Amended
IN
Assembly
April 19, 2021 |
Introduced by Assembly Member Wood |
February 17, 2021 |
(3)Existing
law provides that any county, political subdivision of the state, or other governmental entity in the state may elect to transfer funds in the form of cash or loans to the department in support of the Medi-Cal program, and provides the department discretion to accept or not accept any elective transfer from a county, political subdivision, or other governmental entity for obtaining federal financial participation. Pursuant to this provision, existing law authorizes the Director of Health Care Services to maximize federal financial participation to provide access to services provided by hospitals that are not reimbursed by certified public expenditure by authorizing the use of intergovernmental transfers to fund the nonfederal share of supplemental payments as permitted under federal law, and requires the department to establish various intergovernmental transfer programs, including the Nondesignated Public Hospital Intergovernmental Transfer Program.
For purposes of
the Medi-Cal Specialty Mental Health Services Program, the Drug Medi-Cal Treatment Program, and the Drug Medi-Cal organized delivery system, this bill would require the department to design and implement an intergovernmental transfer program to fund the nonfederal share of supplemental payments and to replace claiming based on certified public expenditures. The bill would require each transferring entity, upon providing any intergovernmental transfer of funds, to certify that the transferred funds qualify for federal financial participation, and would provide that participation in the intergovernmental transfer program is voluntary. The bill would prohibit the director from implementing an intergovernmental transfer program if they determine that the payments do not comply with federal Medicaid program requirements, and would authorize the director to adjust payments to comply with those federal requirements. The bill would require the department to obtain federal approvals and federal matching funds, to
implement these provisions by various means, including policy letters, and, by January 1, 2023, and annually thereafter, to provide a status update on the implementation of these provisions.
(a)For an individual 21 years of age or older, a service is “medically necessary” or a “medical necessity” when it is reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain.
(b)(1)For an individual under 21 years of age, a service is “medically necessary” or a “medical necessity” if the service meets the standards set forth in Section 1396d(r)(5) of Title 42 of the United States Code.
(2)The department and its contractors shall update any model evidence of coverage documents, beneficiary handbooks, and related material to
ensure the medical necessity standard for coverage for an individual under 21 years of age is accurately reflected in all materials.
(3)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, shall implement, interpret, and make specific this subdivision by means of all-county letters, plan letters, plan provider bulletins, manuals, plan contract amendments, or similar instructions until regulations are revised or adopted.
(4)By July 1, 2022, the department shall revise or adopt regulations 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)This section does not preclude coverage for, or reimbursement of, a clinically appropriate and covered mental health or substance use disorder assessment, screening, or treatment service before a provider renders a diagnosis.
(d)This section shall not be construed to limit the application of subdivisions (a) and (b) of Section 51184 of Title 22 of the California Code of Regulations.
(a)Notwithstanding subdivision (c) of Section 14124.24, the department, in consultation with the California Behavioral Health Directors Association and representatives of counties, shall design and implement an intergovernmental transfer program relating to services provided by counties under the Drug Medi-Cal Treatment Program and the Drug Medi-Cal organized delivery system to fund the nonfederal share of supplemental payments, as permitted under Section 433.51 of Title 42 of the Code of Federal Regulations or any other applicable federal Medicaid program laws, and to replace claiming based on certified public expenditures. Upon providing any intergovernmental transfer of funds, each transferring entity shall certify
that the transferred funds qualify for federal financial participation pursuant to applicable federal Medicaid program laws, and in the form and manner specified by the department. The total intergovernmental transfer-funded payment amount, which includes the federal and nonfederal share, paid to a county shall be retained by the county and used for providing substance use disorder treatment under the Drug Medi-Cal Treatment Program and the Drug Medi-Cal organized delivery system.
(b)This section shall be implemented on July 1, 2022, or the date on which all necessary federal approvals have been received, whichever is later, and only to the extent intergovernmental transfers from counties are provided for this purpose.
(c)Participation in the intergovernmental transfer program
under this section is voluntary on the part of the transferring entities for the purposes of all applicable federal laws.
(d)This section shall be implemented only to the extent federal financial participation is available for any reimbursement and federal financial participation is not jeopardized.
(e)If the director determines that the payments do not comply with federal Medicaid program requirements, the director shall not implement an intergovernmental transfer program and may adjust payments as necessary to comply with federal Medicaid program requirements.
(f)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department shall implement
this section by letters, information notices, or similar instructions, without taking further regulatory action.
(g)Notwithstanding Section 10231.5 of the Government Code, by January 1, 2023, and annually thereafter, the department shall provide a status update on the implementation of this section to the Joint Legislative Budget Committee and the fiscal and appropriate policy committees of the Legislature.
(a)Notwithstanding Sections 14708, 14718, and 14723, and subdivisions (e) and (f) of Section 14711, the department, in consultation with the California Behavioral Health Directors Association and representatives of counties, shall design and implement an intergovernmental transfer program relating to Medi-Cal specialty mental health benefits provided by county mental health plans to fund the nonfederal share of supplemental payments, as permitted under Section 433.51 of Title 42 of the Code of Federal Regulations or any other applicable federal Medicaid program laws, and to replace claiming based on certified public expenditures. Upon providing any intergovernmental transfer of funds, each transferring entity shall certify that
the transferred funds qualify for federal financial participation pursuant to applicable federal Medicaid program laws, and in the form and manner specified by the department. The total intergovernmental transfer-funded payment amount, which includes the federal and nonfederal share, paid to a county shall be retained by the county and used for providing Medi-Cal specialty mental health services under the Medi-Cal Specialty Mental Health Services Program.
(b)This section shall be implemented on July 1, 2022, or the date on which all necessary federal approvals have been received, whichever is later, and only to the extent intergovernmental transfers from counties are provided for this purpose.
(c)Participation in the intergovernmental transfer program under this section is
voluntary on the part of the transferring entities for the purposes of all applicable federal laws.
(d)This section shall be implemented only to the extent federal financial participation is available for any reimbursement and federal financial participation is not jeopardized.
(e)If the director determines that the payments do not comply with federal Medicaid program requirements, the director shall not implement an intergovernmental transfer program and may adjust payments as necessary to comply with federal Medicaid program requirements.
(f)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department shall implement this section by letters,
information notices, or similar instructions, without taking further regulatory action.
(g)Notwithstanding Section 10231.5 of the Government Code, by January 1, 2023, and annually thereafter, the department shall
provide a status update on the implementation of this section to the Joint Legislative Budget Committee and the fiscal and appropriate policy committees of the Legislature.