How AB 1906 changes current law

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This bill amends 2 section(s) of the California codes: Section 1367.66 of the Health and Safety Code; Section 10123.18 of the Insurance Code.

• Section 1367.66 of the Health and Safety Code

  nationally recognized clinical guidelines. (e) → any relevant recommendations published pursuant to Section 120164. (e) This section does not apply to a vision-only, dental-only, or Medicare supplement health care service plan contract. (f) (g) This section does not apply to Medi-Cal managed care plan contracts with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000), Chapter 8 (commencing with Section 14200), or Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code.

  amended

• Section 10123.18 of the Insurance Code

  nationally recognized clinical guidelines. (e) SEC. 3.Section 14132 of the Welfare and Institutions Code is amended to read:14132.The following is the schedule of benefits under this chapter:(a)Outpatient services are covered as follows:Physician, hospital or clinic outpatient, surgical center, respiratory care, optometric, chiropractic, psychology, podiatric, occupational therapy, physical therapy, speech therapy, audiology, acupuncture to the extent federal matching funds are provided for acupuncture, and services of persons rendering treatment by prayer or healing by spiritual means in the practice of any church or religious denomination insofar as these can be encompassed by federal participation under an approved plan, subject to utilization controls.(b)(1)Inpatient hospital services, including, but not limited to, physician and podiatric services, physical therapy, and occupational therapy, are covered subject to utilization controls.(2)For a Medi-Cal fee-for-service beneficiary, emergency services and care that are necessary for the treatment of an emergency medical condition and medical care directly related to the emergency medical condition. This paragraph does not change the obligation of Medi-Cal managed care plans to provide emergency services and care. For the purposes of this paragraph, “emergency services and care” and “emergency medical condition” have the same meanings as those terms are defined in Section 1317.1 of the Health and Safety Code.(c)Nursing facility services, subacute care services, and services provided by any category of intermediate care facility for the developmentally disabled, including podiatry, physician, nurse practitioner services, and prescribed drugs, as described in subdivision (d), are covered subject to utilization controls. Respiratory care, physical therapy, occupational therapy, speech therapy, and audiology services for patients in nursing facilities and any category of intermediate care facility for persons with developmental disabilities are covered subject to utilization controls.(d)(1)Purchase of prescribed drugs is covered subject to the Medi-Cal List of Contract Drugs and utilization controls.(2)Purchase of drugs used to treat erectile dysfunction or any off-label uses of those drugs are covered only to the extent that federal financial participation is available.(3)(A)To the extent required by federal law, the purchase of outpatient prescribed drugs, for which the prescription is executed by a prescriber in written, nonelectronic form on or after April 1, 2008, is covered only when executed on a tamper-resistant prescription form. The implementation of this paragraph shall conform to the guidance issued by the federal Centers for Medicare and Medicaid Services, but shall not conflict with state statutes on the characteristics of tamper-resistant prescriptions for controlled substances, including Section 11162.1 of the Health and Safety Code. The department shall provide providers and beneficiaries with as much flexibility in implementing these rules as allowed by the federal government. The department shall notify and consult with appropriate stakeholders in implementing, interpreting, or making specific this paragraph.(B)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may take the actions specified in subparagraph (A) by means of a provider bulletin or notice, policy letter, or other similar instructions without taking regulatory action.(4)(A)(i)For the purposes of this paragraph, “nonlegend” has the same meaning as defined in subdivision (a) of Section 14105.45.(ii)Nonlegend acetaminophen-containing products, including children’s acetaminophen-containing products, selected by the department are covered benefits.(iii)Nonlegend cough and cold products selected by the department are covered benefits.(B)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of → any relevant recommendations published pursuant to Section 120164 of the Health and Safety Code. (e) This section does not apply to a vision-only, dental-only, or Medicare supplement insurance policy. (f) SEC. 3. any relevant recommendations published pursuant to Section 120164 of the Health and Safety Code subject to medical necessity and utilization management controls, Cervical allow patients to self-collect samples and are United States Food and Drug Administration-authorized or cleared subject to medical necessity and utilization management controls, (2) A test described in paragraph (1) shall be ordered or provided by a patient’s health care provider and shall be consistent with both of the following: (A) Any relevant recommendations published pursuant to Section 120164 of the Health and Safety Code. (B) Medi-Cal policies.(3) Reimbursement for a test described in paragraph (1) shall use a clinically appropriate Current Procedural Terminology or Healthcare Common Procedure Coding System billing code in order to comply with Health Insurance Portability and Accountability Act requirements. (4) (5) (6) The coverage described in this subdivision is a covered benefit only to the extent that federal financial participation is available and not otherwise jeopardized and any necessary federal approvals have been obtained.(7) Notwithstanding any other law, the department, without taking any further regulatory action, may implement, interpret, or make specific this subdivision by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions. SEC. 4.

  amended