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
4shall not be a precedent for other types of health care providers
5and that remotely located radiologists supplement, and do not
6supplant,begin delete in-stateend deletebegin insert on-siteend insert radiologists as an integral part of
7providing a high level of care in local communities.
8(b) Notwithstanding Section 14122, the department shall not
9condition Medi-Cal provider enrollment or reimbursement for
10radiology services provided to Medi-Cal beneficiaries undergoing
11imaging
procedures at locations within California on the location
12of the radiologist, if the radiologist meets all of the following
13conditions and criteria:
14(1) The radiologist is licensed pursuant to Division 2
15(commencing with Section 500) of the Business and Professions
16Code.
17(2) The radiologist is enrolled and in good standing in the
18Medicaid program for the state where the radiologist is located, is
19enrolled in good standing in Medicare, or is enrolled in good
20standing in both programs.
21(3) The radiologist is not located outside the United States of
22America.
23(4) The radiologist satisfies all requirements for enrollment and
24participation in the Medi-Cal
program.
25(5) The radiologist consents to Medi-Cal acting through the
26state Medicaid program where the radiologist is located and the
27Medicare Program with respect to any issues concerning the
28radiologist’s enrollment or participation in Medi-Cal.
29(6) The radiologist consents to jurisdiction and venue in
30Sacramento, California, for any and all legal proceedings in any
31way related to the radiologist’s enrollment in Medi-Cal, including,
P3 1but not limited to, formal or informal proceedings, as well as
2administrative, civil, and criminal proceedings.
3(c) 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, interpret, and make specific
this
6section by means of all-county letters, provider bulletins, and
7similar instructions.
8(d) This section shall be implemented only to the extent
9permitted by federal law and to the extent that federal financial
10participation is available.
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