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AB-2340 Medi-Cal: benefits: clinic costs for drugs and supplies.(2013-2014)

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Amended  IN  Senate  June 19, 2014
Amended  IN  Assembly  March 28, 2014

CALIFORNIA LEGISLATURE— 2013–2014 REGULAR SESSION

Assembly Bill
No. 2340


Introduced by Assembly Member Garcia

February 21, 2014


An act to amend Section 131019.5 of the Health and Safety 14132.01 of the Welfare and Institutions Code, relating to public health Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 2340, as amended, Garcia. State Department of Public Health: Office of Health Equity. Medi-Cal: benefits: clinic costs for drugs and supplies.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law provides for a department-administered uniform schedule of health care benefits. Existing law sets the cost that specified clinics bill the Medi-Cal program and the Family PACT Waiver Program for drugs and supplies at an aggregate amount equivalent to the sum of the actual acquisition cost of a drug or supply plus a clinic dispensing fee not to exceed $12 per billing unit, as specified. Existing law sets the cost for a take-home drug that is dispensed for use by the patient within a specific timeframe of 5 or less days from the date medically indicated at the actual acquisition cost for that drug plus a clinic dispensing fee, not to exceed $17 per prescription. Existing law sets the reimbursement at the lesser of the amount billed or the Medi-Cal reimbursement rate and caps reimbursement at the net cost of these drugs or supplies when provided by retail pharmacies under the Medi-Cal program.
This bill would remove the cap on the dispensing fees. The bill would require the clinic dispensing fee to be the difference between the actual acquisition cost of a drug or supply, to be calculated not less than annually, and the Medi-Cal reimbursement rate. The bill would also remove the cap on reimbursement that is based on the cost of drugs or supplies provided by retail pharmacies.

Existing law requires the State Department of Public Health to establish an Office of Health Equity, led by the Deputy Director of the Office of Health Equity, for the purposes of aligning state resources, decisionmaking, and programs to accomplish various goals, including improving the health status of all populations and places, with a priority on eliminating health and mental health disparities and inequities. Existing law requires the office to establish an advisory committee, as specified, to advance the goals of the office and to actively participate in decisionmaking.

This bill would authorize the deputy director to include on the advisory committee representatives from women’s health organizations that focus on health disparities and inequalities related to gender.

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: NOYES   Local Program: NO  

The people of the State of California do enact as follows:


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 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 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, “cost” means an aggregate amount equivalent to the sum of the actual acquisition cost of a drug or supply plus a clinic dispensing fee not to exceed twelve dollars ($12) per billing unit as identified in either 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 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. fee. The actual acquisition cost of a drug or supply shall be calculated not less than annually. The clinic dispensing fee shall be the difference between the actual acquisition cost of a drug or supply and the Medi-Cal reimbursement rate.
(c) Reimbursement shall be at the lesser of the amount billed or the Medi-Cal reimbursement rate.

(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 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.