SB 1322, as introduced, Hernandez. Medi-Cal: preventive services: providers.
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 Program provisions. Existing law provides for a schedule of benefits under the Medi-Cal program, which includes specified preventive services.
This bill would require the department to reimburse Medi-Cal providers for, and would require Medi-Cal managed care plans to cover, preventive services provided by a health care practitioner not subject to professional licensure by the state, that have been recommended by a physician or other licensed practitioner of healing arts acting within the scope of that physician’s or practitioner’s license. The bill would provide that this coverage is available only to the extent that federal financial participation in the cost of providing these services is available. The bill would require the department to convene a working group, as specified, to determine the types of health care practitioners eligible to provide preventive services pursuant to these provisions and to develop a summary of practitioner qualifications for those practitioners to be included in any state plan amendment necessary to implement these provisions.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
(a) The Legislature finds and declares both of
2the following:
3(1) Research suggests that 50 percent of a physician’s time is
4spent providing preventive care and screenings, much of which
5can be provided by other health care practitioners.
6(2) On July 15, 2013, the Centers for Medicare and Medicaid
7Services released an update to federal Medicaid regulations that
8permits state Medicaid programs to reimburse for preventive
9services recommended by a physician or other licensed health care
10practitioner.
11(b) It is the intent of the Legislature in enacting this act to
12maximize federal funds to
provide critical preventive services to
13Medi-Cal beneficiaries by amending state law to reflect the July
1415, 2013, update to federal Medicaid regulations.
Section 14132.04 is added to the Welfare and
16Institutions Code, to read:
(a) (1) The department shall reimburse Medi-Cal
18providers for preventive services, as defined in Section 440.130(c)
19of Title 42 of the Code of Federal Regulations, provided by a health
20care practitioner not subject to professional licensure by the state,
21including, but not limited to, a community health worker, that have
22been recommended by a physician or other licensed practitioner
23of healing arts acting within the scope of that physician’s or
24practitioner’s license.
25(2) Medi-Cal managed care plans shall cover preventive
26services, as defined in Section 440.130(c) of Title 42 of the Code
27of Federal Regulations, provided by a health care practitioner not
28subject to professional licensure by the state, including, but not
29
limited to, a community health worker, that have been
30recommended by a physician or other licensed practitioner of
31healing arts acting within the scope of that physician’s or
32practitioner’s license.
33(3) Coverage for preventive services pursuant to this section
34shall be available only to the extent that federal financial
35participation in the cost of providing these services is available.
P3 1(b) By June 30, 2015, the department shall convene a working
2group to determine the types of health care practitioners eligible
3to provide preventive services pursuant to this section and the
4summary of qualifications for those practitioners to be included
5in any state plan amendment that may be necessary to implement
6this section. The working group shall include representatives from
7consumer advocacy groups, community health worker
8organizations, community clinics, physicians’ groups, and health
9
plans. The summary of practitioner qualifications shall reflect
10widely supported perspectives.
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