Medi-Cal: subacute care services.
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Majority
Fiscal committee
No
Appropriation
No
Current location
Passed
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed Assembly
- Passed Senate
- To Governor
- Became Law
Overview
This bill updates California’s Medi-Cal program to standardize the process for authorizing subacute care services for both pediatric and adult patients. It requires providers to use specific forms – DHCS 6200 and DHCS 6200A – when requesting authorization, and prohibits managed care plans from establishing their own criteria for determining medical necessity that deviates from these forms. Furthermore, the bill prevents managed care plans from requiring additional authorization requests after a patient has been hospitalized for an acute condition.
Key provisions
- Requires providers to use a standardized form (DHCS 6200 or DHCS 6200A) for subacute care authorization requests.
- Prohibits Medi-Cal managed care plans from creating their own medical necessity criteria outside of the specified forms.
- Prevents managed care plans from requiring subsequent authorization requests after a patient returns from an acute hospitalization.
- Authorizes the Department of Health Care Services to impose sanctions on managed care plans for non-compliance.
- Defines pediatric subacute care services based on specific medical technology dependencies.
- Specifies criteria for determining medical necessity for pediatric subacute care, including requirements for tracheostomy and intravenous therapy.
- Establishes a process for reimbursement rates for subacute care services.
- Clarifies the role of the department in establishing level of care criteria and utilization controls.
Who is affected
Bill text
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