Medi-Cal: private duty nursing.

Plain English Breakdown

The bill summary does not provide specific details on how reimbursement rates will be adjusted or what actions will follow from the assessment findings.

Medi-Cal: Private Duty Nursing for Children

This law makes private duty nursing services provided to children under 21 by home health agencies a type of specialty care in Medi-Cal, and requires the state to assess if these services comply with federal Medicaid rules and are adequately reimbursed.

What This Bill Does

• Defines private duty nursing services for children under 21 years old as specialty care for Medi-Cal reimbursement purposes.
• Requires the Department of Health Care Services to assess whether EPSDT (Early Periodic Screening, Diagnostic, and Treatment) private duty nursing services comply with federal Medicaid requirements.
• Includes a comparison between authorized hours of EPSDT private duty nursing services and actual hours provided to children.
• Determines if reimbursement rates for these services are sufficient to cover all authorized hours.

Who It Names or Affects

• Children under 21 years old who need private duty nursing services through Medi-Cal.
• Home health agencies that provide private duty nursing services to eligible children.
• The Department of Health Care Services, which administers the Medi-Cal program and conducts assessments.

Terms To Know

EPSDT

Early Periodic Screening, Diagnostic, and Treatment - a part of the Medicaid program that provides health care services to children under 21 years old.

Medi-Cal

A state-run healthcare program in California for low-income individuals, including children who need private duty nursing services.

Limits and Unknowns

• The bill does not apply to Medi-Cal reimbursement under the Protect Access to Health Care Act of 2024.
• It is unclear how this law will affect current funding and service delivery for private duty nursing in Medi-Cal.

Official Summary Text

AB 2240, as amended, Stefani.
Medi-Cal: private duty
nursing: specialty care.
nursing.
Existing law provides for the licensure of private duty nursing agencies and home health agencies by the State Department of Public Health. Existing law defines “private duty nursing services” as skilled nursing services provided on a shift basis for patients who require individual and continuous nursing care in the patient’s temporary or permanent place of residence or other community-based setting, as specified.
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.
Existing law sets forth various requirements for private duty nursing for purposes of coverage under certain waiver programs within the Medi-Cal program.
Under this bill, private duty nursing services, provided to a child under 21 years of age by a home health agency, would be considered specialty care for purposes of Medi-Cal reimbursement under the provisions of the Medi-Cal Act. The bill would not apply this designation for purposes of Medi-Cal reimbursement under the provisions of the Protect Access to Health Care Act of 2024, an
initiative measure enacted by Proposition 35, as approved by the voters at the November 5, 2024, statewide general election.
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.

Current Bill Text

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