Bill Text: CA AB417 | 2009-2010 | Regular Session | Amended


Bill Title: Medi-Cal Drug Treatment Program: buprenorphine pilot

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Engrossed - Dead) 2010-03-15 - From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on APPR. [AB417 Detail]

Download: California-2009-AB417-Amended.html
BILL NUMBER: AB 417	AMENDED
	BILL TEXT

	AMENDED IN SENATE  MARCH 15, 2010
	AMENDED IN SENATE  JULY 23, 2009
	AMENDED IN ASSEMBLY  MAY 19, 2009
	AMENDED IN ASSEMBLY  MAY 5, 2009
	AMENDED IN ASSEMBLY  APRIL 14, 2009

INTRODUCED BY   Assembly Member Beall

                        FEBRUARY 23, 2009

   An act to amend  , repeal, and add Sections 11758.42,
11758.46, and 11839.2 of   Section 11839.2 of, and to
add and repeal Chapter 3.5 (commencing with Section 11758.50) of Part
1 of Division 10.5 of,  the Health and Safety Code, relating to
Medi-Cal.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 417, as amended, Beall. Medi-Cal Drug Treatment Program:
 buprenorphine.  buprenorphine pilot program.

   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. The Medi-Cal program is, in part, governed and funded by
federal Medicaid provisions.
   Existing law provides for the Medi-Cal Drug Treatment Program
(Drug Medi-Cal), under which each county enters into contracts with
the State Department of Alcohol and Drug Programs for the provision
of various drug treatment services to Medi-Cal recipients, or the
department directly arranges for the provision of these services if a
county elects not to do so. Existing law defines the services
reimbursable under this program, and establishes contracting,
billing, and reimbursement procedures governing this program.

   This bill would, until January 1, 2015, add buprenorphine services
to the list of Drug Medi-Cal services, when they are administered by
a licensed narcotic treatment program and ordered or prescribed by a
physician who complies with federal requirements and works under the
license of the narcotic treatment program.  
   Under existing law, for purposes of Drug Medi-Cal, the department
is required to establish a narcotic replacement therapy dosing fee
for methadone and LAAM.  
   This bill would, until January 1, 2015, require the department to
establish separate dosing fees for methadone, LAAM, and
buprenorphine. The bill would also provide that for purposes of
establishing the dosing fees, the department is required to include
comprehensive services that include physician and medication
services.  
   Under existing law, the department is responsible for licensing
narcotic treatment programs to use replacement narcotic therapy in
the treatment of addicted persons whose addiction was acquired or
supported by the use of a narcotic drug or drugs, not in compliance
with a physician and surgeon's legal prescription. Existing law
authorizes licensed narcotic treatment programs to use methadone and
LAAM for replacement narcotic therapy.  
   This bill would, until January 1, 2015, also authorize licensed
narcotic treatment programs to use buprenorphine for replacement
narcotic therapy.  
   This bill would provide that its provisions shall not be
implemented if the Director of Health Care Services determines that
they would require an unbundling of Drug Medi-Cal reimbursement
rates.  
   This bill would require the State Department of Alcohol and Drug
Programs, by January 1, 2014, to submit a report to the appropriate
policy and fiscal committees of the Legislature regarding the
addition of buprenorphine to Drug Medi-Cal required by this bill.
 
   This bill would establish a buprenorphine medication assisted
treatment pilot program under Drug Medi-Cal, commencing January 1,
2011, and concluding December 31, 2016, for the purpose of
determining the efficacy of buprenorphine in treating opioid
addiction. This bill would require all narcotic treatment programs
participating in the pilot program to operate in accordance with
prescribed requirements.  
   This bill would require that, from January 1, 2011, to June 30,
2013, inclusive, that the reimbursement rate for buprenorphine
treatment services be equal to the uniform statewide daily
reimbursement rate for methadone. Prior to July 1, 2013, the State
Department of Alcohol and Drug Programs would be required to set the
uniform statewide daily reimbursement rate for buprenorphine for the
remainder of the pilot program based on specified criteria. 

   Existing law authorizes licensed narcotic treatment programs to
use methadone and LAAM for replacement narcotic therapy.  
   This bill would, in addition, authorize the use of buprenorphine
and any other federally approved controlled substances used for the
purpose of narcotic replacement treatment. 
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


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

   SECTION 1.    Chapter 3.5 (commencing with Section
11758.50) is added to Part 1 of Division 10.5 of the  
Health and Safety Code   , to read:  
      CHAPTER 3.5.  BUPRENORPHINE MEDICATION ASSISTED TREATMENT PILOT
PROGRAM


   11758.50.  For the purposes of this chapter, "buprenorphine" means
buprenorphine products or combination products approved by the
federal Food and Drug Administration for maintenance or
detoxification of opioid dependence.
   11758.51.  (a) There is established, commencing January 1, 2011,
and concluding December 31, 2016, under the Medi-Cal Drug Treatment
Program (Chapter 3.4 (commencing with Section 11758.40), a
buprenorphine medication assisted treatment pilot program for the
purpose of determining the efficacy of buprenorphine in treating
opioid addiction.
   (b) Participation in the pilot program by narcotic treatment
programs, as described in Article 1 (commencing with Section 11839)
of Chapter 10 of Part 2, is on a voluntary basis. Any licensed
narcotic treatment program may participate.
   (c) All narcotic treatment programs participating in the pilot
program shall operate in accordance with the statutory requirements
of the Drug Addiction Treatment Act of 2000 (Public Law 106-310,
Title 35, Sec. 3502; DATA 2000).
   (d) Medi-Cal fee-for-service or office-based narcotic treatment
programs, as described in Section 11839.6, shall not be affected by
this chapter and shall operate as prescribed under state law and in
accordance with DATA 2000.
   11758.52.  (a) It is the intent of the Legislature that this
chapter not result in the unbundling of reimbursement rates for
services provided under the Medi-Cal Drug Treatment Program.
   (b) Reimbursement for buprenorphine treatment services provided
under this chapter shall be as follows:
   (1) From January 1, 2011, to June 30, 2013, inclusive, the
reimbursement rate for buprenorphine shall be equal to the approved
uniform statewide daily reimbursement rate for methadone, set
annually pursuant to Section 11758.42. Reimbursement for
buprenorphine treatment services shall only be paid, as provided in
this paragraph, if the narcotic treatment program agrees to receive
the reimbursement as payment in full for the buprenorphine treatment
services provided.
   (2) Prior to July 31, 2013, the department shall set the uniform
statewide daily reimbursement rate for buprenorphine treatment
services to be used for the remainder of the pilot program. The
uniform statewide daily reimbursement rate for buprenorphine shall be
based on utilization data reported to the Department of Justice
pursuant to DATA 2000, and reported to the department pursuant to
subdivision (b) of Section 11758.53. The department's annual rate
setting for narcotic replacement and medication assisted therapy
services shall include the uniform statewide daily reimbursement rate
for buprenorphine treatment services.
   11758.53.  (a) For the purposes of providing buprenorphine
treatment services under this chapter, narcotic treatment programs
participating in the program shall be exempt from state and federal
statutes and regulations related to narcotic treatment programs.
   (b) Narcotic treatment programs participating in the pilot program
shall report utilization data to the department, and to the
Department of Justice pursuant to DATA 2000, every six months.
Notwithstanding any other provision of law, the pilot program shall
be exempt from cost reporting requirements.
   (c) Pursuant to subdivision (j) of Section 11755, the department
shall include the utilization data for buprenorphine services in its
annual preparation of the budget.
   11758.54.  (a) This chapter shall remain in effect only until
January 1, 2017, and as of that date is repealed, unless a later
enacted statute, that is enacted before January 1, 2017, deletes or
extends that date.
   (b) It is the intent of the Legislature that, prior to January 1,
2017, the Legislature review the utilization data for buprenorphine
treatment services provided under this chapter and determine whether
buprenorphine treatment services shall continue to be provided under
the Medi-Cal Drug Treatment Program.  
  SECTION 1.    Section 11758.42 of the Health and
Safety Code is amended to read:
   11758.42.  (a) For purposes of this chapter, the following
definitions shall apply:
   (1) "Buprenorphine" means buprenorphine or buprenorphine
combination products approved by the federal Food and Drug
Administration for maintenance or detoxification of opioid
dependence.
   (2) "LAAM" means levoalphacetylmethadol.
   (b) (1) (A) The department shall establish separate narcotic
replacement therapy dosing fees for methadone, LAAM, and
buprenorphine.
   (B) For purposes of establishing the dosing fees, the department
shall include comprehensive services that include physician and
medication services.
   (2) In addition to the narcotic replacement therapy dosing fee
provided for pursuant to paragraph (1), narcotic treatment programs
shall be reimbursed for the ingredient costs of methadone or LAAM
dispensed to Medi-Cal beneficiaries. These costs may be determined on
an average daily dose of methadone or LAAM, as set forth by the
department, in consultation with the State Department of Health Care
Services.
   (c) Reimbursement for narcotic replacement therapy dosing and
ancillary services provided by narcotic treatment programs shall be
based on a per capita uniform statewide daily reimbursement rate for
each individual patient, as established by the department, in
consultation with the State Department of Health Care Services. The
uniform statewide daily reimbursement rate for narcotic replacement
therapy dosing and ancillary services shall be based upon, where
available and appropriate, all of the following:
   (1) The outpatient rates for the same or similar services under
the fee-for-service Medi-Cal program.
   (2) Cost report data.
   (3) Other data deemed reliable and relevant by the department.
   (4) The rate studies completed pursuant to Section 54 of Assembly
Bill 3483 of the 1995-96 Regular Session of the Legislature.
   (d) The uniform statewide daily reimbursement rate for ancillary
services shall not exceed, for individual services or in the
aggregate, the outpatient rates for the same or similar services
under the fee-for-service Medi-Cal program.
   (e) The uniform statewide daily reimbursement rate shall be
established after consultation with narcotic treatment program
providers and county alcohol and drug program administrators.
   (f) Reimbursement for narcotic treatment program services shall be
limited to those services specified in state law and state and
federal regulations governing the licensing and administration of
narcotic treatment programs. These services shall include, but are
not limited to, all of the following:
   (1) Admission, physical evaluation, and diagnosis.
   (2) Drug screening.
   (3) Pregnancy tests.
   (4) Narcotic replacement therapy dosing.
   (5) Intake assessment, treatment planning, and counseling
services. Frequency of counseling or medical psychotherapy, outcomes,
and rates shall be addressed through regulations adopted by the
department. For purposes of this paragraph, these services include,
but are not limited to, substance abuse services to pregnant and
postpartum Medi-Cal beneficiaries.
   (g) Reimbursement under this section shall be limited to claims
for narcotic treatment program services at the uniform statewide
daily reimbursement rate for these services. These rates shall be
exempt from the requirements of Section 14021.6 of the Welfare and
Institutions Code.
   (h) (1) Reimbursement to narcotic treatment program providers
shall be limited to the lower of either the uniform statewide daily
reimbursement rate, pursuant to subdivision (c), or the provider's
usual and customary charge to the general public for the same or
similar service.
   (2) (A) Reimbursement paid by a county to a narcotic treatment
program provider for services provided to any person subject to
Section 1210.1 or 3063.1 of the Penal Code, and for which the
individual client is not liable to pay, does not constitute a usual
and customary charge to the general public for the purposes of this
section.
   (B) Subparagraph (A) does not constitute a change in, but is
declaratory of, existing law.
   (i) No program shall be reimbursed for services not rendered to or
received by a patient of a narcotic treatment program.
   (j) Reimbursement for narcotic treatment program services provided
to substance abusers shall be administered by the department and
counties electing to participate in the program. Utilization and
payment for these services shall be subject to federal Medicaid and
state utilization and audit requirements.
   (k) The amendments made to this section by the act that added this
subdivision shall not be implemented if the Director of Health Care
Services determines that the provisions of the act that added this
subdivision would require an unbundling of Drug Medi-Cal
reimbursement rates.
   (l) This section shall remain in effect only until January 1,
2015, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2015, deletes or extends
that date.  
  SEC. 2.    Section 11758.42 is added to the Health
and Safety Code, to read:
   11758.42.  (a) For purposes of this chapter, "LAAM" means
levoalphacetylmethadol.
   (b) (1) The department shall establish a narcotic replacement
therapy dosing fee for methadone and LAAM.
   (2) In addition to the narcotic replacement therapy dosing fee
provided for pursuant to paragraph (1), narcotic treatment programs
shall be reimbursed for the ingredient costs of methadone or LAAM
dispensed to Medi-Cal beneficiaries. These costs may be determined on
an average daily dose of methadone or LAAM, as set forth by the
department, in consultation with the State Department of Health Care
Services.
   (c) Reimbursement for narcotic replacement therapy dosing and
ancillary services provided by narcotic treatment programs shall be
based on a per capita uniform statewide daily reimbursement rate for
each individual patient, as established by the department, in
consultation with the State Department of Health Care Services. The
uniform statewide daily reimbursement rate for narcotic replacement
therapy dosing and ancillary services shall be based upon, where
available and appropriate, all of the following:
   (1) The outpatient rates for the same or similar services under
the fee-for-service Medi-Cal program.
   (2) Cost report data.
   (3) Other data deemed reliable and relevant by the department.
   (4) The rate studies completed pursuant to Section 54 of Assembly
Bill 3483 of the 1995-96 Regular Session of the Legislature.
   (d) The uniform statewide daily reimbursement rate for ancillary
services shall not exceed, for individual services or in the
aggregate, the outpatient rates for the same or similar services
under the fee-for-service Medi-Cal program.
   (e) The uniform statewide daily reimbursement rate shall be
established after consultation with narcotic treatment program
providers and county alcohol and drug program administrators.
   (f) Reimbursement for narcotic treatment program services shall be
limited to those services specified in state law and state and
federal regulations governing the licensing and administration of
narcotic treatment programs. These services shall include, but are
not limited to, all of the following:
   (1) Admission, physical evaluation, and diagnosis.
   (2) Drug screening.
   (3) Pregnancy tests.
   (4) Narcotic replacement therapy dosing.
   (5) Intake assessment, treatment planning, and counseling
services. Frequency of counseling or medical psychotherapy, outcomes,
and rates shall be addressed through regulations adopted by the
department. For purposes of this paragraph, these services include,
but are not limited to, substance abuse services to pregnant and
postpartum Medi-Cal beneficiaries.
   (g) Reimbursement under this section shall be limited to claims
for narcotic treatment program services at the uniform statewide
daily reimbursement rate for these services. These rates shall be
exempt from the requirements of Section 14021.6 of the Welfare and
Institutions Code.
   (h) (1) Reimbursement to narcotic treatment program providers
shall be limited to the lower of either the uniform statewide daily
reimbursement rate, pursuant to subdivision (c), or the provider's
usual and customary charge to the general public for the same or
similar service.
   (2) (A) Reimbursement paid by a county to a narcotic treatment
program provider for services provided to any person subject to
Section 1210.1 or 3063.1 of the Penal Code, and for which the
individual client is not liable to pay, does not constitute a usual
and customary charge to the general public for the purposes of this
section.
   (B) Subparagraph (A) does not constitute a change in, but is
declaratory of, existing law.
   (i) No program shall be reimbursed for services not rendered to or
received by a patient of a narcotic treatment program.
   (j) Reimbursement for narcotic treatment program services provided
to substance abusers shall be administered by the department and
counties electing to participate in the program. Utilization and
payment for these services shall be subject to federal Medicaid and
state utilization and audit requirements.
   (k) This section shall become operative on January 1, 2015.
 
  SEC. 3.    Section 11758.46 of the Health and
Safety Code is amended to read:
   11758.46.  (a) For purposes of this section, "Drug Medi-Cal
services" means 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
11758.42.
   (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) Buprenorphine services, when they are administered by a
licensed narcotic treatment program and they are ordered or
prescribed by a physician who complies with federal requirements and
works under the license of the narcotic treatment program.
   (b) 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 services" shall also include the following services,
administered by the department, and to the extent consistent with
state and federal law:
   (1) Notwithstanding subdivision (a) of Section 14132.90 of the
Welfare and Institutions Code, day care habilitative services, which,
for purposes of this paragraph, are outpatient counseling and
rehabilitation services provided to persons with alcohol or other
drug abuse diagnoses.
   (2) Case management services, including supportive services to
assist persons with alcohol or other drug abuse diagnoses in gaining
access to medical, social, educational, and other needed services.
   (3) Aftercare services.
   (c) (1) 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.
   (2) The department, county alcohol and drug program
administrators, and alcohol and drug service providers shall automate
the claiming process and the process for the submission of specific
data required in connection with reimbursement for Drug Medi-Cal
services, except that this requirement applies only if funding is
available from sources other than those made available for treatment
or other services.
   (d) A county or a contractor for the provision of Drug Medi-Cal
services shall notify the department, within 30 days of the receipt
of the county allocation, of its intent to contract, as a component
of the single state-county contract, and provide certified services
pursuant to Section 11758.42, for the proposed budget year. The
notification shall include an accurate and complete budget proposal,
the structure of which shall be mutually agreed to by county alcohol
and drug program administrators and the department, in the format
provided by the department, for specific services, for a specific
time period, and including estimated units of service, estimated rate
per unit consistent with law and regulations, and total estimated
cost for appropriate services.
   (e) (1) Within 30 days of receipt of the proposal described in
subdivision (d), the department shall provide, to counties and
contractors proposing to provide Drug Medi-Cal services in the
proposed budget year, a proposed multiple-year contract, as a
component of the single state-county contract, for these services, a
current utilization control plan, and appropriate administrative
procedures.
   (2) A county contracting for alcohol and drug services shall
receive a single state-county contract for the net negotiated amount
and Drug Medi-Cal services.
   (3) Contractors contracting for Drug Medi-Cal services shall
receive a Drug Medi-Cal contract.
   (f) (1) Upon receipt of a contract proposal pursuant to
subdivision (d), a county and a contractor seeking to provide
reimbursable Drug Medi-Cal services and the department may begin
negotiations and the process for contract approval.
   (2) If a county does not approve a contract by July 1 of the
appropriate fiscal year, in accordance with subdivisions (c) to (e),
inclusive, the county shall have 30 additional days in which to
approve a contract. If the county has not approved the contract by
the end of that 30-day period, the department shall contract directly
for services within 30 days.
   (3) Counties shall negotiate contracts only with providers
certified to provide reimbursable Drug Medi-Cal services and that
elect to participate in this program. Upon contract approval by the
department, a county shall establish approved contracts with
certified providers within 30 days following enactment of the annual
Budget Act. A county may establish contract provisions to ensure
interim funding pending the execution of final contracts,
multiple-year contracts pending final annual approval by the
department, and, to the extent allowable under the annual Budget Act,
other procedures to ensure timely payment for services.
   (g) (1) For counties and contractors providing Drug Medi-Cal
services, pursuant to approved contracts, and that have accurate and
complete claims, reimbursement for services from state General Fund
moneys shall commence no later than 45 days following the enactment
of the annual Budget Act for the appropriate state fiscal year.
   (2) For counties and contractors providing Drug Medi-Cal services,
pursuant to approved contracts, and that have accurate and complete
claims, reimbursement for services from federal Medicaid funds shall
commence no later than 45 days following the enactment of the annual
Budget Act for the appropriate state fiscal year.
   (3) The State Department of Health Care Services and the
department shall develop methods to ensure timely payment of Drug
Medi-Cal claims.
   (4) The State Department of Health Care Services, in cooperation
with the department, shall take steps necessary to streamline the
billing system for reimbursable Drug Medi-Cal services, to assist the
department in meeting the billing provisions set forth in this
subdivision.
   (h) The department shall submit a proposed interagency agreement
to the State Department of Health Care Services by May 1 for the
following fiscal year. Review and interim approval of all contractual
and programmatic requirements, except final fiscal estimates, shall
be completed by the State Department of Health Care Services by July
1. The interagency agreement shall not take effect until the annual
Budget Act is enacted and fiscal estimates are approved by the State
Department of Health Care Services. Final approval shall be completed
within 45 days of enactment of the Budget Act.
   (i) (1) A county or a provider certified to provide reimbursable
Drug Medi-Cal services, that is contracting with the department,
shall estimate the cost of those services by April 1 of the fiscal
year covered by the contract, and shall amend current contracts, as
necessary, by the following July 1.
   (2) A county or a provider, except for a provider to whom
subdivision (j) applies, shall submit accurate and complete cost
reports for the previous state fiscal year by November 1, following
the end of the state fiscal year. The department may settle cost for
Drug Medi-Cal services, based on the cost report as the final
amendment to the approved single state-county contract.
   (j) Certified narcotic treatment program providers, that are
exclusively billing the state or the county for services rendered to
persons subject to Section 1210.1 of the Penal Code, Section 3063.1
of the Penal Code, or Section 11758.42 shall submit accurate and
complete performance reports for the previous state fiscal year by
November 1 following the end of that state 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.
   (k) The amendments made to this section by the act that added this
subdivision shall not be implemented if the Director of Health Care
Services determines that the provisions of the act that added this
subdivision would require an unbundling of Drug Medi-Cal
reimbursement rates.
   (l) This section shall remain in effect only until January 1,
2015, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2015, deletes or extends
that date.  
  SEC. 4.    Section 11758.46 is added to the Health
and Safety Code, to read:
   11758.46.  (a) For purposes of this section, "Drug Medi-Cal
services" means 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
11758.42.
   (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.
   (b) 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 services" shall also include the following services,
administered by the department, and to the extent consistent with
state and federal law:
   (1) Notwithstanding subdivision (a) of Section 14132.90 of the
Welfare and Institutions Code, day care habilitative services, which,
for purposes of this paragraph, are outpatient counseling and
rehabilitation services provided to persons with alcohol or other
drug abuse diagnoses.
   (2) Case management services, including supportive services to
assist persons with alcohol or other drug abuse diagnoses in gaining
access                                            to medical, social,
educational, and other needed services.
   (3) Aftercare services.
   (c) (1) 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.
   (2) The department, county alcohol and drug program
administrators, and alcohol and drug service providers shall automate
the claiming process and the process for the submission of specific
data required in connection with reimbursement for Drug Medi-Cal
services, except that this requirement applies only if funding is
available from sources other than those made available for treatment
or other services.
   (d) A county or a contractor for the provision of Drug Medi-Cal
services shall notify the department, within 30 days of the receipt
of the county allocation, of its intent to contract, as a component
of the single state-county contract, and provide certified services
pursuant to Section 11758.42, for the proposed budget year. The
notification shall include an accurate and complete budget proposal,
the structure of which shall be mutually agreed to by county alcohol
and drug program administrators and the department, in the format
provided by the department, for specific services, for a specific
time period, and including estimated units of service, estimated rate
per unit consistent with law and regulations, and total estimated
cost for appropriate services.
   (e) (1) Within 30 days of receipt of the proposal described in
subdivision (d), the department shall provide, to counties and
contractors proposing to provide Drug Medi-Cal services in the
proposed budget year, a proposed multiple-year contract, as a
component of the single state-county contract, for these services, a
current utilization control plan, and appropriate administrative
procedures.
   (2) A county contracting for alcohol and drug services shall
receive a single state-county contract for the net negotiated amount
and Drug Medi-Cal services.
   (3) Contractors contracting for Drug Medi-Cal services shall
receive a Drug Medi-Cal contract.
   (f) (1) Upon receipt of a contract proposal pursuant to
subdivision (d), a county and a contractor seeking to provide
reimbursable Drug Medi-Cal services and the department may begin
negotiations and the process for contract approval.
   (2) If a county does not approve a contract by July 1 of the
appropriate fiscal year, in accordance with subdivisions (c) to (e),
inclusive, the county shall have 30 additional days in which to
approve a contract. If the county has not approved the contract by
the end of that 30-day period, the department shall contract directly
for services within 30 days.
   (3) Counties shall negotiate contracts only with providers
certified to provide reimbursable Drug Medi-Cal services and that
elect to participate in this program. Upon contract approval by the
department, a county shall establish approved contracts with
certified providers within 30 days following enactment of the annual
Budget Act. A county may establish contract provisions to ensure
interim funding pending the execution of final contracts,
multiple-year contracts pending final annual approval by the
department, and, to the extent allowable under the annual Budget Act,
other procedures to ensure timely payment for services.
   (g) (1) For counties and contractors providing Drug Medi-Cal
services, pursuant to approved contracts, and that have accurate and
complete claims, reimbursement for services from state General Fund
moneys shall commence no later than 45 days following the enactment
of the annual Budget Act for the appropriate state fiscal year.
   (2) For counties and contractors providing Drug Medi-Cal services,
pursuant to approved contracts, and that have accurate and complete
claims, reimbursement for services from federal Medicaid funds shall
commence no later than 45 days following the enactment of the annual
Budget Act for the appropriate state fiscal year.
   (3) The State Department of Health Care Services and the
department shall develop methods to ensure timely payment of Drug
Medi-Cal claims.
   (4) The State Department of Health Care Services, in cooperation
with the department, shall take steps necessary to streamline the
billing system for reimbursable Drug Medi-Cal services, to assist the
department in meeting the billing provisions set forth in this
subdivision.
   (h) The department shall submit a proposed interagency agreement
to the State Department of Health Care Services by May 1 for the
following fiscal year. Review and interim approval of all contractual
and programmatic requirements, except final fiscal estimates, shall
be completed by the State Department of Health Care Services by July
1. The interagency agreement shall not take effect until the annual
Budget Act is enacted and fiscal estimates are approved by the State
Department of Health Care Services. Final approval shall be completed
within 45 days of enactment of the Budget Act.
   (i) (1) A county or a provider certified to provide reimbursable
Drug Medi-Cal services, that is contracting with the department,
shall estimate the cost of those services by April 1 of the fiscal
year covered by the contract, and shall amend current contracts, as
necessary, by the following July 1.
   (2) A county or a provider, except for a provider to whom
subdivision (j) applies, shall submit accurate and complete cost
reports for the previous state fiscal year by November 1, following
the end of the state fiscal year. The department may settle cost for
Drug Medi-Cal services, based on the cost report as the final
amendment to the approved single state-county contract.
   (j) Certified narcotic treatment program providers, that are
exclusively billing the state or the county for services rendered to
persons subject to Section 1210.1 of the Penal Code, Section 3063.1
of the Penal Code, or Section 11758.42 shall submit accurate and
complete performance reports for the previous state fiscal year by
November 1 following the end of that state 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.
   (k) This section shall become operative on January 1, 2015.

   SEC. 5.   SEC. 2.   Section 11839.2 of
the Health and Safety Code is amended to read:
   11839.2.   (a)    The following
controlled substances are authorized for use in replacement narcotic
therapy by licensed narcotic treatment programs: 
   (1) 
    (a)  Methadone. 
   (2) 
    (b)  Levoalphacetylmethadol (LAAM) as specified in
paragraph (10) of subdivision (c) of Section 11055. 
   (3) Buprenorphine, as defined in paragraph (1) of subdivision (a)
of Section 11758.42.  
   (b) The amendments made to this section by the act that added this
subdivision shall not be implemented if the Director of Health Care
Services determines that the provisions of the act that added this
subdivision would require an unbundling of Drug Medi-Cal
reimbursement rates.  
   (c) This section shall remain in effect only until January 1,
2015, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2015, deletes or extends
that date.  
   (c) Buprenorphine products or combination products approved by the
federal Food and Drug Administration for maintenance or
detoxification of opioid dependence.  
   (d) Any other federally approved controlled substances used for
the purpose of narcotic replacement treatment.  
  SEC. 6.    Section 11839.2 is added to the Health
and Safety Code, to read:
   11839.2.  (a) The following controlled substances are authorized
for use in replacement narcotic therapy by licensed narcotic
treatment programs:
   (1) Methadone.
   (2) Levoalphacetylmethadol (LAAM) as specified in paragraph (10)
of subdivision (c) of Section 11055.
   (b) This section shall become operative on January 1, 2015.
 
  SEC. 7.    It is the intent of the Legislature
that this act not result in the unbundling of reimbursement rates for
Drug Medi-Cal services.  
  SEC. 8.    (a) The State Department of Alcohol and
Drug Programs shall submit a report to the appropriate policy and
fiscal committees of the Legislature regarding the addition of
buprenorphine to the Medi-Cal Drug Treatment Program (Drug Medi-Cal)
required by this act. The report shall include data on all of the
following:
   (1) The number of narcotic treatment programs dispensing or
administering buprenorphine.
   (2) The number of individuals prescribed buprenorphine through
Drug Medi-Cal.
   (3) The total cost of buprenorphine provided through Drug
Medi-Cal.
   (4) The average annual cost per person of individuals receiving
buprenorphine compared to the average annual cost per person of
individuals receiving methadone through Drug Medi-Cal.
   (5) The efficacy of buprenorphine in treating opioid addiction.
   (b) The report required by this section shall be completed by the
department using existing resources. The report shall be provided to
the appropriate policy and fiscal committees of the Legislature by
January 1, 2014.                                   
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