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

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Date Published: 07/11/2019 09:00 PM
SB382:v95#DOCUMENT

Amended  IN  Assembly  July 11, 2019
Amended  IN  Assembly  June 27, 2019
Amended  IN  Senate  April 29, 2019
Amended  IN  Senate  March 26, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Senate Bill
No. 382


Introduced by Senators Nielsen and Stern

February 20, 2019


An act to add Section 14197.6 to the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


SB 382, as amended, Nielsen. Medi-Cal: managed care health plan.
Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which health care services that are medically necessary are provided to qualified, low-income persons through various health care delivery systems, including managed care pursuant to Medi-Cal managed care plan contracts. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law generally requires Medi-Cal managed care plan contractors to be licensed pursuant to the Knox-Keene Health Care Service Plan Act of 1975. Under the act, a health care service plan is required to provide access to medically necessary health care services to its enrollees who have been displaced by a state of emergency, and existing law enumerates actions that a plan may be required to take to meet the needs of its enrollees during the state of emergency.
This bill would require a Medi-Cal managed care health plan to ensure that an enrollee who remains in a general acute care hospital continues to receive medically necessary postacute care services at the general acute care hospital if specified requirements are met, including that the Medi-Cal managed care health plan is unable to locate a postacute care facility within the plan’s network, as a result of a state of emergency, for purposes of transferring the enrollee to the postacute care facility.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


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 Medi-Cal managed care health plan contracts with the general acute care hospital 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 care 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 care 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) 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.