Bill Text: CA AB68 | 2015-2016 | Regular Session | Enrolled

California Assembly Bill 68 (Prior Session Legislation)

Bill Title: Medi-Cal.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Vetoed) 2016-01-15 - Consideration of Governor's veto stricken from file. [AB68 Detail]

Download: California-2015-AB68-Enrolled.html

BILL NUMBER: AB 68	ENROLLED
	BILL TEXT

	PASSED THE SENATE  SEPTEMBER 2, 2015
	PASSED THE ASSEMBLY  SEPTEMBER 3, 2015
	AMENDED IN SENATE  AUGUST 18, 2015
	AMENDED IN ASSEMBLY  JUNE 1, 2015
	AMENDED IN ASSEMBLY  APRIL 30, 2015
	AMENDED IN ASSEMBLY  MARCH 26, 2015

INTRODUCED BY   Assembly Member Waldron

                        DECEMBER 18, 2014

   An act to add Section 14133.06 to the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 68, Waldron. Medi-Cal.
   Existing law establishes the Medi-Cal program, which is
administered by the State Department of Health Care Services, and
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. Covered benefits under the
Medi-Cal program include the purchase of prescribed drugs, subject to
the Medi-Cal List of Contract Drugs and utilization controls.
   This bill, which would be known as the Patient Access to
Prescribed Epilepsy Treatments Act, would subject, to the extent
permitted by federal law, the denial of coverage by a Medi-Cal
managed care plan of any drug in the seizure or epilepsy therapeutic
drug class prescribed by a Medi-Cal beneficiary's treating provider
to an urgent appeal process, as specified, if the treating provider
demonstrates that in his or her reasonable, professional judgment,
the drug is medically necessary and consistent with specified federal
rules and regulations, and the drug is not on the Medi-Cal managed
care plan formulary.


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

  SECTION 1.  This act shall be known, and may be cited, as the
Patient Access to Prescribed Epilepsy Treatments Act.
  SEC. 2.  Section 14133.06 is added to the Welfare and Institutions
Code, to read:
   14133.06.  (a) It is the intent of the Legislature in enacting
this section that a Medi-Cal beneficiary shall have prompt access to
medically necessary drugs for use in the treatment of seizures and
epilepsy that have been approved by the federal Food and Drug
Administration for use in the treatment of seizures or epilepsy,
including drugs that are not on the formulary of a Medi-Cal managed
care plan or that are subject to prior authorization.
   (b) To the extent permitted by federal law, if any drug used in
the treatment of seizures and epilepsy as described in subdivision
(a) is prescribed by a Medi-Cal beneficiary's treating provider for
the treatment of seizures and epilepsy, and coverage for that
prescribed drug is denied by a Medi-Cal managed care plan in which
the beneficiary is enrolled, that denial shall be reviewed in
accordance with this section.
   (c) (1) The denial by a Medi-Cal managed care plan of a drug
prescribed for the treatment of seizures and epilepsy and approved by
the federal Food and Drug Administration for the use in the
treatment of seizures and epilepsy is subject to the urgent appeal
process described in paragraph (2), if the treating provider
demonstrates, consistent with federal law, that in his or her
reasonable, professional judgment, the drug is medically necessary
and consistent with the federal Food and Drug Administration's
labeling and use rules and regulations, as supported in at least one
of the official compendia identified in Section 1927(g)(1)(B)(i) of
the federal Social Security Act (42 U.S.C. Sec. 1396r-8(g)(1)(B)(i)),
and the drug is not on the formulary for the Medi-Cal managed care
plan.
   (2) In a case in which a plan denies coverage for a drug
prescribed for the treatment of seizures and epilepsy and approved by
the federal Food and Drug Administration for the use in the
treatment of seizures and epilepsy, the beneficiary shall be entitled
to an urgent appeal. For purposes of this section, "urgent appeal"
means an appeal in which the beneficiary, or treatment provider with
the consent of the beneficiary, requests an urgent appeal either
orally or in writing. An urgent appeal shall be resolved by the plan
within 24 hours after the plan receives the request. The 24-hour
period specified in this paragraph shall be in addition to any time
prescribed by federal law.