Plain English Breakdown
The official status shows 'Passed Legislature' but also lists a committee referral date in 2026; this suggests potential uncertainty about final enactment or future legislative steps not fully detailed in the provided metadata.
Reimbursement Rules for Pharmacist Services
This law requires Medi-Cal and private health plans to pay pharmacists at least 85% of physician fees for advanced services, including medication therapy management.
What This Bill Does
- Requires the state to set reimbursement rates for advanced pharmacist services at no less than 85% of physician service fees, which now includes Medication Therapy Management (MTM).
- Directs health care plans and disability insurers to pay pharmacists who are enrolled as providers with those plans.
- Expands eligibility for payments to include pharmacists working at federally qualified health centers or rural health clinics.
- States that willful violations of these new payment requirements by health care service plans count as a crime.
Who It Names or Affects
- Pharmacists providing advanced practice services and medication therapy management, including those in federally qualified health centers or rural health clinics.
- Medi-Cal program administrators at the Department of Health Care Services.
- Health care service plans regulated under the Knox-Keene Act.
- Disability insurers that offer coverage for pharmacist services.
Terms To Know
- Advanced Practice Pharmacist Services
- Specialized pharmacy services, including Medication Therapy Management (MTM), provided by eligible pharmacists or pharmacies.
- Medication Therapy Management (MTM)
- A pharmacist service related to the use of drugs, specifically in conjunction with certain specialty drug therapy categories under Medi-Cal rules.
- Federally Qualified Health Center
- Health care facilities where pharmacists providing services are included as eligible providers for reimbursement under this bill.
Limits and Unknowns
- Medi-Cal changes must still receive federal approval before taking effect.
- Payments by health plans and insurers are only required if the coverage already provides reimbursement for similar services performed by other licensed health care providers.
- The bill states that no state reimbursement is needed for local agencies regarding these new mandates.