California Senate Bill SB485 Amended / Bill

 BILL NUMBER: SB 485AMENDED BILL TEXT AMENDED IN SENATE MARCH 24, 2011 INTRODUCED BY Senator Hernandez FEBRUARY 17, 2011  An act relating to Medi-Cal.   An act to add Section 14134.7 to the Welfare and Institutions Code, relating to Medi-Cal.  LEGISLATIVE COUNSEL'S DIGEST SB 485, as amended, Hernandez. Medi-Cal. Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care services.  Existing law requires the department to develop a program to provide information and assistance to enable Medi-Cal beneficiaries to understand and successfully use the services of the Medi-Cal managed care plans in which they enroll.   This bill would declare the intent of the Legislature regarding legislation that would require the department to provide specified information regarding community clinics to Medi-Cal beneficiaries who do not have a primary care physician, but who utilize the emergency unit of a general acute care hospital for care of routine physical ailments.   This bill would require the department to establish a pilot program to facilitate collaboration between a federally qualified health clinic and a general acute care hospital to provide a Medi-Cal beneficiary with an alternative to the use of the emergency unit of a general acute care hospital for care and services if the Medi-Cal beneficiary, after a medical screening, is determined by a physician and surgeon to not have an emergency medical condition and the Medi-Cal beneficiary is provided the specified information, in writing, before nonemergency medical care is provided in the emergency unit.  Vote: majority. Appropriation: no. Fiscal committee: no   yes  . State-mandated local program: no. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:  SECTION 1.   Section 14134.7 is added to the   Welfare and Institutions Code   , to read:   14134.7. (a) The department shall establish a pilot program to facilitate collaboration between a federally qualified health clinic and a general acute care hospital, as a benefit of the Medi-Cal program, to provide a Medi-Cal beneficiary with an alternative to the use of the emergency unit of a general acute care hospital for care and services if the Medi-Cal beneficiary, after a medical screening, is determined by a physician and surgeon to not have an emergency medical condition and the Medi-Cal beneficiary is provided the following information, in writing, before nonemergency medical care is provided in the emergency unit: (1) The name and address of an available and accessible provider of nonemergency medical care who does not charge a copay or may charge a lower copay than the general acute care hospital. (2) A referral from the general acute care hospital if necessary to coordinate the scheduling of treatment. (b) The department shall submit any necessary application to the federal Centers for Medicare and Medicaid Services for a waiver to implement the pilot project described in this section. The department shall determine the form of waiver most appropriate to achieve the purposes of this section. The waiver request shall be included in any waiver application submitted within 12 months after the effective date of this section, or shall be submitted as an independent application within that time period. After federal approval is secured, the department shall implement the waiver within 12 months of the date of approval. (c) The department shall develop a timeline and process for monitoring and evaluating the pilot project and provide this timeline and process to the appropriate fiscal and policy committees of the Legislature. (d) For purposes of this section, an available and accessible provider of nonemergency medical care includes the office of a physician and surgeon, health clinic, community health center, and hospital outpatient department, provided that the provider of nonemergency medical care is able to diagnose or treat contemporaneously within the same amount of time that a physician within the emergency unit of a general acute care hospital would have taken to provide the same nonemergency services.   SECTION 1.   It is the intent of the Legislature to enact legislation that would, as a pilot program, require the State Department of Health Care Services to mail a letter to Medi-Cal beneficiaries who do not have a primary care physician, but who utilize the emergency unit of a general acute care hospital for care of routine physical ailments, that explains the availability of, and identifies, nearby clinics to visit for care of these ailments.