California Legislature—2015–16 Regular Session

Assembly BillNo. 1257


Introduced by Assembly Member Gray

February 27, 2015


An act to amend Section 14131.10 of the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

AB 1257, as introduced, Gray. Medi-Cal: optional benefits.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. Existing law provides, except as specified, that certain optional Medi-Cal benefits, including, among others, certain adult dental services and optometric and optician services, are excluded from coverage under the Medi-Cal program. Existing law, beginning May 1, 2014, or the effective date of any necessary federal financial participation approvals, whichever is later, provides that only specified adult dental services are a covered Medi-Cal benefit for persons who are 21 years of age or older, as specified.

This bill would make technical, nonsubstantive changes to this provision.

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

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

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SECTION 1.  

Section 14131.10 of the Welfare and Institutions
2Code
is amended to read:

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14131.10.  

(a) Notwithstanding any other provision of this
4chapter, Chapter 8 (commencing with Section 14200), or Chapter
58.75 (commencing with Section 14591), in order to implement
6changes in the level of funding for health care services, specific
7optional benefits are excluded from coverage under the Medi-Cal
8program.

9(b) (1) The following optional benefits are excluded from
10coverage under the Medi-Cal program:

11(A) Adult dental services, except as specified in paragraph (2).

12(B) Acupuncture services.

13(C) Audiology services and speech therapy services.

14(D) Chiropractic services.

15(E) Optometric and optician services, including services
16provided by a fabricating optical laboratory.

17(F) Podiatric services.

18(G) Psychology services.

19(H) Incontinence creams and washes.

20(2) (A) Medical and surgical services provided by a doctor of
21dental medicine or dental surgery, which, if provided by a
22physician, would be considered physician services, and which
23services may be provided by either a physician or a dentist in this
24state, are covered.

25(B) Emergency procedures are also covered in the categories
26of service specified in subparagraph (A). The director may adopt
27regulations for any of the services specified in subparagraph (A).

28(C) Effective May 1, 2014, or the effective date of any necessary
29federal approvals as required by subdivision (f), whichever is later,
30for personsbegin insert who areend insert 21 years of age or older, adult dental benefits,
31subject to utilization controls, are limited to all the following
32medically necessary services:

33(i) Examinations, radiographs/photographic images, prophylaxis,
34and fluoride treatments.

35(ii) Amalgam and composite restorations.

36(iii) Stainless steel, resin, and resin window crowns.

37(iv) Anterior root canal therapy.

38(v) Complete dentures, including immediate dentures.

P3    1(vi) Complete denture adjustments, repairs, and relines.

2(D) Services specified in this paragraph shall be included as a
3covered medical benefit under the Medi-Cal program pursuant to
4Section 14132.89.

5(3) Pregnancy-related services and services for the treatment of
6other conditions that might complicate the pregnancy are not
7excluded from coverage under this section.

8(c) The optional benefit exclusions do not apply to either of the
9following:

10(1) Beneficiaries under the Early and Periodic Screening
11Diagnosis and Treatment Program.

12(2) Beneficiaries receiving long-term care in a nursing facility
13that is both:

14(A) A skilled nursing facility or intermediate care facility as
15defined in subdivisions (c) and (d) of Section 1250 of the Health
16and Safety Code.

17(B) Licensed pursuant to subdivision (k) of Section 1250 of the
18Health and Safety Code.

19(d) This section shall only be implemented to the extent
20permitted by federal law.

21(e) Notwithstanding Chapter 3.5 (commencing with Section
2211340) of Part 1 of Division 3 of Title 2 of the Government Code,
23the department may implement the provisions of this section by
24means of all-county letters, provider bulletins, or similar
25 instructions, without taking further regulatory action.

26(f) The department shall seek approval for federal financial
27participation and coverage of services specified in subparagraph
28(C) of paragraph (2) of subdivision (b) under the Medi-Cal
29program.

30(g) This section, except as specified in subparagraph (C) of
31paragraph (2) of subdivision (b), shall be implemented on the first
32day of the month following 90 days after the operative date of this
33section.



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