Bill Text: CA AB910 | 2019-2020 | Regular Session | Amended
Bill Title: Medi-Cal: dispute resolution.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Engrossed - Dead) 2020-08-05 - In committee: Set, first hearing. Hearing canceled at the request of author. [AB910 Detail]
Download: California-2019-AB910-Amended.html
Amended
IN
Assembly
January 14, 2020 |
Amended
IN
Assembly
January 06, 2020 |
CALIFORNIA LEGISLATURE—
2019–2020 REGULAR SESSION
Assembly Bill
No. 910
Introduced by Assembly Member Wood |
February 20, 2019 |
An act to add Section 14715.5 to the Welfare and Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 910, as amended, Wood.
Medi-Cal: dispute resolution.
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, including specialty mental health services and nonspecialty mental health services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Existing law requires the department to implement managed mental health care for Medi-Cal beneficiaries through contracts with county mental health plans. Under existing law, the county mental health plans are responsible for providing specialty mental health services to eligible Medi-Cal beneficiaries, and Medi-Cal managed care plans deliver nonspecialty mental health services to those persons. Existing law requires county mental health plans and Medi-Cal managed care plans
to be governed by various guidelines, including network adequacy standards and a requirement that a county mental health plan that provides Medi-Cal specialty mental health services enter into a memorandum of understanding with a Medi-Cal managed care plan that provides Medi-Cal health services to some of the same Medi-Cal recipients served by the county mental health plan. Existing regulations provide for a dispute resolution process to be used to resolve matters between a Medi-Cal managed care plan and a county mental health plan.
This bill would require a county mental health plan and Medi-Cal managed care plan that are unable to resolve a dispute to submit a request for resolution to the department. The bill would require the department to issue a written decision to the plans within 30 calendar days from receipt of the request.
request by either the county mental health plan or the Medi-Cal plan. The bill would also prohibit the dispute from delaying the provision of medically necessary services, as specified.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NOBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 14715.5 is added to the Welfare and Institutions Code, immediately following Section 14715, to read:14715.5.
(a) (1) If a county mental health plan and a Medi-Cal managed care plan have a dispute, as described in Section 1850.505 of Title 9 of the California Code of Regulations, and are unable to reach a resolution within 15 business days from the initiation of the dispute resolution process, both the county mental health plan and the Medi-Cal managed care plan shall submit a request for resolution to the department.(2) The department shall, within 30 calendar days from the receipt of the request, request
by either the county mental health plan or the Medi-Cal plan, issue a written decision to the county mental health plan and the Medi-Cal managed care plan.
(b) A dispute between the county mental health plan and the Medi-Cal managed care plan shall not delay the provision of medically necessary services by the Medi-Cal managed care plan or the county mental health plan. Pending resolution of the dispute, both plans shall comply with Section 1850.525 of Title 9 of the California Code of Regulations.