AB 1485, as amended, Patterson. Medi-Cal: radiology.
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 prohibits a requirement of in-person contact between a health care provider and patient under the Medi-Cal program for any service otherwise covered by the Medi-Cal program when the service is appropriately provided by telehealth, as defined. Existing law, for purposes of payment of covered treatment or services provided through telehealth, prohibits the department from limiting the type of setting where services are provided for the patient or by the health care provider.
This bill would prohibit the department from conditioning Medi-Cal provider enrollment or reimbursement for radiology services provided to Medi-Cal beneficiaries undergoing imaging procedures at locations within California on the location of the radiologist, if the radiologist meets specified conditions and criteria, as specified.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 14132.735 is added to the Welfare and
2Institutions Code, to read:
(a) It is the intent of the Legislature that this section
4begin insert shallend insert not bebegin delete consideredend delete a precedent for other types of health carebegin delete5 service providers because the services performed by radiologists
6are provided to attending physicians and not to patients, and
7therefore they do not supplant work performed by other California
8
health care providers.end delete
9radiologists supplement, and do not supplant, in-state radiologists
10as an integral part of providing a high level of care in local
11communities.end insert
12(b) Notwithstanding Section 14122, the department shall not
13condition Medi-Cal provider enrollment or reimbursement for
14radiology services provided to Medi-Cal beneficiaries undergoing
15imaging procedures at locations within California on the location
16of the radiologist, if the radiologist meets all of the
following
17conditions and criteria:
18(1) The radiologist is licensed pursuant to Division 2
19(commencing with Section 500) of the Business and Professions
20Code.
21(2) The radiologist is enrolled and in good standing in the
22Medicaid program for the state where the radiologist is located, is
23enrolled in good standing in Medicare, or is enrolled in good
24standing in both programs.
25(3) The radiologist is not located outside the United States of
26America.
27(4) The radiologist satisfies all requirements for enrollment and
28participation in the Medi-Cal
program.
29(5) The radiologist consents to Medi-Cal acting through the
30state Medicaid program where the radiologist is located and the
31Medicare Program with respect to any issues concerning the
32radiologist’s enrollment or participation in Medi-Cal.
P3 1(6) The radiologist consents to jurisdiction and venue in
2Sacramento, California, for any and all legal proceedings in any
3way related to the radiologist’s enrollment in Medi-Cal, including,
4but not limited to, formal or informal proceedings, as well as
5administrative, civil, and criminal proceedings.
6(c) Notwithstanding Chapter 3.5 (commencing with Section
711340) of Part 1 of Division 3 of Title 2 of the Government Code,
8the department may implement, interpret,
and make specific this
9section by means of all-county letters, provider bulletins, and
10similar instructions.
11(d) This section shall be implemented only to the extent
12permitted by federal law and to the extent that federal financial
13participation is available.
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