While awaiting the start of California’s healthcare committee hearings, which are expected to begin next month, lawmakers are in the process of preparing healthcare-related bills, with a focus on continuing the state’s reforms of the Medi-Cal program.
Assembly Bill 365 would add continuous glucose monitors (CGMs) and related supplies for CGM use as a covered benefit under the Medi-Cal program. CGMs allow diabetics to better track their blood glucose levels through automatically viewing blood glucose levels and trends throughout the day and night. Rather than pricking one’s finger and drawing blood to obtain a blood glucose reading, CGMs are inserted into the skin and worn on the body for at least 10 days.
According to GoodRX, the average starting cost for a CGM system is about $1,000 and can cost thousands of dollars per year to maintain, making this life-saving medical device a barrier for many. AB 365 would also authorize the state’s Department of Health Care Services to require CGM manufacturers to enter a rebate agreement. It would limit the implementation to the extent that any necessary federal approvals are obtained, and federal financial participation is not otherwise jeopardized.
AB 425, or the Pharmacogenomics Advancing Total Health for All Act, would add pharmacogenomic testing as a covered benefit under Medi-Cal. The bill would also define the testing as laboratory genetic testing and would cover the benefit if a medication is being considered for use, approved for use, or already administered in treating the beneficiary’s condition.
AB 488 would require the measures and milestones that network providers of skilled nursing facility services must meet in order to receive payment from a Medi-Cal managed care plan to include program access, staff training, and capital improvement measures aimed at addressing the needs of skilled nursing facility residents with vision loss. Under existing law, California’s Department of Health Care Services (DHCS) is required to establish methodologies, parameters and criteria for directed payments, including milestones and metrics that providers of skilled nursing facility services must meet in order to received a directed payment from a Medi-Cal managed care plan, with at least two of these milestones and metrics tied to workforce measures.
AB 564 would create a more streamlined process in Medi-Cal enrollment by requiring DHCS to allow applicants and providers to submit electronic signatures for all enrollment forms, including but not limited to claims and remit forms in the Medi-Cal program.
AB 576 relates to Medi-Cal reimbursement for abortion services, and would require DHCS to fully reimburse providers for providing medication to terminate a pregnancy that aligns with clinical guidelines, evidence-based research, and the discretion of the provider.
Under AB 586, climate change remediation would be added to the list of community supports. Under existing law, Medi-Cal managed care plans are authorized to cover community supports that are approved as cost effective and medically appropriate. Current Medi-Cal community supports include housing deposits and home modifications.
The bill would also define climate change remediation as the coverage of devices and the installation of those devices as necessary to address health-related complications and barriers linked to extreme weather and climate events. Proposed climate change remediation includes air conditioners, heaters, air filters, and generators.
AB 608 focuses on comprehensive perinatal services under Medi-Cal. Existing law states that pregnant people and targeted low-income children who are eligible and receiving healthcare coverage under any specified Medi-Cal program are eligible for full-scope Medi-Cal benefits during pregnancy and for one year after an individual’s last day of pregnancy. As part of the comprehensive perinatal services under Medi-Cal during the one-year post-pregnancy eligibility period, DHCS would be required to cover additional comprehensive perinatal assessments and individualized care plans.
It would also require DHCS to seek any necessary federal approvals to cover preventive services recommended by physicians or other licensed practitioners that occur in a beneficiary’s home or other community setting by a non-licensed perinatal health worker. The bill would require DHCS to collaborate with stakeholders and other agencies to determine the specific number of additional comprehensive perinatal assessments and individualized care plans, visits, and units of services to be covered.
AB 551 would delay the requirement of the county of original jurisdiction to retain responsibility and the limitation of the transfer provisions until July 1st, 2024, for foster children placed in short-term residential therapeutic programs, community treatment facilities, and group homes. It would also delay the deadline for the adoption of regulations until July 1st, 2028. Under existing law the original county of jurisdiction is required to retain responsibility and transfer provisions under certain circumstances until July 1st. Existing law also requires DHCS and California’s Department of Social Services to adopt regulations by July 1st, 2027, to implement provisions.
AB 719 would require DHCS to have Medi-Cal managed care plans to contract with public transit operators to establish reimbursement rates for nonmedical and nonemergency medical transportation trips provided by a public transit operator.
Senate Bill 299 would delete the requirement for counties to send notice of action terminating eligibility if the pre-populated form is returned, and the purpose for redetermination is loss of contact with the beneficiary. The bill would modify county duties relating to redetermination of Medi-Cal eligibility. Current law requires counties to redetermine the eligibility of Medi-Cal beneficiaries every 12 months, or whenever the county receives information about changes to a beneficiary’s circumstances.
SB 340 focuses on Medi-Cal reimbursement for covered optometric services, and would authorize a provider to obtain eyeglasses from a private entity as an alternative to a purchase of glasses from the Prison Industry Authority. This bill would also authorize providers who are participating in a Medi-Cal program to obtain eyeglasses from the Prison Industry Authority or private entities, based on an optometrist’s needs assessment and quality and value of product.