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.

Existing law, subject to certain exceptions, prohibits a provider under the Medi-Cal program from submitting a reimbursement request to the Medi-Cal program that contains a beneficiary’s social security number in order to receive payment if the department has issued that beneficiary a Medi-Cal beneficiary identification card containing a beneficiary number that includes the issuance date.

This bill would delete the limitation on this prohibition to those instances in which the request is submitted in order to receive payment, but would exempt the submission of a request by a provider for beneficiary eligibility from the prohibition.

Existing law provides that the above prohibition does not apply to a licensed hospital, long-term health care facility, a primary care clinic, or emergency medical transportation services.

This bill would, instead, exempt from this prohibition a licensed hospital, long-term health care facility, a primary care clinic, emergency medical transportation services, or a hospital-based physician, only if the providers of these services have made a good faith effort to obtain a recipient’s beneficiary identification card number. It would, however, terminate this exemption when the department establishes an automated system whereby a provider can access a beneficiary identification card number for submitting reimbursement requests.