BILL NUMBER: SB 447	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 6, 2015

INTRODUCED BY   Senator Allen

                        FEBRUARY 25, 2015

   An act to amend Section 14132.01 of the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 447, as amended, Allen. Medi-Cal: clinics: drugs and supplies.
   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.
   The Medi-Cal program, pursuant to a federal waiver, administers a
program known as the Family Planning, Access, Care, and Treatment
(Family PACT) Program, to provide comprehensive clinical family
planning services to any person who has a family income at or below
200% of the federal poverty level and who is eligible to receive
those services pursuant to the waiver. Existing law requires
reimbursement for drugs and supplies covered under the Medi-Cal
program and Family PACT Program by a licensed community clinic or
free clinic, or an intermittent clinic, to be the lesser of the
amount billed or the Medi-Cal reimbursement rate and caps
reimbursement at the net cost of the drugs or products as provided to
retail pharmacies under the Medi-Cal program. Existing law sets the
costs for drugs and supplies covered under those programs at an
aggregate amount equivalent to the sum of the actual acquisition cost
of a drug or supply plus a clinic dispensing fee not to exceed $12
per billing unit, as specified. Existing law also sets the cost for a
take-home drug that is dispensed for use by the patient within a
specific timeframe of 5 or less days from the date medically
indicated at the actual acquisition cost for that drug plus a clinic
dispensing fee, not to exceed $17 per prescription.
   This bill would revise this reimbursement  formula,
  formula for those drugs subject to a   rebate
under specified federal law,  and would instead require the
clinic dispensing fee to be the difference between the actual
acquisition cost of a drug or supply, to be calculated not less than
annually, and the Medi-Cal reimbursement rate. The bill would remove
the cap on reimbursement that is based on the net cost of drugs or
supplies when provided by retail pharmacies under the Medi-Cal
program.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 14132.01 of the Welfare and Institutions Code
is amended to read:
   14132.01.  (a) Notwithstanding any other law, a community clinic
or free clinic licensed pursuant to subdivision (a) of Section 1204
of the Health and Safety Code or an intermittent clinic operating
pursuant to subdivision (h) of Section 1206 of the Health and Safety
Code, that has a valid license pursuant to Article 13 (commencing
with Section 4180) of Chapter 9 of Division 2 of the Business and
Professions Code shall bill and be reimbursed, as described in this
section, for drugs and supplies covered under the Medi-Cal program
and Family PACT Waiver Program.
   (b) (1)  A   With   respect to those
drugs that are subject to a rebate under Section 1396r-8 of Title 42
of the United States Code, a  clinic described in subdivision
(a) shall bill the Medi-Cal program and Family PACT Waiver Program
for drugs and supplies covered under those programs at the lesser of
cost or the clinic's usual charge made to the general public.
   (2) For purposes of this section, "cost" means an aggregate amount
equivalent to the sum of the actual acquisition cost of a drug or
supply plus a clinic dispensing fee. The actual acquisition cost of a
drug or supply shall be calculated not less than annually. The
clinic dispensing fee shall be the difference between the actual
acquisition cost of a drug or supply and the Medi-Cal reimbursement
rate.
   (c) Reimbursement shall be at the lesser of the amount billed or
the Medi-Cal reimbursement rate.
   (d) A clinic described in subdivision (a) that furnishes services
free of charge, or at a nominal charge, as defined in subsection (a)
of Section 413.13 of Title 42 of the Code of Federal Regulations, or
that can demonstrate to the department, upon request, that it serves
primarily low-income patients, and its customary practice is to
charge patients on the basis of their ability to pay, shall not be
subject to reimbursement reductions based on its usual charge to the
general public.
   (e) Federally qualified health centers and rural health clinics
that are clinics as described in subdivision (a) may bill and be
reimbursed as described in this section, upon electing to be
reimbursed for pharmaceutical goods and services  delivered
through their dispensaries  on a fee-for-service basis, as
permitted by subdivision (k) of Section 14132.100.
   (f) A clinic that otherwise meets the qualifications set forth in
subdivision (a), that is eligible to, but that has elected not to,
utilize drugs purchased under the 340B Discount Drug Program for its
Medi-Cal patients, shall provide notification to the Health Resources
and Services Administration's Office of Pharmacy Affairs that it is
utilizing non-340B drugs for its Medi-Cal patients in the manner and
to the extent required by federal law.