CA SB 1385

Title: Medi-Cal: Supervising providers.
Author: Richard Dale Roth

Summary
SB 1385, as amended, Roth. Medi-Cal: 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.This bill would require Medi-Cal managed care plans to adopt policies and procedures to effectuate a billing pathway for supervising providers, as defined, 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 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 by supervising providers to claim for community health worker services to fee-for-service beneficiaries in the settings described above. 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, 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.

Status
Set for hearing April 22.

Bill Documents
CA SB 1385 - 03/20/24 - Amended Senate
03/20/24 - CA SB 1385 (03/20/24 - Amended Senate)