Bill Text: CA AB2871 | 2019-2020 | Regular Session | Introduced
Bill Title: Medi-Cal: substance use disorder services: reimbursement rates.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2020-03-05 - Referred to Com. on HEALTH. [AB2871 Detail]
Download: California-2019-AB2871-Introduced.html
CALIFORNIA LEGISLATURE—
2019–2020 REGULAR SESSION
Assembly Bill
No. 2871
| Introduced by Assembly Member Fong |
February 21, 2020 |
An act to amend Sections 14021.6 and 14197.1 of the Welfare and Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 2871, as introduced, Fong.
Medi-Cal: substance use disorder services: reimbursement rates.
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, including specialty mental health services and substance use disorder services that are delivered through the Medi-Cal Specialty Mental Health Services Program, the Drug Medi-Cal Treatment Program (Drug Medi-Cal), and the Drug Medi-Cal organized delivery system (DMC-ODS). The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Under Drug Medi-Cal, 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 specifies the method of determining the maximum
allowable reimbursement rates for Drug Medi-Cal and group outpatient drug free services.
Existing law requires the department to implement the Medi-Cal 2020 demonstration project, including the DMC-ODS that provides alcohol and drug use services to eligible persons and authorizes the department to enter into a DMC-ODS contract with a county for the provision of those services within a county service area.
This bill would require the department, in establishing reimbursement rates for services under Drug Medi-Cal and capitated rates for a Medi-Cal managed care plan contract that covers substance use disorder services to ensure that those rates are equal to the reimbursement rates for similar services provided under the Medi-Cal Specialty Mental Health Services Program.
The bill would also require the department to require its managed care contractors that cover substance use
disorder services to set reimbursement rates for those services at equal rates to similar services provided under the Medi-Cal Specialty Mental Health Services Program.
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 14021.6 of the Welfare and Institutions Code is amended to read:14021.6.
(a) For the fiscal years prior to the 2004–05 fiscal year, and subject to the requirements of federal law, the maximum allowable rates for the Drug Medi-Cal Treatment Program shall be determined by computing the median rate from available cost data by modality from the fiscal year that is two years prior to the year for which the rate is being established.(b) (1) For the 2007–08 fiscal year, and subsequent fiscal years, and subject to the requirements of federal law, the maximum allowable rates for the Drug Medi-Cal Treatment Program shall be determined by computing the median rate from the most recently completed cost reports, by specific service codes that are consistent with the federal Health Insurance Portability and Accountability Act
of 1996 (42 U.S.C. Sec. 300gg).
(2) For the 2005–06 and 2006–07 fiscal years, if the State Department of Health Care Services department determines that reasonably reliable and complete cost report data are available, the methodology specified in this subdivision shall be applied to either or both of those years. If reasonably reliable and complete cost report data are not available, the State Department of Health Care Services unavailable, the department shall establish rates for either or both of those years based upon the usual, customary, and reasonable charge for
the services to be provided, as the department may determine in its discretion. This subdivision does not modify subdivision (h) of Section 14124.24, which requires certain providers to submit performance reports.
(c) Notwithstanding subdivision (a), for the 1996–97 fiscal year, the rates for nonperinatal outpatient methadone maintenance services shall be set at the rate established for the 1995–96 fiscal year.
(d) Notwithstanding subdivision (a), the maximum allowable rate for group outpatient drug free services shall be set on a per person basis. A group shall consist of a minimum of 2 and a maximum of 12 individuals, at least one of which shall be a Medi-Cal eligible beneficiary. For groups consisting of two individuals, if one of the individuals is ineligible for Medi-Cal, the individual who is ineligible for Medi-Cal shall be receiving outpatient drug free services for a
substance use disorder diagnosed by a physician.
(e) The department shall develop individual and group rates for extensive counseling for outpatient drug free treatment, based on a 50-minute individual or a 90-minute group hour, not to exceed the total rate established for subdivision (d).
(f) For purposes of developing reimbursement rates under the Drug Medi-Cal Treatment Program, the department shall ensure that the reimbursement rates are equal to the reimbursement rates for similar services provided under the Medi-Cal Specialty Mental Health Services Program.
(f)
(g) (1) 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, interpret, or make specific this section by means of bulletins or similar instructions until the time any necessary regulations are adopted. The department shall adopt regulations by July 1, 2020, in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. Beginning six months after the effective date of the act that added this paragraph, and notwithstanding Section 10231.5 of the Government Code, the department shall, on a semiannual basis and in compliance with Section 9795 of the Government Code, provide a status report to the Legislature until the regulations have been adopted.
(2) Notwithstanding paragraph (1) and Chapter 3.5 (commencing with Section 11340) of Part 1 of
Division 3 of Title 2 of the Government Code, the department may annually establish and update the statewide maximum allowable reimbursement rates specified in this section by means of bulletins or similar instructions.
(g)
(h) Bills for services under the Drug Medi-Cal Treatment Program shall be submitted to the department no later than six months from the date of service.
SEC. 2.
Section 14197.1 of the Welfare and Institutions Code is amended to read:14197.1.
(a) The department shall ensure that all covered mental health benefits and substance use disorder benefits, as(b) (1) For purposes of
establishing a capitated rate for a Medi-Cal managed care plan contract that covers substance use disorder services, the department shall ensure that the reimbursement rates for those services are equal to the reimbursement rates for similar services provided under the Medi-Cal Specialty Mental Health Services Program.
(2) The department shall require a managed care contractor that covers substance use disorder services to set its reimbursement rates for those services at equal rates to similar services provided under the Medi-Cal Specialty Mental Health Services Program.
(b)
(c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department, without taking any further regulatory action, may implement, interpret, or make specific this subdivision by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions until the time regulations are adopted. In doing so, the director shall consult with managed care plans and consumer advocates. By July 1, 2022, the department shall adopt regulations, where as appropriate, in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code.
(c)
(d) The department shall make any findings of noncompliance and corrective action plans available on its Internet Web site. internet website.
(d)
(e) For purposes of this section, “Medi-Cal managed care plan” means any
an individual, organization, or entity that enters into a contract with the department to provide services to enrolled Medi-Cal beneficiaries pursuant to any of the following:
(1) Article 2.7 (commencing with Section 14087.3), excluding dental managed care programs developed pursuant to Section 14087.46.
(2) Article 2.8 (commencing with Section 14087.5).
(3) Article 2.81 (commencing with Section 14087.96).
(4) Article 2.82 (commencing with Section 14087.98).
(5) Article 2.91 (commencing with Section 14089).
(6) Chapter 8 (commencing with Section 14200), excluding dental managed care
plans.
(7) Chapter 8.9 (commencing with Section 14700).
(8) A county Drug Medi-Cal organized delivery system authorized under the California Medi-Cal 2020 Demonstration, Number 11-W-00193/9, or a successor demonstration or waiver, as applicable, as approved by the federal Centers for Medicare and Medicaid Services and described in the Special Terms and Conditions. For purposes of this subdivision, “Special Terms and Conditions” shall have the same meaning as set forth in subdivision (o) of Section 14184.10.
