BILL NUMBER: AB 417	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Beall

                        FEBRUARY 23, 2009

   An act to amend, repeal, and add Section 11758.46 of the Health
and Safety Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 417, as introduced, Beall. Medi-Cal Drug Treatment Program:
buprenorphine.
   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 for the Medi-Cal Drug Treatment Program
(Drug Medi-Cal), under which each county enters into contracts with
the State Department of Alcohol and Drug Programs for the provision
of various drug treatment services to Medi-Cal recipients, or the
department directly arranges for the provision of these services if a
county elects not to do so.
   This bill, commencing January 1, 2012, would add buprenorphine
services to the list of Drug Medi-Cal services, but only if
buprenorphine is prescribed by a physician who complies with federal
requirements regarding qualifications, certification, and limitations
on the number of patients for whom the physician may prescribe
buprenorphine.
   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 11758.46 of the Health and Safety Code is
amended to read:
   11758.46.  (a) For purposes of this section, "Drug Medi-Cal
services" means all of the following services, administered by the
department, and to the extent consistent with state and federal law:
   (1) Narcotic treatment program services, as set forth in Section
11758.42.
   (2) Day care rehabilitative services.
   (3) Perinatal residential services for pregnant women and women in
the postpartum period.
   (4) Naltrexone services.
   (5) Outpatient drug-free services.
   (b) Upon federal approval of a federal Medicaid state plan
amendment authorizing federal financial participation in the
following services, and subject to appropriation of funds, "Drug
Medi-Cal services" shall also include the following services,
administered by the department, and to the extent consistent with
state and federal law:
   (1) Notwithstanding subdivision (a) of Section 14132.90 of the
Welfare and Institutions Code, day care habilitative services, which,
for purposes of this paragraph, are outpatient counseling and
rehabilitation services provided to persons with alcohol or other
drug abuse diagnoses.
   (2) Case management services, including supportive services to
assist persons with alcohol or other drug abuse diagnoses in gaining
access to medical, social, educational, and other needed services.
   (3) Aftercare services.
   (c) (1) Annually, the department shall publish procedures for
contracting for Drug Medi-Cal services with certified providers and
for claiming payments, including procedures and specifications for
electronic data submission for services rendered.
   (2) The department, county alcohol and drug program
administrators, and alcohol and drug service providers shall automate
the claiming process and the process for the submission of specific
data required in connection with reimbursement for Drug Medi-Cal
services, except that this requirement applies only if funding is
available from sources other than those made available for treatment
or other services.
   (d) A county or a contractor for the provision of Drug Medi-Cal
services shall notify the department, within 30 days of the receipt
of the county allocation, of its intent to contract, as a component
of the single state-county contract, and provide certified services
pursuant to Section 11758.42, for the proposed budget year. The
notification shall include an accurate and complete budget proposal,
the structure of which shall be mutually agreed to by county alcohol
and drug program administrators and the department, in the format
provided by the department, for specific services, for a specific
time period, and including estimated units of service, estimated rate
per unit consistent with law and regulations, and total estimated
cost for appropriate services.
   (e) (1) Within 30 days of receipt of the proposal described in
subdivision (d), the department shall provide, to counties and
contractors proposing to provide Drug Medi-Cal services in the
proposed budget year, a proposed multiple-year contract, as a
component of the single state-county contract, for these services, a
current utilization control plan, and appropriate administrative
procedures.
   (2) A county contracting for alcohol and drug services shall
receive a single state-county contract for the net negotiated amount
and Drug Medi-Cal services.
   (3) Contractors contracting for Drug Medi-Cal services shall
receive a Drug Medi-Cal contract.
   (f) (1) Upon receipt of a contract proposal pursuant to
subdivision (d), a county and a contractor seeking to provide
reimbursable Drug Medi-Cal services and the department may begin
negotiations and the process for contract approval.
   (2) If a county does not approve a contract by July 1 of the
appropriate fiscal year, in accordance with subdivisions (c) to (e),
inclusive, the county shall have 30 additional days in which to
approve a contract. If the county has not approved the contract by
the end of that 30-day period, the department shall contract directly
for services within 30 days.
   (3) Counties shall negotiate contracts only with providers
certified to provide reimbursable Drug Medi-Cal services and that
elect to participate in this program. Upon contract approval by the
department, a county shall establish approved contracts with
certified providers within 30 days following enactment of the annual
Budget Act. A county may establish contract provisions to ensure
interim funding pending the execution of final contracts,
multiple-year contracts pending final annual approval by the
department, and, to the extent allowable under the annual Budget Act,
other procedures to ensure timely payment for services.
   (g) (1) For counties and contractors providing Drug Medi-Cal
services, pursuant to approved contracts, and that have accurate and
complete claims, reimbursement for services from state General Fund
moneys shall commence no later than 45 days following the enactment
of the annual Budget Act for the appropriate state fiscal year.
   (2) For counties and contractors providing Drug Medi-Cal services,
pursuant to approved contracts, and that have accurate and complete
claims, reimbursement for services from federal Medicaid funds shall
commence no later than 45 days following the enactment of the annual
Budget Act for the appropriate state fiscal year.
   (3) The State Department of Health Care Services and the
department shall develop methods to ensure timely payment of Drug
Medi-Cal claims.
   (4) The State Department of Health Care Services, in cooperation
with the department, shall take steps necessary to streamline the
billing system for reimbursable Drug Medi-Cal services, to assist the
department in meeting the billing provisions set forth in this
subdivision.
   (h) The department shall submit a proposed interagency agreement
to the State Department of Health Care Services by May 1 for the
following fiscal year. Review and interim approval of all contractual
and programmatic requirements, except final fiscal estimates, shall
be completed by the State Department of Health Care Services by July
1. The interagency agreement shall not take effect until the annual
Budget Act is enacted and fiscal estimates are approved by the State
Department of Health Care Services. Final approval shall be completed
within 45 days of enactment of the Budget Act.
   (i) (1) A county or a provider certified to provide reimbursable
Drug Medi-Cal services, that is contracting with the department,
shall estimate the cost of those services by April 1 of the fiscal
year covered by the contract, and shall amend current contracts, as
necessary, by the following July 1.
   (2) A county or a provider, except for a provider to whom
subdivision (j) applies, shall submit accurate and complete cost
reports for the previous state fiscal year by November 1, following
the end of the state fiscal year. The department may settle cost for
Drug Medi-Cal services, based on the cost report as the final
amendment to the approved single state-county contract.
   (j) Certified narcotic treatment program providers, that are
exclusively billing the state or the county for services rendered to
persons subject to Section 1210.1 of the Penal Code, Section 3063.1
of the Penal Code, or Section 11758.42 shall submit accurate and
complete performance reports for the previous state fiscal year by
November 1 following the end of that state fiscal year. A provider to
which this subdivision applies shall estimate its budgets using the
uniform state daily reimbursement rate. The format and content of the
performance reports shall be mutually agreed to by the department,
the County Alcohol and Drug Program Administrators Association of
California, and representatives of the treatment providers. 
   (k) This section shall remain in effect only until January 1,
2012, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2012, deletes or extends
that date. 
  SEC. 2.  Section 11758.46 is added to the Health and Safety Code,
to read:
   11758.46.  (a) For purposes of this section, "Drug Medi-Cal
services" means all of the following services, administered by the
department, and to the extent consistent with state and federal law:
   (1) Narcotic treatment program services, as set forth in Section
11758.42.
   (2) Day care rehabilitative services.
   (3) Perinatal residential services for pregnant women and women in
the postpartum period.
   (4) Naltrexone services.
   (5) Outpatient drug-free services.
   (6) Buprenorphine services, but only if buprenorphine is
prescribed by a physician who complies with federal requirements
regarding qualifications, certification, and limitations on the
number of patients for whom the physician may prescribe
buprenorphine.
   (b) Upon federal approval of a federal Medicaid state plan
amendment authorizing federal financial participation in the
following services, and subject to appropriation of funds, "Drug
Medi-Cal services" shall also include the following services,
administered by the department, and to the extent consistent with
state and federal law:
   (1) Notwithstanding subdivision (a) of Section 14132.90 of the
Welfare and Institutions Code, day care habilitative services, which,
for purposes of this paragraph, are outpatient counseling and
rehabilitation services provided to persons with alcohol or other
drug abuse diagnoses.
   (2) Case management services, including supportive services to
assist persons with alcohol or other drug abuse diagnoses in gaining
access to medical, social, educational, and other needed services.
   (3) Aftercare services.
   (c) (1) Annually, the department shall publish procedures for
contracting for Drug Medi-Cal services with certified providers and
for claiming payments, including procedures and specifications for
electronic data submission for services rendered.
   (2) The department, county alcohol and drug program
administrators, and alcohol and drug service providers shall automate
the claiming process and the process for the submission of specific
data required in connection with reimbursement for Drug Medi-Cal
services, except that this requirement applies only if funding is
available from sources other than those made available for treatment
or other services.
   (d) A county or a contractor for the provision of Drug Medi-Cal
services shall notify the department, within 30 days of the receipt
of the county allocation, of its intent to contract, as a component
of the single state-county contract, and provide certified services
pursuant to Section 11758.42, for the proposed budget year. The
notification shall include an accurate and complete budget proposal,
the structure of which shall be mutually agreed to by county alcohol
and drug program administrators and the department, in the format
provided by the department, for specific services, for a specific
time period, and including estimated units of service, estimated rate
per unit consistent with law and regulations, and total estimated
cost for appropriate services.
   (e) (1) Within 30 days of receipt of the proposal described in
subdivision (d), the department shall provide, to counties and
contractors proposing to provide Drug Medi-Cal services in the
proposed budget year, a proposed multiple-year contract, as a
component of the single state-county contract, for these services, a
current utilization control plan, and appropriate administrative
procedures.
   (2) A county contracting for alcohol and drug services shall
receive a single state-county contract for the net negotiated amount
and Drug Medi-Cal services.
   (3) Contractors contracting for Drug Medi-Cal services shall
receive a Drug Medi-Cal contract.
   (f) (1) Upon receipt of a contract proposal pursuant to
subdivision (d), a county and a contractor seeking to provide
reimbursable Drug Medi-Cal services and the department may begin
negotiations and the process for contract approval.
   (2) If a county does not approve a contract by July 1 of the
appropriate fiscal year, in accordance with subdivisions (c) to (e),
inclusive, the county shall have 30 additional days in which to
approve a contract. If the county has not approved the contract by
the end of that 30-day period, the department shall contract directly
for services within 30 days.
   (3) Counties shall negotiate contracts only with providers
certified to provide reimbursable Drug Medi-Cal services and that
elect to participate in this program. Upon contract approval by the
department, a county shall establish approved contracts with
certified providers within 30 days following enactment of the annual
Budget Act. A county may establish contract provisions to ensure
interim funding pending the execution of final contracts,
multiple-year contracts pending final annual approval by the
department, and, to the extent allowable under the annual Budget Act,
other procedures to ensure timely payment for services.
   (g) (1) For counties and contractors providing Drug Medi-Cal
services, pursuant to approved contracts, and that have accurate and
complete claims, reimbursement for services from state General Fund
moneys shall commence no later than 45 days following the enactment
of the annual Budget Act for the appropriate state fiscal year.
   (2) For counties and contractors providing Drug Medi-Cal services,
pursuant to approved contracts, and that have accurate and complete
claims, reimbursement for services from federal Medicaid funds shall
commence no later than 45 days following the enactment of the annual
Budget Act for the appropriate state fiscal year.
   (3) The State Department of Health Care Services and the
department shall develop methods to ensure timely payment of Drug
Medi-Cal claims.
   (4) The State Department of Health Care Services, in cooperation
with the department, shall take steps necessary to streamline the
billing system for reimbursable Drug Medi-Cal services, to assist the
department in meeting the billing provisions set forth in this
subdivision.
   (h) The department shall submit a proposed interagency agreement
to the State Department of Health Care Services by May 1 for the
following fiscal year. Review and interim approval of all contractual
and programmatic requirements, except final fiscal estimates, shall
be completed by the State Department of Health Care Services by July
1. The interagency agreement shall not take effect until the annual
Budget Act is enacted and fiscal estimates are approved by the State
Department of Health Care Services. Final approval shall be completed
within 45 days of enactment of the Budget Act.
   (i) (1) A county or a provider certified to provide reimbursable
Drug Medi-Cal services, that is contracting with the department,
shall estimate the cost of those services by April 1 of the fiscal
year covered by the contract, and shall amend current contracts, as
necessary, by the following July 1.
   (2) A county or a provider, except for a provider to whom
subdivision (j) applies, shall submit accurate and complete cost
reports for the previous state fiscal year by November 1, following
the end of the state fiscal year. The department may settle cost for
Drug Medi-Cal services, based on the cost report as the final
amendment to the approved single state-county contract.
   (j) Certified narcotic treatment program providers, that are
exclusively billing the state or the county for services rendered to
persons subject to Section 1210.1 of the Penal Code, Section 3063.1
of the Penal Code, or Section 11758.42 shall submit accurate and
complete performance reports for the previous state fiscal year by
November 1 following the end of that state fiscal year. A provider to
which this subdivision applies shall estimate its budgets using the
uniform state daily reimbursement rate. The format and content of the
performance reports shall be mutually agreed to by the department,
the County Alcohol and Drug Program Administrators Association of
California, and representatives of the treatment providers.
   (k) This section shall become operative on January 1, 2012.