AB 3156

  • California Assembly Bill
  • 2023-2024 Regular Session
  • Introduced in Assembly
  • Passed Assembly May 23, 2024
  • Passed Senate Aug 30, 2024
  • Governor

Medi-Cal managed care plans: enrollees with other health care coverage.

Abstract

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, under fee-for-service or managed care delivery systems. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Under existing federal law, in accordance with third-party liability rules, Medicaid is generally the payer of last resort if a beneficiary has another source of health care coverage in addition to Medicaid coverage. Under this bill, in the case of a Medi-Cal managed care plan enrollee who also has other health care coverage and for whom the Medi-Cal program is a payer of last resort, the department would be required to ensure that a provider that is not contracted with the plan and that is billing the plan for Medi-Cal allowable costs not paid by the other health care coverage does not face administrative requirements significantly in excess of the administrative requirements for billing those same costs to the Medi-Cal fee-for-service delivery system. Under the bill, in the case of an enrollee who meets those coverage criteria, except as specified, a Medi-Cal fee-for-service provider would not be required to contract as an in-network provider with the Medi-Cal managed care plan in order to bill the plan for Medi-Cal allowable costs for covered health care services. The bill would authorize a Medi-Cal managed care plan to require a letter of agreement, or a similar agreement, under either of the following circumstances: (1) if a covered service requires prior authorization, or if a service is not covered by the other health care coverage but is a covered service under the plan, as specified, or (2) if an enrollee requires a covered service and meets the requirements for continuity of care or the completion of covered services through a Medi-Cal managed care plan pursuant to specified provisions under existing law regarding services by a terminated or nonparticipating provider. The bill would require the department to solicit input from specified stakeholders regarding the coordination of payment for services between Medi-Cal enrollees' other commercial health care coverage and their Medi-Cal managed care plans, with a specific emphasis on Medi-Cal recipients receiving regional center services. The bill would require the department to include an item on the agenda of the first meeting of the Medi-Cal Managed Care Advisory Committee of 2025 to discuss this topic and, within 6 months of the advisory committee meeting, take the actions that it deems necessary to provide clarification regarding the conditions for billing plans to providers that render services to enrollees who also have other health care coverage. The bill would specify the intent of the Legislature that the department offer educational resources to an enrollee who needs assistance with understanding continuity of care and coordinating Medi-Cal and their other health care coverage when requested by the enrollee. The bill would require the department, annually from 2025 through 2028, to update the legislative health committees on the effectiveness of implementing these provisions. The bill would authorize the department to implement these provisions through plan letters or similar instructions. The bill would condition implementation of these provisions on receipt of any necessary federal approvals and the availability of federal financial participation.

Bill Sponsors (2)

Votes


Actions


Sep 20, 2024

Assembly

Vetoed by Governor.

Sep 16, 2024

California State Legislature

Enrolled and presented to the Governor at 3:30 p.m.

Aug 31, 2024

Assembly

Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 75. Noes 0.).

Assembly

In Assembly. Concurrence in Senate amendments pending.

Aug 30, 2024

Senate

Read third time. Passed. Ordered to the Assembly. (Ayes 38. Noes 0.).

Aug 26, 2024

Senate

Read second time. Ordered to third reading.

Aug 23, 2024

Senate

Read third time and amended. Ordered to second reading.

Aug 19, 2024

Senate

Read second time. Ordered to third reading.

Aug 15, 2024

Senate

From committee: Do pass. (Ayes 7. Noes 0.) (August 15).

Aug 05, 2024

Senate

In committee: Referred to APPR suspense file.

  • Referral-Committee
APPR suspense file.

Jul 03, 2024

Senate

Read second time and amended. Re-referred to Com. on APPR.

  • Amendment-Passage
  • Reading-1
  • Reading-2
  • Referral-Committee
Com. on APPR.

Senate

From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 11. Noes 0.) (July 3).

Jun 24, 2024

Senate

From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH.

  • Amendment-Introduction
  • Amendment-Passage
  • Reading-1
  • Reading-2
  • Referral-Committee
Com. on HEALTH.

Jun 17, 2024

Senate

In committee: Set, first hearing. Hearing canceled at the request of author.

Jun 05, 2024

Senate

Referred to Com. on HEALTH.

  • Referral-Committee
Com. on HEALTH.

May 24, 2024

Senate

In Senate. Read first time. To Com. on RLS. for assignment.

May 23, 2024

Assembly

Read third time. Passed. Ordered to the Senate. (Ayes 66. Noes 0. Page 5636.)

May 20, 2024

Assembly

Read second time. Ordered to third reading.

May 16, 2024

Assembly

From committee: Do pass. (Ayes 15. Noes 0.) (May 16).

Assembly

Joint Rule 62(a), file notice suspended.

May 15, 2024

Assembly

In committee: Set, first hearing. Referred to APPR. suspense file.

  • Referral-Committee
APPR APPR. suspense file.

Apr 29, 2024

Assembly

Re-referred to Com. on APPR.

  • Referral-Committee
Com. on APPR.

Apr 25, 2024

Assembly

Read second time and amended.

Apr 24, 2024

Assembly

From committee: Amend, and do pass as amended and re-refer to Com. on APPR. with recommendation: To Consent Calendar. (Ayes 16. Noes 0.) (April 23).

Apr 01, 2024

Assembly

Re-referred to Com. on HEALTH.

  • Referral-Committee
Com. on HEALTH.

Mar 21, 2024

Assembly

From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended.

Assembly

Referred to Com. on HEALTH.

  • Referral-Committee
Com. on HEALTH.

Feb 17, 2024

Assembly

From printer. May be heard in committee March 18.

Feb 16, 2024

Assembly

Read first time. To print.

Bill Text

Bill Text Versions Format
AB3156 HTML
02/16/24 - Introduced PDF
03/21/24 - Amended Assembly PDF
04/25/24 - Amended Assembly PDF
06/24/24 - Amended Senate PDF
07/03/24 - Amended Senate PDF
08/23/24 - Amended Senate PDF
09/05/24 - Enrolled PDF

Related Documents

Document Format
04/19/24- Assembly Health PDF
05/14/24- Assembly Appropriations PDF
05/20/24- ASSEMBLY FLOOR ANALYSIS PDF
07/01/24- Senate Health PDF
08/02/24- Senate Appropriations PDF
08/18/24- Sen. Floor Analyses PDF
08/26/24- Sen. Floor Analyses PDF
08/31/24- ASSEMBLY FLOOR ANALYSIS PDF

Sources

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