Today's Law As Amended


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SB-382 Medi-Cal: managed care health plan.(2019-2020)



As Amends the Law Today


SECTION 1.

 Section 14197.6 is added to the Welfare and Institutions Code, to read:

14197.6.
 (a) A Medi-Cal managed care health plan shall ensure that an enrollee who remains in a general acute care hospital, as defined in subdivision (a) of Section 1250 of the Health and Safety Code, continues to receive medically necessary postacute care services at the general acute care hospital if all of the following requirements are met:
(1) The Governor has declared a state of emergency pursuant to Section 8625 of the Government Code. As a result of the state of emergency, the Medi-Cal managed care health plan is unable to locate a postacute care facility within the plan’s network for purposes of transferring the enrollee to the postacute care facility, and, consequently, there is no contracted postacute facility available.
(2) The Medi-Cal managed care health plan has been provided an opportunity to locate a postacute care facility within the plan’s network for transfer, and the Medi-Cal managed care health plan is unsuccessful in securing the transfer, as specified in paragraph (1).
(3) The general acute care hospital contacts the Medi-Cal managed care health plan within 24 hours from the time that the enrollee no longer meets the medical necessity criteria to remain in the general acute care hospital.
(4) (A) The Medi-Cal managed care health plan has not otherwise addressed payment for an extended stay at a general acute care hospital in its contract with the general acute care hospital.
(B) For purposes of this paragraph, “extended stay” means the days of postacute care services provided in the general acute care hospital following the period that the patient no longer meets the medical necessity criteria to receive acute care services from the general acute care hospital.
(b) The daily reimbursement for health care provided by the general acute care hospital until the transfer occurs shall be, at a minimum, the acute administrative day rate established by the department.
(c) This section does not alter, reduce, or modify in any manner the responsibilities and duties of a Medi-Cal managed care health plan relating to benefits, services, or reimbursement standards.
(d) This section shall be implemented only to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.
(e) For purposes of this section, “Medi-Cal managed care health plan” means any individual, organization, or entity that enters into a contract with the department to provide services, excluding dental and mental health services, to enrolled Medi-Cal beneficiaries, pursuant to any of the following:
(1) Article 2.7 (commencing with Section 14087.3).
(2) Article 2.8 (commencing with Section 14087.5).
(3) Article 2.81 (commencing with Section 14087.96).
(4) Article 2.82 (commencing with Section 14087.98).
(5) Article 2.91 (commencing with Section 14089).
(6) Chapter 8 (commencing with Section 14200).
(7) Chapter 3 (commencing with Section 101675) of Part 4 of Division 101 of the Health and Safety Code.