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AB-910 Medi-Cal: dispute resolution.(2019-2020)

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Date Published: 01/14/2020 09:00 PM
AB910:v97#DOCUMENT

Amended  IN  Assembly  January 14, 2020
Amended  IN  Assembly  January 06, 2020

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 910


Introduced by Assembly Member Wood

February 20, 2019


An act to add Section 14715.5 to the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 910, as amended, Wood. Medi-Cal: dispute resolution.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, including specialty mental health services and nonspecialty mental health services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Existing law requires the department to implement managed mental health care for Medi-Cal beneficiaries through contracts with county mental health plans. Under existing law, the county mental health plans are responsible for providing specialty mental health services to eligible Medi-Cal beneficiaries, and Medi-Cal managed care plans deliver nonspecialty mental health services to those persons. Existing law requires county mental health plans and Medi-Cal managed care plans to be governed by various guidelines, including network adequacy standards and a requirement that a county mental health plan that provides Medi-Cal specialty mental health services enter into a memorandum of understanding with a Medi-Cal managed care plan that provides Medi-Cal health services to some of the same Medi-Cal recipients served by the county mental health plan. Existing regulations provide for a dispute resolution process to be used to resolve matters between a Medi-Cal managed care plan and a county mental health plan.
This bill would require a county mental health plan and Medi-Cal managed care plan that are unable to resolve a dispute to submit a request for resolution to the department. The bill would require the department to issue a written decision to the plans within 30 calendar days from receipt of the request. request by either the county mental health plan or the Medi-Cal plan. The bill would also prohibit the dispute from delaying the provision of medically necessary services, 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 14715.5 is added to the Welfare and Institutions Code, immediately following Section 14715, to read:

14715.5.
 (a) (1) If a county mental health plan and a Medi-Cal managed care plan have a dispute, as described in Section 1850.505 of Title 9 of the California Code of Regulations, and are unable to reach a resolution within 15 business days from the initiation of the dispute resolution process, both the county mental health plan and the Medi-Cal managed care plan shall submit a request for resolution to the department.
(2) The department shall, within 30 calendar days from the receipt of the request, request by either the county mental health plan or the Medi-Cal plan, issue a written decision to the county mental health plan and the Medi-Cal managed care plan.
(b) A dispute between the county mental health plan and the Medi-Cal managed care plan shall not delay the provision of medically necessary services by the Medi-Cal managed care plan or the county mental health plan. Pending resolution of the dispute, both plans shall comply with Section 1850.525 of Title 9 of the California Code of Regulations.