Medi-Cal: laboratory rates.

Plain English Breakdown

The exact date for when certain provisions will take effect is contingent upon funding being appropriated.

Medi-Cal: Laboratory Rates

The bill changes how Medi-Cal reimburses laboratory services, exempts certain STI-related services from specific reimbursement rules and data reporting requirements, and removes a 10% payment reduction for clinical lab services.

What This Bill Does

• Changes the way Medi-Cal reimburses providers for clinical lab tests and services to equal the lowest of several metrics instead of limiting payments to below that amount.
• Exempts laboratory services related to diagnosing and treating sexually transmitted infections (STIs) from a specific reimbursement rate calculation starting July 1, 2027, or when funding is available.
• Removes data reporting requirements for lab services related to STI diagnosis and treatment, making this information confidential under the California Public Records Act.
• Requires the State Department of Health Care Services to publish deidentified raw data from laboratory service providers who report more than 10 tests during a collection period.
• Eliminates a 10% payment reduction for clinical lab services that was previously required by law.

Who It Names or Affects

• Medi-Cal program participants and their healthcare providers
• Laboratory service providers in California

Terms To Know

Medi-Cal

A health care program for low-income individuals, funded by both federal and state governments.

Clinical laboratory services

Medical tests performed in a lab to diagnose or treat illnesses.

Limits and Unknowns

• The bill's effectiveness depends on funding being appropriated for the changes it mandates.
• Details about how data will be deidentified and made public are not specified in this summary.

Official Summary Text

SB 339, as amended, Cabaldon.
Medi-Cal: laboratory rates.
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 prohibits Medi-Cal reimbursement to providers for clinical laboratory or laboratory services from exceeding the lowest of the following: (1) the amount billed; (2) the charge to the general public; (3) 100% of the lowest maximum allowance established by the federal Medicare Program; or (4) a reimbursement rate based on an average of the lowest amount that other payers and other state Medicaid programs are paying.
This bill would
instead require the above-described Medi-Cal reimbursement to equal the lowest of those metrics. The bill would
carve out, from the above-described provision,
for dates of service on or after July 1, 2027, or when funding is appropriated to implement this provision, whichever is sooner,
Medi-Cal reimbursement to providers for clinical laboratory or laboratory services related to the diagnosis and treatment of sexually transmitted infections, and would apply
the above-described
that
threshold but excluding the reimbursement rate described in
paragraph (4). The
clause (4) above.
The
bill would exempt data on those services
related to the diagnosis and treatment of sexually transmitted infections
from certain data-reporting requirements that are applicable to the reimbursement rate described in
paragraph (4).
clause (4), for dates of service on or after January 1, 2027, or when funding is appropriated to implement the above-described provision, whichever is sooner.
Under existing law, data reports provided to the department pursuant to those data-reporting requirements are confidential and exempt from disclosure under the California
Public Records Act.
This bill would require the department to make available to the public a dataset, as specified, of the deidentified raw data reported pursuant to the above-described data-reporting requirements by any applicable laboratory service providers that reported a volume greater than 10 tests for the data-collection period. The bill would require the department to publish the associated dataset coincident with publishing updated reimbursement rates.
Existing law requires, with
exceptions,
exemptions,
that payments be reduced by up to 10% for clinical laboratory or laboratory services, in addition to other specified payment reductions under other existing law.
This bill would delete
that 10% payment reduction.

Current Bill Text

Download Bill PDF