Bill Text: CA AB220 | 2025-2026 | Regular Session | Enrolled
Bill Title: Medi-Cal: subacute care services.
Sponsorship: Partisan Bill (Democrat 2)
Status: (Vetoed) 2026-09-27 - Vetoed by Governor. [AB220 Detail]
Download: California-2025-AB220-Enrolled.html
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Enrolled
September 03, 2026 |
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Passed
IN
Senate
August 30, 2026 |
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Passed
IN
Assembly
August 30, 2026 |
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Amended
IN
Senate
August 25, 2026 |
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Amended
IN
Senate
July 08, 2025 |
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Amended
IN
Senate
June 16, 2025 |
CALIFORNIA LEGISLATURE—
2025–2026 REGULAR SESSION
Assembly Bill
No. 220
| Introduced by Assembly Member Jackson (Coauthor: Senator Menjivar) |
January 08, 2025 |
An act to amend Section 14132.25 of the Welfare and Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 220, Jackson.
Medi-Cal: subacute care services.
Existing law establishes 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 requires the department to establish a subacute care program in health facilities, as specified, to be available to patients in health facilities who meet subacute care criteria. Existing law requires that medical necessity for pediatric subacute care be substantiated by specified criteria. Existing regulations require a treatment authorization request for each admission to a subacute
unit.
If a provider substantiates that a patient meets any of the specified criteria for pediatric subacute care, this bill would prohibit a Medi-Cal managed care plan from imposing, or requiring the patient to meet, any additional criteria. If a standard form is developed by the department for purposes of authorization and reauthorization of pediatric or adult subacute care services, the bill would require a Medi-Cal managed care
plan to deem as sufficient and accept from a provider that standard form and would prohibit a plan from creating, or requiring a provider to submit, a separate form created by the plan or any other entity. The bill would prohibit a Medi-Cal managed care plan from requiring a subsequent treatment authorization request upon a patient’s return from a bed hold for acute hospitalization. The bill would authorize the department to impose sanctions on Medi-Cal managed care plans for violations of these provisions, as specified.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NOBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 14132.25 of the Welfare and Institutions Code is amended to read:14132.25.
(a) On or before July 1, 1983, the State Department of Health Care Services shall establish a subacute care program in health facilities to more effectively use the limited Medi-Cal dollars available while at the same time ensuring needed services for these patients. The subacute care program shall be available to patients in health facilities who meet subacute care criteria. Subacute care may be provided by any facility designated by the director as meeting the subacute care criteria that has an approved provider participation agreement with the department.(b) The department shall develop a rate of reimbursement for this subacute care program. Reimbursement rates shall be determined
in accordance with methodology developed by the department, specified in regulation, and may include the following:
(1) All-inclusive per diem rates.
(2) Individual patient-specific rates according to the needs of the individual subacute care patient.
(3) Other rates subject to negotiation with the health facility.
(c) Reimbursement at subacute care rates, as specified in subdivision (b), shall only be implemented if funds are available for this purpose pursuant to the annual Budget Act.
(d) The department may negotiate and execute an agreement with any health facility that meets the standards for providing subacute
care. An agreement may be negotiated or established between the health facility and the department for subacute care based on individual patient assessment. The department shall establish level of care criteria and appropriate utilization controls for patients eligible for the subacute care program.
(e) For the purposes of this section, pediatric subacute services are the health care services needed by a person under 21 years of age who uses a medical technology that compensates for the loss of a vital bodily function.
(f) (1) Medical necessity for pediatric subacute care services shall be substantiated in any one of the following ways:
(A) A tracheostomy with dependence on mechanical ventilation for a minimum of six hours each day.
(B) Dependence on tracheostomy care requiring suctioning at least every six hours, and room air mist or oxygen as needed, and dependence on one of the five treatment procedures listed in
clauses (ii) to (vi), inclusive:
(i) Dependence on intermittent suctioning at least every eight hours and room air mist and oxygen as needed.
(ii) Dependence on continuous intravenous therapy, including administration of a therapeutic agent
necessary for hydration or of intravenous pharmaceuticals, or intravenous pharmaceutical administration of more than one agent, via a peripheral or central line, without continuous infusion.
(iii) Dependence on peritoneal dialysis treatments requiring at least four exchanges every 24 hours.
(iv) Dependence on tube feeding by means of a nasogastric or gastrostomy tube.
(v) Dependence on other medical technologies required
continuously, which, in the opinion of the attending physician and the Medi-Cal consultant, require the services of a professional nurse.
(vi) Dependence on biphasic positive airway pressure at least six hours a day, including assessment or intervention every three hours and lacking either cognitive or physical ability of the patient to protect the patient’s airway.
(C) Dependence on total parenteral nutrition or other intravenous nutritional support, and dependence on one of the treatment procedures specified in clauses (i) to (vi), inclusive, of subparagraph (B).
(D) Dependence on skilled nursing care in the administration of any three of the six treatment procedures specified in clauses (i) to (vi), inclusive, of subparagraph (B).
(E) Dependence on biphasic positive airway pressure or continuous positive airway pressure at least six hours a day, including assessment or intervention every three
hours, and lacking either cognitive or physical ability of the patient to protect the patient’s airway, and dependence on one of the five treatment procedures specified in clauses (i) to (vi), inclusive, of subparagraph (B).
(2) If a provider substantiates that a patient meets any of the criteria under paragraph (1), a Medi-Cal managed care plan shall not impose, nor require the patient to meet, any additional criteria.
(g) The medical necessity determination outlined in paragraph (1) of subdivision (f) is intended solely for the evaluation of a patient who is potentially eligible and meets the criteria to be transferred from an acute care setting to a subacute level of care.
(h) If a standard form is developed by the department for purposes of authorization and reauthorization of pediatric or adult subacute care services, the following shall apply:
(1) A Medi-Cal managed care plan shall deem as sufficient and accept from a provider the standard form developed by the department for purposes of authorization and reauthorization for pediatric or adult subacute care services.
(2) A Medi-Cal managed care plan shall not create, nor require a provider to submit, a separate form created by the Medi-Cal managed care plan or any other entity for purposes of authorization and
reauthorization for pediatric or adult subacute care services.
(i) A Medi-Cal managed care plan shall not require a subsequent
treatment authorization request for subacute care services upon a patient’s return from a bed hold for acute hospitalization as described in Section 51535.1 of Title 22 of the California Code of Regulations.
(j) The department may impose sanctions on Medi-Cal managed care plans pursuant to Section 14197.7 for violations of subdivisions (h) and (i).
