California Assembly Bill AB359 Amended / Bill

 BILL NUMBER: AB 359AMENDED BILL TEXT AMENDED IN SENATE JULY 15, 2009 AMENDED IN ASSEMBLY JUNE 2, 2009 AMENDED IN ASSEMBLY APRIL 15, 2009 INTRODUCED BY Assembly Member Nava (Coauthor: Assembly Member Blakeslee) (Coauthors: Senators Maldonado and Strickland) FEBRUARY 23, 2009 An act to amend Section 104150 of the Health and Safety Code, and to amend Section 14105.18 of  , and to add Section 14132.165 to,  the Welfare and Institutions Code, relating to cancer. LEGISLATIVE COUNSEL'S DIGEST AB 359, as amended, Nava. Breast and cervical cancer: early detection screening: digital mammography: reimbursement rates.  Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services, under which qualified low-income persons are provided with health care services, including breast and cervical cancer services.  Under existing law, the State Department of Public Health participates in a grant program through the federal Centers for Disease Control and Prevention to provide breast and cervical cancer early detection screening. Providers participating in the grant program may only provide screening services to individuals whose family income does not exceed 200% of the federal poverty level  , and provider rates are required to be identical to the rates under the Medi-Cal program  . This bill would, until January 1, 2014, require digital mammography screening to be covered when analog mammography services are not available from the provider, to be reimbursed at the Medi-Cal analog rate  , and would make   conforming changes  .  Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services, under which qualified low-income persons are provided with health care services, including breast and cervical cancer services.   This bill would authorize digital screening eligibility and reimbursement under these programs only for those screenings where the provider agrees to receive reimbursement in full at the analog rate.  Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 104150 of the Health and Safety Code is amended to read: 104150. (a) A provider or entity that participates in the grant made to the department by the federal Centers for Disease Control and Prevention breast and cervical cancer early detection program established under Title XV of the Public Health Service Act (42 U.S.C. Sec. 300k et seq.) in accordance with requirements of Section 1504 of that act (42 U.S.C. Sec. 300n) may only render screening services under the grant to an individual if the provider or entity determines that the individual's family income does not exceed 200 percent of the federal poverty level. (b) (1) The department shall provide for breast cancer and cervical cancer screening services under the grant at the level of funding budgeted from state and other resources during the fiscal year in which the Legislature has appropriated funds to the department for this purpose. These screening services shall not be deemed to be an entitlement. (2) For all mammography screening procedures conducted prior to January 1, 2014, the following provisions apply: (A) A provider may employ digital mammography technology for the purposes of this section when analog mammography technology is not available. (B) The mammography screening reimbursement rate under this section shall be limited to the Medi-Cal reimbursement rate for analog mammography screening.  (C) For purposes of this section, digital mammography screening may be reimbursed, pursuant to Section 14132.16, only at the analog rate and only if the provider agrees to receive reimbursement in full at the analog rate.  (c) To implement the federal breast and cervical cancer early detection program specified in this section, the department may contract, to the extent permitted by Section 19130 of the Government Code, with public and private entities, or utilize existing health care service provider enrollment and payment mechanisms, including the Medi-Cal program's fiscal intermediary. However, the Medi-Cal program's fiscal intermediary shall only be used if services provided under the program are specifically identified and reimbursed in a manner that does not claim federal financial reimbursement. Any contracts with, and the utilization of, the Medi-Cal program's fiscal intermediary shall not be subject to Chapter 3 (commencing with Section 12100) of Part 2 of Division 2 of the Public Contract Code. Contracts to implement the federal breast and cervical cancer early detection program entered into by the department with entities other than the Medi-Cal program's fiscal intermediary shall not be subject to Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code. SEC. 2. Section 14105.18 of the Welfare and Institutions Code, as added by Section 2 of Chapter 496 of the Statutes of 2008, is amended to read: 14105.18. (a) Notwithstanding any other provision of law, provider rates of payment for services rendered in all of the following programs shall be identical to the rates of payment for the same service performed by the same provider type pursuant to the Medi-Cal program. (1) The California Children's Services Program established pursuant to Article 5 (commencing with Section 123800) of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code. (2) The Genetically Handicapped Person's Program established pursuant to Article 1 (commencing with Section 125125) of Chapter 2 of Part 5 of Division 106 of the Health and Safety Code. (3) Except as specified in  Section 14132.165   subdivision (b) of Section 104150 of the Health and Safety Code  , the Breast and Cervical Cancer Early Detection Program established pursuant to Article 1.5 (commencing with Section 104150) of Chapter 2 of Part 1 of Division 103 of the Health and Safety Code and the breast cancer programs specified in Section 30461.6 of the Revenue and Taxation Code. (4) The State-Only Family Planning Program established pursuant to Division 24 (commencing with Section 24000). (5) The Family Planning, Access, Care, and Treatment (Family PACT) Waiver Program established pursuant to subdivision (aa) of Section 14132. (b) The director may identify in regulations other programs not listed in subdivision (a) in which providers shall be paid rates of payment that are identical to the rates of payments in the Medi-Cal program pursuant to subdivision (a). (c) Notwithstanding subdivision (a), services provided under the programs described in subdivisions (a) and (b) may be reimbursed at rates greater than the Medi-Cal rate that would otherwise be applicable if those rates are adopted by the director in regulations. (d) This section shall become operative on January 1, 2010.  SEC. 3.   Section 14132.165 is added to the Welfare and Institutions Code, immediately following Section 14132.16, to read: 14132.165. Digital mammography screening may be reimbursed pursuant to Section 14132.16, but only at the analog rate and only if the provider agrees to receive reimbursement in full at the analog rate.