Bill Text: CA AB1967 | 2013-2014 | Regular Session | Chaptered
Bill Title: Drug Medi-Cal.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Passed) 2014-09-19 - Chaptered by Secretary of State - Chapter 461, Statutes of 2014. [AB1967 Detail]
Download: California-2013-AB1967-Chaptered.html
BILL NUMBER: AB 1967 CHAPTERED
BILL TEXT
CHAPTER 461
FILED WITH SECRETARY OF STATE SEPTEMBER 19, 2014
APPROVED BY GOVERNOR SEPTEMBER 19, 2014
PASSED THE SENATE AUGUST 20, 2014
PASSED THE ASSEMBLY AUGUST 21, 2014
AMENDED IN SENATE JULY 1, 2014
AMENDED IN ASSEMBLY APRIL 10, 2014
AMENDED IN ASSEMBLY MARCH 28, 2014
INTRODUCED BY Assembly Member Pan
FEBRUARY 19, 2014
An act to amend Section 14124.24 of the Welfare and Institutions
Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 1967, Pan. Drug Medi-Cal.
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.
The Medi-Cal program is, in part, governed and funded by federal
Medicaid Program provisions. Existing law establishes the Drug
Medi-Cal Treatment Program (Drug Medi-Cal) under which the department
is authorized to enter into contracts with counties for various drug
treatment services to Medi-Cal recipients, or is required to
directly arrange for these services if a county elects not to do so.
Existing law requires a county to negotiate contracts only with
providers certified to provide Drug Medi-Cal services. Existing law
defines Drug Medi-Cal reimbursable services for purposes of these
provisions.
This bill would require the department to promptly notify the
behavioral health director, or his or her equivalent, of each county
that currently contracts with a certified provider for Drug Medi-Cal
services if the department has commenced or concluded a preliminary
criminal investigation, as defined, of the provider. This bill would
require that any communication between the department and a county
specific to the commencement or conclusion of a preliminary criminal
investigation is confidential and not subject to disclosure pursuant
to, among other things, the California Public Records Act. This bill
would prohibit a county from taking any adverse action against a
provider solely upon the preliminary criminal information disclosed
to the county. This bill would authorize the department to notify the
county if a preliminary criminal investigation of a county owned or
operated program is commenced or concluded by the department. The
bill would also make technical, nonsubstantive changes to the
definition of Drug Medi-Cal reimbursable services.
Existing constitutional provisions require that a statute that
limits the right of access to the meetings of public bodies or the
writings of public officials and agencies be adopted with findings
demonstrating the interest protected by the limitation and the need
for protecting that interest.
This bill would make legislative findings to that effect.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14124.24 of the Welfare and Institutions Code
is amended to read:
14124.24. (a) For purposes of this section, "Drug Medi-Cal
reimbursable services" means the substance use disorder services
described in the California State Medicaid Plan and includes, but is
not limited to, all of the following services, administered by the
department, and to the extent consistent with state and federal law:
(1) Narcotic treatment program services, as set forth in Section
14021.51.
(2) Day care rehabilitative services.
(3) Perinatal residential services for pregnant women and women in
the postpartum period.
(4) Naltrexone services.
(5) Outpatient drug-free services.
(6) Other services upon approval of a federal Medicaid state plan
amendment or waiver authorizing federal financial participation.
(b) (1) While seeking federal approval for any federal Medicaid
state plan amendment or waiver associated with Drug Medi-Cal
services, the department shall consult with the counties and
stakeholders in the development of the state plan amendment or
waiver.
(2) Upon federal approval of a federal Medicaid state plan
amendment authorizing federal financial participation in the
following services, and subject to appropriation of funds, "Drug
Medi-Cal reimbursable services" shall also include the following
services, administered by the department, and to the extent
consistent with state and federal law:
(A) Notwithstanding subdivision (a) of Section 14132.90, day care
habilitative services, which, for purposes of this paragraph, are
outpatient counseling and rehabilitation services provided to persons
with substance use disorder diagnoses.
(B) Case management services, including supportive services to
assist persons with substance use disorder diagnoses in gaining
access to medical, social, educational, and other needed services.
(C) Aftercare services.
(c) (1) The nonfederal share for Drug Medi-Cal services shall be
funded through a county's Behavioral Health Subaccount of the Support
Services Account of the Local Revenue Fund 2011, and any other
available county funds eligible under federal law for federal
Medicaid reimbursement. The funds contained in each county's
Behavioral Health Subaccount of the Support Services Account of the
Local Revenue Fund 2011 shall be considered state funds distributed
by the principal state agency for the purposes of receipt of the
federal block grant funds for prevention and treatment of substance
abuse found at Subchapter XVII of Chapter 6A of Title 42 of the
United States Code. Pursuant to applicable federal Medicaid law and
regulations including Section 433.51 of Title 42 of the Code of
Federal Regulations, counties may claim allowable Medicaid federal
financial participation for Drug Medi-Cal services based on the
counties certifying their actual total funds expenditures for
eligible Drug Medi-Cal services to the department.
(2) (A) If the director determines that a county's provision of
Drug Medi-Cal treatment services are disallowed by the federal
government or by state or federal audit or review, the impacted
county shall be responsible for repayment of all disallowed federal
funds. In addition to any other recovery methods available,
including, but not limited to, offset of Medicaid federal financial
participation funds owed to the impacted county, the director may
offset these amounts in accordance with Section 12419.5 of the
Government Code.
(B) A county subject to an action by the director pursuant to
subparagraph (A) may challenge that action by requesting a hearing in
writing no later than 30 days from receipt of notice of the
department's action. The proceeding shall be conducted in accordance
with Chapter 5 (commencing with Section 11500) of Part 1 of Division
3 of Title 2 of the Government Code, and the director has all the
powers granted therein. Upon a county's timely request for hearing,
the county's obligation to make payment as determined by the director
shall be stayed pending the county's exhaustion of administrative
remedies provided herein but no longer than will ensure the
department's compliance with Section 1903(d)(2)(C) of the federal
Social Security Act (42 U.S.C. Sec. 1396b).
(d) Drug Medi-Cal services are only reimbursable to Drug Medi-Cal
providers with an approved Drug Medi-Cal contract.
(e) Counties shall negotiate contracts only with providers
certified to provide Drug Medi-Cal services.
(f) The department shall develop methods to ensure timely payment
of Drug Medi-Cal claims.
(g) (1) A county or a contracted provider, except for a provider
to whom subdivision (h) applies, shall submit accurate and complete
cost reports for the previous fiscal year by November 1, following
the end of the fiscal year. The department may settle Drug Medi-Cal
reimbursable services, based on the cost report as the final
amendment to the approved county Drug Medi-Cal contract.
(2) Amounts paid for services provided to Drug Medi-Cal
beneficiaries shall be audited by the department in the manner and
form described in Section 14170.
(3) Administrative appeals to review grievances or complaints
arising from the findings of an audit or examination made pursuant to
this section shall be subject to Section 14171.
(h) Certified narcotic treatment program providers that are
exclusively billing the state or the county for services rendered to
persons subject to Section 1210.1 or 3063.1 of the Penal Code or
Section 14021.52 of this code shall submit accurate and complete
performance reports for the previous state fiscal year by November 1
following the end of that fiscal year. A provider to which this
subdivision applies shall estimate its budgets using the uniform
state daily reimbursement rate. The format and content of the
performance reports shall be mutually agreed to by the department,
the County Alcohol and Drug Program Administrators' Association of
California, and representatives of the treatment providers.
(i) Contracts entered into pursuant to this section shall be
exempt from the requirements of Chapter 1 (commencing with Section
10100) and Chapter 2 (commencing with Section 10290) of Part 2 of
Division 2 of the Public Contract Code.
(j) Annually, the department shall publish procedures for
contracting for Drug Medi-Cal services with certified providers and
for claiming payments, including procedures and specifications for
electronic data submission for services rendered.
(k) If the department commences a preliminary criminal
investigation of a certified provider, the department shall promptly
notify each county that currently contracts with the provider for
Drug Medi-Cal services that a preliminary criminal investigation has
commenced. If the department concludes a preliminary criminal
investigation of a certified provider, the department shall promptly
notify each county that currently contracts with the provider for
Drug Medi-Cal services that a preliminary criminal investigation has
concluded.
(1) Notice of the commencement and conclusion of a preliminary
criminal investigation pursuant to this section shall be made to the
county behavioral health director or his or her equivalent.
(2) Communication between the department and a county specific to
the commencement or conclusion of a preliminary criminal
investigation pursuant to this section shall be deemed confidential
and shall not be subject to any disclosure request, including, but
not limited to, the Information Practices Act of 1997 (Chapter 1
(commencing with Section 1798) of Title 1.8 of Part 4 of Division 3
of the Code of Civil Procedure), the California Public Records Act
(Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1
of the Government Code), requests pursuant to a subpoena, or for any
other public purpose, including, but not limited to, court testimony.
(3) Information shared by the department with a county regarding a
preliminary criminal investigation shall be maintained in a manner
to ensure protection of the confidentiality of the criminal
investigation.
(4) The information provided to a county pursuant to this section
shall only include the provider name, national provider identifier
(NPI) number, address, and the notice that an investigation has
commenced or concluded.
(5) A county shall not take any adverse action against a provider
based solely upon the preliminary criminal investigation information
disclosed to the county pursuant to this section.
(6) In the event of a preliminary criminal investigation of a
county owned or operated program, the department has the option to,
but is not required to, notify the county pursuant to this section
when the department commences or concludes a preliminary criminal
investigation.
(7) This section shall not limit the voluntary or otherwise
legally mandated or contractually mandated sharing of information
between the department and a county of information regarding audits
and investigations of Drug Medi-Cal providers.
(8) "Commenced" means the time at which a complaint or allegation
is assigned to an investigator for a field investigation.
(9) "Preliminary criminal investigation" means an investigation to
gather information to determine if criminal law or statutes have
been violated.
SEC. 2. The Legislature finds and declares that Section 1 of this
act, which amends Section 14124.24 of the Welfare and Institutions
Code, imposes a limitation on the public's right of access to the
meetings of public bodies or the writings of public officials and
agencies within the meaning of Section 3 of Article I of the
California Constitution. Pursuant to that constitutional provision,
the Legislature makes the following findings to demonstrate the
interest protected by this limitation and the need for protecting
that interest:
The Legislature finds and declares that in order to protect the
rights of Drug Medi-Cal providers during a preliminary criminal
investigation, including, but not limited to, due process and privacy
rights, the limitations on the public's right of access imposed by
Section 1 of this act are necessary.
