Medi-Cal: health care services. Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. services either through a fee-for-service or a managed care delivery system. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Under existing law, the Medi-Cal program comprises a department-administered uniform schedule of health care benefits. Existing law limits health care services, for purposes of the Medi-Cal program, to a schedule of benefits, as specified. This bill, commencing July 1, 2021, would add enhanced care management, as described, to the schedule of benefits for a beneficiary to obtain as covered Medi-Cal services. The bill would require these provisions to be implemented only to the extent that federal financial participation is available, and not otherwise jeopardized, and any necessary federal approvals are obtained. The bill would require the department to adopt regulations by July 1, 2023. Commencing January 1, 2022, the bill would require the department to provide a status report to the Legislature on a semiannual basis until regulations have been adopted.
The bill would also require each Medi-Cal managed care plan to disclose the availability of in-lieu-of services on its internet website and in its beneficiary handbook and would make a conforming change related to capitation rates for managed care contracts that include in-lieu-of services.