AB 2203: Medi-Cal: primary care services.

Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which basic health care services are provided to qualified low-income persons. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. Existing federal law requires the state to provide payment for primary care services furnished in the 2013 and 2014 calendar years by Medi-Cal providers with specified primary specialty designations at a rate not less than 100% of the payment rate that applies to those services and physicians under the federal Medicare Program. Under state law, this requirement was implemented for both Medi-Cal fee-for-service and managed care plans, only to the extent that the federal medical assistance percentage was equal to 100%, until January 1, 2015.

This bill would, beginning July 1, 2019, require that the basic Medi-Cal rate for primary care services provided by a primary care service provider be not less than 100% of the payment rate that applies to those services as established by the Medicare Program, as specified. The bill would make the payment increases inapplicable to provider rates for specified program services provided to individuals who are not eligible for the Medi-Cal program or the Family Planning, Access, Care, and Treatment (Family PACT) Program. The bill would also make the payments exempt from specified provider payment reductions. The bill would require the Director of Health Care Services to prepare appropriate amendments in the state plan and waiver requests, as necessary, for the implementation of these provisions. This bill would require the department to implement its provisions by provider bulletins or similar instructions until regulations are adopted.