Ed Hernandez
- Democratic
Author
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 medically necessary health care services, including Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) for an individual under 21 years of age who is covered under the Medi-Cal program, subject to utilization controls, and consistent with federal requirements. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Under existing state law, a service is "medically necessary" if it is reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain. This bill would revise the Medi-Cal definition of "medically necessary" for purposes of an individual under 21 years of age to incorporate the existing federal standards related to EPSDT services. The bill would require the department and its contractors to update any model evidence of specified materials to ensure the medical necessity standard for coverage for individuals under 21 years of age is accurately reflected in all materials. The bill would require the department to implement, interpret, and make specific these provisions by means of all-county letters or similar instructions until regulations are revised or adopted by July 1, 2022. The bill would also clarify the meaning of "medically necessary" with regard to prior authorization controls in the Medi-Cal program.
Chaptered by Secretary of State. Chapter 855, Statutes of 2018.
Approved by the Governor.
Enrolled and presented to the Governor at 4 p.m.
Assembly amendments concurred in. (Ayes 39. Noes 0. Page 5869.) Ordered to engrossing and enrolling.
In Senate. Concurrence in Assembly amendments pending.
Read third time. Passed. (Ayes 80. Noes 0. Page 6583.) Ordered to the Senate.
Ordered to third reading.
Read third time and amended.
Read second time. Ordered to third reading.
From committee: Do pass. (Ayes 17. Noes 0.) (August 15).
From committee: Do pass and re-refer to Com. on APPR. (Ayes 15. Noes 0.) (June 26). Re-referred to Com. on APPR.
From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.
Read third time. Passed. (Ayes 38. Noes 0. Page 4334.) Ordered to the Assembly.
In Assembly. Read first time. Held at Desk.
Read second time. Ordered to third reading.
Ordered to second reading.
Read third time and amended.
Read second time and amended. Ordered to third reading.
From committee: Do pass as amended. (Ayes 9. Noes 0. Page 4656.) (April 11).
Set for hearing April 11.
From committee with author's amendments. Read second time and amended. Re-referred to Com. on RLS.
From printer. May be acted upon on or after March 22.
Introduced. Read first time. To Com. on RLS. for assignment. To print.
| Bill Text Versions | Format |
|---|---|
| SB1287 | HTML |
| 02/16/18 - Introduced | |
| 03/22/18 - Amended Senate | |
| 04/16/18 - Amended Senate | |
| 05/21/18 - Amended Senate | |
| 06/20/18 - Amended Assembly | |
| 08/20/18 - Amended Assembly | |
| 08/31/18 - Enrolled | |
| 09/27/18 - Chaptered |
| Document | Format |
|---|---|
| No related documents. |
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