Bill Text: CA AB1257 | 2015-2016 | Regular Session | Amended

California Assembly Bill 1257 (Prior Session Legislation)

Bill Title: Medi-Cal: ground ambulance rates.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2016-02-01 - From committee: Filed with the Chief Clerk pursuant to Joint Rule 56. [AB1257 Detail]

Download: California-2015-AB1257-Amended.html

BILL NUMBER: AB 1257	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  MARCH 26, 2015

INTRODUCED BY   Assembly Member Gray

                        FEBRUARY 27, 2015

   An act to  amend Section 14131.10   add
Article 5.8 (commencing with Section 14188) to Chapter 7 of Part 3 of
Division 9  of the Welfare and Institutions Code, relating to
Medi-Cal.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 1257, as amended, Gray. Medi-Cal:  optional benefits.
  ground ambulance rates. 
   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.   services, including medical transportation
services.  The Medi-Cal program is, in part, governed and funded
by federal Medicaid provisions.  Existing law provides,
except as specified, that certain optional Medi-Cal benefits,
including, among others, certain adult dental services and optometric
and optician services, are excluded from coverage under the Medi-Cal
program. Existing law, beginning May 1, 2014, or the effective date
of any necessary federal financial participation approvals, whichever
is later, provides that only specified adult dental services are a
covered Medi-Cal benefit for persons who are 21 years of age or
older, as specified.   Existing law and regulations
prescribe various requirements governing payment policies and
reimbursement rates for these services. 
   This bill would  make technical, nonsubstantive changes to
this provision.   require the State Department of
Health Care Services to establish payment rates for ground ambulance
services based on changes in the Consumer Price Index-  
Urban and the Geographic Practice Cost Index, and would require the
department to designate a specified ambulance cost study conducted by
the federal Government Accountability Office as the evidentiary
base. 
   Vote: majority. Appropriation: no. Fiscal committee:  no
  yes  . State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

   SECTION 1.    Article 5.8 (commencing with Section
14188) is added to Chapter 7 of Part 3 of Division 9 of the 
 Welfare and Institutions Code   , to read:  

      Article 5.8.  Ground Ambulance Service Rates


   14188.  The department shall establish payment rates for ground
ambulance services based on changes in the Consumer Price Index-Urban
(CPI-U) and the California weighted average Geographic Practice Cost
Index and shall designate the ambulance cost study conducted by the
federal Government Accountability Office (GAO-07-383) as the
evidentiary base.  
  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).
   (B) Acupuncture services.
   (C) Audiology services and speech therapy services.
   (D) Chiropractic services.
   (E) Optometric and optician services, including services provided
by a fabricating optical laboratory.
   (F) Podiatric services.
   (G) Psychology services.
   (H) 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 who are 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) The department shall seek approval for federal financial
participation and coverage of services specified in subparagraph (C)
of paragraph (2) of subdivision (b) under the Medi-Cal program.
   (g) This section, except as specified in subparagraph (C) of
paragraph (2) of subdivision (b), shall be implemented on the first
day of the month following 90 days after the operative date of this
section.