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AB-678 Medi-Cal: podiatric services.(2019-2020)

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Date Published: 07/08/2019 02:00 PM
AB678:v97#DOCUMENT

Amended  IN  Senate  July 08, 2019
Amended  IN  Assembly  April 09, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 678


Introduced by Assembly Member Flora

February 15, 2019


An act to amend Section 14131.10 of, and to repeal and add Section 14133.07 of, the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 678, as amended, Flora. Medi-Cal: podiatric services.
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. services, including podiatric services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law excludes certain optional Medi-Cal benefits, including, among others, podiatric services and chiropractic services, from coverage under the Medi-Cal program, except for specified beneficiaries.

This bill would provide that the exclusion of podiatric services is effective only through December 31, 2019, and would restore podiatric services as a covered benefit of the Medi-Cal program as of January 1, 2020, or the effective date of federal approvals as specified.

Existing provisions. Existing law provides that prior authorization for podiatric services provided on an outpatient or inpatient basis is not required if specified conditions are met, including an urgent or emergency need for services at the time of service.
This bill would repeal these provisions, and would instead prohibit the requirement of prior authorization for podiatric services provided by a doctor of podiatric medicine if a physician and surgeon rendering the same services would not be required to provide prior authorization. The bill would clarify that a doctor of podiatric medicine acting within their scope of practice and providing specified services is subject to the same Medi-Cal billing and services policies as required for a physician and surgeon, including a maximum numerical service limitation in any one calendar month.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.Section 14131.10 of the Welfare and Institutions Code is amended to read:
14131.10.

(a)Notwithstanding any other provision of this chapter, Chapter 8 (commencing with Section 14200), or Chapter 8.75 (commencing with Section 14591), in order to implement changes in the level of funding for health care services, specific optional benefits are excluded from coverage under the Medi-Cal program.

(b)(1)The following optional benefits are excluded from coverage under the Medi-Cal program:

(A)Adult dental services, except as specified in paragraph (2).

(i)The exclusion identified in this subparagraph shall be in effect only through December 31, 2017, and adult dental services shall be covered under the Medi-Cal program as of January 1, 2018, or the effective date of any necessary federal approvals, whichever is later.

(ii)The restoration of adult dental services pursuant to clause (i) shall be effective only to the extent any necessary federal approvals are obtained as required by subdivision (f).

(B)Audiology services and speech therapy services.

(C)Chiropractic services.

(D)Optometric and optician services, including services provided by a fabricating optical laboratory, except as provided in subdivision (g).

(E)Podiatric services.

(i)The exclusion identified in this subparagraph shall be in effect only through December 31, 2019, and podiatric services shall be covered under the Medi-Cal program as of January 1, 2020, or the effective date of any necessary federal approvals, whichever is later.

(ii)The restoration of podiatric services pursuant to clause (i) shall be effective only to the extent any necessary federal approvals are obtained as required by subdivision (f).

(F)Psychology services.

(G)Incontinence creams and washes.

(2)(A)Medical and surgical services provided by a doctor of dental medicine or dental surgery, which, if provided by a physician, would be considered physician services, and which services may be provided by either a physician or a dentist in this state, are covered.

(B)Emergency procedures are also covered in the categories of service specified in subparagraph (A). The director may adopt regulations for any of the services specified in subparagraph (A).

(C)Effective May 1, 2014, or the effective date of any necessary federal approvals as required by subdivision (f), whichever is later, for persons 21 years of age or older, adult dental benefits, subject to utilization controls, are limited to all the following medically necessary services:

(i)Examinations, radiographs/photographic images, prophylaxis, and fluoride treatments.

(ii)Amalgam and composite restorations.

(iii)Stainless steel, resin, and resin window crowns.

(iv)Anterior root canal therapy.

(v)Complete dentures, including immediate dentures.

(vi)Complete denture adjustments, repairs, and relines.

(D)Services specified in this paragraph shall be included as a covered medical benefit under the Medi-Cal program pursuant to Section 14132.89.

(3)Pregnancy-related services and services for the treatment of other conditions that might complicate the pregnancy are not excluded from coverage under this section.

(c)The optional benefit exclusions do not apply to either of the following:

(1)Beneficiaries under the Early and Periodic Screening Diagnosis and Treatment Program.

(2)Beneficiaries receiving long-term care in a nursing facility that is both:

(A)A skilled nursing facility or intermediate care facility as defined in subdivisions (c) and (d) of Section 1250 of the Health and Safety Code.

(B)Licensed pursuant to subdivision (k) of Section 1250 of the Health and Safety Code.

(d)This section shall only be implemented to the extent permitted by federal law.

(e)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement the provisions of this section by means of all-county letters, provider bulletins, or similar instructions, without taking further regulatory action.

(f)This section shall be implemented only to the extent that federal financial participation is available and any necessary federal approvals have been obtained.

(g)(1)Effective no sooner than January 1, 2020, or January 1 of the subsequent calendar year following the legislative action pursuant to paragraph (2), whichever is later, and subject to paragraph (2) and subdivision (f), optometric and optician services, including services provided by a fabricating optical laboratory, shall be covered benefits under the Medi-Cal program.

(2)The restoration of optometric and optician services pursuant to this subdivision is contingent upon the Legislature including funding for these services in the state budget process.

SEC. 2.SECTION 1.

 Section 14133.07 of the Welfare and Institutions Code is repealed.

SEC. 3.SEC. 2.

 Section 14133.07 is added to the Welfare and Institutions Code, to read:

14133.07.
 (a) A doctor of podiatric medicine shall not be required to submit prior authorization for podiatric services rendered in either an outpatient or inpatient basis if a physician and surgeon providing the same services would not be required to submit prior authorization to the department.
(b) A doctor of podiatric medicine acting within their scope of practice and providing services pursuant to subdivision (a) is subject to the same Medi-Cal billing and services policies as required for a physician and surgeon, including, but not limited to, a maximum numerical service limitation in any one calendar month.