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.