Medi-Cal: private duty nursing., the official text

An act to add Section 14149.96 to the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL'S DIGEST

Existing law, the Medi-Cal Act, 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. Under existing law, early and periodic screening, diagnostic, and treatment (EPSDT) services, including private duty nursing services, are covered under Medi-Cal for an individual under 21 years of age in accordance with certain federal provisions. The Medi-Cal program is in part governed by, and funded pursuant to, federal Medicaid program provisions.
This bill would require the department to measure and assess whether private duty nursing services provided as part of the EPSDT benefit are in compliance with federal Medicaid requirements, as specified. The bill would require the assessment to include a comparison of the hours of EPSDT private duty nursing services authorized by the Medi-Cal program to the hours actually provided to eligible beneficiary children and a determination of whether the reimbursement rates for those services are sufficient to ensure that all authorized hours are able to be provided. The bill would require the department to prepare and submit a report to the Legislature on the findings of the assessment by no later than March 1, 2027.

The people of the State of California do enact as follows:

SECTION 1.
Section 14149.96 is added to the Welfare and Institutions Code, to read:
14149.96.
(a) The department shall measure and assess whether private duty nursing services provided as part of the early periodic screening, diagnostic, and treatment (EPSDT) benefit are in compliance with federal Medicaid requirements for the provision of private duty nursing services to children under 21 years of age. The assessment shall include, but is not limited to, both of the following:
(1) A comparison of the number of hours of EPSDT private duty nursing services authorized by the Medi-Cal program to the hours actually provided to eligible beneficiary children.
(2) A determination of whether the reimbursement rates for EPSDT private duty nursing services are sufficient to ensure that all authorized hours are able to be provided to eligible beneficiary children.
(b) By no later than March 1, 2027, the department shall prepare and submit a report to the Legislature on the findings of the assessment described in subdivision (a) in compliance with Section 9795 of the Government Code.