Bill Text: CA SB1385 | 2023-2024 | Regular Session | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Medi-Cal: community health workers: supervising providers.
Spectrum: Moderate Partisan Bill (Democrat 8-1)
Status: (Passed) 2024-07-18 - Chaptered by Secretary of State. Chapter 164, Statutes of 2024. [SB1385 Detail]
Download: California-2023-SB1385-Amended.html
Bill Title: Medi-Cal: community health workers: supervising providers.
Spectrum: Moderate Partisan Bill (Democrat 8-1)
Status: (Passed) 2024-07-18 - Chaptered by Secretary of State. Chapter 164, Statutes of 2024. [SB1385 Detail]
Download: California-2023-SB1385-Amended.html
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Amended
IN
Assembly
June 05, 2024 |
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Amended
IN
Senate
March 20, 2024 |
CALIFORNIA LEGISLATURE—
2023–2024 REGULAR SESSION
Senate Bill
No. 1385
| Introduced by Senator Roth |
February 16, 2024 |
An act to amend Section 14132.36 of the Welfare and Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
SB 1385, as amended, Roth.
Medi-Cal: Supervising community health workers: supervising providers.
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 through various delivery systems, including fee-for-service and managed care. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Under federal law, covered services include “preventive services,” which are defined as, services recommended by a physician or other licensed practitioner of the healing arts acting within the scope of authorized practice under state law to prevent disease, disability, and other health conditions or their progression, prolong life, and promote physical and mental health and efficiency. On July 26, 2022, the federal Centers for Medicare and
Medicaid Services approved the department’s Medicaid State Plan Amendment to add community health workers as a preventive service. Under existing law, the department is required, through existing and regular stakeholder processes, to inform stakeholders about, and accept input from stakeholders on, implementation of the community health worker services benefit.
Under existing law, community health worker services are a covered Medi-Cal benefit subject to any necessary federal approvals. Under existing law, a community health worker is a liaison, link, or intermediary between health and social services and the community to facilitate access to services and to improve the access and cultural competence of service delivery. Existing law requires a Medi-Cal managed care plan to engage in outreach and education efforts to enrollees, and to notify providers, about the community
health worker services benefit, as specified.
This bill would require Medi-Cal managed care plans a Medi-Cal managed care plan, no later than July 1, 2025, to adopt policies and procedures to effectuate a billing pathway for supervising providers, as defined, providers to claim for the provision of community health worker services to enrollees during an emergency department visit and as an outpatient followup to an emergency department visit that are
visit. The bill would require that the policies and procedures be consistent with guidance developed by the department pursuant to the stakeholder process described above. The bill would require the department to develop similar guidance to be used for use by supervising providers to claim for community health worker services to fee-for-service
beneficiaries Medi-Cal members in the fee-for-service delivery system in the settings described above. The
The bill would define a “supervising provider” for purposes of these provisions as an enrolled Medi-Cal provider that submits claims for services provided by a community health worker, is authorized to supervise a community health worker pursuant to the federally approved Medicaid state plan amendment and that
ensures that a community health worker meets the qualifications as required by the department, and directly or indirectly oversees community health workers and the services they deliver to Medi-Cal beneficiaries. 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 14132.36 of the Welfare and Institutions Code is amended to read:14132.36.
(a) Community health worker services are a covered Medi-Cal benefit.(b) For purposes of this section, the following definitions apply:
(1) “Community health worker” has the same meaning as defined in subdivision (b) of Section 18998.
(2)“Supervising provider” is an enrolled Medi-Cal provider that submits claims for services provided by a community health worker. The supervising provider ensures that a community health worker meets the qualifications as required by the department and directly or indirectly oversees community health workers and the services they deliver to Medi-Cal beneficiaries. A supervising provider may be a licensed provider, a hospital, an outpatient clinic, a local health jurisdiction, or a community-based organization.
(2) “Supervising provider” is an enrolled Medi-Cal provider that is authorized to supervise a community health worker pursuant to the federally approved Medicaid state plan amendment and that ensures that a community health worker meets the qualifications as
required by the department. The supervising provider directly or indirectly oversees community health workers and the services that they deliver to Medi-Cal members.
(c) A Medi-Cal managed care plan shall engage in outreach and education efforts to enrollees in a form and manner as directed by the department. At a minimum, the department shall require a Medi-Cal managed care plan to provide the following information to an enrollee:
(1) A description of the community health worker services benefit, including eligibility and coverage criteria.
(2) A list of providers that are authorized to refer an enrollee to community health worker services, and an explanation of how to request a referral.
(3) A list of contracted community health worker entities, including community-based organizations, community clinics, local health jurisdictions, licensed providers, clinics, or hospitals available to provide community health worker services, updated at least annually.
(4) An email address, internet website, and telephone number for an enrollee to access to request additional information regarding community health worker services.
(d) The outreach and education efforts conducted by a Medi-Cal managed care plan pursuant to subdivision (c) shall meet cultural and linguistic appropriateness standards, as determined by the department.
(e) The Medi-Cal
managed care plan shall notify providers about the community health worker services benefit, as set forth by the department.
(f) (1) A No later than July 1, 2025, a Medi-Cal managed care plan shall adopt policies and procedures to effectuate a billing pathway for supervising providers, including contracted hospitals, to claim for the provision of community health worker services to enrollees during an emergency department visit and an outpatient follow up followup to an emergency
department visit, that are consistent with guidance developed by the department pursuant to subdivision (g). paragraph (2).
(2) The department shall, pursuant to No later than July 1, 2025, the department shall, consistent with subdivision (g), develop guidance on policies and procedures to effectuate a billing pathway for supervising providers, including contracted hospitals, to claim for the provision of community health worker services to fee-for-service beneficiaries
Medi-Cal members under the fee-for-service delivery system during an emergency department visit and as an outpatient follow up followup to an emergency department visit.
(g) The department shall, through existing and regular stakeholder processes, inform stakeholders about, and accept input from stakeholders on, implementation of the community health worker services benefit.
(h) This section shall be implemented only to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.
(i) 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 policy letters, provider bulletins, or other similar instructions, without taking any further regulatory action.
