Medi-Cal: laboratory rates.
Vote required
Majority
Fiscal committee
No
Appropriation
No
Current location
Appropriations
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed Senate
- Passed Assembly
- To Governor
- Became Law
Overview
This bill changes how Medi-Cal reimburses laboratories for clinical and laboratory services. Instead of using a complex formula based on billing amounts, charges to the public, Medicare rates, and other payer rates, the bill requires Medi-Cal reimbursement to equal the lowest of those metrics. It creates an exception for sexually transmitted infection (STI) testing, allowing for a different reimbursement rate for those services, and removes a 10% payment reduction for laboratory services. The bill also requires the Department of Health Care Services to make deidentified data on laboratory services publicly available, subject to certain limitations.
Key provisions
- Requires Medi-Cal reimbursement to equal the lowest of billing amounts, public charges, 100% of Medicare rates, and other payer rates.
- Creates an exception for STI testing, applying the standard reimbursement formula but excluding the rate based on other payers.
- Eliminates a 10% payment reduction for clinical laboratory or laboratory services.
- Requires the Department of Health Care Services to publish a public dataset of deidentified laboratory service data for providers reporting over 10 tests.
- Exempts data related to STI testing from certain data reporting requirements.
- Establishes a timeline for the implementation of the new reimbursement rates, with a delay for STI testing.
- Allows the Department to use vendor data for reimbursement rate calculations.
- Requires stakeholder input on the ratesetting methodology.
Who is affected
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Sponsors
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1 on record
Primary sponsor
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