AB 659: Medi-Cal: reimbursement rates.

Existing law provides for 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. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Existing law restricts the Medi-Cal reimbursement rate for clinical laboratory or laboratory services, as specified. Existing law requires that laboratory service providers submit annual data reports to the department, as specified, for the purpose of establishing rates for clinical or laboratory services based on the lowest amounts other payers are paying providers for similar services.

This bill would change the frequency for submitting those reports to every 3 years beginning in 2019, and would require the data in those reports to be based on the previous calendar year. The bill would provide that the reimbursement rates developed pursuant to these provisions shall become effective on July 1, 2020, and July 1 of every 3rd year thereafter.