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AB-2203 Medi-Cal: primary care services.(2017-2018)

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Date Published: 02/12/2018 09:00 PM
AB2203:v99#DOCUMENT


CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 2203


Introduced by Assembly Member Gray

February 12, 2018


An act to add Section 14105.196 to the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 2203, as introduced, Gray. Medi-Cal: primary care services.
Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which basic health care services are provided to qualified low-income persons. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. Existing federal law requires the state to provide payment for primary care services furnished in the 2013 and 2014 calendar years by Medi-Cal providers with specified primary specialty designations at a rate not less than 100% of the payment rate that applies to those services and physicians under the federal Medicare Program. Under state law, this requirement was implemented for both Medi-Cal fee-for-service and managed care plans, only to the extent that the federal medical assistance percentage was equal to 100%, until January 1, 2015.
This bill would, beginning July 1, 2019, require that the basic Medi-Cal rate for primary care services provided by a primary care service provider be not less than 100% of the payment rate that applies to those services as established by the Medicare Program, as specified. The bill would make the payment increases inapplicable to provider rates for specified program services provided to individuals who are not eligible for the Medi-Cal program or the Family Planning, Access, Care, and Treatment (Family PACT) Program. The bill would also make the payments exempt from specified provider payment reductions. The bill would require the Director of Health Care Services to prepare appropriate amendments in the state plan and waiver requests, as necessary, for the implementation of these provisions. This bill would require the department to implement its provisions by provider bulletins or similar instructions until regulations are adopted.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 Section 14105.196 is added to the Welfare and Institutions Code, to read:

14105.196.
 (a) (1) Beginning July 1, 2019, the basic Medi-Cal rate for primary care services provided by a primary care service provider shall not be less than 100 percent of the payment rate that applies to those services as established by the federal Medicare Program, for both fee-for-service and managed care plans that contract with the department pursuant to this chapter and Chapter 8 (commencing with Section 14200).
(2) An adjustment in the basic Medi-Cal rate for primary care services pursuant to paragraph (1) shall be made within 90 days of a change in the payment rate that applies to those services as established by the Medicare Program.
(b) For purposes of this section, the following definitions shall apply:
(1) “Primary care services” means the services defined in Section 1396a(jj) of Title 42 of the United States Code.
(2) “Primary care service provider” means a Medi-Cal provider who either is, or works under the supervision of, a physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine.
(c) Payments for primary care services made pursuant to this section shall be exempt from the payment reductions under Sections 14105.191 and 14105.192.
(d) Payment increases made pursuant to this section shall not apply to provider rates of payment described in Section 14105.18 for services provided to individuals who are not eligible for the Medi-Cal program or the Family Planning, Access, Care, and Treatment (Family PACT) Program.
(e) The director shall prepare appropriate amendments in the state plan and waiver requests, as necessary, for the implementation of this section.
(f) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department shall implement, interpret, or make specific this section by means of provider bulletins or similar instructions, without taking regulatory action, until regulations are adopted.