Medi-Cal: subacute care services.

Plain English Breakdown

The official source does not specify what sanctions are imposed for violations, nor how this will affect patients' access to subacute care services.

Medi-Cal: Subacute Care Services

This law requires providers to use specific forms when requesting authorization for subacute care services and prohibits Medi-Cal managed care plans from creating their own criteria for authorizing these services, unless it's on the official form.

What This Bill Does

• Requires providers to submit a specified form when requesting authorization for pediatric or adult subacute care services.
• Prohibits Medi-Cal managed care plans from developing or using their own criteria to substantiate medical necessity for subacute care that is not listed in the forms.
• Prevents Medi-Cal managed care plans from requiring new approval if someone returns from an acute hospital stay after a bed hold.

Who It Names or Affects

• Providers who give subacute care services
• Medi-Cal managed care plans

Terms To Know

subacute care

Special medical care for patients who need more than regular hospital care but less than intensive care.

Medi-Cal managed care plans

Health insurance companies that provide Medi-Cal services to people in California.

Limits and Unknowns

• The bill does not specify what the sanctions are for violating these rules.
• It is unclear how this will affect patients' access to subacute care services.

Official Summary Text

AB 220, as amended, Jackson.
Medi-Cal: subacute care services.
Existing law establishes 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 and funded by federal Medicaid program provisions. Existing law requires the department to establish a subacute care program in health facilities, as specified, to be available to patients in health facilities who meet subacute care criteria. Existing law requires that medical necessity for pediatric subacute care be substantiated by specified conditions. Existing regulations require a treatment authorization request for each admission to a subacute unit.
This bill would require a provider seeking authorization for pediatric subacute or adult subacute care services pursuant to these provisions to submit with a
treatment authorization request, including an electronic treatment authorization request, a specified form when requesting authorization for subacute care services. The bill would prohibit a Medi-Cal managed care plan from developing or using its own criteria to substantiate medical necessity for pediatric subacute or adult subacute care services with a condition or standard not enumerated in those forms. The bill would prohibit a Medi-Cal managed care plan from requiring a subsequent treatment authorization request upon a patient’s return from a bed hold for acute hospitalization. The bill would authorize the department to impose sanctions on Medi-Cal managed care plans for violations of these provisions, as specified.

Current Bill Text

Download Bill PDF