services.
38(18) Household appliances and household utensil costs directly
39attributable to home care activities.
40(19) Modification of medical equipment for home use.
P9 1(20) Training and orientation for use of life-support systems,
2including, but not limited to, support of respiratory functions.
3(21) Respiratory care practitioner services as defined in Sections
43702 and 3703 of the Business and Professions Code, subject to
5prescription by a physician and surgeon.
6Beneficiaries receiving in-home medical care services are entitled
7to the full range of services within the Medi-Cal scope of benefits
8as defined by this section, subject to medical necessity and
9applicable utilization control. Services provided pursuant to this
10subdivision, which are not otherwise included in the Medi-Cal
11schedule of benefits, shall be available only to the extent that
12federal financial participation for these services is available in
13accordance with a home- and community-based services waiver.
14(t) Home- and community-based services approved by the
15United States Department of Health and Human Services are
16covered to the extent that federal financial participation is available
17for those services under the state plan or waivers granted in
18accordance with Section 1315 or 1396n of Title 42 of the United
19States Code. The director may seek waivers for any or all home-
20and community-based services approvable under Section 1315 or
211396n of Title 42 of the United States Code. Coverage for those
22services shall be limited by the terms, conditions, and duration of
23the federal waivers.
24(u) Comprehensive perinatal services, as provided through an
25agreement with a health care provider designated in Section
2614134.5 and meeting the standards developed by the department
27pursuant to Section 14134.5, subject to utilization controls.
28The department shall seek any federal waivers necessary to
29implement the provisions of this subdivision. The provisions for
30which appropriate federal waivers cannot be obtained shall not be
31implemented. Provisions for which waivers are obtained or for
32which waivers are not required shall be implemented
33notwithstanding any inability to obtain federal waivers for the
34other provisions. No provision of this subdivision shall be
35implemented unless matching funds from Subchapter XIX
36(commencing with Section 1396) of Chapter 7 of Title 42 of the
37United States Code are available.
38(v) Early and periodic screening, diagnosis, and treatment for
39any individual under 21 years of age is covered, consistent with
P10 1the requirements of Subchapter XIX (commencing with Section
21396) of Chapter 7 of Title 42 of the United States Code.
3(w) Hospice service that is Medicare-certified hospice service
4is covered, subject to utilization controls. Coverage shall be
5available only to the extent that no additional net program costs
7(x) When a claim for treatment provided to a beneficiary
8includes both services that are authorized and reimbursable under
9this chapter, and services that are not reimbursable under this
10chapter, that portion of the claim for the treatment and services
11authorized and reimbursable under this chapter shall be payable.
12(y) Home- and community-based services approved by the
13United States Department of Health and Human Services for
14beneficiaries with a diagnosis of AIDS or ARC, who require
15intermediate care or a higher level of care.
16Services provided pursuant to a waiver obtained from the
17Secretary of the United States Department of Health and Human
18Services pursuant to this subdivision, and which are not otherwise
19included in the Medi-Cal schedule of benefits, shall be available
20only to the extent that federal financial participation for these
21services is available in accordance with the waiver, and subject to
22the terms, conditions, and duration of the waiver. These services
23shall be provided to individual beneficiaries in accordance with
24the client’s needs as identified in the plan of care, and subject to
25medical necessity and applicable utilization control.
26The director may under this section contract with organizations
27qualified to provide, directly or by subcontract, services provided
28for in this subdivision to eligible beneficiaries. Contracts or
29agreements entered into pursuant to this division shall not be
30subject to the Public Contract Code.
31(z) Respiratory care when provided in organized health care
32systems as defined in Section 3701 of the Business and Professions
33Code, and as an in-home medical service as outlined in subdivision
35(aa) (1) There is hereby established in the department, a
36program to provide comprehensive clinical family planning
37services to any person who has a family income at or below 200
38percent of the federal poverty level, as revised annually, and who
39is eligible to receive these services pursuant to the waiver identified
P11 1in paragraph (2). This program shall be known as the Family
2Planning, Access, Care, and Treatment (Family PACT) Program.
3(2) The department shall seek a waiver in accordance with
4Section 1315 of Title 42 of the United States Code, or a state plan
5amendment adopted in accordance with Section
61396a(a)(10)(A)(ii)(XXI) of Title 42 of the United States Code,
7which was added to Section 1396a of Title 42 of the United States
8Code by Section 2303(a)(2) of the federal Patient Protection and
9Affordable Care Act (PPACA) (Public Law 111-148), for a
10program to provide comprehensive clinical family planning
11services as described in paragraph (8). Under the waiver, the
12program shall be operated only in accordance with the waiver and
13the statutes and regulations in paragraph (4) and subject to the
14terms, conditions, and duration of the waiver. Under the state plan
15amendment, which shall replace the waiver and shall be known as
16the Family PACT successor state plan amendment, the program
17shall be operated only in accordance with this subdivision and the
18statutes and regulations in paragraph (4). The state shall use the
19standards and processes imposed by the state on January 1, 2007,
20including the application of an eligibility discount factor to the
21extent required by the federal Centers for Medicare and Medicaid
22Services, for purposes of determining eligibility as permitted under
23Section 1396a(a)(10)(A)(ii)(XXI) of Title 42 of the United States
24Code. To the extent that federal financial participation is available,
25the program shall continue to conduct education, outreach,
26enrollment, service delivery, and evaluation services as specified
27under the waiver. The services shall be provided under the program
28only if the waiver and, when applicable, the successor state plan
29amendment are approved by the federal Centers for Medicare and
30Medicaid Services and only to the extent that federal financial
31participation is available for the services. Nothing in this section
32shall prohibit the department from seeking the Family PACT
33successor state plan amendment during the operation of the waiver.
34(3) Solely for the purposes of the waiver or Family PACT
35successor state plan amendment and notwithstanding any other
36law, the collection and use of an individual’s social security number
37shall be necessary only to the extent required by federal law.
38(4) Sections 14105.3 to 14105.39, inclusive, 14107.11, 24005,
39and 24013, and any regulations adopted under these statutes shall
40apply to the program provided for under this subdivision. No other
P12 1provision of law under the Medi-Cal program or the State-Only
2Family Planning Program shall apply to the program provided for
3under this subdivision.
4(5) Notwithstanding Chapter 3.5 (commencing with Section
511340) of Part 1 of Division 3 of Title 2 of the Government Code,
6the department may implement, without taking regulatory action,
7the provisions of the waiver after its approval by the federal Centers
8for Medicare and Medicaid Services and the provisions of this
9section by means of an all-county letter or similar instruction to
10providers. Thereafter, the department shall adopt regulations to
11implement this section and the approved waiver in accordance
12with the requirements of Chapter 3.5 (commencing with Section
1311340) of Part 1 of Division 3 of Title 2 of the Government Code.
14Beginning six months after the effective date of the act adding this
15subdivision, the department shall provide a status report to the
16Legislature on a semiannual basis until regulations have been
18(6) In the event that the Department of Finance determines that
19the program operated under the authority of the waiver described
20in paragraph (2) or the Family PACT successor state plan
21amendment is no longer cost effective, this subdivision shall
22become inoperative on the first day of the first month following
23the issuance of a 30-day notification of that determination in
24writing by the Department of Finance to the chairperson in each
25house that considers appropriations, the chairpersons of the
26committees, and the appropriate subcommittees in each house that
27considers the State Budget, and the Chairperson of the Joint
28Legislative Budget Committee.
this subdivision ceases to be operative, all persons who
30have received or are eligible to receive comprehensive clinical
31family planning services pursuant to the waiver described in
32paragraph (2) shall receive family planning services under the
33Medi-Cal program pursuant to subdivision (n) if they are otherwise
34eligible for Medi-Cal with no share of cost, or shall receive
35comprehensive clinical family planning services under the program
36established in Division 24 (commencing with Section 24000) either
37if they are eligible for Medi-Cal with a share of cost or if they are
38otherwise eligible under Section 24003.
39(8) For purposes of this subdivision, “comprehensive clinical
40family planning services” means the process of establishing
P13 1objectives for the number and spacing of children, and selecting
2the means by which those objectives may be achieved. These
3means include a broad range of acceptable and effective methods
4and services to limit or enhance fertility, including contraceptive
5methods, federal Food and Drug Administration approved
6contraceptive drugs, devices, and supplies, natural family planning,
7abstinence methods, and basic, limited fertility management.
8Comprehensive clinical family planning services include, but are
9not limited to, preconception counseling, maternal and fetal health
10counseling, general reproductive health care, including diagnosis
11and treatment of infections and conditions, including cancer, that
12threaten reproductive capability, medical family planning treatment
13and procedures, including supplies and followup, and
14informational, counseling, and educational services.
15 Comprehensive clinical family planning services shall not include
16abortion, pregnancy testing solely for the purposes of referral for
17abortion or services ancillary to abortions, or pregnancy care that
18is not incident to the diagnosis of pregnancy. Comprehensive
19clinical family planning services shall be subject to utilization
20control and include all of the following:
21(A) Family planning related services and male and female
22sterilization. Family planning services for men and women shall
23include emergency services and services for complications directly
24related to the contraceptive method, federal Food and Drug
25Administration approved contraceptive drugs, devices, and
26supplies, and followup, consultation, and referral services, as
27indicated, which may require treatment authorization requests.
28(B) All United States Department of Agriculture, federal Food
29and Drug Administration approved contraceptive drugs, devices,
30and supplies that are in keeping with current standards of practice
31and from which the individual may choose.
32(C) Culturally and linguistically appropriate health education
33and counseling services, including informed consent, that include
34all of the following:
35(i) Psychosocial and medical aspects of contraception.
P14 1(vii) Reproductive health care.
2(viii) Preconception and nutrition counseling.
3(ix) Prevention and treatment of sexually transmitted infection.
4(x) Use of contraceptive methods, federal Food and Drug
5Administration approved contraceptive drugs, devices, and
7(xi) Possible contraceptive consequences and followup.
8(xii) Interpersonal communication and negotiation of
9relationships to assist individuals and couples in effective
10contraceptive method use and planning families.
11(D) A comprehensive health history, updated at the next periodic
12visit (between 11 and 24 months after initial examination) that
13includes a complete obstetrical history, gynecological history,
14contraceptive history, personal medical history, health risk factors,
15and family health history, including genetic or hereditary
17(E) A complete physical examination on initial and subsequent
19(F) Services, drugs, devices, and supplies deemed by the federal
20Centers for Medicare and Medicaid Services to be appropriate for
21inclusion in the program.
22(9) In order to maximize the
availability of federal financial
23participation under this subdivision, the director shall have the
24discretion to implement the Family PACT successor state plan
25amendment retroactively to July 1, 2010.
26(ab) (1) Purchase of prescribed enteral nutrition products is
27covered, subject to the Medi-Cal list of enteral nutrition products
28and utilization controls.
29(2) Purchase of enteral nutrition products is limited to those
30products to be administered through a feeding tube, including, but
31not limited to, a gastric, nasogastric, or jejunostomy tube.
32Beneficiaries under the Early and Periodic Screening, Diagnosis,
33and Treatment Program shall be exempt from this paragraph.
34(3) Notwithstanding paragraph (2),
the department may deem
35an enteral nutrition product, not administered through a feeding
36tube, including, but not limited to, a gastric, nasogastric, or
37jejunostomy tube, a benefit for patients with diagnoses, including,
38but not limited to, malabsorption and inborn errors of metabolism,
39if the product has been shown to be neither investigational nor
P15 1experimental when used as part of a therapeutic regimen to prevent
2serious disability or death.
3(4) Notwithstanding Chapter 3.5 (commencing with Section
411340) of Part 1 of Division 3 of Title 2 of the Government Code,
5the department may implement the amendments to this subdivision
6made by the act that added this paragraph by means of all-county
7letters, provider bulletins, or similar instructions, without taking
9(5) The amendments made to this subdivision by the act that
10added this paragraph shall be implemented June 1, 2011, or on the
11first day of the first calendar month following 60 days after the
12date the department secures all necessary federal approvals to
13implement this section, whichever is later.
14(ac) Diabetic testing supplies are covered when provided by a
15pharmacy, subject to utilization controls.
16(ad) (1) Nonmedical transportation is covered, subject to
begin delete controls,end delete for a beneficiary to obtain covered begin delete specialty
begin delete services, if those services are more than 60 minutes
20or 30 miles from the beneficiary’s place of residence.end delete
21(2) (A) “Nonmedical transportation” includes, but is not limited
22to, roundtrip transportation for a beneficiary to obtain covered
begin delete specialty careend delete Medi-Cal services by passenger car, taxicab, or any
24other form of public or private conveyance. Nonmedical
25transportation does not include the transportation of sick, injured,
26invalid, convalescent, infirm, or otherwise incapacitated
27beneficiaries by ambulances, litter vans, or wheelchair vans
28 licensed, operated, and equipped in accordance with state and local
29statutes, ordinances, or regulations. Nonmedical transportation
30includes, but is not limited to, mileage reimbursement for
31conveyance by private vehicle, bus passes, taxi vouchers, or train
33(B) The cost of nonmedical transportation shall be paid for a
34beneficiary who can attest in a manner to be specified by the
35department that other available resources have been reasonably
37(3) Nonmedical transportation shall be provided in a form and
38manner that is accessible, in terms of physical and geographic
39accessibility, for the beneficiary, and consistent with policies and
40procedures established for a beneficiary with a disability.
P16 1(4) It is the intent of the Legislature in enacting this subdivision
2to affirm the requirement under Section 431.53 of Title 42 of the
3Code of Federal Regulations, in which the department is required
4to ensure necessary transportation for recipients to and from
5providers. This subdivision shall not be interpreted to add a new
6benefit to the Medi-Cal program.
7(5) (A) Upon enactment of this subdivision, the department
8shall seek any federal approvals necessary to implement this
9subdivision that the department determines are necessary to
10implement this subdivision. This subdivision shall not be
11implemented until all necessary federal approvals are obtained.
12(B) This subdivision shall be implemented only to the extent
13that federal financial participation is available and not otherwise
14jeopardized, and any necessary federal approvals have been
16(6) Notwithstanding Chapter 3.5 (commencing with Section
1711340) of Part 1 of Division 3 of Title 2 of the Government Code,
18the department, without taking any further regulatory action, shall
19implement, interpret, or make specific this subdivision by means
20of all-county letters, plan letters, plan or provider bulletins, or
21similar instructions until the time regulations are adopted. By July
221, 2017, the department shall adopt regulations in accordance with
23the requirements of Chapter 3.5 (commencing with Section 11340)
24of Part 1 of Division 3 of Title 2 of the Government Code.
25Commencing six months after the effective date of the act that
26added this subdivision, and notwithstanding Section 10231.5 of
27the Government Code, the department shall provide a status report
28to the Legislature on a semiannual basis, in compliance with
29Section 9795 of the Government Code, until regulations have been