Amended in Assembly March 26, 2015

California Legislature—2015–16 Regular Session

Assembly Bill No. 1257

Introduced by Assembly Member Gray

February 27, 2015

An act to begin delete amend Section 14131.10 end delete begin insert add Article 5.8 (commencing with Section 14188) to Chapter 7 of Part 3 of Division 9 end insert of the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

AB 1257, as amended, Gray. Medi-Cal: begin delete optional benefits. end delete begin insert ground ambulance rates. end insert

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 begin delete benefits. end delete begin insert services, including medical transportation services. end insert The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. begin delete 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. end delete begin insert Existing law and regulations prescribe various requirements governing payment policies and reimbursement rates for these services. end insert

This bill would begin delete make technical, nonsubstantive changes to this provision. end delete begin insert require the State Department of Health Care Services to establish payment rates for ground ambulance services based on changes in the Consumer Price Index- end insert begin insert Urban and the Geographic Practice Cost Index, and would require the department to designate a specified ambulance cost study conducted by the federal Government Accountability Office as the evidentiary base. end insert

Vote: majority. Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program: no.

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

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert Article 5.8 (commencing with Section 14188) is
added to Chapter 7 of Part 3 of Division 9 of the end insert begin insert Welfare and
Institutions Code end insert begin insert , to read: end insert

begin insert

 

Article begin insert 5.8. end insert   Ground Ambulance Service Rates

 

begin insert 14188. end insert   

The department shall establish payment rates for ground
ambulance services based on changes in the Consumer Price
Index-Urban (CPI-U) and the California weighted average
Geographic Practice Cost Index and shall designate the ambulance
cost study conducted by the federal Government Accountability
Office (GAO-07-383) as the evidentiary base.

end insert

begin delete

SECTION 1.  

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

14131.10.  

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

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

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

(B) Acupuncture services.

(C) Audiology services and speech therapy services.

(D) Chiropractic services.

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

(F) Podiatric services.

(G) Psychology services.

(H) Incontinence creams and washes.

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

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

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

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

(ii) Amalgam and composite restorations.

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

(iv) Anterior root canal therapy.

(v) Complete dentures, including immediate dentures.

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

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

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

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

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

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

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

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

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

(e) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department may implement the provisions of this section by
means of all-county letters, provider bulletins, or similar
instructions, without taking further regulatory action.

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

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

end delete