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SB-456 Medi-Cal managed care: federally qualified health centers and rural health clinics: services that follow the patient.(2017-2018)

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Date Published: 02/16/2017 09:00 PM
SB456:v99#DOCUMENT


CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Senate Bill No. 456


Introduced by Senator Pan

February 16, 2017


An act to add Section 14087.326 to the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


SB 456, as introduced, Pan. Medi-Cal managed care: federally qualified health centers and rural health clinics: services that follow the patient.
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 provisions. Existing law provides that federally qualified health center (FQHC) services and rural health clinic (RHC) services, as defined, are covered benefits under the Medi-Cal program. Existing law requires a managed care entity to offer subcontracts to FQHCs and RHCs in the relevant service area, as a condition of obtaining a contract with the department.
This bill would authorize a federally qualified health center or rural health clinic contracting with a managed care entity to enter into a separate, additional agreement for the provision of services that follow the patient. The bill would define “services that follow the patient” as services that promote continuity of care and contribute to overall patient wellness, as specified. The bill would specify that compensation paid to a federally qualified health center or rural health clinic pursuant to the agreement would be supplemental to, and separate from, the federally qualified health center’s or rural health clinic’s prospective payment rate, and not subject to reconciliation or reduction, as specified.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 Section 14087.326 is added to the Welfare and Institutions Code, to read:

14087.326.
 (a) A federally qualified health center or rural health clinic contracting with a managed care entity of the type described in Section 14087.325 may enter into a separate and additional agreement with the managed care entity for the provision of services that follow the patient, as described in this section.
(b) As used in this section, “services that follow the patient” means services that promote continuity of care and contribute to overall patient wellness. These services include, but are not limited to, all of the following:
(1) Comprehensive care management.
(2) Care coordination.
(3) Health and wellness initiatives.
(4) Comprehensive transitional care.
(5) Individual and family support services.
(6) Referral to community and social supports.
(c) Compensation paid to a federally qualified health center or rural health clinic pursuant to an agreement described in this section shall be supplemental to, and separate from, the federally qualified health center’s or rural health clinic’s prospective payment rate and shall not be subject to a reconciliation pursuant to Section 14087.325, or to any reduction.