SB 97 – California

Status: Enacted
Year Introduced: 2017
Link: https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB97

Health: Among other things, this bill would require the department, no earlier than July 1, 2017, to reimburse facility-related Medi-Cal delivery costs of eligible alternative birth centers based on a statewide all-inclusive rate per delivery that does not exceed 80% of the average diagnosis-related groups Level 1 rates received by general acute care hospitals pursuant to a specified provision and the applicable provisions of the Medi-Cal State Plan, as specified.

The bill would revise eligibility requirements for reimbursements to alternative birth centers, including applicable certification requirements. This bill would make the exclusion of adult dental services effective only through December 31, 2017, as specified. The bill would make optometric and optician services a covered benefit under the Medi-Cal program, contingent upon the Legislature including funding for these services in the state budget process, as specified.

This bill would require the department to follow specified calculations if the determinations pursuant to the interim reconciliation of payments, adjustments, and final audits result in total federal disproportionate share hospital funds claimable for distribution that, in combination with the payment adjustments made to nondesignated public hospitals, as defined, for the same year, are less than the applicable federal disproportionate share hospital allotment. The bill would also require the department to perform specified revised distribution calculations under designated circumstances. This bill would require the department, if the affiliated governmental entity for the designated public hospital is a county subject to specified provisions relating to redirection of funds for services to indigent persons, to determine how to account for whether any additional payment amount distributed to the hospital would otherwise have affected, if at all, the county’s redirection obligation for the 2014–15 fiscal year, as specified, and to determine any necessary adjustments.

This bill, among other things, would modify the way in which reimbursement to Medi-Cal pharmacy providers is calculated by, in part, requiring the department to implement a drug ingredient cost reimbursement methodology based on actual acquisition cost, as defined, and, effective for dates of service on or after April 1, 2017, a dispensing fee that is based upon a pharmacy’s total annual claim volume of the previous year, as specified, and would require the department to reimburse physician-administered drugs that are blood factors, as defined, at an amount that does not exceed 120% of the average sales prices of the last quarter reported.

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