Bill Text: CA AB2340 | 2013-2014 | Regular Session | Amended
Bill Title: Medi-Cal: benefits: clinic costs for drugs and supplies.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Engrossed - Dead) 2014-06-23 - Re-referred to Com. on HEALTH. [AB2340 Detail]
Download: California-2013-AB2340-Amended.html
BILL NUMBER: AB 2340 AMENDED
BILL TEXT
AMENDED IN SENATE JUNE 19, 2014
AMENDED IN ASSEMBLY MARCH 28, 2014
INTRODUCED BY Assembly Member Garcia
FEBRUARY 21, 2014
An act to amend Section 131019.5 of the Health and Safety
14132.01 of the Welfare and Institutions Code,
relating to public health Medi-Cal .
LEGISLATIVE COUNSEL'S DIGEST
AB 2340, as amended, Garcia. State Department of Public
Health: Office of Health Equity. Medi-Cal: benefits:
clinic costs for drugs and supplies.
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 provides for a
department-administered uniform schedule of health care benefits.
Existing law sets the cost that specified clinics bill the Medi-Cal
program and the Family PACT Waiver Program for drugs and supplies at
an aggregate amount equivalent to the sum of the actual acquisition
cost of a drug or supply plus a clinic dispensing fee not to exceed
$12 per billing unit, as specified. Existing law sets the cost for a
take-home drug that is dispensed for use by the patient within a
specific timeframe of 5 or less days from the date medically
indicated at the actual acquisition cost for that drug plus a clinic
dispensing fee, not to exceed $17 per prescription. Existing law sets
the reimbursement at the lesser of the amount billed or the Medi-Cal
reimbursement rate and caps reimbursement at the net cost of these
drugs or supplies when provided by retail pharmacies under the
Medi-Cal program.
This bill would remove the cap on the dispensing fees. The bill
would require the clinic dispensing fee to be the difference between
the actual acquisition cost of a drug or supply, to be calculated not
less than annually, and the Medi-Cal reimbursement rate. The bill
would also remove the cap on reimbursement that is based on the cost
of drugs or supplies provided by retail pharmacies.
Existing law requires the State Department of Public Health to
establish an Office of Health Equity, led by the Deputy Director of
the Office of Health Equity, for the purposes of aligning state
resources, decisionmaking, and programs to accomplish various goals,
including improving the health status of all populations and places,
with a priority on eliminating health and mental health disparities
and inequities. Existing law requires the office to establish an
advisory committee, as specified, to advance the goals of the office
and to actively participate in decisionmaking.
This bill would authorize the deputy director to include on the
advisory committee representatives from women's health organizations
that focus on health disparities and inequalities related to gender.
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. Section 14132.01 of the
Welfare and Institutions Code is amended to read:
14132.01. (a) Notwithstanding any other provision of law, a
community clinic or free clinic licensed pursuant to subdivision (a)
of Section 1204 of the Health and Safety Code or an intermittent
clinic operating pursuant to subdivision (h) of Section 1206 of the
Health and Safety Code, that has a valid license pursuant to Article
13 (commencing with Section 4180) of Chapter 9 of Division 2 of the
Business and Professions Code shall bill and be reimbursed, as
described in this section, for drugs and supplies covered under the
Medi-Cal program and Family PACT Waiver Program.
(b) (1) A clinic described in subdivision (a) shall bill the
Medi-Cal program and Family PACT Waiver Program for drugs and
supplies covered under those programs at the lesser of cost or the
clinic's usual charge made to the general public.
(2) For purposes of this section, "cost" means an aggregate amount
equivalent to the sum of the actual acquisition cost of a drug or
supply plus a clinic dispensing fee not to exceed twelve
dollars ($12) per billing unit as identified in either the Family
PACT Policies, Procedures, and Billing Instructions Manual, or the
Medi-Cal Inpatient/Outpatient Provider Manual governing outpatient
clinic billing for drugs and supplies, as applicable. For purposes of
this section, "cost" for a take-home drug that is dispensed for use
by the patient within a specific timeframe of five or less days from
the date medically indicated means actual acquisition cost for that
drug plus a clinic dispensing fee, not to exceed seventeen dollars
($17) per prescription. Reimbursement shall be at the lesser of the
amount billed or the Medi-Cal reimbursement rate, and shall not
exceed the net cost of these drugs or supplies when provided by
retail pharmacies under the Medi-Cal program. fee. The
actual acquisition cost of a drug or supply shall be calculated not
less than annually. The clinic dispensing fee shall be the difference
between the actual acquisition cost of a drug or supply and the
Medi-Cal reimbursement rate.
(c) Reimbursement shall be at the lesser of the amount billed or
the Medi-Cal reimbursement rate.
(c)
(d) A clinic described in subdivision (a) that
furnishes services free of charge, or at a nominal charge, as defined
in subsection (a) of Section 413.13 of Title 42 of the Code of
Federal Regulations, or that can demonstrate to the department, upon
request, that it serves primarily low-income patients, and its
customary practice is to charge patients on the basis of their
ability to pay, shall not be subject to reimbursement reductions
based on its usual charge to the general public.
(d)
(e) Federally qualified health centers and rural health
clinics that are clinics as described in subdivision (a) may bill
and be reimbursed as described in this section, upon electing to be
reimbursed for pharmaceutical goods and services on a fee-for-service
basis, as permitted by subdivision (k) of Section 14132.100.
(e)
(f) A clinic that otherwise meets the qualifications
set forth in subdivision (a), that is eligible to, but that has
elected not to, utilize drugs purchased under the 340B Discount Drug
Program for its Medi-Cal patients, shall provide notification to the
Health Resources and Services Administration's Office of Pharmacy
Affairs that it is utilizing non-340B drugs for its Medi-Cal patients
in the manner and to the extent required by federal law. All matter
omitted in this version of the bill appears in the bill as amended in
the Assembly, March 28, 2014 . (JR11)
