Medi-Cal: skilled nursing facility services.

Plain English Breakdown

The bill summary does not provide specific details on the funding amount for skilled nursing facilities or how it will be calculated beyond retroactive payments based on total days of service since July 9, 2024.

Medi-Cal Changes for Skilled Nursing Facilities

AB-835 removes network requirements for skilled nursing facilities receiving performance-based directed payments from Medi-Cal managed care plans and makes technical changes to juvenile custody laws.

What This Bill Does

• Removes the requirement that a skilled nursing facility must be part of a network to receive performance-based directed payments from Medi-Cal managed care plans.
• Changes how payments are calculated for services provided by skilled nursing facilities, making them retroactive and based on total days of service since July 9, 2024.

Who It Names or Affects

• Skilled nursing facilities that provide care for Medi-Cal beneficiaries

Terms To Know

Medi-Cal

A health insurance program in California that helps low-income people pay for medical care.

Skilled Nursing Facility

A place where patients receive skilled nursing care and rehabilitation services.

Limits and Unknowns

• The bill does not specify how much funding will be provided to facilities.

Official Summary Text

AB 835, as amended, Calderon.
Juveniles: dependency.
Medi-Cal: skilled nursing facility services.
Existing law 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. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Existing law, the Medi-Cal Long-Term Care Reimbursement Act, requires the department, subject to any necessary federal approvals, for managed care rating periods that begin between January 1, 2023, and December 31, 2026, inclusive, to establish and implement the Workforce and Quality Incentive Program. Under that program, a network provider furnishing skilled nursing
facility services to a Medi-Cal managed care enrollee is authorized to earn performance-based directed payments from the Medi-Cal managed care plan with which they contract, as specified, in addition to other certain payments.
This bill would remove from the above-described provision the qualification that the provider be within the network. The bill would make conforming changes to related provisions. Under the bill, pursuant to conditions of eligibility for directed payments under certain federal regulations, payments made under the Workforce and Quality Incentive Program would be retroactively calculated and paid based on the total number of days, effective July 9, 2024, during which the facility provided services to Medi-Cal beneficiaries, regardless of whether the facility was a network provider.
Existing law authorizes a peace officer to take a minor into temporary custody without a warrant in certain circumstances, including when the officer has reasonable cause to believe that the minor may be subject to the dependency jurisdiction of the juvenile court and that the minor has an immediate need for medical care, the minor is in immediate danger of physical or sexual abuse, or the physical environment or the fact that the minor is left unattended poses an immediate threat to the minor’s health or safety. Under existing law, an officer who takes a minor into temporary custody under that authority is authorized to take the minor to a community service program for abused or neglected children if it is in the best interest of the minor and the public.
This bill would make technical, nonsubstantive changes to that
provision.

Current Bill Text

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