Today's Law As Amended

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SB-447 Medi-Cal: clinics: drugs, devices, and supplies.(2015-2016)



SECTION 1.

 Section 14132.01 of the Welfare and Institutions Code is amended to read:

14132.01.
 (a) Notwithstanding any other provision of  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  drugs, devices,  and supplies covered under the Medi-Cal program and Family PACT Waiver  Program.
(b) (1)  A clinic described in subdivision (a) shall bill the Medi-Cal program and Family PACT Waiver  Program for drugs  contraceptive drugs, devices,  and supplies covered under those programs at the lesser of cost or the clinic’s usual charge made to the general public. Medi-Cal reimbursement rate. 
(c) (1) A clinic described in subdivision (a) shall bill the Medi-Cal program or the Family PACT Program for non-contraceptive drugs, devices, 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,  subdivision only,  “cost” means an aggregate amount equivalent to the sum of the  actual acquisition cost of a drug  non-contraceptive drug, device,  or supply plus a clinic dispensing fee not to exceed twelve dollars ($12) per billing unit as  as determined by the department and  identified in either the Medi-Cal Provider Manual or the  Family PACT Policies, Procedures, and Billing Instructions Manual, or the Medi-Cal Inpatient/Outpatient Provider Manual governing outpatient clinic billing for drugs and supplies, as applicable. For purposes of this section, “cost” for a take-home drug that is dispensed for use by the patient within a specific timeframe of five or less days from the date medically indicated means actual acquisition cost for that drug plus a clinic dispensing fee, not to exceed seventeen dollars ($17) per prescription. Reimbursement shall be at the lesser of the amount billed or  Manual. If the department does not identify a clinic dispensing fee in either the Medi-Cal Provider Manual or the Family PACT Policies, Procedures, and Billing Instructions Manual, the clinic dispensing fee shall be the difference between the actual acquisition cost and  the Medi-Cal reimbursement rate, and shall not exceed the net cost of these drugs or supplies when provided by retail pharmacies under the Medi-Cal program. rate. 
(3) Reimbursement for non-contraceptive drugs, devices, and supplies shall be the lesser of the amount billed or the Medi-Cal reimbursement rate, and shall not exceed the net cost of the non-contraceptive drugs, devices, and supplies when provided by retail pharmacies under the Medi-Cal program.
(c) (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.
(d) (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  drugs, devices, and supplies delivered through their dispensaries  on a fee-for-service basis, as permitted by subdivision (k) of Section 14132.100.
(e) (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.
(g) The department shall seek federal approval of any state plan amendments necessary to implement this section.
(h) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement this section by means of provider bulletins or similar instructions until the time any necessary regulations are adopted. Thereafter, by July 1, 2018, the department shall adopt regulations in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. Until those regulations have been adopted, the department shall provide a status report to the Legislature on a semiannual basis and pursuant to Section 9795 of the Government Code.
(i) This section shall be implemented only if and to the extent that federal financial participation is available and any necessary federal approvals have been obtained.