California Children’s Services Program: providers.

Plain English Breakdown

The official source material did not specify what happens if an application is returned for additional information or the specific qualifications required for advanced practice providers to apply.

California Children’s Services Program: Providers

AB-1450 allows advanced practice providers such as nurse practitioners and physician assistants who meet certain qualifications to apply for approval in the California Children's Services (CCS) program, with specific requirements and timelines.

What This Bill Does

• Allows advanced practice providers like nurse practitioners, physician assistants, and certified registered nurses who meet specified qualifications to apply to be part of the CCS panel.
• Requires these providers to submit an application through the CCS internet website.
• Sets a timeline for the Department of Health Care Services to acknowledge receipt within 5 business days and make a decision on the application within 10 business days.
• Once approved, allows these providers to give initial or ongoing care without needing another doctor's signature for certain services.
• Enables approved providers who are also Medi-Cal ordering, referring, and prescribing only providers to bill Medi-Cal directly.

Who It Names or Affects

• Advanced practice healthcare providers like nurse practitioners and physician assistants
• Children with physical disabilities whose families cannot afford medical care
• The Department of Health Care Services

Terms To Know

Advanced Practice Provider (APP)

A healthcare professional such as a nurse practitioner, physician assistant, or certified registered nurse who can provide primary and specialty health care services.

Medi-Cal

California’s Medicaid program that provides medical coverage to low-income individuals and families.

Limits and Unknowns

• The bill does not specify what happens if an application is returned for additional information.
• It does not detail the specific qualifications required for advanced practice providers to apply.

Official Summary Text

AB 1450, as amended, Hoover.
Air ambulance services.
California Children’s Services Program: providers.
Existing law, the California Children’s Services (CCS) Program, is a statewide program providing medically necessary services required by physically handicapped children whose parents are unable to pay for those services. Existing law requires the State Department of Health Care Services to administer the program. Existing law requires the board of supervisors of each county to designate the county department of public health or the county department of social welfare as the designated agency to administer the program. Existing law prohibits denying eligibility or aid under the program because an otherwise eligible person is receiving treatment services under specified teaching programs provided that treatment services are under the general supervision of a CCS Program panel physician and surgeon.
Existing law requires those panel members to be board certified and have expertise in the care of children. Existing law requires prior authorization for CCS services provided pursuant to these provisions, contingent on the determination by the department or its designee of specified criteria, including that the provider of the services is approved in accordance with the standards of the program.
This bill would authorize the department to approve an advanced practice provider’s, defined as a nurse practitioner, physician assistant, or certified registered nurse that meet specified qualifications, request to be CCS paneled. The bill would require eligible applicants to submit an application through the CCS internet website. The bill would require the department to acknowledge receipt of the application within 5 business days and would require the department to
approve, deny, or return the application for additional information within 10 business days of submission.
The bill would require the advanced practice provider to be paneled prior to providing care, and once paneled, would authorize the advanced practice provider to perform initial or continuing care without the need of a cosignature for specified professional services. The bill would also authorize those paneled providers enrolled as Medi-Cal ordering, referring, and prescribing only providers to bill Medi-Cal directly for independent office and inpatient visits.
The bill would also expand the meaning of a provider to include physician certified by their respective specialty board, except when in the opinion
of the specialist, treatment may be delegated or shared with a family physician and advanced practice providers, as defined, who meet specified criteria.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires that health care service plan contracts and health insurance policies provide coverage for certain services and treatments, including emergency medical transportation services. Existing law requires a health care service plan contract or a health insurance policy issued, amended, or renewed on or after January 1, 2020, to provide, among other things, that if an enrollee, insured, or subscriber receives covered services from a noncontracting air ambulance provider, the individual will pay no more than the same cost sharing that the individual would pay for the same covered services received
from a contracting air ambulance provider, referred to as the in-network cost-sharing amount.
This bill would make a technical, nonsubstantive change to those provisions.

Current Bill Text

Download Bill PDF